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1.
Rev. cuba. cir ; 60(3): e1117, 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1347393

ABSTRACT

Introducción: El plastrón apendicular es una tumoración inflamatoria constituida por el apéndice inflamado, vísceras adyacentes y epiplón mayor. Puede contener o no pus (absceso/flemón). Objetivo: Precisar si está indicada la apendicectomía de urgencia o de intervalo en los pacientes con plastrón y/o absceso apendicular sometidos a tratamiento no quirúrgico inicial. Métodos: Se realizó una revisión en las bases de datos bibliográficas Web of Science, PubMed, Medline y Lilacs, mediante el motor de búsqueda Google académico. Se seleccionaron 28 artículos en inglés y español; 20 (71,2 por ciento) correspondieron al quinquenio 2016-20 y el 96,4 por ciento de autores extranjeros. Desarrollo: El estándar actual es el tratamiento no quirúrgico inicial del plastrón y el drenaje percutáneo del absceso. La apendicectomía de intervalo tiene un beneficio mínimo y puede conducir a un aumento de los costos, estancia hospitalaria, antibioticoterapia intravenosa y de la morbilidad. Se debe realizar un seguimiento cuidadoso en enfermos con riesgo de enfermedad inflamatoria intestinal o cáncer de colon, sin importar qué opción se elija (operación de intervalo u observación). Conclusiones: La apendicectomía de urgencia no es recomendable porque el componente inflamatorio la hace técnicamente difícil, puede necesitar una colectomía y aumentar la morbilidad, aunque actualmente, la apendicectomía laparoscópica de urgencia puede ser más rentable y segura. La decisión posterior de la apendicectomía a intervalos sigue siendo discutible. El intervalo recomendado varía entre 6 y 8 semanas, tres y seis meses después de la normalización clínico humoral(AU)


Introduction: Appendiceal plastron is an inflammatory tumor made up of inflamed appendix, adjacent viscera and greater omentum. It may or may not contain pus (abscess/phlegmon). Objective: To specify whether emergency or interval appendectomy is indicated in patients with appendicular abscess and/or plastron who had undergone initial nonsurgical treatment. Methods: A review was carried out in the bibliographic databases Web of Science, PubMed, Medline and Lilacs, using the search engine Google Scholar. Twenty-eight articles were selected, in English and Spanish; twenty (71.2 percent) corresponded to the quinquennium 2016-20, while 96.4 percent were written by foreign authors. Development: The current standard is the initial nonsurgical treatment of the plastron and percutaneous drainage of the abscess. Interval appendectomy has minimal benefits and can lead to increased costs, hospital stay, intravenous antibiotic therapy and morbidity. Patients at risk for inflammatory bowel disease or colon cancer should be carefully followed up, regardless of which option is chosen (interval operation or observation). Conclusions: Emergency appendectomy is not recommended because the inflammatory component makes it technically difficult; it may require colectomy and increase morbidity, although currently, emergency laparoscopic appendectomy may be more profitable and safer. The subsequent decision for interval appendectomy remains debatable. The recommended interval varies from six to eight weeks, three and six months after clinical-humoral normalization(AU)


Subject(s)
Humans , Appendectomy/methods , Inflammatory Bowel Diseases/epidemiology , Abscess/etiology , Emergencies , Databases, Bibliographic , Colectomy/methods , Search Engine/methods
3.
Rev. argent. coloproctología ; 31(3): 110-110, sept. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1128578

ABSTRACT

Introducción: La enfermedad diverticular de colon es una patología de alta prevalencia en nuestro medio. Su presentación inicial como fístulas no complicadas no es frecuente sin antecedentes de episodios de diverticulitis previa. Objetivos: Presentar detalles técnicos de la cirugía de resección y tratamiento laparoscópico de una fistula colovesical de origen diverticular. Materiales y métodos: Se presenta el caso de un paciente varón de 63 años con dolor en hipogastrio sin alteraciones evacuatorias ni cirugías previas. Sin antecedentes de diverticulitis. Se realizó ecografía abdominal y tomografía computada donde se constata aire en vejiga. El urocultivo es positivo para escherichia coli y el colon por enema detecta pequeño trayecto fistuloso entre colon sigmoides y vejiga. Se decide resección laparoscópica. Resultados: Se realizó una colectomía sigmoidea laparoscópica con identificación de trayecto fistuloso a la vejiga que se aisló y seccionó entre clips de polímero. Se completó con anastomosis primara colorrectal y sondaje vesical prolongado que se retiró a los 15 días. Los parámetros postoperatorios fueron favorables con egreso a las 72 hs. Conclusión: La fístula colovesical es una complicación de la enfermedad diverticular de colon aunque es rara su debut como forma de presentación sin episodios de diverticulitis previa. Se destaca su identificación como trayecto único y no hemos encontrado mención al respecto en la bibliografía. Su resolución de ligadura entre clips es una opción terapéutica efectiva y rápida para su resolución definitiva. El abordaje laparoscópico electivo es de elección y su tratamiento mediante el procedimiento propuesto resultó efectivo y seguro.


Background: Diverticular disease is a high prevalent colonic pathology. Initial presentation as complicated disease includes fistulas, perforation and bleeding. Objetive: To present technical surgical aspects of surgical treatment of laporoscopic resection of colovesical fistula after diverticular disease. Methods: A 63 years old patient presented with low abdominal pain and no transit symptoms. There was no previous surgery and diverticulitis episode. Abdominal ultrasound and CT scan showed air in the bladder. Urine culture was positive to Escherichia coli. Colonic barium x-rays showed a colovesical fistula. Laparoscopic resection was decided as treatment of choice. Results: Laparoscopic sigmoid colectomy, aisolation of fistula tract and posterior clips ligation and section. Primary mecanic anastomosis and 15 days vesical catheter completed the treatment. Postoperative evolution was satisfactory. Conclusions: Colovesical fistula is a frequent complication of complicated diverticular disease, however its debut without previous episodes is rare. The colonic fistula presented as unique tract is unfrequent. Resolution by polimer clips and section associated with colonic resection by laparoscopic is a good option to avoid bladder sutures. This procedure resulted safe and effective.


Subject(s)
Humans , Male , Middle Aged , Urinary Bladder Fistula/surgery , Laparoscopy/methods , Colectomy/methods , Diverticulitis, Colonic/surgery , Diverticulitis, Colonic/complications
4.
Rev. cuba. cir ; 59(3): e918, jul.-set. 2020. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1144442

ABSTRACT

RESUMEN Introducción: Los tumores miofibroblásticos son tumores benignos de origen mesenquimal, de etiología incierta, y frecuente en niños y jóvenes. Objetivo: Describir un nuevo caso de tumor miofibroblástico abdominal. Caso clínico: Se presenta una paciente de 20 años con antecedentes de salud con dolor en abdomen derecho, se realiza tomografía de abdomen contrastada que informa una masa hiperdensa no homogénea en flanco derecho. Se realiza resección quirúrgica del tumor y el estudio anatomopatológico informa un tumor miofibroblástico inflamatorio. Su pronóstico es favorable porque es una entidad benigna y no metastiza. Conclusiones: Los tumores miofibroblásticos de colon son infrecuentes, benignos, que al diagnosticarlos deben resecarse ampliamente para evitar la recidiva(AU)


