Outcomes of Intra- versus Extra-Corporeal Ileocolic Anastomosis after Minimally Invasive Right Colectomy for Cancer: An Observational Study

Càncer colorectal; Anastomosi extracorpòria; Col·lectomia dreta mínimament invasivaCáncer colorrectal; Anastomosis extracorpórea; Colectomía derecha mínimamente invasivaColorectal cancer; Extracorporeal anastomosis; Minimally invasive right colectomyIntracorporeal anastomoses (IA) are increasingly being used in colorectal surgery. Some data suggest that these might confer benefits compared with extracorporeal anastomoses (EA). The aim of this study is to compare the short-term complications associated with IA versus EA for minimally invasive right colectomy. This is a single-centre, retrospective study on a prospective database. Patients who underwent minimally invasive right colectomy for cancer between January 2017 and December 2019 were assessed for inclusion. The primary outcome was global 30-day morbidity. Overall, 189 patients were included, of whom 102 had IA. Global morbidity and medical complications were higher in patients with EA (23.5% vs. 40.2%, p = 0.014; 5.9% vs. 14.9%, p = 0.039, respectively). None of the patients with IA had non-infectious surgical wound complications, compared to 4.6% in the EA group (p = 0.029). No differences were found in anastomotic leakage (9.8% vs. 10.3%, p = 0.55). At multivariable analysis, EA was an independent risk factor for both surgical (OR = 3.71 95% CI: 1.06–12.91, p = 0.04) and overall complications (OR = 3.58 95% CI: 1.06–12.12, p = 0.04). IA lowers the risk for global, medical, and surgical complications with minimum risk for wound complications, without increasing the risk of ALThis research received no external funding

Robotic abdominal resection of tailgut cysts – A technical note with step-by-step description

Tailgut cysts; Retrorectal tumours; Robotic approachQuistes del intestino grueso; Tumores retrorrectales; Enfoque robóticoQuists de l'intestí gruixut; Tumors retrorectals; Enfocament robòticAim Here, we describe a step-by-step standardized technique for tailgut cyst resection using a single-docking robotic approach. Method Each step of the technique is illustrated using a composite collection of four operative patient videos to demonstrate the advantages and feasibility of this technique. The robot platform utilised is Da Vinci Xi. Results Five female patients have undergone this operation in our unit. The size of tumours ranged from 12 to 45 mm. Median operating time was 100 min (range 90–150). Mean blood loss in all the patients was less than 50 ml. There were no major intraoperative complications. One patient had a postoperative presacral collection which required radiological drainage. Length of stay in all patients was one day. Conclusions This technique using a single-docking robotic approach appears safe and feasible. The robotic approach results in improved dexterity and more accurate dissection, better retraction and excellent vision which improves the ease of operating in the pelvis. Therefore, this approach can be replicated for use in a wide variety of patients with tailgut cysts

Influencia de la cirugía laparoscópica en la percepción de la calidad de vida después de apendicectomía. Ensayo clínico multicéntrico, aleatorizado y abierto de comparación de dos técnicas quirúrgicas

