RESUMEN
OBJECTIVE: To present the results of our case series on laparoscopic nephrectomy in xanthogranulomatous pyelonephritis (XGP). METHODS: A retrospective study was conducted that included 143 patients treated with laparoscopic nephrectomy for non-functioning kidney, of whom 15 had XGP, within the time frame of 2011 to 2019. The demographic and clinical data were collected, along with the intraoperative results, complications, and days of hospital stay. RESULTS: Transperitoneal laparoscopic nephrectomy was successfully performed on 15 patients with XGP, with no need for conversion. Mean intraoperative time was 124.4 minutes (range 70-240) and intraoperative blood loss was 148.5 ml (range 30-550), with no blood transfusion required. No intraoperative complications occurred but there was one postoperative complication (6.6%), classified as Clavien-Dindo I (surgical wound infection). Mean hospital stay was 2.85 days (range 2-7). CONCLUSIONS: Nephrectomy is the definitive management for XGP, and the laparoscopic approach should be considered a treatment modality, despite the fact that the pathology involves a severe chronic inflammatory process. Its benefits are reduced surgery duration, less blood loss, a lower complication rate, and fewer days of hospital stay, when performed by a skilled and experienced surgeon.
OBJETIVO: Presentar los resultados de nuestra serie de nefrectomía laparoscópica en pielonefritis xantogranulomatosa (PXG). MÉTODO: Se realizó un estudio retrospectivo que incluyó 143 pacientes tratados con nefrectomía laparoscópica por exclusión renal, de los cuales 15 fueron por PXG, en el periodo comprendido de 2011 a 2019. Se recolectaron datos demográficos y clínicos, resultados transoperatorios, complicaciones y días de estancia hospitalaria. RESULTADOS: Se realizó nefrectomía laparoscópica transperitoneal de forma exitosa en 15 pacientes con PXG, sin necesidad de conversión. El tiempo transoperatorio promedio fue de 124.4 minutos (rango: 70-240). El sangrado transoperatorio fue de 148.5 ml (rango: 30-550), sin requerimiento de transfusión sanguínea. No se reportaron complicaciones transoperatorias; se presentó una complicación en el posoperatorio (6.6%) clasificada como Clavien-Dindo I (infección de la herida quirúrgica). La estancia hospitalaria promedio fue de 2.85 días (rango: 2-7). CONCLUSIONES: El manejo definitivo de la PXG es la nefrectomía, y el abordaje laparoscópico debe ser considerado como una modalidad de tratamiento a pesar de ser una patología que presenta un proceso inflamatorio grave y crónico, obteniéndose beneficios como disminución en el tiempo quirúrgico, menor sangrado, menor tasa de complicaciones y menos días de estancia hospitalaria cuando es realizado por un cirujano experimentado.
Asunto(s)
Laparoscopía , Pielonefritis Xantogranulomatosa , Humanos , Estudios Retrospectivos , Laparoscopía/métodos , Pérdida de Sangre Quirúrgica , Complicaciones Intraoperatorias/cirugía , Nefrectomía/métodos , Pielonefritis Xantogranulomatosa/cirugíaRESUMEN
Objective: The study presents a logistic regression model describing the factors leading to intraoperative complications in laparoscopic sleeve gastrectomy (LSG) and a detailed description of the intraoperative complications that occurred in our operations. Material and methods: The study was designed as a retrospective and cohort study. It includes patients who underwent laparoscopic sleeve gastrectomy between January 2008 and December 2020. Results: The study included 257 patients. The mean (SD) age of all patients included in the study was 40.28 (9.58) years. The body mass index of our patients ranged from 31.2 to 86.6 kg/m2. The Stepwise Backward model was used (Cox and Snell R2 = 0.051, Nagelkerke R2 = 0.072, Hosmer-Lemesxow χ2 = 1.968, df = 4, p = 0.742, overall model accuracy of 70.4%). The model shows that pre-operative diabetes mellitus or hypertension Stage 3 significantly increases the probability or risk of intraoperative complications. Conclusions: The study shows which intraoperative complications occur in LSG, how they can be remedied and which factors can lead to them and influence the outcome of the operation itself. The recognition and successful treatment of intraoperative complications are very important as they reduce the number of reoperations and treatment costs.
Objetivo: El estudio presenta un modelo de regresión logística que describe los factores que conducen a las complicaciones intraoperatorias en la gastrectomía en manga laparoscópica (LSG) y una descripción detallada de las complicaciones intraoperatorias que ocurrieron en nuestras operaciones. Material y métodos: Estudio de cohorte retrospectivo. Incluye pacientes que se sometieron a LSG entre enero de 2008 y diciembre de 2020. Resultados: El estudio incluyó a 257 pacientes. La edad media (DE) de los pacientes del estudio fue de 40.28 (9.58) años. El índice de masa corporal de nuestros pacientes osciló entre 31.2 y 86.6 kg/m2. Se utilizó el modelo Stepwise Backward (Cox y Snell R2 = 0.051, Nagelkerke R2 = 0.072, Hosmer-Lemesxow χ2 = 1.968, gl = 4, p = 0.742, precisión global del modelo del 70.4%). El modelo muestra que la diabetes mellitus o hipertensión preoperatoria en estadio 3 aumenta significativamente la probabilidad de complicaciones intraoperatorias. Conclusiones: El estudio muestra qué complicaciones intraoperatorias ocurren en la LSG, cómo se pueden remediar y qué factores pueden conducir a ellas e influir en el resultado de la operación en sí. El reconocimiento y el tratamiento exitoso de las complicaciones intraoperatorias son muy importantes ya que reducen el número de reintervenciones y los costos del tratamiento.
