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

Optimización de neumoperitoneo preoperatorio en hernia ventral: Uso de un dispositivo de compresión externa

La hernia incisional compleja es un desafío para el cirujano. Son ampliamente conocidos los factores que han permitido mejorar los resultados de la reparación herniaria, entre ellos el neumoperitoneo preoperatorio. Durante la insuflación preoperatoria, el aire difunde tanto en la cavidad abdominal como en el saco herniario. Sin embargo, gran porcentaje del contenido administrado, se distribuye mayormente en el saco herniario y no en la cavidad abdominal. En Latinoamérica, diversos equipos de cirujanos de pared abdominal han compartido experiencias en lo que respecta a la optimización de esta técnica como adyuvancia para el manejo de las hernias complejas. En este contexto, y para optimizar la distribución del aire insuflado hacia la cavidad abdominal, se comenzó a utilizar un dispositivo externo de compresión. Este trabajo busca estandarizar por primera vez esta técnica durante el neumoperitoneo preoperatorio buscando disminuir el volumen de aire insuflado, los días de neumoperitoneo y, por lo tanto, los días de hospitalización previo a la cirugía.

Complicated incisional hernia is challenging for surgeons. The factors that have improved the results of hernia repair are widely known, including preoperative pneumoperitoneum. During preoperative insufflation, air diffuses into both the abdominal cavity and the hernia sac. However, a large percentage of the administered content is distributed mainly in the hernia sac and not in the abdominal cavity. Latin-American teams of abdominal wall surgeons have shared experiences regarding the optimization of this technique as an adjuvant for the management of complicated hernias. In this context and to optimize the distribution of the insufflated air into the abdominal cavity, an external compression device began to be used. This article aims to standardize this technique for the first time during preoperative pneumoperitoneum. The target is to reduce the volume of air insufflated, the days of pneumoperitoneum and, therefore, the days of hospitalization prior to surgery.

A Case of Delayed Recovery of Navel Wound Healing after Laparoscopic Surgery for Cholecystectomy Successfully Treated with a Kampo Formulation Senkinnaitakusan / 日本東洋医学雑誌

We herein report a patient who complained persistent exudate at navel in spite of adequate antibiotics therapy after laparoscopic cholecystectomy was successfully treated with Kampo therapy. The pharmacological effect of this Kampo formulation i.e. senkinnaitakusan is still unknown, but this formulation has been used for persistent infectious diseases. According to the description in the classic textbook, this formulation is suggested to encourage metabolic function and exhibit anti-inflammatory function. There have been no reports of Kampo therapy for the superficial incisional site infection associated with laparoscopic surgery. The authors propose that Kampo medicine is another promising option in the management of surgical site infection (SSI).

Internal post-bariatric hernia due to hepatic adhesion: a case report

ABSTRACT Roux-en-Y gastric bypass, a procedure proven effective for treating morbid obesity and metabolic disorders, carries the risk of complications such as the formation of internal hernias. These hernias are often difficult to diagnose and can be potentially fatal because they can cause structural obstruction. Most internal hernias occur in the jejunojejunostomy mesentery space, followed by Petersen's space hernias, although herniation at other locations can also occur. Our case report presents an example of a rare internal hernia after laparoscopic Roux-en-Y gastric bypass. A 36-year-old woman presented with an uncommon internal hernia located between the liver and alimentary loop, resulting in the formation of a new space and consequently incarcerating the entire biliopancreatic loop. This type of internal hernia is rare and has not been reported in the literature, indicating that this is the first report of such a case. In this case, we realized that the diagnosis was challenging and imaging examinations could not help determine the etiology of the pain and obstruction. Therefore, videolaparoscopy revealed an uncommon hernia formed by firm adhesion between the hepatic segment III and the alimentary loop mesentery. Our case is an example of an internal hernia that was not detected with a normal computed tomography scan of the abdomen and pelvis. Only diagnostic laparoscopy revealed herniation, effectively preventing further complications for the patient.

