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1.
Rev. bras. cir. plást ; 37(1): 60-65, jan.mar.2022. ilus
Article in English, Portuguese | LILACS-Express | LILACS | ID: biblio-1368215

ABSTRACT

Introdução: A microcirurgia reparadora é ramo hoje indissociável e imprescindível na cirurgia plástica. O treinamento é longo, custo financeiro relativamente alto e exige muito dos proponentes. Para melhorar essa equação a favor da formação de novos microcirurgiões no Brasil, é fundamental facilitar o acesso ao treinamento experimental, utilizando materiais simples. Huaraca descreveu uma técnica utilizando um simples fio mononylon 5-0 para substituir o clamp vascular, que é instrumento indispensável da anastomose microcirúrgica e geralmente de alto custo. O objetivo é comparar a técnica de Huaraca com fio de mononylon e o clamp metálico tradicional durante anastomose microcirúrgica vascular. Métodos: Seis ratos da raça Wistar cujas duas artérias femorais foram aleatoriamente selecionadas para sutura término-terminal após secção completa, sendo um dos lados realizado com clamp vascular habitual e o contralateral com técnica de Huaraca, no mesmo tempo cirúrgico e pelo mesmo cirurgião. Resultados: Em ambas as situações, a taxa de patência foi de 67% após 72 horas, sendo que o tempo médio foi de 26 minutos com a técnica de Huaraca e de 18 minutos com o clamp tradicional (p=0,001). Conclusão: Apesar do tempo de execução mais longo, a técnica de Huaraca é medida simples e de baixo custo que pode substituir o clamp vascular tradicional.


Introduction: Reconstructive microsurgery is now an inseparable and essential branch of plastic surgery. The training is long, has a relatively high financial cost and requires a lot of the proponents. To improve this equation in favor of the formation of new microsurgeons in Brazil, it is essential to facilitate access to experimental training, using simple materials. Huaraca described a technique using a simple 5-0 mononylon thread to replace the vascular clamp, which is an indispensable instrument for microsurgical anastomosis and is generally expensive. The objective is to compare the Huaraca technique with mononylon thread and the traditional metal clamp during vascular microsurgical anastomosis. Methods: Six Wistar rats whose both femoral arteries were randomly selected for end-to-end suture after complete section, with one side performed with usual vascular clamp and the contralateral with Huaraca technique, at the same surgical time and by the same surgeon. Results: In both situations, the patency rate was 67% after 72 hours, with an average time of 26 minutes with the Huaraca technique and 18 minutes with the traditional clamp (p=0.001). Conclusion: Despite the longer execution time, the Huaraca technique is a simple and low-cost measure that can replace the traditional vascular clamp.

2.
Rev. bras. oftalmol ; 81: e0026, 2022. graf
Article in English | LILACS | ID: biblio-1376786

ABSTRACT

ABSTRACT Purpose: To describe an innovative animal model of eye transplantation used in rabbits. Methods: six Dutch-belted male rabbits were submitted to lateral orbitotomy in the right eye, wide retrobulbar anatomy exposure, dissection of the structures, identification and distal section of the optic nerve followed by anastomosis either by vicryl (group 1) or fibrin glue (group 2). Electroretinography recording was performed before the section of the optic nerve and every 30 seconds after, to monitor the function of retina. Left eye was used as control group. Results: After optic nerve resection and anastomosis, stable ERG amplitude of the right eye was lost after 302 seconds in group 1 and after 296 seconds on group 2. Left eye kept longer stable ERG amplitude curves. Conclusions: The animal model of whole eye transplantation was effective in describing a novel technique to be used in rabbits, with success of the anatomic procedure. Further studies will clarify the best anastomosis methods and maintenance of function of the receptor organ. Translational relevance: this animal model of whole eye transplantation provides a novel perspective for blind patients and the research models, since we describe a novel mammal animal model. This model can be used as basis of a human model of whole eye transplantation in future studies.


RESUMO Objetivo: Descrever uma técnica cirúrgica inovadora para transplante de olho em um modelo animal em coelhos. Métodos: Seis coelhos machos com Dutch Belted foram submetidos à orbitotomia lateral do olho direito, com ampla exposição da anatomia retrobulbar, dissecção do cone muscular, exposição e secção distal do nervo óptico seguida de anastomose por vicryl (Grupo 1) ou cola de fibrina (Grupo 2). O registro da eletrorretinografia foi realizado antes da secção do nervo óptico e a cada 30 segundos após, para monitorar a função da retina. O olho esquerdo foi usado como grupo controle. Resultados: Após a ressecção do nervo óptico, a estabilidade da amplitude da eletrorretinografia foi perdida no olho direito após 302 segundos no Grupo 1 e após 296 segundos no Grupo 2. O olho esquerdo manteve eletrorretinografia estável por períodos mais longos. Conclusão: O modelo animal de transplante total de olho foi eficaz em descrever uma nova técnica cirúrgica para ser utilizada em laboratório com coelhos, com sucesso do procedimento anatômico. Novos estudos esclarecerão os melhores métodos de anastomose e manutenção da função do órgão receptor.


