RESUMEN
RESUMEN Fundamento: el tratamiento ideal de la hernia inguinal en pacientes geriátricos siempre ha sido un reto. Objetivo: evaluar la eficacia de la técnica de Halsted II en pacientes geriátricos con hernia inguinal. Métodos: se realizó un estudio descriptivo transversal, con el objetivo de demostrar la eficacia de la técnica de Halsted II en pacientes geriátricos con hernia inguinal en el Servicio de Cirugía General del Hospital Militar Clínico Quirúrgico Docente Octavio de la Concepción y de la Pedraja, Camagüey desde julio de 2014 a julio 2017. El universo estuvo constituido por 84 adultos mayores con hernia inguinal y la muestra fue de 72 pacientes. Resultados: en el estudio predominaron los hombres caucásicos entre 60 y 74 años de edad, con hernia indirecta con aumento del anillo interno, además del tabaquismo y las enfermedades pulmonares obstructivas crónicas. La infección de la herida quirúrgica fue la complicación temprana más frecuente, sin ser significativo el número de rechazo al material de sutura no absorbible y recurrencia de la hernia. Conclusiones: la hernia inguinal en el adulto mayor, es más frecuente en los hombres blancos en edades comprendidas entre los 60 y 74 años. El tabaquismo y las enfermedades pulmonares obstructivas crónicas son factores de riesgo para padecer de hernia inguinal y a su vez son agentes asociados a la menor eficacia de la técnica. La herniorrafía de Halsted II es una técnica segura y eficiente en el adulto mayor, con escasa recurrencia y complicaciones postoperatorias.
ABSTRACT Background: the ideal treatment of inguinal hernia in geriatric patients remains a challenge. Objective: to evaluate the effectiveness of the Halsted II technique in geriatric patients with inguinal hernia. Methods: a cross-sectional descriptive study was carried out, with the objective of demonstrating the effectiveness of the Halsted II technique in geriatric patients with inguinal hernia in the General Surgery Service of the Teaching Surgical Clinical Military Hospital Octavio de la Concepción y La Pedraja, Camagüey, in the period from July 2014 to July 2017. The universe consisted of 84 older adults with inguinal hernia and the sample was 72 patients. Results: the study was dominated by Caucasian men between 60 and 74 years of age, with indirect hernia with increased internal ring, in addition to smoking and chronic obstructive pulmonary diseases. Infection of the surgical wound was the most frequent early complication, without being significant the number of rejection to the non-absorbable suture material and recurrence of the hernia. Conclusions: inguinal hernia in the elderly is more common in white men between the ages of 60 and 74. Smoking and chronic obstructive pulmonary diseases are risk factors for suffering from inguinal hernia and in turn are agents associated with the lower efficacy of the technique. Halsted II herniorrhaphy is a safe and efficient technique in the elderly, with low recurrence and postoperative complications.
RESUMEN
SUMMARY OBJECTIVE To compare Mesh-plug, Lichtenstein, transabdominal preperitoneal (TAPP), and totally extraperitoneal (TEP) repairs in regards to operation time, seroma, infection, and recurrence of inguinal hernia repair. METHODS Relevant literature was searched in the Cochrane Library, Pubmed, and Embase. Furthermore, the analysis of randomized controlled studies (RCTs) was performed using methods recommended by the Cochrane Collaboration. The main outcomes including operation time, seroma, infection, and recurrence were evaluated. RESULTS A total of 38 RCTs with 3255 patients were included in the meta-analysis. In addition, the comparison between Mesh-plug, Lichtenstein, TAPP, and TEP showed the differences were not significant regarding operation time, seroma, infection, and recurrence. CONCLUSIONS Meta-analysis suggests that Mesh-plug, Lichtenstein, TAPP, and TEP are comparable in the outcomes of hernia repair, such as operation time, seroma, infection, and recurrence.
RESUMO OBJETIVO Comparar as abordagens de tampão com tela (mesh plug), Lichtenstein, transabdominal preperitoneal (TAPP) e totalmente extraperitoneal (TEP) em relação ao tempo de operação, seroma, infecção e recorrência no reparo de hérnias inguinais. MÉTODOS Estudos relevantes na literatura foram pesquisados nos bancos de dados Cochrane, PubMed e Embase. Além disso, a análise dos estudos clínicos controlados randomizados (RCTs) foi feita utilizando métodos recomendados pela Cochrane Collaboration. Os principais resultados, incluindo tempo de operação, seroma, infecção e recorrência, foram avaliados. RESULTADOS Um total de 38 RCTs com 3.255 pacientes foram incluídos na meta-análise. Além disso, a comparação entre mesh plug, Lichtenstein, TAPP e TEP mostrou que não havia diferenças significativas nos aspectos de tempo de operação, seroma, infecção e recorrência. CONCLUSÕES A meta-análise sugere que mesh plug, Lichtenstein, TAPP e TEP oferecem resultados comparáveis no reparo das hérnia inguinais em relação a tempo de operação, seroma, infecção e recorrência.
Asunto(s)
Humanos , Mallas Quirúrgicas , Laparoscopía , Hernia Inguinal , Recurrencia , Resultado del Tratamiento , Herniorrafia , Metaanálisis en RedRESUMEN
SUMMARY OBJECTIVES Inguinal hernioplasty techniques have been improved since the first hernioplasty. Tension-free techniques that apply synthetic mesh materials, as in the Lichtenstein approach, are the gold standard. Laparoscopic hernioplasty is the strongest alternative to Lichtenstein. The superiority of laparoscopic hernioplasty over Lichtenstein is a major topic of debate. In this study, we aimed to find a conclusion to this debate by comparing our totally extraperitoneal (TEP) experiences with Lichtenstein experiences. METHODS Patients who underwent inguinal hernioplasty at the Gulhane Training and Research Hospital from 2013 to 2018 were included in this retrospective cohort study. The sample included 96 TEP and 90 Lichtenstein patients for a total of 186 patients. The variables assessed were hospitalization duration, postoperative early visual analog scale score, chronic pain, paresthesia, recurrence, and early postoperative complications. Data were collected from patient records and via telephone questionnaire if needed. Data analysis was done by SPSS v20, using chi-square, Fisher's exact, and Mann-Whitney U tests. RESULTS Male/female ratios were similar between the TEP and Lichtenstein groups. There was no difference in mean age between groups (p=0.1). The hospital stay was shorter (p=0.0001), and early postoperative visual analog scale score was lower in the TEP group (p=0.003). Chronic pain, paresthesia, recurrence, and early postoperative complications (hematoma, seroma, wound infection) were similar. CONCLUSIONS TEP is superior to Lichtenstein with shorter hospitalization duration and lower rates of early postoperative pain. No difference between the two techniques was found for chronic pain. We believe that laparoscopic hernioplasty approach may be the best alternative technique for inguinal hernia repair.
RESUMO OBJETIVOS As técnicas de hernioplastia inguinal foram melhoradas desde a primeira hernioplastia. Técnicas livres de tensão que aplicam materiais de malha sintética, como na abordagem de Lichtenstein, são o padrão ouro. A hernioplastia laparoscópica é a alternativa mais forte ao Lichtenstein. A superioridade da hernioplastia laparoscópica sobre o Lichtenstein é um dos principais temas debatidos. Neste estudo, procuramos encontrar uma conclusão para esse debate comparando nossas experiências totalmente extraperitoneais (TEP) com as experiências de Lichtenstein. MÉTODOS Pacientes submetidos à hernioplastia inguinal no Gulhane Training and Research Hospital de 2013 a 2018 foram incluídos neste estudo de coorte retrospectivo. A amostra incluiu 96 pacientes TEP e 90 pacientes Lichtenstein para um total de 186 pacientes. As variáveis avaliadas foram tempo de internação, escore da escala analógica visual precoce no pós-operatório, dor crônica, parestesia, recidiva e complicações pós-operatórias precoces. Os dados foram coletados dos prontuários e do questionário por telefone, se necessário. A análise dos dados foi realizada pelo SPSS v20, utilizando os testes qui-quadrado, exato de Fisher e U de Mann-Whitney. RESULTADOS As razões homem/mulher foram semelhantes entre os grupos TEP e Lichtenstein. Não houve diferença na média de idade entre os grupos (p=0,1). A permanência hospitalar foi menor (p=0,1) e a escala visual analógica precoce foi menor no grupo TEP (p=0,003). Dor crônica, parestesia, recorrência e complicações pós-operatórias imediatas (hematoma, seroma, infecção da ferida) foram semelhantes. CONCLUSÕES O TEP é superior ao Lichtenstein, com menor tempo de internação e menores taxas de dor pós-operatória precoce. Nenhuma diferença entre as duas técnicas foi encontrada para dor crônica. Acreditamos que a abordagem de hernioplastia laparoscópica pode ser a melhor técnica alternativa para correção de hérnia inguinal.