Incontinencia fecal posparto. Revisión de conjunto / Postpartum incontinence. Narrative review

El desarrollo de incontinencia fecal tras el parto es un hecho frecuente. Esta incontinencia responde a una etiología multifactorial en la que el elemento más frecuente es la lesión del esfínter anal. Existen diversos factores de riesgo, que es muy importante conocer y evitar. La lesión esfinteriana puede producirse por desgarro perineal o en ocasiones por la realización de una episiotomía de forma incorrecta. Es muy importante reconocer la lesión cuando se produce y repararla de forma adecuada. El traumatismo de los nervios pudendos puede incrementar el efecto de las lesiones esfinterianas directas. Es frecuente la persistencia de incontinencia a pesar de la reparación esfinteriana primaria. La esfinteroplastia quirúrgica es el tratamiento estándar de las lesiones esfinterianas obstétricas, sin embargo, las terapias de estimulación eléctrica sacra o tibial están siendo aplicadas en pacientes con lesiones esfinterianas no reparadas, con resultados prometedores

The development of fecal incontinence after childbirth is a common event. This incontinence responds to a multifactorial etiology in which the most common element is external anal sphincter injury. There are several risk factors, and it is very important to know and avoid them. Sphincter injury may result from perineal tear or sometimes by incorrectly performing an episiotomy. It is very important to recognize the injury when it occurs and repair it properly. Pudendal nerve trauma may contribute to the effect of direct sphincter injury. Persistence of incontinence is common, even after sphincter repair. Surgical sphincteroplasty is the standard treatment of obstetric sphincter injuries, however, sacral or tibial electric stimulation therapies are being applied in patients with sphincter injuries not repaired with promising results

[Postpartum incontinence. Narrative review]. / Incontinencia fecal posparto. Revisión de conjunto.

The development of fecal incontinence after childbirth is a common event. This incontinence responds to a multifactorial etiology in which the most common element is external anal sphincter injury. There are several risk factors, and it is very important to know and avoid them. Sphincter injury may result from perineal tear or sometimes by incorrectly performing an episiotomy. It is very important to recognize the injury when it occurs and repair it properly. Pudendal nerve trauma may contribute to the effect of direct sphincter injury. Persistence of incontinence is common, even after sphincter repair. Surgical sphincteroplasty is the standard treatment of obstetric sphincter injuries, however, sacral or tibial electric stimulation therapies are being applied in patients with sphincter injuries not repaired with promising results.

PREBIOUS trial: a multicenter randomized controlled trial of PREventive midline laparotomy closure with a BIOabsorbable mesh for the prevention of incisional hernia: rationale and design.

BACKGROUND: Development of an incisional hernia is one of the most frequent complications of midline laparotomies requiring reoperation. This paper presents the rationale, design, and study protocol for a randomized controlled trial, the aim of which is to evaluate the efficacy and safety of prophylactically placing a bioabsorbable synthetic mesh for reinforcement of a midline fascial closure. METHODS: The PREBIOUS trial (PREventive midline laparotomy closure with a BIOabsorbable mesh) is a multicenter randomized controlled trial in which adult patients undergoing elective or urgent open abdominal operations through a midline laparotomy incision are assigned to one of two groups based on the laparotomy closure procedure: an intervention group in which a continuous polydioxanone (PDS) suture is reinforced with a commercially available GORE® BIO-A® Tissue Reinforcement prosthesis (W.L. Gore & Associates, Flagstaff, AZ, USA), or a control group with continuous PDS suture only. Both groups are followed over 6 months. OUTCOMES: The primary outcome is the appearance of incisional hernias assessed by physical examination at clinical visits and radiologically (CT scan) performed at the end of follow-up. Secondary outcomes are the rate of complications, mainly infection, hematoma, burst abdomen, pain, and reoperation. The PREBIOUS trial has the potential to demonstrate that suture plus prosthetic mesh insertion for routine midline laparotomy closure is effective in preventing incisional hernias after open abdominal surgery, to avoid the effects on those affected, such as poor cosmesis, social embarrassment, or impaired quality of life, and to save costs potentially associated with incisional hernia surgical repair.

