Resultados clínicos post operatorios de la técnica de Plugstein en el tratamiento de la hernia inguinal del adulto

Abstract

Introduction: The introduction of tissue-free repair techniques, free of tension, has meant a decrease in recurrence rates. Of the techniques without tension, the most widespread are those of Lichtenstein and that of Mesh-Plug, being the combination of both the Plugstein technique. Objectives: To determine the demographic, anatomical, professional activity and post-operative clinical results of adult patients with inguinal hernia undergoing surgical treatment with the Plugstein technique. Material and method: An observational, descriptive, transverse, non-probabilistic study of consecutive cases in adult patients of both sexes with inguinal hernia operated with the Plugstein technique who attended the abdominal wall clinic of the 2nd Chair of Surgical Clinic of the Hospital de Clínicas of Asunción, from January 1998 to January 2006. Results: 376 patients with inguinal hernia were included, intervened in the 2nd Chair of Surgical Clinic of the Hospital de Clínicas of the Faculty of Medical Sciences from January 1998 to January 2006, 439 repairs were carried out with the Plugstein technique. Hernias were primary in 92.7% (n = 407) of the cases, and relapsed in 7.2% (n = 32). The age of the patients presented a range of 18 to 84 years, average of 51 years, median of 54 years and a concentration in the age group of 41-60 years in 39.1%. The distribution by sex was 87.8% (n = 330) for the male sex and 12.2% (n = 46) for the female sex. The location of the hernia was identified on the right side in 40.7% of the cases (n = 179); on the Left side at 30.5% (n = 134) and bilateral at 14.3% (n = 63). 29.52% (n = 111) came from Asunción, 41.48% (n = 156) from the Gran Asunción and 28.98% (n = 109) from the interior of the country. The work activity of the patients presented a distribution of 60.9% of cases of tasks related to physical effort (n = 229); while 39.1% (n = 147) did not perform occupational activities related to physical effort. Associated diseases; It was found that 288 patients (76.6%) had no associated disease, 70 patients (18.6%) had heart conditions, 7 patients (1.9%) metabolic disorders, 6 patients (1.6%) urological disorders and 5 patients (1.3%) mild respiratory conditions. The average surgical time was 75.6 minutes, with a median of 60 minutes, (minimum 30 - maximum 180). The hospital stay presented an average of 21.8 hours, and a median of 24 hours (minimum 6 - maximum 38). The local complications registered were: bruises, seromas, superficial infection. There were no transoperative complications or operative mortality. Conclusions: The patients presented short hospital stay, framed to the concept of ambulatory surgery. The surgical time was acceptable when dealing with the same technique inguinal hernias of all kinds, using hand-made prosthetic material and also the participation of resident physicians as the main participants. The anatomical variety of the most frequent inguinal hernia corresponded to types 2 and 3 of Gilbert. The participation of a resident doctor in a University Hospital, with a short learning curve, did not influence the results obtained. Post-operative local complications were minimal and similar to others without tension. The period of labor reinsertion in our environment was not similar to foreign publications. The technique can be applied to the treatment of all types of adult inguinal hernia with the same results and low recurrence.