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1.
Gastrointest Endosc Clin N Am ; 30(1): 75-89, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739968

RESUMO

The over-the-scope clip is safe and efficacious and has become the preferred device of choice for the treatment of complex gastrointestinal bleeding, perforation, and gastrointestinal leaks. With its widespread adoption in clinical practice, information on complications associated with over-the-scope clip use is emerging. Nonetheless, the overall complication rate is still very low. Most of the reported complications have been related to the technique rather than the actual device and could likely be prevented with proper technique. In this article, the authors summarize the complications associated with over-the-scope clip use and provide guidance on safety measure to mitigate them.


Assuntos
Endoscopia Gastrointestinal/instrumentação , Complicações Pós-Operatórias/prevenção & controle , Instrumentos Cirúrgicos/efeitos adversos , Desenho de Equipamento , Hemorragia Gastrointestinal/cirurgia , Humanos , Perfuração Intestinal/cirurgia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
3.
Medicine (Baltimore) ; 98(48): e18153, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770257

RESUMO

RATIONALE: Migration of endoclips and stitches into the duodenum after laparoscopic hepatectomy is incredibly rare with a poorly understood mechanism. PATIENT CONCERNS: A 56-year-old woman who underwent laparoscopic left hepatectomy and cholecystectomy in August 2016 was admitted to our hospital with nausea and vomiting in December 2017. DIAGNOSES: Abdominal computed tomography (CT) scan showed high density shades in duodenal ampulla. Esophagogastroduodenoscopy showed deformation of the duodenal ampulla into two lumens; hem-o-lock clips and stitches were detected in the upper lumen. Contrast enhanced CT scan revealed gastric cancer with liver metastasis (GCLM). INTERVENTIONS: The hem-o-lock clips and stitches were present in the wall of the duodenum; therefore, no attempt was made to remove them. High quality liquid diet, partial parenteral nutrition, and chemotherapy were administered to the patient. OUTCOMES: In September 2018, the patient died of hepatic failure caused by GCLM. LESSONS: This rare complication of the migration of endoclips and stitches into the duodenum after laparoscopic hepatectomy can cause epigastric pain and duodenal obstruction. The complication could be potentially avoided using absorbable endoclips and stitches or by performing of ultrasonic dissection by a skilled operator.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Obstrução Duodenal , Migração de Corpo Estranho , Hepatectomia/efeitos adversos , Complicações Pós-Operatórias , Instrumentos Cirúrgicos/efeitos adversos , Colecistectomia Laparoscópica/métodos , Tratamento Conservador/métodos , Obstrução Duodenal/diagnóstico por imagem , Obstrução Duodenal/etiologia , Obstrução Duodenal/fisiopatologia , Obstrução Duodenal/terapia , Endoscopia do Sistema Digestório/métodos , Feminino , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/diagnóstico , Migração de Corpo Estranho/fisiopatologia , Hepatectomia/métodos , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Administração dos Cuidados ao Paciente/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/patologia , Neoplasias Gástricas/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
4.
BMJ Case Rep ; 12(9)2019 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-31533947

RESUMO

We describe a case of attachment of an appendix vermiformis following an inguinal hernia plug repair according to Rutkow and Robbins. A 62-year-old man presented at our outpatient clinic with a progressive sensation of tightness in the right groin area, painful urge of miction and long-lasting nausea with abdominal discomfort. During an open groin exploration, the appendix was found attached to an intraperitoneally located plug. The appendix and plug were removed with an uneventful recovery. During follow-up, the patient was free of groin pain and miction had normalised. Surprisingly, his long-lasting nausea and abdominal discomfort had disappeared as well.


Assuntos
Apêndice/patologia , Hérnia Inguinal/cirurgia , Instrumentos Cirúrgicos/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Apendicectomia , Virilha , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Dor Visceral
5.
Gynecol Oncol ; 155(2): 220-223, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31488245

RESUMO

OBJECTIVES: To determine if intraperitoneal (IP) ports placed concurrently with bowel resection during surgical treatment of ovarian cancer is associated with more complications than those ports placed without concurrent bowel resection. METHODS: The medical records of all patients who had an IP port placed at our institution between 2005 and 2016 were reviewed. Two groups were analyzed: IP ports placed with bowel resection (IP-BR) and those without (IP). RESULTS: Of 306 patient charts reviewed, 31% had a surgery with IP port placement and concurrent bowel resection (IP-BR). Demographics were similar except for mean BMI (25.6 IP-BR vs 27.4 IP, p = 0.007). More IP-BR patients had stage IIIC disease (83.3% IP-BR vs 56.9% IP, p ≤0.01). Patients were cytoreduced to R0 in 48.7% IP-BR vs 56.4% IP (p = 0.253). For adjuvant treatment, IV chemotherapy was administered before IP chemotherapy in 90.4% IP-BR (median 2 cycles), and 50.3% IP, (median 2 cycles, p < 0.01). Ultimately 80.2% IP-BR (median 4 cycles) and 77.8% IP (median 5 cycles) received IP chemotherapy (p = 0.65). Rates of total IP port complications were similar (19.2% IP-BR vs 23.2% IP, p = 0.397), including IP port infections (0% IP-BR vs 0.7% IP, p = 0.5). Eleven percent of IP-BR patients had a bowel complication (e.g. obstruction or perforation) while IP port was in situ vs 2.7% IP (p = 0.01). Only 2.7% IP-BR and 6% IP discontinued IP chemotherapy due to IP port complication (p = 0.3). CONCLUSIONS: Patients who have IP ports placed concurrently with a bowel resection do not appear to have more complications, nor lower rates of IP chemotherapy administration.


Assuntos
Laparoscopia/instrumentação , Neoplasias Ovarianas/cirurgia , Antineoplásicos/uso terapêutico , Quimioterapia Adjuvante , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/instrumentação , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/etiologia , Neoplasias Ovarianas/tratamento farmacológico , Peritônio/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Instrumentos Cirúrgicos/efeitos adversos , Resultado do Tratamento
7.
J Minim Invasive Gynecol ; 26(5): 973-976, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256782

RESUMO

The first port entry in patient who underwent previous abdominal surgery. Palmer's point can be used in patients with suspected periumbilical adhesions, a history of an umbilical hernia, or multiple failed attempts of insufflations at the umbilicus. Palmer's point has its limitations in cases of left upper quadrant surgery, splenomegaly, portal hypertension, and improper nasogastric tube placement giving rise to a bloated stomach. In such cases, a new and safe point for laparoscopic entry is needed. In the present case of a patient who underwent previous upper abdominal surgery with the chevron incision obscuring Palmer's point, laparoscopic entry was made through a novel point that was found to be safe in such cases and can be used in similar cases of previously scarred abdomens.


Assuntos
Abdome/cirurgia , Cicatriz/etiologia , Cicatriz/cirurgia , Laparoscopia , Laparotomia/efeitos adversos , Hemorragia Uterina/cirurgia , Abdome/patologia , Cavidade Abdominal/cirurgia , Adulto , Cicatriz/patologia , Equinococose Hepática/cirurgia , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Laparoscopia/métodos , Instrumentos Cirúrgicos/efeitos adversos , Aderências Teciduais/cirurgia , Hemorragia Uterina/patologia
8.
BMC Res Notes ; 12(1): 459, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31345266

RESUMO

OBJECTIVE: This prospective observation sought to determine if scalpel blades used for abdominal skin incisions in dogs are a significant source of bacterial contamination, and if these blades should be changed prior to use in deeper dissection. RESULTS: Scalpel blades were swabbed for culture prior to skin incision as a control, and then again following ventral midline abdominal skin incision in a total of 75 dogs. Culture and sensitivity results were compared with review of medical records for any evidence of pre- or postoperative incisional surgical site infection/inflammation (SSI). Of the 75 blades swabbed after skin incision, only 2 (2.7%) had positive culture results. Of the 69 patients that survived to suture removal, there was evidence of SSI in 6 patients (8.7%), only one of which had a positive scalpel blade culture (16.7%). Neither the use of postoperative antibiotics nor positive scalpel blade culture results were good predictors of whether a patient would develop a SSI. Results of this pilot study suggest that there is no bacteriological evidence to support the use of a separate blade for deep dissection in routine surgical procedures.


Assuntos
Abdome/cirurgia , Dissecação/métodos , Instrumentos Cirúrgicos/efeitos adversos , Infecção da Ferida Cirúrgica/etiologia , Animais , Dissecação/efeitos adversos , Cães , Feminino , Humanos , Masculino , Projetos Piloto , Período Pós-Operatório , Estudos Prospectivos , Pele , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/microbiologia
9.
BMC Urol ; 19(1): 65, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296191

RESUMO

BACKGROUND: The past four years has seen a rapid roll-out of male medical circumcision services in South Africa in response to clinical trials showing circumcision prevents HIV acquisition in heterosexual men. Clinics conduct substantial numbers of circumcisions per day. We report three cases of glans amputation in adolescents attending high volume clinics where modified Models of Optimising Volume and Efficiency (MOVE) are implemented. CASE PRESENTATIONS: Three cases of glans amputation in young healthy men that presented for voluntary medical male circumcision. The procedures were performed by highly experienced medical officers in two cases. All these cases shared characteristics: younger males with immature genitalia, forceps guided circumcision, and likely operator fatigue. Voluntary male medical circumcision programs should include regular monitoring and evaluation and training of operators to ensure high quality surgical techniques such as working in clean areas and taking frequent breaks. CONCLUSION: Circumcision is a relatively simple medical procedure, however regular training and quality control in high volume Male Medical Circumcision sites is essential to prevent rare catastrophic adverse events.


Assuntos
Amputação Traumática/diagnóstico , Amputação Traumática/etiologia , Circuncisão Masculina/efeitos adversos , Pênis , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Adolescente , Criança , Humanos , Masculino , Instrumentos Cirúrgicos/efeitos adversos , Carga de Trabalho
10.
Respir Res ; 20(1): 140, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277659

RESUMO

BACKGROUND: Bronchoscopic cryobiopsy is a new method of bronchoscopic tissue sampling in interstitial lung disease. In case of transbronchial biopsies, the resultant tissue samples are of high quality, and the lung parenchyma seen in the samples is adequate for a histological diagnosis in most cases. Bleeding after transbronchial biopsy is the most important procedure- associated complication and may be life threatening. This study addresses the risk of bleeding of transbronchial cryobiopsy. METHODS: In this prospective, randomized, controlled multicentre study 359 patients with interstitial lung disease requiring diagnostic bronchoscopic tissue sampling were included. Both conventional transbronchial forceps biopsy and transbronchial cryobiopsy were undertaken in each patient. The sequence of the procedures was randomized. Bleeding severity was evaluated semi-quantitatively as "no bleeding", "mild" (suction alone), "moderate" (additional intervention) or "severe" (prolonged monitoring necessary or fatal outcome), for each intervention. RESULTS: In 359 patients atotal of 1160 cryobiopsies and 1302 forceps biopsies were performed. Bleeding was observed after forceps biopsy in 173 patients (48.2%) and after cryobiopsy in 261 patients (72.7%). Bleeding was significantly greater in the cryobiopsy group (cryobiopsy/forceps biopsy: no bleeding 27.3%/51.8%; mild 56.5%/44.0%; moderate 15.0%/4.2%; severe 1.2%/0%; p < 0.001). The rate of clinically relevant bleeding (moderate or severe) was higher after the cryobiopsy procedures compared to the forceps biopsies (16.2% vs. 4.2%, p < 0.05). No fatal bleeding complications occurred. CONCLUSIONS: Compared to transbronchial forceps biopsy, transbronchial cryobiopsy was associated with an increased risk of bleeding which is of clinical relevance. Therefore training and additional precautions for bleeding control should be considered. TRIAL REGISTRATION: The study was registered with clinicaltrials.gov ( NCT01894113 ).


Assuntos
Brônquios/patologia , Criocirurgia/efeitos adversos , Hemorragia/diagnóstico , Hemorragia/etiologia , Doenças Pulmonares Intersticiais/diagnóstico , Instrumentos Cirúrgicos/efeitos adversos , Idoso , Biópsia/efeitos adversos , Biópsia/métodos , Estudos Cross-Over , Criocirurgia/métodos , Feminino , Humanos , Doenças Pulmonares Intersticiais/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
11.
BMJ Case Rep ; 12(7)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31352393

