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3.
Ann R Coll Surg Engl ; 102(2): 75-83, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31696731

RESUMO

INTRODUCTION: Gynaecological structures such as the ovaries, fallopian tubes, ligaments and uterus are rarely encountered inside a hernial sac. The prevalence of groin hernias containing parts of female genitalia remains unknown. The aim of this review was to summarise the existing evidence on inguinal hernias containing ovaries with or without the other female adnexa. METHODS: A systematic search was conducted for literature published up to February 2018 using the MEDLINE®, Scopus® and Google Scholar™ databases along with the references of the full-text articles retrieved. Papers on observational studies and case reports concerning women who were diagnosed with an ovarian inguinal hernia (pre or intraoperatively) were considered eligible for inclusion in the review. RESULTS: Fifteen papers (13 case reports, 2 case series) comprising seventeen patients (mean age 47.9 years) were evaluated. A left-sided hernia was noted in 13 cases (77%) whereas 4 patients had a right-sided hernia. Eight patients underwent preoperative imaging with computed tomography, ultrasonography or both. This was diagnostic in five cases. In 11 patients, hernia contents were repositioned, 2 had a salpingo-oophorectomy and 2 an oophorectomy. Eight patients underwent hernia repair with mesh placement while three had a herniorrhaphy. CONCLUSIONS: Ovarian inguinal hernias should be considered among the differential diagnoses of a groin mass or swelling. In women of reproductive age, repair of the hernia with the intent to preserve fertility is of critical importance.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Doenças Ovarianas/cirurgia , Ovariectomia , Salpingo-Ooforectomia , Feminino , Hérnia Inguinal/diagnóstico , Hérnia Inguinal/epidemiologia , Herniorrafia/instrumentação , Humanos , Canal Inguinal/diagnóstico por imagem , Canal Inguinal/cirurgia , Doenças Ovarianas/diagnóstico , Doenças Ovarianas/epidemiologia , Ovário/diagnóstico por imagem , Ovário/cirurgia , Prevalência , Telas Cirúrgicas , Tomografia Computadorizada por Raios X , Ultrassonografia
4.
Hinyokika Kiyo ; 65(9): 389-392, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31697883

RESUMO

A 53-year-old man visited a doctor due to left inguinal enlargement. He was diagnosed with left inguinal hernia with omentum as the content by a computed tomography (CT)scan. He underwent open inguinal hernia repair ; however, an inguinal tumor was diagnosed intraoperatively and was resected as much as possible. Although the tumor resection was macroscopically incomplete, he was followed up without any treatment because the tumor was histologically diagnosed as lipoma. Sixteen months after surgery, a 15 cm inguinal mass and a 7 cm left intrascrotal mass were detected by follow-up CT, and he was referred to our hospital. He underwent open surgery for wide excision of the tumor with a diagnosis of spermatic cord liposarcoma and left hydrocele of testis. The spermatic cord tumor was histologically diagnosed as well differentiated liposarcoma. He has been alive without recurrence for more than 10 months after surgery. It is sometimes difficult to distinguish a spermatic cord liposarcoma from inguinal hernia by imaging examinations.


Assuntos
Neoplasias dos Genitais Masculinos , Hérnia Inguinal , Lipossarcoma , Cordão Espermático , Hidrocele Testicular , Diagnóstico Diferencial , Neoplasias dos Genitais Masculinos/diagnóstico , Hérnia Inguinal/diagnóstico , Humanos , Lipossarcoma/diagnóstico , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
5.
Niger J Clin Pract ; 22(10): 1457-1458, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31607739

RESUMO

Among various reasons of swellings in the female inguinal region nuck canal cysts are rare entities. Abnormal persistence of procesus vaginalis opening cause this formation. Presentation at adults can lead misdiagnosis. Inguinal hernia, tumors (benign or malign), cysts, lymphadenopathies and endometriosis are other common reason for female groin swelling. Once diagnosed surgical excision is definitive treatment.


Assuntos
Cistos/diagnóstico por imagem , Edema/etiologia , Hérnia Inguinal/cirurgia , Canal Inguinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Cistos/cirurgia , Erros de Diagnóstico , Feminino , Hérnia Inguinal/diagnóstico , Humanos , Canal Inguinal/cirurgia , Resultado do Tratamento , Ultrassonografia
6.
Rev Col Bras Cir ; 46(4): e20192226, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31576988

RESUMO

Inguinal hernias are a frequent problem and their repair is the most commonly performed procedure by general surgeons. In the last years, new principles, products and techniques have changed the routine of surgeons, who need to recycle knowledge and perfect new skills. In addition, old concepts regarding surgical indication and risk of complications have been reevaluated. In order to create a guideline for the management of inguinal hernias in adult patients, the Brazilian Hernia Society assembled a group of experts to review various topics, such as surgical indication, perioperative management, surgical techniques, complications and postoperative guidance.


Assuntos
Hérnia Inguinal , Herniorrafia/normas , Brasil , Feminino , Hérnia Inguinal/diagnóstico , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Humanos , Masculino , Complicações Pós-Operatórias , Telas Cirúrgicas
7.
J Laparoendosc Adv Surg Tech A ; 29(10): 1349-1351, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31483186

RESUMO

Introduction: The diagnosis of indirect inguinal hernia is usually based on clinical grounds. Physical examination generally showed an inguinal bulge. However, when no bulge is seen, the silk glove sign (SGS) or palpating the processus vaginalis over the pubic tubercle can be useful. The aim of our study is to compare the accuracy of the presence of inguinal bulge with the presence of SGS. Materials and Methods: We conducted a retrospective of all patients undergoing laparoscopic inguinal hernia repair between January 2002 and November 2015. Preoperative diagnosis was obtained by physical examination. The presence of an inguinal bulge or SGS was considered diagnostic of indirect inguinal hernia. Intraoperative diagnosis was made to laparoscopic findings. The sample was divided into two groups: group 1 including the patient with inguinal bulge and group 2 including those with SGS. Results: A total of 1024 inguinal canals were evaluated. Inguinal bulge was observed in 379 inguinal canals (group 1), whereas SGS was detected in 196 (group 2). There were statistically significant differences between both groups regarding gestational age, birth weight, surgical age, and surgical weight. Prematurity and previous episodes of incarceration were statistically more common in group 1 (P < .001). The positive predictive value in group 1 was 98.7%, whereas in group 2 was 86.73% (P < .001). Conclusions: Although we have found that the success rate for accurate diagnosis is higher in patients with inguinal bulge, SGS can be useful in detecting indirect inguinal hernia.


Assuntos
Hérnia Inguinal/diagnóstico , Canal Inguinal/patologia , Exame Físico/métodos , Criança , Pré-Escolar , Feminino , Hérnia Inguinal/patologia , Humanos , Laparoscopia , Masculino , Estudos Retrospectivos
8.
BMJ Case Rep ; 12(8)2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31473637

RESUMO

Gallstone ileus and small bowel diverticulosis are uncommon pathologies. However, the simultaneous presentation of both in this patient provided a diagnostic puzzle for the surgical and radiological teams at our institution. The imaging also demonstrated several typical features for the pathologies in question. Ultimately the management of the patient was not compromised by the diagnostic dilemma, but the imaging findings represent a useful learning opportunity for all radiologists and general surgeons.


