Assuntos
Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/cirurgia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Stents/efeitos adversos , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Idoso , Remoção de Dispositivo/métodos , Serviço Hospitalar de Emergência , Endossonografia/métodos , Seguimentos , Migração de Corpo Estranho/diagnóstico por imagem , Humanos , Obstrução Intestinal/diagnóstico por imagem , Jejuno/patologia , Jejuno/cirurgia , Laparotomia/métodos , Masculino , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
BACKGROUND: Monash Medical Centre introduced the acute surgical unit (ASU) in July 2011. The ASU is modelled on the concept of acute care surgery (ACS). This study reviews the impact of the ASU on the outcomes in an appendicectomy population. METHODS: A retrospective review of all patients (aged 16-99 years) who underwent appendicectomies in the 2-year study time frame (from July 2010 to June 2012) at our centre was performed. The cohort (n = 539) was divided into two groups for analysis: the ASU group, patients admitted on or after 18 July 2011 (n = 283), and the control group, patients admitted prior to 18 July 2011 (n = 256). RESULTS: Median time to operation (1129 min versus 1080 min, P = 0.963) and negative appendicectomy rate (24.2% versus 24.8%, P = 0.871) were similar in both groups. The proportion of operations performed overnight (18.00-08.00 hours) was significantly decreased in the ASU group (17.1% versus 30.7%, P < 0.001). Perforation rate was marginally higher in the ASU group (17.8% versus 11.8%, P = 0.053) but failed to reach statistical significance. There was an increase in the usage of preoperative imaging (40.3% versus 30.5%, P = 0.018) in the ASU group. Operating times, length of stay, laparoscopic-to-open conversion and surgical site infection rates remained similar. CONCLUSION: We conclude that implementation of an ACS model does not lead to objective differences in outcome for patients after appendicectomy. However, the ACS model significantly decreased the number of operations performed after-hours.
Assuntos
Apendicectomia , Apendicite/cirurgia , Serviço Hospitalar de Emergência/organização & administração , Modelos Organizacionais , Centro Cirúrgico Hospitalar/organização & administração , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia/estatística & dados numéricos , Apendicite/diagnóstico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Centro Cirúrgico Hospitalar/estatística & dados numéricos , Resultado do Tratamento , Procedimentos Desnecessários/estatística & dados numéricos , Adulto JovemAssuntos
Abdome Agudo/etiologia , Neoplasias do Ceco/diagnóstico , Criptorquidismo/diagnóstico , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias do Colo Sigmoide/diagnóstico , Neoplasias Testiculares/diagnóstico , Adulto , Neoplasias do Ceco/complicações , Neoplasias do Ceco/secundário , Criptorquidismo/complicações , Humanos , Masculino , Neoplasias Embrionárias de Células Germinativas/complicações , Neoplasias Embrionárias de Células Germinativas/secundário , Neoplasias do Colo Sigmoide/complicações , Neoplasias do Colo Sigmoide/secundário , Neoplasias Testiculares/complicações , Neoplasias Testiculares/patologiaAssuntos
Fístula Biliar/diagnóstico , Fístula Cutânea/diagnóstico , Fístula/diagnóstico , Achados Incidentais , Idoso de 80 Anos ou mais , Fístula Biliar/etiologia , Colelitíase/complicações , Doença Crônica , Fístula Cutânea/etiologia , Fístula/etiologia , Humanos , Masculino , Pneumonia/diagnóstico , Pneumonia/terapia , Doenças Raras , Tomografia Computadorizada por Raios X/métodosRESUMO
BACKGROUND: Transoral incisionless fundoplication (TIF) using the EsophyX™ system has been introduced as a possible alternative for the treatment of gastroesophageal reflux disease (GERD). The efficacy of this procedure in our centers was evaluated. METHODS: Patients were selected for treatment if they had typical GERD symptoms, failed management with proton pump inhibitors (PPIs), a positive esophageal pH test with symptom correlation, and no hiatus hernia larger than 2 cm. RESULTS: Nineteen patients (11 men, 8 women) underwent the TIF procedure between April 2008 and July 2009. Mean age was 48.2 years and body mass index was 24.6. The major complication rate was 3/19, including esophageal perforation, hemorrhage requiring transfusion, and permanent numbness of tongue. At mean 10.8 months follow-up, 5/19 had completely discontinued PPIs, and 3/19 had decreased their PPI dose. However, 10/19 had been converted to laparoscopic fundoplication for recurrent reflux symptoms and an endoscopically confirmed failed valve. Nine of 17 were dissatisfied with the outcome, and eight were satisfied. Thirteen of 19 (68%) were considered to have been unsuccessful. CONCLUSION: At short-term follow-up, the TIF procedure is associated with an excessive early symptomatic failure rate, and a high surgical re-intervention rate. This procedure should not be performed outside of a clinical trial.
