Jose Torres Villachica
ABSTRACT
Objectives: With this cases report, we seek to introduce a classification and treatment system for abdominal wall pathology (hernias of the groin) according to the volumetric measurements obtained with this 3D reconstruction method, describing two cases in order to demonstrate its usefulness in this surgical area. One of them, a standard patient (average hernia size) and the other, with large hernias (loss of domain) and complex treatment. Materials and methods: During the year 2021 two men aged 88 and 67 years with bilateral inguinal hernias without previous abdominal wall or groin surgeries were included in this study. Measurements (volume, surface, diameters) of certain anatomical areas (hernial sacs and rings) were made using preoperative computed tomography and the 3D Slicer® multimedia program, fashioning 3D reconstructions of these structures and its measures. An inguinal hernia score-based chart classification with a therapeutic approach was tailored following the current guidelines and recommendations. Results: These two cases underwent on a quantitative classification based on 5 parameters to be measured (number of organs involved in the hernia sac, number of recurrences, total hernial volume, hernia/abdominal volume rate and hernial ring surface). The first patient which was an usual non complicated case scored 5 on our classification, which means a grade 1, undergoing a laparoscopic technique alone (TAPP). The other patient presented a score according to this chart of 15, which also had a Hernial Vol./Abdominal Vol. rate of almost 25% (23.8), so treatment with botulinum toxin A was developed to increase the elasticity of the abdominal wall and preoperative induced pneumoperitoneum and laparoscopic surgery (TAPP) was performed. Both surgeries were performed fitting the current available scientific literature on this surgical field. Conclusion: The use of 3D technology and the introduction of a classification that allows a quantitative and objective assessment for therapeutic purposes are presented as valuable tools in the prevention of the appearance of hernia recurrences and its complications.
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Index Terms
- The use of 3D technology in the preoperative period for patients with bilateral inguinal hernias.: A quantitative classification proposal aimed to reach surgical approach.
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