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1.
Asian J Endosc Surg ; 17(3): e13320, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38720454

RESUMO

BACKGROUND: Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair has become increasingly favored over open Lichtenstein tension-free mesh repair owing to its associated benefits, including reduced postoperative pain, early return to normal activities, and a comparable recurrence rate. In recent years, emphasis has been placed on patient-reported outcomes, particularly health-related quality of life (QOL), as a critical metric for evaluating surgical success. This study aimed to evaluate the overall QOL following laparoscopic TEP repair of unilateral inguinal hernia. METHODS: This prospective study enrolled patients aged 18 years or older who underwent elective laparoscopic TEP hernia repair for unilateral inguinal hernia from April 2020 to March 2022. Data collected include demographic details, hernia characteristics, postoperative complications, and postoperative QOL assessment. The Short Form 36 Health Survey Version 2 (SF-36v2), a validated general QoL questionnaire, was administered preoperatively and at 1 month, 6 months, and 1 year postoperatively. Statistical analysis utilized paired t-tests for comparisons, with significance set at a p-value <.05. RESULTS: A cohort of 49 patients, with a mean (standard deviation) age of 56.7 (14.0) years, predominantly comprising 47 men, was available for evaluation. Complications were observed in three (6.1%) of cases, with seroma/hematoma occurring in two patients and a wound infection necessitating antibiotic treatment in one patient. Notably, there were no instances of recurrence during the study period. Postoperative assessments revealed significant improvements in both physical and mental health at 1 month, with continued improvement noted up to 12 months. CONCLUSION: Laparoscopic TEP inguinal hernia repair has been shown to improve both physical and mental health in patients with unilateral reducible inguinal hernia, with the majority of the improvement typically occurring within the initial month following surgery. It is crucial to communicate these improvement trends to patients undergoing hernia repair to help manage their expectations effectively.


Assuntos
Hérnia Inguinal , Herniorrafia , Laparoscopia , Qualidade de Vida , Humanos , Hérnia Inguinal/cirurgia , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Feminino , Herniorrafia/métodos , Estudos Prospectivos , Idoso , Adulto , Resultado do Tratamento , Telas Cirúrgicas , Complicações Pós-Operatórias/etiologia
2.
Surg Endosc ; 38(6): 3279-3287, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38658388

RESUMO

BACKGROUND: Oesophagogastroduodenoscopy (OGDS) is the most common diagnostic procedure for upper gastrointestinal diseases. It often causes discomfort and anxiety, which are only mitigated by systemic sedation. However, sedation poses additional risks of adverse cardiopulmonary events, increased medical costs, and prolonged recovery. Transcutaneous electrical nerve stimulation of acupuncture points (Acu-TENS) is a non-invasive and innovative approach that induces analgesic effect during endoscopy. This trial is the first to be reported in English that explores the potential of Acu-TENS to increase patient tolerance during non-sedated elective diagnostic OGDS. METHODS: A double-blinded randomized controlled trial involving 348 subjects was conducted at a tertiary hospital to evaluate the success rate of OGDS with Acu-TENS. Subjects aged 18-75 years scheduled for their first elective diagnostic OGDS were randomized into the intervention (Acu-TENS) and placebo arms. OGDS success was assessed based on subjects' satisfaction ratings on a Likert scale and procedure's technical adequacy. Secondary measures included subjects' willingness to undergo future OGDS under similar conditions, procedure duration, and the endoscopist's perceived ease of the procedure. RESULTS: OGDS success rates were significantly higher with Acu-TENS (77.8%) than with the placebo (68.0%; odds ratio [OR] 1.64, 95% confidence interval [CI] 1.01-2.66, p = 0.043). Subjects who received Acu-TENS expressed higher willingness for future OGDS (78.9%) than those who received the placebo (68.6%; OR 1.71, 95% CI 1.04-2.79, p = 0.031). Procedure duration were significantly shorter in the intervention arm (6.0 min) than in the placebo arm (10.0 min; p = 0.002). No adverse effects were reported, and endoscopists perceived similar procedure ease in both arms. CONCLUSIONS: Acu-TENS improved OGDS success and enhanced patients' experiences during non-sedated OGDS. It demonstrated safety with no side effects and reduced the procedure completion time. It could be used as an adjunct in non-sedated diagnostic OGDS.


