Key points are not available for this paper at this time.
Abstract Aim The aim of this communication is to present a case of preoperative progressive pneumoperitoneum (PPP) and injection of botulinum toxin type A (BT) in a patient with a L3 inguinal hernia and loss of domain. Material and Methods We present the case of a 74-year-old patient with a L3, non-reducible, right inguinal hernia with loss of domain. An abdominal CT scan was performed, showing a hernial orifice of approximately 6.6 × 5.4 cm containing mesenteric fat, ileum and part of the bladder inside. Given the size of the hernia, PPP and BT and was proposed to increase intra-abdominal pressure prior to surgery. Results Botulinum toxin is injected into the rectus abdominis, transverse and oblique muscles. An intraperitoneal catheter is placed, through which 1000 cubic centimeters of pneumoperitoneum are introduced daily until reaching 9000 cc. Open hernioplasty is performed according to the Litchenstein technique, reducing the hernial content in its entirety. A polypropylene mesh is placed. Intra-abdominal pressure was monitored and measured at 9 mmHg before surgery, 12 mmHg during the procedure, and 15 mmHg after the procedure. Conclusions In patients with large L3 hernias and loss of domain, reduction of the herniated content have the risk of producing an abdominal compartment syndrome. There are several techniques to maintain an appropriate intra-abdominal pressure prior to surgery, such as BT or PPP, although their use is mainly described for midline hernias. The use of BT and PPP may be a useful therapy in the treatment of large inguinal hernias with loss of domain.
Escudero et al. (Wed,) studied this question.