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array:23 [ "pii" => "S0185106316300890" "issn" => "01851063" "doi" => "10.1016/j.hgmx.2016.08.008" "estado" => "S300" "fechaPublicacion" => "2018-04-01" "aid" => "125" "copyright" => "Sociedad Médica del Hospital General de México" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Med Hosp Gen Mex. 2018;81 Supl 1:1-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1192 "formatos" => array:3 [ "EPUB" => 53 "HTML" => 896 "PDF" => 243 ] ] "itemSiguiente" => array:19 [ "pii" => "S0185106316300889" "issn" => "01851063" "doi" => "10.1016/j.hgmx.2016.08.007" "estado" => "S300" "fechaPublicacion" => "2018-04-01" "aid" => "124" "copyright" => "Sociedad Médica del Hospital General de México" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Med Hosp Gen Mex. 2018;81 Supl 1:6-11" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1854 "formatos" => array:3 [ "EPUB" => 55 "HTML" => 1507 "PDF" => 292 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical case</span>" "titulo" => "Early primary lymphoedema treated by en bloc excision: A case report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "6" "paginaFinal" => "11" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Linfedema primario precoz, tratado mediante escisión en bloque: reporte de caso" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1050 "Ancho" => 950 "Tamanyo" => 165682 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Final integration of the grafts and new appearance of the limb.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.A. García-Espinoza, V.B. Aguilar-Aragón, S. Vásquez-Ciriaco" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J.A." "apellidos" => "García-Espinoza" ] 1 => array:2 [ "nombre" => "V.B." "apellidos" => "Aguilar-Aragón" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Vásquez-Ciriaco" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0185106316300889?idApp=UINPBA00004N" "url" => "/01851063/00000081000000S1/v1_201804250416/S0185106316300889/v1_201804250416/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical case</span>" "titulo" => "Iliac artery reconstruction secondary to incidental injury in open hernia repair: A case report and literature review" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1" "paginaFinal" => "5" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. Doña-Jaimes, J.A. García-Espinoza, N.E. Basurto Acevedo, N.A. Lechuga-García, M.J. López Juárez, R. Aragón-Soto" "autores" => array:6 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Doña-Jaimes" "email" => array:1 [ 0 => "dr.ronald.dj@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J.A." "apellidos" => "García-Espinoza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "N.E." "apellidos" => "Basurto Acevedo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "N.A." "apellidos" => "Lechuga-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "M.J." "apellidos" => "López Juárez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "R." "apellidos" => "Aragón-Soto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of General and Minimally Invasive Surgery, Hospital Regional de Alta Especialidad de Oaxaca, Oaxaca, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital General de México, Mexico City, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Aldama sin número, colonia Paraje el Tule, San Bartolo Coyotepec, C.P. 71256, Oaxaca, Mexico." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reconstrucción de arteria iliaca secundaria a lesión incidental en hernioplastia abierta: presentación de un caso y revisión de literatura" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 976 "Ancho" => 990 "Tamanyo" => 187778 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Artery reconstruction computer tomography angiography (CTA). (Straightforward identification of the iliac artery lesion.)</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Inguinal hernia repair is one of the most common surgeries performed worldwide by general surgeons. More than 750,000 inguinal hernia repairs are performed each year in the United States.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a> Hernias are more common in men than in women, and in Caucasians than in blacks. There are many techniques for repairing the hernia which can be categorised as tension-free repair (using a mesh) and tension repair where the primary tissues are pulled tight and no mesh is used.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">2</span></a> Lichtenstein tension-free repair using polypropylene mesh is the gold standard for inguinal hernia repair.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">3</span></a> The procedure is easy for surgeons to learn, and can even be performed under local anaesthesia which is attributed to reducing hernia recurrence to <5%.