Cristiano de Souza Leão

Controle de infecção em cirurgia geral: resultado de um estudo prospectivo de 23 anos e 42.274 cirurgias

BACKGROUND: The aim of this study was evaluate a methodology during 23 years in a public hospital used infection for control of surgeries. METHODS: A total of 42,274 surgeries in the General Surgery Division of the Clinics Hospital of the Pernambuco Federal University (January of 1977 until December 1999) were evaluated. The data were acquired through a active search system by the infection control nurse and an epidemiological search during the postoperative period, in the outpatient clinic that centralized all surgical patients after discharge. The infection control committee concentrated its action in the prevention emphasizing precise diagnosis of infections cases; corporal cleaning, control of associated infection, minimal preoperative period, care with the shaving; rigorous asepsia and antisepsia; adequate surgical technique; notification of the infection control results and the infection/surgeon/anesthetist rates; and a rigorous antimicrobial control. RESULTS: Wound infection rate dropped from 15-20% to the actual rate of 7.7%. Urinary infection was reduced from 18.2% to 0.4%, and the respiratory infection from 22.9% to 2.7%. The mortality related to infection was reduced from 2.8% to 0.9% and the rate of wound infection in clean surgeries from 12.8% to 3.4%. In the outpatient surgeries (27,580) the wound infection was 0.4% and the global mortality was 0.007%. CONCLUSION: The authors demonstrated that infection control is not made by expensive investments and equipaments, or computadorized ambient. Infection control is made, in our view, by political decision, manpower and motivation to control the infection control problem.

Profilaxia antimicrobiana na cirurgia bariátrica

BACKGROUND:To analyze the results of the incidence of wound infection under 3 different antibiotics regiments. METHODS: Between January, 1999 and December, 2004, 716 bariatric surgeries had been performed using the technique proposed by Fobi/Capella. Three groups of patients had been compared, according to the antibiotic prophylaxys regimen: Group I: (n=185) ampicillin/sulbactam, 3g in two doses; Group II (n=280): ceftriaxone, 1g (single dose); and Group III: (n=251) ertapenem, 1 g (single dose). RESULTS: Our results demonstrate a rate of wound infection of 3.78% with ampicilina-sulbactam, 6.81% with ceftriaxona and 1.99% in the ertapenem group. There was no significant differences between ampicilina/sulbactam or ceftriaxona in relation to the incidence of wound infection. However, there was a statistically significant difference between Group II (Ceftriaxona) and Group III (Ertapenem). CONCLUSION: The use of ertapenem as the antibiotic prophylaxis for the surgical of morbid obesity was associated to a lower incidence of wound infection than with the use of ceftriaxone, while being similar than ampicillin/sulbactam.

Nutritional status and perioperative fasting time versus complications and hospital stay of surgical patients

INTRODUCTION many factors can have a negative influence over surgical results, such as a compromised nutritional status and the extension of the perioperative fasting time. OBJECTIVE to evaluate the influence of the nutritional status and the perioperative fasting time over the occurrence of surgical complications and over hospital stay, in patients who have undergone surgery of the gastrointestinal tract and/or abdominal wall, and who were subjected to a nutritional care protocol. METHODS cohort study, conducted with 84 patients, from June to November 2014. Data collection was performed by applying a structured questionnaire, search over the records and medical and/or nutritional prescription. Statistical analysis was performed using STATA/SE 12.0 and significance level of 5%. RESULTS nutritional risk was present in 26.2%, and from these 45.4% carried out preoperative nutritional therapy, having an average of 6.6 ± 2.79 days. The preoperative fasting was 4.5 (3.66; 5.50) hours and the postoperative fasting 5.1 (2.5; 20.5) hours. No associations were found between the parameters for assessing body composition and the presence of complications. A negative correlation was observed between the length of hospital stay and the BMI (p = 0.017),while a positive correlation was observed between weight loss and the length of hospital stay (p = 0.036). Patients with higher postoperative fasting time had a higher occurrence of complications (p = 0.021). CONCLUSION the compromised nutritional status and the extension of perioperative fasting time are associated with the occurrence of surgical complications and increased length of hospital stay.

