- Klíčová slova
- staplerová hemoroidopexe, tissue-selecting therapy,
- MeSH
- chirurgická technika pomocí přístrojů a svorek * metody škodlivé účinky statistika a číselné údaje MeSH
- chirurgické staplery MeSH
- hemoroidektomie MeSH
- hemoroidy * chirurgie etiologie MeSH
- lidé MeSH
- pooperační bolest MeSH
- pooperační komplikace MeSH
- recidiva MeSH
- střevní obstrukce chirurgie etiologie MeSH
- Check Tag
- lidé MeSH
Článek poskytuje chirurgický pohled na řešení komplikací celosvětově hojně užívaného operačního výkonu, jakým je laparoskopická sleeve gastrektomie. Sleeve gastrektomie je celosvětově uznávaný bariatrický výkon. Tato operace je hodnocena jako bezpečná, nicméně i ona může být, i když v relativně malém procentu, provázena závažnými komplikacemi. Jednou z nejnebezpečnějších je staple line leak s rozvojem lokální, difúzní peritonitidy či torpidní píštěle. Řešení je svízelné a často je postupně realizováno několik způsobů ošetření, než dojde k definitivnímu zhojení pacienta. Léčbu této komplikace je možno rozdělit na čistě chirurgickou, kombinovanou či čistě endoskopickou. Neexistují nicméně dosud guidelines, jakým způsobem při této komplikaci postupovat, a je tedy terapeutický postup zvolen na základě klinických zkušeností pracoviště doplněných informacemi z dostupné literatury.
The article proposes a surgical look at solving the complications of the widely used surgical procedure worldwide, such as laparoscopic sleeve gastrectomy. Laparoscopic sleeve gastrectomy (LSG) is considered as one of the most efficient bariatric interventions in morbid obesity wordwide. Nevertheless, there are some risks and perhaps the most severe is leak along the staple line with local or diffuse peritonitis or persisting fistula. The treatment of this complication can be strictly surgical, combined or only endoscopic. However, there are no set guidelines to date as the best option of leak management. As a result, every procedure is "tailored" to a specific patient and it always depends on the experience of the respective institutionsupplemented with information available from literature.
PURPOSE OF THE STUDY: Surgical incision closure, as well as total joint replacement itself, plays a key role in the overall outcome of an arthroplasty procedure. Uncomplicated wound healing is the essential condition of successful rehabilitation and the patient's return to normal activities. Although there are many innovative suturing techniques which offer advantages, their safety is still being discussed. The aim of this prospective non-blind randomised study was to evaluate wound healing and complications in relation to skin incision closure with either conventional suture or metal staples. MATERIAL AND METHODS: A total of 72 patients, 21 men and 51 women, who underwent a standard primary total knee arthroplasty (TKA) at our department in the period from January till June 2013, were evaluated. They were allocated to two groups by random assignment based on the patient's date of birth (even or odd day of birth). In group 1 (n=39) skin was closed using metal staples (Leukosan Skin Stapler), in group 2 (n=33), conventional continuous Donati suture was used. The groups, previously assessed as independent and comparable in terms of age, gender and BMI, were compared in the following criteria: suturing time, duration of wound drainage, wound healing, complications, resuturing when necessary, and their relation to the body mass index, skin plica thickness and co-morbidities potentially complicating soft tissue healing. The differences were statistically evaluated by parametric and non-parametric tests, i.e., the median test, χ(2)-test, Student's t-test, Fisher's exact test and Pearson's correlation coefficient. The statistical significance of differences was set at a level of 0.05. RESULTS: A significant difference (p<0.005) between the groups was found in suturing time; the median time for staples was 81 sec in comparison with 290 sec for conventional suture. In both groups, staples or sutures were removed on the 12 th postoperative day and there was no difference in wound drainage (median time, 5 days; p=0.891 for both). Treatment for late discharge was required in two sutured wounds (6.1%) and in three stapled wounds (7.7%). One of the latter was due to early deep wound infection, which later resulted in revision TKA. The groups did not differ in the values of either BMI or plica thickness (Pearson's r). DISCUSSION: Views on alternative suture techniques for skin closure in orthopaedic surgery vary. In this study, the use of metal staples or conventional suture is compared between two groups of patients undergoing TKA, i.e., the same type of procedure. The advantage of staples involves a quick and simple application but, as reported, removal may be more painful with staples than with stitches, and much depends on the technique of staple application. The continuous suture technique may produce skin strangulation at wound margins, which will complicate healing. Staples minimise this risk and are therefore commonly used in TKA surgery. However, only very few studies comparing these two suture techniques in TKA patients have been published. CONCLUSIONS: Correctly performed skin suturing by means of metal staples is not associated with a higher complication rate and is therefore a simple, rapid, efficient and economical alternative to the conventional suture technique.
- MeSH
- časové faktory MeSH
- chirurgická technika pomocí přístrojů a svorek * škodlivé účinky MeSH
- hojení ran MeSH
- index tělesné hmotnosti MeSH
- infekce chirurgické rány etiologie MeSH
- kovy MeSH
- lidé MeSH
- prospektivní studie MeSH
- senioři MeSH
- šicí techniky * škodlivé účinky MeSH
- totální endoprotéza kolene metody MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
Operace hemoroidů podle Longa je v dnešní době již široce rozšířeným a standardním operačním postupem používaným na mnoha chirurgických pracovištích. V českém i zahraničním písemnictví jsou publikovány rozsáhlé studie, ve kterých jsou podrobně popsány výhody i možné komplikace této metody. Procento komplikací se podle jednotlivých pracovišť pohybuje v poměrně širokém rozmezí (5–20 %), kdy ale toto číslo obvykle klesá v závislosti na narůstajících zkušenostech a zvládnutí uvedené metody. Jde převážně o nezávažné komplikace, mezi nejčastější patří krvácení ze staplerové sutury. Závažnější komplikace jako dehiscence sutury či vznik rektovaginální píštěle jsou méně časté. V naší kazuistice prezentujeme neobvyklou komplikaci po tomto výkonu a to slepý uzávěr rekta cirkulárním staplerem PPH. V dostupné literatuře se nám podobnou komplikaci nepodařilo nalézt.
Longo Procedures on hemorrhoids are widely used and standard surgical procedures used in many surgical clinics. Extensive studies, describing benefits and possible complications of the method in a detail, are published in Czech and foreign literature. A wide range of complication rates (5-20%) is reported by individual clinics, however, the rates decrease proportionally to the surgeon's growing experience and mastering of the method. The complications reported are mostly non-serious, bleeding from stapled sutures is one of the commonest ones. However, more serious complications including suture dehiscence or rectovaginal fistules, are less common. Our case-review presents an unusual complication after the procedure, a blind closure of the rectum with a circular PPH stapler. No similar complication has been found in the available literature.
