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1.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(4): 321-326, 2020 Apr 25.
Artículo en Chino | MEDLINE | ID: mdl-32306596

RESUMEN

Acute abdomen, abdominal trauma, gastrointestinal bleeding and gastrointestinal tumors are the main conditions that are routinely treated in gastrointestinal surgery department with high incidence and critical condition. These conditions need emergency or selective operations. During the outbreak of the coronavirus disease 2019 (COVID-19), it's a great challenge for us to meet the patients' requirement under the situation. As the COVID-19 was brought under control in China, the Department of General Surgery in Nanfang Hospital resumed regular medical services gradually. Based on our clinical practice, the four major measures of strengthening pre-hospital screening, perioperative prevention and control, medical staff protection, and ward management were adopted. These main measures include the strict implementation of the appointment system and triage system before admission; the conduction of epidemiological and preliminary screening of viral nucleic acids; the chest CT examination during the perioperative period to re-screen COVID-19; the reduction of the risk of droplets and aerosol transmission; the minimally invasive surgery combined with enhanced recovery program in order to reduce patient's susceptibility and shorten the length of postoperative hospital stay; the reinforcement of specific infection control training for medical staff; the strict implementation of hierarchical protection; the establishment of gastrointestinal surgery prevention and control system; the rehearsal of emergency exercise; the installation of quarantine wards; the screening and management of family care-givers; the strict disinfection of environment and materials. Our preliminary practice shows that following the work guidelines issued by the Guangdong Province COVID-19 Prevention and Control Office and adopting precise management strategies in combination with the specific clinical features of gastrointestinal surgery, it is possible to safely resume regular care for the patients and comply to epidemic control at the same time.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Infección Hospitalaria/prevención & control , Procedimientos Quirúrgicos del Sistema Digestivo , Enfermedades Gastrointestinales/cirugía , Cirugía General/organización & administración , Pandemias/prevención & control , Neumonía Viral/prevención & control , Betacoronavirus , China , Control de Enfermedades Transmisibles/métodos , Brotes de Enfermedades , Adhesión a Directriz , Humanos , Tiempo de Internación
4.
Anticancer Res ; 40(4): 2297-2301, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32234929

RESUMEN

BACKGROUND/AIM: Pancreatic surgery is associated with a high risk of developing deep venous thrombosis (DVT) and malnutrition. We aimed to evaluate the factors predicting the development of DVT, focusing on nutrition assessment tools. PATIENTS AND METHODS: One hundred patients who underwent pancreatic surgery were postoperatively examined for DVT. We assessed the risk factors for the development of DVT after surgery. RESULTS: Postoperative DVT was detected in 11 patients (11%). Patients who developed DVT after surgery were significantly older (p=0.016) and had higher preoperative D-dimer levels (p=0.005) than those who did not. The preoperative prognostic nutritional index (PNI) was mostly associated with the development of DVT (p=0.079). Furthermore, PNI ≤44.3, BUN >20 mg/dl, D-dimer ≥1.9 µg/ml were independent predictors for the development of DVT after surgery. CONCLUSION: A poor nutrition status and dehydration should be preoperatively improved for patients who are identified, as having a high risk of developing DVT after pancreatic surgery.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Evaluación Nutricional , Pancreatectomía/métodos , Complicaciones Posoperatorias/diagnóstico , Trombosis de la Vena/diagnóstico , Anciano , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Humanos , Masculino , Persona de Mediana Edad , Pancreatectomía/efectos adversos , Complicaciones Posoperatorias/etiología , Periodo Preoperatorio , Pronóstico , Factores de Riesgo , Trombosis de la Vena/etiología
5.
Anticancer Res ; 40(4): 1891-1896, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32234877

RESUMEN

BACKGROUND/AIM: Advances in stapling devices have led to their widespread use in colorectal surgery. We compared the strength of four types of anastomoses using bursting pressure. MATERIALS AND METHODS: We created stapled anastomosis models [double stapling technique (DST), functional end-to-end anastomosis (FEEA) unbuttressed or buttressed, and triangulating anastomosis (TA) with two- or three-row stapling] and a hand-sewn anastomosis model. Bursting pressures of each method were measured. The primary end point was the bursting pressure. The effectiveness of buttressing and three-row stapling were the secondary endpoints. RESULTS: The DST group had significantly lower bursting pressure than TA with three-row stapling, FEEA buttressed, and hand-sewn groups. No significant difference was found between the bursting pressure of the FEEA unbuttressed and FEEA buttressed groups and that of the TA with two-row and three-row stapling groups. CONCLUSION: DST has the lowest bursting pressure compared to other anastomotic techniques. Buttressing suture and three-row stapling have no effect on the strength of anastomosis.