ABSTRACT Introduction: Myofibroblastic tumors are benign tumors of mesenchymal origin, of uncertain etiology, and frequent in children and young people. Objective: To describe a new case of abdominal myofibroblastic tumor. Clinical case: The case is presented of a 20-year-old female patient with a health history and pain in the right abdomen. Contrasted abdominal tomography is performed, which shows an inhomogeneous hyperdense mass in the right flank. Surgical resection of the tumor was performed. The pathological study reported an inflammatory myofibroblastic tumor. Its prognosis is favorable because it is a benign entity that does not metastasize. Conclusions: Colon myofibroblastic tumors are infrequent, benign, and when diagnosed, they must be widely removed to avoid recurrence(AU)


Subject(s)
Humans , Female , Young Adult , Abdominal Pain/etiology , Colectomy/methods , Granuloma, Plasma Cell/diagnostic imaging , Neoplasms, Muscle Tissue/diagnosis
5.
J. coloproctol. (Rio J., Impr.) ; 40(3): 237-242, July-Sept. 2020. tab, ilus
Article in English | LILACS | ID: biblio-1134985

ABSTRACT

Abstract Introduction: Minimally invasive colectomy has been performed for some years for many patients worldwide without much complications compared to the open approach. In this study we explained our experience regarding a modification in laparoscopic total colectomy and removing the specimen with Natural Orifice Specimen Extraction (NOSE) through rectum using a plastic cover for the first time. Methods and material: This was an experimental study on a new technique of total colectomy with a small modification. Total colectomy was performed based on 7 port laparoscopic approach. Rectum was sparred. Colon was then taken out through the anal canal using a plastic cover. Results: Thirteen patients underwent laparoscopic total colectomy by removal of the specimen through rectum. Mean age of patients was 42.23 ± 8.15 years. Mean duration of operation was 130 ± 32.4 min. All patients had an uneventful postoperative hospitalization. Discussion: Laparoscopic total colectomy has been proven to have superior benefits than the open approach. In NOSE technique, colon is removed from the anal canal without any complication or consuming much time. This technique might have less pain and removes the complications associated with an incision on the skin to remove the specimen. Also, due to low price of a usual plastic cover, it can be used instead of other techniques to remove the specimen through the rectum.


Resumo Introdução: A colectomia minimamente invasiva vem sendo realizada há alguns anos em muitos pacientes no mundo inteiro, apresentando menos intercorrências do que a abordagem aberta. Neste estudo, os autores relatam sua experiência com uma modificação da colectomia total laparoscópica e extração de espécime em orifício natural (NOSE) pelo reto, usando uma cobertura plástica pela primeira vez. Métodos e materiais: Este foi um estudo experimental sobre uma nova técnica de colectomia total com uma pequena modificação. A colectomia total foi realizada com base na abordagem laparoscópica de sete portas. O reto foi poupado. O cólon foi então retirado pelo canal anal usando uma cobertura plástica. Resultados: Treze pacientes foram submetidos a colectomia total laparoscópica por remoção do espécime pelo reto. A idade média dos pacientes foi de 42,23 ± 8,15 anos. A duração média da operação foi de 130 ± 32,4 minutos. Para todos os pacientes, a internação pós-operatória transcorreu sem intercorrências. Discussão: Foi comprovado que a colectomia total laparoscópica apresenta benefícios superiores à abordagem aberta. Na técnica NOSE, o cólon é removido mais rapidamente do canal anal, sem nenhuma intercorrência. Essa técnica pode causar menos dor e remove as complicações associadas a uma incisão na pele para remover o espécime. Além disso, devido ao baixo preço de uma cobertura plástica comum, ela pode ser usada no lugar de outras técnicas para remover o espécime pelo reto.


Subject(s)
Humans , Male , Female , Laparoscopy/methods , Colectomy/methods , Natural Orifice Endoscopic Surgery , Colon/surgery , Colorectal Surgery , Minimally Invasive Surgical Procedures
6.
Rev. argent. coloproctología ; 31(2): 63-69, jun. 2020. ilus, tab
Article in English, Spanish | LILACS | ID: biblio-1117012

ABSTRACT

Introducción: La introducción del sistema Da Vinci, ha revolucionado el campo de la cirugía mínima invasiva en el cual el cirujano tiene control de la cámara 3D y los instrumentos son de gran destreza y confort ergonómico, acortando la curva de aprendizaje quirúrgica. Objetivo: Describir nuestra experiencia inicial de cirugía robótica colorectal en un hospital de comunidad cerrada de la Ciudad Autónoma de Buenos Aires. Materiales y Método: Estudio retrospectivo descriptivo sobre una base prospectiva de cirugías colorectales robóticas realizadas por el mismo equipo quirúrgico desde mayo de 2016 a abril de 2019. Resultados: Se operaron 41 pacientes. Trece de ellos fueron colectomías derechas, 17 colectomías izquierdas y 11 cirugías de recto. El tiempo quirúrgico promedio fue de 170 minutos (90-330), la estadía hospitalaria de 4 días (3-30), la tasa de conversión de 7,31% (3/41 pacientes) y la tasa de dehiscencia anastomótica del 9,75% (4/41 pacientes). Morbilidad global del 19.5% (8/41 pacientes). Conclusión: Hemos repasado los resultados iniciales de nuestra experiencia en cirugía robótica colorectal en un número reducido de casos, pero suficiente para evaluar la seguridad y reproducibilidad del método al comienzo de una curva de aprendizaje.


Introduction: The introduction of the Da Vinci System, has revolved the field of invasive minimal surgery in which the surgeon has control of the 3d camera and the instruments are of great strength and ergonomic comfort by cutting the surgical learning curve. Objective: Of this preliminary presentation is to describe our initial experience of colorectal robotic surgery in a closed community hospital of the Autonomous City of Buenos Aires. Materials and Method: Retrospective descriptive study on a prospective basis of robotic colorectal surgeries performed by the same surgical team from May 2016 to April 2019.Results: 41 patients were operated. 13 of them were right colectomies, 17 left colectomies and 11 rectum surgeries. The average surgical time was 170 minutes (90-330), the average hospital stay of 4 days (3-30), the conversion rate of 7.31% (3/41 patients) and the anastomotic dehiscence rate of 9 , 75% (4/41 patients). Overall morbidity of 19.5% (8/41 patients).Conclusion: We have reviewed the initial results of our experience in colorectal robotic surgery in a reduced number of cases but sufficient to evaluate the security and reproducibility of the methodic learning of a learning curve.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Colorectal Neoplasms/surgery , Colorectal Surgery/methods , Robotic Surgical Procedures/methods , Retrospective Studies , Treatment Outcome , Colectomy/methods , Minimally Invasive Surgical Procedures/methods , Proctectomy/methods , Hospitals, Community
7.
Rev. cir. (Impr.) ; 72(3): 209-216, jun. 2020. tab, graf, ilus
Article in Spanish | LILACS | ID: biblio-1115544

