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• W3168337038 abstract "espanolIntroduccion. La recurrencia tras la reparacion abierta de la hernia umbilical, constituye un problema importante para el paciente, el sistema sanitario y para el equipo quirurgico. Actualmente, no existe consenso entre las sociedades quirurgicas sobre los factores de riesgo de recidiva. Determinar estos factores es fundamental para corregirlos, realizar el tratamiento mas apropiado y disminuir la tasa de la misma. Objetivo. El proposito de este estudio es evaluar los factores predictivos de recidiva tras la reparacion abierta de la hernia umbilical con y sin malla, en cado uno de los periodos del proceso quirurgico (preoperatorio, intraoperatorio y postoperatorio), en los pacientes operados en nuestro servicio durante 4 anos. Material y Metodos. Estudio observacional retrospectivo de 551 pacientes consecutivos intervenidos durante los anos 2015 a 2018. Se revisaron las historias electronicas de los pacientes y se creo una base de datos para el estudio de los resultados. El modelo de la regresion de Cox univariable y multivariable se utilizo para analizar la supervivencia libre de recurrencia por edad, sexo, indice de masa corporal, ASA del paciente, tabaquismo, diabetes, broncopatia, tamano del defecto, tipo de reparacion, clase de protesis y complicaciones. Las curvas de Kaplan-Meier se utilizaron para analizar la supervivencia libre de recurrencia para factores de riesgo preoperatorios, intraoperatorios y postoperatorios. Resultados. Edad media de los pacientes, 49,9 ± 13,9 anos con una tasa de recurrencia global del 6,5%. Hombres 367 (66,6%) y recidiva del 5,7%. Mujeres 184 (33,4%) y recaida del 8,2% (P = 0,276). Seguimiento medio de 14,6 (± 12,3) meses. La mayoria de los pacientes (96,4%), se clasificaron de bajo riesgo anestesico (ASA I y II), con una recurrencia del 6,3% y 20 pacien-tes ASA III (3,6%) con recidiva del 10% (P = 0,564). Respecto al peso, 124 pacientes (22,5%) tenian un IMC 25-30 con una recurrencia del 6,5% y 212 pacientes (38,5%) con IMC >30 (38,5%) y recidiva del 7,5%. Se contabilizaron 61 pacientes (11,1%) diabeticos con 4 recidivas (6,6%) (p = 0,994). Broncopatia en 64 pacientes (11,6%) con una recurrencia del 10,9% (p = 0,129). Tabaquismo en 132 pacientes (24,5%) con recurrencia del 6,3% y 74 herniorrafias (13,4%) con una recidiva del 8,1%. Hernioplastia con malla simple en 424 casos con una recurrencia del 6,6% y hernioplastia con malla compuesta en 53 casos con una recidiva del 3,8% (P=0,617). Tamano medio del defecto 2,75 cm (0,5-4 cm). Complicaciones postoperatorias: seroma en 22 casos (4%) y tasa recidiva 22,7% (P=0,002), infeccion quirurgica en 18 casos con recurrencia del22,2% (P = 0,006). El analisis estadistico demuestra que por cada ano de edad, el riesgo de recurrencia aumenta un 3% (P = 0.068), que las mujeres tienen un 52% mas riesgo de recidiva que los hombres (P = 0,277), que la obesidad presenta un 46% mas riesgo de recaida (p = 0,313) y que la broncopatia tiene 3 veces mas riesgo de recidiva (P = 0,030). La infeccion quirurgica representa un 75% mas riesgo de recurrencia (p = 0,608) y el seroma representa un riesgo 5 veces mayor de recurrencia, estadisti-amente significativa (p = 0,004). Conclusion. Nuestros resultados indican que a mayor edad, el sexo femenino, ASA III, alto indice de masa corporal, diabetes, broncopatia, tamano del defecto herniario, tipo de reparacion, infeccion quirurgica y seroma fueron los factores asociados con un mayor riesgo de recurrencia despues de la reparacion abierta de la hernia umbilical EnglishIntroduction. Recurrence after open umbilical hernia repair constitutes an important problem for the patient, the health system and the surgical team. Currently, there is no consensus among surgical societies on the risk factors for hernia recurrence. Determining these factors is essential to correct them, carry out the most appropriate treatment and reduce the recurrence rate. Objective.The purpose of this study is to evaluate the predictive factors of recurrence after open repair of umbilical hernia with and without mesh, in each of the periods of the surgical process (preoperative, intraoperative and postoperative), in patients operated on in our service for 4 years. Material and Methods. Retrospective observational study of 551 consecutive patients operated during the years 2015 to 2018. The electronic records of the patients were reviewed and a database was created to study the results. Univariate and multivariate Cox regression was used to analyze recurrence-free survival by age, sex, body mass index, ASA of the patient, smoking, diabetes, bronchopathy, size of the defect, type of repair, class of prosthesis, and complications. Kaplan-Meier curves were used to analyze recurrence-free survival for preoperative, intraoperative, and postoperative risk factors. Results. Mean age of the patients, 49.9 ± 13.9 years. Men 367 (66.6%) and women 184 (33.4%) (P = 0.693). Global recurrence rate 6.5%. Recurrence in women, 8.2%. Recurrence in men 5.7% (P = 0.276). Mean follow-up of 14.6 (± 12.3) months. Most of the patients were classified as low anesthetic risk (ASA I and II), 531 patients (96.4%) with a recurrence of 6.3% and 20 ASA III patients (3.6%) with a recurrence of the 10% (P = 0.564). Regarding weight, 124 patients (22.5%) had a normal weight with a relapse of 5.6%, 215 patients (39%) were overweight with a relapse of 6.5% and 212 were obese (38.5% ) with a recurrence rate of 7.5%. There were 61 diabetic patients (11.1%) with 4 relapses (6.6%) (p = 0.994). Bronchopathy in 64 patients (11.6%) with a recurrence of 10.9% (p = 0.129). Smoking in 132 patients (24.5%) with a recurrence of 6.1% (P = 0.801). Regarding the technical aspects, 477 hernioplasties (86.6%) were performed with a recurrence rate of 6.3% and 74 herniorrhaphies (13.4%) with a recurrence of 8.1%. Simple mesh hernioplasty in 424 cases with a recurrence of 6.6% and hernioplasty with composite mesh in 53 cases with a recurrence of 3.8% (P = 0.617). Average default size 2.75 cm (0.5-4 cm). Postoperative complications: 22 patients (4%) presented seroma with a recurrence of 22.7% (P = 0.002) and 18 patients (3.3%) presented surgical infection with a recurrence rate of 22.2% (P = 0.006 ). After statistical analysis and when adjusting the selected variables, it was detected: that for each year of age, the risk of recurrence increases by 3% (P = 0.068), that women have a 52% higher risk of recurrence than men (P = 0.277), that obesity has a 46% higher risk of relapse (p = 0.313) and that bronchopathy has a 3 times higher risk of recurrence (P = 0.030). Surgical infection represents a 75% higher risk of recurrence (p = 0.608) and postoperative seroma represents a statistically significant 5 times higher risk of recurrence (p = 0.004).Conclusion. Our results indicate that at older age, female sex, ASA III, high body mass index, diabetes, bronchopathy, size of the hernial defect, type of repair, surgical infection and seroma were the factors associated with a higher risk of recurrence. after open umbilical hernia repair." @default.
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• W3168337038 title "Factores predictivos de recurrencia tras la reparación abierta de la hernia umbilical en 551 pacientes consecutivos: estudio observacional retrospectivo" @default.
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