Revista Do Colegio Brasileiro De Cirurgioes[JOURNAL]
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200 papers
Liver regeneration: Literature review.
Toderke EL, Matias JEF
Rev Col Bras Cir · 2025 · PMID 41221928 · Publisher ↗
Liver regeneration is a highly organized tissue growth process and is the livers most important reaction to aggression. The complex mechanisms involved in this process encompass a variety of regenerative pathways that ar...
Liver regeneration is a highly organized tissue growth process and is the livers most important reaction to aggression. The complex mechanisms involved in this process encompass a variety of regenerative pathways that are specific to the different types of aggression. The most studied form of liver regeneration is that which occurs after the loss of hepatocytes in an acute injury, such as in the regenerative process of rodents after partial hepatectomy or administration of harmful chemicals (CCl4, paracetamol, allyl alcohol). These experimental models revealed extracellular and intracellular signaling pathways that are used to return the liver to the size and weight equivalent to those prior to the injury. Understanding the liver regeneration process is a challenge that is justified by the numerous interactions of different cellular components, various mitogenic factors (complete and incomplete), complex mitogenic pathways, and acute phase inflammatory proteins. Hepatocytes, cholangiocytes, and liver progenitor cells have been shown to have regenerative behavior. The regenerative activities of hepatocytes and cholangiocytes are typically characterized by phenotypic fidelity (multiplication), however, when normal regeneration is thwarted, hepatocytes and cholangiocytes function as facultative stem cells (dedifferentiate) or transdifferentiate to restore normal liver structure. This review traces the path taken in recent decades in the study of liver regeneration and highlights new concepts in the area.
Hernias at the laparoscopic cholecystectomy trocar sites.
Biondo-Simões MLP, Biondo-Simões R
Rev Col Bras Cir · 2025 · PMID 41221927 · Publisher ↗
INTRODUCTION: The surgical approach to the abdomen via laparoscopy has been widely used for cholecystectomy. This access route has demonstrated advantages, including the reduction in the incidence of incisional hernias....
INTRODUCTION: The surgical approach to the abdomen via laparoscopy has been widely used for cholecystectomy. This access route has demonstrated advantages, including the reduction in the incidence of incisional hernias. Could this really be a reality? OBJECTIVE: This survey aims to show the existence of these hernias and the profile of patients who present them. METHOD: Incisional hernias operated from January 2017 to May 2024, at the Complexo Hospital do Trabalhador were reviewed. The inclusion criteria were: age 18 years or older and having undergone laparoscopic cholecystectomy, excluding those operated on in the emergency room and those whose medical records did not allow the data to be analyzed to be obtained. RESULTS: 71 hernias were identified at the trocar site, all in the umbilical position (12.98% of all incisional hernias). It predominated in women (73.24%) and the average age was 53.99 ± 13.33 years. Weight changes were present in 91.05% of patients and obesity in 52.25%. The diagnosis was clinical and the hernias were complex. Furthermore, 38.03% were diabetic and 42.25% had high blood pressure. CONCLUSION: Incisional hernia at the umbilical trocar site in laparoscopic cholecystectomy is highly prevalent, with obesity as the main risk factor.
Nomograms for predicting sentinel lymph node metastasis in melanoma in a Southern Brazilian population: an accuracy study.
Candiago Júnior AF, Traebert J, Cordeiro EZ
Rev Col Bras Cir · 2025 · PMID 41221926 · Publisher ↗
INTRODUCTION: Sentinel lymph node biopsy is fundamental for staging and prognostication of cutaneous melanoma when indicated. However, it still yields a high rate of negative results. To reduce the rate of true negatives...
INTRODUCTION: Sentinel lymph node biopsy is fundamental for staging and prognostication of cutaneous melanoma when indicated. However, it still yields a high rate of negative results. To reduce the rate of true negatives, oncology centers have developed nomograms to better stratify patients for whom the procedure is recommended. OBJECTIVE: To study the accuracy of two nomograms developed by the Memorial Sloan-Kettering Cancer Center (MSKCC) and the Melanoma Institute Australia (MIA) for calculating the probability of sentinel lymph node positivity in a population of patients from southern Brazil. METHODS: An accuracy study was conducted, including data from 320 patients diagnosed with melanoma at a referral oncology institution in Santa Catarina, Brazil. The risk of sentinel lymph node positivity was calculated for each patient using the studied nomograms and compared to the results of histopathological examination. Discrimination was assessed by calculating the area under the Receiver Operating Characteristic (ROC) curve, thereby determining the accuracy of each nomogram. RESULTS: The MSKCC nomogram demonstrated an overall accuracy of 69.05%, while the MIA nomogram showed an accuracy of 68.38%. CONCLUSION: The nomograms did not exhibit acceptable levels of accuracy for application in the studied population.
