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1.
Rev. méd. Chile ; 147(6): 718-726, jun. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1020720

ABSTRACT

Background: Exclusive coronary revascularization with both mammary arteries could result in lower rates of adverse events in the long term. Aim: To describe the five-year evolution of a cohort of patients operated on with this technique. Material and Methods: Follow up analyzing survival of 73 patients aged 59 ± 9 years (82% men) who underwent exclusive coronary surgery with two mammary arteries between December 1,2010 and April 12,2017. We studied their clinical characteristics, surgical results, operative morbidity and mortality and adverse events up to June 30, 2018. Results: Six patients had two-vessel lesions and 67 three-vessel lesions. The operative risk calculated by additive and logistic EuroSCORE was 2.5 and 2.3%, respectively. A mean of 3.75 anastomoses /patient were performed, 116 with left mammary artery (73 to the anterior descending artery, 38 to a diagonal artery and 5 for other objectives) and 158 with right mammary artery (69 to a first marginal artery, 23 to a second marginal artery and 64 to posterior descending artery). There was one case of mediastinitis and one (1.5%) patient died. The mean follow-up was 64.6 ± 23.7 months. The 5-year survival was 90.4%. Conclusions: Coronary revascularization with two exclusive mammary arteries allowed a complete revascularization of the heart with a low rate of complications and adverse effects at five years.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Internal Mammary-Coronary Artery Anastomosis/methods , Mammary Arteries/surgery , Postoperative Complications/mortality , Time Factors , Anastomosis, Surgical/methods , Anastomosis, Surgical/mortality , Reproducibility of Results , Risk Factors , Follow-Up Studies , Treatment Outcome , Kaplan-Meier Estimate , Internal Mammary-Coronary Artery Anastomosis/mortality
2.
Rev. chil. cir ; 70(5): 432-438, 2018. tab
Article in Spanish | LILACS | ID: biblio-978010

ABSTRACT

Introducción: La hemicolectomía derecha con anastomosis ileocólica es una cirugía frecuentemente realizada para la que existen muchas formas de realizarla. Objetivo: Evaluar cuál es la mejor anastomosis ilecólica en términos de morbimortalidad y realizar una evaluación comparativa de la evolución clínica posoperatoria según el tipo de configuración anastomótica. Pacientes y Método: Estudio observacional analítico, con criterios de inclusión y exclusión definidos. Las variables a estudiar las dividimos en dos grupos, las relacionadas a la técnica quirúrgica y su configuración anastomótica, y las variables relacionadas con resultados de la intervención quirúrgica, creando una tabla de contingencia en que se cruzan los datos. Análisis de datos con STATA 13.0. Resultados: 216 pacientes con anastomosis ileocólica, destacando significancia estadística al cruzar: A) reoperación y tipo de sutura (p = 0,044), con un OR 3,4 (IC 95% 0,94-18,6), siendo de mayor riesgo la mecánica; B) mortalidad y urgencia (p = 0,001) con un OR 7,76 (IC 95% 1,56-49,29), siendo de mayor riesgo la cirugía de urgencia. Las anastomosis isoperistálticas possen eliminación de gases (p < 0,001), tránsito intestinal (p = 0,009) e ingesta de sólidos (p = 0,005) más precoz. Hay expulsión de gases antes en el abordaje laparoscópico, sutura manual, configuración término lateral e isoperistáltica de la anastomosis y cirugía electiva. Conclusión: Existe gran variabilidad de técnicas para realizar la anastomosis ileocólica. La anastomosis manual muestra menor probabilidad de necesitar una reintervención quirúrgica, la cirugía electiva tiene menor mortalidad que la realizada de urgencia. Sugerimos realizarla vía laparoscópica, con sutura manual, término lateral, isoperistáltica y de forma electiva, por tener una recuperación más corta.


