Use of botulinum toxin type A in the prehabilitation of abdominal wall musculature for hernia repair: a consensus proposal.

The prehabilitation of the abdominal wall through the infiltration of botulinum toxin type A, which induces temporary chemical denervation ("chemical component separation") in the lateral abdominal musculature, is a common practice in units specialized in abdominal wall surgery. However, its use for this indication is currently off-label. The main objective of this article is to describe a consensus proposal regarding indications, contraindications, dosages employed, potential side effects, administration method, and measurement of possible outcomes. Additionally, a proposal for an informed consent document endorsed by the Abdominal Wall Section of the Spanish Association of Surgeons is attached.

Preoperative renal embolisation in patients with polycystic kidney disease requiring incisional hernia repair after renal transplantation.

In the same way that renal transcatheter arterial embolisation (TAE) has demonstrated its effectiveness and safety compared with nephrectomy of the polycystic kidney at the time of transplantation, we propose that TAE can be a minimally invasive option in the surgical preparation for incisional hernia repair in order to reduce the compressive effect of the polycystic kidney, creating space and ensuring safe hernia repair. The objective of this article is to describe the first case in which TAE is used in advance of incisional hernia secondary to renal transplantation in patients with autosomal dominant polycystic kidney disease.

Encuesta nacional a unidades de cirugía colorrectal sobre el cierre de pared abdominal / National survey of colorectal surgery units on abdominal wall closure

Introducción: El objetivo de este estudio es valorar el estado actual y conocimiento de los cirujanos colorrectales españoles en el cierre de pared abdominal. Métodos: Se realizó un cuestionario de 25 preguntas cerradas de respuesta única utilizando un software específico para encuestas online que se distribuyó a cirujanos que se dedican, principalmente, a la cirugía colorrectal en su servicio o pertenecen a una Unidad de Cirugía Colorrectal. Resultados: Respondieron la encuesta 53 cirujanos. La mayoría prefiere el cierre de la laparotomía media con una sutura continua (96,23%) de monofilamento de absorción muy lenta (67,92%) en un solo plano (81,13%). Los puntos en masa, los sistemas de retención y las suturas loop siguen utilizándose. El calibre de sutura habitualmente más utilizado fue del 1 USP (United States Pharmacopeia) (58,49%). La aguja más utilizada es de cuerpo cilíndrico y punta trocar. Solo el 50% realiza habitualmente cierre de la pared tras colocación de un trocar igual o mayor de 10mm. Prácticamente todos conocen la regla del 4:1 y creen que se debe aplicar, pero la técnica de puntos cortos no se realiza. El 50% no colocaría nunca una prótesis profiláctica. El cierre lo suele realizar el mismo cirujano que ha llevado a cabo todo el procedimiento. Uno de cada 5 confiesa desconocer la tasa de hernias incisionales de su unidad. Conclusiones: Se evidencia una falta de consenso y conocimientos básicos en cuanto a los aspectos técnicos de cierre y a la prevención de la aparición de hernias incisionales. Parece aceptado el uso de sutura continua, en un solo plano, con sutura monofilamento de reabsorción lenta. (AU)

Introduction: The purpose of this study is to assess the current status and knowledge of the Spanish colorectal surgeons on the wall closure. Methods: A single answer questionnaire of 25 closed questions was conducted using specific software for online surveys that was distributed to a cohort of colorectal surgeons. Results: 53 surgeons replied to the survey. The vast majority prefer a closure of the midlaparotomy with a very slow absorbing monofilament (67,92%) continuous suture (96,23%) in a single plane (81,13%). Mass stitches, retention systems, and loop sutures continue to be used. The most commonly used suture gauge was USP 1 (United States Pharmacopeia) (58,49%). The most commonly used needle is with a cylindrical body and a trocar tip. Only 50%, routinely perform wall closure after placement of a trocar equal to or greater than 10mm. Almost everyone knows the 4: 1 rule and thinks it should be applied, but the small bites technique is not performed. 50% would never place a prophylactic prosthesis. The closure is usually performed by the same surgeon who has performed the entire procedure. One out of five confesses not knowing the rate of incisional hernias in his unit. Conclusion: There is a lack of consensus and basic knowledge regarding the technical aspects of closure and the prevention of the appearance of incisional hernias. The use of slow absorbing monofilament continuous suture in a single plane seems well accepted. (AU)

National survey of colorectal surgery units on abdominal wall closure.

