Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 16 de 16
Filtrar
Más filtros

Banco de datos
Tipo del documento
País de afiliación
Intervalo de año de publicación
1.
Neurourol Urodyn ; 37(1): 434-439, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-28598517

RESUMEN

AIMS: To analyze whether episiotomy affects the urogenital hiatal area and the difference in the hiatus at rest and during contraction, as an indirect measurement of the contractile capacity of the levator ani muscle. METHODS: We performed an observational, comparative, retrospective study of primiparous women who had normal vaginal deliveries. The urogenital hiatal area was compared in women with and without episiotomy. All women underwent transperineal ultrasound scanning after delivery, and all the images were analyzed offline by the principal investigator who was blinded to all clinical data. The urogenital hiatal area was measured at rest and during both Valsalva and contraction manoeuvres. The difference in the hiatus at rest and during contraction was also calculated. These scanning variables were compared between the study groups. RESULTS: In total, 194 women were analysed (101 with, and 93 without, episiotomy). There were no statistically significant differences between the groups regarding the area of the hiatus at rest (P = 0.583), on Valsalva (P = 0.158), and on contraction (P = 0.468), or in the difference in the hiatus at rest and during contraction (P = 0.095). CONCLUSIONS: In normal vaginal delivery, neither the area of the urogenital hiatus nor its difference at rest and during contraction, as measured by ultrasound, were modified by performing an episiotomy.


Asunto(s)
Episiotomía/efectos adversos , Sistema Urogenital/diagnóstico por imagen , Adolescente , Parto Obstétrico , Femenino , Humanos , Contracción Muscular , Paridad , Diafragma Pélvico/diagnóstico por imagen , Embarazo , Estudios Retrospectivos , Ultrasonografía , Maniobra de Valsalva , Adulto Joven
2.
Neurourol Urodyn ; 36(7): 1839-1845, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28102588

RESUMEN

AIMS: The pathophysiological mechanism of incontinence is multifactorial. We evaluated the role of 3D-4D ultrasound in the assessment of the fascial supports of the urethra and the urethral sphincter complex (USC) for diagnosing stress urinary incontinence. METHODS: Observational case-control study in women with and without stress urinary incontinence attending a urogynecology service and a general gynecology service. All women were interviewed, examined, and classified according to the Pelvic Organ Prolapse Quantification (POP-Q) and underwent a 3D-4D translabial ultrasound. Fascial supports of the urethra were assessed by tomographic ultrasound and were considered to be intact or absent if it was possible to identify them at eight levels on each side, urethral mobility was assessed on maximal Valsalva in sagittal section and the length and volume of the USC at rest and on maximal Valsalva were determined using the Virtual Organ Computer-aided Analysis (VOCAL) program. Variables were compared between continent and incontinent women. RESULTS: A total of 173 women were examined, 78 continent and 95 incontinent. There was a significant difference in urethral mobility between continent and incontinent women (12.82 mm vs. 21.85 mm, P < 0.001), but there was no significant difference in the percentage of supports affected (43.27% vs. 35.94%, P < 0.070). The length of the USC at rest was significantly shorter (P < 0.001) ​​in incontinent patients. CONCLUSIONS: Ultrasound evaluation of urethral supports does not discriminate between continent and incontinent women. However, the length of the USC at rest was shorter and urethral mobility was higher in incontinent women. Neurourol. Urodynam. 9999:XX-XX, 2016. © 2016 Wiley Periodicals, Inc.


Asunto(s)
Fascia/diagnóstico por imagen , Uretra/diagnóstico por imagen , Incontinencia Urinaria de Esfuerzo/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Humanos , Imagenología Tridimensional , Persona de Mediana Edad , Tamaño de los Órganos , Prolapso de Órgano Pélvico/complicaciones , Prolapso de Órgano Pélvico/fisiopatología , Ultrasonografía , Uretra/patología , Uretra/fisiopatología , Incontinencia Urinaria de Esfuerzo/complicaciones , Incontinencia Urinaria de Esfuerzo/fisiopatología , Maniobra de Valsalva , Adulto Joven
3.
Aust N Z J Obstet Gynaecol ; 55(1): 70-5, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25308855

