Revista Do Colegio Brasileiro De Cirurgioes[JOURNAL]
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200 papers
Analysis of the efficacy and safety of conservative treatment of blunt abdominal trauma in children: retrospective study. Conservative treatment of blunt abdominal trauma in children.
Cunha SC, DE-Oliveira Filho AG, Miranda ML … +4 more , Silva MACP, Pegolo PTC, Lopes LR, Bustorff-Silva JM
Rev Col Bras Cir · 2023 · PMID 36995834 · Full text
INTRODUCTION: in Brazil, trauma is responsible for 40% of deaths in the age group between 5 and 9 years old, and 18% between 1 and 4 years, and bleeding is the leading cause of preventable death in the traumatized child....
INTRODUCTION: in Brazil, trauma is responsible for 40% of deaths in the age group between 5 and 9 years old, and 18% between 1 and 4 years, and bleeding is the leading cause of preventable death in the traumatized child. Conservative management of blunt abdominal trauma with solid organs injury - started in the 60s - is the current world trend, with studies showing survival rates above 90%. The objective was to assess the efficacy and safety of conservative treatment in children with blunt abdominal trauma treated at the Clinical Hospital of the University of Campinas, in the last five years. METHODS: retrospective analysis of medical records of patients classified by levels of injury severity, in 27 children. RESULTS: only one child underwent surgery for initial failure of conservative treatment (persistent hemodynamic instability), resulting in a 96% overall success rate of the conservative treatment. Five other children (22%) developed late complications that required elective surgery: a bladder injury, two cases of infected perirenal collections (secondary to injury of renal collecting system), a pancreatic pseudocyst and a splenic cyst. Resolution of the complications was attained in all children, with anatomical and functional preservation of the affected organ. There were no deaths in this series. CONCLUSION: the conservative initial approach in the treatment of blunt abdominal trauma was effective and safe with high resolution and low rate of complications leading to a high preservation rate of the affected organs. Level of evidence III - prognostic and therapeutic study.
Endoscopic ultrasound-guided biliary drainage: a literature review.
DA-Silva RRR, Mafra LGA, Brunaldi VO … +2 more , Almeida LF, Artifon ELA
Rev Col Bras Cir · 2023 · PMID 36995833 · Full text
Neoplasms of the biliopancreatic confluence may present with obstruction of the bile tract, leading to jaundice, pruritus and cholangitis. In these cases drainage of the bile tract is imperative. Endoscopic retrograde ch...
Neoplasms of the biliopancreatic confluence may present with obstruction of the bile tract, leading to jaundice, pruritus and cholangitis. In these cases drainage of the bile tract is imperative. Endoscopic retrograde cholangiopancreatography (ERCP) with placement of a choledochal prosthesis is an effective treatment in about 90% of cases, even in experienced hands. In cases of ERCP failure, therapeutic options traditionally include surgical bypass by hepaticojejunostomy (HJ) or percutaneous transparietohepatic drainage (DPTH). In recent years, endoscopic ultrasound-guided biliary drainage techniques have gained space because they are less invasive, effective and have an acceptable incidence of complications. Endoscopic echo-guided drainage of the bile duct can be performed through the stomach (hepatogastrostomy), duodenum (choledochoduodenostomy) or by the anterograde drainage technique. Some services consider ultrasound-guided drainage of the bile duct the procedure of choice in the event of ERCP failure. The objective of this review is to present the main types of endoscopic ultrasound-guided biliary drainage and compare them with other techniques.
Endoscopic Mini-or Less-Open Sublay Operation (E/MILOS) in ventral hernia repair: a minimally invasive alternative technique.
DE-Carvalho JPV, Pivetta LGA, Amaral PHF … +7 more , Dias ERM, Macret JZ, Ribeiro HB, Francis MY, Antunes PSL, Reinpold W, Roll S
Rev Col Bras Cir · 2023 · PMID 36995832 · Full text
The ideal ventral hernia surgical repair is still in discussion1. The defect closure with a mesh-based repair is the base of surgical repair, in open or minimally invasive techniques2. The open methods lead to a higher s...
