ABSTRACT
Background: Incisional hernia is a common complication after laparotomy. Up to now, there is no consensus on the ideal surgical approach of such hernia. The aim of the present study was to compare the surgical outcomes, feasibility and cost effectiveness of the open mesh repair and laparoscopic repair of incisional hernia.Methods: A randomized controlled study conducted between August 2015 and September 2019 in which 64 patients with incisional hernias were randomly selected for either open mesh repair (36 patients) or laparoscopic repair (28 patients).Results: Patients in both groups were similar in their characteristics. The mean operative time was significantly longer in laparoscopic repair than in open mesh repair (128.6±15 minutes versus 89.8±82 minutes, p<0.05). The peri-operative complications and intra-operative blood loss were comparable in the two groups. The use of the drain was significantly higher in open group than in laparoscopic repair group (44.4% versus 10.7%). The overall rate of postoperative complications was similar in both groups, (25% for each group). The rate of wound infection and the length of hospitalization were significantly less in laparoscopic repair group. The results of postoperative pain score, cosmetic outcomes and recurrence rate showed no significant differences between the two groups but patient's satisfaction was significantly higher in laparoscopic repair. p>0.05.Conclusion: Both laparoscopic and conventional open mesh repair of incisional hernia are equivalent and feasible and safe technique. Laparoscopic repair was superior to open mesh repair in term of surgical site infection, hospital stay and patient’s satisfaction only.
ABSTRACT
Resumen ANTECEDENTES La extracción de un mioma, posterior a la resección laparoscópica, puede ser: directa, mediante colpotomía posterior, minilaparotomía, morcelación intraabdominal estándar o eléctrica. La mayor parte de estas opciones suele requerir la colocación de un trocar de 10-12 mm o la ampliación de la incisión en la piel y fascia para extraer el tejido; esto implica desventajas estéticas y clínicas, como el riesgo de hernias incisionales. CASOS CLÍNICOS Se comunican tres casos de pacientes con diagnóstico de miomatosis de grandes elementos (7 cm el menor y 15 cm el mayor) en los que posterior a la miomectomía por laparoscopia se extrae la pieza quirúrgica íntegra mediante colpotomía posterior, con evolución posquirúrgica favorable y sin síntomas concomitantes. CONCLUSIÓN La extracción transvaginal mediante colpotomía posterior es una alternativa segura y efectiva para retirar piezas quirúrgicas porque la elasticidad de la vagina permite extraer de forma segura piezas grandes, y evitar así el uso del morcelador y sus posibles riesgos. Además, se evita ampliar las incisiones abdominales, lo que implica menor dolor posoperatorio, recuperación más rápida y mejores resultados cosméticos. La vía vaginal es segura, con mínimo riesgo de complicaciones y con mejores resultados posquirúrgicos comparada con el resto de las opciones de cirugía laparoscópica.
Abstract BACKGROUND The extraction of the myoma after laparoscopic resection can be done by: direct extraction, standard intra-abdominal morcellation, electric morcellation, extraction by posterior colpotomy or by minilaparotomy. Most of these options generally require placement of a 10-12 mm trocar and / or enlargement of the skin incision and fascia for tissue removal; In addition to the aesthetic disadvantages, it represents clinical implications such as the risk of incisional hernias. CLINICAL CASES We present 3 cases of patients with diagnosis of myomatosis of large elements, the smallest being 7 cm and the largest being 15 cm, in greater diameter, after the laparoscopic myomectomy the extraction of the complete surgical piece is performed through posterior colpotomy, presenting a favorable postoperative recovery, without associated symptoms. CONCLUSIONS The transvaginal extraction through posterior colpotomy represents a safe and effective alternative for the extraction of surgical pieces, the elasticity of the vagina allows the safe extraction of large pieces, avoiding the use of the morcellator and its possible risks; It also avoids expanding the abdominal incisions, associating to less postoperative pain, faster recovery and better cosmetic results. The vaginal route is a safe option with minimal risk of complications, and with better postsurgical results compared to the other options in laparoscopic surgery.
ABSTRACT
OBJETIVO: Relatar a experiência pessoal no tratamento cirúrgico de hérnias incisionais com a utilização da malha de polipropileno monofilamentar-márlex. MÉTODOS: Foram operados e seguidos 74 pacientes portadores de hérnia incisional originada de tratamento cirúrgico de diferentes afecções da cavidde abdominal, com idade entre 30 e 94 anos, sendo 39 do sexo feminino e 35 do sexo masculino. Destes 41,9 por cento foram submetidos a hernioplastia incisional pela primeira vez e 58,1 por cento já haviam tentado o tratamento sem sucesso. A técnica operatória usada foi a dissecção do saco herniário, ressecção da fibrose resultante de operações anteriores e fixação de tela de márlex substituindo ou reforçando a fáscia transversal por baixo dos músculos da parede abdominal. RESULTADO: 74 pacientes foram operados e seguidos de 1975 a 1995. Na última revisão, em maio de 1998, três pacientes haviam falecido, dois de doenças cardíacas e um de doença neoplasia. Apenas um paciente (1,3 por cento) apresentou recidiva, no início da experiência. Este foi reoperado e terve sua hérnia incisional curada. CONCLUSÃO: o uso da tela de márlex tecnicamente aplicada é o método ideal para a cura definitiva das hérnias incisionais.
BACKGROUND: Personal experience in the treatment of incisional hernia with the use of polypropylene monofilament mesh - marlex, is discussed. METHOD: Seventy-four patients, with ages ranging from 30 to 94 years (39 females and 35 males), with hernia secundary to surgical abdominal procedures, were studied. Half (41,9 percent) of these patients were submitted to surgical correction for the first time, however 58,1 percent were recurrences. Dissection of hernia sac, excision of old fibrosis and marlex mesh interposition were carried out to reinforce transversalis fascia under the muscles of the abdominal wall. RESULTS: Seventy-four patients were operated uppon from 1975 to 1995. Last follow-up carried out in 1998 disclosed three deaths not related to previous surgery. There was one recurrence (1,3 percent) at the beginning of our experience, which required second intervention. CONCLUSION: The use of marlex mesh interposition is a reliable method to correct incisional hernia providing adequate technique is utilized for its fixation.