Risk Factors for Prolonged Postoperative Ileus in Colorectal Surgery: A Systematic Review and Meta-analysis.

BACKGROUND: Prolonged postoperative ileus (PPOI) represents a frequent complication following colorectal surgery, affecting approximately 10-15% of these patients. The objective of this study was to evaluate the perioperative risk factors for PPOI development in colorectal surgery. METHODS: The present systematic review and meta-analysis was conducted in accordance with the PRISMA Statement. PubMed, EMBASE, SciELO, and LILACS databases were searched, without language or time restrictions, from inception until December 2018. The keywords used were: Ileus, colon, colorectal, sigmoid, rectal, postoperative, postoperatory, surgery, risk, factors. The Newcastle-Ottawa scale and the Jadad scale were used for bias assessment, while the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used for quality assessment of evidence on outcome levels. RESULTS: Of the 64 studies included, 42 were evaluated in the meta-analysis, comprising 29,736 patients (51.84% males; mean age 62 years), of whom 2844 (9.56%) developed PPOI. Significant risk factors for PPOI development were: male sex (OR 1.43; 95% CI 1.25-1.63), age (MD 3.17; 95% CI 1.63-4.71), cardiac comorbidities (OR 1.54; 95% CI 1.19-2.00), previous abdominal surgery (OR 1.44; 95% CI 1.19, 1.75), laparotomy (OR 2.47; 95% CI 1.77-3.44), and ostomy creation (OR 1.44; 95% CI 1.04-1.98). Included studies evidenced a moderate heterogeneity. The quality of evidence was regarded as very low-moderate according to the GRADE approach. CONCLUSIONS: Multiple factors, including demographic characteristics, past medical history, and surgical approach, may increase the risk of developing PPOI in colorectal surgery patients. The awareness of these will allow a more accurate assessment of PPOI risk in order to take measures to decrease its impact on this population.

Radiología intervencionista en trauma vascular periférico: Serie de casos / Interventional Radiology for the Management of Peripheral Vascular Trauma: Case Series

Antecedentes: El trauma es la tercera causa de mortalidad en la población mundial y la primera en el grupo etario de adultos menores de 44 años; de esta cifra, el 40-70 % se atribuyen al trauma vascular periférico. Tradicionalmente, el manejo quirúrgico ha sido la primera opción de tratamiento. No obstante, con los recientes avances tecnológicos y el auge de la radiología intervencionista, se han obtenido resultados exitosos a partir de opciones terapéuticas como las endoprótesis. Objetivo: Mostrar tres experiencias exitosas en el manejo con endoprótesis del trauma vascular de cuello, miembro superior e inferior, en un hospital de alta complejidad de Colombia. Casos clínicos: Se trata de tres pacientes con trauma vascular periférico producto de heridas por arma cortopunzante, en dos hombres, y por proyectil de arma de fuego en una mujer. En dos de los casos se evidenciaron pseudoaneurismas. En los tres casos se obtuvo adecuada resolución y exclusión de la circulación de las lesiones. Conclusión: El compromiso vascular ha aumentado su frecuencia en el contexto del trauma, por lo cual, es de importancia conocer su manejo óptimo. Actualmente, la reparación endovascular con endoprótesis en el trauma vascular periférico es un procedimiento mínimamente invasivo y con excelentes desenlaces para pacientes adecuadamente seleccionados.

Background: Trauma is the third leading cause of death among the world population and the first in adults under 44 years; from this, 40-70% is represented by peripheral vascular trauma. Traditionally, surgical management has been the first choice of treatment. However, with the technological advances in interventional radiology, successful outcomes have been obtained from therapeutical options such as with stent placement. Objective: To present three successful experiences after stent placement for the treatment of neck, upper and lower limbs vascular trauma at a high complexity hospital from Colombia. Clinical Cases: Three patients presented with peripheral vascular trauma, two men were wounded by sharp weapons men and one woman by a gunshot. In two of them, there was evidence of pseudoaneurysms. In the three cases, adequate resolution and exclusion from circulation were achieved. Conclusion: Vascular trauma has an increased frequency in general trauma context; hence, it is important to recognize its ideal management. Currently, stent placement for the management of peripheral vascular trauma is a minimally invasive procedure with excellent outcomes for properly selected patients.