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1.
J Crohns Colitis ; 14(6): 726-733, 2020 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31637417

RESUMO

BACKGROUND: The transanal approach to ileal pouch-anal anastomosis [Ta-IPAA] provides better access to the lower pelvis with lower short-term morbidity in ulcerative colitis [UC]. The aim of this study was to assess the long-term functional outcomes after Ta-IPAA vs transabdominal IPAA [Abd-IPAA] in UC. METHODS: A multicentre cohort analysis was performed between March 2002 and September 2017. Patient characteristics, surgical details and postoperative outcomes were compared. CGQL [Cleveland global quality of life] score at 12 months with a functioning pouch was considered the primary end point. RESULTS: A total of 374 patients [100 Ta-IPAA vs 274 Abd-IPAA] were included. Ta-IPAA demonstrated a comparable overall quality of life [CGQL score] to Abd-IPAA [0.75 ± 0.11 vs 0.71 ± 0.14; respectively, p = 0.1]. Quality of life [7.71 ± 1.17 vs 7.30 ± 1.46; p = 0.04] and energy-level items [7.16 ± 1.52 vs 6.66 ± 1.68; p = 0.03] were significantly better after Ta-IPAA, while the quality of health item was comparable [7.68 ± 1.26 vs 7.64 ± 1.44; p = 0.96]. Analysis excluding anastomotic leaks did not change the overall CGQL scores. Stool frequencies [>10/24 h: 22% vs 21%; p = 1.0] and the rate of a single episode of major incontinence during the following 12-month period [27% vs 26%; p = 0.89] were similar. The differences in 30-day morbidity rates [33% vs 41%; p = 0.2] and anastomotic leak rates were not significant [6% vs 13%; p = 0.09]. CONCLUSIONS: This study provides evidence of comparable long-term functional outcome and quality of life after Ta-IPAA and Abd-IPAA for UC.


Assuntos
Parede Abdominal/cirurgia , Canal Anal/cirurgia , Fístula Anastomótica , Colite Ulcerativa/cirurgia , Efeitos Adversos de Longa Duração , Complicações Pós-Operatórias , Proctocolectomia Restauradora , Qualidade de Vida , Adulto , Fístula Anastomótica/diagnóstico , Fístula Anastomótica/etiologia , Fístula Anastomótica/cirurgia , Bolsas Cólicas/efeitos adversos , Pesquisa Comparativa da Efetividade , Europa (Continente) , Feminino , Humanos , Pelve Menor/cirurgia , Efeitos Adversos de Longa Duração/fisiopatologia , Efeitos Adversos de Longa Duração/psicologia , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Proctocolectomia Restauradora/efeitos adversos , Proctocolectomia Restauradora/métodos , Recuperação de Função Fisiológica , Reoperação/métodos , Reoperação/estatística & dados numéricos
2.
Lasers Med Sci ; 30(1): 147-52, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25053520

RESUMO

Endometriosis is a chronic disease affecting mainly women of the reproductive age. Its most common manifestations include impaired fecundity, pelvic pain, and dyschezia. Laparoscopic removal of endometriotic foci remains to be the gold standard for the treatment of endometriosis. More effective techniques of endoscopic approach-among others, laser application-are continually being developed. The aim of the study was to evaluate the efficacy of laparoscopic treatment with the use of CO2 laser ablation vs. electroablation with regard to pain complaints in the affected patients. The study included 48 women (aged 22-42) with varying degrees of endometriosis of the lesser pelvis. The Numeric Rating Scale (NRS) was used to evaluate pain intensity before the surgery in all patients, followed by either laser ablation or electroablation of the endometriotic foci. The results of the laparoscopic treatment were monitored after 3 and 6 months postoperatively. p value of 0.05 was considered to be statistically significant. Patients from both groups reported less intensive pain before/during menstruation (dysmenorrhea) 6 months postoperatively, with more distinct tendency in the electroablation group (p = 0.004) as compared to the laser ablation group (p = 0.025). Despite the initial improvement reported at the 3-month checkup (p = 0.008), 6 months postoperatively, a statistically significant increase in pain intensity was noted in both groups (p = 0.016 and p = 0.032 for CO2 laser ablation and electroablation, respectively). Both surgical methods seem to be effective only in the treatment of endometriosis-related dysmenorrhea, whereas the intensity of other pain complaints (dyspareunia, dysuria, dyschezia, pelvic pain syndrome (PPS)) has remained on the same level.


