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[PMID]:28744748
[Au] Autor:Azzam AZ; Tanaka K
[Ad] Endereço:General Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt. aazzam70@yahoo.com.
[Ti] Título:Biliary complications after living donor liver transplantation: A retrospective analysis of the Kyoto experience 1999-2004.
[So] Source:Indian J Gastroenterol;36(4):296-304, 2017 Jul.
[Is] ISSN:0975-0711
[Cp] País de publicação:India
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND AIM: In living donor liver transplantation (LDLT), biliary complications continue to be the most frequent cause of morbidity and may contribute to mortality of recipients although there are advances in surgical techniques. This study will evaluate retrospectively the short-term and long-term management of biliary complications. METHODS: During the period from May 1999, to May 2004, 505 patients underwent 518 LDLT in the Department of Liver Transplantation and Immunology, Kyoto University Hospital, Japan. The data was collected and analyzed retrospectively. RESULTS: The recipients were 261 males (50.4%) and 257 females (49.6%). Biliary complications were reported in 202/518 patients (39.0%), included; biliary leakage in 79/518 (15.4%) patients, leakage followed by biloma in 13/518 (2.5%) patients, leakage followed by stricture in 9/518 (1.8%) patients, and biliary strictures in 101/518 (19.3%) patients. Proper management of the biliary complications resulted in a significant (p value 0.002) success rate of 96.5% compared to the failure rate which was 3.5%. CONCLUSION: Careful preoperative evaluation and the proper intraoperative techniques in biliary reconstruction decrease biliary complications. Early diagnosis and proper management of biliary complications can decrease their effect on both the patient and the graft survival over the long period of follow up.
[Mh] Termos MeSH primário: Fístula Anastomótica/epidemiologia
Doenças Biliares/epidemiologia
Sistema Biliar/patologia
Transplante de Fígado
Doadores Vivos
Complicações Pós-Operatórias/epidemiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Fístula Anastomótica/prevenção & controle
Doenças Biliares/mortalidade
Doenças Biliares/patologia
Doenças Biliares/prevenção & controle
Procedimentos Cirúrgicos do Sistema Biliar/métodos
Criança
Pré-Escolar
Constrição Patológica
Feminino
Sobrevivência de Enxerto
Seres Humanos
Japão
Transplante de Fígado/mortalidade
Masculino
Meia-Idade
Complicações Pós-Operatórias/mortalidade
Complicações Pós-Operatórias/prevenção & controle
Procedimentos Cirúrgicos Reconstrutivos/métodos
Estudos Retrospectivos
Taxa de Sobrevida
Fatores de Tempo
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.1007/s12664-017-0771-3


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[PMID]:27778169
[Au] Autor:Fung A; Trabulsi N; Morris M; Garfinkle R; Saleem A; Wexner SD; Vasilevsky CA; Boutros M
[Ad] Endereço:Department of Surgery, Colorectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, 3755 Cote Ste Catherine, G-317, Montreal, QC, H3T 1E2, Canada.
[Ti] Título:Laparoscopic colorectal cancer resections in the obese: a systematic review.
[So] Source:Surg Endosc;31(5):2072-2088, 2017 05.