INTRODUCTION: The purpose of this study is to assess the current status and knowledge of the Spanish colorectal surgeons on the wall closure. METHODS: A single answer questionnaire of 25 closed questions was conducted using specific software for online surveys that was distributed to a cohort of colorectal surgeons. RESULTS: 53 surgeons replied to the survey. The vast majority prefer a closure of the midlaparotomy with a very slow absorbing monofilament (67.92%) continuous suture (96.23%) in a single plane (81.13%). Mass stitches, retention systems, and loop sutures continue to be used. The most commonly used suture gauge was USP 1 (United States Pharmacopeia) (58.49%). The most commonly used needle is with a cylindrical body and a trocar tip. Only 50%, routinely perform wall closure after placement of a trocar equal to or greater than 10 mm. Almost everyone knows the 4:1 rule and thinks it should be applied, but the small bites technique is not performed. 50% would never place a prophylactic prosthesis. The closure is usually performed by the same surgeon who has performed the entire procedure. One out of five confesses not knowing the rate of incisional hernias in his unit. CONCLUSION: There is a lack of consensus and basic knowledge regarding the technical aspects of closure and the prevention of the appearance of incisional hernias. The use of slow absorbing monofilament continuous suture in a single plane seems well accepted.

The inguinal hernia management in Costa Rica according to a survey between surgeons: result comparison with 2018 International Groin Hernia Guidelines.

BACKGROUND: Inguinal hernia surgery is a frequent procedure among general surgeons in Costa Rica, but the management and technique are not uniform. The International Guideline for Groin Hernia management was published in 2018 to standardize the inguinal hernia surgery, but the diffusion of the guidelines and its adherence have been extremely varied. PURPOSE: Collect and analyze the current reality regarding groin hernia management in Costa Rica. Secondly evaluate the diffusion and development comparing it to the guideline's recommendations. METHOD: Questionnaire of 42 single and multiple answer questions according to the topics of the International Guideline directed to general surgeons. Diffusion of the inquiry through surgical and hernia association chats and email. Timeframe June-December 2019. RESULTS: 64 surveys were collected, which is a representative number of the general surgeons national college. The most frequent procedure between these was the abdominal wall surgery. Every surgeon did more than 52 groin hernia surgeries in one year, most of them outpatients. The epidural anesthesia was used the most and Lichtenstein's technique was the most frequently used (64%). 68% of the surgeons know how to perform a minimally invasive inguinal hernia surgery but with variable volumes. 38% of participants considered themselves experts in groin hernia management and 52% did not know the 2018 International Guideline. The recommendations of such guideline are followed only partially. CONCLUSIONS: The 2018 Hernia Surge International Guidelines have low diffusion among Costa Rican surgeons. The laparoscopic approach is widely accepted but there are no studies to assess the results and the quality. There should be protocols and studies adapted to Costa Rica's national situation.

Resultados de la reparación de la hernia incisional asociada al trasplante renal en un centro especializado. Análisis de nuestra experiencia de 7 años / Incisional hernia repair outcome after renal transplantation in a reference center. Our experience of 7 years

INTRODUCCIÓN: Las hernias incisionales secundarias al trasplante renal (HITR) se consideran hernias complejas debido a su localización lateral a la vaina del músculo recto abdominal. También influyen la presencia del injerto en la fosa iliaca y la proximidad del área inguinal, el margen costal y los huesos iliacos como rebordes de difícil fijación de la prótesis. Además, estos pacientes presentan connotaciones específicas, como el tratamiento con inmunosupresores, que podrían alterar la evolución postoperatoria. El objetivo del estudio fue analizar los resultados obtenidos en la reparación de las HITR en un hospital terciario, comparando estos datos con la literatura internacional. MÉTODOS: Estudio observacional retrospectivo, desde el 1 de enero de 2011 al 31 de enero de 2018, de los pacientes operados de HITR en nuestra unidad. Análisis de factores preoperatorios, intraoperatorios y de complicaciones postoperatorias observados durante el seguimiento. RESULTADOS: Se operaron 25 pacientes, encontrando un índice de recidiva herniaria del 4% tras un seguimiento mediano de 27,5 meses (20-39). La técnica más utilizada fue la separación posterior de componentes con liberación del transverso en un 42%, seguida de la reparación preperitoneal en un 27% y la reparación interoblicuos en un 12%. La morbilidad postoperatoria global fue del 23%, siendo las más frecuentes las relacionadas con el sitio quirúrgico (12%). CONCLUSIONES: La reparación de las HITR es un procedimiento seguro en nuestro centro, con un índice de recidiva herniaria aceptable, aunque no exento de complicaciones

INTRODUCTION: Incisional hernias secondary to renal transplantation (IHRT) are considered complex hernias because they are lateral to the sheath of the rectus abdominis muscle. The presence of the graft in the iliac fossa and the proximity to the inguinal area, costal margin and iliac bones, as zones with difficult fixation for prostheses, increases repair complexity. In addition, these patients have specific characteristics, such as treatment with immunosuppressive medication, that could alter postoperative evolution. The objective of this study was to analyze the results obtained in IHRT repair at a tertiary hospital, and to compare these data with the international literature. METHODS: Retrospective observational study of patients treated surgically for IHRT in our unit from January 1, 2011 to January 31, 2018. Preoperative conditions, intraoperative factors and postoperative complications during follow-up were analyzed. RESULTS: Twenty-five patients underwent hernia repair, finding a 4% hernia recurrence rate during a median follow-up of 27.5 months (20-39). The most frequently used technique was the posterior transversus abdominis release component separation technique in 42%, followed by preperitoneal repair in 27% and interoblique repair in 12%. The overall postoperative morbidity was 23%, which was frequently related to the surgical site (12%). CONCLUSIONS: IHRT repair is a safe procedure at our medical center, with an acceptable rate of hernia recurrence, but it is not without complications

Incisional hernia repair outcome after renal transplantation in a reference center. Our experience of 7 years. / Resultados de la reparación de la hernia incisional asociada al trasplante renal en un centro especializado. Análisis de nuestra experiencia de 7 años.

INTRODUCTION: Incisional hernias secondary to renal transplantation (IHRT) are considered complex hernias because they are lateral to the sheath of the rectus abdominis muscle. The presence of the graft in the iliac fossa and the proximity to the inguinal area, costal margin and iliac bones, as zones with difficult fixation for prostheses, increases repair complexity. In addition, these patients have specific characteristics, such as treatment with immunosuppressive medication, that could alter postoperative evolution. The objective of this study was to analyze the results obtained in IHRT repair at a tertiary hospital, and to compare these data with the international literature. METHODS: Retrospective observational study of patients treated surgically for IHRT in our unit from January 1, 2011 to January 31, 2018. Preoperative conditions, intraoperative factors and postoperative complications during follow-up were analyzed. RESULTS: Twenty-five patients underwent hernia repair, finding a 4% hernia recurrence rate during a median follow-up of 27.5 months (20-39). The most frequently used technique was the posterior transversus abdominis release component separation technique in 42%, followed by preperitoneal repair in 27% and interoblique repair in 12%. The overall postoperative morbidity was 23%, which was frequently related to the surgical site (12%). CONCLUSIONS: IHRT repair is a safe procedure at our medical center, with an acceptable rate of hernia recurrence, but it is not without complications.

Abdominal Wall Reconstruction Utilizing the Combination of Absorbable and Permanent Mesh in a Retromuscular Position: A Multicenter Prospective Study.

BACKGROUND: Optimal mesh reinforcement for abdominal wall reconstruction (AWR) in complex hernias remains questionable. Use of biologic, absorbable and synthetic meshes has been described. The idea of using an absorbable mesh (AM) under a permanent mesh (PM) in a retromuscular position may help in these challenging situations. METHODS: Between 2011 and 2016, consecutive patients undergoing open AWR utilizing an AM as posterior layer reinforcement and configuration of a large PM were identified in a multicenter prospectively maintained database in four hospitals. Main outcomes included demographics, ventral hernia classifications, perioperative data, complications and recurrences. RESULTS: A total of 169 complex incisional hernias were analyzed. Mean age was 60.9, with mean body mass index 30.7 (range: 20-46). Location of incisional hernias (IH) was: 80 midline, 59 lateral and 30 midline and lateral. 78% were grade I and II in Ventral Hernia Working Group classification. 52% of patients were discharged with no complication. There were 19% seromas, 13% hematomas, 12% surgical-site infection and 10% skin dehiscence. Only partial mesh removal was necessary in one patient. After a mean follow-up of 26 months (range 15-59), there were five (3.2%) recurrences. Reoperations on patients showed a band of fibrosis separating the peritoneum from the PM. CONCLUSION: The combination of AM with very large PM in the same retromuscular position in AWR seems to be safe. The efficacy with recurrence rates below 4% in complex midline and lateral IH may be explained by the use of larger PMs that are extended and configured with the support of AMs. Reoperations on patients have confirmed the previous experimental reports on the use of the AM.

