RESUMO
Introducción. El conjunto de estrategias de recuperación mejorada después de la cirugía (ERAS, por sus siglas en inglés) constituye un enfoque de atención multimodal y multidisciplinario, cuyo propósito es reducir el estrés perioperatorio de la cirugía, disminuir la morbilidad y acortar la estancia hospitalaria. Este estudio tuvo como objetivo describir los resultados clínicos de pacientes sometidos a cirugía por cáncer colorrectal, identificando las complicaciones principales y los factores perioperatorios relacionados con el alta temprana. Métodos. Se analizaron los pacientes consecutivos sometidos a cirugía colorrectal entre los años 2020 y 2023, todos los cuales siguieron el protocolo ERAS institucional. Se evaluaron las características clínicas, los factores perioperatorios, los desenlaces postoperatorios y la tasa global de adherencia al protocolo. Resultados. Un total de 456 pacientes fueron sometidos a cirugía colorrectal, 51% de sexo masculino, con edad media de 60 años. La mayoría de las intervenciones se realizaron por laparoscopia (78 %), con una tasa de conversión del 14,5 %. Las complicaciones postoperatorias incluyeron fuga anastomótica (4,6 %), sangrado, infección intraabdominal y obstrucción intestinal. La estancia hospitalaria promedio fue de 4 días y la mortalidad del 2,8 %. La tasa global de adherencia al protocolo ERAS fue del 84,7 %. Conclusiones. El enfoque combinado de cirugía laparoscópica y protocolo ERAS es factible, seguro y se asocia con una estancia hospitalaria más corta. La implementación y adherencia al protocolo ERAS no solo mejora los resultados postoperatorios, sino que también resalta la importancia de acceder a datos sólidos, permitiendo mejorar la atención perioperatoria local.
Introduction. The Enhanced Recovery After Surgery (ERAS) protocol is a multimodal, multidisciplinary approach to care, the purpose of which is to reduce the perioperative stress of surgery, decrease morbidity, and shorten hospital stay. This study aimed to describe the clinical outcomes of patients undergoing surgery for colorectal cancer, identifying the main complications and perioperative factors related to early discharge. Methods. Consecutive patients undergoing colorectal surgery between 2020 and 2023 were analyzed, who followed the institutional ERAS protocol. Clinical characteristics, perioperative factors, postoperative outcomes, and overall protocol adherence rate were evaluated. Results. A total of 456 patients underwent colorectal surgery, 51% male, with a mean age of 60 years. Most interventions were performed laparoscopically (78%), with a conversion rate of 14.5%. Postoperative complications included anastomotic leak (4.6%), followed by bleeding, intra-abdominal infection, and intestinal obstruction. The average hospital stay was 4 days and mortality was 2.8%. The overall adherence rate to the ERAS protocol was 84.7%. Conclusions. The combined approach of laparoscopic surgery and ERAS protocol is feasible, safe, and associated with a shorter hospital stay. Implementation and adherence to the ERAS protocol not only improves postoperative outcomes, but also highlights the importance of accessing solid data, allowing for improved local perioperative care.
