Laparoscopic endoluminal resection by transgastric single port of gist tumor

Resumen Los tumores gástricos submucosos son infrecuentes, siendo los tumores del estroma gastrointestinal (GIST) los que se encuentran más habitualmente. Los tumores del estroma gastrointestinal representan el dos por ciento de los tumores digestivos. La resección quirúrgica atípica sin realizar linfadenectomía es la primera opción de tratamiento quirúrgico. Las técnicas mínimamente invasivas, tales como combinar el abordaje transgástrico y endoscópico son útiles en tumores localizados cerca de la unión gastroesofágica, evitando riesgo de estenosis. Se pretende describir el abordaje quirúrgico de tumores GIST y nuestra experiencia mediante resección transgástrica con puerto único. Asimismo valorar resección oncológica adecuada en los casos (R0) realizados con abordaje transgástrico. Presentamos el caso de un paciente con un tumor del estroma gastrointestinal submucoso localizado en cuerpo antro gástrico a quién se realiza resección transgástrica mediante puerto único laparoscópico. El abordaje laparoscópico transgástrico de estos tumores, con o sin asistencia endoscópica, mantiene los mismos resultados oncológicos que los obtenidos tras cirugía convencional. Los abordajes mínimamente invasivos son una buena alternativa de abordaje a las técnicas tradicionales.</p

Safety of hospital discharge before return of bowel function after elective colorectal surgery

© 2020 BJS Society Ltd Published by John Wiley & Sons LtdBackground: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients