Asunto(s)
Herpes Zóster , Enfermedades del Sistema Nervioso Periférico , Recto del Abdomen , Anciano , Humanos , Masculino , Abdomen/diagnóstico por imagen , Herpes Zóster/complicaciones , Herpes Zóster/tratamiento farmacológico , Hernia Abdominal/diagnóstico por imagen , Hernia Abdominal/etiología , Hernia Abdominal/virología , Valaciclovir/uso terapéutico , Antivirales/uso terapéutico , Pronóstico , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Enfermedades del Sistema Nervioso Periférico/etiología , Enfermedades del Sistema Nervioso Periférico/virología , Pared Abdominal/diagnóstico por imagen , Pared Abdominal/inervación , Pared Abdominal/virología , Electromiografía , Recto del Abdomen/diagnóstico por imagen , Recto del Abdomen/inervación , Recto del Abdomen/virologíaRESUMEN
A female patient in her middle childhood presented to the paediatric emergency room (ER) after a bicycle accident with an abdominal impact on the bicycle handlebar. On physical examination, a painful ecchymosis on the upper left quadrant was the only abnormal finding. Abdominal ultrasound showed no intra-abdominal lesions, and the patient was discharged home after 24 hours under monitoring. Nine days after the accident, she returned to the ER due to the emergence of an abdominal mass around the area of impact. Abdominal examination detected a tender non-fluctuating mass on the epigastric and left hypochondrium, and abdominal ultrasound revealed a muscle and aponeurosis disruption of the rectus muscle, with fat herniation and cytosteatonecrosis. A conservative approach was chosen, with ambulatory follow-up. One month after the accident, the patient was asymptomatic, no abdominal mass was palpable, and an abdominal CT showed a reduction of the muscle disruption and hernial content.
Asunto(s)
Ciclismo , Hernia Abdominal , Humanos , Ciclismo/lesiones , Femenino , Hernia Abdominal/etiología , Hernia Abdominal/diagnóstico por imagen , Niño , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Ultrasonografía , Pared Abdominal/diagnóstico por imagenRESUMEN
BACKGROUND: Blunt traumatic abdominal wall hernias (TAWHs) are rare but require a variety of operative techniques to repair including bone anchor fixation (BAF) when tissue tears off bony structures. This study aimed to provide a descriptive analysis of BAF technique for blunt TAWH repair. Bone anchor fixation and no BAF repairs were compared, hypothesizing increased hernia recurrence with BAF repair. METHODS: A secondary analysis of the WTA blunt TAWH multicenter study was performed including all patients who underwent repair of their TAWH. Patients with BAF were compared to those with no BAF with bivariate analyses. RESULTS: 176 patients underwent repair of their TAWH with 41 (23.3%) undergoing BAF. 26 (63.4%) patients had tissue fixed to bone, with 7 of those reinforced with mesh. The remaining 15 (36.6%) patients had bridging mesh anchored to bone. The BAF group had a similar age, sex, body mass index, and injury severity score compared to the no BAF group. The time to repair (1 vs 1 days, P = .158), rate of hernia recurrence (9.8% vs 12.7%, P = .786), and surgical site infection (SSI) (12.5% vs 15.6%, P = .823) were all similar between cohorts. CONCLUSIONS: This largest series to date found nearly one-quarter of TAWH repairs required BAF. Bone anchor fixation repairs had a similar rate of hernia recurrence and SSI compared to no BAF repairs, suggesting this is a reasonable option for repair of TAWH. However, future prospective studies are needed to compare specific BAF techniques and evaluate long-term outcomes including patient-centered outcomes such as pain and quality of life.
Asunto(s)
Herniorrafia , Mallas Quirúrgicas , Heridas no Penetrantes , Humanos , Masculino , Femenino , Heridas no Penetrantes/cirugía , Herniorrafia/métodos , Adulto , Persona de Mediana Edad , Traumatismos Abdominales/cirugía , Anclas para Sutura , Recurrencia , Estudios Retrospectivos , Resultado del Tratamiento , Hernia Ventral/cirugía , Hernia Abdominal/cirugía , Hernia Abdominal/etiología , Puntaje de Gravedad del Traumatismo , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/epidemiologíaRESUMEN
PURPOSE: Internal herniation is a well-known complication of laparoscopic Roux-en-Y gastric bypass (L-RYGB). The aim of this study was to evaluate smoking as an independent risk factor for internal herniation after L-RYGB. MATERIALS AND METHODS: This study was performed as an exploratory post hoc analysis of data from a previous published randomized controlled trial (RCT) designed to compare closure and non-closure of mesenteric defects in patients undergoing L-RYGB. The primary outcome of this study was to assess the significance of smoking as a risk factor for internal herniation after L-RYGB. Secondary outcome was early postoperative complications defined as Clavien-Dindo grade ≥ 2. RESULTS: Four hundred one patients were available for post hoc analysis. The risk of internal herniation was significantly higher among patients who were smoking preoperatively (hazard ratio (HR) 2.4, 95% confidence interval (c.i.) 1.3 to 4.5; p = 0.005). This result persisted after adjusting for other patient characteristics (HR 2.2, 1.2 to 4.2; p = 0.016). 6.0% of the patients had postoperative complications within the first 30 days. 4.9% of these patients were smoking and 6.3% were not smoking, p = 0.657. 11.0% of the patients underwent surgery due to internal herniation by 5 years after the primary procedure. CONCLUSION: Smoking is a significant risk factor for internal herniation but did not increase risk for 30 days postoperative complications.
Asunto(s)
Derivación Gástrica , Hernia Abdominal , Laparoscopía , Obesidad Mórbida , Humanos , Derivación Gástrica/métodos , Obesidad Mórbida/cirugía , Estudios Retrospectivos , Hernia Abdominal/etiología , Hernia Interna/complicaciones , Hernia Interna/cirugía , Laparoscopía/métodos , Complicaciones Posoperatorias/etiología , FumarRESUMEN
A patient with a swelling of the abdominal wall is a regular occurrence in general practice and hospital. The diagnosis can often be made with a thorough history and physical examination. An abdominal wall hernia is characterized by an increase in swelling on standing physical examination and Valsalva maneuver, which is often reducible, and a hernia defect is palpable. If no interruption of the abdominal wall is palpable and there is hypoesthesia, there may be an abdominal wall paresis because of thoracic paramedian hernia nuclei pulposi (HNP). Where an abdominal wall hernia is treated surgically in case of symptoms, this is conservatively treated with an HNP.
Asunto(s)
Pared Abdominal , Hernia Abdominal , Humanos , Hernia Abdominal/etiología , Examen Físico/efectos adversos , Maniobra de ValsalvaRESUMEN
BACKGROUND: Petersen's hernia, which occurs after Billroth-II (B-II) or Roux-en-Y (REY) anastomosis, can be reduced by defect closure. This study aims to compare the incidence of bowel obstruction above Clavien-Dindo classification grade III due to Petersen's hernia between the mesenteric fixation method and the conventional methods after laparoscopic or robotic gastrectomy. METHODS: This study was designed as prospective, single-blind, non-inferiority randomized controlled multicenter trial in Korea. Patients with histologically diagnosed gastric cancer of clinical stages I, II, or III who underwent B-II or REY anastomosis after laparoscopic or robotic gastrectomy are enrolled in this study. Participants who meet the inclusion criteria are randomly assigned to two groups: a CLOSURE group that underwent conventional Petersen's defect closure method and a MEFIX group that underwent the mesenteric fixation method. The primary endpoint is the number of patients who underwent surgery for bowel obstruction caused by Petersen's hernia within 3 years after laparoscopic or robotic gastrectomy. DISCUSSION: This trial is expected to provide high-level evidence showing that the MEFIX method can quickly and easily close Petersen's defect without increased postoperative complications compared to the conventional method. TRIAL REGISTRATION: ClinicalTrials.gov NCT05105360. Registered on November 3, 2021.