The ideal ventral hernia surgical repair is still in discussion1. The defect closure with a mesh-based repair is the base of surgical repair, in open or minimally invasive techniques2. The open methods lead to a higher surgical site infections incidence, meanwhile, the laparoscopic IPOM (intraperitoneal onlay mesh) increases the risk of intestinal lesions, adhesions, and bowel obstruction, in addition to requiring double mesh and fixation products which increase its costs and could worsen the post-operative pain3-5. The eTEP (extended/enhanced view totally intraperitoneal) technique has also arisen as a good option for this hernia repair. To avoid the disadvantages found in classic open and laparoscopic techniques, the MILOS (Endoscopically Assisted Mini or Less Open Sublay Repair) concept, created by W. Reinpold et al. in 2009, 3 years after eTEP conceptualization, allows the usage of bigger meshes through a small skin incision and laparoscopic retro-rectus space dissection, as the 2016 modification, avoiding an intraperitoneal mesh placement6,7. This new technique has been called E-MILOS (Endoscopic Mini or Less Open Sublay Repair)8. The aim of this paper is to report the E-MILOS techniques primary experience Brazil, in Santa Casa de Misericórdia de São Paulo.
Evaluation of laparoscopic knot training in a silicone model.
Osorio LFF, Maciel CFE, Gallo CBM … +1 more , Sampaio FJ
Rev Col Bras Cir · 2023 · PMID 36921135 · Full text
INTRODUCTION: in videolaparoscopic surgery, movements are conducted from a twenty times magnified image of an indirect operative field. The video interface used assumes the need for depth perception using two dimensions...
INTRODUCTION: in videolaparoscopic surgery, movements are conducted from a twenty times magnified image of an indirect operative field. The video interface used assumes the need for depth perception using two dimensions instead of three. OBJECTIVE: to evaluate the effectiveness of training to perform the laparoscopic knot in a silicone model, in 8-hour courses, and to analyze the correlation of learning outcomes with factors such as: sex, age, laterality, previous knowledge in endosuture and medical specialty. MATERIAL AND METHODS: in this prospective and randomized study, 56 students were evaluated, who took 8-hour courses, with groups of up to ten students. We used: a white box with camera, LCD screen and silicone piece. Four exercises were performed on the silicone mold: right hand, left hand, needle at 45° and back hand. RESULTS: 56 students (mean age = 33.28 years). The female group, n=18, mean age 29.61 years, 17 right-handed and 1 left-handed. The male group, n=38, mean age 34.57 years, 35 right-handers, 1 left-handed and 2 ambidextrous. In both groups, no correlation was observed between the analyzes of well performed knots when correlated with the age or sex of the participants. CONCLUSION: laparoscopic knot training, in silicone molds, in 8 h courses, proved to be effective. Factors such as gender, age, laterality, previous knowledge in endosuture and medical specialty do not interfere with the learning results.
Comparative analysis of the trauma care profile before and during the COVID-19 pandemic: a cross-sectional study in a tertiary university hospital.
Gobetti JSC, Zraik MB, Afornali CB … +5 more , Goveia CHM, Naufel Junior CR, Coelho GA, Nunes SGB, Simm EB
Rev Col Bras Cir · 2023 · PMID 36921134 · Full text
OBJECTIVES: to evaluate the profile of emergency care of trauma patients at Hospital Universitário Evangélico Mackenzie (HUEM) during the period of restrictive measures due to COVID-19 (03/13/2021 to 04/05/2021), and com...
OBJECTIVES: to evaluate the profile of emergency care of trauma patients at Hospital Universitário Evangélico Mackenzie (HUEM) during the period of restrictive measures due to COVID-19 (03/13/2021 to 04/05/2021), and compare to the same period at the beginning of the pandemic, in 2020, and before the pandemic, in 2019. METHODS: quantitative and descriptive observational cross-sectional study. The final sample of 8,338 was analyzed in terms of date, gender, age and service responsible for providing care; the traumas were analyzed according to the etiology and conduct of the treatment and outcome. RESULTS: there was a percentage increase in non-traumatic emergency care during the pandemic, and the medical clinic held a third of admissions in 2021. There was a reduction in trauma care, since in 2019 traumas were responsible for 44.9% of admissions and by 23.5% in 2021. There was a significant difference in the proportion between the attendance of men and women, and the percentage of men victims of trauma was higher than in the pre-pandemic periods. There was a reduction in absolute numbers, with statistical significance, in traffic accidents, falls from the same level, burns, general blunt trauma and sports and leisure trauma. The proportion of conservative treatments with hospital discharge reduced. There was a significant difference in the number of deaths, decreasing in 2020 but increasing in 2021. CONCLUSION: there was a reduction in trauma care during the pandemic, but the profile remained the adult male victim of a traffic accident. More severe traumas were admitted, resulting in an increase in surgical treatment, hospitalizations and deaths.
Experience of non-operative management of blunt liver trauma at Hospital das Clínicas de Uberlândia: 114 cases.
Fernandes GS, Martins MC, Gomes HL
Rev Col Bras Cir · 2023 · PMID 36921133 · Full text
INTRODUCTION: trauma is the leading cause of death for the age group from 1 to 49 years in Brazil. Non-Operative Management (NOM) is the gold standard in trauma centers and does not affect mortality in comparison to oper...
INTRODUCTION: trauma is the leading cause of death for the age group from 1 to 49 years in Brazil. Non-Operative Management (NOM) is the gold standard in trauma centers and does not affect mortality in comparison to operative treatment. METHODS: medical records were reviewed for 114 patients with blunt liver trauma treated at Hospital das Clínicas of the Federal University of Uberlândia (HC-UFU) from November 2015 to November 2020. RESULTS: the most prevalent gender was masculine (74.5%). The most prevalent age group was 20 to 49 years (65.7%). The majority of admitted patients (60.5%) had an Injury Severity Score (ISS) of more than 15. On hospital admission, 30.7% had HR above 100 bpm and 30.70% had SBP below 100mmHg. NOM was implemented in 77.2% of patients, the failure rate was 11.36% and the specific failure rate, excluding complications of associated injuries that resulted in surgery, was 1.75%. One third of deaths were due to severe traumatic brain injury. CONCLUSION: the failure rate of NOM in this study is similar to the literature reports for liver trauma. The failure rate, excluding complications of associated injuries, is considered low. The recognition of the epidemiological profile of patients admitted at HC-UFU allows multidisciplinary and integrated care with specialized training, as well as the development of institutional protocols, aiming to reduce morbidity and mortality related to hepatic trauma.
Influence of the COVID-19 pandemic on the epidemiological profile of the initial care of victims of falls.
VON-Bahten LC, Zvicker AL, Silva AAD … +4 more , Salviato BZ, Teixeira HM, Ando PK, Bernardelli RS
Rev Col Bras Cir · 2023 · PMID 36921132 · Full text
OBJECTIVE: to assess the epidemiological profile of trauma patients from fall from the same level (FSL) and fall from an elevated level (FEL) during the COVID-19 pandemic, and to compare it with data from different level...
OBJECTIVE: to assess the epidemiological profile of trauma patients from fall from the same level (FSL) and fall from an elevated level (FEL) during the COVID-19 pandemic, and to compare it with data from different levels of restriction (flags) and data prior to the pandemic. METHOD: a cross-sectional study with a probability sample of the medical records of patients aged 18 years or older admitted to the emergency room due to falls, from June 2020 to May 2021. Epidemiological data, such as sex, age and injuries were analyzed, as well the current level of restriction. The three restriction periods were compared between then and the proportion of admissions due to falls was compared with the period from December 2016 to February 2018. RESULTS: a total of 296 admissions were evaluated, 69.9% were victims of FSL and 30.1% of FEL. The mean age was 57.6 years, and 45.6% were over 60 years old. Admissions among men predominated, and 40.2% of patients required hospitalization. During the red flag period, there were proportionally more injuries to the head and neck (p=0.016), injuries to extremities (p=0.015) and neurological trauma (p<0.001). An average of 6.1, 6.3 and 5.2 admissions per day was obtained during the yellow, orange and red flag, respectively. There was a relative increase in falls when compared to the pre-pandemic period. CONCLUSIONS: there was an absolute reduction in admissions of victims of falls in midst of the most restrictive period during the pandemic. However, when compared to pre-pandemic data, there was a relative increase in falls.
Brazilian national bariatric registry - pilot study.
Silva LB, Quadros LG, Campos JM … +8 more , Boas MLV, Marchesini JC, Ferraz ÁAB, Kaiser Junior RL, Elias AA, Vitor R, Chaves LC, Ramos AC
Rev Col Bras Cir · 2023 · PMID 36921131 · Full text
INTRODUCTION: Brazil is a world leader in bariatric surgery. However, the actual number of surgeries performed in the country is still unknown. It is necessary to implement an instrument to monitor the quality of care pr...
INTRODUCTION: Brazil is a world leader in bariatric surgery. However, the actual number of surgeries performed in the country is still unknown. It is necessary to implement an instrument to monitor the quality of care provided. This study evaluated the implementation of a Bariatric Surgery Data Registry in Brazil. METHODOLOGY: the registry was developed with Dendrite Clinical Systems Ltd., with data collected prospectively on an internet-based software. Seven centers were selected based on surgical volume and data entry commitment. The project covered three years after system implementation. RESULTS: 1,363 procedures performed by 17 surgeons were included. Most patients were female (67.2%), with average age of 39 years old and average baseline BMI of 41.5kg/m2. Diabetes mellitus was present in 34.5%, and hypertension in 40.1%. Roux-en-Y gastric bypass was performed in 79.3%, 95.5% by laparoscopy. There was one in-hospital death of cardiovascular cause. The average hospital stay was 2.03 days. The surgery-related complication rate was 0.97% in the first month, with three reoperations. Short-term follow-up was recorded in 75.6% and one-year follow-up in 21.64%. Total body weight loss was 10% in 30 days, rising to 33.3% after one year, with no difference between surgical techniques. CONCLUSIONS: the population profile was in accordance with the global registry of the International Federation for the Surgery of Obesity and Metabolic Disorders. The main difficulty encountered was low postoperative data entry. The experience acquired in this project will help advance data collection and knowledge of the safety and effectiveness of bariatric surgery in Brazil.
Acute mesenteric ischemia and COVID-19: an integrative review of the literature.
Silva JTC, Fonseca Neto OCLD
Rev Col Bras Cir · 2023 · PMID 36921130 · Full text
The novel coronavirus disease 2019 (COVID-19) has spread rapidly around the world after the first cases were reported in December 2019 in China. Despite the prevention of the symptoms presented, extrapulmonary manifestat...
The novel coronavirus disease 2019 (COVID-19) has spread rapidly around the world after the first cases were reported in December 2019 in China. Despite the prevention of the symptoms presented, extrapulmonary manifestations were identified. In particular, there was an increase in cases of Acute Mesenteric Ischemia (AMI), raising its incidence to 1.9%-3.8% in infected patients. The aim of this study was to investigate the existence of an association between IMA and COVID-19 through the literature. An Integrative Literature Review was carried out. The research question was "mesenteric ischemia in patients with COVID-19: coincidence or association?". After searching the database and applying the inclusion and exclusion criteria, 44 were selected for analysis. COVID-19 was confirmed by RT-PCR and imaging tests, gastrointestinal manifestations, alterations and primarily tomographic imaging findings were identified. Most patients were accelerated to laparotomy. As explanations include direct endothelial and injury by the binding of the ACE-2 virus, between hyperinflammation and hypercoagulability, dysregulation of the renin-angiotensin-aldosterone system and factors associated with the severity of the virus. IMA is an emergency with high associated morbidity and mortality, these cases may be a consequence mainly of the thromboinflammatory mechanism associated with SARS-CoV-2. An early diagnosis, diagnosis and diagnoses are crucial to clinical treatment; an assessment regime should be considered in accordance with current evidence and guidelines.
Impact of Roux-en-Y Gastric Bypass and Vertical Gastrectomy on weight loss: a retrospective and longitudinal study in the State of Paraná, Brazil.
Gamba FP, Siqueira BS, Tsuchiya RS … +2 more , Tanaka TM, Grassiolli S
Rev Col Bras Cir · 2023 · PMID 36790229 · Full text
AIM: to compare the impact of Roux's Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) techniques on body weight reduction over 1 and 5 years after bariatric surgery in obese patients in the state of Paraná. METHODS: l...
