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1.
Medicine (Baltimore) ; 99(16): e19888, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32312016

RESUMO

RATIONALE: Although percutaneous endoscopic gastrojejunostomy (PEG-J) tubes are believed to reduce the side effect of aspiration, cautious catheter management is required. Intussusception is a serious complication of these tubes. PATIENT CONCERNS: A 7-year-old boy bedridden with hypoxic encephalopathy owing to drowning at the age of 1 year was admitted our hospital with urinary retention for 1 month. At the age of 4 years, a PEG-J tube was inserted. Concomitant with hyperaldosteronemia, an intestinal intussusception from the duodenum to the jejunum was observed via computed tomography (CT). The patient's condition worsened dramatically; gastrointestinal perforation was suspected, and laparotomy was performed. DIAGNOSIS: Jejuno-jejunal intussusception. INTERVENTIONS: Open surgery was performed to release the intussusception. By assessing the reduced intestinal tract, the intussusception starting from a 50 cm portion from the Treitz ligament had been extended to 100 cm from the Treitz ligament. The oral side jejunum was dilated. No evidence of intestinal perforation or strangulated ileus was observed, and the intussusception was manually remediable. OUTCOMES: Preoperative CT examination showed intussusception from the duodenum to the jejunum. Laparotomy showed intussusception on the anal side of the Treitz ligament. With regard to the CT findings associated with the progression of intussusception to the duodenal site, as a result of the telescope phenomenon extending to the duodenum due to the relaxation of the Treitz ligament through repeated intussusception, it was considered that CT examination revealed intussusception extending from the jejunum to the duodenum of oral side. After 3 postoperative weeks, the patient was finally able to return home. LESSONS: If the ileus is observed during the insertion of a PEG-J, clinicians should consider the possibility of intussusception even in the duodenum.


Assuntos
Endoscopia Gastrointestinal/métodos , Derivação Gástrica/efeitos adversos , Intussuscepção/etiologia , Jejunostomia/efeitos adversos , Estômago/cirurgia , Criança , Duodeno/patologia , Duodeno/cirurgia , Derivação Gástrica/instrumentação , Humanos , Doença Iatrogênica , Íleus/diagnóstico , Íleus/etiologia , Intussuscepção/patologia , Doenças do Jejuno/diagnóstico por imagem , Doenças do Jejuno/etiologia , Doenças do Jejuno/patologia , Jejuno/patologia , Jejuno/cirurgia , Laparotomia/métodos , Masculino , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
2.
Surg Clin North Am ; 100(2): 303-336, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32169182

RESUMO

Robotic surgery is flourishing worldwide. Pancreatic cancer is the fourth leading cause of cancer death in the United States. Most pancreatic operations are undertaken for the management of pancreatic adenocarcinoma. Therefore, it is essential for all physicians caring for patients with cancer to understand the role and importance of molecular tumor markers. This article details our technique and application of the robotic platform to robotic pancreatectomy. The use of the robot does not change the nature of pancreatic operations, but it is our belief that it will improve patient outcomes and, possibly, survival by reducing perioperative complications.


Assuntos
Pancreatectomia/métodos , Pancreatopatias/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Humanos , Jejunostomia/métodos , Laparoscopia/métodos , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/métodos
3.
Med Sci Monit ; 26: e921896, 2020 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-32189715

RESUMO

BACKGROUND Hepaticojejunostomy is a common biliary reconstruction procedure in hepatobiliary surgery. The suture technique plays a key role in the procedure. The conventional suture technique is complex and time-consuming. To facilitate the procedure, we performed it with a modified suture technique. In the present study, we evaluated the efficacy and safety of the technique in hepaticojejunostomy. MATERIAL AND METHODS We enrolled 120 adult patients who underwent hepaticojejunostomy. The patients were divided into a conventional group and a modified suture group according to the suture technique used. Clinical data were collected for analysis. RESULTS No significant differences were found between the 2 groups in terms of demographic data. No significant differences were found between the 2 groups in terms of serum bilirubin, albumin, AST, ALT, or hemoglobin (p>0.05). There were no significant differences between the 2 groups in terms of bile hemorrhage, fever, or cholangitis (p>0.05). The incidences of stenosis and cholelithiasis were similar in the 2 groups (p>0.05). The incidence of bile leakage was lower in the modified suture group than in the conventional group (p=0.04). The average bile duct diameter was 25±6 mm in the modified continuous suture group and 29±7mm in the conventional group, but the difference was not statistically significant (p=0.5). The duration of the anastomosis procedure was 15.4±4.4 min in the modified continuous suture group, which was shorter than in the conventional group (p<0.05). CONCLUSIONS The modified continuous suture technique is efficient and safe for use in hepaticojejunostomy. It can facilitate the procedure and reduce the incidence of bile leakage after hepaticojejunostomy.


