ABSTRACT
BACKGROUND: Findings have shown that laparoscopic incisional hernia repair is superior to conventional open techniques. The objective of the current study was to evaluate the results of laparoscopic surgery on incisional hernias in an outpatient surgery unit in a university hospital. METHODS: Data were gathered prospectively for all laparoscopic incisional hernia repairs from January 1997 to December 2006. A total of 127 patients were operated in an outpatient surgery unit. The patients' clinical features, hernia type, intraoperative and postoperative complications, and reasons for hospital admission are studied. RESULTS: None of the patients required readmission to hospital, 15 had no need for analgesic treatment (11.8%) and the mean requirement was 6 days. The mean time of return to normal activity was less than 10 days and all the patients expressed their satisfaction with the procedure they received. During follow-up we detected 5 recurrences (4.4%). The statistical study showed no significant differences between the hospitalized patients and those treated on an ambulatory basis with regard to morbidity and recurrence rate (P<0.05). We do find a lower intraoperative and early postoperative (<30 d) complication rate in favor of the ambulatory patients (P<0.001). CONCLUSIONS: Laparoscopic repair of incisional hernias can be performed as a highly efficient ambulatory procedure with igual morbidity and recurrences than hospitalized patients.
Subject(s)
Ambulatory Surgical Procedures/methods , Hernia, Ventral/surgery , Laparoscopy/methods , Female , Health Status Indicators , Hospitals, Teaching , Humans , Male , Medical Audit , Middle Aged , Outpatients , Pain Measurement , Postoperative Complications , Prospective Studies , Treatment OutcomeABSTRACT
The laparoscopic repair of ventral hernias is still a controversial therapeutic option, and little is known of its medium- and long-term morbidity. The purpose of the study is to evaluate the postoperative morbidity of laparoscopic ventral hernia repair and analyze the clinical factors that might be related to it. 86 consecutive patients who had ventral hernia and underwent endoscopic surgery in a Universitary teaching hospital. Epidemiological, clinical, postoperative complications, tolerance, aesthetic evaluation of the wall and recurrence rate are analyzed. The mean follow-up (100%) was 42 months (range: 1-5 years) and included clinical and ultrasonographic evaluation. The overall postoperative morbidity rate was 23.2%, with one case of mortality following a sepsis due to intestinal perforation; the rate of re-admissions and recurrences was 3.5%. Statistically significant relationships were shown between the complications and infra-umbilical location (P < 0.001), age over 60 years and female sex (P < 0.05). The dynamic ultrasound study showed 91% and 94% of the patients to be adhesion-free at 1 and 3 years respectively. Aesthetic assessment of the wall at 3 years showed persistent asymmetries in 5% of the patients and a 92% degree of personal satisfaction. The morbidity with laparoscopic ventral hernia repair is not negligible. The surgeon must know these complications and be able to treat them appropriately.
Subject(s)
Hernia, Ventral/surgery , Laparoscopy , Postoperative Complications , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Reoperation , Surgical Mesh/adverse effects , Time FactorsABSTRACT
Introducción. La reparación de las hernias incisionales mediante laparoscopia es una opción terapéutica todavía controvertida y cuya morbilidad es poco conocida, principalmente a medio y largo plazo. Objetivo. Evaluar la morbilidad postoperatoria de la eventroplastia laparoscópica, y analizar qué factores clínicos podrían relacionarse con ella. Pacientes y métodos. Estudio prospectivo de 86 pacientes operados de eventración mediante cirugía endoscópica. Se evalúan parámetros clínicos (edad, sexo, enfermedades asociadas, cirugía abdominal previa, localización y tipo de defecto), complicaciones postoperatorias (hematomas, seromas, obstrucción intestinal, fístulas, infecciones, etc.), tolerancia y valoración estética parietal y tasa de recidivas. El seguimiento medio (100 por ciento) ha sido de 42 meses (rango, 1-5 años) y ha incluido evaluación clínica y ecográfica. Resultados. La morbilidad postoperatoria global fue del 23,2 por ciento, con un caso de mortalidad tras sepsis por perforación intestinal, y una tasa de reingresos y de recidivas del 3,5 por ciento. Se han demostrado relaciones estadísticamente significativas entre las complicaciones y la localización infraumbilical (p < 0,001), la edad mayor de 60 años y el sexo femenino (p < 0,05).El estudio ultrasónico dinámico ha demostrado un 91 y un 94 por ciento de pacientes libres de adherencias al año y 3 años, respectivamente. La valoración estética de la pared a los 3 años ha demostrado asimetrías persistentes en el 5 por ciento de los pacientes y un grado de satisfacción personal del 92 por ciento. Conclusiones. La morbilidad de la eventroplastia laparoscópica no es despreciable. El cirujano debe de conocer estas complicaciones y estar en condiciones de poder tratarlas de forma adecuada. Aconsejamos durante el período de aprendizaje seleccionar hernias incisionales de pacientes varones, menores de 65 años, con defectos inferiores a 12 cm y de localización no infraumbilical (AU)
