Experiencia actual en el abordaje laparoscópico transabdominal preperitoneal de hernias inguinales en el Servicio de Cirugía General del Hospital Nacional: periodo 2018-2022

Introducción: la hernia inguinal es uno de los principales motivos de consulta quirúrgica y su reparación es uno de los procedimientos más comunes en cirugía. Objetivo: determinar la experiencia en el abordaje laparoscópico de las hernias inguinales por técnica transabdominal preperitoneal en el Servicio de Cirugía General del Centro Médico Nacional-Hospital Nacional. Metodología: estudio observacional descriptivo retrospectivo de corte temporal transversal. En pacientes de 16 a 90 años de edad con diagnóstico de hernia inguinal internados en el Servicio de Cirugía General del Centro Médico Nacional-Hospital Nacional para hernioplastia electiva. Resultados: se llevaron a cabo 30 hernioplastias por técnica técnica trans-abdominal pre-peritoneal de los cuales el 73 % fue realizado en hombres y 27 % en mujeres; se identificó una media de edad de 48,4 años, el grupo etario con mayor frecuencia fue de 38 a 48 años. En el examen físico pre quirúrgico se encontraron hernias inguinales unilaterales en el 76.6 % y bilaterales en el 23.3 %; en la mayor parte de los pacientes las hernias fueron primarias en el 86.6 %y recidivada en el 13.3 %. El tiempo quirúrgico en promedio fue de 93.1 minutos; con un tiempo máximo de 120 minutos y mínimo de 60 minutos. El tiempo de hospitalización en el 100 % de los pacientes fue de 48 h. De las complicaciones post operatorias se establece que el 76.6 % no presento ningún tipo de complicación; el 20 % presentó seroma como complicación principal y 3.3 % infección del sitio quirúrgico. Conclusión: debido a su alta frecuencia y a su impacto en la incapacidad laboral y social, las hernias inguinales representan una de las patologías quirúrgicas más importantes con bajas tasas de complicaciones post operatorias y corta estancia hospitalaria.

Introduction: inguinal hernia is one of the main reasons TAPP, e-TEP (Totally extraperitoneal with extended vision) for surgical consultation and its repair is one of the most common surgical procedures. Objective: to determine the experience in the laparoscopic approach of inguinal hernias by preperitoneal transabdominal technique in the Servicio de Cirugía General of the Centro Médico Nacional-Hospital Nacional. Methodology: retrospective descriptive observational study of cross-sectional time. In patients from 16 to 90 years of age with a diagnosis of inguinal hernia admitted to the Servicio de Cirugía General of the Centro Médico Nacional-Hospital Nacional for elective hernioplasty. Results: 30 hernioplasties were carried out by the TAPP technique, of which 73 % were performed in men and 27 % in women; a mean age of 48.4 years was identified, the age group most frequently being 38 to 48 years. In the pre-surgical physical examination, unilateral inguinal hernias were found in 76.6 % and bilateral in 23.3 %; in most of the patients the hernias were primary in 86.6 % and recurred in 13.3 %. Average surgical time was 93.1 minutes; with a maximum time of 120 minutes and a minimum of 60 minutes. The hospitalization time in 100 % of the patients was 48 hours. Of the post-operative complications, it is established that 76.6% did not present any type of complication; 20 % presented seroma as the main complication and 3.3 % surgical site infection. Conclusion: due to its high frequency and its impact on work and social disability, inguinal hernias represent one of the most important surgical pathologies with low rates of postoperative complications and short hospital stay.

Analysis of risk factors of chronic postoperative inguinal pain after laparoscopic trans-abdominal preperitoneal hernia repair and construction of a nomogram prediction model / 国际外科学杂志

Objective:To explore the risk factors of chronic postoperative inguinal pain for laparoscopic trans-abdominal preperitoneal hernia repair and establish a nomogram prediction model for it.Methods:The clinical data of 576 patients who underwent laparoscopic trans-abdominal preperitoneal hernia repair for inguinal pain at the First Hospital of Lanzhou University from January 2015 to December 2020 were analyzed retrospectively. According to different postoperative outcomes, patients were divided into chronic pain group ( n=54) and non-chronic pain group ( n=522), compared two groups of patients in the material, including gender, age, BMI, smoking history, history of drinking, hypertension, diabetes, chronic bronchitis, abdominal surgery history, history of inguinal hernia, hernia type, the hernial sac size, prophylactic use of antibiotics, VAS score, mesh fixation techniques, operation time, length of stay. Measurement data with normal distribution were expressed as ( ± s) and independent sample t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M( Q1, Q3), and the Mann-Whitney U test was used for comparision between groups. Chi-square test was used to compare the measurement data of counting data.Multivariate logistic regression was used to analyze the independent risk factors for chronic postoperative inguinal pain. R software was used to establish the drawing of the nomogram prediction model, and the consistency index, calibration chart and area under the receiver operating characteristic curve was used to evaluate the predictive ability of the nomogram prediction model. Results:According to the results of the Logistic regression analysis, age≤45 years ( OR=2.202, 95% CI: 1.080-4.491), BMI≥24 kg/m 2 ( OR=2.231, 95% CI: 1.204-4.134), hernial sac≤5 cm ( OR=2.623, 95% CI: 1.309-5.257), recurrent hernia ( OR=2.769, 95% CI: 1.118-6.860), preoperative pain ( OR=4.121, 95% CI: 2.004-8.476), suture fixation ( OR=2.204, 95% CI: 1.151-4.219)and Postoperative acute pain (VAS>3) ( OR=5.814, 95% CI: 2.532-13.350) were independent risk factors for chronic postoperative inguinal pain ( P<0.05). Based upon the above independent risk factors, the nomogram prediction model was established and verified. The area under the curve of the nomogram prediction model was 0.779 (95% CI: 0.718-0.840, P<0.01). After internal verification, the concordance index value of the prediction model was 0.779. Conclusion:age≤45 years, BMI ≥24 kg/m 2, hernial sac≤5 cm, recurrent hernia, preoperative pain, suture fixation and Postoperative acute pain (VAS>3) are independent risk factors for chronic postoperative inguinal pain for laparoscopic trans-abdominal preperitoneal hernia repair, the nomogram prediction model has a good accuracy and discrimination with a high value of clinical application.

Evaluation of gastric carcinomas with high resolution transabdominal sonography

Introduction: Assessment of the stomach is not commonly included in routine scanning protocol of upper abdominal ultrasound (USG). Aim: To evaluate the efficacy of high-resolution trans abdominal sonography in the evaluation of gastric carcinomas. Materials and Methods: 42 patients diagnosed gastric carcinoma were included in the study. The patients were taken for conventional abdominal sonography followed by high resolution trans abdominal sonography. An UGI endoscopy was done in all cases and biopsy taken from pathological / suspicious site. The accuracy of high resolution sonography of the fluid filled stomach was evaluated in the diagnosis of gastric carcinoma as compared to endoscopy. Results: Commonest age group in the study with gastric carcinoma was 61-70 years of 35.7% and females are more affected than males of 54.7%. Commonest symptoms with which patients of gastric carcinoma presented was weight loss (73.8%) and abdominal pain (69%). This represented the advance stage of the disease at which most of our patients present. The commonest site of gastric involvement in carcinoma was the antrum – 19 out of 42 cases (45.2%). In all 42 patients of gastric carcinoma (97.7%) wall layering is lost. Wall thickness was increased in all the cases (100%). Wall echotexture is hypoechoic in all the patients. There was luminal narrowing and reduced peristalsis seen in all the 42 (100%) cases. Heterogeneous intraluminal masses were seen in 38 out of 42 (90.5%) cases of gastric carcinoma. Serosal involvement was seen in 35 out of 42 (83.3%). Invasion of pancreas is most common site involvements of spread of gastric carcinoma is 42.8%. Conclusion: High resolution sonography is a supportive diagnostic modality and is a supplementary diagnostic procedure to endoscopy.

Gastrostomía endoscópica -through como dispositivo de instalación / Endoscopic gastrostomy using the pull through kit as installation device

Background: The pull-through method to install endoscopic gastrostomies is not devoid of complications. Aim: To describe and show the results of a trans-abdominal method to perform endoscopic gastrostomies using the accessories available in any endoscopic facility. material and methods: The technique consists in installing an exchange tube using the pull kit, which acts as a tube installer. We attempted the procedure in 14 patients whose ages ranged from 15 days to 83 years in a regional hospital. results: In 13 patients, the tube was correctly installed using the trans-abdominal pathway and they could be fed two hours later. Three months later, 11 patients were alive and did not experience complications associated with the gastrostomy. Conclusions: This preliminary experience supports the use of the described technique to install gastrostomies.

Objetivo: Para evitar las complicaciones de la gastrostomía endoscópica (GE) hemos desarrollado un método transabdominal empleando accesorios disponibles en cualquier unidad de endoscopia y una técnica con la cual los endoscopistas están familiarizados. Describimos el método y mostramos sus resultados. material y método: Esta técnica consiste en instalar una sonda de recambio con la ayuda del kit Pull que actúa como instalador de la sonda. Hemos intentado este procedimiento en 14 pacientes con edades entre 15 días y ochenta y tres años. Esta experiencia se realizó en el Hospital de Iquique. resultados: En 13 pacientes se logró instalar la sonda por vía transabdominal y alimentar dos horas después. A los 3 meses, once permanecían vivos y no habían tenido complicaciones mayores relacionadas a su gastrostomía. Conclusión: Aunque se trata de una experiencia inicial, creemos que esta técnica de gastrostomía combinada presenta una alternativa a otras técnicas endoscópicas de acceso transabdominal.

¿Existen ventajas en el abordaje extraperitoneal para el tratamiento del aneurisma de aorta abdominal? / Are there advantages in the extraperitoneal approach for the treatment of abdominal aortic aneurysm?

Existen controversias acerca de las posibles ventajas del abordaje transperitoneal vs. extraperitoneal en la cirugía de aneurisma de aorta abdominal; con este último, algunos estudios reportan menor morbilidad y complicaciones operatorias. Este estudio describe los resultados que se obtuvieron con los dos abordajes en un solo centro de referencia. Es un estudio retrospectivo, descriptivo, de doce años, en un grupo de 299 pacientes con diagnóstico de aneurisma de aorta abdominal que fueron intervenidos de manera electiva y distribuidos en dos grupos según el abordaje (transperitoneal = grupo 1, extraperitoneal = grupo 2). En total se operaron 93 pacientes en el grupo 1 y 206 pacientes en el 2. En ambos predominaron pacientes del sexo masculino. La edad media fue de 68 años. Las frecuencias de co-morbilidades fueron similares en los dos grupos. Se registró una tendencia a menor número de reoperaciones en el grupo 2 (12,9% vs. 5,8%), De otra parte, se observó una tendencia de mayores complicaciones post-operatorias en el grupo 1 con una frecuencia de 30,1% vs. 12,6% en el grupo 2; sin embargo, el tipo de complicaciones fue similar. Los resultados mostraron una estancia hospitalaria media de 13,3 días (DE ± 10,4) vs. 7,19 días (DE ± 4,20) p= 0,00001, estancia post-operatoria media de 9,16 días (DE ± 8,1) vs. 5,62 días (DE ± 3,46) p= 0,001 y estancia en la unidad de cuidados intensivos media de 2,76 días (DE ± 4,19) vs. 1,56 días (DE ± 1,86) p= 0,00001 en los grupos 1 y 2 respectivamente. La mortalidad inmediata total fue de 3,3%. La frecuencia de mortalidad para los grupos fue de 6,5% (n= 6) vs. 1,9% (n= 4) respectivamente. En nuestra experiencia el abordaje por la vía extraperitoneal presenta una tendencia favorable para los pacientes en cuanto a la estancia hospitalaria, la estancia en la unidad de cuidados intensivos, la frecuencia de complicaciones post-operatorias y la frecuencia de re-intervenciones en el post-operatorio inmediato. Debido al tamaño de la muestra no puede concluirse que hubo una diferencia estadísticamente significativa en cuanto a la mortalidad; sin embargo se observó una tendencia a la reducción de la misma con el abordaje extraperitoneal.

There are current controversies over the benefits of the extraperitoneal vs the transperitoneal approach for repairing an infrarenal abdominal aortic aneurysm. Several studies report a reduction in morbidity and mortality with the former approach. This study reports the short term results using both approaches at one reference center. This is a 12 year, retrospective descriptive study of 299 patients who underwent an elective open repair of an abdominal aortic aneurysm, distributed in two groups: transperitoneal approach group=1, extraperitoneal approach group=2. A total of 93 patients in group 1 and 206 in group 2 were intervened, mainly male patients with an median age of 68 years. The frequencies of co-morbidities were similar in both groups. There was a reduced tendency of reoperations in group 2 (12.9%vs 5.8%), and a greater tendency of postoperative complications in group 1 (30.1% vs 12.6%). However, the types complications were similar. The results show a median hospital stay of 13.3 days (SD+- 10,4) vs. 7.19 days (SD+- 4.20) p=0.00001, median post-operative stay of 9.16 days (SD-+ 8,1) vs. 5.62 days (SD+- 3,46) p= 0.001 and median intensive unit stay of 2.76 days (SD+-4.19) vs 1.56 days (SD+-1.86) p=0.00001 in group 1 y 2 respectively. Early global mortality was 3.3% with a distribution frequency of 6.5% (n=6) in group 1 and 1.9% (n=4) in group 2. In our experience, the extraperitoneal approach offers better results regarding hospital, postoperative and intensive care unit stay, as well as post-operative re-operation rates and complications. Because of the small sample size, the mortality difference was not statistically significant; however, we found an important tendency towards improved mortality rates with this approach.

The diagnositic value of trans-abdominal and trans-virginal ultrasound for hysteromyoma / 中国基层医药

Objective To compare the diagnostic value for hysteromyona with trans-abdominal ultrasound (TAS) and trans-virginal ultrasound(TVS). Methods Two empirical doctors detected respectively 82 patients by TAS and TVS in double blind method. The results were compared with pathological results. Result The correct rate of diagnosis in 82 patients with 123 hysteromyoma focus by TVS and TAS was 96.75% and 86.18% respectively.There was statistical difference between TAS and TVS. The correct rate of combining use of the two method was 98. 37%. Couclusion Either TVS or TAS had its own merit and defect, Combining use of the two method could raise the correct rate.

Comparison of Laparoscopic-assisted Vaginal Hysterectomy and Trans-abdominal Hysterectomy for the Treatment of Large Uterus / 中国微创外科杂志

12 gestational-week uterus) were treated in our hospital by LAVH. The operation time,intraoperative blood loss,and postoperative recovery of the patients were compared to another 110 cases that underwent TAH. Results The operation time in the TAH group was significantly shorter than that in the LAVH group [(109?27) min vs (130?22) min,t=-6.441,P=0.000]. During the operation,the LAVH group had a mean of (121?70) ml blood loss,which was significantly lower than that in the TAH group [(141?73) ml,t=-0.903,P=0.368]. After the operation,the patients in the TAH group had longer recovery time for gastrointestinal function and longer hospital stay than those in the LAVH group [(45?13) h vs (24?6) h,t=15.778,P=0.000;and (7?2) d vs (5?2) d,t=7.530,P=0.000]. Conclusions Compared to TAH,LAVH results in shorter hospital stay and fewer postoperative complications. It is a feasible and safe treatment for large uterus.