SERGIO HENRIQUE BASTOS DAMOUS
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
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- Which Model is Better to Teach How to Perform Tube Thoracostomy: Synthetic, Cadaver, or Animal?(2022) MEYER-PFLUG, Adriano Ribeiro; RASSLAN, Roberto; USSAMI, Edson Yassushi; SILVA, Francisco de Salles Collet e; OTOCH, Jose Pinhata; DAMOUS, Sergio Henrique Bastos; MONTERO, Edna Frasson de Souza; MENOGOZZO, Carlos Augusto Metidieri; VIEIRA, Joaquim Edson; UTIYAMA, Edivaldo MassazoIntroduction: The lack of standardized skill training reported by medical students in performing tube thoracostomies may be associated with higher complications. The ideal training model is yet to be determined. This study sought to evaluate three different models. Methods: Between 2015 and 2017, 204 last-year medical students of Universidade de Sao Paulo with no prior training in tube thoracostomy were randomized into three groups: cadaver, pig, and synthetic models. All groups performed 1-d tube thoracostomy hands-on training and a 40-min theoretical class. The knowledge acquisition was measured by a comparison between a theoretical test before and 3 wk after the class, and the skills improvement was evaluated by a comparison between the skills test on the same day of the hands-on training and another after 24 wk (the retention skill test). A questionnaire was submitted to evaluate their satisfaction rate and self-reported confidence, as per a Likert scale. Results: The theoretical post-test score was higher compared to the pretest score in all groups (P < 0.001). The retention skills test in the cadaver and synthetic groups decreased compared to the skills test (P = 0.01 and P = 0.007, respectively). There was no difference between the groups either in the theoretical test or in the skills test. Student satisfaction was higher in the cadaver and pig groups. The confidence perception increased in all groups after the training. Conclusions: The models used for tube thoracostomy training appear to have a similar impact on skills retention, knowledge acquisition, and confidence. Although the satisfaction rate is lower for the synthetic model, it has no biological risk or ethical issues and is more feasible. (C) 2022 Published by Elsevier Inc.
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.- Outcomes after emergency abdominal surgery in COVID-19 patients at a referral center in Brazil(2021) RASSLAN, Roberto; SANTOS, Jones Pessoa dos; MENEGOZZO, Carlos Augusto Metidieri; PEZZANO, Alvaro Vicente Alvarez; LUNARDELI, Henrique Simonsen; MIRANDA, Jocielle dos Santos; UTIYAMA, Edivaldo Massazo; DAMOUS, Sergio Henrique BastosPurpose COVID-19 is associated with high morbidity and mortality in patients undergoing surgery. Contrary to elective procedures, emergency operations should not be postponed. We aim to evaluate the profile and outcomes of COVID-19 patients who underwent emergency abdominal surgery. Methods We performed a retrospective analysis of perioperative data of COVID-19 patients undergoing emergency surgery from April 2020 to August 2020. Results Eighty-two patients were evaluated due to abdominal complaints, yielding 22 emergency surgeries. The mean APACHE II and SAPS were 18.7 and 68, respectively. Six patients had a PaO2/FiO(2) lower than 200 and more than 50% of parenchymal compromise on chest tomography. The most common indications for emergency surgery were hernias (6; 27.2%). The median length of stay was 30 days, and only two patients required reoperation. Postoperatively, 10 (43.3%) patients needed mechanical ventilation for a mean of 6 days. The overall mortality rate was 31.8%. Conclusion Both postoperative morbidity and mortality are high in COVID-19 patients with respiratory compromise and abdominal emergencies.
- Pneumomediastinum complicating COVID-19: a case series(2021) DAMOUS, Sergio Henrique Bastos; SANTOS JUNIOR, Jones Pessoa dos; PEZZANO, alvaro Vicente Alvarez; CHAMS, Mohamad Abdul Majid; HARITOV, Nathaly; WAKSMAN, Ricardo; LIMA, Helber Vidal Gadelha; MIRANDA, Jocielle dos Santos; RASSLAN, Roberto; UTIYAMA, Edivaldo MassazoBackground Pneumomediastinum is a rare complication of COVID-19 pneumonia, which may or may not be associated with invasive ventilatory support. Therefore, the report and findings associated with its evolution can be of great contribution in the management of this unknown disease. Case presentation Here, we present a series of four patients with severe pneumomediastinum requiring intensive care unit. These patients developed pneumomediastinum before or during orotracheal intubation (OTI) or without OTI. The four patients were three men and one woman with a mean age of 60.5 years (48-74 years). No patients had a known history of lung disease or traumatic events, except for one patient who had a history of smoking, but who was without parenchymal disease. All intubations were performed without complications. No cases of pneumomediastinum occurred after tracheostomy, and none of the patients had tomographic or bronchoscopic evidence of tracheal injury. Although the pneumomediastinum observed in our cases was apparently not related to a violation of the aerodigestive track, this complication was associated with a worse prognosis. Conclusion Pneumomediastinum is a rare complication of COVID-19 pneumonia, and the most likely etiopathogenesis is severe pulmonary involvement, which may or may not be associated with invasive ventilatory support. Future studies with a greater number of cases should elucidate the relationship of pneumomediastinum to a probable prognostic factor.
