Experiencia inicial en la reparación de hernias incisionales/ventrales por laparoscopia en una unidad de cirugía mayor ambulatoria y de corta estancia (UCMA-CE)

Abstract

Hernia is a frequent complication in abdominal surgery. There are a multitude of repair techniques, ranging from classical direct closure of the defect and tension-free mesh repair using open surgery to the recent development of laparoscopic repair. To evaluate the safety and effectiveness of laparoscopic repair of incisional/ventral hernias and its applicability in an outpatient-short stay surgical unit. We performed a prospective study of 135 consecutive patients. All patients had incisional (132 patients) or ventral hernias (2 patients) that were laparoscopically repaired between February 1999 and July 2003. The parameters analyzed were the number of prior abdominal interventions and hernia repairs, the number of defects, their location, operating time, type of mesh, postoperative complications, postoperative length of hospital stay, and recurrence rate during a mean follow-up period of 12 months. Of the 135 patients, 16 (11.8%) underwent conversion to open surgery. The most frequent location of the defect was infraumbilical. Of the 119 patients who underwent laparoscopic repair, more than one hernia was found in 67. The mean operating time was 72.3 +/- 28.3 min. The most frequent immediate complication was seroma in the hernia sac. A total of 92.4% of the patients were discharged within 24 h of the intervention. The recurrence rate was 5.04%. Laparoscopic repair of incisional/ventral hernias is a safe method that allows outpatient management of this defect. Moreover, the technique presents the advantages of minimally invasive surgery, allowing clear identification of multiple hernial defects, with an acceptable percentage of complications and low recurrence rate.