CELSO DE OLIVEIRA BERNINI
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- Laparoscopic Surgery in Abdominal Trauma: Retrospective Study in a Trauma Center in Brazil(2017) MENEGOZZO, Carlos Augusto M.; DAMOUS, Sergio H. B.; ALVES, Pedro H. F.; BERNINI, Celso O.; UTIYAMA, Edivaldo
conferenceObject Prevention of Fascial Dehiscence with Prophylactic Onlay Mesh in Emergency Laparotomy: A Randomized Trial(2019) LIMA, Helber V.; RASSLAN, Roberto; DAMOUS, Sergio H.; TIBERIO, Lima M.; BERNINI, Celso de Oliveira; MONTERO, Edna F.; UTIYAMA, Edivaldo M.bookPart Esplenectomia(2012) DAMOUS, Sérgio; LEAL, Renato; BERNINI, Celso de Oliveira; UTIYAMA, Edivaldo Massazo- Prevention of Fascial Dehiscence with Onlay Prophylactic Mesh in Emergency Laparotomy: A Randomized Clinical Trial(2020) LIMA, Helber V. G.; RASSLAN, Roberto; NOVO, Fernando C. F.; LIMA, Tiberio M. A.; DAMOUS, Sergio H. B.; BERNINI, Celso O.; MONTERO, Edna F. S.; UTIYAMA, Edivaldo M.BACKGROUND: Fascial dehiscence (FD) occurs in up to 14.9% of high-risk patients undergoing emergency laparotomy. Although prophylactic mesh can prevent FD, its use in emergency operations remains controversial. STUDY DESIGN: A prospective randomized clinical trial was conducted at the Hospital das Clinicas from Faculdade de Medicina da Universidade de Sao Paulo in Brazil. It was performed among high-risk patients, defined according to Rotterdam risk model, undergoing midline emergency laparotomy. The patients were randomized into the suture group (SG), with slowly absorbable running sutures placed with a 36-mm-long needle at a suture-to-wound length ratio of 4:1, and the prophylactic mesh group (PMG), with fascial closure as in the SG but reinforced with onlay polypropylene mesh. The primary end point was incidence of FD at 30 days post operation. RESULTS: We analyzed 115 patients; 52 and 63 were allocated to the SG and PMG, respectively. In all, 77.4% of the cases were for colorectal resection. FD occurred in 7 (13.5%) patients in the SG and none in the PMG (p = 0.003). There was no difference between the groups in number of patients with surgical site occurrence (SSO) or SSO requiring procedural intervention. However, some specific SSOs had higher incidences in the mesh group: surgical site infection (20.6% versus 7.7%; p = 0.05), seroma (19.0% versus 5.8%; p = 0.03), and nonhealing incisional wound (23.8% versus 5.8%; p = 0.008). Of SSOs in the PMG and SG, 92.3% and 73.3%, respectively, resolved spontaneously or with bedside interventions. CONCLUSIONS: Prophylactic onlay mesh reinforcement in emergency laparotomy is safe and prevents FD. Surgical site infection, seroma, and nonhealing incisional wound were more common in the mesh group, but associated with low morbidity within 30 days post operation.
- Three-stage management of complex pancreatic trauma with gastroduodenopancreatectomy: A case report(2018) DAMOUS, Sergio Henrique Bastos; DARCE, George Felipe Bezerra; LEAL, Renato Silveira; COSTA JR., Adilson Rodrigues; FERREIRA, Pedro Henrique Alves; BERNINI, Celso de Oliveira; UTIYAMA, Edivaldo MassazoINTRODUCTION: Severe injuries of the pancreatic head and duodenum in haemodynamically unstable patients are complex management. The purpose of this study is to report a case of complex pancreatic trauma induced by gunshot and managed with surgical approaches at three different times. PRESENTATION OF CASE: Exploratory laparotomy was indicated after initial emergency room care, with findings of cloudy blood-tinged fluid and blood clots on the mesentery near the hepatic angle, on the region of the 2nd portion of the duodenum and at the pancreatic head. Gastroduodenopancreatectomy was performed with right hemicolectomy and the peritoneal cavity was temporarily closed by a vacuum peritoneostomy. Surgical reopening occurred on the fifth postoperative day, and the patient was subjected to single-loop reconstruction of the intestinal transit with telescoping pancreaticojejunal anastomosis, biliodigestive anastomosis with termino-lateral hepaticojejunal anastomosis with a Kehr drain and gastroenteroanastomosis in 2 planes. The terminal ileostomy was maintained. After 2 days, the patient was subjected to abdominal wall closure without complications, which required relaxing Gibson incisions and wound closure with polypropylene mesh placement in a pre-aponeurotic position closed with multiple stitches. RESULTS: The patient was discharged on the 40th post-trauma day without drains, with a functioning ileostomy and with a scheduled reconstruction of intestinal transit. CONCLUSION: In the presence of multiple associated injuries, hemodynamic instability and the need for an extensive surgical procedure such as duodenopancreatectomy, damage control surgery performed in stages as reported here enables the clinical stabilization of the patient for definitive treatment, achieving better survival results. (C) 2018 The Authors.