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OBJECTIVE: We would like to investigate the prognostic utility of the previously described factors and offer a new parameter called neutrophil-to-C-reactive protein ratio (NCR) as a predictor of post-operative complications of pancreas cancer. METHODS: 92 patients underwent pancreaticoduodenectomy for the pancreatic head tumor were enrolled in this study. Receiver operating curve analysis was performed to detect the cutoff values, and logistic regression analyses were performed to identify the independent risk factors of complications. RESULTS: In univariate analysis, complications were observed in lymphocyte-to-C-reactive protein ratio levels below 0.06 (Odds Ratio [OR]: 3.92, 95% confidence interval [CI] = 1.08-14.21, p = 0.037). In multivariate analysis, albumin < 3.6 (OR: 3.25, 95% CI: 1.16-9.06, p = 0.024) and NCR < 0.28 (OR: 2.81, 95 % CI: 1.07-7.63, p = 0.042) were the independent and significant predictors of the overall survival. DISCUSSION: Quantification of preoperative NCR and albumin may help surgeons to settle an effective perioperative management, take extra caution, and be aware of post-operative complications of pancreatic cancer patients.
OBJETIVO: Se investigó la proporción de neutrófilos a proteína C reactiva (NCR) como predictor de complicaciones posoperatorias del cáncer de páncreas. MATERIAL Y MÉTODOS: 92 pacientes fueron sometidos a pancreaticoduodenectomía (PD) por el tumor de la cabeza del páncreas incluidos en este estudio. Se realizaron análisis de curva operativa del receptor (ROC) y análisis de regresión logística para detectar los valores de corte y los factores de riesgo independientes de complicaciones. RESULTADOS: En análisis univariado; se observaron complicaciones en niveles de LCR por debajo de 0,06 (OR: 3.92, IC 95%: 1.08-14.21, p = 0.037). En análisis multivariado; albúmina < 3.6 (OR: 3.25, IC 95 %: 1.16-9.06, p = 0.024), NCR < 0.28 (OR: 2.81, IC 95 %: 1.07-7.63, p = 0.042) fueron los predictores independientes y significativos de la supervivencia. CONCLUSIÓN: La cuantificación de la NCR y la albúmina preoperatorias puede ayudar a los cirujanos a establecer un manejo perioperatorio efectivo, tomar precauciones adicionales y estar atentos a las complicaciones posoperatorias.
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Proteína C-Reativa , Neutrófilos , Neoplasias Pancreáticas , Pancreaticoduodenectomia , Complicações Pós-Operatórias , Humanos , Neoplasias Pancreáticas/cirurgia , Neoplasias Pancreáticas/sangue , Masculino , Feminino , Proteína C-Reativa/análise , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/epidemiologia , Pessoa de Meia-Idade , Idoso , Pancreaticoduodenectomia/efeitos adversos , Prognóstico , Estudos Retrospectivos , Contagem de Leucócitos , Albumina Sérica/análise , Adulto , Idoso de 80 Anos ou mais , Fatores de Risco , Curva ROCRESUMO
Background Postoperative complications (POC) are undesirable consequences of surgery and are a major area of concern adversely affecting the quality of surgical care and patient safety. Emergency surgery has been observed to have a higher incidence of different POC. The analysis of POC is of great importance due to their impact on the quality of life of patients and because they have become an indicator to measure the quality of hospital services. Objective This study aimed to describe the POC of emergency surgeries in patients from the general surgery department of a referral hospital in eastern Venezuela. Methodology A cross-sectional retrospective study was conducted, including patients undergoing emergency surgery at "Dr. Luis Razetti" University Hospital, Barcelona, Venezuela, between November 2022 and May 2023. Results Medical records of 178 patients were analyzed. Most were male (53.7%), with an average age of 34.98 and a standard deviation of 18.2 years. POC was registered in 28 (15.7%) patients, with surgical site infection being the most common in 21 (39.62%) patients. Those over 65 years old (21.4% vs. 6.4%, p=0.013), patients with a history of hypertension (25% vs. 6.3%, p=0.002), hypoalbuminemia (100% vs. 43.8%, p=0.027), diagnosed with peritonitis due to hollow viscus perforation (21.4% vs. 6%, p=0.007), trauma (25% vs. 9.3%, p=0.018), and those with a midline incision (75% vs. 31.3%, p<0.001) had a higher frequency of POC. There was a mortality rate of 2.8% with no significant difference based on the development of POC. Conclusion POC represents a significant cause of morbidity and mortality in patients undergoing emergency surgeries. The studied sample showed a similar frequency of POC compared to previous reports but with lower mortality. Complications were associated with higher frequencies of hypertension, midline approach, hypoalbuminemia, and emergency surgery for peritonitis due to hollow viscus perforation and trauma.