[Is] ISSN:1432-2218
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Laparoscopic colorectal cancer operations in obese patients pose technical challenges that may negatively impact oncologic adequacy. A meta-analysis was performed to assess the oncologic outcomes of laparoscopic colorectal cancer resections in obese compared to non-obese patients. Short- and long-term outcomes were assessed secondarily. METHODS: A systematic literature search was conducted from inception until October 01, 2014. Studies that compared outcomes of laparoscopic colorectal malignant neoplasms in obese and non-obese patients were selected for meta-analysis. Studies that defined obesity as body mass index (BMI) ≥ 30 kg/m were included. Oncologic, operative, and postoperative outcomes were evaluated. Pooled odds ratios (OR) and weighted mean differences (WMD) with 95 % confidence intervals (CI) were calculated using fixed-effects models. For oncologic and survival outcomes, a subgroup analysis was conducted for rectal cancer and a secondary analysis was conducted for Asian studies that used a BMI cutoff of 25 kg/m . RESULTS: Thirteen observational studies with a total of 4550 patients were included in the meta-analysis. Lymph node retrieval, distal, and circumferential margins, and 5-year disease-free and overall survival were similar in the obese and non-obese groups. Conversion rate (OR 2.11, 95 % CI 1.58-2.81), postoperative morbidity (OR 1.54, 95 % CI 1.21-1.97), wound infection (OR 2.43, 95 % CI 1.46-4.03), and anastomotic leak (OR 1.65, 95 % CI 1.01-2.71) were all significantly increased in the obese group. CONCLUSIONS: Laparoscopic colorectal cancer operations in obese patients pose an increased technical challenge as demonstrated by higher conversion rates and higher risk of postoperative complications compared to non-obese patients. Despite these challenges, oncologic adequacy of laparoscopic colorectal cancer resections is comparable in both groups.
[Mh] Termos MeSH primário: Neoplasias Colorretais/cirurgia
Laparoscopia
Obesidade/complicações
Complicações Pós-Operatórias
[Mh] Termos MeSH secundário: Fístula Anastomótica
Conversão para Cirurgia Aberta
Seres Humanos
Infecção da Ferida Cirúrgica
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180127
[Lr] Data última revisão:
180127
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.1007/s00464-016-5209-y


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[PMID]:28746154
[Au] Autor:Borstlap WAA; Westerduin E; Aukema TS; Bemelman WA; Tanis PJ; Dutch Snapshot Research Group
[Ad] Endereço:Academic Medical Center, Amsterdam, The Netherlands.
[Ti] Título:Anastomotic Leakage and Chronic Presacral Sinus Formation After Low Anterior Resection: Results From a Large Cross-sectional Study.
[So] Source:Ann Surg;266(5):870-877, 2017 11.
[Is] ISSN:1528-1140
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Little is known about late detected anastomotic leakage after low anterior resection for rectal cancer, and the proportion of leakages that develops into a chronic presacral sinus. METHODS: In this collaborative snapshot research project, data from registered rectal cancer resections in the Dutch Surgical Colorectal Audit in 2011 were extended with additional treatment and long-term outcome data. Independent predictors for anastomotic leakage were determined using a binary logistic model. RESULTS: A total of 71 out of the potential 94 hospitals participated. From the 2095 registered patients, 998 underwent a low anterior resection, of whom 88.8% received any form of neoadjuvant therapy. Median follow-up was 43 months (interquartile range 35-47). Anastomotic leakage was diagnosed in 13.4% within 30 days, which increased to 20.0% (200/998) beyond 30 days. Nonhealing of the leakage at 12 months was 48%, resulting in an overall proportion of chronic presacral sinus of 9.5%. Independent predictors for anastomotic leakage at any time during follow-up were neoadjuvant therapy (odds ratio 2.85; 95% confidence interval 1.00-8.11) and a distal (≤3 cm from the anorectal junction on magnetic resonance imaging) tumor location (odds ratio 1.88; 95% confidence interval 1.02-3.46). CONCLUSIONS: This cross-sectional study of low anterior resection for rectal cancer in the Netherlands in 2011, with almost routine use of neoadjuvant radiotherapy, shows that one third of anastomotic leakages is diagnosed beyond 30 days, and almost half of the leakages eventually do not heal. Chronic presacral sinus is a significant clinical problem that deserves more attention.
[Mh] Termos MeSH primário: Fístula Anastomótica/epidemiologia
Neoplasias Retais/cirurgia
Reto/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Anastomose Cirúrgica
Fístula Anastomótica/diagnóstico
Fístula Anastomótica/fisiopatologia
Doença Crônica
Auditoria Clínica
Estudos Transversais
Feminino
Seres Humanos
Incidência
Modelos Logísticos
Masculino
Meia-Idade
Terapia Neoadjuvante
Radioterapia Adjuvante
Neoplasias Retais/radioterapia
Estudos Retrospectivos
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180123
[Lr] Data última revisão:
180123
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.1097/SLA.0000000000002429


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[PMID]:29277820
[Au] Autor:Takahashi H; Haraguchi N; Nishimura J; Hata T; Yamamoto H; Matsuda C; Mizushima T; Doki Y; Mori M
[Ad] Endereço:Department of Gastroenterological Surgery, Osaka University, Graduate School of Medicine, Suita, Japan htakahashi@gesurg.med.osaka-u.ac.jp.
