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1.
Anticancer Res ; 41(11): 5651-5656, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34732438

RESUMO

BACKGROUND/AIM: The aim of this study was to investigate the risk factors of surgical site infection (SSI) in patients who underwent liver resection for colorectal liver metastases (CRLM). PATIENTS AND METHODS: A total of 151 patients who underwent liver resection for CRLM were included in this study. We investigated the relationship between the patient characteristics and perioperative factors and the incidence of SSI. RESULTS: Nineteen (13%) of these patients developed SSI. Multivariate analysis revealed that modified Glasgow Prognostic Score (mGPS) (1 or 2, odds ratio 3.86, p=0.03) and presence of an enterostomy (yes, odds ratio 3.93, p=0.04) were significant and independent risk factors for SSI. CONCLUSION: A higher mGPS and an enterostomy were risk factors for SSI in patients who underwent a liver resection for CRLM.


Assuntos
Neoplasias Colorretais/patologia , Hepatectomia/efeitos adversos , Neoplasias Hepáticas/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Idoso , Bases de Dados Factuais , Enterostomia/efeitos adversos , Feminino , Humanos , Incidência , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/prevenção & controle , Fatores de Tempo , Tóquio/epidemiologia , Resultado do Tratamento
3.
Surg Endosc ; 35(4): 1903-1907, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33398580

RESUMO

BACKGROUND: Aspiring endoscopic surgery with extraperitoneal mesh application to avoid adhesion and pain from mesh fixation, we adopted the principles of the open Pauli repair of parastomal hernia (PSH). We have termed the procedure ePauli repair. The aim of this account is to inform about feasibility and adverse reactions. METHODS: Patients with PSH selected for ePauli repair with transversus abdominis release (TAR) were enrolled in a prospective observational study. Patients were operated with laparoscopic or robotic assistance and endoscopic Rives-Stoppa repair in cases with concomitant midline hernia. Coated meshes or a buffer mesh was used in the retromuscular pocket for this modification of the Sugarbaker principle. RESULTS: Fifteen patients were included: six patients were operated laparoscopically and nine patients with robotic assistance. The median age of the stomas was 33 months (7-313). Five PSHs were recurrent after previous repairs. Median operating time without midline hernia repair was 156 min (107-233) and with midline hernia repair 241 min (176-286). One serosa lesion arose during operation, prompting intraoperative revision of the ostomy without postoperative morbidity. Two patients had postoperative obstruction and were readmitted to operation: one with multiple adhesions and one had kinking of the stoma bowel caused by insufficient incision of the transversalis fascia. No infections or seromas have been observed. One patient had discoloring of the flank with spontaneous remission, and one patient had recurrence. Median postoperative admission time was 3 days (1-19). Median follow-up is 10 months (0-27). CONCLUSIONS: ePauli repair is technically challenging but feasible. With our limited experience, we are encouraged with the pain, complication, and functional summary after ePauli repair and hopeful for the recurrence profile. ePauli/TAR is not for every patient or every surgeon and whether it should be restrained to recurrent PSH or be offered as first-line treatment for PSH is disputable.


Assuntos
Endoscopia , Herniorrafia , Hérnia Incisional/cirurgia , Peritônio/cirurgia , Estomas Cirúrgicos , Parede Abdominal/cirurgia , Adulto , Idoso , Enterostomia/efeitos adversos , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Telas Cirúrgicas/efeitos adversos , Estomas Cirúrgicos/efeitos adversos
4.
J Pediatr Surg ; 55(11): 2413-2418, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32600839

RESUMO

PURPOSE: To provide an overview of complications after ileostomy or colostomy procedures in children, and to compare outcomes between patients with gastrointestinal motility disorders (i.e. functional constipation, Hirschsprung's disease, pediatric intestinal pseudo-obstruction (PIPO)) and children without motility disorders (including necrotizing enterocolitis, anorectal malformation and inflammatory bowel disease). METHODS: We performed a retrospective study of children who underwent an enterostomy procedure at our institution. The number and type of complications and subsequent reoperations after ostomy formation were determined. Complications were scored using the Clavien-Dindo classification. A complication of ≥ grade III-b was considered a high-grade complication. RESULTS: 129 children with an ileostomy and 61 children with a colostomy were included. Of these, 62 children (32.6%) had motility disorders; functional constipation (n=40), Hirschsprung's disease (n=18) and PIPO (n=4). The total prevalence of complications was 73.2%. Comparing the perioperative data, children with motility disorders significantly more often underwent a laparoscopic procedure (59.7% vs. 10.9%, p=0.000) and had an end stoma-configuration (37.1% vs. 14.1%, p=0.000) as compared to children without motility disorders. Children with motility problems had a higher complication rate (88.7% vs. 65.5%, OR 4.1, 95% CI 1.7-9.8, p=0.001) compared to children without motility problems, and a larger proportion of complications was classified as high-grade complications (61.8% vs. 31.0% p =0.002). CONCLUSION: A high complication rate after enterostomy formation was detected. Children with gastrointestinal motility disorders had more and more severe complications as compared to children without motility disorders. LEVEL OF EVIDENCE: Level III TYPE OF STUDY: Retrospective comparative study.


