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1.
Surg Clin North Am ; 101(2): 307-321, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33743971

RESUMO

Ventral and incisional hernias in obese patients are particularly challenging. Suboptimal outcomes are reported for elective repair in this population. Preoperative weight loss is ideal but is not achievable in all patients for a variety of reasons, including access to bariatric surgery, poor quality of life, and risk of incarceration. Surgeons must carefully weigh the risk of complications from ventral hernia repair with patient symptoms, the ability to achieve adequate weight loss, and the risks of emergency hernia repair in obese patients.


Assuntos
Cirurgia Bariátrica/métodos , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Obesidade/cirurgia , Qualidade de Vida , Telas Cirúrgicas , Hérnia Ventral/complicações , Humanos , Obesidade/complicações
2.
BMC Surg ; 21(1): 158, 2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33752652

RESUMO

BACKGROUND: Laparoscopic paraesophageal hernia repair is associated with higher recurrence rate. Mesh is used to reduce the recurrence rate. This retrospective study is to review our experience of biological mesh fixed with suture and medical glue in hiatal hernias repairs. METHODS: A retrospective chart review was conducted for a consecutive series of patients undergoing laparoscopic hiatal herniorrhaphy between January 2018 and January 2019. After hiatus closure, a piece of biological prosthesis was fixed with medical glue and suture for reinforcement of the crural closure. Clinical outcomes were reviewed, and data were collected regarding operative details, complications, symptoms, and follow-up imaging. Radiological evidence of any size of hiatal hernia was considered to indicate a recurrence. RESULTS: Thirty-six patients underwent surgery uneventfully without any serious complication. There was no mortality. The follow-up was, on average, 18.4 months, and there was no symptomatic recurrence. There was one anatomical recurrence without any related presentation. The method of mesh fixation with medical glue and suture took 12 min on average, and the handling was fairly easy. CONCLUSIONS: Biological mesh fixed with suture and medical glue was safe and effective for repairing large hiatal hernias. Of course, a longer follow-up is still needed for determining long-term outcomes.


Assuntos
Hérnia Hiatal , Herniorrafia , Laparoscopia , Adesivos , Idoso , Idoso de 80 Anos ou mais , Feminino , Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Telas Cirúrgicas , Suturas , Resultado do Tratamento
3.
BMC Surg ; 21(1): 152, 2021 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-33743667

RESUMO

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.


Assuntos
Virilha/cirurgia , Fidelidade a Diretrizes/estatística & dados numéricos , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões , Adulto , Anestesia Local/estatística & dados numéricos , Costa Rica/epidemiologia , Feminino , Herniorrafia/normas , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Inquéritos e Questionários
4.
Rev Col Bras Cir ; 48: e20202672, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33681911

RESUMO

Incisional hernia is a late complication of the most frequent after abdominal surgeries, with resulting morbidity that can worsen the condition. The treatment has been done both by open techniques, using screens or not, and by laparoscopic and robotic methods, which use them systematically. However, introducing a permanent foreign body into the tissues requires more surgical time, despite not closing the parietal defect in most cases and a higher risk of infections. New technologies have been trying to improve these results, with absorbable prostheses (biological or synthetic), but their high cost and recurrences remain a severe problem. Even so, standard repair establishes reinforcement with screens, routine, and whether the approach is traditional or mini-invasive. The authors report their first case of endoscopic repair of incisional hernia, which occurred two years ago, with a Brazilian technique already fifty years old: the transposition with the hernia sac proposed by Prof. Alcino Lázaro da Silva in 1971.


Assuntos
Endoscopia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Telas Cirúrgicas , Brasil , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
5.
BMC Surg ; 21(1): 67, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33522917

RESUMO

BACKGROUND: Congenital primary inguinal hernia is a common condition among children. Although much literature regarding inguinal hernia is available, large scale analysis are few, and rarely do they expand on gender difference or incarcerated hernias. METHODS: Patients with unilateral or bilateral inguinal hernia who were admitted to our hospital and received open inguinal hernia repair (OIHR) or laparoscopic inguinal hernia repair (LIHR) under general anesthesia were included. LIHR was performed using single-site laparoscopic percutaneous extraperitoneal closure (SLPEC). Medical records were retrospectively collected and analyzed. RESULTS: A total of 12,190 patients were included in this study. The ratio of male to female was 4.8:1. There was a total of 10,646 unilateral hernias (87.3%) and 1544 bilateral hernias (12.7%), with a corresponding ratio of 6.9:1. 12,444 hernia repair surgeries, 11,083 (89.1%) OIHR and 1361 (10.9%) LIHR, were held. OIHR had a shorter operative time than LIHR for all unilateral and female bilateral repair, unlike for bilateral male repair. There was no difference between OIHR and LIHR for ipsilateral recurrent hernia in males. There was a difference between OIHR and LIHR for metachronous contralateral hernia. Incarcerated inguinal hernia was associated with longer operative time, hospital stay and higher hospital costs. Females and patients under 1 year were more likely to present with incarcerated hernia. CONCLUSIONS: OIHR should be considered for male patients, especially for unilateral and complete inguinal hernia. LIHR is highly recommended for female patients. For incarcerated hernia, attention should be paid to patients under 1 year old, as they can be 60 times more susceptible, and females. Surgeons should also be aware of ovary hernias in females.


Assuntos
Hérnia Inguinal , Herniorrafia , Laparoscopia , Adolescente , Pequim/epidemiologia , Criança , Pré-Escolar , Feminino , Hérnia Inguinal/complicações , Hérnia Inguinal/congênito , Hérnia Inguinal/epidemiologia , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Herniorrafia/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Laparoscopia/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Fatores Sexuais
6.
Khirurgiia (Mosk) ; (2): 73-79, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33570358

RESUMO

OBJECTIVE: To evaluate the results of using titanium thread mesh implants in the treatment of anterior abdominal wall hernias. MATERIAL AND METHODS: This article evaluates the titanium thread mesh implant used by us in the treatment of 240 patients with anterior abdominal wall hernias; describes the features of this type of implants and the technical features of various types of operations using them. RESULTS: The overall rate of postoperative complications was 2.9%. Hernia recurrence was observed in 2.4% of patients after laparoscopic transabdominal preperitoneal hernioplasty. CONCLUSIONS: The use of a mesh implant made of titanium thread did not reveal any specific complications for this implant. At the stage of gaining experience with a mesh implant made of titanium thread, technical difficulties may occur when placing and fixing it, which increases the duration of surgery.


Assuntos
Hérnia Abdominal , Herniorrafia , Laparoscopia , Telas Cirúrgicas , Materiais Biocompatíveis , Hérnia Abdominal/cirurgia , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Humanos , Laparoscopia/efeitos adversos , Recidiva , Telas Cirúrgicas/efeitos adversos , Titânio , Resultado do Tratamento
7.
Rev Col Bras Cir ; 48: e20202704, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33533825

RESUMO

OBJECTIVES: minimally invasive inguinal hernia repair has proven advantages over open procedures including less pain and earlier return to normal activity. Robotic surgery adds ergonomics, a three-dimensional high definition camera and articulating instruments overcoming some laparoscopic limitations. We aimed to report the outcomes of the early experience of over 97 robotic inguinal hernia repairs performed by a referred surgical group in Brazil. METHODS: a review of a prospective mantined database was conducted in patients submitted to robotic transabdominal preperitoneal (TAPP) inguinal hernia repairs between March 2016 and February 2020. Descriptive statistics were performed. Surgical outcomes data and patient follow-ups are reported. RESULTS: retrospective chart review identified 97 patients submitted to robotic TAPP inguinal hernia repair. Mean age was 36.4 years, with median BMI of 26.9 kg/m2. Mean console time was 58 min (range 40-150) and patients were discharged within 24 hours of their stay in a majority of cases. Mesh was placed in all procedures and there were no conversion rates. Complications were low grade and no recurrence was seen after a mean follow-up of 642 days. CONCLUSION: this study represents to-date the first brazilian case series of robotic TAPP inguinal hernia repair. Our results encourage that robotic assisted TAPP inguinal hernia repair appears to be technically feasible and safe in experienced hands, with good outcomes achieving high health-related quality of life and low recurrence rates in the short and long term.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Resultado do Tratamento
8.
Ann Surg ; 273(4): 648-655, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33443907

