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1.
Anticancer Res ; 40(1): 401-404, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892593

RESUMO

BACKGROUND/AIM: Bile leakage after liver surgery is still a problem to be solved. Here, we introduce a simple new technique, the Clip on Staple method, a preventive measure for bile leakage after anatomical liver resection using a stapling device. PATIENTS AND METHODS: Before liver parenchymal transection, the roots of Glissonean pedicles for target segments were dissected and divided using the Endo-GIA™ Tri-Staple™ Curved Tip. After the parenchymal transection was completed, the full length of the stapled stump was reinforced by multiple clips. The DS Titanium Ligation Clip was used as the clipping device. RESULTS: Twenty patients underwent this technique during anatomical liver resections with stapling devices. No patient developed postoperative bile leakage of any grade. There was no reoperation or readmission within 90 days. CONCLUSION: The Clip on Staple method is simple and offers a preventive effect for postoperative bile leakage after anatomical liver resection using stapling devices.


Assuntos
Bile/metabolismo , Fígado/cirurgia , Instrumentos Cirúrgicos , Grampeamento Cirúrgico , Idoso , Idoso de 80 Anos ou mais , Hepatectomia , Humanos , Processamento de Imagem Assistida por Computador , Pessoa de Meia-Idade , Resultado do Tratamento
2.
Mymensingh Med J ; 29(1): 73-77, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915339

RESUMO

Anterior resection (AR), especially low anterior resection (LAR), for low rectal cancer and colorectal anastomosis is a technical challenge to surgeons. But by using circular stapling devices now it is possible make more LARs technically feasible. A stapled end-to-end colorectal anastomosis is increasingly adopted following a low anterior resection for low rectal cancer. This descriptive cross-sectional study was carried out in the department of Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from December 2015 to December 2016. The ensuing doughnuts created from the stapling device are routinely sent for histological analysis. However, its efficacy remains debatable. This study aims to determine the role of sending distal doughnut for histological examination following a stapled end-to-end colorectal anastomosis done in low anterior resection for low rectal cancers.


Assuntos
Adenocarcinoma/cirurgia , Técnicas Histológicas , Neoplasias Retais/cirurgia , Reto/patologia , Grampeamento Cirúrgico , Adenocarcinoma/patologia , Anastomose Cirúrgica/métodos , Bangladesh , Estudos Transversais , Humanos , Neoplasias Retais/patologia , Reto/cirurgia , Grampeamento Cirúrgico/efeitos adversos
3.
Plast Reconstr Surg ; 145(2): 291-300, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985606

RESUMO

BACKGROUND: Much has been written regarding the new paradigm of prepectoral direct-to-implant reconstruction, but patient selection continues to be unclear. Prepectoral direct-to-implant (PDTI) reconstruction with acellular dermal matrix drape and fluorescent imaging (ADFI) was offered to all patients. METHODS: The PDTI with ADFI protocol is (1) fluorescent imaging following mastectomy, (2) acellular dermal matrix prepectoral drape construction, (3) direct-to-implant placement beneath drape, and (4) repeated fluorescent imaging with implant in place. RESULTS: Patient ages ranged from 29 to 82 years, and body mass index ranged from 19 to 48 kg/m. Implant size ranged from 240 to 800 cc. Two hundred thirty breasts in 131 patients were reconstructed with the PDTI with ADFI protocol between October of 2016 and June of 2018; 32 patients underwent unilateral and 99 underwent bilateral reconstruction. Twelve breasts (5 percent) received postmastectomy radiation therapy after reconstruction. Ten patients (8 percent) had previous lumpectomy and radiation therapy, with local recurrence, and underwent completion mastectomy and PDTI reconstruction with ADFI. Fifteen patients and 22 breasts (9 percent) had subpectoral reconstructions converted to PDTI with ADFI. Ten infections (4 percent) required explantation. Eight breasts (4 percent) were reconstructed with tissue expanders because of poor vascular flow. Seven breasts (3 percent) in five patients received minor cosmetic revision. CONCLUSIONS: SPY fluorescent imaging and expanded use of acellular dermal matrices has created an environment where PDTI reconstruction can be successful in nearly all postmastectomy patients. Tissue expansion/two-stage reconstruction has evolved to a default approach when vascular supply to skin flaps is compromised. PDTI reconstruction with ADFI has resulted in zero necroses of skin flaps, patients rarely undergoing revisions, fewer office visits, and quicker return to preoperative lifestyles. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Implante Mamário/métodos , Neoplasias da Mama/cirurgia , Derme Acelular , Adulto , Idoso , Idoso de 80 Anos ou mais , Implantes de Mama , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/radioterapia , Quimioterapia Adjuvante , Feminino , Humanos , Mastectomia/métodos , Pessoa de Meia-Idade , Imagem Óptica , Músculos Peitorais/transplante , Radioterapia Adjuvante , Grampeamento Cirúrgico , Técnicas de Sutura , Resultado do Tratamento
4.
J Surg Res ; 246: 427-434, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31699537

RESUMO

BACKGROUND: The use of a small circular stapler (CS) has been reported to increase the incidence of benign anastomotic stricture of the intrathoracic anastomosis after esophagectomy, but no study has evaluated the effects of the CS size on cervical esophagogastrostomy. Based on a propensity-matched comparison, the present study was designed to determine whether the perioperative outcomes differ between 21- and 25-mm CSs after minimally invasive esophagectomy with cervical anastomosis. METHODS: From January 2015 to December 2017, 162 patients who received CS cervical esophagogastric anastomosis after minimally invasive esophagectomy for esophageal cancer were identified from our surgical database. A propensity-matched analysis was used to compare the outcomes between the 21- and 25-mm CS groups. Endpoints included anastomotic leak, dysphagia, reflux, stricture, and other major postoperative outcomes within 6 postoperative months. RESULTS: There were 69 and 93 patients in the 21- and 25-mm CS groups, respectively. Propensity matching produced 57 patients in each group. The two groups were not remarkably different in benign anastomotic stricture rate (P = 0.528). All strictures were resolved by balloon dilatation. The 25-mm CS group had a significantly longer operative time in cervical anastomosis than the 21-mm group (P = 0.005). No statistically significant differences in anastomotic leak rates, dysphagia scores, reflux scores, or other postoperative complications were noted between the two groups. CONCLUSIONS: The use of a 21-mm CS in minimally invasive esophagectomy with cervical esophagogastric anastomosis did not result in greater anastomotic stricture as compared with a 25-mm CS. The 21-mm CS was associated with a significantly shorter operative time.


Assuntos
Fístula Anastomótica/epidemiologia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Refluxo Gastroesofágico/epidemiologia , Grampeadores Cirúrgicos/efeitos adversos , Idoso , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/etiologia , Constrição Patológica/epidemiologia , Constrição Patológica/etiologia , Esofagectomia/instrumentação , Esofagectomia/métodos , Esofagostomia/efeitos adversos , Esofagostomia/instrumentação , Esofagostomia/métodos , Feminino , Refluxo Gastroesofágico/etiologia , Gastrostomia/efeitos adversos , Gastrostomia/instrumentação , Gastrostomia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pontuação de Propensão , Estudos Retrospectivos , Grampeamento Cirúrgico/efeitos adversos , Grampeamento Cirúrgico/instrumentação , Grampeamento Cirúrgico/métodos , Fatores de Tempo , Resultado do Tratamento
5.
Anticancer Res ; 39(12): 6799-6806, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810945

RESUMO

BACKGROUND/AIM: In order to overcome postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP), we have developed a new simple technique-Clip on Staple method. PATIENTS AND METHODS: In Clip on Staple method, pancreatic parenchyma was divided using a stapling device with a stepped-height staple design to make linear compression line, and thereafter, the full length of the staple line was reinforced by multiple clips. Clinical outcomes were retrospectively compared between Clip on Staple group (n=23) and Non-Clip group (n=38). RESULTS: The incidence of clinically relevant POPF (CR-POPF) was significantly lower in the Clip on Staple group than in the Non-Clip group (4.3 and 36.8%, p=0.005). Multivariate logistic regression analysis revealed that only Clip on Staple method was an independent predictive factor of a decrease in the occurrence of CR-POPF. CONCLUSION: The Clip on Staple method, a simple and easily applicable technique even in laparoscopic surgery, significantly reduced the occurrence of CR-POPF among patients undergoing DP.


Assuntos
Pâncreas/cirurgia , Pancreatectomia/efeitos adversos , Fístula Pancreática/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Instrumentos Cirúrgicos , Grampeamento Cirúrgico/métodos , Idoso , Feminino , Humanos , Incidência , Laparoscopia , Masculino , Pancreatectomia/métodos , Fístula Pancreática/epidemiologia , Fístula Pancreática/etiologia , Complicações Pós-Operatórias/etiologia , Análise de Regressão
6.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(12): 1165-1169, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874533

RESUMO

Objective: To compare the efficacy and safety of two procedures in the treatment of hemorrhoid: the procedure for prolapse and hemorrhoids (PPH) and stapled transanal rectal resection (STARR). Methods: A retrospective cohort research was conducted. Clinical data of 263 patients undergoing the first elective surgery for grade IV hemorrhoids by the same team of surgeons at our department from January 2015 to December 2016 were analyzed retrospectively, while those had other anorectal diseases, emergency surgery, inflammatory bowel disease, tumor and incomplete clinical data were excluded. PPH was performed in 129 patients and STARR was performed in 134 patients. PPH procedure: a circular purse 2-0 string suture was made at 4 cm above the dentate line; in accordance with the standard protocol, the PPH circular stapling devicewas introduced; the suture was closed, and a pull-through followed; the traction was continued; the stapler was fired; the prolapsed mucosa and submucosa were removed. STARR procedure: 3-5 needles were sutured in the anterior rectal mucosa, protecting the posterior wall mucosa; with the help of a finger the PPH stapler was inserted into the vaginal lumen; the sutures were hooked from both sides of the stapler to maintain traction; according to the disease condition, the suturewas tightened appropriately; stapler was screwed and activated; the anterior wall mucosa was removed; the joint of the both ends of anastomosis was cut; the posterior wall mucosa was removed as well. The short-term efficacy, surgical safety and prognosis of the two groups were compared. Results: There were 67 males (51.9%) in the PPH group and 57 (42.5%) males in the STARR group. The median age of the two groups was 51.0 (22.0, 80.0) years and 49.0 (24.0, 74.0) years, respectively. There were no significant differences in the baseline data between the two groups (all P>0.05). No significant differences in the intraoperative bleeding, length of hospital stay, postoperative analgesic drug use, postoperative bleeding, postoperative infection, etc. were found between two groups (all P>0.05). As compared to PPH group, STAAR group had longer operation time and higher hospitalization cost with significant differences [(44.0±19.3) minutes vs. (26.3±8.5) minutes, t=9.701, P=0.001; (11 047±473) yuan vs. (7674±309) yuan, t=32.826, P=0.001]. One case in STAAR group developed rectovaginal fistula. The median follow-up period of the whole group was 40 (33, 52) months. A total of 108 cases in STARR group and 114 cases in PPH group completed the follow-up. The 3-year disease-relapse rate was 0 in STARR group and 4.2% in PPH group (P=0.042). Conclusion: STARR procedure can improve the prognosis in the treatment of grade IV hemorrhoid, but attention should be paid to the development of complications.


Assuntos
Hemorroidas/cirurgia , Protectomia/métodos , Prolapso Retal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Canal Anal , Feminino , Hemorroidas/classificação , Hemorroidas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Prolapso Retal/complicações , Reto/cirurgia , Estudos Retrospectivos , Grampeamento Cirúrgico , Resultado do Tratamento , Adulto Jovem
7.
Ann R Coll Surg Engl ; 101(8): 571-578, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31672036

RESUMO

INTRODUCTION: There are no definitive data concerning the ideal configuration of ileocolic anastomosis. Aim of this study was to identify perioperative risk factors for anastomotic leak and for 60-day morbidity and mortality after ileocolic anastomoses (stapled vs handsewn). MATERIALS AND METHODS: This is a STROBE-compliant study. Demographic and surgical data were gathered from patients with an ileocolic anastomosis performed between November 2010 and September 2016 at a tertiary hospital. Anastomoses were performed using standardised techniques. Independent risk factors for anastomotic leak, complications and mortality were assessed. RESULTS: We included 477 patients: 53.7% of the anastomoses were hand sewn and 46.3% stapled. Laterolateral anastomosis was the most common configuration (93.3%). Anastomotic leak was diagnosed in 8.8% of patients and 36 were classified as major anastomotic leak (7.5%). In the multivariate analysis, male sex (P = 0.014, odds ratio, OR, 2.9), arterial hypertension (P = 0.048, OR 2.29) and perioperative transfusions (P < 0.001, OR 2.4 per litre) were independent risk factors for major anastomotic leak. The overall 60-day complication rate was 27.3%. Male sex (31.3% vs female 22.3%, P = 0.02, OR 1.7), diabetes (P = 0.03 OR 2.0), smoking habit (P = 0.04, OR 1.8) and perioperative transfusions (P < 0.001, OR 3.3 per litre) were independent risk factors for postoperative morbidity. The 60-day-mortality rate was 3.1% and no significant risk factors were identified. CONCLUSION: Anastomotic leak after ileocolic anastomosis is a relevant problem. Male sex, arterial hypertension and perioperative transfusions were associated with major anastomotic leak. Conversion to open surgery was more frequently associated with perioperative death.


Assuntos
Anastomose Cirúrgica/métodos , Fístula Anastomótica/etiologia , Colo/cirurgia , Íleo/cirurgia , Idoso , Anastomose Cirúrgica/efeitos adversos , Feminino , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Grampeamento Cirúrgico/métodos , Técnicas de Sutura
8.
Anticancer Res ; 39(11): 6393-6401, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704873

RESUMO

BACKGROUND/AIM: Intracorporeal anastomosis (IA) in laparoscopic colectomy for colon cancer is technically difficult, and there is a lack of consensus on the risk of bacterial contamination and cancer cell dissemination. In this study, short- and long-term outcomes of IA were examined. PATIENTS AND METHODS: Short and long-term outcomes of those who underwent IA (n=44) or extracorporeal anastomosis (EA) (n=61) were compared. RESULTS: IA was better than EA for blood loss, incision length, and first stool. Maximum temperature and C-reactive protein on postoperative day 1 were higher for the IA group. The rate of positive cultures from intraoperative lavage was higher for IA. The rate of positive cultures improved to an equivalent level by replacing mechanical pretreatment with chemical pretreatment. IA and EA were equivalent for the results of ascites cytology from lavage. CONCLUSION: With the use of appropriate preoperative treatment, IA takes advantage of the minimally invasive nature of laparoscopic surgery.


Assuntos
Ascite/microbiologia , Colectomia/métodos , Neoplasias do Colo/cirurgia , Laparoscopia/métodos , Complicações Pós-Operatórias/microbiologia , Grampeamento Cirúrgico/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Feminino , Humanos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
9.
J Surg Oncol ; 120(8): 1436-1445, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31721221

RESUMO

BACKGROUND: As most risk factors for anastomotic complications (AC) in rectal cancer patients appear to be noncorrectable, it is needed to find the correctable causes. Additionally, the outcomes of indocyanine-green fluorescence imaging (IFI) and robot-stapled anastomosis have yet been undetermined. METHODS: This study retrospectively analyzed 968 consecutive patients with rectal cancer, who underwent curative robot-assisted anterior resections between 2010 and 2018. IFI parameters and stapling features in the surgical records were reviewed, and reconfirmed. RESULTS: AC occurred in 54 patients (5.6%), 34 (3.5%) with anastomotic leakage (AL) and 24 (2.5%) with anastomotic stenosis (AS). Mechanotechnical faults including defective stapling configurations, including angles lesser than or equal to 150° and outer deviation (more than half from the center of the circle) of linear staples, between the two linear staples were independently associated with AL (P < .001 each). IFI significantly reduced AL rate (2.5% vs 5.3%, P = .029) and AS rate (2% vs 18.8%, P = .006), respectively. Robot linear stapling enabled to maintain the obtuse angle during consecutive staplings and reduced console time. AL and AS were independent risk factors for disease-free survival (P = .02) and local recurrence (P = .03), respectively. CONCLUSIONS: AC were associated with some correctable causes, namely, mechanotechnical errors and lack of use of IFI.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/etiologia , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos , Grampeamento Cirúrgico/efeitos adversos , Adenocarcinoma/mortalidade , Adenocarcinoma/cirurgia , Fístula Anastomótica/diagnóstico , Constrição Patológica/diagnóstico , Constrição Patológica/etiologia , Meios de Contraste , Intervalo Livre de Doença , Enema , Feminino , Humanos , Verde de Indocianina , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias Retais/mortalidade , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Fatores Sexuais , Tomografia Computadorizada por Raios X
10.
Mymensingh Med J ; 28(4): 866-871, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31599253