Asunto(s)
Anastomosis Quirúrgica/métodos , Neoplasias Colorrectales/cirugía , Cirugía Colorrectal/métodos , Grapado Quirúrgico/métodos , Neoplasias Colorrectales/patología , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Humanos , Técnicas de Sutura
6.
Surg Clin North Am ; 100(2): 249-264, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32169179

RESUMEN

Robotic-assisted surgery for benign esophageal disease is described for treatment of achalasia, gastroesophageal reflux, paraesophageal hernias, epiphrenic diverticula, and benign esophageal masses. Robotic Heller myotomy has operative times, relief of dysphagia, and conversion rates comparable to laparoscopic approach, with lower incidence of intraoperative esophageal perforation. The use of robotic platform for primary antireflux surgery is under evaluation, due to prolonged operative time and increased operative costs, with no differences in postoperative outcomes or hospital stay. Studies have shown benefits of robotic surgery in complex reoperative foregut surgery with respect to decreased conversion rates, lower readmission rates, and improved functional outcomes.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Enfermedades del Esófago/cirugía , Esofagectomía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Fundoplicación/métodos , Hernia Hiatal/cirugía , Humanos , Laparoscopía/métodos
7.
Zhonghua Wai Ke Za Zhi ; 58(3): 183-188, 2020 Mar 01.
Artículo en Chino | MEDLINE | ID: mdl-32187922

RESUMEN

The cirrhotic portal hypertension is very common worldwide and poses a serious threat to the health of patients.Over past three decades, the surgical treatment for cirrhotic portal hypertension was strongly challenged by the drugs, endoscopy, interventional therapy and liver transplantation.However, under the multidisciplinary team(MDT) cooperative diagnosis and treatment mode, the surgical treatment still plays a unique and irreplaceable role.Laparoscopic pericardial vascular devascularization is characterized by less injury and bleeding, rapid postoperative recovery, which will coexist with open surgery for portal hypertension. It is important to focus on the development and application of new methods, new technologies and new concepts under the MDT cooperative diagnosis and treatment mode, giving full play to the advantages of each discipline and advocate standardized, individualized and precise treatment should be emphasized to maximize patient clinical benefits.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo , Hipertensión Portal/cirugía , Cirrosis Hepática/cirugía , China , Humanos , Laparoscopía , Esplenectomía
8.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(2): 129-133, 2020 Feb 25.
Artículo en Chino | MEDLINE | ID: mdl-32074791

RESUMEN

Clinical research is a form of scientific study, whose subjects focus on patients. Its main contents include the etiology, diagnosis, treatment and prognosis related to their disease. Its working place is mainly in medical service and institutes. It is organized and conducted jointly by clinical doctors, epidemiologists, statisticians and multidisciplinary experts. Surgical clinical research, different from studies on pharmaceuticals, has inherent limitations, such as difficulties in establishing standardized intervention, designing rigorous control group, achieving real blinded randomization, or setting unified standards for multicenter practice. To overcome these obstacles, the following points should be considered before initiating: (1) clinical problems based on scientific rationale and the principle of "population-intervention-comparison-outcome" (PICO) should be raised. (2) research methods are applied normatively, and "idea, development, exploration, assessment, long-term follow up" (IDEAL) methodology published in Lancet 2009 is recommended for assessment of new surgical techniques. (3) professional research team is built up to accomplish protocol design, study execution, and efficient follow-up collaboratively and successfully. (4) authenticity of clinical data is ensured, and acquisition and verification of data are standardized. Aiming at clinical problems of laparoscopic gastric cancer, Chinese Laparoscopic Gastrointestinal Surgery Study Group (CLASS) established in 2009 has initiated a series of CLASS studies and has led to the rapid development of domestic surgical clinical researches on laparoscopic surgery of gastric cancer like a great fire initiated by spark kindles. Herein, based on the experience of CLASS studies, this review summarizes the difficulties and countermeasures of surgical clinical research, so as to humbly share some experience of our team with fellows and colleagues.


Asunto(s)
Investigación Biomédica/tendencias , Procedimientos Quirúrgicos del Sistema Digestivo , Laparoscopía , Humanos , Proyectos de Investigación , Neoplasias Gástricas/cirugía
9.
J Surg Oncol ; 121(6): 1015-1021, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32090338

RESUMEN

BACKGROUND AND OBJECTIVES: Current data are conflicting as to whether the outcomes of octogenarians undergoing resection for esophagogastric adenocarcinoma are comparable to younger patients. This study aims to compare perioperative outcomes and survival of patients ≥80 years old with younger patients undergoing curative resection for esophagogastric adenocarcinoma. METHODS: Retrospective data were collected on 190 patients who underwent resection with curative intent for adenocarcinomas found in the stomach and esophagogastric junction from 2004 to 2015 at a single institution. RESULTS: Of the 190 patients, 34 (18%) were ≥80 years old. Octogenarians were more likely to have chronic kidney disease (CKD) and were less likely to have received neoadjuvant chemotherapy. Pathologic features were similar between groups. Octogenarians' tumors were more likely to be located in the gastric body as compared to the esophagogastric junction in younger patients. Although the length of stay was comparable, octogenarians were significantly less likely to be discharged home (P < .01). Both groups had a single death during the index admission. Incidence and severity of 90 days postoperative complications were not significantly different between groups. There was no difference in 30-day, 90-day, 1-year, or median survival. CONCLUSIONS: Perioperative outcomes and survival of octogenarians undergoing curative resection for esophagogastric cancer are comparable to younger patients at our institution.


Asunto(s)
Neoplasias Esofágicas/cirugía , Unión Esofagogástrica/cirugía , Neoplasias Gástricas/cirugía , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Factores de Edad , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Neoplasias Esofágicas/patología , Unión Esofagogástrica/patología , Femenino , Humanos , Masculino , Periodo Perioperatorio , Estudios Retrospectivos , Neoplasias Gástricas/patología , Tasa de Supervivencia , Resultado del Tratamiento
10.
Rev Col Bras Cir ; 46(6): e20192314, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-32022110

RESUMEN

OBJECTIVE: to assess whether laparoscopy with peritoneal lavage is superior to computed tomography for staging gastric adenocarcinoma and whether it can modify the surgical approach. METHODS: we conducted a retrospective study of 46 patients with gastric adenocarcinoma treated by the digestive surgery team of the Passo Fundo Clinics Hospital (RS), from January 2015 to December 2018, and submitted to laparoscopy with preoperative peritoneal lavage. All patients underwent preoperative clinical staging with computed tomography. RESULTS: of the 46 patients analyzed, the majority had tumors located in the cardia (34.8%), poorly differentiated (69.6%), and subtype signet ring cells (65.2%). In 91.3%, the computed tomography scan did not identify peritoneal carcinomatosis or distant metastasis. Among these patients with negative computed tomography for distant disease, 21.8% had positive peritoneal lavage for neoplastic cells and had their therapeutic approaches modified. CONCLUSION: laparoscopy and peritoneal lavage altered the surgical decision in 21.8% of patients, providing a more reliable preoperative staging in gastric adenocarcinoma.


Asunto(s)
Adenocarcinoma/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Laparoscopía/métodos , Lavado Peritoneal/métodos , Neoplasias Gástricas/cirugía , Adenocarcinoma/patología , Anciano , Femenino , Gastrectomía/métodos , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Cuidados Preoperatorios , Estudios Retrospectivos , Neoplasias Gástricas/patología , Tomografía Computarizada por Rayos X
11.
Am Fam Physician ; 101(4): 206-212, 2020 02 15.
Artículo en Inglés | MEDLINE | ID: mdl-32053333

RESUMEN

Evaluation and management of acute lower gastrointestinal bleeding focus on etiologies originating distally to the ligament of Treitz. Diverticular disease is the most common source, accounting for 40% of cases. Hemorrhoids, angiodysplasia, infectious colitis, and inflammatory bowel disease are other common sources. Initial evaluation should focus on obtaining the patient's history and performing a physical examination, including evaluation of hemodynamic status. Subsequent evaluation should be based on the suspected etiology. Most patients should undergo colonoscopy for diagnostic and therapeutic purposes once they are hemodynamically stable and have completed adequate bowel preparation. Early colonoscopy has not demonstrated improved patient-oriented outcomes. Hemodynamic stabilization using normal saline or balanced crystalloids improves mortality in critically ill patients. For persistently unstable patients or those who cannot tolerate bowel preparation, abdominal computed tomographic angiography should be considered for localization of a bleeding source. Technetium Tc 99m-labeled red blood cell scintigraphy should not be routinely used in the evaluation of lower gastrointestinal bleeding. Surgical intervention should be considered only for patients with uncontrolled severe bleeding or multiple ineffective nonsurgical treatment attempts. Percutaneous catheter embolization should be considered for patients who are poor surgical candidates. Treatment is based on the identified source of bleeding.


Asunto(s)
Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Enfermedad Aguda , Colonoscopía , Angiografía por Tomografía Computarizada , Procedimientos Quirúrgicos del Sistema Digestivo , Embolización Terapéutica , Hemorragia Gastrointestinal/etiología , Humanos
13.
BMC Surg ; 20(1): 3, 2020 Jan 03.
Artículo en Inglés | MEDLINE | ID: mdl-31900149

RESUMEN

BACKGROUND: Although enhanced recovery after surgery (ERAS) has made great progress in the field of surgery, the guidelines point to the lack of high-quality evidence in upper gastrointestinal surgery. METHODS: Randomized controlled trials in four electronic databases that involved ERAS protocols for upper gastrointestinal surgery were searched through December 12, 2018. The primary endpoints were lung infection, urinary tract infection, surgical site infection, postoperative anastomotic leakage and ileus. The secondary endpoints were postoperative length of stay, the time from end of surgery to first flatus and defecation, and readmission rates. Subgroup analysis was performed based on the type of surgery. RESULTS: A total of 17 studies were included. The results of the meta-analysis indicate that there was a decrease in rates of lung infection (RR = 0.50, 95%CI: 0.33 to 0.75), postoperative length of stay (MD = -2.53, 95%CI: - 3.42 to - 1.65), time until first postoperative flatus (MD = -0.64, 95%CI: - 0.84 to - 0.45) and time until first postoperative defecation (MD = -1.10, 95%CI: - 1.74 to - 0.47) in patients who received ERAS, compared to conventional care. However, other outcomes were not significant difference. There was no significant difference between ERAS and conventional care in rates of urinary tract infection (P = 0.10), surgical site infection (P = 0.42), postoperative anastomotic leakage (P = 0.45), readmissions (P = 0.31) and ileus (P = 0.25). CONCLUSIONS: ERAS protocols can reduce the risk of postoperative lung infection and accelerating patient recovery time. Nevertheless, we should also consider further research ERAS should be performed undergoing gastrectomy and esophagectomy.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/rehabilitación , Recuperación Mejorada Después de la Cirugía , Humanos , Tiempo de Internación/tendencias , Periodo Posoperatorio
14.
Rev Med Suisse ; 16(676-7): 23-26, 2020 Jan 15.
Artículo en Francés | MEDLINE | ID: mdl-31961077

RESUMEN

The main novelties in 2019 are about colorectal surgery and oncologic surgery. Acute diverticulitis and mechanical bowel obstruction are frequently diagnosed in primary care medicine. In 2019, EAES (European Association for Endoscopic Surgery) and SAGES (Society of American Gastrointestinal and Endoscopic Surgeons) published their recommendations for the management of diverticulitis. Recent data, along with our current practice favor ambulatory treatment without antibiotics for mild diverticulitis. For mechanical bowel obstruction, multicentric studies have demonstrated the increasing role of imaging in predicting the need for surgery and reducing operative delays. The role of minimally invasive techniques in this clinical condition is also emphasized. In addition, the latest published results about neoadjuvant treatment of colon and rectal cancer are reviewed.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo , Neoplasias del Recto , Oncología Quirúrgica , Endoscopía , Humanos , Terapia Neoadyuvante , Neoplasias del Recto/cirugía , Oncología Quirúrgica/tendencias , Estados Unidos
15.
J Surg Res ; 246: 52-61, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31561178

