Bilateral V-Y flap for perineal reconstruction after extralevator abdominoperineal excision

A descrição da amputação abdominoperineal extraelevadora (ELAPE) para a ressecção de tumores do recto baixo ou da margem anal, a subsequente estandardização do tempo perineal e a definição das suas indicações precisas, veio colocar enfâse particular na necessidade de recorrer a técnicas de reconstrução do períneo para encerramento dos defeitos perineais provocados por ressecções mais alargadas. Apresentamos um caso de ELAPE por carcinoma pavimento-celular (CPC) da margem do ânus com necessidade de reconstrução do períneo com retalho miocutâneo V-Y bilateral e revemos a literatura quanto às opções existentes e respetivas vantagens, desvantagens e evidência existente.info:eu-repo/semantics/publishedVersio

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system. Results A total of 3288 patients were included in the analysis, of whom 301 (9 center dot 2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P < 0 center dot 001). There were no significant differences in rates of readmission between these groups (6 center dot 6 versus 8 center dot 0 per cent; P = 0 center dot 499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0 center dot 90, 95 per cent c.i. 0 center dot 55 to 1 center dot 46; P = 0 center dot 659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34 center dot 7 versus 39 center dot 5 per cent; major 3 center dot 3 versus 3 center dot 4 per cent; P = 0 center dot 110). Conclusion Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients