RESUMO: A colite por exclusão é descrita como processo inflamatório que ocorre nos segmentos colorretais desprovidos do trânsito fecal. A deficiência dos ácidos graxos de cadeia curta vem sendo considerada como principal fator causal. Objetivo: O objetivo do presente estudo foi avaliar, em modelo experimental de colite de exclusão, a importância da irrigação do segmento desprovido de trânsito com soluções nutricionais na prevenção e tratamento do processo inflamatório. Método: Foram utilizados trinta ratos Wistar, machos, com peso inicial variando entre 350 e 500 gramas, submetidos à derivação do trânsito intestinal através da realização de colostomia proximal e fístula mucosa distal. Os animais foram divididos em três grupos de 10 animais segundo a irrigação do segmento excluso de trânsito ter sido realizada, empregando-se: Grupo SF: solução fisiológica a 0,9%; Grupo GH: solução de glicose a 50%; e Grupo AG: solução de ácidos graxos de cadeia curta. Em todos os animais, a irrigação do colo excluso foi realizada em intervalos de quatro dias sendo sacrificados sempre no 21º pós-operatório. Os fragmentos removidos dos segmentos intestinais foram corados pelas técnicas da hematoxilina-eosina e tricrômio de Masson. As variáveis histológicas estudadas foram: espessura da túnica mucosa, congestão vascular; infiltrado inflamatório e a deposição de colágeno. Os resultados encontrados foram submetidos a estudo estatístico considerando nível de significância de 5% (p< 0,05). Resultados: Verificou-se que no grupo onde se irrigou o cólon excluso com solução de ácidos graxos de cadeia curta houve menor congestão vascular, menor infiltrado inflamatório e menor deposição de colágeno quando comparado aos demais grupos experimentais. Conclusão: Os resultados do presente trabalho mostram que a irrigação de segmentos desprovidos de trânsito fecal com ácidos graxos de cadeia curta, encontra-se relacionada à melhora no processo inflamatório decorrente visto na colite de exclusão. Descritores
PURPOSE: This work had the objective of verifying the validity of using computerized morphometry as a method of quantitative analysis of the interference of edema in scar formation following colon anastomosis. METHODS: Forty-five adult female Wistar rats were utilized, divided into three groups of 15 animals according to whether sacrifice was performed on the first, second or seventh postoperative day. Each group was subdivided into a main group consisting of 10 animals, and a control group consisting of five animals. In the main group, in addition to the quantitative computerized morphometric analysis of the edema in the submucosal layer, the resistance of the colon anastomosis to bursting strength was verified. In the control group, edema quantification was studied alone. RESULTS: The results found via the computerized morphometry method showed that there is a 7% decrease in the presence of edema during the first postoperative week. They confirmed that there is an inverse statistically significant relationship (p< 0.001) between edema presence and the resistance of the anastomosis to bursting strength. CONCLUSION: The use of computerized morphometry is a reliable, fast, objective and low-cost methodology for the quantification of edema in colon anastomoses.
Introduction The treatment of hemorrhoidal disease by conventional technique is associated with significant morbidity, mainly represented by the postoperative pain and the late return to daily activities. A technique of hemorrhoidal dearterialization associated with rectal mucopexy is a minimal invasive surgical option that has been used to treat the hemorrhoidal disease and reduce its inconveniences. Objective To analyze the seven-year results of hemorrhoidal dearterialization associated with rectal mucopexy in the treatment of hemorrhoidal disease. Methods This study analyzed 407 patients with hemorrhoids grade II, III and IV, who underwent the technique of hemorrhoidal dearterialization in the Luzia de Pinho Melo Hospital, during the period between December 2010 and December 2017. Twenty-seven patients (6.6%) had hemorrhoidal disease of the grade II, 240 (59.0%) grade III, and 117 (28.8%) grade IV. In 23 patients (5.7%), the grade was not found. All patients were operated by the same surgeon under spinal anesthesia. The 407 patients underwent dearterialization, with a varying ligation of one to six arterial branches followed by rectal mucopexy by uninterrupted suture. Eighty-two (20.14%) required removal of concomitant perianal piles or external hemorrhoids and/or fibrosed. In the postoperative follow-up the following parameters were evaluated: pain, tenesmus, bleeding, prolapse, thrombosis, and recurrence. Results The tenesmus was postoperative complaint reported by 93.6% of patients. Forty-three (10.5%) presented intense tenesmus and 44 (22%), moderate to intense pain. Four (0.98%) patients presented more intense bleeding in postoperative follow up; none of the patients required blood transfusions. The prolapse occurred in 18 (4.42%) patients, thrombosis in 11 (2.7%), and there were 19 (4.67%) recurrences that were reoperated in this period. Conclusion The hemorrhoidal dearterialization technique presents good results, with light and easy-to-resolve complications and little postoperative pain.
The treatment of hemorrhoidal disease (HD) by conventional hemorrhoidectomy is associated with significant morbidity, mainly represented by the postoperative pain and the late return to daily activities. Doppler-guided hemorrhoid artery ligation (DGHAL) is a minimal-invasive surgical treatment for HD that has been used as an alternative method in order to reduce these inconveniences. Objective: To analyze the initial results of the DGHAL technique associated with rectal mucopexy in the treatment of HD. Methods: Forty-two patients with stage I, III and IV hemorrhoids who were submitted to DGHAL were analyzed from December 2010 to August 2011. Eleven patients (26%) were stage II; 21 (50%), stage III; and 10 (24%), stage IV HD. All patients were operated by the same surgeon under spinal anesthesia and using the same equipment and technique to perform the procedure. The 42 patients underwent ligation of six arterial branches followed by rectal mucopexia by uninterrupted suture. Nine patients needed concomitant removal of perianal skin tag. In the postoperative, the following parameters were evaluated: pain, tenesmus, bleeding, itching, prolapse, mucus discharge and recurrence. The mean postoperative follow-up lasted four months (one to nine months). Results: Tenesmus was the most common postoperative complaint for 85.7% of patients followed by pain, in 28.6%, perianal burning, in 12.3%, mucus discharge and perianal hematoma in 4.7%. Two patients had severe postoperative bleeding and required surgical haemostasis, one of which needed blood transfusion. Ninety-five percent of the patients declared to be satisfied with the method. Conclusion: Even though DGHAL has complications similar to those of other surgical methods, its results present less postoperative pain, allowing faster recovery and return to work. Studies with more cases and a longer follow-up are still necessary to assess the late recurrence.
The doppler-guided transanal hemorrhoidal dearterialization technique associated with mucopexy is a noninvasive surgical option used to treat hemorrhoidal disease (HD). Objective To compare and analyze the results using a variation of the doppler-guided transanal hemorrhoidal dearterialization technique with the technique of selective hemorrhoidal dearterialization with high mucopexy in the treatment of HD. Method A total of 292 patients who underwent surgical treatment for grade II, III and IV HD from March 2012 to December 2017 were studied. From this total, 110 (37.6%) patients underwent a conventional doppler-guided transanal hemorrhoidal dearterialization with mucopexy (CD), and 182 (62.3%) underwent selective hemorrhoidal dearterialization with high mucopexy (SHeLF). In the group of patients undergoing CD, 4 patients (3.64%) had grade II HD, 82 (74.55%) grade III, and 24 (21.82%) grade IV. In the group submitted to SHeLF, 18 (9.89%) patients had grade II HD, 86 (47.25%) had grade III, and 65 (35.71%) had grade IV. The same surgeon operated all patients under spinal anesthesia. In patients undergoing CD, six arterial branches have been dearterialized, while in patients undergoing SHeLF, the hemorrhoidary nipples submitted to a dearterialization were selected (from 1 to 5) by intraoperative evaluation followed by high rectal mucopexy. In the postoperative period, the following parameters were evaluated: pain, tenesmus, bleeding, and recurrence.Moderate results to severe pain was a postoperative complaint reported by 13 (11.82%) patients undergoing CD, and by 19 (10.44%) undergoing SHeLF. Intense tenesmus was reported by 26 (23.64%) patients undergoing CD and by 7 (3.85%) undergoing SHeLF. Three patients (2.73%) undergoing CD and 1 (0.55%) undergoing SHeLF evolved with postoperative bleeding. One patient (0.55%) in the group undergoing CD required surgical review of hemostasis. Six patients (5.45%) who underwent CD and 8 (4.39%) who underwent SHeLF were reoperated due to disease recurrence. Conclusion Comparing statistics, patients undergoing the SHeLF technique have less postoperative pain, tenesmus and postoperative bleeding when compared with CD.
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