Rone Antônio Alves de Abreu

Feasibility analysis of loop colostomy closure in patients under local anesthesia

PURPOSE To verify prospectively the practicability of performing loop colostomy closure under local anesthesia and sedation. METHODS In this study, 21 patients underwent this operation. Lidocaine 2% and bupivacaine 0.5% were utilized. Pain was evaluated during the operation, on the first postoperative day and at hospital discharge. Intraoperative events, postoperative complications and the acceptability of this procedure were analyzed. RESULTS The mean duration of the operation was 133 minutes (range: 85 to 290 minutes). The mean postoperative hospitalization was four days (range: one to twelve days). No patients died. Complications occurred in two patients (9.4%): abdominal wall hematoma and operative wound infection. With regard to pain severity, scores of less than or equal to three were indicated in the intraoperative evaluation by 80% of the patients (17/21) and on the first postoperative day by 85% (18/21). At hospital discharge, 95.2% of the patients (20/21) said they were in favor of the local anesthesia technique. CONCLUSION Loop colostomy closure under local anesthesia and sedation is feasible, safe and acceptable to patients.

Cost-effectiveness analysis on spinal anesthesia versus local anesthesia plus sedation for loop colostomy closure

CONTEXT Studies in the area of health economics are still poorly explored and it is known that the cost savings in this area is becoming more necessary, provided that strict criteria. OBJECTIVE To perform a cost-effectiveness analysis of spinal anesthesia versus local anesthesia plus sedation for loop colostomy closure. METHODS This was a randomized clinical trial with 50 patients undergoing loop colostomy closure either under spinal anesthesia (n = 25) or under local anesthesia plus sedation (n = 25). The duration of the operation, time spent in the post-anesthesia recovery room, pain, postoperative complications, length of hospital stay, laboratory and imaging examinations and need for rehospitalization and reoperation were analyzed. The direct medical costs were analyzed. A decision tree model was constructed. The outcome measures were mean cost and cost per local and systemic postoperative complications avoided. Incremental cost-effectiveness ratios were presented. RESULTS Duration of operation: 146 +/- 111.5 min. vs 105 +/- 23.6 min. (P = 0.012); mean time spent in post-anesthesia recovery room: 145 +/- 110.8 min. vs 36.8 +/- 34.6 min. (P<0.001). Immediate postoperative pain was lower with local anesthesia plus sedation (P<0.05). Local and systemic complications were fewer with local anesthesia plus sedation (P = 0.209). Hospitalization + rehospitalization: 4.5 +/- 4.1 days vs 2.9 +/- 2.2 days (P<0.0001); mean spending per patient: R

Randomized clinical trial comparing spinal anesthesia with local anesthesia with sedation for loop colostomy closure

5,038.05 vs 2,665.57 (P<0.001). Incremental cost-effectiveness ratio: R

Drenagem endoscópica transmural de pseudocisto pancreático: resultados a longo prazo

-474.78, indicating that the strategy with local anesthesia plus sedation is cost saving. CONCLUSION In the present investigation, loop colostomy closure under local anesthesia plus sedation was effective and appeared to be a dominant strategy, compared with the same surgical procedure under spinal anesthesia.

Cisto de colédoco em adulto: anomalia da junção do colédoco com o ducto pancreático submetido à ressecção do cisto e à derivação biliar e pancreática

CONTEXT Recent studies have shown that local anesthesia for loop colostomy closure is as safe as spinal anesthesia for this procedure. OBJECTIVES Randomized clinical trial to compare the results from these two techniques. METHODS Fifty patients were randomized for loop colostomy closure using spinal anesthesia (n = 25) and using local anesthesia (n = 25). Preoperatively, the bowel was evaluated by means of colonoscopy, and bowel preparation was performed with 10% oral mannitol solution and physiological saline solution for lavage through the distal colostomy orifice. All patients were given prophylactic antibiotics (cefoxitin). Pain, analgesia, reestablishment of peristaltism or peristalsis, diet reintroduction, length of hospitalization and rehospitalization were analyzed postoperatively. RESULTS Surgery duration and local complications were greater in the spinal anesthesia group. Conversion to general anesthesia occurred only with spinal anesthesia. There was no difference in intraoperative pain between the groups, but postoperative pain, reestablishment of peristaltism or peristalsis, diet reintroduction and length of hospitalization were lower with local anesthesia. CONCLUSIONS Local anesthesia plus sedation offers a safer and more effective method than spinal anesthesia for loop colostomy closure.

Cisto de úraco em adultos simulando abdômen agudo

BACKGROUND Pancreatic pseudocysts are relatively common complications of pancreatitis in adults. OBJECTIVE To evaluate the long-term results from transmural endoscopic drainage and thus to establish its role in managing pancreatic pseudocyst. METHODS Fourteen patients with pancreatic pseudocyst were studied. Their main complaint was pain in the upper levels of the abdomen. They presented palpable abdominal mass and underwent cystogastrostomy (n = 12) and cystoduodenostomy (n = 2), with clinical follow-up using abdominal computed tomography for up to 51 months. Retrograde endoscopic cholangiopancreatography was attempted in all cases to study the pancreatic duct and classify the cysts. RESULTS There were 10 cases (71.5%) of chronic pancreatitis that had become acute through alcohol abuse and 4 (28.5%) that had become acute through biliary disorders. Both types of endoscopic drainage (cystogastrostomy and cystoduodenostomy) were effective. There was no change in the therapeutic management proposed. Migration of the orthesis into the pseudocyst at the time of insertion (two cases) was the principal complication, and these could be removed during the same operation, by means of a Dormia basket, with the aid of fluoroscopy. There has so far not been any mortality or relapse. The mean hospital stay was 3 days. CONCLUSION Transmural endoscopic drainage was an efficacious form of therapy, presenting a low complication rate and no mortality, and only requiring a short stay in hospital.

Acute and Chronic Pancreatitis — Complications

Common bile duct cysts are rare congenital anomalies which have been diagnosed only in twenty per cent of adults. The etiology is uncertain, but many patients have an anomalous pancreatobiliary junction anatomy. We present a case of a young man with a type I Alonso-Lej/ Todani common bile duct cyst and an anomalous common bile duct-pancreatic junction anatomy. Because the common bile duct did not have a segment of normal caliber, to avoid compromising with the pancreatic channel after the excision of the cyst, we performed a Roux-en-Y anastomosis by anastomosing the biliary duct to the proximal excluded jejunal loop and the common duct-pancreatic junction to the same more distally loop.

Síndrome de Fournier: estudo de 32 pacientes do diagnóstico à reconstrução

Urachus anomalies are generally asymptomatic, but when infected can simulate acute abdomen. This anomaly has to be deemed when abdominal tenderness is associated with inflammation signs in parumbilical or hypogastric regions. Ultrasonography has great sensibility to settle down the diagnosis as observed from our three cases. Ultrasonography images with air suggest intestinal fistula in most cases with sigmoid or ileum as shown here.