Introduction of digital chromoendoscopy for classification of colonic lesions and assessment of experience gain in a tertiary healthcare hospital.
Blassioli VC, Rocha LC, Machado GL … +5 more , Cardoso LAB, Oliveira MBG, Paiva RA, Queiroz FL, Lacerda Filho A
Rev Col Bras Cir · 2025 · PMID 41221925 · Publisher ↗
INTRODUCTION: Colonoscopy is effective in reducing mortality by detecting and removing polyps, but invasive procedures remain common. New techniques, such as the NICE classification with Narrow-band Imaging (NBI), help p...
INTRODUCTION: Colonoscopy is effective in reducing mortality by detecting and removing polyps, but invasive procedures remain common. New techniques, such as the NICE classification with Narrow-band Imaging (NBI), help predict the histology of polyps without resection. This study evaluates the impact of the NICE classification in colonoscopies at a tertiary healthcare service, analyzing examiner performance over time. METHODS: A single-center prospective observational study. Patients who underwent colonoscopy with detected polyps were included, undergoing digital chromoendoscopy for NICE protocol classification, compared with histopathology as the gold standard. The analysis was stratified by two periods and among examiners. RESULTS: Overall accuracy was 70.2%, with sensitivity of 0.663, specificity of 0.761, negative predictive value (NPV) of 0.590, and positive predictive value (PPV) of 0.813, with no significant improvement in the second period. There was a performance gain in sensitivity (0.606 vs. 0.825, p=0.002), with no difference in other variables. DISCUSSION: An improvement was observed in sensitivity and a non-significant improvement in accuracy, NPV, and PPV. Variability among examiners, as indicated by a Kappa of 0.403, and the reduced sample size may have limited more robust results. CONCLUSION: Digital chromoendoscopy is effective for classifying colonic lesions and pre-resection histological identification; however, examiner performance is crucial and should not be the sole basis for clinical decisions. Implementing formal training and continuous practice is essential for improving performance.
Economic impact of graft's cold ischemia time on infection and post-liver transplant costs.
DA-Silva DFM, Becker Júnior OM, Schirmer J … +3 more , Mansur NS, Nishio EA, Roza BA
Rev Col Bras Cir · 2025 · PMID 41221924 · Publisher ↗
INTRODUCTION: Liver transplantation is a complex and costly surgical procedure funded by the Brazilian public health system. This study analyzed the hospital costs of patients who underwent liver transplantation and thei...
INTRODUCTION: Liver transplantation is a complex and costly surgical procedure funded by the Brazilian public health system. This study analyzed the hospital costs of patients who underwent liver transplantation and their relationship with graft cold ischemia time, as well as evaluated the impact of infection rate, length of hospital stay, and hospital expenses on survival and total costs. METHODS: This is a retrospective economic evaluation study that analyzed 40 medical records of patients who underwent liver transplantation in 2018 at a public hospital in São Paulo. Micro- and macro-costing methodologies were applied to calculate direct and fixed postoperative costs. RESULTS: Each additional hour of cold ischemia time increased the risk of infection by 2.6 times (95% CI: 1.28-7.51; p=0.025). Patients with more than 8 hours of cold ischemia had longer hospital stays (average of 36 days) and higher costs (average of R$98,190.42) compared to those with less than 8 hours (20 days and R$49,519.05). Patients who developed an infection remained hospitalized 2.16 times longer and had higher average total costs (R$148,400.00) compared to those without infection (R$58,200.00). Higher expenditures on materials, medications, nursing care, and prolonged stays in the Intensive Care Unit (ICU) were associated with lower survival. CONCLUSION: Cold ischemia time directly influenced the increase in costs and higher rates of posttransplant infection. Higher expenditures on materials, medications, nursing care, and prolonged ICU stays were associated with lower survival rates.
