Subject(s)
Chylothorax , Fistula , Thoracic Duct , Thyroid Gland/surgery , Adult , Chylothorax/etiology , Female , Fistula/etiology , Humans , Lymphography , Thoracic Duct/surgeryABSTRACT
No disponible
Subject(s)
Humans , Endocrine Surgical Procedures/instrumentation , Parathyroid Glands/surgery , Thyroid Gland/surgery , Equipment DesignSubject(s)
Carcinoma, Renal Cell , Carcinoma , Humans , Kidney Neoplasms , Pattern Recognition, Visual , Repression, PsychologyABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Thyroid Neoplasms , Carcinoma/surgery , Prognosis , Incidental Findings , Neoplasm Metastasis/therapyABSTRACT
Antecedentes y objetivo: El cáncer tiroideo puede manifestarse clínicamente por la presencia de un nódulo cervical, o constituir un hallazgo casual en el estudio histológico de la glándula extirpada con diagnóstico, a priori, benigno. El objetivo del presente estudio fue estudiar las diferencias clínicas, de manejo quirúrgico y curso evolutivo entre los tumores tiroideos incidentales y los tumores detectados clínicamente. Material y métodos: Estudio retrospectivo de pacientes intervenidos por enfermedad tiroidea, ya fuese benigna o maligna, en el período comprendido entre enero de 2000 y marzo de 2014. De 1.415 pacientes que se sometieron a algún tipo de cirugía tiroidea se identificaron un total de 264 neoplasias, de las cuales 170 fueron incidentales. Se realizó comparación entre carcinomas incidentales versus no incidentales. Además, entre los incidentales se compararon los casos cuya indicación quirúrgica fue enfermedad de Graves frente a bocio multinodular. Resultados: Los carcinomas incidentales presentaron estadios más precoces y requirieron cirugía menos agresiva. No se observaron diferencias en las complicaciones quirúrgicas entre ambos grupos, aunque tanto la mortalidad como las tasas de recidiva fueron notablemente mayores en el grupo de no incidentales (4,4% vs 0% y 13,2% vs 4,8% respectivamente). Los carcinomas desarrollados sobre enfermedad de Graves no mostraron diferencias respecto al resto de los tumores incidentales, respecto a complicaciones, mortalidad o recidiva tras la cirugía. Conclusiones: El cáncer tiroideo en estadios iniciales presenta mayor supervivencia y mejor respuesta al tratamiento quirúrgico (AU)
Background and objective: Thyroid cancer may be clinically evident as a tumor mass in the neck or as a histopathological incidental finding after thyroid surgery for an apparent benign condition. Our objective was to assess the differences in clinical signs, surgical management, and course between incidental and clinically diagnosed thyroid tumors. Methods: A retrospective study was conducted on patients operated on for benign or malignant thyroid disease from January 2000 to March 2014. Among the 1415 patients who underwent any thyroid surgery, 264 neoplasms were found, of which 170 were incidental. A comparison was made of incidental versus non-incidental carcinomas. Among incidental carcinomas, cases whose indication for surgery was Graves disease were compared to those with multinodular goiter. Results: Incidental carcinomas were in earlier stages and required less aggressive surgery. There were no differences in surgical complications between incidental and clinical tumors, but mortality and relapses were markedly higher in non-incidental cancers (4.4% vs 0% and 13.2% vs 4.8% respectively). Carcinomas developing on Graves disease showed no differences from all other incidental tumors in terms of complications, mortality, or relapse after surgery. Conclusions: Early stage thyroid cancer has better survival and prognosis after surgical treatment (AU)
Subject(s)
Humans , Thyroid Neoplasms/diagnosis , Thyroid Carcinoma, Anaplastic/diagnosis , Incidental Findings , Prognosis , Early Detection of CancerABSTRACT
BACKGROUND AND OBJECTIVE: Thyroid cancer may be clinically evident as a tumor mass in the neck or as a histopathological incidental finding after thyroid surgery for an apparent benign condition. Our objective was to assess the differences in clinical signs, surgical management, and course between incidental and clinically diagnosed thyroid tumors. METHODS: A retrospective study was conducted on patients operated on for benign or malignant thyroid disease from January 2000 to March 2014. Among the 1415 patients who underwent any thyroid surgery, 264 neoplasms were found, of which 170 were incidental. A comparison was made of incidental versus non-incidental carcinomas. Among incidental carcinomas, cases whose indication for surgery was Graves' disease were compared to those with multinodular goiter. RESULTS: Incidental carcinomas were in earlier stages and required less aggressive surgery. There were no differences in surgical complications between incidental and clinical tumors, but mortality and relapses were markedly higher in non-incidental cancers (4.4% vs 0% and 13.2% vs 4.8% respectively). Carcinomas developing on Graves' disease showed no differences from all other incidental tumors in terms of complications, mortality, or relapse after surgery. CONCLUSIONS: Early stage thyroid cancer has better survival and prognosis after surgical treatment.
