Application value of the preoperative progressive pneumoperitoneum in the elderly with large incisional hernia

doi:10.3877/cma.j.issn.1674-392X.2019.02.003

Abstract

Abstract:

Objective

To investigate the clinical application value of the preoperative progressive pneumoperitoneum (PPP) in the treatment of large incisional hernias in the elderly.

Methods

The clinical data of 19 elderly patients with large incisional hernia who underwent PPP prior to hernia repair in the Sixth Hospital Affiliated of Sun Yat-sen University from February 2017 to February2018 were analyzed retrospectively. Abdominal computed tomography (CT) scan, pulmonary function and arterial blood gas analysis were performed before and after PPP. The following indicators were mainly observed: (1) PPP situations: insufflation time (days), completion, the median insufflated volume of air; (2) Changes in the volumes of the incisional hernia (VIH), the volumes of the abdominal cavity (VAC), the pulmonary function and arterial blood gas (PaO₂ and PaCO₂) before and after PPP; (3) operation, postoperative recovery and follow-up situations.

Results

(1) PPP situations: the insufflation time in 19 patients ranged from 11-18 d, 18 patients successfully completed PPP, the median insufflated volume of air for PPP was 4 400-7 200 mL. (2) Changes in the volumes of the incisional hernia (VIH), the volumes of the abdominal cavity (VAC), the pulmonary function and arterial blood gas (PaO₂ and PaCO₂) before and after PPP: Before and after PPP, the mean VIH was (1 086.7±438.9) mL and (1 275.8±521.4) mL (t=3.228, P<0.05), the VIH increased by (189±255.3) mL; the mean VAC was (6 144.0±1 758.4) mL and (8 748.5±2 084.5) mL (t=8.856, P<0.05), theVAC increased by (2 604.5±1 322.3) mL; the mean (VIH/VAC)×100% was 10.9% to 28.5% and 7.3% to 24.9% (t=3.327, P<0.05); the VAC increased by 2 604.5 mL (P<0.01) and was greater than the mean VIH before PPP. After PPP, dynamic lung volumes fell by 5.11% for FVC, 2.45% for FEV1/FVC%, 3.69% for PEF, 1.73% for MEF75, 4.55% for MEF50, 6.8% for MMEF75/25 (t=1.595, 1.605, 0.243, 0.663, 1.682, 1.720, all P>0.05), FEV1 decreased by 6.52% (t=2.137, P<0.05); PaO₂ decreased by 5.71% (t=1.461, P>0.05) and PaCO₂ decreased by 9.14% (t=3.39). (3) Operation, postoperative recovery and follow-up situations: The operations was performed successfully in 19 patients, the mean operating time was 137 to 265 minutes, fascia closure was possible in 89.5% of cases (n=17). No severe complications such as ACS or cardiopulmonary failure occurred. The mean postoperative length of stay in hospital was 4 to 12 days. All patients were followed up for 6-18 months, and there was no hernia recurrence.

Conclustion

PPP is safe and effective in elderly patients with large incisional hernia repair, which is worthy of clinical promotion and application.

Key words: Large incisional hernia, Preoperative progressive pneumoperitoneum, Elderly, Hernia repair, Complication

Fuxin Tang, Yingru Li, Weisheng Yang, Zhipeng Jiang, Taicheng Zhou, Wenchang Gan, Zehui Hou, Ning Ma, Zhuomin Yu, Wei Liu, Hongyan Yu, Shuang Chen. Application value of the preoperative progressive pneumoperitoneum in the elderly with large incisional hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2019, 13(02): 105-110.

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References 17

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参数	气腹前	气腹后	t值	P值
FVC
(L)	2.11±0.63	2.00±0.57	1.311	0.200
(%)	78.33±20.12	73.22±20.21	1.595	0.128
FEV1
(L)	1.95±0.58	1.78±0.48	2.678	0.015
(%)	87.54±23.36	81.02±22.79	2.137	0.047
FEV1/FVC%	92.33±5.65	89.88±7.60	1.605	0.126
PEF
(L)	4.63±1.75	4.61±1.48	0.101	0.920
(%)	77.40±26.15	73.71±20.73	0.243	0.810
MEF75
(L)	4.42±1.53	4.33±1.27	0.628	0.538
(%)	79.13±27.38	77.40±23.09	0.663	0.516
MEF50
(L)	2.85±1.04	2.68±0.84	1.754	0.096
(%)	79.56±29.28	75.01±24.47	1.682	0.110
MMEF75/25
(L)	2.25±0.93	2.03±0.68	2.051	0.055
(%)	79.06±31.04	72.26±23.58	1.720	0.103
PaO₂(mmHg)	82.3±8.6	77.6±10.0	1.461	0.161
PaCO₂(mmHg)	39.4±4.5	35.8±4.0	3.392	0.003

参数	气腹前	气腹后	t值	P值
FVC
(L)	2.11±0.63	2.00±0.57	1.311	0.200
(%)	78.33±20.12	73.22±20.21	1.595	0.128
FEV1
(L)	1.95±0.58	1.78±0.48	2.678	0.015
(%)	87.54±23.36	81.02±22.79	2.137	0.047
FEV1/FVC%	92.33±5.65	89.88±7.60	1.605	0.126
PEF
(L)	4.63±1.75	4.61±1.48	0.101	0.920
(%)	77.40±26.15	73.71±20.73	0.243	0.810
MEF75
(L)	4.42±1.53	4.33±1.27	0.628	0.538
(%)	79.13±27.38	77.40±23.09	0.663	0.516
MEF50
(L)	2.85±1.04	2.68±0.84	1.754	0.096
(%)	79.56±29.28	75.01±24.47	1.682	0.110
MMEF75/25
(L)	2.25±0.93	2.03±0.68	2.051	0.055
(%)	79.06±31.04	72.26±23.58	1.720	0.103
PaO₂(mmHg)	82.3±8.6	77.6±10.0	1.461	0.161
PaCO₂(mmHg)	39.4±4.5	35.8±4.0	3.392	0.003

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