RESUMO

Bleeding per rectum is one of the most alarming conditions for any patient. Haemorrhoids are a common cause of bleeding in anorectal region. Conventional Haemorrhoidectomy is associated with significant pain & morbidity so much so that patient feared of and reluctant to undergo surgery. In 1998, introduction of stapled haemorroidopexy by Longo represented a radical change in the treatment of haemorrhoids. The aim of this prospective study was to evaluate short term & long term clinical & surgical outcome of stapled haemorrhoidopexy. A sample of 130 patients with symptomatic second-, third- & fourth- degree haemorrhoids underwent stapled haemorrhoidopexy from January 2013 to December 2016 at Care Medical college & Hospital & Fast care Hospital, Dhaka. Out of these 90 patients who completed their one year follow up was included for the study & their data was analyzed. Eighty percent of patient was females & the mean age 45 (25-75 years), Mean operative time was 35 minutes (25-70 minutes). Mean hospital stay 1 day (1-2 days). Intraoperative suture was 6 and incomplete doughnut 9. Use of analgesics 5 days. All patients were followed up to at outpatient clinic 12 months postoperatively. Stapled haemorrhoidopexy for haemorrhoids is an efficient procedure with less post operative pain, lower complication rates and better patient compliance & satisfaction.


Assuntos
Hemorroidectomia , Hemorroidas/cirurgia , Grampeamento Cirúrgico , Idoso , Bangladesh , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Resultado do Tratamento
11.
Acta Cir Bras ; 34(8): e201900801, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618401

RESUMO

PURPOSE: To evaluate the effect of fibrin glue on staple-line leak after sleeve gastrectomy. METHODS: Fourteen adult wistar rats 300 gr were randomized into two groups: Control group (n=7) and study group (n=7). All the rats underwent sleeve gastrectomy using lineer stapler. In the study group, fibrin glue was used to reinforce the staple-line. The rats were sacrificed 7 days after surgery. The stomach was resected, submerged in saline and exposed to excess pressure to obtain a burst pressure value. The gastric staple line was evaluated histopathologically according to the Ehrlich Hunt scale. The results of the two groups were compared. RESULTS: The mean Ehrlich-Hunt scores for inflammation, fibroblastic activity and neo-angiogenesis were similar between the groups (p>0.05). Collagen deposition was significantly higher in study group (3.42±0.53) when compared with control group (2.57±0.78) (p=0.035). The mean burst pressure was 137.8±8.5 mmHg for control group and 135.0±8.1 mmHg for study group (p=0.536). CONCLUSION: Reinforcement of the staple-line with fibrin glue has no effect on the burst pressure after sleeve gastrectomy. More studies are needed to evaluate the precautions against leak after sleeve gastrectomy.


Assuntos
Adesivo Tecidual de Fibrina/farmacologia , Gastrectomia/métodos , Grampeamento Cirúrgico/efeitos adversos , Deiscência da Ferida Operatória/prevenção & controle , Animais , Modelos Animais de Doenças , Masculino , Pressão , Distribuição Aleatória , Ratos , Ratos Wistar , Técnicas de Sutura
13.
Int J Colorectal Dis ; 34(9): 1619-1623, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378835

RESUMO

PURPOSE: A rectovaginal fistula (RVF) is a rare disease. It's an epithelium-lined abnormal communication between rectum and vagina. It represents approximately 5% of all anorectal fistulas. RVF may have different causes. METHODS: We present a case of a 58-year-old woman with a rectovaginal fistula after stapled hemorrhoidopexy (Longo operation). RESULTS: A 58-year-old woman presented herself in our department with vaginal fecal discharge and vaginitis almost one month after a stapled hemorrhoidopexy was performed in another hospital. On vaginal examination, a large dorsal defect was palpated at four cm. On rectal examination, the stapler line was palpable at four cm and just distal to this stapler line, a large defect could be palpated. A lower gastrointestinal tract radiography was performed and identified a RVF. The patient was put on antibiotics and two operations were planned. First, a temporary ileostomy was created. After healing of the vaginitis, reconstructive surgery with anatomic fistula repair in combination with the interposition of healthy, vascularised tissue was performed. In this case, we chose the Martius flap. The operation as well as the postoperative course was uneventful. CONCLUSIONS: Cases of postoperative RVF have been increasingly reported since the introduction of stapled hemorrhoidopexy. Patients with RVF can have a varying degree of symptoms. Diagnosis is primarily based on the patient's medical history together with a clinical examination. There are many surgical approaches for RVF. Anatomic fistula repair alone is associated with lower success rates compared with combined procedures with the adjunctive interposition of healthy, vascularised tissue.


