¿Cuál es la utilidad de los pegantes biológicos en la herniorrafia inguinal abierta y laparoscópica?

Autores/as

  • Luis Carlos Domínguez Universidad de la Sabana
  • Álvaro Sanabria Universidad de la Sabana
  • Valentín Vega Universidad de la Sabana
  • Camilo Osorio Universidad de la Sabana

Palabras clave:

hernia inguinal, cirugía, laparoscopía, prótesis e implantes, adhesivo de tejido de fibrina

Resumen

Introducción. Las diferentes estrategias para la reducción del dolor posoperatorio en una herniorrafia inguinal, demuestran variables grados de efectividad clínica.

Se hace una revisión crítica de la literatura científica, evaluando la efectividad de la fijación de la malla con pegantes biológicos en cirugía laparoscópica y abierta (técnica de Lichtenstein y tapón de malla), frente a la no fijación o a la fijación convencional.

Métodos. Se hizo una búsqueda de la literatura científica siguiendo la metodología Best BETs (Best Evidence Topics), para identificar artículos que compararan fijar la malla durante una herniorrafia inguinal con pegantes biológicos contra no fijarla. Los artículos se revisaron según los criterios de apreciación del Journal of the American Medical Association. Se extrajeron los datos de la efectividad de la intervención y se analizaron los desenlaces primarios, como el dolor posoperatorio, la reproducción, la infección, el seroma y el hematoma. Como desenlaces secundarios, se analizaron el costo, el tiempo de estancia hospitalaria, el retorno laboral y el tiempo quirúrgico.

Resultados. Se identificaron once estudios de asig- nación aleatoria. En la herniorrafia transabdominal preperitoneal, la utilización de pegantes biológicos puede reducir el dolor posoperatorio al ser evaluado por la escala visual análoga. Esta ventaja no está completamente establecida en la herniorrafia abierta. En la herniorrafia con técnica extraperitoneal total, el dolor posoperatorio es mayor con el uso de pegantes biológicos. En todas las vías y técnicas de herniorrafia (técnica transabdominal preperitoneal, extraperitoneal total, o abierta) no se documentan diferencias en la tasa de reproducción ni de infección, y es variable la tasa del seroma y el hematoma. Es mayor el costo cuando se utilizan pegantes biológicos.

Conclusiones. No se recomienda la utilización de forma rutinaria de pegantes biológicos para la fijación de la malla durante una herniorrafia inguinal.

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Biografía del autor/a

Luis Carlos Domínguez, Universidad de la Sabana

Grupo de Patología Quirúrgica, Universidad de la Sabana, Chía, Colombia. Departamento de Cirugía, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, D.C. , Colombia

Álvaro Sanabria, Universidad de la Sabana

Grupo de Patología Quirúrgica, Universidad de la Sabana, Chía, Colombia. Fundación Abood Shaio, Bogotá, D.C., Colombia

Valentín Vega, Universidad de la Sabana

Grupo de Patología Quirúrgica, Universidad de la Sabana, Chía, Colombia.

Camilo Osorio, Universidad de la Sabana

Grupo de Patología Quirúrgica, Universidad de la Sabana, Chía, Colombia.

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2011-10-01

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Domínguez, L. C.; Sanabria, Álvaro; Vega, V.; Osorio, C. ¿Cuál Es La Utilidad De Los Pegantes biológicos En La Herniorrafia Inguinal Abierta Y laparoscópica?. Rev Colomb Cir 2011, 26, 260-272.

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