ArticleHernia : the journal of hernias and abdominal wall surgery2025
A structured protocol for Preoperative Progressive Pneumoperitoneum (PPP) in Complex Abdominal Wall Reconstruction (CAWR): our York protocol.
Article in Hernia : the journal of hernias and abdominal wall surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- A practical algorithm for the combined use of preoperative progressive pneumoperitoneum and botulinum toxin A in large incisional hernia repair: learnings after 15 years of experience.Hernia : the journal of hernias and abdominal wall surgery · 2026Article
- Multimodal Prehabilitation for Hernia Repair: Linking Metabolic Modulation and Mechanical Methods.Biomedicines · 2025Review
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6 authors.
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Abstract
backgroundComplex Abdominal Wall Reconstruction (CAWR) in patients with significant loss of domain poses substantial surgical and physiological challenges [1], [2]. Preoperative Progressive Pneumoperitoneum (PPP), involving incremental insufflation of gas into the abdominal cavity, enhances the likelihood of tension-free fascial closure [3]. However, there remains considerable variability and incompleteness in existing PPP protocols, especially concerning venous thromboembolism (VTE) prophylaxis, inferior vena cava (IVC) filter placement, respiratory prehabilitation, and multidisciplinary coordination.
methodsA structured literature review was conducted (MEDLINE® and Embase®, final search April 2025), yielding no comprehensive PPP protocols for CAWR. In response, we convened a multidisciplinary team at a tertiary UK referral centre-including specialists in general surgery, plastic and reconstructive surgery, vascular surgery, interventional radiology, and pharmacy-to develop an integrated, replicable protocol. Consensus development methods (CDMs) informed the iterative refinement process, incorporating clinical experience and best available evidence.
resultsOur seven-week perioperative protocol systematically integrates key preoperative interventions: bilateral abdominal wall botulinum toxin injections, respiratory prehabilitation, abdominal binder use, VTE prophylaxis with low molecular weight heparin (LMWH), planned IVC filter insertion, peritoneal dialysis catheter placement, and scheduled PPP insufflation sessions. Final surgical planning is guided by crosssectional imaging obtained one week preoperatively. Postoperatively, a structured IVC filter removal strategy, including cavogram assessment, is implemented to manage thromboembolic risk.
conclusionWe present a comprehensive PPP protocol designed to optimise outcomes in CAWR. This structured, multidisciplinary approach represents an important step toward standardising care in complex abdominal wall reconstruction.
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