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1.
BMJ Case Rep ; 14(1)2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33419748

RESUMO

Two years after a Hartmann's procedure, an 85-year-old woman was admitted at our emergency department with abdominal bloating and severe constipation for 5 days. Abdominal CT showed a large rectal stump mucocele associated with compression of surrounding structures, causing a mechanical ileus and a bilateral pyelocaliceal dilatation. Successful transanal drainage with a rectal catheter allowed rapid recovery.


Assuntos
Colectomia/efeitos adversos , Colostomia/efeitos adversos , Íleus/diagnóstico , Mucocele/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Doenças Retais/diagnóstico , Idoso de 80 Anos ou mais , Feminino , Humanos , Íleus/etiologia , Íleus/cirurgia , Mucocele/etiologia , Mucocele/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Doenças Retais/etiologia , Doenças Retais/cirurgia
2.
Arq Bras Cir Dig ; 33(3): e1546, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33470376

RESUMO

BACKGROUND: Mortality after emergency surgery in randomized controlled trials. The Hartmann procedure remains the treatment of choice for most surgeons for the urgent surgical treatment of perforated diverticulitis; however, it is associated with high rates of ostomy non-reversion and postoperative morbidity. AIM: To study the results after the Hartmann vs. resection with primary anastomosis, with or without ileostomy, for the treatment of perforated diverticulitis with purulent or fecal peritonitis (Hinchey grade III or IV), and to compare the advantages between the two forms of treatment. METHOD: Systematic search in the literature of observational and randomized articles comparing resection with primary anastomosis vs. Hartmann's procedure in the emergency treatment of perforated diverticulitis. Analyze as primary outcomes the mortality after the emergency operation and the general morbidity after it. As secondary outcomes, severe morbidity after emergency surgery, rates of non-reversion of the ostomy, general and severe morbidity after reversion. RESULTS: There were no significant differences between surgical procedures for mortality, general morbidity and severe morbidity. However, the differences were statistically significant, favoring primary anastomosis in comparison with the Hartmann procedure in the outcome rates of stoma non-reversion, general morbidity and severe morbidity after reversion. CONCLUSION: Primary anastomosis is a good alternative to the Hartmann procedure, with no increase in mortality and morbidity, and with better results in the operation for intestinal transit reconstruction.


Assuntos
Colo Sigmoide/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Diverticulite/complicações , Diverticulite/cirurgia , Perfuração Intestinal/cirurgia , Peritonite/etiologia , Anastomose Cirúrgica/métodos , Colostomia/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Diverticulite/patologia , Humanos , Ileostomia/efeitos adversos , Perfuração Intestinal/patologia , Peritonite/cirurgia , Complicações Pós-Operatórias , Resultado do Tratamento
3.
Khirurgiia (Mosk) ; (7): 54-60, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32736464

RESUMO

OBJECTIVE: To analyze the results of minimally invasive surgical treatment of patients with urgent colon diseases. MATERIAL AND METHODS: There were 89 patients with urgent colon diseases. All patients were divided into 2 groups: the main group - 31 patients who underwent laparoscopic surgeries, the control group - 58 patients operated via open access. Both groups were comparable by age and underlying disease. However, significant differences in gender, severity of comorbidities and complications of the underlying disease were observed. RESULTS: Surgery time, postoperative morbidity (9.7% vs. 6.9%) and postoperative hospital-stay were similar in both groups. Quality of life was significantly better in the main group compared with the control group if colostomy was absent. In case of stoma, there were no between-group differences. CONCLUSION: Laparoscopic surgery is associated with reduced need for analgesics, similar duration of intervention and postoperative morbidity. Complete restoration of quality of life in these patients is observed in 6 months after surgery. Colostomy results similar quality of life after laparoscopic and open surgery.


Assuntos
Doenças do Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Laparoscopia , Qualidade de Vida , Colostomia/efeitos adversos , Humanos , Resultado do Tratamento
5.
Medicine (Baltimore) ; 99(14): e19557, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243372

RESUMO

The self-expanding metallic stent (SEMS) has been comprehensively investigated as a bridge to surgery. SEMS enables the control of acute colonic obstruction. However, comparison between SEMS and diverting colostomy as another bridge procedure was still challenging issue. Thus, the aim of this study was to compare these 2 procedures.In this retrospective cohort study, patients who received diverting colostomy and SEMS for acute left colonic obstruction between February 2016 and August 2018 were included. They were classified into the colostomy group (n = 27), including 5 patients who had SEMS failure previously, and the SEMS group (n = 23). The clinicopathologic parameters, pathologic results, and short-term outcomes were compared.No significant differences were found in clinicopathologic characteristics and complication rates between the 2 groups. After the bridge procedures, the SEMS group showed a higher rate of laparoscopic colonic resection than the colostomy group (100% vs 76%, P = .023). The colostomy group showed a higher rate of rectal cancer (24.0% vs 9.1%, P = .019) and later recovery of flatus (3 vs 2 days, P = .011) than the SEMS group. Additionally, the length of resected colon was longer in the colostomy group than in the SEMS group (33.9 vs 23.4 cm, P = .007).Although SEMS might permit higher laparoscopic resection rates and faster recovery of bowel habits than diverting colostomy, SEMS showed meaningful failure rate including migration and perforation. In addition, diverting colostomy showed acceptable complication rates and feasible performance. An individualized approach is necessary considering the advantages and disadvantages of both procedures.


Assuntos
Neoplasias Colorretais/complicações , Colostomia/métodos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Stents Metálicos Autoexpansíveis/estatística & dados numéricos , Adulto , Idoso , Colectomia/métodos , Colectomia/estatística & dados numéricos , Colostomia/efeitos adversos , Feminino , Humanos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Stents Metálicos Autoexpansíveis/efeitos adversos
6.
Chirurgia (Bucur) ; 115(1): 95-101, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155404

RESUMO

Introduction: Diverting ostomy is a commonly perfomed procedure but may be associated to its own morbidity (early or late complications). Colostomy-related evisceration is a rare but potentially life threatening condition (requiring emergency surgery), relatively undocumented for its mechanisms. Case report: A male aged 84 was admited for chronic low digestive occlusion due to a locally advanced, stenosing, rectal adenocarcinoma. Prior to neoadjuvant therapy, a loop sigmoidostomy was indicated using a left iliac open aproach, with no preparation of the colic content. The sigmoid was loaded with hard stools. The parietal breach was reaproximated by 2 monofilament nylon sutures, fascial and colocutaneus fixation. Colostomy was opened two days later, but was not functional (postoperative paralytic ileus). Parastomal evisceration of ileum in day 3, dehiscence of parietal suture. Emergency operation, using the same aproach. Results: Favourable outcome. Thoraco-abdominal CT scan: N0,M0. Pelvic MRI: proliferative mass of inferior and middle rectum, involving mesorectum fascia, levator ani and a few regional lymphatic nodes. Radio-chemotherapy and abdomino-perineal resection. Pathologic result: colorectal adenocarcinoma, G2, ypT1ypN0, ICD-O: 8140/3. Conclusions: We rewiewed 8 case reports published since 2011, equally distributed as late or early complications. There was no connection with the princeps indication (colorectal cancer in half of cases); neither related to topography (transverse or sigmoid) or type of colostomy (loop or end). Occurence of the complication is not time-dependent (5 to18 months in late, 3 to 12 days for early eviscerations). The main premise is colostomy itself (a place of reduced parieto-abdominal resistence), stressed by increassed intra-abdominal pressure (eg. bronchopulmonary disease, digestive obstruction). Predisposing factors for late evisceration seems to be related to spontaneous rupture of parastomal hernia/colostomy prolapse. As for early evisceration, both technical details and surgical strategy must be considered (indequate fixation; creation of a larger than necessary colostomy aperture).


Assuntos
Adenocarcinoma/cirurgia , Colostomia/efeitos adversos , Hérnia Ventral/cirurgia , Hérnia Incisional/cirurgia , Obstrução Intestinal/cirurgia , Neoplasias Retais/cirurgia , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico por imagem , Idoso de 80 Anos ou mais , Quimiorradioterapia Adjuvante , Hérnia Ventral/etiologia , Humanos , Hérnia Incisional/etiologia , Obstrução Intestinal/etiologia , Pseudo-Obstrução Intestinal/etiologia , Masculino , Protectomia , Neoplasias Retais/complicações , Neoplasias Retais/diagnóstico por imagem , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/cirurgia , Tomografia Computadorizada por Raios X
7.
Ulus Travma Acil Cerrahi Derg ; 26(2): 255-259, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32185770

RESUMO

BACKGROUND: This study evaluated the outcome of the reversal of Hartmann's procedure based on preoperative and intraoperative risk factors. METHODS: We retrospectively reviewed 78 cases, whom we applied the Hartmann's procedure either electively or under emergency conditions in our clinic between the years 2010 and 2016. RESULTS: Of the cases reviewed in this study, 45 patients were males, and 33 patients were females. Of all cases included in this study, 32 cases were operated due to malignancies, 15 cases were operated due to a perforated diverticulum, and 11 cases were operated due to sigmoid volvulus. Reversal of Hartmann's was performed in 32 cases. The morbidity and mortality rates for the reversal of Hartmann's procedure were 37.5% and 0.0%,respectively. CONCLUSION: The reversal of Hartmann's procedure appears to be a safe operation with acceptable morbidity rates. If the correct patient selection, correct operation timing and meticulous surgical preparation are performed, the risk of morbidity and mortality of the reversal of Hartmann's procedure can be minimized.


Assuntos
Colectomia , Colostomia , Reoperação , Colectomia/efeitos adversos , Colectomia/métodos , Doenças do Colo/cirurgia , Colostomia/efeitos adversos , Colostomia/métodos , Feminino , Humanos , Masculino
8.
Dan Med J ; 67(3)2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32138828

RESUMO

INTRODUCTION: Stoma-site incisional hernia is a common complication. Besides decreasing affected patients' quality of life, it may lead to emergency surgery due to incarceration. If stoma sites lead to an incisional hernia analogous to other abdominal incisions, considerable underreporting may be present in the literature. METHODS: This was a single-centre, retrospective cohort study comprising consecutive patients undergoing laparoscopic rectal resection for rectal carcinoma with temporary diverting stoma and subsequent stoma reversal. CTs were reviewed to identify stoma-site incisional hernia, and potential confounders for development of a hernia were assessed. RESULTS: A total of 91 patients underwent stoma reversal and subsequent CT. In all, 72 of the 91 included patients had a transverse colostomy, among whom 19 (26%) developed a hernia. Among the remaining 19 patients treated with an ileostomy, four (21%) developed stoma-site incisional hernia. The mean time from stoma reversal to follow-up CT was 47.6 months (range: 28.5-66.7 months). No significant associations between stoma-site hernia and the included potential risk factors were observed. CONCLUSIONS: 25% developed reversal-site incisional hernia. We were unable to find any predictors for development of stoma reversal-site hernia. If hernias occur as frequently as this study shows, investigation of potential ways to decrease their occurrence is warranted. FUNDING: none. TRIAL REGISTRATION: The study was approved by the Danish Data Protection Agency (R. no. 2012-58-0004).


Assuntos
Colostomia/efeitos adversos , Ileostomia/efeitos adversos , Hérnia Incisional/diagnóstico por imagem , Neoplasias Retais/cirurgia , Estomas Cirúrgicos/efeitos adversos , Idoso , Feminino , Humanos , Incidência , Hérnia Incisional/etiologia , Hérnia Incisional/cirurgia , Laparoscopia/efeitos adversos , Laparotomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X
9.
Dis Colon Rectum ; 63(5): 678-684, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32032196

