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Introduction: Laparoscopic hernia repairs have comparable recurrence rate with less persisting pain and numbness and quicker return to usual activities as compared to open mesh repair. The excellent outcomes of minimally invasive surgery encourage us to extend the laparoscopic technique to complicated groin hernia. Method: A total of 22 patients with complicated groin hernia who presented to our institute from September 2017 to September 2018 were included in this prospective cohort study. Inclusion criteria were patients with age greater than 18 years and clinically diagnosed as complicated groin hernia. Patients with peritonitis, those with previous abdominal surgery and unfit for general anesthesia were excluded from our study. Results: The most common age group was 51-60 (31.8%) years.17 cases were repaired with totally laparoscopic approach (12 TEP, 5 TAPP). Laparoscopic repair with additional procedure was needed in 3 cases and 2 cases were converted to open for completion of the procedure. The mean operating time was 154.8 ± 51.6 (range: 90 to 230) minutes. The average length of hospital stay was 3.8 ± 3 (range: 1 to 12) days. Bleeding from the inferior epigastric and testicular vessels were the major intra-operative complication (11.8%). Seroma and surgical site infection were seen in 2 (11.8%) patients. Conclusion: Laparoscopic approach in cases of complicated groin hernia can achieve desirable patient outcomes without major complications, provided good patient selection and expertise. The evidence for laparoscopic repair as the choice of procedure in complicated groin hernia can be established from further comparative studies.
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INTRODUCTION AND IMPORTANCE: Congenital unilateral absence of the vas deferens and ipsilateral renal agenesis is a rare condition in which the vas deferens is absent unilateral due to a congenital anomaly. This report illustrates the clinical relevance of absence of the vasa deferentia. This occurs either unilateral, which is associated with renal anomalies, or bilateral which leads to azoospermia and often has a genetic link to cystic fibrosis. CASE PRESENTATION: We report the first incidental finding of congenital unilateral absence of the vas deferens and ipsilateral renal agenesis during bilateral laparoscopic totally extraperitoneal inguinal hernia repair in a 70 year old patient. CONCLUSION: Surgeons who encounter unilateral absence of the vas deferens should assess bilateral absence of the vasa deferentia by palpation in adult patients or by laparoscopic exploration of the contralateral inguinal canal in pediatric patients. Renal ultrasonography should be performed in all patients to assess renal anomalies. Genetic counselling is advised when absence of the vasa deferentia is present bilaterally of unilaterally with associated infertility.
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PURPOSE: The objective of the study was to analyze the experience of the Department of Surgery of two institutions of high complexity in Colombia, with the extra peritoneal ventral hernia repair by laparoscopy during the last 2 years and characterize the clinical and surgical aspects most relevant in the procedures performed. METHODS: Observational, descriptive, retrospective study, case series type: collection of data by clinical history and analysis thereof including calculation of frequency and central tendency measurements. RESULTS: 59 Cases of Ventral Hernia Repair by laparoscopy, 41 with Transabdominal Preperitoneal approach and 18 totally Extraperitoneal. In total, 7 complications were presented as follows: 1 Case of recurrence, 1 case of chronic pain, 2 complications Dindo-Clavien IIIa and 1 complication IIIb. CONCLUSIONS: The repair of the ventral hernia by Extraperitoneal route is an innovative approach of increasing popularity, which avoids the contact of the mesh with the intestines, thus avoiding the potential complications that this situation generates with good outcomes and at a lower cost.
Assuntos
Hérnia Ventral/cirurgia , Herniorrafia , Laparoscopia/métodos , Complicações Pós-Operatórias , Adulto , Colômbia/epidemiologia , Feminino , Hérnia Ventral/epidemiologia , Herniorrafia/efeitos adversos , Herniorrafia/instrumentação , Herniorrafia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Peritônio/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Telas CirúrgicasRESUMO
Introducción: la hernia inguinal es uno de los principales motivos de consulta quirúrgica y su reparación es uno de los procedimientos más comunes en cirugía. Objetivo: determinar la experiencia en el abordaje laparoscópico de las hernias inguinales por técnica transabdominal preperitoneal en el Servicio de Cirugía General del Centro Médico Nacional-Hospital Nacional. Metodología: estudio observacional descriptivo retrospectivo de corte temporal transversal. En pacientes de 16 a 90 años de edad con diagnóstico de hernia inguinal internados en el Servicio de Cirugía General del Centro Médico Nacional-Hospital Nacional para hernioplastia electiva. Resultados: se llevaron a cabo 30 hernioplastias por técnica técnica trans-abdominal pre-peritoneal de los cuales el 73 % fue realizado en hombres y 27 % en mujeres; se identificó una media de edad de 48,4 años, el grupo etario con mayor frecuencia fue de 38 a 48 años. En el examen físico pre quirúrgico se encontraron hernias inguinales unilaterales en el 76.6 % y bilaterales en el 23.3 %; en la mayor parte de los pacientes las hernias fueron primarias en el 86.6 %y recidivada en el 13.3 %. El tiempo quirúrgico en promedio fue de 93.1 minutos; con un tiempo máximo de 120 minutos y mínimo de 60 minutos. El tiempo de hospitalización en el 100 % de los pacientes fue de 48 h. De las complicaciones post operatorias se establece que el 76.6 % no presento ningún tipo de complicación; el 20 % presentó seroma como complicación principal y 3.3 % infección del sitio quirúrgico. Conclusión: debido a su alta frecuencia y a su impacto en la incapacidad laboral y social, las hernias inguinales representan una de las patologías quirúrgicas más importantes con bajas tasas de complicaciones post operatorias y corta estancia hospitalaria.
Introduction: inguinal hernia is one of the main reasons TAPP, e-TEP (Totally extraperitoneal with extended vision) for surgical consultation and its repair is one of the most common surgical procedures. Objective: to determine the experience in the laparoscopic approach of inguinal hernias by preperitoneal transabdominal technique in the Servicio de Cirugía General of the Centro Médico Nacional-Hospital Nacional. Methodology: retrospective descriptive observational study of cross-sectional time. In patients from 16 to 90 years of age with a diagnosis of inguinal hernia admitted to the Servicio de Cirugía General of the Centro Médico Nacional-Hospital Nacional for elective hernioplasty. Results: 30 hernioplasties were carried out by the TAPP technique, of which 73 % were performed in men and 27 % in women; a mean age of 48.4 years was identified, the age group most frequently being 38 to 48 years. In the pre-surgical physical examination, unilateral inguinal hernias were found in 76.6 % and bilateral in 23.3 %; in most of the patients the hernias were primary in 86.6 % and recurred in 13.3 %. Average surgical time was 93.1 minutes; with a maximum time of 120 minutes and a minimum of 60 minutes. The hospitalization time in 100 % of the patients was 48 hours. Of the post-operative complications, it is established that 76.6% did not present any type of complication; 20 % presented seroma as the main complication and 3.3 % surgical site infection. Conclusion: due to its high frequency and its impact on work and social disability, inguinal hernias represent one of the most important surgical pathologies with low rates of postoperative complications and short hospital stay.