Results of a Prospective Cohort Study on Open Rives Technique of the Midline Incisional Hernia: Midline Closure and Mesh Overlap.

Background. Rives repair has been traditionally used for large abdominal wall defects with good results on terms of recurrence. However, it is limited by the lateral border of the posterior rectus sheath. The objective of our study was to evaluate recurrence rate, midline closure and mesh overlap in patients operated on elective midline incisional hernia by open Rives retromuscular repair. Methods. This is a prospective observational study of 83 patients who underwent elective open Rives technique between January 2014 and December 2018. Main inclusion criteria were adults with a midline incisional hernia. Recurrence, midline closure and mesh overlap were determined. Results. At a median postoperative follow-up of 32 (5-59) months, 8 cases of recurrence were reported. Patients with recurrence had wider hernia defects (101 ± 52 mm vs 66 ± 36 mm, P = .014) and were repaired with wider meshes (191 ± 93 mm vs 137 ± 68 mm, P = .042). However, although it was not statistically significant, midline closure was lower (38% vs 59%), as well as the overlapping relationship between mesh area and hernia defect area (2.937:1 vs 3.732:1) on patients that developed a recurrence. Conclusions. Rives technique provides good mid-term results in a midline incisional hernia (10% of recurrence at 36 months), including wider hernias in the recurrent cohort. The authors believe that other techniques which allow midline closure and placement of bigger meshes should be considered, especially in those hernias classified as W3 on EuraHS classification (more than 10 cm on width size).

Impact of Surgical Site Infections on Elective Incisional Hernia Surgery: A Prospective Study.

BACKGROUND: Although incisional hernia repair is classified as a clean surgery, it still has a high incidence of surgical site infection (SSI) (0.7%-26.6%). The presence of an SSI could increase early recurrence rates after incisional hernia repair. PATIENTS AND METHODS: Patients undergoing elective incisional hernia repair with no bowel contamination between January and December 2015 were assessed prospectively. Demographic and surgical data, local post-operative complications, and one-year recurrence rates in patients with and without SSI were compared. The management of SSI was determined. RESULTS: Patients with SSI (16/101) showed more prolonged surgical procedures (91 ± 39 vs. 63 ± 30 min, p = 0.012), more post-operative sero-hematomas (38% vs. 8%, p = 0.001), and a higher one-year recurrence rate (19% vs. 4%, p = 0.047). Multivariable analysis revealed the only identified risk factor for SSI to be post-operative sero-hematomas (p = 0.042; odds ratio [OR] = 4.17 [1.05-16.54]). Patients who developed an SSI required antibiotic agents and daily treatment from one to five months. One of these required the removal of the mesh. CONCLUSIONS: Surgical site infection rates are high for incisional hernia surgery (16%), and associated with local complications. Surgical site infection requires long-term treatments and leads to a higher one-year recurrence rate.

El impacto de la planificación familiar sobre la salud reproductiva / Impact of family planning in reproductive health

La salud reproductiva o salud sexual, según se prefiera, es una característica que los países pueden y deben promover con entusiasmo por su benéfico impacto sobre individuos y familias y para alcanzarla, no puede haber duda que una planificación familiar variada, accesible y voluntaria es uno de los componentes insustituibles. Para el autor del presente artículo las premisas en las que debe basarse toda acción social en busca de la salud reproductiva son las siguientes: 1. La sociedad acepta que las mujeres al igual que los hombres tiene derecho de disfrutar del sexo sin que ello lleve, necesariamente, a la reproducción, además que la unión, con o sin matrimonio constituye una relación entre iguales basada en el respeto mutuo y en obligaciones compartidas. 2. Una sexualidad y una reproducción saludables requieren información suficiente y atención adecuada desde los primeros años de vida, sin discriminación sexual por parte de nadie. 3. Los servicios de salud deben valorar a la mujer como ser humano sin inferioridad biológica o social ninguna frente al varón. 4. La mujer debe en todo momento disponer a su gusto de su propia reproducción y, en caso de realizarla, de determinar su oportunidad. 5. Dentro de lo posible y razonable se procurará que el embarazo, lactancia y crianza interfieran lo menos posible con las otras ocupaciones y aspiraciones lícitas de la mujer.