Neumoperitoneo preoperatorio progresivo en pacientes con hernias gigantes de la pared abdominal / Progressive preoperative pneumoperitoneum in patients with giant hernias of the abdominal wall

Introducción Los pacientes con hernias gigantes con pérdida de domicilio requieren una adecuada planificación de la reparación quirúrgica, porque en la mayoría se asocia una elevada comorbilidad. La técnica del neumoperitoneo progresivo preoperatorio descrita por Goñi Moreno permite una adaptación más fisiológica del paciente y de la cavidad abdominal al reintegro de las vísceras al abdomen, lo que permite una reparación quirúrgica adecuada. El objetivo es analizar nuestra experiencia en el tratamiento de este tipo de hernias. Materiales y métodos Estudio retrospectivo en que se analizan 11 pacientes portadores de grandes defectos de pared abdominal, con pérdida de domicilio, tratados mediante dicha técnica, en 2 centros entre los años 2005 y 2010.ResultadosDel total, ocho pacientes presentaban eventraciones abdominales y los otros 3 tenían hernias inguinales. El tiempo medio de insuflación fue de 2 semanas y la cantidad total de aire varió entre 6,6 y 18 l. Dos pacientes presentaron descompensación de su enfermedad pulmonar y se debió posponer temporalmente la insuflación. Otros 2 presentaron enfisema subcutáneo durante los últimos días de insuflación, que se resolvió espontáneamente y sin secuelas. Se utilizaron técnicas de eventroplastia abierta con malla en los 8 casos de eventraciones y técnica preperitoneal para las hernias inguinoescrotales. En el seguimiento posterior se objetivó un caso de recidiva. Conclusiones La técnica de Goñi Moreno sigue siendo una técnica segura para preparar a los pacientes con hernias gigantes con pérdida de domicilio, pues consigue reducir la morbilidad ocasionada por la hiperpresión abdominal tras la reparación de la pared abdominal (AU)

Introduction Patients with giant hernias with loss of domain require proper planning of surgical repair, because of the high associated comorbidity. The progressive preoperative pneumoperitoneum technique described by Goñi Moreno allows a more physiological adaptation of the patient and the abdominal cavity to the reinstatement of the viscera to the abdomen, enabling adequate surgical repair. The objective of this study was to analyze our experience in the treatment of this type of hernia. Materials and methods We carried out a retrospective study that included 11 patients with major abdominal wall defects and loss of domain who were treated with this technique in 2 centers between 2005 and 2010.ResultsEight patients had abdominal hernias and 3 had inguinal hernias. The average insufflation time was 2 weeks and the total amount of air was between 6.6 and 18 l. In 2 patients who showed pulmonary disease decompensation, insufflation had to be temporarily postponed. A further 2 patients had subcutaneous emphysema during the last few days of insufflation, which resolved spontaneously without sequelae. The open mesh repair technique was used in ventral hernias and the preperitoneal technique in all inguinal hernias. There was one recurrence during the 1-year follow-up. Conclusions Goñi Moreno's technique remains safe to prepare patients with giant hernias with loss of domain. This procedure can reduce the morbidity caused by the increase in abdominal pressure after abdominal wall repair (AU)

[Progressive preoperative pneumoperitoneum in patients with giant hernias of the abdominal wall]. / Neumoperitoneo preoperatorio progresivo en pacientes con hernias gigantes de la pared abdominal.

INTRODUCTION: Patients with giant hernias with loss of domain require proper planning of surgical repair, because of the high associated comorbidity. The progressive preoperative pneumoperitoneum technique described by Goñi Moreno allows a more physiological adaptation of the patient and the abdominal cavity to the reinstatement of the viscera to the abdomen, enabling adequate surgical repair. The objective of this study was to analyze our experience in the treatment of this type of hernia. MATERIALS AND METHODS: We carried out a retrospective study that included 11 patients with major abdominal wall defects and loss of domain who were treated with this technique in 2 centers between 2005 and 2010. RESULTS: Eight patients had abdominal hernias and 3 had inguinal hernias. The average insufflation time was 2 weeks and the total amount of air was between 6.6 and 18 l. In 2 patients who showed pulmonary disease decompensation, insufflation had to be temporarily postponed. A further 2 patients had subcutaneous emphysema during the last few days of insufflation, which resolved spontaneously without sequelae. The open mesh repair technique was used in ventral hernias and the preperitoneal technique in all inguinal hernias. There was one recurrence during the 1-year follow-up. CONCLUSIONS: Goñi Moreno's technique remains safe to prepare patients with giant hernias with loss of domain. This procedure can reduce the morbidity caused by the increase in abdominal pressure after abdominal wall repair.

Paraganglioma de vesícula biliar / Paraganglioma of the gallbladder

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