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1.
BMC Surg ; 24(1): 130, 2024 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-38698365

RESUMO

BACKGROUND: Anastomosis configuration is an essential step in treatment to restore continuity of the gastrointestinal tract following bowel resection in patients with Crohn's disease (CD). However, the association between anastomotic type and surgical outcome remains controversial. This retrospective study aimed to compare early postoperative complications and surgical outcome between stapler and handsewn anastomosis after bowel resection in Crohn's disease. METHODS: Between 2001 and 2018, a total of 339 CD patients underwent bowel resection with anastomosis. Patient characteristics, intraoperative data, early postoperative complications, and outcomes were analyzed and compared between two groups of patients. Group 1 consisted of patients with stapler anastomosis and group 2 with handsewn anastomosis. RESULTS: No significant difference was found in the incidence of postoperative surgical complications between the stapler and handsewn anastomosis groups (25% versus 24.4%, p = 1.000). Reoperation for complications and postoperative hospital stay were similar between the two groups. CONCLUSION: Our analysis showed that there were no differences in anastomotic leak, nor postoperative complications, mortality, reoperation for operative complications, or postoperative hospital stay between the stapler anastomosis and handsewn anastomosis groups.


Assuntos
Anastomose Cirúrgica , Doença de Crohn , Complicações Pós-Operatórias , Grampeamento Cirúrgico , Humanos , Doença de Crohn/cirurgia , Feminino , Masculino , Anastomose Cirúrgica/métodos , Estudos Retrospectivos , Adulto , Grampeamento Cirúrgico/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Pessoa de Meia-Idade , Técnicas de Sutura , Reoperação/estatística & dados numéricos , Resultado do Tratamento , Tempo de Internação/estatística & dados numéricos , Fístula Anastomótica/epidemiologia , Fístula Anastomótica/etiologia , Adulto Jovem
2.
Int J Colorectal Dis ; 37(12): 2535-2542, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36441196

RESUMO

BACKGROUND: Immunosuppressants represent an effective pharmacological treatment for the remission and management of Crohn's disease (CD); however, it has not been well-defined if these medications are associated with an increased incidence of postoperative complications after intestinal surgery. This retrospective study evaluated the association between immunosuppressive treatment and complications following bowel resection in patients with CD. METHODS: A total of 426 patients with CD who underwent abdominal surgery between 2001 and 2018 were included in the study. The participants were divided into two groups. In the first group, patients were under immunosuppressive treatment at the time of surgical resection, while in the second group, patients had never received pharmacological therapy for CD before surgery. RESULTS: No statistically significant difference was found in the incidence of postoperative complications between the two groups. Double or triple immunosuppressive therapy was not associated with increased complications compared to monotherapy or no pharmacological treatment. Preoperative risk factors such as hypoalbuminemia, abscess, fistula, intestinal perforation, long duration of symptoms, and the intraoperative performance of more than one anastomosis were related to increased rates of postoperative complications. Factors affecting the occurrence of postoperative complications in the univariate analysis were included in the multivariate analysis using a stepwise logistic regression model, and these factors were also related to increased rates of postoperative surgical complications. CONCLUSION: Immunosuppressive therapy was not associated with increased rates of postoperative complications following bowel resection in patients with CD.


Assuntos
Doença de Crohn , Procedimentos Cirúrgicos do Sistema Digestório , Humanos , Doença de Crohn/tratamento farmacológico , Doença de Crohn/cirurgia , Doença de Crohn/complicações , Estudos Retrospectivos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Anastomose Cirúrgica/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Imunossupressores/efeitos adversos
3.
Minerva Surg ; 77(6): 550-557, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35230040

RESUMO

BACKGROUND: Utilization of preoperative biliary drainage prior to pancreatoduodenectomy for patients with pancreatic ductal adenocarcinoma and obstructive jaundice remains controversial. METHODS: All patients that underwent pancreatoduodenectomy for pancreatic ductal adenocarcinoma at the authors' institution were analyzed retrospectively to evaluate the effect of endoscopic biliary drainage on postoperative outcomes and long-term survival. Age, gender, ASA-Score, operative time, blood loss, intraoperative transfusion rate, and postoperative complications, including postoperative pancreatic fistula, delayed gastric emptying, bleeding, bile fistula, wound infections, sepsis, pulmonary and cardiac complications as well as the need for relaparotomy were analyzed. RESULTS: Two hundred eighty-five patients with similar baseline characteristics underwent pancreatoduodenectomy, 151 patients with biliary drainage (group 1) and 134 without drainage (group 2). More than 60% of patients had one or more postoperative complications, without significant difference between the two groups (P=0.140). The overall incidence of pancreatic fistula was 21.75% in both groups (group 1: 19.87% vs. group 2: 23.88%, P=0.659). Wound healing impairment was the only postoperative complication that differed significantly between the two groups (group 1: 24.50% vs. group 2: 8.96%, P<0.001). In multivariate risk analysis, biliary drainage was the only independent risk factor for wound healing impairment (OR 4.126; 95% CI: 1.295-13.143; P=0.017). The median overall survival was similar in both groups. CONCLUSIONS: Preoperative endoscopic biliary drainage is associated with an increased risk for wound healing impairment and wound infections. Therefore, biliary drainage should not be used routinely in patients with obstructive jaundice prior to pancreatoduodenectomy.


Assuntos
Adenocarcinoma , Carcinoma Ductal Pancreático , Icterícia Obstrutiva , Neoplasias Pancreáticas , Infecção dos Ferimentos , Humanos , Pancreaticoduodenectomia/efeitos adversos , Estudos Retrospectivos , Fístula Pancreática/epidemiologia , Neoplasias Pancreáticas/cirurgia , Icterícia Obstrutiva/etiologia , Adenocarcinoma/cirurgia , Cuidados Pré-Operatórios/efeitos adversos , Drenagem/efeitos adversos , Carcinoma Ductal Pancreático/cirurgia , Complicações Pós-Operatórias/epidemiologia , Infecção dos Ferimentos/complicações , Neoplasias Pancreáticas
4.
Surg Case Rep ; 6(1): 136, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32548741

RESUMO

BACKGROUND: Leiomyosarcoma (LMS) of the inferior vena cava (IVC) is a rare malignancy that originated from the smooth muscle tissue of the vascular wall. Diagnoses, as well as, treatment of the disease are still challenging and to date, a radical surgical resection of the tumor is the only curative approach. CASE REPORT: We report on the case of a 49-year old male patient who presented with suddenly experienced dyspnea. Besides bilateral pulmonary arterial embolism, a lesion close to the head of the pancreas was found using CT scan, infiltrating the infrahepatic IVC. Percutaneous ultrasound-guided biopsy revealed a low-grade LMS. Intraoperatively, a tumor of the IVC was observed without infiltration of surrounding organs or distant metastases. Consequently, the tumor was removed successfully, by en-bloc resection including prosthetic graft placement of the IVC. Histological workup revealed a completely resected (R0) moderately differentiated LMS of the IVC. CONCLUSION: LMS of the infrahepatic IVC is an uncommon tumor, which may present with dyspnea as its first clinical sign. Patients benefit from radical tumor resection. However, due to the poor prognosis of vascular LMS, a careful follow-up is mandatory.

6.
Hepatogastroenterology ; 55(85): 1394-9, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18795697

RESUMO

BACKGROUND/AIMS: Non-invasive measurement of indocyanine green plasma disappearance rate (PDR(ICG)) is supposed to be an accurate liver function parameter. However, its value compared to conventional markers like bilirubin and prothrombin time (PT) is unclear. The authors therefore prospectively determined PDR(ICG) and bilirubin and PT and recorded the clinical course after liver resection. METHODOLOGY: Ninety-six patients underwent liver resection. Three patients died due to liver failure. Twenty patients (21%) developed signs of liver dysfunction. Receiver operating curve (ROC) analysis was performed to assess the value of each parameter to detect postoperative liver failure and dysfunction. RESULTS: PDR(ICG) and PT but not bilirubin preoperatively differentiated between patients with and without cirrhosis. In cirrhosis, PDR(ICG) patients did not recover to preoperative baseline values. ROC analysis revealed that PDR(ICG) [area under the curve (AUC): 0.867] did significantly better indicate postoperative liver dysfunction than bilirubin (AUC: 0.633) and PT (AUC: 0.570). CONCLUSIONS: PDR(ICG) should be measured preoperatively and daily after liver resection in patients at risk (underlying liver disease, resections > 30% standard liver volume).


