Reparación de hernia ventral aislada frente a reparación simultánea con abdominoplastia en pacientes obesos. Evidencia de los últimos 10 años / Isolated ventral hernia repair versus associated to abdominoplasty in obese patients. Last 10 years evidence

Introducción y objetivo: Las eventraciones son frecuentes en pacientes obesos. La asociación de dermolipectomía abdominal en la misma cirugía de hernioplastia tiene ventajas funcionales y estéticas, pero ha sido discutida por las complicaciones de la herida quirúrgica y sistémicas. Son escasos los estudios comparativos y más frecuentes las comunicaciones que solamente incluyen pacientes con hernioplastia - asociada a dermolipectomía. Analizamos la evidencia actual basada en estudios comparativos entre hernioplastia aislada y hernioplastia asociada a dermolipectomía, valorando complicaciones y resultados. Material y método: Revisión narrativa utilizando PubMed, Google Schollar y SciELO con los términos “lipectomía”, “dermolipectomía”, “paniculectomía”, “hernia”, “hernioplastia”, “eventroplastia”, “reparación pared abdominal”, en español e inglés, de trabajos comparativos entre hernioplastia y hernioplastia asociada a dermolipectomía desde 2010 a 2020. Evaluamos las variables: complicaciones postoperatorias, tiempo quirúrgico, estancia hospitalaria, recidiva herniaria y satisfacción del paciente. Resultados: Incluimos 8 artículos. En todos se evaluaron las complicaciones en general, encontrando que fueron significativamente mayores para hernioplastia asociada a dermolipectomía en 6 trabajos, principalmente por la suma de complicaciones, mientras que la infección del sitio quirúrgico fue significativamente mayor en 2 trabajos. Las complicaciones médicas, registradas en 6 trabajos, fueron significativamente mayores en el grupo de hernioplastia asociada a dermolipectomía en 2 de ellos. La recidiva herniaria, registrada en 6 trabajos, fue menor o sin diferencias significativas, mientras que la satisfacción del paciente fue significativamente mayor en los 2 únicos trabajos en que se registró. Se describen las ventajas de la combinación de procedimientos: exposición de la pared abdominal, resultado funcional y estético. (AU)

Background and objective: Ventral or incisional hernias are frequent pathologies, often present in obese patients. Association of abdominal dermolipectomy in the same surgery of hernioplasty has functional and aesthetic advantages, but it has been questioned because of the reported complications, both systemic and of the surgical wound. There are only a few comparative studies about this theme, and more frequently, communications only include patients with hernoiplasty associated to dermolipectomy. Methods: Narrative revisión was conducted using Pubmed, Google Scholar and ScieLo with the terms “lipectomy” “dermolipectomy” “panniculectomy”, “hernia”, “hernioplasty”, “eventroplasty”, “abdominal wall repair”, both in English and in Spanish, of papers comparing hernioplasty and hernioplasty associated to dermolipectomy, from 2010 to 2020. Items evaluated were: postoperative complications, surgical time, days at hospital, hernia recurrence and patient satisfaction. Results: Eight papers were included. Complications were evaluated in all of them, finding that there were significatively higher in hernioplastia associated to dermolipectomy in 6 papers, mainly because the summatory of complications, while surgical place infection was significatively higher in 2 papers. Medical complications, presented in 6 papers, were significatively higher in the group of hernioplasty associated to dermolictomy in 2 of them. Hernia recurreces, presented in 6 papers, were lower or not significative, while patients satisfaction was significatively higher in the only 2 papers presinting this item. Advantages of both procedures combination are described: abdominal wall exposure, functional and aesthetic results. (AU)

Análisis comparativo de 2 técnicas quirúrgicas en el tratamiento de la hernia incisional subxifoidea. Estudio observacional / Comparative analysis of 2 surgical techniques in the treatment of subxiphoid incisional hernia. Observational study

Introducción: La hernia incisional subxifoidea presenta complejidad en su solución quirúrgica por las características de la región anatómica donde aparece. El objetivo de nuestro estudio fue el análisis de los resultados obtenidos con las diferentes técnicas realizadas en nuestro centro durante 9 años, incidiendo en las complicaciones postoperatorias y la tasa de recidiva. Métodos: Estudio observacional, retrospectivo desde enero de 2011 hasta enero de 2019 de los pacientes intervenidos de hernia incisional subxifoidea en nuestra Unidad. Se analizaron las comorbilidades, técnicas quirúrgicas empleadas (eventroplastia preperitoneal o TP, y técnica de doble malla ajustada) y variables postoperatorias, incidiendo en la recidiva herniaria. Las complicaciones se recogieron según la clasificación de Clavien-Dindo. Resultados: Se intervinieron un total de 42 pacientes: 22 (52,4%) mediante una TP, y 20 (47,6%) mediante técnica de doble malla ajustada. Todas las complicaciones registradas fueron leves (grado i) y aparecieron mayoritariamente en el grupo de la TP (p=0,053). El seguimiento medio postoperatorio fue 25,8±15,1 meses; no existieron diferencias estadísticamente significativas en cuanto a recidiva comparando los 2 grupos de tratamiento (p=0,288). Conclusiones: Según nuestros resultados, la TP fue la técnica ideal para reparar una hernia incisional subxifoidea. La técnica de doble malla ajustada puede representar un abordaje eficaz con un bajo índice de complicaciones, aunque analizando globalmente la tasa de recidiva, el cierre fascial por encima de la prótesis preperitoneal conlleva un menor impacto en la misma. (AU)

