Analysis of exercise tolerance on the basis of six-minute walk test - 6MWT and Borg RPE scale in men with inguinal hernia before and after Lichtenstein repair.

<b>Introduction:</b> Assessment of exercise tolerance (ET) plays an important role in qualifications for treatment and rehabilitation. <br><b>Aim: </b>The aim of the study was to assess ET in patients before and after inguinal hernia operations with Lichtenstein method. <br><b>Material and methods:</b> The cohort study included men with inguinal hernia divided into the study group (SG) (n = 50) and control (CG) (n = 50) undergone the Lichtenstein surgery. Patients from the SG met the criterion of coexistence of cardiovascular and respiratory diseases. Day before and on the second day after surgery, patients performed 6MWT and subjectively rate the exertion according to Borg- RPE- Scale (before, immediately after and 10 minutes after the test). 6MWT distance, Borg scale ratings were analysed. On the second day after surgery 66% of patients from the SG and 58% from the CG did not complete the test. Patients from the SG before (500,07 ± 40,38 m) and on the second day after surgery (243,46 ± 18,18 m) achieved shorter distances compared to the CG (565,93 ± 20,41 m; 249,47 ± 26,66 m), p < 0,001 i p = 0,481. A statistically significant negative correlation between 6MWT distance before surgery and age of the patients was confirmed. Patients who did not develop complications achieved significantly longer distances on admission (p = 0,003 for SG, p = 0,004 for CG). For 6MWT before surgery and 2 days after surgery, patients from the SG showed a significantly higher level of fatigue compared to the CG after the test (before: p = 0,001, after: p = 0,001). Patients form the SG often discontinued 6MWT and less tolerated effort compared to the CG. Hence, 6MWT is useful tool for ascertaining physical capacity and ET.

Postoperative Rehabilitation May Reduce the Risk of Readmission After Groin Hernia Repair.

Thirty-day readmission after surgery has been proposed as a quality-of-care indicator. We explored the effect of postoperative rehabilitation on readmission risk after groin hernia repair. We used the French National Discharge Database to identify all index hospitalizations for groin hernia repair in 2011. Readmissions within 30 days of discharge were clinically classified in terms of their relationship to the index stay. We used logistic regression to adjust the risk of readmission for patient, procedure and hospital factors. Among 122,952 index hospitalizations for inguinal hernia repair, 3,357 (2.7%) related 30-day readmissions were recorded. Reiterated analyses indicated that readmission risk was consistently associated with patient complexity: age (per year after 60 years, OR 1.03, 95% CI 1.02-1.03, P < 0.001), hospitalization within the previous year (OR 1.56, 95% CI 1.44-1.69, P < 0.001), and increasing severity and combination of co-morbidities. Postoperative rehabilitation was identified as a protective factor (OR 0.56, 95% CI 0.46-0.69, P < 0.001). Older patients and those with greater comorbidity are at elevated risk of readmission after inguinal hernia repair. Postoperative rehabilitation may reduce this risk. Further studies are warranted to confirm the protective effect of postoperative rehabilitation.

Prevalence of Surgical Repair for Athletic Pubalgia and Impact on Performance in Football Athletes Participating in the National Football League Combine.

PURPOSE: To examine the prevalence and impact of athletic pubalgia (AP) surgery in elite American football athletes participating in the National Football League (NFL) Combine. METHODS: Results from 1,311 athletes participating in the Combine from 2012 to 2015 were evaluated. Athletes with a history of AP repair were identified using the NFL Combine Database. Athlete history and available imaging was reviewed. NFL performance based on draft status, games played, games started, and current status in the NFL was gathered using publicly available databases. Statistical analysis was performed to detect for significant associations between athlete history and NFL performance in the presence of AP repair and pelvic pathology on postsurgical magnetic resonance imaging (MRI). RESULTS: AP repair was identified in 4.2% (n = 55) of athletes. MRI was performed in 35% (n = 19 of 55) with AP repair, of which 53% (n = 10 of 19) had positive pathology. Athletes with repair were not at risk of playing (P = .87) or starting (P = .45) fewer regular season games, going undrafted (P = .27), or not being on an active NFL roster (P = .51). Compared with athletes with negative imaging findings, positive pathology on MRI did not have a significant impact on games played (P = .74), games started (P = .48), draft status (P = .26), or being on an active roster (P = .74). Offensive linemen (P = .005) and athletes with a history of repair within 1 year of the Combine (P = .03) had a significantly higher risk of possessing positive pathology on MRI. CONCLUSIONS: Athletes with a history of successful AP surgery invited to the NFL Combine and those with persistent pathology on MRI are not at increased risk for diminished performance in the NFL. Offensive linemen and athletes less than 1 year out from surgery have a higher risk for positive MRI findings at the pubic symphysis. LEVEL OF EVIDENCE: Level IV, prognostic study-case series.

