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1.
BMC Surg ; 21(1): 135, 2021 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-33726727

RESUMO

BACKGROUND: The best treatment for perforated colonic diverticulitis with generalized peritonitis is still under debate. Concurrent strategies are resection with primary anastomosis (PRA) with or without diverting ileostomy (DI), Hartmann's procedure (HP), laparoscopic lavage (LL) and damage control surgery (DCS). This review intends to systematically analyze the current literature on DCS. METHODS: DCS consists of two stages. Emergency surgery: limited resection of the diseased colon, oral and aboral closure, lavage, vacuum-assisted abdominal closure. Second look surgery after 24-48 h: definite reconstruction with colorectal anastomosis (-/ + DI) or HP after adequate resuscitation. The review was conducted in accordance to the PRISMA-P Statement. PubMed/MEDLINE, Cochrane central register of controlled trials (CENTRAL) and EMBASE were searched using the following term: (Damage control surgery) AND (Diverticulitis OR Diverticulum OR Peritonitis). RESULTS: Eight retrospective studies including 256 patients met the inclusion criteria. No randomized trial was available. 67% of the included patients had purulent, 30% feculent peritonitis. In 3% Hinchey stage II diverticulitis was found. In 49% the Mannheim peritonitis index (MPI) was greater than 26. Colorectal anastomosis was constructed during the course of the second surgery in 73%. In 15% of the latter DI was applied. The remaining 27% received HP. Postoperative mortality was 9%, morbidity 31% respectively. The anastomotic leak rate was 13%. 55% of patients were discharged without a stoma. CONCLUSION: DCS is a safe technique for the treatment of acute perforated diverticulitis with generalized peritonitis, allowing a high rate of colorectal anastomosis and stoma-free hospital discharge in more than half of the patients.


Assuntos
Doença Diverticular do Colo , Peritonite , Anastomose Cirúrgica , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/cirurgia , Humanos , Peritonite/complicações , Peritonite/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
3.
Arq Bras Cir Dig ; 33(3): e1546, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33470376

RESUMO

BACKGROUND: Mortality after emergency surgery in randomized controlled trials. The Hartmann procedure remains the treatment of choice for most surgeons for the urgent surgical treatment of perforated diverticulitis; however, it is associated with high rates of ostomy non-reversion and postoperative morbidity. AIM: To study the results after the Hartmann vs. resection with primary anastomosis, with or without ileostomy, for the treatment of perforated diverticulitis with purulent or fecal peritonitis (Hinchey grade III or IV), and to compare the advantages between the two forms of treatment. METHOD: Systematic search in the literature of observational and randomized articles comparing resection with primary anastomosis vs. Hartmann's procedure in the emergency treatment of perforated diverticulitis. Analyze as primary outcomes the mortality after the emergency operation and the general morbidity after it. As secondary outcomes, severe morbidity after emergency surgery, rates of non-reversion of the ostomy, general and severe morbidity after reversion. RESULTS: There were no significant differences between surgical procedures for mortality, general morbidity and severe morbidity. However, the differences were statistically significant, favoring primary anastomosis in comparison with the Hartmann procedure in the outcome rates of stoma non-reversion, general morbidity and severe morbidity after reversion. CONCLUSION: Primary anastomosis is a good alternative to the Hartmann procedure, with no increase in mortality and morbidity, and with better results in the operation for intestinal transit reconstruction.


Assuntos
Colo Sigmoide/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Diverticulite/complicações , Diverticulite/cirurgia , Perfuração Intestinal/cirurgia , Peritonite/etiologia , Anastomose Cirúrgica/métodos , Colostomia/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Diverticulite/patologia , Humanos , Ileostomia/efeitos adversos , Perfuração Intestinal/patologia , Peritonite/cirurgia , Complicações Pós-Operatórias , Resultado do Tratamento
4.
Updates Surg ; 73(2): 753-762, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33394354

