Estudio comparativo de herniorrafía en emergencia y en situaciones electivas / Comparison study of herniorrhaphy at emergency and elective situations

La hernia inguinal es uno de los problemas urgentes más comunes encontrados por los cirujanos. Hubo 145 pacientes tratados debido al diagnóstico de hernia inguinal. De 44 pacientes que fueron operados en condiciones de emergencia. Alrededor de 131 casos (106 hombres y 25 mujeres) fueron tratados con reparación de malla preperitoneal abierta unilateral. Los pacientes fueron examinados en términos de complicaciones postoperatorias. Los datos recopilados incluidos como edad, sexo, historial médico, afecciones de cirugía, encarcelamiento y estrangulamiento. Hubo un total de 145 pacientes incluidos en el estudio; en el que 44 de ellos (29 hombres y 15 mujeres, rango de edad: 30-72) (Grupo I) fueron operados en condiciones de emergencia y 101 de ellas (51 hombres y 50 mujeres, rango de edad: 25-78) (grupo Ii) fueron operados en condiciones electivas. Hubo comorbilidad en 31 pacientes de grupo I y 77 pacientes del grupo II. Alrededor del 47.7% (n = 21) de los casos que se sometieron a cirugía emergente debido al encarcelamiento, mientras que el 43.6% (n = 44) de los casos que fueron operados en condiciones electivas. Había 12 hernias femorales en el Grupo I y 19 Hernia femoral en el Grupo II. No hay diferencia entre la complicación postoperatoria y las tasas de recurrencia en los casos de hernia inguinal operados en condiciones electivas y en condiciones de emergencia. Es más barato que la reparación laparoscópica, el control del dolor de plomo y la falta de dolor neuropático, tiene complicaciones menos testiculares, y es más ventajoso que otros enfoques abiertos

Inguinal hernia is one of the most common urgent problems encountered by surgeons. There were 145 patients treated due to inguinal hernia diagnosis. Out of 44 patients who were operated under emergency conditions. About 131 cases (106 male and 25 female) were treated with unilateral open preperitoneal mesh repair. Patients were examined in terms of postoperative complications. Data collected included as age, gender, medical history, surgery conditions, incarceration and strangulation. There were total of 145 patients included in the study; in which 44 of them (29 male and 15 female, range of age: 30- 72) (group I) were operated under emergency conditions and 101 of them (51 male and 50 female, range of age: 25-78) (group II) were operated under elective conditions. There was comorbidity in 31 patients of group I and 77 patients of group II. About 47.7% (n=21) of cases who underwent emergent surgery due to incarceration, while 43.6% (n=44) of cases who were operated under elective conditions. There were 12 femoral hernias in group I and 19 femoral hernia in group II. There is no difference between postoperative complication and recurrence rates in inguinal hernia cases operated under elective conditions and under emergency conditions. It is cheaper than laparoscopic repair, lead pain control and lack of neuropathic pain, has less testicular complications, and it is more advantageous than other open approaches.

De garengeot's hernia: case report

ABSTRACT Introduction: De Garengeot hernia is an entity mainly diagnosed intraoperatively. It is more frequently observed in women and is defined as the presence of the vermiform appendix inside to femoral hernia. Most femoral hernias are identified based on clinical diagnosis, but diagnostic imaging is necessary for confirmation. Ultrasound, for example, is a valuable tool to characterize the anatomy of the hernia and its content, and to establish surgical planning. Case presentation: A 75-year-old woman attended the general surgery department of a high complexity hospital in Bogotá, Colombia, due to a painful mass in the right inguinal region. The initial ultrasound study showed a femoral hernia containing the incarcerated appendix and periappendiceal fluid in the hernial sac. The patient developed chronic appendiceal inflammation, so she underwent femoral hernia repair with mesh and appendectomy without complications, achieving a satisfactory recovery. Conclusion: Clinical examination may be sufficient to confirm the presence of a hernia in a large number of cases when the diagnostic approach involves the search of inguinal masses with pain. However, to facilitate surgical planning, diagnostic imaging, especially ultrasound with high-resolution transducers, is the primary tool to characterize the type of hernia and the contents of the hernial sac.