Asunto(s)
Derivación Gástrica , Hernia Abdominal , Laparoscopía , Obesidad Mórbida , Humanos , Hernia Abdominal/diagnóstico por imagen , Hernia Abdominal/etiología , Hernia Abdominal/prevención & control , Estudios Prospectivos , Método Simple Ciego , Mesenterio/cirugía , Laparoscopía/efectos adversos , Laparoscopía/métodos , Derivación Gástrica/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Obesidad Mórbida/cirugía , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Multicéntricos como AsuntoRESUMEN
PURPOSE: Traumatic lumbar hernia (TLH) constitutes a protrusion of content through a defect in the posterior abdominal wall, as a result of injury. This rare entity has been described in limited number of cases. METHODS: A systematic review of the literature was performed according to the meta-analysis of observational studies in epidemiology guidelines. The English literature from 1990 until 2021 was reviewed, using PubMed, EMBASE and Google Scholar bibliographic databases, to identify case reports and case series with patients that were diagnosed with TLH. For each eligible study, demographics, clinical presentation, hernia characteristics, preoperative imaging investigations, operation details, and postoperative data were extracted for assessment. Statistical analysis was performed on SPSS, version 20.0. RESULTS: A total of 62 studies were included for review, with 164 patients with TLH. Mean age was (42.6 ± 14.3) years (47.6% males, 31.1% females, gender not specified in 35 cases). Mean diameter of hernia neck was (6.3 ± 3.1) cm, while the triangles of Petit and Grynfeltt were affected in 74.5% and 14.6%, respectively. Patients diagnosed in the emergency setting account for 54.2%, with CT scan establishing diagnosis in all but one case (97.7%). A delayed diagnosis was made in 45.8%, at a mean 1 year following trauma. Flank bulging (82.8%) and chronic back pain (34.3%) were the most frequent symptoms. In both delayed and acute group, open surgery (63.6% and 92.3%, respectively) was the preferred surgical approach. Postoperative complications were reported in 11.4% of acute and 15.0% of delayed patients. Hernia recurrence was 7%. CONCLUSIONS: TLH is uncommon with 164 cases described since 1990. CT scan is the gold standard in diagnosis. Open surgery is generally the preferred approach, particularly in the emergency setting. Acute TLH can be treated either by primary suture repair or mesh, depending on the local conditions, whereas delayed cases usually require a mesh.
Asunto(s)
Hernia Abdominal , Laparoscopía , Masculino , Femenino , Humanos , Adulto , Persona de Mediana Edad , Herniorrafia/métodos , Mallas Quirúrgicas , Hernia Abdominal/epidemiología , Hernia Abdominal/etiología , Hernia Abdominal/cirugía , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Roux-en-Y gastric bypass (RYGB) is one of the most common bariatric procedures. Internal herniation may lead to small bowel ischemia requiring small bowel resection, resulting in short bowel syndrome. OBJECTIVE: To determine the incidence of extensive small bowel resection in patients operated with RYGB. We also aimed to look for early clinical warning signs among patients requiring extensive small bowel resection. SETTING: Cohort from national quality registers. METHODS: All patients having undergone RYGB between January 2007 to June 2019 were analyzed in the Scandinavian Obesity Surgery Registry (SOReg). We identified patients with small bowel obstruction (SBO) for whom small bowel resection was necessary. Additionally, we assessed clinical signs in these patients. RESULTS: The study included 57,255 patients having undergone RYGB. Closure of the mesenteric openings was performed in 78%. Surgery for SBO was required in 3659 (6%) of patients, and small bowel resection in 188 (.3%). Extensive small bowel resection, resulting in less than 1.5 meters of remaining small bowel, was required in 7 patients (.01%). All patients with extensive small bowel resection presented with abdominal pain and had confirmed internal herniation as the cause of the small bowel resection, and 2 of 7 patients died. Closure of mesenteric defects was not associated with a reduction in overall small bowel resection rates (P = .89) CONCLUSION: Surgery for SBO after RYGB was common (6%). The risk of extensive small bowel resection leading to short bowel was low (.01%). Patients with abdominal pain after RYGB should be assessed for internal hernia, as it can be devastating.
Asunto(s)
Derivación Gástrica , Hernia Abdominal , Obstrucción Intestinal , Laparoscopía , Obesidad Mórbida , Humanos , Derivación Gástrica/efectos adversos , Derivación Gástrica/métodos , Estudios de Cohortes , Suecia/epidemiología , Estudios Retrospectivos , Laparoscopía/métodos , Hernia Abdominal/epidemiología , Hernia Abdominal/etiología , Hernia Abdominal/cirugía , Obstrucción Intestinal/epidemiología , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Dolor Abdominal/epidemiología , Dolor Abdominal/etiología , Obesidad Mórbida/complicacionesRESUMEN
PURPOSE: Outpatient pediatric surgical practice often involves conditions of limited morbidity but significant parental concern. We explore existing evidence-based management recommendations and the mismatch with practice patterns for four common outpatient pediatric surgical conditions. METHODS: Using the Cochrane Rapid Review Group recommendations and librarian oversight, we conducted a rapid review of four outpatient surgical conditions: dermoid cysts, epigastric hernias, hydroceles, and umbilical hernias. We extracted patient demographics, intervention details, outcome measures and evaluated justifications presented for chosen management options. A metric of evidence volume (patient/publication ratio) was generated and compared between diagnoses. RESULTS: Out of 831 articles published since 1990, we identified 49 cohort studies (10-dermoid cyst, 6-epigastric hernia, 25-hydrocele, and 8-umbilical hernia). The 49 publications included 34,172 patients treated across 18 countries. The evidence volume for each outpatient condition demonstrates < 1 cohort/condition/year. The evidence mismatch rate varied between 33 and 75%; many existing recommendations are not evidence-based, sometimes conflicting and frequently misrepresentative of clinical practice. CONCLUSIONS: Published literature concerning common outpatient pediatric surgical conditions is sparse and demonstrates wide variations in practice. All individual practice choices were justified using either risk of complications or patient preference. Most early intervention practices were based on weak or outdated studies and "common wisdom" rather than genuine evidence. LEVEL OF EVIDENCE: III.
Asunto(s)
Hernia Abdominal , Hernia Umbilical , Hidrocele Testicular , Masculino , Niño , Humanos , Hernia Abdominal/etiología , Hernia Umbilical/cirugía , Herniorrafia/efectos adversos , Estudios de Cohortes , Hidrocele Testicular/cirugíaAsunto(s)
Pared Abdominal , Hernia Abdominal , Humanos , Hernia Abdominal/etiología , Hernia Abdominal/cirugíaRESUMEN
PURPOSE: Internal herniation (IH) is the most common complication after Roux-en-Y gastric bypass surgery (RYGB). Although primary closure has reduced the incidence, recurrences are a continued problem. This study aimed to investigate long-term follow-up and recurrence risk of IH surgery. METHODS: A retrospective cohort study of laparoscopic RYGB operated patients operated for a first IH between April 2012 and April 2015 at Skåne University Hospital in Malmö, Sweden. Status of primary closure of mesenteric gaps, time since RYGB, and findings at IH surgery were retrieved from medical records. Follow-up until December 31st, 2019, included recurrences of IH, number of computed tomography (CT) scans, emergency visits, readmissions, and other acute surgeries. RESULTS: IH (n = 44) occurred almost equally in Petersen's space (n = 24) and beneath the jejunojejunostomy (n = 20). Long-term follow-up (median 75 months) of 43 patients registered an IH recurrence rate of 14% (n = 6). All recurrences occurred in the other mesenteric gap. One patient suffered a third IH, and one patient had four IH events. During follow-up, 56% (n = 24) had ER visits for abdominal pain, 47% (n = 20) had ≥ 1 abdominal CT scan, and 40% (n = 17) were readmitted. A third of readmitted (6/17) patients suffered a recurrence of internal herniation. Two other patients were readmitted ≥ 10 times for chronic abdominal pain. CONCLUSION: Surgery for IH had a low risk of recurrence at the treated mesenteric gap, but a 14% recurrence risk at the other mesenteric gap, emphasizing the importance of carefully investigating weaknesses or gaps at the other mesenteric defect during surgery for IH.
Asunto(s)
Derivación Gástrica , Hernia Abdominal , Laparoscopía , Obesidad Mórbida , Humanos , Derivación Gástrica/efectos adversos , Derivación Gástrica/métodos , Estudios de Seguimiento , Obesidad Mórbida/cirugía , Estudios Retrospectivos , Hernia Abdominal/etiología , Complicaciones Posoperatorias/etiología , Dolor Abdominal/etiología , Dolor Abdominal/cirugía , Laparoscopía/métodos , RecurrenciaRESUMEN
Perineal hernias are rare complications of surgeries like abdominoperineal resections. This submission is an educational piece outlining the steps to completing a posterior perineal hernia repair with mesh.
Asunto(s)
Hernia Abdominal , Proctectomía , Neoplasias del Recto , Humanos , Herniorrafia/efectos adversos , Perineo/cirugía , Mallas Quirúrgicas/efectos adversos , Hernia Abdominal/cirugía , Hernia Abdominal/etiología , Proctectomía/efectos adversos , Hernia/complicaciones , Complicaciones Posoperatorias/etiología , Neoplasias del Recto/cirugía , Neoplasias del Recto/complicacionesRESUMEN
Internal hernias are a worrying complication from laparoscopic Roux-en-Y gastric bypass (LRGB), with potential small bowel necrosis and obstruction. An electronic database search of Medline, Embase, and Pubmed was performed. All studies investigating the internal hernia rates in patients whose mesenteric defects were closed vs. not closed during LRGB were analysed. Odds ratios were calculated to assess the difference in internal hernia rate. A total of 14 studies totalling 20,553 patients undergoing LRGB were included. Internal hernia rate (220/12,445 (2%) closure vs. 509/8108 (6%) non-closure) and re-operation for small bowel obstruction (86/5437 (2%) closed vs. 300/3132 (10%) non-closure) were reduced when defects were closed. There was no difference observed when sutures were used to close the defects compared to clips/staples.