RESUMO

OBJECTIVE: The aim of this study was to evaluate which mesh type yields lower recurrence and complication rates after ventral hernia repair. SUMMARY BACKGROUND DATA: More than 400,000 ventral hernia repairs are performed annually in the United States. Although the most effective method for repairing ventral hernias involves using mesh, whether to use biologic mesh versus synthetic mesh is controversial. METHODS: Single-blind, randomized, controlled, pragmatic clinical trial conducted from March 2014 through October 2018; 165 patients enrolled with an average follow up of 26 months. Patients were randomized 1:1 to have their ventral hernias repaired using either a biologic (porcine) or synthetic (polypropylene) mesh. The primary study outcome measure was hernia recurrence at 2 years. RESULTS: A total of 165 patients (68 men), mean age 55 years, were included in the study with a mean follow-up of 26 months. An intention-to-treat analysis noted that hernias recurred in 25 patients (39.7%) assigned to biologic mesh and in 14 patients (21.9%) assigned to synthetic mesh (P = 0.035) at 2 years. Subgroup analysis identified an increased rate of hernia recurrence in the biologic versus the synthetic mesh group under contaminated wound conditions (50.0% vs 5.9%; P for interaction = 0.041). Postoperative complication rates were similar for the 2 mesh types. CONCLUSIONS: The risk of hernia recurrence was significantly higher for patients undergoing ventral hernia repair with biologic mesh compared to synthetic mesh, with similar rates of postoperative complications. These data indicate that the use of synthetic mesh over biologic mesh to repair ventral hernias is effective and can be endorsed, including under contaminated wound conditions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02041494.


Assuntos
Hérnia Ventral/cirurgia , Herniorrafia/métodos , Complicações Pós-Operatórias/prevenção & controle , Prevenção Secundária/métodos , Telas Cirúrgicas , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Recidiva , Estudos Retrospectivos , Método Simples-Cego , Resultado do Tratamento
9.
BMC Surg ; 21(1): 48, 2021 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-33478413

RESUMO

BACKGROUND: For recurrent incarcerated and strangulated hernias, the optimal treatment strategy for each case is needed. CASE PRESENTATION: The study patient was a 70-year-old man. TAPP repair was performed for a left inguinal hernia (JHS Classification II-1) 7 years earlier. The patient experienced transient pain and swelling of the left inguinal region for 5 months and visited our emergency department for abdominal pain and vomiting. A CT scan showed a recurrent left inguinal hernia and small bowel incarceration, and emergency surgery was performed. Laparoscopic observation of the abdominal cavity revealed recurrent left inguinal hernia (Rec II-1) with small bowel incarceration. The small bowel was reduced after pneumoperitoneum, and no findings suggested intestinal tract necrosis. Adhesions around the herniated sac were dissected using an extraperitoneal approach and then shifted to mesh plug repair. No perioperative complications or hernia recurrence were observed in the 10 months after the surgery. CONCLUSIONS: This report describes a novel, successful surgical treatment for a recurrent incarcerated hernia. In our patient, we could easily perform dissection and understand the positional relationship by hybrid surgery using the TEP method. Additionally, in patients with incarcerated hernias, we believe that performing hybrid surgery by combining the TEP method would be useful because bowel dilation caused by intestinal obstruction would not disturb the operative field.


Assuntos
Hérnia Inguinal , Herniorrafia/métodos , Obstrução Intestinal/cirurgia , Laparoscopia , Idoso , Hérnia Inguinal/diagnóstico por imagem , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Humanos , Obstrução Intestinal/etiologia , Masculino , Recidiva , Telas Cirúrgicas , Tomografia Computadorizada por Raios X , Resultado do Tratamento
10.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431531

RESUMO

Angiofibroma is a benign soft tissue tumour presenting as a gradually progressive swelling in the vulvovaginal area in women and in the inguinoscrotal region in men. Being a rare tumour, there are only a few case reports in the literature, and among them, presentation as perineal herniation is very rare. En bloc resection of angiofibroma either via laparoscopic or open approach is the choice of treatment to avoid recurrence. Detailed pathological examination and immunohistochemistry workup are imperative to distinguish it from various mesenchymal tumours. Perineal hernia is itself rare and may occur spontaneously or following abdominoperineal resection, sacrectomy or pelvic exenteration. Surgical repair via open transabdominal and transperineal approaches has been described. Here, we report a case of a young woman who presented with spontaneous reducible perineal hernia with a soft tissue tumour as its content, which on histopathological investigation was found to be an angiofibroma.


