Skip to main content
SpringerLink
Log in

Pneumoperitoneum Aided Hernia Repair

  • Chapter
  • First Online:
Robotic Assisted Hernia Repair

Abstract

In cases of incisional or primary hernia with loss of domain, progressive preoperative pneumoperitoneum (PPP) was described as an excellent alternative to component separation techniques (CST). First described in 1947 by Goni-Moreno, it was used empirically in the ensuing decades by several teams. Objective measures have been published recently.

This pre-operative technique gets a significant extension of the anterolateral abdominal muscles (8.3 cm per side on average) and a significant increase of the abdominal cavity volume (mean 53%). As a consequence, this technique provides the spontaneous reduction of the herniated content at the end of the preparation and before surgery. It is also believed to facilitate the dissection and the surgical repair. Complete closure of the defect can be achieved, without the need of CST, in almost all cases.

Performed prior the repair, this technique allows diaphragmatic rehabilitation and also consists in a pre-operative test since it leads to a progressive abdominal relative compartment syndrome. Contrary to CST, PPP requires a long preparation of the patients before surgical repair. As a consequence, PPP cannot be performed in emergency situations. It is useful for all hernias with loss of domain, not only those in the midline. When insufficient despite complete preparation (5% probably), a CST still remains feasible during the surgical procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Chevrel JP, Rath AM. Classification of incisional hernias of the abdominal wall. Hernia. 2000;4(1):7–11. https://doi.org/10.1007/BF01230581.

    Article  Google Scholar 

  2. Muysoms FE, Miserez M, Berrevoet F, et al. Classification of primary and incisional abdominal wall hernias. Hernia. 2009;13(4):407–14. https://doi.org/10.1007/s10029-009-0518-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Luijendijk RW, Hop WC, van den Tol MP, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000;343(6):392–8. https://doi.org/10.1056/NEJM200008103430603.

    Article  CAS  PubMed  Google Scholar 

  4. Renard Y, Lardière-Deguelte S, de Mestier L, et al. Management of large incisional hernias with loss of domain: a prospective series of patients prepared by progressive preoperative pneumoperitoneum. Surgery. 2016;160(2):426–35. https://doi.org/10.1016/j.surg.2016.03.033.

    Article  PubMed  Google Scholar 

  5. Kingsnorth AN, Sivarajasingham N, Wong S, Butler M. Open mesh repair of incisional hernias with significant loss of domain. Ann R Coll Surg Engl. 2004;86(5):363–6. https://doi.org/10.1308/147870804236.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Bauer JJ, Harris MT, Gorfine SR, Kreel I. Rives-Stoppa procedure for repair of large incisional hernias: experience with 57 patients. Hernia. 2002;6(3):120–3. https://doi.org/10.1007/s10029-002-0071-3.

    Article  CAS  PubMed  Google Scholar 

  7. Stoppa R, Ralaimiaramanana F, Henry X, Verhaeghe P. Evolution of large ventral incisional hernia repair. The French contribution to a difficult problem. Hernia. 1999;3(1):1–3. https://doi.org/10.1007/BF01576729.

    Article  Google Scholar 

  8. Kingsnorth A. The management of incisional hernia. Ann R Coll Surg Engl. 2006;88(3):252–60. https://doi.org/10.1308/003588406X106324.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Slater NJ, Montgomery A, Berrevoet F, et al. Criteria for definition of a complex abdominal wall hernia. Hernia. 2014;18(1):7–17. https://doi.org/10.1007/s10029-013-1168-6.

    Article  CAS  PubMed  Google Scholar 

  10. Lipman J, Medalie D, Rosen MJ. Staged repair of massive incisional hernias with loss of abdominal domain: a novel approach. Am J Surg. 2008;195(1):84–8. https://doi.org/10.1016/j.amjsurg.2007.02.017.

    Article  PubMed  Google Scholar 

  11. Eriksson A, Rosenberg J, Bisgaard T. Surgical treatment for giant incisional hernia: a qualitative systematic review. Hernia. 2014;18(1):31–8. https://doi.org/10.1007/s10029-013-1066-y.

    Article  CAS  PubMed  Google Scholar 

  12. DuBay DA, Choi W, Urbanchek MG, et al. Incisional herniation induces decreased abdominal wall compliance via oblique muscle atrophy and fibrosis. Ann Surg. 2007;245(1):140–6. https://doi.org/10.1097/01.sla.0000251267.11012.85.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Agnew SP, Small W, Wang E, Smith LJ, Hadad I, Dumanian GA. Prospective measurements of intra-abdominal volume and pulmonary function after repair of massive ventral hernias with the components separation technique. Ann Surg. 2010;251(5):981–8. https://doi.org/10.1097/SLA.0b013e3181d7707b.

    Article  PubMed  Google Scholar 

  14. Trivellini G, Zanella G, Danelli PG, Pratolongo D, Ferri O. Surgical treatment of large eventrations. Study of a technic adapted to disorders of respiratory compliance. Chirurgie. 1984;110(2):116–22.

    CAS  PubMed  Google Scholar 

  15. Oliver-Allen HS, Hunter C, Lee GK. Abdominal compartment syndrome as a rare complication following component separation repair: case report and review of the literature. Hernia. 2015;19(2):293–9. https://doi.org/10.1007/s10029-015-1362-9.

    Article  CAS  PubMed  Google Scholar 

  16. Mavrodin CI, Pariza G, Ion D, Antoniac VI. Abdominal compartment syndrome -- a major complication of large incisional hernia surgery. Chirurgia (Bucur). 2013;108(3):414–7.

    CAS  Google Scholar 

  17. De Santis L, Frigo F, Bruttocao A, Terranova O. Pathophysiology of giant incisional hernias with loss of abdominal wall substance. Acta Biomed. 2003;74(Suppl 2):34–7.

    PubMed  Google Scholar 

  18. Alam NN, Narang SK, Pathak S, Daniels IR, Smart NJ. Methods of abdominal wall expansion for repair of incisional herniae: a systematic review. Hernia. 2016;20(2):191–9. https://doi.org/10.1007/s10029-016-1463-0.

    Article  CAS  PubMed  Google Scholar 

  19. Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ. Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg. 2012;204(5):709–16. https://doi.org/10.1016/j.amjsurg.2012.02.008.

    Article  PubMed  Google Scholar 

  20. Carbonell AM, Cobb WS, Chen SM. Posterior components separation during retromuscular hernia repair. Hernia. 2008;12(4):359–62. https://doi.org/10.1007/s10029-008-0356-2.

    Article  CAS  PubMed  Google Scholar 

  21. Appleton ND, Anderson KD, Hancock K, Scott MH, Walsh CJ. Initial UK experience with transversus abdominis muscle release for posterior components separation in abdominal wall reconstruction of large or complex ventral hernias: a combined approach by general and plastic surgeons. Ann R Coll Surg Engl. 2017;99(4):265–70. https://doi.org/10.1308/rcsann.2016.0241.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Fayezizadeh M, Majumder A, Belyansky I, Novitsky YW. Outcomes of retromuscular porcine biologic mesh repairs using transversus abdominis release reconstruction. J Am Coll Surg. 2016;223(3):461–8. https://doi.org/10.1016/j.jamcollsurg.2016.06.008.

    Article  PubMed  Google Scholar 

  23. Jones CM, Winder JS, Potochny JD, Pauli EM. Posterior component separation with transversus abdominis release: technique, utility, and outcomes in complex abdominal wall reconstruction. Plast Reconstr Surg. 2016;137(2):636–46. https://doi.org/10.1097/01.prs.0000475778.45783.e2.

    Article  CAS  PubMed  Google Scholar 

  24. Loh CYY, Nizamoglu M, Shanmugakrishnan RR, et al. Comparing transversus abdominus release and anterior component separation techniques in reconstructing midline hernias: a cadaveric study. J Plast Reconstr Aesthet Surg. 2018; https://doi.org/10.1016/j.bjps.2018.06.005.

  25. Novitsky YW, Fayezizadeh M, Majumder A, Neupane R, Elliott HL, Orenstein SB. Outcomes of posterior component separation with transversus abdominis muscle release and synthetic mesh sublay reinforcement. Ann Surg. 2016;264(2):226–32. https://doi.org/10.1097/SLA.0000000000001673.

    Article  PubMed  Google Scholar 

  26. Pauli EM, Rosen MJ. Open ventral hernia repair with component separation. Surg Clin North Am. 2013;93(5):1111–33. https://doi.org/10.1016/j.suc.2013.06.010.

    Article  PubMed  Google Scholar 

  27. Torregrosa-Gallud A, Sancho Muriel J, Bueno-Lledó J, et al. Modified components separation technique: experience treating large, complex ventral hernias at a University Hospital. Hernia. 2017;21(4):601–8. https://doi.org/10.1007/s10029-017-1619-6.

