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1.
Acta Ortop Mex ; 35(1): 17-22, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34480434

RESUMO

INTRODUCTION: The anterior direct approach to the hip has become popular in recent years, as it favors rapid recovery and better evolution, as well as shorter hospital stay time, painkiller consumption, physical therapy requirement and thus a possible overall reduced cost. The results of the first 50 cases are reported, with this technique assisted by the use of a special traction table. MATERIAL AND METHODS: Retrospective study of 50 hip arthroplasties in 47 patients by said method and special table, between April 2018 and April 2020. Etiology, gender, affected age and side, surgical lapse, transoperative bleeding and implant size were recorded. Immediate clinical and radiographic evolution was evaluated at the start and during the first 90 days. RESULTS: Sample of 18 men and 29 women. The average age was 67.7 years (range 28 to 94). Mean surgical time two hours 37 minutes, average bleeding 513 ml, clinical progress according to Harris scale: excellent 42 (84%), seven good (14%) and one bad (2%), due to infection. There were two calcar fractures without the need to remove an implant, eight cases of muscle mass injury, bruising in four (8%), femorocutaneous nerve paresis in six (12%), superficial infection two cases (4%). No dislocations. CONCLUSION: The anterior approach is a safe and reliable technique with immediate satisfactory outcomes and minor complications.


Assuntos
Artroplastia de Quadril , Luxações Articulares , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos
2.
Acta Ortop Mex ; 35(1): 23-27, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34480435

RESUMO

INTRODUCTION: Total navigated knee replacement uses a computer-guided system, which provides immediate information on pre-cut trans-operative conditions of the knee, in relation to pelvic limb alignment. MATERIAL AND METHODS: Observational, descriptive study conducted from March 2003 to February 2019. Total bilateral knee replacement was performed at the same time surgically by a surgeon, evaluating function and pain on the WOMAC, EVA, and range of motion scores of both knees. Two groups of patients were studied: the first represents presurgical and the second post-surgical. Student's t-test and 2 were applied for statistical analysis. RESULTS: 31 patients (62 prostheses), 83.9% of the female sex and 16.1% male, average age 67.32 years, average follow-up 6.55 years (± 3.8) were studied. It was identified that 100% of the patients in both knees have a deviation between 0o and 2o measured in the mechanical axis. The WOMAC scale showed an average of 22.71 ± 3.34 presurgical and 4.16 ± 1.84) post-surgical, with statistically significant differences. The average analog visual scale was 9.06 ± 0.814 presurgical and 2.35 ± 1.427 post-surgical. CONCLUSIONS: This technique is reliable, safe and satisfactory. Excellent clinical and radiographic results were evident regarding the positioning of prosthetic components.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Cirurgia Assistida por Computador , Idoso , Computadores , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Duração da Cirurgia , Osteoartrite do Joelho/cirurgia , Resultado do Tratamento
3.
Khirurgiia (Mosk) ; (9): 19-26, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34480451

RESUMO

OBJECTIVE: To improve the results of surgical treatment of cervico-mediastinal tumors by using of partial upper cervicosternotomy. MATERIAL AND METHODS: A retrospective analysis included 24 patients who underwent resection of cervico-mediastinal tumors via partial upper cervicosternotomy for the period from January 2002 to December 2019. Immediate and intermediate postoperative outcomes were analyzed. RESULTS: Mean surgery time was 282.7 min, intraoperative blood loss - 325.0 ml. Duration of pleural cavity (mediastinum) drainage was 3 days, hospital-stay - 14 days. Major postoperative complications developed in 3 (12.5%) patients. No 90-day mortality was observed. No local relapses were detected throughout the follow-up period (median 36.1 months). CONCLUSION: Partial cervicosternotomy is a safe and effective approach ensuring adequate visualization and reliable control of great vessels of the upper mediastinum and neck. This access is valuable for en-bloc resection of cervico-mediastinal tumors located in anterior and posterior parts of the thoracic inlet.


Assuntos
Neoplasias do Mediastino , Recidiva Local de Neoplasia , Humanos , Mediastino , Duração da Cirurgia , Estudos Retrospectivos
4.
N Engl J Med ; 385(6): 526-538, 2021 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-34347953

