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1.
Georgian Med News ; (311): 17-21, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33814383

RESUMO

The objective and the goal of this study was to determine how ERAS guidelines affected on hospital stay days and other complications rates in case of elective colorectal surgery in our clinic, compared to traditional care methods. First of all, all team members including surgeons, anesthetists, nurses were being trained in ERAS guidelines principals during two months and we started active implementation process after this. 87 patients, who were needed to be done colorectal surgery treatment, were actively treated according to ERAS guidelines and these patients were gathered in experimental group. At the same time, we started to collect data retrospectively from last 2 years elective colorectal surgery cases and sorted them according to preoperative, intraoperative surgical and anesthesia data, postoperative analgesia, all type of complications. 120 patients were placed in traditional care group (control group). In traditional care group open colorectal surgery was associated with long length of stay 8-10 days. High rates of surgical site infection-24.2%, readmission rate during 30 days-30.8%, PONV-44.2%, respiratory complication-6.7%, deep vein thrombosis-3.3%, urinary retention-2.5%, prolonged postoperative ileus 16.7%. We included 87 patients in ERAS care group during 2 years. In this group our study showed big reduction of hospital stay days and it was average 5 days. Compared to traditional care group incidence of respiratory complications was 0, postoperative PONV- 6.9%, postoperative ileus-5.7%, deep vein thrombosis-0, urinary retention-0, readmission rate-0, surgical site infection-3.4%.


Assuntos
Cirurgia Colorretal , Procedimentos Cirúrgicos do Sistema Digestório , Recuperação Pós-Cirúrgica Melhorada , Cirurgia Colorretal/efeitos adversos , Procedimentos Cirúrgicos Eletivos , Humanos , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
2.
Adv Clin Exp Med ; 30(3): 233-237, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33757163

RESUMO

BACKGROUND: Modern approach to the surgical treatment of Hirschsprung's disease (HD) consists in the earliest possible repair and reduction of the number of surgical interventions. Primary one-stage transanal endorectal pull-through (TEPT) technique requires preoperative determination of the length of aganglionic segment. The efficacy of the standard method - contrast enema - is questionable in patients with a poorly defined transitional zone. OBJECTIVES: To present the proposed laparoscopic method for the management pathway in patients with HD, in whom the determination of the length of aganglionic segment with contrast enema was not possible. MATERIAL AND METHODS: A retrospective analysis of the diagnostic and therapeutic management employed in 14 patients, from 2 weeks to 55 months of age, with diagnosed HD, treated between January 2013 and May 2020. Laparoscopic histological mapping was performed with the use of 3 laparoscopic ports of 3-5 mm diameter. RESULTS: In all patients, laparoscopic mapping allowed for the determination of the length of aganglionic segment and the mode of surgical treatment. Four children with determined short-segment disease underwent TEPT, while 2 underwent temporary colostomy formation using the Duhamel-Martin-Ikeda method. Five patients with long-segment HD underwent laparoscopic-assisted TEPT. One patient with long-segment disease was treated with a temporary double-barrel colostomy and definitive surgery was performed 3 months later using the Duhamel-Martin-Ikeda method. In 2 patients with an initial diagnosis of HD established using current diagnostic pathway, HD pathology was later excluded based on the results of laparoscopic mapping and repeat rectal suction biopsy. No complications related to the laparoscopic procedure were identified. CONCLUSIONS: The method of laparoscopic mapping is effective in the determination of the length of aganglionic segment in children with diagnosed HD. In doubtful cases, it can be the preferred option in establishing the final mode of surgical treatment.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Doença de Hirschsprung , Laparoscopia , Criança , Doença de Hirschsprung/cirurgia , Humanos , Lactente , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento
3.
BMC Surg ; 21(1): 173, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33784994

RESUMO

BACKGROUND: Gastrointestinal surgery in elderly individuals presents unexpected postoperative complications. However, predicting postoperative complications in elderly patients undergoing gastrointestinal surgeries is challenging because of the lack of a reliable preoperative evaluation system. We aimed to prospectively evaluate three new preoperative assessment methods to predict the postoperative complications in elderly patients undergoing elective gastrointestinal surgery. Moreover, we aimed to identify new risk factors of postoperative complications in this patient group. METHODS: This prospective cohort study enrolled 189 patients (age ≥ 65 years) who underwent elective gastrointestinal surgery at Tokyo Medical University Hachioji Medical Center between April 2017 and March 2019. Assessments performed preoperatively included the biological impedance analysis for evaluating the skeletal muscle mass, the SF-8 questionnaire for evaluating the subjective health-related quality of life, and the blood pressure/pulse wave test for assessing arteriosclerosis. The risk factors for Clavien-Dindo Grade ≥ III postoperative complications were assessed using these new evaluation methods. RESULTS: Clavien-Dindo Grade ≥ III postoperative complications were observed in 28 patients (14.8%). Univariate and multivariate analyses identified male sex, low skeletal muscle mass, and cardio-ankle vascular index ≥ 10 (arteriosclerosis) as significant independent risk factors of developing Grade ≥ III complications. CONCLUSIONS: Male sex, low skeletal muscle mass, and arteriosclerosis were significant risk factors of postoperative complications in elderly patients undergoing elective gastrointestinal surgery. The obtained knowledge could be useful in identifying high-risk patients who require careful perioperative management.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Procedimentos Cirúrgicos Eletivos , Complicações Pós-Operatórias , Idoso , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Fatores de Risco
4.
Zhen Ci Yan Jiu ; 46(2): 164-7, 2021 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-33788439

RESUMO

OBJECTIVE: To observe the effect of electroacupuncture (EA) intervention on postoperative sore throat (POST) and postoperative nausea and vomiting (PONV) after endotracheal intubation and general anesthesia. METHODS: According to the random number table, 60 patients of gastrointestinal surgery under general anesthesia with tracheal intubation were randomly divided into EA group (30 cases) and control group (30 cases). Patients in the EA group were given acupuncture at Shaoshang (LU11) 30 minutes before general anesthesia, and EA at Chize (LU5) and Hegu (LI4) continued until the operation was completed. The incidence and severity of POST and visual analogue scale (VAS) score at 12, 24, and 48 h after surgery, and the incidence and severity of PONV at 12, 24 h after surgery were analyzed, respectively. RESULTS: The incidence and severity of POST and PONV, and VAS score in the EA group were significantly lower than those in the control group 12 h and 24 h after surgery (P<0.05). Both groups had significant reductions in VAS score at 24 h and 48 h after surgery compared with that at 12 h (P<0.05). CONCLUSION: EA can significantly improve the prognosis of patients on sore throat and reduce the incidence of PONV.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Eletroacupuntura , Faringite , Humanos , Náusea , Faringite/etiologia , Faringite/terapia , Vômito
5.
Medicine (Baltimore) ; 100(8): e24842, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663105

RESUMO

ABSTRACT: An association between animals and volatile anaesthetic requirements has been shown; however, evidence related to the postoperative outcome of human patients is lacking. Our aim was to investigate whether there is a difference in the requirement for sevoflurane among people undergoing gastrointestinal surgery.We observed 390 adult patients who underwent gastrointestinal surgery with an American Society of Anesthesiologists physical status of I or II with an expected surgery duration of > 2 hours. We used the bispectral index (BIS) to guide the regulation of end-tidal sevoflurane concentration (ETsevo). The mean ETsevo from 20 minutes after endotracheal intubation to 2 hours after the start of surgery was calculated for all patients. Differential sevoflurane requirements were identified according to ETsevo. The BIS, ETsevo, heart rate, mean arterial pressure, dose of sufentanil and cisatracurium, tracheal extubation time, incidence of intraoperative awareness, and incidence of postoperative nausea and vomiting were compared between patients with a low requirement for sevoflurane (group L) and patients with a high requirement for sevoflurane (group H).The mean ETsevo of the 390 patients was 1.55% ±â€Š0.26%. Based on our definition, patients with an ETsevo of < 1.29% were allocated to the low requirement group (group L; n = 69), while patients with an ETsevo of > 1.81% were allocated to the high requirement group (group H; n = 78). The ETsevo of group L was significantly lower than the ETsevo of group H (1.29% ±â€Š0.014% vs 1.82% ±â€Š0.017%, P < .001). There was no significant difference in the ETsevo, BIS, heart rate, mean arterial pressure, dose of sufentanil and cisatracurium, tracheal extubation time, incidence of intraoperative awareness, and incidence of postoperative nausea and vomiting. The tracheal extubation time in the L group was significantly shorter than that in the H group. No intraoperative awareness occurred.There was a significant difference in the requirement for sevoflurane in adult patients. The tracheal extubation time in group L was significantly shorter than that in group H.


Assuntos
Período de Recuperação da Anestesia , Anestesia Geral/métodos , Anestésicos Inalatórios/farmacocinética , Sevoflurano/farmacocinética , Extubação/efeitos adversos , Anestésicos Inalatórios/administração & dosagem , Estudos de Casos e Controles , Monitores de Consciência , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sevoflurano/administração & dosagem
8.
Medicine (Baltimore) ; 100(5): e24409, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592888

RESUMO

ABSTRACT: Infection with the SARS-CoV-2 virus seems to contribute significantly to increased postoperative complications and mortality after emergency surgical procedures. Additionally, the fear of COVID-19 contagion delays the consultation of patients, resulting in the deterioration of their acute diseases by the time of consultation. In the specific case of urgent digestive surgery patients, both factors significantly worsen the postoperative course and prognosis. Main working hypothesis: infection by COVID-19 increases postoperative 30-day-mortality for any cause in patients submitted to emergency/urgent general or gastrointestinal surgery. Likewise, hospital collapse during the first wave of the COVID-19 pandemic increased 30-day-mortality for any cause. Hence, the main objective of this study is to estimate the cumulative incidence of mortality at 30-days-after-surgery. Secondary objectives are: to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for COVID-19-infected patients.A multicenter, observational retrospective cohort study (COVID-CIR-study) will be carried out in consecutive patients operated on for urgent digestive pathology. Two cohorts will be defined: the "pandemic" cohort, which will include all patients (classified as COVID-19-positive or -negative) operated on for emergency digestive pathology during the months of March to June 2020; and the "control" cohort, which will include all patients operated on for emergency digestive pathology during the months of March to June 2019. Information will be gathered on demographic characteristics, clinical and analytical parameters, scores on the usual prognostic scales for quality management in a General Surgery service (POSSUM, P-POSSUM and LUCENTUM scores), prognostic factors applicable to all patients, specific prognostic factors for patients infected with SARS-CoV-2, postoperative morbidity and mortality (at 30 and 90 postoperative days). The main objective is to estimate the cumulative incidence of mortality at 30 days after surgery. As secondary objectives, to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for SARS-CoV-2 infected patients.The protocol (version1.0, April 20th 2020) was approved by the local Institutional Review Board (Ethic-and-Clinical-Investigation-Committee, code PR169/20, date 05/05/20). The study findings will be submitted to peer-reviewed journals and presented at relevant national and international scientific meetings.ClinicalTrials.gov Identifier: NCT04479150 (July 21, 2020).


Assuntos
Doenças do Sistema Digestório , Procedimentos Cirúrgicos do Sistema Digestório , Tratamento de Emergência , Controle de Infecções , Complicações Pós-Operatórias , Tempo para o Tratamento , Adulto , /prevenção & controle , Doenças do Sistema Digestório/diagnóstico , Doenças do Sistema Digestório/epidemiologia , Doenças do Sistema Digestório/mortalidade , Doenças do Sistema Digestório/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/mortalidade , Emergências/epidemiologia , Tratamento de Emergência/efeitos adversos , Tratamento de Emergência/métodos , Tratamento de Emergência/mortalidade , Feminino , Humanos , Incidência , Controle de Infecções/métodos , Controle de Infecções/estatística & dados numéricos , Masculino , Mortalidade , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Projetos de Pesquisa , Medição de Risco/métodos
10.
J Med Case Rep ; 15(1): 93, 2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33618756

RESUMO

BACKGROUND: Current management of choledocholithiasis entails the use of endoscopic retrograde cholangiopancreatography (ERCP) and clearance of the common bile duct. A rare complication of this procedure is the impaction of the basket by a large stone, which necessitates lithotripsy. Here we report a case of an impacted basket during ERCP, which was managed by open surgery with a duodenotomy and the manual removal of the basket. CASE PRESENTATION: A 79-year-old Caucasian man was admitted to our department with yellowish discoloration of urine, skin and eyes. Abdominal ultrasonography showed a slightly thickened gallbladder, multiple gallbladder stones, dilated intrahepatic bile ducts and extrahepatic bile extending to 1.1 cm. A computed tomography (CT) scan demonstrated a stone in the common bile duct, which caused dilation of the biliary ducts. The patient was diagnosed with obstructive jaundice secondary to choledocholithiasis; and underwent an ERCP, a sphincterotomy and stone extraction. Four days following discharge, the patient was readmitted with jaundice, abdominal pain, vomiting and fever. He was diagnosed with ascending cholangitis and treated initially with antibiotics. A second ERCP revealed a dilated common bile duct and choledocholithiasis. Stone removal with a basket failed, as did mechanical lithotripsy. Finally, the wires of the basket were ruptured and stacked in the common bile duct together with the stone. During exploratory laparotomy, adhesiolysis, a Kocher maneuver of the duodenum and a subtotal cholecystectomy were performed. Choledochotomy did not succeed in removing the impacted wires together with the stone. Therefore, a duodenotomy and an extension of the sphincterotomy were performed, followed by high-pressure lavage of the common bile duct to remove additional small biliary stones. The choledochotomy and duodenotomy were closed by a one-layer suture, and a prophylactic gastroenterostomy was performed to prevent leakage from the common bile duct and the duodenum. The postoperative course was satisfactory. CONCLUSIONS: This is the first report in the literature of removal of an impacted Dormia basket through the papilla by performing a duodenotomy and an extension of the sphincterotomy, followed by gastroenterostomy.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Coledocolitíase/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Idoso , Colecistectomia Laparoscópica , Ducto Colédoco/cirurgia , Duodeno/cirurgia , Cálculos Biliares/cirurgia , Gastroenterostomia , Humanos , Masculino , Reoperação , Esfinterotomia Endoscópica , Instrumentos Cirúrgicos , Resultado do Tratamento
11.
Gan To Kagaku Ryoho ; 48(2): 291-293, 2021 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-33597385

RESUMO

A 85-year-old man was admitted due to vomiting. Abdominal CT showed the remarkable expansion of the stomach and the stenotic lesion in the third portion of the duodenum. Duodenal endoscopy showed a circular tumor of the third potion of the duodenum, and biopsy disclosed tubular adenocarcinoma. Operation was performed on the basis of a diagnosis of primary duodenal cancer of the third portion. Liver metastasis, peritoneal dissemination, and apparent lymph node enlargement were not observed. The tumor was present in the third portion of the duodenum and partial duodenectomy was performed. Reconstruction was achieved by side to side anastomosis of the duodenum and the jejunum. Histopathological diagnosis was well differentiated tubular adenocarcinoma, SS, ly1, v1. Primary duodenal cancer is a relatively rare disease, and there are few cases of third portion. If pancreatic invasion and lymph node metastasis are not observed as in this case, it is necessary to examine the indication of partial duodenectomy.


