RESUMO
BACKGROUND: Cholelithiasis (ChL) is common after bariatric surgery (BS). Laparoscopic cholecystectomy (LC), the preferential treatment, is usually recommended only to symptomatic patients. LC may be, however, beneficial to asymptomatic patients as well. A prerequisite to such a policy is that it must be safe. This study aimed to assess whether, in post-bariatric (Post-Bar) patients who develop gallstones, LC achieves the same results as those reported in the general population. METHODS: A cohort of 376 patients undergoing elective LC had their medical records reviewed. Patients were divided into non-bariatric (Non-Bar) and Post-Bar groups, and then compared for characteristics and surgical outcomes. RESULTS: The study included 367 patients, 292 Non-Bar and 75 Post-Bar. Considering characteristics, Post-Bar patients were younger (44.5 ± 11.8 vs 48.4 ± 14.1) and less symptomatic (2.4% vs 19.8%) and had a higher BMI (32.2 ± 4.8 vs 30.8 ± 4.4) than Non-Bar patients. Regarding surgical outcomes, mortality (none), morbidity (1%, only in Non-Bar patients), readmission (1%, only in Non-Bar patients), conversion to laparotomy (0.6%, only in Non-Bar patients) showed no difference between the groups. Operative time (42.6 ± 14.4 min in Non-Bar and 38.2 ± 12.6 min in Post-Bar patients) tended to be lower in Post-Bar patients, p = 0.054. Same-day discharge was higher in Post-Bar patients (98.6%) than in Non-Bar patients (90.4%), p = 0.03. CONCLUSIONS: Compared with Non-Bar patients, LC in Post-Bar patients showed not only similar morbimortality, readmissions, and conversions but also even a higher same-day discharge rate and a trend to lower operative times.
Assuntos
Cirurgia Bariátrica , Colecistectomia Laparoscópica , Cálculos Biliares , Laparoscopia , Obesidade Mórbida , Cirurgia Bariátrica/efeitos adversos , Colecistectomia , Colecistectomia Laparoscópica/efeitos adversos , Cálculos Biliares/cirurgia , Humanos , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/etiologiaAssuntos
Corpos Estranhos/diagnóstico por imagem , Mucosa Gástrica/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagem , Corpos Estranhos/complicações , Corpos Estranhos/cirurgia , Mucosa Gástrica/patologia , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/etiologia , Tomografia Computadorizada por Raios XAssuntos
Humanos , Masculino , Neoplasias Gástricas/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Mucosa Gástrica/diagnóstico por imagem , Neoplasias Gástricas/etiologia , Tomografia Computadorizada por Raios X , Gastroscopia , Corpos Estranhos/cirurgia , Corpos Estranhos/complicações , Mucosa Gástrica/patologia , Pessoa de Meia-IdadeRESUMO
Common bile duct disruption from blunt trauma is very rare. Management, diagnosis and therapy by a non-specialist surgeon can be difficult. We describe a bile duct injury after a motor vehicle crash in a young male, treated with cholecystojejunostomy at his third laparotomy. We also briefly review some diagnostic aspects and therapeutic options from the literature.
Assuntos
Ductos Biliares/lesões , Adolescente , Ductos Biliares/cirurgia , Colangiografia , Humanos , MasculinoRESUMO
PURPOSE: Surgical treatment of gastric cancer has risks, and the current trend in developed countries is to centralize cases in high-volume centers. Many countries, however, particularly the developing ones, have to rely in low-volume centers for the most part of gastric cancer operations. We aimed to verify the characteristics of the patients and tumors as well as the in-hospital outcomes in a community hospital in Brazil treating gastric cancer. METHODS: This is a retrospective study on patients undergoing surgical treatment of gastric adenocarcinoma at a community hospital in Brazil. The authors reviewed demographic, clinical, pathological, and perioperative data. RESULTS: A total of 28 patients were operated on during the study period. Mean age was 69.5 years, 53.6% were male, 67.9% had anemia, 78.5% had ASA score ≥ 3, 89.3% were at nutritional risk, intestinal/diffuse ratio was 1.6, 68.5% had tumor ≥ 6 cm, involvement of lower/middle third of the stomach occurred in 96.4%, 73.7% had serosal invasion, 79% had stage III disease, median number of dissected nodes was 23, median operative time was 255 min, 21.4% had urgent procedures, 67.8% had curative surgery, 50% had distal gastrectomy, 43.5% had a Billroth I, median length of stay was 17 days, 53.6% had some admission to the intensive care unit, 21.4% required relaparotomy, 25% had wound infection/dehiscence, and mortality was 66.7/18.2% (urgent/non-urgent surgery). CONCLUSION: We treat elderly malnourished patients with multiple comorbidities and advanced cancer. Improvement is required in lymph node dissection, non-surgical therapies, and critical care.