Subject(s)
Animals , Male , Optic Nerve/surgery , Retina/physiology , Electroretinography , Eye/transplantation , Orbit/surgery , Rabbits , Retinal Ganglion Cells/physiology , Anastomosis, Surgical , Eye Enucleation , Models, Animal , Slit Lamp Microscopy
3.
ABCD arq. bras. cir. dig ; 35: e1662, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1383214

ABSTRACT

ABSTRACT - BACKGROUND: Although many methods have been defined for colonic anastomosis, anastomotic leak still remains important for sepsis control and successful healing. AIM: The purpose of this study was to compare the effects of conventional suture, polyglactin 910 mesh, and omental flap coverage on healing and anastomotic leak in experimental colonic anastomosis in rats. METHOD: This study was conducted on 18 Wistar rats and the animals were divided into three groups as follows: Group 1: primary suture group; Group 2: primary suture plus polyglactin 910 mesh group; and Group 3: primary suture plus omental flap coverage group. Groups were compared in terms of anastomotic bursting pressure, inflammation, fibroblastic activity, neovascularization, and collagen amount. RESULTS: There was a statistically significant difference in anastomotic bursting pressure between Groups 1 and 2 and between Groups 1 and 3 (p=0.004, p<0.05). There was a significant difference in fibroblastic activity between Groups 1 and 3 (p=0.011, p<0.05) and between Groups 2 and 3 (p=0.030, p<0.05). There was a significant difference in neovascularization and collagen between Groups 1 and 2 and between Groups 1 and 3 (p<0.05). CONCLUSION: This experimental study found that polyglactin 910 mesh and omental flap coverage for colocolic anastomoses improved the physical strength and healing of the anastomosis compared to conventional hand-stitched anastomoses. The polyglactin may be a safe alternative to 910 mesh in cases where the omental flap coverage cannot be used in the colonic anastomosis.


RESUMO - RACIONAL: Embora muitos métodos tenham sido definidos para anastomose colônica, a fistula anastomótica ainda permanece importante para o controle da sepse e a cura bem-sucedida. OBJETIVO: comparar os efeitos da sutura convencional, tela de poliglactina 910 e cobertura de retalho omental na cicatrização e extravasamento anastomótico em anastomose colônica experimental em ratos. MÉTODO: estudo realizado em 18 ratos Wistar, sendo os animais divididos em 3 grupos. Grupo 1: Grupo de sutura primária; Grupo 2: sutura primária com malha de poliglactina 910; Grupo 3: Grupo sutura primária com cobertura de retalho omental. Os grupos foram comparados em termos de pressão de ruptura anastomótica, inflamação, atividade fibroblástica, neovascularização e quantidade de colágeno. RESULTADOS: houve diferença estatisticamente significativa na pressão de ruptura da anastomose entre os Grupos 1 e 2 e os Grupos 1 e 3 (p=0,004, p<0.05). Houve uma diferença significativa na atividade fibroblástica entre os Grupos 1 e 3 (p=0,011, p<0.05) e os Grupos 2 e 3 (p=0,030, p<0.05). Houve uma diferença significativa na neovascularização e colágeno entre os Grupos 1 e 2 e entre os Grupos 1 e 3 (p<0,05, p<0.05). CONCLUSÃO: o estudo experimental demonstrou que a tela de poliglactina 910 e a cobertura do retalho omental para anastomoses colocólicas melhoraram a resistência física e a cicatrização da anastomose em comparação com as anastomoses suturadas manualmente convencionais. A poliglactina pode ser uma alternativa segura à tela 910 nos casos em que a cobertura do retalho omental não pode ser utilizada na anastomose colônica.

4.
Article in Chinese | WPRIM | ID: wpr-933643

ABSTRACT

Objective:To investigate feasibility, efficiency and safety of kissing pancreatojejunostomy after pancreatoduodenectomy.Methods:From Jan 2006 to Sep 2020, the clinical data of 267 patients undergoing pancreatoduodenectomy and kissing pancreatojejunostomy were retrospectively analyzed.Results:Grade B postoperative pancreatic fistula (POPF) occurred in 6.37%, Grade C POPF in 2.25% of patients. There was no mortality within 30 days postoperatively as to pancreatic fistula, by cut-off of pancreatic duct diameter at 3mm, there was no significant difference between two subgroups (15/140 vs. 8/127, P=0.20). also, when grouped by texture of the pancreas, no there was significant difference (20/194 vs. 3/73, P=0.11). Conclusions:Kissing pancreatojejunostomy is feasible and easy to perform. It also does not increase the POPF rate when applied to the pancreatojejunostomy with thin pancreatic duct and soft texture.

