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3.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(8): 728-733, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32810943

RESUMO

Chronic radiation intestinal injury denotes the repeated and prolonged damage of intestine caused by radiotherapy to pelvic malignancy, which usually occurs after three months of radiotherapy. Surgical intervention is indicated when the progressive intestinal injury leads to the development of massive intestinal hemorrhage, obstruction, perforation, fistula and other late complications. However, there is no consensus on the surgical procedures. We illustrate the dilemma in surgical treatment from the points of pathological mechanism and the frequent sites of radiation intestinal injury. Meanwhile, we discuss the surgical alternatives of radiation intestinal injury based on the literature and our experience. The pathological mechanism of chronic radiation injury is progressive occlusive arteritis and parenchymal fibrosis. The frequently involved sites are distal ileum, sigmoid colon and rectum based on the radiotherapy region. The morbidity and mortality are high in surgery of chronic radiation injury due to poor ability of tissue healing, pelvic fibrosis, multiple organ damage, and poor physical condition. Definitive intestinal resection is one of the most common surgical procedures. Extended resection of diseased bowel to ensure that there is no radiation damage in at least one end of the anastomotic bowels is the key to decrease the risk of complications related to anastomotic sites.


Assuntos
Enteropatias , Lesões por Radiação , Anastomose Cirúrgica , Doença Crônica , Humanos , Íleo , Enteropatias/cirurgia , Lesões por Radiação/cirurgia , Reto
6.
Khirurgiia (Mosk) ; (6): 109-113, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32573541

RESUMO

The current trends in the treatment of various surgical diseases of large bowel using minimally invasive operations are reviewed in the manuscript. It is shown that laparoscopy is currently possible in most cases for urgent large bowel diseases.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Enteropatias/cirurgia , Intestino Grosso/cirurgia , Emergências , Humanos , Laparoscopia , Procedimentos Cirúrgicos Minimamente Invasivos
7.
J Surg Res ; 255: 86-95, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32543383

RESUMO

BACKGROUND: Short bowel syndrome (SBS) is a condition that results from inadequate intestinal absorptive capacity, usually after the loss of functional intestine. We have previously developed a severe model of SBS in zebrafish that demonstrated increased intestinal adaptation (IA) and epithelial proliferation in SBS zebrafish. However, many children with SBS do not have this extreme intestinal loss. Therefore, in this study, we developed a variation of this model to evaluate the effects of increasing intestinal length on IA and the complications of SBS. MATERIALS AND METHODS: After Institutional Animal Care and Use Committee approval, adult male zebrafish were assigned to three groups: sham (n = 30), S1-SBS (n = 30), and S3-SBS (n = 30). Sham surgery included ventral laparotomy alone. S1-SBS surgery consisted of laparotomy with creation of a proximal stoma at S1 (jejunostomy equivalent) and ligation at S4. S3-SBS surgery had stoma creation at S3 (ileostomy equivalent) and the same ligation. Fish were harvested at 14 d. Markers of IA were measured from proximal intestinal segments, and the liver was analyzed for development of hepatic steatosis. RESULTS: At 14 d, S3-SBS fish lost less weight than S1-SBS and had increased markers of IA compared with sham fish, which were decreased compared with S1-SBS fish. S3-SBS fish had decreased proximal intestinal inflammation compared with S1-SBS fish. S1-SBS fish developed extensive hepatic steatosis. Although S3-SBS fish have increased hepatic steatosis compared with sham fish, it is decreased compared with S1-SBS. CONCLUSIONS: Longer remnant intestine decreases the extent of IA, inflammation, and hepatic steatosis in a zebrafish model of SBS.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Fígado Gorduroso/epidemiologia , Enteropatias/cirurgia , Intestinos/cirurgia , Síndrome do Intestino Curto/prevenção & controle , Animais , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Modelos Animais de Doenças , Fígado Gorduroso/etiologia , Humanos , Intestinos/fisiopatologia , Masculino , Síndrome do Intestino Curto/etiologia , Síndrome do Intestino Curto/fisiopatologia , Peixe-Zebra
8.
Rev. argent. coloproctología ; 31(2): 42-50, jun. 2020. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1117006

