Estudio comparativo de herniorrafía en emergencia y en situaciones electivas / Comparison study of herniorrhaphy at emergency and elective situations

La hernia inguinal es uno de los problemas urgentes más comunes encontrados por los cirujanos. Hubo 145 pacientes tratados debido al diagnóstico de hernia inguinal. De 44 pacientes que fueron operados en condiciones de emergencia. Alrededor de 131 casos (106 hombres y 25 mujeres) fueron tratados con reparación de malla preperitoneal abierta unilateral. Los pacientes fueron examinados en términos de complicaciones postoperatorias. Los datos recopilados incluidos como edad, sexo, historial médico, afecciones de cirugía, encarcelamiento y estrangulamiento. Hubo un total de 145 pacientes incluidos en el estudio; en el que 44 de ellos (29 hombres y 15 mujeres, rango de edad: 30-72) (Grupo I) fueron operados en condiciones de emergencia y 101 de ellas (51 hombres y 50 mujeres, rango de edad: 25-78) (grupo Ii) fueron operados en condiciones electivas. Hubo comorbilidad en 31 pacientes de grupo I y 77 pacientes del grupo II. Alrededor del 47.7% (n = 21) de los casos que se sometieron a cirugía emergente debido al encarcelamiento, mientras que el 43.6% (n = 44) de los casos que fueron operados en condiciones electivas. Había 12 hernias femorales en el Grupo I y 19 Hernia femoral en el Grupo II. No hay diferencia entre la complicación postoperatoria y las tasas de recurrencia en los casos de hernia inguinal operados en condiciones electivas y en condiciones de emergencia. Es más barato que la reparación laparoscópica, el control del dolor de plomo y la falta de dolor neuropático, tiene complicaciones menos testiculares, y es más ventajoso que otros enfoques abiertos

Inguinal hernia is one of the most common urgent problems encountered by surgeons. There were 145 patients treated due to inguinal hernia diagnosis. Out of 44 patients who were operated under emergency conditions. About 131 cases (106 male and 25 female) were treated with unilateral open preperitoneal mesh repair. Patients were examined in terms of postoperative complications. Data collected included as age, gender, medical history, surgery conditions, incarceration and strangulation. There were total of 145 patients included in the study; in which 44 of them (29 male and 15 female, range of age: 30- 72) (group I) were operated under emergency conditions and 101 of them (51 male and 50 female, range of age: 25-78) (group II) were operated under elective conditions. There was comorbidity in 31 patients of group I and 77 patients of group II. About 47.7% (n=21) of cases who underwent emergent surgery due to incarceration, while 43.6% (n=44) of cases who were operated under elective conditions. There were 12 femoral hernias in group I and 19 femoral hernia in group II. There is no difference between postoperative complication and recurrence rates in inguinal hernia cases operated under elective conditions and under emergency conditions. It is cheaper than laparoscopic repair, lead pain control and lack of neuropathic pain, has less testicular complications, and it is more advantageous than other open approaches.

Hernia of De Garengeot an up to date of diagnosis, initial management and treatment: a narrative review and a case study report / Hernia de De Garengeot: diagnóstico, manejo inicial y tratamiento actualizados: una revisión narrativa y un informe de estudio de caso

INTRODUCTION A De Garengeot hernia is defined by a femoral hernia containing the appendix. Acute appendicitis within a femoral hernia is an extremely rare surgical presentation and occurs in only 0.08-0.013% of cases cited in the literature and 5 to 15% of all femoral hernias. CASE PRESENTATION A 53-year-old woman presented to the emergency room of our hospital in our ward with acute onset of a right-sided inguinal swelling that occurred earlier that day after performing a heavy lift. Her examination revealed acute appendicitis contained within an incarcerated right femoral hernia. The patient underwent laparoscopic appendectomy with open femoral hernia repair. Intraoperatively, the tip of the appendix was incarcerated within the hernial sac. She was removed through the open inguinal incision after the base of the appendix has been divided laparoscopically. The final pathology showed acute inflamed appendicitis with no evidence of neoplasm. DISCUSSION Physicians should be aware of the rare extent of an unusual presentation of appendicitis such as well as surgical options for treatment. The literature does not conclude on a gold standard for the method of approach. CONCLUSION De Garengeot's hernia remains a rare and unusual surgical presentation of femoral hernia, and the complication of the case by incarceration leading to acute appendicitis provides a challenging surgical approach that should be personalized for each patient