AIM: to compare the impact of Roux's Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) techniques on body weight reduction over 1 and 5 years after bariatric surgery in obese patients in the state of Paraná. METHODS: longitudinal and retrospective study, conducted between January 2010 and December 2013, with 737 patients of both sexes submitted to RYGB or SG and evaluated in the preoperative, 1 and 5 years after bariatric surgery (BS). Age, height, body weight, Body Mass Index (BMI), biochemical and pressure parameters were recorded. RESULTS: of the total of patients, men represented lower frequency, were slightly older, with higher body weight, BMI and worse metabolic and pressure conditions than women in pre-BS (p<0.05). Regardless of sex, RYGB and SG were effective in promoting body weight reduction and BMI in 1 and 5 years after BS; the RYGB technique had greater impact on these variables in both sexes (p<0.05). The highest percentage of lost weight was observed in women who underwent the RYGB technique in the first year after BS. Five years after BS, the RYGB technique promoted a higher rate of body weight reduction in men and women compared to the SG technique (p<0.05). CONCLUSION: regardless of sex, the RYGB technique promotes a higher degree of body weight reduction and BMI over time compared to the SG; having its biggest impacts in the 1 year after BS, especially in women.
Impact of surgical checklists on the time of surgical processes: a cross-sectional study.
Batista J, Cruz EDA, Silva DPD … +2 more , Nazário SDS, Antunes BCS
Rev Col Bras Cir · 2023 · PMID 36790228 · Full text
OBJECTIVES: to analyze the impact of the use of checklists on the mean time of the operative processes of patients undergoing hip and knee arthroplasties. METHOD: cross-sectional and analytical research conducted between...
OBJECTIVES: to analyze the impact of the use of checklists on the mean time of the operative processes of patients undergoing hip and knee arthroplasties. METHOD: cross-sectional and analytical research conducted between November/2020 and March/2022 with retrospective consultation in a simple random sample of 291 medical records, distributed in three periods (2010/2013/2016). Descriptive and inferential statistics were used for data analysis; p=0.05 values indicated significance. RESULTS: there was a reduction in the time of entry-exit from the operating room (p=0.002), surgery (p<0.001) and between the onset-anesthesia and the beginning-incision (p=0.021). There was no difference in time between patients with and without the use of checklists (p=0.05) in relation to the variables onset-anesthesia, onset-incision, time of anesthesia and surgery. CONCLUSION: the implementation of checklists potentially contributed to reduce the time of use of the operating room. The nonassociation of its use with the increase in the mean time of the processes in the operating room shows that its application does not interfere negatively in this indicator.
Morphological characteristics of the left gastric, common hepatic and splenic arteries. A descriptive study in human cadaveric specimens.
Saldarriaga B, Larrotta O, Ballesteros L
Rev Col Bras Cir · 2023 · PMID 36790227 · Full text
OBJECTIVE: to evaluate the morphology of the branches of celiac trunk (CT), left gastric (LGA), common hepatic (CHA), and splenic (SA) arteries in cadaveric specimens from a sample of a Colombian population. METHODS: des...
OBJECTIVE: to evaluate the morphology of the branches of celiac trunk (CT), left gastric (LGA), common hepatic (CHA), and splenic (SA) arteries in cadaveric specimens from a sample of a Colombian population. METHODS: descriptive cross-sectional study of 26 blocks from the abdominal upper segment of human cadavers who underwent forensic autopsies at the Instituto de Medicina Legal at Bucaramanga, Colombia. The vascular beds of the celiac trunk were, subsequently, perfused with a semi-synthetic resin. RESULTS: the diameters of LGA, CHA, and SA were 3.6±0.8mm, 5,2±1.2mm, and 5.9±1.0mm, respectively. Statistically, LGA and SA were different (p=<0.001). SA followed a linear trajectory in 8 (31%) samples, slightly tortuous in 4 (15%), and tortuous in 14 (54%). The tortuosity index was 1.25±0.18. Of the branches of CHA, the proper hepatic artery (PHA) had 4.8±1.2mm in diameter and 18.8±9.1mm in length, whereas the gastroduodenal artery (GDdA) had 4.1±0.8mm. In 2 cases (7.7%), an accessory hepatic artery from the LGA was found to supply perfusion to the left hepatic lobe. Finally, in 2 cases (7.7%) the SA came independently from the abdominal aorta. CONCLUSION: the observed emergence incidence of the CT branches from the same level as reported in the literature is lower. The characterization, along with their variants, of LGA, CHA, and SA must be considered in surgical procedures in the upper abdominal segment, to avoid iatrogenic complications.
