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1.
Rev. Col. Bras. Cir ; 49: e20223063, 2022. tab, graf
Article in English | LILACS | ID: biblio-1365386

ABSTRACT

ABSTRACT Objective: to describe the use of the robotic platform in inguinal hernia recurrence after a previous laparoscopic repair. Methods: patients with recurrent inguinal hernias following a laparoscopic repair who have undergone robotic transabdominal preperitoneal between December 2015 through September 2020 were identified in a prospectively maintained database. Outcomes of interest included demographics, hernia characteristics, operative details and rates of 30-day surgical site occurrence, surgical site occurrences requiring procedural interventions, surgical site infection and hernia recurrence were abstracted. Results: nineteen patients (95% male, mean age 55 years, mean body mass index 28) had 27 hernias repaired (N=8 bilateral). Average operative time was 168.9 ± 49.3min (range 90-240). There were two intraoperative complications all of them were bleeding from the inferior epigastric vessel injuries. Three SSOs occurred (N=2 seromas and N=1 hematoma. After a median 35.7 months follow-up (IQR 13-49), no recurrence has been diagnosed. One patient developed chronic postoperative inguinal pain. Conclusions: on a small number of selected patients and experienced hands, we found that the use of the robotic platform for repair of recurrent hernias after prior laparoscopic repair appears to be feasible, safe and effective despite being technically demanding. Further studies in larger cohorts are necessary to determine if this technique provides any benefits in recurrent inguinal hernia scenario.


RESUMO Objetivo: descrevemos nossa experiência com uso da plataforma robótica no tratamento das recidivas operadas previamente por laparoscopia, mantendo assim uma proposta minimamente invasiva a esses pacientes, apesar de haver uma predileção pela via anterior e aberta nestes casos. Métodos: foram incluídos pacientes submetidos a hernioplastia inguinal robótica transabdominal pré-peritoneal como tratamento de recidiva e que foram operados previamente por laparoscopia, entre dezembro de 2015 e setembro de 2020 e mantidos em uma base de dados ambulatorial prospectiva. Variáveis de interesse incluíram dados demográficos, características herniárias, detalhes operatórios, ocorrências do sítio cirúrgico em 30 dias (com ou sem necessidade de intervenção), infeção do sítio cirúrgico, tempo de seguimento e taxa de recidiva. Resultados: dezenove pacientes (95% masculino, média de idade de 55 anos, média de índice de massa corporal 28kg/m2) e 27 hérnias operadas (N=8 bilaterais). Média de tempo cirúrgico 168.9±49.3 min (variando 90-240). N=2 complicações intraoperatórias por lesão de vasos epigástricos inferiores. N=2 seromas e N=1 hematoma foram identificados no pós-operatório; N=1 paciente apresentou dor crônica pós operatória. Após um tempo de seguimento médio de 35.7 meses (intervalo entre quartis 13-49), nenhuma recidiva foi diagnosticada. Conclusões: o uso da plataforma robótica parece ser seguro e efetivo no tratamento das recidivas operadas previamente laparoscopia, nesse pequeno grupo de pacientes selecionados, apesar de requerer expertise em cirurgia robótica. Outros estudos com maiores casuísticas são necessários para estabelecer o papel desta técnica no cenário das hérnias inguinais recidivadas.


Subject(s)
Humans , Male , Female , Laparoscopy/methods , Robotic Surgical Procedures/methods , Hernia, Inguinal/surgery , Recurrence , Surgical Mesh , Retrospective Studies , Treatment Outcome , Herniorrhaphy/methods , Groin , Middle Aged
2.
Rev. argent. cir ; 113(4): 434-443, dic. 2021. graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1356953

ABSTRACT

RESUMEN Antecedentes: La hernioplastia inguinal es el procedimiento quirúrgico más frecuentemente realizado dentro de la Cirugía General. Se realizan anualmente 20 millones de hernioplastias; la técnica de Lichtenstein y la transabdominal preperitoneal (TAPP) mediante cirugía laparoscópica son las más utilzadas. Objetivo: El objetivo del presente estudio es valorar la factibilidad de la realización del TAPP, en un centro universitario, por parte de residentes y cirujanos jóvenes en formación. Se comparó dicho procedimiento con la técnica de Lichtenstein valorando los resultados en los primeros 30 días del posoperatorio. Las principales variables para estudiar fueron: complicaciones, dolor posoperatorio, estadía hospitalaria y costo del procedimiento. Como variables para estudiar, a largo plazo, se compararon la recidiva herniaria y el dolor crónico. Material y métodos: Se realizó un estudio observacional comparando dos técnicas quirúrgicas utilizando la base de datos del Servicio con información adquirida de forma prospectiva. Se analizaron 80 pacientes, divididos en dos grupos: hernioplastia de Lichtenstein (grupo1) y hernioplastia por TAPP (grupo 2), durante el período comprendido desde mayo de 2015 hasta mayo de 2019, en dos Centros Universitarios de Montevideo Uruguay (Hospital de Clínicas y Hospital Español). Resultados: No hubo diferencia significativa en la estadía hospitalaria y complicaciones posoperatorias. El grupo del Lichtenstein presentó una recidiva herniaria. La hernioplastia laparoscópica presentó un tiempo operatorio promedio de 20 minutos más y el costo de materiales fue mayor. Si bien el dolor posoperatorio en las primeras 24 horas fue mayor en TAPP, el dolor a las 48 horas, 7días, un mes, tres meses y seis meses fue similar en ambos grupos. Conclusión: La técnica de TAPP, para la hernia inguinal primaria unilateral, es factible de ser realizada por cirujanos jóvenes o en formación, con un porcentaje de complicaciones, dolor posoperatorio y recidivas similares al Lichtenstein, aunque con un costo de materiales y tiempo operatorio levemente mayor.


