A structured protocol for Preoperative Progressive Pneumoperitoneum (PPP) in Complex Abdominal Wall Reconstruction (CAWR): our York protocol
PMCID: PMC12174292
PMID: 40526283
DOI: 10.1007/s10029-025-03401-z
Journal: Hernia : the journal of hernias and abdominal wall surgery
Publication Date: 2025-6-17
Authors: Abbas AA, Ahmad A, McCleary A, Nicholls M, Chitsabesan P, et al.
Key Points
- First comprehensive, multidisciplinary protocol specifically designed for complex abdominal wall reconstruction
- Systematic seven-week perioperative approach integrating multiple specialized interventions
- Provides a standardized framework for managing high-risk abdominal wall reconstruction patients
Summary
This multidisciplinary study addresses the complex challenge of Abdominal Wall Reconstruction (CAWR) by developing a structured seven-week Progressive Pneumoperitoneum (PPP) protocol for patients with significant abdominal domain loss. The research emerged from a critical gap in existing clinical approaches, bringing together specialists from general surgery, plastic surgery, vascular surgery, interventional radiology, and pharmacy to create a comprehensive, systematic perioperative management strategy.
The protocol integrates multiple critical preoperative interventions, including bilateral botulinum toxin injections, respiratory prehabilitation, abdominal binder use, venous thromboembolism (VTE) prophylaxis, and planned inferior vena cava (IVC) filter placement. By employing consensus development methods and leveraging cross-sectional imaging, the team designed a replicable approach that addresses the complex physiological challenges of CAWR, with particular attention to minimizing surgical and thromboembolic risks.