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Hernias are classified based on anatomical location: inguinal (direct or indirect), femoral or crural. Approximately 96% of hernias are inguinal and 4% are femoral.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a> They can be classified according to their aetiology (congenital or acquired).<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a> The most commonly used classifications for inguinal hernias are those by Gilbert, Hyhus, and Schumpelick. Other classifications systems have been proposed by Bendavid, Alexander, and Zollinger; however, they are difficult to remember and too complex. For this reason, a process to reach a consensus was used to develop an easier classification to categorise hernias into the updated traditional classification as shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">6</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Risk factors for developing a hernia include the following<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">3,7–14</span></a>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><p id="par0020" class="elsevierStylePara elsevierViewall">History of hernia or prior hernia repair (including in childhood)</p></li><li class="elsevierStyleListItem" id="lsti0010"><p id="par0025" class="elsevierStylePara elsevierViewall">Being older</p></li><li class="elsevierStyleListItem" id="lsti0015"><p id="par0030" class="elsevierStylePara elsevierViewall">Being male</p></li><li class="elsevierStyleListItem" id="lsti0020"><p id="par0035" class="elsevierStylePara elsevierViewall">Being Caucasian</p></li><li class="elsevierStyleListItem" id="lsti0025"><p id="par0040" class="elsevierStylePara elsevierViewall">Chronic cough</p></li><li class="elsevierStyleListItem" id="lsti0030"><p id="par0045" class="elsevierStylePara elsevierViewall">Increased intra-abdominal pressure</p></li><li class="elsevierStyleListItem" id="lsti0035"><p id="par0050" class="elsevierStylePara elsevierViewall">Chronic constipation</p></li><li class="elsevierStyleListItem" id="lsti0040"><p id="par0055" class="elsevierStylePara elsevierViewall">Abdominal wall injury</p></li><li class="elsevierStyleListItem" id="lsti0045"><p id="par0060" class="elsevierStylePara elsevierViewall">Smoking</p></li><li class="elsevierStyleListItem" id="lsti0050"><p id="par0065" class="elsevierStylePara elsevierViewall">Ascites</p></li><li class="elsevierStyleListItem" id="lsti0055"><p id="par0070" class="elsevierStylePara elsevierViewall">Prostatism</p></li><li class="elsevierStyleListItem" id="lsti0060"><p id="par0075" class="elsevierStylePara elsevierViewall">Family history of hernia</p></li><li class="elsevierStyleListItem" id="lsti0065"><p id="par0080" class="elsevierStylePara elsevierViewall">Abdominal aortic aneurysm</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Complications related to hernias</span><p id="par0085" class="elsevierStylePara elsevierViewall">Complications of inguinal or femoral hernia are relatively rare, depending on the clinical circumstances in which the patient is admitted to the operating room and the type of hernia. In a randomised study to determine the frequency of complications in a total of 1,983 patients who underwent laparoscopic and open inguinal hernia repair surgery, it was found that 35% had a significant complication and there was a higher range in those who underwent laparoscopic repair than in those who underwent open repair (39% vs 33%; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.02).<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The complications can be grouped into three types depending on when they presented:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">Intraoperative complications (bleeding, nerve injury, vascular injury, vessel injury in the vas deferens, anaesthesia complications), 2% of which occurred in open repair using the Lichtenstein mesh technique and 5% in laparoscopic repair. Vascular injury complications were reported in 5 patients who underwent laparoscopic surgery. No major vascular lesions were found in open repair surgeries.</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall">Short-term post-operative complications (surgical site injection, trocar site infection, wound haematoma, scrotal haematoma, orchitis, seroma or hydrocele, chronic leg pain, chronic inguinal pain, urinary tract infection, and urinary retention) are reported with similar percentages for laparoscopic vs open surgery, with 26% and 20%, respectively. Complications such as wound haematoma, scrotal haematoma, and hydrocele were the most common in both groups.</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">-</span><p id="par0105" class="elsevierStylePara elsevierViewall">Long-term complications (chronic leg pain, chronic inguinal pain, seroma or hydrocele) were the most common.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">8,15</span></a></p></li></ul></p><p id="par0110" class="elsevierStylePara elsevierViewall">External iliac artery injury has a low incidence in open inguinal hernia repair and there are no case reports in the literature.