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Arq. Ciênc. Vet. Zool. UNIPAR (Online) ; 25(2): e5235, jul-dez. 2022.
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1399607


A descorna cirúrgica a campo ainda e uma prática comum em animais de produção, apesar deste procedimento na maioria ainda se realizado por leigos, ou realizada em animais com menos de um ano de idade com ferro candente (avermelhado), esta conduta geralmente é efetuada na propriedade, sendo executada pelo próprio proprietário ou funcionário. O presente experimento usando anestesia geral e bloqueio local do nervo córneo e circularmente na base do corno com abraçadeira de naylon para sutura de pele, associada a ligadura da artéria e veia cornual mostrou ser eficiente reduzindo o tempo cirúrgico a campo e promovendo uma prevenção antecipada de hemorragia que é frequente para este procedimento.(AU)

The surgical dehorning the field and still a common practice in farm animals, although this procedure in most still held by lay people, or performed on animals less than one year old with red-hot iron (red), this conduct is usually done on the property, being executed by the owner himself or employee. This experiment using general anesthesia and local lock of corneal nerve and round the horn base with clamp naylon for skin suture, associated with ligature of the artery and vein cornual is efficient by reducing surgical time field and promoting an early prevention of bleeding is frequent for this procedure.(AU)

El quirúrgica descorne el campo quieto y una práctica común en los animales de granja, aunque este procedimiento en la mayoría todavía en manos de los laicos, o lleva a cabo en animales de menos de un año de edad con hierro al rojo vivo (rojo), este comportamiento se realiza generalmente en la propiedad, los trabajos realizados por el propietario o el propio empleado. Este experimento usando anestesia bloques general y local de los nervios de la córnea y alrededor de la base del cuerno con naylon pinza de sutura de la piel, asociados con la ligadura de la vena y la arteria cornual fue eficiente que reduce el tiempo quirúrgico el campo y la promoción de una prevención temprana sangrado que es común para este procedimiento.(AU)

Animals , Ophthalmic Artery/surgery , Eye Hemorrhage/veterinary , Cattle/surgery , Horns/surgery , Anesthesia, General/veterinary , Ligation/veterinary , Nylons/adverse effects
Article in Chinese | WPRIM | ID: wpr-936077


There are still controversies as to the location of ligating the inferior mesenteric artery and the central lymph node dissection during rectal cancer surgery. The reason is that the level of evidence in this area is low. Existing studies are mostly retrospective, analyses or small-sample randomized controlled trials. These results showed no significant differences between high-ligation and low-ligation, in terms of anastomotic leakage and other short-term postoperative complications. Low-ligation seems better for the recovery of postoperative genitourinary function. Due to the low rate of central lymph node metastasis and many other confounding factors that affect the survival rate, it is difficult to conclude the survival benefits of ligation site or central node dissection. It is necessary to carry out some targeted, well-designed, large-scale randomized controlled trials to explain the related issues of inferior mesenteric artery ligation site and extent of central lymphadenectomy.

Humans , Laparoscopy/methods , Ligation/methods , Lymph Node Excision/methods , Mesenteric Artery, Inferior/surgery , Mesentery , Rectal Neoplasms , Rectum/surgery , Retrospective Studies
Chinese Journal of Hepatology ; (12): 407-412, 2022.
Article in Chinese | WPRIM | ID: wpr-935959


Objective: To investigate the effects of primary preventive treatment under endoscope for esophageal and gastric varices on bleeding rate and its relevant factors. Methods: 127 cases with liver cirrhosis accompanied with esophageal and gastric varices without bleeding history were included in the endoscopic and non-endoscopic treatment group, respectively. Informed consent was obtained from both groups. Gastric varices (Lgf) and esophageal varices (Leg) were diagnosed according to LDRf classification criteria, and the corresponding treatment scheme was selected according to the recommended principle of this method.The incidence rate of bleeding from ruptured esophageal varices were observed at 3, 6 months, and 1, and 2 years in the treated and the untreated group, and the patients with different Child-Pugh scores were followed-up for 2 years. Gender, age, etiology, varicose degree, Child-Pugh grade, platelet count, prothrombin activity, portal vein thrombosis, collateral circulation, portal vein width and other factors affecting the bleeding rate were assessed. Measurement data were described as mean ± standard deviation (x¯±s), and qualitative data of categorical variables were expressed as percentage (%), and χ2 test was used. Results: 127 cases were followed up for 2 years. There were 55 cases in the endoscopic treatment group (18 cases underwent band ligation, 2 cases underwent band ligation combined with tissue adhesive embolization, 28 cases underwent sclerotherapy, and 7 cases underwent sclerotherapy combined with tissue adhesive embolization). Recurrent bleeding and hemorrhage was occurred in 5 (9.1%) and 28 cases (38.9%), respectively (P<0.05). In addition, there were 72 cases in the untreated group (P<0.05). Severe varicose veins proportions in treated and untreated group were 91.1% and 85.1%, respectively (P>0.05). There was no statistically significant difference in liver cirrhosis-related medication and β-blocker therapy between the treated and untreated group (P>0.05). There was no statistically significant difference in the bleeding rate between the different treated groups (P>0.05). The bleeding rates at 3, 6 months, 1, and 2 years in endoscopic treated and untreated group were 2.00% vs. 2.59% (P>0.05), 2.30% vs. 5.88% (P>0.05), 3.10% vs. 7.55% (P>0.05) and 4.00% vs. 21.62% (P<0.05), respectively. All patients with Child-Pugh grade A, B and C in the treated and the untreated group were followed-up for 2 years, and the bleeding rates were 1.8% vs. 8.1% (P<0.05), 1.1% vs. 9.4% (P<0.05) and 9.1% vs. 10.1% (P>0.05), respectively. There were statistically significant differences in the rupture and bleeding of esophageal and gastric varices, varices degree, Child-Pugh grade and presence or absence of thrombosis formation in portal vein (P<0.05); however, no statistically significant differences in gender, age, etiology, platelet count, prothrombin activity, collateral circulation and portal vein width (P>0.05). There was no intraoperative bleeding and postoperative related serious complications in the treated group. Conclusion: The risk of initial episodes of bleeding from esophageal and gastric varices is significantly correlated with the varices degree, Child-Pugh grade, and portal vein thrombosis. Primary preventive treatment under endoscope is safe and effective for reducing the long-term variceal bleeding risk from esophageal and gastric varices.

