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- 231 laparoscopic cholecystectomy in ambulatory: what results?Publication . Goulart, A; Delgado, M; Antunes, MC; Braga dos Anjos, Jntroduction: 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.
- 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.
- Clinicopathological correlation and prognostic significance of VEGF-A, VEGF-C, VEGFR-2 and VEGFR-3 expression in colorectal cancer.Publication . Martins, SF; Garcia, EA; Luz, MA; Pardal, F; Mesquita-Rodrigues, A; Filho, ALBACKGROUND: Colorectal cancer (CRC) is the third most common type of cancer and the fourth most frequent cause of cancer death. Literature indicates that vascular endothelial growth factor is a predominant angiogenic factor and that angiogenesis plays an important role in the progression of CRC. PATIENTS AND METHODS: The present series consisted of tissue samples obtained from 672 patients who had undergone large bowel resection between 2005 and 2010 at the Braga Hospital, Portugal. Archival paraffin-embedded CRC tissue and normal adjacent samples were used to build up tissue microarray blocks and VEGF-A, VEGF-C, VEGFR-2 and VEGFR-3 expression was immunohistochemically assessed. RESULTS: We observed an overexpression of VEGF-C in CRC when tumour cells and normal-adjacent tissue were compared (p=0.004). In tumour samples, VEGF-C-positive cases were associated with VEGFR-3 expression (p=0.047). When assessing the correlation between VEGF-A, VEGF-C, VEGFR-2 and VEGFR-3 expressions and the clinicopathological data, it was revealed that VEGF-A positive cases were associated with male gender (p=0.016) and well-differentiated tumours (p=0.001); VEGF-C with colon cancers (p=0.037), exophytic (p=0.048), moderately-differentiated (p=0.007) and T3/T4 (p=0.010) tumours; VEGFR-2 with invasive adenocarcinoma (p=0.007) and VEGFR-3 with the presence of hepatic metastasis (p=0.032). Overall survival curves for CRC were statistically significant for rectal cancer, VEGF-C expression and stage III (p=0.019) and VEGFR-3 expression and stage IV (p=0.047). CONCLUSION: Quantification of VEGF-A, VEGF-C, VEGFR-2 and VEGFR-3 expression seems to provide valuable prognostic information in CRC and the correlation with clinicopathological data revealed an association with characteristics that contribute to progression, invasion and metastasis leading to poorer survival rates and prognosis.
- Concomitant endoscopic radiofrequency ablation and laparoscopic reflux operative results in more effective and efficient treatment of Barrett esophagusPublication . Goers, TA; Leão, P; Cassera, MA; Dunst, CM; Swanstroem, LLBACKGROUND: Barrett esophagus (BE) caused by gastroesophageal reflux disease can lead to esophageal cancer. The success of endoscopic treatments with BE eradication depends on esophageal anatomy and post-treatment acid exposure. STUDY DESIGN: Between January 2008 and December 2009, 10 patients were selected for combination treatment of BE using laparoscopic anti-reflux surgery and endoscopic radiofrequency ablation. Retrospective review of preoperative, procedural, and postoperative data was performed. RESULTS: Seven study patients had a pathologic diagnosis of nondysplastic BE and 3 patients had a diagnosis of low-grade dysplasia. Average length of BE lesions was 6.4 ± 4.8 cm. Procedure time averaged 154.4 ± 46.4 minutes. At the time of surgery, the mean number of ablations performed was 4.39 ± 1.99. Six patients were noted to have major hiatal hernias requiring reduction. Five patients (80%) had 100% resolution of their BE at their first postoperative endoscopy. The remaining 3 patients had a ≥50% resolution and underwent subsequent endoscopic ablation. Symptomatic results revealed that 4 patients had substantial dysphagia to solids and other symptoms were minimal. Two patients were noted to have complications related to the ablative treatments. One stricture and 1 perforation were observed. CONCLUSIONS: Endoscopic radiofrequency ablation of BE at the time of laparoscopic fundoplication is feasible and can effectively treat BE lesions. A single combined treatment can result in fewer overall procedures performed to obtain BE eradication.
- Divertículo de Meckel perfurado por palito: relato de um caso clínicoPublication . Goulart, A; Pereira, R; Leão, P; Gomes, C; Carvalho, A
- Evaluation of quality parameters of rectal cancer surgery at the Coloproctology Unit of Hospital de BragaPublication . Pimenta de Castro, MA; Martins, SFINTRODUCTION: Rectal cancer (RC) represents 1/3 of all diagnosed colorectal cancers. After the creation of specialized units to treat RC, it became fundamental to establish criteria to assess the quality of the service. Objective: To evaluate the surgical treatment provided to RC patients at the Coloproctology Unit of Hospital de Braga (BH-CU) by means of quality parameters. METHODS: We conducted an observational cross-sectional descriptive study with a convenience sample of 149 patients undergoing surgical treatment in this unit, from January 1st, 2007 to June 30, 2010. RESULTS: We observed that the postoperative mortality rate (4%) and the global dehiscence rate (14.8%) were in accordance with recommended values. Sphincter sparing surgery rate (65.8%) was higher than the recommended minimum; however, more than 12 resected ganglia (36.6%) is inferior than what is recommended. The oncological results were analyzed by the local recurrence rate (6.7%) and the two-year survival rate (91.1%); both values are in accordance with literature. CONCLUSION: We conclude that the BH-CU surgical treatment has a quality level similar to that observed in literature.
- Giant recurrent retroperitoneal liposarcoma initially presenting as inguinal hernia: Review of literature.Publication . Leão, P; Vilaça, S; Oliveira, M; Falcão, JINTRODUCTION: Liposarcomas comprise around 15% of soft tissue tumors. These tumors of mesodermal origin arise as single tumors, present one histologic type and diverse locations (including the retroperitoneum). Diagnosis of liposarcomas of retroperitoneum is difficult because of this unspecific presentation and in 50-100% of the cases there is recurrence from residual tissue. PRESENTATION OF CASE: An 86 year old male patient was admitted in 1996 due to a right and voluminous inguinal hernia. During the herniaplasty, a right paratesticular tumor was isolated and removed. The histologic exam revealed a well-differentiated liposarcoma. A CT scan was performed and a large abdominal mass was detected. The patient underwent a laparotomy and an incomplete resection of the tumor was achieved. After the surgery the patient remained asymptomatic during a long period. Nine years later, the patient underwent another laparotomy with partial removal of the giant recurrent retroperitoneal liposarcoma. CONCLUSION: The purpose of this publication is to report the recurrence of giant retroperitoneal liposarcoma, which is an unusual presentation in surgery today. Furthermore, we would like to emphasize the long-term survival of this patient despite partial resection and the possibility of performing a re-resection in this type of cases.
- Grupo de Biópsia Aspirativa com Agulha Fina: análise dos primeiros 500 casosPublication . Ribas, S; Soares, V; Koch, PO Grupo de Biópsia Aspirativa com Agulha Fina está integrado na Unidade de Cabeça e Pescoço que pertence ao Departamento de Cirurgia do Hospital de S. Marcos. Este grupo foi constituído e iniciou a sua actividade em 2005 e é responsável pela realização de biópsias aspirativas de agulha fina, directas e ecoguiadas, de nódulos localizados na cabeça e pescoço. Este trabalho pretende analisar os primeiros 500 casos de biópsias aspirativas com agulha fina da glândula tiróide. The Group of Fine-needle Aspiration Biopsy is a part of the Unit for Head and Neck which belongs to the Department of Surgery of the Hospital of S. Marcos. This group was formed and started his activity in 2005 and is responsible for carrying out fine needle aspiration biopsies, direct and ultrasound-guided, of nodules found in the head and neck. This paper aims to examine the first 500 cases of fine-needle aspiration biopsies of the thyroid gland.
- Hernioplasty in One-Day Surgery: result of 228 self-adhesive prosthesisPublication . Goulart, A; Delgado, M; Antunes, MC; Braga dos Anjos, JAim: To evaluate the outcomes of inguinal hernia repair with ProGrip® mesh in same-day surgery Methods: Follow-up data was collected at 24 hours and 30 days after surgery. Results: In one year, 228 patients underwent surgical repair of unilateral inguinal hernia. At 24 hours after surgery, 50.64% of patients reported some degree of pain and 66.3% were able to move around the house with few limitations. Thirty days after surgery, 94.39% of patients had returned to their routine activities. Conclusions: The use of the ProGrip® mesh is associated with low post-operative pain and rapid recovery.
- Íleo Paralítico Pós-operatório: Fisiopatologia, Prevenção e TratamentoPublication . Goulart, A; Martins, S