Revista Portuguesa de Cirurgia
https://revista.spcir.com/index.php/spcir
<p>The Portuguese Journal of Surgery (PJS) publishes original works of biomedical content related to the surgery field of knowledge, with the objective of dissemination of scientific knowledge and the promotion of good medical practice.</p> <p>The Journal endorses the principles set out by the COPE (Committee on Publication Ethics in www.publicationethics.org) and requirements for submission of papers in biomedical journals developed by the International Committee of Medical Journal Editors (www.ICMJE.org).</p> <p>The editorial policy incorporates the Editorial Policy Statements issued by the Council of Science Editors, on the responsibility and rights of editors of peer-reviewed journals. (<a href="http://www.councilscienceeditors.org">www.councilscienceeditors.org</a>)</p> <p>All manuscripts submitted for publication are subject to double blind peer review, by external reviewers to the editorial board, except in the cases identified in these Rules.</p> <p>In the evaluation of submitted manuscripts, the editor will follow the recommendations published by the Equator Network (www.equator-network.org), urging the authors to consult the checklist in accordance to <strong>the</strong> type work to publish.</p> <p>The journal adopted the continuous publication, and exclusively online from number 30.</p> <p>It is published in accordance with the principles of free access. (<a href="http://www.budapestopenaccessinitiative.org/boai-10-recommendations">http://www.budapestopenaccessinitiative.org/boai-10-recommendations</a>)</p> <p> </p> <h2>Editor and Property:</h2> <p>The PJS is published and owned by the Portuguese Society of Surgery (Sociedade Portuguesa de Cirurgia).</p> <p> </p> <h2>Affiliated Societies:</h2> <p>Official Organ of the Portuguese Society of Surgery (Sociedade Portuguesa de Cirurgia).</p>Sociedade Portuguesa de Cirurgiaen-USRevista Portuguesa de Cirurgia1646-6918 Editorial
https://revista.spcir.com/index.php/spcir/article/view/1024
Lúcio Lara Santos
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2024-01-112024-01-11565510.34635/rpc.1024 THE PERIOPERATIVE PERIOD AND INTENSIVE CARE MEDICINE
https://revista.spcir.com/index.php/spcir/article/view/1008
<div> <div>High-risk surgery is related to the extent, invasiveness and complexity of the procedure, factors that result in an increased stress response due to surgical trauma, increased oxygen demand and increased rate of postoperative complications, which may lead to patient death.</div> <div>Classically, the perioperative period comprises three interrelated sequential phases: preoperative, intraoperative and postoperative.</div> <div>Regardless of the improvements in surgical treatment observed in terms of anaesthesia, surgical techniques and perioperative care, in patients considered high risk perioperative morbidity and mortality remains high, leading to an eminent need for early recognition of these patients, to allow optimizing the preoperative period by prehabilitating the most severe patients, defining the best anaesthetic-surgical strategy in the intraoperative period, and better managing the postoperative period, which if it happens improves the outcome.</div> <div>Various predictive risk scores and classifications are used in the different phases of the perioperative period to identify and classify patients at higher risk, enabling early identification of patients. All patients should ideally have their risk re-stratified at the end of surgery using some “criteria protocol” to determine immediate postoperative care.</div> <div>The evidence shows that patients considered high risk or patients with a risk of death ≥ 10% should be admitted to intensive care medicine, enabling quality immediate postoperative care.</div> <div>Even though they are not ideal tools, several Intensive Care Units use various indices (Charlson Comorbidity Index, Coexisting Diseases Index, the National Early Warning Score (NEWS2)), among others) as preoperative indicators for postoperative admissions.</div> <div>Perioperative assessment is very important and is justified by the possibility of postoperative complications, which despite having a variable incidence are still an important cause of morbidity and mortality, especially in high-risk patients.