Giant Hernias Managed by Pneumoperitoneum

Pneumoperitoneum to reestablish abdominal space for the visceral contents of massive hernias has been little used in this country. Three patients were treated by this technique. The amounts of air injected were 7,000, 8,500, and 9,000 cc, respectively, in increments of 500 to 1,500 cc every other day. The development of flank tension was used as the cutoff point for each injection. Hernia repair was carried out after 10 to 14 days of treatment; the hernial defects varied in size from 6×6 cm to 10×14 cm. All defects were closed without the use of autogenous or foreign material mesh grafts. Complications included urinary retention, discoid atelectasis, and subcutaneous emphysema. The markedly stretched scrotal skin attenuates rapidly after hernia reduction, making plastic revision unnecessary. Pneumoperitoneum is easy to perform and nonhazardous, and should be used with greater frequency for adult patients with massive hernias.