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1.
Eur J Vasc Endovasc Surg ; 68(2): 238-244, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38677468

RESUMO

OBJECTIVE: This study assessed the potential benefits of using incisional negative pressure wound therapy (iNPWT) for patients undergoing revascularisation due to peripheral arterial disease. METHODS: A prospective randomised controlled trial was conducted to compare the inguinal application of iNPWT vs. standard surgical dressings. Patients were enrolled from February 2021 to November 2022. A total of 133 groin incisions were randomised (66 intervention group, 67 control group). The randomisation sequence was carried out by permuted blocks and allocation assigned by opening opaque envelopes once the revascularisation procedure had finished. Wound healing and complication rates were assessed at post-operative days 5, 14, and 30. Primary and secondary endpoints were: 30 day post-operative surgical site infection (SSI) and surgical site occurrence (SSO) rates, defined as a surgical wound complication other than a SSI. Post-operative SSI was defined according to the US Centers for Disease Control and Prevention criteria. SSO included: wound dehiscence, seroma or lymphocele, haematoma, and lymphorrhagia. The study was registered at ClinicalTrials.gov database (NCT04840576) and reported according to the CONSORT guidelines. RESULTS: iNPWT did not modify the 30 day inguinal SSI and SSO rates (16.7% vs. 20.9% and 37.9% vs. 44.8%; p = .53, relative risk [RR] 0.999, 95% confidence interval [CI] 0.52 - 1.88 and p = .42, RR 1.29, 95% CI 0.89 - 1.86, respectively). It reduced the early SSO rate (19.7% vs. 35.8%; p = .044, RR 1.45, 95% CI 1.047 - 2.013) and post-operative seroma rate (4.6% vs. 19.4%; p = .014, RR 1.73, 95% CI 1.296 - 2.397). CONCLUSION: There were no differences in SSI and SSO rates, although statistically significant reductions in early SSO rates and seroma were found in the intervention group.


Assuntos
Tratamento de Ferimentos com Pressão Negativa , Doença Arterial Periférica , Infecção da Ferida Cirúrgica , Cicatrização , Humanos , Tratamento de Ferimentos com Pressão Negativa/efeitos adversos , Doença Arterial Periférica/cirurgia , Masculino , Feminino , Idoso , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Estudos Prospectivos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/métodos , Resultado do Tratamento , Idoso de 80 Anos ou mais , Virilha , Fatores de Tempo
2.
Rev Esp Enferm Dig ; 107(1): 23-8, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25603328

RESUMO

OBJECTIVE: To describe the profile of the bariatric surgery patients that were admitted to the Emergency Department (ED). METHOD: A retrospective review of the reasons why bariatric surgery patients go to our ED. We analyzed the first 30 days after the surgery. We evaluated the number and indications of admissions, the examinations ordered, and final diagnosis and destination of the patients. RESULTS: From January 2010 to July 2012, 320 patients underwent bariatric surgery at our Institution. Fifty three patients (16.6%) were admitted to the ED at least once. We found 58 admissions (1.1 admissions by patient). Patients who had duodenal switch and Roux-en-Y gastric bypass were the most representative (74%). The main indications for admission were abdominal pain (50%), and problems related to the surgical wounds (22.4%). Blood test was the most performed examination (75.9%). The most frequent final diagnosis was unspecific abdominal pain in 27 cases (46.6%), and complications of the surgical wound in 10 patients (17.2%). Nineteen patients (35.84%) were admitted to the surgical ward from the ED, and 5 of them required surgical revision (9.4%). Multivariate analyses showed that the type of surgery was the only predictor variable for the ED admission. CONCLUSIONS: Attending ED after bariatric surgery is not common, and less than a third of the patients required hospital admission. Just a small percentage of the examinations showed any pathological value. Readmission rate is very low. Surgical procedure is the only predictor for ED admission.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Serviços Médicos de Emergência/estatística & dados numéricos , Complicações Pós-Operatórias/terapia , Dor Abdominal/etiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Reoperação , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto Jovem
3.
J Gastrointest Surg ; 27(3): 631-632, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36443553
8.
Cir Esp ; 86(4): 196-203, 2009 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-19640513

RESUMO

Parenteral iron is a useful and safe therapeutic measure to treat anaemia, and is a proven clinical alternative to blood transfusion. This review article summarises the main characteristics of the different formulations of parenteral iron, their advantages, indications, dosages and adverse effects. Moreover, we analyse some of the most important published articles on parenteral iron therapy in General Surgery and other surgical specialties, as well as providing information about new formulations that will soon be available.


Assuntos
Anemia/tratamento farmacológico , Ferro/administração & dosagem , Humanos , Infusões Intravenosas , Injeções Intravenosas , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios
9.
Cir Esp ; 83(5): 227-34, 2008 May.
Artigo em Espanhol | MEDLINE | ID: mdl-18448024

RESUMO

The therapeutic and diagnostic approach of liver trauma injuries (by extension, of abdominal trauma) has evolved remarkably in the last decades. The current non-surgical treatment in the vast majority of liver injuries is supported by the accumulated experience and optimal results in the current series. It is considered that the non-surgical treatment of liver injuries has a current rate of success of 83-100%, with an associated morbidity of 5-42%. The haemodynamic stability of the patient will determine the applicability of the non-surgical treatment. Arteriography with angioembolisation constitutes a key technical tool in the context of liver trauma. Patients with haemodynamic instability will need an urgent operation and can benefit from abdominal packing techniques, damage control and post-operative arteriography. The present review attempts to contribute to the current, global and practical management in the care of liver trauma.


Assuntos
Fígado/lesões , Fígado/cirurgia , Ferimentos e Lesões/terapia , Angiografia , Humanos , Ferimentos e Lesões/cirurgia
10.
Cir Esp ; 81(4): 197-201, 2007 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-17403355

RESUMO

INTRODUCTION: Isolated adrenal metastasis is uncommon. Both resection and the laparoscopic approach in this entity are controversial. The aim of this study was to evaluate the indications, diagnosis and utility of laparoscopic adrenalectomy (LA) in patients with isolated adrenal metastasis. PATIENTS AND METHOD: A prospective study was conducted in patients with current or previous tumoral disease and with isolated adrenal metastasis. RESULTS: Sixteen patients, with a mean age of 58 years, were selected. Fifteen LA were performed (one patient was found to have an inoperable tumor at surgery). Histopathological analysis revealed non-tumoral disease in two patients. The most common metastatic disease was non-small cell lung carcinoma (NSCLC) (10 patients), followed by colorectal cancer metastasis (two patients). The mean tumor size was 4.7 cm and was 3.8 cm on computed tomography (p = 0.09). The disease-free interval (DFI) in the NSCLC group was shorter than that in the remaining tumors (p = 0.17). The mean length of follow-up was 39 months, with a mean survival of 39.7 months. The mean actuarial survival at 2 and 5 years was 61% and 17%. At the end of the study, five patients were alive: two were disease free, one had recurrent disease, one had margin involvement and one was awaiting resection of the primary tumor. Eight patients died. One patient survived 9 years after surgery. CONCLUSIONS: LA for metastasis can be performed without oncological disadvantage and should be offered to patients with resectable disease, a DFI > 6 months, and a tumoral size that allows laparoscopic resection.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Laparoscopia/métodos , Neoplasias das Glândulas Suprarrenais/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida
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