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1.
BMJ Case Rep ; 14(4)2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33811094

RESUMO

A young male in his early 30s presented to us with increasing swelling at the umbilicus, and an umbilical hernia was diagnosed. At laparoscopic intraperitoneal onlay mesh (IPOM) repair, an unexpected finding of a thin innocuous-looking fibrous film over the small bowel was noted. This finding presented a dilemma as to the probable pathology of this material, and a decision had to be made on whether laparoscopic IPOM could be continued. It was prudently decided to abandon the plan of placing a mesh intraperitoneally and an open repair of the umbilical hernia was done. In retrospect this was a wise decision, as, after 7 months he had to have a laparotomy for intestinal obstruction, when the classic thick fibrous encapsulating abdominal cocoon was seen. Hence here we have followed the evolution of the abdominal cocoon from its original asymptomatic phase to the classic encapsulating sclerosing peritonitis with probably laparoscopic gas insufflation being the precipitating factor.


Assuntos
Hérnia Ventral , Insuflação , Obstrução Intestinal , Laparoscopia , Hérnia Ventral/cirurgia , Humanos , Insuflação/efeitos adversos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Masculino , Peritônio/cirurgia , Telas Cirúrgicas
2.
Acta Cir Bras ; 36(1): e360108, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33605310

RESUMO

PURPOSE: Develop a 3D model for the simulation of laparoscopic inguinal hernioplasty transabdominal preperitoneal (TAPP). METHODS: This is an experimental study, 18 participants were selected, divided into three groups, experimental (GE) surgeons in training, control (GC) experienced surgeons and Shaw (GS) nonexperienced surgeons. The simulation in the 3D model was carried out in 6 sessions fulfilling the 5 stages. Opening the peritoneum with the creation of the preperitoneal space; identification of important structures; hernia identification and reduction; placement and fixation of the mesh in Cooper's ligament and closure of the peritoneum. RESULTS: In the 1st stage, the GE obtained an average of 1.25 ± 0.42 in the 1st session and 3.25 ± 0.62 in the 6th session (p = 0.05) and in the 5th stage 0.91 ± 0.29 in the first session. 1st session and 1.91 ± 0.29 in the 6th session (p = 0.001), with no significant difference between groups. The learning and skill curve in the SG represented 1.08 ± 0.29 1st and 3.50 ± 0.90 6th session (p = 0.001). CONCLUSIONS: The creation of a systematization of training in simulation applied to the three-dimensional model enabled gain in laparoscopic skills and underpinned its theoretical and practical foundations.


Assuntos
Hérnia Inguinal , Laparoscopia , Hérnia Inguinal/cirurgia , Herniorrafia , Humanos , Peritônio/cirurgia , Telas Cirúrgicas
4.
BMJ Case Rep ; 13(9)2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938652

RESUMO

The presence of a cerebrospinal fluid (CSF) shunt was previously considered a contra-indication to laparoscopic surgery, however, case reports appeared that describe laparoscopic surgery proceeding with no adverse outcomes in such patients. The majority of these reports relate to laparoscopic cholecystectomy. Here we present what we believe to be only the second report of a patient undergoing laparoscopic bowel resection in the presence of a lumbo-peritoneal shunt. With this case we aim to add to the evidence that more major laparoscopic procedures can be performed safely in the presence of CSF shunts and with a brief review of the current evidence, have suggested appropriate monitoring and precautionary measures for approaching these procedures.


Assuntos
Derivações do Líquido Cefalorraquidiano , Laparoscopia , Peritônio/cirurgia , Medula Espinal/cirurgia , Adulto , Feminino , Humanos , Vértebras Lombares
5.
BMC Surg ; 20(1): 172, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32736550

RESUMO

BACKGROUND: The bare area was reportedly formed by direct adhesion between the liver and diaphragm, meaning that the bare area lacked serosal components. This study aimed to analyze the structure of the bare area by an integrated study of surgical and laparoscopic images and pathological studies and describe surgical procedures focusing on the multilayered structure. METHODS: Several surgical specimens of hepatectomy were analyzed histologically to evaluate the macroscopic structure of the bare area. Laparoscopic images and cadaver anatomy of the bare area were also examined. RESULTS: The multilayered structure of the bare area comprised the liver, sub-serosal connective tissue, liver serosa, parietal peritoneum, retroperitoneal connective tissue, epimysium of the diaphragm, and diaphragm, in order from the liver to the diaphragm. The liver serosa and the parietal peritoneum fused with each other. This multilayered structure of the bare area is observed almost constantly. There are two layers in the dissection of the bare area in surgical procedures, an outer layer of the fused peritoneum (near the diaphragm) and an inner layer of the fused peritoneum (near the liver). Laparoscopic images enabled us to recognize the multilayered structure of the bare area. CONCLUSIONS: Histopathological findings showed the bare area to be a multilayered structure. In cases where tumors are located underneath the bare area, it could be important to dissect the bare area, with careful attention to its multilayered structure. Surgical dissection of the bare area in the outer layer of the fused peritoneum could allow a sufficient safety margin.


Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias do Colo/cirurgia , Hepatectomia , Neoplasias Hepáticas , Fígado/cirurgia , Peritônio/cirurgia , Idoso , Cadáver , Carcinoma Hepatocelular/patologia , Neoplasias do Colo/patologia , Diafragma/patologia , Diafragma/cirurgia , Dissecação , Feminino , Hepatectomia/métodos , Humanos , Laparoscopia , Fígado/anatomia & histologia , Fígado/patologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Peritônio/anatomia & histologia , Peritônio/patologia , Membrana Serosa/anatomia & histologia , Membrana Serosa/patologia , Membrana Serosa/cirurgia
6.
Zhonghua Fu Chan Ke Za Zhi ; 55(8): 521-528, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32854476

RESUMO

Objective: To introduce the technical essentials of cytoreduction surgery (CRS) with extensive peritonectomy ("rolling carpet" surgery) in stage Ⅲc epithelial ovarian cancer (EOC) and evaluate the feasibility and safety of the operation by analyzing the incidence of surgical complications and perioperative mortality. Methods: From December 2017 to December 2019, 30 patients with stage IIIc EOC who underwent "rolled carpet" CRS and 30 patients who underwent traditional CRS at the same period in Sichuan Cancer Hospital were collected. To summarize the key points of "rolled carpet" CRS operation technology, i.e. the extraperitoneal space was the cut path of ovarian cancer operation, and the tumor in the pelvic cavity was dissociated from the extraperitoneal space of the pelvic cavity. The tumor in the pelvic cavity and all the implants or potential metastases on the parietal peritoneum were removed completely. The clinical and pathological characteristics between the two groups were analyzed retrospectively, and the feasibility and safety of "rolling carpet" CRS were evaluated by comparing the operation related indexes and the occurrence of surgical complications between the two groups. Results: (1) Clinicopathological features: the age of patients in "rolling carpet" CRS group and traditional CRS group were respectively (55.4±9.6) and (54.6±9.5) years, and the median peritoneal cancer index (PCI) was 12 (range, 4-24) and 10 (range, 5-18), respectively. There were no statistical significance between the two groups (all P>0.05). (2) Operation related indexes: in the "rolled carpet" CRS group, all patients (100%, 30/30) were performed optimal CRS, reaching completeness of cytoreduction score (CC score), named CC-0 score, and there was no visible residual lesion after operation. While, in the traditional CRS group, 23 patients (77%, 23/30) reached CC-0 score, 5 cases (17%, 6/30) reached CC-1 score, 2 cases (7%, 2/30) reached CC-2 score, and there were statistical significance between the two groups (P=0.011). The median surgical time was 315 minutes (range, 252-446 minutes) vs 268 minutes (range, 215-372 minutes), the median intraoperative blood loss was 589 ml (range, 300-900 ml) vs 450 ml (range, 250-800 ml), the median ICU hospital stay time was 2 days (range, 1-7 days) vs 1 day (range, 0-5 days), the median total hospital stay time was 14 days (range, 9-17 days) vs 12 days (range, 7-15 days). There were no statistical significance between the two groups (all P>0.05). (3) Surgical complications: there were respectively 5 cases (17%, 5/30) and 3 cases (10%, 3/30) complications with Clavien-Dindo grading Ⅰ-Ⅱ, which was significant no difference between the "rolled carpet" CRS group and the traditional CRS groups (P>0.05). No re-operations were needed and the operative mortality was 0. Conclusion: It is safe and feasible to perform "rolled carpet" CRS in patients with advanced stage Ⅲc EOC with peritoneum implantation and metastasis, which could achieve optimal CRS, and has an acceptable incidence of perioperative complications, no perioperative death.


Assuntos
Carcinoma Epitelial do Ovário/cirurgia , Procedimentos Cirúrgicos de Citorredução/métodos , Neoplasias Ovarianas/cirurgia , Adulto , Idoso , Carcinoma Epitelial do Ovário/patologia , Feminino , Humanos , Hipertermia Induzida , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Neoplasias Peritoneais/patologia , Neoplasias Peritoneais/cirurgia , Peritônio/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
7.
Arch Gynecol Obstet ; 302(4): 793-799, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32653946

RESUMO

PURPOSE: Our aim is to present a review on childbearing following CRS and HIPEC for peritoneal malignancy. METHODS: A review of the English literature, up to December 2019, was conducted, using PubMed/MEDLINE, EmBase and Google Scholar bibliographic databases, following the MOOSE guidelines. The terms "Cytoreductive Surgery", "Hyperthermic Intraperitoneal Chemotherapy", "Peritoneal Carcinomatosis", "Pregnancy", "Fertility Preservation", "Conception" were used. All study designs were eligible for inclusion in the final analysis. RESULTS: In total, 7 studies (5 case reports and 2 case series) were included in the final analysis, reporting on 14 successful pregnancies after CRS and HIPEC. The mean age of patients at the time of CRS/HIPEC was 28.8 ± 5.9 years (range 18-36), while the mean interval between CRS/HIPEC and pregnancy was 29.6 ± 20.3 months (range 9-80 months). Nine patients were treated for pseudomyxoma peritonei, four for primary peritoneal mesothelioma and one for endocrine carcinoma. Mean Peritoneal Carcinomatosis Index was 9.8 ± 7.8 (range 1-26). All patients underwent fertility-sparing CRS (preservation of at least one ovary and the uterus). In 12 cases, conception was spontaneous, whereas two pregnancies were achieved through in-vitro fertilization. One patient developed gestational hypertension, while two labors were preterm. Mean disease-free survival was 64.1 months (range 24-106 months). CONCLUSION: A successful pregnancy is feasible in selected patients, after CRS and HIPEC. Assisted reproduction techniques (IVF using frozen oocytes or frozen embryos, ovarian tissue cryopreservation, preoperative treatment with GnRH analogs) should be discussed pre-operatively with the patient, without, however, compromising overall survival or risking locoregional recurrence.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Preservação da Fertilidade , Hipertermia Induzida/efeitos adversos , Neoplasias Peritoneais/terapia , Peritônio/cirurgia , Técnicas de Reprodução Assistida , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Pré-Escolar , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução/métodos , Intervalo Livre de Doença , Neoplasias das Glândulas Endócrinas , Feminino , Humanos , Hipertermia Induzida/métodos , Lactente , Neoplasias Pulmonares/patologia , Masculino , Mesotelioma/patologia , Pessoa de Meia-Idade , Neoplasias Peritoneais/patologia , Pseudomixoma Peritoneal/patologia , Pseudomixoma Peritoneal/terapia , Resultado do Tratamento
8.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 629-633, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683821

RESUMO

Membrane anatomy is the anatomy of mesentery in broad sense and its beds, which was merged from clinical results of surgical practice, optic observation and traditional theories contradiction or omission. Membrane anatomy is not only a plane, but also a body or bloc which is surrounded by fascia and serous membrane. It is not only fascia, but also a channel or pathway, in which the life event occurred. It is not only mesentery anatomy, but included mesentery beds, on which the mesentery was lied, even buried in. Following the new version of this anatomy map, surgical hazard during operation and postoperative oncological recurrence will be decreased simultaneously. And, following the definition of the mesentery in broad sense, new mesenteries will be discovered under macro surgery, which will optimize surgical operation and get better surgical and oncological results.


Assuntos
Fáscia/anatomia & histologia , Mesentério/anatomia & histologia , Fáscia/patologia , Humanos , Mesentério/patologia , Mesentério/cirurgia , Peritônio/anatomia & histologia , Peritônio/patologia , Peritônio/cirurgia
9.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 643-647, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683823

RESUMO

The theory of membrane anatomy is now widely accepted due to the observation of fine anatomical structure with the help of laparoscopic magnifying effect. From the perspective of systematic anatomy, the mesentery is considered as an integral organ in the theory of mesenteric anatomy. Interfascial anatomy belongs to regional anatomy, which focuses on the guiding significance of fascial space for operation. The theory of membrane anatomy belongs to surgical anatomy or applied anatomy, which emphasizes the anatomy of membrane and mesangial bed, and reveals the existence of 'metastasis V' in the mesentery. It is considered that the essence of membrane anatomy operation is to prevent cancer leakage. Various theories of membrane anatomy seek common ground while reserving differences, complement each other, and upgrade iteratively. They help to explain the structure and function of membrane from different perspectives and they are of great benefit to improve the quality of operations. Thus, they should be treated in an eclectic manner.


Assuntos
Fáscia/anatomia & histologia , Mesentério/anatomia & histologia , Fáscia/patologia , Humanos , Laparoscopia , Mesentério/patologia , Mesentério/cirurgia , Modelos Biológicos , Metástase Neoplásica , Peritônio/anatomia & histologia , Peritônio/patologia , Peritônio/cirurgia
10.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 661-665, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683827

RESUMO

Membrane anatomy refers to the fascia and/or serosa enveloping the organs and their blood vessels and hanging on the posterior wall of the body cavity, which emphasizes the entirety and integrity of the membrane during operation. The concept can also be applied to most surgical operations. This article mainly expounds the application of the concept of membrane anatomy in the process of laparoscopic sleeve gastrectomy, which is embodied in the key steps of separating the greater omentum, mobilizing the fundus, mobilizing the posterior wall of the stomach, cutting the greater curvature of the stomach, reinforcing the staple line of the stomach, and suturing the greater omentum with staple line, in order to make the laparoscopic sleeve gastrectomy more accurate and precise with less bleeding, fewer complications and faster postoperative recovery.


Assuntos
Gastrectomia/métodos , Estômago/cirurgia , Fáscia/anatomia & histologia , Humanos , Laparoscopia , Mesentério/anatomia & histologia , Mesentério/cirurgia , Omento/cirurgia , Peritônio/anatomia & histologia , Peritônio/cirurgia , Grampeamento Cirúrgico/métodos , Suturas
11.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 670-675, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683829

RESUMO

The introduction of total mesorectal excision and wider use of laparoscopic surgery pushed the field of colorectal surgery into an era of interfasical dissection. The Japanese suggestion of fascial arrangement of the trunk in a multilaminar, symmetrical and parallel way helps in better understanding of fascial relationship and interfascial planes surrounding the colon and the rectum. However, different interpretations of the multilayer retroperitoneal fascial relationship, complexity of fascial structures within the pelvis and dense adhesion between two apposed fasciae at special points make it still challenging for the surgeon to decide on the precise interfascial plane for colorectal mobilization. Small vessels on fasica propria of the rectum and various retroperitoneal fascia, especially ureterohypogastric fascia show distinctive features. The root of small vessels on fascia propria of the rectum helps to identify the anterolateral and posterolateral interfascial plane in the middle and low rectum. The longitudinal trajectory of small vessel on ureterohypogastric fascia and scarcity interfascial vascular communication between mesocolic and retroperitoneal fascia help the surgeon to find and stay in the interfacial plane during colorectal mobilization. More knowledge of fascial and interfascial plane will certainly help achieve better mesocolic mesorectal integrity and reduce the risk of injuries to autonomic nerves. More anatomical, histological and embryological studies are warranted with respect to relationship between small vessels and fasciae.


Assuntos
Neoplasias do Colo/cirurgia , Fáscia/anatomia & histologia , Mesentério/cirurgia , Neoplasias Retais/cirurgia , Colectomia/efeitos adversos , Colectomia/métodos , Colo/anatomia & histologia , Colo/cirurgia , Dissecação , Fáscia/irrigação sanguínea , Humanos , Mesentério/anatomia & histologia , Mesentério/irrigação sanguínea , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/prevenção & controle , Peritônio/anatomia & histologia , Peritônio/irrigação sanguínea , Peritônio/cirurgia , Protectomia/efeitos adversos , Protectomia/métodos , Reto/anatomia & histologia , Reto/cirurgia
12.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 683-688, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683830

RESUMO

Objective: To explore the effects of the application of membrane anatomy concept in sleeve gastrectomy on postoperative nausea and vomiting (PONV) in patients with obesity or metabolic diseases. Methods: A retrospective cohort study was conducted. Clinical data of 88 patients with obesity or metabolic diseases who underwent laparoscopic sleeve gastrectomy in The First Affiliated Hospital of Jinan University from September 2018 to June 2019 were retrospectively analyzed. Forty patients underwent sleeve gastrectomy with membrane anatomy concept as membrane anatomy group, and the other 48 patients underwent traditional sleeve gastrectomy as traditional operation group. There were no significant differences in baseline data between the two groups (all P>0.05). The PONV score of and the times of antiemetic drugs used during 0-6 h and 6-24 h after operation were compared between the two groups. Higher PONV represents more serious nause and vomiting, the score ≥5 is defined as clinical significant PONV. Results: All patients of the two groups successfully completed the operation, and there was no conversion to open, reoperation, and operation-related death. The intraoperative blood loss in the membrane anatomy group was significantly less than that in the traditional surgery group [median: 5.0 (5.0, 5.8) ml vs. 10.0 (5.0, 10.0) ml, Z=-3.265, P=0.001]. There were no significant differences between the two groups in terms of operative time, postoperative hospital stay, gastroesophageal reflux, pain score and postoperative complications (all P>0.05). There was no postoperative bleeding or gastric leakage in either groups. There were no significant differences in PONV score, incidence of clinically significant PONV and use of antiemetics 0-6 h after operation between two groups (all P>0.05). From 6 to 24 hours after operation, compared with traditional surgery group, the membrane anatomy group had lower PONV score (4.6±0.9 vs. 5.1±0.7, t=-2.192, P=0.007), lower incidence of clinically significant PONV [55.0% (22/40) vs. 83.3% (40/48), χ(2)=8.414, P=0.004] and less use of antiemetics [3 times: 10.0% (4/40) vs. 27.1% (13/48), Z=-2.880, P=0.004]. Postoperative follow-up ranged from 1 to 6 months (median 3), 32 cases in membranous anatomy group and 38 cases in the traditional operation group were followed up. One case in the traditional operation group received symptomatic treatment in the local hospital due to functional intestinal obstruction 1 month after surgery and was discharged after recovery. The remaining patients had no postoperative complications and were not readmitted to hospital. Conclusion: Sleeve gastrectomy based on membrane anatomy in the treatment of patients with obesity or metabolic syndrome can make surgical procedure more precise and meticulous, reduce the intraoperative bleeding and the incidence of PONV.


Assuntos
Gastrectomia/efeitos adversos , Gastrectomia/métodos , Doenças Metabólicas/cirurgia , Obesidade/cirurgia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Perda Sanguínea Cirúrgica/prevenção & controle , Humanos , Laparoscopia , Mesentério/anatomia & histologia , Mesentério/cirurgia , Peritônio/anatomia & histologia , Peritônio/cirurgia , Náusea e Vômito Pós-Operatórios/etiologia , Estudos Retrospectivos
13.
Khirurgiia (Mosk) ; (6): 24-30, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32573528

RESUMO

OBJECTIVE: To study and systematize clinical symptoms of tuberculous perivisceritis, to clarify diagnostic value of laboratory and instrumental survey in these patients and to identify the features of surgical treatment. MATERIAL AND METHODS: There were 8 patients with tuberculous perivisceritis. Examination included computed tomography of the abdominal cavity and chest, ultrasound, laparoscopy. All patients underwent surgical treatment with histological, cytological, microbiological and molecular genetic analysis of peritoneal exudate and biopsy of peritoneal specimens. RESULTS: Clinical picture of tuberculous perivisceritis is variable and non-specific. Periods of exacerbation are replaced by periods of prolonged remission. The complex of radiological survey used in verification of perivisceritis does not allow accurate determining the nature of disease. However, peritoneal tuberculosis may be suspected as a rule considering signs of thickening of the peritoneum. Objective confirmation of perivisceritis is possible only during surgical intervention. In this case, etiological factor can be established only after a thorough histological examination of resected fibrous capsule. CONCLUSION: Clinical picture of tuberculous perivisceritis does not have specific symptoms. The disease is characterized by prolonged and undulating course. Acute peritonitis and acute intestinal obstruction may be suspected during exacerbation of the pathological process. Laparotomy followed by complete excision of fibrous capsule and adhesiolysis is preferred.


Assuntos
Peritônio/cirurgia , Peritonite Tuberculosa/diagnóstico , Peritonite Tuberculosa/cirurgia , Aderências Teciduais/cirurgia , Doença Aguda , Fibrose/microbiologia , Fibrose/cirurgia , Humanos , Obstrução Intestinal/etiologia , Peritônio/microbiologia , Peritônio/patologia , Aderências Teciduais/microbiologia
14.
J Surg Oncol ; 122(1): 85-95, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32436240

RESUMO

Over the past decade, there has been a considerable increase in the utilization of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the management of patients with peritoneal metastases. This is due to improved safety and favorable oncologic outcomes, including curative potential. CRS/HIPEC has a steep learning curve and requires familiarity with peritonectomy procedures. This review will outline the technical aspects and learning curve of CRS/HIPEC.


Assuntos
Procedimentos Cirúrgicos de Citorredução/métodos , Hipertermia Induzida/métodos , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/terapia , Humanos , Curva de Aprendizado , Peritônio/cirurgia
15.
Dtsch Arztebl Int ; 117(14): 243-250, 2020 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-32449896

RESUMO

BACKGROUND: Lymphocele is the most common complication arising after pelvic lymph node dissection (PLND) in the setting of robot-assisted radical prostatectomy (RARP). The only data available until now on the utility of a peritoneal flap to prevent lymphocele were retrospectively acquired. METHODS: A randomized, controlled, multi-center trial with blinded assessment of endpoints was carried out on 232 patients with prostate cancer who underwent RARP with PLND. The patients in the intervention group were given a peritoneal flap; in the control group, surgery was performed without this modification. The two joint primary endpoints were the rates of symptomatic lymphocele during the same hospitalization as the operative procedure (iT1) and within 90 days of surgery (iT2). The secondary endpoints were lymphocele volume, the need for treatment of lymphocele, complications requiring an intervention, and the degree of postoperative stress incontinence. German Clinical Trials Register number: DRKS00011115. RESULTS: The data were evaluated in an intention-to-treat analysis, which, in this trial, was identical to an as-treated analysis. 108 patients (46.6%) were allotted to the intervention group. There were no statistically significant intergroup differences with respect to any clinical or histopathological criteria. A median of 16 lymph nodes were removed (interquartile range, 11-21). A symptomatic lymphocele arose in 1.3% (iT1) and 9.1% (iT2) of the patients, without any statistically significant difference between the two trial groups (p = 0.599 and p = 0.820, respectively). Nor did the groups differ significantly with respect to lymphocele volume (p = 0.670 on hospital discharge [T1], p = 0.650 90 days after surgery [T2]) or the type and frequency of need for subsequent surgical intervention (p = 0.535; iT2). 81.5% of all patients (n = 189) had no complications at all in the first three months after surgery. Nor were there any intergroup differences at 90 days with respect to the degree of stress urinary incontinence (p = 0.306) or complications (p = 0.486). CONCLUSION: A peritoneal flap after RARP was not found to influence the rate of postoperative lymphocele, whether asymptomatic or requiring treatment.


Assuntos
Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos , Retalhos Cirúrgicos , Idoso , Humanos , Linfocele/epidemiologia , Masculino , Pessoa de Meia-Idade , Peritônio/cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
17.
Khirurgiia (Mosk) ; (3): 29-34, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32271734

RESUMO

OBJECTIVE: Experimental assessment of the effect of modified and unmodified surgical suture material on abdominal adhesive process. MATERIAL AND METHODS: The study was performed on male rats of the Wistar subpopulation. There were 5 animals in each group. In all animals, midline abdominal incision was followed by suturing the parietal peritoneum with modified and unmodified suture material. All animals were euthanized with carbon dioxide vapors in 14 days after surgery. Macro- and microscopic assessment of severity of abdominal adhesive process was carried out. Two types of preparation of excised complexes 'peritoneum-suture material-adhesion' were applied for histological examination: paraffin sections and embedding in epoxy resin. Specimens were stained by Van Gieson and with methylene blue solution. Histological specimens were examined using Axio Imager A1 light microscope (Zeiss, Germany). RESULTS: Polypropylene filaments result extensive adhesions occupying about 75% of the area. Adhesions have a dense structure with signs of vascularization. Modification of suture material with solution of polyhydroxybutyrate/hydroxyvalerate and heparin reduce severity of adhesions. The use of modified suture material was followed by adhesions with more loose structure, no signs of vascularization. Adhesions occupied less than 25% of the area. Histological examination of excised complexes 'peritoneum-suture material-adhesion' revealed accumulation of inflammatory cells around the unmodified suture material, while there were no signs of tissue inflammatory process around the modified sutures. CONCLUSION: Application of polyhydroxybutyrate/hydroxyvalerate and heparin on the surface of surgical sutures is an effective method for prevention of abdominal adhesions.


Assuntos
Materiais Biocompatíveis/efeitos adversos , Heparina/administração & dosagem , Poliésteres/administração & dosagem , Polipropilenos/efeitos adversos , Suturas/efeitos adversos , Aderências Teciduais/prevenção & controle , Animais , Materiais Biocompatíveis/administração & dosagem , Materiais Revestidos Biocompatíveis/administração & dosagem , Materiais Revestidos Biocompatíveis/efeitos adversos , Modelos Animais de Doenças , Heparina/efeitos adversos , Masculino , Neovascularização Patológica/etiologia , Neovascularização Patológica/prevenção & controle , Peritônio/irrigação sanguínea , Peritônio/patologia , Peritônio/cirurgia , Poliésteres/efeitos adversos , Polipropilenos/administração & dosagem , Ratos , Ratos Wistar , Aderências Teciduais/etiologia , Aderências Teciduais/patologia
18.
JSLS ; 24(1)2020.
Artigo em Inglês | MEDLINE | ID: mdl-32265583

RESUMO

Background: The development of devices that can be used to tract organs or other structures and secure an appropriate surgical field during laparoscopic surgery is clinically important. Methods: We developed a novel traction stitch, the Laptraction, which can be used to achieve peritoneal traction during laparoscopic surgery. This study examines the utility and safety of using the Laptraction to achieve peritoneal traction during laparoscopic transperitoneal paraaortic lymphadenectomy (as part of comprehensive staging surgery) in seven endometrial cancer patients. Results: Peritoneal traction was successfully and safely achieved using the Laptraction in all cases, without causing any complications. In all cases, time to deploy Laptraction was <5 min. Conclusions: Laptraction, a newly developed stitch, allows peritoneal traction to be achieved easily and facilitates the identification of essential landmarks during robotic-assisted laparoscopic hysterectomy, which helps to save time and prevent surgical complications.


Assuntos
Laparoscopia/métodos , Excisão de Linfonodo/métodos , Peritônio/cirurgia , Tração/instrumentação , Adulto , Idoso , Aorta , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Tração/métodos , Resultado do Tratamento
19.
Phytomedicine ; 69: 153193, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32120245

RESUMO

BACKGROUND: Although mechanical barriers and modern surgical techniques have been developed to prevent postoperative adhesion formation, high incidence of adhesions still represents an important challenge in abdominal surgery. So far, there has been no available therapeutic drug in clinical practice. PURPOSE: In this study, we explored the efficacy of sodium aescinate (AESS) treatment against postoperative peritoneal adhesions, the potential molecular mechanism was also investigated. STUDY DESIGN AND METHODS: Sixty male Sprague-Dawley rats were randomly divided into 6 groups for the study: the blank, vehicle, positive control and three AESS administration groups (0.5, 1 and 2 mg/kg/d, intravenous administration for 7 days). Adhesions were induced by discretely ligating peritoneal sidewall. An IL-1ß-induced HMrSV5 cell model was also performed to explore possible functional mechanism. RESULTS: The results indicated that the incidence and severity of peritoneal adhesions were significantly lower in the AESS-treated groups than that in the vehicle and positive control group. AESS-treated groups showed that the secretion, activity, and expression of tPA in rat peritoneum were notably increased. The FIB levels in rat plasma were decreased. The immunohistochemical staining analysis demonstrated that collagen I and α-SMA deposition were significantly attenuated in AESS-treated peritoneal tissues. Besides, we found that AESS treatment reduced the protein levels of p-MYPT1. To further explore the mechanisms of AESS, both activator and inhibitors of RhoA/ROCK pathway were employed in this study. It was found that AESS-induced up-regulation of tPA was reversed by activator of ROCK, but the effects of ROCK inhibitors were consistent with AESS. CONCLUSION: Taken together, the findings of in vivo and in vitro experiments proved that AESS could significantly suppress postoperative peritoneal adhesion formation through inhibiting the RhoA/ROCK signaling pathway. Our researches provide important pharmacological basis for AESS development as a potential therapeutic agent on peritoneal adhesions.


Assuntos
Doenças Peritoneais/tratamento farmacológico , Complicações Pós-Operatórias/tratamento farmacológico , Saponinas/farmacologia , Triterpenos/farmacologia , Proteínas rho de Ligação ao GTP/metabolismo , Quinases Associadas a rho/metabolismo , Animais , Linhagem Celular , Colágeno Tipo I/metabolismo , Fibrinogênio/metabolismo , Humanos , Interleucina-1beta/metabolismo , Interleucina-1beta/farmacologia , Masculino , Doenças Peritoneais/patologia , Doenças Peritoneais/prevenção & controle , Peritônio/citologia , Peritônio/cirurgia , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/prevenção & controle , Ratos Sprague-Dawley , Transdução de Sinais/efeitos dos fármacos , Aderências Teciduais
20.
Jpn J Clin Oncol ; 50(5): 574-580, 2020 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-32115631

RESUMO

OBJECTIVE: The purpose of this systematic review is to assess and compare the efficacy of surgical treatment for patients with asymptomatic extra-peritoneal desmoid-type fibromatosis to the wait-and-see policy by evaluating (1) the exacerbation rate (exacerbation; recurrence after surgery or progressive disease following non-surgical treatment) and (2) treatment-associated complications in extra-peritoneal desmoid-type fibromatosis. METHODS: We evaluated documents published between 1 January 1990 and 31 August 2017. The risk of bias in the selected literature was analyzed using the Cochrane Collaboration Risk of Bias Tool. Quality of evidence was evaluated using Grading of Recommendation, Assessment, Development and Evaluation approach. RESULTS: One prospective cohort study, four case-control studies and five case series studies were identified. Meta-analysis was performed to evaluate the exacerbation rate after treatment on one prospective cohort study and four case-control studies. In comparing surgical and non-surgical treatments, the exacerbation rate was significantly higher in the surgical treatment group (odds ratio: 1.32, 95% confidence interval 1.01-1.73, P = 0.05). However, in the case series study, the recurrence rate was 23.4% for the surgical treatment group, while the progressive disease rate was 28.1% for the non-surgical treatment group. The postoperative complication rates associated with surgical treatment in the two studies were 20.8 and 17.2%, respectively. CONCLUSIONS: When considering the exacerbation rate, non-surgical treatment might be appropriate for asymptomatic patients with extra-peritoneal desmoid-type fibromatosis. However, if patients with tumor-related symptoms opt for surgery, including those who face difficulties due to the presence of tumors, it is important to fully explain to them the possibility that the recurrence rate and treatment-associated functional failures may increase depending on the site of occurrence.


Assuntos
Fibromatose Agressiva/cirurgia , Peritônio/cirurgia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Estudos Prospectivos , Viés de Publicação , Risco
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