RESUMEN
While circular staplers are used worldwide - especially for rectal anastomoses - there are relatively few publications on the effectiveness of these instruments. Between May 2008 and March 2009 in a prospective multicenter surveillance study 136 patients were enrolled from nine surgical units in Hungary. Rectal anastomoses were performed mainly in the upper and middle third of the rectum. In 115 cases adenocarcinoma, in 16 patients other type of malignant tumors and in 5 cases with anastomosis in the distal third were estimated too. 20 laparoscopic and 116 "conventional" surgery was performed. 32 mm diameter type CS circular staplers were used in 50, 28 mm in 85, and 25 mm in one case. Intraoperative technical failure of the device occurred in four cases, immediate correction were performed successfully in all of these patients and they recovered without postoperative complications. Late anastomotic leaks were detected in five patients, of which three healed spontaneously and two required reoperation. In the whole series two patients died representing a 1.4 percent mortality rate. The CS circular staplers proved to be appropriate for infraperitoneal rectal anastomoses.
Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/instrumentación , Neoplasias del Recto/cirugía , Recto/cirugía , Engrapadoras Quirúrgicas , Grapado Quirúrgico , Adulto , Anciano , Anastomosis Quirúrgica/instrumentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Enfermedades del Recto/cirugía , Engrapadoras Quirúrgicas/efectos adversos , Grapado Quirúrgico/efectos adversos , Dehiscencia de la Herida Operatoria/etiología , Resultado del TratamientoRESUMEN
Infective complications play major role in mortality of high risk patients demanding intensive care. Selective Bowel Decontamination prevents endogenous infections by reducing the number of potentially pathogen microbes (aerobic bacteria, fungi) in the oropharynx and gastrointestinal tract, saving anaerobic bacteria. It had been used 20 years ago for the first time. Authors survey it's literature ever since. Selective Bowel Decontamination is performed by the mixture of antibiotics and antimycotic drug, administered orally in hydrogel, and suspension form in nasojejunal tube. The number of Gram negative optional aerobic bacteria and fungi decrease significantly in the gut, and the microbial translocation is following this tendency. Foreign authors achieved good results in acute necrotizing pancreatitis, after liver transplant, in polytrauma, in serious burn and in haematological malignancies. According to the literature Selective Bowel Decontamination shows advantages in selected groups of high risk surgical patients. In some studies the administration took few months, but the minimum time was one week. There was no report of increasing MRSA appearance. Regular bacteriological sampling is highly recommended in order to recognize any new antibiotic resistance in time.
Asunto(s)
Bacteriemia/etiología , Bacteriemia/prevención & control , Intestinos/microbiología , Bacteriemia/microbiología , Bacterias Aerobias/efectos de los fármacos , Bacterias Anaerobias/efectos de los fármacos , Quemaduras/complicaciones , Hongos/efectos de los fármacos , Bacterias Gramnegativas/efectos de los fármacos , Neoplasias Hematológicas/complicaciones , Humanos , Trasplante de Hígado/efectos adversos , Resistencia a la Meticilina , Traumatismo Múltiple/complicaciones , Pancreatitis Aguda Necrotizante/complicaciones , Staphylococcus aureus/efectos de los fármacosRESUMEN
The aim of this retrospective study is to highlight the advantages of video-assisted thoracic surgery (VATS) in the assessment of thoracic trauma. In the past 4 years 3 patients had intrapleural or intrapulmonary Kirschner needles which penetrated from the site of a previous humeroscapular osteosynthesis and one patient with a gunshot projectile and haemothorax in the left thorax. They were treated by VATS removal of intrathoracic foreign bodies. No complications developed postoperatively, the chest wall pain was minimal, the duration of hospital stay (3-5 days) and recovery was short. The widespread use of minimal invasive VATS procedure is an alternative approach that provides safe and less invasive operation for acute chest trauma patients. We believe that its extended use for both diagnostic and therapeutic purposes even in some special circumstances is justified today.