Assuntos
Angiofibroma/diagnóstico , Hérnia/etiologia , Herniorrafia/métodos , Períneo/patologia , Neoplasias de Tecidos Moles/diagnóstico , Adulto , Angiofibroma/complicações , Angiofibroma/patologia , Angiofibroma/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Posicionamento do Paciente/métodos , Períneo/diagnóstico por imagem , Períneo/cirurgia , Neoplasias de Tecidos Moles/complicações , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/cirurgia
11.
J Surg Res ; 257: 317-325, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32889330

RESUMO

BACKGROUND: Onlay mesh repair (OMR) has proven to be a widely used, simple, and effective technique for treatment and prevention of hernia occurrence. Despite established benefits, there is still a lack of widespread adoption. In this study, we present the Dual Tacker Device (DTD), an enabling technology that directly addresses the limitations to the adoption of OMR, saving surgical time and effort and making OMR more reproducible across a wide range of patients. METHODS: The DTD mesh fixation system is a semiautomated, hand-held, disposable, multipoint onlay mechanical mesh fixation system that is able to rapidly and uniformly tension and fixate mesh for both hernia treatment and prevention. A cadaveric porcine model was used as a pilot test conducted during a 2 day session to assess the usability of the device and to show that the DTD provided equivalent or superior biomechanical support compared with the standard of care (hand-sewn, OptiFix). RESULTS: Our study included 37 cadaveric porcine incisional closure abdominal wall models. These were divided into four groups: DTD-mediated OMR (n = 14), hand-sewn OMR (n = 7), OptiFix OMR (n = 9), and suture-only repair (no mesh) (n = 7). Eight surgical residents performed device-mediated and hand-sewn OMR. Average time to completion was fastest in the DTD cohort (45.6s) with a statistically significant difference compared with the hand-sewn cohort (343.1s, P < 0.01). No difference in tensile strength was noted between DTD (195.32N), hand-sewn (200.48N), and OptiFix (163.23N). Discreet hand movements were smallest in the DTD (29N) and significant (P < 0.01) when compared with hand-sewn (202N) and OptiFix (35N). CONCLUSIONS: The use of the DTD is not only feasible, but demonstrated improvement in time to completion and economy of movement over current standard of care. While more testing is needed and planned, compared with conventional approaches, the DTD represents a robust proof of principle with promising implications for clinical feasibility and adoptability.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais/instrumentação , Hérnia Ventral/cirurgia , Herniorrafia/instrumentação , Telas Cirúrgicas , Técnicas de Sutura/instrumentação , Animais , Fenômenos Biomecânicos , Cadáver , Ergonomia , Estudos de Viabilidade , Hérnia Ventral/etiologia , Hérnia Ventral/prevenção & controle , Herniorrafia/métodos , Humanos , Modelos Animais , Duração da Cirurgia , Projetos Piloto , Cirurgiões/psicologia , Suínos , Resistência à Tração
12.
Ann Surg ; 273(1): 57-65, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33332873

RESUMO

OBJECTIVE: The aim of this study was to investigate the approach (open or laparoscopic) and mesh type (synthetic or biological) in ventral hernias in a clean setting.Summary of Background Data: The level of evidence on the optimal surgical approach and type of mesh in ventral hernia repair is still low. METHODS: Patients with a ventral abdominal hernia (diameter 4-10 cm) were included in this double-blind randomized controlled trial across 17 hospitals in 10 European countries. According to a 2 × 2-factorial design, patients were allocated to 4 arms (open retromuscular or laparoscopic intraperitoneal, with synthetic or Surgisis Gold biological mesh). Patients and outcome assessors were blinded to mesh type used. Major postoperative complication rate (hernia recurrence, mesh infection, or reoperation) within 3 years after surgery, was the primary endpoint in the intention-to-treat population. RESULTS: Between September 1st, 2005, and August 7th, 2009, 253 patients were randomized and 13 excluded. Six of 61 patients (9.8%) in the open synthetic mesh arm, 15 of 66 patients (22.7%) in the open biological mesh arm, 7 of 64 patients (10.9%) in the laparoscopic synthetic mesh arm and 17 of 62 patients (27.4%) in the laparoscopic biological mesh arm had a major complication. The use of biological mesh resulted in significantly more complications (P = 0.013), also after adjusting for hernia type, body mass index, and study site. The trial was prematurely stopped due to an unacceptable high recurrence rate in the biological mesh arms. CONCLUSIONS: The use of Surgisis Gold biological mesh is not recommended for noncomplex ventral hernia repair. TRIAL REGISTRATION: This trial was registered at controlled-trials.com (ISRCTN34532248).