Endoscopes , Esophageal and Gastric Varices/complications , Gastrointestinal Hemorrhage/surgery , Humans , Hypertension, Portal/complications , Ligation , Liver Cirrhosis/complications , Prothrombin , Sclerotherapy , Tissue Adhesives , Varicose Veins , Venous Thrombosis/complications
Chinese Journal of Surgery ; (12): 113-116, 2022.
Article in Chinese | WPRIM | ID: wpr-935587


Clinical practice using associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) or its modified procedures in treatment of primary hepatocellular carcinoma(HCC) with insufficient future liver remnant(FLR) in the past 10 years has failed to meet our expectations both in achieving decreased perioperative complications and mortality.The efficacy of ALPPS in improving long-term survival outcome of HCC still remains poor.Due to the trauma of two surgery within a short period,and patients with inadequate FLR are all diagnosed at advanced disease stages,ALPPS can only achieve surgical rather than biological tumor-curability.Previous studies have demonstrated comparable 5-year survival rates between early and advanced stages of HCC who underwent regional treatments.Therefore,tumor biological conversion is the key strategy prior to liver remnant volume conversion in improving treatment outcomes for HCC patients with insufficient FLR.Target therapy,immunotherapy together with locally treatment were expected to improve the conversion efficacy.Looking back at the development of ALPPS for the last decade,the rapid proliferation of FLR should be passed on,while the technology costs high risks and result in poor long-term outcome must be cautiously selected.

Carcinoma, Hepatocellular/surgery , Hepatectomy , Humans , Ligation , Liver , Liver Neoplasms/surgery , Portal Vein/surgery , Technology , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-928635


OBJECTIVES@#To study the effect of timing of surgical ligation of patent ductus arteriosus (PDA) on the prognosis of very low birth weight infants (VLBWI).@*METHODS@#The medical data of VLBWI who underwent transthoracic ligation for PDA from June 2018 to May 2021 were reviewed retrospectively. The infants were divided into early ligation group (≤21 days of age) and late ligation group (>21 days of age) based on the age of ligation. The two groups were compared in terms of perioperative clinical features, complications, and mortality. The risk factors for early surgical ligation were analyzed.@*RESULTS@#A total of 72 VLBWI were enrolled, with 19 infants (26%) in the early ligation group and 53 infants (74%) in the late ligation group. There were significant differences in birth weight, gestational age, weight at operation, days of age at operation, rates of preoperative invasive and noninvasive mechanical ventilation, incidence rate of pulmonary hemorrhage, incidence rate of hypotension, preoperative PDA internal diameter (mm/kg), intraoperative PDA external diameter (mm/kg), incidence rate of post-ligation cardiac syndrome, and duration of postoperative invasive mechanical ventilation between the two groups (P<0.05). A binary logistic regression analysis showed that pulmonary hemorrhage was an indication of early surgical ligation of PDA (P<0.05). There were no significant differences in the incidence rates of post-operative complications and the mortality rate between the early ligation and late ligation groups.@*CONCLUSIONS@#Early surgical ligation may be performed for VLBWI who are experiencing pulmonary hemorrhage and hemodynamically significant PDA confirmed by cardiac ultrasound after birth. However, post-ligation cardiac syndrome should attract enough attention. In addition, early surgical ligation of PDA does not increase the risk of surgery-related and long-term complications or death, indicating that it is a safe and feasible treatment option.

Ductus Arteriosus, Patent/surgery , Gestational Age , Humans , Infant , Infant, Newborn , Infant, Very Low Birth Weight , Ligation , Retrospective Studies
Rev. chil. obstet. ginecol. (En línea) ; 86(5): 465-469, oct. 2021. ilus
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388683


Resumen Reportamos el caso de una mujer de 28 años con atraso menstrual de 14 días, diagnosticada en el servicio de urgencia obstétrica del Hospital Félix Bulnes con un embarazo ectópico cervical mediante ultrasonido, en contexto de metrorragia grave. El tratamiento consistió en legrado uterino segmentario más ligadura de arterias cervicales. El estudio histopatológico reveló una mola hidatiforme parcial en el producto del curetaje. La paciente evolucionó favorablemente sin requerir más intervenciones. Este caso da cuenta del exitoso manejo de un embarazo cervical con tratamiento quirúrgico, dando una oportunidad de preservar la fertilidad de la paciente.

Abstract We are reporting the case of a 28-year-old woman with 14-day menstrual delay diagnosed, in the obstetric emergency department of Félix Bulnes Hospital, with a cervical pregnancy through ultrasound, in the context of severe metrorrhagia. The treatment consisted in uterine curettage and ligation of cervical arteries. A histopathological study revealed a partial hydatidiform mole in the curettage product. The patient evolved favorably without other interventions. This case its an example of the successful management of a cervical pregnancy with surgical treatment, giving a chance of preserving the fertility of the patient.

Humans , Female , Pregnancy , Adult , Pregnancy, Ectopic/surgery , Pregnancy, Ectopic/diagnosis , Pregnancy, Ectopic/pathology , Hydatidiform Mole , Cervix Uteri , Curettage , Ligation
Arch. argent. pediatr ; 119(4): e315-e321, agosto 2021. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1281006


La prematiridad fue aumentando la supervivencia desde hace varios años, y eso produce, sobre todo, una preocupación en los prematuros nacidos antes de las 28 semanas de gestación. El tiempo del clampeo del cordón umbilical puede generar diversos trastornos, principalmente, cuando se realiza temprano (10-15 segundos). Ya desde hace 20 años, a través de varias investigaciones, se pudieron demostrar los notorios beneficios del clampeo demorado del cordón (de 2 a 3 minutos). Esta práctica fue instalada en la asistencia obstétrica y neonatal por las recomendaciones de sociedades científicas y de las revisiones sistemáticas, que señalaron las sólidas evidencias que apoyaban esta conducta para prematuros. En esta revisión, se describen los artículos más relevantes en los últimos años, que sustentan notoriamente la aplicación del clampeo demorado del cordón versus el clampeo temprano. Asimismo, esta práctica genera una disminución de los trastornos graves en prematuros.

For several years now, the survival of preterm infants has been increasing, which has shifted our concern to preterm infants born before 28 weeks of gestation in particular. The timing of umbilical cord clamping may lead to several disorders, especially when done early (10-15 seconds). In the last two decades, several investigations have shown the considerable benefits of delayed cord clamping (2-3 minutes). Delayed cord clamping has been practiced in obstetrics and neonatal care based on the recommendations made by scientific societies and in systematic reviews, which have provided solid evidence to support this practice in preterm infants. This review describes the most relevant articles from the last years, which strongly support the use of delayed cord clamping versus early cord clamping. In addition, this practice reduces the rate of severe disorders in preterm infants.

Humans , Male , Female , Pregnancy , Infant, Newborn , Umbilical Cord , Placental Circulation/physiology , Ligation , Time Factors , Infant, Premature
Rev. colomb. cir ; 36(4): 626-636, 20210000. fig, tab
Article in Spanish | LILACS | ID: biblio-1291156


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

Humans , Appendicitis , Laparoscopy , Appendectomy , Bioelectric Energy Sources , Cost Control , Ligation
Rev. argent. cir ; 113(1): 111-116, abr. 2021. graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1288180


RESUMEN El riesgo de insuficiencia hepática posoperatoria es la limitante de mayor importancia para el trata miento de pacientes con tumores hepáticos malignos primarios o secundarios. Entre las diferentes técnicas para incrementar la resecabilidad de tumores hepáticos se desarrolló una estrategia para pa cientes con tumores previamente considerados como irresecables, técnica conocida como ALPPS (as sociating liver partition with portal vein ligation for staged hepatectomy). Informamos acerca de una cirugía ALPPS en terapia reversa en un hombre referido a nuestro centro con diagnóstico sincrónico de cáncer rectal con metástasis hepáticas múltiples consideradas irresecable al momento del diagnóstico.

ABSTRACT The risk for postoperative liver failure is the most important limitation for the treatment of patients with primary or secondary liver cancer. Among the different strategies used to increase resectability in liver tumors, a technique known as ALPPS (associating liver partition with portal vein ligation for staged hepatectomy) was developed for patients with tumors previously considered unresectable. We report the case of a male patient referred to our center with a diagnosis of synchronous multiple liver metastases of colorectal cancer considered unresectable who underwent ALPPS using liver-first reverse approach.

