¿Es complejo reparar la hernia inguinal del prostatectomizado por vía retropúbica mediante el abordaje preperitoneal posterior abierto tipo Nyhus «corto» (técnica de Dávila)?

Abstract

IntroductionStudy of patients who underwent a retropubic prostatectomy and developed an inguinal hernia that has been repaired with the «short» Nyhus technique or «Dr. Davila's technique». Material and methodProspective study: 85 prostatectomized patients (84 retropubic route and one laparoscopic) with 93 repairs using the modified Nyhus technique were selected out of a global series of 3 078 preperitoneal repairs using the same technique on 2863 patients, over the course of 27 years. Mean age: 69.2±7.4 years (42-86 years). There were no criteria to select patients. Technique was performed by means of a preperitoneal space with adhesions post-prostatectomy, and in all cases a low density macroporous polypropylene mesh or a self-fixating Parietene ProGrip® was placed. ResultsIn 92 of the repairs the preperitoneal space was treatable with few difficulties; however, the only laparoscopic prostatectomy showed a great degree of difficulty that was resolved without any incidents. The mean operating time was 24.0±5.7min and 17.4±4.4min on those patients with a self-fixating mesh. Morbidity results: 15 hematomas, 16 seromas, 4 scrotal hematomas. There were no infections, no chronic inguinal pain or relapses during the follow-up process of 64 patients (75.3%) between 1-26 years of age. ConclusionsThere has been no evidence of the alleged complexity and risk of the open preperitoneal approach in the prostatectomized patient in order to treat an inguinal hernia with an open posterior preperitoneal approach by means of the modified Nyhus («short» Nyhus or «Dr. Davila's technique»). Both short and long-term results have been successful.