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Las hernias gigantes de Amyand son hernias inguinales excepcionales por extenderse por debajo de la mitad del muslo en posición de pie y contener al apéndice cecal. Presentamos el caso clínico de un paciente con hernia gigante de Amyand irreductible, a quien se le realizó una combinación de técnicas quirúrgicas para su resolución. El tratamiento quirúrgico de las hernias inguinales gigantes es todo un desafío, debido a la distorsión de la anatomía de la región inguinal y por la pérdida de derecho a domicilio de los órganos, que puede llegar a ocasionar. Consideramos que la combinación de las técnicas de Bassini y Lichtennstein asociado a las maniobras de Ombrédanne y de Camay es una estrategia adecuada para reparar exitosamente las hernias inguinales gigantes grado I. La apendicectomía en la hernia de Amyand tipo I es una alternativa de tratamiento cuando existe riesgo de apendicitis aguda.

Introduction. Giant hernias with loss of domain are those whose hernial sac reaches the midpoint of the thigh in standing position and whose content exceeds the volume of the abdominal cavity. These hernias are a surgical challenge given the difficult reduction of their contents and the primary fascial closure, with a higher risk of complications associated with abdominal compartment syndrome, as well as a higher rate of recurrence and morbidity in patients. Clinical case. A 81-year-old male patient with comorbidity, reconsulting due to a symptomatic giant right inguinoscrotal hernia of two years of evolution, with a Tanaka index of 24%, eligible for a sequential pneumoperitoneum protocol (up to a total of 11,000 cc in cavity) plus application of botulinum toxin (two sessions) in the abdominal wall. Results. Successful correction of the patient’s giant inguinoscrotal hernia was achieved using this protocol, without recurrence of his abdomino-inguinal pathology and satisfaction with the procedure after one year. Conclusion. The sequential pneumoperitoneum protocol continues to be an important alternative in cases with a high risk of complications that require additional reconstructive techniques, while the previous application of botulinum toxin is a considerable adjuvant to further increase the rate of favorable results. However, research in the area should be encouraged to reaffirm its effectiveness. [ABSTRACT FROM AUTHOR]

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Giant Amyand hernias are exceptional inguinal hernias because they extend below the middle of the thigh in the standing position and contain the cecal appendix. We present a patient with an irreducible giant Amyand hernia, who underwent surgical repair, using a combination of techniques for its resolution. The treatment of giant inguinal hernias is quite a challenge, due to the existing anatomical distortion, and the loss of the right to domicile of the organs that it can cause. We consider that the combination of the Bassini and Lichtenstein techniques associated with the Ombrédanne and Camay maneuvers is an appropriate strategy to successfully repair grade I giant inguinal hernias. Appendectomy in Amyand type I hernia is a treatment alternative when a risk of acute appendicitis exists. [ABSTRACT FROM AUTHOR]

La hernia inguinal supone la patología de pared abdominal más frecuente hoy en día. En el saco herniario podemos encontrar diferentes estructuras, como grasa preperitoneal, intestino delgado, colon o incluso la vejiga, resultando inusual la presencia de la trompa de Falopio y el ovario. El contenido tubo-ovárico supone un hallazgo frecuente en población pediátrica, mientras que resulta un hecho extremadamente raro en mujeres en edad reproductiva o menopáusica, siendo imprescindible su tratamiento con el fin de evitar complicaciones relacionadas con la fertilidad y la viabilidad de los anejos. Con el objetivo de revisar la bibliografía descrita al respecto dado la infrecuencia que supone este hallazgo en mujeres adultas, se presenta el siguiente caso clínico de forma resumida, con la consiguiente revisión de la literatura disponible. Se trata de una paciente mujer de 50 años, con antecedentes de mioma uterino, intervenida de forma programada de hernioplastia inguinal derecha, observando contenido tubo-ovárico en el saco herniario, en la cual se realiza hernioplastia inguinal según la técnica de Lichtenstein con preservación de anejos sin complicaciones postoperatorias. Como conclusiones finales, consideramos que los hallazgos intraoperatorios de contenido tubo-ovárico en la cirugía de hernia inguinal en mujeres adultas supone un hecho infrecuente, cuyo conocimiento y manejo resulta necesario para el cirujano general, precisando de un índice de alta sospecha con el fin de evitar complicaciones y otorgar el tratamiento quirúrgico más óptimo para el bienestar de los pacientes.

Introduction: The illustrated anatomical atlases of the 19th century created a new visual language, preparing students for dissection and surgeons for operating. Objective: The objective of this study is to analyze the dissection atlases of the 19th century from a specialty perspective of the abdominal wall. Method: Literature review of PubMed, LILACS, Cochrane Library databases; supplementary search using Google and university libraries. As keywords have been used: abdominal wall, inguinal nerves, ilioinguinal nerve, iliohipogastric nerve, genitocrural nerve, hernia, anatomy and surgery. A critical analysis of texts from any country or language is carried out, with no time limit. Results: 42 illustrated texts are analyzed to select 5 German, 3 English and 4 French atlases. The inguinal blades, the surgical contribution and the neural and vascular variants of corona mortis are discussed. Conclusions: The descriptive anatomy of the 18th century gave way to the topographical during the 19th century, favoring the development of surgical anatomy and surgery as a specialty. Illustrated atlases were the best training medium. Each atlas meant for its author a high vital impact. Most of the knowledge is copied from a small group of surgeons. Cartoonists were essential in turning atlases into works of art. Each country evolves to a surgery with different aspects. Hernia pathology is basic in the development of surgery. A great anatomical variability in the groin and abdominal wall is demonstrated. [ABSTRACT FROM AUTHOR]

Introduction and objective: Guidelines on inguinal hernia repair focus on decreasing the recurrence rate and chronic pain. Since self-adherent meshes do not require additional fixation, they can help, among other factors, to prevent postoperative chronic pain without increasing the frequency of recurrences. We present our results of inguinal hernioplasty by endoscopic TAPP approach with self-adherent mesh in a tertiary hospital to assess the presence of postoperative chronic pain. Method: Retrospective, descriptive, observational, retrospective study, over a period of 24 months, performing laparoscopic inguinal hernioplasty with preperitoneal transabdominal approach using self-adherent mesh (ProGrip™). We analyzed, among others, type of hernia, surgical time, incidents and postoperative complications, postoperative pain and satisfaction at 7 days, 1, 2, 4 and 6 months, as well as recurrence. Results: A total of 131 inguinal hernias were operated on in 100 patients, 31 bilateral and 68 unilateral, in 66 males and 34 females. There were 28 left and 41 right hernias. With respect to postoperative pain, a 1-2 ANS 1-2 was observed in the first 7 days in 14 patients, 9 patients with ANS 1 in the first month, no patient presented chronic pain. There were 9 complications, 8 related to the surgical wound of which 6 were seromas, 2 hematomas and 1 intestinal obstruction that required surgery. There was no recurrence to date, with an average follow-up of 16 months. Conclusion: Inguinal hernioplasty with endoscopic TAPP approach using self-adherent mesh did not increase the frequency of chronic pain or recurrences. Patient satisfaction is very satisfactory. [ABSTRACT FROM AUTHOR]

Introduction and objectives: Bilateral inguinal hernioplasty by endoscopic totally extraperitoneal approach (TEP) seems to increase the probability of complications and early postoperative pain compared to unilateral endoscopic hernioplasty. In this work we also try to determine if bilaterality increases the risk of conversion and recurrence during the learning curve. Methods: Between January 2017 and February 2020, 140 patients underwent TEP surgery by 2 surgeons in a single Center, establishing 2 groups: learning curve (LC) and mastery of the technique (MT). Conversion, intraoperative and postoperative complications, chronic pain, and recurrence were retrospectively analyzed. Logistic regression was performed to assess the effect of bilaterality on the results obtained. Results: 211 procedures were performed (CA: 80; SD: 131). The mean follow-up was 26.7 months (11-70, SD 1.9). The LC group presented an increase in conversion (5 % vs 3.05 %, p = 0.41), postoperative complications (16.2 % vs 10.7 %, p = 0.11) and recurrence (12.8 % vs 0 %, p < 0.001) compared to the MT group. In the LC group, bilaterality associated a non-significant increase in conversion (9.7 % vs 0 %, p = 0.94), complications (29 % vs 25 %, p = 0.76) and recurrence (19.3 % vs 18.7 %, p = 0.96). All the cases of conversion and recurrence took place in the second operated hernia. Conclusions: During the learning curve, bilateral inguinal hernioplasty by TEP increases the risk of conversion and recurrence of the hernia operated on second, and it is advisable not to include bilateral hernias in the initial training period. Studies with a larger number of cases could reach statistical significance. [ABSTRACT FROM AUTHOR]

Introduction: Spiegel-Casseri’s hernia (HSC) is an infrequent entity that represents about 2 % of abdominal wall herniary defects, but frequency could be increased due to its subdiagnosis. The diagnosis of HSC is usually diffi cult and unsuspected and it presents high risk of jamming and strangulation so its surgical management is imperative. A TC is essential for diagnosis. Case report: Male, with pathological antecedents of myasthenia gravis, who consults about bilateral inguinal hernia and left Spiegel-Casseri’s hernia. Due to his clinical history, an open preperitoneal surgical approach with Lichtenstein plastic to repair all the three defects is done. During the postoperative, he had a bruise on the dropped hernial sac, treated with conservative measures and control and didn’t require drainage. Discussion: Most series of notifi ed cases of HSC in the literature show variable incidence of attendant abdominal wall’s defects. In this case, myasthenia gravis, a chronic and weakening disease, prompted three associated parietal defects and limited anesthesiologist options and surgical approaches. HSC is an unusual entity and its association with others hernias even more, but it exists and must be taken into account to achieve an optimal treatment for the patient. [ABSTRACT FROM AUTHOR]

Las hernias inguinales son causa común de dolor inguinal y de consulta al servicio de emergencias. Su reparación es uno de los procedimientos quirúrgicos más realizados. Se clasifican según su característica anatómica en indirectas o directas. Además, tras la anamnesis y exploración física, se pueden catalogar según la escala de Nyhus. Su etiopatogenia se ha descrito multifactorial, ya que se presenta por alteraciones en genes y fibras de colágeno, músculo liso, persistencia de proceso vaginalis, síndromes genéticos y factores ambientales. El diagnóstico es fundamentalmente clínico, aunque si no está claro, el estudio de primera línea es el US. Si persiste la duda, se apoya con imágenes de TAC o resonancia magnética. Debido a la menor incidencia de complicaciones documentada por vía laparoscópica, esta es la vía de elección cuando hay sintomatología. A pesar de esto, la técnica abierta de Lichtenstein continúa siendo utilizada en diversos centros. En pacientes asintomáticos se debe establecer, idealmente, una adecuada relación médico-paciente para ofrecer con detalle riesgo/beneficio y llegar a una decisión conjunta.

Introduction and objective: Conservative management or watchful waiting in patients with asymptomatic inguinal hernia or oligosymptomatic inguinal hernia seems to be a suitable strategy, however, its implementation is under discussion. The objective of this study was to evaluate the feasibility and the results of watchful waiting in patients with asymptomatic inguinal hernia and oligosymptomatic inguinal hernia. Methods: Between 2013 and 2020, a consecutive series of patients with asymptomatic inguinal hernia or oligosymptomatic inguinal hernia who underwent to the watchful waiting approach with a minimum follow-up of 6 months was included. A comparative analysis of patients who remained in watchful waiting and patients who underwent surgery was performed. Quality of life was assessed with the EuraHS Quality of life score survey. Results: A total of 100 patients were included. The average age was 67 years (23-95) and 91 % were male. At 52 months of follow-up, 50 % of the patients had undergone surgery, the main indication being the onset or increase in pain (88 %). No emergency surgeries were recorded. The surgery group showed a significant improvement in the quality of life in the postoperative period. When comparing surgery versus watchful waiting, similar scores were observed regarding the average pain at rest and during activity. Conclusion: The watchful waiting approach seems to be feasible and safe. Oligosymptomatic patients were more likely to underwent surgery, with the onset or increase in groin pain being a determining factor to switch the strategy. [ABSTRACT FROM AUTHOR]

Introduction: Despite the important advances made in recent decades in the prevention of adverse events, foreign body abandonments continue to occur in the surgical fi eld (“never events”). Although the retained objects can occur asymptomatically, the potential complications are numerous, requiring in most cases a reoperation for their removal. Case report: We present the exceptional case of a patient who had to be reoperated to remove a surgical drain migrated to an inguinal hernia sac after accidental and inadverted rupture during its removal in the postoperative period of a previous surgery. Discussion: Most of the safety measures and prevention of these adverse events try to guarantee a correct count of surgical material during surgery. Correct actions must also be ensured in the removal of surgical drains to avoid this type of complications. [ABSTRACT FROM AUTHOR]

A American Câncer Society, num livreto intitulado “Câncer Detection in the Physician’s Office”, chama a atenção, no que denomina “os sete erros trágicos de diagnósticos”, de que a incapacidade de reconhecer que uma hérnia inguinal, que de repente se toma sintomática, pode estar associada com lesões carcinomatosas de cólon ou da próstáta, é uma falha que deve ser evitada. O objetivo dêsse trabalho é despertar a atenção para esta frequente associação. O conhecimento desta relação é de valor comprovado, para o diagnóstico precoce dos tumores malignos dos cólons.

The article describes a clinical case of a patient with a deep supraforaminal hernia, a rare variant of interparietal hernia in the inguinal region. During surgery, an indirect inguinal hernia type IIIB and a lobulated and pedunculated preperitoneal lipoma were found. The hernia was repaired using the plug technique and the region was reinforced with another mesh using the Lichtenstein technique. The patient recovered successfully and there have not been many reports on this variant of hernia. [Extracted from the article]

Introduction: In the last decade, groin pain has become the main complication of hernioplasty and a major public health problem. This problem can only be controlled by ensuring adequate knowledge of lumbar neuroanatomy. The objective of this work is to review the history of inguinal neuroanatomy in relation to hernia pathology and the specialty of the abdominal wall. Method: Literature review of PubMed, LILACS, Cochrane Library databases; supplementary search using Google (Google Play), of university libraries. As keywords have been used: “lumbar plexus”, “inguinal nerves”, “ilioinguinal nerve”, “iliohipogastric nerve”, “genitocrural nerve”, “hernia”, “anatomy” and “surgery”. A critical analysis of published articles, theses, books and monographs is carried out. Manuscripts obtained from any country, by any institution or researcher and in any language, without time limit, are stored in pdf format. Results: The study of the history of the inguinal nerves with current methodology shows the succession of knowledge until reaching the current anatomical terminology and in parallel, the development of surgical techniques until neural pathology is considered of interest. Conclusions: Schmidt’s study offers us the most recognized descriptive topography with the first advice on clinical problems associated with neural injury during a hernia operation. His classification is the one adopted as official anatomical terminology. The concepts of the intramuscular plexus of the psoas and the iliac fossa anastomotic system were introduced by the Spaniard Gómez Durán (1923). A clear disconnection between the advances in hernia and neural anatomical-surgical knowledge is demonstrated, with a delay of two centuries in its topographical application to the abdominal wall specialty. [ABSTRACT FROM AUTHOR]

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Resumen: Objetivos: Informar el empleo de la técnica de neumoperitoneo progresivo preoperatorio en un paciente portador de una hernia inguinoescrotal gigante, además de la implementación del cálculo predictivo del derecho a domicilio, mediante determinaciones volumétricas, de la capacidad abdominal y el contenido herniario. Sede: Hospital de Especialidades Médicas “Dr. Abel Gilbert Pontón” Método: Se aplicó neumoperitoneo progresivo mediante la colocación de catéter de un solo lumen por técnica de Seldinger modificada con el uso de una aguja de Veress, insuflando diariamente bajo control de presión, menor o igual a 15 mm de Hg, mediante el uso de un manómetro colocado a una llave de tres pasos. Al decimoctavo día se realizaron la herniorrafia mediante métodos sin tensión con el uso de prótesis (Técnica Lichtenstein) y resección quirúrgica de escroto redundante. El estado satisfactorio de la expansión de la cavidad abdominal se determinó mediante el cálculo volumétrico del espacio libre en la cavidad abdominal y del contenido del saco herniario. Reporte de caso: Se Trata de un paciente masculino de 33 años de edad sin antecedentes patológicos personales ni quirúrgicos, el cual porta una hernia inguino escrotal gigante de 8 años de evolución con dimensiones de 36x17x17 cm. Dicho paciente acude a emergencia por un cuadro de dolor abdominal de causa no quirúrgica y se decide su ingreso para tratamiento de forma programada. Conclusiones: El neumoperitoneo progresivo preoperatorio, mediante el uso de catéter intrabdominal, permitió aumentar la capacidad de la cavidad abdominal de forma gradual con una adecuada introducción de todo el contenido herniario sin la presencia de complicaciones, y el cálculo volumétrico del espacio libre intrabdominal y del contenido herniario nos permitió determinar cuando el paciente tenía una expansión de la cavidad abdominal adecuada para la realización de la intervención quirúrgica. Palabras claves: Neumoperitoneo progresivo, hernia inguinal, hernia con pérdida de derecho a domicilio

Las hernias inguinales son una patología para tratamiento quirúrgico frecuente, afecta entre un 3 a 5 % de todala población en general, su reparación resulta difícil y peligrosa en caso de recurrencia; un paciente sometido a cirugía tiene entre 19 – 39 % de probabilidades de recidiva, y esto aumenta con cada nuevo procedimiento. Objetivo: caracterizar la prevalencia de recidivas de hernias inguinales en pacientes intervenidos quirúrgicamente en el Servicio de Cirugía General del Hospital Universitario de Caracas entre los años 2015-2020. Métodos: estudio retrospectivo, descriptivo y analítico. Resultados: se estudiaron 52 casos de recidivas de hernias inguinales, 43 % de un total de 120 pacientes sometidos a hernioplastia inguinal, las técnicas quirúrgicas con mayor número de recidivas fueron: la de Bassini con 14 %, la de Rutkow-Robbins con 10 % y la de Linchtenstein con 9 % de los casos; con un tiempo de recidiva posterior a la primera intervención el cual fue mayor al año de la primera intervención. Conclusiones: la recidiva resultó un poco mayor al promedio, el tiempo en el cual ocurrió es mayor al año de la intervención y las técnicas más involucradas fueron, en orden decreciente: Bassini, Rutkow-Robbins, y Linchtenstein.

Introducción. El espacio extraperitoneal, se define como el segmento topográfico ubicado entre el peritoneo parietal internamente y la fascia transversalis externamente. Como resultado del desarrollo y consolidación de la cirugía laparoscópica, en particular de la herniorrafia inguinal por esta vía, se ha presentado un renovado y creciente interés en esta área anatómica, debido a la importancia de su conocimiento detallado en la cirugía de mínima invasión. Métodos. Se hizo una revisión narrativa de la literatura para presentar una información actualizada y detallada sobre la anatomía del espacio extraperitoneal y su importancia en diferentes procedimientos quirúrgicos realizados actualmente. Resultados. Por fuera del espacio peritoneal, se encuentran las áreas anatómicas externas al peritoneo parietal, que incluyen la preperitoneal y la retroperitoneal. Mediante la laparoscopia, se pueden localizar en estos espacios cinco triángulos anatómicos, además de la corona mortis y el triángulo supra vesical. Conclusión. El conocimiento del espacio extraperitoneal es de gran importancia para el cirujano general, teniendo en cuenta los múltiples procedimientos que requieren el abordaje de esta área topográfica.

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Introduction: Uncommon structures such as the content of a hernial sac have been described. However, in Cuba no giant ovarian cyst has been reported as contents of the sac. Objective: To present a female patient with an inguinocrural hernia with a giant ovarian cyst as the content of the hernial sac. Clinical case: 81-year-old female patient with progressive left inguinocrural enlargement of 27 years of evolution. A left inguinocrural hernia with loss of abdominal domain was diagnosed. After six pneumoperitoneums, an operation was carried out and a giant ovarian cyst was found as the contents of the sac, the histological study showed a cystadenoma. A prosthetic synthetic mesh was placed and a combination of techniques was used to repair the posterior wall and the crural ring. Antibiotic therapy was performed according to the protocol. The evolution was satisfactory without reproduction of the hernia. Conclusions: The presence of a giant ovarian cyst as the content of a hernia sac is rare. The combined approach and the use of elements of various techniques allowed a satisfactory repair.

Introduction: Amyand's hernia (AH) is a very rare condition and occurs when the cecal appendix is located within an inguinal hernia. Clinical case: 15-month-old male with a history of right inguinal hernia, who had been scheduled for surgical correction. He was admitted to the emergency room due to a mass in the right inguinal region associated with pain and irritability; during the physical examination, an incarcerated hernia is diagnosed because it cannot be reduced, requiring immediate surgical intervention. Regarding the surgical findings, it was confirmed that the inguinoscrotal hernia was incarcerated, identifying the terminal ileum, cecum, and cecal appendix inside. Appendectomy and high ligation of the vaginal peritoneum duct is performed. The patient progressed favorably. Conclusion: there are few published cases of incarcerated AH. We hope that this article will serve for the timely detection of similar cases to improve their prognosis. [ABSTRACT FROM AUTHOR]

The Amyand hernia was described by Claudius Amyand in 1735 and is currently considered a rare entity that occurs in 1 % of all inguinal hernias in adults. This pathology consists of the finding of a rare presentation of hernias, where the cecal appendix is located within the inguinal hernial sac, without inflammatory characteristics in most cases. Evidently, a key concept associated with the hernia in question is acute appendicitis or also known as the most frequent surgical abdominal pathology predominantly in young people with a lifetime incidence of 7 %, presenting in patients over 60 years of age in a 5-10 % of cases. In the present review, we report the case of a male in the ninth decade of life who comes to a hospital with a symptomatic inguinal hernia, with signs of incarceration and associated intestinal obstruction, with intraoperative finding of Amyand hernia type 3 in the Losanoff and Basson classification, constituting a rare case of incarcerated Amyand hernia. [ABSTRACT FROM AUTHOR]

Se realizó un estudio analítico retrospectivo de casos y controles con el objetivo de establecer la asociación existente entre los factores predisponentes a la infección de la herida quirúrgica de la hernia inguinal en pacientes intervenidos quirúrgicamente en el servicio de Cirugía General del Hospital Provincial “Dr. Antonio Luaces Iraola” de Ciego de Ávila, durante el período comprendido desde mayo de 2016 a diciembre de 2018. Los casos constituyeron 27 pacientes mayores de 18 años que fueron intervenidos quirúrgicamente de hernia inguinal de forma electiva o urgencia que presentaron infección de la herida quirúrgica como complicación y los controles estuvieron representados por 54 pacientes que no presentaron dicha infección en similar periodo de estudio con relación de dos controles por caso. Se utilizó la técnica de independencia basada en la distribución de Chi cuadrado para determinar la presencia de asociación estadística entre variables cualitativas y se realizó en cálculo del Odds Ratio para la cuantificación de riesgo. Predominaron los adultos mayores y el sexo masculino. El tabaquismo y el alcoholismo aumentaron siete y cinco veces respectivamente el riesgo de infección postoperatoria. Los antecedentes de Diabetes Mellitus, Hipertensión Arterial y desnutrición, se presentaron con un riesgo de infección alrededor de dieciséis, nueve y siete veces por ese orden. La cirugía urgente aumentó considerablemente el riesgo de infección y el tiempo quirúrgico menor a una hora se presentó como factor protector de dicha infección. Predominó la hernia inguinal primaria; así como, la cirugía ambulatoria, sin relación de éstas con la infección postoperatoria.

Introducción: En la actualidad se amplía el debate sobre qué técnica sería mejor comparando la cirugía abierta con la técnica laparoscópica, y el interés cosmético a futuro en pacientes mujeres que requieren la resolución quirúrgica de una hernia inguinal, por lo que el objetivo del presente estudio fue hacer una descripción de niñas con hernia inguinal sometidas a técnicas de corrección laparoscópica (técnica de Burnia) versus cirugía convencional para hernias inguinales. Métodos: El presente estudio observacional fue realizado en el Hospital de Niños Dr. Ro-berto Gilbert Elizalde, de Guayaquil, Ecuador, de enero del 2021 al febrero del 2022. Con una muestra no probabilística ingresaron al estudio niñas sometidas a tratamiento quirúrgico por hernia inguinal. Se registró la edad, técnica quirúrgica, estancia hospitalaria, tiempo quirúrgico y complicaciones operatorias. Se realiza un análisis bivariado comparando las técnicas quirúrgicas: abierta versus laparoscópica. Se comparan proporciones con Chi cuadrado y promedios con U de Mann-Whitney. Resultados: 89 pacientes fueron incluidas en el estudio, 76 casos por técnica abierta (TA) y 13 casos por técnica de Burnia (TB). El promedio de edad fue 3.8 años, 5.05 días de hospitalización en TA unilateral y 2.3 días en TB unilateral (P=0.03), 7.2 días de hospitalización en TA bilateral y 2.25 días en TB bilateral (P=0.026). Tiempo quirúrgico 46.9 min en TA unilateral y 40.38 min en TB unilateral (P=0.232). Tiempo operatorio de 64.7 min en TA bilateral y 42.5 min en TB bilateral (P=0.038). Complicaciones 2 casos (2.6%) en TA y 1 caso (7.7%) en TB (P=0.35). Conclusiones: El uso de la técnica laparoscópica disminuyó los tiempos de estancia hospitalaria y tiempo quirúrgico cuando es bilateral. Desde el punto de vista estético las cicatrices fueron menos visibles en el tratamiento quirúrgico por abordaje de mínima invasión.

OBJETIVO: O objetivo do presente estudo é o de identificar os elementos histológicos constituintes da fáscia transversal em 23 pacientes com hérnia inguinal direta, comparando-os com a fáscia de 22 cadáveres sem esta doença. MATERIAIS E MÉTODOS: As biópsias dos pacientes foram obtidas no momento da correção videolaparoscópica. As fáscias foram estudadas histologicamente, sendo empregadas as técnicas de coloração de hematoxilina-eosina e anticorpo monoclonal para colágeno tipo I. RESULTADOS: O tecido conjuntivo denso foi o principal elemento constitutivo das fáscias de pacientes e controles, embora em menor presença nos primeiros, seguido do tecido adiposo. Identificamos, através da técnica de imuno-histoquímica, o colágeno tipo I como sendo a principal proteína das fáscias. CONCLUSÃO: Os autores concluem que a fáscia transversal é constituída principalmente por colágeno tipo I e sugerem o uso de técnicas de correção de hérnia inguinal que aumentem a deposição de colágeno na fáscia, como quando do uso de próteses.

Inguinal herniorrhaphy stands out as one of the most surgical procedures performed worldwide. However, there are few comparative studies between conventional and minimally invasive techniques. This study aimed to compare operational data and clinical evolution of patients who underwent surgical treatment of inguinal hernias using Lichtenstein and laparoscopic techniques. We retrospectively evaluated 45 patients who underwent inguinal herniorrhaphy between January 2016 and January 2019. Sociodemographic and clinical variables were evaluated. Most patients were male, with an average age of 45.7 years. The mean time of surgery was shorter in the Lichtenstein technique, with an average of 65.6 minutes, while the level of pain in the immediate postoperative period was lower in laparoscopy. Two patients who underwent the Lichtenstein technique and 6 patients using the laparoscopic technique experienced complications. Laparoscopy offered an early return to daily activities. The average cost of surgeries was R$ 1526.38 and R$ 4694.06, for Lichtenstein and laparoscopic techniques, respectively. The laparoscopic procedure can be considered appropriate for the treatment of inguinal hernias, however, the reduction of costs intrinsic to the technique must be considered by the surgeon according to the patient's economic conditions. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

La hernia inguinal (HI) es la condición quirúrgica más común en niños, con prevalencia de 0,8 a 4,4%. Las técnicas laparoscópicas pueden reparar la (HI) más rápido, mejor visualización, menos dolor, rápida recuperación y reincorporación a actividad física, con mejores efectos estéticos. Objetivos: Analizar correlación entre las técnicas de cura operatoria de (HI) por laparoscopia y el nivel de satisfacción de pacientes pediátricos. Metodología: Estudio observacional analítico, diseño prospectivo no contemporáneo, corte longitudinal. Revisión de 52 historias clínicas de pacientes operados de (HI) por laparoscopia entre 2016– 2020. Se aplicó un cuestionario y encuesta de evaluación física y del nivel de satisfacción, vía WhatsApp. Se realizó análisis estadístico: tablas de frecuencia y análisis de varianza. Resultados: Al 100% se le realizó técnica intrabdominal preperitoneal (TIAPP), la resección del saco sin cierre del peritoneo fue la técnica más frecuente realizada en pacientes masculino, tiempo quirúrgico promedio 55 min. No hubo complicaciones intraoperatorias, se presentaron hematomas y sangrado leve en el cordón como dificultades técnicas. La Burnia presentó menor dolor posoperatorio (PO). Todas las cicatrices son estéticas, un solo paciente presentó infección de herida en el (PO) y no se presentó recurrencia de (HI). Conclusiones: La laparoscopia permite realizar diagnóstico preciso del tipo de (HI) y de hernia colateral. Existen diversas técnicas, las (TIAPP) y técnicas extracorpóreas percutánea asistidas por laparoscopia (TEPAL) ambas en manos entrenadas son beneficiosas para el paciente. Los padres refieren gran satisfacción por los resultados de la cirugía.

Amyand's hernia is defined as the presence of the vermiform appendix within an inguinal hernial sac. Less than 1% of the world medical publications on hernias address this disease, out of which very few come from Latin America and the Caribbean. This is the case of a 78-year-old male patient who experienced signs and symptoms for approximately five months. He felt a lump in the right inguinal region which progressively increased in size. Two days prior to admission to the intensive care unit, he said his pain level was 8/10. During the right inguinal approach, the hernial sac was opened, revealing parts of the right colon, cecum and appendix with edematous changes. Therefore, the patient underwent an appendectomy and repair with polypropylene mesh. [ABSTRACT FROM AUTHOR]

Introduction. Laparoscopic treatment of inguinal hernia is gaining popularity in many hospitals, but the use of working channel scopes is not as widely extended. We present our long-term experience with the SuPerLap (laparoscopic-assisted percutaneous suture) technique described by Rosell et al.(1) for epigastric hernia repair in the percutaneous, single-port treatment of inguinal hernia using working channel scopes. Materials and methods. A retrospective analysis of a series of male patients with congenital inguinal hernia undergoing surgery from February 2017 to December 2020 was carried out. A 5 mm- 0º pleuroscope with a 3.5 mm working channel, a 20 G epidural needle, a 36 cm/3.5 mm laparoscopic Maryland dissector, and 3-0 polypropylene and polyester sutures were used. Results. 384 inguinal hernia repairs using the SuPerLap technique were performed in 295 male patients -- 206 unilateral repairs and 89 bilateral repairs. In 24 bilateral cases (26.95%), preoperative diagnosis had been unilateral. Mean age was two years (2 weeks-13 years). Mean operating time was 14 minutes (6-50 min) for unilateral repair, and 27 minutes (14-80 min) for bilateral repair. There were two cases of epigastric vessel damage, and one case of early recurrence in a newborn, who successfully underwent re-intervention using the SuPerLap technique. No late complications were recorded after a mean follow-up of 1-36 months. Conclusions. Working channel scopes using the SuPerLap technique avoid additional ports in inguinal hernia repair. They allow for excellent functional results, without visible scars, and minimize spermatic cord manipulation. Laparoscopy allows previously undiagnosed defects to be concomitantly treated. [ABSTRACT FROM AUTHOR]

La hernia de Amyand se define como la presencia de un apéndice vermiforme dentro de un saco herniario inguinal. Menos del 1 % de las publicaciones médicas sobre hernias en el mundo corresponde a este padecimiento, y los reportes en Latinoamérica y el Caribe son escasos. Este artículo describe el caso de un varón de 78 años con un cuadro clínico de cinco meses de evolución aproximadamente. El paciente refiere que sentía una masa en la región inguinal derecha de crecimiento progresivo. Luego se asoció un dolor (de escala 8/10) durante los dos días previos al ingreso en el departamento de urgencias. Durante la operación en la región inguinal derecha, se abre el saco herniario que muestra partes del colon derecho, el ciego y el apéndice (edematosos), por lo que se decide realizar una apendicectomía y la reconstrucción con una malla de polipropileno.

RESUMO - RACIONAL: Três técnicas cirúrgicas para correção de hérnia inguinal estão atualmente validadas. Poucos estudos compararam os resultados entre Lichtenstein e a abordagem laparoscópica transabdominal pré-peritoneal obtidos em uma etapa inicial da curva de aprendizado. OBJETIVO: Comparar os resultados iniciais do tratamento entre a técnica de Liechtenstein e a abordagem pré-peritoneal transabdominal laparoscópica para fornecer uma base para a tomada de decisão do cirurgião. MÉTODO: Os pacientes foram divididos em grupo 1: aborgadem laparoscópica transabdominal pré-peritoneal (114 pacientes), e grupo 2: reparo aberto de Lichtenstein (35 pacientes). Os dados foram coletados em prontuários médicos durante a evolução do pós-operatório imediato e por contato telefônico após a alta hospitalar. Para a análise das variáveis, foi implementado o teste de independência Qui-Quadrado, com nível de significância estabelecido em p-valor = 0,05. RESULTADOS: Houve forte associação entre laparoscopia, menos dor pós-operatória e maior tempo operatório. Além disso, notou-se preferência pela técnica nos casos de recorrência, bilateralidade, hérnia umbilical associada ou obesidade. Neste estudo, a técnica de Lichtenstein foi associada a um menor tempo de retorno ao trabalho e foi o tratamento de escolha para pacientes idosos. CONCLUSÃO: A herniorrafia laparoscópica transabdominal pré-peritoneal deve ser a primeira escolha em casos de bilateralidade, hérnia umbilical associada, obesidade e recorrência para reparo anterior. O risco cirúrgico é adequado para o procedimento, mesmo nos estágios iniciais da curva de aprendizado.

Introduction. Splenogonadal fusion is a rare congenital anomaly of unknown etiology caused by an abnormal fusion of the splenic tissue and the gonadal tissue. Clinical case. 2-year-old patient with paralysis of the 6th, 7th, and 9th cranial nerves, tent-shaped mouth, cleft palate, right pectoralis major hypoplasia, disruptive defect of the right upper limb, and a mass located at the left inguinal region. At inguinal hernia repair surgery, a processus vaginalis with non-reducible content was observed. When opening the hernia sac, a descending segment of splenic tissue merging with the upper pole of the left testis was found. The patient was diagnosed with splenogonadal fusion. The splenic tissue merging with the testis upper pole was resected, and the remaining splenic tissue was reduced towards the abdominal cavity. Discussion. Splenogonadal fusion is difficult to diagnose. Being familiar with it allows unnecessary orchiectomies to be prevented. [ABSTRACT FROM AUTHOR]

Objective: To describe the clinical outcomes of patients with unilateral inguinal hernia (UIH) treated in an ambulatory surgical unit (ASU) of a level III hospital. Methods: The clinical charts of patients treated at the ASU of Cayetano Heredia Hospital from July 2013 to June 2016 were reviewed. Results: 154 patients were included, mean age was 43 years; 101 (65.6%) were males; 104 (67.5%) had ASA I risk; 12 (7.8%) had underlying diseases; 94 (61.0%) undergone the open technique and 60 (39.0%) undergone laparoscopy. Laparoscopy was most frequently applied in women (p=0.037). Surgical time was higher in laparoscopic procedures (p=0.033). No significant differences were observed in variables such as age, surgical risk, anesthetic and surgical complications between open and laparoscopic procedures. Thirty-four (22%) patients were not discharged the day of the procedure: 8 (5.2%) presented complications and 26 (16.8%) had administrative or social reasons. Conclusion: Ambulatory surgery of UIH in adults either by open or laparoscopic procedures is safe and allows discharging patients the day of the procedure. [ABSTRACT FROM AUTHOR]

Presentado en sesión de 24 de julio de 1963

Presentado en sesión 9 de octubre de 1963

Presentado en sesión de 7 de julio de 1954

Androgen insensitivity syndrome, Morris syndrome or testicular feminization is a disorder in sexual differentiation, in which the individual is phenotypically feminine, but with a man's genetic characteristics. The case of a 9-year-old schoolgirl with bilateral inguinal hernia is presented as a form of presentation of Morris syndrome. It is assessed in consultation confirming the presence of testicles in the surgery, corroborated by pathological anatomy. A karyotype was described describing chromosomally 46XY. In prepubertal age it is reevaluated with bilateral inguinal hernias and external genitals of female appearance. It is verified by imaging examinations, the absence of uterine body and annexes, with presence of permeable vagina until its middle third, which ends in a blind sac inside the pelvis, performing orchiectomy by minimal access without vaginoplasty. Bilateral inguinal hernia in childhood was the form of presentation of Morris syndrome in this patient. The case is presented due to the low frequency of occurrence of this condition.

