Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.261
Filtrar
1.
Vasc Endovascular Surg ; 54(5): 445-448, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32295492

RESUMO

Aortoduodenal fistula after endovascular treatment of abdominal aortic aneurysm is a very rare but life-threatening complication. Herein, we describe 4 cases of aortoduodenal fistula diagnosed at 15 to 78 months after the index aortic intervention, all successfully treated by surgery. All patients underwent primary repair of the duodenal wall, creation of tube duodenostomy, stent graft removal, and in situ reconstruction using a rifampicin-soaked prosthesis. Patients received prolonged antibiotic treatment for at least 2 months postoperatively, and all were free of recurrent infection at follow-up. Prompt and appropriate surgical intervention is required to effectively manage this condition.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Doenças da Aorta/etiologia , Implante de Prótese Vascular/efeitos adversos , Duodenopatias/etiologia , Procedimentos Endovasculares/efeitos adversos , Fístula Intestinal/etiologia , Fístula Vascular/etiologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Remoção de Dispositivo , Duodenopatias/diagnóstico por imagem , Duodenopatias/cirurgia , Duodenostomia , Procedimentos Endovasculares/instrumentação , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/cirurgia , Masculino , Stents , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgia
5.
Khirurgiia (Mosk) ; (1): 46-52, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994499

RESUMO

OBJECTIVE: To evaluate the possibility and safety of modified endoscopic stent in the treatment of benign intestinal fistulas. MATERIAL AND METHODS: Analysis of the experience of Sklifosovsky Research Institute for Emergency Care and recent numerous foreign reports confirms that staged treatment followed by delayed radical surgery is the most perspective approach. Modified endoscopic treatment of intestinal fistulas successfully used in 10 patients is reported in the article. RESULTS: Endoscopic stenting of various parts of gastrointestinal tract is a minimally invasive treatment of this pathology and not followed by complications and mortality. An important advantage is early closure of fistula that reduces duration of treatment and improves further social and labor rehabilitation of patients.


Assuntos
Fístula Intestinal/cirurgia , Endoscopia , Humanos , Fístula Intestinal/etiologia , Implantação de Prótese , Stents , Resultado do Tratamento
6.
Gastrointest Endosc Clin N Am ; 30(1): 173-185, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739963

RESUMO

The overstitch endoscopic suturing system has opened a novel arena in endoscopy. To properly apply endoscopic suturing techniques, it is important to understand suture patterns and the different traction methods available. Applications beyond tissue compression in bariatric endoscopy include: closure, traction and fixation. Closure could be applied to perforations, suture dehiscences, fistulas and stoma reduction. Traction could be applied either as a pulley method to improver resection or as an improved method to decrease a defect size and help pull it into an over the scope clip. Fixation has been mainly used to secure stents.


Assuntos
Endoscopia Gastrointestinal/instrumentação , Stents , Instrumentos Cirúrgicos , Técnicas de Sutura/instrumentação , Endoscopia Gastrointestinal/métodos , Fístula Gástrica/cirurgia , Humanos , Fístula Intestinal/cirurgia , Perfuração Intestinal/cirurgia , Ilustração Médica , Estomas Cirúrgicos , Deiscência da Ferida Operatória/cirurgia
7.
Gastrointest Endosc Clin N Am ; 30(1): 147-161, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739961

RESUMO

Endoscopic suturing allows for select patients with perforations, leaks, and fistulas to be managed endoscopically. Experience with the Overstitch endoscopic suturing device suggests it may be superior to endoclips in the management of perforations, because of its ability to achieve full-thickness suturing and create an airtight closure. Although successful closure of leaks and fistulas using the Overstitch device has been described, additional therapy with a multimodality approach is often required because of inherent challenges with fistula recurrence. This article reviews the existing literature on the Overstitch endoscopic suturing system specifically in the management of gastrointestinal perforations, leaks, and fistulas.


Assuntos
Endoscopia Gastrointestinal/instrumentação , Fístula Gástrica/cirurgia , Fístula Intestinal/cirurgia , Perfuração Intestinal/cirurgia , Técnicas de Sutura/instrumentação , Endoscopia Gastrointestinal/métodos , Trato Gastrointestinal/cirurgia , Humanos , Resultado do Tratamento
8.
Gastrointest Endosc Clin N Am ; 30(1): 41-74, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739967

RESUMO

Despite major improvements in endoscopic devices and therapeutic endoscopy, closure of gastrointestinal perforations, dehiscence, and fistulae had remained problematic. However, since the advent of devices such as the over the scope clip and others, endoscopic closure of gastrointestinal defects has become a routine approach. Furthermore, because of its strong apposition force, the over the scope clip may also be used to anchor fully covered self-expanding metal stents. In addition, the over the scope clip is an effective rescue therapy for various types of gastrointestinal bleeding pathologies. It is frequently used as an additional tool in complex gastrointestinal leak cases requiring internal and external drains.


