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1.
Dis Colon Rectum ; 65(3): e176-e178, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-35138289

RESUMO

INTRODUCTION: Stoma prolapse is a common complication associated with ostomy creation, causing leakage, obstruction, and sometimes incarceration. Sometimes ileostomy prolapse cannot be treated with resection and alternative methods must be applied. We propose a new surgical revisional technique for ileostomy prolapse. TECHNIQUE: Under general anesthesia, the prolapsed stoma is dissected and freed from the fascia and skin. The bowel is everted to create a nipple of 2-3 cm and subsequently fixed with a 3-row linear stapler, creating a "Phillips ileostomy." The ileostomy is then sutured to the skin with 3-0 full thickness stitches. RESULTS: In our center, 3 patients were treated in a day surgery setting, and no complication occurred. One patient reported a prolapse recurrence after 6 months and was successfully treated with the same technique with no recurrence at 1 year. CONCLUSIONS: The 3-row stapler fixation of prolapsed ileostomy is simple to perform, preserves the bowel, and can be performed in the day surgery setting.


Assuntos
Doença de Crohn/cirurgia , Ileostomia , Complicações Pós-Operatórias , Proctocolectomia Restauradora , Reoperação/métodos , Estomas Cirúrgicos/efeitos adversos , Adulto , Feminino , Humanos , Ileostomia/efeitos adversos , Ileostomia/métodos , Enteropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Proctocolectomia Restauradora/efeitos adversos , Proctocolectomia Restauradora/métodos , Prolapso , Fatores de Risco , Resultado do Tratamento
2.
Clin J Gastroenterol ; 15(2): 381-387, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35064919

RESUMO

Gastrointestinal duplications are congenital malformations that are usually observed in pediatric patients. Diagnosis in adulthood is quite rare, and preoperative diagnosis of gastrointestinal duplication is difficult, particularly in the small intestine. We encountered an extremely rare adult case of duplication of the jejunum, which showed a stomach-like form diagnosed using double-balloon enteroscopy (DBE). The patient was an 18-year-old male who had been experiencing upper abdominal pain and vomiting repeatedly without any triggers for 3 years. Various examinations were performed, but no cause of symptoms was found. DBE revealed a narrow opening of the lumen at the upper jejunum, and the lumen was covered with mucosal folds similar to those of the stomach. Enteroclysis via DBE showed a tubular structure on the mesenteric side of the jejunum. We diagnosed a jejunal tubular duplication with ectopic gastric mucosa and underwent partial small bowel resection. The patient's abdominal symptoms resolved. From this, DBE can be a useful tool for diagnosing intestinal duplication in adults. We believe that this case and literature review will facilitate the accurate and prompt diagnosis of small intestinal duplication.


Assuntos
Enteroscopia de Duplo Balão , Enteropatias , Adolescente , Adulto , Biópsia , Criança , Humanos , Enteropatias/cirurgia , Intestino Delgado/cirurgia , Jejuno/cirurgia , Masculino
3.
Surgery ; 171(3): 607-614, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34844751

RESUMO

BACKGROUND: Early identification of colorectal surgery patients predicted to have uneventful gastrointestinal recovery may allow for early discharge. Our objective was to identify trajectories of gastrointestinal recovery within a colorectal surgery enhanced recovery pathway. METHODS: Data from 2 prospective studies enrolling adult patients undergoing elective laparoscopic colorectal resection at a specialist colorectal referral center were analyzed (2013-2019). All patients were managed according to a mature enhanced recovery pathway with a 3-day target length of stay. Postoperative gastrointestinal symptoms were collected daily and expressed using the validated I-FEED score. Latent-class growth curve (trajectory) analysis was used to identify different I-FEED trajectories over the first 3 postoperative days. RESULTS: A total of 192 patients were analyzed. Trajectory analysis identified 3 distinct trajectories: trajectory 1 had no gastrointestinal symptoms (41%); trajectory 2 had mild early symptoms with improvement over time (48%); and trajectory 3 had gastrointestinal symptoms that significantly worsened between postoperative days 1 and 2 (11%). I-FEED score ≤1 on postoperative day 1 predicted trajectory 1. Trajectory 1 had the best clinical outcomes, whereas trajectory 3 had the worst. CONCLUSION: I-FEED trajectory over postoperative days 1-3 was associated with clinical outcomes and may be used to predict gastrointestinal recovery. Findings from this study may inform clinical decision making regarding early hospital discharge within colorectal enhanced recovery pathways.


