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1.
Orv Hetil ; 161(51): 2146-2152, 2020 12 20.
Artigo em Húngaro | MEDLINE | ID: mdl-33346743

RESUMO

Összefoglaló. Bevezetés: A vastagbél-diverticulosis a lakosság kb. 60%-át érinti, incidenciája folyamatosan növekszik. A betegek 6%-ánál van szükség sebészi beavatkozásra. Jelenleg nincs egységes irányelv, mikor indokolt elektív mutétet végezni. Módszer: Retrospektív módszerrel elemeztük az osztályunkon 2017. július 17. és 2020. április 30. között vastagbél-diverticulosis miatt operált betegek demográfiai és mutéti adatait, emellett a szövodmények arányát. Összehasonlítottuk az elektív (EM) és a sürgos mutétek (SM), illetve a nyitott és a laparoszkópos mutétek adatait. Eredmények: 38 operált beteg közül 19-nél történt EM, illetve 19 betegnél SM. A betegek átlagéletkora az EM-eknél 64 év, az SM-ek esetében 67 év volt. EM-nél az indikáció 12 esetben recidiváló diverticulitis, 5 esetben colovesicalis, 2 esetben colovaginalis sipoly volt. SM-nél az indikáció 17 esetben perforáció, 2 esetben hasüregi tályog volt. Az EM-ek 89%-a laparoszkópos módon került elvégzésre; az átlagos mutéti ido EM/SM esetében 96 perc/89 perc, az átlagos ápolási napok száma 17/14 volt. Az EM-csoportból 1 beteg, míg az SM-csoportból 5 beteg meghalt. Szignifikáns különbség volt a mutét típusa, a stomaképzés és a transzfúziós igény tekintetében. Nem találtunk szignifikáns eltérést a posztoperatív ápolási napok és a mortalitás tekintetében. Következtetés: Az elektív mutétek alacsonyabb morbiditása és mortalitása, illetve a laparoszkópos technika alkalmazhatósága miatt törekedni kell a tervezett mutétre. Nincs egységes irányelv a relatív mutéti indikáció felállításában: gasztroenterológus és sebész által felállított, személyre szabott kezelési stratégia szükséges. Véleményünk szerint indokolt a mutét, amennyiben igazolt diverticulosis esetében szigorú diéta mellett kiújul a gyulladás. Orv Hetil. 2020; 161(51): 2146-2152. INTRODUCTION: Colonic diverticulosis affects 60% of the population, incidence of the disease grows progressively. During its course, 6% of patients with diverticulosis will need surgical intervention. There is no current guideline when to carry out elective operation. METHOD: We analyzed demographics, surgical patient data and also post-operative complications of patients operated in our department due to colonic diverticulosis between 17-07-2017 and 30-04-2020 retrospectively. We compared the results of elective (ES) and acute surgeries (AS), also laparotomies versus laparoscopies. RESULTS: 19 out of 38 patients underwent ES and 19 AS. ES group average age was 64 years, and 67 in the AS group. Indications of ES were recurring diverticulitis in 12, colovesical fistula in 5 and colovaginal fistula in 2 cases. Indications of AS were perforations in 17 and intraabdominal abscesses in 2 cases. 89% of all ES were operated laparoscopically; average operation time in ES/AS was 96/89 minutes, average hospital stay was 17/14 days. 1 patient after ES and 5 after AS died. Significant difference was found between the groups with regard to the type of operation, frequency of colostomy creation and the need of blood transfusion but no significant difference was demonstrated in average hospital stay and mortality. CONCLUSION: Due to the lower morbidity and mortality rate as well as the benefits of laparoscopic approach, we should always opt for ES. No guideline for relative surgical indication exists: gastroenterologist and surgeon should make a personalized surgical plan. In our opinion, operation should be carried out if diverticulitis reoccurs while the patient is on strict diet. Orv Hetil. 2020; 161(51): 2146-2152.


Assuntos
Diverticulose Cólica/cirurgia , Laparoscopia , Laparotomia , Idoso , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento
2.
JAAPA ; 33(1): 24-26, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31880646

RESUMO

Segmental colitis associated with diverticulosis (SCAD) is a rare variant of chronic colitis that is limited to segments of the left colon that harbor diverticula. Histologically, SCAD is known to mimic chronic idiopathic inflammatory bowel disease. Patients usually present with hematochezia and cramping abdominal pain; SCAD often resolves spontaneously without treatment, or completely after a limited course of therapy. Due to the histologic overlap with ulcerative colitis and occasional Crohn colitis, the implications of an inaccurate diagnosis are significant.


