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1.
Artigo em Inglês | MEDLINE | ID: mdl-33023436

RESUMO

BACKGROUND: Hemorrhoidal disease represents one of the most common anorectal disorders in the general population. Energy devices, such as LigaSureTM scalpel, have reshaped the concept of hemorrhoid surgery and in turn, have improved patient outcomes and simplified the work of surgeon. OBJECTIVE: The study aims to evaluate the outcomes of LigaSureTM hemorrhoidectomy (LH) analyzing main post-operative complications rate, length of stay, operating time and time to return to work. METHODS: In this monocentric descriptive study, from June 2001 to February 2019, 1454 consecutive patients, treated with LH for grade III and IV haemorrhoids, were analyzed. Complications were classified in early, late and long-term if they occurred within 1 month, between 1 and 2 months or after 2 months, respectively. RESULTS: (90.2%) of patients were treated in day surgery regimen and mean operating time was 14.3 minutes. The post-operative pain decreased from 3.7 mean VAS on the 1st post-operative day to 0.1 mean VAS on 30th post-operative day. Early complications rate was 2.1%: urinary retention accounted for 1.8% of patients. 0.3% of patients experienced post-operative bleeding and only one required reoperation. Late complications rate was 5.8%: anal stenosis, incomplete healing and anal fissure were detected in 3.6%, 1.2% and 1% of patients, respectively. The Long term complications rate was 5.3 % : anal fistula, soiling, perianal abscess and recurrence were identified in 0.2%, 0.1%, 0.3% and 4.8% of patients, respectively. CONCLUSION: LH is a safe and fast procedure with a proven minimal complications rate.

2.
Int J Surg Case Rep ; 70: 168-171, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32417732

RESUMO

INTRODUCTION: Gastric fundus ischemia is a rare event, which does not account for many significant clinical studies. This disorder could have different etiologies, but authors agree that a prompt diagnosis and a proper treatment could avoid dangerous complications and ultimately the death of the patient. PRESENTATION OF CASE: We herein report an interesting idiopathic case of acute gastric dilatation and fundus ischemia of an 83-year-old Caucasic woman who was admitted to the Emergency Department complaining of abdominal discomfort, vomiting and constipation. DISCUSSION: In literature, only a few case reports about this condition are reported. Possible risk factors, etiologies, and the different therapeutic options available for this condition are examined, in order to try to favor clinicians to formulate a timely diagnosis and provide patients with rapid healthcare services. CONCLUSION: Further investigations are still needed to analyze the pathophysiological pathways responsible of gastric fundus ischemia and to provide a definitive treatment to this dangerous disorder.

3.
Rev. argent. coloproctología ; 30(4): 104-113, dic. 2019. ilus, tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1096799

