RESUMO
BACKGROUND: Obesity is a public health concern with an increasing occurrence worldwide. Literature regarding impact of obesity on results after management of peritoneal carcinomatosis is poor. Our aim was to compare postoperative and oncological outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for rare peritoneal malignancies according to the body mass index. METHODS: All the patients managed by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for rare peritoneal malignancies (including mainly pseudomyxoma peritonei and peritoneal mesothelioma), between 1995 and 2020, were retrospectively included from the French national registry of rare peritoneal tumors. RESULTS: 1450 patients were retrospectively included (63.5 % female, mean age 54 ± 13 years). Patients were divided into two groups according to their body mass index: non-obese (n = 1248, 86 %) and obese (n = 202, 14 %). Overall morbidity was significantly lower in non-obese patients in comparison with obese patients (n = 532/1248, 43 % vs n = 106/202, 53 %, p = 0.009). Medical and surgical morbidities were significantly lower in non-obese patients in comparison with obese patients (423/1258, 34 % vs n = 86/202, 43 %, p = 0.02 and n = 321/1248, 26 % vs n = 67/202, 33 %, p = 0.003, respectively). One-, 5- and 10-year overall survivals were similar between non-obese and obese patients (95 %, 82 % and 70 % vs 94 %, 76 % and 63 %; p = 0.1). One-, 5- and 10-year disease free survivals were similar between non-obese and obese patients (84 %, 67 % and 61 % vs 79 %, 62 % and 56 %, p = 0.1). CONCLUSION: Obese patients have to be carefully managed after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for rare peritoneal malignancies. Some perioperative prophylactic treatments could be specifically implemented to reduce thromboembolic events, metabolic and wound complications.
RESUMO
BACKGROUND: Acute diverticulitis with extraluminal air constitutes a heterogeneous condition whose management is controversial. The aims of this study are to report the failure rate of conservative treatment for diverticulitis with extraluminal air and to report risk factors of conservative treatment failure. METHODS: A retrospective study was performed from an institutional review board-approved database of patients admitted with acute diverticulitis with extraluminal air from 2015 to 2021 at a tertiary referral center. All patients managed for acute diverticulitis with covered perforation (without intraabdominal abscess) were included. The primary endpoint was failure of medical treatment, defined as a need for unplanned surgery or percutaneous drainage within 30 days after admission. RESULTS: Ninety-three patients (61% male, mean age 57 ± 17 years) were retrospectively included. Ten patients had failure of conservative treatment (11%). These patients were significantly older than 50 years (n = 9/10, 90% versus n = 47/83, 57%, p = 0.007), associated with cardiovascular disease (n = 6/10, 60% versus n = 10/83, 12%, p = 0.002), American Society of Anesthesiologists (ASA) score of 3-4 (n = 4/7, 57% versus 6/33, 18%, p = 0.05), under anticoagulant and antiplatelet (n = 6/10, 60% versus n = 11/83, 13%, p = 0.04) and steroid or immunosuppressive therapy (n = 3/10, 30% versus 5/83, 6%, p = 0.04), and with distant pneumoperitoneum location (n = 7/10, 70% versus n = 14/83, 17%, p = 0.001) compared with those with successful conservative treatment. On multivariate analysis, only distant pneumoperitoneum was an independent risk factor of failure (odds ratio (OR) 6.5, 95% confidence interval (CI) [2-21], p = 0.002). CONCLUSIONS: Conservative treatment with antibiotics for acute diverticulitis with extraluminal air is safe with a success rate of 89%. Patients with distant pneumoperitoneum should be carefully monitored.
