Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.019
Filtrar
1.
Am Surg ; 86(2): 95-103, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32167059

RESUMO

Patients undergoing radical pelvic surgery such as proctectomy or radical cystectomy are at risk of experiencing a variety of complications. Frailty renders patients vulnerable to adverse events. We hypothesize that frailty measured preoperatively using a validated scoring system correlates with increased likelihood of experiencing Clavien-Dindo grade IV complications and 30-day mortality and may be used as a predictive model for patients preoperatively. The NSQIP database was queried for patients who underwent proctectomy or radical cystectomy from 2008 to 2012. Preoperative frailty was calculated using the 11-point modified frailty index (MFI). Patients were scored based on the presence of indicators and categorized into two groups (<3 or ≥3). Major postoperative morbidities and mortality were identified and analyzed in each group. 10,048 proctectomy and cystectomy patients were identified. The MFI was found to be predictive of both 30-day mortality (P < 0.0001) and Clavien-Dindo grade IV complications (P < 0.0001). Receiver operating characteristic analysis demonstrated improved discriminative power of the MFI with the addition of American Society of Anesthesiologists class for both prediction of complications and 30-day mortality. An MFI score of ≥3 is predictive of postoperative morbidity and mortality. Providers should be encouraged to calculate frailty preoperatively to predict adverse outcomes.


Assuntos
Cistectomia/efeitos adversos , Fragilidade/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Protectomia/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Cistectomia/mortalidade , Cistectomia/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Fragilidade/complicações , Fragilidade/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Pelve/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Período Pós-Operatório , Valor Preditivo dos Testes , Protectomia/mortalidade , Protectomia/estatística & dados numéricos , Curva ROC , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
2.
Lancet ; 395(10217): 33-41, 2020 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-31908284

RESUMO

BACKGROUND: Adhesions are the most common driver of long-term morbidity after abdominal surgery. Although laparoscopy can reduce adhesion formation, the effect of minimally invasive surgery on long-term adhesion-related morbidity remains unknown. We aimed to assess the impact of laparoscopy on adhesion-related readmissions in a population-based cohort. METHODS: We did a retrospective cohort study of patients of any age who had abdominal or pelvic surgery done using laparoscopic or open approaches between June 1, 2009, and June 30, 2011, using validated population data from the Scottish National Health Service. All patients who had surgery were followed up until Dec 31, 2017. The primary outcome measure was the incidence of hospital readmissions directly related to adhesions in the laparoscopic and open surgery cohorts at 5 years. Readmissions were categorised as directly related to adhesions, possibly related to adhesions, and readmissions for an operation that was potentially complicated by adhesions. We did subgroup analyses of readmissions by anatomical site of surgery and used Kaplan-Meier analyses to assess differences in survival across subgroups. We used multivariable Cox-regression analysis to determine whether surgical approach was an independent and significant risk factor for adhesion-related readmissions. FINDINGS: Between June 1, 2009, and June 30, 2011, 72 270 patients had an index abdominal or pelvic surgery, of whom 21 519 (29·8%) had laparoscopic index surgery and 50 751 (70·2%) had open surgery. Of the 72 270 patients who had surgery, 2527 patients (3·5%) were readmitted within 5 years of surgery for disorders directly related to adhesions, 12 687 (17·6%) for disorders possibly related to adhesions, and 9436 (13·1%) for operations potentially complicated by adhesions. Of the 21 519 patients who had laparoscopic surgery, 359 (1·7% [95% CI 1·5-1·9]) were readmitted for disorders directly related to adhesions compared with 2168 (4·3% [4·1-4·5]) of 50 751 patients in the open surgery cohort (p<0·0001). 3443 (16·0% [15·6-16·4]) of 21 519 patients in the laparoscopic surgery cohort were readmitted for disorders possibly related to adhesions compared with 9244 (18·2% [17·8-18·6]) of 50 751 patients in the open surgery cohort (p<0·005). In multivariate analyses, laparoscopy reduced the risk of directly related readmissions by 32% (hazard ratio [HR] 0·68, 95% CI 0·60-0·77), and of possibly related readmissions by 11% (HR 0·89, 0·85-0·94) compared with open surgery. Procedure type, malignancy, sex, and age were also independently associated with risk of adhesion-related readmissions. INTERPRETATION: Laparoscopic surgery reduces the incidence of adhesion-related readmissions. However, the overall burden of readmissions associated with adhesions remains high. With further increases in the use of laparoscopic surgery expected in the future, the effect at the population level might become larger. Further steps remain necessary to reduce the incidence of adhesion-related postsurgical complications. FUNDING: Dutch Adhesion Group and Nordic Pharma.


