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HÉRNIA INGUINAL
Aspectos Fundamentais do Tratamento Laparoscópico
Prof. Dr. Ozimo Gama
Cirurgia do Aparelho Digestivo
2014
Hérnia Abdominal
 É uma protrusão
de um órgão ou
uma víscera
através de um
orifício ou defeito
(congênito ou
adquirido) n...
Indicação Cirúrgica
Coelho JC et al., 2014.
• Sintomáticos – ASA
• História Natural
• 2 complicações / 1000 casos / ano
• ...
Cuidados Perioperatórios
Cavazzoli L, 2014.
 Avaliação Pré-Operatória
 Antibioticoprofilaxia
 Baixo Risco : 2,7%
 Alto...
Recidiva : Fatores de risco
• história familiar positiva
• idade >50 anos
• tabagismo
• hérnia recidivada
Junge K et al. R...
Técnica Cirúrgica
 Reparo tecidual
 Livre de Tensão
 Anteriores
 Posteriores
Hérnias Abdominais
Técnica Cirúrgica
Laparoscópica
 Transabdominal Pré-peritoneal (TAPP)
 Transabdominal com tela Intraperitoneal (IPOM)
 ...
Técnica Cirúrgica
Rosen M, 2014.
 Seleção da Técnica
 150 procedimentos
 Co-morbidades / Cirurgias
 Riscos de Complica...
CURRENT SURGICAL APPROACHES
0
5
10
15
20
25
30
35
40
Lichtenstein PHS / Plug Shouldice Laparoscopica
Canada USA
Hérnias Abdominais
Hérnia Inguinal
URGÊNCIA
Anteriores
(C/S Prótese)
SINTOMÁTICOS
UNILATERAL
ANTERIORES
(COM PRÓTESE)
BILA...
• Pneumoperitônio (Cardiopatia e DPOC)
• Sepse (Estranguladas e Perfuradas)
• Ascite
• Hérnia Recorrente pós VL
• Abaixo d...
VISCERAL INJURIES IN RANDOMIZED TRIALS
Trial Comparison Incidence
Bowel Injury
Anderson (2003)
Mahon (2003)
MRC (1999)
Neu...
Meta-Analysis Summary:
LAPAROSCOPY VS. LICHTENSTEIN
Advantages for
LAPAROSCOPY
NO DIFFERENCE
Advantages for
LICHTENSTEIN
•...
Pacientes de Risco
Bathla L, 2014.
 Hérnias Recidivadas
 Idosos (> 75 anos)
 Cirurgia prostática
 Co-morbidades / ASA
...
TAPP
Transabdominal Pré-peritoneal
 Hérnia contralateral
 Anatomia
 Conversão
 Lesões Vasculares
Hernioplastia Inguina...
TEP
Totalmente Extraperitoneal
 Cavidade peritoneal
 Lesões Viscerais
 Obstrução Intestinal
 Fixação da prótese
Hernio...
Custos do Tratamento
Rosen M, 2014.
 Custos Diretos
 Custos Indiretos
Hernioplastia Inguinal Laparoscópica
CONCLUSÕES
 Prevalência
 Indicações Técnicas
 Uso de Próteses
 Medicina Baseada em Evidência
Hernioplastia Inguinal La...
Tratamento Videolaparoscópico das Hérnias Inguinais
Tratamento Videolaparoscópico das Hérnias Inguinais
Tratamento Videolaparoscópico das Hérnias Inguinais
Tratamento Videolaparoscópico das Hérnias Inguinais
Tratamento Videolaparoscópico das Hérnias Inguinais
Tratamento Videolaparoscópico das Hérnias Inguinais
Tratamento Videolaparoscópico das Hérnias Inguinais
Tratamento Videolaparoscópico das Hérnias Inguinais
Tratamento Videolaparoscópico das Hérnias Inguinais
Tratamento Videolaparoscópico das Hérnias Inguinais
Tratamento Videolaparoscópico das Hérnias Inguinais
Tratamento Videolaparoscópico das Hérnias Inguinais
Tratamento Videolaparoscópico das Hérnias Inguinais
Tratamento Videolaparoscópico das Hérnias Inguinais
Tratamento Videolaparoscópico das Hérnias Inguinais
Tratamento Videolaparoscópico das Hérnias Inguinais
Tratamento Videolaparoscópico das Hérnias Inguinais
Tratamento Videolaparoscópico das Hérnias Inguinais
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Tratamento Videolaparoscópico das Hérnias Inguinais

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Revisão da Literatura a cerca do tratamento cirúrgico da Hérnia Inguinal através da Videolaparoscópica com enfase nas indicações, técnica cirúrgica, eventos adversos e resultados.