bookPart Aspectos técnicos na cirurgia de emergência(2022) UTIYAMA, Edivaldo M.; DAMOUS, Sérgio Henrique Bastos; RASSLAN, Roberto; MENEGOZZO, Carlos Augusto Metidieri- Could trauma laparoscopy be the standard of care for hemodynamically stable patients? A retrospective analysis of 165 cases(2023) MENEGOZZO, Carlos Augusto Metidieri; DAMOUS, Sergio Henrique Bastos; SABIONI, Guilherme Rissato; ALVES, Pedro Henrique Ferreira; RASSLAN, Roberto; SILVA, Francisco de Salles Collet e; UTIYAMA, Edivaldo MassazoBackgroundTrauma laparoscopy may provide a less invasive alternative to laparotomy by providing accurate diagnosis and minimally invasive management of selected trauma patients. The risk of missing injuries during the laparoscopic evaluation still refrains surgeons from using this approach. Our aim was to evaluate feasibility and safety of trauma laparoscopy in selected patients.MethodsWe performed a retrospective review of hemodynamically trauma patients who underwent laparoscopic management in a tertiary center in Brazil due to abdominal trauma. Patients were identified by searching through the institutional database. We collected demographic and clinical data, focusing on avoidance of exploratory laparotomy, and missed injury rate, morbidity, and length of stay. Categorical data were analyzed using Chi-square, while numerical comparisons were performed using Mann-Whitney and Kruskal-Wallis test.ResultsWe evaluated 165 cases, of which 9.7% needed conversion to an exploratory laparotomy. One-hundred and twenty-one patients (73%) had at least one intrabdominal injury. Two missed injuries to retroperitoneal organs were identified (1.2%), of which only one was clinically relevant. Three patients died (1.8%), one of which was due to complications from an intestinal injury after conversion. No deaths were related to the laparoscopic approach.ConclusionIn selected hemodynamically stable trauma patients, the laparoscopic approach is feasible and safe, and reduces the need for exploratory laparotomy and its associated complications.
- Splenic Abscesses in Endocarditis: A Rare Disease with High Mortality. The Experience of a Heart Institute in Brazil(2022) RASSLAN, Roberto; ALVES, Vinicios; DAMOUS, Sergio Henrique Bastos; SANTIS, Antonio de; TARASOUTCHI, Flavio; MENEGOZZO, Calos Augusto Metidieri; AKAMINE, Masahiko; RASSLAN, Samir; UTIYAMA, Edivaldo MassazoIntroduction Splenic abscess secondary to endocarditis is a rare complication with high mortality. The treatment modality, splenectomy versus percutaneous drainage, and the best time, before or after valve replacement, are controversial. In the literature, there are only a few small case series about the subject. The objective of this study is to analyze the experience of a referral center in treating such condition. Methods Patients with splenic abscesses due to endocarditis from 2006 to 2020 were retrospectively analyzed. Results Thirteen patients (mean age 46 years old, 69% male) were identified. Eight patients (62%) had at least 2 comorbidities and 5 (38%) had a history of cardiac surgery. The diagnosis was incidental in 6 (46%). The mean time of abscess diagnosis after endocarditis definition was 14 days. Six patients (46%) had at least two organ dysfunctions. The median APACHE II score was 12 overall, and 24.5 in patients who died. Six patients (46%) had a valve replacement, and in two the abscess was diagnosed postoperatively. Of the other four patients, splenectomy was performed before the cardiac operation in three and at the same time in one. Splenectomy was performed immediately in 9 (69%) patients while three patients had percutaneous drainage (23%), one of which underwent splenectomy due to drainage failure. Exclusive antibiotic treatment was performed on only one patient. The median length of hospitalization was 24 days and mortality was 46%. Conclusion Splenic abscess due to endocarditis is a life-threatening condition with controversial treatment that results in a prolonged length of stay and high mortality.
- 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.