    Article  CAS  PubMed  Google Scholar 

  28. Winder JS, Behar BJ, Juza RM, Potochny J, Pauli EM. Transversus abdominis release for abdominal wall reconstruction: early experience with a novel technique. J Am Coll Surg. 2016;223(2):271–8. https://doi.org/10.1016/j.jamcollsurg.2016.04.012.

    Article  PubMed  Google Scholar 

  29. Punjani R, Shaikh I, Soni V. Component separation technique: an effective way of treating large ventral hernia. Indian J Surg. 2015;77(Suppl 3):1476–9. https://doi.org/10.1007/s12262-015-1265-0.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hodgkinson JD, Leo CA, Maeda Y, et al. A meta-analysis comparing open anterior component separation with posterior component separation and transversus abdominis release in the repair of midline ventral hernias. Hernia. 2018;22(4):617–26. https://doi.org/10.1007/s10029-018-1757-5.

    Article  CAS  PubMed  Google Scholar 

  31. Cornette B, De Bacquer D, Berrevoet F. Component separation technique for giant incisional hernia: A systematic review. Am J Surg. 2018;215(4):719–26. https://doi.org/10.1016/j.amjsurg.2017.07.032.

    Article  PubMed  Google Scholar 

  32. Ramirez OM, Ruas E, Dellon AL. “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg. 1990;86(3):519–26.

    Article  CAS  PubMed  Google Scholar 

  33. Ramirez OM. Inception and evolution of the components separation technique: personal recollections. Clin Plast Surg. 2006;33(2):241–6. https://doi.org/10.1016/j.cps.2005.12.011.

    Article  PubMed  Google Scholar 

  34. Ennis LS, Young JS, Gampper TJ, Drake DB. The “open-book” variation of component separation for repair of massive midline abdominal wall hernia. Am Surg. 2003;69(9):733–42; discussion 742–743.

    PubMed  Google Scholar 

  35. Moreno IG. Chronic eventrations and large hernias; preoperative treatment by progressive pneumoperitomeum; original procedure. Surgery. 1947;22(6):945–53.

    CAS  PubMed  Google Scholar 

  36. Bueno-Lledó J, Torregrosa Gallud A, Jiménez Rosellón R, et al. Preoperative preparation of “loss of domain” hernia. Progressive pneumoperitoneum and botulinum toxin type A. Cir Esp. 2017;95(5):245–53. https://doi.org/10.1016/j.ciresp.2017.04.006.

    Article  PubMed  Google Scholar 

  37. Geffen HJAAV, Simmermacher RKJ. Incisional hernia repair: abdominoplasty, tissue expansion, and methods of augmentation. World J Surg. 2005;29(8):1080–5. https://doi.org/10.1007/s00268-005-7972-0.

    Article  PubMed  Google Scholar 

  38. Koontz AR, Graves JW. Preoperative pneumoperitoneum as an aid in the handling of gigantic hernias. Ann Surg. 1954;140(5):759–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. La Meir M, Vierendeels T, Poortmans M. Pneumoperitoneum in repair of giant hernias and eventrations. Acta Chir Belg. 2002;102(4):263–5.

    Article  PubMed  Google Scholar 

  40. Mcadory RS, Cobb WS, Carbonell AM. Progressive preoperative pneumoperitoneum for hernias with loss of domain. Am Surg. 2009;75(6):504–8; discussion 508–509.

    PubMed  Google Scholar 

  41. Quraishi AHM, Borkar MM, Mastud MM, Jannawar GG. Pre-operative progressive pneumoperitoneum for repair of a large incisional hernia. Updat Surg. 2013;65(2):165–8. https://doi.org/10.1007/s13304-012-0134-7.

    Article  Google Scholar 

  42. Oprea V, Matei O, Gheorghescu D, et al. Progressive preoperative pneumoperitoneum (PPP) as an adjunct for surgery of hernias with loss of domain. Chirurgia (Bucur). 2014;109(5):664–9.

    CAS  Google Scholar 

  43. Raynor RW, Del Guercio LR. The place for pneumoperitoneum in the repair of massive hernia. World J Surg. 1989;13(5):581–5.

    Article  CAS  PubMed  Google Scholar 

  44. Sabbagh C, Dumont F, Fuks D, Yzet T, Verhaeghe P, Regimbeau J-M. Progressive preoperative pneumoperitoneum preparation (the Goni Moreno protocol) prior to large incisional hernia surgery: volumetric, respiratory and clinical impacts. A prospective study. Hernia. 2012;16(1):33–40. https://doi.org/10.1007/s10029-011-0849-2.