RESUMO

Introducción: Los pacientes que se presentan con cuadros de peritonitis de origen diverticular (estadios Hinchey III o IV) en un contexto de sepsis severa con inestabilidad hemodinámica (shock séptico) la realización de anastomosis primaria presenta una alta tasa de dehiscencia anastomótica y mortalidad operatoria, aconsejándose la realización de una resección y abocamiento a la manera de Hartmann. Sin embargo, la alta tasa de complicaciones relacionadas a la confección del ostoma, la complejidad de la cirugía de restauración del tránsito intestinal, asociado a que entre el 40 % y el 60 % de los Hartmann no se reconstruyen, ha estimulado a que se intenten otras variables de resolución para esta compleja y grave patología. Diversas publicaciones en los últimos años han propuesto la táctica de "cirugía del control del daño" con el objeto de disminuir la morbimortalidad de estos gravísimos cuadros sépticos y a su vez reducir la tasa de ostomías. El objetivo de este trabajo es presentar nuestra experiencia inicial con esta modalidad de manejo de la peritonitis diverticular Hinchey III/IV sepsis severa e inestabilidad hemodinámica (shock séptico) y realizar una revisión bibliográfica del tema. Material y método: Estudio observacional, descriptivo, de series de casos. Entre noviembre de 2015 y diciembre de 2016. Servicio de coloproctología del complejo médico hospitalario Churruca-Visca de la ciudad de Buenos Aires y práctica privada de los autores. Se utilizó la técnica de laparotomía abreviada y cierre temporal del abdomen mediante un sistema de presión negativa. Resultados: En el periodo descripto se operaron 17 pacientes con peritonitis generalizada purulenta o fecal de origen diverticular. Catorce casos fueron Hinchey III (82,36%) y 3 casos Hinchey IV (17,64%). En 3 casos se observó inestabilidad hemodinámica en el preoperatorio o intraoperatorio. Todos ellos correspondientes al estadio IV de Hinchey. Se describen los 3 casos tratados mediante esta táctica quirúrgica. Discusión: La alta tasa de morbimortalidad de este subgrupo de pacientes incentivó a diversos grupos quirúrgicos a implementar la técnica de control del daño, permitiendo de esta manera estabilizar a los pacientes hemodinámicamente y en un segundo tiempo evaluar la reconstrucción del tránsito intestinal. En concordancia con estas publicaciones, dos de nuestros pacientes operados con esta estrategia, pudieron ser anastomosados luego del segundo lavado abdominal. Conclusión: En pacientes con peritonitis diverticular severa asociado a shock séptico el concepto de laparotomía abreviada con control inicial del foco séptico, cierre temporal del abdomen con sistema de presión negativa y posterior evaluación de la reconstrucción del tránsito intestinal, es muy alentador. Permitiendo una disminución de la morbimortalidad como así también del número de ostomías. (AU)


Introduction: Patients presenting with diverticular peritonitis (Hinchey III or IV stages) in a context of severe sepsis with hemodynamic instability (septic shock), performing primary anastomosis has a high rate of dehiscence anastomotic and operative mortality, advising the realization of a resection and ostoma in the manner of Hartmann. However, the high rate of complications related to performing of ostoma, the complexity of intestinal transit restoration surgery, associated with the 40% to 60% of Hartmann reversal not performed, has encouraged other variables to be attempted resolution for this complex and serious pathology. Several publications in recent years have proposed the tactic of "damage control surgery" in order to reduce the morbidity of these serious septic charts while reducing the rate of ostomies. The objective of this study is to present our initial experience with this modality of management of the diverticular peritonitis Hinchey III/IV severe sepsis and hemodynamic instability (septic shock) and to carry out a bibliographic review of the subject. Material and method: Observational, descriptive study of case series. Between November 2015 and December 2016. Coloproctology service of the Churruca-Visca hospital medical complex in the city of Buenos Aires and private practice of the authors. The technique of abbreviated laparotomy and temporary closure of the abdomen was used by a negative pressure system. Results: In the period described, 17 patients with generalized purulent or fecal peritonitis of diverticular origin were operated. Fourteen cases were Hinchey III (82.36%) and 3 cases Hinchey IV (17.64%).In 3 cases, hemodynamic instability was observed in the preoperative or intraoperative period. all of them corresponding to Hinchey's Stage IV. The 3 cases treated using this surgical tactic are described. Discussion: The high morbidity rate of this subgroup of patients encouraged various surgical groups to implement the damage control technique, thus allowing patients to stabilize hemodynamically and in a second time evaluate reconstruction intestinal transit. In line with these publications, two of our patients operated on with this strategy could be anastomosated after the second abdominal wash. Conclusion: In patients with severe diverticular peritonitis associated with septic shock, the concept of abbreviated laparotomy with initial control of the septic focus, temporary closure of the abdomen with negative pressure system and subsequent evaluation of transit reconstruction intestinal, it's encouraging. Allowing a decrease in morbidity as well as the number of ostomies. (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Peritonite/cirurgia , Choque Séptico , Doença Diverticular do Colo/cirurgia , Tratamento de Ferimentos com Pressão Negativa , Laparotomia/métodos , Peritonite/etiologia , Reoperação , Lavagem Peritoneal , Colostomia/métodos , Colostomia/mortalidade , Doença Aguda , Epidemiologia Descritiva , Sepse , Doença Diverticular do Colo/complicações , Técnicas de Fechamento de Ferimentos Abdominais , Laparotomia/mortalidade
4.
Surg Technol Int ; 30: 113-116, 2017 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-28395390

