Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 524
Filtrar
1.
Khirurgiia (Mosk) ; (2): 40-47, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33570353

RESUMO

OBJECTIVE: To identify the risk factors associated with non-closure of defunctioning stoma in patients with rectal cancer. MATERIAL AND METHODS: A retrospective analysis included patients who underwent surgical treatment at the Ryzhikh National Medical Research Centre of Coloproctology for the period from March 2017 to August 2019. Inclusion criterion was anterior or low anterior resection followed by anastomosis and preventive stoma. Univariate and multivariate analysis enrolled 28 factors for identifying the risk factors of non-closure of defunctioning stoma. RESULTS: There were 246 patients with rectal cancer. Intraoperative fluorescence angiography was applied in 145 cases to assess blood supply within the anastomosis and reduce the risk of anastomotic leakage. According to multivariate analysis, only two factors had significant influence on non-closure of preventive stoma - any grade of anastomotic leakage (OR 6.5; 95% CI 2.2-18.8, p=0.001) and rectal cancer stage IV (OR 7.2; 95% CI 1.9-27.6, p=0.004). CONCLUSION: According to our data, permanent stoma is observed in 15% of patients.


Assuntos
Protectomia/métodos , Neoplasias Retais , Estomas Cirúrgicos , Análise de Variância , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/diagnóstico , Fístula Anastomótica/etiologia , Contraindicações de Procedimentos , Humanos , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Protectomia/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Estudos Retrospectivos , Fatores de Risco , Estomas Cirúrgicos/efeitos adversos
2.
Medicine (Baltimore) ; 99(44): e22741, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126311

RESUMO

Percutaneous balloon dilatation for benign biliary-enteric anastomosis stricture has been the most widely used alternative to endoscopic treatment. However, patency results from the precedent literature are inconsistent.The objective of this study was to evaluate the safety and feasibility of repeated balloon dilatation with long-term biliary drainage for the treatment of benign biliary-enteric anastomosis strictures.Data from patients with benign biliary-enteric anastomosis strictures who underwent percutaneous transhepatic cholangiography (PTC), repeated balloon dilatation with long-term biliary drainage (repeated-dilatation group; n = 23), or PTC and single balloon dilatation with long-term biliary drainage (single-dilatation group; n = 26) were reviewed. Postoperative complications, jaundice remission, and sustained anastomosis patency were compared between the groups.All procedures were successful. No severe intraoperative complications, such as biliary bleeding and perforation, were observed. The jaundice remission rate in the first week was similar in the 2 groups. During the 26-month follow-up period, 3 patients in the repeated-dilatation group had recurrences (mean time to recurrence: 22.84 ±â€Š0.67 months, range: 18-26 months). In the single-dilatation group, 15 patients had recurrences (mean time to recurrence = 15.28 ±â€Š1.63 months, range: 3-18 months). The duration of patency after dilatation was significantly better in the repeated-dilatation group (P = .01). All patients with recurrence underwent repeat PTC followed by balloon dilatation and biliary drainage.Repeated balloon dilatation and biliary drainage is an effective, minimally invasive, and safe procedure for treating benign biliary-enteric anastomosis strictures, and provides significantly higher patency rates than single dilatation.


Assuntos
Cateterismo/métodos , Dilatação/métodos , Drenagem/métodos , Complicações Pós-Operatórias/cirurgia , Estomas Cirúrgicos/efeitos adversos , Adulto , Idoso , Anastomose Cirúrgica/efeitos adversos , Ductos Biliares/patologia , Ductos Biliares/cirurgia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Intestino Delgado/patologia , Intestino Delgado/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Estomas Cirúrgicos/patologia , Resultado do Tratamento
3.
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
5.
Transplant Proc ; 52(6): 1812-1817, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32482445

RESUMO

BACKGROUND: Nearly all publications related to endoscopic treatment of biliary anastomotic stricture after liver transplant have reported cases that can be cannulated. However, very few publications discuss endoscopic treatment of biliary anastomotic stricture (BAS) in which the guide wire does not pass through the stricture site. The purpose of this article is to analyze the long-term outcome of the Rendezvous technique in severe strictures through which guide wires cannot cannulate. METHODS: Between 2010 and 2017, a total of 29 patients who underwent Rendezvous technique because of severe BAS after liver transplant were included in the study. RESULTS: Twenty-nine patients who underwent the Rendezvous technique showed a 100% technical success rate. Ten patients (34.4%) required stent removal; the mean stenting period was 14.9 (SD, 5.6) months (range, 6.65-24.14 months). A total of 19 patients were maintained without stent removal; the stent-maintaining period was 13.1 (SD, 8.4) months (range, 3.48-38.61 months). Two patients receiving left lobe grafts maintained the stents for 27.1 (SD, 16.2) months. In left lobe graft, the duct anastomosis position moves to the right posteroinferior side of the patient. CONCLUSIONS: Our results suggest that the stenting period of the Rendezvous technique was longer in severe BAS than in cannulated endoscopic retrograde cholangiopancreatography cases. Especially in the left liver, the position of the duct anastomosis changed to the right posteroinferior of the patient. Thus, the donor duct and the recipient duct are angulated, kinking worsens, and the stenting period becomes longer.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/métodos , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Stents , Estomas Cirúrgicos/efeitos adversos , Adulto , Anastomose Cirúrgica/efeitos adversos , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Estomas Cirúrgicos/patologia , Resultado do Tratamento , Adulto Jovem
6.
Aliment Pharmacol Ther ; 51(12): 1365-1372, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32383278

