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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. bras. ginecol. obstet ; 43(7): 570-577, July 2021. tab, graf
Article in English | LILACS | ID: biblio-1347252

ABSTRACT

Abstract Sacral colpopexy is one of the standard procedures to treat apical pelvic organ prolapse. In most cases, a synthetic mesh is used to facilitate the colposuspension. Spondylodiscitis is a rare but potentially serious complication that must be promptly diagnosed and treated, despite the lack of consensus in the management of this complication.We report one case of spondylodiscitis after a laparoscopic supracervical hysterectomy and sacral colpopexy treated conservatively. We also present a literature review regarding this rare complication. A conservative approach without mesh removal may be possible in selected patients (stable, with no vaginal lesions, mesh exposure or severe neurologic compromise). Hemocultures and culture of imageguided biopsies should be performed to direct antibiotic therapy. Conservative versus surgical treatment should be regularly weighted depending on clinical and analytical progression. A multidisciplinary team is of paramount importance in the follow-up of these patients.


Resumo A colpopexia sacral é um dos procedimentos padrão para tratar o prolapso de órgãos pélvicos apical. Na maioria dos casos, uma tela sintética é usada para facilitar a colposuspensão. A espondilodiscite é uma complicação rara, mas potencialmente grave, que deve ser prontamente diagnosticada e tratada, apesar da falta de consenso no manejo dessa complicação. Relatamos um caso de espondilodiscite após histerectomia supracervical laparoscópica e colpopexia sacral tratada conservadoramente. Também apresentamos uma revisão da literatura sobre essa complicação rara. Uma abordagem conservadora sem remoção da tela pode ser possível em pacientes selecionadas (estáveis, sem lesões vaginais, exposição da tela ou comprometimento neurológico grave). Hemoculturas e cultura de biópsias guiadas por imagem devemser realizadas para direcionar a antibioticoterapia. O tratamento conservador versus o cirúrgico deve ser avaliado regularmente, dependendo da progressão clínica e analítica. Uma equipe multidisciplinar é de suma importância no acompanhamento desses pacientes.


Subject(s)
Humans , Female , Discitis/etiology , Uterine Prolapse/surgery , Laparoscopy , Gynecologic Surgical Procedures , Surgical Mesh/adverse effects , Pelvic Organ Prolapse/surgery , Conservative Treatment
3.
Medicina (Ribeirão Preto) ; 54(1)jul, 2021. tab
Article in Portuguese | LILACS | ID: biblio-1354789

ABSTRACT

RESUMO: Modelo do estudo: Revisão sistemática. Objetivo: Avaliar se é facultativo ou imprescindível o uso de malha cirúrgica no reparo das pequenas hérnias umbilicais primárias, com orifício menor que 2 cm, a fim de oferecer melhores evidências aos cirurgiões e, assim, aprimorar o método cirúrgico e o seu desfecho. Métodos: Trata-se de uma revisão da literatura, cuja busca foi direcionada aos artigos que abordassem o manejo operatório das hérnias abdominais, sobretudo das hérnias umbilicais de pequeno tamanho. A pesquisa foi realizada nas bases de dados primárias PubMed, LILACS, Cochrane Library e Periódicos CAPES. Resultados: No total, foram incluídos quatro es-tudos. Foram avaliadas as taxas de recorrência, bem como as de complicações pós-operatórias após a correção da hérnia umbilical com e sem o uso de tela, observando-se o tamanho do defeito abdominal. Foi observada diminuição da recorrência das hérnias após o reparo com tela. No entanto, complicações, como infecção da ferida operatória, foram mais comumente observadas com o uso da prótese. Não houve consenso quanto ao uso da tela em hérnias menores que 1 cm. Conclusão: O uso de próteses pode vir a ser o tratamento de escolha no reparo das hérnias umbilicais primárias. Contudo, mais estudos são necessários para avaliar o papel dessa estratégia no manejo das hérnias menores que 1 cm (AU)


ABSTRACT: Study design: Systematic review. Objective: Evaluate whether surgical mesh is optional or essential for the repair small primary umbilical hernias, with an orifice smaller than 2 cm, in order to provide better evidence for surgeons, thus enhancing surgical method and its outcomes. Methods: This is a literature review, whose search was directed towards papers that depicted surgical management of abdominal hernias, especially small umbilical hernias. The research was carried out in the primary the primary databases PubMed, LILACS, Cochrane Library, and Periódicos CAPES. Results: A total of four studies were included. Recurrence rates, as well as postoperative complications, were assessed after an umbilical hernia was corrected with or without the use of a mesh, observing the size of the abdominal defect. A reduction in the re-occurrence of hernias was observed when using a mesh. However, complications, such as surgical site infection, were more commonly noticed with the use of the prosthe-sis. There was no consensus regarding the use of the mesh in hernias smaller than 1 cm. Conclusion: The use of surgical mesh may prove to be the treatment of choice for the repair of primary umbilical hernias. However, more studies are needed to evaluate the role of this strategy in the management of hernias smaller than 1 cm. (AU)


Subject(s)
Humans , Postoperative Complications , Surgical Mesh , Surgical Wound Infection , Hernia, Umbilical , Hernia, Umbilical/surgery
4.
Rev. colomb. cir ; 36(3): 520-530, 20210000. fig, tab
Article in Spanish | LILACS | ID: biblio-1254387

ABSTRACT

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


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


Subject(s)
Humans , Abdominal Wall , Open Abdomen Techniques , Surgical Mesh , Incisional Hernia , Hernia, Ventral
5.
Medicina (B.Aires) ; 81(1): 24-30, mar. 2021. graf
Article in Spanish | LILACS | ID: biblio-1287237

ABSTRACT

Resumen La falla en la reparación de los defectos de la pared abdominal se relaciona con una alteración en la integración del material protésico. El objetivo de este trabajo fue evaluar el comportamiento biológico de mallas utilizadas en cirugía de paredes abdominales en un modelo animal. Luego de la confección de un defecto parietal se colocó una malla intraperitoneal, utilizando 4 grupos de 10 ratas; 1) Prolene (polipropileno microporo de alto peso), 2) Ultrapro (polipropileno + poliglecaprone, macroporo de bajo peso), 3) Proceed (polipropileno + polidoxanona + celulosa oxidada regenerada, macroporo de peso intermedio), y 4) Physiomesh (polipropileno + poliglecaprone, macroporo de bajo peso). Se realizó análisis macroscópico y microscópico a los 30 días y los resultados fueron evaluados por dos observadores independientes. Al examen macroscópico, la integración de la prótesis fue > 75% en todos los grupos. El análisis microscópico mostró mayor inflamación global y número de células gigantes multinucleadas en Prolene (p < 0.01) y menor cantidad de células inflamatorias en la interface músculo-malla en Physiomesh < Ultrapro (p < 0.05). La organización de las fibras de colágeno fue similar para todas las mallas, aunque hubo mayor depósito de colágeno en los espacios inter-filamento para las mallas macroporosas (p < 0.01). Concluimos que las mallas de polipropileno microporo y alto peso producen mayor reacción inflamatoria y de cuerpo extraño. Por lo tanto, las mallas compuestas tendrían una mejor biocompatibilidad y serían mejor toleradas por el huésped.


Abstract An adequate integration of the prosthetic materials used to repair abdominal wall defects is necessary for satisfactory outcomes. We aimed to evaluate, in an animal model, the biological behavior of meshes used for abdominal wall surgery. Four groups of 10 rats were separated. After laparotomy, intraperitoneal prostheses were placed: 1) Prolene (polypropylene microporous, heavy-weight), 2) Ultrapro (polypropylene + poliglecaprone, macroporous low-weight), 3) Proceed (polypropylene + polidoxanone + regenerated oxidized cellulose, microporous medium-weight), 4) Physiomesh (polypropylene + poliglecaprone, macroporous lowweight). Macroscopic and microscopic analyses were performed at 30 days. The results were evaluated by two independent observers and expressed in means with standard deviation. For statistical analysis p < 0.05 was considered significant. On macroscopic examination, mesh integration was greater than 75% in all cases. Microscopic analysis showed greater global inflammation and more multinucleated giant cells in Prolene (p < 0.01). Less inflammatory cells were observed at the muscle-mesh interface in Physiomesh vs. Ultrapro (p < 0.05). Collagen fibers disposition was similar in all meshes, although, microporous meshes had higher collagen deposit in the interfilamentous spaces (p < 0.01). In conclusion, in our animal model, microporous and heavy-weight polypropylene meshes produce greater inflammatory and foreign body reaction. Thus, composite meshes would have greater biocompatibility and better tolerance by the host.


