BRAZILIAN MULTI-SOCIETY POSITION STATEMENT ON EMERGING BARIATRIC AND METABOLIC SURGICAL PROCEDURES.

This Brazilian multi-society position statement on emerging bariatric and metabolic surgical procedures was issued by the Brazilian Society of Bariatric and Metabolic Surgery (SBCBM), the Brazilian College of Digestive Surgery (CBCD), and the Brazilian College of Surgeons (CBC). This document is the result of a Brazilian Emerging Surgeries Forum aimed at evaluating the results of surgeries that are not yet listed in the Federal Council of Medicine (CFM), the regulatory agency that oversees and regulates medical practice in Brazil. The Forum integrated more than 400 specialists and academics with extensive knowledge about bariatric and metabolic surgery, representing the three surgical societies: SBCBM, CBC, and CBCD. International speakers participated online and presented their experiences with the techniques under discussion, emphasizing the regulatory policies in their countries. The indications for surgery and the subsequent procedures were carefully reviewed, including one anastomosis gastric bypass (OAGB), single anastomosis duodeno-ileal with sleeve gastrectomy (SADI-S or OADS), sleeve gastrectomy with transit bipartition (SGTB), and sleeve gastrectomy with ileal interposition (SGII). The recommendations of this document are based on an extensive literature review and discussions among bariatric surgery specialists from the three surgical societies. We concluded that patients with a body mass index over 30 kg/m2 may be candidates for metabolic surgery in the presence of comorbidities (arterial hypertension and type 2 diabetes) with no response to clinical treatment of obesity or in the control of other associated diseases. Regarding the surgical procedures, we concluded that OAGB, OADS, and SGTB are associated with low morbidity rates, satisfactory weight loss, and resolution of obesity-related comorbidities such as diabetes and arterial hypertension. SGII was considered a good and viable promising surgical alternative technique. The recommendations of this statement aim to synchronize our societies with the sentiments and understandings of most of our members and also serve as a guide for future decisions regarding bariatric surgical procedures in our country and worldwide.

Analysis of primary care of victims of interpersonal and self inflicted violence during the COVID-19 pandemic.

OBJECTIVES: to analyze the epidemiological profile of aggression victims admitted at the emergency room on a trauma hospital during the COVID-19 pandemic, to compare these data in different restriction periods and with prepandemic data from the same service. METHODS: cross-sectional study with probabilistic sampling using medical records of patients who were victims of aggression admitted at the hospital between June 2020 and May 2021. In addition to the epidemiological variables, other variables collected were the current restriction level, mechanism of aggression, resulting injuries and the Revised Trauma Score (RTS). The data was compared between the three restriction levels and the proportion of attendances during the study period was compared with the pre-pandemic study (December 2016 to February 2018). RESULTS: the average age was 35.5 years, 86.1% of the patients were male and 61.6% of the attendances were due to blunt injury. The highest average of attendances per day occurred during the "yellow" restriction level (2.9), however there was no significant difference when comparing the restriction periods two by two. There was also no significant difference either in the analysis of the standardized residuals of the proportions of aggressions or the mechanism of aggression in the pre-pandemic and pandemic periods. CONCLUSIONS: there was a predominance of attendances due to blunt trauma and in young male patients. There was no significant difference between the average daily attendance for aggression during the three restriction levels and between the proportion of attendances in the pre-pandemic and pandemic period.

Brazilian multi-society position statement on emerging bariatric and metabolic surgical procedures / Posição das sociedades brasileiras sobre procedimentos cirúrgicos bariátricos e metabólicos emergentes

ABSTRACT This Brazilian multi-society position statement on emerging bariatric and metabolic surgical procedures was issued by the Brazilian Society of Bariatric and Metabolic Surgery (SBCBM), the Brazilian College of Digestive Surgery (CBCD), and the Brazilian College of Surgeons (CBC). This document is the result of a Brazilian Emerging Surgeries Forum aimed at evaluating the results of surgeries that are not yet listed in the Federal Council of Medicine (CFM), the regulatory agency that oversees and regulates medical practice in Brazil. The Forum integrated more than 400 specialists and academics with extensive knowledge about bariatric and metabolic surgery, representing the three surgical societies: SBCBM, CBC, and CBCD. International speakers participated online and presented their experiences with the techniques under discussion, emphasizing the regulatory policies in their countries. The indications for surgery and the subsequent procedures were carefully reviewed, including one anastomosis gastric bypass (OAGB), single anastomosis duodeno-ileal with sleeve gastrectomy (SADI-S or OADS), sleeve gastrectomy with transit bipartition (SGTB), and sleeve gastrectomy with ileal interposition (SGII). The recommendations of this document are based on an extensive literature review and discussions among bariatric surgery specialists from the three surgical societies. We concluded that patients with a body mass index over 30 kg/m2 may be candidates for metabolic surgery in the presence of comorbidities (arterial hypertension and type 2 diabetes) with no response to clinical treatment of obesity or in the control of other associated diseases. Regarding the surgical procedures, we concluded that OAGB, OADS, and SGTB are associated with low morbidity rates, satisfactory weight loss, and resolution of obesity-related comorbidities such as diabetes and arterial hypertension. SGII was considered a good and viable promising surgical alternative technique. The recommendations of this statement aim to synchronize our societies with the sentiments and understandings of most of our members and also serve as a guide for future decisions regarding bariatric surgical procedures in our country and worldwide.

RESUMO Esta declaração multissocietária de posicionamento sobre novos procedimentos cirúrgicos bariátricos e metabólicos emergentes foi emitida pela Sociedade Brasileira de Cirurgia Bariátrica e Metabólica (SBCBM), pelo Colégio Brasileiro de Cirurgia Digestiva (CBCD) e pelo Colégio Brasileiro de Cirurgiões (CBC). Este documento é resultado do Fórum Brasileiro de Cirurgias Emergentes, realizado com o objetivo de avaliar os resultados de cirurgias ainda não listadas no Conselho Federal de Medicina (CFM), órgão regulador que fiscaliza e regulamenta a prática médica no Brasil. O Fórum integrou mais de 400 especialistas e acadêmicos com amplo conhecimento sobre cirurgia bariátrica e metabólica, representando as três sociedades cirúrgicas: SBCBM, CBC e CBCD. Palestrantes internacionais participaram online e apresentaram suas experiências com as técnicas em discussão, enfatizando as políticas regulatórias de seus países. As indicações para cirurgia e os procedimentos subsequentes foram cuidadosamente revisados, incluindo bypass gástrico de uma anastomose (OAGB), anastomose duodeno-Ileal única com gastrectomia vertical (OADS ou SADI-S), gastrectomia vertical com bipartição de trânsito (SGTB) e gastrectomia vertical com interposição ileal (SGII). As recomendações deste documento são baseadas em extensa revisão da literatura e discussões entre especialistas em cirurgia bariátrica das três sociedades cirúrgicas. Concluímos que pacientes com índice de massa corpórea (IMC) acima de 30 kg/m2 podem ser candidatos à cirurgia metabólica na presença de comorbidades (hipertensão arterial e diabetes tipo 2), sem resposta ao tratamento clínico da obesidade ou no controle de outras doenças associadas. Em relação aos procedimentos cirúrgicos, concluímos que OAGB, OADS e SGTB estão associados a baixas taxas de morbidade e com perda de peso satisfatória e resolução de comorbidades relacionadas à obesidade, como diabetes e hipertensão arterial. A SGII foi considerada uma boa e viável técnica cirúrgica, sendo considerada uma alternativa promissora. As recomendações desta declaração visam sincronizar nossas sociedades com os sentimentos e entendimentos da maioria de nossos membros e também servir como um guia para futuras decisões sobre procedimentos cirúrgicos bariátricos em nosso país e no mundo.

Analysis of primary care of victims of interpersonal and self inflicted violence during the COVID-19 pandemic / Análise do atendimento primário de pacientes vítimas de violência interpessoal e autodirigida durante a pandemia da COVID-19

ABSTRACT Objectives: to analyze the epidemiological profile of aggression victims admitted at the emergency room on a trauma hospital during the COVID-19 pandemic, to compare these data in different restriction periods and with prepandemic data from the same service. Methods: cross-sectional study with probabilistic sampling using medical records of patients who were victims of aggression admitted at the hospital between June 2020 and May 2021. In addition to the epidemiological variables, other variables collected were the current restriction level, mechanism of aggression, resulting injuries and the Revised Trauma Score (RTS). The data was compared between the three restriction levels and the proportion of attendances during the study period was compared with the pre-pandemic study (December 2016 to February 2018). Results: the average age was 35.5 years, 86.1% of the patients were male and 61.6% of the attendances were due to blunt injury. The highest average of attendances per day occurred during the "yellow" restriction level (2.9), however there was no significant difference when comparing the restriction periods two by two. There was also no significant difference either in the analysis of the standardized residuals of the proportions of aggressions or the mechanism of aggression in the pre-pandemic and pandemic periods. Conclusions: there was a predominance of attendances due to blunt trauma and in young male patients. There was no significant difference between the average daily attendance for aggression during the three restriction levels and between the proportion of attendances in the pre-pandemic and pandemic period.

RESUMO Objetivo: analisar o perfil epidemiológico dos pacientes vítimas de agressão admitidos na sala de emergência de um hospital de trauma durante a pandemia da COVID-19, comparar tais dados entre os diferentes períodos de restrição e com os dados de um estudo pré-pandêmico do mesmo hospital. Métodos: estudo transversal com amostragem probabilística utilizando prontuários de pacientes vítimas de agressão admitidos no referido hospital entre junho de 2020 e maio de 2021. Além das variáveis epidemiológicas, coletou-se o nível de restrição vigente, o mecanismo de agressão, as lesões resultantes e o Revised Trauma Score (RTS). Os dados foram comparados entre os três níveis e a proporção de atendimentos no período do estudo foi comparada com a do estudo pré-pandêmico (dezembro de 2016 a fevereiro de 2018). Resultados: a média etária foi de 35,5 anos, 86,1% dos pacientes eram do sexo masculino. e 61,6% dos atendimentos corresponderam a agressão física por ferimento contuso. A maior média de atendimentos por dia ocorreu durante o nível amarelo (2,9), contudo não houve diferença significativa nos atendimentos quando comparados os períodos de restrição dois a dois. Também não houve diferença significativa tanto na análise dos resíduos padronizados das proporções de agressões quanto em cada mecanismo de agressão nos períodos pré-pandêmico e pandêmico. Conclusões: houve predominância de atendimentos por agressão por trauma contuso e em pacientes jovens do sexo masculino. Não houve diferença significativa entre a média diária de atendimentos por agressão durante os três níveis de restrição implementados e entre a proporção de atendimentos do período pré-pandemico e pandêmico.

Overview of general surgery medical residency programs and prerequisite program in basic surgical area in Brazil: Historical review and update.

OBJECTIVE: to describe vacancy regulation process by adding, describing the panorama of the General Surgery Residency Program (PRMCG) and the Basic Surgical Prerequisites Program (PRACB). METHOD: descriptive, quali-quantitative, cross sectional study conducted from document analysis from National Commission of Medical Residency (CNRM). RESULTS: in 2018, after evaluation of the General Surgery Services for adequacy of the number of vacancies (DS), the PRACB was instituted as a modality of access to surgical specialties until definitive change in the time of the formation of the general surgeon for three years, in 2022. In the first addition of vacancies in 2018, 127 PRMCG were authorized with 736 vacancies of R1 and 290 PRACB (2 years) with 1.286 vacancies offered for R1. In the second addition in 2021, 423 PRM were authorized with 1.564 R1 vacancies in PRMCG. DISCUSSION: the regulation of the offer of vacancies for the formation of specialties in Brazil should align the evaluation of practice scenarios with the profile of skills. The PRACB modality was instituted for a certain time for budgetary preparation and practice scenarios until the complete transition to training in 3 years. CONCLUSION: Brazil by 2018 was the only country to grant the Board Certification to General Surgeon with only 2 years of training. After a transitional period the same analysis methodology for adding and regulating vacancies was applied to services.

Overview of general surgery medical residency programs and prerequisite program in basic surgical area in Brazil: Historical review and update / Panorama dos programas de residência médica em cirurgia geral e programa de pré-requisito em área cirúrgica básica no Brasil: Resgate histórico e atualização

ABSTRACT Objective: to describe vacancy regulation process by adding, describing the panorama of the General Surgery Residency Program (PRMCG) and the Basic Surgical Prerequisites Program (PRACB). Method: descriptive, quali-quantitative, cross sectional study conducted from document analysis from National Commission of Medical Residency (CNRM). Results: in 2018, after evaluation of the General Surgery Services for adequacy of the number of vacancies (DS), the PRACB was instituted as a modality of access to surgical specialties until definitive change in the time of the formation of the general surgeon for three years, in 2022. In the first addition of vacancies in 2018, 127 PRMCG were authorized with 736 vacancies of R1 and 290 PRACB (2 years) with 1.286 vacancies offered for R1. In the second addition in 2021, 423 PRM were authorized with 1.564 R1 vacancies in PRMCG. Discussion: the regulation of the offer of vacancies for the formation of specialties in Brazil should align the evaluation of practice scenarios with the profile of skills. The PRACB modality was instituted for a certain time for budgetary preparation and practice scenarios until the complete transition to training in 3 years. Conclusion: Brazil by 2018 was the only country to grant the Board Certification to General Surgeon with only 2 years of training. After a transitional period the same analysis methodology for adding and regulating vacancies was applied to services.

RESUMO Objetivo: descrever o contexto do processo de construção e implantação da Matriz de Competências da Cirurgia Geral com tempo de formação em 3 anos e o processo sobre a regulação de vagas, por aditamento, descrevendo o panorama dos Programas de Residência Médica em Cirurgia Geral (PRMCG) e do Programa de Pré-Requisito em área cirúrgica básica (PRACB). Método: estudo descritivo, quanti-qualitativo, transversal, realizado a partir da análise documental das atas, súmulas, nota técnica, resoluções e atos autorizativos da Comissão Nacional de Residência Médica (CNRM), bem como do Diagnóstico Situacional (DS), considerando a matriz de competências da especialidade em sua implementação, por meio de dados coletados no Sistema da Comissão Nacional de Residência Médica (SisCNRM), no portal eletrônico do Ministério da Educação (MEC). Resultado: em 2018, após metodologia de avaliação dos serviços para adequação do número de vagas (DS), foi instituído o PRACB como uma modalidade de acesso às especialidades cirúrgicas e de adaptação dos serviços formadores, até mudança definitiva no tempo de formação do Cirurgião Geral, para três anos, em 2022. No primeiro aditamento de vagas, em 2018, foram autorizados 127 PRMCG (3 anos) com 736 vagas de R1 e 290 pracb (2 anos) com 1286 vagas ofertadas para R1. No segundo aditamento, em 2021, foram autorizados 423 PRM com 1564 vagas de R1 em PRMCG. Atualmente 2495 médicos residentes estão em curso nos PRMCG e 50 (R2) estão concluindo o pracb. A maior concentração de PRM e médicos residentes encontra-se no Estado de São Paulo, em oposição a Região Norte. Discussão: a regulação da oferta de vagas para a formação de especialistas no Brasil deve alinhar a avaliação dos cenários de prática ao perfil das competências para a Especialidade como as necessidades de médicos especialistas indicada pelo perfil socioepidemiológico da população. Contudo, as instituições devem possuir estrutura compatível para a aquisição de competências necessárias ao especialista e dotação orçamentária para o financiamento do processo. A modalidade PRACB foi instituída por tempo determinado para a preparação orçamentária e dos cenários de prática, até a transição completa para a formação em 3 anos, possibilitando ao médico residente, enquanto vigente, acesso às especialidades cirúrgicas. Conclusão: O Brasil até 2018 era o único país a conceder o Título de Especialista em Cirurgia Geral com um tempo exíguo de treinamento - 2 anos. Após um período de transição, a mesma metodologia de análise para aditamento e regulação da oferta de vagas foi aplicada aos serviços. A partir de 2023, o PRMCG com duração de 3 anos, será a modalidade de formação que confere o título de especialista em Cirurgião Geral pela CNRM, promovendo qualificação profissional para assistência e cenários de prática compatíveis com a aquisição de competências. .

The surgeons and the COVID-19 pandemic. / Os cirurgiões e a pandemia do COVID-19.

The current world Covid-19 pandemic has been the most discussed topic in the media and scientific journals. Fear, uncertainty, and lack of knowledge about the disease may be the significant factors that justify such reality. It has been known that the disease presents with a rapidly spreading, it is significantly more severe among the elderly, and it has a substantial global socioeconomic impact. Besides the challenges associated with the unknown, there are other factors, such as the deluge of information. In this regard, the high number of scientific publications, encompassing in vitro, case studies, observational and randomized clinical studies, and even systematic reviews add up to the uncertainty. Such a situation is even worse when considering that most healthcare professionals lack adequate knowledge to critically appraise the scientific method, something that has been previously addressed by some authors. Therefore, it is of utmost importance that expert societies supported by data provided by the World Health Organization and the National Health Department take the lead in spreading trustworthy and reliable information. The Brazilian College of Surgeons suggests in this document various initiatives that may help surgeons, healthcare providers, and patients who will have to face a surgical event under the pandemic.

A atual pandemia do novo coronavírus, Covid-19, tem sido o assunto mais discutido no momento, tanto na mídia como em periódicos científicos. O medo, a incerteza e o desconhecimento sobre o comportamento da doença são os fatores preponderantes que podem justificar essa realidade. Sabe-se de antemão que a enfermidade tem grande disseminação, é mais grave entre idosos e está associada a grande impacto socioeconômico mundial. Além dos desafios em lidar com o desconhecido, há outros relacionados com a sobrecarga de informação e nesse quesito, a grande quantidade de estudos científicos, que englobam pesquisas in vitro, relatos de casos, estudos observacionais e randomizados, além de revisões sistemáticas complementam o panorama de dúvidas. Essa situação é piorada porque o conhecimento sobre o método científico não é dominado pela maioria dos profissionais de saúde, algo que há muito já vem sendo divulgado por vários autores. De sorte que em função desta realidade, torna-se fundamental que sociedades de especialidades apoiadas por dados da Organização Mundial da Saúde e do Ministério da Saúde assumam a liderança da divulgação da informação correta e confiável. O Colégio Brasileiro de Cirurgiões sugere neste documento medidas que podem auxiliar cirurgiões e outros profissionais de saúde, assim como pacientes, em caso de necessidade cirúrgica, a lidar com a atual pandemia.