RESUMO

Se trató de redactar una guía para la práctica segura de la especialidad en tiempos de COVID-19. Se realizó una búsqueda de las publicaciones recientes disponibles en Pub-Med y en otros buscadores, se utilizó la experiencia de expertos a través de diferentes conferencias o comunicados de sociedades científicas. Esta pandemia nos ha obligado a aprender de una manera vertiginosa el manejo de una nueva enfermedad, donde especialistas en cirugía comenzamos a hablar de terminología clínica, virológica, entre otras completamente nueva y desconocida para la mayoría de nosotros. Tuvimos que adaptar nuestra práctica habitual a nuevos estándares, cometiendo diferentes errores en el manejo inicial, provocados por la falta de información previa. La guía trata de abarcar los tópicos considerados más relevantes en este momento, como son el manejo del consultorio, recomendaciones de que patologías se recomienda operar y cuáles no. Recomendaciones de tratamientos alternativos al quirúrgico mientras dura la pandemia. Métodos de diagnósticos utilizados para evaluar infección en pacientes que se someterán a una cirugía, etc. Se agregaron links y apéndices para aquellos que deseen ampliar algún tema en particular, esto evita que la guía sea más extensa y pierda su practicidad con la que fue pensada. Esperamos esta guía sirva para facilitar la compresión de esta nueva enfermedad y su manejo para cualquier cirujano que necesite asistir a pacientes con patología colorrectal. Seguramente al finalizar estas líneas habrá nueva evidencia que deberá ser adaptada e incorporada a la presentada actualmente.


An attempt was made to write a guide for the safe practice of the specialty in times of COVID-19. A search of recent publication available in Pub-Med and other platforms was performed. Experts' opinions and experiences were taken into account from various conferences or communications of scientific societies. This pandemic has forced us to learn the management of a new disease in a sudden way. Surgical specialists began to learn clinical and virologic terminology, among other new concepts previously ignored by most of us. We were forced to adapt our usual practice to new standards, making different mistakes in the initial handling, caused by the lack of prior information.The present guide tries to cover the topics considered most relevant at this time, such as outpatients ́ management, recommendations of which patients we should operate on and which procedures should be postponed. Recommendations for alternative treatments to surgery while the pandemic lasts. Diagnostic methods used to assess infection in patients who will undergo surgery, etc. Links and appendices have been added for those who wish to expand on a particular topic, this prevents the guide from being too extensive and losing the practicality with which it was intended. We hope this guide will facilitate the understanding of this new disease and its management for any surgeon who needs to assist patients with colorectal pathology. By the time we would have finished these lines there will be new evidence that must be adapted and incorporated into those currently presented.


Assuntos
Humanos , Pneumonia Viral , Segurança/normas , Cirurgia Colorretal/normas , Infecções por Coronavirus , Colonoscopia/métodos , Colonoscopia/normas , Assistência Perioperatória/normas , Endoscopia/normas , Pandemias , Assistência Ambulatorial/normas , Equipamento de Proteção Individual/normas , Enteropatias/cirurgia
9.
Rev. argent. coloproctología ; 31(2): 54-63, jun. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1117010

RESUMO

La endometriosis es una de las patologías ginecológicas benignas más frecuente, ocurre en un 7-10% de las mujeres en edad reproductiva y es causal de dolores crónicos e infertilidad. Se trata de una población joven y sana por lo demás. La sospecha diagnóstica de esta entidad debe ser alta y su manejo multidisciplinario.La endometriosis colorrectal representa una variable altamente incapacitante y es aquí donde se plantea la necesidad de un tratamiento más agresivo para su resolución. Frente a esto nos preguntamos, ¿qué rol tiene la cirugía?, ¿cuáles serían sus ventajas y desventajas?, ¿por qué deberíamos elegirla como método terapéutico?.La presente monografía fue inspirada en todas las pacientes que nos plantearon esta controversia. Que motivaron interconsultas, ateneos, búsqueda de bibliografía. Que generaron discusiones, dudas e incertidumbres y nos hicieron salir del rol de cirujanos al que estamos habituados y nos enseñaron a acompañar, cuando no pudimos curar


Assuntos
Humanos , Feminino , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Endometriose/cirurgia , Enteropatias/cirurgia , Equipe de Assistência ao Paciente , Diagnóstico por Imagem , Resultado do Tratamento , Laparoscopia/métodos , Dietoterapia , Endometriose/diagnóstico , Endometriose/tratamento farmacológico , Antagonistas de Hormônios/uso terapêutico , Enteropatias/diagnóstico , Enteropatias/tratamento farmacológico
11.
Rev. esp. enferm. dig ; 112(4): 249-257, abr. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-187502

RESUMO

INTRODUCTION: the aim of this study was to determine the risk factors for rebleeding following device-assisted enteroscopy therapy of small bowel vascular lesions. METHODS: this is a systematic review and meta-analysis. A literature search was performed from January 2003 to October 2019. All studies reporting on at least one risk factor for bleeding recurrence after endoscopic therapy of small bowel vascular lesions were included. A meta-analysis of those risk factors reported in at least three studies was performed to assess their association with rebleeding. The OR and 95 % CI were used for binary outcome data. Heterogeneity analysis was performed using the Tau and I2 index. If I2 > 20 %, potential sources of heterogeneity were identified by sensitivity analyses and a random-effect model was used. RESULTS: the search identified a total of 572 articles and 35 full-text records were assessed for eligibility after screening. Finally, eight studies that included 548 patients were selected. The overall median rebleeding rate was 38.5 % (range: 10.9-53.3 %) with a median follow-up of 24.5 months. Female sex (OR: 1.96, 95 % CI: 1.14-3.37, p = 0.01, I2 = 0 %), Osler-Weber syndrome (OR: 4.35, 95 % CI: 1.22-15.45, p = 0.02, I2 = 0 %) and cardiac disease (OR: 1.89, 95 % CI: 1.12-2.97, p = 0.005, I2: 0 %) were associated with rebleeding. According to the sensitivity analysis, overt bleeding (OR: 2.13, 95 % CI: 1.22-3.70, p = 0.007, I2 = 0 %), multiple lesions (OR: 4.57, 95 % CI: 2.04-10.22, p < 0.001, I2 = 0 %) and liver cirrhosis (OR: 2.61, 95 % CI: 1.11-6.13, p = 0.03, I2 = 0 %) were also predictors for rebleeding. CONCLUSIONS: patient characteristics and comorbidities should be considered for follow-up patient management after effective device-assisted endoscopic therapy, as they can predict rebleeding


No disponible


Assuntos
Humanos , Enteroscopia de Balão/métodos , Hemorragia Gastrointestinal/cirurgia , Enteropatias/cirurgia , Intestino Delgado/cirurgia , Intestino Delgado/irrigação sanguínea , Enteroscopia de Balão/efeitos adversos , Fatores de Risco , Recidiva
12.
Chirurgia (Bucur) ; 115(1): 112-119, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155406

RESUMO

Postoperative ileus (POI) is a complex phenomenon with important morbidity and mortality, well known in many surgical fields. POI occurs commonly after abdominal and pelvic surgery, especially in cancer patients. We report the case of a 63-year-old patient without known risk factors for POI, who underwent total hysterectomy with bilateral adnexectomy for ovarian tumor with suspicion of malignancy, invalidated by the extemporaneous pathology examination. The postoperative evolution is marked by reduced bowel movements, lack of intestinal transit for flatus and stool for 6 days. In cooperation with the general surgeon conservative treatment for POI was administered, without effect. The abdomen remained distended, with no nausea or vomiting. On the 6th postoperative day a wound dehiscence with incomplete evisceration occurred, after a CT scan of the abdomen and pelvic region was requested to make a differential diagnosis between an intestinal mass and other pathology involving the bowell. In conjunction with the General Surgery team the surgical reintervention was decided and performed. After the procedure, the patient successfully regained transit, with flatus and stool emission, but another 2 complications occurred, which were successfully treated: sepsis and deep vein thrombosis. Understanding the pathophysiology could help to prevent, diagnose, and implement protocols in order to avoid POI and its complications, to reduce hospital stay and cost burden.


Assuntos
Hérnia Ventral/cirurgia , Histerectomia/efeitos adversos , Íleus/etiologia , Hérnia Incisional/cirurgia , Neoplasias Ovarianas/cirurgia , Feminino , Hérnia Ventral/diagnóstico por imagem , Hérnia Ventral/etiologia , Humanos , Hérnia Incisional/diagnóstico por imagem , Hérnia Incisional/etiologia , Enteropatias/diagnóstico por imagem , Enteropatias/etiologia , Enteropatias/cirurgia , Pessoa de Meia-Idade , Reoperação , Deiscência da Ferida Operatória/diagnóstico por imagem , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/cirurgia
13.
West Afr J Med ; 37(2): 118-123, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32150629

RESUMO

BACKGROUND: Variable intestinal segments of children may need resection due to congenital or acquired conditions. Resection is done when these intestinal segments are nonviable or dysfunctional. In HICs most resections are for congenital conditions while in LMICs acquired and largely preventable conditions predominate.The spectrum of acquired intestinal conditions leading to bowel resection may also vary between HICs and LMICs. OBJECTIVES: To determine the indications, types and outcomes of intestinal resection for acquired conditions in children. METHODS: A retrospective review of pediatric bowel resections from acquired anomalies over a 10-year period in a tertiary hospital. Data entry and analysis done using SPSS. Fisher's exact test was used to assess level of significance for categorical variables and p-value of <0.05 was adjudged significant. Results are presented as means±SD, ratios, percentages and tables. RESULTS: Fifty-nine males and thirty-three females with a median age of 8 months were recruited. Complicated intussusceptions and right hemicolectomy were the most common indication and procedure respectively. Proportion of right hemicolectomies was more in infants than older children (p=0.0103) while ileal resection was higher in older children (p<0.001). Post-operative complications were seen in 35.8% and mortality rate was 8.7%. CONCLUSION: Complicated intussusception is the main acquired indication for intestinal resection. Right hemicolectomies and ileal resections were done mainly during infancy and beyond infancy respectively.


Assuntos
Colectomia/mortalidade , Doenças do Íleo/cirurgia , Enteropatias/cirurgia , Intussuscepção/cirurgia , Complicações Pós-Operatórias/mortalidade , Distribuição por Idade , Criança , Pré-Escolar , Colectomia/métodos , Feminino , Humanos , Doenças do Íleo/mortalidade , Lactente , Recém-Nascido , Enteropatias/complicações , Enteropatias/mortalidade , Intussuscepção/mortalidade , Masculino , Nigéria/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
15.
J Minim Invasive Gynecol ; 27(2): 262, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31376585

RESUMO

OBJECTIVE: Colorectal involvement represents 90% of bowel endometriosis. The best surgical approach must consider the patient's clinical symptoms, preoperative imaging, and correlation with surgical findings. For patients with severe pain who either have failed medical treatment or contraindications to hormonal treatment and have a single bowel lesion <3 cm that involves the inner muscularis, disc resection is the preferred approach to treat bowel endometriosis [1,2]. Therefore, here we describe the surgical principles for disc resection for deep bowel endometriosis. DESIGN: Step-by-step video illustration of our surgical technique with clarification of surgical principles. SETTING: Tertiary care center. INTERVENTION: A mechanical bowel preparation is given before surgery. A 10-mm port is placed in the umbilicus, and 3 other 5-mm auxiliary ports are placed in the right and left iliac fossa and in the suprapubic region. Dissection starts with development of both medial pararectal spaces. The retrocervical region is approached, and the bowel lesion is isolated. A suture is placed into the endometriosis bowel lesion to facilitate invagination into the stapler. A circular stapler is inserted into the rectum, and the anvil is opened at the level of the endometriosis lesion. Each end of the suture held by 2 graspers are pushed dorsally, whereas the stapling device is gently pushed ventrally, imbricating the delineated area. The stapler is closed, including the endometriosis area. After reassuring that the posterior part of the mesentery is free, the device is fired, excising only the anterior wall of the rectum. CONCLUSION: Disc resection is the technique of choice to treat a focal bowel endometriosis lesion <3 cm.