RESUMO

BACKGROUND: Parastomal hernias are common with permanent colostomies and prone to complications. The short-term results of trials of parastomal hernia prevention are widely published, but long-term results are scarce. OBJECTIVE: The aim of the study is to detect the long-term effects and safety of preventive intra-abdominal parastomal mesh. DESIGN: This is a long-term follow-up of a previous prospective randomized, controlled multicenter trial. SETTINGS: This study was conducted at 2 university hospitals and 3 central hospitals in Finland. PATIENTS: Patients who had a laparoscopic abdominoperineal resection for rectal cancer between 2010 and 2013 were included in the study and invited for a follow-up visit. MAIN OUTCOME MEASURES: The primary outcomes measured were clinical and radiological parastomal hernias. RESULTS: Twenty subjects in the mesh group and 15 in the control group attended the follow-up visit with a median follow-up period of 65 (25th-75th percentiles, 49-91) months. A clinically detectable parastomal hernia was present in 4 of 20 (20.0%) and 5 of 15 (33.3%) subjects in the mesh and control groups (p = 0.45). A radiological parastomal hernia was present in 9 of 19 (45.0%) subjects in the mesh group and 7 of 12 (58.3%) subjects in the control group (p = 0.72). However, when all subjects (n = 70, 1:1) who attended the 12-month follow-up were screened for long-term results according to register data, 9 of 35 (25.9%) subjects in the mesh group and 16 of 35 (45.6%) subjects in control group were diagnosed with a parastomal hernia during the follow-up period (p = 0.10). In addition, only 1 of 35 (2.7%) subjects in the mesh group but 6 of 35 (17.1%) subjects in the control group underwent a parastomal hernia operation during the long-term follow-up (p = 0.030). LIMITATIONS: The study is limited by the small number of patients. CONCLUSION: Prophylactic intra-abdominal keyhole mesh did not decrease the rate of clinically detectable hernias but reduced the need for the surgical repair of parastomal hernias. Further trials are needed to identify a more efficient method to prevent parastomal hernias. See Video Abstract at http://links.lww.com/DCR/B171. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov. Identifier: NCT02368873. ESTUDIO PROSPECTIVO ALEATORIZADO SOBRE EL USO DE MALLA PROTÉSICA PARA PREVENIR UNA HERNIA PARAESTOMAL EN UNA COLOSTOMÍA PERMANENTE: RESULTADOS DE UN SEGUIMIENTO A LARGO PLAZO: PREVENCIÓN DE HERNIA PARAESTOMAL, NEOPLASIA COLORRECTAL/ANAL: Las hernias paraestomales son comunes con colostomías permanentes y son propensas a complicaciones. Los resultados a corto plazo de los ensayos sobre la prevención de la hernia parastomal se publican ampliamente, pero los resultados a largo plazo son escasos.El objetivo del estudio es detectar los efectos a largo plazo y la seguridad de la malla parastomal intraabdominal preventiva.Este es un seguimiento a largo plazo de un estudio aleatorizado prospectivo, controlado y multicentrico previo.Este estudio se realizó en dos hospitales universitarios y tres hospitales centrales en Finlandia.Los pacientes que se sometieron a una resección abdominoperineal laparoscópica por cáncer de recto 2010-2013 fueron incluidos en el estudio e invitados a una visita de seguimiento.Hernias parastomales clínicas y radiológicas.Veinte sujetos en el grupo de malla y 15 en el grupo control asistieron a la visita de seguimiento con una mediana de seguimiento de 65 meses (25-75 ° percentil 49-91). Una hernia paraestomal clínicamente detectable estuvo presente en 4/20 (20.0%) y 5/15 (33.3%) en los grupos de malla y control, respectivamente (p = 0.45). Una hernia parastomal radiológica estuvo presente en 9/19 (45.0%) en el grupo de malla y 7/12 (58.3%) en el grupo de control (p = 0.72). Sin embargo, cuando todos los sujetos (n = 70, 1: 1) que asistieron a los 12 meses de seguimiento fueron evaluados para obtener resultados a largo plazo de acuerdo con los datos del registro, 9/35 (25.9%) sujetos en el grupo de malla y 16/35 (45,6%) sujetos en el grupo control fueron diagnosticados con una hernia paraestomal durante el período de seguimiento (p = 0,10). Además, solo 1/35 (2.7%) en el grupo de malla pero 6/35 (17.1%) en el grupo control se sometieron a una operación de hernia paraestomal durante el seguimiento a largo plazo (p = 0.030).El estudio está limitado por un pequeño número de pacientes.La malla intra-abdominal profiláctica en ojo de cerradura no disminuyó la tasa de hernias clínicamente detectables, pero redujo la necesidad de la reparación quirúrgica de las hernias paraestomales. Se necesitan ensayos adicionales para identificar un método más eficiente para prevenir las hernias parastomales. Vea el resumen del video en http://links.lww.com/DCR/B171. (Traducción-Dr. Gonzalo Hagerman).NCT02368873.


Assuntos
Colostomia/efeitos adversos , Hérnia Incisional/prevenção & controle , Protectomia/efeitos adversos , Neoplasias Retais/cirurgia , Telas Cirúrgicas , Estomas Cirúrgicos/efeitos adversos , Idoso , Feminino , Finlândia , Seguimentos , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
10.
Am J Surg ; 220(4): 1010-1014, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32089244

RESUMO

BACKGROUND: Stomal prolapse is an uncommon complication related to ostomy creation without comparative studies to suggest an optimal approach. Our aim was to assess long-term recurrence rates following surgical repair, specifically local repair vs. laparotomy. METHODS: We conducted a retrospective review of patients who underwent surgical correction of a prolapsed stoma by dedicated colorectal surgeons. The primary outcome was recurrence. We evaluated perioperative risk factors for long-term recurrence, focusing on the surgical approach. RESULTS: Over 12 years, 23 patients underwent 37 surgeries (median follow-up 24 months, range 1-126). Repeat operations for recurrence were performed in 43.5% of patients, 80% within one year. Recurrence was similar regardless of the surgical approach; 43.6% local repair vs 42.9% laparotomy (p = 0.41). Age, sex, body mass index, smoking status, ASA score, type of stoma, and urgency of repair were not associated with recurrence. Re-recurrence resulting in a third operation, occurred in 50% of patients. CONCLUSION: Operative repair of stomal prolapse, regardless of approach, is associated with high recurrence rates. No identifiable factors were associated with recurrence.


