RESUMO
Guidelines are increasingly determining the decision process in day-to-day clinical work. Guidelines describe the current best possible standard in diagnostics and therapy. They should be developed by an international panel of experts, whereby alongside individual experience, above all, the results of comparative studies are decisive. According to the results of high-ranking scientific studies published in peer-reviewed journals, statements and recommendations are formulated, and these are graded strictly according to the criteria of evidence-based medicine. Guidelines can therefore be valuable in helping particularly the young surgeon in his or her day-to-day work to find the best decision for the patient when confronted with a wide and confusing range of options. However, even experienced surgeons benefit because by virtue of a heavy workload and commitment, they often find it difficult to keep up with the ever-increasing published literature. All guidelines require regular updating, usually every 3 years, in line with progress in the field. The current Guidelines focus on technique and perioperative management of laparoscopic ventral hernia repair and constitute the first comprehensive guidelines on this topic. In this issue of Surgical Endoscopy, the first part of the Guidelines is published including sections on basics, indication for surgery, perioperative management, and key points of technique. The next part (Part 2) of the Guidelines will address complications and comparisons between open and laparoscopic techniques. Part 3 will cover mesh technology, hernia prophylaxis, technique-related issues, new technologic developments, lumbar and other unusual hernias, and training/education.
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Parede Abdominal/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia/normas , Laparoscopia/normas , Traumatismos Abdominais/complicações , Traumatismos Abdominais/cirurgia , Medicina Baseada em Evidências , Hérnia Ventral/diagnóstico por imagem , Hérnia Ventral/etiologia , Herniorrafia/métodos , Humanos , Laparoscopia/métodos , Assistência Perioperatória/métodos , Prevenção Secundária , Telas Cirúrgicas/efeitos adversos , Tomografia Computadorizada por Raios X , Falha de TratamentoAssuntos
Parede Abdominal/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia/normas , Laparoscopia/normas , Traumatismos Abdominais/complicações , Traumatismos Abdominais/cirurgia , Hérnia Ventral/diagnóstico por imagem , Hérnia Ventral/etiologia , Herniorrafia/métodos , Humanos , Tomografia Computadorizada por Raios XAssuntos
Parede Abdominal/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia/normas , Laparoscopia/normas , Traumatismos Abdominais/complicações , Traumatismos Abdominais/cirurgia , Hérnia Ventral/diagnóstico por imagem , Hérnia Ventral/etiologia , Herniorrafia/métodos , Humanos , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: There is a need for hernia centers and specialist hernia surgeons because of the increasing complexity of hernia surgery procedures due to new techniques, more difficult cases and a tailored approach with an increasing public awareness demanding optimal treatment results. Therefore, the requirements for accredited/certified hernia centers and specialist hernia surgeons should be formulated by the international and national hernia societies, while taking account of the respective health care systems. METHODS: The European Hernia Society (EHS) has appointed a working group composed of 18 hernia experts from all regions of Europe (ACCESS Group-Hernia Accreditation and Certification of Centers and Surgeons-Working Group) to formulate scientifically based requirements for hernia centers and specialist hernia surgeons while taking into consideration different health care systems. A consensus was reached on the key questions by means of a meeting, a telephone conference and the exchange of contributions. The requirements formulated below were deemed implementable by all participating hernia experts in their respective countries. RESULTS: The ACCESS Group suggests for an adequately equipped hernia center the following requirements: (a) to be accredited/certified by a national or international hernia society, (b) to perform a higher case volume in all types of hernia surgery compared to an average general surgery department in their country, (c) to be staffed by experienced hernia surgeons who are beyond the learning curve for all types of hernia surgery recommended in the guidelines and are responsible for education and training of hernia surgery in their department, (d) to treat hernia patients according to the current guidelines and scientific recommendations, (e) to document each case prospectively in a registry or quality assurance database (f) to perform follow-up for comparison of their own results with benchmark data for continuous improvement of their treatment results and ensuring contribution to research in hernia treatment. To become a specialist hernia surgeon, the ACCESS Group suggests a general surgeon to master the learning curve of all open and laparo-endoscopic hernia procedures recommended in the guidelines, perform a high caseload and additionally to implement and fulfill the other requirements for a hernia center. CONCLUSION: Based on the above requirements formulated by the European Hernia Society for accredited/certified hernia centers and hernia specialist surgeons, the national and international hernia societies can now develop their own programs, while taking account of their specific health care systems.
