HB - Cirurgia
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- 231 colecistectomias em ambulatório... que resultados?Publication . Goulart, A; Delgado, M; Antunes, MC; Braga dos Anjos, JM
- 231 laparoscopic cholecystectomy in ambulatory: what results?Publication . Goulart, A; Delgado, M; Antunes, MC; Braga dos Anjos, JMntroduction: Laparoscopic cholecystectomy is the gold standard procedure for the treatment of lithiasic gallblader pathology and acute cholecystitis. Whether or not it should be done as ambulatory surgery is still being discussed. The present study aims to analyze the quality and safety of laparoscopic cholecystectomy conducted by the Ambulatory Unit of Hospital de Braga and compare the results with those from other European surgical centers performing LC as ambulatory surgery. Material and Methods: Observational prospective study of patients submitted to laparoscopic cholecystectomy in ambulatory surgery during a period of 26 months. Data regarding patients' demography, peri- and postoperative complications, surgical time, time in recovery room, and readmission rates was collected. Results: A total of 231 patients were subjected to Laparoscopic cholecystectomy in the ambulatory unit with overnight stay (time to discharge less than 24 hours). Three patients presented with intra-operative complications, which needed conversion to laparotomy, and four patients were admitted after surgery. The mean time for the procedure was 58 minutes and the mean time for recovery was 19h19 minutes. Postoperative morbidity was 7.8% with 2 nonscheduled admission having occurred. Discussion: One of the controversies regarding laparoscopic cholecystectomy as an outpatient procedure is the need for overnight hospital surveillance. In our unit, we have started LC on an outpatient basis with an overnight stay. Using this protocol, over the past two years, we have operated 231 patients and our results show that this is a completely safe technique. Conclusions: Data from the study suggests that LC is a safe technique when performed in ambulatory practice, having similar results to other european surgical centers.
- 5 anos de GIST: experiência de uma unidade esófago-gástricaPublication . Goulart, A; Carneiro, T; Luís, D; Gomes, A
- Abcessos hepáticosPublication . Leão, P
- Abdominal Catastrophe in Crohn's Disease SurgeryPublication . Palma Rios, H; Goulart, AM; Leão, PINTRODUCTION: Performing surgery on patients with Crohn's disease is a true challenge due to the elevated risk of complications related to the chronic proinflammatory response. Stenosis is the leading cause of intestinal resection in these patients. CASE REPORT: The authors present the case of a 50-year-old woman with inflammatory stenosis of the terminal ileum due to Crohn's disease. The patient underwent a laparoscopic ileocecal resection, which was complicated by a small anastomotic dehiscence with localized peritonitis. Several perforations and dehiscences were observed and necessitated an end ileostomy and an open abdomen treated with negative pressure wound therapy. Multiple surgical interventions in the abdomen were performed and negative pressure was maintained until all fistulas were sealed and granulation tissue formed. Patient was discharged after 134 days of hospitalization with both the abdomen and the ileostomy closed. After several months, a hernia repair was performed with bilateral component separation and polypropylene mesh without complications. CONCLUSIONS: Anastomotic dehiscence after intestinal resection can lead to an abdominal catastrophe. Severe peritonitis with enteric fistulas and an open abdomen demands a multidisciplinary approach. Negative pressure wound therapy and nutritional support are key treatments. In these patients, stoma closure and abdominal wall reconstruction after recovery from the acute event represents another surgical challenge.
- Anal herpesPublication . Goulart, A; Pinto, J; Leão, P
- Avaliação do risco cirúrgico nos doentes com cancro colo-rectal: POSSUM ou ACPGBIPublication . Goulart, A; Martins, SIntroduction: Several models have been developed with the purpose of predicting surgical risk of patients submitted to colorectal cancer surgery. However, to date, there isn’t any model that fulfills this purpose in a satisfactory manner. Methods: We consulted the clinical processes of 345 patients, who were submitted to surgical colorectal cancer treatment at the General Surgery department in Hospital de Braga, and calculated surgical risk based on the following risk assessment scales: Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM), Portsmouth POSSUM (P-POSSUM), ColoRectal POSSUM (CR-POSSUM), Association of Coloproctology of Great Britain and Ireland (ACPGBI) and modified ACPGBI. For all scales, we compared observed and previewed mortality and calculated Receiver Operating Characteristic (ROC) curve. Results and conclusion:The study included 345 patients submitted to colorectal cancer surgery of which 219 were male and 126 were female, with an average age of 68 years old. Most patients (69,0%) presented with colon cancer and 86,4% were submitted to elective surgery. Post-operatory mortality at 30 days was 3,768%. In the present study, despite no model being statistically better than the other, the ACPGBI model was the one that showed more discriminative properties which, along with easier applicability, makes it the best model for evaluating surgical risk in our population.
- Avaliação do risco cirúrgico nos doentes com cancro colo-rectal: POSSUM ou ACPGBI?Publication . Goulart, A; Martins, S
- Avaliação sistemática dos indicadores de qualidade e segurança em cirurgia de ambulatórioPublication . Goulart, A; Delgado, M; Antunes, MC; Braga dos Anjos, JM
- Cancro do Esófago: diagnóstico e estadiamentoPublication . Leão, P