Rectal Neoplasms , Methods , Neoplasm Metastasis , Patients , Therapeutics , Colorectal Neoplasms , Risk , Health Strategies , Liver Failure , Hepatic Insufficiency , Diagnosis , Research Report , Hepatectomy , Ligation , Liver
ABCD arq. bras. cir. dig ; 34(1): e1560, 2021. tab, graf
Article in English | LILACS | ID: biblio-1248509


ABSTRACT Background: Transanal hemorrhoidal dearterialization (THD) is safe and effective minimally invasive treatment for hemorrhoidal disease, but reports regarding recurrence and postoperative complications (pain and tenesmus) vary significantly. Aim: To evaluate if selective dearterialization and mucopexy at the symptomatic hemorrhoid only, without Doppler guidance, achieves adequate control of the prolapse and bleeding and if postoperative morbidity is reduced with this technique. Methods: Twenty consecutive patients with grade II and III hemorrhoids were treated with this new approach and were evaluated for postoperative complications and recurrence. Results: Control of prolapse and bleeding was achieved in all patients (n=20). Postoperative complications were tenesmus (n=2), external hemorrhoidal thrombosis (n=2) and urinary retention (n=2). After a mean follow-up of 13 months no recurrences were diagnosed. Conclusion: Selective dearterialization and mucopexy is safe and achieves adequate control of prolapse and bleeding and, by minimizing sutures in the anal canal, postoperative morbidity is diminished. Doppler probe is unnecessary for this procedure, which makes it also more interesting from an economic perspective.

RESUMO Racional: O tratamento da doença hemorroidária pela técnica de THD (Transanal Hemorrhoidal Dearterialization) é minimamente invasivo e tem se mostrado seguro e eficiente. No entanto, dados sobre a recorrência e complicações (dor e tenesmo) no pós-operatório são muito variáveis. Objetivo: Avaliar se a desarterialização e mucopexia seletiva, sem o uso de Doppler, é suficiente para o controle de sintomas e se a morbidade pós-operatória é menor com esta técnica. Métodos: Vinte pacientes foram tratados com essa técnica e avaliados sobre controle de sintomas, morbidade pós-operatória e recorrência. Resultados: Controle do prolapso e sangramento foi observado em todos pacientes (n=20). Complicações pós-operatórias foram: tenesmo (n=2), trombose hemorroidária externa (n=2), retenção urinária (n=2). Após um seguimento médio de 13 meses, nenhuma recorrência foi detectada. Conclusões: O procedimento de desarterialização e mucopexias seletivas é seguro e eficiente em termos de controle do prolapso e sangramento. Esta técnica resulta em menor morbidade cirúrgica, uma vez que diminui o número de suturas no canal anal, resultando em menos dor e tenesmo pós-operatório. Para este procedimento o uso de ultrassom Doppler é desnecessário, o que diminui custos e o torna mais atrativo do ponto de vista econômico.

Humans , Hemorrhoidectomy , Hemorrhoids/surgery , Anal Canal , Arteries/surgery , Rectum , Treatment Outcome , Ultrasonography, Doppler , Ligation
Rev. méd. Minas Gerais ; 31: 31401, 2021.
Article in Portuguese | LILACS | ID: biblio-1291279


A Hemorragia Pós-parto é a maior causa mundial de histerectomia periparto. Sua abordagem terapêutica deve ser efetuada por uma sucessão de procedimentos farmacológicos e cirúrgicos antes de se recorrer à histerectomia. O acretismo placentário se apresenta como a etiologia de hemorragia pós-parto que mais dificulta a preservação uterina. Sua incidência se relaciona estritamente com a elevação contemporânea das taxas de cesárea, com os demais procedimentos cirúrgicos no útero e com a implantação segmentar da placenta. Com isso, objetiva-se relatar um caso de placenta prévia central e increta tratado por meio de excisão miometrial segmentar com reconstrução da parede uterina durante cesariana. A abordagem cirúrgica foi instituída seguindo os passos de localização per-operatória da placenta, realização de histerotomia corporal alta transversa, extração fetal, confirmação clínica do incretismo placentário, manutenção da placenta in situ, ligadura bilateral dos ramos ascendentes das artérias uterinas, ressecção de todo o segmento uterino anterior invadido por cotilédones placentários, reconstrução da parede uterina, histerorrafia, salpingotripsia bilateral, revisão da cavidade abdominal e laparorrafia. A técnica cirúrgica adotada foi eficiente na obtenção do controle hemorrágico durante a cesariana e não foi associada a complicações per ou pós-operatórias.

Postpartum Hemorrhage is the largest worldwide cause of peripartum hysterectomy. Its therapeutic approach must be performed by a succession of pharmacological and surgical procedures prior to hysterectomy. Placental accreta presents as the etiology of postpartum haemorrhage that makes uterine preservation more difficult. Its incidence is strictly related to the contemporary elevation of cesarean rates, other surgical procedures in the uterus and segmentar implantation of the placenta. We aim to report a case of central and increta placenta treated through segmental myometrial excision with reconstruction of the uterine wall during cesarean section. The surgical approach was instituted following the perioperative localization of the placenta, transverse corporal hysterotomy, fetal extraction, clinical confirmation of placental invasive aspects, maintenance of the placenta in situ, bilateral ligation of the uterine artery ascending branches, resection of the all anterior uterine segment invaded by placental cotyledons, reconstruction of the uterine wall, hysterorrhaphy, bilateral salpingotripsy, revision of the abdominal cavity and laparorrhaphy. The surgical technique adopted was efficient in obtaining hemorrhagic control during cesarean section and was not associated with per or postoperative complications.

Humans , Female , Pregnancy , Placenta Accreta , Placenta Previa , Postpartum Hemorrhage , Hysterectomy , Surgical Procedures, Operative , Uterus , Cesarean Section , Uterine Artery , Peripartum Period , Ligation
Femina ; 49(4): 246-250, 2021. ilus
Article in Portuguese | LILACS | ID: biblio-1224100


Hemorragia pós-parto é a maior causa de histerectomia periparto. Esta revisão descreve e ilustra as técnicas de ligaduras vasculares utilizadas no tratamento cirúrgico da hemorragia pós-parto. São apresentados os detalhes técnicos da ligadura das artérias uterinas, da ligadura das conexões útero-ovarianas, da ligadura tríplice de Tsirulnikov, das ligaduras sequenciais de AbdRabbo e de Morel e da ligadura das artérias ilíacas internas. Também são revistos os fatores que dificultam o sucesso dessas técnicas. As ligaduras vasculares são estratégias eficientes para o controle hemorrágico durante cesarianas e devem integrar o conjunto de técnicas que preservam o útero no tratamento da hemorragia pós-parto.(AU)

Postpartum hemorrhage is the major cause of peripartum hysterectomy. This review describes and illustrates the techniques of vascular ligations used in the surgical treatment of postpartum hemorrhage. The technical details of the uterine arteries ligation, of the ligation of the utero-ovarian connections, of the Tsirulnikov triple ligation, of the AbdRabbo and Morel sequential ligations and of the internal iliac arteries ligation are presented. The factors that hinder the success of these techniques also are reviewed. Vascular ligations are efficient strategies for hemorrhagic control during cesarean sections and should integrate the set of techniques that preserve the uterus in the treatment of postpartum hemorrhage.(AU)

Humans , Female , Pregnancy , Uterine Artery/surgery , Postpartum Hemorrhage/surgery , Ligation/methods , Databases, Bibliographic , Fertility Preservation/methods , Postpartum Hemorrhage/mortality
Medisan ; 24(6) tab
Article in Spanish | LILACS, CUMED | ID: biblio-1143261


Introducción: Las varices esofágicas son canales vasculares que unen la circulación venosa portal y la sistémica. Se forman como consecuencia de la hipertensión portal, predominantemente en la submucosa del tercio inferior del esófago. Objetivo: Caracterizar a pacientes con rotura de varices esofágicas según principales variables clinicoepidemiológicas y terapéutico-endoscópicas. Métodos: Se realizó un estudio observacional, descriptivo y longitudinal de 20 pacientes con hemorragia digestiva alta por rotura de varices esofágicas, los cuales recibieron tratamiento endoscópico con bandas elásticas en el Servicio de Gastroenterología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, de noviembre de 2016 a febrero de 2018. En el análisis estadístico se utilizó el porcentaje como medida de resumen y se aplicó la prueba de independencia de la Χ2 para identificar alguna asociación significativa entre variables. Resultados: Existió un predominio del sexo masculino (80,0 %) y del grupo etario de 51 a 60 años (40,0 %). La mayoría de los afectados presentó cirrosis hepática (60,0 %) como causa de la hipertensión portal y hematemesis (50,0 %) como forma de hemorragia digestiva alta; asimismo, el gran tamaño de las varices fue el principal factor de riesgo asociado a la rotura (70,0 %) y, luego de practicado el tratamiento endoscópico, no se produjo resangrado en la casi totalidad de los pacientes (95,0 %). Conclusiones: La aplicación de este procedimiento terapéutico resultó ser satisfactoria y no provocó complicación alguna.

Introduction: The esophageal varicose veins are vascular channels that unite the portal venous and systemic circulation. They are formed as consequence of the portal hypertension, predominantly in the submucosa of the inferior section of the esophagus. Objective: To characterize patients with break of esophageal varicose veins according to main clinical epidemiological and therapeutic-endoscopic variables. Methods: An observational, descriptive and longitudinal study of 20 patients with upper digestive bleeding due to break of esophageal varicose veins was carried out, they received endoscopic treatment with banding in the Gastroenterology Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from November, 2016 to February, 2018. In the statistical analysis the percentage was used as summary measure and the chi-square test was applied to identify the existence of some significant association among variables. Results: There was a prevalence of the male sex (80.0 %) and the 51 to 60 age group (40.0 %). Most of the patients presented liver cirrhosis (60.0 %) as cause of the portal hypertension and hematemesis (50.0 %) as form of upper digestive bleeding; also, the great size of the esophageal varicose veins was the main risk factor associated with the break (70.0 %) and, after the implementation of the endoscopic treatment, there was no second bleeding in almost all the patients (95.0 %). Conclusions: The application of this therapeutic procedure was satisfactory and it didn't cause any complication.

