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PURPOSE: Obturator Hernia (OH) is a rare type of abdominal wall hernia. It usually occurs in elderly women with late symptomatic presentation, increasing mortality rates. Surgery is the standard of care for OH, and laparotomy with simple suture closure of the defect is commonly used. Given the rarity of this disease, large studies are lacking, and data to drive management are still limited. This systematic review and meta-analysis aimed to describe current surgical options for OHs, with a focus on comparing the effectiveness and safety of mesh use with primary repair. METHODS: PubMed, EMBASE, and Cochrane were searched for studies comparing mesh and non-mesh repair for OH. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. RESULTS: One thousand seven hundred and sixty studies were screened and sixty-seven were thoroughly reviewed. We included 13 observational studies with 351 patients surgically treated for OH with mesh or non-mesh repair. One hundred and twenty (34.2%) patients underwent mesh repair and two hundred and thirty-one (65.81%) underwent non-mesh repair. A total of 145 (41.3%) underwent bowel resection, with the majority having a non-mesh repair performed. Hernia recurrence was significantly higher in patients who underwent hernia repair without mesh (RR 0.31; 95% CI 0.11-0.94; p = 0.04). There were no differences in mortality (RR 0.64; 95% CI 0.25-1.62; p = 0.34; I2 = 0%) or complication rates (RR 0.59; 95% CI 0.28-1.25; p = 0.17; I2 = 50%) between both groups. CONCLUSION: Mesh repair in OH was associated with lower recurrence rates without an increase in postoperative complications. While mesh in clean cases is more likely to offer benefits, an overall recommendation regarding its use in OH repair cannot be made due to potential bias across studies. Given that many OH patients are frail and present emergently, the decision to use mesh is complex and should consider the patient's clinical status, comorbidities, and degree of intraoperative contamination.
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Hérnia do Obturador , Hérnia Ventral , Humanos , Feminino , Idoso , Hérnia do Obturador/cirurgia , Herniorrafia/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Hérnia Ventral/etiologia , Complicações Pós-Operatórias/etiologia , RecidivaRESUMO
Abstract Introduction The cleft palate is one of the most common congenital anomalies treated by plastic surgeons. The cleft width increases the tension of repair and necessitates excessive dissection that might affect maxillary growth. Decreasing the width of cleft minimize tension, dissection and may limit the impact on maxillary growth. Objectives The purpose of the study was to evaluate the effect of nasal layer closure of the hard palate at the time of cleft lip repair in patients with complete cleft lip and palate, to demonstrate the efficacy of narrowing the gap and to reduce the incidence of fistulae or other complications. Methods Thirty patients less than 1 year of age were included in this prospective observational study. A superiorly based vomer flap was used to repair the nasal layer of the cleft hard palate at the time of primary cleft lip repair. 12-14 weeks after the vomer flap, the cleft soft and hard palate was definitively repaired. Alveolar and palatal gaps were recorded during the 1st and 2nd operations to demonstrate the reduction of the gap defect. Results The mean reduction of the alveolar cleft width in patients who had a vomer flap in the first stage was 4.067 mm and the mean reduction of the palatal gap was 4.517 mm. Only 3 patients developed small fistula on the repaired nasal layer that was discovered and corrected during definitive palatoplasty. Conclusion Nasal layer closure is a simple surgical technique that can be used to close the hard palate at the time of cleft lip repair. It is a valuable addition to cleft lip and palate repair that may prevent some cleft palate surgical complications.
Resumo Introdução A fenda palatina é uma das anomalias congênitas mais comumente tratadas por cirurgiões plásticos. A largura da fenda aumenta a tensão do reparo e requer dissecção extensa que pode afetar o crescimento maxilar. Diminuir a largura da fenda minimiza a tensão, a dissecção e pode limitar o impacto no crescimento maxilar. Objetivos Avaliar o efeito do fechamento da camada nasal do palato duro no momento do reparo da fenda labial em pacientes com fenda labiopalatina completa, demonstrar a eficácia do estreitamento do gap (abertura) e reduzir a incidência de fístulas ou outras complicações. Método Trinta pacientes com menos de um ano foram incluídos neste estudo observacional prospectivo. Um retalho do vômer de base superior foi usado para reparar a camada nasal da fenda do palato duro no momento do reparo primário da fenda labial. Doze a 14 semanas após o retalho do vômer, a fenda no palato mole e duro foi submetida a reparo. Os gaps alveolares e palatais foram registradas durante a 1ª e a 2ª cirurgias para demonstrar a redução do defeito. Resultados A redução média da largura da fenda alveolar nos pacientes que apresentaram retalho do vômer no primeiro estágio foi de 4,067 mm e a redução média do gap palatino foi de 4,517 mm. Apenas três pacientes desenvolveram uma pequena fístula na camada nasal submetida a reparo, que foi identificada e corrigida durante a palatoplastia definitiva. Conclusão O fechamento da camada nasal é uma técnica cirúrgica simples que pode ser usada para fechar o palato duro no momento do reparo da fenda labial. É uma adição valiosa ao reparo de fenda labial e palatina que pode prevenir algumas complicações cirúrgicas da fenda palatina.
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INTRODUCTION: The cleft palate is one of the most common congenital anomalies treated by plastic surgeons. The cleft width increases the tension of repair and necessitates excessive dissection that might affect maxillary growth. Decreasing the width of cleft minimize tension, dissection and may limit the impact on maxillary growth. OBJECTIVES: The purpose of the study was to evaluate the effect of nasal layer closure of the hard palate at the time of cleft lip repair in patients with complete cleft lip and palate, to demonstrate the efficacy of narrowing the gap and to reduce the incidence of fistulae or other complications. METHODS: Thirty patients less than 1 year of age were included in this prospective observational study. A superiorly based vomer flap was used to repair the nasal layer of the cleft hard palate at the time of primary cleft lip repair. 12-14 weeks after the vomer flap, the cleft soft and hard palate was definitively repaired. Alveolar and palatal gaps were recorded during the 1st and 2nd operations to demonstrate the reduction of the gap defect. RESULTS: The mean reduction of the alveolar cleft width in patients who had a vomer flap in the first stage was 4.067mm and the mean reduction of the palatal gap was 4.517mm. Only 3 patients developed small fistula on the repaired nasal layer that was discovered and corrected during definitive palatoplasty. CONCLUSION: Nasal layer closure is a simple surgical technique that can be used to close the hard palate at the time of cleft lip repair. It is a valuable addition to cleft lip and palate repair that may prevent some cleft palate surgical complications.
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Fenda Labial , Fissura Palatina , Procedimentos de Cirurgia Plástica , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Humanos , Lactente , Palato Duro/cirurgia , Retalhos Cirúrgicos , Vômer/cirurgiaRESUMO
The overall incidence of duodenal injuries in severely injured trauma patients is between 0.2 to 0.6% and the overall prevalence in those suffering from abdominal trauma is 3 to 5%. Approximately 80% of these cases are secondary to penetrating trauma, commonly associated with vascular and adjacent organ injuries. Therefore, defining the best surgical treatment algorithm remains controversial. Mild to moderate duodenal trauma is currently managed via primary repair and simple surgical techniques. However, severe injuries have required complex surgical techniques without significant favorable outcomes and a consequential increase in mortality rates. This article aims to delineate the experience in the surgical management of penetrating duodenal injuries via the creation of a practical and effective algorithm that includes basic principles of damage control surgery that sticks to the philosophy of "Less is Better". Surgical management of all penetrating duodenal trauma should always default when possible to primary repair. When confronted with a complex duodenal injury, hemodynamic instability, and/or significant associated injuries, the default should be damage control surgery. Definitive reconstructive surgery should be postponed until the patient has been adequately resuscitated and the diamond of death has been corrected.
