GOFFI TECNICA CIRURGICA PDF

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Goffi Tecnica Cirurgica Pdf

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Request PDF on ResearchGate | Sutures and the operating room nurse: criteria in forecasting the need for sutures and Operações fundamentais In: Goffi FS. Técnica Cirúrgica: bases anatômicas, fisiopatológicas e técnicas cirúrgicas. Free download Goffi tecnica cirurgica pdf, O sistema Apache II e o progn stico de pacientes submetidos s opera es de grande e pequeno porte. Apache II scores. Goffi FS, Tolosa EMC. Técnica cirúrgica: Bases anatô- micas, fisiopatológicas e técnica cirúrgica. 4a ed. São. Paulo: Atheneu; 6. Lima GJS, Silva AL, Leite .

Uma forma mais completa e bastante ecltica para a montagem da mesa, de forma mais didtica para o estudante de medicina em treinamento cirrgico, ser apresentada logo a seguir.

O padro de organizao da mesa que ser apresentado atende ordem cronolgica de um ato operatrio genrico e completo, isto , incluindo desde a preparao e anti-sepsia do campo cirrgico, passando pela direse, apresentao, hemostasia, preenso, instrumentos especiais e sntese.

A ordem de utilizao dos instrumentos na mesa deve seguir o sentido horrio. Por serem utilizados antes mesmo da direse, os instrumentos para montagem e pintura do campo operatrio devem ser colocados em primeiro plano nesta organizao.

So eles: P i n a B a c k h a u s utilizada para fixar os panos do campo operatrio ; P i n a P e a n para pintar o campo ; P i n a C h e r o n para pintar o campo em ginecologia, principalmente ; C u b a r e d o n d a para estocar a soluo anti-sptica utilizada na pintura do campo ; Gazes.

INTRODUCTION

Logo em seguida, na sequncia do sentido horrio, os instrumentos para cortar os tecidos devem ser posicionados. Materiais pequenos e de manuseio prtico para exposio e acesso s estruturas por meio da ferida cirrgica como os A f a s t a d o r e s d e F a r a b e u f podem ser necessrios prximos ao quadrante da direse. Os Farabeuf sempre devem estar disponveis em nmero par. As pinas de preenso auxiliam na direse por ajudar na manipulao das bordas da ferida e por serem capazes de promover divulso.

Por esta razo, devem ser colocadas prximas aos instrumentos de direse. A P i n a d e K o c h e r uma p i n a d e t r a o bastante utilizada para manipular e isolar aponeurose, auxiliando na sntese desta estrutura ao final do procedimento e, portanto, pode ser enquadrada como instrumento de preenso.

Contudo, ainda pode ser colocada no quadrante dos instrumentos especiais ou mesmo no quadrante de sntese alguns cirurgies optam por colocar esta pina em um espao de transio entre estes dois quadrantes. As o p e r a e s f u n d a m e n t a i s so tipos de operaes cirrgicas simples que, quando associadas, permitem a realizao de operaes complexas. Vrios foram os fatores histricos que contriburam para solidificar as bases modernas da cirurgia. Dentre eles, destacamos: Estudo e descrio da anatomia humana.

Aprimoramento da anestesia: nos primrdios alguns cirurgies consideravam a dor uma consequncia inevitvel do ato cirrgico, no havendo uma preocupao, por parte da maioria deles, em empregar tcnicas que aliviassem o sofrimento relacionado ao procedimento.

As primeiras tentativas de alvio da dor foram feitas com mtodos puramente fsicos como presso e gelo, bem como uso de hipnose, ingesto de lcool e preparados botnicos. Com a demonstrao da anestesia, em pelo anestesiologista William Thomas Green Morton, os processos cirrgicos tornaram-se mais viveis e menos traumticos.

Melhor conhecimento dos agentes causadores de infeces como, particularmente, as bactrias.

tecnica cirurgica goffi pdf download

A descoberta da penicilina tambm foi um grande marco no s para a cirurgia, mas para a medicina como um todo. Estudo da fisiopatologia e da resposta do organismo agresso cirrgica.

Esses princpios da Tcnica Operatria englobam todos os procedimentos realizados desde a inciso cutnea e da parede, o ato operatrio principal a finalidade da operao , at o fechamento da parede.

After the Veress needle puncture and CO2 insufflation into the abdominal cavity the trocars were inserted. In case of previous surgery the first trocar was inserted under direct vision of the abdominal cavity. In patients that were submitted only to gastrostomy the trocars were inserted as follows: a 10mm optical trocar at the umbilicus or beside it, a second 10mm trocar for manipulation into the left iliac fossa at the para-median line and a third 5mm trocar for manipulation into the right hypocondrium at the para-median line.

In patients that were submitted to surgical treatment for gastroesophageal reflux disease the trocars were inserted as follows: a 10mm optical trocar at the umbilicus or beside it, a second 5mm trocar into the epigastric region to retract the liver, a third 10mm trocar for manipulation into the left flank close to the costal margin, a fourth 10 mm trocar for traction of the stomach into the left pararectal region and a fifth 5mm trocar for manipulation into the right subcostal region at the hemiclavicular line.

Diaphragmatic curoraphy one or two "X" silk sutures and gastric fundoplication Brandalise-Aranha modified technique7 were the initial procedures to be performed followed by gastrostomy in cases submitted to those surgical procedures.

A purse-string suture was performed on the anterior abdominal wall 2. At the center of this suture the gastric mucosa was exposed by using the button control for cut and coagulation of the electrosurgical pencil.

The distal extremity of the probe was guided into the gastric cavity and the balloon was insufflated with 20ml of saline. The purse-string suture was pulled tight and tied narrowing the space between the gastrostomy tube and the gastric wall.

A second simple stitch 2. A Kelly forceps was inserted into the same gastrostomy port in the abdominal wall, then the ends of the simple suture were exteriorized, pulled along with the tube and tied up to the skin with a transfixation suture at the tube entry port thread exteriorization; figure 2 external anchoring; figure 3.

Finally, the gastrostomy feeding tube bolster was fixed to the skin with two 4. Figure 1 - Tri Funnel silicone gastrostomy tube. Figure 2 - Exteriorization of the thread with a Kelly forceps.

Partial sternotomy for management of iatrogenic brachiocephalic trunk injury during tracheotomy

Figure 3 - Gastrostomy tube placement. The ends of the simple suture that were exteriorized and fixed to the skin are depicted through the bolster external anchoring. During the immediate postoperative period patients fast for 8 hours with the gastrostomy tube opened and connected to a collecting bag. After this period patients were debilitated due to a gastrostomy lower than ml then they initially received through an enteral feeding tube a small volume infusion to avoid abdominal distension and diarrhea.

The patients were followed up for at least 6 months at the general surgery ambulatory. During the surgical procedure none of the patients needed blood transfusion.

After the tenth postoperative day this case developed necrotizing fasciitis around the tube and the balloon was extruded. Then the patient was submitted to an exploratory laparotomy in which was not observed signs of peritonitis or accumulation into the abdominal cavity.

152 Manual de técnica cirúrgica para a graduação.pdf

Subsequently the gastrostomy was reverted, and then the linear cutter stapler was used to resect the anterior gastric wall. For nutritional support was chosen classic jejunostomy.

After the second surgical procedure the case progressed satisfactorily, thus during 14 days the patient remained in the hospital to treat cellulites on the abdominal wall with antibiotic therapy.

The gastrostomy tube could not be reinserted and exploratory laparotomy was necessary to replace the gastrotomy tube and investigate the abdominal cavity in two of the cases due to the lateness to look for a hospital.

None of these cases resulted in postoperative or clinical complications.

Exploratory laparotomy was not performed in the third case because of the high surgical risk factor. The gastrostomy surgery was previously postponed due to precarious clinical conditions anemia, bronchopneumonia and subclavian vein thrombosis. Morbidity and mortality data of the laparoscopic procedures performed are depicted in table 1.

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It has associated risk of gastroesophageal reflux, aspiration of gastric contents to the trachea and pulmonary and airways infection, in addition to mechanical lesions to the esophageal mucosa. Moreover sometimes is difficult to infuse certain food and medications through the nasogastric feeding tube due to its small caliber2,8.

Gastrostomy when well indicated brings long term progress to clinical, nutritional and cognitive-motor status, to the easiness to infuse food and medications, to pubertal development and general infection and mortality rates2.

PEG is the technique of choice in our institution; however, when PEG was contraindicated or surgical treatment was necessary to correct gastroesophageal reflux laparoscopy was indicated. Those differences may be explained by the heterogeneous criteria to select patients and to define postoperative morbidity. Postgastrostomy complications more frequently described in the literature are: tube dislodgment, bowel obstruction, bleeding, peritonitis, viscera lesions, fistulas, and pulmonary aspiration of the enteral nutrition.

Gastrostomy may exacerbate the symptoms and cause bronchoaspiration of the gastric contents and the nutritional diet in patients with gastroesophageal reflux disease2,5,6,8. However, in our opinion these three cases should not be statistically included as operative morbidity as this complication was not surgical, it occurred because of inadequate care of the gastrostomy tube at home.

Patient developed cellulites and necrotizing fasciitis around the gastrostomy tube in the only complication directly associated to the procedure. It is supposed that enough leakage of gastric content caused inflammation and contamination of the subcutaneous cellular tissue. This fact associated to the traction of the balloon of the feeding tube against the abdominal wall contributed to the necrosis and posterior tube extrusion on the tenth postoperative day.

In spite of the evident seriousness, the abdominal cavity was not contaminated with gastric contents or nutritional diet because the stomach was anchored to the abdominal wall. The gastrostomy technique described in this manuscript depicted a very attractive way to fix the stomach to the abdominal.

At first as it is performed in the classic open Stamm-Senn technique surgeons tried internally to suture the stomach to the abdominal wall9, Nevertheless, soon it was observed the great technical difficulty to perform this suture as the laparoscopic clamps were almost parallel to the abdominal wall. Externally anchoring the stomach to the abdominal wall fixing it to the skin with a simple suture was the best option to overcome this technical difficulty.

Enteral diet administration was not appropriately done and the balloon was inadvertently deflated in all cases. This is a key point to the indication or not of a laparoscopic gastrostomy; 2 the guidelines on how to manage the gastrostomy tube at home were not clearly and efficiently informed.Evolution of the number of appendectomies by laparotomy between and Critical Reviews in Oncology In the operating room, the cervicotomy was extended, following the anterior margin of the right sternocleidomastoid, because the diagnostic hypothesis was iatrogenic injury to the right common carotid, and vascular surgery support was requested.

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