RESUMO

The COVID-19 pandemic has raised concerns about the negative impact of the fear of contagion on people's willingness to seek medical care and the subsequent effects on patients' prognosis. To date, not much is known about the outcomes of acute surgical diseases in this scenario. The aim of this multicenter observational study is to explore the effects of COVID-19 outbreak on the outcomes of patients who underwent surgery for peritonitis. Patients undergoing surgery for secondary peritonitis during the first COVID-19 surge in Italy (March 23-May 4, 2020-COVID period group) were compared with patients who underwent surgery during the same time interval of year 2019 (no-COVID period group). The primary endpoint was the development of postoperative complications. Logistic regression analysis was conducted to identify predictors of complications. Of the 332 patients studied, 149 were in the COVID period group and 183 were in the no-COVID period group. Patients in the COVID period group had an increased frequency of late presentations to the emergency departments (43% vs. 31.1%; P = 0.026) and a higher rate of postoperative complications (35.6% vs. 18%; P < 0.001). The same results were found in the subset analysis of patients with severe peritonitis at surgical exploration. The ASA score, severity of peritonitis, qSOFA score, diagnosis other than appendicitis, and COVID period resulted independent predictors of complications. During the COVID-19 pandemic patients with peritonitis had a higher rate of complicated postoperative courses, weighing on hospital costs and assistance efforts already pressured by the ongoing sanitary crisis.


Assuntos
/epidemiologia , Peritonite/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adulto , Emergências , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estudos Prospectivos
6.
Khirurgiia (Mosk) ; (7): 12-17, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32736458

RESUMO

OBJECTIVE: To determine the value of membrane protective effect in intestine and liver cells for the effectiveness of minimally invasive surgery for acute peritonitis. MATERIAL AND METHODS: Patients with acute peritonitis undergoing laparoscopic (n=60) and open (n=50) surgery are analyzed. Functional characteristics of liver and bowel, disorders of homeostasis were evaluated in early postoperative period. RESULTS: Reduced negative impact of surgical aggression on the state of liver and intestine is essential to improve treatment outcomes in patients with acute peritonitis undergoing minimally invasive surgery. Fast recovery of intestine inevitably results reduced release of endotoxins while restoration of liver function is associated with rapid elimination of these toxins. These processes prevent severe intoxication and facilitate accelerated recovery. Functional restoration of liver and bowel is associated with reduced oxidative stress during laparoscopic operations. It is also important because peritonitis causes activation of free-radical processes per se. Therefore, an additional source of oxidative phenomena is extremely undesirable in these cases. CONCLUSION: Laparoscopic surgery for acute peritonitis minimizes surgical aggression and is associated with more favorable recovery of liver and bowel function. Undoubtedly, these findings should be considered to choose surgical approach in this severe category of patients.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Peritonite/cirurgia , Doença Aguda , Membrana Celular/metabolismo , Membrana Celular/patologia , Membrana Celular/fisiologia , Humanos , Mucosa Intestinal/metabolismo , Intestinos/patologia , Intestinos/fisiopatologia , Laparoscopia/efeitos adversos , Laparotomia/efeitos adversos , Fígado/metabolismo , Fígado/patologia , Fígado/fisiopatologia , Estresse Oxidativo/fisiologia , Peritonite/metabolismo , Peritonite/fisiopatologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Recuperação de Função Fisiológica , Toxinas Biológicas/biossíntese , Toxinas Biológicas/metabolismo
7.
J Comput Assist Tomogr ; 44(5): 780-783, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842059

RESUMO

INTRODUCTION: Vernix caseosa peritonitis (VCP) is a rare peripartum complication secondary to the introduction of fetal vernix into the maternal peritoneal cavity. Vernix caseosa peritonitis typically manifests a few hours to days after a cesarian section and is often initially misdiagnosed as a more common disease process resulting in delayed diagnosis. We report the computed tomography (CT) findings in 2 patients with VCP and reviewed the previously reported CT findings of VCP. CASES: Two patients, aged 17 and 24 years, presented with signs and symptoms of peritonitis within days of undergoing a cesarian section. In both cases, CT scans of the abdomen and pelvis demonstrated ascites and multiple small, well-defined, peripherally enhancing, cystic peritoneal nodules which were most prominent around the liver and became larger and more numerous over time. Antibiotic therapy was not effective, subsequent laparoscopic peritoneal biopsy demonstrated VCP, and patients were successfully treated with lavage and the addition of intravenous steroids. CONCLUSIONS: Vernix caseosa peritonitis is an underrecognized disorder that is most often mistaken for other more common causes of peritonitis. In the setting of peripartum peritonitis, the CT findings of ascites with multiple small, well-defined, peripherally enhancing, cystic peritoneal nodules, especially adjacent to the liver, which grow in size and number strongly suggests VCP.