Subject(s)
Animals , Rats , Surgical Mesh/adverse effects , Abdominal Wall/surgery , Polyesters , Prostheses and Implants , Materials Testing
6.
Int. braz. j. urol ; 47(2): 287-294, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1154463

ABSTRACT

ABSTRACT Purpose: Despite high success rates in the treatment of urinary incontinence, complications related to the use of polypropylene (PP) meshes are still a concern, especially in vaginal prolapses surgeries. The objective of this study was to assess the effect of autologous platelet-rich plasma (PRP) coating on the integration of PP meshes implanted in the vaginal submucosa of rabbits. Materials and Methods: Thirty adult New Zealand rabbits were randomly divided into two groups (n=15): PP, implanted with conventional PP meshes; and PRP, implanted with autologous PRP coated PP meshes. Animals in both groups (n=5) were euthanized at 7, 30 and 90 days postoperatively, the vaginas extracted and sent to immunohistochemical analysis for the assessment of the pro-inflammatory agent TNF-α, anti-inflammatory agents TGF-β and IL-13, collagen metabolism marker MMP-2, and angiogenesis marker CD-31. AxioVision™ image analysis was used for the calculation of the immunoreactive area and density. Statistical analysis was performed with ANOVA followed by Tukey test (p <0.05). Results: Animals in the PRP group showed significantly increased expression of the angiogenesis agent CD-31 at all experimental times when compared to the PP group (p <0.0001). However, no differences concerning the expression of the other markers were observed between the groups. Conclusion: The addition of autologous PRP gel to PP meshes can be simply and safely achieved and seems to have a positive effect on implantation site angiogenesis. Further investigations are required to ascertain PPR coated meshes clinical efficacy in prolapses and stress urinary incontinence surgeries.


Subject(s)
Animals , Female , Polypropylenes , Platelet-Rich Plasma , Rabbits , Surgical Mesh , Vagina/surgery , Collagen
7.
Int. braz. j. urol ; 47(1): 82-89, Jan.-Feb. 2021. tab
Article in English | LILACS | ID: biblio-1134308

ABSTRACT

ABSTRACT Purpose: We aimed to determine pre-operative and post-operative sexual function scores of patients who underwent four-arm polypropylene mesh implantation surgery to treat urinary incontinence and pelvic organ prolapse. Materials and Methods: A prospective study from January 2011 to November 2015 including patients (n: 72) submitted to surgical mesh implantation (four-arm anterior mesh implant (Betamix POP4®, Betatech Medical, Turkey) questioned the patients with Female Sexual Function Index evaluation form. The questionnaire was applied to all patients at pre-operative, post-operative 3rd month and post-operative 1st year periods. Results: The mean age of the patients was 47.2±7.1 years. The mean Body Mass Index (kg/m2) was 28.7±3.7. The average of incontinence duration (year) was 4.6±2.6 and the average for operation time (min) was 35.7±2.1. After the urinary incontinence and pelvic organ prolapse surgery, it was observed that incontinence complaints of patients reduced. Furthermore, there was a positive change in quality of life and sexual function of patients at the post-operative period. There was a statistically significant increase according to Female Sexual Function Index score among all three periods (16%, 86% and 100% respectively, p=0.001) and improvement of sexual functions was observed. Conclusions: Transvaginal mesh use in the surgical treatment of pelvic organ prolapse improves quality of life. However, risk factors such as transvaginal mesh usage indication, surgical technique and experience of the surgeon, suitability of the material, the current health status of the patient and postoperative personal care of the patient may affect the success of operations.


Subject(s)
Animals , Female , Adult , Urinary Incontinence , Pelvic Organ Prolapse/surgery , Quality of Life , Surgical Mesh/adverse effects , Turkey , Prospective Studies , Surveys and Questionnaires , Treatment Outcome , Middle Aged
8.
Article in English | WPRIM | ID: wpr-922463

