Progressive Pneumoperitoneum For Loss of Domain



UW Health surgeons at UW Hospital and Clinics in Madison, Wisconsin, perform progressive pneumoperitoneum as a preoperative technique for loss of domain. Loss of domain is a condition in which more of the viscera are outside of the abdominal cavity than inside. Preoperative progressive pneumoperitoneum is a technique that insufflates air in the abdomen in preparation for surgery.


Loss of domain typically occurs in patients who have received a previous laparotomy, a large surgical incision in the abdomen, which weakens a large portion of the abdominal wall. Minor hernias of this nature are called incisional hernias. Loss of domain occurs when these incisional hernias create larger-scale defects to the abdominal wall. Because the abdominal wall has already been compromised by a previous surgical incision, it is preferable that any additional surgical incisions are minor.


Patients who suffer from loss of domain may also be subject to poor bowel function, back pain and spine curvature, mesenteric edema, paradoxical respiratory motion, and the degradation of core muscles.


The Procedure


In loss of domain hernia cases, the abdominal cavity can become incapable of containing the viscera within its original barriers. Closing off the original abdominal cavity from the protruding portion is risky as it can greatly increase the pressure within the abdominal cavity, lead to fascial dehiscence (when a wound does not heal and sutured tissues refuse to join together) or induce abdominal compartment syndrome. Preoperative progressive pneumoperitoneum increases a patient's capacity to tolerate the operation and can help prevent future complications. The technique expands the abdominal cavity with insufflated air (in small doses over the course of several days) so that there is enough space for the herniated viscera to be placed back into the original abdominal cavity. Additionally, this technique decreases tension on the tissue of the abdominal cavity, thus increasing the success of the wound healing properly and decreasing the risk of recurrence.


The Difference of Minimally Invasive


There are numerous benefits to having this minimally invasive procedure:

  • Faster recovery
  • Less pain post-operatively
  • Fewer post-operative complications
  • Cosmetic appeal
  • Smaller incisions are more ideal for already weakened abdominal tissue. Large incisions can further weaken the abdominal tissue, increasing the risk of recurrence.