Assuntos
Tratamento Conservador , Falha de Tratamento , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Aguda , Tratamento Conservador/métodos , Doença Diverticular do Colo/terapia , Doença Diverticular do Colo/complicações , Drenagem/métodos , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: The incidence of gastric poorly cohesive carcinoma (PCC) is increasing. The prognosis for patients with peritoneal metastases remains poor and the role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is controversial. The aim was to clarify the impact of gastric PCC with peritoneal metastases treated by CRS with or without HIPEC. METHODS: All patients with peritoneal metastases from gastric cancer treated with CRS with or without HIPEC, in 19 French centres, between 1989 and 2014, were identified from institutional databases. Clinicopathological characteristics and outcomes were compared between PCC and non-PCC subtypes, and the possible benefit of HIPEC was assessed. RESULTS: In total, 277 patients were included (188 PCC, 89 non-PCC). HIPEC was performed in 180 of 277 patients (65 per cent), including 124 of 188 with PCC (66 per cent). Median overall survival (OS) was 14.7 (95 per cent c.i. 12.7 to 17.3) months in the PCC group versus 21.2 (14.7 to 36.4) months in the non-PCC group (P < 0.001). In multivariable analyses, PCC (hazard ratio (HR) 1.51, 95 per cent c.i. 1.01 to 2.25; P = 0.044) was associated with poorer OS, as were pN3, Peritoneal Cancer Index (PCI), and resection with a completeness of cytoreduction score of 1, whereas HIPEC was associated with improved OS (HR 0.52; P < 0.001). The benefit of CRS-HIPEC over CRS alone was consistent, irrespective of histology, with a median OS of 16.7 versus 11.3 months (HR 0.60, 0.39 to 0.92; P = 0.018) in the PCC group, and 34.5 versus 14.3 months (HR 0.43, 0.25 to 0.75; P = 0.003) in the non-PCC group. Non-PCC and HIPEC were independently associated with improved recurrence-free survival and fewer peritoneal recurrences. In patients who underwent HIPEC, PCI values of below 7 and less than 13 were predictive of OS in PCC and non-PCC populations respectively. CONCLUSION: In selected patients, CRS-HIPEC offers acceptable outcomes among those with gastric PCC and long survival for patients without PCC.
Assuntos
Procedimentos Cirúrgicos de Citorredução , Quimioterapia Intraperitoneal Hipertérmica , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Neoplasias Ovarianas/secundário , Neoplasias Peritoneais/secundário , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Adulto JovemRESUMO
Management of functional consequences after pancreatic resection has become a new therapeutic challenge. The goal of our study is to evaluate the risk factors for exocrine (ExoPI) and endocrine (EndoPI) pancreatic insufficiency after pancreatic surgery and to establish a predictive model for their onset. PATIENTS AND METHODS: Between January 1, 2014 and June 19, 2015, 91 consecutive patients undergoing pancreatoduodenectomy (PD) or left pancreatectomy (LP) (72% and 28%, respectively) were followed prospectively. ExoPI was defined as fecal elastase content<200µg per gram of feces while EndoPI was defined as fasting glucose>126mg/dL or aggravation of preexisting diabetes. The volume of residual pancreas was measured according to the same principles as liver volumetry. RESULTS: The ExoPI and EndoPI rates at 6 months were 75.9% and 30.8%, respectively. The rate of ExoPI after PD was statistically significantly higher than after LP (98% vs. 21%; P<0.001), while the rate of EndoPI was lower after PD vs. LP, but this difference did not reach statistical significance (28% vs. 38.5%; P=0.412). There was no statistically significant difference in ExoPI found between pancreatico-gastrostomy (PG) and pancreatico-jejunostomy (PJ) (100% vs. 98%; P=1.000). Remnant pancreatic volume less than 39.5% was predictive of ExoPI. CONCLUSION: ExoPI occurs quasi-systematically after PD irrespective of the reconstruction scheme. The rate of EndoPI did not differ between PD and LP.
Assuntos
Doenças do Sistema Endócrino/etiologia , Insuficiência Pancreática Exócrina/etiologia , Pancreatectomia , Pancreaticoduodenectomia , Complicações Pós-Operatórias/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Sistema Endócrino/diagnóstico , Doenças do Sistema Endócrino/epidemiologia , Insuficiência Pancreática Exócrina/diagnóstico , Insuficiência Pancreática Exócrina/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: Over the last two decades, many surgical teams have developed programs to treat peritoneal carcinomatosis with extensive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Currently, there are no specific recommendations for HIPEC procedures concerning environmental contamination risk management, personal protective equipment (PPE), or occupational health supervision. METHODS: A survey of the institutional practices among all French teams currently performing HIPEC procedures was carried out via the French network for the treatment of rare peritoneal malignancies (RENAPE). RESULTS: Thirty three surgical teams responded, 14 (42.4%) which reported more than 10 years of HIPEC experience. Some practices were widespread, such as using HIPEC machine approved by the European Community (100%), individualized or centralized smoke evacuation (81.8%), "open" abdominal coverage during perfusion (75.8%), and maintaining the same surgeon throughout the procedure (69.7%). Others were more heterogeneous, including laminar flow air circulation (54.5%) and the provision of safety protocols in the event of perfusate spills (51.5%). The use of specialized personal protective equipment is ubiquitous (93.9%) but widely variable between programs. CONCLUSION: Protocols regarding cytoreductive surgery/HIPEC and the associated professional risks in France lack standardization and should be established.
