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Id: biblio-886276
Autor: Lyra Junior, Humberto Fenner; Rodrigues, Igor Kunze; Schiavon, Leonardo de Lucca; D`Acâmpora, Armando José.
Título: Ghrelin and gastrointestinal wound healing. A new perspective for colorectal surgery
Fonte: Acta cir. bras;33(3):282-294, Mar. 2018. tab.
Idioma: en.
Descritores: Reto/cirurgia
Colo/cirurgia
Substâncias Protetoras/uso terapêutico
Grelina/uso terapêutico
-Período Pós-Operatório
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
Cicatrização/efeitos dos fármacos
Anastomose Cirúrgica/efeitos adversos
Fístula Anastomótica/prevenção & controle
Limites: Humanos
Tipo de Publ: Revisão
Responsável: BR1.1 - BIREME


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Id: biblio-973467
Autor: Alvarenga Junior, Valter; Ferraz, Edna Delabio; Rolim, Marcia; Carra, Amabile Marran; Silva, Pedro Teixeira da; Franco, Olavo Borges; Cordeiro, Mariana Menegat Dias; Takiya, Christina Maeda; Baetas-da-Cruz, Wagner; Manso, José Eduardo Ferreira; Ferreira, Manoel Luiz; Eulálio, José Marcus Raso; Silva, Paulo César; Souza, Heitor Siffert Pereira de; Schanaider, Alberto.
Título: Rat models of high risk colorectal anastomoses
Fonte: Acta cir. bras;33(10):914-923, Oct. 2018. graf.
Idioma: en.
Resumo: Abstract Purpose: To evaluate the most frequent surgical techniques of high-risk colorectal anastomoses in rats. Methods: Wistar rats were enrolled in three different models comprising inflammatory (TNBS enema), vascular (portal vein occlusion) or obstructive (a non-ischemic constricting ring) mechanisms associated with colonic anastomosis that had accomplished after these former lesions. Histological analyses (Hematoxylin and eosin and Picrosirius red) were performed. Results: All anastomoses techniques were associated with risk factors and had complications, mainly anastomotic leakage. In Study 1, the use of a pharmacological agent, trinitrobenzene sulfonic acid (TNBS) mimicked an inflammatory bowel disease such as Crohn's disease with 50% of anastomosis leakage, the higher percentage among all models tested. In Study 2, after portal ischemia followed by reperfusion it was observed a dense neutrophil infiltrate in the midst of necrotic tissue and fibrin at the anastomotic site and 5 days after the anastomosis, no collagen was produced. In Study 3, 5 days after the mechanical obstruction some denuded areas of epithelium with marked oedema of mucosa and submucosa were seen, at the anastomotic site and anastomosis group showed some reduction of collagen density when compared with Control/Sham group. Conclusion: All the experimental surgical techniques tested in rats were associated with high-risk colorectal anastomoses and were useful to study colonic anastomotic healing and intestinal leakage.
Descritores: Reto/cirurgia
Colo/cirurgia
Fístula Anastomótica/patologia
Fístula Anastomótica/diagnóstico por imagem
-Cicatrização
Anastomose Cirúrgica/efeitos adversos
Anastomose Cirúrgica/métodos
Ratos Wistar
Modelos Animais de Doenças
Limites: Animais
Ratos
Responsável: BR1.1 - BIREME