Assuntos
Enterostomia , Complicações Pós-Operatórias/epidemiologia , Criança , Colostomia/efeitos adversos , Enterostomia/efeitos adversos , Humanos , Ileostomia/efeitos adversos , Estudos Retrospectivos
5.
Zhonghua Wai Ke Za Zhi ; 58(8): 608-613, 2020 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-32727192

RESUMO

Objective: To compare the wound healing time, Surgical site infection (SSI) rate and other postoperative outcomes between the gunsight closure and purse-string closure technique in loop stoma closure. Methods: Between November 2013 and December 2017, a total of 143 patients who underwent gunsight stoma reversal were included in this multicenter prospective randomized controlled trial. The patients were randomized to undergo gunsight (gunsight group, n=72) or purse-string closure technique (purse-string group, n=71). The primary endpoint was wound healing time. The second endpoints were the incidence of SSI, morbidity, and patient satisfaction. Statistical analysis between groups was performed using the t-test, repeated measures analysis of variance, Mann-Whitney U test, χ(2) test or Fisher's exact test. Results: There were 45 males and 27 females with age of 67 (11) (M(Q(R))) years in gunsight group, 42 males and 29 females with age of 65 (20) years in purse-string group. The body mass index, American Society of Anesthesiologist classification, comorbidities, primary diagnosis, the type of ostomy, intraoperative blood loss, perioperative complications, postoperative hospital stay, hospitalization cost, SSI rate and incisional hernia (stoma site) between the 2 groups were not significantly different (P>0.05). Although had a statistically longer operating time (80(10) minutes vs. 70(10) minutes, Z=-2.381, P=0.017), patients who underwent gunsight procedure and a significantly shorter wound healing time (17(2) days vs. 25(4) days, Z=-10.199, P<0.01), higher patient satisfaction score with regards to wound healing time (3(1) vs. 3(1), Z=-4.526, P<0.01), and higher total patient satisfaction score (25(3) vs. 25(3), Z=-2.529, P=0.011) compared with those who underwent purse-string procedure. Conclusions: The gunsight and purse-string techniques are effective procedures for stoma reversal and both have low SSI rate. The gunsight technique is associated with shorter wound healing time, higher levels of patient satisfaction compared with purse-string technique, and is recommended as the closure technique of choice.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais , Enterostomia/efeitos adversos , Técnicas de Fechamento de Ferimentos Abdominais/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Enterostomia/métodos , Feminino , Humanos , Hérnia Incisional/etiologia , Hérnia Incisional/prevenção & controle , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Estomas Cirúrgicos/efeitos adversos , Infecção da Ferida Cirúrgica/etiologia , Técnicas de Sutura , Fatores de Tempo , Cicatrização
6.
BMC Surg ; 20(1): 141, 2020 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-32571293

RESUMO

BACKGROUND: Laparoscopic approach is now a widespread technique used worldwide, but there are few recent studies on risk factors for parastomal hernia. Therefore, this study was performed to analyze the incidence of parastomal hernia in laparoscopic and open surgery in which a loop stoma was created and was intended to be temporary, and to determine risk factors for parastomal hernia formation. Associations between parastomal hernia and other stoma-related complications were also analyzed. METHODS: A retrospective analysis of patient and surgical characteristics was performed in 153 consecutive patients who underwent a temporary diverting loop ileostomy or colostomy after surgery related to malignant diseases at our hospital from January to December 2016. RESULTS: Parastomal hernia developed in 77 cases (50.3%), including 39 (25.5%) diagnosed by physical examination and 38 (24.8%) detected by CT alone. On multivariate analysis, a stoma not passing through the middle of the rectus abdominis muscle was the only independent risk factor for parastomal hernia formation (p = 0.005) during the median follow-up of 245.0 days. When we analyzed the factors that were associated with a stoma not passing through the middle of the rectus abdominis muscle, the only independent factor associated with this misplacement of the stoma was a laparoscopic approach (p = 0.012). An analysis of stoma-related complications showed that peristomal skin disorders were significantly associated with parastomal hernia (p = 0.049). CONCLUSIONS: This study showed that a stoma that is not formed through the middle of the rectus abdominis muscle is a risk factor for parastomal hernia formation, and that a laparoscopic approach is associated with this risk factor. Moreover, parastomal hernia is significantly associated with peristomal skin disorders.


Assuntos
Enterostomia/efeitos adversos , Hérnia Ventral , Laparoscopia , Estomas Cirúrgicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Colostomia/efeitos adversos , Feminino , Hérnia Ventral/diagnóstico por imagem , Hérnia Ventral/etiologia , Humanos , Ileostomia/efeitos adversos , Incidência , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Telas Cirúrgicas , Estomas Cirúrgicos/efeitos adversos
7.
Chirurgia (Bucur) ; 115(2): 227-235, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32369727