Assuntos
Endometriose/cirurgia , Enteropatias/cirurgia , Endometriose/patologia , Feminino , Humanos , Enteropatias/patologia , Laparoscopia/métodos , Doenças Peritoneais/cirurgia , Doenças Retais/patologia , Doenças Retais/cirurgia , Reto/cirurgia , Resultado do Tratamento
16.
Dig Dis Sci ; 65(5): 1429-1435, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31630343

RESUMO

BACKGROUND: Rates of incomplete colonoscopy in non-expert settings range up to 13%. Expert colonoscopists can complete ~ 95% colonoscopies when other endoscopists fail; however, a small number remain incomplete even in expert hands, typically due to bowel fixity. AIMS: Pentax Retroview™ (EC-3490TLi) is a new slim colonoscope with a short turning radius (STR) and greater tip deflection (210°), which allows easy maneuverability across sharply angulated/fixed colonic bends. We evaluated the utility of this colonoscope for completing colonoscopies that fail even in the hands of expert colonoscopists. METHODS: Retrospective chart review was performed, and main outcomes measured included cecal intubation rate, lesions detected, dosage of sedation used, and complications. RESULTS: Using the STR colonoscope, complete colonoscopy to the cecum was possible in 34/37 patients (91.9%). No loss of lumen/blind advancement was necessary in any of the procedures. No adverse events occurred. Among the completed colonoscopies, 6/34 (17.6%) patients had adenomas, all proximal to the site of prior failure, including one advanced adenoma. All failures (n = 3, 8.1%) had a history of cancer surgeries, with peritoneal carcinomatosis/extensively fixed/frozen bowel (two patients) and an additional diverticular stricture with colo-vesical fistula (one patient). CONCLUSION: STR colonoscope facilitates completion of a high proportion (91.9%) of colonoscopies that previously failed in expert hands. Its STR allows easy maneuverability across segments of sharp angulation with bowel fixity without need for blind advancement. The use of this colonoscope led to the detection of adenomas in 17.6% of patients, all proximal to the site of prior failed colonoscopy.


Assuntos
Colonoscópios , Colonoscopia/instrumentação , Desenho de Equipamento , Enteropatias/cirurgia , Idoso , Colo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Rotação , Resultado do Tratamento
17.
Am J Surg Pathol ; 44(4): 561-565, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31609783

RESUMO

Natural killer (NK) cell enteropathy is a lymphoproliferative disorder, initially described by Mansoor and colleagues, that presents in the gastrointestinal tract, and is often mistaken for extranodal NK/T-cell lymphoma on first assessment. This population of cells in this process have an NK-cell phenotype (CD3, CD56, CD2, CD7), lacks evidence of Epstein-Barr virus infection, has germline rearrangement of the T-cell receptor, and a very indolent clinical course. Indeed, many of such patients had been originally diagnosed as having an NK/T-cell lymphoma, and subsequently received chemotherapy. We report a unique case where an indolent lymphoproliferative disorder with features that resemble NK-cell enteropathy is encountered for the first time outside the gastrointestinal tract, specifically in the female genitourinary tract. We provide morphologic, immunophenotypic, and molecular documentation of such, in association with a completely indolent clinical behavior of this type of process.


Assuntos
Proliferação de Células , Enteropatias/patologia , Células Matadoras Naturais/patologia , Transtornos Linfoproliferativos/patologia , Vagina/patologia , Doenças Vaginais/patologia , Adulto , Feminino , Marcadores Genéticos , Humanos , Enteropatias/genética , Enteropatias/imunologia , Enteropatias/cirurgia , Células Matadoras Naturais/imunologia , Transtornos Linfoproliferativos/genética , Transtornos Linfoproliferativos/imunologia , Transtornos Linfoproliferativos/cirurgia , Resultado do Tratamento , Vagina/imunologia , Vagina/cirurgia , Doenças Vaginais/genética , Doenças Vaginais/imunologia , Doenças Vaginais/cirurgia
18.
Transplantation ; 104(3): 652-658, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31335764

RESUMO

BACKGROUND: Temporary ileostomy during intestinal transplantation (ITx) is the standard technique for allograft monitoring. A detailed analysis of the ITx ileostomy has never been reported. METHODS: A retrospective review of a single-center ITx database was performed. The analysis was divided into ileostomy formation and takedown episodes. RESULTS: One hundred thirty-five grafts underwent ileostomy formation, and 79 underwent ileostomy takedown. Median age at ITx was 7.7 years and weight was 23 kg. Allograft types were intestine (22%), liver/intestine (55%), multivisceral (16%), and modified multivisceral (7%). Sixty-four percent had 1-stage ITx, whereas 36% required 2-staged ITx. Final ileostomy types were end (20%), loop (10%), distal blowhole (59%), and proximal blowhole (11%). Ileostomy formation: Thirty-one grafts had complications (23%), including prolapse (26%), ischemia (16%), and parastomal hernia (19%). Twelve required surgical revision. There were no significant differences in graft type, ileostomy type, survival, and ileostomy takedown rate between grafts with and without complications. Colon inclusive grafts had higher complication rates (P = 0.002). Ileostomy takedown: Ileostomy takedown occurred at a median of 422 days post-ITx. Twenty-five complications occurred after 22 takedowns (28%), including small bowel obstruction (27%) and abscess (18%). Fifteen grafts required surgical correction. Recipients with complications had longer hospital stay (17 versus 9 d; P = 0.001) than those without complications. Graft type, ileostomy type, and survival were not different. CONCLUSIONS: The first of its kind analysis of the surgical ileostomy after ITx reveals that most recipients can undergo successful ileostomy formation/takedown, complication rates are significant but within an acceptable range, and complications do not affect survival. This study demonstrates that the routine use of transplant ostomies remains an acceptable practice after ITx. However, true analysis of risk and benefit will require a randomized control trial.


Assuntos
Ileostomia/métodos , Enteropatias/cirurgia , Intestinos/transplante , Complicações Pós-Operatórias/diagnóstico , Adolescente , Adulto , Aloenxertos/fisiopatologia , Criança , Pré-Escolar , Feminino , Humanos , Ileostomia/efeitos adversos , Lactente , Enteropatias/mortalidade , Enteropatias/fisiopatologia , Intestinos/fisiopatologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
19.
J Minim Invasive Gynecol ; 27(1): 141-147, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30885782

RESUMO

STUDY OBJECTIVE: To examine whether existing quality of health outcome measures can be used to predict or have an association with nonresponse surgery for endometriosis. DESIGN: Retrospective cohort study. SETTINGS: Single endometriosis referral center. PATIENTS: Women (n = 198) undergoing surgery for endometriosis. INTERVENTIONS: Validated health questionnaires and visual analogue scales. MEASUREMENTS AND MAIN RESULTS: Patients were given validated health questionnaires, including Endometriosis Health Profile 30, Gastrointestinal Quality of Life Index, EuroQol-5, Hospital Anxiety and Depression Scale, preoperatively and at 12 months after full surgical excision of endometriosis. Visual analogue scales were also used that measured dyschezia, dysmenorrhea, dyspareunia, and chronic pelvic pain. Surgical management was dependent on severity of disease. Superficial disease was treated by laparoscopic peritoneal excision or laser ablation. Deep infiltrating disease involving the bowel was excised completely together with laparoscopic bowel surgery (shave, disc, or segmental resection) with/without concomitant total hysterectomy and bilateral salpingo-oophorectomy. Nonresponders were defined as women who failed to demonstrate an improvement in pain scores 12 months postoperatively. We examined preoperative and postoperative questionnaires, visual analogue scores, and other variables such as age at onset of symptoms, type of surgery, and the presence of postoperative complications comparing responder and nonresponder women to identify the factors associated with nonresponse. Of 102 women treated for superficial endometriosis, 25 (24.51%) were nonresponders. No factors were associated with nonresponse at 12 months. Of 96 women treated for severe endometriosis involving the bowel, 10 (10.41%) were nonresponders. Nonresponders had significantly less preoperative pain (p = .031) and feeling of control (p = .015) than responders. There was no association between nonresponders and women who underwent a hysterectomy with bilateral salpingo-oophorectomy or those with complications. Radical bowel surgery (resection) was associated with nonresponders. CONCLUSION: Minimal preoperative factors are associated with nonresponse for women having surgery for endometriosis. The severity of pain experienced by women with endometriosis may be used to predict their response to surgery.


Assuntos
Endometriose/cirurgia , Enteropatias/cirurgia , Doenças Peritoneais/cirurgia , Complicações Pós-Operatórias/diagnóstico , Adulto , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Endometriose/epidemiologia , Feminino , Humanos , Enteropatias/epidemiologia , Laparoscopia/efeitos adversos , Laparoscopia/estatística & dados numéricos , Pessoa de Meia-Idade , Doenças Peritoneais/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Período Pré-Operatório , Prognóstico , Qualidade de Vida , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários/estatística & dados numéricos , Falha de Tratamento
20.
J Minim Invasive Gynecol ; 27(2): 268-269, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31783162

RESUMO

STUDY OBJECTIVE: To demonstrate laparoscopic shaving of deeply infiltrative endometriosis affecting the rectosigmoid colon, with particular emphasis on the anatomic and technical aspects of the procedure. DESIGN: Stepwise demonstration of the technique with narrated video footage. SETTING: Intestinal involvement in deep endometriosis is estimated to occur in 8% to 12% of patients, with 90% of occurrences being located in the colorectal segment. Deep endometriosis of the rectosigmoid is defined as endometriosis involving the muscular layer of the bowel wall, usually >5 mm deep, thus excluding superficial lesions that only affect the serosal layer. In cases in which medical therapy is unsatisfactory, rectosigmoid deep endometriosis can be surgically managed by 3 recognized surgical techniques: (1) rectal shaving, (2) disc excision, and (3) segmental resection. There are helpful recommendations for different approaches on the basis of the characteristics of the lesion, including the size, length, depth of invasion, involved rectal circumference, and number of lesions, among other factors [1]. Rectal shaving is well suited for smaller lesions, typically <3 cm, and involves "shaving" the lesion in the affected muscular layer of the bowel wall off the mucosa, ideally without entering the bowel lumen. It is associated with lower rates of perioperative complications and lower probability of long-term postoperative bladder and bowel dysfunctions [2]. INTERVENTIONS: This video demonstrates and highlights the anatomic and technical aspects of the following important steps of the rectal shaving procedure: (1) suspension of ovaries; (2) mobilization of the diseased segment of the rectum; (3) shaving of the lesions, with pertinent comments at different stages of nodule excision; (4) checking for the integrity of the bowel wall; and (5) suture of the muscularis defect after excision of the lesions from the muscularis layer of the bowel. CONCLUSION: Compared with other alternatives, shaving for bowel endometriosis is a more conservative procedure with lower rates of perioperative complications, and it is less likely to result in long-term bladder and bowel dysfunctions. Therefore, shaving is preferable and recommended for appropriate lesions.


Assuntos
Colo Sigmoide/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Endometriose/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Enteropatias/cirurgia , Colo/patologia , Colo/cirurgia , Colo Sigmoide/patologia , Endometriose/patologia , Feminino , Humanos , Enteropatias/patologia , Laparoscopia/métodos , Doenças Retais/patologia , Doenças Retais/cirurgia , Reto/patologia , Reto/cirurgia , Resultado do Tratamento
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