Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720130007&lang=es vol. 141 num. 7 lang. es <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[Aprendizaje del razonamiento clínico por reconocimiento de patrón, en seminarios de casos clínicos prototipos, por estudiantes de tercer año de medicina]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000700001&lng=es&nrm=iso&tlng=es Background: Clinical reasoning is the most important competente in the training process of a physician. Aim: To develop a method for teaching clinical reasoning based on prototypes of clinical cases. Material and Methods: The study was conducted on sixty-four third year medical students. The study and control groups attended lectures and tutorial sessions with patients. The study group attended additionally discussion seminars of prototypical clinical cases. A clinical reasoning test was applied at the start and end of the learning period to both groups. At the end of the study, the opinions of students of the study group were collected in afocus group. Results: After the learning period, both groups significantly increased their clinical reasoning skills. However, the improvement in the study group was more than double than that ofthe control group. The absolute improvement in the study group was 30.9%. Students interviewed in the focus group were unanimous in expressing their satisfaction in each and every aspect discussed. Conclusions: The teaching of clinical reasoning to third year medical students by means of pattern recognition in seminars with clinical cases improved significantly their skills. <![CDATA[Sobrevida a largo plazo en adultos inmunocompetentes mayores de 60 años hospitalizados por neumonía adquirida en la comunidad]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000700002&lng=es&nrm=iso&tlng=es Background: A reduction in long-term survival of adult patients hospitalized with community-acquired pneumonia (CAP), especially older people with múltiple comorbidities, has been reported. Aim: To examine the clinical variables associated to mortality at 72 months of adult patients older than 60 years hospitalized with CAP and compare their mortality with a control group matched for age, gender and place of admission. Material and Methods: Prospective assessment of 465 immunocompetent patients aged 61 to 101 years, hospitalized for CAP in a teaching hospital. Hospital and 30 day mortality was obtained from medical records. Seventy two months survival ofthe 424 patients who were discharged olive, was compared with a group of 851 patients without pneumonia paired for gender and age. Mortality at 72 months was obtained from death certificates. Results: Eighty seven percent of patients had comorbidity. The median hospital length ofstay was 10 days, 8.8% died in the hospital, 29.7% at one year follow-up and 61.9%o at 6 years. The actuarial survival at six years was similar in the cohort of adults hospitalized with CAP and the control group matched for age, gender and site of care. In a multivariate analysis, the clinical variables associated with increased risk of dying during long-term follow-up were older age, chronic cardiovascular and neurological diseases, malignancy, absence of fever, low C-reactive protein at hospital admission and high-risk parameters of the Fine índex. Conclusions: Advanced age, some specific comorbidities, poor systemic inflammatory response at admission and high risk parameters of the Fine Index were associated to increased risk of dying on long-term follow-up among older adults hospitalized for CAP. <![CDATA[Comparación entre CHOP-like y R-CHOP en pacientes con linfoma no Hodgkin difuso de grandes células B y folicular: 10 años de experiencia del Hospital de Clínicas de Montevideo, Uruguay]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000700003&lng=es&nrm=iso&tlng=es Background: The most common types of non-Hodgkin lymphoma (NHL) are diffuse large B cell (DLBCL) and follicular (FL). Aim: To analyze the benefit ofRituxi-mab in overall survival (OS) of patients with NHL. Material and Methods: Review of medical record of 230 adult patients with afirst episode of NHL admitted between 2002 and 2011. We included 67 patients with DLBCL and 36 patients with FL. Results: The overall response (OR) was 64% with 39% complete remissions (CR) in DLBCL treated with CHOP-like and 100% with 89% CR with R-CHOP. The median OS with CHOP-like was 21 months versus not attained R-CHOP (p = 0.016). There was a statistically significant difference in median event-free survival (EvFS) in favor of R-CHOP: not attained versus 8.3 months for CHOP-like (log rank (p = 0.002)). In FL, the OR in patients treated with R-CHOP or R-CHOP-like was 85%) with 54% CR. With CHOP-like the OR was 59%> with 18% CR. The OS at 24 and 36 months in patients treated with R-CHOP or R-CHOP-like was 83 and 65%. The figures for patients treated with CHOP-like were 80 and 66%> respectively. The progression free survival (PFS) was 21 months with CHOP-like versus not attained with R-QT (p = 0,043). Conclusions: When Rituximab was added to CHOP, there was a higher CR, EvFS and OS in DLBCL and higher CR and PFS in FL. <![CDATA[<b>Encuesta de opinión pública sobre reproducción humana y usos de tecnología de reproducción asistida en habitantes de Santiago, Chile</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000700004&lng=es&nrm=iso&tlng=es Background: Advances in reproductive medicine and the use of assisted reproductive technologies (ART) have a great impact in the lives of people and the conformation of their families. Aim: To report the results of an opinion survey applied to inhabitants of Santiago, Chile about the use of ART to conceive. Material and Methods: A survey was designed and applied to a random representative sample of 1.500 people between the ages of 18 and 65 in the 34 municipalities of Santiago. Results: Eighty eight percent of respondents support the use of medical assistance to conceive children. Wide approval exists for the use of in vitro fertilization (IVF) by heterosexual couples, even when not married (85.9%) and by single women (70.4%), by both mole and female participants of every socioeconomic level, age group and religious affiliation. Support decreases significantly when the use of IVF is considered for post-menopausal women (35.1 %) and by same-sex couples (26.6%). Conclusions: Results of this survey indicate that the majority of inhabitants in Santiago favor the use of ART, including IVF. This support decreases significantly for elderly women and homosexual couples. <![CDATA[Influencia del sistema de salud de procedencia y otros factores en el resultado del reemplazo valvular mitral]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000700005&lng=es&nrm=iso&tlng=es Background: There is no consensus regarding which risk factors influence the outcome of mitral valve replacement. Aim: To study the effects ofthe referring health care system and other factors on the results of mitral replacement. Patients and Methods: We included 632 patients operated between 1990 and 2010 receiving the St Jude prosthesis. Patients were divided into three groups, group 1 composed by 180 patients coming from the Public System, group 2 composed by 182 patients coming from the University System and group 3 composed by 270 patients coming from the Private System. Results: Overall operative mortality was 4.3%. There was no difference between groups in mortality. Factors responsible for operative mortality were: emergency operation (Odds Patio (OR): 5.6 P < 0.01) and left ventricular function (according to ejection fraction) grade III to IV (OR: 2.5 p = 0.048). Actuarial survival rates at 1, 5, 10, 15 and 20 years were 95%, 87%, 76%, 61% and 41%, respectively. Risk factors for long-term mortality were diabetes (OR: 3.3 p < 0.01), left ventricular function grades III-IV (OR: 2.6 p < 0.01), New York Heart Association functional class III to PV (OR: 2.1 p < 0.005) and male sex (OR: 1.5 p < 0.032). Conclusions: Referring health care system and type of surgery do not constitute a risk factor for mitral replacement. Risk factors were: emergency surgery, ventricular function grades III-IV, diabetes, functional capacity class III-IV and male sex. Integration of public and private health care systems in a university hospital setting achieves excellent outcomes for complex pathology <![CDATA[Logro de metas de prevención secundaria, prescripción farmacológica y eventos cardiovasculares mayores en pacientes con enfermedad coronaria]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000700006&lng=es&nrm=iso&tlng=es Background: Implementation of health programs to reduce cardiovascular risk, are needed for secondary prevention of cardiovascular diseases. Aim: To evalúate achievements of secondary prevention goals, pharmacologic prescription and major cardiovascular events in patients with coronary artery disease. Material and Methods: Patients who had a first event of acute coronary syndrome, angioplasty or revascularization surgery, between January 2008 and June 2010, were contacted for a clinical and laboratory evaluation between June and October 2011. Results: Seven hundred and two medical records were reviewed and 245 eligible patients were identified. Ofthese, we assessed 202 patients aged 64 ± 10 years (70% males). Sixty seven percent had two ormore cardiovascular riskfactors. A goal ofHDL cholesterol level over 40 mg/dL was achieved in 91 % of patients, smoking cessation in 84% and a total cholesterol < 200 mg/dL in 66%. A blood pressure below 130/85 mm Hgwas achieved in 30% of patients, a normal BMI in 19% and LDL cholesterol levels below 70 mg/dL in 18%. At the moment of assessment, 87%&gt; were using aspirin, 78%&gt; statins, 74% angiotensin converting enzyme inhibitors or angiotensin II receptor antagonists and 66%o were using β - blockers. Twenty two percent of patients had a major cardiovascular event during the follow up, which lasted 28 ± 8 months. Conclusions: A low percentage of cardiovascular goals achievement was observed in this sample of patients, with a high prevalence of overweight and obesity. A high percentage quit smoking after their first cardiovascular event. Despite the high percentage of drug prescription, hypertension and dyslipidemia were not fully controlled. <![CDATA[¿Cómo reciben los padres la noticia del diagnóstico de su hijo con síndrome de Down?]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000700007&lng=es&nrm=iso&tlng=es Background: Having a child with Down syndrome (DS) is usually unexpected and stressful. Aim: To describe the experiences of parents of children with DS at the time of diagnosis. Material and Methods: A self-administered survey was answered by 345 parents (62% women) with an offspring with DS. Results: Eighty four percent of parents received a postnatal diagnosis of DS, 32.3% were informed of the diagnosis in the presence of his or her partner and 19.3%o received some form of printed material regarding DS. Fifty six percent of respondents considered that the delivery of the diagnosis was inadequate. Factors associated with an overall positive experience were prenatal diagnosis (Odds Ratio (OR) 3.91 (95% Confidence Intervals (CI) 2.06-7.44)) and the presence of both parents at the time of the delivery of the diagnosis (OR 1.84 (95%> CI 1.16-2.91)). Fifty three percent of respondents believe that prenatal diagnosis of DS is preferable. Conclusions: The majority of parents are unsatisfied with the way the diagnosis of DS is delivered. Efforts should be made to educate health personnel regarding the delivery of the diagnosis of SD, to foster opportunities for prenatal diagnosis and to improve the delivery of printed material. <![CDATA[Anemia de las enfermedades crónicas asociada a obesidad: papel de la hepcidina como mediador central]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000700008&lng=es&nrm=iso&tlng=es Recent evidence suggests that obesity-related inflammation may play a central role in hepcidin regulation. Hepcidin is a key regulator ofiron homeostasis and has now been suggested as a central mediator ofiron metabolism disorders involved in the pathogenesis of anemia of chronic disease. In this review, we focus on subclinical inflammation in obesity and its effect on hepcidin levels, as the most plausible explanation for the relationship between anemia of chronic disease and obesity. <![CDATA[Purinas y ácido úrico en pre-eclampsia: interacciones fisiopatológicas y proyecciones en investigación]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000700009&lng=es&nrm=iso&tlng=es Uric acid is the final metabolite of purine break down, such as ATP, ADP, AMP, adenosine, inosine and hypoxanthine. The metabolite has been used broadly as a renal failure marker, as well as a risk factor for maternal and neonatal morbidity during pre-eclamptic pregnancies. High purine levels are observed in pre-eclamptic pregnancies, but the sources of these purines are unknown. However, there is evidence that pre-eclampsia (mainly severe pre-eclampsia) is associated with an increased release of cellular fragments (or microparticles) from the placenta to the maternal circulation. These in fact could be the substrate for purine metabolism. Considering this background, we propose that purines and uric acid are part of the same physiopathological phenomenon in pre-eclampsia (i.e., placental