RESUMO
INTRODUCTION: Multiple minimally invasive techniques have been described for ventral hernia repair. The recently described enhanced view totally extraperitoneal (eTEP) ventral hernia repair seems an appealing option since it allows to address midline and lateral hernias, placing the mesh in the retromuscular position without the use of traumatic fixation. AIM: To report on the mid-term result of a series of patients with ventral hernias repaired by the eTEP approach. METHODS: A retrospective analysis of our case series between June 2017 and December 2019. Demographic and clinical data were gathered. Hernia characteristics, surgical details, hernia recurrences, and complications are reported. RESULTS: 66 patients were included in the study. Median follow-up was 22 months (interquartile range 12-26). 60% of patients were male. Mean age, BMI, % of Type-2 diabetes and % of smoking were 59 ± 12 years, 30 kg/m2, 24% and 23%, respectively. Mean hernia defect size was 5.5 ± 2.9 cm. Forty-three eTEP Rives-stoppa and 23 eTEP-Transversus abdominis release (14 unilateral, 9 bilateral) were performed. 22 inguinal hernias and 15 lateral defects were simultaneously repaired. We report 1 recurrence (1.5%) and 10 surgical site occurrences (15%; 6 seromas, 2 hematomas and 2 surgical site infections). Four patients required reinterventions (6%). CONCLUSION: eTEP is a promising approach to treat midline hernias and allows the simultaneous treatment of lateral and inguinal defects, keeping the mesh in the retromuscular position. However, comparative studies must be performed to know its real benefit in laparoscopic ventral hernia repair.
Assuntos
Parede Abdominal , Hérnia Ventral , Hérnia Incisional , Laparoscopia , Parede Abdominal/cirurgia , Idoso , Hérnia Ventral/etiologia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Humanos , Hérnia Incisional/etiologia , Hérnia Incisional/cirurgia , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Telas CirúrgicasRESUMO
BACKGROUND: Hernia repair represents about 25% of all pediatric surgeries. Repair can be done using an open or laparoscopic technique. The open approach has a reported recurrence rate of 1.2% but requires an additional incision to repair for a contralateral hernia. With the laparoscopic approach, no additional incision is needed but the recurrence rate has been reported to be as high as 4%. The objective of this study was to assess the safety and efficacy of a novel sutureless laparoscopic inguinal hernia repair that has the advantages of both approaches. METHODS: Since April 2014 up to March 2017, 26 children (12 girls and 14 boys) aged 3 months to 13 years underwent sutureless laparoscopic inguinal hernia repair. The peritoneum around the internal inguinal ring was severed and folded into the inguinal canal. Regeneration of the peritoneum around the inguinal ring creates a scar that effectively closes the internal orifice. RESULTS: No recurrences or complications were observed in any of the 26 cases after a follow-up of 1-35 months (median, 14 months). CONCLUSIONS: Sutureless laparoscopic inguinal hernia repair provides a new option for the management of patients with a pediatric inguinal hernia. The procedure does not require advanced laparoscopic skills, is easily reproducible, and is safe. THERAPEUTIC STUDY: Level of Evidence IV.
Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Peritônio/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Hérnia Inguinal/patologia , Humanos , Lactente , Masculino , Peritônio/lesões , Recidiva , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Background: Ventral hernias are one of the most common complications of open abdominal surgery and can be repaired laparoscopically. Aim: To assess the feasibility, safety and efficacy of the laparoscopic repair of incisional hernias. Patients and Methods: Retrospective study of the patients undergoing laparoscopic ventral hernia repair from march 2006 to october 2008 at a surgical department of a clinical hospital. We analyzed patient's characteristics, surgical variables, perioperative results, complications and short term follow up. Results: Twenty-one patients aged 54 +/- 14 years (16 females) underwent laparoscopic ventral hernia repair during this period. Their mean body mass index was 32.2 +/-6.5 kg/m². One patient was converted to open surgery. The mean hernia ring diameter was 8.4 +/- 3.9 cm (range 3-17). Median operative time was 92 minutes (range 45-300). Mean hospital stay was 3.0 +/-1.6 days. During the procedure, two patients were simultaneously subjected to a sleeve gastrectomy and cholecystectomy, respectively. Apulmonary atelectasis and a seroma occurred in two patients (10 percent) as early minor complications. As late complications, two patients (10 percent) experienced continuing pain in the area in both operations. No patient died. Follow up was 100 percent with a mean of 14 months (range 4-36), without hernia recurrence during this period. Conclusions: Laparoscopic incisional hernia repair is a feasible technique to perform, without serious complications.
Introducción: La hernia incisional (HI) es una de las complicaciones más frecuentes en cirugía abdominal abierta, siendo una alternativa para su corrección la hernioplastía por vía laparoscópica. El objetivo de este trabajo fue evaluar la factibilidad y eficacia de la reparación laparoscópica de la HI con seguimiento a corto plazo, dando a conocer nuestra experiencia inicial. Material y Método: Estudio retrospectivo de pacientes sometidos a hernioplastía incisional laparoscópica entre marzo de 2006 y octubre de 2008 en el Hospital Clínico de la Pontificia Universidad Católica de Chile. Se evaluó variables demográficas, perioperatorias, morbilidad y recidiva. Resultados: Fueron operados 21 pacientes en este período, 16 de género femenino, con un promedio de edad e índice de masa corporal de 54 +/- 13 años y 32,2 +/- 6,5 kg/m², respectivamente. Uno de ellos se convirtió a cirugía abierta. El diámetro mayor del anillo hemiario fue en promedio 8,4 +/-3,9 cm (rango 3-17) y la mediana de tiempo operatorio fue de 92 minutos (rango 45-300). La estadía hospitalaria fue 3,0 +/-1,6 días, en promedio. Durante la misma cirugía se realizó en dos pacientes gastrectomía en manga y colecistectomía. Se presentaron complicaciones precoces menores en dos pacientes (10 por ciento), una atelectasia pulmonar y un seroma, y complicaciones tardías menores en otros dos pacientes (10 por ciento), que correspondió a dolor prolongado en la zona operatoria en ambos. No hubo mortalidad en la serie. El seguimiento fue 100 por ciento, con un promedio de 14 meses (rango 4-36), sin recidiva en este período. Conclusiones: La hernioplastía incisional laparoscópica es una técnica factible de realizar en nuestro medio, sin complicaciones mayores en esta serie y buenos resultados a un a±o de seguimiento.