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BACKGROUND: The COVID-19 pandemic has resulted in great incertitude and overwhelming changes in healthcare that have had a direct impact on antibiotic prescription. However, the influence of this pandemic on antibiotic consumption in patients undergoing surgery has not yet been analysed. The goal of this study was to analyse antimicrobial consumption and prescription in the same period of 2019 (pre-COVID-19), 2020 (beginning of the COVID-19 pandemic) and 2021 (established COVID-19) according to the DDD system in surgical patients at a tertiary-level hospital. METHODS: A prospectively maintained database was analysed. All patients who underwent elective or emergency gastrointestinal surgery during the same period (2019, 2020 and 2021) were included. Those who received at least 1 of the 10 most frequently prescribed antimicrobials during those periods were analysed. RESULTS: A total of 2975 patients were included in this study. In 2020, the number of procedures performed decreased significantly (653 versus 1154 and 1168 in 2020 versus 2019 and 2021, respectively; Pâ=â0.005). Of all patients who underwent surgery during these periods, 45.08% received at least one of the antimicrobials studied (45.8% in 2020 versus 22.9% and 22.97% in 2019 and 2021, respectively; Pâ=â0.005). Of these, 22.97% of the patients received a combination of these antimicrobials, with ceftriaxone/metronidazole being the most frequent. Hepato-Pancreato-Biliary and Liver Transplant, Emergency Surgery and Colorectal Surgery units had higher antibiotic consumption. CONCLUSIONS: The COVID-19 pandemic has resulted in a significant decrease in surgical activity and higher post-operative antimicrobial prescription compared with previous and subsequent years.
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COVID-19 , Procedimentos Cirúrgicos Eletivos , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , SARS-CoV-2 , Estudos Prospectivos , Uso de Medicamentos/estatística & dados numéricos , Anti-Infecciosos/uso terapêutico , Anti-Infecciosos/administração & dosagem , Adulto , Pandemias , Idoso de 80 Anos ou maisRESUMO
PURPOSE: This aim of this study was to compare the impact on hospital stay and short-term overall complications prior to and following the introduction of an outpatient preoperative ostomy education program to an existing inpatient ostomy education program. DESIGN: A comparison cohort study. SUBJECTS AND SETTING: One hundred thirty-eight consecutive patients undergoing ostomy surgery were included. One group (n = 65, 47%) was given an experimental preoperative ostomy education intervention, along with standard care including a postoperative educational intervention during the initial hospital course. A second group (n = 73, 53%) received the same standardized education in the postoperative period. Data were collected from a single tertiary center located in Seville, Spain, during a 12-month period between July 2014 and June 2015. METHODS: Data were collected in 2 phases. Data from participants undergoing postoperative (standard) education were collected retrospectively. Data for the group receiving preoperative education were collective prospectively. Outcome variables were postoperative length of stay, surgical complications (severity was assessed by the Clavien-Dindo grading system), subsequent interventions, and readmission rates. RESULTS: Analysis indicated no differences between the average length of postoperative hospital stay (12.32 days in the preoperative education group vs 12.76 days in the postoperative education group, P = .401). In contrast, overall complications, mortality, and readmission rates were significantly higher in the preoperative education program group (P = .027, P = .047, and P = .046, respectively). CONCLUSIONS: Delivering a standardized educational intervention during the preoperative period versus postoperative education delivery during the ostomy surgery hospital course did not reduce length of stay. Analysis indicated that overall complications, mortality, and readmission rates were significantly higher in the preoperative education program group but we hypothesize that intervening factors may have influenced these outcomes.
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Estomia , Complicações Pós-Operatórias , Humanos , Estudos de Coortes , Estudos Retrospectivos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios , Tempo de InternaçãoRESUMO
BACKGROUND: Parathyroid gland mediastinal ectopia is an unusual but challenging condition in surgical management of hyperparathyroidism. Posterior mediastinum parathyroid ectopia is rare, and glands need to be removed either with a broad open cervical or thoracic approach. In recent years, several minimally invasive approaches to mediastinal parathyroid glands have been described, but for posterior mediastinum adenomas, proposed techniques are transthoracic. METHODS: The aim of this paper is to describe, to our best knowledge for the first time, a standardized pure endoscopic cervical technique to approach posterior mediastinal parathyroid adenomas which we have used in three patients. RESULTS: The technique was applied in three patients which excellent surgical, postoperative, and cosmetic results. CONCLUSIONS: Endoscopic prevertebral approach is a feasible, sure and inexpensive standardized pure endoscopic cervical approach to posterior mediastinal parathyroid adenomas, which may result in a less aggressive surgical option when compared with thoracic approaches.
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Adenoma/cirurgia , Coristoma/cirurgia , Endoscopia/métodos , Hiperparatireoidismo/cirurgia , Doenças do Mediastino/cirurgia , Glândulas Paratireoides , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia/métodos , Adenoma/complicações , Adenoma/diagnóstico por imagem , Idoso , Coristoma/diagnóstico por imagem , Feminino , Humanos , Hiperparatireoidismo/diagnóstico por imagem , Hiperparatireoidismo/etiologia , Doenças do Mediastino/diagnóstico por imagem , Pessoa de Meia-Idade , Pescoço , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Tecnécio Tc 99m Sestamibi , Cirurgia Torácica VídeoassistidaAssuntos
COVID-19 , Serviço Hospitalar de Emergência/tendências , Utilização de Instalações e Serviços/tendências , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Patologia Cirúrgica/tendências , Aceitação pelo Paciente de Cuidados de Saúde , Procedimentos Cirúrgicos Operatórios/tendências , COVID-19/epidemiologia , COVID-19/prevenção & controle , Bases de Dados Factuais , Emergências , Humanos , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Espanha/epidemiologiaAssuntos
Neoplasias do Colo/complicações , Obstrução Intestinal/etiologia , Intussuscepção/etiologia , Lipoma/complicações , Dor Abdominal/etiologia , Neoplasias do Colo/diagnóstico por imagem , Constipação Intestinal/etiologia , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Intussuscepção/diagnóstico por imagem , Intussuscepção/cirurgia , Laparoscopia , Lipoma/diagnóstico por imagem , Masculino , Pessoa de Meia-IdadeRESUMO
The sinusoidal obstructive syndrome is a complication typically associated with hematopoietic stem cell transplantation. This syndrome, more commonly known as veno-occlusive disease, has also been described after liver transplantation. It can have a life-threatening course. Herein, we describe the hepatic graft loss secondary to the development of a sinusoidal obstructive syndrome after a severe acute cellular rejection and toxic levels of once daily modified released tacrolimus (TAC). We discuss the role of the endotheliitis of acute rejection and toxic metabolites of some immunosuppressants such as azathioprine and TAC. Based on the current scientific evidence, we contemplate the possibility that the etiology of sinusoidal obstruction syndrome post-liver transplantation is multifactorial.
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Hepatopatia Veno-Oclusiva/etiologia , Transplante de Fígado , Complicações Pós-Operatórias/etiologia , Adulto , Quimioterapia Combinada , Feminino , Rejeição de Enxerto/prevenção & controle , Hepatopatia Veno-Oclusiva/patologia , Humanos , Imunossupressores/uso terapêutico , Complicações Pós-Operatórias/patologiaRESUMO
INTRODUCTION: The anatomical variants of the hepatic artery may have important implications for pancreatic cancer surgery. The aim of our study is to compare the outcome following a pancreatoduodenectomy (PD) in patients with or without a variant hepatic artery arising from superior mesenteric artery. MATERIAL AND METHODS: We reviewed 151 patients with periampullary tumoral pathology. All patients underwent oncological PD between January 2005 and February 2012. Our series was divided into two groups: Group A: Patients with a hepatic artery arising from superior mesenteric artery; and Group B: Patients without a hepatic artery arising from superior mesenteric artery. We expressed the results as mean +/- standard deviation for continuous variables and percentages for qualitative variables. Statistical tests were considered significant if p < 0.05. RESULTS: We identified 11 patients with a hepatic artery arising from superior mesenteric artery (7.3%). The most frequent variant was an aberrant right hepatic artery (n = 7), following by the accessory right hepatic artery (n = 2) and the common hepatic artery trunk arising from the superior mesenteric artery (n = 2). In 73% of cases the diagnosis of the variant was intraoperative. R0 resection was performed in all patients with a hepatic artery arising from superior mesenteric artery. There were no significant differences in the tumor resection margins and the incidence of postoperative complications. CONCLUSION: Oncological PD is feasible by the presence of a hepatic artery arising from superior mesenteric artery. The complexity of having it does not seem to influence in tumor resection margins, complications and survival.
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Artéria Hepática/anormalidades , Artéria Mesentérica Superior/anormalidades , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Malformações Vasculares/complicações , Adenocarcinoma/complicações , Adenocarcinoma/cirurgia , Adulto , Idoso , Neoplasias dos Ductos Biliares/complicações , Neoplasias dos Ductos Biliares/cirurgia , Colangiocarcinoma/complicações , Colangiocarcinoma/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/cirurgia , Pancreatectomia , Neoplasias Pancreáticas/complicações , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Purpose: To describe and compare a peritoneal closure technique using cyanoacrylate glue (Glubran 2®, GEM, Cardiolink SL) with a microdroplet device (Glutack®, GEM, Cardiolink SL) in laparoscopic transabdominal preperitoneal repair (TAPP) of inguinal hernia with the routinely used barbed suture peritoneal closure (V-Lock 3.0, Covidien France). Materials and methods: From January to August 2022, 60 patients undergoing TAPP repair for uni- or bilateral inguinal hernia were randomized into one of two groups. One using as mesh fixation and peritoneal closure the Glutack® device with Glubran 2® cyanoacrylate glue (Glu-close group) and the other using mesh fixation with cyanoacrylate and peritoneal closure with V-lock 3.0 (Sut-close group), with a follow-up of 12 months. Demographic variables, operative time, peritoneal closure time, main surgical findings and main intra- and postoperative complications were analyzed prospectively. Results: 63 patients were included with no losses to follow-up. The mean operative time was 34 min (range 58.25) for the glu-close group and 40 (range 64.25) for the sut-close group, with no conversion (0%) for either group. The mean flap closure time was 1.18 min (SD 24 0.19) for the glu-close group and 3.24 min (SD 0.78) for the sut-close group, with statistically significant differences (p < 0.001). The intraoperative complication rate was 0 for the glu-close group and 0 for the sut-close group, with no significant difference. The median hospital stay was 0.8 days (range, 0-1) for both groups. The median duration of follow-up was 12 months and none had hernia recurrence. The postoperative VAS score at the first and second check-up at 1 month and 3 months was 2.83 (SD 1.341) and 0.60 (SD 0.621) in the sut-close group and 1.03 (0.984) and 0.24 (SD 0.435) in the glue-close group, with significant differences (p < 0.001 and p < 0.012). Conclusion: The data demonstrated by the study are that the glue can be used safely to close the peritoneum and that the method provides a small, statistically significant but not clinically relevant reduction in the time to close the peritoneal flap, as well as in postoperative pain after surgery in short and medium term.
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INTRODUCTION: Peritoneal sarcomatosis is a rare disease, with multiple histological origins and poor overall prognosis. The option of radical cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is controversial. The results of a surgical team experienced in these procedures are analyzed and discussed based on the available evidence. METHODS: Study on a prospective database of patients with peritoneal sarcomatosis who underwent CRS and HIPEC, from 2016 to 2022, in a national reference center for sarcomas and peritoneal oncological surgery, who met the established inclusion/exclusion criteria. RESULTS: 23 patients were included in the study, with a median age of 53 years (6-68). Recurrent/persistent clinical presentation predominated (78.3%). Visceral origin (including GIST and non-GIST peritoneal) accounted for 47.8% of patients, compared to 43.5% uterine and 8.7% retroperitoneal. The median PCI was 17 (3-36), with CC0 cytoreduction of 87%. Postoperative morbidity (Dindo Clavien III-IV) of 13%, with no postoperative mortality in the series. Overall survival and disease-free survival at 5 years were 64% and 34%, respectively. Histological grade was the most influential prognostic factor for survival. CONCLUSIONS: The results of the series, with low morbidity, support the benefit of radical peritoneal oncological surgery in patients with peritoneal sarcomatosis after adequate selection, as long as it is performed in high-volume centers, experienced surgeons and expert multidisciplinary teams. However, the role of HIPEC remains to be demonstrated and pending future studies.
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Procedimentos Cirúrgicos de Citorredução , Quimioterapia Intraperitoneal Hipertérmica , Neoplasias Peritoneais , Sarcoma , Humanos , Procedimentos Cirúrgicos de Citorredução/métodos , Neoplasias Peritoneais/terapia , Neoplasias Peritoneais/patologia , Neoplasias Peritoneais/tratamento farmacológico , Pessoa de Meia-Idade , Quimioterapia Intraperitoneal Hipertérmica/métodos , Sarcoma/terapia , Sarcoma/cirurgia , Sarcoma/patologia , Sarcoma/tratamento farmacológico , Feminino , Masculino , Adulto , Idoso , Adulto Jovem , Adolescente , Terapia Combinada/métodos , Estudos Prospectivos , CriançaRESUMO
BACKGROUND AND AIMS: Irritable bowel syndrome (IBS) is a prevalent disorder with a complex and heterogeneous physiopathology, including a dysregulation of gut-brain axis. Treatment for IBS is targeted to the predominant symptom and requires a multidisciplinary approach. This review aims to evaluate the efficacy and safety of sacral nerve stimulation in non-constipated IBS patients Methods: A literature search was carried out on MEDLINE, The Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science databases for all relevant articles. Quality of included papers was assessed using standardized guidelines Results: Of 129 initial citations, 7 articles met our predefined inclusion criteria, including five randomized trials, a pilot study and a descriptive follow-up study. Five of 7 studies reported a positive effect of sacral nerve stimulation on symptoms and quality of life improvement in non-constipated IBS patients. No study reported serious adverse events. CONCLUSIONS: Despite initial promising results of sacral nerve stimulation in non-constipated IBS patients, studies with larger sample sizes and longer follow-up are required.
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Síndrome do Intestino Irritável , Humanos , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/terapia , Seguimentos , Qualidade de Vida , Projetos Piloto , Resultado do TratamentoAssuntos
Síndrome de Budd-Chiari/prevenção & controle , Transplante de Fígado/métodos , Fígado/irrigação sanguínea , Coleta de Tecidos e Órgãos/métodos , Enxerto Vascular/métodos , Síndrome de Budd-Chiari/etiologia , Veias Hepáticas/transplante , Humanos , Veia Ilíaca/transplante , Fígado/cirurgia , Transplante de Fígado/efeitos adversos , Doadores VivosRESUMO
Mesenchymal neoplasms of the gallbladder are rare and in particular leiomyomas of the gallbladder have been rarely reported, all of them in patients with immune system disorders.This is the first report in Spanish of a 23-year-old female patient with a gallbladder leiomyoma without associated immunodeficiency. The patient lacks a previous history of uterine leiomyoma or any other form of neoplasm. She refers several episodes of epygastralgia. A hydatic cyst led to an initial diagnosis and the gallbladder was removed by means of simple cholecystectomy. The abnormal macroscopic aspect of the sample prompted intraoperative biopsy which revealed a benign gallbladder angiomyoma. Subsequent immunohistochemical analysis of the resected sample yielded the diagnosis of intramural endocavitary leiomyoma negative for EBV and C-kit / CD-117. The patient has good general condition and remains asymptomatic 15 months after surgery.
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Neoplasias da Vesícula Biliar/diagnóstico , Leiomioma/diagnóstico , Feminino , Neoplasias da Vesícula Biliar/imunologia , Humanos , Leiomioma/imunologia , Adulto JovemRESUMO
BACKGROUND: An organ shortage is the reason why it is necessary to expand the pool of donors, which can be achieved by using elderly donors. The main goal of this study is to analyze the outcomes of liver transplant (LT) when it is performed with donors older than 75 years. METHODS: We carried out a retrospective case-control study (N = 212) that included LTs with donors older than 75 years (group A, n = 106 cases) that were performed in our center between the years 2010 and 2020. This cohort has been paired off with a similar control group (group B, n = 106) whose donors were significantly younger. A survival analysis using the Kaplan-Meier model was performed. RESULTS: Average (SD) age of donors in group A was statistically greater than group B (A, 79.1 [3.0] years vs B, 54.4 [15.3], P < .001). There were no differences either in the average age of the recipients or in the Model for End-Stage Liver Disease score of both groups. Indications for LT were distributed equally in both groups: the most common was cellular hepatocarcinoma followed by alcohol-related cirrhosis. Survival rates for group A were 81%, 78%, and 67%, in 1, 3, and 5 years, respectively, while in group B they were 85%, 76%, and 71%, respectively, without differences found between the groups (P = .57). CONCLUSIONS: Using elderly liver donors is safe, achieving good outcomes in terms of short- and midterm rates of survival.