O real cirurgião de resgate: relatos de casos de um hospital universitário em Curitiba-PR-Brasil / The real rescue surgery: case reports from a university hospital in Curitiba-PR-Brazil

INTRODUÇÃO: A cirurgia de resgate á baseada em alguns pilares básicos: trauma, cirurgia de emergência, cuidados intensivos cirúrgicos, cuidados nutricionais, cirurgia geral eletiva, resgate cirúrgico e retirar a sepse do abdome. Este modelo de tratamento cirúrgico demonstrou maior eficiência, menor tempo de operação e menor tempo de internação hospitalar. Este artigo aborda dois casos clínicos em que o modelo de cirurgia de resgate foi usado como base para o tratamento. OBJETIVO: A ênfase deste caso é demonstrar que há uma necessidade de uma equipe de cirurgiões prontos para atuar com base nos cinco pilares da cirurgia de resgate para manejar pacientes gravemente feridos. METODOLOGIA: Esse estudo se caracteriza por ser um relato de casos, com análise de prontuário de maneira retrospectiva. CONCLUSÃO: É importante reconhecer que, embora não haja consenso entre as diretrizes para o tratamento de algumas morbidades agudas, cada paciente deve ser tratado individualmente para reduzir a mortalidade intra-hospitalar

INTRODUCTION: Rescue surgery is based on some basic pillars: trauma, emergency surgery, surgical intensive care, elective general surgery and surgical rescue. This model of surgical treatment demonstrated greater efficiency, shorter operating time and shorter hospital stay. This article approach two clinical cases in which the rescue surgery model was used as the basis for treatment. OBJECTIVE: The emphasis of this case is to demonstrate that there is a need for a team of surgeons ready to act based on the five pillars of rescue surgery to manage severely injured patients. METHODOLOGY: This study is characterized by being a case report, with retrospective analysis of medical records. CONCLUSION: It is important to recognize that, although there is no consensus between the guidelines for the treatment of some acute morbidities, each patient must be treated individually to reduce in-hospital mortality

Os cirurgiões e a pandemia do COVID-19 / The surgeons and the COVID-19 pandemic

RESUMO A atual pandemia do novo coronavírus, Covid-19, tem sido o assunto mais discutido no momento, tanto na mídia como em periódicos científicos. O medo, a incerteza e o desconhecimento sobre o comportamento da doença são os fatores preponderantes que podem justificar essa realidade. Sabe-se de antemão que a enfermidade tem grande disseminação, é mais grave entre idosos e está associada a grande impacto socioeconômico mundial. Além dos desafios em lidar com o desconhecido, há outros relacionados com a sobrecarga de informação e nesse quesito, a grande quantidade de estudos científicos, que englobam pesquisas in vitro, relatos de casos, estudos observacionais e randomizados, além de revisões sistemáticas complementam o panorama de dúvidas. Essa situação é piorada porque o conhecimento sobre o método científico não é dominado pela maioria dos profissionais de saúde, algo que há muito já vem sendo divulgado por vários autores. De sorte que em função desta realidade, torna-se fundamental que sociedades de especialidades apoiadas por dados da Organização Mundial da Saúde e do Ministério da Saúde assumam a liderança da divulgação da informação correta e confiável. O Colégio Brasileiro de Cirurgiões sugere neste documento medidas que podem auxiliar cirurgiões e outros profissionais de saúde, assim como pacientes, em caso de necessidade cirúrgica, a lidar com a atual pandemia.

ABSTRACT The current world Covid-19 pandemic has been the most discussed topic in the media and scientific journals. Fear, uncertainty, and lack of knowledge about the disease may be the significant factors that justify such reality. It has been known that the disease presents with a rapidly spreading, it is significantly more severe among the elderly, and it has a substantial global socioeconomic impact. Besides the challenges associated with the unknown, there are other factors, such as the deluge of information. In this regard, the high number of scientific publications, encompassing in vitro, case studies, observational and randomized clinical studies, and even systematic reviews add up to the uncertainty. Such a situation is even worse when considering that most healthcare professionals lack adequate knowledge to critically appraise the scientific method, something that has been previously addressed by some authors. Therefore, it is of utmost importance that expert societies supported by data provided by the World Health Organization and the National Health Department take the lead in spreading trustworthy and reliable information. The Brazilian College of Surgeons suggests in this document various initiatives that may help surgeons, healthcare providers, and patients who will have to face a surgical event under the pandemic.

Abdominal compartment syndrome: knowledge of the medical staff of a University Hospital in Curitiba. / Síndrome compartimental abdominal: análise do conhecimento da equipe médica de um Hospital Universitário de Curitiba.

OBJECTIVE: to assess the physicians' knowledge regarding intra-abdominal hypertension and abdominal compartment syndrome and to compare it with the established literature. METHODS: we conducted a descriptive, observational, cross-sectional, quantitative study. We interviewed 38 physicians through a self-administered questionnaire composed of objective questions. We carried out the study in a tertiary reference university hospital, located in Curitiba, Paraná. RESULTS: the mean age of the participants was 28 years, 60.5% were female and the mean time of medical experience was 3.5 years. Regarding the knowledge on the subject, 57.9% considered that abdominal compartment syndrome starts with intra-abdominal grade III hypertension, 50% considered abdominal perfusion pressure the most reliable method to determine intra-abdominal hypertension, 89.4% considered the intravesical measuring technique as the most used, 71.1% considered oliguria to be the early sign of abdominal compartment syndrome. Of the interviewees, 81.6% did not measure intra-abdominal pressure because there was no protocol defined by the service. Seventy-nine percent of respondents said they did not know the definitions of the consensus of the World Society of the Abdominal Compartment Syndrome (WSACS). CONCLUSION: half of the physicians were able to classify intra-abdominal hypertension and indicate the onset of abdominal compartment syndrome correctly.

OBJETIVO: identificar o conhecimento dos médicos com relação à hipertensão intra-abdominal e síndrome compartimental abdominal e compará-lo com a conduta estabelecida na literatura. MÉTODOS: estudo quantitativo descritivo, observacional, transversal. Foram entrevistados 38 médicos por meio de um questionário auto-aplicado composto por perguntas objetivas. O estudo foi realizado em um hospital universitário, de referência terciária, localizado em Curitiba, Paraná. RESULTADOS: a média de idade dos participantes foi de 28 anos, 60,5% era do sexo feminino e o tempo médio de experiência médica foi de 3,5 anos. Em relação ao conhecimento sobre o tema, 57,9% considerou que a síndrome compartimental abdominal se inicia com a hipertensão intra-abdominal grau III, 50% considerou a pressão de perfusão abdominal o método mais fidedigno para determinar hipertensão intra-abdominal, 89,4% considerou a técnica de aferição intravesical como a mais utilizada, 71,1% considerou a oligúria o sinal precoce de síndrome compartimental abdominal. Não mensurou a pressão intra-abdominal 81,6% dos entrevistados, por não haver protocolo definido pelo serviço. Setenta e nove por cento dos entrevistados afirmou não conhecer as definições do consenso do World Society of the Abdominal Compartment Syndrome (WSACS). CONCLUSÃO: metade dos médicos foi capaz de classificar hipertensão intra-abdominal e indicar o início de um quadro de síndrome compartimental abdominal corretamente.

Síndrome compartimental abdominal: análise do conhecimento da equipe médica de um Hospital Universitário de Curitiba / Abdominal compartment syndrome: knowledge of the medical staff of a University Hospital in Curitiba

RESUMO Objetivo: identificar o conhecimento dos médicos com relação à hipertensão intra-abdominal e síndrome compartimental abdominal e compará-lo com a conduta estabelecida na literatura. Métodos: estudo quantitativo descritivo, observacional, transversal. Foram entrevistados 38 médicos por meio de um questionário auto-aplicado composto por perguntas objetivas. O estudo foi realizado em um hospital universitário, de referência terciária, localizado em Curitiba, Paraná. Resultados: a média de idade dos participantes foi de 28 anos, 60,5% era do sexo feminino e o tempo médio de experiência médica foi de 3,5 anos. Em relação ao conhecimento sobre o tema, 57,9% considerou que a síndrome compartimental abdominal se inicia com a hipertensão intra-abdominal grau III, 50% considerou a pressão de perfusão abdominal o método mais fidedigno para determinar hipertensão intra-abdominal, 89,4% considerou a técnica de aferição intravesical como a mais utilizada, 71,1% considerou a oligúria o sinal precoce de síndrome compartimental abdominal. Não mensurou a pressão intra-abdominal 81,6% dos entrevistados, por não haver protocolo definido pelo serviço. Setenta e nove por cento dos entrevistados afirmou não conhecer as definições do consenso do World Society of the Abdominal Compartment Syndrome (WSACS). Conclusão: metade dos médicos foi capaz de classificar hipertensão intra-abdominal e indicar o início de um quadro de síndrome compartimental abdominal corretamente.

ABSTRACT Objective: to assess the physicians' knowledge regarding intra-abdominal hypertension and abdominal compartment syndrome and to compare it with the established literature. Methods: we conducted a descriptive, observational, cross-sectional, quantitative study. We interviewed 38 physicians through a self-administered questionnaire composed of objective questions. We carried out the study in a tertiary reference university hospital, located in Curitiba, Paraná. Results: the mean age of the participants was 28 years, 60.5% were female and the mean time of medical experience was 3.5 years. Regarding the knowledge on the subject, 57.9% considered that abdominal compartment syndrome starts with intra-abdominal grade III hypertension, 50% considered abdominal perfusion pressure the most reliable method to determine intra-abdominal hypertension, 89.4% considered the intravesical measuring technique as the most used, 71.1% considered oliguria to be the early sign of abdominal compartment syndrome. Of the interviewees, 81.6% did not measure intra-abdominal pressure because there was no protocol defined by the service. Seventy-nine percent of respondents said they did not know the definitions of the consensus of the World Society of the Abdominal Compartment Syndrome (WSACS). Conclusion: half of the physicians were able to classify intra-abdominal hypertension and indicate the onset of abdominal compartment syndrome correctly.

Epidemiological analysis of polytrauma patients with kidney injuries in a university hospital / Análise epidemiológica de politraumatizados com lesões renais em um hospital universitário

Objective: To analyze the characteristics of trauma patients with renal lesions treated at a university hospital in Curitiba. Methods: We conducted a retrospective, cross-sectional study guided by review of medical records of trauma victims who underwent surgical treatment. The variables analyzed were age, gender, mechanism of injury, degree of kidney damage, conduct individualized according to the degree of renal injury, associated injuries, complications and deaths. We classified lesions according to the American Association of Trauma Surgery (TSAA). Results: We analyzed 794 records and found renal lesions in 33 patients, with mean age 29.8 years, most (87.8%) being male. Penetrating trauma accounted for 84.8% of cases. The most common renal injuries were grade II (33.3%), followed by grade I (18.1%), III, IV and V. Nephrectomy treated 45.4% of injuries, 73.3% being total nephrectomy, and 45.4% by nephrorraphy. In 9% treatment was non-surgical. Only 12.1% of patients had isolated renal lesions. Complications ensued in 15.1% and mortality was 6.06%. Conclusion: The surgical approach was preferred due to penetrating trauma mechanism. We achieved low rates of complications and deaths, and neither case could be directly related to kidney damage, and there were patients with multiple lesions. In this sample, we could not observe a direct relationship between kidney damage and complications, deaths or the type of conduct employed.

Objetivo: analisar as características de pacientes vítimas de trauma, com lesões renais atendidos em um hospital universitário de Curitiba. Métodos: estudo transversal retrospectivo guiado por revisão de prontuários de vítimas de trauma submetidos ao tratamento cirúrgico. As variáveis analisadas foram idade, sexo, mecanismo de trauma, grau das lesões renais, conduta individualizada de acordo com o grau da lesão renal, lesões associadas, complicações e óbitos. As lesões foram classificadas de acordo com a Associação Americana de Cirurgia do Trauma (AAST). Resultados: foram analisados 794 prontuários, a lesão renal foi encontrada em 33 pacientes, a média de idade foi 29,8 anos, a maioria dos pacientes era (87,8%) do sexo masculino. O trauma penetrante foi responsável por 84,8% dos casos. As lesões mais frequentes foram as de grau II (33,3%), seguidas pelas lesões de grau I (18,1%) e pelas lesões de grau III, IV e V. Foram tratadas com nefrectomia, 45,4% das lesões, 73,3% por nefrectomia total e 45,4%, por nefrorrafia. Em 9% o tratamento não foi cirúrgico. Apenas 12,1% dos pacientes apresentaram lesões renais isoladas. Complicações foram observadas em 15,1% e a taxa de óbito foi 6,06%. Conclusão: a abordagem cirúrgica foi a preferencial devido ao mecanismo de trauma penetrante. Obtivemos baixos índices de óbitos e complicações, sendo que nenhum dos casos pôde ser relacionado diretamente à lesão renal, e ocorreram em pacientes com múltiplas lesões. Nesta amostra, não foi possível provar relação direta entre lesão renal e complicações, óbitos ou com o tipo de conduta empregada.

Epidemiological analysis of polytrauma patients with kidney injuries in a university hospital.

OBJECTIVE: To analyze the characteristics of trauma patients with renal lesions treated at a university hospital in Curitiba. METHODS: We conducted a retrospective, cross-sectional study guided by review of medical records of trauma victims who underwent surgical treatment. The variables analyzed were age, gender, mechanism of injury, degree of kidney damage, conduct individualized according to the degree of renal injury, associated injuries, complications and deaths. We classified lesions according to the American Association of Trauma Surgery (TSAA). RESULTS: We analyzed 794 records and found renal lesions in 33 patients, with mean age 29.8 years, most (87.8%) being male. Penetrating trauma accounted for 84.8% of cases. The most common renal injuries were grade II (33.3%), followed by grade I (18.1%), III, IV and V. Nephrectomy treated 45.4% of injuries, 73.3% being total nephrectomy, and 45.4% by nephrorraphy. In 9% treatment was non-surgical. Only 12.1% of patients had isolated renal lesions. Complications ensued in 15.1% and mortality was 6.06%. CONCLUSION: The surgical approach was preferred due to penetrating trauma mechanism. We achieved low rates of complications and deaths, and neither case could be directly related to kidney damage, and there were patients with multiple lesions. In this sample, we could not observe a direct relationship between kidney damage and complications, deaths or the type of conduct employed.

Alcoolemia em vítimas fatais de acidente de trânsito no Alto Vale do Itajaí, Santa Catarina, Brasil / Alcoolemy in people fatally injured in traffic crashes on Alto Vale do Itajaí, Santa Catarina, Brasil

O objetivo do estudo foi analisar dados referentes à alcoolemia encontrada em pacientes vítimas fatais de acidente de trânsito encaminhados ao IML de Rio do Sul entre 2004 e 2006. Foram analisados 248 prontuários de pacientes submetidos ao teste de alcoolemia onde 94 pacientes (38%) apresentavam alcoolemia positiva no sangue. Destes 93,6% eram do sexo masculino. Analisando a faixa etária viu-se que 82% estavam entre 17-49 anos. Os dias da semana com maior ocorrência foram sábado e domingo (59%). Ocorreram 65% dos casos entre 18 horas e 2 horas da manhã. Em relação ao mês do ano houve uma distribuição homogênea com discreta predominância nos meses de abril com 12 e dezembro com 13 casos. A BR 470 foi o local em que mais casos ocorreram com 31 óbitos. Os dados encontrados foram condizentes com a literatura.

The objective of the study was analyze data on alcohol found in patients suffering from fatal traffic accident referred to the legal center of necropsy of the ?Rio do Sul/SC? between the years 2004 to 2006. We analyzed records of 248 patients who underwent blood alcohol test, where 94 patients (38%) had positive blood alcohol. Of these 93.6% were male. Looking at the age has been that 82% were between 17-49 years. The days of the week with a higher occurrence was Saturday and Sunday (59%). 65% of cases occurred between 18 pm and 2 o?clock. Along the months of the year there was a homogenous distribution with slight predominance in April with 12 and December with 13 cases. The ?BR 470? was the place where most cases occurred with 31 deaths. Data were consistent with the literature.

Perfil epidemiológico dos óbitos em acidentes de trânsito na região do Alto Vale do Itajaí, Santa Catarina, Brasil / Epidemiological profile of deaths in traffic accidents in the Region Alto Vale do Itajaí, Santa Catarina, Brazil

Os Acidentes de trânsito são a segunda causa de morte de jovens até 29 anos sendo considerado atualmente, um grave problema de saúde pública. Objetivo: Estudo retrospectivo que visa traçar um perfil epidemiológico das vítimas fatais de acidentes de trânsito, no período de 2004 a 2006, na região do Alto Vale do Itajaí, Rio do Sul/SC. Métodos: Os dados foram coletados dos ?Laudos Periciais? do Instituto Médico Legal de Rio do Sul/SC, das vítimas fatais de acidentes de trânsito. Foram analisados: idade, gênero, hora, data e local do acidente, dias de internação, alcoolemia e causa morte. Resultados: foram analisados 356 laudos periciais, 82,9% das vítimas eram do gênero masculino. A média de idade foi de 36,3 anos, sendo que a faixa etária de 20 a 29 anos foi a mais prevalente. Dos acidentes, 49,2% ocorreram em rodovias federais, 44,4% ocorreram no sábado e no domingo sendo que o período das 18 às 24h foi o mais prevalente (41,8%), Rio do Sul e Pouso Redondo também tiveram os maiores percentuais. Dos pacientes com alcoolemia dosada, 38% tiveram valores acima do normal. Conclusão: verificou-se que o perfil das vítimas de trânsito e os aspectos relacionados aos acidentes, analisados neste estudo são compatíveis com outros trabalhos descritos na literatura. Os resultados também sugerem que a região do Alto Vale do Itajaí apresenta índices de mortalidade em acidentes de trânsito relativamente altos quando comparados a outros estudos já realizados em outras regiões.

Accidents of traffic are the second cause of youths? death to 29 years being considered now, a serious problem of public health. Objective: I study retrospective that seeks to draw an epidemic profile of the fatal victims of accidents of traffic, in the period from 2004 to 2006, in the area of the ?Alto Vale do Itajaí, Rio do Sul / SC?. Methods: The data were collected of the ?report autopsy? from Legal Medical Institute of Rio do Sul, of fatal victims of accidents of traffic. They were analyzed: age, gender, hour, it dates and place of the accident, days of internment, ?level of alcohol in the blood? and it causes death. Results: 356 ?reports autopsy? were analyzed, 82,9% of the victims were of the masculine gender. The average of age was of 36,3 years, and the age group from 20 to 29 years was the more prevalente. Of the accidents, 49,2% happened in federal highways, 44,4% happened on Saturday and on Sunday and the period from 18 to 24h was the more prevalente (41,8%), ?Rio do Sul e Pouso Redondo? also had the largest percentile. Of the patients with dosed ?level of alcohol?, 38% had values above the normal. Conclusion: it was verified that the victims? of traffic profile and the aspects related to the accidents, analyzed in this study are compatible with other works described in the literature. The results also suggest that the area of the ?Alto Vale do Itajaí? presents mortality rate relatively in accidents of traffic high when compared the other studies accomplished already in other areas.

Análise de custos entre a raquianestesia e a anestesia venosa com propofol associada ao bloqueio perianal local em operações anorretais / Cost analysis between spinal and venous anesthesia with propofol associated with local perianal block in anorectal procedures

RACIONAL: Atualmente cerca de 90 por cento das operações anorretais podem ser realizadas em regime ambulatorial. A técnica anestésica é fator fundamental na busca de menor tempo de internamento e redução de custos nestes procedimentos. Não há consenso na literatura sobre qual o melhor tipo de anestesia para essas operações. OBJETIVO: Comparar os custos da técnica de raquianestesia com bupivacaína 0,5 por cento isobárica com a técnica de anestesia venosa com propofol associada ao bloqueio perianal local com lidocaína a 2 por cento e bupivacaína 0,5 por cento (anestesia combinada) em pacientes submetidos a operações anorretais. MÉTODOS: Foram analisados dados de 99 pacientes submetidos à operações anorretais, divididos em dois grupos: grupo I (raquianestesia), composto por 50 pacientes e grupo II (anestesia combinada), composto por 49 pacientes. Foram estudados os procedimentos cirúrgicos, tempo de procedimento anestésico-cirúrgico, tempo de internamento e custos globais de cada paciente. RESULTADOS: Não houve diferença estatística significativa entre os grupos estudados em relação ao tipo de procedimento cirúrgico, sexo, idade e complicações. O tempo médio do procedimento anestésico-cirúrgico, no grupo I foi de 53,1 minutos e de 44,08 minutos no grupo II (P=0,034). O tempo médio de internamento foi de 19,68 horas no grupo I e de 7,08 horas no grupo II (P<0,0001). O custo global médio no grupo I foi de R$ 296,49 e de R$ 280,27 no grupo II (P=0,73). CONCLUSÕES: As operações anorretais realizadas com anestesia combinada apresentaram custo semelhante às realizadas com raquianestesia. Houve menor tempo de procedimento anestésico-cirúrgico e menor tempo de internamento nos pacientes operados com anestesia combinada.

BACKGROUND: Approximately ninety percent of anorectal surgical procedures are performed in ambulatory basis. The choice of a proper anesthetic technique is important to achieve shorter hospital stay and low costs. There's no evidence in the literature that an ideal type of anesthesia for these procedures exists. AIM: To compare the costs of patients operated with spinal anesthesia (0,5 percent bupivacaine) with combined anesthesia (propofol and local perineal block with 2 percent lidocaine and 0,5 percent bupivacaine) in anorectal surgical procedures. METHODS: Data from 99 patients submitted to anorectal operations were retrospectively analyzed. They were divided in two groups: 50 patients were operated with spinal anesthesia (group I) and 49 with combined anesthesia (group II). The type of operation, the time of hospital stay, the time of anesthetic and surgical procedure and the costs were analyzed. RESULTS: There were no significant differences between the studied groups regarding the type of operation, gender, age and complications. The time of anesthetic and surgical procedures was 53,1 minutes in group I and 44,08 minutes in group II (P=0,034). The average time of hospital stay was 19,68 hours in group I and 7,08 hours in group II (P<0,0001). The average cost of the procedures was R$ 296,49 in group I and R$ 280,27 in group II (P=0,73). CONCLUSIONS: Anorectal procedures with combined anesthesia (propofol and local perineal block) had similar costs than those with spinal anesthesia. There was a lower time of anesthetic and surgical procedures and shorter hospital stay in the combined anesthesia group.

Trauma hepático: análise do tratamento com balão intra-hepático em um hospital universitário de Curitiba / Hepatic trauma: analysis of the treatment with intrahepatic balloon in a university hospital of Curitiba

OBJETIVO: Discutir a estratégia cirúrgica para tratamento de lesões hepáticas penetrantes graves através de tamponamento com balão intra-hepático. MÉTODOS: Estudo retrospectivo com 18 pacientes com trauma hepático penetrante, tratados com balão, atendidos em um hospital de referência em trauma no sul do Brasil. Foram avaliados: idade, sexo, grau da lesão hepática, segmentos acometidos, quantidade de solução salina infundida no balão intra-hepático e seu tempo de permanência, lesões associadas, terapia nutricional, hemotransfusões, complicações, antibioticoterapia, necessidade de UTI e tempo de internamento. RESULTADOS: Todos os pacientes eram do sexo masculino com idade média de 22,5 anos (18-48). As feridas por arma de fogo foram mais prevalentes, sendo a localização mais comum a região torácica e a transição tóraco-abdominal. A lesão associada mais comum foi a do diafragma, e o segmento hepático mais acometido foi o VIII (29,6 por cento). Sete pacientes (38,9 por cento) sobreviveram e a complicação mais comum foi fístula biliar (42,8 por cento). Dos 11 (61,1 por cento) pacientes que foram a óbito, seis morreram no mesmo dia em que foram operados, três ficaram em média 18,6 dias internados e os demais morreram no 2° e 3° do pós-operatório. CONCLUSÃO: O tratamento das lesões hepáticas transfixantes costuma ser de difícil manejo cirúrgico e com alto índice de morbimortalidade. O uso do balão intra- hepático foi eficaz no tratamento dessas lesões, porém não é isento de complicações tendo suas indicações bem definidas.

OBJECTIVE: The authors discuss the surgical strategies in the management of complex penetrating hepatic lesions through liver balloon tamponade. METHODS: Eighteen patients who received care in a trauma referral center in southern Brazil over the last 5 years were selected retrospectively. Data and variables evaluated were age, sex, hepatic injury grade and location, amount of saline solution filling the balloon and the length of time it was kept in place, associated injuries, the nutritional therapy instituted, hem concentrate transfusion, complications, antibiotics use, ICU need and length of hospital stay. RESULTS: All patients were male with an average age of 22.5 years (18-48). Gunshot wounds were more prevalent than stab wounds and their most common locations were the thorax and thoraco-abdominal regions. The m most commonly associated injury was in the diaphragm, and Couinaud segment VIII was the most often injured hepatic region (29.6 percent). Seven patients (38.9 percent) survived and the most common complication were biliary fistulae (42.8 percent). From the eleven deceased patients (61.1 percent), 6 died on the day of admission, 3 stayed for 18.6 days in hospital and the others died on the 2nd and 3rd postoperative days. CONCLUSION: Transfixing hepatic lesions are usually difficult to manage and carry high morbidity and mortality rates. The use of intrahepatic balloon tamponade can be useful as a therapeutic tool, but not rid of complications, and for that reason it has specific and selected indications.

Colecistopatia aguda e crônica: análise comparativa das taxas e causas de conversão para laparotomia / Acute and chronic cholecystopathies: analysis comparative of the rates and causes of conversion to laparotomy

Objetivo: Analisar a taxa e as principais causas de conversão de colecistectomia videolaparoscópica para cirurgia aberta entre colecistites agudas e crônicas. Métodos: Estudo retrospectivo, analisando 1359 prontuários de pacientes submetidos à colecistectomiano Serviço de Cirurgia Geral do Hospital Universitário Cajuru no período de janeiro de 2000 à outubro de 2006. Resultados: Realizaram-se 1066 colecistectomias videolaparoscópicas, sendo, 701(65,75%) por colecistopatia crônica calculosa, 356 (33,39%) por colecistopatia aguda calculosa, sete 0,65%) por pólipos de vesícula, duas (0,21%) por vesícula hidrópica. A taxa de conversão na colecistopatia aguda foi de 7,86%, e na colecistite crônica ,85% (p=0,0003). A média de idade das taxas de conversão foi de 50,96 ± 17,49 anos para colecistopatia aguda e de 56,45 ± 12,28 anos para crônica (p=0,234). O tempo cirúrgico mediano foi de 152,5 (30 – 36) minutos para aguda e 157,5 (90 – 240) para crônica (p=0,959). As principais causas de conversão nas colecistopatias crônicas foram: anatomia obscura (16 pacientes) e aderências (14 pacientes), sendo que em 10 casos as duas causas estavam associadas. Já na forma aguda, as principais causas foram aderência (13 pacientes) e dificuldades técnicas (8 pacientes); com diferença significativa(p=0,008). Conclusão: A taxa de conversão de cirurgia videolaparoscópica para cirurgia aberta é maior nos casos de colecistopatiacalculosa aguda do que na crônica. Nesta, o fator que mais dificultou a realização do procedimento videolaparoscópico em nosso serviço foi a alteração anatômica; já naquela, foi a presença de aderências.

Objectives: to analyze the rate and main causes for conversion to open surgery among acute and chronic cholecystitis. Methods: a retrospective analysis of 1359 patient medical charts submitted to cholecystectomy in hospital universitário cajuru’s general surgerydepartment was done during the period from january 2000 to october 2006. Results: one thousand and sixty six laparoscopic cholecystectomies were performed, 701 (65.75%) due to chronic cholecystolithiasis, 356 (33.39%) due to acute cholecystolithiasis, seven (0.65%) had gallbladder polyps and two (0.21%) cases had hydropic gallbladder. The conversion rate in acute cases was 7.86%, and in chronic cases were 2.85% (p=0.0003). The average age for conversion was 50.96 ± 17.49 years-old for acute cases and 56.45 ± 12.28 years-old for chronic cases. The operative meantime was 152.5 minutes (30 – 36) for acute and 157.5 minutes(90 – 240) for chronic holecystolithiasis (p=0.959). The conversion reasons for chronic cholecystolithiasis were: obscure anatomy in 16 cases (80%) and adhesions in 14 cases (70%), considering that in ten cases both causes were associated. For acute presentation, conversions were due to adhesions in 13 (46.42%) patients and technical difficulties were found in 8 (28.57%) patients (p=0.008). Conclusion: the rate for conversion of laparoscopic cholecystectomy to open surgery is higher in acute cholecystolithiasis when in comparison to chronic ones. Both, the presence of adhesions in acute cases, and difficult anatomy identification in chronic cases,were the most common reasons to impair the laparoscopic procedures performance in our department.

[Acute and chronic cholecystopathies: analysis comparative of the rates and causes of conversion to laparotomy]. / Colecistopatia aguda e crônica: análise comparativa das taxas e causas de conversão para laparotomia.

OBJECTIVES: To analyze the rate and main causes for conversion to open surgery among acute and chronic cholecystitis. METHODS: A retrospective analysis of 1359 patient medical charts submitted to cholecystectomy in hospitalUniversitário Cajuru's general surgery department was done during the period from january 2000 to october 2006. RESULTS: One thousand and sixty six laparoscopic cholecystectomies were performed, 701 (65.75%) due to chronic cholecystolithiasis, 356 (33.39%) due to acute cholecystolithiasis, seven (0.65%) had gallbladder polyps and two (0.21%) cases had hydropic gallbladder. The conversion rate in acute cases was 7.86%, and in chronic cases were 2.85% (p=0.0003). The average age for conversion was 50.96 +/- 17.49 years-old for acute cases and 56.45 +/- 12.28 years-old for chronic cases. The operative meantime was 152.5 minutes (30 - 36) for acute and 157.5 minutes (90 - 240) for chronic cholecystolithiasis (p=0.959). The conversion reasons for chronic cholecystolithiasis were: obscure anatomy in 16 cases (80%) and adhesions in 14 cases (70%), considering that in ten cases both causes were associated. For acute presentation, conversions were due to adhesions in 13 (46.42%) patients and technical difficulties were found in 8 (28.57%) patients (p=0.008). CONCLUSION: The rate for conversion of laparoscopic cholecystectomy to open surgery is higher in acute cholecystolithiasis when in comparison to chronic ones. Both, the presence of adhesions in acute cases, and difficult anatomy identification in chronic cases, were the most common reasons to impair the laparoscopic procedures performance in our department.

Hepatic trauma: analysis of the treatment with intrahepatic balloon in a university hospital of Curitiba.

OBJECTIVE: The authors discuss the surgical strategies in the management of complex penetrating hepatic lesions through liver balloon tamponade. METHODS: Eighteen patients who received care in a trauma referral center in southern Brazil over the last 5 years were selected retrospectively. Data and variables evaluated were age, sex, hepatic injury grade and location, amount of saline solution filling the balloon and the length of time it was kept in place, associated injuries, the nutritional therapy instituted, hem concentrate transfusion, complications, antibiotics use, ICU need and length of hospital stay. RESULTS: All patients were male with an average age of 22.5 years (18-48). Gunshot wounds were more prevalent than stab wounds and their most common locations were the thorax and thoraco-abdominal regions. The m most commonly associated injury was in the diaphragm, and Couinaud segment VIII was the most often injured hepatic region (29.6%). Seven patients (38.9%) survived and the most common complication were biliary fistulae (42.8%). From the eleven deceased patients (61.1%), 6 died on the day of admission, 3 stayed for 18.6 days in hospital and the others died on the 2nd and 3rd postoperative days. CONCLUSION: Transfixing hepatic lesions are usually difficult to manage and carry high morbidity and mortality rates. The use of intrahepatic balloon tamponade can be useful as a therapeutic tool, but not rid of complications, and for that reason it has specific and selected indications.