Tratamento das hérnias inguinais pela técnica de shouldice: descrição da técnica e resultados iniciais

Uyeno, Wilson Massahiko; Gatto, Luis Fernando Rubira; Lopes Filho, Gaspar de Jesus; Scalabrini, Milton; Sato, Nelson Yukitoshi; Ricca, Artur Berti

doi:10.1590/S0100-69911998000300005

Resumos

A técnica de Shouldice para o tratamento cirúrgico das hérnias inguinais, apesar dos excelentes resultados descritos na literatura, tem sido pouco difundida em nosso meio, No período de junho de 1992 a abril de 1995, 87 hérnias inguinais foram reparadas seguindo os princípios técnicos da Clínica Shouldice, sendo a grande maioria constituída de hérnias primárias (94,7%), A idade dos pacientes variou de 20 a 85 anos, com média de 54 anos e todos foram operados em caráter eletivo, Neste trabalho apresentamos a descrição técnica detalhada do procedimento e os resultados iniciais (taxa de recidiva global de 3,9%) obtidos em um período médio de 13,2 meses de acompanhamento, que sugerem tratar-se de uma boa técnica para o tratamento cirúrgico das hérnias inguinais.

Hérnia inguinal; Técnica de Shouldice

The Shouldice technique, in this report, is described in details and the preliminary results are presented. Between July 1992 and April 1995, 87 inguinal hernias were treated by Shouldice repair in 71 pacients, including 64 (901%) males and seven (9.9%)females with an average of 54 years. Most of them were primary hernias (94.3%) and were performed by residents in general surgery supervised by staff surgeons. All repairs were performed under regional or general anesthesia. The operative diagnosis was indirect hernia in 40 cases (46%), direct in 28 (32,2%) and mixt in 19 (21,8%). The average period of follow-up was 13.2 months and the global recurrence rate 3.9%. The experience demonstrated that good results were attained by surgeons who had no special interest in hernia surgery and testifies to the simplicity and reliability of the method.

Inguinal hernia; Shouldice technique

ARTIGOS ORIGINAIS

Tratamento das hérnias inguinais pela técnica de shouldice: descrição da técnica e resultados iniciais

Inguinal hernias treatment by shouldice technique: technical description and preliminary results

Wilson Massahiko Uyeno^I; Luis Fernando Rubira Gatto^I; Gaspar de Jesus Lopes Filho, TCBC-SP^II; Milton Scalabrini, ACBC-SP^III; Nelson Yukitoshi Sato^III; Artur Berti Ricca^III

^IMédico do Hospital São Paulo da EPM-UNlFESP

^IIProfessor Adjunto da Disciplina de Gastroenterologia Cirúrgica do Departamento de Cirurgia da EPM-UNIFESP

^IIIProfessor Assistente da Disciplina de Gastroenterologia Cirúrgica do Departamento de Cirurgia da EPM-UNlFESP

^{Endereço para correspondência} Endereço para correspondência: Dr. Gaspar de Jesus Lopes Filho Rua Napoleão de Barros, 715 2° andar (Secretaria Gastrocirurgia) 04024-002 - São Paulo - SP

RESUMO

A técnica de Shouldice para o tratamento cirúrgico das hérnias inguinais, apesar dos excelentes resultados descritos na literatura, tem sido pouco difundida em nosso meio, No período de junho de 1992 a abril de 1995, 87 hérnias inguinais foram reparadas seguindo os princípios técnicos da Clínica Shouldice, sendo a grande maioria constituída de hérnias primárias (94,7%), A idade dos pacientes variou de 20 a 85 anos, com média de 54 anos e todos foram operados em caráter eletivo, Neste trabalho apresentamos a descrição técnica detalhada do procedimento e os resultados iniciais (taxa de recidiva global de 3,9%) obtidos em um período médio de 13,2 meses de acompanhamento, que sugerem tratar-se de uma boa técnica para o tratamento cirúrgico das hérnias inguinais.

Unitermos: Hérnia inguinal; Técnica de Shouldice.

ABSTRACT

The Shouldice technique, in this report, is described in details and the preliminary results are presented. Between July 1992 and April 1995, 87 inguinal hernias were treated by Shouldice repair in 71 pacients, including 64 (901%) males and seven (9.9%)females with an average of 54 years. Most of them were primary hernias (94.3%) and were performed by residents in general surgery supervised by staff surgeons. All repairs were performed under regional or general anesthesia. The operative diagnosis was indirect hernia in 40 cases (46%), direct in 28 (32,2%) and mixt in 19 (21,8%). The average period of follow-up was 13.2 months and the global recurrence rate 3.9%. The experience demonstrated that good results were attained by surgeons who had no special interest in hernia surgery and testifies to the simplicity and reliability of the method.

Key words: Inguinal hernia; Shouldice technique.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

REFERÊNCIAS

1. Welsh DRJ, Alexander MAJ. Shouldice repair. Surg Clin North Am 1993; 3:463-95.

2. Shearburn EW, Myers RN. Shouldice repair for inguinal hernia. Surgery 1969; 66(2):450-9.

3. Glassow F. The Shouldice Hospital technique. Int Surg 1986; 71(3): 148-53.

4. Devlin HB, Gillen PH, Waxman BP, et al. Short stay surgery for inguinal hernia: experience of the Shouldice operation, 1970-1982. Br J Surg 1986; 73(2) 123-4.

5. Ayala LA, Souchón E, Alfonzo R, et al. Hernioplastia inguinal por tecnica de Shouldice: reporte acumulativo 1974-1984 / Inguinal hemioplasty by Shouldice's technique: cumulative report 1974-1984. Centro Med 1986; 25 (83):7-10.

6. Sisley JF, Scarborough CS, Morris RC, et al. Shouldice hernia repair: results at the teaching institution. Am J Surg 1987; 53(9):495-6.

7. Irribarren C, Ortiz J A, Cappi R A, et al. La plastica de Shouldice en el tratamiento de la hernia inguinal / A Shouldice's technique en the treatment of inguinal hernia. Rev Argent Cir 1991; 61 (3/4):131-5.

8. Panos RG, Beck DE, Maresh JE, et al. Preliminary results of a prospective randomized study of Cooper's ligament versus Shouldice herniorrhaphy technique. Surg Gynecol Obstet 1992; 175(4): 315-9.

9. Bardavid SC. Hernias inguinales: técnica de Shouldice/Inguinal hernias: Shouldice technic. Rev Chil Cir 1993; 45 (3):264-71.

10. Tanner WA, Ng CY. Shouldice hernia repair: a five year audit. Ir J Med Sci 1993; 162(1):13-6.

11. Silva NC, Reis MCW, Lima APC, et al. Reparo da hernia inguinal pela técnica de Shouldice. Rev Hosp Clín Fac Med São Paulo 1995; 50 (6): 314-316.

12. Hay JMH, Boudet MJ, Fingerhut A, et al. Shouldice inguinal hernia repair in the male adult: The gold-standart? Ann Surg 1995; 22(6): 719-27.

13. Glassow F. Inguinal hernia repair. A comparison of the Shouldice and Cooper ligament repair of the posterior inguinal wall. Am J Surg 1976;131(3) : 306-11.

14. Kux M, Fuchsjager N, Schemper M. Shouldice is superior to Bassini inguinal herniorrhaphy. Am J Surg 1994;168(1): 15-8.

15. Paul A, Troidl H, Williams JL, et al. Randomized trial of modified Bassini versus Shouldice inguinal hernia repair. Br J Surg 1994; 81(10): 1531-4.

16. Silva NC, Sobrinho JMDL, Santos RIC, et al. Tratamento cirúrgico da hérnia inguinal pela técnica de Shouldice. Rev Col Bras Cir 1990; 5(17):94-98.

17. Silva NC. Correção cirúrgica da hernia inguinal pela técnica de Shouldice sob anestesia local / Surgical repair of inguinal hernia by the Shouldice techique under local anesthesia. Rev Hosp Clin Fac Med São Paulo 1992;47(4):167-9.

18. Kux M, Fuchsjager N. Inguinal hernia repair. Br J Surg 1989; 76:788.

19. Bowen JR, Thompson WR, Dorman B A, et al. Change in the management of adult groin hernia. Am J Surg 1978; 135:564-569.

20. Lichtenstein IL. Herniorrhaphy: A personal experience with 6.321 cases. Am J Surg 1987;153:553-559.

21. Schaap HM, Van de Pavoordt HDNM, Bast TJ. The preperitoneal approach in the repair of recurrent inguinal hernias. Surg Gynecol Obstet 1992;174:460-464.

22. Kingsnorth AN, Gray MR, Nott DM. Prospective randomized trial comparing the Shouldice technique and plication darn for inguinal hemia. Br J Surg 1992;79(10):1068-70.

23. Tran VK, Putz MD, Rohde H. A randomized controlled trial for inguinal hernia repair to compare the Shouldice an Bassini-Kirschner Operation. Int Surg 1992;77:235-237.

24. Rodríguez JL. Herniorrafia inguinal: procedimiento de Shouldice/Inguinal herniorrhaphy: Shouldice procedure. Cir Urug 1988; 58 (2/3):86-90.

Recebido em 28/5/97

Aceito para publicação em 4/12/97

Trabalho realizado na Disciplina de Gastroenterologia Cirúrgica do Departamento de Cirurgia da Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-UNlFESP).

1. Welsh DRJ, Alexander MAJ. Shouldice repair. Surg Clin North Am 1993; 3:463-95.
2. Shearburn EW, Myers RN. Shouldice repair for inguinal hernia. Surgery 1969; 66(2):450-9.
3. Glassow F. The Shouldice Hospital technique. Int Surg 1986; 71(3): 148-53.
⁴
Devlin HB, Gillen PH, Waxman BP, et al. Short stay surgery for inguinal hernia: experience of the Shouldice operation, 1970-1982. Br J Surg 1986; 73(2) 123-4.
5. Ayala LA, Souchón E, Alfonzo R, et al. Hernioplastia inguinal por tecnica de Shouldice: reporte acumulativo 1974-1984 / Inguinal hemioplasty by Shouldice's technique: cumulative report 1974-1984. Centro Med 1986; 25 (83):7-10.
6. Sisley JF, Scarborough CS, Morris RC, et al. Shouldice hernia repair: results at the teaching institution. Am J Surg 1987; 53(9):495-6.
7. Irribarren C, Ortiz J A, Cappi R A, et al. La plastica de Shouldice en el tratamiento de la hernia inguinal / A Shouldice's technique en the treatment of inguinal hernia. Rev Argent Cir 1991; 61 (3/4):131-5.
8. Panos RG, Beck DE, Maresh JE, et al. Preliminary results of a prospective randomized study of Cooper's ligament versus Shouldice herniorrhaphy technique. Surg Gynecol Obstet 1992; 175(4): 315-9.
9. Bardavid SC. Hernias inguinales: técnica de Shouldice/Inguinal hernias: Shouldice technic. Rev Chil Cir 1993; 45 (3):264-71.
10. Tanner WA, Ng CY. Shouldice hernia repair: a five year audit. Ir J Med Sci 1993; 162(1):13-6.
11. Silva NC, Reis MCW, Lima APC, et al. Reparo da hernia inguinal pela técnica de Shouldice. Rev Hosp Clín Fac Med Săo Paulo 1995; 50 (6): 314-316.
¹²
Hay JMH, Boudet MJ, Fingerhut A, et al. Shouldice inguinal hernia repair in the male adult: The gold-standart? Ann Surg 1995; 22(6): 719-27.
¹³
Glassow F. Inguinal hernia repair. A comparison of the Shouldice and Cooper ligament repair of the posterior inguinal wall. Am J Surg 1976;131(3) : 306-11.
14. Kux M, Fuchsjager N, Schemper M. Shouldice is superior to Bassini inguinal herniorrhaphy. Am J Surg 1994;168(1): 15-8.
15. Paul A, Troidl H, Williams JL, et al. Randomized trial of modified Bassini versus Shouldice inguinal hernia repair. Br J Surg 1994; 81(10): 1531-4.
16. Silva NC, Sobrinho JMDL, Santos RIC, et al. Tratamento cirúrgico da hérnia inguinal pela técnica de Shouldice. Rev Col Bras Cir 1990; 5(17):94-98.
17. Silva NC. Correçăo cirúrgica da hernia inguinal pela técnica de Shouldice sob anestesia local / Surgical repair of inguinal hernia by the Shouldice techique under local anesthesia. Rev Hosp Clin Fac Med Săo Paulo 1992;47(4):167-9.
18. Kux M, Fuchsjager N. Inguinal hernia repair. Br J Surg 1989; 76:788.
19. Bowen JR, Thompson WR, Dorman B A, et al. Change in the management of adult groin hernia. Am J Surg 1978; 135:564-569.
20. Lichtenstein IL. Herniorrhaphy: A personal experience with 6.321 cases. Am J Surg 1987;153:553-559.
21. Schaap HM, Van de Pavoordt HDNM, Bast TJ. The preperitoneal approach in the repair of recurrent inguinal hernias. Surg Gynecol Obstet 1992;174:460-464.
22. Kingsnorth AN, Gray MR, Nott DM. Prospective randomized trial comparing the Shouldice technique and plication darn for inguinal hemia. Br J Surg 1992;79(10):1068-70.
23. Tran VK, Putz MD, Rohde H. A randomized controlled trial for inguinal hernia repair to compare the Shouldice an Bassini-Kirschner Operation. Int Surg 1992;77:235-237.
24. Rodríguez JL. Herniorrafia inguinal: procedimiento de Shouldice/Inguinal herniorrhaphy: Shouldice procedure. Cir Urug 1988; 58 (2/3):86-90.

Endereço para correspondência:

Dr. Gaspar de Jesus Lopes Filho

Rua Napoleão de Barros, 715 2° andar (Secretaria Gastrocirurgia)

04024-002 - São Paulo - SP

Datas de Publicação

Publicação nesta coleção
28 Jul 2010
Data do Fascículo
Jun 1998

Histórico

Aceito
04 Dez 1997
Recebido
28 Maio 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Welsh DRJ, Alexander MAJ. Shouldice repair. Surg Clin North Am 1993; 3:463-95.

[2] 2. Shearburn EW, Myers RN. Shouldice repair for inguinal hernia. Surgery 1969; 66(2):450-9.

[3] 3. Glassow F. The Shouldice Hospital technique. Int Surg 1986; 71(3): 148-53.

[4] ⁴
Devlin HB, Gillen PH, Waxman BP, et al. Short stay surgery for inguinal hernia: experience of the Shouldice operation, 1970-1982. Br J Surg 1986; 73(2) 123-4.

[5] 5. Ayala LA, Souchón E, Alfonzo R, et al. Hernioplastia inguinal por tecnica de Shouldice: reporte acumulativo 1974-1984 / Inguinal hemioplasty by Shouldice's technique: cumulative report 1974-1984. Centro Med 1986; 25 (83):7-10.

[6] 6. Sisley JF, Scarborough CS, Morris RC, et al. Shouldice hernia repair: results at the teaching institution. Am J Surg 1987; 53(9):495-6.

[7] 7. Irribarren C, Ortiz J A, Cappi R A, et al. La plastica de Shouldice en el tratamiento de la hernia inguinal / A Shouldice's technique en the treatment of inguinal hernia. Rev Argent Cir 1991; 61 (3/4):131-5.

[8] 8. Panos RG, Beck DE, Maresh JE, et al. Preliminary results of a prospective randomized study of Cooper's ligament versus Shouldice herniorrhaphy technique. Surg Gynecol Obstet 1992; 175(4): 315-9.

[9] 9. Bardavid SC. Hernias inguinales: técnica de Shouldice/Inguinal hernias: Shouldice technic. Rev Chil Cir 1993; 45 (3):264-71.

[10] 10. Tanner WA, Ng CY. Shouldice hernia repair: a five year audit. Ir J Med Sci 1993; 162(1):13-6.

[11] 11. Silva NC, Reis MCW, Lima APC, et al. Reparo da hernia inguinal pela técnica de Shouldice. Rev Hosp Clín Fac Med Săo Paulo 1995; 50 (6): 314-316.

[12] ¹²
Hay JMH, Boudet MJ, Fingerhut A, et al. Shouldice inguinal hernia repair in the male adult: The gold-standart? Ann Surg 1995; 22(6): 719-27.

[13] ¹³
Glassow F. Inguinal hernia repair. A comparison of the Shouldice and Cooper ligament repair of the posterior inguinal wall. Am J Surg 1976;131(3) : 306-11.

[14] 14. Kux M, Fuchsjager N, Schemper M. Shouldice is superior to Bassini inguinal herniorrhaphy. Am J Surg 1994;168(1): 15-8.

[15] 15. Paul A, Troidl H, Williams JL, et al. Randomized trial of modified Bassini versus Shouldice inguinal hernia repair. Br J Surg 1994; 81(10): 1531-4.

[16] 16. Silva NC, Sobrinho JMDL, Santos RIC, et al. Tratamento cirúrgico da hérnia inguinal pela técnica de Shouldice. Rev Col Bras Cir 1990; 5(17):94-98.

[17] 17. Silva NC. Correçăo cirúrgica da hernia inguinal pela técnica de Shouldice sob anestesia local / Surgical repair of inguinal hernia by the Shouldice techique under local anesthesia. Rev Hosp Clin Fac Med Săo Paulo 1992;47(4):167-9.

[18] 18. Kux M, Fuchsjager N. Inguinal hernia repair. Br J Surg 1989; 76:788.

[19] 19. Bowen JR, Thompson WR, Dorman B A, et al. Change in the management of adult groin hernia. Am J Surg 1978; 135:564-569.

[20] 20. Lichtenstein IL. Herniorrhaphy: A personal experience with 6.321 cases. Am J Surg 1987;153:553-559.

[21] 21. Schaap HM, Van de Pavoordt HDNM, Bast TJ. The preperitoneal approach in the repair of recurrent inguinal hernias. Surg Gynecol Obstet 1992;174:460-464.

[22] 22. Kingsnorth AN, Gray MR, Nott DM. Prospective randomized trial comparing the Shouldice technique and plication darn for inguinal hemia. Br J Surg 1992;79(10):1068-70.

[23] 23. Tran VK, Putz MD, Rohde H. A randomized controlled trial for inguinal hernia repair to compare the Shouldice an Bassini-Kirschner Operation. Int Surg 1992;77:235-237.

[24] 24. Rodríguez JL. Herniorrafia inguinal: procedimiento de Shouldice/Inguinal herniorrhaphy: Shouldice procedure. Cir Urug 1988; 58 (2/3):86-90.

Brasil