No abstract

INTRODUÇÃO: A partir de 1991, a videolaparoscopia começou a ser considerada no tratamento de doenças colorretais. O aprimoramento da técnica cirúrgica associado aos benefícios encontrados em diversos estudos publicados levou a modificações nas perspectivas da videolaparoscopia. A partir da publicação do estudo COST as ressecções oncológicas laparoscópicas foram reconhecidas como alternativa viável, com resultados semelhantes à cirurgia convencional. PACIENTES E MÉTODOS: Realizou-se pesquisa através de formulário específico e consulta a prontuários dos principais serviços de coloproctologia de Belo Horizonte. Avaliando-se sexo, idade, indicação cirúrgica, procedimento realizado, técnica laparoscópica, complicações, conversão, estadiamento e recidiva (no caso de neoplasias). RESULTADOS: Foram levantados dados sobre 503 cirurgias colorretais laparoscópicas: 347 (68,9%) em mulheres e 156 (31,1%) homens. A técnica cirúrgica foi totalmente laparoscópica em 137 casos, vídeo-assistida 245 casos. O procedimento mais realizado foi a retossigmoidectomia (41,1%), seguido pela colectomia direita (12,5%), colectomia esquerda (6,9%). Doenças benignas foram responsáveis por 259 (51,5%) casos, destes as principais indicações cirúrgicas foram endometriose 126 (48,6%), pólipos 40 (15,4%), doença diverticular 30 (11,6%). Das 240 cirurgias realizadas por doenças malignas as mais frequentes foram retossigmoidectomia 102 (42,5%), colectomia direita 46 (19,1%), colectomia esquerda 18 (7,5%), amputação abdominoperineal 18 (7,5%). Houve 54 conversões (10.7%) dos casos, 12,9% (31/240) nos casos de neoplasias, 8,5% (22/259) nos de doenças benignas. Complicações sistêmicas ou cirúrgicas ocorreram em 31 (6,1%) e 56 (11,1%) casos, respectivamente. Foram registrados onze (2,18%) óbitos nos primeiros 30 dias após a cirurgia. CONCLUSÃO: O estudo atual foi o primeiro levantamento da implantação de cirurgias colorretais laparoscópicas realizado de forma multicêntrica em Minas Gerais. Os dados levantados são consistentes com registros nacionais de videocirurgia colorretal, mostrando a eficiência do método de aprendizado com realização de cirurgias com tutor. Além disso, que pequena parte das cirurgias colorretais são realizadas por via laparoscópica no estado, restritos apenas a centros especializados, sobrecarregando esses serviços e limitando o acesso para a população.

Superior mesenteric artery syndrome is an entity generally caused by the loss of the intervening mesenteric fat pad, resulting in compression of the third portion of the duodenum by the superior mesenteric artery. This article reports the case of a patient with irremovable metastatic adenocarcinoma in the sigmoid colon, that evolved with intense vomiting. Intestinal transit was carried out, which showed important gastric dilation extended until the third portion of the duodenum, compatible with superior mesenteric artery syndrome. Considering the patient's nutritional condition, the medical team opted for the conservative treatment. Four months after the surgery and conservative measures, the patient did not present vomiting after eating, maintaining previous weight. Superior mesenteric artery syndrome is uncommon and can have unspecific symptoms. Thus, high suspicion is required for the appropriate clinical adjustment. A barium examination is required to make the diagnosis. The treatment can initially require gastric decompression and hydration, besides reversal of weight loss through adequate nutrition. Surgery should be adopted only in case of clinical treatment failure.
A síndrome da artéria mesentérica superior é uma entidade clínica causada geralmente pela perda do tecido adiposo mesentérico, resultando na compressão da terceira porção do duodeno pela artéria mesentérica superior. Esse artigo relata o caso clínico de uma paciente portadora de adenocarcinoma de cólon sigmoide metastático irressecável, que evoluiu com vômitos incoercíveis. Realizou-se, então, trânsito intestinal que evidenciou dilatação gástrica importante, que se prolongava até a terceira porção duodenal, quadro radiológico compatível com pinçamento da artéria mesentérica superior. Diante da condição nutricional da paciente, foi optado por iniciar medidas conservadoras (porções alimentares pequenas e mais frequentes, além de decúbito lateral esquerdo após as refeições). Quatro meses após a cirurgia e as medidas conservadoras, a paciente não apresentava mais vômitos pós-prandiais, nem emagrecimento. A síndrome da artéria mesentérica inferior é incomum e os sintomas podem ser inespecíficos. Sendo assim, um índice elevado de suspeita é exigido no ajuste clínico apropriado. O diagnóstico é feito, habitualmente, através de exame radiológico contrastado. O tratamento pode, inicialmente, exigir a descompressão gástrica e a reposição volêmica, além da reversão da perda de peso com nutrição adequada. A cirurgia deve ser reservada para os casos de falha do tratamento clínico

