ABSTRACT
Introducción. La aparición de hernias incisionales/ ventrales es una complicación frecuente de la cirugía abdominal. Hay multitud de técnicas de reparación: el clásico cierre directo del defecto, la reparación sin tensión mediante la colocación de una malla por vía abierta o la reciente aparición de la reparación laparoscópica. Objetivo. Valorar los resultados obtenidos en relación con la eficacia y la seguridad de la reparación de las hernias incisionales/ventrales por vía laparoscópica y su aplicabilidad en la unidad de cirugía mayor ambulatoria y de corta estancia. Pacientes y método. Se realizó un estudio prospectivo de 135 pacientes consecutivos. Todos presentaron una hernia incisional (n = 132) o ventral (n = 2), que fueron reparadas por laparoscopia, entre febrero de 1999 y julio de 2003. Se analizaron los siguientes parámetros: número de intervenciones abdominales quirúrgicas y reparaciones herniarias previas, número de defectos, localización de éstos, duración de la intervención, tipo de malla, complicaciones postoperatorias, estancia postoperatoria y tasa de recurrencia en un período de seguimiento medio de 12 meses. Resultados. De los 135 pacientes, 16 (11,8%) fueron convertidos a cirugía abierta. La localización más frecuente del defecto fue infraumbilical. De los 119 pacientes en los que se realizó la reparación por laparoscopia, en 67 se encontró más de 1 defecto herniario. La duración media de la intervención fue de 72,3 ± 28,3 min. La complicación inmediata que se objetivó un mayor número de veces fue el seroma en el saco herniario. El 92,4% de los pacientes fue dado de alta dentro de las primeras 24 h de la intervención. La tasa de recurrencia se mantuvo en un 5,04%. Conclusión. La reparación laparoscópica de las hernias incisionales/ventrales es un método seguro que permite el manejo ambulatorio de esta enfermedad. Además, esta técnica tiene las ventajas de la cirugía mínimamente invasiva y permite identificar con claridad los defectos herniarios múltiples, con un porcentaje aceptable de complicaciones y una baja tasa de recidivas (AU)
Introduction. Hernia is a frequent complication in abdominal surgery. There are a multitude of repair techniques, ranging from classical direct closure of the defect and tension-free mesh repair using open surgery to the recent development of laparoscopic repair. Objective. To evaluate the safety and effectiveness of laparoscopic repair of incisional/ventral hernias and its applicability in an outpatient-short stay surgical unit. Patients and method. We performed a prospective study of 135 consecutive patients. All patients had incisional (132 patients) or ventral hernias (2 patients) that were laparoscopically repaired between February 1999 and July 2003. The parameters analyzed were the number of prior abdominal interventions and hernia repairs, the number of defects, their location, operating time, type of mesh, postoperative complications, postoperative length of hospital stay, and recurrence rate during a mean follow-up period of 12 months. Results. Of the 135 patients, 16 (11.8%) underwent conversion to open surgery. The most frequent location of the defect was infraumbilical. Of the 119 patients who underwent laparoscopic repair, more than one hernia was found in 67. The mean operating time was 72.3 ± 28.3 min. The most frequent immediate complication was seroma in the hernia sac. A total of 92.4% of the patients were discharged within 24 h of the intervention. The recurrence rate was 5.04%. Conclusion. Laparoscopic repair of incisional/ven-tral hernias is a safe method that allows outpatient management of this defect. Moreover, the technique presents the advantages of minimally invasive surgery, allowing clear identification of multiple hernial defects, with an acceptable percentage of complications and low recurrence rate (AU)
Subject(s)
Male , Female , Adult , Middle Aged , Aged , Humans , Hernia, Ventral/diagnosis , Hernia, Ventral/surgery , Laparoscopy/methods , Ambulatory Surgical Procedures/methods , Postoperative Complications , Length of Stay , Electrocoagulation/methods , Surgical Mesh , Minimally Invasive Surgical Procedures/methods , Ambulatory Surgical Procedures/instrumentation , Ambulatory Surgical Procedures/trends , Prospective Studies , Hernia/surgery , HerniaABSTRACT
INTRODUCTION: Hernia is a frequent complication in abdominal surgery. There are a multitude of repair techniques, ranging from classical direct closure of the defect and tension-free mesh repair using open surgery to the recent development of laparoscopic repair. OBJECTIVE: To evaluate the safety and effectiveness of laparoscopic repair of incisional/ventral hernias and its applicability in an outpatient-short stay surgical unit. PATIENTS AND METHOD: We performed a prospective study of 135 consecutive patients. All patients had incisional (132 patients) or ventral hernias (2 patients) that were laparoscopically repaired between February 1999 and July 2003. The parameters analyzed were the number of prior abdominal interventions and hernia repairs, the number of defects, their location, operating time, type of mesh, postoperative complications, postoperative length of hospital stay, and recurrence rate during a mean follow-up period of 12 months. RESULTS: Of the 135 patients, 16 (11.8%) underwent conversion to open surgery. The most frequent location of the defect was infraumbilical. Of the 119 patients who underwent laparoscopic repair, more than one hernia was found in 67. The mean operating time was 72.3 +/- 28.3 min. The most frequent immediate complication was seroma in the hernia sac. A total of 92.4% of the patients were discharged within 24 h of the intervention. The recurrence rate was 5.04%. CONCLUSION: Laparoscopic repair of incisional/ventral hernias is a safe method that allows outpatient management of this defect. Moreover, the technique presents the advantages of minimally invasive surgery, allowing clear identification of multiple hernial defects, with an acceptable percentage of complications and low recurrence rate.
