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1.
Rev Med Suisse ; 16(712): 2026-2030, 2020 Oct 28.
Artigo em Francês | MEDLINE | ID: mdl-33112514

RESUMO

Vaginal cerclage can be used to treat cervical incompetence, thus reducing the risk of an unfavourable outcome. However, in some cases, it can be ineffective. One of the challenges for the gynaecologist-obstetrician is how to deal with a subsequent pregnancy after a failure of vaginal cerclage. The recently published MAVRIC study shows that performing abdominal cerclage prior or at the beginning of pregnancy reduces the rate of late miscarriage and premature delivery compared to vaginal cerclage. This implies a birth by caesarean section, and therefore a second surgery for the woman. However, it remains to determine the best surgical technique for abdominal cerclage. In the MAVIRC study, cerclage was done by laparotomy. It shall be elucidated whether this technique is superior to laparoscopy.


Assuntos
Abdome/cirurgia , Cerclagem Cervical , Incompetência do Colo do Útero/cirurgia , Vagina/cirurgia , Aborto Espontâneo/prevenção & controle , Cesárea , Feminino , Humanos , Laparoscopia , Laparotomia , Gravidez , Nascimento Prematuro/prevenção & controle
2.
Korean J Gastroenterol ; 76(3): 164-166, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32969365

RESUMO

The World Health Organization has declared novel coronavirus disease 2019 (COVID-19) a global public health emergency. Although respiratory symptoms predominate in COVID-19, thrombosis can occur in patients with COVID-19. This paper reports a case of an 82-year-old female with a prior medical history of hypertension, diabetes presenting with fever and cough, and was diagnosed with COVID-19. The patient subsequently developed progressively worsening of abdominal distention, tenderness, and underwent emergent laparotomy. She was found to have a gangrenous colon. This case adds to the limited literature regarding the extrapulmonary complications of COVID-19.


Assuntos
Colite/diagnóstico , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Trombose Venosa/diagnóstico , Abdome/diagnóstico por imagem , Abdome/cirurgia , Doença Aguda , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Betacoronavirus/isolamento & purificação , Colite/patologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Feminino , Heparina/uso terapêutico , Humanos , Laparotomia , Necrose , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Tomografia Computadorizada por Raios X , Trombose Venosa/complicações , Trombose Venosa/tratamento farmacológico
3.
Anticancer Res ; 40(10): 5939-5947, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988926

RESUMO

Background/Aim: There is an increasing demand for preserving the fertility of young women impacted with early-stage cervical cancer. The aim of this study is to evaluate the oncological and reproductive outcomes of abdominal radical trachelectomy (ART). Patients and Methods: We retrospectively reviewed patients with FIGO stageIA2-IB1 cervical cancer who underwent ART from 2007 to 2018. We also compared the oncological prognosis between the patients who underwent ART and radical hysterectomy (RH). Results: A total of 42 patients underwent ART. During median follow-up 62.5 months, there were 4 (9.5%) recurrences and 1 (2.4%) death. As for tumors ≤2 cm, the 5-year recurrence-free survival (RFS) rate and overall survival (OS) rate for patients who underwent ART was similar to those who underwent RH (89.8% vs. 92.7%, p=0.42 and 97.3% vs. 95.0%, p=0.44, respectively). Nineteen patients attempted to conceive and seven of them were successful. There was one case of a first-trimester miscarriage, two cases of preterm delivery, three cases of full-term delivery and one ongoing pregnancy. Conclusion: ART could be a feasible alternative to RH for patients with tumors ≤2 cm with comparable oncological outcome.


Assuntos
Abdome/cirurgia , Recidiva Local de Neoplasia/cirurgia , Traquelectomia/efeitos adversos , Neoplasias do Colo do Útero/cirurgia , Abdome/fisiopatologia , Adulto , Idoso , Feminino , Fertilidade/fisiologia , Humanos , Histerectomia/efeitos adversos , Recém-Nascido , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/fisiopatologia , Estadiamento de Neoplasias , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias do Colo do Útero/fisiopatologia
4.
Am Surg ; 86(8): 981-984, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32779473

