Hospital Nossa Senhora da Conceição (HNSC), Departamento de Cirurgia Geral, Porto Alegre, RS, Brasil.
Hospital Nossa Senhora das Graças, Unidade de Cirurgia do Aparelho Digestivo, Curitiba, PR, Brasil.
Arq Gastroenterol. 2020 Sep-Dec;57(4):484-490. doi: 10.1590/S0004-2803.202000000-85.
Abdominal wall hernia is one of the most common surgical pathologies. The advent of minimally invasive surgery raised questions about the best technique to be applied, considering the possibility of reducing postoperative pain, a lower rate of complications, and early return to usual activities.
To evaluate the frequency of open and laparoscopic hernioplasties in Brazil from 2008 to 2018, analyzing the rates of urgent and elective surgeries, mortality, costs, and the impact of laparoscopic surgical training on the public health system.
Nationwide data from 2008 to 2018 were obtained from the public health registry database (DATASUS) for a descriptive analysis of the selected data and parameters.
2,671,347 hernioplasties were performed in the period, an average of 242,850 surgeries per year (99.4% open, 0.6% laparoscopic). The economically active population (aged 20-59) constituted the dominant group (54.5%). There was a significant reduction (P<0.01) in open surgeries, without a compensatory increase in laparoscopic procedures. 22.3% of surgeries were urgent, with a significant increase in mortality when compared to elective surgeries (P<0.01). The distribution of laparoscopic surgery varied widely, directly associated with the number of digestive surgeons.
This study presents nationwide data on hernia repair surgeries in Brazil for the first time. Minimally invasive techniques represent a minor portion of hernioplasties. Urgent surgeries represent a high percentage when compared to other countries, with increased mortality. The data reinforce the need for improvement in the offer of services, specialized training, and equalization in the distribution of procedures in all regions.
腹壁疝是最常见的外科疾病之一。微创外科的出现引发了关于最佳应用技术的问题，考虑到减少术后疼痛、降低并发症发生率和尽早恢复正常活动的可能性。
评估 2008 年至 2018 年巴西开放和腹腔镜疝修补术的频率，分析急症和择期手术的比例、死亡率、成本以及腹腔镜手术培训对公共卫生系统的影响。
从公共卫生登记数据库（DATASUS）获得 2008 年至 2018 年的全国数据，对所选数据和参数进行描述性分析。
该期间共进行了 2671347 例疝修补术，平均每年进行 242850 例手术（99.4%为开放性，0.6%为腹腔镜）。经济活跃人口（20-59 岁）构成了主要群体（54.5%）。开放性手术显著减少（P<0.01），但腹腔镜手术并未相应增加。22.3%的手术为急症，与择期手术相比死亡率显著升高（P<0.01）。腹腔镜手术的分布差异很大，与消化外科医生的数量直接相关。
本研究首次提供了巴西疝修补术的全国性数据。微创技术仅占疝修补术的一小部分。与其他国家相比，急症手术比例较高，死亡率增加。这些数据强化了在所有地区提供服务、专门培训和均衡手术分配方面改进的必要性。