Assuntos
Laparoscopia/efeitos adversos , Readmissão do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Aderências Teciduais/etiologia , Abdome/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Pelve/cirurgia , Complicações Pós-Operatórias/epidemiologia , Reoperação/efeitos adversos , Estudos Retrospectivos , Aderências Teciduais/cirurgia , Adulto Jovem
3.
Zhonghua Wai Ke Za Zhi ; 58(1): 52-56, 2020 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-31902171

RESUMO

Recently, with the development and widespread application of total mesorectal excision and neoadjuvant chemoradiotherapy, the long-term overall survival and disease-free survival of patients with middle & low rectal cancer have been greatly improved. Moreover, there are also researches in minimally invasive techniques, such as laparoscopy and robotic surgical system in the radical rectal surgery, as well as the combination of tumor molecular targeting markers and gene sequencing technology. Nowadays, the treatment of rectal cancer has entered a new era of individualized precise medicine. However, there are still some controversies in lateral lymph node dissection. The criteria of diagnosis and treatment, neoadjuvant therapy, indications of lateral lymph node dissection, the area of dissection and neuroprotection are still unsatisfactory. It is necessary to explore the personalized treatment strategies of lateral lymph node dissection in the precise medical era.


Assuntos
Excisão de Linfonodo/métodos , Neoplasias Retais/patologia , Terapia Combinada , Humanos , Metástase Linfática , Pelve/patologia , Pelve/cirurgia , Medicina de Precisão , Neoplasias Retais/cirurgia
4.
Curr Urol Rep ; 21(1): 2, 2020 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-31960158

RESUMO

PURPOSE OF REVIEW: Classically, kidney transplantation (KT) consists of heterotopic implantation of the renal graft in the iliac fossa with vascular anastomosis on the iliac vessel and reimplantation of the graft ureter in the bladder of the recipient. However, a wide range of variations exist in both vascular anastomosis and urinary diversion that the non-transplant surgeon should know. RECENT FINDINGS: For any pelvic surgery in a KT patient, the non-transplant surgeon should preoperatively evaluate the anatomy of the graft, its vascularization and its urinary tract. The transplant ureter should be identified and secured by preoperative JJ stenting whenever needed. For any surgery, maintenance and control of both immunosuppressive treatment and renal function is crucial. The advice or even the assistance of a transplant surgeon should be required because any damage to vascularization or urinary drainage of the renal graft could have dramatic and definitive consequences on graft function.


Assuntos
Transplante de Rim/métodos , Pelve/cirurgia , Transplantes/anatomia & histologia , Humanos , Transplantados , Transplantes/irrigação sanguínea , Derivação Urinária/métodos
6.
Dis Colon Rectum ; 62(12): 1458-1466, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31567923

RESUMO

BACKGROUND: Redo surgery of persisting pelvic sepsis or chronic presacral sinus after low anterior resection for rectal cancer is challenging. Transanal minimally invasive surgery improves visibility and accessibility of the deep pelvis. OBJECTIVE: The aim of this study was to compare the conventional approach with transanal minimally invasive surgery for redo pelvic surgery with or without anastomotic reconstruction. DESIGN: This is a retrospective cohort study. SETTINGS: This study was conducted in a tertiary referral center. PATIENTS: All consecutive patients undergoing redo pelvic surgery after low anterior resection for rectal cancer between January 2005 and March 2018 were included. INTERVENTIONS: Redo surgery was divided into redo anastomosis and intersphincteric completion proctectomy. Transanal minimally invasive surgery procedures since November 2014 were compared with the conventional approach. MAIN OUTCOME MEASURES: Primary end points were procedural characteristics and 90-day major complications. RESULTS: In total, 104 patients underwent redo surgery; 47 received a redo anastomosis (18 conventional and 29 transanal minimally invasive surgery) and 57 underwent intersphincteric completion proctectomy (35 conventional and 22 transanal minimally invasive surgery). The transabdominal part of the transanal minimally invasive surgery procedures was performed laparoscopically in 72% and 59% of redo anastomosis and intersphincteric completion proctectomy, compared with 6% and 34% in the conventional group (p < 0.001 and p = 0.100). The 90-day major complication rate was 33% and 45% after redo anastomosis (p=0.546) and 29% and 41% after intersphincteric completion proctectomy (p=0.349) in conventional surgery and transanal minimally invasive surgery. LIMITATIONS: A limitation of this study is the relatively small sample size. CONCLUSIONS: This study suggests that transanal minimally invasive surgery is a valid alternative to conventional top-down redo pelvic surgery for persisting pelvic sepsis or chronic sinus, with more often a laparoscopic approach for the abdominal part. See Video Abstract at http://links.lww.com/DCR/B87. MANEJO QUIRÚRGICO TRANSANAL MÍNIMAMENTE INVASIVO DE LA SEPSIS PÉLVICA PERSISTENTE O DE UN SENO CRÓNICO DESPUÉS DE RESECCIÓN ANTERIOR BAJA: La cirugía de reoperación por sepsis pélvica persistente o un seno presacro crónico después de una resección anterior baja por cáncer de recto es un desafío. La cirugía transanal mínimamente invasiva mejora la visibilidad y la accesibilidad a la región profunda de la pelvis.El objetivo de este estudio fue comparar el abordaje convencional con la cirugía transanal mínimamente invasiva para cirugía pélvica de reoperación con o sin reconstrucción anastomótica.Este es un estudio de cohorte retrospectiva.Este estudio se realizó en un centro de referencia terciario.Se incluyeron todos los pacientes consecutivos que se sometieron a una cirugía pélvica de reoperación después de una resección anterior baja por cáncer de recto entre enero de 2005 y marzo de 2018.La cirugía de reoperación se dividió en reconstrucción de anastomosis y proctectomía interesfintérica. Los procedimientos de cirugía transanal mínimamente invasiva desde noviembre de 2014 se compararon con el abordaje convencional.Los puntos primarios fueron las características del procedimiento y las complicaciones mayores a 90 días.En total, 104 pacientes fueron sometidos a cirugía de reoperación; 47 recibieron una reconstrucción de anastomosis (18 abordaje convencional y 29 cirugía transanal mínimamente invasiva) y 57 se sometieron a una proctectomía interesfintérica (35 abordaje convencional y 22 cirugía transanal mínimamente invasiva). La parte transabdominal de los procedimientos de cirugía transanal mínimamente invasiva se realizó por vía laparoscópica en el 72% y el 59% de las reconstrucciones de anastomosis y las proctectomías interesfintéricas, respectivamente, en comparación con el 6% y el 34%, respectivamente, en el grupo convencional (p <0.001 y p = 0.100). La tasa de complicaciones mayores a los 90 días fue del 33% y del 45% después de la anastomosis de reconstrucción (p = 0.546) y del 29% y 41% después de la proctectomía interesfintérica (p = 0.349) en cirugía convencional y cirugía transanal mínimamente invasiva, respectivamente.La limitación de este estudio es el tamaño relativamente pequeño de la muestra.Este estudio sugiere que la cirugía transanal mínimamente invasiva es una alternativa válida para la cirugía pélvica de reoperación convencional en sepsis pélvica persistente o seno crónico, con un abordaje laparoscópico utilizado más frecuentemente para la parte abdominal. Vea el Abstract del video en http://links.lww.com/DCR/B87.


Assuntos
Pelve/cirurgia , Protectomia/métodos , Sepse/cirurgia , Cirurgia Endoscópica Transanal/métodos , Adulto , Idoso , Anastomose Cirúrgica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/cirurgia , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
7.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 937-942, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630490

RESUMO

The anorectum is a complex region, whose anatomic structure is the basis and premise of intersphincteric resection (ISR) for low rectal cancer. With the development of pelvic surgery and minimally invasive surgery, the anatomic approaches, surgical planes, extent of excision and reconstruction strategies of ISR have been better understood. Surgeons can furthest preserve anal function as well as adhere to the principles of radical resection. However, the anatomy of the anorectum has not been fully understood. We hope further exploration of the anal canal anatomy, including the perirectal fascia, rectourethral muscle, anococcygeal ligament, hiatal ligament, levator ani muscle, internal and externals phincter, intersphincteric nerves, conjointed longitudinal muscle, intersphincteric spaces and the surgical approaches, by reviewing relevant literatures combined with the experiences of our clinical practice and applied anatomy, will help to improve the accuracy of the surgeries and increase the oncologic and functional outcomes of ISR.


Assuntos
Canal Anal/patologia , Canal Anal/cirurgia , Pelve/cirurgia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Canal Anal/anatomia & histologia , Canal Anal/inervação , Fáscia/anatomia & histologia , Humanos , Diafragma da Pelve/anatomia & histologia , Diafragma da Pelve/patologia , Diafragma da Pelve/cirurgia , Pelve/anatomia & histologia , Pelve/patologia
8.
Cancer Invest ; 37(10): 524-530, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31597501

RESUMO

The oncological benefit of pelvic lymph node dissection (PLND) is still debatable because data on clinical outcomes of radical prostatectomy (RP) without PLND are lacking. In this study, we reported oncological outcome in consecutive 146 patients who underwent RP without PLND. Although 27% of our patients developed biochemical recurrence, the estimated 5-year overall survival rates were 100%, 96.3%, and 95.7% in the low-, intermediate-, and high-risk groups, respectively. These data in our patients were not inferior to those in previous reports that investigated the survivals in patients who received PLND during RP. The therapeutic significance of PLND should be re-evaluated.


