Evolución histórica de 67 hernias de Spiegel

Resumen

Introducción y objetivos: La hernia de Spiegel es un defecto de la pared abdominal de presentación diversa; con diagnóstico y tratamiento no estandarizados. Presentamos nuestra serie de pacientes con Hernia de Spiegel. El objetivo es analizar su evolución histórica y perfeccionar su manejo.

Material y métodos: Se realiza un estudio retrospectivo de los pacientes intervenidos desde 1986 a 2011. Se analizan los factores epidemiológicos, diagnóstico, técnica quirúrgica, morbilidad y recidivas. Realizamos un análisis de la evolución histórica de estas hernias, comparando el periodo 1986-98 y el 1999-2011.

Resultados: SHemos tratado 64 pacientes, 24 varones y 40 mujeres, con una edad media de 54´23 años (rango, 19-93 años). La localización más frecuente fue el lado izquierdo. Tres hernias eran bilaterales. El diagnóstico clínico se hizo en el 59´37 % de los casos. La tomografía computarizada diagnosticó correctamente el defecto en 13 de 16 pacientes y la ecografía en 8 de 14 pacientes. El diagnostico con pruebas de imagen se hizo en el 32´81% de los casos. Las técnicas más frecuentes realizadas fueron hernioplastia abierta y herniorrafia. Se efectuó cirugía de urgencias en el 26´56 % de los casos. Hubo 10 complicaciones postoperatorias. Se identificaron dos recurrencias. En el primer periodo hubo 20 pacientes vs 44 en el segundo. Edad media 60´75 años vs 50´43 años. Mujeres 50% vs 68´18%. Obesidad, como factor predisponente, 25% vs 40´90%. Diagnóstico por imagen 30% vs 34´09%. Se usó malla por vía abierta en el 20% vs 93´18%. Cirugía de urgencias 15% vs 31´81%. Tratamiento laparoscópico 0% vs 4´54%. Recidiva 5% vs 2´27%.

Conclusiones: La hernia de Spiegel requiere un alto índice de sospecha debido a su sintomatología insidiosa. En casos dudosos la tomografía computarizada es la prueba de imagen más fiable. Debido a la alta tasa de complicaciones, su tratamiento es quirúrgico. La reparación abierta de la hernia de Spiegel, con o sin malla, consigue buenos resultados. En los últimos trece años se ha duplicado el número de nuestros pacientes, la edad media ha bajado 10 años, ha aumentado: el porcentaje de mujeres , el de obesidad, la cirugía de urgencias y el uso de malla; se han mantenido el diagnóstico por imagen y las recidivas. Por último destacar la incorporación de la laparoscopia al arsenal terapéutico de la hernia de Spiegel.

Palabras clave: Hernia de Spiegel; Hernia; Malla

TRADUCCIÓN
Resumen(en)

Introduction and aims of this study: A Spigelian hernia is an abdominal wall defect with patients presenting with different symptoms and whose diagnosis and treatment are not yet standardized. We present a series of patients with Spigelian hernia. Our aim is to analyze its historical evolution and improve its management.

Material and approaches: We performed a retrospective study of patients operated from 1986 to 2011, analyzing the epidemiological factors, diagnosis, surgical technique, morbidity and recurrence. We carried out an analysis of the historical evolution of these hernias, comparing the periods 1986-1998 and 1999-2011.

Results: Surgery was performed on 64 patients (24 men and 40 women), whose mean age was 54.23 (age range: 19-93). The more frequent location of the hernia was the left side. Three hernias were found in both sides. Clinical diagnosis was made in 59.37% cases. The defect was correctly diagnosed by computed tomography in 13 of 16 patients and by ultrasound in 8 of 14 patients. In 32.81% cases diagnosis was made with imaging tests. The techniques most frequently performed were open hernioplasty and herniorrhaphy. Emergency surgery was performed in 26.56% cases. There were 10 cases of postoperative complications, with two cases of hernia recurrence identified.

In the first period under study, there were 20 patients treated vs 44 in the second period. Their mean age was 60.75 in the first period vs 50.43 in the second. The percentage of women in the first period was 50% vs 68.18% in the second. Obesity was as a predisposing factor in 25% cases in the first period vs 40.90% in the second. Diagnosis through imaging was made in 30% cases in the first period vs 34.09% in the second. Open repair of the hernia was performed in 20% cases in the first period vs 93.18% in the second. Emergency surgery was needed in 15% cases in the first period vs 31.81% in the second. Laparoscopic treatment was undergone in 0% cases in the first period vs 4.54% in the second. There was recurrence in 5% cases in the first period vs 2.27% cases in the second.

Conclusions: Spigelian hernia requires a high index of suspicion because of its insidious symptoms. In doubtful cases, computed tomography is the most reliable imaging technique. Due to the high rate of complications, its treatment is surgical. The open repair of Spigelian hernias, with or without mesh, achieves good results. In the last thirteen years, the number of patients has doubled and their mean age has dropped 10 years; however, the percentage of women, obesity, emergency surgery and the use of mesh has increased; the percentage of diagnosis through imaging and recurrence has remained the same. Finally, the incorporation of laparoscopy to treatment of spigelian hernias should be noted.

Key words: Spigelian hernia; hernia; mesh.