Search

Resumen Introduccion La eventracion subxifoidea tiene caracteristicas que la diferencian del resto y le dan entidad propia. El hecho de tener su saco muy proximo a los relieves costales oseos y esternon condiciona mucha tension en los margenes; la reparacion, tanto por via abierta como laparoscopica, no ha demostrado buenos resultados a pesar del uso generalizado de protesis. Son poco frecuentes y se presentan en pacientes con comorbilidad importante (cardiopatas severos, trasplantados, inmunodeprimidos), tras intervenciones del area hepato-bilio-pancreatica con incisiones transversales, esternotomias ampliadas por debajo del xifoides o laparotomias medias muy altas para cirugia gastro-esofagica. Material y metodo En nuestra Unidad hemos desarrollado una nueva tecnica, basada en el uso de doble protesis y adaptada a las caracteristicas anatomo-fisiologicas de la region, para la reparacion de estas eventraciones. La serie consta de 35 pacientes intervenidos de forma consecutiva entre 2004 y 2010, siguiendo protocolo quirurgico y de manejo consensuado. Resultados No hubo complicaciones importantes –la mas frecuente es el seroma, 17,4%-, excepto un caso de infeccion de la herida por isquemia de piel en un paciente multioperado y trasplantado. El seguimiento postoperatorio hasta el dia de hoy (entre 4 y 80 meses) no ha demostrado recidivas de la eventracion y no se refieren molestias locales importantes. Conclusiones La tecnica «doble malla ajustada» consigue en nuestro medio unos buenos resultados, tanto desde el punto de vista del cirujano (reproducibilidad, recidiva), como del paciente, con minimas molestias y recuperacion de la calidad de vida.

Introduction: Subxiphoid incisional hernia has characteristics that differentiate it from the rest and make it a distinctive entity. The fact that it has its sac very near the rib cage and sternum determines the pressure in the margins. The repair, by open or by laparoscopic approach, has not demonstrated good results despite the generalised use of a prosthesis. They are uncommon, and have a significant comorbidity in patients (severe heart diseases, transplants, immunosuppressed), after surgery of the hepato-bilio-pancreatic area with transverse incisions, or very high mid-laparotomies for gastro-oesophageal surgery. Material and methods: A new technique has been developed in our Unit, based on a double mesh and adapted to the anatomical and physiological characteristics of the region. The series consisted of 35 consecutive patients operated on between 2004 and 2010, following an agreed surgical and management protocol. Results: There were no significant complications−the most frequent (17.4%) was a seroma−except one case of a wound infection due to skin ischaemia in one patient who had had multiple operations and a transplant. During the post-surgical follow up to the present (between 4 and 80 months), there has been no recurrence of the incisional hernia and no significant local discomfort has been reported. Conclusions: The “adjusted double mesh” technique achieved good results in our hands, from the surgical point of view (reproducibility, recurrence), and for the patient, with minimal discomfort and recovery of quality of life..