ABSTRACT

Resumen Introducción: Si bien la anastomosis intracorpórea (AI) ha demostrado beneficios clínicos sobre la anastomosis extracorpórea (AE) en la hemicolectomía derecha laparoscópica (HDL), su aplicación ha sido limitada por su dificultad técnica y curva de aprendizaje más larga. El presente estudio busca desarrollar y evaluar un modelo simulado para entrenar este procedimiento. Materiales y Método: Se desarrolló un modelo en base a tejido ex vivo, con colon porcino e intestino bovino, montados en un simulador de laparoscopía. Este se modificó sucesivamente en base a entrevistas semiestructuradas a cirujanos hasta lograr el modelo final. Para evaluar apariencia y reacción al modelo, coloproctólogos, cirujanos y residentes previamente expuestos a entrenamiento simulado, realizaron una ileotransverso anastomosis mecánica en el modelo y luego contestaron una encuesta. Resultados: Doce sujetos participaron. Cuatro coloproctólogos, 4 residentes de coloproctología, 2 residentes de cirugía general, 1 cirujano general y 1 cirujano digestivo. El 91,6% valoró positivamente la ergonomía lograda, mientras que el 83,3% y 75% valoraron positivamente el uso del instrumental y la relación anatómica entre estructuras, respectivamente. Todos los participantes consideraron el modelo útil para entrenar sutura manual laparoscópica, el 91,6% para entrenar enterotomías y 83,3% para entrenar el uso de endograpadora. Todos declararon que el módulo permite entender y reflexionar sobre la técnica propuesta. Conclusión: Este modelo desarrollado sería útil para entrenar habilidades críticas para realizar una AI en HDL. Su incorporación a un programa de entrenamiento en laparoscopía avanzada podría contribuir a acortar la curva de aprendizaje de este procedimiento.


Introduction: Although intracorporeal anastomosis has demonstrated clinical benefits over extracorporeal anastomosis in laparoscopic right hemicolectomy, its application has been limited due to its technical difficulty and longer learning curve. The present study aims to develop and evaluate a simulated model to train this procedure. Materials and Method: An ex vivo tissue model was developed with porcine colon and bovine small bowel mounted in a laparoscopic simulator. This was subsequently modified based on semi-structured interviews to experts until the final model was achieved. To evaluate appearance and reaction to the model, the participants performed an ileocolic mechanical anastomosis in the model and answered a survey. Results: Twelve subjects participated. Four colorectal surgeons, 4 colorectal surgery fellows, 2 residents of general surgery, 1 general surgeon and 1 upper digestive surgeon. Of all subjects, 91.6%, 83.3% and 75% deemed ergonomics achieved, the use of instruments, and the anatomical relationship between structures as similar to reality, respectively. All participants deemed the model useful to train laparoscopic manual suturing, while 91.6% and 83.3% of them considered it useful to train enterotomies and the use of an endostapler, respectively. All declared that the model allows to understand the proposed technique. Conclusion: This model would be useful to train critical skills to perform an intracorporeal anastomosis in laparoscopic right hemicolectomy. Its incorporation into an advanced simulated laparoscopy training program could help shorten the learning curve of this procedure.


Subject(s)
Anastomosis, Surgical/methods , Surgeons/education , Simulation Training/methods , Surveys and Questionnaires , Laparoscopy/methods , Colectomy/methods
8.
Rev. cuba. cir ; 59(2): e935, abr.-jun. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1126414

ABSTRACT

RESUMEN Introducción: El cáncer avanzado es aquel que crece fuera del órgano en el cual se originó. La resección quirúrgica es el método más eficaz para lograr la curación de cáncer colorrectal en 50 por ciento de los casos. Objetivo: Evaluar los resultados del tratamiento multidisciplinar, realizado a pacientes con diagnóstico de cáncer colorrectal avanzado. Método: Se realizó un estudio observacional, descriptivo, ambispectivo y de corte transversal en el Hospital Clínico Quirúrgico "Hermanos Ameijeiras" entre enero de 2013 y diciembre de 2018. La muestra fue de 219 casos. Resultados: El 34,2 por ciento de los pacientes tenían entre 70 y 79 años. Hubo predominio de localización en colon ascendente (37,4 por ciento), en 57,1 por ciento fue moderadamente diferenciado y en 34,2 por ciento en estadio IIIA. El 7,8 por ciento de los pacientes tuvo recaída con metástasis, de ellos, 70,5 por ciento en hígado. En 72,6 por ciento la vía de acceso fue laparoscópica. En 50,7 por ciento se realizó hemicolectomía derecha. Las complicaciones se observaron en 25 pacientes (35,2 por ciento). El 91,3 por ciento de los casos recibió terapia adyuvante. En 27,4 por ciento hubo recurrencia. En el análisis del tiempo libre de enfermedad y de la supervivencia se obtuvieron buenos resultados. Conclusiones: El tratamiento combinado, secuencial y multidisciplinario en enfermedad maligna colorrectal avanzada ha demostrado beneficios clínicos y mayor supervivencia. Con una morbilidad y mortalidad relacionada con el proceder quirúrgico aceptable independientemente la vía de acceso empleada(AU)


ABSTRACT Introduction: advanced cancer is cancer that has grown outside the organ in which it originated. Surgical resection is the most effective method to achieve colorectal cancer cure in 50 % of cases. Objectives: the objective was to evaluate the results of the multidisciplinary treatment, carried out on patients diagnosed with advanced colorectal cancer. Method: it is an observational, descriptive, ambispective and cross-sectional study at the "Hermanos Ameijeiras" Surgical Clinical Hospital between January 2013 and December 2018. The sample was 219 cases. Results: 34.2 percent of the patients were between 70 and 79 years old. 56.2 percent were women. There was a predominance of localization in the ascending colon (37.4 percent), in 57.1 percent it was moderately differentiated and in 34.2 percent in stage IIIA. 7.8 percent of the patients had a metastatic relapse, 70.5 percent of them in the liver. In 72.6 percent, the access route was laparoscopic. Right hemicolectomy was performed in 50.7 percent. Complications were observed in 25 patients (35.2 percent). 91.3 percent of the cases received adjuvant therapy. In 27.4 percent there was recurrence. Good results were obtained in the analysis of disease-free time and survival. Conclusion: we conclude that combined, sequential, and multidisciplinary treatment in advanced colorectal malignancy has demonstrated clinical benefits and increased survival. With an acceptable morbidity and mortality related to the surgical procedure regardless of the access route used. Multivisceral and / or en bloc resections and maximum resection manage to increase the free interval of disease progression and alleviate symptoms(AU)


Subject(s)
Humans , Male , Female , Aged , Colorectal Neoplasms/diagnosis , Colectomy/methods , Colon, Ascending/injuries , Neoplasm Metastasis/drug therapy , Epidemiology, Descriptive , Cross-Sectional Studies , Observational Studies as Topic
9.
J. coloproctol. (Rio J., Impr.) ; 40(1): 8-11, Jan.-Mar. 2020.
Article in English | LILACS | ID: biblio-1090847

ABSTRACT

Abstract Introduction Peritoneal antibiotic or normal saline lavage is seen to be beneficial in order to reduce the pain or infection risk through laparoscopic surgeries. It can also be applied for laparoscopic colectomy surgeries. In this study, we have compared the effects of antibiotic solution lavage (gentamycin-clindamycin) with normal saline lavage in patients undergoing laparoscopic colectomy surgery. Method In this double-blind Randomized Controlled Trial (RCT), 40 patients undergoing laparoscopic colectomy surgery were divided into antibiotic and normal saline lavage groups (20 patients in each group). Post-operational pain, need for painkiller, white blood cells count, C-reactive protein level, duration of hospitalization and wound infection were compared in 30 days between the groups. Results Antibiotic lavage group had significantly less pain than the normal saline group (p < 0.05) through 3, 6, 12 and 24 h after surgery. C-reactive protein level, white blood cells count, painkiller use, and hospitalization duration were significantly lower in antibiotic group. However, there was no difference regarding wound or intra-abdominal infection between the both groups. Conclusion Using gentamicin-clindamycin peritonea lavage helps patients undergoing laparoscopic colectomy surgery in pain reduction, need for painkillers and hospitalization duration.