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Introducción. El edema pulmonar por reexpansión es una complicación poco frecuente, secundaria a una rápida reexpansión pulmonar posterior al drenaje por toracentesis o toracostomía cerrada. Al día de hoy, se ha descrito una incidencia menor al 1 % tras toracostomía cerrada, con mayor prevalencia en la segunda y tercera década de la vida. Su mecanismo fisiopatológico exacto es desconocido; se ha planteado un proceso multifactorial de daño intersticial pulmonar asociado con un desequilibrio de las fuerzas hidrostáticas. Caso clínico. Presentamos el caso de un paciente que desarrolló edema pulmonar por reexpansión posterior a toracostomía cerrada. Se hizo una revisión de la literatura sobre esta complicación. Resultados. Aunque la clínica sugiere el diagnóstico, la secuencia de imágenes desempeña un papel fundamental. En la mayoría de los casos suele ser autolimitado, por lo que su manejo es principalmente de soporte; sin embargo, se han reportado tasas de mortalidad que alcanzan hasta el 20 %, por tanto, es importante conocer los factores de riesgo y las medidas preventivas. Conclusión. El edema pulmonar de reexpansión posterior a toracostomía es una complicación rara en los casos con neumotórax, aunque es una complicación que se puede presentar en la práctica diaria, por lo cual debe tenerse en mente para poder hacer el diagnóstico y un manejo adecuado.
Introduction. Re-expansion pulmonary edema is a rare complication secondary to rapid pulmonary re-expansion after drainage by thoracentesis and/or closed thoracostomy. As of today, an incidence of less than 1% has been described after closed thoracostomy, with a higher prevalence in the second and third decades of life. Its exact pathophysiological mechanism is unknown; a multifactorial process of lung interstitial damage associated with an imbalance of hydrostatic forces has been proposed. Clinical case. We present the case of a patient who developed pulmonary edema due to re-expansion after closed thoracostomy, conducting a review of the literature on this complication. Results. Although the clinic suggests the diagnosis, the sequence of images plays a fundamental role. In most cases, it tends to be a self-limited disease, so its management is mainly supportive. However, mortality rates of up to 20% have been recorded. Therefore, it is important to identify patients with major risk factors and initiate preventive measures in these patients. Conclusions. Re-expansion pulmonary edema after thoracostomy is a rare complication in cases with pneumothorax; however, it is a complication that can occur in daily practice. Therefore, it must be kept in mind to be able to make the diagnosis and an adequate management.
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Humanos , Pneumotórax , Edema Pulmonar , Doença Iatrogênica , Complicações Pós-Operatórias , Toracostomia , Lesão Pulmonar AgudaRESUMO
ABSTRACT Purpose: To compare viscotrabeculotomy with anterior chamber irrigation to Ahmed glaucoma valve implantation for secondary glaucoma following silicone oil removal. Methods: A prospective study was conducted on 43 vitrectomized pseudophakic eyes with persistent glaucoma after silicone oil removal. Patients were randomized to either viscotrabeculotomy with anterior chamber irrigation or Ahmed glaucoma valve implantation. All patients were examined on day 1, week 1, and months 1, 3, 6, 9, 12, 18, and 24 postoperatively. Postoperative complications were noted. Success was defined as an intraocular pressure between 6 and 20 mmHg and with an intraocular pressure reduction of >30% compared with the preoperative intraocular pressure. Results: There were 22 eyes in the viscotrabeculotomy with anterior chamber irrigation and 21 eyes in the Ahmed glaucoma valve implantation group. The mean preoperative and postoperative intraocular pressure in the viscotrabeculotomy with anterior chamber irrigation and Ahmed glaucoma valve implantation groups were 35.5 ± 2.6 mmHg and 35.5 ± 2.4 mmHg and 16.9 ± 0.7 mmHg and 17.9 ± 0.9 mmHg respectively (p˂0.0001). There was a statistically significant intraocular pressure reduction at all follow-up time points compared to preoperative values (p˂0.0001) in both groups. The unqualified success rate in the viscotrabeculotomy with anterior chamber irrigation and Ahmed glaucoma valve implantation groups were 72.73% and 61.9%, respectively. A minimal self-limited hyphema was the most common complication. Conclusions: Both viscotrabeculotomy with anterior chamber irrigation and Ahmed glaucoma valve implantation are effective in lowering the intraocular pressure in glaucoma after silicone oil removal with viscotrabeculotomy with anterior chamber irrigation providing greater reduction, higher success rates, and minimal complications.
RESUMO Objetivo: Comparar a viscotrabeculotomia com irrigação da câmara anterior com o implante de válvula de glaucoma de Ahmed para glaucoma secundário após remoção de óleo de silicone. Métodos: Foi realizado um estudo prospectivo de 43 olhos pseudofácicos vitrectomizados com glaucoma persistente após a remoção de óleo de silicone. Os pacientes foram randomizados para viscotrabeculotomia com irrigação da câmara anterior ou implante de válvula de Ahmed. Todos os pacientes foram examinados no primeiro dia, na primeira semana e 1, 3, 6, 9, 12, 18 e 24 meses após a cirurgia. Observaram-se complicações pós-operatórias. O sucesso foi definido como uma pressão intraocular entre 6 e 20 mmHg e uma redução da pressão intraocular >30% em comparação com a pressão intraocular pré-operatória. Resultados: Foram designados 22 olhos para o grupo da viscotrabeculotomia com irrigação da câmara anterior e 21 olhos para o grupo do implante de válvula de Ahmed. A pressão intraocular média pré-operatória foi de 35,5 ± 2,6 mmHg para o grupo da viscotrabeculotomia com irrigação da câmara anterior e pós- e de 35,5 ± 2,4 mmHg no grupo do implante de válvula de Ahmed. e Os valores pós-operatórios foram de 16,9 ± 0,7 mmHg e 17,9 ± 0,9 mmHg para esses mesmos grupos, respectivamente (p<0,0001). Ambos os grupos tiveram uma redução estatisticamente significativa da pressão intraocular em relação aos valores pré-operatórios (p<0,0001) em todos os momentos do acompanhamento. A taxa de sucesso não qualificado nos grupos da viscotrabeculotomia com irrigação da câmara anterior e do implante de válvula de Ahmed foi de 72,73% e 61,9%, respectivamente. A complicação mais comum foi o hifema, autolimitado e mínimo. Conclusões: Tanto a viscotrabeculotomia com irrigação da câmara anterior quanto o implante de válvula de Ahmed são eficazes na redução da pressão intraocular no glaucoma após injeção de óleo de silicone, mas a viscotrabeculotomia com irrigação em câmara anterior proporcionou maior redução da pressão intraocular e maiores taxas de sucesso, com complicações mínimas.
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This case report illustrates the outcome of a deep infection following internal fixation of a fracture of the big toe. Hallux amputation could be avoided through staged salvage procedure. This paper can assist readers on how to effectively and safely recognize and treat this type of injury.
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Fraturas Ósseas , Hallux , Humanos , Hallux/cirurgia , Autoenxertos , Fixação Interna de Fraturas , Transplante AutólogoRESUMO
ABSTRACT Purpose: To describe the frequency, clinical characteristics, complications, and management of glaucoma in eyes that underwent keratoprosthesis implantation. Methods: Patients who underwent keratoprosthesis surgery between June 2010 and January 2020 were retrospectively evaluated for glaucoma association and prognoses. Results: Among 17 patients who underwent keratoprosthesis surgery, 9 (52.9%) were associated with underlying or keratoprosthesis-induced glaucoma. Five eyes (29.4%) had underlying glaucoma and underwent a glaucoma drainage device implantation at least 6 months before keratoprosthesis surgery. One eye (5.9%) with normal intraocular pressure had glaucoma drainage device implantation at the same session with keratoprosthesis surgery due to high-risk characteristics of anterior segment structures. Four eyes with preexisting glaucoma showed progression after keratoprosthesis surgery. Additional antiglaucomatous treatment was commenced in two eyes whereas implantation of 2nd glaucoma drainage device was performed in two eyes. Postoperative complications in three eyes (100%) with glaucoma drainage device implanted 6 months before or at the same session with aphakic type keratoprosthesis surgery with partial vitrectomy included rhegmatogenous retinal detachment in two eyes and bacterial endophthalmitis in one eye. Migration of silicone oil through the tube to the subconjunctival area was seen after pars plana vitrectomy in one eye. None of the three eyes (0%) that underwent glaucoma drainage device implantation years before keratoprosthesis surgery experienced a posterior segment complication other than glaucomatous progression. Out of 11 eyes with no previous history of glaucoma, 3 (27.3%) showed high intraocular pressure and glaucomatous disc changes after keratoprosthesis surgery, which could be pharmacologically controlled. Conclusions: In this cohort, eyes with preexisting glaucoma were more difficult to manage compared to eyes with de novo glaucoma after keratoprosthesis surgery. Retinal complications appeared more often when glaucoma drainage device implantation was performed no more than 6 months before aphakic type keratoprosthesis surgery with partial vitrectomy.
RESUMO Objetivo: Descrever a frequência, as características clínicas, as complicações e o manejo do glaucoma em olhos submetidos a implantes de ceratoprótese. Métodos: Pacientes submetidos à cirurgia de ceratoprótese entre junho de 2010 e janeiro de 2020 foram avaliados retrospectivamente em termos de glaucoma associado e prognóstico. Resultados: Dos 17 pacientes submetidos à cirurgia de ceratoprótese, em 9 (52,9%) foi constatado glaucoma subjacente ou induzido por ceratoprótese. Cinco olhos (29,4%) tinham glaucoma subjacente e receberam a implantação de um dispositivo de drenagem de glaucoma pelo menos 6 meses antes da cirurgia de ceratoprótese. Um olho (5,9%) com pressão intraocular normal teve implantado um dispositivo de drenagem de glaucoma na mesma sessão da cirurgia de ceratoprótese, devido às características de "alto risco" das estruturas do segmento anterior. Quatro dos olhos com glaucoma preexistente apresentaram progressão após a cirurgia de ceratoprótese. Foi iniciado um tratamento antiglaucomatoso adicional em 2 olhos, enquanto outros 2 olhos receberam o implante de um segundo dispositivo de drenagem de glaucoma. Foram observadas complicações pós-operatórias em 3 olhos (100%) com dispositivo de drenagem de glaucoma implantado 6 meses antes ou na mesma sessão da cirurgia de ceratoprótese tipo afácica com vitrectomia parcial, incluindo descolamento de retina regmatogênico em 2 olhos e endoftalmite bacteriana em 1 olho. Em 1 olho observou-se migração do óleo de silicone para a área subconjuntival através do tubo após vitrectomia via pars plana. Nenhum dos 3 olhos (0%) implantados com dispositivo de drenagem de glaucoma anos antes da cirurgia de ceratoprótese apresentou complicações do segmento posterior, exceto progressão glaucomatosa. Dos 11 olhos sem história prévia de glaucoma, 3 (27,3%) apresentaram alta pressão intraocular e alterações do disco glaucomatoso após cirurgia de ceratoprótese, condições que podem ser controladas clinicamente. Conclusões: Nesta coorte, os olhos com glaucoma pré-existente foram mais difíceis de manejar, comparados àqueles que desenvolveram glaucoma após a cirurgia de ceratoprótese. Apareceram mais complicações retinianas quando o implante do dispositivo de drenagem de glaucoma foi realizado no máximo 6 meses antes da cirurgia de ceratoprótese do tipo afácico com vitrectomia parcial.
