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Central de agendamento: (19) 3886.2444 | 3876.3435 | 3836.3839 | 3836.3894 | Facebook

APENDICITE

Apendicite é a principal causa de cirurgia abdominal de emergência. A incidência durante a vida varia de 7% a 14%. Os homens correm risco mais alto.

A doença se instala quando fragmentos de fezes obstruem a luz do apêndice junto ao ceco, provocando distensão, crescimento de bactérias e aumento da pressão interna, que pode levar à gangrena e à perfuração.

O diagnóstico se baseia na história de dores que se iniciam no centro do abdômen e migram para a fossa ilíaca direita, na parte inferior, acompanhadas de náuseas, vômitos, febre baixa e aumento do número de glóbulos brancos no hemograma. No entanto, menos de 50% dos doentes exibem todas essas características.

O ultrassom e a tomografia computadorizada diminuem o risco de diagnósticos equivocados. A tomografia é mais sensível e específica do que o ultrassom, mas custa mais caro e envolve o emprego de radiações, que inviabilizam seu uso na gravidez. Quando as imagens do ultrassom forem duvidosas, a ressonância magnética pode ser empregada.

A retirada do apêndice (apendicectomia) tem sido o tratamento de escolha desde a metade do século 19. Na década de 1990, a laparoscopia tornou-se a técnica preferida por muitos cirurgiões.

A cirurgia laparoscópica ganhou popularidade pelo fato de não abrir a parede abdominal, reduzir o risco de infecções e diminuir a intensidade da dor no pós-operatório. Amortizado os gastos com o aparelho, os custos são mais baixos do que os da cirurgia convencional.

Intervenções laparoscópicas são contraindicadas em pessoas com cirurgias anteriores, apendicite avançada ou doenças pulmonares e cardíacas que impossibilitem a distensão do abdômen com gás, necessária para a visualização adequada dos órgãos.

A máxima tradicional “diagnóstico feito, paciente operado” tem sido questionada nos últimos anos, em diversos centros europeus.

Em vários hospitais, surgiram estudos para testar a hipótese de que a administração de antibióticos intravenosos por um ou dois dias, seguidos da via oral por mais sete dias, seria alternativa razoável à cirurgia.

Neles, de fato, a maioria dos pacientes conseguiu evitar a operação. Os números daqueles em que a antibioticoterapia foi ineficaz, variaram de zero a 53%, conforme o estudo. O índice de perfurações que exigiram cirurgias de emergência não foi mais alto.

Entretanto, no período de quatro a sete meses de acompanhamento daqueles em que os antibióticos deram bons resultados, 10% a 37% tiveram recaídas que levaram à apendicectomia.

Os defensores da antibioticoterapia argumentam que o apêndice seria uma estrutura fisiologicamente ativa, que ofereceria local seguro para colônias de bactérias importantes para repopularizar a flora intestinal depois de quadros de diarreia.

Pelos dados disponíveis, não é possível identificar quem se beneficiaria dessa estratégia “antibióticos antes”.

A World Society of Emergency Surgery afirma: “Como esse procedimento conservador apresenta altos índices de recorrência, os resultados são inferiores aos da apendicectomia tradicional”.

Fonte: http://drauziovarella.com.br