RESUMEN
Blunt traumatic rupture of the diaphragm is a well known but uncommon event of thoracoabdominal traumatic injuries. It occurs in 1-5% of polytrauma patients and requires a high degree of suspicion for a rapid diagnosis. The frequency of delayed diagnosis is difficult to be estimated and up to 30% of blunt diaphragmatic ruptures present late. A case of herniated splenic colic flexure through a defect in the left hemidiaphragm and the subsequent development of colon cancer in this area are presented. We emphasize the importance of making a prompt diagnosis in order to avoid further morbidity and mortality in this rare clinical entity.
Asunto(s)
Adenocarcinoma/etiología , Colon Transverso , Neoplasias del Colon/etiología , Diafragma/lesiones , Hernia Diafragmática Traumática/complicaciones , Traumatismo Múltiple/complicaciones , Accidentes de Tránsito , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirugía , Anciano , Colectomía/métodos , Neoplasias del Colon/diagnóstico , Neoplasias del Colon/cirugía , Diagnóstico Diferencial , Supervivencia sin Enfermedad , Estudios de Seguimiento , Hernia Diafragmática Traumática/diagnóstico por imagen , Hernia Diafragmática Traumática/cirugía , Humanos , Masculino , Estadificación de Neoplasias , Politetrafluoroetileno , Implantación de Prótesis/instrumentación , Radiografía Abdominal , Rotura , Mallas Quirúrgicas , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: The aim of this study was to assess morbidity, mortality, and outcome in select patients after laparoscopic cholecystectomy performed by consultants or by Specialist Registrars (SpRs) and Senior House Officers (SHO), in the General Hospital of Ioannina 'G. Hatzikosta' in northwestern Greece. METHODS: Between January 1, 2001 and December 31, 2005, 1370 laparoscopic cholecystectomies were performed, 445 (33%) by SpRs and SHO and 925 (67%) by consultants. Patients included 982 (71.3%) women and 388 (28.7%) men. The mean age was 46.2 years (range, 17 to 79). All patients had routine blood tests (including liver function tests), electrocardiography, chest x-ray, and abdominal ultrasound scan performed preoperatively. All patients received a general anesthesia, and the standard Reddick and Olsen technique was performed. The Harmonic scalpel was used in all cases. RESULTS: Four conversions (0.3%) were required to an open procedure, (2 in the SpRs and SHO group and 2 in the group of consultants), because of impossible recognition of anatomy around Calot's triangle. The mean operative time was 57 minutes (range, 33 to 97) for SpRs and SHO, while for the consultants it was 49 minutes (range, 27 to 78, P=0.25). Mortality rate was 0% in both groups. There were 44 major complications (2.7%), 17 in the SHO and SpRs group (3.7%) and 27 in the consultant group (1.7%, P=0.11). The complications included bowel thermal injury (consultants [cons], 1; residents [res], none); bile duct injury (cons, 1; res, none); bile leak (cons, 3; res, 5); hemorrhage (cons, 2; res, 2); hematomas at the trocar sites (cons, 5; res, 4); inflammation of the port site at the umbilicus (cons, 4; res, 5); paralytic ileus (cons, 4; res, 3); and hemorrhage from the subxiphoid trocar (cons, 2; res, 3), which stopped spontaneously. The mean hospital stay was 1.3 days, while all the patients resumed their normal activities after 11.7 days (range, 7 to 19). CONCLUSION: Supervised laparoscopic cholecystectomy performed by trainees does not increase surgical morbidity and does not compromise surgical outcome.
Asunto(s)
Colecistectomía Laparoscópica , Colelitiasis/cirugía , Competencia Clínica , Internado y Residencia , Adolescente , Adulto , Anciano , Distribución de Chi-Cuadrado , Femenino , Grecia , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Resultado del TratamientoRESUMEN
Uric acid is the final product of purine metabolism in humans. The final two reactions of its production catalyzing the conversion of hypoxanthine to xanthine and the latter to uric acid are catalysed by the enzyme xanthine oxidoreductase, which may attain two inter-convertible forms, namely xanthine dehydrogenase or xanthine oxidase. The latter uses molecular oxygen as electron acceptor and generates superoxide anion and other reactive oxygen products. The role of uric acid in conditions associated with oxidative stress is not entirely clear. Evidence mainly based on epidemiological studies suggests that increased serum levels of uric acid are a risk factor for cardiovascular disease where oxidative stress plays an important pathophysiological role. Also, allopurinol, a xanthine oxidoreductase inhibitor that lowers serum levels of uric acid exerts protective effects in situations associated with oxidative stress (e.g. ischaemia-reperfusion injury, cardiovascular disease). However, there is increasing experimental and clinical evidence showing that uric acid has an important role in vivo as an antioxidant. This review presents the current evidence regarding the antioxidant role of uric acid and suggests that it has an important role as an oxidative stress marker and a potential therapeutic role as an antioxidant. Further well designed clinical studies are needed to clarify the potential use of uric acid (or uric acid precursors) in diseases associated with oxidative stress.
Asunto(s)
Antioxidantes/farmacología , Estrés Oxidativo , Ácido Úrico/farmacología , Animales , Humanos , Laparoscopía , Daño por Reperfusión/metabolismo , Xantina Oxidasa/fisiologíaRESUMEN
The patient's position during laparoscopic surgery can have a clinically relevant effect on lower limb and splanchnic circulation; this factor has not yet been investigated with respect to oxidative stress markers. In order to assess this effect, a prospective clinical trial was designed wherein 2 groups of patients were studied. In group A, 15 patients underwent upper abdominal nonhepatobiliary operations (13 modified Nissen fundoplications and 2 Taylor vagotomies) in the head-up position. In group B, 15 patients underwent lower abdominal operations (10 laparoscopic colectomies and 5 inguinal hernia repairs) in the head-down position. The pneumoperitoneum was maintained at 14 mm Hg in all cases. Plasma concentrations of thiobarbituric-acid reactive substances (TBARS), a marker of lipid peroxidation, plasma total antioxidant status (TAS), and serum uric acid concentrations were measured preoperatively, 5 minutes after deflation of the pneumoperitoneum, and 24 hours postoperatively. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) serum activities were measured preoperatively and 24 hours postoperatively. In group A, there was a significant increase in TBARS levels (p<0.005) immediately after deflation of the pneumoperitoneum and a significant decrease in TAS and uric acid levels (p<0.005) in the first postoperative day. There was also a significant postoperative elevation in both ALT and AST activities (p<0.001). In group B, no significant increase was found in postoperative TBARS or transaminase levels. TAS and uric acid levels decreased significantly in the first postoperative day (p<0.05) and (p<0.005, respectively). In conclusion, these results show that a combination of pneumoperitoneum and the head-up position causes significant increase in lipid peroxidation, decrease in plasma TAS, and increase in transaminases. The mechanism responsible for these events could be the low-flow ischemia-reperfusion syndrome induced by the pneumoperitoneum and aggravated by the head-up position.
Asunto(s)
Colectomía , Fundoplicación , Laparoscopía , Neumoperitoneo Artificial , Postura , Vagotomía , Adulto , Anciano , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Femenino , Hernia Inguinal/cirugía , Humanos , Peroxidación de Lípido , Masculino , Persona de Mediana Edad , Estrés Oxidativo , Estudios Prospectivos , Sustancias Reactivas al Ácido Tiobarbitúrico , Ácido Úrico/sangreRESUMEN
BACKGROUND: The induction of the pneumoperitoneum increases intraabdominal pressure (IAP), causing splanchnic ischemia, whereas its deflation normalizes IAP and splanchnic blood flow. This procedure appears to represent an ischemia-reperfusion model in humans. METHODS: Thirty laparoscopic cholecystectomies (LC) were performed in 30 patients with a mean age of 54.6 +/- 15.6 years. A group of 20 patients mean age, 57.3 +/- 9.65 who underwent open cholecystectomy (OC) was also studied. Vein plasma levels of thiobarbituric acid-reactive substances (TBARS), a marker of free radical production; plasma total antioxidant status (TAS); and uric acid (UA) levels were measured preoperatively, 5 min after deflation of the pneumoperitoneum or at the end of operation, and 24 h postoperatively. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin (TBL) levels were measured preoperatively and 24 h after the operation. RESULTS: In the LC group, significant elevations in the concentration of TBARS were observed in the early postoperative measurements in comparison with the preoperative measurements. TAS and UA levels were decreased significantly 24 h postoperatively compared to preoperative levels. The postoperative levels of AST, ALT, and TBL increased significantly in comparison with the preoperative levels. In the OC group, no alterations in the concentration of TBARS were observed in the postoperative period. The other parameters had changes similar to those recorded for the LC group. CONCLUSIONS: Free radical-induced lipid peroxidation associated with a decrease in plasma antioxidant capacity and UA levels as well as altered hepatic function is observed after deflation of the pneumoperitoneum. These results suggest that free radicals are generated at the end of a laparoscopic procedure, possibly as a result of an ischemia-reperfusion phenomenon induced by the inflation and deflation of the pneumoperitoneum.
Asunto(s)
Colecistectomía Laparoscópica/efectos adversos , Estrés Oxidativo/fisiología , Neumoperitoneo Artificial/efectos adversos , Sustancias Reactivas al Ácido Tiobarbitúrico/análisis , Alanina Transaminasa/sangre , Antioxidantes/análisis , Aspartato Aminotransferasas/sangre , Bilirrubina/sangre , Biomarcadores/sangre , Colecistectomía/efectos adversos , Femenino , Radicales Libres , Humanos , Isquemia/etiología , Peroxidación de Lípido , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Circulación Esplácnica , Ácido Úrico/sangreRESUMEN
SUMMARY: Seroma is a frequent complication of laparoscopic or open repair of ventral hernias using expanded polytetrafluoroethylene mesh. Aspiration of this seroma has the risk of introducing bacteria, resulting in infection and the recurrence of the hernia. Between May 1996 and December 2000, 51 patents who underwent 53 laparoscopic ventral hernioplasties (44 incisional, 5 large epigastric, and 4 large umbilical) were randomized to participate in a trial comparing the intraperitoneal onlay mesh repair with or without cauterization of the hernia sac. Group A (26 patients; 28 hernias) patients were operated on by using an expanded polytetrafluoroethylene Dual Mesh patch (Gore and Associates, Flagstaff, AZ, U.S.A.) inserted intraperitoneally and secured by full-thickness stitches and endoscopic clips to cover the hernia defect, while the sac was left intact. Group B (25 patients, 25 hernias) patients were operated on according to the same technique as those in group A, but the hernia sac was cauterized by monopolar cautery (5 cases) or harmonic scalpel (20 cases). After surgery, clinical examination and computed tomography scans were used to confirm or test the existence of seroma and recurrence. In group A, four clinically evident seromas were found. Two of them were resolved with no intervention. In the remaining two cases, multiple aspirations were needed for 4 and 7 months, respectively, but 2 and 3 months, respectively, after resolution of the seroma, a recurrence of the hernia was observed. There was one more recurrence without seroma and three with subclinical seromas (only observed on computed tomography scans). In group B, subclinical seroma (only observed in computed tomography scan) resolved in a few days, and one recurrence without seroma was observed. Although only a small number of patients were studied, our findings suggest that the cauterization of the hernia sac prevents seromas and reduces recurrences in laparoscopic repair of ventral hernias.
