RESUMO
A multicenter retrospective study was performed of laparoscopic colon surgery. Thirty unselected patients underwent a variety of procedures including right hemicolectomy (11), sigmoid and left colectomy (7), takedown of sigmoid colostomies (8), low anterior resection (2), AP resection (1), and colotomy (1). The conversion rate from laparoscopic to open was 10 per cent. Comparisons were made between this group and institutional controls for cost and lymph node harvest. Operating technique is discussed. Lymph node harvest was comparable with open procedures. Postoperative length of stay averaged 8.3 days. Hospital costs were $11,010 compared with an institutional norm of $13,050. Major variations in costs were between institutions rather than surgeons or techniques and correlated as well with postoperative length of stay. An anatomically equivalent oncologic resection was able to be performed with an acceptable morbidity (24%) and mortality (0%).
Assuntos
Colo/cirurgia , Laparoscopia , Carcinoma/cirurgia , Colectomia/métodos , Colo Sigmoide/cirurgia , Neoplasias do Colo/cirurgia , Colostomia , Custos Hospitalares , Hospitais Comunitários/economia , Hospitais de Ensino/economia , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação , Excisão de Linfonodo , Reto/cirurgia , Estudos Retrospectivos , Fatores de TempoRESUMO
Arterial insufficiency distal to an antecubital access is fortunately an infrequent but disturbing and often debilitating complication resulting in suboptimal access. During an 8 1/2-year period, 335 vascular access procedures were performed, 108 of which were antecubital brachiocephalic Gore-Tex conduits. Of these Gore-Tex conduits, 1.8% (2/108) had developed symptoms of vascular insufficiency 2 to 3 1/2 months after such access surgery. As previously published, arterial steal after the creation of an AV fistula could be corrected by the placement of an interposition Gore-Tex loop that would cure the problem and save the access. We have presented a procedure to correct a steal syndrome once a Gore-Tex conduit is already in place. Proximal banding and distal ligation with division of the cephalic vein below an end-to-side Gore-Tex loop is a simple surgical solution. It is not only curative but the procedure also maintains the existing Gore-Tex graft as a sustained avenue for access.
