Eficacia de la analgesia peridural continua con bupivacaína y fentanilo en la cirugía de colon / Efficacy of continuous peridural analgesia with bupivacaine and fentanyl in colon surgery

Introducción: En la cirugía de colon se persigue lograr una recuperación acelerada y se debate el método analgésico más ventajoso. Objetivo: Comparar la eficacia analgésica de la infusión continua peridural con bupivacaína y fentanilo frente a la analgesia parenteral en este tipo de intervención. Métodos: Se realizó un estudio cuasi-experimental, prospectivo y longitudinal, en 30 pacientes operados de colon entre agosto 2018 agosto 2019 en el Hospital Militar Central Dr. Carlos J. Finlay; divididos de forma no aleatoria en grupo analgesia peridural y grupo analgesia multimodal endovenosa. Resultados: La demora en despertar y extubar en el grupo peridural fue inferior (1,6-1,8 min) a los 4,9-5,0 min en el multimodal, igual ocurrió con la estadía en Unidad Cuidados Intensivos Quirúrgicos y hospitalaria aunque con discreta diferencia. El 60 por ciento de los pacientes en el grupo peridural presentaron ruidos hidroaéreos en las primeras 24 h y el 80 por ciento expulsó gases a las 48 h o antes, con marcada diferencia del multimodal. La analgesia fue buena en ambos grupos, valores de escala visual análoga inferiores en el grupo peridural, solo el 13,3 por ciento necesitó dosis rescate frente al 26,7 por ciento en el multimodal. Las complicaciones más frecuentes fueron hipotensión (23,3 por ciento) y bradicardia (10 por ciento), sin diferencias entre grupos. La analgesia aceleró la recuperación en el 87,5 por ciento de los casos en el grupo peridural superior al 76 por ciento del grupo multimodal. Conclusiones: La analgesia peridural continua con bupivacaína y fentanilo es más eficaz que la analgesia multimodal endovenosa en la cirugía de colon y acelera la recuperación posoperatoria(AU)

Introduction: In colon surgery, accelerated recovery is pursued and the most advantageous analgesic method is still under debate. Objective: To compare the analgesic efficacy of continuous epidural infusion with bupivacaine and fentanyl versus parenteral analgesia in this type of operation. Methods: A quasiexperimental, prospective and longitudinal study was carried out with thirty patients who underwent colon surgery, between August 2018 and August 2019 at Dr. Carlos J. Finlay Central Military Hospital, nonrandomly divided into an epidural analgesia group and a multimodal intravenous analgesia group. Results: The awakening and extubation time in the epidural group was lower (1.6 -1.8 min) than the 4.9 to 5.0 min for the multimodal group. The same happened with intensive care unit and hospital stay, although with a discrete difference. 60 percent of the patients from the epidural group presented hydroaerial noise within the first 24 hours and 80 percent expelled gasses at 48 hours or earlier, with a marked difference in the multimodal group. Analgesia was good in both groups, with lower visual analog scale values in the peridural group; only 13.3 percent required rescue doses compared to 26.7 percent in the multimodal group. The most frequent complications were hypotension (23.3 percent ) and bradycardia (10 percent ), without differences between groups. Analgesia accelerated recovery for 87.5 percent of cases in the epidural group, compared to 76 percent in the multimodal group. Conclusions: Continuous epidural analgesia with bupivacaine and fentanyl is more effective than multimodal intravenous analgesia in colon surgery and accelerates postoperative recovery(AU)

Programa para mejorar la recuperación posoperatoria en intervenciones electivas de colon / A Program for Improving Postoperative Recovery in Elective Colon Surgeries

Introducción: Los programas de recuperación mejorada después de cirugía constituyen un conjunto de acciones aplicadas al paciente quirúrgico en el período perioperatorio, que se enfoca en reducir el impacto de la cirugía en la respuesta metabólica y endocrina y así lograr una recuperación más temprana de mayor calidad. Objetivo: Evaluar los resultados de la aplicación del protocolo de recuperación mejorada después de la cirugía en procedimientos quirúrgicos mayores electivos del colon. Métodos: Se realizó un estudio descriptivo longitudinal y prospectivo con 163 pacientes con indicación de intervenciones quirúrgicas mayores electivas del colon en el Hospital Clínico Quirúrgico "Hermanos Ameijeiras", durante el período 2017-2020 y se les aplicó el programa ERAS implementado. Resultados: La edad media de los pacientes fue de 65,4±13,2 años con predominio del sexo femenino (57,7 por ciento). El 78,5 por ciento de los pacientes toleraban dieta blanda y expulsaban gases o heces por el recto al segundo día de la operación. La estadía posoperatoria promedio fue de 4,9 ± 3,4 días y en pacientes sin complicaciones se redujo a 4,0±1,0 días. La mortalidad reportada fue de un 3,1 por ciento (5 casos). Se complicó el 20,2 por ciento de los pacientes. El 6,7 por ciento de los pacientes requirió reingreso durante los primeros 30 días. Conclusiones: La implementación de un programa para mejorar la recuperación posoperatoria de pacientes con intervenciones electivas de colon demuestra resultados satisfactorios y mejora los resultados históricos del Hospital Clínico Quirúrgico "Hermanos Ameijeiras", en cuanto a complicaciones, estadía y mortalidad(AU)

Introduction: Enhanced recovery after surgery (ERAS) programs are a set of actions applied to the surgical patient in the perioperative period, focusing on reducing the impact of surgery on the metabolic and endocrine response, with the aim of achieving an earlier recovery of higher quality. Objective: To evaluate the results of the application of the enhanced recovery protocol after surgery in elective major surgical procedures of the colon. Methods: A descriptive, longitudinal and prospective study was conducted with 163 patients indicated for elective major surgery of the colon at Hospital Clínico Quirúrgico "Hermanos Ameijeiras", during the period 2017-2020, and who were applied the implemented ERAS program. Results: The mean age of the patients was 65.4 ± 13.2 years, with a predominance of the female sex (57.7 percent). 78.5 the patients tolerated a soft diet and expelled gases or faces througth the rectum at two days after the operation. The average postoperative stay was 4.9 ± 3.4 days and, in patients without complications, it was reduced to 4.0 ± 1.0 days. Reported mortality was 3.1 percent (five cases). Complications occurred in 20.2 percent of the patients. 6.7 percent of patients required readmission during the first thirty days. Conclusions: The implementation of a program for improving postoperative recovery of patients with elective interventions of the colon shows satisfactory results and improves the historical results of Hospital Clínico Quirúrgico "Hermanos Ameijeiras" in terms of complications, length of stay and mortality(AU)

Enfermedad Diverticular: análisis de defunciones según sexo, grupo etario y regiones en Chile

Objetivo: Describir las defunciones por enfermedad diverticular de intestino en el período 2016 - 2020 en Chile según sexo, grupo etario y región. Material y Método: Estudio descriptivo. Se describieron 406 defunciones por enfermedad diverticular según sexo, grupo etario y región entre los años 2016-2020, realizando un análisis estadístico con el software IBM SPSS Statistics ® que incluyó una Prueba Binomial para análisis de defunciones según "sexo" y la Prueba de Kruskal Wallis para el estudio de significancia entre las variables "sexo" y "grupo etario". Se utilizó un intérvalo de confianza del 99% (p < 0,01). Resultados: se obtuvo una tasa de mortalidad 0,46/100.000 habitantes para el período estudiado. El sexo femenino fue predominante con una relación cercana a 3:1 (p < 0,01). Las defunciones aumentaron con la edad y el grupo etario con mayor número de defunciones fue el de 80-89. Se demostró relación entre sexo y grupo etario (p < 0,01). Las regiones con mayor tasa de mortalidad observada fueron Magallanes, Valparaíso y Maule. Discusión: La tasa de mortalidad es similar a la reportada a nivel mundial. Las mujeres mueren en una proporción mayor que los hombres, tal como es descrito en otros estudios. La mayor tasa de mortalidad observada en algunas regiones del país se podría asociar a la elevada prevalencia de factores de riesgo para la enfermedad. Conclusión: Las defunciones por enfermedad diverticular disminuyeron desde el año 2018, se evidencia que las mujeres presentan un número significativamente mayor de defunciones que los hombres y que existieron diferencias por región.

Aim: To describe deaths from diverticular bowel disease in the period 2016-2020 in Chile according to sex, age group and region. Material and Method: Descriptive study. 406 deaths due to diverticular disease were described according to sex, age group and region between the years 2016-2020, performing a statistical analysis with the IBM SPSS Statistics ® software that included a Binomial Test for analysis of deaths according to "sex" and the Kruskal Wallis Test for the study of significance between the variables "sex" and "age group". A 99% confidence interval (p < 0.01) was used. Results: A mortality rate of 0.46/100,000 inhabitants was obtained for the period. The female sex was predominant in a ratio close to 3:1 (p < 0.01). Deaths increased with age and the age group with the higher number of deaths was 80-89. A relationship between sex and age group was demonstrated (p < 0.01). The regions with the highest observed mortality rate were Magallanes, Valparaíso and Maule. Discussion: The mortality rate is similar to that reported worldwide. Women die at a higher rate than men, as described in other studies. The higher mortality rate observed in some regions of the country could be associated with the high prevalence of risk factors for the disease. Conclusion: Deaths from diverticular disease decreased since 2018, in conjunction with showing that women present a significantly higher number of deaths than men and that there were differences by region.

Aumento de egresos hospitalarios por enfermedad diverticular a nivel nacional en el período 2003-2013 / Increase in hospital discharges due to diverticular disease at the national level in the period 2003-2013

Resumen Introducción: La enfermedad diverticular (ED) es una patología prevalente. Su incidencia ha aumentado, sin embargo, no se cuenta con publicaciones nacionales al respecto. Objetivo: Realizar un análisis de los egresos hospitalarios, edad de presentación, cirugías y letalidad por ED a nivel nacional entre el año 2003 y 2013. Materiales y Método: Se diseñó un estudio en base a datos publicados por la dirección y estadística e información de salud (DEIS) de Chile, entre los años 2003 y 2013. Se calcularon tasas de egreso hospitalarios por año, tasa de ED ajustada por sexo, tasas de intervención quirúrgica y letalidad. Resultados: El total de egresos hospitalarios presentó un alza desde 2.023 hasta 4.172 casos. La tasa de egresos por ED, en el total de la población, presentó un alza de 20 a 33 pacientes por cada 100.000 habitantes. La tasa de egresos hospitalarios presentó un alza de 173 hasta 327 pacientes por cada 100.000 egresos. La edad de presentación disminuyó de 62 a 58 años promedio. En cuanto a las cirugías, disminuyeron de 25% a 17%. La letalidad, es mayor sobre los 60 años y en el subgrupo que requiere cirugía. Discusión: Los resultados concuerdan con la literatura, se presenta un alza de hospitalizaciones, menor edad, menor requerimientos quirúrgicos y mayor letalidad en grupos etarios más avanzados. Conclusión: La enfermedad diverticular es una patología en aumento, desde el punto de vista hospitalario esto se hace evidente ante el crecimiento sostenido de egresos en el período estudiado.

Introduction: Diverticular disease (DD) is a prevalent pathology with multiple clinical manifestations. Its worldwide incidence has increased, however, there are no national publications in this regard. Aim: The objective of this study is to carry out an analysis of hospital discharges, age of presentation, surgeries and fatality due to DD from national data collected between 2003 and 2013. Materials and Method: A study was designed based on data from the management website and statistics and health information (DEIS) for Chile between 2003 and 2013. Hospital discharge rates per year, DD rate adjusted for sex, rates of surgical intervention and fatality were calculated. Results: The total of hospital discharges showed an increase from 2.023 to 4.172 cases. The discharge rate for DD in the total population increased from 20 to 33 patients per 100.000 inhabitants. The hospital discharge rate increased from 173 to 327 patients per 100.000 discharges. The age of presentation decreased from an average 62 to 58 years. Regarding surgeries, they decreased from 25% to 17%. Regarding mortality, it is higher over 60 years and in the surgical versus non-surgical subgroup. Discussion: These results are consistent with the literature; there is an increase in hospitalizations, lower age, lower surgical requirements and higher mortality in more advanced age groups. Conclusión: Diverticular disease is an increasing disease in the inpatient setting over the 10-year period studied.

