Blas AR, Castelán HES, Blas ML, Blas MMC, Blas MR, Domínguez ACP

Language: Spanish
References: 7
Page: 24-30
PDF size: 826.04 Kb.

ABSTRACT

Objective: To present the experience and results over six years of laparoscopic incisional and ventral hernia repair using tissue separator mesh. Material and methods: A descriptive, retrospective and observational study was conducted in 41 patients diagnosed with incisional or ventral hernia where results were documented, operated between 2009 and 2015, by the same surgeon. Postoperative follow-up at 8, 15 and 30 days, and 3, 6 and 12 months, and then every year to date. All patients underwent laparoscopic incisional and ventral hernia repair (LIVHR) with tissue separating mesh. The fixation system was nonabsorbable monofilament transperitoneal at four cardinal points and girth mesh fixed with absorbable agrafes. Results: 41 patients were operated: 25 (60.97%) women and 16 (39.02%) males, aged 22-70 years. Twenty two (53.65%) had incisional hernias and 19 (43.34%) had ventral hernia. Intraoperative blood loss was a minimum of 5 mL and up to 150 mL; in the vast majority (27 patients) the trans-surgical bleeding was 5 mL. The operative time ranged from 60 to 240 minutes, 26 patients required 60-120 minutes, 12 patients 121-180 minutes and only three required 181-240 minutes. In 34 patients it was not required to administer antibiotic; the other seven did receive antibiotic therapy. All were given painkillers. The most frequent comorbidities were smoking in 10 cases and alcoholism in three; in 23 cases no comorbidities were found. The evolution time of the hernia pathology ranged from one to 144 months (median 72 months); the majority (29 cases) had one to two months of evolution. There were 21 (51.21%) urgency surgeries; the other 20 (48.78%) were elective surgery. All patients were operated under general anesthesia. The hospital stay was one day in 39 (95.12%) patients and two days in the two (4.87%) remaining cases. There have been no seromas, hematomas or recurrences, there has been no cases of infection or other complications related to the prosthetic material. Conclusions: Laparoscopic incisional and ventral hernia repair is excellent in patients who present incisional and ventral hernias -even in recurrent cases, in obese subjects and other comorbilidades- with minimal perioperative bleeding and scant use of antibiotics. All the advantages of laparoscopic surgery were demonstrated, such as: shorter hospital stay, minimal pain and thus minimum use of analgesics, and early return to normal activities, among others. It is necessary to do a very controlled postoperative follow-up of these patients for at least five and if possible 15 years to determine the percentage of recurrence when they arise.

REFERENCES

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