RESUMO

Surgical clip migration is a rare complication of laparoscopic cholecystectomy (LC). Surgical clips migrating into the common bile duct (CBD) can lead to stone formation and obstruction. Here, we report a case of acute cholangitis caused by surgical Hem-o-lok clip migration into the bile duct with stone formation 13 months after LC. A 65-year-old man who underwent LC presented with upper abdominal pain and fever for 3 days. Abdominal CT scan showed a radiopaque material in the CBD, diffuse wall thickening and dilatation of intrahepatic and extrahepatic duct. Emergency percutaneous transhepatic biliary drainage was performed. Twodays later, an endoscopic retrograde cholangio-pancreatography was implemented, and muddy stones and one surgical clip were successfully removed by extraction balloon catheter.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Ducto Colédoco/patologia , Corpos Estranhos/diagnóstico por imagem , Migração de Corpo Estranho/diagnóstico por imagem , Cálculos Biliares/etiologia , Instrumentos Cirúrgicos/efeitos adversos , Dor Abdominal/etiologia , Idoso , Ducto Colédoco/diagnóstico por imagem , Febre , Corpos Estranhos/complicações , Corpos Estranhos/cirurgia , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/cirurgia , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Humanos , Masculino , Resultado do Tratamento
12.
JSLS ; 23(2)2019.
Artigo em Inglês | MEDLINE | ID: mdl-31148913

RESUMO

Background and Objectives: Although trocar site hernias (TSHs) occur in only 1.5% to 1.8% of all laparoscopic procedures, TSHs can present serious postoperative complications. The purpose of this study was to survey surgeons who are active members of the Society of Laparoendoscopic Surgeons (SLS) to elicit their experiences with TSHs, including fascial closure preferences. Methods: After reviewing the clinical and epidemiological literature to compile relevant questions, an anonymous survey was designed using Qualtrics web-based software. The survey link was emailed to all SLS members. Descriptive analyses included frequencies, percentages, and χ2 or Fisher's exact tests to assess statistical associations. Results: There were 659 SLS members who completed the survey: 323 general surgeons, 242 gynecologists, 45 colorectal surgeons, 25 bariatric surgeons, and 24 urologists. Nearly 7 in 10 respondents (68.4%) reported at least 1 patient developing a TSH within the previous decade. Compared with other specialties, bariatric surgeons had the smallest proportion of respondents reporting fascial closure for 10- to 12-mm trocars (68%) and the largest proportion indicating no fascial closure for trocars of any size (28%) (P < .01). Among all respondents, 86.6%, 15.3%, and 2.4% close 10- to 12-mm, 8-mm, and 5-mm ports, respectively, without differences according to surgical volume or practice setting. Approximately 6% reported no fascial closure for any size. Conclusion: Port size remains one of the main risk factors for TSH development, with most respondents closing only 10- to 12-mm ports regardless of surgical volume or practice setting. The general trend for port closure for bariatric surgeons is significantly different from that of other surgeons.


Assuntos
Hérnia Ventral/prevenção & controle , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Cirurgiões , Instrumentos Cirúrgicos/efeitos adversos , Inquéritos e Questionários , Adulto , Feminino , Hérnia Ventral/epidemiologia , Hérnia Ventral/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Estados Unidos/epidemiologia
13.
Diagn Interv Radiol ; 25(4): 304-309, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31199286

RESUMO

PURPOSE: Irreversible electroporation (IRE) is a nonthermal tumor ablation technique that induces cell apoptosis while preserving extracellular architecture. Surgical clips and embolic agents may lie adjacent to, or within, the target lesion. It is unknown to date if IRE causes degradation to the embolic agents or surgical clips that may have adverse effects to patients. We aimed to examine the effects of the IRE on the morphology of various embolic agents and the effects of these agents to the ablation field using a previously validated vegetal model. METHODS: Metallic surgical clips and various metallic and nonmetallic embolic agents were inserted within the center of the tuber ablation field. Additionally, clips were inserted on the edge and outside the ablation field. One tuber was ablated as a control. Ablation settings were based on previous published experiments. Tubers were imaged with magnetic resonance imaging (MRI) 18-24 hours after ablation and the ablated field dimensions were measured. Nonmetallic embolic agents were examined microscopically by the pathologist. RESULTS: Nonmetallic agents did not affect the ablation pattern. Metallic implants, however, caused arcing of the ablation margins. There was no macroscopic or microscopic degradation to the agents after IRE. CONCLUSION: The ablation zone arced in the presence of surgical clips at the edge or outside the ablation margins; therefore, nearby critical structures may be susceptible to the effects of IRE. Furthermore, there was no physical degradation of the embolic agents or surgical clips, and this may have importance when considering IRE ablation of previously embolized lesions in vivo.


Assuntos
Técnicas de Ablação/instrumentação , Eletroporação/métodos , Embolização Terapêutica/instrumentação , Verduras/citologia , Técnicas de Ablação/efeitos adversos , Apoptose/fisiologia , Carcinoma Hepatocelular/cirurgia , Embolização Terapêutica/efeitos adversos , Humanos , Fígado/patologia , Fígado/cirurgia , Imagem por Ressonância Magnética/métodos , Tubérculos , Solanum tuberosum/citologia , Instrumentos Cirúrgicos/efeitos adversos
14.
World Neurosurg ; 128: 473-476, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31132497

RESUMO

BACKGROUND: Adverse outcomes after aneurysm clipping can be potentially reversible, when managed appropriately. METHODS: This is a case report describing kinking of a perforator due to clipping of parent vessel aneurysm. RESULTS: Complete recovery of a high-grade motor deficit was achieved after instant reintervention with application of smaller clips in combination with gelfoam soaked in papaverine. CONCLUSION: Use of evoked potentials and intraoperative digital subtraction angiography are recommended and may help in preclinical diagnosis. Knowledge of delayed perforator kinking as a complication may lead to a more rapid diagnosis and management.


Assuntos
Aneurisma Intracraniano/cirurgia , Artéria Cerebral Média/cirurgia , Complicações Pós-Operatórias/cirurgia , Instrumentos Cirúrgicos/efeitos adversos , Idoso , Angiografia Digital , Angiografia Cerebral , Craniotomia , Potenciais Evocados , Humanos , Masculino , Procedimentos Neurocirúrgicos , Paresia/etiologia , Complicações Pós-Operatórias/etiologia , Reoperação
15.
J Laparoendosc Adv Surg Tech A ; 29(7): 976-980, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31058569

RESUMO

Background: Thoracoscopic correction of esophageal atresia (EA) with tracheoesophageal fistula (TEF) has been increasingly widespread, but is still one of the most advanced pediatric surgical skills. This procedure has a challenging learning curve, and usually initially requires a longer operative time than the open approach; furthermore to perform this intervention, the surgeon must be very experienced in endocorporeal knotting. In our opinion, standardization of the technique and the application of "tricks" (including the use of titanium endoclips for TEF closure) to make surgical steps easier, faster, and safe would be useful to the surgeon and to the patient above all. Materials and Methods: We present our experience in thoracoscopic treatment of EA/TEF over the past 12 years; during this period, we have treated 32 neonates. We reviewed all patient clinical records evaluating demographics, surgical technique, postoperative period, and long-term follow-up. Results: Thirty-one patients were affected by type C EA (five presented with a long-gap defect); one by type E EA. Mean gestational age was 36 + 5 weeks (29-41). Mean weight at surgery was 2340 g (990-3715 g). Through a transpleural thoracoscopic approach, after Azygos vein division, TEF was closed by sutures (silk/polydioxanone [PDS]) in 4 patients while in the remaining 28 two 5 mm titanium endoclips were applied. Esophageal anastomosis was then performed with 8-12 interrupted 5/0 absorbable sutures. We had two intraoperative complications in endoclips application (migration and misplacement), which were immediately resolved. After a contrast study on sixth to seventh postoperative day (average eighth), in the absence of leakage, oral feeding was started and chest tube removed. Four to six weeks after surgery, patients underwent endoscopic evaluation. At a follow-up of 9 years, we had no postoperative complications due to endoclips: neither TEF recurrence, nor problems due to clips dislocation. Conclusions: Although the benefits of thoracoscopic correction of EA/TEF are still discussed, we agree with this part of recent literature that considers thoracoscopic approach as a feasible, safe, and advantageous alternative to the traditional open approach. We also want to emphasize that in our experience, TEF closure by titanium endoclips is fast, reducing operative time, and effective, with no reported long-term complications in our case series. Overall success rate after clips application is, in our series, 100%. The only limit we have found, above all for low-weight patients, is the diameter of the clip applier which needs a 5 mm access even if the surgeon uses 3 mm operative instruments.


Assuntos
Atresia Esofágica/cirurgia , Esofagoplastia/instrumentação , Esôfago/cirurgia , Toracoscopia/instrumentação , Fístula Traqueoesofágica/cirurgia , Anastomose Cirúrgica , Esofagoplastia/métodos , Feminino , Humanos , Recém-Nascido , Complicações Intraoperatórias/etiologia , Masculino , Duração da Cirurgia , Instrumentos Cirúrgicos/efeitos adversos , Toracoscopia/efeitos adversos , Toracoscopia/métodos , Resultado do Tratamento
16.
World Neurosurg ; 127: e919-e924, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30959258

RESUMO

OBJECTIVE: Although mannitol is used widely to facilitate brain retraction in cases of ruptured aneurysms, there is no consensus about the intraoperative administration of mannitol in the case of unruptured aneurysms. Accordingly, this study was conducted to identify an intraoperative mannitol administration strategy. METHODS: Mannitol was administered routinely to patients (n = 90) from January 2015 to April 2016 and not administered to patients (n = 97) from May 2016 to June 2017. The patient groups with and without mannitol administration were then compared based on the patient medical records, radiologic data, and digital recordings from an intraoperative microscope. RESULTS: The patient groups with and without mannitol administration were comparable regarding patient age, number of elderly patients, sex, and aneurysm locations. No between-group difference was identified in terms of the intradural procedural time, retraction-induced cortical injury, postoperative electrolyte imbalance, symptomatic infarction, and postoperative epidural hematomas. However, the patient group without mannitol administration showed a significantly lower incidence of chronic subdural hematomas (CSDHs) >50 mL (13.3% vs. 3.1%, P = 0.010). Moreover, a multivariate analysis revealed that an advanced age (P = 0.019), male sex (P <0.001), and mannitol administration (P = 0.040) were all statistically significant risk factors for a postoperative CSDH >50 mL following unruptured aneurysm surgery. CONCLUSIONS: Withholding the administration of mannitol during a pterional or modified procedure for unruptured aneurysms was found to reduce the postoperative occurrence of a CSDH without increasing the operative difficulties or other postoperative complications.


Assuntos
Aneurisma Roto/cirurgia , Hematoma Subdural Crônico/etiologia , Aneurisma Intracraniano/complicações , Manitol/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Aneurisma Roto/tratamento farmacológico , Craniotomia/efeitos adversos , Feminino , Hematoma Subdural Crônico/cirurgia , Humanos , Incidência , Aneurisma Intracraniano/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Fatores de Risco , Instrumentos Cirúrgicos/efeitos adversos
17.
World Neurosurg ; 127: e353-e365, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30928577

RESUMO

BACKGROUND: The treatment strategies of ruptured intracranial aneurysms (RIAs) include surgical clipping and endovascular coiling, and the efficacy and safety of clipping versus coiling are yet controversial. OBJECTIVE: To summarize the available randomized controlled trials to determine the optimal treatment method for patients with RIA. METHODS: PubMed, Embase, and the Cochrane Library were systematically searched for randomized controlled trials published up to September 5, 2017. The summary analysis was performed using a random-effects model. The primary outcomes included poor outcome, mortality, and rebleeding, whereas the secondary outcomes included complete occlusion, incomplete occlusion, severe disability, and vegetative state. RESULTS: We identified 5 trials with data collected from 2883 patients. The summary results indicated that surgical clipping in patients was associated with a high incidence of poor outcome (relative risk [RR], 1.34; 95% confidence interval [CI], 1.18-1.51; P < 0.001), whereas no significant effect was observed on mortality (RR, 1.09; 95% CI, 0.79-1.49; P = 0.608) and rebleeding (RR, 0.65; 95% CI, 0.20-2.06; P = 0.460) compared with endovascular coiling. Furthermore, we noted that surgical clipping significantly increased the incidence of complete occlusion compared with endovascular coiling (RR, 1.30; 95% CI, 1.09 1.55; P = 0.004). Conversely, surgical clipping was associated with a low incidence of incomplete occlusion (RR, 0.67; 95% CI, 0.45-0.99; P = 0.044). No significant differences were noted between surgical clipping and endovascular coiling with respect to the outcomes of severe disability (RR, 1.39; 95% CI, 0.90-2.16; P = 0.140) and vegetative state (RR, 1.35; 95% CI, 0.84-2.17; P = 0.213). CONCLUSIONS: This meta-analysis provides moderate evidence that surgical clipping has few benefits than endovascular coiling for the treatment of RIA.


Assuntos
Aneurisma Roto/cirurgia , Aneurisma Intracraniano/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Instrumentos Cirúrgicos , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Instrumentos Cirúrgicos/efeitos adversos , Resultado do Tratamento
19.
Actas urol. esp ; 43(3): 124-130, abr. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-181170

RESUMO

Introducción: En los últimos años la urología se ha orientado a formas menos invasivas de laparoscopia con un menor impacto en la pared abdominal. Entre ellas ha surgido de una forma prometedora la minilaparoscopia (ML). Nuestro objetivo es comparar los resultados de una serie de pacientes intervenidos de nefrectomía minilaparoscópica y otra mediante laparoscopia convencional (LC). Material y métodos: Seleccionamos en un único hospital 8 nefrectomías realizadas por minilaparoscopia (grupo NmL) de un total de 110 pacientes incluidos en múltiples centros y las comparamos retrospectivamente con una serie contemporánea de 16 pacientes intervenidos por LC (grupo NL). Se emplearon de 1 a 3 trocares de 3 mm y de 5 mm para la NmL y NL, respectivamente, un trocar de 10 mm en el borde pararrectal de una incisión de Pfannenstiel y otro de 11mm paraumbilical para la óptica. Se recogieron la edad, el IMC, el ASA, las complicaciones, los requerimientos analgésicos en el postoperatorio y la satisfacción cosmética mediante el Patient Scar Assessment Questionnaire (PSAQ) al mes de la intervención. Resultados: Ambos grupos fueron comparables y no presentaron diferencias en cuanto al tiempo quirúrgico, número de puertos empleados, estancia hospitalaria y complicaciones intra y postoperatorias. Solo en un paciente del grupo NmL un trocar de 3mm requirió ser substituido por otro de 5mm y un paciente del grupo NL fue convertido a cirugía mano-asistida por intensas adherencias. Los pacientes del grupo NmL presentaron menos dolor postoperatorio en la escala EVA (± 0 vs. 4 ± 25, p = 0,05) y mejor satisfacción en la apariencia en el PSAQ (8,5 ± 1,4 vs. 16,6 ± 3,1, p = 0,05) respecto al grupo NL. Conclusiones: Los resultados obtenidos con el instrumental de ML fueron semejantes a los obtenidos por LC, pero con las ventajas de un menor dolor postoperatorio y mejores resultados cosméticos


Introduction: In recent years urology has been focussing on less invasive forms of laparoscopy with less impact on the abdominal wall. The minilaparoscopy (ML) is promising in this regard. Our objective is to compare the results of a series of patients who underwent minilaparoscopic nephrectomy with another series who underwent conventional laparoscopy (CL). Material and methods: We chose 8 nephrectomies performed by mini-laparoscopy in a single hospital (NmL group) from a total of 110 patients included in multiple centres and compared them retrospectively with a contemporary series of 16 patients who underwent CL (NL group). From 1 to 3 3 mm and 5 mm trocars were used for the NmL and the NL, respectively, one 10 mm trocar in the pararectal edge of a Pfannenstiel incision and another 11 mm paraumbilical trocar for the optics. Age, BMI, ASA, complications, analgesic requirements in the postoperative period and cosmetic satisfaction were recorded using the Patient Scar Assessment Questionnaire (PSAQ), one month after the intervention. Results: Both groups were comparable and there were no differences in terms of surgery time, number of ports used, hospital stay or intra-and postoperative complications. In only one patient from the NmL group, a 3mm trocar had to be replaced by a 5mm trocar and one patient in the NL group was converted to hand-assisted surgery due to severe adherences. The patients in the NmL group had less postoperative pain on the VAS (±0 vs. 4 ± 25, p = 0.05) and were more satisfied with their appearance on the PSAQ (8.5 ± 1.4 vs. 16.6 ± 3.1, p = 0.05) compared to the NL group. Conclusions: The results obtained with the ML instrument were similar to those obtained by CL, but with the advantages of less postoperative pain and better cosmetic results


Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Pessoa de Meia-Idade , Nefrectomia/métodos , Laparoscopia/métodos , Dor Pós-Operatória , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Retrospectivos , Instrumentos Cirúrgicos/efeitos adversos , Período Perioperatório/estatística & dados numéricos
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