Resumo Objetivo Construir e validar checklist cirúrgico para segurança do paciente e prevenção de infecção de sítio cirúrgico. Métodos Pesquisa quantitativa realizada para validar instrumento criado e utilizado em cirurgia segura. O instrumento foi validado por sete peritos. Para concordância entre os juízes utilizou-se o coeficiente de concordância de Kendall e para verificar se a opinião dos juízes diferiu significativamente, o teste de Cochran. O instrumento é validado se houver concordância entre os juízes e a clareza for significante. Resultados Na primeira avaliação do instrumento, obteve-se Kendall de 0,230 para pertinência e 0,390 para clareza, o que implicou em reformulação do checklist. Após a reformulação, obteve-se concordância absoluta para pertinência e não houve diferença significativa para clareza. Com o instrumento validado, foi criado um sistema informatizado para inserção dos dados coletados. Conclusão O instrumento criado foi validado e pode auxiliar na segurança do paciente e prevenção de infecção de sítio cirúrgico.

Abstract Objective To design and validate a surgical checklist to improve patient safety and prevent surgical site infection. Methods This quantitative study was carried out to validate an instrument created and used for surgical safety. Seven experts validated the instrument. For agreement among experts, was used Kendall’s concordance coefficient; if their opinions differed significantly, the Cochran’s test was adopted. An instrument is validated when concordance among experts is achieved and its clarity is significant. Results In the first assessment of the instrument, Kendall’s concordance coefficients were 0.230 in terms of pertinence and 0.390 for clarity. These results cauded a reformulation in the checklist. After reformulation, an absolute concordance was achieved for pertinence and no significant difference was seen in terms of clarity. After instrument validation, was created an information system to input data collected. Conclusion The instrument was validated. It can help improve patient safety and prevent surgical site infection.

Abstract Objective To design and validate a surgical checklist to improve patient safety and prevent surgical site infection. Methods This quantitative study was carried out to validate an instrument created and used for surgical safety. Seven experts validated the instrument. For agreement among experts, was used Kendall’s concordance coefficient; if their opinions differed significantly, the Cochran’s test was adopted. An instrument is validated when concordance among experts is achieved and its clarity is significant. Results In the first assessment of the instrument, Kendall’s concordance coefficients were 0.230 in terms of pertinence and 0.390 for clarity. These results cauded a reformulation in the checklist. After reformulation, an absolute concordance was achieved for pertinence and no significant difference was seen in terms of clarity. After instrument validation, was created an information system to input data collected. Conclusion The instrument was validated. It can help improve patient safety and prevent surgical site infection.

Resumo Objetivo Construir e validar checklist cirúrgico para segurança do paciente e prevenção de infecção de sítio cirúrgico. Métodos Pesquisa quantitativa realizada para validar instrumento criado e utilizado em cirurgia segura. O instrumento foi validado por sete peritos. Para concordância entre os juízes utilizou-se o coeficiente de concordância de Kendall e para verificar se a opinião dos juízes diferiu significativamente, o teste de Cochran. O instrumento é validado se houver concordância entre os juízes e a clareza for significante. Resultados Na primeira avaliação do instrumento, obteve-se Kendall de 0,230 para pertinência e 0,390 para clareza, o que implicou em reformulação do checklist. Após a reformulação, obteve-se concordância absoluta para pertinência e não houve diferença significativa para clareza. Com o instrumento validado, foi criado um sistema informatizado para inserção dos dados coletados. Conclusão O instrumento criado foi validado e pode auxiliar na segurança do paciente e prevenção de infecção de sítio cirúrgico.

