ABSTRACT
A cirurgia de hérnia inguinal (HI) é um dos procedimentos mais comuns na prática do cirurgião geral. Estima-se que 20 milhões dessas operações sejam realizadas no mundo anualmente. Com o advento da técnica sem tensão e implante de tela sintética, as taxas de recidiva caíram expressivamente e a recidiva deixou de ser a principal complicação tardia após o reparo da hérnia inguinal. Hoje a principal complicação pós-operatória tardia da cirurgia de HI é a dor crônica inguinal pós-operatória (DCIP). A definição de DCIP é a dor pós-operatória da região inguinal após 3-6 meses da cirurgia. Relatamos o caso de um jovem paciente do sexo masculino que se apresentou com DCIP após ter sido previamente submetido a duas herniorrafias inguinais. Inicialmente apresentava dor inguinal a esquerda sem abaulamento evidente e na ocasião foi submetido a herniorrafia inguinal esquerda pela técnica de Lichtenstein. Não houve resolução da dor após a cirurgia. Após 1 ano foi novamente operado, dessa vez bilateralmente e infelizmente evoluiu com piora da dor apresentava dor predominantemente neuropática (em queimação e com irradiação para região testicular bilateralmente) e intensidade moderada (escala visual analógica 6), sem melhora com anti-inflamatórios não esteroidais ou analgésicos. Apresentava dor ao toque do anel inguinal externo bilateralmente, hiperestesia no teritório de nervos genito-femoral, ílio-hipogástrico e ílio-inguinal do lado esquerdo e hipoestesia no território dos três nervos do lado direito. Apresentou alívio temporário da dor após bloqueio anestésico inguinal bilateral. Paciente foi então submetido a triplo-neurectomia bilateral com remoção das telas de polipropileno. Em seguimento um ano após o tratamento cirúrgico, o paciente permanece sem dor inguinal. [au]
Inguinal hernia (IH) surgery is one of the most common procedures in the practice of the general surgeon. With adoption of tension-free technique and synthetic mesh implantation, recurrence rates decreased and recurrence is no longer the main late complication after IH repair. Currently, the main late postoperative complication of IH repair is chronic postoperative inguinal pain (CPIP). CPIP is defined as postoperative pain in the inguinal region persisting 3-6 months after surgery. We report the case of a young male patient who presented with CPIP after having undergone two inguinal hernia repairs. Initially, he had left inguinal pain without evident bulging and underwent left inguinal herniorrhaphy using the Lichtenstein technique. There was no relief of pain after surgery. After 1 year, he underwent surgery again, this time bilaterally and unfortunately the pain got worse. He had predominantly neuropathic pain (burning and irradiated to the testicular region bilaterally) and moderate intensity (visual analogue scale 6) refractory to medical management. He had hyperesthesia on the territory of the genitofemoral, iliohypogastric and ilioinguinal nerves on the left side and hypoesthesia in the territory of the three nerves on the right side. A local anesthetic inguinal block provided temporary relief. We performed a bilateral triple neurectomy with removal of the polypropylene mesh. Followed up one year after surgical treatment, the patient remains without inguinal pain. [au]
ABSTRACT
Abstract Purpose: Incisional hernia (IH) is a frequent complication of median laparotomy. The use of prophylactic mesh to reduce IH incidence has gained increasing attention. We hypothesized that in an animal model, linea alba prophylactic reinforcement with a three-dimensional T-shaped polypropylene mesh results in greater abdominal wall resistance. Methods: Study was performed in 27 rabbits. After abdominal midline incision, animals were divided into three groups according to the laparotomy closure method used: (1)3D T-shaped coated mesh; (2)3D T-shaped uncoated mesh; and (3) closure without mesh. After 4 months, each animal's abdominal wall was resected and tensiometric tests were applied. Results included IH occurrence, adhesions to the mesh, and wound complications. Results: There was no significant difference between the groups in maximum tensile strength (p=0.250) or abdominal wall elongation under maximum stress (p=0.839). One rabbit from the control group developed IH (p=1.00). Small intestine and colon adhesions occurred only in the uncoated mesh group (p<0.001) and the degree of adhesions was higher in this group compared to the coated mesh group (p<0.05). Conclusion: Use of the current 3D T-shaped prophylactic mesh model did not result in a significant difference in tensiometric measurements when compared with simple abdominal wall closure in rabbits.