RESUMEN
BACKGROUND: Intracorporeal anastomosis (IA) in right colectomies shows many advantages over extracorporeal anastomosis (EA). Many difficulties encountered in laparoscopic IA can be overcome with hybrid robot-assisted IA or recently with totally robotic procedures. In the literature, few works have been published comparing laparoscopic, hybrid, and totally robotic right colectomies. The aim of this study is to retrospectively analyze the improvements brought on by the evolution of robotic surgery at our specialized center. MATERIALS AND METHODS: Two hundred six (hybrid and totally) robotic right colectomies (RRCs) with IA were compared with 160 laparoscopic right colectomies (LRCs) with EA. A separate analysis carried out by the robotic group compared 30 totally robotic right colectomies (TRRCs) with 176 hybrid robot-assisted right colectomies (HRRCs). Demographics, pathological features, operative details, and postoperative outcomes were retrospectively analyzed from a prospectively maintained database. RESULTS: The groups were comparable with respect to demographics and tumor staging. When compared with LRC, RRC showed shorter time to first flatus (P < .001), stools (P < .001), solid diet (P < .001), and discharge (P < .001). The number of lymph nodes harvested was 23.13 ± 11.2 in RRC versus 20.5 ± 11.2 in LRC (P = .031). Operative time was longer in RRC (253.0 ± 47 minutes versus 209.9 ± 64 minutes; P < .001), but conversion to open (2.4% versus 18.1%; P < .001), anastomotic leaks (0.5% versus 5%; P = .012), and bleeding (0.3% versus 4.4%; P = .024) were significantly less frequent. Subsequent analysis shows no significant increase in operative time in TRRC versus HRRC (261.0 ± 41 minutes versus 251.6 ± 47.6 minutes; P = .310). Even if not statistically significant, TRRC showed faster bowel function recovery and tolerance to solid diet. CONCLUSIONS: We confirmed the clinical advantages of RRC with IA over LRC with EA in postoperative recovery outcomes and complication rate. Furthermore, our preliminary analysis in a cohort of 30 TRRC shows promising results.
Asunto(s)
Anastomosis Quirúrgica/métodos , Colectomía/métodos , Neoplasias del Colon/cirugía , Laparoscopía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Anciano , Anastomosis Quirúrgica/efectos adversos , Colectomía/efectos adversos , Conversión a Cirugía Abierta/estadística & datos numéricos , Femenino , Humanos , Laparoscopía/efectos adversos , Masculino , Persona de Mediana Edad , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/efectos adversosRESUMEN
A case is reported of a recurrent postintubation tracheoesophageal fistula treated with the interposition of a Gore-Tex patch between the trachea and the esophagus.
Asunto(s)
Esofagoplastia/métodos , Mallas Quirúrgicas , Fístula Traqueoesofágica/patología , Fístula Traqueoesofágica/cirugía , Anciano , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Esofagoscopía/métodos , Femenino , Humanos , Politetrafluoroetileno , Pronóstico , Recurrencia , Medición de Riesgo , Resultado del TratamientoAsunto(s)
Colostomía/métodos , Fístula Intestinal/etiología , Trasplante de Riñón/efectos adversos , Complicaciones Posoperatorias , Enfermedades del Sigmoide/etiología , Anciano , Colon Sigmoide , Diagnóstico Diferencial , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/cirugía , Riñón , Fallo Renal Crónico/cirugía , Masculino , Enfermedades del Sigmoide/diagnóstico , Enfermedades del Sigmoide/cirugía , Tomografía Computarizada por Rayos XRESUMEN
We propose a simple, easy technique to perform a stapled colorectal anastomosis close to the anal sphincter that may help to lower leak rates. This is the same technique used by us for successful performance of intrathoracic and abdominal esophagoenteric mechanical anastomoses. The technique consists of hand sewing a double pursestring suture before sectioning the rectum.