Optimization of Surgical Time Through the Implementation of a Rational Protocol to Prevent Bleeding in Sleeve Gastrectomy.

Introduction: Staple line oversewing (SLO) is a prophylactic alternative due to its low cost and its effect of decreasing the incidence and severity of bleeding complications in sleeve gastrectomy (SG). However, this approach significantly increases the surgical time and may be associated with stenosis. The study aims to identify whether its usage was sufficient to optimize the surgical time in patients whose screening for the risk of occult bleeding was negative. Materials and Methods: The study enrolled 103 patients. Having the systolic blood pressure goal of 140 mmHg, the staple line is checked for bleeding points, counting as follows: >5 bleeding points proceed to SLO, <5 bleeding points are managed using clips, and if no bleeding points are found, the procedure can be completed. Results: The bleeding test was positive in 79.6% of the cases and oversewing was necessary for 44.7% of the total. The bleeding test result was significant for the increased surgical time. The mean surgical time in SLO was 16.4% higher than in clipping. There was a significant difference in surgical time between SLO and clipping; however, no significant difference was identified between clipping and continuing the procedure without further measures. No postoperative complication related to staple line bleeding was identified. Discussion: In a scenario with limitations for the use of high-cost homeostatic agents, the stratified protocol to prevent bleeding in SG stapling line was able to significantly reduce surgical time without significant added risks. Conclusion: A stratified protocol to prevent bleeding in SG stapling line was able to significantly reduce surgical time.

Improvement in Muscle Strength and Metabolic Parameters Despite Muscle Mass Loss in the Initial Six Months After Bariatric Surgery.

BACKGROUND: An aggravation in pre-existing sarcopenia or the onset of sarcopenia may occur in the scenario of extensive and fast weight loss in the initial months following bariatric surgery. The accurate identification of sarcopenia criteria and its metabolic repercussions is vital for its correct management. The aim of this study is to evaluate the correlation between the diagnosis criteria for sarcopenia and metabolic repercussions during the first 6 months following bariatric surgery. METHODS: A prospective single-center cohort study was conducted. Convenience sampling was performed among patients with severe obesity undergoing preoperative evaluation for bariatric surgery. Metabolic parameters, nutritional evaluation, and skeletal muscle evaluation were assessed before surgery and 6 months later. RESULTS: A total of 129 patients were selected, 62 participants were included in the final analysis. Mean age was 37.7 years and 88.4% of participants were women. Mean body mass index was 41.8 kg/m2 and 47.8% of patients were sedentary. Sleeve gastrectomy was performed in 41 patients and Roux-en-Y gastric bypass in 21 patients. Significant improvement regarding muscle strength and function after surgery was observed. Sarcopenia criteria were not met by any participant before and after surgery. Blood glucose and ferritin levels remained independently associated with change in muscle strength. CONCLUSIONS: Functional evaluation methods did not reflect the reduction in skeletal muscle mass demonstrated in bioelectrical impedance analysis 6 months after bariatric surgery in comparison to the preoperative baseline. Improvement in muscle strength was followed by improvement in metabolic parameters.

What is the best method to assess the abdominal wall? Restoring strength does not mean functional recovery.

BACKGROUND: Restoring the contractile function to the abdominal wall is a major goal in hernia repair. However, the core understanding is required when choosing the method for outcome assessment. AIM: To assess the role of the anterolateral abdominal muscles on abdominal wall function in patients undergoing hernia repair by analysis of correlation between the surface electromyography activation signal of these muscles and torque produced during validated strength tests. METHODS: Activation of the rectus abdominis, external oblique, and internal oblique/transverse abdominis muscles was evaluated by surface electromyography during two validated tests: Step: 1-A, isometric contraction in dorsal decubitus; 1-B, isometric contraction in lateral decubitus; 2-A, isokinetic Biodex testing; and 2-B, isometric Biodex testing. RESULTS: Twenty healthy volunteers were evaluated. The linear correlation coefficient between root mean square/peak data obtained from surface electromyography signal analysis for each muscle and the peak torque variable was always <0.2 and statistically non-significant (p<0.05). The agonist/antagonist ratio showed a positive, significant, weak-to-moderate correlation in the external oblique (Peak, p=0.027; root mean square, 0.564). Surface electromyography results correlated positively among different abdominal contraction protocols, as well as with a daily physical activity questionnaire. CONCLUSIONS: There was no correlation between surface electromyography examination of the anterolateral abdominal wall muscles and torque measured by a validated instrument, except in a variable that does not directly represent torque generation.

