RESUMO
Laparoscopic ventral hernia repair is currently the subject of intense debate, even though it provides a series of advantages over open surgery and is feasible and safe. Various studies have shown this technique to be as effective as open repair with a lower recurrence rate. Despite the excellent results of laparoscopic repair of ventral hernias, there are numerous controversies associated with this procedure. These controversies concern the indications and contraindications of the procedure, and technical aspects such as how to create the pneumoperitoneum, perform adhesiolysis, manage the hernia sac, and insert and fix the mesh to the anterior abdominal wall. Also controversial are outcome, complications related to postoperative seroma, and which type and size of mesh should be used. The present article aims primarily to address many of these issues, based on the experience of distinct surgeons with expertise in this approach, in order to provide data to establish a consensus on how laparoscopic ventral hernia repair should be performed.
Assuntos
Hérnia Ventral/cirurgia , Laparoscopia/métodos , Humanos , Cuidados Pós-OperatóriosRESUMO
The effectiveness of a therapeutic protocol, using 15,000 to 22,500 IU/day of heparin by subcutaneous injection, to treat the distal postoperative vein thrombosis on the lower limb, was evaluated. The study was made on 427 patients, which were analyzed by the Fibrinogen I125 marked accumulation test, to give an early diagnostic and follow-up of their thrombosis (thrombus lysis, stabilization or expansion). Treatment made, showed its efficacy preventing from proximal expansion, as well as avoiding pulmonary embolism and postphlebitic syndrome. Its cost is lower than other therapeutic option's costs, and it doesn't extend the hospital stay.
Assuntos
Heparina/uso terapêutico , Complicações Pós-Operatórias/tratamento farmacológico , Terapia Trombolítica , Tromboflebite/tratamento farmacológico , Adulto , Esquema de Medicação , Avaliação de Medicamentos , Heparina/administração & dosagem , Humanos , Complicações Pós-Operatórias/prevenção & controle , Síndrome Pós-Flebítica/etiologia , Síndrome Pós-Flebítica/prevenção & controle , Embolia Pulmonar/etiologia , Embolia Pulmonar/prevenção & controle , Tromboflebite/complicações , Tromboflebite/prevenção & controleRESUMO
An evaluation was made of the participation of residents in appendicular surgery as compared to staff surgeons, the evolution of results over the residency period and the influence of the presence of experienced surgeons together with residents during the emergency operation. Seven groups were made according to the surgeons involved. Parietal, intraabdominal and general complications of each group were quantitated, as well as postoperative hospitalization and mortality. Statistical study revealed similar results for the different groups.