Risk factors of postoperative surgical site infection in colon cancer based on a single center database / 中华胃肠外科杂志

Objective: To explore the incidence and risk factors of postoperative surgical site infection (SSI) after colon cancer surgery. Methods: A retrospective case-control study was performed. Patients diagnosed with colon cancer who underwent radical surgery between January 2016 and May 2021 were included, and demographic characteristics, comorbidities, laboratory tests, surgical data and postoperative complications were extracted from the specialized prospective database at Department of General Surgery, Peking Union Medical College Hospital. Case exclusion criteria: (1) simultaneously multiple primary colon cancer; (2) segmental resection, subtotal colectomy, or total colectomy; (3) patients undergoing colostomy/ileostomy during the operation or in the state of colostomy/ileostomy before the operation; (4) patients receiving natural orifice specimen extraction surgery or transvaginal colon surgery; (5) patients with the history of colectomy; (6) emergency operation due to intestinal obstruction, perforation and acute bleeding; (7) intestinal diversion operation; (8) benign lesions confirmed by postoperative pathology; (9) patients not following the colorectal clinical pathway of our department for intestinal preparation and antibiotic application. Univariate analysis and multivariate analysis were used to determine the risk factors of SSI after colon cancer surgery. Results: A total of 1291 patients were enrolled in the study. 94.3% (1217/1291) of cases received laparoscopic surgery. The incidence of overall SSI was 5.3% (69/1291). According to tumor location, the incidence of SSI in the right colon, transverse colon, left colon and sigmoid colon was 8.6% (40/465), 5.2% (11/213), 7.1% (7/98) and 2.1% (11/515) respectively. According to resection range, the incidence of SSI after right hemicolectomy, transverse colectomy, left hemicolectomy and sigmoid colectomy was 8.2% (48/588), 4.5% (2/44), 4.8% (8 /167) and 2.2% (11/492) respectively. Univariate analysis showed that preoperative BUN≥7.14 mmol/L, tumor site, resection range, intestinal anastomotic approach, postoperative diarrhea, anastomotic leakage, postoperative pneumonia, and anastomotic technique were related to SSI (all P<0.05). Multivariate analysis revealed that anastomotic leakage (OR=22.074, 95%CI: 6.172-78.953, P<0.001), pneumonia (OR=4.100, 95%CI: 1.546-10.869, P=0.005), intracorporeal anastomosis (OR=5.288, 95%CI: 2.919-9.577,P<0.001) were independent risk factors of SSI. Subgroup analysis showed that in right hemicolectomy, the incidence of SSI in intracorporeal anastomosis was 19.8% (32/162), which was significantly higher than that in extracorporeal anastomosis (3.8%, 16/426, χ(2)=40.064, P<0.001). In transverse colectomy [5.0% (2/40) vs. 0, χ(2)=0.210, P=1.000], left hemicolectomy [5.4% (8/148) vs. 0, χ(2)=1.079, P=0.599] and sigmoid colectomy [2.1% (10/482) vs. 10.0% (1/10), χ(2)=2.815, P=0.204], no significant differences of SSI incidence were found between intracorporeal anastomosis and extracorporeal anastomosis (all P>0.05). Conclusions: The incidence of SSI increases with the resection range from sigmoid colectomy to right hemicolectomy. Intracorporeal anastomosis and postoperative anastomotic leakage are independent risk factors of SSI. Attentions should be paid to the possibility of postoperative pneumonia and actively effective treatment measures should be carried out.

Preoperative risk factors associated with anastomotic leakage after colectomy for colorectal cancer: a systematic review and meta-analysis / Fatores de risco pré-operatórios associados à fístula anastomótica após colectomia para câncer colorretal: revisão sistemática e metanálise

ABSTRACT Introduction: anastomotic leak (AL) after colectomy for colorectal cancer (CRC) is a life-threatening complication. This systematic review and meta-analysis aimed to evaluate the preoperative risk factors for AL in patients submitted to colectomy. Methods: the bibliographic search covered 15 years and 9 months, from 1st January 2005 to 19th October 2020 and was performed using PubMed, Cochrane Library, Scopus, Biblioteca Virtual em Saúde, Europe PMC and Web of Science databases. The inclusion criteria were cross-sectional, cohort and case-control studies on preoperative risk factors for AL (outcome). The Newcastle-Ottawa scale was used for bias assessment within studies. Meta-analysis involved the calculation of treatment effects for each individual study including odds ratio (OR), relative risk (RR) and 95% confidence intervals (95% CI) with construction of a random-effects model to evaluate the impact of each variable on the outcome. Statistical significance was set at p<0.05. Results: cross-sectional studies were represented by 39 articles, cohort studies by 21 articles and case-control by 4 articles. Meta-analysis identified 14 main risk factors for AL in CRC patients after colectomy, namely male sex (RR=1.56; 95% CI=1.40-1.75), smoking (RR=1.48; 95% CI=1.30-1.69), alcohol consumption (RR=1.35; 95% CI=1.21-1.52), diabetes mellitus (RR=1.97; 95% CI=1.44-2.70), lung diseases (RR=2.14; 95% CI=1.21-3.78), chronic obstructive pulmonary disease (RR=1.10; 95% IC=1.04-1.16), coronary artery disease (RR=1.61; 95% CI=1.07-2.41), chronic kidney disease (RR=1.34; 95% CI=1.22-1.47), high ASA grades (RR=1.70; 95% CI=1.37-2.09), previous abdominal surgery (RR=1.30; 95% CI=1.04-1.64), CRC-related emergency surgery (RR=1.61; 95% CI=1.26-2.07), neoadjuvant chemotherapy (RR=2.16; 95% CI=1.17-4.02), radiotherapy (RR=2.36; 95% CI=1.33-4.19) and chemoradiotherapy (RR=1.58; 95% CI=1.06-2.35). Conclusions: important preoperative risk factors for colorectal AL in CRC patients have been identified based on best evidence-based research, and such knowledge should influence decisions regarding treatment.