Serratus plane block with sedation for patients submitted to axillary dissection: a prospective case series.
Theobald D, Araujo BLC, Thuler LCS … +1 more , Fiorelli RKA
Rev Col Bras Cir · 2023 · PMID 36790226 · Full text
Axillary dissection is a standard surgical procedure for stage III skin and soft tissue tumors and is usually performed under general anesthesia. This study aimed to investigate the feasibility of performing axillary dis...
Axillary dissection is a standard surgical procedure for stage III skin and soft tissue tumors and is usually performed under general anesthesia. This study aimed to investigate the feasibility of performing axillary dissection with Serratus muscle plane block plus intravenous sedation. Fifteen patients undergoing axillary dissection were prospectively recruited. The patients were evaluated during their pre-operative anesthetic appointment, during their procedure, and at post-operative days 1 and 30. The blockade was performed superficial to the Serratus muscle at the level of fourth rib. Sedation was performed using propofol, fentanyl, dexmedetomidine, and S-ketamine. None of the patients required conversion to general anesthesia. Surgeons showed a highly positive response when asked about the anesthetic technique, and most of them found the technique "indistinguishable" from general anesthesia. The median (interquartile range) pain scores at rest over all time frames was 0 (0-0). Furthermore, no patients developed nausea, hemodynamic instability, or any complications associated with the technique. The Serratus plane block associated with intravenous sedation proved feasible for axillary lymphadenectomy, however, further clinical trials should evaluate potential advantages compared to other techniques.
Erratum.
Rev Col Bras Cir · 2023 Jan · PMID 36629723 · Publisher ↗
[This corrects the article doi: 10.1590/0100-6991e-20223410_en].
[This corrects the article doi: 10.1590/0100-6991e-20223410_en].
A retrospective report on the preoperative mandatory SARS-COV-2 infection screening in a single pediatric center. Is it time to stop testing our patients?
Souza CDS, Saruhashi T, Lima MFN … +2 more , Oliveira Junior FI, Cumino DO
Rev Col Bras Cir · 2023 · PMID 36629722 · Full text
The novel coronavirus SARS-COV-2 (COVID-19) pandemic dramatically changed the workflow of healthcare professionals around the world. Surgical procedures were withheld and postponed in a scenario of fear and uncertainty....
The novel coronavirus SARS-COV-2 (COVID-19) pandemic dramatically changed the workflow of healthcare professionals around the world. Surgical procedures were withheld and postponed in a scenario of fear and uncertainty. Despite numerous medical institutions having swiftly and widely implemented pre-operative screening protocols, cost-effective studies remain scarce specially when comparing to other mitigation measures such as the donning of masks and social distancing measures. The objective of our study is to report the monthly positivity rates of SARS-COV-2 infection in our service and compare our data with monthly positivity rates reported by the State Health Department. Between April, 2020, to February, 2022, 7,199 patients had the RT-PCR for SARS-COV-2 collected, with 187 (2.59%) testing positive for COVID-19. Most of them (62.1%) were asymptomatic. The most common symptoms were coryza (10.7%), fever (10%), and diarrhea (8.7%). Nonetheless, there were two deaths due to COVID-19 reported in our center. Further studies are necessary to elucidate the impact of pre-operative screening for SARS-COV-2 in asymptomatic patients.
Incidental gallbladder cancer: what is the prevalence and how do we perform cholecystectomy for presumably benign biliary disease?