Published in: Health & Medicine
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Tratamento Videolaparoscópico das Hérnias Inguinais

  1. 1. HÉRNIA INGUINAL Aspectos Fundamentais do Tratamento Laparoscópico Prof. Dr. Ozimo Gama Cirurgia do Aparelho Digestivo 2014
  2. 2. Hérnia Abdominal  É uma protrusão de um órgão ou uma víscera através de um orifício ou defeito (congênito ou adquirido) na parede abdominal. Hernioplastia Inguinal Laparoscópica
  3. 3. Indicação Cirúrgica Coelho JC et al., 2014. • Sintomáticos – ASA • História Natural • 2 complicações / 1000 casos / ano • Risco Cumulativo de 1% / ano • Tratamento Cirúrgico • Eletivo (0,6% / 7,5%) – Emergência (4,7% / 58%) Hernioplastia Inguinal Laparoscópica
  4. 4. Cuidados Perioperatórios Cavazzoli L, 2014.  Avaliação Pré-Operatória  Antibioticoprofilaxia  Baixo Risco : 2,7%  Alto Risco : 14,3% (p < 0,001) Obesidade, > 75 anos, DMT2, Cateter Urinário, Imunossupressão, Neoplasia e Recidivadas. Hérnias Abdominais
  5. 5. Recidiva : Fatores de risco • história familiar positiva • idade >50 anos • tabagismo • hérnia recidivada Junge K et al. Risk factors related to recurrence in inguinal hernia repair. Hernia, 2006. +2 = tela! Quando devemos utilizar “tela”? Hérnias Abdominais
  6. 6. Técnica Cirúrgica  Reparo tecidual  Livre de Tensão  Anteriores  Posteriores Hérnias Abdominais
  7. 7. Técnica Cirúrgica Laparoscópica  Transabdominal Pré-peritoneal (TAPP)  Transabdominal com tela Intraperitoneal (IPOM)  Totalmente Extraperitoneal (TEP) Hérnias Abdominais
  8. 8. Técnica Cirúrgica Rosen M, 2014.  Seleção da Técnica  150 procedimentos  Co-morbidades / Cirurgias  Riscos de Complicações Hérnias Abdominais
  9. 9. CURRENT SURGICAL APPROACHES 0 5 10 15 20 25 30 35 40 Lichtenstein PHS / Plug Shouldice Laparoscopica Canada USA
  10. 10. Hérnias Abdominais Hérnia Inguinal URGÊNCIA Anteriores (C/S Prótese) SINTOMÁTICOS UNILATERAL ANTERIORES (COM PRÓTESE) BILATERAL ANTERIORES LAPAROSCÓPICA RECORRENTE A.LAPAROSCÓPICA P. ANTERIOR Assintomáticos
  11. 11. • Pneumoperitônio (Cardiopatia e DPOC) • Sepse (Estranguladas e Perfuradas) • Ascite • Hérnia Recorrente pós VL • Abaixo de 15 anos • Gestação (2ª. Trimestre) • Coagulopatias (INR > 1.5) Cavazzola LT, 2008.
  12. 12. VISCERAL INJURIES IN RANDOMIZED TRIALS Trial Comparison Incidence Bowel Injury Anderson (2003) Mahon (2003) MRC (1999) Neumayer (2004) TEP vs. L TAPP vs. L TAPP/TEP vs. Open TEP vs. L TOTAL: 1/81 vs. 1/87 2/59 vs. 0/60 0/462 vs. 1/453 1/989 vs. 0/994 0.25% vs. 0.12% Urinary Bladder MRC (2003) Johansson (1997) Aitola (1998) TAPP/TEP vs. Open TAPP vs. Stoppa TAPP vs. Stoppa TOTAL: 1/462 vs. 0/453 2/207 vs. 0/199 1/24 vs. 0/25 0.58% vs. 0% Vascular Injury MRC (1999) Neumeyer (2004) TAPP/TEP vs. Open TEP vs. L TOTAL: 1/462 vs. 0/453 2/989 vs. 0/994 0.21% vs. 0%
  13. 13. Meta-Analysis Summary: LAPAROSCOPY VS. LICHTENSTEIN Advantages for LAPAROSCOPY NO DIFFERENCE Advantages for LICHTENSTEIN • Wound Infection • Hematoma • Return to Work • Nerve Injury • Chronic Pain • Total Morbidity • Bowel Injury • Bladder Injury • Vascular Injury • Urinary Retention • Testicular Problems • Operating time • Seroma • Hernia recurrence Hernioplastia Inguinal Laparoscópica
  14. 14. Pacientes de Risco Bathla L, 2014.  Hérnias Recidivadas  Idosos (> 75 anos)  Cirurgia prostática  Co-morbidades / ASA  Tabagistas  Obesidade Hernioplastia Inguinal Laparoscópica
  15. 15. TAPP Transabdominal Pré-peritoneal  Hérnia contralateral  Anatomia  Conversão  Lesões Vasculares Hernioplastia Inguinal Laparoscópica
  16. 16. TEP Totalmente Extraperitoneal  Cavidade peritoneal  Lesões Viscerais  Obstrução Intestinal  Fixação da prótese Hernioplastia Inguinal Laparoscópica
  17. 17. Custos do Tratamento Rosen M, 2014.  Custos Diretos  Custos Indiretos Hernioplastia Inguinal Laparoscópica
  18. 18. CONCLUSÕES  Prevalência  Indicações Técnicas  Uso de Próteses  Medicina Baseada em Evidência Hernioplastia Inguinal Laparoscópica

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