EFECTIVIDAD DE LAS ESTRATEGIAS DE CIERRE DE LA PARED ABDOMINAL EN LA PREVENCIÓN DE HERNIAS INCISIONALES POSTLAPAROTOMÍA
DOI:
https://doi.org/10.56238/levv16n55-094Palabras clave:
Laparotomía, Hernia Incisional, Cierre Abdominal, Sutura, Revisión SistemáticaResumen
Introducción: Las hernias incisionales representan una de las complicaciones más prevalentes y costosas tras laparotomías, con un impacto significativo en la morbilidad postoperatoria y la calidad de vida de los pacientes. Se han estudiado diversas estrategias de cierre de la pared abdominal con el objetivo de reducir su incidencia. Objetivo: Evaluar la eficacia de las técnicas de cierre de la pared abdominal en la prevención de hernias incisionales tras laparotomías, mediante una revisión sistemática de la literatura. Método: Siguiendo las directrices PRISMA 2020, se realizó una búsqueda sistemática en las bases de datos PubMed, Embase, Scopus, Cochrane Library y Web of Science. Se incluyeron ensayos clínicos, revisiones sistemáticas y guías que abordan los métodos de cierre abdominal y sus resultados relacionados con la formación de hernias. La calidad de los estudios se evaluó mediante las herramientas GRADE y SIGN. Resultados: Se incluyeron 52 estudios. Se demostró que las técnicas de sutura de mordida pequeña, el uso de suturas triclosanales y la aplicación profiláctica de mallas en pacientes de riesgo son las estrategias más eficaces para reducir la incidencia de hernias incisionales. Conclusión: El cierre eficiente de la pared abdominal debe considerar factores técnicos, materiales utilizados y características individuales del paciente. Adoptar prácticas basadas en la evidencia es esencial para optimizar los resultados quirúrgicos y reducir las complicaciones tardías.
Descargas
Referencias
AHLQVIST, S.; EDLING, A.; ALM, M.; DACKHAMMAR, J. B.; NORDIN, P.; CENGIZ, Y. Trocar site hernia after gastric sleeve. Surgical Endoscopy, v. 36, p. 4386–4391, 2022.
ALBERTSMEIER, M. et al. Effects of the short-stitch technique for midline abdominal closure: short-term results from the randomised-controlled ESTOIH trial. Hernia, v. 26, p. 87–95, 2022.
ANTONIOU, S. A. et al. Single-incision laparoscopic surgery through the umbilicus is associated with a higher incidence of trocar-site hernia than conventional laparoscopy: a meta-analysis of randomized controlled trials. Hernia, v. 20, p. 1–10, 2016.
BOSANQUET, D. C. et al. Systematic review and meta-regression of factors affecting midline incisional hernia rates: analysis of 14,618 patients. PLoS One, v. 10, p. e0138745, 2015.
BROUWERS, M. C. et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ, v. 182, p. E839–E842, 2010.
CANO-VALDERRAMA, O. et al. Extraction-site incisional hernia after laparoscopic colorectal surgery: should we carry out a study about prophylactic mesh closure? Surgical Endoscopy, v. 34, p. 4048–4052, 2020.
DE BEAUX, A. C. Abdominal wall closure. British Journal of Surgery, v. 106, n. 3, p. 163–164, 2019.
DEERENBERG, E. B. et al. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet, v. 386, p. 1254–1260, 2015.
DEERENBERG, E. B. et al. Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies. British Journal of Surgery, v. 109, n. 12, p. 1239–1250, 2022.
GILLION, J. F.; SANDERS, D.; MISEREZ, M.; MUYSOMS, F. The economic burden of incisional ventral hernia repair: a multicentric cost analysis. Hernia, v. 20, p. 819–830, 2016.
GRAT, M. et al. Incisional surgical site infections after mass and layered closure of upper abdominal transverse incisions: first results of a randomized controlled trial. Annals of Surgery, v. 274, p. 690–697, 2021.
GUYATT, G. H. et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, v. 336, p. 924–926, 2008.
HENRIKSEN, N. A. et al. Meta-analysis on materials and techniques for laparotomy closure: the MATCH review. World Journal of Surgery, v. 42, p. 1666–1678, 2018.
HENRIKSEN, N. A. et al. Triclosan-coated sutures and surgical site infection in abdominal surgery: the TRISTAN review, meta-analysis and trial sequential analysis. Hernia, v. 21, p. 833–841, 2017.
HOER, J. et al. Factors influencing the development of incisional hernia. A retrospective study of 2983 laparotomy patients over a period of 10 years. Chirurg, v. 73, p. 474–480, 2002.
HOLIHAN, J. L. et al. Adverse events after ventral hernia repair: the vicious cycle of complications. Journal of the American College of Surgeons, v. 221, p. 478–485, 2015.
ISRAELSSON, L. A.; JONSSON, T. Suture length to wound length ratio and healing of midline laparotomy incisions. British Journal of Surgery, v. 80, p. 1284–1286, 1993.
ISRAELSSON, L. A.; MILLBOURN, D. Prevention of incisional hernias: how to close a midline incision. Surgical Clinics of North America, v. 93, p. 1027–1040, 2013.
JAIRAM, A. P. et al. Prevention of incisional hernia after midline laparotomy with prophylactic mesh reinforcement: a meta-analysis and trial sequential analysis. BJS Open, v. 4, p. 357–368, 2020.
KÖSSLER-EBS, J. B. et al. Incisional hernia rates after laparoscopic or open abdominal surgery—a systematic review and meta-analysis. World Journal of Surgery, v. 40, p. 2319–2330, 2016.
LEE, L. et al. Incisional hernia after midline versus transverse specimen extraction incision: a randomized trial in patients undergoing laparoscopic colectomy. Annals of Surgery, v. 268, p. 41–47, 2018.
MILLBOURN, D.; CENGIZ, Y.; ISRAELSSON, L. A. Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Archives of Surgery, v. 144, p. 1056–1059, 2009.
MUYSOMS, F. E. et al. European Hernia society guidelines on the closure of abdominal wall incisions. Hernia, v. 19, p. 1–24, 2015.
PAGE, M. J. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, v. 372, p. n71, 2021.
WU, X. et al. Antimicrobial-coated sutures to decrease surgical site infections: a systematic review and meta-analysis. European Journal of Clinical Microbiology & Infectious Diseases, v. 36, p. 19–32, 2017.
