Hernioplastia sintensión con doble prótesis (tapón y malla): resultados del Servicio de Cirugía General, Hospital Nacional de Itauguá

Cuenca Torres, Osmar; Ramírez Sotomayor, Julio; Duarte, Andrés; Yaluff, Luis; Jara, Carlos

Las técnicas de reparacion sin sutura de tejidos, libres de tensión, ha significado un descenso de los índices de recurrencia a cifras inferiores al 1%. Todas ellas tienen en común el uso de material biocompatible de prolipopileno y son procedimientos que tienen una curva de aprendizaje corta. La HSTDP es una técnica sencilla, reproducible y con resultados satisfactorios. La técnica consistió en situar un cono plug de malla de prolipopileno sobre el defecto original de la hernia, según propuesta Rutkow y Robbins y posteriormente colocar la malla de polipropileno sobre la pared posterior del conducto inguinal y rodeando las estructuras del cordón espermático, fijándola según la técnica de Lichtenstein. La doble situación de la prótesis, en el defecto original y con un refuerzo anterior, permite tratar de forma más fisiológica y segura el defecto original y a la vez supone un refuerzo de las estructuras anatómicas de la región inguinal...

Introduction:

the introduction of tension-free tissue-free repair techniques has meant a decrease in recurrence rates to figures below 1%. All of them have in common the use of biocompatible polypropylene material and are procedures that have a short learning curve. They are applied in almost any hospital, they have a lower frequency of early complications, their results are reproducible by any surgeon (provided they practice it as the authors describe it).

Objective:

to analyze the applicability and preliminary results of tensionless hernioplasty using double prostheses (plug plus mesh) (HSTDP).

Patients and Methods:

a descriptive observational study of a transverse section, partially retrospective, which included 165 adult patients with inguinal hernia admitted to the General Surgery Service of the Itauguá National Hospital from January 2006 to July 2008, according to the selection protocol and of preset jobs. The technique consisted of placing a polypropylene mesh cone or plug over the original hernia defect, as proposed by Rutkow and Robbins, and subsequently placing a polypropylene mesón the posterior wall of the inguinal canal and surrounding the spermatic cord structures, fixing it according to the Lichtenstein technique.

Results:

there was a predominance of indirect hernias and Gilbert's operative classification III. The median postoperative stay was 25,5 hours. The most frequent postoperative complication has been the presence of seromas in 4 cases (2,2 %) and infection in 7 cases (4 %). No case of prosthetic intolerance was evidenced. The median follow-up has been 14 months, with no recurrences.

Conclusions:

HSTDP is a simple, reproducible technique with satisfactory results. The double situation of the prosthesis, in the original defect and with a previous reinforcement, allows to treat the original defect in a more physiological and safe way and at the same time it supposes a reinforcement of the anatomical structures of the inguinal region.