Estudio prospectivo y aleatorizado de los resultados a largo plazo de la hernioplastia inguinal con malla autoadhesiva frente a la técnica convencional con malla de polipropileno y sutura de fijación / Prospective randomized trial of long-term results of inguinal hernia repair using autoadhesive mesh compared to classic Lichtenstein technique with sutures and polypropylene mesh

INTRODUCCIÓN: Las mallas autoadhesivas se plantean como una alternativa para disminuir el dolor crónico y las recidivas en la hernioplastia inguinal. Pretendemos determinar si el empleo de estas mallas representa algún beneficio en el resultado a largo plazo en comparación con la técnica clásica de Lichtenstein fijando la malla con suturas. MATERIAL Y MÉTODOS: Estudio prospectivo y aleatorizado de pacientes intervenidos de hernia inguinal entre marzo de 2009 y marzo del 2010, incluyendo en el grupo autoadhesivo (AA) 45 individuos en los que se realizó la hernioplastia con malla autoadhesiva y en el grupo Lichtenstein clásico (LC) otros 45 utilizando una malla de polipropileno fijada con sutura monofilar. Se evaluaron tiempo de inactividad, posibles complicaciones, recidivas y grado de dolor al año de la intervención. RESULTADOS: La edad media del grupo AA fue de 60 años frente a los 49 del grupo LC. En ambos, la mayor parte eran varones sin diferencias en las comorbilidades asociadas, siendo el tamaño medio del defecto herniario de 3 cm; en torno al 60% de las hernias eran indirectas. Al año de la intervención, 39 pacientes fueron evaluados en el grupo LC y 38 en el AA. La mediana del tiempo de recuperación de la actividad diaria normal fue de 15 días en ambos grupos. En el grupo AA, el 86,8% estaban asintomáticos, ninguno presentó recidiva herniaria ni precisó tomar analgésicos de forma continua, siendo la mediana del grado de dolor de 0. En el grupo LC, el 87,2% permanecían asintomáticos, un paciente (2,6%) presentó una recidiva y un paciente (2,6%) requería la toma continua de analgésicos por dolor intenso, siendo la mediana de dolor de 0. No hubo mortalidad ni otras complicaciones a largo plazo. CONCLUSIÓN: El empleo de mallas autoadhesivas y parcialmente reabsorbibles en la reparación de la hernia inguinal no presenta diferencias significativas en recuperación, dolor ni complicaciones postoperatorias a largo plazo frente a la hernioplastia con malla de polipropileno fijada con sutura monofilar

INTRODUCTION: The use of autoadhesive meshes with hooks that allow fixation without sutures is a therapeutic alternative to decrease recurrence and chronic pain after inguinal hernia repair. The aim of this study was to evaluate if this kind of mesh has any advantage in long term results in comparison with the classic Lichtenstein technique with sutures and polypropylene mesh. MATERIAL AND METHODS: We report a prospective and randomized study of patients who have been operated on for inguinal hernia between march of 2009 to march 2010, divided into 2 groups of 45 patients. In AutoAdhesive (AA) group, we included patients operated on with an autoadhesive mesh and in Classic Lichtenstein (CL) group we included cases with an inguinal hernioplasty with sutured polypropylene mesh. We evaluated time of inactivity, complications, recurrences and grade of pain after one year. RESULTS: The mean age was 60 years in AA group and 49 in LC group. There were more men than women and there were no differences in co-morbilities between groups. The mean size of hernia orifice was 3 cm in both groups and 60% of the hernias were indirect. After one year, 77 patients were evaluated; 39 in LC group and 38 in AA group. 86,8% and 87,2% of them were asymptomatic. The mean time of recovery of daily activities was 15 days in both groups. There were neither recurrences nor severe chronic pain in the AA group. The mean of grade of pain was 0 (range:0-4) in AA group and 0 (range: 0-5) in LC group. In this group, there was one recurrence and one patient was taking analgesics for intense pain. No mortality nor other long term complications were found. CONCLUSION: The use of autoadhesive and parcial reabsorbible meshes in inguinal hernia repair has no effect on recovery of daily activities, postoperative pain and long term complications compared with hernioplasty with polypropylene mesh fixed with monofilament suture

Endometrioma hepático. Actualización y nuevos abordajes / Hepatic endometrioma. An update and new approaches

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[Prospective randomized trial of long-term results of inguinal hernia repair using autoadhesive mesh compared to classic Lichtenstein technique with sutures and polypropylene mesh]. / Estudio prospectivo y aleatorizado de los resultados a largo plazo de la hernioplastia inguinal con malla autoadhesiva frente a la técnica convencional con malla de polipropileno y sutura de fijación.

