Open versus minimally invasive sphincter-sparing surgery for rectal cancer: a single-center retrospective cohort study in Peru / Cirugía abierta versus mínimamente invasiva con preservación del esfínter para el cáncer de recto: un estudio de cohorte retrospectivo de un solo centro en Perú

ABSTRACT Objective : The study aimed to describe and compare minimally invasive surgery (MIS) and open surgery for rectal cancer in Peru. Material and methods : A retrospective single-center analysis was performed for all patients who underwent sphinctersparing surgery for non-metastatic rectal cancer at Instituto Nacional de Enfermedades Neoplásicas in Peru between January 2016 and December 2020. Clinical, perioperative, pathological, and survival outcomes were compared between both groups. A propensity score matching method was used to minimize bias. Results : 162 patients were included in the final analysis. 124 had open surgery and 38 had MIS. Patients, clinical tumour, pathological characteristics, and perioperative were similar between groups after matching. Similar circumferential resection margin (CRM) with optimal quality of the mesorectum (p=1.000) but higher number of lymph nodes resected in open surgery group (p=0.741) was described. The leakage rate was slightly higher in the MIS group (p=0.358) with 10.5%, while the postoperative hospital stay was longer in the open surgery group after matching (p=0.001; OR 95% 5.2 CI: 1.8-15.6). The estimated recurrence-free survival (RFS) and overall survival (OS) at 3 years in open surgery and MIS was 71.8% (95% CI; 0.58-0.89) and 70% (95% CI; 0.56-0.88) (p=0.431) and 77.7% (95% CI; 0.64-0.94) and 88.9% (95% CI; 0.79-0.99) (p=0.5), respectively. Conclusions: Shorter postoperative hospital stay in the minimally invasive surgery group was reported. RFS, OS, and recurrence rates were similar between both groups. This approach is for non-metastatic rectal cancer in referral centers in Peru.

RESUMEN Objetivo : El estudio tuvo como objetivo describir y comparar la cirugía mínimamente invasiva (CMI) y la cirugía abierta para el cáncer de recto en el Perú. Material y métodos : Se realizó un análisis retrospectivo unicéntrico de todos los pacientes que se sometieron a cirugía conservadora de esfínter por cáncer de recto no metastásico en el Instituto Nacional de Enfermedades Neoplásicas de Perú entre enero de 2016 y diciembre de 2020. Clínica, perioperatoria, patológica y supervivencia se compararon los resultados entre ambos grupos. Se utilizó un método de emparejamiento por puntaje de propensión para minimizar el sesgo. Resultados : 162 pacientes fueron incluidos en el análisis final. 124 tuvieron cirugía abierta y 38 CMI. Los pacientes, el tumor clínico, las características patológicas y el perioperatorio fueron similares entre los grupos después del emparejamiento. Se describió un margen de resección circunferencial (MRC) similar con calidad óptima del mesorrecto (p=1,000) pero mayor número de ganglios linfáticos resecados en el grupo de cirugía abierta (p=0,741). La tasa de fuga fue ligeramente superior en el grupo CMI (p=0,358) con un 10,5%, mientras que la estancia hospitalaria postoperatoria fue mayor en el grupo de cirugía abierta tras el emparejamiento (p=0,001; OR 95% 5,2 IC: 1,8-15,6). La supervivencia libre de recidiva (SLR) estimada y la supervivencia global (SG) a los 3 años en cirugía abierta y CMI fue del 71,8% (IC 95%; 0,58-0,89) y del 70% (IC 95%; 0,56-0,88) (p=0,431) y 77,7% (IC 95%; 0,64-0,94) y 88,9% (IC 95%; 0,79-0,99) (p=0,5), respectivamente. Conclusiones : Se reportó menor estancia hospitalaria postoperatoria en el grupo de cirugía mínimamente invasiva. Las tasas de SLR, SG y recurrencia fueron similares entre ambos grupos. Este abordaje es para cáncer de recto no metastásico en centros de referencia en Perú.