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Case report</span><p id="par0115" class="elsevierStylePara elsevierViewall">A 28-year-old male patient. Originally from and residing in Cuyamecalco Cuicatlán with no prior relevant history, the complaint started with pain in the left inguinal region, which was exacerbated with effort and decreased when taking analgesics. There was an increase in volume that grew when performing the Valsalva manoeuvre. He was assessed by the Department of General Surgery and diagnosed with an inguinal hernia. Surgery was scheduled for inguinal hernia repair surgery, plus placement of a Lichtenstein polypropylene mesh. During the surgery he presented incidental arterial injury with 400<span class="elsevierStyleHsp" style=""></span>ml of blood loss. The site of bleeding was unable to be identified, and so two ring forceps were placed which stopped the bleeding and ended the procedure. He was transferred to this unit.</p><p id="par0120" class="elsevierStylePara elsevierViewall">He was assessed in the Emergency Department at the Hospital Regional de Alta Especialidad de Oaxaca. The patient was conscious, oriented, well-hydrated, normal-coloured skin, uncompromised chest, abdomen flat, bowel sounds present, soft, depressible, non-tender upon palpation, no organomegaly. Transverse wound in the left inguinal region with two forceps inside, left pelvic extremities with no femoral, popliteal, or pedal pulse with diminished capillary refill 6<span class="elsevierStyleHsp" style=""></span>s after digital pressure and decreased temperature in comparison to the right side.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Blood work at admission: Blood gases: venous pH: 7.24, <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span>: 39 <span class="elsevierStyleItalic">p</span>O<span class="elsevierStyleInf">2</span>: 50 HCO<span class="elsevierStyleInf">3</span><span class="elsevierStyleSup">−</span>: 16.7, BEb<span class="elsevierStyleSup">−</span>: 10.7, SO<span class="elsevierStyleInf">2</span>: 77. Blood chemistry: glucose 98<span class="elsevierStyleHsp" style=""></span>mg/dl, urea 15<span class="elsevierStyleHsp" style=""></span>mg/dl, creatinine 0.6<span class="elsevierStyleHsp" style=""></span>mg/dl, albumin 3.8<span class="elsevierStyleHsp" style=""></span>g/dl, AST 29<span class="elsevierStyleHsp" style=""></span>U/l, ALT 36<span class="elsevierStyleHsp" style=""></span>U/l, ALP 90<span class="elsevierStyleHsp" style=""></span>U/l, LDH 758<span class="elsevierStyleHsp" style=""></span>mg/dl, sodium 139<span class="elsevierStyleHsp" style=""></span>mmol/l, K 3.8<span class="elsevierStyleHsp" style=""></span>mmol/l, Cl 105<span class="elsevierStyleHsp" style=""></span>mmol/l, calcium 9.3<span class="elsevierStyleHsp" style=""></span>mg/dl, total bilirubin: 2.06<span class="elsevierStyleHsp" style=""></span>mg/dl, indirect 1.96<span class="elsevierStyleHsp" style=""></span>mg/dl, complete blood count: white blood cells 17,000, haemoglobin 14.5<span class="elsevierStyleHsp" style=""></span>g/dl, platelets 218,000, neutrophils 14.68<span class="elsevierStyleHsp" style=""></span>fl, PT 14<span class="elsevierStyleHsp" style=""></span>s, aPTT 28<span class="elsevierStyleHsp" style=""></span>s, INR 1.07%.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Computed tomography angiography (CTA) was performed with the following significant findings: The left external iliac artery showed no contrast enhancement throughout its entire trajectory. The presence of the ring forceps with which it was clamped were seen at the juncture with the common femoral artery, later bypassing this clamping. A Doppler ultrasound was performed, observing very slow flow rates in this artery, at 22<span class="elsevierStyleHsp" style=""></span>cm/s (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The common femoral artery was also partially clamped as is seen from the blood flow with the Doppler ultrasound. Diagnosis: occlusion of the left external iliac artery. The common femoral artery and common femoral vein were clamped, showing a bypass in their distal segment with diminished flow rates.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Per surgical protocol he was admitted to the operating room where surgery was performed using a Gibson incision. Findings included external iliac artery integrity and a complete blockage just below the inguinal ligament. Full dissection was performed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). An 8 French Fogarty catheter was introduced into the proximal and distal end of the severed artery and the thrombus was extracted. Adequate blood flow was confirmed and end-to-end anastomosis using polypropylene 6-0 was performed to connect the external iliac artery to the PTFE vascular graft (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Distal flow was confirmed, haemostasis was confirmed, and a layered polypropylene 1 closure was used. The procedure was ended.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">Injury to the external iliac artery during open inguinal hernia repair is extremely rare. However, it is a devastating scenario that can result in the loss of the limb if it is not properly treated in time to re-establish normal blood flow to the limb.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a> This type of lesion requires immediate surgical treatment. The CT angiography used for the diagnosis is a versatile technique with a wide range of applications beyond arteriography. Delineating the vascular anatomy is achieved well within a very short acquisition time and vessel injuries can be identified and characterised by the millimetre to be able to determine the type of lesion and its extent.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">17,18</span></a> Managing the lesions depends on the anatomical location, the mechanism of the injury, and its nature. Endovascular diagnosis and treatment may be performed, including placing a stent. A good tolerance has been described, with a short hospital stay, and a combination of endovascular therapy may be performed as a complement to definitive surgical treatment.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a> It is possible to treat most lesions with just polypropylene vascular sutures (4-0 to 6-0). However, in more extensive lesions, an autologous vein graft is the material of choice in traumatic wounds, although in new studies the data do not favour vein grafts and even lean towards prosthetic materials to repair traumatic arterial lesions.<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">19,20</span></a> In this case, a synthetic polytetrafluoroethylene (PTFE) graft was placed and its permeability assessed using Doppler ultrasound, observing good blood flow through the femoral artery while also performing a vein check to rule out thrombosis.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Sometimes the necessary graft materials are not at hand, and so different techniques may be used. The ipsilateral internal iliac artery may serve to re-establish blood flow. The artery is moved to the level of the middle rectal artery. Once the internal iliac artery has been moved, the middle rectal artery is severed and the distal end is sutured with a continuous 4-0 polypropylene suture (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">21</span></a> Should the lesion be continuous to the internal iliac artery and unable to be moved, the contralateral artery can be used following the same steps (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">21</span></a> The extra-anatomical bypass is a femoro-femoral crossover graft. The two femoral arteries should preferably be exposed by two surgical teams, one for each side, and the conserved distal artery identified. A subcutaneous tunnel is created, going over the pubic symphysis between the two groins, and then anastomosis is performed below the inguinal ligament with 4-0 to 6-0 polypropylene vascular sutures.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a></p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">The most important thing with artery lesions is early identification, as well as damage control. It is important for the surgeon performing the reconstruction to have all the necessary materials to successfully complete the procedure. Should they not be available, it is best for the patient to be sent to a specialised centre where treatment can be offered.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a> For our patient, the quick decision to transfer him and the partial perfusion were a factor in his favour for saving the limb. Full knowledge of the anatomy is among the most important technical aspects for performing hernia repair.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethical disclosure</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Protection of human and animal subjects</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Confidentiality of data</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work centre on the publication of patient data.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Right to privacy and informed consent</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1018806" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec977155" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1018805" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Material y método" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec977154" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Complications related to hernias" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Case report" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0025" "titulo" => "Ethical disclosure" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-06-17" "fechaAceptado" => "2016-08-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec977155" "palabras" => array:5 [ 0 => "Hernia" 1 => "Inguinal" 2 => "Iliac artery" 3 => "Injury" 4 => "Grafts" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec977154" "palabras" => array:5 [ 0 => "Hernia" 1 => "Inguinal" 2 => "Arteria iliaca" 3 => "Lesión" 4 => "Injertos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Inguinal hernia repair is one of the most common surgeries performed worldwide by general surgeons. More than 750,000 inguinal hernia repairs are performed each year in the United States. Complications of inguinal or femoral hernia are relatively rare, depending on the clinical circumstances in which the patient is admitted to the operating room and the type of hernia. The complications are classified as: intraoperative, short term and long term. Arterial lesions are the rarest but most dangerous.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To describe surgical techniques used to repair injuries to the external iliac artery during an inguinal hernia repair that is reproducible by general surgeons.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materials and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A case report of an intraoperative external iliac artery injury is presented in which is a polytetrafluoroethylene (PTFE) graft was used over the length of the lesion. Different techniques may be used for revascularisation: autogenous vein graft, synthetic grafts, revascularisation with ipsilateral or contralateral internal iliac artery and femoro-femoral crossover graft.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The surgical technique using PTFE grafts is effective for repairing arterial injuries and it results in timely revascularisation that promotes satisfactory progress.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La plastia inguinal es una de las cirugías más frecuente realizadas a nivel mundial por cirujanos generales. En Estados Unidos más de 750,000 hernioplastias inguinales se realizan por año. Las complicaciones de una hernia inguinal o femoral son relativamente infrecuentes, depende de las circunstancias clínicas en las que se ingresa a quirófano y el tipo de la hernia. Las complicaciones se clasifican en: intraoperatoría, a corto plazo y a largo plazo. Las lesiones arteriales son las más raras pero más graves.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Describir técnicas quirúrgicas para reparación de lesiones de la arteria iliaca durante una plastia inguinal y reproducible por cirujanos generales.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Material y método</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se presenta un caso clínico con lesión de arteria iliaca externa intraoperatoría la cual se realiza injerto de politetrafluoroetileno (PTFE) por la longitud de la lesión. Se puede utilizar diferentes técnicas para la revascularización: injerto de vena autóloga, injertos sintéticos, revascularización con arteria hipogástrica ipsi o contralateral e injerto cruzado femoro-femoral.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La técnica quirúrgica utilizando injerto de PTFE es eficaz para la reparación de lesión arterial y tener una revascularización oportuna que favorece una satisfactoria evolución.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Material y método" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 976 "Ancho" => 990 "Tamanyo" => 187778 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Artery reconstruction computer tomography angiography (CTA). (Straightforward identification of the iliac artery lesion.)</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1640 "Ancho" => 1650 "Tamanyo" => 296802 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Exposure of the inguinal region with proximal and distal ends. Iliac artery lesion with loss of tissue.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1552 "Ancho" => 1650 "Tamanyo" => 257451 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Anastomosis of PTFE graft from the external iliac artery to the femoral artery.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1101 "Ancho" => 950 "Tamanyo" => 106965 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Revascularisation with ipsilateral internal iliac artery.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1558 "Ancho" => 1625 "Tamanyo" => 225975 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Revascularisation with internal iliac artery.