PLASTIA INGUINALFRANCISCO INFANTES GÓMEZ

TÉCNICA DEIRA 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 study of American medical history.

After graduating from Union College in 1970, he earned his medical degree from St. Louis University. While completing training as a general surgeon, Rutkow also received a master’s degree and 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’ American Presidents series edited by Arthur M. Schlesinger, Jr.; Bleeding Blue and Gray: Civil War Surgery and the 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 the two-volume The History of Surgery in the United States (1992 and 1988). In addition to his historical writings, he has edited numerous medical textbooks, including Socioeconomics of Surgery (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 from clinical 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 New York, Rutkow has been inducted into The Johns Hopkins University’s “Society of Scholars,” and he was awarded Union College’s Founders’ Medal. He is listed in Marquis Who’s Who in Medicine and Healthcare.        

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

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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