Presentado en sesión de 3 de setiembre de 1952

Presentado en sesión de 2 de junio de 1948

Presentado en la Sesión del miércoles 27 de marzo de 1946.

Presentado en sesi´on de 3 de Junio de 1942

Presentado en sesión de 6 de noviembre de 1935

Introducción: La hernia inguinal es una de las enfermedades que más comúnmente requiere tratamiento operatorio y representa entre el 10- 15 % de todas las intervenciones programadas. El porcentaje de complicaciones posoperatorias es de 5- 10 % y aunque no son totalmente evitables, deben conocerse sus posibles causas para lograr reducir su incidencia. Objetivo: Identificar los factores asociados a las complicaciones de la cirugía electiva de las hernias inguinales. Métodos: Se realizó un estudio observacional y descriptivo, de una serie de 246 pacientes operados de hernias inguinales mediante cirugía electiva en el servicio de Cirugía General del Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba durante el bienio 2016-2017. Resultados: Se constataron 18 complicaciones (7,3 %). Predominó el grupo etario de 51 a 70 años (47,8 %) y el sexo masculino sobre las féminas con razón de 15,4:1. El estado físico preoperatorio fue clasificado ASA 1 en 183 pacientes (74,4 %) y ASA 2 en 62 (25,2 %). El 72,2 % de los complicados tenían al menos una enfermedad asociada. El tipo 2 según clasificación de Nyhus prevaleció con 73 (29,7 %) y 8 (44,4 %) de los complicados. Conclusiones: Los factores referentes a la edad mayor de 50 años, sexo masculino, antecedentes de hipertensión arterial y diabetes mellitus, y hernias tipo II según la clasificación de Nyhus se asocian a la presentación de complicaciones agudas (edema del cordón espermático e infección del sitio operatorio) y crónicas (recidiva y granuloma) de la cirugía electiva de las hernias inguinales.

Introduction: The robotic transabdominal preperitoneal approach (rTAPP) is a relatively recent technique for the treatment of inguinal hernia. To achieve optimal results, the 10 golden rules described must be followed. Surgeons in training often review videos to familiarize themselves with new techniques, YouTube being one of the most used platforms. The objective of this study is to carry out an evaluation of the 10 most viewed videos on YouTube of inguinal hernia repair by transabdominal preperitoneal approach (rTAPP) to determine if the 10 golden rules are met., Methods: Identify and evaluate the 10 videos with the highest number of views related to rTAPP. Three experienced Surgeons evaluated compliance with the 10 golden rules using a Likert scale. Data were analyzed in Excel (Microsoft) and plotted with Tableau (Tableau Inc). The consistency between evaluators was determined using Cronbach's alpha, considering a value >0.7 acceptable., Results: The average overall evaluation was 3.63 with a range of 2.6 to 4.9. The scores related to compliance with the rules 1, 2, 9, 10 were satisfactory; on the other hand, rules 3, 4, 5, 7 and 8 were weak, particularly rule number 7. Internal consistency was observed between raters with a Cronbach's alpha of 0.98., Conclusions: The lack of compliance with the 10 golden rules in most of the videos demonstrates that the use of videos (YouTube) is not an adequate resource for learning robot-assisted inguinal hernia cure., (Copyright © 2023 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

Copyright of QhaliKay: Revista de Ciencias de la Salud is the property of QhaliKay Revista de Ciencias de la Salud and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Inguinal hernias represent 75% of abdominal wall hernias. In general, an inguinal hernia hospitalization does not require a high number of bed days. However, it is complications that lead to an increase in hospitalizations. The international literature shows that 72.2% of patients with complications of inguinal hernia have at least one associated underlying disease. General objective: Descriptively compare hospital discharges due to inguinal hernia in Chile according to sex and age group, during the period 2017-2020. Materials and methods: Ecological observational study. The numbers of hospitalized cases for inguinal hernia in Chile for the period 2017-2020 (n = 68,159) were studied. Being a public database, no ethics committee was required. Results: In the period studied, the year with the highest number of hospitalizations was 2018 with 19,533 cases. The one with the lowest amount was the year 2020 with 11,234 cases. Men represent 80.34% (54,758) of the total cases studied. The age range with the highest frequency of hospitalization was 45-64 years with 24,168 (35.46%) cases. Conclusions: Inguinal hernia is mostly frequent in the male population. However, by 2020 there was a notable decrease in their numbers, which could be due to the COVID-19 pandemic. Timely detection of this pathology is important, in order to avoid future complications that could have longterm consequences. [ABSTRACT FROM AUTHOR]

La hernia de Amyand es una enfermedad rara que se observa en aproximadamente el 1 % de todas las hernias, y sus complicaciones como la apendicitis aguda o perforada, son aún más raras, aproximadamente el 0,1 %. Su diagnóstico es muy difícil en el período preoperatorio y suele ser un hallazgo incidental. Se recibió un paciente masculino de setenta y tres años de edad que acudió al servicio de emergencias debido a dolor abdominal tipo punzante de moderada intensidad localizado en región inguinal derecha de 4 días de evolución, no refirió otros síntomas acompañantes. Se diagnosticó una hernia inguinal Nyhus III, Amyand tipo 2 y se le realizó apendicectomía incidental y reducción del saco herniario. Durante el postoperatorio no se observaron complicaciones.