Assuntos
Adenocarcinoma , Procedimentos Cirúrgicos do Sistema Digestório , Neoplasias Duodenais , Adenocarcinoma/cirurgia , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Biópsia , Neoplasias Duodenais/cirurgia , Humanos , Masculino
12.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33542008

RESUMO

A 76-year-old man was referred to our clinic after a foreign body seen in his sigmoid colon during a colonoscopy. He had undergone three operations for a left inguinal hernia within the previous 8 years, and the first procedure was a laparoscopic totally extraperitoneal approach. Four years later, removal of migrated and infected mesh was conducted by open approach. He then had a positive stool occult blood test for routine check-up 4 years after the remnant mesh removal. An ill-defined lesion was identified on colonoscopy. CT revealed a 2.7 cm diameter enhancing lesion in the sigmoid colon. Laparoscopic sigmoidectomy was performed, and remnant mesh fragment was found in the sigmoid colon and removed. The migrated mesh could not be wholly removed by open abdominal approach and the remnant mesh fragment migrated to sigmoid colon. It suggests the importance of a laparoscopic approach to remove the entire mesh.


Assuntos
Colo Sigmoide/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Hérnia Inguinal/complicações , Herniorrafia , Laparoscopia , Telas Cirúrgicas/efeitos adversos , Idoso , Humanos , Masculino , Sangue Oculto , Complicações Pós-Operatórias/cirurgia
13.
Medicine (Baltimore) ; 100(5): e24442, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592892

RESUMO

BACKGROUND: Anal fistula is a common anorectal disease. So far, operation is still the optimal method to cure anal fistula. High anal fistula (HAF) is an even more clinically difficult disease to treat. Evidence suggested that seton placement can be a definitive treatment for HAF. However, tightening the seton brings great pain to patients, which affects the clinical application of the therapy. Also, this may lead to difficulty in controlling anal fluids and gas because of the larger scar left and the local defect in the anal after the operation. We propose an innovative seton technique for the treatment of HAF, after long term attempts, the operation of the modified seton cutting technique. The aim of our present study is to compare the difference of anal function, healing time, pain severity, recurrence, and complications between the procedure of the modified seton cutting technique and the conventional cutting seton operation against HAF with a randomized, controlled, prospective study. METHODS: 204 participants in this trial will be randomly divided into treatment group (procedure of the modified seton cutting technique) and control group (cutting seton technique) in a 1:1 ratio. The outcomes of continence state, pain severity after tightening, complete healing of fistula, duration to healing, operation time, recurrence rates, and postoperative complications will be recorded at 1, 2, 3, 4 weeks, then every month in the outpatient clinic. Data will be analyzed by SPSS version 22. CONCLUSIONS: The findings of the study will help to explore the efficacy and safety of the procedure of the modified seton cutting technique against AF. TRIAL REGISTRATION NUMBER: DOI 10.17605/OSF.IO/V6G2S.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Fístula Retal/cirurgia , Técnicas de Sutura , Adolescente , Adulto , Idoso , Canal Anal/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Resultado do Tratamento , Cicatrização , Adulto Jovem
14.
BMC Surg ; 21(1): 83, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33579260

RESUMO

BACKGROUND: The gut microbiota (GM) has been proposed as one of the main determinants of colorectal surgery complications and theorized as the "missing factor" that could explain still poorly understood complications. Herein, we investigate this theory and report the current evidence on the role of the GM in colorectal surgery. METHODS: We first present the findings associating the role of the GM with the physiological response to surgery. Second, the change in GM composition during and after surgery and its association with colorectal surgery complications (ileus, adhesions, surgical-site infections, anastomotic leak, and diversion colitis) are reviewed. Finally, we present the findings linking GM science to the application of the enhanced recovery after surgery (ERAS) protocol, for the use of oral antibiotics with mechanical bowel preparation and for the administration of probiotics/synbiotics. RESULTS: According to preclinical and translational evidence, the GM is capable of influencing colorectal surgery outcomes. Clinical evidence supports the application of an ERAS protocol and the preoperative administration of multistrain probiotics/synbiotics. GM manipulation with oral antibiotics with mechanical bowel preparation still has uncertain benefits in right-sided colic resection but is very promising for left-sided colic resection. CONCLUSIONS: The GM may be a determinant of colorectal surgery outcomes. There is an emerging need to implement translational research on the topic. Future clinical studies should clarify the composition of preoperative and postoperative GM and the impact of the GM on different colorectal surgery complications and should assess the validity of GM-targeted measures in effectively reducing complications for all colorectal surgery locations.


Assuntos
Fístula Anastomótica/prevenção & controle , Antibacterianos/administração & dosagem , Doenças do Colo/cirurgia , Cirurgia Colorretal , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Recuperação Pós-Cirúrgica Melhorada , Microbioma Gastrointestinal , Cuidados Pré-Operatórios/métodos , Probióticos , Infecção da Ferida Cirúrgica/prevenção & controle , Antibioticoprofilaxia , Doenças do Colo/complicações , Doenças do Colo/patologia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Humanos , Complicações Pós-Operatórias , Infecção da Ferida Cirúrgica/tratamento farmacológico
15.
Br J Anaesth ; 126(4): 818-825, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33632521

RESUMO

BACKGROUND: We designed a prospective sub-study of the larger Restrictive versus Liberal Fluid Therapy in Major Abdominal Surgery (RELIEF) trial to measure differences in stroke volume and other haemodynamic parameters at the end of the intraoperative fluid protocols. The haemodynamic effects of the two fluid regimens may increase our understanding of the observed perioperative outcomes. METHODS: Stroke volume and cardiac output were measured with both an oesophageal Doppler ultrasound monitor and arterial pressure waveform analysis. Stroke volume variation, pulse pressure variation, and plethysmographic variability index were also obtained. A passive leg raise manoeuvre was performed to identify fluid responsiveness. RESULTS: Analysis of 105 patients showed that the primary outcome, Doppler monitor-derived stroke volume index, was higher in the liberal group: restrictive 38.5 (28.6-48.8) vs liberal 44.0 (34.9-61.9) ml m-2; P=0.043. Similarly, there was a higher cardiac index in the liberal group: 2.96 (2.32-4.05) vs 2.42 (1.94-3.26) L min-1 m-2; P=0.015. Arterial-pressure-based stroke volume and cardiac index did not differ, nor was there a significant difference in stroke volume variation, pulse pressure variation, or plethysmographic variability index. The passive leg raise manoeuvre showed fluid responsiveness in 40% of restrictive and 30% of liberal protocol patients (not significant). CONCLUSIONS: The liberal fluid group from the RELIEF trial had significantly higher Doppler ultrasound monitor-derived stroke volume and cardiac output compared with the restrictive fluid group at the end of the intraoperative period. Measures of fluid responsiveness did not differ significantly between groups. CLINICAL TRIAL REGISTRATION: ACTRN12615000125527.


Assuntos
Débito Cardíaco/fisiologia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Hidratação/métodos , Monitorização Intraoperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Volume Sistólico/fisiologia , Adulto , Idoso , Procedimentos Cirúrgicos do Sistema Digestório/tendências , Feminino , Hidratação/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/tendências , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Prospectivos , Resultado do Tratamento , Ultrassonografia Doppler/métodos , Ultrassonografia Doppler/tendências
16.
Anticancer Res ; 41(2): 1101-1110, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517321

RESUMO

BACKGROUND/AIM: The purpose of this study was to compare the prognostic value of preoperative carcinoembryonic antigen (CEA), preoperative CEA/tumor size and postoperative CEA in stage I colorectal cancer. PATIENTS AND METHODS: We analyzed a total of 305 consecutive stage I colorectal cancer patients who underwent a radical surgery at our Department. The patients were divided into low and high preoperative CEA groups, low and high preoperative CEA/tumor size groups, and low and high postoperative CEA groups according to the optimal cut-off values. RESULTS: Multivariate analysis showed that postoperative CEA was independently associated with OS and DFS. However, the preoperative CEA and preoperative CEA/tumor size were not. CONCLUSION: The prognostic value of postoperative CEA is better than preoperative CEA and preoperative CEA/tumor size in patients with stage I colorectal cancer. Moreover, the common 5 ng/ml cut-off was not optimal for risk stratification in stage I colorectal cancer.


Assuntos
Biomarcadores Tumorais/metabolismo , Antígeno Carcinoembrionário/metabolismo , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/metabolismo , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Prognóstico , Análise de Sobrevida , Resultado do Tratamento , Carga Tumoral
17.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(1): 35-42, 2021 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-33461250

RESUMO

In the past 30 years, minimally invasive surgery has been greatly improved with the development of the energy platform, instrument platform, and imaging platform. Taking colorectal cancer surgery as an example, the five elements of surgical procedure have developed to a certain extent. The surgical approach has undergone a process from large to small. The range of resection ranges from simple bowel resection to radical resection/extended radical resection, and then to surgery that focuses on preserving organ function. With the recognition of the direction of normal lymphatic drainage and the characteristics of tumor lymphatic metastasis, lymph node dissection has been gradually standardized. The reconstruction of the digestive tract has changed from manual sutures to full endoscopic anastomosis, and then to the concept of functional anastomosis. The removal of the specimen has improved from large incision through the abdominal wall, to small laparoscopic incision, and then to the natural cavity. The evolution of these procedures depends on the advancement of technology platforms and equipment, and the recognition of new concepts. The development of minimally invasive platform must be in the direction of ensuring the implementation of the most optimized surgical approach. The platform is more secure, integrated, multifunctional, and intelligent. In the future, minimally invasive procedures must be aimed at maximizing the benefits of patients. The procedures are more scientific, functional, comfortable and diverse. Surgical innovation has promoted the development of the platform. The platform and the surgical procedure promote each other's development.


Assuntos
Neoplasias Colorretais/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Laparoscopia , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/tendências , Neoplasias Colorretais/patologia , Procedimentos Cirúrgicos do Sistema Digestório/instrumentação , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/tendências , Previsões , Humanos , Laparoscopia/instrumentação , Laparoscopia/métodos , Laparoscopia/tendências , Excisão de Linfonodo , Metástase Linfática , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Técnicas de Sutura/instrumentação , Técnicas de Sutura/tendências
18.
Khirurgiia (Mosk) ; (1): 93-97, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395519

RESUMO

It is very difficult to find certain surgical field in which surgeon's decision is absolutely evidence-based. The objective of evidence-based medicine (and surgery) is offering the best treatment for each patient that should encourage conducting the randomized trials (RT) as the highest level of evidence. The results of RTs often contradict the existing clinical experience, and experience per se does not always confirm the significance of the results obtained. One cannot make any conclusions based on RT data. Treatment strategy for a particular patient remains unclear. The authors have analyzed the results of large-scale RTs devoted to laparoscopic cholecystectomy, rectal surgery, lung cancer surgery, postoperative care, treatment of pulmonary emphysema. It was shown that RT data as the highest level of evidence are not always true for surgery. In most clinical situations, the decision is not based on RT results. The desire of surgeons to master a new technique is often more significant than patient care, while clinical experience and the laws of the market are more important than science. There is no doubt that knowledge of RT results are essential in training period, but this means quite a bit for a particular patient. The best decision can be made during discussion and conversation with colleagues, where an experience of each specialist will have the same value as the best evidence.


Assuntos
Medicina Baseada em Evidências/normas , Medicina de Precisão/normas , Prática Profissional/normas , Qualidade da Assistência à Saúde/normas , Ensaios Clínicos Controlados Aleatórios como Assunto , Procedimentos Cirúrgicos Operatórios , Colecistectomia Laparoscópica , Competência Clínica/normas , Tomada de Decisões , Procedimentos Cirúrgicos do Sistema Digestório , Medicina Baseada em Evidências/métodos , Humanos , Relações Interprofissionais , Cuidados Pós-Operatórios/normas , Enfisema Pulmonar/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/normas
19.
World J Surg ; 45(3): 655-661, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33423099

RESUMO

AIM: Cancer surgery in the COVID-19 pandemic presents many new challenges. For each patient, the risk of contracting COVID-19 during the perioperative period, with the potential for life-threatening sequelae (1), has to be weighed against the risk of delaying treatment. We assessed the response and short-term outcomes from elective colorectal cancer surgery during the pandemic at our institution. METHOD: We report a prospective cohort study of all elective colorectal surgery cases performed at our Trust during the 11 weeks following the national UK lockdown on 23rd March 2020, compared with the same time period in 2019. RESULTS: Eighty-five colorectal operations were performed during the 2020 (COVID) time period, and 179 performed in the 2019 (non-COVID) time period. A significantly higher proportion of cases during the COVID period were cancer-related (66% vs 26%, p < 0.00001). There was no difference in length of hospital stay, complications or readmissions. There were no mortalities in either cohort. Among the cancer patients, there were no differences in TMN staging, R1 resection rate or lymph node yields. No elective patient tested positive for COVID-19 during the perioperative period. CONCLUSION: At the height of the COVID pandemic, we maintained delivery the of high-quality elective colorectal cancer surgery, with no worsening of short-term outcomes and no compromise in the quality of cancer resections. Ongoing monitoring of this cohort is essential. The risks associated with COVID-19 will continue for some time, necessitating adaptive responses to maintain high-quality cancer services.


Assuntos
/epidemiologia , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Excisão de Linfonodo/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Reino Unido/epidemiologia , Adulto Jovem
20.
Chirurg ; 92(2): 115-121, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33432386

RESUMO

BACKGROUND: Indocyanine green (ICG) fluorescence imaging is increasingly being used in various areas of abdominal surgery. The constant improvement in the technology enables easy intraoperative use and progressively influences operative decision-making, also in robotically assisted colorectal surgery. OBJECTIVE: Summation of current evidence on the use of ICG fluorescence imaging in robotically assisted colorectal surgery. MATERIAL AND METHODS: The assessment of evidence is based on a comprehensive literature search (PubMed). RESULTS: First individual studies (feasibility, case matched, prospective cohort, multicenter phase II, single center randomized controlled study/trial) showed a significant reduction in the incidence of anastomotic leakage (AL) after colorectal anastomosis through the use of ICG fluorescence angiography (FA, 9.1% vs. 16.3%; p = 0.04). First feasibility studies demonstrated lymph node detection or navigation as well as ureter visualization. CONCLUSION: The ICG-FA reliably detects tissue perfusion, quickly and effectively with few side effects. It can influence intraoperative decision-making and reduce AL rates. In addition, patients may be offered more precise tumor therapy via ICG sentinel lymph node (SLN) detection and lateral pelvic lymph node (LPN) mapping and navigation. Iatrogenic lesions, such as ureteral injuries can be sufficiently prevented by appropriate visualization; however, valid data in order to be able to derive standardized operative consequences require further convincing multicenter, randomized controlled trials (mRCT).


Assuntos
Cirurgia Colorretal , Procedimentos Cirúrgicos do Sistema Digestório , Procedimentos Cirúrgicos Robóticos , Humanos , Verde de Indocianina , Estudos Prospectivos , Biópsia de Linfonodo Sentinela
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