RESUMEN

The aim of this study was to compare the inguinal area, known as "Hessert's triangle", in patients undergoing surgical treatment for inguinal hernia with the area in fresh cadavers without hernia. The 73 cadavers, which were not fixed in formalin, were examined within 15 h post mortem. A total of 132 measurements were made in these cadavers and compared with 130 measurements in 115 hernia patients. The average age was 44.2 years for patients and 32.7 years for cadavers. The mean height and weight were 1.68 m and 69.9 kg for hernia patients and 1.67 m and 70.0 kg for the cadavers, respectively. The mean area of Hessert's triangle was 8.97 cm2 (range 2.28-29.62 cm2) in the hernia patients and 2.95 cm2 (range 1.37-5.92 cm2) in the cadavers. This difference was statistically significant (P < 0.00). A larger triangle is created by a higher intersections of the internal oblique and transversus muscles and its aponeurosis to the rectus sheath. When these muscles contract, they move toward the inguinal ligament to occlude the triangle, but with a larger triangle, the occlusion is incomplete. Our anatomical measurements verified that the size of Hessert's triangle is an important factor in the etiology of inguinal hernia.

Asunto(s)

RESUMEN

OBJECTIVE: To compare late results (recurrence) of three different techniques for treatment of inguinal hernias in the adult: Bassini, Shouldice and McVay. PATIENTS AND METHODS: The operative late results of three surgical techniques: Bassini, Shouldice and McVay in 119 adult patients with inguinal hernias (some with bilateral pathology, totalizing 136 hernias) were analyzed. The majority of patients were males (93.3%). The analysis was prospective, randomized, with uniform distribution of all three types of inguinal hernia (direct, indirect and combined) among the three groups of operative techniques. The number of recurrences was submitted to an actuarial analysis for a period of 4 years. The results underwent statistical analysis by the Kaplan-Mayer test with actuarial survival curves. RESULTS: Eight hernia operations by the Bassini technique recurred in this time span, 3 in the Shouldice group and 2 in McVay. Among the Bassini recurrences, the worst results were observed with direct hernias (29% recurrence) when compared with indirect ones (16% recurrence). Overall recurrence rates plotted in an actuarial survival curve for 4 years, revealed statistically significant differences between Bassini and Shouldice: 35.7% versus 23.7%; the same happened when comparing Bassini to McVay: 35.7% versus 8.5%. The differences between Shouldice and McVay were not significant. CONCLUSION: A recurrence rate of 35.7% for inguinal herniorraphy with the Bassini technique in a General Surgery University Clinic was surprising and obliged us to interrupt the trial. Our observations point to a prohibitive high failure rate when dealing with the Bassini technique, which was, over a century, the most popular treatment of inguinal hernia all over the world. Shouldice and McVay techniques, even though more complex, should be preferred whenever one makes the choice for "conventional" hernia treatment.

Asunto(s)

RESUMEN

Objetivo. Comparar os resultados tardios (recidivas) obtidos com o emprego de trêstécnicas operatórias para correçao das Hérnias Inguinais no adulto: Bassini, Shouldice e Mc Vay. Casuística e Método. Foram analisados os resultados obtidos em 119 pacientes adultos portadores de hérnias inguinais, alguns com hérnias bilaterais (totalizando 136 hérnias), operados por uma das três técnicas seguintes: Bassini, Shouldice e McVay. A maioria dos pacientes foi do sexo masculino (93,3 por cento). O estudo foi prospectivo, randomizado, com distribuiçao uniforme dos três tipos de hérnias (indireta, direta e mista) entre os três grupos de técnicas operatórias. Foi avaliado o número de recidivas observadas durante um período de quatro anos. Estes resultados foram submetidos à análise estatística através de curvas de sobrevida de Kaplan-Mayer. Resultados. Oito hérnias operadas pela técnica de Bassini recidivaram neste período, três no grupo Shouldice e duas operadas a McVay. Dentre os operados a Bassini, os piores resultados foram observados nas hérnias diretas (29 por cento de recorrência) quando comparados aos obtidos com as hérnias indiretas (16 por cento). Os resultados gerais projetados para quatro anos de seguimento, mostram diferenças estatisticamente significantes entre Bassini e Shouldice: 35,7 por cento vs 23,7 por cento. O mesmo foi observado na comparaçao entre Bassini e McVay: 35,7 por cento vs 8,5 por cento. As diferenças entre os grupos Shouldice e McVay nao foram significantes. Conlcusao. O índice de recidiva de 35,7 por cento para as hérnias operadas pela técnica de Bassini foi surpreendente, obrigando-nos a suspender o estudo. Há um índice excessivamente alto de insucesso após a utilizaçao da técnica de Bassini, que foi durante um século o método mais usado para correçao de hérnias inguinais no mundo inteiro. Os métodos de Shouldice e de McVay, embora de execuçao técnica mais complexa, devem ser as preferidos quando se opta pela utilizaçao de técnicas convencionais de herniorrafia.

Asunto(s)

RESUMEN

In order to relieve complete obstruction of the thoracic esophagus due to spinocellular carcinoma, thirteen patients, all of them in good or at least regular general conditions were submitted to a bypass using a isoperistaltic gastric tube. The disease itself was treated by radiotherapy after surgery. Only one patient died at the hospital due to an error in the radiotherapy schedule. Cervical fistula was observed in six patients seven days after surgery; local treatment was enough for complete healing in five out of six. In one patient surgery was performed in order to repair the anastomotic area. Stenosis was observed in three patients but in all cases it was possible to overcome it by endoscopy. With the progress of the disease other complications were observed such as hemoptysis and respiratory distress. The survival rate was nine months (running between five and sixteen) but it should be noted that swallow capacity was maintained until death. The employed of a bypass of isoperistaltic gastric tube seems to be a desirable alternative in the treatment of esophageal cancer because it allows the reestablishment of deglutition before any treatment such as radiotherapy alone or combined with surgery.