</div> <div>As the systemic and differentiated area of Medical Sciences that specifically addresses the prevention, diagnosis and treatment of potentially reversible acute illness situations in patients presenting with imminent or established failure of one or more vital functions, Intensive Care Medicine through the effective monitoring of the evolutionary course of high-risk patients can play a relevant role in the perioperative period, stratifying not only patients with a real risk of death or morbidity, but above all identifying and treating early postoperative complications.</div> <div>This article aims to revisit the main predictors of perioperative risk, but also the essential aspects of perioperative assessment, especially in patients at high risk of developing postoperative complications.</div> <div>It reinforces the role of intensive care medicine as an active part of the perioperative management of these patients, emphasizing the importance of admitting high-risk patients to intensive care medicine, where effective monitoring of their course and the early identification and appropriate therapeutic approach to postoperative complications that generate high morbidity and mortality clearly have a positive impact.</div> </div>Maria Lobo AntunesFrancisco D'OreyMaria Inês RibeiroPaula MendesSara LançaAntero Fernandes
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2024-01-112024-01-115672110.34635/rpc.1008 EVALUATION OF THE COSTS OF COLORECTAL CANCER TREATMENT ACCORDING TO PHASE OF CARE IN AN ONCOLOGY REFERENCE CENTRE BEFORE COVID 19 PANDEMIC
https://revista.spcir.com/index.php/spcir/article/view/1022
<div> <div><strong>Background</strong>: Colorectal cancer is the second most common cancer in Portugal, which imposes an economic</div> <div>burden in the restricted health care budget. The aim of this study was to estimate the effects of age, stage, gender, Eastern Cooperative Oncology Group performance status, Charlson Comorbidity Index and category of health care activity on the average colorectal cancer treatment costs based on hospital records before COVID19 pandemic.</div> <div> </div> <div><strong>Methods</strong>: The average monthly costs were estimated in three phases: initial, monitoring and final based on the costs of the patient’s hospital activities. The Kruskal Wallis test was applied to identify treatment costs differences within groups.</div> <div> </div> <div><strong>Results</strong>: The study population included 3020 patients diagnosed with colorectal cancer. Hospitalization, younger patients and higher stages were the main contributors for colorectal cancer costs. Stage IV presented a distinctive cost profile. Significant cost differences were found between age groups and stage in all phases. In the first 24 months after diagnosis, treating a colorectal cancer patient in stage I, II, III and IV, cost in average, 5590, 9180, 13300 and 28450 euros, respectively. Patients with Charlson Comorbidity Index score 0 were more expensive than patients with higher scores.</div> <div> </div> <div><strong>Conclusion</strong>: Our findings illustrate the value of costs studies based on national databases. This study showed the impact of several variables in the costs of colorectal cancer treatment, before COVID 19 pandemic, which may be used to improve the budget distribution of the Portuguese health care system.</div> </div>Filipa EsgalhadoLuís AntunesMarina BorgesPedro MedeirosJoaquim Abreu SousaLúcio Lara SantosMaria José Bento
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2024-01-112024-01-1156233310.34635/rpc.1022 ENHANCED RECOVERY AFTER SURGERY: A TRUE REVOLUTION AT COIMBRA UNIVERSITY AND HOSPITAL CENTER
https://revista.spcir.com/index.php/spcir/article/view/957
<div> <div>A small group of anesthesiologists and surgeons from Coimbra University and Hospital Center became interested in a project developed in northern European countries, the Enhanced Recovery After Surgery (ERAS®) Program. This program is based on training and preparing colorectal surgical patients with excellent results with regard to the decrease of complications, duration of hospitalization and the increase of patient and team´s satisfaction. The authors intend to describe the challenge of developing this project at Coimbra University and Hospital Center and display some of the results observed after the implementation of this program in colorectal surgery.</div> </div>Luísa SilvaAna AlmeidaManuel RoseteFilipa CorreiaJosé Guilherme Tralhão
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2024-01-112024-01-1156353910.34635/rpc.957 IMPLEMENTING TEXTBOOK ONCOLOGIC OUTCOME IN THE DEPARTMENT OF SURGICAL ONCOLOGY OF IPO-PORTO: PRELIMINARY RESULTS
https://revista.spcir.com/index.php/spcir/article/view/1011
<div> <div><strong>Background</strong>: Textbook Oncologic Outcome (TOO) serves as a comprehensive quality metric, representing the optimal outcome for oncological patients undergoing therapeutic surgery and, consequently, indicating the quality of healthcare provided.</div> <br> <div><strong>Methods</strong>: The TOO variables were applied to the entire cohort of adult patients (≥18 years of age) diagnosed with esophagus, stomach, pancreas, colon, rectum, urinary bladder, or ovarian cancer at the Portuguese Institute of Oncology of Porto (IPO-Porto) between January 1st, 2022, and June 30th, 2022. This evaluation specifically included patients who underwent surgery with curative intent.</div> <br> <div><strong>Results</strong>: A thorough assessment was conducted on 288 patients. Among the 143 patients with colon cancer, 69.9% achieved the TOO benchmark; for the 46 rectum cancer patients, TOO was attained by 57.1%; 40.0% of the 15 patients with esophageal cancer met the TOO criteria; 59.7% of the 67 patients with stomach cancer achieved TOO; 40% of the 5 patients with pancreatic cancer met the TOO standard; 45.5% of the 12 patients with urinary bladder cancer achieved TOO, while 66.7% of the 9 women with ovarian cancer reached the TOO benchmark. These results are comparable to those of the best comprehensive cancer centers.</div> <br> <div><strong>Conclusions</strong>: Achieving optimal TOO not only signifies the quality of patient care but also reflects positively on the institution. Subsequently, despite obtaining relevant results, there is potential for improving outcomes for patients at IPO-Porto, particularly concerning the evaluated cancers.</div> </div>Catarina Araújo RochaPedro Leite-SilvaMaria José BentoLúcio Lara Santos
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2024-01-112024-01-1156415010.34635/rpc.1011 KARYDAKIS FLAP ON SACROCOCCYGEAL PILONIDAL DISEASE: A BRIEF REVIEW AND DEPARTMENT EXPERIENCE
https://revista.spcir.com/index.php/spcir/article/view/1018
<div> <div><strong>Introduction</strong>: The sacrococcygeal pilonidal disease (SPD) represents a group of abscesses or sinuses with hairy content, occurring in the intergluteal cleft. Karydakis flap (KF) technique is based on the excision of SPD with a mobilized fasciocutaneous flap, with lateral suture lines. With this flap, by decreasing tension in the surgical wound, leads to less pain, faster recovery and, therefore, it reduces recurrence and complication rates. Due to the low learning curve and high reproducibility rate, this technique was routinely introduced in our Department.</div> <br> <div><strong>Methods</strong>: This retrospective study comprised patients submitted to chronic SPD excision between January 2010 and December 2017. Out of 1621 patients, 97 underwent chronic SPD excision under KF technique. Patient data were obtained by analyzing Institution records and making phone calls inquiring surgical complications. Results: Our recurrence rate was 3.1% (n=3) and post-operative complication was 19.6% (n=19).</div> <br> <div><strong>Discussion</strong>: recurrence rate matches the consulted literature for the same procedure: 4% for Kitchen et al., 3.16% for Erkent et al., <1% for Karydakis and 6% for Ferreira et al.. Complication rate was relatively high (19.6%) but similar to some published literature (21% for Petersen et al. and 19% for Kartal et al.; 14% for Ferreira et al.; 10.1% for Erkent et al. and 8.5% for Karydakis).</div> <br> <div><strong>Conclusion</strong>: In agreement with the published literature, this technique is therefore validated for use in our Institution.</div> </div>João MendesRita DuqueJuliana Pereira-MacedoBárbara FreireCarlos OliveiraMárcia CarvalhoArmando PaivaRicardo LemosJosé CurraloFrancisco Sampaio
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2024-01-112024-01-1156515510.34635/rpc.1018 GIANT GASTRIC LIPOMA: A CASE REPORT AND LITERATURE REVIEW
https://revista.spcir.com/index.php/spcir/article/view/1016
<div> <div><strong>Introduction</strong>: Gastric lipomas are rare and defined as giant when they are greater than 4 cm, which is exceedingly rare. Most of them are asymptomatic; however, some symptoms may occur due to complications such as ulceration, digestive bleeding, or gastric obstruction.</div> <br> <div><strong>Case report</strong>: A 63-year-old male patient presented with early satiety, dyspepsia, and one episode of melena. Investigation revealed a ulcerated polypoid lesion, suggestive of a lipoma, in the antrum measuring approximately 7cm. The patient was discussed in a multidisciplinary meeting, and laparoscopic enucleation was proposed. The surgery and post-operative period were uneventful.</div> <br> <div><strong>Literature review</strong>: A total of 40 surgically treated cases of giant gastric lipomas are reported in the literature. The average age at presentation is 55, and the most common symptoms are melena (56%), hematemesis (29%), and epigastric pain (29%). In more than half of the cases, an ulcer is present. On computed tomography, most lesions are well-defined, homogeneous, submucosal, and composed of fat, which is practically pathognomonic.</div> <br> <div><strong>Discussion</strong>: This rare condition should be managed by a multidisciplinary team. We recommend endoscopic techniques for lesions up to 4cm and surgical management for larger lesions. Minimally invasive surgery should be preferred, and enucleation should be the standard procedure.</div> </div>Ruben MartinsHenrique Morais
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2024-01-112024-01-1156576310.34635/rpc.1016 RENAL VEIN CAVERNOUS HEMANGIOMA – RESECTION AND GRAFTING WITH INTERNAL JUGULAR VEIN
https://revista.spcir.com/index.php/spcir/article/view/1000
<div> <div>Cavernous hemangioma of the renal vein is an exceptionally rare condition characterized by the presence of a vascular tumor within the renal vein. Limited information is available regarding its clinical features, prevalence, and treatment options. We present the case of a 67-year-old male with gastric adenocarcinoma who underwent staging imaging revealing an incidental finding of a neoformation within the left renal vein. The patient underwent radical total gastrectomy with excision of the renal vein lesion, followed by reconstruction using the internal jugular vein.</div> <div>Histopathological examination confirmed tubular gastric adenocarcinoma and a cavernous hemangioma involving the renal vein wall. The patient was followed in the medical oncology consultation for gastric cancer. At the 10-month follow-up, the patient remains clinically well, with no evidence of recurrence of either the gastric adenocarcinoma or renal vein hemangioma cavernosum. This case highlights the extremely rare incidental discovery of a renal vein hemangioma cavernosum during gastric cancer staging. Surgical excision with vein reconstruction proved to be a safe and effective treatment option. Further research is needed to establish optimal management strategies for this rare condition.</div> </div>Rita GalamaAugusto MoreiraRosa CapeloJoaquim Abreu de Sousa
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2024-01-112024-01-1156656710.34635/rpc.1000 INFLAMMATORY FIBROUS HYPERPLASIA IN A PATIENT WITH NEUROLOGIC DISTURBANCE
https://revista.spcir.com/index.php/spcir/article/view/898
<div> <div><strong>Introduction</strong>: Inflammatory Fibrous Hyperplasia (IFH) is a pathology characterized by a reactive lesion, in response to a chronic irritant of the oral mucosa. IFH presents itself as a high, slow-growing, asymptomatic lesion. It can vary from flaccid or firm to palpation, with a sessile or pediculate base. The purpose of this article is to report a case of inflammatory fibrous hyperplasia and a discussion based on a literature review.</div> <br> <div><strong>Case Report</strong>: Male, 53 years old, ex-alcoholic and smoker, bedridden after a stroke, without a definite cause for five years, resided in a Hospital and Maternity in the region. A nodular vegetating lesion was found throughout the palatal rim, with fibrous consistency on palpation, non-bleeding and non-painful. 7 by 8 cm. Treated with excisional surgical procedure and biopsy of pathologic tissue.</div> <br> <div><strong>Discussion</strong>: The clinical case described here presents inflammatory fibrous hyperplasia similar to those described in the literature, diagnosed as an exophytic process, well defined, mucosa-like in color, pedicled, asymptomatic, slow growing and without bone involvement. There is a consensus in the literature that the etiopathogenesis of inflammatory fibrous hyperplasia has a close relationship with low-grade chronic trauma intensity.</div> <br> <div><strong>Conclusion</strong>: The hyperplasia inflammatory lesions are common and have, in the majority of cases, little dimensions without symptomatology and associated with persistent local trauma, the treatment consists in excisional surgical procedure and a good prognostic is expected.</div> </div>Felipe Búrigo dos SantosJuliana BoechatRogério GondakLia HonnefJoão Schmitt LopesLetícia BagatimHeron Stähelin da SilvaKelly MaierHeitor Fontes da Silva
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2024-01-112024-01-1156697510.34635/rpc.898 RADIATION-INDUCED SARCOMAS: A SURGICAL CHALLENGE
https://revista.spcir.com/index.php/spcir/article/view/984
<div> <div>Malignant peripheral nerve sheath tumors (MPNST) are uncommon, biologically challenging soft tissue sarcomas. The definitive treatment of these tumors is extremely challenging. In 50% of cases, these tumors are associated with type I neurofibromatosis, but in some cases, the cause can be previous treatment with radiotherapy. The present article pretends to report a clinical case of a radiation-induced MPNST submitted to surgical treatment.</div> </div>Paula Ferreira PintoJosé Carlos PereiraAna Margarida CorreiaCatarina BaíaMariana MarquesJosé SilvaPedro MartinsLúcio Lara SantosJoaquim Abreu de Sousa
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2024-01-112024-01-1156778010.34635/rpc.984 AORTIC LACERATION DURING VERESS NEEDLE INSERTION: A LAPAROSCOPIC DISASTER
https://revista.spcir.com/index.php/spcir/article/view/929
<div> <div><strong>Introduction</strong>: Over 50% of complications related to laparoscopy occur during the entry phase for pneumoperitoneum and trocar insertion. Major vascular injuries, although infrequent (0.04–0.1% of laparoscopic procedures), can lead to significant morbidity and mortality, with 13%–50% going undetected immediately during surgery. Major vascular injuries rank as the second most common cause of death during laparoscopy, following anesthesia-related deaths, with a mortality rate of 6.37%. Immediate response to vascular injuries should prioritize assessment and potential control rather than immediate conversion to laparotomy. Recognized risk factors for entry phase injuries during laparoscopy include obesity, prior abdominal surgeries, surgical experience, inflammatory bowel disease, and pelvic inflammatory disease.</div> <br> <div><strong>Clinical case</strong>: A 47-year-old woman with a BMI of 42.2 kg/m2, no prior abdominal surgeries, and two recent episodes of diverticulitis within six months, was scheduled for an elective left hemicolectomy at a secondary hospital. During Veress needle insertion, blood was observed. Subsequently, upon placing the first trocar, a median retroperitoneal inframesogastric hematoma was identified, and attempts to control bleeding were unsuccessful, leading to conversion due to hemodynamic instability. An infrarenal aortic laceration was revealed, requiring clamping to halt bleeding. The patient was then transferred to a tertiary hospital for vascular surgery intervention, involving aortoplasty with a patch of the great saphenous vein and thrombectomy of the ilio-distal arteries. The time from injury to the start of vascular surgery was 2 hours. The patient was admitted to an Intensive Care Unit, receiving 15 red blood cell units (initial 2 without compatibility testing), 12 plasma units, 3 grams of fibrinogen, and 1 platelet pool. During the intensive care stay, the patient developed leg compartment syndrome, necessitating fasciectomy, and moderate ARDS, complicating disease management.</div> <br> <div><strong>Conclusion</strong>: While major vascular lesions in laparoscopic surgery are rare, they are linked to significant morbidity and mortality. A collaborative effort involving laparoscopic surgeons, anesthesiologists, vascular surgeons, and intensivists is essential to minimize damage and improve vascular repair outcomes. Strict action protocols are crucial to reducing morbidity and mortality associated with major vascular injuries during laparoscopic procedures.</div> </div>Miguel MachadoLuís MalheiroSérgio GaiãoJosé Artur PaivaLaura Elisabete Barbosa
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2024-01-112024-01-1156818510.34635/rpc.929 INTRATHORACIC PERFORATION OF GASTRIC REMNANT FOLLOWING ROUX-EN-Y GASTRIC BYPASS
https://revista.spcir.com/index.php/spcir/article/view/878
<p>.</p>Leonor MatosAlice PimentelAna Marta PereiraAntónio José ReisMarta GuimarãesJoana Noronha
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2024-01-112024-01-1156878810.34635/rpc.878 CHYLOPERITONEUM AFTER GASTRECTOMY: IS IT A MANAGEABLE NIGHTMARE?