What is the best method to assess the abdominal wall? Restoring strength does not mean functional recovery / Qual é o melhor método para avaliação da parede abdominal? Restabelecer força não significa recuperação funcional

ABSTRACT Background: Restoring the contractile function to the abdominal wall is a major goal in hernia repair. However, the core understanding is required when choosing the method for outcome assessment. Aim: To assess the role of the anterolateral abdominal muscles on abdominal wall function in patients undergoing hernia repair by analysis of correlation between the surface electromyography activation signal of these muscles and torque produced during validated strength tests. Methods: Activation of the rectus abdominis, external oblique, and internal oblique/transverse abdominis muscles was evaluated by surface electromyography during two validated tests: Step: 1-A, isometric contraction in dorsal decubitus; 1-B, isometric contraction in lateral decubitus; 2-A, isokinetic Biodex testing; and 2-B, isometric Biodex testing. Results: Twenty healthy volunteers were evaluated. The linear correlation coefficient between root mean square/peak data obtained from surface electromyography signal analysis for each muscle and the peak torque variable was always <0.2 and statistically non-significant (p<0.05). The agonist/antagonist ratio showed a positive, significant, weak-to-moderate correlation in the external oblique (Peak, p=0.027; root mean square, 0.564). Surface electromyography results correlated positively among different abdominal contraction protocols, as well as with a daily physical activity questionnaire. Conclusions: There was no correlation between surface electromyography examination of the anterolateral abdominal wall muscles and torque measured by a validated instrument, except in a variable that does not directly represent torque generation.

RESUMO Racional: A devolução da funcionalidade contrátil da parede abdominal é uma das metas no reparo das hérnias abdominais. Contudo, o entendimento do core deve necessariamente fazer parte na escolha do método de avaliação desse desfecho. Objetivo: Avaliar o papel dos músculos da parede anterolateral na função da parede abdominal com base na correlação entre o sinal de ativação muscular obtido na eletromiografia de superfície e torque produzido durante testes de força validados. Métodos: A ativação dos músculos reto abdominal, oblíquo externo, e oblíquo interno e transverso foi avaliada por eletromiografia de superfície durante dois testes validados. Etapa: 1-A, contração isométrica em decúbito dorsal; 1-B, contração isométrica em decúbito lateral; 2-A, teste isocinético no Biodex; e 2-B, teste isométrico no Biodex. Resultados: Foram avaliados 20 voluntários saudáveis. O coeficiente de correlação linear entre os dados de valor quadrático médio/Pico obtidos análise do sinal da eletromiografia de superfície para cada músculo e o Pico de torque foram sempre <0,2 e estatisticamente insignificantes (p<0.05). A relação agonista/antagonista demonstrou correlação positiva, significativa e de fraca a moderada no músculo externo oblíquo (Pico, p=0,027; valor quadrático médio, 0,564). Os resultados eletromiografia de superfície estiveram positivamente correlacionados nos diferentes protocolos de contração abdominal e também com um questionário de atividade física diária. Conclusões: Não houve correlação entre o exame de eletromiografia de superfície e o torque mensurado por um instrumento validado, exceto em uma variável que não representa diretamente a geração de torque.

Petit lumbar hernia--a double-layer technique for tension-free repair.

This report describes an alternative technique for Petit hernia repair. The treatment of lumbar hernias should follow the concept of tension-free surgery, and the preperitoneal space can be the best place for prosthesis placement. An obese patient had a bulge in the right lumbar region, which gradually grew and became symptomatic, limiting her daily activities and jeopardizing her quality of life. She had previously undergone 2 surgical procedures with different incisions. We created a preperitoneal space and attached a mesh in this position. Another prosthesis was placed on the muscles, with a suitable edge beyond the limits of the defect. There were no complications. It has been described as a safe and tension-free repair for Petit hernia. In larger defects, a second mesh can be used to prevent further enlargement of the triangle and also to provide additional protection beyond the bone limits.

Avaliação dos parâmetros espirométricos de pacientes submetiods à broncoscopia flexível com anestesia local / Evaluation of spirometric parameters in patients undergoing flexible bronchoscopy with local anesthesia

Introdução: A broncoscopia flexível (BF) é um exame diagnóstico e de potencial terapêutico usado com frequência nos serviços de cirurgia torácica. O desconhecimento sobre o verdadeiro impacto na função pulmonar e as possíveis complicações ainda restringemsua aplicação a instituições de maior complexidade. O objetivo deste estudo consiste em avaliar as alterações nos espirométricos após a realização de BF com anestesia local. Identifi-car a segurança do método era o objetivo do trabalho. Métodos: Estudo longitudinal prospectivo para o qual foram selecionados pacientes com indicação de BF em um Hospital Universitário. A avaliação dos pacientes se deteve na realização de oximetria de pulso e exame espirométrico antes e após a realização da BF. A espirometria foi realizada por profissional treinado e de acordo com as recomendações da Sociedade Brasileira de Pneumologia e Tisiologia. A incidência de complicações também foi avaliada. Resultados: A amostra foi formada por 20 pacientes sendo a maioria masculino (55%). A média de idade foi de 56,6 anos, 35% dos pacientes eram fumantes (média de 45,3 anos/maço), 10% asmáticos e 15% tinham DPOC. Houve redução estatisticamente significativa no VEF1, CVF e PEF de respectivamente 0,25 L, 0,44L e 0,85 L/Seg. O Índice de Tiffenaud manteve o padrão, sem diferença significativa. Houve queda significativa também na SpO2 Não houve necessidade de suporte ventilatório. Conclusão: Houve uma significativa redução da função pulmonar e da saturação da hemoglobina após a realização da BF. Contudo, estas alterações não determinaram um impacto clínico significativo, demonstrando a segurança do método.

