RESUMO
BACKGROUND: When Rectocele is part of a complex pelvic organ prolapse, a full repair is recommended. The aim of this study was to evaluate the clinical and radiological results after laparoscopic surgery in patients with symptomatic rectocele and III/IV stage vaginal vault prolapse METHODS: This is a prospective cohort study of women with symptomatic rectoceles and middle compartment prolapse operated on between 2013 and 2015, who underwent a laparoscopic sacrocolpoperineopexy with synthetic Y mesh attached to puborectalis muscles, the anterior and posterior vagina wall and the sacrum. The clinical outcomes measured were symptoms of prolapse, obstructive defecation syndrome and quality of life. Radiological outcomes were distance of the vaginal vault below pubococcigeal line and depth of rectovaginal wall protrusion in dynamic pelvic resonance. RESULTS: 33 patients were included. 32 of them remained asymptomatic after a three years follow-up. Significant differences were shown in the obstructed defecation score and quality of life after 6, 12 and 36 months compared to preoperatively. No differences were identified when the postoperative results were compared. Significant differences were shown in preoperative vaginal vault prolapse (3.2 cms ± 0.8 SD below the pubococcigeal Line) and rectocele size, compared with 1 and 3 years after surgery. There were no significant differences in vaginal vault prolapse when compared after 1 and 3 years. When rectocele size after 1 and 3 years was compared, significant differences were shown, but only one clinical recurrence (3%) was identified after a mean follow-up of 47 months. CONCLUSIONS: Laparoscopic sacrocolpoperineopexy in patients with symptomatic rectocele and III/IV vaginal vault prolapse solves the constipation and obstructed defecation with an excellent quality of life and low clinical recurrences. Radiological deterioration, especially in rectocele size, was identified in the mid-term follow-up without clinical significance.
Assuntos
Laparoscopia , Qualidade de Vida , Feminino , Seguimentos , Humanos , Estudos Prospectivos , Retocele/diagnóstico por imagem , Retocele/cirurgiaRESUMO
We report the first documented clinical case of the use of magnetic seeds to mark axillary lymph node metastasis in breast cancer before neoadjuvant chemotherapy. After chemotherapy, the patient showed a complete radiological response. One single sentinel lymph node was detected using a radiotracer, while the marked node was intraoperative magnetometer-guided identified. The analysis of the nodes showed negative sentinel lymph node and positive marked node, and the subsequent targeted axillary dissection was performed. Marking axillary positive lymph nodes with a magnetic seed is a simple and effective procedure for the intraoperative localisation of the node after neoadjuvant treatment.
RESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Verde de Indocianina/administração & dosagem , Ureter/diagnóstico por imagem , Período Intraoperatório , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/cirurgia , Tomografia Computadorizada por Raios XAssuntos
Verde de Indocianina/administração & dosagem , Fístula Intestinal/diagnóstico por imagem , Complicações Intraoperatórias/prevenção & controle , Ureter/diagnóstico por imagem , Administração Intravenosa , Cirurgia Colorretal/métodos , Corantes/administração & dosagem , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Humanos , Fístula Intestinal/cirurgia , Período Intraoperatório , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ureter/anatomia & histologia , Cateterismo Urinário/métodosRESUMO
BACKGROUND: Closing the defect (CD) during laparoscopic ventral hernia repair began to be performed in order to decrease seroma, to improve the functionality of the abdominal wall, and to decrease the bulging effect. However, tension at the incision after CD in large defects is related to an increased rate of pain and recurrence. We present the preliminary results of a new technique for medium midline hernias as an alternative to conventional CD. METHODS: A prospective controlled study was conducted from January 2015 to January 2017 to evaluate an elective new procedure (LIRA) performed on patients with midline ventral hernias (4-10 cm width). The posterior rectus aponeurosis was opened lengthwise around the hernia defect using a laparoscopic approach to create two flaps and was then sutured. The size of the flaps was estimated using a mathematical formula. An on-lay mesh was placed intraperitoneal overlapping the fascia defect. The data analyzed included patient demographics, operative parameters, and complications. A computerized tomography was performed preoperatively and postoperatively (1 month and 1 year) to evaluate recurrence, distance between rectus and seroma. RESULTS: Twelve patients were included. Mean width of the defect was 5.5 cm. Average VAS (24 h) was 3.9, 1.1 (1 month), and 0 (1 year). Mean preoperative distance between rectus was 5.5 cm; postoperative was 2.2 cm (1 year). Radiological seroma at first month was detected in 50%. Mean follow-up was 15 months. CONCLUSION: The LIRA technique could be considered as an alternative to conventional CD or endoscopic component separation for medium defects under 10 cm in width. This technique obtained a "no tension" effect that could be related to a lower rate of postoperative pain with no recurrence or bulging, being a safe, feasible, and reproducible technique.
Assuntos
Parede Abdominal/cirurgia , Aponeurose/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Procedimentos de Cirurgia Plástica/métodos , Reto do Abdome/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Resultado do TratamentoRESUMO
The metadata listed the wrong given names and family names.
RESUMO
BACKGROUND: Laparoscopic ventral or incisional hernia repair requires intraperitoneal mesh placement. This is associated with an increase in adhesions, bowel obstruction and enterocutaneous fistula. Intraabdominal meshes are laparoscopically fixed using traumatic fixation methods that increase acute, chronic pain and adhesions to bowel loops. The aim was to check the safety and effectiveness of the laparoscopic approach in ventral or incisional hernia, using a self-adhesive mesh in the preperitoneal space without tacks or transfascial sutures, and to objectively assess its benefits and complications. METHODS: Patients aged between 18 and 67 years old with medial, lateral ventral and incisional hernias between 3 and 8 cm in size were included in this study. Fifty patients were included in the study, which was conducted between January 2013 and March 2015. RESULTS: The average length of surgery was 57.3 ± 18 min. The average hospital stay was 1.1 ± 0.3 days. The average time taken to return to work was 9.2 ± 2.4 days. The most common post-operative complication was seroma, which was observed in 13 patients (26 %). The average follow-up was 15.4 ± 5.5 months. Three patients were lost to follow-up during this period. There was no hernia recurrence during examination nor on CT scan during the follow-up period. The average score on the visual analogue scale before surgery was 4 ± 1. After surgery, the score was as follows: 3 ± 0.8 on the first day after surgery, 0.9 ± 0.5 after the first week, 0.4 ± 0.4 after the first month and 0 after 90 days. No patient showed chronic pain. Overall satisfaction (VAS for surgery) was 8.3 ± 0.6. CONCLUSIONS: The use of self-adhesive meshes during the laparoscopic transabdominal preperitoneal approach in small- and medium-sized ventral or incisional hernias is safe and effective, with low post-operative pain, quick functional recovery and high overall satisfaction after surgery with no increase in recurrence in the short term.
Assuntos
Adesivos , Hérnia Ventral/cirurgia , Laparoscopia , Telas Cirúrgicas , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias , Escala Visual Analógica , Adulto JovemRESUMO
No disponible
Assuntos
Humanos , Feminino , Adulto , Colectomia/métodos , Neurilemoma/cirurgia , Neoplasias do Colo/cirurgia , Diagnóstico DiferencialAssuntos
Colectomia/métodos , Neoplasias do Colo/cirurgia , Laparoscopia/métodos , Neurilemoma/cirurgia , Adulto , Neoplasias do Colo/diagnóstico , Diagnóstico Diferencial , Feminino , Hemorragia Gastrointestinal/etiologia , Tumores do Estroma Gastrointestinal/diagnóstico , Humanos , Neurilemoma/diagnóstico , RetoAssuntos
Doenças do Íleo/cirurgia , Fístula Intestinal/cirurgia , Laparoscopia , Doenças do Colo Sigmoide/cirurgia , Tuberculose Gastrointestinal/complicações , Tuberculose Urogenital/complicações , Fístula da Bexiga Urinária/cirurgia , Idoso , Humanos , Doenças do Íleo/diagnóstico , Doenças do Íleo/microbiologia , Fístula Intestinal/diagnóstico , Fístula Intestinal/microbiologia , Masculino , Doenças do Colo Sigmoide/diagnóstico , Doenças do Colo Sigmoide/microbiologia , Tuberculose Gastrointestinal/diagnóstico , Tuberculose Urogenital/diagnóstico , Fístula da Bexiga Urinária/diagnóstico , Fístula da Bexiga Urinária/microbiologiaAssuntos
Humanos , Masculino , Pessoa de Meia-Idade , Fístula da Bexiga Urinária/complicações , Fístula da Bexiga Urinária/diagnóstico , Fístula da Bexiga Urinária/cirurgia , Colectomia/métodos , Colectomia , Laparoscopia , Fístula da Bexiga Urinária/fisiopatologia , Fístula da Bexiga Urinária , Doenças do Colo Sigmoide/patologia , Doenças do Colo Sigmoide/cirurgia , Doenças do Colo SigmoideAssuntos
Endoscopia , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Telas Cirúrgicas , Abdome , Adesivos , Endoscopia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , PeritônioRESUMO
No disponible
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Colectomia/métodos , Neoplasias do Colo/cirurgia , Laparoscopia/métodosRESUMO
No disponible