RESUMEN Introducción. La hernia de Garengeot es una entidad cuyo diagnóstico es principalmente intraoperatorio, se presenta con mayor frecuencia en mujeres y corresponde al hallazgo del apéndice cecal contenido en una hernia femoral. La mayoría de las hernias femorales se identifican mediante diagnóstico clínico, pero para su verificación es importante hacer una valoración con imágenes diagnósticas: el ultrasonido, por ejemplo, es una herramienta valiosa para caracterizar la anatomía de la hernia y su contenido, y para establecer el planeamiento quirúrgico. Presentación de caso. Mujer de 75 años quien asistió al servicio de cirugía general de un hospital de alta complejidad de Bogotá, Colombia, por presentar una masa dolorosa en región inguinal derecha. El estudio ecográfico inicial mostró una hernia femoral conteniendo el apéndice cecal con septos internos que separaban el líquido dentro del saco herniario. La paciente presentó inflamación crónica en el apéndice, por lo que se le practicó herniorrafía femoral con malla y apendicectomía sin complicaciones y con las cuales tuvo una recuperación satisfactoria. Conclusiones. El examen clínico puede ser suficiente para confirmar la presencia de una hernia en un gran número de casos cuando se hace el abordaje diagnóstico de masas inguinales con presencia de dolor; sin embargo, las imágenes diagnósticas, especialmente la ecografía con transductores de alta resolución, constituyen la herramienta de primera línea para caracterizar el tipo de hernia y el contenido del saco herniario, lo que facilita la planeación quirúrgica.

Inguinal hernia in southern Brazil - challenges in follow-up and recurrence rates / Hérnia inguinal no Sul do Brasil - desafios no seguimento e taxas de recorrência

ABSTRACT Introduction: recurrence rates for primary hernia repair range from 0.5 to 15 percent depending upon the hernia site, type of repair, and clinical circumstances. Many risk factors are known and they must be considered before the procedure. In developing countries, follow up and maintenance of databases are critical to understand the real numbers. Methods: a retrospective cohort study analyzed adult patients who have undergone inguinal hernia repair at Hospital de Clínicas de Porto Alegre, a tertiary care government public hospital, between 2013 and 2015. Medical records, telephone, and letter contact have been reviewed in order to complete the minimum period of 5 years of follow-up. The analyzed data focused on the surgeon's experience and the recurrence rate in 5 years of follow-up. Results: a total of 1094 medical records were selected and a complete five years follow-up were possible in 454 patients - 538 inguinal hernia repairs due to bilateral approach in 84 patients. These 454 patients answered, in a validated questionnaire about symptoms of recurrence. The total recurrence rate was 9.29%. For the patients who had Nyhus IV, recurrence rate was 24.1% against 9.9% after primary hernia repair, with a 2.4 higher risk. There was no difference in recurrence between surgeons and training surgeons. Conclusion: our data reveal an acceptable recurrence rate in a tertiary care hospital with residents, and to our knowledge is the first Brazilian report with long term follow up. An increased re-recurrent hernia was found when compared with primary hernia repair.

RESUMO Introdução: a recorrência da hérnia inguinal após hernioplastia varia de 0,5 a 15 por cento, dependendo do local da hérnia, tipo de reparo e circunstâncias clínicas. Muitos fatores de risco são conhecidos e devem ser considerados antes do procedimento. Acompanhamento e adequado bancos de dados são fundamentais para entender a incidência de recidiva. Métodos: estudo de coorte retrospectivo analisou hernioplastias inguinais realizados no Hospital de Clínicas de Porto Alegre entre 2013 e 2015. Para concluir 5 anos de seguimento, analisamos o prontuário e fizemos contato telefônico e por correio. Resultados: o total de 1094 registros médicos foram selecionados e um seguimento de pelo menos 5 anos foi possível em 454 pacientes - 538 reparos de hérnia inguinal devido à abordagem bilateral em 84 pacientes. Os pacientes responderam um questionário validado sobre sintomas de recorrência. A taxa total de recorrência foi de 9,29%. No grupo masculino, a recorrência foi de 10% contra 4% no grupo feminino. Para os pacientes com hérnia Nyhus IV, a recidiva foi de 24% contra 8% após o reparo da hérnia primária, com um risco de 2,8 maior. Não houve diferença na recorrência entre cirurgiões experientes e em treinamento. Conclusão: nossos dados revelam uma taxa de recorrência aceitável em um hospital de ensino, e para o nosso conhecimento é o primeiro artigo com acompanhamento de longo prazo no sul do Brasil. A re-recidiva da hérnia foi maior quando comparada com o reparo da hérnia primária.

