No abstract

Hybrid technique had perioperative outcomes that were more in keeping with pure laparoscopic outcomes than open surgery. Hybrid liver surgery should be considered a minimally invasive approach.

No abstract

No abstract

Tuberculosis remains a public health problem and its rare extrapulmonary forms persist with late diagnosis, which delays the diagnosis and favors the dissemination of the disease. The perianal manifestation occurs in approximately 0.7% of tuberculosis cases and usually manifests as fistulizing disease, but may also present with ulcerated lesions, with necrotic and quite painful clinical picture. Initial treatment should be carried out aimed at controlling perineal and perianal sepsis, with subsequent establishment of specific drug therapy provided by the Health Ministry.

. TREINAMENTO EM CIRURGIA HEPÁTICA AVANÇADA: ANASTOMOSE PORTAL EM MODELO PORCINO. ABCDExpress. 2017;1(2):228.Instituição: ICESP e HC -FMUSP Introdução: Grandes avanços ocorreram nas últimas décadas na cirurgia hepática. Em diversos centros especializados foi relatada mortalidade perioperatória inferior a 5%. Os bons resultados estimulam a expansão das indicações cirúrgicas e refinamentos técnicos cada vez maiores. Um exemplo disso é o aumento das ressecções vasculares na cirurgia oncológica do fígado. Entretanto, a medida que as fronteiras da cirurgia hepática se expandem também surge a preocupação quanto a reprodutibilidade desses procedimentos e o treinamento de novos cirurgiões em cirurgias com curvas de aprendizado tão longas. É indiscutível que a formação de um cirurgião passa necessariamente pelo desenvolvimento de habilidades que dificilmente são adquiridas de outra forma que não em atividades práticas, e isso apresenta implicações éticas. Além da vivência em cirurgias com pacientes reais, contribuições importantes para o treinamento em cirurgia do fígado podem vir de simuladores, modelos artificiais, cadáveres e modelos animais. O modelo porcino é uma opção interessante para esse fim, pois há semelhanças entre o tamanho e a morfologia do fígado e do sistema portal do porco com o de humanos. Objetivo: Demostrar método de treinamento em anastomose vascular utilizado em nosso serviço utilizando o modelo porcino. Método: O suíno é submetido a anestesia geral. Uma incisão em "T invertido" é utilizada. Procedese a dissecção do ligamento hepatoduodenal e esqueletização da veia porta. O controle vascular proximal e distal e obtido e a veia porta é então seccionada e a anastomose portal é então realizada. Resultados: o modelo porcino apresenta satisfatória correlação com a anatomia hepática humana e tem demonstrado ser uma ótima ferramenta complementar para o treinamento de cirurgiões do aparelho digestivo em nosso serviço. Conclusões: A realização cirurgias em modelo porcino não substitui a experiência com cirurgias em pacientes reais. Entretando, trata-se de método de ensino complementar eficaz e seguro no treinamento de novos cirurgiões. ABCDExpress 2017;1(2):228Codigo: 64150 Acesso está disponível em www.revistaabcd.com.br e www.sbad2017.com.br Acesso pelo

Background and aims: Previously, modification of intraplatelet serotonin was hypothesized as a potential intervention to improve liver regeneration in patients undergoing liver resection. However, within a recent study our group showed a potential adverse effect of high intra-platelet serotonin in terms of oncologic outcome. Within this study, exploratory data on the use of selective serotonin reuptake inhibitors (SSRI) was collected. Still, the number of patients with SSRI therapy was limited. Thus, we now aimed to evaluate the use of selective serotonin reuptake inhibitors (SSRI) in a large cohort of patients undergoing liver resection. Methods: 333 patients were included out of our prospectively maintained institutional data base. Intake of SSRI during the perioperative period was recorded. Patients were followed up for postoperative liver dysfunction (LD) and morbidity. Results: In total, 37 patients (9.1%) were perioperatively treated with SSRI. Patients with SSRI intake showed a higher incidence of morbidity (40.9% in no SSRI vs 48.6% in SSRI, p=NS) and a significantly increased incidence of LD (10.5% in no SSRI vs 21.6% in SSRI, p=0.047). Ultimately, logistic regression analysis was computed and showed a significantly increased risk for postoperative LD in patients using SSRI (p=0.039,OR=2.939). Conclusion: The present study is the first one to present solid data on an association between SSRI intake and poor postoperative outcome in patients undergoing liver resection. This association might be due to an impairment of liver regeneration as a result from decreased intra-platelet levels of serotonin.

Background: Symptomatic benign liver tumours (BLT) may be an indication for surgery. Surgical treatment exists of laparoscopic and open liver resection. However, surgical outcomes have never been compared before in a systematic review, as well as the influence of type of surgery on relief of symptoms and quality of life (QOL). Methods: Two independent reviewers performed a systematic literature search in Pubmed and Embase. All articles on surgery for symptomatic BLT were abstracted. Methodological quality was evaluated using the MINORS tool. Outcomes were divided in open and laparoscopic. Results: A total of 69 articles were analysed, including 4913 patients receiving surgery for BLT. 3749 patients received open surgery and 1164 laparoscopic. A total of 1022 major resections were performed: 581 open and 33 laparoscopic. Blood loss, operative time and length of hospital stay were respectively 457ml, 183min and 8,2days for open surgery, versus 124ml, 146 min and 6,4days for laparoscopic. The most common indication for surgery was symptoms: 61,9%. Overall, symptoms decreased from 69% preoperative to 16% postoperative. 2 out of 14 studies using a validated QOL questionnaire reported an advantage for laparoscopy, 12 didn't report differences. A total of 309 complications were reported: (7,2%) open and (3,7%) laparoscopic. Conclusion: Blood loss, operative time, length of hospital stay and complications were less for laparoscopic surgery, which can be explained by the majority of minor resections. However, as the percentages of complications are still far apart, it could be considered to perform more extensive laparoscopic surgery for BLT in selected patients.