ABSTRACT
RESUMEN Se presenta el caso de un paciente masculino de 54 años que, cursando internación por neumonía- COVID-19, intercurrió con shock séptico por diverticulitis aguda Hinchey IV, por lo que se realizó cirugía de Hartmann. Evolucionó con isquemia colónica, se realizó colectomía total y abdomen abierto y contenido (AAyC). El manejo del AAyC se realizó con sistema de vacío (VAC) durante 7 semanas, resultando un AAyC tipo IIIa (Björck) con un gap de 16 cm. Se decidió iniciar, una vez dadas las condiciones clínicas del paciente, el cierre dinámico (CD) con tracción fascial con malla de polipropileno asociado a inyección de toxina botulínica (TB). Esta estrategia permitió el cierre fascial primario (CFP) de la pared abdominal en la quinta semana de comenzado el tratamiento, evitando de esta manera la morbilidad de un cierre por segunda intención.
ABSTRACT We report the case of a 54-year-old male patient hospitalized for COVID-19 pneumonia who developed septic shock due to acute Hinchey IV diverticulitis and required Hartmann's surgery. The patient evolved with colonic ischemia and underwent total colectomy and open abdomen (OA) with temporary abdominal closure (TAC) that was managed with a vacuum-assisted wound closure (VAWC) system for 7 weeks, resulting in a Björck grade 3A OA with a 16-cm gap. As he had a favorable clinic course, dynamic closure with mesh-mediated fascial traction was decided, associated with botulinum toxin (BT) injection. This strategy allowed primary fascial closure (PFC) of the abdominal wall 5 weeks after treatment was initiated, thus avoiding the complications of healing by secondary intention.
ABSTRACT
BACKGROUND:Various new challenges have emerged since the introduction of laparoscopic surgery. Port site hernia is one of the serious complication. Various methods have been introduced to reduce it. The aim of this article is to introduce a procedure that is easy, safe and quick to perform and will help in decreasing port site complications after laparoscopic procedure.MATERIAL AND METHOD:We have described here a simple technique for the facial closure after laparoscopic surgery over 100 patients who underwent laparoscopic cholecystectomy repair at VMMC & Safdarjung Hospital, New Delhi.RESULT:This method was used in 100 patients with no intro-operative complication, no port site hernia reported in a follow up period of 1 year.CONCLUSION:This procedure of fascial closure is safe, quick, effective and easy to perform method of facial closure.
ABSTRACT
PURPOSE: Acute appendicitis is a type of abdominal disease that requires emergency surgery. Over the past three decades, laparoscopic appendectomy has become the standard operation for acute appendicitis. The aim of this paper is to compare the methods of single port appendectomy and conventional appendectomy and to illustrate the advantages of single port appendectomy. METHODS: The first group of patients underwent single port appendectomy using a surgical glove (Group 1), and those in the second group underwent surgery using the TriPort system (Group 2). The third group of patients underwent conventional three port surgery (Group 3). Questionnaires regarding patient satisfaction with scars were administered via telephone interview. Patient characteristics, histopathological data, postoperative data, and satisfaction score were analyzed by t-test and Pearson chi2 test. RESULTS: A statistically significant difference in satisfaction scores was observed among the three groups. Overall, patients in the single port group using a surgical glove would be more likely to recommend the procedure to friends and family than would patients in the other two groups. Better cosmetic results were achieved for both groups of patients who underwent laparoscopic single port appendectomy, compared to those who underwent conventional three port laparoscopic appendectomy, with statistically significant difference. CONCLUSION: Laparoscopic single port appendectomy using a surgical glove is a feasible and safe procedure and shows no differences in terms of risk, such as postoperative complication, compared to a conventional three-trocar technique. Use of this method resulted in better satisfaction compared with the other two groups, illustrating its cosmetic improvement.