Application of an Incisional Hernia Protocol at the Municipal Public Server Hospital of Sao Paulo, Brazil: A Retrospective Study

João Kleber De Almeida Gentile

doi:10.31031/gmr.2021.06.000632

Abstract

Gastroenterology Medicine & Research Application of an Incisional Hernia Protocol at the Municipal Public Server Hospital of Sao Paulo, Brazil: A Retrospective Study Caio Felicio de Oliveira1, Paula Gombar1, João Kleber de Almeida Gentile2*, Renato Migliore2, Rodrigo Biscuola Garcia3, Pedro Marcos Santinho Bueno de Souza3 and e José Cesar Assef4 1Medical Residend of the Discipline of Digestive Surgery, Public Servant Hospital Municipal (HSPM-SP), São Paulo (SP), Brazil 2Medical Professor of the Discipline of Digestive Surgery in University City of São Paulo (UNICID), Medical Doctor and Resident Physician, Department of Digestive Surgery, Public Servant Hospital Municipal (HSPM-SP), São Paulo (SP), Brazil 3Medical Doctor and Attending Physician, Department of Digestive Surgery, Public Servant Hospital Municipal (HSPM-SP), São Paulo (SP), Brazil 4Medical Doctor and Chief, Department of Digestive Surgery, Public Servant Hospital Municipal (HSPM-SP), São Paulo (SP), Brazil *Corresponding author:João Kleber de Almeida Gentile, Medical Professor of the Discipline of Digestive Surgery in University City of São Paulo (UNICID), Medical Doctor and Resident Physician, Department of Digestive Surgery, Public Servant Hospital Municipal (HSPM-SP), São Paulo (SP), Brazil Submission:August 24, 2021;Published: September 16, 2021 DOI: 10.31031/GMR.2021.06.000632 ISSN 2637-7632Volume6 Issue2

Highlights

Abdominal Incisional Hernias (AIH) are a frequent complication in medium incisions that lead to a decrease in life quality, socioeconomic losses and increased morbidity to those who have it
Incisional hernias result from a multifactorial process that includes preoperative factors such as the cessation of smoking, diabetes control, and obesity, such factors affect the proper functioning of the early stages of the healing process
Patient and Method: Retrospective study with registry analysis of medical records and database records created on cloud regarding perioperative information and outcomes of 35 patients with complex incisional hernias treated under the protocol of patient care for incisional hernia on the Municipal Public Server Hospital (Attachment 1) by the Digestive System Surgery Service, between 2015 and 2019

Summary

Result

In our analysis of 35 patients operated by the Digestive System Surgery Team in the period from 2015 to 2019, the average of hospital stay was 4.55 days per patient, with a total of 22.857% of complications, from seromas without serious repercussion to a wall infection which demanded debridement and reassessment for cutaneous flap. Emergencies: Patients in reoperations performed by the Digestive System Surgery Service of the HSPM, even in the presence of infection, should have a wall closure with a continuous suture technique using a slow absorption wire with a mean distance between plications of 5mm. Patients with reoperation who have a history of chronic pain may need to use gabapentin 300mg up to 3 times a day for 3 months after surgery, with medication withdrawal evaluation done in ambulatory. These individuals should be followed up by the neurology ambulatory clinic for chronic pain management. Enoxaparin 40mg every 24 hours after 08 hours from the end of anesthesia (Morphine 2mg + SF 0,9% 8mL) if in severe pain (EV)

Conclusion

Introduction

Methodology

Findings

Discussion