Preoperative progressive pneumoperitoneum in obese patients with loss of domain hernias.

BACKGROUND: Repair of hernias with loss of domain in obese patients can lead to acute respiratory failure.

OBJECTIVES: The objective of this study was to analyze preoperative progressive pneumoperitoneum (PPP) in increasing abdominal cavity volume and its impact on respiratory function.

SETTING: The study was conducted at the University Hospital, State University of Londrina, Brazil, which is a referral center for the treatment of obesity. The patients were hospitalized for the duration of the study.

METHODS: Sixteen obese patients were evaluated. Computed tomography was used to determine hernia sac volume (HSV) and abdominal cavity volume (ACV). Respiratory function was evaluated by measuring vital capacity and forced expiratory volume in the first second (FEV-1). All data were obtained before PPP, on the day before surgery, and on the second postoperative day. PPP was performed daily with insufflation of CO2.

RESULTS: The number of insufflations was 12. The average of total volume inflated was 5.7 L. The HSV was 2953 cm3 before PPP and 1935 cm3 after PPP. The average ACV increased from 8898 to 11,317 cm3 after PPP. The relationship between HSV and ACV was 38.2% before and 16.3% after PPP. There was a favorable improvement in respiratory function with an increase in vital capacity from 1875 to 2760 mL and an increase in FEV-1 from 1060 to 1670 mL after PPP. Respiratory function tests after surgery showed values of 2600 and 1560 mL, respectively, for cavity volume and FEV-1. There were no postoperative respiratory complications.

CONCLUSIONS: This technique can be used safely in the surgical preparation of obese patients with hernias with loss of domain, reducing the relation between HSV and ACV and avoiding pulmonary complications.