Summary of experience with patterning cropped and shaped mesh repair for perineal hernia after abdominoperineal excision in rectal cancer / 中华外科杂志

Objective: To examine the patterning cropped and shaped mesh repair for perineal hernia after abdominoperineal excision (APE) in rectal cancer. Methods: The clinical data of 8 patients with perineal hernia after APE who accepted surgical treatment in the Department of Hepatopancreatobiliary and Hernia Surgery, the First Affiliated Hospital of Fujian Medical University from March 2017 to December 2022 were retrospectively reviewed. There were 3 males and 5 females, aged (67.6±7.2) years (range: 56 to 76 years). Eight patients developed a perineal mass at (11.3±2.9) months (range: 5 to 13 months) after APE. After surgical separation of adhesion and exposing the pelvic floor defect, a 15 cm×20 cm anti-adhesion mesh was fashioned as a three-dimensional pocket shape to fit the pelvic defect, then fixed to the promontory or sacrum and sutured to the pelvic sidewalls and the anterior peritoneum, while two side slender slings were tailored in front of the mesh and fixed on the pectineal ligament. Results: The repair of their perineal hernias went well, with an operating time of (240.6±48.8) minutes (range: 155 to 300 minutes). Five patients underwent laparotomy, 3 patients tried laparoscopic surgery first and then transferred to laparotomy combined with the perineal approach. Intraoperative bowel injury was observed in 3 patients. All patients did not have an intestinal fistula, bleeding occurred. No reoperation was performed and their preoperative symptoms improved significantly. The postoperative hospital stay was (13.5±2.9) days (range: 7 to 17 days) and two patients had postoperative ileus, which improved after conservative treatment. Two patients had a postoperative perineal hernia sac effusion, one of them underwent placement of a tube to puncture the hernia sac effusion due to infection, and continued irrigation and drainage. The postoperative follow-up was (34.8±14.0) months (range: 13 to 48 months), and 1 patient developed recurrence in the seventh postoperative month, no further surgery was performed. Conclusions: Surgical repair of the perineal hernia after APE can be preferred transabdominal approach, routine application of laparoscopy is not recommended, combined abdominoperineal approach can be considered if necessary. The perineal hernia after APE can be repaired safely and effectively using the described technique of patterning cropped and shaped mesh repair.

A preliminary report of laparoscopic extraperitoneal colostomy anterior to posterior sheath of rectus abdominis-transversus abdominis to prevent parastomal hernia / 中华外科杂志

Objective: To examine the preliminary effect of laparoscopic extraperitoneal colostomy anterior to posterior sheath of rectus abdominis-transversus abdominis for the prevention of parastomal hernia after abdominoperineal resection for rectal cancer. Methods: This study is a prospective case series study. From June 2021 to June 2022, patients with low rectal cancer underwent laparoscopic abdominoperineal resection combined with extraperitoneal colostomy anterior to posterior sheath of rectus abdominis-transversus abdominis at the First Department of General Surgery, Shaanxi Provincial People's Hospital were enrolled. The clinical data and postoperative CT images of patients were collected to analyze the incidence of surgical complication and parastomal hernia. Results: Totally 6 cases of patient were enrolled, including 3 males and 3 females, aging 72.5 (19.5) years (M(IQR)) (range: 55 to 79 years). The operation time was 250 (48) minutes (range: 190 to 275 minutes), the stoma operation time was 27.5 (10.7) minutes (range: 21 to 37 minutes), the bleeding volume was 30 (35) ml (range: 15 to 80 ml). All patients were cured and discharged without surgery-related complications. The follow-up time was 136 (105) days (range: 98 to 279 days). After physical examination and abdominal CT follow-up, no parastomal hernia occurred in the 6 patients up to this article. Conclusions: A method of laparoscopic extraperitoneal colostomy anterior to posterior sheath of rectus abdominis-transversus abdominis is established. Permanent stoma can be completed with this method safely. It may have a preventive effect on the occurrence of parastomal hernia, which is worthy of further study.

