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Clinical case
Iliac artery reconstruction secondary to incidental injury in open hernia repair: A case report and literature review
Reconstrucción de arteria iliaca secundaria a lesión incidental en hernioplastia abierta: presentación de un caso y revisión de literatura
R. Doña-Jaimesa,
Corresponding author
dr.ronald.dj@gmail.com

Corresponding author at: Aldama sin número, colonia Paraje el Tule, San Bartolo Coyotepec, C.P. 71256, Oaxaca, Mexico.
, J.A. García-Espinozaa, N.E. Basurto Acevedob, N.A. Lechuga-Garcíaa, M.J. López Juáreza, R. Aragón-Sotob
a Department of General and Minimally Invasive Surgery, Hospital Regional de Alta Especialidad de Oaxaca, Oaxaca, Mexico
b Hospital General de México, Mexico City, Mexico
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    "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&#46; More than 750&#44;000 inguinal hernia repairs are performed each year in the United States&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a> Hernias are more common in men than in women&#44; and in Caucasians than in blacks&#46; There are many techniques for repairing the hernia which can be categorised as tension-free repair &#40;using a mesh&#41; and tension repair where the primary tissues are pulled tight and no mesh is used&#46;<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&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">3</span></a> The procedure is easy for surgeons to learn&#44; and can even be performed under local anaesthesia which is attributed to reducing hernia recurrence to &#60;5&#37;&#46;<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&#58; inguinal &#40;direct or indirect&#41;&#44; femoral or crural&#46; Approximately 96&#37; of hernias are inguinal and 4&#37; are femoral&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a> They can be classified according to their aetiology &#40;congenital or acquired&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a> The most commonly used classifications for inguinal hernias are those by Gilbert&#44; Hyhus&#44; and Schumpelick&#46; Other classifications systems have been proposed by Bendavid&#44; Alexander&#44; and Zollinger&#59; however&#44; they are difficult to remember and too complex&#46; For this reason&#44; 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>&#46;<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&#44;7&#8211;14</span></a>&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><p id="par0020" class="elsevierStylePara elsevierViewall">History of hernia or prior hernia repair &#40;including in childhood&#41;</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&#44; depending on the clinical circumstances in which the patient is admitted to the operating room and the type of hernia&#46; In a randomised study to determine the frequency of complications in a total of 1&#44;983 patients who underwent laparoscopic and open inguinal hernia repair surgery&#44; it was found that 35&#37; had a significant complication and there was a higher range in those who underwent laparoscopic repair than in those who underwent open repair &#40;39&#37; vs 33&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;02&#41;&#46;<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&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">Intraoperative complications &#40;bleeding&#44; nerve injury&#44; vascular injury&#44; vessel injury in the vas deferens&#44; anaesthesia complications&#41;&#44; 2&#37; of which occurred in open repair using the Lichtenstein mesh technique and 5&#37; in laparoscopic repair&#46; Vascular injury complications were reported in 5 patients who underwent laparoscopic surgery&#46; No major vascular lesions were found in open repair surgeries&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall">Short-term post-operative complications &#40;surgical site injection&#44; trocar site infection&#44; wound haematoma&#44; scrotal haematoma&#44; orchitis&#44; seroma or hydrocele&#44; chronic leg pain&#44; chronic inguinal pain&#44; urinary tract infection&#44; and urinary retention&#41; are reported with similar percentages for laparoscopic vs open surgery&#44; with 26&#37; and 20&#37;&#44; respectively&#46; Complications such as wound haematoma&#44; scrotal haematoma&#44; and hydrocele were the most common in both groups&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">-</span><p id="par0105" class="elsevierStylePara elsevierViewall">Long-term complications &#40;chronic leg pain&#44; chronic inguinal pain&#44; seroma or hydrocele&#41; were the most common&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">8&#44;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&#46;</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&#46; Originally from and residing in Cuyamecalco Cuicatl&#225;n with no prior relevant history&#44; the complaint started with pain in the left inguinal region&#44; which was exacerbated with effort and decreased when taking analgesics&#46; There was an increase in volume that grew when performing the Valsalva manoeuvre&#46; He was assessed by the Department of General Surgery and diagnosed with an inguinal hernia&#46; Surgery was scheduled for inguinal hernia repair surgery&#44; plus placement of a Lichtenstein polypropylene mesh&#46; During the surgery he presented incidental arterial injury with 400<span class="elsevierStyleHsp" style=""></span>ml of blood loss&#46; The site of bleeding was unable to be identified&#44; and so two ring forceps were placed which stopped the bleeding and ended the procedure&#46; He was transferred to this unit&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">He was assessed in the Emergency Department at the Hospital Regional de Alta Especialidad de Oaxaca&#46; The patient was conscious&#44; oriented&#44; well-hydrated&#44; normal-coloured skin&#44; uncompromised chest&#44; abdomen flat&#44; bowel sounds present&#44; soft&#44; depressible&#44; non-tender upon palpation&#44; no organomegaly&#46; Transverse wound in the left inguinal region with two forceps inside&#44; left pelvic extremities with no femoral&#44; popliteal&#44; 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&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Blood work at admission&#58; Blood gases&#58; venous pH&#58; 7&#46;24&#44; <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span>&#58; 39 <span class="elsevierStyleItalic">p</span>O<span class="elsevierStyleInf">2</span>&#58; 50 HCO<span class="elsevierStyleInf">3</span><span class="elsevierStyleSup">&#8722;</span>&#58; 16&#46;7&#44; BEb<span class="elsevierStyleSup">&#8722;</span>&#58; 