[Ti] Título:The Severity of Anastomotic Leakage May Negatively Impact the Long-term Prognosis of Colorectal Cancer.
[So] Source:Anticancer Res;38(1):533-539, 2018 01.
[Is] ISSN:1791-7530
[Cp] País de publicação:Greece
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Anastomotic leakage is a major critical complication in colorectal resection. Although its relevance to oncological outcome has been widely investigated, the correlation between the severity of anastomotic leakage and oncological outcome is not well understood. PATIENTS AND METHODS: The clinical characteristics of 615 patients who underwent curative resection of colorectal cancer with anastomosis and normal healing were compared with 44 similar patients who experienced anastomotic leakage. RESULTS: Of the 44 patients, seven had grade A anastomotic leakage, 21 had grade B and 16 had grade C. Patients with grade A and B anastomotic leakage were treated conservatively (n=28), and those with grade C (n=16) were treated surgically. Those treated surgically had significantly worse recurrence-free survival and worse cancer-specific survival. CONCLUSION: Anastomotic leakage had a negative prognostic impact on cancer-specific survival that depended on the severity of anastomotic leakage.
[Mh] Termos MeSH primário: Anastomose Cirúrgica/efeitos adversos
Fístula Anastomótica/cirurgia
Neoplasias Colorretais/mortalidade
Neoplasias Colorretais/cirurgia
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
Complicações Pós-Operatórias/mortalidade
[Mh] Termos MeSH secundário: Idoso
Neoplasias Colorretais/patologia
Intervalo Livre de Doença
Feminino
Seres Humanos
Inflamação/tratamento farmacológico
Masculino
Meia-Idade
Recidiva Local de Neoplasia/diagnóstico
Recidiva Local de Neoplasia/patologia
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180104
[Lr] Data última revisão:
180104
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171227
[St] Status:MEDLINE


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[PMID]:29191359
[Au] Autor:Miller DL; Helms GA; Mayfield WR
[Ad] Endereço:WellStar Thoracic Surgery, WellStar Health System/Mayo Clinic Care Network, Marietta, Georgia. Electronic address: daniel.miller@wellstar.org.
[Ti] Título:Evaluation of Esophageal Anastomotic Integrity With Serial Pleural Amylase Levels.
[So] Source:Ann Thorac Surg;105(1):200-206, 2018 Jan.
[Is] ISSN:1552-6259
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: An anastomotic leak is the most devastating and potentially fatal complication after esophagectomy. Current detection methods can be inaccurate and place patients at risk of other complications. Analysis of pleural fluid for amylase may be more accurate and place patients at less of a risk for evaluating the integrity of an esophageal anastomosis. METHODS: We retrospectively reviewed prospective data of 45 consecutive patients who underwent an Ivor Lewis esophagectomy over an 18-month period and evaluated their anastomotic integrity with serial pleural amylase levels (PAL). RESULTS: There were 40 men (89%), and median age was 63 years (range, 35 to 79). Indication for esophagectomy was cancer in 38 patients (84%); 27 (71%) underwent neoadjuvant chemoradiation. A barium swallow was performed in the first 25 patients at median postoperative day (POD) 5 (range, 5 to 10); the swallow was negative in 23 patients (93%). Serial PALs were obtained starting on POD 3 and stopped 1 day after toleration of clear liquids. The PALs in the no-leak patients were highest on POD 3 (median 42 IU/L; range, 20 to 102 IU/L) and decreased (median 15 IU/L; range, 8 to 34 IU/L) to the lowest levels 1 day after clear liquid toleration (p = 0.04). Two patients had a leak and had peak PALs of 227 IU/L and 630 IU/L, respectively; both leaks occurred on POD 4, 1 day before their scheduled swallow test. The last 20 patients underwent serial PALs only, without a planned swallow test or computed tomography scan for anastomotic integrity evaluation. One of these patients had a leak on POD 5 with a low PAL of 55 IU/L the day before the spike of more than 4,000 IU/L. Two of the leaks were treated with esophageal stent placement and intravenous antibiotics, and the remaining patient's leak resolved with intravenous antibiotics, no oral intake, and observation only. None of the leak patients required transthoracic esophageal repair or drainage of an empyema. There was 1 postoperative death (2%) secondary to aspiration pneumonia on POD 10; no leak was ever identified, and the patient had been eating for 3 days before death. Complications occurred in 15 patients (33%), most commonly respiratory; no respiratory issues occurred in PAL-only evaluated patients. No late anastomotic leaks occurred in any patient while in the hospital or after discharge. CONCLUSIONS: Serial PALs for the detection of esophageal anastomotic leaks proved to be accurate, safe, and inexpensive. Elimination of barium swallows and computed tomography scans for evaluation of anastomotic integrity may decrease aspiration risks as well as associated pulmonary failure during the postoperative period. Serial PALs may be the preferred method of detecting an anastomotic leak after esophagectomy. A prospective randomized study is warranted.
[Mh] Termos MeSH primário: Amilases/análise
Fístula Anastomótica/diagnóstico
Líquidos Corporais/química
Esofagectomia
Esôfago/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Anastomose Cirúrgica
Feminino
Seres Humanos
Masculino
Meia-Idade
Pleura
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
EC 3.2.1.- (Amylases)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171228
[Lr] Data última revisão:
171228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE


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[PMID]:29187499
[Au] Autor:Yamamoto S; Kanai T; Osumi K; Yo K; Takano K; Tsutsui M; Nakanishi R; Yoshikawa Y; Kaneko Y; Nakagawa M
[Ad] Endereço:Division of Surgery, Hiratsuka City Hospital, Hiratsuka, Japan miyamamo@jcom.home.ne.jp.
[Ti] Título:Anastomotic Leakage Using Linear Stapling Device with Pre-attached Bioabsorbable Polyglycolic Acid Felt After Laparoscopic Anterior Resection.
[So] Source:Anticancer Res;37(12):7083-7086, 2017 12.
[Is] ISSN:1791-7530
[Cp] País de publicação:Greece
[La] Idioma:eng
[Ab] Resumo:AIM: Many studies have evaluated the risk factors for anastomotic leakage after laparoscopic anterior resection. In this study in order to increase the tightness of anastomoses and prevent bleeding from their staple lines, a linear stapler with pre-attached bioabsorbable polyglycolic acid (PGA) felt was used for rectal transection, and the short-term surgical outcomes were evaluated. PATIENTS AND METHODS: A prospective registry of 62 patients with rectosigmoidal or rectal carcinoma who initially underwent laparoscopic anterior resection using PGA felt for rectal transection was reviewed. RESULTS: The overall frequency of anastomotic leakage was 1.6% (1/62), and none of the patients developed postoperative staple line bleeding or other adverse events related to the use of PGA felt. CONCLUSION: The frequency of anastomotic leakage was relatively low, and therefore the use of a linear stapler with pre-attached bioabsorbable PGA felt might reduce the risk of adverse events related to anastomosis, especially anastomotic leakage.
[Mh] Termos MeSH primário: Anastomose Cirúrgica/métodos
Fístula Anastomótica/prevenção & controle
Laparoscopia/métodos
Ácido Poliglicólico/química
Neoplasias Retais/cirurgia
Grampeamento Cirúrgico
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Anastomose Cirúrgica/efeitos adversos
Fístula Anastomótica/etiologia
Feminino
Seres Humanos
Laparoscopia/efeitos adversos
Masculino
Meia-Idade
Estudos Prospectivos
Reto/patologia
Reto/cirurgia
Fatores de Risco
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
26009-03-0 (Polyglycolic Acid)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE


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[PMID]:29112566
[Au] Autor:Johnston WF; Stafford C; Francone TD; Read TE; Marcello PW; Roberts PL; Ricciardi R
[Ad] Endereço:Department of Colon and Rectal Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts.
