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1.
Obes Surg ; 2021 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-34546514

RESUMO

PURPOSE: It is currently unknown whether NASH (nonalcoholic steatohepatitis), as compared to simple steatosis, is associated with impaired postoperative weight loss and metabolic outcomes after RYGB surgery. To compare the effectiveness of Roux-en-Y gastric bypass (RYGB) on patients with NASH versus those with simple nonalcoholic fatty liver (NAFL). MATERIALS AND METHODS: We retrospectively retrieved data from 515 patients undergoing RYGB surgery with concomitant liver biopsy. Clinical follow-up and metabolic assessment were performed prior to surgery and 12 months after surgery. We used multivariate analysis of variance (MANOVA) and propensity score matching and we assessed for changes in markers of hepatocellular injury and metabolic outcomes. RESULTS: There were 421 patients with simple NAFL, and 94 with NASH. Baseline alanine and aspartate aminotransferases were significantly higher in patients with NASH (p < 0.01). Twelve months after the RYGB surgery, as determined by both MANOVA and propensity score matching, patients with NASH exhibited a significantly greater reduction in alanine aminotransferase (ß-coefficient - 12 iU/l [- 22 to - 1.83], 95% CI, adjusted p = 0.021) compared to their NAFL counterparts (31 matched patients in each group with no loss to follow-up at 12 months). Excess weight loss was similar in both groups (ß-coefficient 4.54% [- 3.12 to 12.21], 95% CI, adjusted p = 0.244). Change in BMI was comparable in both groups (- 14 (- 16.6 to - 12.5) versus - 14.3 (- 17.3 to - 11.9), p = 0.784). CONCLUSION: After RYGB surgery, patients with NASH experience a greater reduction in markers for hepatocellular injury and similar weight loss compared to patients with simple steatosis.

2.
World J Gastroenterol ; 27(31): 5189-5200, 2021 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-34497444

RESUMO

Near-infrared fluorescence (NIRF) is a technique of augmented reality that, when applied in the operating theatre, allows the colorectal surgeon to visualize and assess bowel vascularization, to identify lymph nodes draining a cancer site and to identify ureters. Herein, we review the literature regarding NIRF in colorectal surgery.


Assuntos
Cirurgia Colorretal , Anastomose Cirúrgica , Fístula Anastomótica , Fluorescência , Humanos , Verde de Indocianina
3.
Rev Med Suisse ; 17(748): 1466-1473, 2021 Sep 01.
Artigo em Francês | MEDLINE | ID: mdl-34468098

RESUMO

Hepatic cystic echinococcosis (HCE), is a cosmopolitan parasitic zoonosis. Autochtonous HCE cases are rare and the majority of cases are imported from endemic areas. It induces the development in the liver of Echinococcus granulosus larvae. Extrahepatic localizations are also possible. Cyst development is slow with an often-late diagnosis. In Switzerland, HCE discovery is usually fortuitous, during an abdominal radiological examination. More rarely, an acute clinical picture reveals a complication that can be severe or even fatal. The diagnosis is based on ultrasound findings that allows cyst characterization according to the WHO classification. This guides the therapeutic choice: simple monitoring, albendazole therapy, percutaneous procedures or surgery.


Assuntos
Equinococose , Echinococcus granulosus , Albendazol/uso terapêutico , Animais , Equinococose/diagnóstico por imagem , Equinococose/terapia , Humanos , Fígado , Zoonoses
4.
Transpl Int ; 2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-34490945

RESUMO

Transplant oncology is a field of growing interest, with increasing number of patients transplanted for cancer [1]. Among such indications, colorectal liver metastasis is under intense scrutiny considering the high number of potential new recipients. The important article by the Oslo group published in the current issue of Transplant International brings more light on their post-transplant fate [2].

5.
Cells ; 10(8)2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34440855

RESUMO

Anal sphincter incontinence is a chronic disease, which dramatically impairs quality of life and induces high costs for the society. Surgery, considered as the best curative option, shows a disappointing success rate. Stem/progenitor cell therapy is pledging, for anal sphincter incontinence, a substitute to surgery with higher efficacy. However, the published literature is disparate. Our aim was to perform a review on the development of cell therapy for anal sphincter incontinence with critical analyses of its pitfalls. Animal models for anal sphincter incontinence were varied and tried to reproduce distinct clinical situations (acute injury or healed injury with or without surgical reconstruction) but were limited by anatomical considerations. Cell preparations used for treatment, originated, in order of frequency, from skeletal muscle, bone marrow or fat tissue. The characterization of these preparations was often incomplete and stemness not always addressed. Despite a lack of understanding of sphincter healing processes and the exact mechanism of action of cell preparations, this treatment was evaluated in 83 incontinent patients, reporting encouraging results. However, further development is necessary to establish the correct indications, to determine the most-suited cell type, to standardize the cell preparation method and to validate the route and number of cell delivery.

6.
Gut ; 70(10): 1914-1924, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34281984

RESUMO

OBJECTIVE: Explore the impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course. DESIGN: Data from consecutive adult LT candidates with COVID-19 were collected across Europe in a dedicated registry and were analysed. RESULTS: From 21 February to 20 November 2020, 136 adult cases with laboratory-confirmed SARS-CoV-2 infection from 33 centres in 11 European countries were collected, with 113 having COVID-19. Thirty-seven (37/113, 32.7%) patients died after a median of 18 (10-30) days, with respiratory failure being the major cause (33/37, 89.2%). The 60-day mortality risk did not significantly change between first (35.3%, 95% CI 23.9% to 50.0%) and second (26.0%, 95% CI 16.2% to 40.2%) waves. Multivariable Cox regression analysis showed Laboratory Model for End-stage Liver Disease (Lab-MELD) score of ≥15 (Model for End-stage Liver Disease (MELD) score 15-19, HR 5.46, 95% CI 1.81 to 16.50; MELD score≥20, HR 5.24, 95% CI 1.77 to 15.55) and dyspnoea on presentation (HR 3.89, 95% CI 2.02 to 7.51) being the two negative independent factors for mortality. Twenty-six patients underwent an LT after a median time of 78.5 (IQR 44-102) days, and 25 (96%) were alive after a median follow-up of 118 days (IQR 31-170). CONCLUSIONS: Increased mortality in LT candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of ≥15, was observed, with no significant difference between first and second waves of the pandemic. Respiratory failure was the major cause of death. The dismal prognosis of patients with DC supports the adoption of strict preventative measures and the urgent testing of vaccination efficacy in this population. Prior SARS-CoV-2 symptomatic infection did not affect early post-transplant survival (96%).


Assuntos
COVID-19/mortalidade , Transplante de Fígado , Pneumonia Viral/mortalidade , Transplantados , Causas de Morte , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/virologia , Sistema de Registros , Fatores de Risco , SARS-CoV-2 , Listas de Espera
7.
Colorectal Dis ; 2021 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-34272795

RESUMO

AIM: Caecal diverticulitis (CD) is an uncommon condition which can be misdiagnosed as acute appendicitis due to similar clinical presentations. Further, its management varies among medical centres. The aim of this study was to review cases of patients with CD, to identify the factors differentiating CD from acute appendicitis and to provide a summary of existing diagnostic methods and therapeutic alternatives regarding its management. METHODS: This systematic review was conducted in accordance with the PRISMA guidelines and the AMSTAR2 checklist. We searched MEDLINE and Embase from inception until 1 October 2018 for original publications reporting cases of CD. RESULTS: Out of the 560 identified studies, 146 publications (988 patients) were included in the qualitative synthesis. Most frequent symptoms of CD were right iliac fossa pain (93.2%), nausea and/or vomiting (35.4%) and fever (26.9%). A total of 443 patients (44.8%) underwent radiological imaging, which reported CD in 225 patients (22.8%). For the other patients, the diagnosis was obtained by surgical exploration (73.9%). Among patients diagnosed with CD by imaging, 67 (29.8%) underwent surgery and 158 (70.2%) were treated conservatively. Among patients who underwent surgical exploration, treatment consisted most frequently of right hemi-colectomy (33%), appendectomy (18.8%) and diverticulectomy with appendectomy (16.3%). CONCLUSION: CD can be misdiagnosed as acute appendicitis, therefore resulting in unnecessary surgical exploration. The review of the literature starting from 1930 highlights the critical role of medical imaging in supporting the clinician to diagnose this condition and administer adequate treatment.

