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.

THE ANALYSIS OF OPEN AND LAPAROSCOPIC TECHNIQUES FOR TENSION -FREE HERNIA REPAIR FOR PATIENTS WITH BILATERAL INGUINAL HERNIA / 现代医院

Objective To analyze the value of open tension -free hemiorrhaghy ( OTFH) and laparoscopic totally extraperitoneal prosthesis ( LTEP) repair in patients with bilateral inguinal hernia .Methods A retrospective method was used to compare the clinical data of 115 patients with bilateral hernias , of which 61 cases received LTEP and 54 cases underwent OTFH , from June 2011 to December 2013, in our hospital .Results The mean operative time of LTEP group (88.2 ±15.6 min) was longer than the OTFH group(75.7 ±21.6) min (p<0.05).The dura-tion of hospitalization in LTEP group(2.6 ±1.1) day was shorter than OTFH group(4.2 ±2.1) d (p<0.05).Hos-pitalization expense of LTEP group (12 012.0 ±2 325.2) yuan was higher than the OTFH group (9 291.3 ±2 010.1) yuan (p<0.05).The incision pain by VAS points was gradually decreased in 24 hours, 48 hours, 72 hours after op-eration, and LTEP group was significant lower than OTFH group in the same time point .In LTEP group 3 case had laceration of peritoneum but turn to no other prosthesis , and 2 cases had acute urinary retentions .11 acute urinary re-tentions occurred in OTFH group , and 2 cases had chronic pain in inguinal area and 1 cases of fat liquefaction .No recurrence was found during a follow -up period of 6 to 24 months in both of 2 groups .Conclusion Both LTEP and OTFH are safe and accessible techniques for patients with bilateral inguinal hernia .OTFH is feasible, and has short process and low cost which is suitable for primary hospitals to carry out .OTFH has the advantages of little trauma , faster postoperative recovery and less complications which is worth promoting in future .