dysfunction) and could become biomarkers for placental dysfunction and postnatal adverse events. <![CDATA[La revisión de manuscritos en la Revista Médica de Chile y sus revisores externos en el año 2012]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000700010&lng=es&nrm=iso&tlng=es Uric acid is the final metabolite of purine break down, such as ATP, ADP, AMP, adenosine, inosine and hypoxanthine. The metabolite has been used broadly as a renal failure marker, as well as a risk factor for maternal and neonatal morbidity during pre-eclamptic pregnancies. High purine levels are observed in pre-eclamptic pregnancies, but the sources of these purines are unknown. However, there is evidence that pre-eclampsia (mainly severe pre-eclampsia) is associated with an increased release of cellular fragments (or microparticles) from the placenta to the maternal circulation. These in fact could be the substrate for purine metabolism. Considering this background, we propose that purines and uric acid are part of the same physiopathological phenomenon in pre-eclampsia (i.e., placental dysfunction) and could become biomarkers for placental dysfunction and postnatal adverse events. <![CDATA[Niveles séricos de alanino-aminotransferasa en población chilena: análisis de los resultados de la encuesta nacional de salud 2009-2010]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000700011&lng=es&nrm=iso&tlng=es Background: Determination of Alanine aminotransferase serum levels ([ALT]s) is a sensitive ana reliable test for liver diseases. Aim: To report the prevalence of abnormal [ALT]s in Chilean population and to identify associated variables. Methods: We analyzed data from a random sub-sample of 2,794 adults surveyed during the second Chilean National Health Survey. Abnormal [ALT]s were defined by using three different cut-off values (COV), two fixed COV (COV1: > 30 IU/L in men and > 19 IU/L in women and COV2 pre-defined by the performing laboratory) and a COV adjusted by age, weight and sex (COV3 > 31 IU/L for women and > 44 IU/L and men > 42 IU/L and > 66 IU/L with a BMI > 23). Logistic regression analysis was performed to determine risk factors for elevated [ALT]s Results: Mean [ALT]s values were 30.14 I U/L in men and 22.03 IU/L in women. The observed prevalence of abnormal [ALT]s defined by different COV were 38%, 11.5%, and 8.1% for COV1, COV2 and COV3 respectively. Variables independently associated to abnormal [ALT]s in a multivariate analysis were the following: serum gamma-glutamyl-transpeptidase (OR: 1.055 [95% CI 1.033-1.078]) and body mass index (OR:1.13 [95% CI 1.09-1.17]). Variables inversely associated with abnormal [ALT]s (COV1) were mole gender (OR-.0.976 [95% CI 0.96-0.99) and HDL-cholesterol (OR:0979 [95% CI 0.96-0.99]). Conclusions: Independently of the COV used, Chilean population exhibits a high prevalence of abnormal [ALT]s which may reflect a significant burden of liver disease. Non-alcoholic fatty liver disease could be a major contributor to elevated [ALT]s considering the association of abnormal [ALT]s and metabolic variables. <![CDATA[Hepatitis aguda por mononucleosis infecciosa en un varón de 21 años]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000700012&lng=es&nrm=iso&tlng=es A 21-year-old mole was admitted because of fever, fatigue, headache, pharyngitis, abdominal pain, loss of appetite, vomiting and dark urine for three days. The patient denied recent use of medicines or any other drug. His physical examination disclosed jaundice, hepato-splenomegaly, whitish-yellow covered tonsils, bilateral anterior and posterior cervical lymph node enlargement associated with edema on the face and neck. Routine blood tests detected abnormalities in serum bilirubins and liver enzymes (total bilirubin: 14.5 mg/dl, direct-reacting bilirubin: 12.9 mg/dl, AST: 697 U/l, ALT: 619 U/l, alkaline phosphatases: 260 U/l, and GGT: 413 U/l). Serological tests showed negative results for viral hepatitis, cytomegalovirus, HIV-1 and HIV-2, and toxoplasmosis markers, while serology for recent infection by EBV was positive (IgM: 70 and 29 U/ml; EBV IgG: 25 and 156 U/ml). Although infrequently, EBV infection can cause acute hepatitis with accentuated cholestatic jaundice (5% of cases), which may constitute an additional diagnostic challenge for primary care physicians. The patient improved with supportive management and was discharged after 12 days. This case study might contribute to increase the suspicion index about acute hepatitis related to EBV.