Preoperative Progressive Pneumoperitoneum and Botulinum Toxin A in a High-Risk Patient With Loss of Domain Inguinoscrotal Hernia.

Autor:	Baco SJ; General Surgery, Public Health Institution Hospital 'Dr Mladen Stojanović', Prijedor, BIH., Mišić J; General Surgery, Saint Luke the Apostle Hospital, Doboj, BIH., Perunicic V; Surgery, General Hospital, Čačak, SRB., Mitric M; General Surgery, Public Health Institution Hospital 'Dr Mladen Stojanović', Prijedor, BIH., Đukanović S; Emergency Medicine, Public Health Institution Dom zdravlja Prijedor, Prijedor, BIH.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Sep 03; Vol. 16 (9), pp. e68509. Date of Electronic Publication: 2024 Sep 03 (Print Publication: 2024).
DOI:	10.7759/cureus.68509
Abstrakt:	We present a challenging case of a loss of domain (LOD) inguinoscrotal hernia in a 77-year-old high-risk patient, successfully managed with the complementary preoperative use of progressive pneumoperitoneum (PPP) and botulinum toxin A (BTA) without complications. Giant inguinoscrotal and LOD hernias, particularly in multimorbid patients, are highly complex and require meticulous preoperative preparation. In this case, PPP was performed with ambient air and a gradual increase in insufflation volume, while BTA was injected at three points on each side, with a total dose of 300 IU. This approach facilitated a complication-free increase in abdominal cavity volume and the repositioning of chronically eventrated abdominal contents. The technique proved safe, feasible, and effective, contributing to atraumatic adhesiolysis, reduced operative time, and avoidance of more invasive surgical methods. A Shouldice pure tissue repair was performed, successfully avoiding the need for prosthetic materials. Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Baco et al.)
Databáze:	MEDLINE
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