[Ti] Título:What Is the Risk of Anastomotic Leak After Repeat Intestinal Resection in Patients With Crohn's Disease?
[So] Source:Dis Colon Rectum;60(12):1299-1306, 2017 Dec.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Approximately half of Crohn's patients require intestinal resection, and many need repeat resections. OBJECTIVE: The purpose of this study was to evaluate the increased risk of clinical anastomotic leak in patients with a history of previous intestinal resection undergoing repeat resection with anastomosis for Crohn's disease. DESIGN: This was a retrospective analysis of prospectively collected departmental data with 100% capture. SETTINGS: The study was conducted at the department of colorectal surgery in a tertiary care teaching hospital between July 2007 and March 2016. PATIENTS: A cohort of consecutive patients with Crohn's disease who were treated with intestinal resection and anastomosis, excluding patients with proximal fecal diversion, were included. The cohort was divided into 2 groups, those with no previous resection compared with those with previous resection. MAIN OUTCOME MEASURES: Clinical anastomotic leak within 30 days of surgery was measured. RESULTS: Of the 206 patients who met criteria, 83 patients had previous intestinal resection (40%). The 2 groups were similar in terms of patient factors, immune-suppressing medication use, and procedural factors. Overall, 20 clinical anastomotic leaks were identified (10% leak rate). There were 6 leaks (5%) detected in patients with no previous intestinal resection and 14 leaks (17%) detected in patients with a history of previous intestinal resection (p < 0.005). The OR of anastomotic leak in patients with Crohn's disease with previous resection compared with no previous resection was 3.5 (95% CI, 1.3-9.4). Patients with 1 previous resection (n = 53) had a leak rate of 13%, whereas patients with ≥2 previous resections (n = 30) had a leak rate of 23%. The number of previous resections correlated with increasing risk for clinical anastomotic leak (correlation coefficient = 0.998). LIMITATIONS: This was a retrospective study with limited data to perform a multivariate analysis. CONCLUSIONS: Repeat intestinal resection in patients with Crohn's disease is associated with an increased rate of anastomotic leakage when compared with initial resection despite similar patient, medication, and procedural factors. See Video Abstract at http://links.lww.com/DCR/A459.
[Mh] Termos MeSH primário: Fístula Anastomótica/etiologia
Doença de Crohn/cirurgia
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Masculino
Meia-Idade
Reoperação
Estudos Retrospectivos
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; VIDEO-AUDIO MEDIA
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171108
[St] Status:MEDLINE
[do] DOI:10.1097/DCR.0000000000000946


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[PMID]:28951446
[Au] Autor:Liu JB; Ban KA; Berian JR; Hutter MM; Huffman KM; Liu Y; Hoyt DB; Hall BL; Ko CY
[Ad] Endereço:American College of Surgeons, 633 N St Clair St, Chicago, IL, 60611, USA jliu@facs.org.
[Ti] Título:Concurrent bariatric operations and association with perioperative outcomes: registry based cohort study.
[So] Source:BMJ;358:j4244, 2017 Sep 26.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo: To determine whether perioperative outcomes differ between patients undergoing concurrent compared with non-concurrent bariatric operations in the USA. Retrospective, propensity score matched cohort study. Hospitals in the US accredited by the American College of Surgeons' metabolic and bariatric surgery accreditation and quality improvement program. 513 167 patients undergoing bariatric operations between 1 January 2014 and 31 December 2016. The primary outcome measure was a composite of 30 day death, morbidity, readmission, reoperation, anastomotic or staple line leak, and bleeding events. Operative duration and lengths of stay were also assessed. Operations were defined as concurrent if they overlapped by 60 or more minutes or in their entirety. In this study of 513 167 operations, 739 (29.5%) surgeons at 483 (57.8%) hospitals performed 6087 (1.2%) concurrent operations. The most frequently performed concurrent bariatric operations were sleeve gastrectomy (n=3250, 53.4%) and Roux-en-Y gastric bypass (n=1601, 26.3%). Concurrent operations were more often performed at large academic medical centers with higher operative volumes and numbers of trainees and by higher volume surgeons. Compared with non-concurrent operations, concurrent operations lasted a median of 34 minutes longer (P<0.001) and resulted in 0.3 days longer average length of stay (P<0.001). Perioperative adverse events were not observed to more likely occur in concurrent compared with non-concurrent operations (7.5% 7.4%; relative risk 1.02, 95% confidence interval 0.90 to 1.15; P=0.84). Concurrent bariatric operations occurred infrequently, but when they did, there was no observable increased risk for adverse perioperative outcomes compared with non-concurrent operations. These results, however, do not argue against improved and more meaningful disclosure of concurrent surgery practices.
[Mh] Termos MeSH primário: Cirurgia Bariátrica/métodos
Avaliação de Processos e Resultados (Cuidados de Saúde)
Complicações Pós-Operatórias/epidemiologia
[Mh] Termos MeSH secundário: Fístula Anastomótica/epidemiologia
Índice de Massa Corporal
Feminino
Seres Humanos
Tempo de Internação/estatística & dados numéricos
Masculino
Meia-Idade
Duração da Cirurgia
Readmissão do Paciente/estatística & dados numéricos
Pontuação de Propensão
Sistema de Registros
Reoperação/estatística & dados numéricos
Estudos Retrospectivos
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171008
[Lr] Data última revisão:
171008
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170928
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j4244


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[PMID]:28935328
[Au] Autor:Loyalka P; Montgomery KB; Nguyen TC; Smalling RW; Howe M; Rajagopal K
[Ad] Endereço:Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas-Houston, and Memorial Hermann-Texas Medical Center, Houston, Texas. Electronic address: pranav.loyalka@uth.tmc.edu.
[Ti] Título:Valve-in-Valve Transcatheter Aortic Valve Implantation: A Novel Approach to Treat Paravalvular Leak.
[So] Source:Ann Thorac Surg;104(4):e325-e327, 2017 Oct.
[Is] ISSN:1552-6259
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Enlarging or "cracking" a surgical stented bioprosthetic valve during valve-in-valve transcatheter aortic valve implantation (TAVI) increases orifice area, reducing transvalvular energy losses. We demonstrate that TAVI with valve cracking can be used to treat paravalvular leak (PVL) while providing optimal aortic valve physiology. A 61-year-old woman with a history of aortic valve replacement with a stented bioprosthesis presented with heart failure. Transthoracic echocardiography revealed severe prosthetic aortic valve stenosis with PVL and severe regurgitation. The patient underwent valve-in-valve TAVI with valve cracking. This successfully treated both the stenosis and the PVL with regurgitation.
[Mh] Termos MeSH primário: Fístula Anastomótica/cirurgia
Bioprótese
Implante de Prótese de Valva Cardíaca/efeitos adversos
Falha de Prótese
Substituição da Valva Aórtica Transcateter/métodos
[Mh] Termos MeSH secundário: Fístula Anastomótica/diagnóstico por imagem
Insuficiência da Valva Aórtica/complicações
Insuficiência da Valva Aórtica/diagnóstico por imagem
Insuficiência da Valva Aórtica/cirurgia
Estenose da Valva Aórtica/complicações
Estenose da Valva Aórtica/diagnóstico por imagem
Estenose da Valva Aórtica/cirurgia
Ecocardiografia/métodos
Feminino
Seguimentos
Insuficiência Cardíaca/diagnóstico
Insuficiência Cardíaca/etiologia
Implante de Prótese de Valva Cardíaca/métodos
Seres Humanos
Meia-Idade
Segurança do Paciente
Recuperação de Função Fisiológica
Reoperação
Medição de Risco
Stents
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170923
[St] Status:MEDLINE


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[PMID]:28930958
[Au] Autor:Haddad NN; Bruns BR; Enniss TM; Turay D; Sakran JV; Fathalizadeh A; Arnold K; Murry JS; Carrick MM; Hernandez MC; Lauerman MH; Choudhry AJ; Morris DS; Diaz JJ; Phelan HA; Zielinski MD; NSAIDs SHAPES Workgroup
[Ad] Endereço:From the Mayo Clinic, Department of Surgery, Division of Trauma, Critical Care and General Surgery (N.N.H., M.C.H., M.D.Z., A.J.C.), Rochester, Minnesota; University of Texas Health Science Center at San Antonio, Department of Surgery (N.N.H.), San Antonio, Texas; University of Maryland School of Medicine, Department of Surgery, Division of Acute Care Surgery (B.R.B., M.H.L., J.J.D.), Baltimore, Maryland; University of Utah, Department of Surgery, Division of General Surgery (T.M.E.), Salt Lake City, Utah; Loma Linda University, Department of Surgery, (D.T.), Loma Linda, California; Johns Hopkins University, Department of Surgery, Division of Acute Care Surgery (J.V.S.), Baltimore, Maryland; Einstein Medical Center, Department of Surgery (A.F.), Philadelphia, Pennsylvania; University of Texas Southwestern/Parkland Hospital, Department of Surgery, (K.A., H.A.P.), Dallas, Texas; East Texas Medical Center (J.S.M.), Alto, Texas; Medical Center of Plano (M.M.C.), Plano, Texas; and Intermountain Medical Center (D.S.M.), Murray, Utah.
[Ti] Título:Perioperative use of nonsteroidal anti-inflammatory drugs and the risk of anastomotic failure in emergency general surgery.
[So] Source:J Trauma Acute Care Surg;83(4):657-661, 2017 Oct.
[Is] ISSN:2163-0763
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used analgesic and anti-inflammatory adjuncts. Nonsteroidal anti-inflammatory drug administration may potentially increase the risk of postoperative gastrointestinal anastomotic failure (AF). We aim to determine if perioperative NSAID utilization influences gastrointestinal AF in emergency general surgery (EGS) patients undergoing gastrointestinal resection and anastomosis. METHODS: Post hoc analysis of a multi-institutional prospectively collected database was performed. Anastomotic failure was defined as the occurrence of a dehiscence/leak, fistula, or abscess. Patients using NSAIDs were compared with those without. Summary, univariate, and multivariable analyses were performed. RESULTS: Five hundred thirty-three patients met inclusion criteria with a mean (±SD) age of 60 ± 17.5 years, 53% men. Forty-six percent (n = 244) of the patients were using perioperative NSAIDs. Gastrointestinal AF rate between NSAID and no NSAID was 13.9% versus 10.7% (p = 0.26). No differences existed between groups with respect to perioperative steroid use (16.8% vs. 13.8%; p = 0.34) or mortality (7.39% vs. 6.92%, p = 0.84). Multivariable analysis demonstrated that perioperative corticosteroid (odds ratio, 2.28; 95% confidence interval, 1.04-4.81) use and the presence of a colocolonic or colorectal anastomoses were independently associated with AF. A subset analysis of the NSAIDs cohort demonstrated an increased AF rate in colocolonic or colorectal anastomosis compared with enteroenteric or enterocolonic anastomoses (30.0% vs. 13.0%; p = 0.03). CONCLUSION: Perioperative NSAID utilization appears to be safe in EGS patients undergoing small-bowel resection and anastomosis. Nonsteroidal anti-inflammatory drug administration should be used cautiously in EGS patients with colon or rectal anastomoses. Future randomized trials should validate the effects of perioperative NSAIDs use on AF. LEVEL OF EVIDENCE: Therapeutic study, level III.
[Mh] Termos MeSH primário: Fístula Anastomótica/epidemiologia
Anti-Inflamatórios não Esteroides/uso terapêutico
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Bases de Dados Factuais
Emergências
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Inflammatory Agents, Non-Steroidal)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170921
[St] Status:MEDLINE
[do] DOI:10.1097/TA.0000000000001583



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