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Acreditação/normas , Certificação/normas , Herniorrafia/normas , Hospitais Especializados/normas , Consenso , Europa (Continente) , Herniorrafia/métodos , Humanos , Curva de Aprendizado , Cirurgiões/normasRESUMO
INTRODUCTION: The Accreditation and Certification of Hernia Centers and Surgeons (ACCESS) Group of the European Hernia Society (EHS) recognizes that there is a growing need to train specialist abdominal wall surgeons. The most important and relevant argument for this proposal and statement is the growing acceptance of the increasing complexity of abdominal wall surgery due to newer techniques, more challenging cases and the required 'tailored' approach to such surgery. There is now also an increasing public awareness with social media, whereby optimal treatment results are demanded by patients. However, to date the complexity of abdominal wall surgery has not been properly or adequately defined in the current literature. METHODS: A systematic search of the available literature was performed in May 2019 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library, with 75 publications identified as relevant. In addition, an analysis of data from the Herniamed Hernia Registry was performed. The percentage of patients with hernia- or patient-related characteristics which unfavorably impacted the outcome of inguinal and incisional hernia repair was also calculated. RESULTS: All present guidelines for abdominal wall surgery recommend the utilization of a 'tailored' approach. This relies on the prerequisite that any surgical technique used has already been mastered, as well as the recognized learning curves for each of the several techniques that can be used for both inguinal hernia (Lichtenstein, TEP, TAPP, Shouldice) and incisional hernia repairs (laparoscopic IPOM, open sublay, open IPOM, open onlay, open or endoscopic component separation technique). Other hernia- and patient-related characteristics that have recognized complexity include emergency surgery, obesity, recurrent hernias, bilateral inguinal hernias, groin hernia in women, scrotal hernias, large defects, high ASA scores, > 80 years of age, increased medical risk factors and previous lower abdominal surgery. The proportion of patients with at least one of these characteristics in the Herniamed Hernia Registry in the case of both inguinal and incisional hernia is noted to be relatively high at around 70%. In general surgery training approximately 50-100 hernia repairs on average are performed by each trainee, with around only 25 laparo-endoscopic procedures. CONCLUSION: A tailored approach is now employed and seen more so in hernia surgery and this fact is referred to and highlighted in the contemporaneous hernia guidelines published to date. In addition, with the increasing complexity of abdominal wall surgery, the number of procedures actually performed by trainees is no longer considered adequate to overcome any recognized learning curve. Therefore, to supplement general surgery training young surgeons should be offered a clinical fellowship to obtain an additional qualification as an abdominal wall surgeon and thus improve their clinical and operative experience under supervision in this field. Practicing general surgeons with a special interest in hernia surgery can undertake intensive further training in this area by participating in clinical work shadowing in hernia centers, workshops and congresses.
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Parede Abdominal/cirurgia , Cirurgia Geral/educação , Hérnia Abdominal/cirurgia , Herniorrafia/educação , Cirurgia Geral/normas , Hérnia Abdominal/complicações , Herniorrafia/normas , Humanos , Laparoscopia , Curva de Aprendizado , Recidiva , Sistema de Registros , Resultado do TratamentoRESUMO
BACKGROUND: : The aim was to assess whether a partially absorbable monofilament mesh could influence postoperative pain and time to return to normal activity after Lichtenstein hernioplasty. METHODS: : The study randomized patients undergoing inguinal hernia repair in 15 centres into two groups according to mesh type: lightweight (poliglecaprone-polypropylene composite) and heavyweight (polypropylene). A modified suture technique was used in the lightweight group. Follow-up on day 7 and at 3, 6 and 12 months evaluated the incidence of early and late complications, recurrence rate, quality of life, postoperative pain and return to physical activity. RESULTS: : A total of 600 patients were randomized and, after monitoring visits (leading to the exclusion of seven hospitals), 392 qualified for assessment. At 12 months, the recurrence rate did not differ (1.9 versus 0.6 per cent; P = 0.493). The lightweight group reported less pain on day 7 (55.2 versus 36.2 per cent; P < 0.001) and at 3 months (17.1 versus 9.8 per cent; P = 0.033) but pain was similar for both groups at 1 year. General health and physical activity according to Short Form 36 scores increased in both groups. CONCLUSION: : Use of partially absorbable mesh reduced postoperative pain in the short term. No difference in pain or recurrence rates were observed at 12 months. REGISTRATION NUMBER: CCT-NAPN-17412 (http://www.controlled-trials.com) Published by John Wiley & Sons, Ltd.