Assuntos
Reação a Corpo Estranho/diagnóstico por imagem , Peritonite/diagnóstico por imagem , Complicações na Gravidez/diagnóstico por imagem , Verniz Caseoso , Abdome/diagnóstico por imagem , Adolescente , Adulto , Cesárea/efeitos adversos , Cistos/diagnóstico por imagem , Cistos/patologia , Cistos/cirurgia , Feminino , Reação a Corpo Estranho/patologia , Reação a Corpo Estranho/cirurgia , Humanos , Laparoscopia , Peritonite/patologia , Peritonite/cirurgia , Gravidez , Complicações na Gravidez/patologia , Complicações na Gravidez/cirurgia , Tomografia Computadorizada por Raios X , Verniz Caseoso/citologia , Verniz Caseoso/imunologia , Adulto Jovem
8.
Surgery ; 168(4): 676-683, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32703678

RESUMO

BACKGROUND: Emergency surgical services often encounter patients with generalized peritonitis. Difficult perioperative decisions impact morbidity, mortality, cost, and utilization of hospital resources. The ability to preoperatively predict patient nonsurvival despite surgical intervention using clinical physiologic indicators was the aim of this study and would be helpful in counseling patients/families. METHODS: A retrospective cohort from an institutional database was queried for nontrauma patients with peritonitis undergoing emergency laparotomy from 2012 to 2016. Time to mortality after surgery was compared: early (≤72 hours) versus late (>72 hours) and no death. RESULTS: After 534 emergency laparotomies, there were 74 (13.9%) mortalities. Of these, death occurred early (≤72 hours) after surgery in 28 (37.8%) patients and late (>72 hours) in 46 (62.2%). Early death patients had a significantly more deranged physiology, as evidenced by higher Acute Physiology and Chronic Health Evaluation II scores (mean 28.1 ± 8.4 vs 22.9 ± 8.7, P = .01), worse acute kidney injury (preoperative creatinine 3.7 ± 3.2 vs 1.9 ± 1.4, P = .001), and greater level of acidosis (pH 7.19 ± 0.12 vs 7.27 ± 0.13, P = .017). Additionally, preoperative lactate was significantly increased in patients with early mortality (6.8 ± 4.1 vs 5.1 ± 4.0, P = .045). Using logarithmic regression, a nomogram was constructed using age, Glasgow Coma Scale, lactate, creatinine, and pH. This nomogram had an area under the curve of 0.908 on receiver operator curve analysis. A score of 13 equates to greater than 50% risk of early mortality after surgery. CONCLUSION: Early mortality (≤72 hours after emergency laparotomy) is associated with decreased pH, elevated creatinine, and elevated lactate. These factors combined into the nomogram constructed may assist surgical teams with patient and family discussions to prevent futile surgical interventions.


Assuntos
Serviço Hospitalar de Emergência , Mortalidade Hospitalar , Laparotomia , Futilidade Médica , Peritonite/cirurgia , Medição de Risco/métodos , Idoso , Tomada de Decisão Clínica , Aconselhamento , Creatinina/sangue , Família , Feminino , Escala de Coma de Glasgow , Humanos , Concentração de Íons de Hidrogênio , Consentimento Livre e Esclarecido , Ácido Láctico/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Peritonite/sangue , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
9.
Khirurgiia (Mosk) ; (5): 20-26, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32500685

RESUMO

OBJECTIVE: To evaluate the results of laparoscopic treatment of patients with advanced appendicular peritonitis. MATERIAL AND METHODS: There were 271 patients with acute appendicitis complicated by peritonitis. The main group consisted of patients who underwent laparoscopic appendectomy after diagnostic laparoscopy (n=231), the control group - diagnostic laparoscopy followed by conversion to median laparotomy (n=36). Four extremely ill patients were operated through laparotomy and excluded from the further analysis. RESULTS: Diagnostic laparoscopy was performed in 267 patients with advanced appendicular peritonitis. Laparoscopic appendectomy, debridement and abdominal drainage were performed in 231 (85.2%) patients. Mean age of patients was 44±18.5 years, duration of disease - 36.2±20.3 hours. Diffuse peritonitis was diagnosed in 219 (82%) patients, advanced peritonitis - in 48 (16.5%) cases. Incidence of conversion was 13.5%. Mortality was absent in both groups. Postoperative morbidity was significantly higher in the conversion group (72.2% vs. 29.4%, p<0.0001). CONCLUSION: Laparoscopic interventions for common appendicular peritonitis are feasible, effective and reduce postoperative morbidity.


