Revista chilena de cirugía
versión On-line ISSN 0718-4026
ACEVEDO F, ALBERTO; VITERBO S, AQUILES; CAPONA P, RODRIGO y DELEPIANE T, VERÓNICA. Ambulatory surgical treatment of incisional hernias avoiding the use of drainages. Rev Chil Cir [online]. 2008, vol.60, n.4, pp. 291-296. ISSN 0718-4026. http://dx.doi.org/10.4067/S0718-40262008000400005.
Background: An ambulatory surgical program using local anesthesia for hernias with a sac smaller as 15 cm and a separation of the aponeurotic borders not wider as 3 cm, was started. Patients classified as American Society of Anesthesiologists (ASA) stages I and II, with social and psychological conditions compatible with postoperative care at home were accepted for this type of treatment. Aim: To report the experiencewith ambulatory treatment of incisional hernias. Material and methods: Prospective observational study of 94 women and 21 men aged 27 to 85 years subjected to ambulatory surgery. Results: Amidone® and Midazolan were administered intravenously immediately before surgery and repeated during the operation when necessary. Local anesthesia was carried out with 200 mi alkalinized Lidocaine® 0,4% with 0.2 mg adrenalin. An incisión was made extirpating the scar and a skin lozenge of proper length and width, exposing the aponeurosis and the hernia sacs. After reduction of the hernia sac, the hernia repair was performed by means of an iso-tensional double invaginating suture or placing prosthetic material in the preperitoneal space, depending in the size of the defect. We avoided stretching, compressing and shearing the tissues and excessive hemostasis with ligature and electrocautery. To reduce dead spaces to a minimum, the subcutaneous suture was anchored to the aponeurosis in all the length of the wound. The wound was bathed with a Gentamycin solution. The patient was discharged after a short observation period wearing an elastic girdle. Controls were done during 30 days by a staff surgeon. Three superficial infections, no hematomas or seromas were observed during this time. Conclusions: This method of wound closure was successful for ambulatory repair of small and middle sized incisional hernias
Palabras llave : Incisional hernia; local anesthesia; ambulatory surgery.