Revista Do Colegio Brasileiro De Cirurgioes[JOURNAL]
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200 papers
Could retrograde reperfusion combined with washout technique broaden the applicability of marginal grafts in liver transplantation? Intra-operative and short-term outcomes of a prospective cohort.
Cirilo Neto O, Moutinho LER, Melo PSV … +4 more , Costa LR, Rabêlo PJM, Amorim AG, Melo CML
Rev Col Bras Cir · 2023 · PMID 37436281 · Full text
INTRODUCTION: many revascularization techniques were designed to reduce the imbalance of ischemia-reperfusion injury. This study's objective is to evaluate retrograde reperfusion (RR) compared to sequential anterograde r...
INTRODUCTION: many revascularization techniques were designed to reduce the imbalance of ischemia-reperfusion injury. This study's objective is to evaluate retrograde reperfusion (RR) compared to sequential anterograde reperfusion (AR), with and without the washout technique (WO). METHOD: this prospective cohort study collected data from 94 deceased donor orthotopic liver transplants and divided it into three groups: RR with WO (RR+WO), AP with WO (AR+WO), and AP without WO (AR). This study did not assign the reperfusion technique to the participants. The primary outcome considered the early graft dysfunction, and secondary outcomes included post-reperfusion syndrome (PRS), post-reperfusion lactate, surgery fluid balance, and vasoactive drug dose during the surgery. RESULTS: 87 patients were submitted to the final analysis-29 in the RR+WO group, 27 in the AR+WO group, and 31 in the AR group. Marginal grafts prevalence was not significantly different between the groups (34% vs. 22% vs. 23%; p=0.49) and early graft dysfunction occurred at the same rate (24% vs. 26% vs. 19%; p=0.72). RR+WO reduced serum post-reperfusion lactate (p=0.034) and the incidence of significant PRS (17% vs. 33% vs. 55%; p=0.051), but norepinephrine dosing >0.5mcg/kg/min were not different during the surgery (20,7% vs. 29,6% vs. 35,5%, p=0.45). CONCLUSIONS: primary outcome was not significantly different between the groups; however, intraoperative hemodynamic management was safer using the RR+WO technique. We theorized that the RR+WO technique could reduce the incidence of PRS and benefit marginal graft survival following diseased donor orthotopic liver transplantation.
Follow up of utility and value of totally implantable chemotherapy catheter in 233 brazilian patients receiving chemotherapy to treat cancer.
César RM, Lage APD, Wainstein A
Rev Col Bras Cir · 2023 · PMID 37436280 · Full text
OBJECTIVES: the present study aims to evaluate cancer patients related to the catheter flow and the general satisfaction of these patients. METHODS: we studied 233 individuals diagnosed with cancer who underwent chemothe...
OBJECTIVES: the present study aims to evaluate cancer patients related to the catheter flow and the general satisfaction of these patients. METHODS: we studied 233 individuals diagnosed with cancer who underwent chemotherapy treatment through venous access through portocath between January 2015 and December 2019. RESULTS: 97% of the patients consulted had palliative chemotherapy, and 99.1% of patients reported satisfaction with the implantation process and treatment method. Regarding catheter flow according to venous return and drip during drug infusion, 98.7% of individuals presented good flow. CONCLUSIONS: the results show that catheter flow was satisfactory in all implant sites observed and emphasize the advantages of using a totally implanted catheter. This benefice happens due to the reduction of emotional factors that cause stress in cancer patients receiving chemotherapy, as well as the reduction of trauma and discomfort experienced by patients during the infusion of peripheral chemotherapy.
Elective pediatric surgery: profile description of children and late referral identification.
Talini C, Carvalho ARDS, Viera CS
Rev Col Bras Cir · 2023 · PMID 37341289 · Full text
Pediatric surgery receives great demand for referrals from primary care services in order to evaluate the need for surgical intervention. However access to this specialized evaluation and in intervention does not always...
Pediatric surgery receives great demand for referrals from primary care services in order to evaluate the need for surgical intervention. However access to this specialized evaluation and in intervention does not always occur at the appropriate time. This study aims to characterize the profile of pediatric patients electively operated in the western Paraná state region, between 2018 and 2020, and identify those who were lately referred to surgical evaluation. This is a descriptive, cross-sectional and retrospective study through the review of electronic medical records. The variables evaluated were sociodemographic data, information on underlying diseases, referral data, specialist assessment and surgical procedure. During this period, 410 patients underwent an elective surgical procedure, of which 289 were included in the research. The sample was predominantly male (72.3%) with a mean age of 57.9 months at the surgeons assessment and 59 months at the date of surgery. Most of the patients came from primary care (75%) and the most common pathology was inguinal hernia (39.1%). The mean time interval between referral through primary care and surgery was 4.98 months, and between the surgeons assessment and surgery was 1.21 months. Of the total sample, 77 (26.6%) patients were identified as being referred late for the surgical procedure. Knowing the profile of patients and the problems experienced in this region in relation to the care provided in pediatric surgery provides subsidies to propose improvement strategies not only for the health system in this location, but for several inner regions of Brazil in a similar situation.
Bacterial cellulose biomaterials for the treatment of lower limb ulcers.
Oliveira GM, Gomes Filho AO, Silva JGMD … +4 more , Silva Junior AGD, Oliveira MDL, Andrade CAS, Lins EM
Rev Col Bras Cir · 2023 · PMID 37222383 · Full text
Chronic ulcers of the lower limbs are common and recurrent, especially in the elderly population, they are disabling injuries that generate a great socioeconomic burden. This scenario encourages the development of new, l...
Chronic ulcers of the lower limbs are common and recurrent, especially in the elderly population, they are disabling injuries that generate a great socioeconomic burden. This scenario encourages the development of new, low-cost therapeutic alternatives. The present study aims to describe the use of bacterial cellulose in the treatment of lower limb ulcers. This is an integrative literature review, carried out in the PubMed and Science Direct databases by associating the descriptors, with the inclusion criteria being clinical studies in the last 5 years, available in full in English, Portuguese and Spanish. Five clinical trials were analyzed and the main therapeutic effects obtained in the experimental groups that used bacterial cellulose dressings were a reduction in the area of the wounds, one of the studies showed a reduction of 44.18cm2 in the area of the wound, the initial lesions measured on average 89.46cm2 and at the end of the follow-up, they had an average of 45.28cm2, since the reduction in pain and the decrease in the number of exchanges were advantages described in all groups that used the BS. It is concluded that BC dressings are an alternative for the treatment of lower limb ulcers, their use also reduces operational costs related to the treatment of ulcers.
Retrospective analysis of surgical and oncological results of laparoscopic surgeries performed by residents of coloproctology.
Mota BBL, Macedo TJB, Parra RS … +3 more , Rocha JJRD, Feres O, Feitosa MR
Rev Col Bras Cir · 2023 · PMID 37222382 · Full text
INTRODUCTION: with the improvement and wide acceptance of laparoscopy in colorectal operations, there was a need for specific training of surgeons in training. There are few studies evaluating the postoperative results o...
INTRODUCTION: with the improvement and wide acceptance of laparoscopy in colorectal operations, there was a need for specific training of surgeons in training. There are few studies evaluating the postoperative results of laparoscopic colectomies performed by resident physicians and their impact on patient safety. PURPOSE: to analyze the surgical and oncological results of laparoscopic colectomies performed by coloproctology residents and compare them with data in the literature. METHODS: this is a retrospective analysis of patients undergoing laparoscopic colorectal surgery performed by resident physicians at the Hospital das Clínicas de Ribeirão Preto, between 2014 and 2018. The clinical characteristics of the patients were studied, as well as the main surgical and oncological aspects in a period of one year. RESULTS: we analyzed 191 operations, whose main surgical indication was adenocarcinoma, most of them stage III. The mean duration of surgeries was 210±58 minutes. There was a need for a stoma in 21.5% of the patients, mainly loop colostomy. The conversion rate was 23%, with 79.5% due to technical difficulties, and the main predictors of conversion were obesity and intraoperative accidents. The median length of stay was 6 days. Preoperative anemia was associated with a higher rate of complications (11.5%) and reoperations (12%). Surgical resection margins were compromised in 8.6% of cases. The one-year recurrence rate was 3.2% and the mortality rate was 6.3%. CONCLUSIONS: videolaparoscopic colorectal surgery performed by residents showed efficacy and safety similar to data found in the literature.