Assuntos
Dispareunia/terapia , Endometriose/cirurgia , Terapia a Laser , Lasers de Gás/uso terapêutico , Dor Pélvica/terapia , Adulto , Endometriose/patologia , Feminino , Humanos , Laparoscopia , Pelve Menor/patologia , Pelve Menor/cirurgia , Resultado do Tratamento , Adulto Jovem
3.
Ann Plast Surg ; 73(5): 578-82, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23759962

RESUMO

Although an abundance of literature exists regarding frequently lifted body areas, there are few reports about body contouring of the mons pubis. Therefore, this paper describes the first clinical results from a new technique, which surgically lifts the mons pubis using superficial fascial system suspension. Fifty patients underwent a lower body lift, including a superficial fascial system suspension of the mons pubis. After a mean follow-up period of 16.9 months (range, 6-31 months), patients were evaluated by standardized preoperative and postoperative photographs using the Pittsburgh Rating Scale. In addition, all patients completed a Likert-type scale questionnaire pertaining to body satisfaction and other bodily changes. Scores from the Pittsburgh Rating Scale improved significantly (P=0.03) from 2.76 (0.43) [range, 1-3] preoperative to 0.5 (0.59) [range, 0-2] postoperative. Fifteen (30%) of the patients assessed the new contour as very good, 26 (52%) patients as good. Eight patients developed a temporary edema in the mons pubis and 1 patient developed an infected fascia suture granuloma, which had to be removed. A mons pubis lift with the aid of the superficial fascial system is a safe surgical technique, which can easily be integrated in body contouring surgeries of the torso.


Assuntos
Pelve Menor/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Tela Subcutânea/cirurgia , Redução de Peso , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Satisfação do Paciente , Estudos Retrospectivos , Inquéritos e Questionários
4.
Vestn Khir Im I I Grek ; 173(6): 37-42, 2014.
Artigo em Russo | MEDLINE | ID: mdl-25823309

RESUMO

The authors analyzed the experience at the period from September 2000 to January 2014. The total exenterations of the small pelvis were performed on 23 patients (12 men and 11 women) at the age from 37 to 71 years old. Supralevator total exenterations with full visceral reconstruction were carried out in 13 cases out of 23. Total infralevator pelvic exenterations were used in 10 cases. There wasn't the intraoperative lethality. Patients (3 cases) died in postoperative period. Postoperative complications developed in 10 patients, though serious complications, which required an application of surgical strategy were noted only in 3 cases. The mean life span consisted of 29 months. The performance of total exenteration of the small pelvis considerably increased the life span of the patients and in case of application of reconstructive methods allowed restoration of quality of life to high level and obtaining moral, psychological and social rehabilitation.


Assuntos
Recidiva Local de Neoplasia/cirurgia , Exenteração Pélvica , Procedimentos de Cirurgia Plástica/métodos , Complicações Pós-Operatórias , Qualidade de Vida , Neoplasias Retais , Neoplasias Urogenitais , Adulto , Idoso , Feminino , Humanos , Pelve Menor/patologia , Pelve Menor/cirurgia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Exenteração Pélvica/efeitos adversos , Exenteração Pélvica/métodos , Exenteração Pélvica/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/psicologia , Complicações Pós-Operatórias/cirurgia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Estudos Retrospectivos , Federação Russa , Análise de Sobrevida , Neoplasias Urogenitais/patologia , Neoplasias Urogenitais/cirurgia
5.
Vestn Khir Im I I Grek ; 172(6): 64-6, 2013.
Artigo em Russo | MEDLINE | ID: mdl-24738206

RESUMO

The study was devoted to the problem of postoperative eventrations in gynaecological practice. Coaptation removable sutures were applied in order to prevent similar complications. Operations were performed in the cases of desolate condition of purulent disease of the uterus and uterine appendages with diffuse suppurative peritonitis. An advanced operative technique of suturing through all layers of abdominal wall demonstrated its high efficacy. No one patient (from 39) had the eventration or wound abscess.


Assuntos
Abscesso Abdominal/cirurgia , Técnicas de Fechamento de Ferimentos Abdominais , Laparotomia/efeitos adversos , Doença Inflamatória Pélvica/cirurgia , Deiscência da Ferida Operatória/prevenção & controle , Técnicas de Sutura , Abscesso Abdominal/etiologia , Adulto , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Laparotomia/métodos , Pelve Menor/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Doença Inflamatória Pélvica/complicações , Reoperação/efeitos adversos
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