Indications and outcomes of liver retransplantation in three medical centers.

INTRODUCTION: retransplantation is the only viable treatment for patients with irreversible graft loss. The objective of this study was to analyze the indications and outcomes of liver retransplantation in three medical centers. METHODS: a total of 66 patients who underwent liver retransplantation from September 1991 to December 2021 were included in the study. A retrospective analysis was performed evaluating patients demographic, clinical, primary diagnosis, indications for and time interval to retransplantation, complications and patient survival. RESULTS: from a total of 1293 primary liver transplants performed, 70 required one or more liver retransplant. The main indication for primary transplant was hepatitis C cirrhosis (21,2%). Hepatic artery thrombosis was the main cause of retransplantation (60,6%), with almost half (46,9%) of retransplants having occurred within 30 days from initial procedure. The average survival time after a repeat liver transplant, was 89,1 months, with confidence interval from 54 to 124,2. The 1-,5- and 10- year survival rate following liver retransplant were 48,4%, 38% and 30,1%, respectively. Male gender, primary non function as the cause for retransplant, prolonged operative time and higher MELD were associated with higher mortality. CONCLUSIONS: operative mortality and morbidity rates of liver retransplantation are higher than those of the first transplantation. Male gender, primary non function, prolonged operative time and higher MELD were associated with less favorable outcomes.

LAPAROSCOPIC AND LAPAROTOMY BARIATRIC SURGERY IN A PUBLIC HOSPITAL IN BRAZIL: ARE THERE DIFFERENCES IN COSTS AND COMPLICATIONS?

BACKGROUND: Despite its increasing popularity, laparoscopy is not the option for bariatric surgeries performed in the Brazilian public health system. AIMS: To compare laparotomy and laparoscopic access in bariatric surgery, considering aspects such as morbidity, mortality, costs, and length of stay. METHODS: The study included 80 patients who were randomly assigned to perform a Roux-en-Y gastric bypass. They were equally divided in two groups, laparoscopic and laparotomy. The results obtained in the postoperative period were evaluated and compared according to the Ministry of Health protocol, and later, in their outpatient returns. RESULTS: The surgical time was similar in both groups (p=0.240). The costs of laparoscopic surgery proved to be higher, mainly due to staplers and staples. The patients included in the laparotomy group presented higher rates of severe complications, such as incisional hernia (p<0.001). Costs related to social security and management of postoperative complications were higher in the open surgery group (R$ 1,876.00 vs R$ 34,268.91). CONCLUSIONS: The costs related to social security and treatment of complications were substantially lower in laparoscopic access when compared to laparotomy. However, considering the operative procedure itself, the laparotomy remained cheaper. Finally, the length of stay, the rate of complications, and return to labor had more favorable results in the laparoscopic route.

Indications and outcomes of liver retransplantation in three medical centers / Indicações e resultados do retransplante hepático em três centros médicos

ABSTRACT Introduction: retransplantation is the only viable treatment for patients with irreversible graft loss. The objective of this study was to analyze the indications and outcomes of liver retransplantation in three medical centers. Methods: a total of 66 patients who underwent liver retransplantation from September 1991 to December 2021 were included in the study. A retrospective analysis was performed evaluating patients demographic, clinical, primary diagnosis, indications for and time interval to retransplantation, complications and patient survival. Results: from a total of 1293 primary liver transplants performed, 70 required one or more liver retransplant. The main indication for primary transplant was hepatitis C cirrhosis (21,2%). Hepatic artery thrombosis was the main cause of retransplantation (60,6%), with almost half (46,9%) of retransplants having occurred within 30 days from initial procedure. The average survival time after a repeat liver transplant, was 89,1 months, with confidence interval from 54 to 124,2. The 1-,5- and 10- year survival rate following liver retransplant were 48,4%, 38% and 30,1%, respectively. Male gender, primary non function as the cause for retransplant, prolonged operative time and higher MELD were associated with higher mortality. Conclusions: operative mortality and morbidity rates of liver retransplantation are higher than those of the first transplantation. Male gender, primary non function, prolonged operative time and higher MELD were associated with less favorable outcomes.

