ABSTRACT
BACKGROUND: Umbilical and epigastric hernias are among the most common hernias of the abdominal wall; however, there is a lack of standardization for their treatment. AIMS: To clarify the controversies regarding therapeutic possibilities, indications, and surgical techniques for umbilical and epigastric hernia repair. METHODS: A systematic review and qualitative analysis of randomized clinical trials published in the last 20 years, involving adults (aged 18 years and over) with umbilical and/or epigastric hernias, was performed by systematically searching the PubMed/Medline, Cochrane, SciELO, and LILACS databases. The risk of bias in individual studies was assessed using the Cochrane Risk of Bias Tool. RESULTS: Initially, 492 studies were selected and, subsequently, 15 randomized controlled clinical trials were chosen that met the inclusion criteria and underwent full reading and qualitative analysis, considering possible bias. CONCLUSIONS: This review concluded that it is evident the superiority of the use of meshes in the repair of epigastric/primary umbilical hernias with a defect larger than 1 cm, even in certain emergency situations. However, suture repair is a good option for patients with a defect smaller than 1 cm. In the laparoscopic approach, recent evidence points towards possible superiority in fixation with fibrin sealant, and fascial defect closure is recommended. In addition, due to a scarcity of randomized controlled trials with low risk of bias, further studies are needed on types, positioning and fixation techniques, as well as the real role of video-assisted laparoscopic surgery in the correction of hernias, especially umbilical.
Subject(s)
Hernia, Umbilical , Herniorrhaphy , Humans , Herniorrhaphy/methods , Hernia, Umbilical/surgery , Randomized Controlled Trials as Topic , Surgical Mesh , Hernia, Abdominal/surgeryABSTRACT
A epilepsia é uma doença heterogênea com alto impacto global, principalmente dentre aquelas pessoas com pobre controle clínico. Um de seus espectros é a esclerose mesial temporal, um tipo de epilepsia do lobo temporal cuja etiologia é estrutural e se caracteriza por lesões hipocampais uni ou bilaterais. Esta é a causa mais comum de epilepsia do lobo temporal farmacorresistente. Em cerca de 2/3 dos casos, ela é relacionada a um nível insatisfatório de controle clínico mediante medidas farmacológicas. Contudo, existe uma opção terapêutica adequada para o controle de crises nesta patologia, a intervenção cirúrgica. O presente trabalho trata-se de um estudo descritivo observacional transversal o qual visa analisar a prevalência da esclerose mesial temporal e o perfil epidemiológico dos pacientes acompanhados no ambulatório de referência do Hospital Universitário Professor Polydoro Ernani de São Thiago. Mais de 80% destes possuem epilepsia resistente a medicamentos, porém apenas 22% deles foram submetidos à cirurgia. Além disso, os pacientes apresentaram um convívio médio de 34 anos com a doença. Diante disso, propõe-se uma discussão acerca dos motivos da baixa disponibilidade da terapia cirúrgica para esclerose mesial temporal e o impacto dessa condição em nossa realidade.
Epilepsy is a heterogeneous disease with a high impact, mainly among those patients who have poorly controlled seizures. The most common cause of pharmacoresistant epilepsy is mesial temporal lobe epilepsy associated with uni or bilateral hippocampal sclerosis. Approximately 60% of the cases, it is related to unsatisfactory clinical control through pharmacological measuresis refractory to pharmacological treatment. However, there is an effective and safe therapeutic option, although still heavily underutilized, which is surgical therapy. This is a cross-sectional observational study, which aimed to analyze the prevalence of mesial temporal sclerosis and the epidemiological profile of these patients at the outpatient clinic of Hospital Universitário Professor Polydoro Ernani de São Thiago. Among the participants, more than 80% of those were considered drug resistant epilepsy, however, only 22% of them were submitted to surgery. Additionally, the patients had an average of 34 year of disease duration. In light of this, we discussed the main reasons for this surgical gap for mesial temporal sclerosis, and the impact of this persistent underutilization of surgical therapy in Brazil.