e.ganio,d.f altomare et al. bjs 2001 milligan-morgan stapled haemorrhage 6% 6% moderate pain 5.3...

E.Ganio,D.F Altomare et al. BJS 2001 Milligan- gan Stapled Haemorrhage 6% 6% Moderate pain 5.3 (days) 3.1(days) Severe pain 2.3 (days) 1 (days) Absence off work 13 (days) 5 (days) Bleeding 16 (days) 14 (days)

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E.Ganio,D.F Altomare et al. BJS 2001

Milligan-Morgan Stapled

Haemorrhage 6% 6%

Moderate pain 5.3 (days)

3.1(days)

Severe pain 2.3 (days)

1 (days)

Absence off work 13 (days)

5 (days)

Bleeding 16 (days)

14 (days)

Page 2: E.Ganio,D.F Altomare et al. BJS 2001 Milligan-Morgan Stapled Haemorrhage 6% 6% Moderate pain 5.3 (days) 3.1 (days) Severe pain 2.3 (days) 1 (days) Absence

(Dati del 1999)

UCP – Unità di Coloproctologia di San Gavino Monreale

Page 3: E.Ganio,D.F Altomare et al. BJS 2001 Milligan-Morgan Stapled Haemorrhage 6% 6% Moderate pain 5.3 (days) 3.1 (days) Severe pain 2.3 (days) 1 (days) Absence

La “ballerina”

Page 4: E.Ganio,D.F Altomare et al. BJS 2001 Milligan-Morgan Stapled Haemorrhage 6% 6% Moderate pain 5.3 (days) 3.1 (days) Severe pain 2.3 (days) 1 (days) Absence

Spugna di fibrina Zaffo rettale

Tampone di Roche Sonda di Imbert Imbert dei poveri

Emostasi accurata

Page 5: E.Ganio,D.F Altomare et al. BJS 2001 Milligan-Morgan Stapled Haemorrhage 6% 6% Moderate pain 5.3 (days) 3.1 (days) Severe pain 2.3 (days) 1 (days) Absence

Complicanze nella Longo (~1000 casi dal 1998 al 2005)

• Legate al tipo di anestesia:

- cefalea, vasodistonia locale, ritardo defecatorio, ritenzione di urina, ecc.

• Comuni:

- Sanguinamento (<10%) - Dolore (8%) - Urgenza persistente (<1%)

• Inconsuete:

- Stenosi (ano a clessidra) = 1 >>> sutura troppo alta + abuso di lassativi

- Fistola retto-vaginale = 1 >>> errore di tecnica

- Ipertono e ragade = 2% >>> mancato riconoscimento preoperatorio

- Ipotono e incontinenza (lesioni sfinteriche?)

- Persistenza agrafes (è una complicazione o una conseguenza?)

- Intervento e/o gestione complicanze in Ospedale non dedicato

UCP – Unità di Coloproctologia di San Gavino Monreale

Page 6: E.Ganio,D.F Altomare et al. BJS 2001 Milligan-Morgan Stapled Haemorrhage 6% 6% Moderate pain 5.3 (days) 3.1 (days) Severe pain 2.3 (days) 1 (days) Absence

PPH: RECIDIVE O RESIDUI ?

- intervento non indicato

- diagnosi sottostimata (indicazione a doppio PPH o STARR)

- imperfetta esecuzione tecnica dell’intervento

- importanza della partecipazione emotiva del paziente nel riferire incidenza ed entità di complicanze e recidive

UCP di San Gavino Monreale - Coordinatore Dott. Nando Gallese

Page 7: E.Ganio,D.F Altomare et al. BJS 2001 Milligan-Morgan Stapled Haemorrhage 6% 6% Moderate pain 5.3 (days) 3.1 (days) Severe pain 2.3 (days) 1 (days) Absence

Errore chirurgico

Rischi peculiaridella tecnica

Caratteristichedel paziente

EVENTI AVVERSI

Page 8: E.Ganio,D.F Altomare et al. BJS 2001 Milligan-Morgan Stapled Haemorrhage 6% 6% Moderate pain 5.3 (days) 3.1 (days) Severe pain 2.3 (days) 1 (days) Absence

Ottimizzazione dell’intervento

UCP di San Gavino Monreale - Coordinatore Dott. Nando Gallese

Page 9: E.Ganio,D.F Altomare et al. BJS 2001 Milligan-Morgan Stapled Haemorrhage 6% 6% Moderate pain 5.3 (days) 3.1 (days) Severe pain 2.3 (days) 1 (days) Absence

Grazie

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