Perforated acute abdomen is a common syndrome among nontraumatic abdominal emergencies [1]. Bowel perforations may occur because of inflammatory, neoplastic, traumatic, or infectious processes in the digestive tract [2]. They can also be due to ingestion of foreign bodies or as a result of diagnostic and therapeutic medical procedures [2]. The bowel perforation

Background Enhanced Recovery Surgical Programs were initially applied to colorectal procedures and used as multimodal approach to relieve the response to surgical stress. An important factor that negatively impacts the success of these programs is the poor tolerance of these patients to certain items in the adopted protocol, especially with regard to post-operative measures. The identification of these factors may help to increase the success rate of such programs, ensuring that benefits reach a greater number of patients and that resources are better allocated. Thus, the aims of this study were to assess the results of the implementation of a Simplified Accelerated Recovery Protocol (SARP) and to identify possible factors associated with failure to implement postoperative protocol measures in patients submitted to laparoscopic colorectal surgery. Methods 161 patients were randomly divided into two groups. The SARP group (n = 84) was submitted to the accelerated recovery program and the CC group (n = 77), to conventional postoperative care. The SARP group was further divided into two subgroups: patients who tolerated the protocol (n = 51) and those who did not (n = 33), in order to analyze factors contributing to protocol nontolerance. Results The groups had similar sociodemographic and clinical characteristics. The SARP group had a shorter hospital stay, better elimination of flatus, was able to walk and to tolerate a diet sooner (p < 0.0001). Complications rates and readmissions to emergency room were similar between groups. Multivariate analysis revealed that prolonged operating time, stoma creation and rates of surgical complications were independently associated with poor adherence to SARP (p < 0.0001). Conclusions The use of our SARP resulted in improved recovery from laparoscopic colorectal surgery and proved to be safe for patients. Extensive surgeries, occurrence of complications, and the need for ostomy were variables associated with poor program adhesion. Trial registration Trial Registry: RBR2b4fyr—Date of registration: 03 October 2017.

No abstract

No abstract

Background: Accelerated Recovery after Surgery Programs were initially applied to colorectal surgery and used a multimodal care approach to relieve the response to surgical stress. An important factor that negatively impacts the success of these programs is the non-tolerance of patients to certain items in the adopted protocol, especially with regard to post-operative measures. The identification of these factors may help to increase the success rate of such programs, ensuring that benefits reach a greater number of patients and that resources are better allocated. Thus, the aims of this study were to assess the results of the implementation of a Simplified Accelerated Recovery Protocol (SARP) and to identify possible factors associated with failure to implement postoperative protocol measures in patients submitted to laparoscopic colorectal surgery.Methods: 161 patients were randomly divided into two groups. The SARP group (n = 84) was submitted to the accelerated recovery program and the CC group (n = 77), to conventional postoperative care. The SARP group was further divided into two subgroups: patients who tolerated the protocol (n=51) and those who did not (n=33), in order to analyze factors contributing to protocol nontolerance.Results: The groups had similar sociodemographic and clinical characteristics. The SARP group had a shorter hospital stay, better elimination of flatus, was able to walk and to tolerate a diet sooner (p < 0.0001). The rates of complications and of returns to the emergency room were similar between groups. In the multivariate analysis of the subgroups, we found that prolonged surgical time, stoma creation, and the development of complications were variables that placed program acceptance at risk (p < 0.0001).Conclusions: The accelerated postoperative recovery program that was adopted, although simplified, was able to improve recovery from laparoscopic colorectal surgery and proved to be safe for patients. Extensive surgeries, occurrence of complications, and the need for ostomy were variables associated with program non-acceptance. Trial registration: Trial Registry: RBR2b4fyr - Date of registration: 03 October 2017.