Obstrucción duodenal congénita de etiología múltiple: reporte de un caso con malrotación intestinal, bandas de Ladd y membrana duodenal intrínseca como causantes de obstrucción intestinal en el neonato / Congenital duodenal obstruction of multiple etiology: case report with intestinal malrotation, Ladd bands and intrinsic duodenal membrane as causes of intestinal obstruction in the neonate

Resumen: La obstrucción duodenal congénita agrupa un amplio espectro de anomalías en el desarrollo del intestino delgado; se clasifica según su etiología tanto en extrínseca como intrínseca. Su presentación es relativamente común, teniendo una incidencia de 1: 2.500-10.000 nacidos vivos y normalmente presenta asociación con aneuploidías (como la trisomía 21) y malformaciones cardíacas. Las imágenes tienen un papel importante en la aproximación diagnóstica y la radiografía de abdomen simple, es el primer escalón en la aproximación de la obstrucción intestinal. El tratamiento involucra una exploración quirúrgica del abdomen con corrección de los defectos encontrados. Este es un reporte de caso de un neonato que presentó obstrucción duodenal congénita de etiología tanto extrínseca (malrotacion intestinal y bandas de Ladd) como obstrucción intrínseca (membranas duodenales).

Abstract: Congenital duodenal obstruction groups together a broad spectrum of abnormalities in the development of the small intestine; it is classified according to its etiology as both extrinsic and intrinsic. Its presentation is relatively common, having an incidence of 1: 2.500-10.000 live births and it is normally associated with aneuploidy (such as trisomy 21) and cardiac malformations. Images play an important role in the diagnostic approach, with simple abdominal radiography being the first step in the approximation of intestinal obstruction. The treatment corresponds to a surgical exploration of the abdomen with resolution of the defects found. This is a case report of a newborn who presented congenital duodenal obstruction of both extrinsic etiology (intestinal malrotation and Ladd bands) and intrinsic obstruction (duodenal membranes).

Como evitar uma retração no meio da cicatriz horizontal e minimizar o risco de necrose nas abdominoplastias clássicas / How to avoid a retraction in the middle of the horizontal scar and minimize the risk of necrosis in the classic abdominoplasty

Introdução: Nas abdominoplastias clássicas, um resultado indesejado após o tracionamento do retalho abdominal é a ocorrência de uma retração suprapúbica, no meio da cicatriz horizontal quando esta coincide com o ponto superior da antiga cicatriz umbilical. Métodos: Foram avaliadas 45 pacientes submetidas à dermolipectomia abdominal associada à lipoaspiração de todo o abdome e flancos, com decorticação de uma área suprapúbica cerca de 5 cm acima da marcação inicial da linha de incisão, com posterior fixação na borda inferior do retalho abdominal. Resultados: Não foram observadas depressões ou necroses na região suprapúbica. Conclusão: Observamos, nos casos operados, que a presença de um coxim dermogorduroso na porção central da linha de sutura nas abdominoplastias clássicas, associada à reconstituição completa dos planos cirúrgicos e fixação deste coxim no retalho abdominal superior, evita a ocorrência de depressões nesta região, evita ocorrência de necroses e melhora a qualidade da cicatriz por redução da tensão de tração sobre os tecidos.

Introduction: In classic abdominoplasty, an undesirable result after abdominal flap traction is the occurrence of a suprapubic retraction in the middle of the horizontal scar when it coincides with the superior point of the old umbilical scar. Methods: Forty-five patients underwent abdominal dermolipectomy associated with liposuction of the entire abdomen and flanks, with decortication of the suprapubic area approximately 5 cm above the initial marking of the incision line, with posterior fixation at the lower border of the abdominal flap. Results: No depressions or necroses were observed in the suprapubic region. Conclusion: We observed that the presence of a dermofat flap in the central portion of the suture line in the classic abdominoplasties associated with the complete reconstruction of the surgical planes and the fixation of this flap in the upper abdominal flap avoids the occurrence of depressions in this region, prevents occurrence of necrosis, and improves the quality of the scar by reducing the tensile stress on the tissues.

Evaluación del gel antiadherencial post quirúrgico: hialuronato de sodio más carboximetilcelulosa y alginato / Evaluation of post-surgical antiadherence gel: sodium hyaluronate plus carboxymethylcellulose and alginate

INTRODUCCIÓN: Antecedentes: Las adherencias son bandas de tejido similar el tejido cicatricial que se forman entre superfícies dentro del organismo y hacen que estas se unan. Se forman más frecuentemente en el abdomen y pelvis después de cirugias intestinales o de los órganos femeninos, estas producen diversar molestias como distención o hinchazón abdominal, estreñimiento, náuseas y vomitos, incluso dolor pélvico intenso y crónico. Las adherencias son parte de un proceso fisiopatológico desencadenado o en respuesta al corte, isquemia, abrasión del peritoneo durante la cirugia. Las zonas alteradas sufren de regeneración mesotelial y fibrosis resultando en la formación de adherencias entre los tejidos serosos dañados. Las adherencias pueden tener un efecto beneficioso, ya que permite neovscularización de zonas isquémicas del intestino, tales como en las anastomosis, pero generalmente ocasionan probelmas cuando se vuelven excesivas. Las adherencias son la principal causa de obstrucción intestinal que causa el 70% de readmisiones hospitalarias. El hialuronato de sodio más carboximetilcelulosa, es descrito como un agente antiadherente no tóxico, no inmunogénico y biocompatible que reduce la incidencia y extensión de las adherencias postoperatorias. Compuesto de hialuronato de sodio y carboximetilcelulosa está modificado químicamente para retardar su tasa de degradación y deputación después de entrar en contato con el organismo. METODOLOGÍA: Se realizó una búsqueda bibliográfica de la literatura con respecto a la eficacia y seguridad del uso del Gel Antiadherencial Post quirúrgico. Se seleccionaron artículos científicos: evaluación de tecnologías santiarias, revisiones sistemáticas, met-análisis y ensayos clínicos. Se realizó una búsqueda dentro de la información generada por grupos que realizan revisiones sistemáticas, evaluación de tencologías sanitarias y guías de práctica clínica, tales como The Cochrane Library y The National Institute for Health and Care Excelence (NICE). Además, se hizo una búsqueda en www.clinicaltrials.gov, para poder identificar ensayos aún en elaboración o que no hayan sido publicados. CONCLUSIONES: Las investigaciones publicadas hasta marzo del 2016 son insuficientes para poder determinar la eficacia y seguridad del gel antiadherencial postquirúrgico (hialuronato de sodio más carboximetilcelulosa). Los resultados de los estudios preclínicos son discordantes con los ensayos clínicos realizados posteriomente. El Instituto de Tecnologías en Salud e Investigación-IETSI, no aprueba el uso del gel antiadherencial en sus presentaciones: (hialuronato de sodio más carboximetilcelulosa, alginato o la combinación de hialuronato de sodio más carboximetilcelulosa y alginato; para la reducción de adherencias abdominlaes y pélvicas.

Tratamiento laparoscópico de la obstrucción intestinal por bridas / Laparoscopic treatment of adhesive small bowel obstruction

Background: Treatment options for adhesive small bowel obstruction (ASBO) involve conservative and surgical management, traditionally through open adhesiolysis. Laparoscopic approach has been performed in recent years; however, limited data exist on its safety and results vary considerably. Our aim is to report our experience of laparoscopic treatment for ASBO. Methods: Retrospective study including patients admitted with the diagnosis of adhesive small bowel obstruction and that were submitted to laparoscopic exploration, between June 2003 and April 2013. We analyzed demographic, surgical variables and outcomes in terms of conversion rate, operative time, re-feeding time and length of stay. Non-parametric tests were used for statistical analysis. Results: Series of 38 patients submitted to laparoscopic exploration, mean age: 51 +/- 16 years, 47 percent male. 53 percent had prior intra-abdominal surgeries. Laparoscopic resolution of bowel obstruction was possible in 31 patients (82 percent), with 7 conversions to open surgery. Median operative time was 60 (25-180) minutes, median re-feeding time was 24 (24-192) hours and median length of stay was 4 (2-52) days. Two patients required re-intervention during their hospital stay, one due to persistent bowel obstruction and one due to ischemic colitis. There were no other complications or mortality. Conclusions: Laparoscopy in adhesive small bowel obstruction was a feasible approach in this series, with good results when laparoscopic resolution is achieved. Patients with no prior surgeries seem to be good candidates for this approach.

Introducción: El tratamiento de la Obstrucción Intestinal por Bridas (OIB) incluye alternativas conservadoras y quirúrgicas, esta última tradicionalmente a través de cirugía abierta. El abordaje laparoscópico ha sido incorporado recientemente, sin embargo, existe información limitada sobre su seguridad y sus resultados varían considerablemente. Nuestro objetivo es presentar la experiencia de nuestro centro en el tratamiento laparoscópico de la OIB. Material y Métodos: Estudio retrospectivo incluyendo pacientes con el diagnóstico de OIB que fueron sometidos a cirugía laparoscópica en nuestro centro, entre junio de 2003 y abril de 2013. Análisis de variables demográficas, quirúrgicas y resultados obtenidos en términos de tasa de conversión, tiempo operatorio, tiempo de realimentación y estadía hospitalaria. Análisis estadístico con pruebas no paramétricas. Resultados: Serie de 38 pacientes, edad promedio: 51 +/- 16 años, 47 por ciento sexo masculino. 53 por ciento con antecedente de cirugía abdominal previa. Resolución completa por laparoscopía fue posible en 31 pacientes (82 por ciento), con 7 conversiones a cirugía abierta. La mediana de tiempo operatorio fue de 60 m (25-180), la mediana de tiempo a la realimentación fue de 24 h (24-192) y la mediana de estadía hospitalaria de 4 (2-52) días. Dos pacientes requirieron reoperaciones durante su hospitalización; uno debido a obstrucción intestinal persistente y otro debido a colitis isquémica. No se presentaron otras complicaciones ni mortalidad en esta serie. Conclusiones: El abordaje laparoscópico en OIB es factible de realizar en pacientes seleccionados, logrando buenos resultados en caso de resolución completa por laparoscopía. Pacientes sin cirugías abdominales previas son buenos candidatos para un abordaje laparoscópico inicial.

Rol de la laparoscopia en la infertilidad inexplicada: experiencia del Hospital Clínico de la Pontificia Universidad Católica de Chile / Role of laparoscopy in unexplained infertility

Antecedentes: Existe una tendencia global creciente de no realizar laparoscopia diagnóstica en el estudio de pacientes con infertilidad inexplicada e histerosalpingografía normal. Este tipo de manejo podría tener ciertos inconvenientes dado que existen lesiones, especialmente tuboperitoneales, que no son diagnosticadas y pudiesen influir en los resultados. Nuestro grupo maneja estas pacientes con laparoscopia diagnóstica/terapéutica y posteriormente tres ciclos de inseminación intrauterina. Objetivos: Validar nuestro manejo de la infertilidad inexplicada, estimar la frecuencia de patología pélvica en pacientes con infertilidad inexplicada con histerosalpingografía normal, evaluar la tasa de embarazo posterior a la resolución laparoscópica de su patología y revisar la literatura existente. Resultados: Se revisaron todas las cirugías laparoscópicas realizadas en pacientes con infertilidad inexplicada del Hospital Clínico de la Universidad Católica, entre los años 2007-2011. De estas, 57 pacientes cumplían los criterios de inclusión y 39 recibieron al menos 1 ciclo de inseminación intrauterina posterior al procedimiento. El 82,4 por ciento de las pacientes presentaron hallazgos a la laparoscopia, siendo los más prevalentes la endometriosis grado I y II (57,8 por ciento), y las adherencias pelvianas (43,8 por ciento). De las 57 pacientes que fueron sometidas a laparoscopia diagnóstica/terapéutica, sólo 25 completaron 3 ciclos de inseminación intrauterina posterior, 8 lograron concepción (32 por ciento). Conclusión: Nuestros resultados son similares a los expuestos en otros trabajos en términos de hallazgos patológicos y tasa de fertilidad post laparoscopia. Dado el escaso acceso a técnicas de fertilización in vitro en nuestro medio, nuestro manejo plantea una excelente alternativa para este grupo de pacientes.

