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Resumen Introduccion Los resultados de la reparacion de la hernia paraestomal (HP) basados en datos provenientes de registros son escasos. El objetivo del presente trabajo es analizar los datos recogidos sobre la HP en el Registro Nacional de Hernia Incisional (EVEREG) y asi evaluar las practicas actuales y resultados en la reparacion de una HP. Metodos Se analizan los datos de la cohorte de HP registradas en el periodo desde julio de 2012 hasta junio de 2018. Se analizan las complicaciones, recidivas y factores asociados a ellas de la cohorte completa de HP, independientemente del tipo de estoma al que se asocian. Posteriormente, se realiza el mismo analisis del grupo de HP con relacion a una colostomia (grupo mas numeroso). Resultados Se estudiaron 353 HP. De estas, 259 (73%) fueron HP en el contexto de una colostomia terminal, 74 (21%) en el de una ileostomia terminal y 20 (6%) en el de una ureteroileostomia (Bricker). La edad media global fue de 68,7 ± 11,1 anos y 135 (38%) pacientes fueron del sexo femenino. El abordaje abierto y la cirugia electiva fueron predominantes (78% y 92%, respectivamente). El 99% se reparo con una malla sintetica no absorbible. Las complicaciones postoperatorias globales fueron altas (30,6%), asi como la recurrencia global (27,5%) tras un seguimiento medio de 9,4 meses. Conclusiones La reparacion de la HP es poco frecuente comparada con el conjunto de reparaciones de la hernia incisional. La cirugia de la HP parece relacionarse con un porcentaje elevado de complicaciones postoperatorias y recidiva.

Endoscopic ultrasound (EUS) procedures are becoming more frequent nowadays and novel techniques are on the rise. These procedures require high technical experience and complex endoscopic skills. The goal of this study was to develop a new minimally invasive animal model of bile duct dilatation in the pig, in order to offer a new tool for endoscopic and surgical therapy training and to test new therapeutic strategies. Twenty-five female pigs underwent laparoscopic surgery in order to perform a common hepatic duct ligation. A pre- and postoperative biochemical analyses were performed: glucose, albumin, total bilirubin (TBil), gamma glutamyl transferase (GGT), alkaline phosphatase, and alanine aminotransferase were measured. Surgical time and intra- and postoperative complications were registered. Five to six days after surgery, an EUS was performed to measure intrahepatic duct size (mm). Distance from the bile duct to the EUS transductor was also recorded (mm). T-student for quantitative variables was applied. Statistical significance was defined as p value ≤ 0.05. The mean surgical time was 29.5 ± 14.9 min. In five pigs (20%), some mild intraoperative problems occurred. A severe postoperative complication occurred in one animal (4%). No postoperative mortality was registered. Postoperative serum analyses showed an increase in total bilirubin (p = 0.005) and gamma glutamyl transferase levels (p = 0.001). Postoperative EUS showed dilatation of the intrahepatic bile duct in 76% of pigs, with a mean diameter of 9.6 ± 3.6 mm (distance from the gastric wall of 17.0 ± 6.4 mm). The surgical procedure described here is a safe technique to induce dilatation of the intrahepatic bile ducts in the pig, with a minimally invasive approach and a high efficacy rate. This animal model might be useful for EUS techniques training and for evaluating new therapeutic approaches.