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Doença Hepática Terminal , Neoplasias Hepáticas , Transplante de Fígado , Humanos , Idoso , Pré-Escolar , Transplante de Fígado/efeitos adversos , Estudos Retrospectivos , Estudos de Casos e Controles , Sobrevivência de Enxerto , Índice de Gravidade de Doença , Doadores de Tecidos , Cirrose Hepática Alcoólica , Fatores Etários , Transplantados , Resultado do TratamentoRESUMO
BACKGROUND AND AIM: Ascaris lumbricoides infection in Spain is anecdotal and is usually associated with travel to areas with high endemicity such as India and South America. Biliopancreatic disease caused by this parasite is both rare and one of the most feared complications. There are few publications in the literature about pancreatic involvement in ascariasis. We describe a case of pancreatic ascariasis diagnosed after a pancreaticoduodenectomy was performed for a suspected pancreatic adenocarcinoma. PATIENT: A 58-year-old man consulted for longstanding abdominal pain and diarrhea. Computed tomography and magnetic resonance scans, endoscopy, and endoscopic ultrasound-guided fine-needle cytology were performed. The pathological diagnosis was moderately differentiated adenocarcinoma of the pancreatic head. RESULTS: Cephalic pancreaticoduodenectomy was performed. The postoperative course was favorable. A pancreatic fistula type B (ISGPF classification) developed and was resolved with conservative treatment. Analysis of the surgical specimen revealed the presence of a pancreatic pseudotumor due to Ascaris lumbricoides. After these findings, treatment was completed with oral albendazole. CONCLUSIONS: Pancreatic ascariasis in our environment is unusual, but should be included in the differential diagnosis of tumors and inflammatory processes of the pancreas.
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Adenocarcinoma/diagnóstico , Ascaríase/diagnóstico , Ascaris lumbricoides/isolamento & purificação , Erros de Diagnóstico , Granuloma de Células Plasmáticas/diagnóstico , Pancreatopatias/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Dor Abdominal/etiologia , Albendazol/uso terapêutico , Animais , Anti-Helmínticos/uso terapêutico , Ascaríase/complicações , Ascaríase/tratamento farmacológico , Ascaríase/cirurgia , Diagnóstico Diferencial , Diagnóstico por Imagem , Diarreia/etiologia , Granuloma de Células Plasmáticas/complicações , Granuloma de Células Plasmáticas/tratamento farmacológico , Granuloma de Células Plasmáticas/parasitologia , Granuloma de Células Plasmáticas/cirurgia , Humanos , Linfoma não Hodgkin/complicações , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/radioterapia , Linfoma não Hodgkin/cirurgia , Masculino , Pessoa de Meia-Idade , Pancreatopatias/complicações , Pancreatopatias/tratamento farmacológico , Pancreatopatias/parasitologia , Pancreatopatias/cirurgia , Fístula Pancreática/etiologia , Pancreaticoduodenectomia , Complicações Pós-Operatórias/etiologia , Indução de Remissão , Procedimentos DesnecessáriosRESUMO
INTRODUCTION: Soft tissue infections (STIs), which include infections of the skin, subcutaneous tissue, fascia, and muscle, encompass a wide variety of heterogeneous pathologies. Treatment of STIs is based on surgical debridement of the affected area. One such treatment, negative pressure wound therapy (NPWT), has improved the management of STIs. OBJECTIVE: The purpose of this study is to assess the safety and utility of NPWT in conjunction with dermatotraction in the early stage management of necrotizing STIs. MATERIALS AND METHODS: The authors report a retrospective series of 3 cases in which NPWT and dermatotraction (NPWT-D) were used in an attempt to manage necrotizing STI. The NPWT-D device combination was employed to approximate the edges of the wounds. The NPWT device was changed every 2 or 3 days, and dermatotraction tension was adjusted concurrently. RESULTS: The NPWT-D device changes ranged from 3 to 4 times for 2 of the 3 patients, as 1 patient passed away secondary to STIs and therefore did not receive complete treatment. The total treatment ranged from 8 to 10 days in the remaining 2 patients. In both cases, complete wound closure was achieved while avoiding skin grafts. After 5 days of therapy in the incomplete treatment case, the wound area was reduced by about half. CONCLUSIONS: Based on the experiences herein, NPWT-D may be a safe and useful alternative surgical treatment for the management of necrotizing STIs. In the present cases, NPWT-D improved and shortened the wound healing process, and it achieved a tertiary wound closure, thereby avoiding the need for skin grafts.
