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J. coloproctol. (Rio J., Impr.) ; 42(1): 102-106, Jan.-Mar. 2022. ilus
Article in English | LILACS | ID: biblio-1375764


Colorectal cancer (CRC) is the fourth most frequently diagnosed cancer in the United States and it is found in 17% of patients thought to have complicated diverticular disease. However, primary adenocarcinoma rarely occur in the colostomy site and the risk of developing malignancy is similar to that of any other colonic segment. Polyps found in CRC screenings can be divided into the following types: hyperplastic polyps, polyps with no malignant potential, adenomatous polyps, polyps with malignant potential, and malignancies. Local complications of the colostomy can appear in the immediate, early, or late postoperative period, with an incidence ranging from 15 to 30%; neoplasia is even less common. (AU)

Humans , Male , Aged , Colostomy/adverse effects , Adenocarcinoma , Colonic Neoplasms , Prolapse , Colonic Polyps , Colon/pathology , Diverticular Diseases
J. coloproctol. (Rio J., Impr.) ; 41(3): 286-288, July-Sept. 2021. tab
Article in English | LILACS | ID: biblio-1346419


Background: A colostomy is a surgical approach that creates an opening for the colon, or/and large intestine through the abdomen. Anorectal malformations are a group of abnormalities of the rectum and anus that are present at birth. Objective: To analyze the common complications of colostomy in anorectal formations. Methods: This was a retrospective study conducted on 50 temporary colostomies performed in children at the Surgical Department of the Abu Ghraib General Hospital in the period from January 2018 to January 2020. Information was collected regarding the patients' age, sex, body weight, associated anomalies, colostomy types and sites, and the indications and complications of colostomies. Results: A total of 44 (88%) cases were reported in the children's 1st month of life. The ratio of male to female was 1:1. Pelvic colostomy was performed in 48 (96%) patients, as 40 (80%) children underwent a loop-type, and 8 (16%) patients underwent doublebarrel colostomy. Transverse colostomy was performed on two patients. Prolapse occurred in 50% of the patients, and skin excoriations occurred in 22% . A total of 10% of the children developed sepsis. Bleeding was seen in 4% of the children after colostomy performance. Stenosis presented in 6% of the children, and this was corrected by repeated dilatation and re-fashioning. Obstruction of intestines was observed in one patient. The retraction developed in 6% of patients. Conclusions: Imperforate anus was themost common indication for stoma formation in the pediatric age group. Loop colostomy was the most common type used, and it had the highest rate of complications. Prolapses and skin excoriation were the most common complications found. (AU)

Humans , Male , Female , Infant, Newborn , Infant , Colostomy/adverse effects , Anorectal Malformations/surgery , Surgical Stomas
J. coloproctol. (Rio J., Impr.) ; 40(4): 311-314, Oct.-Dec. 2020. tab
Article in English | LILACS | ID: biblio-1143185


ABSTRACT Parastomal Hernia (PSH) is a common complication of patient who undergone ostomy especially end colostomy. Presence of hernia defect is associated with the risk of strangulation and obstruction so understanding the potential risk factor such as patient's factor and technical issues is important. This study is evaluating the incidence of PSH hernia in patients who undergone end colostomy due to Abdominoperineal Resection (APR) in a tertiary colorectal surgery referral center and explore the possible risk factors of this complication. The study was designed as a retrospective cross sectional study on 41 patients who undergone end colostomy due to APR. Three patient lost the follow up and 13 patients died and 25 patients were enrolled in study. Demographic data, history of smoking, steroid administration, Diabetes, obstructive pulmonary disease, transfusion, Neoadjuvant therapy, wound infection and Body mass Index (BMI) were gathered. The mean age of participants was 58.8 and the mean BMI was 25.04 kg/m2. The incidence of PSH was 40% and 68% of operations were done with Laparoscopy. This study could not find statistically significant risk factor for PSH. The 40% incidence of PSH is noticeable and specific strategies should be applied to reduce such complications. Larger studies is essential to investigate the possible etiologies of this complication.

RESUMO A hérnia paraestomal é uma complicação comum em pacientes submetidos a estomia, especialmente a colostomia terminal. A presença de defeito de hérnia está associada ao risco de estrangulamento e obstrução, portanto, é importante compreender o potencial fator de risco, como o fator do paciente e questões técnicas. Este estudo avalia a incidência de hérnia paraestomal em pacientes submetidos à colostomia terminal devido à ressecção abdominoperineal em um centro terciário de referência em cirurgia colorretal e explorar os possíveis fatores de risco dessa complicação. O desenho do estudo foi transversal retrospectivo de 41 pacientes submetidos à colostomia terminal devido à ressecção abdominoperineal. Três pacientes foram perdidos no seguimento, 13 pacientes morreram, e 25 pacientes foram incluídos no estudo. Dados demográficos, história de tabagismo, administração de esteroides, diabetes, doença pulmonar obstrutiva, transfusão, terapia neoadjuvante, infecção de ferida operatória e Índice de Massa Corporal foram coletados. A média de idade dos participantes foi 58,8 e o índice de massa corporal médio foi 25,04 kg/m2. A incidência de hérnia paraestomal foi de 40% e 68% das cirurgias foram realizadas por laparoscopia. Este estudo não encontrou fator de risco estatisticamente significativo para hérnia paraestomal. A incidência de 40% de hérnia paraestomal é perceptível e estratégias específicas devem ser aplicadas para reduzir tais complicações. Estudos maiores são essenciais para investigar as possíveis etiologias dessa complicação.