5.
Article in Chinese | WPRIM | ID: wpr-932773

ABSTRACT

Objective:To study the single purse-string parachute suturing technique for pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy, and to determine its feasibility and safety.Methods:The clinical data of 71 patients who underwent laparoscopic pancreaticoduodenectomy using the single purse-string parachute suturing technique for pancreaticojejunostomy from October 2018 to October 2021 at the Second Hospital of Hebei Medical University were retrospectively analyzed. There were 41 males and 30 females, with age (59.1±9.7) years old. The operative time, intraoperative blood loss, complication rate and other data were analyzed.Results:All 71 patients successfully underwent total laparoscopic pancreaticoduodenectomy, with 5 patients who underwent 2D laparoscopic surgery and 66 patients 3D laparoscopic surgery. There were additional vascular resection and reconstruction in 2 patients. The operative time was (388.9±92.9) min, the intraoperative blood loss was (411.3±176.9) ml, and the postoperative hospital stay was (14.1±5.8) d. The operation time of 71 patients who underwent the single purse-string parachute technique of pancreaticojejunostomy was (26.9±6.8) min. Postoperative complications occurred in 18 patients (25.4%). Grade B pancreatic fistula occurred in 2 patients (2.8%), and the longest time for removal of abdominal drain was 17 days after operation. Among the 71 patients, complications including biliary fistula occurred in 6 patients (8.5%), delayed gastric emptying in 5 patients (7.0%), pulmonary infection in 4 patients (5.6%), non-pancreatic fistula-related abdominal infection in 4 patients (5.6%), non-pancreatic fistula-related abdominal bleeding in 1 patient (1.4%), biliary tract bleeding in 1 patient (1.4%), and chylous leakage in 2 patients (2.8%).Conclusion:The single purse-string parachute technique of pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy had the advantages of being safe and reliable. The procedure is worthy of furthers promotion.

6.
Article in Chinese | WPRIM | ID: wpr-932771

ABSTRACT

Objective:To compare the clinical outcomes of a double purse-string and bridging technique versus duct-to-mucosal pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy.Methods:The clinical data of patients who underwent laparoscopic pancreaticoduodenectomy using the double purse-string and bridging pancreaticojejunostomy technique versus those who underwent duct-to-mucosa pancreaticojejunostomy at the Affiliated Jinhua Hospital of Zhejiang University School of Medicine from January 2016 to August 2021 were retrospectively analyzed. Of the 93 patients who underwent laparoscopic pancreaticoduodenectomy, there were 48 males and 45 females, with age of (62±10) years old. These patients were divided into two groups: patients who underwent double purse-string and bridging pancreaticojejunostomy (the double purse-string group, n=51), and patients who underwent duct-to-mucosa pancreaticojejunostomy (the duct-to-mucosa group, n=42). The clinical data of the two groups were compared. Results:All the 93 patients underwent laparoscopic pancreaticoduodenectomy successfully, and there were no deaths within 3 months of operation. Compared with the duct-to-mucosa group, the double purse-string group had significantly shorter time of pancreaticojejunal anastomosis [(32.41±8.75) vs. (47.62±8.90) min] and time of operation [(365.75±43.74) vs. (389.07±45.31) min] (all P<0.05). The postoperative pancreatic fistula rates were 9.8% (5/51) in the double purse-string group and 7.1% (3/42) in the duct-to-mucosa group. There was no significant difference between the two groups ( P>0.05). In the double purse-string group, there were 18 patients with a pancreatic duct diameter >3 mm, and 3 of these patients developed grade B pancreatic fistula, giving a grade B pancreatic fistula rate of 16.6% (3/18). In the duct-to-mucosa group, there were 11 patients with a pancreatic duct diameter >3 mm, and no patients developed grade B pancreatic fistula, giving a pancreatic fistula rate of 0(0/11). Conclusion:Compared with the duct-to-mucosa anastomosis, the double purse string and bridging pancreaticojejunostomy was technically simpler. It shortened the time of pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy, especially for patients with a non-dilated pancreatic duct.

7.
Rev. bras. cir. cardiovasc ; 36(4): 461-467, July-Aug. 2021. tab, graf
Article in English | LILACS | ID: biblio-1347169

ABSTRACT

Abstract Introduction: End-to-end anastomosis and extended end-to-end anastomosis are typically used as surgical approaches to coarctation of the aorta (CoAo) with access at the subclavian artery or an interposition graft. The objective of this study is to analyze the impact of surgical and anatomical characteristics and techniques on early outcomes after surgical treatment of CoAo without cardiopulmonary bypass through left thoracotomy. Methods: This is a quantitative, observational, and cross-sectional analysis of patients who underwent repair of CoAo between July 1, 2010 and December 31, 2017. Seventy-two patients were divided into three groups according to age: 34 in group A (≤ 30 days), 24 in group B (31 days to one year), and 14 in group C (≥ 1 year to 18 years). Results: Aortic arch hypoplasia was associated in 30.8% of the cases, followed by ventricular septal defect (13.2%). The preductal location was more frequent in group A (73.5%), ductal in group B (41.7%), and postductal in group C (71.4%). Long coarcted segment was predominant in groups A and C (61.8% and 71.4%, respectively) and localized in group B (58.3%). Extended end-to-end anastomosis technique was prevalent (68%), mainly in group A (91.2%). Mortality in 30 days was 1.4%. Conclusion: Most of the patients were children under one year of age, and extended end-to-end anastomosis was the most used technique, secondary to arch hypoplasia. Further, overall mortality was low in spite of moderate morbidity in the first 30 postoperative days.


Subject(s)
Humans , Infant, Newborn , Infant , Child , Adult , Aortic Coarctation/surgery , Thoracotomy , Aorta, Thoracic/surgery , Vascular Surgical Procedures , Cross-Sectional Studies
8.
Colomb. med ; 52(2): e4154805, Apr.-June 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1339733

ABSTRACT

Abstract Damage control has well-defined steps. However, there are still controversies regarding whom, when, and how re-interventions should be performed. This article summarizes the Trauma and Emergency Surgery Group (CTE) Cali-Colombia recommendations about the specific situations concerning second interventions of patients undergoing damage control surgery. We suggest packing as the preferred bleeding control strategy, followed by unpacking within the next 48-72 hours. In addition, a deferred anastomosis is recommended for correction of intestinal lesions, and patients treated with vascular shunts should be re-intervened within 24 hours for definitive management. Furthermore, abdominal or thoracic wall closure should be attempted within eight days. These strategies aim to decrease complications, morbidity, and mortality.


Resumen El control de daños es uno de los pilares de la cirugía de trauma. Sin embargo, la reintervención aún genera controversias en cuanto a quién, cuándo y cómo debe realizarse. El presente artículo presenta las recomendaciones del grupo de Cirugía de Trauma y Emergencias (CTE) de Cali, Colombia, respecto a las reintervenciones después de una cirugía de control de daños. Se recomienda el empaquetamiento como la estrategia de control de sangrado y se debe desempaquetar en un lapso entre 48 y 72 horas. La anastomosis diferida debe ser la opción de reparo en las lesiones intestinales. La reintervención vascular en los pacientes manejados con shunt vascular debe ser antes de las 24 horas para dar el manejo definitivo. En un lapso de 8 días se debe intentar realizar el cierre de la pared abdominal o torácica. Estas estrategias buscan disminuir la frecuencia de complicaciones y de morbimortalidad.

9.
Colomb. med ; 52(2): e4194809, Apr.-June 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1339736

ABSTRACT

Abstract Damage control surgery is based on temporal control of the injury, physiologic recovery and posterior deferred definitive management. This strategy began in the 1980s and became a formal concept in 1993. It has proven to be a strategy that reduces mortality in severely injured trauma patients. Nevertheless, the concept of damage control in non-traumatic abdominal pathology remains controversial. This article aims to gather historical experiences in damage control surgery performed in non-traumatic abdominal emergency pathology patients and present a novel management algorithm. This strategy could be a surgical option to treat hemodynamically unstable patients in catastrophic scenarios such as hemorrhagic and septic shock caused by peritonitis, pancreatitis, acute mesenteric ischemia, among others. Therefore, damage control surgery is light amid better short- and long-term results.


Resumen La cirugía de control de daños es una estrategia de control temporal del daño tisular y recuperación fisiológica para un manejo definitivo diferido. Esta estrategia tiene antecedentes en el mundo del trauma desde la década de 1980, hasta su formalización conceptual en 1993. Hasta el momento ha demostrado ser una estrategia factible y que reduce la mortalidad en los pacientes críticamente enfermos. Sin embargo, el manejo de patologías abdominales no traumáticas aun es tema de discusión sobre su factibilidad y seguridad. El presente articulo tiene como objetivo realizar un relato histórico y experiencias en la aplicación de la cirugía de control de daños en emergencias quirúrgicas abdominales no asociadas a trauma y presentar un algoritmo de manejo usando los principios de la cirugía de control de daños. La aplicabilidad del control de daños en no trauma se enfrenta a los contextos de shock hemorrágico y séptico para patologías como peritonitis generalizada, peritonitis postquirúrgica, pancreatitis, isquemia mesentérica aguda, entre otras. Se ha demostrado que el uso de control de daños representa una luz para el cirujano ante la tormenta de la incertidumbre de la descompensación metabólica en el manejo de emergencias abdominales, para crear un puente para su manejo definitivo y permitir anastomosis como estrategia de reconstrucción intestinal y mejorar los resultados a corto y largo plazo.

10.
Acta méd. peru ; 38(2): 127-133, abr.-jun 2021. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1339023

ABSTRACT

RESUMEN Los trastornos pancreáticos, las pancreatitis agudas de etiología biliar son infrecuentes en pediatría y más aún los pseudoquistes pancreáticos, los cuales son colecciones líquidas rodeadas por una cápsula fibrosa sin epitelio, generalmente secundario a una pancreatitis aguda. Presentamos el caso de una paciente femenina de 14 años, con antecedente de pancreatitis aguda de origen biliar hace 10 meses, que presenta dolor abdominal y una masa palpable en epigastrio. Se realizaron estudios imagenológicos, confirmando el diagnóstico de pseudoquiste pancreático y colelitiasis. Se optó por las bondades técnicas y estéticas de la laparoscopía, para esta población. Por lo cual, se realizó una cistogastroanastomosis y colecistectomía laparoscópica, con una evolución favorable. Nosotros reafirmamos que esta técnica, es un método seguro y efectivo, para el manejo de esta patología en pacientes pediátricos, y debería considerarse como primera opción, al no contar con procedimientos endoscópicos. Siendo este, el primer reporte en nuestro medio.


ABSTRACT The pancreatic disorders, as acute pancreatitis, of biliary etiology are rare in pediatrics, even more the pancreatic pseudocysts. They are liquid collections surrounded of a fibrous capsule without epithelium, secondary to acute pancreatitis. We present the case of a 14-year-old female patient with a history of acute pancreatitis because of biliary etiology, 10 months prior. She complained of intermittent abdominal pain and a palpable mass in the epigastrium. The Imaging studies showed a pancreatic pseudocyst and cholelithiasis. The laparoscopy was chosen because the technical and esthetic benefits for this population. Therefore, a laparoscopic cystogastro-ostomy-anastomosis and cholecystectomy were performed, with good progress. We affirm this technique is a safe and effective method for the management of this pathology in pediatric patients, and it should be considered as the first option in case endoscopic procedures are not available. This is the first report in our settings.

11.
Article in Chinese | WPRIM | ID: wpr-911598

ABSTRACT

Objective:To evaluate clinical characteristics and treatment of postoperative anastomotic stricture in pediatric congenital biliary dilatation patients.Methods:The clinical data of 24 children with postoperative anastomotic stricture from Apr 2012 to Oct 2019 in Beijing Children's Hospital was retrospectively analyzed.Results:There were 6 males and 18 females. Patients were divided into bile- leak group (BL, n=6) and non bile-leak group (NBL, n=18) based on whether there was anastomotic leakage after primary surgery. The main symptoms in BL group was persistent obstructive jaundice, and recurrent cholangitis in NBL group. Postoperative symptoms were first shown in an average of 7.0 months in BL group, compared to 59.0 months in NBL group, P<0.05. In BL group, 4 underwent redoing hepaticojejunostomy, 2 underwent anastomosis plasty. In NBL group, 3 underwent redoing hepaticojejunostomy, 15 did anastomosis plasty with multiple biliary stones found necessitating extraction. After reoperation, one patient had bile leakage, 2 patients had recurrent cholangitis within one-month, 21 patients had uneventful recovery. Five were found to have biliary stones in long-term follow-up. Conclusions:Biliary-enteric anastomotic leakage can cause stricture in postoperative patients of congenital biliary dilatation ,reoperation is necessary in symptomatic patients.

12.
Article in Chinese | WPRIM | ID: wpr-911578

ABSTRACT

Objective:To evaluate liver quadrate lobectomy combined with large-bore cholangio-jejunostomy for the treatment of benign biliary-enteric anastomotic stricture.Methods:The clinical data of 32 patients undergoing liver quadrate lobectomy combined with large-caliber cholangio-jejunostomy were retrospectively analyzed. The bile drainage effect and postoperative complications were analyzed. And the clinical effects of different size of biliary-enteric anastomosis were compared.Results:The most common short-term complications were cholangitis (9.4%) and bile leakage (9.4%), and the most common long-term complications were reflux cholangitis (15.6%). No anastomotic restenosis, stone formation or canceration were found. During the follow-up period, the total bilirubin ( t=19.455, P=0.000), direct bilirubin ( t=18.479, P=0.000), alkaline phosphatase ( t=3.229, P=0.002) and γ-glutamyltranspeptidase ( t=3.057, P=0.003) level were significantly improved. The effect of bile drainage in patients with 2-3 cm diameter of biliary-enteric anastomosis was similar to that in patients with >3 cm diameter ( t=0.284, P=0.778). The incidences of cholangitis (χ 2=0.121, P=0.728), bile leakage (χ 2=0.121, P=0.728) and reflux cholangitis (χ 2=0.205, P=0.652) were no statistical difference in both groups. Conclusion:Liver quadrate lobectomy combined with large-caliber cholangio-jejunostomy is effective in the treatment of benign biliary-enteric anastomotic stricture. More than 2cm in diameter of the biliary-enteric anastomosis is enough.

