LUCAS SOUTO NACIF
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
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- Abdominal hernias in cirrhotic patients: Surgery or conservative treatment? Results of a prospective cohort study in a high volume center: Cohort study(2020) PINHEIRO, Rafael Soares; ANDRAUS, Wellington; WAISBERG, Daniel Reis; NACIF, Lucas Souto; DUCATTI, Liliana; ROCHA-SANTOS, Vinicius; DINIZ, Marcio A.; ARANTES, Rubens Macedo; LERUT, Jan; D'ALBUQUERQUE, Luiz Augusto CarneiroBackground: Surgical treatment of abdominal hernias in cirrhotics is often delayed due to the higher morbidity and mortality associated with the underlying liver disease. Some patients are followed conservatively and only operated on when complications occur (""wait and see"" approach). The aim of this study is to compare outcomes of cirrhotic patients undergoing conservative non-operative care or elective hernia repair. Methods: A prospective observational study including 246 cirrhotic patients with abdominal hernia was carried out. Patients were given the option to select their treatment: elective hernia repair or conservative non-operative care. Demographics, characteristics of underlying liver disease, type of hernia, complications and mortality were analyzed. During follow-up of patients who opted for the ""wait and see"" approach, emergency hernia repair was performed in case of hernia complications. Results: Elective hernia repair was performed in 57 patients and 189 patients were kept in conservative care, of which 43 (22.7%) developed complications that required emergency hernia repair. Elective surgery provided better five-years survival than conservative care (80% vs. 62%; p = 0.012). Multivariate analysis identified multiples hernias [Hazards Ratio (HR):6.7, p < 0.001] and clinical follow-up group (HR 3.62, p = 0.005) as risk factors for mortality. Among patients undergoing surgical treatment, multivariate analysis revealed MELD> 11 (HR 7.8; p = 0.011) and emergency hernia repair (HR 5.35; p = 0.005) as independent risk factors for 30-day mortality. Conclusions: Elective hernia repair offers an acceptable morbidity and ensures longer survival. ""Wait and see"" approach jeopardizes cirrhotic patients and should be avoided, given the higher incidence of emergency surgery due to hernia complications.
- Techniques for Closing the Abdominal Wall in Intestinal and Multivisceral Transplantation: A Systematic Review(2022) FORTUNATO, Allana C.; PINHEIRO, Rafael S.; MATSUMOTO, Cal S.; ARANTES, Rubens M.; ROCHA-SANTOS, Vinicius; NACIF, Lucas S.; WAISBERG, Daniel R.; DUCATTI, Liliana; MARTINO, Rodrigo B.; CARNEIRO-D'ALBUQUERQUE, Luiz; ANDRAUS, WellingtonShort bowel syndrome is the most common etiology of intestinal failure, resulting from either resections of different intestinal segments or a congenital condition. Due to the absence or considerable reduction of intes-tinal loops in the abdominal cavity, patients with short bowel syndrome present with atrophy and muscle re-traction of the abdominal wall, which leads to loss of abdominal domain and elasticity. This complication is an aggravating factor of intestinal transplantation since it can prevent the primary closure of the abdominal wall. A vast array of surgical techniques to overcome the challenges of the complexity of the abdominal wall have been described in the literature. The aim of our study was to review the modalities of abdominal wall closure in intestinal/multivisceral transplantation. Our study consisted of a systematic review following the methodological instructions described in the PRISMA guidelines. Duplicate studies and studies that did not meet the criteria for the systematic review were exclud-ed, especially those without relevance and an explicit relationship with the investigated theme. After this step, 63 articles were included in our study. The results obtained with these techniques have been encouraging, but a high incidence of wound complica-tions in some reports has raised concerns. There is no consensus among transplantation centers regarding which technique would be ideal and with high-er success rates and lower rates of complications.
- Multivisceral transplantation of pelvic organs in rats(2023) GALVAO, Flavio Henrique Ferreira; ARAKI, Jun; FONSECA, Ana Bruna Salles; CRUZ JR., Ruy Jorge; LANCHOTTE, Cinthia; WAISBERG, Daniel Reis; CHAIB, Eleazar; NACIF, Lucas Souto; TRALDI, Maria Clara de Camargo; MELLO, Estrella Bianco de; ANDRAUS, Wellington; CARNEIRO-D'ALBUQUERQUE, LuizBackground: Multivisceral transplantation of pelvic organs would be a potential treatment for severe pelvic floor dysfunction with fecal and urinary incontinence, extensive perineal trauma, or congenital disorders. Here, we describe the microsurgical technique of multivisceral transplantation of pelvic organs, including the pelvic floor, in rats. Donor operation: We performed a perineal (including the genitalia, anus, muscles, and ligaments) and abdominal incision. The dissection progressed near the pelvic ring, dividing ligaments, muscles, external iliac vessels, and pudendal nerves, allowing pelvic floor mobilization. The aorta and vena cava were isolated distally, preserving the internal iliac and gonadal vessels. The graft containing the skin, muscles, ligaments, bladder, ureter, rectum, anus and vagina, uterus and ovarian (female), or penile, testis and its ducts (male) was removed en bloc, flushed, and cold-stored. Recipient operation: The infrarenal aorta and vena cava were isolated and donor/ recipient aorta-aorta and cava-cava end-to-side microanastomoses were performed. After pelvic floor and viscera removal, we performed microanastomoses between the donor and the recipient ureter, and the rectum and pudenda nerves. The pelvic floor was repositioned in its original position (orthotopic model) or the abdominal wall (heterotopic model). We sacrificed the animals 2 h after surgery. Results: We performed seven orthotopic and four heterotopic transplantations. One animal from the orthotopic model and one from the heterotopic model died because of technical failure. Six orthotopic and three heterotopic recipients survived up to 2 h after transplantation. Conclusion: The microsurgical technique for pelvic floor transplantation in rats is feasible, achieving an early survival rate of 81.82%.