Hernia femoral encarcelada con contenido de ovario / Incarcerated femoral hernia with ovarian contents

RESUMEN Las hernias femorales representan menos del 10% de las hernias inguinales; aparecen principalmente en mujeres adultas y tienen una mayor tasa de complicaciones asociadas al encarcelamiento comparadas con otras hernias abdominales. El contenido más frecuente en el interior del saco herniario son las asas intestinales, grasa preperitoneal y epiplón. Otras estructuras abdominales, como apéndice, vejiga, divertículo de Meckel, testículos ectópicos y estómago, son extremadamente raros. El útero, el ovario y las trompas de Falopio rara vez están presentes en una hernia inguinal. La hernia femoral encarcelada con ovario como contenido es una condición extremadamente rara en mujeres en la edad adulta. La mayoría de los casos ocurren en niñas y con frecuencia se asocian con defectos congénitos de los genitales. El diagnóstico preoperatorio para establecer el contenido de la hernia puede ser difícil, pero la ecografía convencional puede ser útil para identificar las características del contenido. El tratamiento tradicional es la reparación abierta. Pero, la cirugía laparoscópica permite confirmar el diagnóstico y evaluar la posibilidad de modificaciones isquémicas en el contenido del saco herniario. Se presenta un caso de hernia femoral encarcelada con contenido de ovario.

ABSTRACT Femoral hernias account for less than 10% of inguinal hernias; they occur mainly in adult women and have a higher rate of complications associated with incarceration compared with other abdominal hernias. The most frequent contents inside the hernia sac are intestinal loops, preperitoneal fat and omentum. Other abdominal structures, such as appendix, bladder, Meckel's diverticulum, ectopic testis and stomach are extremely rare. The uterus, ovary, and fallopian tubes are rarely present in an inguinal hernia. Incarcerated femoral hernia with ovary as content is an extremely rare condition in adult females. Most cases occur in girls and are often associated with congenital defects of the genitalia. Preoperative diagnosis to establish the contents of the hernia can be difficult, but conventional ultrasonography can be helpful in identifying the characteristics of the contents. The traditional treatment is open repair. However, laparoscopic surgery can confirm the diagnosis and evaluate the possibility of ischemic changes in the contents of the hernia sac. A case of incarcerated femoral hernia with ovarian content is presented.

Femoral hernia: uncommon, but associated with potentially severe complications / Hérnia femoral: incomum, mas associada a complicações potencialmente graves

ABSTRACT Background: Although the laparoscopic access is becoming the preferable treatment for femoral hernia, there are only few studies on this important subject. Aim: To assess the outcomes of the totally extraperitoneal laparoscopic (TEP) access in the treatment of femoral hernia. Methods: Data of 62 patients with femoral hernia who underwent herniorrhaphy were retrospectively reviewed. The diagnosis of femoral hernia was established by clinical and/or imaging exams in 55 patients and by laparoscopic findings in seven. Results: There were 55 (88.7%) females and 7 (11.3%) males, with female to male ratio of 8:1. The mean age was of 58.9±15.9 years, ranging from 22 to 92 years. Most patients (n=53; 85.5%) had single hernia and the remaining (n=9; 14.5%) bilateral, making a total of 71 hernias operated. Prior lower abdominal operations were recorded in 21 (33.9%) patients. Conversion to laparoscopic transabdominal preperitoneal procedure was performed in four (6.5%). Open herniorrhaphy was needed in two (3.2%), one with spontaneous enterocutaneous fistula in the groin region (Richter's hernia) and the another with incidental perforation of the adjacent small bowel that occurred during dissection of hernia sac. There was no mortality. Conclusion: Femoral hernia is uncommon, and it may be associated with potentially severe complications. Most femoral hernias may be successfully treated with totally extraperitoneal laparoscopic access, with low conversion and complication rates.