Introducción: El tratamiento quirúrgico de la apendicitis aguda supuso un gran avance en el tratamiento de una enfermedad grave que sirvió para prestigiar la cirugía y los resultados que podía ofrecer. La apendicectomía laparotómica, supuso una mejora del tratamiento de la apendicitis aguda disminuyendo espectacularmente la morbimortalidad. La introducción de la cirugía laparoscópica ha aportado nuevas expectativas en cuanto a recuperación postoperatoria. Sin embargo no existe un acuerdo general en que la cirugía laparoscópica aporte sólo ventajas y deben evaluarse sus posibles desventajas.Objetivo: Valorar la efectividad de la apendectomía laparoscópica y sus ventajas o desventajas en relación con la apendectomía laparotómica, haciendo énfasis en la calidad de vida postoperatoria.Diseño: Ensayo clínico multicéntrico, aleatorizado y abierto, de evaluación de la efectividad de dos técnicas quirúrgicas: apendicectomía laparoscópica (AL) y apendicectomía convencional (AC).Material y métodos: En los dos grupos de pacientes se analizaron las posibles variables confusoras, incluyendo: demográficas, patología asociada y características del proceso apendicular. Como variables resultado de influencia en la calidad de vida, se analizaron: hospitalización, dolor postoperatorio, morbimortalidad, y repercusión en la capacidad/dificultad para la realización de actividades físicas habituales, durante los 30 primeros días del postoperatorio. Además se analizó el tiempo quirúrgico y la posible repercusión de la curva de aprendizaje en los pacientes intervenidos por laparoscopia.Resultados: No se encontraron diferencias significativas entre los 2 grupos en ninguna de las variables confusoras. En lo que se refiere a las variables resultado, la mortalidad fue nula en ambos grupos, mientras que la morbilidad supuso un índice de infección de herida significativamente inferior en el grupo AL. En cuanto a la percepción del dolor postoperatorio, fue significativamente inferior en el grupo AL. El periodo de hospitalización fue similar en ambos grupos. Respecto a la valoración de la capacidad/discapacidad para realizar actividades habituales, los pacientes del grupo AL manifestaron tener índices de recuperación superiores en algunas de ellas. El tiempo quirúrgico fue significativamente superior en el grupo AL. La curva de aprendizaje en los pacientes intervenidos por vía laparoscópica tuvo repercusión en cuanto a un significativo incremento de la hospitalización durante la primera etapa del estudio.Conclusiones: La AL presenta, con respecto a la AC, algunas ventajas en la apreciación de la recuperación de actividades habituales en el postoperatorio, tanto en el análisis global como en los parciales de las diferentes actividades consideradas. La duración de la hospitalización ha sido inferior en el grupo AL así como la percepción del dolor postoperatorio y la tasa de infección de herida quirúrgica. Como desventaja, presenta un mayor tiempo quirúrgico.Introduction: Surgical treatment of acute appendicitis marked a breakthrough in the treatment of serious illness that served to boost the prestige surgery and the results that could offer. The laparotomic appendectomy was an improvement of the treatment of acute appendicitis declining dramatically the morbidity and mortality. The introduction of laparoscopic surgery has brought new expectations with regard to postoperative recovery. Nevertheless there does not exist a general agreement in which the laparoscopic surgery contributes only advantages and his possible disadvantages must be evaluated.Objective: To value the efficiency of the laparoscopic appendectomy and his advantages or disadvantages in relation with the laparotomic appendectomy, doing emphasis in the quality of postoperatory life.Design: clinical multicentral, randomized and opened essay, of evaluation of the efficiency of two surgical Technologies : laparoscopic appendectomy (AL) and conventional appendectomy (AC).Material and methods: In both groups of patients the possible variables equal were analyzed, including: demographic, associate pathology and characteristics of the appendicular process. As variables proved from influence in the quality of life, they were analyzed: hospitalization, postoperatory pain, morbimortality and repercussion in the capacity/difficulty for the accomplishment of physical habitual activities, during the first 30 days of the postoperatory time. In addition to this, it was analyzed the surgical time and the possible repercussion in learning courve in the patients controlled for laparoscopic surgery.Results: they did not find significant differences between 2 groups in any of the variables equal. Regarding the variables proved, the mortality was void in both groups, whereas the morbidity supposed an index of infection of significantly low wound in the group AL. As for the perception of the postoperatory pain, i) was significantly low in the group AL. The period of hospitalization was similar in both groups. With regard to the valuation of the capacity/disability to realize habitual activities, the patients of the AL group demonstrated to have top indexes of recovery in some of them. The surgical time was significantly top in the AL group. The learning curve in the patients of AL group had repercussion as for a significant increase of the hospitalization during the first stage of the study.Conclusions: The AL has some advantages in regards to AC in the appraisal of the recovery of habitual activities in the postoperatory time as well as in global analysis and partial ones of the different considered activities. The duration of the hospitalization has been lower in the AL group and also the perception of the postoperatory pain and the infection's rate of surgical wound. Her disadvantage is that requires longer surgical time

Influencia de la cirugía laparoscópica en la percepción de la calidad de vida despues de apendicectomía : ensayo clínico multicéntrico, aleatorizado y abierto de comparación de dos técnicas quirúrgicas/