Convalescence after laparoscopic inguinal hernia repair: a qualitative systematic review.

BACKGROUND: Duration of convalescence after inguinal hernia repair is of major socio-economic interest and an often reported outcome measure. The primary aim was to perform a critical analysis of duration of convalescence from work and activity and secondary to identify risk factors for unexpected prolonged convalescence after laparoscopic inguinal hernia repair. METHODS: A qualitative systematic review was conducted. PubMed, Embase and the Cochrane database were searched for trials reporting convalescence after laparoscopic inguinal hernia repair in the period from January 1990 to January 2016. Furthermore, snowball search was performed in reference lists of identified articles. Randomized controlled trials and prospective comparative or non-comparative trials of high quality were included. Trials with ≥100 patients, >18 years of age and manuscripts in English were included. Scoring systems were used for assessment of quality. RESULTS: The literature search identified 1039 papers. Thirty-four trials were included in the final review including 14,273 patients. There was overall a large variation in duration of convalescence. Trials using non-restrictive recommendations of 1-2 days or "as soon as possible to return to all activities" reported overall a shorter duration of convalescence compared with trials not using recommendations for convalescence. Strenuous physical activity at work, strenuous leisure activity and patients with expectations of a prolonged period of convalescence may be risk factors for prolonged convalescence extending more than a few days after laparoscopic inguinal hernia repair. CONCLUSIONS: Patients should be recommended a duration of 1-2 days of convalescence after laparoscopic inguinal hernia repair. Short and non-restrictive recommendations may reduce duration of convalescence without increasing risk of pain, complications or recurrence rate.

[LAPAROSCOPIC HERNIOPLASTY IN INCARCERATED INGUINAL HERNIAS].

The results of laparoscopic hernioplasty, using TAPP method and operation of Lichtenstein in 80 patients, suffering incarcerated inguinal hernia, were analyzed. While achievement of similar good and excellent immediate and late results, laparoscopic procedure has several advantages and may be used as a method of choice for treatment of inguinal hernia.

Return to work after general surgery: a comparative study / Vuelta al trabajo en cirugía general: estudio comparativo

Purposes. There is scarce information on the time to return to work after general surgery. The aim of this study was to analyze time off work after elective cholecystectomy and to compare the results with those in patients undergoing other surgical interventions. Methods. Observational and comparative study. Inclusion criteria were: being of working age and undergoing elective laparoscopic cholecystectomy (group 1) or unilateral inguinal hernia or haemorrhoidectomy (group 2). Results. 36 patients were included: 18 patients in each group. Overall, return to work occurred at a mean of 35.7 days, with no significant differences (p = 0.656) between groups (group 1: 36.6 days vs. group 2: 35.44 days). The reasons for not returning to work earlier were fear of complications (37.5%), pain control (37.5%), surgeon recommendation (12.5%), and general practitioner recommendation (12.5%). Conclusions. Time to recovery after laparoscopic cholecystectomy is prolonged. No statistically significant differences with less complex surgical procedures were detected (AU)

Objetivos. Existe escasa información acerca de la vuelta al trabajo tras una cirugía general. El objetivo de este estudio fue el de analizar el tiempo de ausencia del trabajo tras una colecistectomía electiva, comparando los resultados con los de aquellos pacientes sometidos a otras intervenciones quirúrgicas. Métodos. Estudio observacional y comparativo. Los criterios de inclusión fueron: estar en edad laboral y someterse a una colecistectomía electiva laparoscópica opcional (grupo 1), cirugía por hernia inguinal unilateral o una hemorroidectomía (grupo 2). Resultados. Se incluyó a un total de 36 pacientes, 18 de ellos en cada grupo. La vuelta al trabajo se produjo a una media de 35,7 días, sin diferencias significativas (p = 0,656) entre los grupos (grupo 1: 36,6 días frente al grupo 2: 35,44 días). Los motivos de no retornar al trabajo con anterioridad fueron el miedo a las complicaciones (37,5%), el control del dolor (37,5%), la recomendación del cirujano (12,5%), y la recomendación del médico de familia (12,5%). Conclusiones. El tiempo de recuperación tras una colecistectomía laparoscópica es largo. No se detectaron diferencias estadísticamente significativas en comparación a las intervenciones quirúrgicas menos complejas (AU)

Meta-analysis of randomized controlled trials comparing Lichtenstein and totally extraperitoneal laparoscopic hernioplasty in treatment of inguinal hernias.

BACKGROUND: Finding the optimal approach to repair an inguinal hernia is controversial. Therefore, for the scientific evaluation of the total extraperitoneal (TEP) and Lichtenstein mesh techniques for the repair of inguinal hernia, meta-analyses of randomized controlled trials are necessary. METHODS: A complete literature search was conducted in the Cochrane Controlled Trials Register Databases, Pubmed, Embase, International Scientific Institute databases, and Chinese Biomedical Literature Database in various languages. RESULTS: Randomized controlled trials (13), including 3279 patients, were retrieved from the electronic databases. The Lichtenstein group was associated with a shorter operating time; however, results show that TEP repair enabled patients a shorter time to return to work, less chronic pain compared with Lichtenstein operation. There was no significant difference in seromas, wound infections, or neuralgia. There are no statistically significant difference in terms of hernia recurrence when the follow-up time is ≤3 y. When follow-up time is >3 y, TEP repair shows a higher recurrence rate compared with Lichtenstein repairs. CONCLUSIONS: There was insufficient evidence to determine the greater effectiveness between TEP and Lichtenstein mesh techniques. In future research, it is necessary for subgroup analyses of unilateral primary hernias, recurrent hernias, and simultaneous bilateral repair to be conducted to define the indications for the TEP approach.

Use of fibrin glue for fixation of mesh and approximation of Peritoneum in Transabdominal Preperitoneal (TAPP) inguinal hernia repair: technical feasibility and early surgical outcomes.

BACKGROUND: It is a common practice to secure both mesh and peritoneum using tacks when performing a transabdominal preperitoneal (TAPP) inguinal hernia repair. The use of tacks to secure the mesh is well documented and has been associated with postoperative chronic pain. Recently, fibrin glue has been used to secure the mesh in these repairs but not used to reapproximate the incised peritoneum. This study assessed the technical feasibility of using fibrin glue for fixation of both mesh and peritoneum. PATIENTS AND METHODS: A total of 33 TAPP hernia repairs were carried out in 27 consecutive patients. In all the patients, both mesh and peritoneum were secured with fibrin glue (20 primary inguinal hernia repairs, 5 bilateral hernia repairs, 1 recurrent inguinal hernia, and 1 recurrent bilateral hernia repair). RESULTS: Patients were followed up at an outpatient clinic between the second and third week after surgery. Six patients were followed up through telephone. Patients were questioned on the following factors: residual postoperative pain (groin and port sites), unplanned GP or hospital visits, employment status and number of days between their surgery and return to both work and normal activities, and recurrence. No patients had residual groin or port site pain at a median of 21 days after surgery. No patient required an unplanned follow-up appointment with their GP. One patient (recurrent repair) developed a seroma postoperatively. Median time to normal activities was 10 days (range, 3 to 21 d). CONCLUSIONS: Total glue fixation of mesh and peritoneum is technically feasible and early results show low rates of postoperative complications and pain. Randomized studies are needed to confirm this.

Assessing the performance of the EQ-VAS in the NHS PROMs programme.

OBJECTIVES: The study aims to increase knowledge about the performance of the EuroQol-visual analogue scales (EQ-VAS) in the UK NHS patient-reported outcome measures (PROMs) programme, which covers groin hernia, hip and knee replacement and varicose vein surgery, and make suggestions for improved collection, coding and analysis of data. METHODS: Four hundred scanned images of matched before-and-after EQ-VAS PROMs responses were selected at random. These were classified according to the different ways in which they were completed. Patient-level PROMs programme data linked to Hospital Episode Statistics for all patients from April 2009 to February 2011 were used to analyse the relationship between the EQ-VAS and the EQ-5D profile, index-weighted profile and condition-specific instruments. The linked PROMs and HES data comprise 331,951 anonymised patient records. RESULTS: A large majority (95 %) of EQ-VAS responses were completed in an unambiguous way, but only a minority (45 %) conformed strictly to the instructions given, posing challenges for data coding. The EQ-VAS data have a predictable and consistent relationship with the EQ-5D profile, although the correlations between the EQ-VAS and other measures of patient-reported health, both before and after surgery and in the change between them, are weak. CONCLUSIONS: EQ-VAS data might be improved by providing better guidance on collection and coding. It is argued that the observed differences in results from EQ-VAS and other measures of health reflect the fact that it measures a broader underlying construct of health, arguably providing a means of summarising overall health that is closer to the patient's perspective.