RESUMO Objetivo: fístula anastomótica (FA) após colectomia para câncer colorretal (CCR) é complicação grave. Esta revisão sistemática e meta-análise avaliou os fatores de risco pré-operatórios para FA em pacientes submetidos à colectomia. Métodos: a pesquisa bibliográfica abrangeu 15 anos e 9 meses (1 de janeiro de 2005 - 19 de outubro de 2020), sendo utilizadas as plataformas PubMed, Cochrane Library, Scopus, Biblioteca Virtual em Saúde, Europe PMC e Web of Science. O critério de inclusão foram estudos transversais, coorte e caso-controle em fatores de risco pré-operatórios para FA (desfecho). A escala Newcastle-Ottawa foi usada para avaliação de viés dos estudos. A metanálise envolveu o cálculo dos efeitos de tratamento para cada estudo individualmente incluindo odds ratio (OR), risco relativo (RR) e intervalo de confiança de 95% (IC95%) com construção de modelo de efeitos aleatórios, para avaliar o impacto de cada variável (p<0,05). Resultados: foram selecionados 39 estudos transversais, 21 coortes e quatro casos-controle. A metanálise identificou 14 fatores de risco para FA em pacientes com CCR após colectomia, que são sexo masculino (RR=1,56; IC 95%=1,40-1,75), tabagismo (RR=1,48; IC 95%=1,30-1,69), alcoolismo (RR=1,35; IC 95%=1,21-1,52), diabetes mellitus (RR=1,97; IC 95%=1,44-2,70), doenças pulmonares (RR=2,14; IC 95%=1,21-3,78), doença pulmonar obstrutiva crônica (RR=1,10; IC 95%=1,04-1,16), doença coronariana (RR=1,61; IC 95%=1,07-2,41), doença renal crônica (RR=1,34; IC 95%=1,22-1,47), altas notas na escala ASA (RR=1,70; IC 95%=1,37-2,09), cirurgia abdominal prévia (RR=1,30; IC 95%=1,04-1,64), cirurgia de emergência (RR=1,61; IC 95%=1,26-2,07), quimioterapia neoadjuvante (RR=2,16; IC 95%=1,17-4,02), radioterapia (RR=2,36; IC 95%=1,33-4,19) e quimiorradioterapia (RR=1,58; IC 95%=1,06-2,35). Conclusões: importantes fatores de risco pré-operatórios para FA colorretais em pacientes com CCR foram identificados com base nas melhores pesquisas baseadas em evidências e esse conhecimento deve influenciar decisões relacionadas ao tratamento.

Características clínicas, demográficas e histopatológicas de pacientes postoperados de cáncer colorrectal internados en el Servicio de Coloproctología del Hospital Nacional, Itauguá ­ Paraguay: periodo 2015 y 2018 / Clinical, demographic and histopathological characteristics of postoperative colorectal cancer patients admitted to Servicio de Coloproctología at the Hospital Nacional, Itauguá - Paraguay: period 2015 and 2018

