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1.
Magy Seb ; 74(4): 117-121, 2021 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-34821580

RESUMO

Összefoglaló. Bevezetés: A colon sigmoideum diverticulosisa veleszületett vagy szerzett lehet. Az óriás vastagbél diverticulum (Giant Colonic Diverticulum, GCD), amelyet 4 cm-nél nagyobb diverticulumként definiálnak, ritka, de klinikailag fontos entitás. A McNutt (1988) osztályozást használják az óriás diverticulumok három alcsoportjának megkülönböztetésére. Az 1-es típusú diverticulumok pulziós pseudo-diverticulumok, amelyek fokozatosan növekszenek. A 2-es típusú diverticulumok gyulladásos eredetuek; egy korábbi suberosalis perforáció után alakulnak ki, ahol a tályogüreg kommunikál a bél lumenével, és a tályogfal fokozatosan rostonyás hegszövetté alakul, melybol hiányoznak a bél szövettani rétegei. A 3. típus a vastagbél valódi, veleszületett diverticulumai, amelyek a bélfal minden rétegét tartalmazzák. Egy 59 éves férfibeteg esetét ismertetjük, akit sürgosséggel vettünk fel Sebészeti Osztályunkra kizáródott bal oldali lágyéksérv diagnózissal. Hasi CT-vizsgálat a sérvtömloben herniálódott sigmabél-szakaszt ábrázolt, bélelzáródás jelei nélkül. Sürgos mutétet végeztünk; bal oldali inguinalis metszést követoen a sérvtömloben a sigmabél 3-as típusú óriás diverticulumát találtuk. Laparotómiát végeztünk, és egy szokatlanul nagy, 7-8 cm hosszú incarcerálódott diverticulumot szabadítottunk fel. Egyéb kóros nem volt a hasüregben, a sigmabél nem károsodott. A diverticulumot TA varrógéppel resecáltuk, a kapocssort seromuscularis varrattal buktattuk. A sérvkaput kívülrol zártuk. A postoperatív szak eseménytelen volt, a beteget a 7. napon otthonába bocsátottuk. Röviden áttekintjük a GCD diagnózisára és kezelésére vonatkozó ajánlásokat. Az elváltozás McNutt 3-as típusa miatt a kevésbé invazív, egyszeru diverticulectomiát választottuk a (Hartmann-szerinti) sigmaresectio helyett. Esetünk az amúgy is kis számban eloforduló GCD rendkívül ritka szövodménye volt, amit egy szokatlan - de sikeres gyógyulást eredményezo - beavatkozással oldottunk meg. Summary. Introduction: The diverticulosis of the sigmoid colon may be congenital or acquired. The Giant Colonic Diverticulum (GCD), defined as a diverticulum larger than 4 cm, is a rare, but clinically important entity. The McNutt (1988) classification is used differentiate the three subgroups of giant diverticula. Type 1 diverticula are pulsion pseudo-diverticula, which enlarge gradually. Type 2 are inflammatory diverticula due to a previous subserosal perforation, where the abscess cavity is communicating with the bowel lumen and its wall would be gradually composed of fibrous scar tissue, lacking the intestinal histological layers. Type 3 are the real, congenital diverticula of the colon, containing all layers of the intestinal wall. We present a case of a 59-year-old male patient, who was admitted to our Dept. of Surgery in emergency with the diagnosis of strangulated left inguinal hernia. Abdominal CT demonstrated the herniation of the sigmoid colon into the hernia sac without the signs of bowel obstruction. The patient was operated on urgently; subsequent to a left inguinal incision, a Type 3 giant diverticulum of the sigmoid colon was found in the hernia sac. Laparotomy was performed, and the unusually large, 7-8 cm long strangulated diverticulum was liberated. There were no other pathological findings, the sigmoid colon was not damaged. The diverticulum was resected with a TA stapler, and the staple line was inverted with a layer of seromuscular sutures. The inguinal hernia orifices were reconstructed both intraabdominally and externally. The postoperative course was uneventful, the patient was discharged on the 7th day. The recommendations concerning the diagnosis and treatment GCD are briefly reviewed. Due to the McNutt Type 3 characteristics, we opted for the less invasive, simple diverticulectomy instead of sigmoid resection (Hartmann's procedure). Our case was an extremely rare complication of the already uncommon GCD, resolved by an unusual surgical intervention leading to a successful cure.


