Evaluación prospectiva de la reparación protésica abierta y laparoscópica de la hernia inguinal primaria unilateral no complicada

Article information

Resumen

Introducción

El objetivo del presente estudio es comparar dos métodos de reparación herniaria inguinal sin tensión

Material y método

Estudio prospectivo entre dos grupos: reparación herniaria laparoscópica mediante técnica transabdominopreperitoneal (TAPP) frente a intervención de Lichtenstein (LICH), con 110 pacientes por grupo, varones con hernia primaria, unilateral, no complicada. Las intervenciones en el grupo TAPP se realizaron bajo anestesia general y en el grupo LICH bajo anestesia raquídea

Resultados

Encontramos un tiempo quirúrgico ligeramente mayor en el grupo TAPP (42,1 frente a 45,4 min; p = 0,530). No hubo complicaciones intraoperatorias en ningún grupo. Se observó un mayor número de complicaciones postoperatorias locorregionales en el grupo LICH, siendo la equimosis inguinoescrotal y la neuralgia inguinal las más frecuentes. El tiempo de analgesia postoperatoria fue menor en el grupo TAPP que en el LICH (9,5 ± 4,6 h frente a 26,8 ± 6,8 h; p = 0,01). Hubo 2 recidivas (1,8%) en el grupo LICH y 3 (2,7%) en el grupo TAPP, para una media de seguimiento de 36,5 meses

Conclusiones

El estudio no encuentra ventajas globales para ninguno de los dos grupos, aunque existe un menor dolor postoperatorio y una más rápida recuperación para la vida laboral en el grupo TAPP que en el LICH

Palabras clave:

Laparoscopia

Hernioplastia

Complicaciones postoperatorias

Introduction

The aim of this study was to compare two methods of tension-free hernia repair.

Material and method

We performed a prospective study of two groups: laparoscopic hernia repair using the transabdominal preperitoneal (TAPP) technique compared with Lichtenstein’s technique. Each group was composed of 110 male patients with unilateral uncomplicated primary hernia. Interventions using TAPP were performed under general anesthetic and those using Lichtenstein’s technique were performed under spinal anesthesia

Results

Operating time was slightly longer in the TAPP group (42.1 vs. 45.4 minutes, p = 0.530). No intraoperative complications were found in either group. A higher number of locoregional postoperative complications were found in the Lichtenstein group. The most frequent were inguinoscrotal ecchymosis and inguinal neuralgia. Postoperative analgesic time was lower in the TAPP group than in the Lichtenstein group (9.5 ± 4.6 hours vs. 26.8 ± 6.8 hours, p = 0.01). There were two recurrences (1.8%) in the Lichtenstein group and three (2.7%) in the TAPP group during a mean follow-up of 36.5 months

Conclusions

Neither group showed overall advantages although postoperative pain was lesser and return to work faster in the TAPP group than in the Lichtenstein group

Key words:

Laparoscopy

Hernioplasty

Postoperative complications

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Bibliografía

[1.]

R. Chung, D. Rowland.

Meta-analyses of randomized controlled trials of laparoscopic vs conventional inguinal hernia repairs.

Surg Endosc, 13 (1999), pp. 689-694

Medline

[2.]

EU Hernia Trialists Collaboration. Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials.

Br J Surg, 87 (2000), pp. 860-867

http://dx.doi.org/10.1046/j.1365-2168.2000.01540.x | Medline

[3.]

M. Liem, Y. Van Der Graaf, C. Van Steensel, R. Boelhouwer, G. Clevers, W. Meijer, et al.

Comparison of conventional anterior surgery and laparoscopic surgery for inguinal hernia repair.

N Engl J Med, 336 (1997), pp. 1541-1547

http://dx.doi.org/10.1056/NEJM199705293362201 | Medline

[4.]

E. Félix, C. Michas, M. González.

Laparoscopic hernioplasty: why does it work?.

Surg Endosc, 11 (1997), pp. 36-41

Medline

[5.]

The MRC laparoscopic groin hernia trial group. Laparoscopic versus open repair of groin hernia: a randomised comparison.

Lancet, 354 (1999), pp. 185-190

Medline

[6.]

A. Serralta, J. Bueno, M. Planells, F. Ibáñez, D. Rodero.

Hernioplastia laparoscópica transabdominopreperitoneal. Resultados de una serie de 223 casos no seleccionados.

Cir Esp, 68 (2000), pp. 219-222

[7.]

E. Laporte, C. Semeraro, C. Vicens, M. Armengol.

Reparación de la hernia inguinal por vía laparoscópica. Descripción técnica y resultados preliminares en 159 pacientes controlados durante un año.

Cir Esp, 59 (1996), pp. 287-291

[8.]

J. Wellwood, M. Sculpher, D. Stoker, G. Nicholls, C. Geddes, A. Whitehead, et al.

Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost.

Br Med J, 317 (1998), pp. 103-110

[9.]

M. Wilson, G. Deans, W. Brough.

Prospective trial comparing Lichtenstein with laparoscopic tension-free mesh repair of inguinal hernia.

Br J Surg, 82 (1995), pp. 274-277

Medline

[10.]

M. Picchio, A. Lombardi, A. Zolovkins, M. Mihelsons, G. La Torre.

Tension free laparoscopic and open hernia repair: randomized controlled trial of early results.

World J Surg, 23 (1999), pp. 1004-1007

Medline

[11.]

D.L. Stoker, D.J. Spiegelhalter, R. Singh, J.M. Wellwood.

Laparoscopic versus open inguinal hernia repair: randomised prospective trial.

Lancet, 343 (1994), pp. 1243-1245

Medline

[12.]

R.B. Cornell, G.M. Kerlakian.

Early complications and outcomes of the current technique of transperitoneal laparoscopic herniorraphy and a comparison to the traditional open approach.

Am J Surg, 168 (1994), pp. 275-279

Medline

[13.]

X. Feliu.

Hernioplastia laparoscópica: complicaciones y resultados.

Cir Esp, 61 (1997), pp. 288-292

[14.]

E. Stark, K. Oestreich, K. Wendl, B. Rumstadt, E. Hagmuller.

Nerve irritation after laparoscopic hernia repair.

Surg Endosc, 13 (1999), pp. 878-881

Medline

[15.]