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Instituto Central, Hospital das Clínicas, Faculdade de Medicina

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Agora exibindo 1 - 10 de 22
  • conferenceObject
    (2021) BIROLINI, Claudio; TANAKA, Eduardo; MIRANDA, Jocielle; MURAKAMI, Abel; UTIYAMA, Edivaldo
  • article 32 Citação(ões) na Scopus
    A retrospective review and observations over a 16-year clinical experience on the surgical treatment of chronic mesh infection. What about replacing a synthetic mesh on the infected surgical field?
    (2015) BIROLINI, C.; MIRANDA, J. S. de; UTIYAMA, E. M.; RASSLAN, S.
    To review the short- and long-term results in patients who underwent removal of infected or exposed mesh and reconstruction of the abdominal wall with simultaneous mesh replacement. Patients undergoing removal of an infected or exposed mesh and single-staged reconstruction of the abdominal wall with synthetic mesh replacement over a 16-year period were retrospectively reviewed from a prospectively maintained database. Patients were operated and followed by a single surgeon. Outcome measures included wound complications and hernia recurrence. From 1996 until 2012, 41 patients (23 F, 18 M), with a mean age of 53.4 years and mean BMI of 31.2 +/- A 8 kg/m(2), were treated for chronic mesh infection (CMI). A suppurative infection was present in 27 patients, and 14 had an exposed mesh. The need for recurrent incisional hernia repair was observed in 25 patients; bowel resections or other potentially contaminated procedures were associated in 15 patients. The short-term results showed an uneventful post-operative course after mesh replacement in 27 patients; 6 (14.6 %) patients developed a minor wound infection and were treated with dressings and antibiotics; 5 (12 %) patients had wound infections requiring debridement and one required complete mesh removal. On the long-term follow-up, there were three hernia recurrences, one of which demanded a reoperation for enterocutaneous fistula; 95 % of the patients submitted to mesh replacement were considered cured of CMI after a mean follow-up of 74 months. CMI can be treated by removal of infected mesh; simultaneous mesh replacement prevents hernia recurrence and has an acceptable incidence of post-operative acute infection. Standard polypropylene mesh is a suitable material to be used in the infected surgical field as an onlay graft.
  • article 8 Citação(ões) na Scopus
    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 Vianna
    BACKGROUND: 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.
  • article 8 Citação(ões) na Scopus
    Active Staphylococcus aureus infection: Is it a contra-indication to the repair of complex hernias with synthetic mesh? A prospective observational study on the outcomes of synthetic mesh replacement, in patients with chronic mesh infection caused by Staphylococcus aureus
    (2016) BIROLINI, Claudio; MIRANDA, Jocielle Santos de; UTIYAMA, Edivaldo Massazo; RASSLAN, Samir; BIROLINI, Dario
    Introduction: The management of chronic mesh infection is challenging and controversial. The use of synthetic material to repair the abdominal wall in the infected setting is not recommended, especially in the presence of active infection caused by Staphylococcus aureus. Methods: This is a prospective observational study designed to evaluate the outcomes in patients with active mesh infection caused by Staphylococcus aureus. Patients underwent simultaneous removal and replacement of polypropylene mesh. The treatment protocol included the complete removal of infected mesh, followed by the anatomical reconstruction, and reinforcement of the abdominal wall using a new onlay polypropylene mesh. Early and late wound complications, medical complications, and hernia recurrences were analyzed. Results: From 2006 until 2014, 22 patients with a mean age of 57.2 years and mean BMI of 29,3 kg/m2 were studied. Sinuses were present in 21 patients. A recurrent ventral hernia was observed in 14 patients; two patients required a complex abdominal wall reconstruction due to enteric fistulas. Bowel resections or other potentially contaminated procedures were associated in 10 patients. Fourteen patients (63.6%) had an uneventful postoperative course; 5 (22.7%) patients had wound infections requiring debridement and three required partial (2) or total (1) mesh removal. Two patients died due to medical complications. Adverse results on long-term follow-up included one hernia recurrence after complete mesh removal and one persistent sinus after partial mesh removal requiring a reoperation to remove mesh remnants. All of the patients were considered free of infection after a mean follow-up of 44 months. Conclusions: Synthetic mesh replacement in patients with active Staphylococcus aureus infection has an acceptable incidence of postoperative wound infection and prevents hernia recurrence. Large-pore polypropylene mesh is a suitable material to be used in the infected surgical field as an onlay graft.
  • article 12 Citação(ões) na Scopus
    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 Souza
    PURPOSE: 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.
  • article 0 Citação(ões) na Scopus
    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 Massazo
    Background 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, NCT 05799742. Enrollment of the first subject in January 2016.
  • conferenceObject
    (2021) BIROLINI, Claudio; FARO JR., Mario Paulo; TANAKA, Eduardo; MIRANDA, Jocielle; UTIYAMA, Edivaldo
  • 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
  • bookPart
    Hérnia incisional gigante
    (2019) BIROLINI, Cláudio; TANAKA, Eduardo Yasushi; MIRANDA, Jocielle Santos de; MURAKAMI, Abel Hiroshi