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Background This study was designed to analyze the influence of age and comprehensive geriatric evaluation on clinical results of pancreaticobiliary disease management in elderly patients. Methods A prospective observational study has been undertaken, including 140 elderly patients (over 75 years) with benign pancreaticobiliary disease. Patients were divided according to age in the following groups: group 1: 7579 years old; group 2: 8084 years old; group 3: 85 years and older. They underwent a comprehensive geriatric assessment with different scales: Barthel Index, Pfeiffer Index, Charlson Index, and Fragility scale, at admission and had been follow-up 90 days after hospital discharge to analyze its influence on morbidity and mortality. Results Overall, 140 patients have been included (group 1=51; group 2=43 and group 3=46). Most of them, 52 cases (37.8%), had acute cholecystitis, followed by 29 cases of acute cholangitis (20.2%) and acute pancreatitis with 25 cases (17.9%). Significant differences has been observed on complications in different age groups (p=0.033). Especially in patients with a Barthel Index result ≤60, which suggests that these less functional patients had more severe complications after their treatment (p=0.037). The mortality rate was 7.1% (10 patients). Conclusions No significant differences were found between age, morbidity and mortality in elderly patients with pancreaticobiliary disease. Comprehensive geriatric scales showed some utility in their association with specific complications. (AU)
Antecedentes Este estudio fue diseñado para analizar la influencia de la edad y la evaluación geriátrica integral en los resultados clínicos del manejo de la enfermedad pancreatobiliar en pacientes de edad avanzada. Métodos Se ha realizado un estudio observacional prospectivo en el que se incluyeron 140 pacientes de edad avanzada (mayores de 75 años) con enfermedad pancreatobiliar benigna. Los pacientes se dividieron según la edad en los siguientes grupos: Grupo 1: 75-79 años; Grupo 2: 80-84 años; Grupo 3: 85 años y más. Se les realizó una valoración geriátrica integral con diferentes escalas: Barthel Index, Pfeiffer Index, Charlson Index y Fragility scale, al ingreso y seguimiento 90 días después del alta hospitalaria para analizar su influencia en la morbimortalidad. Resultados En total, se incluyeron 140 pacientes (Grupo 1=51; Grupo 2=43 y Grupo 3=46). La mayoría de ellos, 52 casos (37,8%), presentaron colecistitis aguda, seguido de colangitis aguda con 29 casos (20,2%) y pancreatitis aguda con 25 casos (17,9%). Se han observado diferencias significativas en las complicaciones en diferentes grupos de edad (p=0,033). Especialmente en pacientes con un índice de Barthel ≤60, lo que sugiere que estos pacientes menos funcionales tuvieron complicaciones más severas después de su tratamiento (p=0,037). La tasa de mortalidad fue de 7,1% (10 pacientes). Conclusiones No se encontraron diferencias significativas entre la edad, la morbilidad y la mortalidad en pacientes ancianos con enfermedad pancreatobiliar. Las escalas geriátricas integrales mostraron cierta utilidad en su asociación con complicaciones específicas. (AU)
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , /diagnóstico , /mortalidade , Morbidade , /cirurgia , Estudos ProspectivosRESUMO
BACKGROUND: This study was designed to analyze the influence of age and comprehensive geriatric evaluation on clinical results of pancreaticobiliary disease management in elderly patients. METHODS: A prospective observational study has been undertaken, including 140 elderly patients (over 75 years) with benign pancreaticobiliary disease. Patients were divided according to age in the following groups: group 1: 75-79 years old; group 2: 80-84 years old; group 3: 85 years and older. They underwent a comprehensive geriatric assessment with different scales: Barthel Index, Pfeiffer Index, Charlson Index, and Fragility scale, at admission and had been follow-up 90 days after hospital discharge to analyze its influence on morbidity and mortality. RESULTS: Overall, 140 patients have been included (group 1=51; group 2=43 and group 3=46). Most of them, 52 cases (37.8%), had acute cholecystitis, followed by 29 cases of acute cholangitis (20.2%) and acute pancreatitis with 25 cases (17.9%). Significant differences has been observed on complications in different age groups (p=0.033). Especially in patients with a Barthel Index result ≤60, which suggests that these less functional patients had more severe complications after their treatment (p=0.037). The mortality rate was 7.1% (10 patients). CONCLUSIONS: No significant differences were found between age, morbidity and mortality in elderly patients with pancreaticobiliary disease. Comprehensive geriatric scales showed some utility in their association with specific complications.
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The aim of this study was to review and to assess the quality of the scientific articles regarding early and late anastomotic leak (AL) after colorectal surgery and their risk factors.An electronic systematic search for articles on Colorectal Surgery, AL and its timing was undertaken using the MEDLINE database via PubMed, Cochrane and Embase. The selected articles were thoroughly reviewed and assessed for methodological quality using a validated methodology quality score (MINCIR score). This review was registered in the PROSPERO registry under ID: CRD42022303012. 9 articles were finally reviewed in relation to the topic of early and late anastomotic leak.There is a lack of consensus regarding the exact cut-off in time to define early and late anastomotic leak, but it is clear that they are two differentiated entities. The first, occurring in relation to technical factors; whereas the latter, is related to impaired healing. (AU)
El objetivo de este estudio fue revisar y evaluar la calidad de los artículos científicos sobre la dehiscència anastomótica temprana y tardía después de cirugía colorrectal y sus factores de riesgo.Se realizó una búsqueda sistemática electrónica de artículos sobre Cirugía colorrectal, dehiscència de anastomoiis colorectal utilizando la base de datos MEDLINE a través de PubMed, Cochrane y Embase. La calidad metodológica de los artículos seleccionados se revisó minuciosamente y se evaluó mediante una puntuación de calidad metodológica validada (puntuación MINCIR). Este estudio fue registrado en PROSPERO con el ID: CRD42022303012. Despues de una seleccion basada en los criterios de búsqueda, finalmente se revisaron 9 artículos en relación al tema la revisión.Se pudo observar que existe una falta de consenso en cuanto al tiempo de corte exacto para definir la fuga anastomótica temprana y tardía, pero está claro que son dos entidades diferenciadas. La primera, ocurriendo en relación a factores técnicos; mientras que la segunda situación clinica se relaciona con una cicatrización alterada. (AU)
Assuntos
Humanos , Deiscência da Ferida Operatória/cirurgia , Cirurgia Colorretal , Anastomose Cirúrgica , Fatores de RiscoRESUMO
The aim of this study was to review and to assess the quality of the scientific articles regarding early and late anastomotic leak (AL) after colorectal surgery and their risk factors.An electronic systematic search for articles on Colorectal Surgery, AL and its timing was undertaken using the MEDLINE database via PubMed, Cochrane and Embase. The selected articles were thoroughly reviewed and assessed for methodological quality using a validated methodology quality score (MINCIR score). This review was registered in the PROSPERO registry under ID: CRD42022303012. 9 articles were finally reviewed in relation to the topic of early and late anastomotic leak.There is a lack of consensus regarding the exact cut-off in time to define early and late anastomotic leak, but it is clear that they are two differentiated entities. The first, occurring in relation to technical factors; whereas the latter, is related to impaired healing. (AU)
El objetivo de este estudio fue revisar y evaluar la calidad de los artículos científicos sobre la dehiscència anastomótica temprana y tardía después de cirugía colorrectal y sus factores de riesgo.Se realizó una búsqueda sistemática electrónica de artículos sobre Cirugía colorrectal, dehiscència de anastomoiis colorectal utilizando la base de datos MEDLINE a través de PubMed, Cochrane y Embase. La calidad metodológica de los artículos seleccionados se revisó minuciosamente y se evaluó mediante una puntuación de calidad metodológica validada (puntuación MINCIR). Este estudio fue registrado en PROSPERO con el ID: CRD42022303012. Despues de una seleccion basada en los criterios de búsqueda, finalmente se revisaron 9 artículos en relación al tema la revisión.Se pudo observar que existe una falta de consenso en cuanto al tiempo de corte exacto para definir la fuga anastomótica temprana y tardía, pero está claro que son dos entidades diferenciadas. La primera, ocurriendo en relación a factores técnicos; mientras que la segunda situación clinica se relaciona con una cicatrización alterada. (AU)
Assuntos
Humanos , Deiscência da Ferida Operatória/cirurgia , Cirurgia Colorretal , Anastomose Cirúrgica , Fatores de RiscoAssuntos
Humanos , Feminino , Idoso , Hemangiossarcoma , Hemangiossarcoma/diagnóstico , Mama , Mama/anormalidades , Mama/diagnóstico por imagemRESUMO
Endoscopic procedures have not become the gold standard in breast surgery. In order to improve today's outcomes we have developed a pilot study in the Breast Pathology Unit of Hospital Germans Trias i Pujol. A surgical procedure was performed creating a pneumoendoscopic cavity by using a Single Incision Laparoscopic Surgery (Single port) approach with a follow up of four years. Four patients underwent pneumoendoscopic single-port breast surgery receiving skin-sparing quadrantectomy and axillary surgery requiring lymphadenectomy in all of them. All patients had immediate reconstruction with a Latisimus Dorsi flap. No perioperative complications appeared. Mean operative time was 290â¯min (range 240-315â¯min) and mean hospital stay was 3,2 days. Surgical margins of all cases were pathologically negative and all patients were disease free after four years of monitoring. All patients were satisfied with the cosmetic outcome in the immediate postoperative and during the follow up. Although all innovative techniques generate hesitation on their beginnings and are liable to improve, we believe that pneumoendoscopic single-port breast surgery can be suitable for breast cancer, offering better cosmetic outcomes with oncological safety.
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Neoplasias da Mama/cirurgia , Endoscopia/métodos , Mastectomia Segmentar/métodos , Tratamentos com Preservação do Órgão/métodos , Neoplasias da Mama/patologia , Endoscopia/instrumentação , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Projetos Piloto , PrognósticoRESUMO
BACKGROUND: The use of synthetic adhesives such as cyanoacrylates has been established previously for a wide range of clinical indications. However, more research is necessary to evaluate their use in digestive closures or anastomosis. New chemical formulations developed to achieve more flexibility of synthetic adhesives (i.e., based on n-butyl-2-cyanoacrylate) could be an alternative to achieve this purpose. The aim of this study was to investigate the feasibility of using flexible cyanoacrylate adhesives for large gastric incision closure in an animal model. METHODS: Twelve farm pigs were divided in two groups depending on the type of closure method applied. In all cases, extra-large seven centimeters gastrostomies were performed. Braided absorbable hand-sewn interrupted suture versus n-butyl-2-cyanoacrylate with softener closure were compared during a 3-week follow-up period. Histopathological aspects, hematologic and inflammatory biomarkers, and endoluminal pressure tolerated until leakage were assessed. The time spent on both closing procedures was compared. RESULTS: No differences between the two groups were found in any of the histopathological and inflammatory variables evaluated. The glued group tolerated a significantly higher pressure than the manual suture group. A reduction of surgery time was also observed. CONCLUSIONS: Our results suggest that flexible cyanoacrylates could be a feasible alternative to improve the clinical outcome of the closure of hollow viscera through more efficient sutureless procedures.
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Embucrilato/farmacologia , Gastrectomia/métodos , Estômago/cirurgia , Deiscência da Ferida Operatória/terapia , Cicatrização/efeitos dos fármacos , Animais , Modelos Animais de Doenças , Estudos de Viabilidade , Masculino , SuínosRESUMO
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