RESUMO

The emergency surgery for colorectal cancer is associated with high rates of morbidity and mortality due to factors related to the characteristics of the patients but also the therapeutic attitude. This study aims to identify the surgical interventions associated with the postoperative complications, with the main causes of morbidity, with the reinterventions and with the postoperative deaths. We included in this retrospective study 431 patients hospitalized and operated in an emergency for complicated colorectal malignant tumors in the Surgery II Clinic of the Clinical Emergency County Hospital "Sf. Ap. Andrei from Galati, in the period 2008-2017. The patients data were collected from observation sheets, operative protocols, pathological, imaging and laboratory bulletins, at the time of the emergency intervention, as well as from those of subsequent admissions in patients who benefited from serial interventions. The postoperative morbidity was 10.44%. The resections with anastomosis were associated with the presence of postoperative complications (p 0.01): pseudomembranous colitis, (p 0.01) and postoperative intestinal occlusion (p 0.01). The practice of lymph node dissection was associated with postoperative complications (p 0.01): pseudomembranous colitis (p 0.01) and intestinal occlusion (p 0.01). The reinterventions were associated with resections with anastomosis (p 0.01), lymph node dissection (p 0.01) or patients with open /semi-open abdomen (p 0.04). The postoperative mortality was 9.28%. It was associated with the practice of lymph node dissection (p 0.01), of the ileostomy (p 0.01), with the open /semi-open abdomen (p 0.04). Patients with colostomy had the lowest number of hospitalization days (p 0.01). The resections with anastomosis per primam and the lymph node dissection were associated with morbidity. The type of main surgery did not influence the postoperative mortality, this being associated with the concomitant surgery: the lymph node dissection, the ileostomy, and the abdomen closure type. The reinterventions were associated with resections with anastomosis per primam, with lymph node dissection and with the open /semi-open abdomen. The duration of hospitalization was significantly shorter in patients with a colostomy.


Assuntos
Colectomia/efeitos adversos , Neoplasias Colorretais/cirurgia , Enterostomia/efeitos adversos , Excisão de Linfonodo/efeitos adversos , Protectomia/efeitos adversos , Anastomose Cirúrgica/efeitos adversos , Emergências , Enterostomia/métodos , Humanos , Protectomia/métodos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
8.
Nutrients ; 12(5)2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32403450

RESUMO

Some temporary double enterostomies (DES) or entero-atmospheric fistulas (EAF) have high output and are responsible for Type 2 intestinal failure. Intravenous supplementations (IVS) for parenteral nutrition and hydration compensate for intestinal losses. Chyme reinfusion (CR) artificially restores continuity pending surgical closure. CR treats intestinal failure and is recommended by European Society for Clinical Nutrition and Metabolism (ESPEN) and American Society for Parenteral and Enteral Nutrition (ASPEN) when possible. The objective of this study was to show changes in nutritional status, intestinal function, liver tests, IVS needs during CR, and the feasibility of continuing it at home. A retrospective study of 306 admitted patients treated with CR from 2000 to 2018 was conducted. CR was permanent such that a peristaltic pump sucked the upstream chyme and reinfused it immediately in a tube inserted into the downstream intestine. Weight, plasma albumin, daily volumes of intestinal and fecal losses, intestinal nitrogen, and lipid absorption coefficients, plasma citrulline, liver tests, and calculated indices were compared before and during CR in patients who had both measurements. The patients included 185 males and 121 females and were 63 ± 15 years old. There were 37 (12%), 269 (88%) patients with EAF and DES, respectively. The proximal small bowel length from the duodeno-jejunal angle was 108 ± 67 cm (n = 232), and the length of distal small intestine was 117 ± 72 cm (n = 253). The median CR start was 5 d (quartile 25-75%, 2-10) after admission and continued for 64 d (45-95), including 81 patients at home for 47 d (28-74). Oral feeding was exclusive 171(56%), with enteral supplement 122 (42%), or with IVS 23 (7%). Before CR, 211 (69%) patients had IVS for nutrition (77%) or for hydration (23%). IVS were stopped in 188 (89%) 2 d (0-7) after the beginning of CR and continued in 23 (11%) with lower volumes. Nutritional status improved with respect to weight gain (+3.5 ± 8.4%) and albumin (+5.4 ± 5.8 g/L). Intestinal failure was cured in the majority of cases as evidenced by the decrease in intestinal losses by 2096 ± 959 mL/d, the increase in absorption of nitrogen 32 ± 20%, of lipids 43 ± 30%, and the improvement of citrulline 13.1 ± 8.1 µmol/L. The citrulline increase was correlated with the length of the distal intestine. The number of patients with at least one liver test >2N decreased from 84-40%. In cases of Type 2 intestinal failure related to DES or FAE with an accessible and functional distal small bowel segment, CR restored intestinal functions, reduced the need of IVS by 89% and helped improve nutritional status and liver tests. There were no vital complications or infectious diarrhea described to date. CR can become the first-line treatment for intestinal failure related to double enterostomy and high output fistulas.


Assuntos
Secreções Corporais/fisiologia , Enterostomia/efeitos adversos , Enterostomia/métodos , Soluções de Nutrição Parenteral , Nutrição Parenteral/métodos , Síndrome do Intestino Curto/terapia , Idoso , Ácidos e Sais Biliares/fisiologia , Digestão/fisiologia , Duodeno/fisiopatologia , Feminino , Suco Gástrico , Humanos , Absorção Intestinal/fisiologia , Jejuno/fisiopatologia , Masculino , Pessoa de Meia-Idade , Suco Pancreático , Saliva , Síndrome do Intestino Curto/etiologia , Síndrome do Intestino Curto/fisiopatologia , Resultado do Tratamento
9.
Vasc Endovascular Surg ; 54(5): 455-457, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32319352

RESUMO

We report a case of a 54-year-old male presenting to a regional hospital with severe hematemesis and hemodynamic instability. His medical history was significant for a previous episode of alcoholic necrotizing pancreatitis and pseudocyst, requiring cystoenterostomy drainage and debridement 10 years prior. He underwent multiple gastroscopies and one emergency laparotomy which failed to definitively treat the bleeding. A splenic artery pseudoaneurysm was diagnosed with computed tomography angiography, adjacent to the previous cystoenterostomy site. The patient was transferred to a major tertiary center with access to interventional radiology and underwent successful embolization of the pseudoaneurysm.


Assuntos
Falso Aneurisma/etiologia , Drenagem/efeitos adversos , Enterostomia/efeitos adversos , Hematemese/etiologia , Artéria Esplênica , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Desbridamento , Embolização Terapêutica , Humanos , Masculino , Pessoa de Meia-Idade , Pseudocisto Pancreático/diagnóstico por imagem , Pseudocisto Pancreático/cirurgia , Pancreatite Alcoólica/diagnóstico por imagem , Pancreatite Alcoólica/cirurgia , Artéria Esplênica/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento
10.
BMC Gastroenterol ; 20(1): 8, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31931724

RESUMO

BACKGROUND: Interleukin-10 (IL10) signalling pathway deficiency results in severe very early onset inflammatory bowel disease (VEOIBD), and enterostomy is often inevitable. However, studies in these surgical populations are lacking. This study aims to determine the enterostomy characteristics, postoperative complications and related risk factors in enterostomy patients. METHODS: From March 1, 2015, to December 31, 2018, patients with IL10R-mutation who underwent enterostomy were recruited for analysis. We collected data on the patients' clinical characteristics, enterostomy characteristics, postoperative complications and related risk factors. RESULTS: Twelve patients required emergency enterostomy, and 10 patients underwent elective enterostomy. Twelve patients experienced postoperative complications, including wound infection (27.3%), wound dehiscence (18.2%), reoperation (18.2%), etc. Compared with the pre-enterostomy values, there was a decrease in C-reactive protein (CRP) (P = 0.001), an increase in albumin (P = 0.001) and an improvement in the weight-for-age (P = 0.029) and body mass index (BMI) Z-scores (P = 0.004) after enterostomy. There was a significant difference between the pre-operation and postoperation medicine expenses (P = 0.002). Univariate binary logistic regression analysis revealed a statistically significant influence of CRP (OR: 1.43, 95% CI: 1.07-1.91, P = 0.016) and a tendency towards a significant influence of intestinal perforation, albumin level, BMI Z-score and weighted paediatric Crohn's disease activity index (wPCDAI). Multivariate logistic regression analysis showed that CRP (OR: 1.40), wPCDAI (OR: 2.88) and perforation (OR: 1.72) showed a tendency to behave as independent risk factors for postoperative complications, but the results were not significant (all P > 0.05). CONCLUSIONS: Surgery and enterostomy showed benefits for VEOIBD with IL-10 signalling deficiency. The timing of intervention, potential postoperative complications, economic burden and other related problems should be considered.


Assuntos
Enterostomia/efeitos adversos , Doenças Inflamatórias Intestinais/cirurgia , Complicações Pós-Operatórias/genética , Receptores de Interleucina-10/deficiência , Transdução de Sinais/genética , Adolescente , Adulto , Idade de Início , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Enterostomia/economia , Feminino , Humanos , Doenças Inflamatórias Intestinais/economia , Doenças Inflamatórias Intestinais/genética , Interleucina-10/genética , Modelos Logísticos , Masculino , Mutação , Complicações Pós-Operatórias/economia , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
11.
Surg Laparosc Endosc Percutan Tech ; 30(2): 123-128, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31985570

RESUMO

PURPOSE: Preoperative progressive pneumoperitoneum (PPP) has not been reported in the management of parastomal hernias; therefore, the present study evaluated its effectiveness in the surgical management of large parastomal hernias. PATIENTS AND METHODS: This prospective, observational study included 23 consecutive patients with large parastomal hernias who underwent PPP between January 2016 and September 2018. The volume of parastomal hernia (VPH), volume of the abdominal cavity (VAC), and the VPH/VAC ratio were measured before and after PPP using abdominal computed tomography scan data. All the hernias were repaired by a laparoscopic or laparoscopic-open-laparoscopic approach using the intraperitoneal Sugarbaker technique. RESULTS: Before and after PPP, the mean VPH was 1442 and 1581 mL (P<0.01), and the mean VAC was 5667 and 9194 mL (P<0.01). The VAC increased by 3527 mL (P<0.01) and was greater than the mean VPH before PPP. The VPH/VAC ratio after PPP was reduced at an average of 8.1% (P<0.01). Fascial closure was achieved in all patients, with no clinical evidence of elevated intra-abdominal pressures. The mean follow-up was 24 months (13 to 40 mo), and, to date, no hernia recurrences have been reported in these patients. CONCLUSIONS: PPP is a feasible and useful tool in the surgical management of large parastomal hernias. It passively expands the abdominal volumes, thereby resulting in respiratory adaptation to elevated intra-abdominal pressures.