RESUMO

BACKGROUND: In patients with lumbar spinal stenosis and degenerative spondylolisthesis, it is uncertain whether decompression surgery alone is noninferior to decompression with instrumented fusion. METHODS: We conducted an open-label, multicenter, noninferiority trial involving patients with symptomatic lumbar stenosis that had not responded to conservative management and who had single-level spondylolisthesis of 3 mm or more. Patients were randomly assigned in a 1:1 ratio to undergo decompression surgery (decompression-alone group) or decompression surgery with instrumented fusion (fusion group). The primary outcome was a reduction of at least 30% in the score on the Oswestry Disability Index (ODI; range, 0 to 100, with higher scores indicating more impairment) during the 2 years after surgery, with a noninferiority margin of -15 percentage points. Secondary outcomes included the mean change in the ODI score as well as scores on the Zurich Claudication Questionnaire, leg and back pain, the duration of surgery and length of hospital stay, and reoperation within 2 years. RESULTS: The mean age of patients was approximately 66 years. Approximately 75% of the patients had leg pain for more than a year, and more than 80% had back pain for more than a year. The mean change from baseline to 2 years in the ODI score was -20.6 in the decompression-alone group and -21.3 in the fusion group (mean difference, 0.7; 95% confidence interval [CI], -2.8 to 4.3). In the modified intention-to-treat analysis, 95 of 133 patients (71.4%) in the decompression-alone group and 94 of 129 patients (72.9%) in the fusion group had a reduction of at least 30% in the ODI score (difference, -1.4 percentage points; 95% CI, -12.2 to 9.4), showing the noninferiority of decompression alone. In the per-protocol analysis, 80 of 106 patients (75.5%) and 83 of 110 patients (75.5%), respectively, had a reduction of at least 30% in the ODI score (difference, 0.0 percentage points; 95% CI, -11.4 to 11.4), showing noninferiority. The results for the secondary outcomes were generally in the same direction as those for the primary outcome. Successful fusion was achieved with certainty in 86 of 100 patients (86.0%) who had imaging available at 2 years. Reoperation was performed in 15 of 120 patients (12.5%) in the decompression-alone group and in 11 of 121 patients (9.1%) in the fusion group. CONCLUSIONS: In this trial involving patients who underwent surgery for degenerative lumbar spondylolisthesis, most of whom had symptoms for more than a year, decompression alone was noninferior to decompression with instrumented fusion over a period of 2 years. Reoperation occurred somewhat more often in the decompression-alone group than in the fusion group. (NORDSTEN-DS ClinicalTrials.gov number, NCT02051374.).


Assuntos
Descompressão Cirúrgica , Vértebras Lombares/cirurgia , Fusão Vertebral , Espondilolistese/cirurgia , Idoso , Dor nas Costas , Feminino , Humanos , Análise de Intenção de Tratamento , Perna (Membro) , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias , Reoperação/estatística & dados numéricos , Resultado do Tratamento
5.
Isr Med Assoc J ; 23(8): 494-496, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34392624

RESUMO

BACKGROUND: Proximal femoral fractures (PFF) are among the most common injuries in the elderly population treated by orthopedic surgeons. Postoperative complications, especially infections, are of great importance due to their effect on patient mortality and morbidity and healthcare costs. OBJECTIVES: To assess the main causes for postoperative infection among PFF patients. METHODS: We conducted a retrospective analysis of PFF patients in our medical center between 2015 and 2017. Patients were divided into two groups based on whether there was postoperative infection during immediate hospitalization and 30 days after surgery. Factors such as time from admission to surgery, duration of surgery, and length of stay were analyzed. Groups were analyzed and compared using a t-test, chi-squared and Fisher's exact tests. RESULTS: Of 1276 patients, 859 (67%) underwent closed reduction internal fixation, 67 (5%) underwent total hip arthroplasty, and 350 (28%) underwent hemiarthroplasty. Of the total, 38 patients (3%) were diagnosed with postoperative infection. The demographics and co-morbidities were similar between the two study groups. The incident of infection was the highest among patients undergoing hemiarthroplasty (6%, P < 0.0001). Length of hospitalization (15 vs. 8 days, P = 0.0001) and operative time (117 vs. 77 minutes, P = 0.0001) were found to be the most significant risk factors for postoperative infection. CONCLUSIONS: Predisposition to postoperative infections in PPF patients was associated with prolonged length of surgery and longer hospitalization. We recommend optimizing fast discharge, selecting the appropriate type of surgery, and improving surgical planning to reduce intraoperative delays and length of surgery.


Assuntos
Artroplastia de Quadril , Fraturas do Fêmur , Fixação Interna de Fraturas , Hemiartroplastia , Duração da Cirurgia , Infecção da Ferida Cirúrgica , Idoso , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Causalidade , Feminino , Fraturas do Fêmur/epidemiologia , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Necessidades e Demandas de Serviços de Saúde , Hemiartroplastia/efeitos adversos , Hemiartroplastia/métodos , Humanos , Israel/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Fatores de Risco , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/epidemiologia
6.
Indian J Ophthalmol ; 69(9): 2304-2309, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34427206

RESUMO

Purpose: : To compare the complication rates, surgical time and learning curve using the 3-D Heads up display system in comparison with the conventional microscope for routine cataract surgery. Methods: : Consecutive consenting adults with uncomplicated cataract were offered phacoemulsification using the 3-D Heads up display system (ARTEVO 800 Carl Zeiss Meditec) or the conventional microscope (Zeiss Lumera 700) by two experienced surgeons. Surgical time, measured from start of corneal incision to removal of microscope from the surgical field and complication rates were compared between the groups. Results: : Of the 343 eyes enrolled, 100 (29%) underwent surgery using the 3-D Heads up display system. The surgical time for 3-D Heads up display system was significantly higher in the 3-D group (8.4 ± 2.1 vs. 6.5 ± 1.8 minutes, P < 0.001). There were no group differences in surgical complications (2% in 3-D vs. 2.5% in conventional microscope, P = 0.28). Comparing across 4 quartiles within the 3-D group, the mean surgical time was slightly higher during the 1st quartile (n = 25, 9.1 ± 1.9 minutes) compared to the last quartile (n = 25, 8.2 ± 1.9 minutes) (p = 0.17). Complications in the 3-D group occurred only in the initial 50% of cases. Seven (7%) cases in the 3-D group were converted to conventional binocular microscope of which 3 each were due to difficulty in depth perception and low illumination while one was due to intraoperative pupillary constriction. Conclusion: : Phacoemulsification with the 3-D Heads up display system takes longer time but offers excellent visualization, ergonomics and safety compared to conventional microscopes. Experienced surgeons should be able to adapt easily after their first 50 surgeries.


Assuntos
Extração de Catarata , Catarata , Oftalmologia , Facoemulsificação , Adulto , Humanos , Duração da Cirurgia
7.
Biomed Res Int ; 2021: 5056291, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34337015

RESUMO

Objective: To compare the clinical and radiographic results of the supercapsular percutaneously assisted total hip (SuperPATH) approach and the conventional approach in hip arthroplasty. Design: Based on a prepublished protocol (PROSPERO: CRD42020177717), we searched PubMed, Embase, and Cochrane for relevant literatures up to January 30, 2021. The methodological qualities were assessed using the guidelines provided by the Cochrane Collaboration for Systematic Reviews. Randomized- or fixed-effect models were used to calculate the weighted mean difference (WMD) or odds ratio (OR), respectively, for continuous and dichotomous variables. Results: 6 articles were included in the study, and 526 patients were selected, which included 233 cases in the SuperPATH groups and 279 cases in the conventional groups, and 4 cases performed two surgeries in succession. The SuperPATH group demonstrated shorter incision length (WMD = -7.87, 95% CI (-10.05, -5.69), P < 0.00001), decreased blood transfusion rate (OR = 0.48, 95% CI (0.25, 0.89), P = 0.02), decreased visual analogue scale (VAS) (WMD = -0.40, 95% CI (-0.72, -0.08), P = 0.02), and higher Harris hip score (HHS) (WMD = 1.98, 95% CI (0.18, 3.77), P = 0.03) than the conventional group. However, there was no difference in VAS (P = 0.14) and HHS (P = 0.86) between the two groups 3 months later, nor in the acetabular abduction angle (P = 0.32) in either group. Conclusions: SuperPATH, as a minimally invasive approach with its reduced tissue damage, quick postoperative recovery, and early rehabilitation, demonstrates the short-term advantages of hip arthroplasty. As the evidences in favor of the SuperPATH technique were limited in a small number of studies and short duration of follow-up, more research is required to further analyze its long-term effect.


Assuntos
Artroplastia de Quadril , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Perda Sanguínea Cirúrgica , Transfusão de Sangue , Humanos , Duração da Cirurgia , Viés de Publicação , Publicações , Risco , Resultado do Tratamento , Escala Visual Analógica
8.
Eur J Obstet Gynecol Reprod Biol ; 264: 271-275, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34343772

RESUMO

OBJECTIVE: This study aimed to compare the surgical outcomes of three-dimensional (3D) and two-dimensional (2D) laparoscopic myomectomy. STUDY DESIGN: A total of 64 patients with symptomatic uterine fibroids were randomly assigned to either the 3D (n = 32) group or the 2D group (n = 32). The primary outcomes were the operative blood loss and change in hemoglobin levels. The secondary outcome was operative time. RESULTS: There were no differences in the baseline demographics between the two groups. The 3D and 2D groups were not significantly different in terms of operative blood loss (129.5 ± 86.5 mL vs. 140.9 ± 89.8 mL, P = 0.412), change in serum hemoglobin levels (1.4 ± 1.6 g/dL vs. 1.6 ± 1.6 g/dL, P = 0.553), and operative time (77.4 ± 37.8 min vs. 82.4 ± 35.4 min, P = 0.344). Furthermore, no differences were observed between the groups with regard to other surgical outcomes. CONCLUSION: The 3D imaging system had no additional surgical benefit in laparoscopic myomectomy compared with to the conventional 2D imaging system.


Assuntos
Laparoscopia , Leiomioma , Miomectomia Uterina , Neoplasias Uterinas , Perda Sanguínea Cirúrgica , Feminino , Humanos , Imageamento Tridimensional , Leiomioma/cirurgia , Duração da Cirurgia , Resultado do Tratamento , Neoplasias Uterinas/cirurgia
9.
Eur J Obstet Gynecol Reprod Biol ; 264: 318-329, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34364019

RESUMO

BACKGROUND: Abdominal lateral suspension with mesh represents an alternative treatment to suspend the vaginal apex. OBJECTIVES: The aim of this study was to summarize literature data regarding the anatomical and functional outcomes, and intra- and postoperative complications of this technique with minimally invasive approach (laparoscopic/robotic). SEARCH STRATEGY: Systematic literature search using MEDLINE/PubMed, SCOPUS, Web of Science. DATA COLLECTION AND ANALYSIS: Two authors extracted data on baseline characteristics (age, BMI, prior pelvic reconstructive surgery, preoperative POP stage), perioperative outcomes (operative time, estimated blood loss, intraoperative and postoperative complications, admission time), objective and subjective success rate, surgical failure, time of follow-up. Data were presented descriptively. MAIN RESULTS: Thirteen studies were included in the review. The overall number of patients for our analysis was 1066. Patients referred for laparoscopic/robotic lateral suspension were most frequently postmenopausal, aged 50 to 65 years, BMI ≥ 25 kg/m2; 22.2% were already hysterectomized, while 17% had already a previous POP surgery. Operative time ranged from 78.4 ± 29.7 to 254 ± 45 min. The overall anatomic success was more than 90% in the apical compartment and more than 88% in the anterior compartment. Subjective cure rate varies from 78.4% to 100% in medium-term follow-up. Post-operative complication grade >= 3 according to Claiven-Dindo Scale was 1.03%. Mesh erosion rate varied between 0% and 13%. CONCLUSIONS: Results coming from our systematic review suggest safety, efficacy and feasibility of minimally invasive lateral suspension with optimal anatomical and functional outcomes. Well-designed, randomized, controlled trials are required to confirm this data.


Assuntos
Laparoscopia , Prolapso de Órgão Pélvico , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Humanos , Duração da Cirurgia , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas/efeitos adversos , Resultado do Tratamento , Vagina/cirurgia
11.
Medicine (Baltimore) ; 100(31): e26172, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397789

RESUMO

ABSTRACT: There are needs to evaluate the risk factors for urinary infection after retrograde upper urinary lithotripsy, to provide insights into the management and nursing care of patients with retrograde upper urinary lithotripsy.Patients who received retrograde upper urinary lithotripsy with a Foley 20 urinary tube insertion from June 1, 2019 to December 31, 2020 in our hospital were selected. Patients were grouped urinary infection and no infection group according to the culture results of urine, and the clinical data of the 2 groups of patients were collected and compared. Single factor and logistic regression analysis were used to analyze the risk factors of urinary tract infection after retrograde upper urinary lithotripsy.Four hundred ten patients with retrograde upper urinary lithotripsy were included, of whom 62 patients had the urinary tract infection, the incidence of urinary tract infection was 15.12%. There were significant differences in the gender, age, diabetes, stone diameter, duration of urinary tube insertion and duration of surgery between infection and no-infection group (all P < .05). The Escherichia coli (62.90%) was the most commonly seen bacterial in patients with urinary tract infection. Female (odds ratio [OR]: 1.602, 95% confidence interval 95% [CI]: 1.132∼2.472), age >50 years (OR: 2.247, 95% CI: 1.346∼3.244), diabetes (OR: 2.228, 95% CI: 1.033∼3.451), stone diameter ≥2 cm (OR: 2.152, 95% CI: 1.395∼3.099), duration of urinary tube insertion ≥3 days (OR: 1.942, 95% CI:1.158∼2.632), duration of surgery ≥90 minutes (OR: 2.128, 95% CI: 1.104∼3.846) were the independent risk factors for the postoperative urinary tract infection in patients with retrograde upper urinary lithotripsy (all P < .05).The incidence of urinary tract infection in patients undergoing retrograde upper urinary lithotripsy was high, counteractive measures targeted on those risk factors are needed to prevent and reduce the postoperative urinary infection in clinical settings.


Assuntos
Cálculos Renais/terapia , Litotripsia/efeitos adversos , Cálculos Ureterais/terapia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Fatores Etários , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Incidência , Litotripsia/métodos , Litotripsia/enfermagem , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Cateterismo Urinário
12.
Medicine (Baltimore) ; 100(31): e26189, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397790

RESUMO

BACKGROUND AND OBJECTIVES: Postoperative major complications after esophageal cancer resection vary and may significantly impact long-term outcomes. This study aimed to build an individualized nomogram to predict post-esophagectomy major morbidity. METHODS: This retrospective study included 599 consecutive patients treated at a single center between January 2017 and April 2019. Of them, 420 and 179 were assigned to the model development and validation cohorts, respectively. Major morbidity predictors were identified using multiple logistic regression. Model discrimination and calibration were evaluated by validation. Regarding clinical usefulness, we examined the net benefit using decision curve analysis. RESULTS: The mean age was 64 years; 79% of the patients were male. The most common comorbidities were hypertension, diabetes mellitus, and stroke history. The 30-day postoperative major morbidity rate was 24%. Multivariate logistic regression analysis showed that age, smoking history, coronary heart disease, dysphagia, body mass index, operation time, and tumor size were independent risk factors for surgery-associated major morbidity. Areas under the receiver-operating characteristic curves of the development and validation groups were 0.775 (95% confidence interval, 0.721-0.829) and 0.792 (95% confidence interval, 0.709-0.874), respectively. In the validation cohort, the nomogram showed good calibration. Decision curve analysis demonstrated that the prediction nomogram was clinically useful. CONCLUSION: Morbidity models and nomograms incorporating clinical and surgical data can be used to predict operative risk for esophagectomy and provide appropriate resources for the postoperative management of high-risk patients.


Assuntos
Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/cirurgia , Esofagectomia/efeitos adversos , Nomogramas , Complicações Pós-Operatórias/etiologia , Fatores Etários , Idoso , Área Sob a Curva , Índice de Massa Corporal , Comorbidade , Doença das Coronárias/epidemiologia , Transtornos de Deglutição/etiologia , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/epidemiologia , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/complicações , Carcinoma de Células Escamosas do Esôfago/epidemiologia , Carcinoma de Células Escamosas do Esôfago/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Fumar/epidemiologia , Carga Tumoral
13.
Medicine (Baltimore) ; 100(34): e27012, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34449473

RESUMO

BACKGROUND: Robotic-assisted gastrectomy has been used for treating gastric cancer since 2002. This meta-analysis was conducted to systematically evaluate the efficacy of Da Vinci robotic distal subtotal gastrectomy (RDG) or laparoscopic distal subtotal gastrectomy (LDG) in patients with gastric cancer. METHODS: We conducted searches in domestic and foreign databases, and collected literature in Chinese and English on the efficacy of RDG and LDG for gastric cancer that have been published since the inception of the database. RevMan 5.4.1 was used for meta-analysis and drawing and Stata14.0 was used for publication bias analysis. RESULTS: A total of 3293 patients in 15 studies were included, including 1193 patients in the RDG group and 2100 patients in the LDG groups respectively. The meta-analysis showed that intraoperative blood loss was significantly lower and the number of resected lymph nodes was higher in the RDG group compared to that in the LDG group. In addition, the times to first postoperative food intake and postoperative hospital stay were shortened, and there was a longer length of distal resection margin and prolonged duration of operation. No significant differences were found between the 2 groups with respect to the first postoperative anal exhaust time, length of proximal resection margin, total postoperative complication rate, postoperative anastomotic leakage rate, incidence of postoperative gastric emptying disorder, pancreatic fistula rate, recurrence rate, and mortality rate. CONCLUSION: RDG is a safe and feasible treatment option for gastric cancer, and it is non-inferior or even superior to LDG with respect to therapeutic efficacy and radical treatment.


Assuntos
Gastrectomia/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Neoplasias Gástricas/cirurgia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Ensaios Clínicos como Assunto , Gastrectomia/métodos , Humanos , Laparoscopia/métodos , Tempo de Internação/estatística & dados numéricos , Excisão de Linfonodo , Duração da Cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Gástricas/patologia
14.
Medicine (Baltimore) ; 100(34): e27075, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34449508

RESUMO

BACKGROUND: Secondary Budd-Chiari syndrome (BCS) occurs due to a blockage in the liver caused by invasion or compression by a large lesion. Conventional treatments for BCS do not solve practical problems, wherease liver transplantation has been only applied as a last-resort therapy and as the only opportunity for a radical cure. We explored the feasibility of applying ex vivo liver resection and autotransplantation (ELRA) for the new indications of treating patients with end-stage hepatic alveolar echinococcosis (HAE). Our center has firstly proposed the idea and successfully treated the 49 patients with HAE. This article for the first time reports the application of ELRA in treating patients with BCS secondary to HAE. METHODS: According to the degree of lesion invasion and surgical options, 11 patients were divided into 4 types. These 11 patients had large lesions that invaded the second and third hilum of the caudate lobe and involved the confluence of the hepatic vein and the inferior vena cava, suprahepatic vena cava, or at least 2 hepatic veins and led to secondary BCS. The aim of the present work was to report 11 patients with life-threatening diseases who underwent ELRA (ex vivo liver resection and autotransplantation) for secondary BCS, to propose a classification system for secondary BCS, and to suggest that secondary BCS is an indication for ELRA. RESULTS: Eleven patients successfully underwent ELRA without intraoperative mortality. The median autograft weight was 690 g (440-950 g); operative time was 12.5 hours (9.4-16.5 hours); Postoperative hospital stay was 15 days (7-21 days). Clavien-Dindo grade IIIa or higher postoperative complications occurred in only 5 patients. CONCLUSIONS: This article for the first time reports the application of ELRA in treating patients with BCS secondary to HAE, not only provides new ideas for alternative treatments of secondary BCS, but also provides a classification system for secondary BCS. This article describes the technical process of outflow tract reconstruction and the experience for expanding the indications for ELRA. Our study demonstrated that ELRA is well feasible for treatment of BCS secondary to advanced HAE.


Assuntos
Síndrome de Budd-Chiari/etiologia , Síndrome de Budd-Chiari/cirurgia , Equinococose Hepática/complicações , Transplante de Fígado/métodos , Adulto , Feminino , Hepatectomia , Humanos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Transplante Autólogo
15.
Medicine (Baltimore) ; 100(32): e26708, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397873

RESUMO

ABSTRACT: Laparoscopic donor hepatectomy (LDH), accepted as a minimally invasive approach, has become increasingly popular for living donor liver transplant. However, the outcomes of LDH remain to be fully clarified when compared with open living donor hepatectomy. Thus, our meta-analysis was designed to assess the efficacy of laparoscopic in comparison with conventional open donor hepatectomy.The PubMed, Cochrane, and Embase electronic databases were searched to identify the articles concerning the comparison of the efficacy of laparoscopic versus open surgery in treatment of living donor liver transplantation updated to March, 2020. The main search terms and medical Subject Heading terms were: "living donor," "liver donor," "minimally invasive," "laparoscopic surgery," and "open surgery." After rigorous evaluation on quality, the data was extracted from eligible publications. The outcomes of interest included intraoperative and postoperative results.The inclusion criteria were met by a total of 20 studies. In all, 2001 subjects involving 633 patients who received laparoscopic surgery and 1368 patients who received open surgery were included. According to the pooled result of surgery duration, the laparoscopic surgery was associated with shorter duration of hospital stay (MD = -1.07, 95% CI -1.85 to -0.29; P = .007), less blood loss (MD = -57.57, 95% CI -65.07 to -50.07; P < .00001), and less postoperative complications (OR = 0.61, 95% CI 0.44-0.85; P = .003). And the open donor hepatectomy achieved a trend of shorter operation time (MD = 30.31, 95% CI 13.93-46.69; P = .0003) than laparoscopic group. Similar results were found in terms of ALT (P = .52) as well as the AST (P = .47) peak level between the 2 groups.LDH showed the better perioperative outcomes as compared with open donor hepatectomy. The findings revealed that LDH may be a feasible and safe procedure for the living donor liver transplantation.


Assuntos
Hepatectomia/métodos , Laparoscopia/métodos , Transplante de Fígado/métodos , Doadores Vivos , Humanos , Duração da Cirurgia , Coleta de Tecidos e Órgãos/métodos
16.
Medicine (Baltimore) ; 100(32): e26773, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397880