Asunto(s)

RESUMEN

A retrospective analysis is made of the data of 87 patients with recurrent inguinal hernias operated at the Hospital das Clínicas of the University of São Paulo in a period of six years. As it happened with other authors, frequency of recurrence was: direct hernia (43.5%), indirect hernia (50%), the less often seen mixed form (3.9%), and crural hernia (2.6%). They discuss local and systemic etiopathogenic factors, strain in the early postoperative period being indicated as a major factor, responsible for 43.1% of the cases. More than half of recurrences (48/85) occurred in the first year, some occurring after a longer period of time (30.6% after three years). The mostly used repair techniques were modified Bassani's technique (suture of the transverse arch to the inguinal ligament) and the Lotheissen-McVay technique, in 46.1% and 42.5% of the cases, respectively. In 9 of the 85 cases, tightening the deep inguinal orifice was enough. Analysis of the rate of surgical failure was difficult, as patients did not routinely return for follow-up visits.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Congenital cystic dilatation of the intrahepatic biliary ducts, known as Caroli's disease, is rarely recognized in general surgical practice and often overlooked. Until now little more than a hundred cases have been described although modern diagnostic procedures disclose more frequently new ones. Three patients with this anomaly have been treated by the authors during the past years and the different aspects concerning diagnosis and treatment are discussed and compared with existing information. In all three patients colic pain in the upper abdomen was the first symptom reported in the first years of life. In one patient jaundice and fever were associated with the abdominal pain and cholangitis developed a secondary biliary cirrhosis. Somatic underdevelopment, consequence of the cirrhosis in this child was observed. In two patients an intrahepatic hepaticojejunostomy was performed and a left hepatectomy in the third. In the two older children intrahepatic gallstones were found; in the younger one no stones were found inside the dilated ducts.

Asunto(s)

RESUMEN

A comparative double-blind study of tinidazole vs placebo was conducted in order to assess the prophylaxis of post-surgical abdominal infections in 40 patients undergoing closure colostomy surgery. During three days the patients were kept on a low residue diet, and underwent a colon mechanical cleansing. About 10 to 12 hours prior to surgery the patients were given placebo or tinidazole in tablets of identical appearance; the dose of tinidazole was of 2 g (4 tablets) in a single oral dose. Evaluation performed after surgery showed that in the tinidazole group occurred two surgical mild infections (10%), while in placebo group occurred nine infections (45%)--four of them severe and one very severe, showing a significative difference between the two groups (p less than 0.05). In placebo group 21 bacteria were isolated, 3 of them were anaerobic; only two aerobic species were identified in the tinidazole group (p less than 0.001). No adverse reactions were reported in both groups. The authors concluded that in this study, tinidazole showed a prophylactic effect on post-surgical abdominal infections in patients who underwent closure colostomy surgery.

Asunto(s)

Asunto(s)

RESUMEN

Spontaneous perforation of the colon without obstruction is related to intestinal and extra intestinal diseases, mainly gynecological procedures. Its etiology is unknown, and there are many theories. Because of its diagnosis peculiarities, as well as its rarity, and mainly the severity of the disease, the authors describe three cases, relating the necessity of early diagnosis and correct surgical treatment.

Asunto(s)

RESUMEN

The authors report upon 5 cases of biliary-enteric fistulas, all of them detected preoperatively in a General Surgery Service during a relatively short period of time (6 months). Two cholecysto-duodenal and one cholecysto-ileal fistula were complications of a pre-existent cholelithiasis. A choledocho-duodenal fistula was caused by a penetrating peptic ulcer and a choledocho-colonic fistula was a iatrogenic traumatic one. The review of the literature demonstrates generally a lower incidence of this pathology in different surgical centers, one or two cases a year. More than 50 per cent of the biliary-enteric fistulas were unexpectedly found during operations on the biliary tract or stomach. This forces the surgeon to change his programmed surgical procedure without adequate preoperative preparation. The consequence is a higher morbidity rate in such operations. The continuing refinement of diagnostical procedures have led to a progressive and more frequent preoperative assessment of these fistulas. Adequate diagnostic methods and surgical procedures adopted in different cases of biliary enteric fistulas are discussed, emphasizing the good results obtained and the lower morbidity.

Asunto(s)

RESUMEN

Sao descritos cinco casos de fistulas bilio-digestivas (F.B.D.) tratadas durante atividade rotineira, em servico de cirurgia geral, em prazo relativamente curto de tempo (seis meses). Tratavam-se de fistulas de etiologias diversas sendo duas fistulas colecisto-duodenais, uma colescistoileal de origem bilio-litiasica, uma coledoco-duodenal sencundaria a ulcera peptica e outra coledoco-colonica de origem traumatica. Todas foram detectadas pre-operatoriamente. Acredita-se que o aprimoramento continuo dos metodos semiotecnicos facilite e torne o diagnostico pre-operatorio destas afeccoes mais frequente, isto, por sua vez, faz com que o preparo pre-operatorio e planejamento cirurgico sejam mais adequados. Sao apresentadas a metodologia semiotecnica e condutas cirurgicas adotadas nos diferentes tipos de F.B.D. da casuistica, ressaltando os bons resultados assim obtidos, com baixa morbilidade

Asunto(s)

Asunto(s)