Preoperative preparation of «loss of domain¼ hernia. Progressive pneumoperitoneum and botulinum toxin type A. / Preparación preoperatoria de la hernia con pérdida de domicilio. Neumoperitoneo progresivo y toxina botulínica tipo A.

Preoperative progressive pneumoperitoneum and botulinum toxin type A are useful tools in the preparation of patients with loss of domain hernias. Both procedures are complementary in the surgical repair, especially with the use of prosthetic techniques without tension, that allow a integral management of these patients. The aim of this paper is to update concepts related to both procedures, emphasizing the advantages that take place in the preoperative management of loss of domain hernias.

Preparación preoperatoria de la hernia con pérdida de domicilio. Neumoperitoneo progresivo y toxina botulínica tipo A / Preoperative preparation of «loss of domain» hernia. Progressive pneumoperitoneum and botulinum toxin type A

El neumoperitoneo progresivo preoperatorio y la toxina botulínica tipo A son herramientas útiles en la preparación de los pacientes con hernias gigantes que han perdido el domicilio. Ambos procedimientos son armas complementarias del procedimiento quirúrgico, especialmente con el uso de técnicas protésicas sin tensión, que permiten el manejo integral de estos pacientes. Este artículo tiene por objeto actualizar conceptos relacionados con ambos procedimientos, incidiendo en las ventajas que aportan en el manejo preoperatorio de las hernias gigantes que han perdido el domicilio (AU)

Preoperative progressive pneumoperitoneum and botulinum toxin type A are useful tools in the preparation of patients with loss of domain hernias. Both procedures are complementary in the surgical repair, especially with the use of prosthetic techniques without tension, that allow a integral management of these patients. The aim of this paper is to update concepts related to both procedures, emphasizing the advantages that take place in the preoperative management of loss of domain hernias (AU)

Partial versus complete removal of the infected mesh after abdominal wall hernia repair.

BACKGROUND: To compare the results with complete mesh removal (CMR) versus partial mesh removal (PMR) in the treatment of mesh infection after abdominal wall hernia repair (AWHR). METHODS: Retrospective review of all patients who underwent surgery for mesh infection between January 2004 and May 2014 at a tertiary center. RESULTS: Of 3470 cases of AWHR, we reported 66 cases (1.9%) of mesh infection, and 48 repairs (72.7%) required mesh explantation. CMR was achieved on 38 occasions, while PMR was undertaken ten times. We observed more postoperative complications in CMR than PMR group (p = 0.04). Three patients with intestinal fistula were reoperated in postoperative period after a difficult mesh removal; one of them died due to multiple organ failure. The overall recurrence rate after explantation was 47.9%: recurrence was more frequent in CMR group (p = 0.001), although persistent or new mesh infection was observed more frequently with PMR (p = 0.001). CONCLUSIONS: Although PMR has less postoperative morbidity, shorter duration of hospitalization and lower rate of recurrence than CMR, prosthetic infection persists in up to 50% of cases.

Tratamiento de la eventración subxifoidea: técnica de doble malla ajustada al defecto / Subxiphoid incisional hernia treatment: a technique using a double mesh adjusted to the defect

Introducción La eventración subxifoidea tiene características que la diferencian del resto y le dan entidad propia. El hecho de tener su saco muy próximo a los relieves costales óseos y esternón condiciona mucha tensión en los márgenes; la reparación, tanto por vía abierta como laparoscópica, no ha demostrado buenos resultados a pesar del uso generalizado de prótesis. Son poco frecuentes y se presentan en pacientes con comorbilidad importante (cardiópatas severos, trasplantados, inmunodeprimidos), tras intervenciones del área hepato-bilio-pancreática con incisiones transversales, esternotomías ampliadas por debajo del xifoides o laparotomías medias muy altas para cirugía gastro-esofágica. Material y método En nuestra Unidad hemos desarrollado una nueva técnica, basada en el uso de doble prótesis y adaptada a las características anatomo-fisiológicas de la región, para la reparación de estas eventraciones. La serie consta de 35 pacientes intervenidos de forma consecutiva entre 2004 y 2010, siguiendo protocolo quirúrgico y de manejo consensuado. Resultados No hubo complicaciones importantes –la más frecuente es el seroma, 17,4%-, excepto un caso de infección de la herida por isquemia de piel en un paciente multioperado y trasplantado. El seguimiento postoperatorio hasta el día de hoy (entre 4 y 80 meses) no ha demostrado recidivas de la eventración y no se refieren molestias locales importantes. Conclusiones La técnica «doble malla ajustada» consigue en nuestro medio unos buenos resultados, tanto desde el punto de vista del cirujano (reproducibilidad, recidiva), como del paciente, con mínimas molestias y recuperación de la calidad de vida (AU)

