Assuntos
Recidiva , Humanos , Masculino , Herniorrafia/métodos , Complicações Pós-Operatórias/cirurgia , Feminino , Reto/cirurgiaAssuntos
Clostridioides difficile , Enterocolite Pseudomembranosa/etiologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Colectomia , Enterocolite Pseudomembranosa/tratamento farmacológico , Enterocolite Pseudomembranosa/cirurgia , Hemorragia Gastrointestinal/etiologia , Humanos , Ileostomia , Hospedeiro Imunocomprometido , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Masculino , Megacolo Tóxico/etiologia , Megacolo Tóxico/cirurgia , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Pneumoperitônio/etiologia , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/microbiologia , Neoplasias do Colo Sigmoide/cirurgiaRESUMO
INTRODUCTION: Transanal endoscopic surgery with conventional laparotomy materials may be an alternative to transanal endoscopic microsurgery (TEM) for the excision of rectal lesions susceptible to local resection. MATERIAL AND METHOD: We prospectively analysed 27 patients included consecutively between 1999 and 2009, on whom a Transanal endoscopic operation (TEO) was performed by total resection of the rectal wall. All procedures were performed with a 40mm rectoscope, initially designed by us and later with the Storz rectoscope, using conventional laparoscopic tools and material. RESULTS: We operated on 27 patients with a mean age of 69.4 years: 23 due to benign lesions and 4 malignant. The medium distance of the tumour to the anal margins was 8.2cm (range 5-15) and a mean tumour diameter of 3.38 ± 1.2cm. There were 4 postoperative complications, 3 due to bleeding and one case of perforation. The mean hospital stay was 6 ± 3.75 days. There was no perioperative mortality or recurrences.. CONCLUSION: Performing transanal endoscopic surgery with conventional laparoscopy material is feasible, with a reduction in costs and accessible to laparoscopy surgeons.
Assuntos
Laparoscópios , Proctoscopia/instrumentação , Neoplasias Retais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
OBJECTIVE: The aim of this study was the prospective evaluation of the functional results of a series endorectal advancement flaps in the treatment of complex anal fistulas. MATERIAL AND METHODS: A total of 90 patients were operated on for a complex anal fistula by means of fistulectomy and endorectal advancement flap. The functional results were evaluated using the Wexner continence scale and an anorectal manometry study before and after surgery. RESULTS: There were seven patients with fistula recurrence (7.7%) and the same surgical procedure was performed on five of them, resulting in healing in all cases. Significant reductions in maximum resting pressure (83.85+/-30.96 vs 46.51+/-18.67; p<0.001) and maximum squeeze pressure (220.97+/-100.21 vs 183.06+/-75.36; p<0.001) were seen 3 months after surgery. On the continence scale, 80% of patients had a normal continence with a value of 0 on the postoperative Wexner scale, while 20% recorded changes in continence values, most of them lower than 3 points. CONCLUSIONS: Endorectal advancement flap is an effective surgical procedure in complex anal fistulas treatment, with a low recurrence rate. Only 20% of the patients showed changes in the continence value.