Rehabilitation following surgery: clinical and psychological predictors of activity limitations.

PURPOSE/OBJECTIVE: Activity limitations following surgery are common, and patients may have an extended period of pain and rehabilitation. Inguinal hernia surgery is a common elective procedure. This study incorporated fear-avoidance models in investigating cognitive and emotional variables as potential risk factors for activity limitations 4 months after inguinal hernia surgery. METHOD: This was a prospective cohort study, predicting activity limitations 4 months postoperatively (Time 3 [T3]) from measures taken before surgery (Time 1, [T1]) and 1 week after surgery (Time 2 [T2]). The sample size at T1 was 135; response rates were 89% and 84% at T2 and T3 respectively. Questionnaires included measures of catastrophizing, fear of movement, depression, anxiety, optimism, perceived control over pain, pain, and activity limitations. Biomedical and surgical variables were recorded. Predictors of T3 activity limitations from T1 and T2 were examined in hierarchical multiple regression equations. RESULTS: Over half of participants (57.7%) reported activity limitations due to their hernia at 4 months post-surgery. Higher activity limitation levels were significantly predicted by older age, higher preoperative activity limitations, higher preoperative anxiety, and more severe postoperative pain and depression scores. CONCLUSIONS/IMPLICATIONS: Interventions to reduce preoperative anxiety and postoperative depression may lead to reduced 4-month activity limitations. However, the additional variance explained by psychological variables was low (ΔR² = 0.05). Our models, which included biomedical and surgical variables, accounted for less than 50% of the variance in activity limitations overall. Therefore, further investigation of psychological variables, particularly cognitions related specifically to activity behavior, would be merited.

Digital evaluation of the muscle functions of the lower extremities among inguinal hernia patients treated using three different surgical techniques: a prospective randomized study.

PURPOSE: An inguinal hernia is a common pathology that can be treated using several different surgical procedures. Although there have been many studies comparing the clinical results of these techniques, there has so far been no digital analysis of the alterations developing secondary to pain with regard to the muscle functions of the lower extremities. This prospective randomized trial was designed to compare this aspect for subjects treated using the laparoscopic techniques and those treated using the conventional method. METHODS: A total of 75 patients, 25 of whom who had undergone hernia repair using the total extraperitoneal technique, 25 of whom who had undergone repair using the transabdominal preperitoneal technique, and 25 who had undergone repair using the Prolene mesh graft technique, were evaluated preoperatively and on the third postoperative day by isometric and isokinetic measurements, the visual analog score (VAS), the necessity of postoperative analgesia, complications, and the time that had elapsed before returning to work, and these results were recorded. RESULTS: Hernia repair using the conventional method led to an average of 3 times more muscle function loss compared with the laparoscopic techniques, and this difference was shown to be statistically significant. The VAS, postoperative complications, and time elapsed before returning to work were lower for laparoscopic surgeries and also were compatible with the findings described in the previous literature. CONCLUSIONS: Use of a digital environment with numerical parameters and measurements recorded using a dynamometer demonstrated that in the early postoperative period and on the third postoperative day, open surgery causes more functional loss in the lower extremities than laparoscopic methods. Therefore, surgeons should use laparoscopic methods whenever possible to reduce both pain and loss of muscle function.

Radially expanding laparoscopic trocar ports significantly reduce postoperative pain in all age groups.

