Introducción: El abordaje TEP podría ser la opción ideal para reparar las hernias inguinales, pero tiene como limitaciones un campo quirúrgico reducido y una disposición restringida de los puertos de trabajo. Para superar estos problemas se ha descrito la modalidad extendida (eTEP) que amplía el campo quirúrgico y permite una mayor flexibilidad en el posicionamiento de los puertos de trabajo. El objetivo de este trabajo es revisar esta modalidad de abordaje como alternativa para tratar las hernias inguinales.Método: Revisión sistemática basada en las bases de datos Cochrane, Google, Embase y Medline usando PubMed, sin restricciones y usando como palabra clave: técnica totalmente extraperitoneal extendida.Resultados: Se describe la experiencia actual con el abordaje extendido y sus pasos técnicos para una correcta creación del espacio y posterior colocación de trócares.Conclusión: Nuestra evaluación multicéntrica de la técnica de acceso eTEP para reparar las hernias inguinales ha encontrado que el abordaje es factible y efectivo. Este nuevo enfoque ofrece una configuración más óptima para tratar un mayor número de hernias inguinales mediante laparoscopia.
Aim
“Incisional hernia is the main complication after laparotomy, the prevention of this is currently aimed at preoperative rehabilitation, modification of the closure technique and the use of prophylactic mesh. The objective of the study was to measure the effectiveness of the modification in the laparotomy closure technique to reduce the incidence of incisional hernia.”
Material and Methods
“A systematic review and meta-analysis were carried out following the PRISMA guidelines. The first objective was to determine the incidence of incisional hernia at one year of follow-up, comparing the modification in the closure technique with the usual closure. The secondary objective was to determine the difference in wound dehiscence and surgical site infection between these two groups. Only clinical trials were included, and the random effects method was used for their analysis. PROSPERO registration number: CRD42021231107”
Results
“Seven clinical trials were included, comparing 1612 patients, the incidence of incisional hernia was significantly lower in the surgical technique modification group OR 0.55 (95% CI 0.38-79). Efficacy to reduce the incidence of wound dehiscence was also analyzed without finding a difference between the two groups OR 0.58 (95% CI 0.27-1.21). There was no statistically significant difference between both groups when comparing seroma hematoma and surgical site infection.”
Conclusions
“The modification in the laparotomy closure technique reduces the incidence of incisional hernia. However, when analyzing globally, only the Small bites and Reinforced tension line techniques contributed to this result.”
Background: Incisional hernia (IH) is the main complication after laparotomy. The objective of this meta-analysis was to evaluate the effectiveness of closure technique modification (CTM) for reducing the incidence of IH to provide objective support for its recommendation.Methods: A meta-analysis was performed according to the PRISMA guidelines. The primary objective was to determine the incidence of IH, and the secondary objective was to determine the incidence of acute evisceration and postoperative complications. Only published clinical trials were included. The risk of bias was analyzed, and the random effects model was used to determine statistical significance.Results: Nine studies comparing 2,612 patients were inclued. The incidence of IH was significantly lower in the CTM group than in the control group, with an OR of 0.39 (95% CI 0.26-0.57). The incidence of acute postoperative evisceration was also reduced, with an OR of 0.46 (95% CI 0.23-0.92). Associated complications, including hematoma, seroma, and postoperative pain, could not be analyzed; however, CTM did not increase the risk of surgical site infection.Conclusion: CTM for midline laparotomy significantly reduces the incidence of IH compared to conventional closure. Limitations of the analysis included differences in follow-up, patient selection, diagnostic methods, and the reporting of postoperative complications among the studies.Funding Information: No funding was received.Registration: This study was prospectively registered in the PROSPERO database under registration number CRD42021231107.
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