<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2307-0420</journal-id>
<journal-title><![CDATA[Cirugía paraguaya]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Cir. Parag.]]></abbrev-journal-title>
<issn>2307-0420</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Paraguaya de Cirugía]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2307-04202016000100013</article-id>
<article-id pub-id-type="doi">10.18004/sopaci.2016.mayo.13-17</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[REPARACIÓN DE DEFECTOS COMPLEJOS DE LA PARED ABDOMINAL Y CIRUGÍA INTESTINAL EN UN TIEMPO]]></article-title>
<article-title xml:lang="en"><![CDATA[REPAIR OF COMPLEX ABDOMINAL WALL DEFECTS AND INTESTINAL SURGERY AT A TIME]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cuenca Torres]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ortíz]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ferreira]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sosa]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gonzalez]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pederzoli]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de Nacional de Asunción Facultad de Ciencias Médicas, Hospital de Clínicas II Cátedra de Clínica Quirúrgica]]></institution>
<addr-line><![CDATA[San Lorenzo ]]></addr-line>
<country>Paraguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>05</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>05</month>
<year>2016</year>
</pub-date>
<volume>40</volume>
<numero>1</numero>
<fpage>13</fpage>
<lpage>17</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S2307-04202016000100013&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S2307-04202016000100013&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S2307-04202016000100013&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Introducción: La reparación de la pared abdominal, presenta escenarios complejos, como los abdómenes abiertos con ostomías o fístulas intestinales, que para su tratamiento el cirujano debe buscar la táctica quirúrgica y el manejo ideal para cada caso. Objetivo: Describir los resultados en la reparación de defectos complejos de la pared abdominal y restitución de tránsito intestinal en un solo tiempo.  Pacientes y método: Estudio observacional, descriptivo, prospectivo y longitudinal, de una serie de casos de 30 pacientes, ambos sexos, mayores a 18 años, portadores de defectos complejos de la pared abdominal (abdomen abierto cicatrizado por segunda intención y hernias paraestomales) y ostomías que ingresaron para cirugía electiva en la II Cátedra de Clínica Quirúrgica del Hospital de Clínicas de marzo del 2011 a diciembre del 2015. Todos los pacientes fueron evaluados con tomografía axial computarizada, según el caso sometidos a preparación con neumoperitoneo progresivo pre operatorio y manejados por equipo multidisciplinario.  Resultados: Fueron incluidos 30 pacientes, 9 mujeres y 21 hombres con un promedio de edad de 51,5 años (20-83 años), diámetros trasverso del defecto parietal con una una media 18,5cm (12 a 25 cm). Los defectos parietales fueron: hernia incisional planeada 27 pacientes (abdomen abierto cicatrizado por segunda intención) y hernias paraestomales 3 pacientes. En 25 pacientes se utilizó técnica de separación de componentes y en los restantes solo cierre anatómico del defecto; en todos los casos refuerzo con prótesis de polipropileno en posición onlay. Las anastomosis intestinales fueron manual en 11 casos y con sutura mecánica en 19 casos. La estancia hospitalaria tuvo promedio de 35 días, complicaciones en 16,6% (2 infecciones de herida operatoria, 2 dehiscencias de anastomosis intestinal y 1 hemoperitoneo), falleció un paciente. Seguimiento a los 24 meses sin recidivas.  Conclusión: La utilización de esta técnica, en pacientes bien seleccionados y con un manejo de grupo de expertos y multidisciplinario podría constituirse en una buena opción.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Introduction: Abdominal wall repair, presents complex scenarios, as the bellies open with ostomy or intestinal fistulas, that treatment the surgeon should seek surgical tactics and ideal management for each case.  Objective:  To describe the results in repair of complex defects of the abdominal wall and return of intestinal transit in a single time.  Patients and methods:  observational, descriptive, prospective and longitudinal study, a series of 30 patients, both sexes, over 18 years, carriers of complex defects of the abdominal wall (open abdomen healed by second intention and paraestomales herniations) and ostomy admitted for elective surgery at the surgical clinic of the Hospital de Clínicas of March 2011 to2015 December II. All patients were evaluated with axial computed tomography, according to the case subject to progressive pneumoperitoneum progressive pre operative and managed by a multidisciplinary team.  Results:  Were included 30 patients, 9 women and 21 men with an average age of 51.5 years (20-83 years), diameters trasverso parietal defect with an average 18, 5cm (12 to 25 cm). Parietal defects were: incisional hernia planned 27 patients (open abdomen scarred by second intention) and paraestomales hernias 3 patients. In 25 patients and separation of components in the remaining technique was used only anatomical closure of the defect; in all cases reinforcement polypropylene in position onlay prosthesis. Intestinal anastomoses were manual in 11 cases and with mechanical suture in 19 cases. The hospital stay was average of 35 days, complications in 16,6% (2 infections of surgical wound, 2 dehiscence of intestinal anastomosis et 1 hemoperitoneo ), died a patient, follow-up at 24 months without recurrence.  Conclusion:  The use of this technique, in well selected patients and a group of experts and multidisciplinary management could be a good choice.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[complejos]]></kwd>
<kwd lng="es"><![CDATA[Cirugía intestinal]]></kwd>
<kwd lng="en"><![CDATA[defects]]></kwd>
<kwd lng="en"><![CDATA[Intestinal surgery]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cuenca]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
<name>
<surname><![CDATA[Ferreira]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Resultados en el manejo del abdomen abierto. Nuestra experiencia]]></article-title>
<source><![CDATA[An. Fac. Cienc. Méd.]]></source>
<year>2012</year>
<volume>45</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>19-25</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Borráez]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Abdomen abierto: La herida más desafiante]]></article-title>
<source><![CDATA[Rev Colomb Cir]]></source>
<year>2008</year>
<volume>23</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>204-9</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Halm]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Lip]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Schmitz]]></surname>
<given-names><![CDATA[PI]]></given-names>
</name>
<name>
<surname><![CDATA[Jeekel]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Incisional hernia after upper abdominal surgery: A randomized controlled trial of midline versus transverse incision]]></article-title>
<source><![CDATA[Hernia]]></source>
<year>2009</year>
<volume>13</volume>
<page-range>275-80</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hernández]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Tratamiento simultáneo de plastia de pared y cierre intestinal]]></article-title>
<source><![CDATA[Cir Gen]]></source>
<year>2004</year>
<volume>26</volume>
<page-range>242-7</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dayton]]></surname>
<given-names><![CDATA[MT]]></given-names>
</name>
<name>
<surname><![CDATA[Buchele]]></surname>
<given-names><![CDATA[BA]]></given-names>
</name>
<name>
<surname><![CDATA[Shirazi]]></surname>
<given-names><![CDATA[SS]]></given-names>
</name>
<name>
<surname><![CDATA[Hunt]]></surname>
<given-names><![CDATA[LB]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Use of an ab- sorbable mesh to repair contaminated abdominalwall defects]]></article-title>
<source><![CDATA[Arch Surg]]></source>
<year>1986</year>
<volume>121</volume>
<page-range>954-60</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lamont]]></surname>
<given-names><![CDATA[PM]]></given-names>
</name>
<name>
<surname><![CDATA[Ellis]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Incisional hernia in re-opened abdominal incisions: an overlooked risk factor]]></article-title>
<source><![CDATA[Br J Surg]]></source>
<year>1988</year>
<volume>75</volume>
<page-range>374-6</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cuenca]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
<name>
<surname><![CDATA[Ferreira]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Tratamiento parietal protésico de las hernias complicadas]]></article-title>
<source><![CDATA[Rev.Arg.Res.Cir]]></source>
<year>2013</year>
<volume>18</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>31-5</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dumanian]]></surname>
<given-names><![CDATA[GA]]></given-names>
</name>
<name>
<surname><![CDATA[Llull]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Ramasastry]]></surname>
<given-names><![CDATA[SS]]></given-names>
</name>
<name>
<surname><![CDATA[Greco]]></surname>
<given-names><![CDATA[RJ]]></given-names>
</name>
<name>
<surname><![CDATA[Lotze]]></surname>
<given-names><![CDATA[MT]]></given-names>
</name>
<name>
<surname><![CDATA[Edington]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Postoperative abdominal wall defects with entero- cutaneous fistulae]]></article-title>
<source><![CDATA[Am J Surg]]></source>
<year>1996</year>
<volume>172</volume>
<page-range>332-4</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dayton]]></surname>
<given-names><![CDATA[MT]]></given-names>
</name>
<name>
<surname><![CDATA[Buchele]]></surname>
<given-names><![CDATA[BA]]></given-names>
</name>
<name>
<surname><![CDATA[Shirazi]]></surname>
<given-names><![CDATA[SS]]></given-names>
</name>
<name>
<surname><![CDATA[Hunt]]></surname>
<given-names><![CDATA[LB]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Use of an ab- sorbable mesh to repair contaminated abdominalwall defects]]></article-title>
<source><![CDATA[Arch Surg]]></source>
<year>1986</year>
<volume>121</volume>
<page-range>954-60</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gilbert]]></surname>
<given-names><![CDATA[AI]]></given-names>
</name>
<name>
<surname><![CDATA[Felton]]></surname>
<given-names><![CDATA[LL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Infection in inguinal hernia repair consi- dering biomaterials and antibiotics]]></article-title>
<source><![CDATA[Surg Gynecol Obstet]]></source>
<year>1993</year>
<volume>177</volume>
<page-range>126-30</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Fansler]]></surname>
<given-names><![CDATA[RF]]></given-names>
</name>
<name>
<surname><![CDATA[Taheri]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Cullinane]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Sabates]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Flint]]></surname>
<given-names><![CDATA[LM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Po- lypropylene mesh closure of the complicated abdominal wound]]></article-title>
<source><![CDATA[Am J Surg]]></source>
<year>1995</year>
<volume>170</volume>
<page-range>15-8</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cheung]]></surname>
<given-names><![CDATA[MT]]></given-names>
</name>
<name>
<surname><![CDATA[Chia]]></surname>
<given-names><![CDATA[NH]]></given-names>
</name>
<name>
<surname><![CDATA[Chiu]]></surname>
<given-names><![CDATA[WY]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Surgical treatment of parasto- mal hernia complicating sigmoid colostomies]]></article-title>
<source><![CDATA[Dis Colon Rec- tum]]></source>
<year>2001</year>
<volume>44</volume>
<page-range>266-70</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Tekkis]]></surname>
<given-names><![CDATA[PP]]></given-names>
</name>
<name>
<surname><![CDATA[Kocher]]></surname>
<given-names><![CDATA[HM]]></given-names>
</name>
<name>
<surname><![CDATA[Payne]]></surname>
<given-names><![CDATA[JG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Parastomal hernia repair: modified Thorlakson technique, reinforced by polypropylene mesh]]></article-title>
<source><![CDATA[Dis Colon Rectum]]></source>
<year>1999</year>
<volume>42</volume>
<page-range>1505-8</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Byers]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Steinberg]]></surname>
<given-names><![CDATA[JB]]></given-names>
</name>
<name>
<surname><![CDATA[Postier]]></surname>
<given-names><![CDATA[RG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Repair of parastomal her- nias using polypropylene mesh]]></article-title>
<source><![CDATA[Arch Surg]]></source>
<year>1992</year>
<volume>127</volume>
<page-range>1246-7</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Leslie]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The parastomal hernia]]></article-title>
<source><![CDATA[Surg Clin North Am]]></source>
<year>1984</year>
<numero>64</numero>
<issue>64</issue>
<page-range>407-15</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Fabian]]></surname>
<given-names><![CDATA[TC]]></given-names>
</name>
<name>
<surname><![CDATA[Croce]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Pritchard]]></surname>
<given-names><![CDATA[FE]]></given-names>
</name>
<name>
<surname><![CDATA[Minard]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Hickerson]]></surname>
<given-names><![CDATA[WL]]></given-names>
</name>
<name>
<surname><![CDATA[Howell]]></surname>
<given-names><![CDATA[RL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Planned ventral hernia. Staged management for acute abdominal wall defects]]></article-title>
<source><![CDATA[Ann Surg]]></source>
<year>1994</year>
<volume>219</volume>
<page-range>643-50</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Voyles]]></surname>
<given-names><![CDATA[CR]]></given-names>
</name>
<name>
<surname><![CDATA[Richardson]]></surname>
<given-names><![CDATA[JD]]></given-names>
</name>
<name>
<surname><![CDATA[Bland]]></surname>
<given-names><![CDATA[KI]]></given-names>
</name>
<name>
<surname><![CDATA[Tobin]]></surname>
<given-names><![CDATA[GR]]></given-names>
</name>
<name>
<surname><![CDATA[Flint]]></surname>
<given-names><![CDATA[LM]]></given-names>
</name>
<name>
<surname><![CDATA[Polk Jr]]></surname>
<given-names><![CDATA[HC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Emergency abdominal wall reconstruction with polypro- pylene mesh: short-term benefits versus long-term complica- tions]]></article-title>
<source><![CDATA[Ann Surg]]></source>
<year>1981</year>
<volume>194</volume>
<page-range>219-23</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