    Article  CAS  PubMed  Google Scholar 

  45. Minossi JG, Oliveira WK, Llanos JC, Ielo SM, Hasimoto CN, Pereira RS. Preoperative progressive pneumoperitoneum in voluminous abdominal wall hernias. Arq Gastroenterol. 2009;46(2):121–6.

    Article  PubMed  Google Scholar 

  46. Dumont F, Fuks D, Verhaeghe P, et al. Progressive pneumoperitoneum increases the length of abdominal muscles. Hernia. 2009;13(2):183–7. https://doi.org/10.1007/s10029-008-0436-3.

    Article  CAS  PubMed  Google Scholar 

  47. Tanaka EY, Yoo JH, Rodrigues AJ, Utiyama EM, Birolini D, Rasslan S. A computerized tomography scan method for calculating the hernia sac and abdominal cavity volume in complex large incisional hernia with loss of domain. Hernia. 2010;14(1):63–9. https://doi.org/10.1007/s10029-009-0560-8.

    Article  CAS  PubMed  Google Scholar 

  48. Sabbagh C, Dumont F, Robert B, Badaoui R, Verhaeghe P, Regimbeau J-M. Peritoneal volume is predictive of tension-free fascia closure of large incisional hernias with loss of domain: a prospective study. Hernia. 2011;15(5):559–65. https://doi.org/10.1007/s10029-011-0832-y.

    Article  CAS  PubMed  Google Scholar 

  49. Blair LJ, Ross SW, Huntington CR, et al. Computed tomographic measurements predict component separation in ventral hernia repair. J Surg Res. 2015; https://doi.org/10.1016/j.jss.2015.06.033.

  50. de Araújo LMG, Serigiolle LC, Gomes HMP, Rodrigues DAB, Lopes CM, Leme PLS. Volume calculation of rats’ organs and its application in the validation of the volume relation between the abdominal cavity and the hernial sac in incisional hernias with “loss of abdominal domain”. Arq Bras Cir Dig. 2014;27(3):177–81.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Petro CC, Raigani S, Fayezizadeh M, et al. Permissive intra-abdominal hypertension following complex abdominal wall reconstruction. Plast Reconstr Surg. 2015; https://doi.org/10.1097/PRS.0000000000001621.

  52. Willis S, Conze J, Müller S, Klosterhalfen B, Schumpelick V. Progressive pneumoperitoneum in treatment of inguinal and scar hernias. Results of animal experiments and clinical applications. Langenbecks Arch Chir. 1996;381(3):132–7.

    Article  CAS  PubMed  Google Scholar 

  53. El Saadi AS, Al Wadan AH, Hamerna S. Approach to a giant inguinoscrotal hernia. Hernia. 2005;9(3):277–9. https://doi.org/10.1007/s10029-004-0291-9.

    Article  PubMed  Google Scholar 

  54. Valliattu AJ, Kingsnorth AN. Single-stage repair of giant inguinoscrotal hernias using the abdominal wall component separation technique. Hernia. 2008;12(3):329–30. https://doi.org/10.1007/s10029-008-0346-4.

    Article  CAS  PubMed  Google Scholar 

  55. Cavalli M, Biondi A, Bruni PG, Campanelli G. Giant inguinal hernia: the challenging hug technique. Hernia. 2015;19(5):775–83. https://doi.org/10.1007/s10029-014-1324-7.

    Article  CAS  PubMed  Google Scholar 

  56. Caldironi MW, Romano M, Bozza F, et al. Progressive pneumoperitoneum in the management of giant incisional hernias: a study of 41 patients. Br J Surg. 1990;77(3):306–7.

    Article  CAS  PubMed  Google Scholar 

  57. Näslund E, Backman L, Melcher A. A novel use for the Port-a-Cath: pneumoperitoneum in the repair of giant hernia. Eur J Surg. 1996;162(4):335–6.

    PubMed  Google Scholar 

  58. Mayagoitia JC, Suárez D, Arenas JC, Díaz de León V. Preoperative progressive pneumoperitoneum in patients with abdominal-wall hernias. Hernia. 2006;10(3):213–7. https://doi.org/10.1007/s10029-005-0040-8.

    Article  CAS  PubMed  Google Scholar 

  59. Mougin N. Is progressive preoperative pneumoperitoneum (PPP) really safe? Assessment of its specific morbi-mortality in a retrospective study over 152 patients. Hum Health Pathol. 2015;35.

    Google Scholar 

  60. Alyami M, Passot G, Voiglio E, et al. Feasibility of catheter placement under ultrasound guidance for progressive preoperative pneumoperitoneum for large incisional hernia with loss of domain. World J Surg. 2015;39(12):2878–84. https://doi.org/10.1007/s00268-015-3206-2.