Asunto(s)
Ascitis/etiología , Hernia Ventral/cirugía , Laparoscopía/efectos adversos , Laparoscopía/métodos , Anciano , Ascitis/terapia , Drenaje/métodos , Femenino , Hernia Ventral/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Probabilidad , Pronóstico , Estudios Prospectivos , Valores de Referencia , Medición de Riesgo , Mallas Quirúrgicas/efectos adversos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: Free radical-induced lipid peroxidation associated with a decrease of antioxidant capacity in plasma is observed after the deflation of the pneumoperitoneum in laparoscopic surgery. In this study, we evaluated the effect of the continuous administration of lipid peroxidation derivatives on emulsified propofol. METHODS: Two groups of 20 patients each who underwent laparoscopic surgery were studied prospectively. Maintenance of anesthesia was achieved with 66% nitrous oxide and either isoflurane or continuous propofol administration. The level of thiobarbituric acid-reactive substances (TBARS) in the plasma was determined as a measure of free radicals before and after surgery. RESULTS: Ten patients in the propofol group had reduced TBARS, as compared to only one in the isoflurane group (p = 0.003). There was a statistically significant difference in age between the patients with reduced TBARS and those without reduced TBARS (p = 0.009) in the propofol group. CONCLUSIONS: Anesthesia with continuous propofol infusion in laparoscopic surgery has a significant scavenging action on the formation of free radicals and exerts its greatest antioxidant effect in patients >/=48 years of age.
Asunto(s)
Anestesia por Inhalación/métodos , Laparoscopía/métodos , Peroxidación de Lípido/fisiología , Propofol/administración & dosificación , Sustancias Reactivas al Ácido Tiobarbitúrico/metabolismo , Colecistectomía Laparoscópica , Femenino , Depuradores de Radicales Libres/metabolismo , Radicales Libres/sangre , Humanos , Isoflurano/administración & dosificación , Isoflurano/metabolismo , Masculino , Persona de Mediana Edad , Óxido Nitroso/administración & dosificación , Óxido Nitroso/metabolismo , Neumoperitoneo Artificial , Propofol/metabolismo , Estudios Prospectivos , Sustancias Reactivas al Ácido Tiobarbitúrico/análisis , Varicocele/cirugíaRESUMEN
Continuous ambulatory peritoneal dialysis catheters can be inserted by open laparotomy as well as by laparoscopy. A prospective randomized study was scheduled to investigate the results of the laparoscopic versus open laparotomy technique for placement of continuous ambulatory peritoneal dialysis catheters. Fifty patients were enrolled and randomly allocated into two groups of 25 patients each. Group A underwent continuous ambulatory peritoneal dialysis catheter placement via the open laparotomy technique. In 22 patients, catheters were inserted via midline incision, and in 3 patients with histories of previous catheterization, a paramedian incision was used. Continuous ambulatory peritoneal dialysis was started 24 to 48 hours later. Group B underwent laparoscopic placement of the catheter with fixation into the pelvis and suture closure of the port wounds. In 21 patients, this catheter placement was the first such placement, and in 4 patients, a previous catheter had been inserted by the open technique and removed for dysfunction. Continuous ambulatory peritoneal dialysis was started at the end of the procedure. The mean operative time was 22 minutes in group A and 29 minutes in group B (P < 0.001). Fluid leakage was observed in eight patients in group A, but in no patients in group B (P < 0.005). Peritonitis occurred in five patients in group A and in three patients in group B (P > 0.1). Tip migration occurred in five patients in group A and no patients in group B (P < 0.005). In group B, two patients underwent a simultaneous cholecystectomy and one underwent incisional hernia repair. Laparoscopic placement of a Tenckhoff catheter leads to better function than does the open procedure; it allows immediate start of dialysis without fluid leakage and permits simultaneous performance of other laparoscopic procedures.
Asunto(s)
Catéteres de Permanencia , Diálisis Peritoneal Ambulatoria Continua , Anciano , Femenino , Humanos , Laparotomía , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
BACKGROUND: Knowledge on the viability of hydatid cysts of the liver during operation is important to the surgeon may dictate the peri-operative therapeutic manoeuvre undertaken. PATIENTS AND METHODS: A prospective study was performed on 23 patients with 28 hydatid cysts of the liver to assess whether intracystic pressure (ICP) could predict viability of protoscoleces. All patients received albendazole (10 mg/kg body weight/day) for 5 days pre-operatively. The ICP was measured from the apex of the cyst, after laparotomy, using a 16-G needle connected to a water manometer. After manometry, the cyst contents were aspirated and the viability of protoscoleces assessed by their flame cell activity, motility and ability to exclude 5% aqueous eosin. RESULTS: The median ICP was 54 +/- 21 cmH2O for 17 viable cysts and zero for 8 non-viable cysts, while 1 additional non-viable cyst and 2 sterilized cysts had high ICP (sensitivity, 100%; specificity, 72%; accuracy, 89%). The median diameter of the viable cysts was 9.3 +/- 3.5 cm and the non-viable cysts 10.7 +/- 2.6 cm. In the right lobe were located 12 viable and 8 non-viable cysts and in the left lobe, 5 viable and 3 non-viable cysts. No significant difference in diameter or ICP were noted between the hepatic lobes. CONCLUSIONS: These findings suggest that the measurement of ICP is a simple, cheap and reliable method for assessment of the viability of hydatid cysts of the liver.
Asunto(s)
Equinococosis Hepática/fisiopatología , Adulto , Anciano , Equinococosis Hepática/diagnóstico , Femenino , Humanos , Masculino , Manometría , Persona de Mediana Edad , Presión , Estudios ProspectivosRESUMEN
After laparoscopic cholecystectomy, CO2 remains within the peritoneal cavity, commonly causing pain. This prospective randomized study was performed to determine the efficacy of intraperitoneal normal saline and bupivacaine infusion on postoperative pain after laparoscopic cholecystectomy. Three hundred patients were randomly assigned to one of six groups of 50 patients each. Group A patients served as controls. In group B patients, normal saline was infused under the right hemidiaphragm and suctioned after the pneumoperitoneum was deflated. After suction, a subhepatic closed drain was left for 24 h. In group C patients, bupivacaine 1.5 mg/kg in solution 2.5 mg/ml, minus 15 ml of this solution, which was infiltrated in the trocar wounds, was infused under the right hemidiaphragm at the end of the cholecystectomy. In group D patients, bupivacaine was given as in group C, but a subhepatic drain was left for 24 h. In group E patients, normal saline was used as in group B plus bupivacaine as in group C. Group F patients were treated as in group E, but a subhepatic drain was left for 24 h. In all groups, 15 ml of a 2.5 mg/ml bupivacaine solution was infiltrated in the trocar wounds. Postoperatively, analgesic medication usage, nausea, vomiting, and pain scores were recorded at 2, 6, 12, 24, 36, 48, and 72 h. Postoperative pain was reduced significantly in the patients of the treatment groups vs. the controls. Between treatment groups, patients in groups B, E, and F had the best results, while those in groups C and D had significantly greater pain than those in groups B, E, and F. It is concluded that postoperative pain after laparoscopic cholecystectomy can be significantly reduced by intraperitoneal normal saline infusion subdiaphragmatically and after its postdeflation suction, bupivacaine infusion in the same area, or without bupivacaine in case a subhepatic drainage has been needed.
Asunto(s)
Anestésicos Locales/administración & dosificación , Bupivacaína/administración & dosificación , Colecistectomía Laparoscópica , Dolor Postoperatorio/tratamiento farmacológico , Adulto , Anciano , Distribución de Chi-Cuadrado , Colecistectomía Laparoscópica/efectos adversos , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Inyecciones Intraperitoneales , Masculino , Persona de Mediana Edad , Dimensión del Dolor/efectos de los fármacos , Dolor Postoperatorio/etiología , Estudios Prospectivos , Valores de Referencia , Resultado del TratamientoRESUMEN
Ultrasonic energy has recently been used for surgical cutting and coagulating. A prospective randomized study was undertaken to determine the effectiveness of ultrasonic energy versus monopolar electrosurgery in human laparoscopic cholecystectomy. Two hundred patients were enrolled and randomized into two groups of 100 patients each. Group A patients underwent laparoscopic cholecystectomy with monopolar electrocautery. Group B patients underwent laparoscopic cholecystectomy with ultrasonically activated shears. In 18 cases of this group, the cystic artery was coagulated and cut without clips. Subhepatic closed drainage was left for 24 h in patients who were candidates for oozing of blood or leakage of bile. The median operating time was 45 min in group A and 37 min in group B. Subhepatic drainage was left in 37 patients of group A and 26 of group B. The median blood loss was 14 ml in group A and 2 ml in group B, while 3 patients of group A and none of group B had bile leakage from the bed of the gallbladder for 1, 1, and 6 days, respectively. Postoperative ultrasound examination showed a minor subhepatic fluid collection in 5 patients of group A and in 1 patient of group B. All these collections were treated without drainage. The length of hospital stay was 1.9 +/- 0.5 days in group A and 1.4 +/- 0.2 days in group B. Postoperative pain scores, nausea, and vomiting were equivalent in both groups. It is concluded that ultrasonically activated coagulating shears are safer, easier to use, faster, and less prone to intraoperative complications and postoperative morbidity than monopolar electrocautery in laparoscopic cholecystectomy.
Asunto(s)
Colecistectomía Laparoscópica/instrumentación , Electrocoagulación/métodos , Hemostasis Quirúrgica/instrumentación , Terapia por Ultrasonido/métodos , Adulto , Anciano , Análisis de Varianza , Pérdida de Sangre Quirúrgica/prevención & control , Distribución de Chi-Cuadrado , Colecistectomía Laparoscópica/métodos , Electrocoagulación/instrumentación , Femenino , Estudios de Seguimiento , Hemostasis Quirúrgica/métodos , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Terapia por Ultrasonido/instrumentaciónRESUMEN
Improvements in laparoscopic techniques and equipment have engendered many new intraabdominal procedures. Laparoscopic hernioplasty was used in 11 patients with 12 incisional abdominal hernias. All repairs were made with an intraperitoneal onlay patch of expanded polytef Gore-Tex DualMesh Biomaterial. The patch was secured by whole-thickness sutures, tied subcutaneously through stab holes, and staples between the sutures to cover the hernia defect without excision of the hernia sac. There were three postoperative complications: one seroma, one hematoma, and one infection. These complications successfully healed without reoperation. No recurrence was observed during a follow-up of 8-21 months (average 15 months). It is concluded that laparoscopic incisional hernioplasty using the new Gore-Tex DualMesh Biomaterial, which is securely sutured and stapled on the abdominal wall, is a promising minimally invasive procedure. Continued follow-up is necessary to determine the long-term results.
Asunto(s)
Hernia Ventral/cirugía , Laparoscopía/métodos , Mallas Quirúrgicas , Adulto , Anciano , Anciano de 80 o más Años , Materiales Biocompatibles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Politetrafluoroetileno , Grapado Quirúrgico , Técnicas de SuturaRESUMEN
After laparoscopic surgery carbon dioxide remains within the peritoneal cavity for a few days, commonly causing pain. This prospective randomized study was performed to determine the efficacy of intraperitoneal infusion of normal saline on postoperative pain after laparoscopic cholecystectomy. Altogether 300 patients were randomly assigned to one of five groups of 60 patients each. Group A: control group, no peritoneal infusion, no subhepatic drain. Group B: no peritoneal infusion but a subhepatic closed brain was left for 24 hours. Group C: normal saline 25 to 30 ml/kg body weight at a temperature of 37 degrees C was infused under the right hemidiaphragm and left in the peritoneal cavity. Group D: normal saline in a room temperature was infused under the right hemidiaphragm and suctioned after the pneumoperitoneum was deflated. Group E: normal saline was infused and suctioned as in group D, but a subhepatic closed drain was left for 24 hours. Postoperatively, analgesic medication usage, nausea, vomiting, and pain scores were determined at 2, 6, 12, 24, 48, and 72 hours (during hospitalization and at home). Postoperative pain was reduced significantly (p < 0.001) in the patients of groups C, D, and E versus controls, whereas no difference was observed between groups A and B. Among groups C < D and E, group E (p < 0.01) had the best results followed by group D and then group C. Intraperitoneal normal saline offered a detectable benefit to patients undergoing laparoscopic cholecystectomy. The beneficial effect was better when the fluid was suctioned after deflation of the pneumoperitoneum and even better when a subhepatic closed drain continued fluid suction during the first postoperative hours.
