Medial incisional ventral hernia repair with Adhesix® autoadhesive mesh: descriptive study.

Nowadays, the gold standard for the surgical treatment of abdominal wall defects is the use of a mesh. There is an extensive variety of meshes, self-adhesive ones being among the most novel technologies. The literature on the self-adhesive mesh Adhesix® (Cousin Biotech Laboratory, 59117 Wervicq South, France) in medial incisional ventral hernia is scarce. We performed a retrospective descriptive study with prospective data collection from 125 patients who underwent prosthetic repair of medial incisional ventral hernia-M1-M5 classification according to European Hernia Society (EHS)-with self-adhesive mesh Adhesix® between 2013 and 2021. Follow-up was performed 1 month and yearly after the surgery. Postoperative complications and hernia recurrences were recorded. Epidemiological results were average BMI 30.5 kg/m2 (SD 5), highlighting that overweight (41.6%) and obesity type 1 (25.6%) were the most represented groups. 34 patients (27.2%) had already undergone a previous abdominal wall surgery. The epigastric-umbilical (M2-M3 EHS classification, 22.4%) and umbilical (M3 EHS classification, 20%) hernias were the predominant groups. The elective surgery technique was Rives or Rives-Stoppa with an associated supraaponeurotic mesh if the closure of the anterior aponeurosis of the rectus sheath was not surgically closed (13 patients). The most frequent postoperative complication was seroma (26.4%). The recurrence rate was 7.2%. The average follow-up length was 2.6 years (SD 1.6 years). According to the results of this study and the literature available, we consider that the self-adhesive mesh Adhesix® is an appropriate alternative mesh option for the repair of medial incisional ventral hernias.

Umbilical hernia repair with composite prosthesis: a single-centre experience.

PURPOSE: Since 2004, composite prosthesis repair is the preferred procedure for umbilical hernia repair in our centre, although long-term results of this technique are lacking. The aim of this study was to analyze the long-term results of a cohort of patients who underwent umbilical hernia repair with this procedure. METHODS: A retrospective cohort study of patients who underwent umbilical hernia repair with composite prosthesis was conducted. Data were obtained from electronic medical records. Univariate and multivariate analyses were performed to analyze the factors associated with postoperative complications and hernia recurrence. RESULTS: Between March 2004 and December 2015, 2135 patients underwent umbilical hernia repair and composite prosthesis (Ventralex or Ventralex ST®) was used in 1538 patients. 179 patients were lost during the follow-up. Finally, 1359 patients were included in the study. The prosthesis was placed in the preperitoneal space in 93.4% of the patients. 86.3% of the patients underwent same-day surgery. Only 2.1% of the patients developed a complication during the follow-up, and 1.8% of the patients required a new surgery. After a mean follow-up of 4.1 years, hernia recurrence rate was 3.9%. Multivariate analysis showed that hernia recurrence was associated with female gender, recurrent hernia, and postoperative complication. Postoperative complications were related to follow-up time and smoking patients. CONCLUSIONS: Long-term results after umbilical hernia repair with composite prosthesis are satisfactory, with a low percentage of complications and recurrences.

Encuesta de calidad percibida en cirugía mayor ambulatoria. Análisis de resultados / No disponible

Introducción: La implantación de unidades de cirugía mayor ambulatoria tiene como objetivo la mejora de la eficiencia y calidad de los hospitales. Se puede distinguir entre calidad objetiva y subjetiva, relacionada esta con aspectos como la satisfacción del paciente o términos de calidad de vida. Material y métodos: Entre mayo-septiembre de 2005 se recogieron113 encuestas, que fueron entregadas previamente al alta a pacientes intervenidos en el servicio de cirugía general y digestiva en régimen de cirugía mayor ambulatoria. La encuesta se componía de 27 ítems (encuesta validada por la comunidad valenciana y específica para cirugía ambulatoria).Resultados: Se obtuvo una positiva valoración global; el 91%reconocía buena información médica previa a la cirugía, y el 99%había recibido buena información finalizado el proceso. Un 74%refería que el resultado de la intervención había sido mejor de lo esperado. Un 53% valoraba el trato recibido como mucho mejor de lo esperado y un 27,4% como mejor. Discusión: En los estudios publicados más de un 70% de los pacientes de cirugía ambulatoria valoran positivamente la calidad del tratamiento quirúrgico. Importantes cuestiones para el paciente son la continuidad en la atención posterior al tratamiento y la información sobre dicho seguimiento. Se encuentran áreas de mejora en lo referente al contacto familiar-paciente en la readaptación, información en la recuperación y confortabilidad (AU)

