ABSTRACT
Objetivo: comunicación de la de la factibilidad de las colectomías totalmente laparoscópicas con extracción de la pieza quirúrgica por orificios naturales. Diseño: Trabajo descriptivo, retrospectivo, observacional. Pacientes y Método: Se incluyó una serie de 6 pacientes en quienes se realizó colectomía totalmente laparoscópica (con anastomosis intracorpórea) y extracción de la pieza quirúrgica por orificio natural. Resultados: Desde enero de 2007 a Agosto de 2011, en el Servicio de Cirugía General del Hospital San Roque, se llevaron a cabo 467 cirugías colorrectales, en 355 pacientes (76%), se realizó abordaje a cielo abierto y en 112 (24%), abordaje videolaparoscopico. En seis de ellos, una neoplasia de sigmoides (T2), y cinco enfermedades diverticulares recurrentes se realizó extracción de la pieza quirúrgica por orificios naturales con anastomosis colorrectal totalmente intracorporea. En 3 pacientes se extrajo la pieza por vía transrectoanal (masculinos) y en los 3 restantes por vía transvaginal. No se presentaron complicaciones intraoperatorias, tampoco postquirúrgicas inmediatas. La recuperación del tránsito intestinal, la ingesta de líquidos y el alta hospitalaria fueron similares a las observadas en las colectomías videoasistidas. Conclusiones: La resección de colon izquierdo por laparoscopía, realizando anastomosis intracorpórea, más extracción de la pieza por oríficios naturales (NOSE), puede ser considerada como una técnica alternativa para pacientes que requieren colectomías electivas, en patología benigna y neoplasias tempranas.
Objective: Communication of totally laparoscopic colectomy with natural orifice specimen extraction. Design: descriptive, retrospective, observational work. Patients and Methods: A series of 6 patients underwent totally laparoscopic colectomy (with intracorporeal anastomosis) and extraction of surgical specimen through natural orifice. Results: From January 2007 to August 2011, 467 colorectal surgeries were performed in the General Surgery Service of the Hospital San Roque. 355 (76%) underwent an open approach and 112 (24%) laparoscopic approach. In six of these cases, a sigmoid tumor (T2), and five recurrent diverticular diseases, we performed totally laparoscopic colectomy, with intracorporeal colorectal anastomosis. In 3 patients, the specimen was removed via transanal (male) and the remaining 3 by transvaginal route. There were no intraoperative or postoperative complications. The recovery of intestinal transit, fluid intake and hospital discharge were similar to those observed in video-assisted colectomy. Conclusions: The left colon resection by a totally laparoscopic technique, with intracorporeal anastomosis and the use of natural orifice specimell extraction (NOSE), can be considered as an alternative for patients requiring elective colectomy in benign disease and early neoplasia.
Subject(s)
Humans , Male , Female , Colectomy/methods , Laparoscopy/methods , Natural Orifice Endoscopic Surgery , Early Diagnosis , Colonic Diseases/surgery , Neoplasm Staging , Colorectal Neoplasms/surgery , Colorectal Neoplasms/diagnosisABSTRACT
INTRODUCTION: Carotid lesions require priority in both evaluation and treatment due to their high morbidity and mortality. Controversy about therapeutic behavior in these patients with or without central neurological deficit is still under in discussion. OBJECTIVES: To present a patient with acute carotid thrombosis due to a shotgun wound and discuss its therapeutic behavior. SETTING: Hospital de Urgencias in Córdoba city. MATERIAL AND METHODS: A 15-year-old male patient is presented with a point-blank shotgun wound in the soft parts of the left cervical region, and a left carotid thrombosis with no central neurological deficit. RESULTS: Wound toilette and carotid revascularization by means of resection and venous by-pass with external carotid ligature was performed. The procedure was finished by delaging for plastic reconstruction of the cervical injury. Carotid postoperative angiographic control showed good permeability with no carotid flow alteration. CONCLUSION: Penetrating carotid injuries should be resolved, if technically possible, with revascularization of the carotid sector. This procedure has to be aborted if the patient is in coma or the lesion is difficult to repair, in such a case ligature should be carried out.