Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery最新文献

{"title":"CLINICAL RELEVANCE OF ESOPHAGEAL MOTILITY DISORDERS AFTER BARIATRIC SURGERY: A PROSPECTIVE STUDY BASED ON HIGH-RESOLUTION IMPEDANCE MANOMETRY.","authors":"Lucas Dos Santos Difante, Eduardo Neubarth Trindade, Antonio de Barros Lopes, Eduardo Ferreira Martins, Isadora Bosini Remus, Manoel Roberto Maciel Trindade","doi":"10.1590/0102-6720202400048e1842","DOIUrl":"10.1590/0102-6720202400048e1842","url":null,"abstract":"<p><strong>Background: </strong>There is recent evidence showing that obesity is associated with gastroesophageal reflux disease and esophageal dysmotility, although symptoms are not always present.</p><p><strong>Aims: </strong>This is a prospective study based on high-resolution manometry findings in bariatric surgery candidates and their correlation with postoperative dysphagia.</p><p><strong>Methods: </strong>Manometric evaluation was performed on candidates for bariatric surgery from 2022 to 2024. The examination was conducted according to the protocol of the fourth version of the Chicago Classification, including different positions and provocative maneuvers to confirm the diagnosis of dysmotility. Patients were followed for 90 days after surgery to verify the occurrence of dysphagia or difficulty adapting to the diet.</p><p><strong>Results: </strong>High-resolution manometry was performed on 46 candidates for bariatric surgery with a mean body mass index of 46.5 kg/m2. Esophagogastric junction outflow obstruction was diagnosed in 16 (34.8%) patients, and ineffective esophageal motility was diagnosed in 8 (17.4%) patients. None of the subjects reported symptoms during the preoperative period. Out of the 46 individuals initially included, 44 underwent bariatric surgery, 23 (52.3%) underwent Roux-en-Y gastric bypass, and 21 (47.7%) underwent sleeve gastrectomy. One patient with esophagogastric junction outflow obstruction reported dysphagia after Roux-en-Y bypass, but symptoms spontaneously resolved during the 90-day follow-up period.</p><p><strong>Conclusions: </strong>Although patients with severe obesity have a high prevalence of esophageal motility disorders, no clinical repercussions were observed after bariatric surgery during the study period.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"37 ","pages":"e1842"},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COSTS FOR THE SURGICAL TREATMENT OF OBESITY THROUGH LAPAROSCOPY IN A FEDERAL TERTIARY HOSPITAL BY THE BRAZILIAN UNIFIED HEALTH SYSTEM.","authors":"Álvaro Antonio Bandeira Ferraz, Hiago Dantas Medeiros, Fernando Santa-Cruz, Flávio Kreimer","doi":"10.1590/0102-6720202400042e1836","DOIUrl":"10.1590/0102-6720202400042e1836","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a multifactorial disease affecting a significant portion of the population. Bariatric surgery emerges as a prominent approach in this context, representing an effective treatment both in the short and long term. The costs associated with bariatric surgery vary depending on the characteristics of the patients, current hospital practices, and available funding sources.</p><p><strong>Aims: </strong>To analyze the costs of minimally invasive bariatric surgery for the treatment of obesity in a tertiary federal public hospital.</p><p><strong>Methods: </strong>An observational and descriptive study aimed at assessing the costs associated with laparoscopic vertical gastrectomy (GV) and Roux-en-Y gastric bypass (RYGB) in a federal public tertiary service from 2018 to 2021. Data were obtained through the management of medical-hospital expenses related to surgical and anesthetic supplies, as well as the amount reimbursed by the funding source to the hospital.</p><p><strong>Results: </strong>Over the analyzed period, a total of 177 minimally invasive bariatric surgeries were performed. In terms of the charges, since 2018, the hospital has been receiving an amount of R$ 6,145.00 for the \"bariatric surgery by videolaparoscopy\" procedure, which includes RYGB, and R$ 4,095.00 for \"vertical gastrectomy.\" Regarding the average hospital cost of surgical supplies, RYGB incurred a total of R$ 9,907.54, while GV incurred a total of R$ 9,315.84. The average total cost of RYGB was R$ 10,799.23, and, for GV, it was R$ 10,207.53. These figures indicate that the hospital incurred a loss of approximately R$ 4,654.23 for performing RYGB and R$ 6,112.53 for GV.