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1.
Rev. colomb. cir ; 37(2): 298-304, 20220316. fig, tab
Article in Spanish | LILACS | ID: biblio-1362976

ABSTRACT

Las neoplasias apendiculares se presentan hasta en el 50 % de los casos como un episodio de apendicitis aguda. Existen características demográficas, clínicas y radiológicas que aumentan las posibilidades de un tumor apendicular subyacente, sin embargo, en la mayoría de los casos, son los hallazgos intraoperatorios los que alertan al cirujano. A pesar de que el tipo histológico determina la radicalidad del manejo quirúrgico de estos pacientes, algunas características macroscópicas pueden orientar a las patologías específicas y a una conducta adecuada. En general, los objetivos del manejo quirúrgico inicial se cumplen con una resección limitada al apéndice cecal, asociada a la citología de mucina y biopsia de los implantes peritoneales si están presentes, reservando las resecciones extendidas, como hemicolectomía derecha oncológica, para los pacientes con compromiso extenso de la base o del mesenterio apendicular ante la sospecha de neoplasias neuroendocrinas o adenocarcinoma del apéndice cecal.


Appendicular neoplasms present in up to 50% of cases as an episode of acute appendicitis. There are demographic, clinical and radiological characteristics that increase the chances of an underlying appendicular tumor; however, in most cases are the intraoperative findings that alert the surgeon. Although the histological type determines the radical nature of the surgical management of these patients, some macroscopic characteristics can guide specific pathologies and appropriate behavior. In general, the objectives of initial surgical management are met with a limited resection of the cecal appendix, associated with mucin cytology and biopsy of peritoneal implants if present, reserving extended resections such as oncological right hemicolectomy for patients with extensive compromise of the base or appendicular mesentery when neuroendocrine neoplasms or adenocarcinoma of the cecal appendix are suspected.


Subject(s)
Humans , Appendectomy , Appendiceal Neoplasms , Incidental Findings , Appendicitis , Adenocarcinoma, Mucinous
2.
Rev. cuba. cir ; 60(3): e1117, 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1347393

ABSTRACT

Introducción: El plastrón apendicular es una tumoración inflamatoria constituida por el apéndice inflamado, vísceras adyacentes y epiplón mayor. Puede contener o no pus (absceso/flemón). Objetivo: Precisar si está indicada la apendicectomía de urgencia o de intervalo en los pacientes con plastrón y/o absceso apendicular sometidos a tratamiento no quirúrgico inicial. Métodos: Se realizó una revisión en las bases de datos bibliográficas Web of Science, PubMed, Medline y Lilacs, mediante el motor de búsqueda Google académico. Se seleccionaron 28 artículos en inglés y español; 20 (71,2 por ciento) correspondieron al quinquenio 2016-20 y el 96,4 por ciento de autores extranjeros. Desarrollo: El estándar actual es el tratamiento no quirúrgico inicial del plastrón y el drenaje percutáneo del absceso. La apendicectomía de intervalo tiene un beneficio mínimo y puede conducir a un aumento de los costos, estancia hospitalaria, antibioticoterapia intravenosa y de la morbilidad. Se debe realizar un seguimiento cuidadoso en enfermos con riesgo de enfermedad inflamatoria intestinal o cáncer de colon, sin importar qué opción se elija (operación de intervalo u observación). Conclusiones: La apendicectomía de urgencia no es recomendable porque el componente inflamatorio la hace técnicamente difícil, puede necesitar una colectomía y aumentar la morbilidad, aunque actualmente, la apendicectomía laparoscópica de urgencia puede ser más rentable y segura. La decisión posterior de la apendicectomía a intervalos sigue siendo discutible. El intervalo recomendado varía entre 6 y 8 semanas, tres y seis meses después de la normalización clínico humoral(AU)


Introduction: Appendiceal plastron is an inflammatory tumor made up of inflamed appendix, adjacent viscera and greater omentum. It may or may not contain pus (abscess/phlegmon). Objective: To specify whether emergency or interval appendectomy is indicated in patients with appendicular abscess and/or plastron who had undergone initial nonsurgical treatment. Methods: A review was carried out in the bibliographic databases Web of Science, PubMed, Medline and Lilacs, using the search engine Google Scholar. Twenty-eight articles were selected, in English and Spanish; twenty (71.2 percent) corresponded to the quinquennium 2016-20, while 96.4 percent were written by foreign authors. Development: The current standard is the initial nonsurgical treatment of the plastron and percutaneous drainage of the abscess. Interval appendectomy has minimal benefits and can lead to increased costs, hospital stay, intravenous antibiotic therapy and morbidity. Patients at risk for inflammatory bowel disease or colon cancer should be carefully followed up, regardless of which option is chosen (interval operation or observation). Conclusions: Emergency appendectomy is not recommended because the inflammatory component makes it technically difficult; it may require colectomy and increase morbidity, although currently, emergency laparoscopic appendectomy may be more profitable and safer. The subsequent decision for interval appendectomy remains debatable. The recommended interval varies from six to eight weeks, three and six months after clinical-humoral normalization(AU)


Subject(s)
Humans , Appendectomy/methods , Inflammatory Bowel Diseases/epidemiology , Abscess/etiology , Emergencies , Databases, Bibliographic , Colectomy/methods , Search Engine/methods
3.
Rev. colomb. cir ; 36(4): 626-636, 20210000. fig, tab
Article in Spanish | LILACS | ID: biblio-1291156

ABSTRACT

Introducción. La apendicectomía por laparoscopia se considera el patrón de oro en el tratamiento de la apendicitis aguda. Sin embargo, su disponibilidad es limitada en nuestro sistema de salud, principalmente por los costos asociados. El objetivo de este estudio fue evaluar la relación entre el uso de los diferentes tipos de energía y los métodos de ligadura de la base apendicular, con las complicaciones postoperatorias, al igual que describir los costos asociados. Métodos. Estudio observacional analítico de una cohorte retrospectiva de pacientes mayores de 15 años a quienes se les realizó apendicectomía por laparoscopia, en un hospital universitario entre los años 2014 y 2018. Se utilizaron modelos de regresión logística y lineal para evaluar la relación entre métodos de ligadura del meso y base apendicular, desenlaces operatorios y costos. Resultados. Se realizaron 2074 apendicectomías por laparoscopia, 58,2 % (n=1207) en mujeres, la edad mediana fue de 32 años. En el 71,5 % (n=1483) la apendicitis aguda no fue complicada. La energía monopolar para la liga-dura del meso apendicular fue la utilizada más frecuentemente en 57,2 % (n=1187) y el Hemolok® el más utilizado para la ligadura de la base apendicular en el 84,8 % (n=1759) de los pacientes. No se observaron diferencias estadísticamente significativas en la tasa de infección del sitio operatorio, reintervención o íleo. El uso de energía simple redujo los costos del procedimiento de manera significativa durante el período evaluado. Discusión. El uso de energía monopolar demostró ser una técnica segura, reproducible y de menor costo en comparación con el uso de energía bipolar, independientemente de la fase de la apendicitis aguda. Lo anterior ha permitido que se realicen más apendicectomías por laparoscopia y que los médicos residentes de cirugía general puedan realizar procedimientos laparoscópicos de forma más temprana


Introduction. Laparoscopic appendectomy is considered the gold standard in the treatment of acute appendicitis. However, its availability is limited in our health system mainly due to the associated costs. The objective of this study is to evaluate the relationship between the use of different types of energy and the methods of ligation of the appendicular base with postoperative complications, as well as to describe the associated costs. Methods. Retrospective observational study of a cohort of patients older than 15 years old who underwent laparoscopic appendectomy in a university hospital between 2014 and 2018. Logistic and linear regression models were used to evaluate the relationship between methods of ligation of the meso and appendicular base, operative outcomes and costs. Results: 2074 laparoscopic appendectomies were performed. Of those, 58.2% (n=1207) were women, median age was 32 years. In 71.5% (n=1483), acute appendicitis was uncomplicated. Monopolar energy for ligation was the most frequently used for ligation of the appendicular meso in 57.2% (n=1187) and Hem-o-lok® the most used for ligation of the appendicular base in 84.8% (n=1759) of the patients. There were no statistically significant differences in the rate of surgical site infection, reoperation, or ileus. The use of simple energy reduced the costs of the procedure significantly during the study period. Discussion. The use of monopolar energy proved to be a safe, reproducible and a lower cost technique compared to the use of bipolar energy, regardless of the phase of acute appendicitis. This has allowed more laparoscopic appendectomies to be performed and the general surgery residents to perform laparoscopic procedures earlier


Subject(s)
Humans , Appendicitis , Laparoscopy , Appendectomy , Bioelectric Energy Sources , Cost Control , Ligation
5.
Medicina (B.Aires) ; 81(4): 649-651, ago. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346520

ABSTRACT

Resumen La apendicitis del muñón es una complicación poco frecuente de la apendicectomía. Puede aparecer desde unas semanas a varios años luego del procedimiento quirúrgico. Para arribar a su diagnóstico es necesario un alto índice de sospecha. El objetivo de esta publicación es hacer una reseña de dos casos de esta entidad ocurridos en nuestra institución y mencionar sus hallazgos imagenológicos más frecuentes. La tomografía computarizada es un excelente método para valorar esta entidad, no solo para su diagnóstico sino también para descartar otras patologías que presentan un cuadro clínico similar.


Abstract Stump appendicitis is a rare complication of appendectomy. It may develop from a few weeks to several years after the surgical procedure. To achieve its diagnosis a high index of suspicion is necessary. The objective of this publication is to make a re view of two cases of this entity that occurred in our institution and to mention its most frequent imaging findings. Computed tomography is an excellent method to assess this entity, not only for its diagnosis but also to rule out other pathologies that present similar clinical features.


Subject(s)
Humans , Appendicitis/surgery , Appendicitis/etiology , Appendicitis/diagnostic imaging , Appendectomy , Postoperative Complications/etiology , Postoperative Complications/diagnostic imaging , Tomography, X-Ray Computed , Diagnosis, Differential
6.
Arch. argent. pediatr ; 119(4): 224-229, agosto 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1280889

ABSTRACT

Introducción. La apendicitis constituye la principal causa de abdomen agudo quirúrgico en pediatría. Durante la pandemia por COVID-19, se replantearon las estrategias de manejo ydisminuyeron las consultas en las guardias, lo que podría asociarse a diagnósticos tardíos y complicaciones. El objetivo de este estudio fue analizar el impacto de la pandemia en los niños con apendicitis aguda. Métodos. Estudio analítico retrospectivocomparativo de pacientes pediátricos conapendicitis aguda durante los cinco meses del confinamiento por COVID-19 versus los meses equivalentes del año previo. Se analizaron la incidencia, la clínica, el estadio, el abordajequirúrgico y las complicaciones. Resultados. Los casos totales de apendicitisse redujeron un 25 % (n = 67 versus n = 50 en 2020). El tiempo medio hasta la consulta fue de 24 horas en ambos períodos (p = 0,989). La incidencia de peritonitis fue del 44 % (n = 22) versus el 37 % (n = 22) (p = 0,22) en 2019. No se evidenció diferencia en los estadios deenfermedad de acuerdo con lo informado en los partes quirúrgicos. En 2019, todas las cirugías se realizaron por vía laparoscópica; en 2020, solo un42 % (n = 21). La incidencia de complicaciones fue del 6 %, contra 7,5 % en el período previo (p = 0,75). Un paciente fue COVID-19 positivo. Conclusión. A pesar de la reducción en el númerode casos de apendicitis, no se evidenció una demora en la consulta en nuestra población. El mayor impacto se asoció a la readecuación del manejo, evitando el abordaje laparoscópico para reducir la diseminación del virus.


Introduction. Appendicitis is the leading cause of surgical acute abdomen in pediatrics. During the COVID-19 pandemic, management strategies were reassessed and the number of visits to the emergency department dropped down, which may be associated with delayed diagnoses and complications. The objective of this study was to analyze the impact of the pandemic on children with acute appendicitis. Methods. Analytical, retrospective, comparative study of pediatric patients with acute appendicitis in the 5 months of COVID-19 lockdown versus the same period in the previous year. Incidence, clinical data, stage, surgical approach, and complications were analyzed. Results. The total number of appendicitis cases went down by 25 % (n = 67 versus n = 50 in 2020). The mean time to consultation was 24 hours in both periods (p = 0.989). The incidence of peritonitis was 44 % (n = 22) versus 37 % (n = 22) (p = 0.22) in 2019. No differences were  observed in terms of appendicitis stage based on surgery reports. In 2019, all surgeries were laparoscopic; while in 2020, only 42 % (n = 21). The incidence of complications was 6 % versus 7.5 % in the previous period (p = 0.75). One patient was COVID-19 positive. Conclusion. Although in our population the number of appendicitis cases dropped down, consultation was not delayed. The greater impact was associated with the reformulation of management strategies, in which the laparoscopic approach is avoided to reduce virus transmission.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Appendectomy/trends , Appendicitis/surgery , Appendicitis/diagnosis , Appendicitis/epidemiology , Practice Patterns, Physicians'/trends , Delayed Diagnosis/trends , COVID-19/prevention & control , Health Services Accessibility/trends , Appendectomy/methods , Argentina/epidemiology , Acute Disease , Incidence , Retrospective Studies , Laparoscopy/trends , Pandemics/prevention & control , Tertiary Care Centers , COVID-19/diagnosis , COVID-19/epidemiology , Hospitals, General
7.
Iatreia ; 34(2): 156-160, abr.-jun. 2021. graf
Article in Spanish | LILACS | ID: biblio-1250066