Esophageal and Gastric Varices , Ligation , Hematemesis , Gastroenterology , Hypertension, Portal , Liver Cirrhosis
Gac. méd. boliv ; 43(2): 219-222, dic. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1249987


La hemorragia diverticular es la causa más frecuente de hemorragia digestiva baja. La hemorragia es abrupta, indolora, abundante. La mayoría de los divertículos que sangran se localizan en el lado derecho, este sangrado se autolimita hasta en un 80% de los casos. Cuando no se autolimita su manejo puede llegar a ser complejo. El manejo de estos sangrados, pueden variar desde conservador, endoscópico, arteriografía más embolización y el quirúrgico. Entre las alternativas de manejo endoscópico, tenemos la terapia de inyección, la térmica, hemoclips, ligadura con banda. El presente caso es de un paciente con hemorragia diverticular en el que se realizó terapia endoscopica combinada, infiltración de adrenalina, aplicación indirecta de hemoclips y aplicación tópica de ácido tranexámico que es un antifibrinolítico.

Diverticular bleeding is the most common cause of lower GI bleeding. The bleeding is most often abrupt, painless and abundant. Most of the bleeding diverticula are located on the right side of the colon, this bleeding is self-limited in up to 80% of cases. When it is not, it could turn into a difficult situation to manage. The management of these bleeds can vary from conservative to an endoscopic, arteriography plus embolization and surgical. Among the endoscopic management alternatives, we have injection therapy, thermal therapy, hemoclips, band ligation. The present case is about a patient with diverticular bleeding who underwent combined endoscopic therapy, adrenaline infiltration, indirect application of hemoclips, and topical application of tranexamic acid, which is an antifibrinolytic.

Male , Aged , Diverticular Diseases , Hemorrhage , Diverticulum , Colon , Endoscopy , Ligation
Rev. méd. Urug ; 36(4): 455-458, dic. 2020. graf
Article in Spanish | LILACS, BNUY | ID: biblio-1144763


Resumen: La ligadura de una rama de la vena porta constituye un procedimiento con buenos resultados para evitar la falla hepática posoperatoria en caso de hepatectomías extremas al provocar la hipertrofia del hígado contralateral. Sin embargo, la repermeabilización de ésta ha sido demostrada por la presencia de anastomosis porto portales intrahepáticas, pudiendo determinar una disminución de la hipertrofia esperada o necesaria. Como objetivo documentamos un caso clínico de repermeabilización intrahepática de la vena porta, evento no deseado de la hepatectomía en dos tiempos para el tratamiento de metástasis hepáticas bilobares de origen colorrectal y describimos alternativas para evitar o tratar dicha repermeabilización.

Summary: Left or right portal vein ligation to prevent post-operative liver failure in the case of extreme hepatectomy constitutes a procedure with a good prognosis, as it causes contralateral liver hypertrophy. However, its revascularization has been proved by intrahepatic porto-portal anastomoses, which could result in a reduction of the expected or required hypertrophy. The study aims to record a clinical case of intrahepatic revascularization of the portal vein, an unwanted event of the two-stage hepatectomy to treat bilobar hepatic metastasis of colorectal origin, and describe alternatives to avoid or treat such revascularization.

Resumo: A ligadura de um ramo da veia porta é um procedimento com bons resultados para evitar a insuficiência hepática pós-operatória em hepatectomias extremas por causar hipertrofia do fígado contralateral. No entanto, sua repermeabilização tem sido demonstrada pela presença de anastomose porto-portal intra-hepática, que pode determinar diminuição da hipertrofia esperada ou necessária. Como objetivo, documentamos um caso clínico de repermeabilização da veia porta intra-hepática, um evento indesejado de hepatectomia em dois estágios para o tratamento de metástases hepáticas bilobares de origem colorretal, e descrevemos alternativas para evitar ou tratar essa repermeabilização.

Portal Vein , Liver Failure/therapy , Ligation , Colorectal Neoplasms/therapy , Hepatectomy/adverse effects , Liver Neoplasms/therapy , Neoplasm Metastasis
Rev. méd. Hosp. José Carrasco Arteaga ; 12(3): 193-198, 30-11-2020. tab
Article in Spanish | LILACS | ID: biblio-1255375


INTRODUCCIÓN: El re-sangrado de várices esofágicas posterior a la ligadura de la misma, es una complicación frecuente, que eleva de manera significativa la morbi-mortalidad en este grupo de pacientes. El presente estudio tiene la finalidad de describir la frecuencia de re-sangrado por VE luego de la ligadura endoscópica, así como la frecuencia de ciertos factores y su asociación con el re-sangrado. MATERIALES Y MÉTODOS : Estudio observacional, descriptivo y de correlación, transversal. Participaron 179 pacientes a los que se les realizó ligadura endoscópica de varices esofágicas. Para el análisis de asociación se aplicó la prueba Chi 2, se obtuvo razón de prevalencia, con IC 95%. La información fue presentada por medio de tablas con frecuencias y porcentajes. RESULTADOS: El alcoholismo fue la principal causa de la cirrosis hepática en los pacientes con ligadura de varices esofágicas, con un porcentaje de 44.1%. La mayor parte de los casos se encontró dentro de la clase funcional Child Pugh Score B, con una frecuencia del 36.3%. La frecuencia de re-sangrado fue del 49.2% (IC 95% 41.55% ­ 56.76%), siendo más frecuente en varones mayores ≥ 65 años con el 58%, y en el sexo masculino (64.8%). Falleció el 43 % de la muestra, a causa de re-sangrado tras la ligadura. Hubo relación estadísticamente significante de el re-sangrado con factores como: TPT mayor a 33.3 (RP: 1.91, IC 95% 1.07 -3.39, valor p =0.00); anemia moderada, severa (RP: 1.43, IC 95% 1.05 ­ 1.96, valor p = 0.02) y transfusión sanguínea (RP: 2.23, IC 95% 1.37 ­ 3.65, valor p = 0.00). CONCLUSIÓN: La frecuencia de re-sangrado fue del 49.2% (tanto temprana como tardía), la mayoría de pacientes con re-sangrado fueron de sexo masculino y de 65 o más años. Se encontró relación estadísticamente significativa entre el re-sangrado y factores como: tiempo parcial de tromboplastina por encima de valores normales, anemia moderada o severa y el haber recibido transfusiones sanguíneas. La mortalidad por re-sagrando fue del 43% para toda la población de estudio.

BACKGROUND: Re-bleeding of esophageal varices after endoscopic ligation is a frequent complication, that significantly increases morbidity and mortality in this patients. This study aims to describe the frequency of rebleeding due to esophageal varices after endoscopic ligation, as well as the frequency of certain factors and their association with rebleeding. METHODS: Cross-sectional, descriptive and correlational, observational study. A total of 179 patients who underwent endoscopic ligation of esophageal varices participated. For the association analysis Chi2 test was applied, prevalence ratio was obtained, with 95% IC. Data was presented with charts, with frequencies and percentages. RESULTS: Alcoholism was the main cause of cirrhosis in patients that underwent ligation of esophageal varices (44.1%). Most of the cases were classified as Child Pugh Sore B functional class, with a frequency of 36.3%. The prevalence of rebleeding was 49.2% (95% CI 41.55%- 56.76%), it was more frequent in patients 65 years old and older (58%), and male patients (64.8%). Death rate due to rebleeding after ligation was 43%. We found significant statistical association of rebleeding with factors such as: TPT >33.3 (PR: 1.91, 95% CI 1.07-3.39, p value =0.00); moderate and severe anemia (PR: 1.43, 95% CI 1.05-1.96, p value =0.02), and blood transfusion (PR: 2.23. 95% CI 1.37-3.65, p value=0.00). CONCLUSION: Rebleeding frequency was 49.2% (early and late rebleeding), it was more common in male patients, and patients aged 65 or more. This study found statistical association between rebleeding and: elevated values of partial thromboplastin time, moderate and severe anemia, and blood transfusion. Mortality due to rebleeding was 43%.

Humans , Male , Female , Esophageal and Gastric Varices , Alcoholism , Hemorrhage , Ligation , Liver Cirrhosis , Risk Factors , Morbidity
Rev. bras. cir. cardiovasc ; 35(5): 831-833, Sept.-Oct. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1137329


Abstract Patent ductus arteriosus (PDA) is a clinical condition mostly found in premature newborns. Among several medical, surgical and interventional treatment options, extrapleural ligation through a left minithoracotomy is recognized as a safe, efficient and less expensive technique. In fact, it requires short surgical times, grants good exposure of the duct and nearby structures (e.g., thoracic duct, left recurrent laryngeal nerve), and avoids pleural space opening and subsequent pulmonary complications in preterm patients. This approach seems ideal due to its lower costs, especially in developing countries with a high birth rate and limited resources.

Humans , Infant, Newborn , Thoracotomy/methods , Ductus Arteriosus, Patent/surgery , Ductus Arteriosus, Patent/diagnostic imaging , Pleura/surgery , Infant, Premature , Infant, Newborn, Diseases/surgery , Infant, Newborn, Diseases/diagnostic imaging , Ligation
Rev. argent. coloproctología ; 31(2): 70-72, jun. 2020. ilus
Article in English, Spanish | LILACS | ID: biblio-1117014


Objetivo: Presentar el caso infrecuente de sangrado tardío posterior al tratamiento con macroligadura elástica de hemorroides, tratamiento propuesto por A. Reis Neto. Caso Clínico: Mujer de 26 años con tratamiento de hemorroides con macroligadura elástica. A los 28 días es admitida en urgencia por proctorragia abundante sin signos de shock hipovolémico. Laboratorio: Hematocrito 27%, Hemoglobina 8,9 mg/dl. Se realiza colonoscopia evidenciando la cicatriz de macroligadura con signos de coágulo desprendido sin sangrado activo. Se decide conducta expectante con tratamiento de la hipovolemia incial y anemia. Evoluciona sin resangrado con control endoscópico a los 60 y 180 (sin sangrado y excelentes resultados). Discusión: La macroligadura es una técnica alternativa para el tratamiento de hemorroides con excelentes resultados anatómicos y funcionales. Presenta menor dolor postoperatorio, bajo índice de complicaciones (ninguna severa o propia del método). No existen comunicaciones sobre sangrado tardío grave tanto en ligaduras convencionales como macroligadura. Conclusiones: Se presenta el primer caso comunicado a la fecha de un sangrado tardío en macroligaduras que fue resuelto en forma conservadora.