</p><p><strong>Conclusion: </strong>Despite the increasing number of eligible patients for surgical treatment of obesity and the consequent quantitative growth of these procedures funded by the Brazilian Unified Health System (SUS), the costs exceed the reimbursement from the funding source in federal public hospitals. There is a need for a precise assessment of financing in the fight against obesity.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"37 ","pages":"e1836"},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PROGNOSTIC MARKERS FOR THROMBOTIC EVENTS IN PATIENTS WITH GASTRIC OR COLORECTAL ADENOCARCINOMAS.","authors":"Emilly de Assis Machado, Marcelo Gerardin Poirot Land, Alberto Schanaider","doi":"10.1590/0102-6720202400039e1833","DOIUrl":"10.1590/0102-6720202400039e1833","url":null,"abstract":"<p><strong>Background: </strong>The relationship between thrombosis and cancer is based on evidence that cancer promotes prothrombotic changes in the host hemostatic system. The activation of blood coagulation is closely linked to tumor growth and dissemination.</p><p><strong>Aims: </strong>To evaluate whether quantifications of plasma circulation tumor deoxyribonucleic acid (DNA) and thrombin-antithrombin complex could act as predictors for thrombotic events and death in patients with gastric or colorectal adenocarcinomas, while also evaluating the Karnofsky Performance Status.</p><p><strong>Methods: </strong>Eighty-two patients were included in the study and divided into three groups: controls (n=20), gastric adenocarcinomas (n=21), and colorectal adenocarcinomas (n=41). In order to calculate the Karnofsky index, information was collected to measure the patient's ability to perform common daily tasks. The following serum measurements were conducted: complete blood count, platelet count, extracellular deoxyribonucleic acid, and thrombin-antithrombin complex.</p><p><strong>Results: </strong>Ten patients (16%) experienced thrombosis during treatment. Patients with thrombin-antithrombin complex levels greater than 0.53 had a five-times higher risk of thrombosis. Lower Karnofsky Performance Status was also a risk factor for the event in this population. Neither thrombin-antithrombin complex nor plasma circulation tumor DNA were predictors of death after multivariate adjustment. Thus, Karnofsky index signaled a better overall survival prognosis for colorectal and gastric adenocarcinoma patients.</p><p><strong>Conclusions: </strong>Thrombin-antithrombin complex acts as a marker for thrombosis in patients with colorectal and gastric adenocarcinomas. We recommend prophylactic anticoagulation when the Karnofsky value is low and/or the thrombin-antithrombin complex concentration is greater than 0.53 ng/ml.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"37 ","pages":"e1833"},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11655070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PORTAL VEIN THROMBOSIS AFTER IATROGENIC ENDOSCOPIC BILIARY PROSTHESIS PLACEMENT.","authors":"Sterphany Ohana Soares Azevêdo Pinto, Marcelo Olivati do Amaral, Angelo So Taa Kum, Marcos Eduardo Lera Dos Santos, Ralph Rodrigo Francisco Martins Tavares, Luiz Augusto Carneiro D'Albuquerque, José Jukemura, André Luis Montagnini","doi":"10.1590/0102-6720202400038e1832","DOIUrl":"10.1590/0102-6720202400038e1832","url":null,"abstract":"","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"37 ","pages":"e1832"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ADENOCARCINOMA AND DYSPLASIA IN BARRETT ESOPHAGUS: CRITICAL ANALYSIS OF RISK FACTORS AND SURVEILLANCE PROTOCOLS.","authors":"Eduardo Gallon, Sérgio Szachnowicz, André Fonseca Duarte, Francisco Tustumi, Rubens Antonio Aissar Sallum, Paulo Herman, Ulysses Ribeiro Junior","doi":"10.1590/0102-6720202400033e1826","DOIUrl":"10.1590/0102-6720202400033e1826","url":null,"abstract":"<p><strong>Background: </strong>Identification of epidemiological risk factors in Barrett esophagus resulting in dysplasia and adenocarcinoma and its impact on prevention and early detection.</p><p><strong>Aims: </strong>To evaluate epidemiological risk factors involved in the development of dysplasia and esophageal adenocarcinoma from Barrett esophagus in a specific population. To critically analyze the surveillance period, aiming to individualize follow-up time according to identified risks.