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OBJECTIVES: Endoscopic vacuum therapy (EVT) possesses a unique mechanism of action providing a less invasive alternative for the management of transmural gastrointestinal defects (TGID). This study evaluates the efficacy and safety of a novel homemade EVT (H-EVT) for the treatment of TGID. METHODS: Retrospective multicenter study including patients who underwent H-EVT for TGID between January 2019 and January 2022. Main outcomes included technical and clinical success as well as safety outcomes. Subgroup analyses were included by defect location and classification. Logistic regression analyses were performed to determine predictors for successful closure. RESULTS: A total of 144 patients were included. Technical success was achieved in all patients, with clinical success achieved in 88.89% after a mean of 3.49 H-EVT exchanges over an average of 23.51 days. After excluding 10 cases wherein it was not possible to achieve negative pressure, successful closure occurred in 95.52% of patients. Time to clinical success was less for defects caused by endoscopic (hazard ratio [HR] 0.63; 95% confidence interval [CI] 0.33-1.20) compared to surgical procedures and for patients with simultaneous intracavitary and intraluminal H-EVT placement (HR 0.70; 95% CI 0.55-0.91). Location and classification of defect did not impact clinical success rate. Simultaneous placement of both an intraluminal and intracavitary H-EVT (odds ratio 3.08; 95% CI 1.19-7.95) was a significant predictor of clinical success. Three device-related adverse events (2.08%) occurred. CONCLUSIONS: The use of the H-EVT is feasible, safe, and effective for the management of TGID.
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Tratamento de Ferimentos com Pressão Negativa , Humanos , Tratamento de Ferimentos com Pressão Negativa/efeitos adversos , Tratamento de Ferimentos com Pressão Negativa/métodos , Fístula Anastomótica/cirurgia , Endoscopia/métodos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Spinal cord infarction is an uncommon phenomenon, which can be caused by different etiologies, constituting a real diagnostic challenge which can lead to devastating consequences. General anesthesia in beach chair positioning with intraoperative hypotension in order to avoid surgical bleeding are associated with hypoperfusion and potential neurological ischemia-related complications. We present a case of spinal cord ischemia in the context of shoulder surgery in a beach chair position.
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Articulação do Ombro , Isquemia do Cordão Espinal , Humanos , Ombro/cirurgia , Posicionamento do Paciente/efeitos adversos , Articulação do Ombro/cirurgia , Isquemia/complicações , Complicações Intraoperatórias/etiologia , Isquemia do Cordão Espinal/complicações , Artroscopia/efeitos adversosRESUMO
Background: Complications following arthroscopic anterior cruciate ligament reconstruction (ACLR) are rare, but injuries to the popliteal artery can occur. Popliteal pseudoaneurysms are a potential complication and can cause significant morbidity if not diagnosed and treated promptly. Cases Description: We describe the cases of two patients who developed nerve injuries following arthroscopic ACLR, with subsequent diagnosis of a popliteal pseudoaneurysm. The peroneal nerve recovered spontaneously in both cases, while the tibial nerve was reconstructed using autologous nerve grafting. Satisfying, functional recoveries were observed 24 months postoperatively. Conclusion: Prompt diagnosis and effective treatment of popliteal pseudoaneurysms are crucial to prevent further complications. However, timely diagnosis can be challenging due to inconsistent clinical presentations and a low index of suspicion. This case report highlights the need for increased awareness of this uncommon complication and provides insights into its pathophysiological mechanisms.
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Abstract Spinal cord infarction is an uncommon phenomenon, which can be caused by different etiologies, constituting a real diagnostic challenge which can lead to devastating consequences. General anesthesia in beach chair positioning with intraoperative hypotension in order to avoid surgical bleeding are associated with hypoperfusion and potential neurological ischemia-related complications. We present a case of spinal cord ischemia in the context of shoulder surgery in a beach chair position.
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Humanos , Articulação do Ombro/cirurgia , Isquemia do Cordão Espinal/complicações , Artroscopia/efeitos adversos , Ombro/cirurgia , Posicionamento do Paciente/efeitos adversos , Complicações Intraoperatórias/etiologia , Isquemia/complicaçõesRESUMO
Introducción: Los programas de recuperación mejorada después de cirugía constituyen un conjunto de acciones aplicadas al paciente quirúrgico en el período perioperatorio, que se enfoca en reducir el impacto de la cirugía en la respuesta metabólica y endocrina y así lograr una recuperación más temprana de mayor calidad. Objetivo: Evaluar los resultados de la aplicación del protocolo de recuperación mejorada después de la cirugía en procedimientos quirúrgicos mayores electivos del colon. Métodos: Se realizó un estudio descriptivo longitudinal y prospectivo con 163 pacientes con indicación de intervenciones quirúrgicas mayores electivas del colon en el Hospital Clínico Quirúrgico "Hermanos Ameijeiras", durante el período 2017-2020 y se les aplicó el programa ERAS implementado. Resultados: La edad media de los pacientes fue de 65,4±13,2 años con predominio del sexo femenino (57,7 por ciento). El 78,5 por ciento de los pacientes toleraban dieta blanda y expulsaban gases o heces por el recto al segundo día de la operación. La estadía posoperatoria promedio fue de 4,9 ± 3,4 días y en pacientes sin complicaciones se redujo a 4,0±1,0 días. La mortalidad reportada fue de un 3,1 por ciento (5 casos). Se complicó el 20,2 por ciento de los pacientes. El 6,7 por ciento de los pacientes requirió reingreso durante los primeros 30 días. Conclusiones: La implementación de un programa para mejorar la recuperación posoperatoria de pacientes con intervenciones electivas de colon demuestra resultados satisfactorios y mejora los resultados históricos del Hospital Clínico Quirúrgico "Hermanos Ameijeiras", en cuanto a complicaciones, estadía y mortalidad(AU)
Introduction: Enhanced recovery after surgery (ERAS) programs are a set of actions applied to the surgical patient in the perioperative period, focusing on reducing the impact of surgery on the metabolic and endocrine response, with the aim of achieving an earlier recovery of higher quality. Objective: To evaluate the results of the application of the enhanced recovery protocol after surgery in elective major surgical procedures of the colon. Methods: A descriptive, longitudinal and prospective study was conducted with 163 patients indicated for elective major surgery of the colon at Hospital Clínico Quirúrgico "Hermanos Ameijeiras", during the period 2017-2020, and who were applied the implemented ERAS program. Results: The mean age of the patients was 65.4 ± 13.2 years, with a predominance of the female sex (57.7 percent). 78.5 the patients tolerated a soft diet and expelled gases or faces througth the rectum at two days after the operation. The average postoperative stay was 4.9 ± 3.4 days and, in patients without complications, it was reduced to 4.0 ± 1.0 days. Reported mortality was 3.1 percent (five cases). Complications occurred in 20.2 percent of the patients. 6.7 percent of patients required readmission during the first thirty days. Conclusions: The implementation of a program for improving postoperative recovery of patients with elective interventions of the colon shows satisfactory results and improves the historical results of Hospital Clínico Quirúrgico "Hermanos Ameijeiras" in terms of complications, length of stay and mortality(AU)
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Humanos , Feminino , Idoso , Colo/cirurgia , Recuperação Pós-Cirúrgica Melhorada , Epidemiologia Descritiva , Estudos LongitudinaisRESUMO
One in eight women will have a lifetime diagnosis of confirmed breast cancer, and one in three of these women will undergo a mastectomy. About half of women undergoing mastectomies will opt for some type of breast reconstruction. Breast cancer itself and breast reconstruction bring physical changes that are accompanied by psychological changes of varying degrees. The decision process about cancer treatment and whether or not to perform breast reconstruction brings suffering. In the case of choosing to perform the reconstruction, deciding when to perform it and which surgical technique to choose from among several available is quite complex, and may result in regret. The author provides a brief literature review on this subject and comments on the work carried out by Cai and Momeni, comparing data and results.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Neoplasias da Mama , Mamoplastia , Ansiedade , Neoplasias da Mama/complicações , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mamoplastia/efeitos adversos , Mamoplastia/métodos , Mastectomia/métodos , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
AIM: To introduce a novel endo-luminal balloon-assisted drainage (EBAD) and compare postoperative complication rates between EBAD and diverting stoma (DS) groups. METHODS: The single center prospective non-random cohort study included a total of 163 patients in convenience patients with rectal cancer between January 2019 and January 2021. Out of 163 patients, 83 underwent DS and 80 EBAD. Primary endpoints were postoperative complication rate. RESULTS: The total number of complications was 28 in the DS group vs. 22 in the EBAD group (P = 0.388). 18 patients (21.7%) in the DS group and 14 patients (17.5%) in the EBAD group developed postoperative complication (P = 0.501). There were no differences identified for anastomotic leak rates between the two groups (P = 0.677). The rate of the pelvic abscess was lower in the EBAD group (1/80, 1.3%) than in the DS group (4/83, 4.8%) but with no statistical significance (P = 0.386). Compared with the DS group, the median operative time was shorter in the EBAD group (225 vs. 173.5 min, P < 0.001). Regarding incomplete small bowel obstruction, a higher prevalence was observed in the DS group compared to the EBAD group (7.2% vs 2.5%, P = 0.301). 7 patients (11.3%) in the DS group developed a para-stomal hernia, while no patient suffered a catheter-related complication. The median postoperative hospital stay was shorter in the DS groups than in the EBAD group (7 vs 8 days, P = 0.009). The median residence time of endo-luminal balloon-assisted drainage was 5.41 days. The median average and total volume of drainage were 51.57 ml/day and 255 ml, respectively. CONCLUSION: EBAD is feasible and safe with similar postoperative complications when compared with a DS. EBAD may replace DS after rectum resection.
