RESUMO
BACKGROUND: Transversus abdominis release (TAR) is an effective technique for treating large midline and off-midline hernias. Recent studies have demonstrated that robotic TAR (rTAR) is technically feasible and associated with improved outcomes compared to open surgery. There is no published experience to date describing abdominal wall reconstruction using the novel robotic platform HUGO RAS System (Medtronic®). METHODS: All consecutive patients who underwent a rTAR in our institution were included. Three of the four arm carts of the HUGO RAS System were used at any given time. Each arm configuration was defined by our team in conjunction with Medtronic® personnel. rTAR was performed as previously described. Upon completion of the TAR on one side, a redocking process with different, mirrored arms angles was performed to continue with the contralateral TAR. Operative variables and early morbidity were recorded. RESULTS: Ten patients were included in this study. The median BMI was 31 (21-40.6) kg/m2. The median height was 1.6 m (1.5-1.89 m). A trend of decreased operative time, console time, and redocking time was seen in these consecutive cases. No intraoperative events nor postoperative morbidity was reported. The median length of stay was 3 (1-6) days. CONCLUSION: Robotic TAR utilizing the HUGO RAS system is a feasible and safe procedure. The adoption of this procedure on this novel platform for the treatment of complex abdominal wall hernias has been successful for our team.
Assuntos
Músculos Abdominais , Procedimentos Cirúrgicos Robóticos , Humanos , Procedimentos Cirúrgicos Robóticos/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Adulto , Idoso , Herniorrafia/métodos , Tempo de Internação/estatística & dados numéricos , Hérnia Ventral/cirurgiaRESUMO
Introducción: La hernia lumbar es un tipo muy infrecuente de hernia de la pared abdominal con un reducido número de casos publicados. Puede producirse a través de dos triángulos anatómicos: uno superior o triángulo de Grynfelt-Lesshaft y uno inferior o triángulo de Petit. Presentación del caso: Presentamos el caso de una mujer de 64 años con una tumoración blanda y reductible en la región posterolateral izquierda de la pared abdominal. La tomografía computarizada confirmó la existencia de una hernia lumbar a través del triángulo superior o Grynfelt-Lesshaft. Fue intervenida mediante un abordaje laparoscópico transabdominal en el que tras la reducción del contenido herniario (tejido graso) se colocó una malla de doble capa en posición intraperitoneal. Fue dada de alta a las 24 horas de la intervención sin observarse complicaciones inmediatas. Discusión: Se trata de un tipo muy infrecuente de hernia de la pared por lo que su diagnóstico requiere una alta sospecha clínica y a menudo una confirmación radiológica mediante tomografía computarizada. Conclusiones: La reparación de la hernia lumbar está indicada para evitar posibles complicaciones y puede realizarse tanto por vía abierta como laparoscópica, debiendo incluir la colocación de material prótesico en forma de malla para reducir el riesgo de recidiva.
Introduction: Lumbar hernia is a very rare type of abdominal wall hernia with a small number of published cases. It can occur through two anatomical triangles: an upper one or Grynfelt-Lesshaft triangle and a lower one or Petit triangle. Case presentation: We present the case of a 64-year-old woman with a soft and reducible tumor in the left posterolateral region of the abdominal wall. Computerized tomography confirmed the existence of a lumbar hernia through the superior triangle or Grynfelt-Lesshaft triangle. Patient was operated through a transabdominal laparoscopic approach in which after reduction of hernial content (fatty tissue) a double-layer mesh was placed in an intraperitoneal position. She was discharged 24 hours after the intervention and no immediate complications were observed. Discussion: Lumbar hernia is a very rare type of abdominal wall hernia and its diagnosis requires high clinical suspicion and often radiological confirmation by computerized tomography. Conclusion: Lumbar hernia repair is indicated to avoid possible complications and can be performed with an open or laparoscopic approach. Repair should include a mesh to reduce the risk of recurrence.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Laparoscopia/métodos , Hérnia Abdominal/cirurgia , Hérnia Abdominal/etiologia , Herniorrafia/métodos , Resultado do Tratamento , Parede Abdominal/cirurgiaRESUMO
Appendix-associated hernias are extremely rare. They have been described sporadically in the literature, mostly as inguinal hernias. Appendix-associated incisional hernias are even more unusual. High clinical awareness is needed as complications can arise if misdiagnosis or delay occurs. We present an 80-year-old man with acute appendicitis in an incisional hernia. After successful surgery, the patient made a full recovery.
Assuntos
Apendicectomia , Apendicite/diagnóstico , Herniorrafia/efeitos adversos , Hérnia Incisional/diagnóstico , Doenças Raras/diagnóstico , Dor Abdominal/etiologia , Parede Abdominal/cirurgia , Idoso de 80 Anos ou mais , Apendicite/etiologia , Apendicite/cirurgia , Apêndice/diagnóstico por imagem , Apêndice/cirurgia , Hérnia Inguinal/cirurgia , Humanos , Hérnia Incisional/etiologia , Hérnia Incisional/cirurgia , Masculino , Náusea/etiologia , Doenças Raras/etiologia , Doenças Raras/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Vômito/etiologiaRESUMO
RESUMEN Introducción: el empleo de corticoesteroides es una estrategia eficaz para reducir el dolor postoperatorio. Objetivo: determinar la utilidad de la betametasona en la prevención del dolor postoperatorio en pacientes intervenidos por hernia discal lumbar. Métodos: se realizó un estudio cuasi-experimental en 100 pacientes intervenidos por hernia discal lumbar en el Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro¼, de la provincia de Villa Clara, durante el período de abril de 2013 a diciembre de 2015. Se dividieron en un grupo control y en un grupo estudio; previo a la incisión quirúrgica, se les administró diclofenaco 75 mg endovenoso y 8 mg de betametasona (solo en el grupo estudio). Resultados: el 70 % de los pacientes eran masculinos, y la edad media fue 45,99 años. En el grupo estudio el tiempo de aparición del dolor () y su intensidad, a las 4, 8 y 24 horas, fue significativamente menor que en el grupo control (pα< 0,010, pα< 0,001 y <0,001); el 48 % de los pacientes pudieron levantarse sin dolor, 32 % menos requirieron analgesia de rescate, y el grado de satisfacción fue significativamente mejor. Conclusiones: la administración de betametasona antes de la incisión quirúrgica resultó muy útil en la prevención del dolor postoperatorio en los pacientes intervenidos de hernia discal lumbar.
ABSTRACT Introduction: use of corticosteroids is an effective strategy to reduce postoperative pain. Objective: to determine usefulness of betamethasone in the prevention of postoperative pain in patients operated for lumbar disc herniation. Methods: a quasi-experimental study was carried out in 100 patients operated for lumbar disc herniation at "Arnaldo Milián Castro" Clinico-Surgical University Hospital, in Villa Clara province from April 2013 to December 2015. They were divided into a control group and a study one; prior to surgical incision, intravenous diclofenac 75mg and betamethasone 8mg were administered (only in the study group). Results: 70% of the patients were male, and the mean age was 45.99 years. In the study group, the time of onset of pain () and its intensity, at 4, 8 and 24 hours, was significantly lower than in the control group (pα <0.010, pα <0.001 and <0.001); 48% of the patients were able to get up without pain, 32 % less required rescue analgesia, and the degree of satisfaction was significantly better. Conclusions: administration of betamethasone before surgical incision was very useful in the prevention of postoperative pain in patients operated for lumbar disc herniation.
Assuntos
Dor Pós-Operatória , Betametasona , Hérnia , Vértebras LombaresAssuntos
Hérnia Ventral , Hérnia Incisional , Transplante de Fígado , Estudos de Coortes , Humanos , Fatores de RiscoAssuntos
Hérnia Hiatal/cirurgia , Laparoscopia , Fundoplicatura , Humanos , Próteses e Implantes , Telas CirúrgicasRESUMO
BACKGROUND AND OBJECTIVES: Inguinal hernia repair is among the most common procedures performed worldwide and the laparoscopic totally extraperitoneal (TEP) approach is a recognized and effective surgical technique. Although technically advantageous because of the option of no mesh fixation and no need for creation of a peritoneal flap resulting, in less postoperative pain and faster recovery, TEP has not achieved the popularity it deserves, mainly because of its complexity and steep learning curve. Minilaparoscopy was first described in the 1990s and has recently gained significantly from better instrumentation that may increase TEP's effectiveness and acceptance. We performed a prospective study, to analyze the outcomes of minilaparoscopy in pain and operative time when compared to the conventional laparoscopic technique in hernia repair. METHODS: Fifty-eight laparoscopic inguinal hernia repairs were performed: 36 by traditional laparoscopic technique and 22 by minilaparoscopic instruments (mini). A study protocol was applied prospectively for data collection. Variables analyzed were early postoperative pain (at hour 6 after procedure), pain at discharge, use of on-demand analgesics, and operative time. RESULTS: The mini group presented reduced early postoperative pain and operative time. The present study also suggests less postoperative pain at discharge with mini procedures, although this difference was not statistically significant. No difference between the groups regarding on-demand use of analgesics was found. CONCLUSIONS: This study corroborates findings in previously published papers that have shown the feasibility of minilaparoscopy in laparoscopic TEP hernia repair and its benefits regarding postoperative pain, operative time, and aesthetic outcomes.
Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Telas Cirúrgicas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Prospectivos , Recidiva , Resultado do TratamentoRESUMO
PURPOSE: Brazil is the fifth most populous country in the world with widespread regional and social inequalities. Regional disparities in healthcare are unacceptably large, with the remote and poor regions of the north and northeast having reduced life expectancy compared to the south region, where life expectancy approaches that of rich countries. We report our experience of a humanitarian surgery mission to the Amazonas state, in the northwest part of Brazil. METHODS: In August 2014, a team of seven consultant surgeons, and two trainees with the charity 'International Hernia', visited three hospitals in the Amazonas state to provide hernia surgery and training. RESULTS: Eighty-nine hernias were repaired in 74 patients (female = 22, male = 52) with a median age of 44 years (range 2-83 years). Nine patients underwent more than one type of hernia repair, and there were 9 laparoscopic inguinal and ventral incisional hernia repairs. Local doctors were trained in hernia repair techniques, and an International Hernia Symposium was held at the University of the State of Amazonas, Manaus. CONCLUSION: The humanitarian mission provided hernia surgery to an underserved population in Brazil and training to local doctors, building local sustainability. Continued cooperation between host and international surgeons for future missions to Brazil will ensure continuing surgical training and technical assistance.