Objetive: To present an infrequent clinical report of a case of late bleeding after rubber macroband ligation. Case report: A 28-year-old female with severe rectal bleeding but no associated shock was presented 28 days after rubber macroband ligation at emergency room. Blood samples showed acute anemia. An urgent colonoscopy was performed which showed a scar without acute bleeding. Medical treatment was settled. There was no secondary bleeding in follow up. Endoscopic control was done at 60 and 180 days. Discusion: Hemorrhoidal rubber macroband ligation is a modification of conventional rubber band ligation. It was proposed and developed by J.A. Reis Neto (Campinas, SP, Brazil). Morbidity is low and results are excellent. There is no previous report of delayed bleeding considering both rubber band and macroband ligation. Conclusion: The First case of late bleeding after rubber band ligation treated with conservative measures.

Humans , Female , Adult , Gastrointestinal Hemorrhage/etiology , Hemorrhoids/surgery , Ligation/adverse effects , Postoperative Complications , Colonoscopy , Watchful Waiting , Gastrointestinal Hemorrhage/diagnosis , Ligation/methods
Rev. cir. (Impr.) ; 72(3): 250-256, jun. 2020. tab, ilus
Article in Spanish | LILACS | ID: biblio-1115551


Resumen Las fístulas anorrectales complejas son un desafío para el coloproctólogo. Son una patología frecuente que afecta la calidad de vida de los pacientes. La patogénesis aún no está clara, estarían involucradas citoquinas y el proceso de transición de epitelio a mesénquima. El gold standard para su estudio es la resonancia nuclear magnética, su uso por sí mismo disminuye la recurrencia. El objetivo del tratamiento es lograr la curación sin afectar la función del esfínter evitando las recidivas. Existen múltiples técnicas, siendo la de mayor aceptación la ligadura interesfinteriana del trayecto fistuloso, con tasa de curación sobre el 70%, con mínimo impacto en continencia. Esta revisión incluye otras técnicas como el colgajo endorrectal de avance, uso de sellante, permacol, células madres, Anal fistula plug, Video asisted anal fistula treatment, Over the scope clip y fistula laser closure.

Complex anal fistula are a challenge for colorectal surgeons. It is a common pathology in population. Pathogenesis is still unclear, it would be involved citokines and the process of epitelial to eesenchymal transition. The gold standard for study is MRI, its use reduces recurrences. The goal of treatment is heal the fistula without damaging the function of the sphincter and avoid recurrences. There are multiple techniques, the most accepted is ligation of intersphincteric fistula tract with cure rate over 70%, with minimal impact in continence. This review includes other techniques like rectal advancement flap, fibrin glue, permacol, stem cells, anal fistula plug, video asisted anal fistula treatment, over the scope clip and fistula laser closure.

Humans , Surgical Flaps/surgery , Rectal Fistula/surgery , Rectal Fistula/therapy , Ligation/methods , Anal Canal/surgery , Rectal Diseases/surgery , Rectal Diseases/therapy , Digestive System Surgical Procedures/methods , Video-Assisted Surgery
Prensa méd. argent ; 106(4): 237-244, 20200000. tab
Article in English | LILACS, BINACIS | ID: biblio-1368101


External division of the superior laryngeal nerve supplies the crico-thyroid muscle to excite length and thickness of the vocal fold. Thus, increasing voice tone. The vicinity with the superior thyroid vessels sets the external branch of the superior laryngeal nerve in danger every time the superior end of the thyroid is dissected. Thus, the aim of present study is to assess the rate and complication of external branch of the superior laryngeal nerve injury post- thyroidectomy when segregated ligation of superior thyroid vessels closes to thyroid capsule without prior nerve identification and without nerve stimulator or intraoperative neuro-monitoring. The presented study is a prospective, non- randomized clinical study included 1450 patients who underwent thyroidectomy which either (total thyroidectomies, near total thyroidectomies or lobectomy and isthmectomy) in the Department of Surgery/AL-Diawania Teaching Hospital in Diawania City, Iraq, between January 2000 and February 2018. All patients underwent thyroidectomy through segregated ligation of superior thyroid artery very closely to thyroid capsule without prior nerve identification and without nerve stimulator or intraoperative neuromonitoring. Postoperative indirect laryngoscopy vocal cord examination with long term follow up through physical examination and clinical history to evaluate nerve integrity. In present study, the total cases with EBSLN injury were 38 (2.6%), in which the transient EBSLN injury occurred in 28 (1.9%) of patients and permanent injury occurred in 10 (0.7%) of patients and majority of cases with EBSLN injury were occur in patients with large size goiter 29 (2%) more than small size goiter 9 (0.6%) And these differences were statistically significant differences, (P<0.005). In addition to, the majority of cases with EBSLN injury were occur in male {25(1.7%)} more than female patients {13(0.9%)} And these differences were statistically significant differences, (P<0.005). Segregated ligation of superior thyroid artery is a safe technical option, cost effective, time preserved and need surgical skills to minimized risk of injury to the external laryngeal nerve

Humans , Thyroid Gland/injuries , Thyroid Gland/pathology , Thyroidectomy , Vocal Cords/injuries , Carotid Artery, External , Cranial Nerve Injuries/complications , Laryngoscopy , Ligation , Prospective Studies