Assuntos
Endoscopia Gastrointestinal/instrumentação , Hemorragia Gastrointestinal/cirurgia , Fístula Intestinal/cirurgia , Perfuração Intestinal/cirurgia , Instrumentos Cirúrgicos , Deiscência da Ferida Operatória/cirurgia , Desenho de Equipamento , Humanos , Ilustração Médica
9.
Gastrointest Endosc Clin N Am ; 30(1): 25-39, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739966

RESUMO

In gastrointestinal perforation or fistula, endoscopic closure techniques could be used as alternatives to surgery. Early endoscopic recognition and treatment of gastrointestinal perforation is the most important factor determining procedural success and clinical outcomes. The over-the-scope clip with full-thickness grasping capability provides greater technical and clinical success rates compared with the through-the-scope clips. Although the technical success rate of chronic fistula closure is comparable to perforation closure, it has a significantly lower clinical success owing to its less healthy tissue edge of the fistula. The over-the-scope clip system should be considered before surgery for the closure of perforation and fistula.


Assuntos
Endoscopia Gastrointestinal/instrumentação , Fístula Intestinal/cirurgia , Perfuração Intestinal/cirurgia , Instrumentos Cirúrgicos , Endoscopia Gastrointestinal/métodos , Desenho de Equipamento , Humanos , Resultado do Tratamento
10.
Surgery ; 167(3): 590-597, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31883631

RESUMO

BACKGROUND: A mesh-related intestinal fistula is an uncommon and challenging complication of ventral hernia repair. Optimal management is unclear owing to lack of prospective or long-term data. METHODS: We reviewed our prospective data for mesh-related intestinal fistulas from 2004 to 2017and compared suture repair versus ventral hernia repair with mesh at the time of mesh-related intestinal fistula takedown. RESULTS: Eighty-two mesh-related intestinal fistulas were treated; none of the fistulas had closed spontaneously, and all fistula persisted at the time of our treatment. Mean age was 61 ± 12 years with 33-month follow-up. Comorbidities were similar between groups. Defects were 2.5-times larger in ventral hernia repair with mesh (324 ± 392 cm2 vs 1301 ± 133 cm2; P = .044). Components separation (64% vs 21%; P = .0003) and panniculectomy (35% vs 7%; P = .0074) were more common in ventral hernia repair with mesh. Mortality occurred in 4 patients. Complications were similar. In patients undergoing ventral hernia repair with non-bridged, acellular, porcine dermal matrix, hernia recurrence was less than in patients without mesh (26% vs 66%; P = .0030). Only partial excision of the mesh involved with the fistula resulted in a substantial increase in developing another fistula (29% vs 6%; P < .05). CONCLUSION: Patients undergoing preperitoneal ventral hernia repair with mesh for mesh-related intestinal fistula had a lesser rate of hernia recurrence and similar complications compared to suture repair despite larger hernias. Complete mesh excision decreases the risk of fistula recurrence. We maintain that ventral hernia repair with mesh during mesh-related intestinal fistula takedown represents the best opportunity for a durable herniorrhaphy.


Assuntos
Hérnia Ventral/cirurgia , Herniorrafia/efeitos adversos , Fístula Intestinal/cirurgia , Complicações Pós-Operatórias/cirurgia , Telas Cirúrgicas/efeitos adversos , Técnicas de Sutura/efeitos adversos , Idoso , Animais , Feminino , Seguimentos , Hérnia Ventral/prevenção & controle , Herniorrafia/instrumentação , Herniorrafia/métodos , Humanos , Incidência , Fístula Intestinal/epidemiologia , Fístula Intestinal/etiologia , Fístula Intestinal/prevenção & controle , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Recidiva , Reoperação/efeitos adversos , Reoperação/instrumentação , Reoperação/métodos , Prevenção Secundária/instrumentação , Prevenção Secundária/métodos , Resultado do Tratamento
11.
Medicine (Baltimore) ; 98(49): e18192, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804338

RESUMO

RATIONALE: Tension-free repair of inguinal hernia with prosthetic materials in adults has become a routine surgical procedure. However, serious complications may arise such as mesh displacement, infection, and even enterocutaneous fistula (EF). The management of chronic mesh infection (CMI) complicated by an EF is very challenging. A simple treatment of infected mesh removal and negative pressure wound therapy (NPWT) may cure the patients with EF with CMI. PATIENT CONCERNS: A 75-year-old male patient underwent tension-free treatment for a bilateral inguinal hernia at a county hospital 10 years ago. Three months before admission, the right groin gradually formed a skin sinus with outflow of fetid thin pus, and it could not heal. DIAGNOSES: The patient was diagnosed preoperatively with mesh plug adhesion to the intestine, which resulted in low-flow EF combined with CMI. INTERVENTIONS: The patient received a simple treatment mode consisting of an incision made from the original incision, but the new incision did not penetrate the abdominal cavity; treatment included resection of the fistula, removal of the mesh, repair of the intestine and local tissue, and continuous irrigation of vacuum sealing drainage (VSD) devices for NPWT. OUTCOMES: The infected mesh was completely removed. Five VSD devices were utilized to treat the EF and wound. The time from intervention to wound healing was 35 days, and follow-up for 6 months revealed no infection and no hernia recurrence in the right groin. LESSONS: The NPWT is effective in treating CMI concomitant with EF and does not increase the risk of hernia recurrence.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Fístula Intestinal/cirurgia , Infecção da Ferida Cirúrgica/cirurgia , Idoso , Remoção de Dispositivo , Herniorrafia/métodos , Humanos , Masculino , Tratamento de Ferimentos com Pressão Negativa/métodos , Telas Cirúrgicas/microbiologia
12.
World J Surg Oncol ; 17(1): 201, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31785618

RESUMO

BACKGROUND: Gastric cancer (GC) remains one of the leading causes of cancer-related death. Arteriointestinal fistula is a very rare but lethal postoperative complication in GC patients after gastrectomy. However, very few reports associated with arteriointestinal fistula have been published, and there is no matured diagnosis and treatment consensus for arteriointestinal fistula. Herein, we will investigate the etiology, clinical feature, diagnostic method, treatment, and prognosis by summarizing two patients we treated and consulting related cases reported in recent years. CASE PRESENTATION: A 61-year-old male and 75-year-old female with advanced gastric cancer of gastric antrum underwent radical distal gastrectomy and D2 regional lymphadenectomy. Residual gastrojejunostomies by the Roux-en-Y method were performed. The two patients recovered well after gastrectomy, and they received postoperative adjuvant chemotherapy. However, both of them suffered sudden hematemesis and melena about 2 months after surgery, resulting in unstable vital signs. Emergency exploratory laparotomy and interventional embolotherapy by digital subtraction angiography were immediately respectively performed. During this process, arteriointestinal fistulas were found in both of them. Pseudoaneurysms of gastroduodenal artery and common hepatic artery were respectively ruptured and bleeding into the duodenum. Finally, the male patient recovered, while the female patient died because of rebleeding and hemorrhagic shock. CONCLUSIONS: Arteriointestinal fistula, with low morbidity but high mortality, is an acute and fatal postoperative complication for GC patients after radical gastrectomy. DSA is the preferred method to diagnose arteriointestinal fistula. Embolotherapy by DSA should be performed immediately once arteriointestinal fistula is confirmed. Emergency laparotomy is another selection if the embolotherapy failed. We should pay more attention to perioperative preventive measures for formation of pseudoaneurysm, which is the leading cause of arteriointestinal fistula.


Assuntos
Abdome/cirurgia , Fístula Arteriovenosa/cirurgia , Gastrectomia/efeitos adversos , Hemorragia Gastrointestinal/cirurgia , Artéria Ilíaca/cirurgia , Fístula Intestinal/cirurgia , Neoplasias Gástricas/cirurgia , Abdome/patologia , Idoso , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/etiologia , Feminino , Seguimentos , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Humanos , Artéria Ilíaca/patologia , Fístula Intestinal/diagnóstico , Fístula Intestinal/etiologia , Laparotomia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/patologia
14.
Surg Clin North Am ; 99(6): 1151-1162, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676054

RESUMO

Medical treatment remains the mainstay of perianal disease management for CD; however, aggressive surgical management should be considered for severe or recurrent disease. In all cases of perianal CD, medical and surgical treatments should be used in tandem by a multidisciplinary team. Significant development has been made in the treatment of Crohn's-related fistulas, particularly minimally invasive options with recent clinical trials showing success with mesenchymal stem cell applications. Inevitably, some patients with severe refractory disease may require fecal diversion or proctectomy. When considering reversal of a diverting or end ileostomy, cessation of proctitis is the most important factor.