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Updated traditional \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Nyhus–Stoppa \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Gilbert \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Schumpelick \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1. Small indirect \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">L1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2. Medium indirect \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">L2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3. Large indirect \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IIIB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">L3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4. Small direct \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IIIA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5. Medium direct \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IIIA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6. Large direct \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7. Combined \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IIIB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MC \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8. Femoral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IIIC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">0. Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1727875.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Updated traditional classification of inguinal hernias.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0120" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factors associated with postoperative complications and hernia recurrence for patients undergoing inguinal hernia repair: a report from the VA Cooperative Hernia Study Group" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.D. Matthews" 1 => "T. Anthony" 2 => "L.T. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjsurg.2007.07.018" "Revista" => array:6 [ "tituloSerie" => "Am J Surg" "fecha" => "2007" "volumen" => "194" "paginaInicial" => "611" "paginaFinal" => "617" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17936422" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0125" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.G. Schmedt" 1 => "S. Sauerland" 2 => "R. 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Year/Month | Html | Total | |
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2024 October | 53 | 10 | 63 |
2024 September | 85 | 9 | 94 |
2024 August | 67 | 9 | 76 |
2024 July | 102 | 10 | 112 |
2024 June | 66 | 6 | 72 |
2024 May | 54 | 5 | 59 |
2024 April | 74 | 8 | 82 |
2024 March | 93 | 5 | 98 |
2024 February | 118 | 7 | 125 |
2024 January | 146 | 15 | 161 |
2023 December | 118 | 5 | 123 |
2023 November | 107 | 7 | 114 |
2023 October | 175 | 24 | 199 |
2023 September | 113 | 20 | 133 |
2023 August | 108 | 8 | 116 |
2023 July | 111 | 9 | 120 |
2023 June | 127 | 6 | 133 |
2023 May | 189 | 10 | 199 |
2023 April | 184 | 3 | 187 |
2023 March | 132 | 7 | 139 |
2023 February | 108 | 3 | 111 |
2023 January | 119 | 9 | 128 |
2022 December | 121 | 5 | 126 |
2022 November | 108 | 3 | 111 |
2022 October | 72 | 12 | 84 |
2022 September | 92 | 10 | 102 |
2022 August | 100 | 18 | 118 |
2022 July | 85 | 9 | 94 |
2022 June | 66 | 7 | 73 |
2022 May | 87 | 10 | 97 |
2022 April | 68 | 13 | 81 |
2022 March | 109 | 11 | 120 |
2022 February | 92 | 7 | 99 |
2022 January | 156 | 20 | 176 |
2021 December | 114 | 20 | 134 |
2021 November | 118 | 28 | 146 |
2021 October | 122 | 11 | 133 |
2021 September | 94 | 13 | 107 |
2021 August | 80 | 8 | 88 |
2021 July | 53 | 10 | 63 |
2021 June | 61 | 4 | 65 |
2021 May | 74 | 16 | 90 |
2021 April | 242 | 11 | 253 |
2021 March | 86 | 12 | 98 |
2021 February | 75 | 16 | 91 |
2021 January | 63 | 13 | 76 |
2020 December | 56 | 56 | 112 |
2020 November | 65 | 12 | 77 |
2020 October | 30 | 4 | 34 |
2020 September | 39 | 9 | 48 |
2020 August | 46 | 7 | 53 |
2020 July | 21 | 6 | 27 |
2020 June | 29 | 11 | 40 |
2020 May | 38 | 5 | 43 |
2020 April | 25 | 4 | 29 |
2020 March | 37 | 15 | 52 |
2020 February | 41 | 10 | 51 |
2020 January | 45 | 5 | 50 |
2019 December | 52 | 7 | 59 |
2019 November | 35 | 8 | 43 |
2019 October | 39 | 5 | 44 |
2019 September | 47 | 6 | 53 |
2019 August | 25 | 4 | 29 |
2019 July | 25 | 5 | 30 |
2019 June | 78 | 16 | 94 |
2019 May | 163 | 53 | 216 |
2019 April | 105 | 17 | 122 |
2019 March | 9 | 1 | 10 |
2019 February | 18 | 2 | 20 |
2019 January | 19 | 1 | 20 |
2018 December | 11 | 0 | 11 |
2018 November | 35 | 0 | 35 |
2018 October | 39 | 3 | 42 |
2018 September | 37 | 8 | 45 |
2018 August | 14 | 3 | 17 |
2018 July | 16 | 6 | 22 |
2018 June | 12 | 0 | 12 |
2018 May | 8 | 3 | 11 |
2018 April | 1 | 0 | 1 |
2018 February | 0 | 1 | 1 |
2018 January | 3 | 0 | 3 |
2017 December | 0 | 1 | 1 |
2017 November | 2 | 1 | 3 |
2017 October | 2 | 2 | 4 |
2017 September | 3 | 3 | 6 |
2017 August | 2 | 3 | 5 |
2017 July | 2 | 2 | 4 |
2017 June | 0 | 3 | 3 |
2017 May | 1 | 4 | 5 |
2017 April | 2 | 3 | 5 |
2017 March | 8 | 22 | 30 |
2017 February | 4 | 5 | 9 |
2017 January | 0 | 2 | 2 |
2016 December | 1 | 3 | 4 |
2016 November | 2 | 10 | 12 |
2016 October | 7 | 17 | 24 |
2016 September | 0 | 3 | 3 |