RESUMEN Introducción: el cáncer colorrectal se desarrolla a partir de lesiones precursoras a nivel del colon, recto y ano, siendo responsable del 16,9 % de todas las muertes por cáncer y en los hombres es la tercera neoplasia maligna más común a nivel mundial. Objetivo: caracterizar a los pacientes postoperados de cáncer colorrectal del Servicio de Coloproctología del Hospital Nacional, Itauguá ­ Paraguay en el periodo entre 2015 y 2018. Metodología: estudio observacional descriptivo, retrospectivo de corte transversal. Se utilizaron fichas de pacientes postoperados de cáncer colorrectal del Servicio de Coloproctología del Hospital Nacional, Itauguá ­ Paraguay en el periodo entre 2015 y 2018. Resultados: del total de las 26 fichas de pacientes revisadas, el 70 % fue de sexo masculino y el rango etario más común fue entre 60 - 71 años (52 %); el tipo histológico de cáncer más frecuente fue el adenocarcinoma moderadamente diferenciado 78 %, el estadio más común fue adenocarcinoma de tipo II A (clasificación de la American Joint Committe on Cancer (AJCC-TNM) 65 %, presentó metástasis a distancia 3,81 % y la ubicación de cáncer más frecuente fue el recto 34,78 %. El motivo de consulta más frecuente fue hemorragia 70 %, la complicación más común fue la dehiscencia y no hubo óbitos. Conclusión: el mayor porcentaje de pacientes pertenece al sexo masculino y al grupo etario de mayores a 60 años, fue frecuente el adenocarcinoma moderadamente diferenciado y el estadio más común de tipo II A, la ubicación más frecuente fue el recto y motivo de consulta fue hemorragia (rectorragia)., por lo cual se deberían implementar medidas para la prevención de esta patología.

ABSTRACT Introduction: colorectal cancer develops from precursor lesions in the colon, rectum and anus, being responsible for 16,9 % of all deaths from cancer and in men it is the third most common malignant neoplasm worldwide. Objective: to characterize postoperative colorectal cancer patients of the Coloproctology Service of the Hospital Nacional, Itauguá - Paraguay in the period between 2015 and 2018. Methodology: descriptive, retrospective, cross-sectional observational study. Cards of postoperative colorectal cancer patients from the Coloproctology Service of the Hospital Nacional, Itauguá - Paraguay in the period between 2015 and 2018 were used. Results: of the total of the 26 patient files reviewed, 70 % were male and the most common age range was between 60 - 71 years (52 %); the most frequent histological type of cancer was moderately differentiated adenocarcinoma 78 %, the most common stage was adenocarcinoma type II A (classification of the American Joint Committee on Cancer (AJCC-TNM) 65 %, present distant metastases 3,81 % and the most frequent location of cancer was the rectum 34,78 % .The most frequent reason for consultation was hemorrhage 70 %, the most common complication was dehiscence and there were no deaths. Conclusion: the highest percentage of patients belongs to the male sex and to the age group over 60 years old, moderately differentiated adenocarcinoma was frequent and the most common stage was type II A, the most frequent location was the rectum and the reason for consultation was hemorrhage (rectorrhagia), for which measures must be implemented to prevent this pathology.

Post-operative complications in patients undergoing early closure compared to delayed closure of ileostomy: A meta-analysis

BACKGROUND@#The objective of this study was to evaluate the postoperative outcomes of early ileostomy closure compared to delayed closure in adult patients that have undergone bowel surgery. Specific outcomes measured included wound infection, ileus, postoperative obstruction, anastomotic failure, total number of complications and mortality.@*METHODS@#Online search was made through Medline, Cochrane, EBSCHost, and ClinicalKey databases up to June 2018 for randomized controlled trials comparing early (<4 weeks) and delayed (≥ 4 weeks) closure of ileostomy. Review Manager 5.3 was utilized for data analysis. The odds ratio was determined for each of the outcomes.@*RESULTS@#Eight RCT's met the inclusion criteria, yielding 1126 patients (506 in early closure and 620 in delayed closure group). Statistical analysis showed no advantage of delayed closure over early closure of ileostomy in terms of post-operative complications (OR 1.13, 95% CI, 0.84-1.54, p=0.45), rate of anastomotic leakage (OR 0.96;95% CI, 0.55-1.66, p=0.54) and over-all mortality (OR 2.00;95% CI, 0.18-22.29, p=0.57). Early closure patients were found to be less likely to have post-operative ileus or obstruction when compared to delayed closure (OR 0.36;95% CI, 0.14-0.90, p=0.03). However, early closure was more likely to cause postoperative wound infection compared to delayed closure (OR 2.32;95% CI, 1.48-3.63, p=0.0002).@*CONCLUSION@#Early closure of ileostomy is beneficial in terms of development of less post-operative ileus. Delayed closure of ileostomy is advantageous in terms of less wound infections.

