Eventraciones: Reconstitución plástica de la línea alba mediante doble sutura invaginante isotensional (DSII)

Abstract

Reconstruction of midline incisional hernias using a double isotensional sutureBackground: Incisional hernias of the midline are frequently multisacular and its treatment without a mesh is followed by a high rate of recurrences. Aim: To report a new technique for the treatment of midline incisional hernias, performing an isotensional suture of the midline with Vycril ® 2-0, followed by a double invaginant suture of the rectus aponeurosis with Ethybond ® 2-0. Material and Methods: Observational prospective study of 90 women and 26 men, aged 54 ± 13 and 59 ± 13 years respectively, with a hernia sac smaller than 15 cm and with an aponeurotic defect smaller than 3 cm, operated between January 2002 and December 2005. Results: Surgery was performed under local anesthesia on an ambulatory basis. The surgical procedure consisted in the excision of a skin lozenge which included the scar, dissection and reduction of all sacs and isotensional suture of the midline with Vycryl #1 ® . This suture was followed by a double invaginating suture of the rectus sheath in the midline with Ethylon ® 0. Five superficial infections and two hematomas were observed. Seven recurrences (7%) in 99 patients (85% of the sample), were found during a mean follow up of 4.6 years (range 2-6). Conclusions: The double invaginating isotensional suture (DIIS) is an acceptable alternative for the treatment of small and middle size incisional hernias of the midline. ResumenLas eventrorrafias sin malla de la línea media se asocian con una elevada tasa de recidivas. En esta publicación damos cuenta de una técnica fascial utilizable en eventraciones pequeñas y medianas de la línea media que hemos llamado doble sutura invaginante isotensional (DSII). El estudio observacional descriptivo es una serie clínica constituida por 90 mujeres con una edad promedio de 54 ± 12,9 años y 26 varones con una edad promedio de 59 ± 13,7 años, intervenidos entre el 1º de Enero de 2002 y el 31 de Diciembre de 2005. En 14 casos se trató de una eventración recidivada. Se intervinieron pacientes con un Rev. Chilena de Cirugía.

Repair of Incisional Hernias of the Midline Under Local Anesthesia in an Ambulatory Basis

“…These pathologies may coexist with the incisional hernia and can be simultaneously treated with this technique under local anesthesia (9). In these cases it is necessary to act up on the umbilicus which in small defects can be preserved.…”

“…This fact makes it imperative to explore the scar in all its length (6). We considered the performance of tissue repair by means of an original technique developed in our Hernia Center (9). This technique pursue a reconstruction of the "linea alba" by means of an isotensional repair followed by a double invaginating suture (DIIR) (Fig 3).…”