Introduction: The implantation of the ambulatory surgery units persecutes the improvement of the efficiency and quality of the hospitals. It is possible to be distinguished between subjective and objective quality, related this one to aspects like the satisfaction of the patient or terms of quality of life. Material and methods: Between May-September 2005,113 surveys took shelter that were given previously to the discharge to patients in the service of general and digestive surgery. Results: A positive global valuation was obtained; 91% recognized good medical information previous the surgery, and 99%had received adapted information finalized the process. A 74%refereed that the result of the intervention had been better than the awaited thing. Discussion: In the published studies more of a 70% of the ambulatory surgery patients valued positively the quality of the surgical treatment. Important questions for the patient are the continuity in the attention subsequent to the treatment and the information on this pursuit. Areas of improvement were found respect to the contact relative-patient in the readjustment area, information in the recovery and comfortableness (AU)

Encuesta sobre variabilidad de la práctica médica en las unidades de cirugía mayor ambulatoria / No disponible

Introducción: La variabilidad en la práctica clínica es, hoy en día, una realidad. Su concepto implica el reconocimiento de que pacientes y poblaciones semejantes reciben servicios sanitarios diferentes. Material y método: El objetivo del trabajo es analizar las variaciones de la práctica médica en las unidades de cirugía mayor ambulatoria (CMA) de la Comunidad de Madrid. Se envió una encuesta a dichas unidades analizando la variabilidad desde el punto de vista organizativo, quirúrgico y anestésico, así como de los protocolos pre- y postquirúrgicos, y los reingresos. Resultados: El 57,1% de las unidades son integradas. Ninguna de ellas está acreditada. El 64,3% tienen consulta externa de alta resolución. En el 71% de las unidades encuestadas, no todos los procesos subsidiarios de ser realizados como CMA se completaron como tal. Ninguno de los profesionales que trabajan en estas unidades obtiene ningún tipo de compensación económica. En un 21,4% de las unidades no se utilizan criterios establecidos para el alta. Un 14,3% no realiza encuesta telefónica postoperatoria. El 71,4% de las unidades no tienen indicadores específicos de calidad y un 14,3% no conocen el porcentaje de reingresos. Conclusión: La variabilidad en las distintas unidades de CMA es grande, a pesar de que existen criterios muy específicos respecto a la organización y funcionamiento de las mismas (AU)

Introduction: The variability in the clinical practice today is a fact. The concept implicates that patients receive different health services. Material and methods: The goal is to analyse the changes in the medical practice in ambulatory surgery unit (ASU) of the Comunidad de Madrid. We sent a survey to these units in order to realize the variability since de vision of the organization, surgery and anaesthetic units and to analyse the pre and postoperative protocols and the readmissions. Results: The 57.1% of the units are integrated. Neither of them is accredited. The 64.3% have a specialize consult. In the 71% of the units, same procedures that could be done as ASU weren’t make so. Neither of the professionals who work in these units gets an economic compensation. In the 21.4% of the units don’t use some settled criterion for the discharge. A 14.3% of the units don’t get any postoperative survey follow-up by phone call. The 71.4% of the units haven’t specific indicator of quality and a 14.3% of the units don’t know the number of readmitted. Conclusion: The variability in the different units of ambulatory surgical unit is big, although there are criteria very specific about the organization and performance of their (AU)

Bypass biliopancreático. Comentario / Biliopancreatic bypass. Comment

No disponible

The Shouldice herniorrhaphy in the treatment of inguinal hernias: a prospective study on 775 patients.

The authors present a study of 775 patients who underwent a Shouldice herniorrhaphy between 1987 and 2000, as performed by one surgeon. Average patient age was 52 years, and 93% of patients were male. Local anesthesia with sedation was used in 643 cases (83%) and regional anesthesia in 13%. The length of the incision was 9.5 cm. The average duration of surgery was 57.5 min (40-75). Tolerance to local anesthesia with sedation was 93%, a similar percentage to that of general anesthesia. The most significant postoperative complications were: urinary retention 8%, headache 7%, and ecchymosis 6%. Hospitalization time in 76% of the cases was 1 day, while 20% of interventions were undertaken on an outpatient basis. The average absence from work was 20 days. The recurrence rate at 7 years was 2%.