10&#46;7&#44; SO<span class="elsevierStyleInf">2</span>&#58; 77&#46; Blood chemistry&#58; glucose 98<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; urea 15<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; creatinine 0&#46;6<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; albumin 3&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#44; AST 29<span class="elsevierStyleHsp" style=""></span>U&#47;l&#44; ALT 36<span class="elsevierStyleHsp" style=""></span>U&#47;l&#44; ALP 90<span class="elsevierStyleHsp" style=""></span>U&#47;l&#44; LDH 758<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; sodium 139<span class="elsevierStyleHsp" style=""></span>mmol&#47;l&#44; K 3&#46;8<span class="elsevierStyleHsp" style=""></span>mmol&#47;l&#44; Cl 105<span class="elsevierStyleHsp" style=""></span>mmol&#47;l&#44; calcium 9&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; total bilirubin&#58; 2&#46;06<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; indirect 1&#46;96<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; complete blood count&#58; white blood cells 17&#44;000&#44; haemoglobin 14&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#44; platelets 218&#44;000&#44; neutrophils 14&#46;68<span class="elsevierStyleHsp" style=""></span>fl&#44; PT 14<span class="elsevierStyleHsp" style=""></span>s&#44; aPTT 28<span class="elsevierStyleHsp" style=""></span>s&#44; INR 1&#46;07&#37;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Computed tomography angiography &#40;CTA&#41; was performed with the following significant findings&#58; The left external iliac artery showed no contrast enhancement throughout its entire trajectory&#46; The presence of the ring forceps with which it was clamped were seen at the juncture with the common femoral artery&#44; later bypassing this clamping&#46; A Doppler ultrasound was performed&#44; observing very slow flow rates in this artery&#44; at 22<span class="elsevierStyleHsp" style=""></span>cm&#47;s &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The common femoral artery was also partially clamped as is seen from the blood flow with the Doppler ultrasound&#46; Diagnosis&#58; occlusion of the left external iliac artery&#46; The common femoral artery and common femoral vein were clamped&#44; showing a bypass in their distal segment with diminished flow rates&#46;</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&#46; Findings included external iliac artery integrity and a complete blockage just below the inguinal ligament&#46; Full dissection was performed &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; An 8 French Fogarty catheter was introduced into the proximal and distal end of the severed artery and the thrombus was extracted&#46; 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 &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Distal flow was confirmed&#44; haemostasis was confirmed&#44; and a layered polypropylene 1 closure was used&#46; The procedure was ended&#46;</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&#46; However&#44; 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&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a> This type of lesion requires immediate surgical treatment&#46; The CT angiography used for the diagnosis is a versatile technique with a wide range of applications beyond arteriography&#46; 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&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">17&#44;18</span></a> Managing the lesions depends on the anatomical location&#44; the mechanism of the injury&#44; and its nature&#46; Endovascular diagnosis and treatment may be performed&#44; including placing a stent&#46; A good tolerance has been described&#44; with a short hospital stay&#44; and a combination of endovascular therapy may be performed as a complement to definitive surgical treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a> It is possible to treat most lesions with just polypropylene vascular sutures &#40;4-0 to 6-0&#41;&#46; However&#44; in more extensive lesions&#44; an autologous vein graft is the material of choice in traumatic wounds&#44; although in new studies the data do not favour vein grafts and even lean towards prosthetic materials to repair traumatic arterial lesions&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">19&#44;20</span></a> In this case&#44; a synthetic polytetrafluoroethylene &#40;PTFE&#41; graft was placed and its permeability assessed using Doppler ultrasound&#44; observing good blood flow through the femoral artery while also performing a vein check to rule out thrombosis&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Sometimes the necessary graft materials are not at hand&#44; and so different techniques may be used&#46; The ipsilateral internal iliac artery may serve to re-establish blood flow&#46; The artery is moved to the level of the middle rectal artery&#46; Once the internal iliac artery has been moved&#44; the middle rectal artery is severed and the distal end is sutured with a continuous 4-0 polypropylene suture &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;<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&#44; the contralateral artery can be used following the same steps &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">21</span></a> The extra-anatomical bypass is a femoro-femoral crossover graft&#46; The two femoral arteries should preferably be exposed by two surgical teams&#44; one for each side&#44; and the conserved distal artery identified&#46; A subcutaneous tunnel is created&#44; going over the pubic symphysis between the two groins&#44; and then anastomosis is performed below the inguinal ligament with 4-0 to 6-0 polypropylene vascular sutures&#46;<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&#44; as well as damage control&#46; It is important for the surgeon performing the reconstruction to have all the necessary materials to successfully complete the procedure&#46; Should they not be available&#44; it is best for the patient to be sent to a specialised centre where treatment can be offered&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a> For our patient&#44; the quick decision to transfer him and the partial perfusion were a factor in his favour for saving the limb&#46; Full knowledge of the anatomy is among the most important technical aspects for performing hernia repair&#46;</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&#46;</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&#46;</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&#46;</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&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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          "identificador" => "xres1018806"
          "titulo" => "Abstract"
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          "titulo" => "Keywords"
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        2 => array:3 [
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          "titulo" => "Resumen"
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              "titulo" => "Introducci&#243;n"
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          "titulo" => "Background"
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          "titulo" => "Complications related to hernias"
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          "titulo" => "Case report"
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          "titulo" => "Ethical disclosure"
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              "titulo" => "Protection of human and animal subjects"
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              "titulo" => "Confidentiality of data"
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              "titulo" => "Right to privacy and informed consent"
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        10 => array:1 [
          "titulo" => "References"
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      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-06-17"
    "fechaAceptado" => "2016-08-08"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:5 [
            0 => "Hernia"
            1 => "Inguinal"
            2 => "Iliac artery"
            3 => "Injury"
            4 => "Grafts"
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          "palabras" => array:5 [
            0 => "Hernia"
            1 => "Inguinal"
            2 => "Arteria iliaca"
            3 => "Lesi&#243;n"
            4 => "Injertos"
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    "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&#46; More than 750&#44;000 inguinal hernia repairs are performed each year in the United States&#46; Complications of inguinal or femoral hernia are relatively rare&#44; depending on the clinical circumstances in which the patient is admitted to the operating room and the type of hernia&#46; The complications are classified as&#58; intraoperative&#44; short term and long term&#46; Arterial lesions are the rarest but most dangerous&#46;</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&#46;</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 &#40;PTFE&#41; graft was used over the length of the lesion&#46; Different techniques may be used for revascularisation&#58; autogenous vein graft&#44; synthetic grafts&#44; revascularisation with ipsilateral or contralateral internal iliac artery and femoro-femoral crossover graft&#46;</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&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
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            "titulo" => "Materials and methods"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La plastia inguinal es una de las cirug&#237;as m&#225;s frecuente realizadas a nivel mundial por cirujanos generales&#46; En Estados Unidos m&#225;s de 750&#44;000 hernioplastias inguinales se realizan por a&#241;o&#46; Las complicaciones de una hernia inguinal o femoral son relativamente infrecuentes&#44; depende de las circunstancias cl&#237;nicas en las que se ingresa a quir&#243;fano y el tipo de la hernia&#46; Las complicaciones se clasifican en&#58; intraoperator&#237;a&#44; a corto plazo y a largo plazo&#46; Las lesiones arteriales son las m&#225;s raras pero m&#225;s graves&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Describir t&#233;cnicas quir&#250;rgicas para reparaci&#243;n de lesiones de la arteria iliaca durante una plastia inguinal y reproducible por cirujanos generales&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Material y m&#233;todo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se presenta un caso cl&#237;nico con lesi&#243;n de arteria iliaca externa intraoperator&#237;a la cual se realiza injerto de politetrafluoroetileno &#40;PTFE&#41; por la longitud de la lesi&#243;n&#46; Se puede utilizar diferentes t&#233;cnicas para la revascularizaci&#243;n&#58; injerto de vena aut&#243;loga&#44; injertos sint&#233;ticos&#44; revascularizaci&#243;n con arteria hipog&#225;strica ipsi o contralateral e injerto cruzado femoro-femoral&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La t&#233;cnica quir&#250;rgica utilizando injerto de PTFE es eficaz para la reparaci&#243;n de lesi&#243;n arterial y tener una revascularizaci&#243;n oportuna que favorece una satisfactoria evoluci&#243;n&#46;</p></span>"
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                  \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&nbsp;\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&#8211;Stoppa&nbsp;\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&nbsp;\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&nbsp;\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&#46; Small indirect&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">L1&nbsp;\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&#46; Medium indirect&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">L2&nbsp;\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&#46; Large indirect&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IIIB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">L3&nbsp;\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&#46; Small direct&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IIIA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M1&nbsp;\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&#46; Medium direct&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IIIA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M2&nbsp;\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&#46; Large direct&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M3&nbsp;\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&#46; Combined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IIIB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MC&nbsp;\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&#46; Femoral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IIIC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
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Article information
ISSN: 01851063
Original language: English
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