Asim A Abbas, Anisah Ahmad, Alastair McCleary, Marcus Nicholls, Praminthra Chitsabesan, Srinivas Chintapatla
{"title":"复杂腹壁重建（CAWR）术前进行性气腹（PPP）的结构化方案：我们的York方案。","authors":"Asim A Abbas, Anisah Ahmad, Alastair McCleary, Marcus Nicholls, Praminthra Chitsabesan, Srinivas Chintapatla","doi":"10.1007/s10029-025-03401-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Complex 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.</p><p><strong>Methods: </strong>A 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.</p><p><strong>Results: </strong>Our 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.</p><p><strong>Conclusion: </strong>We 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.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"207"},"PeriodicalIF":2.4000,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174292/pdf/","citationCount":"0","resultStr":"{\"title\":\"A structured protocol for Preoperative Progressive Pneumoperitoneum (PPP) in Complex Abdominal Wall Reconstruction (CAWR): our York protocol.\",\"authors\":\"Asim A Abbas, Anisah Ahmad, Alastair McCleary, Marcus Nicholls, Praminthra Chitsabesan, Srinivas Chintapatla\",\"doi\":\"10.1007/s10029-025-03401-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Complex 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.</p><p><strong>Methods: </strong>A 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.</p><p><strong>Results: </strong>Our 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.</p><p><strong>Conclusion: </strong>We present a comprehensive PPP protocol designed to optimise outcomes in CAWR. 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A structured protocol for Preoperative Progressive Pneumoperitoneum (PPP) in Complex Abdominal Wall Reconstruction (CAWR): our York protocol.
Background: Complex 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.
Methods: A 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.
Results: Our 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.
Conclusion: We 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.
期刊介绍：
Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery.
Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.
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