Introduction: Flexible bronchoscopy (FB) is a diagnostic test of therapeutic potential often used in thoracic surgery services. Lack of knowledge about its true impact on lung function and possible complications still restrict its use in institutions of higher complexity. The aim of this study is to evaluate the changes in spirometry after conducting FB with local anesthesia and determine the safety of the method. Methods: A longitudinal prospective study of patients referred to FB in a university Hospital. The evaluation of patients focused on performing pulse oximetry and spirometry before and after completion of FB. Spirometry was performed by trained professional and in accordance with the recommendations of the Sociedade Brasileira de Pneumologia e Tisiologia (Brazilian Thoracic Association). The incidence of complications was also evaluated. Results: The sample consisted of 20 patients, most of whom males (55%). The mean age was 56.6 years, and 35% of the patients were smokers (mean 45.3 years/pack), 10% had asthma, and 15% had chronic obstructive pulmonary disease (COPD). There was a statistically signifi cant reduction in FEV1, FVC and PEF (respectively, 0.25 L, 0.44 L and 0.85 L/sec). The Tiffenaud Index remained at the standard level, with no signifi cant difference. There was also a signifi cant decrease in SpO2. There was no need for ventilatory support. Conclusion: There was a signifi cant reduction in lung function and hemoglobin saturation after completion of FB. However, these changes did not have a signifi cant clinical impact, confi rming the safety of the method.

May polyester with collagen coating mesh decrease the rate of intraperitoneal adhesions in incisional hernia repair?

BACKGROUND: Among meshes used in incisional hernias in open technique repair, the polypropylene is the most commonly used due to flexibility, cellular growth stimulation, satisfactory inflammatory response, easy manipulation and low price. However, it induces adhesions formation when in contact with the intra-abdominal contents. AIM: To evaluate the formation of adhesions after polypropylene and collagen coated polyester mesh with intraperitoneal placement. METHODS: Twenty six female Wistar rats were randomized in three groups. In the group 0 (sham) there was no prosthesis placement, in the polypropylene (group 1) the prosthesis was placed at the peritoneal surface and in the group 2, collagen coated polyester mesh was placed. The rats were killed on postoperative day 21 to evaluate adhesions regarding its degree, mesh percentage of involvement, bowel involvement and strength needed to cause rupture. RESULTS: There was no difference in weight between groups. The group 0 did not develop any adhesions. The groups 1 and 2 developed prosthetic mesh surface adhesions, mostly in the omentum. There was no difference in adhesion degree and percentage of surface involvement between groups. The collagen coated mesh did not develop adhesions. The adhesions occurred at the free edge of the mesh, in contact with the polyester. The Polypropylene group presented 80% of the surface involved with adhesions, while the collagen coated polyester group presented 10% (p<0,005). CONCLUSION: There was no difference between adhesion, degree of adhesion and strength needed to cause rupture. However, the polypropylene mesh presented significantly higher surface of adhesion when compared to the collagen coated polyester mesh.

Pode a tela de poliéster coberta com colágeno diminuir as taxas aderências intraperitoneais na correção de hérnia incisional? / May polyester with collagen coating mesh decrease the rate of intraperitoneal adhesions in incisional hernia repair?

RACIONAL: Entre as telas utilizadas na reparação de hérnias incisionais na técnica aberta, a de polipropileno é a mais utilizada devido à flexibilidade, estimulação do crescimento celular, resposta inflamatória satisfatória, fácil manipulação e baixo preço. No entanto, induz a formação de aderências, quando em contato com os conteúdos intra-abdominais. OBJETIVO: Avaliar as aderências formadas após a colocação intraperitoneal da tela de polipropileno e a tela de poliéster coberta com colágeno. MÉTODO: Foram utilizadas 26 ratas Wistar fêmeas, randomizadas em três grupos. No grupo 0 (sham) não houve colocação de prótese, apenas laparotomia; no grupo 1 foi implantada a prótese de polipropileno na superfície peritoneal; e no grupo 2, a prótese composta por poliéster coberta por colágeno. Todos os animais foram mortos 21 dias após o procedimento e avaliados quanto às vísceras envolvidas nas aderências, grau das aderências, percentual da tela acometimento por aderências e a força necessária para a sua ruptura. RESULTADOS: Não houve diferença de peso entre os grupos. O grupo 0 não apresentou aderência. Os grupos 1 e 2 apresentaram aderências na superfície da prótese, predominante no omento. O grau de aderências, superfície acometida não teve diferença representativa entre os grupos. A cobertura de colágeno não demonstrou aderências. As aderências ocorreram na borda livre da tela, em contato com a face de poliéster. Análise do tipo de superfície comprometida por aderências, o grupo polipropileno teve 80% e o grupo poliéster com colágeno apenas 10% (p<0,005). CONCLUSÃO: Para os parâmetros avaliados aderência, grau e força máxima de ruptura não houve diferença. No entanto, a tela de polipropileno teve superfície acometida pela aderência significativamente maior em relação à tela de poliéster protegida com colágeno.

BACKGROUND: Among meshes used in incisional hernias in open technique repair, the polypropylene is the most commonly used due to flexibility, cellular growth stimulation, satisfactory inflammatory response, easy manipulation and low price. However, it induces adhesions formation when in contact with the intra-abdominal contents. AIM: To evaluate the formation of adhesions after polypropylene and collagen coated polyester mesh with intraperitoneal placement. METHODS: Twenty six female Wistar rats were randomized in three groups. In the group 0 (sham) there was no prosthesis placement, in the polypropylene (group 1) the prosthesis was placed at the peritoneal surface and in the group 2, collagen coated polyester mesh was placed. The rats were killed on postoperative day 21 to evaluate adhesions regarding its degree, mesh percentage of involvement, bowel involvement and strength needed to cause rupture. RESULTS: There was no difference in weight between groups. The group 0 did not develop any adhesions. The groups 1 and 2 developed prosthetic mesh surface adhesions, mostly in the omentum. There was no difference in adhesion degree and percentage of surface involvement between groups. The collagen coated mesh did not develop adhesions. The adhesions occurred at the free edge of the mesh, in contact with the polyester. The Polypropylene group presented 80% of the surface involved with adhesions, while the collagen coated polyester group presented 10% (p<0,005). CONCLUSION: There was no difference between adhesion, degree of adhesion and strength needed to cause rupture. However, the polypropylene mesh presented significantly higher surface of adhesion when compared to the collagen coated polyester mesh.

Análise das aderências resultantes da fixação de telas cirúrgicas com selantes de fibrina e sutura: modelo experimental intraperitoneal / Analysis of adhesions resulted from mesh fixation with fibrin sealant and suture: experimental intraperitoneal model

OBJETIVO: Comparar fixação cirúrgica de telas de polipropileno (PP) e telas de polipropileno revestido (PCD), usando fio de sutura de polipropileno e cola biológica, quanto à formação de aderências intraperitoneais. MÉTODOS: Amostra de 46 ratas Wistar, randomizadas em seis grupos: dois grupos-controle, com cinco ratas cada, que foram submetidos um à incisão medial (IM) e o outro à uma incisão em forma de U (IU); nenhum desses grupos recebeu tela. Dois grupos com tela de PP, um com dez ratas, fixada com sutura (PPF), e o outro, com seis ratas, fixada com cola biológica (PPC). E Dois grupos com tela de PCD, no primeiro, com dez animais, a tela foi fixada com sutura (PCDF), e no segundo, com dez animais, com cola biológica (PCDC). RESULTADOS: Após o prazo de 21 dias, os grupos-controle não apresentaram aderências significantes. O grupo PPC apresentou menor grau de aderência do que o grupo PPF (p=0,01). Não houve diferença entre as fixações nos grupos com PCD. CONCLUSÃO: A comparação da fixação apresentou diferença estatística significativa apenas à tela de PP, com menor grau de aderência utilizando a cola. As aderências se localizaram predominantemente nas extremidades das telas estudadas.

OBJECTIVE: To compare surgical fixation of polypropylene mesh (PP) and coated polypropylene mesh (PCD) using polypropylene suture and fibrin glue, as for the formation of intraperitoneal adhesions. METHODS: A sample of 46 female Wistar rats were randomized into six groups: two control groups, with five rats each, were subjected to one medial incision (MI) and the other to a U-shaped incision (UI), none of these groups received the mesh. Two groups of PP mesh, with ten rats, fixed with suture (PPF), the other with six rats, fixed with biological glue (PPC). And two groups of PCD mesh, at first, with ten animals, the mesh was fixed with sutures (PCDFs) and the second with ten animals with biological glue (PCDC). RESULTS: After 21 days, the control groups showed no significant adhesions. The PPC group showed a lower degree of adhesion than the PPF group (p = 0.01). There was no difference between the groups with PCD. CONCLUSION: Comparison of fixation was statistically different only with PP mesh, with lesser degrees of adherence when using the glue. Adhesions were predominantly located at the extremities of the meshes studied.

Comparative study of intraperitoneal adhesions associated with the use of meshes of polypropylene and polypropylene coated with omega-3 fatty acid.

OBJECTIVE: To compare intraperitoneal adhesion formation with placement of polypropylene mesh and use of lightweight polypropylene mesh coated with omega-3 fatty in rats. METHODS: Twenty-seven Wistar rats were randomized into three groups. In group 0 no mesh was placed; in group 1 we implanted a polypropylene mesh; and in group 2 there was implantation of a polypropylene mesh coated with omega-3 fatty acid. We evaluated adhesions presence and degree, breaking strength, percentage of area covered and retraction of the implanted meshes. RESULTS: Group 0 had no adhesion. Groups 1 and 2 showed adhesions on the surface of the mesh, omentum, liver and intestinal loops. There were grades 1 and 2 adhesions in 100% of the polypropylene coated group and in 60% of the polypropylene group. The remaining were grade 3 adhesions, and differed significantly between groups (p <0.001). The breaking strength of adhesions on the polypropylene coated group was significantly higher than with the polypropylene alone (p = 0.016). There was no difference in mesh retraction or area covered by the mesh. The analysis of the mesh coated with omega-3 fatty acid distribution showed adhesions preferentially located at the edges when compared to polypropylene, predominantly in the center. CONCLUSION: The type of adhesions, percentage of surface affected and retraction were not significantly different between meshes. The fatty acids coated mesh had a lower degree of adhesions and these required a greater force to rupture, possibly by their occurrence at the edges of the mesh.