Assuntos
Colectomia , Colite/cirurgia , Doença Diverticular do Colo/cirurgia , Ileostomia , Dor Abdominal/etiologia , Colite/complicações , Colite/patologia , Colonoscopia , Diarreia/etiologia , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/patologia , Diverticulose Cólica/complicações , Diverticulose Cólica/patologia , Diverticulose Cólica/cirurgia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Pessoa de Meia-Idade
3.
J Surg Res ; 243: 434-439, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31279270

RESUMO

BACKGROUND: As the availability and use of robotic surgery increases, current data suggest comparable outcomes to laparoscopic surgery but at an increased cost. Elective sigmoid resection for diverticular disease is the most common colorectal application of robotic surgery and there is limited comparative data specifically for this indication. METHODS: We identified all elective cases of laparoscopic- and robot-assisted surgery for diverticular disease among a practice of 7 colorectal surgeons within an established enhanced recovery protocol. We performed propensity matching based on surgical indications (recurrent disease, ongoing symptoms, or fistula), stoma creation, and body mass index to create a matched cohort. Our primary outcomes were return of bowel function, length of stay, opioid use, and pain scores during the first 72 h postoperatively. Secondary outcomes were operative room and hospital charges. RESULTS: From 2011 to 2016, 69 robotic cases were propensity matched from a group of 222 laparoscopic cases to create a 1:1 case ratio that was equivalent in terms of patient demographics and operative indications. Time to first bowel movement was slightly quicker in the robotic group (1 [1] versus 2 [1.5], P = 0.09), while length of stay (3.5 [1.6] versus 3.6 [1.4] d, P = 0.64) was equivalent. Pain scores were lower in the robotic group on day 0 (4.6 versus 6.1, P = 0.0001), but similar on day 1 and day 2 (4.3 versus 4.1, P = 0.62 and 3.8 versus 3.3, P = 0.19). There was no difference in postoperative 72-h opioid use between groups (110.8 MME [144.5] versus 97.4 MME [101.5], P = 0.70). In the robotic arm operating room charges were slightly more ($2835 ± $394 versus $2196 ± $359, P < 0.0001), but total hospital charges were over significantly increased ($41,159 [$7840] versus $25,761 [$11,689], P < 0.0001). CONCLUSIONS: Via a carefully matched cohort of elective sigmoid resection for diverticular disease at a single community institution, we have demonstrated that laparoscopic- and robotic-assisted surgery result in clinically equivalent return of bowel function, length of stay, postoperative pain, and opioid use.


Assuntos
Colectomia/estatística & dados numéricos , Diverticulose Cólica/cirurgia , Laparoscopia/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Doenças do Colo Sigmoide/cirurgia , Idoso , Colectomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos
5.
Updates Surg ; 70(4): 427-432, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30173365

RESUMO

ERAS protocol and indocyanine green fluorescence angiography (ICG-FA) represent the new surgical revolution minimizing complications and shortening recovery time in colorectal surgery. As of today, no studies have been published in the literature evaluating the impact of the ICG-FA in the ERAS protocol for the patients suitable for colorectal surgery. The aim of our study was to assess whether the systematic evaluation of intestinal perfusion by ICG-FA could improve patients outcomes when managed with ERAS perioperative protocol, thus reducing surgical complication rate. This is a retrospective case-control study. From March 2014 to April 2017, 182 patients underwent laparoscopic colorectal surgery for benign and malignant diseases. All the patients were enrolled in ERAS protocol. Two groups were created: Group A comprehended 107 patients managed within the ERAS pathway only and Group B comprehended 75 patients managed as well as with ERAS pathway plus the intraoperative assessment of intestinal perfusion with ICG-FA. Two board-certified laparoscopic colorectal surgeons jointly performed all procedures. Six (5.6%) clinically relevant anastomotic leakages (AL) occurred in Group A, while there was none in Group B, demonstrating that ICG-FA integrated in the ERAS protocol can lead to a statistically significant reduction of the AL. Mean operative time between the two groups was not statistically significant. In five cases (6.6%), the demarcation line set by the fluorescence made the surgeon change the resection line previously marked. The prevalence of all other complications did not differ statistically between the two groups. Our study confirms that combination between ICG and ERAS protocol is feasible and safe and reduces the anastomotic leakage, possibly leading to consider ICG-FA as a new ERAS item.


Assuntos
Fístula Anastomótica/prevenção & controle , Protocolos Clínicos , Neoplasias Colorretais/cirurgia , Corantes , Diverticulose Cólica/cirurgia , Angiofluoresceinografia/métodos , Verde de Indocianina , Intestinos/diagnóstico por imagem , Assistência Perioperatória/métodos , Idoso , Estudos de Casos e Controles , Neoplasias Colorretais/diagnóstico por imagem , Diverticulose Cólica/diagnóstico por imagem , Feminino , Humanos , Laparoscopia , Masculino , Duração da Cirurgia , Estudos Retrospectivos
6.
Cir Cir ; 86(5): 432-436, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30226485

RESUMO

Introducción: La fuga de anastomosis (FA) en cirugía colorrectal es una complicación temida por el incremento de la morbimortalidad. La tasa de FA se reporta desde el 1 hasta el 25%. Realizar el diagnóstico de forma temprana es difícil. Objetivo: Determinar el rendimiento diagnóstico de la proteína C reactiva (PCR) en una cohorte de pacientes sometidos a cirugía colorrectal electiva con anastomosis. Método: Se realizó un estudio prospectivo, comparativo, en 138 pacientes sometidos a cirugía colorrectal con anastomosis de forma electiva, analizando los valores séricos de la PCR los días 1, 3, 5 y 7 del posoperatorio, así como los de leucocitos y otros datos de sepsis abdominal. Resultados: La tasa de FA fue del 6.5%, y los valores de la PCR fueron significativamente más altos en el grupo de pacientes con FA en el tercer día del posoperatorio. Con un punto de corte de 18.5 mg/dl en el tercer día del posoperatorio se obtuvo una sensibilidad del 81%, una especificidad del 91%, un valor predictivo positivo del 45% y un valor predictivo negativo del 98%. Conclusión: La medición de la PCR en el tercer día del posoperatorio en pacientes sometidos a cirugía colorrectal electiva con anastomosis primaria o secundaria permite identificar las complicaciones sépticas, incluida la FA. Introduction: The anastomotic leakage (AL) in colorectal surgery is a complication feared by the increase in morbidity and mortality. The rate of AF is reported from 1 to 25%. Making the diagnosis early is difficult. Objective: To determine the diagnostic performance of the C reactive protein (CRP) in a cohort of patients undergoing elective colorectal surgery with anastomosis. Method: A prospective, comparative study was conducted in 138 patients undergoing elective anastomosis with colorectal surgery, analyzing the serum values of CRP on postoperative days 1, 3, 5 and 7, as well as leukocytes and other abdominal sepsis data. Results: The AL rate was 6.5%, the CRP values were significantly higher in the group of patients with AF on the 3rd postoperative day; with a cut-off point of 18.5 mg/dl on the third postoperative day, it obtained sensitivity 81%, specificity 91%, positive predictive value 45%, negative predictive value 98%. Conclusion: Measurement of CRP on the third postoperative day in patients undergoing elective colorectal surgery with primary or secondary anastomosis allows the identification of septic complications including leakage of anastomosis.


Assuntos
Fístula Anastomótica/diagnóstico , Proteína C-Reativa/análise , Neoplasias Colorretais/cirurgia , Diverticulose Cólica/cirurgia , Adulto , Idoso , Fístula Anastomótica/sangue , Biomarcadores , Doenças do Colo/cirurgia , Diagnóstico Precoce , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doenças Retais/cirurgia
7.
J Pediatr Surg ; 53(7): 1437-1439, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29680278

RESUMO

Total colonic aganglionosis is a rare phenotype of Hirschsprung disease (HD). While the diagnosis is generally established within the neonatal period there are reports of delayed presentation. In this case, we describe a 9-month old girl with no previous medical or surgical history who presented with a small bowel obstruction. A contrast enema performed as part of the work up demonstrated right sided colonic diverticula with no other anatomical abnormalities. Surgical intervention was required to manage the obstruction and colonic biopsies were consistent with HD. This case highlights the association of the unusual finding of colonic diverticula with total colonic HD in infants.


Assuntos
Diverticulose Cólica/diagnóstico por imagem , Doença de Hirschsprung/diagnóstico por imagem , Procedimentos Cirúrgicos do Sistema Digestório , Diverticulose Cólica/cirurgia , Feminino , Doença de Hirschsprung/cirurgia , Humanos , Lactente , Obstrução Intestinal/cirurgia
8.
Minerva Chir ; 73(1): 29-35, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29154517

RESUMO

BACKGROUND: The use of a protective stoma represents an important issue in colorectal surgery. Although evidence suggests that loop ileostomy may be superior, the optimal method for temporary decompression of colorectal anastomosis still remains controversial. Aim of this study was to make an evidence-based proposal for a tailored approach to the use of diverting colostomy or ileostomy. METHODS: A retrospective analysis of all patients subjected to creation and closure of a diverting loop colostomy or loop ileostomy between May 2007 and November 2014 in our institution was performed. Early and late complications, mortality and morbidity, time between formation and closure of the stoma in respect to adjuvant chemotherapy and the length of hospital stay were assessed and compared between the two groups. RESULTS: Outcomes of 167 patients (m=95; f=72) undergoing a loop colostomy (N.=130) or ileostomy (N.=37) were analyzed. The most frequent diagnosis was malignancy (64.1%), followed by abdominal emergency operations (18.6%) and complicated diverticular disease (17.4%). There was no mortality. Adjuvant chemotherapy (26.3%) resulted in delayed stoma reversal (P<0.001). Complications following construction of the stoma such as electrolyte disorder (P<0.001), renal insufficiency (P=0.048), and skin irritation (P=0.003) occurred significantly more often within the ileostomy group. Within the colostomy group, the rate of stoma prolapse (P=0.074) tended to be higher. CONCLUSIONS: Both methods have advantages and disadvantages. Loop transverse colostomy could be the preferred technique for older patients to avoid electrolyte disorder and renal insufficiency. Further prospective trials with documentation of electrolyte metabolism and quality of life should follow.


Assuntos
Colo/cirurgia , Colostomia/métodos , Ileostomia/métodos , Reto/cirurgia , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/prevenção & controle , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Fístula Anastomótica/epidemiologia , Fístula Anastomótica/prevenção & controle , Quimioterapia Adjuvante , Doenças do Colo/cirurgia , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/cirurgia , Terapia Combinada , Diverticulose Cólica/cirurgia , Emergências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Estomas Cirúrgicos , Desequilíbrio Hidroeletrolítico/epidemiologia , Desequilíbrio Hidroeletrolítico/etiologia , Desequilíbrio Hidroeletrolítico/prevenção & controle
9.
Rev. argent. coloproctología ; 28(2): 181-191, Dic. 2017. ilus, tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1008650

RESUMO

Introducción: La colopatía diverticular es la enfermedad benigna más frecuente del colon, llegando a tener una incidencia del 70% a los 65 años de edad. El tratamiento fue variando a lo largo de los años. El objetivo de la presente monografía es realizar una recopilación de datos actualizados que permitan analizar las diferentes variables terapéuticas en relación al tratamiento médico y más específicamente quirúrgico de la enfermedad diverticular aguda. Materiales y Método: Se realizó una revisión bibliográfica actualizada en base a buscadores académicos médicos (PubMed, MedLine, Ovid, ResearchGate, Google Scholar, Lilacs, Rima, Cochrane) a partir de la cual se analizaron las diferentes variables relacionadas al tratamiento (manejo médico y quirúrgico). Resultados: Se desarrolló una guía de tratamiento en relación a la enfermedad diverticular complicada y no complicada y sus variables terapéuticas teniendo en cuenta la clasificación de HINCHEY. Conclusiones: La enfermedad diverticular tiene una incidencia en aumento en las últimas décadas, ya sea por un incremento en los factores de riesgo (dietas hipercalóricas, con un bajo contenido de fibras y verduras; obesidad; estrés) como por los avance en los métodos de diagnósticos, por lo que hay que saber diferenciar la terapéutica teniendo en cuenta no sólo la clasificación de HINCHEY sino también el estado general del paciente. En la mayoría de los casos no requerirá de una conducta quirúrgica para su resolución, siendo está indicada a los tipos III/IV y ante la falta de respuesta al tratamiento médico en los demás tipos. La elección de la técnica quirúrgica (Operación de Hartmann, Resección con anastomosis primaria con o sin ostomía de protección o lavado y drenaje de cavidad abdominal) se establecerá en base al estado general del paciente al momento del acto quirúrgico y a la experiencia del cirujano. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Diverticulose Cólica/cirurgia , Diverticulose Cólica/terapia , Doenças Diverticulares/classificação , Doença Aguda , Incidência , Fatores Etários , Diverticulose Cólica/epidemiologia , Comportamento Alimentar , Doenças Diverticulares/fisiopatologia , Doenças Diverticulares/história
10.
Metas enferm ; 20(9): 25-31, nov. 2017. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-168762

RESUMO

Se presenta el caso de un varón de 48 años, con diagnóstico de enfermedad diverticular complicada, que presenta sangrado recurrente posterior a la cirugía. La valoración enfermera se realiza teniendo como marco la Teoría del Autocuidado de Dorothea Orem. Se identificaron los factores condicionantes básicos y los requisitos de autocuidado universales del desarrollo y de desviación a la salud. Se utilizó el modelo de Análisis de Resultados del Estado Actual (AREA) y la taxonomía de la North American Nursing Diagnosis Association (NANDA), elaborándose un plan de cuidados considerando los resultados esperados y las intervenciones de Enfermería propuestas también en la Nursing Interventions Classification (NIC) y la Nursing Outcomes Classification (NOC). La aplicación del modelo AREA para el razonamiento clínico de Enfermería ayuda a priorizar los requisitos de autocuidado alterados del paciente, lo que permite identificar el diagnóstico enfermero principal, los diagnósticos secundarios y los diagnósticos de riesgo y, de esta forma, planificar los cuidados específicos para brindar una atención de salud integral (AU)


We hereby present the case of a 48-year-old male patient, with diagnosis of complicated diverticular disease, presenting recurrent postsurgical bleeding. Nursing evaluation was conducted within the setting of the Dorothea Orem's Self-Care Theory. Basic determining factors were identified, as well as universal self-care requirements for development and health deviation. The study used the model from the Analysis of Current Status Outcomes (ACSO), and the taxonomy by the North American Nursing Diagnosis Association (NANDA); the care plan was prepared considering the expected outcomes and the nursing interventions also put forward by the Nursing Interventions Classification (NIC) and the Nursing Outcomes Classification (NOC). The application of the ACSO model for the clinical rationale of Nursing allows to prioritize the altered self-care requirements of the patient, which facilitates the identification of the primary Nursing diagnosis, secondary diagnoses and risk diagnoses, and therefore, to plan the specific care in order to offer comprehensive patient care (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente/normas , Diverticulose Cólica/complicações , Avaliação em Enfermagem/métodos , Autocuidado/métodos , Fatores de Risco , Hemorragia/complicações , Recidiva , Avaliação de Processos e Resultados em Cuidados de Saúde , Diverticulose Cólica/cirurgia
11.
Clin J Gastroenterol ; 10(6): 491-497, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29030789

RESUMO

This review addresses the management of sigmoid colon diverticular disease associated with foreign bodies. In addition, two novel cases are presented. One case describes the management of diverticular bleeding secondary to a chicken bone and the other case reports retrieval of a retained EndoRings™ Device. The review identified 40 relevant publications including 50 subjects. Foreign bodies within sigmoid diverticular disease may be associated with inflammation, perforation, abscess and fistula. In current practice, diagnosis is often achieved with CT scan. Patients with colonic perforation or fistula generally require colonic resection. Patients with inflammation may merit conservative management, including colonoscopic foreign body retrieval. Chicken bones, tooth picks, and biliary stents have been reported in patients with inflammation, perforation and fistula, whereas all published patients with fish bone related diverticulosis complications experienced inflammation. Treatment might be best guided by the consequences of the foreign body rather than the nature of the underlying retained object. Diverticular bleeding secondary to a chicken bone was diagnosed at CT angiography and treated with colonoscopic snare retrieval of the bone and clipping of the bleeding diverticulum. The EndoRings™ Device was retrieved with a colonoscopic balloon.


Assuntos
Colo Sigmoide/cirurgia , Diverticulose Cólica/etiologia , Diverticulose Cólica/cirurgia , Corpos Estranhos/complicações , Corpos Estranhos/cirurgia , Idoso , Idoso de 80 Anos ou mais , Animais , Osso e Ossos , Galinhas , Colo Sigmoide/diagnóstico por imagem , Colonoscópios , Colonoscopia , Angiografia por Tomografia Computadorizada , Diverticulose Cólica/diagnóstico por imagem , Feminino , Corpos Estranhos/diagnóstico por imagem , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Técnicas Hemostáticas , Humanos
12.
Trop Doct ; 47(4): 355-359, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28764591

RESUMO

Many patients with massive lower gastrointestinal (GI) haemorrhage from diverticulosis are subjected to total colectomy when preoperative localisation is unavailable. We dissected colectomy specimens and noted that there was limited retrograde reflux in most of these cases. Therefore, we sought to assess the value of a positive endoluminal erythrocyte presence (PEEP) test (presence of fresh blood in the caecum) to direct segmental colectomies in 14 patients who required emergency operations for massive lower GI haemorrhage. Overall, 13 (93%) patients who had segmental colectomy guided by the PEEP test had successful control of bleeding. There was no mortality and a 14% postoperative morbidity after segmental resections guided by the PEEP test. One patient had persistent bleeding and required a completion colectomy on the third postoperative day. We propose that the PEEP test be added to the surgical armamentarium to guide segmental resection in the absence of localisation by conventional means. However, we advocate blind total colectomy if the PEEP test is equivocal and early completion colectomy if there is significant re-bleeding.


Assuntos
Ceco/patologia , Colectomia/métodos , Diverticulose Cólica/cirurgia , Eritrócitos/patologia , Hemorragia Gastrointestinal/cirurgia , Adulto , Idoso , Diverticulose Cólica/diagnóstico , Feminino , Hemorragia Gastrointestinal/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
13.
Am Surg ; 83(3): 303-307, 2017 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-28316316

RESUMO

Data regarding management of colonic diverticulitis in renal transplant recipients (RTRs) are limited. This study aims to identify prevalence, risk factors, and outcomes in RTRs with colonic diverticulosis and diverticulitis. Between January 2004 and December 2013, all patients who underwent kidney transplantation were analyzed. Among all RTSs, patients who had a pretransplant colonoscopic diagnosis of diverticulosis and patients with a proven attack of diverticulitis were included in our analysis. There were 1578 RTRs with a mean age of 50 ± 14 years at the time of transplantation. Of these, 409 patients had colonoscopic evaluation and 174 (43%) were diagnosed with diverticular disease. Fifteen (0.9%) out of 1578 developed a primary attack of diverticulitis. Two patients underwent a Hartmann's procedure due to perforation. Among 13 patients who were initially treated nonoperatively, 4 required surgery due to refractory diverticulitis (n = 2) and recurrence (n = 2). Tobacco use (59% vs 48%, P = 0.02), increased age (58 vs 51 years, P < 0.0001), diabetes (33% vs 35%, P = 0.03), coronary artery disease (38% vs 22%, P = 0.001), and autosomal dominant polycystic kidney disease etiology (P = 0.04) were more common in RTRs with diverticulosis. Majority of RTRs with diverticulitis can be managed nonoperatively. Surgical treatment is warranted in patients with perforated, persistent, and recurrent diverticulitis. A special care and follow-up may be needed in RTRs with autosomal dominant polycystic kidney disease etiology, smoking history, and coronary artery disease due to higher risk of diverticulosis and subsequent potential diverticulitis.


Assuntos
Doença Diverticular do Colo/cirurgia , Diverticulose Cólica/cirurgia , Transplante de Rim , Colonoscopia , Doença Diverticular do Colo/diagnóstico por imagem , Diverticulose Cólica/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Ann Ital Chir ; 87: 23-30, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27025236

RESUMO

AIM: The aim of our study was to compare the efficacy of the circular compression stapler and the circular mechanical stapler in transanal colorectal anastomosis after left colectomy or anterior rectal resection. MATERIALS AND METHODS: We performed a retrospective analysis of 10 patients with disease of the, sigmoid colon or rectum (carcinoma or diverticular disease) who underwent left colectomy or anterior rectal resection with end-to-side transanal colorectal anastomosis. A follow-up was planned for all patients at 1, 3 and 6 months after surgery and the anastomosis was evaluated by colonoscopy at 1 year. RESULTS: In all patients an end-to-side transanal colorectal anastomosis was performed using a circular compression stapler (CCS group) or circular mechanical staplers with titanium staples (CMS group). The mean distance of the anastomosis from the anal margin was 6.4 ± 1.5 cm in the CCS group and 18.2 ± 11.2 cm in the CMS group. All patients in the CCS group expelled the ring after a mean time of 8.2 postoperative days. At 12 months colonoscopy revealed that all CCS patients had a satisfactory anastomosis with mean size of the colic lumen at the level of anastomotic line of 26.3 mm. CONCLUSIONS: In our experience the circular compression stapler a valuable alternative to the circular mechanical stapler for the creation of transanal colorectal anastomosis, in line with the relevant literature. KEY WORDS: Anastomotic leakage, Anastomotic stenosis, Circular compression stapler, Circular mechanical stapler, Transanal colorectal anastomosis.


Assuntos
Colectomia/métodos , Colo/cirurgia , Reto/cirurgia , Grampeadores Cirúrgicos , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Fístula Anastomótica/prevenção & controle , Carcinoma/cirurgia , Colo/patologia , Neoplasias Colorretais/cirurgia , Constrição Patológica , Diverticulose Cólica/cirurgia , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos
16.
Surg Endosc ; 30(7): 2792-8, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26487196

RESUMO

BACKGROUND: The utilization of minimally invasive surgery is increasing in colorectal surgery. We sought to compare the outcomes of patients who underwent elective open, laparoscopic, and robotic total abdominal colectomy. METHODS: The NIS database was used to examine the clinical data of patients who underwent an elective total colectomy procedure during 2009-2012. Multivariate regression analysis was performed to compare the three surgical approaches. RESULTS: We sampled a total of 26,721 patients who underwent elective total colectomy. Of these, 16,780 (62.8 %) had an open operation, while 9934 (37.2 %) had a minimally invasive approach (9614 laparoscopic surgery, and 326 robotic surgery). The most common indication for an operation was ulcerative colitis (31 %). Patients who underwent open surgery had significantly higher mortality and morbidity compared to laparoscopic (AOR 2.48, 1.30, P < 0.01) and robotic approaches (AOR 1.04, 1.30, P < 0.01 and P = 0.04, respectively). There was no significant difference in mortality and morbidity between the laparoscopic and robotic approaches (AOR 0.96, 1.03, P = 0.10, P = 0.78). However, conversion rate of laparoscopic surgery to open was significantly higher than that of robotic approach (13.3 vs. 1.5 %, P < 0.01). Patients who underwent laparoscopic surgery had significantly lower total hospital charges compared to patients who underwent open surgery (mean difference = $21,489, P < 0.01). Also, total hospital charges for a robotic approach were significantly higher than for a laparoscopic approach (mean difference = $15,595, P < 0.01). CONCLUSION: Minimally invasive approaches to total colectomy are safe, with the advantage of lower mortality and morbidity compared to an open approach. Although there was no significant difference in the morbidity between minimally invasive approaches, robotic surgery had a significantly lower conversion rate compared to laparoscopic approach. Total hospital charges are significantly higher in robotic surgery compared to laparoscopic approach.


Assuntos
Colectomia/métodos , Doenças do Colo/cirurgia , Laparoscopia/métodos , Laparotomia/métodos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Colectomia/economia , Colite Ulcerativa/cirurgia , Neoplasias Colorretais/cirurgia , Conversão para Cirurgia Aberta , Doença de Crohn/cirurgia , Bases de Dados Factuais , Doença Diverticular do Colo/cirurgia , Diverticulose Cólica/cirurgia , Procedimentos Cirúrgicos Eletivos/economia , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Preços Hospitalares , Humanos , Laparoscopia/economia , Laparotomia/economia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/economia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Mortalidade , Análise Multivariada , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/economia , Resultado do Tratamento
18.
Int J Surg ; 21: 45-50, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26192969

RESUMO

AIM: Recent investigations have shown improved patient reported outcome after preservation of the inferior mesenteric artery in sigmoid resection for diverticular disease. We report on our experience with preservation of the superior rectal artery (SRA). METHODS: This is an observational single center study in a high-volume, level II inner city hospital from 2006 to 2008. Inclusion criteria were all patients with diverticular disease. Exclusion criteria were stoma formation, cancer, and iatrogenic perforation. Patients were investigated in group A with preservation of the SRA, and group B ligation of the SRA. Outcomes assessed, included incidence of anastomotic breakdown, intraoperative complications, hospital stay, and risk factors. RESULTS: The patient population included 259 patients, 46 patients were excluded, leaving 100 patients in group A and 113 patients in group B. Patients in both groups were comparable regarding age, gender, co-morbidities and stage of disease. Anastomotic breakdown occurred in one patient in group A and in eight patients in group B (p = 0.038). Incidence of intraoperative bleeding, wound dehiscence, and length of stay was increased in group B (p < 0.03; p < 0.04; p = 0.05). Obesity was an independent risk factor for anastomotic dehiscence in group B (p < 0.04). CONCLUSION: Our data comprise the largest patient population reported so far on vascular preservation in surgery for diverticular disease. The results of this study support the establishment of evidence based recommendations on the level of dissection in diverticular disease. Specifically obese patients are at risk of anastomotic breakdown with ligation of the SRA.


Assuntos
Colectomia/métodos , Colo Sigmoide/irrigação sanguínea , Diverticulose Cólica/cirurgia , Artéria Mesentérica Inferior/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Colo Sigmoide/cirurgia , Feminino , Seguimentos , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
Drugs Aging ; 32(5): 349-60, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25893309

RESUMO

Diverticulosis is the most common pathological finding in routine colonoscopy. Diverticular disease comprises both diverticulitis and diverticular hemorrhage. This review examines the pathophysiological basis for disease including the importance of the elastin/collagen profile in diverticula formation. It summarizes the latest epidemiological findings with an emphasis on age- and sex-related differences. Risk factors including obesity, medications, hereditary factors, and diet are critically reviewed with the most up-to-date evidence. A detailed appraisal of therapeutic options is provided with special emphasis on 5-aminosalicylate, probiotics, mesalamine, percutaneous abscess drainage, and image-guided embolization. The role of antibiotics and surgery is discussed and compared with guideline recommendations. A more conservative approach, averting admission and even antibiotics, is explored. Finally, a careful review of the data surrounding the utility of colonoscopy in diagnosis and management is provided given the increasing number of reports citing the low incidence of colorectal neoplasia after an episode of diverticulitis. Throughout the review we focus on the older patient with diverticular disease.


Assuntos
Diverticulite/epidemiologia , Diverticulite/terapia , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/terapia , Idoso , Idoso de 80 Anos ou mais , Colonoscopia , Diverticulite/tratamento farmacológico , Diverticulite/cirurgia , Diverticulose Cólica/tratamento farmacológico , Diverticulose Cólica/cirurgia , Diverticulose Cólica/terapia , Feminino , Hemorragia Gastrointestinal/tratamento farmacológico , Hemorragia Gastrointestinal/cirurgia , Humanos , Masculino , Fatores de Risco
20.
Rev Esp Enferm Dig ; 107(3): 162-70, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25733040

RESUMO

Colonic diverticular disease is a chronic disorder presenting with a variety of abdominal symptoms and recurrent episodes of acute diverticulitis. It is close linked to age so its prevalence has risen notably during the last decades in western countries, increasing costs related to medical attention. Recently, several works have provided evidence to a series of measures that could improve the outcomes as well as reduce expenses associated to this process.The aim of the present review is to expose a view of the new trends in the management of diverticulitis and colonic diverticular disease, based on the highest clinical evidence available.


Assuntos
Doenças do Colo/terapia , Gerenciamento Clínico , Doença Diverticular do Colo/cirurgia , Doença Diverticular do Colo/terapia , Diverticulite/terapia , Diverticulose Cólica/cirurgia , Diverticulose Cólica/terapia , Anastomose Cirúrgica , Doenças do Colo/cirurgia , Diverticulite/cirurgia , Humanos , Laparoscopia , Lavagem Peritoneal
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