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1.
Medicine (Baltimore) ; 99(1): e16791, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895764

RESUMO

The present study aimed to investigate the feasibility of vaginal delivery combined with vaginal tightening surgery and perineal body repair.From January 2017 to April 2017, 5 cases underwent vaginal delivery combined with vaginal tightening surgery and perineal body repair. We retrospectively analyzed the clinical data.The incisions of 5 cases were all primary healing; vulva form was improved, and there were no postoperative hematoma, infection or vaginal mucosa prolapse. Sexual function was improved to different degrees. The pelvic muscle force test showed that both the type I and type II myofiber scores were increased.It is feasible to perform vaginal delivery combined with vaginal tightening surgery and perineal body repair, which is a safe and effective method for improving sex life and pelvic floor function.


Assuntos
Parto Obstétrico/efeitos adversos , Vagina/cirurgia , Adulto , Feminino , Humanos , Lacerações/etiologia , Lacerações/cirurgia , Diafragma da Pelve/fisiopatologia , Diafragma da Pelve/cirurgia , Períneo/lesões , Períneo/cirurgia , Gravidez , Qualidade de Vida , Vagina/fisiopatologia , Vulva/cirurgia
3.
Pediatr Surg Int ; 35(10): 1137-1141, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31420742

RESUMO

PURPOSE: The aim of this study was to investigate risk factors for recurrence in the perineal canal (PC). METHODS: Patients with PC who underwent operations were enrolled in this study and were divided into recurrence and non-recurrence groups. Preoperative infection, the age at the operation, the presence of colostomy and the treatment procedure for fistula were retrospectively investigated. Regarding the treatment procedure for fistula, either closure of the rectal wall with stitches or ligation of fistula in the rectum was performed. These factors were compared between the two groups. RESULTS: Six of 17 patients with PC who underwent surgical treatment had recurrence. There were no significant differences in the incidence of preoperative infection, age at operation or presence of colostomy (p = 0.60, 0.38, 1.00, respectively). In the recurrence group, all patients were treated by closure of the rectal wall. In the non-recurrence group, five were treated by the closure of the rectal wall with stitches and six by ligation of the fistula. There was a significant association between recurrence and the treatment procedure for fistula (p = 0.04). CONCLUSION: Closure of the rectal wall with stitches is a risk factor for the recurrence of PC.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Fístula/cirurgia , Períneo/anormalidades , Doenças Retais/cirurgia , Reto/anormalidades , Feminino , Fístula/diagnóstico , Humanos , Lactente , Masculino , Períneo/cirurgia , Doenças Retais/diagnóstico , Reto/cirurgia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
4.
J Surg Res ; 243: 469-480, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31377486

RESUMO

BACKGROUND: Abdominoperineal resection (APR) is the primary surgical approach to low rectal cancers. Both prone and lithotomy patient positioning during the perineal dissection are currently acceptable approaches. There is no consensus on whether patient positioning has an impact on operative and oncologic outcomes. The aim of this review was to compare the perioperative and long-term oncologic outcomes between prone and lithotomy patient positioning. MATERIALS AND METHODS: Search of Medline, Embase, Web of Science, CENTRAL, PubMed, and ClinicalTrials.gov databases was performed. Articles were eligible for inclusion if they compared prone and lithotomy positioning for the perineal portion of APR for rectal cancer in one of the primary outcomes. Quality of included studies was assessed using Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. RESULTS: Nine studies with 888 patients in the prone group and 897 in the lithotomy group were included. Compared with lithotomy position, prone position had a significantly lower perforation rate (risk ratio: 0.50, 95% confidence interval [CI]: 0.32 to 0.79, P = 0.003) and rates of positive circumferential resection margin involvement (risk ratio: 0.66, 95% CI: 0.44 to 1.00, P = 0.05). Prone position also had a significantly shorter operative time than lithotomy position (mean difference: -45.20 min, 95% CI: -63.03 to -27.36, P < 0.00001). Positioning did not affect 5-y overall survival or local and distal recurrence. CONCLUSIONS: Prone positioning may lead to lower rates of perforation and circumferential resection margin involvement in APR. In addition, it may lead to shorter operative time. Larger randomized studies are required to confirm the results of this review and examine the difference in long-term outcomes.


Assuntos
Períneo/cirurgia , Decúbito Ventral , Neoplasias Retais/cirurgia , Humanos , Duração da Cirurgia , Complicações Pós-Operatórias , Decúbito Dorsal
5.
Pediatr Surg Int ; 35(10): 1109-1114, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31392503

RESUMO

PURPOSE: Many kinds of operative procedures have been proposed for anorectal malformation (ARM) patients. At our institution, sacroperineal or sacroabdominoperineal anorectoplasty (SP-SAP) have been performed from 1984 to 2007. The aim of this study is clarify the change over the time in the postoperative bowel function in male ARM patients. METHODS: Patient data were collected from 1984 to 2007. Fifty-two male patients with high- and intermediate-type ARM were enrolled. The patients' characteristics and bowel function were reviewed and analyzed retrospectively. The bowel function was evaluated according to the evacuation score (ES) of the Japan Society of ARM Study Group. RESULTS: The operative procedures were SP-SAP in 52 male patients. The total ES improved chronologically and significantly until 11 years of age. Regarding the clinical stratification of the ES, the ratio of "excellent" and "good" results was over 91.9% at 11 years of age. A satisfactory bowel movement score was achieved by 9 years of age. The constipation, incontinence and soiling scores improved slowly but continuously until 11 years of age. CONCLUSION: The ES showed continuous improvement after a definitive operation. An understanding of the characteristics of improvement is very important in managing the postoperative bowel function in ARM patients.


Assuntos
Abdominoplastia/métodos , Canal Anal/anormalidades , Malformações Anorretais/cirurgia , Defecação/fisiologia , Períneo/cirurgia , Reto/anormalidades , Região Sacrococcígea/cirurgia , Canal Anal/diagnóstico por imagem , Canal Anal/cirurgia , Malformações Anorretais/diagnóstico , Malformações Anorretais/fisiopatologia , Seguimentos , Humanos , Lactente , Masculino , Período Pós-Operatório , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reto/diagnóstico por imagem , Reto/cirurgia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
6.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(7): 689-693, 2019 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-31302971

RESUMO

Perianal necrotizing fasciitis is a serious soft tissue infectious disease of perianal and perineal regions, where a synergistic action of multiple bacteria (including aerobic bacteria and anaerobic bacteria) results in suppurative necrosis of the skin and soft tissue. The disease progress may rapidly cause systemic sepsis through blood circulation, often with complicating shock and MODS, or death. Any delay in diagnosis and treatment of early acute infections may lead to higher mortality because of lack of standardized treatment. The Clinical Guidelines Committee aims to formulate expert consensus on the treatment of perianal necrotizing fasciitis in terms of etiology and pathology, clinical manifestations, laboratory and imaging study, preoperative preparation, surgical treatment (the application of antibiotics, the timing and key points of debridement, assistant therapy), postoperative wound care, nutritional support, surgical reconstruction and rehabilitation. This consensus is a reference for clinicians based on patient conditions.


Assuntos
Doenças do Ânus/diagnóstico , Doenças do Ânus/terapia , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/terapia , Antibacterianos/uso terapêutico , Doenças do Ânus/patologia , China , Consenso , Fasciite Necrosante/patologia , Humanos , Necrose , Períneo/patologia , Períneo/cirurgia
7.
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
8.
Rev Esp Salud Publica ; 932019 Jul 16.
Artigo em Espanhol | MEDLINE | ID: mdl-31293278

RESUMO

OBJECTIVE: The conduction of episiotomy is a questioned practice given the strong scientific evidence on its adverse effects. The study objectives were to know the episiotomy rate and its adaptation to the recommendations of the Ministry of Health, Consumption and Social Welfare and assess the associated factors. METHODS: It has been made a Observational, descriptive and transversal quantitative study, it was carried out in the university clinical hospital arrixaca. Data were collected from deliveries attended between January 1, 2016 and October 30, 2017, obtaining a sample of 10,630 women, registered in the SELENE computer program which is the clinical database of said hospital. To perform the data analysis, were used the SPSS statistical program and an Excel database. At the first level, it was carried out a descriptive analysis of the obstetric variables and, at a second level, the data were compared with the Ministry of Health indicators by means of a comparison of two proportions and the chi-square test. In order to estimate the Effect Size, the Cramer V was used for qualitative variables and the relative risk was calculated for each pair of qualitative variablesas a relative measure of the effect, to determine the strength of association between the variables. RESULTS: The episiotomy rate was 36.5%. When the birth started spontaneously, the percentage was 35.5%, when it was induced 47.2% and stimulated rate was 42.3%. The rate in eutocic deliveries was 20.6% and in instrumented was 95.25%. In primiparas, the episiotomy was 49.64% and in multiparas the conduction was 15.55%. Was observed a tendency of second-degree tears (43.40%), followed by first-degree (35.61%) and third-degree (19.81%) with episiotomy. CONCLUSIONS: The episiotomy rate in our study exceeds current recommendations. The variables associated with the performance of the episiotomy are induced or stimulated delivery, instrumentation and primiparity. There is a significant relationship between the practice of episiotomy and the greater degree of tear.


Assuntos
Episiotomia/estatística & dados numéricos , Obstetrícia/estatística & dados numéricos , Períneo/cirurgia , Centros Médicos Acadêmicos , Adulto , Feminino , Hospitais Universitários , Humanos , Paridade , Gravidez , Risco , Espanha , Universidades , Adulto Jovem
9.
Am J Surg ; 218(3): 462-466, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288926

RESUMO

BACKGROUND: The "weekend effect," whereby surgeries performed during weekend haven been associated with poorer postoperative outcomes. We explored whether Saturday elective procedures at our hospital were associated with poorer post-operative outcomes when compared with weekday surgeries. METHODS: A retrospective cohort study of patients undergoing elective surgery on the abdomen or perineum from 2008 to 2015 was performed. Procedures were classified by day (Group 1: Monday, Tuesday, Wednesday; Group 2: Saturday). Multivariate regression analyses were performed to determine group differences in procedure duration, length-of-stay (LOS) and complications. RESULTS: In adjusted analyses, there were no statistically significant differences between Group 1 (n = 816) and Group 2 (n = 269) procedures in terms of procedure duration (Group 2 - Group 1 = 13.6 min, p = .19), LOS (Group 2 - Group 1 = 1.9 days, p = .14) and complications (OR 0.58, p = .46). CONCLUSION: Saturday elective procedures were not associated with poorer outcomes.


Assuntos
Abdome/cirurgia , Plantão Médico/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos , Tempo de Internação/estatística & dados numéricos , Períneo/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
11.
Vet Surg ; 48(7): 1299-1308, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31282055

RESUMO

OBJECTIVE: To describe perioperative management, surgical procedure, and outcome in mares with third-degree perineal lacerations (TDPL) treated with a single-stage repair, the Utrecht repair method (URM). STUDY DESIGN: Retrospective study. ANIMALS: Twenty mares with TDPL. METHODS: Medical records of mares with TDPL reconstructed with a URM were reviewed for perioperative management; surgical outcome; and postoperative fertility, athletic performance, and complications. RESULTS: Mares ranged in age from 3.5 to 11 years. Long-term follow-up was available for 13 mares. Mean duration of follow-up was 9 years (median, 9.5; range, 2-215 months (17.9 years)). Standardized perioperative fasting and postoperative refeeding protocols were used. Only five mares received supportive gastric medication. Reconstruction of the rectovestibular shelf was successful in 18 of 20 mares. Two of 20 mares developed a small rectovestibular fistula after the initial repair, which was successfully repaired with a second surgery. Other postoperative complications were observed in 13 mares and consisted of mild postanesthetic myositis, facial nerve paralysis, esophageal obstruction, rectal obstipation, partial perineal dehiscence, and rectal or vestibular wind-sucking. Six of seven mares that were subsequently bred became pregnant. One mare was successfully used for embryo recovery, and five of six mares foaled without recurrence of a TDPL. Nine of 13 mares were used for riding at various levels. CONCLUSION: The alternative single-stage reconstruction for TDPL was successful in 18 of 20 mares after a single surgery. No major complications related directly to the technique were noted. CLINICAL SIGNIFICANCE: The URM is a valid alternative surgical technique for repairing TDPL in mares.


Assuntos
Doenças dos Cavalos/cirurgia , Cavalos/lesões , Lacerações/veterinária , Períneo/lesões , Anestesia Geral , Animais , Feminino , Lacerações/cirurgia , Períneo/cirurgia , Complicações Pós-Operatórias , Reto , Estudos Retrospectivos
13.
Am J Surg ; 218(1): 119-124, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31203950

RESUMO

PURPOSE: This study aimed to determine one-year outcomes and the impact of various factors on the need for readmission and reoperation following abdominoperineal resection (APR). METHOD: A multivariate logistic regression analysis was conducted to determine predictors of readmission and/or reoperation within one year of APR performed between January-2000 and December-2013. RESULTS: 536 patients were analyzed for whom the most common indication for surgery was rectal cancer(86.4%). Within one year of operation, 14.2% (n = 76) of patients have major (grade III/IV of Clavien-Dindo [CD]) and 26.1%(n = 140) of patients have minor complications (grade I/II of CD). Respective major and minor perineal wound complication(PWC) rates were 10.4% and 5.6%.Readmission and reoperation rates within 90 days following discharge were 25% and 8.8%, respectively. While PWC (n = 53,39.2%) and small bowel obstruction(n = 23,17%) were the most common causes of readmission within 90 days,PWC(n = 20,23.3%) and distant metastasis(n = 20,23.3%) were the main causes of long-term readmission(90-day to 1 year). CONCLUSION: Perineal wound complications were the most common cause of readmission and reoperation within one year of APR. Well-coordinated efforts aimed at decreasing the perineal wound morbidity may impact the need for readmission and reoperation.


Assuntos
Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Protectomia , Reoperação/estatística & dados numéricos , Fatores Etários , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Períneo/cirurgia , Neoplasias Retais/cirurgia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
14.
J Pediatr Surg ; 54(9): 1778-1781, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31204055

RESUMO

BACKGROUND: Posterior sagittal anorectoplasty (PSARP) is the most common surgical treatment for patients with anorectal malformations. Such patients are often subjected to prolonged nil per os (NPO), antibiotic use, and use of parenteral nutrition. Our aim was to review our institutional experience with patients undergoing PSARP using an accelerated standardized postoperative pathway. METHODS: Our hospital database was queried from 2004 to 2016 for patients diagnosed with imperforate anus who underwent a surgical procedure. Short term outcomes, hospital length of stay (LOS), and cost were evaluated. RESULTS: Sixty-three patients were identified during the study period. Of these patients, 34 (54.0%) had a fistula to the urogenital tract or had no demonstrable fistula and one cloaca and 29 (46.0%) had a fistula in the perineum. Approximately half of patients underwent primary PSARP, including 8 patients with fistulas located in the vestibule and vagina in girls and two with no apparent fistulas (12.7% of total cohort). Only two postoperative complications occurred: one superficial surgical site infection and one perineal wound dehiscence. Among the whole cohort, median LOS was 3 days. Median time to PO intake was 2 days, and median cost was $11,532. No complications occurred among the subset of 8 patients undergoing primary PSARP. CONCLUSION: Patients undergoing PSARP experienced similar outcomes compared to historical series, suggesting that the accelerated pathway for early refeeding and reduced use of antibiotics may be beneficial in appropriately selected patients. TYPE OF STUDY: Case series with no comparison group Level of evidence Level IV.


