ABSTRACT
To determine if preoperative-intraoperative factors such as age, comorbidities, American Society of Anesthesiologists (ASA) classification, body mass index (BMI), and severity of peritonitis affect the rate of morbidity and mortality in patients undergoing a primary anastomosis (PA) or Hartmann Procedure (HP) for perforated diverticulitis. This is a systematic review and meta-analysis, conducted according to PRISMA, with an electronic search of the PubMed, Medline, Cochrane Library, and Google Scholar databases. The search retrieved 614 studies, of which 11 were included. Preoperative-Intraoperative factors including age, ASA classification, BMI, severity of peritonitis, and comorbidities were collected. Primary endpoints were mortality and postoperative complications including sepsis, surgical site infection, wound dehiscence, hemorrhage, postoperative ileus, stoma complications, anastomotic leak, and stump leakage. 133,304 patients were included, of whom 126,504 (94.9%) underwent a HP and 6800 (5.1%) underwent a PA. There was no difference between the groups with regards to comorbidities (p = 0.32), BMI (p = 0.28), or severity of peritonitis (p = 0.09). There was no difference in mortality [RR 0.76 (0.44-1.33); p = 0.33]; [RR 0.66 (0.33-1.35); p = 0.25]. More non-surgical postoperative complications occurred in the HP group (p = 0.02). There was a significant association in the HP group between the severity of peritonitis and mortality (p = 0.01), and surgical site infection (p = 0.01). In patients with perforated diverticulitis, PA can be chosen. Age, comorbidities, and BMI do not influence postoperative outcomes. The severity of peritonitis should be taken into account as a predictor of postoperative morbidity and mortality.
Subject(s)
Intestinal Perforation , Peritonitis , Postoperative Complications , Humans , Postoperative Complications/epidemiology , Postoperative Complications/mortality , Intestinal Perforation/mortality , Intestinal Perforation/surgery , Peritonitis/mortality , Peritonitis/surgery , Peritonitis/etiology , Body Mass Index , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/methods , Preoperative Period , Diverticulitis/surgery , Diverticulitis/complications , Diverticulitis/mortality , Severity of Illness Index , Age Factors , Comorbidity , Intraoperative Period , MorbidityABSTRACT
The aim of this study is to describe the state of gender representation in surgery across Ecuador. A survey of female surgeons in Ecuador was conducted, collecting information regarding demographics, academics, family and relationships, sexual harassment, discrimination and gender preference of one's own surgeon. All statistical analysis was conducted with IBM-SPSS version 25. The platform, Worlde, was used for discourse analysis. Of the 144 female surgeons who received the survey, 105 responded. Almost half of respondents had a higher degree in addition to their surgical training. Leadership positions in the workplace were reported to be held by males in 66.7% of cases. Relationship problems caused by the surgical profession were reported by 72.4% of respondents. Feelings of guilt for not dedicating enough time to family were reported by 72.4%, and a feeling of not being supported by their partner was reported by 31.4% of respondents. Sexual harassment was described by 55.2%, and discrimination by 48.6% of the female surgeons in our sample. The majority (89.5%) would choose surgery again if given the opportunity. Significant gender disparities remain within the surgical community in Ecuador.
Subject(s)
Sexual Harassment , Surgeons , Ecuador/epidemiology , Female , Humans , Male , Surveys and Questionnaires , WorkplaceABSTRACT
INTRODUCCIÓN: El abdomen abierto es una estrategia quirúrgica que ha permitido realizar un manejo quirúrgico de infecciones intraabdominales; una de las patologías intraabdominales que puede ser manejada como abdomen abierto es la diverticulitis. El manejo de la diverticulitis con un cuadro clínico séptico es quirúrgico y se pueden requerir de terapias que no son de aplicación frecuente. CASO CLÍNICO: Se trata de un paciente de sexo masculino de 46 años de edad que luego de ser diagnosticado con diverticulitis y tras una serie de intervenciones tuvo un desenlace con abdomen abierto, fistula biliar, ileostomía, colostomía, estado séptico y desnutrición severa. EVOLUCIÓN: El paciente fue manejando en forma integral, para el tratamiento quirúrgico se recurrió a la técnica de presión negativa (TPN) o sistema «vaccum¼, requirió varias cirugías para cambio del sistema vaccum y revisión de ostomías; el cierre definitivo de cavidad se realizó junto con el servicio de Cirugía Plástica. CONCLUSIÓN: El manejo adecuado del cuadro abdominal sin duda fue la clave para la recuperación del paciente, la utilización de técnicas innovadoras y con fundamento científico asegura una evolución adecuada del paciente.(AU)
