Questionário sobre a conduta dos cirurgiões pediátricos do Brasil no manejo das doenças da vesícula biliar em crianças
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2022-02-22
Autores
Tedesco, Bruna Aliotto Nalin [UNESP]
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Universidade Estadual Paulista (Unesp)
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Objetivo Descrever e analisar as condutas dos cirurgiões pediátricos brasileiros no manejo das doenças da vesícula biliar em crianças, através da aplicação de questionário. Métodos Foi elaborado um questionário sobre o manejo das doenças da vesícula biliar em crianças. Incluíram-se perguntas sobre colelitíase, colecistite aguda, pancreatite aguda biliar, pólipo vesicular, colecistectomia, exploração de vias biliares, análise dos produtos da colecistectomia e acompanhamento pós-operatório. Após validado, o questionário impresso foi aplicado no Curso Básico de Cirurgia Pediátrica do Research Institute Against Digestive Cancer (IRCAD) – Barretos, e a versão on-line SurveyMonkeyâ foi divulgada via e-mail e WhatsApp aos cirurgiões pediátricos cadastrados nas Sociedades Brasileira e Paulista de Cirurgia Pediátrica. As respostas por questão foram computadas e analisadas. Foi realizada análise comparativa das respostas por macrorregião do país e por função exercida (médico docente/assistente ou médico residente/estagiário). Considerou-se consenso entre os respondedores quando a taxa de resposta comum ao questionamento foi maior ou igual a 75%. Resultados 351 cirurgiões pediátricos responderam ao questionário. Sobre a colelitíase assintomática, a maioria opta pelo acompanhamento de bebês e crianças pequenas e pela realização de cirurgia em crianças, adolescentes e pacientes hematológicos. Na colelitíase sintomática, a maioria opta por cirurgia em todos os pacientes. Houve consenso na conduta antibioticoterapia e cirurgia após colecistite aguda. Houve maioria de respostas a favor da realização de colangiopancreatografia retrógrada endoscópica (CPRE) após pancreatite aguda biliar e consenso pela realização de colecistectomia na mesma patologia. A maioria dos cirurgiões pediátricos brasileiros utiliza antibiótico profilático na pancreatite aguda. Para investigação diagnóstica da pancreatite, houve consenso quanto a realização de ultrassonografia. Também observamos consenso quanto à laparoscopia ser a via cirúrgica preferencial para colecistectomia, quanto ao uso de antibiótico profilaxia pré-operatória e quanto ao envio da vesícula biliar para análise anatomopatológica. Não houve consenso quanto a realização de colangiografia intraoperatória, quanto ao manejo dos pólipos vesiculares, quanto ao melhor momento para alta hospitalar após colecistectomia, quanto ao tempo de acompanhamento pós-operatório e quanto a recomendação de dieta hipogordurosa. Observamos divergências de condutas de acordo com a região brasileira analisada, assim como houve divergência de opinião entre médicos docentes/assistentes e médicos residentes/estagiários. Conclusão Muitas condutas analisadas possuem falta de consenso entre os cirurgiões pediátricos brasileiros. Há também a prática de condutas que diferem das preconizadas na literatura atualmente em adultos, como o uso de antibiótico profilático na pancreatite aguda biliar e na profilaxia cirúrgica pré-operatória da colecistectomia eletiva. O Brasil, por ser um país de dimensões continentais, acentua essas divergências. Estudos clínicos randomizados com crianças são necessários para esclarecer os principais pontos de divergência.