Humans , Male , Female , Colostomy/adverse effects , Proctectomy/adverse effects , Hernia/physiopathology
ABCD arq. bras. cir. dig ; 33(3): e1546, 2020. tab, graf
Article in English | LILACS | ID: biblio-1152618


ABSTRACT Background: The Hartmann procedure remains the treatment of choice for most surgeons for the urgent surgical treatment of perforated diverticulitis; however, it is associated with high rates of ostomy non-reversion and postoperative morbidity. Aim: To study the results after the Hartmann vs. resection with primary anastomosis, with or without ileostomy, for the treatment of perforated diverticulitis with purulent or fecal peritonitis (Hinchey grade III or IV), and to compare the advantages between the two forms of treatment. Method: Systematic search in the literature of observational and randomized articles comparing resection with primary anastomosis vs. Hartmann's procedure in the emergency treatment of perforated diverticulitis. Analyze as primary outcomes the mortality after the emergency operation and the general morbidity after it. As secondary outcomes, severe morbidity after emergency surgery, rates of non-reversion of the ostomy, general and severe morbidity after reversion. Results: There were no significant differences between surgical procedures for mortality, general morbidity and severe morbidity. However, the differences were statistically significant, favoring primary anastomosis in comparison with the Hartmann procedure in the outcome rates of stoma non-reversion, general morbidity and severe morbidity after reversion. Conclusion: Primary anastomosis is a good alternative to the Hartmann procedure, with no increase in mortality and morbidity, and with better results in the operation for intestinal transit reconstruction.

RESUMO Racional: O procedimento a Hartmann permanece sendo o tratamento de escolha da maioria dos cirurgiões para o tratamento cirúrgico de urgência da diverticulite perfurada, entretanto está associado com altas taxas de não reversão da ostomia e de morbidade pós-operatória. Objetivo: Estudar os resultados após o procedimento de Hartmann vs. ressecção com anastomose primária, com ou sem ileostomia, para o tratamento da diverticulite perfurada com peritonite purulenta ou fecal (grau de Hinchey III ou IV), e comparar as vantagens entre as duas formas de tratamento. Método: Busca sistemática na literatura de artigos observacionais e randomizados comparando ressecção com anastomose primária vs. procedimento de Hartmann no tratamento de urgência da diverticulite perfurada. Analisar como desfechos primários a mortalidade após a operação de urgência e a morbidade geral após ela; como desfechos secundários, a morbidade severa após a operação de urgência, as taxas de não reversão da ostomia, a morbidade geral e severa após a reversão. Resultados: Não houve diferenças significativas entre os procedimentos cirúrgicos para mortalidade, morbidade geral e morbidade severa. Contudo, as diferenças foram significativas estatisticamente favorecendo anastomose primária na comparação com procedimento de Hartmann nos desfechos taxas de não reversão do estoma, morbidade geral e morbidade severa após reversão. Conclusão: A anastomose primária apresenta-se como boa alternativa ao procedimento de Hartmann, sem aumento de mortalidade e morbidade, e com melhores resultados na operação de reconstrução do trânsito intestinal.

Humans , Peritonitis/etiology , Colon, Sigmoid/surgery , Digestive System Surgical Procedures/adverse effects , Diverticulitis/surgery , Diverticulitis/complications , Intestinal Perforation/surgery , Peritonitis/surgery , Postoperative Complications , Digestive System Surgical Procedures/methods , Anastomosis, Surgical/methods , Colostomy/adverse effects , Ileostomy/adverse effects , Treatment Outcome , Diverticulitis/pathology , Intestinal Perforation/pathology
J. coloproctol. (Rio J., Impr.) ; 35(2): 106-112, Apr-Jun/2015. tab
Article in English | LILACS | ID: lil-752418


The objective was to characterize the clientele of ostomy patients living in Pouso Alegre, Minas Gerais, Brazil. Among the causes that led patients to acquire an ostomy, the most prevalent was neoplasia; the type of ostomy was a permanent colostomy. Most people were not told that they would be submitted to the stoma. In addition, individuals were not subject to stoma demarcation, and irrigation was not performed. Regarding the type of complication, 34 (48.60%) had dermatitis; 14 (20%), retraction; and 13 (18.60%), prolapse. With respect to stoma diameter, 34 (48.60%) had 20-40 mm and 23 (32.90%), 40-60 mm. With this study, we became aware of the profile of ostomized patients treated at the municipality of Pouso Alegre/MG; it is expected that, with these data, the improvement of care to this population can be subsidized. We suggest that nursing professionals think of health action strategies with respect to guidance on stoma manufacture and to measures aiming for the prevention of possible complications, promoting ways to help these patients to make decisions and to verbalize feelings, so that they feel supported in coping with changes in their body image, for the sake of survival. (AU)

O objetivo foi caracterizar a clientela de estomizados residentes em Pouso Alegre, Minas Gerais. maioria das causas que levaram os pacientes a adquirir ostomia foi neoplasia; o tipo de ostomia era colostomia em definitivo. A maioria dos indivíduos não foram comunicados de que seriam submetidos ao estoma. Além disso, os indivíduos não foram submetidos à demarcação do estoma e não foi realizada irrigação. Com relação ao tipo de complicação, 34(48,60%) apresentaram dermatite; 14 (20%), retração e 13 (18,60%), prolapso. Com relação ao diâmetro do estoma, 34 (48,60%) mensuravam 20 a 40 mm e 23 (32,90%), 40 a 60 mm. Este estudo possibilitou conhecer o perfil dos pacientes ostomizados atendidos do município de Pouso Alegre/MG e espera-se que, com esses dados, se possa subsidiar a melhoria da assistência a essa clientela. Sugere-se aqui aos enfermeiros pensar em estratégias de aç ões de saúde com relação às orientaç ões sobre a confecção do estoma, medidas de prevenção de possíveis complicaç ões, promovendo meios para auxiliar esses pacientes a tomarem decisões, verbalizarem sentimentos, de modo que se sintam apoiados no enfretamento das mudanças da sua imagem corporal em prol da sobrevivência. (AU)

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Health Profile , Colostomy/adverse effects , Colostomy/nursing
ABCD arq. bras. cir. dig ; 28(1): 65-69, 2015. tab
Article in English | LILACS | ID: lil-742742


BACKGROUND: The use of laparoscopy for the treatment of gastric cancer suffered some resistance among surgeons around the world, gaining strength in the past decade. However, its oncological safety and technical feasibility remain controversial. AIM: To describe the results from the clinical and anatomopathological point of view in the comparative evaluation between the surgical videolaparoscopic and laparotomic treatments of total gastrectomy with linphadenectomy at D2, resection R0. METHOD: Retrospective analyses and comparison data from patients submitted to total gastrectomy with D2 linphadenectomy at a sole institution. The data of 111 patients showed that 64 (57,7%) have been submitted to laparotomic gastrectomy and 47 (42,3%) to gastrectomy entirely performed through videolaparoscopy. All variables related to the surgery, post-operative follow-up and anatomopathologic findings have been evaluated. RESULTS: Among the studied variables, videolaparoscopy has shown a shorter surgical time and a more premature period for the introduction of oral and enteral nourishment than the open surgery. As to the amount of dissected limph nodes, there has been a significant difference towards laparotomy with p=0,014, but the average dissected limph nodes in both groups exceed 25 nodes as recommended by the JAGC. Was not found a significant difference between the studied groups as to age, ASA, type of surgery, need for blood transfusion, stage of the disease, Bormann classification, degree of differentiation, damage of the margins, further complications and death. CONCLUSION: The total gastrectomy with D2 lymphadenectomy performed by laparoscopy presented the same benefits known of laparotomy and with the advantages already established of minimally invasive surgery. It was done with less surgical time, less time for re-introduction of the oral and enteral diets and lower hospitalization time compared to laparotomy, without increasing postoperative ...

RACIONAL: A utilização da videolaparoscopia para o tratamento das neoplasia gástricas sofreu certa resistência entre os cirurgiões ao redor do mundo, ganhando força na década passada. Porém, sua segurança oncológica e viabilidade técnica continuam controversas. OBJETIVO: Demonstrar os resultados do ponto de vista clínico e anatomopatológico na avaliação comparativa entre o tratamento cirúrgico videolaparoscópico e laparotômico da gastrectomia total com linfadenectomia a D2, ressecção R0. MÉTODOS: Estudo retrospectivo dos dados dos prontuários dos pacientes submetidos à gastrectomia total com lindadenectomia a D2, em uma única instituição. Dos 111 prontuários, 64 (57,7%) foram submetidos à gastrectomia laparotômica e 47 (42,3%) à gastrectomia totalmente vídeolaparoscópica. Foram avaliadas variáveis relacionadas ao ato cirúrgico, a evolução pós-operatória e a achados anatomopatológicos. RESULTADOS: A técnica videolaparoscópica demonstrou tempo cirúrgico menor e período para re-introdução alimentar oral e enteral mais precoce que a operação laparotômica. Quanto ao número de linfonodos dissecados, houve diferença significante a favor da laparotômica (p=0,014); porém, a média de linfonodos dissecados em ambos os grupos ultrapassou os 25 preconizados pela JAGC. Não foi encontrada diferença significante entre os grupos estudados no que diz respeito à idade, gênero, ASA, tipo de operação, necessidade de hemotransfusão, estadiamento, classificação de Bormann, grau de diferenciação, comprometimento de margens, complicações e óbito. CONCLUSÕES: A gastrectomia total com linfadenectomia a D2 realizada por videolaparoscopia apresenta os mesmos benefícios conhecidos da cirurgia laparotômica e com as vantagens já estabelecidas da cirurgia minimamente invasiva. Ela apresentou menor tempo cirúrgico, menor tempo para a re-introdução das dietas oral e enteral e tempo de alta menor em relação à laparotômica, sem aumentar as complicações pós-operatórias. .

Aged , Female , Humans , Colostomy/adverse effects , Herniorrhaphy , Laparoscopy , Surgical Stomas/adverse effects , Recurrence , Reoperation , Surgical Mesh
Rev. Col. Bras. Cir ; 39(5): 389-393, set.-out. 2012. tab
Article in Portuguese | LILACS | ID: lil-656253


OBJETIVO: Avaliar a morbimortalidade de operações realizadas para fechamento de colostomias e ileostomias em alça. MÉTODOS: Foram analisados os dados epidemiológicos, complicações pós-operatórias, morbidade e mortalidade de pacientes que se submeteram à operações para fechamento de colostomias e ileostomias em alça. Foram excluídos os pacientes cujos dados não puderam ser obtidos nos prontuários e os que operações para fechamento requereram laparotomia mediana. RESULTADOS: Foram operados 88 pacientes, sendo cinco excluídos. Foram avaliados os dados de 83 pacientes, 56 pacientes com colostomias (grupo C) e 27 com ileostomias (grupo I). O sexo masculino predominou em ambos os grupos (grupo C = 71,9% e grupo I = 57,7%). No grupo C a indicação mais comum para a confecção do estoma foi trauma abdominal (43,9%) e no grupo I foi proteção de anastomose colorretal (57,6%). A taxa de deiscência de anastomose no grupo C foi 3,5% e no grupo I foi 19,2 %. A morbidade no grupo I foi maior do que no grupo C (30,7% X 12,2%). Ocorreu um óbito no grupo I. CONCLUSÃO: O estudo sugere que taxas de morbidade associadas ao fechamento do estoma são altas e foram maiores no grupo de pacientes com ileostomia em alça.

