Experiencia del tratamiento de la hernia incisional en un hospital de tercer nivel en Colombia / Experience of the treatment of incisional hernia in a third level hospital in Colombia

Introducción. El manejo de las hernias se ha instaurado como un problema quirúrgico común, estimándose su aumento en los próximos años. El objetivo del presente trabajo fue describir el curso clínico, los aspectos del tratamiento quirúrgico y factores asociados a la presencia de complicaciones en pacientes intervenidos por hernia incisional. Métodos. Estudio descriptivo en el que se analizaron las características de una cohorte de pacientes llevados a corrección quirúrgica de hernia incisional en el Hospital Universitario Hernando Moncaleano Perdomo, un centro de alta complejidad en Neiva, Colombia, entre 2012 y 2019. Los datos fueron recolectados en programa Microsoft Excel® y analizados en SPSSTM, versión 21. Resultados. Se realizaron 133 correcciones de hernias incisionales, 69,9 % en mujeres y la mayoría ubicadas en la línea media (84,2 %). La edad media de los pacientes al momento de la intervención fue de 52 años ±14,6. Las comorbilidades más frecuentes fueron obesidad, hipertensión y diabetes. La causa más frecuente de la hernia fue traumática (61,7 %). La frecuencia de complicaciones fue superior al 50 %, en su mayoría menores; se encontró asociación con obesidad para la presencia de seroma. La mortalidad fue del 2,3 %. Conclusión.La hernia incisional es un problema de salud pública. Consideramos que la obesidad y el uso de malla pueden ser factores de riesgo asociados con la presentación de complicaciones postoperatorias, así como el aumento de los gastos relacionados con días de hospitalización

Introduction. Hernias management has become a common surgical problem, with an estimated increase in the coming years. The objective of this study was to describe the clinical course, aspects of surgical treatment and factors associated with the presence of complications in patients operated on for incisional hernia. Methods. Descriptive study, in which the characteristics of a cohort of patients taken to surgical correction of incisional hernia at the Hospital Universitario Hernando Moncaleano Perdomo, a high complexity medical center located in Neiva, Colombia, between 2012 and 2019 were analyzed, whose data were collected in Microsoft Excel® software and analyzed in SPSSTM, version 21. Results. One-hundred-thirty-three incisional hernia corrections were performed. The mean age at the intervention was 52 years ±14.6. The most frequent comorbidities were weight disorders, hypertension and diabetes. Only one laparoscopy was performed, the first etiology of the hernia was traumatic (61.7%) and midline (84.2%). The frequency of complications was greater than 50%, mostly minors. An association with obesity was found for the presence of seroma. Mortality was 2.3%. Conclusion. Incisional hernia is a public health problem. We consider that obesity and the use of mesh are a risk factor associated with the presentation of postoperative complications as well as the increase in costs related to days of hospitalization

Caracterización de un grupo de pacientes sometidos a herniorrafia lateral con malla retromuscular en un centro de tercer nivel de 2015 a 2019 / Characterization of a group of patients who underwent lateral herniorrhaphy with retromuscular mesh in a third level center from 2015 to 2019

Introducción. El objetivo de este estudio fue describir las características de la población y determinar las principales complicaciones de los pacientes que son llevados a cirugía por hernia lateral en el abdomen. Métodos. Estudio observacional retrospectivo, que incluyó a los pacientes sometidos a herniorrafia lateral, entre 2015 y 2019 en un centro de tercer nivel. La información se obtuvo del registro de historias clínicas. Las variables analizadas se clasificaron según las características sociodemográficas de los pacientes, clínicas y quirúrgicas. Se hizo una caracterización de acuerdo con los resultados encontrados. Resultados. Se incluyeron 51 pacientes con hernia lateral, 29 de ellos mujeres, con un promedio de edad de 59 años y de índice de masa corporal de 28 kg/m2. El 60 % tenía comorbilidades de base, siendo la hipertensión arterial la más frecuente. La mayoría se clasificaron como ASA II. En cuanto a la localización, la L3 fue la más común (37,2 %). Se presentaron complicaciones postquirúrgicas en el 27,4 % de los pacientes, siendo las más frecuentes seromas, hematomas e infecciones de sitio operatorio. Ningún paciente requirió reintervención para el manejo de las complicaciones. Conclusión. Conocer la población y determinar cuáles son las principales complicaciones postquirúrgicas de un procedimiento permite tomar medidas para disminuir su frecuencia, pero en este caso, se necesitan estudios adicionales para determinar cuáles son los mayores factores asociados a las complicaciones