Factors influencing the occurrence of parastomal hernia after preventive ileostomy for colorectal cancer / 中国医师杂志

Objective:To explore the risk factors related to the formation of parastomal hernia (PSH) in patients with colorectal cancer after preventive ileostomy, provide Evidence-based medicine basis for prevention and treatment, and reduce the incidence of incision hernia (SSIH) at the stoma.Methods:The clinical data of 214 patients who underwent laparoscopic radical resection of colorectal cancer combined with preventive loop ileostomy in the General Surgery Department of the Linyi People′s Hospital from January 2019 to May 2021 were retrospectively analyzed. The incidence of PSH was statistically analyzed, and the risk factors of PSH were analyzed by binary logistic regression.Results:There were 177 cases of PSH in 214 patients, with an incidence rate of 82.71%. There were 5 cases of SSIH (2.34%). The results of single factor analysis showed that there were significant differences in body mass index (BMI), postoperative diversion time and the proportion of stoma through rectus abdominis muscle between the PSH group and the non PSH group (all P<0.05); The results of binary logistic regression analysis showed that BMI, postoperative diversion time, rectus abdominis muscle stoma, incision infection and liquefaction were important influencing factors for the formation of PSH after preventive loop ileostomy for colorectal cancer (all P<0.05). Conclusions:BMI, postoperative diversion time, rectus abdominis muscle stoma, incision infection and liquefaction are important influencing factors for the formation of PSH after preventive ileostomy. Intervention measures can be targeted to reduce the incidence of SSIH by reducing the risk of PSH.

Research progress in the design of surgical flaps for impacted mandibular third molars / 中国基层医药

The incidence of impacted mandibular third molars is high. Many complications occur after extraction of impacted third molars, such as bleeding, pain, swelling, and dry grooves, which affect quality of life. To reduce postoperative complications, various skin flap designs have emerged with time. This paper summarizes the current research progress in designing impacted mandibular third molar flaps, providing a reference for clinical work.

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.

Neumoperitoneo progresivo preoperatorio para el tratamiento de la hernia inguinoescrotal gigante: reporte de caso / Progressive Preoperative Pneumoperitoneum for Giant Inguinoscrotal Hernia: a Case Report

Resumen Introducción: El procedimiento de neumoperitoneo progresivo preoperatorio para el manejo de hernias gigantes con "Pérdida de dominio" o Pérdida de derecho a domicilio" fue introducido en 1940 por Goñi Moreno en Argentina. Autores como Herszage, Berlemont, Koontz, Gravez y Martínez Munive presentaron variaciones interesantes del método original. Su uso se recomienda para preparación previa de pacientes con hernias gigantes y grandes contenidos de vísceras en el saco herniario, en los cuales no sería posible su re-introducción y efectuar la hernioplástia, o en los que su reducción de manera forzada pudiera llevar al paciente al desarrollo de un síndrome compartimental abdominal en el postoperatorio inmediato. Caso clínico: Paciente de sexo masculino de 65 años de edad, que presenta cuadro clínico de un mes de evolución caracterizado por dolor a nivel de la región inguinal izquierda, en el cual se evidencia presencia de hernia inguino escrotal gigante izquierda, no reductible, con aproximadamente un 40% de contenido abdominal. Resultados: La mayoría de los estudios describen el uso del neumoperitoneo progresivo para la reparación de las eventraciones gigantes, sin embargo, en nuestra experiencia y en la de otros autores, esta técnica también puede utilizarse para resolver las hernias inguinales y umbilicales gigantes, con buenos resultados. En todos los casos se aconseja utilizar material protésico. Conclusión: El uso del neumoperitoneo preoperatorio progresivo, se trata de una técnica segura y fácil de realizar que puede complementar las técnicas de eventroplastía complejas, aportando ventajas en la preparación de los pacientes con grandes defectos de pared abdominal y obteniendo buenos resultados.

Abstract Introduction: The procedure of progressive preoperative pneumoperitoneum for the management of giant hernias with "Loss of domain" or "Loss of the right of domain" was introduced in 1940 by Goñi Moreno in Argentina, followed in later years by authors such as Herszage, Berlemont, Koontz, Gravez and Martínez Munive, all with some interesting variations of the original method. Its use is recommended for previous preparation of patients with giant hernias and large contents of viscera in the hernial sac, in which it would not be possible to re-introduce and perform hernioplasty, or in which its forced reduction could lead to the patient to the development of an abdominal compartment syndrome in the immediate postoperative period. Clinical case: A 65-year-old male patient with a clinical picture of one month of evolution characterized by pain in the left inguinal region. There was evidence of a giant left inguinal scrotum, not reducible, with approximately 40% abdominal contents. Results: Most studies describe the use of progressive pneumoperitoneum for the repair of giant hernias, however, in our experience and in that of other authors, this technique can also be used to resolve hernias giant inguinal and umbilical, with good results. In all cases it is recommended use prosthetic material. Conclusion: The use of progressive preoperative pneumoperitoneum is a safe and easy-to-perform technique that can complement complex eventroplasty's techniques, providing advantages in the preparation of patients with large abdominal wall defects and obtaining good results.

Manejo laparoscópico de las hernias ventrales mediante abordaje totalmente extraperitoneal (eTEP): experiencia inicial y resultados a corto plazo / Laparoscopic Management of Ventral Hernias by Totally Extraperitoneal (eTEP) Approach: Initial Experience and Short-Term Results / Manejo laparoscópico de hérnias ventrais usando uma abordagem totalmente extraperitoneal (eTEP): experiência inicial e resultados em curto prazo

Introducción. El manejo de la hernia ventral sigue siendo un desafío para los cirujanos. Su reparación mediante técnicas mínimamente invasivas, como la totalmente extraperitoneal (eTEP) laparoscópica, permite una amplia disección del espacio a reparar, una recuperación postoperatoria más rápida, menor dolor postoperatorio y estancia hospitalaria. El abordaje eTEP es un enfoque novedoso que utiliza el espacio retromuscular para colocar material protésico y fortalecer la pared abdominal. El objetivo es describir los resultados a corto plazo de nuestra experiencia inicial con la técnica eTEP en el manejo de las hernias ventrales. Metodología. Estudio observacional, descriptivo, retrospectivo, donde se incluyen pacientes con el diagnóstico de hernia ventral, sometidos a cirugía laparoscópicaeTEP, entre julio-2021 y junio-2022. Resultados. De un total de 21 pacientes, el 61.9% fueron hombres. El 47.6% tenían sobrepeso y el 52.4% obesidad. Estancia hospitalaria media: 1.6 días. El 66.7% fueron hernias incisionales. Las técnicas quirúrgicas realizadas fueron: Rives-Stoppa (71.4%) asociándose liberación del músculo transverso en el 28.6%. El 19% de los pacientes presentaron complicaciones globales y solo uno fue grave, requiriendo reintervención quirúrgica. Se observó la presencia de seroma clínico en el 9.5% y ecográfico en 57.1%. No se evidenciaron hematomas, infección de herida quirúrgica ni casos de recidiva herniaria. Discusión y conclusiones. El abordaje laparoscópico eTEP Rives-Stoppa, asociado o no a separación posterior de componentes, en el manejo de las hernias ventrales ofrece buenos resultados asociando una baja incidencia de complicaciones postoperatorias, corta estancia hospitalaria, baja incidencia de recidivas herniarias, por lo que podría considerarse una técnica segura y efectiva en el tratamiento de las hernias ventrales.

Introduction. Managing ventral hernia remains a challenge for surgeons. Repairing it using minimally invasive techniques, such as laparoscopic totally extraperitoneal (eTEP), which allows for a wide dissection of the space to be repaired, faster postoperative recovery, less postoperative pain and shorter hospital stay. The eTEP approach is a novel technique that focus on the uses of the retromuscular space to place prosthetic material and strengthen the abdominal wall. The objective is to describe the short-term results of our initial experience with the eTEP technique in the management of ventral hernias. Methodology. Observational, descriptive, retrospective, study, which included patients with a diagnosis of ventral hernia, undergoing laparoscopic eTEP surgery, between July-2021 and June-2022. Results. Of a total of 21 patients, 61.9% were men. 47.6% were overweight and 52.4% were obese. Average hospital stay: 1.6 days. 66.7% were incisional hernias. The surgical techniques performed were: Rives-Stoppa (71.4%) with associated transversus abdominis muscle release in 28.6%. 19% of the patients presented global complications and only one was severe, requiring surgical reintervention. The presence of clinical seroma was observed in 9.5% and ultrasound in 57.1%. There was no evidence of hematomas, surgical wound infection or cases of hernia recurrence. Discussion and conclusions. The laparoscopic-eTEP Rives-Stoppa approach, associated or not with posterior separation of components, in the management of ventral hernias offers good results with a low incidence of postoperative complications, short hospital stay, low incidence of hernia recurrences, so it could be considered a safe and effective technique in the treatment of ventral hernias.