ABSTRACT Background: Inguinal hernia repair is one of the most common procedures in general surgery. Each year, 20 million surgeries for inguinal hernia repaired are performed; the most common techniques used are the Lichtenstein procedure and the transabdominal preperitoneal (TAPP) laparoscopic approach. Objective: The aim of the present study is to evaluate the outcomes of the TAPP approach performed by residents and young surgeons in training in a university center. TAPP was compared with the Lichtenstein and the outcomes at 30 days were compared. The variables considered were complications, postoperative pain, length of hospital stay and procedure-related costs. The long-term variables analyzed were recurrence and chronic pain. Material and methods: We conducted an observational study comparing two surgical techniques, using prospectively acquired information from the database of our department. The cohort was made up of 80 patients undergoing inguinal hernia repair in two university-based hospitals in Montevideo, Uruguay (Hospital de Clínicas and Hospital Español), between May 2015 and May 2019. The patients were divided into two groups: Lichtenstein procedure (group 1) and TAPP procedure (group 2). Results: There were no significant differences in length of hospital stay and postoperative complications. One patient in the Lichtenstein group presented hernia recurrence. Mean operative time was 20 minutes longer with laparoscopic hernia repair, and the cost of the materials was higher. Postoperative pain at 24 hours was greater in the TAPP group, but was similar at 48 hours, 7 days, one month, three months and six months in both groups. Conclusion: The use of TAPP technique for unilateral primary inguinal hernia is feasible to perform by young surgeons or surgeons in training, and the percentage of complications, postoperative pain and recurrences is similar to that of the Lichtenstein technique, although the cost of materials and operative time are slightly higher.


Subject(s)
Laparoscopy/methods , Hernia, Inguinal/surgery , Pain, Postoperative , Postoperative Complications , General Surgery , Surgical Procedures, Operative , Costs and Cost Analysis , Chronic Pain , Herniorrhaphy , Operative Time , Hernia , Hernia, Inguinal/diagnostic imaging , Hospitals , Length of Stay , Methods
3.
Medisan ; 25(4)2021. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1340213

ABSTRACT

Se describe el caso clínico de un paciente de 58 años de edad con antecedentes personales de insuficiencia cardiaca congestiva mal controlada, quien acudió a emergencias del Hospital Luis Bernaza de Guayaquil, Ecuador, por presentar dolor abdominal difuso, constipación y masa inguinoescrotal gigante. Se realizan los estudios pertinentes y se diagnostica una hernia inguinoescrotal gigante con pérdida de domicilio, sin datos de obstrucción intestinal. Se empleó la técnica de Goñi Moreno durante 12 días para aumentar el diámetro de la cavidad abdominal y regresar el contenido del saco a su lugar. Se efectuó laparotomía exploratoria y hernioplastia con resultado satisfactorio y seguimiento por consulta externa durante 2 meses, sin alteraciones.


The case report of a 58 years patient with personal history of a poor controlled congestive heart failure is described, who went to the emergency service of Luis Bernaza Hospital in Guayaquil, Ecuador, due to a diffuse abdominal pain, constipation and giant inguinoescrotal mass. The pertinent studies were carried out and a giant inguinoescrotal hernia is diagnosed with home loss, without data of intestinal obstruction. The Goñi Moreno technique was used during 12 days to increase the diameter of the abdominal cavity and return the content from the sack to its place. An exploratory laparotomy and hernioplastia were carried out with satisfactory result and follow up in the outpatient department during 2 months, without alterations.


Subject(s)
Abdominal Pain , Hernia, Inguinal/surgery , Adult , Abdominal Cavity , Hernia, Inguinal/diagnosis
4.
Rev. cuba. cir ; 60(2): e947, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1280213

ABSTRACT

Introducción: En los últimos años, la aplicación de la cirugía laparoscópica ha permitido ofrecer una nueva expectativa en el tratamiento de la hernia inguinal, ya que no solo permite la colocación de una malla sin tensión, sino que además permite colocarla en la auténtica zona débil de la región inguinal: su pared posterior. Objetivo: Mostrar los resultados obtenidos con la implementación de la hernioplastia laparoscópica como tratamiento alternativo en la reparación de las hernias inguinales. Método: Se realizó un estudio cuasi experimental en el servicio de Cirugía General del Hospital General Docente "Comandante Pinares", durante el período comprendido de junio de 2015 hasta mayo de 2017, con una muestra de 27 pacientes. Se controlaron variables como edad, tipo de hernia inguinal, complicaciones del proceder, recidivas del tratamiento, así como la efectividad del proceder en comparación con técnicas convencionales. Resultados: La hernia inguinal unilateral fue la más frecuente tratada, las complicaciones estuvieron dadas por la inguinodinia y rechazo a la malla. Disminuyeron variables como pérdidas sanguíneas, tiempo quirúrgico, la efectividad se consideró buena en la mayoría de los casos. Conclusiones: Se demuestra que la hernioplastia laparoscópica tiene mayores ventajas biológicas, sociales y económicas(AU)


Introduction: In recent years, the usage of laparoscopic surgery has offered new expectations regarding inguinal hernia treatment, since it not only allows the placement of a mesh without tension, but also allows it to be placed in the authentic weak area of the inguinal region, its posterior wall. Objective: To show the outcomes obtained with the implementation of laparoscopic hernioplasty as an alternative treatment in inguinal hernias repair. Method: A quasiexperimental study was carried out, during the period from June 2015 to May 2017, in the general surgery service of Comandante Pinares General Teaching Hospital, with a sample of 27 patients. Variables such as age, type of inguinal hernia, procedural complications, treatment recurrences, as well as the effectiveness of the procedure were controlled in comparison with conventional techniques. Results: Unilateral inguinal hernia was the most frequently treated. Complications were caused by inguinodynia and mesh rejection. Variables such as blood loss and surgical time decreased. Effectiveness was considered good in most cases. Conclusions: Laparoscopic hernioplasty is shown to have greater biological, social and economic advantages(AU)


Subject(s)
Humans , Adult , Laparoscopy/methods , Herniorrhaphy/methods , Hernia, Inguinal/surgery
6.
ABCD arq. bras. cir. dig ; 34(2): e1600, 2021. tab
Article in English | LILACS | ID: biblio-1345017

ABSTRACT

ABSTRACT Background: Repair of inguinal hernia concomitant with cholecystectomy was rarely performed until more recently when laparoscopic herniorrhaphy gained more adepts. Although it is generally an attractive option for patients, simultaneous performance of both procedures has been questioned by the potential risk of complications related to mesh, mainly infection. Aim: To evaluate a series of patients who underwent simultaneous laparoscopic inguinal hernia repair and cholecystectomy, with emphasis on the risk of complications related to the mesh, especially infection. Methods: Fifty patients underwent simultaneous inguinal repair and cholecystectomy, both by laparoscopy, of which 46 met the inclusion criteria of this study. Results: In all, hernia repair was the first procedure performed. Forty-five (97,9%) were discharged within 24 h after surgery. Total mean cost of the two procedures performed separately ($2,562.45) was 43% higher than the mean cost of both operations done simultaneously ($1,785.11). Up to 30-day postoperative follow-up, seven (15.2%) presented minor complications. No patient required hospital re-admission, percutaneous drainage, antibiotic therapy or presented any other signs of mesh infection after three months. In long-term follow-up, mean of 47,1 months, 38 patients (82,6%) were revaluated. Three (7,8%) reported complications: hernia recurrence; chronic discomfort; reoperation due a non-reabsorbed seroma, one in each. However, none showed any mesh-related complication. Satisfaction questionnaire revealed that 36 (94,7%) were satisfied with the results of surgery. All of them stated that they would opt for simultaneous surgery again if necessary. Conclusion: Combined laparoscopic inguinal hernia repair and cholecystectomy is a safe procedure, with no increase in mesh infection. In addition, it has important advantage of reducing hospital costs and increase patient' satisfaction.


RESUMO Racional: Reparo da hérnia inguinal concomitante à colecistectomia era raramente realizado até mais recentemente, quando a herniorrafia laparoscópica ganhou mais adeptos. Embora geralmente seja opção atraente para pacientes, a realização simultânea tem sido questionada pelo risco potencial de complicações relacionadas à tela, principalmente infecção. Objetivo: Avaliar uma série de pacientes submetidos a colecistectomia e herniorrafia inguinal laparoscópica simultâneas, com ênfase no risco de complicações relacionadas a tela, em especial infecção. Métodos: Cinquenta pacientes foram submetidos a herniorrafia e colecistectomia simultâneas por videolaparoscopia, dos quais 46 atenderam aos critérios de inclusão. Resultados: Em todos, a herniorrafia foi realizada inicialmente. Quarenta e cinco (97,9%) tiveram alta em 24 h. O custo médio total dos dois procedimentos realizados separadamente ($2.562,45) foi 43% maior do que o custo médio das duas operações feitas simultaneamente ($1.785,11). Após 30 dias de acompanhamento pós-operatório, sete (15,2%) apresentaram complicações menores. Após três meses, nenhum necessitou de readmissão hospitalar, drenagem, antibioticoterapia ou sinal de infecção de tela. No seguimento em longo prazo, média de 47,1 meses, 38 (82,6%) foram reavaliados. Três (7,8%) relataram complicações: recorrência de hérnia; desconforto crônico; reoperação por seroma não reabsorvido. No entanto, nenhum apresentou qualquer complicação relacionada à tela. Questionário de satisfação revelou que 36 (94,7%) ficaram satisfeitos com o resultado da operação. Todos afirmaram que optariam pela ela simultânea novamente se necessário. Conclusão: O reparo da hérnia inguinal concomitante com colecistectomia por laparoscopia é procedimento seguro, sem aumento de infecção da tela. Além disso, tem a vantagem importante de reduzir custos hospitalares e aumentar a satisfação do paciente.


Subject(s)
Humans , Laparoscopy , Hernia, Inguinal/surgery , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Recurrence , Surgical Mesh/adverse effects , Cholecystectomy , Treatment Outcome , Herniorrhaphy/adverse effects
7.
ABCD arq. bras. cir. dig ; 34(2): e1603, 2021. tab
Article in English | LILACS | ID: biblio-1345013

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Adult , Aged , Laparoscopy , Hernia, Femoral/surgery , Hernia, Inguinal/surgery , Retrospective Studies , Treatment Outcome , Herniorrhaphy/adverse effects , Groin/surgery , Middle Aged
8.
ABCD arq. bras. cir. dig ; 34(2): e1597, 2021. graf
Article in English, Portuguese | LILACS | ID: biblio-1345009

ABSTRACT

ABSTRACT Background: Since publication of our paper "Ten Golden Rules for a Safe MIS Inguinal Hernia Repair" we have received many questions. As the authors, we feel it is important to address these topics as a follow-up to our paper. Aim: To discuss in more details the main points of controversy, review the rules and update de recommendations. Method: The questions and discussions came mainly over five rules, numbered 3, 5, 6, 7, 10. We analyzed all the comments about recommendations and update some technical principles. Results: Rule 3 - Removing normal fat plugs from the obturator canal is unnecessary and therefore is not recommended; Rule 5 - transection of the uterine round ligament (1 cm proximal to the deep ring) facilitates adequate dissection. When performed in this way it does not appear to be associated with complications; Rule 6 - transection of huge sacs are safer than over-dissection of the cord structures. Whether dissecting completely the sac or abandon the distal part it results in less postoperative seromas is an ongoing debate; Rule 7 - any retroperitoneal structure traversing the internal ring is or play a role like a hernia. Failing to identify and remove the lipoma will ultimately result in the patient experiencing a recurrence; Rule 10 - in TAPP peritoneum should preferably be closed with suture than tackes. Conclusion: 10 Golden Rules emphasize the most important surgical tips and technical steps that allow the safe performance of MIS repairs of inguinal hernias, regardless the technique.


RESUMO Racional: Desde a publicação de nosso artigo "Dez Regras de Ouro para o Reparo Seguro de Hérnia Inguinal MIS", recebemos muitos questionamentos. Como autores, sentimos que é importante abordar esses tópicos como seguimento do artigo Objetivo: Discutir com mais detalhes os principais pontos de controvérsia, revisar as regras e atualizar as recomendações. Método: As dúvidas e discussões surgiram principalmente sobre cinco regras, numeradas 3, 5, 6, 7, 10. Analisamos todos os comentários sobre as recomendações e atualizamos alguns dos princípios técnicos. Resultados: Regra 3 - remoção dos plugs de gordura normais do canal obturador é desnecessária e, portanto, não é recomendada; Regra 5 - transecção do ligamento redondo do útero (1 cm proximal ao anel profundo) facilita a dissecção adequada e quando realizado dessa forma, não parece estar associada com complicações; Regra 6 - transecção de grandes sacos herniários é mais segura do que a dissecção excessiva das estruturas do cordão espermático e, se dissecar completamente o saco ou abandonar a parte distal, resulta em menos seromas pós-operatórios ainda é motivo de debate; Regra 7 - qualquer estrutura retroperitoneal que atravessa o anel interno é ou desempenha o papel como uma hérnia e deixar de identificar e remover o lipoma acabará resultando em recorrência; Regra 10 - na TAPP o peritônio deve ser fechado preferencialmente com sutura do que com tacks. Conclusão: As 10 Regras de Ouro enfatizam as dicas cirúrgicas e etapas técnicas mais importantes que permitem a realização segura de reparos MIS de hérnias inguinais, independentemente da técnica.


Subject(s)
Humans , Female , Laparoscopy , Hernia, Inguinal/surgery , Peritoneum , Recurrence , Treatment Outcome , Minimally Invasive Surgical Procedures , Dissection , Herniorrhaphy
9.
Acta cir. bras ; 36(1): e360108, 2021. tab, graf
Article in English | LILACS | ID: biblio-1152693

ABSTRACT

ABSTRACT Purpose Develop a 3D model for the simulation of laparoscopic inguinal hernioplasty transabdominal preperitoneal (TAPP). Methods This is an experimental study, 18 participants were selected, divided into three groups, experimental (GE) surgeons in training, control (GC) experienced surgeons and Shaw (GS) nonexperienced surgeons. The simulation in the 3D model was carried out in 6 sessions fulfilling the 5 stages. Opening the peritoneum with the creation of the preperitoneal space; identification of important structures; hernia identification and reduction; placement and fixation of the mesh in Cooper's ligament and closure of the peritoneum. Results In the 1st stage, the GE obtained an average of 1.25 ± 0.42 in the 1st session and 3.25 ± 0.62 in the 6th session (p = 0.05) and in the 5th stage 0.91 ± 0.29 in the first session. 1st session and 1.91 ± 0.29 in the 6th session (p = 0.001), with no significant difference between groups. The learning and skill curve in the SG represented 1.08 ± 0.29 1st and 3.50 ± 0.90 6th session (p = 0.001). Conclusions The creation of a systematization of training in simulation applied to the three-dimensional model enabled gain in laparoscopic skills and underpinned its theoretical and practical foundations.


Subject(s)
Humans , Laparoscopy , Hernia, Inguinal/surgery , Peritoneum/surgery , Surgical Mesh , Herniorrhaphy
10.
Acta cir. bras ; 36(8): e360808, 2021. tab, graf
Article in English | LILACS, VETINDEX | ID: biblio-1339009

ABSTRACT

ABSTRACT Purpose: To develop a reproducible training program model covering the steps of the extended totally extraperitoneal approach (e-tep) technique for correction of ventral or incisional hernia repair. Methods: Training sessions with surgeons in the laboratory using both porcine specimens and a new ethylene vinyl acetate (EVA) model simulating the operative steps of the e-tep technique. Students were interviewed and asked to answer a questionnaire pre and post the sessions to assess their performance and evaluated the course and model. Results: A total of 25 trained abdominal wall surgeons was evaluated at the end of the course. It was obtained a 100% satisfaction score of the training, as well as increased confidence levels up to 9 and 10 in all technical aspects of the surgery, having 96% of the surgeons performed a surgery under supervision of the proctors after the course. Conclusions: This training model is simple, effective, low cost, and replicable in guidance on the beginning of e-tep technique adoption, and performance. As a result, surgeons can get more confident and more able to perform surgeries employing this technique.


Subject(s)
Humans , Animals , Laparoscopy , Abdominal Wall/surgery , Hernia, Inguinal/surgery , Hernia, Ventral/surgery , Peritoneum/surgery , Surgical Mesh , Swine , Treatment Outcome , Endoscopy , Herniorrhaphy
11.
Article in Chinese | WPRIM | ID: wpr-921571

ABSTRACT

We reported a case of irreducible indirect inguinal hernia caused by sigmoid colon cancer entering the right groin.The patient complained about a right groin mass for more than 60 years with progressive enlargement for 3 years and pain for half a month.Abdominal CT examination at admission showed rectum and sigmoid colon hernia in the right inguinal area and thickening of sigmoid colon wall.Electronic colonoscopy and pathological diagnosis showed sigmoid colon cancer.Therefore,the result of preliminary diagnosis was irreducible indirect inguinal hernia caused by sigmoid colon cancer entering the right groin.We converted laparoscopic exploration to laparotomy followed by radical sigmoidectomy and employed end-to-end anastomosis of descending colon and rectum in combination with repair of right inguinal hernia.The patient recovered well after operation and was discharged.


Subject(s)
Colon, Sigmoid/surgery , Groin , Hernia, Inguinal/surgery , Humans , Laparoscopy , Sigmoid Neoplasms/surgery
12.
Rev. Col. Bras. Cir ; 48: e20202704, 2021. tab, graf
Article in English | LILACS | ID: biblio-1155355

ABSTRACT

ABSTRACT Objectives: minimally invasive inguinal hernia repair has proven advantages over open procedures including less pain and earlier return to normal activity. Robotic surgery adds ergonomics, a three-dimensional high definition camera and articulating instruments overcoming some laparoscopic limitations. We aimed to report the outcomes of the early experience of over 97 robotic inguinal hernia repairs performed by a referred surgical group in Brazil. Methods: a review of a prospective mantined database was conducted in patients submitted to robotic transabdominal preperitoneal (TAPP) inguinal hernia repairs between March 2016 and February 2020. Descriptive statistics were performed. Surgical outcomes data and patient follow-ups are reported. Results: retrospective chart review identified 97 patients submitted to robotic TAPP inguinal hernia repair. Mean age was 36.4 years, with median BMI of 26.9 kg/m2. Mean console time was 58 min (range 40-150) and patients were discharged within 24 hours of their stay in a majority of cases. Mesh was placed in all procedures and there were no conversion rates. Complications were low grade and no recurrence was seen after a mean follow-up of 642 days. Conclusion: this study represents to-date the first brazilian case series of robotic TAPP inguinal hernia repair. Our results encourage that robotic assisted TAPP inguinal hernia repair appears to be technically feasible and safe in experienced hands, with good outcomes achieving high health-related quality of life and low recurrence rates in the short and long term.


RESUMO Objetivo: a cirurgia minimamente invasiva das hérnias inguinais apresenta vantagens comprovadas em relação aos procedimentos convencionais, incluindo menos dor e retorno precoce às atividades rotineiras. A cirurgia robótica acrescenta uma melhor ergonomia, ótica estável tridimensional de alta definição e instrumentos articulados, superando algumas limitações laparoscópicas. O objetivo deste estudo é relatar os resultados da experiência inicial de 97 cirurgias de correção de hérnias inguinais robóticas pela técnica transabdominal pré-peritoneal (TAPP) realizadas por um grupo cirúrgico referência no Brasil. Métodos: foi realizada uma revisão de um banco de dados mantido prospectivamente de pacientes submetidos a cirurgias de hérnia inguinal TAPP robótica entre março de 2016 e fevereiro de 2020. Uma análise detalhada dos resultados foi feita e dados dos resultados cirúrgicos e acompanhamento dos pacientes são relatados. Resultados: a revisão retrospectiva do prontuário identificou 97 pacientes submetidos à cirurgia de hérnia inguinal TAPP robótica. A idade média foi de 36,4 anos, com IMC médio de 26,9 kg/m2. O tempo médio de procedimento cirúrgico no console robótico foi de 58 minutos. A colocação de prótese foi realizada em todos os procedimentos e não houve taxas de conversão ou intercorrências. Conclusão: este estudo representa a primeira série de casos de cirurgia robótica de hérnia inguinal pela técnica transabdominal pré-peritoneal no Brasil. Os resultados descritos reforçam que a hernioplastia inguinal robótica apresenta-se como tecnicamente viável e segura em mãos experientes, com bons resultados quanto a qualidade de vida e baixas taxas de recidiva a curto e longo prazo.


