Initial experience with intraoperative testing and repair of colorectal anastomosis using a TAMIS approach after a positive leak test.

Anastomotic leak is one of the most feared complications of colorectal anastomosis. Different techniques have been described for intraoperative testing of anastomotic integrity. These include air insufflation, methylene blue and endoscopic visualisation. If an anastomotic leak is identified intraoperatively, there are various management options. Redo anastomosis is a possibility, but may be difficult in some cases. Defunctioning is another option, but there is an associated morbidity and signficant detrimental effect on quality of life. Direct transanal repair is only possible when a low anastomosis has been performed. When the anastomotic leak occurs high in the rectum or a partial mesorectal excision is performed a transanal approach is technically very challenging. We present our experience with transanal minimally invasive surgery (TAMIS) approach for anastomotic assessment and repair in four patients. In all cases, a colorectal anastomosis was performed and the air insufflation test was positive. We assessed the anastomosis with TAMIS. In three cases, a defect was found and subsequently sutured. In one case, a scar in the rectal mucosa was found and reinforced with a suture. A protective ileostomy was performed in two cases, while in the other two cases, no stoma was added. All four patients were discharged with no further complications. Both protective ileostomies were taken down after radiological and endoscopic confirmation of anastomotic integrity and all 4 anastomoses remain intact after follow-up. TAMIS intraoperative assessment and repair of anastomotic leak is a safe and feasible technique whcih may avoid the need for a defunctioning stoma.

Formación de un residente de cirugía general en la unidad de cirugía mayor ambulatoria de un hospital de tercer nivel / General surgery trainee education in the ambulatory surgery setting of a tertiary hospital

Objetivos: la cirugía mayor ambulatoria ha adquirido entidad propia dentro de las unidades asistenciales, con un importante papel en la formación del residente. El objetivo de este estudio es valorar la formación actual de un residente de cirugía general en la unidad de cirugía ambulatoria de un hospital de tercer nivel. Materiales y método: se trata de un estudio retrospectivo, observacional y descriptivo. Las variables estudiadas han sido meses de rotación, intervenciones realizadas como cirujano principal, primer o segundo ayudante, sesiones de la unidad y tiempo de consulta. Resultados: en nuestro hospital dedicamos 6 meses de la residencia a la unidad de cirugía ambulatoria (2 en el primer año, 4 en el tercero), abarcando patologías de la pared abdominal, proctología básica, colelitiasis, patología benigna de la mama y patología de piel y partes blandas. El primer año se intervienen una media de 125 pacientes (36,16% como cirujano principal, 56% como primer ayudante y 7,84% como segundo). Durante el tercer año se realiza patología más compleja, llevándose a cabo una media de 206 intervenciones (68,40% como cirujano, 30,90% como primer ayudante y el 0,70% como segundo ayudante). Durante estos meses se realiza además actividad asistencial en consultas externas, sesiones clínicas relacionadas con patología de la unidad y sesión conjunta semanal sobre la evolución de los pacientes de pared compleja. Conclusión: dicha rotación realizada por un residente de cirugía general es imprescindible ya que en ella adquiere los cimientos para futuras intervenciones más complejas (AU)

Objectives: Ambulatory surgery has become entity within the health care units, with an important role in the learning of residents. The aim of this study is to assess the current training of general surgery residents in a ambulatory surgery unit of a tertiary hospital. Materials and methods: We show a retrospective, observational and descriptive study. The variables studied have been months of rotation, as chief surgeon interventions, first or second assistant, unit meetings and consultation time. Results: In our hospital, we dedicated 6 months of our residence period in the ambulatory surgery unit (two in the first year, four in the third), including diseases of the abdominal wall, basic proctology, cholelithiasis, benign breast disease and pathology of skin and soft tissue. The first year we operate an average of 125 procedures (36.16% as surgeon, 56% as first assistant and 7.84% as second). During the third year, there is a more complex pathology index, with an average of 206 interventions (68.40% as surgeon, 30.90% as first assistant and 0.70 as second). During these months we also participate in outpatient care activities, clinical sessions and a weekly staff session. Conclusions: This period is essential in a general surgery resident learning because it stablish the basis for their future more complex technics (AU)