Resumo Introdução A lavagem peritoneal com antibiótico ou com soro fisiológico normal é benéfica para reduzir o risco de dor ou de infecção durante cirurgias laparoscópicas, além de poder ser aplicada também em colectomias laparoscópicas. Neste estudo, comparamos os efeitos da lavagem com solução antibiótica (gentamicina-clindamicina) e da lavagem com solução salina normal em pacientes submetidos à colectomia laparoscópica. Método Neste Ensaio Clínico Randomizado (ECR), controlado e duplo-cego, 40 pacientes submetidos à colectomia laparoscópica foram divididos em dois grupos (20 pacientes em cada grupo) para receberem antibiótico ou solução salina normal. Dor pós-operatória, necessidade de analgésico, contagem de leucócitos, nível de proteína C-reativa, tempo de internação e infecção da ferida foram comparados entre os grupos em 30 dias. Resultados De forma significativa, o Grupo Antibiótico apresentou menos dor que o Grupo Salina Normal (p < 0,05) em 3, 6, 12 e 24 horas após a cirurgia. O nível de proteína C-reativa, a contagem de leucócitos, o uso de analgésicos e o tempo de internação foram significativamente menores no Grupo Antibiótico. Porém, não houve diferença em relação à infecção da ferida ou intra-abdominal entre os dois grupos. Conclusão O uso da lavagem peritoneal com gentamicina-clindamicina ajuda a reduzir a dor, a necessidade de analgésicos e o tempo de internação de pacientes submetidos à colectomia laparoscópica.


Subject(s)
Humans , Pain, Postoperative/drug therapy , Surgical Wound Infection/drug therapy , Peritoneal Lavage , Laparoscopy , Colectomy/methods , Anti-Bacterial Agents/therapeutic use , Clindamycin/therapeutic use , Gentamicins/therapeutic use , Double-Blind Method , Saline Solution/therapeutic use , Length of Stay
10.
Rev. cir. (Impr.) ; 71(5): 392-397, oct. 2019. tab
Article in Spanish | LILACS | ID: biblio-1058292

ABSTRACT

Resumen Introducción: El cáncer colorrectal es la cuarta patología neoplásica en incidencia y mortalidad en Colombia y, aunque hay evidente mejoría en sus desenlaces, este alto volumen hace indispensable la participación integrada de cirujanos colorrectales y cirujanos generales dedicados a esa área de interés. A la fecha es la cirugía el pilar del tratamiento de esta enfermedad, la cual debe ser realizada dentro de unos parámetros que permitan asegurarle al paciente la resección completa de la misma. Uno de estos parámetros incluye un adecuado vaciamiento ganglionar que nos permite evaluar el pronóstico de la enfermedad y la necesidad de terapias complementarias. Objetivo: Evaluar la calidad de la disección ganglionar en la cirugía oncológica colorrectal efectuada por cirujanos generales en dos instituciones de la ciudad de Bogotá. Materiales y Método: Estudio observacional analítico de corte transversal; se analizaron 315 pacientes llevados a cirugía electiva oncológica colorrectal por cirujanos generales en el periodo de 2014 a 2017 en nuestras instituciones. Resultados: La mediana de ganglios linfáticos recuperados fue de 16, el número de ganglios disecados se asoció con localización del tumor (p = 0,002) y la neoadyuvancia (p = 00,001). Sin embargo, no se encontró asociación con el sexo, tipo de abordaje y volumen de sangrado. Conclusiones: Las colectomías realizadas por cirujanos generales mantienen un volumen óptimo en relación a la disección ganglionar sin comprometer el resto de los desenlaces. El número de ganglios linfáticos recuperados se asoció con la localización del tumor y la terapia neoadyuvante.


Introduction: Colorectal cancer is the 4th neoplastic disease in terms of incidence and mortality in Colombia, even though the clinical outcomes are improving. The high volume of this patients is requesting the collaboration between colorectal surgeons and general surgeons dedicated to this area of interest. To date is surgery the mainstay of the treatment of this disease which should be carried out within parameters that allow to assure the patient the complete resection of the lesion. One of these parameters includes a suitable lymph node emptying that allows us to evaluate the prognosis of the disease and the need of complementary therapies. Aim: To evaluate the quality of the lymph node dissection in colorectal surgery performed by general surgeons in two academic institutions in Bogota, Colombia. Materials and Method: Transversal cohort in analytical and observational study. We analyzed 315 patients scheduled for elective colorectal surgery by general surgeons in the period from 2014 to 2017 in our institutions. Results: The mean of the lymph node recovered was 16, the number of dissected lymph nodes was associated with the tumor location (p = 0.002), and the neoadjuvant (p = 0.001). However, no association within sex, approach and bleeding was found. Conclusions: The colectomies performed by general surgeons maintain an optimal volume in relation with lymph node dissection without affect the remaining clinical outcomes. The number of lymph nodes recovered is associated with tumor location and neoadjuvant therapy.


Subject(s)
Humans , Colectomy/methods , Surgeons , Oncologists , Lymph Node Excision/methods , Colorectal Neoplasms/surgery , Colombia , Surgical Oncology/methods
11.
Rev. argent. cir ; 111(3): 163-170, set. 2019. ilus, tab
Article in Spanish | LILACS | ID: biblio-1057358

ABSTRACT

Antecedentes: la hemicolectomía derecha laparoscópica con abordaje suprapúbico (HDLS) y empleo de tecnología robótica o laparoscópica de incisión única ha sido recientemente informada. La utilización de la técnica estándar multipuerto en HDLS no se ha descripto previamente. Material y métodos: entre enero y agosto del año 2018 fueron intervenidos 4 pacientes, 3 mujeres y 1 hombre, con mediana de 64 años de edad y diagnóstico de adenocarcinoma de colon derecho. Resultados: el procedimiento se realizó exitosamente en todos los pacientes, con una mediana de tiempo operatorio de 210 minutos (r:170-240). Ningún paciente tuvo complicaciones y fueron dados de alta en una mediana de 4 días (r:3-5). Todas las piezas quirúrgicas tuvieron márgenes negativos y un recuento ganglionar > 12 ganglios. A 7, 5, 4 y 2 meses del seguimiento, los pacientes se hallan vivos y libres de enfermedad. Conclusión: la técnica de HDLS multipuerto es una alternativa sencilla, factible y segura para el tratamiento del cáncer de colon en pacientes seleccionados, con un resultado funcional, estético y oncológico favorable.


Background: The suprapubic approach for laparoscopic right hemicolectomy has been reported with robotic surgery or single incision laparoscopy. The use of the suprapubic approach for standard multiport laparoscopic right hemicolectomy has not been previously described. Material and methods: Between January and September 2018, four consecutive patients (three women and one man; median age: 64 years) with right-sided colon cancer underwent laparoscopic right hemicolectomy using the suprapubic multiport approach. Results: The procedure was successful in all the patients and mean operative time was 210 minutes (IQR: 170-240). There were no complications and were discharged on postoperative day 4 (IQR: 3-5). All the surgical specimens had negative margins and lymph node count was > 12 lymph nodes. All the patients are alive and free from disease at 7, 5, 4 and 2 months of follow-up. Conclusion: The suprapubic approach for standard multiport laparoscopic right hemicolectomy is an easy, feasible and safe alternative for the treatment of colon cancer in selected patients, with a favorable functional, esthetic and oncological result.


Subject(s)
Humans , Male , Female , Middle Aged , Colon , Colonic Neoplasms , Colonic Neoplasms/surgery , General Surgery , Colectomy/methods , Colon/diagnostic imaging , Diagnosis , Methods
12.
An. Facultad Med. (Univ. Repúb. Urug., En línea) ; 6(1): 45-56, jun. 2019. ilus, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1088692

ABSTRACT

Introducción: A pesar de que la evidencia actual respalda ampliamente el abordaje laparoscópico para las resecciones de colon y recto en función de su seguridad y resultados oncológicos, el desarrollo y adopción del mismo ha sido lento y aún hoy no es de rutina en la mayoría de los centros. Se presenta la experiencia inicial en la Clínica Quirúrgica 2 del Hospital Maciel. Métodos: Estudio retrospectivo que comprende 41 resecciones laparoscópicas en el período 2016-2018. Resultados: El tiempo operatorio medio fue de 3 h para las colectomías y 4 h para las resecciones de recto. El porcentaje de conversión fue de 10%, la falla de sutura del 12% y la mortalidad a 30 días del 13%. Discusión: El abordaje laparoscópico para la colectomía y resección de recto es seguro y con aceptables resultados oncológicos de acuerdo a nuestros resultados. La curva de aprendizaje se sustenta en el volumen anual de cirugías, la realización de otros procedimientos de laparoscopía avanzada y el entrenamiento en simuladores. Conclusiones: nuestra experiencia muestra resultados inmediatos similares a los reportados en la literatura nacional, aunque el tiempo seguimiento aún es insuficiente para analizar los resultados oncológicos a largo plazo.


Introduction: Although current evidence widely supports the laparoscopic approach for resections of the colon and rectum according to their safety and oncological results, the development and adoption of the same has been slow and even today is not routine in most centers. The initial experience is presented in the Surgical Clinic 2 of the Maciel Hospital. Methods: A retrospective study comprising 41 laparoscopic resections in the period 2016-2018. Results: The mean operative time was 3 hours for colectomies and 4 hours for rectal resections. The conversion rate was 10%, the suture failure was 12% and the 30-day mortality was 13%. Discussion: The laparoscopic approach for colectomy and rectal resection is safe and with acceptable oncological results according to our results. The learning curve is based on the annual volume of surgeries, the performance of other advanced laparoscopy procedures and training in simulators. Conclusions: our experience shows immediate results similar to those reported in the national literature, although the follow-up time is still in sufficient to analyze the long-termoncological results.


Introdução: Embora as evidências atuais apóiem amplamente a abordagem laparoscópica para ressecções do cólon e do reto de acordo com sua segurança e resultados ontológicos, o desenvolvimento e a adoção dos mesmos têm sido lentos e até hoje não é rotineiro na maioria dos casos os centros. A experiência inicial é apresentada na Clínica Cirúrgica 2 do Hospital Maciel. Métodos: Estudo retrospectivo com 41 ressecções laparoscópicas no período 2016-2018. Resultados: O tempo operatório médio foi de 3 horas para colectomias e 4 horas para ressecções retais. A taxa de conversão foi de 10%, a falha na sutura foi de 12% e a mortalidade em 30 dias foi de 13%. Discussão: A abordagem laparoscópica para a colectomia e ressecção retal é segura e com resultados ontológicos aceitáveis de acordo com nossos resultados. A curva de aprendizado é baseada no volume anual de cirurgias, no desempenho de outros procedimentos avançados de laparoscopia e no treinamento em simuladores. Conclusões: nossa experiência mostra resultados imediatos semelhantes aos relatados na literatura nacional, embora o tempo de seguimento ainda seja insuficiente para analisar os resultados ontológicos em longo prazo.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Laparoscopy/adverse effects , Laparoscopy/mortality , Laparoscopy/statistics & numerical data , Colectomy/methods , Proctectomy/methods , Postoperative Period , Surgical Wound Infection , Sutures/adverse effects , Retrospective Studies , Laparoscopy/education , Minimally Invasive Surgical Procedures , Video-Assisted Surgery , Abscess , Intraoperative Period
13.
Rev. Col. Bras. Cir ; 46(4): e20192171, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1041126

ABSTRACT

RESUMO Objetivo: avaliar a influência da mobilização da flexura esplênica nos principais resultados cirúrgicos de pacientes submetidos à ressecção de câncer do cólon sigmoide ou reto. Métodos: os bancos de dados MEDLINE, Cochrane Central Register de Ensaios Controlados e LILACS foram pesquisados usando os termos "mobilização da flexura esplênica", "cirurgia colorretal", "câncer retal", "ressecção anterior", "câncer de cólon sigmoide", "ressecção de sigmoide". O desfecho principal foi a deiscência da anastomose. Outros desfechos analisados foram mortalidade, sangramento, infecção e complicações gerais. Os tamanhos dos efeitos foram estimados por meio do agrupamento dos dados de seis estudos de caso-controle (1.433 pacientes) publicados até janeiro de 2018. Resultados: nossa meta-análise revelou que pacientes submetidos à mobilização completa da flexura esplênica tinham um risco maior de deiscência anastomótica (RR=2,27, IC95%: 1,22-4,23) em comparação àqueles não submetidos a esse procedimento. Nenhuma diferença pôde ser demonstrada entre os grupos em termos de mortalidade, sangramento, infecção e complicações gerais. Conclusão: a mobilização da flexura esplênica está associada a um maior risco de deiscência anastomótica nas ressecções de câncer de reto ou cólon sigmoide. Esta manobra cirúrgica deve ser utilizada com cautela no manejo cirúrgico dos tumores colorretais.


ABSTRACT Objective: to evaluate the influence of the splenic flexure mobilization for the main surgical outcomes of patients submitted to resection of sigmoid and rectal cancer. Methods: we searched the MEDLINE, Cochrane Central Register of Controlled Trials and LILACS, using the terms "splenic flexure mobilization", "colorectal surgery", "rectal cancer", "anterior resection", "sigmoid colon cancer", and "sigmoid resection". The main outcome was anastomotic dehiscence. Other outcomes analyzed were mortality, bleeding, infection and general complications. We estimated the effect sizes by grouping data from six case-control studies (1,433 patients) published until January 2018. Results: our meta-analysis showed that patients undergoing complete mobilization of the splenic flexure had a higher risk of anastomotic dehiscence (RR=2.27, 95%CI: 1.22-4.23) compared with those not submitted to this procedure. There was no difference between the groups in terms of mortality, bleeding, infection and general complications. Conclusion: splenic flexure mobilization is associated with a higher risk of anastomotic dehiscence in resections of sigmoid and rectal cancer. This surgical maneuver should be used with caution in the surgical management of sigmoid or rectal cancers.


