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1.
JSLS ; 25(2)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248335

RESUMO

Background: Deloyers procedure enables anastomosis of the ascending colon to the rectum following extended resections that prevent usual fashion anastomosis. During the procedure, the right colon is completely mobilized and counterclockwise rotated to allow tension free and well-vascularized anastomosis while preserving the ileocecal valve. The purpose of this manuscript is to report our experience with laparoscopic Deloyers procedure in a hostile abdomen due to adhesions from previous surgeries. Methods: We report the outcomes and our technique of laparoscopic Deloyers procedure in three patients. All patients had a surgical complication necessitating the creation of end colostomy with a short colonic remnant. The bowel status prevented restoration of continuity by the common colorectal anastomosis and laparoscopic Deloyers was elected. Results: The procedure was successful in all patients, with no intra-operative complication and average surgery duration of three hours. Patients had uneventful postoperative recovery with only one case of minor complication and an adequate functional outcome. Conclusion: Laparoscopic Deloyers is safe and allows the restoration of bowel continuity with preservation of ileocecal valve and good functional outcome even in hostile abdomen.


Assuntos
Abdome/cirurgia , Colo/cirurgia , Endoscopia Gastrointestinal/métodos , Laparoscopia/métodos , Reto/cirurgia , Abdome/patologia , Adulto , Idoso , Anastomose Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aderências Teciduais/etiologia , Resultado do Tratamento
2.
J Clin Neurosci ; 90: 212-216, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34275552

RESUMO

BACKGROUND: Performing a successful microsurgical vascular anastomosis (MVA) is challenging and requires lots of practice. However, the most efficient practice protocol is yet to be found. We aimed to compare and analyze two major practice patterns for fine motor tasks as applied to learning MVA: distributed and mass practice protocols. Ten neurosurgeons with comparable experience in microsurgery (but no experience in vascular anastomosis) were randomized to practice MVA either using a distributed (1 session/day) or a mass practice (6 sessions/day) protocol. A total of 24 sessions of practice and 2 recall test sessions were given. Anastomosis score, time to complete a single stitch and the total time to complete an anastomosis were recorded. Mass practice protocol caused a clear fatigue effect observed toward the end of each mass practice trial block. Statistical comparison using one-way analysis of variance showed significantly higher anastomosis scores and shorter times to place a single stitch as well as to complete the anastomosis in distributed practice group for the last 3 acquisition practice trials, and the 2 recall tests (p < 0.05). The relative advantage of the distributed practice protocol could be attributed to forgetting/spacing effect. Although mass practice protocol resulted in worse performance, it still showed a gradual improvement trend in performance from beginning to the end. Therefore, certain adjustments to a mass practice protocol (such as increasing the number of practice blocks) could potentially lead to an eventual performance level comparable to a distributed protocol. This point is a subject of further investigation.


Assuntos
Anastomose Cirúrgica/educação , Microcirurgia/educação , Neurocirurgiões/educação , Treinamento por Simulação/métodos , Anastomose Cirúrgica/métodos , Competência Clínica , Humanos , Aprendizagem , Microcirurgia/métodos
3.
Medicine (Baltimore) ; 100(27): e26575, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232203

RESUMO

ABSTRACT: The anterolateral thigh free flap is one of the most preferred options for reconstructing soft tissues of the extremities and vascular anastomosis is one of the most important factors for flaps survival. T-anastomosis and double venous anastomosis have been widely used for increasing flap survival. This report shows both application of T-shape pedicle and multiple venous anastomosis to each 43 cases for extremity reconstruction that have not been described so far in the literature and it showed the necessity of multiple anastomosis. The locations of the lesions were 8 upper extremities (4 hands, 3 forearms, and 1 upper arm) and 35 lower extremities (5 forefeet, 6 dorsal feet, 4 plantar feet, 11 ankles, and 9 lower legs). We applied T-shaped arterial pedicle to limited anatomical area that had 2 or more major arterial communication sites to overcome the obstruction by reverse flow from communication vessels when 1 of the 2 anastomosis was obstructed. We classified multiple venous anastomosis according to flow direction and the vascular connections between the superficial and deep veins. In result, 37 cases survived completely but 2 flaps developed severe necrosis (>50%) because of infection and hematoma and 4 flaps developed partial necrosis due to wound infection. In conclusion, T-shaped pedicle and multiple venous anastomosis is a method to improve free flap survival and useful in cases where sacrificing a dominant vessel is inevitable or those in which only 1 vessel remains.


