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>Journals >Cirujano General >Year 2002, Issue 4


Martínez MA, Quijano OF, Padilla LR, Hesiquio SR, Álvarez CO, Medina RO
Double lumen catheter for pneumoperitoneum in giant hernias. Report on four patients
Cir Gen 2002; 24 (4)

Language: Español
References: 28
Page: 313-318
PDF: 4. Kb.


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ABSTRACT

Objective: To report the use of a new technique for the application of the pre-operative pneumoperitoneum in four patients with giant hernias.
Setting: Third level health care hospitals.
Method: Pre-operative pneumoperitoneum was ambulatory applied through a double lumen catheter placed in the abdominal cavity using a modified Seldinger technique. Through one lumen, 1000 to 1200 ml of environmental air was insufflated per day during 7 days. Through the other lumen, intra-abdominal pressure was simultaneously measured to avoid exceeding 12 mmHg. On the 8th day, Lichtenstein-type tension-free plasties were performed for the inguinal hernias and modified Stoppa was used for ventral hernias.
Description of the cases: We treated four patients, two women and two men, aged between 42 and 64 years, with an evolution time of the post-incisional hernia of 9 to 11 years in three of them, the fourth patient had no history of previous surgery but carried a giant inguinal right hernia, of 24 years of evolution. Dimensions of the herniary sac were of 20 x 30 cm (case No 4) to 45 x 55 cm (case No. 3). Lichtenstein-type plasty was performed in three of the patients (cases 1,3, and 4) and, in the other, a modified Stoppa technique was used. No complications occurred and after four years of observation no recurrence has developed.
Conclusion: Progressive pre-operative pneumoperitoneum, with a double lumen catheter allowed to increase the capacity of the abdominal wall, without the risk of increasing pressure when reducing the herniary sac, and permitted to perform the plasty as usual with minimal morbidity.


Key words: Pre-operative pneumoperitoneum, giant hernia, tension-free plasty.


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