ABSTRACT
Hasta la fecha la reparación quirúrgica de las hernias inguinales ha evolucionado notablemente, existiendo hoy distintas alternativas disponibles. Como todo acto quirúrgico no está exento de complicaciones, las que deben ser conocidas por el médico tratante y enfrentadas desde la primera consulta del paciente. La recurrencia de las hernias inguinales tiene una incidencia variable dependiendo de la técnica aplicada, sin embargo no hay estudios randomizados que permitan concluir al respecto. Por otra parte, aunque se ha documentado la disminución de complicaciones con la anestesia regional, su uso no se ha masificado. Numerosas son las complicaciones que presentan compromiso visceral: a nivel genital existe el riesgo de orquitis, trauma del conducto deferente e hidrocele; a nivel vascular y neural se pueden dañar estructuras propias de la zona anatómica a intervenir; también existe el riesgo de dañar la vejiga o el intestino cuando éstos están en el saco hernario; y por último se pueden presentar infecciones, complicación común en todas las cirugías. En conclusión, podemos establecer que el éxito de nuestra hernioplastía, se basa en tres pilares fundamentales: establecer una estrecha relación médico paciente en el preoperatorio, conocer ampliamente la técnica quirúrgica practicada y reconocer las complicaciones durante el postoperatorio.
Subject(s)
Humans , Digestive System Surgical Procedures , Hernia, Inguinal/surgery , Hernia, Inguinal/complications , Orchitis/complications , Intraoperative Complications , RecurrenceABSTRACT
This study prospectively examined the role of cognitive behavioral therapy (CBT) in (1) alleviating psychological and somatic distress, and (2) lowering arrhythmic events requiring shocks. Forty-nine of 61 consecutive patients were randomized into therapy (CBT, n = 25) or no therapy (NT, n = 24) and completed a battery of self-report questionnaires at baseline and at 9-month follow-up. CBT was administered at preimplant, predischarge, and at seven routine follow-up visits. Patients were 65 +/- 10 years old, 65% were men, and 92% Caucasian. Eighteen (72%) CBT patients and 18 (75%) NT patients were retained at follow-up. Compared to CBT patients, NT patients reported higher levels of depression (P = 0.046), more anxiety (P = 0.013), more psychological distress (P = 0.015), poorer overall adjustment (P = 0.009), and poorer sexual functioning (P = 0.003). Mean number of shocks did not differ between the CBT and NT groups (2.85 vs 2.30, respectively); however, more patients in the CBT group (61%) than the NT group (33%) received shocks (P = 0.070). At follow-up, a subgroup analysis revealed that the significant differences observed between the CBT and NT groups were attributable to the patients who received shocks in both groups. In conclusion, CBT was associated with decreased depression, decreased anxiety, and increased adjustment for ICD recipients, particularly among those patients receiving shocks. CBT can be administered effectively at routine follow-up visits or transtelephonically with little added inconvenience to the ICD recipient.