13.
Article in Chinese | WPRIM | ID: wpr-910586

ABSTRACT

Objective:To evaluate the clinical application efficacy of four-stitch cholangiojejunostomy.Methods:Of 38 patients who received four-needle biliary and enterointestinal anastomosis in the Department of Hepatobiliary Surgery, Yuebei People's Hospital Affiliated to Shantou University Medical College from November 2016 to April 2020 were included, and the diseases, surgical methods and postoperative complications of four-needle biliary and enterointestinal anastomosis were analyzed.Results:There were 26 males and 12 females with an average of 57.3(44-77) years. Among 38 patients, there were 12 hilar cholangiocarcinoma patients, 10 pancreatic head cancer, 9 duodenal papillary cancer, 4 intrahepatic and extrahepatic bile duct stones, 1 pancreatic cystic adenoma, 1 gastric cancer invading pancreatic head and 1 gallbladder carcinoma. The procedure included pancreatoduodenectomy in 20, radical resection of hilar cholangiocarcinoma in 12, hepatectomy with biliary-enteric anastomosis in 4, radical resection of gastric cancer combined with pancreaticoduodenectomy in 1, radical resection of gallbladder carcinoma in 1. One, two and three ductal openings were anastomosed in 27, 7 and 4 patients, respectively. 10 patients have bile duct diameter <6 mm. Postoperative anastomotic leakage occurred in 1, and all patients were received followed-up visit for 2 months to 4 years without anastomotic stenosis.Conclusion:Four-stitch cholangiojejunostomy is simple, safe, effective, and convenient for small biliary ductal surgeries.

14.
Article in Chinese | WPRIM | ID: wpr-933593

ABSTRACT

Objective:To investigate the effects of three reconstruction methods after gastrectomy on long-term quality of life in patients with stage Ⅰ proximal gastric cancer.Methods:A retrospective study was performed on 157 cases including respectively total gastrectomy with Roux-en-Y anastomosis (TG+RY group, 75 cases), 39 cases of proximal gastrectomy with esophagogastrostomy (PG+EG group) and 43 cases of proximal gastrectomy with jejunal interposition anastomosis (PG+JI group). The primary outcomes were evaluated in terms of alimentary tract symptoms, nutritional status of postoperative patients and long-term complications. Secondary outcomes pertaining to safety and long-term survival status were included as well.Results:The improvement of Visick grading in PG+JI and TG+RY group were better than that in PG+EG group ( P adj<0.01); The nutritional status of PG+JI group was better than TG+RY group and PG+EG group ( P adj<0.01); PG+JI group and PG+EG group had extra complications related to remnant stomach, but there was no significant difference in anastomotic and biliary related complications among the three groups; The incidence of reflux esophagitis in PG+JI group was significantly lower than that in PG+EG group ( P adj<0.01). There was no significant difference between the three groups in operation time, intraoperative blood loss, early postoperative complications, pathological results, 5-year cumulative survival rate and 5-year disease-free survival rate ( P>0.05). Conclusions:PG+JI improves the long-term quality of life for patients with stage Ⅰ proximal gastric cancer compared to TG+RY and PG+EG .

15.
Article in Chinese | WPRIM | ID: wpr-909198

ABSTRACT

Objective:To systematically evaluate manual suture versus mechanical anastomosis in esophagojejunostomy, two methods of digestive tract reconstruction after laparoscopic total gastrectomy. Methods:A computer-based online search of PubMed, CBM, Wanfang database and CNKI database was performed to retrieve clinical studies related to manual suture (manual suture group) and mechanical anastomosis (mechanical anastomosis group) in esophagojejunostomy after laparoscopic total gastrectomy published between January 2015 and October 2020. The quality of eligible literature was evaluated and data were extracted for meta-analysis using Review Manager 5.4 software.Results:Four clinical studies involving 746 patients were included in the final analysis. Meta-analysis results revealed that there was no significant difference in operative time between manual suture and mechanical anastomosis methods [ MD = 8.32, 95% CI (-5.94, 22.57), P > 0.05]. The intraoperative blood loss in manual suture group was significantly less than that in mechanical anastomosis group [ MD = -9.54, 95% CI (-15.54, -3.55), P < 0.05]. The time to exhaust in the manual suture group was shorter than that in the mechanical anastomosis group [ MD = -0.38, 95% CI (-0.59, -0.18), P < 0.05]. The length of hospital stay in the manual suture group was less than that in the mechanical anastomosis group [ MD = -0.88, 95% CI (-1.23, -0.54), P < 0.05]. The incidence of anastomotic leakage in the manual suture group was significantly lower than that in the mechanical anastomosis group [ OR = 0.23, 95% CI (0.06, 0.93), P < 0.05]. The incidence of anastomotic stenosis in the manual suture group was significantly lower than that in the mechanical anastomosis group [ OR = 0.14, 95% CI (0.04, 0.54), P < 0.05]. Conclusion:After total gastrectomy, continuous suture of oesophago-jejuno ends with barbed threads under laparoscopy is safer and less expensive and needs less time to postoperative recovery and shorter length of hospital stay compared with mechanical anastomosis.

16.
Article in Chinese | WPRIM | ID: wpr-911975

ABSTRACT

Objective:To evaluate the effect of different superficial vascular patterns on pregnancy outcome and residual anastomosis following laser coagulation in placentae with twin-to-twin transfusion syndrome (TTTS).Methods:This study retrospectively collected and analyzed the clinical data and postnatal placenta perfusion characteristics of 57 cases of TTTS who received fetoscopic laser occlusion of chorioangiopagous vessels (FLOC) and delivered at Peking University Third Hospital from April 2014 to April 2019. According to the vascular pattern, all the cases are divided into four groups, which were parallel, staggered, mixed, and monoamniotic groups. Differences in the operation time and method, pregnancy outcome, and residual vascular anastomosis between the four groups were compared using analysis of variance, non-parametric tests, and Chi-square (or Fisher's exact) tests. Results:Among the 57 cases, the staggered, mixed, parallel, and monoamniotic types were accounted for 68.4%(39/57), 15.8%(19/57), 14.0%(8/57), and 1.7%(1/57), respectively. After exclusion of one case of monoamniotic type, gestational weeks at onset and surgery in the parallel group were both later than the staggered and mixed groups [23.0 (22.0-26.3) weeks vs 21.0 (17.0-24.7) weeks and 22.6 (21.3-23.9) weeks, H=10.306, P=0.006; 25.0 (22.6-26.3) weeks vs 22.0 (17.4-24.9) weeks and 23.2 (22.4-24.0) weeks, H=9.926, P=0.007; all P'<0.016 7]. There was no statistical significance in the differences in operation time and method, gestational age at the end of the pregnancy, neonatal birth weight, or birth weight discordance between the three groups. The diameter of residual vascular anastomosis of women in the staggered group was less than that in the mixed group [0.6 (0.1-5.0) mm vs 1.4 (0.3-5.1) mm, P'<0.016 7], but no significant difference was observed in the parallel-group [0.9 (0.2-3.6) mm] neither with the mixed or staggered group. The staggered group was noted for an increased distance ratio of umbilical cord insertion compared with the parallel and the mixed group [0.66 (0.59-1.00) vs 0.49 (0.25-0.55) and 0.48 (0.42-0.53); P'<0.016 7]. There was no significant difference between the parallel and the mixed groups. Conclusions:Placental superficial vascular patterns may affect the residual vascular anastomosis in women with TTTS following FLOC, which should be thoroughly evaluated before the operation to develop an individual management plan to reduce residual anastomosis incidence.

17.
Rev. bras. cir. cardiovasc ; 35(6): 906-912, Nov.-Dec. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1143983

ABSTRACT

Abstract Objective: To investigate the correlation between cardiac output values and renal neutrophil gelatinase-associated lipocalin (NGAL) levels as a biomarker of renal ischemia. Methods: Forty patients, who underwent off-pump coronary artery bypass (OPCAB) surgery and in whom the positioning of the heart was fixed with simple suspension sutures without a mechanical stabilizer, were included in the study. Continuous cardiac output (CO) measurements were recorded using the arterial pressure waveform analysis method (FloTrac sensor system) in the perioperative period. CO was recorded every minute during non-anatomical cardiac positioning for left anterior descending artery (LAD), diagonal artery (D), circumflex artery (Cx), and right coronary artery (RCA) bypasses. Serum NGAL samples were analyzed in the preoperative, perioperative, and postoperative periods. Results: The CO values measured at various non-anatomical cardiac positions during distal anastomosis for LAD, D, Cx, and RCA were significantly lower than pre- and postoperative values measured with the heart in normal anatomical position (3.45±0.78, 2.9±0.71, 3.11±0.56, 3.19±0.81, 5.03±1.4, and 4.85±0.78, respectively, P=0.008). There was no significant difference between CO values measured at various non-anatomical cardiac positions during distal anastomosis. Although there was no significant correlation between NGAL levels and age, duration of surgery, preoperative CO, D-CO, RCA-CO, and postoperative CO measurements, there was a significant correlation between NGAL levels and LAD-CO (P=0.044) and Cx-CO (P=0.018) at the postoperative 12th hour. Conclusion: Full revascularization may be achieved by employing the OPCAB technique while using simple suspension sutures without a mechanical stabilizer and by providing safe CO levels and low risk of renal ischemia.