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Neoplasias Retais , Reto , Anastomose Cirúrgica , Estudos de Coortes , Drenagem/efeitos adversos , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Neoplasias Retais/cirurgia , Reto/cirurgia , Estudos RetrospectivosRESUMO
PURPOSE: Posterior fossa tumors are the most frequent pediatric solid tumor. Its main treatment is a surgical resection. Being a frequent procedure does not mean that it is exempt from complications, such as surgical site infections (SSI). The main objective of this paper is to study the risk factors associated with SSI following a resection of posterior fossa tumors in a purely pediatric population. METHODS: A retrospective case-control study including all posterior fossa tumor surgeries performed at our hospital between January 2014 and December 2019 was conducted. All patients with a diagnosis of a postoperative SSI have been included as cases, and those who had surgery and no infectious complications have been considered as controls. RESULTS: When analyzing risk factors, we have found that patients with ventriculoperitoneal shunt (VPS) (p = 0.03) or external ventricular drainage (EVD) (p = 0.005) placement had a greater chance of presenting a postoperative surgical site infection. Prolonged operative time (p < 0.001) and cerebrospinal fluid (CSF) leak through the wound (p = 0.002) also caused an increase in the risk of SSI in the postoperative period. A higher hemoglobin value (p = 0.002) would seem to be a preventive factor. CONCLUSIONS: Some strategies that could help to reduce the risk of infections are managing hydrocephalus preferably with endoscopic third ventriculostomy, minimizing the needed operative time to perform the procedure, obtaining an adequate serum hemoglobin level, and avoiding CSF leak through the wound.
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Hidrocefalia , Neoplasias Infratentoriais , Estudos de Casos e Controles , Criança , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Neoplasias Infratentoriais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , VentriculostomiaRESUMO
Resumen Introducción: La colecistectomía laparoscópica es actualmente el gold standard en patología vesicular litiásica. Hay un grupo de pacientes que tiene un gran proceso inflamatorio que impide la identificación adecuada del triángulo de seguridad. Dado lo anterior, una alternativa es la realización de colecistectomía subtotal por laparoscopia, para reducir el riesgo de lesión de vía biliar. Objetivo: Describir los resultados clínicos y quirúrgicos en pacientes que se sometieron a la realización de colecistectomía subtotal laparoscópica en el Hospital Universitario Clínica San Rafael en el periodo comprendido entre febrero de 2015 y febrero de 2017. Materiales y Método: Serie de casos, donde se realizó un análisis descriptivo para determinar la distribución de las variables, se utilizaron tablas de contingencia, pruebas Fischer según el caso y su distribución en número y normalidad. Resultados: Se obtuvo información de 28 pacientes, con un promedio de edad de 56,1 años, mayor proporción de hombres. En cuanto a las características clínicas se observaron los antecedentes de diabetes e hipertensión arterial. No hubo complicaciones ni sangrado intraoperatorio importantes. En resultados posoperatorios no se presentó lesión de vía biliar en ninguno, hubo 3 reingresos (10,7%) y hubo una reintervención relacionada con colección intraabdominal. Se reportó una mortalidad secundaria a neumonía. Conclusión: La colecistectomía subtotal es un procedimiento seguro en cuanto a la prevención de lesión de vía biliar.
Introduction: Laparoscopic cholecystectomy is actually the gold standard surgical approach to the gallbladder disease. Some patients with severe cholecystitis and inflammatory changes that makes impossible to dissect the hepatocystic triangle. Is in this case, where the laparoscopic subtotal cholecystectomy is an option, to reduce the risk of biliary injury. Aim: To describe the clinical and surgical results in patients that underwent in laparoscopic subtotal cholecystectomy at Hospital Universitario Clínica San Rafael since February 2015 to February 2017. Materials and Method: A case series study was carried out, with a descriptive analysis to determine the distribution of them. We used contingency tables and fischer tests. Results: 28 laparoscopic subtotal cholecystectomy. The average age of 56.1 years, fifty percent was men. At the clinical characteristics, the history of diabetes and arterial hypertension was observed. There was no bile duct lesion in any and there was a reintervention due to intra-abdominal collection and only one mortality. 50% had biliary leakage and 25% of cases required endoscopic intervention. Conclusion: Laparoscopic subtotal cholecystectomy is a safe procedure.
Assuntos
Humanos , Masculino , Feminino , Colecistectomia/métodos , Colecistite/complicações , Complicações Pós-Operatórias , Colecistite/cirurgia , Resultado do TratamentoRESUMO
El síndrome de apneas e hipoapneas obstructivas del sueño se asocia con una disminución de la calidad de vida, bajo rendimiento escolar y, hasta en el 40% de los niños, trastornos de conducta como hiperactividad, enuresis, ansiedad y depresión. Varios estudios demostraron que la adenoamigdalectomía es efectiva para mejorar o resolver los trastornos respiratorios del sueño. Si bien esta cirugía tiene resultados beneficiosos, no está exenta de riesgos. El dolor y el sangrado posoperatorio son las dos causas principales de morbilidad. Otras complicaciones de la cirugía son las náuseas y los vómitos posoperatorios, el retraso en la alimentación, la deshidratación, la otalgia referida, los cambios en la voz y, raras veces, la muerte.En este artículo se realizan recomendaciones sobre el cuidado posoperatorio de los niños con adenoamigdalectomía
Obstructive sleep apnea and hypopnea syndrome is associated with decreased quality of life, poor school performance and, in up to 40% of children, behavioral problems such as hyperactivity, enuresis, anxiety and depression. Several studies have shown that adenoamygdalectomy is effective in improving or resolving sleep-disordered breathing. While this surgery has beneficial results, it is not without risks. Postoperative pain and bleeding are the two main causes of morbidity. Other complications of surgery include postoperative nausea and vomiting, delayed feeding, dehydration, referred earache, voice changes, and, rarely, death. Recommendations on postoperative care for children undergoing adenoamygdalectomy are mentioned in this article.
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Humanos , Masculino , Feminino , Criança , Tonsilectomia , Adenoidectomia , Complicações Pós-Operatórias , Transtornos Respiratórios , Tonsila Faríngea/cirurgia , Apneia Obstrutiva do SonoRESUMO
BACKGROUND AND PURPOSE: Despite the advances achieved in surgical techniques in recent years, an intestinal stoma is still needed in many patients undergoing colorectal surgery. However, the intestinal stoma may be associated with serious complications and the need for a second surgical procedure. In extreme cases, when it is not possible to access the abdominal cavity, the management of a complicated stoma is challenging. The purpose of this study was to describe the use of a Dacron vascular prosthesis (DVP) in patients with intestinal stoma complications. METHODS: In patients with a shallow, superficial stoma or mucocutaneous separation (MCS), we sutured the prosthesis in the intestinal loop (at the edge of an intestinal fistula) to create a device to direct the fecal content to the collection bag. RESULTS: We included 9 patients in this series (colorectal cancer, n = 5; Crohn's disease, n = 2; giant abdominal hernia and morbid obesity, n = 2). The results obtained were promising since they showed good evolution in patients with severe intestinal complications and an impossibility of surgical correction of the stoma. Five patients presented complete healing, and two patients presented partial healing. There were two deaths caused by sepsis, which were not related to the surgical procedure. With this technique, there was a reduction in the leakage of intestinal contents into the peritoneal cavity and an increase in the healing of the peristomal dermatitis in most of the patients. The DVP could possibly represent a surgical alternative in selected patients with complicated stomas when surgical correction may not be a suitable option. CONCLUSIONS: The authors recommend this technique for selected complex cases of stoma complications after unsuccessful attempts to adapt collecting equipment. The placement of the DVP allowed the peristomal skin to heal and improved the contamination of the peritoneal cavity.
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Enterostomia , Estomas Cirúrgicos , Prótese Vascular , Humanos , Polietilenotereftalatos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estomas Cirúrgicos/efeitos adversosRESUMO
OBJETIVO: Identificar factores de riesgo asociados a complicaciones mayores en pacientes con pielonefritis xantogranulomatosa sometidos a nefrectomía. MÉTODO: Análisis retrospectivo de expedientes clínicos de pacientes con pielonefritis xantogranulomatosa sometidos a nefrectomía. Se analizaron el sexo, el índice de masa corporal, el índice de comorbilidad de Charlson, la clasificación del estado físico de la American Society of Anesthesiologists, la etapa de Malek, el conteo leucocitario y los valores de creatinina. Las complicaciones se estratificaron en menores y mayores según la clasificación de Clavien-Dindo. Se realizó análisis univariado y bivariado usando las pruebas exacta de Fisher y ji al cuadrado de Pearson, y se establecieron medidas de riesgo utilizando la odds ratio (OR). RESULTADOS: Se analizaron 72 pacientes con una edad media de 50 años, el 83% mujeres, el 58.3% con urocultivo positivo y el 66% con litiasis renal. El 32% tuvieron alguna complicación mayor y el 15% requirieron admisión a la unidad de cuidados intensivos. Los valores elevados de creatinina (OR: 3.8; intervalo de confianza del 95% [IC95%]: 1.1-13; p = 0.02) y la etapa Malek II-III (OR: 4.5; IC95%: 1.2-17.5; p = 0.02) se asociaron con complicaciones mayores. CONCLUSIÓN: El estadio de Malek y los valores elevados de creatinina incrementan el riesgo de desarrollar complicaciones mayores en los pacientes con pielonefritis xantogranulomatosa sometidos a nefrectomía. OBJECTIVE: To identify preoperative risk factors associated with major complications in patients with xanthogranulomatous pyelonephritis undergoing total nephrectomy. METHOD: Retrospective analysis of patient's charts with xanthogranulomatous pyelonephritis who underwent nephrectomy. Risk factors included for analysis were gender, body mass index, Charlson comorbidity index, American Society of Anesthesiologists physical status classification, Malek's stage, leukocyte count and creatinine levels. Postoperative complications were stratified in minor and major according to Clavien-Dindo's classification. Univariate and bivariate analysis using Fisher's exact test, Pearson's chi-squared and odds ratio (OR) was performed. RESULTS: 72 patients were analyzed, 83% women, mean age of 50 years, 58.3% positive urine cultures and 66% kidney stones. Major complications were present in 32% of cases, and 15% were admitted to the intensive care unit. Elevated creatinine (OR: 3.8; 95% confidence interval [95%CI]: 1.1-13; p = 0.02) and Malek's stage II to III (OR: 4.5; 95%CI: 1.2-17.5; p = 0.02) were associated with major complications. CONCLUSION: The Malek Stage and elevated creatinine increases the risk of major complications in patients undergoing nephrectomy due to xanthogranulomatous pyelonephritis.
