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The aim of this study was to evaluate the very long-term results of the stapled hemorrhoidopexy technique.
Stapled hemorrhoidopexy was performed on 155 patients between 2000 and 2003, and the early results have already been published. In this study, we evaluated the same patients after a very long follow-up. Data were collected with regard to late complications, rate and timing of recurrences, and patients’ degree of satisfaction.
From a total of 155 patients, 98 patients were evaluated: 59 (60.2%) were interviewed by telephone and 39 (39.8%) were evaluated by outpatient consultation. The mean follow-up was 193 months (range: 184-231), 52 were female, 52 were grade III hemorrhoids, and 46 were grade IV. Recurrence was higher in grade IV (26.1%) than in grade III (7.7%) (p=0.014). Recurrence after prolonged follow-up was seen in 16 patients (16.3%) and 11 (11.2%) required reoperations. The complications were skin tags (3.1%), anal sub-stenosis (2.1%), and fecal incontinence (2.1%). After a prolonged follow-up, 82.5% of patients were either very satisfied or satisfied with the surgery.
Stapled hemorrhoidopexy is a safe and effective treatment for hemorrhoidal disease grades III and IV. Recurrence is higher for grade IV hemorrhoids and may occur up to 9 years of follow-up. Reoperations were infrequent and there is a high patient’s degree of satisfaction associated with this technique.
The influence of body mass index on perioperative complications of hiatal hernia surgery is controversial in the surgical literature.
The aim of this study was to evaluate the influence of body mass index on perioperative complications and associated risk factors for its occurrence.
Two groups were compared on the basis of body mass index: group A with body mass index <32 kg/m2 and group B with body mass index ³32 kg/m2. A multivariate analysis was carried out to identify independent predictors for complications. Complications were classified based on the Clavien-Dindo score.
A total of 49 patients were included in this study, with 30 in group A and 19 in group B. The groups were compared based on factors, such as age, Charlson Comorbidity Index, surgical techniques used, type and location of hiatal hernia, and length of stay. Findings showed that 70% of patients had complex hiatal hernia. In addition, 14 complications also occurred: 7 pleuropulmonary and 7 requiring reoperation. From the seven reoperated, there were three recurrences, two gastrointestinal fistulas, one diaphragmatic hernia, and one incisional hernia. Complications were similar in both the groups, with type IV hiatal hernia being the only independent predictor.
Body mass index does not affect perioperative complications in anti-reflux surgery and type IV hiatal hernia is an independent predictor of its occurrence.
Hospital costs in surgery constitute a burden for the health system in all over the world. Multimodal protocols such as the ACERTO project enhance postoperative recovery.
The aim of this study was to analyze the hospital costs in patients undergoing major digestive surgical procedures with or without the perioperative care strategies proposed by the ACERTO project.
Retrospective data from elective patients undergoing major digestive surgical procedures in a university hospital between January 2002 and December 2011 were collected. The investigation involved two phases: between January 2002 and December 2005, covering cases admitted before the implementation of the ACERTO protocol (pre-ACERTO period), and cases operated between January 2006 and December 2011, after implementation (ACERTO period). The primary outcome was the comparison of hospital costs between the two periods. As secondary end point, we compared length of stay (LOS), postoperative complications, surgical-site infection (SSI) rate, and mortality.
We analyzed 381 patients (239 of the pre-ACERTO period and 142 of the ACERTO period) who underwent major procedures on the gastrointestinal tract. Patients operated after within the ACERTO protocol postoperative LOS had a median of 3 days shorter (p=0.001) when compared with pre-ACERTO period [median (IQR): 10 (12) days vs. 13 (12) days]. Mortality was similar between the two periods. Postoperative complications risk, however, was 29% greater (RR: 1.29; 95%CI 1.11-1.50) in the pre-ACERTO period (p=0.002). SSI risk was also greater in pre-ACERTO period (RR: 1.33; 95%CI 1.14-1.50). Costs (mean and SE) per patients were R$24,562.84 (1,349.33) before the implementation and R$19,912.81 (1,459.89) after the ACERTO protocol (p=0.02).
The implementation of the ACERTO project in this University Hospital reduced the hospital costs in major digestive procedures. Moreover, the implementation of this modern perioperative care strategy also reduced postoperative complications, SSI risks, and LOS.
