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2.
Medicine (Baltimore) ; 99(40): e22421, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019419

RESUMO

BACKGROUND: Laparoscopic surgery develops rapidly in both elective and emergency settings. The study aimed to determine the role of different laparoscopic methods for the emergency treatment of complicated diverticulitis. METHODS: MEDLINE, EMBASE, Science Citation Index Expanded, and the Cochrane database were searched up to November 2019 to identify all published articles related to the topic. Statistical analysis was performed using Stata 15. RESULTS: Fourteen publications were included in the analysis. Laparoscopic surgery was applied in 425 patients, and 493 patients underwent open colon resection (OCR). Postoperative mortality, morbidity, severe complications, and reoperation rates were not significantly different between the laparoscopic and open surgery groups. Subgroup analysis was performed based on the different laparoscopic methods (laparoscopic colon resection [LCR] and laparoscopic lavage and drainage [LLD]). Subgroup analysis indicated that LCR was superior to OCR in terms of morbidity, while OCR was superior to LLD in terms of severe complications. CONCLUSIONS: The safety of laparoscopic surgery for the emergency treatment of complicated diverticulitis is related to different surgical methods. LCR is suggested to be a better choice according to the postoperative outcomes. More definite conclusions can be drawn in future randomized controlled trials.


Assuntos
Doença Diverticular do Colo/cirurgia , Laparoscopia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia
3.
Medicine (Baltimore) ; 99(40): e22431, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019422

RESUMO

BACKGROUND: In this analysis, we aimed to systematically compare the procedural and post-operative complications (POC) associated with laparoscopic versus open abdominal surgery for right-sided colonic cancer resection. METHODS: We searched MEDLINE, http://www.ClinicalTrials.gov, EMBASE, Web of Science, Cochrane Central, and Google scholar for English studies comparing the POC in patients who underwent laparoscopic versus open surgery (OS) for right colonic cancer. Data were assessed by the Cochrane-based RevMan 5.4 software (The Cochrane Community, London, UK). Mean difference (MD) with 95% confidence intervals (CIs) were used to represent the results for continuous variables, whereas risk ratios (RR) with 95% CIs were used for dichotomous data. RESULTS: Twenty-six studies involving a total number of 3410 participants with right colonic carcinoma were included in this analysis. One thousand five hundred and fifteen participants were assigned to undergo invasive laparoscopic surgery whereas 1895 participants were assigned to the open abdominal surgery. Our results showed that the open resection was associated with a shorter length of surgery (MD: 48.63, 95% CI: 30.15-67.12; P = .00001) whereas laparoscopic intervention was associated with a shorter hospital stay [MD (-3.09), 95% CI [-5.82 to (-0.37)]; P = .03]. In addition, POC such as anastomotic leak (RR: 0.96, 95% CI: 0.60-1.55; P = .88), abdominal abscess (RR: 1.13, 95% CI: 0.52-2.49; P = .75), pulmonary embolism (RR: 0.40, 95% CI: 0.09-1.69; P = .21) and deep vein thrombosis (RR: 0.94, 95% CI: 0.39-2.28; P = .89) were not significantly different. Paralytic ileus (RR: 0.87, 95% CI: 0.67-1.11; P = .26), intra-abdominal infection (RR: 0.82, 95% CI: 0.15-4.48; P = .82), pulmonary complications (RR: 0.83, 95% CI: 0.57-1.20; P = .32), cardiac complications (RR: 0.73, 95% CI: 0.42-1.27; P = .27) and urological complications (RR: 0.83, 95% CI: 0.52-1.33; P = .44) were also similarly manifested. Our analysis also showed 30-day re-admission and re-operation, and mortality to be similar between laparoscopic versus OS for right colonic carcinoma resection. However, surgical wound infection (RR: 0.65, 95% CI: 0.50-0.86; P = .002) was significantly higher with the OS. CONCLUSIONS: In conclusion, laparoscopic surgery was almost comparable to OS in terms of post-operative outcomes for right-sided colonic cancer resection and was not associated with higher unwanted outcomes. Therefore, laparoscopic intervention should be considered as safe as the open abdominal surgery for right-sided colonic cancer resection, with a decreased hospital stay.