Introduction. To describe the characteristics of the population and to determine the main complications of patients who undergo surgery for lateral hernia. Methods. We performed a retrospective observational study, including patients who underwent lateral herniorrhaphy between 2015 and 2019 in a third-level medical center, obtaining information through the registration of medical records. The analyzed variables were classified according to the patients' clinical, surgical and sociodemographic characteristics, performing a characterization according to the results found. Results. Fifty-one patients due to lateral hernia were included, 29 of them were women, with a mean age of 59 years and a body mass index of 28 Kg/m2. Of those, 60% presented basic comorbidities, being arterial hypertension the most frequent. Most were classified as ASA II. Regarding the location, the L3 was the most commonly presented hernia, referring to 37.2%. Postoperative complications occurred in 27.4% of the patients, with seromas being the most frequent, followed by hematomas and surgical site infections. No patient required reintervention for the management of complications. Conclusion. By knowing the population and determining which are the main complications, measures can be taken to reduce their incidence. Additional studies are needed to determine which are the main factors associated with complications

Onlay versus rives-stoppa techniques in the treatment of incisional hernias / Técnicas onlay versus rives-stoppa no tratamento das hérnias incisionais

ABSTRACT BACKGROUND: In the surgical correction of large incisional hernias, the use of a prosthesis is essential in most cases regardless of the technique chosen. The preference is for the polypropylene prosthesis. AIMS: To compare the onlay and Rives-Stoppa techniques in the correction of incisional hernias, their immediate results, complications, advantages, and disadvantages. METHODS: Two groups of patients with incisional hernias were analyzed, submitted to the onlay (19 patients) and Rives-Stoppa (17 patients) techniques, and that used polypropylene prostheses. General epidemiological variables, perioperative data variables, and postoperative complications were assessed. RESULTS: The patients' epidemiologic profile was similar between both groups. The majority were women (58.4%), with a mean age of 65.5 years and a previous mean body mass index of 41.5 kg/m². The Rives-Stoppa technique was employed in most patients (52.7%). Those submitted to the onlay technique had longer abdominal drainage time and longer hospital stay, as well as a higher incidence of seromas and surgical wound infection. CONCLUSIONS: The incisional herniorrhaphy technique with the placement of a pre-peritoneal polypropylene mesh by the Rives-Stoppa technique was superior to the onlay due to lower rates of drain use, hospital stay, and postoperative complications.

RESUMO RACIONAL: Na correção cirúrgica das grandes hérnias incisionais, independente da técnica escolhida, na maioria das vezes, o uso de uma prótese é imprescindível. A preferência é pelas próteses de polipropileno. OBJETIVOS: Comparar a técnicas onlay e Rives-Stoppa na correção de hérnias incisionais, os seus resultados imediatos, as complicações, as vantagens e desvantagens. MÉTODOS: Foram analisados dois grupos de portadores de hérnias incisionais, submetidos à técnica onlay (19 pacientes) e técnica Rives-Stoppa (17 pacientes), utilizando prótese de polipropileno. As variáveis gerais epidemiológicas, variáveis de dados perioperatórios e complicações pós-operatórias foram analisados. RESULTADOS: O perfil epidemiológico dos pacientes foi semelhante entre os grupos, a maioria eram mulheres (58.4%), com média de idade de 65.5 anos e com índice de massa corpórea (IMC) médio prévio de 41,5kg/m². A técnica de Rives-Stoppa foi utilizada na maioria dos pacientes (52.7%). Pacientes submetidos a técnica onlay apresentaram maior tempo de uso de dreno abdominal e maior tempo de internação hospitalar, além de maior incidência de seromas e infecção de ferida operatória. CONCLUSÕES: A técnica de herniorrafia incisional com colocação de tela de polipropileno pré-peritoneal, pela técnica de Rives-Stoppa apresentou-se superior à técnica onlay, devido menor taxa de uso de drenos, menor taxa de tempo de internação hospitalar, bem como menor taxa de complicações pós-operatórias.