</p><p><strong>Methods: </strong>A retrospective case-control study was carried out at a tertiary center involving patients diagnosed and followed up for Barrett esophagus. Patients who developed esophageal adenocarcinoma and/or dysplasia were compared to those who did not, considering variables such as gender, age, smoking status, body mass index, ethnicity, and Barrett esophagus extension. Logistic regression was performed to measure the odds ratio for risk factors associated with the outcome of adenocarcinoma and dysplasia. The presence of epidemiological risk factors in this population was correlated with the time taken to develop esophageal adenocarcinoma from metaplasia.</p><p><strong>Results: </strong>A statistically significant difference was observed in smoking status, race, gender, Barrett esophagus extension, and age between the group with esophageal adenocarcinoma and the group without it. Smokers and former smokers had a 4.309 times higher risk of developing esophageal adenocarcinoma, and each additional centimeter of Barrett esophagus increased the risk by 1.193 times. In the dysplasia group, smoking status, Barrett esophagus extension, and age were statistically significant factors; each additional centimeter of Barrett esophagus extension increased the risk of dysplasia by 1.128 times, and each additional year of age increased the risk by 1.023 times. Patients without risk factors did not develop esophageal adenocarcinoma within 12 months, even with prior dysplasia.</p><p><strong>Conclusions: </strong>The study confirmed a higher risk of developing dysplasia and esophageal adenocarcinoma in specific epidemiological groups, allowing for more cost-effective monitorization for patients with Barrett esophagus.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"37 ","pages":"e1826"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ADULT-TO-PEDIATRIC LIVING DONOR LIVER TRANSPLANT IN RECIPIENTS >20 KG: A CASE SERIES OF FULL LEFT LOBE GRAFTS.","authors":"Catalina Ortiz, José Donizeti Meira Junior, Juan Carlos Pattillo, Eduardo Viñuela, Nicholas Jarufe, Jorge Martínez, Eduardo Briceño, Martin Dib","doi":"10.1590/0102-6720202400035e1828","DOIUrl":"10.1590/0102-6720202400035e1828","url":null,"abstract":"<p><strong>Background: </strong>Chile presents one of the lowest organ donation rates, resulting in pediatric liver waitlist mortality rates up to 38.1%. Live donor liver transplantation is one of the main alternatives to decrease waitlist mortality, mostly utilized in our country for small children up to 20 kg.</p><p><strong>Aims: </strong>The aim of this study was to report a three-case series of adult-to-pediatric living donor liver transplantation using a full left lobe graft.</p><p><strong>Methods: </strong>We report three cases of children with more than 20 kg who received complete left hemi-grafts in different clinical scenarios. The indications and techniques adopted are discussed.</p><p><strong>Results: </strong>Three children, two girls and one boy, aged 11, 7, and 3 years, were transplanted. The indications for transplant were fulminant hepatitis of autoimmune etiology, hepatoblastoma, and chronic liver failure due to autoimmune hepatitis, respectively. The evolution was satisfactory in all three children, and to date, all are well, approximately 12-24 months after the transplant.</p><p><strong>Conclusions: </strong>The use of a living donor left lateral segment (segments 2 and 3) has been successfully employed in pediatric liver transplantation. However, it is only suitable for infants and low-weight children. This approach using the whole left hemi-liver graft contributes to the reduction of small-for-size syndrome, mortality rate, and waiting times associated with deceased donors.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"37 ","pages":"e1828"},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NEOADJUVANT TREATMENT OF LIVER METASTASES OF COLORECTAL CANCER: PREDICTIVE FACTORS OF PATHOLOGICAL RESPONSE.","authors":"Nayssem Khessairi, Ines Mallek, Mehdi Mbarek, Elmontassar Belleh Zaafouri, Lassaad Gharbi, Ahlem Lahmar Boufaroua, Dhouha Bacha, Sana Ben-Slama","doi":"10.1590/0102-6720202400036e1829","DOIUrl":"10.1590/0102-6720202400036e1829","url":null,"abstract":"<p><strong>Background: </strong>Surgery after neoadjuvant chemotherapy (CT) improves the prognosis of colorectal liver metastases (CRLM).</p><p><strong>Aims: </strong>The aim of this study was to evaluate the predictive factors of the histological response of CRLM after neoadjuvant treatment.</p><p><strong>Methods: </strong>A retrospective monocentric study including patients with CRLM operated after neoadjuvant treatment. Assessment of histological response was based on the Rubbia-Brandt tumor regression grading score. The scores were grouped into two types of response: Response Group (R) and No Response Group (NR).</p><p><strong>Results: </strong>The study included 77 patients (mean age=56 years, sex ratio=1.57). Node metastases were noticed in 62% of cases. Synchronous liver metastasis was present in 42 cases (55%) and metachronous liver metastasis in 45%. Neoadjuvant treatment consisted of CT only in 52 patients (68%) and CT with targeted therapy in 25 patients (32%). Chemo-induced lesions were present in 44 patients (57%). Histological response was presented (Group R) in 36 cases (47%) and absent (Group NR) in 41 cases (53%). The overall survival of our patients was 32 months. For Group R, survival was significantly greater (p=0.001). The predictive factors of histological response identified were delay in the onset of liver metastasis greater than 14 months (p=0.027) and neoadjuvant treatment combining CT and targeted therapy (p=0.031). In multivariate analysis, the type of neoadjuvant treatment (p=0.035) was an independent predictive factor of histological response.</p><p><strong>Conclusions: </strong>Predictive factors of histological response would allow us to identify patients who would benefit most from neoadjuvant treatment. These patients with CRLM onset of more than 14 months and treated with CT combined with targeted therapy would be the best candidates for a neoadjuvant CT strategy followed by surgical resection.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"37 ","pages":"e1829"},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SURVIVAL AND PROGNOSTIC FACTORS OF ANAL CANCER: A STUDY BASED ON DATA FROM THE HOSPITAL-BASED CANCER REGISTRY OF A HIGH-COMPLEXITY ONCOLOGY CARE CENTER.","authors":"Wallace Henrique Pinho da Paixão, Gelcio Luiz Quintella Mendes, Débora Santos da Silva, Rosyane Garcês Moreira Lima de Souza, Rodrigo Otavio de Castro Araujo, Karina Cardoso Meira, Rafael Tavares Jomar","doi":"10.1590/0102-6720202400037e1830","DOIUrl":"10.1590/0102-6720202400037e1830","url":null,"abstract":"<p><strong>Background: </strong>Anal cancer is a relatively rare disease, and there is a lack of survival data from low- and middle-income countries.</p><p><strong>Aims: </strong>The aim of this study was to investigate the survival rates and prognostic factors of anal cancer cases treated at a High-Complexity Oncology Care Center in Rio de Janeiro, Brazil.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted involving 665 cases of squamous cell carcinoma of the anus/anal canal treated from 2000 to 2016. To estimate the 5-year overall survival probability and survival according to selected variables, the Kaplan-Meier method and the log-rank test were applied. To identify factors associated with survival, the Cox proportional hazards model, stratified by staging, was used to estimate hazard ratios (HR). Ninety-five percent confidence intervals (95%CI) were also calculated.</p><p><strong>Results: </strong>The overall survival probability was 62.20% (95%CI 57.90-66.20). Higher survival rates were observed in female cases, those with non-advanced staging, and those treated with chemoradiotherapy (p<0.001). Among cases with advanced staging, being female was a protective factor against death (HR=0.52; 95%CI 0.28-0.93). Compared to chemoradiotherapy, at least one type of treatment was identified as a risk factor: chemoradiotherapy + surgery among cases with non-advanced staging (HR=22.65; 95%CI 5.65-90.81), radiotherapy among cases with advanced staging (HR=2.71; 95%CI 1.39-5.30), and among cases with unknown staging, no treatment (HR=3.36; 95%CI 1.73-6.50), radiotherapy (HR=2.38; 95%CI 1.46-3.88), and radiotherapy + surgery (HR=3.99; 95%CI 1.20-13.27).</p><p><strong>Conclusions: </strong>The findings support the superiority of chemoradiotherapy over other therapeutic modalities for anal cancer, resulting in increased survival and a better prognosis.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"37 ","pages":"e1830"},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SEX AND ASA CLASSIFICATION, NOT FASTING TIME, ARE ASSOCIATED WITH THE LIKELIHOOD OF COMPLICATIONS IN THE POSTOPERATIVE PERIOD.","authors":"Adeline Mariano Silva Resende, José Luis Braga de Aquino, Vania Aparecida Leandro-Merhi","doi":"10.1590/0102-6720202400027e1820","DOIUrl":"10.1590/0102-6720202400027e1820","url":null,"abstract":"<p><strong>Background: </strong>According to the literature, some factors are associated with the development of postoperative complications including surgical approach, smoking, comorbidities, nutritional status, classification of the American Society of Anesthesiologists (ASA), fasting time period, and others. In the case of surgical patients, some factors are important for the assessment of the outcomes.</p><p><strong>Aims: </strong>To investigate the factors associated with the likelihood of postoperative complications in surgical patients.</p><p><strong>Methods: </strong>A prospective observational study was conducted with patients who were admitted to hospital more than 24 h. The following variables were investigated: nutritional risk screening, body mass index, ASA classification, fasting time, length of hospital stay, and postoperative complications. For statistical analysis, the Chi-square, Fisher's exact, and Mann-Whitney tests were used. To investigate the risk factors associated with postoperative complications, simple and multiple Cox regression analyses were used.</p><p><strong>Results: </strong>In the total group of patients, there was an association between postoperative complications and men (p=0.0197), surgical risk (ASA) (p=0.0397) and length of hospital stay (p<0001); men showed a risk 2.2 times greater than women for some kind of postoperative complication (p=0.0456; PR=2.167; 95%CI 1.015-4.624). In patients undergoing gastrointestinal surgery, there was an association between postoperative complications and length of hospital stay (p<0001). In patients undergoing other surgeries, there was an association between postoperative complications and length of hospital stay (p<0001) and ASA classification (p=0.0160); ASA classification was considered a factor associated with the probability of postoperative complications (p=0.0335; PR=4.125; 95%CI 1.117-15.237).</p><p><strong>Conclusions: </strong>Men in the total group of patients and the ASA 3 or 4 criteria in the group of patients undergoing other surgeries were considered factors associated with the occurrence of complications in the postoperative period.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"37 ","pages":"e1820"},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CRITICAL VIEW OF SAFETY: A PROSPECTIVE SURGICAL AND PHOTOGRAPHIC ANALYSIS IN LAPAROSCOPIC CHOLECYSTECTOMY - DOES IT HELP TO PREVENT IATROGENIC LESIONS?","authors":"Ana Carolina Buffara Blitzkow, Alexandre Coutinho Teixeira de Freitas, Júlio Cezar Uili Coelho, Antonio Carlos Ligocki Campos, Marco Aurelio Raeder da Costa, Victor Assad Buffara-Junior, Jorge Eduardo Fouto Matias","doi":"10.1590/0102-6720202400034e1827","DOIUrl":"10.1590/0102-6720202400034e1827","url":null,"abstract":"<p><strong>Background: </strong>The incidence of biliary duct injuries remains higher in laparoscopic cholecystectomy (LC) in comparison to open surgery. The Critical View of Safety (CVS) was introduced by Strasberg as a strategy for reducing this catastrophic complication. AIM: The aim of this study was to evaluate how often an adequate CVS is achieved during LC, the determining factors for its success, and the associated surgical outcomes.</p><p><strong>Methods: </strong>This is a prospective study. CVS photographs of all patients who underwent LC by the same surgeon between 2020 and 2023 were taken. Success in achieving CVS was analyzed by the surgeon herself and posteriorly by hepatobiliary specialists. Patients were classified into two groups: CVS achieved and CVS not achieved. Finally, multivariable logistic regression was used to examine the association between preoperatory factors and surgical complications.</p><p><strong>Results: </strong>Three hundred and nine consecutive patients were submitted to LC. There were 73.5% elective CL and 26.5% acute cholecystitis. The age ranged from 14 to 87 years, and 76.8% were female. The median body mass index was 26.7. Previous abdominal surgeries were present in 64%, and 26% were obese. The CVS was achieved in 79.9% of the patients, and there were no surgical complications in this group. The factors associated with nonachievement were acute cholecystitis (p=0.007), male sex (p=0.014), and previous surgeries (p=0.021). Three patients needed a subtotal cholecystectomy due to severe inflammation. There was no statistical correlation between the identification of CVS and surgical complications.</p><p><strong>Conclusions: </strong>The CVS is achieved in most patients. Acute cholecystitis, male sex, and previous abdominal operations are associated with difficulties in obtaining CVS.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"37 ","pages":"e1827"},"PeriodicalIF":0.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11506944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}