RESUMO Introdução: retransplante é o único tratamento viável para pacientes com perda irreversível do enxerto. O objetivo deste estudo foi analisar as indicações e resultados do retransplante hepático em três centros médicos. Métodos: foram incluídos no estudo 66 pacientes submetidos a retransplante hepático no período de setembro de 1991 a dezembro de 2021. Foi realizada uma análise retrospectiva avaliando dados demográficos, clínicos, diagnóstico primário dos pacientes, indicações e intervalo de tempo para retransplante, complicações e sobrevida do paciente. Resultados: de um total de 1.293 transplantes primários de fígado realizados, 70 necessitaram de um ou mais retransplantes de fígado. A principal indicação de transplante primário foi cirrose por hepatite C (21,2%). A trombose da artéria hepática foi a principal causa de retransplante (60,6%), sendo que quase metade (46,9%) dos retransplantes ocorreu dentro de 30 dias do procedimento inicial. O tempo médio de sobrevivência após retransplante de fígado foi de 89,1 meses, com intervalo de confiança de 54 a 124,2. A taxa de sobrevivência de 1,5 e 10 anos após o retransplante de fígado foi de 48,4%, 38% e 30,1%, respectivamente. Gênero masculino, disfunção primária do enxerto como causa de retransplante, tempo operatório prolongado e maior MELD foram associados a maior mortalidade. Conclusão: as taxas de mortalidade e morbidade operatórias do retransplante hepático são superiores às do primeiro transplante. Sexo masculino, disfunção primária do enxerto, tempo operatório prolongado e maior MELD foram associados a desfechos menos favoráveis.

Laparoscopic and laparotomy bariatric surgery in a public hospital in brazil: are there differences in costs and complications? / Cirurgia bariátrica laparoscópica e convencional em hospital público no brasil: há diferenças nos custos e complicações?

ABSTRACT BACKGROUND: Despite its increasing popularity, laparoscopy is not the option for bariatric surgeries performed in the Brazilian public health system. AIMS: To compare laparotomy and laparoscopic access in bariatric surgery, considering aspects such as morbidity, mortality, costs, and length of stay. METHODS: The study included 80 patients who were randomly assigned to perform a Roux-en-Y gastric bypass. They were equally divided in two groups, laparoscopic and laparotomy. The results obtained in the postoperative period were evaluated and compared according to the Ministry of Health protocol, and later, in their outpatient returns. RESULTS: The surgical time was similar in both groups (p=0.240). The costs of laparoscopic surgery proved to be higher, mainly due to staplers and staples. The patients included in the laparotomy group presented higher rates of severe complications, such as incisional hernia (p<0.001). Costs related to social security and management of postoperative complications were higher in the open surgery group (R$ 1,876.00 vs R$ 34,268.91). CONCLUSIONS: The costs related to social security and treatment of complications were substantially lower in laparoscopic access when compared to laparotomy. However, considering the operative procedure itself, the laparotomy remained cheaper. Finally, the length of stay, the rate of complications, and return to labor had more favorable results in the laparoscopic route.

RESUMO RACIONAL: Apesar de sua crescente popularidade, a laparoscopia não é a via de acesso em cirurgias bariátricas realizadas no sistema público de saúde brasileiro. OBJETIVOS: Comparar os acessos laparoscópico e laparotômico em cirurgia bariátrica, considerando aspectos como morbidade, mortalidade, custos e tempo de hospitalização. MÉTODOS: Foram incluídos 80 pacientes candidatos a by-pass gástrico em Y-de-Roux, aleatoriamente divididos em dois grupos, de acordo com a via de acesso. Os resultados obtidos no período pós-operatório foram avaliados e comparados de acordo com o protocolo do Ministério da Saúde, e posteriormente, em seus retornos ambulatoriais. RESULTADOS: O tempo cirúrgico foi semelhante em ambos os grupos (p=0.240). Os custos da cirurgia laparoscópica foram maiores, principalmente devido aos grampeadores e cargas. Contudo, os pacientes designados à via aberta apresentaram maior índice de complicações graves, como hérnia incisional (p<0.001). Desta forma, os custos com o tratamento das complicações e com o seguro social foram maiores neste grupo (R$ 1,876.00 vs R$ 34,268.91). CONCLUSÃO: Os gastos relacionados ao seguro social e ao tratamento de complicações foram substancialmente menores na cirurgia laparoscópica quando comparada à cirurgia aberta. Entretanto, considerando o procedimento operatório em si, a via aberta foi a mais acessível financeiramente. Por fim, o tempo de hospitalização, a taxa de complicações e o tempo de retorno ao trabalho tiveram resultados mais favoráveis na via laparoscópica.

Comparative study of Polypropylene versus Parietex composite®, Vicryl® and Ultrapro® meshes, regarding the formation of intraperitoneal adhesions.

PURPOSE: To compare the polypropylene mesh (Marlex®) to Vicryl®, Parietex composite® and Ultrapro® meshes to assess the occurrence of adhesions in the intraperitoneal implantation. METHODS: Sixty Wistar rats were allocated into three groups: PP+V, in which all the animals received a polypropylene and a Vicryl® mesh; PP+PC, with the implantation of polypropylene and Parietex composite® meshes and PP+UP, in which there was implantation of polypropylene and Ultrapro®. Macroscopic analysis was performed 28 days later to assess the percentage of mesh area affected by adhesion. RESULTS: in the PP+ V group, the Vicryl® mesh showed lower adhesion formation (p=0.013). In the PP+PC, there were no differences between polypropylene and Parietex composite® (p=0.765). In the PP+UP group, Ultrapro® and polypropylene meshes were equivalent (p=0.198) . CONCLUSION: All the four meshes led to adhesions, with the Vicryl® mesh showing the least potential for its formation.