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Dioxanos/uso terapêutico , Hérnia Inguinal/cirurgia , Poliésteres/uso terapêutico , Polipropilenos/uso terapêutico , Telas Cirúrgicas , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Prevenção Secundária , Resultado do TratamentoRESUMO
BACKGROUND: Current recommendations for hernia treatment suggest applying techniques aimed at reducing postoperative pain in patients experiencing intense preoperative pain. However, there is still no reliable stratification method of preoperative pain, its circumstances, intensity and frequency, and the current assessments of hernia symptoms are performed by means of a subjective evaluation. The aim of this work is to discuss preoperative pain before hernia repair and determine its nature depending on the type and length of hernia persistence and the patient's age. MATERIALS AND METHODS: The data from 1647 patients before inguinal hernia repairs (2010-2017) were registered prospectively in the National Hernia Repair Register (demographic data, pain score and influence on everyday activities). RESULTS: The most common symptom upon admission was pain (949 patients at rest; 57.6% and 1561 at physical activity; 94.8%). A significant influence of hernia persistence on the pain occurrence and intensity was not observed between patients with hernia < 12-months (60.8%;VAS5.0) and > 5-years (58.3%;VAS5.4) (p = 0.068). The occurrence and intensity of pain was significantly higher patients < 40-years (63.7%;VAS5.4) than patients > 60-years (54.3%;VAS4.8) (p = 0.008). CONCLUSIONS: While pain at rest is not a significant problem, undertaking physical activities may intensify pain and increase the number of patients suffering from it. Preoperative assessment of pain may help determine the group of younger patients who could benefit the most from inguinal hernia repair. New indications for prompter admission for treatment should be planned in future studies of patients showing pain at rest for possible prevention of postoperative neuropathy.
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Hérnia Inguinal/diagnóstico , Hérnia Inguinal/cirurgia , Dor/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Herniorrafia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Polônia , Sistema de Registros , Estudos Retrospectivos , Telas Cirúrgicas , Adulto JovemRESUMO
BACKGROUND: International guidelines on the prevention and treatment of parastomal hernias are lacking. The European Hernia Society therefore implemented a Clinical Practice Guideline development project. METHODS: The guidelines development group consisted of general, hernia and colorectal surgeons, a biostatistician and a biologist, from 14 European countries. These guidelines conformed to the AGREE II standards and the GRADE methodology. The databases of MEDLINE, CINAHL, CENTRAL and the gray literature through OpenGrey were searched. Quality assessment was performed using Scottish Intercollegiate Guidelines Network checklists. The guidelines were presented at the 38th European Hernia Society Congress and each key question was evaluated in a consensus voting of congress participants. RESULTS: End colostomy is associated with a higher incidence of parastomal hernia, compared to other types of stomas. Clinical examination is necessary for the diagnosis of parastomal hernia, whereas computed tomography scan or ultrasonography may be performed in cases of diagnostic uncertainty. Currently available classifications are not validated; however, we suggest the use of the European Hernia Society classification for uniform research reporting. There is insufficient evidence on the policy of watchful waiting, the route and location of stoma construction, and the size of the aperture. The use of a prophylactic synthetic non-absorbable mesh upon construction of an end colostomy is strongly recommended. No such recommendation can be made for other types of stomas at present. It is strongly recommended to avoid performing a suture repair for elective parastomal hernia. So far, there is no sufficient comparative evidence on specific techniques, open or laparoscopic surgery and specific mesh types. However, a mesh without a hole is suggested in preference to a keyhole mesh when laparoscopic repair is performed. CONCLUSION: An evidence-based approach to the diagnosis and management of parastomal hernias reveals the lack of evidence on several topics, which need to be addressed by multicenter trials. Parastomal hernia prevention using a prophylactic mesh for end colostomies reduces parastomal herniation. Clinical outcomes should be audited and adverse events must be reported.