Assuntos
Retalhos de Tecido Biológico/irrigação sanguínea , Extremidade Inferior/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Lesões dos Tecidos Moles/cirurgia , Extremidade Superior/cirurgia , Veias/cirurgia , Adolescente , Adulto , Idoso , Anastomose Cirúrgica/métodos , Feminino , Humanos , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Extremidade Superior/irrigação sanguínea , Adulto Jovem
4.
Medicine (Baltimore) ; 100(19): e25871, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106638

RESUMO

RATIONALE: : Despite significant advances in microsurgical techniques, simultaneous vascularized lymph node transfer (VLNT) and lymphovenous anastomosis (LVA) surgeries may be effective for treatment of end-stage lymphedema. This case report describes the successful treatment of end-stage lymphedema with VLNT and LVA. PATIENT CONCERNS: A 72-year-old patient with bilateral lower extremity lymphedema was referred to our lymphedema clinic. This patient had a history of lymphoma and treated with radiotherapy on right inguinal area 26 years ago. Interestingly, the patient developed lymphedema on both the right and left lower extremities although she had radiotherapy on her right inguinal area. DIAGNOSIS: According to the indocyanine green lymphography, lymphoscintigraphy, and magnetic resonance lymphangiography, the patient was diagnosed with end-stage lymphedema (International Society of Lymphology stage 3). INTERVENTION: The patient underwent simultaneous VLNT and LVA for treatment of end-stage lymphedema. OUTCOMES: Significant reduction in circumference and volume of lower extremity was achieved following simultaneous VLNT and LVA. LESSONS: Simultaneous VLNT and LVA surgeries may be effective in patients with end-stage lymphedema.


Assuntos
Linfonodos/cirurgia , Linfedema/etiologia , Linfedema/cirurgia , Linfoma/radioterapia , Idoso , Anastomose Cirúrgica/métodos , Feminino , Humanos , Extremidade Inferior
5.
J Cardiothorac Surg ; 16(1): 185, 2021 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-34174918

RESUMO

BACKGROUND: The Freestyle® bioprosthesis is used for pathologies of the aortic root. Additional resection of the ascending aorta and the proximal arch in dissections or aneurysms might be indicated. The aim was to assess mid-term outcome regarding prosthetic performance, stroke, reoperations, and survival in various pathologies comparing patients with and without additional procedures on the ascending aorta and proximal arch focusing on the standardised technique of unilateral antegrade cerebral perfusion under moderate hypothermia. METHODS: Retrospective data analysis of 278 consecutive patients after Freestyle® root replacement between September 2007 and March 2017. Patients were divided in three categories due to the pathology of the aortic root (re-operation vs endocarditis vs dissection). Two groups based on the aortic anastomosis technique (open arch anastomosis (OA) versus non-open arch anastomosis (non-OA) were compared (119 OA vs 159 non-OA). Cardiovascular risk, previous cardiac events, intra- and postoperative data were evaluated. Inferential statistics were performed with Mann-Whitney U-test. Nominal and categorical variables were tested with Fisher-Freeman-Halton exact test. Kaplan-Meier estimate was used to assess survival. RESULTS: The follow-up rate was 90% (median follow-up: 39.5 months). There were differences in the indication (endocarditis: OA 5 (4.2%) vs non-OA 36 (24%), p < 0.0001; dissection: OA 13 (10.9%) vs non-OA 2 (1.3%); p = 0.0007). OA patients had less perioperative stroke (1 (1%) vs 15 (10%), p = 0.001) and shorter hospital stay (9 vs 12 days, p = 0.0004). There were no differences in the mortality (in-hospital: OA 8 (7%) vs non-OA 8 (5%); p = 0.6; death at follow-up: OA 5 (5%) vs non-OA 15 (11%); p = 0.1). Overall valve performance showed a well-functioning valve in 97.3% at follow-up. CONCLUSION: The valve performance showed excellent results regardless of the initial indication. The incidence of stroke was lower in patients receiving an open arch anastomosis using unilateral antegrade cerebral perfusion without elevated mortality or prolonged hospital stay.


Assuntos
Anastomose Cirúrgica/métodos , Aneurisma Dissecante/cirurgia , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/métodos , Prótese Vascular , Endocardite/cirurgia , Idoso , Anastomose Cirúrgica/efeitos adversos , Aneurisma Dissecante/mortalidade , Aneurisma Aórtico/mortalidade , Implante de Prótese Vascular/efeitos adversos , Feminino , Humanos , Hipotermia Induzida , Estimativa de Kaplan-Meier , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Perfusão , Desenho de Prótese , Reoperação , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
6.
Artigo em Inglês | MEDLINE | ID: mdl-34019746

RESUMO

An aortic aneurysm may cause loss of the sinotubular junction. Reduction in the diameter of the sinotubular junction may reestablish aortic valve competence in patients with an ascending aortic aneurysm and aortic valve regurgitation with normal aortic cusps. With this video tutorial we describe an alternative technique for replacing the ascending aorta with restoration of the sinotubular junction.


Assuntos
Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Insuficiência da Valva Aórtica/prevenção & controle , Valva Aórtica , Complicações Pós-Operatórias/prevenção & controle , Enxerto Vascular , Anastomose Cirúrgica/métodos , Valva Aórtica/fisiopatologia , Valva Aórtica/cirurgia , Anuloplastia da Valva Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Enxerto Vascular/efeitos adversos , Enxerto Vascular/métodos
7.
Medicine (Baltimore) ; 100(20): e25872, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011053

RESUMO

RATIONALE: Despite significant advances in microsurgical techniques, simultaneous release of transverse carpal ligament (TCL) and lymphovenous anastomosis (LVA) surgeries may be effective for treatment of carpal tunnel syndrome (CTS) and advanced-stage lymphedema. This case report describes the successful treatment of lymphedema with LVA in a patient with CTS and advanced-stage lymphedema. PATIENT CONCERNS: A 60-year-old female patient was referred to our lymphedema clinic with a 12-year history of chronic, acquired, right upper extremity lymphedema and CTS following right mastectomy and axillary lymph node dissection and adjuvant chemoradiotherapy for treating breast cancer. DIAGNOSIS: According to the indocyanine green lymphography, magnetic resonance lymphangiography, and electromyography, the patient was diagnosed with CTS and advanced-stage lymphedema (International Society of Lymphology late stage 2). INTERVENTION: Release of the TCL was performed first, followed by LVA at the wrist, forearm, and antecubital area. The right arm was compressed and elevated immediately postoperatively and postoperative compression bandage therapy with 35 to 40 mm Hg pressure was instituted following surgery. OUTCOMES: After 2 simultaneous surgeries, the patient had significant circumference and volume reduction of the right hand. The CTS and lymphedema symptoms have decreased following synchronous TCL release and LVA surgeries. LESSONS: Simultaneous LVA and release of the TCL may be effective and safe in patients with advanced lymphedema and CTS.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Linfedema/cirurgia , Complicações Pós-Operatórias/cirurgia , Anastomose Cirúrgica/métodos , Neoplasias da Mama/terapia , Síndrome do Túnel Carpal/etiologia , Doença Crônica/terapia , Feminino , Humanos , Verde de Indocianina/administração & dosagem , Excisão de Linfonodo/efeitos adversos , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/cirurgia , Linfedema/diagnóstico , Linfedema/etiologia , Linfografia , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Extremidade Superior/irrigação sanguínea , Extremidade Superior/cirurgia , Veias/cirurgia
8.
Pan Afr Med J ; 38: 231, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34046136

RESUMO

Colonic volvulus usually occurs as a single event that can affect various parts of the colon. The usual sites affected being the sigmoid colon (75%) and the caecum (22%). The phenomenon of multiple sites simultaneously undergoing volvulus is an extremely rare occurrence. We report a rare case of simultaneous sigmoid and transverse colon volvulus in a 52-year-old female. The clinical presentation and the radiological findings were that of large bowel obstruction. A subtotal colectomy and colocolic anastomosis were performed and the postoperative period was uneventful. Though rare the development of transverse and sigmoid volvulus in the same patient must always be considered in the differential diagnosis, when dealing with recurrent intermittent abdominal pain or acute intestinal obstruction.


Assuntos
Colo Sigmoide/patologia , Colo Transverso/patologia , Obstrução Intestinal/etiologia , Volvo Intestinal/complicações , Dor Abdominal/etiologia , Anastomose Cirúrgica/métodos , Colectomia , Colo Sigmoide/cirurgia , Colo Transverso/cirurgia , Feminino , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgia , Volvo Intestinal/cirurgia , Pessoa de Meia-Idade
9.
Pediatr Surg Int ; 37(8): 983-989, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33907863

RESUMO

Esophageal atresia-tracheoesophageal fistula (EA-TEF) is one of the common congenital anomalies occurring in newborns. Over the last eight decades, various technical modifications have been proposed in the surgical repair of EA-TEF. Preservation of azygos vein is one such modification that has gained considerable attention. However, a consensus statement regarding the superiority of its preservation over its division is lacking. We aim to compare the outcomes of surgery between the two groups of newborns, i.e., those undergoing repair with and without azygos vein preservation, in terms of its complications. The authors systematically searched the databases PubMed, EMBASE, Web of Science, and Scopus through December 2020. The incidence of anastomotic complications and chest infection was compared among the two groups of newborns, i.e., those undergoing surgical repair with (group A) and without azygos vein preservation (group B). Statistical analysis was performed using a fixed-effects model, and pooled risk ratio (RR) and heterogeneity (I2) were calculated. The methodological quality of the studies was assessed using the Downs and Black scale. Six comparative studies, consisting of a total of 671 newborns, were included in the meta-analysis. As compared to group B, newborns belonging to group A showed a significantly lower incidence of pneumonitis in the postoperative period (RR 0.31; 95% CI 0.17-0.57, p = 0.0001). However, no significant difference in the incidence of anastomotic complications including anastomotic leak (RR 0.73; 95% CI 0.48-1.12, p = 0.15) and stricture (RR 0.63; 95% CI 0.36-1.09, p = 0.10) was observed between the two groups. The average Downs and Black scale scores ranged from 20 to 24. The risk of bias was low (n = 1) and moderate (n = 5) in the included studies. Kappa statistics showed a value of 0.902 (p < 0.001), highlighting an almost perfect agreement among the two observers. The present meta-analysis revealed the superiority of surgical repair of EA-TEF performed with preservation of azygos vein in terms of the incidence of postoperative chest infection. However, no significant difference in the occurrence of anastomotic leak and stricture was observed between the two groups. The level of evidence of the published comparative studies is limited. Therefore, well designed, randomized controlled trial utilizing a standardized operative approach on a larger sample-size needs to be conducted for optimal comparison between the two approaches.


Assuntos
Veia Ázigos/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Atresia Esofágica/cirurgia , Fístula Traqueoesofágica/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Anastomose Cirúrgica/métodos , Fístula Anastomótica/etiologia , Constrição Patológica/complicações , Feminino , Humanos , Recém-Nascido , Masculino , Pneumonia/complicações , Estudos Retrospectivos , Resultado do Tratamento
10.
Int J Comput Assist Radiol Surg ; 16(8): 1335-1345, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33891254

RESUMO

PURPOSE: The introduction of novel endoscopic instruments is essential to reduce trauma in visceral surgery. However, endoscopic device development is hampered by challenges in respecting the dimensional restrictions, due to the narrow access route, and by achieving adequate force transmission. As the overall goal of our research is the development of a patient adaptable, endoscopic anastomosis manipulator, biomechanical and size-related characterization of gastrointestinal organs are needed to determine technical requirements and thresholds to define functional design and load-compatible dimensioning of devices. METHODS: We built an experimental setup to measure colon tissue compression piercing forces. We tested 54 parameter sets, including variations of three tissue fixation configurations, three piercing body configurations (four, eight, twelve spikes) and insertion trajectories of constant velocities (5 mms-1, 10 mms-1,15 mms-1) and constant accelerations (5 mms-2, 10 mms-2, 15 mms-2) each in 5 samples. Furthermore, anatomical parameters (lumen diameter, tissue thickness) were recorded. RESULTS: There was no statistically significant difference in insertion forces neither between the trajectory groups, nor for variation of tissue fixation configurations. However, we observed a statistically significant increase in insertion forces for increasing number of spikes. The maximum mean peak forces for four, eight and twelve spikes were 6.4 ± 1.5 N, 13.6 ± 1.4 N and 21.7 ± 5.8 N, respectively. The 5th percentile of specimen lumen diameters and pierced tissue thickness were 24.1 mm and 2.8 mm, and the 95th percentiles 40.1 mm and 4.8 mm, respectively. CONCLUSION: The setup enabled reliable biomechanical characterization of colon material, on the base of which design specifications for an endoscopic anastomosis device were derived. The axial implant closure unit must enable axial force transmission of at least 28 N (22 ± 6 N). Implant and applicator diameters must cover a range between 24 and 40 mm, and the implant gap, compressing anastomosed tissue, between 2 and 5 mm.


Assuntos
Colonoscopia/métodos , Neoplasias Colorretais/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Neoplasias Experimentais , Reto/cirurgia , Anastomose Cirúrgica/métodos , Animais , Fenômenos Biomecânicos , Neoplasias Colorretais/fisiopatologia , Pressão , Suínos
11.
Lancet Gastroenterol Hepatol ; 6(6): 482-497, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33872568

RESUMO

The majority of patients with Crohn's disease and a proportion of patients with ulcerative colitis will ultimately require surgical treatment despite advances in diagnosis, therapy, and endoscopic interventions. The surgical procedures that are most commonly done include bowel resection with anastomosis, strictureplasty, faecal diversion, and ileal pouch. These surgical treatment modalities result in substantial alterations in bowel anatomy. In patients with inflammatory bowel disease, endoscopy plays a key role in the assessment of disease activity, disease recurrence, treatment response, dysplasia surveillance, and delivery of endoscopic therapy. Endoscopic evaluation and management of surgically altered bowel can be challenging. This consensus guideline delineates anatomical landmarks and endoscopic assessment of these landmarks in diseased and surgically altered bowel.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Endoscopia/métodos , Doenças Inflamatórias Intestinais/cirurgia , Intestinos/patologia , Adulto , Anastomose Cirúrgica/métodos , Pontos de Referência Anatômicos/diagnóstico por imagem , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/cirurgia , Bolsas Cólicas/efeitos adversos , Consenso , Constrição Patológica/cirurgia , Doença de Crohn/diagnóstico , Doença de Crohn/cirurgia , Humanos , Intestinos/anatomia & histologia , Intestinos/cirurgia , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Proctocolectomia Restauradora/métodos , Recidiva , Índice de Gravidade de Doença
12.
Cardiovasc Intervent Radiol ; 44(8): 1266-1272, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33890168

RESUMO

PURPOSE: To investigate clinical outcomes and safety of extraluminal recanalization for duct-to-duct anastomotic obstruction after living donor liver transplantation (LDLT). MATERIALS AND METHODS: Extraluminal recanalization was performed as a salvage procedure after failure of intraluminal cannulation in eight patients who underwent percutaneous transhepatic treatment of duct-to-duct anastomotic obstruction 11.0 ± 5.27 months after LDLT between October 2012 and April 2019. Technical details, safety, and outcomes of extraluminal recanalization were investigated. RESULTS: Total ten sessions of extraluminal recanalization were performed in the eight patients with the stiff backend of a 0.035 inch hydrophilic guide wire, 22-gauge Chiba needle, or Colapinto needle. Percutaneous common bile duct access was performed in three sessions to obtain a straight course for the puncture. There was one instance of subcapsular and intraparenchymal hematoma requiring placement of an additional drainage catheter and conservative treatment. During a follow-up period ranging from 18.4 to 100.7 months, the drainage catheter was removed in seven of the eight patients, including three patients who had recurrent stricture requiring repeat percutaneous treatment and one who underwent a routine change of an endoscopic retrograde biliary drainage catheter. CONCLUSIONS: Extraluminal recanalization can be an effective and safe salvage procedure after failed intraluminal cannulation of duct-to-duct anastomotic obstruction in LDLT.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Drenagem/métodos , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/terapia , Terapia de Salvação/métodos , Adulto , Idoso , Anastomose Cirúrgica/métodos , Cateteres , Drenagem/instrumentação , Humanos , Fígado/cirurgia , Transplante de Fígado/métodos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
13.
World J Surg Oncol ; 19(1): 130, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33882952

RESUMO

BACKGROUND: The application of side-to-end anastomosis (SEA) in sphincter-preserving resection (SPR) is controversial. We performed a meta-analysis to compare the safety and efficacy of SEA with colonic J-pouch (CJP) anastomosis, which had been proven effective in improving postoperative bowel function. METHODS: The protocol was registered in PROSPERO under number CRD42020206764. PubMed, Embase, Web of Science, and the Cochrane Register of Controlled Trials databases were searched. The inclusion criteria were randomized controlled trials (RCTs) that evaluated the safety or efficacy of SEA in comparison with CJP anastomosis. The outcomes included the pooled risk ratio (RR) for dichotomous variables and weighted mean differences (WMDs) for continuous variables. All outcomes were calculated with 95% confidence intervals (CI) by STATA software (Stata 14, Stata Corporation, TX, USA). RESULTS: A total of 864 patients from 10 RCTs were included in the meta-analysis. Patients undergoing SEA had a higher defecation frequency at 12 months after SPR (WMD = 0.20; 95% CI, 0.14-0.26; P < 0.01) than those undergoing CJP anastomosis with low heterogeneity (I2 = 0%, P = 0.54) and a lower incidence of incomplete defecation at 3 months after surgery (RR = 0.28; 95% CI, 0.09-0.86; P = 0.03). A shorter operating time (WMD = - 17.65; 95% CI, - 23.28 to - 12.02; P < 0.01) was also observed in the SEA group without significant heterogeneity (I2 = 0%, P = 0.54). A higher anorectal resting pressure (WMD = 6.25; 95% CI, 0.17-12.32; P = 0.04) was found in the SEA group but the heterogeneity was high (I2 = 84.5%, P = 0.84). No significant differences were observed between the groups in terms of efficacy outcomes including defecation frequency, the incidence of urgency, incomplete defecation, the use of pads, enema, medications, anorectal squeeze pressure and maximum rectal volume, or safety outcomes including operating time, blood loss, the use of protective stoma, postoperative complications, clinical outcomes, and oncological outcomes. CONCLUSIONS: The present evidence suggests that SEA is an effective anastomotic strategy to achieve similar postoperative bowel function without increasing the risk of complications compared with CJP anastomosis. The advantages of SEA include a shorter operating time, a lower incidence of incomplete defecation at 3 months after surgery, and better sphincter function. However, close attention should be paid to the long-term defecation frequency after SPR.


