Efeitos da terapia de fotobiomodulação na prevenção de complicações na cicatrização da ferida cirúrgica da herniorrafia da parede abdominal com tela de polipropileno

Abstract

Introduction: Every year, millions of people around the world are submitted to abdominal wall herniorrhaphy surgery with a prosthesis implant. The recurrence rate and complications at a surgical site that are still unacceptable, despite the evolution in surgical techniques and, increasingly, in biocompatible materials’ manufacture. This fact, determines a significant morbidity / mortality and social impact, since a good part of the patients submitted to this type of procedure are in the functional working phase, in addition to increasing exponentially the healthcare cost. The prostheses represent a remarkable advance in the techniques of herniorrhaphy surgery. Therefore, despite the fact, the external biocompatible components may cause in tissue the inflammatory reaction, vary from exudative process to a granuloma reaction, adhesions formation, fistula formation, hernia recurrence, infection or rejection of the graft, until allergic / immunological hypersensitivity response. Numerous studies indicate that low level laser therapy (LLLT) has been described as an important instrument to reduce the inflammatory and edematous process, improves tissue repairing and provides analgesia. Objectives: To delineate and analyze the Photobiomodulation effects on tissue repair of surgical wound to abdominal wall herniorrhaphy. Methodology: A prospective, randomized, longitudinal, controlled clinical study were performed to 40 patients in both genders submitted to abdominal wall herniorrhaphy, randomly distributed in two groups: 20 patients from the Laser Group (GL) and 20 patients of the Placebo Group (GP). The GP patients received CW Diode Laser, GaA1As, with the following parameters: λ = 660 nm wavelength, P = 50 mW, E = 0,5 J/pto, application time/pto - 10 seconds, laser beam output area tip = 3mm2, Exp Rda: 17 J/cm2, PD: 1,7 W/cm2 and Fluence: 1 J/cm2 transoperatively, by applying it before fixation polypropylene Mesh and after hernia sac treatment, also closure the aponeurosis and after skin closure in a total of 3 sessions. In GP, LLLT were applied during the immediate postoperative period and on the 1st, 2nd postoperative day. In Placebo group (laser-off), patients were induced to believe that they received the same treatment as LG. In the preoperative period, blood samples (CPK and DHL) were collected from the patients as well as during postoperative (PO) post Lasertherapy. These biochemical markers above were collected from the interstitial infiltrate for analysis, in order to evaluate the edema, inflammatory process; there were also assessed through the presence or absence of phlogistic signs, such as: hyperemia, local temperature, burning sensation and seroma. The pain by visual analogue scale at the 7th and 14th PO were assessed. Epithelial healing was evaluated by means of photographs in the immediate postoperative period, 7th and 14th PO. Results: Photobiomodulation was demonstrated a hyperemia reduction, pain relief as well as reduction in the burning sensation on the surgical wound, while in the first and second weeks. The LLLT accelerated healing in the LG, besides a reduction in the amount of surgical wound secretion, contributing to decrease the infection at wound site. In the Laser Group, there was a diminution of CPK values in blood postoperatively as same as CPK dosage of interstitial wound infiltrate, thus indicating an anti-inflammatory response acceleration and suggesting that these inflammatory markers may guide the Laser treatment. In the DHL evaluation, the values were lower in the Laser group, signaling an improvement in muscle repair. Low level laser therapy facilitated wound repair due to a faster resolution of the acute inflammatory process. Conclusion: Photobiomodulation indicated that just three LLLT applications could reduce the edema, inflammation, burning sensation and secretion amount, then stimulating a 10 better cicatrization of surgical wounds and aiding in the postoperative analgesia process in abdominal wall herniorrhaphy surgery.