ABSTRACT

Guided bone regeneration (GBR) uses resorbable and non-resorbable membranes as biological barriers. This study compared the differences in hard tissue stability between GBR using evidence-based digital titanium mesh and resorbable collagen membranes during implant placement. A total of 40 patients (65 implant sites) were enrolled and divided into two groups: resorbable membrane and digital titanium mesh groups. The alveolar bone was analyzed at two- and three-dimensional levels using cone-beam computed tomography and by reconstructing and superimposing the hard tissues at four time points: preoperatively, postoperatively, before second-stage surgery, and 1 year after loading. The use of digital titanium mesh showed less alveolar bone resorption in vertical and horizontal directions two-dimensionally before the second-stage surgery and 1 year after loading. Regarding volumetric stability, the percentage of resorption after 6 months of healing with resorbable membrane coverage reached 37.5%. However, it was only 23.4% with titanium mesh. Although postoperative bone volume was greater at all labial sites with resorbable membrane than with digital titanium mesh, after substantial bone resorption within 1 year of loading, the labial bone thickness at the upper part of implants was thinner with resorbable membrane than with digital titanium mesh. Furthermore, digital titanium meshes made according to ideal bone arch contour reduced soft tissue irritation, and the exposure rate was only 10%. Therefore, although both resorbable membrane and digital titanium mesh in GBR were able to successfully reconstruct the bone defect, digital titanium meshes were better at maintaining the hard tissue volume in the osteogenic space.


Subject(s)
Bone Regeneration , Bone Resorption , Humans , Osteogenesis , Surgical Mesh , Titanium
9.
Article in Chinese | WPRIM | ID: wpr-921556

ABSTRACT

Objective To observe the patients after transvaginal mesh(TVM)implantation surgery by using transperineal ultrasound(TPUS),compare the diagnosis of pelvic organ prolapse(POP)by TPUS and clinical examination[according to the Pelvic Organ Prolapse Quantification(POP-Q)system published by the International Continence Society],and to explore the role of ultrasound in postoperative evaluation as well as the high-risk factors of post-surgery POP recurrence. Methods This is a retrospective study based on the POP-Q records and TPUS data sets of patients within 6 months after TVM surgery during September 2013 and November 2019.The diagnostic results of TPUS and POP-Q were compared.The incidences of hiatal ballooning and levator avulsion were separately compared between the TPUS group and the control group. Results A total of 147 patients were enrolled.The Kappa values between TPUS and POP-Q in the diagnosis of anterior and posterior compartment POP were 0.268(


Subject(s)
Humans , Pelvic Floor/diagnostic imaging , Pelvic Organ Prolapse/diagnostic imaging , Retrospective Studies , Surgical Mesh/adverse effects , Ultrasonography
10.
Article in Chinese | WPRIM | ID: wpr-879409

ABSTRACT

OBJECTIVE@#To compare the clinical effects of three different methods of binding multi-fold rib graft, iliac bone graft and titanium mesh graft in tuberculosis of thoracic vertebra by approach of transverse rib process.@*METHODS@#A hundred and seven patients with tuberculosis of thoracic vertebra received surgical treatment from January 2010 to December 2016 were retrospectively analyzed. The patients were divided into three groups according different methods of bone graft. The surgical approach of the transverse rib process was used in all 107 patients, after thoroughly remove the necrotic tissue of tuberculosis, three different bone grafts were used respectively including iliac bone graft (36 cases, group A), binding multi-fold rib graft (35 cases, group B), titanium mesh bone graft (36 cases, group C). Perioperative indexes, the time required for bone graft during operation, intraoperation blood loss, the loss rate of the anterior edge of the lesion, Cobb angle, postoperative bone graft fusion time, spinal nerve recovery and Oswestry Disability Index were compared among three groups.@*RESULTS@#All the patients were followed up for 13 to 24 months, and the operation time required for bone graft was (23.2±4.1) min in group A, (23.8± 4.4)min in group B, and (25.5±4.2) min in group C, with no statistically significant difference among three groups (@*CONCLUSION@#The approach of transverse rib process for debridement of lesions can effectively treat tuberculosis of thoracic vertebra by binding multi-fold rib graft, iliac bone graft and titanium mesh graft, but binding multi-fold rib graft can effectively avoid iliac bone donor complications, and is an effective alternative to iliac bone graft, which is worth popularizing.


