RESUMO
INTRODUCTION: Laparoscopic IPOM is technically challenging, especially regarding fascial closure. Hybrid repair has been proposed as a simpler approach. We aimed to compare hybrid and laparoscopic intraperitoneal onlay mesh repair (IPOM) in patients undergoing ventral hernia repair (VHR). METHODS: We performed a systematic review of Cochrane, Scopus, and MEDLINE databases to identify studies comparing hybrid versus laparoscopic IPOM VHR reporting the outcomes of recurrence, mortality, seroma, postoperative complications, reoperation, surgical site infection, and operative time. Statistical analysis was performed using RStudio 4.1.2 using a random-effects model. RESULTS: We screened 2,896 articles and fully reviewed 22 of them. A total of five studies, encompassing 664 patients were included. Among them, 337 (50.8%) underwent laparoscopic IPOM. All patients had incisional hernias, with a mean diameter varying from 3 to 12.7 cm, 60% were women, with a mean BMI varying from 29.5 to 38. The hybrid approach had a lower rate of seroma when compared to the laparoscopic (OR 0.22; 95% CI 0.05 to 0.92; p = 0.038; I²=78%). We found no difference in recurrence, mortality, postoperative complications, reoperation, surgical site infection, and operative time between groups. CONCLUSION: Hybrid IPOM is a safe and effective method for incisional hernia repair. Moreover, it facilitates fascial defect closure and decreases postoperative seromas.
RESUMO
Reconhecido pela Organização Mundial de Saúde em 2016, o linfoma anaplásico de grandes células associado ao implante mamário (BIA-ALCL) é um subtipo incomum de linfoma não Hodgkin de células T, que se desenvolve após a inserção de próteses mamárias. A doença é uma afecção rara que afeta cerca de uma a cada 30.000 pessoas com implante mamário texturizado. As principais manifestações clínicas são o seroma tardio, assimetria mamária, massa e contratura capsular, com frequência mais elevada do primeiro. O explante da prótese com capsulectomia total pode ser suficiente para tratar o ALCL, com ressecções estendidas a locais adjacentes, quando necessário. Entretanto, em alguns casos, é realizada a radioterapia e/ou quimioterapia adjuvante. Conclui-se que, para um diagnóstico precoce e um tratamento efetivo, mulheres com seroma de aparecimento súbito e tardio deverão realizar exames complementares para a exclusão dessa afecção, mesmo com tempo inferior à média de desenvolvimento, que é de cerca de 10,6 anos.
Recognized by the World Health Organization in 2016, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon subtype of T-cell non-Hodgkin lymphoma that develops after the insertion of breast implants. The disease is a rare condition that affects approximately one in every 30,000 people with textured breast implants. The main clinical manifestations are late seroma, breast asymmetry, mass, and capsular contracture, with a higher frequency of the former. Explantation of the prosthesis with total capsulectomy may be sufficient to treat ALCL, with resections extended to adjacent sites when necessary. However, in some cases, adjuvant radiotherapy and/or chemotherapy is performed. It is concluded that, for an early diagnosis and effective treatment, women with sudden and late-onset seroma should undergo additional tests to exclude this condition, even with a shorter development time than the average, which is around 10.6 years.
RESUMO
RESUMEN Introducción: Cada año en América Latina, más de 200,000 mujeres son diagnosticadas con cáncer de mama. Como parte del tratamiento de esta enfermedad, la cirugía es uno de los pilares fundamentales. El acto quirúrgico es una experiencia extrema para el paciente y el cirujano, necesaria en esta patología para el tratamiento completo y, como todo acto médico, no está exento de complicaciones. En Paraguay no se cuentan con estadísticas sobre la prevalencia de las complicaciones debidas a cirugías por cáncer de mama, por lo que este trabajo tiene como principal objetivo establecer dicha frecuencia en un hospital de cuarto nivel de complejidad. Materiales y métodos: Estudio retrospectivo, observacional, de corte transversal. Muestreo no probabilístico de casos consecutivos. La selección de sujetos de estudios se realizó de la población de pacientes que fueron sometidos a cirugía por cáncer de mama, en el Hospital de Clínicas en el periodo enero de 2018 a agosto 2022, y que cumplan con los criterios de inclusión y exclusión. Todas las variables han sido extraídas de la ficha clínica y fueron documentadas en el formulario de registro de datos. Se esperaba una frecuencia de 42 % de complicaciones post quirúrgicas utilizando el programa estadístico EPIINFO 7 para un IC de 95% a precisión de 5%, el tamaño mínimo a incluir debía ser de 143 pacientes. Resultados: Se analizaron 203 historias clínicas de pacientes con diagnóstico de cáncer de mama que fueron sometidas a cirugía como parte del tratamiento, correspondientes al periodo comprendido entre enero de 2018 a agosto de 2022. Cumplieron con los criterios de inclusión 201 pacientes. Se registraron un total de 92 pacientes que presentaron alguna complicación relacionada a la cirugía, que corresponden 46 % del total de pacientes en el periodo de tiempo estudiado. De las complicaciones encontradas, 40 desarrollaron seromas, representando el 43% del total de pacientes con complicaciones; 18 pacientes tuvieron infección de la herida operatoria, representando el 20%. 7 pacientes presentaron dehiscencia de la herida operatoria, siendo el 7,5% del total; y 5 desarrollaron un hematoma, siendo el 5,3%. Entre otras complicaciones encontradas, 4 pacientes presentaron linfedema (4,3%), 4 dolor crónico (4,3%), 3 extrusión de prótesis mamaria (3,2 %), 2 de celulitis del miembro superior afecto (2,1%), 2 presentaron necrosis del complejo areola-pezón (2,1%), 1 sufrimiento de piel sin necrosis, 1 sufrimiento del complejo areola-pezón sin necrosis (1% ambos), 1 presentó fistula (1%), 1 disfunción del miembro superior homolateral (1%), y una contractura capsular (1%). Discusión: Se registraron 92 pacientes con una complicación post quirúrgica luego de una cirugía por cáncer de mama; representa así el 46% del total de pacientes estudiados. Esta prevalencia se corresponde con lo publicado en la literatura. En cuanto a las complicaciones encontradas, la más frecuente en nuestra revisión fue el seroma, que se presentó en un 40% de las complicaciones. Las publicaciones describen a esta como una de las complicaciones más frecuentemente relacionadas a la cirugía mamaria, con frecuencias que varían desde 18 al 86% según diversos autores. Conclusión: De 201 pacientes que cumplieron con los criterios de inclusión y exclusión, se registraron un total de 92 pacientes que presentaron alguna complicación relacionada a la cirugía, que corresponden 46 % del total de pacientes en el periodo de tiempo estudiado. La complicación más frecuente fue el seroma. Todos los hallazgos de este estudio se correlacionan con lo encontrado en la literatura.