Assuntos
Colostomia/efeitos adversos , Ileostomia/efeitos adversos , Laparotomia/métodos , Complicações Pós-Operatórias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prolapso , Recidiva , Reoperação , Estudos Retrospectivos , Adulto Jovem
11.
Sci Rep ; 10(1): 3643, 2020 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-32107426

RESUMO

Hartmann's reversal procedures are often fraught with complications or failure to recover. This being a fact, it is often difficult to select patients with the optimal indications for a reversal. The post-recovery morbidity and mortality rates in the literature are heterogeneous between 0.8 and 44%. The identification of predictive risk factors of failure of such interventions would therefore be very useful to help the practitioner in his approach. Given these elements, it was important to us to analyze the practice of two French university hospitals in order to highlight such risk factors and to allow surgeons to select the best therapeutic strategy. We performed a bicentric observational retrospective study between 2010 and 2015 that studied the characteristics of patients who had undergone Hartmann surgery and were subsequently reestablished. The aim of the study was to identify factors influencing morbidity and postoperative mortality of Hartmann's reversal. Primary outcome was complications within the first 90 postoperative days. 240 patients were studied of which 60.4% were men. The mean age was 69.48 years. The median time to reversal was 8 months. 79.17% of patients were operated as emergency cases where the indication was a diverticular complication (39.17%). Seventy patients (29.2%) underwent a reversal and approximately 43% of these had complications within the first 90 postoperative days. The mean age of these seventy patients was 61.3 years old and 65.7% were males. None of them benefited from a reversal in the first three months. We identified some risk factors for morbidity such as pre-operative low albuminemia (p = 0.005) and moderate renal impairment (p = 0.019). However, chronic corticosteroid use (p = 0.004), moderate renal insufficiency (p = 0.014) and coronary artery disease (p = 0.014) seem to favour the development of anastomotic fistula, which is itself, a risk factor for mortality (p = 0.007). Our study highlights an important rate of complications including significant anastomotic fistula after Hartmann's reversal. Precarious nutritional status and cardiovascular comorbidities should clearly lead us to reconsider the surgical indication for continuity restoration.


Assuntos
Colostomia/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
12.
Cir Cir ; 88(1): 88-90, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31967605

RESUMO

Background: Postoperative intussusception is an unusual complication in children; the incidence is 0.01-0.25%. Clinical Case: Female of 11 months who underwent colostomy, 48 h later presents abdominal pain, vomiting gastrobiliar and abdominal distension. A laparotomy was performed, finding a double ileo-ileal invagination 60 cm from the ileocecal valve. Discussion: The postoperative intestinal invaginations are extremely rare and most of them occur within the first 7 days. The etiology of postoperative intussusception is unknown. Conclusions: Postoperative children with intestinal occlusion, intussusception should be suspected and an immediate laparotomy should be performed.


Assuntos
Colostomia/efeitos adversos , Valva Ileocecal , Intussuscepção/etiologia , Complicações Pós-Operatórias/etiologia , Dor Abdominal/etiologia , Feminino , Humanos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/etiologia , Valva Ileocecal/diagnóstico por imagem , Lactente , Intussuscepção/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Prolapso , Reoperação
13.
J Surg Res ; 245: 544-551, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31470335

RESUMO

BACKGROUND: Metabolic syndrome (MS) is defined as the cluster: hypertension, obesity, and diabetes. Operative diverticulitis in the setting of MS can be challenging to manage. The aim of our study was to evaluate the impact of MS on outcomes in operative acute diverticulitis patients. METHODS: We analyzed the (2012-2015) NSQIP database. We identified acute diverticulitis patients who underwent surgery. MS was defined as follows: body mass index (BMI) >30 kg/m2, hypertension, and diabetes. Our primary outcome measure was the occurrence of any adverse events (complications, 30-d readmission, and mortality). Secondary outcome measures were complications, hospital length of stay, 30-d readmission, and mortality. Regression and receiver operating characteristic curve analysis was performed. RESULTS: A total of 4572 patients were identified. Mean BMI was 29 ± 10 kg/m2. 14.6% (275) of obese patients had metabolic syndrome. Adverse events were higher in patients with MS (odds ratio [OR], 8.1; P < 0.001) versus the obese group and the obese and hypertensive group. Patients with MS had higher odds of reintubation (OR 1.9; P = 0.03), >48 h ventilator dependence (OR 3.5; P = 0.01), myocardial infarction (OR 2.3; P = 0.03), and superficial or deep surgical-site infections (OR 2.1; P = 0.01) compared with patients with no MS. MS patients had a longer length of stay (ß = 1.23; P = 0.02), higher 30-d readmissions (OR 1.7; P < 0.01), and mortality (OR 2.1; P < 0.01). The area under the receiver operating characteristic curve of metabolic syndrome for predicting adverse outcomes was 0.797, which was higher than the area under the receiver operating characteristic curve for BMI (0.58), hypertension (0.51), or diabetes (0.64) alone. CONCLUSIONS: Adverse events in patients with MS after surgery for diverticulitis are higher than obesity, hypertension, or diabetes alone. Patients with MS have longer recovery, and higher rates of complications, readmissions, and mortality. LEVEL OF EVIDENCE: Level III Prognostic.


Assuntos
Colectomia/efeitos adversos , Colostomia/efeitos adversos , Doença Diverticular do Colo/cirurgia , Síndrome Metabólica/complicações , Complicações Pós-Operatórias/epidemiologia , Adulto , Índice de Massa Corporal , Colectomia/métodos , Colostomia/métodos , Feminino , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Medição de Risco
14.
Acta Chir Belg ; 120(1): 57-60, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30103665

RESUMO

Introduction: A parastomal hernia (PSH) is the most common complication of a stoma creation. The PSH contents normally consist of mobile abdominal structures, i.e. omentum and small or large bowel loops. A herniated stomach is thereby very rare, given that only eight cases are reported in the literature.Patients and methods: Two female patients with clinical symptoms of gastric involvement in a PSH were admitted in our centre.Results: Computed tomography (CT) imaging, nasogastric decompression and an efficient operative intervention ensured a good clinical outcome in both patients, but with a long hospital stay and temporary gastroparesis in one patient. Regarding our two cases and the eight cases reported in the literature, mainly older females with colostomies are at risk and most of them need surgery. Conclusions: In patients presenting with obstructive symptoms, one should be aware of a possible gastric outlet obstruction because of its involvement in a PSH, although sporadic. Surgery might be considered as the treatment of choice because conservative treatment mostly fails. Earlier surgery might perhaps also reduce postoperative hospital stay and gastroparesis.


Assuntos
Colostomia/efeitos adversos , Hérnia Incisional/diagnóstico por imagem , Hérnia Incisional/etiologia , Gastropatias/diagnóstico por imagem , Gastropatias/etiologia , Estomas Cirúrgicos/efeitos adversos , Idoso , Feminino , Humanos , Hérnia Incisional/cirurgia , Gastropatias/cirurgia , Tomografia Computadorizada por Raios X
15.
Int Wound J ; 17(1): 187-190, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31663272

RESUMO

Pyoderma gangrenosum is an uncommon ulcerative cutaneous lesion manifesting as rapidly progressing single or multiple skin ulcers. Permanent stoma in inflammatory bowel disease patients remains an independent risk of pyoderma gangrenosum. In the current report, we describe a case of pyoderma gangrenosum in a post-colostomy ulcerative colitis patient with chronic hepatitis B. Pyoderma gangrenosum began seemingly as peristomal dermatitis that rapidly developed into painful ulcerations with subsequent appearance of sterile pustules and ulcerations in the left lower leg. The patient significantly improved after active management with prednisolone, antiviral therapy with entecavir, and wound dressings. Our case suggests that physicians and surgeons should have a high index of suspicion of pyoderma gangrenosum in post-colostomy ulcerative colitis patients who develop peristomal dermatitis.


Assuntos
Antibacterianos/uso terapêutico , Colite Ulcerativa/cirurgia , Colostomia/efeitos adversos , Fístula Cutânea/complicações , Hepatite B Crônica/complicações , Pioderma Gangrenoso/tratamento farmacológico , Pioderma Gangrenoso/etiologia , Adulto , Fístula Cutânea/microbiologia , Humanos , Masculino , Resultado do Tratamento
16.
J Surg Res ; 246: 457-463, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31706537

RESUMO

BACKGROUND: Readmissions after colorectal operations adversely impact patient recovery and are associated with about $300 million in additional health care expenditure in the United States alone. The present study aimed to characterize nonelective, short-term readmissions of colorectal surgery patients who underwent colostomy. METHODS: The Nationwide Readmissions Database was used to identify patients who received a colostomy from 2010 to 2015. Patients were stratified by discharge-to-readmission interval: immediate (within 7 d) and delayed (7-30 d). Nonparametric trend analysis and multivariable regression were performed to identify predictors of immediate and delayed readmission. RESULTS: Of an estimated 376,693 operations requiring colostomies during the study, in-hospital survival was 92.3%, with higher rates after elective compared with nonelective operations (96.5 versus 90.8%, P < 0.001). Overall, 15.3% patients undergoing elective and nonelective colostomy creation returned to the hospital within 30 d, with 41.6% of these readmissions occurring by the first week of discharge (immediate). Readmission rates and proportion of immediate and delayed groups did not significantly change over the 6-year study period. Nonhome discharge increased the odds of immediate (AOR 1.25, 95% CI 1.17-1.34) and delayed readmission (AOR 1.44, 95% CI 1.35-1.54). Annually, immediate and delayed rehospitalizations after colostomy creation were responsible for $64 and 82 million in excess costs, respectively. CONCLUSIONS: Colostomy creation is associated with a steady and high rate of rehospitalization. Nonhome discharge, in addition to several patient comorbidities, is associated with higher odds of readmission. Programs aimed at reduction of immediate readmission are warranted.


Assuntos
Colostomia/efeitos adversos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Transferência de Pacientes/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologia
17.
J Pediatr Surg ; 55(1): 90-95, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31704044

RESUMO

INTRODUCTION: Gastrointestinal (GI) operations represent a significant proportion of the surgical site infection (SSI) burden in pediatric patients, resulting in significant morbidity. We have previously demonstrated that a GI bundle decreases SSI rates, length of stay (LOS), and hospital charges. Following this success, we hypothesized that by targeting the preoperative antibiotics for stoma closures based on organisms found in infected wounds, we could further decrease SSI rates. METHODS: As part of a broad quality improvement effort to reduce SSI rates, we reviewed the responsible pathogens and their sensitivities as well as the preoperative antibiotic used, and found that 15% of wound infections were caused by enterococcus. Based on this information, starting in April 2017, we changed the prior preoperative antibiotic cefoxitin to ampicillin-sulbactam, which more accurately targeted the prevalent pathogens from April 2017 to October 2018. RESULTS: The baseline SSI rate for all stoma takedown patients was 21.4% (25 of 119). After bundle implementation, this decreased to 7.9% (17 of 221; p = 0.03) over a period of 2.5 years. Then, after changing the preoperative antibiotics, our rate of SSI decreased further to 2.2% (1 of 44; p = 0.039) over a period of 1.5 years. CONCLUSION: Significant reduction of SSI in GI surgery can be accomplished with several prevention strategies (our GI bundle). Then a change of the preoperative antibiotic choice, chosen based on causative wound infection organisms, may further decrease SSI rates. We recommend an institution specific analysis of wound infections and modification of preoperative antibiotics if the responsible organisms are resistant to the original antibiotic choice. TYPE OF STUDY: Retrospective cohort study. LEVEL OF EVIDENCE: Level III.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Estomas Cirúrgicos/efeitos adversos , Infecção da Ferida Cirúrgica/prevenção & controle , Ampicilina/uso terapêutico , Criança , Colostomia/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Feminino , Humanos , Ileostomia/efeitos adversos , Tempo de Internação , Masculino , Pacotes de Assistência ao Paciente , Estudos Retrospectivos , Sulbactam/uso terapêutico , Infecção da Ferida Cirúrgica/microbiologia
18.
J Surg Res ; 247: 220-226, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31708198

RESUMO

BACKGROUND: Despite the increased adoption of minimally invasive techniques in colorectal surgery, an open resection with ostomy creation remains an accepted operation for perforated diverticulitis. In the United States, there is an increase in the rates of both morbid obesity and diverticular disease. Therefore, we wanted to explore whether outcomes for morbidly obese patients with diverticulitis are worse than nonmorbidly obese patients after open colectomy for diverticulitis. MATERIALS AND METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2015, we identified adults with emergent admission for diverticulitis (International Classification of Diseases, Ninth Revision, code 562.11) with evidence of preoperative sepsis and intraoperative contaminated/dirty wound classification, in which a resection with ostomy (Current Procedural Terminology codes 44141, 44143, or 44144) was performed. We excluded cases with age >90 y, ventilator dependence, evidence of disseminated cancer and missing sex, race, body mass index, functional status, American Society of Anesthesiologists class, length of stay (LOS), or operative time data. Morbid obesity was defined as body mass index >35 kg/m2. Risk variables of interest included age, sex, race, medical comorbidities, requirement for preoperative transfusion, preoperative sepsis, and operative time. Outcomes of interest included LOS, 30-d postoperative complications, and mortality. Univariate and propensity scores with postmatching analyses were performed. RESULTS: A total of 2019 patients met inclusion and exclusion criteria, of which 413 (20.5%) were morbidly obese. Morbidly obese patients tended to be younger (mean 57.2 versus 62.6 y) and female (54.5% versus 45.5%). Morbidly obese patients also had higher rates of insulin-dependent diabetes (8.0% versus 4.2%), hypertension (60.1% versus 51.3%), renal failure (3.4% versus 1.5%), and higher American Society of Anesthesiologists class (class 4: 23.5% versus 19.6% and class 5: 1.45% versus 0.87%). Morbidly obese patient had no increase in 30-d mortality or LOS, but they had higher rates of superficial wound infection (9.0% versus 5.8%; P = 0.0259), deep wound infection (4.4% versus 1.9%; P = 0.0073), acute renal failure (4.8% versus 2.4%; P = 0.0189), postoperative septic shock (17.7% versus 12.1%; P = 0.0040), and return to the operating room (11.1% versus 6.4%; P = 0.0015). We identified 397 morbidly obese patients well matched by propensity score to 397 nonmorbidly obese patients. Conditional logistic regression showed no difference in LOS (median 12.9 versus 12.4 d; P = 0.4648) and no increased risk of 30-d mortality (P = 0.947), but morbid obesity was an independent predictor for return to the operating room (adjusted odds ratio: 27.09 [95% confidence interval: 2.68-274.20]; P = 0.005). CONCLUSIONS: This analysis of a large national clinical database demonstrates that morbidly obese patients presenting with perforated diverticulitis undergoing a Hartmann's procedure do not have increased mortality or LOS compared with nonobese patients. After adjusting for the effects of morbid obesity, morbidly obese patients had increased risk of return to operating room. Despite literature describing the many perioperative risks of obesity, our analysis showed only increased reoperation for obese patients with diverticulitis.


Assuntos
Colostomia/efeitos adversos , Doença Diverticular do Colo/cirurgia , Perfuração Intestinal/cirurgia , Obesidade Mórbida/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Sepse/cirurgia , Adulto , Idoso , Índice de Massa Corporal , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/mortalidade , Feminino , Humanos , Perfuração Intestinal/etiologia , Perfuração Intestinal/mortalidade , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Período Perioperatório/mortalidade , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Sepse/etiologia , Sepse/mortalidade , Resultado do Tratamento , Estados Unidos/epidemiologia
19.
Rev Gastroenterol Peru ; 39(3): 215-221, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31688844

RESUMO

The surgical treatment of colorectal pathology can often lead to the need for a stoma, either colostomy or ileostomy. This surgery is associated with a high rate of complications. OBJECTIVE: The objective of this study is to describe the frequency of stomas complications, identify associated risk factors as well as new prevention strategies. MATERIALS AND METHODS: Prospective observational cohort study on patients who underwent an ileostomy or colostomy at the Hospital U. Infanta Leonor between April 2016 and October 2017. RESULTS: A total of 87 stomas were performed in 83 patients, of which 77.01% had at least one complication. The most presented complication was dermatitis (54.02%), followed by detachment (40.23%) and flat stoma (21.84%). The greatest number of complications occurred in the second week of the postoperative period. The average height of the stomas made was 10.6 mm. BMI was associated as a risk factor for the development of stoma complications. Of all the patients, 55 had follow-up until 6 months. CONCLUSION: Although our complication rate is high, this outcome is similar to others studies previously published. BMI was the unique risk factor associated with the development of stoma complications. New strategies related to the surgical technique can be developed to decrease our complication rate.


Assuntos
Colostomia/efeitos adversos , Ileostomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Fatores de Risco
20.
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
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