Artículos de revistas
Is There A Role For Pyloric Exclusion After Severe Duodenal Trauma? [existe Lugar Para A Exclusão Pilórica No Trauma Duodenal Grave?]
Registro en:
Revista Do Colegio Brasileiro De Cirurgioes. Colegio Brasileiro De Cirurgioes, v. 41, n. 3, p. 228 - 231, 2014.
1006991
10.1590/S0100-69912014000300016
2-s2.0-84906345873
Autor
Neto J.C.
Pereira B.M.T.
Ribeiro Jr. M.A.F.
Rizoli S.
Fraga G.P.
Rezende-Neto J.B.
Institución
Resumen
Duodenal trauma is an infrequent injury, but linked to high morbidity and mortality. Surgical management of duodenal injuries is dictated by: patient's hemodynamic status, injury severity, time of diagnosis, and presence of concomitant injuries. Even though most cases can be treated with primary repair, some experts advocate adjuvant procedures. Pyloric exclusion (PE) has emerged as an ancillary method to protect suture repair in more complex injuries. However, the effectiveness of this procedure is debatable. The "Evidence Based Telemedicine - Trauma & Acute Care Surgery " (EBT-TACS) Journal Club performed a critical appraisal of the literature and selected three relevant publications on the indications for PE in duodenal trauma. The first study retrospectively compared 14 cases of duodenal injuries greater than grade II treated by PE, with 15 cases repaired primarily, all penetrating mechanisms. Results showed that PE did not improve outcome. The second study, also retrospective, compared primary repair (34 cases) to PE (16 cases) in blunt and penetrating grade > II duodenal injuries. The authors concluded that PE was not necessary in all cases. The third was a literature review on the management of challenging duodenal traumas. The author of that study concluded that PE is indicated for anastomotic leak management after gastrojejunostomies. In conclusion, the choice of the surgical procedure to treat duodenal injuries should be individualized. Moreover, there is insufficient high quality scientific evidence to support the abandonment of PE in severe duodenal injuries with extensive tissue loss. 41 3 228 231 Asensio, J.A., Feliciano, D.V., Britt, L.D., Kerstein, M.D., Management of duodenal injuries (1993) Curr Probl Surg, 30 (11), pp. 1023-1093 Fraga, G.P., Biazotto, G., Villaça, M.P., Andreollo, N.A., Mantovani, M., Trauma de duodeno: Análise de fatores relacionados à morbimortalidade (2008) Rev Col Bras Cir, 35 (2), pp. 94-102 Lucas, C.E., The therapeutic challenges in treating duodenal injury (2013) Pan J Trauma, 2 (3), pp. 126-133 Moore, E.E., Cogbill, T.H., Malangoni, M.A., Jurkovich, G.J., Champion, H.R., Gennarelli, T.A., Organ injury scaling, II: Pancreas, duodenum, small bowel, colon, and rectum (1990) J Trauma, 30 (11), pp. 1427-1429 Vaughan, G.D., Frazier, O.H., Graham, D.Y., Mattox, K.L., Petmecky, F.F., Jordan, G.L., The use of pyloric exclusion in the management of severe duodenal injuries (1977) Am J Surg, 134 (6), pp. 785-790 Degiannis, E., Krawczykowski, D., Velmahos, G.C., Levy, R.D., Souter, I., Saadia, R., Pyloric exclusion in severe penetrating injuries of the duodenum (1993) World J Surg, 17 (6), pp. 751-754 Fraga, G.P., Biazotto, G., Bortoto, J.B., Andreollo, N.A., Mantovani, M., The use of pyloric exclusion for treating duodenal trauma: Case series (2008) Sao Paulo Med J, 126 (6), pp. 337-341 Seamon, M.J., Pieri, P.G., Fisher, C.A., Gaughan, J., Santora, T.A., Pathak, A.S., A ten-year retrospective review: Does pyloric exclusion improve clinical outcome after penetrating duodenal and combined pancreaticoduodenal injuries? (2007) J Trauma, 62 (4), pp. 829-833 Velmahos, G.C., Constantinou, C., Kasotakis, G., Safety of repair for severe duodenal injuries (2008) World J Surg, 32 (1), pp. 7-12 Ordoñez, C., García, A., Parra, M.W., Scavo, D., Pino, L.F., Millán, M., Complex penetrating duodenal injuries: Less is better (2014) J Trauma Acute Care Surg, 76 (5), pp. 1177-1183