The meshes that are implanted in reconstructive surgery of the abdominal wall are usually fixed to prevent wrinkling or moving while completing their integration into the tissue. Classical fixation with sutures can cause greater postoperative pain due to direct injury or trapping of regional nerves and some patients will suffering from chronic pain of varying intensity, which could severely affect their quality of life. Any improvement that reduces the intensity of postoperative pain and the incidence of chronic pain would facilitate patients to resume their usual physical and / or working activities more quickly, having an obvious social, labor and economical impact. The objective of this research project was to evaluate the results of the use of cyanoacrylate (CA) as a method of non-traumatic mesh fixation. A first prospective and randomized multicenter study compared CA versus the classic polypropylene suture for mesh fixation in 370 patients undergoing inguinal hernioplasty according to the Lichtenstein technique. The most remarkable result was a statistically significant reduction of acute pain in the Glue group during the first postoperative 30 days, although the differences did not remain after one year of follow-up. It should be noted that the use of CA also significantly shortened the surgical time (35. 3 minutes versus 39. 9 minutes). In addition, no differences were observed in the incidence of complications (hematoma, infection, etc. ) or early hernia recurrence rate. The second part of the project evaluated the safety of cyanoacrylate in a different field, the fixation of prophylactic meshes, since the existing evidence confirms that its use significantly reduces the incisional hernia incidence in at-risk patients. To this end, a series of 52 patients with obesity or overweight who underwent a laparoscopic resection for colon cancer was analyzed, implanting a retrofascial and premuscular mesh in 15 of them. No adverse effects or significant differences were observed in the complications and, although the follow-up is still short, no incisional hernias have been observed in the patients of the Mesh group compared to 10. 8% presented in the No Mesh patients group. The conclusions of this project are: . To use cyanoacrylate for mesh fixation is a fast, simple, safe and efficient method. Using CA to fix the mesh reduced significantly the acute pain during the first postoperative month in patients undergoing Lichtenstein hernioplasty, although in this study the incidence of chronic pain did not change. . Mesh fixation with cyanoacrylate instead of sutures facilitates certain procedures and can reduce the operative time, without increasing the incidence or severity of postoperative complications (seroma, infection, hematoma, etc. ) and without there being differences in the groin hernia recurrence rate. In addition, it is not associated with adverse effects. Therefore, the routine use of cyanoacrylate should be considered as an excellent alternative during the open repair of inguinal hernia. . Cyanoacrylate can also be used in other indications, such as the implantation of prophylactic meshes. By extension, and given its characteristics, CA could be routinely used in the future in numerous procedures of repair and reconstruction of abdominal wall, as in laparoscopic hernioplasty or the treatment of primary and incisional ventral hernias.
Análisis de complicaciones y resultados a corto y medio plazo de la utilización de cianoacrilato para la fijación de mallas en cirugía reparadora de la pared abdominal
Hoyuela Alonso, C. (Author). 11 Oct 2018
Student thesis: Doctoral thesis
Student thesis: Doctoral thesis