Introduction: Subxiphoid incisional hernia has characteristics that differentiate it from the rest and make it a distinctive entity. The fact that it has its sac very near the rib cage and sternum determines the pressure in the margins. The repair, by open or by laparoscopic approach, has not demonstrated good results despite the generalised use of a prosthesis. They are uncommon, and have a significant comorbidity in patients (severe heart diseases, transplants, immunosuppressed), after surgery of the hepato-bilio-pancreatic area with transverse incisions, or very high mid-laparotomies for gastro-oesophageal surgery. Material and methods: A new technique has been developed in our Unit, based on a double mesh and adapted to the anatomical and physiological characteristics of the region. The series consisted of 35 consecutive patients operated on between 2004 and 2010, following anagreed surgical and management protocol. Results: There were no significant complications -the most frequent (17.4%) was a seroma exceptone case of a wound infection due to skin is chaemia in one patient who had had multiple operations and a transplant. During the post-surgical follow up to the present(between 4 and 80 months), there has been no recurrence of the incisional hernia and no significant local discomfort has been reported. Conclusions: The «adjusted double mesh» technique achieved good results in our hands, from the surgical point of view (reproducibility, recurrence), and for the patient, with minimal discomfort and recovery of quality of life (AU)

[Subxiphoid incisional hernia treatment: a technique using a double mesh adjusted to the defect]. / Tratamiento de la eventración subxifoidea: técnica de doble malla ajustada al defecto.

INTRODUCTION: Subxiphoid incisional hernia has characteristics that differentiate it from the rest and make it a distinctive entity. The fact that it has its sac very near the rib cage and sternum determines the pressure in the margins. The repair, by open or by laparoscopic approach, has not demonstrated good results despite the generalised use of a prosthesis. They are uncommon, and have a significant comorbidity in patients (severe heart diseases, transplants, immunosuppressed), after surgery of the hepato-bilio-pancreatic area with transverse incisions, or very high mid-laparotomies for gastro-oesophageal surgery. MATERIAL AND METHODS: A new technique has been developed in our Unit, based on a double mesh and adapted to the anatomical and physiological characteristics of the region. The series consisted of 35 consecutive patients operated on between 2004 and 2010, following an agreed surgical and management protocol. RESULTS: There were no significant complications -the most frequent (17.4%) was a seroma- except one case of a wound infection due to skin ischaemia in one patient who had had multiple operations and a transplant. During the post-surgical follow up to the present (between 4 and 80 months), there has been no recurrence of the incisional hernia and no significant local discomfort has been reported. CONCLUSIONS: The «adjusted double mesh¼ technique achieved good results in our hands, from the surgical point of view (reproducibility, recurrence), and for the patient, with minimal discomfort and recovery of quality of life.

Nuevo método de operar en la eventración compleja: separación anatómica de componentes con prótesis y nuevas inserciones musculares / New surgical technique in complex incisional hernias: Component Separation Technique (CST) with prosthesis and new muscle insertions

Introducción El objetivo de este trabajo es mostrar a la comunidad quirúrgica una nueva técnica para el tratamiento de eventraciones complejas y catastróficas desarrollada en este equipo: separación anatómica de componentes (SAC) modificada por Carbonell-Bonafé. Material y método Se trató a 100 pacientes con eventración compleja. Se documentó tamaño, contenido y reductibilidad de la eventración (tomografía computarizada preoperatoria), recidivas y técnicas de cierre previas, talla y peso, alteraciones tróficas de la piel y necesidad de neumoperitoneo preoperatorio. Se operó siguiendo un protocolo homogéneo, con medida de presión intraabdominal antes, durante y tras la intervención. Se evaluó al paciente en consulta a los 15 y 30 días, mensualmente durante 3 meses, al sexto mes y anualmente hasta 5 años. Resultados Entre enero de 2003 y mayo de 2008 se intervino a 100 pacientes consecutivos. En el postoperatorio inmediato se tuvo un 12% de seromas, un 8% de isquemia parcial de bordes de la herida y un fallecimiento debido a fallo multiorgánico; en el postoperatorio tardío se tuvo un 6% de algias transitorias en los puntos de anclaje óseo. Los pacientes reanudaron su actividad habitual en una media de 2 meses con gran mejoría en su calidad de vida. No se han encontrado recidivas hasta la fecha. Conclusiones La técnica SAC que esta Unidad ha modificado es un excelente recurso en el tratamiento de grandes eventraciones: garantiza el éxito del cierre con poca morbilidad y, además, reconstruye la biomecánica de la pared abdominal (AU)

Introduction Our goal is to show the surgical community a new technique developed by our team for treating complex and catastrophic ventral hernias: Separation of Anatomical Component (SAC) amended by Carbonell–Bonafé. Materials and methods A total of 100 patients with complex incisional hernias have been treated. The size, content and reducibility of ventral hernia (preoperative CT scan), recurrences and pre-closure techniques, height and weight, trophic skin alterations and need for preoperative pneumoperitoneum were all documented. The operation was performed following a standardised protocol; intra-abdominal pressure (IAP) was measured before, during and after the intervention. Patients were evaluated in the clinic at 15 and 30 days, monthly for 3 months, at sixth months and annually for up to 5 years. Results A total of 100 consecutive patients were operated on between January 2003 and May 2008. In the immediate post-surgical period there were 12% seromas, 8% of partial-ischaemia on the edges of the wound and 1 death due to multi-organ failure. In the later period, 6% had transitional pain in bone anchorage points. They resumed their normal activities after an average of 2 months, with great improvement in their quality of life. There have been no recurrences to date. Conclusions The SAC technique, as modified by our Unit, is an excellent resource in managing large ventral hernias: successfully closing with low morbidity, as well as reconstructing the biomechanics of the abdominal wall (AU)

[New surgical technique in complex incisional hernias: Component Separation Technique (CST) with prosthesis and new muscle insertions]. / Nuevo método de operar en la eventración compleja: separación anatómica de componentes con prótesis y nuevas inserciones musculares.

INTRODUCTION: Our goal is to show the surgical community a new technique developed by our team for treating complex and catastrophic ventral hernias: Separation of Anatomical Component (SAC) amended by Carbonell-Bonafé. MATERIALS AND METHODS: A total of 100 patients with complex incisional hernias have been treated. The size, content and reducibility of ventral hernia (preoperative CT scan), recurrences and pre-closure techniques, height and weight, trophic skin alterations and need for preoperative pneumoperitoneum were all documented. The operation was performed following a standardised protocol; intra-abdominal pressure (IAP) was measured before, during and after the intervention. Patients were evaluated in the clinic at 15 and 30 days, monthly for 3 months, at sixth months and annually for up to 5 years. RESULTS: A total of 100 consecutive patients were operated on between January 2003 and May 2008. In the immediate post-surgical period there were 12% seromas, 8% of partial-ischaemia on the edges of the wound and 1 death due to multi-organ failure. In the later period, 6% had transitional pain in bone anchorage points. They resumed their normal activities after an average of 2 months, with great improvement in their quality of life. There have been no recurrences to date. CONCLUSIONS: The SAC technique, as modified by our Unit, is an excellent resource in managing large ventral hernias: successfully closing with low morbidity, as well as reconstructing the biomechanics of the abdominal wall.

[Prosthetic infection after hernioplasty. Five years experience]. / Infección de la prótesis en la reparación herniaria. Nuestra experiencia en 5 años.

INTRODUCTION: Prosthesis infection is an infrequent but important complication in abdominal wall surgery. The aim of this study is to evaluate the incidence and risk factors for the infection of the prosthesis after hernia repair, as well as the treatment to apply. MATERIAL AND METHOD: Between January 2002 and December 2006, we performed 1055 prosthetic hernia repairs: 761 inguinal hernias (72.1%), 74 umbilical hernias (7%) and 220 ventral hernias (20.9%). We prospectively analysed preoperative, intraoperative and postoperative variables, as well as the incidence of infection of surgical wound and of prosthesis. We used ASA classification for preoperative anaesthetic evaluation. RESULTS: The overall percentage of infection of the prosthesis was 1.3%. Infection was observed in 11 repairs with polypropylene mesh (PPL), in 4 with PTFE mesh, and one case in combined mesh. Risk factors of mesh infection were: obesity (p=0.002), diabetes (p=0.020), the type of repair (p=0.047), emergency surgery (p=0.001), the type and size of mesh (p=0.003; p=0.007) and time of surgery >180 min (p<0.001). Seven of the 11 patients with infection of PPL prosthesis were resolved with conservative treatment, whereas all the cases with PTFE infection or mixed mesh needed removal to solve the problem. CONCLUSIONS: Several factors are involved in producing a prosthesis infection. Whereas antibiotic treatment and surgical drainage of the infection can be sufficient in most PPL mesh infection, PTFE prostheses need to be removed prematurely in order to halt the infection process.

Infección de la prótesis en la reparación herniaria. Nuestra experiencia en 5 años / Prosthetic infection after hernioplasty. Five years experience

Introducción: la infección de la prótesis es una complicación infrecuente pero importante en la cirugía de la pared abdominal. El objetivo de este estudio es valorar la incidencia y los factores de riesgo influyentes en la infección de la prótesis tras la reparación herniaria, así como el tratamiento a aplicar. Material y método: entre enero de 2002 y diciembre de 2006, se realizaron en total 1.055 reparaciones protésicas herniarias: 761 hernias inguinocrurales (72,1%), 74 hernias umbilicales (7%) y 220 eventroplastias (20,9%). Se analizaron de forma prospectiva variables preoperatorias, intraoperatorias y postoperatorias, así como la incidencia de infección de herida quirúrgica y de prótesis. Se utilizó la clasificación ASA para la valoración preoperatoria anestésica. Resultados: el porcentaje de infección del biomaterial en general fue del 1,3%. Observamos infección en 11 reparaciones con prótesis de polipropileno (PPL), en 4 con PTFE-e y 1 caso en prótesis combinada. Fueron factores de riesgo en la infección del biomaterial: la obesidad (p=0,002), la diabetes mellitus (p=0,020), el tipo de reparación (p=0,047), la intervención de urgencia (p=0,001), el tipo y el tamaño de la prótesis (p=0,003 y p=0,007) y el tiempo quirúrgico >180min (p<0,001). De 11 pacientes con infección de prótesis de PPL, 7 respondieron al tratamiento con curas, mientras que todos los casos con infección de PTFE-e o prótesis mixta necesitaron de su extirpación para resolver el problema. Conclusiones: existen numerosos factores de riesgo influyentes en la tasa de infección del biomaterial. Mientras que la terapia antibiótica adecuada y el drenaje quirúrgico de la infección pueden ser suficientes en la mayoría de las infecciones de prótesis de PPL, las de PTFE-e requieren extirpación precoz para acabar con el proceso infectivo (AU)

Introduction: Prosthesis infection is an infrequent but important complication in abdominal wall surgery. The aim of this study is to evaluate the incidence and risk factors for the infection of the prosthesis after hernia repair, as well as the treatment to apply. Material and method: Between January 2002 and December 2006, we performed 1055 prosthetic hernia repairs: 761 inguinal hernias (72.1%), 74 umbilical hernias (7%) and 220 ventral hernias (20.9%). We prospectively analysed preoperative, intraoperative and postoperative variables, as well as the incidence of infection of surgical wound and of prosthesis. We used ASA classification for preoperative anaesthetic evaluation. Results: The overall percentage of infection of the prosthesis was 1.3%. Infection was observed in 11 repairs with polypropylene mesh (PPL), in 4 with PTFE mesh, and one case in combined mesh. Risk factors of mesh infection were: obesity (p=0.002), diabetes (p=0.020), the type of repair (p=0.047), emergency surgery (p=0.001), the type and size of mesh (p=0.003; p=0.007) and time of surgery >180min (p<0.001). Seven of the 11 patients with infection of PPL prosthesis were resolved with conservative treatment, whereas all the cases with PTFE infection or mixed mesh needed removal to solve the problem. Conclusions: Several factors are involved in producing a prosthesis infection. Whereas antibiotic treatment and surgical drainage of the infection can be sufficient in most PPL mesh infection, PTFE prostheses need to be removed prematurely in order to halt the infection process (AU)