Scopinaro-type biliopancreatic diversion (BPD-S) and its variations are the surgeries that offer the best immediate results in weight loss and regain in the late follow-up. It has a high rate of immediate complications and demands control with frequent laboratory tests.
The aim of this study was to analyze the late postoperative complications of 1570 patients operated by biliopancreatic diversion with gastric preservation laparoscopic video with up to 20 years of postoperative follow-up.
In a follow-up period of up to 20 years, the clinical and surgical complications of 1570 patients with grade II or III obesity were evaluated who were operated on from 2001 to 2014 with the same team of surgeons. Clavien Dindo 11 classification was used for analysis and comparison. Laboratory tests and body mass index (BMI) were used in the analysis of late metabolic outcomes.
On the one hand, complications in 204 patients were recorded (13%), and 143 patients (9.1%) were reoperated. On the other hand, 61 patients (29.9%), who had postoperative complications were clinically treated with good evolution in 9.2 years (95%CI 8.2-10.3), with a median of 9.5 years (95%CI 6.1-12.9). Gastroileal anastomosis ulcers occurred in 44 patients (2.8%). Patients with malnutrition, severe anemia, or chronic diarrhea were operated on with common loop elongation (n=64 - 4%), conversion to gastric diversion (n=29 - 5%), or reversal of surgery (n=10 - 0.6%). One death was registered throughout casuistry (0.06%).
Metabolic result of DBP-S was considered excellent in most patients, even referring to changes in the frequency of bowel movements, loose stools, and unpleasant odor. Complications are usually serious and most of the patients require surgical treatment. Therefore, the biliopancreatic diversion of Scopinaro should be reserved for exceptional cases, as there are safer surgical alternatives with less serious side effects.
Inguinal hernia repair is the most common procedure in general surgery and 80,000 operations are performed annually in Great Britain, 100,000 in France and 700,000 in the US. Given its high frequency has a major impact, both in the medical and economic aspects.
Analyze the immediate postoperative complications comparing mesh versus non mesh hernioplasty.
Randomized control trial, with the enrollment of 263 patients underwent surgery for inguinal hernia randomized by randomization table. Treatment (mesh, Lichtenstein or without mesh, Bassini technique) was assigned using sequentially numbered opaque envelopes having fulfilled the inclusion criteria. The variables analyzed were: postoperative pain, seroma, hematoma, infection, return to normal activities and recurrence.
The mean age was 55.5 years, 88% patients were male and 12% female. The pain was higher in patients operated with mesh.
The inguinal hernia repair mesh group had less immediate postoperative complications and significantly earlier return to work than hernioplasty without mesh, this being one of the most important conclusions.
Gastric bypass is today the most frequently performed bariatric procedure, but, despite of it, several complications can occur with varied morbimortality. Probably all bariatric surgeons know these complications, but, as bariatric surgery continues to spread, general surgeon must be familiarized to it and its management. Gastric bypass complications can be divided into two groups: early and late complications, taking into account the two weeks period after the surgery. This paper will focus the late ones.
Literature review was carried out using Medline/PubMed, Cochrane Library, SciELO, and additional information on institutional sites of interest crossing the headings: gastric bypass AND complications; follow-up studies AND complications; postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative complications. Search language was English.
There were selected 35 studies that matched the headings. Late complications were considered as: anastomotic strictures, marginal ulceration and gastrogastric fistula.
Knowledge on strategies on how to reduce the risk and incidence of complications must be acquired, and every surgeon must be familiar with these complications in order to achieve an earlier recognition and perform the best intervention.
Gastric bypass is today the most frequently performed bariatric procedure,but, despite of it, several complications can occur with varied morbimortality. Probably all bariatric surgeons know these complications, but, as bariatric surgery continues to spread, general surgeon must be familiarized to it and its management. Gastric bypass complications can be divided into two groups: early and late complications, taking into account the two weeks period after the surgery. This paper will focus the early ones.
Literature review was carried out using Medline/PubMed, Cochrane Library, SciELO, and additional information on institutional sites of interest crossing the headings: gastric bypass AND complications; follow-up studies AND complications; postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative complications. Search language was English.
There were selected 26 studies that matched the headings. Early complications included: anastomotic or staple line leaks, gastrointestinal bleeding, intestinal obstruction and incorrect Roux limb reconstruction.
Knowledge on strategies on how to reduce the risk and incidence of complications must be acquired, and every surgeon must be familiar with these complications in order to achieve an earlier recognition and perform the best intervention.
Hepatectomies have been increasingly recommended and performed in Brazil; they present great differences related to immediate complications.
Assessing the immediate postoperative complications in a series of 88 open liver resections.
Prospective database of patients subjected to consecutive hepatectomies over nine years. The post-hepatectomy complications were categorized according to the Clavien-Dindo classification; complications presenting grade equal to or greater than 3 were considered major complications. Hepatic resections involving three or more resected liver segments were considered major hepatectomies.
Eighty-four patients were subjected to 88 hepatectomies, mostly were minor liver resections (50 cases, 56.8%). Most patients had malignant diseases (63 cases; 71.6%). The mean hospitalization time was 10.9 days (4-43). Overall morbidity and mortality rates were 37.5% and 6.8%, respectively. The two most common immediate general complications were intra-peritoneal collections (12.5%) and pleural effusion (12.5%). Bleeding, biliary fistula and liver failure were identified in 6.8%, 4.5% and 1.1% of the cases, respectively, among the hepatectomy-specific complications.
The patients operated in the second half of the series showed better results, which were apparently influenced by the increased surgical expertise, by the modification of the hepatic parenchyma section method and by the increased organ preservation.
Biliary reconstitution has been considered the Achilles’s heel of liver transplantations due to its high rate of postoperative complications.
To evaluate the risk factors for occurrence of biliary strictures and leakages, and the most efficient methods for their treatment.
Of 310 patients who underwent liver transplantation between 2001 and 2015, 182 medical records were retrospectively analyzed. Evaluated factors included demographic profile, type of transplantation and biliary reconstitution, presence of vascular and biliary complications, their treatment and results.
153 (84.07%) deceased donor and 29 (15.93%) living donor transplantations were performed. Biliary complications occurred in 49 patients (26.92%): 28 strictures (15.38%), 14 leakages (7.7%) and seven leakages followed by strictures (3.85%). Hepatic artery thrombosis was present in 10 patients with biliary complications (20.4%; p=0,003). Percutaneous and endoscopic interventional procedures (including balloon dilation and stent insertion) were the treatment of choice for biliary complications. In case of radiological or endoscopic treatment failure, surgical intervention was performed (biliodigestive derivation or retransplantation (32.65%). Complications occurred in 25% of patients treated with endoscopic or percutaneous procedures and in 42.86% of patients reoperated. Success was achieved in 45% of patients who underwent endoscopic or percutaneous procedures and in 61.9% of those who underwent surgery.
Biliary complications are frequent events after liver transplantation. They often require new interventions: endoscopic and percutaneous procedures at first and surgical treatment when needed. Hepatic artery thrombosis increases the number of biliary complications.
Obesity is characterized by excessive accumulation of body fat, which causes damage to the health of individuals, such as breathing difficulties.
To verify the results of non-invasive ventilation as a preventive strategy on the decline of respiratory function and postoperative complications in patients undergoing Roux-en-Y gastric bypass.
This is a randomized trial, according to CONSORT standards, with obese adults aged 18-40 years. Randomized control group (n=25) only received guidelines regarding posture, early ambulation and cough stimuli, and in the NIV group (n=25), in addition to the aforementioned group, non-invasive ventilation was performed with two pressure levels, once day for 60 min, from the 1st to the 3rd postoperative day (POD). Both groups were evaluated in the preoperative period and in the 1st and 3rd POD for respiratory function, which were: slow vital capacity (VC), inspiratory capacity (IC), minute volume (MV), tidal volume maximal inspiratory muscle strength (Pimax) and peak expiratory flow (PEF). The length of hospital stay and the episodes of postoperative complications were recorded.
Of the 50 patients the majority were young adults with degrees of obesity between III and IV. In the intergroup analysis, there was an improvement in the CVL and MV only in the 1st POD in the NIV group, CI in the three moments evaluated in the NIV group and the PFE in the 1st and 3rd PDO also in this group. The most frequent complications were pneumonia, followed by operative wound infection and atelectasis. There was a significant difference between groups, showing a higher occurrence in pneumonia and atelectasis in the control group. The days of hospitalization and intensive care unit were similar.
It was observed a faster recovery until the 3rd POD in the IC and PEF variables in the NIV group; in addition, there were fewer complications in this group.
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