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Tratamento de Ferimentos com Pressão Negativa/métodos , Infecções dos Tecidos Moles/terapia , Técnicas de Fechamento de Ferimentos , Terapia Combinada , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Tratamento de Ferimentos com Pressão Negativa/efeitos adversos , Estudos Retrospectivos , Infecções dos Tecidos Moles/patologia , Infecções dos Tecidos Moles/cirurgia , Técnicas de Fechamento de Ferimentos/efeitos adversosRESUMO
BACKGROUND: The presence of collateral circulation in liver cirrhosis patients with portal hypertension is quite frequent due to re-permeabilization of closed embryonic channels. In some cases, these shunts could measure over 1 cm wide, therefore, containing a significative blood flow. Its management during liver transplantation could be challenging due to possible complications resulting from either ligation of the shunts or from ignoring them. We present the case of a patient with recurrent hepatic encephalopathy (HE) and a large spontaneous portosystemic shunt (SPSS) who submitted to liver transplant and review the literature identifying options, complications, and outcomes with the aim of facilitating decision making. MATERIAL AND METHODS: A 68-year-old, Spanish man diagnosed with liver cirrhosis with portal hypertension and recurrent episodes of HE is proposed for LT. The patient's Child-Pugh score was A6-B7, and the Model for End-stage Liver Disease score was 12. Preoperatively, a computed tomography scan showed a large SPSS running to the inferior cava vein. During the surgery, a small-sized portal vein and a large shunt measuring almost 3 cm wide were identified. After reperfusion, portal vein flow was 1000 to 1100 mL/min. Owing to the previous HE and the risk of low portal flow, the shunt was closed increasing the portal flow to 1800 mL/min. The patient was discharged without any complications. CONCLUSIONS: The presence of large SPSSs are frequent during LT. Decision making intraoperatively can be challenging due to possible complications derived from ligation of the SPSS or from ignoring it. Either preoperative assessment of a further HE risk or portal vein flow measurement after reperfusion are essential to achieve a correct resolution.
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Encefalopatia Hepática/cirurgia , Complicações Intraoperatórias/cirurgia , Transplante de Fígado/métodos , Veia Porta/anormalidades , Malformações Vasculares/cirurgia , Idoso , Circulação Colateral , Encefalopatia Hepática/complicações , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/cirurgia , Complicações Intraoperatórias/etiologia , Ligadura/efeitos adversos , Ligadura/métodos , Cirrose Hepática/complicações , Cirrose Hepática/cirurgia , Transplante de Fígado/efeitos adversos , Masculino , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Recidiva , Tomografia Computadorizada por Raios X , Malformações Vasculares/complicações , Veia Cava Inferior/diagnóstico por imagemRESUMO
OBJECTIVE: Obesity is one of the main growing epidemics of the last century and is responsible for many deaths worldwide. The aim of this study is to analyze the impact of the body mass index (BMI) of the recipient on survival and morbidity after liver transplantation (LT). MATERIAL AND METHODS: We conducted a retrospective cohort study of all transplanted recipients in a third-level hospital between 2006 and 2018. The following donor variables were analyzed: age, sex, weight, BMI, cause of death. Additionally, the following recipient variables were analyzed: age, sex, weight, height, BMI, procedure indication. Finally, outcome variables were analyzed: postoperative complications, early mortality, graft loss, and overall survival. This study strictly complies with the Helsinki Congress and the Istanbul Declaration regarding donor source. RESULTS: We analyzed 825 of 837 LTs from January 2006 to December 2018. These were grouped by BMI categories: 271 (29%) normal, 322 (34.3%) overweight, and 228 (24.3%) obesity. The overall survival at 5 years was 83% in the normal group, 76% in the overweight group, and 71% in the obesity group. These differences were statistically significant (P = .027). The early mortality rate was 4.42% in the normal weight group, 6.5% in the overweight group, and 5.26% in the obesity group. No differences were found between groups in terms of postoperative complications: hemorrhagic, vascular, biliary, respiratory, hemodynamic, digestive, renal, neurologic, rebel ascites, and infections. No differences were found regarding the need for re-operation. CONCLUSIONS: In this study, overall survival in LT decreases as the BMI of recipient increases; but overweight and obesity do not constitute a risk factor for early morbidity and mortality in LT.