Subject(s)
Bone Transplantation , Humans , Lumbar Vertebrae , Retrospective Studies , Ribs/surgery , Spinal Fusion , Surgical Mesh , Thoracic Vertebrae/surgery , Titanium , Treatment Outcome , Tuberculosis, Spinal/surgery
11.
Chinese Medical Journal ; (24): 200-205, 2021.
Article in English | WPRIM | ID: wpr-878027

ABSTRACT

BACKGROUND@#It has been a global trend that increasing complications related to pelvic floor surgeries have been reported over time. The current study aimed to outline the development of Chinese pelvic floor surgeries related to pelvic organ prolapse (POP) over the past 14 years and investigate the potential influence of enhanced monitoring conducted by the Chinese Association of Urogynecology since 2011.@*METHODS@#A total of 44,594 women with POP who underwent pelvic floor surgeries between October 1, 2004 and September 30, 2018 were included from 22 tertiary academic medical centers. The data were reported voluntarily and obtained from a database. We compared the proportion of each procedure in the 7 years before and 7 years after September 30, 2011. The data were analyzed by performing Z test (one-sided).@*RESULTS@#The number of different procedures during October 1, 2011-September 30, 2018 was more than twice that during October 1, 2004-September 30, 2011. Regarding pelvic floor surgeries related to POP, the rate of synthetic mesh procedures increased from 38.1% (5298/13,906) during October 1, 2004-September 30, 2011 to 46.0% (14,107/30,688) during October 1, 2011-September 30, 2018, whereas the rate of non-mesh procedures decreased from 61.9% (8608/13,906) to 54.0% (16,581/30,688) (Z = 15.53, P < 0.001). Regarding synthetic mesh surgeries related to POP, the rates of transvaginal placement of surgical mesh (TVM) procedures decreased from 94.1% (4983/5298) to 82.2% (11,603/14,107) (Z = 20.79, P < 0.001), but the rate of laparoscopic sacrocolpopexy (LSC) procedures increased from 5.9% (315/5298) to 17.8% (2504/14,107).@*CONCLUSIONS@#The rate of synthetic mesh procedures increased while that of non-mesh procedures decreased significantly. The rate of TVM procedures decreased while the rate of LSC procedures increased significantly.@*TRIAL REGISTRATION NUMBER@#NCT03620565, https://register.clinicaltrials.gov.


Subject(s)
China , Female , Gynecologic Surgical Procedures/adverse effects , Humans , Pelvic Floor/surgery , Pelvic Organ Prolapse/surgery , Surgical Mesh/adverse effects , Treatment Outcome , Vagina
12.
ABCD arq. bras. cir. dig ; 34(4): e1642, 2021. tab
Article in English, Portuguese | LILACS | ID: biblio-1360003

ABSTRACT

RESUMO - RACIONAL: Três técnicas cirúrgicas para correção de hérnia inguinal estão atualmente validadas. Poucos estudos compararam os resultados entre Lichtenstein e a abordagem laparoscópica transabdominal pré-peritoneal obtidos em uma etapa inicial da curva de aprendizado. OBJETIVO: Comparar os resultados iniciais do tratamento entre a técnica de Liechtenstein e a abordagem pré-peritoneal transabdominal laparoscópica para fornecer uma base para a tomada de decisão do cirurgião. MÉTODO: Os pacientes foram divididos em grupo 1: aborgadem laparoscópica transabdominal pré-peritoneal (114 pacientes), e grupo 2: reparo aberto de Lichtenstein (35 pacientes). Os dados foram coletados em prontuários médicos durante a evolução do pós-operatório imediato e por contato telefônico após a alta hospitalar. Para a análise das variáveis, foi implementado o teste de independência Qui-Quadrado, com nível de significância estabelecido em p-valor = 0,05. RESULTADOS: Houve forte associação entre laparoscopia, menos dor pós-operatória e maior tempo operatório. Além disso, notou-se preferência pela técnica nos casos de recorrência, bilateralidade, hérnia umbilical associada ou obesidade. Neste estudo, a técnica de Lichtenstein foi associada a um menor tempo de retorno ao trabalho e foi o tratamento de escolha para pacientes idosos. CONCLUSÃO: A herniorrafia laparoscópica transabdominal pré-peritoneal deve ser a primeira escolha em casos de bilateralidade, hérnia umbilical associada, obesidade e recorrência para reparo anterior. O risco cirúrgico é adequado para o procedimento, mesmo nos estágios iniciais da curva de aprendizado.