Assuntos
Colectomia/métodos , Neoplasias do Colo/cirurgia , Laparoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Idoso , Colectomia/efeitos adversos , Feminino , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia
4.
BMC Surg ; 20(1): 194, 2020 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-32867744

RESUMO

BACKGROUND: Studies have suggested differences in postoperative outcomes between patients with obesity and those without following adrenalectomy, but these remained to be ascertained with synthesis of available evidence. The aim of this systematic review and meta-analysis was to investigate the association between obesity and outcomes of patients after laparoscopic adrenalectomy. METHODS: We searched EMBASE, PubMed, Global Index Medicus, and Web of Science, without language restriction, to identify cohort studies published between January 1, 2000 and November 6, 2019. We considered studies with data comparing outcomes of adults with and without obesity after laparoscopic adrenalectomy. Random-effects meta-analysis was used to pool study-specific estimates. This review was registered with PROSPERO, CRD42018117070. RESULTS: Five studies with data on a pooled sample of 353 patients with obesity and 828 without were included in the meta-analysis. The risk of bias was moderate to low. We found no association between obesity and the various stages of postoperative complications: Clavien-Dindo grade 1 (OR = 1.57; 95%CI = 0.55-4.48; I2 = 44.6%), grade 2 (OR = 1.12; 95%CI = 0.54-2.32; I2 = 0.0%), grade 3 (OR = 1.79; 95%CI = 0.58-5.47; I2 = 0.0%;), grade 4 (OR = 0.43; 95%CI = 0.05-3.71; I2 = 0.0%), and grade 5 (death) (OR = 0.43; 95% CI = 0.02-14.31). Furthermore, no association was found between obesity and readmission rates (OR = 0.7; 95% CI = 0.13-3.62) and conversion of laparoscopic to open surgery (OR = 0.62; 95% CI = 0.16-2.34; I2 = 19.5%). CONCLUSIONS: This study suggests that obesity is not associated with complications following laparoscopic adrenalectomy. This meta-analysis might have been underpowered to detect a true association between obesity and patient outcome after laparoscopic adrenalectomy due to the small number of included studies. Larger studies are needed to clarify the role of obesity in patients undergoing laparoscopic adrenalectomy.


Assuntos
Adrenalectomia/métodos , Laparoscopia/métodos , Obesidade/epidemiologia , Adulto , Humanos , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório
5.
Medicine (Baltimore) ; 99(33): e21557, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872005

RESUMO

PURPOSE: The aim of this study was to compare the effectiveness between laparoscopic herniorrhaphy (LH) and open herniorrhaphy (OH) in children with inguinal hernia. METHODS: PubMed, EmBase, and the Cochrane library were searched to select trials from their inception till April 2019. The summary of relative risks (RRs) and weighted mean differences (WMDs) with corresponding 95% confidence intervals (CIs) were employed to evaluate the treatment effectiveness between LH and OH. RESULTS: Six randomized controlled trials (RCTs) including a total of 594 children were selected. No significant differences were observed between LH and OH regarding the risk of postoperative complications. However, LH significantly reduced the risk of major postoperative complications when compared with OH. Moreover, LH showed association with a shorter operative time in bilateral inguinal hernia when compared with OH, whereas no significant difference between groups for unilateral inguinal hernia. Finally, children who received LH showed association with longer time to discharge than those who received OH, whereas no significant difference was observed between the groups for time to resume full activity. CONCLUSIONS: These findings suggested that children who received LH had protection against major postoperative complications than those who received OH. Moreover, children who received LH had shorter operative time, and longer time to discharge.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Criança , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Medicine (Baltimore) ; 99(33): e21603, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872015

RESUMO

RATIONALE: Schwannomas of the seminal vesicles are extremely rare, and only cases of single seminal vesicle schwannomas have been reported. Here, we report a case of multiple schwannoma of the seminal vesicle. PATIENT CONCERNS: We report a rare case of multiple schwannoma of the seminal vesicle that occurred in a 48-year-old man during physical examination. Multiple mixed masses in the left region of the seminal vesicle were documented with transrectal ultrasonography and magnetic resonance imaging. The patient presented no clinical symptoms, no family history of the disease and no history of genetic disease. DIAGNOSIS: Postoperative pathology revealed a diagnosis of seminal vesical schwannoma. INTERVENTIONS: The patient underwent robotic-assisted laparoscopic surgery to remove the mass. OUTCOMES: The patient recovered rapidly and the length of hospitalization was 6 days after operation. At present, there is no recurrence in 10 month follow up. LESSONS: Whether benign or malignant, single or multiple, schwannomas still need to be diagnosed by pathology because of the limitations of examination methods. Surgical resection is still the preferred treatment.


Assuntos
Neoplasias dos Genitais Masculinos/patologia , Neurilemoma/patologia , Glândulas Seminais/patologia , Neoplasias dos Genitais Masculinos/diagnóstico por imagem , Neoplasias dos Genitais Masculinos/cirurgia , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Glândulas Seminais/diagnóstico por imagem
7.
Am Surg ; 86(9): 1169-1174, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862663

RESUMO

BACKGROUND: Dehydration drives a significant proportion of readmissions following bariatric surgery. Routinely performed body composition testing and total body water (TBW) calculations may present a novel method for diagnosing dehydration for outpatient intervention. We sought to determine if a change in TBW from preoperative baseline could help identify bariatric patients requiring outpatient intravenous fluid (IVF) administration for dehydration. METHODS: The VUMC Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was retroactively queried for all patients undergoing bariatric surgery at an accredited bariatric surgery center from January 1, 2017 to May 31, 2018. Body composition test results presurgery and postsurgery were extracted from the electronic health record. Change in TBW was compared between patients requiring outpatient IVF and those who did not use multivariable logistic regression. RESULTS: 583 patients underwent surgery over the study period (388 laparoscopic Roux-en-Y gastric bypass, 195 sleeve). 62 (10.6%) required outpatient fluid administration for dehydration. After multivariable analysis, patients with an increased hospital length of stay at index operation were more likely to require outpatient IVF (odds ratio [OR] 1.65, 95% CI 1.22-2.2). Preexisting diabetes diagnosis was protective (OR 0.35, 95% CI 0.16-0.74). Neither 1-week nor 1-month change in TBW from preoperative baseline was significantly different between patients receiving outpatient IVF and those who did not. CONCLUSION: Increased hospital length of stay predicts patients at risk of postoperative dehydration requiring IVF administration. Body composition testing and TBW were not useful in distinguishing between populations. Further research is needed to examine the efficacy of outpatient IVF in preventing hospital readmissions for dehydration.


Assuntos
Cirurgia Bariátrica/métodos , Água Corporal/fisiologia , Hidratação/métodos , Laparoscopia/métodos , Obesidade Mórbida/cirurgia , Pacientes Ambulatoriais , Complicações Pós-Operatórias/terapia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/metabolismo , Complicações Pós-Operatórias/metabolismo , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos
8.
Zhonghua Fu Chan Ke Za Zhi ; 55(9): 589-599, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32957747

RESUMO

Objective: To compare the long-term oncological outcomes between laparoscopic and abdominal surgery in stage Ⅰa1 (lymph-vascular space invasion-positive, LVSI+)- Ⅰb1 cervical cancer patients with different tumor sizes. Methods: Based on the Big Database of Clinical Diagnosis and Treatment of Cervical Cancer in China (1538 project database), patients with stage Ⅰa1 (LVSI+)-Ⅰb1 cervical cancer who treated by laparoscopic or abdominal surgery were included. The 5-year overall survival (OS) and 5-year disease-free survival (DFS) between the two surgical approaches were compared under 1∶1 propensity score matching (PSM) in different tumor diameter stratification. Results: (1) A total of 4 891 patients with stage Ⅰa1 (LVSI+)-Ⅰb1 cervical cancer who underwent laparoscopy or laparotomy from January 1, 2009 to December 31, 2016 were included in the 1538 project database. Among them, 1 926 cases in the laparoscopic group and 2 965 cases in the abdominal group. There were no difference in 5-year OS and 5-year DFS between the two groups before matching. Cox multivariate analysis suggested that laparoscopic surgery was associated with lower 5-year DFS (HR=1.367, 95%CI: 1.105-1.690, P=0.004). After 1∶1 PSM matching, 1 864 patients were included in each group, and there was no difference in 5-year OS between the two groups (94.1% vs 95.4%, P=0.151). While, the inferior 5-year DFS was observed in the laparoscopic group (89.0% vs 92.3%, P=0.004). And the laparoscopic surgery was associated with lower 5-year DFS (HR=1.420, 95%CI: 1.109-1.818, P=0.006). (2) In stratification analysis of different tumor sizes, and there were no difference in 5-year OS and 5-year DFS between the laparoscopic group and abdominal group in tumor size ≤1 cm, >1-2 cm and >2-3 cm stratification (all P>0.05). Cox multivariate analysis showed that laparoscopic surgery were not related to 5-year OS and 5-year DFS (P>0.05). In the stratification of tumor size >3-4 cm, there was no difference in 5-year OS between the two groups (P>0.05). The 5-year DFS in the laparoscopic group was worse than that in the abdominal group (75.7% vs 85.8%, P=0.025). Cox multivariate analysis suggested that laparoscopic surgery was associated with lower 5-year DFS (HR=1.705, 95%CI: 1.088-2.674, P=0.020). Conclusions: For patients with stage Ⅰa1 (LVSI+)-Ⅰb1 cervical cancer, laparoscopic surgery is associated with lower 5-year DFS, and the adverse effect of laparoscopic surgery on oncology prognosis is mainly reflected in patients with tumor size >3-4 cm. For patients with tumor sizes ≤1 cm, >1-2 cm and >2-3 cm, there are no difference in oncological prognosis between the two surgical approaches.


Assuntos
Laparoscopia/métodos , Laparotomia/métodos , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia , Adulto , Idoso , China/epidemiologia , Intervalo Livre de Doença , Feminino , Humanos , Histerectomia/métodos , Excisão de Linfonodo/métodos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Resultado do Tratamento
9.
Zhonghua Fu Chan Ke Za Zhi ; 55(9): 609-616, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32957749

RESUMO

Objective: To compare the prognosis of patients with cervical cancer in stage Ⅰb2-Ⅱa2 undergoing laparoscopic radical hysterectomy or abdominal radical hysterectomy. Methods: From January 1, 2009 to December 31, 2018, patients with stage Ⅰb2-Ⅱa2 who underwent laparoscopic or abdominal radical hysterectomy (laparoscopic group and abdominal group) in Peking University People's Hospital were collected. The clinicopathological data were retrospectively analyzed. There were 237 cases in this study, including 115 cases in laparoscopic group and 122 cases in abdominal group. The clinicopathological characteristics, surgery-related complications, recurrence and death were analyzed between the two groups. The related factors of recurrence and death were also analyzed.During laparoscopic surgery, the pressure of the carbon dioxide pneumoperitoneum were controlled, to try avoid the tumor tissue in the vagina from being exposed to the abdominal cavity when taking out the uterine specimen through the vagina, and fully flushed the abdominal cavity with sterile water after the specimen was taken out. Results: (1) Clinicopathological characteristics: there was no significant differences between the two groups among age, pathological type, pathological grade, clinical stage, depth of interstitial infiltration, lymph node metastasis,parametrial infiltration, vaginal stump infiltration, lymph-vascular space invasion (LVSI), neoadjuvant chemotherapy, and postoperative adjuvant treatments (all P>0.05). (2) Surgery-related complications: the incidence of surgery-related complications in the laparoscopic group and the abdominal group were 32.2% (37/115) and 25.4% (31/122), respectively. There was no statistically significant difference between the two groups (P>0.05). (3) Recurrence and death: during the follow-up period, the recurrence rates of the laparoscopic group and the abdominal group were respectively 15.7% (18/115) and 12.3% (15/122). There was no statistically significant difference between the two groups (P=0.456). The 5-year overall survival rates of the laparoscopic group and the open group were 86.8% and 87.8%, and the 5-year tumor-free survival rates were 81.7% and 84.6%, respectively. There were no statistically significant differences between the two groups (P=0.405, P=0.429). (4) Analysis of related factors of recurrence and death: univariate analysis showed that neoadjuvant chemotherapy, lymph node metastasis, vaginal stump infiltration, LVSI and interstitial infiltration depth were risk factors for postoperative recurrence of cervical cancer patients (all P<0.05); neoadjuvant chemotherapy, lymph node metastasis, parametrial infiltration, vaginal stump infiltration, LVSI and interstitial infiltration depth were risk factors for postoperative death in patients with cervical cancer (all P<0.05). Multivariate analysis showed that neoadjuvant chemotherapy and lymph node metastasis were independent risk factors for postoperative recurrence and death of cervical cancer patients (P<0.05). Conclusion: There is no significant difference in the prognosis of patients with cervical cancer in stage Ⅰb2-Ⅱa2 undergoing laparoscopic radical hysterectomy with non-touch operative technique and abdominal radical hysterectomy.


Assuntos
Histerectomia/efeitos adversos , Laparoscopia/métodos , Excisão de Linfonodo , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia , Intervalo Livre de Doença , Feminino , Humanos , Histerectomia/métodos , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias do Colo do Útero/mortalidade
10.
Zhonghua Fu Chan Ke Za Zhi ; 55(9): 617-623, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32957750

RESUMO

Objective: To evaluate the oncologic outcomes of different laparoscopic radical hysterectomy. Methods: From January 2011 to December 2014, the laparoscopic operation cases of cervical cancer at stage Ⅰb1, Ⅰb2, Ⅱa1 and Ⅱa2, including the histologic subtypes of squamous-cell carcinoma, adenocarcinoma and adenosquamous carcinoma, were collected in five clinical centers. The data were divided into two groups according to the surgical procedures, that is, modified laparoscopic-vaginal radical hysterectomy (mLVRH) and total laparoscopic radical hysterectomy (TLRH). The overall survival rate (OS), disease-free survival rate (DFS) at 5 years were retrospectively analyzed in this study. Results: There were 674 cases in total, including 377 cases of mLVRH, 297 cases of TLRH. (1) The OS at 5 years: the mLVRH was 96.1% and the TLRH was 92.0%, and the mLVRH was higher than that of TLRH (P=0.010). Stratify analysis, including stage of disease (Ⅰb1 and Ⅱa1), histologic subtypes (squamous-cell carcinoma, adenocarcinoma), lymph node metastasis, revealed that, ① Stage of disease: in stage Ⅰb1, the OS at five years of mLVRH was higher than that in TLRH group (98.6% vs 93.6%, P=0.012). In stage Ⅱa1, there was significant difference between the two groups, the OS at five years of mLVRH and TLRH were 93.6% and 77.6% (P=0.007). ② Histologic subtypes: for the OS at five years of squamous-cell carcinoma, mLVRH and TLRH were 96.1% and 92.3%, and there was significant difference (P=0.046); for adenocarcinoma, the OS at five years were 91.0% and 88.6%, and there was no difference between two groups (P=0.230). ③ Lymph node metastasis: the mLVRH and TLRH with lymph node metastasis, the OS at five years were 98.6% and 96.4%; the mLVRH and TLRH without lymph node metastasis, the OS at five years were 89.3% and 80.8%. There were no significant differences between the two groups,respectively (P=0.156, P=0.093). (2) The DFS at 5 years: there was no significant difference between mLVRH and TLRH (94.1% vs 90.9%, P=0.220). Stratify analysis for stage of disease, the mLVRH group was higher than that in the TLRH group in stage Ⅰb1 (97.0% vs 92.8%, P=0.039). However, for stage Ⅱa1, there was no significant difference between mLVRH and TLRH group (88.2% vs 75.8%, P=0.074). Conclusions: The results of this retrospective study indicated that different laparoscopy surgical procedures had diverse oncologic outcomes. The OS at 5 years of the mLVRH is superior to the TLRH. The DFS at 5 years in Ⅰb1 stage, the mLVRH is higher than the TLRH. Therefore, the modified laparoscopy is still an alternative surgery for early cervical cancer patients when following the principle of no-tumor-exposure.


Assuntos
Histerectomia/métodos , Laparoscopia/métodos , Excisão de Linfonodo , Neoplasias do Colo do Útero/cirurgia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias do Colo do Útero/patologia
11.
Medicine (Baltimore) ; 99(38): e22175, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957341

RESUMO

BACKGROUND: Management of malignant diseases in elderly patients has become a global clinical issue because of increased life expectancy worldwide. Advancements in surgical techniques and perioperative management have reduced age-related contraindications for LPD. Past articles have reported that elderly patients undergoing laproscopic pancreatoduodenectomy (LPD) are at an increased risk compared to younger patients. The aim of this article is to compare a multicenter center risk of LPD in elderly and nonelderly patients. METHODS: Retrospective review (n = 237) of perisurgical outcomes in patients undergoing LPD during the months of September 2012 to December 2017. Outcomes in elderly patients (aged ≥75 years) were compared with those in nonelderly patients. RESULTS: Transfer to ICU was more frequent in elderly patients (odds ratio [OR] 6.49, P = .001) and the mean hospital stay was longer (21.4 days compared with 16.6 days), (P = .0033) than for nonelderly patients. There was no statistically significant difference in operation time (P = .494), estimated blood loss (P = .0519), blood transfusion (P = .863), decreased gastric emptying (P = .397), abdominal pain (P = .454), food intake (P = .241), time to self-ambulation (P = 1), reoperation (P = .543), postoperative pancreatic fistula (POPF) grade A (P = .454), POPF grade B (P = .736), POPF grade C (P = .164), hemorrhage (P = .319), bile leakage (P = .428), infection (P = .259), GI bleeding (P = .286), morbidity (P = .272) or mortality (P = .449) between the 2 groups. CONCLUSIONS: Elderly patients who underwent LPD in this study had good overall outcomes after LPD that were similar to young patients. The perioperative and long-term outcomes of LPD are not worse. Rates of ICU admission and hospital stays increased in elderly patients undergoing LPD when compared with nonelderly ones. LPD can be performed on elderly patients with similar outcomes as younger patients; therefore, age itself should not be a contraindication for LPD for pancreatic cancer, but it suggests that elderly patients with comorbidities should be more stringently selected for surgery.


Assuntos
Laparoscopia/métodos , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , China , Cuidados Críticos/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos
12.
Medicine (Baltimore) ; 99(38): e22220, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957359

RESUMO

This study aimed to describe a novel puncture and discission with a needle (PDN) method facilitating laparoscopic common bile duct exploration (LCBDE).The clinical data of 81 patients with cholelithiasis or choledocholithiasis who underwent LCBDE with PDN between January, 2017 and December, 2017 were retrospectively analyzed. Time for puncture and discission of the bile duct, blood loss, postoperative complications (such as bile leakage, common bile duct [CBD] strictures, and recurrence of choledocholithiasis), and postoperative hospital stay were recorded to evaluate the safety of the method.PDN was performed in all 81 patients with a 100% surgical success rate. Surgery went smoothly. Neither mortality nor complications associated with PDN (portal vein injury or biliary leakage) were observed. The mean time for puncture and discission of the CBD was 2.4 minutes and the maximum blood loss was 100 mL. CBD strictures or recurrence of choledocholithiasis were not noted after 12 to 24 months of follow-up.LCBDE with PDN is a novel method and has the advantages of reliability, convenience, and efficiency without additional costs or complications.


Assuntos
Coledocolitíase/cirurgia , Ducto Colédoco/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Laparoscopia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
13.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(3): 106-110, jul.-sept. 2020. graf
Artigo em Espanhol | IBECS | ID: ibc-189900

RESUMO

La convivencia con la infección por COVID-19 (coronavirus disease 2019) en todos los entornos hospitalarios y de salud supone un reto actual de adaptación, creación de circuitos, protocolos y nuevos modelos de asistencia. Son todavía bastantes las incógnitas a resolver sobre esta infección en la actualidad, y mucho más desconocido es el impacto que la misma supone si lo trasladamos al terreno quirúrgico. La evidencia respecto al efecto del SARS-CoV-2 y cirugía laparoscópica es escasa y de calidad limitada, pero aun así, la laparoscopia ha sido considerada de elección por las distintas sociedades científicas en pacientes COVID para la mayoría de indicaciones en ginecología, por las conocidas ventajas hacia el paciente respecto a la vía abierta: menor morbilidad y estancia hospitalaria y porque comporta procedimientos quirúrgicos autónomos y contenidos respecto a la liberación de humo y donde, además, el instrumental y la disposición en quirófano permiten un alejamiento del cirujano y del resto de profesionales en el área quirúrgica respecto al paciente. A modo global, las dos recomendaciones fundamentales en quirófano de cirugía laparoscópica en esta época COVID incluyen: el uso de equipo de protección personal adecuado para el personal de quirófano y la adopción de precauciones para reducir la exposición al CO2 y el humo quirúrgico que puede producirse en estos procedimientos


Coexistence with COVID-19 infection (coronavirus disease 2019) in all hospital and health care settings is a current challenge of adaptation, as well as the creation of new protocols and care models. At present, there are still many unknowns about this infection, and much more unknown is the impact into the surgical field. Although evidence regarding the effect of SARS-CoV-2 and laparoscopic surgery is scarce, laparoscopy has been considered the method of choice by different scientific societies for most indications in gynaecology during the COVID-19 pandemic. This is due to the advantages over the open route. There is less morbidity and hospital stay, and in addition, as it involves autonomous and contained surgical procedures with respect to smoke release. Moreover, the instruments and the setting in the operating room mean that there can be safe distance from the surgeon and other staff to the patient. Overall, the main recommendations in laparoscopic surgery during the COVID era include: the use of Personal Protective Equipment for operating room personnel, and the adoption of safety measures to reduce CO2 exposure and surgical smoke reléase


Assuntos
Humanos , Feminino , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Laparoscopia/métodos , Reação em Cadeia da Polimerase , Algoritmos , Aerossóis/administração & dosagem , Aerossóis/normas , RNA Viral/sangue , Fatores de Risco
14.
Medicine (Baltimore) ; 99(34): e21787, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846810

RESUMO

Laparoscopic inguinal herniorrhaphy has been well established for the management of primary and recurrent inguinal hernias. Single-incision laparoscopic surgery (SILS) has now been accepted as a less invasive alternative to conventional laparoscopic surgery. However, commercially available access devices for SILS had disadvantages such as rigidness and crowding. This series aimed to analyze the feasibility and safety of single-incision laparoscopic trans-abdominal pre-peritoneal hernioplasty (SILS-TAPP) by applying our self-made device for managing inguinal hernia.We collected and reviewed the medical records of patients who received SILS-TAPP using a self-made glove-port device between January 2014 and January 2016. All operations were performed by the same surgical team. The demographics and intra- and perioperative outcomes were evaluated.SILS-TAPP was successfully performed in 105 patients (131 inguinal hernia repairs). No major intra- and postoperative morbidities were encountered, and no conversion to a conventional 3-port approach or open surgery was required. The mean operative time was 73.5 min and the mean postoperative hospital stay was 2.1 days. Three minor short-term complications were noted, which were resolved without surgical intervention. One recurrence was diagnosed during follow-up and treated using a second TAPP procedure.SILS-TAPP was shown to be a feasible, safe procedure in patients with an inguinal hernia. A simple self-made glove-port device was proven as a practical method of SILS-TAPP.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/instrumentação , Laparoscopia/instrumentação , Adulto , Idoso , Estudos de Viabilidade , Feminino , Luvas Cirúrgicas , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Recidiva , Estudos Retrospectivos , Umbigo/cirurgia
15.
Medicine (Baltimore) ; 99(34): e21841, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846831

