RESUMO
Background: Surgical site infections (SSI) have an important impact on morbidity and mortality. Objective: This study, therefore, sought to assess the effect of a surgical care bundle on the incidence of SSI in colorectal surgery. Methods: We conducted a quasi-experimental intervention study with reference to the introduction of a surgical care bundle in 2011. Our study population, made up of patients who underwent colorectal surgery, was divided into the following two periods: 2007-2011 (pre-intervention) and 2012-2017 (post-intervention). The intervention's effect on SSI incidence was analyzed using adjusted odds ratios (OR). Results: A total of 1,727 patients were included in the study. SSI incidence was 13.0% before versus 11.6% after implementation of the care bundle (OR: 0.88, 95% confidence interval: 0.66-1.17, p = 0.37). Multivariate analysis showed that cancer, chronic obstructive pulmonary disease, neutropenia, and emergency surgery were independently associated with SSI. In contrast, laparoscopic surgery proved to be a protective factor against SSI. Conclusions: Care bundles have proven to be very important in reducing SSI incidence since the measures that constitute these protocols are mutually reinforcing. In our study, the implementation of a care bundle reduced SSI incidence from 13% to 11.6%, though the reduction was not statistically significant.
Assuntos
Humanos , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção da Ferida Cirúrgica/epidemiologia , Cirurgia Colorretal/efeitos adversos , Pacotes de Assistência ao Paciente , Incidência , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Surgical site infections (SSI) have an important impact on morbidity and mortality. OBJECTIVE: This study, therefore, sought to assess the effect of a surgical care bundle on the incidence of SSI in colorectal surgery. METHODS: We conducted a quasi-experimental intervention study with reference to the introduction of a surgical care bundle in 2011. Our study population, made up of patients who underwent colorectal surgery, was divided into the following two periods: 2007-2011 (pre-intervention) and 2012-2017 (post-intervention). The intervention's effect on SSI incidence was analyzed using adjusted odds ratios (OR). RESULTS: A total of 1,727 patients were included in the study. SSI incidence was 13.0% before versus 11.6% after implementation of the care bundle (OR: 0.88, 95% confidence interval: 0.66-1.17, p = 0.37). Multivariate analysis showed that cancer, chronic obstructive pulmonary disease, neutropenia, and emergency surgery were independently associated with SSI. In contrast, laparoscopic surgery proved to be a protective factor against SSI. CONCLUSIONS: Care bundles have proven to be very important in reducing SSI incidence since the measures that constitute these protocols are mutually reinforcing. In our study, the implementation of a care bundle reduced SSI incidence from 13% to 11.6%, though the reduction was not statistically significant.
Assuntos
Cirurgia Colorretal , Pacotes de Assistência ao Paciente , Infecção da Ferida Cirúrgica , Cirurgia Colorretal/efeitos adversos , Humanos , Incidência , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
The medium arcuate ligament syndrome is a rare disorder that results from luminal narrowing of the celiac artery by the insertion of diaphragmatic muscle or the celiac nerve plexus. The syndrome is characterized by weight loss, postprandial abdominal pain, nausea, vomiting and an epigastric murmur. Surgical management involves the complete division of the medial arcuate ligament. We present two cases satisfactorily treated by laparoscopic surgery. The role of minimally invasive surgery in the treatment of this syndrome is a safe alternative approach to open surgery.
El síndrome de ligamento arcuato medio es un trastorno poco frecuente que resulta del estrechamiento luminal de la arteria celíaca por la inserción de fibras musculares diafragmáticas o bandas fibrosas del plexo nervioso celíaco. El síndrome se caracteriza por pérdida de peso, dolor abdominal posprandial, náuseas, vómitos y un soplo epigástrico. El manejo quirúrgico implica la división completa del ligamento arqueado mediano. Presentamos dos casos tratados satisfactoriamente mediante cirugía laparoscópica. El papel de la cirugía mínimamente invasiva en el tratamiento de este síndrome es una vía de abordaje segura alternativa a la cirugía abierta.
