RESUMO
BACKGROUND: Laparoscopy has rapidly emerged as the preferred surgical approach for a number of different diseases because it allows for a correct diagnosis and proper treatment. However, it is not being applied in a widespread manner for the management of benign or malignant colorectal disease. Its natural evolution seems to be the development of mini-instruments and optics (diameter, =5 mm). This study aimed to illustrate retrospectively the results of an initial minilaparoscopic colorectal surgery experience at two different institutions. METHODS: Between January 2001 and December 2006, a total of 517 patients underwent a laparoscopic colon procedure. Among them, 161 (31.1%) underwent surgery with mini-instruments. The primary end point was the feasibility rate for minilaparoscopic colon resection. The secondary end points were safety and the impact of the technique on the duration of laparoscopy. RESULTS: No conversion to classical laparoscopy and eight cases converted to the open approach were registered. The rate for major complications was 3.1%, whereas the rate for minor complications ranged as high as 11.8%. CONCLUSIONS: Even if limited by its retrospective design, the reported experience shows that minilaparoscopic surgery may be a safe and effective approach to colon pathology. The described features make minilaparoscopy a challenging alternative to laparoscopy for colon disease. If proven to be cost effective without undue risk, as long as adequate training is obtained and proper preparation is observed, minilaparoscopy may become a standard surgical approach for selected patients.
Assuntos
Colectomia/métodos , Cirurgia Colorretal/métodos , Laparoscopia/métodos , Adulto , Idoso , Colectomia/efeitos adversos , Colo/cirurgia , Doenças do Colo/cirurgia , Cirurgia Colorretal/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Gastrointestinal stromal tumors show an increasing incidence. Immunohistochemistry is mandatory to make differential diagnosis with other mesenchimal tumors. We retrospectively reviewed 15 primary stomach GISTs operated during the last decade. Gastroscopy, Ultrasonography and CT scan were employed to obtain the diagnosis. Tumor size ranged from 1.5 to 30 cm in diameter. Treatment consisted of curative surgical resection without sistematic lymph node dissection. A wedge resection was sufficient in 8 cases. In 2 patients a distal subtotal gastrectomy was required and in 1 a total enlarged gastrectomy with pancreaticosplenectomy was performed. 4 GISTs were incidentally discovered and removed during surgical procedures for other gastrointestinal malignancies. In 4 cases a laparoscopic wedge resection was possible. In all cases postoperative course was uneventful. No adjuvant treatment was administered. Concerning the follow-up, two patients died for local and distant relapse while 13 are still alive (most of them operated during the last three years). GISTs show a very unpredictable clinical course and curative surgery is the only potential effective curative treatment.