RESUMO

BACKGROUND: Insufficient data exist for peristomal pyoderma gangrenosum (PPG), which primarily affects patients with inflammatory bowel disease (IBD). AIMS: To evaluate the risk factors and treatment response of PPG in IBD patients in a real-life cohort. METHODS: Cases of PPG were identified retrospectively using ICD-9/10 codes in patients with IBD who had an ostomy at a tertiary care centre. Disease-specific characteristics were compared between groups with and without PPG, and response to therapy was evaluated in patients with PPG. RESULTS: The cohort included 41 IBD patients with PPG and 123 IBD controls with an ostomy who never developed PPG. Patients with PPG were more likely to be female (76% vs 51%, P = 0.006), had higher BMIs (29.78 ± 0.89 vs 23.53 ± 0.51, P < 0.0001) and had increased usage of pouch belts (97% vs 71%, P = 0.0008) compared to controls. There were no differences in age at surgery (41.76 ± 2.60 vs 43.49 ± 1.50, P = 0.57) or IBD diagnosis (63% vs 54% Crohn's disease, P = 0.28) between PPG and controls. 85% of PPG patients achieved complete resolution with different treatments, including surgery. Complete resolution with topical corticosteroids and calcineurin inhibitors alone were low (14% and 13% respectively). Higher rates of complete resolution were reported with anti-tumour necrosis factor (TNF) agents (63%) and surgical interventions (80%). CONCLUSIONS: Female gender, higher BMI and pouch belts were associated with increased risk of developing PPG. Most PPG cases resolved after treatment with the highest rates of complete resolution seen with anti-TNF agents and surgical intervention.


Assuntos
Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/terapia , Pioderma Gangrenoso/etiologia , Pioderma Gangrenoso/terapia , Estomas Cirúrgicos/efeitos adversos , Adulto , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Doença de Crohn/epidemiologia , Doença de Crohn/terapia , Feminino , Humanos , Imunossupressores/uso terapêutico , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/epidemiologia , Masculino , Pessoa de Meia-Idade , Estomia/efeitos adversos , Prognóstico , Pioderma Gangrenoso/diagnóstico , Pioderma Gangrenoso/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator de Necrose Tumoral alfa/imunologia
7.
Dan Med J ; 67(3)2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32138828

RESUMO

INTRODUCTION: Stoma-site incisional hernia is a common complication. Besides decreasing affected patients' quality of life, it may lead to emergency surgery due to incarceration. If stoma sites lead to an incisional hernia analogous to other abdominal incisions, considerable underreporting may be present in the literature. METHODS: This was a single-centre, retrospective cohort study comprising consecutive patients undergoing laparoscopic rectal resection for rectal carcinoma with temporary diverting stoma and subsequent stoma reversal. CTs were reviewed to identify stoma-site incisional hernia, and potential confounders for development of a hernia were assessed. RESULTS: A total of 91 patients underwent stoma reversal and subsequent CT. In all, 72 of the 91 included patients had a transverse colostomy, among whom 19 (26%) developed a hernia. Among the remaining 19 patients treated with an ileostomy, four (21%) developed stoma-site incisional hernia. The mean time from stoma reversal to follow-up CT was 47.6 months (range: 28.5-66.7 months). No significant associations between stoma-site hernia and the included potential risk factors were observed. CONCLUSIONS: 25% developed reversal-site incisional hernia. We were unable to find any predictors for development of stoma reversal-site hernia. If hernias occur as frequently as this study shows, investigation of potential ways to decrease their occurrence is warranted. FUNDING: none. TRIAL REGISTRATION: The study was approved by the Danish Data Protection Agency (R. no. 2012-58-0004).


Assuntos
Colostomia/efeitos adversos , Ileostomia/efeitos adversos , Hérnia Incisional/diagnóstico por imagem , Neoplasias Retais/cirurgia , Estomas Cirúrgicos/efeitos adversos , Idoso , Feminino , Humanos , Incidência , Hérnia Incisional/etiologia , Hérnia Incisional/cirurgia , Laparoscopia/efeitos adversos , Laparotomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X
8.
Dis Colon Rectum ; 63(5): 678-684, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32032196

RESUMO

BACKGROUND: Parastomal hernias are common with permanent colostomies and prone to complications. The short-term results of trials of parastomal hernia prevention are widely published, but long-term results are scarce. OBJECTIVE: The aim of the study is to detect the long-term effects and safety of preventive intra-abdominal parastomal mesh. DESIGN: This is a long-term follow-up of a previous prospective randomized, controlled multicenter trial. SETTINGS: This study was conducted at 2 university hospitals and 3 central hospitals in Finland. PATIENTS: Patients who had a laparoscopic abdominoperineal resection for rectal cancer between 2010 and 2013 were included in the study and invited for a follow-up visit. MAIN OUTCOME MEASURES: The primary outcomes measured were clinical and radiological parastomal hernias. RESULTS: Twenty subjects in the mesh group and 15 in the control group attended the follow-up visit with a median follow-up period of 65 (25th-75th percentiles, 49-91) months. A clinically detectable parastomal hernia was present in 4 of 20 (20.0%) and 5 of 15 (33.3%) subjects in the mesh and control groups (p = 0.45). A radiological parastomal hernia was present in 9 of 19 (45.0%) subjects in the mesh group and 7 of 12 (58.3%) subjects in the control group (p = 0.72). However, when all subjects (n = 70, 1:1) who attended the 12-month follow-up were screened for long-term results according to register data, 9 of 35 (25.9%) subjects in the mesh group and 16 of 35 (45.6%) subjects in control group were diagnosed with a parastomal hernia during the follow-up period (p = 0.10). In addition, only 1 of 35 (2.7%) subjects in the mesh group but 6 of 35 (17.1%) subjects in the control group underwent a parastomal hernia operation during the long-term follow-up (p = 0.030). LIMITATIONS: The study is limited by the small number of patients. CONCLUSION: Prophylactic intra-abdominal keyhole mesh did not decrease the rate of clinically detectable hernias but reduced the need for the surgical repair of parastomal hernias. Further trials are needed to identify a more efficient method to prevent parastomal hernias. See Video Abstract at http://links.lww.com/DCR/B171. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov. Identifier: NCT02368873. ESTUDIO PROSPECTIVO ALEATORIZADO SOBRE EL USO DE MALLA PROTÉSICA PARA PREVENIR UNA HERNIA PARAESTOMAL EN UNA COLOSTOMÍA PERMANENTE: RESULTADOS DE UN SEGUIMIENTO A LARGO PLAZO: PREVENCIÓN DE HERNIA PARAESTOMAL, NEOPLASIA COLORRECTAL/ANAL: Las hernias paraestomales son comunes con colostomías permanentes y son propensas a complicaciones. Los resultados a corto plazo de los ensayos sobre la prevención de la hernia parastomal se publican ampliamente, pero los resultados a largo plazo son escasos.El objetivo del estudio es detectar los efectos a largo plazo y la seguridad de la malla parastomal intraabdominal preventiva.Este es un seguimiento a largo plazo de un estudio aleatorizado prospectivo, controlado y multicentrico previo.Este estudio se realizó en dos hospitales universitarios y tres hospitales centrales en Finlandia.Los pacientes que se sometieron a una resección abdominoperineal laparoscópica por cáncer de recto 2010-2013 fueron incluidos en el estudio e invitados a una visita de seguimiento.Hernias parastomales clínicas y radiológicas.Veinte sujetos en el grupo de malla y 15 en el grupo control asistieron a la visita de seguimiento con una mediana de seguimiento de 65 meses (25-75 ° percentil 49-91). Una hernia paraestomal clínicamente detectable estuvo presente en 4/20 (20.0%) y 5/15 (33.3%) en los grupos de malla y control, respectivamente (p = 0.45). Una hernia parastomal radiológica estuvo presente en 9/19 (45.0%) en el grupo de malla y 7/12 (58.3%) en el grupo de control (p = 0.72). Sin embargo, cuando todos los sujetos (n = 70, 1: 1) que asistieron a los 12 meses de seguimiento fueron evaluados para obtener resultados a largo plazo de acuerdo con los datos del registro, 9/35 (25.9%) sujetos en el grupo de malla y 16/35 (45,6%) sujetos en el grupo control fueron diagnosticados con una hernia paraestomal durante el período de seguimiento (p = 0,10). Además, solo 1/35 (2.7%) en el grupo de malla pero 6/35 (17.1%) en el grupo control se sometieron a una operación de hernia paraestomal durante el seguimiento a largo plazo (p = 0.030).El estudio está limitado por un pequeño número de pacientes.La malla intra-abdominal profiláctica en ojo de cerradura no disminuyó la tasa de hernias clínicamente detectables, pero redujo la necesidad de la reparación quirúrgica de las hernias paraestomales. Se necesitan ensayos adicionales para identificar un método más eficiente para prevenir las hernias parastomales. Vea el resumen del video en http://links.lww.com/DCR/B171. (Traducción-Dr. Gonzalo Hagerman).NCT02368873.


Assuntos
Colostomia/efeitos adversos , Hérnia Incisional/prevenção & controle , Protectomia/efeitos adversos , Neoplasias Retais/cirurgia , Telas Cirúrgicas , Estomas Cirúrgicos/efeitos adversos , Idoso , Feminino , Finlândia , Seguimentos , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
9.
Trials ; 21(1): 24, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31907033

RESUMO

BACKGROUND: Although the wound-healing period for purse-string closure (PSC) after stoma reversal is longer than that required for the primary closure method, the rate of wound infection is reduced. The application of negative-pressure wound therapy (NPWT) can reduce the healing period for many types of wounds. Herein, we describe a planned trial to test the hypothesis that NPWT can reduce the healing period for PSC after stoma reversal. METHODS/DESIGN: Patients undergoing stoma reversal will be recruited and allocated into intervention and control groups, with 1:1 randomisation. Patients in the control group will receive standard postsurgical wound care; patients in the intervention group will receive NPWT using the PICO™ system. The target sample size will be 38 patients, as this will provide 80% power at the 5% level of significance to detect a 7-day reduction in the wound-healing period in the intervention group compared to that in the control group. The primary endpoint will be the duration to wound healing, defined as the time to nearly complete epithelisation of the wound, without any discharge or surgical site infection (SSI). Secondary endpoints will be the SSI rate, length of postoperative hospital stay, number of wound dressings and visits to the hospital for wound dressing after discharge, total cost of wound dressings, and patient and observer scar assessment scale scores. DISCUSSION: The results of this planned randomised controlled study will clarify the role of NPWT in patients undergoing stoma reversal and strengthen the rationale for choosing a dressing technique. TRIAL REGISTRATION: Clinical Research Information Service (CRIS), KCT0004063. Registered on 6 June 2019.


Assuntos
Tratamento de Ferimentos com Pressão Negativa , Reepitelização , Estomas Cirúrgicos/efeitos adversos , Infecção da Ferida Cirúrgica/prevenção & controle , Técnicas de Fechamento de Ferimentos/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Bandagens/economia , Bandagens/estatística & dados numéricos , Ensaios Clínicos Fase IV como Assunto , Feminino , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa/economia , Tratamento de Ferimentos com Pressão Negativa/instrumentação , Tratamento de Ferimentos com Pressão Negativa/estatística & dados numéricos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Pele/fisiopatologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
10.
Int J Colorectal Dis ; 35(2): 199-212, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31912267

RESUMO

PURPOSE: Parastomal hernia (PSH) is a common complication following stoma formation. The incidence of PSH varies widely due to several factors including differences in diagnostic modality, observer, definition, and classification used for diagnosing PSH. The aim of this systematic review was to evaluate the diagnostic accuracy of the modalities used to identify PSH. METHODS: Embase, MEDLINE, Cochrane, Web of Science, and Google Scholar databases were searched. Studies reporting PSH incidence rates detected by two or more different diagnostic modalities or inter-observer variation on one diagnostic modality were included. Article selection and assessment of study quality were conducted independently by two researchers using Cochrane Collaboration's tool for assessing risk of bias. PROSPERO registration: CRD42018112732. RESULTS: Twenty-nine studies (n = 2514 patients) were included. Nineteen studies compared CT to clinical examination with relative difference in incidence rates ranging from 0.64 to 3.0 (n = 1369). Overall, 79% of studies found an increase in incidence rate when using CT. Disagreement between CT and clinical examination ranged between 0 and 37.3% with pooled inter-modality agreement Kappa value of 0.64 (95% CI 0.52-0.77). Four studies investigated the diagnostic accuracy of ultrasonography (n = 103). Compared with peroperative diagnosis, CT and ultrasonography both seemed accurate imaging modalities with a sensitivity of 83%. CONCLUSION: CT is an accurate diagnostic modality for PSH diagnosis and increases PSH detection rates, as compared with clinical examination. Studies that specially focus on the diagnostic accuracy are needed and should aim to take patient-reported outcomes into account. A detailed description of the diagnostic approach, modality, definition, and involved observers is prerequisite for future PSH research.