Assuntos
Laparoscopia , Síndrome do Ligamento Arqueado Mediano/cirurgia , Adolescente , Humanos , Masculino , Adulto JovemRESUMO
Introducción: El cáncer anal ha experimentado un aumento de incidencia en los últimos años. Está mediado por el VPH y precedido de cambios precancerosos planteando la posibilidad de dirigir los esfuerzos preventivos hacia los grupos de alto riesgo. Sigue siendo controvertida la indicación de cribado y los métodos de detección ideales. Objetivo: Validar las pruebas de cribado implementadas en la actualidad comparadas con la biopsia como "gold standard". Material y Métodos: Estudio transversal con recogida de datos prospectiva, en una cohorte de hombres VIH+ que tienen sexo con hombres, pertenecientes al Hospital Gregorio Marañón e Infanta Leonor en un periodo de 2 años. Resultados: Se seleccionaron 179 pacientes con 286 visitas a la consulta de screening en las que se llevaron a cabo 3 pruebas de cribado en paralelo (citología anal, genotipado del VPH y anoscopia de alta resolución (AAR) con toma de biopsia dirigida sobre zona sospechosa o aleatoria). La sensibilidad y especificidad para la detección de displasia de alto grado y cáncer y su grado de concordancia con la biopsia fue la siguiente: citología 3,23%/94,43% (k: 0,03), genotipado de VPH de alto riesgo 90,32%/27,45% (k: 0,05), AAR 32,26%/87,45 (k: 0, 17) siendo el rendimiento diagnóstico de las tres pruebas muy bajo. Conclusión: La citología presenta un rendimiento diagnóstico muy bajo comparado con el genotipado que representa el mayor. A la luz de nuestros resultados, los protocolos clínicos tal y como vienen desarrollándose en la actualidad deberían de ser abandonados.
Introduction: The incidence of anal cancer has increased in recent years. It is mediated by HPV and preceded by precancerous changes, raising the possibility of directing preventive efforts towards high-risk groups. The indication of screening remains controversial and which methods would be the ideal ones. Objective: To validate the screening tests established actually, comparing it with the biopsy considered as the "gold standard". Materials and Methods: A cross-sectional study was performed, with prospective data collection in a cohort of VIH+ patients, who have male homosexual anal relations, belonging to Gregorio Marañón and Infanta Leonor Hospitals in a period of 2 years. Results: A total of 179 patients were selected with 286 visits to the screening Outpatient Clinic in which 3 parallel screening tests were performed (anal cytology, HPV genotyping and high resolution anoscopy (AAR) with a biopsy directed on a suspicious or random area). The sensitivity and specificity for the detection of high-grade dysplasia and cancer and their degree of agreement with the biopsy was as follows: cytology 3.23%/94.43% (k: 0.03), high HPV genotyping. risk 90.32%/27.45% (k: 0.05), AAR 32.26%/87.45 (k: 0, 17), the diagnostic accuracy of the three tests being very low. Conclusion: Cytology shows a very low diagnostic accuracy compared to the genotype that represents the highest one. In light of our results, clinical protocols as they are currently being developed should be abandoned.
Assuntos
Humanos , Masculino , Adulto , Neoplasias do Ânus/patologia , Carcinoma de Células Escamosas/patologia , Programas de Rastreamento/métodos , Homossexualidade Masculina , Canal Anal/citologia , Canal Anal/patologia , Canal Anal/virologia , Canal Anal/diagnóstico por imagem , Neoplasias do Ânus/virologia , Papillomaviridae/genética , Lesões Pré-Cancerosas , Biópsia , Carcinoma de Células Escamosas/virologia , Carcinoma de Células Escamosas/diagnóstico por imagem , Estudos Transversais , Valor Preditivo dos Testes , Curva ROC , Técnicas Citológicas , Sensibilidade e Especificidade , Soropositividade para HIV , Proctoscopia/métodos , Infecções por Papillomavirus/patologia , Detecção Precoce de Câncer/métodos , Técnicas de GenotipagemRESUMO
Resumen Introducción: La perforación esofágica es una posible complicación de la artrodesis cervical anterior. Sin embargo, estas suelen ocurrir intraoperatoriamente o en el posoperatorio precoz. Caso clínico: Mujer de 35 años sometida, 3 años antes, a artrodesis de C3-C5, que tras sufrir un traumatismo leve con latigazo cervical, comienza con disfagia. Se objetiva un absceso retroesofágico por perforación esofágica, causado por rotura de la placa protésica y extrusión de un tornillo.
Introduction: Esophageal perforation is a possible complication after anterior cervical fusion. However, these complications usually appear intraoperatively or in the early postoperative course. Case report: A 35-years-old females, who underwent a C3-C5 anterior cervical fusion 3 years ago, after suffering a mild cervical trauma, she complained of dysphagia. A retroesophageal abscess was observed, caused by esophageal perforation, secondary to plaque rupture and screw extrusion.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Fusão Vertebral/efeitos adversos , Perfuração Esofágica/cirurgia , Perfuração Esofágica/etiologia , Artrodese/efeitos adversos , Imageamento por Ressonância Magnética , Resultado do Tratamento , Perfuração Esofágica/diagnóstico por imagemRESUMO
Resumen Introducción El espacio prevesical es una localización infrecuente de hernia. La hernia prevesical es causa infrecuente de obstrucción intestinal. Presentamos el caso de un paciente intervenido en nuestro centro y realizamos una revisión de la literatura. Caso clínico Varón de 67 años sin antecedentes médico- quirúrgicos de interés que acude a Urgencias por dolor suprapúbico de 24 h de evolución. A la exploración destacan distensión abdominal y dolor en la localización previamente descrita. Se realiza estudio analítico completo y TC abdominal, en el que se objetiva dilatación de asas del intestino delgado con cambio de calibre a nivel pélvico. Se decide realizar laparotomía exploradora: herniación de 25 cm de íleon de aspecto isquémico en el espacio prevesical. Se realiza resección intestinal y anastomosis enteroentérica L-L manual monoplano. El estudio anatomopatológico de la pieza quirúrgica no revela otros datos de interés. El paciente presenta buena evolución postoperatoria con tolerancia oral progresiva y es dado de alta al quinto día de la intervención. Conclusiones Las hernias del espacio prevesical son causa infrecuente de dolor abdominal y de obstrucción intestinal. Se localizan entre los ligamentos umbilicales laterales y el fundus de la vejiga, donde se forma un anillo peritoneal. Deben sospecharse ante dolor inguinal o supra-púbico sin tumoración palpable en el piso abdominal inferior. El diagnóstico es radiológico, mediante TC. El tratamiento es quirúrgico y ocasionalmente puede precisar resección intestinal.
Introduction Prevesical space is an infrequent location of hernias. Prevesical hernia is a rare cause of bowel obstruction. We present a case operated at our institution and review the available evidence in literature. Case report A 67-years-old mail, without any relevant medical history, came to the Emergency Department complaining of suprapubic pain during the last 24 h. Physical examination revealed abdominal distension and suprapubic pain. A CT scan revealed small bowel dilation with a gauge change in the pelvis. Exploring laparotomy was performed, observing a hernia in the prevesical space and 25 cm of ileal loops incarcerated with ischemic aspect. A small bowel resection and latero-lateral manual running suture anastomosis was performed. Histological findings were not relevant. The patient presented an uneventful postoperative course and was discharged the 5th day after surgery. Conclusions Hernias in the prevesical space are infrequent causes of abdominal pain and bowel obstruction. They are located between lateral umbilical ligaments and bladder fundus, where a ring is located. They must be suspected in cases of inguinal or suprapubic pain without palpable lump in the lower abdominal quadrants. Diagnosis can be only radiologically achieved, by CT scan. Surgical treatment is mandatory, often requiring bowel resection.
Assuntos
Humanos , Masculino , Idoso , Hérnia Abdominal/cirurgia , Hérnia Abdominal/complicações , Obstrução Intestinal/etiologia , Hérnia Abdominal/diagnóstico por imagem , Obstrução Intestinal/cirurgiaRESUMO
Objetivo: Presentación de un caso y revisión de la literatura. Caso clínico: Varón de 59 años que acude a la consulta de cirugía general por tumoración en miembro inferior derecho. La exploración física revela una tumoración no dolorosa de 3 cm sugestiva de lipoma. Se realiza ecografía que informa de la existencia de una hernia del músculo tibial anterior. Dado que el paciente se encuentra asintomático, se decide tratamiento rehabilitador. Conclusiones: Las hernias musculares, habitualmente localizadas en los miembros inferiores, suponen una entidad a tener en cuenta en el diagnóstico diferencial de tumores de partes blandas. Su diagnóstico es clínico con confirmación ecográfica y su tratamiento habitualmente es conservador, aunque en casos sintomáticos puede requerir cirugía.
Objective: Presentation of a case report and review of literature. Case report: A 59-years old male came to the Outpatient Clinic complaining of a painless lump in right lower limb. Physical examination revealed a 3 cm diameter tender lump, suggestive of lipoma. Ultrasonography revealed a hernia in the tibial anterior muscle. Given that the patient was asymptomatic, rehabilitation treatment was decided. Conclusions: Muscular hernias, usually located in lower limbs, must be considered in the differential diagnosis of soft tissue lumps. Diagnosis is usually confirmed with ultrasonography and conservative treatment is indicated, though symptomatic cases might require surgery.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Hérnia/diagnóstico , Lipoma/diagnóstico , Doenças Musculares/diagnóstico , Diagnóstico DiferencialRESUMO
BACKGROUND: Duodenal carcinoma is very rare. It represents 33-45% of the all tumours of the small bowel. The symptoms are non-specific, and the diagnosis is often accidental. CLINICAL CASE: A 35-year old man was admitted to our hospital with post-prandial abdominal pain. Upper gastrointestinal examination revealed a tumour of the third duodenal portion, which was diagnosed, using endoscopic biopsy, as a tubular adenoma with high grade dysplasia. The computed axial tomography scan, the magnetic resonance imaging, and the endoscopic ultrasound showed the neoplasia of the third duodenal portion with no lymph node or peritoneal metastases. Partial resection of the duodenum was performed. The definitive histopathological diagnosis was primary adenocarcinoma of the third duodenal portion. pT2 N0M0, originated in a tubular adenoma. CONCLUSIONS: Primitive neoplasia of the duodenum is very rare. Duodeno-cephalo-pancreatectomy is recommended in proximally located tumours, while segmental resection of the duodenum is appropriate for distal locations, with the same survival.
Assuntos
Adenocarcinoma/patologia , Neoplasias Duodenais/patologia , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Adenoma Viloso/cirurgia , Adulto , Diferenciação Celular , Progressão da Doença , Neoplasias Duodenais/diagnóstico por imagem , Neoplasias Duodenais/cirurgia , Endossonografia , Humanos , Imageamento por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios XRESUMO
Colonic lipomas have very low frequency, are usually asymptomatic and diagnosis is made incidentally. Seventy-five per cent of lipomas larger than 4 cm are symptomatic, causing abdominal pain, rectal bleeding, obstruction and exceptionally invagination. The resection of invaginated segment is mandatory in cases with invagination and can be performed by laparoscopy when colonic dilation is moderate. We present a 73-year-old man who entered the emergency department complaining of intermitent abdominal pain, rectal bleeding, absence of bowel movements and flatulence, during four days. A CT scan showed a generalized colonic dilation until left lower quadrant. A colo-colonic invagination secondary to an endoluminal lipoma was observed in sigmoid colon. A laparoscopic sigmoidectomy was performed with extracorporeal termino-terminal anastomosis. The postoperative period was uneventful and the patient was discharged from the hospital five days later. A sumbmucous colonic lipoma was diagnosed in the pathological study.
Assuntos
Colo Sigmoide , Neoplasias do Colo/complicações , Intussuscepção/etiologia , Lipoma/complicações , Idoso , Humanos , MasculinoRESUMO
Colonic lipomas have very low frequency, are usually asymptomatic and diagnosis is made incidentally. Seventy-five per cent of lipomas larger than 4 cm are symptomatic, causing abdominal pain, rectal bleeding, obstruction and exceptionally invagination. The resection of invaginated segment is mandatory in cases with invagination and can be performed by laparoscopy when colonic dilation is moderate. We present a 73-year-old man who entered the emergency department complaining of intermitent abdominal pain, rectal bleeding, absence of bowel movements and flatulence, during four days. A CT scan showed a generalized colonic dilation until left lower quadrant. A colo-colonic invagination secondary to an endoluminal lipoma was observed in sigmoid colon. A laparoscopic sigmoidectomy was performed with extracorporeal termino-terminal anastomosis. The postoperative period was uneventful and the patient was discharged from the hospital five days later. A sumbmucous colonic lipoma was diagnosed in the pathological study.
Assuntos
Colo Sigmoide , Neoplasias do Colo/complicações , Intussuscepção/etiologia , Lipoma/complicações , Idoso , Humanos , MasculinoRESUMO
Colonic lipomas have very low frequency, are usually asymptomatic and diagnosis is made incidentally. Seventy-five per cent of lipomas larger than 4 cm are symptomatic, causing abdominal pain, rectal bleeding, obstruction and exceptionally invagination. The resection of invaginated segment is mandatory in cases with invagination and can be performed by laparoscopy when colonic dilation is moderate. We present a 73-year-old man who entered the emergency department complaining of intermitent abdominal pain, rectal bleeding, absence of bowel movements and flatulence, during four days. A CT scan showed a generalized colonic dilation until left lower quadrant. A colo-colonic invagination secondary to an endoluminal lipoma was observed in sigmoid colon. A laparoscopic sigmoidectomy was performed with extracorporeal termino-terminal anastomosis. The postoperative period was uneventful and the patient was discharged from the hospital five days later. A sumbmucous colonic lipoma was diagnosed in the pathological study.
Assuntos
Colo Sigmoide , Intussuscepção/etiologia , Lipoma/complicações , Neoplasias do Colo/complicações , Humanos , Idoso , MasculinoRESUMO
BACKGROUND: To date there is no consensus about the treatment of choice for symptomatic or complicated simple liver cysts. METHODS: A retrospective study of all patients diagnosed with simple liver cyst surgically managed at Ramon y Cajal Hospital during the period between 1998 and 2008 was performed. RESULTS: We analyzed 21 patients, 18 females (85.7%) and three males (14.3%) with a mean age of 64.2 years. Ten patients (47.6%) were asymptomatic. During follow-up, cyst growth was determined. Three patients (14.3%) presented an infected simple liver cyst. Seven patients (33.3%) presented abdominal pain and one patient (4.8%) reported an abdominal mass during self-examination. Treatment consisted of unroofing and cyst drainage in 18 patients (85.7%) and cyst enucleation in three patients (14.3%). Postoperative complications appeared in two patients (9.6%). There was no mortality. Pathology revealed simple liver cyst in 17 patients (80.9%) and liver cystadenoma in four (19.1%). The latter were reoperated for complete cyst resection. Recurrence rate was 23.5% (four cases) for the simple liver cysts. In all cases, unroofing was performed. CONCLUSION: In some cases, cystadenomas show ultrasonographic and radiological features similar to simple liver cysts, implying an incorrect surgical approach. We recommend performing an intraoperative biopsy of all resected liver cysts to confirm its nature. Unroofing is associated with a high recurrence rate (>20%). Therefore, we propose cyst enucleation as the best surgical treatment.
Assuntos
Cistos/cirurgia , Laparotomia , Hepatopatias/cirurgia , Dor Abdominal/etiologia , Idoso , Fístula Biliar/etiologia , Biópsia , Estudos Transversais , Cistadenoma/diagnóstico , Cistadenoma/diagnóstico por imagem , Cistadenoma/epidemiologia , Cistadenoma/patologia , Cistadenoma/cirurgia , Cistos/complicações , Cistos/diagnóstico por imagem , Cistos/epidemiologia , Cistos/patologia , Drenagem , Feminino , Humanos , Hepatopatias/complicações , Hepatopatias/diagnóstico por imagem , Hepatopatias/epidemiologia , Hepatopatias/patologia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pneumonia/etiologia , Complicações Pós-Operatórias/etiologia , Recidiva , Reoperação , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Retroperitoneal ganglioneuromas are rare entities. Their treatment is complete surgical resection. Due to the proximity to major vessels, variable location and unknown malignant status, surgeons are often reluctant to use a laparoscopic approach for the resection of retroperitoneal masses. To our knowledge, only five cases of laparoscopic resection of retroperitoneal ganglioneuroma have been previously reported. CLINICAL CASE: We present the case of a 53-year-old woman who complained of intense, diffuse, stabbing, intermittent, nonradiating abdominal pain sharpest in both flanks during the preceding 6 months. A contrast-enhanced CT scan showed a well-defined, homogeneous 4-cm mass located in the retroperitoneum, extending from the exit of the inferior mesenteric vessels up to the renal veins. A laparoscopic anterior transperitoneal approach was performed with infraumbilical Hasson trocar and two 10-mm trocars in both iliac fossas. Operation time was 90 min. The patient was discharged on the second postoperative day. Histopathology reported a retroperitoneal ganglioneuroma. After 12 months follow-up, the patient is alive and disease-free. CONCLUSIONS: For digestive surgeons not used to the retroperitoneal access through the lateral position, the anterior transperitoneal approach can be a safe alternative for the resection of retroperitonal neoplasms.
Assuntos
Ganglioneuroma/cirurgia , Laparoscopia , Neoplasias Retroperitoneais/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , PeritônioRESUMO
INTRODUCCIÓN: El manejo clásico de la infección de la malla consiste en su extracción, pero esto suele provocar una hernia mayor que en el momento de su reparación. Describimos una técnica novedosa para el manejo conservador de la infección de la malla. MATERIAL Y MÉTODOS: La tasa de infección de malla herniaria en nuestra serie fue del 1%. Describimos 3 casos (hernias inguinal, ventral y paraestomal) que presentaron infección de la malla. Todos ellos fueron manejados de forma conservadora, con apertura de la herida, lavado a presión con gentamicina (80mg/8horas) y tratamiento intravenoso con Amoxicilina/Ácido Clavulánico (875mg+125mg/8horas) durante 7 días, consiguiendo cultivos estériles en todos los casos. A continuación se realice un cierre por tercera intención de la herida. La infección no reapareció en ninguno de los pacientes. CONCLUSIÓN: El manejo conservador de la infección de la malla, incluyendo drenaje, lavado con antibiótico y cierre de la herida por tercera intención, puede ser una alternativa a la extracción de la malla infectada.
INTRODUCTION: Standard management of infected mesh advocates its removal, but this often results in a larger hernia than at the time of original repair. In this article we describe a novel approach to manage conservatively an infected prosthetic mesh. Patient and Methods: Mesh infection rate at our institution was 1%. We describe 3 cases (inguinal, ventral and parastomal hernias) that presented prosthetic mesh infections. All the cases were satisfactorily managed with a conservative approach, consisting in wound opening and pressurized wound irrigation with gentamicin (80mg/8hours) and intravenous infusion of Amoxicilin/Clavulanic acid (875mg+125mg/8hours) during 7 days, achieving sterile cultures of the mesh surface in all the cases. A 3rd intention closure of the wound was performed. There is no clinical evidence of recurrent infection in any case. Conclusion: Conservative management of mesh infection, including drainage, antibiotic irrigation and wound closure, is a potential alternative to mesh removal.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Hérnia Inguinal , Hérnia Ventral , Telas CirúrgicasRESUMO
BACKGROUND: Abdominal wall bleeding in the port-site insertion place during laparoscopic surgery is sometimes difficult to control and can be associated with morbidity ranging from parietal pain up to haematoma and massive haemoperitoneum. PATIENTS AND METHODS: We perform a retrospective study of our experience in the management of the abdominal wall bleeding port-site using a Foley's catheter (24F), in those cases when haemostasis with electrocautery was not achieved. RESULTS: This technique was used in 35 patients (27 women and 8 men) with a mean age of 45,37 years (range 24-82 years). The median of time up to the removal of the catheter was 36 hours (range 24-48 hours), without observing bleeding or prolongation of the hospital stay or readmission. CONCLUSIONS: The use of Foley's catheter is a simple and efficient method for the control of the port-site bleeding during laparoscopic surgery.
Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Cateterismo/métodos , Hemostasia Cirúrgica/métodos , Laparoscopia , Parede Abdominal , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo/instrumentação , Feminino , Hemostasia Cirúrgica/instrumentação , Humanos , Laparoscopia/instrumentação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Instrumentos CirúrgicosRESUMO
BACKGROUND: Surgical resection is the only potentially curative treatment for pancreatic cancer, but it is associated with high complication rates. Outcome is poor, even in those resected cases. Identification of prognostic factors preoperatively may help to improve treatment of these patients, based on the expected response. METHODS: A retrospective study of clinical variables of 59 patients with histological diagnosis of pancreatic carcinoma at University Hospitals Ramon y Cajal and La Princesa (Madrid, Spain) between 1999 and 2003 was performed. RESULTS: We analyzed 59 patients (32 males and 27 females) with a mean age of 63.76 years. All patients were operated on, performing palliative surgery in 32% and tumor resection in 68%, including pancreaticoduodenectomy in 51% and distal pancreatectomy in 17%. Median overall survival was 14 months (range: 1-110 months). We observed that the presence of abdominal pain (p = 0.042) and back pain (p = 0.004) at diagnosis, palpation of abdominal mass at physical examination (p = 0.012), preoperative levels of hemoglobin <12 g/dl (p = 0.0006) and serum albumin <2.8 g/dl (p = 0.021), perineural infiltration (p = 0.025), lymph node affection (p = 0.004), stages II, III, and IV (p = 0.001), and presence of residual tumor (R+) (p = 0.008) are all associated with poor survival. CONCLUSIONS: Abdominal and back pain, palpation of abdominal mass at physical examination, preoperative levels of hemoglobin <12 g/dl and serum albumin <2.8 g/dl, perineural infiltration, lymph node affection, stages II, III, and IV, and the presence of residual tumor are associated with poor outcome.
Assuntos
Neoplasias Pancreáticas/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirurgia , Prognóstico , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
INTRODUCCIÓN: Las hemorragias en los puntos de entrada de los trócares son en ocasiones difíciles de cohibir y se asocian con una morbilidad que oscila desde el dolor parietal y el hematoma, hasta el hemoperitoneo masivo. MATERIAL Y MÉTODOS: Realizamos un estudio retrospectivo de nuestra experiencia en el control de las hemorragias en los puntos de entrada de los trócares de laparoscopia mediante compresión con balón de sonda de Foley, en los que la hemostasia mediante electrocoagulación no fue efectiva. RESULTADOS: La técnica fue empleada en 35 pacientes (27 mujeres y 8 varones) con una edad media de 45,37 años (intervalo 24 - 82 años). La mediana de tiempo hasta la retirada de la sonda fue 36 horas (intervalo 24 - 48 horas), sin evidenciarse ningún tipo de complicación hemorrágica, prolongación de la estancia ni reingreso hospitalario. CONCLUSIONES: La compresión con balón de sonda de Foley es un método sencillo y eficaz para el control de las hemorragias a través de los orificios de los trócares de laparoscopia.
BACKGROUND: Abdominal wall bleeding in the port-site insertion place during laparoscopic surgery is sometimes difficult to control and can be associated with morbidity ranging from parietal pain up to haematoma and massive haemoperitoneum. PATIENTS AND METHODS: We perform a retrospective study of our experience in the management of the abdominal wall bleeding port-site using a Foleys catheter (24F), in those cases when haemostasis with electrocautery was not achieved. RESULTS: This technique was used in 35 patients (27 women and 8 men) with a mean age of 45,37 years (range 24-82 years). The median of time up to the removal of the catheter was 36 hours (range 24-48 hours), without observing bleeding or prolongation of the hospital stay or readmission. CONCLUSIONS: The use of Foleys catheter is a simple and efficient method for the control of the port-site bleeding during laparoscopic surgery.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Perda Sanguínea Cirúrgica/prevenção & controle , Cateterismo/métodos , Hemostasia Cirúrgica/métodos , Laparoscopia , Parede Abdominal , Cateterismo/instrumentação , Hemostasia Cirúrgica/instrumentação , Laparoscopia/instrumentação , Estudos Retrospectivos , Instrumentos CirúrgicosRESUMO
INTRODUCTION: Standard management of infected mesh advocates its removal, but this often results in a larger hernia than at the time of original repair. In this article we describe a novel approach to manage conservatively an infected prosthetic mesh. PATIENT AND METHODS: Mesh infection rate at our institution was 1%. We describe 3 cases (inguinal, ventral and parastomal hernias) that presented prosthetic mesh infections. All the cases were satisfactorily managed with a conservative approach, consisting in wound opening and pressurized wound irrigation with gentamicin (80mg/8hours) and intravenous infusion of Amoxicilin/Clavulanic acid (875mg+125mg/8hours) during 7 days, achieving sterile cultures of the mesh surface in all the cases. A 3rd intention closure of the wound was performed. There is no clinical evidence of recurrent infection in any case. CONCLUSION: Conservative management of mesh infection, including drainage, antibiotic irrigation and wound closure, is a potential alternative to mesh removal.
Assuntos
Enterobacter cloacae/isolamento & purificação , Infecções por Enterobacteriaceae/terapia , Herniorrafia/instrumentação , Infecções Relacionadas à Prótese/terapia , Infecções Estafilocócicas/terapia , Telas Cirúrgicas/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Terapia Combinada , Infecções por Enterobacteriaceae/diagnóstico , Feminino , Gentamicinas/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa , Infecções Relacionadas à Prótese/diagnóstico , Infecções Estafilocócicas/diagnósticoRESUMO
BACKGROUND: Resection of liver metastases is accepted as treatment for diverse tumours, implying a survival improvement. Metastases often recur after first hepatectomy and, very few would be potentially resectable. MATERIALS AND METHODS: A retrospective study of 18 patients undergoing repeated hepatectomies (two or more liver resections in the same patient) due to metastases of colorectal cancer between 1988 and 2006 was performed. RESULTS: Thirteen men and five women, mean age 57.55 years, participated. In all patients, repeated liver resection was performed due to recurrence of the metastases. Complications rate after first hepatectomy was 11.1% and after the second 16.6%. Mortality rate was 11.1% after second hepatectomy, and there was no mortality after third hepatectomy. Three- and 5-year survival after colectomy was 88.9% and 77.8%, respectively; after first hepatectomy 3- and 5-year survival was 88.9% and 61.1%, respectively; after second hepatectomy, 3- and 5-year survival was 83.3% and 61.1% respectively; and 3-year survival after third hepatectomy was 67%. CONCLUSION: Repeated resections by expert surgeons for recurrent liver metastases can be safely performed, with low morbidity and mortality rates similar to first hepatectomies. Repeated resections of liver metastases of colorectal cancer improve global survival.
Assuntos
Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Neoplasias Colorretais/patologia , Hepatectomia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Recidiva , Reoperação , Estudos Retrospectivos , Análise de SobrevidaRESUMO
INTRODUCTION: Axillary lymphadenectomy is nowadays not recommended to treat ductal carcinoma in situ (DCIS), but there is controversy surrounding the indication for sentinel lymph node biopsy (SLNB). MATERIALS AND METHODS: A prospective study of a selected group of patients diagnosed preoperatively with DCIS was performed between 2004 and 2009. Indications for SLNB were histologically determined high-grade tumours, tumour size >2 cm and patients scheduled to undergo a mastectomy. RESULTS: Sixty-five patients were analysed. Surgical technique was mastectomy in 39 patients (60%) and conservative breast surgery in 26 (40%). Definitive histological study of the resected breast tumour revealed 43 cases (66.2%) of DCIS, 15 (23.1%) of ductal invasive carcinoma and seven (10.7%) microinvasive tumours. In confirmed DCIS, only 6.9% of sentinel lymph nodes were positive, in microinvasive carcinoma 28.5% and in invasive carcinoma 40% were positive. Total number of patients with positive sentinel lymph nodes was 11 (16.9%). Of 39 mastectomies, 12 corresponded to microinvasive or invasive carcinoma and six (50%) showed a positive SLNB. CONCLUSIONS: Performing SLNB avoids an unnecessary second surgery to study axillary lymph nodes in invasive carcinoma diagnosed after definitive histological study. In patients undergoing a mastectomy, this study requires an axillary lymphadenectomy that is not useful in up to 50% of cases. We think that in a selected group of patients with DCIS, SLNB improves tumour staging, adapts the treatment and avoids second surgery in this group of patients.