Assuntos
Bioprótese , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Laparoscopia , Telas Cirúrgicas , Adulto , Idoso , Método Duplo-Cego , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Resultado do Tratamento
13.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(12): 1182-1186, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33353274

RESUMO

Objective: Petersen hernia is a rare but severe complication after gastrectomy, which has been reported by very few studies. This study is dedicated to summarize the clinical characteristics and management of Petersen hernia after gastrectomy in patients with gastric cancer in order to provide reference to clinical practice. Methods: A descriptive case-control study was carried out. All the qualified patients were screened from the database of digestive malignancies in Nanjing Drum Tower Hospital. The inclusion criteria were as follows: Petersen hernia confirmed during operation; previous gastrectomy history due to gastric cancer; complete clinical data. The clinical manifestation, perioperative data and follow-up outcome were summarized. Results: A total of 12 qualified patients were included. They were all male with a mean age of (65.3±8.5) years old, and whose clinical presentation had last for (6~143) hours (median: 21 hours). Common complaints included abdominal pain and bloating. All the patients were admitted to the emergency department. Preoperative CT showed dilatation and effusion of small intestine. Other imaging manifestations included whirlpool sign, target sign, mesenteric retraction or congestion and edema, abdominal and pelvic effusion, etc. Hematological examination showed white blood cell count, ratio of neutrophils, procalcitonin and C-reactive protein were higher than the normal range. The median interval to previous gastrectomy is 20.5 (0.5-55.0) months. The previous gastrectomy of 12 cases included 2 cases of laparoscopic surgery and 10 of laparotomies. Ten cases underwent emergency surgery immediately, and 2 cases underwent surgery after ineffective conservative treatment. Six cases received small bowel restoration without bowel resection, and the other 6 cases received small bowel resection with a mean length of 76 (11~300) cm. Six cases were transferred into ICU with a stay of (2.5±0.8) days. One case deceased at postoperative day 2, due to subtotal small bowel resection, and the other 11 cases survived without grade III or above complication according to Clavien-Dindo classification. The overall postoperative hospitalization was (9.2±3.6) days. During the postoperative follow-up, no acute gastrointestinal symptoms or acute abdomen recurred. Conclusions: Petersen hernia is more common in male, whose onset and progress are rapid and emergent, and prognosis is poor.


Assuntos
Gastrectomia/efeitos adversos , Laparoscopia , Neoplasias Gástricas , Idoso , China , Bases de Dados Factuais , Herniorrafia/métodos , Humanos , /etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia
15.
Magy Seb ; 73(4): 167-171, 2020 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-33310920