Perioperative management protocol for abdominal wall hernia repair in a public reference healthcare unit in Amazonas - Brazil.
Souza TGM, Furtado SDC, Soares MCCX … +1 more , Westphal FL
Rev Col Bras Cir · 2025 · PMID 41221923 · Full text
INTRODUCTION: Abdominal hernias are frequent surgical conditions that incur high hospital costs and significantly affect patients socioeconomic lives. It is crucial to reassess and update operational protocols, as severa...
INTRODUCTION: Abdominal hernias are frequent surgical conditions that incur high hospital costs and significantly affect patients socioeconomic lives. It is crucial to reassess and update operational protocols, as several aspects of perioperative care require revision, especially following the introduction of protocols aimed at accelerating postoperative recovery. OBJECTIVE: To develop a protocol for perioperative procedures in abdominal wall hernia repair surgeries. METHOD: This is a prospective study with a mixed approach, utilizing a modified Delphi consensus method. The sample comprised physicians with residency in general surgery, with a minimum of five years of experience and routine involvement in treating abdominal wall hernias. Questionnaires were administered in three stages, addressing various aspects related to perioperative care in patients undergoing abdominal wall hernia repair surgeries. For the analysis of collected data, the Content Validity Index (CVI) was calculated based on the percentage of agreement among participants, and Cronbachs Alpha coefficient was used to assess the internal consistency of the questionnaire. RESULTS: The study generated a protocol for perioperative clinical-surgical procedures focused on abdominal wall hernia repair surgeries. CONCLUSION: The development of a consensus among specialists resulted in the creation and publication of a protocol for perioperative clinical-surgical procedures in abdominal hernia repair surgeries.
C-reactive protein for detection of colorectal anastomotic leakage and safer early discharge.
Marques TM, Rovaris EM, Nahime RH … +8 more , Stevanato PR, Kupper BE, Bettiati AL, Bezerra TS, Takahashi RM, Nakagawa WT, Lopes A, Aguiar S
Rev Col Bras Cir · 2025 · PMID 41221922 · Full text
INTRODUCTION: Colorectal anastomotic leakage is associated with increased mortality, need for reoperation, diverting stomas, delayed discharge and higher costs. Early detection of anastomotic leaks can significantly impa...
INTRODUCTION: Colorectal anastomotic leakage is associated with increased mortality, need for reoperation, diverting stomas, delayed discharge and higher costs. Early detection of anastomotic leaks can significantly impact morbidity and clinical outcomes. The aim of this study is to identify the role of C-reactive protein (CRP) in the early detection of anastomotic leakage to improve treatment and fasten rehabilitation. METHODS: This is a prospective study that included 180 patients submitted to colectomies at AC Camargo Cancer Center from October 2021 to December 2022. C-reactive protein was systematically assessed on the third day after surgery. Postoperative care was provided by a single colorectal team based on our protocol for early recovery, which includes early feeding and mobilization, opioid avoidance and antibiotic prophylaxis. RESULTS: 180 patients were included in the study, comprising 79 women and 101 men, with a mean age of 62 years. Eighteen out of 180 patients presented with anastomotic leakage (10%). Analyzing the ROC curve for CRP, the area under the curve (AUC) was 0.860. The cutoff value was 11.2mg/dL, with an ROC of 0.81, resulting in a sensitivity of 77.8% and specificity of 84.0%. The negative predictive value (NPV) was 97.1%. An alternative cutoff with higher accuracy was 15.0mg/dL which has NPV of 96.1%, and more clinical applicability. CONCLUSION: A postoperative CRP of less than 15.0mg/dL, measured on the 3rd postoperative day, was effective in predicting a low risk of anastomotic leakage on asymptomatic patients allowing safe early discharge.
Assessment of the interval between diagnosis and definitive treatment of lung cancer at a public institution in São Paulo.
Fiuza OR, Maior BSS, Moraes LB … +4 more , Carvalho DAX, Perfeito JAJ, Evangelista Neto E, Miotto A
Rev Col Bras Cir · 2025 · PMID 40960752 · Full text
INTRODUCTION: This study aimed to investigate the interval between the diagnosis and definitive surgical treatment of lung cancer patients at a public institution in São Paulo. METHOD: A retrospective observational study...