RESUMO

RATIONALE: Ovarian microcystic stromal tumor is a relatively rare tumor type, which is characterized by morphology with microcyst structure, solid cellular areas, and hyalinized fibrous stroma. The most reported tumors were stage I with good prognosis. PATIENT CONCERNS: We report a case of a 33-year-old woman with primary ovarian microcystic stromal tumor with significant bizarre nuclei. We describe the clinical, histopathological, and immunohistochemical findings and review the English literatures. So far, as we know, the patient presented here is a rare case of ovarian microcystic stromal tumor with prominent bizarre nuclei accounting for about 50% of the tumor cells. DIAGNOSES: She was diagnosed with ovarian microcystic stromal tumor with significant bizarre nuclei. INTERVENTIONS: The right ovarian tumor was resected laparoscopically on October 19, 2018. OUTCOMES: Up to now, the patient is free of disease at 19 months of follow-up. LESSONS: This is a rare case of ovarian microcystic stromal tumor with obvious bizarre nuclei. This report will contribute to expand the morphological spectrum of ovarian microcystic stromal tumor.


Assuntos
Núcleo Celular/patologia , Neoplasias Ovarianas/patologia , Tumores do Estroma Gonadal e dos Cordões Sexuais/cirurgia , beta Catenina/metabolismo , Adulto , Assistência ao Convalescente , Biomarcadores Tumorais/metabolismo , Núcleo Celular/metabolismo , Núcleo Celular/ultraestrutura , Feminino , Humanos , Imuno-Histoquímica/métodos , Laparoscopia/métodos , Resultado do Tratamento
16.
Clinics (Sao Paulo) ; 75: e2083, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32756820

RESUMO

Questions regarding the transmissibility of the novel coronavirus disease (COVID-19) remain unanswered. It is known that the transmission of the severe acute respiratory syndrome coronavirus (SARS-CoV) occurs predominantly through droplets and contact. However, aerosols can be generated in some situations, such as orotracheal intubation, ventilation, and the use of electric or ultrasonic scalpels, and can therefore potentially contaminate the care team if adequate protection is not used. It is therefore necessary to assess issues of transmissibility of COVID-19 during surgery in infected patients. This review gathers the recent research pertaining to this topic. A search of the literature was performed using the PubMed and UpToDate databases with the search terms "surgery" and "covid-2019," in addition to other MeSH variants of these terms. We do not have consistent evidence on the exposure of healthcare professionals assisting patients with COVID-19 undergoing laparoscopy or the impact of such exposure. In view of the evidence obtained and drawing parallels with other infectious and contagious diseases, medical personnel must wear complete protective attire for proper protection against the generated aerosol. Further studies are required to assess the impact of such surgeries on healthcare professionals conducing or assisting with these procedures.


Assuntos
Infecções por Coronavirus/prevenção & controle , Coronavirus , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Laparoscopia/métodos , Pneumonia Viral/prevenção & controle , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão
17.
Medicine (Baltimore) ; 99(34): e21701, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846788

RESUMO

Obturator hernia is a relatively rare type of abdominal hernia, in which abdominal contents protrude through the obturator canal, a condition that can lead to small bowel obstruction. Its rarity and nonspecific signs and symptoms make a preoperative diagnosis difficult. The present study analyzed the clinical manifestations, diagnostic methods and operative treatment outcomes in patients with obturator hernia.Between January 2012 and October 2019, 1028 adults underwent surgical repair of abdominal wall hernia at the Department of Surgery, Kyungpook National University Hospital. The medical records of eleven patients who were treated for small bowel obstruction due to obturator hernia were retrospectively evaluated. Patient characteristics, clinical presentation, preoperative radiological diagnosis, operative findings, treatment, complications, and outcomes were recorded.All 11 patients were elderly women, with a mean age of 80.2 years (range, 71-87 years). Their mean body mass index was 17.9 kg/m (range, 11.9-22.2 kg/m). Symptoms at presentation were abdominal pain and vomiting, with a mean duration of symptoms prior to admission of 5.6 days (range, 1-15 days). Based on abdominopelvic computed tomography (CT) scans, all 11 patients were preoperatively diagnosed with obturator hernia, followed by laparoscopic exploration or laparotomy as soon as possible. Of the 11 patients, 6 (54.5%) had left-sided, four (36.4%) had right-sided, and one (9.1%) had bilateral obturator hernias. Three patients (27.3%) required resection of the ileum due to perforation or strangulation. All underwent simple closure of the hernia defect with interrupted or purse-string sutures. Ten patients recovered uneventfully, whereas one had wound seroma and ileus. Recurrence has not been observed in the 8 surviving patients.Obturator hernia should be included in the differential diagnosis of intestinal obstruction of unknown origin, especially in emaciated elderly women with chronic disease. Early surgical intervention without delay is imperative to avoid postoperative morbidity and mortality associated with intestinal strangulation due to obturator hernia. Obturator hernia can be sufficiently repaired with simple suture closure without mesh.