RESUMO Racional: Embora o acesso laparoscópico esteja se tornando o tratamento preferencial para a hérnia femoral, poucos são os estudos sobre esse importante assunto. Objetivo: Avaliar os resultados do acesso laparoscópico totalmente extraperitoneal no tratamento da hérnia femoral. Métodos: Os dados de 62 pacientes com hérnia femoral que foram submetidos a herniorrafia foram revisados ​​retrospectivamente. O diagnóstico foi estabelecido por exames clínicos e/ou de imagem em 55 pacientes e por achados laparoscópicos em sete. Resultados: Havia 55 (88,7%) mulheres e 7 (11,3%) homens, com proporção feminino/masculino de 8: 1. A média de idade foi de 58,9±15,9 anos (22-92). A maioria (n=53, 85,5%) apresentava hérnia única e o restante (n=9, 14,5%) bilaterais, perfazendo um total de 71 hérnias femorais operadas. Operações prévias no abdome inferior foram registradas em 21 (33,9%) pacientes. A conversão para procedimento pré-peritoneal transabdominal laparoscópico foi realizada em quatro (6,5%). Herniorrafia aberta foi necessária em dois pacientes (3,2%), um com fístula enterocutânea espontânea na região da virilha (hérnia de Richter) e o outro com perfuração incidental do intestino delgado adjacente que ocorreu durante a dissecção do saco herniário. Não houve mortalidade. Conclusão: A hérnia femoral é incomum e pode estar associada a complicações potencialmente graves. A maioria das hérnias femorais pode ser tratada com sucesso através do acesso laparoscópico totalmente extraperitoneal, com baixas taxas de conversão e complicações.

Femoral hernia containing the right fallopian tube: a rare finding / Hérnia femoral contendo a trompa de falópio direita: um achado raro

Abstract Femoral hernias comprise a small proportion of all groin hernias. They are more common in women and have a high rate of incarceration and strangulation, leading to emergency repair. A 61-year-old female patient was admitted to the emergency department complaining of a 2-day painful lump in the right groin, that had become more intense in the last 24 hours. Physical examination suggested the presence of a strangulated femoral hernia, and the patient underwent emergency surgical repair. Intraoperatively, the right fallopian tube was observed in the hernia sac. Since there were no signs of ischemia, the tube was reduced back into the pelvic cavity and the hernia was repaired. The postoperative period was uneventful, and the patient was discharged without complications, 3 days after surgery.

Resumo As hérnias femorais representamuma pequena fração de todas as hérnia da região inguinal. Elas são mais comuns entre as mulheres e estão associadas a elevadas taxas de complicações, como encarceramento e estrangulamento, com necessidade de cirurgia urgente. Uma paciente do sexo feminino, de 61 anos, recorreu ao serviço de emergência por quadro de dor e tumefação da região inguinal direita com 2 dias de evolução e agravamento nas últimas 24 horas. O exame objetivo sugeria a presença de uma hérnia femoral encarcerada, e a paciente foi submetida a cirurgia urgente. Intraoperatoriamente, confirmou-se o diagnóstico de hérnia femoral encarcerada, que continha a trompa de falópio direita no interior do saco herniário. Uma vez que a que a trompa não apresentava sinais de isquemia, o conteúdo da hérnia foi reduzido, e procedeu-se à sua reparação. O período pós-operatório decorreu sem intercorrências, e a paciente teve alta no 3° dia após a cirurgia.

Inflamed Appendix in an Incarcerated Femoral Hernia / Apéndice inflamado en una hernia femoral incarcerada

ABSTRACT The presence of appendicitis in an incarcerated femoral hernia is an extremely rare occurrence, known as De Garengeot's hernia, with potentially serious complications. An incarcerated femoral hernia was noticed intraoperatively, and the hernial sac, closely fused with femoral blood vessels, contained the phlegmonously inflamed vermiform appendix. Appendectomy and mesh hernioplasty were carried out. The postoperative period was uneventful.

RESUMEN La presencia de apendicitis en una hernia femoral incarcerada es una condición extremadamente rara, conocida como hernia de Garengeot, la cual presenta complicaciones potencialmente serias. Una hernia femoral incarcerada fue observada intraoperativamente, y el saco herniario, estrechamente fusionado con los vasos sanguíneos femorales, contenía el apéndice vermiforme con una inflamación flemónica. Se realizaron una apendicectomía y una hernioplastia con malla. El período postoperatorio se desarrolló sin problemas.

Hernia femoral de Littré estrangulada: reporte de caso clínico / Strangulated Littré femoral hernia: case report

Resumen Objetivo: Presentar un caso de hernia femoral de Littré estrangulada. Caso clínico: Hombre de 86 años, que consultó por cuadro de dolor abdominal periumbilical postraumático de 4 días de evolución que se acompañaba de vómitos y ausencia de deposiciones con tránsito de gases conservado. Destacaba al examen masa dolorosa e indurada de 3 cm de diámetro no reductible bajo arcada inguinal derecha. Se realizó una herniorrafia femoral con abordaje preperitoneal, identificando una hernia de Littré estrangulada y realizándose una resección intestinal más reparación tisular del defecto herniario. Conclusión: Las hernias de Littré femorales son una entidad extremadamente rara y el manejo quirúrgico óptimo no está establecido.

Abstract Objective: To present a case of strangulated Littré femoral hernia. Clinical case: 86 years old man with 4 days of post-traumatic periumbilical abdominal pain accompanied by vomiting and absence of stools with gas transit preserved. Examination highlighted a painful and indurated mass of 3 cm in diameter that it was not reducible below right inguinal arch. A femoral hernia repair with preperitoneal approach was performed by identifying a strangulated Littré hernia performing bowel resection and tissue repair of the hernia defect. Conclusion: Littré femoral hernias are an extremely rare entity and optimal surgical management is not established.

Intervenciones en hernias inguinocrurales: bilateralidad y recidiva hemiaria. Servicio de Cirugía del Hospital Naval de Viña del Mar / Reoperations in femoral and inguinal hernias: bilaterality and relapse. Surgery Service in the Navy Hospital Viña del Mar

Introducción: En nuestro país la hernioplastia inguinocrural es una de las intervenciones quirúrgicas más frecuentes, pero hay escasos estudios acerca de los resultados a largo plazo. Materiales y método: Estudio observacional de cohorte retrospectiva utilizando base de datos, fichas clínicas y electrónicas, con el objeto de analizar las causas de reintervenciones en hernioplastias inguinocrurales desde el año 2000 hasta el 2010, con seguimiento hasta junio del 2015. Resultados y discusión: Se realizaron 1.765 intervenciones con los códigos de hernia inguinal y femoral, de los cuales 100 casos requirieron reintervención: 84 hombres y 16 mujeres, con edad promedio de 62 años para la primera cirugía. En un tercio se encontró HTA, y en el 38% de los hombres uropatía obstructiva, sin ser estadísticamente significativo (p = 0,6). Se demostró intervención por hernia contralateral en el 38% de los casos, con aparición predominante dentro de los 3 primeros años desde la primera cirugía; en el 37% se demostró recidiva herniaria. Los pacientes que recidivaron equivalen al 2,7% del total de cirugías realizadas, pero al considerar las recidivas solo con técnica de Lichtenstein, esta fue del 1,7% con respecto al total de hernioplastias realizadas, presentándose dentro de los 3 primeros años. En 5 casos se demostró doble recidiva y en 2 casos triple recidiva. Cinco pacientes presentaron complicaciones: 2 hematomas, un seroma, una inguinodinia crónica y un paciente falleció por obstrucción intestinal postoperatoria. Conclusión: Nuestros resultados son similares a casuísticas nacionales y metaanálisis reportados en cuanto a tipo de pacientes, comorbilidades asociadas y porcentaje de recidiva a largo plazo, con menor tasa de complicaciones.

Introduction: In our country, hernioplasty for inguinocrural hernia is one of the most frequent surgical procedures, but there are scanty studies bring over of the long-term results. Materials and method: Observational retrospective cohort study, using clinical data base of patient's clinical history, in order to analyze the cause of reoperations on our inguinocrural hernioplasty data base, from the year 2000 to the year 2010, and with a follow up until June 2015. Results and discussion: In total they were performed 1,765 interventions coded crural and inguinal hernia, 100 cases required reoperation, 84 men and 16 women with an average age of 62 years for the first surgery. In a third hypertension was found, and in 38% of men, obstructive uropathy, not statistically significant (P=.6). Reoperation for contralateral hernia was performed in 38% of the cases, with predominant appearance within the first three years after the first surgery; in 37% of the cases, hernia recurrence was demonstrated. Patients, who recurred, were equivalent to 2.7% of all surgeries performed, but considering Lichtenstein technique, it was only 1.7% of all hernioplasties, occurring within the first three years. In 5 cases, we found double recurrence, and triple recurrence in two. Five patients had complications: two bruising, seroma, chronic inguinal pain and one death by postoperative intestinal obstruction. Conclusion: Our results were similar to those reported in our country in relation to the type of patients, comorbidities and recurrence at long-term, but with a lower rate of complications.

Diez años de experiencia empleando la técnica con plug de Lichtenstein en la hernia femoral / Femoral Hernia. Ten years of experience in using the Lichtenstein Plug Technique

Introducción: se han desarrollado diversas técnicas para la reparación de la hernia femoral. La técnica con el Plug de Lichtenstein desde el año 1989 ha permitido obtener un menor índice de complicaciones y recidivas, así como una recuperación temprana de las actividades habituales del paciente. Su aplicación, ampliamente difundida en la cirugía electiva, también puede realizarse en la cirugía de urgencia. El objetivo de este trabajo es valorar la experiencia de nuestro grupo básico de trabajo en el tratamiento quirúrgico de la hernia femoral mediante la aplicación de esta técnica. Métodos: se realizó un estudio observacional descriptivo con carácter retrospectivo en nuestro grupo básico de trabajo, del servicio de cirugía del Hospital General Docente Enrique Cabrera entre los años 2001 al 2010, a un conjunto de pacientes a los cuales se les aplicó la técnica del Plug de Lichtenstein para la reparación de la hernia femoral. Se estudiaron las variantes anatómicas de las hernias así como las complicaciones posoperatorias y la evolución clínica. Resultados: la edad media de los pacientes fue de 58,7 años (19-92 años) y el sexo femenino fue el de mayor incidencia (78 por ciento), además la localización más frecuente, la derecha (67,5 por ciento). La prótesis empleada en la hernioplastia fue la de polipropileno. Se aplicó la anestesia local a 29 pacientes (63 por ciento). El tiempo quirúrgico medio fue de 25 minutos (15-65 minutos). La deambulación fue precoz y la estancia media hospitalaria fue menos de 24 horas, en la mayoría de los pacientes. Solo se constató una infección de la herida y una recidiva herniaria en un paciente. Conclusiones: la técnica del Plug de Lichtenstein debe considerarse entre las de elección en el tratamiento de la hernia femoral(AU)

Introduction: many technical procedures have been developed to repair femoral hernia. Since 1989, the Lichtenstein Plug technique has allowed lower rates of post operative complications and recurrence as well an earlier recovery of the daily life activities of the patients. This technique, widely known in elective surgery, can also be performed in the emergency surgery. Objective: to assess the experience of our basic working team in the surgical treatment of the femoral hernia through this technique. Methods: a retrospective, descriptive and observational study was conducted by our basic working team from the surgery service at Dr. Enrique Cabrera General Teaching Hospital from 2001 to 2010, which covered the patients who underwent surgical repair of femoral hernia through the Lichtenstein Plug technique. The anatomical variants of the hernias as well as the postoperative complications and the clinical progress were studied. Results: the mean age of the patients were 58.7 years old, (19-92 years), with prevalence of females (78 percent). The most frequent location of hernias was on the right (67.5 percent). Polypropylene reticular mesh was the most commonly used. Local anaesthesia was applied in 29 patients (63 percent), and the mean surgical time was 25 minutes (15-65 minutes). The average length of stay at hospital was less than 24 hours. Just one patient developed wound sepsis and herniary recurrence. Conclusions: the Lichtenstein Plug procedure should be regarded as a choice in treating femoral hernia(AU)

Hernia de Garengeot.: Reporte de caso y revisión de la literatura / De Garengeot hernia: A case report and literature review

Objetivo: Reportar un caso de hernia de Garengeot. Sede: Centro Médico de Tercer Nivel. Diseño: Reporte de caso. Reporte del caso: Se presenta el caso de una mujer de 82 años de edad, admitida con diagnóstico de oclusión intestinal alta por una probable hernia inguinal complicada, motivo por el que se llevó a laparotomía exploradora encontrando una hernia de Richter y una de Garengeot en el canal femoral izquierdo; se trató con apendicectomía, reducción de la hernia de Richter y cierre del canal femoral con material de sutura no absorbible; la paciente evolucionó de forma satisfactoria y actualmente se encuentra sin complicaciones. Discusión: La presencia del apéndice cecal herniado en el canal femoral se conoce como hernia de Garengeot. Su frecuencia es muy baja, el diagnóstico preoperatorio es complejo y el tratamiento tiene relación con el tiempo de evolución y la coexistencia del proceso inflamatorio. Ante la presencia de apendicitis complicada se recomienda la realización de apendicectomía, con cierre del defecto herniario con sutura sin utilizar materiales protésicos.

