{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T19:13:09Z","timestamp":1773429189212,"version":"3.50.1"},"reference-count":52,"publisher":"FapUNIFESP (SciELO)","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ABCD, arq. bras. cir. dig."],"abstract":"<jats:p>ABSTRACT Large hiatal hernias, besides being more prevalent in the elderly, have a different clinical presentation: less reflux, more mechanical symptoms, and a greater possibility of acute, life-threatening complications such as gastric volvulus, ischemia, and visceral mediastinal perforation. Thus, surgical indications are distinct from gastroesophageal reflux disease-related sliding hiatal hernias. Heartburn tends to be less intense, while symptoms of chest pain, cough, discomfort, and tiredness are reported more frequently. Complaints of vomiting and dysphagia may suggest the presence of associated gastric volvulus. Signs of iron deficiency and anemia are found. Surgical indication is still controversial and was previously based on high mortality reported in emergency surgeries for gastric volvulus. Postoperative mortality is especially related to three factors: body mass index above 35, age over 70 years, and the presence of comorbidities. Minimally invasive elective surgery should be offered to symptomatic individuals with good or reasonable performance status, regardless of age group. In asymptomatic and oligosymptomatic patients, besides obviously identifying the patient\u2019s desire, a case-by-case analysis of surgical risk factors such as age, obesity, and comorbidities should be taken into consideration. Attention should also be paid to situations with greater technical difficulty and risks of acute migration due to increased abdominal pressure (abdominoplasty, manual labor, spastic diseases). Technical alternatives such as partial fundoplication and anterior gastropexy can be considered. We emphasize the importance of performing surgical procedures in cases of large hiatal hernias in high-volume centers, with experienced surgeons.<\/jats:p>","DOI":"10.1590\/0102-672020230069e1787","type":"journal-article","created":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T09:54:33Z","timestamp":1707126873000},"source":"Crossref","is-referenced-by-count":4,"title":["BRAZILIAN HERNIA AND ABDOMINAL WALL SOCIETY STATEMENT ON LARGE HIATAL HERNIAS MANAGEMENT"],"prefix":"10.1590","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0285-2122","authenticated-orcid":false,"given":"Andr\u00e9","family":"BRANDALISE","sequence":"first","affiliation":[{"name":"Centro M\u00e9dico de Campinas,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3594-5744","authenticated-orcid":false,"given":"Fernando Augusto Mardiros","family":"HERBELLA","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2707-511X","authenticated-orcid":false,"given":"Renato Abrantes","family":"LUNA","sequence":"additional","affiliation":[{"name":"Universidade Federal do Estado do Rio de Janeiro,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6238-3532","authenticated-orcid":false,"given":"Sergio","family":"SZACHNOWICZ","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1823-0042","authenticated-orcid":false,"given":"Rubens Antonio Aissar","family":"SALLUM","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5115-569X","authenticated-orcid":false,"given":"Carlos Eduardo","family":"DOMENE","sequence":"additional","affiliation":[{"name":"Sociedade Brasileira de Cirurgia Laparosc\u00f3pica e Rob\u00f3tica,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1586-5037","authenticated-orcid":false,"given":"Paula","family":"VOLPE","sequence":"additional","affiliation":[{"name":"Centro Integrado de Medicina Avan\u00e7ada,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2356-2789","authenticated-orcid":false,"given":"Leandro Totti","family":"CAVAZZOLLA","sequence":"additional","affiliation":[{"name":"Universidade Federal do Rio Grande do Sul,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5103-5807","authenticated-orcid":false,"given":"Marcelo Lopes","family":"FURTADO","sequence":"additional","affiliation":[{"name":"Sociedade Brasileira de H\u00e9rna e Parede Abdominal,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1465-5430","authenticated-orcid":false,"given":"Christiano Marlo Paggi","family":"CLAUS","sequence":"additional","affiliation":[{"name":"Universidade Positivo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3673-7341","authenticated-orcid":false,"given":"Jos\u00e9 Francisco de Mattos","family":"FARAH","sequence":"additional","affiliation":[{"name":"Hospital do Servidor P\u00fablico Estadual,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6688-0819","authenticated-orcid":false,"given":"Eduardo","family":"CREMA","sequence":"additional","affiliation":[{"name":"Universidade Federal do Tri\u00e2ngulo Mineiro,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","published-online":{"date-parts":[[2023]]},"reference":[{"issue":"3","key":"ref1","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1016\/j.athoracsur.2012.04.083","article-title":"A randomized multiinstitution comparison of the laparoscopic Nissen and Hill repairs.","volume":"94","author":"Aye RW","year":"2012","journal-title":"Ann Thorac Surg."},{"issue":"3","key":"ref2","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1016\/j.jtcvs.2012.12.026","article-title":"A clinical prediction rule for perioperative mortality and major morbidity after laparoscopic giant paraesophageal hernia repair.","volume":"145","author":"Ballian N","year":"2013","journal-title":"J Thorac Cardiovasc Surg."},{"issue":"3","key":"ref3","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1007\/s11605-017-3598-4","article-title":"A hill gastropexy combined with nissen fundoplication appears equivalent to a collis-nissen in the management of short esophagus.","volume":"22","author":"Bellevue OC","year":"2018","journal-title":"J Gastrointest Surg."},{"issue":"4","key":"ref4","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1007\/s00464-014-3744-y","article-title":"Assessment and reduction of diaphragmatic tension during hiatal hernia repair.","volume":"29","author":"Bradley DD","year":"2015","journal-title":"Surg Endosc."},{"issue":"4","key":"ref5","first-page":"224","article-title":"The polypropylene mesh in the laparoscopic repair of large hiatal hernias: technical aspects.","volume":"25","author":"Brandalise A","year":"2012","journal-title":"Arq Bras Cir Dig."},{"issue":"1","key":"ref6","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/0002-9610(80)90424-9","article-title":"Acute gastric volvulus. A study of 25 cases.","volume":"140","author":"Carter R","year":"1980","journal-title":"Am J Surg."},{"issue":"4","key":"ref7","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.thorsurg.2019.07.002","article-title":"Laparoscopic approach to paraesophageal hernia repair.","volume":"29","author":"Chan EG","year":"2019","journal-title":"Thorac Surg Clin."},{"issue":"6","key":"ref8","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1016\/j.soard.2013.03.013","article-title":"Prevalence of hiatal hernia in the morbidly obese.","volume":"9","author":"Che F","year":"2013","journal-title":"Surg Obes Relat Dis."},{"issue":"5","key":"ref9","doi-asserted-by":"crossref","first-page":"2243","DOI":"10.1007\/s00464-019-07014-3","article-title":"Paraesophageal hernia repair: a curative consideration for chronic anemia?","volume":"34","author":"Cheverie JN","year":"2020","journal-title":"Surg Endosc."},{"issue":"4","key":"ref10","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.thorsurg.2019.07.006","article-title":"Preoperative evaluation and clinical decision making for giant paraesophageal hernias: who gets an operation?","volume":"29","author":"Choi S","year":"2019","journal-title":"Thorac Surg Clin."},{"issue":"3","key":"ref11","doi-asserted-by":"crossref","first-page":"2295","DOI":"10.1007\/s00464-022-09514-1","article-title":"Does bioabsorbable mesh reduce hiatal hernia recurrence rates? A meta-analysis.","volume":"37","author":"Clapp B","year":"2023","journal-title":"Surg Endosc."},{"issue":"6","key":"ref12","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.1007\/s00464-015-4522-1","article-title":"The use of crural relaxing incisions with biologic mesh reinforcement during laparoscopic repair of complex hiatal hernias.","volume":"30","author":"Crespin OM","year":"2016","journal-title":"Surg Endosc."},{"issue":"2","key":"ref13","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1007\/s00464-021-08425-x","article-title":"Elective paraesophageal hernia repair in elderly patients: an analysis of ACS-NSQIP database for contemporary morbidity and mortality.","volume":"36","author":"Damani T","year":"2022","journal-title":"Surg Endosc."},{"issue":"6","key":"ref14","doi-asserted-by":"crossref","first-page":"765","DOI":"10.21614\/chirurgia.113.6.765","article-title":"Large paraesophageal hiatus hernia: is surgery mandatory?","volume":"113","author":"Dellaportas D","year":"2018","journal-title":"Chirurgia (Bucur)."},{"issue":"1","key":"ref15","first-page":"39","article-title":"Clinical and in vitro analysis of determinants of gastroesophageal competence.","volume":"137","author":"DeMeester TR","year":"1979","journal-title":"A study of the principles of antireflux surgery. Am J Surg."},{"issue":"10","key":"ref16","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1007\/s004649900832","article-title":"Sac excision is essential to adequate laparoscopic repair of paraesophageal hernia.","volume":"12","author":"Edye M","year":"1998","journal-title":"Surg Endosc."},{"issue":"5","key":"ref17","doi-asserted-by":"crossref","first-page":"2332","DOI":"10.1007\/s00464-020-07647-9","article-title":"How high is too high? Extensive mediastinal dissection in patients with hiatal hernia repair.","volume":"35","author":"Flores LE","year":"2021","journal-title":"Surg Endosc."},{"issue":"1","key":"ref18","doi-asserted-by":"crossref","first-page":"23","DOI":"10.4293\/108680812X13517013316951","article-title":"Open versus laparoscopic hiatal hernia repair.","volume":"17","author":"Fullum TM","year":"2013","journal-title":"JSLS."},{"issue":"1","key":"ref19","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1007\/s00268-010-0814-8","article-title":"Tailored or routine addition of an antireflux fundoplication in laparoscopic large hiatal hernia repair: a comparative cohort study.","volume":"35","author":"Furn\u00e9e EJB","year":"2011","journal-title":"World J Surg."},{"issue":"11","key":"ref20","doi-asserted-by":"crossref","first-page":"4337","DOI":"10.1007\/s00464-013-3069-2","article-title":"Laparoscopic repair of hiatal hernias: new classification supported by long-term results.","volume":"27","author":"Grubnik VV","year":"2013","journal-title":"Surg Endosc."},{"issue":"6","key":"ref21","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1016\/S1091-255X(03)00077-5","article-title":"Short esophagus or bad dissected esophagus? An experimental cadaveric study.","volume":"7","author":"Herbella FAM","year":"2003","journal-title":"J Gastrointest Surg."},{"issue":"1","key":"ref22","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1007\/s00464-020-07404-y","article-title":"Minimally invasive approach to hiatal hernia repair is superior to open, even in the emergent setting: a large national database analysis.","volume":"35","author":"Hosein S","year":"2021","journal-title":"Surg Endosc."},{"issue":"8","key":"ref23","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1001\/archsurg.133.8.867","article-title":"Postoperative function following laparoscopic collis gastroplasty for shortened esophagus.","volume":"133","author":"Jobe BA","year":"1998","journal-title":"Arch Surg."},{"issue":"4","key":"ref24","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1007\/s00464-019-06930-8","article-title":"Use of computed tomography volumetric measurements to predict operative techniques in paraesophageal hernia repair.","volume":"34","author":"Kao AM","year":"2020","journal-title":"Surg Endosc."},{"issue":"35","key":"ref25","doi-asserted-by":"crossref","first-page":"4959","DOI":"10.3748\/wjg.v18.i35.4959","article-title":"Cameron ulcers: an atypical source for a massive upper gastrointestinal bleed.","volume":"18","author":"Kapadia S","year":"2012","journal-title":"World J Gastroenterol."},{"issue":"1","key":"ref26","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1177\/155335060601300108","article-title":"Classification of hiatal hernias using dynamic three-dimensional reconstruction.","volume":"13","author":"Kavic SM","year":"2006","journal-title":"Surg Innov."