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Id: lil-782834
Autor: Lu, Zhenhai; Peng, Jianhong; Li, Cong; Wang, Fulong; Jiang, Wu; Fan, Wenhua; Lin, Junzhong; Wu, Xiaojun; Wan, Desen; Pan, Zhizhong.
Título: Efficacy and safety of a NiTi CAR 27 compression ring for end-to-end anastomosis compared with conventional staplers: A real-world analysis in Chinese colorectal cancer patients
Fonte: Clinics;71(5):264-270, May 2016. tab, graf.
Idioma: en.
Projeto: Science and Technology Planning Project of Guangdong Province.
Resumo: OBJECTIVES: This study aimed to evaluate the safety and efficacy of a new nickel-titanium shape memory alloy compression anastomosis ring, NiTi CAR 27, in constructing an anastomosis for colorectal cancer resection compared with conventional staples. METHODS: In total, 234 consecutive patients diagnosed with colorectal cancer receiving sigmoidectomy and anterior resection for end-to-end anastomosis from May 2010 to June 2012 were retrospectively analyzed. The postoperative clinical parameters, postoperative complications and 3-year overall survival in 77 patients using a NiTi CAR 27 compression ring (CAR group) and 157 patients with conventional circular staplers (STA group) were compared. RESULTS: There were no statistically significant differences between the patients in the two groups in terms of general demographics and tumor features. A clinically apparent anastomotic leak occurred in 2 patients (2.6%) in the CAR group and in 5 patients (3.2%) in the STA group (p=0.804). These eight patients received a temporary diverting ileostomy. One patient (1.3%) in the CAR group was diagnosed with anastomotic stricture through an electronic colonoscopy after 3 months postoperatively. The incidence of postoperative intestinal obstruction was comparable between the two groups (p=0.192). With a median follow-up duration of 39.6 months, the 3-year overall survival rate was 83.1% in the CAR group and 89.0% in the STA group (p=0.152). CONCLUSIONS: NiTi CAR 27 is safe and effective for colorectal end-to-end anastomosis. Its use is equivalent to that of the conventional circular staplers. This study suggests that NiTi CAR 27 may be a beneficial alternative in colorectal anastomosis in Chinese colorectal cancer patients.
Descritores: Colo Sigmoide/cirurgia
Anastomose Cirúrgica/instrumentação
Neoplasias Colorretais/cirurgia
-Período Pós-Operatório
Grampeadores Cirúrgicos/efeitos adversos
Anastomose Cirúrgica/efeitos adversos
Anastomose Cirúrgica/métodos
Estudos Retrospectivos
Resultado do Tratamento
Desenho de Equipamento
Segurança de Equipamentos/instrumentação
Ligas
Fístula Anastomótica/etiologia
Limites: Humanos
Masculino
Feminino
Adulto
Pessoa de Meia-Idade
Idoso
Idoso de 80 Anos ou mais
Adulto Jovem
Responsável: BR1.1 - BIREME


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Id: biblio-978011
Autor: Muñoz P, Nelson; Rodríguez G, Marcelo; Pérez-Castilla, Alberto; Campaña W, Nicolás; Campaña V, Gonzalo.
Título: Aplicabilidad del Colon Leakage Score como predictor de filtración anastomótica en cirugía de cáncer colorrectal / Applicability of the Colon Leakage Score as an anastomotic leakage predictor in colorectal cancer surgery
Fonte: Rev. chil. cir;70(5):439-444, 2018. tab, graf.
Idioma: es.
Resumo: Introducción: La filtración anastomótica (FA) en cirugía colorrectal aumenta la morbimortalidad. La identificación de factores de riesgo y la creación de un modelo predictivo ayudaría en la decisión de crear un ostoma desfuncionalizante, hecho que, actualmente, recae en el criterio del cirujano. Dekker creó el Colon Leakage Score (CLS) estableciendo criterios objetivos. Objetivo: Establecer el CLS en pacientes intervenidos por cáncer de colon izquierdo y recto en Clínica INDISA, estableciendo valores de corte locales, su sensibilidad y especificidad. Pacientes y Método: Corresponde a un estudio de pruebas diagnósticas, cuya intervención es la aplicación del CLS comparándolo con la presencia de filtración anastomótica (gold standard), definida por criterios clínicos y radiológicos. Se utilizó análisis de curvas ROC, índice de Youden y regresión logística. Resultados: De 180 pacientes, hubo FA en 12 (6,6%). La media de CLS en quienes hubo FA fue de 11,5 y en quienes no hubo FA de 6,9 (p = 0,0001). El área bajo la curva para predicción de FA con el CLS fue de 0,829 (IC 95% 0,69-0,96), con un valor de corte de 11, sensibilidad de 67% y especificidad de 89%. En el análisis de regresión logística, el OR para la predicción de FA utilizando el CLS fue de 1,48 (IC 95% 1,22-1,79 p < 0,001). Conclusión: El CLS es una herramienta que permite predecir el riesgo de FA en pacientes intervenidos por cáncer de colon izquierdo y recto. Ante un valor mayor o igual a 11 se debería crear un ostoma protector, generando un cambio en la práctica clínica.

Introduction: Anastomotic filtration increases morbidity and mortality in colorrectal surgery. Identification of risk factors and creation of a predictive model would help the decision of creating a defunctionalizing ostoma, that currently is taken by the surgeon. Dekker created de Colon Leakege Score (CLS) with objective criteria. Objective: Establish CLS in patients that underwent left colon and rectum surgery with cancer diagnosis in Clinica INDISA, define the local cutting value, it's specificity and sensibility. Patients and Methods: Corresponds to a diagnostic test's study, that intervention is CLS application, comparing with the presence of anastomotic filtration (gold standard), defined by clinical and radiologic criteria. For the analysis, ROC curves, Youden's index and logistic regression. Results: From 180 patients, anastomotic filtration was present in 12 (6.6%). Average CLS score in patients with anastomotic filtration was 11.5 and in those without anastomotic filtration was 6.9 (p = 0.0001). Area under the curve for anastomotic filtration prediction using CLS was 0.829 (CI 95% 0.69-0.96) with a cutting value of 11, 67% of sensibility and 89% of specificity. Logistic regression analysis, OR for anastomotic filtration prediction using CLS was 1.48 (CI 95% 1.22-1.79 p < 0.001). Conclusion: CLS is a tool that permits predicting anastomotic filtration risk in patients that underwent left colon and rectum surgery. With a CLS value equal or more than 11, we should create a protective ostoma, generating a clinical practice local change.
Descritores: Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
Neoplasias Colorretais/cirurgia
Medição de Risco/métodos
Fístula Anastomótica/diagnóstico
-Prognóstico
Reto/cirurgia
Modelos Logísticos
Estudos Retrospectivos
Curva ROC
Sensibilidade e Especificidade
Colo/cirurgia
Fístula Anastomótica/etiologia
Limites: Humanos
Masculino
Feminino
Pessoa de Meia-Idade
Idoso
Idoso de 80 Anos ou mais
Tipo de Publ: Estudo Clínico
Responsável: CL61.1 - Biblioteca Central Campus Sur


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Id: biblio-978010
Autor: Muñoz P, Nelson; Rodríguez G, Marcelo; Pérez-Castilla, Alberto; Campaña W, Nicolás; Campaña V, Gonzalo.
Título: Análisis de variables relacionadas con la morbimortalidad de la anastomosis ileocólica después de hemicolectomía derecha / Analysis of variables related to morbidity and mortality of the ileocolic anastomosis after right hemicolectomy
Fonte: Rev. chil. cir;70(5):432-438, 2018. tab.
Idioma: es.
Resumo: Introducción: La hemicolectomía derecha con anastomosis ileocólica es una cirugía frecuentemente realizada para la que existen muchas formas de realizarla. Objetivo: Evaluar cuál es la mejor anastomosis ilecólica en términos de morbimortalidad y realizar una evaluación comparativa de la evolución clínica posoperatoria según el tipo de configuración anastomótica. Pacientes y Método: Estudio observacional analítico, con criterios de inclusión y exclusión definidos. Las variables a estudiar las dividimos en dos grupos, las relacionadas a la técnica quirúrgica y su configuración anastomótica, y las variables relacionadas con resultados de la intervención quirúrgica, creando una tabla de contingencia en que se cruzan los datos. Análisis de datos con STATA 13.0. Resultados: 216 pacientes con anastomosis ileocólica, destacando significancia estadística al cruzar: A) reoperación y tipo de sutura (p = 0,044), con un OR 3,4 (IC 95% 0,94-18,6), siendo de mayor riesgo la mecánica; B) mortalidad y urgencia (p = 0,001) con un OR 7,76 (IC 95% 1,56-49,29), siendo de mayor riesgo la cirugía de urgencia. Las anastomosis isoperistálticas possen eliminación de gases (p < 0,001), tránsito intestinal (p = 0,009) e ingesta de sólidos (p = 0,005) más precoz. Hay expulsión de gases antes en el abordaje laparoscópico, sutura manual, configuración término lateral e isoperistáltica de la anastomosis y cirugía electiva. Conclusión: Existe gran variabilidad de técnicas para realizar la anastomosis ileocólica. La anastomosis manual muestra menor probabilidad de necesitar una reintervención quirúrgica, la cirugía electiva tiene menor mortalidad que la realizada de urgencia. Sugerimos realizarla vía laparoscópica, con sutura manual, término lateral, isoperistáltica y de forma electiva, por tener una recuperación más corta.

Introduction: Right hemicolectomy with ileocolic anastomosis is a frequent surgery with many ways to perform it. Objective: To evaluate which is the best ileocolic anastomosis in terms of morbidity and mortality and to make a comparative evaluation of the postoperative clinical evolution according to the type of anastomosis. Patients and Method: Analytical observational study, with defined inclusion and exclusion criteria. The variables to be studied are divided into two groups, those related to the surgical technique and its anastomotic configuration, and the variables related to the results of the surgical intervention, creating a contingency table that crosses the data. Data analysis with STATA 13.0. Results: 216 patients with ileocolic anastomosis, highlighting statistical significance when crossing: A) reoperation and type of suture (p = 0.044), with UN or 3.4 (95% CI 0.94 to 18.6), being of greater risk the mechanics; B) mortality and urgency (p = 0.001) with an OR 7.76 (95% CI 1.56-49.29), with emergency surgery being of greater risk. Isoperistaltic anastomosis with gas elimination (p < 0.001), intestinal transit (p = 0.009) and solid intake (p = 0.005) earlier. There is earlier expulsion of gases in the laparoscopic approach, manual suture, end-to-side and isoperistaltic of the anastomosis and elective surgery. Conclusion: There is great variability of techniques to perform the ileocolic anastomosis. Manual anastomosis is less likely to require surgical reoperation, elective surgery has a lower mortality than that of emergency surgery. We suggest performing it laparoscopically, with manual suture, lateral term, isoperistaltic and electively, for having a shorter recovery.
Descritores: Anastomose Cirúrgica/métodos
Anastomose Cirúrgica/mortalidade
Colectomia/métodos
Colectomia/mortalidade
-Reoperação
Anastomose Cirúrgica/efeitos adversos
Estudos Retrospectivos
Colectomia/efeitos adversos
Colo/cirurgia
Fístula Anastomótica/etiologia
Fístula Anastomótica/epidemiologia
Íleo/cirurgia
Limites: Humanos
Masculino
Feminino
Adolescente
Adulto
Pessoa de Meia-Idade
Idoso
Idoso de 80 Anos ou mais
Adulto Jovem
Tipo de Publ: Estudo Comparativo
Estudo Observacional
Responsável: CL61.1 - Biblioteca Central Campus Sur


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Id: biblio-899651
Autor: Braghetto M, Italo; Figueroa G, Manuel; Sanhueza P, Belén; Valladares H, Héctor; Cardemil H, Gonzalo; Cortés L, Solange; Contreras B, Caterina.
Título: Evolución y pronóstico oncológico de fístulas anastomóticas esofágicas en el tratamiento del cáncer de esófago: estudio comparativo según vía de ascenso de tubo gástrico / Outcome and oncological prognosis of esophageal anastomotic fistulas in the treatment of esophageal cancer: comparative study according to gastric tube ascent
Fonte: Rev. chil. cir;70(1):19-26, 2018. tab, graf, ilus.
Idioma: es.
Resumo: Resumen Introducción La filtración de anastomosis esofágica es un evento que se asocia a mala evolución postoperatoria Su frecuencia y gravedad dependerá principalmente de aspectos técnicos quirúrgicos. Objetivos Analizar la frecuencia, manejo y pronóstico de las filtraciones de anastomosis esofágicas en esofagectomías por cáncer comparando la vía de ascenso del tubo gástrico y sitio de anastomosis. Material y Método Análisis de base prospectiva de pacientes con cáncer esofágico sometidos a esofagectomía. Análisis estadístico con test exacto de Fisher. Resultados De un total de 37 pacientes con cáncer esofágico tratados en nuestra institución en el período de estudio (5 años), se incluyeron 34 esofagectomías totalmente mini invasivas secundarias a cáncer de esófago. Un 79,4% correspondieron a esofagectomías totales con anastomosis cervical, en el 20,6% restante se realizó esofagectomía distal con anastomosis intratorácica. La tasa de filtración de la anastomosis esofágica fue de un 38,2% (13/34), todas fueron secundarias a esofagectomías totales. De estas un 69,2% (9/13) se clasificaron como Clavien - Dindo I-II. La tasa de filtración fue de 54,5% (6/11) para ascenso retroesternal y 43,7% (7/16) para ascenso mediastínico, sin ser estadísticamente diferente (p = 1,0). La tasa de reoperaciones fue de un 11,7%, siendo en todas secundario a ascensos mediastínicos posteriores, de estas fueron 3 casos de aseos vídeo-toracoscópicos y una reparación de vena innominada. No existió diferencia estadística entre las vías de ascenso y la tasa de reoperaciones (p = 0,26). La serie presentó una mortalidad quirúrgica de 5,8% concentrados todos en el grupo de pacientes con esofagectomías totales con ascenso mediastínico posterior. Conclusión Las filtraciones en anastomosis esofágicas son frecuentes en pacientes operados con intención curativa de cáncer esofágico. Las filtraciones de anastomosis esofágicas cervicales con ascenso retroesternal no requirieron reoperaciones, ni presentaron mortalidad postoperatoria.

