Manejo das hérnias paraestomais Management of paraestomal hernias

INTRODUÇÃO: A hérnia paraestomal representa complicação tardia de virtualmente todos os estomas intestinais. As manifestações clínicas oscilam desde um simples problema estético até o estrangulamento do conteúdo herniado. O grau de incapacidade produzido pela hérnia é variável. Existe gama muito grande de procedimentos utilizando ou não material protético de variada especificidade e de resultados controversos. MÉTODOS: Foi realizada revisão de literatura nos sites de pesquisa PubMed, Bireme e Scielo, com os descritores hérnias paraestomais, tratamento cirúrgico, hérnia, colostomia e ileostomia. Selecionaram-se, principalmente, os estudos de aplicação de técnicas cirúrgicas e adicionou-se a experiência clínica dos autores. CONCLUSÃO: Apesar das várias técnicas e meios à disposição do cirugião para o manuseio das hérnias paraestomais, ainda não há método ideal que venha a ser recomendado para todos os casos. Assim, a análise criteriosa dos fatores de riscos do paciente pode ajudar a escolher a melhor opção de tratamento que deve ser individualizada a cada caso.<br>INTRODUCTION: Paraestomal hernia represents a late complication of virtually all intestinal stoma. Clinical manifestations range from a simple cosmetic problem to the strangulation of the herniated contents. The degree of disability produced by the hernia is variable. There is a wide range of procedures using or not using prosthetic material of different specificity and controversial results. METHODS: Was performed a literature review on sites PubMed, BIREME, SciELO with the headings paraestomal hernias, surgery, hernia, colostomy and ileostomy. Were selected mainly studies with the application of surgical techniques and added to the authors' clinical experience. CONCLUSION: Despite various techniques and available devices to handle the paraestomal hernias, there is no ideal method that may be recommended for all cases. Thus, a careful analysis of risk factors can choose the best treatment option that should be done individualizely to each case

Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence

Abstract We systematically searched available databases. We reviewed 6,143 studies published from 1833 to 2017. Reports in English, French, German, Italian, and Spanish were considered, as were publications in other languages if definitive treatment and recurrence at specific follow-up times were described in an English abstract. We assessed data in the manner of a meta-analysis of RCTs; further we assessed non-RCTs in the manner of a merged data analysis. In the RCT analysis including 11,730 patients, Limberg & Dufourmentel operations were associated with low recurrence of 0.6% (95%CI 0.3–0.9%) 12 months and 1.8% (95%CI 1.1–2.4%) respectively 24 months postoperatively. Analysing 89,583 patients from RCTs and non-RCTs, the Karydakis & Bascom approaches were associated with recurrence of only 0.2% (95%CI 0.1–0.3%) 12 months and 0.6% (95%CI 0.5–0.8%) 24 months postoperatively. Primary midline closure exhibited long-term recurrence up to 67.9% (95%CI 53.3–82.4%) 240 months post-surgery. For most procedures, only a few RCTs without long term follow up data exist, but substitute data from numerous non-RCTs are available. Recurrence in PSD is highly dependent on surgical procedure and by follow-up time; both must be considered when drawing conclusions regarding the efficacy of a procedure