},{"issue":"4","key":"ref27","doi-asserted-by":"crossref","DOI":"10.4293\/JSLS.2020.00061","article-title":"Video-laparoscopic treatment of intrathoracic gastric volvulus.","volume":"24","author":"Lopes LR","year":"2020","journal-title":"JSLS."},{"issue":"4","key":"ref28","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1097\/00000658-200010000-00016","article-title":"Laparoscopic repair of giant paraesophageal hernia: 100 consecutive cases.","volume":"232","author":"Luketich JD","year":"2000","journal-title":"Ann Surg."},{"key":"ref29","article-title":"Impact of body mass index on perioperative outcomes for complex hiatus hernia by videolaparoscopy.","volume":"35","author":"Luna RA","year":"2022","journal-title":"Arq Bras Cir Dig."},{"issue":"4","key":"ref30","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1097\/SLE.0000000000000655","article-title":"Suture cruroplasty versus mesh hiatal herniorrhaphy for large hiatal hernias (HHs): an updated meta-analysis and systematic review of randomized controlled trials.","volume":"29","author":"Memon MA","year":"2019","journal-title":"Surg Laparosc Endosc Percutan Tech."},{"issue":"11","key":"ref31","doi-asserted-by":"crossref","first-page":"1978","DOI":"10.1007\/s00464-007-9490-7","article-title":"Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes.","volume":"21","author":"Morgenthal CB","year":"2007","journal-title":"Surg Endosc."},{"issue":"4","key":"ref32","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/j.amjsurg.2018.07.037","article-title":"Watchful waiting versus elective repair for asymptomatic and minimally symptomatic paraesophageal hernias: a cost-effectiveness analysis.","volume":"216","author":"Morrow EH","year":"2018","journal-title":"Am J Surg."},{"issue":"5","key":"ref33","doi-asserted-by":"crossref","first-page":"1854","DOI":"10.1016\/j.athoracsur.2011.06.030","article-title":"Quality of life after collis gastroplasty for short esophagus in patients with paraesophageal hernia.","volume":"92","author":"Nason KS","year":"2011","journal-title":"Ann Thorac Surg."},{"issue":"9","key":"ref34","doi-asserted-by":"crossref","first-page":"3040","DOI":"10.1007\/s00464-019-06843-6","article-title":"Quantifying tension in tension-free hiatal hernia repair: a new intra-operative technique.","volume":"33","author":"Navaratne L","year":"2019","journal-title":"Surg Endosc."},{"issue":"4","key":"ref35","first-page":"481","article-title":"Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial.","volume":"244","author":"Oelschlager BK","year":"2006","journal-title":"Ann Surg."},{"issue":"4","key":"ref36","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/j.jamcollsurg.2011.05.017","article-title":"Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial.","volume":"213","author":"Oelschlager BK","year":"2011","journal-title":"J Am Coll Surg."},{"issue":"7","key":"ref37","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1007\/s11605-008-0520-0","article-title":"Vagotomy during hiatal hernia repair: a benign esophageal lengthening procedure.","volume":"12","author":"Oelschlager BK","year":"2008","journal-title":"J Gastrointest Surg."},{"issue":"3","key":"ref38","doi-asserted-by":"crossref","first-page":"1186","DOI":"10.1007\/s00464-016-5089-1","article-title":"Laparoscopic paraesophageal hernia repair is safe in elderly patients.","volume":"31","author":"Parker DM","year":"2017","journal-title":"Surg Endosc."},{"issue":"12","key":"ref39","doi-asserted-by":"crossref","first-page":"1910","DOI":"10.1007\/s11605-010-1308-6","article-title":"Laparoscopic repair of large hiatal hernia without prosthetic reinforcement: late results and relevance of anterior gastropexy.","volume":"14","author":"Poncet G","year":"2010","journal-title":"J Gastrointest Surg."},{"key":"ref40","article-title":"Laparoscopic antireflux surgery: are old questions answered? Mesh hernioplasty.","volume":"35","author":"Saad AR","year":"2023","journal-title":"Arq Bras Cir Dig."},{"issue":"5","key":"ref41","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1097\/SLE.0b013e3182a12680","article-title":"Laparoscopic paraesophageal hernia repair: current controversies.","volume":"23","author":"Soper NJ","year":"2013","journal-title":"Surg Laparosc Endosc Percutan Tech."