Assuntos
Divertículo , Hérnia Inguinal , Divertículo/diagnóstico , Divertículo/cirurgia , Humanos , Laparotomia , Masculino , Pessoa de Meia-Idade
2.
Surg Clin North Am ; 101(6): 1111-1121, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34774272

RESUMO

As care of the injured patient continues to evolve, new surgical technologies and new resuscitative therapies can change the algorithms that drive trauma care. In particular, the advent of resuscitative endovascular balloon occlusion of the aorta has changed the way trauma surgeons treat patients in extremis. The science of resuscitation continues to evolve, leading to controversy about the optimal administration of fluid and blood products. Laparoscopy has given additional tools to the trauma surgeon to potentially avoid exploratory laparotomy, and rib fracture fixation can be beneficial in the proper patient.


Assuntos
Aorta/lesões , Oclusão com Balão , Costelas/cirurgia , Choque Hemorrágico/terapia , Toracotomia/métodos , Lesões do Sistema Vascular/cirurgia , Oclusão com Balão/métodos , Tratamento de Emergência , Procedimentos Endovasculares , Humanos , Laparoscopia , Laparotomia , Costelas/lesões , Choque Hemorrágico/etiologia , Lesões do Sistema Vascular/terapia
3.
Surg Clin North Am ; 101(6): 939-949, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34774273

RESUMO

Incisional hernia remains a common complication following abdominal surgery, and its incidence can be reduced with standardized wound closure techniques. Robust evidence exists to support certain fascial closure methods, such as using a small bites, 4-to-1, continuous slow absorbable suture technique for elective midline laparotomies. On the other hand, there are other common surgical practices that lack quality data to support their routine use, such as abdominal binders, negative-pressure wound therapy, and reapproximation of subcutaneous tissue.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais , Hérnia Ventral/cirurgia , Hérnia Incisional/cirurgia , Laparotomia , Músculos Abdominais/cirurgia , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparotomia/efeitos adversos , Laparotomia/métodos , Implantação de Prótese , Telas Cirúrgicas , Técnicas de Sutura
4.
Anticancer Res ; 41(10): 5171-5177, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34593469

RESUMO

BACKGROUND/AIM: Computed tomography and positron emission tomography cannot detect all minute distant metastases and fully evaluate extensive vascular invasion in patients with pancreatic ductal adenocarcinoma (PDAC). The aim of this study was to investigate predictors of laparotomy only and palliative surgery in PDAC patients planning surgical resection. PATIENTS AND METHODS: We reviewed 239 PDAC patients planning surgical resection. Patients were divided into two groups based on resection status. Multivariate analyses were performed to identify predictors of unresectable disease at laparotomy. RESULTS: Twenty-five patients had unresectable disease at laparotomy. Multivariate analysis revealed that anatomical borderline resectable status (yes/no) (HR=5.458, p=0.012), pretreatment CA19-9 (>260/≤260 ng/ml) (HR=4.907, p=0.041), and tumor size (>25/≤25 mm) (HR=21.42, p=0.004) were associated with unresectable disease at laparotomy. CONCLUSION: Borderline resectable status, pretreatment CA19-9, and tumor size were closely associated with unresectable disease at laparotomy in PDAC patients planning surgical resection.


Assuntos
Adenocarcinoma/patologia , Antígeno CA-19-9/sangue , Carcinoma Ductal Pancreático/patologia , Laparotomia/métodos , Neoplasias Pancreáticas/patologia , Cuidados Pré-Operatórios , Adenocarcinoma/sangue , Adenocarcinoma/cirurgia , Idoso , Carcinoma Ductal Pancreático/sangue , Carcinoma Ductal Pancreático/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/cirurgia , Prognóstico , Curva ROC , Estudos Retrospectivos
5.
Rev Col Bras Cir ; 48: e20213010, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34644742

