Background Acute appendicitis is the most frequent non-obstetric surgical emergency during pregna... more Background Acute appendicitis is the most frequent non-obstetric surgical emergency during pregnancy. The benefits of laparoscopy during pregnancy are well known, but complications can occur, and these can affect both the mother and/or the foetus. We present results of laparoscopic surgical treatment of acute appendicitis in pregnant women, analysing the occurrence of adverse postoperative, obstetric and foetal outcomes and reviewing literature. Materials and methods Retrospective observational study on pregnant women with a preoperative diagnosis of acute appendicitis. Results n = 63, mean age 28.4 years, average gestational age of 17.7 weeks (3–30 weeks). 6.4 % exploratory laparoscopies, 92 % laparoscopic appendectomies and one right colectomy were performed. Conversion rate was 3.2 %. When symptoms begun within 48 hours prior to surgery, a perforated appendicitis was found in 11 %; whereas when the time from symptom onset to surgery was greater than or equal to 48 hours, it was evident in 31 % of the cases (p 0.008). The only independent variable associated with the presence of postoperative complications was symptom duration prior to surgery greater than or equal to 48 hours (OR 4.8; 95 % CI 1.1–16.2; p 0.04). Seven minor and 2 mayor postoperative complications were observed. Patients with complications spent, on average, twice as many days hospitalized (p < 0.001); and had 8 times more risk of preterm delivery (p 0.03). Obstetric complications were more frequent in pregnant women operated during the first trimester. Foetal mortality was 1.6 %. Conclusion Surgical morbidity of acute appendicitis in pregnant women is linked to the delay in the diagnosis and treatment of the inflammatory condition. Laparoscopic appendectomy during pregnancy is not exempt from postoperative, obstetric and foetal complications. It is necessary to standardize the definitions of “complication” in order to collate reliably the outcomes presented in the literature.
Introducción: Las consultas por complicaciones de la enfermedad hemorroidal son frecuentes y algu... more Introducción: Las consultas por complicaciones de la enfermedad hemorroidal son frecuentes y algunos pacientes requieren tratamiento quirúrgico. En estos, la técnica HAL/RAR puede resultar de utilidad. Materiales y métodos: Se confeccionó una base de pacientes prospectiva, tomando en cuenta todos los pacientes operados con esta técnica en un período de dos años en dos hospitales universitarios de Buenos Aires. Se evaluaron las complicaciones del procedimiento (objetivo primario) y el índice de satisfacción del paciente (objetivo secundario). Resultados: 56 pacientes fueron incluidos, con una mediana de seguimiento de 89 días (7 - 469). Las complicaciones más frecuentes fueron dolor (19,64%) y sangrado (14,21%). Un 23% de los pacientes presentó recidiva de su enfermedad. En la escala de satisfacción, la mayoría de los pacientes manifestaron sentirse muy conformes o conformes.Conclusiones: El HAL-RAR parece ser de utilidad para el tratamiento quirúrgico de la enfermedad hemorroidal, p...
Introduccion: Las fistulas peri ano-rectales continuan siendo un desafio diagnostico y terapeutic... more Introduccion: Las fistulas peri ano-rectales continuan siendo un desafio diagnostico y terapeutico. Material y Metodo: Se realizo un estudio retrospectivo por revision de historias clinicas de pacientes intervenidos quirurgicamente por fistulas peri ano rectales en el Hospital E. Erill y el Hospital Universitario Austral, durante el periodo marzo del ano 2000 y marzo de 2005. Se efectuaron 40 procedimientos quirurgicos en 34 pacientes. Siete fueron del sexo femenino, con una media de edad de 34.7 anos y 27 masculinos, con una media de edad de 44.2 anos. La relacion masculino/femenino fue de 3.8:1. Resultados: En la serie analizada las fistulas interesfinterianas fueron las de mayor incidencia (59 por ciento) y el procedimiento quirurgico implementado con mas frecuencia fue el de la fistulectomia (37.5 por ciento). Nuestro indice de recidivas del 18 por ciento, se reduce al 9 por ciento si se excluyen las producidas en fistulas rectovaginales. La alta tasa de recidivas en FRV hace suponer un comportamiento fisiopatologico diferente a las de origen criptogenetico. La incidencia de incontinencia ha sido de 6 por ciento (dos casos) y solo para gases. (AU)
Purpose Pelvic floor dysfunction has a high prevalence in the adult population. The Dynamic and M... more Purpose Pelvic floor dysfunction has a high prevalence in the adult population. The Dynamic and Multiplanar Evaluation of the Pelvic Floor (DMRIPF) represents an ideal tool for multidisciplinary management. The purpose of this analysis is to evaluate the added value of the Dynamic and Multiplanar Evaluation of the Pelvic Floor in patients with suspected pelvic floor disorders. Methods Retrospective analysis of a consecutive series of patients who underwent a DMRIPF due to suspected pelvic floor disorders between April 2005 and July 2019. Results 359 patients were included. The average number of diagnoses achieved by physical examination was 1.2 vs. 2.5 by the Dynamic and Multiplanar Evaluation of the Pelvic Floor (p Conclusion The Dynamic and Multiplanar Evaluation of the Pelvic Floor allows the detection of multi-compartment defects that could otherwise go undetected, or even alter the initial clinical diagnosis, representing an ideal tool for multidisciplinary approach of pelvic ...
Background Acute appendicitis is the most frequent non-obstetric surgical emergency during pregna... more Background Acute appendicitis is the most frequent non-obstetric surgical emergency during pregnancy. The benefits of laparoscopy during pregnancy are well known, but complications can occur, and these can affect both the mother and/or the foetus. We present results of laparoscopic surgical treatment of acute appendicitis in pregnant women, analysing the occurrence of adverse postoperative, obstetric and foetal outcomes and reviewing literature. Materials and methods Retrospective observational study on pregnant women with a preoperative diagnosis of acute appendicitis. Results n = 63, mean age 28.4 years, average gestational age of 17.7 weeks (3–30 weeks). 6.4 % exploratory laparoscopies, 92 % laparoscopic appendectomies and one right colectomy were performed. Conversion rate was 3.2 %. When symptoms begun within 48 hours prior to surgery, a perforated appendicitis was found in 11 %; whereas when the time from symptom onset to surgery was greater than or equal to 48 hours, it was evident in 31 % of the cases (p 0.008). The only independent variable associated with the presence of postoperative complications was symptom duration prior to surgery greater than or equal to 48 hours (OR 4.8; 95 % CI 1.1–16.2; p 0.04). Seven minor and 2 mayor postoperative complications were observed. Patients with complications spent, on average, twice as many days hospitalized (p < 0.001); and had 8 times more risk of preterm delivery (p 0.03). Obstetric complications were more frequent in pregnant women operated during the first trimester. Foetal mortality was 1.6 %. Conclusion Surgical morbidity of acute appendicitis in pregnant women is linked to the delay in the diagnosis and treatment of the inflammatory condition. Laparoscopic appendectomy during pregnancy is not exempt from postoperative, obstetric and foetal complications. It is necessary to standardize the definitions of “complication” in order to collate reliably the outcomes presented in the literature.
Introducción: Las consultas por complicaciones de la enfermedad hemorroidal son frecuentes y algu... more Introducción: Las consultas por complicaciones de la enfermedad hemorroidal son frecuentes y algunos pacientes requieren tratamiento quirúrgico. En estos, la técnica HAL/RAR puede resultar de utilidad. Materiales y métodos: Se confeccionó una base de pacientes prospectiva, tomando en cuenta todos los pacientes operados con esta técnica en un período de dos años en dos hospitales universitarios de Buenos Aires. Se evaluaron las complicaciones del procedimiento (objetivo primario) y el índice de satisfacción del paciente (objetivo secundario). Resultados: 56 pacientes fueron incluidos, con una mediana de seguimiento de 89 días (7 - 469). Las complicaciones más frecuentes fueron dolor (19,64%) y sangrado (14,21%). Un 23% de los pacientes presentó recidiva de su enfermedad. En la escala de satisfacción, la mayoría de los pacientes manifestaron sentirse muy conformes o conformes.Conclusiones: El HAL-RAR parece ser de utilidad para el tratamiento quirúrgico de la enfermedad hemorroidal, p...
Introduccion: Las fistulas peri ano-rectales continuan siendo un desafio diagnostico y terapeutic... more Introduccion: Las fistulas peri ano-rectales continuan siendo un desafio diagnostico y terapeutico. Material y Metodo: Se realizo un estudio retrospectivo por revision de historias clinicas de pacientes intervenidos quirurgicamente por fistulas peri ano rectales en el Hospital E. Erill y el Hospital Universitario Austral, durante el periodo marzo del ano 2000 y marzo de 2005. Se efectuaron 40 procedimientos quirurgicos en 34 pacientes. Siete fueron del sexo femenino, con una media de edad de 34.7 anos y 27 masculinos, con una media de edad de 44.2 anos. La relacion masculino/femenino fue de 3.8:1. Resultados: En la serie analizada las fistulas interesfinterianas fueron las de mayor incidencia (59 por ciento) y el procedimiento quirurgico implementado con mas frecuencia fue el de la fistulectomia (37.5 por ciento). Nuestro indice de recidivas del 18 por ciento, se reduce al 9 por ciento si se excluyen las producidas en fistulas rectovaginales. La alta tasa de recidivas en FRV hace suponer un comportamiento fisiopatologico diferente a las de origen criptogenetico. La incidencia de incontinencia ha sido de 6 por ciento (dos casos) y solo para gases. (AU)
Purpose Pelvic floor dysfunction has a high prevalence in the adult population. The Dynamic and M... more Purpose Pelvic floor dysfunction has a high prevalence in the adult population. The Dynamic and Multiplanar Evaluation of the Pelvic Floor (DMRIPF) represents an ideal tool for multidisciplinary management. The purpose of this analysis is to evaluate the added value of the Dynamic and Multiplanar Evaluation of the Pelvic Floor in patients with suspected pelvic floor disorders. Methods Retrospective analysis of a consecutive series of patients who underwent a DMRIPF due to suspected pelvic floor disorders between April 2005 and July 2019. Results 359 patients were included. The average number of diagnoses achieved by physical examination was 1.2 vs. 2.5 by the Dynamic and Multiplanar Evaluation of the Pelvic Floor (p Conclusion The Dynamic and Multiplanar Evaluation of the Pelvic Floor allows the detection of multi-compartment defects that could otherwise go undetected, or even alter the initial clinical diagnosis, representing an ideal tool for multidisciplinary approach of pelvic ...
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Papers by Gustavo Lemme