Assuntos
Pontos de Acupuntura , Estimulação Elétrica Nervosa Transcutânea , Humanos , Método Duplo-Cego , Masculino , Pessoa de Meia-Idade , Feminino , Adulto , Estimulação Elétrica Nervosa Transcutânea/métodos , Idoso , Adulto Jovem , Adolescente , Satisfação do Paciente , Endoscopia do Sistema Digestório/métodos , Endoscopia do Sistema Digestório/efeitos adversos
3.
World J Surg ; 48(6): 1373-1384, 2024 06.
Artigo em Inglês | MEDLINE | ID: mdl-38563570

RESUMO

BACKGROUND: Limited data exists on Charlson's weighted index of comorbidity (WIC) predictability for postoperative outcomes following perforated peptic ulcer (PPU) surgery. This study assesses the utility of WIC and other predictive scores in forecasting both postoperative mortality and morbidity in PPU. MATERIALS & METHODS: Patients with PPUs operated between 2018 and 2021 in a Malaysian tertiary referral center were included. Clinical data were retrospectively analyzed for association with mortality and morbidity measured with the Comprehensive Complication Index (CCI). Predictability of WIC and other predictors were examined using area under receiver-operator characteristic (ROC) curve (AUC). RESULTS: Among 110 patients included, 18 died (16.4%) and 36 (32.7%) had significant morbidity postoperatively (High CCI, ≥26.2). Both mortality and high CCI were associated with age >65 years, female sex, comorbidities (diabetes mellitus, hypertension, and renal disease), and American Society of Anesthesiologist score >2. Most patients who died had renal dysfunction, metabolic acidosis, lactate >2 mmol/L upon presentation preoperatively. While surgery >24 h after presentation correlated with mortality and high CCI, the benefit of earlier surgery <6 h or <12 h was not demonstrated. WIC (AUC, 0.89; 95% CI, 0.81-0.99) showed similar predictability to Peptic Ulcer Perforation (PULP) (AUC, 0.97; 95% CI, 0.93-1.00) for mortality. PULP effectively predicted high CCI (AUC, 0.83; 95% CI, 0.73-0.93; p < 0.001). CONCLUSION: WIC is valuable in predicting mortality, highlighting the importance of comorbidity in risk assessment. PULP score was effective in predicting both mortality and high CCI. Early identification of patients with high perioperative risk will facilitate patients' triage for escalated care, leading to a better outcome.


Assuntos
Úlcera Péptica Perfurada , Complicações Pós-Operatórias , Humanos , Feminino , Masculino , Úlcera Péptica Perfurada/cirurgia , Úlcera Péptica Perfurada/mortalidade , Pessoa de Meia-Idade , Idoso , Estudos Retrospectivos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Comorbidade , Malásia/epidemiologia , Adulto , Medição de Risco/métodos
4.
ANZ J Surg ; 92(7-8): 1692-1699, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35429223

RESUMO

BACKGROUND: Since access to essential surgical care (ESC) in rural Sarawak, Malaysia, remains subpar, this study aimed to identify pitfalls in its ESC delivery and possible solutions to improve it. METHODS: This cross-sectional study was undertaken in the Sarawak General Hospital between January 2019 and December 2019. It assessed the caseload of five essential surgical procedures referred from nearby district hospitals. It analysed the number of patients stranded in the accident and emergency department, their waiting time for ward transfer and the duration between admission day and timing of surgery for patients with appendicitis. RESULTS: There were 259 referrals for one of the five essential surgical procedures. The baseline characteristics between the referred and the local cohorts of patients for the designated procedures were comparable in terms of gender (P = 0.486), body mass index (P = 0.598) and ASA score (P = 0.284), with the exceptions being that the referred cohorts were older (43.2 vs. 39.7, P = 0.008) and with different racial composition (p < 0.001). The mean number of patients stranded in emergency department was 34.2 ± 4.9 per day and the mean bed waiting time was 21.4 ± 6.3 h. For patients who required appendicectomy, 70.8% of patients had surgery performed within 24 h of admission. CONCLUSION: The delivery of ESC in Sarawak's district hospitals demands urgent attention for improvement. The action framework proposed outlined six priorities: infrastructure development, service delivery, surgical training, finance, information management and governance.


