RESUMO
BACKGROUND: It is possible to resect the perforated segment and reestablish intestinal continuity with adequate morbidity and mortality results in patients with complicated diverticulitis. AIMS: To evaluate the type of surgery performed at our center and the results of the procedures in patients with complicated diverticulitis. MATERIAL AND METHODS: All patients that underwent sigmoidectomy due to complicated diverticulitis within the time frame of 2005-2012 were included in the study. The primary objective was to evaluate the type of surgery performed. The secondary objective was to evaluate patient morbidity and mortality after 30 postoperative days. RESULTS: The study included 77 patients with a mean age of 51.17±12.80 years. The majority of the patients were men (64.9%) (n=50) and the mean BMI was 28.24±4.06kg/m2. A total of 63.6% (n=49) patients presented with a Hinchey iii-iv classification. Sigmoidectomy with primary anastomosis was performed in 58.4% (n=45) of the patients, 48.8% (22/45) of whom presented with Hinchey iii-iv. Primary anastomosis was more frequently performed in patients that had Hinchey i-ii(P=.001). Open surgery was carried out in 85.7% (n=66) of the cases. The mean surgery duration was longer in the patients with primary anastomosis (181.73±68.2min vs. 152.13±65.8min) (P>.05). Colorectal surgeons performed the procedures in 44.2% (n=34) of the cases. Complications presented in 23.4% (n=18) of the patients and there was a tendency toward more complications in patients that underwent the Hartmann's procedure. The mortality rate was 2.6% (n=2). CONCLUSIONS: Sigmoidectomy with primary anastomosis is a frequent surgery in patients with complicated diverticulitis at our hospital. There was no difference in morbidity and mortality, compared with the Hartmann's procedure.
Assuntos
Colectomia/métodos , Colo Sigmoide/cirurgia , Doença Diverticular do Colo/cirurgia , Doenças do Colo Sigmoide/cirurgia , Adulto , Idoso , Anastomose Cirúrgica , Colectomia/mortalidade , Doença Diverticular do Colo/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Doenças do Colo Sigmoide/complicações , Doenças do Colo Sigmoide/mortalidade , Resultado do TratamentoRESUMO
This retrospective analysis evaluated 123 patients with sigmoid volvulus that underwent surgery at the Belen Hospital, Trujillo, Peru, from January 1, 1967 to December 31, 1992 in an attempt to identify by univariate analysis factors of prognostic value of operative mortality. The surgical procedures performed were destortion plus colopexia (n = 19), intestinal resection with primary anastomosis (n = 69) and resection plus colostomy (n = 35) with an operative death rate of 0%, 13% and 31.4% respectively (p = 0.005). The overall operative mortality rate was of 19.4%. The following parameters were evaluated: age, sex, duration of obstruction, mean arterial pressure, leukocyte count, type of peritoneal fluid, state of the bowel and surgical technique. Analysis of post-operative mortality disclosed the following factors associated with increased mortality: age older than 40 (p = 0.008), mean arterial pressure lower than 70 mmHg (p = 0.0001), presence of purulent or fecaloid peritoneal fluid (p = 0.001) and evidence of gangrenous colon with perforation (p = 0.0001). There were no statistically significant differences in mortality rate with regard to sex, length of history and leukocyte count. Therefore, we emphasize the need to take into account these risk factors to better clarify appropriate therapy options.
Assuntos
Obstrução Intestinal/mortalidade , Obstrução Intestinal/cirurgia , Complicações Pós-Operatórias/mortalidade , Doenças do Colo Sigmoide/mortalidade , Doenças do Colo Sigmoide/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos RetrospectivosRESUMO
Se realizó una evaluación retrospectiva de 57 pacientes operados por vúlvulo de sigmoides en el HNCH. Edad promedio de 51 años. Predominó el sexo masculino. La gestación se presentó en 4 casos. Tiempo de enfermedad promedio 3.9 dias. Las manifestaciones clínicas más frecuentes fueron: dolor y distensión abdominal (100 por ciento), no eliminación de heces y flatos (94.7 por ciento), ruidos hidroaéreos disminuidos o ausentes (78.9 por ciento), vómitos (56.1 por ciento). El estudio radiológico fue característico de esta patología. Los principales hallazgos operatorios fueron: sigmoides isquémicos y peritonitis. Las técnicas quirúrgicas realizadas: desvolvulación (36.8 por ciento) y resección primaria con anastomosis termino-terminal (28.1 por ciento) o con colostomía a lo Hartmann (28.1 por ciento). Las complicaciones post-operatorias más frecuentes: compromiso respiratorio (33.3 por ciento) e infección de herida operatoria (25 por ciento) La causa más frecuentes de reintervención quirúrgica fue evisceración. Permanencia hospitalaria promedio de 17.5 dias. La recurrencia y mortalidad fue de 7 por ciento respectivamente