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1.
ABCD arq. bras. cir. dig ; 37: e1807, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1563606

ABSTRACT

ABSTRACT BACKGROUND: Umbilical and epigastric hernias are among the most common hernias of the abdominal wall; however, there is a lack of standardization for their treatment. AIMS: To clarify the controversies regarding therapeutic possibilities, indications, and surgical techniques for umbilical and epigastric hernia repair. METHODS: A systematic review and qualitative analysis of randomized clinical trials published in the last 20 years, involving adults (aged 18 years and over) with umbilical and/or epigastric hernias, was performed by systematically searching the PubMed/Medline, Cochrane, SciELO, and LILACS databases. The risk of bias in individual studies was assessed using the Cochrane Risk of Bias Tool. RESULTS: Initially, 492 studies were selected and, subsequently, 15 randomized controlled clinical trials were chosen that met the inclusion criteria and underwent full reading and qualitative analysis, considering possible bias. CONCLUSIONS: This review concluded that it is evident the superiority of the use of meshes in the repair of epigastric/primary umbilical hernias with a defect larger than 1 cm, even in certain emergency situations. However, suture repair is a good option for patients with a defect smaller than 1 cm. In the laparoscopic approach, recent evidence points towards possible superiority in fixation with fibrin sealant, and fascial defect closure is recommended. In addition, due to a scarcity of randomized controlled trials with low risk of bias, further studies are needed on types, positioning and fixation techniques, as well as the real role of video-assisted laparoscopic surgery in the correction of hernias, especially umbilical.


RESUMO RACIONAL: As hérnias umbilicais e epigástricas estão entre as hérnias mais comuns da parede abdominal, porém falta padronização em relação ao seu tratamento. OBJETIVOS: Esclarecer as controvérsias acerca das possibilidades terapêuticas, indicações e técnicas cirúrgicas relacionadas ao tratamento das hérnias umbilicais e epigástricas. MÉTODOS: Foi realizada revisão sistemática e análise qualitativa dos estudos publicados nos últimos 20 anos, envolvendo indivíduos maiores de 18 anos com hérnias umbilicais e/ou epigástricas, por meio de busca nas bases de dados PubMed/Medline, Cochrane, LILACS e SciELO, sendo selecionados estudos do tipo ensaios clínicos randomizados controlados para análise. Foi determinado o risco de viés de cada estudo individualmente de acordo com a ferramenta Cochrane Risk of Bias Tool. RESULTADOS: Foram inicialmente selecionados 492 estudos e, posteriormente, escolhidos 15 ensaios clínicos randomizados controlados que preencheram os critérios de inclusão e foram submetidos à leitura integral e análise qualitativa, considerando os possíveis viés. CONCLUSÕES: Esta revisão concluiu que é evidente a superioridade do uso de telas no tratamento das hérnias epigástricas/umbilicais primárias com defeito superior a 1 cm, mesmo em certas situações de emergência. No entanto, o reparo com sutura pode ser uma opção em pacientes com defeito menor que 1 cm. Na abordagem laparoscópica, evidências recentes apontam para possível superioridade na fixação com selantes de fibrina e o fechamento do defeito fascial é recomendado. Ademais, devido à escassez de ensaios clínicos randomizados controlados com baixo risco de viés, foi identificada a necessidade de desenvolver mais estudos sobre os tipos, técnicas de posicionamento e fixação das telas, assim como sobre qual o real papel da cirurgia videolaparoscópica na correção das hérnias, especialmente as umbilicais.

2.
ABCD arq. bras. cir. dig ; 37: e1813, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1563611

ABSTRACT

ABSTRACT BACKGROUND: Maintaining normal intra-abdominal pressure (IAP) levels must be one major outcome of any ventral hernia repair, avoiding hypertension or abdominal compartment syndrome. AIMS: To evaluate IAP during ventral hernia repair using Lázaro da Silva's procedure. METHODS: IAP measurements using intravesical pressure were performed during four crucial intraoperative moments. Twenty-eight patients submitted to incisional herniorrhaphy were analyzed. RESULTS: The IAP increased by 0.5 mmHg during the procedure, regardless of the type of prior laparotomy, sex, age, obesity, or hernia width. CONCLUSIONS: Despite the IAP increase observed, Lázaro da Silva's procedure did not result in intra-abdominal hypertension or abdominal compartment syndrome.


RESUMO RACIONAL: A manutenção dos níveis normais de pressão intra-abdominal (PIA) deve ser um dos principais resultados de qualquer correção de hérnia ventral, evitando hipertensão ou síndrome do compartimento abdominal. OBJETIVOS: Avaliar a PIA durante a correção de hérnia ventral pela técnica de Lázaro da Silva. MÉTODOS: As medidas da PIA por meio de pressão intravesical foram realizadas durante quatro momentos cruciais do intraoperatório. Foram analisados 28 pacientes submetidos à herniorrafia incisional. RESULTADOS: A PIA aumentou 0,5 mmHg durante o procedimento, independentemente do tipo de laparotomia prévia, sexo, idade, obesidade ou extensão da hérnia. CONCLUSÕES: Apesar do aumento da PIA observado, o procedimento de Lázaro da Silva não resultou em hipertensão intra-abdominal ou síndrome do compartimento abdominal.

3.
Rev. colomb. cir ; 38(3): 483-491, Mayo 8, 2023. tab, fig
Article in Spanish | LILACS | ID: biblio-1438567

ABSTRACT

Introducción. El manejo de las hernias se ha instaurado como un problema quirúrgico común, estimándose su aumento en los próximos años. El objetivo del presente trabajo fue describir el curso clínico, los aspectos del tratamiento quirúrgico y factores asociados a la presencia de complicaciones en pacientes intervenidos por hernia incisional. Métodos. Estudio descriptivo en el que se analizaron las características de una cohorte de pacientes llevados a corrección quirúrgica de hernia incisional en el Hospital Universitario Hernando Moncaleano Perdomo, un centro de alta complejidad en Neiva, Colombia, entre 2012 y 2019. Los datos fueron recolectados en programa Microsoft Excel® y analizados en SPSSTM, versión 21. Resultados. Se realizaron 133 correcciones de hernias incisionales, 69,9 % en mujeres y la mayoría ubicadas en la línea media (84,2 %). La edad media de los pacientes al momento de la intervención fue de 52 años ±14,6. Las comorbilidades más frecuentes fueron obesidad, hipertensión y diabetes. La causa más frecuente de la hernia fue traumática (61,7 %). La frecuencia de complicaciones fue superior al 50 %, en su mayoría menores; se encontró asociación con obesidad para la presencia de seroma. La mortalidad fue del 2,3 %. Conclusión.La hernia incisional es un problema de salud pública. Consideramos que la obesidad y el uso de malla pueden ser factores de riesgo asociados con la presentación de complicaciones postoperatorias, así como el aumento de los gastos relacionados con días de hospitalización