Assuntos
Hospitais de Distrito , Encaminhamento e Consulta , Estudos Transversais , Atenção à Saúde , Humanos , Malásia
5.
Ann Hepatobiliary Pancreat Surg ; 26(2): 199-203, 2022 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-35272270

RESUMO

Gallstone ileus is an uncommon cause of intestinal obstruction. It may present with typical symptoms of intestinal obstruction with or without biliary sepsis. Its management strategies vary depending on the patient and operative factors. Enterotomy and stone removal alone versus synchronous cholecystectomy and fistula disconnection at the same stage, often pose a debate among surgeons. The decision for operative strategies largely depends on the surgeon's experience, patient's physiology, and operative difficulties. As literature on gall stone ileus remains insufficient at a regional level, we report four cases of gallstone ileus managed with different approaches. Three patients were managed in a staged-manner, whereas one patient received a definitive procedure performed at index surgery. Clinical challenges and associated operative strategies are discussed. Findings of the current study were compared to those of the literature. The need for a definitive fistula disconnection and repair or cholecystectomy following stone removal in these patients was subsequently discussed.

6.
Chin J Traumatol ; 25(6): 392-394, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35031204

RESUMO

Blunt traumatic tracheobronchial injury is rare, but can be potentially life-threatening. It accounts for only 0.5%-2% of all trauma cases. Patients may present with non-specific signs and symptoms, requiring a high index of suspicion with accurate diagnosis and prompt treatment. A 26-year-old female was brought into the emergency department after sustained a blunt trauma to the chest from a high impact motor vehicle accident. She presented with signs of respiratory distress and extensive subcutaneous emphysema from the chest up to the neck. Her airway was secured and chest drain was inserted for right sided pneumothorax. CT of the neck and thorax revealed a collapsed right middle lung lobe with a massive pneumothorax, raising the suspicion of a right middle lobe bronchus injury. Diagnosis was confirmed by bronchoscopy. In view of the difficulty in maintaining her ventilation and persistent pneumothorax with a massive air leak, immediate right thoracotomy via posterolateral approach was performed. The right middle lobar bronchus tear was repaired. There were no intra- or post-operative complications. She made an uneventful recovery. She was asymptomatic at her first month follow-up. A repeated chest X-ray showed expanded lungs. Details of the case including clinical presentation, imaging and management were discussed with an emphasis on the early uses of bronchoscopy in case of suspected blunt traumatic tracheobronchial injury. A review of the current literature of tracheobronchial injury management was presented.


Assuntos
Pneumotórax , Ferimentos não Penetrantes , Humanos , Feminino , Adulto , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Pneumotórax/cirurgia , Brônquios/diagnóstico por imagem , Brônquios/cirurgia , Brônquios/lesões , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/cirurgia , Ferimentos não Penetrantes/diagnóstico , Broncoscopia , Traqueia/lesões
9.
Ann Med Surg (Lond) ; 65: 102294, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33948169

RESUMO

INTRODUCTION AND IMPORTANCE: A totally implantable venous access device (TIVAD), also referred to as 'chemoport', is frequently used for oncology patients. Chemoport insertion via the subclavian vein access may compress the catheter between the first rib and the clavicle, resulting in pinch-off syndrome (POS). The sequela includes catheter transection and subsequent embolization. It is a rare complication with incidence reported to be 1.1-5.0% and can lead to a devastating outcomes. CASE PRESENTATION: 50-year-old male had his chemoport inserted for adjuvant chemotherapy 3 years ago. During the removal, remaining half of the distal catheter was not found. There was no difficulties during the removal. Chest xray revealed that the fractured catheter had embolized to the right ventricle. Further history taking, he did experienced occasional palpitation and chest discomfort for the past six months. Electrocardiogram and cardiac enzymes were normal. Urgent removal of the fractured catheter via the percutaneous endovascular approach, under fluoroscopic guidance by an experience interventional radiologist was done. The procedure was successful without any complication. Patient made an uneventful recovery. He was discharged the following day, and was well during his 3rd month follow up. CONCLUSION: Early detection and preventive measures can be done to prevent pinch-off syndrome. Unrecognized POS can result in fatal complications such as cardiac arrhythmia and septic embolization. Retrieval via the percutaneous endovascular approach provide excellent outcome in the case of embolized fractured catheter.