Assuntos
Enterostomia/efeitos adversos , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Laparoscopia/métodos , Pneumoperitônio Artificial/métodos , Cuidados Pré-Operatórios/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estomas Cirúrgicos/efeitos adversos
12.
Surg Innov ; 27(2): 203-210, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31941417

RESUMO

Objective. The aim of this study is to present a 3-dimensional (3D)-printed device to simply perform abdominal enterostomy and colostomy. Summary Background Data. Enterostomy and colostomy are frequently performed during abdominal surgery. 3D-printed devices may permit the creation of enterostomy easily. Methods. The device was designed by means of a CAD (computer-aided design) software, Rhinoceros 6 by MC Neel, and manufactured using 3D printers, Factory 2.0 by Omni 3D and Raise 3D N2 Dual Plus by Raise 3D. Colostomy was scheduled on a human cadaver and on 6 Pietrain pigs to test the device and the surgical technique. Results. The test on the cadaver showed that the application of the device was easy. Test on porcine models confirmed that the application of the device was also easy on the living model. The average duration of the surgical procedure was 32 minutes (25-40 minutes). For the female pigs, return to full oral diet and recovery of a normal bowel function was observed at postoperative day 2. The device fell by itself on average on the third day. Until day 10, when euthanasia was practiced, the stoma mucosa had a good coloration indicating a perfect viability of tissues. No complications were observed. Conclusions. This is the first study that describes the use of a 3D-printed device in abdominal surgery. End-type colostomy using a 3D-printed device can be safely and easily performed in an experimental porcine model, without postoperative complications. Further studies are needed to evaluate its utility in the clinical setting.


Assuntos
Enterostomia/instrumentação , Impressão Tridimensional , Animais , Colostomia/efeitos adversos , Colostomia/instrumentação , Enterostomia/efeitos adversos , Desenho de Equipamento , Equipamentos e Provisões , Estudos de Viabilidade , Complicações Pós-Operatórias , Suínos
13.
J Urol ; 203(6): 1200-1206, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31898920

RESUMO

PURPOSE: Stomal stenosis has been reported to occur in 12% to 45% of patients following Malone antegrade continence enema and Mitrofanoff appendicostomy. The standard stoma technique entails excision of the distal appendix. We evaluated a novel technique with preservation of the appendiceal tip and vessels, and opening the lumen in a more proximal and vascular area to determine whether the incidence of stenosis would be decreased. MATERIALS AND METHODS: Medical records of patients who underwent appendicostomy for Malone antegrade continence enema or urinary diversion were retrospectively evaluated. We included cases with a minimum of 1 year of followup and those in which the distal portion of a complete appendix was oriented for use as the stomal end in the umbilicus. Variables such as age, gender, body mass index, antegrade continence enema or urinary diversion, open or laparoscopic approach, cecal and appendiceal adhesions, retrocecal position, cecal imbrication, technique and stenosis were recorded. Cox proportional hazards analyses were performed to determine association of covariates. RESULTS: A total of 123 patients met inclusion criteria. The incidence of stenosis following standard stoma technique was 13% (12 of 93 patients) with a median followup of 9.4 years. Of these cases 75% occurred within 1 year of surgery. Stomal stenosis did not occur after the new stoma technique in 30 patients with a median followup of 3.3 years. Only technique cohort (standard vs new) was associated with stenosis (p=0.04). CONCLUSIONS: Stomal stenosis of appendicostomy may be lessened by preservation of the distal appendiceal vasculature and tip, and opening the lumen in a more proximal location.


Assuntos
Apêndice/cirurgia , Constrição Patológica/prevenção & controle , Enterostomia/métodos , Estomas Cirúrgicos , Adolescente , Criança , Pré-Escolar , Constipação Intestinal/terapia , Constrição Patológica/etiologia , Enterostomia/efeitos adversos , Feminino , Humanos , Lactente , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos , Irrigação Terapêutica/métodos , Derivação Urinária
14.
Chirurg ; 91(3): 245-251, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-31570963

RESUMO

After formation of a permanent terminal stoma by enterostomy, parastomal hernia (PSH) occurs in up to 80% of cases and leads to a wide variety of symptoms and complications with a high rate of emergency operations due to incarceration (ca. 15%). Consequently, greater consideration should be given to PSH prevention even as early as the time of enterostomy and generously applied indications for elective repair of manifest PSH. The aim of this article is to summarize and evaluate the current evidence for PSH repair and prevention. Poor postoperative results after attempted repair of manifest PSH with slit meshes in different layers of the abdominal wall shift the focus onto stoma lateralization (sandwich and Sugarbaker techniques) or 3­dimensional tunnel-shaped implants with meshes to cover the stomal edges. To date, the best strategy for PSH prevention has still not been defined and techniques with slit meshes show different results. Nevertheless, 10 prospective randomized trials, meta-analyses, a Cochrane review and guidelines from the European Hernia Society (EHS) about various slit-mesh devices in sublay, onlay and intraperitoneal positions confirmed significantly reduced rates of PSH after mesh augmentation compared to conventionally sutured enterostomy without morbidity associated with the implanted material. Despite the positive data situation PSH prevention is seldom performed in daily practice, which is due to uncertainty surrounding the most suitable surgical strategy, the necessity to spend additional time at the end of a demanding operation, the aversion to implanting meshes into a contaminated operative field and the lack of remuneration of preventive surgical procedures. Future trials should, therefore, no longer compare standard enterostomy techniques with one prevention method in general but should have a new focus on techniques providing adequate results in PSH repair (Sugarbaker, sandwich and 3­D tunnel meshes), probe the advantages and evaluate the differences in outcome between these strategies.