RESUMO

Acute appendicitis is the leading cause of abdominal emergency surgery worldwide and appendectomy continues to be the definitive treatment of choice. This cost-effectiveness analysis evaluates laparoscopic versus open appendectomies performed in public health services in the state of Bahia (Brazil). We conducted a retrospective observational study using the database from the Department of Informatics of the Unified Health System (DATASUS). Available data on appendectomies between 2008 and 2019 were included, and we evaluated the temporal trend of hospital admissions, procedure-related mortality rates, length of stay, and costs. Statistical analysis was performed using the R-software (R Foundation, v.4.0.3) and the BioEstat software (IMDS, v. 5.3), considering p<0.05 as significant. During 2008-2019, 53,024 appendectomies were performed in the public health services in Bahia, of which 94.9% were open surgeries. The open technique was associated with a higher mortality rate (4.9/1,000 procedures; p<0.05) and a higher risk of death (RR=4.5; p<0.05) compared to laparoscopy (1.1/1,000 procedures). Laparoscopic appendectomy (median of 2.7 days) had a shorter length of stay compared to laparotomy (median of 4.15 days) (p<0.05). There was no difference in the medians of costs nor hospital services, per procedure (p=0.08 and p=0.08, respectively). Laparoscopic professional median costs were higher by US$ 1.39 (p<0.05). Minimally invasive surgery for appendicitis is a safe and efficacious procedure in Brazilian public health care services, as it provides advantages over the open method (including lower procedure-related mortality rate and earlier discharges), and it did not imply higher expenses for public service budgets in the state of Bahia.


Assuntos
Apendicite , Laparoscopia , Apendicectomia , Apendicite/cirurgia , Análise Custo-Benefício , Humanos , Laparotomia , Tempo de Internação , Estudos Retrospectivos , Resultado do Tratamento
6.
J Med Case Rep ; 15(1): 537, 2021 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-34696817

RESUMO

BACKGROUND: Ehlers-Danlos syndrome is a clinically and genetically heterogeneous group of heritable connective tissue disorders caused by a defect in collagen synthesis and structure. The vascular subtype (Ehlers-Danlos syndrome IV) is reported to be associated with a higher incidence of gastrointestinal perforations. The most reported site of perforation is the colon, followed by the small bowel. Perforation of the stomach is very rare, and there are no reported cases to date of classic types I and II. CASE PRESENTATION: We present the case of a 14-year-old Saudi girl who visited our emergency department with abdominal pain and vomiting. Initially, she was diagnosed with gastroenteritis and discharged once her condition stabilized. After 48 hours, she developed severe abdominal pain with recurrent vomiting and peritonitis evident on clinical examination. Initial abdominal x-ray failed to show any free air; however, enhanced computed tomography revealed free air and contrast extravasation in the proximal gut. During exploratory laparotomy, a large perforation was found on the anterior wall of the stomach due to the underlying ischemia. The posterior wall had ischemic mucosa with an intact healthy serosa. A free-hand partial gastrectomy was performed to resect all ischemic parts of the stomach. Detailed examinations and laboratory workup were carried out after the surgery to figure out the possible underlying cause. The clinical findings during the physical examination supported marfanoid features. Marfan's syndrome and related disorders sequencing panel was requested, and Deoxyribonucleic acid (DNA) samples were sent. Given results were supporting the diagnosis of classical Ehlers-Danlos syndrome, the patient was labeled as a case of Ehlers-Danlos syndrome. During the postoperative period, she developed a wound infection that was managed successfully with vacuum-assisted closure dressing. She recovered well without gastrointestinal sequelae in the 4 years of follow-up. CONCLUSIONS: Heritable systemic connective tissue diseases must be given serious consideration in young patients with unusual spontaneous perforation. Such patients might develop life-threatening conditions that require immediate intervention. Hence, correct and timely diagnosis is important to prepare for the anticipated complications.


