Tratamiento de la enfermedad hemorroidal mediante desarterialización y hemorroidopexia. Experiencia de varias unidades especializadas / Treatment of haemorrhoids by transanal haemorrhoidal dearterialization. Experience of several specialized units

INTRODUCCIÓN: Durante varias décadas, las hemorroidectomías de Milligan-Morgan y Ferguson han sido la referencia en el tratamiento de la enfermedad hemorroidal sintomática. Sin embargo las técnicas escisionales llevan asociadas una morbilidad no despreciable. En los últimos años han surgido una serie de técnicas dedicadas a disminuir estos problemas. La desarterialización hemorroidal transanal (THD) guiada por doppler es una de estas técnicas. El objetivo de este estudio es analizar sus resultados según la experiencia de varias unidades especializadas. MÉTODOS: El estudio se realizó en 5 hospitales de la red pública de España. Se analizan y comparan los resultados pre- y posquirúrgicos, así como la homogeneidad interhospitalaria de dicha técnica. Se recogieron de forma prospectiva consecutiva datos de un total de 475 pacientes intervenidos mediante THD, la mayoría con hemorroides grado III(267 casos [56%]). RESULTADOS: La técnica anestésica preferida fue la anestesia raquídea, en un total de 398 casos (81%). Encontramos mejoría global tras la intervención ya que existen diferencias estadísticamente significativas entre síntomas pre- y postoperatorios (p = 0,03). La estancia media fue de 0,4 ± 0,3 días. Los días de analgesia media fueron 8,8 ± 2,7 días (paracetamol y AINE). La tasa acumulada de complicaciones fue del 16%. CONCLUSIONES: La THD es una técnica segura y fácilmente reproducible. Los resultados posquirúrgicos generan una escasa morbilidad, con una estancia hospitalaria muy reducida que permite una rápida reincorporación a la vida laboral, y una tasa de recurrencia baja

INTRODUCTION: Milligan-Morgan and Ferguson haemorrhoidectomy has been the gold standard treatment for symptomatic haemorrhoids for many years. However, escisional techniques are associated with a significant morbidity rate. In recent years, diverse techniques have been described in an attempt to decrease these complications. The guided transanal haemorrhoidal dearterialization THD) doppler is one of these techniques. We report our experience with this new technique. METHODS: We performed a prospective study of 475 patients from 5 hospitals from the National Health System, in Spain. The majority of these patients suffered from third grade haemorrhoids (256 [56%]) and underwent THD. We analyse and compare preoperative and postoperative results as well as the homogeneity of the technique between hospitals. RESULTS: Spinal anaesthesia was the most elected procedure by the anaesthetist (81.0%). Statistically significant differences were found between pre and postoperative symptoms (P = .03), with an overall improvement after surgery. The average hospitalization was 0.4 ± 0.3 days. The mean number of days of oral analgesics was 8.8 ± 2.7 days. The cumulative complication rate is 16%. CONCLUSION: THD is a safe and easily reproducible procedure. Postoperative outcomes demonstrated a low rate of morbidity and recurrence together with early discharge; therefore, a rapid incorporation to daily activities was noted

Colonic obstruction caused by endometriosis solved with a colonic stent as a bridge to surgery.

Self-expanding metal stents are an established treatment for malignant colon strictures, either as palliative treatment or as a bridge to later surgery. Little data exist regarding the use of stents for benign obstructions and the rate of subsequent complications related to the procedure is high. After reviewing the existing literature, we found only one case of stent placement in an intestinal obstruction caused by endometriosis, as a bridge to surgery. The use of prostheses in benign disease has a higher rate of complications such as stent migration and gut perforation. Such complications are even more likely to happen when the stent has been placed as a bridge to surgery and it is delayed for more than 7 days. This is the case of a young woman presenting an acute intestinal obstruction related to endometrioma. Stent placement was used in this case as a bridge to surgery with successful results.

Treatment of haemorrhoids by transanal haemorrhoidal dearterialization. Experience of several specialized units.

INTRODUCTION: Milligan-Morgan and Ferguson haemorrhoidectomy has been the gold standard treatment for symptomatic haemorrhoids for many years. However, escisional techniques are associated with a significant morbidity rate. In recent years, diverse techniques have been described in an attempt to decrease these complications. The guided transanal haemorrhoidal dearterialization THD) doppler is one of these techniques. We report our experience with this new technique. METHODS: We performed a prospective study of 475 patients from 5 hospitals from the National Health System, in Spain. The majority of these patients suffered from third grade haemorrhoids (256 [56%]) and underwent THD. We analyse and compare preoperative and postoperative results as well as the homogeneity of the technique between hospitals. RESULTS: Spinal anaesthesia was the most elected procedure by the anaesthetist (81.0%). Statistically significant differences were found between pre and postoperative symptoms (P=.03), with an overall improvement after surgery. The average hospitalization was 0.4±0.3 days. The mean number of days of oral analgesics was 8.8±2.7 days. The cumulative complication rate is 16%. CONCLUSION: THD is a safe and easily reproducible procedure. Postoperative outcomes demonstrated a low rate of morbidity and recurrence together with early discharge; therefore, a rapid incorporation to daily activities was noted.

Carcinoma oat-cell del tracto gastrointestinal / Small (oat)-cell carcinoma of the gastrointestinal tract

No disponible

Metástasis pancreática solitaria de carcinoma de mama / Solitary pancreatic metastasis from breast cancer

La aparición de una metástasis única de un carcinoma de mama en el páncreas es un hecho poco frecuente, ya que normalmente acontece en el contexto de una carcinomatosis peritoneal. Su diagnóstico preoperatorio es difícil por su similitud en la presentación con neoplasias primarias de dicha glándula. Presentamos el caso de una paciente intervenida por tumoración pancreática que se diagnosticó, tras el estudio anatomopatológico de la pieza de resección, de metástasis de carcinoma ductal infiltrante de mama. Realizamos una revisión de esta entidad. (AU)