An experimental study of the electrical activity of the bypassed stomach in the Roux-en-Y gastric bypass

BACKGROUND Surgical options for morbid obesity are diverse, and the Roux-en-Y gastric bypass, initially described by Fobi has gained popularity. Knowledge about the physiology of the bypassed stomach is limited because this newly produced segment of the stomach is inaccessible to endoscopic or contrast radiological studies. AIM To evaluate the myoelectric activity of the bypassed stomach and its reply to the feeding. METHODS An experimental protocol was conducted to evaluate postoperative gastric bypassed motility in dogs submitted to the Roux-en-Y gastric bypass procedure. Two groups of five animals were studied on postoperative fasting and after a standard meal, recording electrical response and control activity. Both control and Roux-en-Y gastric bypass operated study group had a pair of electrodes placed on three points of the remaining stomach: fundus, body and antrum. Data registration was performed after complete ileus resolution, and analysed with DATA Q Inst. series 200. RESULTS The results achieved on the conditions of this study suggest that: 1. the remaining stomach maintain the same pattern of motility; 2. there is a reduced fasting electromyography activity following the Roux-en-Y gastric bypass procedure; 3. significantly reduced fasting electric control activity when compared both groups, and a markedly reduced fasting response electric activity and; 4. the electric response to the feeding kept the same standard of the stomach, however in a statistically reduced way. CONCLUSION The electrical activity of the bypassed stomach of Roux-en-Y gastric bypass procedure kept the same pattern but in a statistically reduced number of contraction.

Obstrução gastrointestinal por fitobezoar na cirurgia bariátrica

OBJETIVO: O objetivo do presente estudo foi avaliar o quadro clinico, a incidencia, os fatores predisponentes e a evolucao de pacientes com fitobezoar apos Gastroplastia Vertical e Y de Roux. METODO: No periodo de Novembro de 1997 a Janeiro de 2004, foram realizadas 512 operacoes para o tratamento da Obesidade morbida, seguindo a tecnica proposta por Fobi/Capella (Septacao gastrica com reconstituicao em Y de Roux Proximal). Em dez pacientes foram identificados fitobezoar. RESULTADOS: A incidencia de fitobezoar, causando algum tipo de obstrucao gastrointestinal, foi de 1,95% (10/512). Todos os casos de fitobezoar estavam relacionados ao fio de sutura inabsorvivel do tipo prolene. Sete pacientes apresentaram quadro semioclusivo e de obstrucao intestinal e foram tratados com laparotomia exploradora, resseccao da anastomose enteroenteral e confeccao de nova enteroenteroanastomose. Nos tres pacientes com bezoar situado na anastomose gastrojejunal, a seccao do fio e a retirada do corpo estranho foram realizadas por endoscopia digestiva alta. CONCLUSOES: A confeccao de anastomose intestinal com fio inabsorvivel predispoe a formacao de bezoar em pos-operatorio de gastroplastia.

Infecção cirúrgica em colecistectomia videolaparoscópica usando ácido peracético como esterilizante dos instrumentais

OBJECTIVE: To determine the frequency of surgical site infection in patients undergoing laparoscopic cholecystectomy with instruments sterilized by peracetic acid. METHODS: We conducted a retrospective, cohort, descriptive, cross-sectional study. Peracetic acid has been used for sterilization following the protocol recommended by the manufacturer. We observed the criteria and indicators of process and structure for preventing surgical site infection pre and intraoperatively. For epidemiological surveillance, outpatient visits were scheduled for the 15th and between the 30th and 45th days after discharge. RESULTS: Among the 247 patients, there were two cases of surgical site infection (0.8%). One patient was readmitted to systemic antibiotic therapy and percutaneous puncture; in the other the infection was superficial and followed at the clinic. CONCLUSION: Ethical issues prevent the conduction of a prospective study because of peracetic acid have been banned for the sterilization of instruments that penetrate organs and cavities. Nevertheless, these results encourage prospective case-control studies comparing its use (historical control) with ethylene oxide sterilization.

PREVALENCE OF INCIDENTAL GALLBLADDER CANCER IN A TERTIARY-CARE HOSPITAL FROM PERNAMBUCO, BRAZIL

BACKGROUND Gallbladder cancer is sometimes incidentally uncovered following cholecystectomy for gallstones diseases. The supposed highly variable prevalence of incidental gallbladder cancer through our country is unknown. OBJECTIVE To explore the prevalence of incidental gallbladder cancer in our tertiary-care hospital. METHODS A cross-sectional study was carried out on patients who consecutively underwent cholecystectomy due to gallstones disease at Faculdade Pernambucana de Saúde, Instituto de Medicina Integral Professor Fernando Figueira - FPS/IMIP, from January, 2007 to December, 2010. Data on incidental gallbladder cancer patients were explored for prevalence estimation and description of our experience with the management of this malignancy. RESULTS Our analysis involved 2018 patients with a marked predominance of women (n=1.697; 84.1%) over men (n=321; 15.9%). The 3-year prevalence estimate of 0.34% was recorded for incidental gallbladder cancer in our sample. Regarding tumor staging, there were 1 T1a, 1 T1b, and 5 T2 adenocarcinoma tumors. Laparoscopic cholecystectomy alone was performed for the T1a tumor, and additional radical surgery was performed in five others. One patient presented metastatic disease at the time of repeat surgery. The final pathology revealed residual/additional disease in all T2 tumors after radical surgery whereas the T1b patient underwent a salvage Whipples procedure due to a secondary distal cholangiocarcinoma. The patient with T1a tumor is alive after 3-year follow-up but all of the others died because of disease recurrence/progression up to 12 months. CONCLUSION This study confirms the poor prognosis of Gallbladder cancer even when incidentally diagnosed following cholecystectomy and supposes a 3-year prevalence estimate of 0.34% for incidental gallbladder cancer in our Center from Pernambuco State, Brazil.

Exploring flow rate selection in HIPEC procedures

Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as a main comprehensive treatment of peritoneal malignancies. However, current data on the literature are very heterogeneous in terms of its technical particularities, which require some efforts to standardization of practices. In these setting, we present some early data from a pioneering clinical trial in Brazil (ClinicalTrials.gov Identifier: NCT02249013) to explore the dynamic relationships between flow rates and temperature parameters in the first cases of our study, which may help in selecting better technical parameters during HIPEC procedures.

Avaliação da atividade mioelétrica do trato gastrointestinal em cães: avaliação de um sistema de fixação de eletrodos na parede abdominal

OBJECTIVE: The use of intra-abdominal electrodes in the study of gastrointestinal electrical wave is an important instrument of the gastrointestinal mioelectric activity. However, the dislocations of the electrodes in non-anaesthetized animals due to diaphragmatic muscle movements, gastrointestinal movements and mainly due to the animals habits, especially in dogs. The study has the objective to demonstrate a procedure that stabilize the system using simple resources an irrelevant cost. METHODS: The authors demonstrate under diagrams and picture a fixed system to fix the electrical electrodes through the animal skin using bottoms. RESULTS: The system was used in 5 animals. Each animal had 3 bipolar electrodes. During the study it was not identified any electrode migration. The animals was kept resting until the complete recovery of the postoperative ileus. CONCLUSION: The procedure proposed is efficient, simple, and easy to be made and allow an acquisition of the mioelectric activity, in dogs not anaesthetized, for long periods.

Neoplasias do intestino delgado: experiência de cinco anos

OBJETIVO: Analisar a experiencia do Servico de Cirurgia Geral - HC/UFPE com os tumores do intestino delgado, na tentativa de colaborar com a definicao de metas para o manejo dessas lesoes. METODO: Constitui-se este estudo em uma analise retrospectiva de12 pacientes portadores de neoplasias intestinais atendidos no SCG-HC/UFPE, no periodo de cinco anos (1994-1999). Sete eram do sexo masculino (58%). A media de idade a admissao foi de 52 anos. A principal queixa referida foi dor abdominal (83%), seguida por sangramento digestivo e perda ponderal (42%). Massa abdominal palpavel foi evidenciada em 50% dos casos. Sete (58%) apresentavam lesoes malignas. Dentre as neoplasias benignas, quatro eram leiomiomas. Uma paciente, portadora de sindrome de Peutz-Jeghers, apresentou um hamartoma. Dez foram submetidos a tratamento operatorio. Em seis, enterectomia com enteroanastomose foi empregada. Tres foram operados em carater de urgencia (um por perfuracao intestinal, um por enterorragia macica e um por obstrucao intestinal). RESULTADOS: A mortalidade relacionada a operacao foi de 17%. Todos os pacientes que evoluiram para obito apresentavam neoplasias malignas avancadas e perda ponderal superior a15% de seu peso. CONCLUSOES: Tumores do intestino delgado sao lesoes incomuns, mesmo em servicos de referencia. Um alto grau de suspeicao deve ser mantido visando o diagnostico precoce.