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1.
Metas enferm ; 23(10): 17-20, dic.-ene. 2021. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-ET2-7573

RESUMO

OBJETIVO: determinar la resistencia a la degradación en solución salina de diversos anillos moldeables para ostomía, así como comprobar si existen diferencias estadísticamente significativas entre la resistencia a la degradación de los anillos moldeables de Coloplast (Col-2 y Col-4,2) con respecto a dos anillos moldeables comerciales de otros fabricantes (Fab1 y Fab2). MÉTODOS: el material objeto de ensayo consiste en cuatro modelos de anillos moldeables: Col-2 de 2 mm de espesor, Col-4,2 de 4,2 mm de espesor, Fab1 y Fab2 de espesor 4 mm. El tamaño de la muestra de ensayo fue de 10 unidades por tipo de sistema. Los ensayos fueron realizados en el laboratorio de ensayos del Instituto de Biomecánica de Valencia, utilizando una máquina universal de ensayos INSTRON8874/511, con unas condiciones ambientales de temperatura (23 ºC) y de humedad (56%). RESULTADOS: el análisis estadístico de los resultados revela diferencias estadísticamente significativas (p< 0,001) entre las muestras pertenecientes a Coloplast (Col-2= 1,84 N y Col-4,2 = 1,97 N) con las muestras de los fabricantes 1 y 2 (Fab1= 0,90 N y Fab2= 0,92 N). No se observan diferencias estadísticamente significativas entre las dos muestras de Coloplast (p= 0,706) ni entre las dos muestras de los otros dos fabricantes (p= 0,917). CONCLUSIÓN: las dos muestras de Coloplast presentan valores de fuerza de penetración significativamente mayores (dos veces superiores) que las muestras de los otros dos fabricantes y, por tanto, una mayor resistencia a la degradación a las seis horas de estar sumergida en un suero salino. Sin embargo, no se observan diferencias estadísticamente significativas en la resistencia a la degradación entre las dos muestras de Coloplast a pesar de ser anillos de diferente grosor. Este efecto se debe a que las mediciones se han realizado con penetraciones de 1 mm


OBJECTIVE: to determine the resistance to degradation in saline solution for different moldable rings for ostomy, as well to confirm if there are any statistically differences between the resistance to degradation in Coloplast moldable rings (Col-2 and Col-4.2) vs. two moldable rings marketed by other manufacturers (Fab1 and Fab2). METHODS: the material object of the trial consisted in four models of moldable rings: Col-2 with 2 mm thickness, Col-4.2 with 4.2 mm thickness, and Fab1 & Fab2 4 mm thickness. The trial sample size was 10 units per type of system. The trials were conducted at the testing laboratory of the Biomechanical Institute, Valencia, using a universal testing machine INSTRON8874/511, under environmental conditions of temperature (23 ºC) and humidity (56%). RESULTS: the statistical analysis of results revealed statistically significant differences (p< 0.001) between the Coloplast samples (Col-2= 1.84 N and Col-4.2 = 1.97 N) and the samples from manufacturers 1 and 2 (Fab1= 0.90 N and Fab2= 0.92 N). No statistically significant differences were observed between the two Coloplast samples (p= 0.706) or between the two samples from the other two manufacturers (p= 0.917). CONCLUSION: the two Coloplast samples presented significantly higher penetration strength values (twice higher) than the samples from the other two manufacturers; and therefore, higher resistance to degradation at six hours of being immersed in saline. However, no statistically significant differences were observed in terms of resistance to degradation between both Coloplast samples, regardless of the different thickness of the rings. This effect was due to measurements being conducted with 1mm penetrations


Assuntos
Humanos , Estomia/métodos , Fenômenos Biomecânicos , Estomas Cirúrgicos , Ensaios Clínicos como Assunto , Solução Salina , Estomia/enfermagem , Análise de Variância , Colostomia/métodos
2.
Rev Col Bras Cir ; 48: e20202644, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33503140