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

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

Comparative study of laparoscopic Keyhole and Sugarbaker technique in the treatment of terminal paracolostomy hernia / 中华外科杂志

Objective: To compare laparoscopic Keyhole repair with Sugarbaker repair in consecutive patients with parastomal hernia. Methods: From January 2015 to December 2021, 117 patients with parastomal hernia were treated with Keyhole or Sugarbaker laparoscopy repairs in the Department of Hernia and Bariatrci Surgery, the First Affiliated Hospital of University of Science and Technology of China, and the clinical data were retrospectively analyzed. There were 45 males and 72 females, aged (68.6±8.6) years (range: 44 to 84 years). Laparoscopic Sugarbaker repair was performed in 89 cases, and Keyhole repair was performed in 28 cases. The t-test, Mann-Whitney U test, χ2 test and Fisher exact test were used to compare the observation indicators between the two groups, such as operation time, incidence of operation-related complications, and postoperative recurrence rate. Results: The follow-up period was (M(IQR)) 33 (36) months (range: 12 to 84 months). Compared to the Sugarbaker group, the hernia ring area of the Keyhole group was bigger (35 (26) cm2 vs. 25 (16) cm2, Z=1.974, P=0.048), length of stay was longer ((22.0±8.0) d vs. (14.1±6.2) d, t=5.485, P<0.01), and the postoperative rate of recurrence was higher (28.6% (8/28) vs. 6.7% (6/89), χ2=7.675, P=0.006). There was no difference in operation time and postoperative complications between the two groups. Conclusions: Laparoscopic Sugarbaker repair is superior to Keyhole repair in the recurrence rate of parastomal hernia treated with compsite mesh (not funnel-shaped mesh). There are no differences in operation time and postoperative complications between the two groups.

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

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

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

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

Clinical value of mesh prophylaxis for parastomal hernia based on evidence-based medicine / 中华外科杂志

The incidence of parastomal hernia is substantially high, significantly affecting the quality of life of patients with stoma. How to effectively solve the problem of parastomal hernia is a long-term focus of hernia and abdominal wall surgery and colorectal surgery. The European Hernia Society guidelines on prevention and treatment of parastomal hernia published in 2018 has recommended the use of a prophylactic mesh to prevent parastomal hernia for the first time. In the following 5 years, more randomized controlled trials of multi-center, large-sample, double-blind, long-term follow-up have been published, and no significant effect of mesh prophylaxis has been observed on the incidence of parastomal hernia. However, whether mesh could decrease surgical intervention by limiting the symptoms of parastomal hernias would become a potential value of prophylaxis, which requires further research to elucidate.

Impacto del sitio de extracción en la incidencia de hernias incisionales en pacientes sometidos a cirugía laparoscópica por cáncer colorrectal

Introducción: El objetivo de este estudio fue comparar la tasa de hernia incisional (HI) tras la extracción de piezas operatorias por mini-laparatomia media periumbilical (MM) versus mini-laparotomía transversa suprapúbica (MTS) en pacientes sometidos a cirugía laparoscópica por cáncer colorrectal (CLCC), y evaluar los factores asociados a su ocurrencia. Material y Método: Estudio de cohorte no concurrente. Se incluyen todos los pacientes consecutivos sometidos a CLCC en nuestro centro entre septiembre 2006 y diciembre 2017, cuya pieza operatoria fuese extraída por una MM o MTS y que contaran con un control tomográfico en el seguimiento. El diagnóstico de HI se realizó mediante tomografía computada, evaluada por dos radiólogos de forma independiente. Se agruparon los pacientes en MM y MTS, y se evaluaron las tasas de HI según sitio de extracción. Además, se realizó una regresión logística para identificar factores asociados a HI. Resultados: Se identificaron 1090 pacientes que tuvieron resecciones colorrectales lapa-roscópicas durante el período estudiado. De estos, 254 cumplieron con los criterios de inclusión. La edad media de la serie fue de 63 años (53,5% son hombres) con un IMC de 26,4 kg/m2. El sitio de extracción fue una MTS en un 53,1% y una MM en un 46,9%. Se identificó un total de 41 (34,5%) HI en el grupo de MM versus 17 (12,6%) en MTS (p = 0,001) en la TC de seguimiento realizado en una mediana de 18 meses (RIC 12-32) postoperatorios. En la regresión logística, el sitio de extracción (OR = 3,33, IC 95% 1,72-7,14, p < 0,001) y la presencia de patología bronquial obstructiva se asociaron de manera independiente con HI (OR = 3,45, IC 95% 1,11-11,11, p = 0,03). Conclusión: La MTS se asocia a una menor tasa de HI que la MM en pacientes sometidos a CLCC. Esto se debe tener en consideración al momento de elegir el sitio de extracción de pieza operatoria en CLCC.