9.
Rev Med Suisse ; 17(743): 1159-1166, 2021 Jun 16.
Artigo em Francês | MEDLINE | ID: mdl-34133093

RESUMO

A stoma is the opening of the digestive tract to the skin, whether performed using a medical device or surgery. The goals of a stoma may be to supplement anatomical nutrition, to decompress the digestive tract, or to protect a part of the digestive tract or the perineum. Stomas can be performed at all levels of the digestive tract and be of different anatomical types. The management of stomas, as well as the management of their potential complications, whose incidence can reach 80%, require specific knowledge, which constitutes the objective of the present article.


Assuntos
Estomas Cirúrgicos , Humanos , Incidência
10.
Rev Med Suisse ; 17(743): 1167-1171, 2021 Jun 16.
Artigo em Francês | MEDLINE | ID: mdl-34133094

RESUMO

Total pancreatectomy is a procedure primarily performed for chronic pancreatitis refractory to conservative therapy. It may nevertheless be indicated in the event of a malignant tumor, either as a treatment for a surgical complication or as a prevention of anastomotic leakage. If possible, islet auto-transplantation should be combined with total pancreatectomy for benign disease, in order to prevent a severe diabetes. Until recently, malignant disease was considered an absolute contraindication to islet auto-transplantation. A recent series from Milan showed promising oncological results in auto-transplantation for malignant disease, opening up new perspectives for total pancreatectomy for cancer.


Assuntos
Diabetes Mellitus , Transplante das Ilhotas Pancreáticas , Pancreatite Crônica , Humanos , Pancreatectomia , Pancreatite Crônica/cirurgia , Transplante Autólogo , Resultado do Tratamento
11.
J Hepatol ; 75(3): 610-622, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33951535

RESUMO

BACKGROUND & AIMS: Liver transplantation (LT) has been proposed as an effective salvage therapy even for the sickest patients with acute-on-chronic liver failure (ACLF). This large collaborative study was designed to assess the current clinical practice and outcomes of patients with ACLF who are wait-listed for LT in Europe. METHODS: This was a retrospective study including 308 consecutive patients with ACLF, listed in 20 centres across 8 European countries, from January 2018 to June 2019. RESULTS: A total of 2,677 patients received a LT: 1,216 (45.4%) for decompensated cirrhosis. Of these, 234 (19.2%) had ACLF at LT: 58 (4.8%) had ACLF-1, 78 (6.4%) had ACLF-2, and 98 (8.1%) had ACLF-3. Wide variations were observed amongst countries: France and Germany had high rates of ACLF-2/3 (27-41%); Italy, Switzerland, Poland and the Netherlands had medium rates (9-15%); and the United Kingdom and Spain had low rates (3-5%) (p <0.0001). The 1-year probability of survival after LT for patients with ACLF was 81% (95% CI 74-87). Pre-LT arterial lactate levels >4 mmol/L (hazard ratio [HR] 3.14; 95% CI 1.37-7.19), recent infection from multidrug resistant organisms (HR 3.67; 95% CI 1.63-8.28), and renal replacement therapy (HR 2.74; 95% CI 1.37-5.51) were independent predictors of post-LT mortality. During the same period, 74 patients with ACLF died on the waiting list. In an intention-to-treat analysis, 1-year survival of patients with ACLF on the LT waiting list was 73% for ACLF-1 or -2 and 50% for ACLF-3. CONCLUSION: The results reveal wide variations in the listing of patients with ACLF in Europe despite favourable post-LT survival. Risk factors for mortality were identified, enabling a more precise prognostic assessment of patients with ACLF. LAY SUMMARY: Acute-on-chronic liver failure (ACLF) is a severe clinical condition for which liver transplantation is an effective therapeutic option. This study has demonstrated that in Europe, referral and access to liver transplantation (LT) for patients with ACLF needs to be harmonised to avoid inequities. Post-LT survival for patients with ACLF was >80% after 1 year and some factors have been identified to help select patients with favourable outcomes.

12.
Semin Liver Dis ; 41(2): 172-181, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33957694

RESUMO

For patients with early-stage hepatocellular carcinoma (HCC), liver transplantation offers the best chance of cure. Over the past two decades, selection criteria to determine eligibility for liver transplantation have been constantly refined but a fair allocation strategy of liver grafts to HCC patients remains challenging. In Europe, over a dozen transplantation networks apply different liver transplantation criteria for HCC patients. In this review, we explore and compare candidate selection and liver graft allocation strategies for patients with HCC with a European perspective and discuss the ethical and technical challenges involved. In addition, we suggest possible paths for future improvement such as transitioning from fixed selection and allocation criteria to a more flexible model of benefit, which includes criteria concerning the graft, response to treatment, the biology of the tumor, and other relevant recipient factors.

13.
Artigo em Inglês | MEDLINE | ID: mdl-33965578

RESUMO

BACKGROUND & AIMS: Nonalcoholic fatty liver disease (NAFLD) may be a risk factor for hepatocellular carcinoma (HCC), but the extent of this association still needs to be addressed. Pooled incidence rates of HCC across the disease spectrum of NAFLD have never been estimated by meta-analysis. METHODS: In this systematic review, we searched Web of Science, Embase, PubMed, and the Cochrane Library from January 1, 1950 through July 30, 2020. We included studies reporting on HCC incidence in patients with NAFLD. The main outcomes were pooled HCC incidences in patients with NAFLD at distinct severity stages. Summary estimates were calculated with random-effects models. Sensitivity analyses and meta-regression analyses were carried out to address heterogeneity. RESULTS: We included 18 studies involving 470,404 patients. In patients with NAFLD at a stage earlier than cirrhosis, the incidence rate of HCC was 0.03 per 100 person-years (95% confidence interval [CI], 0.01-0.07; I2 = 98%). In patients with cirrhosis, the incidence rate was 3.78 per 100 person-years (95% CI, 2.47-5.78; I2 = 93%). Patients with cirrhosis undergoing regular screening for HCC had an incidence rate of 4.62 per 100 person-years (95% CI, 2.77-7.72; I2 = 77%). CONCLUSIONS: Patients with NAFLD-related cirrhosis have a risk of developing HCC similar to that reported for patients with cirrhosis from other etiologies. Evidence documenting the risk in patients with nonalcoholic steatohepatitis or simple steatosis is limited, but the incidence of HCC in these populations may lie below thresholds used to recommend a screening. Well-designed prospective studies in these subpopulations are needed. The protocol for this systematic review is registered in the Prospero database (registration number CRD42018092861).

14.
Surgery ; 170(3): 813-821, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33888314

RESUMO

BACKGROUND: Anemia is a recognized risk factor for perioperative related morbidity and mortality and is frequently reported in liver surgeries with an estimated incidence of 32%. We aim to assess the impact of intravenous iron administration in the immediate postoperative period on anemia and iron status as well as to determine the kinetics of hepcidin after liver surgery. METHODS: The HepciFer trial, a randomized controlled trial, included 50 patients undergoing liver surgery. In accordance with the randomization process, patients received either ferric carboxymaltose (15 mg/kg, maximum 1 g) or placebo 4 hours after surgery. RESULTS: The mean hemoglobin level, 7 days after surgery, did not differ significantly between the intervention and control group (11.1 ± 1.8 g/dL and 10.4 ± 1.6 g/dL, respectively) with a mean difference of +0.7 g/dL ([95% confidence interval, -0.3 to +1.7], P = .173). Within patients receiving intravenous iron supplementation, none presented biological signs of functional iron deficiency. Hepcidin levels remained significantly higher during the observation period in the intervention group. Inflammatory biomarkers, red blood cells transfusion rate and hospital duration of stay were similar between groups. CONCLUSION: Intravenous ferric carboxymaltose administration did not result in a significant increase of hemoglobin levels 7 days after surgery. However, this study suggests that intravenous iron supplementation in the immediate postoperative settings prevents functional iron deficiency. Intravenous iron supplementation overcame the hepcidin-mediated blockade of iron absorption and should be considered as the preferred route of administration in the postoperative period.

15.
Updates Surg ; 73(5): 1983-1988, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33837948

RESUMO

Our objective was to determine current practice in Switzerland regarding the use of pNPWT in abdominal surgery. An online survey was carried out to evaluate the use of pNPWT among abdominal surgeons in Switzerland. One hundred and ten participants replied to the survey from 16.12.2019 to 15.01.2020. Eleven were excluded, leaving 99 responders for analysis. Seventy participants (70.7%) were using pNPWT, 3 (3%) have stopped using it and 26 (26.3%) have never used it. pNPWT was used on midline laparotomy by 63 responders (90%), closed stoma wounds by 21 (30%), closed perineal wounds by 20 (28.6%), Pfannenstiel incisions by 18 (23.7%), groin incisions by 16 (22.9%), subcostal incisions by 13 (18.6%), Mc Burney incisions by 3 (4.3%) and other incisions by 18 (25.7%). Forty-eight participants (68.6%) used pNPWT on less than 10% of patients, 14 (20%) on 10-25% of patients, six (8.6%) on 25-50% of patients and two (2.9%) on 75-100% of patients. Suggestions for improvement to pNPWT were: better sealing, recyclable system, better adaptation to the perineum, smaller device, reduced cost and possibility to check the surgical wound through the dressing. In conclusion, pNPWT is widely used among Swiss surgeons, mostly on midline incisions. However, most of them apply pNPWT on a small proportion of patients only. Suggestions for improvement were a better sealing for complex wounds, reduced cost and possibility to check the wound during the therapy.

16.
J Robot Surg ; 2021 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-33723791

RESUMO

Robotic-assisted surgery (RAS) involves training processes and challenges that differ from open or laparoscopic surgery, particularly regarding the possibilities of observation and embodied guidance. The video recording and the dual-console system creates a potential opportunity for participation. Our research, conducted within the department of visceral surgery of a big Swiss, public, academic hospital, uses a methodology based on the co-analysis of video recordings with surgeons in self-confrontation interviews, to investigate the teaching activity of the lead surgeon supervising a surgeon in training at the dual console. Three short sequences have been selected for the paper. Our analysis highlights the skills-in-construction of the surgeon in training regarding communication with the operating team, fluency of working with three hands, and awareness of the whole operating site. It also shows the divergent necessities of enabling verbalization for professional training, while ensuring a quiet and efficient environment for medical performance. To balance these requirements, we argue that dedicated briefing and debriefing sessions may be particularly effective; we also suggest that the self-confrontation video technique may be valuable to support the verbalization on both the mentor's and the trainee's side during such debriefing, and to enhance the mentor's reflexivity regarding didactic choices.

17.
JHEP Rep ; : 100260, 2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33644725

RESUMO

BACKGROUND: The coronavirus 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems and it may have heavily impacted patients with liver cancer (LC). This project has evaluated if the schedule of LC screening or procedures has been interrupted /delayed because of the COVID-19 pandemic. MATERIAL AND METHODS: An international survey evaluated the impact of COVID-19 pandemic on clinical practice and clinical trials from March 2020 to June 2020, as the first phase of a multicentre, international and observational project. The focus was on patients with hepatocellular carcinoma or intrahepatic cholangiocarcinoma, cared for around the world during the first COVID-19 pandemic wave. RESULTS: Ninety-one centres expressed interest to participate and 76 were included in the analysis, from Europe, South America, North America, Asia and Africa (73.7%, 17.1%, 5.3%, 2.6% and 1.3% per continent, respectively). Eighty-seven per cent of the centres modified their clinical practice: 40.8% the diagnostic procedures, 80.9% the screening program, 50% cancelled curative and/or palliative treatments for LC, and 44.0% cancelled the liver transplantation program. Forty-five out 69 (65.2%) centres in which clinical trials were running modified their treatments in that setting, but 58.1% were able to recruit new patients. The phone call service was modified in 51.4% of centres which had this service prior to COVID-19 pandemic (n=19/37). CONCLUSION: The first wave of the COVID-19 pandemic had a tremendous impact on the routine care of patients with LC. Modifications in screening, diagnostic and treatment algorithms may have significantly impaired the outcome of patients. Ongoing data collection and future analyses will report the benefits and disadvantages of the strategies implemented, aiding future decision making.

18.
Medicine (Baltimore) ; 100(6): e24425, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578535

RESUMO

ABSTRACT: In humans, thrombocytopenic patients have increased incidence of post-hepatectomy liver failure (PHLF), but existing evidence is heterogeneous. Our objective was to determine if preoperative platelet count or antiplatelet drugs were associated with PHLF.Patients who underwent hepatic resection in the University Hospitals of Geneva, Switzerland, from 01.12.2009 to 18.12.2018 were identified. Platelet count at day 0, postoperative days (POD) 1, 3, and 5 were retrieved. Occurrence of PHLF according to the ISGLS definition was determined. Logistic regression was performed to determine if platelet count or antiplatelet drug were predictors for PHLF.Five hundred ninety seven patients were included. Eighty patients (17.8%) had a preoperative platelet count <150 (G/l) and 24 patients (5.3%) had a platelet count <100 (G/l). Thirty five patients (5.9%) were under antiplatelet drug. Platelet count significantly decreased at POD 1 and POD 3 when compared to preoperative platelet count (182 ±â€Š71.61 (G/l) vs 212 ±â€Š85.26 (G/l), P < .0001; 162 ±â€Š68.5 (G/l) vs 212 ±â€Š85.26 (G/l), P < .0001). At POD 5, post-operative platelet count did not significantly differ from its preoperative value. Forty three patients (11.2%) suffered from PHLF. Their platelet count was not significantly different than patients without PHLF (211 ±â€Š89.7 (G/l) vs 211 ±â€Š83.5 (G/l), P = .671). One patient with PHLF had a platelet count <100 (G/l) and 5 had a count <150 (G/l). Univariate logistic regression did not identify preoperative thrombocytopenia (<100 (G/l) or <150 (G/l)), postoperative thrombocytopenia, or the presence of antiagregant drug, as predictors of PHLF. We did not identify preoperative or postoperative thrombocytopenia as predictor of PHLF in a cohort of 597 patients.


Assuntos
Hepatectomia/efeitos adversos , Falência Hepática/etiologia , Contagem de Plaquetas , Cuidados Pré-Operatórios/métodos , Feminino , Hepatectomia/métodos , Humanos , Falência Hepática/sangue , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/efeitos adversos , Contagem de Plaquetas/métodos , Valor Preditivo dos Testes , Estudos Retrospectivos
19.
Int J Colorectal Dis ; 36(1): 19-26, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32886194

RESUMO

BACKGROUND: Closed perineal wounds often fail to heal by primary intention after abdomino-perineal resection (APR) and are often complicated by surgical site infection (SSI) and/or wound dehiscence. Recent evidence showed encouraging results of prophylactic negative-pressure wound therapy (pNPWT) for prevention of wound-related complications in surgery. Our objective was to gather and discuss the early existing literature regarding the use of pNPWT to prevent wound-related complications on perineal wounds after APR. METHODS: Medline, Embase, and Web of Science were searched for original publications and congress abstracts reporting the use of pNPWT after APR on closed perineal wounds. RESULTS: Seven publications were included for analysis. Two publications reported significantly lower incidence of SSI in pNPWT patients than in controls with a risk reduction of about 25-30%. Two other publications described similar incidences of SSI between the two groups of patients but described SSI in pNPWT patients to be less severe. One study reported significantly lower incidence of wound dehiscence in pNPWT patients than in controls. CONCLUSION: The largest non-randomized studies investigating the effect of pNPWT on the prevention of wound-related complications after APR showed encouraging results in terms of reduction of SSI and wound dehiscence that deserve further investigation and confirmation.


Assuntos
Tratamento de Ferimentos com Pressão Negativa , Protectomia , Neoplasias Retais , Humanos , Períneo/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Cicatrização
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