Repair of large incisional hernias. To drain or not to drain. Randomized clinical trial

ABSTRACT PURPOSE: To evaluate the occurrence of seroma and surgical wound infection after surgery. METHODS: A total of 42 individuals with large incisional hernias were subjected toonlay mesh repair. Following the mesh placement, the participants were randomly allocated to two groups. In group 1, closed-suction drains were placed in the subcutaneous tissue, while progressive tension sutures were performed in group 2. The participants were subjected to clinical and ultrasound assessment to detect seroma and surgical wound infection at three time-points after surgery. RESULTS: The occurrence of seroma at the early, intermediate or late assessments was respectively 19.0%, 47.6%, 52.4% in group 1 and 28.6%, 57.1%, 42.9% in group 2 and was not significantly different between groups (p 0.469; 0.631; 0.619). Surgical wound infection occurred 19% in group 1 and 23.8% in group 2, without a significant difference between the groups (p>0.999). CONCLUSION: The frequency of seroma and infection did not exhibit significant differences between individuals subjected to onlay mesh repair of large incisional hernias with drains or progressive tension sutures without drainage.

Endoanal pilonidal sinus: case report and literature review / Cisto pilonidal endoanal: relato de caso e revisão de literatura

ABSTRACT: Pilonidal sinus is a term first used by Hodges in 1880 to describe granulomatous lesions containing hairs in its interior. The presence of endoanal pilonidal sinus is rare and only nine cases have been reported in medical literature. This article describes a male, 42 years, initially submitted to fistulotomy with seton placement that four years later evolved with complaints of anal purulent discharge associated with painful anal groin. During the first evaluation a small endoanal tumor was found. It was located in posterolateral anus position and contained hair in its interior, without purulent discharge at that moment. Underwent surgery that confirmed the presence of endoanal pilonidal sinus. The sinus was opened and left to heal by secondary intention. The patient had good outcome with no signs of recurrence. (AU)

RESUMO: O termo cisto pilonidal foi descrito pela primeira vez por Hodges em 1880 para descrever lesões granulomatosas contendo pêlos em seu interior. A presença de cisto pilonidal endoanal é rara e existem apenas nove casos relatados na literatura médica. Descreve-se um caso masculino, 42 anos, em acompanhamento há 5 anos no serviço. Submetido inicialmente à fistulostomia em dois tempos com sedenho, evoluindo 4 anos depois com queixas de secreção purulenta intermitente por via anal associada a presença de tumoração dolorosa. No exame físico constatou-se presença de orifício contendo pêlos em seu interior, sem secreção purulenta no momento do exame. Foi encaminhado para tratamento cirúrgico que confirmou diagnóstico de cisto pilonidal endoanal. No procedimento foi realizada abertura do cisto que foi deixado para cicatrizar por segunda intenção. O paciente apresentou boa evolução, sem sinais de recidiva local. (AU)

Repair of large incisional hernias. To drain or not to drain. Randomized clinical trial.

PURPOSE: To evaluate the occurrence of seroma and surgical wound infection after surgery. METHODS: A total of 42 individuals with large incisional hernias were subjected toonlay mesh repair. Following the mesh placement, the participants were randomly allocated to two groups. In group 1, closed-suction drains were placed in the subcutaneous tissue, while progressive tension sutures were performed in group 2. The participants were subjected to clinical and ultrasound assessment to detect seroma and surgical wound infection at three time-points after surgery. RESULTS: The occurrence of seroma at the early, intermediate or late assessments was respectively 19.0%, 47.6%, 52.4% in group 1 and 28.6%, 57.1%, 42.9% in group 2 and was not significantly different between groups (p 0.469; 0.631; 0.619). Surgical wound infection occurred 19% in group 1 and 23.8% in group 2, without a significant difference between the groups (p>0.999). CONCLUSION: The frequency of seroma and infection did not exhibit significant differences between individuals subjected to onlay mesh repair of large incisional hernias with drains or progressive tension sutures without drainage.