Aim: To compare the rate of incisional hernia (IH) according to the extraction site in patients undergoing laparoscopic colorectal cancer surgery (LCCS), and to evalúate the risk factors associated with its occurrence. Material and Method: Cohort study including all consecutive patients undergoing LCCS in our center between September 2006 and December 2017, where the specimen was extracted through a median mini-laparotomy (MM) or transverse suprapubic mini-laparotomy (TSM) and have a tomographic control during follow-up. The diagnosis of IH was made by computed tomography evaluated by two radiologists, independently. The rate of IH was calculated for both groups and a regression analysis were performed to identify factors associated with IH. Results: Some 1090 patients undergoing laparoscopic colorectal resections were identified during the study period; of these, 254 met the inclusion criteria. The mean age of the series was 63 years (53.5% are men) with a BMI of 26.4 kg/m2. The extraction site was a TSM in 53.1% and a MM in 46.9%. A total of 41 (34.5%) IH were identified in the MM group versus 17 (12.6%) in TSM (p = 0.001) in the follow-up CT performed at a median of18 months (IQR 12-32) postoperative. In logistic regression, the extraction site (OR = 3.33, 95% CI 1.72-7.14, p < 0.001) and the presence of obstructive bronchial pathology were independently associated with IH (OR = 3, 45, 95% CI 1.11-11.11, p = 0.03). Conclusión: A TSM is associated with a lower rate of IH compared to a MM as extraction site in patients undergoing LCCS. This must be taken into account when choosing the extraction site in patients having LCCS.

A STUDY OF CLINICAL PROFILE OF PATIENTS HAVING NONINCISIONAL VENTRAL ABDOMINAL HERNIA

IntroductionAbdominal wall hernias are a common surgical problem. Lakhs of patients are affected eachyear, most commonly presenting with primary ventral, incisional, and inguinal hernias.Whether symptomatic or asymptomatic, hernias commonly cause pain or aestheticallydistressing to patients. These concerns, coupled with the risk of incarceration, are the mostcommon reasons patients seek surgical repair of hernias. The presence of a ventral hernia isitself, an indication for repair. The tension-free repair has revolutionized hernia surgery. Theuse of mesh prosthesis to approximate the fascial defect has resulted in a decrease inrecurrence rates for any hernias.Material and methodsA clinical study of 60 cases of ventral hernia has been done during the period from march2019 to April 2021 on inpatient admitted to tertiary care teaching L.G. hospital, Ahmedabadwith follow up period of 6 months.Results• 60 cases of ventral hernias were studied with follow up a period of 6 months. Commonestventral hernia was umbilical hernia which accounts for 60% of cases. Swelling was the mostcommon complaint in 91.66% pts. Mesh repair is the technique of choice for all ventralhernias with large defect. Though retro rectus mesh placement is more physiological.Laparoscopic approach for ventral hernia repair has advantages of good operative fieldvisibility, lessened duration of hospital stays, minimal postoperative scar. Laparoscopic repairis gaining good acceptance in current era and time. Complications in both open approach andlaparoscopic approach remain same.ConclusionIrrespective of advance nourishment and decreased number of pregnancies as compared tothe past, still abdominal wall hernia is not infrequent. Simultaneously; multiple and effectivesurgical techniques and various planes of mesh placement, have increased cure rate up to100% with minimum serious post operative complication.

¿Supuración crónica o pseudoquiste infectado? Una complicación de la eventroplastia con malla / Chronic suppuration or infected pseudocyst? A complication of incisional hernia repair with mesh

RESUMEN Las infecciones crónicas posteriores a reparaciones de la pared abdominal pueden presentarse como colecciones que involucran a la malla y suelen obligar a su extracción, mientras que los pseudoquistes son colecciones estériles con una gruesa pared fibrótica que debe ser extirpada para lograr la curación. Presentamos una paciente de 75 años con antecedente de eventroplastia, que consultó por un tumor abdominal de 6 meses de evolución, con características imagenológicas de pseudoquiste parietal. Durante la operación se encontró una malla preperitoneal no integrada a los tejidos y rodeada de "biofilm" y líquido turbio. La prótesis se retiró fácilmente y la aponeurosis, muy engrosada, se cerró borde a borde. El posoperatorio transcurrió sin incidentes y el cultivo desarrolló estafilococo aureus sensible a trimetoprima-sufametoxazol. Seis meses después, la evolución fue favorable y sin signos de recidiva.

ABSTRACT Chronic infections after abdominal wall repairs may present as collections involving the mesh which usually require removing the mesh, while pseudocysts are sterile collections with a thick fibrotic wall that must be removed to achieve healing. We report the case of a 75-year-old female patient with a history incisional hernia repair who sought medical advice due to an abdominal tumor which appeared 6 months before consultation with imaging tests suggestive of an abdominal wall pseudocyst. Surgery revealed a preperitoneal mesh without tissue integration surrounded by biofilm and cloudy fluid. The mesh was easily removed and the edges of the thick aponeurosis were sutured. The postoperative period evolved uneventful and the fluid culture was positive for staphylococcus aureus sensitive to trimethoprim-sufamethoxazole. Six months later the patient evolved with favorable outcome without recurrence.