Subject(s)
Adenocarcinoma, Follicular/epidemiology , Carcinoma, Papillary/epidemiology , Thyroid Neoplasms/epidemiology , Thyroidectomy , Adenocarcinoma, Follicular/diagnosis , Adenocarcinoma, Follicular/surgery , Adult , Carcinoma, Papillary/diagnosis , Carcinoma, Papillary/surgery , Comorbidity , Female , Goiter, Nodular/epidemiology , Goiter, Nodular/surgery , Graves Disease/epidemiology , Graves Disease/surgery , Humans , Incidental Findings , Male , Middle Aged , Postoperative Complications/epidemiology , Prognosis , Retrospective Studies , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/surgeryABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Trachea/injuries , Thyroidectomy/adverse effects , Graves Disease/surgery , Graves Ophthalmopathy/diagnosis , Postoperative ComplicationsABSTRACT
OBJETIVOS: La hemorragia digestiva alta (HDA) es una potencial complicación tras la cirugía bariátrica, con una incidencia entre el 2 y el 4%. El objetivo de este estudio es presentar nuestra incidencia de HDA tras cirugía bariátrica, su forma de presentación y su manejo mediante un algoritmo terapéutico. Pacientes y método: Estudio observacional prospectivo de una serie de 300 cirugías bariátricas por laparoscopia de manera consecutiva, desde enero del 2004 hasta diciembre del 2012. Se recogen datos demográficos, forma de presentación, diagnóstico y tratamiento de la HDA. En 280 pacientes se practicó bypass gástrico según la técnica de Wittgrove modificada, con anastomosis circular en 265 y anastomosis longitudinal en 15. En 20 pacientes se practicó gastrectomía vertical. RESULTADOS: Aparecieron 27 casos (9%) de HDA tratados con: cirugía en un caso por inestabilidad hemodinámica; con gastroscopia diagnóstica-terapéutica en 13 casos (en 2 casos, 2 veces); en 10 de ellos, apareció de forma precoz (1-6 días) cuyo origen fue la línea de sutura de la anastomosis gastroyeyunal (GY) y en 3 de forma tardía, a los 15-20 días, siendo su origen una úlcera en la boca anastomótica. En el resto (13 pacientes), el manejo fue de forma conservadora. CONCLUSIONES: Aunque el manejo conservador de la HDA resuelve la mayoría de los casos, la clínica y la forma de presentación deben alertarnos, por lo que, en casos graves de sangrado, se requerirá de una endoscopia urgente. Es importante un equipo multidisciplinar y una comunicación estrecha entre cirujanos y endoscopistas para el manejo de esta seria complicación
OBJECTIVE: Gastrointestinal bleeding (GB) is a potential complication after bariatric surgery and its frequency is around 2-4% according to the literature. The aim of this study is to present our experience with GB after bariatric surgery, its presentation and possible treatment options by means of an algorithm. PATIENTS AND METHOD: From January 2004 to December 2012, we performed 300 consecutive laparoscopic bariatric surgeries. A total of 280 patients underwent a laparoscopic Roux en Y gastric bypass with creation of a gastrojejunal anastomosis using a circular stapler type CEAA No 21 in 265 patients and with a linear stapler in 15 patients. Demographics, clinical presentation, diagnostic evaluation and treatment were reviewed. A total of 20 patients underwent a sleeve gastrectomy. RESULTS: Twenty-seven cases (9%) developed GB. Diagnosis and therapeutic endoscopy was required in 13 patients. The onset of bleeding occurred between the 1st-6th postop days in 10 patients, and the origin was at the gastrojejunostomy staple-lines, and 3 patients had bleeding from an anastomotic ulcer 15-20 days after surgery. All other patients were managed non-operatively. CONCLUSION: Conservative management of gastrointestinal bleeding is effective in most cases, but endoscopy with therapeutic intent should be considered in patients with severe or recurrent bleeding. Multidisciplinary postoperative follow- up is very important for early detention and treatment of this complication
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Endoscopy, Digestive System/methods , Bariatric Surgery/adverse effects , Gastrointestinal Hemorrhage/etiology , Obesity, Morbid/surgery , Postoperative Complications/surgery , Gastric Bypass/adverse effects , LaparoscopyABSTRACT
OBJECTIVE: Gastrointestinal bleeding (GB) is a potential complication after bariatric surgery and its frequency is around 2-4% according to the literature. The aim of this study is to present our experience with GB after bariatric surgery, its presentation and possible treatment options by means of an algorithm. PATIENTS AND METHOD: From January 2004 to December 2012, we performed 300 consecutive laparoscopic bariatric surgeries. A total of 280 patients underwent a laparoscopic Roux en Y gastric bypass with creation of a gastrojejunal anastomosis using a circular stapler type CEAA No 21 in 265 patients and with a linear stapler in 15 patients. Demographics, clinical presentation, diagnostic evaluation and treatment were reviewed. A total of 20 patients underwent a sleeve gastrectomy. RESULTS: Twenty-seven cases (9%) developed GB. Diagnosis and therapeutic endoscopy was required in 13 patients. The onset of bleeding occurred between the 1(st)-6(th) postop days in 10 patients, and the origin was at the gastrojejunostomy staple-lines, and 3 patients had bleeding from an anastomotic ulcer 15-20 days after surgery. All other patients were managed non-operatively. CONCLUSION: Conservative management of gastrointestinal bleeding is effective in most cases, but endoscopy with therapeutic intent should be considered in patients with severe or recurrent bleeding. Multidisciplinary postoperative follow- up is very important for early detention and treatment of this complication.
Subject(s)
Algorithms , Bariatric Surgery/adverse effects , Emergency Treatment , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/surgery , Gastroscopy , Postoperative Complications/etiology , Postoperative Complications/surgery , Adult , Gastric Bypass/adverse effects , Humans , Male , Middle Aged , Prospective StudiesSubject(s)
Colitis/etiology , Enema/adverse effects , Absorbable Implants , Aged , Colitis/pathology , Colitis/therapy , Dilatation , Humans , Male , Necrosis , Sigmoidoscopy , StentsABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Colitis/complications , Colitis/diagnosis , Enema/adverse effects , Enema/methods , Abdominal Pain/complications , Abdominal Pain/etiology , Colonoscopy/methods , Colonoscopy , Constriction, Pathologic/complications , Leukocytosis/complications , Leukocytosis/diagnosis , Peritoneum/pathology , Peritoneum , Tomography, Emission-Computed , SigmoidoscopyABSTRACT
INTRODUCCIÓN: La estenosis de la anastomosis gastroyeyunal (GY) representa la complicación más frecuente en la cirugía de derivación gástrica por laparoscopia, llegando en algunas series a alcanzar el 15%. Presentamos nuestra incidencia de estenosis de la anastomosis GY en el bypass gástrico laparoscópico, su forma de presentación y su manejo a largo plazo. MATERIAL Y MÉTODO: Desde enero del 2004 hasta diciembre del 2012 se han realizado 280 bypass gástricos por la laparoscopia, según la técnica de Wittgrove modificada. La anastomosis GY circular se practicó con material de autosutura tipo CEAA n° 21 en 265 casos, en los restantes se realizó con una anastomosis longitudinal con grapadora lineal de 45 mm. A todos los pacientes con intolerancia persistente a la alimentación se les realizó tránsito baritado o gastroscopia. Cuando se evidenció estenosis GY (diámetro <10 mm), se procedió a dilatación neumática endoscópica. RESULTADOS: En 20 casos (7,1%) se desarrolló una estenosis GY, en 4 de ellos el diagnóstico inicial fue con tránsito baritado. Todos los casos fueron confirmados por gastroscopia. De ellos, 5 pacientes tenían antecedentes de hemorragia digestiva alta que precisaron esclerosis endoscópica de la línea de sutura de la anastomosis GY. Todos los casos se han resuelto mediante dilatación endoscópica, precisando en un caso 2 sesiones de dilatación, en otro caso 3 sesiones y el resto, una. No se han detectado reestenosis. Uno de los pacientes sufrió una perforación de úlcera postanastomótica. CONCLUSIONES: La estenosis de la anastomosis GY es una complicación frecuente tras el bypass gástrico en Y de Roux. Favorecida por anastomosis de pequeño calibre. La endoscopia es la piedra angular para el diagnóstico y tratamiento, pues resuelve la mayoría de casos, siendo rara la revisión quirúrgica
OBJETIVE: Gastrojejunal stricture (GYS), not only is a common complication after laparoscopic gastric bypass, but its frequency is about 15% according to bibliography. Our aim is to present our experience after 280 laparoscopic gastric bypass. PATIENTS AND METHOD: From January 2004 to December 2012, 280 patients underwent a laparoscopic Roux en Y gastric bypass with creation of the gastrojejunal anastomosis is performed with circular stapler type CEAA No 21 in 265 patients and with a linear stapler in 15 patients. In all patients with persistent feeding intolerance were performed barium transit and/or gastroscopy. When gastrojejunal stricture showed proceeded to endoscopic pneumatic dilation. RESULTS: Twenty cases (7.1%) developed a gastrojejunal stricture, in 4 of these cases the initial diagnosis was made by barium transit and all case were confirmed by endoscopy. Five patients had a history of digestive bleeding that required endoscopic sclerosis of the bleeding lesion. All cases were resolved by endoscopic dilatation. One patient suffered a perforation and a re-intervention. At follow-up has not been detected re-stricture. CONCLUSION: Structure at the gastrojejunal anastomosis after gastric bypass is the commonest complication early after surgery. Endoscopic balloon dilatation is a safe and effective therapy
Subject(s)
Humans , Male , Female , Adult , Constriction, Pathologic/diagnosis , Constriction, Pathologic/surgery , Gastric Bypass , Jejunoileal Bypass/methods , Jejunoileal Bypass/trends , Jejunoileal Bypass , Bariatric Surgery/methods , Bariatric Surgery , Risk Factors , Anastomosis, Roux-en-Y/methods , Anastomosis, Roux-en-Y/trends , Anastomosis, Roux-en-Y , Anastomosis, Surgical/methods , Prospective Studies , Heparin/therapeutic use , Antibiotic Prophylaxis/methods , Antibiotic Prophylaxis/trends , Endoscopy/methods , EndoscopyABSTRACT
OBJECTIVE: Gastrojejunal stricture (GYS), not only is a common complication after laparoscopic gastric bypass, but its frequency is about 15% according to bibliography. Our aim is to present our experience after 280 laparoscopic gastric bypass. PATIENTS AND METHOD: From January 2004 to December 2012, 280 patients underwent a laparoscopic Roux en Y gastric bypass with creation of the gastrojejunal anastomosis is performed with circular stapler type CEAA No 21 in 265 patients and with a linear stapler in 15 patients. In all patients with persistent feeding intolerance were performed barium transit and/or gastroscopy. When gastrojejunal stricture showed proceeded to endoscopic pneumatic dilation. RESULTS: Twenty cases (7.1%) developed a gastrojejunal stricture, in 4 of these cases the initial diagnosis was made by barium transit and all case were confirmed by endoscopy. Five patients had a history of digestive bleeding that required endoscopic sclerosis of the bleeding lesion. All cases were resolved by endoscopic dilatation. One patient suffered a perforation and a re-intervention. At follow-up has not been detected re-stricture. CONCLUSION: Structure at the gastrojejunal anastomosis after gastric bypass is the commonest complication early after surgery. Endoscopic balloon dilatation is a safe and effective therapy.