Assuntos
Adenocarcinoma/cirurgia , Gastrectomia , Hospitais Comunitários , Excisão de Linfonodo , Neoplasias Gástricas/cirurgia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Taxa de SobrevidaRESUMO
Common bile duct disruption from blunt trauma is very rare. Management, diagnosis and therapy by a non-specialist surgeon can be difficult. We describe a bile duct injury after a motor vehicle crash in a young male, treated with cholecystojejunostomy at his third laparotomy. We also briefly review some diagnostic aspects and therapeutic options from the literature.
Assuntos
Adolescente , Humanos , Masculino , Ductos Biliares/lesões , Ductos Biliares/cirurgia , ColangiografiaRESUMO
BACKGROUND: Gastric bypass is a widespread bariatric procedure that carries a high incidence of gallstone formation postoperatively. Controversy exists regarding the importance and consequences of gallstones in these patients. There are surgeons who consider gallstone-related complications after gastric bypass important enough to require routine removal of the gallbladder during gastric bypass (prophylactic cholecystectomy). However, this can lead to increased costs and risks. This study aimed to identify complications related to cholelithiasis after Roux-en-Y gastric bypass (RYGBP). METHODS: This is a prospective observational study of 40 morbidly obese patients free of gallbladder disease. The patients underwent open RYGBP at a public hospital in Brazil from February to October 2007. They were followed up clinically and ultrasonographically at 6 months and 1, 2, and 3 years after surgery. Of the patients, 38 patients were followed up for 3 years. RESULTS: Eleven patients (28.9%) developed cholelithiasis, four (10.5%) experienced biliary pain, and 2 suffered from acute biliary pancreatitis (5.3%). These patients had their gallbladders removed laparoscopically. No patient presented with acute cholecystitis, choledocholithiasis, or bile duct dilation during the follow-up period. There were no deaths. CONCLUSIONS: Gallstone-related complications after RYGBP were relatively common. Some of these complications, like acute pancreatitis, are known to have potentially severe outcomes. It seems reasonable to perform cholecystectomy during gastric bypass in the presence of cholelithiasis or after this procedure if gallstones develop.
Assuntos
Colelitíase/etiologia , Derivação Gástrica/efeitos adversos , Dor/etiologia , Pancreatite/etiologia , Adulto , Colecistectomia Laparoscópica , Colelitíase/complicações , Colelitíase/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Cholecystolithiasis (CL) is a common occurrence after bariatric surgery. Few studies have prospectively analyzed not only gallstone formation after Roux-en-Y gastric bypass (RYGBP), but also its complications and symptoms. This study aimed to identify the incidence of CL itself and symptomatic CL after RYGBP as well as the presence of predictive factors for CL. METHODS: A prospective observational study was performed on 40 morbidly obese patients free of gallbladder disease undergoing RYGBP at a public hospital in Brazil between February and October 2007. They were followed up clinically, biochemically (lipid profile), and ultrasonographically at 6 months and 1, 2, and 3 years after surgery. Postoperative prophylactic bile salt therapy (ursodiol) was not prescribed. Of the 40 patients, 38 completed the 3-year follow-up. They were divided into two groups: those who formed gallstones and those who did not. These groups were compared with respect to gender, age, preoperative body mass index (BMI) and lipid profile results, and postoperative percentage of excess BMI lost (%EBL) and lipid profile results. RESULTS: The overall postoperative incidence of CL was 28.9 % (11 out of 38), with a 15.7 % incidence of symptomatic CL (6 out of 38). Gender, age, preoperative BMI, postoperative %EBL, and preoperative and postoperative lipid profile results were not identified as predictive factors for CL after RYGBP. CONCLUSIONS: There was a high incidence of CL after RYGBP, occurring primarily in the first 2 years postoperatively. There was no identified predictive factor for gallstone formation after RYGBP. Most patients who formed gallstones were symptomatic, some with potentially severe complications.
Assuntos
Colecistectomia/estatística & dados numéricos , Colecistolitíase/epidemiologia , Derivação Gástrica , Obesidade Mórbida/cirurgia , Adulto , Índice de Massa Corporal , Brasil/epidemiologia , Colecistolitíase/diagnóstico por imagem , Colecistolitíase/etiologia , Colecistolitíase/cirurgia , Suscetibilidade a Doenças , Feminino , Seguimentos , Derivação Gástrica/efeitos adversos , Humanos , Incidência , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/diagnóstico por imagem , Obesidade Mórbida/epidemiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , UltrassonografiaRESUMO
Os autores apresentam um caso de síndrome de Chilaiditi em uma mulher de 56 anos de idade. Mesmo tratando-se de condição benigna com rara indicação cirúrgica, reveste-se de grande importância pela implicação de urgência operatória que representa o diagnóstico equivocado de pneumoperitônio nesses pacientes. É realizada revisão da literatura, com ênfase na fisiopatologia, propedêutica e tratamento desta entidade.