Systemization of laparoscopic inguinal hernia repair (tapp) based on a new anatomical concept: inverted y and five triangles / Sistematização do reparo da hérnia inguinal laparoscópica (tapp) baseada em um novo conceito anatômico: y invertido e cinco triângulos

ABSTRACT Background: Laparoscopic inguinal hernia repair has been shown to be superior than open repairs with faster return to daily activities and decrease in the occurrence of chronic pain. However, higher direct costs and mandatory use of general anesthesia are arguments against their use. In addition, increased complexity of surgery resulting from an anatomy that is unusual to general surgeons prevents the widespread adoption of laparoscopic approach. Aim: To propose a technical systematization for transabdominal laparoscopic repair (TAPP) of inguinal hernias based on anatomical concepts. Method: To offer a systematization of TAPP repair based on well defined anatomic landmarks, describing the concept of "inverted Y", identification of five triangles and three zones of dissection, to achieve the "critical view of safety" for laparoscopic inguinal hernia repair. Results: Since this standardization was developed five years ago, many surgeons were trained following these precepts. Reproducibility is high, as far as, it´s rate of adoption among surgeons. Conclusion: The concept of the "inverted Y", "Five triangles" and the dissection based in "Three Zones" establish an effective and reproducible standardization of the TAPP technique.

RESUMO Racional: O reparo laparoscópico da hérnia inguinal tem se mostrado superior aos reparos abertos, com retorno mais rápido às atividades diárias e diminuição na ocorrência de dor crônica. No entanto, custos diretos mais altos e o uso obrigatório de anestesia geral são argumentos contra seu uso. Além disso, o aumento da complexidade da operação resultante de uma anatomia incomum aos cirurgiões gerais impede a ampla adoção da abordagem laparoscópica. Objetivo: Propor uma sistematização técnica para reparo laparoscópico transabdominal (TAPP) de hérnias inguinais com base em conceitos anatômicos. Método: Oferecer sistematização do reparo do TAPP baseado em pontos anatômicos bem definidos, descrevendo o conceito de "Y invertido", identificação de cinco triângulos e três zonas de dissecação, para alcançar a "visão crítica de segurança" para o reparo de hérnia inguinal laparoscópica. Resultados: Desde que essa padronização foi desenvolvida há cinco anos, muitos cirurgiões foram treinados seguindo esses preceitos. A reprodutibilidade é muito alta, assim como a taxa de adoção entre cirurgiões. Conclusão: O conceito de "Y invertido", dos "Cinco triângulos" e a dissecção baseada em "Três Zonas" estabelecem uma padronização efetiva e reprodutível da técnica TAPP.

Laparoscopic splenectomy for patients with idiopathic thrombocytopenic purpura and Helicobacter pylori / 中华肝胆外科杂志

Objective To evaluate the short-term and long-term outcomes of laparoscopic splenectomy combined with eradication of Helicobacter pylori (HP) in patients with idiopathic thrombocytopenic purpura (ITP).Methods 72 patients with ITP were divided into three groups:the eradication of Hp group (group A),the untreated or failure group (group B),and the Hp-negative group (group C).Results Hppositive Patients (group A and group B) were significantly shorter in the course of disease before splenectomy (26.7± 13.8 months vs.45.2±22.1 months,P＜0.05),and lower in platelet counts peak within 7 days after splenectomy (134.9±53.9) × 109/L vs.(250.9± 160.5) × 109/L,P＜0.05) than Hp-negative patients.After discharge from hospital,in 28 patients who received infection therapy against Hp by taking amoxicillin,CLA,omeprazole for one month,21 (75.0％) patients had the Hp eradicated,but in 7 patients the eradication failed.The PLT between these 2 groups of patients were (189.6± 114.8)× 109/L vs.(124.0±45.7) × 109/L,(P＜0.05).The long-term outcomes in platelet counts and remission rates after spleuectomy of the three groups of patients were (149.7±90.6) × 109/L,76.1％ (group A);(98.5±64.1) × 109/L,66.6％(group B);(172.4± 102.0)× 109/L,80.0％ (group C).The platelet count in group B was significantly lower than group C (P＜0.05).There was no statistical significance between group A and group C (P＞0.05).There was no significant difference in the remission rates in the three groups.Conclusions Eradication of Hp improved the short-term and long-term outcomes of Hp-positive ITP patients after splenectomy.

