The two enteral routes were associated with the same number of complications. However, the presence of a jejunostomy allowed enteral therapy for longer periods, especially in patients with complications, thus avoiding the need for parenteral nutrition.
OBJETIVO: Apresentar os resultados do Hospital Israel Pinheiro - IPSEMG em 41 duodenopancreatectomias realizadas para neoplasias. MÉTODO: Foram coletados dados referentes a 41 pacientes submetidos a duodenopancreatectomias entre 1997 e 2004. A principal operação realizada foi a Whipple "clássica" sem preservação do piloro. A anastomose pancreático-jejunal foi realizada por meio de sutura ducto-mucosa. Foram analisadas a mortalidade e as complicações pós-operatórias. Para avaliar se havia diferença de resultados com a maior experiência da equipe, o estudo foi dividido em dois períodos de quatro anos cada: 1997 a 2000 e 2001 a 2004. RESULTADOS: As complicações pós-operatórias ocorreram em 58% dos casos e a mortalidade foi de 22%. As principais complicações foram pneumonia e infecção de ferida operatória. Quatro pacientes (10%) evoluíram com fistulas pancreáticas, porém obteve-se sucesso com o tratamento conservador em todos os casos. A necessidade de hemotransfusão no peroperatório relacionou-se a um pior prognóstico. Observou-se uma redução das taxas de morbi-mortalidade no período de 2001 a 2004, entretanto sem significância estatística. Os pacientes apresentaram sobrevida global em cinco anos de 35% e de 26% quando considerados apenas aqueles com adenocarcinoma de cabeça de pâncreas. CONCLUSÕES: A duodenopancreatectomia é um procedimento cirúrgico complexo, com elevada morbi-mortalidade. Entretanto, com o aumento da experiência das equipes cirúrgica, anestésica e de medicina intensiva, observa-se uma redução nas taxas de complicação.
Patients undergoing esophagectomy for cancer are a difficult to treat group of patients. At diagnosis they will present some degree of malnutrition in up to 80% and the causes are from multifactorial origin: the inability of food ingestion, advanced age, taste disturbances, and morbidity related to neoadjuvant treatment. In order to restaure the nutritional status, enteral nutritional support is preferable to parenteral support because of the risks of septic complications associated with venous catheters. During the postoperative period, the oral route is often inaccessible in these patients due to swallowing disorders and eventually mechanical ventilation, and if possible, often it does not provide sufficient caloric amounts for postoperative energy balance. For these reasons, it is usually recommended additional nutritional support. There are few studies in the literature that specifically address which is the most adequate route for enteral nutrition in patients undergoing esophagectomy. Nasojejunal catheters present a higher incidence of local complications, such as displacement and occlusion, whereas jejunostomy is more associated with reinterventions for the treatment of complications secondary to extravasation. Although there is weak evidence in the literature and a lack of randomized, prospective and multicenter studies evaluating the best enteral nutrition route in the postoperative period of esophagectomy, the use of the nasoenteric catheter seems to be adequate due to its simplicity of positioning and low rates of severe complications. In this paper a review is performed of the evidence about this subject.
Background: This study aimed to evaluate the main drivers of robot assisted radical prostatectomy (RARP) hospitalization costs, in addition to assess perioperative predictors that impact costs.
Methods: Overall, 474 RARP were analyzed between February 2018 and December 2019. The association between perioperative variables and total direct costs was analyzed by simple and multiple linear regression. Discussion: The main drivers of RARP hospitalization costs were robotic surgical supplies. Costs increased with American Society of Anesthesiologists score 3, a onehour increase in OR time, increased utilization of polymeric clip packs and longer length of hospital stay. There was a 11.5% reduction in costs with the use of four robotic instruments instead of five. Conclusion: Costs of hospitalization were mainly influenced by the OR time, use of surgical supplies and length of hospital stay. Reducing the number of robotic instruments used in RARP represented the potentially modifiable factor with the greatest impact on cost reduction.
Background: Due to the longer life expectancy and consequently an increase in the elderly population, a higher incidence of gastric cancer is expected in this population in the coming decades. Aim: To compare the results of laparoscopic GC surgical treatment between individuals aged<65 years (group I) and ≥ 65 years (group II), according to clinical, surgical, and histopathological characteristics. Methods: A observational retrospective study was performed by analyzing medical charts of patients with gastric cancer undergoing total or subtotal laparoscopic gastrectomy for curative purposes by a single oncologic surgery team. Results: Thirty-six patients were included in each group. Regarding the ASA classification, 31% of the patients in group I was ASA 1, compared to 3.1% in group II. The mean number of concomitant medications in group II was statistically superior to group I (5±4.21 x 1.42±3.08, p<0.001). Subtotal gastrectomy was the most performed procedure in both groups (69.4% and 63.9% in groups I and II, respectively) due to the high prevalence of distal tumors in both groups, 54.4% group I and 52.9% group II. According to Lauren's classification, group I presented a predominance of diffuse tumors (50%) and group II the intestinal type (61.8%). There was no difference between the two groups regarding the number of resected lymph nodes and lymph node metastases and the days of hospitalization and mortality. Conclusion: Laparoscopic gastrectomy showed to be a safe procedure, without a statistical difference in morbidity, mortality, and hospitalization time between both groups.
Objetivo: Discutir e sintetizar os aspectos da transposição, enumerando os sinais e sintomas, métodos diagnósticos e tratamentos, além de descrever a aplicabilidade, a técnica utilizada e possíveis evoluções da correção cirúrgica. Revisão Bibliográfica: Foi realizada uma revisão literária narrativa com busca nas bases de dados Scielo, Public/Publisher MEDLINE (PubMed), National Center for Biotechnology Information (NCBI) e Springer, entre os anos 1981 e 2020, com os descritores ‘Transposição de Grandes Vasos”, “Transposição de Grandes Artérias”, “Técnicas operatórias TGV”, “Arterial Switch Operation” e “Cirurgia de Lecompte”. Esta entidade patológica engloba múltiplas alterações anatômicas que podem acompanhar a inversão na posição das grandes artérias, influenciando a apresentação clínica. É a principal causa de procedimentos cirúrgicos neonatais, com diferentes técnicas que se adequam de acordo com o estado do paciente. O diagnóstico só é confirmado por exames de imagem. Considerações finais: A TGV, se não acompanhada de shunt sanguíneo, é incompatível com a vida. Portanto, requer estabilização hemodinâmica e monitorização cuidadosa, até que seja eleito o método cirúrgico mais adequado para restaurar a comunicação entre fluxos sistêmico e pulmonar.
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