RESUMO
BACKGROUND: Laparoscopic liver resections (LLR) have been increasingly performed in recent years. Most of the available evidence, however, comes from specialized centers in Asia, Europe and USA. Data from South America are limited and based on single-center experiences. To date, no multicenter studies evaluated the results of LLR in South America. The aim of this study was to evaluate the experience and results with LLR in South American centers. METHODS: From February to November 2019, a survey about LLR was conducted in 61 hepatobiliary centers in South America, composed by 20 questions concerning demographic characteristics, surgical data, and perioperative results. RESULTS: Fifty-one (83.6%) centers from seven different countries answered the survey. A total of 2887 LLR were performed, as follows: Argentina (928), Brazil (1326), Chile (322), Colombia (210), Paraguay (9), Peru (75), and Uruguay (8). The first program began in 1997; however, the majority (60.7%) started after 2010. The percentage of LLR over open resections was 28.4% (4.4-84%). Of the total, 76.5% were minor hepatectomies and 23.5% major, including 266 right hepatectomies and 343 left hepatectomies. The conversion rate was 9.7%, overall morbidity 13%, and mortality 0.7%. CONCLUSIONS: This is the largest study assessing the dissemination and results of LLR in South America. It showed an increasing number of centers performing LLR with the promising perioperative results, aligned with other worldwide excellence centers.
Assuntos
Laparoscopia , Neoplasias Hepáticas , Argentina , Ásia , Brasil , Chile , Colômbia , Europa (Continente) , Hepatectomia , Humanos , Fígado , Neoplasias Hepáticas/cirurgia , PeruRESUMO
We reviewed the results of 101 talectomies in 56 patients with arthrogrypotic clubfeet. The average age at the time of surgery was 4.3 years and the mean follow-up was 6 years. Talectomy was performed as a primary procedure in 16 feet and as a salvage procedure in 85 feet that underwent other surgical procedures before talectomy. We graded our results as good when the foot was plantigrade, able to wear regular shoes, pain free, and, very important, patient satisfaction. We used a chi2 statistical test and, after comparing results with age <4 to >4 years at time of surgery, tendo Achilles tenotomy, time of casting, radiological complete excision of talus, and transcalcaneal pin placement, only the immobilization time needed to be statistically significant to achieve a good result. We conclude that feet must be individualized for treatment and that, after reduction of the calcaneus in the mortise, a short leg cast must be placed for 8 weeks to maintain position and alignment.
Assuntos
Artrogripose/complicações , Pé Torto Equinovaro/cirurgia , Tálus/cirurgia , Tendão do Calcâneo/cirurgia , Fatores Etários , Tornozelo/cirurgia , Calcâneo/cirurgia , Criança , Pré-Escolar , Pé Torto Equinovaro/complicações , Pé Torto Equinovaro/diagnóstico por imagem , Interpretação Estatística de Dados , Feminino , Seguimentos , Humanos , Lactente , Masculino , Aparelhos Ortopédicos , Radiografia , Tendões/cirurgia , Fatores de TempoRESUMO
This was a prospective study to determine the functional results in patients with obstetric palsy treated with the Sever L'Episcopo procedure using a simple five-grade scale consisting of the ability to reach the abdomen (grade 0), upper thorax (grade I), mouth (grade II), forehead (grade III), and occiput (grade IV), which translates into an improvement in basic daily activities. Forty-nine procedures were done in 48 patients (one bilateral) with a preoperative and postoperative evaluation of each case. Range of motion was also recorded for each patient both preoperatively and postoperatively. The overall results showed an improvement of two grades in 61% of our patients. The improvement in range of motion averaged 64 degrees for active abduction and 42 degrees for active external rotation. Functional goals must be the principal concern. With this method of evaluation, we can measure (in a simple way) improvement in the activities of daily living.