BACKGROUND: Trocar entry points have been identified as a significant source of pain after laparoscopic surgery. This is particularly true of the larger 12-mm ports that require deep fascial closure to avoid port-site herniation. We investigated whether using radially expanding trocars not requiring fascial closure compared to conventional cutting trocars for the 12-mm port in transabdominal preperitoneal (TAPP) hernia repairs had any effect on postoperative analgesic requirements and return to work or normal activity. METHODS: The number of days analgesia was required postoperatively and the number of days taken to return to normal activity was recorded for 143 consecutive patients who underwent TAPP hernia repair by a single experienced laparoscopic surgeon. Exactly the same operative technique was used in these patients with the exception of the 12-mm port site entry. In group 1 (104 patients), a conventional cutting trocar was used requiring deep fascial closure. In group 2 (39 patients), a radially expanding trocar was used and the fascial defect was not closed. RESULTS: Analgesia was required for an average of 10.5 days in group 1 and 2.4 days in group 2 (P < 0.001). The average time to return to work or to normal activity was 23.4 days in group 1 and 15.6 days in group 2 (P = 0.004). There was no significant difference between the two groups with respect to the patients' age, sex, or operating time. CONCLUSION: Using the laparoscopic TAPP hernia repair as a standardised operation, changing from 12-mm fascial port closure to a technique that uses port dilation (not requiring a potentially "tight" deeper fascial closure) in a similar group of patients shows that there is a significant reduction in postoperative analgesic requirement and an earlier return to productive work or normal lifestyle. Perhaps dilating ports should replace those larger 10-, 12-, and 15-mm ports that require deeper sutures in all laparoscopic surgical operations.

Dolor y costos hospitalarios en la reparación de la hernia inguinal primaria: Lichtenstein frente a Desarda / Pain and hospital costs in primary inguinal hernia repair: Lichtensten versus Desarda

La hernia inguinal tiene una alta incidencia en la población y representa un problema de salud por sus importantes implicaciones sociales y laborales. El objetivo de este trabajo fue comparar los resultados del tratamiento de la hernia inguinal mediante dos técnicas quirúrgicas distintas: una protésica (técnica de Lichtenstein) y otra anatómica (técnica de Desarda), haciendo hincapié en la valoración del dolor posoperatorio y los costos hospitalarios de dichos procedimientos, además de otros factores. Se realizó un estudio prospectivo aleatorizado de 625 pacientes intervenidos quirúrgicamente entre enero de 2003 y enero del 2009 en el Hospital General Docente Dr Enrique Cabrera (La Habana). Fueron también estudiadas otras variables, como edad, localización y tipo de hernia, duración de la intervención y complicaciones. El tiempo quirúrgico fue menor en la hernioplastia de Lichtenstein y hubo un comportamiento similar en cuanto al dolor posoperatorio entre el primero y tercer día, y en la hernioplastia fue superior al quinto día. Se encontró diferencia estadísticamente significativa en cuanto al costo hospitalario, que fue superior con la técnica protésica. Con la técnica de Desarda se obtienen los mismos resultados satisfactorios en las hernias no recidivadas que con la técnica de Lichtenstein, y el costo hospitalario es menor(AU)

The inguinal hernia has a high incidence in population and represents a health problem due to its significant social and working implications. The objective of present paper was to compare the results of inguinal hernia treatment using two different techniques: a prosthetic one (Lichtenstein technique) and other of anatomical type (Desarda's technique) emphasizing on evaluation of postoperative pain and the hospital costs due to such procedures in addition to other factors. A randomized and prospective study was conducted in 625patients operated on between January, 2003 and January, 2009 in the Dr Enrique Cabrera General Teaching Hospital (La Habana). Other variables were also studied including the age, localization and the type of hernia, length of surgical intervention and the complications. The surgical time was minor in the Lischtenstein hernioplasty and there was a similar behavior as regards the postoperative pain between the first and the third day, and in the hernioplasty it was higher at fifth day. There was a significant statistic difference as regards the hospital cost that was higher using the prosthetic technique. With the Desarda's technique it is possible to obtain the same satisfactory results in non-relapsing hernias that with the Lichtenstein's technique and the hospital cost is minor(AU)

Validity, reliability and responsiveness of patient-reported outcome questionnaires when assessing hip and groin disability: a systematic review.

BACKGROUND: Novel treatment interventions are advancing rapidly in the management of hip and groin disability in the physically active young to middle-aged population. OBJECTIVE: To recommend the most suitable patient-reported outcome (PRO) questionnaires for the assessment of hip and groin disability based on a systematic review of evidence of validity, reliability and responsiveness of these instruments. METHODS: MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, PsycINFO, SportsDiscus and Web of Science were all searched up to January 2009. Two reviewers independently rated measurement properties of the PRO questionnaires in the included studies, according to a standardised criteria list. RESULTS: The computerised search identified 2737 publications. Forty-one publications investigating measurement properties of PRO questionnaires assessing hip or groin disability were included in the study. Twelve different questionnaires designed for patients with hip disability and one questionnaire for patients with groin disability were identified. Hip dysfunction and Osteoarthritis Outcome Score (HOOS) contains adequate measurement qualities to evaluate patients with hip osteoarthritis (OA) or total hip replacement (THR). Hip Outcome Score (HOS) is the best available questionnaire for evaluating hip arthroscopy, but the Inguinal Pain Questionnaire, the only identified questionnaire evaluating groin disability, does not contain adequate measurement qualities. CONCLUSIONS: HOOS is recommended for evaluating patients with hip OA undergoing non-surgical treatment and surgical interventions such as THR. HOS is recommended for evaluating patients undergoing hip arthroscopy. Current and new PRO questionnaires should also be evaluated in younger patients (age <50) with hip and/or groin disability, including surgical and non-surgical patients.

Proposed algorithm for the management of athletes with athletic pubalgia (sports hernia): a case series.

STUDY DESIGN: A case series of 6 athletes with a suspected sports hernia. BACKGROUND: Groin pain in athletes is common, and 1 source of groin pain is athletic pubalgia, or a sports hernia. Description of this condition and its management is scarce in the physical therapy literature. The purpose of this case series is to describe a conservative approach to treating athletes with a likely sports hernia and to provide physical therapists with an algorithm for managing athletes with this dysfunction. CASE DESCRIPTION: Six collegiate athletes (age range, 19-22 years; 4 males, 2 females) with a physician diagnosis of groin pain secondary to possible/probable sports hernia were referred to physical therapy. A method of evaluation was constructed and a cluster of 5 key findings indicative of a sports hernia is presented. The athletes were managed according to a proposed algorithm and received physical therapy consisting of soft tissue and joint mobilization/manipulation, neuromuscular re-education, manual stretching, and therapeutic exercise. OUTCOMES: Three of the athletes received conservative intervention and were able to fully return to sport after a mean of 7.7 sessions of physical therapy. The other 3 athletes reached this outcome after surgical repair and a mean of 6.7 sessions of physical therapy. DISCUSSION: Conservative management including manual therapy appears to be a viable option in the management of athletes with a sports hernia. Follow-up randomized clinical trials should be performed to further investigate the effectiveness of conservative rehabilitation compared to a homogeneous group of patients undergoing surgical repair for this condition. LEVEL OF EVIDENCE: Therapy, level 4.

Sports hernias: a systematic literature review.

This review summarises the existing knowledge about pathogenesis, differential diagnosis, conservative treatment, surgery and post-surgical rehabilitation of sports hernias. Sports hernias occur more often in men, usually during athletic activities that involve cutting, pivoting, kicking and sharp turns, such as those that occur during soccer, ice hockey or football. Sports hernias generally present an insidious onset, but with focused questioning a specific inciting incident may be identified. The likely causative factor is posterior inguinal wall weakening from excessive or high repetition shear forces applied through the pelvic attachments of poorly balanced hip adductor and abdominal muscle activation. There is currently no consensus as to what specifically constitutes this diagnosis. As it can be difficult to make a definitive diagnosis based on conventional physical examination, other methods, such as MRI and diagnostic ultrasonography are often used, primarily to exclude other conditions. Surgery seems to be more effective than conservative treatment, and laparoscopic techniques generally enable a quicker recovery time than open repair. However, in addition to better descriptions of surgical anatomy and procedures and conservative and post-surgical rehabilitation, well-designed research studies are needed, which include more detailed serial patient outcome measurements in addition to basing success solely on return to sports activity timing. Only with this information will we better understand sports hernia pathogenesis, verify superior surgical approaches, develop evidence-based screening and prevention strategies, and more effectively direct both conservative and post-surgical rehabilitation.

