P-067 PREHABILITATION IN A LOSS OF DOMAIN BILATERAL INGUINOSCROTAL HERNIA: USE OF BOTULINUM TOXIN AND PREOPERATIVE PROGRESSIVE PNEUMOPERITONEUM

Autor: M Orellana León, S Lorenzo Mañas, P Vázquez Beltrán, V Vega Novillo, I Justo Alonso, T Butrón Vila, S Fernández Nöel, L Lavin Montoro, M Bernaldo De Quirós Fernández, K Falcón Bonilla, A Martínez Pozuelo, B Otero Torrón
Rok vydání: 2023
Předmět:
Zdroj: British Journal of Surgery. 110
ISSN: 1365-2168
0007-1323
DOI: 10.1093/bjs/znad080.203
Popis: Aim Describe the use of botulinum toxin A (BT) and preoperative progressive pneumoperitoneum (PPP) in a loss of domain inguinoscrotal hernia following our hospital's protocol. Material and methods Single case report of a 60-year-old male, with loss of domain bilateral inguinoscrotal hernia. We performed prehabilitation with respiratory physiotherapy (RP), BT and PPP. We applied BT 30 days before surgery, injecting a total of 500U in 12 sites of abdominal wall: 4 in the lateral abdominal muscle and 2 of them in each rectus abdominis. We calculated, using the Tanaka index, the ratio between the abdominal cavity volume (ACV) and the hernia volume (HV), which was 32%, as well as the amount of pneumoperitoneum to insufflate, which according to our protocol is HV x3 + 100cc. The PPP catheter was placed 10 days before repair, insufflating a total of 6.900cc within seven consecutive days of catheter placement. Results With the application of prehabilitation (BT, RP, PPP) we achieve a lengthening of 18.5 cm and a decrease of 27 mm of the thickness as well as an increase in the volume of the abdominal cavity of×4.200cc. Afterwards, a hernioplasty with Stoppa and bilateral Litchenstein technique was performed. as well as a scrotoplasty and circumcision for the patient's phimosis in collaboration with Plastic and Urology services. The surgical procedure was performed without complications. After 7 months there is no hernia recurrence. Conclusions BT and PPP help to repair the inguinoscrotal hernia, avoiding the mayor surgical techniques like component separation diminishing morbidity.
Databáze: OpenAIRE
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