Abordaje microquirúrgico transanal. Experiencia inicial. Indicaciones y resultados / Transanal microsurgical approach. Initial experience. Indications and results

Introducción: El tratamiento quirúrgico de las afecciones del recto bajo se encuentra en permanente revisión intentando mantener una adecuada función de continencia y urogenital. Una opción reciente es el abordaje microquirúrgico transanal. El objetivo del trabajo es evaluar una serie de pacientes tratados mediante dicho abordaje, analizando indicaciones, resultados inmediatos y alejados. Material y método: Se seleccionaron 41 pacientes operados en el período comprendido entre febrero de 2009 y febrero de 2015. Resultados: En 41 pacientes, las afecciones tratadas fueron: pólipos, 22; cáncer de recto, 14; estenosis de anastomosis, 2; absceso retrorrectal, 1; endometriosis, 1; poliposis adenomatosa familiar, 1. Los pacientes con pólipos llegaron a consulta: por primera vez, 15; recidivados, 4; segunda recidiva, 2; tercera recidiva, 1. Los procedimientos realizados fueron: resección local, 29; microcirugía transanal transabdominal (TATA), 6; dilatación de estenosis, 4; biopsia transrectal, 3; drenaje de absceso retrorrectal, 1; control de hemorragia, 1; colocación de stent, 1. En cáncer de recto: resección local, 7; biopsia transrectal, 2; TATA, 4; colocación de stent, 1. El tiempo operatorio promedio fue 48,6 minutos, y la estadía hospitalaria promedio 2,21 días. De los 29 pacientes en quienes se realizó resección local, fueron controlados 25 durante un período de 6 a 72 meses. Se complicaron 11 pacientes, sin mortalidad ni recidivas locales. Conclusiones: Este abordaje permite tratar lesiones del recto y último segmento del colon sigmoides. Otorga mejor visión permitiendo una disección más exacta, mejorando resultados postoperatorios inmediatos y alejados en patología benigna y maligna, minimizando la posibilidad de recidivas. (AU)

Introduction: The surgical treatment of conditions located at the low rectum is in constant review, triying to maintain proper urogenital and continence function. One of the most recent options is the transanal microsurgical. The aim of this paper is to analyze a series of patients treated with this approach, its indications, immediate and long term results. Material and Methods: 41 patients were analyzed retrospectively in the period between February 2009 and February 2015. Results: In these patients, treated conditions were polyps: 22; rectal cancer: 14; anastomotic stricture: 2; retrorectal abscess: 1; endometriosis: 1; familial adenomatous polyposis: 1. Patients affected with polyps reached the first consultation in 15 opportunities; 4 on first recurrence; 2 with second recurrence; 1 with third recurrence. The procedures were 29 local resections; 6 transanal transabdominal resections (TATA); 4 dilations of stenosis; 3 transrectal biopsies; 1 retrorectal abscess drainage; 1 hemorrhage control; 1 stent placement. In rectal cancer were: 7 local resection; 2 transrectal biopsies; 4 TATA; 1 stent placement. Mean operative time was 48.6 minutes and mean hospital stay was 2.21 days. Of the 29 patients in whom local resection was performed, 25 were controlled for a period of 6 to 72 months. 11 patients were complicated; no deaths or local recurrences were registered. Conclusions: This approach allows to treat lesions located throughout the rectum and the last segment of sigmoid colon. A better insight is obtained allowing a more accurate dissection, thus improving the immediate and remote postoperative results and minimizes the possibility of recurrence, particularly when it comes to benign conditions. (AU)

Rectal stenosis in pigs associated with Salmonella Typhimurium and porcine circovirus type 2 (PCV2) infection / Estenose retal em suínos associada à enterite causada por Salmonella Typhimurium em animais infectados pelo circovírus suíno tipo 2 (PCV2)

Rectal stricture is an acquired annular fibrous constriction of the rectum that results from a variety of chronic necrotizing enteric diseases. In pigs, it is in most cases a sequel of Salmonella infection. Porcine circovirus type 2 (PCV2) is a known pathogen causing immunosuppression in pigs worldwide. PCV2 infected pigs may be predisposed to salmonellosis. In this report, rectal stenosis was observed in 160 pigs from a herd that experienced an outbreak of enteric salmonellosis over a 4-month period. Distension of the abdominal wall and diarrhea were the main clinical signs observed. Five animals were analyzed showing annular cicatrization of the rectal wall 5.0-7.0 cm anterior to the anorectal junction and Salmonella-positive immunostaining in the large intestine. Salmonella Typhimurium was isolated from fragments of the large intestine. Porcine circovirus type 2 antigen was observed in the mesenteric lymph-node in 4 pigs and in the large intestine in 3 pigs.

Estenose retal é uma constrição anular fibrosa do reto que pode ser decorrente de qualquer doença entérica crônica necrotizante. Em suínos, é em muitos casos uma seqüela de infecção por Salmonella. Circovírus suíno tipo 2 é um patógeno bem conhecido que causa imunodepressão em suínos e apresenta distribuição mundial. No presente trabalho, estenose retal foi observada em 160 suínos em um rebanho que teve um surto de salmonelose entérica durante 4 meses. Distensão da parede abdominal e diarreia foram os principais sinais clínicos observados. Foram analisados cinco suínos que demonstraram cicatrização anular da parede do reto 5,0 a 7,0 cm anterior a junção anoretal e imuno-histoquímica positiva para Salmonella spp. no intestino grosso. Antígeno de Circovírus suíno tipo 2 foi observado no linfonodo mesentérico de quatro suínos e no intestino grosso de três.

A New Surgical Approach to the Rectal Anastomotic Stricture: Endoscopic

Rectal stricture is an occasional complication of abdominoperineal pull-through and low anterior resection of the rectum and irradiation injury. Although the causes and pathogenesis of this phenomenon are poorly understood, various techniques for stricture dilatation have been described. In this article, we present two cases of severe postoperative rectal stricture that were not amenable to conventional methods of dilation but were succesfully managed by transanal electroresection using endoscopic transurethral electroreectoscope.