ABSTRACT
Introdução:As hérnias incisionais decorrentes da gastroplastias são uma ocorrência frequente, exigindo planejamento, técnica cirúrgica adequada e colaboração do paciente no pós-operatório, para um adequado resultado. Objetivos: Demonstrar o tratamento das hérnias incisionais em conjunto com as dermolipectomias (ancôra e clássica) associadas ao lifting do púbis, realizado em 62 pacientes submetidos à gastroplatias em Y de Roux por via aberta ou por videolaparoscopia. Métodos: Estudo retrospectivo, transversal, baseado em análise de prontuários de 382 pacientes. Neste artigo será descrito o planejamento, táticas e técnicas cirúrgicas utilizadas e os resultados obtidos. Resultados: Obteve-se sucesso em todos os casos, sem nenhuma incidência de recidiva da hérnia tardiamente. Conclusão: A abordagem adotada mostrou-se eficaz, facilmente reproduzível e com baixos índices de complicações ou intercorrências.
Introduction: Incisional hernias resulting from gastroplasty are a frequent ocurrence, requiring planning, surgical technique and patient compliance after surgery for an appropriate outcome. Objective: To demonstrate the treatment of incisional hernias in combination with dermolipectomy (anchor, or classic) and pubic lifting, performed in 62 patients undergoing Roux-Y gastroplasty by open surgery and videolaparoscopy. Methods: This is a retrospective, cross sectional study, based on the analysis of 382 patients records. Study plan, strategy, surgical techniques and results will be described. Results: Success was obtained in all cases, with no incidence of hernia recurrence. Conclusion: The approach was effective, easily reproducible, with low complications rates.
Subject(s)
Humans , Female , Adult , History, 21st Century , Gastroplasty , Medical Records , Cross-Sectional Studies , Retrospective Studies , Plastic Surgery Procedures , Abdomen , Herniorrhaphy , Incisional Hernia , Obesity , Gastroplasty/methods , Medical Records/classification , Cross-Sectional Studies/methods , Plastic Surgery Procedures/methods , Herniorrhaphy/methods , Incisional Hernia/surgery , Incisional Hernia/therapy , Abdomen/surgery , Obesity/surgery , Obesity/therapyABSTRACT
El diagnóstico y tratamiento de las hernias incisionales complejas constituye un tema obligado para todos los cirujanos, cuyo desafío es prevenir las complicaciones y disminuir las recurrencias, lo que justifica la realización de este estudio con el objetivo de identificar sus aspectos clínicos y quirúrgicos más relevantes. Métodos: se realizó un estudio observacional, descriptivo de serie de casos correspondiente a 320 pacientes operados electivos por hernias incisionales complejas en el servicio de cirugía del Hospital Universitario Dr Juan B Zayas de Santiago de Cuba durante 15 años (1994-2009). Resultados: predominó el sexo femenino y el grupo etario de 31 a 60 años. Las hernias suprapúbicas fueron las más frecuentes en ambos sexos; en mujeres con intervenciones ginecológicas previas y en hombres, prostáticas. El neumoperitoneo progresivo preoperatorio y la antibioticoterapia profiláctica se aplicaron a todos los pacientes. Las técnicas quirúrgicas más utilizadas fueron las de Jean Rives y Robert Bendavid y la bioprótesis de polipropileno. Índice de recurrencia de 6,5 por ciento con predominio del sexo masculino. El tiempo quirúrgico fluctuó de 1 a 2 horas y la estadía hospitalaria entre 1 y 3 días. Fallecieron 4 pacientes, el 1,3 por ciento de la serie. Conclusiones: el único tratamiento efectivo para las hernias incisionales complejas radica en la técnica quirúrgica sin tensión con aplicación correcta de la bioprótesis indicada y su fijación con la sutura de su mismo material, por lo que se recomienda la protocolización y clasificación de estas hernias para unificar criterios con respecto a su diagnóstico y tratamiento(AU)
Diagnosis and treatment of complex incisional hermias is a compulsory topic for all surgeons. The challenge ahead is to prevent complications and to reduce relapses, which warrants the conduction of a study with the objective of identifying their most relevant clinical and surgical aspects. Methods: Observational and descriptive study of a case series involving 320 patients operated on from complex incisional hernias at the surgery service of Dr Juan B Zayas university hospital in Santiago de Cuba during 15 years (1994-2009). Results: Females and 31-60 years age group predominated. The suprapubic hernias were the most frequent in both sexes; in females who underwent previous gynecological interventions and in men who underwent prosthatic procedures. Preoperative progressive pneumoperitoneum and prophylactic antibiotic therapy were applied to all patients. The most used surgical techniques were Jean Rives' and Robert Bendavid's and the polypropylene bioprothesis. The relapse index was 6.5 percent and males predominated. The surgical time ranged 1 to 2 hours and the stay at hospital lasted one to 3 days. Four patients died, which accounted for 1.3 percent of the case series. Conclusions: The only effective treatment for complex incisional hernias lies in non-tensile surgical technique with correct application of the indicated bioprothesis and its fixing with a suture of the same material, so protocoling and classification of these hernias are recommended in order to unify criteria with respect to their diagnosis and treatment(AU)