RESUMEN
The purpose of this study was to describe the outcome of patients undergoing surgery with recognized and unrecognized factor VIII inhibitor. The setting was a tertiary care center with a community-based general surgery training program. Two patients with acquired factor VIII inhibitor coagulopathy required cholecystectomy. Interventions included intravenous immunoglobulin (IVIG) and factor VIII transfusions. An elderly patient undergoing urgent open cholecystectomy for acute cholecystitis exsanguinated despite postoperative recognition and treatment of factor VIII inhibitor. A second patient with known factor VIII inhibitor underwent laparoscopic cholecystectomy with perioperative transfusions of factor VIII and IVIG. No hemorrhage occurred, but cost to the patient exceeded 50,000 dollars. Acquired factor VIII inhibitor coagulopathy is rare and potentially lethal. Preoperative recognition and appropriate hematologic intervention is crucial to achieve a successful outcome.
Asunto(s)
Colecistectomía/efectos adversos , Factor VIII/antagonistas & inhibidores , Hemofilia A/complicaciones , Hemorragia Posoperatoria/terapia , Adulto , Anciano , Autoanticuerpos/inmunología , Trastornos de la Coagulación Sanguínea/complicaciones , Trastornos de la Coagulación Sanguínea/inmunología , Transfusión de Componentes Sanguíneos/economía , Transfusión de Componentes Sanguíneos/métodos , Pérdida de Sangre Quirúrgica/prevención & control , Colecistectomía Laparoscópica/efectos adversos , Factor VIII/inmunología , Resultado Fatal , Femenino , Hemofilia A/inmunología , Humanos , Inmunoglobulinas Intravenosas/economía , Inmunoglobulinas Intravenosas/uso terapéutico , Masculino , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/prevención & control , Resultado del TratamientoRESUMEN
Esophageal dilators (EDs) are commonly used during antireflux surgery but are a known cause of esophageal perforation. We hypothesized that the usage of ED during laparoscopic fundoplications (LFs) would not improve dysphagia rates or outcome. A retrospective review of 268 consecutive patients and a postoperative patient survey were performed to compare outcomes in patients undergoing LF. Eighty-nine patients had an ED placed and 179 did not. Significant postoperative dysphagia occurred in seven (8%) and six (3%), respectively (P = 0.123) and postoperative heartburn in five (6%) and three (2%), respectively (P = 0.865), in a mean 26.8-month follow-up. Patient survey results demonstrated good to excellent satisfaction in 89 per cent of patients in both groups. We conclude that the results of LF are equivalent with respect to control of heartburn and risk of dysphagia regardless of ED usage. Selective rather than routine use of EDs is recommended.