Silva DAGD, Veloso OLL, Valadares MSP … +4 more , Costa RSD, Silveira MG, Carvalho FC, Sousa MG
Rev Col Bras Cir · 2023 · PMID 36629721 · Full text
OBJECTIVE: to determine the prevalence of incidental gallbladder cancer (IGBC) in cholecystectomies performed in a tertiary public hospital and to describe technical and epidemiological aspects of performing cholecystect...
OBJECTIVE: to determine the prevalence of incidental gallbladder cancer (IGBC) in cholecystectomies performed in a tertiary public hospital and to describe technical and epidemiological aspects of performing cholecystectomies for presumably benign disease. METHOD: descriptive, retrospective observational study, based on analysis of medical records of patients undergoing cholecystectomy with preoperative hypothesis of benign disease between January 2018 and January 2022. RESULTS: prevalence of gallbladder adenocarcinoma in our sample was 0.16%, similar to data in the literature. Technical aspects during cholecystectomy were also described with a frequency similar to that found in the literature. CONCLUSION: despite a rare disease, IGBC is relevant in the routine of the General Surgeon. Its diagnosis, staging and treatment directly affect the prognosis. Technical aspects during cholecystectomy are not always remembered by surgeons and can interfere with the prognosis and subsequent treatment of the patient.
Relationship between the use and types of helmets with facial injuries - a prospective study.
Aires CCG, Araújo HT, Souza RRL … +3 more , Santos AJFD, Vasconcellos RJH, Vasconcelos BCDE
Rev Col Bras Cir · 2023 · PMID 36629720 · Full text
INTRODUCTION: many studies have demonstrated the benefits of helmet to prevent and reduce severity of injuries in motorcyclists. OBJECTIVE: the aim of the present study was to evaluate a possible relationship between the...
INTRODUCTION: many studies have demonstrated the benefits of helmet to prevent and reduce severity of injuries in motorcyclists. OBJECTIVE: the aim of the present study was to evaluate a possible relationship between the use of different types of helmets and the occurrence of facial injuries among victims of motorcycle accidents, seen at Hospital da Restauração, Recife/PE, Brazil. MATERIALS AND METHODS: demographic and trauma data were collected from hospitalized motorcycle accident victims with facial injuries from December 2020 to July 2021. Pearsons chi-square test was used to assess association between two categorical variables using a margin of error of 5%. RESULTS: among the participants, the average age was 33.46 years. The age group between 18 and 29 years was the most prevalent. Most participants were male. 60.0% of motorcyclists used helmets at the time of the accident and of this percentage 37.6% used fixed full-face helmet, 16.5% open-face helmet and the other 5.9% articulated full-face helmet. 62.7% of participants had facial fractures. Among the fractures, those of the zygomatic-orbital complex were the most common fracture and were significantly associated with the use of helmets, especially with open-face helmet. CONCLUSIONS: the use of helmets was associated with a lower number of facial fractures among patients who were victims of motorcycle accidents. Fracture of the zygomatic-orbital complex was related to the absence of a helmet at the time of the accident, as well as the use of open-face helmets.
Peroral endoscopic myotomy for the treatment of achalasia in the Unified Healthcare System (SUS): results of a short-term.
França IR, Caldas EAL, Barros MF … +3 more , Silva JTDD, Pontual JP, Ferraz ÁAB
Rev Col Bras Cir · 2023 · PMID 36629719 · Full text
INTRODUCTION: achalasia is a chronic disease. Since there is no curative treatment, diagnosed patients have pharmacological and/or surgical techniques available, aimed at minimizing the condition. POEM appears as a promi...
INTRODUCTION: achalasia is a chronic disease. Since there is no curative treatment, diagnosed patients have pharmacological and/or surgical techniques available, aimed at minimizing the condition. POEM appears as a promising new type of palliative treatment with good rates of symptom improvement. OBJECTIVE: evaluate the profile of POEM at the Clinical Hospital of the Federal University of Pernambuco (HC - UFPE) and correlate it with the world scenario. METHODS: data collection was performed retrospectively from September 2017 to October 2019 with all patients undergoing POEM at the HC - UFPE. Sociodemographic, clinical, and hospital variables were evaluated before and three months after the procedure. RESULTS: of 27 patients (52.41 ± 19.24 years old) who underwent the procedure, 66.7% had idiopathic etiology and 33.3% had etiology secondary to Chagas disease. 48% patients underwent previous procedures, of which seven used some type of medication for symptom control, two underwent pneumatic endoscopic dilation, and four underwent Heller cardiomyotomy with partial fundoplication. 62.5% of the evaluated patients had type II achalasia before the procedure. Seven (25.9%) patients presented the following adverse events: four presented bleeding, two pneumoperitoneum, and one both complications, all being treated conservatively. The Eckardt score reduced from 8.37 ± 1.45 to 0.85 ± 1.06 (p-value <0.001). CONCLUSION: clinical improvement of symptoms and the patient profile followed the worldwide trend, with emphasis on the etiology secondary to Chagas disease, endemic in Brazil. Gastroesophageal reflux remains the main post-operative symptom.
Low cost and easy acquisition: corn grain in microsurgery training.
Fernandes MRN, Tramontin DF, Pimentel ALJC … +5 more , Costa LVPD, Santana Neto D, Xavier DP, Bentes LGB, Santos DRD
Rev Col Bras Cir · 2023 · PMID 36629718 · Full text
OBJECTIVES: develop an easily accessible model for training the initial motor practice in microsurgery using corn kernels. METHODS: ten corn kernels (Zea mays) were used. A 7mm longitudinal cut was made on one side of th...
OBJECTIVES: develop an easily accessible model for training the initial motor practice in microsurgery using corn kernels. METHODS: ten corn kernels (Zea mays) were used. A 7mm longitudinal cut was made on one side of the corn grain. The training consisted of performing 4 simple knots between the edges of the incision, using 10-0 mononylon thread. The parameters analyzed were 1) cost of the model; 2) assembly time of the model test system; 3) time for performing the knots; 4) distance between the knots. RESULTS: in all corn kernels tested, it was possible to perform the proposed microsurgical suture training, without any difficulty in the procedure. The average time to perform the 4 knots was 6.51±1.18 minutes. The total cost of the simulator model was R$3.59. The average distance between the knots was 1.7±0.3mm. The model developed from corn grains has an extremely low cost when compared to the use of animals or high-tech simulators. Other advantages are the easy availability of canned corn kernels and the possibility of making more than four knots along the 7mm incision. CONCLUSION: the training model developed has low cost, is easy to acquire and viable for training basic manual skills in microsurgery.
Antibiotic cement-coated plate is a viable and efficient technique for the definitive management of metaphyseal septic nonunions of the femur and tibia.
Bidolegui F, Codesido M, Pereira S … +3 more , Abraham A, Pires RE, Giordano V
Rev Col Bras Cir · 2023 · PMID 36629717 · Full text
OBJECTIVE: the management of septic metaphyseal nonunions is challenging, with inconsistent outcomes. Antibiotic cement-coated implants have been demonstrated good outcome for diaphyseal infected nonunions, however there...
OBJECTIVE: the management of septic metaphyseal nonunions is challenging, with inconsistent outcomes. Antibiotic cement-coated implants have been demonstrated good outcome for diaphyseal infected nonunions, however there is no data in metaphyseal infected nonunions. METHODS: fifteen adult patients with septic metaphyseal nonunions of the femur or tibia were treated with antibiotic cement-coated plates. The antibiotic cement-coated plate was prepared with either gentamicin or vancomycin. Outcome measures were infection control, bone healing, return to pre-injury level on daily activities, and quality of life at the last follow-up visit. A p value of <5% was considered significant. RESULTS: Methicillin-susceptible S. aureus was isolated in 53.3% cases. Average postoperative follow-up time was 18 months. Local infection control and radiographic bone healing were adequately achieved in 93.3% patients. No patient presented recurrent symptoms of surgical site infection. Fourteen patients reported to be either able, or on the same level as before injury, with 73.3% reporting no problems in all five dimensions of the EQ-5D-3L. Persistent infection was the only variable associated with a reduced long-term quality of life. CONCLUSION: antibiotic cement-coated plate is a viable and efficient surgical technique for the definitive management of juxta-articular metaphyseal septic nonunions of the femur and tibia.
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