RESUMO
OBJECTIVE: Staple line bleeding control (SLBC) after laparoscopic sleeve gastrectomy (LSG) is a serious problem. Cauterization alone is generally not preferred because of concerns about weakening the staple line. The aim of this study was to compare the suturing and monopolar cauterization methods for SLBC in LSG. METHODS: 212 patients were divided into two groups as cautery and suture groups. Demographic characteristics, intraoperative, and post-operative results were analyzed. RESULTS: Post-operative complications were seen in seven patients, four of them staple line bleeding (three patients were in the cautery group and one patient was in the suture group), and three of them leakage (all patients were in the suture group) from the staple line. There was no significant difference between the groups in terms of staple line bleeding (p = 0.35), staple line leakage (p = 0.09), blood loss (p = 0.12), intraoperative complications (p = 0.16), post-operative hemoglobin decrease (p = 0.63), and length of hospital stay (p = 0.35), but the operation time was longer in the suture group. CONCLUSION: This is the first study in literature comparing monopolar cauterization with another technique. Monopolar cauterization can be used for SLBC in LSG. It is a safe and efficient method as well as inexpensive.
OBJETIVO: El control del sangrado de la línea de grapas (SLBC) después de la gastrectomía en manga laparoscópica(LSG) es un problema grave. Generalmente, no se prefiere la cauterización sola debido a preocupaciones sobre el debilitamiento de la línea de grapas. El objetivo de este estudio fue comparar los métodos de sutura y cauterización monopolar para SLBC en LSG. MÉTODOS: 212 pacientes fueron divididos en 2 grupos de cauterización y sutura. Se analizaron las características demográficas, los resultados intraoperatorios y posoperatorios. RESULTADOS: Se observaron complicaciones posoperatorias en siete pacientes, cuatro de ellos sangrado en la línea de grapas (tres pacientes estaban en el grupo de cauterización, un paciente en el grupo de sutura) y tres de ellos fuga (todos los pacientes estaban en el grupo de sutura) del línea de grapas. No hubo diferencia significativa entre los grupos en términos de sangrado de la línea de grapas (p = 0.35), fuga dela línea de grapas (p = 0.09), pérdida de sangre (p = 0.12), complicaciones intraoperatorias (p = 0.16), disminución de hemoglobina postoperatoria (p = 0.63), duración dela estancia hospitalaria (p = 0.35), pero el tiempo de operación fue mayor en el grupo de sutura. CONCLUSIÓN: Este es el primer estudio que compara la cauterización monopolar con otra técnica. La cauterización monopolar se puede utilizar para SLBC en LSG. Es un método seguro, eficaz y económico.
Assuntos
Laparoscopia , Obesidade Mórbida , Cauterização , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Hemorragia/etiologia , Humanos , Laparoscopia/métodos , Obesidade Mórbida/cirurgia , Grampeamento Cirúrgico/métodos , Suturas/efeitos adversos , Resultado do TratamentoRESUMO
We aimed to discuss the weight loss success of the revision of RYGB to sleeve gastrectomy (SG). Between January 2019 and June 2020, four patients' files were analyzed retrospectively. Post-RYGB mean minimal BMI was 27.4 ± 9.47 kg/m², before SG the mean BMI was 43.41 ± 4.16 kg/m2. Post-operative gastric fistula developed in two patients. The mean follow-up time after revision surgery was 17.25 ± 6.89 months, mean excess weight loss (EWL) was 74.77 ± 8.94%, and mean BMI was 32.65 ± 2.9 kg/m2. Despite high rate of major complications, revision of RYGB to SG is successful in weight loss and resolving certain complications of RYGB.
Nuestro objetivo era discutir el éxito en la pérdida de peso de la revisión de BGYR a gastrectomía en manga (SG). Entre enero de 2019 y junio de 2020, se analizaron retrospectivamente los archivos de cuatro pacientes. El IMC mínimo medio post BGYR fue 27.4 ± 9.47 kg/m², antes de SG el IMC medio fue 43.41 ± 4.16 kg/m2. En dos pacientes se desarrolló una fístula gástrica posoperatoria. El tiempo medio de seguimiento después de la cirugía de revisión fue de 17.25 ± 6.89 meses, la pérdida media de exceso de peso (PEP) fue de 74.77 ± 8.94% y el IMC medio fue de 32.65 ± 2.9 kg/m2. A pesar de la alta tasa de complicaciones mayores, la revisión de BGYR a SG tiene éxito en la pérdida de peso y la resolución de ciertas complicaciones de BGYR.
Assuntos
Derivação Gástrica , Obesidade Mórbida , Gastrectomia/efeitos adversos , Humanos , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Reoperação , Estudos Retrospectivos , Resultado do Tratamento , Redução de PesoAssuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Hepatopatia Gordurosa não Alcoólica , Carcinoma Hepatocelular/etiologia , Carcinoma Hepatocelular/patologia , Humanos , Fígado/patologia , Cirrose Hepática/patologia , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/patologia , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/patologiaAssuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Hepatopatia Gordurosa não Alcoólica , Carcinoma Hepatocelular/genética , Carcinoma Hepatocelular/patologia , Humanos , Fígado/patologia , Cirrose Hepática/patologia , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/patologia , Hepatopatia Gordurosa não Alcoólica/genética , Hepatopatia Gordurosa não Alcoólica/patologiaRESUMO
A 52-year-old female underwent laparoscopic repair for recurrent epigastric hernia by hybrid natural orifice transluminal endoscopic surgery. Three 5-mm abdominal trocars and a 15-mm transvaginal trocar were used. The defect was closed by intracorporeal suturing before mesh fixation. She was discharged uneventfully on the 2nd post-operative day. Intracorporeal closing the defect may reduce the bulging of the mesh in laparoscopic ventral hernia repair. This case is the first hybrid transvaginal ventral hernia repair using defect closure technique.
Una mujer de 52 años se sometió a reparación laparoscópica por razón de una hernia epigástrica recurrente mediante cirugía endoscópica transluminal de orificio natural híbrido. Se utilizaron tres trócares abdominales de 5 mm y un trócar transvaginal de 15 mm. El defecto se cerró mediante sutura intracorpórea antes de la fijación de la malla. Fue dada de alta sin incidentes. El cierre intracorpóreo del defecto puede reducir el abultamiento de la malla en la reparación laparoscópica de la hernia ventral. Este caso es la primera reparación de hernia ventral transvaginal híbrida que utiliza la técnica de cierre de defectos.
Assuntos
Hérnia Ventral , Laparoscopia , Cirurgia Endoscópica por Orifício Natural , Feminino , Hérnia Ventral/cirurgia , Herniorrafia , Humanos , Pessoa de Meia-Idade , Telas CirúrgicasRESUMO
INTRODUCCIÓN: La extracción de muestras de orificio natural (NOSE) para resecciones colorrectales, que mejoran aún más las ventajas de la cirugía mínimamente invasiva, se utilizan cada vez con mayor frecuencia. En este estudio, nuestro objetivo fue comparar los métodos de extracción de muestras de nariz y transabdominales en casos de resecciones de colon derecho totalmente laparoscópicas. MÉTODOS: Se incluyeron datos de 52 pacientes que se sometieron a cirugía laparoscópica de colon derecho entre 2013 y 2019. La extracción de muestras transabdominales se realizó en 35 pacientes, mientras que 17 pacientes fueron sometidos a NOSE. Se compararon datos demográficos, hallazgos operativos, resultados patológicos y datos de seguimiento. RESULTADOS: Las mujeres (94% frente a 28%, p = 0,0001), comórbidas (76% frente a 40%, p = 0,01) y antecedentes de cirugía abdominal previa (75% frente a 23%, p = 0,001) fueron más altas en el grupo NOSE . Todas las otras características preoperatorias de los grupos fueron comparables. La pérdida de sangre intraoperatoria, el tiempo de operación y las tasas de complicaciones fueron similares en ambos grupos. La escala VAS postoperatoria (2.8 ± 1.2 vs. 4.5 ± 2.4, p = 0.001) y los puntajes cosméticos fueron mejores en el grupo NOSE (10 vs. 7, p = 0.0001). Los resultados oncológicos fueron similares después de un seguimiento medio de 27.4 ± 20.5 (1-77) meses. CONCLUSIÓN: El método NOSE después de la resección laparoscópica del colon derecho fue un método más ventajoso en términos de cosméticos y dolor postoperatorio que la extracción de muestras transabdominales. INTRODUCTION: Natural orifice specimen extraction (NOSE) for colorectal resections, which further enhance the advantages of minimally invasive surgery, are being used increasingly more often. In this study, we aimed to compare NOSE and transabdominal specimen extraction methods in cases of totally laparoscopic right colon resections. METHODS: Data of 52 patients who underwent laparoscopic right colon surgery between 2013 and 2019 were included in the study. Transabdominal specimen removal was done in 35 patients, while 17 patients underwent NOSE. Demographic data, operative findings, pathological results, and follow-up data were compared. RESULTS: Female (94% vs. 28%, p = 0.0001), co-morbid (76% vs. 40%, p = 0.01), and previous abdominal surgery history (75% vs. 23%, p = 0.001) were higher in the NOSE group. All the other pre-operative features of the groups were comparable. Intraoperative blood loss, operation time, and complication rates were similar in both groups. Post-operative visual analog scale (2.8 ± 1.2 vs. 4.5 ± 2.4, p = 0.001) and cosmetic scores were better in the NOSE group (10 vs. 7, p = 0.0001). Oncologic results were similar after a mean follow-up of 27.4 ± 20.5 (1-77) months. CONCLUSION: The NOSE method following laparoscopic right colon resection was a more advantageous method in terms of cosmetics and post-operative pain than transabdominal specimen extraction.
Assuntos
Colectomia , Laparoscopia , Colo Sigmoide , Feminino , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos RetrospectivosRESUMO
A 47-year-old woman admitted with constipation and a sigmoid colon adenocarcinoma and liver metastasis was diagnosed. Synchronous laparoscopic anterior resection and liver metastasectomy were done and transanal specimen extractions were performed for both resection materials. No recurrence or procedure-related problem was found in the follow-up of the 14th months, and her esthetic score was determined as 9/10. Transanal specimen extraction can be a viable method for patients with left-sided colon cancer with liver metastasis. It avoids additional abdominal incision, and as far as we know, this is the first liver specimen removed through the anus.
Una mujer de 47 años ingresó con estreñimiento y fue diagnosticada de adenocarcinoma de colon sigmoide y metástasis hepáticas. Se realizaron resección anterior laparoscópica sincrónica y metastasectomía hepática, y se extrajeron muestras transanales de ambos materiales de resección. No se encontró ningún problema relacionado con la recidiva o el procedimiento en el seguimiento a los 14 meses, y su puntaje estético se determinó como 9/10. La extracción transanal de muestras puede ser un método viable para pacientes con cáncer de colon izquierdo con metástasis hepáticas. Esta técnica previene la incisión abdominal adicional. Hasta donde sabemos, esta es la primera muestra de hígado extraída a través del ano.
Assuntos
Laparoscopia , Cirurgia Endoscópica por Orifício Natural , Colectomia , Feminino , Humanos , Fígado , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Resultado do TratamentoRESUMO
BACKGROUND AND AIM: Biliary fistulas are the most common morbidity (8.2-26%) following hydatid liver surgery. The aim of our study was to reduce the incidence of postoperative biliary fistulas after the suturing of cystobiliary communications by applying a bile leakage test. PATIENTS AND METHODS: A total of 133 hydatid liver cysts from 93 patients were divided into two groups, according to whether the test was performed. Tests were performed on 56 cysts from 34 patients, and the remaining 77 cysts from 59 patients were treated without the test. In both groups, all visible biliary orifices in the cysts were suture ligated, and drains were placed in all cysts. The visibility of the biliary orifices and postoperative biliary drainage through the drains were recorded. Patients in both groups were also compared with respect to the number of days living with the drains, the length of the hospital stay, and secondary interventions related to biliary complications. RESULTS: Biliary orifices were more visible in the tested cysts (13% vs. 48%; P <0.001). Fewer biliary complications occurred in the tested patients (8.8% vs. 27.7%, P = 0.033). The mean drain removal time (4.1 ± 3.3 days vs. 6.8 ± 8.9 days, P < 0.05) and the length of the hospital stay (6.7 ± 2.7 days vs. 9.7 ± 6.3 days, P,0.01) were shorter for the tested patients. None of the patients in the test group required postoperative Endoscopic retrograde cholangiopancreaticography (ERCP) or nasobiliary drainage (0.0% vs. 8.4%, P = 0.09). There were no long-term biliary complications for either group after three years of follow-up. CONCLUSIONS: Identification of biliary orifices with a bile leakage test and the suturing of cystobiliary communications significantly reduced postoperative biliary complications following hydatid liver surgery.
Assuntos
Bile , Fístula Biliar/prevenção & controle , Equinococose Hepática/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Adolescente , Adulto , Fatores Etários , Ductos Biliares/cirurgia , Distribuição de Qui-Quadrado , Colangiopancreatografia Retrógrada Endoscópica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND AND AIM: Biliary fistulas are the most common morbidity (8.2-26 percent) following hydatid liver surgery. The aim of our study was to reduce the incidence of postoperative biliary fistulas after the suturing of cystobiliary communications by applying a bile leakage test. PATIENTS AND METHODS: A total of 133 hydatid liver cysts from 93 patients were divided into two groups, according to whether the test was performed. Tests were performed on 56 cysts from 34 patients, and the remaining 77 cysts from 59 patients were treated without the test. In both groups, all visible biliary orifices in the cysts were suture ligated, and drains were placed in all cysts. The visibility of the biliary orifices and postoperative biliary drainage through the drains were recorded. Patients in both groups were also compared with respect to the number of days living with the drains, the length of the hospital stay, and secondary interventions related to biliary complications. RESULTS: Biliary orifices were more visible in the tested cysts (13 percent vs. 48 percent; P <0.001). Fewer biliary complications occurred in the tested patients (8.8 percent vs. 27.7 percent, P = 0.033). The mean drain removal time (4.1±3.3 days vs. 6.8±8.9 days, P<0.05) and the length of the hospital stay (6.7±2.7 days vs. 9.7±6.3 days, P,0.01) were shorter for the tested patients. None of the patients in the test group required postoperative Endoscopic retrograde cholangiopancreaticography (ERCP) or nasobiliary drainage (0.0 percent vs. 8.4 percent, P = 0.09). There were no long-term biliary complications for either group after three years of follow-up. CONCLUSIONS: Identification of biliary orifices with a bile leakage test and the suturing of cystobiliary communications significantly reduced postoperative biliary complications following hydatid liver surgery.