Assuntos
Corantes/farmacocinética , Hepatectomia/efeitos adversos , Insuficiência Hepática/diagnóstico , Verde de Indocianina/farmacocinética , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/cirurgia , Idoso , Estudos de Coortes , Feminino , Insuficiência Hepática/sangue , Insuficiência Hepática/etiologia , Humanos , Testes de Função Hepática , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Resultado do Tratamento
7.
Clin Transplant ; 21(6): 689-95, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17988260

RESUMO

Measurement of indocyanine green plasma disappearance rate (PDR(ICG)) has been suggested as a meaningful liver function parameter. However, there are only very limited data concerning its value in the monitoring of graft dysfunction (GDF) and primary non-function (PNF) especially during molecular absorbent recirculating system (MARS) therapy. This study was therefore performed to evaluate the diagnostic accuracy to detect and monitor GDF with the measurement of the PDR(ICG) in direct comparison with conventional markers like bilirubin and prothrombin time (PT). Of the 19 liver recipients, four patients with GDF and two patients with PNF were treated with 38 MARS cycles. Only PDR(ICG) did reliably indicate liver function between patients with GDF/PNF and patients with sufficient graft function who served as controls. Moreover, receiver operating characteristic analysis showed the highest areas under the curve (AUC) for PDR(ICG) (AUC(PDRICG max): 0.840, AUC(PDRICG max): 0.822), followed by bilirubin (AUC(bilirubin): 0.528) and PT (AUC(PT): 0.546). In contrast to the decrease of the serum bilirubin concentration due to MARS, a noticeable improvement of PDR(ICG) was evident only in patients with GDF. Patients with acute fulminant failure and PNF had significantly lower PDR(ICG) values, which did not improve even during continuous MARS treatments. Conclusively, monitoring of PDR(ICG) is superior to bilirubin and PT measurements to determine the graft function especially in patients with PNF and GDF undergoing MARS therapy.


Assuntos
Bilirrubina/sangue , Corantes/farmacocinética , Função Retardada do Enxerto/terapia , Verde de Indocianina/farmacocinética , Transplante de Fígado/fisiologia , Desintoxicação por Sorção/métodos , Adulto , Função Retardada do Enxerto/sangue , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante Homólogo , Resultado do Tratamento
8.
World J Surg Oncol ; 5: 55, 2007 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-17517122

RESUMO

BACKGROUND: The objective of this study was to examine the extent of surgical procedures, pathological findings, complications and outcome of patients treated in the last 12 years for gallbladder cancer. METHODS: The impact of a standardized more aggressive approach compared with historical controls of our center with an individual approach was examined. Of 53 patients, 21 underwent resection for cure and 32 for palliation. RESULTS: Overall hospital mortality was 9% and procedure related mortality was 4%. The standardized approach in UICC stage IIa, IIb and III led to a significantly improved outcome compared to patients with an individual approach (Median survival: 14 vs. 7 months, mean+/-SEM: 26+/-7 vs. 17+/-5 months, p = 0.014). The main differences between the standardized and the individual approach were anatomical vs. atypical liver resection, performance of systematic lymph dissection of the hepaticoduodenal ligament and the resection of the common bile duct. CONCLUSION: Anatomical liver resection, proof for bile duct infiltration and, in case of tumor invasion, radical resection and lymph dissection of the hepaticoduodenal ligament are essential to improve outcome of locally advanced gallbladder cancer.


Assuntos
Colecistectomia/métodos , Neoplasias da Vesícula Biliar/cirurgia , Hepatectomia/métodos , Linfonodos/patologia , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Estudos de Casos e Controles , Colecistectomia/normas , Feminino , Neoplasias da Vesícula Biliar/mortalidade , Neoplasias da Vesícula Biliar/patologia , Hepatectomia/normas , Humanos , Imuno-Histoquímica , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Complicações Pós-Operatórias/epidemiologia , Probabilidade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Análise de Sobrevida , Resultado do Tratamento
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