Hematoma subcapsular esplénico espontáneo y mononucleosis infecciosa: una asociación de interés para el cirujano

La rotura espontánea de bazo es una complicación infrecuente pero muy grave de la mononucleosis infecciosa. Dada la urgencia con la que suele presentarse tal situación, la esplenectomía suele ser la opción quirúrgica más utilizada. Presentamos el caso de un paciente en el que con el diagnóstico de rotura esplénica espontánea se somete a laparoscopia diagnóstica en la que se consigue la preservación del bazo con buena evolución clínica. A la luz de este paciente, consideramos que, en caso de estabilidad clínica y hematomas subcapsulares de bazo, la laparoscopia con preservación esplénica es una opción viable y con buenos resultados. (provisto por Infomedic International)

Spontaneous rupture of the spleen is a rare but very serious complication of infectious mononucleosis. Given the urgency with which such a situation usually presents, splenectomy is usually the most used surgical option. We present the case of a patient diagnosed with spontaneous splenic rupture who underwent diagnostic laparoscopy in which spleen preservation was achieved with good clinical evolution. In the light of this patient, we consider that, in the case of clinical stability and subcapsular haematomas of the spleen, laparoscopy with splenic preservation is a viable option with good results. (provided by Infomedic International)

Long-Term Anorectal Manometry Outcomes After Laparoscopic and Transanal Total Mesorectal Excision.

Background: During transanal total mesorectal excision (TaTME), sustained dilation of the anal canal occurs, which can cause anatomical and functional damage to the sphincter complex. This study aimed to analyze the impact of laparoscopic total mesorectal excision (LaTME) and TaTME in anorectal sphincter function. Materials and Methods: An observational study was conducted comparing two cohorts of patients who underwent LaTME or TaTME for rectal cancer. The two groups were paired for comparison based on age, gender, and distance of the neoplasm to the anal margin. The anorectal function was assessed by manometry before surgery and at least 6 months after primary intervention or stoma closure. The intestinal function was assessed using the low anterior resection syndrome (LARS) score. Results: Twenty-two patients were included. There were no significant differences in baseline characteristics between groups except for the time between surgery and testing. A decrease in the mean resting and squeeze pressures between pre- and postoperative manometry was observed in both the treatment groups, the difference being only significant in the squeeze pressure values (TaTME P = .003; LaTME P = .004). After surgery, squeeze pressure reduction correlated with a worsening of the LARS point count (rho 0.587; P = .004). The time elapsed since surgery was negatively correlated with the LARS point count (rho -0.696; P = .001) and the difference between pre- and postoperative mean squeeze pressures (rho -0.499; P = .018). Conclusion: Manometric findings after TME are comparable between the laparoscopic and the transanal approach. Deterioration of both anal sphincter function and LARS improves with time after surgery.

Reconstrucción pélvica tras amputación abdominoperineal del recto / Pelvic reconstruction after abdominoperineal resection of the rectum

A pesar de los avances en el tratamiento del cáncer de recto y la expansión del abordaje terapéutico multimodal, todavía es necesaria la realización de una amputación abdominoperineal (AAP) como tratamiento radical en el 20-30% de los casos. La AAP del recto está gravada con una importante morbilidad, destacando la obstrucción intestinal y las complicaciones de la herida, pudiendo desarrollarse una enteritis radica en el 15% de los casos sometidos a radioterapia postoperatoria. Además, con el fin de mejorar los resultados oncológicos a nivel local, se recomienda la realización de una AAP ampliada, técnica que precisa de un procedimiento de reconstrucción perineal que permita un cierre sin tensión en un tejido previamente radiado y prevenga el desarrollo de hernias perineales. El objetivo de este trabajo es revisar los métodos de reparación pélvica y perineal tras la AAP por cáncer, con especial atención a las nuevas técnicas de reparación protésica (AU)

Despite the advances in the treatment of cancer of the rectum and the expansion of the multimodal therapeutic technique, abdominoperineal resection (APR) still needs to be performed as radical treatment in 20-30% of cases. APR of the rectum involves a significant morbidity, including intestinal obstruction and wound complications, with radiotherapy-induced enteritis being able to develop in 15% of cases subjected to post-operative radiotherapy. Furthermore, with the aim of improving local oncology results, an extended APR is recommended; a technique that requires a perineal reconstruction technique that allows a tension free closure in a previously radiated tissue and may prevent perineal hernias developing. The objective of this article is to review pelvic and perineal repair methods after APR due to cancer, with special attention to the new prosthetic repair techniques (AU)

[Pelvic reconstruction after abdominoperineal resection of the rectum]. / Reconstrucción pélvica tras amputación abdominoperineal del recto.

Despite the advances in the treatment of cancer of the rectum and the expansion of the multimodal therapeutic technique, abdominoperineal resection (APR) still needs to be performed as radical treatment in 20-30% of cases. APR of the rectum involves a significant morbidity, including intestinal obstruction and wound complications, with radiotherapy-induced enteritis being able to develop in 15% of cases subjected to post-operative radiotherapy. Furthermore, with the aim of improving local oncology results, an extended APR is recommended; a technique that requires a perineal reconstruction technique that allows a tension free closure in a previously radiated tissue and may prevent perineal hernias developing. The objective of this article is to review pelvic and perineal repair methods after APR due to cancer, with special attention to the new prosthetic repair techniques.

Cirugía laparoscópica con puerto único: ampliación del espectro de utilización / Single port laparoscopic surgery: Widening the spectrum of use

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Prevention of trocar site hernias: description of the safe port plug technique and preliminary results.

The aim of this study was to describe a new technique to prevent the development of incisional hernias in trocar sites. Between March and June 2006, a pilot study was conducted to determine the feasibility of the safe port plug technique using the Bioabsorbable Hernia Plug to prevent incisional hernia in trocar sites. The device was implanted in the umbilical trocar site (10-11 mm) of 17 patients undergoing laparoscopic surgery during the study period. The mean follow-up of patients was 14.6 months. Implantation of the Bioabsorbable Hernia Plug device by the safe port plug technique was possible in all cases. No patient presented complications in the follow-up. Our preliminary experience suggests that this technique is simple and feasible, and we hypothesized that this technique could be superior to conventional fascial closure: a hypothesis that must be proven in a randomized prospective trial that is currently in progress.

Division of the small bowel with the LigaSure Atlas device during the right laparoscopic colectomy.

BACKGROUND: Bowel division and anastomosis were facilitated greatly with the advent of stapling techniques. Since then, there have not been any new evolving technologies to facilitate these maneuvers. For this reason, we recently applied the LigaSure Atlas device (Valleylab, Boulder, CO) to the division of the small bowel during this procedure to obtain a reliable and low-cost division of the ileum. METHODS: After vessel ligation and ileocolic mobilization, the terminal ileum is sealed and divided with the LigaSure Atlas. This device is applied sequentially along the small bowel twice to ensure an adequate seal before the cut. A terminolateral ileotransversostomy is performed extracorporeally with a mechanical circular stapling device, installing the anvil of the circular stapler into the ileal stump. RESULTS: We have not encountered any problems with this technique since its introduction in our institution, and no leakage or bursting of the ileal stumps. CONCLUSIONS: This technique enables an easy, reliable, and inexpensive technical option to optimize the right laparoscopic colectomy procedure.