Assuntos
Doenças do Tecido Conjuntivo , Síndrome de Ehlers-Danlos , Perfuração Intestinal , Gastropatias , Adolescente , Colo , Síndrome de Ehlers-Danlos/complicações , Síndrome de Ehlers-Danlos/diagnóstico , Feminino , Humanos , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Laparotomia
7.
Curr Opin Organ Transplant ; 26(6): 640-645, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34593704

RESUMO

PURPOSE OF REVIEW: Donor hysterectomy for live donor uterus transplantation was from the start performed by laparotomy, but minimal invasive surgery has entered the scene. In particular robotic-assisted laparoscopy is used since robotics is advantageous in the complex donor hysterectomy surgery in narrow space. This review covers the development and benefits of robotics and the published robotic donor hysterectomy experiences. RECENT FINDINGS: Robotic donor hysterectomy publications are scarce with eight cases in Sweden, five in USA, and one each in China and Spain. Robotics have been performed for either the entire donor hysterectomy or with conversion to laparotomy for the last steps of the surgical procedure. The total operative times are in line with open surgery, although a decrease is expected in the future. The estimated blood loss and hospital stays are less than at open surgery. The complication panorama includes hydronephrosis, ureteric fistula and pressure alopecia. Live births with healthy babies have been reported. SUMMARY: In uterus transplantation, robotic live donor hysterectomy has proven to be feasible, safe and associated with successful live births. The robotic donor hysterectomy is a low-volume procedure and an international registry to gather collective information is crucial for further evaluation and development.


Assuntos
Laparoscopia , Procedimentos Cirúrgicos Robóticos , Feminino , Humanos , Histerectomia/efeitos adversos , Laparoscopia/efeitos adversos , Laparotomia , Doadores Vivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos
8.
Ulus Travma Acil Cerrahi Derg ; 27(6): 662-667, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34710230

RESUMO

BACKGROUND: The aim of this study is to evaluate the patients with intestinal perforation secondary to necrotizing enterocolitis (NEC) following cardiac surgery in the terms of risk factors and diagnosis/treatment process. METHODS: A series of cases operated for intestinal perforation secondary to NEC were retrospectively reviewed in two groups. Group I involved patients who had cardiac surgery for congenital heart disease previous to intestinal perforation secondary to NEC. Group II consisted patients who had intestinal perforation secondary to NEC without any previous cardiac surgery. Demographic characteristics, prenatal and postnatal features, and pre- and post-operative course of groups were statistically compared to define differences. RESULTS: Thirty-two patients underwent laparotomy secondary to intestinal perforation in this period. The gestational age and birth weight were smaller in Group II (p=0.001, p=0.001). Intrauterine growth retardation was more frequent in Group II (p=0.05). More Group I patients had hypotensive periods (p=0.018) before the diagnosis of NEC. Prostaglandin treatment and requirement of renal replacement therapy were more frequent in Group I (p=0.022, p=0.03). The mortality rate was higher in Group I (p=0.018). All patients in Group I were late stage NEC at the time of diagnosis. CONCLUSION: NEC developing after cardiac surgery is different from NEC seen in the neonatal period in the terms of etiology, facilitating factors, and clinical course. Mortality rate is higher in NEC after cardiac surgery. The diagnosis of intestinal perforation might be difficult in NEC after cardiac surgery due to insignificant physical examination findings and characteristic radiological signs of NEC. The history of prostaglandin usage and requirement of renal replacement were thought as alarming signs in terms of possible intestinal complications after cardiac surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Enterocolite Necrosante , Perfuração Intestinal , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Enterocolite Necrosante/complicações , Enterocolite Necrosante/cirurgia , Feminino , Humanos , Recém-Nascido , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Laparotomia , Gravidez , Estudos Retrospectivos
9.
Ann Ital Chir ; 922021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34569476

RESUMO

Meckel's Diverticulum is the most frequent congenital anomaly of the digestive system in the population, with a prevalence of 2% on results of a postmortem. Clinically, it can remain silent through all life, or it gets complicated in an acute abdomen sight. In emergency, we can find Meckel's Diverticulum much more in childhood than in adult subjects, with a ratio of 2:1, and, therefore, it joins differential diagnosis with other pathologies being able to cause acute abdomen sight. In adult subjects that doesn't happen: usually, we can achieve the diagnosis sureness only during an exploratory laparotomy. The Authors report the clinic case of a Meckel's Diverticulum found in a 78 years old patient during an exploratory laparotomy like accidental discovery. KEY WORDS: Complications, Laparoscopy, Meckel's disease, Diverticulum.


Assuntos
Abdome Agudo , Laparoscopia , Divertículo Ileal , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Idoso , Diagnóstico Diferencial , Humanos , Laparotomia , Divertículo Ileal/complicações , Divertículo Ileal/diagnóstico , Divertículo Ileal/cirurgia
10.
Rozhl Chir ; 100(5): 246-251, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34465106

RESUMO

We present 3 case-reports with penetrating abdominal injury from our practice in this article. An urgent laparotomy was performed in all cases because of haemodynamic instability or the mechanism of injury. Penetrative abdominal traumas are associated with a high risk of life-threatening intra-abdominal injuries, require urgent revision and are often accompanied by postoperative infections of the peritoneal cavity. In recent years, there has been a growing tendency towards mini-invasive approaches or even non-operative treatment. This trend is particularly evident in the United States of America, where doctors experience a higher number of penetrating injuries compared to the prevalent blunt force trauma in Europe. The authors describe the need to follow all recommended procedures in the pre-hospital and hospital phases of treatment of these patients and compare them with recent literature. Key words: penetrating abdominal trauma.


Assuntos
Traumatismos Abdominais , Ferimentos não Penetrantes , Ferimentos Penetrantes , Traumatismos Abdominais/cirurgia , Europa (Continente) , Humanos , Laparotomia , Estudos Retrospectivos , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/cirurgia
11.
S Afr J Surg ; 59(3): 90-93, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34515423

RESUMO

BACKGROUND: This study reviews the Pietermaritzburg Metropolitan Trauma Service (PMTS) experience with the management of blunt abdominal trauma (BAT). METHODS: A retrospective review of the hybrid electronic medical registry (HEMR) between December 2012 and September 2019 was conducted. All patients admitted following BAT were included. RESULTS: During the study period, 1 123 BAT patients were managed by the PMTS. The mean age was 29.19 years (SD 14.03). Of these admissions, 73.6% were male. The most common mechanism was road traffic crashes (RTCs) - 435 motor vehicle collisions (MVCs) and 250 pedestrian vehicle collisions (PVCs). There were 186 assaults, 118 falls, 62 community assaults, 22 accidents related to agriculture, construction or industry, 11 sporting injuries, nine animal injuries, seven patients injured by falling objects, five injured by trains, two hangings, one burn-related fall and two other causes. The mechanism of injury was unknown in 22 cases. There were 445 abdominal CT scans and 270 whole body CT scans. Surgical management was required for 395 patients. There were 259 index laparotomies and 176 repeat laparotomies. Four patients underwent selective arterial embolisation. Laparoscopy was undertaken in ten, and subsequently converted to laparotomy in five. There were 106 orthopaedic operations. Hospital stay ranged from 0-155 days (median stay three days). ICU admission was required in 24.9% of patients. The mortality rate was 7.5%. CONCLUSION: BAT is common in South Africa. Whilst the vast majority of patients require non-operative treatment, a welldefined subset require a laparotomy. Imaging is central to the management of patients with BAT.


Assuntos
Traumatismos Abdominais , Ferimentos não Penetrantes , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/epidemiologia , Adulto , Animais , Humanos , Laparotomia , Masculino , Estudos Retrospectivos , África do Sul/epidemiologia , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/etiologia
12.
Ann Surg ; 274(4): e370-e380, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34506326

RESUMO

OBJECTIVE: The aim of this study was to determine which initial surgical treatment results in the lowest rate of death or neurodevelopmental impairment (NDI) in premature infants with necrotizing enterocolitis (NEC) or isolated intestinal perforation (IP). SUMMARY BACKGROUND DATA: The impact of initial laparotomy versus peritoneal drainage for NEC or IP on the rate of death or NDI in extremely low birth weight infants is unknown. METHODS: We conducted the largest feasible randomized trial in 20 US centers, comparing initial laparotomy versus peritoneal drainage. The primary outcome was a composite of death or NDI at 18 to 22 months corrected age, analyzed using prespecified frequentist and Bayesian approaches. RESULTS: Of 992 eligible infants, 310 were randomized and 96% had primary outcome assessed. Death or NDI occurred in 69% of infants in the laparotomy group versus 70% with drainage [adjusted relative risk (aRR) 1.0; 95% confidence interval (CI): 0.87-1.14]. A preplanned analysis identified an interaction between preoperative diagnosis and treatment group (P = 0.03). With a preoperative diagnosis of NEC, death or NDI occurred in 69% after laparotomy versus 85% with drainage (aRR 0.81; 95% CI: 0.64-1.04). The Bayesian posterior probability that laparotomy was beneficial (risk difference <0) for a preoperative diagnosis of NEC was 97%. For preoperative diagnosis of IP, death or NDI occurred in 69% after laparotomy versus 63% with drainage (aRR, 1.11; 95% CI: 0.95-1.31); Bayesian probability of benefit with laparotomy = 18%. CONCLUSIONS: There was no overall difference in death or NDI rates at 18 to 22 months corrected age between initial laparotomy versus drainage. However, the preoperative diagnosis of NEC or IP modified the impact of initial treatment.


Assuntos
Drenagem , Enterocolite Necrosante/cirurgia , Doenças do Prematuro/cirurgia , Perfuração Intestinal/cirurgia , Laparotomia , Transtornos do Neurodesenvolvimento/epidemiologia , Enterocolite Necrosante/mortalidade , Enterocolite Necrosante/psicologia , Estudos de Viabilidade , Feminino , Humanos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/mortalidade , Doenças do Prematuro/psicologia , Perfuração Intestinal/mortalidade , Perfuração Intestinal/psicologia , Masculino , Transtornos do Neurodesenvolvimento/diagnóstico , Taxa de Sobrevida , Resultado do Tratamento
13.
JNMA J Nepal Med Assoc ; 59(234): 204-206, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-34506464

RESUMO

Colon carcinoma spreads locally around the intestine wall and can undergo distant metastasis via the hematogenous or lymphatic spread. It rarely metastasizes to the female genital tract and is not fully reported to involve a uterine leiomyoma. Herein we report such an unusual case of a 27 years female a known case of sigmoid colon adenocarcinoma who presented with abdominal pain with bilateral adnexal mass and per vaginal bleeding. Exploratory laparotomy with bilateral resection of ovaries with subsequent polypectomy was done, which on histopathology, it revealed metastatic adenocarcinoma in bilateral ovaries and submucosal leiomyoma. Hence, a lesion with dimorphic histomorphology should be carefully evaluated to rule out the possibility of malignant-to-benign tumor-to-tumor metastasis.


Assuntos
Adenocarcinoma , Leiomioma , Neoplasias do Colo Sigmoide , Adenocarcinoma/cirurgia , Adulto , Feminino , Humanos , Laparotomia , Leiomioma/cirurgia , Neoplasias do Colo Sigmoide/cirurgia
14.
JNMA J Nepal Med Assoc ; 59(237): 506-509, 2021 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-34508419

RESUMO

Gastric volvulus is defined as an abnormal rotation of the stomach. Classical textbook presentation may not always be present. Meticulous assessment and broadened differential diagnosis are thus crucial. Various types have been described in literature. Low threshold for detection with aggressive resuscitation and immediate surgical exploration on suspected incarceration or perforation are mandatory. We report a case of 16-years-female who had atypical presentation of mesenteroaxial gastric volvulus. Emergency exploratory laparotomy with wedge resection and primary repair of stomach with anterolateral gastropexy was performed. She had uneventful recovery with discharge on fifth postoperative day.


Assuntos
Volvo Gástrico , Adolescente , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Feminino , Humanos , Laparotomia , Volvo Gástrico/diagnóstico por imagem , Volvo Gástrico/cirurgia
15.
Rev Assoc Med Bras (1992) ; 67(5): 753-758, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34550268

RESUMO

OBJECTIVE: A surgery is essential for the management of early endometrial carcinoma. Due to the comorbidities associated with the disease, the complications of surgery are common. Laparoscopic surgery may reduce surgical complications but also have oncological risks. We aimed to compare recurrence and overall survival (OS) associated with laparoscopy and laparotomy for early endometrial cancer. METHODS: We included women treated for presumed early endometrial carcinoma at the Clinics Hospital of Ribeirão Preto Medical School from January 1998 to December 2017. We designed a 1:2 propensity score-matched case-control and compared the patients' characteristics, short-term outcomes, recurrence, and OS. RESULTS: A total of 252 women were included in this study, 168 underwent laparotomy, and 84 underwent laparoscopy. The two groups were well balanced according to most of the variables, and obesity was a characteristic of patients in both groups. Laparoscopy was associated with increased surgical time (194.7 min vesus 165.6 min; p<0.001) and reduced rate of surgical complications (6.5% versus 0; p=0.038). Laparoscopic surgery was not associated with the risk of tumor recurrence (HR: 0.41, 95%CI 0.14-1.19, p=0.100) or all-cause mortality (HR: 0.49, 95%CI 0.18-1.35, p=0.170). CONCLUSION: Laparoscopy was safe in terms of oncological outcomes and was associated with a lower rate of surgical complications. Our data support the use of minimally invasive surgery as the preferential approach in the management of early endometrial carcinoma.


Assuntos
Neoplasias do Endométrio , Laparoscopia , Estudos de Casos e Controles , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Histerectomia , Laparotomia , Recidiva Local de Neoplasia/epidemiologia , Estadiamento de Neoplasias , Pontuação de Propensão , Estudos Retrospectivos
16.
Rev Esp Enferm Dig ; 113(11): 787-788, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34470447

RESUMO

A 30-year-old male with no medical history was admitted to the hospital with abdominal pain, vomiting, and inability to pass gas through the rectum. In the physical examination a non-mobile, smooth, firm mass was palpated in the lower abdominal quadrants. An abdominal mass was detected by a CT scan. Thus, the patient underwent laparotomy and the mass was excised together with a bowel segment, and a terminal anastomosis was performed. No peritoneal or liver seeding was observed, and the patient recovered uneventfully.


Assuntos
Obstrução Intestinal , Tumores Fibrosos Solitários , Dor Abdominal , Adulto , Anastomose Cirúrgica , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Laparotomia , Masculino , Tumores Fibrosos Solitários/complicações , Tumores Fibrosos Solitários/diagnóstico por imagem , Tumores Fibrosos Solitários/cirurgia
17.
N Z Med J ; 134(1540): 16-24, 2021 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-34482385

RESUMO

INTRODUCTION: Liver injuries sustained in blunt and penetrating abdominal trauma may cause serious patient morbidity and even mortality. AIM: To review the recent experience of liver trauma at Auckland City Hospital, describing the mechanism of injury, patient management, outcomes and complications. METHODS: A retrospective cohort study was performed, including all patients admitted to Auckland City Hospital with liver trauma identified from the trauma registry. Patient clinical records and radiology were systematically examined. RESULTS: Between 2006-2020, 450 patients were admitted with liver trauma, of whom 92 patients (20%) were transferred from other hospitals. Blunt injury mechanisms, most commonly motor-vehicle crashes, predominated (87%). Stabbings were the most common penetrating mechanism. Over half of liver injuries were low risk American Association for the Surgery of Trauma (AAST) grade I and II (56%), whereas 20% were severe grade IV and V. Non-operative management was undertaken in 72% of patients with blunt liver trauma and 92% of patients with penetrating liver trauma underwent surgery. Liver complications occurred in 11% of patients, most commonly bile leaks (7%), followed by delayed haemorrhage (2%). Thirty-two patients died (7%), with co-existing severe traumatic brain injury as the leading cause of death. There was a significant reduction in death from haemorrhage in patients with grade IV and V liver trauma between the first and second half of the study period (p=0.0091). CONCLUSION: Although the incidence and severity of liver trauma at Auckland City Hospital remained stable, there was a reduction in mortality, particularly death as a result of haemorrhage.