Asunto(s)
Laparoscopía , Obesidad Mórbida , Humanos , Adulto , Obesidad Mórbida/cirugía , Estudios Retrospectivos , Estudios de Cohortes , Resultado del Tratamiento , Laparoscopía/efectos adversos , Complicaciones Intraoperatorias/epidemiología , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/cirugía , Gastrectomía/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Índice de Masa CorporalRESUMEN
BACKGROUND: One of the most serious complications of cholecystectomy is bile duct disruption, which can be associated with concomitant vascular injury in up to 3.4%. The incidence, demographic characteristics and treatment are underreported worldwide. OBJECTIVE: To determine the incidence of vascular lesions in patients with a diagnosis of bile duct disruption secondary to cholecystectomy from January 1, 2015 to December 31, 2019, confirmed by preoperative CT angiography or intraoperative findings. METHOD: Retrospective, observational and analytical study of a series of cases between 2015 and 2019. Where a total of 144 cases of bile duct disruption were found, 15 cases (10%) with concomitant vascular injury. RESULTS: The most frequent vascular injury was of the right hepatic artery in 13 patients (87%). The level of biliary disruption most frequently associated was Strasberg E3 and E4 in 5 patients (36%), respectively. The treatment of vascular injury was ligation of the injured vessel in 11 patients (73%). The treatment established for the repair of biliary disruption was the hepatic jejunum anastomosis in 14 patients (93%). CONCLUSIONS: The presence of injury at the level of the right hepatic artery is the most frequent and its ligation did not show a significant impact on biliodigestive reconstruction, as long as an adequate technique is performed (Hepp-Couinaud).
ANTECEDENTES: Una de las complicaciones más serias de la colecistectomía es la disrupción de la vía biliar, la cual puede estar asociada con lesión vascular concomitante hasta en un 3.4%. Su incidencia, características demográficas y tratamiento son infrarreportados en todo el mundo. OBJETIVO: Conocer la incidencia de las lesiones vasculares en pacientes con diagnóstico de disrupción de la vía biliar secundaria a colecistectomía, del 1 de enero de 2015 al 31 de diciembre de 2019, confirmado por angiotomografía preoperatoria o por hallazgos transoperatorios. MÉTODO: Estudio retrospectivo, observacional y analítico de una serie de casos del 2015 al 2019. Encontrando 144 casos de disrupción de la vía biliar, 15 (10%) con lesión vascular concomitante. RESULTADOS: La lesión vascular más frecuente fue la de arteria hepática derecha, en 13 pacientes (87%). El nivel de disrupción biliar más habitualmente asociado fue Strasberg E3 y E4, en 5 pacientes (36%) cada uno. El tratamiento de la lesión vascular fue ligadura del vaso en 11 pacientes (73%). El tratamiento de la disrupción de vía biliar fue anastomosis hepático-yeyunal en 14 pacientes (93%). CONCLUSIONES: La presencia de lesión de la arteria hepática derecha es la más frecuente y su ligadura no tiene una repercusión significativa en la reconstrucción biliodigestiva, siempre y cuando se realice una técnica adecuada (Hepp-Couinaud).
Asunto(s)
Colecistectomía Laparoscópica , Lesiones del Sistema Vascular , Humanos , Conductos Biliares/cirugía , Conductos Biliares/lesiones , Colecistectomía/efectos adversos , Colecistectomía Laparoscópica/efectos adversos , Incidencia , Complicaciones Intraoperatorias/epidemiología , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/cirugía , Estudios RetrospectivosRESUMEN
OBJECTIVE: To compare 90-day morbidity in patients undergoing lung lobectomy performed by either robotic-assisted thoracic surgery (RATS) or video-assisted thoracic surgery (VATS). Intraoperative complications, drainage time, length of hospital stay, postoperative pain, postoperative quality of life, and readmissions within 90 days were also compared. METHODS: This was a two-arm randomized clinical trial including patients with lung lesions (primary lung cancer or lung metastasis) who were candidates for lung lobectomy. Patients with comorbidities that precluded surgical treatment were excluded. All patients followed the same postoperative protocol. RESULTS: The overall sample comprised 76 patients (39 in the VATS group and 37 in the RATS group). The two groups were similar regarding gender, age, BMI, FEV1 in % of predicted, and comorbidities. Postoperative complications within 90 days tended to be more common in the VATS group than in the RATS group, but the difference was not significant (p = 0.12). However, when only major complications were analyzed, this tendency disappeared (p = 0.58). Regarding postoperative outcomes, the VATS group had a significantly higher number of readmissions within 90 days than did the RATS group (p = 0.029). No significant differences were found regarding intraoperative complications, drainage time, length of hospital stay, postoperative pain, and postoperative quality of life. CONCLUSIONS: RATS and VATS lobectomy had similar 90-day outcomes. However, RATS lobectomy was associated with a significant reduction in the 90-day hospital readmission rate. Larger studies are necessary to confirm such a finding.(ClinicalTrials.gov identifier: NCT02292914 [http://www.clinicaltrials.gov/]).
Asunto(s)
Neoplasias Pulmonares , Procedimientos Quirúrgicos Robotizados , Brasil , Humanos , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/cirugía , Tiempo de Internación , Pulmón/patología , Pulmón/cirugía , Neoplasias Pulmonares/patología , Nitrilos , Neumonectomía/efectos adversos , Complicaciones Posoperatorias/etiología , Calidad de Vida , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Procedimientos Quirúrgicos Robotizados/métodos , Cirugía Torácica Asistida por Video/efectos adversos , Cirugía Torácica Asistida por Video/métodosRESUMEN
PURPOSE: Bile duct injuries (BDI) during a laparoscopic cholecystectomy still remain as one of the most feared complications in surgery. The use of laparoscopy for its management is a controversial subject of discussion. The purpose of this study is to assess the amount of possibilities that a laparoscopic approach allows in its resolution. METHODS: A retrospective analysis of all the patients diagnosed with BDI at our center was carried out. The analysis was made considering three different scenarios in which laparoscopy can be used: (1) intraoperative management of BDI; (2) postoperative management of bile peritonitis; (3) deferred treatment of BDI. RESULTS: We analyzed 22 patients in total who were divided into three groups according to the different scenarios proposed. In the first group, the applicability of laparoscopy was 45%, some complications occurred in two patients, and primary patency was obtained in seven. In the second group, four of them presented a grade III complication. In the third group, the applicability of laparoscopy was 13.6%. Only one patient presented a IIIa complication and primary patency was obtained in all of them. CONCLUSIONS: Laparoscopy plays a more important role in BDI management every day. This approach, in selected cases, is associated with good long-term results and perioperative advantages of a minimally invasive approach.
Asunto(s)
Colecistectomía Laparoscópica , Laparoscopía , Conductos Biliares/lesiones , Conductos Biliares/cirugía , Colecistectomía Laparoscópica/efectos adversos , Colecistectomía Laparoscópica/métodos , Humanos , Enfermedad Iatrogénica , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/cirugía , Laparoscopía/efectos adversos , Estudios RetrospectivosRESUMEN
La cirugía de los terceros molares retenidos puede ser considerada una intervención de rutina para el cirujano bucomaxilofacial. Como todo procedimien-to quirúrgico, puede presentar complicaciones intra y postoperatorias. Las más frecuentes son el dolor, edema, trismus, hemorragia y fracturas de las piezas dentarias a extraer, o de las tablas óseas. Pero tam-bién se pueden presentar otras complicaciones ines-peradas, como la impulsión o desplazamiento de la pieza dentaria a espacios anatómicos vecinos, entre los que podemos encontrar al espacio pterigomandi-bular, la celda submaxilar, el seno maxilar, el espacio infratemporal, según se trate de terceros molares retenidos inferiores o superiores. En el presente ar-tículo, se describe una situación clínica de un tercer molar superior, que fue accidentalmente impulsado a la región infratemporal, y removido en una segunda cirugía realizada 3 semanas después del primer in-tento de exodoncia. Se analizan también los estudios preoperatorios para su correcto diagnóstico, y las maniobras clínicas e instrumentales tendientes a po-sibilitar su remoción minimizando las complicaciones intra y postquirúrgicas (AU)
Surgery of retained third molars can be considered a routine intervention for the oral surgeon. Like any surgical procedure, it can present intra and posto-perative complications. The most frequent are pain, edema, trismus, hemorrhage and fractures of the teeth to be extracted or of the bone tables. But other unexpected complications can also occur, such as the impulsion or displacement of the tooth to neighbo-ring anatomical spaces, among which we can find the pterygomandibular space, the submaxillary cell, the maxillary sinus, the buccal space, the infratemporal space and the lateral pharyngeal space, depending on whether they are lower or upper retained third mo-lars. In this article, the clinical case of a third upper molar is described, which was accidentally driven to the infratemporal region, which was removed in a second surgery performed 3 weeks after the first attempt at exodontics. It should be noted the impor-tance of diagnostic imaging as an indispensable com-plement to the correct location of the displaced tooth and its subsequent removal (AU)
Asunto(s)
Humanos , Femenino , Adulto , Diente Impactado/cirugía , Fosa Infratemporal , Complicaciones Intraoperatorias/cirugía , Tercer Molar/cirugía , Extracción Dental/efectos adversos , Radiografía Panorámica/métodos , Tomografía Computarizada de Haz Cónico/métodos , Espacio Parafaríngeo , Tercer Molar/diagnóstico por imagenRESUMEN
Objetivo: Describir en un caso clínico una nueva técni- ca para la localización y la remoción de agujas fracturadas du- rante la anestesia odontológica mediante planificación virtual. Caso clínico: Una paciente de género femenino de 52 años de edad concurre a la Cátedra de Cirugía y Traumatolo- gía Bucomaxilofacial I de la Facultad de Odontología de la Universidad de Buenos Aires y relata que dos meses atrás, durante la atención odontológica, se produjo la fractura de la aguja durante la anestesia troncular mandibular. Se realiza diagnóstico y planificación virtual para conocer la ubicación exacta de la aguja y se confecciona un modelo estereolito- gráfico y una guía quirúrgica individualizada para removerla. El uso de una guía quirúrgica individualizada y confeccio- nada mediante planificación virtual permitió ubicar la aguja tridimensionalmente y con mayor precisión en espacios pro- fundos y disminuir tiempos operatorios (AU)