Introduction. Hernias management has become a common surgical problem, with an estimated increase in the coming years. The objective of this study was to describe the clinical course, aspects of surgical treatment and factors associated with the presence of complications in patients operated on for incisional hernia. Methods. Descriptive study, in which the characteristics of a cohort of patients taken to surgical correction of incisional hernia at the Hospital Universitario Hernando Moncaleano Perdomo, a high complexity medical center located in Neiva, Colombia, between 2012 and 2019 were analyzed, whose data were collected in Microsoft Excel® software and analyzed in SPSSTM, version 21. Results. One-hundred-thirty-three incisional hernia corrections were performed. The mean age at the intervention was 52 years ±14.6. The most frequent comorbidities were weight disorders, hypertension and diabetes. Only one laparoscopy was performed, the first etiology of the hernia was traumatic (61.7%) and midline (84.2%). The frequency of complications was greater than 50%, mostly minors. An association with obesity was found for the presence of seroma. Mortality was 2.3%. Conclusion. Incisional hernia is a public health problem. We consider that obesity and the use of mesh are a risk factor associated with the presentation of postoperative complications as well as the increase in costs related to days of hospitalization


Subject(s)
Humans , Hernia, Abdominal , Incisional Hernia , Postoperative Complications , Reoperation , Abdominal Wall , Hernia, Ventral
4.
Rev. Col. Bras. Cir ; 50: e20233405, 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1431276

ABSTRACT

ABSTRACT The ideal ventral hernia surgical repair is still in discussion1. The defect closure with a mesh-based repair is the base of surgical repair, in open or minimally invasive techniques2. The open methods lead to a higher surgical site infections incidence, meanwhile, the laparoscopic IPOM (intraperitoneal onlay mesh) increases the risk of intestinal lesions, adhesions, and bowel obstruction, in addition to requiring double mesh and fixation products which increase its costs and could worsen the post-operative pain3-5. The eTEP (extended/enhanced view totally intraperitoneal) technique has also arisen as a good option for this hernia repair. To avoid the disadvantages found in classic open and laparoscopic techniques, the MILOS (Endoscopically Assisted Mini or Less Open Sublay Repair) concept, created by W. Reinpold et al. in 2009, 3 years after eTEP conceptualization, allows the usage of bigger meshes through a small skin incision and laparoscopic retro-rectus space dissection, as the 2016 modification, avoiding an intraperitoneal mesh placement6,7. This new technique has been called E-MILOS (Endoscopic Mini or Less Open Sublay Repair)8. The aim of this paper is to report the E-MILOS techniques primary experience Brazil, in Santa Casa de Misericórdia de São Paulo.


RESUMO O tratamento cirúrgico ideal para correção das hérnias ventrais ainda é motivo de grande discussão1. O fechamento do defeito associado a utilização de telas para reforço da parede abdominal são passos fundamentais da terapia cirúrgica, podendo ser realizados tanto pela via aberta quanto pelas técnicas minimamente invasivas2. A via aberta apresenta maiores taxas de infecção de sítio cirúrgico, enquanto o reparo laparoscópico IPOM (intraperitoneal onlay mesh) acarreta um risco aumentado de lesões intestinais, aderências e obstruções intestinais, além de requerer uso de telas de dupla face e dispositivos de fixação que encarecem o procedimento e não raro aumentam a dor no pós-operatório3-5. A técnica eTEP (extended/enhanced view totally extraperitoneal), tem ganhado importância, mostrando-se uma boa opção para a correção das hérnias ventrais também2. A fim de se evitar as desvantagens das técnicas abertas e laparoscópicas "clássicas" o conceito MILOS (Endoscopically Assisted Mini or Less Open Sublay Repair), desenvolvido por W. Reinpold et al. em 2009, 3 anos antes do advento do eTEP, possibilita ao cirurgião o uso de telas de grandes dimensões no plano retromuscular através de uma pequena incisão na pele e dissecção laparoscópica deste espaço, conforme modificação realizada em 2016, evitando a colocação de uma tela no espaço intraperitoneal6-7. Esta nova técnica passou a se chamar EMILOS (Endoscopic Mini or Less Open Sublay Repair)8 Este artigo tem como objetivo relatar nossa experiência inicial no emprego da técnica E-MILOS no Brasil, na Santa Casa de Misericórdia de São Paulo.

5.
MedUNAB ; 25(3): [359-384], 01-12-2022.
Article in English | LILACS | ID: biblio-1437219

ABSTRACT

Introducción. El manejo de la hernia ventral sigue siendo un desafío para los cirujanos. Su reparación mediante técnicas mínimamente invasivas, como la totalmente extraperitoneal (eTEP) laparoscópica, permite una amplia disección del espacio a reparar, una recuperación postoperatoria más rápida, menor dolor postoperatorio y estancia hospitalaria. El abordaje eTEP es un enfoque novedoso que utiliza el espacio retromuscular para colocar material protésico y fortalecer la pared abdominal. El objetivo es describir los resultados a corto plazo de nuestra experiencia inicial con la técnica eTEP en el manejo de las hernias ventrales. Metodología. Estudio observacional, descriptivo, retrospectivo, donde se incluyen pacientes con el diagnóstico de hernia ventral, sometidos a cirugía laparoscópicaeTEP, entre julio-2021 y junio-2022. Resultados. De un total de 21 pacientes, el 61.9% fueron hombres. El 47.6% tenían sobrepeso y el 52.4% obesidad. Estancia hospitalaria media: 1.6 días. El 66.7% fueron hernias incisionales. Las técnicas quirúrgicas realizadas fueron: Rives-Stoppa (71.4%) asociándose liberación del músculo transverso en el 28.6%. El 19% de los pacientes presentaron complicaciones globales y solo uno fue grave, requiriendo reintervención quirúrgica. Se observó la presencia de seroma clínico en el 9.5% y ecográfico en 57.1%. No se evidenciaron hematomas, infección de herida quirúrgica ni casos de recidiva herniaria. Discusión y conclusiones. El abordaje laparoscópico eTEP Rives-Stoppa, asociado o no a separación posterior de componentes, en el manejo de las hernias ventrales ofrece buenos resultados asociando una baja incidencia de complicaciones postoperatorias, corta estancia hospitalaria, baja incidencia de recidivas herniarias, por lo que podría considerarse una técnica segura y efectiva en el tratamiento de las hernias ventrales.


Introduction. Managing ventral hernia remains a challenge for surgeons. Repairing it using minimally invasive techniques, such as laparoscopic totally extraperitoneal (eTEP), which allows for a wide dissection of the space to be repaired, faster postoperative recovery, less postoperative pain and shorter hospital stay. The eTEP approach is a novel technique that focus on the uses of the retromuscular space to place prosthetic material and strengthen the abdominal wall. The objective is to describe the short-term results of our initial experience with the eTEP technique in the management of ventral hernias. Methodology. Observational, descriptive, retrospective, study, which included patients with a diagnosis of ventral hernia, undergoing laparoscopic eTEP surgery, between July-2021 and June-2022. Results. Of a total of 21 patients, 61.9% were men. 47.6% were overweight and 52.4% were obese. Average hospital stay: 1.6 days. 66.7% were incisional hernias. The surgical techniques performed were: Rives-Stoppa (71.4%) with associated transversus abdominis muscle release in 28.6%. 19% of the patients presented global complications and only one was severe, requiring surgical reintervention. The presence of clinical seroma was observed in 9.5% and ultrasound in 57.1%. There was no evidence of hematomas, surgical wound infection or cases of hernia recurrence. Discussion and conclusions. The laparoscopic-eTEP Rives-Stoppa approach, associated or not with posterior separation of components, in the management of ventral hernias offers good results with a low incidence of postoperative complications, short hospital stay, low incidence of hernia recurrences, so it could be considered a safe and effective technique in the treatment of ventral hernias.


Introdução. O manejo da hérnia ventral continua sendo um desafio para os cirurgiões. Seu reparo por meio de técnicas minimamente invasivas, como a totalmente extraperitoneal (eTEP) laparoscópica, permite ampla dissecção do espaço a ser reparado, recuperação pós-operatória mais rápida, menor dor pós-operatória e menor tempo de internação. A abordagem eTEP é uma nova abordagem que usa o espaço retromuscular para colocar material protético e fortalecer a parede abdominal. O objetivo é descrever os resultados de curto prazo de nossa experiência inicial com a técnica eTEP no manejo de hérnias ventrais. Metodologia. Estudo observacional, descritivo, retrospectivo, longitudinal, que inclui pacientes com diagnóstico de hérnia ventral, submetidos a cirurgia laparoscópica-eTEP, entre julho-2021 e junho-2022. Resultados. De um total de 21 pacientes, 61.9% eram homens; 47.6% estavam com sobrepeso e 52.4% obesos. Tempo médio de internação: 1.6 dias; 66.7% eran hérnias incisionais. As técnicas cirúrgicas realizadas foram: Rives-Stoppa (71.4%) associada à liberação do músculo transverso em 28.6%. 19% dos pacientes apresentaram complicações globais e apenas um foi grave, necesitando de reintervenção cirúrgica. A presença de seroma clínico foi observada em 9.5% e ultrassonográfica em 57.1%. Não houve evidência de hematoma, infecção de ferida cirúrgica ou casos de recidiva de hérnia. Discussão e conclusões. A abordagem laparoscópica eTEP Rives-Stoppa, associada ou não à separação posterior dos componentes, no manejo das hérnias ventrais oferece bons resultados associando baixa incidência de complicações pós-operatórias, curto tempo de internação, baixa incidência de recidivas de hérnias, pelo que pode ser considerada uma técnica segura e eficaz no tratamento das hérnias ventrais.


Subject(s)
Laparoscopy , Hernia, Ventral , Hernia, Abdominal , Incisional Hernia , Hernia
6.
ABCD (São Paulo, Online) ; 35: e1692, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1402855

ABSTRACT

ABSTRACT BACKGROUND: The development of an incisional hernia is a common complication following laparotomy. It also has an important economic impact on healthcare systems and social security budget. The mesh reinforcement of the abdominal wall was an important advancement to increase the success of the repairs and reduce its long-term recurrence. The two most common locations for mesh placement in ventral hernia repairs include the premuscular (onlay technique) and retromuscular planes (sublay technique). However, until now, there is no consensus in the literature about the ideal location of the mesh. AIM: The aim of this study was to compare the two most common incisional hernia repair techniques (onlay and sublay) with regard to the complication rate within the first 30 days of postoperative care. METHOD: This study analyzes 115 patients who underwent either onlay or sublay incisional hernia repairs and evaluates the 30-day postoperative surgical site occurrences and hernia recurrence for each technique. RESULTS: We found no difference in the results between the groups, except in seroma formation, which was higher in patients submitted to the sublay technique, probably due to the lower rate of drain placement in this group. CONCLUSION: Both techniques of mesh placement seem to be adequate in the repair of incisional hernias, with no major difference in surgical site occurrences.


RESUMO RACIONAL: O desenvolvimento de hérnia incisional é uma complicação comum após laparotomias. Também tem um impacto econômico importante nos sistemas de saúde e no orçamento da previdência social. O reforço com tela da parede abdominal foi um avanço importante para aumentar o sucesso dos reparos e ajudou a reduzir sua recorrência em longo prazo. Os dois locais mais comuns para colocação de tela em reparos de hérnia incisional incluem os planos pré-muscular (técnica onlay) e retromuscular (técnica sublay). Porém, até o momento, não há consenso na literatura sobre a localização ideal da tela. OBJETIVOS: Comparar as duas técnicas de reparo de hérnia incisional mais comuns (onlay e sublay) em relação à taxa de complicações nos primeiros 30 dias de pós-operatório. MÉTODO: Analisar 115 pacientes submetidos a reparos de hérnia incisional onlay ou sublay e avaliar, como desfecho, as ocorrências de sítio cirúrgico no pós-operatório de trinta dias e a recorrência precoce para cada técnica. RESULTADOS: Não encontramos diferença nos resultados entre os grupos, exceto na formação de seroma, que foi maior nos pacientes submetidos à técnica de sublay, provavelmente pela menor taxa de colocação de dreno neste grupo. CONCLUSÃO: Assim, ambas as técnicas de colocação de tela parecem ser adequadas no reparo de hérnias incisionais, sem grande diferença nos desfechos precoces, relacionados a ao sítio cirúrgico.

7.
Rev. colomb. cir ; 36(3): 520-530, 20210000. fig, tab
Article in Spanish | LILACS | ID: biblio-1254387

ABSTRACT

El abdomen abierto es una opción terapéutica en pacientes críticamente enfermos. Se utiliza cuando el cierre de la cavidad abdominal no puede o no debe ser realizado. No obstante, su utilidad como parte de una estrategia tradicionalmente aceptada ha disminuido, en la medida en que se han incrementado las secuelas en la pared abdominal, en especial la hernia ventral. Los procedimientos requeridos para la reconstrucción anatómica y funcional de la pared abdominal, como parte del tratamiento de una hernia ventral, revisten una alta complejidad y constituyen un nuevo escenario quirúrgico. Igualmente, conllevan incertidumbre respecto a su naturaleza y posibles complicaciones, además de que condicionan mayores gastos al sistema de salud. Para evitar los problemas del cierre tardío de la pared abdominal, se han desarrollado alternativas para superar el abordaje tradicional de "tratar y esperar", hacia "tratar y reconstruir" tempranamente. El objetivo de la presente revisión es realizar una descripción de los principales avances en el tratamiento del abdomen abierto y el papel del cierre temprano de la pared abdominal, haciendo énfasis en la importancia de un cambio conceptual en el mismo


The open abdomen is a therapeutic option in critically ill patients. It is used when the closure of the abdominal cavity cannot or should not be performed. However, its usefulness as part of a traditionally accepted strategy has diminished, as sequelae in the abdominal wall, especially ventral hernia, have increased. The procedures required for the anatomical and functional reconstruction of the abdominal wall, as part of the treatment of a ventral hernia, are highly complex and constitute a new surgical scenario. Likewise, they lead to uncertainty regarding their nature and possible complications, in addition to conditioning higher expenses for the health system. To avoid the problems of delayed closure of the abdominal wall, alternatives have been developed to overcome the traditional "try and wait" approach to "treat and reconstruct" early. The objective of this review is to describe the main advances in the treatment of the open abdomen and the role of early closure of the abdominal wall, emphasizing the importance of a conceptual change in it


Subject(s)
Humans , Abdominal Wall , Open Abdomen Techniques , Surgical Mesh , Incisional Hernia , Hernia, Ventral
8.
Rev. guatemalteca cir ; 27(1): 82-86, 2021. ilus
Article in Spanish | LILACS, LIGCSA | ID: biblio-1373034