INTRODUCTION: This study aimed to investigate the interval between the diagnosis and definitive surgical treatment of lung cancer patients at a public institution in São Paulo. METHOD: A retrospective observational study was conducted, using medical records to collect data on the periods between the first abnormal chest computed tomography (CT) scan, the initial consultation with the specialist, and the subsequent tumor resection. RESULTS: The analysis of 20 patients revealed a substantial average waiting period of 425.6 days between diagnosis and definitive treatment. During this interval, an average of 282 days elapsed between diagnosis and the initial specialist consultation, while the period between the first consultation and treatment averaged 143 days. By comparing the initial and final staging, 70% of the patients progressed to a higher stage over this period. CONCLUSIONS: The identified interval is concerning and exposes patients to elevated risks during this waiting period. This prolonged duration poses potential threats to patient health, resulting in decreased quality of life, increased risk of disease progression, reduced chances of cure, and diminished overall survival prospects. Addressing and minimizing this extended interval is crucial for improving patient outcomes and enhancing the effectiveness of lung cancer treatment.
Associations between sleeve gastrectomy, cholecystectomy, and gastroesophageal reflux disease in obese patients: an integrative review.
Cordeiro GG, Amaral VVD, Mattos Júnior LAR … +4 more , Lemos MC, Kreimer F, Araújo Júnior JGC, Ferraz ÁAB
Rev Col Bras Cir · 2025 · PMID 40960751 · Full text
INTRODUCTION: Adaptations of the gastrointestinal tract after sleeve gastrectomy have been associated with an increased incidence of gastroesophageal reflux disease (GERD) and cholelithiasis. Associations between GERD an...
INTRODUCTION: Adaptations of the gastrointestinal tract after sleeve gastrectomy have been associated with an increased incidence of gastroesophageal reflux disease (GERD) and cholelithiasis. Associations between GERD and increased enterohepatic biliary circulation post-cholecystectomy have been demonstrated. The objective of this study was to analyze the possible associations between cholecystectomy, sleeve gastrectomy and gastroesophageal reflux disease in obese patients. METHODS: This is an integrative review of the literature, selecting full publications, published in Portuguese, English and Spanish, between 2010 and 2023, in the databases: Web of Science, MEDLINE, LILACS, EMBASE and IBECS. The initial sample consisted of 783 studies, of which nine were selected for analysis. RESULTS: The synthesis of the selected articles showed that in the post-sleeve gastrectomy follow-up, 32.9% of patients developed cholelithiasis, considering 17.1% in the symptomatic form, with 15.4% of the sample undergoing cholecystectomy. The development of GERD after cholecystectomy was evident in 53.6% of patients. CONCLUSION: Evidence from current literature suggests a relationship between GERD and patients undergoing sleeve gastrectomy and cholecystectomy procedures. The causal mechanism appears multifactorial, especially linked to anatomical, metabolic and physiological changes resulting from surgical interventions. Therefore, more studies are needed to better elucidate the outcomes and effects on the gastrointestinal dynamics that permeate this condition.
Vital signs following autotransfusion in liposuction and concurrent aesthetic procedures.
Oliveira JA, Gontijo PM, Paranhos JSSG … +1 more , Gontijo LC
Rev Col Bras Cir · 2025 · PMID 40960750 · Full text
INTRODUCTION: Liposuction might lead to complications such as bleeding and anemia, and the volume of blood lost cannot be predicted. Autotransfusion has hemodynamic benefits and may be associated with better patient reco...
INTRODUCTION: Liposuction might lead to complications such as bleeding and anemia, and the volume of blood lost cannot be predicted. Autotransfusion has hemodynamic benefits and may be associated with better patient recovery. OBJECTIVE: To evaluate whether Autolog IQTM impacts the vital signs of patients undergoing liposuction. METHODS: A retrospective case-control study with patients undergoing liposuction from July to November 2023. Observers were blinded to data collection and analysis, and 98 patients were included and classified into an intervention group (autotransfusion during the procedure) or control group. RESULTS: 49 patients used Autolog, and 49 patients made up the control group, selected conveniently. 94 patients (96%) were women, with a mean age of 39±9.17 years and a mean weight of 26.5±3.55kg. Heart rate (HR) response in the postoperative period (MD -12, 95% CI: -19.42 to -4.58, p=0.002) and during anesthesia recovery (MD -8, 95% CI: -13.56 to -2.44, p=0.005) compared to the perioperative period favored the Autolog group. Mean arterial pressure during anesthesia recovery compared to the perioperative period (MD -25, 95% CI: -30.5 to -19.95, p<0.001); the MEWS score at hospital discharge (MD 1, 95% CI: 0.56 to 1.44, p<0.001); and HR at hospital discharge compared to postoperative (MD 10.5, 95% CI: 2.5 to 18.5, p=0.01) and anesthesia recovery (MD 8, 95% CI: 1.45 to 14.55, p=0.02) favored the control group. CONCLUSIONS: Autotransfusion showed potential benefits in immediate postoperative heart rate response and anesthesia recovery. Broader studies are needed in this population.
Clinical and surgical profiles of patients submitted to plastic surgery procedures after bariatric surgery in a public hospital in Brazil's Midwest.
Macedo JLS, Rosa SC, Macedo LFR … +3 more , Macedo CR, Gonçalves MF, Moura BDM
Rev Col Bras Cir · 2025 · PMID 40834225 · Full text
INTRODUCTION: Patients who undergo to gastroplasty present massive weight loss and the plastic surgery represents an important play in the treatment. The aim of this study is to present the profile of patients who underw...
INTRODUCTION: Patients who undergo to gastroplasty present massive weight loss and the plastic surgery represents an important play in the treatment. The aim of this study is to present the profile of patients who underwent plastic surgery after bariatric surgery performed at the Reference Public Hospital in West-Center of Brazil. METHODS: A descriptive, analytical and retrospective study was performed in a single public hospital on patients who underwent post-bariatric plastic surgery from January 2011 to December 2023. Three hundred and sixteen patients who underwent plastic surgery following Roux-Y gastroplasty were studied. Measures included BMI (body mass index) before gastroplasty and before plastic surgery, medical complications and comorbidities. RESULTS: 316 patients (297 female, 19 male) with a mean age of 43 years underwent 268 separated operations. The average BMI at the time of plastic surgery was 27,39kg/m2 . Average weight loss was 47,44kg and mean pre-weight loss BMI (max BMI) was 45,5kg/m2 .The most important preplastic comorbities were: arterial hypertension (12,7%), degenerative artrophaty (7,0%), diabete melito (5,7%) and methabolic syndrom (4,4%). From 316 patients operated, 75,7% were underwent abdominoplasty followed by mammaplasy (41,4%), ritidoplasty (12,0%), and brachioplasty (12,0%). Thirty-nine (12,3%) patients had hernia repair in combination with abdominoplasty. The complication rate was 31,3%. CONCLUSION: Epidemiological profile of postbariatric patients who underwent body contour surgery showed peculiar clinical, anthropometric and surgical aspects, specially the low prevelence of comorbidities, the low number of associated surgeries and rate of postoperative complications in the group studied.
A comparative cost analysis study of pulmonary robotic and video-assisted lobectomy: results of a randomized controlled trial (BRAVO Study).
Terra RM, Trindade JRM, Araujo PHXN … +3 more , Lauricella LL, Zaidan EP, Fernandesa PMP
Rev Col Bras Cir · 2025 · PMID 40834224 · Full text
INTRODUCTION: Robotic thoracic surgery has potential benefits, but the cost is still considered a limiting factor for its wide dissemination in most countries. METHODS: We compared the costs of robotic-assisted (RATS) an...
INTRODUCTION: Robotic thoracic surgery has potential benefits, but the cost is still considered a limiting factor for its wide dissemination in most countries. METHODS: We compared the costs of robotic-assisted (RATS) and video-assisted thoracic surgery (VATS) in the treatment of lung cancer or pulmonary metastasis. Cost analysis was based on micro-costing and individual cost analysis during surgical admission and frequency of services (emergency service, clinic visits, imaging exams, chemotherapy and radiotherapy, reoperation or additional procedures, rehospitalization, and ICU stay) during postoperative 90-day follow-up. RESULTS: A total of 76 patients were included in this cost analysis (RATS=37, VATS=39). Groups were equivalent in terms of age, gender, comorbidities, and pre-operative status. Total costs of pulmonary lobectomy did not differ between the RATS and VATS groups when considering cost of surgical hospitalization and follow-up of up to 90 days. Mean individual cost per patient in the RATS group was R$35,590.41 (±12,514.97) and R$41,066.98 (±25,891.04) in the VATS group, p=0.564. CONCLUSION: Robotic and video-assisted thoracic surgery had similar costs, but longer follow-up studies could be important to demonstrate RATS and VATS costs differences.