Introduction Post operative leaks of esophageal anastomosis after esophagectomy is a risky event associated with poor postoperative evolution. Its frequency and severity will depend mainly on surgical technical aspects. Objectives To analyze the frequency, management and prognosis of leakage of esophageal anastomosis after esophagectomy for esophageal cancer. Material and Method Analysis of our prospective oncologic database of patients with esophageal cancers submmitted to esofagectomy. Statistical analysis with Fisher's exact test. Results 34 out of 37 esophageal cancer patients were included submitted to completely invasive mini esophagectomy. Cervical anastomosis was performed in 79.4% of patients, in the remaining 20.6%, a distal esophagectomy with intrathoracic anastomosis was performed. The leak rate was 38.2% (13/34), of these, 69.2% (9/13) correspond to grade Clavien - Dindo I - II complications. The leak rate was 54.5% (6/11) for retro-sternal gastric ascensus and 43.7% (7/16) for mediastinal route, without significative difference (p = 1.0). The reoperation rate was 11.7%, being a 100% secondary to mediastinal ascensus, 3 of them were submitted to thoracoscopic toilets and an innominate vein repair. Postoperative mortality rate was 5.8%, all concentrated in the group of patients with posterior mediastinal ascensus, but without statistical difference (p = 0.26). Conclusion Leaks are frequent in patients operated on for esophageal cancer, especially after cervical esophago-gastro-anastomosis with anterior route for ascensus. However, retro-sternal ascensus did not require re-operations, nor postoperative mortality compared to gastric ascensus through posterior mediastinum
Descritores: Neoplasias Esofágicas/cirurgia
Anastomose Cirúrgica/efeitos adversos
Esofagectomia/efeitos adversos
Fístula Anastomótica/etiologia
-Prognóstico
Reoperação
Análise de Sobrevida
Seguimentos
Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos
Limites: Humanos
Masculino
Feminino
Adulto
Pessoa de Meia-Idade
Idoso
Idoso de 80 Anos ou mais
Tipo de Publ: Estudo Comparativo
Responsável: CL61.1 - Biblioteca Central Campus Sur


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Id: lil-787076
Autor: Guarneri, Carolina; Vanerio, Patricio; Lyford-Pike, Patrick.
Título: Técnica con indocianina verde (ICG) como predictor de la falla de sutura: inicio de la experiencia en nuestro medio / Technical indocyanine green (ICG) as a predictor of suture failure
Fonte: Rev. chil. cir;68(3):214-218, jun. 2016. ilus.
Idioma: es.
Resumo: Objetivo: Valorar en el intraoperatorio en tiempo real, el flujo sanguíneo de los cabos anastomóticos y la anastomosis. El objetivo final de este trabajo busca que este sea el inicio de un estudio prospectivo, con el fin de auditar las anastomosis colónicas de forma intraoperatoria buscando así disminuir el número de fallas de suturas. Material y método: Se realizó un estudio prospectivo, observacional y descriptivo, desarrollado en el Hospital de Clínicas en el período comprendido entre enero de 2014 y julio 2015. Se incluyeron en el mismo pacientes sometidos a resección de colon y reconstrucción primaria del tránsito intestinal de coordinación. El indocianina verde (ICG) se empleó como colorante vital fluorescente para la valoración in situ de la anastomosis colónica. La presencia de falla de sutura en el postoperatorio en relación con la perfusión anastomótica objetivada con ICG constituye un parámetro de importancia en nuestro estudio. Resultados: En lo referente a la perfusión de la anastomosis, destacamos que en el primer caso la misma fue sensiblemente inferior en el cabo colónico, en tanto que en los 2 casos restantes la vascularización de los cabos fue óptima. Conclusiones: La técnica con ICG constituye una herramienta apropiada para poder auditar la calidad de las anastomosis intestinales realizadas de coordinación. Se trata de una técnica segura, aplicable en nuestro medio. Siendo un predictor de falla de sutura, permite un descenso de la morbimortalidad postoperatoria por esta causa.

Aim: Rate intraoperatively in real time, blood flow and ends anastomotic and anastomosis. The ultimate goal of this work seeks to make this the beginning of a prospective study in order to audit the colonic anastomosis intraoperatively and seeking to reduce the number of sutures failure. Material and method: A prospective, observational and descriptive study, to be held in the Clinics Hospital in the period between January 2014 and July 2015. They were included in the same patients undergoing resection of colon and intestinal transit reconstruction on primary coordination. Indocyanine green (ICG) was used as a fluorescent vital dye for in situ evaluation of colonic anastomosis. The presence of failure postoperative suture relative to the anastomotic objectified perfusion with ICG, is an important parameter in our study.Results:Regarding the perfusion of the anastomosis, in the first case it was significantly lower than in the colonic out. While in the remaining two cases the vascularization of the ends was optimal. Conclusions: The technique with indocyanine green is an appropriate tool to audit the quality of intestinal anastomoses performed coordination.
Descritores: Anastomose Cirúrgica/efeitos adversos
Fístula Anastomótica/diagnóstico
Verde de Indocianina
Complicações Intraoperatórias/diagnóstico
-Complicações Pós-Operatórias/prevenção & controle
Prognóstico
Estudos Prospectivos
Colo/cirurgia
Estudo Observacional
Limites: Humanos
Masculino
Feminino
Pessoa de Meia-Idade
Idoso de 80 Anos ou mais
Tipo de Publ: Relatos de Casos
Responsável: CL1.1 - Biblioteca Central


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Id: biblio-830094
Autor: López-Köstner, Francisco; Cerda C, Cesar; Wainstein G, Claudio; Kronberg, Udo; Larach K, Andrés; Larach S, Jorge; Zarate, Alejandro J; Castro A, Lorna.
Título: Impacto de las filtraciones anastomóticas en cirugía colorrectal / Impact of anastomotic leak in colorectal surgery
Fonte: Rev. chil. cir;68(6):417-421, dic. 2016. ilus, tab.
Idioma: es.
Resumo: Introducción: La filtración de anastomosis es una de las complicaciones de mayor impacto en cirugía colorrectal. Objetivo: Analizar la frecuencia e impacto de las filtraciones anastomóticas en cirugía laparoscópica colorrectal. Material y método: Estudio longitudinal de base de datos prospectiva de pacientes operados por cirugía colorrectal entre julio de 2007 y agosto de 2014. Resultados: De un total de 654 pacientes operados, 52,3% correspondían a hombres con una edad promedio de 57 años (42-72). La indicación más frecuente fue cáncer colorrectal con 244 pacientes, 159 (24,3%) operados por cáncer de colon y 85 (12,9%) por cáncer de recto, seguido por la enfermedad diverticular con 239 pacientes (36,5%) y 171 pacientes (26,1%) con otros diagnósticos. En 44 pacientes (6,7%) se objetivó filtración anastomótica, con una mediana de 4 días desde el postoperatorio para su diagnóstico. Como factores asociados a filtración se identificó al género masculino, riesgo anestesiológico según ASA, necesidad de conversión a laparotomía y la anastomosis ileoanal. En relación con el tratamiento, 15 pacientes (33,7%) fueron tratados de forma médica exitosa y 29 fue necesario reintervenirlos, de los cuales 23 (79,3%) requirieron una ostomía de protección. No hubo mortalidad asociada a la cirugía, y el promedio de hospitalización en los pacientes con filtración fue de 12 vs. 5 días para los pacientes sin filtración de la anastomosis. Conclusión: Este trabajo permite identificar a grupos de pacientes con mayor riesgo de filtraciones anastomóticas, quienes duplican su estadía hospitalaria y en un alto porcentaje deben ser reintervenidos. La sospecha y diagnostico precoz reducen la morbimortalidad.