ABSTRACT

Introducción: La incidencia de eventración post quirúrgica es del 2-20%, se da mayormente en pacientes con factores de riesgo durante los primeros tres años posteriores a la cirugía inicial. La mayoría de las hernias de la pared abdominal pueden ser reparadas fácilmente, sin embargo, las hernias gigantes (>10cm de diámetro) o aquellas con pérdida de domicilio requieren métodos de expansión gradual de la pared abdominal pre y/o transoperatoriamente. Se ha descrito que posterior a la aplicación de toxina botulínica serotipo A (TBA) de forma bilateral en la pared abdominal, los defectos disminuyen clínica y tomográficamente hasta 5.25cm, por su efecto selectivo en terminaciones nerviosas periféricas colinérgicas, provocando atrofia muscular sin fibrosis. El efecto máximo ocurre al mes de la aplicación y dura 28 semanas. Esta técnica permite planear preoperatoriamente la magnitud de la cirugía. Nuestro caso, paciente masculino de 33 años. Quien ingresa por politrauma. Se realiza procedimiento quirúrgico abdominal y posteriormente se eviscera en múltiples ocasiones. Se cierra herida y posteriormente desarrolla hernia ventral gigante con la que egresa. Se realiza TC abdominal evidenciando defecto herniario de 15.9cm, con este resultado se aplica toxina botulínica serotipo A en la pared abdominal bilateral (50 unidades en cada lado) guiado por ultrasonido. 25 días después se realiza TC abdominal control que evidencia defecto herniario de 14.7cm y se decide ingreso para cirugía electiva. Se decide llevar a sala de operaciones donde se realiza hernioplastía con liberación de componentes anteriores mas colocación de malla de polietileno (cuatro semanas posteriores a la aplicación de la toxina), quedando defecto totalmente cerrado y sin tensión. Paciente con adecuada evolución posterior a intervención por lo que egresa. Actualmente sin defecto herniario recurrente. Conclusión: El uso de toxina botulínica serotipo A es un nuevo recurso prequirúrgico para la preparación de pacientes con hernias ventrales gigantes, ya que permite el cierre sin tensión en la mayoría de los casos. Además, ayuda a que transoperatoriamente la separación de componentes se realice de una mejor manera, ya que se da mejor manipulación al momento de desplazar las estructuras musculares. Idealmente se debe de realizar la intervención quirúrgica cuatro semanas posteriores a su aplicación. (AU)


ntroduction: The incidence of post-surgical eventration is 2-20%, it occurs mostly in patients with risk factors during the first three years after the initial surgery. Most abdominal wall hernias can be easily repaired, however, giant hernias (>10cm of diameter) or those with the loss of domain require methods of gradual expansion of the abdominal wall pre or intraoperatively. It has been described that after the application of botulinum toxin A bilaterally in the abdominal wall, the defect can decrease clinically and tomographically up to 5.25cm, due to its selective effect on cholinergic peripheral nerve endings, that cause muscle atrophy without fibrosis. The maximum effect occurs one month after the application and lasts 28 weeks. This technique allows to plan preoperatively the magnitude of the surgery. Description of case: A 33 year old male patient, who entered the emergency room due to polytrauma. Abdominal surgical procedure was performed and later he eviscerates on multiple occasions. The wound was closed and later he develops a giant ventral hernia with which it is discharged. An abdominal CT was performed, showing a hernia defect of 15.9cm. With this result botulinum toxin A was applied guided by ultrasound bilaterally in the abdominal wall (50 U on each side). A control abdominal CT was performed after 25 days, which it revealed a hernia defect of 14.7 cms, so admission was decided for elective surgery. The patient was taken to the operating room where a hernioplasty with anterior components separation plus the placement of a polyethylene mesh was performed (four weeks after the application of the botulinum toxin A), the hernia defect was completely close without tension. The patient had an adequate post-surgical evolution for which it was discharge. Currently without a recurrent hernia defect. Conclusion: The use of botulinum toxin A is a new pre-surgical resource for the preparation of patients with giant ventral hernias, since it allows the closure without tension in most cases. In addition, it helps transoperatively with the components separation, since there is a better manipulation at the time of displacing the muscular structures. Ideally, the surgical intervention should be performed four weeks after its application. (AU)


Subject(s)
Humans , Male , Adult , Wounds and Injuries/complications , Botulinum Toxins, Type A/administration & dosage , Hernia, Ventral/surgery , Surgical Mesh/trends , Intraoperative Complications/diagnosis , Laparotomy/instrumentation
9.
Rev. Col. Bras. Cir ; 48: e20202672, 2021. graf
Article in English | LILACS | ID: biblio-1155361

ABSTRACT

ABSTRACT Incisional hernia is a late complication of the most frequent after abdominal surgeries, with resulting morbidity that can worsen the condition. The treatment has been done both by open techniques, using screens or not, and by laparoscopic and robotic methods, which use them systematically. However, introducing a permanent foreign body into the tissues requires more surgical time, despite not closing the parietal defect in most cases and a higher risk of infections. New technologies have been trying to improve these results, with absorbable prostheses (biological or synthetic), but their high cost and recurrences remain a severe problem. Even so, standard repair establishes reinforcement with screens, routine, and whether the approach is traditional or mini-invasive. The authors report their first case of endoscopic repair of incisional hernia, which occurred two years ago, with a Brazilian technique already fifty years old: the transposition with the hernia sac proposed by Prof. Alcino Lázaro da Silva in 1971.


RESUMO A hérnia incisional é uma das complicações tardias mais frequentes, após operações abdominais, resultando em alta morbidade. O tratamento tem sido feito tanto por técnicas abertas, com telas ou sem, quanto por métodos laparoscópicos e robóticos, que utilizam próteses de forma sistemática. No entanto, a introdução de um corpo estranho permanente entre os tecidos requer mais tempo cirúrgico, não fecha o defeito parietal na maioria dos casos e está associado a maior risco de infecções. Novas tecnologias têm sido utilizadas para melhorar esses resultados, empregando próteses absorvíveis (biológicas ou sintéticas), mas o alto custo e as recidivas continuam sendo um grave problema. No entanto, a reparação padrão rotineiramente estabelece reforço com telas, seja na abordagem tradicional ou minimamente invasiva. Os autores relatam o primeiro caso do reparo endoscópico de hérnia incisional, usando técnica brasileira com 50 anos de idade: a transposição com o saco herniário, conforme proposta pelo Prof. Alcino Lázaro da Silva, em 1971.


Subject(s)
Humans , Male , Surgical Mesh , Endoscopy , Herniorrhaphy/methods , Incisional Hernia/surgery , Hernia, Ventral/surgery , Brazil , Treatment Outcome , Length of Stay , Middle Aged
10.
Rev. Col. Bras. Cir ; 48: e20202879, 2021. graf
Article in English | LILACS | ID: biblio-1155364

ABSTRACT

ABSTRACT Introduction: currently, there are several clinical applications for robot-assisted surgery and in the hernia scenario, robot-assisted surgery seems to have the ability to overcome laparoscopic ventral hernias repairs limitations, facilitating dissection, defect closure, and mesh positioning. Exponentially grown in numbers of robotic approaches have been seen and even more complex and initially not suitable cases have recently become eligible for it. An appropriate tension-free reestablishment of the linea alba is still a major concern in hernia surgery and even with the robotic platform, dissecting and suturing in anterior abdominal wall may be challenging. This article reports a technical image artifice during a da vinci Xi-platform robotic ventral hernia repair allowing the surgeon to establish a more familiar and ergonomic manner to perform dissection and suturing in anterior abdominal wall. Technical Report: a step by step guided technique of image inversion artifice is described using detailed commands and figures to assure optimal surgical field and ergonomics whenever acting in robotic ventral hernias repair with the da Vinci Xi-platform. Our group brief experience is also reported, showing an easy and reproducible feature among surgeons with safe outcomes. Conclusion: we consider that image inversion artifice is a simple and reproducible feature in robotic ventral hernia repair. Through a step-by-step guide, this report enables the creation of an artifice providing a comfortable operative field and allowing the surgeon to achieve its best proficiency in hernia surgery.