Background: There is an increased global tendency for avoiding a diagnostic laparoscopic surgery, among patients with unexplained infertility and a normal histerosalpingography. This decision may have certain consequences, as there may be undiagnosed lesions, such as tuboperitoneal ones, which could have an impact in the management of these patients. Our group treats them with diagnostic therapeutic laparoscopy, followed by three cycles of intrauterine insemination. Objectives: Validate our management of unexplained infertility, estimate the frequency of pelvic pathology in patients with unexplained infertility with a normal histerosalpingography, evaluate the pregnancy rate after the laparoscopic resolution of their pathology, and review the existent literature. Results: We reviewed all laparoscopic surgeries performed in patients with unexplained infertility in Hospital Clínico de la Pontificia Universidad Católica, between 2007-2011. From these, 57 patients met the inclusion criteria, and 39 of them received at least one intrauterine insemination cycle after the procedure. Laparoscopic alterations were present in 82.4 percent of the patients, being the most prevalent ones endometriosis grade I and II (57.8 percent) and pelvic adhesions (43.8 percent). Of the 57 patients who underwent laparoscopy, only 25 completed three cycles of intrauterine insemination, 8 of which conceived (32 percent). Conclusion: Our results are similar to those exposed in other series, regarding pathologic findings and fertility rate after laparoscopy. As there is limited access to advanced reproductive techniques in our country, our management represents an excellent choice for this group of patients.

Histeroscopia ambulatorial em casos de abortamento consecutivo / Office hysteroscopy study in consecutive miscarriage patients

OBJETIVO: Avaliar a prevalência de alterações anatômicas uterinas diagnosticadas através da histeroscopia ambulatorial em uma população de pacientes com mais de dois abortamentos consecutivos. Comparar a prevalência de alterações uterinas entre as pacientes com dois abortos em relação as pacientes com três ou mais abortamentos de repetição. MÉTODOS: Foi realizado um estudo transversal em 66 pacientes com diagnóstico de dois ou mais abortamentos de repetição. As pacientes foram divididas em dois grupos: Grupo A (até dois abortamentos, 23 pacientes) e Grupo B (três ou mais abortamentos, 43 pacientes), sendo submetidas à histeroscopia diagnóstica ambulatorial em que foram identificadas alterações congênitas e adquiridas da cavidade uterina. RESULTADOS: Foram encontradas em 22 (33,3 por cento) pacientes alterações uterinas, sendo em nove casos alterações congênitas [útero arqueado (quatro casos), septo uterino (dois casos) e útero bicorno (um caso)] e em 13 pacientes alterações adquiridas [sinéquia (sete casos), pólipo endometrial (quatro casos) e mioma uterino (dois casos). Não houve diferença significativa entre grupos em relação às alterações uterinas adquiridas e congênitas. Foi encontrada uma correlação positiva entre alterações anatômicas na histeroscopia e número de abortamentos (r = 0,31; p = 0,02). CONCLUSÃO: As pacientes com mais de dois abortamentos apresentam uma alta prevalência de alterações uterinas diagnosticadas por histeroscopia. No entanto não há diferença na prevalência ou na distribuição das lesões em relação ao número de abortamentos.

OBJECTIVE: To assess the prevalence of uterine anatomical abnormalities found by office diagnostic hysteroscopy in a population of patients experiencing more than two consecutive miscarriages and compare the prevalence of uterine abnormalities between patients with two miscarriages and those with three or more consecutive miscarriages. METHODS: A cross-sectional study of 66 patients with two or more consecutive miscarriages diagnosis was conducted. Patients were divided into two groups: Group A (up to two miscarriages, 23 patients), and Group B (3 miscarriages, 43 patients). They underwent an outpatient diagnostic hysteroscopy study, with either congenital or acquired abnormalities of the uterine cavity being identified. RESULTS: Uterine changes were found in 22 (33.3 percent) patients, with 9 cases of congenital changes [arcuate uterus (4 cases), septate uterus (2 cases), and bicornuate uterus (1 case)], and 13 patients with acquired changes [intrauterine adhesions (7 cases), endometrial polyp (4 cases), and uterine leiomyoma (2 cases)]. No significant differences were found between the groups as regarding both acquired and congenital uterine changes. A positive correlation was found between anatomical changes on hysteroscopy and number of miscarriages (r = 0.31; p = 0.02). CONCLUSION: Patients with more than two miscarriages have a high prevalence of uterine cavity abnormalities diagnosed by hysteroscopy; however there are no differences in prevalence or distribution of these lesions related to the number of recurrent miscarriages.

Oclusión intestinal: nuestra experiencia en el tratamiento quirúrgico / Bowel obstruction: authors' experience with the surgical management

El síndrome de Oclusión Intestinal representa entre un 20 % y 30 % de los cuadros de Abdomen Agudo. El objetivo es relacinar edad, sexo, riesgo ASA, altura de la oclusión, retardo en el tratamiento quirúrgico con mortalidad, complicaciones médicas y quirúrgicas. Se realizú en el Servicio de Guardia Central H:N:C. UNC.. Diseño: estudio prospectivo y protocolizado. Material y métodos: entre enero de 2004 y enero de 2007, se operaron 52 pacientes con un cuadro de oclusión intestinal. Del total 32 de ellos fueron hombres y 20 mujeres; el promedio de edad correspondió a 52,11 años. Riesgo Quirúrgico: el 46,15 % de los pacientes presentó riesgo A.S.A. III, 38,69 % riesgo A.S.A. II, 11,53 % riesgo A.S.A. I y 9,61 % riesgo A.S.A. IV. Los síntomas mós frecuentes fueron dolor abdominal y distensión abdominal y los signos de distensión abdominal y timpanismo abdominal. Resultados: en las Oclusiones altas las Bridas fueron la causa más frecuente y en Oclusiones bajas el Cáncer de sigmoides. La mortalidad global fue de 13,45 %. Respecto de las Complicaciones médicas postquirúrgicas, 14 pacientes en total las presentron, la más frecuente fue la Insuficiencia Renal Aguda con 9 casos. respecto de las complicaciones del acto quirúrgico, 12 pacientes en toal las presentron; las más frecuentes fueron las infecciones de la herida quirúrgica con 7 casos. Conclusiones: el riesgo A.S.A. elevado mostró ser uno de los factores predictivos más importantes respecto del incremento de la mortalidad en cuadros oclusivos de urgencia, junto con la edad y el retraso de la indicación quirúrgica.

Bowel obstruction syndrome represents 20 to 30 % of acute abdominal consult. Objectives: to relate age, gender, ASA risk, large or smal intestinal obstruction, opportunity chirurgic treatment, medical and clinic complications. Establishment: Central Guard Service of N.C.H. of the C.N.U. Design: protocolized and prospective study. Methods and materials: between January 2004 and January 2007 it has been operated 52 patients with acute bowel obstruction, 32 of them were males and 20 females. The middle age eas 52,11 years. Chirurgic risk: 46,15 % had ASA risk III, 38,69 % had ASA risk II, 11,53 % had ASA risk I, and 9,61 % had ASA risk IV. Most common sympotom was abdominal pain and abdominal distension, and the most common signs were distension and tympanic abdominal. Results: the most common cause of small bowel obstruction sigmoid cancer. Global mortality was 13,45 %. Post chirurgic complications: 9 patients had acute renal failure and 7 had wound surgery infection. Conclusions: the most important factors that increase mortality on acute bwel obstructions are elevated risk ASA, age adn retard of surgery treatment.

Factores asociados con la no adherencia a la terapia antirretroviral en personas con síndrome de inmunodeficiencia adquirida / Factors associated to non-adherence to antiretroviral therapy in persons with AIDS

Objetivo: Determinar los factores que se asocian a la no adherencia a la terapia antirretroviral (TARV) en personas con Síndrome.

