RESUMO
PURPOSE: Primary aim of this study is to compare the postoperative outcomes of the laparoscopic intracorporeal rectus aponeuroplasty (LIRA) technique to the intraperitoneal onlay mesh closing the defect (IPOM plus), in terms of recurrence and bulging rates at one-year follow-up; secondary aim is to compare the postoperative complications, seroma and pain at 30 days and one-year after surgery. METHODS: Patients with midline ventral hernia of 4-10 cm in width were included. Computed tomography scan was performed before, 1 and 12 months after surgery. Pain was evaluated using the visual analogue scale. RESULTS: Forty-five and forty-seven consecutive patients underwent LIRA and IPOM plus, respectively. Preoperatively, smoke habits and chronic obstructive pulmonary disease rates were statistically significantly higher in the LIRA group (p = 0.0001 and p = 0.012, respectively). Two bulgings (4.4%) occurred in the LIRA group, while in the IPOM plus group occurred 10 bulgings (21.3%) and three recurrences (6.4%) (p = 0.017 and p = 0.085, respectively). Postoperatively, seven (15.6%, Clavien-Dindo I) and four complications (8.5%, two Clavien-Dindo I, two Clavien-Dindo III-b) occurred in the LIRA and in the IPOM plus group, respectively (p = 0.298). One month after surgery, clinical seroma, occurred in five (11.1%) and eight patients (17%) in the LIRA and in the IPOM plus group, respectively (p = 0.416). During follow-up, pain reduction occurred, without statistically significant differences. CONCLUSIONS: In this study, even if we analysed a small series, LIRA showed lower bulging and recurrence rates in comparison to IPOM plus at one-year follow-up. Further prospective studies, with a large sample of patients and longer follow-up are required to draw definitive conclusions.
Assuntos
Hérnia Ventral , Hérnia Incisional , Laparoscopia , Humanos , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Telas Cirúrgicas/efeitos adversos , Estudos Prospectivos , Seroma/etiologia , Hérnia Ventral/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Dor/cirurgia , Hérnia Incisional/cirurgia , RecidivaRESUMO
The presence of peritoneal tuberculosis has to be clinically suspected in all patients with abdominal pain of unknown etiology, particularly when it is accompanied by fever, ascites, and abdominal distension. Access to the abdominal cavity using routine laparoscopy provides essential information on the diagnosis, from both macroscopic images and biopsy sampling, which will later provide a pathological and microbiological confirmation. This helps discriminate between potential differential diagnoses that may include similar symptoms. Other laboratory tests have to be considered as diagnostic aids, as well as for the indication of laparoscopy, including ADA, and Gallium-67 or Ca-125 scans.
Assuntos
Laparoscopia , Peritonite Tuberculosa/diagnóstico , Feminino , Humanos , Pessoa de Meia-IdadeAssuntos
Falso Aneurisma/patologia , Colecistectomia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/patologia , Artéria Hepática/patologia , Complicações Pós-Operatórias/patologia , Falso Aneurisma/cirurgia , Angiografia , Colecistite/complicações , Colecistite/cirurgia , Embolização Terapêutica , Artéria Hepática/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeAssuntos
Doenças dos Ductos Biliares/patologia , Ducto Hepático Comum/patologia , Litíase/patologia , Idoso , Doenças dos Ductos Biliares/diagnóstico por imagem , Doenças dos Ductos Biliares/cirurgia , Procedimentos Cirúrgicos do Sistema Biliar , Colangiopancreatografia Retrógrada Endoscópica , Diagnóstico Diferencial , Feminino , Ducto Hepático Comum/diagnóstico por imagem , Ducto Hepático Comum/cirurgia , Humanos , Litíase/diagnóstico por imagem , Litíase/cirurgia , Resultado do TratamentoRESUMO
Introducción: La cirugía laparoscópica ha avanzado en todos los campos quirúrgicos. En el campo de la hernia inguinal la realización de TEP y TAPP es diaria en nuestro centro. La ambulatorización de estos enfermos está en aumento, puesto que cuando iniciamos la implantación de la cirugía laparoscópica de la hernia todos permanecían entre 24-48 horas postoperatorias. Actualmente el alta es en 12 horas y se ha iniciado el proceso de ambulatorización (sin pernocta) en pacientes seleccionados. Material y métodos: Analizamos nuestros resultados desde el 2007 (fecha en la que comenzamos a realizar técnicas endoscópicas en hernias inguinales) hasta 2013. Realizamos un análisis en nuestra serie de pacientes con criterios de inclusión para cirugía laparoscópica