Assuntos
Anastomose Cirúrgica/métodos , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Jejunostomia , Técnicas de Sutura , Adulto , Ductos Biliares/cirurgia , Feminino , Humanos , Masculino
5.
Int J Surg ; 76: 53-58, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32109648

RESUMO

BACKROUND: C-reactive protein (CRP) and procalcitonin (PCT) have shown to be reliable predictors of inflammatory complications and anastomotic leak after colorectal surgery. Their predictive value after partial pancreaticoduodenectomy (PD) remains unclear. MATERIALS AND METHODS: All consecutive pancreaticoduodenectomies (2009-2018) at our hospital were included. Drain amylase was evaluated on postoperative day (POD) 1, serum CRP and PCT were evaluated on POD 1-3. Receiver-operating characteristics curves were performed and significant cut-off values were tested using logistic regression. RESULTS: Among 188 patients who underwent partial PD, clinically relevant pancreatic fistulas (POPF) occurred in 30 (16%) patients, including 20 (10.6%) with Grade B and 10 (5.3%) patients with Grade C. Postoperative complications (Clavien-Dindo ≥ III) were reported in 46 (24.5%) patients, including Grade IIIa in 16 (8.5%), IIIb in 18 (9.6%), IVa in 3 (1.6%), IVb in 2 (1.1%) and V in 7 (3.7%) patients. Drain amylase on POD 1 showed the largest area under the curve (0.872, p < 0.001), followed by CRP (0.803, p < 0.001) and PCT on POD 3 (0.651, p < 0.011). Drain amylase on POD 1 > 303 U/l (OR 0.045, 95% CI 0.010-0.195, p < 0.001), CRP > 203 mg/l (OR 0.098, 95% CI 0.041-0.235, p < 0.001) and PCT > 0.85 µg/l (OR 0.393, 95%CI 0.178-0.869, p = 0.02) were significant predictors of relevant POPF in the univariate analysis. CRP > 203 mg/l (OR 0.098, 95% CI 0.024-0.403, p = 0.001) and drain amylase > 303 U/l (OR 0.064, 95% CI 0.007-0.554, p = 0.01) remained independent predictors in the multivariable analysis. The combination of drain amylase on POD 1 and CRP on POD 3 had a sensitivity and specificity of 87.4% and 90.9% to predict relevant POPF. CONCLUSION: Drain amylase on POD 1 and CRP on POD 3 can accurately predict clinically relevant POPF after partial pancreaticoduodenectomy. The accuracy of PCT on POD 3 is limited.


Assuntos
Amilases , Proteína C-Reativa , Fístula Pancreática , Pancreaticoduodenectomia , Idoso , Amilases/sangue , Biomarcadores/análise , Proteína C-Reativa/análise , Drenagem/efeitos adversos , Feminino , Humanos , Jejunostomia/efeitos adversos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pancreatectomia/efeitos adversos , Fístula Pancreática/diagnóstico , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Curva ROC , Sensibilidade e Especificidade
6.
Anticancer Res ; 40(2): 1167-1173, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014970

RESUMO

BACKGROUND: A gastrostomy feeding tube is one method for long-term feeding support in patients undergoing radio(chemo)therapy for head and neck cancer (HNC). The aim of this study was to analyze the safety of prophylactic gastrostomy tube placement and usage in HNSCC patients. PATIENTS AND METHODS: HNC patients undergoing percutaneous endoscopic gastrostomy (PEG) or radiological percutaneous gastrostomy (RPG) tube placement prior to radio(chemo)therapy from 2010-2014 were retrospectively reviewed regarding procedural and long-term gastrostomy tube-related complications, usage of PEG/RPG, weight profile, pretreatment and posttreatment body mass index. RESULTS: A total of 212 patients underwent prophylactic feeding tube placement (71% RPG, 27% PEG and 2% surgical jejunostomy). A total of 173 patients utilized their gastrostomy tubes for either total or supplemental nutrition support. Despite this, 157 patients (74%) lost weight during therapy (mean weight loss=8 kg). The rate of severe tube-related complications (peritonitis/incorrect placement) was low and similar in both groups (PEG 2.7% vs. RPG 3.4%). CONCLUSION: Although a very high proportion of patients used their PEG/RPG during radio(chemo)therapy there was a high mean weight loss. Serious complications of tube placement were rare.


Assuntos
Gastrostomia , Neoplasias de Cabeça e Pescoço/dietoterapia , Intubação Gastrointestinal , Adulto , Idoso , Idoso de 80 Anos ou mais , Peso Corporal , Quimiorradioterapia , Nutrição Enteral/efeitos adversos , Nutrição Enteral/métodos , Feminino , Gastrostomia/efeitos adversos , Gastrostomia/métodos , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/métodos , Jejunostomia , Masculino , Pessoa de Meia-Idade , Recidiva , Resultado do Tratamento
7.
J Visc Surg ; 157(2): 167-168, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31959468
8.
J Surg Res ; 245: 249-256, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31421370

RESUMO

BACKGROUND: Technical improvement of gastrojejunostomy is critical in bariatric and metabolic surgery. In this study, a novel magnetic compression approach for gastrojejunostomy was evaluated. MATERIALS AND METHODS: Both cylindrical and rectangular magnets were used in rabbits, and the magnets were named according to their location. All the magnets were perorally introduced into the stomach. The position of the jejunal magnet was controlled by a connecting line. When the jejunal magnet spontaneously entered the jejunum, the gastric magnet was introduced into the stomach. An extracorporeal magnet was used to guide these two magnets together, and the magnet pair was left to create a side-to-side anastomosis. The state of the animals and extrusion time of the magnets were observed. The anastomoses were evaluated by burst pressure and histology. RESULTS: Gastrojejunostomy was successfully established in all animals. Cylindrical and rectangular magnets spontaneously entered the jejunum through the pylorus within 2.4 ± 0.5 and 6.0 ± 0.8 d, respectively (P < 0.01). The cylindrical and rectangular magnet pairs fell off within 15.3 ± 0.8 and 11.9 ± 1.1 d, respectively (P < 0.01). The burst pressures were statistically similar between the two types of magnets (P > 0.05). Histological examination showed sealed anastomoses with mild inflammation of the mucosa and fibrosis within the submucosa. CONCLUSIONS: The feasibility and efficacy of establishing gastrojejunostomy by guidewire introduction of magnets, which were guided together with an extracorporeal magnet, were confirmed in rabbits. In humans, with the clinical use of this procedure, surgery would be greatly simplified.


Assuntos
Derivação Gástrica/instrumentação , Gastrostomia/instrumentação , Jejunostomia/instrumentação , Imãs , Animais , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Gastrostomia/efeitos adversos , Gastrostomia/métodos , Jejunostomia/efeitos adversos , Jejunostomia/métodos , Masculino , Modelos Animais , Pressão , Coelhos
9.
Arch. argent. pediatr ; 117(6): 648-650, dic. 2019. ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1046632

RESUMO

El síndrome de la arteria mesentérica superior es una enfermedad poco frecuente en pediatría. Se produce por la compresión de la tercera porción duodenal a su paso entre la arteria mesentérica superior y la aorta abdominal (compás aortomesentérico). La mayoría de los pacientes presentan factores predisponentes:pérdida de peso aguda o compresiones extraabdominales.Se presenta el caso de una niña de 12 años de edad a quien se le diagnosticó el síndrome sin presentar factores predisponentes.Comenzó de modo súbito con náuseas, vómitos incoercibles y dolor abdominal, que era posprandial y se aliviaba, llamativamente, en decúbito lateral izquierdo. Esto constituyó la sospecha clínica del síndrome, por lo que se solicitó una angio tomografía computada abdominal y se observó el estrechamiento del compás aortomesentérico. Se realizó un tratamiento médico conservador, sin respuesta clínica. Se decidió el tratamiento quirúrgico y se logró la resolución del cuadro clínico


The superior mesenteric artery syndrome is rarely seen in children. It results from an intestinal obstruction due to compression of the third portion of duodenum between the superior mesenteric artery and the abdominal aorta. In most of the cases there are predisposing factors such as rapid weight loss or extra-abdominal compression.We report a case of a superior mesenteric artery syndrome in a twelve-year-old female patient without predisposing factors. The girl began suddenly with nauseas, continuous vomiting and abdominal pain. The abdominal pain was postprandial and it decreased in left lateral decubitus position. Clinically, this characteristic suggested superior mesenteric artery syndrome. Angio-computed tomography scan confirmed the diagnosis. Given that conservative treatment ultimately failed, patient was subjected to surgery and the illness was resolved.


Assuntos
Humanos , Feminino , Criança , Síndrome da Artéria Mesentérica Superior/cirurgia , Síndrome da Artéria Mesentérica Superior/diagnóstico por imagem , Jejunostomia , Duodenopatias/diagnóstico por imagem , Obstrução Duodenal
10.
J Stroke Cerebrovasc Dis ; 28(12): 104401, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31570263

RESUMO

BACKGROUND: Direct enteral feeding tube (DET) placement for dysphagia after stroke is associated with poor outcomes. However, the relationship between timing of DET placement and poststroke mortality and disability is unknown. We sought to determine the risk of mortality and severe disability in patients who receive DET at different times after stroke. METHODS: We used the Ontario Stroke Registry and linked administrative databases to identify patients with acute ischemic stroke or intracerebral hemorrhage between 2003 and 2013 who received DET (gastrostomy or jejunostomy) during their hospital admission. We grouped patients by week of DET placement and evaluated mortality at 30 days and 6 months after DET insertion, and disability at discharge. We used Cox proportional hazard models and multiple logistic regression to determine the association between time from admission to DET placement and outcomes, adjusting for patient and hospital factors. RESULTS: In the study sample of 1367 patients, the median time from admission to DET placement was 17 days. After adjustment, each week of delay to DET placement was associated with lower mortality at 30 days (adjusted hazard ratio [aHR] .88, 95% confidence interval [CI] .79-.98), but not at 6 months (aHR .98, 95% CI .91- 1.05), and a higher likelihood of severe disability at discharge (adjusted odds ratio 1.35, 95% CI 1.13- 1.60). CONCLUSIONS: Later DET placement after stroke was associated with lower 30-day mortality but higher severe disability at discharge. Further research is needed to understand the reasons for these observations and to optimize patient selection and timing of DET.


Assuntos
Transtornos de Deglutição/reabilitação , Nutrição Enteral/instrumentação , Gastrostomia/instrumentação , Jejunostomia/instrumentação , Reabilitação do Acidente Vascular Cerebral/instrumentação , Acidente Vascular Cerebral/terapia , Tempo para o Tratamento , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Deglutição , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/mortalidade , Transtornos de Deglutição/fisiopatologia , Avaliação da Deficiência , Nutrição Enteral/efeitos adversos , Nutrição Enteral/mortalidade , Feminino , Gastrostomia/efeitos adversos , Gastrostomia/mortalidade , Humanos , Jejunostomia/efeitos adversos , Jejunostomia/mortalidade , Masculino , Ontário , Recuperação de Função Fisiológica , Sistema de Registros , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/efeitos adversos , Reabilitação do Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Resultado do Tratamento
11.
Am Surg ; 85(10): 1150-1154, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657313

RESUMO

Bile duct injury represents a complication after laparoscopic cholecystectomy, impairing quality of life and resulting in subsequent litigations. A five-year experience of bile duct injury repairs in 52 patients at a community hospital was reviewed. Twenty-nine were female, and the median age was 51 years (range, 20-83 years). Strasberg classification identified injuries as Type A (23), B (1), C (1), D (5), E1 (5), E2 (6), E3 (4), E4 (6), and E5 (1). Resolution of the bile duct injury and clinical improvement represent main postoperative outcome measures in our study. The referral time for treatment was within 4 to 14 days of the injury. Type A injury was treated with endobiliary stent placement. The remaining patients required T-tube placement (5), hepaticojejunostomy (20), and primary anastomosis (4). Two patients experienced bile leak after hepaticojejunostomy and were treated and resolved with percutaneous transhepatic drainage. At a median follow-up of 36 months, two patients (Class E4) required percutaneous balloon dilation and endobiliary stent placement for anastomotic stricture. The success of biliary reconstruction after complicated laparoscopic cholecystectomy can be achieved by experienced biliary surgeons with a team approach in a community hospital setting.


Assuntos
Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/estatística & dados numéricos , Ductos Biliares/diagnóstico por imagem , Ductos Biliares Extra-Hepáticos/lesões , California , Colecistectomia Laparoscópica/estatística & dados numéricos , Feminino , Hospitais Comunitários , Humanos , Jejunostomia/métodos , Jejunostomia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/classificação , Estudos Retrospectivos , Stents/estatística & dados numéricos , Fatores de Tempo , Tempo para o Tratamento , Ferimentos e Lesões/classificação , Adulto Jovem
12.
Arq Bras Cir Dig ; 32(3): e1452, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31644672

RESUMO

BACKGROUND: In high-income countries, morbid obesity is a growing health problem that has already reached epidemic proportions. When performing a laparoscopic gastric bypass several operative methods exist. AIM: To describe the institutional experience using a knotless unidirectional barbed suture (V-Loc 180/Covidien, Mansfield, MA) to create a hand-sewn gastrojejunostomy (GJ) and jejunojejunostomy (JJ) during bariatric surgery. METHODS: Evaluation of a case series of 87 morbidly obese patients who underwent laparoscopic gastric bypass with a hand-sewn gastrojejunostomy (GJA) and jejunojejunostomy (JJA) between 01/2015 and 06/2017. The patients were divided into two groups: in group I, GJA und JJA sutures were performed using the knotless unidirectional barbed suture; in group II, GJA and JJA were sutured with resorbable multifilament thread (Vicryl® 3/0 Ethicon, Livingstone, UK). The recorded data on gender, age, BMI, ASA score, operative time, postoperative morbidity, length of hospital stay, and reoperation, were analyzed and compared. RESULTS: All procedures were completed laparoscopically with no mortality. The mean operative time was 123.23 (±30.631) in group I and 127.57 (±42.772) in group II (p<0.05). The postoperative complications did not differ significantly between the two groups. Early complications were observed for two patients (0.9%) in the barbed suture group and for one patient (0.42%) in the multifilament suture group (p<0.05). In group I two patients (0.9%) required reoperation: on the basis of jejunojejunal stenosis in one patient, and local abscess near the gastrojejunostomy, without a leakage, in the other. In group II one patient (0.42%) required reoperation due to stenosis of the GJA. The duration of hospital admission was similar for both groups: 3.36 (±0.743) days in group I vs. 3.38 (±1.058) days in group II (p<0.05). CONCLUSION: The novel anastomotic technique is a safe and effective method and can be applied to gastrojejunal anastomosis and jejunojejunal anastomosis in laparoscopic gastric bypass.


Assuntos
Cirurgia Bariátrica/instrumentação , Segurança de Equipamentos/instrumentação , Obesidade Mórbida/cirurgia , Técnicas de Sutura/instrumentação , Adulto , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Cirurgia Bariátrica/métodos , Feminino , Derivação Gástrica/instrumentação , Derivação Gástrica/métodos , Humanos , Jejunostomia/instrumentação , Jejunostomia/métodos , Jejuno/cirurgia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Poliglactina 910 , Complicações Pós-Operatórias , Estudos Prospectivos , Estômago/cirurgia , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/instrumentação
13.
Pediatr Surg Int ; 35(12): 1421-1425, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31555861

RESUMO

AIM: We compared robotic hepaticojejunostomy anastomosis (RHJA) with laparoscopic hepaticojejunostomy anastomosis (LHJA) in children undergoing complete excision of choledochal cyst. METHODS: Difficulty of suturing (DOS) during anastomosis was scored blindly, from intraoperative video recordings, using: 5 = impossible; 4 = difficult; 3 = tedious; 2 = slow; and 1 = easy. A panel of fiveindependent surgeons was also asked to compare RHJA with matched LHJA and score + 1 if RHJA appeared superior to LHJA, 0 if RHJA appeared equivalent to LHJA, and - 1 if RHJA appeared inferior to LHJA. RESULTS: RHJA (n = 10) was performed between 2017 and 2019; LHJA (n = 27) was performed between 2009 and 2018. LHJA cases were matched for age, weight, and anastomosis diameter to RHJA cases. Complete excision was performed laparoscopically in both groups. DOS was lower in RHJA with less variance. The panel all scored RHJA as + 1. Total anastomotic time (TAT) and TAT per suture were significantly shorter for RHJA. Times taken to ambulate and for return of bowel sounds postoperatively were significantly shorter for RHJA. There was one anastomotic leak with LHJA (3.7%) and no anastomotic complications with RHJA. CONCLUSIONS: RHJA is a more stable anastomosis that can be performed quicker, and thus, would appear to be superior to LHJA.


Assuntos
Cisto do Colédoco/cirurgia , Hepatectomia/métodos , Jejunostomia/métodos , Laparoscopia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Anastomose Cirúrgica/métodos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Resultado do Tratamento
14.
J Laparoendosc Adv Surg Tech A ; 29(10): 1345-1348, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31532300

RESUMO

Aim: In children, the diameter at the hepaticojejunostomy anastomosis (HJA) can range from 10 mm to less than 5 mm, irrespective of the type of choledochal cyst (CC). We developed a maneuver that involves everting the mucosa (EM) of the Roux-en-Y loop jejunum and the common hepatic duct mucosa circumferentially, to facilitate suturing during laparoscopic HJA (lap-HJA). Otherwise, it is extremely difficult to distinguish between the lumen and the mucosa on the jejunal side. Methods: We used EM to treat 18 consecutive children with CC between 2016 and 2018. After transumbilical, extracorporeal Roux-en-Y loop-plasty, the closed end of the jejunum was incised with a scalpel and bleeding points were coagulated with bipolar diathermy. During lap-HJA, the mucosa at the incision was everted circumferentially by using 7/0 absorbable sutures and anastomosed securely to the common hepatic duct by using 5/0 or 6/0 absorbable sutures. Results: Mean age at surgery was 4.0 years old. HJA diameters were <5 mm (n = 4), 5-9 mm (n = 11), and >9 mm (n = 3). In all cases, EM allowed the lumen at the incision in the Roux-en-Y loop jejunum to be distinguished readily, and suturing proceeded smoothly. After follow-up of a mean of 1.5 years (range 0.5-3.0), no anastomotic leakages or stenoses have been reported. Conclusions: EM greatly facilitated secure anastomosis during lap-HJA, even when the diameter at the anastomosis was <5 mm. The safety and efficiency of lap-HJA in children with CC could be improved by this simple maneuver.


Assuntos
Anastomose Cirúrgica/métodos , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Cisto do Colédoco/cirurgia , Mucosa Intestinal/cirurgia , Jejunostomia/métodos , Laparoscopia/métodos , Adolescente , Anastomose em-Y de Roux , Fístula Anastomótica/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Técnicas de Sutura
15.
Perm J ; 232019.
Artigo em Inglês | MEDLINE | ID: mdl-31496496

RESUMO

BACKGROUND: Feeding jejunostomy (FJ) tubes are routinely placed during esophagectomy. However, their effect on immediate postoperative outcomes in this patient population is not clear. OBJECTIVES: To evaluate the effect of FJ tube placement during esophagectomy on postoperative morbidity and mortality. METHODS: The National Surgical Quality Improvement Program database was used to evaluate the effect of FJ tube placement during esophagectomy on 30-day postoperative morbidity and mortality rates. A propensity score-matched cohort was used to compare postoperative outcomes of patients with and without FJ tubes. RESULTS: An FJ tube was placed in 45% of 2059 patients undergoing esophagectomy. The anastomotic leak rate was 13.5%. Patients with FJ tubes were more likely to have preoperative radiation therapy (59.6% vs 54.9%, p = 0.041), transhiatal esophagectomy (21.5% vs 19.2%, p = 0.012), a malignant diagnosis (93.2% vs 90.4%), and longer operative time (393 min vs 348 min, p < 0.001). In a case-matched cohort, mortality (2% vs 2.4%, p = 0.618) and severe morbidity (38.2% vs 34.6%, p = 0.128) were comparable between patients with and without FJ tubes. FJ tube placement was associated with higher overall morbidity (46% vs 38.6%, p = 0.002), superficial wound infection (6.3% vs 2.9%, p = 0.001), and return to the operating room (16.7% vs 12.5%, p = 0.016). In a subgroup of patients with anastomotic leak, FJ was associated with shorter hospital stay (20.1 days vs 24.3 days, p = 0.046). CONCLUSION: These mixed findings support selective rather than routine FJ tube placement during esophagectomy.


Assuntos
Nutrição Enteral/métodos , Esofagectomia/métodos , Jejunostomia/métodos , Fístula Anastomótica/epidemiologia , Fístula Anastomótica/etiologia , Estudos de Casos e Controles , Nutrição Enteral/efeitos adversos , Nutrição Enteral/mortalidade , Esofagectomia/efeitos adversos , Esofagectomia/mortalidade , Feminino , Humanos , Jejunostomia/efeitos adversos , Jejunostomia/mortalidade , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
16.
World J Gastroenterol ; 25(31): 4427-4436, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31496622

RESUMO

Some controversy surrounds the postoperative feeding regimen utilized in patients who undergo esophagectomy. Variation in practices during the perioperative period exists including the type of nutrition started, the delivery route, and its timing. Adequate nutrition is essential for this patient population as these patients often present with weight loss and have altered eating patterns after surgery, which can affect their ability to regain or maintain weight. Methods of feeding after an esophagectomy include total parenteral nutrition, nasoduodenal/nasojejunal tube feeding, jejunostomy tube feeding, and oral feeding. Recent evidence suggests that early oral feeding is associated with shorter LOS, faster return of bowel function, and improved quality of life. Enhanced recovery pathways after surgery pathways after esophagectomy with a component of early oral feeding also seem to be safe, feasible, and cost-effective, albeit with limited data. However, data on anastomotic leaks is mixed, and some studies suggest that the incidence of leaks may be higher with early oral feeding. This risk of anastomotic leak with early feeding may be heavily modulated by surgical approach. No definitive data is currently available to definitively answer this question, and further studies should look at how these early feeding regimens vary by surgical technique. This review aims to discuss the existing literature on the optimal route and timing of feeding after esophagectomy.


Assuntos
Fístula Anastomótica/prevenção & controle , Nutrição Enteral/métodos , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Nutrição Parenteral/métodos , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/reabilitação , Fístula Anastomótica/epidemiologia , Fístula Anastomótica/etiologia , Caquexia/epidemiologia , Caquexia/etiologia , Caquexia/prevenção & controle , Nutrição Enteral/efeitos adversos , Neoplasias Esofágicas/complicações , Esofagectomia/métodos , Esofagectomia/reabilitação , Humanos , Incidência , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/métodos , Jejunostomia/efeitos adversos , Jejunostomia/métodos , Nutrição Parenteral/efeitos adversos , Qualidade de Vida , Padrão de Cuidado , Fatores de Tempo , Resultado do Tratamento
17.
Cir Cir ; 87(S1): 53-57, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501625

RESUMO

There are few reported cases of small bowel injury due to blunt abdominal trauma. We describe the clinical presentation and surgical management of these lesions. This is the clinical case of a polytraumatized male with a duodenal injury IIID3 according to AAST, who underwent resection of the intestinal segment with duodeno-duodenum anastomosis with favorable results. The infrequent presentation of injuries to the small intestine due to blunt trauma may lead the clinician to overlook the need for intentional interrogation about the kinematics of the trauma, while at the same time neglecting the taking of complementary diagnostic imaging studies, this because of a lack of clinical suspicion. It is important to analyze the patient's context, which will allow us to assess the need to delve into diagnostic studies in order to optimize their treatment.


Assuntos
Traumatismos Abdominais/cirurgia , Duodeno/lesões , Ferimentos não Penetrantes/cirurgia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/etiologia , Acidentes de Trânsito , Adulto , Colectomia , Duodeno/irrigação sanguínea , Duodeno/cirurgia , Gastrostomia , Hematoma/classificação , Hemoperitônio/etiologia , Humanos , Íleo/irrigação sanguínea , Isquemia/etiologia , Isquemia/cirurgia , Jejunostomia , Lacerações/classificação , Fígado/lesões , Masculino , Mesentério/lesões , Nutrição Parenteral , Pneumoperitônio/diagnóstico por imagem , Pneumoperitônio/etiologia , Ferimentos não Penetrantes/etiologia
18.
J Laparoendosc Adv Surg Tech A ; 29(10): 1378-1382, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31539299