ABSTRACT

RESUMEN Introducción: la apendicitis aguda es causa frecuente de dolor abdominal. Su complicación más frecuente es la infección del sitio operatorio, siendo el compromiso pélvico muy raro. Presentamos el caso de una paciente sin vida sexual activa, con una enfermedad pélvica inflamatoria como complicación posoperatoria de una apendicitis aguda. Esta ingresó por dolor abdominal, varias semanas después de una apendicetomía, sin signos de infección incisional, pero con una tomografía que reportaba un hidrosalpinx izquierdo. Evolucionó hacia el deterioro clínico a pesar de la reanimación con cristaloides y antibióticos de amplio espectro. Fue llevada a laparotomía para control del foco. Se encontró un hidrosalpinx izquierdo y necesitó de una segunda cirugía por el compromiso anexial derecho. Luego de estas intervenciones hubo recuperación. Conclusión: la enfermedad pélvica inflamatoria es una etiología poco frecuente (aunque posible) de abdomen agudo en pacientes sin vida sexual activa.


SUMMARY Introduction: Acute appendicitis is a frequent cause of abdominal pain and its most frequent complication is surgical site infection, with pelvic involvement being very rare. The following is a case of a patient with pelvic inflammatory disease as postoperative complication after appendectomy. The patient was admitted for abdominal pain several weeks after an appendectomy, without signs of incisional surgical site infection but with a CT scan that re-ported a left hydrosalpinx. The patient progresses with clinical deterioration despite resuscitation with crystalloids and broad-spectrum antibiotics. A laparotomy was performed for infection control. A left hydrosalpinx was found and needed a second surgery due to right adnexal involvement. After this she recovered. Conclusion: Pelvic inflammatory disease is a rare but possible etiology of the acute abdomen in patients who's never had sexual intercourse.


Subject(s)
Humans , Appendectomy , Pelvic Inflammatory Disease , Postoperative Complications , Surgical Wound Infection , Abdomen, Acute
8.
J. coloproctol. (Rio J., Impr.) ; 41(2): 152-155, June 2021. graf
Article in English | LILACS | ID: biblio-1286997

ABSTRACT

Abstract Tumours of the appendix are rare and tend to be diagnosed incidentally, in cases of acute appendicitis. For some authors, appendiceal neuroendocrine tumours (ANETs) are the most frequent neoplasm of the appendix, observed in 0.3% to 0.9% of cases acute appendicitis. The present is a unicentric retrospective study conducted between January 2005 and March 2017. Out of a total of 3,007 surgeries for appendiceal pathologies performed in the adult population at the hospital where the present study was conducted, there were 70 (2.33%) malignant cases, 20 (28.6%) of which were ANETs. The patients had a median age of 44 years (range: 18 to 85 years), and were predominantly women (there were 1.9 times more women than men). In 16 cases (80%), a simple appendicectomy was performed (1 patient was submitted to a right hemicolectomy later). The cases of ANETs had a good prognosis in our series: 85% of the patients are either alive today or were alive after 5 years of follow-up. Despite the fact that ANETs are described as the most frequent tumor of the appendix, this was not confirmed in our series, in which they only represented 28.6% of the cases; adenocarcinoma was the most frequent tumor (65.7%) among our sample.


Resumo Tumores do apêndice são raros, e tendem a ser diagnosticados de forma incidental, em casos de apendicite aguda. Para alguns autores, tumores neuroendócrinos do apêndice (TNEAs) são as neoplasias mais frequentes do apêndice, e são observados em 0,3 a 0,9% de todos os casos agudos de apendicite. Este é um estudo monocêntrico e retrospectivo realizado entre janeiro de 2005 e março de 2017. Entre umtotal de 3.007 cirurgias para patologias do apêndice realizadas na população adulta no hospital em que o estudo foi conduzido, houve 70 (2,33%) casos de malignidade, 20 (28,6%) dos quais eram TNEAs. Os pacientes tinham uma idade média de 44 anos (gama: 18-85 anos), e eram predominantemente mulheres (havia 1,9 vezes mais mulheres do que homens). Em 16 casos (80%), realizou-se uma simples apendicectomia (1 paciente foi submetido a uma hemicolectomia direita mais tarde). Os casos de TNEAs tiveram um bom prognóstico em nossa série: 85% dos pacientes estão vivos hoje, ou estavam após um seguimento de 5 anos. Apesar de os TNEAs serem descritos como os tumores mais frequentes do apêndice, isso não foi confirmado nesta série, na qual eles representaram apenas 28,6% dos casos; adenocarcinoma foi o tumor mais frequente (65,7%) emnossa amostra.


Subject(s)
Humans , Male , Female , Appendiceal Neoplasms , Adenocarcinoma , Neuroendocrine Tumors , Appendectomy , Appendix/surgery
9.
Rev. colomb. cir ; 36(3): 481-486, 20210000. fig, tab
Article in Spanish | LILACS | ID: biblio-1254307

ABSTRACT

Introducción. La prevención de las complicaciones en el manejo de la apendicitis aguda sigue siendo un reto para el cirujano pediatra; por lo que es de gran importancia comparar las opciones de manejo quirúrgico, para saber si es posible prevenir dichos resultados, que finalmente llevan a un aumento en el uso de recursos necesarios para tratar a un paciente. El objetivo de este estudio fue comparar las complicaciones postoperatorias y los costos de la laparoscopia transumbilical asistida y la laparoscopia multipuerto, en pacientes pediátricos en un hospital general de cuarto nivel de la ciudad de Bogotá, D.C., Colombia, entre octubre de 2011 y enero de 2019. Métodos. Estudio observacional, descriptivo, retrospectivo, de corte transversal, con muestreo no probabilístico a conveniencia, en el que se incluyeron los pacientes entre 0 y 16 años de edad, con historia clínica completa y diagnóstico postquirúrgico de apendicitis aguda, los cuales fueron intervenidos mediante cirugía laparoscópica transumbilical asistida o por multipuerto. Se hizo un análisis descriptivo univariado y bivariado. Resultados. De los 850 pacientes operados en ese periodo, la técnica quirúrgica más usada fue multipuerto (n=528, 62,1%) y se presentaron complicaciones en 59 (6,94%) de los pacientes. El diagnóstico postquirúrgico más frecuente fue apendicitis no perforada (n=762, 89,6%). Al comparar los dos grupos se encontró un valor de p de 0,9685 para la edad, 0,5364 para el diagnóstico postquirúrgico, 0,1127 para las complicaciones postoperatorias y 0,0085 para el costo. Discusión. El costo de hospitalización y las complicaciones de los pacientes a quienes se les practicó apendicectomía transumbilical asistida es similar a la técnica por multipuerto


Introduction. The prevention of complications in the management of acute appendicitis remains a challenge for the pediatric surgeon. Therefore, it is of great importance to compare the surgical management options, to know if it is possible to prevent these results, which ultimately lead to an increase in the use of resources necessary to treat a patient. The objective of this study was to compare the postoperative complications and costs of assisted transumbilical laparoscopy and multiport laparoscopy in pediatric patients. Method. Observational, descriptive, retrospective, cross-sectional study with non-probabilistic convenience sampling, where patients between 0 and 16 years old with a complete medical history, with a postsurgical diagnosis of acute appendicitis, who underwent assisted transumbilical surgery or by multiport performed at a fourth level general hospital in Bogotá, Colombia, between October 2011 and January of 2019. A descriptive univariate and bivariate analysis was performed. Results. Of the 850 patients operated on in this period, the most used surgical technique was multiport (n=528; 62.1%) and complications occurred in 59 (6.94%) of the patients. The most frequent postsurgical diagnosis was non-perforated appendicitis (n=762; 89.6%). Comparing the two groups, a p-value of 0.9685 was found for age, 0.5364 for postsurgical diagnosis, 0.1127 for postoperative complications, and 0.0085 for cost. Discussion. The cost of hospitalization and complications for patients who underwent assisted transumbilical appendectomy is similar to the multiport technique


Subject(s)
Humans , Appendicitis , Minimally Invasive Surgical Procedures , Appendectomy , Postoperative Complications , Costs and Cost Analysis
10.
Rev. colomb. cir ; 36(1): 91-97, 20210000. tab
Article in Spanish | LILACS | ID: biblio-1150523

ABSTRACT

Introducción. La mortalidad perioperatoria se considera una de las herramientas clave para medir la fuerza del sistema de salud de un país en el área quirúrgica. Actualmente, no se cuenta con las cifras totales de las apendicectomías realizadas en nuestro pais, a pesar de ser un procedimiento quirúrgico extremadamente común. Métodos. Estudio de cohorte retrospectivo con datos de pacientes de todas las edades, reportados como afiliados al sistema de salud contributivo de Colombia y a quienes se les realizó una apendicectomía entre el 1° de enero de 2011 y el 31 de diciembre de 2016. La información se obtuvo de bases de datos nacionales y se procesó a partir del cálculo de variables, como la tasa de mortalidad perioperatoria y el volumen quirúrgico, estimando una tasa de mortalidad a treinta días, por sexo, grupo etario y región geográfica. Resultados. Entre las 231.570 apendicectomías que se identificaron, se halló una mayor tasa de mortalidad perioperatoria en el grupo etario de hombres mayores de 80 años con 17,3 %. La región oriental presentó la menor tasa de mortalidad con 0,01 %. El mayor volumen quirúrgico se presentó en el año 2012 y el menor en el año 2016.Discusión. La tasa de mortalidad de apendicectomía en diferentes grupos etarios es similar a la de otros países de ingresos medios y bajos, en tanto que la mayor heterogeneidad de la tasa de mortalidad entre las diferentes regiones, se percibe en los grupos de menores de un año y de mayores de 65 años. Este estudio se constituye como una aproximación inicial a la tasa de mortalidad en apendicectomías realizadas en Colombia


Introduction. Perioperative mortality is considered one of the key tools to measure the strength of a country's health system, in the surgical area. Currently, there are no total figures for appendectomies performed in our country, despite being an extremely common surgical procedure.Methods. Retrospective cohort study with data from patients of all ages, reported as affiliated to the contributory health system in Colombia and who underwent an appendectomy between 01/01/2011 and 12/31/2016. The information, which was obtained from national databases, was processed by calculating variables such as perioperative mortality rate and surgical volume, estimating a 30-day mortality rate, by sex, age group and geographic region. Results. Among the 231,570 appendectomies that were identified, a higher perioperative mortality rate was found in the age group of men older than 80 years with 17.31%. The eastern region had the lowest mortality rate with 0.01%. The highest surgical volume occurred in 2012 and the lowest in 2016.Discussion.The mortality rate from appendectomies in different age groups is similar to that of other low- and middle-income countries, while the greater heterogeneity of the mortality rate between the different regions is seen in the groups of children under one year of age and older over 65 years old. This study constitutes an initial approximation to the mortality rate in appendectomies performed in Colombia


Subject(s)
Humans , Appendectomy , Mortality , Laparoscopy , Age Groups
11.
Rev. colomb. cir ; 36(1): 150-154, 20210000. fig, tab
Article in Spanish | LILACS | ID: biblio-1150540

ABSTRACT

La incidencia de las hernias inguinales en Colombia es de aproximadamente 15 por cada 1000 habitantes, y el riesgo de presentar una hernia inguinal durante la vida es del 27 % en hombres y del 3 % en mujeres. Existen presentaciones poco frecuentes como la hernia de Amyand que consiste en la protrusión del apéndice cecal, inflamada o no, dentro del contenido del saco herniario. A nivel global, tiene una incidencia del 0,13 % al 1 % y su tratamiento se realiza basándose en la clasificación de Losanoff y Basson. Sin embargo, una de las controversias aún existentes respecto al manejo quirúrgico, es la indicación del uso o no de mallas al momento de realizar la hernioplastia y el resultado final del mismo, así que este es el punto donde se centra la revisión de nuestro artículo. Se presenta el caso de un paciente de 79 años con una hernia de Amyand tipo 2, a quien se le practicó hernioplastia con malla de baja densidad absorbible, con adecuada evolución posquirúrgica