10.
Asian J Surg ; 44(1): 158-163, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32423838

RESUMO

BACKGROUND: To evaluate the clinical outcomes and satisfaction of patients following laparoscopic Heller myotomy for achalasia cardia in four tertiary centers. METHODS: Fifty-five patients with achalasia cardia who underwent laparoscopic Heller myotomy between 2010 and 2019 were enrolled. The adverse events and clinical outcomes were analyzed. Overall patient satisfaction was also reviewed. RESULTS: The mean operative time was 144.1 ± 38.33 min with no conversions to open surgery in this series. Intraoperative adverse events occurred in 7 (12.7%) patients including oesophageal mucosal perforation (n = 4), superficial liver injury (n = 1), minor bleeding from gastro-oesophageal fat pad (n = 1) & aspiration during induction requiring bronchoscopy (n = 1). Mean time to normal diet intake was 3.2 ± 2.20 days. Mean postoperative stay was 4.9 ± 4.30 days and majority of patients (n = 46; 83.6%) returned to normal daily activities within 2 weeks after surgery. The mean follow-up duration was 18.8 ± 13.56 months. Overall, clinical success (Eckardt ≤ 3) was achieved in all 55 (100%) patients, with significant improvements observed in all elements of the Eckardt score. Thirty-seven (67.3%) patients had complete resolution of dysphagia while the remaining 18 (32.7%) patients had some occasional dysphagia that was tolerable and did not require re-intervention. Nevertheless, all patients reported either very satisfied or satisfied and would recommend the procedure to another person. CONCLUSIONS: Laparoscopic Heller myotomy and anterior Dor is both safe and effective as a definitive treatment for treating achalasia cardia. It does have a low rate of oesophageal perforation but overall has a high degree of patient satisfaction with minimal complications.


Assuntos
Acalasia Esofágica/cirurgia , Miotomia de Heller/métodos , Laparoscopia/métodos , Satisfação do Paciente/estatística & dados numéricos , Adulto , Idoso , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/psicologia , Transtornos de Deglutição/cirurgia , Acalasia Esofágica/complicações , Acalasia Esofágica/psicologia , Perfuração Esofágica/epidemiologia , Perfuração Esofágica/etiologia , Feminino , Seguimentos , Miotomia de Heller/efeitos adversos , Miotomia de Heller/psicologia , Humanos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Laparoscopia/efeitos adversos , Laparoscopia/psicologia , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Segurança , Centros de Atenção Terciária/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento
11.
Asian J Endosc Surg ; 13(3): 437-440, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31338969

RESUMO

Intrathoracic organo-axial gastric volvulus is a rare clinical entity associated with paraesophageal hernia. It is characterized by migration of the stomach into the thoracic cavity through an enlarged hiatal defect and rotation around its long axis connecting the cardia and the pylorus. A 72-year-old woman presented with epigastric pain that radiated to the left scapula for 1 week prior to presentation. Computed tomography scan of her thorax and abdomen demonstrated paraoesophageal hernia with organo-axial intrathoracic gastric volvulus. Laparoscopically, the stomach was returned to its abdominal position, the mediastinal sac was excised and after adequate intra-abdominal length of the esophagus was attained, the hiatal defect was closed primarily and reinforced with a composite mesh. An anterior 180° partial fundoplication was performed as both an anti-reflux procedure and also as a form of gastropexy. She had an uneventful recovery and remains well after 2 years.


Assuntos
Hérnia Hiatal , Laparoscopia , Volvo Gástrico , Idoso , Feminino , Fundoplicatura , Hérnia Hiatal/diagnóstico por imagem , Hérnia Hiatal/cirurgia , Humanos , Volvo Gástrico/diagnóstico por imagem , Volvo Gástrico/etiologia , Volvo Gástrico/cirurgia
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