Asunto(s)
Derivación Gástrica , Hernia Abdominal , Laparoscopía , Obesidad Mórbida , Humanos , Derivación Gástrica/efectos adversos , Obesidad Mórbida/cirugía , Estudios Retrospectivos , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/etiología , Hernia Abdominal/etiología , Hernia Abdominal/cirugía , Laparoscopía/efectos adversos , Mesenterio/cirugía , Hernia Interna/complicaciones , Hernia Interna/cirugíaAsunto(s)
Derivación Gástrica , Hernia Abdominal , Laparoscopía , Obesidad Mórbida , Humanos , Hernia Abdominal/etiología , Hernia Abdominal/prevención & control , Hernia Abdominal/cirugía , Obesidad Mórbida/complicaciones , Obesidad Mórbida/cirugía , Hernia Interna/cirugía , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/cirugía , Estudios RetrospectivosRESUMEN
During the laparoscopic Roux-en-Y gastric bypass procedure, closing mesentery or not was still controversial according to preexisted studies. So, the current meta-analysis aimed to compare the outcome of closure versus non-closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass. Fifteen studies were included, enrolling 53,488 patients. Based on the outcome of analysis, regarding internal hernia, Petersen space's IH, jejunal mesenteric's IH, hospital days, and reoperation, closure of the mesentery was better than non-closure. Besides, small bowel obstruction, anastomosis ulcer, stenosis, leakage, bleeding, gastrointestinal perforation, and postoperative BMI of patients show no difference between non-closure and closure.
Asunto(s)
Derivación Gástrica , Hernia Abdominal , Laparoscopía , Obesidad Mórbida , Humanos , Derivación Gástrica/efectos adversos , Derivación Gástrica/métodos , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Hernia Abdominal/etiología , Hernia Abdominal/cirugía , Laparoscopía/métodos , Mesenterio/cirugía , Estudios RetrospectivosRESUMEN
Lumbar hernias are congenital or acquired posterolateral abdominal wall hernias and are located in the superior or inferior lumbar triangle. Traumatic lumbar hernias are rare, and the optimal method to repair these is not well-defined. We present the case of a 59-year-old obese female who presented after a motor vehicle collision with an 8.8 cm traumatic right-sided inferior lumbar hernia and overlying complex abdominal wall laceration. The patient underwent an open repair with retro rectus polypropylene mesh and biologic mesh underlay several months after the abdominal wall wound healed, and the patient lost 60 pounds. The patient recovered well without complications or recurrence at the one-year follow-up. This case demonstrates a complex, open surgical approach to repair a large traumatic lumbar hernia not amenable to laparoscopic repair.
Asunto(s)
Pared Abdominal , Hernia Abdominal , Hernia Ventral , Laceraciones , Laparoscopía , Humanos , Femenino , Persona de Mediana Edad , Mallas Quirúrgicas , Hernia Abdominal/etiología , Hernia Abdominal/cirugía , Pared Abdominal/cirugía , Región Lumbosacra/cirugía , Laceraciones/cirugía , Hernia Ventral/etiología , Hernia Ventral/cirugía , HerniorrafiaRESUMEN
INTRODUCTION: Internal herniation (IH) can be a life-threatening complication of Roux-en-Y gastric bypass (RYGB). Randomised controlled trials support the routine closure of mesenteric spaces at RYGB. However, there is currently no consensus on the method of closure in clinical practice. The purpose of this survey is to understand bariatric surgeons' practice in this regard. METHODS: We conducted an international survey, whereby questions were created through collaboration of a consensus group of bariatric surgeons and hosted on the SurveyMonkey platform. The survey was distributed among British Obesity and Metabolic Surgery Society (BOMSS) members and international professional channels including The Upper Gastrointestinal Society (TUGS) and social media. RESULTS: One hundred and thirty-six surgeons from 34 countries completed the survey. Of these, 49 respondents were UK-based surgeons with a cumulative experience of approximately 2500 RYGB per annum. Forty-five (91.8%) respondents reported always closing mesenteric defects, of whom 57.8% elected to use non-absorbable non-barbed sutures, followed by staples/clips in 28.9% and a selection of other methods. Most respondents used more than one method. A total of 2 UK and 14 non-UK participants reported never closing mesenteric spaces. CONCLUSIONS: This survey has shown heterogeneity among defect closure and no consensus on preferred type. Additionally, there remains a practice of non-closure of mesenteric defects. We hope these findings help to inform further needed research and consensus building among experts.
Asunto(s)
Derivación Gástrica , Hernia Abdominal , Laparoscopía , Obesidad Mórbida , Humanos , Derivación Gástrica/efectos adversos , Obesidad Mórbida/cirugía , Laparoscopía/efectos adversos , Hernia/complicaciones , Obesidad/cirugía , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Hernia Abdominal/etiologíaRESUMEN
Internal hernia (IH) is a serious complication that can occur after both laparoscopic and open surgery for the treatment of gastric cancer; the transverse colon and mesocolon, act as a natural partition between stomach and the small intestine and, once any type of gastrojejunal anastomosis is constructed, a potential space for internal hernia is created. We present the case of a 68-year-old patient diagnosed with intestinal ischemia due to an IH in the site of the jejunojejunostomy after an open gastrectomy for gastric cancer, treated with negative wound pressure therapy (NWPT) on open abdomen (ABTHERATM dressing).
Asunto(s)
Hernia Abdominal , Laparoscopía , Neoplasias Gástricas , Humanos , Anciano , Neoplasias Gástricas/cirugía , Anastomosis en-Y de Roux , Hernia Abdominal/etiología , Hernia Abdominal/cirugía , Gastrectomía/efectos adversos , Hernia Interna/cirugíaRESUMEN
The present study determined the characteristics of perineal hernia treatment in the literature, and the incidence of postoperative recurrence was stratified according to repair techniques. A systematic search of the available literature on the treatment of postoperative perineal hernias was performed using a major database. The types of repair techniques and outcome were entered into an electronic database and a pooled analysis was performed. A total of 213 cases of postoperative perineal hernia repair were collected from 20 relevant articles in the literature after excluding case reports (n < 3). Synthetic mesh was the material used most frequently for perineal hernia repair (55.9%). The most frequently used approach in perineal hernia repair was the perineal approach (56.5%). The recurrence rate was highest with the use of biological mesh (40.4%) and the perineal approach (35.6%). The recurrence rate was lowest in the combined abdominal & perineal approach (0%), followed by the abdominal approach (8.8%) and the laparoscopic approach (11.8%). A number of different repair techniques have been described in the literature. The use of synthetic mesh via a combined abdominal-perineal approach or intraabdominal/laparoscopic approach was shown to be associated with a reduced postoperative recurrence rate.
Asunto(s)
Hernia Abdominal , Hernia Incisional , Humanos , Herniorrafia/métodos , Mallas Quirúrgicas/efectos adversos , Hernia Abdominal/etiología , Hernia Abdominal/cirugía , Abdomen/cirugía , Hernia Incisional/cirugía , Perineo/cirugía , Hernia/epidemiología , Hernia/etiología , Hernia/prevención & control , Complicaciones Posoperatorias/etiologíaRESUMEN
BACKGROUND: Perineal hernias are rare, underreported and poorly studied complications of extensive pelvic surgeries. Their management is challenging, with currently no treatment algorithm available. METHOD: MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were searched. Studies comprising at least 3 patients who underwent surgical perineal hernia repair were included. The primary outcome was perineal hernia recurrence. The secondary outcomes were overall complications and surgical site occurrences. RESULTS: Twenty-nine studies were included, comprising 325 patients undergoing 347 repairs. Overall complications were 33% (95% confidence interval 24%-43%) in the entire cohort, 31% (19%-44%) after perineal repair, 39% (14%-67%) after abdominal repair, and 36% (19%-53%) after mesh repair (20% with biological, 46% with synthetic mesh). The surgical site occurrence rate was 18% (8%-29%). The overall recurrence rate was 22% (15%-29%). Recurrence after perineal repair was 19% (10%-29%): 20% with mesh (25% with biological, 19% with synthetic), 24% with primary repair, and 39% with flap repair. Recurrence after an abdominal repair was 18% (11%-26%): 16% with laparoscopic, 12% with open, 16% with mesh (24% with biological, 16% with synthetic), 30% with primary, and 25% with flap repair. No significant differences could be found in the meta-analysis regarding overall complications and recurrence. CONCLUSION: Synthetic mesh repair seems to be associated with a lower recurrence rate than other techniques, especially after an abdominal approach. The perineal and abdominal approaches appear to be safe, with similar recurrence rates. The combined approach seems promising, but more evidence is needed.