Subject(s)
Gastric Bypass/adverse effects , Gastric Bypass/methods , Jejunum/pathology , Jejunum/surgery , Laparoscopy , Stomach/pathology , Stomach/surgery , Adult , Anastomosis, Roux-en-Y , Constriction, Pathologic/etiology , Female , Humans , Male , Middle Aged , Prospective Studies , Time FactorsABSTRACT
INTRODUCCIÓN: Las abdominoplastias se han convertido en un proceso quirúrgico frecuente en pacientes con pérdida masiva de peso tras cirugía bariátrica. Este tipo de procedimientos no están exentos de complicaciones que afectan a la calidad de vida y satisfacción del paciente. El objetivo de este estudio es encontrar los factores de riesgo para desarrollar dichas complicaciones y evaluar la satisfacción de nuestros pacientes. MATERIAL Y MÉTODOS: A un total de 72 pacientes, de los 175 intervenidos de cirugía bariátrica, se les realizó una abdominoplastia entre 2003 y 2008. Fueron revisados, retrospectivamente: datos demográficos, estado pre- y poscirugía, comorbilidades, tasa de complicaciones y reintervención. El nivel de satisfacción fue medido mediante una encuesta expresada en una escala tipo Likert. Se realizó un análisis comparativo de las distintas variables entre pacientes con y sin complicaciones. RESULTADOS: a) Complicaciones: tasa global del 45,5%. La más frecuente fue el seroma (23,6%); infección (13,9%), sangrado (11,1%), hematoma (6,9%) (requiriendo transfusión [6,9%]), necrosis de piel (6,9%) y necrosis umbilical (4,2%). Se reintervino a 8 pacientes (11,1%). b) Satisfacción: 1) muy satisfecho: 51,4%; 2) satisfecho: 31,9%; 3) insatisfecho: 8,3%; 4) muy insatisfecho: 8,3%.c) Se encuentra una relación estadísticamente significativa entre complicaciones, reintervención, estancia media y satisfacción (p < 0,001). CONCLUSIÓN: Las complicaciones son relativamente frecuentes en este tipo de pacientes, alargando la estancia media y posteriores controles ambulatorios. No hemos identificado factores de riesgo que ayuden a prevenir este tipo de complicaciones. El grado de insatisfacción está en relación con las complicaciones postoperatorias del procedimiento quirúrgico y no con el resultado estético
BACKGROUND: Body contouring surgery is in high demand following the increase in bariatric surgery. But these types of procedures are associated with high complication rates that cause long hospital stays and have a negative effect on patient satisfaction. The purpose of this study is to identify predictors of complications in order to optimize outcomes in these patients and find a relationship between complication rate and satisfaction. MATERIAL AND METHODS: Out of a group of 175 post-bariatric patients, 72 patients underwent body contouring surgery following massive weight loss from 2003-2008. They were reviewed retrospectively for demographic data, pre- and postoperative weight status, co-morbidities and complications and reoperation rate. Patient satisfaction was evaluated. RESULTS: a) Complications: The overall complication rate was 45.8%. The most frequent were seromas (23.6%); infection (13.9%), bleeding (11.1%), hematoma (6.9%) (needing transfusions [6.9%]), skin necrosis (6.9%) and umbilical necrosis (4.2%). A total of 8 patients required reoperation (11.1%).b) Satisfaction rating: 1) very satisfied: 51.4%, 2) satisfied: 31.9%, 3) dissatisfied: 8.3%, 4) very dissatisfied: 8.3%.c) The presence of complications was significantly associated with patients' satisfaction, reoperation rate and longer hospital stays (P<.001). CONCLUSIONS: Post operative complications were frequent. No predictors could be found to prevent these complications and optimize patient selection and appropriate timing of surgery. Patients with complications had a significantly higher reoperation rate, longer hospital stay and more dissatisfaction. The patients' satisfaction was negatively influenced by complication occurrence and not by the aesthetic results
Subject(s)
Humans , Lipectomy/methods , Bariatric Surgery/methods , Obesity/surgery , Abdominoplasty/methods , Patient Satisfaction , Postoperative ComplicationsABSTRACT
BACKGROUND: Body contouring surgery is in high demand following the increase in bariatric surgery. But these types of procedures are associated with high complication rates that cause long hospital stays and have a negative effect on patient satisfaction. The purpose of this study is to identify predictors of complications in order to optimize outcomes in these patients and find a relationship between complication rate and satisfaction. MATERIAL AND METHODS: Out of a group of 175 post-bariatric patients, 72 patients underwent body contouring surgery following massive weight loss from 2003-2008. They were reviewed retrospectively for demographic data, pre- and postoperative weight status, co-morbidities and complications and reoperation rate. Patient satisfaction was evaluated. RESULTS: a) COMPLICATIONS: The overall complication rate was 45.8%. The most frequent were seromas (23.6%); infection (13.9%), bleeding (11.1%), hematoma (6.9%) (needing transfusions [6.9%]), skin necrosis (6.9%) and umbilical necrosis (4.2%). A total of 8 patients required reoperation (11.1%). b) Satisfaction rating: 1) very satisfied: 51.4%, 2) satisfied: 31.9%, 3) dissatisfied: 8.3%, 4) very dissatisfied: 8.3%. c) The presence of complications was significantly associated with patients' satisfaction, reoperation rate and longer hospital stays (P<.001). CONCLUSIONS: Post operative complications were frequent. No predictors could be found to prevent these complications and optimize patient selection and appropriate timing of surgery. Patients with complications had a significantly higher reoperation rate, longer hospital stay and more dissatisfaction. The patients' satisfaction was negatively influenced by complication occurrence and not by the aesthetic results.