Assuntos
Linfonodos/cirurgia , Pelve/patologia , Neoplasias da Próstata/cirurgia , Idoso , Seguimentos , Humanos , Excisão de Linfonodo/métodos , Linfonodos/patologia , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Pelve/cirurgia , Próstata/patologia , Próstata/cirurgia , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento
9.
Vet Ital ; 55(3): 269-274, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31599552

RESUMO

In this study the caecum and large colon were harvested from 24 slaughtered horses. On each sample, an 8­cm long enterotomy was performed. Enterotomies were closed using either barbed or unbarbed glycomer­631. We compared the time to close, appearance, length of suture material, bursting pressure, and costs associated with each type of material. Our findings demonstrated that time to close was significantly shorter (caecum, P = 0.034; pelvic flexure, P = 0.039) using barbed sutures (caecum 610.4 seconds; pelvic flexure 699.3 seconds) than unbarbed sutures (caecum 661.0 seconds, pelvic flexure 743.1 seconds). The length of suture material used was significantly less (caecum, P < 0.0001; pelvic flexure, P < 0.0001) with barbed (caecum 28.1 cm, pelvic flexure 32.0 cm,) compared with unbarbed sutures (caecum 41.6 cm; pelvic flexure 46.6 cm). There were no significant differences in bursting pressure (caecum, P = 0.294; pelvic flexure, P = 0.430) between barbed (caecum, 172.5 mmHg, pelvic flexure, 188.9 mmHg) and unbarbed sutures (caecum 178.3 mmHg, pelvic flexure 183.3 mmHg). The cost was higher using barbed sutures. However, the use of barbed sutures was faster, left less suture material in the tissue, and sustained comparable bursting pressure to unbarbed sutures. We therefore conclude that barbed sutures are a valid alternative to unbarbed sutures for closing large intestine enterotomy in horses.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/veterinária , Cavalos/cirurgia , Técnicas de Sutura/veterinária , Suturas/veterinária , Animais , Ceco/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Pelve/cirurgia , Técnicas de Sutura/estatística & dados numéricos , Suturas/estatística & dados numéricos
10.
World Neurosurg ; 132: 118-128, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31476476

RESUMO

Spinal alignment, particularly with respect to spinopelvic parameters, is highly correlated with morbidity and health-related quality-of-life outcomes. Although the importance of spinal alignment has been emphasized in the deformity literature, spinopelvic parameters have not been considered in the context of spine oncology. Because the aim of oncologic spine surgery is mostly palliative, consideration of spinopelvic parameters could improve postoperative outcomes in both the primary and metastatic tumor population by taking overall vertebral stability into account. This review highlights the relevance of focal and global spinal alignment, particularly related to spinopelvic parameters, in the treatment of spine tumors.


Assuntos
Procedimentos Neurocirúrgicos/métodos , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/cirurgia , Coluna Vertebral/patologia , Coluna Vertebral/cirurgia , Humanos , Pelve/patologia , Pelve/cirurgia , Neoplasias da Coluna Vertebral/secundário
12.
Med Sci Monit ; 25: 5953-5960, 2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31399554

RESUMO

BACKGROUND Screw penetration into the hip joint is a severe complication during acetabular fracture surgery. The standard fluoroscopic views of the pelvis cannot provide adequate safety during screw insertion. The aim of this research was to determine and evaluate the accuracy of the acetabular lateral view for screw placement. MATERIAL AND METHODS Twenty screws were randomly chosen and intentionally penetrated into the articular surface (1-2 mm), and the remaining 20 screws were extra-articular ones positioned in close proximity to the articular surface. Three surgeons, each evaluating 40 screws, provided a total of 120 rated observations for each screw position. We compared the traditional view or combined with lateral acetabular view with the criterion standard based on unaided visual assessment. A blinded and independent review of each pelvic intraoperative fluoroscopy was made by 3 independent observers. Specificity, sensitivity, positive predictive value, negative predictive value, correct interpretation, intra-class correlation coefficients (ICC), and Youden index were calculated. RESULTS There were significant differences in sensitivity, NPV, correct interpretation, and Youden index between the 2 groups (P<0.05). The ICC was 0.531 when the antero-posterior, iliac, and obturator oblique views were used. The ICC was remarkably increased when using a combination of the ''lateral'' view and the standard views for screw perforation of the joint. CONCLUSIONS Use of the lateral view of the acetabulum can be a complementary method to identify malpositioned screws, and it helps increase the accuracy rate of inserting screws in the treatment of posterior wall fracture.


Assuntos
Acetábulo/diagnóstico por imagem , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Acetábulo/lesões , Acetábulo/cirurgia , Adulto , Idoso , Parafusos Ósseos , Cadáver , Fluoroscopia/métodos , Fraturas do Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Pelve/cirurgia , Cirurgia Assistida por Computador/métodos
13.
Surgery ; 166(6): 1084-1091, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31377000

RESUMO

BACKGROUND: Thromboprophylaxis aims to reduce venous thromboembolism but has the potential to increase bleeding. We sought to evaluate the risk of venous thromboembolism and transfusion after major abdominopelvic procedures and to quantify the association of the procedure with venous thromboembolism. METHODS: The American College of Surgeons' National Surgical Quality Improvement Program was queried for patients who received an abdominopelvic surgery between 2005 and 2016. Patient factors, operative factors, and outcomes were collected. Multivariable analyses were used to determine the association between individual procedures and venous thromboembolism. Area under the curve analyses were performed to assess whether addition of the procedure to Caprini score improved the association of the model with venous thromboembolism. The primary outcome was risk of venous thromboembolism within 30 days of surgery. Secondary outcomes were the risk of transfusion within 30 days and the association between operative time with venous thromboembolism. RESULTS: There were 896,441 patients who received an abdominopelvic procedure. The overall risk of venous thromboembolism was 1.9% (n = 16,665). Procedures with the highest risk of venous thromboembolism were esophagectomy (5.5%) and partial esophagectomy (5.3%). The overall risk of transfusion was 9.5% (n = 84,889). Procedures with the highest risk of transfusion were pelvic exenteration (53.6%) and radical cystectomy (37.7%). On multivariable analyses, individual procedures were independently associated with venous thromboembolism, despite adjusting for Caprini score. Area under the curve analyses indicated risk prediction of the baseline model (area under the curve 0.59) improved when procedures were added (area under the curve 0.68). CONCLUSION: Patients undergoing abdominopelvic surgery are at a high risk of venous thromboembolism and transfusion. Improved risk stratification may be possible by including more procedural information in scoring systems.


Assuntos
Anticoagulantes/administração & dosagem , Transfusão de Sangue/estatística & dados numéricos , Hemorragia Pós-Operatória/epidemiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Tromboembolia Venosa/prevenção & controle , Abdome/cirurgia , Adulto , Idoso , Anticoagulantes/efeitos adversos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pelve/cirurgia , Hemorragia Pós-Operatória/induzido quimicamente , Hemorragia Pós-Operatória/terapia , Medição de Risco , Fatores de Risco , Tromboembolia Venosa/etiologia
14.
Cochrane Database Syst Rev ; 8: CD004318, 2019 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-31449321

RESUMO

BACKGROUND: This an update of the review first published in 2009.Major abdominal and pelvic surgery carries a high risk of venous thromboembolism (VTE). The efficacy of thromboprophylaxis with low molecular weight heparin (LMWH) administered during the in-hospital period is well-documented, but the optimal duration of prophylaxis after surgery remains controversial. Some studies suggest that patients undergoing major abdominopelvic surgery benefit from prolongation of the prophylaxis up to 28 days after surgery. OBJECTIVES: To evaluate the efficacy and safety of prolonged thromboprophylaxis with LMWH for at least 14 days after abdominal or pelvic surgery compared with thromboprophylaxis administered during the in-hospital period only in preventing late onset VTE. SEARCH METHODS: We performed electronic searches on 28 October 2017 in the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, LILACS and registered trials (Clinicaltrials.gov October 28, 2017 and World Health Organization International Clinical Trials Registry Platform (ICTRP) 28 October 2017). Abstract books from major congresses addressing thromboembolism were handsearched from 1976 to 28 October 2017, as were reference lists from relevant studies. SELECTION CRITERIA: We assessed randomized controlled clinical trials (RCTs) comparing prolonged thromboprophylaxis (≥ fourteen days) with any LMWH agent with placebo, or other methods, or both to thromboprophylaxis during the admission period only. The population consisted of persons undergoing abdominal or pelvic surgery for both benign and malignant pathology. The outcome measures included VTE (deep venous thrombosis (DVT) or pulmonary embolism (PE)) as assessed by objective means (venography, ultrasonography, pulmonary ventilation/perfusion scintigraphy, spiral computed tomography (CT) scan or autopsy). We excluded studies exclusively reporting on clinical diagnosis of VTE without objective confirmation. DATA COLLECTION AND ANALYSIS: Review authors identified studies and extracted data. Outcomes were VTE (DVT or PE) assessed by objective means. Safety outcomes were defined as bleeding complications and mortality within three months after surgery. Sensitivity analyses were also performed with unpublished studies excluded, and with study participants limited to those undergoing solely open and not laparoscopic surgery. We used a fixed-effect model for analysis. MAIN RESULTS: We identified seven RCTs (1728 participants) evaluating prolonged thromboprophylaxis with LMWH compared with control or placebo. The searches resulted in 1632 studies, of which we excluded 1528. One hundred and four abstracts, eligible for inclusion, were assessed of which seven studies met the inclusion criteria.For the primary outcome, the incidence of overall VTE after major abdominal or pelvic surgery was 13.2% in the control group compared to 5.3% in the patients receiving out-of-hospital LMWH (Mantel Haentzel (M-H) odds ratio (OR) 0.38, 95% confidence interval (CI) 0.26 to 0.54; I2 = 28%; moderate-quality evidence).For the secondary outcome of all DVT, seven studies, n = 1728, showed prolonged thromboprophylaxis with LMWH to be associated with a statistically significant reduction in the incidence of all DVT (M-H OR 0.39, 95% CI 0.27 to 0.55; I2 = 28%; moderate-quality evidence).We found a similar reduction when analysis was limited to incidence in proximal DVT (M-H OR 0.22, 95% CI 0.10 to 0.47; I2 = 0%; moderate-quality evidence).The incidence of symptomatic VTE was also reduced from 1.0% in the control group to 0.1% in patients receiving prolonged thromboprophylaxis, which approached significance (M-H OR 0.30, 95% CI 0.08 to 1.11; I2 = 0%; moderate-quality evidence).No difference in the incidence of bleeding between the control and LMWH group was found, 2.8% and 3.4%, respectively (M-H OR 1.10, 95% CI 0.67 to 1.81; I2 = 0%; moderate-quality evidence).No difference in mortality between the control and LMWH group was found, 3.8% and 3.9%, respectively (M-H OR 1.15, 95% CI 0.72 to 1.84; moderate-quality evidence).Estimates of heterogeneity ranged between 0% and 28% depending on the analysis, suggesting low or unimportant heterogeneity. AUTHORS' CONCLUSIONS: Prolonged thromboprophylaxis with LMWH significantly reduces the risk of VTE compared to thromboprophylaxis during hospital admittance only, without increasing bleeding complications or mortality after major abdominal or pelvic surgery. This finding also holds true for DVT alone, and for both proximal and symptomatic DVT. The quality of the evidence is moderate and provides moderate support for routine use of prolonged thromboprophylaxis. Given the low heterogeneity between studies and the consistent and moderate evidence of a decrease in risk for VTE, our findings suggest that additional studies may help refine the degree of risk reduction but would be unlikely to significantly influence these findings. This updated review provides additional evidence and supports the previous results reported in the 2009 review.


Assuntos
Anticoagulantes/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Hemorragia Pós-Operatória/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Abdome/cirurgia , Esquema de Medicação , Humanos , Pelve/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Hemorragia Pós-Operatória/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Tromboembolia Venosa/epidemiologia
15.
World Neurosurg ; 132: 408-420.e1, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31465853

RESUMO

OBJECTIVE: This systematic review and meta-analysis aims to assess and compare the postoperative outcomes of iliac screw (IS) fixation versus sacral 2 alar iliac (S2AI) screw fixation in the adult and pediatric populations. METHODS: We searched all comparative studies that compared postoperative outcomes of IS and S2AI fixation techniques for pelvic fixation from the PubMed and Scopus databases up to June 23, 2019. RESULTS: Eleven of 951 studies (N = 632 patients) were eligible; 8, 10, 5, 6, 3, 7, 2, and 2 studies were included in pooling of postoperative complications, revisions, implant failure, screw breakage, screw prominence, wound dehiscence, wound infection, visual analog scale (VAS), and ambulatory status (AS), respectively. The IS technique had a statistically significant higher chance of postoperative complications, revisions, implant failure, screw breakage, screw prominent, wound dehiscence, and wound infection by 1.89 (95% confidence interval [CI], 1.48-2.40), 1.91 (95% CI, 1.29-2.82), 2.28 (95% CI, 1.55-3.35), 3.96 (95% CI, 1.46-10.75), 6.83 (95% CI, 2.54-18.37), 4.62 (95% CI, 1.32-16.25), and 3.03 (95% CI, 1.62-5.66), respectively compared with the S2AI fixation technique. In subgroup analysis, the IS technique had a statistically significant higher chance of postoperative complications and revisions of 1.65 (95% CI, 1.25-2.16) and 1.71 (95% CI, 1.03-2.84) in pediatric populations and 2.32 (95% CI, 1.60-3.38) and 1.94 (95% CI, 1.00-3.73) in the adult populations compared with the S2AI fixation technique. IS screw fixation had a lower AS of -0.40 (95% CI, -0.76 to -0.15) than did S2AI fixation in the adult and pediatric populations. However, there was no difference in pain VAS between both groups. CONCLUSIONS: Sacropelvic fixation with IS screw fixation had more postoperative complications and revisions and lower AS than did S2AI fixation.


Assuntos
Parafusos Ósseos , Ílio/cirurgia , Pelve/cirurgia , Região Sacrococcígea/cirurgia , Adulto , Criança , Humanos , Fixadores Internos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação , Fusão Vertebral , Resultado do Tratamento
16.
BMC Womens Health ; 19(1): 95, 2019 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299947

RESUMO

BACKGROUND: The combination of intrapelvic and extrapelvic endometriosis is a very rare condition in gynecology. Patients with endometriosis involving the sciatic nerve are easily misdiagnosed because they usually present with atypical symptoms of endometriosis. Here, we present a rare case of an endometrioma passing through the left greater sciatic foramen. Removal of the endometriotic lesion was performed with a concomitant laparoscopic and transgluteal approach through the cooperation of gynecologists and orthopedic (neuro)surgeons. CASE PRESENTATION: A 20-year-old woman presented with complaints of severe dysmenorrhea lasting for more than 6 years and dysfunction of her left lower limb lasting for approximately 4 months. Both CT and MRI demonstrated a suspected intrapelvic and extrapelvic endometriotic cyst (7.3 cm × 8.1 cm × 6.5 cm) passing through the left greater sciatic foramen. Laparoscopic exploration showed a cyst full of dark fluid occupying the left obturator fossa and extending outside the pelvis. A novel combination of transgluteal laparoscopy was performed for complete resection of the cyst and decompression of the sciatic nerve. Postoperative pathology confirmed the diagnosis of endometriosis. Long-term follow-up observation showed persistent pain relief and lower limb function recovery in the patient. DISCUSSION AND CONCLUSIONS: When a woman complains of unexplained unilateral sciatica, especially a woman suffering from dysmenorrhea, endometriosis of the sciatica nerve should be considered as a potential etiology. Complete excision of the endometriotic lesion and adequate neurolysis (or decompression) of the sciatic nerve through the multidisciplinary cooperation of experienced gynecologists with proper training in laparoscopic pelvic (neuro)surgery and orthopedic (neuro)surgeons is effective.


Assuntos
Dismenorreia/cirurgia , Endometriose/cirurgia , Laparoscopia/métodos , Ciática/cirurgia , Dismenorreia/etiologia , Dismenorreia/patologia , Endometriose/complicações , Endometriose/patologia , Feminino , Humanos , Extremidade Inferior/patologia , Extremidade Inferior/cirurgia , Pelve/patologia , Pelve/cirurgia , Nervo Isquiático/patologia , Nervo Isquiático/cirurgia , Ciática/etiologia , Ciática/patologia , Adulto Jovem
17.
Dis Colon Rectum ; 62(9): 1136-1140, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31318767

RESUMO

BACKGROUND: In laparoscopic extralevator abdominoperineal excision, reconstruction of the pelvic peritoneum helps to prevent the small intestine from adhering to pelvic wall tissues, thus avoiding small-bowel obstruction and perineal complications. However, there are difficulties in pelvic peritoneum closure if the patient has received preoperative radiotherapy and has a rigid pelvis. We report a novel laparoscopic method for pelvic peritoneum reconstruction using the bladder peritoneum flap in laparoscopic extralevator abdominoperineal excision after neoadjuvant radiotherapy. TECHNIQUE: After transection of the rectum, if the patient had a rigid pelvis, we chose to perform the novel technique for the pelvic peritoneum closure in a 3-step approach. The flap has an arch shape with the bottom at the anterior wall of the pelvic cavity entrance. The height of the arched flap is equal to the distance from the bladder to the sacral promontory. The peritoneum was incised with electrocautery at the planned level and peeled off the bladder. The bladder peritoneum flap was then rotated to cover the entrance of the pelvic cavity and sutured to the brim of the pelvis. RESULTS: Acceptable postoperative short-term and long-term outcomes (5- to 22-month follow-ups) were achieved in 3 patients who underwent bladder peritoneum flap closure. CONCLUSIONS: The bladder peritoneum flap appears to be safe and feasible for intracorporeal closure of the pelvic cavity in laparoscopic extralevator abdominoperineal excision after neoadjuvant radiotherapy. The procedure provides a novel option for patients with severe fibrosis of the pelvis when another peritoneum reconstruction method is not feasible.