ABSTRACT - BACKGROUND: Three surgical techniques for inguinal hernia repair are currently validated. Few studies have compared results among Lichtenstein and transabdominal preperitoneal (TAPP) laparoscopic approach obtained at an early step of the learning curve. AIM: This study aims to compare the early treatment results between the Liechtenstein technique and the laparoscopic TAPP approach to provide a basis for the surgeon's decision-making. METHODS: Patients were divided into two groups: those who underwent laparoscopic TAPP approach (114 patients), and those who underwent open Lichtenstein repair (35 patients). Data were collected from the medical records during the evolution of the immediate postoperative period and by telephone contact after hospital discharge. For the analysis of the variables, the chi-square test of independence was implemented, with a level of significance set at a p-value of 0.05. RESULTS: There was a strong association between laparoscopy, less postoperative pain, and longer operative time. In addition, a preference for the technique in cases of recurrence, bilaterality, associated umbilical hernia, or obesity was noticed. In this study, the Lichtenstein technique was associated with a shorter time to return to work and was the treatment of choice for elderly patients. CONCLUSION: TAPP laparoscopic herniorrhaphy should be the first choice in cases of bilaterality, associated umbilical hernia, obesity, and recurrence to a previous anterior repair. The surgical risk is adequate for the procedure, even at early stages of the learning curve.


Subject(s)
Humans , Aged , Laparoscopy , Herniorrhaphy , Postoperative Period , Surgical Mesh , Prospective Studies , Liechtenstein
13.
ABCD arq. bras. cir. dig ; 34(3): e1527, 2021. graf
Article in English, Portuguese | LILACS | ID: biblio-1355502

ABSTRACT

ABSTRACT Background: The use of polypropylene meshes for surgical repair of the abdominal wall contributes to a reduction of the of recurrence rates of hernias or defects. However, its intra-abdominal use comes along with the formation of adhesions and several complications. The study and the search for alternative materials, including bovine pericardium, have been regarded as an option for the correction and treatment of resulting hernias with better adaptations and effectiveness. Aim: Evaluating the inflammatory process of the bovine pericardium in comparison with the inflammatory process of synthetic polypropylene mesh. Method: Bovine pericardium mesh and polypropylene mesh were placed, both on the same animal. The first group had the mesh removed for analysis on day 20, and the second group on day 40. The variables congestion, granulation, giant cells, necrosis, acute inflammation, chronic inflammation and collagen were analyzed. Results: All variables were found in greater numbers as a response to the polypropylene mesh, except for the collagen, which, on day 40, was greater in response to the bovine pericardium mesh. Conclusion: The data in this study suggest that there is less inflammatory reaction in response to bovine pericardium mesh when compared to polypropylene mesh.


RESUMO Racional: O uso de telas de polipropileno para a correção cirúrgica da parede abdominal contribui para redução dos índices de recidiva das hérnias ou defeitos. No entanto, o seu uso intra-abdominal cursa com a formação de aderências e diversas complicações. O estudo e a busca por materiais alternativos, como pericárdio bovino, têm se mostrado uma opção na correção e tratamento de hérnias que resultem com melhores adaptações e efetividades. Objetivo: Avaliar o processo inflamatório do pericárdio bovino em comparação ao processo inflamatório da tela sintética de polipropileno. Método: Foi realizada a colocação de tela de pericárdio bovino e polipropileno, ambas no mesmo animal. O primeiro grupo as teve retiradas para análise no dia 20, e o segundo grupo no dia 40. Foram analisadas as variáveis congestão, granulação, células gigantes, necrose, inflamação aguda, inflamação crônica e colágeno. Resultados: Todas as variáveis foram encontradas em maior número como resposta a tela de polipropileno, exceto a variável colágeno, que no dia 40 apresentou-se em maior quantidade em resposta à tela de pericárdio bovino. Conclusão: Há menor reação inflamatória em resposta a tela de pericárdio bovino, quando comparada com a de polipropileno.


Subject(s)
Animals , Cattle , Polypropylenes , Abdominal Wall/surgery , Pericardium , Surgical Mesh , Tissue Adhesions
14.
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
15.
Rev. Col. Bras. Cir ; 48: e20213029, 2021. graf
Article in English | LILACS | ID: biblio-1287883

ABSTRACT

ABSTRACT Lumbar and para-iliac hernias are rare and occur after removal of an iliac bone graft, nephrectomies, retroperitoneal aortic surgery, or after blunt trauma to the abdomen. The incidence of hernia after the removal of these grafts ranges from 0.5 to 10%. These hernias are a problem that surgeons will face, since bone grafts from the iliac crest are being used more routinely. The goal of this article was to report the technique to correct these complex hernias, using the technique of fixing the propylene mesh to the iliac bone and the result of this approach. In the period of 5 years, 165 patients were treated at the complex hernia service, 10 (6%) with hernia in the supra-iliac and lumbar region, managed with the technique of fixing the mesh to the iliac bone with correction of the failure. During the mean follow-up of 33 months (minimum of 2 and maximum of 48 months), there was no recurrence of the hernias.