Objective To describe and analyze the conduct of Brazilian pediatric surgeons in the management of gallbladder diseases in children, through the application of a questionnaire. Methods A questionnaire on the management of gallbladder diseases in children was developed. Questions about cholelithiasis, acute cholecystitis, acute biliary pancreatitis, gallbladder polyp, cholecystectomy, bile duct exploration, analysis of cholecystectomy products and postoperative follow-up were included. Once validated, the printed questionnaire was applied in the Basic Course of Pediatric Surgery of the Research Institute Against Digestive Cancer (IRCAD) – Barretos, and the online version SurveyMonkeyâ was disseminated by email and WhatsApp to pediatric surgeons registered in the Brazilian’s and São Paulo’s Pediatric Surgery Societies. The answers per question were computed and analyzed. A comparative analysis of the responses was performed by region of the country and by function performed (permanent staff/consultant or trainee/surgical resident). Consensus among respondents was considered when the common response rate to the question was greater than or equal to 75%. Results 351 pediatric surgeons responded to the questionnaire. Regarding asymptomatic cholelithiasis, most opt for monitoring infants and toddlers and performing surgery in children, adolescents and hematological patients. In symptomatic cholelithiasis, most opt for surgery in all patients. There was consensus on antibiotic therapy and surgery after acute cholecystitis. There was a majority of responses in favor of performing endoscopic retrograde cholangiopancreatography (ERCP) after acute biliary pancreatitis and consensus for performing cholecystectomy in the same pathology. Most Brazilian pediatric surgeons use prophylactic antibiotics in acute pancreatitis. For the diagnostic investigation of pancreatitis, there was a consensus regarding the performance of ultrasound. We also observed a consensus regarding laparoscopy being the preferred surgical option for cholecystectomy, regarding the use of preoperative antibiotic prophylaxis and regarding the sending of the gallbladder for anatomopathological analysis. There was no consensus regarding the performance of intraoperative cholangiography, regarding the management of gallbladder polyps, regarding the best time for hospital discharge after cholecystectomy, regarding the time of postoperative follow-up and regarding the recommendation of a low-fat diet. We observed differences in conduct according to the Brazilian region analyzed, as well as differences of opinion between permanent staff/consultant and trainee/surgical resident. Conclusion Many approaches analyzed have a lack of consensus among Brazilian pediatric surgeons. There is also the practice of conducts that differ from those recommended in the literature currently in adults, such as the use of prophylactic antibiotics in acute biliary pancreatitis and preoperative surgical prophylaxis of elective cholecystectomy. Brazil, being a country of continental dimensions, accentuates these divergences. Randomized clinical trials with children are needed to clarify the main points of disagreement.
Objective To describe and analyze the conduct of Brazilian pediatric surgeons in the management of gallbladder diseases in children, through the application of a questionnaire. Methods A questionnaire on the management of gallbladder diseases in children was developed. Questions about cholelithiasis, acute cholecystitis, acute biliary pancreatitis, gallbladder polyp, cholecystectomy, bile duct exploration, analysis of cholecystectomy products and postoperative follow-up were included. Once validated, the printed questionnaire was applied in the Basic Course of Pediatric Surgery of the Research Institute Against Digestive Cancer (IRCAD) – Barretos, and the online version SurveyMonkeyâ was disseminated by email and WhatsApp to pediatric surgeons registered in the Brazilian’s and São Paulo’s Pediatric Surgery Societies. The answers per question were computed and analyzed. A comparative analysis of the responses was performed by region of the country and by function performed (permanent staff/consultant or trainee/surgical resident). Consensus among respondents was considered when the common response rate to the question was greater than or equal to 75%. Results 351 pediatric surgeons responded to the questionnaire. Regarding asymptomatic cholelithiasis, most opt for monitoring infants and toddlers and performing surgery in children, adolescents and hematological patients. In symptomatic cholelithiasis, most opt for surgery in all patients. There was consensus on antibiotic therapy and surgery after acute cholecystitis. There was a majority of responses in favor of performing endoscopic retrograde cholangiopancreatography (ERCP) after acute biliary pancreatitis and consensus for performing cholecystectomy in the same pathology. Most Brazilian pediatric surgeons use prophylactic antibiotics in acute pancreatitis. For the diagnostic investigation of pancreatitis, there was a consensus regarding the performance of ultrasound. We also observed a consensus regarding laparoscopy being the preferred surgical option for cholecystectomy, regarding the use of preoperative antibiotic prophylaxis and regarding the sending of the gallbladder for anatomopathological analysis. There was no consensus regarding the performance of intraoperative cholangiography, regarding the management of gallbladder polyps, regarding the best time for hospital discharge after cholecystectomy, regarding the time of postoperative follow-up and regarding the recommendation of a low-fat diet. We observed differences in conduct according to the Brazilian region analyzed, as well as differences of opinion between permanent staff/consultant and trainee/surgical resident. Conclusion Many approaches analyzed have a lack of consensus among Brazilian pediatric surgeons. There is also the practice of conducts that differ from those recommended in the literature currently in adults, such as the use of prophylactic antibiotics in acute biliary pancreatitis and preoperative surgical prophylaxis of elective cholecystectomy. Brazil, being a country of continental dimensions, accentuates these divergences. Randomized clinical trials with children are needed to clarify the main points of disagreement.
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Vesícula biliar, Crianças, Colelitíase