},{"issue":"6","key":"ref42","doi-asserted-by":"crossref","first-page":"2560","DOI":"10.1007\/s00464-019-07291-y","article-title":"Safety of robotic assisted laparoscopic recurrent paraesophageal hernia repair: insights from a large single institution experience.","volume":"34","author":"Sowards KJ","year":"2020","journal-title":"Surg Endosc."},{"issue":"3","key":"ref43","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1177\/000313482008600336","article-title":"Efficacy and safety of recurrent paraesophageal hernia repair with Roux-en-Y gastric bypass.","volume":"86","author":"Spann MD","year":"2020","journal-title":"Am Surg."},{"issue":"6","key":"ref44","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1007\/s00464-008-0205-5","article-title":"Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series.","volume":"23","author":"Stadlhuber RJ","year":"2009","journal-title":"Surg Endosc."},{"issue":"4","key":"ref45","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1097\/00000658-200210000-00012","article-title":"Paraesophageal hernias: operation or observation?","volume":"236","author":"Stylopoulos N","year":"2002","journal-title":"Ann Surg."},{"issue":"1","key":"ref46","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s11605-016-3231-y","article-title":"Non-elective paraesophageal hernia repair portends worse outcomes in comparable patients: a propensity-adjusted analysis.","volume":"21","author":"Tam V","year":"2017","journal-title":"J Gastrointest Surg."},{"issue":"3","key":"ref47","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1177\/000313481808400322","article-title":"Videoesophagography versus endoscopy for prediction of intraoperative hiatal hernia size.","volume":"84","author":"Tatum JM","year":"2018","journal-title":"Am Surg."},{"issue":"2","key":"ref48","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.amjsurg.2003.12.069","article-title":"Stapled-wedge Collis gastroplasty for the shortened esophagus.","volume":"188","author":"Terry ML","year":"2004","journal-title":"Am J Surg."},{"issue":"1","key":"ref49","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s11701-017-0697-x","article-title":"Robotic paraesophageal hernia repair: a single-center experience and systematic review.","volume":"12","author":"Vasudevan V","year":"2018","journal-title":"J Robot Surg."},{"issue":"12","key":"ref50","doi-asserted-by":"crossref","first-page":"3049","DOI":"10.1007\/s11605-021-05005-1","article-title":"Complications following robotic hiatal hernia repair are higher compared to laparoscopy.","volume":"25","author":"Ward MA","year":"2021","journal-title":"J Gastrointest Surg."},{"issue":"10","key":"ref51","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1001\/archsurg.134.10.1069","article-title":"Importance of dissection of the hernial sac in laparoscopic surgery for large hiatal hernias.","volume":"134","author":"Watson DI","year":"1999","journal-title":"Arch Surg."},{"issue":"2","key":"ref52","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.jamcollsurg.2018.03.033","article-title":"Abnormal high-resolution manometry findings and outcomes after paraesophageal hernia repair.","volume":"227","author":"Wirsching A","year":"2018","journal-title":"J Am Coll Surg."}],"container-title":["ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S\u00e3o Paulo)"],"original-title":["POSI\u00c7\u00c3O DA SOCIEDADE BRASILEIRA DE H\u00c9RNIA E PAREDE ABDOMINAL SOBRE O TRATAMENTO DE GRANDES H\u00c9RNIAS DE HIATO"],"link":[{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_pdf&pid=S0102-67202023000100555&tlng=en","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T09:54:51Z","timestamp":1707126891000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0102-67202023000100555&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023]]},"references-count":52,"alternative-id":["S0102-67202023000100555"],"URL":"https:\/\/doi.org\/10.1590\/0102-672020230069e1787","relation":{},"ISSN":["2317-6326","0102-6720"],"issn-type":[{"value":"2317-6326","type":"electronic"},{"value":"0102-6720","type":"print"}],"subject":[],"published":{"date-parts":[[2023]]},"article-number":"e1787"}}