Descripció del recurs: 28 abril 2010Introducción: El tratamiento quirúrgico de la apendicitis aguda supuso un gran avance en el tratamiento de una enfermedad grave que sirvió para prestigiar la cirugía y los resultados que podía ofrecer. La apendicectomía laparotómica, supuso una mejora del tratamiento de la apendicitis aguda disminuyendo espectacularmente la morbimortalidad. La introducción de la cirugía laparoscópica ha aportado nuevas expectativas en cuanto a recuperación postoperatoria. Sin embargo no existe un acuerdo general en que la cirugía laparoscópica aporte sólo ventajas y deben evaluarse sus posibles desventajas. Objetivo: Valorar la efectividad de la apendectomía laparoscópica y sus ventajas o desventajas en relación con la apendectomía laparotómica, haciendo énfasis en la calidad de vida postoperatoria. Diseño: Ensayo clínico multicéntrico, aleatorizado y abierto, de evaluación de la efectividad de dos técnicas quirúrgicas: apendicectomía laparoscópica (AL) y apendicectomía convencional (AC). Material y métodos: En los dos grupos de pacientes se analizaron las posibles variables confusoras, incluyendo: demográficas, patología asociada y características del proceso apendicular. Como variables resultado de influencia en la calidad de vida, se analizaron: hospitalización, dolor postoperatorio, morbimortalidad, y repercusión en la capacidad/dificultad para la realización de actividades físicas habituales, durante los 30 primeros días del postoperatorio. Además se analizó el tiempo quirúrgico y la posible repercusión de la curva de aprendizaje en los pacientes intervenidos por laparoscopia. Resultados: No se encontraron diferencias significativas entre los 2 grupos en ninguna de las variables confusoras. En lo que se refiere a las variables resultado, la mortalidad fue nula en ambos grupos, mientras que la morbilidad supuso un índice de infección de herida significativamente inferior en el grupo AL. En cuanto a la percepción del dolor postoperatorio, fue significativamente inferior en el grupo AL. El periodo de hospitalización fue similar en ambos grupos. Respecto a la valoración de la capacidad/discapacidad para realizar actividades habituales, los pacientes del grupo AL manifestaron tener índices de recuperación superiores en algunas de ellas. El tiempo quirúrgico fue significativamente superior en el grupo AL. La curva de aprendizaje en los pacientes intervenidos por vía laparoscópica tuvo repercusión en cuanto a un significativo incremento de la hospitalización durante la primera etapa del estudio. Conclusiones: La AL presenta, con respecto a la AC, algunas ventajas en la apreciación de la recuperación de actividades habituales en el postoperatorio, tanto en el análisis global como en los parciales de las diferentes actividades consideradas. La duración de la hospitalización ha sido inferior en el grupo AL así como la percepción del dolor postoperatorio y la tasa de infección de herida quirúrgica. Como desventaja, presenta un mayor tiempo quirúrgico.Introduction: Surgical treatment of acute appendicitis marked a breakthrough in the treatment of serious illness that served to boost the prestige surgery and the results that could offer. The laparotomic appendectomy was an improvement of the treatment of acute appendicitis declining dramatically the morbidity and mortality. The introduction of laparoscopic surgery has brought new expectations with regard to postoperative recovery. Nevertheless there does not exist a general agreement in which the laparoscopic surgery contributes only advantages and his possible disadvantages must be evaluated. Objective: To value the efficiency of the laparoscopic appendectomy and his advantages or disadvantages in relation with the laparotomic appendectomy, doing emphasis in the quality of postoperatory life. Design: clinical multicentral, randomized and opened essay, of evaluation of the efficiency of two surgical Technologies : laparoscopic appendectomy (AL) and conventional appendectomy (AC). Material and methods: In both groups of patients the possible variables equal were analyzed, including: demographic, associate pathology and characteristics of the appendicular process. As variables proved from influence in the quality of life, they were analyzed: hospitalization, postoperatory pain, morbimortality and repercussion in the capacity/difficulty for the accomplishment of physical habitual activities, during the first 30 days of the postoperatory time. In addition to this, it was analyzed the surgical time and the possible repercussion in learning courve in the patients controlled for laparoscopic surgery. Results: they did not find significant differences between 2 groups in any of the variables equal. Regarding the variables proved, the mortality was void in both groups, whereas the morbidity supposed an index of infection of significantly low wound in the group AL. As for the perception of the postoperatory pain, i) was significantly low in the group AL. The period of hospitalization was similar in both groups. With regard to the valuation of the capacity/disability to realize habitual activities, the patients of the AL group demonstrated to have top indexes of recovery in some of them. The surgical time was significantly top in the AL group. The learning curve in the patients of AL group had repercussion as for a significant increase of the hospitalization during the first stage of the study

Double Barreled Wet Colostomy : Initial Experience and Literature Review

Background. Pelvic exenteration and multivisceral resection in colorectal have been described as a curative and palliative intervention. Urinary tract reconstruction in a pelvic exenteration is achieved in most cases with an ileal conduit of Bricker, although different urinary reservoirs have been described. Methods. A retrospective and observational study of six patients who underwent a pelvic exenteration and urinary tract reconstruction with a double barreled wet colostomy (DBWC) was done, describing the preoperative diagnosis, the indication for the pelvic exenteration, the complications associated with the procedure, and the followup in a period of 5 years. A literature review of the case series reported of the technique was performed. Results. Six patients had a urinary tract reconstruction with the DBWC technique, 5 male patients and one female patient. Age range was from 20 to 77 years, with a medium age 53.6 years. The most frequent complication presented was a pelvic abscess in 3 patients (42.85%); all complications could be resolved with a conservative treatment. Conclusion. In the group of our patients with pelvic exenteration and urinary tract reconstruction with a DBWC, it is a safe procedure and well tolerated by the patients, and most of the complications can be resolved with conservative treatmen