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Introduction: The ventral hernia is defined as a protrusion of a part in an organism or tissue through an abdominal hole. Actually, there are many techniques and materials you can choose from, both by laparoscopic and open repair, it is advisable to know the indications of each of them. Objective: This study aims to show that the selection of patients is uniform in terms of defect size such as Body Mass Index or comorbidity of the patient that they decide on one way or another. Material and methods: Between May 2013 and May 2019, the data of 197 patients operated by a defect of abdominal wall closure have been collected in the General Surgery Service of the Hospital General Universitario of Castellon. In this study, the 75 patients (38 %) who were given laparoscopic access were analyzed, in order to verify that when patients are not randomized there is a selection bias to perform the laparoscopic route. All data were collected from the EVEREG database and analyzed with Excel. The literature review is carried out in Pubmed and Cochrane. Results: The laparoscopic access be much better to use but it has nothing to do with the size of the defect of one and another population, which required various techniques of separation and/or reconstruction of the abdominal wall housing the prosthetic reinforcement extraperitoneal and without using it as a "bridge". Thus, in addition to the studies offering the results for small defects, it is added that there is a wide variety of techniques not specified in most of the analyzes and that further heterogenic the results. Conclusion: The implementation of laparoscopic surgery requires an indication guide according to sizes and what technique to perform in this way.

ResumenObjetivoValoración de las posibles ventajas del neumoperitoneo preoperatorio en el manejo de las hernias inguinales gigantes.Material y métodosEstudio prospectivo mediante el seguimiento de 2 casos clínicos de hernias inguinoescrotales gigantes que requirieron neumoperitoneo preoperatorio en nuestro centro, desde octubre de 2013 hasta marzo de 2014.ResultadosDurante los últimos 5 meses, en nuestro centro se han diagnosticado 2 hernias inguinoescrotales gigantes candidatas a neumoperitoneo preoperatorio. Se trataba de 2 varones con una edad media de 60.5 años (55-66). Ninguno presentaba clínica relevante, y acudieron a consultas externas derivados por otros especialistas. En uno de los pacientes la hernia era bilateral, y en el otro, unilateral. Como prueba de imagen preoperatoria se realizó una tomografía computarizada en ambos casos.Los pacientes ingresaron una semana antes de la intervención (rango: 6-8 días) para efectuar un neumoperitoneo preoperatorio mediante la colocación de aguja de Verres, con insuflación diaria de aire ambiente (entre 240-1 000cc).En ambos casos se realizó como técnica de reparación una hernioplastia con abordaje posterior preperitoneal mediante laparotomía media. Destacó el íleo paralítico como complicación inmediata (2-4 días). La estancia media posoperatoria fue de 17.5 días (15-20 días). Se realizó un mes de seguimiento posquirúrgico, sin que se evidenciaran complicaciones. Únicamente habría que destacar la falta de reducción de tamaño de la bolsa escrotal.ConclusionesEl neumoperitoneo progresivo preoperatorio favorece la reparación de hernias inguinoescrotales gigantes con pérdida de derecho a domicilio. Se trata de un procedimiento seguro y reproducible, con bajo índice de complicaciones y alta tolerabilidad por parte del paciente.AbstractObjectiveTo assess the potential benefits of preoperative pneumoperitoneum in the management of giant inguinal hernias.Material and methodsProspective study using follow-up of two cases of giant hernias inguinoscrotal requiring preoperative pneumoperitoneum in our center from October 2013 to March 2014.ResultsDuring the last 5 months have been diagnosed two subsidiaries of giant hernias inguinoscrotal preoperative pneumoperitoneum in our center. These were 2 men with a mean age of 60.5 (55-66). None had clinically relevant and attended outpatients referred by other specialists. In one patient the hernia was bilateral and the other unilateral. As evidence of preoperative imaging in both cases computed tomography was performed.Patients admitted a week before surgery (range 6-8 days) to perform preoperative pneumoperitoneum by Verres needle placement with daily blow ambient air (between 240-1 000cc).It was performed as a repair technique in the 2 cases with preperitoneal hernioplasty posterior approach through a midline laparotomy. Highlight ileus as immediate complication (2-4 days). The mean postoperative hospital stay was 17.5 days (15-20 days). One month postoperative follow-up was performed with no evidence of complications, only underline the lack of reduction in size of the scrotum.ConclusionsProgressive preoperative pneumoperitoneum favors repairing giants hernias inguinoscrotal loss right at home. It is a safe and reproducible procedure with a low complication rate and high tolerability by the patient.