Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 3 de 3
Filtrar
1.
Langenbecks Arch Surg ; 408(1): 50, 2023 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-36662279

RESUMEN

PURPOSE: Fascial dehiscence is still an important cause of morbidity and mortality in the postoperative period of abdominal surgery. Different authors have sought to identify risk factors for this entity. Two risk scores have been developed, but they include postoperative variables, which hinder preventive decision-making during the early surgical period. Our aim is to identify preoperative and intraoperative risk factors for fascial dehiscence and to develop and validate a risk prediction score that allows taking preventive behaviors. METHODS: All adult patients, with no prior history of abdominal surgery, who underwent midline laparotomy by a general surgery division between January 2009 and December 2019 were included. Recognized preoperative risk factors for fascial dehiscence were evaluated in a univariate analysis and subsequently entered in a multivariate stepwise logistic regression model. A prognostic risk model was developed and posteriorly validated by bootstrapping. This study was conducted following the STROBE statement. RESULTS: A total of 594 patients were included. Fascial dehiscence was detected in 41 patients (6.9%). On multivariate analysis, eight factors were identified: chronic obstructive pulmonary disease (COPD), immunosuppression, smoking, prostatic hyperplasia, anticoagulation use, sepsis, and overweight. The resulting score ranges from 1 to 8. Scores above 3 are predictive of 18% risk of dehiscence with a sensitivity of 70% and specificity of 80% (ROC 0.88). CONCLUSIONS: We present a new preoperative prognostic score to identify patients with a high risk of fascial dehiscence. It can be a guide for decision-making that allows taking intraoperative preventive measures. External validation is still required.


Asunto(s)
Laparotomía , Dehiscencia de la Herida Operatoria , Adulto , Humanos , Estudios Retrospectivos , Dehiscencia de la Herida Operatoria/etiología , Dehiscencia de la Herida Operatoria/cirugía , Factores de Riesgo , Laparotomía/efectos adversos , Laparotomía/métodos , Modelos Logísticos
2.
Surg Endosc ; 36(6): 4312-4320, 2022 06.
Artículo en Inglés | MEDLINE | ID: mdl-34668068

RESUMEN

BACKGROUND: Ultrasound-guided transversus abdominis plane block (US-TAP) is an important component of multimodal analgesia in laparoscopic inguinal hernia repair, although it has certain limitations. To overcome them, surgeons have developed several techniques to perform local anesthetic infiltration under laparoscopic guidance, but no trials evaluating these in transabdominal preperitoneal (TAPP) hernia repair were conducted till the date. The aim of this study was to compare the efficacy of a novel laparoscopic-guided local anesthetic infiltration technique (LDAI) with US-TAP in postoperative pain control and analgesic consumption for patients undergoing elective TAPP hernia repair. METHODS: This was a double-blind randomized controlled trial conducted at a single tertiary academic center between 2019 and 2020 on adult patients undergoing elective laparoscopic TAPP inguinal hernia repair. Postoperative pain and analgesic consumption were compared for LDAI vs. US-TAP up to 30 postoperative days. RESULTS: 62 patients were included (31 LDAI, 31 US-TAP). Female gender was significantly higher in the LDAI group (8, 25.81%; US-TAP 0; p = 0.005). Mean anesthetic time (US-TAP group: 142.2 min, SD = 17.7; LDAI group: 127.1 min, SD = 15.5; p < 0.001) and mean operative time (US-TAP group: 117.2 min, SD = 15.9; LDAI group: 103.8 min, SD = 15.2; p < 0.001) were significantly shorter in the LDAI group. Pain scores assessed at the first-hour postoperative, at the moment of discharge, and at 8, 24, and 48 postoperative hours showed no significant differences between both groups. No significant difference was found regarding postoperative analgesic rescue administration in the recovery room and analgesic consumption after discharge between groups. CONCLUSION: LDAI is a safe and effective local anesthetic technique in elective TAPP hernia repair. Pain control is similar to US-TAP block, with shorter anesthesthetic and surgical time and better health resources allocation.


Asunto(s)
Hernia Inguinal , Laparoscopía , Músculos Abdominales/cirugía , Adulto , Anestésicos Locales , Femenino , Hernia Inguinal/cirugía , Herniorrafia/métodos , Humanos , Laparoscopía/métodos , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/cirugía
3.
Int J Surg ; 79: 103-104, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32447001

RESUMEN

The end of 2019 was marked by the emergence of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Our problem is centered in the post operative follow up of those patients who underwent an elective procedure immediately before the isolation and those who require an emergency surgery. We outline the measures we have taken to reduce the possibility of spread of the virus.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Herniorrafia , Pandemias , Neumonía Viral/epidemiología , Cuidados Posoperatorios , Betacoronavirus , COVID-19 , Procedimientos Quirúrgicos Electivos , Servicios Médicos de Urgencia , Humanos , SARS-CoV-2
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA