OBJECTIVE: to present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis. METHODS: we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years); 11 patients were male, and four were female. RESULTS: forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision. CONCLUSION: the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.

La obesidad es una enfermedad crónica multifactorial. El paciente puede presentar varias condiciones clínicas asociadas a ella. El cuadro clínico es complejo, lo que puede dificultar el uso de tratamientos y métodos convencionales. La cirugía bariátrica es un tratamiento eficaz a largo plazo para esta afección. Basado en una revisión de la literatura, el artículo tiene como objetivo discutir la importancia del seguimiento psicológico y nutricional post-bariátrico. La pregunta fundamental que subyace a este estudio es: ¿cómo pueden las estrategias típicas en el postoperatorio contribuir a que el individuo se someta a cirugía le dé mayor importancia a su dieta y salud mental? La estrategia de tratamiento más efectiva ha sido la cirugía bariátrica, sin embargo, la evaluación multidisciplinaria que puntúa el estado biológico, social y psicológico del paciente es fundamental, ya que los cambios psicopatológicos son comunes a los individuos obesos. Aunque la cirugía bariátrica contribuye a la mejora de la calidad de vida de los pacientes, es necesario prestar mayor atención al tratamiento postoperatorio. Se debe alentar a estos individuos a continuar con el seguimiento nutricional y psicológico en el postoperatorio, de modo que sea posible prevenir posibles complicaciones a medio y largo plazo.

No abstract

A obesidade é uma doença crônica multifatorial. O paciente pode apresentar diversas condições clínicas associadas a ela. O quadro clínico é complexo, o que pode dificultar o emprego de tratamentos e métodos convencionais. A cirurgia bariátrica é um efetivo tratamento a longo prazo para esta condição. A partir de uma revisão da literatura, o artigo tem como objetivo discutir a importância do acompanhamento psicológico e nutricional pós-bariátrica. A pergunta norteadora que alicerça este estudo é: de que forma as estratégias típicas no pós-operatório podem contribuir para que o indivíduo submetido à cirurgia dê maior importância a sua dieta e a sua saúde mental? A estratégia de tratamento mais eficaz tem sido a realização da cirurgia bariátrica, porém, a avaliação multidisciplinar que pontua o estado do paciente de ordem biológica, social e psicológica é fundamental, uma vez que as alterações psicopatológicas são comuns aos indivíduos obesos. Apesar da cirurgia bariátrica contribuir com a melhora na qualidade de vida dos pacientes, é preciso que haja uma atenção maior ao tratamento pós-operatório. Esses indivíduos devem ser estimulados a continuar com o acompanhamento nutricional e psicológico no pós-operatório, para que, dessa forma, seja possível prevenir possíveis complicações em médio e longo prazo.

Obesity is a multifactorial chronic disease. The patient may present several clinical conditions associated with it. The clinical picture is complex, which can hinder the use of conventional treatments and methods. Bariatric surgery is an effective long-term treatment for this condition. Based on a literature review, the article aims to discuss the importance of post-bariatric psychological and nutritional follow-up. The fundamental question that underpits this study is: how can typical strategies in the postoperative period contribute to the individual undergoing surgery to give greater importance to his diet and mental health? The most effective treatment strategy has been bariatric surgery, however, the multidisciplinary evaluation that scores the patient’s biological, social and psychological status is fundamental, since psychopathological changes are common to obese individuals. Although bariatric surgery contributes to the improvement in the quality of life of patients, there needs to be greater attention to postoperative treatment. These individuals should be encouraged to continue with nutritional and psychological follow-up in the postoperative period, so that it is possible to prevent possible complications in the medium and long term.