RESUMO

BACKGROUND: Rectovaginal fistula (RVF) is a disastrous complication of Crohn's disease (CD) that is exceedingly difficult to treat. It is a disabling condition that negatively impacts a woman's quality of life. Current treatment algorithms range from observation to medical management to the need for surgical intervention. A wide variety of success rates have been reported for all management options. The choice of surgical repair methods depends on various fistula and patient characteristics, and its published success rates vary with initial success being around 50% rising to 80% with repeated surgery. Several surgical and sphincter sparing approaches have been described for the management of rectovaginal fistula, aimed to minimize the recurrence and to preserve the continence. MATERIALS AND METHODS: A retrospective study was performed for RVF repair between 2008 and 2014 in our tertiary centre at the University Hospital of Tor Vergata, Italy. All the patients were affected by Crohn's disease and underwent surgery for an RVF under the same senior surgeon. All patients were prospectively evaluated. RESULTS: All 43 patients that underwent surgery for RVF were affected by Crohn's disease. The median age was 43 years (range 21-53). Four different surgical approaches were performed: drainage and seton, rectal advacenment flap (RAF), vaginal advancement flap (VAF), transperineal approach using porcine dermal matrix (PDM), and martius flap (MF). The median time to success was six months (range 2-11). None of the patients were lost during the 18 months of follow-up. The failure group rate was 19% in contrast with the healing rate group that was 81%. No demographic of disease-related factors were found to influence healing. CONCLUSION: The case series of this study supports the dogma that "there are no absolute rules when treating Crohn's fistula". There is no gold standard technique; however, it is mandatory to minimize the recurrence with a sphincter saving technique. Randomized trials are needed to find a standard surgical approach.


Assuntos
Doença de Crohn/complicações , Procedimentos Cirúrgicos do Sistema Digestório , Procedimentos Cirúrgicos em Ginecologia , Fístula Retovaginal , Adulto , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Humanos , Itália , Pessoa de Meia-Idade , Qualidade de Vida , Fístula Retovaginal/etiologia , Fístula Retovaginal/cirurgia , Reto/cirurgia , Estudos Retrospectivos , Retalhos Cirúrgicos/cirurgia , Vagina/cirurgia , Adulto Jovem
5.
Surg Technol Int ; 30: 125-130, 2017 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-28072899

RESUMO

BACKGROUND: The clinical leakage rate after anterior resection varies from 2.8-20%, with a 6-22% mortality rate and a 10-80% risk of permanent stoma. Endo-SPONGE® (B. Braun Melsungen AG, Melsungen, Germany) may treat extraperitoneal anastomotic leakage in the lesser pelvis. It consists of an open-pored sponge inserted into the cavity. A drainage tube fixed to a low vacuum drainage system is then connected to the sponge through the anus. MATERIAL AND METHODS: Between January 2007 and December 2014, 14 patients with anastomotic leakage following low anterior resection were treated with Endo-SPONGE® and were prospectively evaluated. In all patients, a CT-scan was performed and they received an intravenous antibiotic therapy with piperacillin+tazobactam (4.5g,3 times/daily). Complete healing was defined as endoscopically proven closure of the insufficiency cavity with a normal mucosa. RESULTS: Stapled straight end to end, colorectal anastomoses were performed in all patients between 3-7 cm above the anal verge, a protective loop ileostomy was performed in every patient. The diagnosis of anastomotic leakage was performed after a median interval of 14 days, the median size of the cavity was 81x46 mm. Fluid collection was drained, percutaneosly in 12 cases, surgically in two patients. The median duration of therapy was 35 days, with 3-14 sponge exchanges for each patient. Median healing time was 37 days. No intraoperative complications were recorded, however, we found five cases of mild anal pain treated medically. CONCLUSION: Considering the literature and our results, the Endo-SPONGE® seems an effective, minimally invasive procedure to treat extraperitoneal anastomotic leakage, reducing morbidity, mortality, and hospital stay.


