Comparación de sutura mecánica con sutura manual de la faringe en laringectomía total / Comparison of mechanical suture with manual suture of the pharynx in total laryngectomy

Introducción: La sutura mecánica es una opción para el cierre de la faringorrafia en laringectomía total por cáncer de laringe. Objetivo: Comparar el uso de sutura mecánica lineal con sutura manual de la faringe durante la laringectomía total por cáncer de laringe. Material y Método: Se realizó un estudio de tipo experimental prospectivo. Se compararon dos grupos pacientes: Los pacientes con sutura mecánica desde 2018 a marzo de 2020 y los pacientes con sutura manual previa a enero de 2018 en el Servicio de Otorrinolaringología del Hospital Barros Luco. Se analizaron fístula faringo-cutánea posoperatoria (FFC), tiempo operatorio, estadía hospitalaria y costo. Resultados: El estudio incluyó a 14 pacientes, cada grupo con n = 7. El grupo con sutura mecánica presento 0% de FFC y el grupo sutura manual 28%. El grupo con sutura mecánica reinicio alimentación a los 7 días y el grupo con sutura manual en promedio a los 11,5 (7-23) días. (p = 0,0023). El tiempo promedio de cirugía para el grupo experimental es de 288 ± 37,4 minutos y con sutura manual 311 ± 32,4 minutos. (p = 0,0176). El promedio de hospitalización para el grupo experimental fue de 11 ± 2,6 días (9 a 16), y para el grupo control fue de 21 ± 14 días (10 a 49) (p < 0,0001). Conclusión: La sutura mecánica es un procedimiento fácil de usar y seguro. Existiría un beneficio en el uso de sutura mecánica para el cierre faríngeo al compararlo con la sutura manual al disminuir el número de FFC, el tiempo operatorio y los días de hospitalización.

Introduction: Mechanical suture is an option for the closure of the pharyngorrhaphy in total laryngectomy due to laryngeal cancer. Aim: To compare the use of linear mechanical suture with manual pharyngeal suture during total laryngectomy for laryngeal cancer. Material and Method: A prospective experimental study was carried out. Two patient groups were compared: patients with mechanical suture from 2018 to March 2020 and patients with manual suture prior to January 2018 at the otorhinolaryngology service of the Barros Luco Hospital. Postoperative pharyngocutaneous fistula (FFC), operative time, hospital stay and cost were analyzed. Results: The study included 14 patients, each group with n = 7. The group with mechanical suture presented 0% of FFC and the group with manual suture 28%. The group with mechanical suture restarted feeding at 7 days and the group with manual suture on average at 11.5 (7-23) days (p = 0.0023). The average surgery time for the experimental group was 288 ± 37.4 minutes, while for the group with manual suture was 311 ± 32.4 minutes (p = 0.0176). The mean hospitalization for the experimental group was 11 ± 2.6 days (9 to 16), and for the control group it was 21 ± 14 days (10 to 49) (p < 0.0001). Conclusion: The mechanical suture is an easy to use and safe procedure. There would be a benefit in the use of mechanical suture for pharyngeal closure when buying it with manual suture by reducing the number of FFCs, operative time and days of hospitalization.

Divertículo de Meckel en asociación a onfalocele y tetralogía de Fallot: reporte de caso y revisión de la literatura / Meckel's diverticulum in association with omphalocele and tetralogy of Fallot: Case report and literature review

El onfalocele o exónfalos se definen como un defecto congénito de la pared abdominal, que consiste en la herniación de las vísceras abdominales a través del anillo umbilical. Esta entidad rara vez se asocia a la comunicación del divertículo de Meckel con el saco del onfalocele. Teniendo en cuenta la escasa prevalencia de dicha entidad, compartimos el reporte de caso de un paciente recién nacido, con diagnóstico de onfalocele menor, en quien se sospechaba ruptura del saco, sin embargo, de manera intraoperatoria se encontró que la aparente ruptura del saco, correspondía a la comunicación con un divertículo de Meckel. El caso además se asoció con hallazgos ecocardiográficos de tetralogía de Fallot

Omphalocele or exomphalos are defined as a congenital defect of the abdominal wall, which consists of the herniation of the abdominal viscera through the umbilical ring. This entity is rarely associated with the communication of Meckel's diverticulum with the omphalocele sac. Considering the low prevalence of this entity, we report the case of a newborn with a diagnosis of minor omphalocele, in whom rupture of the sac was suspected; however, intraoperatively it was found that the apparent rupture of the sac corresponded to a communication with a Meckel's diverticulum. The case was also associated with echocardiographic findings of tetralogy of Fallot

Application standard of mechanical suture technique in thoracoscopic surgery and management of complications / 中国胸心血管外科临床杂志

@#The precise resection and suture of bronchia, vascular and pulmonary tissue are the key techniques in thoracic surgery. Mechanical suture technique has gradually become a routine operation in thoracic surgery. However, at present, there is still a lack of consensus and guidelines on the application of this technique in thoracic surgery, neither strong evidence-based medical support. In this study, we discuss the application standard of mechanical suture technique in thoracoscopic surgery, irregular treatment techniques, intraoperative complications, and management principles to promote the standardized application of mechanical suture technique. We also explain the shortcomings of the technique in order to promote the further improvement and perfection.

ASSESSMENT OF MECHANICAL AND MANUAL SUTURE IN THE SURGICAL TREATMENT OF THE PHARYNGOESOPHAGEAL DIVERTICULUM / AVALIAÇÃO DA SUTURA MECÂNICA E MANUAL NO TRATAMENTO CIRÚRGICO DO DIVERTÍCULO FARINGOESOFÁGICO

Background: The occurrence of the pharyngoesophageal, or Zenker diverticulum is not frequent in the national scenario, and the technique of the diverticulectomy with cricomyotomy in medium and great dimension diverticula is still the most indicated. Because the resection of the diverticulum requires the suture of the pharynx, dehiscence can occur, thereafter delaying swallowing. Hence, the idea is to accomplish this surgical procedure, comparing the manual and mechanical suture, in order to evaluate the real benefit of the mechanical technique. Aim: To evaluate the results of the pharyngoesophageal diverticulectomy with cricomyotomy using manual and mechanical suture with regard to local and systemic complications. Method: Fifty-seven patients with pharyngoesophageal diverticula diagnosed through high digestive endoscopy and pharyngeal esophagogram were studied. The applied surgical technique was diverticulectomy with myotomy of the cricopharyngeal muscle, done in 24 patients (42.2%) the mechanical suture (group A) with the mechanical linear suture device and in 33 (57.8%) a manual closure of the pharynx (group B). Results: In the postoperative period, one patient of group A (4.1%) presented fistula caused by dehiscence of the pharyngeal suture, and three of group B (15.1%) presented the same complication, with a good outcome using a conservative treatment. In the same group, three patients (9.0%) presented stenosis of the suture of the pharynx, with good outcome and with endoscopic dilatations, and no patient from group A presented such complication. Lung infection was present in five patients, being two (8.3%) of group A and three (9.0%) on B, having good outcomes after specific treatment. In the late review, done with 43 patients (94.4%) of group A and 22 (88.0%) on B, the patients declared to be pleased with the surgical procedure, because they were able to regain normal swallowing. Conclusion: The diverticulectomy with myotomy and pharyngeal closure using mechanical suture was proven appropriate, for having restored regular swallowing in most of the patients, and the mechanical closure of the pharynx proved to be more effective in comparison to the manual one, because it provided a lower index of local post-surgical complications.

Racional: A ocorrência do divertículo faringoesofágico, ou de Zenker, é pouco frequente no cenário nacional, sendo que a técnica da diverticulectomia com cricomiotomia em divertículos de média e grandes dimensões ainda é a mais indicada. Devido à ressecção do divertículo necessitar de sutura da faringe ocorre possibilidade de deiscência, o que retarda o retorno da deglutição. Daí a ideia de realizar este procedimento cirúrgico, comparando a sutura manual com a mecânica, para avaliar o real benefício da técnica mecânica. Objetivo: Avaliar os resultados da diverticulectomia faringoesofágica com cricomiotomia utilizando à sutura manual e mecânica em relação às complicações locais e sistêmicas. Métodos: Foram estudados 57 pacientes com divertículos faringoesofágicos diagnosticados através da endoscopia digestiva alta e faringoesofagograma. A técnica cirúrgica empreendida foi a diverticulectomia com miotomia do músculo cricofaríngeo, sendo a sutura mecânica realizada em 24 pacientes (42,2%, grupo A) com o aparelho linear e em 33 (57,8%, grupo B) a manual para o fechamento da faringe. Resultados: Na avaliação do pós-operatório precoce, um paciente do grupo A (4,1%) apresentou fístula consequente à deiscência da sutura da faringe e três do grupo B (15,1%) ambos com boa evolução com tratamento conservador. Neste mesmo grupo, três pacientes (9,0%) apresentaram estenose da sutura da faringe, com boa evolução com dilatações endoscópicas sendo que nenhum do grupo A apresentou esta complicação. A infecção pulmonar esteve presente em cinco pacientes, dois (8,3%) do grupo A e três (9,0%) do grupo B, com boa evolução com tratamento específico. Na avaliação tardia, realizada em 43 pacientes, 17(94,4%) do grupo A e 22 (88,0%) do grupo B, os pacientes referiram estarem satisfeitos com o procedimento cirúrgico, pois conseguiram resgatar a deglutição normal. Conclusões: A diverticulectomia com a miotomia do cricofaríngeo demonstrou ser procedimento cirúrgico ...

Anastomosis terminal funcional con sutura mecánica en cirugía intestinal: resultados precoces de una serie prospectiva / Experience with mechanical anastomoses in bowel surgery

Background: The use of mechanical anastomoses reduce the length of gastrointestinal surgical procedures. Aim: To report the experience with mechanical functional terminal anastomoses in bowel surgery. Material and Methods: Prospective non randomized registry of all mechanical anastomoses carried out in a surgical service. Results: A total of 327 patients (193 women) were analyzed. Two hundred and one anastomoses were ileo-colonic and 126 were entero-enteral. Seventeen percent of patients experienced some complication. Fourteen required a new operation due to peritonitis or deep infection of the surgical site. The global rate of anastomotic dehiscence was 3.1 percent. No differences in the rate of complications between surgeons with experience and trainees were observed. Conclusions: Mechanical anastomoses in bowel surgery are safe and require a short learning period to be used.

Se presenta nuestra experiencia con la anastomosis terminal funcional con sutura mecánica en cirugía intestinal. La serie corresponde a 327 pacientes, un 59 por ciento de género femenino. Del total de anastomosis 201 fueron íleo colónicas y 126 entero enterales. El instrumento de sutura más utilizado fue de 75 u 80 mm de longitud y no se registran incidentes durante la confección de la anastomosis. La morbilidad específica se encuentra en el 17 por ciento de la serie, sin diferencias entre los dos tipos de anastomosis. Catorce paciente fueron reoperados por peritonitis o infección profunda del sitio quirúrgico La tasa global de dehiscencia anastomó-tica fue de un 3,1 por ciento ( 5 y 4 casos respectivamente) sin alcanzar significación estadística. Al comparar si la anastomosis fue realizada por un cirujano con experiencia o en formación, tampoco se encontraron diferencias estadísticamente significativas, por lo que nos parece una técnica segura y con una corta curva de aprendizaje.