Assuntos
Dor Abdominal/diagnóstico , Cálculos Biliares/diagnóstico , Hérnia Inguinal/diagnóstico , Íleus/diagnóstico , Enteropatias/diagnóstico , Dor Abdominal/etiologia , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Enfisema/complicações , Enfisema/diagnóstico , Cálculos Biliares/complicações , Hérnia Inguinal/complicações , Humanos , Íleus/complicações , Enteropatias/complicações , Masculino
9.
BMJ Case Rep ; 12(9)2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31540925

RESUMO

A 33-year-old postpartum patient, who had an uncomplicated repeat caesarean section 4 weeks prior, presented with a 2-day history of acute right lower quadrant, incisional and groin pain. She was found to have a palpable tender lump in the right groin. A CT scan with contrast identified fluid along the anterior abdominal wall of the right lower quadrant (inguinal region) measuring about 1.7 cm, a preliminary diagnosis of an incarcerated inguinal hernia was made and the patient underwent immediate surgery. The hernia sac was dissected free and had chocolate cyst that was confirmed to be endometrioma on histopathology. The hernia defect was repaired. Postoperative, the patient did well and was discharged home. We emphasise to consider this differential diagnosis of extrapelvic inguinal endometrioma in reproductive-aged women with or without history of endometriosis especially in a post-caesarean patient who has atypical presentations.


Assuntos
Parede Abdominal/patologia , Cesárea/efeitos adversos , Endometriose/patologia , Hérnia Inguinal/diagnóstico , Herniorrafia , Dor Abdominal , Parede Abdominal/cirurgia , Adulto , Diagnóstico Diferencial , Endometriose/cirurgia , Feminino , Hérnia Inguinal/patologia , Hérnia Inguinal/cirurgia , Humanos , Período Pós-Parto , Resultado do Tratamento
10.
Surgery ; 166(4): 607-614, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31375319

RESUMO

BACKGROUND: For many surgeons, a prior prostatectomy is considered a contraindication to laparoscopic totally extraperitoneal hernia repair. This study aims to evaluate the safety, efficacy, and efficiency of totally extraperitoneal in these patients. METHODS: This is a review of a prospectively collected hernia database evaluating patients who underwent totally extraperitoneal repair between October 2009 and March 2018. Patients with prior prostatectomy were matched to controls without prior prostatectomy. Secondary analysis compared the case group to patients who underwent open hernia repair. RESULTS: In the study, 1,751 patients underwent laparoscopic totally extraperitoneal repair. Thirty patients with a prior prostatectomy were matched to 90 controls. Operative duration was greater in the prostatectomy group (56 vs 36 minutes, P < .0001) and more peritoneal tears occurred (40% vs 12%, P = .002). Duration of stay, return to activity, complications, and rates of recurrence and chronic pain were equivalent. When compared with prior prostatectomy patients who underwent open hernia repair, the laparoscopic totally extraperitoneal group had equivalent rates of complications and outcomes with a faster return to activities of daily living (3 vs 7 days P = .007). CONCLUSION: Despite a more difficult dissection, laparoscopic totally extraperitoneal repair in patients with prior prostatectomy is safe, efficacious, and efficient. In addition, totally extraperitoneal offers similar outcomes to open repair with a quicker recovery in this patient population.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Segurança do Paciente , Prostatectomia/métodos , Adulto , Idoso , Estudos de Coortes , Bases de Dados Factuais , Hérnia Inguinal/diagnóstico , Humanos , Laparotomia/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco
11.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451459

RESUMO

We reported a case of right inguinal endometriosis in a 41-year-old woman with unremarkable surgical and gynaecological history. She presented with right groin swelling for a month since her last menstrual period. Clinically the swelling was first diagnosed as inguinal hernia and later histologically proven to be endometriosis.


