Estenosis anastomóticas benignas en la cirugía radical del cáncer de recto. Resultados del tratamiento con dilatación hidrostática / Benign anastomotic strictures after oncologic rectal cancer surgery. Results of treatment with hydrostatic dilation

Introducción Las estenosis anastomóticas tras cirugía de cáncer de recto son frecuentes y precisan tratamientos desde medidas conservadoras hasta cirugía de resección Pacientes y método De marzo de 2001 a agosto de 2008 se intervinieron 422 carcinomas de recto, en el 83,8% se realizó anastomosis. Se definió la estenosis como la incapacidad de pasar el colonoscopio. Se realizó tratamiento mediante dilatación hidrostática. Se analizaron las diferencias entre los tratamientos con y sin éxito. Resultados Serie de 26 pacientes con estenosis de anastomosis (7,34%). Dieciséis varones y 10 mujeres, con una mediana de 66 años (57–74). Las intervenciones fueron 26 resecciones anteriores: 10 anastomosis término-terminales, 10 lateroterminales, 4 reservorios en J y 2 coloplastias . La mediana de altura de la estenosis fue de 10 cm (4–12). Trece pacientes recibieron radioterapia (RT) preoperatoria (50%). Nueve pacientes portaban ileostomía (34,7%). La mediana de diagnóstico fue 6 meses (3–10). El diagnóstico se realizó: por tacto rectal en 19,2%, por colonoscopia 23,1% y por clínica en 57,7%. Se realizaron una mediana de 2 (1–4) sesiones de dilatación. La mediana de seguimiento fue de 39 meses (23 a 49). El resultado fue bueno en el 88,5% y fracasó en 11,5%. La morbilidad fue del 3,8% (una perforación tras la dilatación). No existió mortalidad. ConclusionesLas estenosis anastomóticas tras cirugía de cáncer de recto son frecuentes (7,05%), suelen originar clínica (52,9%) y pueden tratarse con éxito mediante dilatación en más del 88% de los pacientes (AU)

Introduction Benign anastomotic strictures after rectal cancer surgery are common and their treatment can vary from conservative measures to surgical resection. Patients and methods Between March 2001 and August 2008, 422 patients with rectal cancer underwent anterior resection and 83.8% were treated with primary anastomosis. Anastomotic stricture has been defined as the inability to pass a colonoscope. Hydrostatic balloon dilation was performed. Results of success and failure dilation were assessed. Results Twenty-six patients (7.34%) with anastomotic stricture were treated; 16 men and 10 women, with a median age of 66 years (57–74). A total of 26 anterior resections were performed, as well as 10 end-to-end anastomosis, 10 side-to-end, 4 j-pouch and 2 pouch coloplasties. The median stricture height was 10cms (4–12). Thirteen patients had preoperative radiotherapy (50%), and 9 patients had an ileostomy (34.7%). The median time of diagnosis was 6 months (3–10). The diagnosis was made by: rectal digital examination in 19.2%, colonoscopy 23.1% and clinical symptoms in 57.7%. The median number of dilation sessions required was 2 (1–4). The median of follow-up was 39 months (23 to 49). Results were successful 88.5,% and unsuccessful in 11.5%. Morbidity was 3.8% (one perforation after dilation). There was no mortality. Conclusions Benign anastomotic strictures after rectal cancer surgery are frequent (7.05%), develop symptoms (52.9%) and can be successfully treated by hydrostatic dilation in more than 88% patients (AU)

[Benign anastomotic strictures after oncologic rectal cancer surgery. Results of treatment with hydrostatic dilation]. / Estenosis anastomóticas benignas en la cirugía radical del cáncer de recto. Resultados del tratamiento con dilatación hidrostática.

INTRODUCTION: Benign anastomotic strictures after rectal cancer surgery are common and their treatment can vary from conservative measures to surgical resection. PATIENTS AND METHODS: Between March 2001 and August 2008, 422 patients with rectal cancer underwent anterior resection and 83.8% were treated with primary anastomosis. Anastomotic stricture has been defined as the inability to pass a colonoscope. Hydrostatic balloon dilation was performed. Results of success and failure dilation were assessed. RESULTS: Twenty-six patients (7.34%) with anastomotic stricture were treated; 16 men and 10 women, with a median age of 66 years (57-74). A total of 26 anterior resections were performed, as well as 10 end-to-end anastomosis, 10 side-to-end, 4 j-pouch and 2 pouch coloplasties. The median stricture height was 10cms (4-12). Thirteen patients had preoperative radiotherapy (50%), and 9 patients had an ileostomy (34.7%). The median time of diagnosis was 6 months (3-10). The diagnosis was made by: rectal digital examination in 19.2%, colonoscopy 23.1% and clinical symptoms in 57.7%. The median number of dilation sessions required was 2 (1-4). The median of follow-up was 39 months (23 to 49). Results were successful 88.5,% and unsuccessful in 11.5%. Morbidity was 3.8% (one perforation after dilation). There was no mortality. CONCLUSIONS: Benign anastomotic strictures after rectal cancer surgery are frequent (7.05%), develop symptoms (52.9%) and can be successfully treated by hydrostatic dilation in more than 88% patients.