RESUMO

ABSTRACT: Delayed recovery (DR) is very commonly seen in the patients undergoing laparoscopic radical biliary surgery, we aimed to investigate the potential risk factors of DR in the patients undergoing radical biliary surgery, to provide evidences into the management of DR.Patients who underwent radical biliary surgery from January 1, 2018 to August 31, 2020 were identified. The clinical characteristics and treatment details of DR and no-DR patients were compared and analyzed. Multivariable logistic regression analyses were conducted to identify the potential influencing factors for DR in patients with laparoscopic radical biliary surgery.We included a total of 168 patients with laparoscopic radical biliary surgery, the incidence of postoperative DR was 25%. There were significant differences on the duration of surgery, duration of anesthesia, and use of intraoperative combined sevoflurane inhalation (all P < .05), and there were not significant differences on American Society of Anesthesiologists, New York Heart Association, tumor-lymph node- metastasis, and estimated blood loss between DR group and control group (all P > .05). Multivariable logistic regression analyses indicated that age ≥70 years (odd ratio [OR] 1.454, 95% confidence interval [CI] 1.146-1.904), body mass index ≥25 kg/m2 (OR 1.303, 95% CI 1.102-1.912), alcohol drinking (OR 2.041, 95% CI 1.336-3.085), smoking (OR 1.128, 95% CI 1.007-2.261), duration of surgery ≥220 minutes (OR 1.239, 95% CI 1.039-1.735), duration of anesthesia ≥230 minutes (OR 1.223, 95% CI 1.013-1.926), intraoperative combined sevoflurane inhalation (OR 1.207, 95% CI 1.008-1.764) were the independent risk factors for DR in patients with radical biliary surgery (all P < .05).It is clinically necessary to take early countermeasures against various risk factors to reduce the occurrence of DR, and to improve the prognosis of patients.


Assuntos
Período de Recuperação da Anestesia , Anestesia Geral/efeitos adversos , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Laparoscopia/métodos , Complicações Pós-Operatórias/prevenção & controle , Medição de Risco/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , China/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco
17.
Ann R Coll Surg Engl ; 103(8): 569-575, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34464575

RESUMO

INTRODUCTION: Chronic postsurgical pain (CPP) remains the main complication after Lichtenstein hernioplasty. The open new simplified totally extraperitoneal (ONSTEP) technique is a more recent transinguinal procedure that seems to be associated with less CPP. The aim of this study was to compare outcomes of the ONSTEP versus the Lichtenstein procedure for primary inguinal hernia. METHODS: In this prospective, double-blinded and single-centre clinical trial, CPP at the six-month follow up assessed by a visual analogue scale was the primary endpoint. Secondary endpoints were operative time, perioperative complications, length of hospital stay, early pain, time to return to daily activities and to work, pain-related sexual dysfunction, aesthetic satisfaction and recurrence. RESULTS: A total of 100 men were allocated to undergo either the Lichtenstein (n=50) or the ONSTEP (n=50) hernioplasty. The incidence of CPP was nonsignificantly lower in the ONSTEP group compared with the Lichtenstein group (28% vs 42%; p=0.142). However, the ONSTEP procedure required less operative time (42 vs 62min; p<0.001). Patients from the ONSTEP group resumed their daily activities earlier (5.94±3.9 days vs 8.56±5.14 days; p=0.009), had fewer postsurgical complications (5 vs 19; p=0.001) and expressed better satisfaction with the cosmetic result (p=0.041). No recurrence was observed after six months of follow up. CONCLUSION: CPP was similar, but the ONSTEP technique was associated with shorter operating time, earlier return to normal daily activities, fewer postsurgical complications and better cosmetic results.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor Crônica/etiologia , Método Duplo-Cego , Herniorrafia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/etiologia , Satisfação do Paciente , Estudos Prospectivos , Recuperação de Função Fisiológica , Escala Visual Analógica , Adulto Jovem
18.
J Laparoendosc Adv Surg Tech A ; 31(9): 1079-1083, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34357803

RESUMO

Background: Thoracoscopic diaphragmatic plication has gained popularity in the treatment of congenital diaphragmatic eventration (CDE), but the therapeutic effect and prognosis have rarely been compared with nonendoscopic surgery. Materials and Methods: The medical records of 77 children who had received treatment for CDE in our institution from September 2006 to January 2019 were retrospectively analyzed. According to the repair approach, the children were divided into a thoracoscopic plication group and a modified small incision plication group. The perioperative characteristics and follow-up details after diaphragm plication were compared between the two groups. Results: Among 77 children with CDE, 44 cases were in the thoracoscopic plication group and 33 cases were in the modified small incision plication group. All the cases of CDE were unilateral, with 13 cases on the left side and 64 cases on the right side. There were no differences in the preoperative characteristics between the two groups. The modified small incision plication group had a higher bleeding volume (P = .000) and a greater proportion of patients needing chest drainage (P = .000), whereas the differences in the total and postoperative hospital stays (P = .088, P = .247, respectively) did not significantly differ between the two groups. There were no differences in postoperative improvement in the location of the diaphragm between the two groups or between the right and left lesions (P = .438, P = .677, respectively). The total follow-up time was 2-11 years. No recurrence was reported during this period in either of the groups, but the incidence of postoperative thoracic deformities was higher in the modified small incision plication group (P = .013). Conclusions: Compared with the modified small incision plication, thoracoscopic plication has the advantages of smaller blood loss, a low percentage of intrathoracic drainage tube usage, and no occurrence of thoracic deformities.


Assuntos
Eventração Diafragmática , Criança , Diafragma/cirurgia , Eventração Diafragmática/cirurgia , Humanos , Duração da Cirurgia , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
19.
Beijing Da Xue Xue Bao Yi Xue Ban ; 53(4): 728-733, 2021 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-34393236

RESUMO

OBJECTIVE: To explore the differences of alignment and operative time between portable accelerometer-based navigation device (PAD) and computer assisted surgery (CAS) in total knee arthroplasty (TKA). METHODS: Data of patients using iASSIST (a kind of PAD) and OrthoPilot (a kind of CAS) for TKA in Peking University Third Hospital from December 2017 to December 2019 were retrospectively collected. The differences of preoperative general data, preoperative alignment, operative time and postoperative alignment were studied between the two groups. RESULTS: A total of 82 patients were enrolled in our study, including 40 patients in the PAD group and 42 patients in the CAS group. Gender, age, body mass index (BMI), surgical side, preoperative hip-knee-ankle (HKA) angle and preoperative HKA angle deviation didn't show statistically significant difference between the PAD group and the CAS group (P>0.05). Postoperative HKA angle (180.8°±2.2° vs.181.8±1.6°, t=-2.458, P=0.016) and postoperative coronal femoral-component angle (CFA, 90.6°±1.8° vs. 91.6°±1.6°, t =-2.749, P=0.007) of the PAD group were smaller than those of the CAS group, but there was no significant difference in coronal tibia-component angle (CTA, 90.0°±1.3° vs.89.6°±1.4°, t=1.335, P=0.186) between the two groups. There was no significant difference in the rate of outliers (varus or valgus > 3°) for postoperative HKA angle (10.0% vs.11.9%, χ2 =0.076, P=0.783), CFA (12.5% vs. 14.3%, χ2=0.056, P=0.813) and CTA (2.5% vs. 0%, χ2=1.063, P=0.303). There was no significant difference in the accuracy of postoperative HKA angle (2.1° vs. 2.0°, t=0.055, P=0.956), CFA (1.4° vs. 1.8°, t=-1.365, P=0.176) and CTA (1.0° vs. 1.1°, t=-0.828, P=0.410) between the two groups. The precision of postoperative HKA angle (1.1° vs. 1.3°, F=1.251, P=0.267), CFA (1.3° vs. 1.4°, F=0.817, P=0.369) and CTA (0.8° vs. 0.9°, F=0.937, P=0.336) were also not significantly different. We also didn't find statistically significant difference in operative time between the two groups [(83.4±25.6) min vs. (86.5±17.7) min, t=-0.641, P=0.524]. CONCLUSION: PAD and CAS had similar accuracy and precision in alignment in TKA, and there was no significant difference in operative time, which indicates that PAD has a broad application prospect in TKA.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Cirurgia Assistida por Computador , Acelerometria , Humanos , Articulação do Joelho/cirurgia , Duração da Cirurgia , Estudos Retrospectivos , Tíbia/cirurgia
20.
BMC Musculoskelet Disord ; 22(1): 730, 2021 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-34429099

RESUMO

Patient-specific Instrumentation (PSI) is an innovative technique aiding the precise implementation of the preoperative plan during total knee arthroplasty (TKA) by using patient-specific guides and cutting blocks. Despite of the theoretical advantages, studies have reported contradictory results, thus there is no consensus regarding the overall effectiveness of PSI. Through the critical assessment of a meta-analysis published lately, this correspondence aims to highlight the complexity of comparing the efficacy of PSI to standard instrumentation (SI). The accuracy of component alignment, patient-reported outcome measures (PROMs), surgery time, blood loss, transfusion rate, and postoperative complications are commonly used outcomes for investigating the efficacy of PSI-aided TKA. By assessing component alignment, the expertise of the surgeon(s) should be taken into consideration, since PSI may not provide benefits for expert surgeons but might improve accuracy and patient safety during the learning curve of novice surgeons. With respect to PROMs and postoperative complications, PSI may not improve short-term results; however, long-term follow up data is missing. Regarding transfusion rates, favorable trends can be observed, but further studies utilizing recent data are needed for a clear conclusion. When assessing surgery time, we suggest focusing on operating room turnover instead of procedure time.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Artroplastia do Joelho/efeitos adversos , Humanos , Duração da Cirurgia , Medidas de Resultados Relatados pelo Paciente , Navios
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