Hernioplastia inguinal de Rutkow y Robbins, sin recurrencias / Rutkow y Robbins' inguinal hernioplasty without recurrences

La universalización del uso de las bioprótesis y sus actuales pioneros Lichtenstein, Gilbert, Rutkow y Robbins, están logrando vencer lo que hasta hoy ha sido el fantasma de la cirugía herniaria: las recurrencias. Las técnicas a base de tapón de malla ya tienen más de 20 años de evaluación y son ampliamente aceptadas por la mayoría de los cirujanos. Se estudiaron 34 pacientes afectos de hernia inguinal a los cuales se les realizó hernioplastia de Rutkow y Robbins entre enero del 2001 y diciembre del 2004. Con el objetivo de determinar la efectividad de dicha técnica, se analizaron las variables: edad, sexo, lado y variedad de hernia, tiempo de hospitalización y anestesia, material protésico utilizado, complicaciones posoperatorias y recurrencias(AU)

The universalization of the use of bioprostheses and its pioneers Lichtenstein, Gilbert, Rutkow and Robbins are being able to overcome what has been the ghost of hernial surgery: recurrences. The techniques based on mesh plug have been evaluated for more than 20 years and are widely accepted by most of the surgeons. METHODS. 334 patients with inguinal hernia that had undergone Rutkow y Robbins' hernioplasty from January 2001 to December 2004 were studied. The following variables were analyzed in order to determine the effectiveness of this technique: sex, age, side and variety of hernia, time of hospitalization and anesthesia, prosthetic material used, postoperative complications and recurrences(AU)

Hernioplastia inguinal de Rutkow y Robbins, sin recurrencias / Rutkow y Robbins' inguinal hernioplasty without recurrences

La universalización del uso de las bioprótesis y sus actuales pioneros Lichtenstein, Gilbert, Rutkow y Robbins, están logrando vencer lo que hasta hoy ha sido el fantasma de la cirugía herniaria: las recurrencias. Las técnicas a base de tapón de malla ya tienen más de 20 años de evaluación y son ampliamente aceptadas por la mayoría de los cirujanos. Se estudiaron 34 pacientes afectos de hernia inguinal a los cuales se les realizó hernioplastia de Rutkow y Robbins entre enero del 2001 y diciembre del 2004. Con el objetivo de determinar la efectividad de dicha técnica, se analizaron las variables: edad, sexo, lado y variedad de hernia, tiempo de hospitalización y anestesia, material protésico utilizado, complicaciones posoperatorias y recurrencias(AU)

The universalization of the use of bioprostheses and its pioneers Lichtenstein, Gilbert, Rutkow and Robbins are being able to overcome what has been the ghost of hernial surgery: recurrences. The techniques based on mesh plug have been evaluated for more than 20 years and are widely accepted by most of the surgeons. METHODS. 334 patients with inguinal hernia that had undergone Rutkow y Robbins' hernioplasty from January 2001 to December 2004 were studied. The following variables were analyzed in order to determine the effectiveness of this technique: sex, age, side and variety of hernia, time of hospitalization and anesthesia, prosthetic material used, postoperative complications and recurrences(AU)

Técnica de Trabucco: primer reporte nacional (septiembre de 2005) / Trabucco’s technique: first national report (September 2005)

Se realizó un estudio prospectivo en pacientes operados de hernia inguinal primaria indirecta o reproducida por primera vez, a quienes se aplicó la técnica libre de tensión, de Trabucco. Se creó una base de datos con 335 pacientes, operados entre junio del 2000 y junio del 2004, en los hospitales Comandante Manuel Fajardo y el Hospital General de Santiago de Cuba. El uso de esta técnica quirúrgica mostró gran efectividad en cuanto al número de recidivas (0,5 por ciento) y de complicaciones (14 por ciento), al confort posoperatorio y la rápida incorporación de los pacientes a sus labores cotidianas y a la vida laboral, lo que presupone un índice coste-beneficio favorable (aspecto que no incluimos entre los objetivos propuestos). Pudimos concluir que la técnica de Trabucco es un método novedoso y muy efectivo nuestro medio, pues muestra ventajas iguales a las de las restantes hernioplastias libres de tensión(AU)

A prospective study was undertaken in patients operated on of primary indirect inguinal hernia, or hernia reproduced for the first time. Trabucco´s tension-free technique was applied. A database with 335 patients that underwent surgery from June 2000 to June 2004 at Comandante Manuel Fajardo Hospital and the General Hospital of Santiago de Cuba, was created. The use of this surgical technique showed great effectiveness as regards the number of relapses (0.5 per cent) and complications (14 per cent), the postoperative comfort, and the rapid incorporation of the patients to their daily activities and to work., which presupposes a favorable cost-benefit index (an aspect that was not included among the objectives proposed). It was concluded that Trabucco´s technique is a novel and very efficient method in our setting, since it has the same advantages of the rest of the tension-free hernioplasties(AU)