Femoral hernia: uncommon, but associated with potentially severe complications / Hérnia femoral: incomum, mas associada a complicações potencialmente graves

ABSTRACT Background: Although the laparoscopic access is becoming the preferable treatment for femoral hernia, there are only few studies on this important subject. Aim: To assess the outcomes of the totally extraperitoneal laparoscopic (TEP) access in the treatment of femoral hernia. Methods: Data of 62 patients with femoral hernia who underwent herniorrhaphy were retrospectively reviewed. The diagnosis of femoral hernia was established by clinical and/or imaging exams in 55 patients and by laparoscopic findings in seven. Results: There were 55 (88.7%) females and 7 (11.3%) males, with female to male ratio of 8:1. The mean age was of 58.9±15.9 years, ranging from 22 to 92 years. Most patients (n=53; 85.5%) had single hernia and the remaining (n=9; 14.5%) bilateral, making a total of 71 hernias operated. Prior lower abdominal operations were recorded in 21 (33.9%) patients. Conversion to laparoscopic transabdominal preperitoneal procedure was performed in four (6.5%). Open herniorrhaphy was needed in two (3.2%), one with spontaneous enterocutaneous fistula in the groin region (Richter's hernia) and the another with incidental perforation of the adjacent small bowel that occurred during dissection of hernia sac. There was no mortality. Conclusion: Femoral hernia is uncommon, and it may be associated with potentially severe complications. Most femoral hernias may be successfully treated with totally extraperitoneal laparoscopic access, with low conversion and complication rates.

RESUMO Racional: Embora o acesso laparoscópico esteja se tornando o tratamento preferencial para a hérnia femoral, poucos são os estudos sobre esse importante assunto. Objetivo: Avaliar os resultados do acesso laparoscópico totalmente extraperitoneal no tratamento da hérnia femoral. Métodos: Os dados de 62 pacientes com hérnia femoral que foram submetidos a herniorrafia foram revisados ​​retrospectivamente. O diagnóstico foi estabelecido por exames clínicos e/ou de imagem em 55 pacientes e por achados laparoscópicos em sete. Resultados: Havia 55 (88,7%) mulheres e 7 (11,3%) homens, com proporção feminino/masculino de 8: 1. A média de idade foi de 58,9±15,9 anos (22-92). A maioria (n=53, 85,5%) apresentava hérnia única e o restante (n=9, 14,5%) bilaterais, perfazendo um total de 71 hérnias femorais operadas. Operações prévias no abdome inferior foram registradas em 21 (33,9%) pacientes. A conversão para procedimento pré-peritoneal transabdominal laparoscópico foi realizada em quatro (6,5%). Herniorrafia aberta foi necessária em dois pacientes (3,2%), um com fístula enterocutânea espontânea na região da virilha (hérnia de Richter) e o outro com perfuração incidental do intestino delgado adjacente que ocorreu durante a dissecção do saco herniário. Não houve mortalidade. Conclusão: A hérnia femoral é incomum e pode estar associada a complicações potencialmente graves. A maioria das hérnias femorais pode ser tratada com sucesso através do acesso laparoscópico totalmente extraperitoneal, com baixas taxas de conversão e complicações.