RESUMO Introdução: as qualidades da cirurgia robótica em diversos campos da cirurgia minimamente invasiva são notórias e, no cenário de hérnias abdominais, ela tem se mostrado capaz de superar as limitações da laparoscopia facilitando a dissecção, o fechamento do defeito herniário e o posicionamento da tela. O número de abordagens robóticas cresceu exponencialmente e casos ainda mais complexos e inicialmente inadequados tornaram-se recentemente elegíveis para uma cirurgia menos invasiva. A reconstrução adequada da linha alba e livre de tensão ainda é uma grande preocupação na cirurgia de hérnia e, mesmo com a plataforma robótica, dissecar e suturar na parede abdominal anterior pode ser um desafio. Este artigo relata um artifício técnico com inversão de imagem durante a correção de hérnia ventral robótica com a plataforma Da vinci Xi, permitindo ao cirurgião estabelecer uma maneira mais familiar e ergonômica de realizar dissecção e sutura na parede abdominal anterior. Nota Técnica: uma técnica guiada passo a passo com artifício de inversão de imagem é descrita usando comandos e figuras detalhadas para garantir campo cirúrgico ideal e melhor ergonomia ao cirurgião sempre que atuar na correção de hérnias ventrais robóticas com a plataforma Da vinci Xi. Nossa breve experiência de grupo também é relatada, mostrando-se uma técnica fácil e reprodutível entre cirurgiões com resultados seguros. Conclusão: consideramos que o artifício de inversão de imagens é uma característica simples e reprodutível na correção de hérnia ventral robótica. Por meio de um guia passo a passo, este artigo detalha a criação de um artifício técnico que proporciona um campo operatório confortável ao cirurgião atingindo sua melhor proficiência em cirurgia de hérnia.


Subject(s)
Humans , Laparoscopy , Abdominal Wall , Robotic Surgical Procedures , Hernia, Ventral/surgery , Surgical Mesh , Herniorrhaphy
11.
Rev. colomb. cir ; 35(1): 43-50, 2020. fig, tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1095472

ABSTRACT

Introducción. La cirugía de hernia ventral implica una situación de complejidad, dadas las múltiples variables que se deben controlar para estimar los posibles factores determinantes del éxito quirúrgico y la aparición de complicaciones. Según la literatura científica mundial, la incidencia de hernia ventral se estima entre el 10 y el 15 %, y la tasa promedio de complicaciones de esta cirugía varía entre el 10 y el 37 %. El objetivo del presente estudio fue describir la experiencia y los resultados de la cirugía de hernia ventral en dos instituciones de IV nivel, en el periodo de enero de 2015 a marzo de 2019.Métodos. Se trata de un estudio observacional, descriptivo y de cohorte histórica, de pacientes mayores de edad sometidos a corrección de hernia ventral en las Clínicas Colsanitas en los últimos cinco años. Los datos se tomaron del registro estadístico de las instituciones en mención. Resultados. Se incluyeron 612 pacientes en un periodo de cinco años, la mayoría de los cuales era de sexo femenino, con sobrepeso, y predominantemente, con defectos combinados mediales; la tasa general de complicaciones fue del 20 % y, el porcentaje de infección del sitio operatorio, de 9 %; para el desarrollo de esta infección, la técnica de separación de componentes se encontró como un factor de riesgo (p=0,01; RR=2,9; IC 95% 1,32-6,5). En este estudio, no se analizó la recidiva como factor de los diferentes resultados. Conclusiones. Existen pocos datos en la literatura nacional sobre los resultados de este tipo de procedimiento quirúrgico. Es por ello que se procuró brindar a la comunidad científica los resultados de morbimortalidad de esta muestra de pacientes intervenidos por hernia ventral en los últimos cinco años


Introduction: Ventral hernia surgery involves a complex scenario, given the multiple variables that must be controlled to estimate the possible determinants of surgical success and the appearance of complications. Ac-cording to the world literature, the incidence of ventral hernia is estimated between 10% and 15%, and the average complication rate of this surgery varies between 10% and 37%. The objective of this study was to describe the experience and outcomes in ventral hernia surgery in two insti-tutions of IV level, in the period from January 2015 to March 2019.Methods: This is an observational, descriptive and historical cohort study of patients undergoing correction of ventral hernia at Colsanitas Clinics in the last five years. The data were collected from the statistical record of the mentioned institutions.Results: A total of 612 patients were included in a five-year period, most of whom were female, overweight, and predominantly with medial combined defects; the overall complication rate was 20%, and the percentage of op-erative site infection, 9%. From the development of this infection, the component separation was found as a risk factor (p= 0.01; RR= 2.9; CI95% 1.32-6.5). In this study, recurrence was not analyzed as an outcome factor.Conclusions: There is little data in the national literature on the results of this type of surgical procedure, which is why we tried to provide the scientific community with the morbidity and mortality results in our population of patients operated for ventral hernia in the last five years.


Subject(s)
Humans , Hernia, Ventral , Prostheses and Implants , Surgical Mesh , Surgical Wound Infection
12.
VozAndes ; 31(1): 42-45, 2020.
Article in Spanish | LILACS | ID: biblio-1118254

ABSTRACT

Las hernias incisionales con pérdida de dominio (HIPD), tiene una prevalencia entre el 5 - 20%, por su complejidad técnica son un desafío para el cirujano de pared abdominal, debido a la disminución de la compliance abdominal, por atrofia y retracción muscular, así como las complicaciones asociadas al procedimiento. Presentamos el uso preoperatorio del neumoperitoneo progresivo (NPP), como técnica de preparación de la pared abdominal, mediante la colocación de un catéter permanente multipropósito (tipo pig tail) guiado por tomografía computarizada, para un paciente masculino de 69 años, agricultor, portador de colostomía por vólvulo de sigma, que presentó sepsis abdominal secundaria a dehiscencia de anastomosis, que derivó en colostomía, y formación de HIPD de 25 x 15 cm. Los beneficios del NPP son: reduce el tamaño de la segunda cavidad formada, facilita la colocación de la malla, disminuye la tensión en el cierre de la pared abdominal y el desarrollo del síndrome de hipertensión intraabdominal, por lo tanto, una menor probabilidad de recidiva postquirúrgica. La técnica de reparación utilizada fue liberación del músculo transverso del abdomen (TAR), que está indicada en HIPD con buenos resultados en cuanto a recidiva y complicaciones asociadas. Conclusiones: La reparación de HIPD, es técnicamente difícil, porque se afecta la compliance de la pared abdominal, más aún en nuestro caso por la presencia de colostomía. La optimización de la pared abdominal preoperatoria con técnica de neumoperitoneo progresivo más técnica TAR es una de las opciones válidas que se dispone para lograr este objetivo


