TPW 7.01 Sac Puncture and Pneumo-Dissection (SPPED) a Novel Technique for Safe and Efficient Diaphragmatic Hernia Sac Reduction"

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ID: 324092
2026
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Abstract
Abstract Aim This abstract and accompanying video describe a novel laparoscopic technique, Sac-Puncture and Pneumo-Dissection (SPPED), developed to achieve rapid and safe access to the optimal dissection plane for large diaphragmatic-hernia sacs. The technique utilizes pneumatic pressure to enable gentle separation of the hernia sac from surrounding mediastinal tissues. Methods A 65-year-old patient with recurrent gastric volvulus secondary to a large anterior diaphragmatic-hernia was treated using the SPPED technique. Patient in a split-leg position, one 11-mm supra-umbilical port and three 5-mm ports (one in the right-upper-quadrant and two in the left-upper-quadrant). Following partial reduction of the hernia contents, a superficial puncture was created in a safe area of the hernia sac. This puncture was gently enlarged to allow carbon dioxide to enter the extra-sac plane. Pneumatic pressure facilitated dissection of the sac, assisted by gentle traction applied at the puncture edge. This manoeuvre allowed progressive eversion of the sac into the abdominal cavity, enabling easy separation of the pleura from the peritoneal sac. The sac was subsequently detached from the hiatal ring with minimal effort in the appropriate dissection plane, minimizing trauma to diaphragmatic tissues. Mesh repair was performed following sac excision. Mediastinal drains were placed for 48h and mesh was used for hernia repair. The patient was discharged after 72 hours with no complication for 26 month follow up. Conclusion SPPED is a safe and efficient laparoscopic technique for large diaphragmatic hernia sac dissection, preserving diaphragmatic tissue, crus, and integrity of the perimysium while minimizing operative trauma and complications.
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Authors Samer Zino, Ruaridh Glancy, Wadah Mohamed, Roisin McKenna Favier
Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag087.371
URL
https://doi.org/10.1093/bjs/znag087.371
Keywords Keywords not found

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