Assuntos
Hérnia Abdominal/cirurgia , Herniorrafia , Missões Médicas , Socorro em Desastres , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Criança , Pré-Escolar , Feminino , Herniorrafia/educação , Humanos , Cooperação Internacional , Masculino , Pessoa de Meia-Idade , Telas Cirúrgicas , Adulto JovemRESUMO
Summary Objective: all individuals regardless of their age or level of development require physical, emotional and cognitive preparation before an operation. It is known that the attitudes of pediatric nurses towards pediatric patients are influential on the anxiety levels of children awaiting an operation. This study aims to determine the effect of pre-op trainning on the anxiety levels of pediatric patients hospitalized for hernioplasty surgery. Methods: this cross sectional and quasi-experimental study included a total of 100 patients aged 7-12 years admitted for inguinal hernia surgery, 50 of which were the control group and 50 the experiment group. The data was gathered using the patients’ identification forms and a child steady state anxiety scale. Research data was evaluated with appropriate statistical methods. Results: the groups showed similar socio-demographic features and no statistically significant difference was observed (p>0.05). During the pre-op period neither of the groups showed any statistically significant difference in terms of both state and trait anxiety levels (p>0.05), however the experiment group showed a statistically significant drop in their anxiety levels during the post-op period (p<0.05). Conclusion: the state anxiety levels of children receiving a planned pre-op trainning are lower compared to children who did not receive such trainning. Reducing the anxiety levels of sick children is possible through giving visual and tangible information appropriate with the age and developmental level of the sick child during the pre-op period. .
Resumo Objetivo: todo indivíduo, independentemente da idade ou fase de desenvolvimento, requer preparo físico, emocional e cognitivo antes de qualquer operação. Sabe-se que a atitude dos enfermeiros frente ao paciente pediátrico tem influência sobre o nível de ansiedade das crianças que esperam para serem operadas. Este estudo tem como objetivo determinar o efeito do preparo pré-operatório sobre os níveis de ansiedade de pacientes pediátricos hospitalizados para procedimento de hernioplastia. Métodos: este estudo transversal e quase-experimental incluiu um total de 100 pacientes com idade de 7 a 12 anos internados para cirurgia de hérnia inguinal; 50 deles formaram o grupo de controle e os demais 50, o grupo de experimento. Os dados foram colhidos a partir de formulários de identificação dos pacientes e uma escala de estado-traço de ansiedade para crianças. Os dados da pesquisa foram avaliados com os devidos métodos estatísticos. Resultados: os grupos mostraram características sociodemográficas semelhantes e nenhuma diferença estatisticamente significativa foi observada (p>0,05). Durante o período pré- -operatório, nenhum dos grupos apresentou qualquer diferença estatisticamente significativa em termos de níveis de estado de ansiedade ou traços (p>0,05); no entanto, o grupo de experimento mostrou queda estatisticamente significativa dos níveis de ansiedade no período pós-operatório (p<0,05). Conclusão: os níveis de estado de ansiedade das crianças que receberam preparo pré-operatório planejado são mais baixos em comparação com as crianças que não receberam esse treinamento. Reduzir os níveis de ansiedade de crianças doentes é possível quando se oferece informações visuais e palpáveis adequadas à idade e à fase de desenvolvimento da criança no período pré-operatório. .
Assuntos
Criança , Feminino , Humanos , Masculino , Ansiedade/prevenção & controle , Ansiedade/psicologia , Cuidados Pré-Operatórios/psicologia , Estudos de Casos e Controles , Estudos Transversais , TurquiaRESUMO
El conocimiento de los biomateriales es una obligación de los cirujanos en la actualidad, debido al uso cada vez más aceptado de estos en los procedimientos quirúrgicos. De hecho, los resultados obtenidos con los implantes: cifras de recidivas muy bajas y número mínimo de complicaciones, lo demuestran. La introducción en Cuba de la malla Surgimesh® desarrollada por la compañía Aspide Medical, con características físico-químicas de polipropileno que proporcionan efectos óptimos, motivó a realizar esta revisión bibliográfica sobre el tema.
The knowledge of biomaterials is nowadays compulsory for surgeons, due to the increasingly acceptance in their use in the surgical procedures. In fact, the obtained results with implants: very low relapses cases and minimal number of complications, demonstrate it. The introduction in Cuba of the Surgimesh® mesh, developed by the Aspide Medical company, with physical-chemical characteristics of polypropylene which provide optimal effects, motivated to carry out this literature review on the topic.