Assuntos
Doença de Crohn/terapia , Fístula Intestinal/cirurgia , Doenças Retais/terapia , Terapia Combinada , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Feminino , Humanos , Fístula Intestinal/etiologia , Fístula Intestinal/fisiopatologia , Masculino , Protectomia/efeitos adversos , Protectomia/métodos , Prognóstico , Doenças Retais/diagnóstico , Doenças Retais/etiologia , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
18.
Dis Colon Rectum ; 62(10): 1222-1230, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31490831

RESUMO

BACKGROUND: Surgical treatment of ileosigmoid fistulas in Crohn's disease is poorly characterized. OBJECTIVE: The purpose of this study was to identify differences in patient postoperative outcomes for isolated ileosigmoid fistulas by surgical approach (laparoscopic versus open) and sigmoid colon repair type (sigmoid resection versus primary repair). DESIGN: Using a prospectively collected database, we gathered perioperative data from chart reviews to calculate differences and associations between treatment groups. SETTINGS: The study was conducted at a single tertiary care center. PATIENTS: Patients with Crohn's disease who underwent surgery for isolated ileosigmoid fistulas between July 1, 2010, and June 30, 2016 were included. RESULTS: We identified 84 patients, with an average age of 37 years. A total of 51 were men and 33 were women; 34 underwent a sigmoid resection, whereas 50 had a primary repair of the sigmoid. All of the patients underwent an ileocolic resection. A total of 67 surgeries were initially attempted laparoscopically, of which 17 (25.4%) were converted to open, with 50 (59.5%) completed laparoscopically. There were no significant differences in length of stay or incidence of postoperative complications by surgical approach (laparoscopic versus open). For patients who underwent a primary sigmoid repair versus a sigmoid resection, there were no significant differences in postoperative complications, but there was a significant difference in the length of stay (6.36 vs 9.56 d for primary repair versus resection; multivariate p value of 0.022). MAIN OUTCOME MEASURES: Postoperative complications and length of stay were measured. LIMITATIONS: The study was limited by its small sample size, cross-sectional nature of the data, and limited information about preoperative outpatient medical treatment. CONCLUSIONS: Laparoscopic surgery for isolated ileosigmoid fistulas in Crohn's disease is safe and does not result in a different length of stay or incidence of postoperative complications. Primary repair (rather than resection) of the sigmoid colon in these cases, when feasible, appears to be safe and is likely to be cost-effective given the reduced length of stay. See Video Abstract at http://links.lww.com/DCR/A993. TÉCNICAS QUIRÚRGICAS Y DIFERENCIAS EN LOS RESULTADOS POSTOPERATORIOS PARA LOS PACIENTES CON ENFERMEDAD DE CROHN CON FÍSTULAS ILEO-SIGMOIDEAS: UNA EXPERIENCIA EN UNA SOLA INSTITUCIÓN, 2010-2016: El tratamiento quirúrgico de las fístulas ileo-sigmoideas en la enfermedad de Crohn está mal caracterizado. OBJETIVO: Identificar las diferencias en los resultados postoperatorios de los pacientes para las fístulas ileo-sigmoideas aisladas por abordaje quirúrgico (laparoscópica versus abierta) y tipo de reparación de colon sigmoide (resección sigmoidea versus reparación primaria). DISEÑO:: Utilizando una base de datos recopilada de forma prospectiva, se recopilaron datos perioperatorios de las revisiones de los gráficos para calcular las diferencias y las asociaciones entre los grupos de tratamiento. AJUSTE: Un solo centro de atención terciaria. PACIENTES: Pacientes con enfermedad de Crohn que se sometieron a una cirugía para fístulas ileo-sigmoideas aisladas entre el 1 de julio de 2010 y el 30 de junio de 2016. RESULTADOS: Se identificaron 84 pacientes, con una edad promedio de 37 años. Un total de 51 eran hombres y 33 mujeres; 34 se sometieron a una resección sigmoidea, mientras que 50 tuvieron una reparación primaria del sigmoide. Todos los pacientes fueron sometidos a resección ileocólica. Inicialmente, un total de 67 círugias se intentaron por vía laparoscópica, de las cuales 17 (25,4%) se convirtieron en cirugías abiertas, y 50 (59,5%) se completaron por vía laparoscópica. No hubo diferencias significativas en la duración de la estancia o la incidencia de complicaciones postoperatorias por abordaje quirúrgico (laparoscópica versus abierta). Para los pacientes que se sometieron a una reparación sigmoidea primaria versus una resección sigmoidea, no hubo diferencias significativas en las complicaciones postoperatorias, pero sí hubo una diferencia significativa en la duración de la estancia hospitalaria (6,36 versus a 9,56 días para la reparación primaria frente a la resección; p multivariable -valor de 0.022). PRINCIPALES MEDIDAS DE RESULTADOS: Complicaciones postoperatorias y duración de la estancia. LIMITACIONES: Tamaño de muestra pequeño, naturaleza transversal de los datos e información limitada sobre el tratamiento médico ambulatorio preoperatorio del paciente. CONCLUSIONES: La cirugía laparoscópica para fístulas ileo-sigmoideas aisladas en la enfermedad de Crohn es segura y no ocasiona una duración diferente de la estancia hospitalaria ni una incidencia diferente de complicaciones postoperatorias. La reparación primaria (en lugar de la resección) del colon sigmoide en estos casos, cuando es posible, parece ser segura y es probable que sea rentable, dada la duración reducida de la estancia. Vea el Resumen del Video en http://links.lww.com/DCR/A993.