Assuntos
Hérnia Abdominal/diagnóstico por imagem , Hérnia Incisional/diagnóstico por imagem , Estomas Cirúrgicos/efeitos adversos , Tomografia Computadorizada por Raios X , Ultrassonografia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hérnia Abdominal/epidemiologia , Humanos , Incidência , Hérnia Incisional/epidemiologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Resultado do Tratamento , Adulto Jovem
11.
Clinics (Sao Paulo) ; 75: e1353, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939559

RESUMO

OBJECTIVE: Stoma prolapse is an intussusception of the bowel through a mature stoma. It can be caused by increased intra-abdominal pressure, excessively mobile bowel mesentery and/or a large opening in the abdominal wall at the time of stoma formation. It occurs predominantly in loop stomas, and correction methods include conservative modalities, such as local reduction to the prolapsed bowel, or surgical treatment. The purpose of this study was to describe our experience with the treatment of colostomy prolapse using a novel mesh strip technique. METHODS: Between February 2009 and March 2018, ten consecutive male patients underwent correction of colostomy prolapse under local anesthesia by peristomal placement of a polypropylene mesh strip. Operation time, short- and long-term complications, and recurrence rates were recorded and analyzed. RESULTS: No postoperative complications, morbidity or mortality were observed. The median length of the prolapse ranged from 6-20 cm, and the median operative time was 30 minutes. The median duration of follow-up was 25 months (range, 12-89 months). No relapse, mesh strip extrusion, local infection or granuloma formation were found. CONCLUSION: A simple, fast, and low-cost operation under local anesthesia using a mesh strip is a valuable option to treat colostomy prolapse.


Assuntos
Doenças do Colo/cirurgia , Colostomia/reabilitação , Complicações Pós-Operatórias/cirurgia , Telas Cirúrgicas , Estomas Cirúrgicos/efeitos adversos , Parede Abdominal , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prolapso , Resultado do Tratamento
12.
J Wound Ostomy Continence Nurs ; 47(1): 32-38, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929442

RESUMO

PURPOSE: The aim of this study was to evaluate both surgical and patient-centered stomal complications after stoma formation, with emphasis on underreported symptoms and complaints. DESIGN: Prospective, single-group study. SUBJECTS AND SETTING: Patients undergoing emergency and elective ostomy surgery between January 1, 1999, and June 1, 2016, in 3 acute care hospitals were followed up by stoma care nurse specialists in NHS Lanarkshire, Scotland. METHODS: Data were collected on surgery type (emergency or elective), stoma type (ileostomy or colostomy), stoma-related complications including surgical complications (stenosis, retractions, hernia, and prolapse) and so-called "patient-centered" complications (skin changes, odor, leakage, soiling, and nighttime emptying) at 5 time points: 10 days, 3 months, 6 months, 1 year, and 2 years postoperatively. For this study, we report comparisons at 10 days and 2 years, using frequencies reported as percentages. RESULTS: Data from 3509 consecutive stoma surgeries were analyzed. Complication rates were similar in both emergency and elective cases. The nighttime symptoms of leakage and soiling were significantly greater in the ileostomy group and worsened over the 2-year period. The parastomal hernia rate was 34.5% at 2 years, a finding more common in the colostomy group (46.4% vs 20.1%, P < .001). However, the rate of clinically significant hernia was similar when comparing the colostomy group with the ileostomy group (3.6% vs 2.2%, P = .38). Emergency stoma surgeries (40.2%) were preoperatively sited compared with 95.9% of elective cases. CONCLUSIONS: Our prospective multicenter study demonstrated that stoma-related complications are similar irrespective of whether the stoma was formed via an elective surgery or emergency surgery. Nighttime symptoms of leakage, soiling, and emptying were high post-stoma formation, particularly in the ileostomy group, and worsened over the 2-year period. Findings from our study highlight the presence and persistence of complications. We believe our work highlights the importance of having frequent discussions with patients about making decisions about approaches to reduce complications to enhance patient outcomes.


Assuntos
Estomas Cirúrgicos/efeitos adversos , Adulto , Idoso , Estudos de Coortes , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Feminino , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Escócia/epidemiologia
13.
J Pediatr Surg ; 55(1): 90-95, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31704044

RESUMO

INTRODUCTION: Gastrointestinal (GI) operations represent a significant proportion of the surgical site infection (SSI) burden in pediatric patients, resulting in significant morbidity. We have previously demonstrated that a GI bundle decreases SSI rates, length of stay (LOS), and hospital charges. Following this success, we hypothesized that by targeting the preoperative antibiotics for stoma closures based on organisms found in infected wounds, we could further decrease SSI rates. METHODS: As part of a broad quality improvement effort to reduce SSI rates, we reviewed the responsible pathogens and their sensitivities as well as the preoperative antibiotic used, and found that 15% of wound infections were caused by enterococcus. Based on this information, starting in April 2017, we changed the prior preoperative antibiotic cefoxitin to ampicillin-sulbactam, which more accurately targeted the prevalent pathogens from April 2017 to October 2018. RESULTS: The baseline SSI rate for all stoma takedown patients was 21.4% (25 of 119). After bundle implementation, this decreased to 7.9% (17 of 221; p = 0.03) over a period of 2.5 years. Then, after changing the preoperative antibiotics, our rate of SSI decreased further to 2.2% (1 of 44; p = 0.039) over a period of 1.5 years. CONCLUSION: Significant reduction of SSI in GI surgery can be accomplished with several prevention strategies (our GI bundle). Then a change of the preoperative antibiotic choice, chosen based on causative wound infection organisms, may further decrease SSI rates. We recommend an institution specific analysis of wound infections and modification of preoperative antibiotics if the responsible organisms are resistant to the original antibiotic choice. TYPE OF STUDY: Retrospective cohort study. LEVEL OF EVIDENCE: Level III.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Estomas Cirúrgicos/efeitos adversos , Infecção da Ferida Cirúrgica/prevenção & controle , Ampicilina/uso terapêutico , Criança , Colostomia/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Feminino , Humanos , Ileostomia/efeitos adversos , Tempo de Internação , Masculino , Pacotes de Assistência ao Paciente , Estudos Retrospectivos , Sulbactam/uso terapêutico , Infecção da Ferida Cirúrgica/microbiologia
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.
Surg Today ; 50(3): 284-291, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31512061

RESUMO

PURPOSE: Peristomal skin disorders (PSDs) are common stoma-related complications. However, there is no standard method for the evaluation of PSDs, and the true incidence is unclear. There are also no reports on risk factors for severe PSDs. Therefore, this study was performed to analyze the incidence of PSD in temporary loop stoma based on the DET score and ABCD-stoma score and to determine the risk factors for all and severe PSDs. METHODS: A retrospective analysis of patient and surgical characteristics was carried out in 333 consecutive cases of stoma creation with loop ileostomy or colostomy performed at our hospital from January 2014 to December 2016. RESULTS: PSDs were diagnosed in 262 patients (78.7%), including 79 (23.7%) and 71 (21.3%) that were defined as severe based on DET and ABCD-stoma scores, respectively. Multivariate analyses showed that parastomal hernia was an independent risk factor for severe PSD defined by DET score and that adjuvant chemotherapy was an independent risk factor for severe PSD defined by the ABCD-stoma score. CONCLUSIONS: Severe PSDs are associated with parastomal hernia when diagnosed by the DET score and with adjuvant chemotherapy when diagnosed by the ABCD-stoma score.


Assuntos
Dermatopatias/diagnóstico , Dermatopatias/etiologia , Estomas Cirúrgicos/efeitos adversos , Quimioterapia Adjuvante , Humanos , Incidência , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Dermatopatias/epidemiologia
16.
Acta Chir Belg ; 120(1): 57-60, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30103665

RESUMO

Introduction: A parastomal hernia (PSH) is the most common complication of a stoma creation. The PSH contents normally consist of mobile abdominal structures, i.e. omentum and small or large bowel loops. A herniated stomach is thereby very rare, given that only eight cases are reported in the literature.Patients and methods: Two female patients with clinical symptoms of gastric involvement in a PSH were admitted in our centre.Results: Computed tomography (CT) imaging, nasogastric decompression and an efficient operative intervention ensured a good clinical outcome in both patients, but with a long hospital stay and temporary gastroparesis in one patient. Regarding our two cases and the eight cases reported in the literature, mainly older females with colostomies are at risk and most of them need surgery. Conclusions: In patients presenting with obstructive symptoms, one should be aware of a possible gastric outlet obstruction because of its involvement in a PSH, although sporadic. Surgery might be considered as the treatment of choice because conservative treatment mostly fails. Earlier surgery might perhaps also reduce postoperative hospital stay and gastroparesis.