Onlay versus sublay techniques for incisional hernia repair: 30-day postoperative outcomes / Comparação das técnicas onlay e sublay para correção de hérnia incisional: desfechos nos primeiros 30 dias pós-operatórios

ABSTRACT BACKGROUND: The development of an incisional hernia is a common complication following laparotomy. It also has an important economic impact on healthcare systems and social security budget. The mesh reinforcement of the abdominal wall was an important advancement to increase the success of the repairs and reduce its long-term recurrence. The two most common locations for mesh placement in ventral hernia repairs include the premuscular (onlay technique) and retromuscular planes (sublay technique). However, until now, there is no consensus in the literature about the ideal location of the mesh. AIM: The aim of this study was to compare the two most common incisional hernia repair techniques (onlay and sublay) with regard to the complication rate within the first 30 days of postoperative care. METHOD: This study analyzes 115 patients who underwent either onlay or sublay incisional hernia repairs and evaluates the 30-day postoperative surgical site occurrences and hernia recurrence for each technique. RESULTS: We found no difference in the results between the groups, except in seroma formation, which was higher in patients submitted to the sublay technique, probably due to the lower rate of drain placement in this group. CONCLUSION: Both techniques of mesh placement seem to be adequate in the repair of incisional hernias, with no major difference in surgical site occurrences.

RESUMO RACIONAL: O desenvolvimento de hérnia incisional é uma complicação comum após laparotomias. Também tem um impacto econômico importante nos sistemas de saúde e no orçamento da previdência social. O reforço com tela da parede abdominal foi um avanço importante para aumentar o sucesso dos reparos e ajudou a reduzir sua recorrência em longo prazo. Os dois locais mais comuns para colocação de tela em reparos de hérnia incisional incluem os planos pré-muscular (técnica onlay) e retromuscular (técnica sublay). Porém, até o momento, não há consenso na literatura sobre a localização ideal da tela. OBJETIVOS: Comparar as duas técnicas de reparo de hérnia incisional mais comuns (onlay e sublay) em relação à taxa de complicações nos primeiros 30 dias de pós-operatório. MÉTODO: Analisar 115 pacientes submetidos a reparos de hérnia incisional onlay ou sublay e avaliar, como desfecho, as ocorrências de sítio cirúrgico no pós-operatório de trinta dias e a recorrência precoce para cada técnica. RESULTADOS: Não encontramos diferença nos resultados entre os grupos, exceto na formação de seroma, que foi maior nos pacientes submetidos à técnica de sublay, provavelmente pela menor taxa de colocação de dreno neste grupo. CONCLUSÃO: Assim, ambas as técnicas de colocação de tela parecem ser adequadas no reparo de hérnias incisionais, sem grande diferença nos desfechos precoces, relacionados a ao sítio cirúrgico.

Early incisional hernia after liver transplantation: risk factors and hernia repair results / Hérnia incisional precoce após transplante hepático: fatores de risco e resultados do reparo cirúrgico

ABSTRACT BACKGROUND: Liver transplantation is a complex and valuable therapy. However, complications that burden postoperative quality of life, such as incisional hernia, are to be better elucidated, such as risk factors and prophylactic measures. AIM: This study aimed to define the rate of incisional hernia in patients who underwent liver transplantation in a population in southern Brazil and to assess the related risk factors in order to establish measures for prior optimization and specific prophylactic care in the future. METHODS: Patients undergoing adult Liver transplantation from January 2004 to November 2020 were retrospectively analyzed, assessing demographic features, surgical outcomes, and predisposing factors. RESULTS: Among 261 liver transplantation patients included, incisional hernia was diagnosed in 71 (27.2%). Of the 71 incisional hernia patients, 28 (39.4%) developed IH during the first post-transplant. Majority of the patients were male (52/71, 73.2%); of the 71 patients, 52 had hepatitis C virus (HCV) and 33 (46.5%) had hepatocellular carcinoma (HCC). Male gender (p=0.044), diabetes mellitus (p=0.008), and acute cellular rejection (p<0.001) were risk factors for IH. In all, 28 (39.4%) patients were submitted for hernia repair with mesh, with a recurrence rate of 17.8%. CONCLUSION: Incisional hernia after liver transplantation is a relatively common problem associated with male gender, diabetes, and acute cellular rejection. This is a problem that should not be trivialized in view of the complexity of liver transplantation, as it can lead to a reduction in quality of life as well as jeopardize late liver transplantation results and lead to incarceration and strangulation.