Aim: To describe in a clinical case a new virtual plan- ning technique for locating and removing a fractured dental anesthetic needle. Clinical case: A 52-year-old patient visited the De- partment of Oral and Maxillofacial Surgery I (School of Dentistry, University of Buenos Aires) with a retained den- tal needle in the pterygomandibular space. The needle had fractured during inferior alveolar nerve block two months previously. Virtual diagnosis and planning were performed to locate the needle and a stereolithographic model and a customized surgical guide were prepared. The use of cus- tomized surgical guides prepared by virtual planning ena- bled precise location of the dental needle in deep spaces and reduced operating times (AU)
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Cuerpos Extraños/cirugía , Anestesia Dental/instrumentación , Mandíbula , Agujas , Tomografía Computarizada de Haz Cónico , Cuerpos Extraños/diagnóstico por imagen , Estereolitografía , Complicaciones Intraoperatorias/cirugía , Mandíbula/cirugía , Mandíbula/diagnóstico por imagenRESUMEN
RESUMEN Introducción: la propia asistencia médica provoca, en determinadas situaciones, problemas de salud que pueden llegar a ser importantes para el enfermo. El análisis de la mortalidad es uno de los parámetros utilizados para investigar la seguridad en la realización de procederes de cirugía mayor. Objetivo: determinar los factores asociados a la mortalidad operatoria en cirugías mayores. Materiales y métodos: se realizó un estudio observacional, descriptivo y retrospectivo, de los pacientes que fallecieron tras la realización de una cirugía mayor, en el Hospital Militar Docente Dr. Mario Muñoz Monroy, de Matanzas, en el período comprendido de enero de 2011 a diciembre de 2019. Resultados: la tercera edad aportó 77,3 % de los fallecidos. La hipertensión arterial, diabetes mellitus y cardiopatía isquémica fueron las principales comorbilidades. El abdomen agudo fue el diagnóstico operatorio más frecuente con 98 (58,3 %). Las complicaciones aportaron el 11,9 % de los fallecidos; los eventos adversos, 29,7 %, y por el curso natural de la enfermedad, murió un 58,3 %. El síndrome de disfunción múltiple de órganos y el shock séptico resultaron las principales causas de muerte (62 %). Conclusiones: la mortalidad operatoria estuvo asociada a factores de riesgo como edad avanzada, enfermedades crónicas y cirugía de urgencia. Los eventos adversos elevan la incidencia de mortalidad en cirugía mayor. Las infecciones son la principal causa de mortalidad operatoria (AU).
ABSTRACT Introduction: medical care itself causes, in certain situations, health problems that could be very important for the patient. The mortality analysis is one of the parameters used to study safety performing procedures of major surgery. Objective: to determine the factors associated to operatory mortality in major surgeries. Materials and methods: a retrospective, descriptive and observational study was carried out of the patients who passed away after undergoing a major surgery in the Military Hospital Dr. Mario Munoz Monroy in the period between January 2011 and December 2019. Results: 77.3 % of the deceased were elder people. The main co-morbidities were arterial hypertension, diabetes mellitus and ischemic heart disease. The most frequent surgery diagnosis was acute abdomen with 98 patients (58.3 %). Complications yielded 11.9 % of the deceases, adverse events 29.7 % and 58.3 % died due to the natural course of the disease. The organs multiple dysfunction syndrome and septic shock were the main causes of dead (62 %). Conclusions: operatory mortality was associated to risk factors like advanced age, chronic diseases and emergency surgery. The adverse events increase mortality incidence in major surgery. Infections are the main causes of operatory mortality (AU).
Asunto(s)
Humanos , Masculino , Femenino , Procedimientos Quirúrgicos Operativos/mortalidad , Mortalidad Hospitalaria/tendencias , Quirófanos/métodos , Cirugía General/métodos , Servicio de Cirugía en Hospital/normas , Servicio de Cirugía en Hospital/tendencias , Pacientes Internos , Complicaciones Intraoperatorias/cirugíaRESUMEN
In laparoscopic cholecystectomy (LC), the treatment of iatrogenic biliary tract injury has been given much attention. However, most accidental right hepatic artery (RHA) injuries are treated with simple clipping. The reason is that the RHA has difficulty in revascularization, and it is generally considered that RHA injury does not cause serious consequences. However, some studies suggest that some cases of RHA ligation can cause a series of pathological changes correlated to arterial ischemia, such as liver abscess, bile tumor, liver atrophy and anastomotic stenosis. Theoretically, RHA blood flow should be restored when possible, in order to avoid the complications of right hepatic ischemia. The present study involved two patients, including one male and one female patient. Both patients were admitted to the hospital with the diagnosis of chronic cholecystitis and gallbladder stone, and developed ischemia of the right half hepatic after accidental transection of the RHA. Both patients underwent continuous end-end anastomosis of the RHA with 6-0 Prolene suture. After the blood vessel anastomosis, the right half liver quickly recovered to its original bright red. No adverse complications were observed in follow-ups at three and six months after the operation. Laparoscopic repair of the RHA is technically feasible. Reconstruction of the RHA can prevent complications associated with right hepatic ischemia.
Asunto(s)
Colecistectomía/efectos adversos , Cálculos Biliares/cirugía , Arteria Hepática/lesiones , Complicaciones Intraoperatorias/cirugía , Laparoscopía/métodos , Procedimientos Quirúrgicos Vasculares/métodos , Lesiones del Sistema Vascular/etiología , Femenino , Arteria Hepática/cirugía , Humanos , Masculino , Persona de Mediana Edad , Lesiones del Sistema Vascular/diagnóstico , Lesiones del Sistema Vascular/cirugíaRESUMEN
A hidradenite supurativa (HS) é uma doença inflamatória crônica da pele caracterizada por apresentar nodulações subcutâneas, dolorosas e com sinais flogísticos, inicialmente enrijecidas e que evoluem para consistência amolecida. Ocorre em 1 a 4% da população mundial. A sua etiologia ainda é pouco conhecida, sugere-se que aconteça devido à oclusão do ducto apócrino dos folículos pilosos por fatores precipitantes como fricção de tecido adiposo, higiene precária, entre outras. Seu diagnóstico é eminentemente clínico, pela identificação de lesões típicas recorrentes em forma de nodularidades, abcessos, tratos fistulosos ou cicatrizes. Não há testes patognomônicos. Sua evolução é variável e de difícil manejo, o qual pode ser feito com terapia tópica, sistêmica ou por exérese cirúrgica. Este trabalho revisa a avaliação por imagem da hidroadenite supurativa e demonstra imagens de um caso avaliado por ressonância magnética. A avaliação por exames de imagem, apesar de pouco específica para firmar diagnóstico, é muito útil na determinação da extensão da doença, assim como na exclusão de diagnósticos diferenciais, destacando-se o papel da ressonância magnética na avaliação das lesões anogenitais, com potencial de reduzir recorrências.
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by painful deep-seated skin nodules with phlogistic signs, which are initially hard and progress to have a soft consistency. It occurs in 14% of the world population. Etiology of HS is still poorly understood and is suggested to occur due to occlusion of the apocrine duct of the hair follicles by triggering factors such as friction of the adipose tissue and poor hygiene, among others. Diagnosis is eminently clinical, through the identification of typical recurrent lesions that include nodules, abscesses, sinus tracts, or scars. There are no pathognomonic tests used to confirm its presence. Progression is variable and difficult to manage, which can be done with topical or systemic therapy or surgical excision. This work reviews the imaging assessment of HS and shows images of a case assessed by magnetic resonance imaging. Imaging assessment, although not specific enough for a diagnosis, is useful to determine the extent of the disease and to exclude differential diagnoses. Moreover, magnetic resonance imaging has an important role in the assessment of anogenital lesions and a potential to reduce recurrences.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Imagen por Resonancia Magnética/métodos , Ultrasonografía/métodos , Hidradenitis Supurativa/cirugía , Hidradenitis Supurativa/etiología , Hidradenitis Supurativa/diagnóstico por imagen , Ultrasonografía Doppler/métodos , Procedimientos de Cirugía Plástica/métodos , Análisis de Frecuencia de Resonancia/métodos , Complicaciones Intraoperatorias/cirugía , Dermatosis Nodular Contagiosa/cirugía , Dermatosis Nodular Contagiosa/etiología , Dermatosis Nodular Contagiosa/diagnóstico por imagenRESUMEN
Defeitos parciais de orelha podem ser tratados de diversas formas, dentre elas o fechamento primário, cicatrização por segunda intenção ou retalhos. Diversas opções técnicas foram descritas para a sua reconstrução de modo a manter o contorno natural da orelha, sem sacrificar tecido sadio ou alterar sua estética e função. Apresentamos neste artigo dois casos atendidos no Instituto do Câncer do Hospital de Base de São José do Rio Preto de reconstrução de defeitos condrocutâneos de orelha após ressecção de carcinoma basocelular em região central da orelha, com a confecção de retalho retroauricular ilhado transposto através de uma janela cartilaginosa e com o pedículo desepidermizado. Área doadora com fechamento primário. Tal procedimento constitui técnica segura, pois a região retroauricular é ricamente vascularizada, é de fácil execução, em único estágio e com resultado estético e funcional satisfatório.
Partial ear defects can be treated in several ways, including primary closure, healing by secondary intention, or flaps. Several surgical options have been described for reconstruction in order to maintain the natural contour of the ear, without sacrificing healthy tissues or changing the aesthetics and function. In this article, we present two cases of reconstruction of chondrocutaneous defects of the ear after resection of basal cell carcinoma in the central region of the ear, with the production of a retroauricular island flap transposed through a cartilaginous window with the de-epidermized pedicle. The donor area healed following a primary closure. This procedure can be performed in a single stage, yields satisfactory aesthetic and functional results, and is safe because the retroauricular region is richly vascularized.
Asunto(s)
Humanos , Masculino , Adulto , Anciano , Colgajos Quirúrgicos/cirugía , Colgajos Quirúrgicos/efectos adversos , Neoplasias del Oído/cirugía , Carcinoma Basocelular/cirugía , Carcinoma Basocelular/fisiopatología , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/métodos , Cartílago Auricular/anomalías , Cartílago Auricular/cirugía , Cartílago Auricular/crecimiento & desarrollo , Deformidades Adquiridas del Oído/cirugía , Oído Externo/anatomía & histología , Oído Externo/anomalías , Oído Externo/cirugía , Complicaciones Intraoperatorias/cirugía , Complicaciones Intraoperatorias/prevención & controlRESUMEN
Introdução: O hematoma, complicação mais frequente do face-lift, pode exigir reabordagem cirúrgica e atrasar a recuperação do paciente. Na literatura, sua incidência varia entre 0,2 e 8%, sendo fundamentais novos estudos para padronização das medidas de prevenção. O objetivo é apresentar uma proposta de sistematização perioperatória que previna eficientemente a formação de hematomas em ritidoplastias. Métodos: Foram analisados 594 prontuários de pacientes operados pelo autor entre os anos de 2011 a 2018 a fim de se comparar as incidências de hematomas anteriores e posteriores à sistematização implementada no ano de 2015. Resultados: De julho de 2011 a dezembro de 2014, antes da adoção da sistematização, houve uma incidência de hematomas de 3,43% em 233 casos. Após sua adoção, houve uma queda para 1,66% em 361 casos realizados. Os últimos 177 casos consecutivos não apresentaram a complicação. Conclusão: Observamos redução expressiva da incidência de hematomas pós-ritidoplastias após o uso da padronização proposta. Nenhuma das medidas adotadas seria eficiente isoladamente, sendo o conjunto essencial na prevenção desta grave complicação.