    Article  CAS  PubMed  Google Scholar 

  61. López Sanclemente MC, Robres J, López Cano M, et al. Progressive preoperative pneumoperitoneum in patients with giant hernias of the abdominal wall. Cir Esp. 2013;91(7):444–9. https://doi.org/10.1016/j.ciresp.2012.08.004.

    Article  PubMed  Google Scholar 

  62. Raynor RW, Del Guercio LR. Update on the use of preoperative pneumoperitoneum prior to the repair of large hernias of the abdominal wall. Surg Gynecol Obstet. 1985;161(4):367–71.

    CAS  PubMed  Google Scholar 

  63. Astudillo R, Merrell R, Sanchez J, Olmedo S. Ventral herniorrhaphy aided by pneumoperitoneum. Arch Surg. 1986;121(8):935–6.

    Article  CAS  PubMed  Google Scholar 

  64. Luder PJ, Haller BG, Gertsch P, Blumgart LH, Lerut JP. Pneumoperitoneum and Mersilene mesh in the treatment of giant abdominal wall hernias. Helv Chir Acta. 1990;56(6):927–30.

    CAS  PubMed  Google Scholar 

  65. Coelho JC, Brenner AS, Freitas AT, Campos AC, Wiederkehr JC. Progressive preoperative pneumoperitoneum in the repair of large abdominal hernias. Eur J Surg. 1993;159(6–7):339–41.

    CAS  PubMed  Google Scholar 

  66. Toniato A, Pagetta C, Bernante P, Piotto A, Pelizzo MR. Incisional hernia treatment with progressive pneumoperitoneum and retromuscular prosthetic hernioplasty. Langenbecks Arch Surg. 2002;387(5–6):246–8. https://doi.org/10.1007/s00423-002-0316-8.

    Article  PubMed  Google Scholar 

  67. Beitler JC, Gomes SM, Coelho ACJ, Manso JEF. Complex inguinal hernia repairs. Hernia. 2009;13(1):61–6. https://doi.org/10.1007/s10029-008-0432-7.

    Article  CAS  PubMed  Google Scholar 

  68. Poghosyan T, Veyrie N, Corigliano N, Helmy N, Servajean S, Bouillot J-L. Retromuscular mesh repair of midline incisional hernia with polyester standard mesh: monocentric experience of 261 consecutive patients with a 5-year follow-up. World J Surg. 2012;36(4):782–90. https://doi.org/10.1007/s00268-012-1443-1.

    Article  PubMed  Google Scholar 

  69. Tian W, Fei Y. [Application of Da Vinci robotic surgery to hernia repair]. Zhonghua Wei Chang Wai Ke Za Zhi Chin. J Gastrointest Surg. 2018;21(7):740–3.

    Google Scholar 

  70. Warren JA, Love M. Incisional hernia repair: minimally invasive approaches. Surg Clin North Am. 2018;98(3):537–59. https://doi.org/10.1016/j.suc.2018.01.008.

    Article  PubMed  Google Scholar 

  71. Suwa K, Okamoto T, Yanaga K. Closure versus non-closure of fascial defects in laparoscopic ventral and incisional hernia repairs: a review of the literature. Surg Today. 2016;46(7):764–73. https://doi.org/10.1007/s00595-015-1219-y.

    Article  PubMed  Google Scholar 

  72. Vorst AL, Kaoutzanis C, Carbonell AM, Franz MG. Evolution and advances in laparoscopic ventral and incisional hernia repair. World J Gastrointest Surg. 2015;7(11):293–305. https://doi.org/10.4240/wjgs.v7.i11.293.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General, Digestive and Endocrine Surgery, Robert-Debre University Hospital, University of Reims Champagne-Ardenne, Reims, France

    Yohann Renard, Cheryne Hammoutene & Jean-Pierre Palot

Authors
  1. Yohann Renard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cheryne Hammoutene
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jean-Pierre Palot
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Our Lady of the Lake Physician Group, Baton Rouge, LA, USA

    Karl A. LeBlanc

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Renard, Y., Hammoutene, C., Palot, JP. (2019). Pneumoperitoneum Aided Hernia Repair. In: LeBlanc, K. (eds) Robotic Assisted Hernia Repair. Springer, Cham. https://doi.org/10.1007/978-3-030-23025-8_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-23025-8_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-23024-1

  • Online ISBN: 978-3-030-23025-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation