ABSTRACT
PURPOSE: Approximately 20 million individuals worldwide undergo inguinal hernia surgery annually. The Lichtenstein technique is the most commonly used surgical procedure in this setting. The objective of this study was to revisit this technique and present ten recommendations based on the best practices. METHODS: PubMed and Scientific Electronic Library Online were used to systematically search for articles about the Lichtenstein technique and its modifications. Literature regarding this technique and surgical strategies to prevent chronic pain were the basis for formulating ten recommendations for best practices during Lichtenstein surgery. RESULTS: Ten recommendations were proposed based on best practices in the Lichtenstein technique: neuroanatomical assessment, chronic pain prevention, pragmatic neurectomy, spermatic cord structure management, femoral canal assessment, hernia sac management, mesh characteristics, fixation, recurrence prevention, and surgical convalescence. CONCLUSION: The ten recommendations are practical ways to achieve a safe and successful procedure. We fell that following these recommendations can improve surgical outcomes using the Lichtenstein technique.
Subject(s)
Hernia, Inguinal , Herniorrhaphy , Surgical Mesh , Humans , Hernia, Inguinal/surgery , Herniorrhaphy/methods , Chronic Pain/prevention & control , Chronic Pain/etiology , Spermatic Cord/surgery , Treatment Outcome , RecurrenceABSTRACT
INTRODUCTION: Abdominal wall hernias encompass both ventral and incisional hernias, often poorly classified regarding complexity in general. This study aims to conduct a review on the primary topics related to defining the complexity of ventral hernias. METHODS: this is a scope review conducted following the guidelines recommended by the PRISMA-ScR directive. Searches were carried out in electronic databases including PubMed, LILACS, and EMBASE, using the descriptors: Abdominal Hernia, Hernia, Ventral Hernia, Incisional Hernia, Complex, Classification, Classify, Grade, Scale, and Definition. Combinations of these terms were employed when appropriate. Inclusion criteria encompassed articles with definitions and classifications of complex hernias, as well as those utilizing these classifications to guide treatments and patient allocation. Synonyms and related topics were also considered. Articles outside the scope or lacking the themes in their title or abstract were excluded. The database search was conducted up to July 29, 2023. RESULTS: several hernia classifications were identified as useful in predicting complexity. For this study, we considered six main criteria: size and location, loss of domain, use of abdominal wall relaxation techniques, characteristics of imaging exams, status of the subcutaneous cellular tissue, and likelihood of recurrence. CONCLUSION: complex abdominal wall hernias can be defined by characteristics analyzed collectively, relating to the patients previous clinical status, size and location of the hernia defect, status of subcutaneous cellular tissue, myofascial release techniques, and other complicating factors.
Subject(s)
Hernia, Ventral , Humans , Hernia, Ventral/classification , Hernia, Ventral/surgery , Hernia, Ventral/diagnosis , Incisional Hernia/surgery , Abdominal Wall , RecurrenceABSTRACT
ABSTRACT Introduction: Abdominal wall hernias encompass both ventral and incisional hernias, often poorly classified regarding complexity in general. This study aims to conduct a review on the primary topics related to defining the complexity of ventral hernias. Methods: this is a scope review conducted following the guidelines recommended by the PRISMA-ScR directive. Searches were carried out in electronic databases including PubMed, LILACS, and EMBASE, using the descriptors: Abdominal Hernia, Hernia, Ventral Hernia, Incisional Hernia, Complex, Classification, Classify, Grade, Scale, and Definition. Combinations of these terms were employed when appropriate. Inclusion criteria encompassed articles with definitions and classifications of complex hernias, as well as those utilizing these classifications to guide treatments and patient allocation. Synonyms and related topics were also considered. Articles outside the scope or lacking the themes in their title or abstract were excluded. The database search was conducted up to July 29, 2023. Results: several hernia classifications were identified as useful in predicting complexity. For this study, we considered six main criteria: size and location, loss of domain, use of abdominal wall relaxation techniques, characteristics of imaging exams, status of the subcutaneous cellular tissue, and likelihood of recurrence. Conclusion: complex abdominal wall hernias can be defined by characteristics analyzed collectively, relating to the patients previous clinical status, size and location of the hernia defect, status of subcutaneous cellular tissue, myofascial release techniques, and other complicating factors.
RESUMO Introdução: As hérnias da parede abdominal, englobam em seu conceito as hérnias ventrais e incisionais. Essas hérnias são mal classificadas quanto à complexidade de forma geral. Esse estudo tem por objetivo realizar uma revisão sobre os principais tópicos relacionados à definição de complexidade das hérnias ventrais. Métodos: trata-se de revisão de escopo realizada com as orientações preconizadas pela diretriz PRISMA-ScR. Foram realizadas buscas nas bases de dados eletrônicas do PubMed, LILACS e EMBASE, empregando os descritores: "Abdominal Hernia"; Hernia; "Ventral Hernia"; "Incisional Hernia"; Complex; Classification, Classify, Grade, Scale e definition. Combinações entre os termos foram utilizadas quando oportunas. Os critérios de inclusão abrangiam artigos com definições e classificações de hérnias complexas, além daqueles que usavam essas classificações para orientar tratamentos e alocação de pacientes. Sinônimos e tópicos relacionados também foram considerados. Artigos fora do escopo ou sem os temas no título ou resumo foram excluídos. A busca nas bases de dados foi realizada até o dia 29/07/2023. Resultados: diversas classificações de hérnias foram identificadas como sendo úteis para prever complexidade. Consideramos para esse estudo seis critérios principais: tamanho e localização, perda de domicílio, uso de técnicas de relaxamento da parede abdominal, características dos exames de imagem, status do tecido celular subcutâneo e chance de recorrência. Conclusão: as hérnias complexas da parede abdominal podem ser definidas por características analisadas conjuntamente e que estão relacionadas ao estado clínico prévio do paciente, tamanho e localização do defeito herniário, status do tecido celular subcutâneo, técnicas de liberação miofascial e outros fatores complicadores..
ABSTRACT
INTRODUCTION: it is estimated that approximately 20 million people undergo inguinal hernia surgery annually in the world, with the Lichtenstein technique being the most performed surgical procedure. The objective of this study is to analyze the knowledge of the technical principles used in the Lichtenstein technique. METHOD: Survey-type intersectional study approved by the research ethics committee of São Camilo University Center (CAAE: 70036523.1.0000.0062). During the research period, 11,622 e-mails were sent to members of the main national surgical societies with research on the technical principles of Lichtenstein surgery. The survey was carried out using an electronic form with 10 multiple-choice questions. The form was answered anonymously on the SurveyMonkey and Google Forms platforms. RESULT: 744 responses were received to the electronic form. Based on this number of respondents, our survey has a confidence level of 95% with a margin of error of 3.5%. It was observed that there is no standardization of the technique among the majority of responders (53.4%). Many surgeons still perform digital dissection of the spermatic cord (47%). A small number of interviewees (15.2%) performed sutures with absorbable thread in the region of the internal oblique aponeurosis, while more than half (55.2%) continued to perform sutures with non-absorbable thread. Most surgeons use a small overlap or fix the mesh juxtaposed to the pubic symphysis (51%). CONCLUSION: Our research identified that a small percentage of respondents adequately know the technical principles of Lichtenstein surgery. The result brings us new insights into the need to review Lichtenstein technique.
Subject(s)
Hernia, Inguinal , Humans , Male , Dissection , Groin/surgery , Hernia, Inguinal/surgery , Herniorrhaphy/methods , Recurrence , Surgical MeshABSTRACT
ABSTRACT Introduction: it is estimated that approximately 20 million people undergo inguinal hernia surgery annually in the world, with the Lichtenstein technique being the most performed surgical procedure. The objective of this study is to analyze the knowledge of the technical principles used in the Lichtenstein technique. Method: Survey-type intersectional study approved by the research ethics committee of São Camilo University Center (CAAE: 70036523.1.0000.0062). During the research period, 11,622 e-mails were sent to members of the main national surgical societies with research on the technical principles of Lichtenstein surgery. The survey was carried out using an electronic form with 10 multiple-choice questions. The form was answered anonymously on the SurveyMonkey and Google Forms platforms. Result: 744 responses were received to the electronic form. Based on this number of respondents, our survey has a confidence level of 95% with a margin of error of 3.5%. It was observed that there is no standardization of the technique among the majority of responders (53.4%). Many surgeons still perform digital dissection of the spermatic cord (47%). A small number of interviewees (15.2%) performed sutures with absorbable thread in the region of the internal oblique aponeurosis, while more than half (55.2%) continued to perform sutures with non-absorbable thread. Most surgeons use a small overlap or fix the mesh juxtaposed to the pubic symphysis (51%). Conclusion: Our research identified that a small percentage of respondents adequately know the technical principles of Lichtenstein surgery. The result brings us new insights into the need to review Lichtenstein technique.
RESUMO Introdução: estima-se que aproximadamente 20 milhões de pessoas sejam submetidas a cirurgia de hérnia inguinal anualmente no mundo, sendo a técnica de Lichtenstein o procedimento cirúrgico mais realizado. O objetivo desse estudo é analisar o conhecimento dos principios técnicos empregados na técnica de Lichtenstein. Método: estudo tipo levantamento interseccional aprovado pelo comitê de ética em pesquisa do Centro Universitário São Camilo (CAAE: 70036523.1.0000.0062). Durante o período da pesquisa foram encaminhados 11.622 e-mails aos membros das principais sociedades cirúrgicas nacionais com uma pesquisa sobre os princípios técnicos da cirurgia de Lichtenstein. A pesquisa foi realizada por formulário eletrônico com 10 questões de múltipla escolha. O formulário foi respondido de forma anônima nas plataformas SurveyMonkey e Google Forms. Resultado: foram recebidos 744 respostas ao formulário eletrônico. Com base nesse número de respondedores, nossa pesquisa apresenta grau de confiança de 95% com margem de erro de 3,5%. Foi observado que não há padronização da técnica entre a maioria dos respondedores (53.4%). Muitos cirurgiões ainda fazem dissecção digital do funículo espermático (47%). Um pequeno número de entrevistados (15,2%) realizam sutura com fio absorvível na região da aponeurose do obliquo interno, enquanto, mais da metade (55,2%) continua fazendo sutura com fio inabsorvível. A maior parte dos cirurgiões utilizam overlap pequeno ou fixam a tela justaposta a sínfise púbica (51%). Conclusão: nossa pesquisa identificou que uma porcentagem pequena dos entrevistados conhecem adequadamente os princípios técnicos da cirurgia de Lichtenstein. O resultado nos traz novas percepções sob a necessidade de revistar a consagrada técnica de Lichtenstein.
ABSTRACT
Clostridium difficile infection is a common complication following intestinal dysbiosis caused by abusive antibiotic use. It presents medical importance due to the high rates of recurrence and morbidity. Fecal microbiota transplantation is an effective alternative for the treatment of recurrent and refractory C. difficile infection and consists of introducing the intestinal microbiota from a healthy donor into a patient with this infection. The exact physiological mechanism by which fecal microbiota transplantation alters the intestinal microbiota is not well established, but it is clear that it restores the diversity and structure of the microbiota by promoting increased resistance to colonization by C. difficile. Several routes of transplant administration are being studied and used according to the advantages presented. All forms of application had a high cure rate, and the colonoscopic route was the most used. No relevant complications and adverse events have been documented, and the cost-effectiveness over conventional treatment has proven advantageous. Despite its efficacy, it is not commonly used as initial therapy, and more studies are needed to establish this therapy as the first option in case of refractory and recurrent Clostridium difficileinfection.
Subject(s)
Clostridioides difficile , Enterocolitis, Pseudomembranous/therapy , Fecal Microbiota Transplantation , HumansABSTRACT
ABSTRACT Clostridium difficile infection is a common complication following intestinal dysbiosis caused by abusive antibiotic use. It presents medical importance due to the high rates of recurrence and morbidity. Fecal microbiota transplantation is an effective alternative for the treatment of recurrent and refractory C. difficile infection and consists of introducing the intestinal microbiota from a healthy donor into a patient with this infection. The exact physiological mechanism by which fecal microbiota transplantation alters the intestinal microbiota is not well established, but it is clear that it restores the diversity and structure of the microbiota by promoting increased resistance to colonization by C. difficile. Several routes of transplant administration are being studied and used according to the advantages presented. All forms of application had a high cure rate, and the colonoscopic route was the most used. No relevant complications and adverse events have been documented, and the cost-effectiveness over conventional treatment has proven advantageous. Despite its efficacy, it is not commonly used as initial therapy, and more studies are needed to establish this therapy as the first option in case of refractory and recurrent Clostridium difficileinfection.
RESUMO A infecção por Clostridium difficile é uma complicação comum após a disbiose intestinal ocasionada pelo uso abusivo de antibióticos. Apresenta elevada importância médica devido às altas taxas de recorrência e morbidade. O transplante de microbiota fecal é uma alternativa eficaz para o tratamento da infecção recorrente e refratária pelo C. difficile e consiste na introdução da microbiota intestinal de um doador saudável em um paciente portador desta infecção. O mecanismo fisiológico exato pelo qual o transplante de microbiota fecal altera a microbiota intestinal não está tão bem estabelecido, mas é evidente que restaura a diversidade e a estrutura da microbiota promovendo aumento da resistência à colonização pelo C.difficile. Diversas vias de administração do transplante estão sendo estudadas e utilizadas de acordo com as vantagens apresentadas. Todas as formas de aplicação apresentaram elevada taxa de cura, sendo a via colonoscópica a mais utilizada. Não foram documentados complicações e efeitos adversos relevantes, e seu custo benefício em relação ao tratamento convencional se mostrou vantajoso. Apesar da sua eficácia é pouco utilizado como terapia inicial, sendo necessários mais estudos para firmar essa terapêutica como primeira opção no caso de infecção por Clostridium difficile refratária e recorrente.