Assuntos
Colectomia/métodos , Doença de Crohn/cirurgia , Doenças do Íleo/cirurgia , Fístula Intestinal/cirurgia , Laparoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Doenças do Colo Sigmoide/cirurgia , Adulto , Doença de Crohn/complicações , Estudos Transversais , Feminino , Humanos , Doenças do Íleo/etiologia , Incidência , Fístula Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças do Colo Sigmoide/etiologia , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
19.
Chirurgia (Bucur) ; 114(4): 487-493, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31511135

RESUMO

Introduction: Crohn disease (CD) has seen a steady increase in incidence over the years in Romania. Laparoscopy had a slow evolution as a feasible therapeutic option for patients with CD. Material and Method: The study is retrospective. The period on which the data was gathered spread over 8 years (01.01.2011-01.01.2019). Data was retrieved from three Clinical Hospitals in Bucharest, Romania Results: the preoperative diagnosis of an intestinal fistula (p = 0,02), sepsis (p = 0.01 ) or increased age should be regarded as a limitation for a laparoscopic approach in CD complications. Also in emergency settings an open approach should be the mainstay treatment (approach p = 0.000001). Conclusion: Laparoscopy is a feasible surgical option in the treatment of surgical complication in CD. In order to increase the safety of the intervention, correct selection of patients is important.


Assuntos
Doença de Crohn/epidemiologia , Doença de Crohn/cirurgia , Fatores Etários , Doença de Crohn/complicações , Humanos , Fístula Intestinal/epidemiologia , Fístula Intestinal/cirurgia , Laparoscopia/estatística & dados numéricos , Laparotomia/estatística & dados numéricos , Seleção de Pacientes , Estudos Retrospectivos , Romênia/epidemiologia , Sepse/epidemiologia , Sepse/etiologia , Sepse/cirurgia , Resultado do Tratamento
20.
J Nepal Health Res Counc ; 17(2): 258-260, 2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31455945

RESUMO

Intussusception is one of the common causes of acute abdomen in early childhood, particularly in children younger than two years of age. The majority of cases in children are idiopathic. Pathologic lead points can be identified in only 25 percent of cases. Here. we present a case of 15 months female child with Ileoileal postoperative intussusception with an anastomotic margin as a lead point, following resection anastomosis done for patent vitello intestinal duct. Role of high clinical suspicion, investigations and judgement are highlighted in managing the case. Keywords: Anastomosis; ileoileal; postoperative intussusception; patent vitello-intestinal duct.


Assuntos
Fístula Intestinal/cirurgia , Intussuscepção/cirurgia , Complicações Pós-Operatórias/cirurgia , Umbigo/cirurgia , Ducto Vitelino/cirurgia , Feminino , Humanos , Lactente , Fístula Intestinal/congênito , Intussuscepção/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Umbigo/anormalidades , Ducto Vitelino/anormalidades
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA