10 research outputs found
ESPECTRO CLINICO DE LA FISTULA RECTOVAGINAL: ANALISIS DE 38 PACIENTES
Se revisa en forma retrospectiva los resultados del tratamiento quirúrgico de 38 pacientes intervenidas en forma consecutiva por una fÃstula rectovaginal (FRV) en un periodo de 12 años. Se define como simple una FRV baja, menor de 2,5 cm y de origen traumático o infeccioso y compleja una FRV alta, mayor de 2,5 cm y de origen neoplásico, actÃnico o inflamatorio. La etiologÃa más común fue la neoplásica en el 39% (15/38) de los casos: debido a persistencia tumoral de un cáncer cervicouterino (Ca CU) tratado con radioterapia y/o cirugÃa en 10 pacientes, cáncer de recto en 3 y cáncer de ano en 2. En dos pacientes con cáncer de recto se efectuó cirugÃa radical con conservación de esfÃnteres en una de ellas y exenteración posterior en la otra con una sobrevida de 70 meses libre de enfermedad y fallecimiento a los 60 meses respectivamente. En los dos casos de cáncer anal se realizó una exenteración posterior por persistencia tumoral luego de recibir radioquimioterapia según el esquema de Nigro. La FRV actÃnica se presentó en el 34% (13/38) de los casos, 12 de las cuales fueron sometidas a una operación de Parks (anastomosis coloanal con mucosectomÃa rectal) con éxito en todos los casos, quedando el 40% de ellas con algún disturbio de la continencia. Cuatro pacientes (11%) corresponden a una complicación quirúrgica luego de cirugÃa pélvica, 3 de las cuales cierran sólo mediante una desfuncionalización. Las FRV de origen obstétrico (16%) se corrigieron mediante una reparación local generalmente mediante un colgajo rectal grueso y reparación esfinteriana simultánea con resultados satisfactorios. En los casos de persistencia tumoral por Ca CU se logró una desfuncionalización adecuada en la mayorÃa de los casos mediante una sigmoidostomÃa en asa con una sobrevida de hasta 26 meses. En esta serie, el 84% de los casos corresponden a FRV complejas y el 50% de ellas fueron sometidas a una reparación con cirugÃa radical por vÃa abdominal sin necesidad de una ostomÃa definitiva. Las series de FRV son muy heterogéneas probablemente por patrones de referencia distintos, lo que hace difÃcil hacer un análisis comparativo.A retrospective analysis of surgical treatment in 38 patients with recto-vaginal fistula (RVF) in a twelve years period is being presented. Is defined as a simple RVF when is low, less than 2.5 cm and traumatic or infections in origin, and as a complex are if it is high, larger than 2.5 cm and of neoplastic, actinic or inflammatory origin. The most common etiology was neoplastic, 39% (15/38): due to persistence of cervical cancer in 10 patients, treated with radiotherapy, surgery or both; rectal carcinoma in 3 patients and anal cancer in 2. Two patients with rectal carcinoma were treated with radical surgery and sphincter conservation in one of them and posterior exenteration on the other, they survival free of disease to and 60 months respectively. Both cases with anal cancer were managed with posterior exenteration because tumoral persistence after receiving radio and chemotherapy by the nigro scheme. Actinic RVF were present in 34% (13/38); twelve of them were treated by the Parks operation (coloanal anastomosis and rectal mucosectomy), successful in all of them, although 40% had some kind of continence disturbance. Four patients with RVF (11%) were consequence of pelvic surgery complications, three of them closed only after a diverting procedure. Obstetrical RVF (16%) were repared by a local procedure using a thick rectal flap and simultaneous sphincter repair always with good results. In cases of cervical cancer with tumoral remnants, a diverting loop sigmoidostomy was sufficient in most of them and some of them with 26 months survival. In this series, 84% are complex RVF and 50% of them were submitted to abdominal radical surgery with no need of a permanent ostomy. Series of RVF are heterogeneous in composition due diferences in etiology of each group making difficult comparative studies
Lomas-Cooperman technique for rectal prolapse in the elderly patient
