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1.
Tech Coloproctol ; 26(12): 973-979, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-36197564

RESUMEN

BACKGROUND: Ventral mesh rectopexy (VMR) is widely accepted for the treatment of rectal prolapse or obstructed defecation. However, despite good anatomical results, the improvement of functional symptoms (constipation or incontinence) cannot always be obtained and in some cases these symptoms may even worsen. The aim of the present study was to identify possible predictors of functional failure after VMR. METHODS: Data of all consecutive patients who had VMR for the treatment of rectal prolapse and/or obstructed defecation between January 2017 and December 2020 in three different pelvic floor surgical centres in Italy were analysed to identify possible predictors of functional failure, intended as persistence, worsening or new onset of constipation or faecal incontinence. Symptom severity was assessed pre- and postoperatively with the Wexner Constipation score and Obstructed Defecation Syndrome score. Quality of life was assessed, also before and after treatment, with the Patients Assessment of Constipation Quality of Life questionnaire, the Pelvic Floor Disability Index and the Pelvic Floor Impact Questionnaire. Faecal incontinence was evaluated with the Cleveland Clinic Incontinence Score. The functional outcomes before and after surgery were compared. RESULTS: Sixty-one patients were included (M:F ratio 3:60, median age 64 years [range 33-88 years]). Forty-two patients (68.9%) had obstructed defecation syndrome, 12(19.7%) had faecal incontinence and 7 patients (11.5%) had both. A statistically significant reduction between pre- and postoperative Obstructed Defecation Syndrome and Wexner scores was reported (p < 0.0001 in both cases). However, the postoperative presence of constipation occurred in 22 patients (36.1%) (this included 3 cases of new-onset constipation). The presence of redundant colon and the pre-existent constipation were associated with an increased risk of persistence of constipation postoperatively or new-onset constipation (p = 0.004 and p < 0.0001, respectively). The use of postoperative pelvic floor rehabilitation (p = 0.034) may reduce the risk of postoperative constipation. CONCLUSIONS: VMR is a safe and effective intervention for correcting the anatomical defect of rectal prolapse. The degree of prolapse, the presence of dolichocolon and pre-existing constipation are risk factors for the persistence or new onset of postoperative constipation. Postoperative rehabilitation treatment may reduce this risk.


Asunto(s)
Incontinencia Fecal , Laparoscopía , Prolapso Rectal , Humanos , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Prolapso Rectal/complicaciones , Prolapso Rectal/cirugía , Incontinencia Fecal/etiología , Incontinencia Fecal/cirugía , Defecación , Mallas Quirúrgicas/efectos adversos , Calidad de Vida , Laparoscopía/métodos , Resultado del Tratamiento , Estreñimiento/etiología , Estreñimiento/cirugía , Recto/cirugía
3.
Ann R Coll Surg Engl ; 104(7): e208-e210, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35442821

RESUMEN

The optimal surgical procedure for Siewert II oesophagogastric junction cancer is still debated. The minimally invasive Ivor Lewis technique can be considered the most adequate intervention from the oncological perspective but it is still contested owing to its technical difficulties. To allow an easier thoracoscopic stage during the procedure, we performed it with laparoscopic trans-hiatal oesophageal transection and transabdominal extraction. An 80-year-old man with stage 3 Siewert II oesophagogastric junction adenocarcinoma not suitable for neoadjuvant therapy underwent minimally invasive Ivor Lewis oesophagectomy with two-field lymphadenectomy, using a laparoscopic and thoracoscopic approach in prone position. The trans-hiatal oesophageal resection permitted easy extraction of a transabdominal specimen and frozen section examination. The prone position, together with the absence of the specimen in the operative field, allowed easier mediastinal node dissection and oesophagogastric anastomosis with better visualisation. The postoperative course was uneventful. Pathology showed a G3-pT3, N2 adenocarcinoma with 6/30 metastatic lymph nodes.


Asunto(s)
Adenocarcinoma , Neoplasias Esofágicas , Laparoscopía , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Anciano de 80 o más Años , Neoplasias Esofágicas/diagnóstico , Esofagectomía/métodos , Unión Esofagogástrica/patología , Unión Esofagogástrica/cirugía , Humanos , Laparoscopía/métodos , Masculino , Estudios Retrospectivos
4.
Ann R Coll Surg Engl ; 103(1): e4-e6, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32820640

RESUMEN

In the past few years, minimally invasive oesophagectomy has become an increasingly popular approach for oesophagectomy showing advantages in terms of fewer postoperative complications, shorter hospital stay and faster recovery. We present the case of a 60-year-old man with a lesion of the distal third of the oesophagus and solid pulmonary nodule who underwent McKeown subtotal oesophagectomy by laparoscopic and thoracoscopic approach in prone position with concomitant thoracoscopic pulmonary wedge resection. The postoperative course was smooth, and the patient was discharged on postoperative day 10. The procedure is feasible and safe, and combines better respiratory postoperative outcomes even when associated with other diagnostic or therapeutic lung procedures.


Asunto(s)
Neoplasias Esofágicas/cirugía , Esofagectomía/métodos , Laparoscopía/métodos , Neoplasias Pulmonares/cirugía , Neumonectomía/métodos , Toracoscopía/métodos , Biopsia , Terapia Combinada/efectos adversos , Terapia Combinada/métodos , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/patología , Esofagectomía/efectos adversos , Esófago/diagnóstico por imagen , Esófago/patología , Esófago/cirugía , Estudios de Factibilidad , Humanos , Laparoscopía/efectos adversos , Pulmón/diagnóstico por imagen , Pulmón/patología , Pulmón/cirugía , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundario , Masculino , Persona de Mediana Edad , Posicionamiento del Paciente/efectos adversos , Posicionamiento del Paciente/métodos , Neumonectomía/efectos adversos , Posición Prona , Toracoscopía/efectos adversos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
5.
Ann R Coll Surg Engl ; 102(6): e130-e132, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32326737

RESUMEN

Minimally invasive oesophagectomy has become popular, but studies showed a higher rate of postoperative hiatus hernia compared with open oesophagectomy. Our video presents the laparoscopic biosynthetic mesh repair of a symptomatic giant hiatus hernia in a 71-year-old man who had undergone minimally invasive oesophagectomy one year earlier for distal adenocarcinoma of the oesophagus. The operative time was 120 minutes. The patient started oral intake on postoperative day one and was discharged on postoperative day three. Postoperative computed tomography at six months showed no signs of recurrence. In the setting of a symptomatic hiatus hernia post-minimally invasive oesophagectomy, we suggest an initial laparoscopic approach, because of its countless advantages.


Asunto(s)
Esofagectomía/efectos adversos , Hernia Hiatal/cirugía , Herniorrafia/métodos , Laparoscopía/métodos , Complicaciones Posoperatorias/cirugía , Toracoscopía/efectos adversos , Adenocarcinoma/terapia , Anciano , Quimioradioterapia Adyuvante , Colon Transverso/diagnóstico por imagen , Diafragma/diagnóstico por imagen , Diafragma/cirugía , Neoplasias Esofágicas/terapia , Hernia Hiatal/diagnóstico , Hernia Hiatal/etiología , Herniorrafia/instrumentación , Humanos , Intestino Delgado/diagnóstico por imagen , Laparoscopía/instrumentación , Masculino , Terapia Neoadyuvante , Readmisión del Paciente , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Mallas Quirúrgicas , Técnicas de Sutura , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
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