Assuntos
Apendicite/cirurgia , Peritonite/cirurgia , Doença Aguda , Adulto , Apendicectomia , Apendicite/complicações , Desbridamento , Drenagem , Humanos , Laparoscopia , Pessoa de Meia-Idade , Peritonite/etiologia , Estudos Retrospectivos , Adulto Jovem
10.
Khirurgiia (Mosk) ; (5): 27-33, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32500686

RESUMO

OBJECTIVE: To identify the most important high risk criteria for predicting course of disease, as well as optimal preoperative preparation and surgical strategy in patients with secondary peritonitis. MATERIAL AND METHODS: A prospective study enrolled 43 patients with diffuse secondary peritonitis. RESULTS: Significant predictors were Charlson's comorbidity index (p=0.001) and SOFA score of organ dysfunction within 3 days after admission. Rapid regression of organ dysfunction (SOFA1 - p=0.0001, SOFA2 - p=0.012, SOFA3 - p=0.017) and reduced time of examination and preoperative preparation (threshold value - 520 min after admission) are predictors of favorable outcome in patients with diffuse secondary peritonitis. There was no reliable correlation between the treatment outcome and preoperative preparation (infusion volume p=0.23, duration p=0.37, absence/presence of antibacterial therapy p=0.26). Elimination or control of infection is the fundamental principle of the management of patients with diffuse secondary peritonitis.


Assuntos
Peritonite/terapia , Sepse/terapia , Comorbidade , Hospitalização , Humanos , Escores de Disfunção Orgânica , Gravidade do Paciente , Peritonite/etiologia , Peritonite/cirurgia , Cuidados Pré-Operatórios , Prognóstico , Estudos Prospectivos , Sepse/etiologia , Sepse/cirurgia
11.
Ann R Coll Surg Engl ; 102(7): 519-524, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32538103

RESUMO

INTRODUCTION: Laparostomy is important in the management of patients with intra-abdominal gastrointestinal catastrophe or trauma. It carries significant risk and is resource intensive, both in terms of nursing and surgically. The main goal is to achieve prompt myofascial closure (MFC) in order to minimise morbidity and mortality. Early MFC was initially defined as within 2-3 weeks but there is growing evidence that this should be measured in days. METHODS: Retrospective analysis was undertaken of laparostomy cases between 2016 and 2018 at an acute trust and trauma centre serving a population of 500,000. Indication, duration of open abdomen (OA), number of relook procedures and consultant presence were examined to see whether they affected MFC rates, morbidity and mortality. RESULTS: Overall, 76 laparostomies were performed during the 3-year study period. The most common indication was peritonitis (68.4%). As duration of OA and number of relook procedures increased, the chances of MFC fell significantly. After day 1, MFC rates fell by 20% with each subsequent 24 hours. Leaving the abdomen open primarily at index procedure compared with performing laparostomy following a postoperative complication was associated with significantly higher MFC rates (92.6% vs 68.2%, (p=0.006). The mortality rate was 15.8%. CONCLUSIONS: If the OA is not closed within five days or by the third relook procedure, then achieving MFC is unlikely. Alternative methods should be employed to close the abdomen rather than continuing to take the patient back to theatre for relook laparotomies while increasing the risk of morbidity and mortality. A proactive strategy to forming primary laparostomy at the index procedure has high closure rates.


Assuntos
Abdome/cirurgia , Técnicas de Fechamento de Ferimentos Abdominais , Laparotomia/métodos , Tratamento de Ferimentos com Pressão Negativa/métodos , Peritonite/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Reino Unido/epidemiologia , Adulto Jovem
12.
Am Surg ; 86(4): 308-312, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32391754

RESUMO

Acute diverticulitis is an emergency surgical condition that is commonly managed via an acute surgical unit model. Operative surgery is indicated in selected situations including generalized peritonitis or fistulous disease; however, limited data exist on how borderline patients potentially needing surgery may be salvaged by close clinical management with modern interventional techniques. The aims of the study were to identify the operative surgery rates in acute diverticulitis and predictors for identifying patients with complicated diverticulitis. Retrospective data collection was performed on a prospectively held database at a high-volume acute surgical unit at Logan Hospital, Queensland. Patient demographic data, disease-related factors, and treatment-related factors were collected for reporting and analysis. Over three years (2016-2018), 201 patients (64%) were admitted with uncomplicated diverticulitis and 113 patients (36%) with complicated diverticulitis. An observable downward trend was noted in the number of yearly admissions for uncomplicated diverticulitis. Complicated diverticulitis was associated with male gender (P = 0.039), increased length of hospital stay (P < 0.001), temperature ≥37.5 (P = 0.025), increased white cell count (P < 0.001), and elevated C-reactive protein (P < 0.001). Twelve patients (11%) with complicated diverticulitis initially failed conservative management. Seven patients (6%) underwent a definitive Hartmann's procedure, and 5 patients (4%) underwent percutaneous drainage of abscesses. Acute diverticulitis can be safely managed nonoperatively by medical therapy and percutaneous drainage of abscesses, with surgery reserved for patients with complicated diverticulitis with sepsis or peritonitis.


Assuntos
Antibacterianos/uso terapêutico , Doença Diverticular do Colo/terapia , Drenagem , Abscesso Abdominal/tratamento farmacológico , Abscesso Abdominal/etiologia , Abscesso Abdominal/cirurgia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Colostomia , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/tratamento farmacológico , Doença Diverticular do Colo/cirurgia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Peritonite/etiologia , Peritonite/cirurgia , Estudos Retrospectivos
13.
Orv Hetil ; 161(23): 977-979, 2020 06.
Artigo em Húngaro | MEDLINE | ID: mdl-32453696

RESUMO

Primary peritonitis is very rare in healthy children without predisposing factors. In the absence of unique factors and signs, the clinical picture does not differ from secondary peritonitis. Therefore, the diagnosis is almost always an intraoperative diagnosis. Case report: We admitted a previously healthy 15-year-old boy with symptoms of acute enteritis. Within 24 hours, he developed acute abdomen and signs of septic shock. Computer tomography of the abdomen revealed air bubbles in the middle of the abdomen and near the terminal ileum. Suspecting perforation, we performed an emergency laparotomy. However, there was no perforation to be found in the background of the purulent peritonitis. We initiated empirical broad-spectrum antimicrobial therapy which we later adjusted. Septic shock and complications were treated successfully. We could not find the source of the primary peritonitis. Since hospital discharge, the child has been asymptomatic. In primary peritonitis, due to the nonspecific, rapidly progressing symptoms, an emergency surgery can not be avoided. With proper antibiotics and supportive therapy, the prognosis is favourable. Orv Hetil. 2020; 161(23): 977-979.


Assuntos
Peritonite/cirurgia , Abdome Agudo/etiologia , Adolescente , Antibacterianos/uso terapêutico , Serviço Hospitalar de Emergência , Humanos , Laparotomia , Masculino , Peritonite/diagnóstico , Choque Séptico/tratamento farmacológico
14.
Khirurgiia (Mosk) ; (3): 13-21, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32271732

RESUMO

AIM: To compare the results of open and laparoscopic interventions for PGDU complicated by advanced peritonitis. MATERIAL AND METHODS: A retrospective analysis enrolled 172 patients with PGDU who underwent surgery for the period 2014-2016. The research was performed at the bases of the Department of Faculty-Based Surgery No. 1 of the Medical Faculty of the Pirogov Russian National Research Medical University. Further analysis enrolled 138 patients in accordance with inclusion and exclusion criteria (laparoscopic intervention - 116 patients, open surgery - 22). Propensity score matching (pseudorandomization) was applied after comparative analysis of patients' characteristics and treatment outcomes in order to ensure maximum comparability of both groups. RESULTS: Length of hospital-stay (7.1 vs. 9.8 days), incidence of extra-abdominal complications (6.3%. vs. 41.2%) and adverse events Clavien-Dindo grade II (6.3% vs. 35.3%) were significantly lower after minimally invasive surgery (p<0.05). CONCLUSION: Analysis of comparable groups of patients with PGDU complicated by peritonitis revealed that laparoscopic surgery is accompanied by significantly lower incidence of extra-abdominal postoperative complications and shorter hospital-stay compared with open surgery. Mortality and incidence of intra-abdominal postoperative complications were similar in both groups.


Assuntos
Laparoscopia/métodos , Técnicas de Abdome Aberto/métodos , Úlcera Péptica Perfurada/cirurgia , Peritonite/cirurgia , Humanos , Úlcera Péptica Perfurada/complicações , Peritonite/etiologia , Pontuação de Propensão , Distribuição Aleatória , Estudos Retrospectivos , Técnicas de Sutura , Resultado do Tratamento
15.
Ann R Coll Surg Engl ; 102(5): e100-e101, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32159372

RESUMO

Anastomotic dehiscence following colonoscopy for routine surveillance after anterior resection for colorectal cancer is unreported in the English literature. It is a potentially fatal complication requiring awareness, quick recognition and management. We present the case of a 45-year-old woman who presented 12 hours after a routine follow-up colonoscopy with peritonitis due to anastomotic rupture diagnosed on computed tomography. The patient was taken to theatre for emergency laparotomy and formation of an end colostomy. Her postoperative recovery and follow-up were optimal.


Assuntos
Colonoscopia/efeitos adversos , Ileostomia/efeitos adversos , Peritonite/diagnóstico , Neoplasias Retais/cirurgia , Deiscência da Ferida Operatória/diagnóstico , Anastomose Cirúrgica/efeitos adversos , Colostomia , Drenagem , Feminino , Humanos , Pessoa de Meia-Idade , Peritonite/etiologia , Peritonite/cirurgia , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/cirurgia , Tomografia Computadorizada por Raios X
17.
Updates Surg ; 72(1): 185-191, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32077062

RESUMO

Diffuse peritonitis represents a life-threatening complication of acute appendicitis (AA). Whether laparoscopy is a safe procedure and presents similar results compared with laparotomy in case of complicated AA is still a matter of debate. The objective of this study is to compare laparoscopic (LA) and open appendectomy (OA) for the management of diffuse peritonitis caused by AA. This is a prospective multicenter cohort study, including 223 patients with diffuse peritonitis from perforated AA, enrolled in the Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) study from February to May 2018. Two groups were created: LA = 78 patients, mean age 42.51 ± 22.14 years and OA = 145 patients, mean age 38.44 ± 20.95 years. LA was employed in 34.98% of cases. There was no statically significant difference between LA and OA groups in terms of intra-abdominal abscess, postoperative peritonitis, rate of reoperation, and mortality. The wound infection rate was higher in the OA group (OR 21.63; 95% CI 3.46-895.47; P = 0.00). The mean postoperative hospital stay in the LA group was shorter than in the OA group (6.40 ± 4.29 days versus 7.8 ± 5.30 days; P = 0.032). Although LA was only used in one-third of cases, it is a safe procedure and should be considered in the management of patients with diffuse peritonitis caused by AA, respecting its indications.


Assuntos
Apendicectomia/métodos , Apendicite/complicações , Apendicite/cirurgia , Laparoscopia/métodos , Laparotomia/métodos , Peritonite/etiologia , Peritonite/cirurgia , Abdome Agudo , Adulto , Idoso , Apendicite/mortalidade , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Peritonite/mortalidade , Complicações Pós-Operatórias , Prognóstico , Estudos Prospectivos , Reoperação , Segurança , Adulto Jovem
19.
Eur J Histochem ; 64(1)2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31941266

RESUMO

The tissue inflammatory response can influence the outcome of anastomotic healing. Anastomotic leakage represents a dreadful complication after gastrointestinal surgery, in particular sepsis and intra-abdominal infections impair the restorative process of colic anastomoses. It has been debated whether the administration of non-steroidal anti-inflammatory drugs (NSAIDs) is a risk factor for dehiscence, since many patients receive NSAIDs in the early postoperative period. Our aim was, for the first time, to analyze the morpho-functional effects of postoperative administration of two commonly used NSAIDs, Diclofenac and Ketorolac, on the healing process of colo-colic anastomoses constructed under condition of fecal peritonitis in a rat model. Sixty adult male rats underwent two surgical procedures: peritonitis induction and colo-colic anastomosis, and were divided into three groups: 20 rats received saline; 20 rats 4 mg/kg Diclofenac and 20 rats 5 mg/kg Ketorolac. We assessed anastomosis strength, morphological features of tissue wound healing, immunohistochemical metalloproteinase 9 (MMP9) expression and collagen deposition and content by Sirius red staining and hydroxyproline level. We found no significant difference in bursting pressure, collagen content and organization and morphological features between the groups, except a significantly reduced presence of inflammatory cells and MMP9 expression in the groups treated with NSAIDs. Our findings showed that Diclofenac and Ketorolac administration did not affect post-surgical healing and did not increase the leakage risk of colo-colic anastomoses during peritonitis.


Assuntos
Anti-Inflamatórios não Esteroides/farmacologia , Ceco/cirurgia , Diclofenaco/farmacologia , Cetorolaco/farmacologia , Peritonite/cirurgia , Cicatrização/efeitos dos fármacos , Anastomose Cirúrgica , Fístula Anastomótica/etiologia , Fístula Anastomótica/patologia , Animais , Anti-Inflamatórios não Esteroides/uso terapêutico , Ceco/metabolismo , Ceco/patologia , Diclofenaco/uso terapêutico , Inflamação/tratamento farmacológico , Inflamação/patologia , Cetorolaco/uso terapêutico , Masculino , Metaloproteinase 9 da Matriz/metabolismo , Peritonite/metabolismo , Peritonite/patologia , Ratos Wistar , Fatores de Risco , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/patologia
20.
J Surg Res ; 246: 236-242, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31610351

RESUMO

BACKGROUND: Peritonitis is an emergency which frequently requires surgical intervention. The aim of this study was to describe factors influencing seeking and reaching care for patients with peritonitis presenting to a tertiary referral hospital in Rwanda. METHODS: This was a cross-sectional study of patients with peritonitis admitted to University Teaching Hospital of Kigali. Data were collected on demographics, prehospital course, and in-hospital management. Delays were classified according to the Three Delays Model as delays in seeking or reaching care. Chi square test and logistic regression were used to determine associations between delayed presentation and various factors. RESULTS: Over a 9-month period, 54 patients with peritonitis were admitted. Twenty (37%) patients attended only primary school and 15 (28%) never went to school. A large number (n = 26, 48%) of patients were unemployed and most (n = 45, 83%) used a community-based health insurance. For most patients (n = 44, 81%), the monthly income was less than 10,000 Rwandan francs (RWF) (11.90 U.S. Dollars [USD]). Most (n = 51, 94%) patients presented to the referral hospital with more than 24 h of symptoms. More than half (n = 31, 60%) of patients had more than 4 d of symptoms on presentation. Most (n = 37, 69%) patients consulted a traditional healer before presentation at the health care system. Consultation with a traditional healer was associated with delayed presentation at the referral hospital (P < 0.001). Most (n = 29, 53%) patients traveled more than 2 h to reach a health facility and this was associated with delayed presentation (P = 0.019). The cost of transportation ranged between 5000 and 1000 RWF (5.95-11.90 USD) for most patients and was not associated with delayed presentation (P = 0.449). CONCLUSIONS: In this study, most patients with peritonitis present in a delayed fashion to the referral hospital. Factors associated with seeking and reaching care included sociodemographic characteristics, health-seeking behaviors, cost of care, and travel time. These findings highlight factors associated with delays in seeking and reaching care for patients with peritonitis.


Assuntos
Medicina Tradicional Africana/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Peritonite/cirurgia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Gastos em Saúde/estatística & dados numéricos , Hospitais Universitários/economia , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Medicina Tradicional Africana/psicologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Peritonite/economia , Ruanda , Fatores Socioeconômicos , Procedimentos Cirúrgicos Operatórios/economia , Procedimentos Cirúrgicos Operatórios/psicologia , Centros de Atenção Terciária/economia , Centros de Atenção Terciária/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Adulto Jovem
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