Introduction: Hematoma, the most frequent complication of face-lift procedures, may require a second surgical approach, which delays patient recovery. In the literature, its incidence ranges from 0.2% to 8%, and further studies are essential to standardize preventive measures. The objective is to present a proposal of perioperative systematization for effectively prevention of hematoma formation after rhytidectomies. Methods: We analyzed the medical records of 594 patients who underwent operation by the author between 2011 and 2018 to compare the incidence of hematomas before and after the systematization implemented in 2015. Results: From July 2011 to December 2014, before the adoption of the systematization, the incidence of hematomas was 3.43% in 233 cases. After its adoption, the incidence decreased to 1.66% in 361 cases. The last 177 consecutive cases did not have this complication. Conclusion: We observed a significant reduction in the incidence of hematomas following rhytidectomy after the use of the proposed standardization. None of the measures would be effective alone; thus, their combined adoption is essential in preventing this serious complication.
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Humanos , Masculino , Femenino , Adulto , Complicaciones Posoperatorias/cirugía , Procedimientos Quirúrgicos Operativos/efectos adversos , Procedimientos Quirúrgicos Operativos/métodos , Ritidoplastia/efectos adversos , Ritidoplastia/métodos , Protocolos Clínicos/normas , Hematoma/complicaciones , Hematoma/prevención & control , Complicaciones Intraoperatorias/cirugíaAsunto(s)
Drenaje , Endoscopía , Complicaciones Intraoperatorias/cirugía , Seudoquiste Pancreático , Stents Metálicos Autoexpandibles , Adulto , Drenaje/efectos adversos , Drenaje/instrumentación , Drenaje/métodos , Endoscopía/efectos adversos , Endoscopía/instrumentación , Endoscopía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Seudoquiste Pancreático/diagnóstico por imagen , Seudoquiste Pancreático/etiología , Seudoquiste Pancreático/cirugía , Pancreatitis/complicaciones , Cirugía Asistida por Computador/métodos , Resultado del Tratamiento , Ultrasonografía Intervencional/métodosRESUMEN
PURPOSE: Pediatric living donor liver transplantation (LDLT) in low weight recipients remains one of the most complex surgical procedures, with portal vein (PV) complications occurring in up to 19% of cases. When decreased PV flow is diagnosed intra- or perioperatively, intraoperative stent placement is a good substitute for surgical adjustment. Still, at the present moment, little is known about the technical feasibility, safety, efficacy, and long-term outcome of intraoperative stenting in LDLT. METHODS: Between 2006 and 2017, seven pediatric recipients underwent PV stent placement during the transplant or in the immediate post-operative setting. Preoperative, operative, and post-operative parameters were documented retrospectively. RESULTS: In total, nine stents were placed in seven patients. Procedures were technically successful in all patients. During the mean imaging follow-up period of 1313 days, none of the patients showed PV abnormality and PV stent remained patent throughout the post-transplant course. There were no deaths or graft loses during the follow-up period. CONCLUSIONS: Intraoperative stenting through the inferior mesenteric vein approach offers both a high feasibility and satisfactory results, with the potential for excellent long-term primary patency despite continued growth in children.
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Atresia Biliar/cirugía , Cuidados Intraoperatorios , Complicaciones Intraoperatorias/cirugía , Trasplante de Hígado/efectos adversos , Vena Porta , Stents , Preescolar , Constricción Patológica , Femenino , Humanos , Lactante , Complicaciones Intraoperatorias/etiología , Donadores Vivos , Masculino , Estudios RetrospectivosRESUMEN
ANTECEDENTES: Las lesiones de vías biliares por colecistectomía son una complicación seria. Numerosos factores alteran el resultado de su reconstrucción. MÉTODO: Evaluación de la reconstrucción de lesiones de vía biliar y sus factores de riesgo (de enero de 2008 a enero de 2017). RESULTADOS: Se evaluaron 58 pacientes (72.4% mujeres; media de edad 41.8 años). El 67.8% tuvo colecistectomía laparoscópica como cirugía inicial. El 79.3% se diagnosticó posoperatoriamente. La referencia promedio fue 9 semanas y su reparación temprana (< 1 semana) ocurrió en el 27.6%. La lesión más común fue Amsterdam tipo D (55.2%) y Bismuth-Strasberg E4 (34.5%). La morbilidad fue del 39.6% (fuga biliar 10.3%, estenosis 6.9% y colangitis recurrente12.1%), con un 3% de mortalidad perioperatoria. Se logró un éxito del 81% de acuerdo con la clasificación de McDonald. Los factores de riesgo para las complicaciones fueron baja hemoglobina, baja albúmina, baja fosfatasa alcalina, tutores biliares y lesiones E3-E5 (análisis univariado). Los factores de riesgo para falla terapéutica fueron la reparación previa en otro centro, los tutores biliares y la reparación posterior a 1 semana tras la lesión (univariado y multivariado). CONCLUSIÓN: Pueden obtenerse buenos resultados en las reconstrucciones de vías biliares en centros especializados. Existen algunos factores de riesgo para los resultados de las reconstrucciones que deben de ser validados. BACKGROUND: Bile duct injury during cholecystectomy is a serious complication. Multiple factors may alter their outcome. . METHOD: We retrospectively evaluated our results following bile duct injury surgery repair and possible poor outcome risk factors from January 2008 to January 2017. RESULTS: 58 patients (72.4% female; mean age 41.8 years) were evaluated. 67.8% underwent open cholecystectomy as initial surgery. 79.3% of bile duct injury were diagnosed postoperatively. Mean referral time was 9 weeks and early (< 1 week) repair was performed in 27.6%. Most common lesion was Amsterdam type D (55.2%) and Bismuth-Strasberg E4 (34.5%). Morbidity was 39.6%. Biliary leak occurred in 10.3%, bilio-enteric stricture in 6.9% and recurrent cholangitis in 12.1%, with 3% perioperative mortality. There was an 81% treatment success rate (McDonald classification). Risk factors for complications were: low hemoglobin, low albumin, low alkaline phosphatase, biliary stents and E-3-E5 lesions (univariate analysis only). Risk factors for treatment failure were: previous repair outside our center, use of biliary stents and repair later than 1 week after lesion (univariate and multivariate analysis). CONCLUSIONS: Good efficacy and safety outcomes in bile repair surgery can be achieved in specialized centers. There are possible risk factors influencing outcomes that should be further validated.