Introduction: Anastomotic leak is the most important complication on colorectal surgery. Objective: Analyze the frequency and impact of anastomotic leaks in laparoscopic colorectal surgery. Material and methods: Longitudinal study of prospective database of patients undergoing colorectal surgery between July 2007 and August 2014. Results: 654 patients operated, 52.3% were men with an average age of 57 years (42-72). The most frequent indication was colorectal cancer in 244 patients, 159 (24.3%) operated for colon cancer and 85 (12.9%) for rectal cancer followed by diverticular disease in 239 patients (36.5%) and 171 patients (26.1%) with other diagnoses. In 44 patients (6.7%) anastomotic leakage was observed with a median of 4 days post surgery for diagnosis. As factors associated with filtration, we identified male gender, anesthesic risk according to ASA, need for conversion to laparotomy and ileoanal anastomosis. With regard to treatment, 15 (33.7%) were successfully treated with medical therapy alone and 29 required re-intervention, of which 23 (79.3%) required an ostomy protection. There was no mortality associated with surgery and average LOS was 12 vs. 5 days in patients with filtration compared with patients without anastomotic leakeage. Conclusion: This serie helps to identify patients groups with increased risk of anastomotic leakage who double their hospital LOS and in a higher percentage should need re-intervention. Suspicion and early diagnosis reduces morbidity and mortality.
Descritores: Fístula Anastomótica/epidemiologia
Cirurgia Colorretal/efeitos adversos
Laparoscopia/efeitos adversos
-Fístula Anastomótica/terapia
Estudos Longitudinais
Complicações Pós-Operatórias/epidemiologia
Fatores de Risco
Limites: Humanos
Masculino
Feminino
Adulto
Pessoa de Meia-Idade
Idoso
Responsável: CL1.1 - Biblioteca Central


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Texto completo SciELO Brasil
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Id: lil-762817
Autor: ASKARPOUR, Shahnam; PEYVASTEH, Mehran; JAVAHERIZADEH, Hazhir; ASKARI, Nasim.
Título: EVALUATION OF RISK FACTORS AFFECTING ANASTOMOTIC LEAKAGE AFTER REPAIR OF ESOPHAGEAL ATRESIA / AVALIAÇÃO DOS FATORES DE RISCO QUE AFETAM DEISCÊNCIA DE ANASTOMOSE APÓS REPARAÇÃO DE ATRESIA ESOFÁGICA
Fonte: ABCD arq. bras. cir. dig;28(3):161-162, July-Sept. 2015. tab.
Idioma: en.
Resumo: Background:Anastomotic leak are reported among neonates who underwent esophageal atresia. Aim: To find risk factors of anastomotic leakage in patients underwent esophageal repair. Methods: All cases with esophageal atresia were included. In this case control study, patients were classified in two groups according to presence or absence of anastomotic leaks. Duration of study was 10 years. Results: Sixty-one cases were included. Mean±SD age at time of surgery in patients with leakage and without leakage was 9.50±7.25 and 8.83±6.93 respectively (p=.670). Blood transfusion and two layer anastomosis had significant correlation with anastomotic leakage. Conclusion:Blood transfusion and double layer anastomosis are associated with higher rate of anastomotic leakage.

Racional:Fístulas são relatadas entre os recém-nascidos que foram submetidos à reparação de atresia de esôfago. Objetivo:Encontrar fatores de risco de deiscência de anastomose nos pacientes submetidos à correção cirúrgica do esôfago. Métodos:Todos os casos com atresia de esôfago foram incluídos. Neste estudo caso-controle, os pacientes foram classificados em dois grupos de acordo com a presença ou ausência de fístula. Duração do estudo foi de 10 anos. Resultados:Sessenta e um casos foram incluídos. A média±DP da idade no momento da operação em pacientes com deiscência e sem foi 9,50±7,25 e 8,83±6,93, respectivamente (p=0,670). Transfusão de sangue e duas camadas anastomose tiveram correlação significativa com a deiscência da anastomose. Conclusão:Transfusão de sangue e anastomose em dois planos estão associadas com maior taxa de deiscência.
Descritores: Fístula Anastomótica/epidemiologia
Atresia Esofágica/cirurgia
-Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Limites: Feminino
Humanos
Recém-Nascido
Masculino
Tipo de Publ: Research Support, Non-U.S. Gov't
Responsável: BR1.1 - BIREME


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Texto completo SciELO Chile
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Id: lil-745624
Autor: Norero, Enrique; Báez, Sergio; Briceño, Eduardo; Martínez, Cristian; Ceroni, Marco; Escalona, Alex; Aguayo, Gloria; González, Paulina; Araos, Fernando; Calvo, Alfonso; Díaz, Alfonso; Viñuela, Eduardo.
Título: Gastrectomía totalmente laparoscópica por neoplasias gástricas: Experiencia en un centro público / Totally laparoscopic gastrectomy for the treatment of gastric tumors
Fonte: Rev. méd. Chile;143(3):281-288, mar. 2015. graf, tab.
Idioma: es.
Resumo: Background: The laparoscopic approach for the treatment of gastric tumors has many advantages. Aim: To evaluate the results of a laparoscopic gastrectomy program developed in a public hospital. Patients and Methods: Retrospective review of epidemiological, perioperative and follow-up data of patients who were treated with a laparoscopic gastrectomy due to gastric tumors between 2006 and 2013. A totally laparoscopic technique was used for all cases. Complications were evaluated according to the Clavien-Dindo classification. Results: Fifty one patients, aged 65 (36-85) years, underwent a laparoscopic gastrectomy. In 22 patients a total gastrectomy was performed. Conversion rate to open surgery was 8%. Operative time was 330 (90-500) min and bleeding was 200 (20-500) ml. Median hospital stay was 7 (3-37) days. Postoperative morbidity was present in 17 (33%) patients, 3 (6%) patients had complications grade 3 or higher and one patient died (1.9%). Tumor pathology was adenocarcinoma in 39 patients. A complete resection was achieved in 97%. Twenty nine patients (74%) with gastric adenocarcinoma had early gastric cancer and 84% of patients were in stage one. Median lymph node count was 24. Median follow-up was 26 (1-91) months. There was no cancer related mortality among patients subjected to a curative resection. Overall survival for patients with adenocarcinoma was 92% at 3 years. Conclusions: This study supports the feasibility and safety of a laparoscopic gastrectomy program in a public hospital; with low morbidity, adequate lymph node dissection and long-term survival. This approach must be considered an option for selected patients with gastric cancer.
Descritores: Adenocarcinoma/cirurgia
Obstrução da Saída Gástrica
Gastrectomia/métodos
Laparoscopia/métodos
Complicações Pós-Operatórias
Neoplasias Gástricas/cirurgia
-Fístula Anastomótica
Adenocarcinoma/mortalidade
Chile
Conversão para Cirurgia Aberta/estatística & dados numéricos
Seguimentos
Gastrectomia/estatística & dados numéricos
Hospitais Públicos
Tempo de Internação
Laparoscopia/estatística & dados numéricos
Duração da Cirurgia
Período Perioperatório
Reoperação
Estudos Retrospectivos
Taxa de Sobrevida
Neoplasias Gástricas/mortalidade
Resultado do Tratamento
Limites: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Humanos
Masculino
Pessoa de Meia-Idade
Responsável: CL1.1 - Biblioteca Central



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