Aspectos atuais da herniorrafia no idoso

Pitrez, Fernando Antônio Bohrer; Pioner, Sérgio Ricardo; Lemchen, Hélio; Irigaray, João Henrique; Nunes e Silva, Daniel

doi:10.1590/S0100-69912000000100010

Resumos

A hérnia no paciente maior de 65 anos, ainda hoje, admite questionamentos quanto à sua etiologia, evolução e manejo. As condições clínicas do paciente e a debilidade dos tecidos da parede abdominal multiplicam as dificuldades inerentes à herniorrafia. O manejo cirúrgico apropriado é o reparo eletivo precoce, que apresenta índices limitados de complicações, sendo de maneira geral uma operação segura. Em casos de emergência, tentativas de desencarceramento estão contra-indicadas, já que em idosos a sintomatologia de sepse intra-abdominal inicia1 é frustra. O tratamento cirúrgico deve ser preconizado, pois nas operações de emergência a morbi/mortalidade da herniorrafia está significativamente elevada. A presente revisão pretende analisar os fatores envolvidos no sucesso da herniorrafia no idoso, destacando os aspectos atuais do pré, trans e pós-operatório.

Hérnia; Herniorrafia; Idoso; Complicações

The abdominal wall hernias in an elderly population, until today admit questions about etiology evolution and management. The tecnical difficulties of herniorrhaphy are increased because of the clinical status and the weakness of the tissues. The elective herniorrhaphy is the choice, because it is safety and has few complications. In emergency, attempts to reduce the incarcerated hernia should be avoided, because of the risks of intra-abdominal sepsis. The elective surgery should be indicated, the emergecy herniorrhaphy is associated with higher mortality and morbidity. The presesent article aims to review the current features related in successful herniorrhaphy in old patient, emphasyzing all the stages of the surgery.

Hernia; Herniorrhaphy; Elderly; Complications

ARTIGO DE ATUALIZAÇÃO

Aspectos atuais da herniorrafia no idoso

Current aspects of herniorrhaphy in the elderly

Fernando Antônio Bohrer Pitrez, ACBC-RS^I; Sérgio Ricardo Pioner, ACBC-RS^II; Hélio Lemchen, ACBC-RS^II; João Henrique Irigaray^II; Daniel Nunes e Silva^III

^IProfessor Adjunto de Cirurgia Geral da FFFCMPA e Cirurgião do Centro Integrado de Hérnias da ISCMPA

^IICirurgião do Centro Integrado de Hérnias da ISCMPA

^IIIAcadêmico de Medicina da FFFCMPA

^{Endereço para correspondência} Endereço para correspondência: Dr. Fernando Antonio B. Pitrez Rua Padre Chagas, 367/801 90570-080 - Porto Alegre RS

RESUMO

A hérnia no paciente maior de 65 anos, ainda hoje, admite questionamentos quanto à sua etiologia, evolução e manejo. As condições clínicas do paciente e a debilidade dos tecidos da parede abdominal multiplicam as dificuldades inerentes à herniorrafia. O manejo cirúrgico apropriado é o reparo eletivo precoce, que apresenta índices limitados de complicações, sendo de maneira geral uma operação segura. Em casos de emergência, tentativas de desencarceramento estão contra-indicadas, já que em idosos a sintomatologia de sepse intra-abdominal inicia1 é frustra. O tratamento cirúrgico deve ser preconizado, pois nas operações de emergência a morbi/mortalidade da herniorrafia está significativamente elevada. A presente revisão pretende analisar os fatores envolvidos no sucesso da herniorrafia no idoso, destacando os aspectos atuais do pré, trans e pós-operatório.

Unitermos: Hérnia; Herniorrafia; Idoso; Complicações.

ABSTRACT

The abdominal wall hernias in an elderly population, until today admit questions about etiology evolution and management. The tecnical difficulties of herniorrhaphy are increased because of the clinical status and the weakness of the tissues. The elective herniorrhaphy is the choice, because it is safety and has few complications. In emergency, attempts to reduce the incarcerated hernia should be avoided, because of the risks of intra-abdominal sepsis. The elective surgery should be indicated, the emergecy herniorrhaphy is associated with higher mortality and morbidity. The presesent article aims to review the current features related in successful herniorrhaphy in old patient, emphasyzing all the stages of the surgery.

Key words: Hernia; Herniorrhaphy; Elderly; Complications.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Recebido em 28/8/99

Aceito para publicação em 6/12/99

Trabalho realizado no Serviço de Cirurgia Geral do Complexo Hospitalar Santa Casa, Fundação Faculdade Federal de Ciências Médicas de Porto Alegre - Rio Grande do Sul.

1. Rosenthal RA. Small-bowel disorders and abdominal wall hernia in the elderly patient. Surg Clin North Am 1994;74(2):261-291.
2. Rutkow IM. Epidemiologic, economic and sociologic aspects of hernia surgery in the United States in the 1990's. Surg Clin North Am 1998;78(6):941-951.
3. Deysine M, Grimson R, Soroff HS. Herniorrhaphy in the elderly - Benefits of a clinic for the treatment of external abdominal wall hernias. Am J Surg 1987;153:387-391.
4. Pitrez FAB, Oliveira, JR., Furtado JP, et al. Hérnia inguinal no paciente idoso. Rev Col Bras Cir 1993;20(4):174-178.
5. Cians EGF, Cuneo S, Vitale FB, et al. Hernia repair in elderly patients. Br J Surg 1997;84:983-985.
6. Roraek-Madsen M. Herniorrhaphy in patients aged 80 years or more. Eur J Surg 1992;158:591.
7. Nehme AE. Groin hernias in elderly patients - Management and prognosis. Am J Surg 1983;146:257-260.
8. Wagh PV, Leverick AP, Sun CN, et al. Direct inguinal herniation in men: a disease of collagen. J Surg Res 1974;17:425-428.
9. Abrahamsen J. Hernias. In: Schwartz SI, Ellis H, Husser WC (eds).Maingot's Abdominal Operations. 9th ed. Norwalk, Connecticut. Appleton and Lange editora, 1990, pp 215-296.
10. Pitrez FAB, Pioner S. Hérnia Periestomal. In Silva LA - Hérnias da Parede Abdominal. 1Ş Ediçăo. Rio de Janeiro. Atheneu Editora, 1997, pp 223-234.
11. Lewis BS, Wenger JS, Wayne JD. Small bowel enteroscopy and intraoperative enteroscopy for obscure gastrointestinal bleeding. Am J Gastroenterol 1991;86:171-177.
12. Pioner SR, Pitrez FAB, Pioner GT. Herniorrafia pré-peritoneal para hérnias da regiăo inguinal. Col Bras Cir 1995; 22(2):142-146.
13. Tinwald GR, Cooperman M. Inguinal and femoral hernia repair in geriatric patients. Surg Gynecol Obstet 1982;154:704-706.
14. Kotz WJ, Sabiston DC. Hernias. In: Sabiston DC. Textbook of surger, the biological basis of modern surgical pratice. 5Ş ed. Saunders Editora. Philadelphia, 1998, pp 639-654.
15. Miller RD - Anesthesia. In: Way LW.Current: surgical diagnosis and treatement. 10th ediçăo. Lange Editora. Connecticut 1994, pp 174- 176.
16. Pitrez FAB, Lemchem HF, Serra A, et al. Semiologia das hérnias ínguino-crurais. Rev Med Sta Casa 1995; 6(12):1.259-1.263.
17. Emory RE, LaPorta AJ. Obturator hernia. Surgery Rounds. 1993, 43-46.
18. Pitrez FB. Fundamentos de Pré e Pós-operatório. Porto Alegre: Fundo Editorial Byk Editora, 1987.
19. Lubin MF, Kelly KG. Cuidado peri-opetório do paciente idoso. In Merli GJ, Weitz HH - Assistęncia Clínica ao Paciente Cirúrgico. Rio de Janeiro. Revinter Editora, 1997, pp 217-226.
20. Silva AL, Barbosa CA. Pré e pós-operatório em hérnia inguinal. In Pitrez FAB, Pioner SR - Pré e pós-operatório em cirurgia geral e especializada. Porto Alegre. Artmed Editora, 1999, pp 299-310.
21. Goldman L, et al - Multifactorial index os cardiac risk in noncardiac surgical procedures. N Engl J Med 1977;297:845-50.
22. Young DV. Comparison of local, spinal, and general anesthesia for inguinal herniorrhaphy. Am J Surg 1987;153:560-563.
23. Guillen J, Aldrite A. Anesthesic factors influencing morbidity and mortality of elderly patients undergoing inguinal herniorrhaphy. Am J Surg 1970;120:760.
24. Job CA, Fernandez MA, Dorph DJ, et al. Inguinal hernia repair: comparison of local, epidural and general anesthesia. NY State J Med 1979;79:1.730-40.
25. Teasdale C, McCrum A, Williams NB, et al - Aspects of treatment: a randomized controlled trial to compare local with general anesthesia for short stay inguinal hernia repair. Ann R Coll Surg Engl 1982; 64:238-241.
26. Keith A. On the origin and nature of hernia. Br J Surg 1924; 11:455.
27. Stoppa RE, WarLaumont CR, Verhalghe PJ, et al. Prosthetic repair in the treatment of groin hernias. Int Surg 1986;71:154.
28. Capozzi JA, Berkenfield JA, Cherry JK. Repair of inguinal hernia in the adult with prolene mesh. Surg Gynecol Obstet 1988; 167:124- 128.
29. Robbins AW, Rutkow IM. The mesh-plug hernioplasty. Surg Clin North Am 1993; 73:501-512.
30. Velasco JM, Vallina Vl, Esposito DJ, et al. Laparoscopic herniorrhaphy in the geriatric population. Am Surg 1998; 64(7): 633-637.
31. Newman L, Eubanks S, Manson E, et al. Is laparoscopic herniorrhaphy na effective alternative to open hernia repair? J Lap Endo Surg 1993;3:121.
32. Dhoste K. Haemodynamic and ventilatory changes during laparoscopic cholecystectomy in elderly ASA III patient. Can J Anaesth 1996;43: 8,783-788.
33. Branco PD, Birolini D, Oliveira, MR. Cirurgia na senilidade. In Azul LGC, Filho ETC, Decort LV - Clínica do indivíduo idoso. Săo Paulo. Guanabara Koogan Editora, 1981; pp 282-290.
34. Brittenden J Heys SD, Eremin O. Femoral hernia: mortality and morbidity following elective and emergency surgery. J R Coll Surg Edinb 1991;36:86-88.
35. Fenyo OG. Diagnostic problems of acute abdominal diseases in the aged. Acta Chir Scand 1974;140:396.
36. Resnick NM. Geriatric medicine. In Tierney LM, McPhee SJ, Papadakis MA - Current Medical Diagnosis & Treatment. 36th ediçăo. Lange Editora., Connecticut 1997, pp 48-68.
37. Rose JDR, Roberts GM, Williams G, et al. Cardiff Crohn's disease jubilee: the incidence over 50 years. Gut 1988:29:346.

Endereço para correspondência:

Dr. Fernando Antonio B. Pitrez Rua Padre Chagas, 367/801

90570-080 - Porto Alegre RS

Datas de Publicação

Publicação nesta coleção
31 Jul 2009
Data do Fascículo
Fev 2000

Histórico

Aceito
06 Dez 1999
Recebido
28 Ago 1999

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

[1] 1. Rosenthal RA. Small-bowel disorders and abdominal wall hernia in the elderly patient. Surg Clin North Am 1994;74(2):261-291.

[2] 2. Rutkow IM. Epidemiologic, economic and sociologic aspects of hernia surgery in the United States in the 1990's. Surg Clin North Am 1998;78(6):941-951.

[3] 3. Deysine M, Grimson R, Soroff HS. Herniorrhaphy in the elderly - Benefits of a clinic for the treatment of external abdominal wall hernias. Am J Surg 1987;153:387-391.

[4] 4. Pitrez FAB, Oliveira, JR., Furtado JP, et al. Hérnia inguinal no paciente idoso. Rev Col Bras Cir 1993;20(4):174-178.

[5] 5. Cians EGF, Cuneo S, Vitale FB, et al. Hernia repair in elderly patients. Br J Surg 1997;84:983-985.

[6] 6. Roraek-Madsen M. Herniorrhaphy in patients aged 80 years or more. Eur J Surg 1992;158:591.

[7] 7. Nehme AE. Groin hernias in elderly patients - Management and prognosis. Am J Surg 1983;146:257-260.

[8] 8. Wagh PV, Leverick AP, Sun CN, et al. Direct inguinal herniation in men: a disease of collagen. J Surg Res 1974;17:425-428.

[9] 9. Abrahamsen J. Hernias. In: Schwartz SI, Ellis H, Husser WC (eds).Maingot's Abdominal Operations. 9th ed. Norwalk, Connecticut. Appleton and Lange editora, 1990, pp 215-296.

[10] 10. Pitrez FAB, Pioner S. Hérnia Periestomal. In Silva LA - Hérnias da Parede Abdominal. 1Ş Ediçăo. Rio de Janeiro. Atheneu Editora, 1997, pp 223-234.

[11] 11. Lewis BS, Wenger JS, Wayne JD. Small bowel enteroscopy and intraoperative enteroscopy for obscure gastrointestinal bleeding. Am J Gastroenterol 1991;86:171-177.

[12] 12. Pioner SR, Pitrez FAB, Pioner GT. Herniorrafia pré-peritoneal para hérnias da regiăo inguinal. Col Bras Cir 1995; 22(2):142-146.

[13] 13. Tinwald GR, Cooperman M. Inguinal and femoral hernia repair in geriatric patients. Surg Gynecol Obstet 1982;154:704-706.

[14] 14. Kotz WJ, Sabiston DC. Hernias. In: Sabiston DC. Textbook of surger, the biological basis of modern surgical pratice. 5Ş ed. Saunders Editora. Philadelphia, 1998, pp 639-654.

[15] 15. Miller RD - Anesthesia. In: Way LW.Current: surgical diagnosis and treatement. 10th ediçăo. Lange Editora. Connecticut 1994, pp 174- 176.

[16] 16. Pitrez FAB, Lemchem HF, Serra A, et al. Semiologia das hérnias ínguino-crurais. Rev Med Sta Casa 1995; 6(12):1.259-1.263.

[17] 17. Emory RE, LaPorta AJ. Obturator hernia. Surgery Rounds. 1993, 43-46.

[18] 18. Pitrez FB. Fundamentos de Pré e Pós-operatório. Porto Alegre: Fundo Editorial Byk Editora, 1987.

[19] 19. Lubin MF, Kelly KG. Cuidado peri-opetório do paciente idoso. In Merli GJ, Weitz HH - Assistęncia Clínica ao Paciente Cirúrgico. Rio de Janeiro. Revinter Editora, 1997, pp 217-226.

[20] 20. Silva AL, Barbosa CA. Pré e pós-operatório em hérnia inguinal. In Pitrez FAB, Pioner SR - Pré e pós-operatório em cirurgia geral e especializada. Porto Alegre. Artmed Editora, 1999, pp 299-310.

[21] 21. Goldman L, et al - Multifactorial index os cardiac risk in noncardiac surgical procedures. N Engl J Med 1977;297:845-50.

[22] 22. Young DV. Comparison of local, spinal, and general anesthesia for inguinal herniorrhaphy. Am J Surg 1987;153:560-563.

[23] 23. Guillen J, Aldrite A. Anesthesic factors influencing morbidity and mortality of elderly patients undergoing inguinal herniorrhaphy. Am J Surg 1970;120:760.

[24] 24. Job CA, Fernandez MA, Dorph DJ, et al. Inguinal hernia repair: comparison of local, epidural and general anesthesia. NY State J Med 1979;79:1.730-40.

[25] 25. Teasdale C, McCrum A, Williams NB, et al - Aspects of treatment: a randomized controlled trial to compare local with general anesthesia for short stay inguinal hernia repair. Ann R Coll Surg Engl 1982; 64:238-241.

[26] 26. Keith A. On the origin and nature of hernia. Br J Surg 1924; 11:455.

[27] 27. Stoppa RE, WarLaumont CR, Verhalghe PJ, et al. Prosthetic repair in the treatment of groin hernias. Int Surg 1986;71:154.

[28] 28. Capozzi JA, Berkenfield JA, Cherry JK. Repair of inguinal hernia in the adult with prolene mesh. Surg Gynecol Obstet 1988; 167:124- 128.

[29] 29. Robbins AW, Rutkow IM. The mesh-plug hernioplasty. Surg Clin North Am 1993; 73:501-512.

[30] 30. Velasco JM, Vallina Vl, Esposito DJ, et al. Laparoscopic herniorrhaphy in the geriatric population. Am Surg 1998; 64(7): 633-637.

[31] 31. Newman L, Eubanks S, Manson E, et al. Is laparoscopic herniorrhaphy na effective alternative to open hernia repair? J Lap Endo Surg 1993;3:121.

[32] 32. Dhoste K. Haemodynamic and ventilatory changes during laparoscopic cholecystectomy in elderly ASA III patient. Can J Anaesth 1996;43: 8,783-788.

[33] 33. Branco PD, Birolini D, Oliveira, MR. Cirurgia na senilidade. In Azul LGC, Filho ETC, Decort LV - Clínica do indivíduo idoso. Săo Paulo. Guanabara Koogan Editora, 1981; pp 282-290.

[34] 34. Brittenden J Heys SD, Eremin O. Femoral hernia: mortality and morbidity following elective and emergency surgery. J R Coll Surg Edinb 1991;36:86-88.

[35] 35. Fenyo OG. Diagnostic problems of acute abdominal diseases in the aged. Acta Chir Scand 1974;140:396.

[36] 36. Resnick NM. Geriatric medicine. In Tierney LM, McPhee SJ, Papadakis MA - Current Medical Diagnosis & Treatment. 36th ediçăo. Lange Editora., Connecticut 1997, pp 48-68.

[37] 37. Rose JDR, Roberts GM, Williams G, et al. Cardiff Crohn's disease jubilee: the incidence over 50 years. Gut 1988:29:346.

Brasil

Brasil

Aspectos atuais da herniorrafia no idoso

Current aspects of herniorrhaphy in the elderly

Resumos

Datas de Publicação

Histórico