El trauma de duodeno comúnmente se produce por un trauma penetrante que puede asociarse a lesiones vasculares y de órganos adyacentes. En el manejo quirúrgico se recomienda realizar un reparo primario o el empleo de técnicas quirúrgicas simples. Sin embargo, el abordaje de lesiones severas del duodeno es un tema controversial. Anteriormente, se han descrito técnicas como la exclusión pilórica o la pancreatoduodenectomía con resultados no concluyentes. El presente artículo presenta una propuesta del manejo de control de daños del trauma penetrante de duodeno, a través, de un algoritmo de cinco pasos. Este algoritmo plantea una solución para el cirujano cuando no es posible realizar el reparo primario. El control de daños del duodeno y su reconstrucción depende de una toma de decisiones respecto a la porción del duodeno lesionada y el compromiso sobre el complejo pancreatoduodenal. Se recomiendan medidas rápidas para contener el daño y se proponen vías de reconstrucción duodenal diferente a las clásicamente descritas. Igualmente, la probabilidad de complicaciones como fistula duodenales es considerable, por lo que proponemos, que el manejo de este tipo de fistulas de alto gasto se aborde por medio de una laparostomía retroperitoneal (lumbotomía). El abordaje del trauma penetrante de duodeno se puede realizar a través del principio "menos es mejor".
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Algoritmos , Duodeno/lesões , Ferimentos Penetrantes/cirurgia , Hemorragia/terapia , Humanos , Ilustração Médica , Ferimentos Penetrantes/classificação , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/diagnósticoRESUMO
Abstract The overall incidence of duodenal injuries in severely injured trauma patients is between 0.2 to 0.6% and the overall prevalence in those suffering from abdominal trauma is 3 to 5%. Approximately 80% of these cases are secondary to penetrating trauma, commonly associated with vascular and adjacent organ injuries. Therefore, defining the best surgical treatment algorithm remains controversial. Mild to moderate duodenal trauma is currently managed via primary repair and simple surgical techniques. However, severe injuries have required complex surgical techniques without significant favorable outcomes and a consequential increase in mortality rates. This article aims to delineate the experience in the surgical management of penetrating duodenal injuries via the creation of a practical and effective algorithm that includes basic principles of damage control surgery that sticks to the philosophy of "Less is Better". Surgical management of all penetrating duodenal trauma should always default when possible to primary repair. When confronted with a complex duodenal injury, hemodynamic instability, and/or significant associated injuries, the default should be damage control surgery. Definitive reconstructive surgery should be postponed until the patient has been adequately resuscitated and the diamond of death has been corrected.
Resumen El trauma de duodeno comúnmente se produce por un trauma penetrante que puede asociarse a lesiones vasculares y de órganos adyacentes. En el manejo quirúrgico se recomienda realizar un reparo primario o el empleo de técnicas quirúrgicas simples. Sin embargo, el abordaje de lesiones severas del duodeno es un tema controversial. Anteriormente, se han descrito técnicas como la exclusión pilórica o la pancreatoduodenectomía con resultados no concluyentes. El presente artículo presenta una propuesta del manejo de control de daños del trauma penetrante de duodeno, a través, de un algoritmo de cinco pasos. Este algoritmo plantea una solución para el cirujano cuando no es posible realizar el reparo primario. El control de daños del duodeno y su reconstrucción depende de una toma de decisiones respecto a la porción del duodeno lesionada y el compromiso sobre el complejo pancreatoduodenal. Se recomiendan medidas rápidas para contener el daño y se proponen vías de reconstrucción duodenal diferente a las clásicamente descritas. Igualmente, la probabilidad de complicaciones como fistula duodenales es considerable, por lo que proponemos, que el manejo de este tipo de fistulas de alto gasto se aborde por medio de una laparostomía retroperitoneal (lumbotomía). El abordaje del trauma penetrante de duodeno se puede realizar a través del principio "menos es mejor".
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BACKGROUND: An international group proposed a standardized terminology to report outcomes after bile duct repair. Data on this surgical complication vary depending on the center and country where patients are treated. The aim of this work is to show disparities in the care process of bile duct injury between patients from two different income-level countries, using a standard terminology of outcomes and clinical reporting. METHODS: A retrospective review comparing primary repair and re-repaired cases performed in an upper middle-income country (UMIC) versus primary repair cases treated in a high-income country (HIC) was performed. All pertinent data included in the tabular reporting system and outcomes classification were collected. Patients' characteristics were reported by calculating descriptive statistics. RESULTS: A total of 261 patients from UMIC (148 (56%) primary repair and 113 (44%) re-repair) were compared with 122 primary repair from HIC. Open cholecystectomy (55.4% vs 3.3%) and more E4 injuries (37.8% vs 19.7%) were found in the UMIC group. More Accordion 3 and higher complications were present in the UMIC primary and repair groups, as well as more episodes of postoperative acute cholangitis. Eleven patients were listed for liver transplant in the UMIC re-repair group. Primary patency by the end of the index treatment period was present in 217 (83%) of the full UMIC cohort. Median time to loss of primary patency was not reached in the primary repair, and was 3.8 years in the re-repair group. Patency was below HIC primary repaired cases. CONCLUSIONS: Standardized reporting outcomes after primary repair are applicable to re-repaired patients and are helpful to compare different populations, showing better outcomes in HIC. Measures of surgical access disparities exist among the process of bile duct injury care.
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Ductos Biliares , Colecistectomia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Complicações Pós-Operatórias , Ductos Biliares/lesões , Ductos Biliares/cirurgia , Fatores Econômicos , HumanosRESUMO
Introducción: El trauma de abdomen tiene una incidencia que varía según las publicaciones, pero el colon y el recto son estructuras anatómicas generalmente comprometidas. Objetivo: Determinar las características clínico-quirúrgicas y los resultados terapéuticos en pacientes con lesiones traumáticas de colon y recto tratados con técnicas derivativas. Método: Se realizó un estudio descriptivo, retrospectivo y multicéntrico en hospitales clínico-quirúrgicos seleccionados de La Habana, desde 2010 hasta 2015. El universo estuvo conformado por todos los pacientes ingresados en las instituciones con trauma rectocolónico único o múltiple tratados quirúrgicamente por colostomía. Resultados: Los pacientes estudiados se caracterizaron por edades: jóvenes (menos de 30), sexo masculino (69,2 por ciento), evolución hasta el tratamiento quirúrgico mayor de 12 horas (46,2 por ciento); causadas por empalamientos y otros (53,8 por ciento) y heridas con arma blanca (23,1 por ciento). Se aplicaron principalmente las técnicas quirúrgicas de colostomía en asa y de Hartman. Tanto el tiempo quirúrgico como la estadía fueron prolongados. La frecuencia de complicaciones graves y la mortalidad fue alta. Los costos fueron elevados. Conclusiones: La colostomía aun es una alternativa quirúrgica viable, pero su selección debe estar basada en la evaluación individualizada de los casos y en los índices pronósticos(AU)
Introduction: Abdominal trauma has an incidence that varies, according to publications; but the colon and the rectum are generally compromised anatomical structures. Objective: To determine the clinical-surgical characteristics and the therapeutic results in patients with traumatic lesions of the colon and the rectum treated with derivative techniques. Method: A descriptive, retrospective and multicenter study was conducted in selected clinical-surgical hospitals in Havana, from 2010 to 2015. The total sample consisted of all patients admitted with single or multiple rectocolonic trauma and treated with colostomy. Results: The patients studied were characterized by age: young (less than 30), male (69.2 percent), evolution until surgical treatment over 12 hours (46.2 percent); caused by impalements and others (53.8 percent) and stab wounds (23.1 percent). The surgical techniques of loop colostomy and Hartman colostomy were applied, mainly. Both surgical time and stay were prolonged. The frequency of serious complications and mortality was high. The costs were high. Conclusions: Colostomy is still a viable surgical alternative, but its selection must be based on the individualized evaluation of the cases and the prognostic rates(AU)
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Humanos , Masculino , Adulto , Reto/lesões , Colostomia/métodos , Colo/lesões , Epidemiologia Descritiva , Estudos RetrospectivosRESUMO
Introducción: El uso de autoinjerto es el procedimiento de elección para la reconstrucción del ligamento cruzado anterior (LCA). El éxito se basa en sus resultados y calidad de vida postoperatoria. La reconstrucción primaria es una técnica nueva, con resultados prometedores y una disminución en las complicaciones y efectos secundarios. Por lo tanto, se expone esta técnica, que de forma primaria y sin necesidad de utilizar injertos estabilice el LCA. Objetivo: Comparar resultados entre la reparación primaria del LCA y la reconstrucción con el uso de autoinjerto de hueso-tendón-hueso. Métodos: Se realizó un estudio transversal clínico-epidemiológico, usando las variables de tendencia central para la medición de resultados. Se dio seguimiento postoperatorio a los pacientes para medir las variables de dolor, grados de movilidad y tiempo de incorporación al ejercicio. Resultados: El promedio de dolor fue de 4.6 ± 1.33, los arcos de movilidad en flexión fueron de 90.16º ± 3.23 en la primera semana y el tiempo de incorporación al ejercicio fue de 13.84 ± 3.14 semanas. Conclusiones: No se encontró diferencia en los resultados de dolor postoperatorio. Una marcada diferencia se evidenció en los rangos de movilidad y tiempo de incorporación al ejercicio, favoreciendo a la reparación primaria en el tiempo que le tomó al paciente retornar a la actividad física.
Introduction: The use of autograft is the procedure of choice for reconstruction of the anterior cruciate ligament (ACL). The success is based on its results and postoperative quality of life. Primary reconstruction is a new technique with promising results and decreased complications. This technique is exposed to ensure stabilization without the use of grafts. Objective: Compare results between primary repair and reconstruction using bone-tendon-bone autograft. Methods: A clinical epidemiological cross-sectional study was conducted using variables of central tendency for measuring results. Postoperative follow-up was given to patients measuring the variables of pain, range of motion, and incorporation time to exercise. Results: Follow up to meet the rehabilitation protocol. The average pain was 4.6 ± 1.33, the range of motion in flexion was 90.16º ± 3.23 in the first week, and the time returning to the exercise was 13.84 ± 3.14 weeks. Conclusions: No difference was found in the results of postoperative pain. A marked difference was observed in the ranges of motion and incorporation time to exercise, favoring primary repair in the time it took patients to return to physical activity.
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Humanos , Procedimentos Cirúrgicos Operatórios/reabilitação , Ligamento Cruzado Anterior , Transplante Ósseo , Estudo Comparativo , Ligamentos/lesõesRESUMO
We reviewed all the available data regarding the current management of non-complex rhegmatogenous retinal detachment and aimed to propose a new decision-making algorithm aimed to improve the single surgery success rate for mid-severity rhegmatogenous retinal detachment. An online review of the Pubmed database was performed. We searched for all available manuscripts about the anatomical and functional outcomes after the surgical management, by either scleral buckle or primary pars plana vitrectomy, of retinal detachment. The search was limited to articles published from January 1995 to December 2015. All articles obtained from the search were carefully screened and their references were manually reviewed for additional relevant data. Our search specifically focused on preoperative clinical data that were associated with the surgical outcomes. After categorizing the available data according to their level of evidence, with randomized-controlled clinical trials as the highest possible level of evidence, followed by retrospective studies, and retrospective case series as the lowest level of evidence, we proceeded to design a logical decision-making algorithm, enhanced by our experiences as retinal surgeons. A total of 7 randomized-controlled clinical trials, 19 retrospective studies, and 9 case series were considered. Additional articles were also included in order to support the observations further. Rhegmatogenous retinal detachment is a potentially blinding disorder. Its surgical management seems to depend more on a surgeon´s preference than solid scientific data or is based on a good clinical history and examination. The algorithms proposed herein strive to offer a more rational approach to improve both anatomical and functional outcomes after the first surgery.
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La atresia esofágica de brecha larga es la falta congénita de continuidad del esófago con o sin comunicación a la vía aérea, donde una extensa separación entre los cabos esofágicos (mayor de cuatro centímetros) impide una anastomosis primaria. Para su tratamiento existen varias técnicas, pero ninguna es ideal. Se reportó un paciente transicional masculino, de un año y tres meses de edad, de raza blanca, procedente de Manzanillo, Granma, con diagnóstico de atresia esofágica de brecha larga en la etapa neonatal, al cual se le realizó sustitución esofágica temprana con estómago. Se revisó el expediente clínico del paciente, y se extrajeron los datos relacionados con los antecedentes, el cuadro clínico, los exámenes complementarios y el tratamiento.
Long gap esophageal atresia is the congenital lack of the continuity of esophagus with or without communication to the air way, where an extensive separation between the esophageal pouches (more than four centimeters) inhibit the primary anastomosis. For its treatment there are several techniques, but none of them is ideal. A male patient, with diagnosis of long gap esophageal atresia in the neonatal stage was reported, to whom the early esophageal replacement with stomach was performed. The patient's clinical record was revised, of which the data related with the history, the clinical manifestations, the complementary exams and the treatment were taken.
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La perforación esofágica comprende un reto clínico para el médico: esto por la gran cantidad de variantes clínicas que puede presentar. Es importante destacar que es una verdadera emergencia por las desastrosas consecuencias de un diagnóstico tardío, por lo cual el médico debe tener una visión clara de su presentación así como sospechar de su existencia en ocasiones, donde a pesar de una clínica ambigua, el antecedente de ciertos acontecimientos nos acercan a este diagnóstico. Caso clínico: Paciente femenina de 58 años de edad, quien inicia enfermedad actual en marzo del 2013 al presentar dolor torácico de fuerte intensidad, concomitantemente hematemesis en 3 oportunidades posterior ingesta de cuerpo extraño (espina de pescado) es llevada a quirófano donde se realiza una toracotomía amplia derecha con visualización de lesión grado IV de tercio medio de esófago torácico y retiro de cuerpo extraño, cervicotomía exploradora izquierda para exclusión esofágica extrínseca y yeyunostomía de alimentación. Conclusión: Creemos que el mejor manejo de las lesiones de esófago es hacer diagnóstico rápido y, de ser posible, realizar la reparación primaria. Para esto, es necesario tener un alto índice de sospecha en lesiones de cuello y tórax, pues debido a que se encuentra rodeado de la vía aérea y estructuras vasculares importantes, muchas veces es pasada por alto, lo que aumenta el riesgo de complicaciones y, por tanto, la morbimortalidad(AU)
Esophageal perforation comprises a clinical challenge for physicians: it is because many clinical variants which may occur. Importantly, it is a true emergency, the dire consequences of a late diagnosis, so the doctor must have a clear view of your presentation and suspect their existence sometimes, where despite an ambiguous clinical, history of certain events bring us to this diagnosis. Case report: Female patient, 58 years old, who started presenting illness in March 2013 to have chest pain of high intensity concomitantly hematemesis in 3 subsequent opportunities intake foreign body (fishbone) is taken to surgery where it takes one wide right thoracotomy, left explorer cervicotomy + extrinsic esophageal exclusion feeding jejunostomy. Conclusion: We believe that the best management of esophageal injuries is to make rapid diagnosis and, if possible, perform primary repair. For this it is necessary to have a high index of suspicion in lesions neck and chest, then because it is surrounded by the airway and major vascular structures, often is overlooked, which increases the risk of complications and therefore, the morbidity and mortality(AU)
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Humanos , Feminino , Pessoa de Meia-Idade , Dor no Peito , Hematemese , Perfuração Esofágica , Corpos Estranhos , Ferimentos e Lesões , Toracotomia , EmergênciasRESUMO
