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1.
Surg Endosc ; 30(12): 5222-5227, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27005291

RESUMO

BACKGROUND: The avoidance of postoperative chronic pain is of the foremost importance and has a deep impact on patient satisfaction. The objective of this study is to evaluate the selective transabdominal preperitoneal laparoscopic neurectomy for treatment of refractory inguinodynia. METHODS: Prospective study in a University Hernia Center included 16 consecutive patients with chronic pain. Primary endpoint was pain control (measured by appropriate questionnaire and need of analgesics). Secondary endpoint was surgical morbidity. Follow-up was 2 years (range 12 months-4 years). RESULTS: The mean operating time was 52 (range 36-68) minutes, and there were no intraoperative complications. All patients had histologic confirmation of neurectomy. Anatomical variation was found in ten patients (62.5 %), being a common trunk ilioinguinal/iliohypogastric nerve the most frequent (nine patients, 56.25 %). One patient developed hypoesthesia in the territory of the femorocutaneous nerve by nerve injury. Reoperation was performed 6 months afterward to complete ilioinguinal nerve neurectomy. Neuropathic pain medications were continued by five patients. Pain was completely eliminated in 11 (68.75 %). CONCLUSIONS: Management of patients with neural groin pain should be done in a multidisciplinary unit. Selective neurectomy by a transabdominal preperitoneal laparoscopic approach is a safe and highly effective option in selected patients for the treatment of refractory postoperative chronic pain. Careful anatomical planning is essential to avoid inadvertent injuries and more suffering to these patients.


Assuntos
Hérnia Inguinal/cirurgia , Neuralgia/cirurgia , Dor Pós-Operatória/cirurgia , Satisfação do Paciente , Dor Pélvica/cirurgia , Adulto , Feminino , Herniorrafia/efeitos adversos , Humanos , Canal Inguinal/inervação , Laparoscopia , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento
3.
Surg Endosc ; 22(3): 744-9, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17704881

RESUMO

BACKGROUND: Nonmidline incisional hernia is a surgical problem of major interest, but to date, little information on this problem is available. This study aimed to analyze the results of nonmidline laparoscopic incisional hernioplasty in a multidisciplinary abdominal wall unit over the past 10 years. METHODS: This prospective study examined a series of 199 patients undergoing surgery for incisional hernia via the laparoscopic approach: 146 midline and 53 nonmidline. A comparative analysis compared midline and nonmidline defects, and a descriptive analysis compared four nonmidline types: 18 lumbar, 11 subcostal, 14 inguinal, and 10 lateral. Clinical and follow-up parameters were assessed during a mean follow-up period of 64 months (range, 12-120 months). RESULTS: The nonmidline incisional hernias were significantly larger, involved more preoperative pain, and required a longer hospital stay than the midline incisional hernias (p < 0.001). Also, the intraoperative complications and the consumption of analgesics were more frequent in the nonmidline group (p < 0.05). The postoperative morbidity and recurrence rates were similar in the two groups. No statistical differences were noted between the four types of nonmidline incisional hernias. The most common nonmidline type was lumbar hernia (34%). Hematomas (17%) predominated in the inguinal types, and pain predominated in the lumbar types. Two early recurrences were diagnosed for poor mesh placement: one subcostal and one lumbar. CONCLUSIONS: Laparoscopic incisional hernioplasty can be applied to nonmidline defects with the same rates of morbidity and recurrence as for patients with midline defects. The four types of nonmidline defects seem to have their own evolutionary characteristics.


Assuntos
Parede Abdominal/cirurgia , Hérnia Ventral/cirurgia , Laparoscopia/métodos , Dor Pós-Operatória/fisiopatologia , Idoso , Feminino , Seguimentos , Hérnia Ventral/diagnóstico , Humanos , Canal Inguinal , Laparoscopia/efeitos adversos , Tempo de Internação , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Medição da Dor , Complicações Pós-Operatórias/fisiopatologia , Probabilidade , Estudos Prospectivos , Medição de Risco , Telas Cirúrgicas , Resultado do Tratamento
4.
Hernia ; 10(1): 87-9, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16283074

RESUMO

Parapubic hernia is a rare entity, the aetiology of which is usually associated with pelvic surgery, traumatisms and bone malformations. Treatment is difficult because the defect is usually limited by altered fibrotic anatomical planes. We present a case of incisional pubic hernia in a patient with congenital bladder exstrophy and multiple surgeries for pelvic reconstruction, who was treated using a plasty combined with a double intra-abdominal/supra-aponeurotic mesh. The therapeutic possibilities are described for the laparoscopic and open approaches in the management of these complex hernias.


Assuntos
Extrofia Vesical/epidemiologia , Hérnia Ventral/cirurgia , Adulto , Extrofia Vesical/cirurgia , Feminino , Hérnia Ventral/etiologia , Humanos , Histerectomia , Ílio/cirurgia , Telas Cirúrgicas , Tomografia Computadorizada por Raios X , Procedimentos Cirúrgicos Urogenitais , Vagina/cirurgia
7.
Cir Esp ; 78(3): 203; author reply 203-4, 2005 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-16420826
8.
Surg Endosc ; 19(2): 184-7, 2005 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15573242

RESUMO

BACKGROUND: Lumbar hernias are uncommon defects of the posterior abdominal wall. Surgical treatment is still controversial in these cases. The aim of this study was to compare outcome and costs of the laparoscopic approach vs the open method. METHODS: We conducted a prospective nonrandomized study of 16 patients who underwent operation for secondary lumbar hernia between January 1997 and January 2003. Nine were treated via the laparoscopic approach and seven with an open technique. The following variables were analyzed: clinical data, hospital data (operating time and length of stay), patient comfort (consumption of analgesics and time to return to normal activities), and recurrences. Hospital costs were also analyzed. RESULTS: There were no differences between the two groups in terms of age and history, although the defects of the patients in the laparoscopic group were smaller. Mean operating time, postoperative morbidity, mean hospital stay, consumption of analgesics, and time to return to normal activities were significantly lower in the laparoscopic group (p < 0. 01). No were there any statistical differences between the two types of surgical procedure in terms of hospital costs. However, the final cost did show differences when expenses for readmissions and recurrences were taken into account (p < 0.01). CONCLUSION: The laparoscopic approach to secondary lumbar hernia repair is more efficient and more profitable than the traditional open technique.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Hérnia Abdominal/cirurgia , Laparoscopia , Idoso , Custos e Análise de Custo , Procedimentos Cirúrgicos do Sistema Digestório/economia , Feminino , Hérnia Abdominal/economia , Hospitalização/economia , Humanos , Complicações Intraoperatórias/epidemiologia , Laparoscopia/economia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Espanha , Telas Cirúrgicas , Resultado do Tratamento
10.
Cir. Esp. (Ed. impr.) ; 73(3): 183-187, mar. 2003. ilus
Artigo em Es | IBECS | ID: ibc-19835

RESUMO

Objetivo. El espacio preperitoneal de la región inguinal, tal y como se observa en la cirugía endoscópica totalmente extraperitoneal (TEP), puede presentar dificultades de compresión en los cirujanos no familiarizados con esta técnica. El objetivo de este trabajo es contribuir a la descripción de las fascias y espacios anatómicos de la región inguinal posterior como se aprecian en la reparación endoscópica TEP, unificar y simplificar conceptos y favorecer el aprendizaje del procedimiento.Pacientes y métodos. Desde 1996 han sido intervenidos mediante procedimiento TEP 250 pacientes, en los que se han efectuado 280 reparaciones. Además de la experiencia práctica, se han analizado los vídeos de 20 intervenciones grabadas, efectuando una revisión bibliográfica y consiguiendo un consenso terminológico entre los autores.Resultados. Para operar en el espacio adecuado, la fascia transversalis debe quedar en el techo del espacio de trabajo y la fascia preperitoneal en el suelo.La fascia espermática interna es una dependencia de la fascia preperitoneal que engloba a conducto deferente y vasos espermáticos en su trayecto hacia el anillo inguinal profundo; debe abrirse en el caso de las hernias indirectas. La identificación, sencilla, de vasos epigástricos inferiores, tracto iliopúbico y ligamento de Cooper permite las necesarias referencias anatómicas para efectuar la técnica con seguridad.La creación de un gran espacio preperitoneal desperitonizado permite la ubicación de una gran malla que tapiza y rebasa suficientemente todas las áreas débiles de la región inguinocrural. Mención especial requiere la identificación de zonas de riesgo, las cuales se sitúan todas mediales al ligamento de Cooper y caudales al tracto iliopúbico.Conclusiones. Un conocimiento preciso de la anatomía de la región inguinal preperitoneal es necesario para la ejecución correcta de la reparación TEP.Lo anterior, junto con el seguimiento estricto de una serie de pasos quirúrgicos, puede contribuir a la difusión del procedimiento (AU)


Assuntos
Feminino , Humanos , Cavidade Peritoneal/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Hérnia Inguinal/cirurgia , Cavidade Peritoneal/anatomia & histologia , Fáscia/anatomia & histologia , Fáscia/cirurgia , Endoscopia/métodos , Canal Inguinal/anatomia & histologia , Canal Inguinal/cirurgia
12.
Hernia ; 6(4): 167-70, 2002 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-12424594

RESUMO

Spigelian hernias are rare defects of the abdominal wall. Our aim is to analyse the bibliography and present a series of 28 patients. A Medline bibliographical study was performed between 1970 and 2000 with analysis of the number of cases, series, ratio of cases to year and type of journal. We also present a personal study and analyse epidemiological, diagnostic, and treatment factors. There are 159 articles, 479 cases, and 19 series of more than five patients published in 85 journals (42.3% medical). Our diagnosis was preoperative in 75%, and programmed surgery was 3.6 times more common than emergency surgery. We found a significant relationship between hospital stay and type of surgery (P < 0.02) and surgical technique used (P < 0.001). We found that spigelian hernias have a multidisciplinary interest; they are given almost equal treatment in medical and surgical journals; preoperative diagnosis can be established in 75% of cases; and the best results are offered by the extraperitoneal laparoscopic approach.


Assuntos
Hérnia Ventral/cirurgia , Adolescente , Adulto , Idoso , Feminino , Hérnia Ventral/diagnóstico , Hérnia Ventral/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Publicações Periódicas como Assunto/estatística & dados numéricos
13.
Surg Endosc ; 16(12): 1806, 2002 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-12232651

RESUMO

Spigelian hernia is an uncommon hernia of the abdominal wall. Diagnosis and treatment are controversial because it is frequently an emergency pathology. We report two patients with preoperative diagnosis and treatment using totally extraperitoneal laparoscopy under regional anesthesia in a day surgery department.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Hérnia Ventral/cirurgia , Laparoscopia/métodos , Peritônio/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
Hernia ; 6(1): 21-5, 2002 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-12090576

RESUMO

Laparoscopic repair of abdominal wall hernias is still a controversial and nongeneralized therapeutic option. The aim of this paper is to evaluate the results of laparoscopic surgery on abdominal wall hernias at a day-surgery unit and to describe our procedure protocol. Prospective analysis of 300 patients undergoing laparoscopic surgery for abdominal wall hernias was conducted: 260 preperitoneal and 40 intraperitoneal. The patients' clinical features, hernia type, intraoperative and postoperative complications, and follow-up are studied for both types of surgery. All the patients receiving surgery with extraperitoneal laparoscopy were completed as a day-surgical procedure with a rate of conversion to open surgery of 2.3%. Twelve (30%) of the 40 patients operated on for ventral hernias using intraperitoneal laparoscopy required hospitalization: five for perioperative complications and seven for pain (16%). There was no case of infection or mesh rejection. The recurrence rates were 0.78% (two cases) for the inguinal hernias and 2.5% (one case) for the ventral hernias. In conclusion, laparoscopic repair of abdominal wall hernias in a day-surgery setting is an efficient alternative to open surgery.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Hérnia Ventral/cirurgia , Laparoscopia , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Feminino , Hérnia Ventral/epidemiologia , Humanos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia
15.
Surg Endosc ; 16(7): 1107, 2002 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-11984659

RESUMO

Lumbar hernias are an uncommon variety of abdominal wall defect. Diagnosis depends largely on the capacity for clinical suspicion, and confirmation is based on imaging tests. Surgical treatment is controversial due to difficulty in defining the borders of the lumbar defect and the involvement of a bone margin. We present a case of traumatic lumbar hernia in the Petit triangle, diagnosed by computed tomography (CT) and repaired laparoscopically as a major ambulatory surgery procedure. The laparoscopic approach enabled us to identify the whole of the lumbar area and effect a profound reconstruction on the same side as the defect.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Herniorrafia , Laparoscopia/métodos , Acidentes de Trânsito , Feminino , Hérnia/diagnóstico , Hérnia/etiologia , Humanos , Região Lombossacral , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos
16.
Cir. Esp. (Ed. impr.) ; 70(6): 291-294, dic. 2001. tab
Artigo em Es | IBECS | ID: ibc-818

RESUMO

Introducción. La reparación laparoscópica de las hernias ventrales cubre el defecto dejando una prótesis intraabdominal. De la adecuada elección del material protésico pueden depender los resultados y complicaciones de esta técnica. Objetivo. Evaluar los resultados de la cirugía laparoscópica en las hernias ventrales con el uso de dos mallas diferentes en posición intraabdominal: Goretex® (politetrafluoroetileno) y Parietex® (poliéster y colágeno).Pacientes y métodos. Análisis retrospectivo de 46 pacientes intervenidos de hernia ventral mediante cirugía laparoscópica. Se estudian las características clínicas de los pacientes (antecedentes médicos y quirúrgicos), el tipo de eventración (clasificación SWR), las complicaciones intra y postoperatorias, la estancia hospitalaria y el seguimiento, en función del tipo de material implantado. Resultados. Todos los pacientes se completaron por cirugía laparoscópica. El análisis estadístico de la morbilidad ha demostrado la existencia de una relación significativa entre el íleo postoperatorio en los defectos múltiples y las mallas de Goretex (p < 0,05) y de los seromas con la malla de Goretex (p < 0,01). El 70 por ciento de las intervenciones realizadas con Parietex se completaron como cirugía mayor ambulatoria y las de Goretex tuvieron una estancia media de 6 días (rango: 2-16). La tasa de recidivas es del 4,3 por ciento (un caso en cada grupo).Conclusiones. La reparación laparoscópica en las hernias ventrales es una alternativa eficaz a la reparación abierta con una baja morbilidad que no se relaciona con el tipo de defecto. Tanto la malla bilaminar Parietex® como la de Goretex® son seguras para su uso intraabdominal (AU)


Assuntos
Adulto , Idoso , Feminino , Masculino , Pessoa de Meia-Idade , Humanos , Hérnia Ventral/cirurgia , Manutenção Corretiva , Telas Cirúrgicas , Materiais Biocompatíveis/uso terapêutico , Próteses e Implantes , Laparoscopia/métodos , Estudos Retrospectivos , Laparoscopia/métodos , Laparoscopia , Laparoscopia/classificação , Laparoscopia/instrumentação , Laparoscopia/normas , Laparoscopia/tendências
17.
Surg Laparosc Endosc Percutan Tech ; 11(2): 103-6, 2001 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11330373

RESUMO

Ventral hernia repair is still a difficult problem for surgeons because of the high recurrence rate and possible postoperative complications. Repairs with a prosthesis have reduced the recurrence rate, but the anterior approach still involves high morbidity and a long hospital stay. The purpose of this article was to evaluate the results of laparoscopic surgery on ventral hernias using a new double-layer mesh in an intra-abdominal position. A retrospective analysis was performed of the first 20 patients undergoing laparoscopic surgery for ventral hernia (75% incisional and 25% umbilical) with intra-abdominal prosthetic repair using a double-layer mesh consisting of three-dimensional multifiber polyester on one side and a hydrophilic resorbable nonstick collagen membrane on the other (Parietex composite, Sofradim, Villefranche sur Saone, France). The procedure was done on an outpatient basis in 85% of the cases. There was no morbidity or mortality. During a mean follow-up period of 10 months we found no infections, rejections, fistulas, recurrences, or alterations in bowel function. Laparoscopic repair of ventral hernias is an efficient alternative to open repair, with a low morbidity rate and short hospital stay. The double-layer mesh is safe for intra-abdominal use.


Assuntos
Hérnia Ventral/cirurgia , Laparoscopia , Telas Cirúrgicas , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
Cir. Esp. (Ed. impr.) ; 69(4): 371-374, abr. 2001.
Artigo em Es | IBECS | ID: ibc-1064

RESUMO

Introducción. La reparación de las hernias ventrales todavía supone un difícil problema para el cirujano general por su alto índice de recidivas y de complicaciones postoperatorias. Las reparaciones con prótesis han disminuido la tasa de recidivas, pero la vía anterior todavía supone una considerable morbilidad y una elevada estancia hospitalaria. Objetivo. Evaluar los resultados de la cirugía laparoscópica en las hernias ventrales y la tolerancia de una nueva malla en posición intraabdominal. Pacientes y métodos. Análisis retrospectivo de los primeros 20 pacientes que se han intervenido por hernia ventral (75 por ciento incisionales y 25 por cientoumbilicales) mediante cirugía laparoscópica con reparación protésica intraabdominal con una malla bilaminar: por un lado, poliéster multifibra tridimensional y, por otro lado, una membrana antiadherente hidrofílica y reabsorbible de colágeno. Resultados. Todos los pacientes fueron intervenidos sin morbimortalidad. El 85 por ciento de las intervenciones se realizaron como cirugía sin ingreso. Durante el seguimiento medio de 10 meses no se han encontrado infecciones, rechazos, fístulas, recidivas ni alteraciones del tránsito intestinal. Conclusiones. La reparación laparoscópica en las hernias ventrales es una alternativa eficaz a la reparación abierta y la malla bilaminar Parietex® es segura para su uso intraabdominal (AU)


Assuntos
Adulto , Feminino , Masculino , Pessoa de Meia-Idade , Humanos , Hérnia Ventral/cirurgia , Laparoscopia , Complicações Pós-Operatórias , Implantação de Prótese , Estudos Retrospectivos
19.
Cir. Esp. (Ed. impr.) ; 68(5): 432-435, nov. 2000. tab, graf
Artigo em Es | IBECS | ID: ibc-5631

RESUMO

Introducción. La producción de fístulas biliares tras la retirada del tubo de Kehr es un problema de la cirugía de la vía biliar que presenta una importancia aún mayor en el trasplante hepático. En su etiología se han barajado diversos factores, entre los que destacan la interferencia que puedan llegar a ocasionar, en el desarrollo del trayecto fibroso en torno al tubo, tanto el tipo de material utilizado (generalmente látex o silicona) como el tratamiento con corticoides que suele ser administrado a estos pacientes. Objetivos. Comparar el grado de adherencias peritoneales producidas por dos tipos de materiales de tubos en "T" (látex y silicona), y analizar la influencia que sobre aquéllas pueda tener la administración de corticoides. Material y métodos. Se han utilizado 50 ratas hembra distribuidas en cinco grupos (control, látex, silicona, látex más corticoides y silicona más corticoides) y se ha estudiado, mediante un sistema de puntuación, el grado de adherencias peritoneales producidas por un fragmento de tubo de Kehr colocado en el espacio subhepático de la cavidad peritoneal. Se calculó un índice de producción de adherencias, que se utilizó para comparar a los grupos entre sí. Resultados. El índice de producción de adherencias media ñ desviación estándar fue: grupo de látex: 6,7 ñ 1,4; grupo de silicona: 2,1 ñ 1,7; grupos de látex tratados con corticoides: 3,5 ñ 1,4, y grupo de silicona más corticoides: 1,2 ñ 1,3. Se encontraron diferencias al comparar los dos materiales (p < 0,001). La administración de corticoides redujo la producción de adherencias tanto en el grupo de látex (p < 0,001) como en el de silicona (p < 0,05). Conclusiones. Los tubos de silicona condicionan una menor formación de adherencias peritoneales postoperatorias que los de látex, y la administración de corticoides reduce dicha formación en ambos casos (AU)


Assuntos
Animais , Feminino , Ratos , Compostos de Silício/análise , Compostos de Silício/farmacologia , Compostos de Silício/química , Látex/análise , Látex/farmacocinética , Látex/química , Corticosteroides/análise , Corticosteroides/farmacologia , Corticosteroides/química , Corticosteroides/uso terapêutico , Fibrose Retroperitoneal/cirurgia , Fibrose Retroperitoneal/complicações , Fibrose Retroperitoneal/diagnóstico , Fibrose Retroperitoneal/etiologia , Fístula Biliar/classificação , Fístula Biliar/diagnóstico , Fístula Biliar/fisiopatologia , Laparotomia , Aderências Teciduais/cirurgia , Aderências Teciduais/diagnóstico , Aderências Teciduais/complicações , Aderências Teciduais/patologia , Aderências Teciduais/classificação , Aderências Teciduais/epidemiologia , Doenças Peritoneais/cirurgia , Doenças Peritoneais/diagnóstico , Doenças Peritoneais/patologia , Doenças Peritoneais , Neoplasias Experimentais/cirurgia , Neoplasias Experimentais/complicações , Neoplasias Experimentais/diagnóstico , Neoplasias Experimentais/etiologia
20.
Ambul Surg ; 8(3): 158, 2000 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-10856848

RESUMO

Introduction: The creation of Outpatient Surgery (OPS) units to combine the quality of medical attention and rationalize costs allows for greater efficiency in the use of resources. Aim: To report our series of patients undergoing surgery at the OPS units integrated into our Hospital (Type II): Patients and method: Between May 1994 and March 1998, 832 outpatients, of a total of 5230, underwent surgery at our General Surgery Unit. The criteria for exclusion from the programme depended on the patient and the enviroment or resulted from the operation itself. Results: Mean patient age was 47.5 years; there were 420 males and 412 females. Surgery was performed for 229 inguinofemoral hernias, 47 umbilical-epigastric hernias, nine incisional hernias, 193 pilonidal sinuses, 156 mammary nodules, 65 varicose veins, 64 arteriovenous fistulae and 69 proctology operations. The most common anesthesia techniques performed were rachianesthesia and local anesthesia. Eight point seven percent of the patients required admission (OPS failure), the most frequent causes being excessive pain, orthostatic-syncopal hypotension, nausea and vomiting and urine retention. There was no morbidity or mortality. Conclusion: OPS is a highly efficient procedure for resolving the most common pathologies in General Surgery. The anesthesia technique was an important factor in the rate of failure.

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