RESUMO
INTRODUCTION: Penetrating Crohn's disease (CD) often necessitates surgical intervention, with the open approach traditionally favored. Robotic-assisted surgery offers potential benefits but remains understudied in this complex patient population. Additionally, the lack of standardized surgical complexity scoring in CD hinders research and comparisons. METHODS: We retrospectively analyzed adult patients with penetrating CD who underwent either robotic-assisted ileocolic resection (RICR) or open ileocolic resection (OICR) at our institution from January 2007 to December 2021. We assessed endpoints, including length of stay, complications, readmissions, reoperations, and other perioperative outcomes. RESULTS: RICR demonstrated safety outcomes comparable to OICR. Importantly, RICR patients experienced significantly reduced estimated blood loss (p < 0.0001), shorter hospital stays (median 4.5 days versus 6.9 days; p = 0.01), lower surgical site infection rates (0% versus 15.4%; p = 0.01), and decreased 30-day readmission rates (0% versus 15.4%; p = 0.01). Linear regression analysis revealed the need for additional strictureplasties (coefficient: 84.8; p = 0.008), colonic resections (coefficient: 41.7; p = 0.008), and estimated blood loss (coefficient: 0.07; p = 0.002) independently correlated with longer operative times). CONCLUSION: Robotic-assisted surgery appears to be a safe and potentially beneficial alternative for the surgical management of penetrating CD, offering advantages in perioperative outcomes reducing length of stay, blood loss, surgical site infection rates, and readmission rates. Further validation with larger cohorts is warranted.
Assuntos
Colectomia , Doença de Crohn , Íleo , Tempo de Internação , Readmissão do Paciente , Procedimentos Cirúrgicos Robóticos , Humanos , Doença de Crohn/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Masculino , Estudos Retrospectivos , Feminino , Adulto , Tempo de Internação/estatística & dados numéricos , Resultado do Tratamento , Pessoa de Meia-Idade , Íleo/cirurgia , Colectomia/métodos , Colectomia/efeitos adversos , Readmissão do Paciente/estatística & dados numéricos , Colo/cirurgia , Reoperação/estatística & dados numéricos , Reoperação/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Perda Sanguínea Cirúrgica/estatística & dados numéricosRESUMO
10 cases of pancreatic ascites are presented. Ascitic fluid lipase is complementary to the determination of ascitic amylase in the diagnosis of pancreatic ascites and may be a more reliable diagnostic indicator of pancreatic ascites on a random ascitic fluid sample. Conservative management, consisting of abdominal paracentesis with or without diurectics, proved to be the treatment of choice in 3 of our patients who failed to reveal an associated pseudocyst.
Assuntos
Ascite/diagnóstico , Líquido Ascítico/enzimologia , Lipase/análise , Pancreatite/diagnóstico , Adenocarcinoma/diagnóstico , Adulto , Idoso , Consumo de Bebidas Alcoólicas , Ascite/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/diagnóstico , Pancreatite/complicaçõesRESUMO
The extremely unusual patient reported here had malignant histiocytosis with extensive gastrointestinal involvement. The presenting symptoms were those of a gastrointestinal disorder and barium studies of the upper gastrointestinal tract revealed an infiltrative process of the entire small bowel. A biopsy of the small bowel demonstrated abnormal malignant cells and the diagnosis of malignant histiocytosis was considered and confirmed at postmortem. Strongyloidiasis, which was also found in this patient, may represent a hyperinfestation phenomenon due to altered host-parasite balance.