BACKGROUND: Open abdomen is a surgical strategy which has being used to manage severe abdominal infections; one of those pathologies that can be managed is diverticulitis. Management of diverticulitis with an associated septic abdomen must be surgical and infrequent therapies may be required to treat it. CASE REPORT: It is about a 43-years old male patient who was diagnosed with diverticulitis and after many surgical procedures came with an open abdomen, biliary fistula, ileostomy, colostomy, septic shock and severe malnutrition. EVOLUTION: A complete management and Negative-Pressure Therapy or «vaccum¼ system was used for initial surgical treatment, the patient required additional procedures to change the system and check the ostomies. Definitive closure was performed with the collaboration of Plastic Surgery service. CONCLUSION: A proper management of this case was the key of the patient's recovery undoubtedly. Use of innovative and science-based techniques ensures and adequate patient outcome.(AU)
Subject(s)
Humans , Male , Child, Preschool , Middle Aged , Peritonitis/therapy , Negative-Pressure Wound Therapy , SepsisABSTRACT
INTRODUCCIÓN: La patología biliar afecta a un gran porcentaje de la población adulta, motivo por el cual su tratamiento en la actualidad ha cambiado hacia un nuevo paradigma de cuidado bajo el concepto de "Acute Care Surgery" (ACS) *, el cual se caracteriza por priorizar la valoración integral del paciente e intervención precoz de la patología. En el Hospital Vicente Corral Moscoso (HVCM) bajo este modelo ACS, y mediante la utili-zación de protocolos estandarizados se ha logrado dar un giro importante en el tratamiento oportuno de la patología bi-liar mediante la utilización de herramientas habituales como pruebas de laboratorio, imagenología y si es el caso, la resolución quirúrgica mediante técnica mínimamente invasiva o por vía convencional.OBJETIVO:Describir el comportamiento de la patología biliar y su manejo en el servicio de Trauma y Emergencia del Hospital "Vicente Corral Moscoso", durante el período de enero a ju-nio de 2014, bajo el modelo ACS. MÉTODOS:Estudio descriptivo transversal, que analizó los casos de colecistitis aguda litiásica (CAL), coledocolitiasis, pancreatitis aguda biliar (PAB) y su manejo, registrado en la base de datos digital del servicio de Emergencia del Hospital Vicente Corral Moscoso, bajo criterios clínicos, de laboratorio e imagenológicos, durante el periodo de enero a junio del 2014.RESULTADOS:El estudio contó con un total de 240 pa-cientes atendidos en el servicio de Trauma y Emergencia del HVCM, durante el periodo de enero a junio de 2014. La patología en orden de frecuencia fue: en un 47% la Coledocolitiasis; 35% colecistitis aguda y, pancreatitis aguda biliar 18%. La prevalencia fue mayor en el sexo femenino en un 85%, 67%, y 81% respectivamente y el tratamiento se adaptó a cada patología.* "Acute Care Surgery" (ACS): si bien no existe una definición literal hace referencia a una disciplina tripartita que engloba la ci-rugía de trauma, general en emergencias y cuidados críticos quirúrgicos, y que prioriza la identificación y manejo de las patologías potencialmente letales y de alta morbili-dad. En nuestro medio lo más próximo a la definición seria Cirugía de Trauma y Emergencias.El manejo de la pancreatitis aguda biliar (PAB) bajo el concepto de cuidado agu-do de pacientes quirúrgicos o "Acute Care Surgery" hace indispensable una interven-ción oportuna y temprana, utilizando todos los recursos disponibles para un manejo in-tegral. CONCLUSIONES: La implementación del modelo de Cirugía de Trauma y Emergencias en nuestra insti-tución ha logrado un manejo integral de colecistitis aguda litiásica, pancreatitis agu-da biliar y coledocolitiasis, disminuyendo las complicaciones asociadas y evitando las recidivas de cuadros de mayor gravedad.
Biliary disease affects a large percentage of the adult population, for this reason its treat-ment now has shifted to a new paradigm of care under the concept of "Acute Care Surgery" (ACS) 1, which is characterized by prioritize the comprehensive patient assess-ment and the early intervention of patholo-gy. In the Vicente Corral Moscoso Hospital (VCMH) under this model ACS and using standardized protocols, has achieved an im-portant turn in the early treatment of biliary pathology using standard tools such as labo-ratory tests, radiology and if it is necessary in any case through the resolution by minima-lly invasive surgical technique or by conven-tional means.OBJECTIVE: To describe the behavior of the biliary di-sease and its management in the service of Trauma and Emergency of the "Vicente Corral Moscoso Hospital" during the period January-June 2014, under the model (ACS) during the period January-June 2014. METHODS: A cross-sectional study, which analyzed ca-ses of acute cholecystitis (CAL), choledo-cholithiasis, acute biliary pancreatitis (ABP) and their management, registered in the di-gital database service of the Emergency in the Vicente Corral Moscoso Hospital, under clinical criteria, laboratory and imaging, du-ring the period January-June 2014.RESULTS: The study involved a total of 240 patients treated in the Trauma and Emergency in the VCMH during the period January- Sep-tember 2014. The pathology in order of fre-quency was 47% choledocholithiasis, 35% acute cholecystitis and acute biliary pan-creatitis 18%, the prevalence was higher in women by 85%, 67% and 81% respectively and treatment was adapted to the corres-ponding pathologies. CONCLUSIONS: The implementation model of Trauma and Emergency Surgery at our institution has achieved an integrated management of the acute cholecystitis, acute biliary pan-creatitis and choledocholithiasis, reducing the associated complications and avoiding the recurrence of more serious pictures.