Assuntos
Hérnia do Obturador/patologia , Hérnia do Obturador/cirurgia , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Hérnia do Obturador/complicações , Hérnia do Obturador/diagnóstico por imagem , Humanos , Obstrução Intestinal/etiologia , Laparoscopia/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
19.
Am Surg ; 86(8): 1032-1035, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32757764

RESUMO

BACKGROUND: Laparoendoscopic transhiatal esophagectomy (THE) provides advantages over traditional THE by not only avoiding laparotomy but by also allowing more precise esophageal mobilization. Occasionally, the length of the gastric conduit is insufficient to allow delivery into the neck after laparoscopic mobilization and requires laparotomy to complete the procedure. We hypothesize that the need for laparotomy will correlate with the measurement of mediastinal height (distance from thoracic vertebrae T1-T12) on chest CT. METHODS: Medical records of all patients who underwent attempted laparoendoscopic-assisted THE at a tertiary referral center between March 1, 2003 and January 31, 2019 were reviewed. Patients' mediastinal height was measured using computed tomography (CT) imaging of the chest by investigators and analyzed for correlation between mediastinal height and successful completion of a totally laparoendoscopic procedure. RESULTS: A total of 21 cases met inclusion criteria: 9 successful laparoendoscopic THE procedures and 12 failed laparoendoscopic THE procedures (those requiring addition of a mini-laparotomy or thoracotomy). The mean mediastinal length for successful laparoendoscopic surgery was 23.5 cm, whereas the mean mediastinal length for failed laparoscopic surgeries was 24.8 cm (P = .03). Patient's overall height was not found to correlate with the need for conversion. CONCLUSIONS: Shorter mediastinal length is associated with successful laparoendoscopic or laparoscopic THE. This information is readily available to clinicians from routine preoperative staging studies (chest CT) and may be used to potentially predict the success rate of a totally laparoendoscopic approach and aid in patient selection. Further prospective evaluation of these findings is warranted.


Assuntos
Regras de Decisão Clínica , Conversão para Cirurgia Aberta , Esofagectomia/métodos , Laparoscopia/métodos , Laparotomia , Mediastino/anatomia & histologia , Adulto , Idoso , Tomada de Decisão Clínica/métodos , Feminino , Humanos , Masculino , Mediastino/diagnóstico por imagem , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Seleção de Pacientes , Cuidados Pré-Operatórios , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
20.
Am Surg ; 86(9): 1083-1087, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32809844

RESUMO

INTRODUCTION: Robotic hiatal hernia repair offers potential advantages over traditional laparoscopy, most notably enhanced visualization, improved ergonomics, and articulating instruments. The clinical outcomes, however, have not been adequately evaluated. We report outcomes of laparoscopic and robotic hiatal hernia repairs. METHODS: A retrospective observational cohort study was performed of all hiatal hernia repairs performed from 2006 through 2019. Operative, demographic, and outcomes data were compared between laparoscopic and robotic groups. Discrete variables were analyzed with Chi-square of Fisher's exact test. Continuous variables were analyzed with Student's t test (mean) or Wilcoxon rank sum (medians). All analyses were performed using R statistical software. RESULTS: Laparoscopic repair was performed in 278 patients and robotic repair in 114. More recurrent hernias were repaired robotically (24.5% vs 12.9%, P = .08). Operative times were no different between groups (175 vs 179 minutes; P = .681). Robotic repair resulted in significantly shorter length of stay (LOS; 2.3 vs 3.3 days; P = .003). Rate of readmission was no different, and there were no differences in acute complications. For patients with at least 1 year of follow-up, recurrence rates were lower after robotic repair (13.3% vs 32.8%; P = .008); however, mean follow-up is significantly longer after laparoscopic repair (23.7 ± 28.4 vs 15.1 ± 14.9 months; P < .001). DISCUSSION: Robotic hiatal hernia repair offers technical advantages over laparoscopic repair with similar clinical outcomes.


Assuntos
Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Robótica/métodos , Seguimentos , Humanos , Tempo de Internação/tendências , Duração da Cirurgia , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
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