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Summary:
Various techniques have been developed for the repair of femoral hernia. The
technique with the Lichtenstein Plug since1989 has allowed obtaining a lower
rate of complications and recurrences, as well as an early recovery of the
patient’s usual activities. Its applications have widely spread in elective
surgery; can also be performed in emergency surgery. The aim of this work was
to review the experience of our basic group of work in the surgical treatment
of femoral hernia using this technique.
Methods: A
retrospective descriptive observational study was conducted in our basic work
group from the surgery service of the General Teaching Hospital “Enrique
Cabrera” between 2009 and 2018, to which this surgical technique was applied.
We study the anatomical variants of hernias as well as post-operative
complications and clinical evolution.
Results: The
mean age of the patients was 58.7 years (19-92 years), with females having the
highest incidence 78%, along with maximum location on the, i.e., 67.5%. The
prosthesis used in the hernioplasty was that of polypropylene. Local anesthesia
was applied in 29 patients (63%) of them. The average surgical time was 25 min
(15-65 min). Ambulation was early and the average hospital stay was less than
24 h, in most patients. Only one infection of the wound and one hernia
recurrence in one patient was confirmed.
Conclusion:
Therefore, we believe that the Lichtenstein Plug technique should be considered
among the techniques of choice in the treatment of femoral hernia.
Keywords: Femoral hernia, Lichtenstein plug technique,
Polypropylene mesh
INTRODUCTION
Many technical
procedures have been developed to repair femoral hernia. Since 1989 the
Lichtenstein Plug technique has diminished the post-operative complication and
recurrence. The advantages present, in term of pain and post-operative
discomfort, recovery of physical and labor activity are very good. This
technique can be indicated in complicated hernia [1,2]. The aim of this article
is to describe the surgical technique and to analyze the preliminary results of
our series of 46 patients.
METHODS
We performed a
descriptive and observational study with a retrospective Character in our
surgical group at “Dr. Enrique Cabrera” Teaching and General Hospital, between
the years 2009-2018 in the patients who underwent surgical repair of femoral
hernia through the Lichtenstein Plug technique and their post-operative
behavior. The following variables were analyzed: age, type of hernia, tolerance
to local anesthesia, surgical technique, operating time, post-operative pain,
wound sepsis and recurrence of hernia; return to activity. All these items were
collected in Microsoft Excel base and later were processed in the SPSS
statistics program.
RESULTS
Table 1 shows the most relevant results of this series. We
can see that the largest number of patients was women, 36 in total, 78% and
there were only 10 men, 22%; which is in accordance with what has been reported
by other authors. The most frequent location was the right one in 31 patients,
67.5% and the average age of the
patients was 58. 7 years,
The only recurrences observed in our series
were in a patient who was operated on because of a relapsed, incarcerated
hernia. In the surgical act a wide femoral orifice was observed that was
occluded with a cylinder of polypropylene mesh like all the other patients. In
the postoperative period he presented wound infection and recurrence at four
months. In the reoperation, it was found that the cylindrical prosthesis was of
insufficient size to occlude the femoral orifice. This patient underwent a
pre-peritoneal repair with a wide patch of polypropylene mesh.
DISCUSSION
The great
advantage of this technique is the absence of tension and for this the mesh
must completely occlude the hernial orifice. Therefore the prosthesis will be
adapted to the size of the hole and not the reverse, avoiding the partial
closure of the hole when it is large, since this would give rise to tension
zones with the consequent risks of recurrence. In the primary femoral hernia (Figure 1), the hernial orifice is
small (Figure 2) and can be
satisfactorily occluded with the polypropylene cylindrical prosthesis (Figure 3). The low rate of
complications and its simple and rapid execution Means that we consider it as a
technique of choice in cases of primary femoral hernia. In recurrent femoral
hernia, the ring is generally larger, and in cases of urgent surgery due to a
stuck or strangulated femoral hernia, it is often necessary to expand the
hernia ring to adequately manage the affected bowel. In no case should one try
to reduce the size of the hole by suture, even large, because of the danger of
recurrence. In these cases, it may be useful to replace the Lichtenstein
cylindrical prosthesis with a cone-shaped mesh as it has been used by other
authors. The prosthetic material used in the cases has been a monofilament
polypropylene mesh, as it is considered the most appropriate, since it is
strong, resistant to infection and the cases of intolerance are practically
non-existent since the yellow a rapid interstitial fibroblastic proliferation
that fixes it intimately to the tissues, which fixes it intimately to the
tissues, according to reports Mansilla Molina et al. [8]. In our series, we did
not have any deaths and the highest morbidity occurred in the group of older
patients. For this reason, to get her with the high probability of
strangulation of the femoral hernia [9], we believe that all patients diagnosed
with femoral hernia, regardless of age and surgical risk, should undergo a
programmed procedure after adequate preparation, thus avoiding situations
adverse events that increase morbidity and mortality, according to what was
expressed by Porrero in 1993 and Chamary also in 1993 [10-12]. Local anesthesia
was the most used in our series, 63%, due to the great benefits they bring to
the patients with high surgical risk, however, at present the most frequently
used is the regional one [13,14]. Finally, we can affirm that the series we
present is not very extensive, but it is supported by good results, both in the
immediate post-operative period and in there incorporation of the patients to
his habitual activity, as well as, in the absence of recurrences or
complications delayed, when applying the Lichtenstein Plug technique in the
repair of the femoral hernia. We can conclude affirming like other authors
[14-16]. Which are equally significant, the convenience of repair when
performed under local anesthesia, which is ideal if it is scheduled surgery,
since the reduction of tissues trauma and post-operative discomfort and a lower
incidence of sepsis and tissues tension, reduce potential recurrence and favor
early Ambulation [17-19]. Main moments of the surgical process.
CONCLUSION
For all of the above, we believe that the
Lichtenstein Plug technique should be the treatment of choice in the surgical
treatment of femoral hernia.
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