RESUMO RACIONAL: O transplante de fígado é uma terapia complexa e valiosa. Entretanto, complicações que prejudicam a qualidade de vida pós-operatória, como a hérnia incisional, devem ser mais bem elucidadas, analisando os fatores de risco e medidas profiláticas. OBJETIVOS: Definir a taxa de hérnia incisional em pacientes submetidos a transplante de fígado em uma população do sul do Brasil, avaliar os fatores de risco relacionados, a fim de estabelecer futuramente medidas de otimização prévia e cuidados profiláticos específicos. MÉTODOS: Foram analisados, retrospectivamente, pacientes submetidos a transplante de fígado adultos, de janeiro de 2004 a novembro de 2020, avaliando suas características demográficas, resultados cirúrgicos e fatores predisponentes. RESULTADOS: Dentre os 261 pacientes transplantados hepáticos incluídos, a hérnia incisional foi diagnosticada em 71 (27,2%). Vinte e oito do total de 71 pacientes com hérnia incisional (39,4%) desenvolveram hérnia incisional durante o primeiro ano pós-transplante. A maioria era do sexo masculino [n=52, (73,2%)]; 52/71 (73,2%) apresentavam cirrose secundária ao vírus da hepatite C; 33/72 (46,5%) foram portadores de carcinoma hepatocelular. Sexo masculino (p=0,044), diabetes mellitus (p=0,008) e rejeição celular aguda (p<0,001) foram fatores de risco estatisticamente significantes para hérnia incisional. Vinte e oito pacientes (39,4%) foram submetidos à hernioplastia incisional com tela, com taxa de recidiva de 17,8%. CONCLUSÕES: Hérnia incisional após transplante de fígado é um problema relativamente comum, associado ao sexo masculino, diabetes e também a rejeição celular aguda. Este é um problema que não deve ser banalizado, já que pode levar à redução da qualidade de vida, comprometer os resultados tardios do transplante de fígado e pode levar a encarceramento ou estrangulamento.

Infección temprana de la malla quirúrgica en herniorrafia incisional. Incidencia, factores de riesgo y desenlaces en más de 60.000 pacientes / Early infection of the surgical mesh in incisional herniorrhaphy. Incidence, risk factors, and outcomes in more than 60,000 patients

Introducción. La infección de la malla en cirugía de reparación de hernias de pared abdominal es un desenlace pobre, asociado a un incremento en el riesgo de complicaciones. El objetivo del presente estudio fue analizar la incidencia, los factores asociados y desenlaces en pacientes llevados a herniorrafia incisional con malla con posterior diagnóstico de infección temprana. Métodos. Estudio de cohorte retrospectiva. Se utilizaron los datos de egresos hospitalarios de la National Inpatient Sample (NIS) de los Estados Unidos de América para identificar a todos los pacientes adultos llevados a herniorrafia incisional durante los años 2010 a 2015. Se utilizaron modelos de regresión logística bivariada y multivariada para evaluar los factores de riesgo en infección temprana de la malla, y finalmente, modelos de regresión logística y lineal, según el tipo de variable dependiente, de tipo stepwise forward para evaluar la asociación entre el diagnóstico de infección de malla y los desenlaces adversos. Resultados. En total se incluyeron 63.925 pacientes. La incidencia de infección temprana de la malla fue de 0,59 %, encontrando como factores asociados: comorbilidades (obesidad, desnutrición proteico calórica, anemia carencial y depresión), factores clínico-quirúrgicos (adherencias peritoneales, resección intestinal, cirugía laparoscópica y complicaciones no infecciosas de la herida) y administrativos o asistenciales. Conclusiones. La infección temprana, aunque infrecuente, se asocia con un aumento significativo en el riesgo de complicaciones. La optimización prequirúrgica con base en los factores de riesgo para este desenlace nefasto es un elemento clave para la reducción de la incidencia y mitigación del impacto de la infección en los pacientes con herniorrafía incisional con malla.