Abbreviation of preoperative fasting and malnutrition: impact on cost-effectiveness of surgical patients.
Arruda WSC, Dock-Nascimento DB, Aguilar-Nascimento JE
Rev Col Bras Cir · 2025 · PMID 40638509 · Full text
INTRODUCTION: Abbreviating preoperative fasting improves clinical outcomes, such as reducing hospital stay, morbidity and postoperative mortality. However, there is a lack of data regarding the reduction of hospital cost...
INTRODUCTION: Abbreviating preoperative fasting improves clinical outcomes, such as reducing hospital stay, morbidity and postoperative mortality. However, there is a lack of data regarding the reduction of hospital costs. Therefore, the objective of the research was to analyze whether reducing preoperative fasting time with the provision of carbohydrate-rich liquid has an influence on hospital costs for surgical patients. METHODS: Retrospective data were collected from patients undergoing surgical procedures at a University Hospital in 2019. The main outcome variable investigated was cost hospital in reais. Data such as gender, age, type of surgery, length of stay, nutritional data, and outcomes were also collected. Next, a comparative analysis of the variables was carried out in relation to patients who followed the preoperative fasting abbreviation protocol, with liquid rich in carbohydrates, and those whose protocol was not applied. RESULTS: The mean (± standard deviation) fasting time of the study participants was 267.92±89.8 (range: 120-605) minutes in the group that shortened the fast and 768.6±247.8 (150 -1244) minutes in the group that did not perform the abbreviation (p<0.01). In relation to hospital costs, it was observed that patients who shortened their fasting had a lower average cost than those who did not shorten it (R$ 3,245.37±4,157.5 vs R$ 10,897.39±16,701.3; p< 0.01). They were shown to be significantly associated with higher cost, malnutrition and prolonged preoperative fasting. CONCLUSIONS: According to data from this study, shortening preoperative fasting reduces hospital costs. Corroborating prolonged fasting, malnutrition also makes hospitalization more expensive.
Gastric cancer treatment in Brazil: a multicenter study of the Brazilian Gastric Cancer Association.
Ramos MFKP, Pereira MA, Ribeiro TF … +17 more , Braghiroli Neto O, Coimbra FJF, Rodrigues MAG, Sabino FD, Ribeiro Junior U, Cuenca RM, Victer FC, Tomasich FDS, Ishak G, Kalil AN, Ferraz ÁAB, Moreira LF, Quireze Junior C, Andreollo NA, Castro OAP, Pinheiro FAS, Weston AC
Rev Col Bras Cir · 2025 · PMID 40366960 · Full text
INTRODUCTION: Gastric cancer (GC) has distinct characteristics and management according to the region of the world, and the objective of our study was to evaluate how it is being managed in Brazil. METHODS: This is a mul...
INTRODUCTION: Gastric cancer (GC) has distinct characteristics and management according to the region of the world, and the objective of our study was to evaluate how it is being managed in Brazil. METHODS: This is a multicenter study that involved 18 oncology referral centers. Data were collected using the REDCap platform and compiled at the end of one year. RESULTS: All Brazilian regions were represented, and 635 patients were included. Most patients were from the Southeast (40.6%) and Northeast (29.6%) regions. The mean age was 62 years, with a predominance of males. Most patients (84.6%) had good performance status, with an ECOG score of 1-2. Less than 10% of patients were covered by medical insurance. A quarter of the patients underwent diagnostic laparoscopy, but endoscopic ultrasound and PET scans were rarely performed. The cT3 category was the most common (40.6%), lymph node involvement was described in 48.9%, and distant metastases, in 14.4% of the staging exams. The final cTNM staging was III (29.4%), II (26%), I (24.2%) and IV (20.5%). Most patients underwent surgery with curative intent (74.4%) and open access (82.8%). Preoperative chemotherapy was performed in 37.2% of cases, and the most common surgical procedures were subtotal gastrectomy (45.3%) and total gastrectomy (33.1%). CONCLUSION: The present study allowed us to evaluate the current panorama of surgical treatment of Gastric Cancer, representing all regions of Brazil. Stage III, distal, and diffuse tumors continue to be prevalent in Brazil, and there has been relevant use of diagnostic laparoscopy, preoperative chemotherapy, and minimally invasive surgery.