Distribution and Impact of the Visceral Fat Area in Patients With Colorectal Cancer

PURPOSE: The purposes of this study were to investigate the distribution of the visceral fat area (VFA) and general obesity and to compare visceral and general obesity as predictors of surgical outcomes of a colorectal cancer resection. METHODS: The prospectively collected data of 102 patients with preoperatively-diagnosed sigmoid colon or rectal cancer who had undergone a curative resection at Pusan National University Yangsan Hospital between April 2011 and September 2012 were reviewed retrospectively. Men with a VFA of >130 cm2 and women with a VFA of >90 cm2 were classified as obese (VFA-O, n = 22), and the remaining patients were classified as nonobese (VFA-NO, n = 80). RESULTS: No differences in morbidity, mortality, postoperative bowel recovery, and readmission rate after surgery were observed between the 2 groups. However, a significantly higher number of harvested lymph nodes was observed in the VFA-NO group compared with the VFA-O group (19.0 +/- 1.0 vs. 13.5 +/- 1.2, respectively, P = 0.001). CONCLUSION: Visceral obesity has no influence on intraoperative difficulties, postoperative complications, and postoperative recovery in patients with sigmoid colon or rectal cancer.

Combined Laparoscopic-endoscopic Procedure for Colon Tumor:Report of 32 Cases / 中国微创外科杂志

Objective To investigate the experience of combined laparoscopic-endoscopic procedure for colon tumor . Methods Clinical data of 32 cases of colon tumor receiving combined laparoscopic-endoscopic procedure from January 2011 to June 2014 were analyzed retrospectively , including 25 cases of endoscopic assisted laparoscopic operation ( laparoscopic resection of colon segment or laparoscopic radical resection of colon cancer with positioning of colonic lesions by endoscopy ) and 7 cases of laparoscopic assisted endoscopic operation ( intraoperative endoscopic resection under the monitor of laparoscopy ) . Results Twenty-five cases were performed endoscopic-assisted laparoscopic surgery , including endoscopic-assisted laparoscopic radical resection for colon cancer in 20 cases and endoscopic-assisted laparoscopic segmental resection of colon in 5 cases.The combined procedure contained endoscopic-assisted positioning lesions , laparoscopic bowel resection and reconstruction , and lymph node dissection .The success rate of endoscopic-assisted positioning was 100%(25/25).No conversion to laparotomy was required .No surgical complications occurred . Follow-up for 6 -48 months ( median, 30 months ) in 25 cases found no signs of recurrence and metastasis .One patient died of myocardial infarction and the remaining 24 patients survived .Seven cases were performed laparoscopic-assisted endoscopic surgery , including laparoscopic-assisted endoscopic submucosal dissection colon ( ESD) in 3 cases, laparoscopic-assisted endoscopic mucosal resection ( EMR) in 2 cases, and laparoscopic-assisted endoscopic polypectomy in 2 cases.Intestinal perforation occurred during the operation in 1 case of ESD, which was given a laparoscopic colon perforation repair .Follow-up for 9 -36 months ( median, 24 months) in 7 cases showed no deaths or signs of recurrence and metastasis . Conclusion Combined laparoscopic-endoscopic procedure has advantages of both laparoscopy and endoscopy to improve surgical safety , on the basis of good cooperation of laparoscopic and endoscopic teams .

Complicaciones posoperatorias de la cirugía colónica / Postoperative complications of colon surgery

La cirugía del colon supone un importante trabajo en cualquier servicio de cirugía digestiva. Como cualquier cirugía mayor puede presentar complicaciones posoperatorias, tanto quirúrgicas como médicas, muchas de ellas pueden ser graves o incluso fatales. En este trabajo revisamos las complicaciones quirúrgicas posoperatorias más frecuentes: sepsis de origen abdominal, íleo posquirúrgico, hemorragia, fístula, evisceración, lesión ureteral, problemas con la colostomía y lesión de grandes vasos mesentéricos superiores. Todo cirujano digestivo debe conocer las posibles complicaciones de la cirugía colónica para conseguir un diagnóstico precoz y un manejo adecuado de las mismas.

Colon surgery comprises a high number of patients treated in a gastrointestinal surgery department. Like any major surgery, it may present diverse surgical and medical postoperative complications. In this article we review the most frequent surgical complications of colon surgery: abdominal sepsis, postoperative ileus, bleeding, fistula, evisceration, ureteral lesion, colostomy problems and damage to upper mesenteric vessels. Every colorectal surgeon must know all the possible complications of colon surgery to achieve an early diagnosis and correct management.

Foreign Body Granulomas Simulating Recurrent Tumors in Patients Following Colorectal Surgery for Carcinoma: a Report of Two Cases

We report here two cases of foreign body granulomas that arose from the pelvic wall and liver, respectively, and simulated recurrent colorectal carcinomas in patients with a history of surgery. On contrast-enhanced CT and MR images, a pelvic wall mass appeared as a well-enhancing mass that had invaded the distal ureter, resulting in the development of hydronephrosis. In addition, a liver mass had a hypointense rim that corresponded to the fibrous wall on a T2-weighted MR image, and showed persistent peripheral enhancement that corresponded to the granulation tissues and fibrous wall on dynamic MR images. These lesions also displayed very intense homogeneous FDG uptake on PET/CT.

Mortality rate and high-risk factors in post-operative generalized peritonitis after colon surgery

Background: Post operative generalized peritonitis is a serious complication of abdominal surgery with a high mortality rate. Objectives: 1) To figure out the mortality rate of patients with generalized peritonitis after colon surgery. 2) To discover the risk factors for intensive care. Subjects and method: The retrospective research was conducted on the records of all patients with post-operative generalized peritonitis in Binh Dan Hospital. The patients with generalized peritonitis that were not related to colon surgery were exempted. The data was processed by SPSS. 11.5 software. Results: During 6 years from Jan 1998 to Jan 2004, there were 38 patients (26 men, 12 women) that met the research criteria were included. Ages of patients ranged from 23 to 91, with most of them being 41 years of age or more. The mortality rate was 31.6% (12 cases). There was no difference in mortality rate between male and female. High risk factors included age over 60; underlying malignant disease and late re-operation. Conclusion: The mortality rate of patients with post-operative peritonitis after colon surgery remained high. Intervention as soon as the peritonitis signs were presented (within 24hrs) was an important factor that impacted on prognosis.

Effect of Anesthetic Methods on Gastrointestinal Bowel Movement after Colon Surgery / 대한마취과학회지

BACKGROUND: Gastrointestinal bowel movements are reduced by opioid-based anesthesia. Remifentanil is commonly used as total intravenous anesthesia. This study compared to the effect of various anesthetic methods on gastrointestinal bowel movement after colon surgery. METHODS: Ninety patients were allocated randomly into three groups. Thirty patients received intraoperative inhalation anesthesia (desflurane + N2O, Group I), 30 patients received intraoperative total intravenous anesthesia (propofol + remifentanil, Group II), and 30 patients received intraoperative epidural anesthesia (epidural lidocaine + propofol, Group III). All patients received postoperative epidural analgesia with a mixture of ropivacaine and morphine. The time to the first passage of flatus, hospital stay and visual analog pain scale were recorded. RESULTS: There was no significant difference in first passage of flatus among groups (Group I: 92.7 +/- 19.6, Group II: 86.9 +/- 19.4, Group III: 81.9 +/- 12.8 hours, P = 0.063). There were no significant difference in the hospital stay and visual analog scale among the three groups. CONCLUSIONS: Total intravenous anesthesia with remifentanil did not reduce the gastrointestinal bowel movements compared with those of inhalation or epidural anesthesia.

Effects of heart-shape anastomosis on 31 cases hirschsprung′s disease / 实用儿科临床杂志

Objective To explore and summarize the heart-shape anastomosis for hirschsprung′s disease .Methods Before the operation,the colon was cleaned thoroughly ,31 cases of this group (8 month-6 years old)underwent colonic pull-through and the dilated segment of colon was pulled out and resected.Normal colon and lower segment of rectum′s stomosis were stomosed as heart-shape (higher anterior and lower posterior).After replacing the colon and stomosis ,close the abdomen layer by layer.Results All 31 cases anus sphincter muscle were retained at most degree,so that retained their function of normal defecation .All 31 cases were healed and discharged, without one case with early complications as stomosis fistila,et al.No stomosis stenosis or other late period complication were found in 24 cases with long period follow-up.Conclusions Heart-shape stomosis is a good method for hirschsprung′s disease,especially fitful to the common type and short-segment type and long-segment type with diseased part in sigmoid colon .This method is easy,convenient,no special equipment was needed,easy to be publicized.