RESUMEN
BACKGROUND: Esophageal cancer is the 8th most common and 6th most deadly malignancy worldwide. It is an aggressive type of cancer with poor prognosis, despite advances in therapeutic methods including those in thoracoabdominal surgery, chemotherapy and radiotherapy. It rarely manifests in young patients, but occurs frequently in older people. It has been related with achalasia regarding mainly the squamous cell carcinoma rather than the adenocarcinoma. Infiltrating esophageal tumors and radiotherapy can lead to the development of aortoesophageal fistula, a pathological communication between the aorta and the esophagus. CASE: We present the case of a 24-year-old male patient with a known history of achalasia for almost 15 years with a history of heavy smoking and drinking that presented with advanced lower esophageal adenocarcinoma. The patient was submitted, as per to his will, directly to Ivor Lewis esophagogastrectomy. One month later, dysphagia was manifested due to stenosis of the anastomosis, without any signs of local recurrence, and an esophageal metallic stent was placed. In the 3rd postoperative month, upper gastrointestinal bleeding presented due to an aortoesophageal fistula, caused by anastomotic dehiscence due to local recurrence and pressure from the stent, which was treated surgically. The patient, refusing chemotherapy at all stages, developed peritoneal carcinomatosis and died 6 months after surgery. CONCLUSION: Esophageal cancer is an aggressive type of cancer with a poor prognosis that is typically dia-gnosed in advanced stages. Despite the development of new therapeutic approaches, the high recurrence rate and the poor prognosis remain.
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Adenocarcinoma/cirugía , Acalasia del Esófago/etiología , Fístula Esofágica/etiología , Neoplasias Esofágicas/cirugía , Esofagectomía/efectos adversos , Adenocarcinoma/etiología , Anastomosis Quirúrgica/efectos adversos , Neoplasias Esofágicas/etiología , Esofagectomía/métodos , Hemorragia Gastrointestinal/etiología , Humanos , Masculino , Stents/efectos adversos , Adulto JovenRESUMEN
Surgical treatment of haemorrhoids is, primarily, performed on an outpatient basis, and as so, the reduction of the operative time and the hospitalization duration is necessary. In order to achieve these results, both the surgical procedure and the anaesthesia modality should be optimized. Therefore, in this randomized controlled trial, we proposed the hemorrhoidal arteries ligation under pudendal nerve block, as an enhanced outpatient modality, versus the standard of doppler guided hemorrhoidal arteries ligation under spinal anaesthesia. Preliminary results showed that the experimental group was characterized by a similar to the control arm, symptoms remission rate, a lower operation duration and an improved postoperative recovery.
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Hemorreoidectomía/métodos , Hemorroides/cirugía , Procedimientos Quirúrgicos Ambulatorios , HumanosRESUMEN
Following the excision of hemorrhoidal nodes during hemorrhoidectomy, intense pain is reported to be the main postoperative problem, which can last for several weeks. Hemorrhoidopexy, an alternative treatment for hemorrhoids introduced in the late nineties, replaced hemorrhoid excision by a reduction of the hemorrhoids to their normal anatomical position, via an excision of a mucosal ring above the internal hemorrhoidal cushions. The latter excision results in minimal or no postoperative pain. In 2010, a new variant of the hemorrhoidopexy set was introduced in the European market. The variations of this set, including a detachable anvil and a lined proctoscope, aid the surgeon in performing an easier and safer hemorrhoidopexy.
