ABSTRACT
Introducción: La tasa de dehiscencia anastomótica en cirugía colorrectal se estima entre un 4% a 20%. El plasma rico en fibrina y leucocitos (PRF-L) es un concentrado plaquetario de segunda generación y su aplicación en anastomosis colorrectales en animales ha evidenciado interesantes resultados que suponen una menor tasa. El objetivo de este estudio fue evaluar la viabilidad de aplicar L-PRF en cirugía colorrectal y determinar la incidencia de fuga anastomótica después de una anastomosis colorrectal. Materiales y Métodos: El estudio tuvo lugar en el Hospital Clínico Regional de Concepción Chile, en el periodo 2018-2021. Se realizó un ensayo clínico randomizado a 1 ciego. Se incluyeron a 106 pacientes sometidos a anastomosis colorrectal termino-terminal grapada. Se formó un grupo experimental con 53 pacientes y otro control con 53 pacientes. Resultados: A todos se les realizó anastomosis termino-terminal grapada. la indicación de cirugía fue cáncer en 79% y se realizó cirugía video-laparoscópica en 46%. No hubo diferencias estadísticamente significativas en variables socio-demográficas, ni relacionadas con la cirugía. Hubo dehiscencia anastomótica en 5 pacientes (9,4%) del grupo control y 1 (1,9%) en el grupo experimental sin diferencias estadísticamente significativas (p = 0,24). Conclusiones: A pesar de que no hubo diferencias con significación estadística entre los grupos, se apreció una tendencia en favor del PRF-L. Se logró establecer la seguridad de la aplicación de PRF-L en anastomosis colorrectales.
Introduction: Anastomotic leak rate in colorectal surgery is estimated between 4 and 20 percent. Leukocyte and and platelet-rich fibrin plasma (L-PRF) is second generation platelet concentrate whose application in colorectal anastomosis in animals has shown promising results that suppose a lower leakage rate. Aim: The objective of this study was to assess the feasibility of using L-PRF in colorectal surgery and to determine the incidence of anastomotic leak after colorectal anastomosis. Methods: This study took place in Hospital Clínico Regional de Concepción Chile, between years 2018 and 2021. A randomized and one-blinded experimental design was used, that included 106 patients that underwent end-to-end stapled colorectal anastomosis, 53 of them received L-PRF during anastomosis (experimental group). Results: Surgical indication in 79% was cancer and laparoscopic procedure was performed in 46% of patients. There were no statistically significant differences in sociodemographic nor surgery related variables. Anastomotic leak occurred in 5 patients of the control group (9.4%) and 1 patient from de experimental group (1.9%), with no statistically significant differences (p = 0.24). Conclusion: Although we did not detect significant differences among both groups, we observed a tendency favoring L-PRF treatment. We were able to stablish the safety of L-PRF use in colorectal anastomosis.
ABSTRACT
Background: Mortality from colorectal cancer (CCR) in Chile has nearly doubled over the past 15 years. International studies have shown that CCR screening programs based on fecal occult blood test (FOBT) reduce CCR mortality. Aim: To analyze the results from a CCR screening model in people over 50 years. Material and Methods: Between 2007 and 2009, a prospective multicenter study was performed in seven major Chilean cities. FOBT using an immunological method, was measured in asymptomatic subjects aged 50 years or more, without risk factors. In patients with a positive FOBT, with symptoms or with family risk factors, a colonoscopy was indicated. Results: A total of 6348 subjects were assessed, FOBT was performed in 4938 of them, with a compliance of 77%. The result was positive in 9.6%. A total of 2359 colonoscopies were ordered, with an overall compliance of 50.1%. Of the 1184 colonoscopies performed, adenomas and high risk adenomas were found in 304 (26%) and 75 (6%) patients, respectively. Thirteen patients were diagnosed with stage I and IICCR. Three of these lesions were excised endoscopically and 10 surgically. The detection rate of polyps, high risk adenomas and cancer was 75, 12 and 2 per 1000 screened individuals, respectively. Conclusions: This program allowed the early detection of an important number of high risk colon lesions, and all patients with CCR were diagnosed at early stages.