A variety of surgical procedures is used to correct complete rectal prolapse (RP). We analysed the immediate and long-term results of the Lomas-Cooperman technique in the management of symptomatic RP in elderly patients with severe concomitant diseases. Across a 13-year period, all patients with RP having undergone surgery with this procedure were retrospectively evaluated. The technique consisted in placing a triply folded piece of polypropylene mesh encircling the anal canal through a perineal approach. A total of 22 patients (20 female) with a mean age of 84 years (range, 72-93 years) with severe concomitant pathologies were assessed. Four patients were classified as ASA II and 18 as ASA III. Mean Karnofsky score was 50%, ranging between 40% and 60%. All patients were operated on under regional anaesthesia without incidents. Mean operative time was 35 min(range, 20-60 min) and mean hospital stay was 4.5 days (range, 2-17 days). The most common immediate postoperative complication was urinary tract infection, found in 18% of the cases. Mean follow-up was 32 months (range, 4-84 months). During follow-up, 4 cases (18%) of mesh exteriorisation were detected, requiring mesh trimming at the outpatient clinic. Rectal prolapse recurred in 2 patients; one of them was managed with a new cerclage reaching a satisfactory outcome. Thus, by intention-to-treat basis, the recurrence rate was 4.5%. Constipation was resolved in three out of 4 patients, but in 18% of the cases late faecal impact was recorded. Mean preoperative incontinence score improved from 5.1+/-0.62 to 3.4+/-1.61 (p<0.0001) after surgery. Anal cerclage with the Lomas-Cooperman technique constitutes a simple and reproducible surgical technique with an acceptable morbidity and recurrence rate in high-risk elderly patients with RP
Surgical treatment of colon cancer. Retrospective analysis of 439 patients Resultados del tratamiento quirúrgico del cáncer de colon. Análisis de 439 pacientes
Background: Mortality for colon cancer duplicated in the last 15 years in Chile. Aim: To analyze immediate and late results of surgical treatment of colon cancer. Material and Methods: Retrospective analysis of 439 patients aged 22 to 92 years, 55% women, subjected to elective surgery for colon cancer between 1991 and 2007. Results: At the moment of surgery 86% of tumors were resectable and 25% were in stage IV. Twenty one percent of patients had surgical complications, 4% had to be reoperated and 1% died. Ten years global survival for stages I to III was 82%. Survival significantly decreased for stages IIIb and forward. Preoperative carcinoembrionic antigen, vascular permeation, the number of involved lymph nodes and chemotherapy were relevant prognostic factors. If TNM classification is included in the model, only vascular permeation and lymph node involvement remain as prognostic factors. Conclusions: TNM classification and lymph node involvement are the main survival prognostic fa
Indicaciones resultados alejados del tratamiento quirúrgico electivo de la enfermedad diverticular del colon sigmoides
Predictive factors of stenosis after stapled colorectal anastomosis: Prospective analysis of 179 consecutive patients
The incidence, risk factors, and clinical relevance of stenosis of stapled colorectal anastomosis (CRA) were studied prospectively. Anastomotic stricture was defined as the inability of traversing the anastomosis with the rigid proctoscope. The population studied consisted of 179 patients (94 males) with an average age of 59.3 years (range: 20 to 91 years). The main indication for surgery was colorectal cancer in 59% of the cases, followed by diverticular disease in 23%. The first endoscopic control was performed before 4 months in 25% of the patients, between 5 and 10 months in 50%, and during the following 10 months in 25%. Stenosis was verified with the rigid instrument in 21.1% of the cases and with the flexible colonoscope in 4.4%. The barium enema performed in 12 cases confirmed a punctiform stenosis in 5 patients, 4 of whom had been asymptomatic. An endoscopic dilatation was performed on 5 of the 8 symptomatic patients, with one relapse that required an additional dilatation. I
Factores pronósticos en el cáncer colorrectal: Análisis multivariado de 224 pacientes
Tratamiento de la rectitis actÃnica hemorrágica con aplicación tópica de formalina al 4%
Background: Hemorrhagic radiation rectitis occurs in 15% of patients subjected to pelvic irradiation.
One of the treatment alternatives is the topical application of 4% formaldehyde. Aim: To report the results
of the use of topical formaldehyde in radiation rectitis. Material and Methods: Twenty patients aged 36
to 80 years (13 women) with hemorrhagic radiation rectitis were prospectively recruited. Fistula or stenosis
was discarded endoscopically. Formaldehyde was applied in the operating room or at the outpatient clinic.
Results: Fifteen patients required repeated transfusions. The application was performed in the operating room
in fi ve patients. Bleeding stopped in three patients with one application, in 12 patients with two applications
and in four, with three applications. In one patient, bleeding did not stop after the fi rst application and had a
sigmoid perforation; therefore no further application was attempted. One patient had a severe proctitis after
the procedure, which subsided with symptomatic treatment after 15 days. Conclusions: Topical formaldehyde
application for hemorrhagic rectitis is effective to stop bleeding but has complications in 10% of patients.Introducción: La rectitis actÃnica hemorrágica es una complicación que se presenta en el 15% de los
pacientes sometidos a radioterapia por una neoplasia pélvica. Existen distintas alternativas para su tratamiento,
entre las que se cuenta la aplicación de formalina al 4%. Presentamos los resultados del tratamiento de esta
complicación en una serie prospectiva no aleatoria. Material y Método: Desde marzo de 2004 a mayo de
2007 se reclutaron en forma prospectiva todos los pacientes tratados por una rectitis actÃnica hemorrágica en nuestro servicio. En todos los pacientes se descartó una estenosis o fÃstula por endoscopia fl exible. Los
pacientes fueron sometidos a aplicación de formalina en pabellón o ambulatoria según la evaluación del
tratante. Resultados: La serie corresponde a 20 pacientes, 13 mujeres, con un promedio de edad de 61 años
(36-80), 15 requerÃan transfusiones a repetición. La indicación de radioterapia fue por un cáncer cérvico uterino
en 9 casos, de próstata en 7 casos y endometrio en 4. El promedio de sesiones necesarias para controlar
el sangrado fue de 2 (1-3); en 5 pacientes la aplicación se realizó en pabellón. Tres pacientes mejoraron con
una aplicación, 12 pacientes con 2 aplicaciones y 4 con 3 procedimientos. Un paciente continúa sangrado después
de un procedimiento, pero presenta una perforación de sigmoides en terreno neoplásico y no se intentó
una segunda sesión, por lo que se considera un fracaso del procedimiento. Además un paciente presentó una
proctitis intensa que cedió con tratamiento sintomático en 15 dÃas, con lo que la morbilidad del procedimiento
alcanza a un 10%. El éxito acumulado es de un 95% de los casos, con detención del sangrado, sin necesidad
de transfusiones. Conclusión: Estimamos que el tratamiento con formalina al 4% es un procedimiento seguro
para el tratamiento de la rectitis actÃnica hemorrágica, con buenos resultados en la gran mayorÃa de los
pacientes, evitando procedimientos más caros o de mayor morbilidad
Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence
Abstract We systematically searched available databases. We reviewed 6,143 studies published from 1833 to 2017. Reports in English, French, German, Italian, and Spanish were considered, as were publications in other languages if definitive treatment and recurrence at specific follow-up times were described in an English abstract. We assessed data in the manner of a meta-analysis of RCTs; further we assessed non-RCTs in the manner of a merged data analysis. In the RCT analysis including 11,730 patients, Limberg & Dufourmentel operations were associated with low recurrence of 0.6% (95%CI 0.3–0.9%) 12 months and 1.8% (95%CI 1.1–2.4%) respectively 24 months postoperatively. Analysing 89,583 patients from RCTs and non-RCTs, the Karydakis & Bascom approaches were associated with recurrence of only 0.2% (95%CI 0.1–0.3%) 12 months and 0.6% (95%CI 0.5–0.8%) 24 months postoperatively. Primary midline closure exhibited long-term recurrence up to 67.9% (95%CI 53.3–82.4%) 240 months post-surgery. For most procedures, only a few RCTs without long term follow up data exist, but substitute data from numerous non-RCTs are available. Recurrence in PSD is highly dependent on surgical procedure and by follow-up time; both must be considered when drawing conclusions regarding the efficacy of a procedure