INTRODUCTION: The use of autoadhesive meshes with hooks that allow fixation without sutures is a therapeutic alternative to decrease recurrence and chronic pain after inguinal hernia repair. The aim of this study was to evaluate if this kind of mesh has any advantage in long term results in comparison with the classic Lichtenstein technique with sutures and polypropylene mesh. MATERIAL AND METHODS: We report a prospective and randomized study of patients who have been operated on for inguinal hernia between march of 2009 to march 2010, divided into 2 groups of 45 patients. In AutoAdhesive (AA) group, we included patients operated on with an autoadhesive mesh and in Classic Lichtenstein (CL) group we included cases with an inguinal hernioplasty with sutured polypropylene mesh. We evaluated time of inactivity, complications, recurrences and grade of pain after one year. RESULTS: The mean age was 60 years in AA group and 49 in LC group. There were more men than women and there were no differences in co-morbilities between groups. The mean size of hernia orifice was 3cm in both groups and 60% of the hernias were indirect. After one year, 77 patients were evaluated; 39 in LC group and 38 in AA group. 86,8% and 87,2% of them were asymptomatic. The mean time of recovery of daily activities was 15 days in both groups. There were neither recurrences nor severe chronic pain in the AA group. The mean of grade of pain was 0 (range:0-4) in AA group and 0 (range: 0-5) in LC group. In this group, there was one recurrence and one patient was taking analgesics for intense pain. No mortality nor other long term complications were found. CONCLUSION: The use of autoadhesive and parcial reabsorbible meshes in inguinal hernia repair has no effect on recovery of daily activities, postoperative pain and long term complications compared with hernioplasty with polypropylene mesh fixed with monofilament suture.

Alteraciones metabólicas tras cirugía de la obesidad mórbida mediante la técnica del cruce duodenal. Seguimiento a largo plazo / Metabolic changes after morbid obesity surgery using the duodenal switch technique. Long term follow-up

Introducción La técnica del cruce duodenal (CD) es considerada una cirugía compleja y con serias complicaciones metabólicas por su carácter malabsortivo, lo que hace que su uso no se haya extendido entre los cirujanos bariátricos. A pesar de ello la consideramos una técnica adecuada en superobesos. Pacientes y métodos Estudio prospectivo de 110 pacientes con obesidad mórbida intervenidos consecutivamente con la técnica del CD y seguidos durante un período mínimo de cuatro años tras la cirugía. Hemos evaluado la pérdida de peso, evolución de las comorbilidades y las complicaciones metabólicas. Resultados La pérdida del exceso de peso fue superior al 50% en el 75% de los pacientes después de 12 meses de seguimiento. Un total de 68 pacientes (75,5%) experimentaron completa corrección de las comorbilidades que presentaban. Las alteraciones metabólicas más frecuentes fueron el déficit de hierro y la elevación de la PTH. Conclusiones El CD es una técnica segura y eficaz para el tratamiento de la obesidad mórbida, con buenos resultados ponderales, elevado porcentaje de remisión de las comorbilidades, morbimortalidad similar a otras técnicas y con alteraciones nutricionales corregibles y por tanto asumibles (AU)

Introduction The duodenal switch (DS) technique is considered to be complex surgery with a series of metabolic complications due to its malabsorptive character. For these reasons, it has not been extensively used by bariatric surgeons. Despite this, we consider it to be a suitable technique for the grossly obese. Patients and methods A retrospective study was performed on 110 patients with morbid obesity operated on using the DS technique and who were followed up for a minimum period of four years after surgery. We evaluated the weight loss, the outcomes of the comorbidities, and the metabolic complications. Results The loss of excess weight was greater than 50% in 75% of the patients after 12 months follow up. The comorbidities suffered by 68 patients (75.5%) were completely resolved. The most frequent metabolic complications were iron (Fe) deficiency and an increased parathyroid hormone (PTH).Conclusions DS is a safe and effective technique for the treatment of morbid obesity, with good weight loss results, a high percentage of remission of the comorbidities, a similar morbidity and mortality to other techniques, and with correctable nutritional changes, and thus acceptable (AU)

[Metabolic changes after morbid obesity surgery using the duodenal switch technique. Long term follow-up]. / Alteraciones metabólicas tras cirugía de la obesidad mórbida mediante la técnica del cruce duodenal. Seguimiento a largo plazo.

INTRODUCTION: The duodenal switch (DS) technique is considered to be complex surgery with a series of metabolic complications due to its malabsorptive character. For these reasons, it has not been extensively used by bariatric surgeons. Despite this, we consider it to be a suitable technique for the grossly obese. PATIENTS AND METHODS: A retrospective study was performed on 110 patients with morbid obesity operated on using the DS technique and who were followed up for a minimum period of four years after surgery. We evaluated the weight loss, the outcomes of the comorbidities, and the metabolic complications. RESULTS: The loss of excess weight was greater than 50% in 75% of the patients after 12 months follow up. The comorbidities suffered by 68 patients (75.5%) were completely resolved. The most frequent metabolic complications were iron (Fe) deficiency and an increased parathyroid hormone (PTH). CONCLUSIONS: DS is a safe and effective technique for the treatment of morbid obesity, with good weight loss results, a high percentage of remission of the comorbidities, a similar morbidity and mortality to other techniques, and with correctable nutritional changes, and thus acceptable.

Utilización de mallas autoadhesivas en la hernioplastia frente a la técnica convencional. Resultados de un estudio prospectivo y aleatorizado / Use of adhesive mesh in hernioplasty compared to the conventional technique. Results of a randomised prospective study

Introducción: El empleo de mallas confeccionadas con materiales reabsorbibles y estructuras que las permiten fijarse al tejido sin suturas, se plantea como posibilidad terapéutica en la hernioplastia inguinal, disminuyendo tiempos quirúrgicos y mejorando supuestamente dolor y recuperación postoperatoria. Material y métodos: Estudio prospectivo y aleatorizado de pacientes intervenidos de hernia inguinal unilateral entre marzo de 2009 y marzo de 2010. En el grupo AutoAdhesiva (AA) se incluyeron los sometidos a hernioplastia inguinal con malla autoadhesiva (Parietene Progrip®) y en el grupo Lichtenstein clásico (LC) aquellos sometidos a hernioplastia con malla de polipropileno fijada con sutura monofilar. Durante 7 días postoperatorios se evaluaron las complicaciones y el dolor mediante la escala visual analógica. Resultados: Un total de 90 pacientes fueron divididos en 2 grupos de 45. La edad media fue de 60 y 49 años, siendo, en ambos, el tamaño medio del defecto herniario de 3cm y aproximadamente un 60% hernias indirectas. El tiempo de colocación de la malla y el quirúrgico global fue menor en el grupo AA frente al LC: 56 segundos frente a 3minutos y 52 segundos y 17minutos y 45 segundos frente a los 20minutos con 10 segundos respectivamente. No hubo diferencias en estancia hospitalaria, analgesia, complicaciones ni dolor postoperatorio. Conclusión: El empleo de este tipo de mallas disminuye el tiempo de colocación de la prótesis y el quirúrgico total, sin efecto en el dolor y complicaciones postoperatorias recoces frente a la hernioplastia con malla de polipropileno fijada con sutura monofilar (AU)

Introduction: The use of meshes made with reabsorbable materials and structures that allow them to be fixed to the tissue without sutures, is considered as a therapeutic possibility in inguinal hernioplasty, reducing surgical times and supposedly improving pain and post-operative recovery. Material and methods: A prospective randomised study of patients intervened for inguinal hernia between March 2009 and March 2010. Those patients subjected to hernia repair with a self-adhesive mesh (Parietene Progrip®) were placed in the in the SA (self-adhesive) group, and those subjected to hernia repair with a polypropylene mesh fixed with a monofilament suture in the CL (Classic Lichenstein) group. Complications and pain, using the visual analogue scale, were evaluated over 7 days. Results: A total of 90 patients were divided into 2 groups of 45. The mean age was 60 y and 49 years, respectively, with the mean size of the hernia defect being 3cm, and approximately 60% were indirect hernias. The time of fixing the mesh and the overall surgery time was lower in the SA group than in the LC group: 56s versus 3min and 52s, and 17min and 45s versus 20min and 10s, respectively. There were no differences in hospital stay, complications or post-operative pain. Conclusion: The use of this type of mesh reduces the time of fixing the prosthesis and the total surgical time, with no effect on early post-operative pain or surgical complications compared to hernioplasty with a polypropylene mesh fixed with a monofilament suture (AU)

[Use of adhesive mesh in hernioplasty compared to the conventional technique. Results of a randomised prospective study]. / Utilización de mallas autoadhesivas en la hernioplastia frente a la técnica convencional. Resultados de un estudio prospectivo y aleatorizado.

INTRODUCTION: The use of meshes made with reabsorbable materials and structures that allow them to be fixed to the tissue without sutures, is considered as a therapeutic possibility in inguinal hernioplasty, reducing surgical times and supposedly improving pain and post-operative recovery. MATERIAL AND METHODS: A prospective randomised study of patients intervened for inguinal hernia between March 2009 and March 2010. Those patients subjected to hernia repair with a self-adhesive mesh (Parietene Progrip(®)) were placed in the in the SA (self-adhesive) group, and those subjected to hernia repair with a polypropylene mesh fixed with a monofilament suture in the CL (Classic Lichenstein) group. Complications and pain, using the visual analogue scale, were evaluated over 7 days. RESULTS: A total of 90 patients were divided into 2 groups of 45. The mean age was 60 y and 49 years, respectively, with the mean size of the hernia defect being 3cm, and approximately 60% were indirect hernias. The time of fixing the mesh and the overall surgery time was lower in the SA group than in the LC group: 56s versus 3min and 52s, and 17min and 45s versus 20min and 10s, respectively. There were no differences in hospital stay, complications or post-operative pain. CONCLUSION: The use of this type of mesh reduces the time of fixing the prosthesis and the total surgical time, with no effect on early post-operative pain or surgical complications compared to hernioplasty with a polypropylene mesh fixed with a monofilament suture.