Subject(s)
Mesenteric Ischemia , Mesenteric Vascular Occlusion , Thrombosis , Humans , Mesenteric Veins/diagnostic imaging , Mesenteric Veins/surgery , Mesenteric Ischemia/diagnostic imaging , Mesenteric Ischemia/etiology , Mesenteric Ischemia/surgery , Mesenteric Vascular Occlusion/diagnostic imaging , Mesenteric Vascular Occlusion/etiology , Mesenteric Vascular Occlusion/surgery , Thrombosis/etiologyABSTRACT
BACKGROUND: Despite the acceptance of the laparoscopic approach for the treatment of perforated peptic ulcers, its definitive implantation is still a matter of discussion. We performed a comparative study between the open and laparoscopic approach focused on postoperative surgical complications. METHODS: Retrospective observational study in which patients operated on for perforated peptic ulcus in our center between 2001 and 2017 were analyzed. Only those in whom suture and/or omentoplasty had been performed were selected, either for open or laparoscopic approach. Demographic, clinical, and intraoperative variables, complications, mortality and length of stay were collected. Both groups, open and laparoscopic surgery patients, were compared. RESULTS: The final study sample was 250 patients, 190 (76%) men and 60 (24%) women, mean age 54 years (SD ± 16.7). In 129 cases (52%), the surgical approach was open, and in 121 (48%) it was laparoscopic. Grades III-V complications of the Clavien-Dindo Classification occurred in 23 cases (9%). Operative mortality was 1.2% (3 patients). Laparoscopically operated patients had significantly fewer complications (p = 0.001) and shorter hospital stay (p < 0.001). In multivariate analysis, laparoscopic approach (p = 0.025; OR:0.45-95%CI: 0.22-0.91), age (p = 0.003; OR:1.03-95%CI: 1.01-1.06), and Boey score (p = 0.024 - OR:1.71 - CI95%: 1.07-2.72), were independent prognostic factors for postoperative surgical complications. CONCLUSION: Laparoscopic surgery should be considered the first-choice approach for patients with perforated peptic ulcer. It is significantly associated with fewer postoperative complications and a shorter hospital stay than the open approach.
Subject(s)
Laparoscopy , Peptic Ulcer Perforation , Female , Humans , Laparoscopy/adverse effects , Length of Stay , Male , Middle Aged , Peptic Ulcer Perforation/surgery , Postoperative Complications/etiology , Retrospective Studies , Treatment OutcomeABSTRACT
The management and prognosis of benign esophageal strictures differ from those of malignant strictures. Distinguishing between the two entities may occasionally be challenging, despite endoscopy and biopsies. The consequences of erroneous treatment may be fatal. We review this topic in a patient who required an emergency esophagectomy following a perforation after dilation due to a peptic stricture, which concealed an esophageal cancer.
Subject(s)
Esophageal Neoplasms , Esophageal Perforation , Esophageal Stenosis , Constriction, Pathologic , Dilatation , Esophageal Neoplasms/complications , Esophageal Neoplasms/surgery , Esophageal Perforation/diagnostic imaging , Esophageal Perforation/etiology , Esophageal Perforation/surgery , Esophageal Stenosis/diagnostic imaging , Esophageal Stenosis/etiology , Esophageal Stenosis/surgery , Humans , Neoplasm Recurrence, LocalABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Intestinal Obstruction/diagnostic imaging , Intestinal Obstruction/etiology , Hernia, Diaphragmatic/complications , Hernia, Diaphragmatic/diagnostic imaging , Intestinal Obstruction/pathology , Radiography, Thoracic , Laparoscopy/methodsABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Adenocarcinoma/surgery , Anastomosis, Surgical/adverse effects , Anastomotic Leak/surgery , Adenocarcinoma/complications , Endosonography , Esophageal Neoplasms/surgery , Foreign-Body Migration/diagnostic imaging , Postoperative Complications/diagnostic imaging , Stents/adverse effects , Anastomotic Leak/etiology , Device Removal , Esophageal Neoplasms/complications , Foreign-Body Migration/therapy , Gastroscopy , Magnetic Resonance Imaging , Pancreatitis/diagnostic imaging , Pancreatitis/etiology , Postoperative Complications/therapy , Tomography, X-Ray Computed/methodsABSTRACT
A 75-year-old male who underwent an Ivor Lewis esophagectomy due to a distal adenocarcinoma had a leak at the gastroplasty on the 5th day after surgery, which required two surgeries and a primary suture. He was transferred to our hospital due to a poor outcome and endoscopy revealed a 2.5cm gap perianastomotically on the gastroplasty wall, for which a stent was placed. Due to hemodynamic impairment, a thoracotomy procedure was performed, which revealed stent protrusion into the cavity. The patient underwent an esophagogastric anastomosis resection, cervical esophagostomy and gastrostomy. Sepsis was resolved postoperatively and the patient had a protracted stay in the PACU due to poor respiratory dynamics following a prolonged intubation.