INTRODUCTION: Correction of gastroschisis can be accomplished by primary or staged closure. There is, however, no consensus regarding the best approach or criteria to favor one method over the other has been established. OBJECTIVE: To compare the outcome of primary and staged closure in newborns with gastroschisis using intravesical pressure (IVP) as the decision criterion. PATIENTS & METHODS: We prospectively analyzed 45 newborns with gastroschisis. An IVP with a threshold of 20 cm H2O was used to indicate primary or staged closure, and the outcomes between the two methods were compared. RESULTS AND DISCUSSION: Newborns in whom primary closure was feasible were born at a lower gestational age. There was no significant difference in the frequency of complications, time to begin oral feeding, length of parenteral nutrition or length of hospital stay. Compared with previous reports, our data showed higher rates of prenatal diagnosis and cesarean delivery, a lower average birth weight, a higher rate of small gestational age babies and a more frequent association with intestinal atresia. Conversely, our data showed a lower rate of postoperative necrotizing enterocolitis and a lower average length of hospital stay. CONCLUSION: No significant difference was observed in the outcome of newborns who underwent primary closure or staged closure of gastroschisis when using an IVP below 20 cm H2O as the criterion for primary closure.

OBJETIVO: Relatar a experiência inicial do Centro Infantil Boldrini com a esplenectomia laparoscópica (EL) em crianças e adultos jovens. MÉTODO: Foram revisados os prontuários de 40 pacientes (mediana da idade de 6,6 anos; 1 a 22,8) submetidos à EL entre Julho de 2000 e Maio de 2002. As principais indicações de acordo com a doença de base foram: doença falciforme (DF) em 20 pacientes (50%), esferocitose hereditária em 10 (25 %), púrpura trombocitopência idiopática em oito (20 %), doença de Hodgkin em um e anemia hemolítica a esclarecer em um. RESULTADOS: Trinta e oito esplenectomias foram completadas por via laparoscópica (duas conversões) e em doze foi realizada adicionalmente a colecistectomia. A mediana do tempo operatório foi de 127,5 minutos (90-240 min) e sete (17,5 %) baços acessórios foram encontrados. Sangramento intra-operatório foi significativo apenas nas duas conversões, mas não houve necessidade de transfusões. A mediana do peso dos baços foi de 250 g (106-1000; n=36). Complicações pós-operatórias ocorreram em sete (17,5 %) pacientes e, nos portadores de DF, 35% desenvolveram síndrome torácica aguda. A mediana da permanência hospitalar pós-operatória foi de dois dias (2 - 14). O seguimento variou de 23 dias a dois anos (mediana de 11 meses). CONCLUSÕES: A EL pode ser realizada de modo seguro mesmo em baços de grande tamanho e é opção atrativa que pode substituir o procedimento aberto. Em pacientes com DF, a taxa de complicações permanece alta, sugerindo mecanismos outros que vão além da escolha da via de acesso cirúrgica.

BACKGROUND: Laparoscopic splenectomy (LS) is becoming the procedure of choice in the treatment of children with hematological disorders. However, concerns remains regarding conversion rates, dissection and extraction of the spleen. The authors analyze their early experience at Boldrini's Children Cancer Center-Brazil in 40 LS performed in children and young adults. METHODS: Retrospective review of the charts of 40 patients (median age of 6.6 years; range 1 to 22.8) who underwent LS, between July/ 2000 and May/ 2002. The main indications were sickle cell disease (SCD) (20 - 50 %), hereditary spherocytosis (10 - 25 %) and idiopathic thrombocytopenic purpura (8 - 20 %). RESULTS: All but two splenectomies were performed exclusively by laparoscopy, and 12 patients also underwent a concomitant cholecystectomy. The mean operating time was 127.5 minutes (90-240m). In seven patients (17.5%) accessory spleens were found and removed. Intraoperative bleeding was significant only in the two cases that required conversion to an open procedure, although no transfusion was needed. The median weight of the spleen was 250 g (range 106g-1000g; n=36). Complications were observed in seven patients (17.5 %) with SCD that developed acute chest syndrome. There were no deaths in this series and the median postoperative stay at the hospital was two days (2 - 14). Follow-up ranged from 23 days to two years. CONCLUSIONS: On the basis of our experience, LS is a safe procedure, even to treat large spleens and became an attractive option that might replace the open procedure. In SCD patients, the rate of complications remains high, suggesting mechanisms other than the scope of the choice of surgical approach.