Recto (colpo, perineo) sacropexia ventral en el tratamiento del prolapso rectal y rectogenital / Ventral rectal sacropexy (colpo-perineal) in the treatment of rectal and rectogenital prolapse

Introducción La sacrorrectopexia ventral con malla permite la corrección del prolapso rectal minimizando la disección del recto. La colpopexia posterior corrige los prolapsos apicales y posteriores de la vagina. La combinación de ambos procedimientos permite la corrección simultánea de los prolapsos de los órganos pelvianos (POP).Objetivo Presentar los resultados de una serie de pacientes con distintos tipos de POP tratados mediante la misma técnica quirúrgica. Material y método Entre enero de 2005 y agosto de 2008 intervinimos mediante una recto(colpo)sacropexia ventral a 57 pacientes diagnosticados de alguna forma de POP, que dividimos en tres grupos: grupo A, prolapso rectal total aislado o combinado con histerocele o colpocele (11 pacientes); grupo B, rectoenterocele con invaginación rectal interna y/o periné descendente (4 pacientes), y grupo C, prolapso genital del compartimento medio-posterior (42 pacientes). Se intervino por vía laparoscópica a los 15 pacientes de los grupos A y B y a 11 del grupo C. En 41 casos se empleó una malla biológica, y en los demás, una sintética macroporosa. Resultados La media de edad de la serie era 66 (19–81) años; 55 eran mujeres y 2, varones; la mediana de seguimiento fue 25 (4–48) meses). No hubo complicaciones postoperatorias mayores. En el grupo A registramos una recurrencia del prolapso (1/11); los 7 pacientes que presentaban incontinencia mejoraron tras la intervención; no se registró ningún caso de estreñimiento de novo y 8 de los 9 pacientes de los grupos A y B, con defecación obstructiva, mejoraron. En el grupo C se detectaron 9 (21%) recurrencias de alguno de los compartimentos vaginales, pero sólo 4 (9%) requirieron reintervención. En todas las recurrencias se había utilizado una malla biológica (..) (AU)

Introduction Ventral sacral-rectopexy with mesh corrects rectal prolapse and minimises rectal dissection. Subsequent colpopexy corrects apical and posterior prolapses of the vagina. The combination of both procedures can lead to the simultaneous correction of pelvic organ prolapses (POP). Objective To present the results of a patient series with several types of POP treated using the same approach and operation. Material and method A total of 57 patients diagnosed with any type of POP were operated on between January 2005 and August 2008 using ventral rectal-colpo-sacropexy, who were grouped into three types: A, total rectal prolapse isolated or combined with a hysterocele or colpocele (11 patients); B, rectoenterocele with internal rectal invagination and/or descending perineum (4 patients); and C, middle and posterior genital compartment prolapse (42 patients). The laparoscopic approach was used in the 15 patients of groups A and B and 11 from group C. A b iological mesh was used in 41 patients and a macroporous synthetic one in the rest. Results The mean age of the patients in the series was 66 (19–81) years, with 55 females and 2 males. The median follow up was 25 (4–48) months. There were no major post-surgical complications. A recurrence of prolapse was recorded in one patient in group A (1/11); the 7 patients who suffered from incontinence improved after the surgery, no case of de novo constipation being recorded and an improvement in 8 of the 9 patients from groups A and B with obstructive defaecation. There were 9 (21%) recurrences detected in group C, but only 4 (9%) required reintervention. In all the recurrences a biological mesh had been used. Conclusions Laparoscopic ventral rectal-colpo-pexy is an effective technique to correct POP. Although safe and innocuous, the results with biological meshes did not last as long (AU)

[Ventral rectal sacropexy (colpo-perineal) in the treatment of rectal and rectogenital prolapse]. / Recto (colpo, perineo) sacropexia ventral en el tratamiento del prolapso rectal y rectogenital.

INTRODUCTION: Ventral sacral-rectopexy with mesh corrects rectal prolapse and minimises rectal dissection. Subsequent colpopexy corrects apical and posterior prolapses of the vagina. The combination of both procedures can lead to the simultaneous correction of pelvic organ prolapses (POP). OBJECTIVE: To present the results of a patient series with several types of POP treated using the same approach and operation. MATERIAL AND METHOD: A total of 57 patients diagnosed with any type of POP were operated on between January 2005 and August 2008 using ventral rectal-colpo-sacropexy, who were grouped into three types: A, total rectal prolapse isolated or combined with a hysterocele or colpocele (11 patients); B, rectoenterocele with internal rectal invagination and/or descending perineum (4 patients); and C, middle and posterior genital compartment prolapse (42 patients). The laparoscopic approach was used in the 15 patients of groups A and B and 11 from group C. A biological mesh was used in 41 patients and a macroporous synthetic one in the rest. RESULTS: The mean age of the patients in the series was 66 (19-81) years, with 55 females and 2 males. The median follow up was 25 (4-48) months. There were no major post-surgical complications. A recurrence of prolapse was recorded in one patient in group A (1/11); the 7 patients who suffered from incontinence improved after the surgery, no case of de novo constipation being recorded and an improvement in 8 of the 9 patients from groups A and B with obstructive defaecation. There were 9 (21%) recurrences detected in group C, but only 4 (9%) required reintervention. In all the recurrences a biological mesh had been used. CONCLUSIONS: Laparoscopic ventral rectal-colpo-pexy is an effective technique to correct POP. Although safe and innocuous, the results with biological meshes did not last as long.