Cardiorespiratory evaluation in pre and post operative moments of laparoscopic cholecystectomy

To analyze the changes in both respiratory function and cardiopulmonary exercise tests results in patients subjected to laparoscopic cholecystectomy. METHODS: Fifty patients were evaluated (76% women) and the average age was 47.8±14.2 years. All individuals underwent the measurement of spirometry, manovacuometry, 6-minute walk test (6MWT) and stair-climbing test (SCT). All tests were performed at the first (PO1), fifth (PO5) and thirtieth (PO30) postoperative days. BMI average was 28.8±4.8 kg/m2. Sample comprised 68% non-smokers, 20% current smokers, and 12% former smokers. There was no incidence of postoperative complication whatsoever. There was a significant decrease in spirometric values at PO1, but values were similar to the ones of PRE at PO30. Manovacuometry showed alterations at PO1 displaying values that were similar to the ones of PRE at PO30. 6MWT was significantly shorter at until PO5, but at PO30 values were similar to ones of PRE. As for SCT, values were significantly compromised at PO5 and PO30 since they were similar to the ones of PRE. Patients submitted to laparoscopic cholecystectomy present a decrease in cardiorespiratory function on the first postoperative moments but there is a rapid return to preoperative conditions.(AU)

Efficacy of surgical versus conservative treatment in esophageal perforation: a systematic review of case series studies

PURPOSE: To evaluate the efficacy of surgical treatment for esophageal perforation. METHODS: A systematic review of the literature was performed. We conducted a search strategy in the main electronic databases such as PubMed, Embase and Lilacs to identify all case series. RESULTS: Thirty three case series met the inclusion criteria with a total of 1417 participants. The predominant etiology was iatrogenic (54.2%) followed by spontaneous cause (20.4%) and in 66.1% the localization was thoracic. In 65.4% and 33.4% surgical and conservative therapy, respectively, was considered the first choice. There was a statistically significance different with regards mortality rate favoring the surgical group (16.3%) versus conservative treatment (21.2%) (p<0.05). CONCLUSION: Surgical treatment was more effective and safe than conservative treatment concerning mortality rates, although the possibility of bias due to clinical and methodological heterogeneity among the included studies and the level of evidence that cannot be ruled out.(AU)

Study on functional cardiorespiratory changes after laparoscopic Nissen fundoplication / Estudo das alterações funcionais cardiorrespiratórias após a fundoplicatura laparoscópica à Nissen

PURPOSE: To analyze the behavior of cardiopulmonary function in postoperative of laparoscopic Nissen fundoplication. METHODS: Thirty-two patients, 13 males (41%) and 19 females (59%), were evaluated. Their age ranged from 25 to 67 years, with a mean of 44.4 ± 10.9. Pulmonary volumes, respiratory pressures and exercise tests were performed in the preoperative period (PRE) and in the first (PO1), second (PO2), fifth (PO5) and thirtieth (PO30) postoperative periods. RESULTS: Thirty-two patients were evaluated, of whom 59% were females. Mean age was 44.4 ± 10.9 years. Lung volumes had significant decrease at PO1 and PO2 and were similar to PRE values at PO5. Respiratory pressures were altered only at PO1. The distance covered in the 6-minute walk test had significant reduction until PO2, and climbing time in the stair-climbing test significantly increased at PO2. CONCLUSION: Patients submitted to LNF surgery have decreased cardiorespiratory function in the early postoperative period; however, they soon return to preoperative conditions.(AU)

OBJETIVO: Analisar o comportamento da função cardiopulmonar no pós-operatório de fundoplicatura Nissen laparoscópica. MÉTODOS: Trinta e dois pacientes, 13 homens (41%) e 19 mulheres (59%) foram avaliados. A idade variou de 25 to 67 anos, com media de 44.4 ± 10.9. Os volumes pulmonares, as pressões respiratórias e testes de exercício foram realizados no período pré-operatório (PRE) e no primeiro (PO1), segundo (PO2), quinto (PO5) e trigésimo (PO30) períodos pós-operatórios. RESULTADOS: Trinta e dois pacientes foram avaliados, dos quais 59% eram do sexo feminino. A média de idade foi de 44,4 ± 10,9 anos. Os volumes pulmonares apresentaram diminuição significativa no PO1 e PO2 e foram semelhantes aos valores PRE no PO5. As pressões respiratórias estiveram alteradas apenas no PO1. A distância percorrida no teste da caminhada de 6 minutos apresentou redução significativa até o PO2, e o tempo de subida no teste de escada aumentou significativamente no PO2. CONCLUSÃO: Pacientes submetidos à FLN apresentaram diminuição da função cardiorrespiratória no início do período pós-operatório, no entanto, elas rapidamente regressaram às condições pré-operatórias.(AU)

Intestinal healing in rats submitted to ethanol ingestion / Cicatrização intestinal em ratos submetidos à ingestão de etanol

PURPOSE: To study the effect of alcoholism on intestinal healing and postoperative complications in rats METHODS: One hundred and sixty rats were divided into two groups: control and treated. The control group received water and the treated group 30 percent ethanol. After 180 days, colotomy with anastomosis were performed. After, the groups were divided into four subgroups: 20 rats for study at the following moments: 4th, 7th, 14th and 21st postoperative. The analyzed parameters were: weight gain, breaking strength, tissue hydroxyproline, postoperative complications and histopathological study RESULTS: Weight gain was greater in the control group (p<0.05). When all the subgroups were clustered, breaking strength was significantly greater in the control (p<0.05). Histopathology and hydroxyproline dosage did not show differences. There were five surgical site infections in the treated group while the control group showed two (p>0.05). Nine fistulas occurred in the treated group whereas the control group two (p<0.05). There were three deaths in the control group and seven in the treated group (p>0.05). CONCLUSIONS: Treated group undergo a malnutrition process that is revealed by lower weight gain. Impaired intestinal healing as indicated by smaller breaking strength. There were a larger number of postoperative complications in the treated animals.(AU)

OBJETIVO: Estudar o efeito do alcoolismo no processo de cicatrização intestinal e suas complicações pós-operatórias em ratos. MÉTODOS: Cento e sessenta ratos foram divididos em dois grupos: tratado e controle. O controle recebeu água, enquanto o tratado etanol a 30 por cento. Após 180 dias foram realizadas colotomia, seguida de anastomose. Após os animais foram divididos em quatro subgrupos de 20 ratos para estudo nos seguintes momentos: 4º, 7º, 14º e 21º pós-operatório. Os parâmetros analisados foram: ganho de peso, força de ruptura, hidroxiprolina tecidual, complicações pós-operatórias e estudo histopatológico. RESULTADOS: O ganho de peso foi superior no grupo controle (p<0,05). Após agrupamento dos momentos a força de ruptura foi superior no controle (p<0,05). Não houve diferença quanto à histopatologia e hidroxiprolina. Houve cinco infecções de incisão no grupo tratado, enquanto no controle ocorreram duas (p>0,05). Houve nove fístulas no grupo tratado, enquanto no controle duas (p<0,05). Ocorreram sete mortes no grupo tratado e apenas três no controle (p>0,05). CONCLUSÕES: No grupo tratado ocorreu um processo de subnutrição evidenciado pelo menor ganho de peso. Piora na cicatrização intestinal, indicada pela menor força de ruptura. Ocorreu um maior número de complicações pós-operatórias no grupo tratado.(AU)