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Conductos Biliares/lesiones , Conductos Biliares/cirugía , Colecistectomía , Complicaciones Intraoperatorias/cirugía , Adolescente , Adulto , Anciano , Colecistectomía/efectos adversos , Femenino , Humanos , Complicaciones Intraoperatorias/epidemiología , Complicaciones Intraoperatorias/etiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Insuficiencia del Tratamiento , Adulto JovenRESUMEN
Bile duct injury during laparoscopy is the most important complication of laparoscopic cholecystectomy. Bile duct injuries place an enormeous burden on the health and productivity of the population. To avoid this severe complication, it has been one of the central objectives of the biliary surgery since its beginings. Traditional teaching of surgery fails in the prevention of laparoscopic bile duct injuries, and they cannot control the problem. Assessment of biliary anatomy of the bile duct injury is mandatory for prevention of iatrogenic bile duct injuries. With a proper knowledge for identification and categorization of the triangle of Calot to avoid technical errors we will achieve system changes to improve patient safety. Finally, although medical consensus and substantial evidence exist promoting the importance of the Critical Vision on Safety, with the development of a fundamental support to the regularization, a safe operative technique will decrease the rate of severe complications of the bile duct injury
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Humanos , Adolescente , Adulto , Persona de Mediana Edad , Conductos Biliares/lesiones , Estudios Prospectivos , Colecistectomía Laparoscópica , Complicaciones Intraoperatorias/cirugía , Errores Médicos , Enfermedad IatrogénicaRESUMEN
Introdução: O ceratoacantoma é uma neoplasia epitelial de rápido crescimento, mais frequente em áreas de exposição solar. Habitualmente, apresenta-se como lesão única, arredondada, com depressão central preenchida de queratina. As semelhanças clínicas e histopatológicas com o carcinoma de células escamosas, frequentemente, dificultam o diagnóstico diferencial. A biópsia excisional é a abordagem de escolha, permitindo diagnóstico e tratamento. Método: O presente estudo é observacional e retrospectivo, com dados de 162 pacientes tratados de 2005 a 2013, no Hospital Felício Rocho, em Belo Horizonte, MG. Todos os pacientes submeteram-se à excisão cirúrgica dos tumores. Foram estudados: sexo, idade, número de lesões, localização, tamanho do tumor e diagnóstico pré-operatório. Resultados: Dos 162 pacientes, totalizando 173 lesões, 154 (95,06%) apresentavam ceratoacantoma único. Noventa e dois eram do gênero masculino (56,80%) e 70 do feminino (43,20%). A idade dos pacientes variou de 11 a 96 anos, com média de 71,23 anos. As lesões localizavam-se predominantemente nos membros superiores (43,64%), na face (28,48%) e nos membros inferiores (17,58%). Nas hipóteses diagnósticas formuladas pelos cirurgiões, no pedido do exame anatomopatológico, houve diagnóstico correto em 63,13%. Conclusão: O ceratoacantoma é uma neoplasia epitelial de características morfológicas semelhantes ao carcinoma de células escamosas, o que, por muitas vezes, dificulta o diagnóstico. Torna-se necessária, portanto, a excisão cirúrgica completa das lesões suspeitas para diagnóstico e tratamento corretos.
Introduction: Keratoacanthoma is an epithelial neoplasm of rapid growth, more frequent in areas of sun exposure, and usually appears as a single, rounded lesion with a central depression filled with keratin. Clinical and histopathological similarities with squamous cell carcinoma often make differential diagnosis difficult. Excisional biopsy is the approach of choice, allowing diagnosis and treatment. Method: This is an observational and retrospective study, in which data of 162 patients treated at the Hospital Felício Rocho from 2005 to 2013, in Belo Horizonte, MG, were analyzed. All patients underwent surgical excision of tumors. Data on sex, age, number of lesions, location, tumor size, and preoperative diagnosis were studied. Results: Of the 162 patients, with a total of 173 lesions, only 154 (95.06%) had keratoacanthoma. There were 92 male (56.80%) and 70 female (43.20%) patients. The age of patients ranged from 11 to 96 years, with an average of 71.23 years. The lesions were located predominantly in the upper limbs (43.64%), face (28.48%), and lower limbs (17.58%). In the diagnostic hypotheses formulated by surgeons at the request of the pathology, the diagnosis was correct in 63.13%. Conclusion: Keratoacanthoma is an epithelial tumor with morphological characteristics similar to those of squamous cell carcinoma, which often complicates the diagnosis. Therefore, the complete excision of the suspicious lesions is necessary for correct diagnosis and treatment.