Incisional hernias with loss domain (HIPD), has a prevalence between 5 - 20%, due to its technical complexity are a challenge for abdominal wall surgeon, because decrease in abdominal compliance, for muscle atrophy and retraction, as well as complications associated with the procedure. We present the preoperative use of progressive pneumoperitoneum (NPP), as a technique for preparing the abdominal wall, by placing a multipurpose permanent catheter (pig tail type) guided by computed tomography, for a 69-year-old male patient, farmer, and colostomy carrier. by sigma volvulus, which presented abdominal sepsis secondary to anastomosis dehiscence, which led to a colostomy, and HIPD formation of 25 x 15 cm. The benefits of NPP are: it reduces the size of the second cavity formed, facilitates the placement of the mesh, reduces the tension in the closure of the abdominal wall and the development of intra-abdominal hypertension syndrome, therefore a lower probability of post-surgical recurrence. The repair technique used was release of the transverse muscle of the abdomen (TAR), which is indicated in HIPD. Conclusions: HIPD repair is technically difficult because compliance of the abdominal wall is affected, even more so in our case due to the presence of a colostomy. Optimization of the preoperative abdominal wall with the progressive pneumoperitoneum technique plus the TAR technique is one of the valid options available to achieve this goal


Subject(s)
Humans , Male , Aged , Incisional Hernia , Hernia, Ventral , Laparotomy , Pneumoperitoneum, Artificial , Surgical Mesh , Abdominal Wall
13.
ABCD (São Paulo, Impr.) ; 33(2): e1517, 2020. tab, graf
Article in English | LILACS | ID: biblio-1130525

ABSTRACT

ABSTRACT Background: The best technique for incisional hernioplasty has not been established yet. One of the difficulties to compare these techniques is heterogeneity in the profile of the patients evaluated. Aim: To analyze the results of three techniques for incisional hernioplasty after open bariatric surgery. Method: Patients who underwent incisional hernioplasty were divided into three groups: onlay technique, simple suture and retromuscular technique. Results and quality of life after repair using Carolina's Comfort Scale were evaluated through analysis of medical records, telephone contact and elective appointments. Results: 363 surgical reports were analyzed and 263 were included: onlay technique (n=89), simple suture (n=100), retromuscular technique (n=74). The epidemiological profile of patients was similar between groups. The onlay technique showed higher seroma rates (28.89%) and used a surgical drain more frequently (55.56%). The simple suture technique required longer hospital stay (2.86 days). The quality of life score was worse for the retromuscular technique (8.43) in relation to the onlay technique (4.7) and the simple suture (2.34), especially because of complaints of chronic pain. There was no difference in short-term recurrence. Conclusion: The retromuscular technique showed a worse quality of life than the other techniques in a homogeneous group of patients. The three groups showed no difference in terms of short-term hernia recurrence.


RESUMO Racional: A melhor técnica de hernioplastia incisional ainda não foi definida. Uma das dificuldades na comparação é a heterogenicidade no perfil dos pacientes avaliados. Objetivo: Analisar os resultados de três técnicas de hernioplastia incisional após cirurgia bariátrica aberta. Método: Os pacientes que realizaram hernioplastias incisionais foram estudados e divididos em três grupos: técnica onlay, sutura simples e técnica retromuscular. Resultados e qualidade de vida após o reparo utilizando o Carolina's Comfort Scale foram avaliados através de análise de prontuários, contato telefônico e consultas eletivas. Resultados: Foram analisados 363 relatos cirúrgicos e 263 foram incluídos: técnica onlay (n=89), sutura simples (n=100), técnica retromuscular (n=74). O perfil epidemiológico dos pacientes foi similar entre os grupos. A técnica onlay apresentou maiores taxas de seroma (28,89%) e usou dreno com maior frequência (55,56%). A sutura simples obteve maior tempo de internação (2,86 dias). O escore de qualidade de vida foi pior na técnica retromuscular (8,43) em relação à onlay (4,7) e à sutura simples (2,34), especialmente devido às queixas de dor crônica. Não houve diferença quanto a recidiva em curto prazo. Conclusão: A técnica retromuscular apresentou pior qualidade de vida do que as demais técnicas em um grupo homogêneo de pacientes. Os três grupos não mostraram diferenças em termos de recidiva de hérnia em curto prazo.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Bariatric Surgery , Herniorrhaphy/methods , Incisional Hernia/surgery , Hernia, Ventral/surgery , Postoperative Complications/epidemiology , Quality of Life , Recurrence , Surgical Mesh , Suture Techniques
14.
Rev. colomb. cir ; 35(3): 422-428, 2020. tab, fig
Article in Spanish | LILACS | ID: biblio-1123175

ABSTRACT

Introducción. Analizamos los costos en el reparo extraperitoneal de la hernia ventral por laparoscopia, desde la perspectiva del sistema general de salud de Colombia, con el fin de mostrar los beneficios de dicho abordaje y su impacto económico, al compararlo con la técnica más implementada, el IPOM plus. Métodos. Se realizó un análisis económico de costo-beneficio, desde la perspectiva del Sistema General de Seguridad Social en Salud (SGSSS) de Colombia, comparando los costos del reparo de hernia ventral con la técnica extraperitoneal, TAPP o TEP, versus el IPOM plus. Se tomaron como costos de referencia lo establecido en el manual tarifario del Instituto de Seguros Sociales. Los datos fueron analizados con Stata V.15 Resultados. Se recolectó y analizó información de 109 procedimientos; 59 del grupo extraperitoneal TAPP/TEP y 50 del grupo IPOM plus, realizados durante los años 2015 a 2018, por el grupo de pared abdominal de Clínica Colsanitas, identificando un ahorro del 69,8 % o resultados de costo-beneficio a favor del grupo extraperitoneal.Discusión. El abordaje extraperitoneal en el reparo de hernia ventral se consideró una estrategia de alto costo-beneficio para el sistema de salud, validado por la experiencia del grupo de pared abdominal de Clínica Colsanitas, al compararla con el abordaje habitual. Teniendo en cuenta que los insumos utilizados para la disección no cambian, la prótesis utilizada para cada una de las técnicas representa un costo importante a considerar, tanto para el sistema como para las instituciones de salud


Introduction. Costs in the extraperitoneal repair of ventral hernia by laparoscopy were analyzed from the perspective of the general health system of Colombia, in order to show the benefits of this approach and its economic impact, when compared with the most implemented technique, IPOM plus. Methods. A cost-benefit economic analysis was performed from the perspective of the General Social Security System in Health (SGSSS) of Colombia, comparing the costs of ventral hernia repair with the extraperitoneal technique, TAPP or TEP, against IPOM plus. The reference costs were taken as established in the rate manual of the Social Security Institute. Data were analyzed with Stata v.15.Results. Information from 109 procedures was collected and analyzed; 59 of the extraperitoneal group TAPP / TEP and 50 of IPOM plus group, carried out during the years 2015 to 2018, by the abdominal wall group of Clinica Colsanitas, identifying a saving of 69,8 % or cost-benefit results in favor of the extraperitoneal group.Discussion. The extraperitoneal approach in ventral hernia repair was considered a high cost-benefit strategy for the health system, validated by the experience of the abdominal wall group of Clínica Colsanitas, when compared with the usual approach. Given that the inputs used for dissection do not change, the prosthesis used for each of the techniques represents an important cost to consider, both for the system and health institutions


Subject(s)
Humans , Hernia, Ventral , Surgical Procedures, Operative , Surgical Mesh , Surgical Wound Infection
15.
Rev. colomb. cir ; 34(1): 25-28, 20190000.
Article in English | LILACS | ID: biblio-982069

ABSTRACT

La estandarización de la reparación de la hernia ventral sigue siendo difícil de alcanzar. Los cirujanos utilizan una gran cantidad de técnicas, herramientas y tecnología para reparar defectos similares. Sin embargo, existen principios basados en la evidencia que deben aplicarse a todas las reparaciones, independientemente de la técnica que permita la estandarización y mejores resultados. Se proponen seis principios como base para la reconstrucción compleja de la pared abdominal


Standardization of ventral hernia repair remains elusive. Surgeons use a plethora of techniques, tools, and technology to repair similar defects. Nevertheless, evidence-based principles exist that should be applied to all repairs irrespective of technique allowing standardization and improved outcomes. Six principles are proposed as the basis for complex abdominal wall reconstruction


Subject(s)
Humans , Hernia, Ventral , Prostheses and Implants , Surgical Procedures, Operative , Herniorrhaphy
16.
Acta cir. bras ; Acta Cir. Bras. (Online);34(6): e201900603, 2019. tab, graf
Article in English | LILACS | ID: biblio-1019263

ABSTRACT

Abstract Purpose To Compare the extent and intensity of adhesions formed between the intra-abdominal organs and the intraperitoneal implants of polypropylene mesh versus polypropylene/polyglecaprone versus polyester/porcine collagen used for correction of abdominal wall defect in rats. Methods After the defect in the abdominal wall, thirty Wistar rats were placed in three groups (ten animals each) for intraperitoneal mesh implant: polypropylene group, polypropylene/polyglecaprone group, and polyester/porcine collagen group. The macroscopic evaluation of the extent and intensity of adhesions was performed 21 days after the implant. Results The polypropylene group had a higher statistically significant impairment due to visceral adhesions (p value = 0.002) and a higher degree of intense adherence in relation to polypropylene/polyglecaprone and polyester/porcine collagen groups (p value<0.001). The polyester/porcine collagen group showed more intense adhesions than the polypropylene/polyglecaprone group (p value=0.035). Conclusions The intraperitoneal implantation of polypropylene meshes to correct defects of the abdominal wall caused the appearance of extensive and firm adhesions to intra-abdominal structures. The use of polypropylene/polyglecaprone or polyester/porcine collagen tissue-separating meshes reduces the number and degree of adhesions formed.


Subject(s)
Animals , Male , Rats , Peritoneal Diseases/etiology , Polyesters/administration & dosage , Polypropylenes/administration & dosage , Surgical Mesh/adverse effects , Tissue Adhesions/etiology , Collagen/administration & dosage , Dioxanes/administration & dosage , Polyesters/adverse effects , Polypropylenes/adverse effects , Materials Testing , Collagen/adverse effects , Rats, Wistar , Abdominal Wall/pathology , Dioxanes/adverse effects
17.
Rev. bras. cir. plást ; 33(1): 56-63, jan.-mar. 2018. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-883638

ABSTRACT

Introdução: Os pacientes com defeitos de parede abdominal chegam ao consultório do cirurgião plástico em situações muitas vezes complexas, necessitando de abordagem cirúrgica avançada. Métodos: Estudo primário, retrospectivo e descritivo de pacientes submetidos a procedimentos cirúrgicos de reconstrução de parede abdominal pelo Serviço de Cirurgia Plástica do Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE). Resultados: Foram revisados e incluídos os prontuários de 18 pacientes, 15 (83,3%) do sexo feminino e 3 (16,7%) do masculino, com idade variando de 16 a 79 anos (média de 41 anos). Dezessete pacientes possuíam histórico de cirurgia prévia (94,4%), sendo a cesárea presente em 8 dos casos (44,4%), seguida de cirurgia oncológica com 6 (33,3%), cirurgia do trauma com 2 (11,1%) e bariátrica com 2 (11,1%). Em relação à etiologia do defeito, 8 (44,4%) eram decorrentes de fasciite necrosante, 4 (22,2%) de hérnia incisional, 2 (11,1%) por trauma, 2 (11,1%) por infecção de ferida operatória e 2 (11,1%) por neoplasia de parede abdominal, sendo somente um (5,5%) paciente com defeito de espessura total. A técnica cirúrgica de separação dos componentes foi realizada em 7 dos casos (38,9%), seguida de retalho de avanço simples em 6 (33,3%), fechamento com tela associado à abdominoplastia em 3 (16,7%), e expansor tecidual em 2 (11,1%). Quanto às complicações, houve 4 casos (22,2%). Conclusões: Defeitos de parede abdominal são casos desafiadores para o cirurgião plástico, seu tratamento se mostra árduo, porém com resultados satisfatórios mesmo nos casos mais severos.


Introduction: Patients with abdominal wall defects present challenging complications that require the use of advanced surgical approaches. Methods: This primary, retrospective, and descriptive study evaluated patients who underwent abdominal wall reconstruction at the Plastic Surgery Service of the Clinics Hospital of the Federal University of Pernambuco. Results: The medical records of 18 patients were reviewed, including 15 women (83.3%) and 3 men (16.7%), with a mean age of 41 years (range, 16-79 years). Seventeen patients (94.4%) had a history of previous surgery. The causes of abdominal injury were cesarean section in eight cases (44.4%), oncologic surgery in six (33.3%), trauma surgery in two (11.1%), and bariatric surgery in two (11.1%). The etiology of the defect was necrotizing fasciitis in eight cases (44.4%), incisional hernia in four (22.2%), trauma in two (11.1%), surgical wound dehiscence in two (11.1%), abdominal wall neoplasia in two (11.1%), and total thickness defect in one (5.5%). The surgical interventions included the component separation technique in seven cases (38.9%), simple VY advancement flap in six (33.3%), closure with abdominoplasty in three (16.7%), and tissue expander in two (11.1%). Four patients (22.2%) presented complications. Conclusions: Abdominal wall defects are challenging cases for plastic surgeons, as their treatment is difficult, but the results are satisfactory even in the most severe cases.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , History, 21st Century , Minor Surgical Procedures , Medical Records , Retrospective Studies , Fasciitis, Necrotizing , Plastic Surgery Procedures , Abdominal Wall , Hernia, Abdominal , Abdomen , Fascia , Hernia, Ventral , Minor Surgical Procedures/adverse effects , Minor Surgical Procedures/methods , Medical Records/statistics & numerical data , Fasciitis, Necrotizing/surgery , Fasciitis, Necrotizing/complications , Plastic Surgery Procedures/instrumentation , Plastic Surgery Procedures/methods , Abdominal Wall/abnormalities , Abdominal Wall/surgery , Hernia, Abdominal/surgery , Hernia, Abdominal/complications , Fascia/injuries , Abdomen/surgery , Hernia, Ventral/surgery , Hernia, Ventral/complications
18.
Rev. Col. Bras. Cir ; 45(6): e2040, 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-976944

ABSTRACT

RESUMO Objetivo: comparar a formação de aderências intraperitoneais, induzidas em ratos, quando utilizadas as telas de polipropileno e Sepramesh®. Métodos: foram utilizados 20 ratos Wistar, machos, agrupados randomicamente em dois grupos de dez animais cada. Duas telas de dimensão 10x20mm foram dispostas intraperitonealmente em cada animal, uma de polipropileno (PP) e a outra Sepramesh®. No Grupo 1, a tela de polipropileno foi posicionada à direita e a tela Sepramesh® à esquerda. No Grupo 2, a disposição das telas foi invertida. Após 14 dias do procedimento, os animais foram eutanasiados e a incorporação e a porcentagem de aderências, em cada tela, analisadas macroscopicamente. Os dados coletados foram submetidos à análise estatística com nível de significância adotado de p<0,05. Resultados: todas as telas apresentaram aderências. Nas telas Sepramesh®, a porcentagem de superfície coberta por aderências variou entre 2% e 86%, com média de 18,6±18,6%, enquanto que, nas telas de polipropileno, variou entre 6% e 86%, com média de 57,4%±34,9% (p<0,05). Os sítios preferenciais de formação de aderências, em ambas as telas, foram as bordas. Conclusão: embora nenhuma tela tenha sido capaz de inibir completamente o desenvolvimento de aderências, a tela Sepramesh® apresentou menos aderências em relação à tela de polipropileno. A preferência da formação de aderências nas bordas das próteses evidencia a importância da fixação adequada das telas.


