Prescindencia del drenaje en la eventrorrafia ambulatoria / Ambulatory surgical treatment of incisional hernias avoiding the use of drainages

RESUMEN

Se incorporó al programa de cirugía ambulatoria con anestesia local a las eventraciones clasificadas como pequeñas o medianas (anillo hemiario menor de 3 cm). Se intervinieron pacientes ASA I y II con condiciones sociales y psicológicas compatibles. El propósito de esta presentación es dar a conocer el resultado de una serie de medidas, en especial de la sutura anclada a la aponeurosis del celular subcutáneo, que han hecho posible prescindir del avenamiento de la herida quirúrgica. El estudio comprende 94 mujeres y 21 varones con una edad promedio de 64,1 (27-85) años. Se premedicó a los enfermos con una mezcla de Amidona® y Midazolan iv y se utilizó anestesia local monitorizada, con 200 mi de Lidocaina® al 0,4 por ciento alcalinizada y adicionada de 0,1 mg de adrenalina. Empleamos una rafia sin malla en los anillos de un diámetro menor a 3 cm. Se ancló la sutura del tejido celular subcutáneo a la aponeurosis, se efectuó quimioprofilaxis irrigando la herida con una solución de Gentamicina.y se indicó el uso de una faja elástica en el postoperatorio. Los controles se efectuaron durante 30 días por un cirujano del equipo consignando las complicaciones. Hubo 3 infecciones superficiales y no se apreciaron hematomas ni seromas. Este resultado permite recomendar esta técnica sin drenaje en las eventrorrafias ambulatoria de tamaño pequeño y mediano.

ABSTRACT

Background: An ambulatory surgical program using local anesthesia for hernias with a sac smaller as 15 cm and a separation of the aponeurotic borders not wider as 3 cm, was started. Patients classified as American Society of Anesthesiologists (ASA) stages I and II, with social and psychological conditions compatible with postoperative care at home were accepted for this type of treatment. Aim: To report the experience with ambulatory treatment of incisional hernias. Material and methods: Prospective observational study of 94 women and 21 men aged 27 to 85 years subjected to ambulatory surgery. Results: Amidone® and Midazolan were administered intravenously immediately before surgery and repeated during the operation when necessary. Local anesthesia was carried out with 200 mi alkalinized Lidocaine® 0,4 percent with 0.2 mg adrenalin. An incision was made extirpating the scar and a skin lozenge of proper length and width, exposing the aponeurosis and the hernia sacs. After reduction of the hernia sac, the hernia repair was performed by means of an iso-tensional double invaginating suture or placing prosthetic material in the preperitoneal space, depending in the size of the defect. We avoided stretching, compressing and shearing the tissues and excessive hemostasis with ligature and electrocautery. To reduce dead spaces to a minimum, the subcutaneous suture was anchored to the aponeurosis in all the length of the wound. The wound was bathed with a Gentamycin solution. The patient was discharged after a short observation period wearing an elastic girdle. Controls were done during 30 days by a staff surgeon. Three superficial infections, no hematomas or seromas were observed during this time. Conclusions: This method of wound closure was successful for ambulatory repair of small and middle sized incisional hernias.