RESUMO

OBJECTIVE: to establish the epidemiological profile of ostomized patients treated at the Health Care Service for Ostomy Patients in Juiz de Fora and region (SASPO/JF) and to quantify the pathologies that led to the stoma as well as the ostomy-related complications. METHOD: a retrospective study was carried out with the analysis of 496 medical records of patients registered at HCSOP/JF over 30 years and who remained in at the service in June 2018. The following variables were considered: age, sex, pathology that led to the stoma, type, time, location and complications of stomas. RESULTS: 53.43% were male patients and 46.57% female. The average age was 56.24 years among men and 58.40 years among women. Eight patients had two types of ostomies simultaneously and a total of 504 ostomies were as follows: 340 colostomies (67.46%), 117 ileostomies (23.21%) and 47 urostomies (9.33%). Additionally, 47.65% of the colostomies and 76.92% of the ileostomies were temporary, while all urostomies were permanent. In 70.24% of cases, the reason for making the stoma was malignancy. There were 277 stomas with one or more complications (54.96%). CONCLUSIONS: most of the ostomized patients were over 50 years old and the main diagnosis that led to the stoma was malignancy. Ileostomies had a higher percentage of complications than colostomies and urostomies and, for all types of stomas, the most frequent complication was dermatitis.


Assuntos
Neoplasias do Colo/cirurgia , Neoplasias Colorretais/cirurgia , Assistência à Saúde/estatística & dados numéricos , Estomia/métodos , Estomia/estatística & dados numéricos , Adulto , Idoso , Cirurgia Colorretal , Colostomia/métodos , Colostomia/estatística & dados numéricos , Feminino , Humanos , Ileostomia/métodos , Ileostomia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
Ann R Coll Surg Engl ; 102(9): 654-662, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32777932

RESUMO

INTRODUCTION: The aim of this systematic review was to appraise the current literature on the use of percutaneous endoscopic colostomy (PEC) as an alternative to major surgery and endoscopic decompression alone for treating sigmoid volvulus in frail, comorbid patients. METHODS: A systematic literature search of literature published between April 2000 and January 2017 was carried out using the MEDLINE®, Embase™ and CINAHL® (Cumulative Index to Nursing and Allied Health Literature) databases. The search terms were "percutaneous endoscopic colostomy", "PEC", "sigmoidopexy", "sigmoidostomy" and "sigmoid volvulus". The studies identified were screened and those that did not fulfil the inclusion criteria were excluded. FINDINGS: Seven observational studies and seven case reports (comprising eighty-one patients) were found to match our inclusion criteria. All patients had recurrent sigmoid volvulus and were treated with PEC either with a single PEC tube or with two PEC tubes inserted. Sigmoid volvulus recurred in 10 of the 81 patients; 3 of these individuals developed recurrence with PEC tubes in situ and 7 following tube removal. There were seven deaths after the procedure. The most frequent morbidity associated with PEC tube insertion was site infection (n=6). CONCLUSIONS: Our systematic review highlights the use of PEC as an alternative in managing recurrent sigmoid volvulus in frail, comorbid patients unfit for or refusing surgery, with the best outcomes seen in those patients where two PEC tubes were inserted and remained in situ indefinitely. Further studies are needed to improve the safety and efficacy of the procedure as well as post-procedure care.


Assuntos
Colostomia , Volvo Intestinal/cirurgia , Doenças do Colo Sigmoide/cirurgia , Sigmoidoscopia , Colo Sigmoide/cirurgia , Colostomia/métodos , Humanos , Sigmoidoscopia/métodos
4.
Rev. cir. (Impr.) ; 72(4): 347-349, ago. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1138721

RESUMO

Resumen Introducción: Los hongos dematiáceos se caracterizan por la presencia de abundante melanina en su pared celular. Presentan una distribución mundial, siendo más comunes en climas tropicales y subtropicales. Producen infecciones cutáneas y subcutáneas, además de enfermedades alérgicas, neumonías, abscesos cerebrales o infecciones diseminadas. Caso Clínico: Presentamos el caso de un paciente con adenocarcinoma de recto intervenido quirúrgicamente con hallazgo incidental de divertículo de Meckel y en el cual en el estudio anatomopatológico reveló la presencia de un hongo dematiáceo


Introduction: Dematiaceous fungi are characterized by the presence of brown melanine or melanine like pigments in their cell wall. They are generally distributed worldwide, being more common in tropical and subtropical climates. The clinical syndromes are often cutaneous and subcutaneous infections, but can be also responsible of allergic diseases, pneumonias, cerebral abscesses or disseminated infections. Clinical Case: We present the case of a patient with a diagnosis of rectal adenocarcinoma intervening surgically and with an incidental finding of Meckel's Diverticulum. The anatomopathological study revealed the presence of a dematiaceous fungi.


