[Planning, management and results of the implantation of laparoscopic surgery of the colon and rectum in a general hospital]. / Planificación, gestión y resultados de la implantación de la cirugía laparoscópica de colon y recto en un hospital general.

INTRODUCTION: The introduction of laparoscopic surgery in a hospital is a slow process requiring the involvement of a multidisciplinary team. PATIENTS AND METHOD: We performed a prospective, descriptive study of all patients who underwent laparoscopic surgery of the colon and rectum in the Mataró Hospital between 2003 and 2006. We also describe the model used to introduce laparoscopic surgery of the colon and rectum in our center. RESULTS: Between 2003 and 2006, 166 patients with colorectal disease underwent laparoscopic surgery. Patients included for rectal disease represented 36% of the total. The conversion rate was 7% of the mean in all the periods studied, with a complications rate of 13.25%. CONCLUSIONS: The controlled development of laparoscopic surgery allows satisfactory results to be obtained in colorectal disease.

Fístula aortoentérica secundaria: revisión de la literatura a propósito de un caso / No disponible

Las fistulas aortoentéricas constituyen una complicación grave de la cirugía protésica por su elevada morbi-motalidad. La forma de presentación clínica más frecuente es en forma de hemorragia digestiva alta masiva, hipotensión y shock. No obstante, en algunos casos las manifestaciones clínicas aparecen en forma de fiebre y molestias abdominales poco específicas que permiten realizar su diagnóstico. La tomografía axial computerizada y la fibrogastroscopia constituyen los estudios diagnósticos de elección por su elevada resolución. El tratamiento debe ser siempre quirúrgico, con la resección de la prótesis en su totalidad, ligadura de la arteria aorta a nivel infrarrenal, revascularización de las extremidades mediante un bypass axilo-bifemoral y extirpación del segmento de intestino delgado perforado (AU)

Aortoenteric fistulas are an important complication of protesic surgery due to their high morbidity an mortality. The most frequent form of clinical manifestation is the massive upper gastrointestinal bleeding, hypotension and shock. However, in some cases the feber and the abdominal pain may be the only manifestation. The computerized tomography and the oral endoscopy are the most useful complementary techniques. Treatment almost always requires excision of the infected graft and revascularization with an extra anatomic bypass followed by perforated duodenum excision (AU)

[Diverticular disease of the cecal appendix]. / Enfermedad diverticular del apéndice cecal.

INTRODUCTION: Appendiceal diverticula are uncommon, with an incidence of less than 1% in surgical specimens. We report a series of 14 patients with diverticular disease of the cecal appendix. PATIENTS AND METHOD: A total of 547 patients with a clinical diagnosis of acute appendicitis underwent surgery over 4 years. Of these, 11 patients showed acute appendiceal diverticulitis at histological examination, and three patients showed diverticulosis associated with appendicitis. Clinical features were compared between the group of patients with diverticular disease and the group with acute appendicitis. Statistical analysis was performed using Students t-test and the chi-squared test. RESULTS: The overall incidence of appendiceal diverticula was 2.6%, and 2% of cases had acute diverticulitis. In the group with diverticular disease, the mean age and the percentage of patients under clinical observation before the decision to perform surgery was made were significantly higher. There was a nonsignificant predominance of male over female patients and no differences were found in mean white cell count. No radiological investigations were performed in the diverticular group. CONCLUSIONS: The incidence of appendiceal diverticula was much higher in our series than that reported in the literature. We found no clinical or perioperative data that would serve to differentiate acute diverticulitis from acute appendicitis.