The incidence of inguinal hernias in Colombia is approximately 15 per 1000 inhabitants, and the risk of presenting an inguinal hernia during life is 27% in men and 3% in women. There are rare presentations such as Amyand's hernia, which consists of the protrusion of the cecal appendix, inflamed or not, within the content of the hernial sac. At a global level, it has an incidence of 0.13% to 1% and its treatment is based on the Losanoff and Basson classification. However, one of the still existing controversies regarding surgical management is the indication of the use or not of meshes at the time of performing the hernioplasty, and the final result of it, this is the point where the review of our article focuses. We present the case of a 79-year-old patient with a type 2 Amyand hernia who underwent hernioplasty with a low-density absorbable mesh, with adequate postoperative evolution


Subject(s)
Humans , Hernia, Inguinal , Appendectomy , Prostheses and Implants , Herniorrhaphy
12.
Rev. Col. Bras. Cir ; 48: e20213010, 2021. tab
Article in English | LILACS | ID: biblio-1340673

ABSTRACT

ABSTRACT Acute appendicitis is the leading cause of abdominal emergency surgery worldwide and appendectomy continues to be the definitive treatment of choice. This cost-effectiveness analysis evaluates laparoscopic versus open appendectomies performed in public health services in the state of Bahia (Brazil). We conducted a retrospective observational study using the database from the Department of Informatics of the Unified Health System (DATASUS). Available data on appendectomies between 2008 and 2019 were included, and we evaluated the temporal trend of hospital admissions, procedure-related mortality rates, length of stay, and costs. Statistical analysis was performed using the R-software (R Foundation, v.4.0.3) and the BioEstat software (IMDS, v. 5.3), considering p<0.05 as significant. During 2008-2019, 53,024 appendectomies were performed in the public health services in Bahia, of which 94.9% were open surgeries. The open technique was associated with a higher mortality rate (4.9/1,000 procedures; p<0.05) and a higher risk of death (RR=4.5; p<0.05) compared to laparoscopy (1.1/1,000 procedures). Laparoscopic appendectomy (median of 2.7 days) had a shorter length of stay compared to laparotomy (median of 4.15 days) (p<0.05). There was no difference in the medians of costs nor hospital services, per procedure (p=0.08 and p=0.08, respectively). Laparoscopic professional median costs were higher by US$ 1.39 (p<0.05). Minimally invasive surgery for appendicitis is a safe and efficacious procedure in Brazilian public health care services, as it provides advantages over the open method (including lower procedure-related mortality rate and earlier discharges), and it did not imply higher expenses for public service budgets in the state of Bahia.


RESUMO Apendicite aguda é a principal causa de cirurgia abdominal de emergência no mundo e a apendicectomia continua sendo o tratamento definitivo de escolha. A presente investigação avalia desfechos e custos das apendicectomias laparoscópicas versus abertas realizadas em serviços públicos de saúde no estado da Bahia (Brasil). Realizou-se estudo observacional retrospectivo, utilizando a base de dados do DATASUS. Incluiu-se dados disponíveis sobre apendicectomias na Bahia entre 2008 e 2019, avaliando-se a tendência temporal de internações, taxas de mortalidade por procedimentos, tempo de permanência e custos. A análise estatística foi realizada no R-software (Fundação R, v.4.0.3) e no software BioEstat (IMDS, v.5.3), considerando p<0,05 significativo. Entre 2008 e 2019, realizou-se 53.024 apendicectomias no serviço público de saúde na Bahia, das quais 94,9% foram cirurgias abertas. A laparotomia foi associada à maior taxa de mortalidade (4,9/1.000 procedimentos; p<0,05) e maior risco de morte (RR=4,5; p<0,05) do que laparoscopia (1,1/1.000 procedimentos). Apendicectomia laparoscópica (mediana de 2,7 dias) obteve menor tempo de internamento do que cirurgia laparotômica (mediana de 4,15 dias) (p<0,05). Não houve diferença entre as medianas dos custos e nem dos serviços hospitalares por procedimento (p=0,08 e p=0,08, respectivamente). A mediana do custo de profissionais na laparoscopia foi significativamente mais elevada, em US$ 1,39 (p<0,05). A cirurgia minimamente invasiva para apendicite é um procedimento seguro e eficaz, proporcionando vantagens sobre a laparotomia (incluindo menor taxa de mortalidade e alta precoce), não implicando, por sua vez, em maiores despesas para cofres públicos no estado da Bahia.


Subject(s)
Humans , Appendicitis/surgery , Laparoscopy , Appendectomy , Retrospective Studies , Treatment Outcome , Cost-Benefit Analysis , Laparotomy , Length of Stay
13.
Rev. Col. Bras. Cir ; 48: e20202717, 2021. graf
Article in English | LILACS | ID: biblio-1340671

ABSTRACT

ABSTRACT Acute appendicitis (AA) is a frequent cause of abdominal pain requiring surgical treatment. During the COVID-19 pandemic, surgical societies considered other therapeutic options due to uncertainties in the evolution of the disease. The purpose of this study is to assess the treatment of AA by members of two Brazilian surgical societies in this period. A common questionnaire was sent in 2020. There were 382 responses. Most surgeons had more than 15 years of profession (68.3%) and treated more than five cases per month (44.8%). About 72.5% would indicate chest CT to investigate COVID-19 in patients with AA. For those patients sustaining uncomplicated AA, without COVID-19, 60.2% would indicate laparoscopic appendectomy (VLA), followed by open appendectomy (OA) (31.7%) and non-operative management (NOM) (1.3%). For those with mild COVID-19, OA was suggested by 51.0%, followed by VLA (29.6%) and NOM (6.0%). For those with severe COVID-19, OA was proposed by 35.3%, followed by NOM (19.9%) and VLA (18.6%). For patients with periappendiceal abscesses, without COVID-19, VLA was suggested by 54.2%, followed by OA (33.2%) and NOM (4.4%). For those with mild COVID-19, OA was proposed in 49.5%, followed by VLA (29.3%) and NOM (8.9%). In those with severe COVID-19, OA was proposed in 36.6%, followed by NOM (25.1%) and VLA (17.3%). This information, based on two recognized Brazilian surgical societies, can help the surgeon to select the best approach individually.


RESUMO A apendicite aguda (AA) é causa frequente de abdome agudo cirúrgico. Durante a pandemia de COVID-19, devido às incertezas na evolução da doença, sociedades consideraram outras opções terapêuticas. Nosso objetivo é descrever o tratamento da AA por membros do CBC e SBAIT neste período. O questionário foi enviado em 2020. Houve 382 respostas. A maioria dos profissionais tinha mais de 15 anos de profissão (68,3%) e atendia mais de cinco casos por mês (44,8%). Cerca de 72,5% realizariam TC de tórax para investigação de COVID-19 em pacientes com AA. Nos com AA não complicada, sem COVID-19, 60,2% optariam pela apendicectomia videolaparoscópica (AVL), seguido de apendicectomia aberta (AAB) (31,7%) e tratamento não operatório (TNO) (1,3%). Nos com COVID-19 leve, AAB foi proposta por 51,0%, seguido da AVL (29,6%) e TNO (6,0%). Nos com COVID-19 grave, a AAB foi proposta por 35,3%, seguido de TNO (19,9%) e AVL (18,6%). Nos com AA complicadas com abscesso, sem COVID-19, AVL foi sugerida por 54,2%, seguida da AAB (33,2%) e TNO (4,4%). Nos com COVID-19 leve, a AAB foi proposta em 49,5%, seguidos da AVL (29,3%) e TNO (8,9%). Nos com COVID-19 grave, a AAB foi proposta em 36,6%, seguido de TNO (25,1%) e AVL (17,3%). Estas são opções de cirurgiões de duas sociedades cirúrgicas reconhecidas e podem auxiliar o colega que está na linha de frente a definir a melhor conduta individualmente.


Subject(s)
Humans , Appendicitis/surgery , Appendicitis/epidemiology , Laparoscopy , COVID-19 , Appendectomy , Acute Disease , Retrospective Studies , Pandemics , SARS-CoV-2 , Length of Stay
15.
Clin. biomed. res ; 41(4): 306-312, 20210000. tab, graf
Article in Portuguese | LILACS | ID: biblio-1349512

ABSTRACT

Introdução: A apendicectomia é o tratamento de escolha da apendicite aguda. Embora a preferência pelas técnicas minimamente invasivas seja tendência mundial, a cirurgia aberta ainda é realidade na maioria dos hospitais públicos. O índice de complicações pós-operatórias varia de acordo com a técnica cirúrgica empregada. O presente estudo objetiva comparar a incidência de complicações pós-operatórias entre a apendicectomia aberta e laparoscópica. Métodos: Coorte retrospectiva incluindo pacientes submetidos à apendicectomia no Hospital de Pronto Socorro de Porto Alegre entre novembro de 2015 a novembro de 2019. Foram avaliados dados demográficos, tempo de evolução dos sintomas, técnica cirúrgica, achados transoperatórios, necessidade de drenos ou ostomias, tempo cirúrgico, tempo de internação, experiência do cirurgião e desfechos. Resultados: Foram incluídos 358 pacientes, com idade de 32 ± 13,8 anos, e predomínio do sexo masculino (58,9%); 58,1% foram submetidos a cirurgia aberta, 41,9% a laparoscopia e 8% necessitaram conversão. As apendicites foram classificadas como complicadas em um terço dos casos. O tempo cirúrgico foi menor na cirurgia aberta (79,3 ± 38,8 vs. 104 ± 35,2 minutos; p < 0,001). O índice de complicações pós-operatórias foi de 21,2%, sendo significativamente maior na técnica aberta (26,4% vs. 13%; p = 0,003). O tempo de internação, a necessidade de reintervenção e mortalidade não apresentaram diferença entre as técnicas. Conclusão: Embora a apendicectomia aberta seja um procedimento seguro, com bons resultados e baixa morbimortalidade, a laparoscopia oferece potenciais vantagens em termos de evolução pós-operatória, inclusive em casos complicados. Deve ser indicada rotineiramente havendo disponibilidade de material e capacitação da equipe cirúrgica. (AU)


Introduction: Appendectomy is the treatment of choice for acute appendicitis. Although the preference for minimally invasive techniques is a worldwide trend, open surgery remains a reality in most public hospitals. The rate of postoperative complications varies according to the surgical technique employed. The present study aimed to compare the incidence of postoperative complications between open and laparoscopic appendectomy. Methods: This retrospective cohort study included patients undergoing appendectomy at the Hospital de Pronto Socorro de Porto Alegre between November 2015 and November 2019. Demographic and clinical data, duration of symptoms, surgical technique, intraoperative findings, use of abdominal drains or stomas, operative time, length of stay, surgeon's experience, and outcomes were assessed. Results: Three hundred and fifty-eight patients were included, predominantly male (58.9%), with a mean age of 32 ± 13.8 years; 58.1% underwent open surgery, 41.9% underwent laparoscopic surgery, and 8% required conversion. One third of the cases were classified as complicated. The mean operative time was shorter for open surgery (79.3 ± 38.8 vs. 104 ± 35.2 minutes; p < 0.001). The rate of postoperative complications was 21.2%, with a significantly higher incidence in the open technique (26.4% vs. 13%; p = 0.003). Length of stay, reoperation rate, and mortality did not differ between the techniques. Conclusions: Although open appendectomy is a safe and efficient procedure, associated with low morbidity and mortality rates, laparoscopy provides potential clinically beneficial advantages in terms of postoperative outcomes, even in complicated cases. Therefore, it should be routinely performed where laparoscopic equipment and skillful staff are available. (AU)


Subject(s)
Appendectomy/adverse effects , Surgical Procedures, Operative/statistics & numerical data , Laparoscopy , Postoperative Complications
16.
Rev. venez. cir ; 74(1): 10-12, 2021. ilus
Article in Spanish | LILACS, LIVECS | ID: biblio-1283697

ABSTRACT

El mucocele apendicular es la dilatación quística del apéndice con acumulación de material mucinoso. Su forma de presentación más frecuente es dolor en fosa ilíaca derecha, sin embargo, la mitad de los casos son asintomáticos. En el presente trabajo se presenta caso de un paciente con diagnóstico incidental de mucocele apendicular, al cual se le realizó apendicectomía laparoscópica como tratamiento definitivo. Caso clínico: Paciente masculino de 44 años sin antecedentes patológicos conocidos, quien se realiza ultrasonido abdominal que informa tumor quístico en fosa ilíaca derecha. Se decide resolución quirúrgica laparoscópica. Informe histológico: mucocele apendicular sin evidencia de malignidad y recuperación satisfactoria del paciente. Conclusión: La neoplasia mucinosa del apéndice es una patología poco frecuente, puede presentarse con una variedad de manifestaciones clínicas hasta un hallazgo incidental. El tratamiento es fundamentalmente quirúrgico y el abordaje laparoscópico es de elección en pacientes sin evidencia de ruptura y diseminación de la enfermedad(AU)


The appendicular mucocele is a cystic dilation of the appendix with accumulation of mucinous material. The most frequent form of presentation is pain in the right iliac fossa; however, half of the cases are asymptomatic patients. In the present work we present a case of a patient with an incidentally diagnosis of appendicular mucocele who underwent laparoscopic appendectomy as definitive treatment. Clinical case: A 44-year-old male patient with no known pathological history, who underwent an abdominal ultrasound that reported a cystic tumor in the right iliac fossa. Laparoscopic surgical resolution was decided, the histological examination revealed appendicular mucocele without evidence of malignancy and satisfactory recovery of the patient. Conclusion: Mucinous neoplasia of the appendix is an uncommon pathology, patients are often asymptomatic or have nonspecific symptoms, and the diagnosis is made incidentally in the course of other examination. Treatment is primarily surgical and the laparoscopic approach is the choice in patients without evidence of rupture and dissemination of the disease(AU)


Subject(s)
Humans , Male , Adult , Appendiceal Neoplasms/surgery , Ilium/pathology , Mucocele/pathology , Appendectomy , Drug Therapy , Mucocele
17.
Autops. Case Rep ; 11: e2021335, 2021. graf
Article in English | LILACS | ID: biblio-1345354

ABSTRACT

Mucinous adenocarcinoma of the appendix is a rare neoplasm with a low propensity for lymph node metastasis. The present case refers to an appendicular mucinous adenocarcinoma with inguinal lymph node metastasis. A 71-year-old woman underwent an appendectomy due to a clinical presentation of acute appendicitis. However, the histological examination of the surgical specimen revealed a mucinous adenocarcinoma of the appendix. After staging, the patient underwent a right hemicolectomy and was proposed for adjuvant chemotherapy. At the 3rd year of follow-up, inguinal lymphadenopathy was diagnosed, which biopsy confirmed inguinal node metastases from primary colorectal cancer, with areas of extracellular mucin. Restaging revealed liver and peritoneal metastasis, and the patient was proposed for palliative chemotherapy. Appendicular neoplasms, due to their rarity, represent a diagnostic and therapeutic challenge. This clinical case depicts an unusual metastasis pathway for an unusual neoplasm.


Subject(s)
Male , Female , Aged , Appendiceal Neoplasms/pathology , Adenocarcinoma, Mucinous/pathology , Lymphatic Metastasis/pathology , Appendectomy , Lymphadenopathy/complications
18.
Rev. argent. cir ; 112(4): 517-525, dic. 2020. tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1288164

ABSTRACT

RESUMEN Antecedentes: La apendicitis aguda (AA) es una de las principales patologías quirúrgicas en México y el mundo. A pesar de ser una patología frecuente, el manejo quirúrgico presenta una tasa del 10-20% de apendicitis blancas (AB) o hiperplasia folicular linfoide (HPL) por histopatología. Objetivo: Comparar los hallazgos clínicos, de laboratorio y radiológicos de pacientes con sospecha de AA con su diagnóstico por histopatología. Material y métodos: El estudio es retrospectivo, observacional y transversal. Se analizaron los datos de los pacientes con diagnóstico clínico de apendicitis aguda, desde febrero de 2013 hasta diciembre de 2017, atendidos en un hospital de tercer nivel en Monterrey, México. Se compararon los hallazgos de los pacientes con diagnóstico de AA vs. HPL, AA no complicadas vs. AA complicadas y pacientes pediátricos vs. adultos. Se realizó un análisis descriptivo por medio de frecuencias y porcentajes, y mediana y rango intercuartil (RIC), dada la distribución no paramétrica de estas variables. Se compararon los hallazgos por laboratorio mediante la prueba de Mann-Whitney. Se consideró una p< 0,05 como estadísticamente significativa. Resultados: En nuestro medio, ambos sexos tienen la misma frecuencia de presentación de AA. El tiempo de evolución es significativo en la presentación frecuente de AA complicada. Existe asociación entre leucocitosis, neutrofilia total y porcentual y recuento plaquetario mayor en presencia de AA vs. HPL. Conclusión: Los estudios de laboratorio no muestran cambios significativos en pacientes pediátricos con AA. En adultos con AA no complicada vs. apendicitis complicada, el aumento en WBC, NEU y NEU% son estadísticamente significativos.


ABSTRACT Background: Acute appendicitis (AA) is one of the main surgical pathologies in our country and worldwide. Despite being a surgery that is frequently done, it is still reported a 10-20% of negative appendectomies (NA). Objective: The objective of the study is to compare clinical, laboratory and radiology results with the histopathology diagnosis. Material and methods: A retrospective study was done analyzing the data of patients with clinical diagnosis of AA from February 2013 to December 2017, in a tertiary hospital in Monterrey, Mexico. They were classified by their histopathological results into different groups: AA or NA; and the AA was subdivided into complicated AA and uncomplicated AA. Finally, these groups were also subdivided by ages, into pediatric and adult groups of each category. A descriptive analysis was made using frequencies, percentages, median and the interquartile range. Laboratory results were compared with the Mann-Whitney test. Considering a p-value of p < 0.05 as statistically significant. Results: In our group of patients both genders had AA in a similar frequency, the time between the appearance of symptoms and reaching for medical advice was an important factor for having complicated AA. There is a correlation between leukocytosis, neutrophil count and platelet count elevated in presence of AA against NA. Conclusion: Laboratory studies did not report significant changes in pediatric patients with AA. In adults with uncomplicated AA vs. complicated AA, white blood cell count, and neutrophil count are statistically significant.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Young Adult , Appendectomy , Appendicitis/diagnosis , Pseudolymphoma/diagnosis , Appendicitis/diagnostic imaging , Tomography, X-Ray Computed , Cross-Sectional Studies , Retrospective Studies , Ultrasonography , Clinical Laboratory Techniques
19.
Rev. argent. cir ; 112(4): 450-458, dic. 2020. graf, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1288157

ABSTRACT

RESUMEN Antecedentes: la pandemia por COVID-19 generó cambios en el manejo de pacientes con todo tipo de patologías. Mostramos la experiencia respecto de los pacientes con apendicitis aguda (AA) operados en un hospital universitario de la Ciudad Autónoma de Buenos Aires durante los meses de confina miento y su comparación con el mismo período del año 2019 a fin de evaluar las diferencias. Material y métodos: se analizó en forma retrospectiva una base confeccionada de forma prospectiva. Se compararon pacientes operados de AA, consignando los datos respecto del período preoperatorio, comparando datos inherentes a la cirugía y sus resultados en los períodos marzo-julio de 2019 y 2020. Resultados: fueron incluidos 127 pacientes, 46 de ellos operados durante la pandemia. Los pacientes operados durante la pandemia presentaron mayor incidencia de peritonitis (61,7% vs. 76,1%; p: 0,09) y mayor requerimiento de drenaje abdominal (9,9% vs. 23,9%; p: 0,03). También tuvieron mayor in cidencia de complicaciones (10,9 vs. 4,9%; p: 0,21), reoperaciones (8,7 vs. 1,23%, p: 0,03), reinterna ciones (6,5 vs. 0%, p: 0,02) y requerimiento de antibioticoterapia endovenosa prolongada (6,5 vs. 0%; p: 0,02). La estadía hospitalaria fue mayor para la cohorte operada durante la pandemia: 3,24 días (Desvío estándar [D.E.]: 7,31) vs. 1,89 días (D.E: 2,04). Conclusiones: durante la pandemia por COVID-19, el número de pacientes operados por AA disminuyó con respecto al año 2019; se observaron estadios más avanzados de la enfermedad, mayores compli caciones en el posoperatorio y mayor estadía hospitalaria.


ABSTRACT Background: COVID-19 pandemic has generated changes regarding the management of patients with all kind of pathologies. Here we show the experience concerning the surgical treatment of acute appendicitis (AA) in a teaching hospital in the city of Buenos Aires during the lockdown, and its comparison with the same period of 2019 in order to assess the differences between the timing for consultation, intraoperative findings and the treatment outcome. Material and methods: A prospective database was retrospectively analyzed. We compared patients undergoing surgical treatment for AA in March-July of 2019 v. March-July 2020, taking into account the preoperative period and comparing the outcome regarding the surgical intervention and the impact in the postoperative period between the two groups. Results: 127 patients were included, 46 treated during the pandemic. Patients undergoing surgical treatment during the pandemic had a higher incidence of peritonitis (61.7% vs. 76.1%; p = 0.09) and higher requirement of abdominal drainage (9.9% vs. 23.9%; p = 0.03). There was an increase in the incidence of complications (10.9 vs. 4.9%; p: 0.21), reoperations (8.7 vs. 1.23%, p: 0.03), readmissions (6.5 vs. 0%, p: 0.02) and need for out-patient intravenous antibiotics (6.5 vs. 0%; p: 0.02). The average hospital length was of 1.89 (SD 2.04) and 3.24 (SD 7.31) for the groups operated before and during pandemic, respectively. Conclusions: During the COVID-19 pandemic, the number of patients undergoing surgical intervention because of AA decreased compared to the previous year, with increased complications in the postoperative period, higher compromise of the appendix, and longer hospital stay.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Appendectomy/statistics & numerical data , Appendicitis/surgery , COVID-19 , Appendicitis/complications , Peritonitis , Emergency Medical Services/statistics & numerical data , Pandemics
20.
Rev. Assoc. Med. Bras. (1992) ; 66(11): 1493-1497, Nov. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1143650

ABSTRACT

SUMMARY INTRODUCTION: Acute appendicitis (AA) is the most common cause of surgical acute abdomen. Postoperative complications in emergency care are reflections of the surgical procedure and pre- and postoperative factors. OBJECTIVE: Define prognostic factors for patients who underwent appendectomy, comparing them with the literature. METHODS: Descriptive observational study with a cross-sectional design based on data from the emergency/urgency appendectomy records between September 2018 and April 2019. Variables of interest were considered based on intrinsic patient data, clinical status, and perioperative management factors. Primary outcomes considered: postoperative complications from hospital admission discharge and prolonged hospital stay for > 2 days. Secondary outcome: death. The results were evaluated by Fisher's exact test (p <0.05). RESULTS: We identified 48 patients undergoing an appendectomy. Young adults accounted for 68.7%. From the total, 58.3% were males, 6 (12.5%) had hospitalization> 2 days, 4 (8.3%) had complications and no deaths. Among the variables, the stage of AA, the time of complaint up until seeking care, and advanced age were correlated with worse prognosis during hospitalization (p <0.05). The emergence of immediate postoperative complications was correlated with longer hospital stay (p <0.05). DISCUSSION: The descriptive data of the sample converge with the epidemiological profile of patients with AA in the literature, corroborating the applicability of conventional guidelines. The results strengthen the hypothesis that the patient's flow with abdominal manifestations is complicated from the first contact with SUS to the resolution of the condition. CONCLUSION: Knowledge of the epidemiological profile and perioperative predictors that are most related to complications favor the appropriate management of patients.


RESUMO INTRODUÇÃO: Apendicite aguda (AA) é causa mais comum de abdome agudo cirúrgico. Complicações pós-operatórias na emergência são reflexos do ato cirúrgico e fatores pré e pós-operatórios. OBJETIVO: Definir fatores prognósticos para paciente pós apendicectomia, comparando com a literatura. MÉTODOS: Estudo observacional descritivo e analítico com formação de base transversal de dados dos prontuários de apendicectomias de emergência/urgência entre setembro de 2018 e abril de 2019. Variáveis de interesse foram consideradas a partir dos dados intrínsecos ao paciente, quadro clínico e manejo perioperatório. Desfechos primários combinados considerados foram complicações pós-operatórias da internação até alta hospitalar e prolongamento da internação > dois dias. Desfecho secundário foi óbito. Resultados avaliados pelo teste exato de Fisher (p<0,05). RESULTADOS: Identificaram-se 48 pacientes submetidos à apendicectomia. Adultos jovens corresponderam a 68,7%. Do total, sexo masculino (58,3%), seis (12,5%) tiveram internação > dois dias, quatro (8,3%) cursaram com complicação e nenhum óbito. Dentre as variáveis consideradas, fase de apresentação da AA tempo de queixa até procura do atendimento e idade avançada correlacionaram com pior prognóstico durante internação (p<0,05). Surgimento de complicações pós-operatórias imediatas correlacionou-se com maior tempo de internação (p<0,05). DISCUSSÃO: Dados descritivos da amostra convergem com perfil epidemiológico de pacientes com AA na literatura, corroborando aplicabilidade das diretrizes convencionais. Resultados fortalecem a hipótese de que o fluxo do paciente com manifestações abdominais é complicado desde o primo-contato com o SUS até a resolução do quadro. CONCLUSÃO: Conhecimento do perfil epidemiológico e dos preditores perioperatórios que mais se relacionam com complicações favorecem manejo adequado dos pacientes.


Subject(s)
Humans , Male , Female , Young Adult , Appendectomy , Appendicitis/surgery , Appendicitis/epidemiology , Laparoscopy , Postoperative Complications/epidemiology , Prognosis , Brazil/epidemiology , Cross-Sectional Studies , Retrospective Studies , Treatment Outcome , Length of Stay
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