Assuntos
Colectomia/efeitos adversos , Recuperação Pós-Cirúrgica Melhorada , Enteropatias/cirurgia , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Protectomia/efeitos adversos , Idoso , Protocolos Clínicos , Feminino , Humanos , Enteropatias/patologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos
4.
Surg Endosc ; 36(5): 3227-3233, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34287705

RESUMO

BACKGROUND: Double-balloon enteroscopy (DBE) is used for the diagnosis and therapy of small bowel disease. Endoscopic sampling and marking small bowel lesions destined for surgery permit intracorporeal resection and reconstruction (IRR), thereby facilitating a complete minimally invasive technique. There are limited data that compare outcomes of IRR to conventional extracorporeal resection and reconstruction (ERR). The purpose of this study was to evaluate the surgical outcomes of patients undergoing pre-operative DBE for lesion marking followed by laparoscopic IRR compared to those undergoing ERR. METHODS: A retrospective chart review was performed on patients who underwent DBE followed by small bowel resection from 2006 to 2017 at a single tertiary care medical center. IRR was defined as laparoscopic inspection to identify the lesion (previously marked by DBE or by laparoscopic-assisted DBE) followed by intra-abdominal bowel resection and anastomosis with specimen extraction via minimal extension of a laparoscopic port site. ERR was defined as extracorporeal resection and/or reconstruction performed via a conventional or mini-laparotomy abdominal incision. RESULTS: A total of 82 patients met inclusion criteria and were reviewed. Thirty-two patients (39%) had ERR and 50 patients (61%) had IRR. The most common indications for DBE were small bowel bleeding (76%) and small bowel mass or thickening on prior imaging studies (16%). Successful DBE was higher in the IRR group when compared to the ERR group, but not significantly different (90% vs 75%, p-value 0.07). Patients who underwent IRR had faster bowel function recovery (2 vs 4 days, p < 0.01), shorter time to discharge (3 vs 7 days, p < 0.01), and fewer post-operative complications (10 vs 18; p < 0.01), when compared to the ERR group. CONCLUSION: DBE successfully facilitated laparoscopic small bowel IRR and this approach was associated with faster return of bowel function, shorter recovery time, and decreased morbidity when compared to ERR.


Assuntos
Enteroscopia de Duplo Balão , Enteropatias , Enteroscopia de Duplo Balão/métodos , Hemorragia Gastrointestinal/etiologia , Humanos , Enteropatias/cirurgia , Intestino Delgado/patologia , Intestino Delgado/cirurgia , Estudos Retrospectivos
5.
Abdom Radiol (NY) ; 47(5): 1636-1643, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-32382818

RESUMO

PURPOSE: The purpose of this study was to identify the significant imaging predictors of transmural intestinal necrosis in patients with acute mesenteric ischemia (AMI). METHODS: The medical records and CT imaging of 48 patients between 2011 and 2019 suspected of having AMI that underwent exploratory laparotomy with bowel resection and pathological confirmation of ischemic bowel injury were retrospectively reviewed. Using histopathology as a gold standard, various parameters related to vascular insufficiency and bowel injury were analyzed and correlated with outcome of ischemic bowel necrosis using nonparametric tests. Univariate analysis was performed using Fisher's exact test followed by binary logistic regression test for multivariate analysis. RESULTS: 48 Patients (19 females, 40%) with a median age of 68.5 years (IQR of 17 years) built our retrospective cohort. 26 (54%) patients were found to have transmural intestinal necrosis on histopathology (case group) whereas 22 (46%) patients had partial mucosal injury (control group). Pneumatosis intestinalis (p = 0.005, odd's ratio of 2.07-63.14) and severity (> 70% or complete occlusion) of vascular narrowing (p = 0.019, odd's ratio of 1.39-42.30) were identified as the most significant predictors of transmural ischemic necrosis on imaging. Dilatation of bowel did not approach the statistical significance on multivariate analysis although it was found significant on univariate analysis (p = 0.041). CONCLUSION: Pneumatosis intestinalis and severity of vascular luminal narrowing are the most important imaging predictors of transmural ischemic bowel necrosis in patients presenting with AMI. The presence of these findings on CT scan should raise high index of suspicion for irreversible transmural ischemic necrosis. In the absence of these factors, endovascular management might be beneficial.


Assuntos
Traumatismos Abdominais , Enteropatias , Isquemia Mesentérica , Adolescente , Feminino , Humanos , Enteropatias/cirurgia , Isquemia/diagnóstico por imagem , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/cirurgia , Necrose/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
6.
Am Surg ; 87(12): 1893-1900, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34772281

RESUMO

BACKGROUND: COVID-19 is a deadly multisystemic disease, and bowel ischemia, the most consequential gastrointestinal manifestation, remains poorly described. Our goal is to describe our institution's surgical experience with management of bowel ischemia due to COVID-19 infection over a one-year period. METHODS: All patients admitted to our institution between March 2020 and March 2021 for treatment of COVID-19 infection and who underwent exploratory laparotomy with intra-operative confirmation of bowel ischemia were included. Data from the medical records were analyzed. RESULTS: Twenty patients were included. Eighty percent had a new or increasing vasopressor requirement, 70% had abdominal distension, and 50% had increased gastric residuals. Intra-operatively, ischemia affected the large bowel in 80% of cases, the small bowel in 60%, and both in 40%. Sixty five percent had an initial damage control laparotomy. Most of the resected bowel specimens had a characteristic appearance at the time of surgery, with a yellow discoloration, small areas of antimesenteric necrosis, and very sharp borders. Histologically, the bowel specimens frequently have fibrin thrombi in the small submucosal and mucosal blood vessels in areas of mucosal necrosis. Overall mortality in this cohort was 33%. Forty percent of patients had a thromboembolic complication overall with 88% of these developing a thromboembolic phenomenon despite being on prophylactic pre-operative anticoagulation. CONCLUSION: Bowel ischemia is a potentially lethal complication of COVID-19 infection with typical gross and histologic characteristics. Suspicious clinical features that should trigger surgical evaluation include a new or increasing vasopressor requirement, abdominal distension, and intolerance of gastric feeds.


Assuntos
COVID-19/complicações , Enteropatias/cirurgia , Enteropatias/virologia , Isquemia/cirurgia , Isquemia/virologia , Feminino , Humanos , Laparotomia , Masculino , Massachusetts , Pessoa de Meia-Idade , SARS-CoV-2
7.
BMC Gastroenterol ; 21(1): 362, 2021 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-34620099

RESUMO

BACKGROUND: Patients with intestinal Behçet's disease (BD) frequently undergo intestinal resections, which significantly affects postoperative morbidity and mortality. The aim of this study was to identify the association between C-reactive protein (CRP) levels and postoperative outcomes in patients with intestinal BD who underwent surgical bowel resection. METHODS: Patients who were diagnosed with intestinal BD and underwent intestinal surgery due to BD at Severance Hospital between November 2005 and April 2018 were retrospectively investigated. Clinical relapse was defined as a disease activity index of BD (DAIBD) > 40, existence of newly added medications, re-hospitalization, or re-operation related to intestinal BD. The relationship between CRP level and postoperative outcomes was analyzed, and a receiver operating characteristic (ROC) curve was drawn to specify a cut-off value. RESULTS: Ninety patients with intestinal BD were included. Among them, 44 were male (48.9%), and the median age at diagnosis was 38 years (range, 11-69 years). The median total disease follow-up duration was 130 months (range, 3-460 months). Forty patients (44.4%) underwent laparoscopic surgery. A higher CRP level immediately after surgery was significantly associated with postoperative complications (OR 1.01, 95% CI 1.004-1.018, p < 0.01), re-operation (hazard ratio [HR] 1.01, 95% CI 1.005-1.020, p < 0.01), and re-admission (HR 1.01, 95% CI 1.006-1.017 p < 0.01). The ROC curve showed that CRP predicts the risk of postoperative complications (p < 0.01) at a cut-off value of 41.9% with a sensitivity of 60.0% and specificity of 67.7%. CONCLUSIONS: Postoperative CRP levels in patients with intestinal BD undergoing surgical resection were associated with postoperative outcomes.