Assuntos
Humanos , Neoplasias Colorretais , Recuperação Pós-Cirúrgica Melhorada , Tempo de Internação , Laparoscopia , Cirurgia Colorretal , Procedimentos Cirúrgicos Minimamente InvasivosRESUMO
INTRODUCTION: Radical gastrectomy has traditionally been the pillar treatment with curative intent for malignant tumors of the stomach. The safety of the laparoscopic approach for advanced gastric cancer (AGC) is still under debate. In our institution, laparoscopic gastrectomy is the most performed approach. OBJECTIVE: Our aim is to describe the experience of a high-volume center in the treatment of AGC in Colombia and to analyze the short-term results and the overall survival rate at 1, 3, and 5 years comparing the open and laparoscopic approaches. METHODS: A cross-sectional retrospective study of patients who underwent gastrectomy for advanced gastric cancer by open or laparoscopic approaches were performed. A Will-Coxon Mann Whitney test was performed in terms of lymph node status and surgical approach. Survival analysis was performed using the Kaplan-Meier method for overall survival at 1, 3, and 5 years. An initial log-rank test was performed to test the relationships between the operative variables and overall survival, the statistical value was accepted if p < 0.20. Data with an initial statistical relationship in the log-rank test were included in a secondary analysis using multivariate Cox proportional regression, variables with a value of p < 0.05 were considered statistically significant. RESULTS: 310 patients met the inclusion criteria. 89% underwent laparoscopic gastrectomy and 10.9% open gastrectomy. The resection margins were negative at 93.5% and the In terms of lymph node dissection, the median lymph nodes extracted was 20 (12;37), with statistically significant differences between the approaches in favor of the laparoscopic approach (Median 21 vs 12; z = - 2.19, p = 0.02). The survival rate was at 1, 3, and 5 years of 84.04%, 66.9%, and 65.47% respectively. The presence of complications and the ICU requirement have a negative impact on survival at 1 year (p 0.00). CONCLUSION: A laparoscopic approach is safe with acceptable morbidity and mortality rates for treating gastric cancer. D2 Lymphadenectomy could be performed successfully in a laparoscopic approach in a high-volume center and a properly standardized technique. Major postoperative morbidity with intensive care unit requirement seems to influence overall survival rates.
Assuntos
Laparoscopia , Neoplasias Gástricas , Humanos , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Colômbia/epidemiologia , Estudos Transversais , Gastrectomia/métodos , Excisão de Linfonodo/métodos , Laparoscopia/métodos , Resultado do TratamentoRESUMO
Appendicitis is one of the most common conditions that leads to an acute abdomen. Surgical management is the gold standard for therapy. The main cause of appendicitis is an obstruction in the appendicular lumen. Intestinal ascariasis infection is undoubtedly one of the least frequent. We present a female patient with acute appendicitis resulting from Ascaris lumbricoides as an incidental intraoperative diagnosis.
Assuntos
Apendicite , Apêndice , Ascaríase , Obstrução Intestinal , Laparoscopia , Doença Aguda , Animais , Apendicite/complicações , Apendicite/cirurgia , Ascaríase/complicações , Ascaríase/diagnóstico , Ascaríase/tratamento farmacológico , Ascaris lumbricoides , Feminino , Humanos , Obstrução Intestinal/etiologia , Laparoscopia/efeitos adversosRESUMO
Objective. This study evaluated the effect of age and coasting period over oocyte quality and their posterior development under in vitro conditions from prepubertal Bos indicus crossbred donors. Material and methods. Donors females received a norgestomet implant and estradiol benzoate. Four days later a unique dosage of 150 IU of eCG was administered. Three coasting periods (24, 48, and 56 h) and four ages (3, 6, 10, and 12 months) were proved. All antral follicles were aspirated and an in vitro culture proceed was done. Results. 439 follicles were aspirated, of which 385 (87.7%) were 2-5 mm, 41 (9.33%) were 5-10 mm, and 13 (2.3%) were 10 mm. After aspiration, a total of 373 oocytes (84.9%) were recovered, finding differences (p<0.05) between averages of 6 (9.3) and 10 months old animals (32.3). 285 (76.4 %) recovered oocytes were subjected to in vitro process. Cleavage values were significantly higher (p<0.05) in 10 (27.1%) and 12 months animals (26.8%). Although the number of transferable embryos was low, there were differences between ages (p<0.05) obtaining a higher percentage in age 3 (12.6%). Conclusions. A coasting period higher than 24 h has a negative effect on oocyte quality. Some oocytes from 3 months old calves were competent for in vitro embryo development; however, higher numbers of embryos were produced from 10 and 12 months of age prepuber females, indicating they have higher competency in vitro.