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Alvoradasfeb132012
- 1. CIRURGIA HEPATOBILEOPANCREÁTICA: ONDEESTAMOS? PARA ONDE VAMOS? Paolo R. Salvalaggio Roberto F. Meirelles Jr. São Paulo, 13 de fevereiro de 2012
- 2. AGENDA Definir especialidade Necessidade e vantagens da especialidade para a rede credenciada Equipe Problemas médicos a serem tratados Fluxo de encaminhamento
- 3.
- 4. “ Grupo deespecialistas que se dedica integralmente ao tratamento das doenças complexas do fígado, do pâncreas e das vias biliares…” CIR. HEPATOBILEOPANCREÁTICA
- 5. Especialidade nova MultidisciplinarEm conjunto com avanço de métodos diagnósticos e terapias complementares CIR. HEPATOBILEOPANCREÁTICA
- 6. HABILIDADES: Clínico-cirúrgica (25F,20VB, 30P) Interpretação de exames de imagem, intervenção, US intraoperatório, terapias adjuvantes e neoadjuvantes CIR. HEPATOBILEOPANCREÁTICA
- 7. Trata algumas doençasrelativamente comuns Câncer pâncreas Metástases de tumores colorretais para o fígado Aumenta de importância com complexidade de pacientes e dos tipos de tratamento Inclui doenças mais raras e que são raramente tratadas em ambiente não especializado CIR. HEPATOBILEOPANCREÁTICA
- 8. Porque investir emequipe de Cir. Hepatobileopancreática?
- 9. DEFININDO O PROBLEMAPopulação cresce e envelhece “ Boom” econômico no país e mais pessoas têm acesso a planos de saúde Necessidade de serviços especializados e tecnologia de ponta Regras da ANS AMIL como líder no setor
- 10. DEFININDO O PROBLEMACusto de tratamento alto Alguns problemas associados a litígio Necessidade de equipe multidisciplinar
- 11. . Relationship betweenhospital volume and late survival after pancreaticoduodenectomy “ Hospital volume strongly influences both perioperative risk and long-term survival after pancreaticoduodenectomy” Birkmeyer, et al. Surgery 1999; 26(2):178-83 RESULTADOS E VOLUMES
- 12. Pancreatectomia, Surgery, Ann.Surg. 2003 Cirurgia Hepática, Ann. Surg., 2005 Câncer, Ann. Surg. 2009 Cirurgia bariátrica, JACS 2011 Trauma, Am. Surg. 2012 Transplantes, AJT 2004; Liver Transpl., 2011 Stent coronariano, JAMA 2000 RESULTADOS E VOLUMES
- 13. EQUIPE MULTIDISCIPLINAR OncologiaTrauma UTI Cirurgia bariátrica Cirurgia cardíaca/cardiologia Transplantes
- 14.
- 15. EQUIPE MULTIDISCIPLINAR Necessidadede equipe multidisciplinar Diagnóstico Estadiamento Melhor tratamento NCCN Clinical Practice Guidelines in Oncology 2012 Pancreatic and hepatobiliary cancer
- 16.
- 17. EQUIPE MULTIDISCIPLINAR Influênciapositiva para protocolos em cirurgia HBP Menor tempo de UTI Menor taxa de transfusão Rando et al, Acta Gastroenterol Latinoam 2010;40(1):10-21
- 18.
- 19. PROSPECÇÃO 2011 CódigosAMB ~75 procedimentos/ano Necessidade de equipe especializada
- 20. Dr. Paolo Rogériode Oliveira Salvalaggio • Ex-Professor da: University of Washington e da Saint Louis University, EUA • Treinamento em transplantes e cirurgia hepatobileopancreática pela Northwestern University, EUA • Pós-Doutorado, Yale University, EUA • Mestre e Doutor em Cirurgia pela UFPR • Especialista em Cirurgia pelo CBC • Especialista em Videocirurgia pela AMB
- 21.
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- 23. Dr. Roberto FerreiraMeirelles Jr. Mestre em Ciências da Saúde, FAMERP Doutor em Clínica Cirúrgica pela FMRP-USP Surgical Research Fellowship pela Cornell University, EUA Cirurgião de Transplante de Órgãos Abdominais e Imunologia pela University of Minnesotta, EUA Ex-Professor Adjunto do Serviço de Pâncreas e Vias Biliares da FAMERP e da Disciplina de Transplante e Cirurgia do Fígado do HC- FMUSP Membro Titular do Colégio Brasileiro de Cirurgia do Aparelho Digestivo, ABTO e ATS Cirurgião do grupo Amilpar desde 2006
- 24.
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- 26. EQUIPE Dr. MarceloFilipe Carneiro - Formado no Hospital Beneficiência Portuguesa - Cirurgião, grupo Amil Dr. Eduardo Quadros dos Santos - Formado no Hospital Beneficiência Portuguesa - Cirurgião, grupo Amil
- 27. AMBULATORIO CIR HBPAMILPAR
- 28. AMBULATORIO CIR HBPAMILPAR
- 29. Paciente da redecredenciada procura call center para agendar consulta com Cirurgia Geral…
- 30. AMBULATORIO CIR HBPAMILPAR
- 31. EQUIPEDE CIRURGIA GERAL Atende o paciente e verifica necessidade de atendimento do GRUPO DE CIRURGIA HBP…
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- 33. … noambulatório cirúrgico… 32 anos CL de rotina e colega liga com lesão Strasberg E1 MRI sem lesão vascular Operada dia seguinte, sem coleção Reparo HJ em 70 min Alta no 5PO sem complicações
- 34.
- 35. Lesao VBP Temabcesso ou coleção que necessite drenagem? Há fístula? Qual nível/classificação de lesão? Há lesão vascular concomitante? Há sofrimento hepático ou atrofia lobar concomitante?
- 36. Lesão VBP… MB-MTMúltiplas cirurgias, intervenções e procedimentos, internamentos: até ressecção e transplante Colangite Estudos de qualidade de vida controversos Processos e custo
- 37. COMO PODEMOS AJUDAR? AMBULATÓRIO CIR. HBP AMILPAR LISTA DE PROBLEMAS: Estenoses e tumores biliares COLEDOCOTOMIA OU PROCEDIMENTOS NA PAPILA COLEDOCO ou HEPATICOJEJUNOSTOMIA Tumores primários (e secundários) do FÍGADO NODULE, SEGMENTE, HEPATE, LOBECTOMIAS radiofreqüência Tumores do Pancreas e Complicações da Pancreatite cronica GDP, pancreatectomias parcias, Pancreaticojejunostomias
- 38. ENCAMINHAMENTO Hospital Alvoradade Moema Edifício Medical Center Av. Ministro Gabriel de Resende Passos, 500, sala 203, 2º. A, Moema, SP-SP TERÇAS 9-13hs (11) 2186-1505, (11) 2186-9936, com Cassia
- 39. AMBULATORIO CIR HBPAMILPAR
- 40. Após atendimento do GRUPO DE CIRURGIA HBP, médicos da cirurgia geral receberão feedback e se necessário paciente retornará para seus cuidados
- 41. SUMÁRIO CIR.HEPATOBILEOPANCREÁTICA VANTAGENS-Multidisciplinare resultados Hepatogastro-Amil-Hospital Alvorada Indicações e fluxo de atendimento Agendamento - Alvorada de Moema TERÇAS 9-13hs 2186-1505, 2186-9936, com Cassia Dr.Paolo-96656620, Dr.Meirelles-89024852 EQUIPE 8546-6620
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Notas do Editor
- #3 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #4 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #5 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #6 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #7 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #8 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #10 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #11 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #12 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #13 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #14 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #15 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #16 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #17 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #18 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #19 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #20 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #21 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #24 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #27 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #28 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #29 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #31 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #35 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #36 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #37 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #38 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #39 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #40 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up
- #42 Overall center follow-up reporting often inadequate -> reliance on select reports Single center studies - limited by power, bias from subject loss-to-follow-up