Pneumoperitoneum as management adjunctive treatment in an obese patient with loss of domain hernia. A case report

Background Obesity is an important risk factor for development of hernias on the anterior abdominal wall1 Incisional Abdominal wall hernias have been appearing at 13% secondary to laparotomies.2 However, some types of hernias require advanced and challenging pre or perioperative management, particularly in the case of giant hernias or a hernia associated with loss of domain.3-4 Challenges for the specialized surgeons are multiple. They must assure a successful tension-free closure of the fascial defect. Also to prevent surgically abdominal compartment syndrome caused for induced quickly the visceras and finally avoid recurrence of the hernia . 5-6 Early preoperative progressive pneumoperitoneum (PPP) is a technique that helps in big eventrations with loss of domain to reintroduce protruded organs. PPP is a technique that pursues the prevention of abdominal hypertension syndrome. PPP acts as a pneumatic tissue expander. 7 A muldisciplinary team can improve decision making and therefore reduce the risk of a long-term complication. We show a case where PPP was performed in no acute painful, reducible with high risk of incarceration, morbid obesity with high risk to infection and complications, showing the benefic of PPP in our patient. Keywords: Incisional hernia; complex incisional hernia; Loss of domain hernia; Preoperative progressive pneumoperitoneum(PPP); Ventral hernia; morbid obesity; Goni Moreno