Does aortic valve repair in valve-sparing aortic root reconstruction compromise the longevity of the procedure?

OBJECTIVES: The effect of performing aortic valve repair in combination with valve-sparing operation on the length of time for which patients are free from reoperation is unclear. The objective of this study was to determine if the performance of aortic valve repair during valve-sparing operation modified the freedom from reoperation time. METHODS: From January 2003 to July 2014, 78 patients with a mean age of 49±15 years underwent valve-sparing operation. Sixty-eight percent of these patients were male. Twenty-two (28%) aortic valve repair procedures were performed in this patient population. In the aortic valve repair + valve-sparing operation group, 77.3% of patients had moderate/severe aortic insufficiency, while in the valve-sparing operation group, 58.6% of patients had moderate/severe aortic insufficiency (ns = not significant). Additionally, 13.6% of patients in the aortic valve repair + valve-sparing operation group had functional class III/IV, while 14.2% of patients in the valve-sparing operation group had functional class III/IV (ns). RESULTS: The in-hospital and late mortality rates, for the aortic valve repair + valve-sparing operation and valve-sparing operation groups were similar, as they were 4.5% and 3.6%; and 0% and 1.8%, respectively. In the aortic valve repair + valve-sparing operation group, 0% of patients presented moderate/severe aortic insufficiency during late follow-up, while in the valve-sparing operation group, 14.2% of patients presented with moderate/severe aortic insufficiency during this period (ns). In the aortic valve repair + valve-sparing operation group, 5.3% of patients presented with functional class III/IV, while in the valve-sparing operation group, 4.2% of patients presented with functional class III/IV (ns). In the aortic valve repair + valve-sparing operation group, 0% of patients required reoperation, while in the valve-sparing operation group, 3.6% of patients required reoperation over a mean follow-up period of 1621±1156 days (75 patients). CONCLUSION: Valve-sparing operation is a safe and long-lasting procedure and performance of aortic valve repair when necessary does not increase risk of reoperation on the aortic valve.

Correção laparoscópica de fístula vesicovaginal: relato de caso / Laparoscopic repair of vesicovaginal fistula: a case report

Apesar de constituírem complicação incomum, as fístulas vesicovaginais apresentam expressivo impacto na qualidade de vida dos pacientes. As abordagens minimamente invasivas têm ganhado mais espaço no tratamento de doenças geniturinárias. Ainda são poucos os relatos do acesso laparoscópico para correção das fístulas vesicovaginais. Relata-se aqui um caso de fístula pós-histerectomia tratada totalmente de forma laparoscópica com ótimo resultado. As vantagens do acesso laparoscópico, assim como alguns detalhes técnicos, são discutidos...

Despite being an uncommon complication, vesicovaginal fistulas have significant impact on patient quality of life. Minimally invasive approaches have gained more space in the treatment of genitourinary diseases. There are few reports on laparoscopic approaches for correction of vesicovaginal fistulas. This is a case report of a post-hysterectomy fistulatreated exclusively through laparoscopy with excellent results. The advantages of the laparoscopic approach, as well as some technical details, are discussed...

Prostatectomia retropúbica videolaparoscópica: experiência inicial / Laparoscopic retropubic prostatectomy: initial experience

Introdução: o tratamento cirúrgico da hiperplasia benigna da próstata inclui a ressecção transuretral e a prostatectomia suprapúbica, dependendo do volume prostático. O acesso videolaparoscópico criou alternativa minimamente invasiva à prosatatectomia suprapúbica convencional. Objetivo: avaliar a viabilidade da técnica aberta por via laparoscópica. Pacientes e métodos: entre junho de 2006 e outubro de 2009, 15 pacientes foram submetidos à prostatectomia retropúbica videolaparoscópica no tratamento da hiperplasia prostática benigna (HPB). O acesso videolaparoscópico foi utilizado como alternativa minimamenteinvasiva à adenomectomia aberta. Foram avaliadas as características dos pacientes, o volume prostático e as complicações no per e pós-operatórios imediato e tardio. Resultados: a idade média foi de 68 anos (62-75 anos); o peso prostático médio foi de 123 gramas (70-190 gramas); o tempo cirúrgico variou de 120 minutos a 220 minutos. A perda de sangue estimada foi de 450 mL na média, sendo necessária transfusão em apenas um paciente. A permanência hospitalar média foi de três dias. O tempo com sonda vesical de demora foi de seis dias; e o tempo de irrigação vesical de um dia em todos os pacientes. O estudoanatomopatológico confirmou o diagnóstico de HPB em todos os casos. Nas complicações pós-operatórias, um paciente apresentou infecção superficial da ferida operatória, com boa resposta à antibioticoterapia. Conclusões: a prostatectomia retropúbica laparoscópica parece ser procedimento seguro, que permite reproduzir os princípios da cirurgia aberta. Neste trabalho observou-se baixa taxa de complicações, similar à da literatura.

Introduction: The surgical treatment of benign prostatic hyperplasia includes transurethral resection and suprapubic prostatectomy depending on prostate volume. The laparoscopic access creates a minimally invasive alternative to conventional suprapubic prostatectomy. Objective: to assess the feasibility of the open laparoscopic technique. Patients and methods: Between June 2006 and October 2009, 15 patients underwent laparoscopic retropubic prostatectomy in the treatment of benign prostatic hyperplasia (BPH). Laparoscopic access was used as a minimally invasive alternative to open adenomectomy. Patient characteristics and prostate volume were assessed, as well as complications in the early and late perioperative and postoperative stages. Results: Mean age was 68 years (62-75 years), mean prostate weight 123 grams (70-190 grams). Time of surgery ranged from 120 to 220 minutes. Mean estimated blood loss was 450 mL and transfusion was required for one patient. Mean hospital stay was three days. Time with indwelling catheter was six days and time of bladder irrigation was of one day for all patients. Anatomicopathological studies confirmed the diagnosis of BPH in all cases.Among postoperative complications, one patient had a superficial surgical wound infection, which responded well to antibiotic therapy. Conclusions:Laparoscopic retropubic prostatectomy appears to be a safe procedure that reproduces the principles of open surgery. In this study we observed a low rate of complications, similar to previous studies.

Cistectomia radical videolaparoscópica com neobexiga ileal ortotópica: experiência inicial / Laparoscopy radical cystectomy with ileal orthotopic blad - der: A preliminary experience

Apesar de ser o padrão-ouro no tratamento dos tumores invasivos de bexiga, a cistoprostatectomia ainda apresenta significativo impacto na qualidade de vida dos pacientes. As abordagens minimamente invasivas têm ganhado cada vez mais espaço no tratamento das neoplasias urológicas. Ainda são poucas as séries na literatura sobre o acesso videolaparoscópico para confecção de neobexiga ortotópica após a cistoprostatectomia radical. Relata-se um caso de câncer invasor de bexiga tratado de forma laparoscópica com ótimo resultado. As vantagens do acesso laparoscópico, assim como alguns detalhes técnicos, são discutidas.

Although it is not considered a gold standard in treating invasive bladder tumors, cystoprostatectomy still has significant impacts on patients? life quality. The minimally invasive approaches have gained importance in the treatment of bladder neoplasia. There are sill few reports on the use of laparoscopy for providing orthotopic bladder upon radical cystoprostatectomy. This is a case report of invasive bladder cancer that was treated with laparoscopy and yielded optimal result. The advantages of laparoscopy and some technical details are herein discussed.