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Hemorroides/cirugía , Dolor Postoperatorio/prevención & control , Proctoscopios , Proctoscopía/instrumentación , Grapado Quirúrgico/métodos , Adulto , Anciano , Estudios de Cohortes , Diseño de Equipo , Femenino , Estudios de Seguimiento , Hemorreoidectomía/instrumentación , Hemorreoidectomía/métodos , Hemorroides/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Dimensión del Dolor , Seguridad del Paciente , Proctoscopía/métodos , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
Aim. The aim of this paper is to investigate if the insertion of the pelvic drainage tube via the perineal wound could be considered as an independent risk factor for perineal healing disorders, after abdominoperineal resection for rectal malignancy. Patients and Methods. The last two decades, 75 patients underwent elective abdominoperineal resection for malignancy. In 42 patients (56%), the pelvic drain catheter was inserted through the perineal wound (PW group), while in the remaining 33 (44%) through a puncture skin wound of the perineum (SW group). Patients' data with respect to age (P = 0.136), stage (P > 0.05), sex (P = 0.188) and comorbidity (P = 0.128) were similar in both groups. 25 patients (PW versus SW: 8 versus 17, P = 0.0026) underwent neoadjuvant radio/chemotherapy. Results. The overall morbidity rate was 36%, but a significant increase was revealed in PW group (52.4% versus 9%, P = 0.0007). In 33.3% of the patients in the PW group, perineal healing was delayed, while in the SW group, no delay was noted. Perineal healing disorders were revealed as the main source of increased morbidity in this group. Conclusion. The insertion of the pelvic drain tube through the perineal wound should be considered as an independent risk factor predisposing to perineal healing disorders.
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AIM: The aim of this experimental study is to investigate the effects of tacrolimus on colonic anastomotic healing after subcutaneous administration. MATERIALS AND METHODS: Forty Albino-Wistar male rats were divided into two groups, with two equal subgroups each. They all underwent colonic resection followed by a single-layer, inverted colon anastomosis and were injected subcutaneously with either 1 ml of 0.9% NaCl solution or tacrolimus (0.1 mg/kg body weight) depending on their group. Half of the rats were sacrificed on the fourth postoperative day, while the remaining half were sacrificed on the eighth postoperative day. Macroscopical and histological assessment was performed, while anastomotic bursting pressures and the tissue concentrations in hydroxyproline and collagenase I were evaluated. RESULTS: On the fourth postoperative day, the bursting pressures (217.00 ± 11.12, p < 0.001), the fibroblast activity (2.80 ± 0.42, p = 0.022), the neoangiogenesis (2.10 ± 0.32, p = 0.007) and the tissue hydroxyproline concentration (254.23 ± 67.10, p = 0.001) were significantly higher in the tacrolimus-treated animals. Furthermore, tacrolimus significantly decreased the inflammatory cell infiltration (1.50 ± 0.53, p < 0.001) and the tissue collagenase I concentration (4.16 ± 0.76, p = 0.002). On the eighth day, the bursting pressure (264.00 ± 32.61, p < 0.001) and the hydroxyproline tissue concentration (331.04 ± 55.56, p = 0.002) were significantly higher in the tacrolimus subgroups. The inflammatory cell infiltration (1.20 ± 0.42, p < 0.001) and the collagenase I concentration (1.61 ± 0.83, p < 0.001) were significantly lower. In addition, the adhesion formation score was significantly lower (1.20 ± 0.92, p = 0.065). CONCLUSION: Tacrolimus, when injected subcutaneously, promotes healing of colonic anastomoses in rats. It impairs not only inflammatory response but also collagen degradation, resulting to increased anastomotic strength on the fourth as well as on the eighth postoperative day.
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Colon/cirugía , Inmunosupresores/farmacología , Tacrolimus/farmacología , Cicatrización de Heridas/efectos de los fármacos , Anastomosis Quirúrgica , Animales , Colagenasas/efectos de los fármacos , Colagenasas/metabolismo , Colon/metabolismo , Colon/patología , Hidroxiprolina/efectos de los fármacos , Hidroxiprolina/metabolismo , Masculino , Presión/efectos adversos , Ratas , Ratas Wistar , Rotura/etiologíaRESUMEN
Transcatheter arterial embolization is a valuable, minimally invasive method, used as treatment for upper gastrointestinal bleeding, after failed primary endoscopic approach. It is a safe and effective procedure, but it's use is limited because of relatively high rates of rebleeding and mortality. The aim of this paper is to present a case of severe, massive upper gastrointestinal bleeding deriving from gastric angiodysplasia, which was treated successfully with superselective embolization. The patient recovered from the haemorrhagic shock and avoided emergency surgical intervention.
RESUMEN
BACKGROUND: The purpose of this experimental study was to assess the effects of the immediate postoperative intraperitoneal administration of oxaliplatin and 5-FU on the healing of colonic anastomoses in rats. METHODS: Sixty rats were randomized into 4 groups of 15 rats each and were subjected to colonic anastomoses. To the 1st group, saline solution was administered immediately postoperatively, intraperitoneally. To the 2nd group, 5-FU was administered, to the 3rd group oxaliplatin and to the 4th group 5-FU and oxaliplatin were administered immediately postoperatively, intraperitoneally. After killing the rats on the 8th postoperative day, the anastomoses were examined macroscopically and the anastomotic bursting pressures were measured. The anastomoses were also examined histologically and the hydroxyproline contents were determined. RESULTS: Rupture of the anastomosis was observed in no rats of the 1st group, in 3 rats of the 2nd group, in 4 rats of the 3rd group and in 7 rats of the 4th group (P = 0.016). The bursting pressure (P < 0.001), the hydroxyproline content (P < 0.001) and the concentration of collagen (P < 0.001) and fibroblasts (P < 0.001) were significantly lower in the 2nd, 3rd and 4th group in comparison with the 1st group. The formation of adhesions and the leukocytosis on the anastomoses were significantly higher in the 2nd, 3rd and 4th group than in the 1st group (P < 0.001). CONCLUSIONS: The immediate postoperative, intraperitoneal administration of oxaliplatin, 5-FU or the combination of 5-FU and oxaliplatin impairs the healing of colonic anastomoses in rats.
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Antimetabolitos Antineoplásicos/farmacología , Antineoplásicos/farmacología , Colon/cirugía , Fluorouracilo/farmacología , Compuestos Organoplatinos/farmacología , Cicatrización de Heridas/efectos de los fármacos , Anastomosis Quirúrgica , Animales , Antimetabolitos Antineoplásicos/administración & dosificación , Antineoplásicos/efectos adversos , Colon/irrigación sanguínea , Colon/química , Colon/patología , Fluorouracilo/efectos adversos , Hidroxiprolina/análisis , Hidroxiprolina/efectos de los fármacos , Leucocitosis/etiología , Masculino , Neovascularización Fisiológica/efectos de los fármacos , Compuestos Organoplatinos/efectos adversos , Oxaliplatino , Presión/efectos adversos , Ratas , Ratas Wistar , Rotura/etiología , Adherencias Tisulares/etiologíaRESUMEN
AIM: The aim of this experimental study is the assessment of the effects of the immediate post-operative intraperitoneal administration of 5-fluorouracil and irinotecan on the healing process of large bowel anastomoses in rats. MATERIALS AND METHODS: Sixty male Wistar rats were divided into 4 groups of 15 rats each. The rats underwent large bowel resection and anastomosis, followed by the intraperitoneal administration of normal saline (group 1), 5-fluorouracil (group 2), irinotecan (group 3) or the combination of 5-fluorouracil and irinotecan (group 4). All animals were killed on the eighth post-operative day. During post-mortem examination, the anastomoses were assessed macroscopically for a possible anastomotic leak and the extent of adhesion formation. Subsequently, the anastomotic bursting pressure was measured, and the anastomoses were assessed histologically. RESULTS: No anastomotic dehiscence was observed in the rats of group 1. In groups 2 and 3, we observed 3 anastomotic leaks in each group, and in group 4, we observed 5 leaks (P = 0.111). The mean bursting pressure of the anastomoses in group 1 was significantly higher compared to groups 2, 3 and 4 (P < 0.001). The least inflammatory cell infiltration score was observed in group 1 (P < 0.001). The lowest neoangiogenesis score was observed in group 2 and the highest in group 4. The collagen formation in group 1 was significantly higher compared to the other 3 groups (P < 0.001). Similar results were observed for the fibroblast activity, where group 1 revealed significantly higher fibroblast scores compared to groups 2, 3 and 4 (P < 0.001). Finally, groups 2, 3 and 4 showed significantly lower hydroxyproline levels compared to the control group (P < 0.001). CONCLUSION: The immediate, post-operative intraperitoneal administration of 5-fluorouracil or irinotecan had a negative effect on the healing process of the large bowel anastomoses in rats. The negative effects of the combination of 5-fluorouracil and irinotecan were statistically more significant compared to the single use of 5-fluorouracil or irinotecan.
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Antimetabolitos Antineoplásicos/farmacología , Antineoplásicos Fitogénicos/farmacología , Camptotecina/análogos & derivados , Colon/cirugía , Fluorouracilo/farmacología , Cicatrización de Heridas/efectos de los fármacos , Anastomosis Quirúrgica , Fuga Anastomótica/etiología , Animales , Antimetabolitos Antineoplásicos/efectos adversos , Antineoplásicos Fitogénicos/efectos adversos , Camptotecina/efectos adversos , Camptotecina/farmacología , Colon/irrigación sanguínea , Colon/química , Colon/patología , Fluorouracilo/efectos adversos , Hidroxiprolina/análisis , Hidroxiprolina/efectos de los fármacos , Irinotecán , Masculino , Neovascularización Fisiológica/efectos de los fármacos , Presión/efectos adversos , Ratas , Ratas Wistar , Rotura/etiología , Adherencias Tisulares/etiologíaRESUMEN
AIM: The aim of this study is to present our experience with the laparoscopic treatment approach for colonic carcinoma. PATIENTS AND METHODS: Between 2005 and 2010, laparoscopic colectomy was performed in 13 patients; 9 patients underwent laparoscopic right hemicolectomy, 3 sigmoidectomy and 1 patient underwent laparoscopic caecectomy. RESULTS: With regards to the right hemicolectomies, the average operative time was 168 min and the average hospital stay 5.3 days. In patients who underwent laparoscopic sigmoidectomy, the average operative time was 176 min, while the average hospital stay was 10.2 days. Finally, the laparoscopic caecectomy was performed in 85 min. There was one conversion (7.7%) to an open procedure, as well as one case (7.7%) of anastomotic leakage, which was treated with re-laparotomy and a Hartmann's procedure. Up to today, all patients remain healthy with no signs of tumor recurrence. CONCLUSION: Laparoscopic colectomy for cancer, in the hands of an experienced laparoscopic surgeon, is a safe and efficient procedure.
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Carcinoma/cirugía , Neoplasias del Ciego/cirugía , Colectomía , Neoplasias del Colon/cirugía , Laparoscopía , Adulto , Anciano , Fuga Anastomótica/etiología , Fuga Anastomótica/cirugía , Carcinoma/patología , Neoplasias del Ciego/patología , Colectomía/efectos adversos , Neoplasias del Colon/patología , Femenino , Humanos , Laparoscopía/efectos adversos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Neoplasias del Colon Sigmoide/patología , Neoplasias del Colon Sigmoide/cirugía , Factores de Tiempo , Resultado del TratamientoRESUMEN
AIM: The aim of this study is to present our experience in colonic lipomas. PATIENTS AND METHODS: We present 4 patients (1 male, 3 females) of mean age 65.5 years (range, 61-72 years) treated for single colonic lipomas. The diameters of the lesions were 4.5, 4, 3.5 and 2.5 cm, respectively. In 3 cases, colonic lipomas were located within the cecum, while in one patient within the descending colon, proximally to the splenic flexure. RESULTS: Lipomas of diameter greater than 3 cm caused nonspecific symptoms. Lipomas of higher diameter were removed laparoscopically with colotomy; in two cases, the patients underwent open hemicolectomy, because of the suspicion of malignancy, while the smallest lesion was resected endoscopically, using a bipolar snare. All patients recovered without complications and remain healthy with no signs of recurrence. CONCLUSION: In cases of ulcerated lipomas, greater than 3 cm of diameter, surgical resection is recommended.
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Neoplasias del Colon/cirugía , Lipoma/cirugía , Anciano , Neoplasias del Colon/diagnóstico , Femenino , Humanos , Lipoma/diagnóstico , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: The purpose of this experimental study is to investigate the effects of iloprost on colonic anastomotic healing in rats, after intraperitoneal administration. METHODS: Forty male Albino-Wistar rats were randomized into two groups of twenty animals each. They all underwent colonic resection followed by an inverted anastomosis. The rats of Group A (control) received 3 ml of NaCl intraperitoneally, while those of Group B (iloprost) received iloprost (2 µg/kg body weight), immediately postoperatively and daily until killed. Each group was further divided into two equal subgroups, depending on the day of killing. The animals of subgroups 1 were killed on the fourth postoperative day, while those of subgroups 2 on the eighth. Macroscopical and histological assessments were performed. Besides, anastomotic bursting pressures and the tissue concentrations in hydroxyproline and collagenase I were also evaluated. RESULTS: No anastomotic dehiscence was noted. The mean bursting pressure was higher in the iloprost group compared with the control group, but a significant difference was revealed only on the fourth postoperative day. Furthermore, iloprost significantly increased the new vessel formation on the fourth, as well as on the eighth postoperative day. CONCLUSION: Iloprost enhances the early phase of colonic anastomotic healing in rats.
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Colon/cirugía , Iloprost/farmacología , Vasodilatadores/farmacología , Cicatrización de Heridas/efectos de los fármacos , Anastomosis Quirúrgica , Animales , Colagenasas/análisis , Colagenasas/efectos de los fármacos , Colon/irrigación sanguínea , Colon/química , Colon/patología , Hidroxiprolina/análisis , Hidroxiprolina/efectos de los fármacos , Iloprost/efectos adversos , Masculino , Neovascularización Fisiológica/efectos de los fármacos , Presión/efectos adversos , Ratas , Ratas Wistar , Rotura/etiología , Factores de Tiempo , Adherencias Tisulares/etiología , Vasodilatadores/efectos adversosRESUMEN
AIM: The aim of this study is to review the time between formation and closure of loop ileostomies following total mesorectal excision in patients with rectal cancer. PATIENTS AND METHODS: A retrospective study of 170 patients who underwent low anterior resection for rectal cancer, between 1990 and 2009. Loop ileostomies were created in 8 patients. RESULTS: Of the 8 patients with defunctioning loop ileostomies, 4 received adjuvant chemo-radiotherapy, 3 received neo-adjuvant chemo-radiotherapy and 1 did not receive anything. There was 12.5% morbidity. The time from formation to closure for the patient with no adjuvant therapy was 3 months and for those with adjuvant therapy was 7 months. This was a significant delay. CONCLUSION: Time between formation and closure of loop ileostomy following anterior resection of rectum is significantly delayed by adjuvant chemotherapy.
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Ileostomía/métodos , Neoplasias del Recto/cirugía , Quimioterapia Adyuvante , Colectomía , Terapia Combinada , Humanos , Radioterapia Adyuvante , Estudios Retrospectivos , Factores de TiempoRESUMEN
AIM: The aim of this study is to present our patients with laparoscopic right hemicolectomy due to cancer. PATIENTS AND METHODS: Between 2005 and 2009, laparoscopic right hemicolectomy for cancer was performed in 9 patients. RESULTS: The average operative time was 168 min. The average hospital stay was 5.3 days. There was one conversion (11.1%) to an open procedure. There were no postoperative complications. All the patients remain so far with no signs of tumor recurrence. CONCLUSION: Laparoscopic right hemicolectomy for cancer in the hands of an experienced laparoscopic surgeon is a safe and efficient procedure.
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Colectomía , Neoplasias del Colon/cirugía , Anciano , Femenino , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
INTRODUCTION: When performing a colonic resection for cancerous lesions, a complete mesocolic excision (CME) can lead to improved oncologic results. The CME along with the high vessel ligation, meaning the ligation of the supplying vessels close to their origin, can ensure maximal lymph node harvest. The principles of CME and high ligation have been applied by us during colonic resections for cancer. We present our experience with tumors of the proximal colon, for which a radical right hemicolectomy has been performed. PATIENTS AND METHODS: Between 1989 and 2008, we performed a right hemicolectomy in 115 patients. The mean age was 65.6 years (range 35-86). The tumor was located in the cecum in 37% of patients, the ascending colon in 58% of the patients and the hepatic flexure in 5% of the patients. All patients underwent complete mesocolic excision and high ligation of the supplying vessels. A total of 93% (107/115) of these operations were performed on an elective basis. Out of all patients, 48 (42%) received adjuvant chemotherapy. RESULTS: No patient died during the immediate postoperative period. The postoperative morbidity was 13.9% (16/115). One patient developed a metachronous rectal carcinoma 28 months after his surgery, for which he underwent an abdoperineal resection. The 5-year survival rate lies at 72.4% (55/76). Twenty patients (26.3%) died due to metastatic disease before completing 5 years of follow-up. The remaining 39 patients have been operated after the end of 2004 and have therefore not completed 5 years from the day of their operation yet. CONCLUSIONS: There is no doubt that standardized oncologic surgery shows particular importance by reducing the rate of local recurrence and achieving increased survival. It is important to remember that colon cancer treatment today is multimodal and that the improvement in patients' survival in the last decades is surely linked with the improvement in chemotherapy and the advances in the agents used. However, optimal surgery is with no doubt an important element of good oncological outcome, as the experience with rectal cancer treatment has taught us.
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Colectomía/métodos , Mesocolon/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Colon/irrigación sanguínea , Colon/cirugía , Neoplasias del Colon/cirugía , Femenino , Humanos , Ligadura , Masculino , Mesocolon/irrigación sanguínea , Persona de Mediana Edad , Análisis de SupervivenciaRESUMEN
AIM: In this study, we present our patients with metachronous colorectal cancer. PATIENTS AND METHODS: In the period between 1990 and 2009, 670 patients with colorectal cancer were treated. RESULTS: Metachronous cancer was developed in 4 (0.6%) patients. The time interval between index and metachronous cancer was 28 months to 22 years (mean 146 months). CONCLUSION: Metachronous colorectal cancer is a potential risk that proves the necessity of postoperative colonoscopic control of all patients with colorectal cancer.
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Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/cirugía , Neoplasias Primarias Secundarias/diagnóstico , Anciano , Colonoscopía , Femenino , Humanos , MasculinoRESUMEN
The aim of this study is to report our experience with laparoscopic sigmoidectomy due to cancer. Between 2007 and 2009, laparoscopic sigmoidectomy for cancer was performed in 3 patients. The average operative time was 176 min. The average hospital stay was 10.2 days. There was one anastomotic leak. The patient was subjected to laparotomy and a Hartmann's procedure and drainage of the peritoneal cavity was performed. In conclusion, laparoscopic sigmoidectomy for cancer is a safe and efficient procedure.
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Colectomía , Neoplasias del Colon Sigmoide/cirugía , Adulto , Colectomía/efectos adversos , Femenino , Humanos , Laparoscopía , Masculino , Persona de Mediana EdadRESUMEN
AIM: Aim of this study is to present the incidence of anastomotic leakage after anterior resection for rectal cancer and to demonstrate the therapeutic approach for the treatment of this complication. PATIENTS AND METHODS: Between 1990 and 2009, 170 patients underwent low anterior resection with total mesorectal excision (TME). RESULTS: A total of 14 (8.2%) anastomotic leaks were confirmed. Reoperation was carried out in six patients with major leaks. Eight patients with minor leaks were treated conservatively by nutritional support and antibiotic therapy. CONCLUSION: The incidence of anastomotic leakage after anterior resection of the rectum for rectal cancer is relatively low.