Introduction: Right hemicolectomy with ileocolic anastomosis is a frequent surgery with many ways to perform it. Objective: To evaluate which is the best ileocolic anastomosis in terms of morbidity and mortality and to make a comparative evaluation of the postoperative clinical evolution according to the type of anastomosis. Patients and Method: Analytical observational study, with defined inclusion and exclusion criteria. The variables to be studied are divided into two groups, those related to the surgical technique and its anastomotic configuration, and the variables related to the results of the surgical intervention, creating a contingency table that crosses the data. Data analysis with STATA 13.0. Results: 216 patients with ileocolic anastomosis, highlighting statistical significance when crossing: A) reoperation and type of suture (p = 0.044), with UN or 3.4 (95% CI 0.94 to 18.6), being of greater risk the mechanics; B) mortality and urgency (p = 0.001) with an OR 7.76 (95% CI 1.56-49.29), with emergency surgery being of greater risk. Isoperistaltic anastomosis with gas elimination (p < 0.001), intestinal transit (p = 0.009) and solid intake (p = 0.005) earlier. There is earlier expulsion of gases in the laparoscopic approach, manual suture, end-to-side and isoperistaltic of the anastomosis and elective surgery. Conclusion: There is great variability of techniques to perform the ileocolic anastomosis. Manual anastomosis is less likely to require surgical reoperation, elective surgery has a lower mortality than that of emergency surgery. We suggest performing it laparoscopically, with manual suture, lateral term, isoperistaltic and electively, for having a shorter recovery.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Anastomosis, Surgical/methods , Anastomosis, Surgical/mortality , Colectomy/methods , Colectomy/mortality , Reoperation , Anastomosis, Surgical/adverse effects , Retrospective Studies , Colectomy/adverse effects , Colon/surgery , Anastomotic Leak/etiology , Anastomotic Leak/epidemiology , Ileum/surgery
3.
West Indian med. j ; 62(8): 711-715, Nov. 2013. tab
Article in English | LILACS | ID: biblio-1045738

ABSTRACT

BACKGROUND: Anastomotic leakage remains a concern in general surgical practice. The significance lies in the resultant abdominal sepsis, related morbidity and mortality, risk of anastomotic loss, permanent stoma creation and the effect on local recurrence and overall patient survival in colorectal cancer cases. OBJECTIVES: This study serves to determine the leak rates and the mortality thereof related to colonic and rectal anastomoses at the University Hospital of the West Indies (UHWI) in Kingston, Jamaica. Independent factors contributing to anastomotic leaks in these patients will also be assessed and correlations determined. METHODS: A review of the medical records of one hundred and thirty-three cases of colonic and rectal anastomoses identified retrospectively over a three-year period provided relevant information for analysis. RESULTS: Anastomotic leaks were identified in twelve patients, providing a leak rate of 9.0%. No 30-day mortality related to anastomotic leakage was noted. Based on a multivariate analysis, male gender was identified as the sole independent factor related to anastomotic leakage. CONCLUSION: Colorectal anastomotic leak rates at UHWI fell at the upper limit of leak rates typically quoted in the literature. No modifiable risk factor appeared to contribute to this leak rate. Early identification and intervention is critical in limiting mortality associated with colorectal anastomotic leakage.


ANTECEDENTES: La fuga anastomótica sigue siendo una preocupación en la práctica quirúrgica general. La importancia radica en la sepsis abdominal resultante, la morbilidad y mortalidad asociadas, el riesgo de pérdida anastomótica, la creación de estomas permanentes, y el efecto sobre la recidiva local así como en la supervivencia de los pacientes en general, en los casos de cáncer colorrectal. OBJETIVOS: Este estudio sirve para determinar las tasas de fuga y la mortalidad asociadas con ellas, en relación con las anastomosis colónicas y rectales en el Hospital Universitario de West Indies (HUWI) en Kingston, Jamaica. Asimismo, se evaluaran los factores independientes que contribuyen a las fugas anastomóticas en estos pacientes, y se determinaran las correlaciones. MÉTODOS: Una revisión de los registros médicos de ciento treinta y tres casos de anastomosis colónicas y rectales identificados retrospectivamente durante un período de más de tres años, proporcionaron la información relevante para el análisis. RESULTADOS: Se identificaron fugas anastomóticas en doce pacientes para una tasa de fuga de 9.0% . No se observó ninguna mortalidad de 30 días relacionada con fugas anastomóticas. Basado en un análisis multivariante, se identificó el género masculino como el único factor independiente relacionado con la fuga anastomótica. CONCLUSIÓN: Las tasas de fuga anastomótica colorrectal en UHWI cayeron al límite superior de las tasas de fuga típicamente citadas en la literatura. Ningún factor de riesgo no modificable pareció contribuir a esta tasa de fuga. La intervención e identificación temprana es esencial a la hora de limitar la mortalidad asociada con la pérdida anastomótica colorrectal.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Anastomosis, Surgical/mortality , Anastomotic Leak/mortality , Anastomosis, Surgical/adverse effects , Retrospective Studies , Risk Factors , Anastomotic Leak/etiology
4.
Iranian Journal of Cancer Prevention. 2009; 2 (2): 103-106
in English | IMEMR | ID: emr-119073

