RESUMEN
BACKGROUND: In this prospective non-randomized observational cohort study we evaluated: the feasibility and effectiveness of primary umbilical hernia repair with open tension-free and sutureless technique using a porcine small intestinal submucosa (Surgisis) prosthesis, the quality of the treatment in terms of reduction of postoperative discomfort and the complications at early and long-term follow-up. METHODS: Thirty-six consecutive patients, mean age 45.25 +/- 12.19 years, affected by primary umbilical uncomplicated hernia with a defect size < or = 3 cm, were treated in a day-surgery setting. A tailored flat Surgisis graft was used to ensure an overlap of at least 2 cm; in all patients the mesh was fixed by fibrin glue. Collected data included: visual analogic scale (VAS) pain scores at 24 hours, 72 hours, and 7, 15, and 30 days and number of analgesic medications after operation, complications rate, the quality of life measured by Short Form 36 health survey questionnaire (SF-36) before the operation and at long term follow-up. RESULTS: The mean follow-up time was 5.6 +/- 1.4 years. Postoperative pain was low: the mean visual analogic scale (VAS) scores were 2.8 at 24 h, 1.8 at 72 h, and 0.9, 0.3, and 0.04 at 7, 15, and 30 days, respectively. 77.8% of the patients (28/36) did not use any analgesic drugs. Seroma was reported in 13.8% of the patients (5/36); there were no hematomas, infection, chronic pain and no major complications or mortality (< or = 30 days). Recurrence rate was 2.8% (1/36). Patient satisfaction showed a significant improvement in all SF-36 domain scores (P < 0.001). CONCLUSIONS: The biologic mesh seems to be a safe and reliable device for repairing primary umbilical hernia with high patient comfort, even if not yet an alternative to synthetic mesh.
Asunto(s)
Colágeno/uso terapéutico , Hernia Umbilical/cirugía , Herniorrafia/instrumentación , Dolor Postoperatorio/prevención & control , Mallas Quirúrgicas , Adulto , Anciano , Estudios de Factibilidad , Femenino , Adhesivo de Tejido de Fibrina , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Prevención Secundaria , Técnicas de Sutura , Factores de Tiempo , Resultado del TratamientoRESUMEN
Hemorrhoidal disease is one of the most common anorectal disorders, from 10% to 20% of all patients admitted at a clinical investigation need to undergo surgery, stapled haemorrhoidopexy is gaining wide acceptance as an interesting, safe and less painful technique, but hemorrhage is one of the most serious early complications and is a severe complication in day surgery. In our day surgery proctology, surgical procedures represent about 32%. Of these, 24% are for hemorrhoidal disease, we present our protocol and experience for early and safe discharge, 6h after stapled hemorrhoidopexy surgery.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Hemorroides/cirugía , Grapado Quirúrgico , Hemorragia Gastrointestinal/prevención & control , Esponja de Gelatina Absorbible , Humanos , Complicaciones Posoperatorias/prevención & control , RectoRESUMEN
A model for vascular microanastomosis is presented. Attention is drawn to problems involved in the technique for such operations and it is shown that results can be greatly improved by using a microscope. Six-month angiographic follow-up results in a personal series are illustrated and some clinical indications for this form of surgery are explained.