Assuntos
Doenças dos Anexos , Endometriose , Virilha/patologia , Hérnia Inguinal/diagnóstico , Doenças dos Anexos/diagnóstico , Doenças dos Anexos/patologia , Adulto , Diagnóstico Diferencial , Endometriose/diagnóstico , Endometriose/patologia , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Ligamento Redondo do Útero/patologia
12.
Rev. cuba. cir ; 58(2): e774, mar.-jun. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1093164

RESUMO

RESUMEN Introducción: Es necesario conocer la historia de la cirugía, en general, y de la herniología, en particular, para poder comprender mejor los enormes avances experimentados en esas disciplinas. Muchas de las técnicas quirúrgicas modernas están basadas en los conocimientos y experiencias aportados por los primeros cirujanos, pero no fue hasta la divulgación de la obra del francés Eduardo Bassini, en 1889, que comenzó el impetuoso desarrollo de la cirugía de la hernia inguinal a escala mundial. Entre las más notables reparaciones de hernia inguinal, además de la de Bassini, se citan las de McVay, Halsted, Shouldice y la hernioplastia libre de tensión, popularizada por Lichtenstein. Objetivo: Profundizar en los aspectos cognoscitivos relacionados con los fundamentos históricos del diagnóstico y tratamiento de la hernia inguinal, su evolución y aplicación en la cirugía actual. Método: Revisión bibliográfica digital de publicaciones actualizadas en las bases de datos SciELO, Latindex, Elsevier, PubMed, Medline y Web of Science y Google Académico. Conclusiones: La cirugía de las hernias en general, y de las inguinales, en particular, nunca es rutina; debe ser individualizada a las características de cada enfermo y a los recursos disponibles. El futuro de la cirugía herniaria solo puede entenderse ligado al conocimiento de sus fundamentos históricos, del profundo dominio de la anatomía topográfica y de una esmerada técnica quirúrgica(AU)


ABSTRACT Introduction: It is necessary to know the history of surgery, in general, and herniology, in particular, in order to understand better the enormous advances experienced in these disciplines. Many of the modern surgical techniques are based on the knowledge and experiences contributed by the first surgeons, but it was not until the disclosure of the work of the French Eduardo Bassini, in 1889, that the impetuous development of inguinal hernia surgery began to scale worldwide. Among the most notable inguinal hernia repairs, in addition to that of Bassini, are those of McVay, Halsted, Shouldice and tension-free hernioplasty, popularized by Lichtenstein. Objective: To deepen the cognitive aspects related to the historical foundations of the diagnosis and treatment of inguinal hernia, its evolution and application in current surgery. Method: Digital bibliographic review of publications updated in the databases SciELO, Latindex, Elsevier, PubMed, Medline and Web of Science and Google Scholar. Conclusions: Surgery for hernias in general, and particularly for inguinal hernias is never routine. They must be individualized to the characteristics of each patient and the resources available. The future of hernia surgery can only be understood if it is associated with the knowledge of its historical foundations, the deep mastery of topographic anatomy and a careful surgical technique(AU)


Assuntos
Humanos , Herniorrafia/história , Hérnia Inguinal/diagnóstico , Hérnia Inguinal/terapia , Literatura de Revisão como Assunto , Bases de Dados Bibliográficas/tendências
13.
Surg Laparosc Endosc Percutan Tech ; 29(4): 247-251, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31135709

