Premetto che non sono un medico ! Comunque avrei la seguente questione da porre: ho notato che ci sono diverse tecniche o metodologie di intervento per la risoluzione dell'ernia inguinale che possono essere più o meno invasive . Per le ernie di media , piccola entità si prevede a volte l'anestesia locale. Il mio quesito è il seguente quale risulta essere allo stato attuale la tecnica migliore (parlo per ernie di media entità) cioè la meno invasiva , quella che richiede la minor anestesia , il più veloce recupero e sopratutto il minor rischio di recidiva? A dimenticavo anche la meno dolorosa?. Ho letto che a volte la Kugel patch tende a spostarsi...............anche se in teoria è quella che offre la miglior risoluzione del problema (se fatta come si deve!). Esiste una classifica per le varie tecniche........................
Il fatto che ci siano così tante tecniche dipende da molti fattori, ma in sostanza vuol dire che non si è ancora trovata la tecnica migliore in senso assoluto e quindi definitiva. Ogni chirurgo esegue la tecnica che per capacità e conoscenza gli dà i migliori risultati. Ognuna ha i suoi vantaggi e i suoi svantaggi, ma a parità di perfezione di esecuzione e di capacità tecnica, sono sovrapponibili. Quindi un chirurgo che sappia fare bene una tecnica anteriore avrà gli stessi risultati di una tecnica posteriore se eseguita a regola d'arte, con rischi diversi per ogni tecnica. Tutto sta nel conoscere i rischi e cercare di ridurli al minimo. In ogni caso: chirurgo esperto e tecnica corretta assicurano le percentuali di successo riportate dalla letteratura.
Questo è quello che ho trovato...........potrebbe essere utile a qualcuno nel caso volesse scegliersi la metodologia di intervento!!!!! Io ho scelto (bisogna vedere se il chirurgo sarà d'accordo), secondo me forse la Kugel patch è quella che guarda più in la per una possibile tecnica definitiva!!!!
There are two different kinds of hernia repair:
Tension repair
Tension-free repair
Tension Repair
For a long time, tension repair was the only repair option available to people with hernias. In this procedure, the surgeon makes an incision in the abdomen over the hernia site, pushes any protruding tissue back into the correct position within the abdominal cavity, and then stitches it closed. Today, tension repairs are recommended only for children or for very small hernias. There are some major disadvantages to tension repair, including:
Discomfort A 4-6 week recovery period A 10-15% chance that the hernia will recur
Tension-free Repair
Today, tension-free repair techniques for hernia are more common. It's likely that your doctor will recommend one of the following techniques to repair your hernia. Taking the time to understand your options means you'll be prepared to discuss them with your doctor.
The five most common tension-free repair techniques:
Flat Mesh Repair
After making an incision over your hernia, your surgeon will use a patch made out of flat plastic (polypropylene) mesh and stitch it to the tissue surrounding your hernia. Advantages:
Hernias recur in only 3% of flat mesh repair patients
Quick recovery
Only minor discomfort following procedure
Can be done under local anesthesia Disadvantages:
If the hernia is large, more stitches may be required to fasten the mesh, increasing the risk of nerve damage Procedure can take between 40 and 60 minutes
Plug and Patch Repair
Commonly used to treat inguinal hernias, this technique is similar to flat mesh repair. Advantages:
Similar to flat mesh repair Disadvantages:
Does not protect well against formation of new hernias Plug may shrink, increasing risk of: recurrence plug changing position Some people experience long-term discomfort because they can feel the plug through their skin
Laparoscopic Repair
In laparoscopic surgery, your surgeon inserts a laparoscope (a thin instrument with a light source and magnifying lens) through a small incision in your abdomen. The laparoscope enables your surgeon to examine the hernia and place a mesh patch on the inside of your abdominal wall. This surgery is called posterior hernia repair. It differs from traditional mesh repairs (discussed above), in which the mesh is placed on the outside of the abdominal wall. Advantages:
Pressure from within the abdominal cavity helps to hold the mesh in place Disadvantages:
Must be performed under general anesthesia, the riskiest part of any surgical procedure
Can require an overnight stay in the hospital Procedure can take 60 minutes .
Kugel Patch
This is another technique your surgeon might use if you have an inguinal hernia. The Kugel patch is a piece of mesh with a firm outer ring that helps stabilize it when your doctor places it under the hernia. Because of the ring, only minimal suturing is required.
Advantages:
Minimally invasive Can be done under local or regional anesthesia Disadvantages:
For some people, the firm outer rim of the patch can cause pain and discomfort following surgery The patch can move thereby causing a recurrence Three-dimensional Mesh Repair
The newest technique on the hernia repair scene combines many of the advantages of earlier tension-free repair techniques. A new device (the PROLENE Hernia System, manufactured by Ethicon Inc., a Johnson & Johnson company) is revolutionizing the repair of inguinal hernias. It consists of three attached components: an underlay patch that provides an effective posterior repair on the inside of the abdominal wall a connector similar to a plug an "onlay" patch that lays flat over the abdominal wall Advantages:
Greater comfort Little suturing, reducing the risk of nerve damage Can be done under local or regional anesthesia Quicker recovery Medical Professionals Click on this icon for clinical information on the PROLENE Hernia System
Disadvantages:
Your surgeon may not yet be trained to perform three-dimensional mesh repair.
Click here to find a surgeon trained in three-dimensional mesh repair in your area.
The Best Way to Seal a Barrel
Feeling overwhelmed by your tension-free hernia repair options? Consider the similarities between your body and a barrel filled with water for a moment. (It may not be flattering, but it will help point out the differences between the techniques discussed here.)
If this barrel has a hole in it, there are a couple of obvious ways to fix it:
By placing a patch on the outside (as in traditional mesh repair). Problem? This repair might fail because the water pressure might push the patch out. By placing a plug in the hole itself (as in plug and patch repair). Problem? This repair might fail for the same reason—water pressure could push the plug out. By placing a patch on the inside of the barrel (as in a laparoscopic posterior repair). Problem? Maybe none. With the inside patch, at least water pressure would hold the patch in place and help to seal the hole. Is there a better way to fix the barrel? What about combining all three techniques? A patch on the inside, a plug in the middle and a patch on the outside. You may want to consider the advantages of this three-in-one approach to barrel repair when you ask your doctor about the PROLENE Hernia System.
Hernias were diagnosed as early as 1564. At that time, a truss, a mechanical device used to push the hernia back in, was one method used for controlling hernias. Trusses were fashioned from a variety of materials and in a variety of shapes depending on the type of hernia. Another treatment option was to place the patient into an upside-down position, basically hanging them by their feet, the logic being that gravity would make the hernia go back into the abdominal cavity. These methods were not successful.
During the last decade of the 19th century, rapid advances were made in the knowledge of anatomy, surgical antiseptics and anesthesia, which led to the surgical treatment of hernias. The first surgical hernia repair was invented in 1890 by Bassini.
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