CLAUDIO AUGUSTO VIANNA BIROLINI
Índice h a partir de 2011
7
Projetos de Pesquisa
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Instituto Central, Hospital das Clínicas, Faculdade de Medicina
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- Early assessment of bilateral inguinal hernia repair: A comparison between the laparoscopic total extraperitoneal and Stoppa approaches(2016) UTIYAMA, Edivaldo Massazo; DAMOUS, Sergio Henrique Bastos; TANAKA, Eduardo Yassushi; YOO, Jin Hwan; MIRANDA, Jocielle Santos de; USHINOHAMA, Adriano Zuardi; FARO JR., Mario Paulo; BIROLINI, Claudio Augusto ViannaBACKGROUND: The present clinical trial was designed to compare the results of bilateral inguinal hernia repair between patients who underwent the conventional Stoppa technique and laparoscopic total extraperitoneal repair ( LTE) with a single mesh and without staple fixation. PATIENTS AND METHODS: This controlled, randomised clinical trial was conducted at General Surgery and Trauma of the Clinics Hospital, Medical School, the University of Sao Paulo between September 2010 and February 2011. Totally, 50 male patients, with a bilateral inguinal hernia, older than 25 years were considered eligible for the study. The following parameters were analysed during the early post-operative period: ( 1) The intensity of surgical trauma, operation time, C-reactive protein ( CRP) levels, white blood cell count, bleeding and pain intensity; ( 2) quality of life assessment; and ( 3) post-operative complications. RESULTS: LTE procedure was longer than the Stoppa procedure ( 134.6 min +/- 38.3 vs. 90.6 min +/- 41.3; P < 0.05). The levels of CRP were higher in the Stoppa group ( P < 0.05) but the number of leucocytes, haematocrit, and haemoglobin were similar between the groups ( P > 0.05). There was no difference in pain during the 1st and 7th post-operative, physical functioning, physical limitation, the impact of pain on daily activities, and the Carolinas Comfort Scale during the 7th and 15th post-operative ( P > 0.05). Complications occurred in 88% of Stoppa group ( 22 patients) and 64% in LTE group ( 16 patients) ( P < 0.05). CONCLUSION: The comparative study between the Stoppa and LTE approaches for the bilateral inguinal hernia repair demonstrated that: ( 1) The LTE approach showed less surgical trauma despite the longer operation time; ( 2) Quality of life during the early post-operative period were similar; and ( 3) Complication rates were higher in the Stoppa group.
- Polypropylene and polypropylene/polyglecaprone (Ultrapro(r)) meshes in the repair of incisional hernia in rats(2015) UTIYAMA, Edivaldo Massazo; ROSA, Maria Beatriz Sartor de Faria; ANDRES, Marina de Paula; MIRANDA, Jocielle Santos de; DAMOUS, Sérgio Henrique Bastos; BIROLINI, Cláudio Augusto Vianna; DAMOUS, Luciana Lamarão; MONTERO, Edna Frasson de SouzaPURPOSE: To compare the inflammatory response of three different meshes on abdominal hernia repair in an experimental model of incisional hernia. METHODS: Median fascial incision and skin synthesis was performed on 30 Wistar rats. After 21 days, abdominal hernia developed was corrected as follows: 1) No mesh; 2) Polypropylene mesh; and, 3) Ultrapro(r) mesh. After 21 days, the mesh and surrounding tissue were submitted to macroscopic (presence of adhesions, mesh retraction), microscopic analysis to identify and quantify the inflammatory and fibrotic response using a score based on a predefined scale of 0-3 degrees, evaluating infiltration of macrophages, giant cells, neutrophils and lymphocytes. RESULTS: No significant difference was seen among groups in adherences, fibrosis, giant cells, macrophages, neutrophils or lymphocytes (p>0.05). Mesh shrinkage was observed in all groups, but also no difference was observed between polypropylene and Ultrapro mesh (7.0±9.9 vs. 7.4±10.1, respectively, p=0.967). Post-operatory complications included fistula, abscess, dehiscence, serohematic collection and reherniation, but with no difference among groups (p=0.363). CONCLUSION: There is no difference between polypropylene (high-density) and Ultrapro(r) (low-density) meshes at 21 days after surgery in extraperitoneal use in rats, comparing inflammatory response, mesh shortening, adhesions or complications.
conferenceObject Bilateral Inguinal Hernia Repair and Male Fertility: A Randomized Clinical Trial Comparing Lichtenstein vs Laparoscopic Transabdominal Preperitoneal(2022) DAMOUS, Sergio H. B.; DAMOUS, Luciana L.; BORGES, Victor A.; FONTELLA, Amanda K.; MIRANDA, Jocielle S.; KOIKE, Marcia K.; SAITO, Osmar C.; BIROLINI, Claudio A. V.; UTIYAMA, Edivaldo M.- Bilateral inguinal hernia repair and male fertility: a randomized clinical trial comparing Lichtenstein versus laparoscopic transabdominal preperitoneal (TAPP) technique(2023) DAMOUS, Sergio Henrique Bastos; DAMOUS, Luciana Lamarao; BORGES, Victor Andre; FONTELLA, Amanda Karsburg; MIRANDA, Jocielle dos Santos; KOIKE, Marcia Kiyomi; SAITO, Osmar Cassio; BIROLINI, Claudio Augusto Vianna; UTIYAMA, Edivaldo MassazoBackground The effects of hernia repair on testicular function remain uncertain, regardless of the technique used. Studies that analyze testicular volume and flow after hernia repair or hormonal measurements are scarce and show contradictory results. This study aimed to evaluate the impact of bilateral inguinal hernia repair on male fertility in surgical patients in whom the Lichtenstein and laparoscopic transabdominal preperitoneal (TAPP) techniques were used.Methods A randomized clinical trial comparing open (Lichtenstein) versus laparoscopic (TAPP) hernia repair using polypropylene mesh was performed in 48 adult patients (20 to 60 years old) with primary bilateral inguinal hernia. Patients were evaluated preoperatively and 90 and 180 postoperative (PO) days. Sex hormones (Testosterone, FSH, LH and SHGB) analysis, testicular ultrasonography, semen quality sexual activity changes and quality of life (QoL) were performed. Postoperative pain was evaluated using the visual analog scale (VAS).Results Thirty-seven patients with aged of 44 +/- 11 years were included, 19 operated on Lichtenstein and 18 operated on TAPP. The surgical time was similar between techniques. The pain was greater in the Lichtenstein group on the 7th PO day. The biochemical and hormonal analyses, testicular ultrasonography (Doppler, testicular volume, and morphological findings) and sperm quality were similar between groups. However, the sperm morphology was better in the Lichtenstein group after 180 days (p < 0.05 vs. preoperative) and two patients who underwent Lichtenstein hernia repair had oligospermia after 180 days. The QoL evaluation showed a significant improvement after surgery in the following domains: physical function, role emotional, bodily pain and general health (p < 0.05). On comparison of Lichtenstein vs. TAPP none of the domains showed statistically significant differences. No patient reported sexual changes.Conclusion Bilateral inguinal hernia repair with polypropylene mesh, whether using Lichtenstein or TAPP, does not impair male fertility in terms of long-term outcomes.Trial registration: Approved by the Ethics Committee for the Analysis of Research Projects (CAPPesq) of the HC/FMUSP, Number 2.974.457, in June 2015, Registered on Plataforma Brasil in October 2015 under Protocol 45535015.4.0000.0068. Registered on Clinicaltrials.gov, NCT 05799742. Enrollment of the first subject in January 2016.
conferenceObject Effects of polypropylene mesh in testis and duct deferens in rats: a comparative study of two approaches(2015) UTIYAMA, Edivaldo M.; DAMOUS, Sergio H.; MIRANDA, Jocielle S.; SANDERS, Felipe Hada; PARDO, Maisa H.; PARDO, Maisa; MONTERO, Edna F. S.; DAMOUS, Luciana L.; DAMOUS, Luciana; BIROLINI, Claudio- Great saphenous vein aneurysm: A differential diagnosis of femoral hernia and review(2015) MIRANDA, Jocielle Santos de; DAMOUS, Sergio Henrique Bastos; FARO JUNIOR, Mario Paulo; YOO, Jin Hwan; YASSUSHI, Eduardo Tanaka; ZUARDI, Adriano; MURAKAMI, Abel Hiroshi; BIROLINI, Claudio; UTIYAMA, Edivaldo MassazoINTRODUCTION: Venous aneurysms are unusual clinical entities that might be difficult to diagnose and usually appear as an asymptomatic incidental finding on physical examination or imaging study and discovered only during the surgical exploration. They are important differential diagnosis of groin and other subcutaneous mass. PRESENTATION OF CASE: We report a case of a 67-years-old woman who had a groin mass misdiagnosed as femoral hernia, which was subsequently diagnose as great saphena vein aneurysm in the intraoperative set and treated with ligature and resection. DISCUSSION: In conclusion, venous aneurysms of the superficial system are lesions that are important differential diagnosis of groin and other subcutaneous mass. CONCLUSION: Diagnosis is readily available by duplex ultrasonography; however, in most cases, the diagnosis is done only in the operative field. (C) 2015 The Authors.
- Does a bilateral polypropylene mesh alter the duct deferens morphology, testicular size and testosterone levels? Experimental study in rats(2020) DAMOUS, Sergio Henrique Bastos; DAMOUS, Luciana Lamarao; MIRANDA, Jocielle dos Santos; MONTERO, Edna Frasson de Souza; BIROLINI, Claudio; UTIYAMA, Edivaldo MassazoPurpose: To evaluate the effect of a PP mesh on duct deferens morphology, testicular size and testosterone levels. Methods: Forty adult male rats were distributed into groups: 1) no surgery; 2) inguinotomy; 3) mesh placed on the duct deferens; and 4) mesh placed on the spermatic funiculus. After 90 postoperative days, the inguinal region was resected, and blood samples were collected for the measurement of serum testosterone (pg/dl). The ducts deferens were sectioned in three axial sections according to the relationship with the mesh - cranial, medial and caudal. The wall thickness and duct deferens lumen area were measured. Results: The morphology of the duct deferens was preserved in all groups. The mesh placement did not alter this morphology in any of the analyzed segments. Surgery, with or without mesh placement, did not alter the morphology, wall thickness or lumen area (p>0.05). In all operated groups, serum testosterone levels were similar (p>0.05) but there was a decrease in testicle size (p<0.05). Conclusion: Surgery, with or without mesh placement, did not alter the morphology of the duct deferens and, although this treatment resulted in testicular size reduction, it did not affect serum testosterone levels.
- Could polypropylene mesh impair male reproductive organs? Experimental study with different methods of implantation(2020) DAMOUS, S. H. B.; DAMOUS, L. L.; MIRANDA, J. S.; MONTERO, E. F. S.; BIROLINI, C.; UTIYAMA, E. M.Purpose To evaluate the vas deferens and testicles of rats submitted to bilateral inguinotomy and polypropylene (PP) mesh placement. Method Sixty Wistar rats were randomized into three groups: Control (inguinotomy only), mesh placement over the vas deferens (Mesh-DD) or under the spermatic funiculus (Mesh-SF). The following analyses were performed: vas deferens morphometry (lumen area and wall thickness), quantification of collagen fibers, spermatogenesis, apoptosis (cleaved caspase-3 and TUNEL) and cellular proliferation (Ki67). Quantitative gene expression (qPCR) for apoptosis and inflammatory cytokines were evaluated by RT-PCR. Results In the apoptosis pathway, Mesh-DD showed one upregulated gene (Il10) and three downregulated genes (Fadd, Tnfrsf1b and Xiap). In Mesh-SF, 17 genes were downregulated. In the inflammation pathway (Mesh-DD), one gene was upregulated (Il1r1), and one gene was downregulated (Ccl12). In Mesh-SF, three genes were upregulated (Il1r1, Tnfsf13b and Csf1), and two were downregulated (Ccl12 and Csf2). PP mesh placement preserved spermatogenesis and did not alter the vas deferens or the testicle. In the ductus deferens, there was reduced luminal area (30 days), increased wall thickness (90 days), and increased type III collagen and cell proliferation (30 and 90 days) (p < 0.05). In the testicle, cell proliferation was greater in the Mesh-DD (p < 0.05). Conclusions PP mesh, whether or not in direct contact with spermatic funicular structures, induces changes that were not sufficient to cause damage to the evaluated organs.
- The early outcomes of complex abdominal wall reconstruction with polyvinylidene (PVDF) mesh in the setting of active infection: a prospective series(2022) BIROLINI, Claudio; TANAKA, Eduardo Yassushi; MIRANDA, Jocielle Santos de; MURAKAMI, Abel Hiroshi; DAMOUS, Sergio Henrique Bastos; UTIYAMA, Edivaldo MassazoPurpose The use of synthetic mesh to repair infected abdominal wall defects remains controversial. Polyvinylidene fluoride (PVDF) mesh was introduced in 2002 as an alternative to polypropylene, with the advantages of improved biostability, lowered bending stiffness, and minimum tissue response. This study aimed to evaluate the short-term outcomes of using PVDF mesh to treat infected abdominal wall defects in the elective setting. Methods This prospective clinical trial started in 2016 and was designed to evaluate the short- and mid-term outcomes of 38 patients submitted to abdominal wall reconstruction in the setting of active mesh infection and/or enteric fistulas (AI) when compared to a group of 38 patients submitted to clean ventral hernia repairs (CC). Patients were submitted to single-staged repairs, using onlay PVDF mesh (DynaMesh (R)-CICAT) reinforcement to treat their defects. Results Groups had comparable demographic characteristics. The AI group had more previous abdominal operations and required a longer operative and anesthesia time. At 30 days, surgical site occurrences were observed in 16 (42.1%) AI vs. 17 (44.7%) CC, p = 0.817; surgical site infection occurred in 4 (10.5%) AI vs. 6 (15.8%) CC, p = 0.497; and a higher number of procedural interventions were required in the CC group, 15.8 AI vs. 28.9% CC, p = 0.169. Both groups did not have chronic infections at 1 year of follow-up, and one hernia recurrence was observed in the AI group. Conclusions The use of PVDF mesh in the infected setting presented favorable results with a low incidence of wound infection.
- Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis(2015) UTIYAMA, Edivaldo Massazo; PFLUG, Adriano Ribeiro Meyer; DAMOUS, Sérgio Henrique Bastos; RODRIGUES-JR, Adilson Costa; MONTERO, Edna Frasson de Souza; BIROLINI, Claudio Augusto ViannaOBJECTIVE: to present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis. METHODS: we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years); 11 patients were male, and four were female. RESULTS: forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision. CONCLUSION: the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.