The authors report a case of Chilaiditi's syndrome in a 56-year-old woman. Although this is a benign condition with rare surgical indication, it has great importance for implying surgical emergency in cases where such condition is equivocally diagnosed as pneumoperitoneum. A literature review is performed with emphasis on pathophysiology, diagnostic work-up and treatment of this entity.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Abdome Agudo , Abdome Agudo/diagnóstico , Colo/anormalidades , Diafragma/anormalidades , Fígado/anormalidades , Pneumoperitônio , Radiografia Torácica , SíndromeRESUMO
BACKGROUND: Splenic abscess is a rare condition but carries high mortality (up to 100 percent when untreated) and surgery has been the standard of therapy. CASE REPORT: An adult male had been undergone thrombolytic therapy for a heart attack and presented spontaneous intrasplenic hematoma which, subsequently, have turned into an abscess. Once it was a large multiloculated collection, subtotal splenectomy was the only treatment that could spare some splenic tissue. This approach was carried out successfully and the patient is presently healthy. CONCLUSION: Subtotal splenectomy is an effective option for the management of splenic abscesses.
INTRODUÇÃO: Abcesso esplênico é condição rara e trás consigo alta mortalidade (quase 100 por cento quando não tratado) e a cirurgia é a forma de tratamento de escolha. RELATO DE CASO: Homem adulto foi submetido à terapia tromboembólica como tratamento de enfarte de miocárdio e apresentou hematoma espontâneo de baço, o qual tranformou-se em abcesso. Desde que ele era multiloculado e grande, esplenectomia subtotal foi considerada o único tratamento que poderia retirar todo o tecido comprometido. Este procedimento foi realizado com sucesso e o paciente evoluiu bem sem complicações. CONCLUSÃO: Esplenectomia sub-total é uma efetiva opção para o manuseio dos abcessos esplênicos.
RESUMO
OBJETIVO: Comparar os resultados da hernioplastia inguinal pelas técnicas de Shouldice modificada por Berliner (SB), que realiza dois planos de sutura superpostos e de Falci-Lichtenstein (FL) que utiliza prótese de polipropileno. MÉTODO: Foram estudados prospectivamente 312 pacientes operados pelo mesmo cirurgião entre 1997 e 2004. O Grupo 1 constou de 84 pacientes operados pela técnica de FL e o Grupo 2 foi formado por 228 pacientes operados pela técnica de SB. Todos eram masculinos, maiores de 18 anos e portadores de hérnias inguinais tipo 3A, 3B e 4 da classificação de Nyhus. Os grupos foram semelhantes em relação a idade, lado operado, tipo de hérnia, anestesia empregada e tempo de seguimento (média de 3,5 anos). RESULTADOS: A duração média dos procedimentos foi de 53 min no Grupo 1 e de 57 min no Grupo 2 (p=0,2982); a permanência hospitalar foi menor que 24h para 94 por cento dos pacientes do Grupo 1 e 92 por cento do Grupo 2 (p=0,8050); a incidência de complicações foi de 9,5 por cento no Grupo 1 e de 12,3 por cento no Grupo 2 (p=0,5557) sendo a mais comum o hematoma/equimose e a taxa de recidiva foi de 1,2 por cento no Grupo 1 e de 5,4 por cento no Grupo 2 (p=0,0935). Nenhum desses resultados apresentou diferença significante. CONCLUSÃO: A técnica SB mostrou-se comparável à técnica de FL em homens, maiores de 18 anos com hérnias tipo 3 A, 3 B e 4 de Nyhus, além de não exigir material protético.
BACKGROUND: To compare the results of the inguinal hernia repair with the Falci-Lichtenstein (FL) tecnique that uses polypropylene mesh and the Shouldice modified by Berliner (SB) tecnique, a repair in two layers of continuous suture. METHODS: It is presented a prospective study of 312 patients operated on between 1997 and 2004 by one single surgeon. Group 1 was composed for 84 patients treated with the FL repair and group 2 for 228 patients with the SB repair. All the patients were men, over 18 years , with types 3 A, 3 B and 4 hernias according to the Nyhus classification. The groups were similar in age, operated side, hernia type, anestesia and follow up period. RESULTS: Mean operative time was 53min in group 1 and 57min in group 2 (p=0,2982); length of hospital stay was 1 day in 94 percent of the cases in group 1 and 92 percent in group 2 (p=0,8050); postoperative complication rate was 9,5 percent in group 1 and 12,3 percent in group 2 (p=0,5557) and the most frequent was hematoma/ecchymosis. The recurrence rate at 3,5 years mean follow up time was 1,2 percent in group 1 and 5,4 percent in group 2 (p=0,0935). None of these results were significant. CONCLUSION: The SB repair proved to be as good as the FL tecnique in men, over 18 years with type 3 A, 3 B and 4 inguinal hernias; besides it do not require a mesh prosthesis.