RESUMO Hérnias lombares e para-ilíacas são raras e ocorrem após a retirada de enxerto ósseo ilíaco, nefrectomias, cirurgia aórtica retroperitoneal, ou ainda, após traumas contusos sobre o abdômen. A incidência de hérnia após a retirada destes enxertos varia de 0,5 a 10%. Essas hérnias constituem um problema com o qual os cirurgiões irão se defrontar, uma vez que os enxertos ósseos da crista ilíaca estão sendo usados mais rotineiramente. O objetivo desse artigo foi relatar a técnica para correção dessas hérnias, consideradas complexas, utilizando-se a técnica de fixação de tela de propileno ao osso ilíaco e o resultado dessa abordagem. No período de 5 anos, 165 pacientes foram atendidos no serviço de hérnias complexas, 10 (6%) com hérnia da região suprailíaca e lombar, manejados com a técnica de fixação de tela ao osso ilíaco corrigindo a falha. Durante o seguimento médio de 33 meses (mínimo de 2 e máximo de 48 meses), não houve recidiva das hérnias.


Subject(s)
Humans , Ilium , Lumbosacral Region , Surgical Mesh , Herniorrhaphy , Hernia
16.
ABCD arq. bras. cir. dig ; 34(2): e1599, 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1345012

ABSTRACT

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.


Subject(s)
Humans , Laparoscopy , Incisional Hernia/surgery , Hernia, Ventral/surgery , Surgical Mesh , Retrospective Studies , Herniorrhaphy
17.
ABCD arq. bras. cir. dig ; 34(1): e1577, 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1284906

ABSTRACT

ABSTRACT Background: In the definition of the mesh to be used to correct hernias, porosity, amount of absorbable material and polypropylene should be considered in the different stages of healing process. Aim: To evaluate the inflammatory reaction in the use of macro and microporous meshes of high and low weight in the repair of defects in the abdominal wall of rats. Methods: Ninety Wistar rats (Rattus norvegicus albinus) were used. The animals were submitted to similar surgical procedures, with lesion of the ventral abdominal wall, maintaining the integrity of the parietal peritoneum and correction using the studied meshes (Prolene®, Ultrapro® and Bard Soft®). Euthanasia was performed at 30, 60 and 120 days after surgery. The abdominal wall segments were submitted to histological analysis using H&E, Masson's trichrome, immunohistochemistry, picrosirius red and tensiometric evaluation. Results: On the 120th day, the tensiometric analysis was superior with Ultrapro® macroporous mesh. The inflammatory process score showed a significant prevalence of subacute process at the beginning and at the end of the study. Microporous meshes showed block encapsulation and in macroporous predominance of filamentous encapsulation. Conclusion: The Ultrapro® mesh showed better performance than the others in healing process of the abdominal wall.


RESUMO Racional: Na definição da tela a ser utilizada na correção das hérnias deve-se considerar a porosidade, quantidade de material absorvível e polipropileno ou inabsorvível nas diversas fases da cicatrização. Objetivo: Avaliar a reação inflamatória das telas macro e microporosas de alta e baixa gramatura no reparo de defeito da parede abdominal de ratos. Método: Foram utilizados 90 ratos da raça Wistar (Rattus norvegicus albinus). Os animais foram submetidos a procedimentos cirúrgicos semelhantes, com lesão da parede abdominal ventral, mantendo a integridade do peritônio parietal e correção utilizando as telas Prolene®, Ultrapro® e Bard Soft®. Realizou-se a eutanásia aos 30, 60 e 120 dias de pós-operatório. Os segmentos da parede abdominal foram submetidos à análise histológica com H&E, tricômio de Masson, imunoistoquímica, picrosirius red e análise tensiométrica. Resultado: No 120º dia a análise tensiométrica mostrou superioridade da tela macroporosa Ultrapro®. O escore do processo inflamatório demonstrou prevalência significativa de processo subagudo no início e no final do estudo. As telas microporosas mostraram encapsulamento em bloco e as macroporosas encapsulamento predominantemente filamentar. Conclusão: A tela Ultrapro® mostrou melhor desempenho em relação às demais na cicatrização da parede abdominal.


Subject(s)
Animals , Rats , Polypropylenes , Abdominal Wall/surgery , Peritoneum , Surgical Mesh , Rats, Wistar
18.
Rev. Col. Bras. Cir ; 48: e20202879, 2021. graf
Article in English | LILACS | ID: biblio-1155364

ABSTRACT

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


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


Subject(s)
Humans , Laparoscopy , Abdominal Wall , Robotic Surgical Procedures , Hernia, Ventral/surgery , Surgical Mesh , Herniorrhaphy
19.
Rev. Col. Bras. Cir ; 48: e20202672, 2021. graf
Article in English | LILACS | ID: biblio-1155361

ABSTRACT

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


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


Subject(s)
Humans , Male , Surgical Mesh , Endoscopy , Herniorrhaphy/methods , Incisional Hernia/surgery , Hernia, Ventral/surgery , Brazil , Treatment Outcome , Length of Stay , Middle Aged
20.
Rev. argent. cir ; 112(4): 526-534, dic. 2020. tab, il
Article in Spanish | LILACS, BINACIS | ID: biblio-1288165

ABSTRACT

RESUMEN Antecedentes: el dolor inguinal crónico posoperatorio representa una complicación que altera la ca lidad de vida después de la hernioplastia inguinal. Su incidencia es variable con informes de hasta el 16%. Objetivo: describir el tratamiento y los resultados en pacientes con dolor inguinal crónico luego de una hernioplastia inguinal con malla. Material y métodos: estudio descriptivo, observacional y retrospectivo. Se definió como dolor ingui nal crónico posoperatorio la presencia de dolor inguinal por daño nervioso o afectación del sistema somatosensorial tisular que persiste por más de 6 meses luego de la cirugía inicial. Se revisaron las historias clínicas de los pacientes que cursaban el posoperatorio de hernioplastia inguinal convencio nal y laparoscópica en el período 2010-2018. Se realizó la encuesta EuraHS Quality of life score antes y después del abordaje terapéutico multidisciplinario para evaluar cambios en el dolor y restricción de la actividad física. Los resultados fueron analizados y comparados. Resultados: se identificaron 8 pacientes con dolor inguinal crónico posoperatorio grave. El 100% fue evaluado por el Servicio de tratamiento del dolor y requirieron 3 o más fármacos para manejo del do lor. Posteriormente requirieron bloqueo guiado por tomografía computarizada a causa de la persisten cia de los síntomas. Se realizaron 3 (50%) exploraciones quirúrgicas con retiro de material protésico y 2 triples neurectomías. Se observó una disminución estadísticamente significativa (p < 0,05) en el dolor en reposo, dolor durante la actividad y dolor que experimentaron en la última semana. Conclusión: el abordaje multidisciplinario y escalonado permitiría seleccionar a los pacientes que se beneficiarán con el tratamiento quirúrgico.


ABSTRACT Background: Chronic postoperative inguinal pain represents a complication that alters the quality of life after inguinal hernioplasty. Its incidence is variable with reports of up to 16%. Objective: To describe the treatment and results in patients with chronic inguinal pain after an inguinal hernioplasty with mesh. Material and methods: Descriptive, observational and retrospective study. The postoperative chronic inguinal pain was defined as the presence of inguinal pain due to nerve damage or involvement of the somatosensory tissue system that persists for more than 6 months after the initial surgery. The medical records of patients in the postoperative period of conventional and laparoscopic inguinal hernioplasty in the period 2010-2018 were reviewed. The EuraHS Quality of life score pre and post multidisciplinary therapeutic approach was used to evaluate changes in pain and restriction of physical activity. The results were analyzed and compared. Results: 8 patients with severe chronic postoperative inguinal pain were identified. 100% were eva luated by the pain management service and required 3 or more drugs for pain management. Sub sequently, they required block guided by computed tomography due to persistence of symptoms. 3 (50%) surgical examinations were performed with removal of prosthetic material and 2 triple neurec tomies. A statistically significant decrease (p <0.05) was observed in pain at rest, pain during activity and pain experienced in the last week. Conclusion: The multidisciplinary and step up approach would allow selecting the patients who will benefit from the surgical treatment.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Pain, Postoperative/surgery , Surgical Mesh/adverse effects , Herniorrhaphy/adverse effects , Planning Techniques , Laparoscopy , Denervation , Herniorrhaphy/rehabilitation , Groin
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