Reparo das hérnias abertas e laparoscópicas no Sistema Público de Saúde brasileiro. Estudo nacional baseado em dados populacionais em período de 11 anos / Open vs laparoscopic hernia repair in the brazilian public health system. an 11-year nationwide population-based study

ABSTRACT BACKGROUND: Abdominal wall hernia is one of the most common surgical pathologies. The advent of minimally invasive surgery raised questions about the best technique to be applied, considering the possibility of reducing postoperative pain, a lower rate of complications, and early return to usual activities. OBJECTIVE: To evaluate the frequency of open and laparoscopic hernioplasties in Brazil from 2008 to 2018, analyzing the rates of urgent and elective surgeries, mortality, costs, and the impact of laparoscopic surgical training on the public health system. METHODS: Nationwide data from 2008 to 2018 were obtained from the public health registry database (DATASUS) for a descriptive analysis of the selected data and parameters. RESULTS: 2,671,347 hernioplasties were performed in the period, an average of 242,850 surgeries per year (99.4% open, 0.6% laparoscopic). The economically active population (aged 20-59) constituted the dominant group (54.5%). There was a significant reduction (P<0.01) in open surgeries, without a compensatory increase in laparoscopic procedures. 22.3% of surgeries were urgent, with a significant increase in mortality when compared to elective surgeries (P<0.01). The distribution of laparoscopic surgery varied widely, directly associated with the number of digestive surgeons. CONCLUSION: This study presents nationwide data on hernia repair surgeries in Brazil for the first time. Minimally invasive techniques represent a minor portion of hernioplasties. Urgent surgeries represent a high percentage when compared to other countries, with increased mortality. The data reinforce the need for improvement in the offer of services, specialized training, and equalization in the distribution of procedures in all regions.

RESUMO CONTEXTO: Hérnias de parede abdominal são patologias cirúrgicas frequentes. O surgimento da cirurgia minimamente invasiva levantou questionamentos sobre a melhor técnica a ser aplicada, considerando a possível redução de dor pós-operatória e de complicações, e retorno precoce às atividades habituais. OBJETIVO: Avaliar frequência de hernioplastias abertas e laparoscópicas no Brasil entre os anos de 2008 e 2018, analisar taxas de cirurgias urgentes e eletivas, mortalidade, custos e o impacto do treinamento em cirurgia laparoscópica no sistema público de saúde. MÉTODOS Análise de banco de dados do registro de saúde pública (DATASUS) entre 2008 e 2018 para coleta dos dados e parâmetros selecionados. RESULTADOS: Foram realizadas 2.671.347 hernioplastias no período, média de 242.850 cirurgias/ano (99,4% abertas, 0,6% laparoscópicas). Predominou a faixa etária economicamente ativa (20-59 anos), 54,5% do total. Houve redução significativa das cirurgias abertas (P<0,01), sem aumento compensatório da laparoscopia. 22,3% das cirurgias foram de urgência, com aumento significativo da mortalidade em relação às cirurgias eletivas (P<0,01). Observou-se distribuição heterogênea da videolaparoscopia, diretamente relacionada com o número de cirurgiões digestivos. CONCLUSÃO: Este estudo apresenta pela primeira vez os dados populacionais das cirurgias de hérnia no Brasil. As técnicas minimamente invasivas representam uma parcela pouco significativa das hernioplastias. As cirurgias urgentes apresentam percentual elevado comparado a outros países, com aumento significativo na mortalidade, reforçando a necessidade de políticas que permitam aumento da oferta do serviço, treinamento especializado e equalização na distribuição dos procedimentos em todas as regiões.

Hernia de Garengeot: presentación de un caso y revisión de la literatura / De Garengeot hernia: a case report and literature review

INTRODUCTION: Femoral hernias have a high risk of strangulation or obstruction, and their acute presentations are associated with a high risk of mortality, occurring in up to 60% of cases with complications. The presence of the appendix within the femoral sac has been described in a maximum of 1% of cases, which has been called Garengeot hernia, but only 0.08% with concomitant appendicitis. CASE REPORT: Woman 56 years old, cholecystectomized, with no other relevant history, 5 months of evolution, right femoral region volume increase, consultation for 24 hours of evolution of habitual pain exacerbation, CT scan showing complicated hernia, with appendix inside of the hernial sac. The right inguinal approach is performed, the cecal appendix is the only content within the hernial sac, with signs of acute appendicitis, appendectomy and hernia repair with Prolene mesh. Diagnosis is confirmed with biopsy. DISCUSSION AND CONCLUSION: Acute appendicitis within De Garengeot's hernia is extremely rare and often difficult to diagnose. The diagnosis of a femoral hernia appendicitis is often obscured by nonspecific clinical findings that indicate a complicated hernia. Computed tomography may be useful to definitively diagnose acute appendicitis contained within a femoral hernia. It is important to always consider De Garengeot hernia as a differential diagnosis in patients with inguinal mass of acute pain, so as not to delay its detection and management.

Femoral hernia containing the right fallopian tube: a rare finding / Hérnia femoral contendo a trompa de falópio direita: um achado raro

Abstract Femoral hernias comprise a small proportion of all groin hernias. They are more common in women and have a high rate of incarceration and strangulation, leading to emergency repair. A 61-year-old female patient was admitted to the emergency department complaining of a 2-day painful lump in the right groin, that had become more intense in the last 24 hours. Physical examination suggested the presence of a strangulated femoral hernia, and the patient underwent emergency surgical repair. Intraoperatively, the right fallopian tube was observed in the hernia sac. Since there were no signs of ischemia, the tube was reduced back into the pelvic cavity and the hernia was repaired. The postoperative period was uneventful, and the patient was discharged without complications, 3 days after surgery.

Resumo As hérnias femorais representamuma pequena fração de todas as hérnia da região inguinal. Elas são mais comuns entre as mulheres e estão associadas a elevadas taxas de complicações, como encarceramento e estrangulamento, com necessidade de cirurgia urgente. Uma paciente do sexo feminino, de 61 anos, recorreu ao serviço de emergência por quadro de dor e tumefação da região inguinal direita com 2 dias de evolução e agravamento nas últimas 24 horas. O exame objetivo sugeria a presença de uma hérnia femoral encarcerada, e a paciente foi submetida a cirurgia urgente. Intraoperatoriamente, confirmou-se o diagnóstico de hérnia femoral encarcerada, que continha a trompa de falópio direita no interior do saco herniário. Uma vez que a que a trompa não apresentava sinais de isquemia, o conteúdo da hérnia foi reduzido, e procedeu-se à sua reparação. O período pós-operatório decorreu sem intercorrências, e a paciente teve alta no 3° dia após a cirurgia.

Inflamed Appendix in an Incarcerated Femoral Hernia / Apéndice inflamado en una hernia femoral incarcerada

ABSTRACT The presence of appendicitis in an incarcerated femoral hernia is an extremely rare occurrence, known as De Garengeot's hernia, with potentially serious complications. An incarcerated femoral hernia was noticed intraoperatively, and the hernial sac, closely fused with femoral blood vessels, contained the phlegmonously inflamed vermiform appendix. Appendectomy and mesh hernioplasty were carried out. The postoperative period was uneventful.

RESUMEN La presencia de apendicitis en una hernia femoral incarcerada es una condición extremadamente rara, conocida como hernia de Garengeot, la cual presenta complicaciones potencialmente serias. Una hernia femoral incarcerada fue observada intraoperativamente, y el saco herniario, estrechamente fusionado con los vasos sanguíneos femorales, contenía el apéndice vermiforme con una inflamación flemónica. Se realizaron una apendicectomía y una hernioplastia con malla. El período postoperatorio se desarrolló sin problemas.

Fascitis necrotizante de la pared abdominal como presentación infrecuente de una hernia de Garengeot: caso clínico / Necrotizing fasciitis caused by a Garengeot's hernia: case report

