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1.
Hernia ; 2024 Mar 14.
Artículo en Inglés | MEDLINE | ID: mdl-38485812

RESUMEN

PURPOSE: Parastomal hernia (PH) stands out as a prevalent complication following end colostomies, significantly affecting patients' quality of life. Various surgical strategies, predominantly involving prophylactic mesh deployment, have been explored with variable outcomes. This study details our experience and mid-term outcomes utilizing a funnel-shaped mesh. METHODS: A single-center, prospective, non-randomized, observational study examined consecutive patients undergoing colorectal surgery with end colostomy, incorporating a 3D-funnel mesh from January 2019 to December 2021 (PM group). A historical cohort of patients with end colostomy without prophylactic mesh served as the comparison (C group). Postoperative morbidity within 30 days was documented, and clinical examinations and radiological tests were employed for parastomal hernia diagnosis during follow-up. RESULTS: Seventy-two patients participated, with thirty-four in the PM group and thirty-eight in the C group. The PM group experienced 16 postoperative complications, unrelated to the mesh, while the C group recorded 20 complications (p = 0.672). Median follow-up was 22.06 months for the PM group and 63.18 months for the C group. The PM group exhibited a lower parastomal hernia incidence during follow-up (8.8%) compared to the C group(68.4%) (p < 0.001). CONCLUSION: Prophylactic use of a 3D-funnel mesh appears effective in reducing parastomal hernia incidence in the short and mid-term, without an associated increase in postoperative morbidity.

2.
Cir. Esp. (Ed. impr.) ; 96(2): 88-95, feb. 2018. tab, graf
Artículo en Español | IBECS | ID: ibc-172255

RESUMEN

Introducción: La colecistectomía laparoscópica ambulatoria es segura y proporciona mejor aprovechamiento de recursos sanitarios y satisfacción percibida, sin repercutir en la calidad asistencial. La educación preoperatoria ha demostrado disminución del estrés, del dolor y náuseas postoperatorios en algunas intervenciones. El objetivo principal del estudio es valorar el impacto de la educación preoperatoria sobre el dolor postoperatorio en la colecistectomía laparoscópica ambulatoria. Los objetivos secundarios fueron evaluar las náuseas postoperatorias, morbilidad, ingresos no esperados, readmisiones, calidad de vida y grado de satisfacción. Métodos: Estudio prospectivo, aleatorizado, doble ciego. Entre abril de 2014 y mayo de 2016 fueron intervenidos 62 pacientes de colecistectomía laparoscópica ambulatoria. Criterios de inclusión: ASA I-II, edad 18-75 años, criterios de ambulatorización, ecografía abdominal con colelitiasis. Aleatorización de pacientes en grupo A: educación preoperatoria intensificada, y grupo B: control. Resultados: Sesenta y dos pacientes incluidos, 44 mujeres (71%), 18 hombres (29%), edad media 46,8 años (20-69). Media IMC de 27,5. Tasa de ambulatorización del 92%, 5 casos requirieron ingreso, 2 fueron por náuseas. La media del grado de dolor según EVA fue a las 24 h de 2,9 en el grupo A y de 2,7 en el grupo B. No complicaciones graves ni reingresos. La encuesta de satisfacción y el test de calidad de vida no mostraron diferencias entre grupos. Conclusiones: Las bajas cifras de dolor y complicaciones impiden evidenciar diferencias atribuibles a la educación preoperatoria. Sin embargo, un correcto protocolo de información se debería integrar en la preparación preoperatoria de los pacientes (AU)


Introduction: Outpatient laparoscopic cholecystectomy is a safe procedure and provides a better use of health resources and perceived satisfaction without affecting quality of care. Preoperative education has shown less postoperative stress, pain and nausea in some interventions. The principal objective of this study is to assess the impact of preoperative education on postoperative pain in patients undergoing ambulatory laparoscopic cholecystectomy. Secondary objectives were: to evaluate presence of nausea, morbidity, hospital admissions, readmissions rate, quality of life and satisfaction. Methods: Prospective, randomized, and double blind study. Between April 2014 and May 2016, 62 patients underwent outpatient laparoscopic cholecystectomy. Inclusion criteria: ASA I-II, age 18-75, outpatient surgery criteria, abdominal ultrasonography with cholelithiasis. Patient randomization in two groups, group A: intensified preoperative education and group B: control. Results: Sixty-two patients included, 44 women (71%), 18 men (29%), mean age 46,8 years (20-69). Mean BMI 27,5. Outpatient rate 92%. Five cases required admission, two due to nausea. Pain scores obtained using a VAS was at 24-hour, 2,9 in group A and 2,7 in group B. There were no severe complications or readmissions. Results of satisfaction and quality of life scores were similar for both groups. Conclusions: We did not find differences due to intensive preoperative education. However, we think that a correct information protocol should be integrated into the patient's preoperative preparation (AU)