RESUMEN

BACKGROUND: Low-density neutrophils (LDN) have been shown to be increased in peripheral blood in patients with various diseases and closely related to immune-mediated pathology. However, the frequency and function of LDN in circulating blood of the patients following abdominal surgery have not been well understood. METHODS: LDN were determined by CD66b(+) cells, which were copurified with mononuclear cells by density gradient preparations of peripheral blood of surgical patients. The effects of the purified LDN on T cell proliferation and tumor cell lysis were examined in vitro. Neutrophil extracellular traps (NETs) production was examined by extracellular nuclear staining. RESULTS: The number of LDN with an immature phenotype is markedly increased in peripheral blood samples in patients after abdominal surgery. The frequency of LDN correlated positively with operative time and intraoperative blood loss. The purified LDN significantly suppressed the proliferation of autologous T cells stimulated with anti-CD3 mAb coated on plate and partially inhibited the cytotoxicity of lymphocytes activated with recombinant interleukin-2 against a human gastric cancer cell, OCUM-1. The LDN also produced NETs after short-term culture in vitro, which efficiently trap many OCUM-1. These results suggest that surgical stress recruits immunosuppressive LDN in the circulation in the early postoperative period. CONCLUSIONS: The LDN may support the lodging of circulating tumor cells via NETs formation and inhibit T cell-mediated antitumor response in target organs, which may promote postoperative cancer metastases. Functional blockade of LDN might be an effective strategy to reduce tumor recurrence after abdominal surgery.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Neoplasias Gastrointestinales/cirugía , Recurrencia Local de Neoplasia/inmunología , Neutrófilos/inmunología , Estrés Fisiológico/inmunología , Antígenos CD/inmunología , Antígenos CD/metabolismo , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Moléculas de Adhesión Celular/inmunología , Moléculas de Adhesión Celular/metabolismo , Comunicación Celular/inmunología , Línea Celular Tumoral , Proliferación Celular , Técnicas de Cocultivo , Trampas Extracelulares/inmunología , Trampas Extracelulares/metabolismo , Proteínas Ligadas a GPI/inmunología , Proteínas Ligadas a GPI/metabolismo , Neoplasias Gastrointestinales/inmunología , Neoplasias Gastrointestinales/patología , Humanos , Recuento de Leucocitos , Recurrencia Local de Neoplasia/epidemiología , Células Neoplásicas Circulantes/inmunología , Neutrófilos/metabolismo , Tempo Operativo , Linfocitos T/inmunología
16.
Ann R Coll Surg Engl ; 102(2): 153-159, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31508982

RESUMEN

INTRODUCTION: Anastomosis formation constitutes a critical aspect of many gastrointestinal procedures. Barbed suture materials have been adopted by some surgeons to assist in this task. This systematic review and meta-analysis compares the safety and efficacy of barbed suture material for anastomosis formation compared with standard suture materials. METHODS: An electronic search of Embase, Medline, Web of Science and Cochrane databases was performed. Weighted mean differences were calculated for effect size of barbed suture material compared with standard material on continuous variables and pooled odds ratios were calculated for discrete variables. FINDINGS: There were nine studies included. Barbed suture material was associated with a significant reduction in overall operative time (WMD: -12.87 (95% CI = -20.16 to -5.58) (P = 0.0005)) and anastomosis time (WMD: -4.28 (95% CI = -6.80 to -1.75) (P = 0.0009)). There was no difference in rates of anastomotic leak (POR: 1.24 (95% CI = 0.89 to 1.71) (P = 0.19)), anastomotic bleeding (POR: 0.80 (95% CI = 0.29 to 2.16) (P = 0.41)), or anastomotic stricture (POR: 0.72 (95% CI = 0.21 to 2.41) (P = 0.59)). CONCLUSIONS: Use of barbed sutures for gastrointestinal anastomosis appears to be associated with shorter overall operative times. There was no difference in rates of complications (including anastomotic leak, bleeding or stricture) compared with standard suture materials.


Asunto(s)
Anastomosis Quirúrgica/instrumentación , Procedimientos Quirúrgicos del Sistema Digestivo/instrumentación , Suturas , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Fuga Anastomótica/etiología , Constricción Patológica/etiología , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Diseño de Equipo , Humanos , Tempo Operativo , Complicaciones Posoperatorias , Hemorragia Posoperatoria/etiología , Técnicas de Sutura/instrumentación
17.
J Surg Res ; 246: 1-5, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31541708

RESUMEN

BACKGROUND: Intestinal atresia is a congenital defect resulting in intestinal discontinuity and can be associated with significant morbidity related to intestinal failure. The bowel proximal to the atresia is often significantly dilated and dysfunctional. The treatment approaches of this dilated bowel include resection with primary anastomosis versus tapering enteroplasty with preservation of bowel length. The purpose of this study was to compare these two approaches in regard to bowel function as characterized by the time to full enteral feeding. METHODS: A retrospective review was performed of intestinal atresia repair performed at a tertiary referral pediatric hospital from 2007 to 2017. Length of stay, time to full enteral feeds, and complications were assessed in patients who underwent repair with tapering enteroplasty (n = 8) and compared with those who underwent resection and anastomosis (n = 39). RESULTS: The median age at surgery, gender distribution, weeks gestational age (WGA), location of the atresia, and comorbidities were similar between the two groups. Overall, there was no statistically significant difference in length of stay and time to full enteral feeds between groups. Three of eight (38%) patients in the tapered group and five of 39 patients (13%; P = 0.12) in the nontapered group underwent further surgical exploration because of bowel dysmotility. Factors associated with longer length of hospital stay were abdominal reoperation and WGA, and factors associated with longer time to full enteral feeds were WGA, abdominal reoperation, and gastroschisis. CONCLUSIONS: Tapering enteroplasty at initial operation for intestinal atresias preserves bowel length and has statistically equivalent outcomes to resection and anastomosis in regard to the length of stay and time to full enteral feeds.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Nutrición Enteral/estadística & datos numéricos , Atresia Intestinal/cirugía , Intestino Delgado/anomalías , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Dilatación Patológica/etiología , Dilatación Patológica/cirugía , Femenino , Motilidad Gastrointestinal , Humanos , Lactante , Recién Nacido , Atresia Intestinal/complicaciones , Intestino Delgado/cirugía , Tiempo de Internación/estadística & datos numéricos , Masculino , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Reoperación/métodos , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
19.
Ann R Coll Surg Engl ; 102(3): 194-203, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31858809

RESUMEN

INTRODUCTION: Postoperative ileus occurs frequently following abdominal surgery. Identification of groups at high risk of developing ileus before surgery may allow targeted interventions. This review aimed to identify baseline risk factors for ileus. METHODS: A systematic review was conducted with reference to PRISMA and MOOSE guidelines. It was registered on PROSPERO (CRD42017068697). Searches of MEDLINE, EMBASE and CENTRAL were undertaken. Studies reporting baseline risk factors for the development of postoperative ileus based on cohort or trial data and published in English were eligible for inclusion. Dual screening of abstracts and full texts was undertaken. Independent dual extraction was performed. Bias assessment was undertaken using the quality in prognostic studies tool. Meta-analysis using a random effects model was undertaken where two or more studies assessed the same variable. FINDINGS: Searches identified 2,430 papers, of which 28 were included in qualitative analysis and 12 in quantitative analysis. Definitions and incidence of ileus varied between studies. No consistent significant effect was found for association between prior abdominal surgery, age, body mass index, medical comorbidities or smoking status. Male sex was associated with ileus on meta-analysis (odds ratio 1.12, 95% confidence interval 1.02-1.23), although this may reflect unmeasured factors. The literature shows inconsistent effects of baseline factors on the development of postoperative ileus. A large cohort study using consistent definitions of ileus and factors should be undertaken.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Ileus/etiología , Humanos , Ileus/diagnóstico , Complicaciones Posoperatorias/etiología , Factores de Riesgo
20.
Am J Surg ; 219(1): 75-79, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31164194

RESUMEN

BACKGROUND: Almost a decade after international guidelines defining anastomotic leak (AL) were published, the definition of AL remains inconsistent. METHODS: A 3-round modified Delphi study was conducted among a national panel of 8 surgeon experts to assess consensus related to the definition of AL following colorectal resection. Consensus was defined when a scenario was rated as very important or absolutely essential by at least 85% of the experts in round 3. RESULTS: Seven of fifteen (47%) clinical and radiological scenarios of AL achieved consensus. 80% of clinical scenarios reached consensus. 30% of radiological scenarios reached consensus including CT demonstrating air bubbles around the anastomosis. No consensus was achieved in 70% of radiological scenarios. CONCLUSIONS: Consensus on the definition of AL is difficult to reach, in relation to international guidelines; which implies that further refinement of the definition of AL is needed to compare patient outcomes.


Asunto(s)
Fuga Anastomótica/diagnóstico por imagen , Colon/cirugía , Técnica Delfos , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Recto/cirugía , Tomografía Computarizada por Rayos X , Humanos
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