Elective incisional hernia repair: lower risk of postoperative wound infection with laparoscopic versus open repair

INTRODUCTION@#The superiority of laparoscopic repair over open repair of incisional hernias (IHs) in the elective setting is still controversial. Our study aimed to compare the postoperative outcomes of laparoscopic and open elective IH repair in an Asian population.@*METHODS@#This retrospective study was conducted in an acute general hospital in Singapore between 2010 and 2015. Inclusion criteria were IH repair in an elective setting, IHs with diameter of 3-15 cm, and location at the ventral abdominal wall. We excluded patients who underwent emergency repair, had recurrent hernias or had loss of abdominal wall domain (i.e. hernia sac containing more than 30% of abdominal contents or any solid organs). Postoperative outcomes within a year such as recurrence, pain, infection, haematoma and seroma formation were compared between the two groups.@*RESULTS@#There were 174 eligible patients. The majority were elderly Chinese women who were overweight. Open repair was performed in 49.4% of patients, while 50.6% underwent laparoscopic repair. The mean operation time for open repair was 116 minutes (116 ± 60.6 minutes) and 139 minutes (136 ± 64.1 minutes) for laparoscopic repair (P = 0.079). Within a year after open repair, postoperative wound infection occurred in 15.1% of the patients in the open repair group compared to 1.1% in the laparoscopic group (P = 0.0007). Postoperative pain, recurrence and haematoma/seroma formation were comparable.@*CONCLUSION@#Elective laparoscopic IH repair has comparable outcomes with open repair and may offer the advantage of reduced postoperative wound infection rates.

Incisional hernia repair in rats: description of the sublay technique under videomagnification system

Purpose: To describe the technique of sublay correction of incisional hernia in Wistar rats under videomagnification system. Methods: Five male rats of the species Rattus norvegicus, of the Wistar lineage, with body weight between 250­350 g and 60 days old were used. Incisional hernia was inducted in all animals. After that, the incisional hernia was immediately corrected by the sublay method. Results: There were no cases of recurrence of the incisional hernia after placement of the polypropylene mesh using the sublay technique. No postoperative complications were observed. Conclusions: The technique is suitable for execution in Wistar rats.

Robotic trans-abdominal preperitoneal approach (tapp) approach for lateral incisional hernias / Abordagem robótica transabdominal pré-peritoneal (rtapp) para hérnias incisionais laterais

ABSTRACT Background: Lateral incisional hernias arise between the linea alba and the posterior paraspinal muscles. Anatomical boundaries contain various topographic variations, such as multiple nearby bony structures and paucity of aponeurotic tissue that make it particularly challenging to repair. Aim: To describe a robotic assisted surgical technique for incisional lumbar hernia repair. Methods: Retrospective data was collected from four patients who underwent robotic-assisted repair of their lumbar hernias after open nephrectomies. Results: Age ranged from 41-53 y. Two patients had right sided flank hernias while the other two on the left. One patient had a recurrent hernia on the left side. The patients were placed in lateral decubitus position contralateral to the hernia defect side. A trans-abdominal preperitoneal approach was used in all cases. Each case was accomplished with two 8 mm robotic ports, a 12 mm periumbilical port, and a 5 mm assistance port that allowed docking on the ipsilateral hernia side. The hernias were identified, a preperitoneal plane was created, and the hernia sac completely dissected allowing for complete visualization of the defect. All defects were primarily closed. Polypropylene or ProGripTM mesh was applied with at least 5 cm overlap and secured using either #0 Vicryl® transfacial sutures, Evicel® or a combination of both. The peritoneal space was closed with running suture and the ports were removed and closed. The average surgical length was 4 hr. The post-operative length of stay ranged from 0-2 days. Conclusion: The robotics platform may provide unique advantages in the repair of lateral incisional hernias and represents a safe, feasible and effective minimally invasive approach for the correction of lateral incisional hernias.

RESUMO Racional: As hérnias incisionais laterais surgem entre a linha alba e os músculos paravertebrais posteriores. Os limites anatômicos contêm várias variações topográficas, como várias estruturas ósseas próximas e escassez de tecido aponeurótico que tornam o reparo particularmente difícil . Objetivo: Descrever uma técnica assistida por robótica para o reparo de hérnia lombar incisional. Métodos: Dados foram coletados retrospectivamente de quatro pacientes que foram submetidos ao reparo de hérnia lombar após nefrectomias abertas por técnica robótica. Os pacientes tinham entre 41-53 anos de idade. Dois possuíam hérnia no flanco direito e os outros dois no flanco esquerdo. Resultados: Os pacientes foram colocados em posição de decúbito lateral contralateral ao lado do defeito. Abordagem pré-peritoneal transabdominal foi realizada em todos os casos. Cada procedimento foi realizado com dois trocárteres robóticos de 8 mm, um periumbilical de 12 mm e um auxiliar de 5 mm, permitindo docking ipsilateral ao lado da hérnia. As hérnias foram identificadas, plano pré-peritoneal foi criado e o saco herniário completamente dissecado, permitindo completa visualização do defeito. Todos os defeitos foram fechados primariamente com fio de sutura 0/1V-Loc. Tela de polipropileno ou ProGripTM foi usada com pelo menos 5 cm de overlap e fixada com sutura transfacial com Vicryl® 0, Evicel® ou combinação dos dois. O espaço pré-peritoneal foi fechado com sutura contínua e os trocárteres removidos. O tempo operatório médio foi de 4 h. O tempo de permanência hospitalar variou entre 0-2 dias. Conclusão: A plataforma robótica é capaz de providenciar vantagens únicas no reparo de hérnias incisionais laterais e representa abordagem minimamente invasiva segura, factível e eficaz para o reparo das hérnias laterais incisionais.

Endoscopic transposition with the hernial sac (eTHS) in ventral hernia repair - technical description / Transposição endoscópica do saco herniário (TeSH) no tratamento da hérnia ventral - descrição da técnica

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.

Incisional hernia, a rare complication of the anterolateral transpsoas approach / Hernia incisional, una complicación poco frecuente del abordaje transpsoas anterolateral

Abstract: Introduction: Anterolateral transpsoas approach is considered as safe access to the retroperitoneum with low risk of complications. The most frequent described complications due to this approach were nerve, bowel, urethral and kidney injury. An incisional hernia is a rare complication in anterolateral approach, as a result of a nonhealing surgical wound or late disruption of the fascia; it occurs in 1% of the incisions after primary closure. Case description: We report a 75-year-old woman who underwent spinal surgery with a double approach, consisting of an anterolateral transpsoas approach and posterior lumbar approach. Two months post-surgery, the patient developed a lateral abdominal tumor at the surgical site. Conclusion: To prevent incisional hernia, a meticulous dissection must be performed to avoid muscle denervation and weakening of the abdominal wall, as well as proper repair of the fascia its critical to ensure an adequate closure of the wound.

Resumen: Introducción: El Abordaje anterolateral transpsoas se considera como un acceso seguro al retroperitoneo con bajo riesgo de complicaciones. Las complicaciones descritas más frecuentes debido a este abordaje fueron lesiones nerviosas, intestinales, uretrales y renales. Una hernia incisional es una complicación poco frecuente en el abordaje anterolateral, como resultado de una herida quirúrgica no cicatrizada o una ruptura tardía de la fascia; ocurre en 1% de las incisiones después del cierre primario. Caso clínico: Informamos de una mujer de 75 años que se sometió a una cirugía de columna vertebral con un doble abordaje quirúrgico, que consiste en un abordaje anterolateral transpsoas y un abordaje lumbar posterior. Dos meses después de la cirugía, el paciente desarrolló un tumor abdominal lateral en el sitio quirúrgico. Conclusión: Para prevenir la hernia incisional, se debe realizar una disección meticulosa para evitar la denervación muscular y el debilitamiento de la pared abdominal, así como la correcta reparación de la fascia es crítico para asegurar un cierre adecuado de la herida.

Hernia incisional en laparotomía de McBurney: complicaciones de una hernia inusual / Incisional hernia after McBurney incision: complications of an unusual hernia

Resumen Introducción Actualmente, la mayoría de las series que hablan sobre hernia incisional, no mencionan hernias incisionales en laparotomías de McBurney. La incidencia reportada de hernia incisional en esta laparotomía varía entre 0,7% y 2%. Aún más escasas son las publicaciones sobre sus complicaciones. El objetivo del presente reporte de casos es el de discutir el diagnóstico, tratamiento y resultados de dos pacientes operados en nuestra institución por hernia de McBurney complicada. Reporte de Casos: Se describen 2 pacientes femeninos de 68 y 65 años de edad que fueron operadas de urgencia por hernia incisional en laparotomía de McBurney complicada. La evolución postoperatoria fue diferente en ambas y una de ellas falleció. Discusión Se discuten los factores de riesgo para el desarrollo de estas hernias, el diagnóstico y tratamiento. Además, se discute la importancia de la apendicectomía laparoscópica para la prevención de estas hernias. Conclusiones Las complicaciones de la hernia en laparotomía de McBurney, las cuales son severas y potencialmente letales, se diagnostican tardíamente debido al retraso en la presentación y en el diagnóstico. La amplia utilización de la cirugía laparoscópica para la apendicectomía seguramente reducirá aún más la incidencia de este tipo de hernia durante los próximos años.

Introduction Currently, most series over incisional hernia do not mention this hernia occurring in McBurney's laparotomy. The reported incidence for this type of hernia is 0.7% to 2%. Even more scarce are publications regarding its complications. The purpose of this report is to discuss the diagnostic, treatment and outcomes of two patients operated on our institution for complicated McBurney´s hernia. Report of Cases: Two female patients 68 and 65 years-old operated on emergency grounds for complicated incisional hernia over a McBurney´s incision are described. Postoperative evolution was different in both cases and one of them died. Discussion We discuss risk factor for this specific incisional hernia development, its diagnosis and treatment. Besides, the importance of laparoscopic appendectomy was stressed. Conclusions Complicated incisional hernia over McBurney's incision is an infrequent severe clinical condition habitually diagnosed late. The widespread utilization of laparoscopic appendectomy will reduce even more the incidence of this kind of hernia within the next few years.

Incisional hernioplasty techniques: analysis after open bariatric surgery / Análise das técnicas de hernioplastia incisional após cirurgia bariátrica aberta

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.

Maximum inspiratory and expiratory pressures in the pre and postoperative periods of patients with incisional abdominal hernia corrected by Lázaro da Silva technique / Pressões máximas inspiratórias e expiratórias no pré e pós-operatório de pacientes com hérnias incisionais abdominais corrigidas pela técnica de Lázaro da Silva

ABSTRACT Objective: To verify the effect of longitudinal abdominal incisional herniorrhaphy on respiratory muscle pressure. Method: The technique of incisional herniorrhaphy used was proposed by Lázaro da Silva. To measure the pressure, we used a water manometer in 20 patients, median age 48.5 years (range 24 70). We analyzed the maximum inspiratory pressure at the level of residual volume (IP-RV) and functional residual capacity (IP-FRC) and the maximum expiratory pressure of functional residual capacity (EP-FRC) and total lung capacity (EP-TLC) in the preoperative and late postoperative (40 90 days) periods, in 13 patients with large incisional hernias and in 7 patients with medium incisional hernias. Results: There was a significant increase in IP-FRC (p = 0.027), IP-RV (p = 0.011) and EP-TLC (p = 0.003) in patients with large incisional hernias. EP-FRC increased, but not significantly. In patients with medium incisional hernias, the changes were not significant. Conclusion: Surgical correction of large incisional hernias improves the function of the breathing muscles; however, surgery for medium incisional hernias does not alter this function.

RESUMO Objetivo: verificar o efeito da herniorrafia incisional abdominal longitudinal na pressão dos músculos da respiração. Método: a técnica de herniorrafia incisional utilizada foi a proposta por Lázaro da Silva. Para aferir a pressão foi utilizado manômetro de água, em 20 pacientes, idade mediana 48,5 anos (mínimo 24, máximo 70). Foram analisadas a pressão máxima inspiratória no nível do volume residual (PIVR) e da capacidade residual funcional (PICRF) e a pressão máxima expiratória da capacidade residual funcional (PECRF) e da capacidade pulmonar total (PECPT), no pré-operatório e pós-operatório tardio (entre 40 e 90 dias), em 13 pacientes com hérnias incisionais grandes e em 7 pacientes com hérnias incisionais médias. Resultados: houve aumento significante da PICRF (p=0.027), da PIVR (p=0.011), da PECPT (p=0.003) nos pacientes com hérnias incisionais grandes. A PECRF aumentou, porém de forma não significante. Nos pacientes com hérnias incisionais médias as alterações não foram significantes. Conclusão: a correção cirúrgica da hérnia incisional grande melhora a função dos músculos da respiração, porém a cirurgia da hérnia incisional média não altera a referida função.

Tracking stem cells in the incisional hernial sac: a gaze beyond pure tissue repairs / Rastreando células-tronco no saco herniário incisional: um olhar para além dos reparos puramente teciduais

ABSTRACT Objective: the hernial sac is typically a bilayer structure consisting of connective tissue lined underneath by peritoneum. Some incidental findings on it, like smooth muscle cells and heterotopic ossification, can be explained as the end-stage metaplasia from undifferentiated cells. This study aimed to search for mesenchymal stem cells in the incisional hernial sac by an immuno-histochemistry screening test. Methods: fifteen specimens of them were submitted to histochemistry analysis using CD133 monoclonal antibodies, a specific marker of mesenchymal stem cells. The biopsies were obtained from patients submitted to pure tissue repair for incisional hernias - the transposition with the hernial sac technique (Lázaro da Silva, 1971). Results: two-thirds of the specimens expressed on average 20 (twenty) CD133+ cells in each one. Conclusion: despite the screening nature of this study, the hernial sac may be considered a source of stem cells. This could explain those abnormal findings, and perhaps the induction of new fibroblasts in procedures that use it to optimize wound healing.

RESUMO Objetivo: o saco herniário é tipicamente uma estrutura de duas camadas, constituída de tecido conjuntivo revestido por peritônio. Alguns achados incidentais, como células musculares lisas e ossificação heterotópica, podem ser explicados como o estágio final de metaplasia das células indiferenciadas que habitam o saco herniário. Este estudo teve como objetivo procurar células-tronco adultas no saco herniário incisional por um teste de triagem imuno-histoquímica. Métodos: quinze espécimes foram submetidos à análise histoquímica utilizando anticorpos monoclonais CD133, um marcador específico de células-tronco mesenquimais. As biópsias foram obtidas de pacientes submetidos ao reparo cirúrgico de hérnias incisionais, segundo a técnica da transposição com o saco herniário, proposta por Lázaro da Silva em 1971. Resultados: dois terços das amostras expressaram em média 20 (vinte) células CD133+ cada uma. Conclusão: apesar da natureza apenas de triagem deste estudo, o saco herniário pode ser considerado uma fonte de células-tronco em potencial. Isso poderia explicar aqueles achados anormais e talvez a indução de novos fibroblastos em procedimentos que o utilizam para otimizar a cicatrização dessas feridas.

Comparative study of four different types of intraperitoneal mesh prostheses in rats

Abstract Purpose: To compare four types of mesh regarding visceral adhesions, inflammatory response and incorporation. Methods: Sixty Wistar rats were divided into four groups, with different meshes implanted intraperitoneally: polytetrafluoroethylene (ePTFE group); polypropylene with polydioxanone and oxidized cellulose (PCD); polypropylene (PM) and polypropylene with silicone (PMS). The variables analyzed were: area covered by adhesions, incorporation of the mesh and inflammatory reaction (evaluated histologically and by COX2 immunochemistry). Results: The PMS group had the lowest adhesion area (63.1%) and grade 1 adhesions. The ePTFE and PM groups presented almost the total area of their surface covered by adherences (99.8% and 97.7% respectively) The group ePTFE had the highest percentage of area without incorporation (42%; p <0.001) with no difference between the other meshes. The PMS group had the best incorporation rate. And the histological analysis revealed that the inflammation scores were significantly different. Conclusions: The PM mesh had higher density of adherences, larger area of adherences, adherences to organs and percentage of incorporation. ePTFE had the higher area of adherences and lower incorporation. The PMS mesh performed best in the inflammation score, had a higher incorporation and lower area of adherences, and it was considered the best type of mesh.

La técnica de separación de componentes como adyuvante quirúrgico en la reparación de hernias suprapúbicas / The component separation technique as surgical adjuvant in suprapubic hernia repair

La hernia incisional suprapúbica constituye una enfermedad infrecuente, consecuencia generalmente de cirugías pélvicas en especial las que abordan el espacio retropúbico de Retzius. El objetivo dle trabajo es reportar los resultados del tratamiento quirúrgico de la hernia suprapúbica mediante el proceder tradicional de Rives-Stoppa asociado a la técnica de separación de componentes con bioprótesis de polipropileno como refuerzo. Se reportan tres pacientes con hernias suprapúbicas grandes. Estas se definieron como: todo defecto localizado en una distancia no mayor de 5 cm a la sínfisis del pubis con diámetro del anillo herniario superior a los 10 cm en su eje mayor medido transoperatoriamente. Fueron intervenidos quirúrgicamente tres pacientes, un hombre y dos mujeres. El primero con antecedentes de prostatectomía retropúbica y las dos últimas de cirugía ginecológica. En el primero, se complementó la operación de Rives-Stoppa con la técnica de separación anterior de componentes y refuerzo supra aponeurótico. Las dos últimas preferimos la separación posterior de componentes para evitar la disección anterior extensa. Las complicaciones más frecuentes fueron los seromas y hasta la fecha no se han reportado recurrencias. La reparación preperitoneal combinada con la técnica de separación de componentes anterior o posterior, constituyen alternativas válidas en la reparación de hernias incisionales complejas como son las hernias suprapúbicas. Esto permitió el cierre del defecto aponeurótico para cubrir y proteger la bioprótesis con la reconstrucción consiguiente de la línea alba(AU)

Suprapubic incisional hernia is a rare disease, generally the result of pelvic surgeries, especially those approaching the retropubic space of Retzius. To report the results of the surgical treatment of the suprapubic hernia by means of the traditional procedure of Rives-Stoppa associated to the component separation technique with polypropylene bioprosthesis as reinforcement. Three patients with large suprapubic hernias are reported. These were defined as: any defect located at a distance of no more than 5 cm from the symphysis pubis with diameter of the hernial ring over 10 cm at its major axis measured trans-operatively. Three patients, one man and two women were operated. The first, with a history of retropubic prostatectomy and the last two, with a history of gynecological surgery. In the first, the operation of Rives-Stoppa was complemented with the component separation technique and supra-aponeurotic reinforcement. For the last two, we preferred the posterior component separation in order to avoid extensive anterior dissection. The most frequent complications were seromas and, to date, no relapses have been reported. Preperitoneal repair combined with the technique of anterior or posterior component separation are valid alternatives in the repair of complex incisional hernias, such as suprapubic hernias. This allowed closure of the aponeurotic defect to cover and protect the bioprosthesis with the consequent reconstruction of the linea alba(AU)

Reparación protésica en una paciente con hernia incisional catastrófica / Prosthetic repair in a patient with catastrophic incisional hernia

Se presenta el caso clínico de una paciente de 66 años de edad, blanca, con antecedentes de hipertensión arterial, diabetes mellitus de tipo II y sobrepeso, quien fue operada en el Hospital General Universitario Dr Juan Bruno Zayas Alfonso de Santiago de Cuba por presentar una eventración gigante en la pared abdominal anterior, que no le permitía deambular sin apoyo. Se realizó la reparación protésica que resultó eficaz y segura, con 13 años sin recurrencia

The case report of a 66 years white patient with a history of hypertension, type II diabetes mellitus and overweight is presented, who was operated on at Dr Juan Bruno Zayas Alfonso University General Hospital in Santiago de Cuba due to a considerable eventration in the front abdominal wall that didn't allow her wandering around without support. The prosthetic repair which was effective and safe, was carried out with no recurrence during 13 years