Assuntos
Hemorroidas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Fístula Retovaginal/cirurgia , Retalhos Cirúrgicos/cirurgia , Grampeamento Cirúrgico , Bário , Enema , Feminino , Humanos , Pessoa de Meia-Idade , Fístula Retovaginal/diagnóstico por imagem
14.
Zentralbl Chir ; 144(4): 387-395, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31412416

RESUMO

Obstructed defecation syndrome (ODS) is characterized by disturbed defecation, and morphological disorders can be differentiated from functional pathologies. Differential diagnosis from irritable bowel syndrome and slow transit constipation is frequently difficult. Most patients are female, and rectal intussusception and anterior rectocele are frequent morphological pathologies. In addition to patients' history and basic proctological diagnostic testing, MR defecography plays a central role. As ODS is a benign condition, conservative treatment should be initiated primarily. After failure of conservative treatment and in terms of a morphological disorder, the indication for surgery should be discussed, whereas transabdominal procedures (e.g. resection rectopexy, rectopexy) and transanal procedures (e.g. STARR) are available. Adequate therapy remains a challenge due to multifactorial aetiology and the variety of symptoms - this affects both conservative and surgical treatment options.


Assuntos
Defecação , Constipação Intestinal , Defecografia , Feminino , Humanos , Retocele , Reto , Grampeamento Cirúrgico , Resultado do Tratamento
15.
Zentralbl Chir ; 144(4): 402-407, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31412419

RESUMO

Discrimination between functional and morphological influences in obstructive defecation syndrome is challenging. The predictability of surgical success is still in discussion. Final understanding of the rectally induced variability in colonic motility is still missing, so that morphological changes cannot solely serve as indication. Finally the physiology of the enteric nervous system has to be taken into account in choosing an approach. A modified Sullivan procedure was tested in the treatment of distal deep rectocele with respect to short- and long-term results for complications, obstructive symptoms and explicitly with regard to urge and clustering complaints. Between January 2009 and January 2014, 35 women complaining of obstructive symptoms with distal deep rectocele were operated on in a modified Sullivan technique. There were no intraoperative nor early postoperative complications; 4 weeks postoperatively no urge or clustering was discovered. In a long-term questionnaire, more than 80% of the patients were satisfied with the procedure; the mean obstructive defecations score was lowered by 9 points.


Assuntos
Retocele , Grampeamento Cirúrgico , Constipação Intestinal , Defecação , Feminino , Humanos , Complicações Pós-Operatórias , Resultado do Tratamento
16.
Khirurgiia (Mosk) ; (8): 17-21, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31464269

RESUMO

OBJECTIVE: To confirm simplicity, safety and efficacy of stapling devices for gastroesophageal anastomosis (including those formed in mediastinum) in the treatment of gastroesophageal junction cancer. MATERIAL AND METHODS: There were 147 patients with cardioesophageal cancer. Tumors Siewert type II and III were predominant (44.2 and 40.3%, respectively). Simultaneous procedures were performed in 30.6% of cases. RESULTS: Postoperative complication rate was 42.2%. Pneumonia was the most common. Postoperative mortality was 2.7%.


Assuntos
Neoplasias Esofágicas/cirurgia , Junção Esofagogástrica/cirurgia , Esofagectomia , Gastrectomia , Humanos , Grampeamento Cirúrgico , Resultado do Tratamento
17.
Khirurgiia (Mosk) ; (8): 53-58, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31464275

RESUMO

OBJECTIVE: To evaluate the influence of reinforcement of staple line of colorectal anastomosis on the incidence of leakage. MATERIAL AND METHODS: A systematic review was performed in accordance with the PRISMA recommendations. Statistical analysis was carried out in the Review Manager 5.3 software. RESULTS: This trial included four original articles published in 2011-2018. There were 493 patients. Reinforcement of anastomosis was made in 232 (47%) cases, colorectal anastomosis was not reinforced in 261 (53%) patients. Anastomotic leakage rate was 5.6 and 11.1% in both groups, respectively (OR 0.55, CI 0.13-2.33; p=0.42). Transabdominal reinforcement reduced leakage rate by 10.2% (OR 0.18, CI 0.06-0.55; p=0.002) while transanal reinforcement was ineffective (OR 1.66, CI 0.38-7.19; p=0,5). Incidence of preventive stoma was similar (OR 0.3, CI 0.07-1.22; p=0.09), but it was possible to abandon preventive stoma in 18% of cases after anastomotic reinforcement. CONCLUSION: A small number of studies dedicated to anastomosis reinforcement resulted controversial data.


Assuntos
Anastomose Cirúrgica/métodos , Fístula Anastomótica/prevenção & controle , Colo/cirurgia , Protectomia/métodos , Neoplasias Retais/cirurgia , Reto/cirurgia , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/etiologia , Fístula Anastomótica/cirurgia , Humanos , Grampeamento Cirúrgico/efeitos adversos , Grampeamento Cirúrgico/métodos
18.
Transplant Proc ; 51(7): 2225-2227, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378466

RESUMO

BACKGROUND: Ligation of renal hilus is the most important stage of laparoscopic donor nephrectomy. Laparoscopic staplers are securely used for renal pedicle control. We present our donor nephrectomy cases in which we used 1 stapler for renal artery and vein ligation. METHODS: Demographic data, number of arteries and veins, ligation types, operation time, and complication rates are recorded. RESULTS: One hundred twenty laparoscopic donor nephrectomy cases who were operated between December 2017 and August 2018 in Istinye University Hospital and Istanbul Aydin University Hospital were retrospectively evaluated. All of the operations were done by 2 surgeons with a fully laparoscopic method. None of the cases were converted to open nephrectomy. There was 1 renal artery in 110 (91.7%) cases, 2 renal arteries in 9 (7.5%) cases, and 3 arteries in 1 (0.8%) case. Renal artery and vein were ligated with single stapler in 115 (95.8%) cases. Double stapler was used in 5 (4.2%) patients. There were no major complications for donors and no implantation problems for grafts. DISCUSSION: Laparoscopic donor nephrectomy is the most used technique for living donor operations. Vascular stapler is securely used for renal artery and vein ligation with high costs. Two or, due to the number of vessels, sometimes 3 staplers are used in the standard technique. In our study, the operation was finished securely in 95.8% of the patients with single stapler use. Single stapler use for ligating renal hilus is safe in kidneys even with suitable multiple arteries and veins in laparoscopic donor nephrectomy.


Assuntos
Laparoscopia/métodos , Ligadura/instrumentação , Doadores Vivos , Nefrectomia/métodos , Grampeamento Cirúrgico/instrumentação , Coleta de Tecidos e Órgãos/métodos , Adulto , Feminino , Humanos , Rim/irrigação sanguínea , Transplante de Rim , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Artéria Renal/cirurgia , Estudos Retrospectivos , Grampeamento Cirúrgico/métodos
20.
Am J Case Rep ; 20: 1049-1056, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31320605

RESUMO

BACKGROUND Correctly diagnosing a staple-line mass after pulmonary resection for lung malignant tumor can be difficult. Differential diagnoses of recurrence, infectious mass, granuloma, and so on must be considered, despite their rarity. We report two cases of pulmonary staple-stump granuloma after segmentectomy for lung cancer. CASE REPORT Case 1 involved a 70-year-old man with small nodule in the left upper lobe identified on computed tomography (CT). Video-assisted thoracoscopic (VATS) left upper division segmentectomy was performed. Histopathological examination revealed squamous carcinoma. Follow-up CT 1 year postoperatively showed a shadow at the staple-stump, with growth evident later. CT-guided biopsy found no malignancy. However, complete left upper lobectomy was performed because of the gradually enlarging lesion. Histopathological examination revealed epithelioid granuloma. Case 2 involved a 60-year-old with suspected lung cancer in the right upper lobe. VATS right upper division segmentectomy (S2) was performed. CT at 30 months postoperatively showed a shadow at the staple line, with subsequent growth. VATS right upper lobectomy was performed. Intraoperative rapid diagnosis revealed epithelioid granuloma. These two cases were compared with five cases of staple-stump recurrence in our institution. All cases of recurrence grew concentrically or radially from the staple line with the mass surrounding the staple line. On the other hand, cases of granuloma extended along the long axis of the staple line, and 3-dimensional CT (3DCT) may help to understand the morphology. CONCLUSIONS Although preoperative differentiation of staple-line granuloma is difficult and pathological diagnosis is important, characteristic radiologic features and 3DCT may facilitate diagnosis.


Assuntos
Granuloma/etiologia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Grampeamento Cirúrgico/efeitos adversos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Idoso , Feminino , Granuloma/diagnóstico , Granuloma/cirurgia , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia
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