ABSTRACT
OBJECTIVE: This article tests the protective effect of a commercially available mixture of hyaluronic acid, chondroitin sulfate, and poloxamer 407 on the damage caused by the exposure of esophageal mucosa to button batteries in an animal model. METHODS: Experimental study. Sixty porcine esophageal samples were distributed in three groups: control (CG), exposure (EG), and exposure-protection (EPG). In EG and EPG, one CR2032 button battery per sample was inserted, both were subdivided into 2-, 4-, 6-, and 24-hour exposure subgroups, with subsequent battery removal. EPG samples were irrigated with the solution 1 hour after battery exposure. Esophageal pH and final voltage of the battery were measured. RESULTS: pH in CG remained stable. No significant differences in pH at 1 hour were found between EG and EPG. In EPG, the pH of the mucosa exposed to the anode was lower than in GE at 2 hours (12.44 vs. 11.89, p = 0.203) and 4 hours (13.78 vs. 11.77, p < 0.0001). In the cathode pH was significantly higher in EG at 2 hours (2.5 vs. 4.11, p < 0.0001), 4 hours (2.33 vs. 4.78, p < 0.0001), and 6 hours (2.17 vs. 2.91, p < 0.0001). Significant voltage reduction at 1 hour was found in EG compared to EPG (0.48 vs. 1.08 V, p = 0.004). CONCLUSION: Exposure to hyaluronic acid solution buffers the acidification on the side exposed to the cathode and basification on the anode. This effect can be maintained up to 3 to 5 hours, even after stopping its application. Our results suggest that a solution containing hyaluronic acid could be used as an esophageal protector after accidental ingestion of button batteries.
Subject(s)
Foreign Bodies , Hyaluronic Acid , Animals , Swine , Esophagus/surgery , Electric Power SuppliesABSTRACT
INTRODUCTION: Acute appendicitis is the most frequent cause of acute abdomen in children. The objective of this study was to analyze the causes, approach, and results of complications requiring surgery following appendectomy. MATERIAL AND METHODS: A retrospective study of the appendectomies conducted in three third-level institutions from 2015 to 2019 was carried out. Complications, causes, and number of re-interventions, time from one surgery to another, surgical technique used, operative findings at baseline appendectomy according to the American Association for the Surgery of Trauma (AAST) classification, and hospital stay were collected. RESULTS: 3,698 appendicitis cases underwent surgery, 76.7% of which laparoscopically, with 37.2% being advanced (grades II-V of the AAST classification). Mean operating time was 50.4 minutes (49.8 ± 20.1 for laparoscopy vs. 49.9 ± 20.1 for open surgery, p > 0.05), and longer in patients requiring re-intervention (68.6 ± 27.2 vs. 49.1 ± 19.3, p < 0.001). 76 re-interventions (2.05%) were carried out. The causes included postoperative infection (n = 46), intestinal obstruction (n = 20), dehiscence (n = 4), and others (n = 6). Re-intervention risk was not impacted by the baseline approach used (open surgery or laparoscopy, OR: 1.044, 95% CI: 0.57-1.9), but it was by appendicitis progression (7.8% advanced vs. 0.7% incipient, OR: 12.52, 95% CI: 6.18-25.3). There was a tendency to use the same approach both at baseline appendectomy and re-intervention. This occurred in 72.2% of laparoscopic appendectomies, and in 67.7% of open appendectomies. The minimally invasive approach (50/76) was more frequent than the open one (27 laparoscopies and 23 ultrasound-guided drainages vs. 26 open surgeries) (p < 0.05). 55% of obstruction patients underwent re-intervention through open surgery (p > 0.05). CONCLUSION: Re-intervention rate was higher in advanced appendicitis cases. In this series, the minimally invasive approach (laparoscopic or ultrasound-guided drainage) was the technique of choice for re-interventions.
INTRODUCCION: La apendicitis aguda es la causa más frecuente de abdomen agudo en niños. El objetivo de este trabajo es estudiar las causas, abordaje y resultados de las complicaciones que requieren intervención quirúrgica después de la apendicectomía. MATERIAL Y METODOS: Estudio retrospectivo de las apendicectomías realizadas en 3 centros de tercer nivel entre 2015-2019. Se recogieron las complicaciones, causas y número de reintervenciones, intervalo entre ambas cirugías, técnica empleada, hallazgos operatorios según la Clasificación de la American Association for the Surgery of Trauma (AAST) en la apendicectomía inicial y tiempo de ingreso. RESULTADOS: Se intervinieron 3.698 apendicitis, un 76,7% por vía laparoscópica, encontrando un 37,2% evolucionadas (grado II-V de la clasificación AAST). El tiempo medio quirúrgico fue de 50,4 minutos (laparoscopia 49,8 ± 20,1 vs. laparotomía 49,9 ± 20,1, p > 0,05), superior en aquellos pacientes que requirieron reintervención (68,6 ± 27,2 vs. 49,1 ± 19,3, p < 0,001). Se realizaron 76 reintervenciones (2,05%). Las causas fueron: infección postoperatoria (n = 46), obstrucción intestinal (n = 20), dehiscencia (n = 4) y otras (n = 6). El abordaje inicial no influyó en el riesgo de reintervención (laparotomía o laparoscopia, OR 1,044, IC 95% 0,57-1,9), pero sí el grado de evolución de la apendicitis (7,8% evolucionadas vs. 0,7% incipientes, OR 12,52, IC 95% 6,18-25,3). Hubo una tendencia a reintervenir por el mismo abordaje que la apendicectomía, esto ocurrió en un 72,2% de las apendicectomías laparoscópicas y en un 67,7% de las apendicectomías abiertas. El abordaje mínimamente invasivo (50/76) fue más frecuente que la laparotomía (27 laparoscopias y 23 drenajes ecoguiados frente a 26 laparotomías) (p < 0,05). El 55% de los pacientes obstruidos se reintervinieron por vía abierta (p > 0,05). CONCLUSION: El índice de reintervención fue superior en las apendicitis evolucionadas. En esta serie, el abordaje mínimamente invasivo (laparoscópico o drenaje ecoguiado) fue la técnica de elección en las reintervenciones.
Subject(s)
Appendicitis , Laparoscopy , Appendectomy/methods , Appendicitis/surgery , Child , Humans , Laparoscopy/methods , Length of Stay , Retrospective StudiesABSTRACT
Introducción: La apendicitis aguda es la causa más frecuente deabdomen agudo en niños. El objetivo de este trabajo es estudiar lascausas, abordaje y resultados de las complicaciones que requieren in-tervención quirúrgica después de la apendicectomía.Material y métodos: Estudio retrospectivo de las apendicectomíasrealizadas en 3 centros de tercer nivel entre 2015-2019. Se recogieronlas complicaciones, causas y número de reintervenciones, intervalo entreambas cirugías, técnica empleada, hallazgos operatorios según la Clasi-ficación de la American Association for the Surgery of Trauma (AAST)en la apendicectomía inicial y tiempo de ingreso.Resultados: Se intervinieron 3.698 apendicitis, un 76,7% por víalaparoscópica, encontrando un 37,2% evolucionadas (grado II-V de laclasificación AAST). El tiempo medio quirúrgico fue de 50,4 minutos(laparoscopia 49,8 ± 20,1 vs. laparotomía 49,9 ± 20,1, p > 0,05), superioren aquellos pacientes que requirieron reintervención (68,6 ± 27,2 vs.49,1 ± 19,3, p < 0,001).Se realizaron 76 reintervenciones (2,05%). Las causas fueron: infec-ción postoperatoria (n = 46), obstrucción intestinal (n = 20), dehiscencia(n = 4) y otras (n = 6). El abordaje inicial no influyó en el riesgo dereintervención (laparotomía o laparoscopia, OR 1,044, IC 95% 0,57-1,9),pero sí el grado de evolución de la apendicitis (7,8% evolucionadas vs.0,7% incipientes, OR 12,52, IC 95% 6,18-25,3).Hubo una tendencia a reintervenir por el mismo abordaje que laapendicectomía, esto ocurrió en un 72,2% de las apendicectomías lapa-roscópicas y en un 67,7% de las apendicectomías abiertas. El abordajemínimamente invasivo (50/76) fue más frecuente que la laparotomía(27 laparoscopias y 23 drenajes ecoguiados frente a 26 laparotomías)(p < 0,05). El 55% de los pacientes obstruidos se reintervinieron porvía abierta (p > 0,05).
Introduction: Acute appendicitis is the most frequent cause ofacute abdomen in children. The objective of this study was to analyzethe causes, approach, and results of complications requiring surgeryfollowing appendectomy.Materials and methods: A retrospective study of the appendecto-mies conducted in three third-level institutions from 2015 to 2019 wascarried out. Complications, causes, and number of re-interventions, timefrom one surgery to another, surgical technique used, operative findingsat baseline appendectomy according to the American Association forthe Surgery of Trauma (AAST) classification, and hospital stay werecollected.Results: 3,698 appendicitis cases underwent surgery, 76.7%of which laparoscopically, with 37.2% being advanced (grades II-Vof the AAST classification). Mean operating time was 50.4 min-utes (49.8 ± 20.1 for laparoscopy vs. 49.9 ± 20.1 for open surgery,p > 0.05), and longer in patients requiring re-intervention (68.6 ± 27.2vs. 49.1 ± 19.3, p < 0.001).76 re-interventions (2.05%) were carried out. The causes includedpostoperative infection (n = 46), intestinal obstruction (n = 20), dehis-cence (n = 4), and others (n = 6). Re-intervention risk was not impactedby the baseline approach used (open surgery or laparoscopy, OR: 1.044,95% CI: 0.57-1.9), but it was by appendicitis progression (7.8% ad-vanced vs. 0.7% incipient, OR: 12.52, 95% CI: 6.18-25.3).There was a tendency to use the same approach both at baseline ap-pendectomy and re-intervention. This occurred in 72.2% of laparoscopicappendectomies, and in 67.7% of open appendectomies. The minimallyinvasive approach (50/76) was more frequent than the open one (27laparoscopies and 23 ultrasound-guided drainages vs. 26 open surger-ies) (p < 0.05). 55% of obstruction patients underwent re-interventionthrough open surgery (p > 0.05).
