[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.

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

Introducción. La introducción de la cirugía laparoscópica avanzada en un hospital es un proceso lento que requiere la implicación de un equipo multidisciplinario. Pacientes y método. Presentamos un estudio prospectivo y descriptivo de todos los pacientes intervenidos por laparoscopia de colon y recto en el Hospital de Mataró entre los años 2003 y 2006. Conjuntamente se describe el modelo de implantación de la cirugía laparoscópica de colon y recto en nuestro centro. Resultados. Entre 2003 y 2006 se intervino por laparoscopia a 196 pacientes con enfermedad colorrectal. El porcentaje de pacientes intervenidos por afección rectal alcanzó en el último período el 36% del total. La media del índice de conversión en todos los períodos estudiados fue el 7%, con una tasa de complicaciones del 13,25%. Conclusiones. El desarrollo de la técnica laparoscópica de forma controlada permite obtener unos resultados satisfactorios en la cirugía de colon y recto (AU)

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 (AU)

[Intestinal endometriosis. Current status]. / Endometriosis intestinal. Estado actual.

Endometriosis affects a wide spectrum of premenopausal women. Intestinal involvement, affecting mainly the large bowel and sometimes the small bowel, is much less frequent. Diagnosis is relatively straightforward in women with long standing pelvic endometriosis but is difficult in acute intestinal obstruction, since a diagnosis of endometriosis is not often considered in this entity. We performed an exhaustive review of the medical literature, including the option of medical treatment, which is rarely effective in intestinal endometriosis. In most patients with intestinal symptoms, the disease is so severe that surgical treatment is required. Recent studies indicate that the most effective approach is laparoscopic. We analyze the most important classical and recent series of patients and discuss treatment results.

Endometriosis intestinal. Estado actual / Intestinal endometriosis. Current status

La endometriosis es un proceso que afecta a un amplio sector de la población femenina en edad premenopáusica, y a un pequeño porcentaje de ellas les afecta el intestino, principalmente el grueso y más raramente el delgado. Su diagnóstico es relativamente sencillo en el contexto clínico de una paciente con una endometriosis pelviana florida y con clínica de larga evolución, pero es muy difícil en la situación de oclusión intestinal aguda, ya que su rareza hace que generalmente no se piense en este proceso y se planteen por ello serios problemas diagnósticos y terapéuticos. Se realiza una revisión exhaustiva de la literatura médica y del tratamiento médico actual, que es raramente eficaz en el manejo de la endometriosis intestinal como tal. En la mayoría de los casos, cuando se producen síntomas digestivos, la afección es tan grave que deberá realizarse el tratamiento quirúrgico, y parece, a la luz de los trabajos actuales, que la vía de abordaje más adecuada es la laparoscópica. Se analizan las series más importantes, clásicas y actuales, y sus resultados en el tratamiento de este proceso (AU)

Endometriosis affects a wide spectrum of premenopausal women. Intestinal involvement, affecting mainly the large bowel and sometimes the small bowel, is much less frequent. Diagnosis is relatively straightforward in women with long standing pelvic endometriosis but is difficult in acute intestinal obstruction, since a diagnosis of endometriosis is not often considered in this entity. We performed an exhaustive review of the medical literature, including the option of medical treatment, which is rarely effective in intestinal endometriosis. In most patients with intestinal symptoms, the disease is so severe that surgical treatment is required. Recent studies indicate that the most effective approach is laparoscopic. We analyze the most important classical and recent series of patients and discuss treatment results (AU)

Enfermedad diverticular del apéndice cecal / Diverticular disease of the cecal appendix

Introducción. Los divertículos apendiculares constituyen una rareza y su incidencia es < 1%. Se presenta una serie de 14 pacientes con este diagnóstico. Pacientes y método. De un total de 547 pacientes intervenidos por apendicitis aguda durante un período de 4 años, 11 presentaban una diverticulitis apendicular aguda y 3 una diverticulosis asociada a apendicitis. Se comparan las características clínicas entre el grupo de pacientes con enfermedad diverticular del apéndice y el grupo de apendicitis aguda. El estudio estadístico se realiza mediante el test de la t de Student y el test de la (..) (AU)

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 Student’s 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 (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.