Subject(s)
Laparoscopy/methods , Herniorrhaphy/methods , Robotic Surgical Procedures/methods , Hernia, Inguinal/surgery , Quality of Life , Treatment Outcome , Middle Aged
13.
Rev. cuba. med. mil ; 49(4): e895, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1156529

ABSTRACT

Recientemente leímos con interés el artículo publicado por Saliou y otros, titulado Factores asociados a las complicaciones de la cirugía electiva de las hernias inguinales1 (artículo I) en el cual describen las características asociadas a las complicaciones posquirúrgicas, de pacientes atendidos por hernias inguinales, en el Servicio de Cirugía General del Hospital Provincial Docente Saturnino Lora, de una ciudad de Cuba. Sin embargo, este trabajo publicado en la Revista Cubana de Medicina Militar presenta resultados similares a otro publicado previamente en la Revista Cubana de Cirugía, realizado por los mismos autores, cuyo título es "Complicaciones posquirúrgicas de las hernias inguinales"2 (artículo II). Al analizar el contenido de ambos artículos, siguiendo las directrices del Comité Internacional de Directores de Revistas Biomédicas (ICMJE),3 el artículo I sería una publicación duplicada, porque no muestra una clara diferencia entre ambos trabajos, ni cita adecuadamente al artículo II. Además, existe una superposición notoria de los resultados que fueron presentados en ambos trabajos. Esto genera problemas, porque se podría contabilizar inadvertidamente a ambos resultados, lo cual crea un escenario epidemiológico sesgado para posteriores investigaciones. Para que un trabajo sea considerado como una publicación secundaria autorizada, el artículo I debería cumplir las siguientes características: i) la publicación secundaria debería estar dirigido a diferentes lectores, ii) la publicación secundaria debería informar que se basa en un trabajo publicado anteriormente mediante una nota o cita y iii) el título de la publicación secundaria también debería señalar de que se trata de una versión secundaria.3 Esto no se evidencia en el artículo I, a pesar de que el artículo II ya estaba publicado (fecha de aprobación: octubre del 2019 vs fecha de publicación: abril - junio del 2019, respectivamente). En el caso de tratarse de manuscritos basados en la misma base de datos, que también contempla el ICMJE,3 el método analítico y las conclusiones deberían ser marcadamente diferentes, sin embargo, esto no queda claro entre ambos manuscritos. Si bien el artículo I efectúa una asociación entre las complicaciones posquirúrgicas, y algunas características de los pacientes operados por hernias inguinales, y el artículo II solo describe las características de las complicaciones posquirúrgicas de estos pacientes, se observa una aparente omisión intencional de datos en el artículo II, para poder dar estas ligeras diferencias entre ambos artículos. En este artículo no se presentan datos iniciales tales como edad, sexo y antecedentes clínicos necesarios para una mejor comprensión de los resultados. Todas estas características de los pacientes, solo aparecen para el análisis del...(AU)


Subject(s)
Humans , Male , Female , Hernia, Inguinal/surgery , Hernia, Inguinal/complications
14.
Arq. gastroenterol ; 57(4): 484-490, Oct.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1142335

ABSTRACT

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.


Subject(s)
Humans , Adult , Young Adult , Laparoscopy , Herniorrhaphy/methods , Hernia, Femoral/surgery , Hernia, Inguinal/surgery , Postoperative Complications/epidemiology , Surgical Mesh , Brazil/epidemiology , Public Health , Treatment Outcome , Herniorrhaphy/statistics & numerical data , Hernia, Femoral/epidemiology , Hernia, Inguinal/epidemiology , Middle Aged
15.
Rev. Assoc. Med. Bras. (1992) ; 66(11): 1548-1552, Nov. 2020. tab
Article in English | LILACS, SES-SP | ID: biblio-1143626

ABSTRACT

SUMMARY INTRODUCTION: In the future, surgery will be centralized in hospitals with the best value (excellent results with reduced cost). High-performance teams will be required; however, available data concerning the specific abilities necessary to build and manage them are poor. OBJECTIVES: Share the set of competencies and skills established to build and lead a high-performance general surgery team. METHODS: In November 2012, a general surgery team started its activities at a tertiary hospital in Sao Paulo, Brasil. The model consisted of high volume performed by a small team. Experienced surgeons, motivated, and with technical and moral excellence were selected. A sense of unity was created and goals were shared. Complex cases were discussed daily and a prospective database to follow outcomes was established. The payment value was above the market. RESULTS: In 6 years and 4 months, 11,006 surgical procedures were performed (8,597 electives and 2,409 in an urgent setting). Cholecystectomy was the most common procedure (4,101; being 3,676 electives), followed by inguinal hernioplasty (n: 1,827) and appendectomy (n: 925). A total of 449 elective oncologic procedures were performed. The surgical site infection rate in clean procedures was 0.12%, 80 patients required re-do surgery (2.4% in an urgent setting and 0.2% of the electives). There were 22 postoperative deaths (0.66% for urgent and 0.07% for electives), 5 of the 6 deaths in elective patients were in oncologic cases. CONCLUSION: A competent surgical team, inserted in a model that favors performance and values the individual can deliver high volume with exceptional results.


RESUMO INTRODUÇÃO: No futuro as cirurgias serão centralizadas em hospitais que tenham melhor valor (resultados excelentes com custo reduzido). Equipes de alta performance serão necessárias, entretanto a literatura acerca das habilidades específicas para montar e gerir essas equipes é muito pobre. OBJETIVOS: Compartilhar as competências e habilidades estabelecidas para construir e liderar uma equipe de cirurgia geral de alto desempenho. MÉTODOS: Em novembro de 2012, a equipe de cirurgia geral iniciou suas atividades em um hospital terciário na cidade de São Paulo (SP, Brasil). O modelo consistia em produzir alto volume com um time pequeno. Cirurgiões experientes, motivados e com excelência técnica e moral foram selecionados. Um senso de unidade foi criado e objetivos coletivos estabelecidos e compartilhados. O pagamento estava acima da média do mercado. RESULTADOS: Em 6 anos e 4 meses, 11.006 procedimentos cirúrgicos foram realizados (8.597 eletivos e 2.409 de urgência/emergência). A colecistectomia foi o procedimento mais comum (n: 4.101, sendo 3.676 eletivas), seguida da hernioplastia inguinal (n: 1.827) e da apendicectomia (n: 925). Um total de 449 cirurgias oncológicas eletivas foram realizadas. A infecção de sítio cirúrgico em procedimentos limpos foi de 0,12% (2,4% para cirurgias de urgência e 0,2% nas eletivas). Ocorreram 22 óbitos cirúrgicos (0,66% na urgência e 0,07% nas eletivas), 5 dos 6 óbitos eletivos ocorreram em pacientes oncológicos. CONCLUSÃO: Uma equipe competente, inserida em um modelo que favorece o desempenho e valoriza o indivíduo é capaz de entregar grande volume com resultados excepcionais.


Subject(s)
Humans , Surgeons , Surgical Wound Infection , Brazil , Elective Surgical Procedures , Hernia, Inguinal/surgery
17.
Rev. argent. cir ; 112(3): 293-302, jun. 2020. graf
Article in Spanish | LILACS | ID: biblio-1279742

ABSTRACT

RESUMEN Introducción: los octogenarios son un grupo demográficamente en crecimiento. Este aumento en la esperanza de vida pone al cirujano frecuentemente frente a pacientes de edad avanzada con una hernia inguinal. Objetivo: analizar la aplicabilidad, seguridad y eficacia del tratamiento quirúrgico ambulatorio de la hernia inguinal en pacientes mayores de 80 años. Material y método: estudio comparativo, de cohorte retrospectiva. Se analizaron todas las hernio plastias inguinales por vía abierta con técnica de Lichtenstein realizadas entre 2008 y 2017, con al menos un mes de seguimiento. Estos pacientes fueron comparados de forma retrospectiva con todos aquellos de iguales características de entre 50 y 79 años tratados durante el mismo período de tiempo. Resultados: entre 2008 y 2017, 491 pacientes ingresaron en el Programa de Cirugía Mayor Ambulato ria y fueron sometidos a reparación de una hernia inguinal con técnica de Lichtenstein. De estos, 133 pacientes (27, 1%) eran mayores de 80 años, y 358 pacientes (72,9%) de entre 50 y 79 años. La mor bilidad posoperatoria global de la serie fue del 9,75% (13,5% para mayores de 80 años y 8,4% para el grupo control, p = NS). Tampoco hubo diferencia estadísticamente significativa en admisión temprana (3,8% vs. 2,8% del grupo control, p = NS). Conclusión: la cirugía ambulatoria en la hernioplastia por vía abierta, en pacientes mayores de 80 años, fue aplicada de forma segura y eficaz.


ABSTRACT Background: Octogenarians are a demographically growing group. This increase in life expectancy of ten makes surgeons face older patients with inguinal hernia. Objective: The aim of this study was to analyze the applicability, safety and efficacy of ambulatory inguinal hernia in patients > 80 years, Material and methods: We conducted a retrospective and observational cohort study. Data from all the open inguinal hernia repair procedures performed using the Lichtenstein technique between January 2008 and December 2017 and followed-up after one month were analyzed. These patients were retrospectively compared with similar patients aged 50-79 years who were treated during the same period. Results: Between 2008 and 2017, 491 patients admitted in the Major Ambulatory Surgery program underwent inguinal hernia repair using the Lichtenstein technique. 133 (27.1%) were > 80 years and 358 (72.9%) were between 50 and 79 years. Overall postoperative morbidity was 9.75% (13.5% in > 80 years and 8.4% in the control group; p = NS). There were no significant differences in unanticipated mortality (3.8% vs. 2.8%un the control group, p = NS). Conclusion: Ambulatory surgery for open inguinal hernia repair in patients > 80 years is a safe and effective strategy.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Efficacy , Hernia, Inguinal/surgery , Argentina , Safety , Aged , Retrospective Studies , Cohort Studies , Herniorrhaphy/methods , Ambulatory Surgical Procedures/methods
19.
Rev. venez. cir ; 73(2): 25-29, 2020. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1291541

ABSTRACT

El objetivo del presente trabajo es reportar y analizar nuestra experiencia con la técnica endoscópica transabdominal preperitoneal (TAPP) en el tratamiento de la hernia inguinal. Métodos: Estudio retrospectivo mediante la revisión de nuestra base de datos electrónica y las historias clínicas en físico de la Clínica Santa Sofía, de los pacientes con diagnóstico de hernia inguinal tratados por los autores en los últimos 8 años. Se incluyeron para el análisis los casos con abordaje laparoscópico, recolectándose sexo, edad, diagnóstico pre e intraoperatorio, procedimientos adicionales, tiempo quirúrgico, complicaciones perioperatorias, tiempo de hospitalización, y morbilidad. Resultados: Se recolectaron 158 intervenciones de hernias inguinales en 102 pacientes, 89 hombres y 13 mujeres, de las cuales 135 (85,4%) fueron por abordaje laparoscópico tipo TAPP. Mediante la laparoscopia se modificó el diagnóstico preoperatorio en 17 pacientes (16.6%). El tiempo quirúrgico promedio fue de 50,5±11,6 minutos, y se presentaron 3 complicaciones perioperatorias y 4 tardías, para una morbilidad total de 5,1%. La estancia hospitalaria fue de 1±0,08 días y el tiempo de seguimiento promedio fue de 7,5±15,4 meses, detectándose 3 recidivas (2,2%) en ese período. Cinco pacientes presentaron dolor crónico posoperatorio, ninguno debilitante, que cedió gradualmente en todos los casos utilizando analgésicos comunes. Conclusiones: La técnica TAPP es una alternativa válida en el tratamiento de la hernia inguinal. Sus principales ventajas son las de optimizar el diagnóstico, permitiendo la reparación en un solo tiempo de hernias no diagnosticadas clínicamente, y su baja incidencia de dolor posoperatorio crónico(AU)


Currently the Lichtenstein technique is the most used worldwide for inguinal hernia repair, however, the laparoscopic approach has been gaining ground in recent years. The objective of the present work is to present and analyze our experience with the transabdominal preperitoneal (TAPP) technique for the treatment of this pathology.Methods: A retrospective study by the revision of our electronic database and the Santa Sofía clinic physical medical records, of the patients with groin hernia diagnosis treated by the authors in the last 8 years. The cases with the laparoscopic approach were included, collecting sex, age, pre and intraoperative diagnosis, additional procedures, surgical time, perioperative complications, hospital stay, and morbidity.Results : A 158 inguinal hernia repairs were collected in 102 patients, 87 males, and 13 females, of which 135 (85.4%) were through laparoscopic approach TAPP type. By means of laparoscopy, the preoperative diagnosis was modified in 17 patients (16.6%). Mean surgical time was 50.5±11.6 minutes, and 3 perioperative complications and 4 late complications were observed, for total morbidity of 5.1%. Hospital stay was 1±0.08 days, and mean follow-up was 7.5±15.4 months, detecting 3 recurrences (2.2%) at that time. Five patients presented chronic postoperative pain, none debilitating, which gradually yielded in all cases by common pain relievers.Conclusions : The TAPP technique is a valid alternative for the treatment of an inguinal hernia. Its main advantages are to optimize the diagnosis, allowing the repair of clinically undiagnosed hernias in one surgical time, and its low incidence of chronic postoperative pain(AU)


Subject(s)
Humans , Male , Female , Laparoscopy , Chronic Pain , Hernia, Inguinal/surgery , Surgical Procedures, Operative , Retrospective Studies , Aftercare
20.
Rev. venez. cir ; 73(1): 14-17, 2020. ilus, tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1283942

ABSTRACT

Se describe a la hernia de Amyand como la presencia del apéndice cecal dentro de un saco herniario inguinal con un proceso inflamatorio-infeccioso o no, cuya frecuencia <1% de los casos de hernias inguinales. Exponer caso clínico y revisión bibliográfica de la hernia de Amyand tipo 3. Paciente masculino de 65 años de edad con enfermedad actual de inicio 10 días previo a su ingreso cuando posterior a esfuerzo físico presenta aumento de volumen no reductible en región inguinal derecha dolorosa, posteriormente 24 horas previo a su ingreso presenta dolor de fuerte intensidad en región inguinal derecha, persistencia del aumento de volumen y signos de flogosis, náuseas y alzas térmicas no cuantificadas, por lo cual acude a nuestra institución. Examen fisico: Abdomen blando depresible, doloroso a la palpación profunda en fosa ilíaca derecha, sin signos de irritación peritoneal, se apreciaba aumento de volumen en region inguinal derecha, no reductible, doloroso a la palpación con rubor y calor local, genitales masculinos con dolor a la palpación del testìculo derecho. Hernia inguinal derecha atascada. Intervención quirúrgica: Hernioplastia inguinal por técnica de cierre preperitoneal, sin colocación de malla, apendicectomía atípica por técnica de Pouchet. La hernia de Amyand es una patología poco frecuente, que se presenta <1% y acompañada de complicaciones <0,1%, debe sospecharse en pacientes que presente una patología herniaria derecha con leucocitosis y neutrofilia sin otro foco infeccioso demostrado, donde el diagnóstico principalmente se hace intraoperatorio como lo expone el presente caso(AU)


Amyand's hernia is described as the presence of the cecal appendix within an inguinal hernial sac with an inflammatory-infectious process or not, the frequency of which is <1% of cases of inguinal hernias. To present a clinical case and a bibliographic review of Amyand hernia type 3. A 65-year-old male patient with current disease that started 10 days before admission when, after physical effort, he presented a non-reducible increase in volume in the right inguinal region. Painful, later 24 hours before admission, he presented pain of strong intensity in the right inguinal region, persistence of increased volume and signs of phlogosis, nausea and thermal increases not quantified, for which he came to our institution. Physical exam: painful depressible soft abdomen on deep palpation in the right iliac fossa without signs of peritoneal irritation, volume increase was observed in the right inguinal region, not reducible, painful on palpation with flushing and local heat, male genitalia with pain on palpation of the right testicle. Stuck right inguinal hernia. Surgical intervention: Inguinal hernioplasty by preperitoneal closure technique without mesh placement, atypical appendectomy by Pouchet technique. Amyand's hernia is a rare pathology, which presents <1% and accompanied by complications <0.1%, it should be suspected in patients presenting a right hernia pathology with leukocytosis and neutrophilia without another proven infectious focus, where the diagnosis is mainly made intraoperatively as exposed in the present case(AU)


Subject(s)
Humans , Male , Aged , Appendicitis/surgery , Appendicitis/pathology , Hernia, Inguinal/surgery , Hernia, Inguinal/pathology , Appendectomy , Peritonitis/surgery , Peritonitis/pathology , Acute Disease
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