RESUMO

INTRODUCTION: There are 2 standard techniques of laparoscopic groin hernia repair, totally extraperitoneal repair (TEP) and transabdominal preperitoneal repair (TAPP). TEP has the advantage that the peritoneal cavity is not breached but is, however, considered to be more difficult to master when compared with TAPP. We describe herein our experience of TEP repair of inguinal hernia over the last 14 years. MATERIALS AND METHODS: This study is a retrospective analysis of a prospectively maintained database of all patients with groin hernia who underwent TEP repair in a single surgical unit between January 2004 and January 2018. Patients' demographic profile and hernia characteristics (duration, side, extent, content, and reducibility) were noted in the prestructured proforma. Clinical outcomes included the operation time, intraoperative and postoperative complications, length of postoperative hospital stay, hernia recurrence, chronic pain, recurrence, seroma, and wound infections. Long-term follow-up was carried out in the outpatient department. RESULTS: Over the last 14 years, TEP repair was performed in 841 patients and a total of 1249 hernias were repaired. The mean age of patients was 50.7 years. There were 748 primary and 345 unilateral hernias. The majority were direct (61%) inguinal hernias. Telescopic dissection was the commonest method of space creation. The average operating time was 54.8 and 77.9 minutes for unilateral and bilateral hernias, respectively. With 81 conversions, the success rate for TEP was 93.5%. Seroma was the most common postoperative complication seen in 81 patients. The incidence of chronic groin pain was 1.4%. The follow-up ranged from 3 months to 10 years, and there were only 3 recurrences (<1%). CONCLUSION: In conclusion, TEP repair is an excellent technique of laparoscopic inguinal hernia repair with acceptable complications after long-term follow-up.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Dor Pós-Operatória/fisiopatologia , Peritônio/cirurgia , Telas Cirúrgicas , Adulto , Bases de Dados Factuais , Feminino , Seguimentos , Hérnia Inguinal/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Estudos Retrospectivos , Medição de Risco , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
14.
Rev. cir. (Impr.) ; 71(2): 157-161, abr. 2019. ilus
Artigo em Espanhol | LILACS | ID: biblio-1058249

RESUMO

INTRODUCCIÓN: Los tumores paratesticulares representan del 7%-10% de las masas intraescrotales. Los sarcomas abarcan el 90% de las lesiones malignas del cordón espermático y de éstas, aproximadamente, el 3%-7% son liposarcomas. CASO CLÍNICO: Presentamos el caso de un varón de 45 años, que consultó en urgencias por una masa inguinoescrotal derecha no reductible, diagnosticándose de hernia inguinal incarcerada. Se realizó cirugía urgente evidenciando una gran tumoración de aspecto lipomatoso, dependiente de cordón espermático. Se realizó orquiectomía y hernioplastía inguinal. La anatomía patológica, reveló un liposarcoma bien diferenciado de cordón espermático. Posteriormente, se realizó estudio de extensión, sin afectación a distancia y no precisó tratamiento adyuvante. Actualmente, tras dos años de seguimiento no ha presentado recidiva. DISCUSIÓN: Sólo alrededor de 200 casos han sido comunicados previamente en la literatura y sólo 61 de éstos se presentaron simulando una hernia inguinal incarcerada. Debido a la baja incidencia de esta patología es difícil de conocer la historia natural y llegar a conclusiones sobre los resultados del tratamiento, el cual hasta el momento sigue siendo la orquiectomía radical, con escisión amplia de los tejidos locales. El papel de la radio y quimioterapia aun es controvertido. CONCLUSIONES: Los sarcomas del cordón espermático son neoplasias raras con alta tasa de recurrencia local. Su manejo inicial es quirúrgico. Se requiere de un alto índice de sospecha clínica para el diagnóstico ya que las implicaciones oncológicas varían en función del tratamiento que, en ocasiones, es llevado a cabo por cirujanos generales al simular una hernia inguinal.


INTRODUCTION: Paratesticular tumors represent 7%-10% of intraescrotal masses. Sarcomas account for 90% of malignant lesions of the spermatic cord and of these approximately 3%-7% are liposarcomas. CLINICAL CASE: This is the case of a 45 year old male who consulted in the emergency department for a non-reducible right inguino-scrotal mass and was diagnosed with an incarcerated inguinal hernia. Emergency surgery was performed which revealed a large lipomatous tumor, originating from the spermatic cord. Orchiectomy and hernioplasty were performed. Histopathology revealed a well-differentiated liposarcoma of the spermatic cord. Later extension study was conducted, without distant affectation, and did not require adjuvant treatment. Today, after two years of monitoring has been no recurrence. DISCUSSION: Only about 200 cases have been previously reported in the literature and only 61 of these were presented mimicking an incarcerated inguinal hernia. Due to the low incidence of this disease it is difficult to know the natural history and draw conclusions on the results of treatment, which so far remains the radical orchiectomy with wide local excision of the tissue. The role of radiotherapy and chemotherapy is still controversial


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Testiculares/cirurgia , Lipossarcoma/cirurgia , Cordão Espermático , Cordão Espermático/patologia , Neoplasias Testiculares/diagnóstico , Orquiectomia/métodos , Tomografia Computadorizada por Raios X , Diagnóstico Diferencial , Hérnia Inguinal/cirurgia , Hérnia Inguinal/diagnóstico , Lipossarcoma/diagnóstico
17.
Am Surg ; 85(2): 196-200, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30819298

RESUMO

The aim of this study was to evaluate the utility of immediate repair of a contralateral occult hernia at the same time as incipient hernia repair. A total of 693 patients were diagnosed preoperatively with a unilateral groin hernia from January 2006 to December 2017. The open technique was used for 541 patients, and the laparo-endoscopic technique was used for 152 patients. The incidences of occult contralateral hernia confirmed during surgery under laparo-endoscopic techniques and those of contralateral metachronous hernia after a unilateral groin hernia repair with open technique were compared. Fifty-one (9.4%) of 541 patients underwent a contralateral metachronous hernia repair after unilateral groin hernia repair. Twenty-three (15.1%) of 152 patients had occult contralateral hernias using laparo-endoscopic techniques. There was a significant difference in the incidence of contralateral metachronous hernia and that of occult contralateral hernia (P = 0.02). It is concluded that finding and repairing an occult contralateral hernia at the time of laparo-endoscopic technique has the advantage of avoiding a second operation. However, it has been considered overtreatment to repair all patients with an occult contralateral hernia.


Assuntos
Hérnia Inguinal/epidemiologia , Hérnia Inguinal/cirurgia , Herniorrafia , Laparoscopia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Hérnia Inguinal/diagnóstico , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
19.
Reg Anesth Pain Med ; 44(2): 228-233, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30700617

RESUMO

BACKGROUND AND OBJECTIVES: The major concern after inguinal hernioplasty is chronic postsurgical pain and impaired quality of life due to central sensitization. Preoperative, intraoperative, and postoperative pre-emptive analgesia using regional techniques may help prevent the development of central sensitization. This study evaluated the effect of regional anesthesia followed by continuous regional analgesia on postoperative pain and functional outcome following inguinal hernioplasty. METHODS: Seventy-two consecutive patients scheduled to undergo open mesh inguinal hernioplasty were randomly allocated to one of three groups: subarachnoid block alone (group SAB), general anesthesia alone (group GA), or subarachnoid block combined with a continuous transverse abdominis plane block (group TAP). Pain and functional outcome was assessed before and 6 months following the surgery using the Core Outcome Measures Index score adapted for patients with hernia (COMI-hernia). During the first 72 hours postoperatively, pain was assessed at rest and during five different activities using the numerical rating scale. RESULTS: Six months following the surgery, the COMI-hernia score was lower in group TAP than in group GA or group SAB (0.54±0.41 vs 0.88±0.43 and 1.00±0.54, respectively; p<0.02). Pain at rest (p<0.02) and during activities (p<0.001) was lowest in group TAP during the first 72 hours postoperatively. CONCLUSIONS: A subarachnoid block combined with continuous postoperative analgesia via a transverse abdominis plane catheter provided better pain control and functional outcome 6 months following inguinal hernioplasty as well as better postoperative analgesia. CLINICAL TRIAL REGISTRATION: CTRI/2016/09/007238.


Assuntos
Cateteres de Demora , Dor Crônica/prevenção & controle , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Músculos Abdominais/inervação , Adulto , Cateteres de Demora/tendências , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Feminino , Hérnia Inguinal/diagnóstico , Herniorrafia/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/tendências , Manejo da Dor/métodos , Manejo da Dor/tendências , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Recuperação de Função Fisiológica/fisiologia , Método Simples-Cego , Espaço Subaracnóideo , Resultado do Tratamento
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