Progressive Preoperative Pneumoperitoneum and Botulinum Toxin as Adjuvant Techniques in the Management of Hernias with Loss of Continent
DOI:
https://doi.org/10.31243/mdc.uta.v9i4.3046.2025Keywords:
Hernia, loss of domain, botulinum toxin, progressive pneumoperitoneum, preoperative managementAbstract
Introduction: “Loss-of-domain” hernias are defined as those in which the hernia sac exceeds 15–20% of the abdominal cavity volume, often leading to respiratory and circulatory compromise. The Tanaka Index is commonly used for diagnosis. Management strategies include preoperative adjuvant techniques such as progressive pneumoperitoneum and botulinum toxin type A injection; both aimed at expanding abdominal capacity and reducing wall tension.
Objective: To narratively review current evidence on the role of progressive preoperative pneumoperitoneum and botulinum toxin A as adjuvant strategies in the management of loss-of-domain hernias, focusing on their impact in reducing surgical complications and improving postoperative outcomes.
Methods: A narrative literature review was conducted based on scientific publications retrieved from databases such as PubMed, Scielo, ScienceDirect, Web of Science, and Elsevier, prioritizing relevant information published in English and Spanish within the last five years. As this is a narrative review, no systematic protocols were applied; therefore, the results are presented in a descriptive and analytical manner.
Results: The reviewed evidence shows that these techniques facilitate reintegration of abdominal contents, decrease tension during closure, and improve respiratory tolerance. Progressive pneumoperitoneum gradually enlarges abdominal volume, while botulinum toxin A induces temporary muscle relaxation, both contributing to safer surgical repair and reduced risk of complications such as abdominal compartment syndrome.
Conclusions: Available literature supports the use of progressive pneumoperitoneum and botulinum toxin as effective and safe preoperative adjuncts for loss-of-domain hernias. Individualized patient selection and tailored application remain essential for optimizing outcomes
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Copyright (c) 2025 Evelyn Johanna Solano Benalcázar , Jackson André Tapia Cueva, Ariana Nicole Sari Yánez , Víctor Peñafiel Gaibor
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