Estudo comparativo de aderências intraperitoneais associadas ao uso das telas de polipropileno e de malha leve de polipropileno revestida com ácido graxo ômega-3 / Comparative study of intraperitoneal adhesions associated with the use of meshes of polypropylene and polypropylene coated with omega-3 fatty acid

OBJETIVO: Comparar as aderências entre dois grupos de ratas Wistar submetidas à colocação intraperitoneal da tela de polipropileno e malha leve de polipropileno revestida com ácido graxo ômega-3. MÉTODOS: Foram utilizadas 27 ratas Wistar randomizadas em três grupos. No grupo 0 não houve colocação de prótese, no grupo 1 houve implantação da prótese de polipropileno e no grupo 2, implantação de prótese de polipropileno revestida com ácido graxo ômega-3. Foi avaliadas a presença de aderências, grau, força de ruptura, percentual de área recoberta e retração das telas aferidas. RESULTADOS: O grupo 0 não apresentou aderência. Os grupos 1 e 2 apresentaram aderência na superfície da prótese, omento, fígado e alça intestinal. Foram encontradas aderências grau 1 e 2 em 100% do grupo polipropileno revestida com ácido graxo ômega-3 e em 60% do grupo polipropileno. As demais eram aderências grau 3, e diferiram significativamente entre os grupos (p< 0,001). A força de ruptura da aderência na tela polipropileno revestida com ácido graxo ômega-3 foi significativamente maior do que na tela de polipropileno (p= 0,016). Não houve diferença na retração das telas ou superfície acometida pelas telas. A análise da tela revestida com ácido graxo ômega-3 demonstrou distribuição preferencialmente nas bordas em relação ao polipropileno, com predomínio no centro. CONCLUSÃO: O tipo de aderência, percentual de superfície acometida e retração não foram significativamente diferentes entre as telas. A tela de baixo peso apresentou menor grau de aderências, e, estas, necessitaram força maior para ruptura, possivelmente pelo predomínio de sua ocorrência nas bordas da tela.

OBJECTIVE: To compare intraperitoneal adhesion formation with placement of polypropylene mesh and use of lightweight polypropylene mesh coated with omega-3 fatty in rats. METHODS: Twenty-seven Wistar rats were randomized into three groups. In group 0 no mesh was placed; in group 1 we implanted a polypropylene mesh; and in group 2 there was implantation of a polypropylene mesh coated with omega-3 fatty acid. We evaluated adhesions presence and degree, breaking strength, percentage of area covered and retraction of the implanted meshes. RESULTS: Group 0 had no adhesion. Groups 1 and 2 showed adhesions on the surface of the mesh, omentum, liver and intestinal loops. There were grades 1 and 2 adhesions in 100% of the polypropylene coated group and in 60% of the polypropylene group. The remaining were grade 3 adhesions, and differed significantly between groups (p <0.001). The breaking strength of adhesions on the polypropylene coated group was significantly higher than with the polypropylene alone (p = 0.016). There was no difference in mesh retraction or area covered by the mesh. The analysis of the mesh coated with omega-3 fatty acid distribution showed adhesions preferentially located at the edges when compared to polypropylene, predominantly in the center. CONCLUSION: The type of adhesions, percentage of surface affected and retraction were not significantly different between meshes. The fatty acids coated mesh had a lower degree of adhesions and these required a greater force to rupture, possibly by their occurrence at the edges of the mesh.

Analysis of adhesions resulted from mesh fixation with fibrin sealant and suture: experimental intraperitoneal model.

OBJECTIVE: To compare surgical fixation of polypropylene mesh (PP) and coated polypropylene mesh (PCD) using polypropylene suture and fibrin glue, as for the formation of intraperitoneal adhesions. METHODS: A sample of 46 female Wistar rats were randomized into six groups: two control groups, with five rats each, were subjected to one medial incision (MI) and the other to a U-shaped incision (UI), none of these groups received the mesh. Two groups of PP mesh, with ten rats, fixed with suture (PPF), the other with six rats, fixed with biological glue (PPC). And two groups of PCD mesh, at first, with ten animals, the mesh was fixed with sutures (PCDFs) and the second with ten animals with biological glue (PCDC). RESULTS: After 21 days, the control groups showed no significant adhesions. The PPC group showed a lower degree of adhesion than the PPF group (p = 0.01). There was no difference between the groups with PCD. CONCLUSION: Comparison of fixation was statistically different only with PP mesh, with lesser degrees of adherence when using the glue. Adhesions were predominantly located at the extremities of the meshes studied.

Radiological evaluation of the patency of duodenal-esophageal anastomosis during a long postoperative follow-up: effectiveness of an alkaline reflux model in rats.

