Redução de hérnia escrotal com protusão de omento em um cão / Reducing escrotal hernia with oment protusion in dog

Hérnia é uma protrusão de vísceras através de um orifício adquirido, tendo como constituintes o anel, conteúdo e saco herniário. As hérnias escrotais ocorrem quando, por algum defeito no anel inguinal, alguma víscera se desloca por ele, chegando até a bolsa escrotal. Sua etiologia não é completamenteelucidada, sendo a elevação da pressão intra-abdominal um dos prováveis desencadeadores. Em caninos, essa é uma condição rara e os poucos relatos citam em animais jovens. Objetivou-se descrever a ocorrência de uma hérnia escrotal unilateral esquerda com protrusão de omento maior em um cão da raça Dachshund com 14 anos de idade e com 12,1 kg de peso corporal. Para a redução do conteúdo à cavidade abdominal, foi necessária a realização de incisão na região inguinal cranial, abertura do saco herniário e a orquiectomia. Destaca-se a importância do tratamento cirúrgico da hérnia escrotal, bem como a inclusão dessa afecção no diagnóstico diferencial para afecções testiculares de cães adultos ou idosos.

Hernia is a protrusion of viscera through an acquired orifice, having as constituents the ring, contents and hernial sac. Scrotal hernias occur when, due to a defect in the inguinal ring, some viscera travel through it, reaching the scrotum. Its etiology is not completely elucidated, and the increase in intra-abdominal pressure is one of the probable triggers. In canines, this is a rare condition and the few reports mention it in young animals. The objective was to describe the occurrence of a left unilateral scrotal hernia with protrusion of the greater omentum in a 14-year-old Dachshund dog weighing 12.1 kg of body weight. To reduce the content of the abdominal cavity, it was necessary to make an incision in the cranial inguinal region, open the hernial sac and orchiectomy. The importance of surgical treatment of scrotal hernia is highlighted, as well as the inclusion of this condition in the differential diagnosis for testicular disorders of adult or elderly dogs.

Redução de hérnia escrotal com protusão de omento em um cão / Reducing escrotal hernia with oment protusion in dog

Hérnia é uma protrusão de vísceras através de um orifício adquirido, tendo como constituintes o anel, conteúdo e saco herniário. As hérnias escrotais ocorrem quando, por algum defeito no anel inguinal, alguma víscera se desloca por ele, chegando até a bolsa escrotal. Sua etiologia não é completamenteelucidada, sendo a elevação da pressão intra-abdominal um dos prováveis desencadeadores. Em caninos, essa é uma condição rara e os poucos relatos citam em animais jovens. Objetivou-se descrever a ocorrência de uma hérnia escrotal unilateral esquerda com protrusão de omento maior em um cão da raça Dachshund com 14 anos de idade e com 12,1 kg de peso corporal. Para a redução do conteúdo à cavidade abdominal, foi necessária a realização de incisão na região inguinal cranial, abertura do saco herniário e a orquiectomia. Destaca-se a importância do tratamento cirúrgico da hérnia escrotal, bem como a inclusão dessa afecção no diagnóstico diferencial para afecções testiculares de cães adultos ou idosos.

Hernia is a protrusion of viscera through an acquired orifice, having as constituents the ring, contents and hernial sac. Scrotal hernias occur when, due to a defect in the inguinal ring, some viscera travel through it, reaching the scrotum. Its etiology is not completely elucidated, and the increase in intra-abdominal pressure is one of the probable triggers. In canines, this is a rare condition and the few reports mention it in young animals. The objective was to describe the occurrence of a left unilateral scrotal hernia with protrusion of the greater omentum in a 14-year-old Dachshund dog weighing 12.1 kg of body weight. To reduce the content of the abdominal cavity, it was necessary to make an incision in the cranial inguinal region, open the hernial sac and orchiectomy. The importance of surgical treatment of scrotal hernia is highlighted, as well as the inclusion of this condition in the differential diagnosis for testicular disorders of adult or elderly dogs.

Factores asociados a las complicaciones de la cirugía electiva de las hernias inguinales / Factors associated with the complications of elective surgery of inguinal hernias

Introducción: La hernia inguinal es una de las enfermedades que más comúnmente requiere tratamiento operatorio y representa entre el 10- 15 por ciento de todas las intervenciones programadas. El porcentaje de complicaciones posoperatorias es de 5- 10 por ciento y aunque no son totalmente evitables, deben conocerse sus posibles causas para lograr reducir su incidencia. Objetivo: Identificar los factores asociados a las complicaciones de la cirugía electiva de las hernias inguinales. Métodos: Se realizó un estudio observacional y descriptivo, de una serie de 246 pacientes operados de hernias inguinales mediante cirugía electiva en el servicio de Cirugía General del Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba durante el bienio 2016-2017. Resultados: Se constataron 18 complicaciones (7,3 por ciento). Predominó el grupo etario de 51 a 70 años (47,8 por ciento) y el sexo masculino sobre las féminas con razón de 15,4:1. El estado físico preoperatorio fue clasificado ASA 1 en 183 pacientes (74,4 por ciento) y ASA 2 en 62 (25,2 por ciento). El 72,2 por ciento de los complicados tenían al menos una enfermedad asociada. El tipo 2 según clasificación de Nyhus prevaleció con 73 (29,7 por ciento) y 8 (44,4 por ciento) de los complicados. Conclusiones: Los factores referentes a la edad mayor de 50 años, sexo masculino, antecedentes de hipertensión arterial y diabetes mellitus, y hernias tipo II según la clasificación de Nyhus se asocian a la presentación de complicaciones agudas (edema del cordón espermático e infección del sitio operatorio) y crónicas (recidiva y granuloma) de la cirugía electiva de las hernias inguinales(AU)

Introduction: Inguinal hernia is a common surgical treatment illness and represents 10-15 percent of the programmed surgery. The postoperative complications records are 5-10 percent, although they are not avoidable, it is mandatory to know the possible causes to decrease the incidence rate. Objective: To identify the associated factors on the complications of elective inguinal hernia surgery. Methods: An observational and descriptive study of a series of 246 patients operated on elective inguinal hernia surgery in the General Surgery Service of "Saturnino Lora" Hospital of Santiago de Cuba during the years 2016-2017. Results: There were 18 complications (7,3 percent) of the sample. The age group of 51 to 70 years (47,8 percent) predominated and the male sex over females with a ratio of 15,4:1. Preoperative physical state was classified ASA 1 in 183 patients (74,4 percent) and ASA 2 in 62 (25,2 percent). 72,2 percent of the complicated patients had at least one associated disease. Type 2 according to Nyhus classification prevailed with 73 (29,7 percent) patients of the sample, and eight (44,4 percent) of complicated patients. Conclusions: Associated factors on acute and chronic complications of elective inguinal hernia surgery related to age, sex, associated illness, preoperative physical state and type of hernia according to Nyhus classification do not differ from that reported by the national and foreign literature(AU)

Complicaciones posquirúrgicas de las hernias inguinales / Post-surgical complications of inguinal hernias

RESUMEN Introducción: La hernia inguinal es una de las enfermedades más frecuentes y que con mayor número de modificaciones técnicas opera el cirujano general. El porcentaje de complicaciones internacionalmente aceptado oscila entre 5 y 10 por ciento. Objetivo: Identificar las complicaciones en la cirugía electiva de las hernias inguinales. Métodos: Se realizó un estudio observacional y descriptivo, de una serie de 246 pacientes, operados mediante cirugía electiva de las hernias inguinales en el Servicio de Cirugía General del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba durante los años 2016-2017. Resultados: Se constataron 18 complicaciones (7,3 por ciento) de la muestra. El tipo 2 según la clasificación de Nyhus prevaleció con 73 (29,7 por ciento) enfermos para el total, y ocho (44,4 por ciento) de los complicados. Las operaciones efectuadas fueron abiertas, entre las cuales primaron las tisulares de sobrecapas fasciales (Goderich) con 111 (45,1 por ciento) y las protésicas (Lichtenstein) con 85 (34,5 por ciento). Se presentaron complicaciones en 7 (38,8 por ciento) y 3 (16,6 por ciento) pacientes, respectivamente. El método anestésico más utilizado fue local con sedación en 171 (69,5 por ciento) y en 13 de ellos (72,3 por ciento) se produjeron complicaciones. El tiempo quirúrgico predominante fue de 30 minutos a una hora en 156 enfermos (63,4 por ciento), donde se registraron 10 complicados (55,5 por ciento). Del total de operaciones, el 96,7 por ciento fueron ambulatorias (238 pacientes). El 85,7 por ciento de los casos fueron intervenidos por residentes, grupo que aportó el 94,5 por ciento de las complicaciones diagnosticadas. Conclusiones: Las características de la población de enfermos aquejados de complicaciones posquirúrgicas de las hernias inguinales, referentes a tipo 2 de hernia según Nyhus y presencia de recidiva a largo plazo no difieren de lo reportado por la bibliografía nacional y extranjera(AU)

ABSTRACT Introduction: Inguinal hernia is one of the most frequent illness and with a great number of technical modifications that were operated by the general surgeon. The complications percentage internationally accepted oscillated between 5 and 10 percent. Objective: To identify the complications in the elective surgery of inguinal hernias. Methods: an observational and descriptive study of a series of 246 patients was performed on the complications of elective inguinal hernia surgery in the General Surgery Service of the Provincial Teaching Hospital Saturnino Lora of Santiago de Cuba during the years 2016 -2017. Results: There were 18 complications (7.3 percent) of the sample. Type 2 according to Nyhus classification prevailed with 73 (29.7 percent) patients of the sample, and eight (44.4 percent) of complicated patients; the operations carried out were open, among which the fascial overlayer tissue prevailed (Goderich) with 111 (45.1 percent) and the prosthetic (Lichtenstein) with 85 (34.5 percent). Complications occurred in 7 (38.8 percent) and 3 (16.6 percent) patients, respectively. The most used anaesthetic method was local with sedation in 171 (69.5 percent) and in 13 of them (72.3 percent) there were complications. The predominant surgical time was 30 minutes to one hour in 156 patients (63.4 percent), where 10 complications were recorded (55.5 percent). Of the total operations, 96.7 percent were ambulatory (238 patients). There were operated on 85.7 percent of the cases by residents, a group that contributed 94.5 percent of the complications diagnosed. Conclusions: The characteristics of patients suffering from acute and chronic complications of elective inguinal hernia surgery, related to Type 2 according to Nyhus classification, the open operations carried out, the anaesthetic method employed, surgical time, ambulatory surgery and surgeon level, do not differ from that reported by the national and foreign literature(AU)

Herniorrafia de Mohan P. Desarda modificada en la reparación de hernia inguinal sin prótesis / Modified Mohan P. Desarda herniorraphy in inguinal hernia repair with no prosthesis

Introducción: La afección herniaria es uno de los procesos mejor estudiados y cuyo tratamiento persigue la excelencia, aunque todavía quedan muchas controversias por resolver. Objetivo: Valorar los resultados de la aplicación de la técnica del Dr. Mohan P. Desarda modificada en el Servicio de Cirugía del Hospital General Docente Enrique Cabrera. Métodos: Se realizó un estudio prospectivo aleatorio de 1 010 pacientes intervenidos quirúrgicamente con el diagnóstico de hernia inguinal desde enero del 2004 hasta diciembre del 2017. A estos pacientes se les realizó la técnica quirúrgica del Dr. Mohan P. Desarda modificada, los cuales fueron evolucionados por consulta externa y finalmente por teléfono. Resultados: La mayor incidencia ocurrió en el sexo masculino con 915 (90,6 por ciento) pacientes y la edad promedio fue de 58,3 años. La localización más frecuente fue la derecha en 497 (49,0 por ciento) pacientes. Se aplicó la anestesia local a 690 (68,3 por ciento) pacientes. Se trataron de manera ambulatoria 783 (77,4 por ciento) pacientes. En 46 (34,5 por ciento) pacientes se diagnosticaron complicaciones. La recidiva se observó en 6 pacientes (0,6 por ciento) del total. Conclusiones: Con la herniorrafia de Mohan P. Desarda modificada, se obtienen resultados satisfactorios al igual que con las técnicas protésicas, aportando ahorros económicos importantes(AU)

Introduction: Hernia is one of the best studied processes in order to achieve treatment of excellence, but there are still many pending controversies to be solved. Objective: To determine the results of the modified Mohan P. Desarda technique in the surgical service of Enrique Cabrera general teaching hospital. Method: A prospective randomized study was performed on 1010 surgical patients with the diagnosis of inguinal hernia from January 2004 to December 2017. These patients were operated on by using modified Dr Mohan P. Desarda's technique and they were followed up in the outpatient service and finally by phone. Results: The highest incidence rate was found in males, with 915 (90.6 percent) patients and the average age was 58.3 years. The most common location was on the right side of 497 (49 percent) patients. Local anesthesia was used in 690 (68.3 percent) patients and 783 (77.4 percent) were treated as outpatients. Forty six (34.5 percent) patients suffered complications. Recurrence occurred in 6 patients, which accounted for 0.6 percent of the total number. Conclusions: Modified Mohan P. Desarda herniorraphy achieves satisfactory results as well as the other prosthetic techniques, thus contributing important economic savings(AU)

Impact of obesity and surgical skills in laparoscopic totally extraperitoneal hernioplasty / Impacto da obesidade e habilidades cirúrgicas na hernioplastia laparoscópica totalmente extraperitoneal

ABSTRACT Background: Laparoscopic totally extraperitoneal (TEP) hernia repair is a technically demanding procedure. Recent studies have identified BMI as an independent factor for technical difficulty in the learning period. Aim: To analyze the effect of overweight and obesity on the technical difficulties of TEP. Method: Prospective study on patients who underwent a symptomatic inguinal hernia by means of the TEP technique. Were analyzed gender, BMI, previous surgery, hernia type, operative time and complications. Technical difficulty was defined by operative time, major complications and recurrence. Patients were classified into four groups: 1) underweight, if less than 18,5 kg/m²; 2) normal range if BMI between 18,5 and 24,9 kg/m²; 3) overweight if BMI between 25-29,9 kg/m²; and 4) obese if BMI≥30 kg/m². Results: The cohort had a total of 190 patients, 185 men and 5 women. BMI values ranged from 16-36 kg/m² (average 26 kg/m²). Average operating time was 55.4 min in bilateral hernia (15-150) and 37.8 min in unilateral (13-150). Time of surgery was statistically correlated with increased BMI in the first 93 patients (p=0.049). Conclusion: High BMI and prolonged operative time are undoubtedly correlated. However, this relationship may be statistically significant only in the learning period. Although several clinical features can influence surgical time, upon reaching an experienced level, surgeons appear to easily handle the challenges.

RESUMO Racional: A hernioplastia laparoscópica totalmente extraperitoneal (TEP) é procedimento tecnicamente exigente. Estudos recentes identificaram o IMC como um fator independente para a dificuldade técnica durante o período de aprendizagem. Objetivo: Analisar o efeito do sobrepeso e da obesidade sobre as dificuldades técnicas na TEP. Método: Estudo prospectivo em pacientes submetidos à hernioplastia inguinal sintomática por meio da TEP. Foram analisados gênero, IMC, operação prévia, tipo de hérnia, tempo operatório e presença de complicações. A dificuldade técnica foi definida pelo tempo operatório, complicações maiores e recorrência. Os pacientes foram classificados em quatro grupos: 1) baixo peso, se menor que 18,5 kg/m²; 2) peso normal se IMC entre 18,5 e 24,9 kg/m²; 3) sobrepeso se IMC entre 25 e 29,9 kg/m²; e 4) obesos se IMC≥30 kg/m². Resultados: A coorte incluiu 190 pacientes, 185 homens e cinco mulheres. Os valores de IMC variaram de 16-36 kg/m² (média de 26 kg/m²). O tempo médio de operação foi de 55,4 min nas hérnias bilaterais (15-150) e 37,8 min nas unilaterais (13-150). O tempo cirúrgico foi estatisticamente correlacionado com o aumento do IMC nos primeiros 93 pacientes (p=0,049). Conclusão: IMC elevado e tempo operatório prolongado estão indubitavelmente correlacionados. No entanto, esta relação pode ser estatisticamente significativa apenas no período de aprendizagem. Embora várias características clínicas possam influenciar o tempo cirúrgico, ao chegar a um nível experiente, os cirurgiões parecem lidar facilmente com os desafios.

Internal inguinal ring closure by laparoscopy using homologous pericardium grafts in horses / Oclusão do anel vaginal em equinos utilizando enxerto de pericárdio homólogo fixado por laparoscopia

ABSTRACT: The occlusion of inguinal ring is the treatment to avoid the inguinal hernia in horses. The aim of this study is evaluate the efficacy of homologous pericardium grafts for internal inguinal ring closure in horses, comparing mechanical or manual laparoscopic suture. Cross over study, using six healthy intact male Mangalarga breed horses aged between 3 and 12 years. Horses were operated under general anesthesia in 25º Trendelenburg position. Five laparoscopic portals were employed. Pericardium grafts measuring 4x5cm were anchored covering the left and right internal inguinal rings using either manual intracorporeal suture or laparoscopic stapler. Horses were followed-up during 11 weeks when were submitted to a laparoscopic control. Surgical time, trans and postoperative complications and effectiveness of internal inguinal closure were evaluated and statistically analyzed. The level of significance was set at 5% P<0.05. The procedures were realized without complications and the mean time required for manual and mechanical suture procedures differed significantly (67.8±15.3 and 14.1±2.1 min respectively; P<0.05). All manually sutured grafts remained in place and partial suture dehiscence with incomplete occlusion of the internal inguinal ring was observed in two stapled grafts. Non-severe complications were observed trans or postoperatively. One synechiae and three omental adhesions were observed by laparoscopic control on day 77, but without clinical relevance in the evaluated period. The use of homologous pericardium grafts was effectiveness to internal inguinal ring closure by laparoscopy. Mechanical suture was faster to perform than manual, but provided less satisfactory results concerning safety of graft fixation.

RESUMO: A oclusão dos anéis inguinais é o tratamento indicado para evitar as hérnias inguinais comumente observadas nos equinos. O objetivo do trabalho é avaliar a eficácia do uso de enxerto de pericárdio homólogo para recobrimento do anel inguinal interno de equinos, fixado por laparoscopia, comparando a sutura manual e mecânica. Para tanto, foram utilizados seis equinos machos não castrados da raça Mangalarga com idade entre 3 e 12 anos. Os cavalos foram operados sob anestesia geral em posição de Trendelenburg com inclinação de 25º. Cinco portais laparoscópicos foram empregados. Enxertos de pericárdio homólogo, medindo 4X5cm, foram ancorados recobrindo os anéis inguinais internos esquerdo e direito, sendo em um dos lados fixado com sutura manual intracorpórea e o contralateral fixado com grampos, escolhidos por sorteio previamente ao procedimento, distribuído equitativamente. Os cavalos foram acompanhados por 11 semanas do período pós-operatório. O tempo cirúrgico, eventuais complicações trans ou pós-operatórias e a efetividade do procedimento foram avaliados e analisados estatisticamente com nível de significância de 5% P<0,05. Os procedimentos foram realizados sem complicações, com tempo médio requerido para realização da sutura manual e com grampos de 67,8±15,3 e 14,1±2,1 minutos, respectivamente, havendo diferença significativa P<0,05. Todos os implantes suturados manualmente levaram à oclusão do anel inguinal profundo, enquanto houve deiscência parcial da sutura, com incompleta oclusão do anel, em dois dos seis implantes fixados por sutura mecânica, na avaliação aos 77 dias. Não ocorreram complicações significativas no período trans ou pós-operatório, sendo observada a presença de uma sinéquia e três aderências de omento durante laparoscopia de controle aos 77 dias, porém sem relevância clínica no período estudado. O uso de pericárdio homólogo foi efetivo para oclusão do anel vaginal em equinos por laparoscopia. A sutura mecânica foi realizada em menor tempo, quando comparada à sutura manual, porém propiciou resultado menos satisfatório no que diz respeito à segurança da técnica para fixação do enxerto.

Application value of initiative content reduction surgery in the prevention and treatment of postoperative intra-abdominal hypertension of obese patients with giant ventral hernia / 中华消化外科杂志

Objective To investigate the clinical effect of initiative content reduction surgery in the herniorraphy on the prevention and treatment of postoperative intra-abdominal hypertension of obese patients with giant ventral hernia.Methods The retrospective cross-sectional study was adopted.The clinical data of 62 obese patients with giant ventral hernias who were admitted to the Chao-Yang Hospital of Capital Medical University from January 2011 to December 2015 were collected.The initiative content reduction surgery was adopted during the herniorraphy of ventral hemia.Observation indices:(1) surgery situations:operation time,length of resected intestines,volume of intraoperative blood loss.(2) Postoperative recovery situations:change between preoperative and postoperative urethral bladder pressure,organ function of heart,lung,liver and kidney,time of gastrointestinal function recovery,time of drainage tube removal and duration of postoperative hospital stay.(3) Postoperative complications:incisional infection and intestinal fistula.(4) Follow-up situations.Follow-up using outpatient examination at 1 week,1 month,3 months and 6 months after surgery and using telephone interview at postoperative year 1 was conducted up to June 2016.The follow-up included hernia recurrence and chronic infection.Measurement data with normal distribution were represented as x ± s.Measurement data with skewed distribution were represented as M (range) and analyzed by rank-sum test.Results (1) Surgery situations:all the 62 patients received successful herniorraphy of giant ventral hemia combined with initiative content reduction surgery.Operation time,length of resected intestines and volume of intraoperative blood loss were (115 ±22)minutes,(207 ± 64)cm and (52 ± 35)mL.(2) Postoperative recovery situations:the preoperative urethral bladder pressure was 18 cmH2O (range,15-22 cmH2O,1 cmH2O =0.098 kPa) and postoperative urethral bladder pressure was 8 cmH2O (range,6-11 cmH2O),with a significantly statistical difference between before and after surgery (Z =-9.662,P ＜ 0.05).There was no abnormal function of heart,lung,liver and kidney after operation.The time of gastrointestinal function recovery,time of drainage tube removal and duration of postoperative hospital stay were 3.8 days (range,3.0-6.0) days,(3.8 ± 1.1) days and (14.5 ± 1.9) days.(3)Postoperative complications:of 62 patients,4 were complicated with incisional infection and improved after symptomatic treatment.There was no intestinal fistula.(4) Follow-up situations:all the 62 patients were followed up for (36 ± 19) months.During the follow-up,3 patients had incisional hernia recurrence and then were followed up without reoperation.No chronic infection occurred.Conclusion Initiative content reduction surgery is effective and feasible in the prevention and treatment of intraoperative intra-abdominal hypertension of obese patients with giant ventral hernia.

Experiencia cubana en el uso de la malla Laparomesh / Cuban experience in the Laparomesh mesh use

Introducción: las hernias incisionales constituyen un problema que diariamente enfrentan los cirujanos. Las técnicas protésicas ofrecen múltiples formas de resolverlas y prevenirlas. Objetivo: interpretar los beneficios de la malla Laparomesh en la reparación y prevención de las hernias incisionales. Métodos: se realizó un estudio observacional, descriptivo, longitudinal y prospectivo en 37 pacientes intervenidos en los hospitales universitarios Comandante Manuel Fajardo de La Habana y Juan Bruno Sayas de Santiago de Cuba, de noviembre de 2008 a junio de 2013, con hernias múltiples de la línea media o riesgo de desarrollar hernias incisionales, a los cuales se les realizó hernioplastia con la malla Laparomesh. Resultados: la media de edad fue 46 años y predominó el sexo masculino. Se utilizó la anestesia espinal o general y cefazolina como profilaxis antibiótica. Conclusiones: no existieron hasta el momento manifestaciones de rechazo al material protésico, ni complicaciones inmediatas. No recidiva herniaria con seguimiento promedio de 36 meses(AU)

Introduction: incisional hernias are a regular problem faced by the surgeon where prosthetic techniques provide many choices for solution and prevention. Objective: to show the advantages of the Laparomesh mesh for the prevention and repair of incisional hernia. Methods: an observational, descriptive, longitudinal and prospective study was conducted in 37 patients who had been operated on in Manuel Fajardo and Juan Bruno Sayas teaching hospitals in Havana and Santiago de Cuba, respectively, from November 2008 to June 2013. They had midline incisional hernias or were at risk of developing them, so they underwent hernioplasty with Laparomesh mesh. Results: the average age was 46 and males prevailed. Spinal or general anesthesia was used as well as prophylaxis with cefazolin. Conclusions: there have been no manifestations of rejection to the prosthetic material up to now. Neither immediate complications norhernial recurrence have been so far observed with an average follow-up of 36 months(AU)

Aspectos clínicos y quirúrgicos de las hernias incisionales complejas / Clinical and surgical aspects of the complex incisional hernias

El diagnóstico y tratamiento de las hernias incisionales complejas constituye un tema obligado para todos los cirujanos, cuyo desafío es prevenir las complicaciones y disminuir las recurrencias, lo que justifica la realización de este estudio con el objetivo de identificar sus aspectos clínicos y quirúrgicos más relevantes. Métodos: se realizó un estudio observacional, descriptivo de serie de casos correspondiente a 320 pacientes operados electivos por hernias incisionales complejas en el servicio de cirugía del Hospital Universitario Dr Juan B Zayas de Santiago de Cuba durante 15 años (1994-2009). Resultados: predominó el sexo femenino y el grupo etario de 31 a 60 años. Las hernias suprapúbicas fueron las más frecuentes en ambos sexos; en mujeres con intervenciones ginecológicas previas y en hombres, prostáticas. El neumoperitoneo progresivo preoperatorio y la antibioticoterapia profiláctica se aplicaron a todos los pacientes. Las técnicas quirúrgicas más utilizadas fueron las de Jean Rives y Robert Bendavid y la bioprótesis de polipropileno. Índice de recurrencia de 6,5 por ciento con predominio del sexo masculino. El tiempo quirúrgico fluctuó de 1 a 2 horas y la estadía hospitalaria entre 1 y 3 días. Fallecieron 4 pacientes, el 1,3 por ciento de la serie. Conclusiones: el único tratamiento efectivo para las hernias incisionales complejas radica en la técnica quirúrgica sin tensión con aplicación correcta de la bioprótesis indicada y su fijación con la sutura de su mismo material, por lo que se recomienda la protocolización y clasificación de estas hernias para unificar criterios con respecto a su diagnóstico y tratamiento(AU)

Diagnosis and treatment of complex incisional hermias is a compulsory topic for all surgeons. The challenge ahead is to prevent complications and to reduce relapses, which warrants the conduction of a study with the objective of identifying their most relevant clinical and surgical aspects. Methods: Observational and descriptive study of a case series involving 320 patients operated on from complex incisional hernias at the surgery service of Dr Juan B Zayas university hospital in Santiago de Cuba during 15 years (1994-2009). Results: Females and 31-60 years age group predominated. The suprapubic hernias were the most frequent in both sexes; in females who underwent previous gynecological interventions and in men who underwent prosthatic procedures. Preoperative progressive pneumoperitoneum and prophylactic antibiotic therapy were applied to all patients. The most used surgical techniques were Jean Rives' and Robert Bendavid's and the polypropylene bioprothesis. The relapse index was 6.5 percent and males predominated. The surgical time ranged 1 to 2 hours and the stay at hospital lasted one to 3 days. Four patients died, which accounted for 1.3 percent of the case series. Conclusions: The only effective treatment for complex incisional hernias lies in non-tensile surgical technique with correct application of the indicated bioprothesis and its fixing with a suture of the same material, so protocoling and classification of these hernias are recommended in order to unify criteria with respect to their diagnosis and treatment(AU)

Repair of umbilical hernia using three methods in adult / 国际外科学杂志

Objective To evaluate the outcomes of umbilical hernia repairing in adults.Methods Forty-nine cases of umbilical hernia admitted between 2003 and 2008 were analyzed retrospectively.Opera-tive techniques included traditional repair (n = 14),Kugel patch (n = 21) and mesh plug-patch (n = 14).Results The operative time of traditional repair was shorter than those for patients who underwent Kugel patch hernioplasty or mesh plug-patch hemiorrhaphy.But the pain was significantly higher.With a follow-up of 1 -6 years,whereas no recurrence was documented for the tension-free hemiorraphy,but a case recurred for traditional repair.Conclusion Tension-free hemiorraphy is a safe,efficacious and lower complications technique for the repair of umbilical hernia.

Spinal Anesthesia for a Formerly Premature Infant with Unilateral Vocal Cord Paralysis Undergoing Inguinal Herniorrhaphy: A case report / 대한마취과학회지

In premature infants, the incidence of inguinal hernia has been reported to be 14-30%. It is generally accepted that inguinal hernia should be repaired as soon as possible, as the incidence of incarceration is higher in infant than in children. However, the risk of life-threatening apnea after surgery is significant in this age group. Spinal anesthesia in premature infants offer a safe alternative to general anesthesia, especially if intubation should be avoid because of coexisting disease. We present a case of successful spinal anesthesia for inguinal herniorraphy in a premature female infant at a postconceptual age 44 + 6 weeks weighing 2,620 g with coexisting unilateral vocal cord paralysis to illustrate technical details and feasibility of this technique even in very low birth weight (birth weight < 1,500 g) infants.

The Comparative Analysis between Laparoscopic Inguinal Herniorrhaphy and Open Inguinal Herniorrhaphy

PURPOSE: Published evidence comparing laparoscopic and open herniorraphy is contraversial. Laparoscopic surgery has became or is being tried as a standard in most of abdominal surgery due to its advantages. But disadvantages of laparoscopic surgery include the need for general anethesia, a problem particularly in over increasingly aged population, limit its more use. This study aimed to investigate the availability and indication of both laparoscopic and open herniorraphy. METHODS: The records and data of 85 inguinal hernia patients who underwent laparoscopic herniorrhaphy (n=20) or open herniorrhaphy (n=65), with similiar sex and age distribution, were retrospectively analyzed. Laparoscopic herniorrhaphy equated to totallly extraperitoneal approach (TEP) repair and open herniorrhaphy to Bassini repair and Lichtenstein repair. As statistical method, the one way Anova Tests and Post Hoc Tests was used. RESULTS: There was no significant difference noted between the groups in relation to sex, age, site, complication rate, or recurrence rate in both group. The laparoscopic group has a shorter mean postoperative hospital day than open group. However there was no statistical significance. Postoperative analgesic administration is significantly decreased in mesh applied group. CONCLUSION: The advantages of laparoscopic herniorrhaphy is not revealed in all patients. Indications for laparoscopic herniorrhaphy are being restricted to recurrent, bilateral hernia. Patient selection has been stepped up. Thus elderly patients and patients with significant morbidity who may well require monitoring after procedure are being advised to undergo open tension free repair with local anethesia. These recommendation apply similarly young patients with small, simple primary defects. After studying more cases, a reevaluation must be done concerning the advantage of both laparoscopic and open herniorraphy.

Herniorrafia umbilical em bovinos - Análise de técnicas e sua avaliação pós-operatória / Bovine umbilical herniorraphy - Technical analysis and postoperatory evaluation

Visando aprimorar o tratamento cirúrgico de hérnias umbilicais em bovinos, utilizaram-se 32 animais das raças Holandesa P.B., Girolanda, Gir, Limousin, Simental e Nelore, machos e fêmeas, com idade variando entre quatro e doze meses, portadores de hérnia umbilical recidivada. Como condição para participar do estudo, estabeleceu-se que cada bovino apresentasse até três recidivas. Os animais foram divididos em dois grupos de 16, sendo que o Grupo I foi submetido à laparorrafia pelo método de sutura em jaquetão, com pontos de reforço, ao passo que nos animais do Grupo II utilizou-se o método de sutura em pontos simples, separados e interrompidos, alternados com pontos de relaxamento. Dos 16 bovinos estudados no Grupo I, cinco (31,25 por cento) recuperaram-se, sendo que os outros 11 (68,75 por cento) sofreram recidivas. No Grupo II, 12 (75 por cento) dos bovinos estudados recuperaram-se, enquanto que os quatro animais (25 por cento) restantes sofreram recidivas. A análise estatística pelo teste do Qui-quadrado revelou diferença significativa entre as técnicas de sutura na herniorrafia umbilical em bovinos, apontando a técnica de sutura em pontos simples, separados e interrompidos, alternados com pontos de relaxamento, como a mais eficiente, quando comparada à sutura em jaquetão, com pontos de reforço, neste tipo de intervenção cirúrgica.

Comparison of the effect of various herniorraphy in inguinal hernia / 中国普通外科杂志

Objective To evaluate the effect of various herniorraphy in treating inguinal hernia. Methods The clinical data of 108 patients who underwent conventional Bassini herniorraphy (BH), tension free herniorraphy (TH), or laparoscopic herniorraphy (LH),respectively were analysed and comparated. Results The operation time in TH was less than that in BH, and in LH was longer than that in TH. The ability recovery, hospita stay and postoperative complication in TH and LH were less than those in BH.All the patients were followed up for at least 1 year.Of them, 1 recurred after BH, but there was no recurrence after TH and LH. The blood neutrophils, serum level of fibrin, C-reactive protein and alpha-1 antitrypsin increased significantly in the patients undergoing herniorraphy, which were significantly higher in the patients underwent TH and LH. Conclusions The curative effect of TH and LH is much better than that of BH in treating ingumal hernia. Application of marlex for herniorraphy might increase inflammation response, but it will not increase the incidence of infection.

Three dimension with bilayer patch mesh in repairing inguinal hernia / 中国普通外科杂志

Objective To study the effect of appling a new tension-free three dimension with bilayer mesh herniorraphy(TFTDBMH) in treating inguinal hernia in order to decrease the compilcation and the recurrence rates after herniorraphy. Methods The clinical data of 47 male patients with ingular hernia treated by TFTDBMH were analyzed. All the 47 patients were males with an average age of sixty-five years old. There were 36 patients with indirect hernias and 11 direct hernias in this series. During operation, their inguinal regions were extensively dissected and the transverse fascias were separated from peritoneum after the hernia sacs were completely dissected to reach the hernia sac necks. The base layer of the belayed patch mesh was put into the space between the transverse fascia and the peritoneum, then the hernia sac was put into abdominal cavities. The upper layer of the bilyer patch mesh was saw up to the inguinal ligaments and the arcade inferior boarder,then a three - dimension structures were formed at the inguinal regions. Results After operation, all the patients had no any bad reaction. They could be out-of-bed activity on the first day after operation. They could be discharged on the third day after operation.All the patients were followed up for one to two years, these patients felt well,no scar formation on the operative area,and no recurrence postoperatively. Conclusions This operation could be applied for the patients with inguinal hernia and the inguinal posterior walls need to be repaired. This operation fits to the human body anatomy. The postoperative complication and postoperative recurrence rate are low.This operative procedure is more complicated. It request that the operators must have higher operative technique.

Optimum Concentration of Lidocaine in Pediatric Caudal Anesthesia for Inguinal Herniorraphy / 대한마취과학회지

To determine the best concentration of lidocaine for caudal anesthesia under supplementary general inhalation anesthesia via faee mask, 85 children aged 1 month to 12 years scheduled for inpatients or outpatients inguinal herniorraphy were randomiaed to receive caudal anesthesia with lidocaine in one of four concentrations(0.5, 0.75, 1.0 or 1.5%) mixing l: 200,000 epinephrine. After incision, gradual reduction in inspired halothane resulted, if tolerated by subject, in an inspired concentration of 0.5% at 10 minutes after incision. Percents of patients who received more than 0.5% of endtidal halothane concentration at hernia sac ligation were 30.0, 28.6, 16.7 and 20.0% in the subjeets receiving 0.5, 0.75, 1.0 and 1.5% lidocaine, respectively. There was no significant differences among groups in pain/discomfort scores and caudal effectiveness scores. A subject receiving 1.5 % lidocaine complained of leg weakness and another of retching. About ninety percents of all subjects could gain the analgesic levels at T dermatome although most of subjects receiving 0.5% lidocaine had the short duration less than 1 hour. Postoperative analgesic effects in the subjects receiving 1.0% lidocaine were superior to those receiving 0.5 and 0.75% solution. Although all concentrations were effective for combined general-caudal anesthesia in children, we conclude that 1.0% lidocaine offers the best combination of effectiveness, postoperative analgesia, adequate anesthetic levels and less complication for pediatric inguinal herniorraphy.