OBJECTIVE: To evaluate the morbidity and mortality of operations for closure of loop colostomies and ileostomies. METHODS: We analyzed epidemiological data, postoperative complications, morbidity and mortality of patients who underwent operations for closure of loop colostomies and ileostomies. We excluded patients whose data could not be obtained from the files and operations that required laparotomy for closure. RESULTS: 88 patients were operated on, five being excluded. We evaluated the data of 83 patients, 56 patients with colostomies (group C) and 27 with ileostomies (group I). Males predominated in both groups (C = 71.9% and I = 57.7%). In group C the most common indication for making the stoma was abdominal trauma (43.9%) and in group I it was protecting a colorectal anastomosis (57.6%). The rate of anastomotic dehiscence in group C was 3.5% and in group I 19.2%. Morbidity was higher in group I than in group C (30.7% vs. 12.2%). There was one death in group I. CONCLUSION: The study suggests that morbidity associated with stoma closure is high, being higher in patients with loop ileostomy.

Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Colostomy/adverse effects , Ileostomy/adverse effects , Postoperative Complications/epidemiology , Postoperative Complications/mortality , Reoperation , Retrospective Studies
J. coloproctol. (Rio J., Impr.) ; 31(4): 397-400, Oct.-Dec. 2011. ilus
Article in English | LILACS | ID: lil-623494


Intestinal evisceration at the site of a stoma is a rare event, with high morbimortality. Its clinical manifestation often occurs between the sixth and seventh days after surgery. The risk factors most frequently related to evisceration are: increased intra-abdominal pressure, digestive tract cancer surgery, emergency surgery and stomas in the surgical incision. The authors report the case of a male patient, aged 62, suffering from adenocarcinoma of the rectum with obstructive acute abdomen, who underwent loop transversotomy for decompression. On the fourth day after surgery, he had a bronchospasm crisis, with evisceration of ileum and colon through the colostomic hole. The association of some triggering factors, such as emergency surgery, colorectal malignant neoplasm, increased intra-abdominal pressure and technical failure of colostomy were decisive in the development of this rare peri-colostomy complication. (AU)

A evisceração intestinal desenvolvida no sítio de um estoma é um evento raro, tendo elevada morbimortalidade. Sua manifestação clínica ocorre frequentemente entre o sexto e o sétimo dias de pós-operatório. Os fatores de risco mais frequentemente relacionados à evisceração são: aumento da pressão intra-abdominal, câncer do aparelho digestório, cirurgia de urgência e estomias na incisão cirúrgica. Os autores relatam o caso de um paciente do sexo masculino, com 62 anos, portador de adenocarcinoma do reto médio com abdômen agudo obstrutivo, sendo submetido à transversostomia em alça, com finalidade descompressiva. No quarto dia de pós-operatório com crise de broncoespasmo, apresentou evisceração do cólon e íleo pelo orifício abdominal colostômico. A associação de alguns fatores desencadeantes, como a cirurgia de urgência, a doença neoplásica colorretal maligna, o aumento da pressão intra-abdominal e a falha técnica na confecção da colostomia, foram determinantes para o desenvolvimento desta rara complicação pericolostômica. (AU)

Humans , Male , Middle Aged , Colostomy/adverse effects , Surgical Stomas/adverse effects , Intestines/surgery , Bronchial Spasm/complications , Abdominal Wound Closure Techniques
Cir. & cir ; 77(5): 365-368, sept.-oct. 2009. tab
Article in Spanish | LILACS | ID: lil-566473


Introducción: El colon es el segundo órgano más frecuentemente lesionado en las heridas por trauma penetrante de abdomen. En México, las lesiones por arma blanca o de fuego van en aumento. Nuestro objetivo fue evaluar el principal manejo para las lesiones traumáticas de colon. Material y métodos: Estudio retrospectivo y aleatorizado de 178 pacientes con trauma abdominal y lesiones de colon, en un lapso de cinco años (enero de 2003 a junio de 2008) en el Hospital General de Balbuena. Se comparó el uso del cierre primario y cirugía derivativa con colostomía. Se analizó sexo, grupo de edad, tipo de herida, grado de lesión y mortalidad. Resultados: De 178 pacientes, 156 fueron hombres (87.6 %) y 22 mujeres (12.4 %). El grupo de edad con mayor afección fue el de 21 a 30 años; 74 pacientes (41.6 %) presentaron heridas por instrumento punzocortante y 104 pacientes (58.4 %) heridas por arma de fuego. El principal manejo fue mediante cierre primario: 92 casos (51.7 %) versus 86 (48.3 %) para cirugía derivativa; sin embargo, en las heridas por arma de fuego el principal manejo fue la colostomía (67 casos). La mortalidad fue de 17 casos (9.55 %) debido a causas diversas como lesiones a múltiples órganos de manera asociada. Conclusiones: En las lesiones colónicas debe individualizarse el tratamiento, según la etiopatogenia, grado de lesión y lesiones asociadas.

BACKGROUND: Colon trauma is frequent and its prevalence is difficult to establish because of the different factors that intervene in its origin. In Mexico, traumatic colon injuries, albeit stab wounds or gunshot wounds, are on the rise. Our objective was to evaluate the most appropriate management for traumatic colon injuries. METHODS: We conducted a retrospective study of 178 case files of patients with abdominal trauma and colon lesions during a 5-year period from January 2003 to June 2008 from the General Hospital of Balbuena, Mexico City. The study compared the use of primary closure vs. colostomy, analyzing variables such as sex, age, type of wound, severity of lesion and mortality. RESULTS: There were a total of 178 patients; 156 were male (87.6%) and 22 were female (12.4%). The most affected age group was between 21 and 30 years; 74 patients (41.6%) had stab wounds and 104 patients (58.4%) had gunshot wounds. Management consisted mainly of primary closure in 92 cases (51.7%) vs. colostomy in 86 patients (48.3%). However, 64% of gunshot wounds were treated with colostomy. Reported mortality was 9.55% and this was due to different factors such as multiple organ injury. CONCLUSIONS: Treatment of traumatic colon injury should be case specific, taking into account the mechanism of the lesion, its severity and associated injuries.

Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Colon/surgery , Colostomy/statistics & numerical data , Wounds, Stab/surgery , Wounds, Gunshot/surgery , Wound Infection/epidemiology , Digestive System Surgical Procedures/statistics & numerical data , Abdominal Injuries/surgery , Shock/etiology , Shock/therapy , Colon/injuries , Colostomy/adverse effects , Colostomy , Postoperative Complications/prevention & control , Wounds, Stab/epidemiology , Wounds, Gunshot/epidemiology , Surgical Wound Infection/epidemiology , Wound Infection/drug therapy , Mexico/epidemiology , Digestive System Surgical Procedures/adverse effects , Digestive System Surgical Procedures , Retrospective Studies , Suture Techniques , Multiple Trauma/epidemiology , Multiple Trauma/surgery , Abdominal Injuries/epidemiology , Viscera/injuries , Young Adult
Rev. argent. coloproctología ; 19(2): 79-88, jun. 2008. tab
Article in Spanish | LILACS | ID: lil-579579


Introducción: La conducta quirúrgica óptima para el tratamiento de la colopatía diverticular perforada es aún motivo de controversia. La resección y anastomosis primaria como forma de tratamiento de la colopatía diverticular perforada ha ganado espacio en el ámbito de la cirugía de urgencia. En el presente trabajo se analiza en forma retrospectiva nuestra experiencia en el tratamiento quirúrgico de la patología colónica diverticular perforada en presencia de peritonitis purulenta generalizada (Hinchey III). Material y Método: Se analizan 24 pacientes operados en el Servicio de Proctología del Hospital y por médicos pertenecientes al Servicio, que se desempeñan en la práctica privada, en el periodo comprendido entre Enero de 1997 y Diciembre de 2006 portadores de diverticulitis aguda perforada con peritonitis purulenta generalizada (Hinchey III). Resultados: De los 24 pacientes incluidos en la serie, la resección con anastomosis primaria (RAP) fue utilizada en 18 casos (75 por ciento). En seis casos la anastomosis fue protegida mediante una colostomía transversa sobre varilla. Se presentaron complicaciones en tres casos (12,5 por ciento) en dos relacionados con la cirugía (absceso de pared y absceso retroperitoneal) y 1 caso de embolia de arteria radial. No se registraron dehiscencias anastomóticas. El cierre de la colostomía transversa se efectuó en los seis casos dentro de los 90 días de la primera cirugía. Los seis casos restantes fueron tratados mediante resección y operación tipo Hartmann. En este grupo 2 pacientes (33 por ciento) tuvieron complicaciones relacionadas con la cirugía (absceso de pared y necrosis de la colostomía). Un paciente falleció luego de tres lavados de la cavidad peritoneal. Conclusión: A la luz de estos resultados consideramos que la RAP es una variante válida para el tratamiento de la colopatía diverticular perforada en presencia de peritonitis purulenta generalizada (Hinchey III)...

Background: The optimal surgical conduct for the treatment of perforated diverticular disease is still a controversial issue. The resection and primary anastomosis as a way of treating this disease has gained space in the area of emergency surgery. The aim of this study was to analyze our experience in the surgical treatment of perforated diverticular disease with diffuse peritonitis (Hinchey III). Materials and Methods: We analyzed 24 Hinchey III patients operated by the same surgeons at the Proctology Service of our Hospital and in private practice, between January 1997 and December 2006. Results: Of the 24 patients included in the serie, resection with primary anastomosis (RPA) was performed in 18 cases (75 per cent). In six cases the anastomosis was protected by transverse colostomy. There were three postoperative complications (12.5 per cent), in two cases related to surgery (one surgical site infection and one retroperitoneal abscess) and l case of embolism of radial artery. There were no anastomotic dehiscence. The closure of the transverse colostomy was performed in all six cases within 90 days after the first surgery. The six remaining cases were treated through resection and Hartmann's procedure. In this group 2 patients (33 per cent) had complications related to surgery (abscess at surgical site and necrosis of the colostomy). One patient died after three relaparotomies. Conclusion: The RPA is a valid option for the treatment of diverticular perforated disease with diffuse purulent peritonitis (Hinchey III). We believe that peritonitis will not determine the possibility of a successful RPA. Probably are the general and local patients conditions, an adequate infrastructure care center and surgical team training in colon surgery are nessesary to performed this treatment in perforated diverticular diseases with purulent diffuse peritonitis. More series will endorse this treatment.

Humans , Male , Female , Middle Aged , Aged, 80 and over , Diverticulosis, Colonic/surgery , Diverticulosis, Colonic/complications , Intestinal Perforation/complications , Peritonitis/surgery , Peritonitis/etiology , Anastomosis, Surgical/methods , Colorectal Surgery/methods , Colostomy/adverse effects , Colostomy/methods , Morbidity , Postoperative Complications , Sepsis/etiology , Sepsis/mortality
Acta cir. bras ; 23(3): 230-236, May-June 2008. ilus, tab
Article in English | LILACS | ID: lil-484381


PURPOSE: To elaborate an animal model with the objective of studying the continence of the biological valves surgically performed in the left colon of rats. METHODS: Thirty four rats were operated on and divided into three groups (G). G1 (sham) animals which underwent laparotomy only; G2 (perineal amputation without valves): animals which underwent amputation of the anal sphincter complex combined with a perineal colostomy; G3 (abdominoperineal amputation combined with valves): animals which underwent abdominoperineal amputation combined with three, equidistant and circumferential (360(0)), extra-mucosal seromyotomies, of the descending colon, which were sutured to create biological valves combined with perineal colostomy. Animals were euthanized in the late postoperative period and surgical valves were saved for histopathological study. RESULTS: Surgical procedure provoked intestinal dilation, as well as segmented chambers along the descending colon. Retained fecalomas between the valves and proximal to them were also noted. Six rats died of intestinal obstruction due to fecal impaction at the surgical site. The sequence of events was: stasis, obstruction, distention, perforation, peritonitis and death. Histopathology showed inflammation due to foreign body type reaction around the sutured colon causing partial concentric stenosis, capable of interfering normal mechanical activity of the distal colon. This process resulted in retardation of the intestinal transit. CONCLUSION: Extra-mucosal seromyotomies, with seromuscular suture, can be used as an operative procedure capable of causing retardation in the intestinal transit of rats.

OBJETIVO: Modelo de experimentação, com confecção de válvulas biológicas no cólon esquerdo de ratos com o objetivo de estudar o grau de continência dessas válvulas. MÉTODOS: Trinta e quatro ratos foram operados e distribuidos em três grupos: G1 (grupo simulado) submetido apenas à laparotomia, G2 (grupo amputado sem válvula) submetido à amputação do conjunto esfincteral mais colostomia perineal e G3 (grupo amputado com válvula) submetido à amputação do conjunto esfincteral, confecção de três seromiotomias extra-mucosas, eqüidistantes e circunferenciais (360(0) - válvulas biológicas), no colon descendente mais colostomia perineal. No pós-operatório tardio, os animais dos três grupos foram submetidos à eutanásia para coleta da peça cirúrgica e estudo histopatológico das válvulas. RESULTADOS: Os resultados mostraram que o procedimento culminou em dilatação intestinal, confirmada pela formação de verdadeiras câmaras de segmentação e pela presença de fecalomas retidos entre as válvulas e cranialmente a elas. Seis ratos morreram em decorrência de obstrução intestinal por impacção de fezes no local operado, na seqüência: obstrução, estase, distensão, perfuração, peritonite e morte. As alterações histopatológicas confirmaram o processo inflamatório com reação do tipo corpo estranho, no perímetro do cólon suturado, proporcionando uma estenose parcial concêntrica, levando à alteração da atividade mecânica do cólon distal, resultando no retardo do trânsito intestinal. CONCLUSÃO: As seromiotomia extramucosas, com sutura seromuscular, podem ser utilizadas como técnica operatória para se obter retardo do trânsito intestinal em ratos.

Animals , Male , Rats , Colon, Descending/pathology , Colon, Descending/surgery , Colostomy/methods , Fecal Impaction/etiology , Gastric Emptying/physiology , Anastomosis, Surgical/methods , Colon, Descending/ultrastructure , Colostomy/adverse effects , Disease Models, Animal , Fecal Incontinence/pathology , Fibrosis/pathology , Foreign-Body Reaction/pathology , Giant Cells, Foreign-Body/ultrastructure , Lymphocytes, Tumor-Infiltrating , Postoperative Complications/mortality , Rats, Wistar , Suture Techniques
Rev. argent. coloproctología ; 19(1): 18-25, mar. 2008. ilus, tab
Article in Spanish | LILACS | ID: lil-574120


Antecedentes: Si bien las colostomías transversas son menos frecuentes en la actualidad, su uso en las cirugías colorrectales sigue siendo útil y la morbilidad relacionada a la misma es elevada. Objetivos: Analizar y discutir las complicaciones en una serie de .pacientes en quienes se efectuaron colostomías transversas y su posterior cierre, todas realizadas por un mismo equipo quirúrgico. Lugar de aplicación: Medio sanatorial de la ciudad de Buenos Aires. Población y método: Estudio retrospectivo de 46 colostomías transversas realizadas a pacientes con afecciones colorrectales y 48 cierres de colostomías entre 1988 y 2006. Las colostomías se efectuaron en 26 hombres y 20 mujeres con una edad promedio de 62 años (rango = 44-87). El 78,24 % fueron realizadas en forma simultánea a la operación principal, las restantes como única cirugía o como primer paso de cirugía en etapas. Se realizaron 48 cierres de colostomías transversas, 9 fueron en pacientes derivados de otros centros. Fueron 25 mujeres y 23 hombres con una edad promedio de 56 años (rango= 46-78). Resultados: Hubieron 16 (34,78 %) complicaciones colostómicas desde la confección hasta el cierre, del ostoma, 4 (8,70 %) prolapsos, 4 (8,70 %) dermatitis severas, 3 (6,52 %) hernias paracolostómicas, 2 (4,35 %) edemas y 2 (4,35 %) cierres espontáneos. no hubo óbitos vinculados a la confección de las colostomías y el seguimiento final hasta el cierre fue en 39 (84,78 %) pacientes. Posteriormente al cierre de las colostomías hubieron 12 (25 %) complicaciones. 5 (10,42 %) abscesos. 3 (6,35 %) eventraciones y 3 (6,25 %) seromas, una fístula anastomótica (2,08 %) que se resolvió espontáneamente en 48 horas...

Background: Even though colostomy is less frequent nowadays, it's use in colorectal disease is still useful and the morbidity related to it is high. Objectives: Analyze and discuss the complications in patients that underwent transverse colostomies and posterior closure. Setting: Private clinics in Buenos Aires. Population and Method: Retrospective study of 46 transverse colostomies realized in patients with colorectal diseases and 48 closures of colostomies between 1998 and 2006: 26 men, 20 women, average age of 62 years (range = 44-87). The 78,24 per cent were realized in simultaneous form with the major procedure, the others as an only surgery or as a first step in stage surgeries. 48 transversal closures were done, 9 of them in patients derivative from other clinics. Patients were 25 women and 23 men with an average age of 56 years (range = 46-78). Results: There were 16 (34,78 per cent) colostomy complications, 4 (8,70 per cent) prolapses, 4 (8,70 per cent) severe dermatologic complications, 3 (6,52 per cent) parastomal hernias, 2 (4.35 per cent) edemas and 2 (4.35 per cent) spontaneous closures. there were no deaths related with the confection and the follow up until the closure was at 39 (84,78 per cent) patients. After colostomy closure appeared 12 (25 per cent) complications. 5 (10,42 per cent) abscesses. 3 (6,35 cent) ventral hernias and 3 (6,35 per cent) seromas, 1 (2,08 per cent) anastomotic leak that resolved spontaneously within 48 hours. Conclusions: The results of this investigation suggest: 1. Know that not all of the transverse colostomy will close, that will be an issue for the patient and an extra cost. 2. Due to high morbidity and mortality, accurate indications should be taken when proceeding a transversal colostomy. 3. Most of complications are result of a bad technique. 4. It shouldn't be considered as a minor surgery, this ex pose the need of a qualified surgical team.

Humans , Male , Adult , Female , Middle Aged , Colostomy/adverse effects , Colostomy/methods , Postoperative Complications , Colorectal Surgery/methods , Morbidity , Surgical Wound Dehiscence
Clinics ; 60(4): 271-276, Aug. 2005. ilus, tab
Article in English | LILACS | ID: lil-408025


Hérnias paracolostômicas são complicações freqüentes de estomas intestinais. A correção pode ser realizada através do seu reposicionamento ou mantendo a mesma localização, associada ao reforço da parede abdominal com ou sem o emprego de prótese. MÉTODOS: Os resultados do tratamento cirúrgico de hérnias paracolostômicas são analisados em 22 pacientes em nosso serviço nos últimos 15 anos. Todos os pacientes eram portadores de colostomias terminais após ressecção abdominoperineal do reto. RESULTADOS: Em 15 (68,2%) pacientes, a correção da hérnia foi realizada mantendo-se a colostomia no local original, em 2 (9,1%) deles através de herniorrafia simples e em 13 (59,1%) com reforço da aponeurose com prótese biológica. Nos outros 7 (31,8%) pacientes, a correção foi realizada por reposicionamento da colostomia. O seguimento médio pós-operatório foi de 50,2 meses. Recidiva foi observada em 3 (13,6%) casos (em média 16 meses após correção). CONCLUSÃO: A hérnia paracolostômica continua a ser um desafio cirúrgico devido a sua elevada recidiva. Correção primária com prótese pode ser favorecida, uma vez que freqüentemente se observa fraqueza da aponeurose.

Female , Humans , Male , Bioprosthesis , Colostomy/adverse effects , Hernia, Ventral/surgery , Surgical Mesh , Surgical Stomas/adverse effects , Follow-Up Studies , Hernia, Ventral/etiology , Recurrence , Reoperation , Retrospective Studies , Treatment Outcome
Rev. chil. cir ; 52(6): 639-42, dic. 2000. tab
Article in Spanish | LILACS | ID: lil-282173


El cierre de la colestomía en asa (CCA) es una técnica sencilla en comparación con el restablecimiento de tránsito post operación de Hartmann (RT); en la literatura se le asigna una considerable morbilidad e incluso mortalidad, probablemente porque con frecuencia se presentan a ambos procedimientos en conjunto. El objetivo de este trabajo fue comparar 2 series contemporáneas de CCA y RT, realizadas por los mismos cirujanos entre enero de 1978 y diciembre de 1997, para demostrar diferencias significativas con respecto a la morbimortalidad, a favor del cierre de la colostomía en asa. Se compararon 75 casos de CCA con 63 de RT, similares en cuanto a edad, sexo, estado nutricional, enfermedades concomitantes y lapso entre la confección y el cierre de la colostomía. Las principales indicaciones de la colostomía. Las principales indicaciones de la colostomía en asa fueron el trauma colorrectal y la obstrucción del colon distal por cáncer (25,3 por ciento c/u), mientras que para la operación de Hartmann, fueron la diverticulitis complicada (25 por ciento) y el vólvulo del sigmoides (20 por ciento). Se observó una significativa menor morbilidad global en el CCA (8 por ciento) que en el RT (38,1 por ciento). Del mismo modo hubo menos infección de herida operatoria en el CCA (4 por ciento) que en el RT (19,1 por ciento) (p<0,01). Aunque no hubo diferencias estadísticamente significativas, la incidencia de reoperación también fue menor en el CCA que en el RT (1,3 por ciento v/s 4,8 por ciento). Asimismo, hubo menor mortalidad en el CCA (0 por ciento) que en el RT (3,2 por ciento), lo que clínicamente es importante

Humans , Male , Female , Colostomy/adverse effects , Intestinal Neoplasms/surgery , Morbidity , Digestive System Surgical Procedures/statistics & numerical data , Nutritional Status/physiology , Intestinal Obstruction/epidemiology , Postoperative Complications/epidemiology , Gastrointestinal Transit/physiology
Acta cir. bras ; 15(supl.3): 24-9, 2000. ilus, tab, graf
Article in Portuguese | LILACS | ID: lil-282450


O tratamento das lesões do cólon têm se modificado com relação à escolha da técnica do reparo primário à colostomia e ao reparo secundário. Entre os fatores de risco para síntese primária está o tempo transcorrido. O objetivo deste estudo é avaliar as interferências do tempo transcorrido entre a feitura da lesão e a síntese, sobre o processo de cicatrização. Para isto utilizaram-se 80 ratos Wistar PUC-PR. Sob anestesia inalatória confeccionou-se uma lesão no cólon esquerdo compromentendo 50 por cento da circunferência da intestinal. Após 12, 18 e 24 horas procedeu-se à síntese. Comparou-se estas colorrafias com as realizadas imediatamente após a lesão. Avaliaram-se as cicatrizes com 4 e 7 dias, verificando-se a existência de deiscências, a capacidade de suportar pressão e a síntese de colágeno. Registrou-se o óbito de 5 ratos...

Animals , Female , Rats , Wound Healing/physiology , Collagen , Colon/injuries , Colostomy/adverse effects , Peritonitis/etiology , Photomicrography , Rats, Wistar , Risk Factors , Sepsis/etiology
Acta cir. bras ; 15(supl.3): 53-7, 2000. tab, graf
Article in Portuguese | LILACS | ID: lil-282455


Este estudo teve como objetivo analisar a ocorrência de complicações em pacientes submetidos à colostomia e reconstrução do trânsito intestinal. Para isto, estudou-se 56 pacientes, com idade média de 39 anos, sendo 37 homens e 19 mulheres. As principais indicações para a colostomia foram ferimento por arma de fogo (35 por cento), doença diverticular perfurada (12,5 por cento) e câncer colo-retal (12 por cento). O tipo de colostomia mais realizado foi terminal (70 por cento), com utilização do sigmóide em 71,4 por cento dos casos. O tempo médio de permanência da colostomia foi de 5,5 meses. A reconstrução do trânsito foi realizada através de anastomose término-terminal em 85,7 por cento dos pacientes, através de síntese mecânica com stapler circular em 5 pacientes ou manual em 51 pacientes. Observou-se taxa de complicações de 25 por cento, sendo as mais frequentes a infecção de parede (35,7 por cento), as fístulas (28,6 por cento) e a hemorragia digestiva baixa (21,4 por cento). Conclui-se que a reconstrução do trânsito intestinal não está isenta de riscos cirúrgicos e apresenta taxas consideráveis de complicações pós-operatórias, sendo que a infecção continua a ser um dos maiores desafios existentes neste procedimento.

Humans , Male , Female , Adult , Colostomy/adverse effects , Postoperative Complications , Anti-Bacterial Agents/therapeutic use , Wound Healing , Clinical Protocols , Colostomy , Drainage , Surgical Wound Infection , Surgical Wound Dehiscence
African Journal of Urology. 1998; 4 (2): 98-104
in English | IMEMR | ID: emr-47346


This study was carried out to evaluate a new simple technique for the construction of a stable colorectal valve that can avoid regurgitation of rectal contents to the colon without temporary faecal diversion. This new technique was applied in four mongrel dogs. The sigmoid is separated from the rectum. The terminal end of the sigmoid is everted to form a nipple valve that is anastomosed obliquely end-to-side in the distal part of the opened rectum. Therefore, the distal half of the nipple valve is projecting inside the rectal lumen. The proximal part of the rectum is closed after leaving a stent reaching from the anus up to the area above the valve. Postoperative descending and ascending proctographic studies revealed a non-obstructed unidirectional flow of rectal contents to the exterior. We therefore conclude that this technique is relatively simple and safe and successfully allows easy unidirectional flow of rectal contents to the exterior without impediment to the faecal stream and without the need for temporary proximal colostomy

Female , Animals , Sigmoidoscopy , Colonoscopy , Anastomosis, Surgical , Colostomy/adverse effects , Acidosis , Dogs
Rev. Col. Bras. Cir ; 22(3): 169-70, maio-jun. 1995. ilus
Article in Portuguese | LILACS | ID: lil-156616


A case of large paracolostomy hernia, repaired by extra-peritoneal access with the ostomy kept in its original site, is present. The use of Marlex mesh is recommended in the repair of large herniation without changing the ostomy site. It proved to be easy to done with good post-operative results

Humans , Male , Middle Aged , Colostomy/adverse effects , Hernia, Ventral/surgery , Hernia, Ventral/etiology