Introduction: Every year in Latin America, more than 200,000 women are diagnosed with breast cancer. As part of the treatment of this disease, surgery is one of the fundamental pillars. The surgical act is an extreme experience for the patient and the surgeon, necessary in this pathology for complete treatment and, like any medical act, it is not exempt from complications. In Paraguay there are no statistics on the prevalence of complications due to surgeries for breast cancer, so the main objective of this work is to establish said frequency in a hospital of fourth level of complexity. Materials and methods: retrospective, observational, cross-sectional study. non-probabilistic sampling of consecutive cases. The selection of study subjects was made from the population of patients who underwent surgery for breast cancer, at the Hospital de Clínicas in the period January 2018 to August 2022, and who met the inclusion and exclusion criteria. All the variables have been extracted from the clinical record and were documented in the data recording form. A frequency of 42% of post-surgical complications was expected using the statistical program EPIINFO 7 for a CI of 95% with a precision of 5%, the minimum size to include had to be 143 patients. Results: 203 medical records of patients diagnosed with breast cancer who underwent surgery as part of the treatment, corresponding to the period from January 2018 to August 2022, were analyzed. 201 patients met the inclusion criteria. A total of 92 patients who presented some complication related to surgery were registered, corresponding to 46% of the total number of patients in the period of time studied. Of the complications found, 40 developed seromas, representing 43% of all patients with complications; 18 patients had surgical wound infection, representing 20%. 7 patients presented dehiscence of the surgical wound, being 7.5% of the total; and 5 developed a hematoma, being 5.3%. Among other complications found, 4 patients presented lymphedema (4.3%), 4 chronic pain (4.3%), 3 extrusion of breast prosthesis (3.2%), 2 cellulitis of the affected upper limb (2.1%), 2 presented necrosis of the nipple-areola complex (2.1%), 1 suffering from skin without necrosis, 1 suffering from the nipple-areola complex without necrosis (1% both), 1 presented fistula (1%), 1 homolateral upper limb dysfunction (1%), and capsular contracture (1%). Discussion: 92 patients with a post-surgical complication after surgery for breast cancer were registered; thus represents 46% of all patients studied. This prevalence corresponds to what has been published in the literature. Regarding the complications found, the most frequent in our review was seroma, which occurred in 40% of the complications. The publications describe this as one of the complications most frequently related to breast surgery, with frequencies ranging from 18 to 86% according to various authors. Conclusion: Of 201 patients who met the inclusion and exclusion criteria, a total of 92 patients who presented some complication related to surgery were registered, corresponding to 46% of the total number of patients in the period of time studied. The most frequent complication was seroma. All the findings of this study correlate with what is found in the literature.
Assuntos
Neoplasias da MamaRESUMO
INTRODUCTION: Seroma is a frequent complication that can affect the final result of reconstructive and cosmetic surgeries. METHODOLOGY: This study evaluated the effectiveness of 5-Fluorouracil and 75% hypertonic glucose in preventing seroma in a mastectomy rat model, as well as cellular and vascular events in adjacent tissues. A left mastectomy with lymphadenectomy was performed in 60 Wistar-Albino female rats. Animals randomly allocated to the control group (Group I; n = 20) were sutured right after mastectomy. The intervention groups received 1.0 mL of 75% hypertonic glucose (Group II; n = 20) or 1.0 mL of 5-Fluorouracil (Group III; n = 20) at the surgical site before suturing. The assessment of the presence of seroma was performed in all animals at 24, 48, and 72 h and on the 7th and 12th postoperative day. After the 12th day, a tissue sample was taken from the surgical site and sent for histological analysis. The occurrence of seroma was assessed using GEE. A significance level of 5% was adopted. RESULTS: Differences in seroma formation over time were observed for both Control Group I (p=0.041) and Intervention Group II (p<0.001). In Intervention Group III, there was no difference in the percentage and volume of seroma across the assessment points (p=0.627). When both the Control and Intervention Group II were compared to Intervention Group III, we found a reduction in seroma formation in the last group. The reduction in the inflammatory process was more regular to Intervention Group III. CONCLUSION: In this animal model, 5-Fluorouracil was more effective in preventing seroma formation than 75% Hypertonic Glucose. No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .
Assuntos
Glucose , Mastectomia , Ratos , Animais , Mastectomia/efeitos adversos , Seroma/etiologia , Seroma/prevenção & controle , Seroma/cirurgia , Fluoruracila , Ratos Wistar , Modelos AnimaisRESUMO
PURPOSE: Drain placement in retromuscular ventral hernia repair is controversial. Although it may reduce seroma formation, there is a concern regarding an increase in infectious complications. We aimed to perform a meta-analysis on retromuscular drain placement in retromuscular ventral hernia repair. METHODS: We performed a literature search of Cochrane, Scopus and PubMed databases to identify studies comparing drain placement and the absence of drain in patients undergoing retromuscular ventral hernia repair. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics. RESULTS: 3808 studies were screened and 48 were thoroughly reviewed. Four studies comprising 1724 patients were included in the analysis. We found that drain placement was significantly associated with a decrease in seroma (OR 0.34; 95% CI 0.12-0.96; P = 0.04; I2 = 78%). Moreover, no differences were noted in surgical site infection, hematoma, surgical site occurrences or surgical site occurrences requiring procedural intervention. CONCLUSIONS: Based on the analysis of short-term outcomes, retromuscular drain placement after retromuscular ventral hernia repair significantly reduces seroma and does not increase infectious complications. Further prospective randomized studies are necessary to confirm our findings, evaluate the optimal duration of drain placement, and report longer-term outcomes.
Assuntos
Hérnia Ventral , Hérnia Incisional , Humanos , Seroma/etiologia , Herniorrafia/efeitos adversos , Hérnia Ventral/cirurgia , Hérnia Ventral/complicações , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/cirurgia , Drenagem , Telas Cirúrgicas/efeitos adversos , Hérnia Incisional/cirurgiaRESUMO
Introduction: Negative pressure therapy gains ground in surgical practice as an intervention to improve healing. Post-bariatric patients undergoing abdominal dermolipectomy are at increased risk of local complications. There is a notable dearth of current Brazilian studies on this. This study aims to analyze the presence of complications in patients undergoing post-bariatric dermolipectomy surgery with negative pressure dressing in closed surgical incisions. Method: Descriptive study that evaluated complications of surgical incisions in 20 patients undergoing post-bariatric dermolipectomy surgery with negative pressure therapy. Data tabulated in Windows Excel software and analyzed in the Statistical Package for the Social Sciences 18.0 program. Qualitative variables were presented in simple frequency and quantitative as mean, standard deviation, and amplitude. CEP-UNISUL approved the study. Results: 20 patients undergoing negative pressure therapy, 80% (n=16) female, mean age 39.55 years (±9.08). Anchor incision was chosen in 70% (n=14) of the surgeries, with an average tissue removal of 1940 grams (±710.37) and hospitalization time of 40.20 hours (±19.18), corresponding to 1,66 daily. Only 15% (n=3) of patients had complications (dehiscence, seroma, and hematoma, which occurred in the same proportion). There was no case of necrosis. Conclusion: The use of negative pressure therapy in closed surgical incisions of post-bariatric dermolipectomy seems to contribute to reducing postoperative complications.
Introdução: Terapia de pressão negativa ganha espaço na prática cirúrgica como intervenção para melhorar cicatrização. Pacientes pós-bariátricos submetidos a dermolipectomia abdominal apresentam maior risco de complicações locais. Há uma notável escassez de estudos brasileiros atuais acerca disso. O objetivo desse estudo é analisar a presença de complicações em pacientes submetidos a cirurgia de dermolipectomia pós-bariátrica com curativo de pressão negativa em incisões cirúrgicas fechadas. Método: Estudo descritivo que avaliou complicações de incisões cirúrgicas de 20 pacientes submetidos a cirurgia de dermolipectomia pós-bariátrica com terapia de pressão negativa. Dados tabulados no software Windows Excel e analisados no programa Statistical Package for the Social Sciences 18.0. Variáveis qualitativas foram apresentadas em frequência simples e quantitativas através de média, desvio padrão e amplitude. O estudo foi aprovado pelo CEP-UNISUL. Resultados: 20 pacientes submetidos a terapia de pressão negativa, sendo 80% (n=16) do sexo feminino, com idade média de 39,55 anos (±9,08). Incisão em âncora foi escolha em 70% (n=14) das cirurgias, com retirada média de tecido de 1940 gramas (±710,37) e tempo de hospitalização de 40,20 horas (±19,18), correspondendo a 1,66 diárias. Apenas 15% (n=3) dos pacientes apresentaram complicações (deiscência, seroma e hematoma, que aconteceram na mesma proporção). Não houve caso de necrose. Conclusão: Uso da terapia de pressão negativa em incisões cirúrgicas fechadas de dermolipectomia pós-bariátrica parece contribuir na redução das complicações pós-operatórias.
RESUMO
The effectiveness of using quilting/progressive tension sutures in reducing seroma formation after abdominoplasties is well established in the literature, eliminating the use of drains regardless of the simultaneous performance of liposuction. However, despite being widely studied and advocated, the quilting/progressive tension sutures technique is still not widespread, and most surgeons still insist on the use of drains. The author provides a brief literature review on this subject and comments on the work carried out by Wen et al., analyzing divergences between literature data and those presented by Wen et al., and trying to identify the causes of low adherence to the evaluated technique.
Assuntos
Abdominoplastia , Lipectomia , Humanos , Abdominoplastia/métodos , Drenagem/métodos , Lipectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Prevalência , Estudos Retrospectivos , Seroma/epidemiologia , Seroma/etiologia , Seroma/prevenção & controle , Técnicas de Sutura , Suturas/efeitos adversosRESUMO
ABSTRACT BACKGROUND: In the surgical correction of large incisional hernias, the use of a prosthesis is essential in most cases regardless of the technique chosen. The preference is for the polypropylene prosthesis. AIMS: To compare the onlay and Rives-Stoppa techniques in the correction of incisional hernias, their immediate results, complications, advantages, and disadvantages. METHODS: Two groups of patients with incisional hernias were analyzed, submitted to the onlay (19 patients) and Rives-Stoppa (17 patients) techniques, and that used polypropylene prostheses. General epidemiological variables, perioperative data variables, and postoperative complications were assessed. RESULTS: The patients' epidemiologic profile was similar between both groups. The majority were women (58.4%), with a mean age of 65.5 years and a previous mean body mass index of 41.5 kg/m². The Rives-Stoppa technique was employed in most patients (52.7%). Those submitted to the onlay technique had longer abdominal drainage time and longer hospital stay, as well as a higher incidence of seromas and surgical wound infection. CONCLUSIONS: The incisional herniorrhaphy technique with the placement of a pre-peritoneal polypropylene mesh by the Rives-Stoppa technique was superior to the onlay due to lower rates of drain use, hospital stay, and postoperative complications.
RESUMO RACIONAL: Na correção cirúrgica das grandes hérnias incisionais, independente da técnica escolhida, na maioria das vezes, o uso de uma prótese é imprescindível. A preferência é pelas próteses de polipropileno. OBJETIVOS: Comparar a técnicas onlay e Rives-Stoppa na correção de hérnias incisionais, os seus resultados imediatos, as complicações, as vantagens e desvantagens. MÉTODOS: Foram analisados dois grupos de portadores de hérnias incisionais, submetidos à técnica onlay (19 pacientes) e técnica Rives-Stoppa (17 pacientes), utilizando prótese de polipropileno. As variáveis gerais epidemiológicas, variáveis de dados perioperatórios e complicações pós-operatórias foram analisados. RESULTADOS: O perfil epidemiológico dos pacientes foi semelhante entre os grupos, a maioria eram mulheres (58.4%), com média de idade de 65.5 anos e com índice de massa corpórea (IMC) médio prévio de 41,5kg/m². A técnica de Rives-Stoppa foi utilizada na maioria dos pacientes (52.7%). Pacientes submetidos a técnica onlay apresentaram maior tempo de uso de dreno abdominal e maior tempo de internação hospitalar, além de maior incidência de seromas e infecção de ferida operatória. CONCLUSÕES: A técnica de herniorrafia incisional com colocação de tela de polipropileno pré-peritoneal, pela técnica de Rives-Stoppa apresentou-se superior à técnica onlay, devido menor taxa de uso de drenos, menor taxa de tempo de internação hospitalar, bem como menor taxa de complicações pós-operatórias.
RESUMO
Introdução: O aumento mamário é um procedimento estético frequente na cirurgia plástica, o plano ideal ainda não foi encontrado. Cada loja tem sua indicação, suas vantagens e desvantagens. A técnica da loja intramuscular foi inicialmente descrita para uso em cirurgias de aumento dos glúteos com implantes de silicone, e mais tarde sua segurança foi reforçada com a utilização do método XYZ. O estudo tem a finalidade de apresentar a utilização da técnica intramuscular na mamoplastia de aumento com implante de silicone. Métodos: Este estudo descreve em detalhes a técnica da loja intramuscular na mamoplastia de aumento com implante de silicone, utilizada em 50 pacientes do sexo feminino. Resultados: A técnica intramuscular propicia uma boa definição de contorno estético nos quadrantes mediais das mamas. Tivemos um caso de seroma no pós-operatório, causado por erro técnico na separação dos fascículos. Conclusão: A técnica é segura e apresenta baixa incidência de complicações.
Introduction: Breast augmentation is a frequent aesthetic procedure in plastic surgery; the ideal plane has not yet been found. Each pocket has its indication, its advantages, and disadvantages. The intramuscular pocket technique was initially described for use in buttock augmentation surgeries with silicone implants, and later its safety was reinforced with the use of the XYZ method. This study aims to present the use of the intramuscular technique in breast augmentation with a silicone implant. Methods: This study describes the intramuscular pocket technique in breast augmentation with a silicone implant used in 50 female patients. Results: The intramuscular technique provides a good definition of aesthetic contour in the medial quadrants of the breasts. We had a case of seroma in the postoperative period caused by a technical error in separating the fascicles. Conclusion: The technique is safe and has a low incidence of complications.
RESUMO
RESUMO A mamoplastia com próteses é uma das cirurgias plásticas mais realizadas no mundo. O processo cicatricial ao redor do implante e a presença de um biofilme pode acarretar o desenvolvimento de patologias como contratura capsular e seroma. Essas patologias parecem estar relacionadas fisiopatologicamente com o desenvolvimento do linfoma associado aos implantes mamários (BIA-ALCL), sendo este também um diagnóstico diferencial. A proposta deste trabalho é relatar o caso de uma paciente com desconforto mamário, que após 2 cirurgias prévias para drenagem de seroma e troca de próteses, apresentava desconforto mamário e alteração em exames de imagens da mama esquerda. Sendo submetida a uma capsulectomia em bloco da mama esquerda e completa à direita, tendo suas próteses substituídas. Os exames para investigação de BIA-ALCL foram negativos e os achados patológicos foram sugestivos de contratura capsular à esquerda e formação de dupla cápsula à direita. O trabalho enfatiza a importância do diagnóstico diferencial em patologias mamárias, o acompanhamento a longo prazo e medidas de profilaxia na formação do biofilme.
Abstract Mammoplasty with prostheses is one of the most performed plastic surgeries in the world. However, the healing process around the implant and the presence of a biofilm can lead to the development of pathologies such as capsular contracture and seroma. These pathologies seem to be physiologically related to the development of lymphoma associated with breast implants (BIA-ALCL), which is also a differential diagnosis. The purpose of this study is to report the case of a patient with breast discomfort who, after two previous surgeries for seroma drainage and prosthesis replacement, presented breast discomfort and alteration in imaging of the left breast. She was, submitted to a capsulectomy in a block of the left breast and complete on the right, having her prostheses replaced. Bia-ALCL investigation tests were negative and pathological findings were suggestive of left capsular contracture and double capsule formation on the right. The study emphasizes the importance of differential diagnosis in mammary pathologies, long-term follow-up, and prophylaxis measures in biofilm formation.
RESUMO
INTRODUCCIÓN: la patología herniaria es un foco de atención por su impacto en frecuencia y complicaciones relacionadas con esta; afecta del 10% - 15% de la población general, hasta en un 25% de la población económicamente activa. OBJETIVO: describir la prevalencia de complicaciones locales en el sitio quirúrgico de los pacientes diagnosticados y postoperados de hernia inguinal no complicada. METODOLOGÍA: estudio descriptivo, de corte transversal no intervencionista en las Salas de Cirugía General en el Hospital de Especialidades de San Felipe, de septiembre del 2018 a febrero del 2019. Los datos fueron obtenidos de la revisión de historia clínica y entrevista con cada paciente. RESULTADOS: dicha patología se encuentra más en hombres que mujeres; la complicación más frecuente fue el seroma seguida de las infecciones; en dichos pacientes el Índice de Masa Corporal en su mayoría estaba en un rango normal, no presentaban ninguna comorbilidad, ni hábito tóxico al momento del estudio y no se relacionan con las patologías preexistentes. CONCLUSIÓN: de los 108 pacientes estudiados, 75 de ellos no presentaron ningún tipo de complicación temprana en el sitio quirúrgico; las que se presentaron fue el seroma en 15 pacientes (IC 7,99% - 21,87%) y la Infección de herida quirúrgica en 8 pacientes (IC 2,65% - 19,43%). De la profesión u oficio que se relacionó fue la agricultura.
INTRODUCTION: hernia pathology is a focus of attention due to its impact on frequency and complications related to it, affecting 10% - 15% of the general population, up to 25% of the economically active population. OBJECTIVES: to describe the prevalence of local complications at the surgical site in patients diagnosed and post-operated with uncomplicated inguinal hernia. METHODOLOGY: descriptive, non-interventional cross-sectional study in the General Surgery Rooms of the San Felipe Specialties Hospital from September 2018 to February 2019. The data were obtained from the review of the clinical history and interview with each patient. RESULTS: this pathology is found more in men than women, the most frequent complication was seroma followed by infections; In these patients, the Body Mass Index was mostly in a normal range, they did not present any comorbidity or toxic habit at the time of the study, and they were not related to pre-existing pathologies. CONCLUSIONS: of the 108 patients studied, 75 of them did not present any type of early complication at the surgical site; those that occurred were seroma in 15 patients (CI 7.99% - 21.87%) and surgical wound infection in 8 patients (CI 2.65% - 19.43%). Of the profession or trade that was related was agriculture.
Assuntos
Hérnia Inguinal , HérniaRESUMO
We recently described silicone induced granuloma of breast implant capsule (SIGBIC) as an implant capsule illness related to intact silicone breast implants. The precursor to SIGBIC development is gel bleeding/shedding from the implant shell/interior content. Currently, although the literature widely discussed the pathogenesis of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), the trigger point for its development is still a black-box. In this case report, we report a 46-year-old woman with SIGBIC diagnosis in her right breast and BIA-ALCL in her left breast, diagnosed with ultrasound and breast magnetic resonance. Microscopy confirmed silicone bleeding from the implant surface/ content. The imaging findings reported that SIGBIC and BIA-ALCL were similar; however, BIA-ALCL had an intracapsular collection.
RESUMO
BACKGROUND: Increasing number of patients are being operated because of breast cancer. Seroma is the most common problem that occurs after surgery that increases morbidity. For postoperative pain management, Thoracic Paravertebral Block (TPVB) has long been considered the gold standard technique. With performing TPVB, sympathetic nerves are also blocked. OBJECTIVE: With this study, we aimed to search the effect of TPVB on seroma reduction in patients who undergo mastectomy and axillary node dissection surgery. METHODS: Forty ASA I-II female patients aged 18-65, who were scheduled to go under elective unilateral mastectomy and axillary lymph node resection were included to the study. Patients were randomized into two groups as TPVB and control group. Ultrasound guided TPVB with 20 mL 0.25% bupivacaine was performed at T1 level preoperatively to the TPVB group patients. All patients were provided with i.v. patient-controlled analgesia device. Seroma formation amounts, morphine consumptions and Numeric Rating Scale (NRS) scores for pain were recorded 24th hour postoperatively. RESULTS AND CONCLUSIONS: Mean seroma formation at postoperative 24th hour was 112.5±53.3 mL in the control group and 74.5±47.4 mL in the TPVB group (p=0.022). NRS scores were similar between two groups (p=0.367) at postoperative 24th hour but mean morphine consumption at postoperative 24th hour was 5.6±4 mg in the TPBV group, and 16.6±6.9 mg in the control group (p <0.001). TPVB reduces the amount of seroma formation while providing effective analgesia in patients who undergo mastectomy and axillary lymph node removal surgery.