Assuntos
Laparoscopia/métodos , Pelve/cirurgia , Peritônio/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias Retais/cirurgia , Retalhos Cirúrgicos , Bexiga Urinária/cirurgia , Idoso , Seguimentos , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Períneo/cirurgia , Neoplasias Retais/radioterapia , Estudos Retrospectivos
18.
Acta Orthop Belg ; 85(2): 253-259, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31315018

RESUMO

The purpose of this study was to compare various sagittal spinopelvic parameters between patients with and without degenerative lumbar spondylolisthesis (DLS). A total of 165 patients who underwent surgery for low back and/or radicular pain were divided into two groups: those without DLS (non-DLS group; n = 85) and those with DLS (DLS group; n = 80). In all sagittal spinopelvic parameters, no significant difference was found between the non-DLS and DLS groups. The mean pelvic incidence (PI) value of the DLS group (56.4°) was almost similar to that of the non-DLS group (57.5°). The cross-sectional ratio of lumbar musculature was significantly smaller in the DLS group than in thenon-DLS group (p = 0.046). Contrary to the results of previous studies, a high PI may not be a predisposing factor for DLS development. Atrophy of back extensor muscles may play a role in the pathogenesis of DLS.


Assuntos
Pelve/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Espondilolistese/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pelve/cirurgia , Radiografia , Estudos Retrospectivos , Coluna Vertebral/cirurgia , Espondilolistese/cirurgia
19.
J Orthop Surg Res ; 14(1): 232, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337419

RESUMO

BACKGROUND: Pelvic tumors are usually resected through the utilitarian pelvic incision, an extended ilioinguinal/iliofemoral approach. The pararectus approach, an intrapelvic anatomical approach with extraperitoneal access to the pelvis, has been established previously for the treatment of pelvic and acetabular fractures. However, it has not been used to address pelvic tumors. The study aimed at investigating the feasibility of this approach for pelvic tumor surgery and the possibilities of combining this approach with standard approaches to the hip joint. METHODS: Thirteen patients that underwent pelvic tumor resections were retrospectively reviewed. Tumor resections were performed through the pararectus (n = 10) or extended pararectus approach (n = 3). In six of those cases, the pararectus approach was combined with extrapelvic approaches including the modified Gibson (n = 4), the Kocher-Langenbeck (n = 1), and the trochanteric flip approach (n = 1). The mean follow-up was 32.6 ± 9.1 months. RESULTS: In all cases, the tumor resections were carried out according to the preoperative plan. In seven of 13 cases, wide resections were performed; six of 13 cases were planned close resections. Four cases of major complications were observed (vascular injury, deep infection, iliac vein thrombosis, total hip arthroplasty dislocation). Minor complications were observed in two cases. One tumor recurred locally. At the final follow-up, 10 patients were alive, eight of those without evidence of disease. CONCLUSION: The study demonstrated the suitability of the pararectus approach for pelvic tumor resections. The possibility to combine the approach with standard approaches to the hip joint allowed for single-stage reconstructions of the pelvis and the hip joint without sacrificing surgical margins and function. The pararectus approach is a versatile option adding to the established approaches for musculoskeletal tumor surgery of the pelvis.


Assuntos
Neoplasias Ósseas/cirurgia , Neoplasias Pélvicas/cirurgia , Pelve/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reto do Abdome/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Adulto , Idoso , Neoplasias Ósseas/diagnóstico por imagem , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pélvicas/diagnóstico por imagem , Pelve/diagnóstico por imagem , Reto do Abdome/diagnóstico por imagem , Estudos Retrospectivos , Neoplasias de Tecidos Moles/diagnóstico por imagem , Adulto Jovem
20.
Br J Surg ; 106(9): 1156-1166, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31304580

RESUMO

BACKGROUND: Patients undergoing prolonged pelvic surgery may develop compartment syndrome of one or both lower limbs in the absence of direct trauma or pre-existing vascular disease (well leg compartment syndrome). This condition may have devastating consequences for postoperative recovery, including loss of life or limb, and irreversible disability. METHODS: These guidelines represent the collaboration of a multidisciplinary group of colorectal, vascular and orthopaedic surgeons, acting on behalf of their specialty associations in the UK and Ireland. A systematic analysis of the available peer-reviewed literature was undertaken to provide an evidence base from which these guidelines were developed. RESULTS: These guidelines encompass the risk factors (both patient- and procedure-related), diagnosis and management of the condition. Key recommendations for the adoption of perioperative strategies to facilitate prevention and effective treatment of well leg compartment syndrome are presented. CONCLUSION: All surgeons who carry out abdominopelvic surgical procedures should be aware of well leg compartment syndrome, and instigate policies within their own institution to reduce the risk of this potentially life-changing complication.


Assuntos
Síndromes Compartimentais/prevenção & controle , Perna (Membro)/irrigação sanguínea , Pelve/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Adulto , Fatores Etários , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/terapia , Decúbito Inclinado com Rebaixamento da Cabeça , Humanos , Obesidade/complicações , Posicionamento do Paciente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Fatores de Risco , Equilíbrio Hidroeletrolítico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA