Fístula colovesical: aplicabilidad del abordaje laparoscópico y resultados según su etiología / Colovesical Fistula: Applicability of the Laparoscopic Approach and Results According to Etiology

INTRODUCCIÓN: Las fístulas colovesicales son una entidad poco frecuente y con una incidencia precisa desconocida. El objetivo de este estudio es describir una serie de casos de pacientes intervenidos por fístula colovesical de origen benigno y maligno y valorar la aplicabilidad del abordaje laparoscópico en ambos grupos. MÉTODOS: Realizamos un estudio descriptivo de 34 pacientes intervenidos en nuestro centro entre enero de 2001 y marzo de 2018 con el diagnóstico de fístula colovesical. Se incluyen pacientes intervenidos de manera electiva (28) y de urgencia (6). Se categorizaron según el diagnóstico mediante pruebas complementarias por TC abdominal, colonoscopia y cistoscopia, y se realizó un abordaje laparoscópico en los pacientes sin infiltración del trígono vesical y plano retroperitoneal y con situación clínica favorable. RESULTADOS: En los casos con patología benigna (13) se realizaron 4 intervenciones vía laparotómica y 9 vía laparoscópica, con 3 conversiones. En todos los casos se realizó sigmoidectomía. En 11 pacientes se realizó cistectomía parcial y en 2 casos el manejo fue conservador con sonda vesical. En los 21 pacientes con patología maligna se realizaron 5 abordajes laparoscópicos y se convirtieron 3, con 16 casos abordados vía laparotómica. Se realizaron sigmoidectomía, hemicolectomía izquierda, resección anterior y exenteración pélvica, y abordaje urológico en todos los casos. Dieciséis pacientes (76%) tuvieron complicaciones, la mayoría menores (I-II según la clasificación de Clavien-Dindo) e intervenidos por abordaje laparotómico. CONCLUSIONES: El tratamiento de elección en las fístulas colovesicales es la cirugía con resección colónica y abordaje urológico según el caso y el diagnóstico etiológico. El abordaje laparoscópico puede ser factible en casos muy bien seleccionados y con una situación clínica favorable, teniendo en cuenta que el umbral de conversión debe ser bajo y la intervención ha de ser llevada a cabo por un equipo con experiencia

INTRODUCTION: Colovesical fistulae have significant morbidity. The aim of our study was to describe a case series of benign and malignant colovesical fistulae, focusing on the viability of the laparoscopic approach. METHODS: We reviewed the characteristics of 34 patients with diverticular and colon adenocarcinoma-related colovesical fistulae treated surgically from January 2001 to March 2018, 28 with elective surgery and 6 by urgent surgery. The diagnosis was established by abdominal CT scan, colonoscopy and cystoscopy. Clinically stable patients, with no retroperitoneal or bladder trigone invasion, were approached laparoscopically. RESULTS: There were 13 benign cases (all of them approached by sigmoidectomy), 9 performed by laparoscopy with 3 conversions. Partial cystectomy was done in 11 cases, and in two cases conservative management with urinary catheter. Five laparoscopic approaches were performed in 21 patients diagnosed with malignant colovesical fistula, with 3 conversions and 16 laparotomies. The procedures were sigmoidectomy, left colectomy, anterior resection and pelvic exenteration. All of them required partial or total cystectomy. Sixteen patients had complications, most of which were minor (Clavien-Dindo classificationI-II) and with laparotomy approach. CONCLUSIONS: The laparoscopic approach can be feasible in well-selected and stable patients, but we have to take into consideration that the conversion rate can be high and this surgery should be performed by experienced surgeons

Colovesical Fistula: Applicability of the Laparoscopic Approach and Results According to Etiology. / Fístula colovesical: aplicabilidad del abordaje laparoscópico y resultados según su etiología.

INTRODUCTION: Colovesical fistulae have significant morbidity. The aim of our study was to describe a case series of benign and malignant colovesical fistulae, focusing on the viability of the laparoscopic approach. METHODS: We reviewed the characteristics of 34 patients with diverticular and colon adenocarcinoma-related colovesical fistulae treated surgically from January 2001 to March 2018, 28 with elective surgery and 6 by urgent surgery. The diagnosis was established by abdominal CT scan, colonoscopy and cystoscopy. Clinically stable patients, with no retroperitoneal or bladder trigone invasion, were approached laparoscopically. RESULTS: There were 13 benign cases (all of them approached by sigmoidectomy), 9 performed by laparoscopy with 3 conversions. Partial cystectomy was done in 11 cases, and in two cases conservative management with urinary catheter. Five laparoscopic approaches were performed in 21 patients diagnosed with malignant colovesical fistula, with 3 conversions and 16 laparotomies. The procedures were sigmoidectomy, left colectomy, anterior resection and pelvic exenteration. All of them required partial or total cystectomy. Sixteen patients had complications, most of which were minor (Clavien-Dindo classificationI-II) and with laparotomy approach. CONCLUSIONS: The laparoscopic approach can be feasible in well-selected and stable patients, but we have to take into consideration that the conversion rate can be high and this surgery should be performed by experienced surgeons.

Tratamiento mediante microcirugía endoscópica transanal de un hamartoma quístico retrorrectal birrecidivado / Transanal endoscopic microsurgery treatment of twice recurred tail-gut

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Are there differences between right and left colectomies when performed by laparoscopy?

BACKGROUND: There is an extended belief that the laparoscopic approach to left colectomy (LC) is technically more demanding and associated with more postoperative complications than to right colectomy (RC). However, there is no consensus in the literature about whether the short-term outcomes of RC differ from those of LC. The aim of this paper was to compare the postoperative course of patients undergoing RC and LC. METHODS: We retrospectively analyzed 1000 consecutive patients who underwent a laparoscopic RC or LC between 1998 and 2012. Factors analyzed were intraoperative complications, surgical time, postoperative complications, and length of stay. The two groups were divided into four subgroups (neoplasia, diverticular disease, polyps, and others). RESULTS: LC was associated with more postoperative complications than RC and longer operative time both in the two main groups (postoperative complications 30 vs. 19%; operative time 139 vs. 118 min) and in the neoplasia subgroups (27 vs. 18%; 137 vs. 118 min). No differences between groups were found for rates of reintervention or death. Comparison between LC subgroups showed that the operative time was longer and the conversion rate was higher in the diverticular disease subgroup than in the neoplasia subgroup (155 vs. 137 min; 21 vs. 8%). CONCLUSIONS: In this large cohort of patients undergoing laparoscopic colectomy, LC carried a higher risk than RC of postoperative complications. These findings provide new data on the differences between the two surgeries. Our findings strengthen the notion that right and left colectomies have a different intraoperative and postoperative course and should be analyzed as two separate entities.

Factores de morbimortalidad postoperatoria tras cirugía laparoscópica por cáncer de colon en pacientes octogenarios / Postoperative morbidity and mortality factors after laparoscopic resection for colon cancer in octogenarians

Introducción: Dado el aumento del diagnóstico de cáncer de colon y el acceso al tratamiento en pacientes mayores de 80 años, nuestro objetivo es valorar si el abordaje laparoscópico sigue aportando las ventajas demostradas en la recuperación postoperatoria, al tiempo que analizamos los factores que pueden influir en dichos resultados. Material y método Se han analizado retrospectivamente 593 pacientes, intervenidos de cáncer de colon por laparoscopia de forma electiva entre enero de 1999 y diciembre de 2010. Se dividieron en 33 grupos: A) menores de 70 años (n = 230), B) 70-79 años (n = 209), C) mayores o igual a 80 años (n=154). Las variables independientes: sexo, enfermedades asociadas, cirugía abdominal previa, índice de Karnosfky, índice de masa corporal (IMC), nivel de hemoglobina, proteínas y albúmina, CEA, grado de ASA, localización y estadificación tumoral. Variables dependientes perioperatoria: conversión, tiempo operatorio y pérdidas hemáticas; y postoperatorias: complicaciones locales y generales, requerimiento de unidad de cuidados intensivos, reintervenciones, estancia hospitalaria y éxitus. Resultados El grupo C presentó una mayor incidencia (p<0,001) de hipertensión arterial, diabetes mellitus, cardiopatía, neumopatía y ASA grado 3, así como valores inferiores de índice de Karnofsky, IMC, hemoglobina, albúmina y proteínas totales. Durante el postoperatorio se observó (p>0,001), mayor incidencia de complicaciones generales (respiratorias y urinarias), reintervenciones, ingresos en unidad de cuidados intensivos, éxitus y mayor estancia hospitalaria. Conclusión Aunque la cirugía laparoscópica ofrece ventajas a los pacientes mayores de 80 años con cáncer de colon, este grupo de pacientes presenta un mayor riesgo de complicaciones que la población más joven y, en consecuencia, debemos ser cuidadosos en su manejo (AU)

Introduction: Given the increase in the diagnosis in colon cancer and the access to treatment in patients over 80 years old, our aim is to assess whether laparoscopic surgery still has the demonstrated advantages in post-operative recovery, as well as to analyse the factors that may influence these results. Material and method: A retrospective analysis was made on a total of 593 patients subjected to elective laparoscopy surgery due to cancer of the colon between January 1999 and December 2010. They were divided into three age groups: A) less than 70 years (n = 230),B) 70-79 years (n = 209), C) 80 years or over (n = 154). The independent variables were: gender, concomitant diseases, previous abdominal surgery, Karnosfky index, BMI, level of, haemoglobin, proteins and albumin, CEA, and ASA grade, location (..) (AU)

[Postoperative morbidity and mortality factors after laparoscopic resection for colon cancer in octogenarians]. / Factores de morbimortalidad postoperatoria tras cirugía laparoscópica por cáncer de colon en pacientes octogenarios.

INTRODUCTION: Given the increase in the diagnosis in colon cancer and the access to treatment in patients over 80 years old, our aim is to assess whether laparoscopic surgery still has the demonstrated advantages in post-operative recovery, as well as to analyse the factors that may influence these results. MATERIAL AND METHOD: A retrospective analysis was made on a total of 593 patients subjected to elective laparoscopy surgery due to cancer of the colon between January 1999 and December 2010. They were divided into three age groups: A) less than 70 years (n = 230), B) 70-79 years (n = 209), C) 80 years or over (n=154). The independent variables were: gender, concomitant diseases, previous abdominal surgery, Karnosfky index, BMI, level of, haemoglobin, proteins and albumin, CEA, and ASA grade, location and stage of tumour. The peri-operative dependent variables were: conversion, operating time and blood loss; and post-operative: local and general complications, need for intensive care, further surgery, hospital stay, and death. RESULTS: Group C had a higher incidence (P<.001) of arterial hypertension, diabetes mellitus, heart disease, chest disease and grade 3 ASA, as well as lower values for the Karnofsky Index, body mass index (BMI), haemoglobin, albumin and total protein. A higher incidence (P>.001) of general complications (respiratory and urinary), further surgery, admission to intensive care unit, longer hospital stay and death, was also observed in the post-operative period in this group. CONCLUSION: Although laparoscopic surgery offers advantages to patients over 80 years-old, this group has a higher risk of complications than the younger population and, as a result, we must take great care in their management.