Síndrome De McKittrick-Wheelock Mediante Cirugía Transanal Mínimamente invasiva, dispositivo SILS.

Presentamos el caso de un paciente varón de 80 años de edad sin alergias conocidas y con antecedentes de riesgo cardiovascular, diabetes mellitus tipo II, insuficiencia renal (IR) crónica estadio III, nefropatía diabética, colon irritable de dos años de evolución e ingreso previo por insufiencia renal aguda de causa prerrenal, hiperpotasemia y acidosis metabólica que precisó diálisis

Cierre primario diferido después de eventroplastia complicada

ResumenLa reparación de la hernia incisional gigante requiere una técnica de disección compleja, con un alto riesgo de complicaciones posoperatorias.Presentamos un caso de eventración recidivada en el que se realizó una técnica de separación de componentes para su cierre primario. El caso se complicó con un sangrado posoperatorio secundario a la lesión inadvertida de un vaso perforante, por lo que tuvo que ser reintervenido de urgencias. A los 3 días fue dado de alta sin más complicaciones. A los pocos días reingresó por isquemia intestinal con síndrome compartimental abdominal asociado, que se trató mediante laparotomía descompresiva dejando el abdomen abierto. Posteriormente se realizó el cierre primario diferido con una segunda técnica de separación de componentes, controlando las presiones de cierre aponeurótico mediante un dinamómetro digital. Al año de seguimiento el paciente mantiene una buena calidad de vida, y se descarta recidiva herniaria mediante tac de control.A pesar de tratarse de una dolencia benigna, no debemos menospreciar las importantes complicaciones que pueden aparecer en el posoperatorio, sobre todo cuando se trata de una hernia incisional de gran tamaño que ha precisado una disección considerable de la pared abdominal.En el contexto de cualquier posoperatorio de cirugía abdominal, cuando un paciente presenta distensión y dolor abdominal hay que descartar la existencia de hipertensión intraabdominal para evitar la progresión al síndrome compartimental agravado con una alta mortalidad a la que este se asocia.AbstractLarge incisional hernia repair requires a laborious dissection and it is associated with a high risk of postoperative complications.We present a case of recurrent incisional hernia in which an anatomic component separation technique was performed for primary closure. The patient presented complications with postoperative bleeding due to a perforant vessel undetected damage so he had to be reoperated. After 3 days he was discharged without complications. Afterwards he was readmitted to the hospital because of an intestinal ischaemia associated with abdominal compartment syndrome that was treated by decompressive laparotomy leaving an open abdomen. Subsequently, a delayed primary closure with a second separating components technique was carried out, controlling the tension strength edge while aponeurotic closure was performed using a digital dynamometer. After one year, the patient maintains a good quality of life with no recurrence shown in a CT scan.Although it is a benign disease, the serious complications that can occur in the postoperative setting should not be underestimaed, especially when a large incisional hernia is present and an important dissection of the abdominal wall has been performed.In the context of any postoperative abdominal surgery, when a patient has bloating and abdominal pain, it is mandatory to rule out the existence of intra-abdominal hypertension to prevent the development of a compartment syndrome, thus reducing the risk of mortality

Predictors of complications and mortality following left colectomy with primary stapled anastomosis for cancer: results of a multicentric study with 1111 patients

Aim: Reports detailing the morbidity–mortality after left colectomy are sparse and do not allow definitive conclusions to be drawn. We aimed to identify risk factors for anastomotic leakage, perioperative mortality and complications following left colectomy for colonic malignancies. Method: We undertook a STROBE-compliant analysis of left colectomies included in a national prospective online database. Forty-two variables were analysed as potential independent risk factors for anastomotic leakage, postoperative morbidity and mortality. Variables were selected using the ‘least absolute shrinkage and selection operator’ (LASSO) method. Results: We analysed 1111 patients. Eight per cent of patients had a leakage and in 80% of them reoperation or surgical drainage was needed. A quarter of patients (24.9%) experienced at least one minor complication. Perioperative mortality was 2%, leakage being responsible for 47.6% of deaths. Obesity (OR 2.8, 95% CI 1.00–7.05, P = 0.04) and total parenteral nutrition (TPN) (OR 3.7, 95% CI 1.58–8.51, P = 0.002) were associated with increased risk of leakage, whereas female patients had a lower risk (OR 0.36, 95% CI 0.18–0.67, P = 0.002). Corticosteroids (P = 0.03) and oral anticoagulants (P = 0.01) doubled the risk of complications, which was lower with hyperlipidaemia (OR 0.3, P = 0.02). Patients on TPN had more complications (OR 4.02, 95% CI 2.03–8.07, P = 0.04) and higher mortality (OR 8.7, 95% CI 1.8–40.9, P = 0.006). Liver disease and advanced age impaired survival, corticosteroids being the strongest predictor of mortality (OR 21.5, P = 0.001). Conclusion: Requirement for TPN was associated with more leaks, complications and mortality. Leakage was presumably responsible for almost half of deaths. Hyperlipidaemia and female gender were associated with lower rates of complications. These findings warrant a better understanding of metabolic status on perioperative outcome after left colectomy