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1.
Surg Clin North Am ; 99(6): 1095-1109, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676050

RESUMO

Treatment of inflammatory bowel disease (IBD) is often multidimensional, requiring both medical and surgical therapies at different times throughout the course of the disease. Both medical and surgical treatments may be used in the acute setting, during a flare, or in a more elective maintenance role. These treatments should be planned as complementary and synergistic. Gastroenterologists and colorectal surgeons should collaborate to create a cohesive treatment plan, arranging the sequence and timing of various treatments. This article reviews the anticipated postoperative recovery after surgical treatment of IBD, possible postoperative complications, and considerations of timing surgery with medical therapy.


Assuntos
Colectomia/efeitos adversos , Colite Ulcerativa/cirurgia , Colostomia/efeitos adversos , Doença de Crohn/cirurgia , Anastomose Cirúrgica , Colectomia/métodos , Colite Ulcerativa/diagnóstico , Bolsas Cólicas/efeitos adversos , Colostomia/métodos , Doença de Crohn/diagnóstico , Feminino , Seguimentos , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/cirurgia , Masculino , Monitorização Fisiológica/métodos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Recidiva , Medição de Risco , Fatores de Tempo
2.
Surg Clin North Am ; 99(6): 1111-1121, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676051

RESUMO

Patients with inflammatory bowel disease are at an increased risk of cancer secondary to long-standing intestinal inflammation. Surgical options must take into account the significant risk of synchronous disease at other colonic sites. Ileal pouch anal anastomosis is a viable option for patients with ulcerative colitis, but this should be restricted to early cancers that are unlikely to require preoperative or postoperative radiation treatment.


Assuntos
Transformação Celular Neoplásica/patologia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/cirurgia , Lesões Pré-Cancerosas/patologia , Anastomose Cirúrgica , Colectomia/métodos , Colite Ulcerativa/epidemiologia , Colite Ulcerativa/patologia , Colite Ulcerativa/cirurgia , Neoplasias Colorretais/cirurgia , Comorbidade , Doença de Crohn/epidemiologia , Doença de Crohn/patologia , Doença de Crohn/cirurgia , Feminino , Humanos , Incidência , Doenças Inflamatórias Intestinais/patologia , Masculino , Lesões Pré-Cancerosas/epidemiologia , Prognóstico , Medição de Risco , Estomas Cirúrgicos , Análise de Sobrevida
3.
Surg Clin North Am ; 99(6): 1123-1140, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676052

RESUMO

Elective abdominal surgery for inflammatory bowel disease is common. Surgery for Crohn's disease is not curative, and treatment must be individualized to the disease process. Surgery for ulcerative colitis generally is curative but consideration of patient-specific factors is important for staging of the procedure and determining whether ileal pouch-anal anastomosis is appropriate.


Assuntos
Colectomia/métodos , Colite Ulcerativa/cirurgia , Doença de Crohn/cirurgia , Procedimentos Cirúrgicos Eletivos/métodos , Anastomose Cirúrgica , Colite Ulcerativa/diagnóstico , Bolsas Cólicas , Doença de Crohn/diagnóstico , Feminino , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/cirurgia , Masculino , Proctocolectomia Restauradora/métodos , Prognóstico , Medição de Risco , Resultado do Tratamento
4.
Surg Clin North Am ; 99(6): 1141-1150, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676053

RESUMO

Although improved medical therapies have been associated with decreased rates of emergent intestinal resection for inflammatory bowel disease, prompt diagnosis and management remain of utmost importance to ensure appropriate patient care with reduced morbidity and mortality. Emergent indications for surgery include toxic colitis, acute obstruction, perforation, acute abscess, or massive hemorrhage. Given this broad spectrum of emergent presentations, a multidisciplinary team including surgeons, gastroenterologists, radiologists, nutritional support services, and enterostomal therapists are required for optimal patient care and decision making. Management of each emergency should be individualized based on patient age, disease type and duration, and patient goals of care.


