PLASTIA

INGUINAL

FRANCISCO INFANTES GÓMEZ

TÉCNICA DE

IRA M. RUTKOW

Ira Rutkow is a clinical professor of surgery at the

University of Medicine and Dentistry of New Jersey. He

also holds a doctorate of public health from Johns

Hopkins University. He is the author of Bleeding Blue

and Gray: Civil War Surgery and the Evolution of

American Medicine and Surgery: An Illustrated History,

which was a New York Times Notable Book of the Year.

He and his wife divide their time between New York

City and the Catskills.

IRA RUTKOW is a surgeon and author whose current professional activities are focused on the studyof American medical history.

After graduating from Union College in 1970, he earned his medical degree from St. LouisUniversity. While completing training as a general surgeon, Rutkow also received a master’s degreeand a doctorate in public health from the Johns Hopkins School of Hygiene and Public Health.

He is the author of seven books, most recently Seeking the Cure: A History of Medicine in America(2010). Rutkow’s other works include James A. Garfield (2006), part of Times Books’ AmericanPresidents series edited by Arthur M. Schlesinger, Jr.; Bleeding Blue and Gray: Civil War Surgery andthe Evolution of American Medicine (2005); American Surgery: An Illustrated History (1998);Surgery: An Illustrated History (1993), named a New York Times Notable Book of the Year; and thetwo-volume The History of Surgery in the United States (1992 and 1988). In addition to hishistorical writings, he has edited numerous medical textbooks, including Socioeconomics ofSurgery (1989) and authored journal articles and book chapters on various surgical techniques.

Rutkow, who developed the PerFix mesh-plug operation for groin hernia repair, is retired fromclinical practice and writes full-time. A recipient of the American Medical Writers Association“Medical Book Award,” and the Fletcher Pratt Literary Award of the Civil War Round Table of NewYork, Rutkow has been inducted into The Johns Hopkins University’s “Society of Scholars,” and hewas awarded Union College’s Founders’ Medal. He is listed in Marquis Who’s Who in Medicine andHealthcare.

Dr. Rutkow and his wife divide their time between New York City and their farm in the HudsonValley.

Principio: la reparación mediante un

tapón de malla (que es preferible a una

malla extendida) es siempre un

tratamiento eficaz sea cual sea el

defecto existente.

Indicaciones:

En todas las hernias inguinocrurales

basado en el axioma “a menor

disección, mejores resultados”.

a.- Malla: El tapón se forma igual que en la técnica de Gilbert

pero su tamaño se debe de acomodar al defecto existente.

b.- Fijación: varía según el tipo de hernia.

Tipo I. No se requiere sutura nunca.

Tipo II. Usualmente no requiere sutura. La decisión de

utilizar puntos depende del cirujano.

Tipo III. El cono es fijado siempre a los márgenes del

orificio herniario con varios puntos sueltos reabsorbibles.

Tipo IV y V. El defecto directo es circunscrito cerca de su

base con electrocauterio para dejar un margen visible

alrededor del tejido sano, y luego la hernia es reducida. El

tapón se inserta a través del defecto posterior y se fija.

Tipo VI o en pantalón. Pueden precisarse ocasionalmente

dos tapones.

Siempre se debe realizar después una maniobra de

Valsalva para evaluar su correcta posición.

Refuerzo posterior: en todos los casos se coloca una

segunda malla de refuerzo sin sutura. La sección lateral

para dejar paso al cordón se cierra con 2 puntos sueltos

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