Comparison between polypropylene and polypropylene with poliglecaprone meshes on intraperitoneal adhesion formation.

OBJECTIVE: to compare intraperitoneal adhesion formation in rats when using polypropylene and polypropylene with poliglecaprone meshes. METHODS: we used twenty male, Wistar rats, divided in two groups. In group 1, the rats received the polypropylene mesh on their right side and the polypropylene with poliglecaprone mesh on their left side. In group 2 the position of the meshes was inverted. After 30 days, we analyzed the presence or not of adhesion formation, including only those over the meshes. The findings undergone an analysis through the Mann-Whitney test, at a level of significance of p≤0.05. RESULTS: all meshes presented adhesions. We verified that, for the polypropylene meshes, the percentage of their surface covered by adhesions varied from 10.5 to 100%, with an average of 34.07±24.21%, while for the polypropylene with poliglecaprone mesh, the percentage covered by adhesions varied between 8.5% and 100%, with an average of 44.7±32.85% (p=0.12). CONCLUSION: both meshes lead to adhesion formation, none being superior to the other.

Comparative study of Polypropylene versus Parietex composite®, Vicryl® and Ultrapro® meshes, regarding the formation of intraperitoneal adhesions

Abstract Purpose: To compare the polypropylene mesh (Marlex®) to Vicryl®, Parietex composite® and Ultrapro® meshes to assess the occurrence of adhesions in the intraperitoneal implantation. Methods: Sixty Wistar rats were allocated into three groups: PP+V, in which all the animals received a polypropylene and a Vicryl® mesh; PP+PC, with the implantation of polypropylene and Parietex composite® meshes and PP+UP, in which there was implantation of polypropylene and Ultrapro®. Macroscopic analysis was performed 28 days later to assess the percentage of mesh area affected by adhesion. Results: in the PP+ V group, the Vicryl® mesh showed lower adhesion formation (p=0.013). In the PP+PC, there were no differences between polypropylene and Parietex composite® (p=0.765). In the PP+UP group, Ultrapro® and polypropylene meshes were equivalent (p=0.198) . Conclusion: All the four meshes led to adhesions, with the Vicryl® mesh showing the least potential for its formation.

Comparison between polypropylene and polypropylene with poliglecaprone meshes on intraperitoneal adhesion formation / Estudo comparativo entre tela de polipropileno e poliglecaprone com tela de polipropileno na formação de aderências intraperitoneais

ABSTRACT Objective: to compare intraperitoneal adhesion formation in rats when using polypropylene and polypropylene with poliglecaprone meshes. Methods: we used twenty male, Wistar rats, divided in two groups. In group 1, the rats received the polypropylene mesh on their right side and the polypropylene with poliglecaprone mesh on their left side. In group 2 the position of the meshes was inverted. After 30 days, we analyzed the presence or not of adhesion formation, including only those over the meshes. The findings undergone an analysis through the Mann-Whitney test, at a level of significance of p≤0.05. Results: all meshes presented adhesions. We verified that, for the polypropylene meshes, the percentage of their surface covered by adhesions varied from 10.5 to 100%, with an average of 34.07±24.21%, while for the polypropylene with poliglecaprone mesh, the percentage covered by adhesions varied between 8.5% and 100%, with an average of 44.7±32.85% (p=0.12). Conclusion: both meshes lead to adhesion formation, none being superior to the other.

RESUMO Objetivo: comparar a formação de aderências intraperitoneais em ratos, com o uso de tela de polipropileno e tela composta de polipropileno e poliglecaprone. Métodos: vinte ratos Wistar machos, foram alocados em dois grupos. No grupo 1 os ratos receberam tela de polipropileno no lado direito e tela de polipropileno e poliglecaprone no lado esquerdo. No grupo 2 inverteu-se a posição das telas. Analisou-se a presença ou não de aderências após 30 dias, sendo incluídas apenas aderências sobre as telas. Os resultados foram submetidos à análise estatística, adotando-se como nível de significância p≤0,05. Resultados: todas as telas se apresentaram com aderências. Verificou-se que, na tela de polipropileno, a porcentagem de superfície coberta por aderências variou entre 10,5 a 100%, com média 34,07±24,21% enquanto que na tela de polipropileno e poliglecaprone a porcentagem de tela coberta por aderências variou entre 8,5 a 100%, com média 44,7±32,85% (p=0,12) . Conclusão: ambas as telas dão origem às aderências, não havendo vantagem de aplicação no reparo intraperitoneal de uma em relação à outra.