RESUMO
INTRODUCTION: The open abdomen is a widespread therapeutic resource; however, it is also a source of complications, of which the enteroatmospheric fistulas (EAFs) pose one of the greatest problems. The objective of this study was to describe the implemented strategy for handling enteroatmospheric fistulas, and secondarily, to analyze the differential results based on a change in the conservative local treatment specifically designed for the stated complication. MATERIALS AND METHODS: From March 2002 to March 2014, patients treated for EAF were retrospectively analyzed. They were divided into 2 groups: Group 1 (G1: 2002 - 2007), treated with an occlusive vacuum device (SIVACO), similar to that used for other enterocutaneous fistulas, and Group 2 (G2: 2008 - 2014), covered in a specific modality for EAF. Results of conservative and surgical treatment were described and then the two groups were statistically compared. RESULTS: Study participants comprised 62 patients. Twelve cases (19.4%) healed with conservative treatment. This was statistically related with a baseline albumin level >3 g/dL, single lesions with no visible mucosa and baseline output <700 mL/d. In G1, the output fall was higher, while G2 required fewer wound dressing changes and enteral nutrition was feasible in a significantly higher number of patients. Forty-seven patients underwent reconstructive surgery. The mortality-associated variables were preoperative hypoalbuminemia and 2 or more anastomoses. Overall mortality was 8% (5 patients). In the multivariate model, only initial output (<700 mL/d) was an independent predictor for spontaneous closure, whereas 2 or more anastomoses and hypoalbuminemia were negative independent predictors. CONCLUSION: Systematic management of enteroatmospheric fistulas, following a rigorous protocol and a two-step specific treatment, resulted in a practical approach and yielded good results in healing and mortality.
Assuntos
Técnicas de Fechamento de Ferimentos Abdominais/mortalidade , Tratamento Conservador/mortalidade , Fístula Intestinal/mortalidade , Fístula Intestinal/terapia , Tratamento de Ferimentos com Pressão Negativa/mortalidade , Complicações Pós-Operatórias/mortalidade , Técnicas de Fechamento de Ferimentos Abdominais/estatística & dados numéricos , Argentina/epidemiologia , Terapia Combinada/mortalidade , Terapia Combinada/estatística & dados numéricos , Tratamento Conservador/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa/estatística & dados numéricos , Prevalência , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: External small bowel fistulae (ESBF) are serious complications that represent a major challenge for general surgeons. They are still associated with significant morbidity and mortality. This article reviews the management of ESBF with emphasis on the treatment using sub-atmospheric pressure as well a timing, strategies and techniques of reconstructive surgery. METHODS: Relevant articles from 1960 to 2010 were identified using various electronic databases to review randomized controlled trials, prospective observational studies, retrospective studies and case reports and highlight key references. CONCLUSIONS: External small bowel fistulae require multidisciplinary management and multimodal approaches with a primary essential focus on early recognition and diminishment of mortality factors such as sepsis and malnutrition. In most cases, the initial treatment is conservative, including clinical and nutritional recovery, output control and extensive local wound care. At this stage, the application of local negative pressure is highly effective. This procedure also allows for a spontaneous closure in many patients. Other cases require careful consideration of surgical reconstruction, knowing that success rates are variable and largely dependent on the patient's condition as well as on local aspects of the lesion. Best surgical results are obtained via intra-peritoneal access with extensive enterolysis, resection of the bowel segment from which the fistulae originate and direct abdominal wall closure.
Assuntos
Fístula Intestinal/terapia , Intestino Delgado , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/etiologia , Fístula Intestinal/cirurgiaRESUMO
BACKGROUND: Enterocutaneous fistulas arise as complications in 0.8%-2% of abdominal operations. The global mortality rate is 5%-37%, yet it may exceed 60% in the case of high-output fistulas and when sepsis and malnutrition are involved. The objective of this prospective cohort study with retrospective data analyses was to analyze our ten-year experience with a vacuum-compaction device for the management of high-output, postoperative enterocutaneous fistulas at the Department of General Surgery, E. Tornú Hospital, and the Intensive Care Unit, Churruca Hospital, Buenos Aires, Argentina. PATIENTS AND METHODS: Ninety-one patients presented 179 fistulas; 73 (69.2%) were men whose mean age was 48 years. Sepsis and malnutrition were present in 66 (72.5%). The mean initial fistula output was 1,485 ml/day. Conservative management was carried out according to diagnostic and therapeutic priority staging. A vacuum-compaction system (SIVACO; Spanish acronym) was used to control output. RESULTS: Output was entirely suppressed in 37 (40.7%) patients after 1-7 days of treatment, and reduced to less than 500 ml/day (average=138) in 52 (57.1%) patients. Spontaneous closure was achieved in 42 (46.2%) patients, whereas 37 (40.7%) patients did not improve after 20-380 (average=111) days of treatment. Those patients required surgical correction, which had an 83.8% success rate. Overall mortality was 16.5% (15 patients). CONCLUSIONS: The vacuum-compaction device proved effective for reducing fistula output in 89 of 91 patients (97.8%).
Assuntos
Fístula Cutânea/cirurgia , Fístula Intestinal/cirurgia , Tratamento de Ferimentos com Pressão Negativa , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Estudos de Coortes , Fístula Cutânea/etiologia , Fístula Cutânea/mortalidade , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Feminino , Humanos , Fístula Intestinal/etiologia , Fístula Intestinal/mortalidade , Masculino , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa/instrumentação , Tratamento de Ferimentos com Pressão Negativa/métodos , Análise de Sobrevida , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Malignant mesotheliomas are derivated from mesothelial tissue or serosa. They may originate from the pleura, periotoneum, pericardium, and other miscellaneous serosal surfaces. Mesotheliomas are relatively rare and are clearly related to exposure to asbestos. Asbestos is widely used for industrial purposes and most of these patients have had occupational exposure. An unusual variety of this pathology is the mesothelioma with deciduoid morphology not associated with the exposure to asbestos. There are very rare the patients reported with this variety of peritoneal mesothelioma. The diagnosis of mesothelioma may be difficult to determine preoperatively. A patient with this pathology is reported and the clinical features laboratory findings and the therpay performed, are detailed in the article
Assuntos
Adulto , Humanos , Feminino , Mesotelioma/diagnóstico , Mesotelioma/etiologia , Terapia Combinada/métodos , SobrevivênciaRESUMO
Malignant mesotheliomas are derivated from mesothelial tissue or serosa. They may originate from the pleura, periotoneum, pericardium, and other miscellaneous serosal surfaces. Mesotheliomas are relatively rare and are clearly related to exposure to asbestos. Asbestos is widely used for industrial purposes and most of these patients have had occupational exposure. An unusual variety of this pathology is the mesothelioma with deciduoid morphology not associated with the exposure to asbestos. There are very rare the patients reported with this variety of peritoneal mesothelioma. The diagnosis of mesothelioma may be difficult to determine preoperatively. A patient with this pathology is reported and the clinical features laboratory findings and the therpay performed, are detailed in the article
Assuntos
Adulto , Humanos , Feminino , Terapia Combinada , Mesotelioma , SobrevidaRESUMO
En la mayoría de las series de complicaciones de la cirugía laparoscópica se hallan presentes las colecciones abdominales postoperatorias. Ante este suceso, el drenaje percutáneo es actualmente el tratamiento de elección. Sin embargo cuando dicho método fracasa, o bien no tiene indicación precisa, la laparotomía se impone. En este trabajo se presentan tres pacientes operados por vía laparoscópica que presentaron este tipo de complicaciones y fueron resueltos con una reintervención también por vía laparoscópica. Los resultados obtenidos fueron satisfactorios. Los autores consideran que la relaparoscopía puede ser, en este capítulo, una alternativa terapéutica previa a la laparotomía, no excluyente de la misma incluso en el mismo acto quirúrgico (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Colecistectomia Laparoscópica/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Abscesso Abdominal/cirurgia , Reoperação/estatística & dados numéricos , Laparoscopia/efeitos adversos , Laparoscopia/estatística & dados numéricos , Abscesso Abdominal/etiologia , Colecistectomia Laparoscópica/métodos , Colecistectomia Laparoscópica/normasRESUMO
En la mayoría de las series de complicaciones de la cirugía laparoscópica se hallan presentes las colecciones abdominales postoperatorias. Ante este suceso, el drenaje percutáneo es actualmente el tratamiento de elección. Sin embargo cuando dicho método fracasa, o bien no tiene indicación precisa, la laparotomía se impone. En este trabajo se presentan tres pacientes operados por vía laparoscópica que presentaron este tipo de complicaciones y fueron resueltos con una reintervención también por vía laparoscópica. Los resultados obtenidos fueron satisfactorios. Los autores consideran que la relaparoscopía puede ser, en este capítulo, una alternativa terapéutica previa a la laparotomía, no excluyente de la misma incluso en el mismo acto quirúrgico
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Abscesso Abdominal/cirurgia , Colecistectomia Laparoscópica/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Reoperação/estatística & dados numéricos , Abscesso Abdominal/etiologia , Colecistectomia Laparoscópica/métodos , Colecistectomia Laparoscópica/normas , Laparoscopia/efeitos adversos , Laparoscopia/estatística & dados numéricosRESUMO
Las enfermedades torácicas por debajo de los 30 años de edad infrecuentes, sobre todo las que tardíamente dan síntomas; no se halló patología en 562 radiografías de tórax solicitadas a menores de 30 años que debían ser operados. Hay prevalencia de patología abdominal oculta sobre la torácica oculta en los menores de 30 años. El costo de la radiografía de tórax es alto y, por lo tanto, habría que replantear su necesidad como estudio preoperatorio sistemático en ese grupo etario
Assuntos
Radiografia Torácica/economia , Inquéritos e Questionários , Neoplasias Pulmonares/diagnóstico por imagem , Análise Custo-Benefício , Tuberculose Pulmonar/diagnóstico por imagemRESUMO
Las enfermedades torácicas por debajo de los 30 años de edad infrecuentes, sobre todo las que tardíamente dan síntomas; no se halló patología en 562 radiografías de tórax solicitadas a menores de 30 años que debían ser operados. Hay prevalencia de patología abdominal oculta sobre la torácica oculta en los menores de 30 años. El costo de la radiografía de tórax es alto y, por lo tanto, habría que replantear su necesidad como estudio preoperatorio sistemático en ese grupo etario