Asunto(s)
Colecistectomía Laparoscópica/efectos adversos , Dolor Postoperatorio/tratamiento farmacológico , Cloruro de Sodio/administración & dosificación , Colelitiasis/cirugía , Enfermedad Crónica , Estudios de Seguimiento , Humanos , Infusiones Parenterales , Persona de Mediana Edad , Dolor Postoperatorio/etiología , Neumoperitoneo Artificial/efectos adversos , Estudios Prospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: The Sugiura procedure is an alternative treatment for bleeding gastroesophageal varices. Laparoscopic Sugiura procedure has not previously been described. The aim of this study is to develop a laparoscopic oesophageal transection with an EEA stapler, as well as a complete laparoscopic modified Sugiura procedure. METHODS: We used six female farm pigs weighing 40-50 kg. Six trocars were used. The steps of the procedure are: 1) mobilization of the lower oesophagus and truncal vagotomy; 2) oesophageal resection-anastomosis with an EEA stapler; 3) devascularization of the corpus and fundus of the stomach and the lower 10 cm of the oesophagus; 4) splenectomy; 5) Nissen fundoplication; 6) pyloroplasty. RESULTS: The mean operation time was 180 min, while the mean blood loss 260 ml. All staple lines are integral during autopsy at the end of the procedure. CONCLUSIONS: Laparoscopic oesophageal transection with an EEA stapler as well as a complete laparoscopic modified Sugiura procedure are feasible.
Asunto(s)
Várices Esofágicas y Gástricas/cirugía , Esófago/cirugía , Hemorragia Gastrointestinal/cirugía , Laparoscopía/métodos , Animales , Pérdida de Sangre Quirúrgica , Femenino , Fundoplicación , Píloro/cirugía , Esplenectomía , Engrapadoras Quirúrgicas , Porcinos , Vagotomía TroncalRESUMEN
BACKGROUND/AIMS: Sugiura procedure is an alternative in the treatment of the bleeding gastroesophageal varices. The postoperative alterations of CT and biochemical features versus pre-operative levels in patients operated on for haemorrhagic portal hypertension were studied. MATERIAL AND METHODS: Eight patients with liver cirrhosis and portal hypertension who underwent emergency or elective modified Sugiura's operation, were included in this study. The hepatic function and the CT scan ratio of transverse caudate lobe width to transverse right lobe width, pre-operatively and during the early and late postoperative period were studied. RESULTS: The hepatic function was aggravated during the immediate postoperative period but was remarkably improved, versus pre-operative status, after the first 15-30 postoperative days. The caudate to right lobe ratio from 0.66-1.7 pre-operatively, decreased to < 0.65 in all cases after the first postoperative month or year. One patient died on the 64th postoperative day from progressive hepatic failure, while all tests of the first postoperative month follow-up were improved. Another patient presented a light rebleeding 4 years after operation, while the hepatic tests were average. CONCLUSIONS: The modified Sugiura's procedure is an effective procedure in the disappearence of the oesophageal varices, followed by low mortality and low recurrent bleeding, but it mainly leads to an improvement of the hepatic function, probably due to improved hepatic portal blood flow.