Asunto(s)
Humanos , Masculino , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Colecistectomía Laparoscópica/métodos , Colelitiasis/cirugía , Colecistitis/cirugía , Cálculos Biliares/cirugía , Educación del Paciente como Asunto/organización & administración , Estudios Prospectivos , Procedimientos Quirúrgicos Ambulatorios/métodos
3.
Cir Esp (Engl Ed) ; 96(2): 88-95, 2018 Feb.
Artículo en Inglés, Español | MEDLINE | ID: mdl-29224843

RESUMEN

INTRODUCTION: Outpatient laparoscopic cholecystectomy is a safe procedure and provides a better use of health resources and perceived satisfaction without affecting quality of care. Preoperative education has shown less postoperative stress, pain and nausea in some interventions. The principal objective of this study is to assess the impact of preoperative education on postoperative pain in patients undergoing ambulatory laparoscopic cholecystectomy. Secondary objectives were: to evaluate presence of nausea, morbidity, hospital admissions, readmissions rate, quality of life and satisfaction. METHODS: Prospective, randomized, and double blind study. Between April 2014 and May 2016, 62 patients underwent outpatient laparoscopic cholecystectomy. INCLUSION CRITERIA: ASA I-II, age 18-75, outpatient surgery criteria, abdominal ultrasonography with cholelithiasis. Patient randomization in two groups, group A: intensified preoperative education and group B: control. RESULTS: Sixty-two patients included, 44 women (71%), 18 men (29%), mean age 46,8 years (20-69). Mean BMI 27,5. Outpatient rate 92%. Five cases required admission, two due to nausea. Pain scores obtained using a VAS was at 24-hour, 2,9 in group A and 2,7 in group B. There were no severe complications or readmissions. Results of satisfaction and quality of life scores were similar for both groups. CONCLUSIONS: We did not find differences due to intensive preoperative education. However, we think that a correct information protocol should be integrated into the patient's preoperative preparation. Registered in ISRCTN number ISRCTN83787412.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Colecistectomía Laparoscópica , Educación del Paciente como Asunto , Adulto , Anciano , Colecistectomía Laparoscópica/métodos , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/prevención & control , Satisfacción del Paciente , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios , Estudios Prospectivos , Calidad de Vida , Adulto Joven
4.
Cir. Esp. (Ed. impr.) ; 92(5): 324-328, mayo 2014. tab
Artículo en Español | IBECS | ID: ibc-123159

RESUMEN

INTRODUCCIÓN: Aunque los resultados de la colecistectomía laparoscópica estándar son excelentes, se continúa intentando minimizar el número de puertos con el objeto de disminuir el dolor postoperatorio, conseguir una recuperación más temprana y mejorar el resultado estético del paciente. El objetivo de este estudio es presentar los resultados de los primeros 100 casos de colecistectomía por puerto único practicados en un hospital de segundo nivel. MATERIAL Y MÉTODOS: Estudio prospectivo, observacional, unicéntrico. Se intervino a 100 pacientes entre enero de 2010 y abril de 2012. CRITERIOS DE INCLUSIÓN: pacientes mayores de 16 años con colelitiasis sintomática operados por colecistectomía simple mediante incisión umbilical única. Criterios de exclusión: antecedentes de colecistitis aguda, colangiopancreatografía retrógrada endoscópica, pancreatitis o sospecha de coledocolitiasis, IMC > 35 y laparotomías previas. Se estudiaron distintas variables epidemiológicas, quirúrgicas y de seguridad. RESULTADOS: La edad media de los pacientes fue de 39,89 ± 11,5 años. El tiempo quirúrgico medio fue de 67,94 ± 25,5 min. Presentaron complicaciones postoperatorias 2 pacientes: seroma y fuga biliar. En 2 casos fue necesaria la utilización de trocar accesorio. La estancia media fue de 1,13 ± 0,8 días. El 35% de los pacientes fueron tratados en régimen de cirugía mayor ambulatoria. Todos los pacientes se mostraron muy satisfechos con el resultado estético. CONCLUSIONES: La colecistectomía mediante incisión umbilical única es una buena técnica cuando se utiliza en casos seleccionados y por cirujanos expertos. Puede facilitar la práctica de la colecistectomía en régimen ambulatorio. No se han presentado complicaciones graves. El índice de satisfacción estética es muy elevado