de la hernia inguinal y exclusión de cara a fomentar la ambulatorización del proceso. Además realizamos un análisis del contexto hospitalario y extrahospitalario que han influido tanto positiva como negativamente (con significación estadística y sin significación) en el desarrollo de las técnicas laparoscópicas en la hernia inguinal. Resultados: Las circunstancias principales que nos impiden actualmente aumentar las altas en CMA en hospital comarcal son la dispersión geográfica de los pacientes y la falta de medios de atención en las proximidades de sus domicilios. La correcta selección de los pacientes ha hecho posible que la técnica se implante en nuestro centro y se realice en términos de hospitalización de corta estancia, con una visión más cercana de la ambulatorización del proceso. Conclusiones: En conclusión debemos ir progresando hasta conseguir un índice de ambulatorización cercano al 40-50 % (como objetivo real), aunque conocemos que algunas de las dificultades son grandes (siendo la principal la gran distancia entre el domicilio y el hospital). Los óptimos resultados, con una tasa de recidiva menor del 0,2 %, tasa de infección del O %, tasa de complicaciones menores muy baja, hacen que nuestro futuro vaya encaminado a seguir aplicando las técnicas endoscópicas en la cirugía de la hernia inguinal (AU)
Introduction: Laparoscopic surgery has advanced in all surgical fields. Inguinal hernia laparoscopic repair (TEP and TAPP) is a common procedure in our center. The ambulatory surgery of these patients is increasing, because when we started the introduction of laparoscopic hernia surgery all remained within 24-48 hours after surgery. Today the outcome is at 12 hours and only out-patient (no overnight) process in selected patients. Material and methods: We analyze our results from 2007 (the date we started performing endoscopic techniques in inguinal hernias) until 2013. We analyzed our series of patient looking for inclusion criteria for Laparoscopic Inguinal hernia surgery and exclusion, in order to promote one day surgery. Furthermore we analyze the hospital and social setting which influenced both positively and negatively (statistically significant and not significant) in the development of laparoscopic techniques for inguinal hernia. Results: The main current circumstances which limit the ambulatory surgery are the geographic dispersion of patients and the lack of health center in the proximity of their homes (AU)
Assuntos
Humanos , Herniorrafia/métodos , Hérnia Inguinal/cirurgia , Laparoscopia/métodos , Procedimentos Cirúrgicos Ambulatórios/métodos , Hospitalização/estatística & dados numéricos , Endoscopia , Complicações Pós-Operatórias/epidemiologiaRESUMO
No disponible
Assuntos
Humanos , Feminino , Gravidez , Adulto , Fístula Cutânea/diagnóstico , Fístula Intestinal/diagnóstico , Complicações Pós-Operatórias , Fístula Intestinal/dietoterapiaRESUMO
No disponible
Assuntos
Humanos , Feminino , Idoso , Fístula Cutânea/diagnóstico , Fístula Intestinal/diagnóstico , Doenças do Íleo/diagnóstico , Hérnia Umbilical/complicações , Perfuração Intestinal/complicaçõesRESUMO
La sospecha clínica de tuberculosis peritoneal debe estar presenteen todo paciente con dolor abdominal de etiología desconocida;sobre todo si se acompaña de fiebre, ascitis y distensión abdominal.El acceso por vía laparoscópica a la cavidad abdominalde forma reglada contribuye de manera primordial al diagnósticotanto por la imagen macroscópica como para la toma de biopsia,que dará posteriormente la confirmación anatomopatológica ymicrobiológica. Ayudando a discriminar entre los posibles diagnósticosdiferenciales que acontecen con clínica similar. Otraspruebas diagnósticas analíticas deben ser tenidas en cuenta paraayudar tanto a la indicación de laparoscopia como de cara al diagnóstico,son tales como la ADA, gammagrafía con Galio-67 y Ca-125
The presence of peritoneal tuberculosis has to be clinically suspectedin all patients with abdominal pain of unknown etiology,particularly when it is accompanied by fever, ascites, and abdominaldistension. Access to the abdominal cavity using routine laparoscopyprovides essential information on the diagnosis, fromboth macroscopic images and biopsy sampling, which will laterprovide a pathological and microbiological confirmation. Thishelps discriminate between potential differential diagnoses thatmay include similar symptoms. Other laboratory tests have to beconsidered as diagnostic aids, as well as for the indication of laparoscopy,including ADA, and Gallium-67 or Ca-125 scans (AU)