Hernia femoral complicada: presentación de un caso en un Centro Diagnóstico Integral, Venezuela / Complicated femoral hernia: presentation of a case in an integral diagnostic centre, Venezuela

La hernia femoral se presenta entre el 2 y el 5 por ciento de los casos, por lo que no se presenta con frecuencia. Se observa con un mayor predominio en las mujeres, pues generalmente evolucionan a complicaciones con elevada incidencia hacia la estrangulación. Se presenta el caso de una paciente femenina de 45 años de edad, con una hernia femoral complicada de 3 días de evolución, a la cual se le realizó una intervención quirúrgica de urgencia. El objetivo de este trabajo fue describir los elementos clínicos, resultados de exámenes complementarios, hallazgos quirúrgicos, intervención quirúrgica realizada y la evolución de este caso en el servicio de Cirugía General del Centro Diagnóstico Integral-UD1 parroquia Caricuao, municipio Libertador, Estado Distrito Capital Venezuela, en el mes de marzo de 2010. Se concluye que el diagnóstico y una intervención quirúrgica precoz contribuyen a disminuir la morbilidad y la mortalidad de estos pacientes. La técnica con plug de Lichtenstein ha permitido obtener un menor índice de complicaciones y recidivas, por lo cual su empleo debe considerarse como tratamiento de elección en las hernias crurales que se intervienen, tanto de forma urgente como electiva

The femoral hernia appears between 2-5 percent of the cases, one does not appear frequently, it is observed with a greater predominance in the women, evolve generally to complications with high incidence towards the throttling. The case of a feminine patient of 45 years of age with a complicated femoral hernia of 3 days of evolution appears, to which an emergency operation was realised to him. The objective of this work was To describe the clinical elements, surgical results of complementary examinations, findings, operation realised and the evolution of this case in the service of General Surgery of the Center Integral Diagnosis-UD1 Caricuao parish, Liberating municipality Been Capital District Venezuela in the 10 month March of the 2010. One concludes that the diagnosis and a precocious operation contributes to diminish the morbidity and the mortality of these patients. The technique with plug of Lichtenstein has allowed to obtain a smaller index of complications and recidivas, thus thus its use must be considered like treatment of election in the crurales hernias that are found as much of urgent form as elective

Femoral hernia repair under local anesthesia / 中华普通外科杂志

Objective To evaluate the choices and surgical skills for tension-free femoral hernia repair under local anesthesia. Methods The clinical data of 109 nonincarcerated femoral hernia patients were summarized from December 2002 to December 2009. Patients were divided into 3 groups according the time period at which the surgery was performed. 85 patients from 2002 to 2008 were divided into 2 groups,45 cases treated with preperitoneal repair ( preperitoneal group), and the other 40 cases with mesh-plug repair (plug group). The 24 cases admitted from January 2009 to December 2009 received modified preperitoneal repair. Operation time, VAS, length of hospitalization, incidence of recurrence, foreign body feelings and seroma were compared among the three groups. Results All the 109 patients were repaired under local anesthesia, and there was no perioperative death. The statistical indicator value of incidence of recurrence, foreign body sensation and seroma in preperitoneal group was lower than plug group (P ＜0.05). The modified preperitoneal repair was better in operation time, VAS, length of hospitalization than preperitoneal group (P ＜ 0.05). Conclusions Modified preperitoneal repair under local anesthesia is the choice for treating femoral hernia without incarceration. Modified preperitoneal repair is faster, more minimally invasive and faster recovery.

Polypropylene-Prolene Hernia System in the application of tension-free herniorrhaphy of femoral hernia / 中国普通外科杂志

Objective To study the application of Polypropylene-Prolene Hernia System ( PHS) in tension-free herniorrhaphy of femoral hernia. Methods A total of 36 patients with femoral hernia were randomly divided into 2 groups to receive respectively PHS or Plug repair procedure. Data collected included; operative time, hospital stay, postoperative complications and recurrence rate. Results In PHS and Plug groups, the operative time were (42?7) min and (41?4) min respectively, the hospital stay was (4. 1?1. 0) d and (4.4?1. 2) d respectively. During the follow up period from 6 to 30 months,there was no recurrence, one case of scrotal hydrocele in PHS group, and there were two cases of recurrence and one case of ecchymoma in Plug group. Five patients complained of foreign body feeling in Plug group, and no patient in PHS group ( P