INTRODUCTION: Despite the excellent results obtained with standard laparoscopic cholecystectomy, the efforts for minimizing the ports needed to reduce postoperative pain, for a quicker recovery and to improve the patient's cosmetics continue. The aim of this study is to report the results of the first 100 cases of single port laparoscopic cholecystectomy performed in a secondary care hospital. MATERIAL AND METHODS: Prospective, observational and unicentric study including 100 patients between January 2010 and April 2012. Inclusion criteria: symptomatic cholelythiasis patients over 16 years of age on whom a single port laparoscopic cholecystectomy was performed. Exclusion criteria: history of acute cholecystitis, pancreatitis or suspected choledocholithiasis, Endoscopic retrograde cholangiopancreatography, BMI > 35 and previous laparotomies. We studied epidemiological, surgical and safety variables. RESULTS: The mean patient age was 39.89 ± 11.5 years. The mean time of the surgical procedure was 67.94 ± 25.5 min. There were 2 cases of postoperative complications: a non-infected seroma and a biliar leak. In 2 cases the use of an accessory trocar was needed. The mean hospital stay was 1.13 ± 0.8 days. A total of 35% patients were included in the major ambulatory surgery program. The overall patient satisfaction survey rating showed a high level of cosmetic satisfaction in 100% of patients. CONCLUSIONS: Single port laparoscopic cholecystectomy is a good technique when performed in selected cases by expert surgeons. It is feasible to include the single port laparoscopic cholecystectomy in a major ambulatory surgery program. We have not had serious complications. There is a high cosmetic satisfaction index with this technique


Asunto(s)
Humanos , Colecistectomía Laparoscópica/estadística & datos numéricos , Ombligo/cirugía , Procedimientos Quirúrgicos Ambulatorios/estadística & datos numéricos , Cirugía Endoscópica por Orificios Naturales/estadística & datos numéricos , Estudios Prospectivos , Complicaciones Posoperatorias/epidemiología
5.
Cir Esp ; 92(5): 324-8, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24169438

RESUMEN

INTRODUCTION: Despite the excellent results obtained with standard laparoscopic cholecystectomy, the efforts for minimizing the ports needed to reduce postoperative pain, for a quicker recovery and to improve the patient's cosmetics continue. The aim of this study is to report the results of the first 100 cases of single port laparoscopic cholecystectomy performed in a secondary care hospital. MATERIAL AND METHODS: Prospective, observational and unicentric study including 100 patients between January 2010 and April 2012. INCLUSION CRITERIA: symptomatic cholelythiasis patients over 16-years of age on whom a single port laparoscopic cholecystectomy was performed. EXCLUSION CRITERIA: history of acute cholecystitis, pancreatitis or suspected choledocholithiasis, Endoscopic retrograde cholangiopancreatography, BMI>35 and previous laparotomies. We studied epidemiological, surgical and safety variables. RESULTS: The mean patient age was 39,89 ± 11,5 years. The mean time of the surgical procedure was 67,94 ± 25,5 min. There were 2 cases of postoperative complications. A non-infected seroma and a biliar leak. In 2 cases the use of an accessory trocar was needed. The mean hospital stay was 1,13 ± 0,8 days. A total of 35% patients were included in the major ambulatory surgery programme.The overall patient satisfaction survey rating showed a high level of cosmetic satisfaction in 100% of patients. CONCLUSIONS: Single port laparoscopic cholecystectomy is a good technique when performed in selected cases by expert surgeons. It is feasible to include the single port laparoscopic cholecystectomy in a major ambulatory surgery programme. We have not had serious complications. There is a high cosmetic satisfaction index with this technique.


Asunto(s)
Colecistectomía Laparoscópica/métodos , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Centros de Atención Secundaria , Adulto Joven
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