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1.
Gastroenterology ; 158(1): 137-150.e1, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31476299

RESUMO

BACKGROUND & AIMS: Stenosis is a common complication of Crohn's disease (CD) that has no effective medical therapy. Development of antifibrotic agents will require testing in randomized controlled trials. Computed tomography enterography- and magnetic resonance enterography-based technologies might be used to measure outcomes in these trials. These approaches have been validated in studies of patients with symptomatic strictures who underwent imaging evaluations followed by resection with histopathologic grading of the intestinal tissue for inflammation and/or fibrosis (the reference standard). Imaging findings have correlated with findings from quantitative or semiquantitative histologic evaluation of the degree of fibromuscular stenosis and/or inflammation on the resection specimen. However, it is not clear whether histologic findings are an accurate reference standard. We performed a systematic review of all published histologic scoring systems used to assess stenosing CD. METHODS: We performed a comprehensive search of Embase and MEDLINE of studies through March 13, 2019, that used a histologic scoring system to characterize small bowel CD and assessed inflammatory and fibrotic alterations within the same adult individual. All scores fitting the criteria were included in our analysis, independent of the presence of stricturing disease, as long as inflammation and fibrosis were evaluated separately but in the same scoring system. RESULTS: We observed substantial heterogeneity among the scoring systems, which were not derived from modern principles for evaluative index development. None had undergone formal validity or reliability testing. None of the existing indices had been constructed according to accepted methods for the development of evaluative indices. Basic knowledge regarding their operating properties were lacking. Specific indices for evaluating the important pathologic component of myofibroblast hypertrophy or hyperplasia have not been proposed. CONCLUSIONS: In a systematic review of publications, we found a lack of validated histopathologic scoring systems for assessment of fibromuscular stenosis. Data that describe the operating properties of existing cross-sectional imaging techniques for stenosing CD should be questioned. Development and validation of a histopathology index is an important research priority.


Assuntos
Constrição Patológica/diagnóstico , Doença de Crohn/complicações , Íleo/patologia , Índice de Gravidade de Doença , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Fibrose , Humanos , Íleo/diagnóstico por imagem , Íleo/cirurgia , Imagem por Ressonância Magnética , Padrões de Referência , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X
2.
Ann R Coll Surg Engl ; 101(8): 571-578, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31672036

RESUMO

INTRODUCTION: There are no definitive data concerning the ideal configuration of ileocolic anastomosis. Aim of this study was to identify perioperative risk factors for anastomotic leak and for 60-day morbidity and mortality after ileocolic anastomoses (stapled vs handsewn). MATERIALS AND METHODS: This is a STROBE-compliant study. Demographic and surgical data were gathered from patients with an ileocolic anastomosis performed between November 2010 and September 2016 at a tertiary hospital. Anastomoses were performed using standardised techniques. Independent risk factors for anastomotic leak, complications and mortality were assessed. RESULTS: We included 477 patients: 53.7% of the anastomoses were hand sewn and 46.3% stapled. Laterolateral anastomosis was the most common configuration (93.3%). Anastomotic leak was diagnosed in 8.8% of patients and 36 were classified as major anastomotic leak (7.5%). In the multivariate analysis, male sex (P = 0.014, odds ratio, OR, 2.9), arterial hypertension (P = 0.048, OR 2.29) and perioperative transfusions (P < 0.001, OR 2.4 per litre) were independent risk factors for major anastomotic leak. The overall 60-day complication rate was 27.3%. Male sex (31.3% vs female 22.3%, P = 0.02, OR 1.7), diabetes (P = 0.03 OR 2.0), smoking habit (P = 0.04, OR 1.8) and perioperative transfusions (P < 0.001, OR 3.3 per litre) were independent risk factors for postoperative morbidity. The 60-day-mortality rate was 3.1% and no significant risk factors were identified. CONCLUSION: Anastomotic leak after ileocolic anastomosis is a relevant problem. Male sex, arterial hypertension and perioperative transfusions were associated with major anastomotic leak. Conversion to open surgery was more frequently associated with perioperative death.


Assuntos
Anastomose Cirúrgica/métodos , Fístula Anastomótica/etiologia , Colo/cirurgia , Íleo/cirurgia , Idoso , Anastomose Cirúrgica/efeitos adversos , Feminino , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Grampeamento Cirúrgico/métodos , Técnicas de Sutura
3.
Pan Afr Med J ; 33: 184, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31565144

RESUMO

We here report a case of bladder urothelial carcinoma, a rare tumor in subjects less than 40 years, as well as our therapeutic experience. The study involved a 37-year old patient with a history of urinary tract infection and of staying at a riparian area (bilharzia) presenting with hypogastralgia and total macroscopic hematuria. Clinical and paraclinical assessment showed voluminous bladder mass suggesting infiltrative tumor without local or distant lymph node or organic involvement. Surgical management was based on resection of bladder tumor and biopsy followed by total cystectomy with substitutive ileal enterocystoplasty. The postoperative course was uneventful. The patient also underwent adjuvant chemotherapy and vitamin B-12 therapy. Clinical and paraclinical assessment, performed after 6 and 12 months, showed no recurrence.


Assuntos
Carcinoma de Células de Transição/cirurgia , Cistectomia/métodos , Neoplasias da Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Carcinoma de Células de Transição/diagnóstico , Carcinoma de Células de Transição/patologia , Quimioterapia Adjuvante/métodos , Seguimentos , Humanos , Íleo/cirurgia , Masculino , Recidiva Local de Neoplasia , Resultado do Tratamento , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/patologia , Vitamina B 12/administração & dosagem
5.
Khirurgiia (Mosk) ; (8. Vyp. 2): 65-69, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31502596

RESUMO

Laparoscopic colon resections are currently becoming a standart method of surgical treatment of colon cancer. Long-term oncologic outcomes of such procedures are shown to be non-inferior to outcomes of traditional open surgery, while short-term results and morbidity profile are more favourable. The current direction of colon mini-invasive surgery development is to make procedures more easily tolerable by patients, using less traumatic methods and operative approaches. The article contains a review of one of such methods, which allows less traumatic performance of laparoscopic right hemicolectomy - an intracorporeal ileotransversoanastomosis. The current evidence concerning safety and efficacy are reviewed, when authors' own data are also brought to support implementation of this method into routine practice.


Assuntos
Colectomia/métodos , Colo Transverso/cirurgia , Neoplasias do Colo/cirurgia , Íleo/cirurgia , Anastomose Cirúrgica/métodos , Humanos , Laparoscopia , Resultado do Tratamento
6.
Int J Colorectal Dis ; 34(9): 1585-1590, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31377853

RESUMO

PURPOSES: Bowel resection in patients with Crohn's disease (CD) has a high reported rate of postoperative complications and surgical recurrence. A macroscopically normal resection margin is recommended in CD surgery as wider margins do not translate in reduced recurrence rates. The aim of this study was to evaluate the association between resection margin status and anastomotic complications following ileocaecal resection for primary CD. METHODS: All patients treated with ileocaecal resection for primary CD from 2010 to 2018 were included in this retrospective observational study. Emergency operations and recurrent CD were excluded. Patients in whom an anastomosis was not fashioned at the time of the surgery were also excluded. Histopathology data collected included macroscopic description, presence of macroscopic and microscopic involvement of the proximal and distal resection margins. The primary outcome was the rate of positive resection margin in patients who developed anastomotic complications (anastomotic leaks and intra-abdominal collections), and the secondary outcomes were overall complications rate, length of hospital stay, reoperations and rehospitalisation within 30 days. RESULTS: A total of 104 patients were included. The proximal resection margin was microscopically involved in 19 patients (18.2%). Ten patients (9.6%) developed intra-abdominal anastomotic related complications, with 5 patients out of 10 (50%) in the group of postoperative anastomotic complications having a positive microscopic proximal margin at histology, compared to 14 patients (14.9%) in the group that did not develop anastomotic complications (p < 0.0001). CONCLUSIONS: Microscopic involvement of the proximal resection margin is more frequent in patients who develop postoperative anastomotic complications following elective ileocaecal resection for primary CD.