Acute mechanical intestinal obstruction: the problem of diagnosis of strangulation without CT scans

To assess the possibility of pre-operative differentiation of strangulated and non-strangulated intestinal obstruction based on clinical; radiological and laboratory features without CT scan, 66 patients with acute bowel obstruction were studied prospectively. Forty-nine [74%] were male, 17 [26%] female with a wide age distribution. In 56 [85%] the small bowel was obstructed, in ten [15%] the large bowel. Adhesions were the most common cause of obstruction [36%], followed by hernias [20%], volvulus [12%], intussusception [11%], malignancies [11%] and other causes [10%]. At surgery strangulation, defined as compromise of the blood supply and necessitating resection of gangrenous bowel, was found in 18 [27%] of the patients. Ten patients [15%] developed complications after surgery and ten patients died, mostly from age and cardiovascular conditions. Persistent abdominal pain, rebound tenderness, elevated temperature, leukocytosis, and air-fluid levels were considered as possible predictive factors for the pre-operative diagnosis of strangulation but it was concluded that such factors were not sufficiently reliable and early surgery was imperative to detect reversible ischemic bowel in strangulated obstruction

Analysis of different causes of mechanical intestinal obstruction

To find out the frequency of different causes of Mechanical Intestinal Obstruction, presenting at CMH Rawalpindi. None random convenient sampling. The study was done in CMH Rawalpindi from July 2003 to Dec. 2003. Hundred patients fulfilling the inclusion criteria were included in the study. Most of the patients were soldiers and their families. Data was collected on the patient proforma. A total of 100 patients were treated for mechanical bowel obstruction during the study period [83 male and 17 female]. Seventy- nine [79%] patients had obstruction of the small intestine and twenty-one [21%] had obstruction of the large intestine. Adhesions and External hernia accounted for almost more than half the causes of mechanical intestinal obstruction in our patients. The adhesions represent leading cause of intestinal obstruction. There were 38 cases of intestinal obstruction due to adhesions in all these cases the plain abdominal x-rays revealed the typical features of small bowel obstruction with air fluid levels and dilated loops of bowel. In 35 of these patients there was a history of previous abdominal surgery including 9 females and 26 males. The initial treatment was conservative by keeping the patients nil orally, nasogastric decompression and intravenous fluids. Intestinal obstruction is one of the common clinical conditions in Pakistan. Mechanical intestinal obstruction due limited to adhesions, is the most common cause, followed by strangulated/ obstructed external hernia, malignancy and tuberculosis

Pattern of intestinal obstruction in Benghazi

Intestinal obstruction [I.O] is one of the most common surgical emergencies worldwide and accounts for a large percentage of surgical admission of acute abdominal pain. Aims: To determine the incidence, aetiology, management and the changing pattern of I.O in Benghazi Teaching Hospitals [7th October and Al-Jala], which cover all the surgical adult emergencies in Benghazi areas. A retrospective study which included all patients admitted to Benghazi hospitals in the period between January 2001 to December 2003 with the diagnosis of I.O. 202 patients with 245 episodes of obstruction were found. Male preponderance was observed in all age groups. Postlaparotomy adhesions were the most common cause of I.O [42%], followed by faecal impaction [15%], entrapment of bowel in external hernias[12%]. one third of patients with adhesions followed appendectomy. Although biliary disease is the most common surgical disease in Libya, there was no single case of stone ileus. Mortality rate was 2%. In Benghazi during the last decade, the most common cause of I.O was due to of postlaparatomy adhesions, while external hernias was the third common cause of obstruction. This may reflect improvement of health care services and increasing rate of elective surgical procedures of hernias. Infection and the level of skills of the surgeon may be factors leading to the high rate of postlaparotomy adhesions

Comparação entre a tela de submucosa intestinal suína acelular (Surgisis®) e a tela polipropileno (Marlex®) na formação de aderências peritoneais ­ estudo experimental em ratos / Comparison between the acelular porcine intestinal submucosa mesh (Surgisis®) and the polypropylene mesh (Marlex®) in the formation of peritonial adhesions ­ an experimental study in rats

Introdução: Comparar o índice de aderências intraperitoneais entre a tela de submucosa intestinal suína (Surgsis®) e tela polipropileno intraperitoneal (Marlex®) em modelo animal. Metodologia: Foram analisados três grupos de ratas albinas totalizando 40 animais grupo 0 (Sham operation sem tela) = 5 ratos, grupo 1 (tela de polipropileno) = 15 ratos, grupo 2 (tela de submucosa intestinal suína intraperitoneal) = 20 ratos. Estes foram anestesiados com xilasina (5mg/kg) e quetamina (50mg/kg) para a realização do procedimento. Após 21 dias, os animais foram mortos e avaliou-se o percentual de tela comprometida, o tipo de víscera envolvida, o tipo de aderência (graduado de 0 ­ ausência de aderências, a 3 ­ aderências firmes), bem como a força necessária para sua ruptura. Resultados: No grupo 1, todos os animais apresentaram aderências, sendo as aderências 2 e 3 os tipos mais freqüentes (86,6%). Em um animal houve aderência firme do intestino delgado. No grupo 2, foram encontradas aderências do tipo 0 e 1 em 75% dos animais; as do tipo 3 não foram encontradas. Quando comparados, os grupos diferiram estatisticamente (p<0,001) em todos os parâmetros avaliados. Conclusão: A tela de Marlex® apresentou índices elevados de aderências, o que pode representar uma maior possibilidade de complicações pós-operatórias (AU)

Introduction: To compare the rate of intraperitoneal adhesions between the porcine intestinal submucosa surgical mesh (Surgsis®) and intraperitoneal polypropylene mesh (Marlex®) in animal model. Methodology: A total of 40 albino female rats divided in three groups were analyzed: Group 0 (Sham operation without mesh) = 5 rats, Group 1 (polypropylene mesh) = 15 rats, and Group 2 (intraperitoneal intestinal submucosa mesh) = 20 rats. The animals were anesthetized with xylasine (5mg/kg) and ketamine (50mg/kg) prior to the procedure. After 21 days, the animals were killed and we evaluated the percentage of compromised mesh, the type of viscera involved, the type of adhesions (rated in a scale from 0 =absence of adhesions to 3 = firm adhesions), as well as the necessary force for their rupture. Results: All animals in Group 1 presented adhesions, types 2 and 3 being the most frequent ones (86.6%). One animal had firm adhesion of the small intestine. In Group 2, adhesions type 0 and 1 were found in 75% of the animals, and type 3 was not found. When the groups were compared, they were statistically different (p<0.001) in all the evaluated parameters. Conclusion: The Marlex® mesh presented higher rates of adhesion, which can increase the possibility of postoperative complications (AU)

Laparoscopic management of ovarian endometriomas comparative study incision peeling versus incision coagulation

To compare the effect of incision-peeling versus incision coagulation of pelvic endometriomas. Prospective, blind, randomized controlled study was performed on 88 patients diagnosed as having bilateral ovarian endometriomas. All patients were subjected to three puncture operative laparoscopy. In each patient one endometrioma was randomly chosen for mechanical peeling of its wall [peeled group] while the lining of the other endometrioma was coagulated. The records were blind to the observers of the results. No statistically significant difference between the two groups was found regarding the recurrence rate. While coagulated group is statistically better than peeled group regarding ovarian volume, ovarian dominance and response to clomphine citrate and ovarian dominance and number of occytes retrived during IVF and ICSI. Also there was statistically significant difference between the two groups regarding periovarian adhesions and distal tubal affection. No difference of the rate of recurrence of endometriomas either treated by laparoscopic excision of cyst wall or by coagulation. Ovarian endometriomas treated by incision, evacuation and coagulation provides for a more favourable outcome than peeling of cyst wall, with regard to the ovarian volume, the ovarian dominance and yield of follicles and the ovarian dominance and yield of oocytes. Peeling causes more periovarian adhesions and fimbrial affection of the ipsilateral tube

Induction of endometriosis by implantation of endometrial fragments in female rats

Endometriosis is defined as the growth of endometrial tissues in ectopic places outside the uterus. This disease has an important effect on the health and fertility of affected women. It's etiology is not clearly known. For better understanding the pathophysiology of this disease, many researchers study on several aspects of the disease on animals. In this experimental study endometriosis was induced in female rats surgically and then its side effects were investigated with special focus on adhesion formation that is a major problem in women with this disease. In Protestrous phase, female rats were randomly divided into two groups. In both groups, under intra peritoneal anesthesia, laparotomy was done and left horn and associated fat were removed. In experimented group [A], the removed endometrium was cut to six square pieces [2mm each] and they were sutured to the peritoneum, near ovaries and subcutaneous. In sham group [B], the same procedure was done for the fat tissues around the removed horn and the pieces were sutured to the same places. After 8 weeks, in Protestrous phase, clinical adhesion and size of implants were evaluated. The total mean size of implants was calculated in each group, and this was significantly larger in experimented group [25.4 mm versus 2 mm p=0.000]. The mean diameter of implants that calculated for each site of implantation in experimented group were significantly larger in left peritoneum [p=0.002], followed by right [p=0.000] and left [p=0.000] ovaries. The endometrial tissues grew in 100% of implants in subcutaneous area. Clinical adhesions [Score. 2] were detected in 7 out of 10 in experimented group and in 2 out 10 in control group. The number of Esterous cycle were similar in both groups. Our study showed that after inducing endometriosis by surgical approach, only endometrial implants grew as a cystic structures and this is a unique aspect of endometrial cells. Our results showed that endometriosis had a direct effect on adhesion formation, not surgery alone and induction of this disease didn't have any adverse effect on ovarian function in female rats

Laparoscopy and small bowel obstruction in children

Three issues are studied: 1. What is well-known about post-operative small bowel obstructions. The cost of this pathology, the complications associated [blood loss, enterocutaneous fistulas, major bowel resections, abdominal wall damages, death], the distribution of adhesions in the abdominal cavity, and previous surgeries. 2. Small bowel obstructions happen after laparoscopy and the incidence is more than 1% of patients: herniation of the small bowel through a trocar site, herniation of the omentum through a trocar site, peritoneal defect, spillage of stones and stercolitis. Suggestions to avoid small bowel obstruction after laparoscopy include the use of smaller trocars whenever possible, repairing the fascia under direct vision, carefully desufflating the abdominal cavity, avoiding bleeding, spilled stones and staples and washing the abdominal cavity at the end of the surgical procedure. 3. The treatment of small obstruction is feasible by laparoscopy, reliability, and results are studied with a multicentric GECI [Groupe dEtude en Coelioscopie Infantile] and literature series. We obtained good results for 2/3 children

Descending colon obstruction caused by a parietocolic band: a case report.

A 54-year-old male who had no history of previous surgery presented with chronic intermittent constipation. A barium enema showed a 2-cm stenotic lesion at the junction between splenic flexure and descending colon. A colonoscopy revealed extra-luminal compression without mucosal lesion. Laparotomy revealed a parietocolic band compressing the proximal part of the descending colon. The band was lysed. The patient's symptom has improved since the procedure.

Mechanical bowel obstruction: the Chandigarh experience.

Intestinal obstruction is a fairly common surgical emergency in India, but there is little data available regarding the spectrum of intestinal obstruction in India, or its related complications. This paper represents a retrospective review of 97 patients who underwent surgery for intestinal obstruction at Government Medical College and Hospital, Chandigarh, India, over four years (1997-2000). The case files of all these patients were reviewed and analysed for patient particulars, pre-operative clinical examination and investigations, intraoperative findings, final diagnosis, post-operative morbidity, and mortality. The mean age of our patients was 39.46 years, with an overall male to female ratio of 2.46:1. Most of the patients were in the age group of 17 to 60 years (62.89%). A total of 107 causes for the obstruction could be identified at surgery, with intra-abdominal adhesions and bands (27.10%) being the commonest followed by obstructed herniae (22.43%). Strangulation was present in 21 patients at the time of surgery. This group of patients had a significantly higher post-operative morbidity than patients with simple obstruction, although no statistically significant difference was seen in between the mortality rates in these two groups.