Prevalência de inguinodinia em pacientes submetidos à herniorrafia inguinal na Faculdade de Medicina de Botucatu – UNESP
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Data
2017-08-07
Autores
Camargo, Daniel [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: As hérnias ínguino-crurais são protrusões anormais do peritônio em consequência a persistência do conduto peritônio vaginal ou ao enfraquecimento da parede abdominal na região inguinal. São classificadas quanto ao tipo, podendo ser direta, indireta ou mista, além das femorais. Sua real incidência é desconhecida, porém seu tratamento cirúrgico, a herniorrafia inguinal, é atualmente um dos procedimentos mais realizados no mundo. Dentre as complicações, destacam-se a recorrência e a dor crônica pós-operatória, ou inguinodinia. As técnicas cirúrgicas atuais diminuíram consideravelmente a recorrência, porém estudos mostram que a inguinodinia pode chegar a 43% dos casos, e pode ser subdividida em neuropática, somática ou disejaculatória, sendo o seu diagnóstico fundamental no sucesso do tratamento. Objetivo: Identificar os pacientes submetidos à herniorrafia inguinal em nosso serviço que desenvolveram inguinodinia, avaliando suas características epidemiológicas, etiológicas e somatossensoriais, permitindo traçar o perfil de risco para o desenvolvimento da dor crônica no pós-operatório. Materiais e métodos: Análise retrospectiva observacional dos prontuários eletrônicos de todos os pacientes submetidos à herniorrafia inguinal realizada no HC-FMB entre junho de 2012 e dezembro de 2015, além de entrevista telefônica para identificação de pacientes com sintomatologia compatível com inguinodinia, seguida de avaliação médica focada na propedêutica da dor para caracterização da dor crônica pós-operatória. Resultados: Foram identificados 267 procedimentos de herniorrafia inguinal no período estudado, sendo 90,3%em pacientes do sexo masculino. A idade média foi de 53,9 anos, variando entre 17 e 96 anos. Hérnias exclusivamente à direita ocorreram em 52,1% dos casos, 30,7% à esquerda e 17,2% apresentaram enfermidade bilateral. As hérnias indiretas totalizaram 49,2% do total, enquanto as diretas ocorreram em 35,1% e as mistas em 14,1%. As hérnias ínguino-crurais foram identificadas em 1,6% delas. As telas sintéticas foram utilizadas em 84,6% dos casos. Entre os pacientes contatados, 111 preencheram critérios de inclusão, dos quais 19 responderam positivamente em relação à dor crônica e foram convidados para avaliação médica e foram examinados. Desses, 16 foram diagnosticados com inguinodinia, resultando em uma incidência de 14,4% dos casos avaliados, com ocorrência maior em mulheres com hérnia femoral submetidas à técnica de Mcvay. Conclusão: A taxa de complicação e as características demográficas dos pacientes corroboram com a literatura, bem como a incidência de inguinodinia. Destaca-se o seu subdiagnóstico, que acarreta em sofrimento físico e psicológico, além de prejuízos pessoais e sociais aos pacientes que evoluem com dor crônica no pós-operatório.
Introduction: Groin hernias are peritoneum abnormal protrusions due to abdominal wall weakening at the inguinal region. They are classified according to type, being direct, indirect or mixed besides the femoral ones. The actual incidence is unknown, but the surgical treatment is currently one of the most performed surgical procedures in the world. Among the complications, its recurrence and chronic postoperative pain, or inguinodynia stand out. Current surgical techniques have considerably reduced the incidence of recurrence, but studies show that inguinodynia can reach up to 43% of the cases, subdivided into neuropathic, somatic or disejaculatory, and the diagnosis is fundamental for the success of the treatment. Objective: To identify the patients submitted to inguinal herniorrafy at our service who developed inguinodynia, evaluating their epidemiological, etiological and somatosensory characteristics, allowing tracing the risk profile for the development of chronic postoperative pain. Materials and methods: Retrospective observational analysis of the electronic charts of all patients submitted to inguinal hernioplasty performed at the HC-FMB between June 2012 and December 2015, in addition to a telephone interview to identify patients with probable symptoms of inguinodynia, followed by medical evaluation focused on the propaedeutic of pain for the characterization of chronic postoperative pain. Results:A total of 267 inguinal hernioplasty procedures were identified in the study period, 90.3% of which were male patients. The mean age was 53.9 years, ranging from 17 to 96 years. Right groin hernias occurred in 52.1% of the cases, 30.7% to the left and 17.2% presented bilateral illness. Indirect hernias totaled 49.2% of the total, while direct ones occurred in 35.1% and mixed ones in 14.1%. Femoral hernias were identified in 1.6% of them. The synthetic mesheswere used in 84.6% of the cases. Success was achieved in contacting 111 patients, of whom 19 met criteria for medical evaluation and were examined. Of these, 16 were diagnosed with inguinodynia, resulting in an incidence of 14.4% of the cases evaluated, with a higher occurrence in women with femoral hernia submitted to the Mcvay technique. Conclusion: The complication rate and the demographic characteristics of the patients corroborate with the literature, as well as the incidence of inguinodynia. It’s lack of diagnoses is evident, which leads to physical and psychological suffering, as well as personal and social harm to patients who develop chronic postoperative pain.
Introduction: Groin hernias are peritoneum abnormal protrusions due to abdominal wall weakening at the inguinal region. They are classified according to type, being direct, indirect or mixed besides the femoral ones. The actual incidence is unknown, but the surgical treatment is currently one of the most performed surgical procedures in the world. Among the complications, its recurrence and chronic postoperative pain, or inguinodynia stand out. Current surgical techniques have considerably reduced the incidence of recurrence, but studies show that inguinodynia can reach up to 43% of the cases, subdivided into neuropathic, somatic or disejaculatory, and the diagnosis is fundamental for the success of the treatment. Objective: To identify the patients submitted to inguinal herniorrafy at our service who developed inguinodynia, evaluating their epidemiological, etiological and somatosensory characteristics, allowing tracing the risk profile for the development of chronic postoperative pain. Materials and methods: Retrospective observational analysis of the electronic charts of all patients submitted to inguinal hernioplasty performed at the HC-FMB between June 2012 and December 2015, in addition to a telephone interview to identify patients with probable symptoms of inguinodynia, followed by medical evaluation focused on the propaedeutic of pain for the characterization of chronic postoperative pain. Results:A total of 267 inguinal hernioplasty procedures were identified in the study period, 90.3% of which were male patients. The mean age was 53.9 years, ranging from 17 to 96 years. Right groin hernias occurred in 52.1% of the cases, 30.7% to the left and 17.2% presented bilateral illness. Indirect hernias totaled 49.2% of the total, while direct ones occurred in 35.1% and mixed ones in 14.1%. Femoral hernias were identified in 1.6% of them. The synthetic mesheswere used in 84.6% of the cases. Success was achieved in contacting 111 patients, of whom 19 met criteria for medical evaluation and were examined. Of these, 16 were diagnosed with inguinodynia, resulting in an incidence of 14.4% of the cases evaluated, with a higher occurrence in women with femoral hernia submitted to the Mcvay technique. Conclusion: The complication rate and the demographic characteristics of the patients corroborate with the literature, as well as the incidence of inguinodynia. It’s lack of diagnoses is evident, which leads to physical and psychological suffering, as well as personal and social harm to patients who develop chronic postoperative pain.
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Palavras-chave
Cirurgia, Dor, Hérnia, Inguinodinia