RESUMO

Összefoglaló. Esetismertetések: 66 éves no vizsgálatai irreponibilis fájdalmas inguinalis terime miatt kezdodtek. Ultrahangvizsgálat során a panaszok hátterében femoralis sérvben kizárt gangraenás appendix vermiformis igazolódott. Inguinalis metszésbol appendectomiát és hernioplasticát végeztünk. Posztoperatív szövodménye nem volt, szövettana appendicitist igazolt. Pár héttel késobb egy 76 éves, több társbetegséggel rendelkezo férfi fájdalmas, sercego gangraenás, jobb inguinalis terime miatt került átvételre. CT-vizsgálat femoralis sérvbe kizárt abscedáló appendix vermiformist ábrázolt. Inguinalis metszésbol, illetve alsó median laparotomiából a féregnyúlványt a hasüregbe reponáltuk, majd appendectomia és inguinalis necrectomia történt. Posztoperatív adhéziós ileus és hasfali disruptio miatt egy alkalommal reoperáltuk, adhaesiolysist és hasfali resuturát végeztünk. Ezt követoen lágyéki sebén negatív nyomásos sebkezelést alkalmaztunk, a beteget a 22. napon otthonába bocsájtottuk. Az appendix szövettana low grade mucinosus neoplasiát igazolt. Megbeszélés: A femoralis sérvbe szorult appendix vermiformis de Garengeot-sérvként ismeretes, extrém ritka incidenciájú sérvtípus, ennél is ritkább az appendix mucinosus neoplásiájával szövodo variánsa. E sérv klinikai megjelenése széles spektrumon mozoghat, pontos preoperatív diagnózisa CT-vizsgálat nélkül kifejezetten nehéz. A mutéti megoldásra többféle lehetoség választható, mely nagyban függ az esetleges komplikációktól, a rendelkezésre álló eszközöktol, az intraoperatív lelettol, valamint az operáló sebész jártasságától. CASE REPORTS: a 66-year-old woman was admitted to our Department due to a painful inguinal lump. During examinations an incarcerated femoral hernia was found with an inflamed vermiform appendix inside the hernial sac. Appendectomy and femoral hernioplasty was performed from inguinal approach. The patient was discharged home without complications. Pathological examinations of the specimen showed signs of acute appendicitis. A few weeks later a 76-year-old man with severe comorbidities was admitted to our unit due to painful gangraenous inguinal skin lesion. CT scan showed an incarcerated femoral hernia containing the appendix with subcutaneous abscess. Appendectomy, hernioplasty, and inguinal necrosectomy was performed from an inguinal and low median approach. Another operation was necessary due to postoperative obstruction and subcutaneous dehiscence. After intraabdominal adhaesiolysis and abdominal wall reconstruction negative pressure wound therapy was applied to the inguinal wound, the patient was discharged 22 days after the primary operation. Pathological examinations of the appendix showed low grade mucinous neoplasm. DISCUSSION: The femoral hernia containing the appendix is called de Garengeot's hernia and is one of the rarest types of inguinofemoral hernias. The clinicopathology of this type of hernia can cover a wide range of symptoms. The definitive preoperative diagnosis is relatively difficult to find without a CT-scan. The surgical approach and treatment depends on the manifestation, clinical findings and on the available equipment and the expertise of the surgeon.


Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Hérnia Femoral/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Idoso , Apendicite/diagnóstico por imagem , Apendicite/etiologia , Apêndice/diagnóstico por imagem , Apêndice/cirurgia , Pré-Escolar , Feminino , Hérnia Femoral/diagnóstico por imagem , Humanos , Lactente , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
Arq Gastroenterol ; 57(4): 484-490, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33331481

RESUMO

BACKGROUND: Abdominal wall hernia is one of the most common surgical pathologies. The advent of minimally invasive surgery raised questions about the best technique to be applied, considering the possibility of reducing postoperative pain, a lower rate of complications, and early return to usual activities. OBJECTIVE: To evaluate the frequency of open and laparoscopic hernioplasties in Brazil from 2008 to 2018, analyzing the rates of urgent and elective surgeries, mortality, costs, and the impact of laparoscopic surgical training on the public health system. METHODS: Nationwide data from 2008 to 2018 were obtained from the public health registry database (DATASUS) for a descriptive analysis of the selected data and parameters. RESULTS: 2,671,347 hernioplasties were performed in the period, an average of 242,850 surgeries per year (99.4% open, 0.6% laparoscopic). The economically active population (aged 20-59) constituted the dominant group (54.5%). There was a significant reduction (P<0.01) in open surgeries, without a compensatory increase in laparoscopic procedures. 22.3% of surgeries were urgent, with a significant increase in mortality when compared to elective surgeries (P<0.01). The distribution of laparoscopic surgery varied widely, directly associated with the number of digestive surgeons. CONCLUSION: This study presents nationwide data on hernia repair surgeries in Brazil for the first time. Minimally invasive techniques represent a minor portion of hernioplasties. Urgent surgeries represent a high percentage when compared to other countries, with increased mortality. The data reinforce the need for improvement in the offer of services, specialized training, and equalization in the distribution of procedures in all regions.