Assuntos
Fístula Anastomótica/cirurgia , Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Drenagem , Reto/cirurgia , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Neoplasias Colorretais/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Drenagem/efeitos adversos , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tampões de Gaze Cirúrgicos
6.
Surg Technol Int ; 30: 165-169, 2017 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-28072903

RESUMO

BACKGROUND: Minimal access surgery for incisional hernia repair is still debated, especially for giant wall defects. Laparoscopic repair may reduce pain and hospital stay. This study was designed to evaluate the feasibility of the laparoscopic technique in giant hernia. MATERIALS AND METHODS: From 2007 to 2013, 35 consecutive patients with giant ventral hernia, according to the Chevrel classification, underwent laparoscopic repair. Fourteen patients were obese, with a body mass index (BMI) > 30 and in 21 patients the mean BMI was 24 (range 22-28). In all patients, the wall defect was larger than 20 cm. RESULTS: Mean operative time was 159±30 minutes, and, for defects larger than 25 cm, it was 210±20 minutes. Patient conversion did not occur. In 29 patients, the mean wall defect was 20x25 cm, and in six patients the mean wall defect was 26x31 cm, and, as measured from within the peritoneal cavity, the mean overlap was 5 cm (range 3-6). Short-term antibiotic prophylaxis consisted of Cefazolin 2 g IV (intravenous) the day of surgery. All patients were discharged within 72-96 hrs. The mean follow-up was 24 months. No infection occurred and no chronic pain was recorded. However, three seroma were observed (outpatient treatment) and two xiphoid recurrences were observed. CONCLUSIONS: Laparoscopic hernia repair is technically feasible and is safe in patients with giant fascial defects as well as obese patients. This operation decreases postoperative pain, hastens the recovery period, and reduces postoperative morbidity and recurrence. This approach should be reserved for patients with no history of previous hernia repair. Further studies are expected to confirm these promising results.

7.
Minerva Gastroenterol Dietol ; 63(1): 44-49, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27768009

RESUMO

BACKGROUND: Hemorrhoidectomy is considered the gold standard and the most effective and definitive treatment for grades 3 or 4 hemorrhoids, and Milligan-Morgan's and Ferguson's procedures are the most widely used techniques throughout the world. The aim of the study was to present our surgical technique using LigasureTM vessel sealing, focus on technical aspects and surgical tricks showing our results with a huge number of patients and a long-term follow-up. METHODS: Between June 2001 and June 2014 at the University Hospital of Tor Vergata, Rome, Italy, 1000 patients were selected to underwent LigasureTM hemorrhoidectomy for III and IV degree hemorrhoids. Age range 19-80 years, ASA I-II-III. Operating time, postoperative pain score, hospital stay, early and late postoperative complications, wound healing time and time to return to normal activities were assessed. Patients were followed-up at one week, one month, six, and twelve months after the operation and after 60 months they responded to the follow-up telephone interview and replied to the questionnaire. RESULTS: One-thousand patients were undergone LigasureTM hemorrhoidectomy. The mean follow-up was 7 years and 110 (11%) patients was lost from the follow-up after the first postoperative month. Among early postoperative complications, 21 patients (2.1%) has urinary retention treated with a urinary catheter and removed before the discharge. 3 (0.3%) patients had a minor bleeding that required a package of hemostatic absorbable sponge, as late complications, in 35 patients (4%) anal fissure due to hard stool, an incomplete healing was observed in 11 patients (1.1%) after the first month. Three transphincteric anal fistulas (0.3%) were collected and four perianal abscess (0.4%) were observed during the first month of the follow-up and they required a delayed surgical treatment. At the end of the seven years of follow-up 70 recurrences (7.8%) and 35 anal stenosis (4%) were detected. CONCLUSIONS: If technical guidelines are respected rigorously and the device is applied correctly, feared late complications, such as impaired fecal continence, anal stricture and postoperative pain can be minimized.


Assuntos
Hemorroidectomia/instrumentação , Hemorroidas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Ânus/etiologia , Constrição Patológica/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Recidiva , Adulto Jovem
8.
Minerva Gastroenterol Dietol ; 63(1): 38-43, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27845508

RESUMO

BACKGROUND: Hemorrhoidectomy is considered the most efficient method to treat hemorrhoids of III and IV grades. The aim of this study was to compare conventional diathermy hemorrhoidectomy and radiofrequency hemorrhoidectomy based on a large series of patients. METHODS: Between June 2001 and June 2014, 1000 patients have been treated with radiofrequency hemorrhoidectomy (group A) and 500 patients have been treated with diathermy (group B) as a day-case procedure. Operating time, postoperative pain score, hospital stay, early and late postoperative complications, wound healing time and time to return to normal activities were assessed. RESULTS: The mean follow-up was seven years. The mean operating time for radiofrequency hemorrhoidectomy was shorter than diathermy but not significantly. Patients treated with radiofrequency had significantly less postoperative pain (measured on a Visual Analogue Scale; P=0.001), a shorter wound healing time, less time off work and postoperative complications (P=0.001) than patients who had diathermy. Neither wound healing nor mean hospital stay (day-case surgery) was significantly different. CONCLUSIONS: Radiofrequency hemorrhoidectomyis a valid alternative to the conventional diathermy technique, due to the reduction of operative time, postoperative pain, early and late complication rate.


Assuntos
Ablação por Cateter , Diatermia , Hemorroidectomia/métodos , Hemorroidas/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hemorroidas/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias , Escala Visual Analógica , Cicatrização , Adulto Jovem
12.
Surg Laparosc Endosc Percutan Tech ; 23(2): 109-20, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23579503

RESUMO

INTRODUCTION: Low-cost box models (BMs) are a valuable tool alternative to virtual-reality simulators. We aim to provide surgical trainees with a description of most common BMs and to present their validity to achieve basic and advanced laparoscopic skills. MATERIALS AND METHODS: A literature search was undertaken for all studies focusing on BMs, excluded were those presenting data on virtual-reality simulators only. Databases were screened up to December 2011. RESULTS: Numerous studies focused on various BMs to improve generic tasks (ie, instrument navigation, coordination, and cutting). Only fewer articles described models specific for peculiar operations. All studies showed a significant improvement of basic laparoscopic skills after training with BMs. Furthermore, their low costs make them easily available to most surgical trainees. CONCLUSIONS: BMs should be developed by all surgical trainees during their training. Fields for future improvement regard endoscopy and complex laparoscopic operations for which ad hoc BMs are not available.


Assuntos
Simulação por Computador/economia , Redução de Custos , Educação de Pós-Graduação em Medicina/métodos , Laparoscopia/educação , Modelos Educacionais , Competência Clínica , Feminino , Humanos , Internato e Residência , Masculino , Reprodutibilidade dos Testes
13.
Rev. argent. coloproctología ; 24(1): 9-11, mar. 2013. ilus
Artigo em Espanhol | LILACS | ID: lil-748639

RESUMO

Los tumores de células granulares (Abrikossoff) son tumores estromales benignos que se manifiestan más frecuentemente en la cabeza y cuello. La ubicación colorrectal es menos frecuente. Presentamos 2 casos de ubicación colorrectal. En el primer caso se trató de un tumor ubicado en el recto bajo, a 4 cm del margen anal, que se resecó mediante técnica transanal. El siguiente caso se ubicó en el ciego y, ante la falta de exéresis endoscópica, se resecó mediante hemicolectomía derecha laparoscópica. Ambos tuvieron diagnóstico histopatológico de Tumor de Células Granulares (TCG) confirmado por inmunohistoquímica. Los TCG son tumores generalmente benignos con características inequívocas en el estudio histológico (abundante citoplasma eosinófilo, núcleos pequeños, uniformes y redondos, sin mitosis evidentes) e inmunohistoquímico (PAS y proteína S-100 positivas). Aparecen entre la 4ª y 6ª década en cualquier parte del organismo. En el tubo digestivo aparecen más frecuentemente en el esófago. Debe sospecharse su presencia ante la aparición de un nódulo submucoso sólido, menor de 2 cm, y generalmente único.


Granular cell tumors (Abrikossoff) are benign stromal tumors that usually appear in the head and neck. Colorectal location is less frequent. We present two clinical cases in this location. The first patient presented with a tumor located in the lower rectum, 4 cm from the anal verge, which was resected via local excision. The second case was located in the cecum, and it was resected by laparoscopic right colectomy. Both cases had histopathology diagnosis of Granular cell tumors (GCT) confirmed by immunohistochemistry. GCT are usually benign tumors with unequivocally features in histological analysis (abundant-eosinophilic cytoplasm, small nuclei, round and uniform, without evident mitoses) and immunohistochemichal staining (PAS and S-100 protein positive). The age of presentation is around 4th and 6th decades at any part of the body. In the digestive tract they grow more frequently at the esophagus. Diagnosis should be suspected when facing a unique, solid, less than 2 cm submucosal nodule.


Assuntos
Humanos , Masculino , Adulto , Neoplasias Colorretais/cirurgia , Tumor de Células Granulares/cirurgia , Seguimentos , Neoplasias Colorretais/patologia , Tumor de Células Granulares/patologia
14.
Rheumatol Int ; 31(9): 1239-41, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20012623

RESUMO

Churg-Strauss syndrome is a relapsing-remitting vasculitis that frequently involves digestive system. Ischemic perforation of the large bowel is relatively rare and potentially life threatening. We report a case treated with high dose of steroids for a relapsing of Churg-Strauss vasculopathy that underwent emergency surgery for multiple large-bowel perforations. Massive use of steroids is common for controlling relapse of this disease, but this increases the risk of intestinal perforation. A prompt switching to alternative drugs when intestinal tract is involved should be considered in order to prevent surgery.


Assuntos
Síndrome de Churg-Strauss/tratamento farmacológico , Doenças do Colo/induzido quimicamente , Glucocorticoides/efeitos adversos , Perfuração Intestinal/induzido quimicamente , Metilprednisolona/efeitos adversos , Dor Abdominal/diagnóstico , Dor Abdominal/cirurgia , Doença Aguda , Idoso , Antibacterianos/uso terapêutico , Síndrome de Churg-Strauss/diagnóstico , Síndrome de Churg-Strauss/cirurgia , Doenças do Colo/prevenção & controle , Glucocorticoides/uso terapêutico , Humanos , Ileostomia , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/cirurgia , Masculino , Metilprednisolona/uso terapêutico , Complicações Pós-Operatórias/tratamento farmacológico , Insuficiência Respiratória/diagnóstico , Índice de Gravidade de Doença
15.
Surg Technol Int ; 20: 128-32, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21082557

RESUMO

INTRODUCTION: Colostomy is one of the most frequent procedures in emergency surgery. Several techniques have been described. The aim of this essay is to present our results using a circular stapler device when executing an end-type colostomy raising in emergency surgery. MATERIAL AND METHODS: During a period of 4 years, 47 patients underwent end-type colostomy raised under emergency circumstances using a circular stapler device. We gathered information on each patient, and performed 2 years follow-up. RESULTS: Forty-seven patients, 72.3% male and 27.7% female, were enrolled in this study. The most common indication was colorectal cancer (48.9%). We had an average rate of complications of 13.63% without a need to be operated on: parastomal hernia (6.81%), mild local cellulitis (4.54%), and retraction (2.27%). The medium diameter of colostomy at the time of surgery and after 1 month was equal to 3.4 cm and 3.1 cm respectively. Follow-up screenings showed that the diameter of colostomy held constant at 3 cm. DISCUSSION: End-type colostomy using a stapler device can be safely performed under emergency circumstances. It is not related to a higher rate of stomal stenosis in our series. This is the first essay that reports the diameter of colostomy with this technique. Early and late complications are similar to those that appear with the classical technique. Therefore, the end-type colostomy executed by means of a circular stapler device can be considered a safe and reliable technique.