RESUMO

Purpose: Various studies have shown the benefit of three-dimensional (3D) systems over two-dimensional (2D) systems in endoscopic surgery. However, few studies have focused on pediatric endosurgery. The purpose of this study was to assess the impact of 2D and 3D environments on the time taken and forceps manipulation by comparing experts and trainees using a laparoscopic hepaticojejunostomy simulator. Methods: We have developed a simulator of laparoscopic hepaticojejunostomy for congenital biliary dilatation. Seventeen participants of pediatric surgeons (4 experts and 13 trainees) performed hepaticojejunostomy using our simulator in both 2D and 3D environment. We evaluated the required time, total path length, and average velocities of bilateral forceps in both situations. Results: Obtained results show the findings for the required time (seconds; 2D, experts: 810.43 ± 321.64 vs. trainees: 1136.02 ± 409.96, P = .17) (seconds; 3D, experts: 660.21 ± 256.48 vs. trainees: 1017 ± 280.93, P = .039), total path length of right forceps (mm; 2D, experts: 38838.23 ± 30686.63 vs. trainees: 52005.47 ± 31675.02, P = .48)(mm; 3D, experts: 24443.09 ± 12316.32 vs. trainees: 45508.09 ± 26926.27, P = .16), total path length of left forceps (mm; 2D, experts: 131635.54 ± 71669.94 vs. trainees: 245242.48 ± 130940.25, P = .48)(mm; 3D, experts: 88520.42 ± 56766.63 vs. trainees: 230789.75 ± 107315.85, P = .024), average velocities of right forceps (mm/second; 2D, experts: 44.80 ± 21.85 vs. trainees: 44.37 ± 18.92, P = .97) (mm/second; 3D, experts: 37.28 ± 16.49 vs. trainees: 42.58 ± 14.40, P = .54), average velocities of left forceps (mm/second; 2D, experts: 156.65 ± 38.69 vs. trainees: 202.58 ± 63.80, P = .20) (mm/second; 3D, experts: 125.64 ± 44.30 vs. trainees: 219.42 ± 43.82, P < .01). Conclusion: The experts performed more effectively when using the 3D system. Using 3D, the total path length of the left forceps of expert pediatric surgeons was significantly shorter than trainee pediatric surgeons, and the average velocities of the left forceps tip of expert pediatric surgeons was significantly slower than trainee pediatric surgeons. These results suggest that training of assisting hand is necessary for advanced pediatric endosurgery to avoid organ injury.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/métodos , Cisto do Colédoco/cirurgia , Ducto Hepático Comum/cirurgia , Jejunostomia/métodos , Laparoscopia/métodos , Pediatria , Treinamento por Simulação/métodos , Procedimentos Cirúrgicos do Sistema Biliar/educação , Competência Clínica , Humanos , Imageamento Tridimensional , Jejunostomia/educação , Jejuno/cirurgia , Laparoscopia/educação , Pediatria/educação , Pediatria/métodos , Instrumentos Cirúrgicos
20.
Medicina (Kaunas) ; 55(8)2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31416274

RESUMO

Background and Objectives: Nowadays, with the increasing laparoscopic expertise and accessibility to modern surgical tools, laparoscopic assisted ERCP (LAERCP) has become an effective approach for the management of bile stone disease in patients with modified gastrointestinal anatomy. In contrast to patients with gastric bypass in whom a transgastric LAERCP approach is usually performed, the resultant anatomy of Roux-en-Y hepaticojejunostomy precludes a gastric approach as the newly formed bilioenteric anastomosis is not reachable through the stomach. Therefore, a transjejunal approach has been described as an alternative LAERCP technique. To the best of our knowledge this is the tenth case of transjejunal LAERCP reported worldwide. Materials and Methods: We present the case of a 50-year-old female with history of biliary injury during a cholecystectomy corrected with Roux-en-Y hepaticojejunostomy who presented to our center with manifestations of acute abdomen. After laboratory and image analysis, diagnosis of intrahepatic lithiasis was confirmed. The decision to perform a transjejunal LAERCP was made due to the complex anatomy in this patient. No complications were found during surgery and in the follow up period. Conclusions: Transjejunal LAERCP is an effective approach for endoscopic management of biliary complications in patients with Roux-en-Y hepaticojejunostomy and other modified gastrointestinal anatomy. Previous recommendations by more experienced teams have been reported, nonetheless, there are too few cases reported to make definitive recommendations and conclusions. In limited settings, such as ours, some of these recommendations may not be applicable. We are certain that, with the increasing expertise and innovations in laparoscopy surgery for the management of complications that cannot be addressed by endoscopic or noninvasive measures, more cases will be reported.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia Laparoscópica , Jejunostomia , Feminino , Derivação Gástrica , Humanos , Pessoa de Meia-Idade , Estômago/cirurgia
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