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Hérnia Ventral/terapia , Herniorrafia/métodos , Estomia/efeitos adversos , Estomas Cirúrgicos/efeitos adversos , Hérnia Ventral/diagnóstico , Hérnia Ventral/etiologia , Humanos , Laparoscopia , Telas CirúrgicasRESUMO
INTRODUCTION: Although many surgeons have adopted the use of biologic and biosynthetic meshes in complex abdominal wall hernia repair, others have questioned the use of these products. Criticism is addressed in several review articles on the poor standard of studies reporting on the use of biologic meshes for different abdominal wall repairs. The aim of this consensus review is to conduct an evidence-based analysis of the efficacy of biologic and biosynthetic meshes in predefined clinical situations. METHODS: A European working group, "BioMesh Study Group", composed of invited surgeons with a special interest in surgical meshes, formulated key questions, and forwarded them for processing in subgroups. In January 2016, a workshop was held in Berlin where the findings were presented, discussed, and voted on for consensus. Findings were set out in writing by the subgroups followed by consensus being reached. For the review, 114 studies and background analyses were used. RESULTS: The cumulative data regarding biologic mesh under contaminated conditions do not support the claim that it is better than synthetic mesh. Biologic mesh use should be avoided when bridging is needed. In inguinal hernia repair biologic and biosynthetic meshes do not have a clear advantage over the synthetic meshes. For prevention of incisional or parastomal hernias, there is no evidence to support the use of biologic/biosynthetic meshes. In complex abdominal wall hernia repairs (incarcerated hernia, parastomal hernia, infected mesh, open abdomen, enterocutaneous fistula, and component separation technique), biologic and biosynthetic meshes do not provide a superior alternative to synthetic meshes. CONCLUSION: The routine use of biologic and biosynthetic meshes cannot be recommended.
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Parede Abdominal/cirurgia , Abdominoplastia , Materiais Biocompatíveis , Produtos Biológicos , Hérnia Abdominal/cirurgia , Herniorrafia , Complicações Pós-Operatórias , Telas Cirúrgicas , Abdominoplastia/efeitos adversos , Abdominoplastia/instrumentação , Abdominoplastia/métodos , Materiais Biocompatíveis/efeitos adversos , Materiais Biocompatíveis/uso terapêutico , Produtos Biológicos/efeitos adversos , Produtos Biológicos/uso terapêutico , Consenso , Herniorrafia/efeitos adversos , Herniorrafia/instrumentação , Herniorrafia/métodos , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controleRESUMO
BACKGROUND: Laparoscopic ventral hernia repair is becoming a popular technique with good results and fast postoperative recovery. The mesh is placed directly under the peritoneum and anchored with transabdominal sutures and tacks. However, the ideal size of the mesh covering the hernia orifice is know, nor the ideal type or amount of tacks has to be described. METHODS: To assess the forces acting on a single tack, a mathematical model of the ventral hernia was created. The force was described in reference to the surface of the hernia orifice and the pressure in the abdominal cavity. The following different types of mesh were examined in vitro: Proceed (knitted mesh), Dual Mesh (expanded polytetrafluoroethylene [ePTFE] flat mesh), and Shelhigh (biologic flat mesh). The following different tacks also were examined: Protac, Anchor, and EMS. A pig model was used to measure the forces needed to destroy the connection between mesh and tissue and to describe the place of destruction (mesh, tissue, or tack) and the force needed. RESULTS: The force acting on a single tack proportionally depends on the surface of the hernia orifice and the pressure in the abdominal cavity. The force needed to disconnect the tissue and mesh reached 8.97 +/- 0.11 N for ProTac, 2.67 +/- 0.22 N for Anchor, and 6.67 +/- 1.32 N for EMS. These values do not allow the mesh to be held in the right position when the orifice exceeds 10 cm for Protac and EMS. The disconnection of the EMS and Protac junction damages the tissue. Anchor tacks are insufficient to hold the mesh and stay in the tissue CONCLUSIONS: In the case of small hernias (diameter<10 cm) EMS or ProTac used alone are not enough to hold the mesh. Anchor is not recommended alone in any hernia.
Assuntos
Hérnia Ventral/cirurgia , Laparoscopia , Telas Cirúrgicas , Suturas , Animais , Fenômenos Biomecânicos , Modelos Animais , Modelos Biológicos , SuínosRESUMO
BACKGROUND: Avoiding mesh fixation to the surrounding tissue in ventral hernioplasty would simplify the operation, decrease the time of the procedure, and decrease the risk of suture-related complications. METHODS: Four hospitals included 111 patients according to the common protocol for prospective clinical evaluation of sutureless ventral hernioplasty. Surgical technique involves placement of the polypropylene mesh with flat-shape memory in either the retromuscular or preperitoneal space without suture anchoring. RESULTS: Local complication rate was low (12.6%, 14 patients), postoperative pain measured according to the visual analogue scale was minimal (mean 4, range 1-8). Three recurrences (3%) were recorded. Mild scar discomfort, which did not require treatment nor limit physical activity, was recorded in 28 (25%), 18 (17%), and 11 (14%) patients at 6-month, 1- and 2-year follow-up, respectively. CONCLUSIONS: Results of the study suggest that the sutureless sublay technique is safe and effective in the treatment of ventral abdominal hernia, especially in small and medium defects.
Assuntos
Hérnia Ventral/cirurgia , Implantação de Prótese/métodos , Telas Cirúrgicas , Técnicas de Sutura/instrumentação , Suturas , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Resultado do TratamentoRESUMO
Although the mesh plug procedure is an effective operation, sutureless implantation of a single onlay mesh, if successful, would avoid the risks of plug-related complications. One hundred patients with primary inguinal hernias were randomized to undergo PerFix Plug or Hertra 1 implantation. Mean duration of the operation was similar, 38 versus 35 min for plug and onlay mesh implantation, respectively (nonsignificant, NS). The level of postoperative pain and early complication rate was similarly low in both groups (NS). Recurrence rate was the same-2 patients in each group (4%)-all following large hernia repair. The level of long-term discomfort was low after each type of operation (NS). Implantation of the onlay mesh-Hertra 1 as compared to the use of PerFix Plug is simple, safe, and equally effective in small and medium inguinal hernia repair, suggesting that a plug device is not necessary for successful hernia surgery.
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Hérnia Inguinal/cirurgia , Telas Cirúrgicas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
Peritoneal dialysis is becoming more and more common as a method of treating patients at the final stage of renal failure. In the year 2002 the number of patients treated with this method in Poland amounted to 1324. Studies have demonstrated that inguinal and abdominal hernias develop more frequently in chronic renal failure patients. The percentage of patients with hernia diagnosed within the first five years of dialysis is about 10%. Continuation of dialysis with the hernia condition left untreated may result in severe complications which are the third most frequent cause of converting treatment method into hemodialysis in PD patients. Currently in Poland there is no national standard in existence as to the management of hernias, and the only British standard from 1998 does not reflect the present expertise of either surgical treatment or dialysis methods. The aim of the current questionnaire based study investigating Polish peritoneal dialysis centers was to assess the treatment when hernia had been diagnosed in the PD patient. Of 49 dialysis centers in Poland, 39 do have protocols on managing the patient before and after the operation. A considerable diversity has been found as to surgical techniques used and the ways the patients are managed in hospital. Following the need expressed by 33 dialysis centers in Poland for some standard for relevant procedures, the authors formulated principles of modern hernia treatment in PD patients. Accordingly, the main principles include: 1) consulting a surgeon collaborating with the center before qualifying for peritoneal dialysis and when hernia symptoms have manifested; 2) Tension-free methods used in a treatment of choice (recommended by PHS); 3) Application of antibiotic prophylaxis (preferably first generation cephalosporin); 4) Induction of local or epidural anesthesia; 5) Peritoneal dialysis programme does not need to be discontinued but low volume dwells or preferably intermittent APD is recommended immediately after surgery.
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Hérnia Inguinal/etiologia , Hérnia Inguinal/terapia , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/normas , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Auditoria Médica , Polônia , Inquéritos e QuestionáriosRESUMO
Tension-free hernioplasty is performed using prosthetic material in one-half of hernia repair procedures in Poland but in 85% of those in the region of Pomerania. This questionnaire study of surgeons in Pomerania examined their sources of knowledge about and the factors influencing their choice of groin hernia surgery. The questionnaire was sent to surgeons from 19 hospitals and was answered by 109 (83% of hernia surgeons in the region). We analyzed their reported knowledge of particular operative techniques, factors important in selecting the technique (personal experience, trends in surgical center), and the available sources of information (e.g., medical literature, internet, information from teachers, sales representatives). All respondents reported being familiar with and able to perform tension-free techniques, but only 44% are influenced by their individual professional skills in selecting the technique. Another 44% base their decision on trends in their hospital, and only 22% consider the patient's preferences. The most frequently quoted sources of scientific information are articles in the medical literature and conference reports (90%). Only 8% of the respondents are governed in their professional work by information from pharmaceutical company representatives. Most surgeons (70%) would prefer to make a decision about using a new surgical technique after practical training sessions or workshops led by experienced colleagues. In contrast to common opinion, the information from sales representatives are of only minor importance compared to that of evidence-based data and attendance at workshops and courses.
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Tomada de Decisões , Herniorrafia , Implantação de Prótese/métodos , Atitude do Pessoal de Saúde , Humanos , Relações Interprofissionais , Pessoa de Meia-Idade , Satisfação do Paciente , Padrões de Prática Médica , Implantação de Prótese/normas , Estudos Retrospectivos , Telas Cirúrgicas , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The material and the surgical technique used to close an abdominal wall incision are important determinants of the risk of developing an incisional hernia. Optimising closure of abdominal wall incisions holds a potential to prevent patients suffering from incisional hernias and for important costs savings in health care. METHODS: The European Hernia Society formed a Guidelines Development Group to provide guidelines for all surgical specialists who perform abdominal incisions in adult patients on the materials and methods used to close the abdominal wall. The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and methodological guidance was taken from Scottish Intercollegiate Guidelines Network (SIGN). The literature search included publications up to April 2014. The guidelines were written using the AGREE II instrument. An update of these guidelines is planned for 2017. RESULTS: For many of the Key Questions that were studied no high quality data was detected. Therefore, some strong recommendations could be made but, for many Key Questions only weak recommendations or no recommendation could be made due to lack of sufficient evidence. RECOMMENDATIONS: To decrease the incidence of incisional hernias it is strongly recommended to utilise a non-midline approach to a laparotomy whenever possible. For elective midline incisions, it is strongly recommended to perform a continuous suturing technique and to avoid the use of rapidly absorbable sutures. It is suggested using a slowly absorbable monofilament suture in a single layer aponeurotic closure technique without separate closure of the peritoneum. A small bites technique with a suture to wound length (SL/WL) ratio at least 4/1 is the current recommended method of fascial closure. Currently, no recommendations can be given on the optimal technique to close emergency laparotomy incisions. Prophylactic mesh augmentation appears effective and safe and can be suggested in high-risk patients, like aortic aneurysm surgery and obese patients. For laparoscopic surgery, it is suggested using the smallest trocar size adequate for the procedure and closure of the fascial defect if trocars larger or equal to 10 mm are used. For single incision laparoscopic surgery, we suggest meticulous closure of the fascial incision to avoid an increased risk of incisional hernias.
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Parede Abdominal/cirurgia , Técnicas de Fechamento de Ferimentos Abdominais , Hérnia Ventral/prevenção & controle , Adulto , Feminino , Hérnia Ventral/diagnóstico , Hérnia Ventral/etiologia , Humanos , Laparoscopia/efeitos adversos , Laparotomia/efeitos adversos , Masculino , Telas Cirúrgicas , Técnicas de Sutura , SuturasRESUMO
In the period of 1984-1996, 569 patients were treated for acute pancreatitis and 37 of them (6.5%) developed infected pancreatic necrosis (IPN). All these patients were submitted to repeated laparotomies according to Bradley's procedure. The IPN was caused by: bile duct stones--in 11 cases, alcohol abuse-14, ERCP-6, trauma-1, in 6 cases the etiology was cryptogenic. The accuracy of imaging tests was: USG-62%, CT-100%. Sepsis was present in all cases, and multiorgan insufficiency-in 25 patients. Hospital mortality was 30% (11 patients). The most frequent reason of death was multiorgan insufficiency. The actuarial survival was 26 patients (70%).
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Pancreatite Necrosante Aguda/cirurgia , Doença Aguda , Adulto , Idoso , Alcoolismo/complicações , Doenças dos Ductos Biliares/complicações , Colelitíase/complicações , Mortalidade Hospitalar , Humanos , Laparotomia , Pessoa de Meia-Idade , Pancreatite/complicações , Pancreatite/cirurgia , Pancreatite Necrosante Aguda/etiologia , Pancreatite Necrosante Aguda/mortalidade , Reoperação , Taxa de SobrevidaRESUMO
PURPOSE: A classification of parastomal hernias (PH) is needed to compare different populations described in various trials and cohort studies, complete the previous inguinal and ventral hernia classifications of the European Hernia Society (EHS) and will be integrated into the EuraHS database (European Registry of Abdominal Wall Hernias). METHODS: Several members of the EHS board and invited experts gathered for 2 days to discuss the development of an EHS classification of PH. The discussions were based on a literature review and critical appraisal of existing classifications. RESULTS: The classification proposal is based on the PH defect size (small is ≤5 cm) and the presence of a concomitant incisional hernia (cIH). Four types were defined: Type I, small PH without cIH; Type II, small PH with cIH; Type III, large PH without cIH; and Type IV, large PH with cIH. In addition, the classification grid includes details about whether the hernia recurs after a previous PH repair or whether it is a primary PH. Clinical validation is needed in the future to assess if the classification allows us to differentiate the treatment strategy and if the classification impacts outcome in these different subgroups. CONCLUSION: A classification of PH divided into subgroups according to size and cIH was formulated with the aim of improving the ability to compare different studies and their results.
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Hérnia Abdominal/classificação , Estomas Cirúrgicos/efeitos adversos , Colostomia/efeitos adversos , Europa (Continente) , Hérnia Abdominal/etiologia , Hérnia Inguinal/classificação , Hérnia Ventral/classificação , Humanos , Ileostomia/efeitos adversos , Sistema de Registros , Sociedades Médicas , Derivação Urinária/efeitos adversosRESUMO
PURPOSE: In 2009, the European Hernia Society published the EHS Guidelines for the Treatment of Inguinal Hernia in Adult Patients. The Guidelines contain recommendations for the treatment of inguinal hernia from diagnosis till aftercare. The guidelines expired January 1, 2012. To keep them updated, a revision of the guidelines was planned including new level 1 evidence. METHODS: The original Oxford Centre for Evidence-Based Medicine ranking was used. All relevant level 1A and level 1B literature from May 2008 to June 2010 was searched (Medline and Cochrane) by the Working Group members. All chapters were attributed to the two responsible authors in the initial guidelines document. One new chapter on fixation techniques was added. The quality was assessed by the Working Group members during a 2-day meeting and the data were analysed, especially with respect to any change in the level and/or text of any of the conclusions or recommendations of the initial guidelines. In the end, all relevant references published until January 1, 2013 were included. The final text was approved by all Working Group members. RESULTS: For the following topics, the conclusions and/or recommendations have been changed: indications for treatment, treatment of inguinal hernia, day surgery, antibiotic prophylaxis, training, postoperative pain control and chronic pain. The addendum contains all current level 1 conclusions, Grade A recommendations and new Grade B recommendations based on new level 1 evidence (with the changes in bold). CONCLUSIONS: Despite the fact that the Working Group responsible for it tried to represent most kinds of surgeons treating inguinal hernias, such general guidelines inevitably must be fitted to the daily practice of every individual surgeon treating his/her patients. There is no doubt that the future of guideline implementation will strongly depend on the development of easy to use decision support algorithms tailored to the individual patient and on evaluating the effect of guideline implementation on surgical outcome. At the 35th International Congress of the EHS in Gdansk, Poland (May 12-15, 2013), it was decided that the EHS, IEHS and EAES will collaborate from now on with the final goal to publish new joint guidelines, most likely in 2015.
