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1.
Medicina (B.Aires) ; 81(1): 115-118, mar. 2021. graf
Article in Spanish | LILACS | ID: biblio-1287251

ABSTRACT

Resumen El tratamiento escalonado de la pancreatitis aguda necrotizante infectada consiste en el uso de antibióticos de amplio espectro, drenaje y necrosectomía mínimamente invasiva, si fuese necesaria. Esto ha reemplazado a la cirugía abierta como el estándar de tratamiento. El desbridamiento retroperitoneal video asistido (VARD), es una forma de necrosectomía quirúrgica mínimamente invasiva. Presentamos una serie de 5 casos (2 mujeres y 3 varones) con pancreatitis aguda grave y necrosis pancreática infectada tratados de forma escalonada y VARD. El rango de edad fue de 27 a 60 años. Todos los pacientes tuvieron pancreatitis de etiología biliar. El rango del APACHE II fue de 16 a 20. El rango del tiempo para el drenaje percutáneo lumbar fue de 4 a 7 semanas. Hubo una complicación del drenaje percutáneo (fistula duodenal) que se resolvió con tratamiento médico. Los cultivos de todas las necrosis fueron positivos. El tiempo para la realización del VARD tuvo un rango de 6 a 10 semanas. Un paciente requirió dos procedimientos. Hubo dos fístulas pancreáticas tipo B asociadas al VARD, que se trataron conservadoramente. No hubo mortalidad. A largo plazo, dos pacientes fueron diagnosticados de insuficiencia pancreática exocrina y endocrina. Concluimos que en los pacientes con necrosis pancreática infectada que requieran desbridamiento, el VARD es una alternativa segura, efectiva y con buenos resultados a largo plazo.


Abstract The step-up approach for infected necrotizing pancreatitis, consisting of broad-spectrum antibiotics, drainage followed, if necessary, by minimally invasive necrosectomy, has replaced open surgery as the standard of management. Video-assisted retroperitoneal debridement (VARD) is a surgical minimally invasive necrosectomy. This is a 5 cases series (2 female and 3 males) with severe acute pancreatitis and infected pancreatic necrosis who underwent step up approach and VARD. The age ranged from 27 to 60 years old. Al patients had biliary pancreatitis. APACHE II ranged from 16 to 20. The time to percutaneous lumbar drainage ranged from 4 to 7 weeks. There was one complication associated with percutaneous drainage (duodenal fistula) with nonoperative management. All necrotizing pancreatitis had positive cultures. The time to perform VARD ranged from 6 to 10 weeks. One patient required two procedures. There were two type B pancreatic fistulas associated with VARD, managed nonoperatively. There was no mortality. During long-term follow-up two patients were diagnosed with exocrine and endocrine pancreatic insufficiency. We conclude that VARD is a safe and effective procedure in patients with infected necrotizing pancreatitis requiring debridement, and with good long-term outcomes.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pancreatitis, Acute Necrotizing/surgery , Retroperitoneal Space , Acute Disease , Treatment Outcome , Debridement
2.
Int. braz. j. urol ; 47(1): 103-111, Jan.-Feb. 2021. tab
Article in English | LILACS | ID: biblio-1134316

ABSTRACT

ABSTRACT Objective: This study aims to compare renal functional outcomes of access techniques in patients who underwent off-clamp (Off-C) laparoscopic partial nephrectomy (LPN). Materials and Methods: Thirty-four Off-C LPNs in patients with functioning contralateral kidney from March 2011 to June 2018 were included in the study. Twenty-two patients underwent transperitoneal, 12 patients underwent retroperitoneal Off-C LPN. The primary outcome was glomerular filtration rate changes over time, postoperatively. The secondary outcome was the evaluation of trifecta and pentafecta rate. Results: Preoperative demographics, tumor size (26.59 vs. 22.83mm, p=0.790), RENAL score (5.45 vs. 5.33, p=0.990), operation time (79.95 vs. 81.33 min, p=0.157), blood loss (170.23 vs. 150.83mL, p=0.790) were similar in both groups. Although preservation of renal function was better in group 2 in the early period, similar results were found in both groups at the end of the first year, postoperatively. No positive surgical margin and postoperative major complications were detected in any patient. While trifecta goals were achieved in all the patients in the cohort, pentafecta rates were 90.9% and 91.7% in the transperitoneal and retroperitoneal groups, respectively. Conclusions: Transperitoneal and retroperitoneal access were found to have similar outcomes in terms of preservation of renal function at the end of the first year postoperatively. Off-C LPN may be considered as a safe and effective treatment option in patients having non-complex renal tumors.


Subject(s)
Humans , Laparoscopy , Kidney Neoplasms/surgery , Retroperitoneal Space , Retrospective Studies , Treatment Outcome , Nephrectomy
3.
Chinese Medical Journal ; (24): 1209-1214, 2021.
Article in English | WPRIM | ID: wpr-878127

ABSTRACT

BACKGROUND@#The optimal treatment for large impacted proximal ureteral stones remains controversial. The aim of this study was to evaluate the efficacy, safety, and potential complications of mini-percutaneous nephrolithotomy (MPCNL) and retroperitoneal laparoscopic ureterolithotomy (RPLU) in the treatment of impacted proximal ureteral stones with size greater than 15 mm.@*METHODS@#A total of 268 patients with impacted proximal ureteral stones greater than 15 mm who received MPCNL or RPLU procedures were enrolled consecutively between January 2014 and January 2019. Data on surgical outcomes and complications were collected and analyzed.@*RESULTS@#Demographic and ureteral stone characteristics found between these two groups were not significantly different. The surgical success rate (139/142, 97.9% vs. 121/126, 96.0%, P = 0.595) and stone-free rate after 1 month (139/142, 97.9% vs. 119/126, 94.4%, P = 0.245) of RPLU group were marginally higher than that of the MPCNL group, but there was no significant difference. There was no significant difference in the drop of hemoglobin between the two groups (0.8 ± 0.6 vs. 0.4 ± 0. 2 g/dL, P = 0.621). The mean operative time (68.2 ± 12.5 vs. 87.2 ± 16.8 min, P = 0.041), post-operative analgesics usage (2/121, 1.7% vs. 13/139, 9.4%, P = 0.017), length of hospital stay after surgery (2.2 ± 0.6 vs. 4.8 ± 0.9 days, P < 0.001), double J stent time (3.2 ± 0.5 vs. 3.9 ± 0.8 days, P = 0.027), time of catheterization (1.1 ± 0.3 vs. 3.5 ± 0.5 days, P < 0.001), and time of drainage tube (2.3 ± 0.3 vs. 4.6 ± 0.6 days, P < 0.001) of MPCNL group were significantly shorter than that of the RPLU group. The complication rate was similar between the two groups (20/121, 16.5% vs. 31/139, 22.3%, P = 0.242).@*CONCLUSIONS@#MPCNL and RPLU have similar surgical success and stone clearance in treating impacted proximal ureteral stones greater than 15 mm, while patients undergoing MPCNL had a lower post-operative pain rate and a faster recovery.


Subject(s)
Humans , Laparoscopy , Length of Stay , Nephrolithotomy, Percutaneous/adverse effects , Retroperitoneal Space/surgery , Treatment Outcome , Ureteral Calculi/surgery
4.
Int. j. med. surg. sci. (Print) ; 7(2): 1-5, jun. 2020. ilus
Article in English | LILACS | ID: biblio-1179279

ABSTRACT

We report the case of an 86-year-old adult man who, as a pedestrian, is hit by a motorcycle, suffering polytrauma; in initial care, he refers to thoraco-abdominal pain and subsequently neurological deterioration. Assessed by a neurosurgeon and general surgeon, a right chest tube is placed and a laparoscopy is performed where there is little bleeding from the abdominal cavity. It shows deterioration of its general state and dies in respiratory failure. During the necropsy procedure there is subarachnoid hemorrhage and cerebral herniation, rib fractures and pneumonic consolidation, a massive retroperitoneal hematoma is observed due to rupture of simple renal cyst.


Reportamos el caso de un hombre de 86 años que, siendo peatón, es atropellado por una motocicleta, sufriendo politraumatismo. En la atención inicial refiere a dolor toracoabdominal y posteriormente deterioro neurológico. Evaluado por un neurocirujano y un cirujano general, se coloca un tubo torácico derecho y se realiza una laparoscopia y observándose poco sangrado de la cavidad abdominal. El paciente muestra deterioro de su estado general y muere por insuficiencia respiratoria. Durante el procedimiento de necropsia se determina hemorragia subaracnoidea y hernia cerebral, fracturas costales y consolidación neumónica, se observa un hematoma retroperitoneal masivo por rotura de quiste renal simple.


Subject(s)
Humans , Male , Aged, 80 and over , Rupture, Spontaneous , Kidney/injuries , Kidney Diseases/complications , Retroperitoneal Space
5.
Int. braz. j. urol ; 46(4): 538-544, 2020. tab, graf
Article in English | LILACS | ID: biblio-1134207

ABSTRACT

ABSTRACT The indication for simultaneous bilateral native nephrectomy and the choice of surgical technique is of key importance, as these patients are burdened with a large comorbidity. The paper reports our experience of seven successful and completed simultaneous bilateral native nephrectomy procedures with retroperitoneal approach in the patient's flank position. Seven patients (mean age 34), were indicated for the removal of both kidneys before the planned transplant. Six patients underwent haemodialysis from 48 to 84 months, and one underwent peritoneal dialysis for 60 months. Two patients had undergone graftectomy. The indications were chronic infection or hypertension. The length of the kidneys ranged from 5.8 to 10cm. All procedures were performed by the laparoscopic technique with retroperitoneal approach, with the patient in the flank position. Three trocars were used on each side. The retroperitoneal space created did not require balloon dilatation. The kidneys were removed through the 10mm trocar hole after splitting. The duration of the procedure ranged from 150 to 240 minutes, average 139 minutes and blood loss ranged from100 to 250mL, average 142mL. There were no complications. In 6 patients, the postoperative dialysis was performed at zero-day. One patient continued peritoneal dialysis. Patients were discharged on the 2nd day, except one with peritoneal dialysis, who was discharged on the 3rd day. Retroperitoneal laparoscopic bilateral native nephrectomy is a safe and effective technique, and it can be considered as an ideal approach for native nephrectomy. It allows for the preservation of peritoneal integrity and vessels for future vascular access.


Subject(s)
Humans , Male , Female , Adult , Aged , Nephrectomy , Retroperitoneal Space/surgery , Kidney Transplantation , Peritoneal Dialysis , Laparoscopy
7.
Int. braz. j. urol ; 45(6): 1144-1152, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1056343

ABSTRACT

ABSTRACT Background: Laparoscopic retroperitoneal simple nephrectomy (LRSN) has been widely accepted as a mainstay option for benign non-functioning kidney. The complexity of the procedure, however, differs and remains a subject of controversy. Objective: To develop a standardised Harbin Medical University nephrectomy score (HMUNS) system for evaluating LRSN complexity. Subjects and methods: A total of 6 variables with different factors comprising primary diseases, history of upper urinary tract surgery, body mass index (BMI), surgeon's learning curve, kidney volume, and Mayo Adhesive Probability (MAP) scores were included in the HMUN score. 95 consecutive patients who underwent LRSN at our institution were divided into low (2 to 6 points) and high (7 to 17 points) complexity groups with HMUNS and investigated the differences of operative time (OT), estimated blood loss (EBL), postoperative hospitalisation time (PHT), rate of intraoperative conversion to open surgery, and the Clavien-Dindo classification (CDC) between both groups. Results: Longer mean operative times (193.2±69.3 min vs. 151.9±46.3 min, p <0.05), more median estimated blood loss (100.0mL vs. 50.0mL, p <0.05), and higher rates of conversion to open surgery (1.2% vs. 25%, p <0.05) were observed in the high-complexity group (n=12) than in the low-complexity group (n=83). However, there were no remarkable differences between the two groups related to the baseline characteristics, post-surgical hospitalisation times, and postoperative complications. Conclusions: The HMUNS can effectively reflect LRSN complexity, thus providing a quantitative system for risk estimation and treatment decisions. Because of some limitations, further well-designed studies are necessary to confirm our findings. Patient summary: The HMUNS, including primary diseases, history of upper urinary tract surgery, BMI, surgeon's learning curve, kidney volume, and MAP score, can provide an effective quantitative tool to evaluate the complexity of LRSN.


Subject(s)
Humans , Male , Female , Adult , Aged , Laparoscopy/methods , Risk Assessment/methods , Nephrectomy/methods , Postoperative Complications , Reference Values , Retroperitoneal Space/surgery , Reproducibility of Results , Retrospective Studies , Risk Factors , Laparoscopy/standards , Statistics, Nonparametric , Operative Time , Length of Stay , Middle Aged , Nephrectomy/standards
8.
Rev. méd. Chile ; 147(10): 1266-1272, oct. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1058593

ABSTRACT

Background: CT-guided core biopsy is a widely used diagnostic technique for retroperitoneal lesions. Aim: To evaluate the diagnostic yield and safety of this procedure. Material and Methods: Review of medical records of 136 patients aged 57 ± 16 years (55% males) subjected to core biopsies performed between 2006 and 2016. Procedure images, biopsy reports and patients' medical charts were reviewed. Diagnostic yield was calculated in those patients whose final diagnosis was confirmed using strict criteria for malignancy. Results: A final diagnosis was confirmed in 122/136 patients. Of these, 110 had malignant lesions. The sensitivity and global accuracy of the procedure for malignancy were 93%. In only 4 of 13 benign lesions (31%), a specific diagnosis was obtained with the biopsy. Only minor complications were reported (6 small, self-contained hematomas). There were no major complications. Conclusions: CT-guided core biopsy of retroperitoneal lesions is a safe procedure, with an excellent diagnostic yield.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Retroperitoneal Neoplasms/pathology , Tomography, X-Ray Computed/methods , Image-Guided Biopsy/methods , Retroperitoneal Neoplasms/diagnosis , Retroperitoneal Space/pathology , Radiography, Interventional/methods , Chile , Cross-Sectional Studies , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity , Statistics, Nonparametric , Biopsy, Large-Core Needle/methods
9.
Rev. Assoc. Med. Bras. (1992) ; 65(5): 578-585, May 2019.
Article in English | LILACS | ID: biblio-1012969