Introdução. O manejo da hérnia ventral continua sendo um desafio para os cirurgiões. Seu reparo por meio de técnicas minimamente invasivas, como a totalmente extraperitoneal (eTEP) laparoscópica, permite ampla dissecção do espaço a ser reparado, recuperação pós-operatória mais rápida, menor dor pós-operatória e menor tempo de internação. A abordagem eTEP é uma nova abordagem que usa o espaço retromuscular para colocar material protético e fortalecer a parede abdominal. O objetivo é descrever os resultados de curto prazo de nossa experiência inicial com a técnica eTEP no manejo de hérnias ventrais. Metodologia. Estudo observacional, descritivo, retrospectivo, longitudinal, que inclui pacientes com diagnóstico de hérnia ventral, submetidos a cirurgia laparoscópica-eTEP, entre julho-2021 e junho-2022. Resultados. De um total de 21 pacientes, 61.9% eram homens; 47.6% estavam com sobrepeso e 52.4% obesos. Tempo médio de internação: 1.6 dias; 66.7% eran hérnias incisionais. As técnicas cirúrgicas realizadas foram: Rives-Stoppa (71.4%) associada à liberação do músculo transverso em 28.6%. 19% dos pacientes apresentaram complicações globais e apenas um foi grave, necesitando de reintervenção cirúrgica. A presença de seroma clínico foi observada em 9.5% e ultrassonográfica em 57.1%. Não houve evidência de hematoma, infecção de ferida cirúrgica ou casos de recidiva de hérnia. Discussão e conclusões. A abordagem laparoscópica eTEP Rives-Stoppa, associada ou não à separação posterior dos componentes, no manejo das hérnias ventrais oferece bons resultados associando baixa incidência de complicações pós-operatórias, curto tempo de internação, baixa incidência de recidivas de hérnias, pelo que pode ser considerada uma técnica segura e eficaz no tratamento das hérnias ventrais.

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.

Architectural analysis of subconjunctival oblique limbus incision techniques in manual cataract extraction surgery by optical coherence tomography imaging

The purpose was to assess the profile of subconjunctival oblique limbus incision (SCOLI) design by using anterior-segment optical coherence tomography (AS-OCT) and try to emphasize the proper technique of wound construction. The structural dimensions and integrity of the wound were acquired from the patients, who had undergone manual small-incision cataract surgery with SCOLI techniques, using a Canon OCT anterior-segment imaging system on the first postoperative day. The use of AS-OCT allowed for an in vivo evaluation of SCOLI in high definition. The radial OCT scan image showed three staggered incisions, including conjunctiva incision, scleral entrance, and inner corneal lip. A tangential scan demonstrated that the internal lip is parallel to the curvature of the peripheral cornea. The en face image showed an asymmetric 4 arc-shaped configuration rather than a symmetrical one. In conclusion, AS-OCT could be used to analyze SCOLI to determine optimal wound construction and geometry. The results of this study indicated that an asymmetric 4 arc-shaped limbus tunnel incision was superior to the conventional linear equivalent in stability and nucleus delivery.

Effect of continuous intra-incisional bupivacaine on postoperative pain in non-traumatic spinal fixation surgeries: a randomized controlled trial

Abstract Background Continuous injection of local anesthetics by using surgical wound catheters for postoperative pain relief has gained acceptance in recent years. However, whether this method can be alternatively used instead of systemic opioids in different surgical procedures has not yet been elucidated. Objectives The aim was to investigate the effect of continuous injection of bupivacaine through a catheter inside the surgical wound on reducing the postoperative pain of lumbar spine fusion surgeries. Methods In this clinical trial, 31 patients undergoing non-traumatic lumbar spine stabilization surgery were randomly assigned to receive (n = 15) or do not receive (n = 16) bupivacaine through a catheter inside the surgical wound, postoperatively. Pain intensity (NRS), dose of required morphine, and drug-related complications within 24 hours of intervention were assessed and compared by the Mann-Whitney and independent t-test. Results Mean pain intensity was significantly lower in the case group over the first postoperative hour in the recovery room (p < 0.001), which continued for the first 2 hours after entering the ward. The mean morphine intake was lower in the bupivacaine group during the first postoperative 24 hours (16 ± 0.88 vs. 7.33 ± 0.93 mg, p < 0.001). The two groups were not significantly different regarding drug-related complications. Conclusion Continuous intra-incisional infusion of bupivacaine helped better pain reduction during the early postoperative hours while sparing morphine consumption in the first postoperative day.

Caracterización de las infecciones posoperatorias en un servicio de cirugía general / Characterization of Postoperative Infections in a General Surgery Service

Introducción: Las infecciones del sitio quirúrgico u operatorio constituyen un grave problema sanitario por lo que su prevención y tratamiento representan un reto para las instituciones hospitalarias. Objetivo: Describir las características de las infecciones posoperatorias según las principales causas relacionadas con su aparición. Métodos: Se realizó un estudio descriptivo y observacional con 207 pacientes ingresados y operados de cirugías mayores que presentaron infecciones posoperatorias en el Servicio de Cirugía General del Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba, durante 2018-2020. Resultados: La tasa global de infecciones posquirúrgicas fue de 4,18 pr ciento. Las infecciones incisionales superficiales, seguidas de las profundas fueron las más frecuentes. El número de pacientes infectados se triplicó en los operados con urgencia respecto a los electivos, con predominio de los apendicectomizados. El tiempo quirúrgico y la estadía hospitalaria promedio se elevaron en los pacientes infectados. Fallecieron 12 integrantes de la casuística, atribuible a la infección generalizada y el choque séptico. Conclusiones: La aparición de las infecciones posquirúrgicas se relacionan con factores dependientes del enfermo; de la propia cirugía como es la calificación del cirujano actuante, así como la presencia de factores de riesgos preoperatorios y durante la intervención. La infección incisional superficial es la más frecuente, en tanto que la mayoría de los pacientes que fallecen corresponden a aquellos con infección de órganos y espacios(AU)

Introduction: Surgical (or operative) site infections are a serious health problem, a reason why their prevention and treatment represent a challenge for hospital institutions. Objective: To describe the characteristics of postoperative infections according to the main causes related to their occurrence. Methods: A descriptive and observational study was carried out with 207 patients admitted and operated on in major surgeries who presented postoperative infections in the general surgery service of Saturnino Lora Provincial Teaching Hospital of Santiago de Cuba, during 2018-2020. Results: The overall rate of postoperative infections was 4.18 percent. Superficial incisional infections, followed by deep incisional infections, were the most frequent. The number of infected patients was tripled in those operated on urgently compared to electively, with a predominance of appendectomized patients. Surgical time and average hospital stay were higher in infected patients. 12 members of the casuistics have passed, attributable to generalized infection and septic shock. Conclusions: The occurrence of postoperative infections is related to factors depending on the patient; on the surgery itself, such as the qualification of the surgeon; as well as on the presence of preoperative and intraoperative risk factors. Superficial incisional infection is the most frequent, while most of the patients who die correspond to those with infection of organs and spaces(AU)

Hernia incisional y pérdida de dominio con neumoperitoneo progresivo preoperatorio más separacion de componentes. Un reporte de caso / Progressive preoperative pneumoperitoneum and components separation in incisional hernia with loss of domain. A case study report

Introducción: Una hernia con pérdida de dominio tiene un contenido de saco herniario de 50% o más del contenido de la cavidad abdominal, que conlleva a efectos locales y sistémicos. Reporte de Caso: Presentamos el caso de una paciente con hernia incisional y pérdida de dominio de 30 años de evolución, quien fue sometida a neumoperitoneo preoperatorio y durante acto quirúrgico, para evitar el cierre del defecto herniario con tensión, se realizó separación de componentes. Conclusión: El neumoperitoneo progresivo preoperatorio es un método recomendable en el manejo de pacientes con hernias gigantes y pérdida de dominio, porque es de bajo costo, seguro, fácil de realizar y evita las posibles complicaciones a las que el cierre del defecto con tensión conlleva.

Background:Ahernia with loss of domain has a hernia sac content of 50% or more than the content of the abdominal cavity, which leads to local and systemic effects. The case of a patient with an incisional hernia Report case: with loss of domain and 30 years of evolution is presented, she underwent preoperative pneumoperitoneum and during surgery, anterior component separation was performed to avoid tension in the closure of the hernia defect. Conclusion:Preoperative progressive neumoperitoneum is a recommended method in the management of patients with giant hernias and loss of domain, because it is low cost, safe and easy to perform and avoids the possible complications that the closure of the defect with tension entails

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.

Incisional hernia after bariatric surgery: only the physical examination is enough? / Hérnia incisional após a cirurgia bariátrica: apenas o exame físico é suficiente?

ABSTRACT BACKGROUND: Incisional hernia is characterized by a bulging of the abdominal wall caused by the prolapse of intracavitary structures, such as a segment of the small intestine, through the trocar orifice. Ultrasonography and physical examination are used in the diagnosis of incisional hernia. AIMS: This study aimed to evaluate the difference between physical examination and abdominal ultrasonography at the diagnosis of incisional hernia in patients who underwent laparoscopic bariatric surgery. METHODS: A total of 123 patients who underwent Roux-en-Y gastric bypass type bariatric surgery performed by laparoscopy were analyzed for the presence or absence of hernia by physical and ultrasonography examination at each trocar incision site. RESULTS: In our results, a total of 7 hernias were detected by physical examination, while ultrasonography detected a total of 56 hernias in at least one of the incision sites. Lin's concordance analysis showed that the tests are not concordant. The association between body mass index and hernia detection (p=0.04 for physical examination and p=0.052 for ultrasonography) was observed. Ultrasonography detected more incisional hernias in 10-mm or larger trocars than in 5-mm trocars (p<0.0001, p<0.05). No differences were noted among the trocar types that were used. CONCLUSIONS: Abdominal ultrasonography showed to have a higher accuracy than physical examination, resulting in a substantial increase in incisional hernia detection at the trocar sites.

RESUMO RACIONAL: A hérnia incisional é caracterizada por um abaulamento da parede abdominal causada por um prolapso das estruturas intracavitárias, como um segmento do intestino delgado, através de um orifício de trocarte. A ultrassonografia e o exame físico são usados no diagnóstico da hérnia incisional. OBJETIVOS: Avaliar a diferença entre o exame físico e a ultrassonografia abdominal no diagnóstico da hérnia incisional em pacientes submetidos a cirurgia bariátrica por videolaparoscopia. MÉTODOS: O total de 123 pacientes submetidos à cirurgia bariátrica, tipo derivação gástrica em Y de Roux, foram avaliados para a presença ou ausência de hérnia incisional por exame físico e ultrassonografia, nos sítios incisionais de cada trocarte. RESULTADOS: O total de sete hérnias foram detectados por exame físico, enquanto a ultrassonografia detectou um total de 56 hérnias em pelo menos um sítio incisional. A análise de concordância de Lin mostrou que os testes empregados não são concordantes. A associação entre o Índice de Massa Corpórea e a detecção de hérnia foi observada (p=0.04, para exame físico, p=0.052 para ultrassonografia). A ultrassonografia detectou mais hérnias incisionais em trocartes de 10 mm ou mais do que em trocartes de 5 mm (p<0,0001, p<0.05). Não foi observada diferença entre os tipos de trocartes empregados. CONCLUSÕES: A ultrassonografia abdominal demonstrou ter acurácia mais elevada que o exame físico, resultando em um aumento substancial na detecção de hérnia incisional nos locais de inserção dos trocartes.

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.

Robotic-assisted versus laparoscopic incisional hernia repair: differences in direct costs from a brazilian public institute perspective / Hernioplastia incisional robótica versus laparoscópica: diferenças nos custos diretos sob a perspectiva de um instituto público brasileiro

ABSTRACT BACKGROUND: Robotic-assisted surgery research has grown dramatically in the past two decades and the advantages over traditional videolaparoscopy have been extensively debated. For hernias, the robotic system can increase intraoperative strategies, especially in complex hernias or incisional hernias. AIMS: This study aimed to compare the direct cost differences between robotic and laparoscopic hernia repair and determine each source of expenditure that may be related to the increased costs in a robotic program from the perspective of a Brazilian public institution. METHODS: This study investigated the differences in direct costs from the data generated from a trial protocol (ReBEC: RBR-5s6mnrf). Patients with incisional hernia were randomly assigned to receive laparoscopic ventral incisional hernia repair (LVIHR) or robotic ventral incisional hernia repair (RVIHR). The direct medical costs of hernia treatment were described in the Brazilian currency (R$). RESULTS: A total of 19 patients submitted to LVIHR were compared with 18 submitted to RVIHR. The amount spent on operation room time (RVIHR: 2,447.91±644.79; LVIHR: 1,989.67±763.00; p=0.030), inhaled medical gases in operating room (RVIHR: 270.57±211.51; LVIHR: 84.55±252.34; p=0.023), human resources in operating room (RVIHR: 3,164.43±894.97; LVIHR: 2,120.16±663.78; p<0.001), material resources (RVIHR: 3,204.32±351.55; LVIHR: 736.51±972.32; p<0.001), and medications (RVIHR: 823.40±175.47; LVIHR: 288.50±352.55; p<0.001) for RVIHR was higher than that for LVIHR, implying a higher total cost to RVIHR (RVIHR: 14,712.24±3,520.82; LVIHR: 10,295.95±3,453.59; p<0.001). No significant difference was noted in costs related to the hospital stay, human resources in intensive care unit and ward, diagnostic tests, and meshes. CONCLUSION: Robotic system adds a significant overall cost to traditional laparoscopic hernia repair. The cost of the medical and robotic devices and longer operative times are the main factors driving the difference in costs.

RESUMO RACIONAL: A pesquisa em cirurgia robótica assistida cresceu dramaticamente nas últimas duas décadas e as vantagens sobre a videolaparoscopia tradicional têm sido amplamente debatidas. Para as hérnias, o sistema robótico pode aumentar as estratégias intraoperatórias, principalmente em hérnias complexas ou hérnias incisionais. OBJETIVOS: Comparar as diferenças de custo direto entre a hernioplastia incisional robótica e a laparoscópica e determinar cada fonte de gasto que pode estar relacionada ao aumento de custos em um programa de robótica na perspectiva de uma instituição pública brasileira. MÉTODOS: Investigar as diferenças nos custos diretos dos dados gerados a partir de um protocolo de ensaio clínico (ReBEC: RBR-5s6mnrf). Pacientes com hérnia incisional foram aleatoriamente designados para serem submetidos a reparo robótico ou laparoscópico (RVIHR). Os custos foram descritos na moeda brasileira (R$). RESULTADOS: Dezenove pacientes submetidos à cirurgia robótica foram comparados com dezoito submetidos à cirurgia laparoscópica. O valor gasto com tempo de centro cirúrgico (Robótica: 2.447,91±644,79; Robótica: 1.989,67±763,00; p=0,030), gases medicinais inalados em centro cirúrgico (Robótica: 270,57±211,51; Robótica: 84,55±252,34; p=0,023), recursos humanos em centro cirúrgico (Robótica: 3.164,43±894,97; Laparoscópica: 2.120,16±663,78; p<0,001), recursos materiais (Robótica : 3.204,32±351,55; Robótica: 736,51±972,32; p<0,001) e medicamentos (Robótica: 823,40±175,47; Robótica: 288,50 ± 352,55; p<0,001) para cirurgia robótica foi maior que cirurgia laparoscópica, implicando em maior custo total para cirurgia robótica (Robótica: 14.712,24±3.520,82; Laparoscópica: 10.295,95±3.453,59; p<0,001). Não foi observada diferença significativa nos custos relacionados à permanência hospitalar, recursos humanos em UTI e enfermaria, exames diagnósticos e telas. CONCLUSÕES: O sistema robótico adiciona um custo global significativo à hernioplastia incisional laparoscópica tradicional. O custo dos dispositivos médicos e robóticos, além de tempos cirúrgicos mais prolongados, são os principais fatores que impulsionam a diferença nos custos.