Assuntos
Hérnia Inguinal/diagnóstico , Hérnia Inguinal/cirurgia , Herniorrafia/normas , Telas Cirúrgicas , Adulto , Anestesia/normas , Antibioticoprofilaxia , Competência Clínica , Endoscopia , Europa (Continente) , Medicina Baseada em Evidências , Feminino , Herniorrafia/economia , Humanos , Masculino , Dor Pós-Operatória/prevenção & controle , RecidivaRESUMO
BACKGROUND: This paper describes an investigation of biomechanical behaviour of hernia repair, which is focused on the selection of safe linking of certain type of implant with fascia in laparoscopic operation. The strength of various fixations of the implant to the fascia is analysed. METHODS: The research is based on experimental observations of operated hernia model behaviour during a dynamic impulse load corresponding to post-operative cough. Fifty seven different types of models of implanted mesh are considered. Five types of implants and five types of connectors are used. Mechanical properties of the implants as well as limit tearing forces of joints are identified in uni-axial tensile tests. Mathematical model of implanted mesh based on finite element method is proposed. The identified mechanical properties of the materials are applied and the model is calibrated using quantities measured during experiments. FINDINGS: The presented results point at trans-abdominal sutures and ProTacks (connectors) and at DynaMesh (implant) as the most reliable materials used in ventral hernia operation, in the tested materials group. Desired properties of implants seem to be: elastic properties similar to the properties of tissues and high local strength, as fixation have a local character. The proposed mathematical model can be applied to simulate real behaviour of an implant with appropriate accuracy and to estimate the number of tacks for the implantation of hernia meshes. INTERPRETATION: The presented results may help in the deeper understanding of the fascia-mesh system behaviour, and thus may lead to improve the fixation methods.
Assuntos
Hérnia Ventral/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Modelos Teóricos , Animais , Bioprótese , Calibragem , Fasciotomia , Herniorrafia/instrumentação , Humanos , Próteses e Implantes , Telas Cirúrgicas , Suturas , Suporte de CargaRESUMO
BACKGROUND: The literature dealing with abdominal wall surgery is often flawed due to lack of adherence to accepted reporting standards and statistical methodology. MATERIALS AND METHODS: The EuraHS Working Group (European Registry of Abdominal Wall Hernias) organised a consensus meeting of surgical experts and researchers with an interest in abdominal wall surgery, including a statistician, the editors of the journal Hernia and scientists experienced in meta-analysis. Detailed discussions took place to identify the basic ground rules necessary to improve the quality of research reports related to abdominal wall reconstruction. RESULTS: A list of recommendations was formulated including more general issues on the scientific methodology and statistical approach. Standards and statements are available, each depending on the type of study that is being reported: the CONSORT statement for the Randomised Controlled Trials, the TREND statement for non randomised interventional studies, the STROBE statement for observational studies, the STARLITE statement for literature searches, the MOOSE statement for metaanalyses of observational studies and the PRISMA statement for systematic reviews and meta-analyses. A number of recommendations were made, including the use of previously published standard definitions and classifications relating to hernia variables and treatment; the use of the validated Clavien-Dindo classification to report complications in hernia surgery; the use of "time-to-event analysis" to report data on "freedom-of-recurrence" rather than the use of recurrence rates, because it is more sensitive and accounts for the patients that are lost to follow-up compared with other reporting methods. CONCLUSION: A set of recommendations for reporting outcome results of abdominal wall surgery was formulated as guidance for researchers. It is anticipated that the use of these recommendations will increase the quality and meaning of abdominal wall surgery research.