Estudio Descriptivo: Caracterización Clínica de Hernias Ventrales e Incisionales Sometidas a Reparación Laparoscópica en el Centro de Salud Tipo B del IESS ­ La Troncal, 2013 - 2016 / Descriptive Study: Clinical Characterization of Ventral and Incisional Herniae Treated with Laparoscopic Reparation at IESS B Type Health Center ­ La Troncal, 2013-2016

OBJETIVO: Describir las características clínicas de los pacientes con diagnóstico de hernia ventral e incisional intervenidos para resolución con cirugía laparoscópica y los resultados obtenidos. MÉTODO: Se incluyeron los pacientes sometidos a reparación laparoscópica de hernias ventrales e incisionales realizadas durante el periodo entre enero de 2013 hasta Diciembre de 2016. Las variables de estudio fueron: sexo, edad, tipo de hernia, diámetro de la hernia, síntoma principal y complicaciones transoperatorias y postoperatorias. RESULTADOS: Se incluyeron 21 pacientes, predominó el sexo masculino (52.38 %) y los grupos de edad más frecuentemente afectados estuvieron entre 50 y 69 años de edad (80.95 %). El 52.38 % de pacientes tuvieron un diagnóstico de hernia incisional y el 57.15 % de los defectos herniarios tuvieron un tamaño mayor a 10 cm (: 11.80 ±4.06 cm). La tasa de conversión fue del 4.76 % y el 9.52 % (n=2) de los pacientes refirió continuar con dolor luego de 3 y 6 meses después de la cirugía. CONCLUSIÓN: Las características de los pacientes intervenidos fueron similares a las reportadas en la bibliografía disponible, la experiencia en la resolución laparoscópica de hernias ventrales e incisionalesen el Centro de Salud tipo B IESS de La Troncal fue satisfactoria.(au)

AIM: To describe clinical characteristics of patients diagnosed with ventral and incisional hernias treated with laparoscopic surgery and its results. METHODS: The study included patients who underwent laparoscopic surgery to treat ventral and incisional hernias which were performed from January 2013 to December 2016. Studied variables were: sex, age, type of hernia, hernia diameter, main symptom and complications. RESULTS: 21 patients were included, male sex predominated (52.8 %) and the most affected age groups were those between 50 and 69 years old (80.95 %). 52.38 % of the patients were diagnosed with incisional hernia and 57.15 % of protrusion defects were larger than 10 cm (: 11.80 ±4.06 cm). Conversion rate reached 4.76 % and 9.52 % (n=2) of patients referred pain after 3-6 months after the procedure. CONCLUSION: Patients' characteristics were similar to those reported by many bibliographic fonts. Experience with laparoscopic resolution of ventral and incisional herniae at IESS B type health center ­ La Troncal was satisfactory(au)

A comparison of curative effect between total Intravenous Anesthesia and combined intravenous with inhalation anesthesia in patients with Iarparoscopic cholecystectomy / 中国基层医药

Objective To study the application of total intravenous anesthesia(TIVA) in patients with larp-aroscopic cholecystectomy(LC). Methods 100 cases with LC were randomly and evenly assigned to two groups: the combined intravenous with inhalation anesthesia(CIIA) group(n = 50) and the TIVA group(n = 50). The maintain anesthesia. BP, HR and SpO2 at all stages and time for extubation,the consciousness were recorded. Results The pneumoperitoneum after 10 min HR(96.8±13.5)times/min,SBP(142.5±14.3) mmHg、DBP(93.0±14.3) mm-Hg in A group higher than before induction of anesthesia(82.3±12.5) times/min, (129.0±21.7) mmHg, (77.3±13.5) mmHg(P < 0.05～0.01) ; The pneumoperitoneum after 10 min HR (84.0±11.0) times/min, pneumoperito-neum comphte(76.3±9.0) times/rain in B group lower than the(96.8±13.5) times/min, (84.1±11.0) times/min in A group(P >0.05); B group patients completed the opening time(6.5±1.5) min、extubation time (11.5±1.4) min、pestoperative nausea and vomiting in 3 cases,after 8 h VAS value of (2.8±1.1) in group B were lower than the (10.5±2.8) min,(25.2±9.5)min,12 cases(5.4±2.1) in group A(t =2. 411, P <0.05). Conclusion The application of TIVA to LC anesthetic effect is satisfaction.