https://revista.spcir.com/index.php/spcir/article/view/1012
<div> <div>Chylous ascites is a serious and rare complication after gastrectomy for gastric cancer. Most cases improve with conservative treatment, but substantial morbidity and mortality can be associated. We describe the case of a 48-year-old-male submitted to partial gastrectomy with D2 lymphadenectomy for gastric adenocarcinoma. Three days after starting a liquid diet, it was diagnosed a chyle fistula. Conservative treatment was started with improvement of the patient and he was discharged. After eighteen days, the patient was readmitted due to a large volume chyloperitoneum, requiring paracentesis. Medical treatment was reinstituted, with amelioration and dismissal of the patient. The patient returned to the emergency department due to abdominal pain and fever and was submitted to laparoscopic abdominal drainage. There was resolution of refractory ascites during hospitalization. Chylous ascites is a rare complication after radical resections for gastric cancer. Therefore, there is no well-defined treatment and these cases remain a therapeutic challenge. The therapeutic strategies described include dietary measures, the use of pharmacological agents, total parenteral nutrition and, in selected cases, surgical or percutaneous interventions.</div> </div>Bárbara CastroCatarina OrtigosaAmélia TavaresFernando ViveirosManuel Oliveira
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2024-01-112024-01-1156899410.34635/rpc.1012 GIANT PRIMARY PULMONARY LEIOMYOSARCOMA
https://revista.spcir.com/index.php/spcir/article/view/1005
<p>A 57-year-old woman with backpain was diagnosed with a right hemithorax mass. Transthoracic needle biopsy showed a low-grade leiomyosarcoma.</p> <p>Surgery was performed, with resection of the tumor en bloc with the 5th right rib and the right lung. Pathology showed a 22 x 19 x 10 cm, 2700 g primary pulmonary leiomyosarcoma, an extremely rare finding.</p>Ana Margarida SilvaInês Bertão ColaçoFilipe LeiteGonçalo Paupério
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2024-01-112024-01-1156959610.34635/rpc.1005 CONVERTING A SLEEVE GASTRECTOMY INTO ROUX-EN-Y GASTRIC BYPASS AFTER GASTRIC FISTULA
https://revista.spcir.com/index.php/spcir/article/view/1006
<div> <div>Sleeve Gastrectomy (SG) is the most widely performed bariatric surgery worldwide. Despite being considered a relatively simple surgery compared with other metabolic choices, it has no negligible risk of postoperative complications.</div> <div>Gastric fistulas are one of the most feared complications and the most consensual explanation is the increased intraluminal pressure because of any cause of gastric emptying impairment. Due to its complex nature and multifactorial origin, the treatment is challenging and usually involves clinical, endoscopic and surgical management.</div> <div>To date, there is no consensus about the treatment or the ideal time for treating gastric fistulas after SG, but conversion to RYGB remains one of the options to solve this issue mainly as it can decrease the intraluminal pressure of the gastric tube. We aim to present a video of a laparoscopic conversion to RYGB in a patient with gastric fistula after SG.</div> </div>Jorge NogueiroFábio GomesFernando ResendeAndré PinhoHugo Santos-SousaJohn PretoEduardo Lima da Costa
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2024-01-112024-01-1156979810.34635/rpc.1006 LAPAROSCOPIC REPAIR OF UMBILICAL HERNIA AND DIASTASIS RECTI BY LIRA TECHNIQUE
https://revista.spcir.com/index.php/spcir/article/view/991
<div> <div>Diastasis rectus abdominis is produced by an anormal separation of the rectus abdominis with s widening of the Linea alba, producing a deformity of the abdominal Wall when the abdomen is contracted. It can be symptomatic provoking pain or discomfort in the abdomen, musculoskeletal or urogenital problems and a negative corporal image with consequences in the quality of life.</div> <div>The most frequent presentations are in obese males and in women after pregnancy. The pathological diastasis recti exists with the widening of the rectus abdominis just over the umbilicus is superior to 2 centimeters. Depending on the distance, it can be more or less serious (and more or less probable the resolution by conservative treatments).</div> <div>The first treatment is physical therapy. When it is associated to hernias of the linea alba it is recommended surgical treatment including hernia repair and diastasis repair. The presence of diastasis recti it not only causes of symptoms but increases the possibility of appearing mor hernia defects.</div> <div>The surgical approach depends on the characteristic of the patients. If the patient needs an abdominoplasty, na open approach with dermolipectomy is performed. If there is no need for abdominoplasty, it will be better to perform a minimal invasive approach.</div> <div>Minimally invasive procedures have fewer wound complications, and therefore, decrease the morbidity of these surgeries. Minimally invasive approach can be made by several techniques: subcutaneous (SCOLA), retromuscular (e-TEP) or intraperitoenal (IPOM, LIRA).</div> <div>The advantage of the LIRA technique is that it can be made an approximation of the fascia, with repair of the hernia ring and the middle line, without opening the linea alba.</div> <div>In the video we present the surgical technique.</div> </div>Carmen MailloPedro SerralheiroGenoveva PiçarraMaria de Jesús OliveiraRaquel Camacho AbreuNuno Figueiredo
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2024-01-112024-01-11569910110.34635/rpc.991