Assuntos
Traumatismos Abdominais/epidemiologia , Lesões por Esmagamento/epidemiologia , Fígado/lesões , Mortalidade/tendências , Ferimentos não Penetrantes/epidemiologia , Ferimentos Perfurantes/epidemiologia , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/terapia , Acidentes por Quedas , Acidentes de Trânsito , Falso Aneurisma/epidemiologia , Sistema Biliar/lesões , Lesões Encefálicas Traumáticas/mortalidade , Causas de Morte , Lesões por Esmagamento/mortalidade , Lesões por Esmagamento/terapia , Embolização Terapêutica , Hemobilia/epidemiologia , Hemorragia/mortalidade , Artéria Hepática , Humanos , Laparoscopia , Laparotomia , Motocicletas , Necrose , Nova Zelândia/epidemiologia , Pedestres , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/terapia , Ferimentos Perfurantes/mortalidade , Ferimentos Perfurantes/terapia
18.
Pol Przegl Chir ; 93(5): 1-5, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34552028

RESUMO

OBJECTIVE: The aim of this study was to compare the post-operative effects of closed incision negative pressure wound therapy with conventional dressing in emergency laparotomy. METHODS: This study was conducted from 1st November 2018 to 31st March 2020 in ABVIMS & Dr. R.M.L. Hospital, New Delhi. The potential candidates for the study were patients of 18 years and above who were admitted in surgical emergency and underwent emergency laparotomy by a midline incision. Fifty random patients were alternatively allotted to group A (25 patients) and group B (25 patients). In the patients of group A, closed incision negative pressure wound therapy (ciNPWT) was applied on midline closed wound after an exploratory laparotomy procedure. The patients in group B, standard dry gauze dressing was done. RESULTS: The mean age of patients in group A and group B were 46.76±12.20 and 41.96±8.33 years, respectively (p-value-0.11). The wound infection was present in 12% of cases in group A and 32% in group B, but when we calculate the p-value, it was found to be statistically non-significant (p-value-0.08). Similarly, seroma formation and wound dehiscence were found less in group A as compared to group B but not reached up to a statistically significant limit (p-value 0.55 and 0.38 respectively). The frequency of dressing change was 1-2 per week in 92% of cases in group A while it was 3-4 per week in 68% of cases in group B. The mean time of the frequency of dressing change was 1.24±0.72 per week and 4.28±1.90 per week in both the groups respectively (p-value <0.001). There was no significant (p>0.05) difference in the duration of hospital stay between group A (mean hospital stay 8.20±2.34 days) and group B (mean hospital stay 8.21±3.37 days). CONCLUSION: Closed incision negative pressure wound therapy has no advantages over conventional dressing in terms of post-operative complications and hospital stay. However, it reduces the frequency of dressing change significantly, which reduces the mental stress of the patient and the burden of changing daily dressing.


Assuntos
Tratamento de Ferimentos com Pressão Negativa , Adulto , Bandagens , Humanos , Laparotomia , Pessoa de Meia-Idade , Deiscência da Ferida Operatória , Infecção da Ferida Cirúrgica/prevenção & controle
19.
J Laparoendosc Adv Surg Tech A ; 31(10): 1224-1226, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34520262

RESUMO

Although once thought to be a point of contention, the use of minimally invasive surgery for the hemodynamically stable pediatric trauma patients has grown dramatically since its conception in the 1970s and becoming a widely acceptable option for select patient populations. An accumulation of literature over the decades has continued to support laparoscopy for both diagnostic and therapeutic purposes in the pediatric trauma patients as laparoscopy is likely to decrease morbidity, hospital cost, and negative laparotomy rates. In this review, we describe what we believe to be the critical aspects of diagnostic laparoscopy in the setting of pediatric trauma.


Assuntos
Traumatismos Abdominais , Laparoscopia , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Criança , Humanos , Lactente , Laparotomia , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Retrospectivos
20.
ANZ J Surg ; 91(10): 2201-2202, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34476883

RESUMO

Giant inguinoscrotal hernias are an uncommon but challenging surgical entity. We report on how to repair a giant inguinoscrotal hernia using a single-stage approach suitable for emergency surgery. This involves a combined laparotomy and inguinal approach, with posterior component separation and transversus abdominis release.


Assuntos
Hérnia Inguinal , Hérnia Ventral , Músculos Abdominais , Hérnia Inguinal/cirurgia , Herniorrafia , Humanos , Laparotomia , Masculino , Escroto/diagnóstico por imagem , Escroto/cirurgia
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