Assuntos
Ceco/cirurgia , Doença de Crohn/cirurgia , Íleo/cirurgia , Margens de Excisão , Complicações Pós-Operatórias/etiologia , Adulto , Anastomose Cirúrgica/efeitos adversos , Ceco/patologia , Doença de Crohn/patologia , Feminino , Humanos , Íleo/patologia , Masculino , Resultado do Tratamento
7.
Eur J Pediatr ; 178(9): 1413-1421, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31327075

RESUMO

Psychosocial and functional outcomes after intestinal resection in pediatric Crohn's disease (CD) are lacking. Therefore, we (I) assessed health-related quality of life (HRQOL), colorectal function, and satisfaction with surgery and (II) investigated their relationship with surgical outcomes, after ileocecal resection for CD. Crohn's patients that underwent ileocecal resection during childhood were included. HRQOL and colorectal function were assessed using SF-36 and COREFO, respectively, and compared with reference values. Satisfaction was scored on a 5-point Likert scale. In total, 80 patients (50% male, median age 23.0 years) were included. Physical HRQOL was impaired (SF-36 [mean]: CD, 47 vs. general, 54; p < 0.001), while mental HRQOL was similar to that in the general population. Overall colorectal function was impaired (COREFO [mean]: CD, 12.6 vs. normal, 7.2; p < 0.001). Worse colorectal function was associated with increasing clinical disease activity and longer interval since resection. Majority of patients was satisfied with surgery (81% satisfied/very satisfied, 11% neither satisfied nor dissatisfied, 8% dissatisfied/very dissatisfied). Decreased satisfaction with surgery was associated with increased clinical disease activity but not related to colorectal function.Conclusions: Physical HRQOL and colorectal function in CD patients who underwent ileocecal resection during childhood seem impaired and related to adverse surgical outcomes. This emphasizes the need for post-operative monitoring and prophylactic therapies. What is Known: • Up to 25% of pediatric-onset Crohn's disease (CD) patients undergo an intestinal resection within 5 years from diagnosis. • Many children and adults with CD experience disruption of their daily activities and health-related quality of life (HRQOL). What is New: • Physical HRQOL and colorectal function are impaired in patient with CD that underwent ileocecal resection during childhood. • Increasing clinical disease activity, a longer interval since surgery, severe complications related to surgery, and recurrent surgeries are all associated with worse colorectal function.


Assuntos
Ceco/cirurgia , Doença de Crohn/cirurgia , Íleo/cirurgia , Satisfação do Paciente/estatística & dados numéricos , Qualidade de Vida , Adolescente , Adulto , Criança , Doença de Crohn/fisiopatologia , Estudos Transversais , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino , Recuperação de Função Fisiológica , Resultado do Tratamento , Adulto Jovem
8.
Curr Urol Rep ; 20(9): 50, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31342172

RESUMO

PURPOSE OF REVIEW: The goal of this paper was to evaluate the current use of enterocystoplasty, a historical operation for bladder dysfunction but with continued and increasing modern relevance. RECENT FINDINGS: Since the advent of third line neuromodulation techniques for neurogenic and idiopathic overactive bladder (OAB), the usage of enterocystoplasty has decreased. However, this procedure continues to be utilized in pediatric urology patients and the most refractory OAB patients. Adult urologist should be familiar with this operative technique in an effort to manage pediatric patients transitioning to adulthood. Minimally invasive techniques for this surgical procedure have been described with very limited outcome data. It is important for all urologists to be familiar with enterocystoplasty, both technically and with the unique needs of these patients postoperatively. Further studies evaluating the outcomes of this procedure in idiopathic overactive bladder patients and efforts to standardize recommendations for neurogenic bladder patients will help guide care in the future.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Íleo/cirurgia , Doenças da Bexiga Urinária/cirurgia , Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Anastomose Cirúrgica , Criança , Humanos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Bexiga Urinaria Neurogênica/cirurgia , Bexiga Urinária Hiperativa/cirurgia
9.
Khirurgiia (Mosk) ; (6): 35-40, 2019.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-31317939

RESUMO

AIM: To evaluate safety of early closure of ileostomy in patients with rectal cancer after primary surgery. MATERIAL AND METHODS: The trial included patients from several medical centers without signs of anastomotic leakage. CT-proctography or rectoscopy were performed in 8 days after primary surgery to confirm integrity of the anastomoses. Exclusion criteria were factors affecting normal tissue regeneration (diabetes mellitus, steroid drugs prescription, etc.). Patients with intact anastomoses and no exclusion criteria were randomized into 2 groups: group 1 (n=31) with early closure of ileostomy (in 8-13 days after surgery) and group 2 (n=34) with delayed closure (after 12 weeks). All data were analyzed. RESULTS: Postoperative morbidity was similar in both groups (6.45% vs. 5.88%, p=0.08). However, less duration of reconstructive surgery was noted in group 1 (50 (27-126) min vs. 71 min (31-134). This value was 1.42 times less in the main group (95% CI 1.30-1.52; p=0.02). CONCLUSION: Early closure of ileostomy in patients after surgery for rectal cancer is feasible and does not result increased postoperative morbidity. This approach may be considered as an alternative to delayed closure. However, further researches devoted to analysis of ileostomy-associated complications and quality of life are necessary.