Assuntos
Canal Anal/cirurgia , Anus Imperfurado/cirurgia , Fístula/cirurgia , Períneo/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reto/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Resultado do Tratamento
15.
BMJ Case Rep ; 12(4)2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036739

RESUMO

Necrotising fasciitis (NF) is a potentially lethal spread of infection that is uncommonly seen within the province of surgery. Seen mostly in the extremities and the perineal regions, it has been reported rarely to involve the retroperitoneal space and presents with a spectrum of symptoms and signs as such. Literature supports classification of NF based on the microbes involved. Irrespective of the aetiology and the causative organism, NF remains a serious surgical emergency with high morbidity and mortality not only associated with the disease process itself, but also with the extensive surgical debridement it requires in its management along with antimicrobial administration. We present a case of such an infection found in the retroperitoneal space secondary to a perineal infection forming a rare presentation of this deadly process, and how it was successfully managed secondary to timely surgical intervention.


Assuntos
Fasciite Necrosante/diagnóstico por imagem , Períneo/microbiologia , Espaço Retroperitoneal/microbiologia , Administração Intravenosa , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Colostomia/métodos , Corynebacterium/isolamento & purificação , Desbridamento , Fasciite Necrosante/tratamento farmacológico , Fasciite Necrosante/cirurgia , Feminino , Humanos , Jejunostomia/métodos , Laparotomia/métodos , Períneo/diagnóstico por imagem , Períneo/patologia , Períneo/cirurgia , Espaço Retroperitoneal/patologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
16.
Int J Colorectal Dis ; 34(7): 1227-1232, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31123808

RESUMO

BACKGROUND: Following abdominoperineal resection (APR) for rectal cancer, perineal wound complications are common. Omental flap creation may allow for decreased morbidity. The aim of this study was to assess wound complications in rectal cancer patients undergoing APR with and without the addition of an omental flap. METHODS: The National Surgical Quality Improvement Program Proctectomy targeted database from 2016 to 2017 was used to identify all patients undergoing APR for rectal cancer. The primary outcomes were wound complications such as superficial site infection, deep wound infection, organ space infection, and wound dehiscence. RESULTS: There were 3063 patients identified. One hundred seventy-three (5.6%) patients underwent APR with an omental flap repair while 2890 (94.4%) patients underwent APR without an omental flap repair. Patients in both groups were similar with regard to age, gender, body mass index, American Society of Anesthesia class, and neoadjuvant cancer treatment (all p > 0.05). Patients who underwent an omental flap repair were significantly more likely to have a postoperative organ space infection (10.4% vs. 6.5%, p = 0.04). There was no significant difference in rates of superficial site infection, deep wound infection, wound dehiscence, or reoperation between the two patient groups. In multivariable analysis, omental flap creation was independently associated with organ space infection (OR 1.72, 95%CI 1.02-2.90, p = 0.04). CONCLUSIONS: This is the largest study to evaluate omental flap use in rectal cancer patients undergoing APR. Omental flaps are independently associated with organ space infection.


Assuntos
Abdome/cirurgia , Omento/cirurgia , Períneo/cirurgia , Neoplasias Retais/cirurgia , Retalhos Cirúrgicos/patologia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Deiscência da Ferida Operatória/etiologia , Infecção da Ferida Cirúrgica/etiologia , Resultado do Tratamento
18.
BMC Surg ; 19(1): 43, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023331

RESUMO

BACKGROUND: Long standing ostomy related complications such as parastomal hernia and stoma prolapse may be at a higher risk of developing spontaneous rupture and evisceration, especially in patients suffering from chronic cough. Such patients may need early refashioning of the stoma to prevent this serious complication. Parastomal evisceration is a very rare complication of stomas and to date, only few cases have been reported in the literature. CASE PRESENTATION: A 51 year old patient with chronic obstructive pulmonary disease (COPD) and extensive hidradenitis suppurativa of the perineum underwent a temporary defunctioning loop sigmoid colostomy and subsequent perineal skin excision and skin grafting. The ostomy was complicated by a parastomal hernia and stoma prolapse 6 weeks post operatively. Five months later he developed spontaneous rupture of parastomal hernia and evisceration of small bowel. Urgent surgery was done and reduction of small bowel loops and re-siting of the sigmoid colostomy was done. DISCUSSION AND CONCLUSIONS: Parastomal evisceration is an extremely rare life threatening stoma-related complication which requires urgent treatment.


Assuntos
Colostomia/efeitos adversos , Hérnia Incisional/patologia , Hérnia Incisional/cirurgia , Enteropatias/patologia , Enteropatias/cirurgia , Intestino Delgado/patologia , Intestino Delgado/cirurgia , Estomas Cirúrgicos/patologia , Hidradenite Supurativa/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Períneo/cirurgia , Doença Pulmonar Obstrutiva Crônica/complicações , Ruptura Espontânea , Transplante de Pele
19.
Tech Coloproctol ; 23(4): 367-372, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30982933

RESUMO

BACKGROUND: Abdominal colostomy has been reported as an option with good quality of life for patients requiring abdominoperineal resection (APR) for very low rectal cancer. Some young, compliant patients, nevertheless, are very motivated to avoid abdominal colostomy following APR. Spiral smooth muscle cuff perineal colostomy as neosphincter reconstruction can be a reasonable alternative. We have published before the results of a series of sphincter reconstruction in the conventional technique following APR. As we developed our technique for colorectal resection sphincter reconstruction, we also changed to a laparoscopic approach. The aim of the present study was to evaluate the feasibility of laparoscopic neosphincteric reconstruction and outline the aspects of the technique. METHODS: This retrospective study was conducted on 15 patients treated at our institution during a 6 year period for low rectal cancer by laparoscopic APR and spiral smooth muscle cuff perineal colostomy as sphincter reconstruction. At follow-up at a median time of 3.7 years (range 3-9 years) after surgery, patients underwent functional evaluation which included the modified Holschneider continence score (0-16), assessing consistency of stool, frequency, impulse, discrimination, warning period, incontinence for formed or fluid feces, soiling, wearing pads, drugs, enema where a score of 13-16 is associated with normal continence, as well as neosphincter manometry. RESULTS: Laparoscopic sphincter reconstruction was feasible in all 15 patients. Two of the fifteen patients (13%) required secondary colostomy in the long term due to neosphincter malfunction and neosphincter perforation after enema. Four of the remaining thirteen patients (30%) were partially continent according to the Holschneider continence score (HCS) with a score of 7-12. The other 9 (70%) were continent (HCS: 13-16). Neosphincter manometry showed a median resting pressure of 33 cm H2O (range 30-41 cm H2O) and a median squeeze pressure of 95 cm H2O (range 84-150 cm H2O). CONCLUSIONS: Laparoscopic sphincter reconstruction following APR is a feasible option offering an alternative to abdominal colostomy for selected patients.


Assuntos
Canal Anal/cirurgia , Laparoscopia/métodos , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias Retais/cirurgia , Abdome/cirurgia , Adulto , Idoso , Canal Anal/lesões , Canal Anal/fisiopatologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Períneo/cirurgia , Complicações Pós-Operatórias/etiologia , Protectomia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
20.
J Vet Med Sci ; 81(5): 703-706, 2019 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-30944273

RESUMO

We describe the successful surgical repair of third-degree perineal lacerations with rectovestibular fistulae in four cases using the single-stage modified Aanes method with purse-string suture of the vaginal vestibule and rectum. Fistulae formation and dehiscence of the repair were not observed after surgery. Two cows had five calves and one cow had four calves after surgery. The pregnant cows delivered normally. Additionally, there was no dehiscence of the suture line during the subsequent parturition. The breeding and fertility results obtained after the surgery are presented. According to the results of the present study, the modified Aanes method for the repair of third-degree perineal lacerations with rectovestibular fistulae appears to have a good prognosis for fertility following surgery in cows.


Assuntos
Doenças dos Bovinos/cirurgia , Complicações do Trabalho de Parto/veterinária , Períneo/lesões , Fístula Retovaginal/veterinária , Animais , Bovinos , Feminino , Fertilidade , Complicações do Trabalho de Parto/cirurgia , Períneo/cirurgia , Gravidez , Fístula Retovaginal/cirurgia
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