Assuntos
Síndrome de Behçet , Proteína C-Reativa , Enteropatias , Adolescente , Adulto , Idoso , Síndrome de Behçet/cirurgia , Proteína C-Reativa/análise , Criança , Feminino , Humanos , Enteropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Adulto Jovem
9.
J Clin Lipidol ; 15(4): 574-578, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34344629

RESUMO

Xanthomas are visibly deformed cholesterol deposits that are commonly associated with lipid disorders, such as familial hypercholesterolemia (FH) or rare sitosterolemia. We present the first report of two cases of carotid sheath xanthomas in patients with lipid disorders. Case 1 involved a 26-year-old woman presenting with two heterogeneous mutations on the ABCG5 gene-as noted on genetic testing-who was finally diagnosed with sitosterolemia. Ultrasonography (US) revealed hypoechoic masses centered in the bilateral carotid sheath, which gradually reduced in size after diet control and the use of ezetimibe. Case 2 involved a 27-year-old man who was diagnosed with possible FH and had recurrent bilateral buttock xanthomas, as well as bilateral carotid sheath masses detected by US. Postoperative pathological examination of the resected right neck mass confirmed a xanthoma with proliferation of multinucleated giant cells and deposition of cholesterol clefts.


Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Hipercolesterolemia/diagnóstico por imagem , Hiperlipoproteinemia Tipo II/diagnóstico por imagem , Enteropatias/diagnóstico por imagem , Erros Inatos do Metabolismo Lipídico/diagnóstico por imagem , Fitosteróis/efeitos adversos , Xantomatose/diagnóstico por imagem , Adulto , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/cirurgia , Feminino , Humanos , Hipercolesterolemia/complicações , Hipercolesterolemia/cirurgia , Hiperlipoproteinemia Tipo II/complicações , Hiperlipoproteinemia Tipo II/cirurgia , Enteropatias/complicações , Enteropatias/cirurgia , Transtornos do Metabolismo dos Lipídeos/complicações , Transtornos do Metabolismo dos Lipídeos/diagnóstico por imagem , Transtornos do Metabolismo dos Lipídeos/cirurgia , Erros Inatos do Metabolismo Lipídico/complicações , Erros Inatos do Metabolismo Lipídico/cirurgia , Masculino , Xantomatose/complicações , Xantomatose/cirurgia
10.
Nutrients ; 13(6)2021 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-34205024

RESUMO

Nutritional management of patients with intestinal failure often includes the use of oligomeric formulas. Implementing the use of oligomeric formulas in surgical patients with maldigestion or malabsorption could be a nutritional strategy to be included in clinical protocols. We aim to generate knowledge from a survey focused on the effectiveness of nutritional therapy with oligomeric formulas with Delphi methodology. Each statement that reached an agreement consensus among participants was defined as a median consensus score ≥7 and as an interquartile range ≤3. The use of oligomeric formulas in surgical patients, starting enteral nutrition in the post-operative phase in short bowel syndrome and in nonspecific diarrhea after surgical procedures, could improve nutritional therapy implementation. Stakeholders agreed that early jejunal enteral nutrition with oligomeric formula is more effective compared to intravenous fluid therapy and it is useful in patients undergoing upper gastro-intestinal tract major surgery when malabsorption or maldigestion is suspected. Finally, oligomeric formulas may be useful when a feeding tube is placed distally to the duodenum. This study shows a practical approach to the use of oligomeric formulas in surgical patients with intestinal disorders and malabsorption, and it helps clinicians in the decision-making process.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Alimentos Formulados , Enteropatias/dietoterapia , Terapia Nutricional/métodos , Adulto , Consenso , Técnica Delfos , Nutrição Enteral/métodos , Feminino , Humanos , Enteropatias/cirurgia , Masculino
11.
Curr Opin Gastroenterol ; 37(5): 434-440, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34265795

RESUMO

PURPOSE OF REVIEW: The aim of this study was to provide practical tips to readers on how to perform deep enteroscopy efficiently. RECENT FINDINGS: Deep enteroscopy has revolutionized the diagnosis and management of small intestinal conditions in recent years. They are extremely valuable, but may be technically challenging to perform, regardless if it is double balloon enteroscopy, single balloon enteroscopy or spiral enteroscopy. The common issues to these procedures are repetitive motion, extended procedure duration and physical exertion during scope advancement. These situations may in turn lead to a variety of ergonomic issues that need to be addressed accordingly to prevent occupational injuries to the endoscopists and their assistants. Depending on the clinical indications, the technical approach and execution of these procedures may be carried out differently. Some guiding principles may be applied to make performing these procedures more smoothly, effectively and deeply. SUMMARY: Careful planning and skilful manipulations are essential to performing an efficient and stress-free deep enteroscopy. There are many simple ways to improve on the ergonomics and performance of these procedures.


Assuntos
Enteropatias , Laparoscopia , Enteroscopia de Duplo Balão , Endoscopia Gastrointestinal , Humanos , Enteropatias/cirurgia , Intestino Delgado/diagnóstico por imagem
12.
J Gastroenterol Hepatol ; 36(11): 3183-3190, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34269477

RESUMO

BACKGROUND AND AIM: With the advent of video capsule endoscopy (VCE) and device-assisted enteroscopy (DAE), the indication of intraoperative enteroscopy (IOE) has become limited due to reported high morbidity/mortality. Most of the earlier studies on IOE were small/from pre-VCE/DAE era. We aimed to evaluate the impact of IOE in management of small bowel disorders (SBD) in post-VCE/DAE era. METHODS: Patients with SBD undergoing IOE over last 15 years were evaluated retrospectively. Overall diagnostic/therapeutic yield, incremental diagnostic yield over preoperative investigations, and adverse events were noted. We also evaluated the number of cases in which IOE changed the management or guided surgical or endoscopic therapy. Rebleeding and recurrence were evaluated in patients with available follow-up data. RESULTS: A total of 89 patients (59 male, 9-82 years) were included in the study. Overall diagnostic and therapeutic yield were 92.1% and 85.4%, respectively. Common findings of IOE were benign ulcers/strictures (30.1%), vascular lesions (26%), diverticula (15.1%), and tumors (13.7%). A total of 49.4% (44/89), 36% (32/89), and 20.2% (18/89) underwent VCE, DAE, or both, respectively, before IOE. Incremental diagnostic yield over preoperative work-up was 31.5% (28/89), and IOE changed the management in 37.1% (33/89) patients. IOE was used to guide surgery/endotherapy in 39.3% (35/89) patients. Recurrent gastrointestinal bleed occurred in 21.2% (14/66) patients. Morbidity and mortality rates were 20.2% (18/89) and 3.4% (3/89), respectively. CONCLUSIONS: Intraoperative enteroscopy remains an essential technique to evaluate SBD and can detect new and additional lesions even after extensive preoperative evaluation. IOE is useful in guiding therapy in preoperatively identified lesions and can change management in a substantial proportion of patients. Hence, IOE has a definitive role in post-VCE/DAE era in carefully selected patients with SBD.


Assuntos
Endoscopia Gastrointestinal , Enteropatias , Intestino Delgado , Cuidados Intraoperatórios , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Endoscopia por Cápsula , Criança , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/métodos , Feminino , Humanos , Enteropatias/diagnóstico por imagem , Enteropatias/cirurgia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/cirurgia , Cuidados Intraoperatórios/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto Jovem
13.
Indian J Pathol Microbiol ; 64(Supplement): S175-S177, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34135164

RESUMO

Pancreatic and gastric heterotopias are rare congenital anomalies which have been reported throughout the length of the gastrointestinal tract. Combined gastric and pancreatic heterotopias, although very rare, have been described mainly in the duodenum followed by jejunum with ileum being a rare site. The reported incidence of this combined heterotopias is low, ranging from <1% to 13%. Extensive literature search has revealed that only Four cases of combined pancreatic and gastric heterotopias have been reported in the small intestine till date. Hence, we report this case for its rarity and unusual presentation as intussusception in a young male.


Assuntos
Enteropatias/congênito , Enteropatias/diagnóstico por imagem , Intestino Delgado/patologia , Intussuscepção/congênito , Intussuscepção/diagnóstico , Pâncreas/patologia , Adolescente , Coristoma/complicações , Humanos , Enteropatias/cirurgia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/cirurgia , Masculino , Pâncreas/diagnóstico por imagem , Ultrassonografia
14.
Dis Colon Rectum ; 64(11): 1407-1416, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-33951687

RESUMO

BACKGROUND: Elective stoma closure is a common, standardized procedure in digestive surgery. OBJECTIVE: This study aimed to evaluate the feasibility of day-case surgery for elective stoma closure. DESIGN: This is a prospective, single-center, nonrandomized study of consecutive patients undergoing day-case elective stoma closure. SETTING: This study was performed at a French tertiary hospital between January 2016 and June 2018. PATIENTS: Elective stoma closure was performed by local incision with an ASA score of I, II, or stabilized III. OUTCOME MEASURES: The primary end point was the day-case surgery success rate in the overall population (all patients having undergone elective stoma closure) and in the per protocol population (patients not fulfilling any of the preoperative or perioperative exclusion criteria). The secondary end points (in the per protocol population) were the overall morbidity rate (according to the Clavien-Dindo classification), the major morbidity rate (Clavien score ≥3), and day-case surgery quality criteria (unplanned consultation, unplanned hospitalization, and unplanned reoperation). RESULTS: Between January 2016 and June 2018, 236 patients (the overall population; mean ± SD age: 54 ± 17; 120 men (51%)) underwent elective stoma closure. Fifty of these patients (21%) met all the inclusion criteria and constituted the per protocol population. The day-case surgery success rate was 17% (40 of 236 patients) in the overall population and 80% (40 of 50 patients) in the per protocol population. In the per protocol population, the overall morbidity rate was 30% and the major morbidity rate was 6%. Of the 40 patients with successful day-case surgery, the unplanned consultation rate and the unplanned hospitalization rate were both 32.5%. There were no unplanned reoperations. LIMITATIONS: This was a single-center study. CONCLUSION: In selected patients, day-case surgery for elective stoma closure is feasible and has acceptable complication and readmission rates. Day-case elective stoma closure can therefore be legitimately offered to selected patients. See Video Abstract at http://links.lww.com/DCR/B583. RESULTADOS A CORTO PLAZO DEL CIERRE DE ESTOMA AMBULATORIO UN ESTUDIO OBSERVACIONAL Y PROSPECTIVO: ANTECEDENTES:El cierre electivo de un estoma es un procedimiento común y estandarizado en cirugía digestiva.OBJETIVO:Evaluar la viabilidad de la cirugía ambulatoria para el cierre electivo de estomas.DISEÑO:Un estudio prospectivo, unicéntrico, no aleatorizado de pacientes consecutivos sometidos a cierre de estoma electivo ambulatorio.ESCENARIO:Un hospital terciario francés entre enero de 2016 y junio de 2018.PACIENTES:Cierre electivo de estoma realizado por incisión local con una puntuación de la American Society of Anesthesiologists de I, II o III estabilizado.PRINCIPALES MEDIDAS DE RESULTADO:El resultado principal fue la tasa de éxito de la cirugía ambulatoria en la población general (todos los pacientes habiendo sido sometidos a cierre de estoma electivo) y en la población por protocolo (pacientes que no cumplían con ninguno de los criterios de exclusión preoperatorios o perioperatorios). Los resultados secundarios (en la población por protocolo) fueron la tasa de morbilidad general (según la clasificación de Clavien-Dindo), la tasa de morbilidad mayor (puntuación de Clavien ≥ 3) y los criterios de calidad de la cirugía ambulatoria (consulta no planificada, hospitalización no planificada y reoperación no planificada).RESULTADOS:Entre enero de 2016 y junio de 2018, 236 pacientes (la población general; edad media ± desviación estándar: 54 ± 17; 120 hombres (51%)) se sometieron al cierre electivo del estoma. Cincuenta de estos pacientes (21%) cumplieron todos los criterios de inclusión y constituyeron la población por protocolo. La tasa de éxito de la cirugía ambulatoria fue del 17% (40 de 236 pacientes) en la población general y del 80% (40 de 50 pacientes) en la población por protocolo. En la población por protocolo, la tasa de morbilidad general fue del 30% y la tasa de morbilidad mayor fue del 6%. De los 40 pacientes con cirugía ambulatoria exitosa, la tasa de consultas no planificadas y la tasa de hospitalización no planificada fueron ambas del 32.5%. No hubo reoperaciones no planificadas.LIMITACIONES:Este fue un estudio de un solo centro.CONCLUSIÓN:En pacientes seleccionados, la cirugía ambulatoria para el cierre electivo de estoma es factible y tiene tasas aceptables de complicaciones y reingreso. Por lo tanto, se puede ofrecer legítimamente el cierre electivo ambulatorio de estoma a pacientes seleccionados. Consulte Video Resumen en http://links.lww.com/DCR/B583.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Enterostomia/efeitos adversos , Enteropatias/cirurgia , Complicações Pós-Operatórias/epidemiologia , Estomas Cirúrgicos/efeitos adversos , Técnicas de Fechamento de Ferimentos/efeitos adversos , Adulto , Idoso , Estudos de Viabilidade , Feminino , França , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
15.
Exp Biol Med (Maywood) ; 246(18): 2029-2038, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34053233

RESUMO

Abdominal paracentesis drainage (APD), as an effective treatment of severe acute pancreatitis (SAP) in clinical settings, can ameliorate intestinal barrier damage and the overall severity of SAP. However, the mechanism underlying therapeutic effects of APD on damaged intestinal mucosal barrier during SAP is still unclear. Here, SAP was induced by injecting 5% Na-taurocholate retrograde into the biliopancreatic duct of rats to confirm the benefits of APD on enteral injury of SAP and further explore the possible mechanism. Abdominal catheter was placed after SAP was induced in APD group. As control group, the sham group received no operation except abdominal opening and closure. By comparing changes among control group, sham group, and APD group, APD treatment obviously lowered the intestinal damage and reduced the permeation of intestinal mucosal barrier, which was evidenced by intestinal H&E staining, enteral expression of tight junction proteins, intestinal apoptosis measurement and detection of serum diamine oxidase, intestinal fatty acid binding protein and D-lactic acid. Furthermore, we found that APD polarized intestinal macrophages toward M2 phenotype by the determination of immunofluorescence and western blotting, and this accounts for the benefits of APD for intestinal injury in SAP. Importantly, the protective effect against intestinal injury by APD treatment was mediated through the inhibited ASK1/JNK pathway. In summary, APD improved the intestinal mucosal barrier damage in rats with SAP through an increasing portion of M2 phenotype macrophages in intestine via inhibiting ASK1/JNK pathway.


Assuntos
Enteropatias/cirurgia , Ativação de Macrófagos/fisiologia , Macrófagos/metabolismo , Pancreatite/cirurgia , Animais , Modelos Animais de Doenças , Masculino , Paracentese/métodos , Ratos Sprague-Dawley
16.
Afr J Paediatr Surg ; 18(2): 114-116, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33642413

RESUMO

Internal hernia through an iatrogenic defect in the hepatic falciform ligament and acquired jejunal atresia in a 8-day-old neonate was reported. The PubMed, MEDLINE, CNKI, Wanfang and Weipu databases were searched The literature about the hepatic falciform ligament iatrogenic defect causing internal hernia was analysed. Ten other cases were collected from the world literature. Herniated intestinal necrosis was found in four cases. All cases were recovered uneventfully after operation. Internal herniation through an iatrogenic defect in the hepatic falciform ligament is extremely rare. However, the case reports are increasing, especially in the era of laparoscopic surgery. Adequate closure or open the defect is essential to prevent internal hernia occurrence.


Assuntos
Hérnia Abdominal/etiologia , Hérnia Interna/etiologia , Laparoscopia/efeitos adversos , Ligamentos/lesões , Fígado/lesões , Hérnia Abdominal/diagnóstico , Hérnia Abdominal/cirurgia , Humanos , Doença Iatrogênica , Recém-Nascido , Hérnia Interna/diagnóstico , Hérnia Interna/cirurgia , Enteropatias/cirurgia , Ligamentos/cirurgia , Masculino
17.
Curr Opin Organ Transplant ; 26(2): 229-233, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33651002

RESUMO

PURPOSE OF REVIEW: Intestinal transplantation has evolved to be a viable treatment option for patients with intestinal failure. This review shows the most current tendencies and practices of intestinal transplant centers and an overall comparison to intestinal rehabilitation. RECENT FINDINGS: This review outlines that timing for referral and advances in preoperative and postoperative care of intestinal and multivisceral transplant candidates are crucial to achieve results comparable to intestinal rehabilitation. SUMMARY: Current practices have shown that intestinal transplantation continues to improve overall results and could be considered in patients with permanent home parenteral nutrition. Timing for referral and preoperative and postoperative management are crucial to optimize long-term results.


Assuntos
Enteropatias , Transplante de Fígado , Nutrição Parenteral no Domicílio , Humanos , Enteropatias/cirurgia , Intestinos
18.
Curr Opin Organ Transplant ; 26(2): 200-206, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33595982

RESUMO

PURPOSE OF REVIEW: Intestinal transplantation (ITx) is the last therapeutic option in chronic intestinal failure (CIF) patients who develop life-threatening complication related to home parenteral nutrition (HPN). Improvement of quality of life (QoL) has been proposed as one of the nonconventional indications for ITx in these patients. This review aims to summarize the current evidence about QoL assessment in ITx recipients. RECENT FINDINGS: Several studies were conducted to determine QoL in ITx patients, with differences in the samples and instruments used to assess it. Patients evaluated for ITx had lower QoL than those on HPN without complications. QoL seems to improve in most psychological, emotional and social areas after a successful ITx, a trend that seems to increase over time. These results would support the rehabilitative role of ITx for patients with irreversible CIF and impossibility to continue receiving HPN. SUMMARY: Although QoL after ITx patients improved over time compared with life on HPN, the heterogeneity in the samples included in several studies, and the lack of validated assessment tools, hinder the possibility to draw conclusions about improvement of QoL after ITx.


Assuntos
Enteropatias , Nutrição Parenteral no Domicílio , Doença Crônica , Humanos , Enteropatias/cirurgia , Intestinos , Qualidade de Vida
19.
Korean J Radiol ; 22(5): 742-750, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33569933

RESUMO

OBJECTIVE: To assess the safety and clinical efficacy of percutaneous transhepatic enteral stent placement for recurrent malignant obstruction in patients with surgically altered bowel anatomy. MATERIALS AND METHODS: Between July 2009 and May 2019, 36 patients (27 men and 9 women; mean age, 62.7 ± 12.0 years) underwent percutaneous transhepatic stent placement for recurrent malignant bowel obstruction after surgery. In all patients, conventional endoscopic peroral stent placement failed due to altered bowel anatomy. The stent was placed with a transhepatic approach for an afferent loop obstruction (n = 27) with a combined transhepatic and peroral approach for simultaneous stent placement in afferent and efferent loop obstruction (n = 9). Technical and clinical success, complications, stent patency, and patient survival were retrospectively evaluated. RESULTS: The stent placement was technically successful in all patients. Clinical success was achieved in 30 patients (83.3%). Three patients required re-intervention (balloon dilatation [n = 1] and additional stent placement [n = 2] for insufficient stent expansion). Major complications included transhepatic access-related perihepatic biloma (n = 2), hepatic artery bleeding (n = 2), bowel perforation (n = 1), and sepsis (n = 1). The 3- and 12-months stent patency and patient survival rates were 91.2%, 66.5% and 78.9%, 47.9%, respectively. CONCLUSION: Percutaneous enteral stent placement using transhepatic access for recurrent malignant obstruction in patients with surgically altered bowel anatomy is safe and clinically efficacious. Transhepatic access is a good alternative route for afferent loop obstruction and can be combined with a peroral approach for simultaneous afferent and efferent loop obstruction.


Assuntos
Neoplasias/cirurgia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Enteropatias/mortalidade , Enteropatias/cirurgia , Enteropatias/terapia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Cuidados Paliativos , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento
20.
BMC Surg ; 21(1): 73, 2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541322

RESUMO

BACKGROUND: Intestinal failure (IF) is a rare but severe form of organ failure. The condition is defined as body's inability to absorb adequate fluids, macronutrients and minerals for growth and development, so that intravenous supplementation is necessary. A broad spectrum of diseases, trauma and complications of surgery might eventually end up with intestinal failure. Nowadays, intestinal failure patients are preferably cared for in intestinal rehabilitation units (IRU). Autologous gastrointestinal reconstruction (AGIR) refers to non-transplant operative management of IF patients designed to improve enteral tolerance and gut absorptive capacity. CASE PRESENTATION: Herein we present five cases with complications of surgeries due to peptic ulcer bleeding, blunt abdominal trauma, obesity and gastric tumor. The surgeries were complicated by anastomotic leak, peritonitis and fistula formation. By adopting multidisciplinary decisions and special care for each complication, all the five patients were successfully managed and discharged. DISCUSSION AND CONCLUSIONS: As presented, re-anastomosis in presence of abdominal contamination will probably fail. In patients with intestinal failure, PN should start as soon as possible to increase the success rate of future surgeries and prevent potential need for intestinal transplantation. We suggest referring patients with complicated outcomes of gastrointestinal surgeries to the IRUs to reduce morbidity and mortality.


Assuntos
Gastrectomia , Derivação Gástrica , Enteropatias/cirurgia , Fístula Intestinal/cirurgia , Intestino Delgado/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Fístula Anastomótica , Humanos , Enteropatias/complicações , Masculino , Pessoa de Meia-Idade , Falha de Tratamento
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