Intraabdominal hypertension and Abdominal Compartment Syndrome in patients with COVID-19: an integrative review.
Costa ACFGS, Fonseca Neto OCLD
Rev Col Bras Cir · 2023 · PMID 37222348 · Full text
The first cases of COVID-19 were diagnosed in China, rapidly evolving with worldwide spread, turning into a pandemic. A percentage of these patients develop the severe form of the disease and progress to respiratory dist...
The first cases of COVID-19 were diagnosed in China, rapidly evolving with worldwide spread, turning into a pandemic. A percentage of these patients develop the severe form of the disease and progress to respiratory distress syndrome, requiring support in Intensive Care Units. Intra-abdominal Hypertension and Abdominal Compartment Syndrome are characterized by increased intra-abdominal pressure, and are subject to several predisposing factors, such as mechanical ventilation assistance, extracorporeal membrane oxygenation, elevated PEEP, intestinal obstructions, excessive fluid replacement, major burns and coagulopathies. Hence, for the management of patients with severe COVID-19, there are numerous risk factors for the development of intra-abdominal hypertension and abdominal compartment syndrome. Therefore, this study proposes to analyze the variables that directly interfere with the increase in intra-abdominal pressure in patients with COVID-19, as well as the changes in the organic systems caused, through an integrative literature review.
Challenges to implement laparoscopic appendectomy as the first-line treatment for acute appendicitis: a fifteen-year experience in a tertiary hospital in Brazil.
Damous SHB, Menegozzo CAM, Rocha MC … +2 more , Collet-E-Silva FS, Utiyama EM
Rev Col Bras Cir · 2023 · PMID 37222347 · Full text
BACKGROUND: the barriers to implement emergency laparoscopy in public teaching hospitals involve issues such as resident learning curves and resource costs and availability. This study was designed to describe the issues...
BACKGROUND: the barriers to implement emergency laparoscopy in public teaching hospitals involve issues such as resident learning curves and resource costs and availability. This study was designed to describe the issues facing the implementation of laparoscopic approach for acute appendicitis over 15 years in a single academic center in Brazil. MATERIALS AND METHODS: retrospective study of patients undergoing emergency appendectomy from 2004 to 2018. Clinical data were compared to four major actions implemented in the emergency surgical service: minimally invasive surgery training for residents (2007), laparoscopic stump closure using metal clips (2008), 24/7 availability of laparoscopic instruments for emergency surgeries (2010), and third-party contract for maintenance of the laparoscopic instruments and implementation of polymeric clips for stump closure (2013). We evaluated the increase in laparoscopic appendectomy after the implementation of those major changes. RESULTS: we identified 1168 appendectomies during the study period, of which 691 (59%), 465 (40%), and 12 (1%) were open, laparoscopic, and converted, respectively. The implementation of the major changes since 2004 resulted in an increase of laparoscopic appendectomies from 11% in 2007 to 80% in 2016. These actions were decisive in the widespread use of laparoscopy for acute appendicitis (p<0.001). The standardization of the hem-o-lok clip in the treatment of the appendiceal stump made the procedure more feasible, reducing the surgical time using laparoscopic access and increasing the team's adherence, so that this became the route of choice in about 85% of cases in the period from 2014 to 2018, 80% performed by 3rd year resident physicians. No intraoperative complications were noted related to laparoscopic access, even in more complicated appendicitis. There was no mortality reported, no reoperations or readmissions to hospital during a 30-day postoperative period. CONCLUSION: the development of a feasible, reproducible, and safe technical standardization, associated with continuous cost optimization, are the cornerstones for a consistent and viable change in the current practice for appendectomies in middle and lower-income countries.
Trauma surgery workforce in the state of Rio Grande do Sul, Brazil.
Baldissera N, Fonseca MK, Cunha CEBD … +3 more , Ribeiro JAM, Dalcin RR, Schneider RF
Rev Col Bras Cir · 2023 · PMID 37222346 · Full text
OBJECTIVE: to describe the current scope of certified trauma surgeons trained in the state of Rio Grande do Sul, including demographic data, geographic distribution, remuneration, and perspectives related to this special...
OBJECTIVE: to describe the current scope of certified trauma surgeons trained in the state of Rio Grande do Sul, including demographic data, geographic distribution, remuneration, and perspectives related to this specialty. METHOD: cross-sectional survey based on information collected through an electronic questionnaire sent to potential participants. RESULTS: the response rate was 64% (n=75). There was a predominance of males (72%) with a mean age of 43 years. Most surgeons graduated from the Hospital de Pronto Socorro de Porto Alegre, and work in referral centers for trauma surgery in the capital and metropolitan region. More than 60% did not have any other training in a surgical subspecialty, though only a third stated that trauma surgery is their main source of income. CONCLUSION: trauma centers are poorly distributed and most surgeons work in referral hospitals in the metropolitan region of Porto Alegre. Due to the lack of recognition, limited financial income and shift work patterns, the career in trauma surgery care is unattractive, with only one third of surgeons performing most of their activities in this specialty.
Fecal microbiota transplantation and its repercussions in patients with melanoma refractory to anti-PD-1 therapy: scope review.
Barbosa EC, Bucar EEC, Jubé GR … +6 more , Silveira LB, Silva NCD, Faria PCC, Ramos PLC, Moraes VRY, Barros JOB
Rev Col Bras Cir · 2023 · PMID 37222345 · Full text
INTRODUCTION: despite being extremely effective in some cases, up to 70% of patients with melanoma do not respond to anti-PD-1/PD-L1 (primary resistance) and many of the responders eventually progress (secondary resistan...
INTRODUCTION: despite being extremely effective in some cases, up to 70% of patients with melanoma do not respond to anti-PD-1/PD-L1 (primary resistance) and many of the responders eventually progress (secondary resistance). Extensive efforts are being made to overcome this resistance through new strategies, especially aimed at modulating the intestinal microbiota. OBJECTIVE: to assess whether fecal microbiota transplantation (FMT), associated with immunotherapy, is beneficial in the clinical course of patients with refractory melanoma. METHODS: this is a scope review, based on studies collected on the MEDLINE, ScienceDirect, The Cochrane Library, Embase and BMJ Journals; using the terms: "Antibodies, Monoclonal"; "Drug Resistance, Neoplasm"; "Fecal Microbiota Transplantation"; "Host Microbial Interactions"; "Immunotherapy"; "Melanoma"; and "Microbiota". Clinical trials, in English, with relevant data on the subject and fully available were included. A cut-off period was not determined, due to the limited amount of evidence on the topic. RESULTS: crossing the descriptors allowed the identification of 342 publications and, after applying the eligibility criteria, allowed the selection of 4 studies. From the analyses, it was observed that a considerable part of those studied overcame resistance to immune checkpoint inhibitors after FMT, with better response to treatment, less tumor growth and increased beneficial immune response. CONCLUSION: it is noted that FMT favors the response of melanoma to immunotherapy, translated into significant clinical benefit. However, further studies are necessary for the complete elucidation of the bacteria and the mechanisms involved, as well as for the translation of new evidence to oncological care practice.
Transoral thyroid and parathyroid surgery in Brazil: where are we?
Tenório LR, Bertelli AA, Nakai MY … +3 more , Menezes MB, Russell JO, Gonçalves AJ
Rev Col Bras Cir · 2023 · PMID 37222344 · Full text
INTRODUCTION: thyroid surgery through the transoral vestibular approach is a reality in many countries. While several competing remote access techniques have been developed in the last 20 years, many were not reproducibl...
INTRODUCTION: thyroid surgery through the transoral vestibular approach is a reality in many countries. While several competing remote access techniques have been developed in the last 20 years, many were not reproducible. Transoral Endoscopic Neck Surgery (TNS) has been shown to be reproducible in different centers around the world, and approximately five years after its description it has been adopted relatively quickly for various reasons. To date, there are at least 7 Brazilian studies published, including a series of more than 400 cases. The aim of this work is to study the progression of Transoral Neck Surgery in Brazil and describe the profile of surgeons involved in this new approach. METHODS: this is a retrospective study with descriptive statistics. A REDCap based survey about transoral endoscopic thyroidectomy and parathyroidectomy vestibular approach (TOETVA/TOEPVA) was done with 66 Brazilian surgeons regarding surgeon profile, numbers of cases performed by geographic region, what kind of training was necessary prior to the first case and behavior of the surgeon proposing these new approaches. RESULTS: response rate of this survey was 53%. To date, 1275 TOETVA/TOEPVA cases had been performed in Brazil, 1229 thyroidectomies (96.4%), 42 parathyroidectomies (3.3%) and 4 combined procedures (0.3%). Most of the cases were done in the southeast region (821, 64.4%), 538 (42.2%) cases in the State of São Paulo and 283 (22.2%) cases in the State of Rio de Janeiro. CONCLUSIONS: TOETVA is becoming popular in Brazil. Younger surgeons, especially those between 30 and 50 years old were more likely to adopt this approach.
Comparison of bacterial profile of gallbladder with gallstones from patients undergoing cholecystectomy due to complicated and uncomplicated cholelithiasis: changes in the epidemiological scenario.
Hirata BHN, Sasagawa S, Navarini A … +3 more , Mateus HC, Pacheco Junior AM, Salles MJC
Rev Col Bras Cir · 2023 · PMID 37162041 · Full text
INTRODUCTION: cholelithiasis is a highly prevalent disease of the digestive system in the world. In Brazil, it is a routine condition, whose studies suggest a prevalence of around 10% of adults. Colonization of bile and...
INTRODUCTION: cholelithiasis is a highly prevalent disease of the digestive system in the world. In Brazil, it is a routine condition, whose studies suggest a prevalence of around 10% of adults. Colonization of bile and gallstone pathogens can occur when there is bacterial stasis and proliferation. This proliferation is facilitated by the adhesion and biofilm formation capacity of some bacteria. There are also lithogenic processes that involve bacterial participation. Studies have shown changes in the microbiota of the gallbladder of patients undergoing cholecystectomy, which may impact empirical treatment with antibiotics. METHODOLOGY: microbiological analyzes of the sonication fluid of the gallstones and of two samples with bile were performed. Identification and antimicrobial susceptibility testing were performed according to a standard routine. RESULTS: of the 34 patients, 76.4% were female. The age group was 48 years +/- 16.61. Acute cholecystitis occurred in 50% of cases. Bactobilia was evidenced in 32.1% of the cases. Klebisiella pneumoniae was noted as the most prevalent pathogen in acute cholecystitis; and Enterobacter sp, in cases of uncomplicated cholelithiasis. Greater sensitivity was obtained in the search for microorganisms in the sonication fluid samples of the stones in relation to the bile samples (p=0.0058). CONCLUSION: there was a higher prevalence of bactobilia in patients with acute cholecystitis compared to those with uncomplicated cholelithiasis. The use of sonication in bacterial investigation proved to be superior to the conventional method and can be considered.
Long-term evaluation of patients with BMI = 50kg/m2 who underwent Bariatric Surgery.
Meira MD, Oliveira FSC, Coutinho LR … +4 more , Leão LHA, Vasconcelos GP, Siqueira LT, Ferraz ÁAB
Rev Col Bras Cir · 2023 · PMID 37162040 · Full text
PURPOSE: to determine the risks and benefits of bariatric surgery in patients with super obesity (SO) in comparison with obesity grades II and III. METHODS: retrospective cohort that included a study group of 178 patient...
PURPOSE: to determine the risks and benefits of bariatric surgery in patients with super obesity (SO) in comparison with obesity grades II and III. METHODS: retrospective cohort that included a study group of 178 patients with SO and a control group of 181 patients with BMI 35-49.9Kg/m2. The groups were formed in a 1:1 nearest neighbor matching. The main variables were pre- and postoperative BMI and comorbidities, occurrence of severe postoperative complications, bowel obstruction, marginal ulcer, fistulae and 30-day death, besides the necessity of emergency room (ER) admission and abdominal computed tomography (CT) scans in the postoperative period due to acute abdomen. RESULTS: the study group comprised 74.0% of women while the control group had 56.7%. The mean follow-up time was similar between both groups (5.48 x 6.09 years, p=0.216). There was no statistically significant difference on the prevalence of hypertension and T2D between the groups according to the surgical technique. All deaths occurred in the Study group (BMI = 50kg/m2) who underwent RYGB. There was no difference between the groups regarding the occurrence of severe complications. Data on ER admissions and the need for abdominal CT to investigate postoperative abdominal pain did not show statistically significant difference between the groups. CONCLUSION: despite the high risk related to bariatric surgery in patients with SO, the benefits related to the remission of comorbidities are significant; although being lower than those found in patients with milder grades of obesity.
Smoking cessation for peripheral arterial disease: systematic review protocol.
Kuramoto DAB, Zanin LFS, Flumignan RLG … +4 more , Flumignan CDQ, Reicher ME, Correia RM, Nakano LCU
Rev Col Bras Cir · 2023 · PMID 37075468 · Full text
BACKGROUND: peripheral arterial disease has smoking as its main avoidable vascular risk factor. However, most studies do not focus on smoking as the main exposure variable. OBJECTIVES: to assess the impact of smoking ces...
BACKGROUND: peripheral arterial disease has smoking as its main avoidable vascular risk factor. However, most studies do not focus on smoking as the main exposure variable. OBJECTIVES: to assess the impact of smoking cessation interventions versus active comparator, placebo or no intervention, on peripheral arterial disease outcomes. METHODS: we will use the Cochrane Handbook for Systematic Reviews of Interventions to guide whole this review process. We will consider parallel or cluster-randomised controlled trials (RCTs), quasi-RCTs, and cohort studies. We will search CENTRAL, MEDLINE, Embase, PsycINFO, LILACS and IBECS. We will also conduct a search of ClinicalTrials.gov and the ICTRP for ongoing or unpublished trials. Each research step will involve at least two independent reviewers. We will create a table, using GRADE pro GDT software, reporting the pooled effect estimates for the following outcomes: all-cause mortality, lower limb amputation, adverse events, walking distance, clinical severity, vessel or graft secondary patency, and QoL. CONCLUSIONS: we will assess these outcomes according to the five GRADE considerations to assess the certainty of the body of evidence for these outcomes, and to draw conclusions about the certainty of the evidence within the review.
The learning curve of bilateral laparoscopic varicocelectomy: a prospective study.
Belkovsky M, Passerotti CC, Maximiano LF … +2 more , Otoch JP, Cruz JASD
Rev Col Bras Cir · 2023 · PMID 37075467 · Full text
Varicocele occurs in 15% of general male population and in 35% of infertile men. Since 1992, surgical correction with laparoscopic varicocelectomy is the gold standard for treatment of symptomatic patients or patients wi...
Varicocele occurs in 15% of general male population and in 35% of infertile men. Since 1992, surgical correction with laparoscopic varicocelectomy is the gold standard for treatment of symptomatic patients or patients with abnormal seminal analysis. The learning curve for this frequently performed procedure has not yet been described. In the present study, we investigated the learning curve of a single urologist in training performing his first 21 laparoscopic varicocelectomies using qualitative and quantitative tools to evaluate his performance during the process. Our results show that 14 bilateral laparoscopic varicocelectomies are enough to achieve the plateau of the learning curve.
Comparative analysis between open transvesical and laparoscopic adenomectomy in the treatment of benigne prostatic hyperplasia in a tertiary hospital in Curitiba-PR: a retrospective study.
Sfredo LR, Oliveira IC, Novakoski GKO … +5 more , Digner IS, Silva IVMD, Lacerda DAM, Campos BCMM, Santos LS
Rev Col Bras Cir · 2023 · PMID 37075466 · Full text
OBJECTIVE: the aim of this study was to compare the results of open and videolaparoscopic transvesical prostatectomy techniques in the treatment of benign prostatic hyperplasia (BPH) in a tertiary hospital. METHODS: we r...
OBJECTIVE: the aim of this study was to compare the results of open and videolaparoscopic transvesical prostatectomy techniques in the treatment of benign prostatic hyperplasia (BPH) in a tertiary hospital. METHODS: we reviewed medical records of patients who underwent transvesical adenectomy due to BPH between March 2019 and March 2021 at the urology service of Hospital de Clínicas do Paraná (HCPR), 42 patients were included in the open transvesical prostatectomy group and 22 in the videolaparoscopic group. Then, a comparison was made between the techniques in terms of surgical time, bleeding, length of stay, need for intensive care, among others, in addition to postoperative outcome. RESULTS: the mean surgical time was shorter in the open technique compared to the laparoscopic technique (141 min vs 274 min). The videolaparoscopic group had a shorter mean hospital stay (3.5 days vs 6.36 days). There was no statistical significance in the comparison regarding the need for an intensive care unit, as well as in the assessment of postoperative bleeding. CONCLUSION: comparatively, the techniques demonstrated a similar outcome, with a low rate of complications and satisfactory results for the treatment of BPH. The laparoscopic technique is a surgery with a shorter hospital stay, but at the expense of a longer surgical time.
The care of the patients with hipoplastic left heart syndrome in places of social and economic vulneability. An ethical analysis.
Rocha IEGM, Fonseca FLBS, Silva J
Rev Col Bras Cir · 2023 · PMID 37075465 · Full text
The birth of a child means hope and joy, particularly for the parents and the healthcare team. When this child is born with a severe malformation and a poor prognosis, as in the case of hypoplastic left heart syndrome, t...
The birth of a child means hope and joy, particularly for the parents and the healthcare team. When this child is born with a severe malformation and a poor prognosis, as in the case of hypoplastic left heart syndrome, the scenario is one of great uncertainty and emotional suffering. The role of the health team becomes fundamental for the identification of conflicts of values and for the search for shared decisions that promote the best benefit to the child. When the diagnosis is made during fetal life, it is necessary to develop counseling strategies appropriate to the context of each family. In places with limited care resources, precarious prenatal care and short temporal conditions, the recommended counseling is compromised. Indication of treatment requires technical competence and a detailed analysis of ethical issues, and consultation with institutional clinical bioethics services or commissions is important. The article proposes to address the moral conflicts of two clinical cases and the respective bioethical analysis that involves principles and values in contexts of vulnerability and uncertainty, contrasting two situations where the indication of treatment was based on accessibility to treatment.
Analysis of primary care of victims of interpersonal and self inflicted violence during the COVID-19 pandemic.
Teixeira HM, DA-Silva AA, DA-Rocha AKC … +4 more , Valderrama MR, Bernardelli RS, Silva VWM, Bahten LCV
Rev Col Bras Cir · 2023 · PMID 37075464 · Full text
OBJECTIVES: to analyze the epidemiological profile of aggression victims admitted at the emergency room on a trauma hospital during the COVID-19 pandemic, to compare these data in different restriction periods and with p...
OBJECTIVES: to analyze the epidemiological profile of aggression victims admitted at the emergency room on a trauma hospital during the COVID-19 pandemic, to compare these data in different restriction periods and with prepandemic data from the same service. METHODS: cross-sectional study with probabilistic sampling using medical records of patients who were victims of aggression admitted at the hospital between June 2020 and May 2021. In addition to the epidemiological variables, other variables collected were the current restriction level, mechanism of aggression, resulting injuries and the Revised Trauma Score (RTS). The data was compared between the three restriction levels and the proportion of attendances during the study period was compared with the pre-pandemic study (December 2016 to February 2018). RESULTS: the average age was 35.5 years, 86.1% of the patients were male and 61.6% of the attendances were due to blunt injury. The highest average of attendances per day occurred during the "yellow" restriction level (2.9), however there was no significant difference when comparing the restriction periods two by two. There was also no significant difference either in the analysis of the standardized residuals of the proportions of aggressions or the mechanism of aggression in the pre-pandemic and pandemic periods. CONCLUSIONS: there was a predominance of attendances due to blunt trauma and in young male patients. There was no significant difference between the average daily attendance for aggression during the three restriction levels and between the proportion of attendances in the pre-pandemic and pandemic period.
Assessing morbidity, mortality, and survival in patients with peritoneal carcinomatosis undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
Vallejo JSA, Queiroz FL, Lacerda Filho A … +5 more , França Neto PR, Costa BXMD, Paiva RA, Garcia SLM, Silva SB
Rev Col Bras Cir · 2023 · PMID 37075463 · Full text
OBJECTIVE: Peritoneal carcinomatosis (PC) indicates advanced stage cancer, which is generally associated with a poor outcome and a 6 to 12 months. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherap...
OBJECTIVE: Peritoneal carcinomatosis (PC) indicates advanced stage cancer, which is generally associated with a poor outcome and a 6 to 12 months. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an option for treating patients with primary PC, such as mesothelioma, or secondary PC, such as colorectal cancer (CRC) or pseudomixoma. Until recently, such patients were deemed untreatable. The purpose of this study was to assess the results of CRS + HIPEC in patients with PC. Postoperative complications, mortality and survival rates were evaluated according to the diagnosis. RESULTS: Fifty-six patients with PC, undergoing full CRS + HIPEC between October 2004 and January 2020, were enrolled. The mortality rate was 3.8% and the morbidity rate was 61.5%. Complications were significantly higher in proportion to the duration of surgery (p<0.001). The overall survival rates, as shown in the Kaplan-Meyer curve, were respectively 81%, 74% and 53% at 12, 24 and 60 months. Survival rates according to each diagnosis for the same periods were 87%, 82% and 47% in patients with pseudomixoma, and 77%, 72% and 57% in patients with CRC (log-rank 0.371, p=0.543). CONCLUSION: CRS with HIPEC is an option for pacients with primary or secondary PC. Although complication rates are high, a longer survival rate may be attained compared to those seen in previously published results; in some cases, patients may even be cured.
Bilateral inguinal transabdominal pre-peritoneal laparoscopic hernioplasty associated to bilateral laparoscopic varicocelectomy in the same intervention: a feasibility study.
Belkovsky M, Sarmento EO, Novaes LFC … +5 more , Passerotti CC, Pontes Junior J, Maximiano LF, Otoch JP, DA-Cruz JAS
Rev Col Bras Cir · 2023 · PMID 36995836 · Full text
INTRODUCTION: Inguinal hernia and varicocele are common conditions in male population. Laparoscopy brings the opportunity to treat them simultaneously, through the same incision. However, there are different opinions abo...
INTRODUCTION: Inguinal hernia and varicocele are common conditions in male population. Laparoscopy brings the opportunity to treat them simultaneously, through the same incision. However, there are different opinions about the risks for testicular perfusion of multiple procedures in the inguinal region. In this study, we assessed the feasibility of simultaneous laparoscopic procedures by studying clinical and surgical outcomes of patients undergoing bilateral inguinal hernioplasty using the transabdominal preperitoneal (TAPP) technique with and without concomitant bilateral laparoscopic varicocelectomy (VLB). METHODS: a sample of 20 patients from the University Hospital of USP-SP with indirect inguinal hernia and varicocele with indication for surgical correction was selected. Patients were randomized into two groups, 10 undergoing TAPP (Group I) and 10 undergoing simultaneous TAPP and VLB (Group II). Data regarding total operative time, complications and postoperative pain was gathered and analyzed. RESULTS: there was no statistical difference between groups regarding total operative time and postoperative pain. Only one complication (spermatic cord hematoma) was observed in Group I and no complications were observed in Group II. CONCLUSIONS: simultaneous TAPP and VLB in was shown to be effective and safe, which provides a basis for conducting studies on larger scales.
Risk factors for the development of endometrial lesions in breast cancer patients using tamoxyphen: a retrospective cohort study.
Vizzotto AO, Nicolau SM, Lopes GM … +1 more , Castelo Filho A
Rev Col Bras Cir · 2023 · PMID 36995835 · Full text
INTRODUCTION: breast cancer is the cancer with the highest incidence in women in Brazil, representing 29.7% of all cancers. More than two thirds of women with breast cancer show expression for hormone receptors, and in t...
INTRODUCTION: breast cancer is the cancer with the highest incidence in women in Brazil, representing 29.7% of all cancers. More than two thirds of women with breast cancer show expression for hormone receptors, and in these cases, hormone therapy with tamoxifen is indicated, which may represent a risk factor for the development of endometrial cancer (four-fold greater relative risk). OBJECTIVE: this study aimed to evaluate the association of tamoxifen and the development of endometrial disturbances and to assess possible other associated risk factors. PATIENTS AND METHOD: a total of 364 breast cancer patients were evaluated, 286 who used tamoxifen and 78 who did not use this hormone therapy. Results: patients who used tamoxifen had a mean follow-up time of 51.42 months similar to those without hormone therapy (p=0.081). A total of 21 (7.3%) women who used tamofixen and no cases among women without hormone therapy presented endometrial changes during follow-up (p=0.01). Despite information regarding obesity was available for only 270 women, obesity was also significantly associated with the development of endometrial changes (p=0.008). CONCLUSION: furthermore, the association between tamofixen and endometrial changes remained significant (p=0.039) after adjusting for obesity.
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