Assuntos
Colectomia/métodos , Hemorragia Gastrointestinal/cirurgia , Doenças Inflamatórias Intestinais/complicações , Obstrução Intestinal/cirurgia , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Anastomose Cirúrgica , Colite Ulcerativa/complicações , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/terapia , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Doença de Crohn/terapia , Emergências , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Obstrução Intestinal/etiologia , Obstrução Intestinal/fisiopatologia , Perfuração Intestinal/fisiopatologia , Masculino , Equipe de Assistência ao Paciente/organização & administração , Prognóstico , Medição de Risco , Resultado do Tratamento
5.
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
6.
Medicine (Baltimore) ; 98(44): e17783, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689848

RESUMO

RATIONALE: Postoperative intussusception in adults is a rare but serious complication after gastrointestinal anastomosis surgery. Postoperative intussusception in adults caused by tube feeding was rarely been reported before. The aim of the current study was to summarize the clinical data on a group of patients with tube feeding associated postoperative intussusceptions. The possible etiology and preventive measures will also be discussed. PATIENT CONCERNS: During the period from May 2013 to January 2018, patients who received gastrointestinal anastomosis in our center were retrospectively reviewed. Preoperative variables including standard demographic and pathological characteristics as well as the treatment and prognosis were also analyzed. DIAGNOSES: Tube feeding associated postoperative intussusceptions. INTERVENTIONS: 7 patients were identified with tube feeding associated postoperative intussusceptions with a prevalence of 0.38%. Intussusceptions occurred from 10 to 69 days (median 25.7 days) postoperatively in an acute form. OUTCOMES: None of the patients had spontaneous reduction and all patients underwent surgery. Antegrade efferent limb intussusceptions were found in all the cases. Intussusception occurred at efferent loop at 23.6 cm (range 15-60) from the gastrointestinal or Braun anastomosis. None of the patients was found recurrence throughout the follow-up period. LESSONS: In contrast with other postoperative intussusceptions, the tube feeding associated postoperative intussusceptions have special clinical manifestations. It is more likely to occur in early period of time after the surgery and in an acute form. Surgical correction is recommended for most of patients. Several measures have been proposed to prevent such complications after gastrointestinal surgery, however more research and information are still needed.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Nutrição Enteral/efeitos adversos , Enteropatias/epidemiologia , Intussuscepção/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Feminino , Humanos , Enteropatias/etiologia , Intussuscepção/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Prevalência , Estudos Retrospectivos
7.
Pan Afr Med J ; 33: 328, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692786

RESUMO

Urethral stricture is a disease whose cause and management vary according to the context. This study aims to analyze the epidemiological etiological and therapeutic features of urethral stricture in our department. We conducted a longitudinal cross-sectional study of patients with acquired urethral stricture admitted to our department between March 2014 and February 2016. The average age of our patients was 24.5 years (10 and 81years). The diagnosis was confirmed by retrograde and voiding Urethro-Cystography (UCG). The average stricture length was 2.28cm (0.5-5cm). The therapeutic approaches included: resection with termino-terminal anastomosis; retrograde dilatation etc. Outcome assessment performed 6-15 months after surgery was satisfactory with absence of recidivism, PMR ≤30cc and strong urine flow and weak in the case of recurrence of dysuria or PMR ≥100cc. Urethral stricture accounted for 7.14% of our urologic treatments. Most of our patients were farmers from the rural area. A history of recurrent urethritis was most often reported by our patients and 78,57% of them were married men, among whom 91% were polygamous). The main reason for consultation was dysuria (50% of the study population) and 50.01% of our patients had secondary urinary tract infection, most commonly caused by Escherichia coli. The main cause of urethral stricture was an infection (56.52%). The most affected area was the bulbar urethra (45.60% of cases). UCG was the most used technique (39.13%). Overall outcomes were good (85,65%) and failure rate reached 13.04%; the highest success rate was achieved with resection with anastomosis (94.44% respectively). Urethral stricture is common among young people. Infection is the main cause in our department. Prevention is essential as well as an efficient and effective management of sexually transmitted infections.


Assuntos
Anastomose Cirúrgica/métodos , Disuria/etiologia , Estreitamento Uretral/cirurgia , Uretrite/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos Transversais , Cistografia/métodos , Disuria/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estreitamento Uretral/diagnóstico , Uretrite/epidemiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Adulto Jovem
8.
Anticancer Res ; 39(11): 6393-6401, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704873

RESUMO

BACKGROUND/AIM: Intracorporeal anastomosis (IA) in laparoscopic colectomy for colon cancer is technically difficult, and there is a lack of consensus on the risk of bacterial contamination and cancer cell dissemination. In this study, short- and long-term outcomes of IA were examined. PATIENTS AND METHODS: Short and long-term outcomes of those who underwent IA (n=44) or extracorporeal anastomosis (EA) (n=61) were compared. RESULTS: IA was better than EA for blood loss, incision length, and first stool. Maximum temperature and C-reactive protein on postoperative day 1 were higher for the IA group. The rate of positive cultures from intraoperative lavage was higher for IA. The rate of positive cultures improved to an equivalent level by replacing mechanical pretreatment with chemical pretreatment. IA and EA were equivalent for the results of ascites cytology from lavage. CONCLUSION: With the use of appropriate preoperative treatment, IA takes advantage of the minimally invasive nature of laparoscopic surgery.


Assuntos
Ascite/microbiologia , Colectomia/métodos , Neoplasias do Colo/cirurgia , Laparoscopia/métodos , Complicações Pós-Operatórias/microbiologia , Grampeamento Cirúrgico/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Feminino , Humanos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
9.
Isr Med Assoc J ; 21(11): 728-731, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31713360

RESUMO

BACKGROUND: Evaluation of low rectal anastomosis is often recommended prior to ostomy closure, but the efficacy of such evaluations is uncertain. OBJECTIVES: To assess whether routine colonic preoperative evaluation has an effect on postoperative ileostomy closure results. METHODS: We performed a retrospective study evaluating all patients who underwent ileostomy closure over 9 years. Patient demographics, clinical, surgical details, and surgical outcomes were recorded and analyzed. RESULTS: The study comprised 116 patients who underwent ileostomy closure, of them 65 were male (56%) with a mean age of 61 years (range 20-91). Overall, 98 patients (84.4%) underwent colonic preoperative evaluation prior to ileostomy closure. A contrast enema was performed on 61 patients (62.2%). Abnormal preoperative results were observed in 12 patients (12.2%). The overall complication rate was 35.3% (41 patients). No differences in postoperative outcome was observed in patient gender (P = 1), age (P = 0.96), body mass index (P = 0.24), American Society of Anesthesiologists score (P = 0.21), and the Charlson Comorbidity Index score (P = 0.93). Among patients who had postoperative complications, we did not observe a difference between patients who underwent preoperative evaluation compared to those who did not (P = 0.42). No differences were observed among patients with preoperative findings interpreted as normal or abnormal (P = 1). The time difference between ileostomy creation and closure had no effect on the ileostomy closure outcome (P = 0.34). CONCLUSIONS: Abnormal findings in preoperative colonic evaluation prior to ileostomy closure were not associated with worse postoperative outcome.


Assuntos
Colo/anormalidades , Ileostomia , Cuidados Pré-Operatórios , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Colonoscopia , Enema , Feminino , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
10.
Am Surg ; 85(10): 1150-1154, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657313

RESUMO

Bile duct injury represents a complication after laparoscopic cholecystectomy, impairing quality of life and resulting in subsequent litigations. A five-year experience of bile duct injury repairs in 52 patients at a community hospital was reviewed. Twenty-nine were female, and the median age was 51 years (range, 20-83 years). Strasberg classification identified injuries as Type A (23), B (1), C (1), D (5), E1 (5), E2 (6), E3 (4), E4 (6), and E5 (1). Resolution of the bile duct injury and clinical improvement represent main postoperative outcome measures in our study. The referral time for treatment was within 4 to 14 days of the injury. Type A injury was treated with endobiliary stent placement. The remaining patients required T-tube placement (5), hepaticojejunostomy (20), and primary anastomosis (4). Two patients experienced bile leak after hepaticojejunostomy and were treated and resolved with percutaneous transhepatic drainage. At a median follow-up of 36 months, two patients (Class E4) required percutaneous balloon dilation and endobiliary stent placement for anastomotic stricture. The success of biliary reconstruction after complicated laparoscopic cholecystectomy can be achieved by experienced biliary surgeons with a team approach in a community hospital setting.


Assuntos
Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/estatística & dados numéricos , Ductos Biliares/diagnóstico por imagem , Ductos Biliares Extra-Hepáticos/lesões , California , Colecistectomia Laparoscópica/estatística & dados numéricos , Feminino , Hospitais Comunitários , Humanos , Jejunostomia/métodos , Jejunostomia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados (Cuidados de Saúde) , Complicações Pós-Operatórias/classificação , Estudos Retrospectivos , Stents/estatística & dados numéricos , Fatores de Tempo , Tempo para o Tratamento , Ferimentos e Lesões/classificação , Adulto Jovem
11.
Kyobu Geka ; 72(10): 772-776, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31582694

RESUMO

The important point in vascular anastomosis is anastomosis with a secure suture and prevention of thrombosis. Uncertainty in sutures can cause bleeding from the anastomotic site and post operative pseudoaneurysm formation. In addition, the failure of the antithrombotic function causes early occlusion of the anastomotic site due to thrombus formation, causing intimal thickening and causing stenosis of the anastomotic site. Vascular anastomosis must be performed with attention to the property and site of the blood vessel, the method of graft formation, and the procedure of suturing. Training is required for fast and accurate sutures, and it is also important to conduct off the job training to efficiently improve your proficiency.


Assuntos
Artérias , Suturas , Anastomose Cirúrgica , Constrição Patológica , Humanos , Técnicas de Sutura , Procedimentos Cirúrgicos Vasculares
12.
Kyobu Geka ; 72(10): 777-780, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31582695

RESUMO

It is well known that proximal part of a sequential bypass grafting often demonstrates better patency than distal part does due to more favorable hemodynamics of side-to-side anastomosis. Therefore, we adopt side-to-side anastomosis( parallel fashion) even for most distal part of bypass grafting. In addition to superiority in hemodynamics, side-to-side anastomosis (parallel fashion) provides a couple of advantages such as ① easiness in creating a very long opening of the anastomosis, ② compatibility in size (diameter) mismatch between graft conduit and coronary artery, and ③ excellent hemostasis from the suture line. This article describes technical details and tips of side-to-side anastomosis in both parallel fashion and diamond( cross direction) fashion.


Assuntos
Ponte de Artéria Coronária , Vasos Coronários , Anastomose Cirúrgica , Hemodinâmica , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares
13.
Kyobu Geka ; 72(10): 869-873, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31582712

RESUMO

Reconstruction after esophagectomy for esophageal cancer is concluded with 3 factors like as choice of organ, construction route and anastomotic method. The stomach is commonly preferred as a reconstructive organ at over 80% hospitals in Japan. This is known as the gastric tube. But, there are 3 types of a gastric tube as a whole stomach, a sub-whole stomach and a narrow gastric tube. Surgeons should choice a proper type under these characteristics of a reconstructive distance and a blood flow. In our hospital, we use a sub-whole stomach willingly through post sternal route. The rate of anastomotic leakage was 2.7%.And there were no problems to raise up to cervical side. Still more, it is referred to the problem between reconstructive route.


Assuntos
Neoplasias Esofágicas , Esofagectomia , Anastomose Cirúrgica , Fístula Anastomótica , Neoplasias Esofágicas/cirurgia , Humanos , Japão , Estômago
14.
Nihon Shokakibyo Gakkai Zasshi ; 116(10): 833-841, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31597882

RESUMO

A 65-year-old man was admitted complaining of high fever and pain in the right lower abdomen. An ileocolonic side-to-end anastomosis had been performed 38 years previously for an abscess in a colonic diverticulum. On the current admission, findings on contrast-enhanced computed tomography suggested an amebic liver abscess and intestinal amebiasis. Colonoscopy revealed an irregularly shaped ulcer and false membrane in the ileal blind end of the ileocolonic anastomosis. Amebic trophozoites were seen by rapid microscopy. Amebiasis in the blind end of the ileum has rarely been reported. This case is of particular interest because the intestinal amebiasis also led to a liver abscess.


Assuntos
Amebíase , Disenteria Amebiana/diagnóstico , Abscesso Hepático Amebiano/diagnóstico , Idoso , Anastomose Cirúrgica , Colonoscopia , Humanos , Masculino
15.
Khirurgiia (Mosk) ; (10): 13-20, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31626234

RESUMO

OBJECTIVE: To analyze the effectiveness of vacuum-assisted closure system for esophageal anastomotic leakage. MATERIAL AND METHODS: There were 10 patients with upper gastrointestinal anastomotic leakage who were treated at our institution in 2015-2018. Vacuum aspiration system was applied in all cases. RESULTS: Esophageal wall defect was successfully closed in 9 out of 10 patients after 2-4 courses and the system was eliminated in 11 days on the average. Localized cavity with granulation tissue developed in 1 patient after 5 courses and the system was also eliminated. CONCLUSION: Endoscopic vacuum-assisted therapy is an innovative, minimally invasive, economically profitable and successful method for anastomotic leakage. This procedure should be taken into consideration and widely used in multi-field hospitals.


Assuntos
Fístula Anastomótica/cirurgia , Doenças do Esôfago/cirurgia , Esofagectomia/efeitos adversos , Esôfago/cirurgia , Tratamento de Ferimentos com Pressão Negativa , Anastomose Cirúrgica , Fístula Anastomótica/etiologia , Esofagoscopia , Humanos
16.
Chirurg ; 90(11): 887-890, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31620821

RESUMO

BACKGROUND: Fluorescence angiography with indocyanine green (ICG-FA) is frequently used in colorectal surgery to assess the blood perfusion in the region of an anastomosis. Previous studies with ICG-FA in both open and laparoscopic surgery could show a low rate of anastomotic leakage, e.g. the PILLAR II study with a leakage rate of 1.4%. This article presents own results, the current status of ICG-FA and the fields of application. OBJECTIVE: The aim of the study was to analyze whether the results obtained so far with ICG-FA are sufficient to recommend an extended use of this relatively new method in colorectal surgery. MATERIAL AND METHODS: From July 2009 to June 2019 a total of 378 colorectal resections (280 colon resections and 98 rectal resections) with intraoperative examination of the anastomosis using ICG-FA were performed. In 13 patients (3.4%) there was reduced intraoperative perfusion, which led to a change in the operative procedure (resection of the anastomosis and new anastomosis, colostomy). RESULTS: The total anastomotic leakage rate was 3.7% with 8 leaks in the colon (2.9%) and 6 in the rectum (6.1%). Without the intraoperative change in 13 patients the rate of leakages could have increased to 7.1% (27/378). The use of ICG-FA in the group of patients studied potentially led to a reduction of the leakage rate by 48%. Current publications show similar results with a potential decrease in the rate of anastomotic leaks in colorectal surgery. CONCLUSION: The results show a very low rate of anastomotic leakage when using ICG-FA. These results are promising in colorectal surgery but controlled randomized studies are lacking and should be carried out before final recommendations can be given.


Assuntos
Colo , Cirurgia Colorretal , Angiofluoresceinografia/métodos , Anastomose Cirúrgica/métodos , Fístula Anastomótica/prevenção & controle , Colectomia/métodos , Colo/irrigação sanguínea , Colo/cirurgia , Neoplasias Colorretais/cirurgia , Cirurgia Colorretal/métodos , Procedimentos Cirúrgicos do Sistema Digestório , Humanos , Verde de Indocianina , Cuidados Intraoperatórios
17.
Medicine (Baltimore) ; 98(43): e17575, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651860

RESUMO

RATIONALE: Chylothorax remains a poorly understood phenomenon, and no optimal treatment or guidelines have been established. This is the first report of treating congenital chylothorax and lymphedema in a low-birth-weight infant by lymphovenous anastomosis (LVA). PATIENT CONCERNS: We report a case of successful LVA for persistent congenital chylothorax and lymphedema resistant to other conservative therapies. DIAGNOSIS: The diagnosis of chylothorax was confirmed by the predominance of lymphocytes in the pleural fluid draining from the chest tube. In addition, the infant developed oliguria and generalized lymphedema. INTERVENTIONS: LVA under local anesthesia combined with light sedation was performed at his medial thighs and left upper arm. OUTCOMES: Although his subcutaneous edema markedly improved, the decrease in chest tube drainage was gradual. No additional treatment was required. LESSONS: LVA is of considerable value as a surgical treatment option in the setting of persistent congenital chylothorax and lymphedema, because LVA is a less invasive procedure.


Assuntos
Quilotórax/congênito , Vasos Linfáticos/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Anastomose Cirúrgica/métodos , Quilotórax/cirurgia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Cavidade Pleural/cirurgia
19.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 997-1000, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630499

RESUMO

Indocyanine green (ICG) fluorescence imaging has been widely used in surgery. In colorectal surgery specifically, more and more studies have shown that intraoperative fluorescence imaging is a safe and feasible method to assess anastomotic perfusion, and its use may decrease the incidence of anastomotic leakage. Meanwhile, indocyanine green can also be used to mark the location of lesion, identify sentinel lymph nodes, protect the ureter, and so on. It can also provide detection and guidance in the operation of peritoneal metastasis and liver metastasis of colorectal cancer. The application of indocyanine green fluorescence imaging can offer great value for surgery through improving the accuracy and outcomes of oncological resections. According to existing studies, we are still at an early application stage of indocyanine green fluorescence imaging technology in colorectal surgery. Lacking prospective randomized controlled studies, neither standards nor guidelines for injection dosage, site and observation period are satisfactory. Therefore, deep researches and establishment of standardized operational procedure are required to enhance the safety and accuracy of tumor resection and improve outcomes.


Assuntos
Colo/cirurgia , Neoplasias Colorretais/diagnóstico , Corantes Fluorescentes/administração & dosagem , Verde de Indocianina/administração & dosagem , Reto/cirurgia , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/etiologia , Fístula Anastomótica/prevenção & controle , Colo/irrigação sanguínea , Colo/patologia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Humanos , Reto/irrigação sanguínea , Reto/patologia
20.
Anticancer Res ; 39(10): 5761-5765, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31570479

RESUMO

BACKGROUND/AIM: To clarify the usefulness of intraoperative colonoscopy (CS) for preventing postoperative anastomotic leakage and bleeding in rectal cancer surgery. PATIENTS AND METHODS: The data of rectal cancer patients who underwent circular-stapled anastomosis from January 2008 to December 2016 were compared between 162 patients who received intraoperative CS (the CS group) and 23 patients who did not receive intraoperative CS (the non-CS group). RESULTS: Anastomotic leakage rate in the CS group (8.6%) was similar to that in the non-CS group (4.3%) (p=0.70). Postoperative anastomotic bleeding rate was also similar between the CS and non-CS groups (2.4% vs. 0%, p=0.50). Although a positive air leak test was observed in two patients in the CS group, no postoperative leakage developed by adding intraoperative treatment. CONCLUSION: Although intraoperative CS did not significantly reduce the incidence of postoperative anastomotic leakage or bleeding, it can be useful for certain cases.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Neoplasias Retais/cirurgia , Reto/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Fístula Anastomótica/prevenção & controle , Colonoscopia/métodos , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Hemorragia Pós-Operatória/prevenção & controle , Período Pós-Operatório , Estudos Prospectivos , Estudos Retrospectivos
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