Subject(s)
Humans , Male , Coronary Artery Bypass, Off-Pump , Lipocalin-2/metabolism , Cardiac Output , Coronary Vessels , Kidney
18.
Rev. gastroenterol. Perú ; 40(4): 355-360, oct.-dic 2020. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1280416

ABSTRACT

RESUMEN Las filtraciones de anastomosis colorrectales tienen una incidencia de 5 a 15% y su manejo depende de las manifestaciones clínicas, la distancia desde el margen anal y su ubicación intra o extra peritoneal. En algunos casos seleccionados el manejo endoscópico ha demostrado ser un tratamiento efectivo. En el presente reporte de caso se utilizó el sistema de drenaje rectal transanal asistido por vacío descrito por Weidenhagen et al., para el tratamiento de una fuga anastomótica pero se utilizó una espuma de polivinilo en vez la espuma tradicionalmente usada de poliuretano con el fin de disminuir el número de cambios de la espuma y el tiempo de tratamiento.


ABSTRACT Colorectal anastomosis leaks have an incidence of 5 to 15% and their management depends on the clinical manifestations, the distance to the anal verge and the intra or extra peritoneal location. In some selected cases, endoscopic management has proven to be an effective treatment. In this case report, the vacuum-assisted transanal rectal drainage system described by Weidenhagen et al. was used for the treatment of an anastomotic leak. We used a polyvinyl sponge instead of the polyurethane sponge traditionally used with the intention to reduce sponge changes and treatment time.

19.
Metro cienc ; 28(2): 12-18, 01/04/2020.
Article in Spanish | LILACS | ID: biblio-1128594

ABSTRACT

RESUMEN El síndrome de Pinza Aortomesentérica o "Síndrome de Wilkie" es una entidad muy rara, se caracteriza por una pérdida de peso impor-tante y vómitos de alimentos parcialmente digeridos. La sospecha diagnóstica se fundamenta por la presencia de factores predisponen-tes y/o de riesgo. Estudios imagenológicos como un esofagogastroduodeno seriado y ecografía Doppler permiten su confirmación. El tratamiento primario se apoya en una adecuada nutrición. Frente al fracaso del tratamiento médico, se indica el manejo quirúrgico con diferentes técnicas para resolver la oclusión. Se presenta el caso de una adolescente con oclusión gastroduodenal crónica, fallo en el tratamiento médico y resolución quirúrgica con buenos resultados.Palabras claves: Síndrome de la arteria mesentérica superior, obstrucción duodenal, reflujo duodenogástrico, laparotomía, anastomosis quirúrgica; gastroparesia.


ABSTRACT Superior mesenteric artery syndrome or "Wilkie syndrome" is a very rare entity, characterized by significant weight loss and vomiting of partially digested food. The diagnostic suspicion is based on the presence of predisposing and/or risk factors. Imaging studies such as serial esophagogastroduodenum and Doppler ultrasound allow its confirmation. The primary treatment is supported by adequate nutrition. Following the failure of medical treatment, surgical management is indicated with different techniques to resolve the occlusion. We present the case of a teenager with chronic gastroduodenal occlusion, failure in medical treatment and surgical resolution with good results.Keywords: Superior mesenteric artery syndrome; duodenal obstruction; duodenogastric reflux; laparotomy; anastomosis, surgical; gas-troparesis


Subject(s)
Humans , Female , Adolescent , Superior Mesenteric Artery Syndrome , Anastomosis, Surgical , Duodenogastric Reflux , Gastroparesis , Laparotomy , Mesenteric Arteries
20.
Int. braz. j. urol ; 46(1): 108-115, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1056353

ABSTRACT

ABSTRACT Objective: Cystectomy with urinary diversion is the gold standard for muscle invasive bladder cancer. It also may be performed as part of pelvic exenteration for non-urologic malignancy, neurogenic bladder dysfunction, and chronic conditions that result in a non-functional bladder (e.g., interstitial cystitis, radiation cystitis). Our objective is to describe the surgical technique of urinary diversion using large intestine as a conduit whilst creating an end colostomy, thereby avoiding a primary bowel anastomosis and to show its applicability with respect to urologic conditions. Materials and Methods: We retrospectively reviewed five cases from a single institution that utilized the described method of urinary diversion with large intestine. We describe operative times, hospital length of stay (LOS), and describe post-operative complications. Results: Five patients with a variety of urologic and oncologic pathology underwent the described procedures. Their operative times ranged from 5 hours to 11 hours and one patient experienced a Clavien III complication. Conclusion: We describe five patients who underwent this procedure for various medical indications, and describe their outcomes, and believe dual diversion of urinary and gastrointestinal systems with colon as a urinary conduit to be an excellent surgical option for the appropriate surgical candidate.


Subject(s)
Humans , Male , Adult , Colon, Sigmoid/surgery , Colostomy/methods , Urinary Diversion/methods , Urinary Bladder Diseases/surgery , Anastomosis, Surgical , Cystectomy/methods , Reproducibility of Results , Treatment Outcome , Operative Time , Length of Stay , Medical Illustration , Middle Aged
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