Introduction: The surgical procedure to repair a subxiphoid incisional hernia is a complex technique due to the anatomical area that it appears. The objective of our study is the analysis of the results obtained with the different surgical techniques performed in our center for 9 years, especially postoperative complications and the recurrence rate. Methods: It is an observational, retrospective study from January 2011 to January 2019 of patients operated of subxiphoid incisional hernia in our Unit. We analysed the comorbidities, surgical techniques (preperitoneal hernia repair or TP, and adjusted double mesh technique) and postoperative variable, especially the hernia recurrence. The postoperative complications were summarized flowing the Clavien-Dindo classification. Results: 42 patients were operated: 22 (52,4%) TP and 20 (47,6%) adjusted double mesh technique. All the complications registered were minor (grade I) and it appeared mostly in TP group (P=.053). The average follow up was 25.8±15.1 months; there were no statistically significant differences in hernia recurrence comparing two treatment groups (P=.288). Conclusions: According to our results, TP is the ideal technique to repair a subxiphoid incisional hernia. Adjusted double mesh technique may represent an effective approach with a low complication rate, although globally analyzing the recurrence rate, aponeurosis closure over the preperitoneal mesh entails less impact on it. (AU)

Comparative analysis of 2 surgical techniques in the treatment of subxiphoid incisional hernia. Observational study.

INTRODUCTION: The surgical procedure to repair a subxiphoid incisional hernia is a complex technique due to the anatomical area that it appears. The objective of our study is the analysis of the results obtained with the different surgical techniques performed in our center for 9 years, especially postoperative complications and the recurrence rate. METHODS: It is an observational, retrospective study from January 2011 to January 2019 of patients operated of subxiphoid incisional hernia in our Unit. We analysed the comorbidities, surgical techniques (preperitoneal hernia repair or TP, and adjusted double mesh technique) and postoperative variable, especially the hernia recurrence. The postoperative complications were summarized flowing the Clavien-Dindo classification. RESULTS: 42 patients were operated: 22 (52,4%) TP and 20 (47,6%) adjusted double mesh technique. All the complications registered were minor (grade I) and it appeared mostly in TP group (P = .053). The average follow up was 25.8 ± 15.1 months; there were no statistically significant differences in hernia recurrence comparing two treatment groups (P = .288). CONCLUSIONS: According to our results, TP is the ideal technique to repair a subxiphoid incisional hernia. Adjusted double mesh technique may represent an effective approach with a low complication rate, although globally analyzing the recurrence rate, aponeurosis closure over the preperitoneal mesh entails less impact on it.

Comparative analysis of 2 surgical techniques in the treatment of subxiphoid incisional hernia. Observational study. / Análisis comparativo de 2 técnicas quirúrgicas en el tratamiento de la hernia incisional subxifoidea. Estudio observacional.

INTRODUCTION: The surgical procedure to repair a subxiphoid incisional hernia is a complex technique due to the anatomical area that it appears. The objective of our study is the analysis of the results obtained with the different surgical techniques performed in our center for 9 years, especially postoperative complications and the recurrence rate. METHODS: It is an observational, retrospective study from January 2011 to January 2019 of patients operated of subxiphoid incisional hernia in our Unit. We analysed the comorbidities, surgical techniques (preperitoneal hernia repair or TP, and adjusted double mesh technique) and postoperative variable, especially the hernia recurrence. The postoperative complications were summarized flowing the Clavien-Dindo classification. RESULTS: 42 patients were operated: 22 (52,4%) TP and 20 (47,6%) adjusted double mesh technique. All the complications registered were minor (grade I) and it appeared mostly in TP group (P=.053). The average follow up was 25.8±15.1 months; there were no statistically significant differences in hernia recurrence comparing two treatment groups (P=.288). CONCLUSIONS: According to our results, TP is the ideal technique to repair a subxiphoid incisional hernia. Adjusted double mesh technique may represent an effective approach with a low complication rate, although globally analyzing the recurrence rate, aponeurosis closure over the preperitoneal mesh entails less impact on it.

Totally endoscopic suprabupic approach to ventral hernia repair: Advantages of a new minimally invasive procedure. / Abordaje totalmente endoscópico suprapúbico de la hernia ventral. Ventajas de un nuevo procedimiento mínimamente invasivo.

Laparoscopic ventral hernia repair is in full development with the appearance of surgical techniques that try to diminish the disadvantages associated with this procedure. Totally endoscopic subcutaneous ventral hernia surgery with suprapubic access is a new minimally invasive surgical technique that surgically corrects the hernia defect associated or not with diastasis recti with the advantages of not penetrating the intra-abdominal space, thereby avoiding placement of the prosthesis in contact with the viscera and consequent complications (appearance of adhesions or fistulae).