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Laparoscopy/methods , Adrenalectomy/methods , Peritoneum/surgery , Retroperitoneal Space/surgery , Reproducibility of Results , Treatment Outcome , Laparoscopy/standards , Adrenal Gland Neoplasms/surgery , Adrenalectomy/standards
10.
Rev. Assoc. Med. Bras. (1992) ; 65(2): 100-104, Feb. 2019.
Article in English | LILACS | ID: biblio-990322

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Male , Female , Biopsy/methods , Laparoscopy/methods , Kidney/pathology , Kidney Diseases/pathology , Retroperitoneal Space , Tomography, Emission-Computed , Practice Guidelines as Topic , Kidney Diseases/diagnostic imaging
11.
Zagazig univ. med. j ; 25(6): 898-908, 2019. ilus
Article in English | AIM, AIM | ID: biblio-1273874

ABSTRACT

Background: Ultrasound (US)-guided transmuscular quadratus lumborum (TQL) block and oblique subcostal transversus abdominis plane (OSTAP) block are components of multimodal analgesia for abdominal surgeries.The aim of the study is to compare the analgesic efficacy of US-guided TQL block versus US-guided OSTAP block after upper abdominal surgeries.Methods: This prospective randomized study was conducted on 40 patients scheduled for elective open upper abdominal surgery under general anesthesia. Patients were randomly allocated into2groups; OSTAPGroup (20 patients) received US-guided OSTAP block, and TQL Group (20 patients) received US-guided TQL block. At the end of surgical procedure, while patients were still under general anesthesia, each group received 30 mL bupivacaine 0.25%. Postoperative measurements included pain scores, time to first opioid analgesic request, postoperative total opioid consumption, patient satisfaction, and complications.Results: Patients of TQL group had statistically significant lower 24 h postoperative total morphine consumption than patients of OSTAP group (13.25±2.88 mg and 20.10±3.21 mg, respectively,P < 0.001), and longer time to first opioid analgesic request (373.25±18.76 min. and 245.75±11.50 min., respectively,P < 0.001). Patients received TQL block had also statistically significant lower postoperative pain scores, less frequent morphine doses, and more patient satisfaction.Conclusion: US-guided TQL block is more effective postoperative analgesic modality than US-guided OSTAP block in patients undergoing elective open upper abdominal surgery under general anesthesia


Subject(s)
Abdominal Oblique Muscles , Retroperitoneal Space , Surgical Procedures, Operative
12.
Int. braz. j. urol ; 44(6): 1174-1181, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-975656

ABSTRACT

ABSTRACT Objective: To evaluate the safety and feasibility of total retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection for a tuberculous nonfunctional kidney. Materials and Methods: A total of 27 individuals diagnosed with unilateral nonfunctional kidney secondary to tuberculosis were treated between June 2011 and June 2015. All patients had normal renal function on the contralateral side and underwent the standard four-drug anti-tuberculosis treatment for at least four weeks before surgery. Total retroperitoneal laparoscopic nephroureterectomy was performed in all patients, and the urinary-bladder junction of distal ureter was managed using different auto-suture techniques. Results: Nineteen male and 8 female patients with an average age of 47.3 years (range, 36-64 years) underwent surgery. All the operations were successfully performed without conversion. The median operative time was 109.3 min (range, 75-138 min), the median blood loss was 157.5 mL (range, 70-250 mL), and the median hospitalization time was 3.7 days (range, 3-6 days). No serious perioperative complications occurred. Anti-tuberculosis chemotherapy was prescribed to all patients, with the entire course of treatment lasting six months. No recurrence of tuberculosis of the bladder or the contralateral kidney was observed during the median follow-up period of 26.7 months (range, 6-54 months). Conclusion: Retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection is a safe and feasible approach for the treatment of tuberculous non-functional kidneys.


Subject(s)
Humans , Male , Female , Adult , Tuberculosis, Renal/surgery , Laparoscopy/methods , Nephroureterectomy/methods , Retroperitoneal Space/surgery , Treatment Outcome , Operative Time , Middle Aged
13.
Oncol. (Guayaquil) ; 28(3): 232-240, 30 de Diciembre 2018.
Article in Spanish | LILACS | ID: biblio-1000439

ABSTRACT

Introducción: De los tumores de retroperitóneo, el liposarcoma es considerado de crecimiento rápido y gran porcentaje de recurrencia, los autores lo consideran una patología inusual. Los sarcomas retroperitoneales son poco comunes constituyen el 10 a 15% de todos los sarcomas y su incidencia anual está estimada en 2.7 casos por millón de habitantes. Se decide realizar el presente estudio debido a ser patología inusual, siendo el objetivo principal la importancia del manejo quirúrgico de este tipo de tumores gigantes retroperitoneales. Métodos: Estudio descriptivo, retrospectivo, longitudinal, realizado en el Hospital Abel Gilbert Pontón desde enero 2013 a diciembre 2017. Se realiza revisión de historias clínica de todos los pacientes que acudieron a consulta externa presentando masa abdominal. Se seleccionan aquellos con diagnóstico anatomopatológico de liposarcoma retroperitoneal gigante, con datos completos en su historial y con mínimo 2 controles por consulta externa. Resultados: la muestra estudiada fue de 4 pacientes intervenidos quirúrgicamente entre 40 y 65 años. Tumores entre 45 a 70 cm, 1 caso con compromiso a órganos vecinos. No se reportaron complicaciones. Recibieron el alta en promedio a las 2 semanas de operados Conclusión: La serie de casos revisada evidencia que el manejo adecuado de este tipo de patologías, es multidisciplinario, siendo la piedra angular el tratamiento quirúrgico.


Introduction: Of the retroperitoneal tumors, the liposarcoma is considered of fast growth and great percentage of recurrence, the authors consider it an unusual pathology. Retroperitoneal sarcomas are uncommon, accounting for 10 to 15% of all sarcomas, and their annual incidence is estimated at 2.7 cases per million inhabitants. It was decided to perform the present study due to its unusual pathology, the main objective being the importance of the surgical management of this type of giant retroperitoneal tumors. Methods: A descriptive, retrospective, longitudinal study was carried out at the Abel Gilbert Pontón Hospital from January 2013 to December 2017. A review of the clinical histories of all the patients who attended the outpatient clinic presenting abdominal mass was performed. Those with anatomopathological diagnosis of giant retroperitoneal liposarcoma are selected, with complete data in their history and with at least 2 controls by external consultation. Results: the sample studied was of 4 patients surgically intervened between 40 and 65 years. Tumors between 45 to 70 cm, 1 case with commitment to neighboring organs. No complications were reported. They were discharged on average 2 weeks after surgery. Conclusion: The series of cases reviewed shows that the proper management of this type of pathologies is multidisciplinary, being the cornerstone the surgical treatment.


Subject(s)
Humans , Retroperitoneal Neoplasms , Retroperitoneal Space , Liposarcoma , Sarcoma , Abdominal Neoplasms , Neoplasms
14.
Rev. argent. cir ; 110(2): 81-85, jun. 2018. ilus, tab
Article in Spanish | LILACS | ID: biblio-957898

ABSTRACT

Objetivo: comparar los resultados obtenidos en adrenalectomía retroperitoneoscópica posterior (ARP) con los obtenidos por vía transperitoneal lateral (ATL) a corto y mediano plazo. Material y métodos: estudio de cohortes prospectivo. Se incluyeron 22 pacientes a quienes se les realizaron 24 adrenalectomías (12 ARP y 12 ATL) entre los meses de enero de 2015 y mayo de 2016. En el grupo ARP se realizó a 1 paciente adrenalectomía bilateral simultánea y a 1 paciente, bilateral sincrónica. Fueron comparados datos basales, clínicos, quirúrgicos y evolutivos. Resultados: la mediana de tiempo de seguimiento fue de 6,5 meses (r 1-16). Los grupos ARP y ATL fueron comparables en edad, sexo, BMI y presencia de cirugías previas. Los adenomas fueron las lesiones predominantes (41,7% en cada grupo). El promedio de tiempo operatorio en ART y ATL fue 104,3 ± 21,2 y 146 ± 32,9 minutos, respectivamente (p 0,05). No hallamos diferencias en tiempo de internación, sangrado y complicaciones. Todos los pacientes lograron curación clínica. Conclusiones: la técnica ARP es una vía segura, con resultados comparables a ATL y menor tiempo operatorio. También permite intervenir de manera simultánea y sincrónica ambas glándulas adrenales sin necesidad de reposicionar al paciente.


Objetive: to compare the results of posterior retroperitoneoscopic (PRA) or lateral transperitoneal approach (LTA) in laparoscopic adrenalectomy in the short and medium term. Material y methods: prospective cohort study. We included 22 patients who underwent 24 adrenalectomies (12 PRA and 12 LTA) between January 2015 and May 2016. In the PRA group, two simultaneous bilateral laparoscopic adrenalectomies were performed (1 synchronous bilateral adrenalectomy). Baseline, clinical and surgical outcome were compared. Results: the median follow-up time was 6.5 months (range: 1-16). The PRA and LTA groups were comparable in age, gender, BMI and presence of previous surgeries. Adenomas were the predominant lesions (41.7% in each group). The average operating time in PRA and LTA was 104.3 ± 21.2 and 146 ± 32.9 minutes, respectively (p=0.05). We found no differences in length of hospital stay, bleeding and complications. All patients achieved clinical cure. Conclusions: the PRA technique is a safe approach, with results comparable to LTA and shorter operating time. It also allows to intervene simultaneously and synchronously both adrenal glands without the need of repositioning the patient.


Subject(s)
Humans , Female , Middle Aged , Aged , Retroperitoneal Space/surgery , Laparoscopy/methods , Adrenalectomy , Body Mass Index , Prospective Studies , Cohort Studies
15.
Int. braz. j. urol ; 44(1): 63-68, Jan.-Feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-892940

ABSTRACT

ABSTRACT Objectives The aim of our study is to present early outcomes of our series of retroperitoneal-RAPN (Robot Assisted Partial Nephrectomy). Materials and methods From September 2010 until December 2015, we performed 81 RAPN procedures (44 at left kidney and 37 at right). Average size was 3cm (1-9). Average PADUA score 7.1 (5-10). Average surgical time (overall and only robot time), ischemia time, blood loss, pathological stage, complications and hospital stay have been recorded. Results All of the cases were completed successfully without any operative complication or surgical conversion. Average surgical time was 177 minutes (75-340). Operative time was 145 minutes (80-300), overall blood loss was 142cc (60-310cc). In 30 cases the pedicle was late clamped with an average ischemia time of 4 minutes (2-7). None of the patient had positive surgical margins at definitive histology (49pT1a, 12pT1b, 3pT2a, 2pT3a). Hospital stay was 3 days (2-7). Conclusions The retroperitoneal robotic partial nephrectomy approach is safe and allows treatment of even quite complex tumors. It also combines the already well known advantages guaranteed by the da Vinci® robotic surgical system, with the advantages of the retroperitoneoscopic approach.


Subject(s)
Humans , Male , Female , Retroperitoneal Space/surgery , Robotic Surgical Procedures/methods , Kidney Neoplasms/surgery , Nephrectomy/methods , Treatment Outcome , Middle Aged
16.
Article in English | WPRIM | ID: wpr-715750

ABSTRACT

Abdominal compartment syndrome can produce a critical situation if not diagnosed early and managed properly. We report a case of abdominal compartment syndrome that was caused by massive irrigation of surgical fluid during endoscopic lumbar diskectomy at the L4–L5 level. There was a sudden increase in peak inspiratory pressure during the operation, and the patient's tidal volume and blood pressure decreased. When the patient's position was changed from prone to supine, abdominal distension and cyanosis of both lower extremities were discovered. Ultrasonic findings showed fluid collection in both the chest and intra-abdominal cavity. Thoracentesis and abdominal decompression surgery were performed, and the patient's overall state improved. We concluded that irrigation fluid used during the endoscopic operation leaked into the retroperitoneal space and caused abdominal compartment syndrome.


Subject(s)
Blood Pressure , Cyanosis , Diskectomy , Endoscopy , Intra-Abdominal Hypertension , Lower Body Negative Pressure , Lower Extremity , Retroperitoneal Space , Thoracentesis , Thorax , Tidal Volume , Ultrasonics
17.
ABCD arq. bras. cir. dig ; 31(2): e1379, 2018. graf
Article in English | LILACS | ID: biblio-949227

ABSTRACT

ABSTRACT Background : Acute pancreatitis is the third most common gastrointestinal disorder requiring hospitalization in the United States, with annual costs exceeding $2 billions. Severe necrotizing pancreatitis is a life-threatening complication developed in approximately 20% of patients. Its mortality rate range from 15% in patients with sterile necrosis to up 30% in case of infected one associated with multi-organ failure. Less invasive treatment techniques are increasingly being used. These techniques can be performed in a so-called step-up approach. Aim: To present the technique for videoscopic assisted retroperitoneal debridement (Vard technique) with covered metallic stent in necrotizing pancreatitis. Method: A guide wire was inserted through the previous catheter that was removed in the next step. Afterwards, the tract was dilated over the guide wire. Then, a partially covered metallic stent was deployed. A 30 degrees laparoscopic camera was inserted and the necrosis removed with forceps through the expanded stent under direct vision. Finally, the stent was removed and a new catheter left in place. Result : This technique was used in a 31-year-old man with acute pain in the upper abdomen and diagnosed as acute biliary pancreatitis with infected necrosis. He was treated with percutaneous drains at weeks 3, 6 and 8. Due to partial recovery, a left lateral VARD was performed (incomplete by fixed and adherent tissue) at 8th week. As the patient´s inflammatory response was reactivated, a second VARD attempt was performed in three weeks later. Afterwards, patient showed complete clinical and imaging resolution. Conclusions : Videoassisted retroperitoneal necrosectomy using partially covered metallic stent is a feasible technique for necrotizing pancreatitis.


RESUMO Racional: A pancreatite aguda é a terceira doença gastrointestinal mais comum que requer hospitalização nos Estados Unidos, com custos anuais superiores a $ 2 bilhões. A pancreatite necrosante grave é uma complicação potencialmente fatal, desenvolvida em aproximadamente 20% dos pacientes. A taxa de mortalidade varia de 15% em pacientes com necrose estéril para 30% no caso de uma infecção infectada com falência multiorgânica. As técnicas de tratamento menos invasivas são cada vez mais utilizadas. Elas podem ser realizadas em uma abordagem chamada "step-up". Objetivo: Apresentar a técnica de desbridamento retroperitoneal assistido com videografia (técnica VARD) com stent metálico coberto em pancreatite necrosante. Método: Um fio guia é inserido através do cateter anterior que foi removido no próximo passo. Depois, o trajeto é dilatado sobre o fio guia. Em seguida, um stent metálico parcialmente coberto é implantado. Uma câmera laparoscópica de 30º é inserida e a necrose removida com fórceps através do stent expandido sob visão direta. Finalmente, o stent é removido e um novo cateter deixado no lugar. Resultado: Esta técnica foi utilizada em um homem de 31 anos com dor aguda na parte superior do abdome e diagnosticado como pancreatite biliar aguda com necrose infectada. Ele foi tratado com drenos percutâneos nas semanas 3, 6 e 8. Devido à recuperação parcial, realizou-se um VARD lateral esquerdo (incompleto por tecido fixo e aderente) na 8ª semana. À medida que a resposta inflamatória do paciente foi reativada, uma segunda tentativa VARD foi realizada em três semanas mais tarde. Posteriormente, o paciente apresentou resolução clínica e de imagem completa. Conclusão: A necrosectomia retroperitoneal assistida em vídeo com stent metálico parcialmente coberto é uma técnica viável para pancreatite necrosante.


Subject(s)
Humans , Male , Adult , Stents , Pancreatitis, Acute Necrotizing/surgery , Debridement/methods , Prosthesis Design , Retroperitoneal Space , Video Recording , Laparoscopy , Surgery, Computer-Assisted
18.
J. coloproctol. (Rio J., Impr.) ; 37(4): 323-327, Oct.-Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-894001

ABSTRACT

ABSTRACT Abscesses are a rare complication of transanal minimally invasive surgery and transanal endoscopic micro surgery. Reported cases have been in the rectal and pre-sacral areas and have been managed with either antibiotics alone or in conjunction with laparotomy and diverting colostomy. We report a case of a large retroperitoneal abscess following a Transanal minimally invasive surgery full thickness rectal polyp excision. The patient was successfully managed conservatively with antibiotics and a percutaneous drain. Retroperitoneal infection should be included in a differential diagnosis following a Transanal minimally invasive surgery procedure as the presentation can be insidious and timely intervention is needed to prevent further morbidity.


RESUMO Os abscessos são uma complicação rara da cirurgia de ressecção transanal minimamente invasiva (TAMIS) e da micro cirurgia endoscópica transanal (TEMS). Os casos notificados foram nas áreas rectal e pré-sacral e foram administrados com antibióticos isoladamente ou em conjunto com laparotomia e desvio de colostomia. Relatamos um caso de grande abscesso retroperitoneal após uma excisão de pólipo retal de espessura total TAMIS. O paciente foi tratado com sucesso com a administração de antibióticos e drenagem percutânea. Para prevenir mais morbidade é necessária incluir a infecção retroperitoneal no diagnostico diferencial após um procedimento TAMIS onde a apresentação pode ser insidiosa e a intervenção atempada.


Subject(s)
Humans , Male , Middle Aged , Retroperitoneal Space/physiopathology , Abscess , Transanal Endoscopic Surgery/adverse effects
19.
Rev. chil. cir ; 69(5): 416-420, oct. 2017. ilus
Article in Spanish | LILACS | ID: biblio-899627

ABSTRACT

Resumen Introducción: El hematoma retroperitoneal (HR) es una enfermedad infrecuente con una elevada morbimortalidad, siendo complicado cuando se presenta con dolor y shock hipovolémico. Presentación del caso: Paciente del sexo masculino, de 20 años de edad, sin antecedentes mórbidos. Ingresa en Urgencias por dolor abdominal en el flanco izquierdo, irradiado a dorso y testículo ipsilateral, de 6 h de evolución, de inicio súbito e intensidad severa; el paciente está pálido, hemodinámicamente estable, sin signos de irritación peritoneal. Se solicita pielo-TC por sospecha de litiasis ureteral, que muestra un extenso HR, probable aneurisma aórtico roto. Una angio-TC informa HR adyacente y anterior a psoasilíaco izquierdo, de20 × 11 × 8,5 cm, volumen 972 cc, adenopatías retroperitoneales paraaórticas bilaterales sangrantes y múltiples nódulos pulmonares bilaterales indicativos de diseminación secundaria. Se constata testículo derecho duro, de tamaño normal, eco testicular con masa sólida quística, que indica de lesión orgánica. Discusión: Trauma y enfermedad tumoral son las principales causas de HR. El cáncer testicular suele presentarse en pacientes jóvenes, requiriendo una pronta derivación y estudio debido a su rápida progresión. En nuestro caso, el HR fue un hallazgo imagenológico, destacando que el sangrado de un conglomerado de adenopatías es anecdótico.


Abstract Introduction: Retroperitoneal hematoma (RH) is a rare disease with high morbidity, being complicated when presented with pain and hypovolemic shock. Case report: Male, 20 years old, no morbid history. Arrive to Emergency Service for abdominal pain in the left flank radiating to the back and ipsilateral testis, 6 h of evolution, sudden onset, high intensity; pacient pale, hemodynamically stable without signs of peritoneal irritation. Pielo-TC is requested on suspicion of ureteral stones showing extensive RH, likely ruptured aortic aneurysm. CT angiography reports RH and adjacent preceding left iliopsoas, 20 × 11 × 8.5 cm, volume 972 cc, retroperitoneal bleeding bilateral para-aortic lymphadenopathy and multiple bilateral pulmonary nodules suggestive of secondary spread. Hard right testicle with normal size, testicular ultrasound pointing solid cystic mass, suggestive of organic lesion. Discussion: Trauma and tumor pathology are the main causes of RH. Testicular cancer usually occurs in young patients, requiring early referal and study because of its rapid progression. In our case, the HR was an imaging finding, highlighting that the bleeding of a cluster of lymph nodes is anecdotal.


Subject(s)
Humans , Male , Young Adult , Retroperitoneal Space , Testicular Neoplasms/complications , Carcinoma, Embryonal/complications , Hematoma/etiology , Hematoma/diagnostic imaging , Testicular Neoplasms/therapy , Testicular Neoplasms/diagnostic imaging , Abdominal Pain/etiology , Carcinoma, Embryonal/therapy , Carcinoma, Embryonal/diagnostic imaging , Computed Tomography Angiography
20.
Rev. bras. anestesiol ; 67(5): 548-551, Sept-Oct. 2017. graf
Article in English | LILACS | ID: biblio-897753

ABSTRACT

Abstract A 68 year-old male patient was hospitalized for radical prostatectomy. He had no abnormal medical history including neurological deficit before the operation. Prior to general anesthesia, an epidural catheter was inserted in the L3-4 interspace for intraoperative and postoperative analgesia. After surgery for nine hours, he developed confusion and flaccid paralysis of bilateral lower extremities occurred. No pathology was detected from cranial computed tomography and diffusion magnetic resonance imaging no pathology was detected. His thoracic/lumbar magnetic resonance imaging. Intraabdominal pressure was shown to be 25 mmHg, and abdominal ultrasonography revealed progression in the inflammation/edema/hematoma in the perirenal region. The Bromage score was back to 1 in the right foot on the 24th hour and in the left foot on the 26th hour. Paraplegia developed in patients after epidural infusion might be caused by potentiated local anesthetic effect due to retroperitoneal hematoma and/or elevated intra-abdominal pressure.


Resumo Paciente do sexo masculino, 68 anos, hospitalizado para prostatectomia radical. O paciente não tinha história médica anormal, inclusive nem déficit neurológico, antes da operação. Antes da anestesia geral, um cateter peridural foi inserido no espaço intermédio L3-4 para analgesia no intra e pós-operatório. Após a cirurgia, que durou nove horas, o paciente desenvolveu confusão e paralisia flácida bilateral dos membros inferiores. Tomografia computadorizada de crânio e imagem de difusão por ressonância magnética não detectaram lesão. Os achados nas imagens de ressonância magnética torácica/lombar eram normais. A pressão intra-abdominal era de 25 mmHg e o ultrassom abdominal revelou progressão de inflamação/edema/hematoma na região perirrenal. O escore de Bromage voltou a 1 no pé direito na 24a hora e no pé esquerdo na 26a hora. A paraplegia desenvolvida nos pacientes após a infusão epidural pode ter sido causada por um efeito potencializado do anestésico local devido a hematoma retroperitoneal e/ou pressão intra-abdominal elevada.


Subject(s)
Humans , Male , Aged , Paralysis/etiology , Postoperative Complications , Prostatectomy , Sensation Disorders/etiology , Hematoma/complications , Anesthesia, Epidural/adverse effects , Retroperitoneal Space , Hematoma/etiology
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