Assuntos
Doenças do Colo/cirurgia , Colostomia/instrumentação , Colostomia/métodos , Grampeamento Cirúrgico/instrumentação , Grampeamento Cirúrgico/métodos , Suturas , Adulto , Idoso , Idoso de 80 Anos ou mais , Colostomia/efeitos adversos , Cuidados Críticos , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grampeamento Cirúrgico/efeitos adversos , Resultado do Tratamento
16.
Int J Surg ; 8(8): 648-52, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20797456

RESUMO

INTRODUCTION: Incidence and etiology of persistent pain after stapled hemorrhoidectomy remain uncertain. Characteristics, clinical course and management of this complication have not yet been assessed. Purpose of this essay is to describe our experience with persistent pain in our series of patients with this technique. METHODS: This retrospective study evaluated 126 cases of stapled hemorrhoidectomy treated from 2006 to 2009. We gathered information on each patient regarding type of prolapsed hemorrhoids, number of haemostatic suture placed, histology of each doughnut and post operative complications. A close follow up was done in those patients complaining about pain. RESULTS: Early and late complications occurred in 11.9% and 16.7% of patients respectively. At two weeks from surgery 18 patients (14.3%) were complaining of persistent pain. The average number of haemostatic sutured placed in this group and in all series is 4.5 and 2.5 respectively. Eight patients (6.34%), 3 (2.4%) and 2 (1.6%) patients were still complaining of persistent pain at 1 month, 4 months and 6 months of follow up, respectively. In these patients, endoanal manometry was normal at 4 months from surgery, while endoanal ultrasound showed retained staples in 3 of them. At 7 months from surgery a staples removal was performed in 2 patients that were still complaining of pain. CONCLUSIONS: Incidence of pain at 2 weeks after surgery resulted in 14.3% of patients. In most patients its etiology remains unclear but we reckon it might be related to the high number of haemostatic sutures placed. Staples removal resulted successfully.


Assuntos
Hemorroidas/cirurgia , Dor Pós-Operatória/etiologia , Grampeamento Cirúrgico/efeitos adversos , Adulto , Idoso , Canal Anal/diagnóstico por imagem , Analgésicos/uso terapêutico , Remoção de Dispositivo , Feminino , Seguimentos , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Dor Pós-Operatória/terapia , Estudos Retrospectivos , Suturas/efeitos adversos , Suturas/estatística & dados numéricos , Ultrassonografia
17.
Int J Surg ; 8(5): 353-5, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20438874

RESUMO

We present a case of a patient who developed a metachronous splenic metastasis from renal clear cell carcinoma, for which he has undergone a left nephrectomy 14 years earlier. During his routine follow up a CT scan showed a splenic mass which was considered an isolated metastasis possibly originating from the renal cancer. A splenectomy was performed and histopatological examination of the spleen confirmed the presence of clear cell carcinoma with infiltration of the capsule. Splenic metastases are uncommon and from the reported literature we understand that splenic metastasis from renal cell carcinoma is extremely rare. The optimal treatment seems to be splenectomy with a good long term outcome. With this report the authors would like to discuss the possibility that it could be a case of local recurrence rather than a real metastasis. A revision of previous reports in the literature is performed too.


Assuntos
Carcinoma de Células Renais/secundário , Neoplasias Renais/patologia , Nefrectomia , Neoplasias Esplênicas/secundário , Idoso , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/cirurgia , Seguimentos , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Masculino , Metástase Neoplásica , Tomografia por Emissão de Pósitrons , Esplenectomia , Neoplasias Esplênicas/diagnóstico , Neoplasias Esplênicas/cirurgia , Fatores de Tempo , Tomografia Computadorizada por Raios X
19.
Surg Laparosc Endosc Percutan Tech ; 18(4): 407-8, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18716545

RESUMO

We describe the case of a left colon adenocarcinoma anastomotic recurrence that metastasized to a benign transsphincteric fistula-in-ano, presumably through the implantation of viable malignant cells shed from the secondary tumor, and discuss the implications of these findings in colorectal cancer surgery.


Assuntos
Adenocarcinoma/secundário , Recidiva Local de Neoplasia/patologia , Inoculação de Neoplasia , Fístula Retal/patologia , Neoplasias Retais/secundário , Neoplasias do Colo Sigmoide/patologia , Adenocarcinoma/cirurgia , Colectomia , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Fístula Retal/etiologia , Neoplasias do Colo Sigmoide/cirurgia
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