RESUMO
Background: Surgical site infections (SSI) have an important impact on morbidity and mortality. Objective: This study, therefore, sought to assess the effect of a surgical care bundle on the incidence of SSI in colorectal surgery. Methods: We conducted a quasi-experimental intervention study with reference to the introduction of a surgical care bundle in 2011. Our study population, made up of patients who underwent colorectal surgery, was divided into the following two periods: 2007-2011 (pre-intervention) and 2012-2017 (post-intervention). The intervention's effect on SSI incidence was analyzed using adjusted odds ratios (OR). Results: A total of 1,727 patients were included in the study. SSI incidence was 13.0% before versus 11.6% after implementation of the care bundle (OR: 0.88, 95% confidence interval: 0.66-1.17, p = 0.37). Multivariate analysis showed that cancer, chronic obstructive pulmonary disease, neutropenia, and emergency surgery were independently associated with SSI. In contrast, laparoscopic surgery proved to be a protective factor against SSI. Conclusions: Care bundles have proven to be very important in reducing SSI incidence since the measures that constitute these protocols are mutually reinforcing. In our study, the implementation of a care bundle reduced SSI incidence from 13% to 11.6%, though the reduction was not statistically significant.
Assuntos
Humanos , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção da Ferida Cirúrgica/epidemiologia , Cirurgia Colorretal/efeitos adversos , Pacotes de Assistência ao Paciente , Incidência , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Surgical site infections (SSI) have an important impact on morbidity and mortality. OBJECTIVE: This study, therefore, sought to assess the effect of a surgical care bundle on the incidence of SSI in colorectal surgery. METHODS: We conducted a quasi-experimental intervention study with reference to the introduction of a surgical care bundle in 2011. Our study population, made up of patients who underwent colorectal surgery, was divided into the following two periods: 2007-2011 (pre-intervention) and 2012-2017 (post-intervention). The intervention's effect on SSI incidence was analyzed using adjusted odds ratios (OR). RESULTS: A total of 1,727 patients were included in the study. SSI incidence was 13.0% before versus 11.6% after implementation of the care bundle (OR: 0.88, 95% confidence interval: 0.66-1.17, p = 0.37). Multivariate analysis showed that cancer, chronic obstructive pulmonary disease, neutropenia, and emergency surgery were independently associated with SSI. In contrast, laparoscopic surgery proved to be a protective factor against SSI. CONCLUSIONS: Care bundles have proven to be very important in reducing SSI incidence since the measures that constitute these protocols are mutually reinforcing. In our study, the implementation of a care bundle reduced SSI incidence from 13% to 11.6%, though the reduction was not statistically significant.
Assuntos
Cirurgia Colorretal , Pacotes de Assistência ao Paciente , Infecção da Ferida Cirúrgica , Cirurgia Colorretal/efeitos adversos , Humanos , Incidência , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
The medium arcuate ligament syndrome is a rare disorder that results from luminal narrowing of the celiac artery by the insertion of diaphragmatic muscle or the celiac nerve plexus. The syndrome is characterized by weight loss, postprandial abdominal pain, nausea, vomiting and an epigastric murmur. Surgical management involves the complete division of the medial arcuate ligament. We present two cases satisfactorily treated by laparoscopic surgery. The role of minimally invasive surgery in the treatment of this syndrome is a safe alternative approach to open surgery.
El síndrome de ligamento arcuato medio es un trastorno poco frecuente que resulta del estrechamiento luminal de la arteria celíaca por la inserción de fibras musculares diafragmáticas o bandas fibrosas del plexo nervioso celíaco. El síndrome se caracteriza por pérdida de peso, dolor abdominal posprandial, náuseas, vómitos y un soplo epigástrico. El manejo quirúrgico implica la división completa del ligamento arqueado mediano. Presentamos dos casos tratados satisfactoriamente mediante cirugía laparoscópica. El papel de la cirugía mínimamente invasiva en el tratamiento de este síndrome es una vía de abordaje segura alternativa a la cirugía abierta.