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Complicações Pós-Operatórias , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
Background: The rupture of the suture in the abdominal wall, but with integrity of the cutaneous suture, results in a condition known as incisional hernia. It is characterized by the protrusion of the abdominal viscera through orifices or areas ofthe abdominal wall. In most of the cases these defects in the abdominal wall are iatrogenic. The incisional hernia occursin an intact wall that is weakened by surgical incisions. The available literature on the incidence of incisional herniasin animals is scarce. With the aim to contribute to the information about incisional hernia in animals, it was decided todescribe the case of incisional hernia in a female dog after performing ovariohysterectomy (OH).Case: An adult mongrel shelter bitch, of unknown age, weighing 9.5 kg was admitted for OH in a practical class of theveterinary surgical technical discipline. Once the anesthetic condition was established, a retro-umbilical cutaneous incisionwas made. After opening the abdominal cavity, the bitch was castrated routinely. The abdominal wall was sutured including peritoneum, muscle fascia, and rectus abdominis muscle with nylon thread and U-stitches. The subcutaneous tissuewas then sutured with the same thread using Cushing suture. Ten days after the surgery, when the stitches were removed,the bitch revealed an increase in volume at the region of the surgical scar. Incisional hernia was diagnosed after carefulpalpation. For correction of the hernia, the bitch was submitted to surgical procedure. After the skin opening, an intenseinflammatory reaction was observed in the subcutaneous tissue. The inflamed skin and subcutaneous tissue were removed.The abdominal cavity was closed with nylon thread by means of U-stitches. The subcutaneous and skin...(AU)
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Animais , Feminino , Cães , Hérnia Incisional/veterinária , Cães/cirurgia , Histerectomia/veterinária , Cirurgia Veterinária/educação , Ovariectomia/veterináriaRESUMO
Introduction: Frailty is a term used to quantify the physiological age of patients. Higher levels of frailty correlate with higher complications and mortality rates after different surgical procedures. The objective of this work is to evaluate the relationship between frailty and the complications and mortality rates after elective spinal surgeries within 90 days. Material and Methods: A retrospective observational analytical study of patients older than 18 years with elective spine surgery was performed. The following variables were analyzed differentially according to their Modified Frailty Index (mFI) with a cut-off point of 0,18: age, sex, body mass index, ASA score, details of the procedures, length of stay, complications, unscheduled rehospitalizations, reoperations, and mortality within 90 postoperative days. Results: 257 patients were included. Within the 30 complications, 16 occurred in the non-frail group (8%) and 14 in frail patients (24.5%), (p = 0.02). Six complications were infectious in the group of frail patients (10.5%) and 4 in the non-frail patients (2%), (p = 0.009). No significant differences were detected regarding the duration of surgeries, the length of stay or the reoperations, re-hospitalizations or mortality rates. Conclusion: Patients with a modified Frailty Index ≥0,18 who underwent elective spine surgery were 3 times more likely to present complications, particularly, infectious ones.
Introducción: La fragilidad es un término utilizado para cuantificar la edad fisiológica de los pacientes. Niveles más altos de fragilidad se correlacionan con mayores tasas de complicaciones y mortalidad luego diferentes procedimientos quirúrgicos. El objetivo de este trabajo es evaluar la relación entre la fragilidad y la tasa de complicaciones y mortalidad posterior a cirugías columna electivas dentro de los 90 días. Material y Métodos: Se realizó un estudio analítico observacional retrospectivo de pacientes mayores de 18 años operados de manera electiva en su columna vertebral. Se analizaron las siguientes variables de manera diferencial según su Índice de Fragilidad modificado (IFm) con punto de corte en 0,18: edad, sexo, índice de masa corporal, score de ASA, detalles de los procedimientos, días de internación, complicaciones, reinternaciones, reoperaciones, y mortalidad dentro de los 90 días postoperatorios. Resultados: Se incluyeron 257 pacientes. De las 30 complicaciones, 16 ocurrieron en el grupo de los no frágiles (8%) y 14 a pacientes frágiles (24,5%), (p= 0,02). Seis complicaciones fueron infecciosas en el grupo de pacientes frágiles (10,5%) y 4 en los no frágiles (2%), (p= 0,009). No se detectaron diferencias significativas en cuanto a la duración de las cirugías, los días de internación, en la tasa de reoperaciones, reinternaciones ni en la mortalidad. Conclusión: Los pacientes operados electivamente de columna con un Índice de Fragilidad Modificado ≥0,18 presentaron una probabilidad 3 veces mayor de presentar complicaciones, particularmente infecciosas.