Asunto(s)
Várices Esofágicas y Gástricas/cirugía , Hipertensión Portal/fisiopatología , Hígado/fisiopatología , Adulto , Anciano , Causas de Muerte , Procedimientos Quirúrgicos Electivos , Urgencias Médicas , Femenino , Estudios de Seguimiento , Hemorragia Gastrointestinal/cirugía , Humanos , Hipertensión Portal/complicaciones , Hipertensión Portal/diagnóstico por imagen , Hígado/diagnóstico por imagen , Circulación Hepática , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática/fisiopatología , Fallo Hepático/etiología , Masculino , Persona de Mediana Edad , Sistema Porta/fisiopatología , Vena Porta/fisiopatología , Complicaciones Posoperatorias , Recurrencia , Flujo Sanguíneo Regional , Tasa de Supervivencia , Tomografía Computarizada por Rayos XRESUMEN
The efficacy of low-molecular-weight heparins (LMWH) alone versus a combination of Daflon 500 mg with LMWH in preventing postoperative symptomatic thromboembolism was investigated. A total of 1372 patients aged 40 years or older undergoing major abdominal, pelvic, or abdominal wall surgery were randomized into four groups. Group A (n = 591) received enoxoparin 20 mg or fraxiparin 0.3 ml. Group B (n = 595) received the regimens of group A plus Daflon 500 mg. Group C (n = 93) received enoxoparin 40 mg or fraxiparin 0.6 ml. Group D (n = 93) received the regimens of group C plus Daflon 500 mg. Each LMWH was given subcutaneously once a day during the hospitalization and continued in groups C and D for 15 days after discharge (high risk patients). Daflon 500 mg was given as two tablets every 8 hours during the day before surgery, two tablets 6 hours before surgery, and two tablets once a day on postoperative days 4 to 15. Daily clinical examination was performed; and phlebography or perfusion lung scanning (or both) were used in symptomatic patients to confirm deep vein thrombosis (DVT) or pulmonary embolism (PE). The wound was examined on a daily basis for hematomas. The diagnosis of PE was established in two patients of group A and in three patients of group C; symptomatic DVT was established in one patient in group A and three patients of group C. Neither DVT nor PE were established in Daflon 500 mg groups. These data suggest that the combination of Daflon 500 mg and LMWH is more effective than LMWH alone for preventing symptomatic thromboembolism.
Asunto(s)
Anticoagulantes/uso terapéutico , Diosmina/uso terapéutico , Heparina de Bajo-Peso-Molecular/uso terapéutico , Complicaciones Posoperatorias/prevención & control , Tromboembolia/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/administración & dosificación , Diosmina/administración & dosificación , Método Doble Ciego , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Heparina de Bajo-Peso-Molecular/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Flebografía , Complicaciones Posoperatorias/diagnóstico por imagen , Estudios Prospectivos , Factores de Riesgo , Tromboembolia/diagnóstico por imagenAsunto(s)
Colangitis Esclerosante/inducido químicamente , Equinococosis Hepática/tratamiento farmacológico , Formaldehído/efectos adversos , Colangitis Esclerosante/tratamiento farmacológico , Femenino , Estudios de Seguimiento , Formaldehído/uso terapéutico , Humanos , Persona de Mediana Edad , Ácido Ursodesoxicólico/administración & dosificación , Ácido Ursodesoxicólico/uso terapéuticoRESUMEN
Primary treatment of liver hydatidosis is surgical, but the recurrence rate is about 10%. To minimize the risk of recurrence, 67 consecutive patients with liver hydatidosis were prospectively treated by mebendazole or albendazole for 5 days before surgery. During the operation the viability of the protoscoleces was assessed. Seventeen patients who had viable protoscoleces at the time of the operation received the same benzimidazole one extra month postoperatively, while the remaining 50 patients who had dead protoscoleces didn't receive postoperative therapy. None of the patients developed recurrence of the disease after a follow-up period of 15-67 months (average 41 months). These results suggest that a 5-day preoperative benzimidazole therapy either combined or not with a monthly postoperative course according to the viability of the protoscoleces at the time of operation, may erase the risk of recurrence after surgical treatment of the liver hydatidosis.