Assuntos
Neoplasias da Mama/cirurgia , Mastectomia , Bloqueio Nervoso/métodos , Complicações Pós-Operatórias/prevenção & controle , Seroma/prevenção & controle , Adolescente , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Excisão de Linfonodo , Pessoa de Meia-Idade , Estudos Prospectivos , Nervos Espinhais , Adulto JovemRESUMO
Abstract Background: Increasing number of patients are being operated because of breast cancer. Seroma is the most common problem that occurs after surgery that increases morbidity. For postoperative pain management, Thoracic Paravertebral Block (TPVB) has long been considered the gold standard technique. With performing TPVB, sympathetic nerves are also blocked. Objective: With this study, we aimed to search the effect of TPVB on seroma reduction in patients who undergo mastectomy and axillary node dissection surgery. Methods: Forty ASA I-II female patients aged 18-65, who were scheduled to go under elective unilateral mastectomy and axillary lymph node resection were included to the study. Patients were randomized into two groups as TPVB and Control group. Ultrasound guided TPVB with 20 mL 0.25% bupivacaine was performed at T1 level preoperatively to the TPVB group patients. All patients were provided with i.v. patient-controlled analgesia device. Seroma formation amounts, morphine consumptions and Numeric Rating Scale (NRS) scores for pain were recorded 24th hour postoperatively. Results and conclusions: Mean seroma formation at postoperative 24th hour was 112.5 ± 53.3 mL in the control group and 74.5 ± 47.4 mL in the TPVB group (p = 0.022). NRS scores were similar between two groups (p = 0.367) at postoperative 24th hour but mean morphine consumption at postoperative 24th hour was 5.6 ± 4 mg in the TPBV group, and 16.6 ± 6.9 mg in the control group (p < 0.001). TPVB reduces the amount of seroma formation while providing effective analgesia in patients who undergo mastectomy and axillary lymph node removal surgery.
Resumo Introdução: Observa-se aumento do número de pacientes submetidos à cirurgia por neoplasia mamária. Seroma é a mais frequente complicação pós-operatória que aumenta a morbidade. Há muito tempo, considera-se o Bloqueio Paravertebral Torácico (BPVT) a técnica padrão-ouro para o controle da dor pós-operatória. O BPVT provoca, igualmente, o bloqueio da inervação simpática. Objetivo: Identificar o efeito do BPVT na redução de seroma em pacientes que realizaram mastectomia e dissecção dos linfonodos axilares. Método: Foram incluídas no estudo 40 pacientes do sexo feminino ASA I-II, entre 18 e 65 anos de idade, submetidas a mastectomia eletiva unilateral com ressecção de linfonodos axilares. As pacientes foram randomizadas em grupo BPVT e grupo controle. As pacientes do grupo BPVT foram submetidas ao BPVT guiado por ultrassom no nível de T1 e 20 mL de bupivacaína 0,25% foram administrados antes da cirurgia. Bomba de infusão IV ACP foi prescrita para todas as pacientes. Na 24ª hora pós-operatória foram registradas a quantidade de produção de seroma, o consumo de morfina e a avaliação da dor pela escala de avaliação numérica (NRS - do inglês Numeric Rating Scale). Resultados: A quantidade média de seroma na 24ª hora pós-operatória foi 112,5 ± 53,3 mL no grupo controle e 74,5 ± 47,4 mL no grupo BPVT (p = 0,022). Na 24ª hora pós-operatória a pontuação NRS foi semelhante nos dois grupos (p = 0,367), porém o consumo médio de morfina foi 5,6 ± 4 mg no grupo BPVT e 16,6 ± 6,9 mg no grupo controle (p < 0,001). Conclusões: O BPVT reduz a quantidade de seroma enquanto proporciona analgesia efetiva em pacientes que se submetem a mastectomia e remoção dos linfonodos axilares.
Assuntos
Complicações Pós-Operatórias/prevenção & controle , Neoplasias da Mama/cirurgia , Seroma/prevenção & controle , Mastectomia , Bloqueio Nervoso/métodos , Nervos Espinhais , Método Duplo-Cego , Estudos Prospectivos , Excisão de Linfonodo , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The number of bariatric surgeries for the treatment of morbid obesity has increased, and there is growing demand for postbariatric abdominoplasty. The aim of this study was to evaluate the impacts of Scarpa's fascia preservation on total drainage volume, time to drain removal, and seroma formation in anchor-line abdominoplasty. METHODS: A total of 42 postbariatric patients were randomly assigned to two groups and underwent anchor-line abdominoplasty. Scarpa's fascia was not preserved during abdominoplasty in one group (n = 21) but was preserved in the other group (n = 21). A suction drain was left in place until the drainage volume was less than 30 ml/24 h. Seroma formation was assessed by abdominal ultrasound on the twentieth postoperative day; only fluid collections greater than 30 ml were considered seromas. RESULTS: The time to drain removal was shorter, and the total drainage volume was lower in the fascial preservation group than in the fascial dissection group. However, no difference in the seroma formation rate was observed between the groups. CONCLUSION: Scarpa's fascia preservation decreased the drainage volume and the time to drain removal but not the rate of seroma formation. LEVEL OF EVIDENCE II: 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.
Assuntos
Abdominoplastia , Cirurgia Bariátrica , Cirurgia Bariátrica/efeitos adversos , Drenagem , Fáscia , Humanos , Complicações Pós-Operatórias/prevenção & controle , Seroma/etiologia , Seroma/prevenção & controleRESUMO
Introduction: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare subtype of CD30-positive and ALKnegative (anaplastic lymphoma kinase) T cell lymphoma, which can develop in the pericapsular fibrous tissue and the late seromas around breast implants. If BIA-ALCL is suspected, an adequate diagnostic flow is essential. Materials and methods: A flowchart of the procedures performed in the diagnostic investigation is discussed, associating a clinical case, and conducting a review on the topic. Results: In the assessment of late and recurrent periprosthetic seromas, prior communication from the surgeon and the pathologist is essential, aiming at the adequate collection and storage of the aspirated material. The material must be promptly fractionated for microbiological assessment by culture, immediate or transoperative cytologic assessment, immunophenotyping by flow cytometry (10 mL), direct cytopathological examination, and obtaining cell block material (50 mL). For flow cytometry, the material must be sent fresh, 70% alcohol or 10% buffered formalin can be added for the other procedures. If it is impossible to send the aspirated fluid to the laboratory in less than six hours, it can be temporarily stored in a refrigerator at 4°C. Immunophenotyping should be extensive, always assessing the expression of CD30 and ALK, regardless of cytological aspects. In cases of late and recurrent seromas in which BIA-ALCL is considered, even if initially discarded, it is suggested to perform capsulectomy with the removal of the prosthesis or careful clinical and laboratory monitoring. Conclusion: The diagnostic flowchart is essential, aiming at false-negative tests.
RESUMO
ABSTRACT Background: Laparoscopic best approach of repairing inguinoscrotal hernias are still debatable. Incorrect handling of the distal sac can possibly result in damage to cord structures and negative postoperative outcomes as ischemic orquitis or inguinal neuralgia. Aim: To describe a new technique for a minimally invasive approach to inguinoscrotal hernias and to analyze the preliminary results of patients undergoing the procedure. Methods: A review of a prospectively maintained database was conducted in patients who underwent minimally invasive repair using the "primary abandon-of-the-sac" (PAS) technique for inguinoscrotal hernias. Patient´s demographics, as well as intraoperative variables and postoperative outcomes were also analyzed. Results: Twenty-six male were submitted to this modified procedure. Mean age of the case series was 53.8 years (range 34-77) and body mass index was 26.8 kg/m2 (range 20.8-34.2). There were no intraoperative complications or conversion. Average length of stay was one day. No surgical site infections, pseudo hydrocele or neuralgia were reported after the procedure and two patients presented seroma. No inguinal hernia recurrence was verified during the mean 21.4 months of follow up. Conclusion: The described technique is safe, feasible and reproducible, with good postoperative results.
RESUMO Racional: A melhor maneira laparoscópica do reparo de hérnias inguinoescrotais permanece ainda aberta a discussão. O manuseio incorreto do saco herniário pode resultar em danos às estruturas do cordão e resultados pós-operatórios indesejados, como orquite isquêmica ou neuralgia inguinal. Objetivo: Descrever uma nova técnica de abordagem minimamente invasiva das hérnias inguinoescrotais e analisar os resultados preliminares de pacientes submetidos ao procedimento. Métodos: Foi realizada na série de casos a análise retrospectiva de um banco de dados mantido prospectivamente em pacientes submetidos a reparo minimamente invasivo usando a técnica "abandono primário do saco" (PAS) para hérnias inguinoescrotais. Dados demográficos dos pacientes, bem como variáveis intraoperatórias e resultados pós-operatórios são descritos. Resultados: Vinte e seis homens foram submetidos ao procedimento. A idade média foi de 53,8 anos e o índice de massa corpórea de 26,8 kg/m2. Não houve complicações intraoperatórias ou conversão para operação aberta. A duração média da estadia hospitalar foi de um dia. Não foram relatadas infecções de sítio cirúrgico, hematomas ou neuralgia após o procedimento e a presença de seroma ocorreu em dois pacientes. Nenhuma recorrência de hérnia inguinal foi verificada durante média de 21,4 meses. Conclusão: A técnica descrita é segura e replicável, apresentando bons resultados pós-operatórios.
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Laparoscopia/métodos , Herniorrafia/métodos , Hérnia Inguinal/cirurgia , Recidiva , Telas Cirúrgicas , Infecção da Ferida Cirúrgica , Estudos Retrospectivos , Resultado do Tratamento , Virilha/cirurgiaRESUMO
Introdução: A abdominoplastia é um procedimento para a melhoria do contorno corporal e a técnica tem sido aprimorada pela associação da dissecção limitada do retalho cutâneo e pontos de adesão no mesmo ato operatório, evitando-se a formação de seroma pós-abdominoplastia, complicação que incomoda tanto o paciente quanto o cirurgião. Portanto, o objetivo é avaliar se o uso de pontos de adesão está associado a menor incidência de seroma após abdominoplastia quando comparado ao uso de drenos. Métodos: Revisão sistemática da literatura com metanálise, envolvendo as seguintes bases de dados: Science Direct, Scielo, Pubmed, Lilacs, CINAHL e Scopus. Para analisar os dados foi utilizado o programa Stata 12.0 e a estatística I² proposta por Higgins, com intervalo de confiança de 95% para o risco relativo para seroma, segundo o tipo de intervenção (dreno, ponto de adesão, dreno com ponto de adesão). Sendo registrado no PROSPERO sob o número CRD42019120399. Resultados: Cinco estudos preencheram os critérios de inclusão e foram incluídos na metanálise. Ao comparar o uso de dreno de sucção com pontos de adesão, os pontos de adesão mostraram um fator de proteção na prevenção do seroma (RR: 0,13; IC 95%: 0,02-0,66). Conclusão: Os achados sugerem que o uso de pontos de adesão em abdominoplastia em detrimento do uso de drenos pode ser uma técnica eficaz para prevenção da formação de seromas.
Introduction: Abdominoplasty, which aims to improve body contour, has been upgraded by its association with limited dissection of the cutaneous flap and quilting sutures in the same surgery to avoid the formation of postabdominoplasty seroma, a complication that troubles both patient and surgeon. Therefore, this study aimed to assess whether the use of quilting sutures is associated with a lower incidence of seroma after abdominoplasty than the use of drains. Methods: A systematic review of the literature and a meta-analysis were performed of the Science Direct, Scielo, Pubmed, Lilacs, CINAHL, and Scopus databases. The data analysis was performed using the Stata 12.0 program and the I² statistic proposed by Higgins, with a 95% confidence interval for the relative risk for seroma by intervention type (drain, quilting sutures, drain with quilting sutures). The study was registered in PROSPERO (CRD42019120399). Results: Five studies met the inclusion criteria and were included in the meta-analysis. Quilting sutures showed a protective effect (versus use of drain with quilting sutures) in the prevention of seroma (relative risk, 0.13; 95% confidence interval, 0.020.66). Conclusion: These findings suggest that the use of quilting sutures instead of drains in abdominoplasty can effectively prevent seroma formation.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , História do Século XXI , Sucção , Cirurgia Plástica , Drenagem , Metanálise como Assunto , Seroma , Abdome , Abdominoplastia , Sucção/métodos , Sucção/estatística & dados numéricos , Cirurgia Plástica/métodos , Cirurgia Plástica/estatística & dados numéricos , Drenagem/métodos , Drenagem/estatística & dados numéricos , Seroma/cirurgia , Seroma/terapia , Abdominoplastia/métodos , Abdominoplastia/estatística & dados numéricos , Abdome/cirurgiaRESUMO
Introdução: Abdominoplastia é um procedimento não apenas com características estéticas, mas também de reconstrução estrutural da parede abdominal. O objetivo do trabalho é mostrar a experiência dos autores em abdominoplastias, enfocando nos resultados estéticos da cicatriz e a evolução destes pacientes, aplicando as técnicas de ressecção em bloco do Professor Ronaldo Pontes (RP). Métodos: O estudo foi uma série retrospectiva de casos de 124 pacientes, entre março de 2014 a março de 2017, submetidos à abdominoplastia em bloco pela técnica RP. Resultados: Na nossa casuística, demonstrou-se uma mínima incidência de complicações encontradas com a técnica em Bloco RP, em comparação às encontradas na literatura, e, também, demonstrou um número pífio de casos de alterações na cicatrização. Conclusão: A técnica descrita e suas variantes atendem a necessidade de diversos tipos de casos e garantem cirurgias seguras e eficazes, com resultados muito satisfatórios, sendo uma técnica reprodutível.
Introduction: Abdominoplasty involves not only aesthetic characteristics but abdominal wall structural reconstruction. This study aimed to illustrate the authors' experience with abdominoplasty, focusing on the scar's aesthetic results and the evolution of application of the block resection technique of Professor Ronaldo Pontes (RP). Methods: The study included a series of retrospective cases of 124 patients treated between March 2014 and March 2017 who underwent RP block abdominoplasty. Results: In our studies, a minimal incidence of complications and a small number of healing alterations were noted with the RP block technique compared to those found in the literature. Conclusion: A técnica descrita e suas variantes atendem a necessidade de diversos tipos de casos e garantem cirurgias seguras e eficazes, com resultados muito satisfatórios, sendo uma técnica reprodutível.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , História do Século XXI , Complicações Pós-Operatórias , Cicatriz Hipertrófica , Seroma , Estética , Abdominoplastia , Hematoma , Complicações Pós-Operatórias/cirurgia , Cicatriz Hipertrófica/cirurgia , Cicatriz Hipertrófica/complicações , Seroma/cirurgia , Abdominoplastia/efeitos adversos , Abdominoplastia/métodos , Hematoma/cirurgiaRESUMO
Introdução: Abdominoplastia é um dos procedimentos cirúrgicos estéticos mais realizados. Seroma é a complicação local mais comum associada com abdominoplastia, com uma incidência média de 10%. A maior incidência de seroma pós-operatório (PO) ocorre no décimo primeiro dia PO. Ecografia abdominal é o método de escolha para o diagnóstico de seroma após abdominoplastia. Novas técnicas surgiram ao longo dos anos na tentativa de trazer melhores resultados estéticos com menos complicações, como lipoabdominoplastia descrita por Saldanha. Porém, estudos anatômicos recentes questionam a necessidade da manutenção da fáscia de Scarpa descrita na técnica de lipoabdominoplastia, descrevendo que em torno de 90% do sistema linfático abdominal está no plano subdérmico e 10% em um sistema linfático profundo justa-aponeurose abdominal. O objetivo é comparar a incidência de seroma na lipoabdominoplastia sem preservação da fáscia de Scarpa com a abdominoplastia clássica. Métodos: Coorte prospectiva, cega na qual serão analisados 40 pacientes consecutivos que realizaram abdominoplastia sem lipoaspiração associada (n = 20) ou lipoabdominoplastia (n = 20) no Hospital de Clínicas de Porto Alegre entre abril de 2016 e maio de 2017. Todos foram submetidos à ecografia de parede abdominal no 10o dia PO. Resultados: A incidência de seroma foi de 5% (n = 1) no grupo de abdominoplastia clássica e de 10% (n = 2) no grupo de lipoabdominoplastia, sem diferença estatística. Conclusão: Estes resultados, neste grupo de pacientes, mostram que não houve diferença estatística entre os dois grupos.
Introduction: Abdominoplasty is among the most commonly performed surgical procedures. Seroma is the most common local complication associated with abdominoplasty, with an average incidence of 10%. The highest incidence of postoperative (PO) seroma occurs on the eleventh postoperative day (POD). Abdominal ultrasound is the method of choice for diagnosing seroma after abdominoplasty. New techniques have emerged aiming to improve aesthetic results with fewer complications, such as lipoabdominoplasty described by Saldanha. However, recent anatomical studies have questioned the need for Scarpa fascia preservation recommended in the lipoabdominoplasty technique, describing that around 90% of the abdominal lymphatic system is in the subdermal plane, while the other 10% is in a deep lymphatic system near the abdominal aponeurosis. The objective is to compare the incidence of seroma in lipoabdominoplasty without Scarpa fascia preservation to that in classic abdominoplasty. Methods: Prospective blinded cohort in which 40 consecutive patients who underwent abdominoplasty without associated liposuction (n = 20) or lipoabdominoplasty (n = 20) at the Hospital de Clínicas of Porto Alegre between April 2016 and May 2017 were analyzed. All patients underwent abdominal wall ultrasonography on the tenth POD. Results: The incidence of seroma was 5% (n = 1) in the classic abdominoplasty group and 10% (n = 2) in the lipoabdominoplasty group, with no statistical difference. Conclusion: These results showed no statistically significant intergroup difference in seroma development.