Assuntos
Colostomia/efeitos adversos , Hérnia Incisional/diagnóstico por imagem , Hérnia Incisional/etiologia , Gastropatias/diagnóstico por imagem , Gastropatias/etiologia , Estomas Cirúrgicos/efeitos adversos , Idoso , Feminino , Humanos , Hérnia Incisional/cirurgia , Gastropatias/cirurgia , Tomografia Computadorizada por Raios X
17.
Int J Colorectal Dis ; 35(3): 403-411, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31875261

RESUMO

BACKGROUND: Compromised wound healing following stoma reversal is a frequent problem. The use of negative suction drainage for reduction of complications remains controversial. METHODS: The patient database of our center was reviewed for patients with ileostomy reversal between 2007 and 2017. Risk factors for wound complications were analyzed using multivariate regression analysis. Systematic review and meta-analysis was performed. Ultimately, results of this study were integrated into meta-analysis to assess the effect of drainage placement on wound healing. RESULTS: In our institutional analysis, a total of 406 patients with ileostomy reversal were included (n = 240 (59.1%) with drainage vs. n = 166 (40.8%) without drainage). In multivariate analysis, body mass index (BMI) was a risk factor for wound complications (odds ratio (95% CI) 1.06 (1.02-1.12)). Patients with drainage needed significantly fewer interventions than those without drainage (17.1% vs. 28.9%, p = 0.005). Placement of drainage significantly reduced the risk of wound complications even in the group with elevated BMI (odds ratio (95% CI) 0.462 (0.28-0.76), p = 0.003). Meta-analysis identified 6 studies with a total of 1180 patients eligible for further analysis (2 prospectively randomized trials; 4 retrospective cohort studies). Overall analysis revealed a significantly beneficial effect of wound drainage following ileostomy reversal (RR (95% CI) 0.47 (0.34, 0.66); p < 0.0001). CONCLUSION: In our institutional analysis as well as meta-analysis, the use of subcutaneous suction drains was beneficial for prevention of wound healing complications following ostomy reversal. Drainage placement is especially valuable in high-risk situations such as in obese patients.


Assuntos
Ileostomia/métodos , Complicações Pós-Operatórias/prevenção & controle , Sucção/métodos , Estomas Cirúrgicos/fisiologia , Cicatrização , Fístula Anastomótica/prevenção & controle , Índice de Massa Corporal , Humanos , Reoperação , Estudos Retrospectivos , Fatores de Risco , Estomas Cirúrgicos/efeitos adversos , Infecção da Ferida Cirúrgica/prevenção & controle
18.
Asian J Endosc Surg ; 13(1): 77-82, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30675994

RESUMO

INTRODUCTION: Parastomal hernia (PH) is a common late complication of stoma formation for which laparoscopic repair is a well-accepted modality of treatment. Keyhole repair has been frequently reported with recurrence, but our modification in surgical technique have lesser and acceptable recurrence rates. The present study aimed to assess the results of modified laparoscopic keyhole plus repair in the treatment of symptomatic PH. METHODS: We reviewed our prospectively maintained database to search for patients who had undergone laparoscopic modified keyhole repair between January 2008 and April 2018. All 23 symptomatic patients who had undergone this procedure were included in the present study. RESULTS: A total of 23 patients were studied. The median age was 37 years (range, 22-54 years). Two patients with large PHs underwent open excision of the redundant skin and then laparoscopic modified keyhole repair. There was one conversion to open repair because of dense adhesions. The mean operative time was 112 ± 37 minutes. The mean postoperative hospital stay was 3 ± 2 days. There were no significant intraoperative or postoperative complications. During follow-up, three patients had a seroma, which was managed conservatively. One morbidly obese patient who had an ileal conduit-related stomal hernia had a symptomatic recurrence 3 years after surgery. CONCLUSION: The modified laparoscopic keyhole plus repair is a safe, feasible, and effective technique for PH repair; it has an acceptable recurrence rate and offers good cosmesis and functional outcomes.


Assuntos
Hérnia Ventral/cirurgia , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Estomia/efeitos adversos , Estomas Cirúrgicos/efeitos adversos , Adulto , Humanos , Hérnia Incisional/etiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
19.
Jpn J Clin Oncol ; 50(1): 20-28, 2020 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-31665375

RESUMO

OBJECTIVES: Anastomotic leakage (AL) after anterior resection always leads to longer hospital stays, decreased quality of life and even increased mortality. Despite extensive research, no consensus on the world well-concerned surgical-related risk factors exists. We therefore conducted a meta-analysis of the available published literature to identify the effects of surgical-related risk factors for AL after anterior resection for rectal cancer, hoping to provide more information and improved guidance for clinical workers managing patients with rectal cancer who are at a high risk for AL. METHODS: In this study, the relevant articles were systematically searched from EMBASE, MEDLINE, PubMed, WangFang (Database of Chinese Ministry of Science & Technology), Chinese National Knowledge Infrastructure Database and China Biological Medicine Database. The pooled odds ratio (OR) with 95% confidence interval (95% CI) were calculated. Meta-analysis was performed using of RevMan 5.3 software. RESULTS: A total of 26 studies met the inclusion criteria and comprised 34238 cases. Analysis of these 26 studies showed that no defunctioning stoma was highly correlated with AL (pooled OR = 1.28, 95%CI: 1.05-1.57, P = 0.01, random effect), and intraoperative blood transfusion was significantly associated with AL (pooled OR = 1.64, 95%CI: 1.34-2.02, P = 0.02, random effect). However, the AL was not associated with type of anastomosis, type of surgery, technique of anastomosis, level of inferior mesenteric artery ligation, operation time and splenic flexure mobilization. CONCLUSIONS: Depend on this meta-analysis, no defunctioning stoma and intraoperative blood transfusion are the major surgical-related risk factors for AL after resection for rectal cancer. Because of the inherent limitations of the research, future prospective randomized controlled trials will need to confirm this conclusion.


Assuntos
Fístula Anastomótica/etiologia , Neoplasias Retais/cirurgia , Reação Transfusional/etiologia , Anastomose Cirúrgica/efeitos adversos , Transfusão de Sangue , China , Humanos , Ligadura , Masculino , Razão de Chances , Qualidade de Vida , Fatores de Risco , Estomas Cirúrgicos/efeitos adversos
20.
Clin. biomed. res ; 40(1): 27-32, 2020.
Artigo em Português | LILACS | ID: biblio-1116850

RESUMO

Introdução: O fechamento de estomas, embora rotineiramente performado, ainda não pode ser considerado um procedimento simples. Nós reportamos, desta forma, a morbidade, mortalidade e fatores de riscos associados a este procedimento em um período de dez anos. Métodos: Revisão retrospectiva de 252 prontuários (149 homens; 103 mulheres), com uma média de 56 anos de idade (18 a 89 anos), que foram submetidos a fechamento de estomas, com análise de complicações clínicas e cirúrgicas, características relacionadas ao estoma, entre outros. Admissão em UTI, complicações precoces (até 30 dias) (classificação de Clavien-Dindo), e tardias, além de óbito, foram analisados. Os testes T de Student, ANOVA, Qui-Quadrado de Pearson, exato de Fischer e de Mann-Whitney foram utilizados para análise paramétrica e não-paramétrica. Resultados: Tumores colorretais (64%) e diverticulite (10%) foram as principais causas para a confecção do estoma. 112 (44,4%) dos pacientes tiveram pelo menos uma complicação cirúrgica. As complicações precoces foram infecção de ferida operatória (13%), fistula e deiscência anastomótica/intestinal (9%), abscessos de cavidade ou parede abdominais (8,3%); tardiamente houveram 36 casos de hérnia incisional (14,2%) e uma estenose intestinal (0,3%). Comorbidades levaram a 10% maior probabilidade de ter uma ou mais complicações cirúrgicas, e todas as cinco mortes ocorreram nestes pacientes (2%). Estomas de intestino grosso, maior tempo operatório e admissão em UTI estiveram significamente relacionados a aumento da morbidade. Conclusão: Pacientes com comorbidades e estomas de intestino grosso tiveram mais risco de complicações. Cuidados pré e perioperatórios, e melhor seleção de pacientes são importantes na redução da morbimortalidade.(AU)


Introduction: Although routinely performed, stoma closure cannot as yet be considered a simple procedure. We report here the morbidity, mortality and risk factors associated with this procedure over a 10-year period. Methods: The medical records of 252 patients (149 men; 103 women), with a mean age of 56 years (18 to 89 years), who underwent stoma closure were retrospectively reviewed for postoperative clinical and surgical complications, stoma-related features, among others. ICU admission, early surgical complications (within 30 days) according to the Clavien-Dindo classification, late surgical complications, and death were analyzed. Student's t-test, ANOVA, Pearson's chi-square test, Fisher's exact test, and MannWhitney U test were used for parametric and nonparametric data. Results: Colorectal tumors (64%) and diverticulitis (10%) were the main reasons for stoma surgery. Overall, 112 (44.4%) patients had at least one surgical complication. Early complications included surgical wound infection (13%), fistula and anastomotic/ intestinal dehiscence (9%), and abdominal wall or intra-abdominal abscesses (8.3%). Late complications included 36 (14.2%) cases of incisional hernia and one case (0.3%) of stricture. Patients with comorbidities were 10% more likely to have one or more surgical complications, and all 5 deaths occurred in these patients (2%). Large-bowel ostomies, longer operative time and ICU admission were significantly related to increased morbidity. Conclusion: Patients with an increased number of comorbidities and large-bowel ostomies are at higher risk for complications. Pre- and perioperative care and accurate patient selection are important to reduce morbidity and mortality.(AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Complicações Pós-Operatórias/epidemiologia , Estomas Cirúrgicos/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Infecção da Ferida Cirúrgica/epidemiologia , Fatores de Tempo , Tabagismo/epidemiologia , Neoplasias Colorretais/cirurgia , Estudos Retrospectivos , Fatores de Risco , Diverticulite/cirurgia , Hipertensão/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...