Assuntos
Ar Condicionado/métodos , Antineoplásicos/uso terapêutico , Carcinoma/terapia , Procedimentos Cirúrgicos de Citorredução/métodos , Hipertermia Induzida/métodos , Infusões Parenterais/métodos , Neoplasias Peritoneais/terapia , Equipamento de Proteção Individual/estatística & dados numéricos , Padrões de Prática Médica , França , Humanos , Saúde Ocupacional , Gestão de Riscos , Fumaça , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Sphincter-sparing procedures are increasingly advocated in the treatment of chronic anal fissures (CAF) resistant to conservative management. Herein, we report about our results with sphincter-sparing transanal mucosal advancement flap anoplasty (MAAP) to treat CAF. PATIENTS AND METHODS: The present study was a retrospective single-center analysis of patients in whom conservative management of CAF failed and who subsequently underwent MAAP between January 2003 and December 2008. RESULTS: A total of 26 patients with a median age of 46.5 years (range: 17-79 years) had undergone MAAP after suffering with CAF for a median period of 9 months (range: 4-36 months). Surgery was well tolerated in all patients. One patient developed a perianal abscess at the operative site 3 weeks after MAAP, which required excision. At 2, 12, and 24 months follow-up, all patients were free of pain with no fissure recurrence or any worsening of incontinence. CONCLUSIONS: Mucosal advancement flap anoplasty might be another sphincter-sparing treatment option in patients suffering from CAF. To draw final conclusions about the value of MAAP in the treatment of CAF, more solid data are required.
Assuntos
Fissura Anal/cirurgia , Mucosa/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Cicatrização/fisiologia , Adolescente , Adulto , Idoso , Antibioticoprofilaxia , Doença Crônica , Estudos de Coortes , Feminino , Fissura Anal/diagnóstico , Fissura Anal/tratamento farmacológico , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto JovemRESUMO
AIM OF THE STUDY: Lymph node involvement is one of the most significant prognostic factors of patients with rectal cancer. Despite major advances in our understanding of the propagation of the rectal cancer, the lymphatic drainage of the rectum remains unclear. This study was designed to assess the number of lymph nodes located around the superior rectal artery and to assess the frequency of Mondor's lymph nodes. PATIENTS AND METHODS: Twenty-five anatomic subjects were studied. All resections were performed using total mesorectal excision. Lymph nodes were sought in the tissue surrounding the superior rectal artery up to 2 cm under the ending of the superior rectal artery by manual dissection and were submitted for histological examination. The correlation between the number of lymph nodes, and the volume and weight of the tissue surrounding the superior rectal artery was evaluated by non-parametric Spearman test. RESULTS: The mean number of lymph nodes per specimen was 2.7 +/- 1.4. The size of the lymph nodes varied between 1 and 7 mm. The lymph nodes were mostly smaller than 3 mm (56%). The number of lymph nodes in the superior rectal mesentery was independent of its volume and its weight. Seven subjects had a Mondor's lymph node. The mean size of Mondor's lymph node was 3.4 +/- 2.1 cm. CONCLUSIONS: The number of NL located around the superior rectal artery is small, varying between 1 and 5. The Mondor's lymph node is an inconstant rectal NL. Its only characteristic is its location in the bifurcation or trifurcation of the superior rectal artery.
Assuntos
Linfonodos/patologia , Neoplasias Retais/patologia , Dissecação/métodos , Feminino , Humanos , Linfonodos/anatomia & histologia , Masculino , Artéria Mesentérica Inferior/anatomia & histologia , Artéria Mesentérica Inferior/patologia , Artéria Mesentérica Superior/anatomia & histologia , Artéria Mesentérica Superior/patologia , Estadiamento de Neoplasias , Neoplasias Retais/irrigação sanguíneaRESUMO
Lymph node (LN) involvement is one of the most significant prognostic factors of patients with rectal cancer. However, the distribution of rectal LN is not well known. The rectal LN are mainly located around the rectal arteries. In the mesorectum, the LN are mainly located posteriorly. The number of LN by patient varies considerably. Many reasons can explain this variability. Acquired factors such as infection, inflammation or metastatic involvement facilitate the detection of LN. In contrast, preoperative radiotherapy reduces the number and size of lymph nodes. The procedure of resection affects the number of LN harvested. Extensive lymphadenectomies increase the number of LN harvested. The technique used by pathologist has equally a major influence. The fat clearing method allows detection of a greater number of LN than manual dissection particularly for small LN. Toxicity of these solutions and a time-consuming process explain that fat clearing method is rarely used in clinical practice. Detection of rectal lymph nodes is difficult and tedious but is necessary for an accurate staging of patients with rectal cancer.