Assuntos
Ileostomia/métodos , Íleo/cirurgia , Neoplasias Retais/cirurgia , Anastomose Cirúrgica , Humanos , Protectomia , Reoperação , Fatores de Tempo
10.
J Immunol Res ; 2019: 9406146, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31321245

RESUMO

Crohn's disease (CD) results from dysregulated immune responses to gut microbiota in genetically susceptible individuals, affecting multiple areas of the gastrointestinal tract. Innate lymphoid cells (ILCs) are tissue-resident innate effector lymphocytes which play crucial roles in mucosal immune defense, tissue repair, and maintenance of homeostasis. The accumulation of IFN-γ-producing ILC1s and increased level of proinflammatory cytokines produced by ILCs has been observed in the inflamed terminal ileum of CD patients. To date, the precise mechanisms of ILC plasticity and gene regulatory pathways in ILCs remain unclear. Signal transducer and activator of transcription 3 (STAT3) regulates gene expression in a cell-specific, cytokine-dependent manner, involving multiple immune responses. This study proposes the positive correlation between the prevalence of STAT3 rs744166 risky allele "A" with the severity of disease in a cohort of 94 CD patients. In addition, the results suggest an increased STAT3 activity in the inflamed ileum of CD patients, compared to unaffected ileum sections. Notably, IL-23 triggers the differentiation of CD117+NKp44- ILC3s and induces the activation of STAT3 in both CD117+NKp44- and CD117-NKp44- ILC subsets, implying the involvement of STAT3 in the initiation of ILC plasticity. Moreover, carriage of STAT3 "A" risk allele exhibited a higher basal level of STAT3 tyrosine phosphorylation, and an increased IL-23 triggered the pSTAT3 level. We also demonstrated that there was no delayed dephosphorylation of STAT3 in ILCs of both A/A and G/G donors. Overall, the results of this study suggest that IL-23-induced activation of STAT3 in the CD117-NKp44- ILC1s involves in ILC1-to-ILC3 plasticity and a potential regulatory role of ILC1 function. Those genetically susceptible individuals carried STAT3 rs744166 risky allele appear to have higher basal and cytokine-stimulated activation of STAT3 signal, leading to prolonged inflammation and chronic relapse.


Assuntos
Doença de Crohn/genética , Linfócitos/metabolismo , Fator de Transcrição STAT3/genética , Fator de Transcrição STAT3/metabolismo , Doença de Crohn/imunologia , Doença de Crohn/patologia , Doença de Crohn/cirurgia , Progressão da Doença , Humanos , Íleo/imunologia , Íleo/cirurgia , Imunidade Inata/genética , Inflamação/metabolismo , Interleucina-23/farmacologia , Linfócitos/efeitos dos fármacos , Linfócitos/imunologia , Receptor 2 Desencadeador da Citotoxicidade Natural/metabolismo , Fosforilação , Proteínas Proto-Oncogênicas c-kit/metabolismo , Fator de Transcrição STAT3/química , Tirosina/química
11.
BMC Surg ; 19(1): 74, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266497

RESUMO

BACKGROUND: Intussusception is a relatively common condition seen in children. In comparison, adult intussusception is rare and usually occurs as a complication in patients with organic diseases. It is responsible for 1% of all bowel obstructions, in most of intussusceptions a malignant tumor is involved. Herein, we present an extremely unusual case of intussusception that occurred as a complication at the site of a functional end-to-end anastomosis. CASE PRESENTATION: A 57-year-old female patient was diagnosed with tumors in the ascending and descending colon and was referred to our department. Laparoscopic hemicolectomy and laparoscopic descending colectomy were performed. The mechanical intestinal obstruction occurred on the 9th day postoperatively, and computed tomography scan revealed intussusception at the site of the ileocolic anastomosis. Endoscopic reduction was attempted, but the procedure was challenging. Surgery was then performed and revealed that the site of ileocolic anastomosis firmly adhered to the side wall and right retroperitoneum. However, the intestine in the oral side of the anastomosis was not fixed. Examination of the anastomotic site revealed that the ileum had passed through the anastomosis and prolapsed into the transverse colon. The ileocolic anastomosis was resected. End-to-end anastomosis was performed, and surgery was then completed. No neoplastic lesions were observed in the resected tissue of the lead point of intussusception. The postoperative clinical course was favorable, and the patient was discharged on the 11th day after the second round of surgery. CONCLUSIONS: There are no reports the anastomosis is involved as part of the intussception, as observed in the present case. Intussusception should thus be considered as one of the causes of postoperative mechanical intestinal obstruction.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Colectomia/efeitos adversos , Doenças do Íleo/etiologia , Obstrução Intestinal/etiologia , Intussuscepção/etiologia , Colectomia/métodos , Colo/cirurgia , Feminino , Humanos , Doenças do Íleo/diagnóstico , Doenças do Íleo/cirurgia , Íleo/cirurgia , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgia , Intussuscepção/diagnóstico , Intussuscepção/cirurgia , Laparoscopia , Pessoa de Meia-Idade
12.
BMJ Case Rep ; 12(6)2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31248892

RESUMO

Retained gossypiboma is a rare and under-reported complication of surgery, which can present in a variety of ways. Thus, a very high index of suspicion is required by the clinician to clinch the diagnosis in a postoperative patient. A 45-year-old woman, who was otherwise asymptomatic, presented to the General Surgery outpatient department (OPD) with a contrast-enhanced CT suggestive of a retained intra-abdominal foreign body from previous surgery. An exploratory laparotomy was planned on elective basis. Intraoperatively, dense inter-bowel adhesions were found in the upper abdomen. After a meticulous adhesiolysis, an ileoileal fistula and an intraluminal surgical sponge were discovered. Resection and anastomosis of the involved ileal segment was done. An asymptomatic patient with a migrated intramural gossypiboma with an ileoileal fistula is an extremely rare occurrence. In these circumstances, it becomes almost impossible for the surgeon to clinch the diagnosis of a gossypiboma in an otherwise asymptomatic patient, without the aid of radiological investigations.


Assuntos
Fístula/complicações , Fístula/diagnóstico por imagem , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico por imagem , Migração de Corpo Estranho/diagnóstico por imagem , Fístula Intestinal/complicações , Fístula Intestinal/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Fístula/cirurgia , Corpos Estranhos/cirurgia , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/cirurgia , Humanos , Doenças do Íleo/complicações , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/cirurgia , Íleo/diagnóstico por imagem , Íleo/cirurgia , Fístula Intestinal/cirurgia , Pessoa de Meia-Idade , Tampões de Gaze Cirúrgicos , Tomografia Computadorizada por Raios X/métodos
13.
Expert Rev Gastroenterol Hepatol ; 13(8): 807-813, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31203691

RESUMO

Background: In patients with Crohn's disease (CD), endoscopic recurrence precedes clinical recurrence after ileocolonic resection. Guidelines recommend ileocolonoscopy within the first year after surgery. The study examined endoscopic monitoring and treatment decisions in CD patients in a real-world setting. Methods: The Practicrohn study involved adult patients from 26 Spanish hospitals who underwent ileocolonic resection with anastomosis from 2007 to 2010. Medical records data were collected retrospectively from diagnosis to index surgery and up to 5 years after surgery. Results: Of 314 analyzed patients, 262 (83%) underwent endoscopic evaluation, but only 30% (n = 95) had planned endoscopy as part of follow-up within the first year after surgery. An upward trend was observed in the proportion of endoscopies performed or planned within the first year after surgery across the selection period. More patients with than without endoscopic recurrence in the first year after surgery had a medication change, mainly for endoscopic activity in the absence of clinical symptoms (54 vs 13%; p = 0.02). Conclusions: Between 2007 and 2010, endoscopic monitoring of patients within the first year after CD-related surgery was less than adequate based on current standards, but showed improvement. Medication changes were in general agreement with current guideline recommendations. This work was presented as a poster (number P686) by M. Barreiro-de Acosta et al. at ECCO (European Crohn's and Colitis Organisation) '18 in Vienna, Austria, 14-17 February 2018.


Assuntos
Colo/cirurgia , Doença de Crohn/diagnóstico , Doença de Crohn/terapia , Íleo/cirurgia , Adolescente , Adulto , Assistência ao Convalescente , Anastomose Cirúrgica , Colectomia , Doença de Crohn/cirurgia , Endoscopia Gastrointestinal , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha , Adulto Jovem
14.
Gut ; 68(10): 1774-1780, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31233395

RESUMO

OBJECTIVE: Evaluate the cost-effectiveness of laparoscopic ileocaecal resection compared with infliximab in patients with ileocaecal Crohn's disease failing conventional therapy. DESIGN: A multicentre randomised controlled trial was performed in 29 centres in The Netherlands and the UK. Adult patients with Crohn's disease of the terminal ileum who failed >3 months of conventional immunomodulators or steroids without signs of critical strictures were randomised to laparoscopic ileocaecal resection or infliximab. Outcome measures included quality-adjusted life-years (QALYs) based on the EuroQol (EQ) 5D-3L Questionnaire and the Inflammatory Bowel Disease Questionnaire (IBDQ). Costs were measured from a societal perspective. Analyses were performed according to the intention-to-treat principle. Missing cost and effect data were imputed using multiple imputation. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated to show uncertainty. RESULTS: In total, 143 patients were randomised. Mean Crohn's disease total direct healthcare costs per patient at 1 year were lower in the resection group compared with the infliximab group (mean difference €-8931; 95% CI €-12 087 to €-5097). Total societal costs in the resection group were lower than in the infliximab group, however not statistically significant (mean difference €-5729, 95% CI €-10 606 to €172). The probability of resection being cost-effective compared with infliximab was 0.96 at a willingness to pay (WTP) of €0 per QALY gained and per point improvement in IBDQ Score. This probability increased to 0.98 at a WTP of €20 000/QALY gained and 0.99 at a WTP of €500/point of improvement in IBDQ Score. CONCLUSION: Laparoscopic ileocaecal resection is a cost-effective treatment option compared with infliximab. CLINICAL TRIAL REGISTRATION NUMBER: Dutch Trial Registry NTR1150; EudraCT number 2007-005042-20 (closed on 14 October 2015).


Assuntos
Colectomia/métodos , Doença de Crohn/terapia , Custos de Cuidados de Saúde , Ileíte/terapia , Infliximab/uso terapêutico , Laparoscopia/economia , Adulto , Ceco/cirurgia , Colectomia/economia , Análise Custo-Benefício , Doença de Crohn/economia , Feminino , Seguimentos , Fármacos Gastrointestinais/economia , Fármacos Gastrointestinais/uso terapêutico , Humanos , Ileíte/diagnóstico , Ileíte/economia , Íleo/cirurgia , Infliximab/economia , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
15.
Updates Surg ; 71(3): 587-593, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31243726

RESUMO

All of the anastomotic techniques used for jejuno-ileal atresia aim to overcome the size discrepancy between the resected bowel ends, lessen anastomotic complication and prevent development of short bowel syndrome. Aim of study was to evaluate the outcomes of end-to-side oblique anastomosis for jejuno-ileal atresia and verifying the risk factors for complications. A prospective study was conducted on patients with jejuno-ileal atresia managed by end-to-side oblique anastomotic technique over a 7-year period. Data were collected and analyzed to evaluate the outcomes of this surgical technique as morbidity and mortality. The study included 40 patients, 26 males and 14 females. The mean operation time was 105 minutes, the mean time for starting oral feeding was 5.7 days and the mean duration of hospital stay was 9.13 day. Postoperative complications occurred in 11 patients (27.5%). Death was recorded in six cases; survival rate was 85%. End-to-side oblique anastomosis is simple and effective surgical procedure for most types of jejuno-ileal atresia. The technique results in wide and early functioning anastomosis, relatively low morbidity and mortality. As with any neonatal surgery, the overall prognosis and outcomes is primarily dependent on prematurity, birth weight and associated anomalies in addition to the amount of residual bowel function that exist after surgery.


Assuntos
Anastomose Cirúrgica/métodos , Íleo/cirurgia , Atresia Intestinal/cirurgia , Intestino Delgado/anormalidades , Jejuno/cirurgia , Feminino , Idade Gestacional , Humanos , Íleo/anormalidades , Recém-Nascido , Intestino Delgado/cirurgia , Jejuno/anormalidades , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Prospectivos , Resultado do Tratamento
16.
Surg Technol Int ; 34: 302-309, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31037718

RESUMO

AIM: To compare surgical, functional and early survival outcomes for robot-assisted radical cystectomy (RARC) with intracorporeal orthotopic neobladder (ONB) reconstruction in patients age = 75 y to those in patients age < 75 y using Propensity Score Matching. METHODS: We collected data from 15 patients age = 75 y from among 60 consecutive RARC with ONB reconstruction performed at our institution from January 2015 to July 2018. All procedures were performed by a single surgeon after modular training under the supervision of a skilled surgeon. Demographic, surgical, functional and survival data were prospectively collected and compared to the corresponding data from 15 patients from the same series age < 75 y, matched according to the ASA score, body mass index, clinical stage and associated carcinoma in situ using Propensity Score Matching. RESULTS: There were no significant differences between the two groups with regard to preoperative parameters, such as ASA score, BMI and preoperative stage. The same homogeneity was found for intraoperative parameters, such as operation time, number of nodes retrieved and ONB time. The only statistically significant difference noted was in the percentage of nerve-sparing procedures, which was higher in the younger patient group (p < 0.001). The percentages of early and late postoperative complications were higher in the older patients, but the differences were not statistically significant. Moreover, there were no differences among the two populations in terms of functional outcomes (daytime and nighttime continence, potency), or in either cancer-specific or overall mortality. CONCLUSIONS: RARC with totally intracorporeal ONB diversion can be offered to older patients with an expectation of good surgical, functional and early survival outcomes, although further studies with a larger sample size will be needed to confirm these results.


Assuntos
Cistectomia/métodos , Íleo/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Idoso , Cistectomia/estatística & dados numéricos , Humanos , Pontuação de Propensão , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Resultado do Tratamento , Derivação Urinária/estatística & dados numéricos
17.
J Urol ; 202(3): 612-616, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31042110

RESUMO

PURPOSE: Reaugmentation cystoplasty rates vary in the literature but have been reported as high as 15%. It is likely that bladders augmented with detubularized and reconfigured bowel are less likely to require reaugmentation. We assessed the incidence of reaugmentation among patients with spina bifida at 2 high volume reconstruction centers. MATERIALS AND METHODS: We retrospectively reviewed medical records of patients with spina bifida who underwent enterocystoplasty before age 21 years (1987 to 2017). Those who did not undergo augmentation with a detubularized and reconfigured bowel segment were excluded from analysis. Data on demographic and surgical variables were collected. Reaugmentation was the main outcome. One analysis was performed using the entire cohort and another analysis was restricted to patients with ileocystoplasty performed in the last 15 years (2002 to 2017). Survival analysis was used. RESULTS: A total of 289 patients were identified. Enterocystoplasty was performed in patients at a median age of 8.1 years (median followup 11.3, IQR 5.2-14.9). Most initial augmentations were performed using ileum (93.4%), followed by sigmoid (6.2%). Seven patients underwent reaugmentation, including 6 with initial augmentation using ileum and 1 with initial augmentation using sigmoid. On survival analysis risk of reaugmentation was 1.1% at 5 years and 3.3% at 10 years after the original surgery. All reaugmentations occurred within the first 9 years of followup. In the more contemporary cohort (162, median followup 7.0 years) only 1 patient underwent reaugmentation at 2.0 years. CONCLUSIONS: The risk of reaugmentation after enterocystoplasty with a detubularized and reconfigured bowel in the spina bifida population is lower than that reported in initial series.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Disrafismo Espinal/complicações , Bexiga Urinaria Neurogênica/cirurgia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/estatística & dados numéricos , Criança , Pré-Escolar , Colo Sigmoide/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Feminino , Humanos , Íleo/cirurgia , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Bexiga Urinária/inervação , Bexiga Urinária/cirurgia , Bexiga Urinaria Neurogênica/etiologia , Procedimentos Cirúrgicos Urológicos/métodos , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos
18.
Med Sci Monit ; 25: 3417-3424, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31068569

RESUMO

BACKGROUND Nowadays, more than 170 million patients suffer from diabetes mellitus worldwide. This study aimed to investigate the effects of sleeve gastrectomy (SG) and ileal transposition (IT) surgery on the control of diabetes. MATERIAL AND METHODS Goto-Kakizaki rats were used to establish type 2 diabetes models and undergo SG or IT surgery. At 2 months post-surgery, insulin, glucose, triglycerides (TG), total cholesterol (TC), glucose tolerance, glucagon-like peptide-1 (GLP-1) levels, and insulin sensitivity were evaluated. RESULTS SG significantly shortened operative time and post-operative recovery time compared to IT surgery (P<0.05). SG and IT surgery resulted in significantly induced weight loss, significantly decreased levels of glucose, and significantly enhanced levels of Ghrelin compared the Sham surgery group (P<0.001). SG and IT surgery resulted in significantly increased GLP-1 levels compared to Sham surgery (P<0.001). SG resulted in better reduction of oral glucose tolerance test (OGTT) glucose compared to IT surgery (P<0.05). SG and IT surgery significantly upregulated insulin tolerance test (ITT) levels compared to Sham surgery (P<0.001). SG induced better reductions in TC and TG compared to IT surgery (P<0.05). CONCLUSIONS In non-obese rats with spontaneous diabetes, both SG and IT surgery were found to control diabetes by regulating body weight and levels of glucose, Ghrelin, GLP-1, OGTT glucose, insulin, TC, and TG. Moreover, SG demonstrated advantages of shorter operative time, shorter post-operative recovery time, and better control of diabetes compared to IT surgery.


Assuntos
Diabetes Mellitus Experimental/terapia , Gastrectomia/métodos , Íleo/cirurgia , Anastomose Cirúrgica/métodos , Animais , Glicemia/análise , Peso Corporal/fisiologia , Colesterol/análise , Colesterol/sangue , Diabetes Mellitus Experimental/sangue , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/terapia , Modelos Animais de Doenças , Grelina/análise , Grelina/sangue , Peptídeo 1 Semelhante ao Glucagon/análise , Peptídeo 1 Semelhante ao Glucagon/sangue , Glucose/metabolismo , Teste de Tolerância a Glucose , Insulina/sangue , Resistência à Insulina , Masculino , Ratos , Ratos Endogâmicos , Perda de Peso
19.
JNMA J Nepal Med Assoc ; 57(215): 56-58, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31080248

RESUMO

Accidental foreign body ingestion is a common problem encountered in Emergency. Deliberate foreign body ingestion may result due to an act of insanity or an act of daring. A shaman locally known as Dhami was brought to Emergency with the history of ingestion of bell clappers. He denied the history of psychiatric illness or substance abuse. On physical examination, there were signs of peritonitis. Laparotomy was done to remove the foreign bodies. Post-operative period was uneventful. Apart from the surgical intervention, psychological counselling was given to him. This is a rare interesting case due to the fact that the 15 cm long foreign bodies passing all the way through without significant injury and finally causing obstruction in ileocecal junction and perforation in the distal ileum. Keywords: foreign bodies; Nepal; shaman.


Assuntos
Corpos Estranhos/complicações , Obstrução Intestinal/etiologia , Perfuração Intestinal/etiologia , Peritonite/etiologia , Corpos Estranhos/cirurgia , Humanos , Íleo/lesões , Íleo/cirurgia , Obstrução Intestinal/cirurgia , Perfuração Intestinal/cirurgia , Laparotomia , Masculino , Pessoa de Meia-Idade , Nepal
20.
BMJ Case Rep ; 12(5)2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31092482

RESUMO

A 56-year-old man presented acutely with abdominal pain and raised inflammatory markers. Initial CT images demonstrated acute inflammation in the right upper quadrant surrounding a high-density linear structure. The appearance was of a chicken bone causing a contained small bowel perforation. This was managed conservatively with intravenous antibiotics and the patient was discharged 10 days later. The same patient returned to the hospital 2 months later, once again with an acute abdomen. CT imaging on this occasion showed distal migration of the chicken bone as well as free gas and fluid indicative of a new small bowel perforation. The patient underwent an emergency laparotomy, washout and small bowel resection. No foreign body was found at laparotomy or in the histopathology specimen. The postoperative course was complicated by an anastomotic leak. A further CT on that admission demonstrated that the chicken bone had migrated to the rectum!


Assuntos
Migração de Corpo Estranho/diagnóstico , Íleo/cirurgia , Perfuração Intestinal/cirurgia , Reto/cirurgia , Abdome Agudo/etiologia , Migração de Corpo Estranho/cirurgia , Humanos , Íleo/diagnóstico por imagem , Fístula Intestinal/diagnóstico , Fístula Intestinal/terapia , Perfuração Intestinal/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral/métodos , Reto/diagnóstico por imagem , Tomografia Computadorizada por Raios X
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