ABSTRACT
BACKGROUND: Since it's description in 1923, Hartmann's procedure is widely used for the surgical treatment of acute left colonic complications when preoperative bowel lavage is not feasible and/or there is high risk of anastomotic dehiscence. OBJECTIVE: Analyze the results of Hartmann's operation in the surgical treatment of consecutive patients at a single institution during a 30-month interval. TYPE OF STUDY: Prospective, non-randomized and longitudinal study. MATERIAL AND METHODS: Patients treated with the Hartmann procedure between March 1995 and September 1998. Surgical indication, intraoperative findings, morbidity and mortality were analyzed as well as the rate of reestablishment of bowel continuity and it's morbimortality. RESULTS: Ninety-two patients underwent a Hartmann procedure. The mean patient's age was 60 +/- 25 years (range of 21 to 88 years) and 60% were older than 65 years. An emergency operation was carried out in 91% of the cases. Most of the patients had intra-abdominal sepsis (56%) and benign colonic process (83%). The morbidity rate was 34% and mortality rate 19. During follow-up the bowel continuity was reestablished in 32% of the cases without fatalities. CONCLUSIONS: Hartmann's procedure is a good option for non-elective surgical treatment complicated rectosigmoid pathology. The morbidity and mortality of the operation are highly dependent on the degree of preoperative sepsis and the patient's preexisting condition. The rate of reestablishment of bowel continuity was low probably because of short follow-up.
Subject(s)
Colon/surgery , Colonic Diseases, Functional/surgery , Digestive System Surgical Procedures , Adult , Aged , Aged, 80 and over , Female , Humans , Longitudinal Studies , Male , Middle AgedABSTRACT
BACKGROUND: The reinstitution of oral intake in patients who have undergone intraabdominal surgery has traditionally progressed in a stepwise fashion beginning with clear liquids, liquid diet and after an adequate tolerance regular diet. OBJECTIVE: To determine if the reinstitution of oral intake after major abdominal surgery with regular diet offers benefits into which it's not harmful for patients and reduce the in-hospital stay. TYPE OF STUDY: Prospective, randomized, open study conducted between October 1996 to May 1997. MATERIAL AND METHODS: Patients aged 18 and older submitted to elective or urgent surgery of the abdomen and pelvis were included with the exception of: bariatric surgery, esophageal resection, pyloroplasty, pancreato-duodenal resection, laparoscopic surgery and patients under ventilatory support or with enteral or parenteral nutrition. As soon as postoperative ileus disappeared patients were randomly assigned to receive regular diet (group 1) or clear liquids (group 2) as the first oral intake. Oral diet tolerance was evaluated as well as the caloric and protein intake, the in-hospital stay and the cost. RESULTS AND MEASUREMENTS: Group 1 was conformed by 63 patients, and group 2 for 69 patients. There was no difference between, sex, age, kind of surgery (elective or emergency) and the type of pathology. 96.6% of patients in group 1 tolerated regular diet and 96.9% of patients in group 2 tolerated clear liquids. Only two patients of each group required oral intake suspension. The in-hospital stay was 2.6 +/- 2.0 days in group 1 against 3.4 +/- 2.6 in group 2 (P = < 0.005), the cost of the in-hospital stay period after the beginning of oral intake was 2726 +/- 2107 pesos in group 1 against 3547 +/- 2690 in group 2 (P = < 0.005), the caloric and protein intake were 1307 +/- 523 Kcals with 55.9 +/- 23.2 grams of proteins in group 1 and 651 +/- 204 Kcals and 0 grams of proteins in group 2 (P = < 0.00001). CONCLUSIONS: No difference was found in adverse reactions with the use of regular diet as the first meal. The in-hospital stay and the cost were reduced significantly and the calories and grams of proteins are higher in group 1. These results suggest that the routine use of clear liquids as the initial postoperative diet may be unnecessary and nutritionally suboptimal when compared with regular diet.
Subject(s)
Diet , Postoperative Care , Abdomen/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Dietary Proteins/administration & dosage , Emergencies , Energy Intake , Female , Humans , Length of Stay , Male , Middle Aged , Prospective StudiesSubject(s)
Cysts/surgery , Liver Diseases/surgery , Adult , Cysts/congenital , Cysts/diagnosis , Female , Humans , Liver Diseases/congenital , Liver Diseases/diagnosis , Male , Middle Aged , Postoperative ComplicationsABSTRACT
Se presenta el informe de siete casos de quiste de coledoco estudiados en el Hospital de Especialidades del Centro Medico de Occidente de 1977 a la fecha con predominio en sexo femenino con edades de 12 a 45 anos. Se analizan las caracteristicas clinicas y patologicas de las cuatro variedades de quiste de coledoco de acuerdo con la clasificacion de Longmire asi como la utilidad de los diferentes metodos diagnosticos. La colangiografia percutanea fue el metodo diagnostico de mayor seguridad seguido del sonograma. Se diagnosticaron cinco quistes de coledoco tipo I, un quiste tipo IV, y un quiste tipo III, este ultimo es la variedad mas rara y consideramos que es el decimo reporte en la literatura mundial. La cistoyeyunoanastomosis se practico en seis pacientes y en uno se reseco parcialmente el quiste reconstruyendose con asa de yeyuno. No hubo mortalidad todos los pacientes estan asintomaticos a la fecha