ABSTRACT Objective: to compare the formation of induced intraperitoneal adhesions in rats when using polypropylene and Sepramesh® meshes. Methods: we used 20 male Wistar rats, randomly grouped in two groups of ten animals each. We arranged two 10x20mm meshes intraperitoneally into each animal, one being the polypropylene (PP), and the other, Sepramesh®. In Group 1, the polypropylene mesh was positioned to the right, and the Sepramesh®, to the left. In Group 2, the meshes' layout was reversed. After 14 days of the procedure, we euthanized the animals and analyzed the incorporation and percentages of adhesions macroscopically in each mesh. We submitted the collected data to statistical analysis with a significance level of 5% (p<0.05). Results: all meshes showed adhesions. In the Sepramesh® ones, the percentage of surface covered by adhesions ranged from 2% to 86%, with a mean of 18.6±18.6%, while in the polypropylene meshes, it varied between 6% and 86%, with an average of 57.4%±34.9% (p<0.05). The preferred adhesion sites on both meshes were the edges. Conclusion: although no mesh was able to completely inhibit the development of adhesions, the Sepramesh® mesh presented less adhesions to the polypropylene mesh. The most common sites of adhesion formation were the edges of the prosthesis, which evidences the importance of the adequate fixation of the meshes.


Subject(s)
Animals , Male , Rats , Peritoneal Diseases/prevention & control , Polypropylenes , Surgical Mesh , Tissue Adhesions/prevention & control , Coated Materials, Biocompatible , Hernia, Ventral/surgery , Postoperative Complications/prevention & control , Rats, Wistar , Disease Models, Animal
19.
Article in Chinese | WPRIM | ID: wpr-733686

ABSTRACT

Objective To investigate the clinical features, diagnosis and treatment of colorectal cancer in patients with incarcerated extracorporeal hernia. Methods The clinical manifestations, diagnosis and treatment of 9 cases of incarcerated hernias combined with colorectal cancer from January 2012 to December 2017 were retrospectively analyzed. Results All the patients were treated with surgery. Three cases underwent Hartmann surgery and incarcerated release, high ligation of hernia sac; 2 cases underwent tumor resection and tension-free hernia repair; 1 case underwent necrotic bowel resection, tumor resection and ileal stoma and tension-free hernia repair; 1 case underwent transverse colostomy and incarcerated release, high cyst ligation; 1 case underwent tension-free hernia repair and limited colon cancer radical resection; 1 case underwent high ligation of the hernia sac and limited tumor resection. Intraoperative and postoperative pathology confirmed that this group was all incarcerated abdominal hernia combined with colorectal cancer. There were 4 patients misdiagnosed before surgery. Conclusions The diagnosis and treatment often ignore the presence of colorectal cancer due to the typical clinical manifestations of incarcerated abdominal hernia. The preoperative misdiagnosis rate is high. Completing CT scans before surgery can help clarify the diagnosis and select a reasonable surgical approach.

20.
ABCD (São Paulo, Impr.) ; 30(2): 108-113, Apr.-June 2017. graf
Article in English | LILACS | ID: biblio-885701

ABSTRACT

ABSTRACT Background: Extramedullary hematopoiesis depends on complex pathophysiological mechanisms linked to hematopoietic stem cells and the proteins considered mediators of the inflammation. The identification of hematopoietic cells outside bone marrow in the adult is an occurrence that can occasionally follows the inflammatory response, was considered a secondary occurrence, but current biomolecular studies have changed that concept. Aim: Describe the presence of clusters of precursor cells of platelets (megakaryocytes), and cells of the inflammatory response in the abdominal wall and spleen of rats with experimentally induced incisional hernias and repaired with different synthetic prostheses. Methods: Twenty-five rats with incisional hernias previously performed, were divided into groups of five animals each: Group 1, repair of the hernia defect without prosthetic implant; Group 2, repair with polypropylene prosthesis; Group 3, repair using polypropylene with low weight; Group 4, the use of polypropylene and polyglecaprone prosthesis; Group 5, of polypropylene and polyglactin prosthesis. All prostheses were cut in rhombus format with area 2,625 cm². The animals were reoperated after 10 days, the abdominal walls were removed with the viscera attached to them and the material was processed for histological study. Results: Megakaryocyte niches in the abdominal wall and spleen, occasionally removed together with the adhesions produced in animals with implantation of prostheses and significant inflammatory reaction. Conclusion: The intense inflammatory reaction due to the prostheses with polypropylene in their composition was disproportionate to the expected response, indicating that further studies should be accomplished including immunophenotyping evaluation and specific panels of monoclonal antibodies to better understand the findings.


RESUMO Racional: A hematopoiese extramedular depende de mecanismos fisiopatológicos complexos, havendo relação destas células-tronco hematopoiéticas com proteínas mediadoras da inflamação. A identificação de células hematopoiéticas fora da medula óssea no adulto, situação que ocasionalmente pode acompanhar a resposta inflamatória era considerada ocorrência secundária, mas estudos biomoleculares modificaram este conceito. Objetivo: Descrever agrupamentos de células precursoras das plaquetas (megacariócitos) e células da resposta inflamatória, na parede abdominal e no baço de ratos com hérnias incisionais induzidas experimentalmente e reparadas com diferentes próteses sintéticas. Métodos: Vinte e cinco ratos com hérnias incisionais previamente realizadas foram distribuídos em grupos com cinco animais: Grupo 1, reparo do defeito herniário sem implante de prótese; Grupo 2, reparo com prótese de polipropileno; Grupo 3, reparo empregando polipropileno com baixa gramatura; Grupo 4, utilização de prótese de polipropileno e poliglecaprone; Grupo 5, prótese de polipropileno e poliglactina. Todas as próteses foram recortadas na forma de losangos com área de 2,625 cm². Os animais foram reoperados após 10 dias, as paredes abdominais foram retiradas em bloco com as vísceras a elas aderidas e o material foi processado em rotina histológica. Resultados: Foram evidenciados nichos de megacariócitos na parede abdominal e no baço coletado juntamente com as aderências em animais com implante de próteses, além de reação inflamatória significativa. Conclusão: A intensa reação inflamatória, local e sistêmica em relação às próteses com polipropileno em sua composição, foi desproporcional à resposta esperada, requerendo aprofundamento do estudo com avaliação da imunofenotipagem e painéis específicos de anticorpos monoclonais para melhor esclarecimento.


Subject(s)
Animals , Rats , Spleen/cytology , Blood Platelets , Abdominal Wall , Incisional Hernia/surgery , Incisional Hernia/immunology , Inflammation/etiology , Polymers , Prosthesis Design , Stem Cells , Surgical Mesh/adverse effects , Rats, Wistar , Inflammation/immunology
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