RESUMO

INTRODUCTION: Damage control laparotomy (DCL) is a life-saving surgical technique, but the resultant open abdomen (OA) carries serious morbidity/mortality. Many methods are utilized to manage OAs, but discrepancy exists in distinguishing closure from coverage techniques. We observed a difference in our DCL patient outcomes managed with the Wittmann Patch (WP) closure device versus the more popular ABThera (AB) coverage device. We hypothesized that the WP contributed to an improved fascial closure rate of the OAs after DCL. METHODS: A retrospective review of OAs managed with the AB or WP at our Level 1 trauma center was performed using billing codes to capture DCL patients from 2011 to 2019. Patients were divided into AB alone or WP groups. Major endpoints included primary fascial closure (PFC) and delayed fascial closure (DFC, fascial closure after greater than 7 days). RESULTS: 189 patients were identified as AB and 38 as WP. Rates of death before closure, age, gender, and Injury Severity Score were similar in both groups. PFC = 81%-90% for AB versus WP, respectively. Excluding patients with preexisting hernias PFC = 87%-100% for AB versus WP (P < .05) and DFC = 44%-100% for AB versus WP (P ≤ 0.001). WP had a statistically higher rate of PFC and DFC. There was a decreased incidence of complications in the WP versus AB group. CONCLUSIONS: While not well reported in the peer-reviewed literature, the application of the WP for management of the OA is an active form of pursuing PFC when compared with the AB, a coverage device. Our interinstitutional results have demonstrated superior PFC and DFC rates and fewer complications, in patients managed with the WP compared with the AB.


Assuntos
Abdome/cirurgia , Traumatismos Abdominais/cirurgia , Técnicas de Fechamento de Ferimentos Abdominais/instrumentação , Laparotomia , Adulto , Idoso , Fasciotomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Cicatrização
5.
Khirurgiia (Mosk) ; (7): 6-11, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32736457

RESUMO

OBJECTIVE: To analyze morbidity and factors affecting mortality in emergency abdominal surgery in the Russian Federation. MATERIAL AND METHODS: The study included patients with acute abdominal diseases aged 18 years and older. All patients were hospitalized in emergency surgical care departments of 3.194 state healthcare institutions in 84 regions of the Russian Federation in 2018. Morbidity, surgical activity and mortality were analyzed. RESULTS: There were 680.337 cases of hospitalization in emergency surgical department, morbidity rate was 582 cases per 100 000. The most common emergency surgical diseases were acute appendicitis (142.3 cases per 100 000), acute cholecystitis (139.0 cases per 100 000) and acute pancreatitis (131.2 cases per 100 000). Surgery was performed in 399.051 (58.7%) patients. In-hospital mortality rate was 2.4% (16 051 cases). CONCLUSION: There are certain factors affecting mortality rate in acute abdominal diseases. The leading problems in organizing emergency surgical care in Russia are insufficient equipment of rural and small municipal surgical hospitals, different staffing with surgeons in rural areas and large cities and late hospitalization of patients.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Doenças do Sistema Digestório/epidemiologia , Doenças do Sistema Digestório/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Abdome/cirurgia , Doença Aguda/epidemiologia , Doença Aguda/mortalidade , Doença Aguda/terapia , Adolescente , Adulto , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Doenças do Sistema Digestório/mortalidade , Procedimentos Cirúrgicos do Sistema Digestório/mortalidade , Emergências/epidemiologia , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Morbidade , População Rural/estatística & dados numéricos , Federação Russa/epidemiologia , Adulto Jovem
6.
Am Surg ; 86(8): 1038-1042, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731742

RESUMO

BACKGROUND: Adhesions are bands of tissue that form postoperatively after intra-abdominal surgery. Adhesions cause significant morbidity and despite ongoing research no agent or method has been shown to completely prevent adhesions. Human amnion-derived matrix is a complex tissue matrix derived from human placenta and has been used in other areas of surgery to promote healing and decrease scar tissue formation. Our hypothesis was that aerosolized human amnion-derived matrix particulate solution (HAMPS) applied during abdominal surgery would decrease adhesion formation in rats. METHODS: Twenty-four Sprague-Dawley rats were divided into 4 different groups. Group 1 was the control group (CG) which had cecal abrasion 20× with a surgical rasp to generate the adhesion model. Groups 2-4 were the treatment groups (TGs) and had cecal abrasion plus application of the HAMPS at concentrations of 6.25, 12.5, and 25 mg/cc, respectively. After 30 days, rats were euthanized and adhesion assessment performed. RESULTS: In all groups there were minimal adhesions noted at necropsy. Moderate inflammation was 33% in CG versus 11% in combined TGs. Average adhesion was 1.00 in CG versus 0.44 in combined TGs. This indicated an observational improvement in adhesions/inflammation in the TGs, although this did not reach statistical significance. There was a trend toward significance in the 12.5 mg/cc group alone (P = .054). CONCLUSION: Overall, HAMPS showed an observational decrease in adhesions in TGs although not statistically significant. There was a trend toward significance in the 12.5 mg group. Additional studies will have to be performed to further evaluate this subgroup.


Assuntos
Abdome/cirurgia , Âmnio/transplante , Complicações Pós-Operatórias/prevenção & controle , Aderências Teciduais/prevenção & controle , Abdome/patologia , Animais , Humanos , Masculino , Ratos , Ratos Sprague-Dawley , Aderências Teciduais/etiologia , Resultado do Tratamento
7.
Epidemiol Infect ; 148: e147, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32605670

RESUMO

Major surgery carried out in low- and middle-income countries is associated with a high risk of surgical site infections (SSI), but knowledge is limited regarding contributory factors to such infections. This study explores factors related to patients developing an SSI in a teaching hospital in Ghana. A prospective cohort study of patients undergoing abdominal surgical procedures was conducted at Korle Bu Teaching Hospital. Patient characteristics, procedures and environmental characteristics were recorded. A 30-day daily surveillance was used to diagnose SSI, and Poisson regression analysis was used to test for association of SSI and risk factors; survival was determined by proportional hazard regression methods. We included 358 patients of which 58 (16.2%; 95% CI 12.7-20.4%) developed an SSI. The median number of door openings during an operation was 79, with 81% being unnecessary. Door openings greater than 100 during an operation (P = 0.028) significantly increased a patient's risk of developing an SSI. Such patients tended to have an elevated mortality risk (hazard ratio 2.67; 95% CI 0.75-9.45, P = 0.128). We conclude that changing behaviour and practices in operating rooms is a key strategy to reduce SSI risk.


Assuntos
Abdome/cirurgia , Microbiologia do Ar , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/microbiologia , Adulto , Feminino , Gana/epidemiologia , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Salas Cirúrgicas , Estudos Prospectivos , Fatores de Risco
8.
Anaesth Intensive Care ; 48(4): 314-317, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32727217

RESUMO

Practising anaesthetists who are Fellows of the Australian and New Zealand College of Anaesthetists were surveyed with the objective of gaining insight into current analgesic preferences, with particular regard to neuraxial techniques, when managing patients having major open and laparoscopic abdominal surgery. Major abdominal surgery is common and effective analgesia is fundamental to optimal postoperative recovery. A multitude of analgesic options exist, with epidurals recommended in recent Enhanced Recovery After Surgery protocols. We believe the place of epidurals is increasingly questioned in the setting of continuous improvement in surgical technique, with increasing laparoscopic and robotic-assisted surgery. Evidence for various techniques is mixed and benefit-risk profiles exist for all alternatives. An opioid epidemic and abuse crisis has directed attention towards opioid minimisation strategies. The survey was completed by 28% (275) of the 975 Fellows who received it, with good representation across the Australian and New Zealand College of Anaesthetists' general membership. Respondents manage laparoscopic major abdominal surgery more frequently than open procedures, with approximately one-third of respondents each providing anaesthesia for two open laparotomies versus four to eight laparoscopic cases per month. Respondents reported a high perceived benefit of neuraxial analgesia, which was discordant with their clinical practice. Less than half of the respondents used epidural or spinal analgesia in open surgery (48% versus 49% of respondents, respectively). A minority (16%) of respondents use a neuraxial technique in major laparoscopic surgery, with a strong preference for intrathecal morphine (74%) when they choose to do so. Further investigation of the role of intrathecal analgesia is warranted given the shift towards laparoscopic major abdominal surgery, the perceived benefits of neuraxial techniques and the need for opioid-sparing analgesic strategies.


Assuntos
Analgesia Epidural , Analgésicos , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Abdome/cirurgia , Analgésicos Opioides , Anestesistas , Austrália , Humanos , Nova Zelândia , Dor Pós-Operatória , Padrões de Prática Médica , Inquéritos e Questionários
9.
Br J Anaesth ; 125(3): 358-372, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32660719

RESUMO

BACKGROUND: Intrathecal hydrophilic opioids decrease systemic opioid consumption after abdominal surgery and potentially facilitate enhanced recovery. A meta-analysis is needed to quantify associated risks and benefits. METHODS: A systematic search was performed to find RCTs investigating intrathecal hydrophilic opioids in abdominal surgery. Caesarean section and continuous regional or neuraxial techniques were excluded. Several subgroup analyses were prespecified. A conventional meta-analysis, meta-regression, trial sequential analysis, and provision of GRADE scores were planned. RESULTS: The search yielded 40 trials consisting of 2500 patients. A difference was detected in 'i.v. morphine consumption' at Day 1 {mean difference [MD] -18.4 mg, (95% confidence interval [CI]: -22.3 to -14.4)} and Day 2 (MD -25.5 mg [95% CI: -30.2 to -20.8]), pain scores at Day 1 in rest (MD -0.9 [95% CI: -1.1 to -0.7]) and during movement (MD -1.2 [95% CI: -1.6 to -0.8]), length of stay (MD -0.2 days [95% CI: -0.4 to -0.1]) and pruritus (relative risk 4.3 [95% CI: 2.5-7.5]) but not in nausea or sedation. A difference was detected for respiratory depression (odds ratio 5.5 [95% CI: 2.1-14.2]) but not when two small outlying studies were excluded (odds ratio 1.4 [95% CI: 0.4-5.2]). The level of evidence was graded as high for morphine consumption, in part because the required information size was reached. CONCLUSIONS: This study showed important opioid-sparing effects of intrathecal hydrophilic opioids. Our data suggest a dose-dependent relationship between the risk of respiratory depression and the dose of intrathecal opioids. Excluding two high-dose studies, intrathecal opioids have a comparable incidence of respiratory depression as the control group. CLINICAL TRIAL REGISTRATION: PROSPERO-registry: CRD42018090682.


Assuntos
Abdome/cirurgia , Analgesia Epidural/métodos , Analgésicos Opioides/uso terapêutico , Analgésicos Opioides/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Humanos , Gravidez , Insuficiência Respiratória/induzido quimicamente
10.
Br J Anaesth ; 125(3): 383-392, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32682559

RESUMO

BACKGROUND: Higher intraoperative driving pressures (ΔP) are associated with increased postoperative pulmonary complications (PPC). We hypothesised that dynamic adjustment of PEEP throughout abdominal surgery reduces ΔP, maintains positive end-expiratory transpulmonary pressures (Ptp_ee) and increases respiratory system static compliance (Crs) with PEEP levels that are variable between and within patients. METHODS: In a prospective multicentre pilot study, adults at moderate/high risk for PPC undergoing elective abdominal surgery were randomised to one of three ventilation protocols: (1) PEEP≤2 cm H2O, compared with periodic recruitment manoeuvres followed by individualised PEEP to either optimise respiratory system compliance (PEEPmaxCrs) or maintain positive end-expiratory transpulmonary pressure (PEEPPtp_ee). The composite primary outcome included intraoperative ΔP, Ptp_ee, Crs, and PEEP values (median (interquartile range) and coefficients of variation [CVPEEP]). RESULTS: Thirty-seven patients (48.6% female; age range: 47-73 yr) were assigned to control (PEEP≤2 cm H2O; n=13), PEEPmaxCrs (n=16), or PEEPPtp_ee (n=8) groups. The PEEPPtp_ee intervention could not be delivered in two patients. Subjects assigned to PEEPmaxCrs had lower ΔP (median8 cm H2O [7-10]), compared with the control group (12 cm H2O [10-15]; P=0.006). PEEPmaxCrs was also associated with higher Ptp_ee (2.0 cm H2O [-0.7 to 4.5] vs controls: -8.3 cm H2O [-13.0 to -4.0]; P≤0.001) and higher Crs (47.7 ml cm H2O [43.2-68.8] vs controls: 39.0 ml cm H2O [32.9-43.4]; P=0.009). Individualised PEEP (PEEPmaxCrs and PEEPPtp_ee combined) varied widely (median: 10 cm H2O [8-15]; CVPEEP=0.24 [0.14-0.35]), both between, and within, subjects throughout surgery. CONCLUSIONS: This pilot study suggests that individualised PEEP management strategies applied during abdominal surgery reduce driving pressure, maintain positive Ptp_ee and increase static compliance. The wide range of PEEP observed suggests that an individualised approach is required to optimise respiratory mechanics during abdominal surgery. CLINICAL TRIAL REGISTRATION: NCT02671721.


Assuntos
Abdome/cirurgia , Cuidados Intraoperatórios/métodos , Respiração com Pressão Positiva/métodos , Complicações Pós-Operatórias/prevenção & controle , Mecânica Respiratória/fisiologia , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos
11.
PLoS One ; 15(7): e0235636, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614891

RESUMO

OBJECTIVE: The use of epidural analgesia after major surgery is a well-established analgesia method. Epidural analgesia for postoperative pain relief needs to be monitored regularly in order to evaluate patient satisfaction and avoid side effects. However, due to the new available regional techniques, the role of epidural analgesia is being questioned and data about patient satisfaction is lacking. The current study was designed to evaluate patient satisfaction with epidural analgesia, its efficacy and reasons for premature termination of epidural analgesia. MATERIALS AND METHODS: We conducted a retrospective survey of all patients who undergone surgery at Uppsala University hospital between October 2012 and January 2014 requiring continuous epidural analgesia for postoperative pain relief. Patients' satisfaction with epidural analgesia and its effectiveness were evaluated by using paper questionnaire. RESULTS: During the study period 579 epidurals were inserted in patients scheduled for vascular, hepatobiliary, esophageal and other major abdominal surgery. The average treatment time was 3.8±1.8 days. Epidural analgesia consisted either of bupivacaine 0.1%+sufentanil 1 µg/ml solution or ropivacaine 0.2% solution. If patient needed opiates during treatment with epidural analgesia, only ropivacaine 0,2% solution was used. 494 (87.9%) patients were satisfied with their analgesia with no difference in satisfaction between sexes being observed. In 62 cases (11.2%) patient controlled analgesia was used on top of epidural analgesia with ropivacaine 0.2% solution, and 50.8% of patients were satisfied in this group. 514 (91.4%) patients were reported as having a good effect, 24 (4.3%) patients reported or were tested to show some effect, and 24 (4.3%) had no effect. No major neurological complications (epidural hematoma or abscess) were observed. CONCLUSIONS: Our retrospective survey indicates that patients are satisfied with continuous epidural analgesia used in major surgery.


Assuntos
Analgesia Epidural , Satisfação do Paciente , Abdome/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgesia Controlada pelo Paciente , Anestésicos Locais/administração & dosagem , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor , Dor Pós-Operatória/tratamento farmacológico , Estudos Retrospectivos , Inquéritos e Questionários , Suécia , Adulto Jovem
12.
Surgery ; 168(5): 793-799, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32682507

RESUMO

BACKGROUND: Postoperative gastrointestinal dysfunction remains a major determinant of the duration of stay after complex abdominal surgery. This study was performed to evaluate the effectiveness of heated fennel therapy in accelerating the recovery of gastrointestinal function. METHODS: This surgeon-blinded, prospective randomized controlled study included 381 patients with hepatobiliary, pancreatic, and gastric tumors who were divided into 2 groups. The patients in the experimental groups received heated fennel therapy, and those in the control groups received heated rice husk therapy. We compared the baseline characteristics, time to first postoperative flatus and defecation, fasting time, duration of postoperative hospital stay, grading of abdominal pain, classification of abdominal distension, inflammatory markers, and nutritional status indicators. RESULTS: The time to first flatus and first defecation and the fasting time were statistically significantly less in the heated fennel therapy group than those in the control groups (P < .05 each); and abdominal distension was also relieved in the experimental groups (P < .001). Heated fennel therapy had no obvious beneficial effect on inflammatory markers but improved the serum albumin (ALB) level of the patients at postop day 9 (P < .001). Among the patients with alimentary tract reconstruction, those in the heated fennel therapy group had a clinically important, lesser hospital stay than those in the control group (9.2 5 ± 5.1 versus 11.1 ± 6.4; P < .023). CONCLUSION: Heated fennel therapy facilitated the gastrointestinal motility function of patients early postoperatively.


Assuntos
Abdome/cirurgia , Recuperação Pós-Cirúrgica Melhorada , Foeniculum , Motilidade Gastrointestinal/efeitos dos fármacos , Fitoterapia , Adulto , Idoso , Feminino , Humanos , Tempo de Internação , Masculino , Medicina Tradicional Chinesa , Pessoa de Meia-Idade , Neoplasias Pancreáticas/fisiopatologia , Neoplasias Pancreáticas/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Neoplasias Gástricas/fisiopatologia , Neoplasias Gástricas/cirurgia
13.
Surgery ; 168(5): 778-784, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32709486

RESUMO

BACKGROUND: Surgeons often impose restrictions on patient activities after an abdominal operation in an effort to prevent complications such as incisional hernia. This study addresses the current recommendations concerning the restriction of activities given by a diverse group of surgeons to their patients after abdominal surgery. METHODS: A 14-item survey was posted on surgeon-specific social media platforms, primarily the American College of Surgeons Communities. This survey included questions about demographics, practice type, and activity recommendations after open and minimally invasive abdominal surgery. Descriptive, multivariable, and qualitative analyses were performed. RESULTS: A total of 420 surgeons completed the survey. The majority of respondents identified as general surgeons (76.2%). Practice types included private (37.6%), academic (34.3%), underserved (10.1%), and Veterans Affairs (5.6%). After an open laparotomy, the majority of respondents (53.1%) recommended that patients refrain from heavy lifting or strenuous activity for 6 weeks. For a minimally invasive abdominal operation, recommendations were even more variable, restricting activity for 2 weeks (34.4%), 4 weeks (23.8%), 6 weeks (15.5%), or no restrictions (12.6%). On average, participating surgeons recommended an earlier return to activity by 2.3 weeks for patients undergoing minimally invasive surgery compared with an open operation (95% confidence interval 2.1-2.5, P < .001). Qualitative analysis provided additional information regarding surgeons' rationale for decision making. Only 23.8% of the respondents indicated that their recommendations were based on evidence in literature. CONCLUSION: This survey on surgeon recommendations for convalescence after an abdominal operation indicates the wide variation in practices with insufficient evidence to guide decision making. Future clinical trials examining various durations and intensities of postoperative restrictions will be important to determine a safe and patient-centered approach for recovery after an abdominal operation.


Assuntos
Abdome/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Padrões de Prática Médica , Cirurgiões , Tomada de Decisões , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Pesquisa Qualitativa , Inquéritos e Questionários , Fatores de Tempo
14.
Br J Anaesth ; 125(2): 122-132, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32711724

RESUMO

BACKGROUND: Despite several clinical trials on haemodynamic therapy, the optimal intraoperative haemodynamic management for high-risk patients undergoing major abdominal surgery remains unclear. We tested the hypothesis that personalised haemodynamic management targeting each individual's baseline cardiac index at rest reduces postoperative morbidity. METHODS: In this single-centre trial, 188 high-risk patients undergoing major abdominal surgery were randomised to either routine management or personalised haemodynamic management requiring clinicians to maintain personal baseline cardiac index (determined at rest preoperatively) using an algorithm that guided intraoperative i.v. fluid and/or dobutamine administration. The primary outcome was a composite of major complications (European Perioperative Clinical Outcome definitions) or death within 30 days of surgery. Secondary outcomes included postoperative morbidity (assessed by a postoperative morbidity survey), hospital length of stay, mortality within 90 days of surgery, and neurocognitive function assessed after postoperative Day 3. RESULTS: The primary outcome occurred in 29.8% (28/94) of patients in the personalised management group, compared with 55.3% (52/94) of patients in the routine management group (relative risk: 0.54, 95% confidence interval [CI]: 0.38 to 0.77; absolute risk reduction: -25.5%, 95% CI: -39.2% to -11.9%; P<0.001). One patient assigned to the personalised management group, compared with five assigned to the routine management group, died within 30 days after surgery (P=0.097). There were no clinically relevant differences between the two groups for secondary outcomes. CONCLUSIONS: In high-risk patients undergoing major abdominal surgery, personalised haemodynamic management reduces a composite outcome of major postoperative complications or death within 30 days after surgery compared with routine care. CLINICAL TRIAL REGISTRATION: NCT02834377.


Assuntos
Abdome/cirurgia , Débito Cardíaco/fisiologia , Hidratação/métodos , Hemodinâmica/fisiologia , Cuidados Intraoperatórios/métodos , Complicações Pós-Operatórias/prevenção & controle , Idoso , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Risco
15.
Ann R Coll Surg Engl ; 102(7): 519-524, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32538103

RESUMO

INTRODUCTION: Laparostomy is important in the management of patients with intra-abdominal gastrointestinal catastrophe or trauma. It carries significant risk and is resource intensive, both in terms of nursing and surgically. The main goal is to achieve prompt myofascial closure (MFC) in order to minimise morbidity and mortality. Early MFC was initially defined as within 2-3 weeks but there is growing evidence that this should be measured in days. METHODS: Retrospective analysis was undertaken of laparostomy cases between 2016 and 2018 at an acute trust and trauma centre serving a population of 500,000. Indication, duration of open abdomen (OA), number of relook procedures and consultant presence were examined to see whether they affected MFC rates, morbidity and mortality. RESULTS: Overall, 76 laparostomies were performed during the 3-year study period. The most common indication was peritonitis (68.4%). As duration of OA and number of relook procedures increased, the chances of MFC fell significantly. After day 1, MFC rates fell by 20% with each subsequent 24 hours. Leaving the abdomen open primarily at index procedure compared with performing laparostomy following a postoperative complication was associated with significantly higher MFC rates (92.6% vs 68.2%, (p=0.006). The mortality rate was 15.8%. CONCLUSIONS: If the OA is not closed within five days or by the third relook procedure, then achieving MFC is unlikely. Alternative methods should be employed to close the abdomen rather than continuing to take the patient back to theatre for relook laparotomies while increasing the risk of morbidity and mortality. A proactive strategy to forming primary laparostomy at the index procedure has high closure rates.


Assuntos
Abdome/cirurgia , Técnicas de Fechamento de Ferimentos Abdominais , Laparotomia/métodos , Tratamento de Ferimentos com Pressão Negativa/métodos , Peritonite/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Reino Unido/epidemiologia , Adulto Jovem
16.
BMC Surg ; 20(1): 124, 2020 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-32517682

RESUMO

BACKGROUND: Cocoon abdomen is a relatively rare abdominal disease characterized by the total or partial encasement of the small intestinal by a dense fibro-collagenous membrane. CASE PRESENTATION: We reported an unusual case of idiopathic cocoon abdomen with congenital colon malrotation. Laparotomy and sac release were performed on the patient. The patient was no recurrence 6 months after operation. A literature review was also performed. CONCLUSION: Preoperative diagnosis of abdominal cocoon is difficult. A careful history, physical examination and appropriate radiology may be helpful in making a definitive diagnosis. If conservative treatment can't relieve symptoms effectively, surgery is currently considered to be important in the management of this disease.


Assuntos
Abdome/anormalidades , Colo/anormalidades , Anormalidades do Sistema Digestório/diagnóstico , Volvo Intestinal/diagnóstico , Abdome/cirurgia , Colo/cirurgia , Humanos , Obstrução Intestinal/cirurgia , Intestino Delgado/cirurgia , Laparotomia/métodos , Masculino , Pessoa de Meia-Idade , Radiografia
18.
Rev Col Bras Cir ; 47: e20202430, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32491027

RESUMO

OBJECTIVE: To verify the effect of longitudinal abdominal incisional herniorrhaphy on respiratory muscle pressure. METHOD: The technique of incisional herniorrhaphy used was proposed by Lázaro da Silva. To measure the pressure, we used a water manometer in 20 patients, median age 48.5 years (range 24 70). We analyzed the maximum inspiratory pressure at the level of residual volume (IP-RV) and functional residual capacity (IP-FRC) and the maximum expiratory pressure of functional residual capacity (EP-FRC) and total lung capacity (EP-TLC) in the preoperative and late postoperative (40 90 days) periods, in 13 patients with large incisional hernias and in 7 patients with medium incisional hernias. RESULTS: There was a significant increase in IP-FRC (p = 0.027), IP-RV (p = 0.011) and EP-TLC (p = 0.003) in patients with large incisional hernias. EP-FRC increased, but not significantly. In patients with medium incisional hernias, the changes were not significant. CONCLUSION: Surgical correction of large incisional hernias improves the function of the breathing muscles; however, surgery for medium incisional hernias does not alter this function.


Assuntos
Hérnia Ventral/cirurgia , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Respiração , Músculos Respiratórios , Abdome/cirurgia , Adulto , Idoso , Feminino , Humanos , Capacidade Inspiratória , Masculino , Manometria , Fluxo Expiratório Máximo , Pessoa de Meia-Idade , Período Pós-Operatório , Cuidados Pré-Operatórios , Testes de Função Respiratória , Adulto Jovem
19.
Rev Med Liege ; 75(5-6): 280-285, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-32496667

RESUMO

During the last decade minimal invasive approach progressed in all sectors of abdominal surgery. Technological improvements allowed to perform more complex procedures laparoscopically with increased safety. The implementation of pre-, per- and postoperative protocols with an adaptation of surgical, anesthetic and analgesia methods and the patient's involvement in the healing process led to enhanced recovery after surgery. The centralization of complex esophageal and pancreatic surgery established the CHU of Liège as a tertiary referral institution for complex oncological surgery thanks to a large cooperation with regional hospitals.


Assuntos
Laparoscopia , Participação do Paciente , Abdome/cirurgia , Humanos
20.
Isr Med Assoc J ; 22(6): 369-373, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32558443

RESUMO

BACKGROUND: Left ventricular assist devices (LVADs) are used more commonly in patients with advanced-stage heart failure. Some of these patients may require elective or urgent abdominal surgical procedures. OBJECTIVES: To determine the outcomes of the management of LVAD-supported patients who underwent elective and urgent abdominal surgical procedures in our institution. METHODS: A retrospective review was conducted on 93 patients who underwent LVAD implantation between August 2008 and January 2017. All abdominal surgeries in these patients were studied, and their impact on postoperative morbidity and mortality Ten patients underwent abdominal surgical procedures. Of these procedures, five were emergent and five were elective. The elective cases included one bariatric surgery for morbid obesity, one hiatal hernia repair, two cholecystectomies, and one small bowel resection for a carcinoid tumor. The emergency cases included suspected ischemic colitis, right colectomy for bleeding adenocarcinoma, laparotomy due to intraabdominal bleeding, open cholecystectomy for gangrenous cholecystitis, and laparotomy for sternal and abdominal wall infection. All patients undergoing elective procedures survived. Of the five patients who underwent emergency surgery, three died (60%, P = 0.16) and one presented with major morbidity. One of the two survivors required reintervention. In total, 12 interventions were performed on this group of patientswas evaluated. RESULTS: Ten patients underwent abdominal surgical procedures. Of these procedures, five were emergent and five were elective. The elective cases included one bariatric surgery for morbid obesity, one hiatal hernia repair, two cholecystectomies, and one small bowel resection for a carcinoid tumor. The emergency cases included suspected ischemic colitis, right colectomy for bleeding adenocarcinoma, laparotomy due to intraabdominal bleeding, open cholecystectomy for gangrenous cholecystitis, and laparotomy for sternal and abdominal wall infection. All patients undergoing elective procedures survived. Of the five patients who underwent emergency surgery, three died (60%, P = 0.16) and one presented with major morbidity. One of the two survivors required reintervention. In total, 12 interventions were performed on this group of patients. CONCLUSIONS: It is safe to perform elective abdominal procedures for LVAD-supported patients. The prognosis of these patients undergoing emergency surgery is poor and has high mortality and morbidity rates.


Assuntos
Abdome/cirurgia , Coração Auxiliar , Idoso , Feminino , Insuficiência Cardíaca/cirurgia , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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