Subject(s)
Humans , Rectal Neoplasms/surgery , Sigmoid Neoplasms/surgery , Colectomy/methods , Proctectomy/methods , Postoperative Complications , Treatment Outcome , Colectomy/adverse effects , Proctectomy/adverse effects
14.
Rev. argent. cir ; 110(4): 211-214, dic. 2018. ilus
Article in Spanish | LILACS | ID: biblio-985192

ABSTRACT

La preocupación por los trastornos intestinales y la oclusión, como consecuencia de la formación de bridas peritoneoviscerales producidas por gestos quirúrgicos manuales e instrumentales, ha dado lugar a procedimientos con miras a evitarlas o minimizarlas. En este marco, la técnica de mesenteroplicatura con sostén transitorio tiene el propósito de favorecer el ordenamiento fibrointestinal, cuando la patología tratada haga sospechar que se producirán adherencias y más aún si la intervención ha sido causada por estas. Los fundamentos del procedimiento son los mismos que sostienen las técnicas usuales, por lo tanto no hay controversias en cuanto a las indicaciones. La lógica de la sutura transitoria está en que el tutor pierde su objetivo y se retira cuando finaliza el proceso adherencial, alrededor de las dos semanas de la intervención. Se presentan tres casos de oclusión intestinal operados con el procedimiento, controlados y con buenos resultados.


Peritoneal adhesions produced as a consequence of manual or instrumental manipulation during surgery cause bowel obstruction. Several procedures have been developed to avoid or minimize adhesions. Mesenteric plication with temporary suture support organizes the healing process in the bowel in case of high suspicion of adhesions will develop, particularly when bowel obstruction is produced by adhesions. The basis of this technique is the same as for standard procedures and, thus, there are no controversies about its indications. The rationale of temporary suture support is that when the healing process is over, about two weeks after the intervention, the suture support is no longer needed. We report three cases of intestinal obstruction undergoing mesenteric plication and temporary suture support, with favorable outcomes.


Subject(s)
Humans , Male , Adult , Middle Aged , Young Adult , Surgical Procedures, Operative/methods , Intestinal Obstruction/surgery , Tuberculoma/diagnosis , Peritonitis, Tuberculous/surgery , Tuberculosis, Pulmonary/diagnosis , Colectomy/methods , Cholecystitis, Acute , Abdomen, Acute/surgery
15.
Rev. argent. cir ; 110(4): 195-201, dic. 2018. map, tab
Article in Spanish | LILACS | ID: biblio-985189

ABSTRACT

Antecedentes: La cirugía laparoscópica colorrectal continúa en camino de convertirse en el abordaje de elección para el tratamiento de la patología colorrectal benigna y maligna. Sin embargo, su aplicabilidad aún es baja y está mayormente limitada a grandes centros urbanos. Objetivo: analizar la factibilidad de un programa de cirugía laparoscópica colorrectal en un centro de comunidad rural. Como objetivo secundario, comparar los resultados con la cirugía abierta convencional Material y métodos: se analizó una base de datos prospectiva de todos los pacientes operados de forma electiva y consecutiva entre junio de 2012 y diciembre de 2016. Se empleó un criterio de alta estandarizado. Los pacientes fueron divididos en dos grupos según la cirugía fuese laparoscópica (grupo A) o convencional (grupo B). El análisis de variables se realizó con los métodos de Chi cuadrado y T-test según corresponda. Resultados: se realizaron 129 resecciones colorrectales con una proporción de varones del 60% y una mediana de edad de 64 años. El 83% pertenecía a comunidades vecinas. Hubo un 35% de pacientes ASA I, 56% ASA II y 9% ASA III. La distancia promedio del lugar de residencia fue 75 km con una superficie de distribución de 24 000 km2. La mediana de internación fue de 4 días. La aplicabilidad de la laparoscopia fue del 74% con una tasa de conversión del 6%. Ambos grupos fueron similares en términos de sexo, IMC, diagnóstico, ASA, proporción de ASA III-IV, antecedentes clínicos y quirúrgicos, así como también distancia de su lugar de residencia. El grupo A presentó una media de edad menor que el grupo B (61 años vs. 69 años; p < 0,01). No se observaron diferencias en términos de tipo de cirugía y tiempo operatorio. La morbilidad posoperatoria fue 18% y la tasa de readmisión fue del 4%, sin diferencias entre grupos. Conclusiones: la cirugía laparoscópica colorrectal puede ser realizada en un centro rural con bajo índice de readmisión y complicaciones y resultados comparables a los de la cirugía abierta convencional.


Of benign tumors and colorectal cancer. However, its use is low and limited to large urban centers. Objective: The aim of this study was to analyze the feasibility of a laparoscopic colorectal surgery program in a rural community center. The secondary outcome was to compare these results with those of conventional open surgery. Material and methods: We analyzed a prospective data base of all the patients undergoing scheduled and consecutive surgery between June 2012 and December 2016. A standardized discharge criterion was used. The patients were divided into two groups: laparoscopic surgery (group A) and conventional surgery (group B). The variables were analyzed with the chi-square test or Student's t test, as applicable. Results: A total of 129 colorectal resections were performed; median age was 64 years, 60% were men and 83% belonged to neighbor communities. The ASA physical status classification system was grade 1 in 35% of the patients, grade 2 in 56% and grade 3 in 9%. The average distance between patients' place of residence was of 75 km comprising an area of 24,000 km2. Patients were hospitalized for a median of 4 days. The applicability of laparoscopy was 74% with a conversion rate of 6%. There were no significant differences in sex, BMI, diagnosis, ASA grade, proportion of ASA grade 3-4 patients, clinical history, previous surgeries and distance from the place of residency. Compared to group B, patients in group A were younger (61.6 years vs. 69 years; p < 0.01). There were no differences in terms of type of surgery and surgery duration. Postoperative morbidity was 18% and the readmission rate was 4%, with no differences between the groups. Conclusions: Laparoscopic colorectal surgery can be performed in a rural center with low readmission rate and complications; these results are similar to those of conventional open surgery.


Subject(s)
Laparoscopy/methods , Colorectal Surgery/methods , Rural Population , Retrospective Studies , Laparoscopy/statistics & numerical data , Colectomy/methods , Colorectal Surgery/statistics & numerical data
16.
Rev. argent. cir ; 110(2): 101-105, jun. 2018. ilus, tab
Article in Spanish | LILACS | ID: biblio-957902

ABSTRACT

Antecedentes: la diverticulitis cecal es una patología poco común en los países occidentales. Clínicamente es indistinguible de una apendicitis aguda. Objetivos: exhibir los resultados de acuerdo con diferentes abordajes terapéuticos. Material y métodos: se presentan cinco casos de diverticulitis cecal tratados en nuestra institución entre enero de 2013 y diciembre de 2015. Revisión retrospectiva de historias clínicas e imágenes. Revisión de la literatura. Resultados: fueron incluidos cinco pacientes. En cuatro hubo resolución quirúrgica y uno tuvo buena evolución con tratamiento médico. Conclusiones: si bien es poco frecuente, la diverticulitis cecal debe considerarse dentro de los diagnósticos diferenciales frente a un cuadro de dolor abdominal localizado en fosa ilíaca derecha acompañado de estudios por imágenes no categóricos de apendicitis aguda.


Background: cecal diverticulitis is a rare disease in western countries. It is clinically indistinguishable from acute appendicitis. Objetive: to show outcome with different therapeutic approaches. Material and methods: we present five cases of cecal diverticulitis treated at our institution between January 2013 and December 2015. Retrospective review of medical records and images. Review of the literature. Results: five patients were included. Four cases required surgical treatment while one patient resolved with medical treatment. Conclusions: Although it is rare, cecal diverticulitis must be considered within the differential diagnoses in the face of abdominal pain located in the right iliac fossa and non-categorical imaging of acute appendicitis.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Diverticulitis/surgery , Typhlitis/pathology , Gentamicins/administration & dosage , Tomography, X-Ray Computed , Abdominal Pain/complications , Ultrasonography , Laparoscopy , Colectomy/methods , Diverticulitis/drug therapy , Diverticulitis/diagnostic imaging , Abdomen, Acute/complications , Metronidazole/administration & dosage
17.
Prensa méd. argent ; 104(2): 73-78, 20180000. tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1370661

ABSTRACT

Introduccion: La cirugía robótica colorectal se llevó a cabo por primera vez en el Hospital Clínic de Barcelona en Enero de 2016. El objetivo de este estudio es presentar nuestra experiencia inicial en cirugía robótica de pacientes afectos de patología colorectal. Metodos: Esta es una revisión retrospectiva de los datos recogidos de forma prospectiva de los pacientes intervenidos de patología colorectal mediante cirugía robótica entre Enero y Diciembre 2016. Se obtuvieron para análisis las características de los pacientes y los datos tanto peri como postoperatorios. Resultados: Un total de 40 pacientes con una edad media de 69.3 años (42- 93) y un índice de masa corporal medio de 26.8 kg/m2 (15-37) fueron intervenidos mediante cirugía robótica de su patología colorectal. La indicación quirúrgica fue por patología maligna en el 90 % de los casos y patología benigna en el 10 %. La intervención más frecuente fue la sigmoidectomía (57.5 %), seguida de la hemicolectomía derecha (20 %), la resección anterior baja (12.5 %), la hemicolectomía izquierda (7.5 %) y la resección segmentaria de ángulo esplénico (2.5 %). El tiempo operatorio medio fue de 159.9 min (90-260). El número medio de ganglios resecados fue 18.1 (5-42). La estancia mediana fue de 4.6 días (2-13). No hubo ningún caso de conversión a cirugía abierta, únicamente hubo un caso convertido a cirugía laparoscópica (2.5 %) y el índice de fallos de sutura fue de 2.6%. Conclusiones: Aunque se trata de nuestra experiencia inicial, podemos considerar que la cirugía robótica es una técnica factible y segura en pacientes afectos de patología colorectal


ntroduction Robotic colorectal surgery was first performed at our institution in January 2016. The objective of this study is to present our initial experience with robotic colorectal surgery. Methods: This is a retrospective review of the prospectively collected data of all patients who underwent robotic colorectal surgery from January 2016 to December 2016. Baseline, perioperative, and postoperative data were obtained for analysis. Results: A total of 40 patients with a mean age of 69.3 years (42-93) and a body mass index of 26.8 kg/m2 (15-37) underwent robotic colorectal surgery between January and December 2016. The indication for surgery was malignancy in 90% and benign diseases in 10% of the patients. The most common operation was sigmoidectomy (57.5%) followed by right colectomy (20%), low anterior resection (12.5%), left colectomy (7.5%) and splenic flexure segmentary resection (2.5%). The mean operative time was 159.9 (90-260) minutes. The median number of lymph nodes harvested was 18.1 (5-42). The median duration of hospital stay was 4.6 days (2- 13). Conversion to laparoscopic surgery occurred in one case (2.5%) and anastomotic leakage rate was 2.6% Conclusions: Despite being our initial experience, we can consider robotic surgery as a safe and feasible technique for patients with colorectal diseases


Subject(s)
Humans , Middle Aged , Aged , Aged, 80 and over , Rectum/pathology , Retrospective Studies , Colectomy/methods , Colon/pathology , Colorectal Surgery/methods , Minimally Invasive Surgical Procedures/methods , Robotic Surgical Procedures/methods , Perioperative Medicine
18.
Rev. chil. cir ; 70(5): 432-438, 2018. tab
Article in Spanish | LILACS | ID: biblio-978010

ABSTRACT

Introducción: La hemicolectomía derecha con anastomosis ileocólica es una cirugía frecuentemente realizada para la que existen muchas formas de realizarla. Objetivo: Evaluar cuál es la mejor anastomosis ilecólica en términos de morbimortalidad y realizar una evaluación comparativa de la evolución clínica posoperatoria según el tipo de configuración anastomótica. Pacientes y Método: Estudio observacional analítico, con criterios de inclusión y exclusión definidos. Las variables a estudiar las dividimos en dos grupos, las relacionadas a la técnica quirúrgica y su configuración anastomótica, y las variables relacionadas con resultados de la intervención quirúrgica, creando una tabla de contingencia en que se cruzan los datos. Análisis de datos con STATA 13.0. Resultados: 216 pacientes con anastomosis ileocólica, destacando significancia estadística al cruzar: A) reoperación y tipo de sutura (p = 0,044), con un OR 3,4 (IC 95% 0,94-18,6), siendo de mayor riesgo la mecánica; B) mortalidad y urgencia (p = 0,001) con un OR 7,76 (IC 95% 1,56-49,29), siendo de mayor riesgo la cirugía de urgencia. Las anastomosis isoperistálticas possen eliminación de gases (p < 0,001), tránsito intestinal (p = 0,009) e ingesta de sólidos (p = 0,005) más precoz. Hay expulsión de gases antes en el abordaje laparoscópico, sutura manual, configuración término lateral e isoperistáltica de la anastomosis y cirugía electiva. Conclusión: Existe gran variabilidad de técnicas para realizar la anastomosis ileocólica. La anastomosis manual muestra menor probabilidad de necesitar una reintervención quirúrgica, la cirugía electiva tiene menor mortalidad que la realizada de urgencia. Sugerimos realizarla vía laparoscópica, con sutura manual, término lateral, isoperistáltica y de forma electiva, por tener una recuperación más corta.


Introduction: Right hemicolectomy with ileocolic anastomosis is a frequent surgery with many ways to perform it. Objective: To evaluate which is the best ileocolic anastomosis in terms of morbidity and mortality and to make a comparative evaluation of the postoperative clinical evolution according to the type of anastomosis. Patients and Method: Analytical observational study, with defined inclusion and exclusion criteria. The variables to be studied are divided into two groups, those related to the surgical technique and its anastomotic configuration, and the variables related to the results of the surgical intervention, creating a contingency table that crosses the data. Data analysis with STATA 13.0. Results: 216 patients with ileocolic anastomosis, highlighting statistical significance when crossing: A) reoperation and type of suture (p = 0.044), with UN or 3.4 (95% CI 0.94 to 18.6), being of greater risk the mechanics; B) mortality and urgency (p = 0.001) with an OR 7.76 (95% CI 1.56-49.29), with emergency surgery being of greater risk. Isoperistaltic anastomosis with gas elimination (p < 0.001), intestinal transit (p = 0.009) and solid intake (p = 0.005) earlier. There is earlier expulsion of gases in the laparoscopic approach, manual suture, end-to-side and isoperistaltic of the anastomosis and elective surgery. Conclusion: There is great variability of techniques to perform the ileocolic anastomosis. Manual anastomosis is less likely to require surgical reoperation, elective surgery has a lower mortality than that of emergency surgery. We suggest performing it laparoscopically, with manual suture, lateral term, isoperistaltic and electively, for having a shorter recovery.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Anastomosis, Surgical/methods , Anastomosis, Surgical/mortality , Colectomy/methods , Colectomy/mortality , Reoperation , Anastomosis, Surgical/adverse effects , Retrospective Studies , Colectomy/adverse effects , Colon/surgery , Anastomotic Leak/etiology , Anastomotic Leak/epidemiology , Ileum/surgery
19.
Rev. chil. cir ; 70(1): 53-58, 2018. ilus
Article in Spanish | LILACS | ID: biblio-899656

ABSTRACT

Resumen Introducción La clasificación y el manejo de los tumores neuroendocrinos (TNEs) han cambiado drásticamente en la última década. Se realiza un análisis crítico del manejo de los TENs colorrectales primarios intervenidos en nuestro centro a la luz de la nueva clasificación. Material y Método Análisis retrospectivo de los resultados del tratamiento quirúrgico radical de este tipo de lesiones en un período de 15 años. Resultados Se trata de 10 pacientes, con un promedio de 56 años (extremos 48-76), 6 ubicados cercanos a la válvula ileocecal (VIC) que se presentaron con un cuadro de obstrucción intestinal incompleto y tres en el recto (2 pólipos) y un pólipo en colon sigmoides. La cirugía efectuada incluye cuatro resecciones anteriores y seis colectomías derechas (con resección de una metástasis hepática en 1 caso). La mediana de seguimiento fue de 78,3 meses (extremos 8-180), durante el cual dos pacientes fallecen por metástasis a distancia. Conclusión Los TNEs ubicados en el colon habitualmente se presentaron como grandes masas tumorales cercanos a la VIC, lo que proporcionalmente no ocurre con las lesiones del rectosigmoides que son diagnosticados más precozmente como pólipos o lesiones submucosas. Algunos tumores de bajo grado muestran un compromiso avanzado en la pared y/o los linfonodos regionales lo que justifica la resección radical y/o la quimioterapia adyuvante. A la luz de esta experiencia, es necesario complementar el grado del tumor OMS 2010 (Ki-67 y número de mitosis) con el estadio TNM para caracterizar adecuadamente los TNEs, lo que influye en el manejo multidisciplinario.


Background The nomenclature and staging classification of neuroendocrine tumors (NETs) has changed drastically in the past decade. Objective To do a critical analysis of management of colorectal NETs in our institution in the light of the new classification. Methods We retrospectively reviewed the records of consecutive patients operated on with radical intention due to a colorectal NET in the last 15 years. Results There were 10 patients, median age was 56 years (range 48-76), six of them located near the ileocecal valve, three in the rectum (2 of them polyps) and one polyp in the sigmoid colon. Surgical procedure included four anterior resections and six right colectomy (one with hepatic resection). The median follow up was 78.3 months (range 8-180). Two patients died due to metastatic disease. Conclusion NETs located near de ileocecal valve were diagnosed usually as a big tumor with obstructing symptoms, while NETs of the rectum and sigmoid colon more frequently were detected as polyps or submucosal lesions. Some low grade TENs may invade the colonic wall and/or have metastasis in the regional lymph nodes and those cases need radical resection and/or adjuvant therapy. Combine the grade (Ki-67 and number and/or number of mitosis) of 2010 WHO classification with TNM showed prognostic value for classification and staging colorectal NETs with important therapeutic implications.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Colorectal Neoplasms/surgery , Colectomy/methods , Neuroendocrine Tumors/surgery , Immunohistochemistry , Colorectal Neoplasms/pathology , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Neuroendocrine Tumors/pathology
20.
ABCD arq. bras. cir. dig ; 31(4): e1406, 2018. tab
Article in English | LILACS | ID: biblio-973376

ABSTRACT

ABSTRACT Background: Deep infiltrating colorectal endometriosis may severely affect the quality of life and fertility of patients. Although segmental resection is a therapeutic option that provides positive outcomes in the management of symptoms, its functional effects are still unproven. Aim: Assess the late impact of the laparoscopic approach in treating deep infiltrating endometriosis with segmental colorectal resection. Methods: Prospective case series of 46 patients submitted to laparoscopic treatment of deep infiltrating endometriosis with segmental colorectal resection between 2013 and 2016. Fertility, gynecological and bowel symptoms were assessed at the preoperative period and at three and 12 months (or more) after the procedure. Results: Preoperative interview assessed the prevalence of infertility (45.6%), gynecological (87%) and intestinal (80.4%) symptoms. At the third month after the procedure a significant reduction in the prevalence of gynecological symptoms (p<0,001), tenesmus (p=0,001) and dysquesia (p=0,002) was observed. After a period of 12 months or more following the procedure a significant reduction in the prevalence persisted for dysmenorrhea (p=0,001), deep dyspareunia (p=0,041), chronic pelvic pain (p=0,011) and dysquesia (p=0,001), as compared to the preoperative period. Total pregnancy rate was 57.1% and spontaneous pregnancy 47.6%. Conclusion: The treatment of deep infiltrating endometriosis using segmental colorectal resection has provided early and late relief of gynecological and bowel symptoms. The outcomes also indicate a positive impact on the fertility of infertile patients.


RESUMO Racional: A endometriose profunda infiltrativa colorretal pode impactar de maneira importante na qualidade de vida e na fertilidade das pacientes. A ressecção segmentar é uma opção terapêutica com resultados positivos na queda dos sintomas, porém ainda sem efeitos funcionais comprovados. Objetivo: Avaliar o impacto tardio do tratamento laparoscópico da endometriose profunda infiltrativa com ressecção segmentar colorretal. Métodos: Série de casos prospectiva com 46 pacientes submetidas ao tratamento laparoscópico para endometriose profunda infiltrativa com ressecção segmentar colorretal entre 2013 e 2016. Foram analisados sintomas ginecológicos, intestinais e a fertilidade no período pré-operatório, três e 12 meses ou mais após o procedimento. Resultados: Na entrevista pré-operatória, foram levantadas as prevalências de sintomas ginecológicos (87%), intestinais (80,4%) e de infertilidade (45,6%). No 3º mês pós-operatório, observou-se redução significativa da prevalência dos sintomas ginecológicos (p<0,001) e de sintomas intestinais, tenesmo (p=0,001) e disquesia (p=0,002). Após 12 meses ou mais observou-se diminuição significativa da prevalência de dismenorreia (p=0,001), de dispareunia profunda (p=0,041) e de dor pélvica crônica (p=0,011) além de disquesia (p=0,001) em relação ao período pré-operatório. As taxas de gravidez total e espontânea foram de 57,1% e 47,6%, respectivamente. Conclusão: O tratamento da endometriose profunda infiltrativa com ressecção segmentar colorretal proporcionou alívio precoce e tardio dos sintomas ginecológicos e intestinais. Os resultados sugerem impacto positivo sobre a fertilidade em pacientes inférteis.


Subject(s)
Humans , Female , Pregnancy , Middle Aged , Young Adult , Laparoscopy/methods , Colectomy/methods , Endometriosis/surgery , Proctectomy/methods , Postoperative Complications , Time Factors , Prospective Studies , Treatment Outcome , Laparoscopy/adverse effects , Colectomy/adverse effects , Proctectomy/adverse effects , Infertility, Female
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