BACKGROUND: Performing experimental studies has played an important role in acquiring knowledge about esophageal carcinogenesis. In this context, the choice of a more reliable experimental model requires proof of its effectiveness in order to lend greater credibility to the results. The objective of this study was to evaluate the patency of duodenal-esophageal anastomosis during long-term postoperative follow-up in rats. METHODS: This was an experimental study in which 45 female Wistar rats were used. A side-to-side anastomosis was performed, going from the anterior side of the esophagus to the second duodenal portion. A standardized radiological technique was used to carry out a contrasted radiological study of the esophagus, stomach, and duodenum during weeks 4, 12, 20, and 30 after surgery. Different contrast media were used, and the animals were divided into groups, ie, group 1 (100% barium sulfate), group 2 (50% barium sulfate), and group 3 (60% aqueous iodinated contrast media). Contrast radiographs were taken in each group at weeks 4, 12, 20, and 30 after the surgical procedure. The radiographic images were evaluated by two radiologists who were blinded regarding the contrast groups. Macroscopic evaluation of each animal was compared with the radiological findings. RESULTS: Postoperative mortality was 13.33%. The remaining animals were divided into study groups. All the contrast radiological examinations showed evidence of the location of the esophagus, stomach, and proximal portion of the intestine, and demonstrated the laterolateral relationship of the distal esophagus and the duodenum in the epigastric region. Patency of the anastomosis was observed at each examination period. The different contrast media used were able to demonstrate this outcome shortly after the first phase of injection. Necropsies corroborated the radiological findings. CONCLUSION: Regardless of the contrast agent used, contrasted radiography revealed that side-to-side duodenal-esophageal anastomosis in rats allowed patent communication during long-term postoperative follow-up.

Toracotomia ou dissecção esofágica trans-hiatal: qual a melhor abordagem para o esôfago curto? / Thoracotomy versus transhiatal esophageal dissection: which is the best surgical approach to short esophagus?

PURPOSE: To evaluate different approaches performed to obtain a more significant esophageal length. METHODS: An experimental model using 28 cadavers was conceived. Randomized groups: Group A (n=10) underwent laparotomic transhiatal approach; Group B (n=9) which differed from the first in the conduction of a wide phrenotomy and Group C (n=9) esophageal dissection was performed through a left anterolateral thoracotomy. RESULTS: Final length variations for Group A were 2.12cm and 3.29cm and for Group B 3.24 cm and 3.66cm, without and with esophageal traction, respectively. In Group C length gain observed was 3.81 cm. The mediastinal dissections conducted through the hiatus was considered the procedure that produced the better esophageal mobilization, and the association of wide phrenotomy significantly improved the results. CONCLUSION: The mediastinal dissection was the most effective to improving gain in abdominal esophagus. When toracotomy and laparotomy were compared, no significant differences were observed in the outcome.

OBJETIVO: Avaliar diferentes procedimentos realizados para obtenção de um ganho mais significativo no comprimento esofágico. MÉTODOS: Um estudo experimental utilizando 28 cadáveres foi realizado. Randomização dos grupos: Grupo A (n=10): Submetido à abordagem laparotômica trans-hiatal; Grupo B (n=9): Diferente do primeiro apenas pela realização de uma frenotomia ampla; e Grupo C (n=9): A dissecção esofágica foi realizada por uma toracotomia anterior esquerda. RESULTADOS: A variação final do comprimento para o Grupo A foi 2,2 cm e 3,29 cm e para o Grupo B 3,24cm e 2,66cm, medidas na ausência e presença de tração esofágica, respectivamente. No Grupo C o ganho de comprimento observado foi de 3,81 cm. A dissecção mediastinal conduzida através do hiato foi considerada o procedimento de melhor mobilização esofágica e a associação de uma ampla frenotomia levou a uma significativa melhora nos resultados. CONCLUSÃO: A dissecção mediastinal foi a mais efetiva para promover o aumento do esôfago abdominal. Quando comparadas toracotomia e laparotomia, nenhuma diferença significativa foi observada no desfecho do estudo.

Thoracotomy versus transhiatal esophageal dissection: which is the best surgical approach to short esophagus?

PURPOSE: To evaluate different approaches performed to obtain a more significant esophageal length. METHODS: An experimental model using 28 cadavers was conceived. Randomized groups: Group A (n=10) underwent laparotomic transhiatal approach; Group B (n=9) which differed from the first in the conduction of a wide phrenotomy and Group C (n=9) esophageal dissection was performed through a left anterolateral thoracotomy. RESULTS: Final length variations for Group A were 2.12cm and 3.29cm and for Group B 3.24 cm and 3.66cm, without and with esophageal traction, respectively. In Group C length gain observed was 3.81 cm. The mediastinal dissections conducted through the hiatus was considered the procedure that produced the better esophageal mobilization, and the association of wide phrenotomy significantly improved the results. CONCLUSION: The mediastinal dissection was the most effective to improving gain in abdominal esophagus. When toracotomy and laparotomy were compared, no significant differences were observed in the outcome.

Abordagem videolaparoscópica para divertículo esofágico / Laparoscopic approach for esophageal diverticula

A toracotomia persiste como a abordagem clássica para cirurgia dos divertículos de esôfago. Seguindo a evolução das técnicas cirúrgicas minimamente invasivas, apresenta-se neste relato um procedimento alternativo, onde a abordagem laparoscópica transhiatal foi a opção terapêutica para um divertículo esofágico epifrênico. Devido aos resultados apresentados, sugere-se que a videolaparoscopia deva ser considerada como importante opção em centros com experiência em cirurgia videolaparoscópica avançada.

Thoracotomy remains as the classic approach to surgery for esophageal diverticula. Following the evolution of minimally invasive surgical techniques, this report presents an alternative procedure, where the approach of transhiatal laparoscopy was the therapeutic option for an epiphrenic esophageal diverticulum. Due to the results presented, it is suggested that laparoscopy should be considered as an important option in centers with experience in advanced laparoscopic surgery.

Effectiveness of the combined use of lactic acid film and polypropylene mesh in the formation of intraperitoneal adhesions--an experimental model in rats.

OBJECTIVE: To evaluate the efficacy of a lactic acid biomaterial (SurgiWrap®) as a protector of the polypropylene mesh (Marlex®) regarding the formation of intraperitoneal adhesions in rats. METHODS: Forty Wistar rats formed the following groups: Group 0 (Sham)--only laparotomy; Group I--polypropylene mesh; Group II--polypropylene mesh protected by a film of lactic acid. These animals were submitted to laparotomy and placement (or not) of the meshes at closing. After 21 days they were sacrificed for analysis of the adhesion type (0-3), percentage of affected area and strength needed to rupture. RESULTS: Group 0 showed no intraperitoneal adhesions. Regarding classification, type 3 adhesions had the highest prevalence in both groups 1 and 2. As for the strength to break adhesions, Group 1 had an average of 1.58 N and Group 2, 1.23 N. The mesh was surrounded by adhesions in more than 50% of their surface area in 87% of Group 1 subjects and in 84% of Group 2 individuals. Through different statistical methods we found that there was no significant difference between groups for both variables. CONCLUSION: The combined use of polypropylene mesh and lactic acid bioprotector showed similar results in relation to intraperitoneal adhesion formation when compared to the sole use of the same mesh.

Efetividade do uso combinado de filme de ácido lático e tela de polipropileno na formação de aderências intraperitoneal: um modelo experimental em ratos / Effectiveness of the combined use of lactic acid film and polypropylene mesh in the formation of intraperitoneal adhesions: an experimental model in rats

OBJETIVO: Avaliar a eficácia do uso de um biomaterial de ácido lático (SurgiWrap®) como protetor de tela de polipropileno (Marlex®) em relação à formação de aderências intraperitoneais em ratos. MÉTODO: Quarenta ratas Wistar formaram os grupos a seguir: Grupo 0 (Sham) - apenas laparotomia; Grupo I - tela de polipropileno; Grupo II - tela de polipropileno protegida por filme de ácido lático. Estes animais foram operados com laparotomia e colocação das telas no fechamento. Após 21 dias foram sacrificados para análise aderencial quanto ao tipo (0 a 3), porcentagem de área acometida e força necessária para rompimento. RESULTADOS: O Grupo 0 não apresentou aderências intraperitoneais. Em relação à classificação foi evidenciado a maior prevalência de aderências tipo 3 em ambos os grupos. Quanto à força para ruptura aderencial o Grupo 1 obteve média de 1,58 N e o Grupo 2 de 1,23 N. A tela foi envolvida por aderências em mais de 50 por cento da área de sua superfície em 87 por cento no Grupo 1 e 84 por cento no Grupo 2. Por diferentes métodos estatísticos constatou-se que não houve diferença significativa entre os grupos nas variáveis estudadas. CONCLUSÃO: A utilização do combinado tela de polipropileno e bioprotetor de ácido lático demonstrou índices semelhantes em relação à formação de aderências intraperitoneais quando comparada ao uso individual da mesma tela.

OBJECTIVE: To evaluate the efficacy of a lactic acid biomaterial (SurgiWrap®) as a protector of the polypropylene mesh (Marlex®) regarding the formation of intraperitoneal adhesions in rats. METHODS: Forty Wistar rats formed the following groups: Group 0 (Sham) - only laparotomy; Group I - polypropylene mesh; Group II - polypropylene mesh protected by a film of lactic acid. These animals were submitted to laparotomy and placement (or not) of the meshes at closing. After 21 days they were sacrificed for analysis of the adhesion type (0-3), percentage of affected area and strength needed to rupture. RESULTS: Group 0 showed no intraperitoneal adhesions. Regarding classification, type 3 adhesions had the highest prevalence in both groups 1 and 2. As for the strength to break adhesions, Group 1 had an average of 1.58 N and Group 2, 1.23 N. The mesh was surrounded by adhesions in more than 50 percent of their surface area in 87 percent of Group 1 subjects and in 84 percent of Group 2 individuals. Through different statistical methods we found that there was no significant difference between groups for both variables. CONCLUSION: The combined use of polypropylene mesh and lactic acid bioprotector showed similar results in relation to intraperitoneal adhesion formation when compared to the sole use of the same mesh.

Evolução clínica de pacientes operados por fraturas diafisárias do fêmur em um serviço especializado: um estudo prospectivo / Clinical evolution of the patients treated surgically for femoral shaft fractures in a specialized service: a prospective study

Introdução: As fraturas de diáfise de fêmur estão geralmente associadas a traumas de alta energia. O tratamento adequado dessa condição exige o conhecimento de particularidades anatômicas e funcionais, além de ter um papel importante no prognóstico do paciente. O objetivo deste estudo foi avaliar a evolução dos pacientes operados por fratura diafisária de fêmur durante um período de cinco anos em um serviço de referência em ortopedia para trauma. Métodos: Estudo prospectivo, onde foram avaliados parâmetros de evolução clínica pós-operatória, como complicações cirúrgicas, transfusão sanguínea, permanência hospitalar e consolidação em relação às condições pré-operatórias e ao tratamento cirúrgico instituído. A técnica cirúrgica fez o uso de haste femoral intramedular bloqueada e os pacientes foram acompanhados até o final do primeiro ano. Resultados: 29 pacientes foram avaliados, sendo o principal mecanismo de trauma o acidente de trânsito (55,1%). Foi evidenciado maior prevalência de consolidação insatisfatória (n=6) e tempo operatório em pacientes que necessitaram transfusão sanguínea transoperatória (n=17). A taxa de consolidação relatada foi de 89,7%, com tempo médio de 151±57. Ao final do acompanhamento, 79,3% dos casos foram considerados. A reintervenção foi necessária em 34,5% dos casos e as principais complicações foram infecção e consolidação insatisfatória. Houve uma morte durante o período de seguimento. Conclusões: Os resultados encontrados com o uso de haste medular bloqueada foram considerados adequados. Transfusão sanguínea e tempo operatório prolongado foram associados a pior prognóstico

Introduction: Fractures of the diaphysis of the femur are usually associated with high energy trauma. Proper treatment of this condition requires knowledge of anatomical and functional features and plays an important role in prognosis. The aim of this study was to evaluate the evolution of patients operated for femoral diaphyseal fractures over a period of five years in a referral center for orthopedic trauma. Methods: A prospective study in which we evaluated postoperative clinical parameters such as surgical complications, blood transfusion, hospital stay and consolidation in relation to preoperative conditions and surgical treatment performed. The surgical technique used locked intramedullary femoral nailing and the patients were followed for one year. Results: 29 patients were evaluated, and the primary mechanism of injury was traffic accidents (55.1%). There was evidence of a greater prevalence of poor consolidation (n = 6) and operative time in patients who required transoperative blood transfusion (n = 17). The consolidation rate was 89.7% with mean time of 151 ± 57. At the end of follow-up 79.3% of the cases were considered. Reintervention was required in 34.5% of the cases and the main complications were infection and unsatisfactory consolidation. There was one death during the follow-up period. Conclusions: The results found using locked medullary nailing were considered appropriate. Blood transfusion and longer operative time were associated with poor prognosis

Prevalência de alcoolemia em óbitos por acidente de transporte e por outras causas externas / Prevalence of alcoholemy in deaths from traffic accidents and other external causes

Introdução: Trauma é a principal causa de óbitos em indivíduos entre 18 e 44 anos de vida no Brasil. Por mais de um século, o álcool tem sido reconhecido como um dos principais fatores de risco para acidentes fatais, desempenhando um importante papel na etiologia do trauma. O objetivo deste estudo foi comparar o diagnóstico de alcoolemia entre mortos por acidentes de trânsito e outras causas externas (afogamento, homicídio e suicídio). Métodos: Foi realizado um estudo transversal onde se utilizaram dados secundários do Departamento de Medicina Legal de Porto Alegre no período de janeiro a dezembro de 2001. As variáveis estudadas foram o nível de alcoolemia e óbitos por causas externas. Resultados: Foram analisados 1.588 óbitos. Os homicídios ocorreram na faixa etária entre 19 e 45 anos, representando 80% dos casos. As causas externas ocorrem com mais frequência em homens e a maior causa de óbitos entre mulheres foi por acidente de trânsito, com menor alcoolemia. Os pacientes que apresentam alcoolemia positiva tiveram uma razão de prevalência de 1,18 (IC 95%:1,05 a 1,32) em relação ao óbito por acidente de trânsito em comparação ao suicídio. Conclusão: Este estudo demonstra que o álcool é fator contribuinte de morte por causas externas, especialmente aquelas causadas por acidentes de trânsito e homicídio

Introduction: Trauma is the leading cause of death in individuals between 18 and 44 years of age living in Brazil. For over a century, alcohol has been recognized as a major risk factor for fatal accidents, playing an important role in the etiology of trauma. The aim of this study was to compare the diagnosis of alcoholemy in individuals who died in traffic accidents and from other external causes (drowning, homicide and suicide). Methods: We conducted a cross-sectional study based on secondary data from the Department of Forensic Medicine of Porto Alegre from January to December 2001. The variables were blood alcohol content (BAC) and deaths from external causes. Results: We analyzed 1,588 deaths. The murders occurred between the ages of 19-45 years, accounting for 80% of the cases. External causes occur more frequently in men, and traffic accidents are the leading cause of death among women, with lower blood alcohol levels. Patients with positive blood alcohol content had a prevalence ratio of 1.18 (95% CI: 1.05 to 1.32) in relation to death by traffic accidents as compared to suicide. Conclusion: This study demonstrates that alcohol is a contributing factor of death from external causes, especially those caused by traffic accidents and homicide