Objetivo: Presentar la experiencia en el manejo del trauma de colon en la Unidad de Politraumatizados. Hospital Domingo Luciani. IVSS, Caracas. Métodos: Se realizó un estudio retrospectivo, descriptivo y de corte transversal, basado en la revisión de historias clínicas de los pacientes ingresados en nuestra institución durante el periodo enero 2009 diciembre 2012, quienes en la exploración quirúrgica presentaron trauma de colon, se evaluaron las variable: sexo,tiempo de evolución de la lesión, estabilidad hemodinámica,mecanismo de trauma, localización de la lesión, grado de lesión de colon, grado de contaminación, lesiones asociadas y conducta quirúrgica. Los resultados se expresaron en gráficos circulares y diagramas de barras.Resultados:Se revisó un total de 403 pacientes, de los cuales el 95% estuvo representado por el sexo masculino, el tiempo de evolución fue menor a 6 Horas en un 96%, el 75% de los pacientes ingresaron estables hemodinamicamente, la herida por arma de fuego representó el mecanismo de lesión más frecuente (84%). En cuanto al segmento de colon más afectado, se encuentra el colon transverso y ascendente con un 34 y 29% respectivamente. La lesión grado II de colon predominó con un 45%. La contaminación de cavidad grado A se observó en un 38%. La reparación primaria fue la conducta más empleada representando un 82.1%, El intesti-no delgado resultó el órgano asociado más afectado (35%). Conclusión: El tratamiento para lesiones de colon es la reparación primaria. La colostomía debe ser tomada en cuenta por el cirujano en presencia de inestabilidad hemodinámica, índice de trauma abdominal y tiempo de evolución de la lesión(AU)
Objective: To present the experience in the management of the trauma of colon at Trauma Unit. Hospital Domingo Luciani. IVSS, Caracas. Methods: We conducted a retrospective, descriptive and study of cross section, based on the review of medical records of patients admitted to our institution during the period January 2009 December 2012, who in surgical exploration showed colon trauma, assessed the variable: sex, time of evolution of the injury,hemodynamic stability, mechanism of trauma, localization of the lesion, degree of lesion of colon, degree of contamination, associated injuries and surgical conduct. Results were expressed in pie charts and bar charts. Results: A total of 403 patients, of whom 95% was represented by male. Evolution time was less than 6 hours in a 96%, 75 %of the patients were stable hemodynamic, gunshot wound represented the mechanism of injury more frequently (84%). As for the most affected colon segment transverse and ascending colon with a 34 and 29% is respectively. Lesion grade II of colon predominated with 45%. Grade A contamination of cavity was observed in38%. Primary repair was the more employed conduct, representing an 82.1%, the small intestine was the most associated affected organ (35%). Conclusion: Treatment of choice for colon injuries is the primary repair. The colostomy must be taken into account by the surgeon in the presence of hemodynamic instability, index of abdominal trauma and time evolution of the lesion(AU)
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Humanos , Masculino , Feminino , Ferimentos e Lesões , Colostomia , Colo , Traumatismos Abdominais , Laparotomia , Terapêutica , Ferimentos por Arma de Fogo , Coleta de Dados , Colo Ascendente , Colo TransversoRESUMO
BACKGROUND: Numerous studies have established the safety of primary repair for civilian penetrating colonic injuries with little data exploring the experience of surgeon performing the procedure. Owing to financial, staff and administrative constraints in the developing world, surgeons-in-training sometimes find themselves faced with having to perform major surgery for penetrating colonic injuries with no experienced surgeon in attendance, but available for advice via phone. With this thought, we collected retrospective data to analyse our outcomes based on this practice. MATERIALS AND METHODS: Over a 10-year period 62 patients with penetrating colonic trauma underwent laparotomies with analysis done on 53 cases. Severity of injury, grade of operating surgical staff and outcome were noted. Outcomes of "inexperienced surgeons" and "experienced surgeons" were compared to determine if a difference exists in outcome based on experience or grade of surgeon. RESULTS: A total of 53 patients with penetrating colon injures underwent primary repair and/or anastomosis with 18 (34%) performed by "inexperienced surgeons" and 35 (66%) by "experienced surgeons". There was one death unrelated to colon trauma with an inexperienced surgeon and one anastomotic leak in a patient operated on by an experienced surgeon. CONCLUSION: This data supports previous reports on the safety of primary repair for penetrating colonic injuries and raises the point that in cases of lower severity of injury inexperienced surgeons have similar results to experienced surgeons with regard to primary repair.
RESUMO
Objetivo: Informar si la evolución > 6 horas, grado de contaminación y lesión, sitio anatómico lesionado, PATI (penetrating abdominal trauma index) > 25 y presencia de otras lesiones en trauma de colon, se asocian a mayor morbimortalidad en pacientes con lesión colónica a quienes se les realizó cierre primario. Material y métodos: Estudio prospectivo, observacional, longitudinal, descriptivo, en el Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí. Se incluyeron pacientes con trauma abdominal sometidos a cirugía que presentaron lesión colónica. Análisis estadístico básico con χ2. Resultados: 481 pacientes fueron intervenidos por trauma abdominal; 77 (16.1 %) tuvieron lesión colónica, de los cuales 90 % (n = 69) se intervino en las primeras seis horas; 91 % fue lesión penetrante. El colon transverso fue el más lesionado (38 %, n = 29); las lesiones grado I y II representaron 75.3 % (n = 58). Se efectuó cierre primario en 76.66 % (n = 46), resección con anastomosis en 8.3 % (n = 5) y colostomía en 15 % (n = 9). Hubo lesiones asociadas en 76.6 % (n = 59) y contaminación en 85.7 % (n = 66); 82.8 % (58) tuvo PATI < 25; complicaciones asociadas al procedimiento operatorio, 28.57 % (n = 22); reintervenciones, 10 % (n = 8); estancia hospitalaria promedio, 11.4 días; mortalidad no relacionada a lesión de colon, 3.8 % (n = 3). Conclusiones: El cierre primario es un procedimiento seguro para el tratamiento de lesiones colónicas. Los pacientes con cierre primario presentaron menor morbilidad (p < 0.009). Los pacientes con cirugía en las primeras seis horas (p < 0.006) y estabilidad hemodinámica (p < 0.014) tuvieron menor riesgo de complicación.
BACKGROUND: Primary repair of colon injuries is an accepted therapeutic option; however, controversy persists regarding its safety. Our objective was to report the evolution and presence of complications in patients with colon injury who underwent primary closure and to determine if the time interval (>6 h), degree of injury, contamination, anatomic site injured, PATI (Penetrating Abdominal Trauma Index) >25, and the presence of other injuries in colon trauma are associated with increased morbidity and mortality. METHODS: This was a prospective, observational, longitudinal and descriptive study conducted at the Central Hospital "Dr. Ignacio Morones Prieto," San Luis Potosí, Mexico, from January 1, 2003 to December 31, 2007. We included patients with abdominal trauma with colon injury subjected to surgical treatment. chi(2) was used for basic statistical analysis. RESULTS: There were 481 patients with abdominal trauma who underwent surgery; 77(16.1%) had colon injury. Ninety percent (n = 69) were treated in the first 6 h; 91% (n = 70) were due to penetrating injuries, and gunshot wound accounted for 48% (n = 37). Transverse colon was the most frequently injured (38%) (n = 29). Grade I and II injuries accounted for 75.3% (n = 58). Procedures included primary repair (76.66 %) (n = 46); resection with anastomosis (8.3%) (n = 5); and colostomy (15%) (n = 9). Associated injuries were present in 76.6% (n = 59). There was some degree of contamination in 85.7% (n = 66); 82.8% (58) had PATI <25. Complications associated with the surgical procedure were observed in 28.57% (n = 22). Reoperation was necessary in 10% (n = 8). Average hospital stay was 11.4 days. Mortality was 3.8% (n = 3); none of these were related to colon injury. CONCLUSIONS: Primary repair is a safe procedure for treatment of colon injuries. Patients with primary repair had lower morbidity (p <0.009). Surgery during the first 6 h (p <0.006) and in hemodynamically stable patients (p <0.014) had a lower risk of complications.