Assuntos
Sistema Linfático , Reto/imunologia , Humanos , Excisão de Linfonodo , Metástase Linfática , Sistema Linfático/patologia , Cuidados Pré-Operatórios , Prognóstico , Neoplasias Retais/patologia , Neoplasias Retais/radioterapia , Neoplasias Retais/cirurgia , Reto/irrigação sanguínea , Reto/patologiaRESUMO
BACKGROUND: Lymph node involvement is one of the most significant prognostic factors of patients with rectal cancer. However, the distribution of mesorectal lymph nodes is not well known. This study was designed to assess lymph nodes in the mesorectum and to evaluate the correlation between the volume and weight of the mesorectum and the number of lymph nodes. METHODS: The mesorectums of 20 human cadavers were studied. The volume and weight of the superior rectal mesentery, superior mesorectum and inferior mesorectum were measured. Lymph nodes were sought by manual dissection and were submitted for histological examination. The correlation between the number of lymph nodes and the volume and weight of the mesorectum was evaluated by non-parametric Spearman test. RESULTS: A total of 178 lymph nodes were identified. The mean number of lymph nodes per specimen was 9.2 +/- 4.5. The lymph nodes were mostly smaller than 3 mm and located in the superior and posterior parts of the mesorectum. A positive correlation was found between the number of mesorectal lymph nodes and the volume and weight of the mesorectum. The number of lymph nodes in the superior rectal mesentery was independent of its volume and its weight. CONCLUSIONS: Mesorectal lymph nodes are mainly located above the peritoneal reflection within the posterior mesorectum. The positive correlation between the volume or the weight of the mesorectum and the number of mesorectal lymph nodes should be considered as a possible means to determine the minimum number of mesorectal lymph nodes required for histological examination.
Assuntos
Linfonodos/anatomia & histologia , Mesentério/anatomia & histologia , Reto/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Dissecação , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática/patologia , Masculino , Tamanho do Órgão , Neoplasias Retais/patologia , Reto/patologia , Estatísticas não Paramétricas , Pesos e MedidasRESUMO
Surgical simulators have undergone a significant development, especially since the rise of mini-invasive surgery. The main simulators of digestive surgery have been developed for solid organs such as the liver and spleen. Studies relating to soft tissues like the pelvic organs are rare. The aim of this work was to create a model of female pelvis that will be used as a basis for the development of a patient specific pelvic simulator. A dynamic MRI acquisition is used to evaluate and to set the simulation model.
Assuntos
Simulação por Computador , Modelos Anatômicos , Pelve/anatomia & histologia , Feminino , Humanos , Imageamento por Ressonância MagnéticaRESUMO
Whether or not there is a benefit to laparoscopy versus open surgery in the management of acute appendicitis remains a subject of controversy despite the publication of numerous randomized studies. Operative time is longer for the laparoscopic approach. The incidence of abdominal wall abscess is decreased for laparoscopy but the incidence of deep intra-abdominal abscess may be increased, especially in the case of complicated appendicitis. Post-operative pain is diminished and resumption of normal activity is quicker with the laparoscopic approach. Hospitalization is shorter but the cost of hospital care is higher; nevertheless, the global cost may be less - particularly for patients whose return to work is hastened by a laparoscopic approach. Laparoscopy diminishes the number of normal appendectomies, particularly in women of reproductive age where the diagnosis may be unclear. Laparoscopic appendectomy is practicable and has advantages over open appendectomy under certain circumstances. These advantages are most evident in the young female, the working patient, and the obese patient. Overall, the advantages of laparoscopy are, at best, modest and clinical benefit is not always demonstrable. The risk of deep abscess, particularly in patients with perforated or gangrenous appendicitis, remains an unknown and should be evaluated by further studies.
Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia , Complicações Pós-Operatórias , Adulto , Fatores Etários , Idoso , Apendicectomia/efeitos adversos , Apendicectomia/economia , Feminino , Custos de Cuidados de Saúde , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/economia , Laparoscopia/métodos , Laparotomia/efeitos adversos , Laparotomia/economia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Fatores SexuaisRESUMO
INTRODUCTION: Mechanical bowel preparation (MBP), aimed at reducing the infectious complications of colorectal surgery, was considered as indispensable. This benefit is actually disputed. The aim of this study was to report an experience of colorectal surgery without MBP. MATERIALS AND METHODS: Hundred ninety patients without MBP and without low residue diet, who underwent colorectal surgery with primary anastomosis not requiring a diverting stoma were included. The main outcome were the rate of mortality, anastomotic leak, wound infection and intra-abdominal abscess. Secondary outcomes were duration of intravenous perfusion, nasogastric aspiration, total hospitalisation stay and time to realimentation. RESULTS: The procedure was performed by laparotomy (n=142) or laparoscopy (n=48). Forty-eight patients underwent emergency surgery. Ninety-two patients were operated for malignancy. The rate of mortality was 6.3% in correlation with the scale of AFC. The rate of anastomotic leak was 3.7%. The rate of specific morbidity was independent of scale of AFC on the contrary to the frequency of non-specific complications. The mean duration of intravenous perfusion and nasogastric suction were 6 days and 0.3 day. The patient had normal diet to the 4th day (4+/-3 days). The mean hospital stay was 13.4 days. CONCLUSION: The colorectal surgery without MBP may be safely performed and could improve the quality of life of patients in the perioperatory period.
Assuntos
Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Laparoscopia , Laparotomia , Cuidados Pré-Operatórios/métodos , Reto/cirurgia , Fatores Etários , Idoso , Colectomia , Colonoscopia , Interpretação Estatística de Dados , Procedimentos Cirúrgicos do Sistema Digestório/mortalidade , Emergências , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação , Masculino , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Estudos Prospectivos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Fatores de TempoRESUMO
BACKGROUND: Pancreaticoduodenectomy (PD) is the standard surgical treatment for malignant ampullomas but is still associated with a mortality and morbidity still ranging from 0 to 10% and from 15 to 40%, respectively. Ampullectomy is an alternative to PD for benign ampulloma or, in high-risk patients, for invasive carcinoma. The aim of this study was to report early and long term results of surgical ampullectomy for presumed benign ampullomas. PATIENTS AND METHODS: From 1981 to 2004, 26 patients from two institutions underwent surgical ampullectomy. Of the 26 patients, 8 had familial adenomatous polyposis (FAP). Surgical ampullectomy was indicated on a multisciplinary basis. RESULTS: Final pathological examination revealed 15 adenomas, 4 in situ adenocarcinomas, 2 endocrine tumors, and 5 other benign lesions. There was no postoperative mortality. Specific morbidity was 8% (N=2). Mean follow-up was 86+/-70 months (range: 3-204). Actuarial overall 5-year survival was 92%. There were 4 local recurrences (none in patients with FAP). Four patients died during follow-up (including 3 from initial disease). CONCLUSION: Ampullectomy is a good alternative to PD in case of benign or non-invasive malignant ampullary lesion, including in selected cases of FAP.
Assuntos
Ampola Hepatopancreática/cirurgia , Neoplasias do Ducto Colédoco/cirurgia , Adenocarcinoma/cirurgia , Adenoma/cirurgia , Polipose Adenomatosa do Colo/cirurgia , Adulto , Idoso , Carcinoma in Situ/cirurgia , Causas de Morte , Doenças do Ducto Colédoco/cirurgia , Feminino , Seguimentos , Granuloma de Células Plasmáticas/cirurgia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Estudos Retrospectivos , Somatostatinoma/cirurgia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
UNLABELLED: The aim of this study was to assess the morphology of the main pancreatic duct (MPD) using multiplanar reconstructions and to compare this with the morphology of the MPD of anatomic subjects. MATERIALS AND METHODS: The morphology of the MPD was studied by means of multiplanar reconstructions obtained on the one hand from thin tomodensitometric slices and on the other hand from the dissection of anatomic subjects. This study involved 15 subjects in each group. RESULTS: Full multiplanar reconstruction was obtained in 13 cases. In 2 cases, the isthmus did not appear in the reconstructions. The morphology of the MPD was similar in both groups. The length of the MPD was identical at the head and isthmus of the pancreas in both groups but was greater in the dissection group than in the reconstruction group in the body and tail areas of the pancreas. The diameter of the MPD was greater at the head of the pancreas in the dissection group and was identical in both groups for the other segments of the MPD. CONCLUSIONS: Multiplanar tomodensitometric reconstruction of the main pancreatic duct is feasible. This new technique, currently under evaluation, could allow the study of canalar pathologies of the pancreas through tomodensitometry.
Assuntos
Ductos Pancreáticos/anatomia & histologia , Ductos Pancreáticos/diagnóstico por imagem , Colangiopancreatografia Retrógrada Endoscópica , Duodeno/anatomia & histologia , Humanos , Processamento de Imagem Assistida por Computador/métodos , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios XRESUMO
The objective of this study was to evaluate the possibilities of reinnervation of the gracilis muscle, transposed around the anus, by the pudendal nerve using an end-to-side nerve anastomosis. This study was carried out in 14 cases (7 adult human cadavers bilaterally). The gracilis muscle and its vascular-nervous bundle have been dissected and the nerve innervating the gracilis muscle has been cut at its origin. The gracilis muscle, accompanied by its nerve, has then been transposed around the anus. The pudendal nerve has been dissected from its extrapelvic part. The reinnervation using an end-to-side nerve anastomosis has been considered as feasible when the proximal ending of the nerve of the gracilis was put into a tension-free contact with the extrapelvic part of the pudendal nerve. The extrapelvic part of the pudendal nerve has a common trunk in 12 cases. The width of the extrapelvic part of the pudendal nerve was 2.6+/-0.7 mm, range 1-3.5. The width of the proximal endings of the nerve innervating the gracilis muscle was 2.3+/-0.5 mm, range 2-3. The reinnervation of the gracilis muscle by the pudendal nerve has been possible in 14 cases. An average supplementary length of 17.4+/-15.4 mm was available (range 5-52). These results suggest an eventual practical aspect of this technique for the reconstruction of a functional sphincter using the gracilis muscle transposed around the anus.
Assuntos
Canal Anal/cirurgia , Anastomose Cirúrgica/métodos , Músculo Esquelético/transplante , Idoso , Idoso de 80 Anos ou mais , Canal Anal/inervação , Cadáver , Humanos , Músculo Esquelético/inervação , Transferência de Nervo/métodos , Nervo Obturador/anatomia & histologia , Pelve/inervação , Períneo/inervação , Procedimentos de Cirurgia Plástica , Coxa da Perna/inervaçãoRESUMO
The aim of this comprehensive literature review was to analyse evidence based data in the field of pancreaticoduodenectomy. Pylorus preserving does reduce mortality or morbidity of the standard procedure and could increase the risk of delayed gastric emptying. Pancreaticogastrostomy does not decrease the rate of postoperative pancreatic fistula and is not superior to the pancreaticojejunal anastomosis which is more physiological. No other procedure (chemical occlusion, octreotide, stenting) has been demonstrated to prevent pancreatic fistula. Octreotide injection could be advocated in centres where there is a high rate of pancreatic fistula, when pancreatic parenchyma is soft and the main pancreatic duct thin. Intra-abdominal drainage is not beneficial and could be associated with some morbidity. Its use needs to be further evaluated. When a resection is done for pancreatic cancer, less than 5% of patients are a live five years after surgery with postoperative mortality rate of 5% in expert centres and a high morbidity rate (25-50%). Extended lymphadenectomy does not increase survival. The first trials showed that adjuvant therapies could be beneficial for pancreatic cancers, but further trials did not confirm these findings. Adjuvant therapy is not validated for pancreatic cancers and needs to be considered only in the settings of clinical trials.
Assuntos
Neoplasias Pancreáticas/terapia , Pancreaticoduodenectomia/métodos , Quimioterapia Adjuvante , Esvaziamento Gástrico , Humanos , Fístula Pancreática/prevenção & controle , Piloro/cirurgia , Radioterapia AdjuvanteRESUMO
Ten per cent of patients with polycystic hepato-renal disease have cysts of the pancreas. This cysts are generally uncommon and asymptomatic. An extension of the whole pancreas is rare. We report about case of a patient with a pancreatic polycystic disease associated with a minor polycystic hepato-renal disease. The symptoms was related to the number and the size of the cysts. The pancreatic cysts have been treated by laparoscopic fenestration with a satisfying result in a medium term.