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Vol. 89. Issue 6.
Pages 370-378 (June 2011)
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Vol. 89. Issue 6.
Pages 370-378 (June 2011)
DOI: 10.1016/S2173-5077(11)70046-1
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Subxiphoid Incisional Hernia Treatment: a Technique Using a Double Mesh Adjusted to the Defect
Tratamiento de la eventración subxifoidea: técnica de doble malla ajustada al defecto
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Fernando Carbonell Tatay??
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, Providencia García Pastor, José Bueno Lledó, María Saurí Ortiz, Santiago Bonafé Diana, José Iserte Hernández, Fernando Sastre Olamendi
Unidad de Cirugía de Pared Abdominal, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Fe, Valencia, Spain
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Abstract
Introduction

Subxiphoid incisional hernia has characteristics that differentiate it from the rest and make it a distinctive entity. The fact that it has its sac very near the rib cage and sternum determines the pressure in the margins. The repair, by open or by laparoscopic approach, has not demonstrated good results despite the generalised use of a prosthesis. They are uncommon, and have a significant comorbidity in patients (severe heart diseases, transplants, immunosuppressed), after surgery of the hepato-bilio-pancreatic area with transverse incisions, or very high mid-laparotomies for gastro-oesophageal surgery.

Material and methods

A new technique has been developed in our Unit, based on a double mesh and adapted to the anatomical and physiological characteristics of the region. The series consisted of 35 consecutive patients operated on between 2004 and 2010, following an agreed surgical and management protocol.

Results

There were no significant complications−the most frequent (17.4%) was a seroma−except one case of a wound infection due to skin ischaemia in one patient who had had multiple operations and a transplant. During the post-surgical follow up to the present (between 4 and 80 months), there has been no recurrence of the incisional hernia and no significant local discomfort has been reported.

Conclusions

The “adjusted double mesh” technique achieved good results in our hands, from the surgical point of view (reproducibility, recurrence), and for the patient, with minimal discomfort and recovery of quality of life.

Keywords:
Subxiphoid incisional hernia
Double mesh
Preperitoneal repair
Incisional hernia
Resumen
Introducción

La eventración subxifoidea tiene características que la diferencian del resto y le dan entidad propia. El hecho de tener su saco muy próximo a los relieves costales óseos y esternón condiciona mucha tensión en los márgenes; la reparación, tanto por vía abierta como laparoscópica, no ha demostrado buenos resultados a pesar del uso generalizado de prótesis. Son poco frecuentes y se presentan en pacientes con comorbilidad importante (cardiópatas severos, trasplantados, inmunodeprimidos), tras intervenciones del área hepato-bilio-pancreática con incisiones transversales, esternotomías ampliadas por debajo del xifoides o laparotomías medias muy altas para cirugía gastro-esofágica.

Material y método

En nuestra Unidad hemos desarrollado una nueva técnica, basada en el uso de doble prótesis y adaptada a las características anatomo-fisiológicas de la región, para la reparación de estas eventraciones. La serie consta de 35 pacientes intervenidos de forma consecutiva entre 2004 y 2010, siguiendo protocolo quirúrgico y de manejo consensuado.

Resultados

No hubo complicaciones importantes –la más frecuente es el seroma, 17,4%−, excepto un caso de infección de la herida por isquemia de piel en un paciente multioperado y trasplantado. El seguimiento postoperatorio hasta el día de hoy (entre 4 y 80 meses) no ha demostrado recidivas de la eventración y no se refieren molestias locales importantes.

Conclusiones

La técnica «doble malla ajustada» consigue en nuestro medio unos buenos resultados, tanto desde el punto de vista del cirujano (reproducibilidad, recidiva) como del paciente, con mínimas molestias y recuperación de la calidad de vida.

Palabras clave:
Eventración subxifoidea
Doble prótesis
Reparación preperitoneal
Hernia incisional
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