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Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Neoplasias Cutáneas/cirugía , Procedimientos Quirúrgicos Operativos/métodos , Biopsia/métodos , Procedimientos de Cirugía Plástica/métodos , Células Epiteliales/patología , Epitelio/cirugía , Complicaciones Intraoperatorias/cirugía , Queratoacantoma/cirugía , Queratoacantoma/patología , Proliferación Celular , QueratoacantomaRESUMEN
BACKGROUND: The Da Vinci Robotic Surgical System has positioned itself as a tool that improves the ergonomics of the surgeon, facilitating dissection in confined spaces and enhancing the surgeon's skills. The technical aspects for successful bile duct repair are well-vascularized ducts, tension-free anastomosis, and complete drainage of hepatic segments, and all are achievable with robotic-assisted approach. METHODS: This was a retrospective study of our prospectively collected database of patients with iatrogenic bile duct injury who underwent robotic-assisted Roux-en-Y hepaticojejunostomy. Pre-, intra-, and short-term postoperative data were analyzed. RESULTS: A total of 30 consecutive patients were included. The median age was 46.5 years and 76.7% were female. Neo-confluences with section of hepatic segment IV were performed in 7 patients (those classified as Strasberg E4). In the remaining 23, a Hepp-Couinaud anastomosis was built. There were no intraoperative complications, the median estimated blood loss was 100 mL, and the median operative time was 245 min. No conversion was needed. The median length of stay was 6 days and the median length of follow-up was 8 months. The overall morbidity rate was 23.3%. Two patients presented hepaticojejunostomy leak. No mortality was registered. CONCLUSION: Robotic surgery is feasible and can be safely performed, with acceptable short-term results, in bile duct injury repair providing the advantages of minimally invasive surgery. Further studies with larger number of cases and longer follow-up are needed to establish the role of robotic assisted approaches in the reconstruction of BDI.
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Anastomosis en-Y de Roux , Conductos Biliares/lesiones , Conductos Biliares/cirugía , Complicaciones Intraoperatorias/cirugía , Yeyunostomía , Procedimientos Quirúrgicos Robotizados , Adulto , Colecistectomía/efectos adversos , Femenino , Humanos , Complicaciones Intraoperatorias/etiología , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Introdução: Apesar do avanço no diagnóstico e no tratamento das pacientes com neoplasia mamária, ainda há casos que se apresentam como doença localmente avançada. Nesse contexto, o controle oncológico requer ressecções extensas e complexos procedimentos reparadores. A participação do cirurgião plástico nas equipes multidisciplinares de tratamento oncológico tem apresentado importância crescente tanto nas etapas de planejamento como de execução. O objetivo é analisar prospectivamente casos de pacientes com extensas ressecções no tórax e reconstrução de parede torácica quanto aos seus resultados e complicações no período de 2014-2016. Métodos: Seguimento prospectivo por 6 meses de 15 casos de pacientes submetidas a extensas ressecções oncológicas no tórax e reconstrução por um mesmo cirurgião plástico em hospitais da rede pública de São Paulo-SP. Foram coletados os dados: idade, diagnóstico, queixa pré-operatória, extensão da área de ressecção e incidência de complicações locais. Resultados: As pacientes tinham idade média de 49,2 anos, a queixa mais comum era massa papável, o diagnóstico mais comum era neoplasia da mama (80%), a maioria das ressecções preservou o plano muscular e a área média de ressecção foi de 259,2 cm2. O retalho miocutâneo do grande dorsal em V-Y foi o mais utilizado, e o toracoabdominal foi o segundo. Epiteliólise foi detectada em 13,3% das pacientes e necrose parcial menor que 5% do retalho em 13,3%. Conclusão: Na presente casuística, as pacientes portadoras de neoplasias extensas no tórax representaram um desafio para a reconstrução local, necessitando de planejamento pré-operatório minucioso e com múltiplas opções. A participação do cirurgião plástico no tratamento desses casos contribuiu para redução de morbidade e demonstrou baixo índice de complicações.
Introduction: In spite of advances in the diagnosis and treatment of patients with breast cancer, there are still cases that present with locally advanced disease. In this context, cancer control requires extensive resections and complex repair procedures. The participation of the plastic surgeon in the multidisciplinary cancer treatment teams has been increasingly important in both the planning and execution stages. The aim of this study is to prospectively analyze patients who underwent extensive chest resections and thoracic wall reconstruction with regard to their results and complications in the period 2014-2016. Methods: Prospective 6-month follow-up of 15 patients who underwent extensive oncological resections in the chest and reconstruction by the same plastic surgeon in public hospitals of São Paulo was done. The following data were collected: age, diagnosis, preoperative complaint, extent of resection area, and incidence of local complications. Results: Patients had a mean age of 49.2 years, the most common complaint was a papillary mass, the most common diagnosis was breast cancer (80%), the most resection area preserved was the muscular plane, and the mean resection area was 259.2 cm2. The V-Y latissimus dorsi myocutaneous flap was the most used, and the thoracoabdominal flap was the second. Epitheliolysis was detected in 13.3% of the patients, and partial necrosis less than 5% of the flap in 13.3%. Conclusion: In the present study, patients with extensive cancers in the thorax presented a challenge for local reconstruction, requiring detailed preoperative planning and multiple options. The participation of the plastic surgeon in the treatment of these patients contributed to the reduction of morbidity rate and low rate of complications.