Abstract

BOMBIL, I  and  LUSHIKU, L. Experience with insufflation technique in the management of incisional hernia with loss of domain. S. Afr. j. surg. [online]. 2021, vol.59, n.4, pp.137-139. ISSN 2078-5151.  http://dx.doi.org/10.17159/2078-5151/2021/v59n4a3660.

BACKGROUND: The loss of intra-abdominal domain makes it impossible to reconstruct the abdominal wall defect without prior correction of container/content mismatch. This study reports on the use of an insufflation technique to enable repairMETHOD: Over an 8-year period, 19 incisional hernia patients with loss of domain between 20% and 50% were treated with an insufflation technique to create sufficient intra-abdominal domain to effect repair. Ambient air was insufflated into the abdominal cavity via an indwelling catheter. After progressive pneumoperitoneum was completed over a period of 10 to 14 days, the hernias were repairedRESULTS: There were 16 females and three males. The defect size ranged from 7-25 cm. The mean air insufflated was 7.2 litres. After pneumoperitoneum, approximation of the linea alba was possible in all cases with a mean intraoperative pre-deflation and post-closure peak airway pressure within normal (21 and 20 cmH₂O respectively). Tissue repair and implant reinforcement were performed in 17 and two cases respectively. There were three instances of surgical site complications and no 30-day recurrenceCONCLUSION: Repair of incisional hernia with significant loss of domain was made possible by the insufflation technique that enabled tension-free closure of the abdominal wall defect by direct suture, evidenced by the normal peak airway pressure after closure

Keywords : insufflation technique; incisional hernia; complications of laparotomy.

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