ABSTRACT

Esophageal anastomosis leaks continue to be a significant cause of morbidity and mortality after esophagectomy. The purpose of the present study was to identify the predisposing factors of esophageal anastomotic leakage. 95 patients who underwent surgical resection for esophageal or cardia cancer were included for the study. The mean age of the patients was 59.5 years and male to female ratio was 1.56 to 1. The preferred management strategy for anastomotic leakage was the conservative approach when possible. The operative approach was reserved for those patients with fulminant sepsis or those who did not respond to the conservative management. Data were analyzed using SPSS 13.0 software and P-values less than 0.05 were considered significant. Sixty six patients had cervical esophageal anastomosis and 29 had intrathoracic anastomosis; 18.9% anastomotic leakage was diagnosed. Patients with symptoms longer than 6 months prior to operation, and diabetic patients had a significantly higher risk of anastomotic leakage. Our data showed that the presences of diabetes mellitus as well as prolonged symptoms [more than six months] are associated with higher anastomotic leakage after esophagectomy. Controlling blood glucose, early diagnosis of esophageal cancer, early resection of tumor before a long-term period of symptoms, and effective screening program for esophageal cancer may reduce the risk of esophageal leakage


Subject(s)
Humans , Male , Female , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/mortality , Esophagectomy/adverse effects , Diabetes Complications , Causality
5.
Acta cir. bras ; 22(1): 57-62, Jan.-Feb. 2007. ilus
Article in English | LILACS | ID: lil-440734

ABSTRACT

PURPOSE: To test the use of intraluminal protection in colonic anastomosis without intestinal cleansing. The intraluminal liner was fashioned from porcine submucosa preserved in glycerin and then fixed 10 cm anteriorly to the anastomotic site. This technique was compared with the one used in termino-terminal colonic anastomosis without intraluminal protection. METHODS: Twenty-eight dogs were divided into two groups of fourteen animals each. Clinical and histopathological tests were performed on the fourth and twenty-first postoperative days. RESULTS: The morbidity and mortality rates were higher in animals that did not receive the intraluminal liner. Histopathological examinations in animals in which the intraluminal liner was used showed better healing, characterized by milder inflammation and increased amount of collagen. CONCLUSION: It can be concluded that the use of intraluminal protection decreases complication rates in colonic anastomosis and promotes better healing.


OBJETIVO: Testar o uso da proteção intraluminal na anastomose colônica sem preparo intestinal. O protetor intraluminal usado foi confeccionado a partir da submucosa de suíno conservada em glicerina, e fixado a 10 cm cranialmente ao sítio anastomótico. Essa técnica foi comparada com a técnica de anastomose colônica término-terminal sem uso do protetor intraluminal. MÉTODOS: Foram utilizados 28 cães divididos em dois grupos de 14 animais cada. A avaliação foi através de exames clínicos e histopatológicos. A avaliação anatomo-patológica foi realizada no quarto e vigésimo primeiro dias de pós-operatório. RESULTADOS: Um maior número de casos de morbi-mortalidade foi observado nos animais operados sem o protetor intraluminal. O exame histopatológico dos animais nos quais foram usados os protetores intraluminais mostrou melhor cicatrização, caracterizada por processo inflamatório mais discreto e maior quantidade de colágeno. CONCLUSÃO: O uso do protetor diminui o número de complicações em anastomoses de cólon e melhora a cicatrização.


Subject(s)
Animals , Female , Dogs , Anastomosis, Surgical/methods , Colon/surgery , Glycerol/therapeutic use , Intestinal Mucosa/transplantation , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/mortality , Collagen , Inflammation , Models, Animal , Postoperative Complications , Swine , Surgical Wound Dehiscence/etiology , Wound Healing
6.
Cir. & cir ; 74(5): 329-333, sept.-oct. 2006. tab
Article in Spanish | LILACS | ID: lil-573416

ABSTRACT

Introducción: el procedimiento de Hartmann es una alternativa de tratamiento para cirugías colorrectales de emergencia, sin embargo, su reconexión es difícil y propensa a complicaciones. Se ha propuesto que un periodo de tiempo mayor entre el procedimiento inicial y la reconexión puede disminuir las complicaciones. El objetivo de esta investigación es determinar la morbilidad y mortalidad de la reconexión posHartmann, y analizar la presencia de factores de riesgo para complicaciones. Material y métodos: se analizaron retrospectivamente 48 pacientes cuyas edades oscilaron entre 57 ± 16 años, de los cuales 19 (40 %) eran mayores de 65 años y 21 (44 %) tenían enfermedades crónicas concomitantes. Se buscaron factores de morbilidad y mortalidad con prueba U de Mann- Whitney y prueba exacta de Fisher. Resultados: la indicación más frecuente del procedimiento fue la diverticulitis aguda (42 %). El periodo entre el procedimiento de Hartmann y la reconexión fue de ocho meses, con un rango de 1 a 46 meses. La duración aproximada de la cirugía de reconexión fue de 267 minutos (rango de 120 a 540). Se presentaron complicaciones en 29 pacientes (60 %), incluyendo fístulas de la anastomosis en seis (12 %) y muerte en cuatro (8 %). No se asociaron mayores complicaciones o más tiempo quirúrgico, con un intervalo de tiempo menor entre el procedimiento de Hartmann y la reconexión. Conclusiones: la reconexión posHartmann es un procedimiento con alta morbilidad y mortalidad, sin que se asocie al intervalo de tiempo entre el procedimiento y la reconexión.


BACKGROUND: Hartmann's operation is an alternative for emergency colorectal surgeries, but its reversal may be difficult and prone to complications. A longer interval for its reversal has been recommended to decrease complications. METHODS: In order to determine rates of morbi-mortality and to ascertain the association between the time interval for its reversal and presence of complications, we undertook a retrospective analysis of 48 patients with a mean age of 57 +/- 16 years. Nineteen patients (40%) were >65 years, and 21 (44%) had one or more underlying chronic disease. Perioperative factors associated with morbi-mortality were determined by means of the Mann-Whitney U test and Fisher exact test. RESULTS: Acute diverticulitis was the most frequent indication (42%). Mean interval between Hartmann's operation and its reversal was 8 months (range: 1 to 46 months). Mean duration of the reversal operation was 267 min (range: 120 to 540 min). There were complications in 29 patients (60%) including anastomotic leaks in 6 (12%) and operative deaths in 4 (8%). A shorter interval between Hartmann's operation and its reversal was not associated with more complications or longer surgical time. CONCLUSIONS: Hartmann's reversal operation has high rates of morbidity and mortality that are not influenced by the time interval from the original operation.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Anastomosis, Surgical/methods , Colostomy/methods , Postoperative Complications/epidemiology , Anastomosis, Surgical/mortality , Comorbidity , Postoperative Complications/mortality , Diverticulitis, Colonic/epidemiology , Diverticulitis, Colonic/surgery , Colonic Diseases/epidemiology , Colonic Diseases/surgery , Emergencies , Surgical Wound Infection/epidemiology , Risk Factors
7.
Rev. chil. cir ; 57(2): 149-154, abr. 2005. ilus, tab
Article in Spanish | LILACS | ID: lil-425184

ABSTRACT

Introducción: La cirugía laparoscópica intestinal ha demostrado ser factible, comparable en términos de resultados con la cirugía abierta, y con ventajas claras en el postoperatorio. Sus mayores desventajas radican en los tiempos operatorios mayores, y en los costos, especialmente debido al uso de engrapadoras mecánicas. El objetivo de este trabajo es evaluar la factibilidad y resultados de una anastomosis colónica manual por vía laparoscópica en cerdos. Material y Métodos. Se realizó un estudio experimental prospectivo en 37 cerdos. En ellos, se administró antibióticos preoperatorios, anestesia general, se insufló el neumoperitoneo a 15 mmHg, se practicó una sección a nivel del sigmoides, y se efectuó una anastomosis manual laparoscópica, término- terminal, en un plano, con sutura continua de Vycril 3.0. Se realizó una prueba de hermeticidad insuflando aire por vía rectal. Los cerdos se realimentaron al día siguiente. Luego de una semana se sacrificaron los animales, se realizó la autopsia, y se registró el estado de la anastomosis, la presencia de peritonitis o abscesos, y las complicaciones de la herida operatoria. Resultados. En todos los cerdos (37) se pudo realizar la anastomosis. No hubo casos de conversión. El tiempo operatorio mediano fue de 60 minutos (130-45), siendo de 70 minutos para los primeros 18 cerdos, y de 50 para los últimos 19. No registramos filtración al realizar la prueba de hermeticidad. El tránsito mediano a deposiciones fue de 2 días. La tasa de morbilidad fue de 16 por ciento, constituido por un seroma de la herida operatoria, 3 infecciones de la herida operatoria y 2 hernias incisionales (5 por ciento). No tuvimos casos de peritonitis purulenta, ni fecaloídea. No hubo evidencia de abscesos parianastomóticos. Hubo un caso (3 por ciento) de filtración anastomótica subclínica. Registramos un caso (3 por ciento) de mortalidad operatoria debido a una depresión respiratoria postanestésica. Conclusión. La anastomosis colónica manual por vía laparoscópica en este modelo experimental, es factible de realizar con una baja tasa de morbimortalidad y baja tasa de filtración anastomótica. Su realización pudiera permitir difundir el abordaje laparoscópico en cirugía de colon a un costo menor.


Subject(s)
Animals , Colon/surgery , Laparoscopy/methods , Anastomosis, Surgical/methods , Anastomosis, Surgical/mortality , Minimally Invasive Surgical Procedures , Models, Animal , Prospective Studies , Reproducibility of Results , Swine
8.
Rev. bras. colo-proctol ; 18(2): 90-3, abr.-jun. 1998. tab
Article in Portuguese | LILACS | ID: lil-285654

ABSTRACT

Foram avaliados todos os casos de óbito hospitalar ocorridos em um serviço especializado em Coloproctologia, durante um período de cinco anos. Os doentes eram portadores de doenças benignas e malignas. A doença primária, as doenças associadas, juntamente com suas complicaçöes, e os procedimentos realizados foram revistos. Houve maior incidência de óbitos decorrentes da própria doença (51,9 porcento) e de complicaçöes clínicas (26,9 porcento), enquanto que os óbitos por complicaçöes cirúrgicas corresponderam a 21,2 porcento do total de causas de morte


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Colorectal Surgery/mortality , Postoperative Complications/mortality , Hospital Mortality , Intraoperative Complications/mortality , Aged, 80 and over , Anastomosis, Surgical/mortality , Lung Diseases/complications , Colonic Neoplasms/mortality , Intestinal Obstruction/mortality , Rectal Neoplasms/mortality
9.
Rev. AMRIGS ; 38(4): 290-3, out.-dez. 1994. tab
Article in Portuguese | LILACS | ID: lil-155214

ABSTRACT

Anastomose coloanal e o ultimo recurso cirurgico para preservacao do esfincter anal do paciente, evitando, portanto, uma colostomia definitiva. O carcinoma do reto medio, e algumas vezes do reto inferior, pode nao necessitar a resseccao do assoalho pelvico e anus para seu tratamento. Analisaram os 40 pacientes que realizaram anastomose coloanal no periodo de setembro/88 a dezembro/93, no HNSC, cujos diagnosticos foram: carcinoma em 34 pacientes, proctite actinica em 3, adenoma viloso em 1, adenoma viloglandular em 1 e linfoma em 1. Desses, 24 eram homens e 16 mulheres. A classificacao de Dukes modificada nos casos de carcinoma foi: A = 0 paciente, B = 6 pacientes, C = 24 pacientes e D = 4 pacientes. A distancia media da lesao a margem anal foi de 6 cm. Houve 3 casos de obito pos-operatorio e as complicacoes pos-operatorias vinculadas ao metodo ocorreram em 5 pacientes (12,5 por cento ) e nao vinculadas ao metodo em 11 (27,5 por cento ). Estenose de anastomose foi a complicacao mais comum no pos-operatorio tardio, ocorrendo em 7 pacientes. Apos fechar a colostomia, 35 pacientes ficaram continentes, com uma media diaria de 2,3 evacuacoes. A anastomose coloanal e uma boa alternativa para evitar uma colostomia definitiva. Contudo, nao deve substituir a amputacao abdomino-perineal para tumores extensos do reto inferior e a anastomose colorretal quando esta e tecnicamente factivel


Subject(s)
Humans , Adult , Middle Aged , Anastomosis, Surgical/statistics & numerical data , Anastomosis, Surgical/methods , Anastomosis, Surgical/mortality , Colorectal Neoplasms/complications , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/mortality , Colorectal Neoplasms/surgery , Colostomy
10.
Acta cir. bras ; 7(4): 151-3, out.-dez. 1992. ilus
Article in Portuguese | LILACS | ID: lil-187307

ABSTRACT

Os autores mostraram em estudo experimental anastomoses intestinais feitas em cao com objetivo de testar o uso de adesivo à base de resorcina com formaldeido 3 por cento e glutaraldeído 25 por cento (Colagel).R Para isto utilizaram 6 caes mestiços, 3 machos e três fêmeas, com peso médio de 15 kg. Eram confeccionadas, em cada cao, duas secçoes transversas no intestino delgado, distante uma da outra 40 cm e reconstituiçao término-terminal. A primeira anastomose era feita com sutura em plano único extra-mucoso e pontos separados de fio monofilamentar de nylon 5-0 e a segunda anastomose era feita por técnica de telescopagem utilizando-se o adesivo em teste. Todos os animais morreram antes da data prevista para o sacrifício, num intervalo de tempo de 24 a 72 horas. A necrópsia revelou integridade da primeira anastomose com deiscência parcial ou total da segunda. Concluem nao ser este adesivo biológico útil em anastomoses intestinais pela técnica proposta.


Subject(s)
Animals , Male , Female , Dogs , Adhesives , Biocompatible Materials , Intestines/surgery , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/mortality , Formaldehyde/therapeutic use , Glutaral/therapeutic use , Intestines/pathology , Necrosis , Peritonitis/etiology , Resorcinols/therapeutic use , Surgical Wound Dehiscence
11.
Rev. argent. cir ; 62(5): 128-31, mayo 1992. ilus
Article in Spanish | LILACS | ID: lil-109333

ABSTRACT

Se presenta la experiencia obtenida en 38 casos de "bypass" con vena safena in situ a las arterias del tobillo y pie. La población tenía una edad promedio de 66 años y en el 65% correspondió a hombres. El 88% presentaba diabetes. El 82% tenía lesiones tróficas y el resto dolor en reposo. Se utilizó la técnica descripta por Leather para realizar la cirugía. El análisis estadístico por tabla de vida demostró una permeabilidad acumulativa del 78.4% a 30 días y del 55.5% a 24 meses, con una mortalidad operatoria del 5.26%. Se logró salvar el miembro en el 76.3% de los casos


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Anastomosis, Surgical/methods , Ankle , Arterial Occlusive Diseases/surgery , Arteriovenous Anastomosis , Foot , Saphenous Vein/surgery , Amputation/statistics & numerical data , Anastomosis, Surgical/statistics & numerical data , Anastomosis, Surgical/mortality , Arterial Occlusive Diseases/epidemiology , Arterial Occlusive Diseases/etiology , Diabetes Mellitus/complications , Smoking , Thrombosis/complications , Vascular Surgical Procedures
12.
Rev. med. (Säo Paulo) ; 71(1/2): 19-24, jan. 1992.
Article in Portuguese | LILACS | ID: lil-154424

ABSTRACT

Os autores fazem extensa revisao da literatura, abordando praticamente todos os aspectos relacionados a anastomoses intestinal. Sao relembrados os principios tecnicos da anastomose intestinal, o processo de cicatrizacao que sucede sua realizacao assim como os fatores locais e sistemicos que influenciam na sua realizacao. Compara-se os diversos fios e as diversas tecnicas de sutura inclusive as anastomoses mecanicas com grampeadores...


Subject(s)
Anastomosis, Surgical/methods , Surgical Staplers , Intestines/surgery , Anastomosis, Surgical/mortality , Surgical Wound Dehiscence/etiology , Suture Techniques
13.
Rev. bras. cir. cardiovasc ; 5(2): 79-85, ago. 1990. ilus, tab
Article in Portuguese | LILACS | ID: lil-164296

ABSTRACT

As anastomoses sistêmico-pulmonares continuam sendo um importante procedimento no tratamento e na preparaçao dos cardiopatas cianóticos, com hipoplasia das artérias pulmonares, para a correçao total. Todas têm vantagens e desvantagens e os resultados dependerao de idade e peso dos pacientes e da complexidade da cardiopatia. O presente estudo relata a experiência com sete casos de anastomoses mamária-artéria pulmonar, realizadas através de toracotomia direita (5) e esquerda (2), em pacientes portadores de tetralogia de Fallot (quatro femininos e três masculinos). A idade variou de dois a 63 meses (m = 18,4), com peso médio de 7,9 kg. Seis apresentavam graus variados de hipoplasia pulmonar. Houve dois óbitos pós-operatórios (l( e 2( dias), devidos a trombose da artéria mamária, no local de seu clampleamento. Dois pacientes foram submetidos a correçao total (um mês e três anos após): no 1( (menina de 24 meses, 10 kg de peso), a anastomose foi feita pelas más condiçoes gerais, apesar do bom tamanho das pulmonares. No 2( (menino de 15 meses, 8,1 kg, no qual uma operaçao de Blalock-Taussig clássica foi feita e trombosou no 3( mês de vida), foi possível observar o progressivo desenvolvimento das artérias pulmonares, por estudo hemodinâmico. Em ambos, o funcionamento da anastomose era perfeito e a correçao foi bem sucedida. Três outros pacientes aguardam o momento oportuno para a correçao final. Apesar do reduzido número e do curto tempo de observaçao, acredita-se que a anastomose mamária-pulmonar possa ser outra opçao paliativa para os portadores de cardiopatias congênitas cianogênicas, com hipoplasia das artérias pulmonares e que os melhores resultados devam ser obtidos nos pacientes maiores, fora de situaçoes de emergência e com pequenas artérias pulmonares.


Subject(s)
Child, Preschool , Infant , Humans , Male , Female , Anastomosis, Surgical , Heart Defects, Congenital/surgery , Anastomosis, Surgical/mortality , Palliative Care , Pulmonary Artery/surgery , Reoperation
14.
Cir. & cir ; 54(1): 5-8, ene.-feb. 1987. ilus, tab
Article in Spanish | LILACS | ID: lil-134752

ABSTRACT

Se hace una descripción amplia de la engrapadora intraluminal (ILS) y de la técnica quirúrgica para su empleo. Se realizaron 18 anastomosis gastrointestinales en 17 pacientes. Dichas anastomosis fueron término-terminales y efectuadas en diferentes órganos:esófago, intestino, colon y recto.La tasa de mortalidad fue de 11 por ciento y la morbilidad directa provocada por la utilización del instrumento fue de 5.5 por ciento. En 94.5 por ciento de los pacientes los resultados fueron satisfactorios. Se hace hincapié en la necesidad de realizar una adecuada técnica quirúrgica y se demuestra que las anastomosis engrapadas son tan efecivas como las realizadas a mano. La utilización de la engrapadora intraluminal (ILS) en cirugía técnicamente difícil como pueden ser las anastomosis esofágicas y rectalesfacilita los procedimientos y las complicaciones observadas no difieren grandemente respecto a las técnicas convencionales de sutura.


Subject(s)
Humans , Male , Female , Middle Aged , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/mortality
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