Garengeot's hernia corresponds to the presence of the appendix within a femoral hernia, associated or not with acute appendicitis. The diagnosis of this uncommon situation is usually done during surgery. Furthermore, the clinical presentation as necrotizing fasciitis is a rare condition. We report a 54 years old obese hypertensive woman with rheumatoid arthritis of 40 years of evolution treated with methotrexate and prednisone. She consulted for pain and erythema in the right inguinal region. Laboratory revealed leukocytosis and an elevated C-reactive Protein. Suspecting a cellulitis, the patient was admitted for antimicrobial therapy. A pelvic magnetic resonance imaging showed a perforated acute appendicitis in an inguinal hernia with extensive pelvic cellulitis associated with signs of fasciitis. At surgery, an extensive groin and pubic fasciitis was evident, with a necrotic and perforated appendix within a femoral hernia. Surgical debridement, open appendectomy, and femoral hernioplasty without mesh were carried out. Vacuum-assisted closure was installed in the coverage defect. Three surgical debridement procedures were required for the closure of the wound. Two weeks after the first surgical procedure, the patient was discharged in good condition. During the follow-up, she evolved with a surgical wound dehiscence, which was managed with wound dressings until closure.

Hernia de Garengeot. A propósito de un caso / De Garengeot´s hernia. Apropos of a case

RESUMEN El epónimo hernia De Garengeot queda reservado para describir la presencia del apéndice cecal dentro de un saco herniario crural. Es infrecuente el hallazgo del apéndice dentro del canal femoral, situación que se presenta en el 0.9 % de las hernias femorales. La presencia de apendicitis dentro del canal femoral es una rareza, representando del 0.13 a 0.8% de todos los casos de apendicitis aguda. Se presenta un caso, se describe el cuadro clínico y el tratamiento quirúrgico (AU).

ABSTRACT The eponym De Garengeot´s hernia is reserved to describe the presence of the cecal appendix inside a crural hernia sac. It is infrequent to find the appendix inside the femoral canal, location presented in 0.9 % of femoral hernias. The presence of appendicitis inside the femoral canal is a rarity representing from 0.13 to 0.8 % of all the cases of acute appendicitis. A case is presented, and the clinical characteristics and the surgical treatment are described (AU).

Hernia femoral de Littré estrangulada: reporte de caso clínico / Strangulated Littré femoral hernia: case report

Resumen Objetivo: Presentar un caso de hernia femoral de Littré estrangulada. Caso clínico: Hombre de 86 años, que consultó por cuadro de dolor abdominal periumbilical postraumático de 4 días de evolución que se acompañaba de vómitos y ausencia de deposiciones con tránsito de gases conservado. Destacaba al examen masa dolorosa e indurada de 3 cm de diámetro no reductible bajo arcada inguinal derecha. Se realizó una herniorrafia femoral con abordaje preperitoneal, identificando una hernia de Littré estrangulada y realizándose una resección intestinal más reparación tisular del defecto herniario. Conclusión: Las hernias de Littré femorales son una entidad extremadamente rara y el manejo quirúrgico óptimo no está establecido.

Abstract Objective: To present a case of strangulated Littré femoral hernia. Clinical case: 86 years old man with 4 days of post-traumatic periumbilical abdominal pain accompanied by vomiting and absence of stools with gas transit preserved. Examination highlighted a painful and indurated mass of 3 cm in diameter that it was not reducible below right inguinal arch. A femoral hernia repair with preperitoneal approach was performed by identifying a strangulated Littré hernia performing bowel resection and tissue repair of the hernia defect. Conclusion: Littré femoral hernias are an extremely rare entity and optimal surgical management is not established.

Intervenciones en hernias inguinocrurales: bilateralidad y recidiva hemiaria. Servicio de Cirugía del Hospital Naval de Viña del Mar / Reoperations in femoral and inguinal hernias: bilaterality and relapse. Surgery Service in the Navy Hospital Viña del Mar

Introducción: En nuestro país la hernioplastia inguinocrural es una de las intervenciones quirúrgicas más frecuentes, pero hay escasos estudios acerca de los resultados a largo plazo. Materiales y método: Estudio observacional de cohorte retrospectiva utilizando base de datos, fichas clínicas y electrónicas, con el objeto de analizar las causas de reintervenciones en hernioplastias inguinocrurales desde el año 2000 hasta el 2010, con seguimiento hasta junio del 2015. Resultados y discusión: Se realizaron 1.765 intervenciones con los códigos de hernia inguinal y femoral, de los cuales 100 casos requirieron reintervención: 84 hombres y 16 mujeres, con edad promedio de 62 años para la primera cirugía. En un tercio se encontró HTA, y en el 38% de los hombres uropatía obstructiva, sin ser estadísticamente significativo (p = 0,6). Se demostró intervención por hernia contralateral en el 38% de los casos, con aparición predominante dentro de los 3 primeros años desde la primera cirugía; en el 37% se demostró recidiva herniaria. Los pacientes que recidivaron equivalen al 2,7% del total de cirugías realizadas, pero al considerar las recidivas solo con técnica de Lichtenstein, esta fue del 1,7% con respecto al total de hernioplastias realizadas, presentándose dentro de los 3 primeros años. En 5 casos se demostró doble recidiva y en 2 casos triple recidiva. Cinco pacientes presentaron complicaciones: 2 hematomas, un seroma, una inguinodinia crónica y un paciente falleció por obstrucción intestinal postoperatoria. Conclusión: Nuestros resultados son similares a casuísticas nacionales y metaanálisis reportados en cuanto a tipo de pacientes, comorbilidades asociadas y porcentaje de recidiva a largo plazo, con menor tasa de complicaciones.

Introduction: In our country, hernioplasty for inguinocrural hernia is one of the most frequent surgical procedures, but there are scanty studies bring over of the long-term results. Materials and method: Observational retrospective cohort study, using clinical data base of patient's clinical history, in order to analyze the cause of reoperations on our inguinocrural hernioplasty data base, from the year 2000 to the year 2010, and with a follow up until June 2015. Results and discussion: In total they were performed 1,765 interventions coded crural and inguinal hernia, 100 cases required reoperation, 84 men and 16 women with an average age of 62 years for the first surgery. In a third hypertension was found, and in 38% of men, obstructive uropathy, not statistically significant (P=.6). Reoperation for contralateral hernia was performed in 38% of the cases, with predominant appearance within the first three years after the first surgery; in 37% of the cases, hernia recurrence was demonstrated. Patients, who recurred, were equivalent to 2.7% of all surgeries performed, but considering Lichtenstein technique, it was only 1.7% of all hernioplasties, occurring within the first three years. In 5 cases, we found double recurrence, and triple recurrence in two. Five patients had complications: two bruising, seroma, chronic inguinal pain and one death by postoperative intestinal obstruction. Conclusion: Our results were similar to those reported in our country in relation to the type of patients, comorbidities and recurrence at long-term, but with a lower rate of complications.

Cirugía laparoscópica de una hernia de Garengeot: presentación poco frecuente de una hernia crural / Laparoscopic Surgery of a Garengeot's Hernia: A rare presentation of a crural hernia

Introducción: La hernia de Garengeot es una rara presentación de una hernia crural. Caso clínico: Se presenta el caso de una mujer de 64 años de edad, que consultó por dolor en fosa ilíaca derecha. Se le realizó una tomografía axial, que mostró un proceso inflamatorio en cuadrante inferior derecho del abdomen. Se le practicó una laparoscopia exploradora, encontrando el apéndice cecal en el anillo crural. Se realizó apendicectomía y reparación de la hernia vía laparoscópica. En nuestra revisión este es el tercer caso publicado en el mundo de resolución laparoscópica, y el primero en Chile.

Background: Garengeot's hernia is a rare presentation of a femoral hernia. Case report: We report a case of a 64 year-old female patient complaining of right lower abdominal pain. She was studied by CT-Scan that showed an inflammatory process in right lower cuadrant. We made an exploratory laparoscopy and found the cecal appendix in the crural defect. We did a laparoscopic appendectomy and crural hernia repair with mesh. To our knowledge, this is the third laparoscopic case published in the world and the first of Chile.

Diez años de experiencia empleando la técnica con plug de Lichtenstein en la hernia femoral / Femoral Hernia. Ten years of experience in using the Lichtenstein Plug Technique

Introducción: se han desarrollado diversas técnicas para la reparación de la hernia femoral. La técnica con el Plug de Lichtenstein desde el año 1989 ha permitido obtener un menor índice de complicaciones y recidivas, así como una recuperación temprana de las actividades habituales del paciente. Su aplicación, ampliamente difundida en la cirugía electiva, también puede realizarse en la cirugía de urgencia. El objetivo de este trabajo es valorar la experiencia de nuestro grupo básico de trabajo en el tratamiento quirúrgico de la hernia femoral mediante la aplicación de esta técnica. Métodos: se realizó un estudio observacional descriptivo con carácter retrospectivo en nuestro grupo básico de trabajo, del servicio de cirugía del Hospital General Docente Enrique Cabrera entre los años 2001 al 2010, a un conjunto de pacientes a los cuales se les aplicó la técnica del Plug de Lichtenstein para la reparación de la hernia femoral. Se estudiaron las variantes anatómicas de las hernias así como las complicaciones posoperatorias y la evolución clínica. Resultados: la edad media de los pacientes fue de 58,7 años (19-92 años) y el sexo femenino fue el de mayor incidencia (78 por ciento), además la localización más frecuente, la derecha (67,5 por ciento). La prótesis empleada en la hernioplastia fue la de polipropileno. Se aplicó la anestesia local a 29 pacientes (63 por ciento). El tiempo quirúrgico medio fue de 25 minutos (15-65 minutos). La deambulación fue precoz y la estancia media hospitalaria fue menos de 24 horas, en la mayoría de los pacientes. Solo se constató una infección de la herida y una recidiva herniaria en un paciente. Conclusiones: la técnica del Plug de Lichtenstein debe considerarse entre las de elección en el tratamiento de la hernia femoral(AU)

Introduction: many technical procedures have been developed to repair femoral hernia. Since 1989, the Lichtenstein Plug technique has allowed lower rates of post operative complications and recurrence as well an earlier recovery of the daily life activities of the patients. This technique, widely known in elective surgery, can also be performed in the emergency surgery. Objective: to assess the experience of our basic working team in the surgical treatment of the femoral hernia through this technique. Methods: a retrospective, descriptive and observational study was conducted by our basic working team from the surgery service at Dr. Enrique Cabrera General Teaching Hospital from 2001 to 2010, which covered the patients who underwent surgical repair of femoral hernia through the Lichtenstein Plug technique. The anatomical variants of the hernias as well as the postoperative complications and the clinical progress were studied. Results: the mean age of the patients were 58.7 years old, (19-92 years), with prevalence of females (78 percent). The most frequent location of hernias was on the right (67.5 percent). Polypropylene reticular mesh was the most commonly used. Local anaesthesia was applied in 29 patients (63 percent), and the mean surgical time was 25 minutes (15-65 minutes). The average length of stay at hospital was less than 24 hours. Just one patient developed wound sepsis and herniary recurrence. Conclusions: the Lichtenstein Plug procedure should be regarded as a choice in treating femoral hernia(AU)

Hernioplastia de Jean Rives en pacientes con hernia inguinofemoral / Jean Rives´ hernioplasty in patients with inguinofemoral hernia

Se efectuó un estudio descriptivo, longitudinal y observacional sobre los primeros 120 pacientes operados de hernia inguinal con la técnica de hernioplastia de Jean Rives en el Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, desde enero de 2001 hasta igual mes de 2009. En la serie, 56,6 por ciento de sus integrantes eran hombres, con una edad media de 64,4 años; en tanto 50,8 por ciento del total presentaban hernias primarias, con predominio del estadio III-B de la clasificación de Nyhus. Como profilaxis antibiótica predominó la cefazolina (67,5 por ciento); y como material protésico, el polipropilene (73,3 por ciento). Se utilizó anestesia local y sedación en 56,6 por ciento de la casuística. Las complicaciones posoperatorias representaron 2,4 por ciento y no se produjo recurrencia herniaria. El mencionado procedimiento es seguro y eficaz para la reparación quirúrgica de las hernias inguinocrurales.

A descriptive, longitudinal, and observational study on the first 120 patients surgically treated due to inguinal hernia using Jean Rives´hernioplasty technique at Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba was carried out from January, 2001 to January, 2009. In the series, 56,6 percent of its members were male, having a mean age of 64,4 years; meanwhile 50,8 percent out of the total had primary hernias, with a prevalence of III-B stage according to Nyhus classification. Cefazolin (67,5 percent) and polypropilene (73,3 percent) prevailed as antibiotic prophylaxis and prosthesis material, respectively. Local anesthesia and sedation were used in 56,6 percent of the case material. Postoperative complications represented 2,4 percent and no hernia recurrence was observed. The aforementioned procedure is safe and effective to carry out the reparative surgery of the inguinocrural hernias.

Hernia femoral complicada: presentación de un caso en un Centro Diagnóstico Integral, Venezuela / Complicated femoral hernia: presentation of a case in an integral diagnostic centre, Venezuela

La hernia femoral se presenta entre el 2 y el 5 por ciento de los casos, por lo que no se presenta con frecuencia. Se observa con un mayor predominio en las mujeres, pues generalmente evolucionan a complicaciones con elevada incidencia hacia la estrangulación. Se presenta el caso de una paciente femenina de 45 años de edad, con una hernia femoral complicada de 3 días de evolución, a la cual se le realizó una intervención quirúrgica de urgencia. El objetivo de este trabajo fue describir los elementos clínicos, resultados de exámenes complementarios, hallazgos quirúrgicos, intervención quirúrgica realizada y la evolución de este caso en el servicio de Cirugía General del Centro Diagnóstico Integral-UD1 parroquia Caricuao, municipio Libertador, Estado Distrito Capital Venezuela, en el mes de marzo de 2010. Se concluye que el diagnóstico y una intervención quirúrgica precoz contribuyen a disminuir la morbilidad y la mortalidad de estos pacientes. La técnica con plug de Lichtenstein ha permitido obtener un menor índice de complicaciones y recidivas, por lo cual su empleo debe considerarse como tratamiento de elección en las hernias crurales que se intervienen, tanto de forma urgente como electiva

The femoral hernia appears between 2-5 percent of the cases, one does not appear frequently, it is observed with a greater predominance in the women, evolve generally to complications with high incidence towards the throttling. The case of a feminine patient of 45 years of age with a complicated femoral hernia of 3 days of evolution appears, to which an emergency operation was realised to him. The objective of this work was To describe the clinical elements, surgical results of complementary examinations, findings, operation realised and the evolution of this case in the service of General Surgery of the Center Integral Diagnosis-UD1 Caricuao parish, Liberating municipality Been Capital District Venezuela in the 10 month March of the 2010. One concludes that the diagnosis and a precocious operation contributes to diminish the morbidity and the mortality of these patients. The technique with plug of Lichtenstein has allowed to obtain a smaller index of complications and recidivas, thus thus its use must be considered like treatment of election in the crurales hernias that are found as much of urgent form as elective

Morfologia y morfometria del anillo femoral en el hombre / Morphology and morphometry of the femoral ring in the male

La hernia femoral se forma cuando un divertículo peritoneal pasa a través del anillo femoral. Es más frecuente en mujeres que en hombres y en el lado derecho. La literatura es controvertida sobre la forma del anillo femoral quirúrgico, y se omiten sus dimensiones. Por otro lado, no existen explicaciones de naturaleza fisiológica o anatómica que justifiquen la mayor incidencia de la hernia femoral en el lado derecho. Buscando determinar la forma más frecuente del anillo femoral quirúrgico y sus dimensiones, como también esclarecer por qué ocurren más hernias femorales en el lado derecho, realizamos disecciones en 25 cadáveres adultos del sexo masculino. Fueron encontrados anillos en forma de trapecio en el 48 por ciento de los casos, de forma triangular en el 44 por ciento y de forma semicircular en el 8 por ciento de los casos. En relación a la morfometría, la media de las áreas del lado derecho fue de 0,67 cm2 y del lado izquierdo de 0,60 cm2, factor que podría justificar la mayor incidencia de hernias a la derecha.