Assuntos
Humanos , Masculino , Idoso , Diverticulite/cirurgia , Alternaria/patogenicidade , Divertículo Ileal/cirurgia , Colostomia/métodos
5.
Cir. pediátr ; 33(3): 146-148, jul. 2020.
Artigo em Espanhol | IBECS | ID: ibc-193558

RESUMO

INTRODUCCIÓN: La bolsa colónica congénita (BCC) es una malformación poco común en la que se produce una dilatación variable del colon asociada a malformación anorrectal (MAR); generalmente presenta una fístula hacia el tracto genitourinario. CASO CLÍNICO: Paciente femenino de 2 días de vida, sin antecedentes médicos de relevancia, presenta distensión abdominal y ano imperforado. Es sometida a colostomía, presenta evolución irregular con débitos altos a través de la colostomía, se realizan estudios contrastados de imagen donde se observa exteriorización errónea de asa de yeyuno, se somete a laparotomía exploratoria donde se comprueba lo descrito y además se reporta como hallazgo incidental agenesia colónica con desembocadura del íleon en una bolsa de 6 cm de diámetro que se conecta con la vejiga. DISCUSIÓN: La BCC es una patología común en ciertos países orientales y extremadamente rara en países occidentales; en Ecuador no se encontraron registros de casos reportados. Se debe realizar un correcto análisis prequirúrgico de los pacientes con MAR para conseguir una adecuada planificación y abordaje quirúrgico, disminuyendo con ello la morbimortalidad en el paciente


INTRODUCTION: Congenital pouch colon (CPC) is a rare malformation. It causes variable dilatation of the colon associated with anorectal malformation (ARM), usually presenting a fistula towards the genitourinary tract. CLINICAL CASE: 2-day-old female patient, with no relevant medical history. She had abdominal distension and imperforate anus. She underwent colostomy. She had an irregular evolution with high colostomy debits. Contrast imaging studies were performed, which demonstrated an erroneous exteriorization of the jejunal loop. She underwent an exploratory open surgery, which confirmed the previous diagnosis and incidentally found colonic agenesis, with ileum entering in a pouch of 6 cm of diameter that connects with the bladder. DISCUSSION: CPC is a common pathology in certain eastern countries and extremely rare in western countries. In Ecuador, no records of reported cases were found. A correct pre-surgical analysis of ARM patients should be carried out to achieve an adequate planning and surgical approach, thus reducing morbidity and mortality


Assuntos
Humanos , Feminino , Recém-Nascido , Colo/anormalidades , Colo/cirurgia , Parede Abdominal/cirurgia , Colostomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fístula Intestinal/cirurgia , Radiografia Abdominal
6.
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
7.
JSLS ; 24(2)2020.
Artigo em Inglês | MEDLINE | ID: mdl-32273670

RESUMO

Background and Objectives: In patients with obstructing rectal cancers who require intestinal diversion before neoadjuvant therapy, minimizing diversion-related recovery and instituting early chemoradiation are critical to optimizing outcomes. Methods: A novel, simple, safe, and inexpensive technique was developed for single-port laparoscopic diverting sigmoid loop colostomy in a low-resource environment. Results: Ten consecutive patients with locally advanced rectal cancer underwent single-port, diverting sigmoid loop colostomy using a novel application of the EK glove port. Operative time averaged 59.5 min (range 40-75 min). There were no conversions to multiport laparoscopy or open surgery. There were no intraoperative or early postoperative surgical complications. All patients started chemoradiation therapy within 1 week of diverting colostomy. No surgical reinterventions were required. Conclusion: Single-port laparoscopic diverting sigmoid loop colostomy utilizing an EK glove port is a novel, technically simple, safe, and cost-effective procedure, especially applicable to patients with obstructing rectal cancer who receive care in a low resource environment.


Assuntos
Colo Sigmoide/cirurgia , Colostomia/métodos , Laparoscopia/métodos , Neoplasias Retais/cirurgia , Adulto , Idoso , Feminino , Luvas Cirúrgicas , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Neoplasias Retais/patologia
8.
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
9.
J Laparoendosc Adv Surg Tech A ; 30(6): 701-705, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32216702

RESUMO

Introduction: One-stage anorectoplasty provides maximum potential for "normal" defecation reflexes right at birth and avoids complications and problems of colostomy. One-stage laparoscopic anorectoplasty (OSLARP) for rectourinary fistula (RUF) is restricted by distended bowel obscuring the working space for laparoscopy. This study describes transperineal intracath meconiolysis and evacuation (TIME) technique for OSLARP in the treatment of RUF in neonates. Materials and Technique: High male anorectal malformation (ARM) admitted from January 2016 to March 2019 were included in the study. Diagnosis of level of ARM was made on the basis of invertogram. Patient presenting with lethal comorbidities were excluded who underwent colostomy. The technique involved placement of a 16G intracath in the perineum through the site of future neo-anus, which was identified using muscle stimulator. Meconiolysis and evacuation was done using warm saline and 2% N-acetyl. The creation of enough abdominal space was achieved after evacuation and two working instruments were placed in paraumbilical positions. The laparoscopic dissection and division of fistula was done as followed in standard laparoscopic anorectoplasty. Results: Seventeen patients were selected for TIME technique but on laparoscopy 2 patients had severe necrotizing enterocolitis hence they underwent laparoscopy-assisted high sigmoid colostomy. Fifteen patients underwent OSLARP successfully. Mean weight was 2.5 ± 0.4 kg, mean gestational age was 36 ± 5 weeks, and mean age of presentation was 3.5 ± 1 days after birth. The TIME technique was successful decompressing bowel in all the patients. Out of 15 patients of OSLARP, 14 had rectoprostatic urethral fistula and 1 had rectovesical fistula. Mean total operative duration of OSLARP was 46 ± 15 minutes. Patients who could be followed for 3 years had good results in terms of continence and bowel movements. Discussion: TIME technique is a very simple and effective way to overcome the problem of associated colonic distention in neonatal one-stage laparoscopic anoplasty.


Assuntos
Canal Anal/cirurgia , Malformações Anorretais/cirurgia , Colostomia/métodos , Laparoscopia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reto/cirurgia , Malformações Anorretais/fisiopatologia , Defecação , Humanos , Recém-Nascido , Masculino , Estudos Retrospectivos
10.
Surg Today ; 50(8): 855-862, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31950257

RESUMO

PURPOSE: We analyzed the morbidity and mortality associated with Hartmann's reversal (HR) and the risk factors for major complications and mortality. METHODS: The subjects of this retrospective study were patients who underwent HR in a high-volume center. We evaluated complications as categorical variables using univariate analyses. RESULTS: Between 2003 and 2018, 199 patients underwent HR at our hospital [56.5 years; body mass index (BMI): 26.3 kg/m2; American Society of Anesthesiology score (ASA) 3: 7.5%; 36.2% had hernias]. The mean time to HR was 20.2 months and the mean operation time was 302 min. The anastomosis was stapled in 71.4% and was performed in the low/medium rectum in 21.6%. Midline hernias were repaired with mesh in 80.1%. The mean hospitalization period was 10.1 days. Surgical site infection (SSI) developed in 27.1% of the patients, 94.4% of whom were treated at the bedside. BMI was a risk factor for SSI (27.8 vs. 25.6; p = 0.047). Major complications (Clavien-Dindo III-V) developed in 27 patients (13.5%), including anastomosis dehiscence in 2.5%. ASA, BMI, age, hernia repair, and rectal stump size were not associated with major complications. The mortality rate was 2.5%. An ASA of 3 was associated with high mortality (p = 0.03). CONCLUSION: Hartmann's reversal remains challenging but can have low complication and mortality rates if performed on selected patients in a reference center. An ASA of 3 was the only predictor of mortality.


Assuntos
Colostomia/métodos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Colostomia/mortalidade , Feminino , Hospitais/estatística & dados numéricos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Seleção de Pacientes , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Deiscência da Ferida Operatória/epidemiologia , Deiscência da Ferida Operatória/etiologia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Adulto Jovem
11.
J Cancer Educ ; 35(2): 301-311, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-30685831

RESUMO

The purpose of this research was to examine the effects of continuous care model of information-based hospital-family integration on colostomy patients. Miles' operation is a major operative method for treating low rectal cancer, and this operation results in a permanent colostomy. It is difficult for patients to adapt to their colostomy. Previous studies have applied generally conventional nursing models to colostomy patients. This was a single-blind randomized controlled trial study. The sample of 155 patients who met the inclusion criteria was randomly assigned to either the experimental (n = 81) or control group (n = 74). The control group was provided with a routine standard of care. The experimental group was provided with an experimental treatment that consisted of an information-based (WeChat, blog, QQ, telephone, etc.) hospital-family integration continuous care model. Study variables were collected and instruments were selected as follows: basic information, State-Trait Anxiety Inventory (STAI), a self-efficacy scale, a colostomy complication assessment table, a quality of life scale, and a table of the degree of satisfaction. No statistically significant differences were found in demographic information between the experimental and control groups. In comparison with the control group, subjects in the experimental group had less anxiety and could better cope with anxiety, had a better self-efficacy and quality of life scores, and had fewer complications. The patients in the experimental group were shown to be more satisfied with the care model. In addition, the most useful and popular service is the online social tools WeChat and QQ, because they can communicate with video, and they are more real-time, efficient, and cheap. The continuous care model of information-based hospital-family integration significantly strengthened patients' self-efficacy and confidence, which decreased colostomy complications, ultimately improving the quality of life.


Assuntos
Adaptação Psicológica , Colostomia/métodos , Continuidade da Assistência ao Paciente/normas , Família/psicologia , Hospitais/normas , Qualidade de Vida , Autoeficácia , Feminino , Sistemas de Informação Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Telefone
12.
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
13.
J Surg Oncol ; 121(5): 718-729, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31777095

RESUMO

BACKGROUND AND OBJECTIVES: The primary treatment for locally advanced cases of cervical cancer is chemoradiation followed by high-dose brachytherapy. When this treatment fails, pelvic exenteration (PE) is an option in some cases. This study aimed to develop recommendations for the best management of patients with cervical cancer undergoing salvage PE. METHODS: A questionnaire was administered to all members of the Brazilian Society of Surgical Oncology. Of them, 68 surgeons participated in the study and were divided into 10 working groups. A literature review of studies retrieved from the National Library of Medicine database was carried out on topics chosen by the participants. These topics were indications for curative and palliative PE, preoperative and intraoperative evaluation of tumor resectability, access routes and surgical techniques, PE classification, urinary, vaginal, intestinal, and pelvic floor reconstructions, and postoperative follow-up. To define the level of evidence and strength of each recommendation, an adapted version of the Infectious Diseases Society of America Health Service rating system was used. RESULTS: Most conducts and management strategies reviewed were strongly recommended by the participants. CONCLUSIONS: Guidelines outlining strategies for PE in the treatment of persistent or relapsed cervical cancer were developed and are based on the best evidence available in the literature.


Assuntos
Exenteração Pélvica/normas , Neoplasias do Colo do Útero/cirurgia , Anastomose Cirúrgica , Brasil , Colostomia/métodos , Diagnóstico por Imagem , Drenagem , Feminino , Humanos , Laparoscopia , Excisão de Linfonodo , Avaliação Nutricional , Estomia , Cuidados Paliativos , Diafragma da Pelve/cirurgia , Lavagem Peritoneal , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Sociedades Médicas , Retalhos Cirúrgicos , Cateteres Urinários , Coletores de Urina , Vagina/cirurgia , Gravação em Vídeo
14.
Int Braz J Urol ; 46(1): 108-115, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31851467

RESUMO

OBJECTIVE: Cystectomy with urinary diversion is the gold standard for muscle invasive bladder cancer. It also may be performed as part of pelvic exenteration for non-urologic malignancy, neurogenic bladder dysfunction, and chronic conditions that result in a non-functional bladder (e.g., interstitial cystitis, radiation cystitis). Our objective is to describe the surgical technique of urinary diversion using large intestine as a conduit whilst creating an end colostomy, thereby avoiding a primary bowel anastomosis and to show its applicability with respect to urologic conditions. MATERIALS AND METHODS: We retrospectively reviewed five cases from a single institution that utilized the described method of urinary diversion with large intestine. We describe operative times, hospital length of stay (LOS), and describe post-operative complications. RESULTS: Five patients with a variety of urologic and oncologic pathology underwent the described procedures. Their operative times ranged from 5 hours to 11 hours and one patient experienced a Clavien III complication. CONCLUSION: We describe five patients who underwent this procedure for various medical indications, and describe their outcomes, and believe dual diversion of urinary and gastrointestinal systems with colon as a urinary conduit to be an excellent surgical option for the appropriate surgical candidate.


Assuntos
Colo Sigmoide/cirurgia , Colostomia/métodos , Derivação Urinária/métodos , Adulto , Anastomose Cirúrgica , Cistectomia/métodos , Humanos , Tempo de Internação , Masculino , Ilustração Médica , Pessoa de Meia-Idade , Duração da Cirurgia , Reprodutibilidade dos Testes , Resultado do Tratamento , Doenças da Bexiga Urinária/cirurgia
15.
Clin Ter ; 170(1): e1-e6, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31850476

RESUMO

Anorectal avulsion is an exceptional rectal trauma. In this kind of lesions, the anus and the sphincter no longer join the perineum and are pulled upward. We present a case of 34-years-old patient who was admitted because of a pelvic-perineal trauma, presenting a partial anorectal avulsion, exposed femoral fracture with thigh's lacerated-contused wound. Our treatment included primary plastic of the internal anal sphincter with replanting of the rectum on the anal canal and a diverting loop sigmoid colostomy (SCS), so as to prevent sepsis. Closure of the protective SCS was performed four months after the trauma.


Assuntos
Canal Anal/lesões , Canal Anal/cirurgia , Malformações Anorretais/cirurgia , Períneo/fisiopatologia , Reto/lesões , Reto/cirurgia , Doenças do Colo Sigmoide/cirurgia , Adulto , Malformações Anorretais/diagnóstico , Colostomia/métodos , Humanos , Masculino , Roma , Resultado do Tratamento
16.
J Surg Res ; 247: 251-257, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31780053

RESUMO

BACKGROUND: After traumatic injury, primary anastomosis after colon resection has overtaken ostomy diversion. Improved technology facilitating primary anastomosis speed and integrity may have driven this change. Trends in ostomy versus anastomosis have yet to be quantified, and recent literature comparing outcomes is incomplete. METHODS: The National Trauma Databank (2007-2014) was queried for all blunt colon injuries requiring resection. Patients were dichotomized into study groups based on whether they underwent ostomy creation. Ostomy creation frequency was compared over time. After subgrouping patients by colon injury location, multivariate regression adjusted for baseline characteristics and evaluated the impact of ostomy on clinical outcomes. RESULTS: A total of 13,949 colon injuries requiring colectomy were identified. Ostomy frequency did not vary by study year (P = 0.536). Univariate analysis showed that patients undergoing ostomy were older (median, 40 versus 32; P < 0.001) and more often had comorbidities (65% versus 56%; P < 0.001). Multivariate analysis showed that ostomy creation was significantly associated with lower mortality after sigmoid colon injury (odds ratio, 0.512; P = 0.011) and higher rates of unplanned reoperation after transverse colon injury (odds ratio, 3.135; P = 0.048). Across all colon injuries, ostomies were significantly associated with longer hospital length of stay, intensive care unit length of stay, and ventilator days. CONCLUSIONS: Ostomy creation for colonic injury has reached an equilibrium trough. The impact of ostomy creation varies by not only clinical outcome but also injury location. Further study is needed to define the optimal surgical management for blunt colon injuries requiring resection.


Assuntos
Colectomia/tendências , Colo/lesões , Doenças do Colo/cirurgia , Colostomia/tendências , Ferimentos não Penetrantes/cirurgia , Adulto , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/estatística & dados numéricos , Anastomose Cirúrgica/tendências , Colectomia/métodos , Colectomia/estatística & dados numéricos , Colo/cirurgia , Colostomia/métodos , Colostomia/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Sistema de Registros/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Reoperação/tendências , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
17.
Ann Ital Chir ; 90: 432-441, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31814600

RESUMO

BACKGROUND: The treatment of acute diverticulitis is a matter of debate and has undergone significant changes. Currently the main focus of surgical treatment is a more conservative and less invasive management. AIMS AND METHODS: To focus the role of surgery in the treatment of acute diverticulitis, the Authors have conducted a review of the literature of the last two decades and have revised critically their own experience. RESULTS: The indications for elective surgery based on the number of episodes, the young age at diagnosis and the presence of risk factors such as immunosuppression, have to be overcome in favour of a more individual approach based on the severity of the disease. Similarly the presence of pneumoperitoneum is no longer a compelling indication for urgent surgery just as it was in the past. In the treatment of complicated diverticulitis with abscess (Hinchey I-II) is used more and more conservative treatments consisting of guided percutaneous drainage combined with antibiotics. Resection with primary anastomosis with or without diverting ileostomy is preferable to Hartmann's procedure in case of perforated diverticulitis with peritonitis (Hinchey III-IV), using the latter only in the case of comorbidities, severe sepsis, hemodynamic instability or longtime feculent peritonitis (Hinchey IV). Recently, laparoscopic peritoneal lavage was introduced in the treatment of diverticulitis. CONCLUSIONS: Thanks to the progress made in conservative and interventional treatment and laparoscopic surgery, an increasingly less invasive treatment is proposed in the management of acute diverticulitis. KEY WORDS: Acute diverticulitis, Laparoscopic surgery, Surgical treatment.


Assuntos
Diverticulite/cirurgia , Abscesso Abdominal/tratamento farmacológico , Abscesso Abdominal/etiologia , Abscesso Abdominal/cirurgia , Doença Aguda , Idade de Início , Anastomose Cirúrgica/métodos , Antibacterianos/uso terapêutico , Colectomia , Colostomia/métodos , Terapia Combinada , Diverticulite/complicações , Diverticulite/tratamento farmacológico , Diverticulite/epidemiologia , Drenagem , Procedimentos Cirúrgicos Eletivos , Humanos , Hospedeiro Imunocomprometido , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Laparoscopia/métodos , Estudos Multicêntricos como Assunto , Peritonite/tratamento farmacológico , Peritonite/etiologia , Pneumoperitônio/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Fatores de Risco , Irrigação Terapêutica
18.
Rev. argent. coloproctología ; 30(4): 104-113, dic. 2019. ilus, tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1096799

RESUMO

Introducción: Los pacientes que se presentan con cuadros de peritonitis de origen diverticular (estadios Hinchey III o IV) en un contexto de sepsis severa con inestabilidad hemodinámica (shock séptico) la realización de anastomosis primaria presenta una alta tasa de dehiscencia anastomótica y mortalidad operatoria, aconsejándose la realización de una resección y abocamiento a la manera de Hartmann. Sin embargo, la alta tasa de complicaciones relacionadas a la confección del ostoma, la complejidad de la cirugía de restauración del tránsito intestinal, asociado a que entre el 40 % y el 60 % de los Hartmann no se reconstruyen, ha estimulado a que se intenten otras variables de resolución para esta compleja y grave patología. Diversas publicaciones en los últimos años han propuesto la táctica de "cirugía del control del daño" con el objeto de disminuir la morbimortalidad de estos gravísimos cuadros sépticos y a su vez reducir la tasa de ostomías. El objetivo de este trabajo es presentar nuestra experiencia inicial con esta modalidad de manejo de la peritonitis diverticular Hinchey III/IV sepsis severa e inestabilidad hemodinámica (shock séptico) y realizar una revisión bibliográfica del tema. Material y método: Estudio observacional, descriptivo, de series de casos. Entre noviembre de 2015 y diciembre de 2016. Servicio de coloproctología del complejo médico hospitalario Churruca-Visca de la ciudad de Buenos Aires y práctica privada de los autores. Se utilizó la técnica de laparotomía abreviada y cierre temporal del abdomen mediante un sistema de presión negativa. Resultados: En el periodo descripto se operaron 17 pacientes con peritonitis generalizada purulenta o fecal de origen diverticular. Catorce casos fueron Hinchey III (82,36%) y 3 casos Hinchey IV (17,64%). En 3 casos se observó inestabilidad hemodinámica en el preoperatorio o intraoperatorio. Todos ellos correspondientes al estadio IV de Hinchey. Se describen los 3 casos tratados mediante esta táctica quirúrgica. Discusión: La alta tasa de morbimortalidad de este subgrupo de pacientes incentivó a diversos grupos quirúrgicos a implementar la técnica de control del daño, permitiendo de esta manera estabilizar a los pacientes hemodinámicamente y en un segundo tiempo evaluar la reconstrucción del tránsito intestinal. En concordancia con estas publicaciones, dos de nuestros pacientes operados con esta estrategia, pudieron ser anastomosados luego del segundo lavado abdominal. Conclusión: En pacientes con peritonitis diverticular severa asociado a shock séptico el concepto de laparotomía abreviada con control inicial del foco séptico, cierre temporal del abdomen con sistema de presión negativa y posterior evaluación de la reconstrucción del tránsito intestinal, es muy alentador. Permitiendo una disminución de la morbimortalidad como así también del número de ostomías. (AU)


Introduction: Patients presenting with diverticular peritonitis (Hinchey III or IV stages) in a context of severe sepsis with hemodynamic instability (septic shock), performing primary anastomosis has a high rate of dehiscence anastomotic and operative mortality, advising the realization of a resection and ostoma in the manner of Hartmann. However, the high rate of complications related to performing of ostoma, the complexity of intestinal transit restoration surgery, associated with the 40% to 60% of Hartmann reversal not performed, has encouraged other variables to be attempted resolution for this complex and serious pathology. Several publications in recent years have proposed the tactic of "damage control surgery" in order to reduce the morbidity of these serious septic charts while reducing the rate of ostomies. The objective of this study is to present our initial experience with this modality of management of the diverticular peritonitis Hinchey III/IV severe sepsis and hemodynamic instability (septic shock) and to carry out a bibliographic review of the subject. Material and method: Observational, descriptive study of case series. Between November 2015 and December 2016. Coloproctology service of the Churruca-Visca hospital medical complex in the city of Buenos Aires and private practice of the authors. The technique of abbreviated laparotomy and temporary closure of the abdomen was used by a negative pressure system. Results: In the period described, 17 patients with generalized purulent or fecal peritonitis of diverticular origin were operated. Fourteen cases were Hinchey III (82.36%) and 3 cases Hinchey IV (17.64%).In 3 cases, hemodynamic instability was observed in the preoperative or intraoperative period. all of them corresponding to Hinchey's Stage IV. The 3 cases treated using this surgical tactic are described. Discussion: The high morbidity rate of this subgroup of patients encouraged various surgical groups to implement the damage control technique, thus allowing patients to stabilize hemodynamically and in a second time evaluate reconstruction intestinal transit. In line with these publications, two of our patients operated on with this strategy could be anastomosated after the second abdominal wash. Conclusion: In patients with severe diverticular peritonitis associated with septic shock, the concept of abbreviated laparotomy with initial control of the septic focus, temporary closure of the abdomen with negative pressure system and subsequent evaluation of transit reconstruction intestinal, it's encouraging. Allowing a decrease in morbidity as well as the number of ostomies. (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Peritonite/cirurgia , Choque Séptico , Doença Diverticular do Colo/cirurgia , Tratamento de Ferimentos com Pressão Negativa , Laparotomia/métodos , Peritonite/etiologia , Reoperação , Lavagem Peritoneal , Colostomia/métodos , Colostomia/mortalidade , Doença Aguda , Epidemiologia Descritiva , Sepse , Doença Diverticular do Colo/complicações , Técnicas de Fechamento de Ferimentos Abdominais , Laparotomia/mortalidade
19.
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
20.
Wounds ; 31(11): 285-291, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31730510

RESUMO

BACKGROUND: Isolation of the enteroatmospheric fistula (EAF) opening and prevention of contamination of the rest of the wound by effluent are important factors in the management of EAF. OBJECTIVE: The aim of this study is to describe an easily reproducible technique for effluent control in patients with EAF. MATERIALS AND METHODS: A retrospective analysis was conducted on all patients who underwent the present technique between 2013 and 2015. The surgical technique included condom-EAF anastomosis, fistula ring creation, negative pressure wound therapy (NPWT), and adaptation of an ostomy bag. RESULTS: A total of 7 patients with a Björck grade 4 abdomen were included. All fistulas were located in the small bowel with a median number of 2 EAFs (range, 2-3) in each patient, and the majority had moderate output volume. The mean number of NPWT changes was 10 (range, 5-18), the mean time of NPWT use was 75.7 days (range, 60-120 days), and the mean length of stay was 108.2 days (range, 103-160 days). The mean time of ostomy formation to restitution of bowel continuity was 14.3 months (range, 8-20 months). Open anterior component separation was employed in all cases for closure of the abdominal wall. No mortality, ventral herniation, or refistulization was registered in the study. The mean follow-up time was 8.5 months (range, 6-12 months). CONCLUSIONS: This is an easily reproducible and safe technique for effluent control in patients with Björk grade 4 abdomen with established EAF.


Assuntos
Cavidade Abdominal/cirurgia , Técnicas de Fechamento de Ferimentos Abdominais , Enterostomia/métodos , Fístula Intestinal/cirurgia , Cicatrização/fisiologia , Adulto , Idoso , Colostomia/métodos , Feminino , Humanos , Fístula Intestinal/fisiopatologia , Masculino , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa , Estudos Retrospectivos , Estomas Cirúrgicos/fisiologia , Técnicas de Sutura , Resultado do Tratamento
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