Introduction. Mesh infection in abdominal wall hernia repair surgery has poor outcome, associated with an increased risk of complications. The objective of this study was to analyze the incidence, associated factors, and outcomes in patients undergoing incisional herniorrhaphy with mesh and subsequent diagnosis of early infection.Methods. Retrospective cohort study. Hospital discharge data from the National Inpatient Sample (NIS) of the United States of America were used to identify all adult patients undergoing incisional herniorrhaphy during the years 2010 to 2015. Bivariate and multivariate logistic regression models were used to evaluate risk factors in early mesh infection, and finally, logistic and linear regression models, according to the type of dependent variable, of the stepwise forward type to evaluate the association between the diagnosis of mesh infection and adverse outcomes.Results. A total of 63,925 patients were included. The incidence of early infection of the mesh was 0.59%, finding as associated factors: comorbidities (obesity, protein-caloric malnutrition, deficiency anemia and depression), clinical-surgical factors (peritoneal adhesions, intestinal resection, laparoscopic surgery and surgical site complications) and administrative or healthcare.Conclusions. Early infection, although rare, is associated with a significantly increased risk of complications. Pre-surgical optimization based on risk factors for this poor outcome is a key element in reducing the incidence and mitigating the impact of infection in patients with mesh incisional herniorrhaphy.

Application value of ambulatory surgery mode for small and medium abdominal wall hernia repair / 中华消化外科杂志

Objective:To investigate the application value of ambulatory surgery mode for small and medium abdominal wall hernia repair.Methods:The retrospective and descriptive study was conducted. The clinical data of 33 patients with small and medium abdominal wall hernia who were admitted to Beijing Chaoyang Hospital of Capital Medical University from January 2019 to January 2021 were collected. There were 19 males and 14 females, aged 54(range, 26?85)years. Patients individually underwent Onlay repair, Sublay repair, intraperitoneal onlay mesh repair (IPOM)according to the diagnosis and treatment mode of ambulatory surgery. Observation indicators: catogaries of small and medium abdominal wall hernia, surgical methods, intraoperative measured diameter of hernia ring defect, operation time, volume of intraoperative blood loss, duration of hospital stay, delayed discharge of patients, hospitalization expenses, postoperative follow-up, complications, postoperative visual analogue scale of pain, chronic pain, postoperative satisfaction. Follow-up using telephone interview or outpatient examinations was conducted to detect hernia recurrence, surgical-related complications (wound infection, pain, hematoma or seroma, intestinal leakage, intestinal obstruction) and postoperative satisfaction at postoperative 3 days, 7 days, 1 month, 3 months, 6 months and 12 months. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range), and count data were represented as absolute numbers. Results:Of the 33 patients, 16 cases had umbilical hernia, 14 cases had incisional hernia, 3 cases had lumbar hernia. There were 7 patients treated with Onlay repair, 16 with Sublay repair, and 10 cases with IPOM. The intraoperative measured diameter of hernia ring defect, operation time and volume of intraoperative blood loss of 33 patients were 2.8(range, 1.0?6.0)cm, 51(range, 20?85)minutes, 4.3(range, 1.0?10.0)mL. The duration of hospital stay of 33 patients was 24?48 hours, including 25 cases with duration of hospital stay ≤24 hours, 8 cases with duration of hospital stay >24 hours and ≤48 hours. Of the 8 patients undergoing IPOM with delayed discharge, 5 cases had postoperative pain and 3 cases had dizziness, nausea and vomiting after general anesthesia. They were recovered and discharged from hospital after observation and symptomatic support until the next morning. The hospitalization expenses were 17 139(range, 6404?34 124)yuan. All the 33 patients were followed up regularly after operation. No hernia recur-rence, wound infection, hematoma and seroma, intestinal fistula or intestinal obstruction was observed during the follow-up period. From postoperative 3 days to 12 months, the visual analogue scale of pain was from 2.90±0.10 to 0 for patients with Onlay repair, from 3.10 ±0.10 to 0 for patients with Sublay repair, from 3.50 ±0.20 to 0 for patients with IPOM. No patient suffered from chronic pain after the operation and postoperative satisfaction of patients was 100%. Conclusion:The ambulatory surgery mode has safety and feasibility in small and medium abdominal wall hernia repair.

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

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

Fístula enterocutánea en una hernia incisional / Enterocutaneous fistula in an incisional hernia

Introducción: Los defectos técnicos en el cierre de la laparotomía, como la utilización de suturas inadecuadas, muy apretadas o distancia incorrecta entre los puntos, presencia de cuerpos extraños, hematomas o la inclusión de un asa intestinal (pellizcamiento de esta), pueden provocar la aparición de una hernia incisional, y peor aún acompañarse de una fístula intestinal. Objetivo: Corroborar la importancia del cierre correcto y cuidadoso de la pared abdominal después de una laparotomía. Presentación del caso: Se trata de una paciente de 34 años de edad con antecedentes de tres cesáreas en un período de seis años, la última hace seis meses, que fue atendida en el Hospital Mnazi Mmoja, en Tanzania, refiriendo salida de contenido líquido amarillento a nivel de la cicatriz quirúrgica. Al examen físico se constata hernia incisional y un asa intestinal adherida a la piel con un orificio de menos de un cm por donde sale contenido intestinal amarillento. Se interviene con diagnóstico preoperatorio de hernia incisional y fístula enterocutánea; se realiza resección de 3 tres cm del íleon, anastomosis termino-terminal donde se encuentra el orificio fistuloso y hernioplastia mediante la técnica de Rives con utilización de malla de polipropileno. La evolución posoperatoria fue satisfactoria. Conclusiones: Se refuerza la afirmación que es de suma importancia el cierre correcto y cuidadoso de la pared abdominal después de una laparotomía, sobre todo si se realiza con urgencia(AU)

Introduction: In the closure of the laparotomy, technical defects such as the use of inadequate sutures, too tight or incorrect distance between stitches, the presence of foreign bodies, hematomas or the inclusion of an intestinal loop (pinching) can cause the appearance of an incisional hernia which, even worse, can be accompanied by an intestinal fistula. Objective: To corroborate the importance of the correct and careful closure of the abdominal wall after performing laparotomy. Case presentation: A 34-year-old patient with a history of three previous cesarean sections in a six-year period, the last one performed six months, was treated at the Mnazi Mmoja Hospital in Tanzania when she reported the release of a yellowish liquid content at the surgical scar level. Physical examination revealed an incisional hernia and an intestinal loop attached to the skin with a hole of less than one cm through which yellowish intestinal content was coming out. She was operated on with the preoperative diagnosis of incisional hernia and enterocutaneous fistula; a three-cm resection of the ileum, end-to-end anastomosis where the fistulous orifice was located, and hernioplasty were performed using the Rives technique with polypropylene mesh. The postoperative evolution was satisfactory. Conclusions: The assertion that correct and careful closure of the abdominal wall after laparotomy is of utmost importance, especially if it is performed urgently, is reinforced(AU)

Ventral and Inguinal Hernia Repair- Polyglactin - 910 better than Polypropylene?

Background: Mesh repair has been one of the most popular methods of hernia repair with the lowest recurrence rates as compared to other tissue repairs. With increasing incidence of incisional hernia which is only 2nd to inguinal hernia in incidence, number of surgeries performed for incisional hernia has increased considerably. The mesh fixation has traditionally been done with Polypropylene which are non-absorbable sutures. This study aims to compare the group of patients in which polyglactin-910 was used with patients in which polypropylene was used. Methods: The study is a prospective study conducted over a period of 4 years at the largest tertiary care hospital of Western India. 400 patients were included from which 256 patients had inguinal hernia and the rest 144 had ventral incisional hernias. Two groups were framed from these 400 patients – one in which polyglactin-910 was used (120 patients) and the other in which polypropylene (280 patients) was used. All the patients were followed up for at least 1 year and the complications were compared. Result: Out of 400 patients in 120 patients mesh repair was done with polglactin-910 and rest with poplypropylene, and study was conducted over a period of 4years with results showing incidence of pain 23% with poplypropylene against relatively low incidence with polyglactin-910 of 12%. Another observation was that incidence of sinus formation was 13% with polypropylene and only 0.8% with polyglactin-910. Conclusion: The study concluded that the association of pain and sinus formation was higher with polypropylene

Incisional Hernia: A Comprehensive Study on the Incidence and Management of Abdominal Incisional Hernia

Background and objectives: Incisional hernia is the one true iatrogenic hernia. The Incisional hernia occurs in less than 5-11% of patients subjected to abdominal operation. Incisional hernia usually starts within few months after surgery, as a result of failure of the lines of closure of the abdominal wall following laparotomy. If left unattended they tend to attain large size and cause discomfort to the patient. This study has been undertaken to assess the magnitude of this problem, various factors leading to development of this condition and the different modalities of treatment practiced in our set up. Methodology: The present study was conducted at the Department of General Surgery; AMC MET Medical college and Seth L. G. Hospital Ahmedabad, in which 60 patients of incisional hernia were treated during June 2018 to April 2020. Interpretation and Conclusion: Successful repair relies on knowledge of the dynamics of the abdominal wall, thorough technical execution, appropriate selection of synthetic or bioprosthetic material, and constitution of surgical team. Though laparoscopic repair has been demonstrated to be safe and a more resilient repair than open repair, open mesh repair remains a suitable alternative.

Abdomen abierto y cierre temprano de la pared abdominal / Open abdomen and early closure of the abdominal wall

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