Assuntos
Hérnia Femoral/cirurgia , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia , Adulto , Brasil/epidemiologia , Hérnia Femoral/epidemiologia , Hérnia Inguinal/epidemiologia , Herniorrafia/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Saúde Pública , Telas Cirúrgicas , Resultado do Tratamento , Adulto Jovem
17.
Chirurgia (Bucur) ; 115(6): 767-774, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33378635

RESUMO

Background: Development of seroma after incisional hernia repair is a common complication. Our study aims to compare the outcomes of sublay incisional hernia repairs with or without spray instillation of fibrin glue. Methods: We enrolled fifty patients undergoing incisional hernia repair. In all patients a suction drain was placed in the subcutaneous space. In one group (FG) 4 ml fibrin glue was instilled in the subcutaneous space. In the control group (C) patients did not receive any prevention measure. Wounds fluids were collected on post-operative day 1 (POD) and once daily until drain removal. All patients were followed up by ultrasound on POD 15, 20, 40, 60. Results: Drain fluid production, even if in significantly greater amount in the C group (p 0.01) as compared with the FG group, decreased after POD 1 in both groups. Drain was removed on POD-5 in 80% of FG patients and in 36% of C patients (p 0.01). No infective or bleeding complications were detected. In group FG average hospital stay was of 5.5 ÃÂ+- 2 days versus 7.1 +- 1.5 days in group C (p 0.01). At ultrasounds examination, seroma development was similar among two groups. Conclusions: Spray instillation of fibrin glue during the surgical repair reduces amount of drained fluid and hospital stay without increasing surgical complications. However, seroma occurrence was not significantly reduced.


Assuntos
Adesivo Tecidual de Fibrina/administração & dosagem , Hérnia Ventral , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Hérnia Incisional , Seroma/prevenção & controle , Adesivos Teciduais/administração & dosagem , Administração Tópica , Adesivo Tecidual de Fibrina/uso terapêutico , Hérnia Ventral/cirurgia , Humanos , Hérnia Incisional/cirurgia , Tempo de Internação , Seroma/etiologia , Sucção , Adesivos Teciduais/uso terapêutico , Resultado do Tratamento
18.
Rev. cuba. cir ; 59(4): e1022, oct.-dic. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1149846

RESUMO

RESUMEN Introducción: En la provincia de Mayabeque se emplea la técnica de Lichtenstein en la reparación de la hernia inguinal, con una recidiva inferior al 3 por ciento. Objetivo: Caracterizar a los pacientes con diagnóstico de hernia inguinal operados por la técnica de hernioplastia de Lichtenstein. Métodos: Se realizó un estudio longitudinal y retrospectivo en pacientes operados de hernia inguinal en el Hospital "Leopoldito Martínez" de enero-2013 a diciembre-2017. El universo estuvo constituido por 218 y una muestra probabilística sistemática de 128 casos. Los datos se obtuvieron de las historias clínicas. Las variables cuantitativas se resumieron mediante media aritmética y desviación estándar y las variables cualitativas mediante los por cientos. La comparación de proporciones se realizó a través del chi-cuadrado y la dócima de Duncan, considerándose un nivel de significación para p < 0,05. Resultados: Predominó el sexo masculino (94,54 por ciento), la edad entre 41 - 60 años (42,96 por ciento), tipo de hernia III A (60,15 por ciento) y evolución media de la misma 42,3 meses; el tiempo quirúrgico fue de 1-2 horas (65,62 por ciento) con media de 1 h, 26 minutos. Prevalecieron las complicaciones dolor agudo (13,28 por ciento) e infección del sitio quirúrgico (3,12 por ciento) y estadía hospitalaria < 24 horas (79,68 por ciento) con una recidiva de 2,34 por ciento. Conclusiones: La técnica de Lichtenstein es efectiva en la reparación de la hernia inguinal en la provincia de Mayabeque. La media del tiempo quirúrgico se estima en 1 hora y 26 minutos como máximo y la estadía hospitalaria a expensas de las complicaciones de 24-72 horas. El por ciento de recidivas es alto y debe mejorar depurando la técnica(AU)


ABSTRACT Introduction: In Mayabeque Province, the Lichtenstein technique is used to repair inguinal hernia, with a recurrence below 3 percent. Objective: To characterize patients with a diagnosis of inguinal hernia operated on by the Lichtenstein hernioplasty technique. Methods: A longitudinal and retrospective study was carried out in patients operated on for inguinal hernia at Leopoldito Martínez Hospital, from January-2013 to December-2017. The universe consisted of 218, with a systematic probabilistic sample of 128 cases. The data were obtained from medical records. Quantitative variables were summarized by arithmetic mean and standard deviation, while qualitative variables were summarized by percentages. The comparison of proportions was carried out through the chi-square and Duncan's test, considering a level of significance of P< 0.05. Results: There was a predominance of the male sex predominated (94.54 percent), the age between 41 and 60 years (42.96 percent), and the hernia type III A (60.15 percent), with mean evolution of 42.3 month. Surgical time was 1-2 hours (65.62 percent), with a mean of one hour and 26 minutes. There was predominance of acute pain complications (13.28 percent), surgical-site infection (3.12 percent) and hospital stay below 24 hours (79.68 percent), with a recurrence of 2.34 percent. Conclusions: The Lichtenstein technique is effective for inguinal hernia repair in the Mayabeque Province. Mean surgical time is estimated to be a maximum of one hour and 26 minutes, while hospital stay, at the expense of complications, was 24-72 hours. The percentage of recurrences is high and should improve by refining the technique(AU)


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Registros Médicos , Herniorrafia/métodos , Hérnia Inguinal/diagnóstico , Estudos Retrospectivos , Estudos Longitudinais
19.
Khirurgiia (Mosk) ; (10): 44-48, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33047585

RESUMO

OBJECTIVE: To reveal the association of tension-free inguinal hernia repair and pathospermia in fertile men. MATERIAL AND METHODS: We have retrospectively analyzed medical records of 512 men who appealed to andrologist with complaints of the absence of pregnancy in wife in 2018. We evaluated duration and features of infertility, presence/absence of previous inguinal hernia repair, spermogram data (according to WHO criteria, 2010) in all patients. RESULTS: Duration of infertility in men after inguinal hernia repair persists for 4.2±2.1 years. Right-sided hernia repair was performed in 36 (48.6%) patients, left-side - 23 (31%), bilateral repair - 15 (20.2%) patients. Men with impaired sperm motility prevailed among patients after right-sided inguinal hernia repair (17 (47.2%) people). Left-sided hernia repair was followed by asthenozoospermia in 8 (34.7%) cases, bilateral hernia repair - in 3 (20%) cases. The most severe abnormalities in semen analysis (azoospemia) develop after bilateral hernia repair. CONCLUSION: Inguinal tension-free hernia repair is a risk factor for male infertility in 14.4% of cases. It is very important to examine a man in case of infertile marriage. Previous surgical interventions including inguinal hernia repair should be considered.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Infertilidade Masculina/etiologia , Astenozoospermia/diagnóstico , Astenozoospermia/etiologia , Azoospermia/diagnóstico , Azoospermia/etiologia , Herniorrafia/métodos , Humanos , Infertilidade Masculina/diagnóstico , Masculino , Estudos Retrospectivos , Fatores de Risco , Análise do Sêmen
20.
Khirurgiia (Mosk) ; (10): 88-94, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33047591

RESUMO

Conventional «open¼ procedures for ventral hernias and diastasis recti are widely known, used everywhere and have a great number of author's improvements related to surgeon's experience, availability of modern information, equipment and materials. K. LeBlanc and W. Booth (1993) reported IPOM-method with non-adhesive coating that is considered a milestone in surgery of anterior abdominal wall and ventral hernia. This technique has gained recognition among surgeons around the world due to its technical simplicity, minimal invasiveness and high reproducibility. However, certain disadvantages of this technique have been shown over the past time that justified advisability of searching for another methods of anterior abdominal wall reinforcement. Thus, E-Milos, LIRA, TESAR, eTEP, REPA, TARM, TARUP techniques are currently available. This review is devoted to technical features of these techniques, their potential advantages and disadvantages.


Assuntos
Parede Abdominal/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Parede Abdominal/anatomia & histologia , Hérnia Abdominal/cirurgia , Hérnia Ventral/patologia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Reprodutibilidade dos Testes , Telas Cirúrgicas
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