Assuntos
Laparoscopia , Síndrome do Ligamento Arqueado Mediano/cirurgia , Adolescente , Humanos , Masculino , Adulto JovemRESUMO
Introducción: El cáncer anal ha experimentado un aumento de incidencia en los últimos años. Está mediado por el VPH y precedido de cambios precancerosos planteando la posibilidad de dirigir los esfuerzos preventivos hacia los grupos de alto riesgo. Sigue siendo controvertida la indicación de cribado y los métodos de detección ideales. Objetivo: Validar las pruebas de cribado implementadas en la actualidad comparadas con la biopsia como "gold standard". Material y Métodos: Estudio transversal con recogida de datos prospectiva, en una cohorte de hombres VIH+ que tienen sexo con hombres, pertenecientes al Hospital Gregorio Marañón e Infanta Leonor en un periodo de 2 años. Resultados: Se seleccionaron 179 pacientes con 286 visitas a la consulta de screening en las que se llevaron a cabo 3 pruebas de cribado en paralelo (citología anal, genotipado del VPH y anoscopia de alta resolución (AAR) con toma de biopsia dirigida sobre zona sospechosa o aleatoria). La sensibilidad y especificidad para la detección de displasia de alto grado y cáncer y su grado de concordancia con la biopsia fue la siguiente: citología 3,23%/94,43% (k: 0,03), genotipado de VPH de alto riesgo 90,32%/27,45% (k: 0,05), AAR 32,26%/87,45 (k: 0, 17) siendo el rendimiento diagnóstico de las tres pruebas muy bajo. Conclusión: La citología presenta un rendimiento diagnóstico muy bajo comparado con el genotipado que representa el mayor. A la luz de nuestros resultados, los protocolos clínicos tal y como vienen desarrollándose en la actualidad deberían de ser abandonados.
Introduction: The incidence of anal cancer has increased in recent years. It is mediated by HPV and preceded by precancerous changes, raising the possibility of directing preventive efforts towards high-risk groups. The indication of screening remains controversial and which methods would be the ideal ones. Objective: To validate the screening tests established actually, comparing it with the biopsy considered as the "gold standard". Materials and Methods: A cross-sectional study was performed, with prospective data collection in a cohort of VIH+ patients, who have male homosexual anal relations, belonging to Gregorio Marañón and Infanta Leonor Hospitals in a period of 2 years. Results: A total of 179 patients were selected with 286 visits to the screening Outpatient Clinic in which 3 parallel screening tests were performed (anal cytology, HPV genotyping and high resolution anoscopy (AAR) with a biopsy directed on a suspicious or random area). The sensitivity and specificity for the detection of high-grade dysplasia and cancer and their degree of agreement with the biopsy was as follows: cytology 3.23%/94.43% (k: 0.03), high HPV genotyping. risk 90.32%/27.45% (k: 0.05), AAR 32.26%/87.45 (k: 0, 17), the diagnostic accuracy of the three tests being very low. Conclusion: Cytology shows a very low diagnostic accuracy compared to the genotype that represents the highest one. In light of our results, clinical protocols as they are currently being developed should be abandoned.
Assuntos
Humanos , Masculino , Adulto , Neoplasias do Ânus/patologia , Carcinoma de Células Escamosas/patologia , Programas de Rastreamento/métodos , Homossexualidade Masculina , Canal Anal/citologia , Canal Anal/patologia , Canal Anal/virologia , Canal Anal/diagnóstico por imagem , Neoplasias do Ânus/virologia , Papillomaviridae/genética , Lesões Pré-Cancerosas , Biópsia , Carcinoma de Células Escamosas/virologia , Carcinoma de Células Escamosas/diagnóstico por imagem , Estudos Transversais , Valor Preditivo dos Testes , Curva ROC , Técnicas Citológicas , Sensibilidade e Especificidade , Soropositividade para HIV , Proctoscopia/métodos , Infecções por Papillomavirus/patologia , Detecção Precoce de Câncer/métodos , Técnicas de GenotipagemRESUMO
Resumen Introducción: La perforación esofágica es una posible complicación de la artrodesis cervical anterior. Sin embargo, estas suelen ocurrir intraoperatoriamente o en el posoperatorio precoz. Caso clínico: Mujer de 35 años sometida, 3 años antes, a artrodesis de C3-C5, que tras sufrir un traumatismo leve con latigazo cervical, comienza con disfagia. Se objetiva un absceso retroesofágico por perforación esofágica, causado por rotura de la placa protésica y extrusión de un tornillo.
Introduction: Esophageal perforation is a possible complication after anterior cervical fusion. However, these complications usually appear intraoperatively or in the early postoperative course. Case report: A 35-years-old females, who underwent a C3-C5 anterior cervical fusion 3 years ago, after suffering a mild cervical trauma, she complained of dysphagia. A retroesophageal abscess was observed, caused by esophageal perforation, secondary to plaque rupture and screw extrusion.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Fusão Vertebral/efeitos adversos , Perfuração Esofágica/cirurgia , Perfuração Esofágica/etiologia , Artrodese/efeitos adversos , Imageamento por Ressonância Magnética , Resultado do Tratamento , Perfuração Esofágica/diagnóstico por imagemRESUMO
Resumen Introducción El espacio prevesical es una localización infrecuente de hernia. La hernia prevesical es causa infrecuente de obstrucción intestinal. Presentamos el caso de un paciente intervenido en nuestro centro y realizamos una revisión de la literatura. Caso clínico Varón de 67 años sin antecedentes médico- quirúrgicos de interés que acude a Urgencias por dolor suprapúbico de 24 h de evolución. A la exploración destacan distensión abdominal y dolor en la localización previamente descrita. Se realiza estudio analítico completo y TC abdominal, en el que se objetiva dilatación de asas del intestino delgado con cambio de calibre a nivel pélvico. Se decide realizar laparotomía exploradora: herniación de 25 cm de íleon de aspecto isquémico en el espacio prevesical. Se realiza resección intestinal y anastomosis enteroentérica L-L manual monoplano. El estudio anatomopatológico de la pieza quirúrgica no revela otros datos de interés. El paciente presenta buena evolución postoperatoria con tolerancia oral progresiva y es dado de alta al quinto día de la intervención. Conclusiones Las hernias del espacio prevesical son causa infrecuente de dolor abdominal y de obstrucción intestinal. Se localizan entre los ligamentos umbilicales laterales y el fundus de la vejiga, donde se forma un anillo peritoneal. Deben sospecharse ante dolor inguinal o supra-púbico sin tumoración palpable en el piso abdominal inferior. El diagnóstico es radiológico, mediante TC. El tratamiento es quirúrgico y ocasionalmente puede precisar resección intestinal.
Introduction Prevesical space is an infrequent location of hernias. Prevesical hernia is a rare cause of bowel obstruction. We present a case operated at our institution and review the available evidence in literature. Case report A 67-years-old mail, without any relevant medical history, came to the Emergency Department complaining of suprapubic pain during the last 24 h. Physical examination revealed abdominal distension and suprapubic pain. A CT scan revealed small bowel dilation with a gauge change in the pelvis. Exploring laparotomy was performed, observing a hernia in the prevesical space and 25 cm of ileal loops incarcerated with ischemic aspect. A small bowel resection and latero-lateral manual running suture anastomosis was performed. Histological findings were not relevant. The patient presented an uneventful postoperative course and was discharged the 5th day after surgery. Conclusions Hernias in the prevesical space are infrequent causes of abdominal pain and bowel obstruction. They are located between lateral umbilical ligaments and bladder fundus, where a ring is located. They must be suspected in cases of inguinal or suprapubic pain without palpable lump in the lower abdominal quadrants. Diagnosis can be only radiologically achieved, by CT scan. Surgical treatment is mandatory, often requiring bowel resection.
Assuntos
Humanos , Masculino , Idoso , Hérnia Abdominal/cirurgia , Hérnia Abdominal/complicações , Obstrução Intestinal/etiologia , Hérnia Abdominal/diagnóstico por imagem , Obstrução Intestinal/cirurgiaRESUMO
Objetivo: Presentación de un caso y revisión de la literatura. Caso clínico: Varón de 59 años que acude a la consulta de cirugía general por tumoración en miembro inferior derecho. La exploración física revela una tumoración no dolorosa de 3 cm sugestiva de lipoma. Se realiza ecografía que informa de la existencia de una hernia del músculo tibial anterior. Dado que el paciente se encuentra asintomático, se decide tratamiento rehabilitador. Conclusiones: Las hernias musculares, habitualmente localizadas en los miembros inferiores, suponen una entidad a tener en cuenta en el diagnóstico diferencial de tumores de partes blandas. Su diagnóstico es clínico con confirmación ecográfica y su tratamiento habitualmente es conservador, aunque en casos sintomáticos puede requerir cirugía.
Objective: Presentation of a case report and review of literature. Case report: A 59-years old male came to the Outpatient Clinic complaining of a painless lump in right lower limb. Physical examination revealed a 3 cm diameter tender lump, suggestive of lipoma. Ultrasonography revealed a hernia in the tibial anterior muscle. Given that the patient was asymptomatic, rehabilitation treatment was decided. Conclusions: Muscular hernias, usually located in lower limbs, must be considered in the differential diagnosis of soft tissue lumps. Diagnosis is usually confirmed with ultrasonography and conservative treatment is indicated, though symptomatic cases might require surgery.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Hérnia/diagnóstico , Lipoma/diagnóstico , Doenças Musculares/diagnóstico , Diagnóstico DiferencialRESUMO
BACKGROUND: Duodenal carcinoma is very rare. It represents 33-45% of the all tumours of the small bowel. The symptoms are non-specific, and the diagnosis is often accidental. CLINICAL CASE: A 35-year old man was admitted to our hospital with post-prandial abdominal pain. Upper gastrointestinal examination revealed a tumour of the third duodenal portion, which was diagnosed, using endoscopic biopsy, as a tubular adenoma with high grade dysplasia. The computed axial tomography scan, the magnetic resonance imaging, and the endoscopic ultrasound showed the neoplasia of the third duodenal portion with no lymph node or peritoneal metastases. Partial resection of the duodenum was performed. The definitive histopathological diagnosis was primary adenocarcinoma of the third duodenal portion. pT2 N0M0, originated in a tubular adenoma. CONCLUSIONS: Primitive neoplasia of the duodenum is very rare. Duodeno-cephalo-pancreatectomy is recommended in proximally located tumours, while segmental resection of the duodenum is appropriate for distal locations, with the same survival.
Assuntos
Adenocarcinoma/patologia , Neoplasias Duodenais/patologia , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Adenoma Viloso/cirurgia , Adulto , Diferenciação Celular , Progressão da Doença , Neoplasias Duodenais/diagnóstico por imagem , Neoplasias Duodenais/cirurgia , Endossonografia , Humanos , Imageamento por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios XRESUMO
Colonic lipomas have very low frequency, are usually asymptomatic and diagnosis is made incidentally. Seventy-five per cent of lipomas larger than 4 cm are symptomatic, causing abdominal pain, rectal bleeding, obstruction and exceptionally invagination. The resection of invaginated segment is mandatory in cases with invagination and can be performed by laparoscopy when colonic dilation is moderate. We present a 73-year-old man who entered the emergency department complaining of intermitent abdominal pain, rectal bleeding, absence of bowel movements and flatulence, during four days. A CT scan showed a generalized colonic dilation until left lower quadrant. A colo-colonic invagination secondary to an endoluminal lipoma was observed in sigmoid colon. A laparoscopic sigmoidectomy was performed with extracorporeal termino-terminal anastomosis. The postoperative period was uneventful and the patient was discharged from the hospital five days later. A sumbmucous colonic lipoma was diagnosed in the pathological study.
Assuntos
Colo Sigmoide , Neoplasias do Colo/complicações , Intussuscepção/etiologia , Lipoma/complicações , Idoso , Humanos , MasculinoRESUMO
Colonic lipomas have very low frequency, are usually asymptomatic and diagnosis is made incidentally. Seventy-five per cent of lipomas larger than 4 cm are symptomatic, causing abdominal pain, rectal bleeding, obstruction and exceptionally invagination. The resection of invaginated segment is mandatory in cases with invagination and can be performed by laparoscopy when colonic dilation is moderate. We present a 73-year-old man who entered the emergency department complaining of intermitent abdominal pain, rectal bleeding, absence of bowel movements and flatulence, during four days. A CT scan showed a generalized colonic dilation until left lower quadrant. A colo-colonic invagination secondary to an endoluminal lipoma was observed in sigmoid colon. A laparoscopic sigmoidectomy was performed with extracorporeal termino-terminal anastomosis. The postoperative period was uneventful and the patient was discharged from the hospital five days later. A sumbmucous colonic lipoma was diagnosed in the pathological study.