Assuntos
Enterostomia/efeitos adversos , Hérnia Ventral/prevenção & controle , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Telas Cirúrgicas , Estomas Cirúrgicos/efeitos adversos , Hérnia Ventral/etiologia , Humanos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Inflamm Bowel Dis ; 26(7): 1050-1058, 2020 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31639193

RESUMO

BACKGROUND: Crohn's disease recurrence after ileocolic resection is common and graded with the Rutgeerts score. There is controversy whether anastomotic ulcers represent disease recurrence and should be included in the grading system. The aim of this study was to determine the impact of anastomotic ulcers on Crohn's disease recurrence in patients with prior ileocolic resections. Secondary aims included defining the prevalence of anastomotic ulcers, risk factors for development, and their natural history. METHODS: We conducted a retrospective cohort study of patients undergoing an ileocolic resection between 2008 and 2017 at a large academic center, with a postoperative colonoscopy assessing the neoterminal ileum and ileocolic anastomosis. The primary outcome was disease recurrence defined as endoscopic recurrence (>5 ulcers in the neoterminal ileum) or need for another ileocolic resection among patients with or without an anastomotic ulcer in endoscopic remission. RESULTS: One hundred eighty-two subjects with Crohn's disease and an ileocolic resection were included. Anastomotic ulcers were present in 95 (52.2%) subjects. No factors were associated with anastomotic ulcer development. One hundred eleven patients were in endoscopic remission on the first postoperative colonoscopy. On multivariable analysis, anastomotic ulcers were associated with disease recurrence (adjusted hazard ratio [aHR] 3.64; 95% CI, 1.21-10.95; P = 0.02). Sixty-six subjects with anastomotic ulcers underwent a second colonoscopy, with 31 patients (79.5%) having persistent ulcers independent of medication escalation. CONCLUSION: Anastomotic ulcers occur in over half of Crohn's disease patients after ileocolic resection. No factors are associated with their development. They are associated with Crohn's disease recurrence and are persistent.


Assuntos
Colectomia/efeitos adversos , Doença de Crohn/cirurgia , Enterostomia/efeitos adversos , Enteropatias/etiologia , Complicações Pós-Operatórias/etiologia , Úlcera/etiologia , Adulto , Colo/cirurgia , Colonoscopia , Doença de Crohn/patologia , Enterostomia/métodos , Feminino , Humanos , Íleo/cirurgia , Enteropatias/diagnóstico , Masculino , Complicações Pós-Operatórias/diagnóstico , Modelos de Riscos Proporcionais , Recidiva , Estudos Retrospectivos , Fatores de Risco , Úlcera/diagnóstico
16.
World J Gastroenterol ; 25(46): 6781-6789, 2019 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-31857779

RESUMO

BACKGROUND: A one-stage laparoscopic operation has recently been considered a favorable option for the management of patients with Hirschsprung's disease (HD) due to its superior cosmetic results. One-stage transanal endorectal pull-through for the treatment of rectosigmoid HD has been widely used in newborns without complications. However, enterostomy is required in some HD cases for enterocolitis and dilated colon. Our transumbilical enterostomy (TUE) and two-stage laparoscopy-assisted anorectoplasty were effective and achieved a similar cosmetic effect to one-stage laparoscopy on the abdominal wall in patients with anorectal malformation, but the effect in patients with HD is unclear. AIM: To evaluate the safety, efficacy and cosmetic results of TUE in two-stage laparoscopy-assisted pull-through for HD. METHODS: From June 2013 to June 2018, 53 patients (40 boys, 13 girls; mean age at enterostomy: 5.5 ± 2.2 mo) who underwent enterostomy and two-stage laparoscopy-assisted pull-through for HD with stoma closure were reviewed at our institution. Two enterostomy approaches were used: TUE in 24 patients, and conventional abdominal enterostomy (CAE) in 29 patients. Eleven patients with rectosigmoid HD had severe preoperative enterocolitis or a dilated colon. 26 patients had long-segment HD, and 16 patients had total colonic aganglionosis (TCA). The patients with left-sided HD underwent the two-stage laparoscopic Soave procedure, and the patients with right-sided HD and TCA underwent the laparoscopic Duhamel procedure. Demographics, enterostomy operative time, complications and cosmetic results were respectively evaluated. RESULTS: There were no differences between the groups with respect to gender, age at enterostomy, weight and clinical type (P > 0.05). No conversion to open technique was required. Two patients experienced episodes of stomal mucosal prolapse in the TUE group and 1 patient in the CAE group (8.33% vs 3.45%, P > 0.05). No parastomal hernia was observed in either of the two groups. Wound infection at the stoma was seen in 1 case in the TUE group, and 2 cases in the CAE group (4.17% vs 6.90%, P > 0.05). No obstruction was noted in any of the patients in the TUE group, whereas obstruction was found in 1 patient in the CAE group. Enterocolitis was observed in 3 and 5 patients in the TUE and CAE group, respectively (12.50% vs 17.24%, P > 0.05). There was no significant difference between the TUE group and CAE group in terms of the incidence of soiling and constipation (P > 0.05). The cosmetic result using the scar score in the TUE group was better than that in the CAE group (6.83 ± 0.96 vs 13.32 ± 1.57, P < 0.05). CONCLUSION: TUE is a safe and feasible method for the treatment of HD, and the staged enterostomy and two-stage laparoscopy-assisted pull-through achieved a similar cosmetic effect to the one-stage laparoscopic procedure.


Assuntos
Enterostomia/métodos , Doença de Hirschsprung/cirurgia , China/epidemiologia , Enterostomia/efeitos adversos , Enterostomia/estatística & dados numéricos , Feminino , Humanos , Lactente , Laparoscopia , Masculino , Cirurgia Endoscópica por Orifício Natural , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
17.
Wound Manag Prev ; 65(12): 22-30, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31887105

RESUMO

Colorectal cancer is common in China, and studies on the sexuality of patients with an ostomy are limited, particularly information about the relationship between sexual experience and stigma. PURPOSE: A study was conducted to assess the association between sexual experience and stigma in Chinese patients with an enterostomy. METHOD: A cross-sectional, descriptive study was conducted between May 2017 and August 2018 among patients with an ostomy at 3 general hospitals. Patients 18 to 70 years old with a history of ostomy surgery more than 1 month prior, who had a regular sexual partner, and were willing to provide informed consent were eligible to participate; persons with mental illness, preoperative sexual dysfunction (SD), or tumor recurrence or metastasis were excluded. Study participants completed a paper-and-pencil questionnaire including demographic (gender, educational level, occupation, geographic place of residence, and monthly family income) and ostomy-related (type of ostomy, time since ostomy surgery, insurance coverage, ostomy-related complications, and sexual guidance) information. Sexual experience was assessed using the 5-item Chinese version of the Arizona Sexual Experience Scale (C-ASEX) (range 5 to 30; scores >19 reflect sexual dysfunction). Stigma (internalization of perceived shameful experience) was assessed using the 24-item, Likert-type Chinese version of the Social Impact Scale (C-SIS) (score range 24 to 96; lower scores indicate less stigma). Quantitative data from the questionnaires were deindentified and entered into statistical software for analysis by 2 researchers. Multivariate regression analysis was used to assess the associations among sexual experience, stigma, and other factors. RESULTS: Of the 240 questionnaires distributed, 187 (77.9%) were completed and included in the final analysis. The average C-ASEX score was 22.77 ± 6.78, and 118 participants (63.1%) had SD. The average C-SIS score was 59.36 ± 11.20, indicating a moderate level of stigma. A significant association was found between sexual experience and stigma (B = 0.101, P = .006). Sexual experience perceptions were determined by sexual guidance needs (B = 3.179, P <.001), geographic area of residence (B = -2.087, P = .014), receipt of sexual guidance (B = -2.989, P = .001), and insurance coverage (B = 1.822, P = .015). CONCLUSION: Health care workers should strive to reduce the stigma of having a stoma and offer sexual guidance as a means to improve quality of sexual life. Particular attention should be paid to the sexual well-being of persons living in rural areas and those paying for medical expenses out of pocket.


Assuntos
Enterostomia/psicologia , Comportamento Sexual/psicologia , Estigma Social , Adulto , Idoso , China , Estudos Transversais , Enterostomia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Análise de Regressão , Inquéritos e Questionários
18.
Rev. enferm. UERJ ; 27: e45758, jan.-dez. 2019. ilus
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1099963

RESUMO

Objetivo: identificar e analisar as evidências disponíveis na literatura sobre as complicações de estomia intestinal e pele periestoma. Método: revisão integrativa, em bases virtuais de dados, com inclusão de estudos do tipo ensaio clínico randomizado, publicados nos idiomas inglês, espanhol e português, no período de maio 2013 a maio de 2019. Resultados: foram selecionados 19 estudos e agrupados em três categorias: técnicas cirúrgicas apontando técnicas inovadoras acerca do tipo de suturas, ressecção e exteriorização de alça intestinal, além de reforços para prevenção de hérnias; barreiras de pele e equipamentos coletores, abordando principalmente as barreiras de pele para prevenção e tratamento da dermatite; cuidados de enfermagem mostrando cuidados e programas de acompanhamento, como visitas domiciliares, consultas e programas educativos. Conclusões: As estratégias descritas nos estudos revisados são importantes na medida em que poderão enriquecer o conhecimento do enfermeiro e dessa forma reduzir complicações de estomia e pele periestoma e melhorar a qualidade de vida dessas pessoas.


Objective: to identify and analyze the evidence available in the literature on the complications of intestinal ostomy and peristomal skin. Method: integrative review in virtual databases, including randomized clinical trialstudies published in English, Spanish and Portuguese, from May 2013 to May 2019. Results: 19 studies were selected and grouped into three categories: surgical techniques pointing innovative techniques about the type of sutures, resection and externalization of the intestinal loop, in addition to reinforcements to prevent hernias; skin barriers and collecting equipment, mainly addressing skin barriers for the prevention and treatment of dermatitis; nursing care showing care and follow-up programs such as home visits, consultations, and educational programs. Conclusion: the strategies described in the reviewed studies are important as they may enrich the knowledge of nurses and thus reduce complications of ostomy and peristome skin and improve the quality of life of these people.


Objetivo: identificar y analizar la evidencia disponible en la literatura sobre las complicaciones de la ostomía intestinal y la piel peristomal. Método: revisión integradora en bases de datos virtuales, incluidos estudios de ensayos clínicos aleatorizados publicados en inglés, español y portugués, de mayo de 2013 a mayo de 2019. Resultados: se seleccionaron 19 estudios y se agruparon en tres categorías: técnicas quirúrgicas que apuntan técnicas innovadoras sobre el tipo de suturas, resección y externalización del asa intestinal, además de refuerzos para prevenir hernias; barreras cutáneas y equipos de recolección, principalmente para abordar las barreras cutáneas para la prevención y el tratamiento de la dermatitis; atención de enfermería que muestra programas de atención y seguimiento, como visitas domiciliarias, consultas y programas educativos. Conclusiones: Las estrategias descritas en los estudios revisados on importantes ya que pueden enriquecer el conocimiento de las enfermeras y, por lo tanto, reducir las complicaciones de la ostomía y la piel peristómica y mejorar la calidad de vida de estas personas.


Assuntos
Humanos , Adulto , Enterostomia/efeitos adversos , Enterostomia/enfermagem , Dermatite/enfermagem , Enfermagem Baseada em Evidências , Complicações Pós-Operatórias/enfermagem , Complicações Pós-Operatórias/prevenção & controle , Qualidade de Vida , Dermatite/prevenção & controle
19.
Tech Coloproctol ; 23(11): 1037-1056, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31606801

RESUMO

BACKGROUND: Worldwide, stomas represent a medical and social problem. Data from the literature on stoma management are extensive but not homogeneous. In Italy, no guidelines exist for this topic. Thus, clear and comprehensive clinical guidelines based on evidence-based data and best practice are need. In 2018, the Multidisciplinary Italian Study group for STOmas, called MISSTO, was founded. The aim was to elaborate guidelines for practice management of enteral and urinary stomas in adults. METHODS: A systematic review of the literature was performed using PubMed, National Guideline Clearinghouse, and other databases. The research included guidelines, systematic reviews, meta-analyses, randomized clinical trials, cohort studies, and case reports. Five main topics were identified: "stoma preparation", "stoma creation", "stoma complications", "stoma care", and "stoma reversal". The systematic review was performed for each topic, and studies were evaluated according to the GRADE system, AGREE II tool. RESULTS: Recommendations were elaborated in the form of statements with an established grade of recommendation for each statement. For low levels of scientific evidence statements, a consensus conference composed of expert members of the major Italian scientific societies in the field of stoma management and care was held. After discussing, correcting, validating, or eliminating the statements by the experts, the final version of the guidelines was elaborated and prepared for publication. This manuscript is focused on statements on the surgical management of enteral stomas. CONCLUSIONS: These guidelines are the first Italian guidelines on multidisciplinary management of enteral stomas with the aim of assisting surgeons during stoma management and care.


Assuntos
Enterostomia/efeitos adversos , Enterostomia/métodos , Hérnia Abdominal/prevenção & controle , Estomas Cirúrgicos , Adulto , Colostomia , Medicina Baseada em Evidências , Hérnia Abdominal/etiologia , Humanos , Ileostomia , Consentimento Livre e Esclarecido , Itália , Educação de Pacientes como Assunto , Prolapso
20.
J Nurs Manag ; 27(8): 1614-1619, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31424580

RESUMO

AIM: To explore and improve nursing care for infants after enterostomy. METHODS: A total of 483 infants who underwent enterostomy from January 2014 to January 2019 were enrolled in this study. RESULTS: During hospitalization and follow-up, there were 30 infants with peripheral skin complications, including 15 cases of allergic dermatitis, 13 cases of faecal dermatitis and two cases of avulsion injury. CONCLUSION: Without proper and effective nursing care, the peripheral skin complications of enterostomy-related can easily develop. Therefore, careful postoperative care and effective family follow-up and guidance are essential after discharge, and using WeChat to follow-up can provide timely and effective follow-up and guidance to patients. IMPLICATIONS FOR NURSING MANAGEMENT: This study summarizes the experience of nursing care for infants over a 5-year period. Nurses must provide sound care for infants after enterostomy, timely and effectively address complications, guide nursing care performed by family members and strengthen follow-up through the WeChat online support group to reduce the occurrence of complications.


Assuntos
Enterostomia/enfermagem , Cuidados de Enfermagem/métodos , Complicações Pós-Operatórias/enfermagem , China/epidemiologia , Enterostomia/efeitos adversos , Feminino , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Estudos Retrospectivos , Cicatrização
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