<hr/>Un paciente varón de 21 años, fue hospitalizado por fiebre, astenia, cefalea, faringitis, dolor abdominal, pérdida del apetito, vómitos y orina oscura desde tres días antes. El paciente negó uso reciente de medicamentos y cualquier otra droga. Su examen físico reveló ictericia, hepato-esplenomegalia, amigdalitis, adenopatías cervicales anteriores y posteriores, asociadas con edema facial y cervical. Los exámenes de laboratorio mostraron elevación sérica de bilirrubina y enzimas hepáticas (bilirrubina total: 14,5 mg/dl, bilirrubina directa: 12,9 mg/dl, AST: 697 U/l, ALT: 619 U/l, fosfatasas alcalinas: 260 U/l, y gama-GT: 413 U/l). Los tests serológicos resultaron negativos para hepatitis viral A, B o C, citomegalovirus, VIH-1 y VIH-2, y toxoplasmosis; pero la serología de infección reciente por VEB fue positiva (IgM: 70 y 29 U/ml; IgG: 25 y 156 U/ml). Aunque raramente, las infecciones por VEB pueden causar una hepatitis aguda con acentuada ictericia colestásica (5% de los casos), que suele constituir un desafío diagnóstico adicional para los médicos en atención primaria. El paciente mejoró durante un tratamiento de apoyo y recibió alta hospitalaria después de 12 días. Este caso estimula a aumentar el índice de sospecha de hepatitis aguda relacionada con VEB. <![CDATA[Síndrome Hughes-Stovin: Caso clínico]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000700013&lng=es&nrm=iso&tlng=es We report a 25yearold mole admitted to a critical care unit for fever, lung opacities and acute respiratory failure. A chest angio-CAT sean showed multiple pulmonary artery aneurysms. A deep venous thrombosis of both lower limbs was also documented. A Hughes-Stovin syndrome was postulated. An inferior vena cava filter was placed. The patient received antimicrobial therapy subsiding fever and respiratory failure. Subsequently, he was treated with intravenous and oral steroids and one dose of cyclophosphamide. The patient was discharged in good conditions fifteen days after admission. <![CDATA[Lipoma gástrico gigante sintomático tratado con gastrectomía subtotal laparoscópica: caso clínico]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000700014&lng=es&nrm=iso&tlng=es Gastric lipoma is a rare benign gastric tumor. We report a 62-year-old man, who presented with abdominal pain, vomiting and weight loss. An upper gastrointestinal endoscopy showed a gastric antral, submucosal tumor. Abdominal ultrasound and computed tomography revealed a large antral lesion with content of high echogenicity and fat density, measuring 11 x 6 cm. The patient was treated with a laparoscopic distal subtotal gastrectomy, and a Roux-en-Y reconstruction. The patient had no postoperative morbidity, was started on a liquid diet on the third postoperative day and was discharged on the third postoperative day. The pathological study revealed a gastric lipoma with clear margins. This laparoscopic procedure represents a good alternative in the treatment of this benign gastric tumor. <![CDATA[Uso versus no uso de malla en hernioplastía inguinal: ¿existe un rol para la reparación sin malla? Revisión global de la evidencia]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000700015&lng=es&nrm=iso&tlng=es There is controversy about the effectiveness of mesh techniques for inguinal hernia repair (IHR) when compared with non-mesh procedures. The aim of this study was to systematically review the available evidence on the effectiveness of mesh compared to non-mesh IHR techniques. Cochrane Central and MEDLINE databases and the TRIP Database engine were reviewed looking for systematic reviews (SR) and clinical trials (CT) published from 1990 to 2012, comparing the effectiveness, in terms of operative time, postoperative pain, morbidity, hospital stay, return to work, costs and recurrence, of mesh and non-mesh IHR techniques. We retrieved 3,069 articles, 17 of which met the selection criteria (3 SR and 14 RCT), representing a population of 15,124 subjects (7361 mesh and 7763 non-mesh IHR). According to these studies, mesh IHR techniques are associated with less surgical time, pain, hospital stay, recurrence and sooner return to work than non-mesh techniques. It is concluded that mesh techniques are more effective than those not using a mesh. <![CDATA[<b>El peregrinar de un paper</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000700016&lng=es&nrm=iso&tlng=es There is controversy about the effectiveness of mesh techniques for inguinal hernia repair (IHR) when compared with non-mesh procedures. The aim of this study was to systematically review the available evidence on the effectiveness of mesh compared to non-mesh IHR techniques. Cochrane Central and MEDLINE databases and the TRIP Database engine were reviewed looking for systematic reviews (SR) and clinical trials (CT) published from 1990 to 2012, comparing the effectiveness, in terms of operative time, postoperative pain, morbidity, hospital stay, return to work, costs and recurrence, of mesh and non-mesh IHR techniques. We retrieved 3,069 articles, 17 of which met the selection criteria (3 SR and 14 RCT), representing a population of 15,124 subjects (7361 mesh and 7763 non-mesh IHR). According to these studies, mesh IHR techniques are associated with less surgical time, pain, hospital stay, recurrence and sooner return to work than non-mesh techniques. It is concluded that mesh techniques are more effective than those not using a mesh. <![CDATA[<b>La ciencia de Unánue</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000700017&lng=es&nrm=iso&tlng=es There is controversy about the effectiveness of mesh techniques for inguinal hernia repair (IHR) when compared with non-mesh procedures. The aim of this study was to systematically review the available evidence on the effectiveness of mesh compared to non-mesh IHR techniques. Cochrane Central and MEDLINE databases and the TRIP Database engine were reviewed looking for systematic reviews (SR) and clinical trials (CT) published from 1990 to 2012, comparing the effectiveness, in terms of operative time, postoperative pain, morbidity, hospital stay, return to work, costs and recurrence, of mesh and non-mesh IHR techniques. We retrieved 3,069 articles, 17 of which met the selection criteria (3 SR and 14 RCT), representing a population of 15,124 subjects (7361 mesh and 7763 non-mesh IHR). According to these studies, mesh IHR techniques are associated with less surgical time, pain, hospital stay, recurrence and sooner return to work than non-mesh techniques. It is concluded that mesh techniques are more effective than those not using a mesh. <![CDATA[<b>FE DE ERRATAS</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000700018&lng=es&nrm=iso&tlng=es There is controversy about the effectiveness of mesh techniques for inguinal hernia repair (IHR) when compared with non-mesh procedures. The aim of this study was to systematically review the available evidence on the effectiveness of mesh compared to non-mesh IHR techniques. Cochrane Central and MEDLINE databases and the TRIP Database engine were reviewed looking for systematic reviews (SR) and clinical trials (CT) published from 1990 to 2012, comparing the effectiveness, in terms of operative time, postoperative pain, morbidity, hospital stay, return to work, costs and recurrence, of mesh and non-mesh IHR techniques. We retrieved 3,069 articles, 17 of which met the selection criteria (3 SR and 14 RCT), representing a population of 15,124 subjects (7361 mesh and 7763 non-mesh IHR). According to these studies, mesh IHR techniques are associated with less surgical time, pain, hospital stay, recurrence and sooner return to work than non-mesh techniques. It is concluded that mesh techniques are more effective than those not using a mesh. <![CDATA[<b>FE DE ERRATAS</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000700019&lng=es&nrm=iso&tlng=es There is controversy about the effectiveness of mesh techniques for inguinal hernia repair (IHR) when compared with non-mesh procedures. The aim of this study was to systematically review the available evidence on the effectiveness of mesh compared to non-mesh IHR techniques. Cochrane Central and MEDLINE databases and the TRIP Database engine were reviewed looking for systematic reviews (SR) and clinical trials (CT) published from 1990 to 2012, comparing the effectiveness, in terms of operative time, postoperative pain, morbidity, hospital stay, return to work, costs and recurrence, of mesh and non-mesh IHR techniques. We retrieved 3,069 articles, 17 of which met the selection criteria (3 SR and 14 RCT), representing a population of 15,124 subjects (7361 mesh and 7763 non-mesh IHR). According to these studies, mesh IHR techniques are associated with less surgical time, pain, hospital stay, recurrence and sooner return to work than non-mesh techniques. It is concluded that mesh techniques are more effective than those not using a mesh.