Assuntos
Anastomose Cirúrgica/métodos , Bolsas Cólicas , Neoplasias Retais , Canal Anal/cirurgia , Anastomose Cirúrgica/efeitos adversos , Humanos , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Neoplasias Retais/cirurgia , Resultado do Tratamento
14.
Pan Afr Med J ; 38: 122, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33912292

RESUMO

Congenital segmental dilatation of the intestine is a rare disease. It is rarely located in the jejunum and its etiology is still unknown despite many theories suggesting its mechanism. We report a case of a 17 months girl who experienced nonspecific symptoms (abdominal pain, constipation and loss of appetite) since early her infancy. She had no growth retardation and had moderate abdominal distension on physical examination. Investigations undertaken could not increase suspicion of congenital segmental dilatation of the intestine (CSDI). The diagnosis was made peroperatively and a resection was done, followed by end-to-end jejunal anastomosis. There were no postoperative complications and the patient is doing well after four months. One should think of CSDI in children with chronic subocclusion or digestive hemorrhage.


Assuntos
Anastomose Cirúrgica/métodos , Doenças do Jejuno/diagnóstico , Jejuno/anormalidades , Dor Abdominal/etiologia , Constipação Intestinal/etiologia , Dilatação Patológica/congênito , Dilatação Patológica/diagnóstico , Dilatação Patológica/cirurgia , Feminino , Humanos , Lactente , Doenças do Jejuno/congênito , Doenças do Jejuno/cirurgia , Jejuno/cirurgia
15.
J Surg Oncol ; 123 Suppl 1: S81-S87, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33740257

RESUMO

BACKGROUND AND OBJECTIVES: To investigate the effects of different suture reinforcement methods for anastomotic leakage and other postoperative complications after the use of a laparoscopic double stapling technique (DST). METHODS: We collected the data of 124 patients who underwent laparoscopic radical resection of colorectal cancer from July 2017 to September 2018 at our institution. Patients were divided into three groups according to the suture reinforcement methods: intermittent, continuous suture reinforcement, and non-reinforcement (n = 41, 41, and 42, respectively). One-way analysis of variance, χ2 , Fisher's exact, and nonparametric tests were used for statistical analysis. RESULTS: Among the 124 patients, there were no statistically significant differences in operation times, intraoperative blood loss, postoperative hospital stays and recovery of bowel movement. Nine patients were diagnosed with anastomotic leakage (AL). The incidences of serious AL in the intermittent and continuous suture reinforcement groups were lower than that in the control group, with lower reoperation rate, shorter average lengths of stay and lower treatment costs of two experimental groups. CONCLUSION: Intermittent and continuous sutures after laparoscopic DST is effective, safe, and feasible on anastomotic leakage prevention. These procedures could be popularized in rectal surgery on patients with high risk of AL.


Assuntos
Anastomose Cirúrgica/métodos , Fístula Anastomótica/prevenção & controle , Neoplasias Colorretais/cirurgia , Anastomose Cirúrgica/efeitos adversos , Perda Sanguínea Cirúrgica , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Ann R Coll Surg Engl ; 103(5): e144-e147, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33682425

RESUMO

The current global COVID-19 pandemic is caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Currently, acquired tracheoesophageal fistulas are mainly iatrogenic lesions produced by prolonged tracheal intubation. We present a case of tracheoesophageal fistula with severe tracheal stenosis following tracheal intubation in a patient with SARS-CoV-2 infection.


Assuntos
COVID-19/terapia , Intubação Intratraqueal/efeitos adversos , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Síndrome do Desconforto Respiratório/terapia , Estenose Traqueal/cirurgia , Fístula Traqueoesofágica/cirurgia , Adulto , Anastomose Cirúrgica/métodos , Broncoscopia/métodos , COVID-19/complicações , Humanos , Masculino , Salas Cirúrgicas , Isoladores de Pacientes , Respiração Artificial , Síndrome do Desconforto Respiratório/etiologia , SARS-CoV-2 , Tomografia Computadorizada por Raios X , Estenose Traqueal/etiologia , Fístula Traqueoesofágica/etiologia
17.
Medicine (Baltimore) ; 100(13): e25357, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787638

RESUMO

BACKGROUND: Total ear amputation is a relatively rare trauma with an absolute indication for surgical treatment. Numerous techniques for auricular reconstruction have been described. When local and general conditions allow microsurgical replantation, this must be the first choice. We propose the association of microsurgical techniques with some modification (modified Baudet technique) to obtain higher survival rate of the reimplanted stump. METHODS: This study included cases of 3 male patients with total ear amputation, the injuries and their mechanism (workplace accident) being identical. Chief complaints were pain, bleeding, important emotional impact due by an unaesthetic appearance. The established diagnosis was traumatic complete ear amputation (grade IV auricular injury according to Weerda classification). Microsurgical replantation was performed only with arteriorraphy, and no vein anastomosis. Cartilage incisions and skin excisions were made to enlarge the cartilage-recipient site contact area. Medicinal leeches were used to treat venous congestion, to which systemic anticoagulant therapy was added. RESULTS: The results showed the survival of the entire replanted segment in all cases, with good function and esthetical appearance. Patients were fully satisfied with the final outcome. CONCLUSION: Microsurgical replantation is the gold standard, for the surgical treatment of total ear amputation. We believe that cartilage incisions and the increased surface of contact between cartilage and recipient site has an adjuvant role in revascularization of the amputated stump (with only arterial anastomosis) and the use of hirudotherapy helps to relieve early venous congestion.


Assuntos
Amputação Traumática/cirurgia , Artérias/cirurgia , Orelha Externa/cirurgia , Microcirurgia/métodos , Reimplante/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Anastomose Cirúrgica/métodos , Animais , Orelha Externa/irrigação sanguínea , Orelha Externa/lesões , Estética , Hirudo medicinalis , Humanos , Hiperemia/etiologia , Hiperemia/prevenção & controle , Aplicação de Sanguessugas/métodos , Masculino , Microcirurgia/efeitos adversos , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Reimplante/efeitos adversos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos
18.
J Cardiothorac Surg ; 16(1): 46, 2021 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-33757562

RESUMO

BACKGROUND: Intrathoracic esophagogastric anastomotic leak is one of the deadliest complications after esophagectomy. In recent years, we have implemented new method for the treatment of intrathoracic esophagogastric anastomotic leak with the nasogastric placement of sump drainage tube through fistula into abscess cavity. The aim of this study is to compare the efficacy of the new method and conventional therapies for intrathoracic anastomotic leak after esophagectomy. METHOD: Esophagectomy and esophagogastric anastomotic procedures were performed in 875 patients at our institution from January 2008 to December 2019. Of these patients, 43(4.9%) patients developed intrathoracic anastomotic leaks postoperatively were enrolled into our study and their clinical data were retrospectively assessed. 20 (47%) patients from January 2008 to December 2012 received conventional treatments (group 1) known as the traditional "three-tube method", and 23 (53%) patients from January 2013 to December 2019 received new treatments (group 2), consisted of conventional therapies and the nasogastric placement of sump drainage tube through fistula into abscess cavity. RESULTS: The presence of intrathoracic anastomotic leak was proven by contrast esophagography in 43 patients (4.9%). Among them, The average duration of chest tube was 47 days in group 1 and 28 days in group 2. The average length of leak treatment was 52 days in group 1 and 35 days in group 2. The average length of postoperative hospital stay was 56 days in group 1 and 39 days in group 2, respectively. 7(35%) patients among 20 patients died from intrathoracic anastomotic leak in group 1; and 3(13%) patients among 23 patients died from intrathoracic anastomotic leak in group 2. Compared with the conventional treatments (group 1), The average duration of chest tube was significantly decreased in the new treatments (group 2) (P < 0.01), as well as the length of leak treatment (P < 0.05) and the length of postoperative hospital stay (P < 0.01). However, there was no significant difference in the mortality rate (P = 0.148 > 0.05). CONCLUSION: In conclusion, Our results showed this method of the nasogastric placement of sump drainage tube through fistula appears to be an safe, effective, technically feasible treatment option for intrathoracic esophagogastric anastomotic leak. The efficacy and feasibility could be further investigated with a well-designed and large-scale RCT research.


Assuntos
Fístula Anastomótica/terapia , Drenagem/métodos , Esofagectomia/efeitos adversos , Intubação Gastrointestinal/instrumentação , Idoso , Anastomose Cirúrgica/métodos , Neoplasias Esofágicas/cirurgia , Feminino , Humanos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
19.
Surg Endosc ; 35(5): 2362-2372, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33625588

RESUMO

BACKGROUND: Intracorporeal rectal transection at the anorectal junction for ultralow rectal cancer is technically difficult due to pelvic width and limited roticulation, which might require a transanal transection or an oblique transection with multiple firings. These procedures were reported to be associated with the increased risk of morbidity. To address these problems, we presented a novel technique Transanterior Obturator Nerve Gateway (TANG) to transect rectum for ultralow rectal cancer and evaluated its safety and feasibility in this study. METHODS: A total of 210 consecutive patients who underwent laparoscopic coloanal anastomosis with or without partial intersphincteric resection (CAA/pISR) for rectal cancers between January 2017 and January 2020 were included. Eighty of these patients were analyzed using propensity score matching (PSM). The perioperative characteristics, TANG-related variables, and genitourinary and anal function outcomes were analyzed. RESULTS: Among these enrolled patients, 170 patients underwent traditional transection, and 40 underwent TANG transection; the patients were matched to include 40 patients in each group by PSM. After PSM, there were no significant differences in the operating time (p = 0.351) or bleeding volume (p = 0.474) between the two groups. However, the TANG group had fewer cases of conversion to transanal transection (0 vs. 13, p < 0.001). Moreover, the patients in TANG group had a more desirable transection with longer distal resection margin (1.7 vs. 1.1 cm, p < 0.001), shorter stapling line (6.6 vs. 10.3 cm, p < 0.001) and fewer stapler firings (p < 0.001). The overall postoperative complication rates and genitourinary and anal function outcomes were not significantly different between the two groups. CONCLUSIONS: The TANG approach appears to be a safe, feasible and effective approach for intracorporeal ultralow rectal transection with more distal resection, more vertical transection and fewer stapler firings.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Nervo Obturador/cirurgia , Neoplasias Retais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Feminino , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Pontuação de Propensão , Reto/cirurgia , Resultado do Tratamento
20.
Colorectal Dis ; 23(6): 1562-1568, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33539644

RESUMO

AIM: The COVID-19 pandemic has forced surgeons to adapt their standard procedures. The modifications introduced are designed to favour minimally invasive surgery. The positive results obtained with intracorporeal resection and anastomosis in the right colon and rectum prompt us to adapt these procedures to the left colon. We describe a 'don't touch the bowel' technique and outline the benefits to patients of the use of less surgically aggressive techniques and also to surgeons in terms of the lower emission of aerosols that might transmit the COVID-19 infection. METHODS: This was an observational study of intracorporeal resection and anastomosis in left colectomy. We describe the technical details of intracorporeal resection, end-to-end stapled anastomosis and extraction of the specimen through mini-laparotomy in the ideal location. RESULTS: We present preliminary results of 17 patients with left-sided colonic pathologies, 15 neoplasia and two diverticular disease, who underwent four left hemicolectomies, six sigmoidectomies and seven high anterior resections. Median operating time was 186 min (range 120-280). No patient required conversion to extracorporeal laparoscopy or open surgery. Median hospital stay was 4.7 days (range 3-12 days). There was one case of anastomotic leak managed with conservative treatment. CONCLUSION: Intracorporeal resection and end-to-end anastomosis with the possibility of extraction of the specimen by a mini-laparotomy in the ideal location may present benefits and also adapts well to the conditions imposed by the COVID-19 pandemic. Future comparative studies are needed to demonstrate these benefits with respect to extracorporeal anastomosis.


Assuntos
COVID-19/prevenção & controle , Colectomia/métodos , Doenças do Colo/cirurgia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Laparoscopia/métodos , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , COVID-19/epidemiologia , COVID-19/transmissão , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia
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