Electronic preoperative fasting abbreviation protocol: creation, application, and training of the patient care team.
Gonçalves RC, Nascimento JEA, Rezio MA … +2 more , Ferraz ECM, Carvalho R
Rev Col Bras Cir · 2025 · PMID 40366959 · Full text
INTRODUCTION: The preoperative fasting time does not, in practice, meet current recommendations for preoperative care. The implementation of clinical protocols for shortening preoperative fasting has faced numerous barri...
INTRODUCTION: The preoperative fasting time does not, in practice, meet current recommendations for preoperative care. The implementation of clinical protocols for shortening preoperative fasting has faced numerous barriers. The present study aims to evaluate whether the creation, application and professional training to use a fasting abbreviation protocol, linked to the electronic medical record, is capable of managing and reducing preoperative fasting time. METHODS: The study was conducted in two public hospitals in Goiânia, Goiás, Brazil. The DMAIC project methodology (Problem Definition - Measurement - Analysis - Implementation and Control) was used. Initially, the preoperative fasting time was measured in both institutions and the possible root causes for its prolongation were analyzed. Based on this assessment, a fasting abbreviation protocol was developed, managed through the electronic medical record, and the preoperative fasting time was again measured. In parallel, training was carried out for the multidisciplinary team to apply the protocol. RESULTS: Preoperative fasting time was high and superior to current recommendations in both hospitals. The causes for this prolongation were identified and treated. There was a reduction in preoperative fasting time in both institutions (11.50 vs 8.17 hours, p:0.000) and (8.77 vs 8.07 hours, p:0.025). CONCLUSION: The construction of a protocol, considering the needs of each institution, its management through electronic health records and the use of multiple methodologies for training patient care teams make it possible to reduce the duration of preoperative fasting.
Erratum.
Rev Col Bras Cir · 2025 Apr · PMID 40197925 · Full text
BACKGROUND: [This corrects the article doi: 10.1590/0100-6991e-20243787-en]. BACKGROUND: [This corrects the article doi: 10.1590/0100-6991e-20243787].
BACKGROUND: [This corrects the article doi: 10.1590/0100-6991e-20243787-en]. BACKGROUND: [This corrects the article doi: 10.1590/0100-6991e-20243787].
Erratum.
Rev Col Bras Cir · 2025 Apr · PMID 40197924 · Full text
BACKGROUND: [This corrects the article doi: 10.1590/0100-6991e-20243753-en]. BACKGROUND: [This corrects the article doi: 10.1590/0100-6991e-20243753].
BACKGROUND: [This corrects the article doi: 10.1590/0100-6991e-20243753-en]. BACKGROUND: [This corrects the article doi: 10.1590/0100-6991e-20243753].
Are eviscerations preventable?
Tomasi JF, Tolfo FM, Constantino LM … +1 more , Cacciatori FA
Rev Col Bras Cir · 2025 · PMID 40008774 · Full text
INTRODUCTION: The incidence of eviscerations is 3.5% in the literature. The use of prophylactic meshes in patients at high risk of evisceration has been studied. The objective of this study is to evaluate the characteris...
INTRODUCTION: The incidence of eviscerations is 3.5% in the literature. The use of prophylactic meshes in patients at high risk of evisceration has been studied. The objective of this study is to evaluate the characteristics of patients undergoing abdominal wall resuturing due to evisceration and verify the benefit of using prophylactic mesh in this sample. METHODS: This is a retrospective cohort study, which analyzed the medical records of patients who underwent abdominal wall resuturing procedures between January 2010 and December 2023 in a tertiary hospital. The inclusion criteria were patients who underwent abdominal wall resuturing in the study hospital, with index surgery in the same hospital and median access. Patients under 18 years of age, patients undergoing laparoscopic surgery and non-median access were excluded. The Rotterdam risk score for aponeurosis dehiscence, modified by Lima, was used as a parameter. RESULTS: The final sample of 252 patients was made up of 74.2% men. The median age was 64 years and the median BMI was 24.3kg/m2. The median number of days between surgery and resuturing was 8. The median hemoglobin was 11.1g/dL. The incidence of neoplasia, smoking and COPD was 47.2%, 32.1% and 13% respectively. Elective surgeries were 58.8%. CONCLUSION: It was concluded that, using the modified Rotterdam score, of the 227 patients, 164 (72.2%) would have received prophylactic mesh, which potentially would have prevented evisceration.
Surgical treatment of bronchopulmonary malformations in children: experience in a Brazilian center.
Victória ÁM, Botelho F, Picarro C … +4 more , Cruzeiro PCF, Emil S, Fraga JC, Miranda ME
Rev Col Bras Cir · 2025 · PMID 40008773 · Full text
INTRODUCTION: Bronchopulmonary malformations (BPM) are lower respiratory tract anomalies that include congenital malformations of the pulmonary airways (CMPA), bronchogenic cysts (BC), bronchopulmonary sequestrations (BP...
INTRODUCTION: Bronchopulmonary malformations (BPM) are lower respiratory tract anomalies that include congenital malformations of the pulmonary airways (CMPA), bronchogenic cysts (BC), bronchopulmonary sequestrations (BPS), and congenital lobar emphysema (CLE). Prenatal detection in low- and middle-income countries is less common than in high-income ones. This study aims to show the experience in the surgical approach to BPM in a Brazilian center, with emphasis on clinical evolution and surgical results, according to the time of diagnosis (prenatal versus postnatal). METHODS: We retrospectively analyzed medical records of patients under the age of 18 who underwent surgery for BPM at a referral center in a middle-income country between 2000 and 2021. Based on the time of BPM diagnosis, we divided the children into two groups: prenatal and postnatal. These groups were evaluated in terms of age at surgery, history of pneumonia before the operation, surgical outcomes (perioperative and postoperative complications, duration of mechanical ventilation, duration of chest tube, length of hospital stay), and histological type of BPM. RESULTS: In the cohort of 66 patients, 43 (65.1%) had a prenatal diagnosis of BPM, while 23 (34.8%) were identified after birth. Compared with patients diagnosed prenatally, those diagnosed after birth underwent surgery at a higher age (mean of 978 days ± 1341.0 versus mean of 200 days ± 360.9; p<0.01), and had a higher incidence of pneumonia before surgery (65% vs. 12%, p < 0.01). There was no association between the time of BPM diagnosis and postoperative outcomes. All patients with BPS were in the prenatal group, and all patients with CLE were in the postnatal one. There was a higher prevalence of CMPA in the prenatal group compared with the postnatal one (72% vs. 39%, p < 0.01). CONCLUSION: In a Brazilian center, approximately 2/3 of the patients had an intrauterine diagnosis of bronchopulmonary malformations and were treated early at a neonatology center. Patients diagnosed with BPM only after birth were more likely to have pneumonia and undergo surgery at an older age than patients with an intrauterine diagnosis. Prospective, multicenter studies, including asymptomatic patients treated conservatively, without surgical interventions, and patients operated by video-assisted thoracoscopy, would be well indicated to evaluate the future evolution of children with BPM and to establish protocols appropriate to the Brazilian reality.
Current context and the experience of Brazilian Medical Societies with Specialist Title Exams.
Pereira Júnior GA, Colleoni Neto R, Giampani Júnior J … +7 more , Guede JC, Camargo ACK, Matsunaga FT, Nomura RMY, Marques FO, Lutaif JE, Fernandes CE
Rev Col Bras Cir · 2025 · PMID 39841725 · Full text
The editorial discusses the need for the Specialist Title to be valued by Medical Societies, as a stage after the conclusion of medical residency and a mandatory prerequisite for taking the tests. Finally, it shows the e...
The editorial discusses the need for the Specialist Title to be valued by Medical Societies, as a stage after the conclusion of medical residency and a mandatory prerequisite for taking the tests. Finally, it shows the experience of seven Medical Societies with their specialist title exams.
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