RESUMEN

BACKGROUND: Defects of anterior vaginal wall fascia are generally assumed to be factors in the aetiology of cystocele. However, to date, there is very little information on diagnosis by imaging. AIM: To document the appearance of vaginal fornices before and after childbirth using 4D ultrasound volume data sets as an aid in diagnosing paravaginal defects of the anterior vaginal wall. MATERIALS AND METHODS: This study was performed by re-analysing data sets obtained in a previously published study involving ante- and postpartum pelvic floor assessment by ultrasound. Two hundred and two nulliparous women had been seen at a mean gestation of 37.2 weeks at two tertiary hospitals. One hundred and sixty-three returned 3 months postpartum. All the participants underwent an interview and 4D translabial ultrasound at both antepartum and postpartum appointments. The integrity of vaginal fornices and levator ani was assessed by tomographic ultrasound. RESULTS: Vaginal fornices were assessed in both ante- and postnatal volumes, and loss of forniceal tenting was found in 85 patients (52%). On average, seven slices were affected (range, 1-16). On multivariate analysis, controlling for potential confounders, including partial/complete avulsion, loss of forniceal tenting remained independently associated with increased cystocele descent (P = 0.005). CONCLUSIONS: Vaginal childbirth is associated with loss of tenting of the vaginal fornices, independent of levator trauma, and also with impaired anterior vaginal wall support. This evidence suggests the existence of paravaginal defects and may imply a role for such defects in the causation of anterior vaginal wall prolapse.


Asunto(s)
Fascia/diagnóstico por imagen , Parto , Vagina/diagnóstico por imagen , Adolescente , Adulto , Cistocele/diagnóstico por imagen , Cistocele/etiología , Fascia/lesiones , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Persona de Mediana Edad , Diafragma Pélvico/diagnóstico por imagen , Diafragma Pélvico/lesiones , Periodo Posparto , Embarazo , Tercer Trimestre del Embarazo , Ultrasonografía , Vagina/lesiones , Adulto Joven
4.
Int Urogynecol J ; 22(8): 1011-8, 2011 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-21468738

RESUMEN

INTRODUCTION AND HYPOTHESIS: The aim of the study was to evaluate the association of avulsion and postnatal hiatal dimensions with delivery mode. These anatomical changes on pelvic floor muscle may be assessed by 3-4D ultrasonography. METHODS: This is a prospective observational study that included 164 women: 20 nulliparous, 20 primigravid, and 124 postpartum women (62 at 1 month, 62 at 9 months postpartum). We performed an introital 3-4D ultrasonography to assess levator ani muscle's integrity, levator hiatal area at rest, on Valsalva, and on contraction. RESULTS: Levator ani avulsion was diagnosed in 59.5% of forceps deliveries. There were no statistically significant differences in postnatal hiatal dimensions between normal vaginal deliveries at 9 months postpartum and nulligravid. Levator hiatal area was significantly higher after forceps delivery. CONCLUSION: Low incidence of levator avulsion takes place in normal vaginal deliveries. However, forceps delivery is the riskiest type of delivery for pelvic floor pathology and its recovery.


Asunto(s)
Cesárea/efectos adversos , Extracción Obstétrica/efectos adversos , Músculo Esquelético/lesiones , Diafragma Pélvico/anatomía & histología , Diafragma Pélvico/patología , Adulto , Femenino , Humanos , Imagenología Tridimensional , Músculo Esquelético/diagnóstico por imagen , Complicaciones del Trabajo de Parto/diagnóstico por imagen , Complicaciones del Trabajo de Parto/etiología , Diafragma Pélvico/diagnóstico por imagen , Diafragma Pélvico/lesiones , Embarazo , Estudios Prospectivos , Ultrasonografía , Adulto Joven
5.
Cir Esp ; 89(5): 282-9, 2011 May.
Artículo en Español | MEDLINE | ID: mdl-21458783

RESUMEN

INTRODUCTION: Endoscopic surgery has characteristics that increase the difficulties of learning. Five years ago, an intensive colorectal laparoscopic surgery course was designed to offer training in the technical bases of this type of surgery. The aim of this article is to determine the impact of the colorectal surgery course on clinical practice, and to investigate the factors that limit its applicability and the training preferences of the surgeons. MATERIAL AND METHODS: Twenty-two courses of four days duration, with 36 hours of lessons (4 in seminar form and 32 in the surgery), and with 7 trainees, were held between June 2005 and December 2010. A survey was sent out in December 2010 to assess the impact of the course on the colorectal laparoscopic surgery activity of the trainee, to find out the difficulties encountered in its application, and to evaluate the training expectations in endoscopic surgery in this group of surgeons. RESULTS: The questionnaire was sent to 148 surgeons, with 74 (50%) responses received. The mean period after the course was 26.5 (2-60) months. A monthly increase of more than 5 cases was observed in 70% of the centres. The course enabled them to consolidate the activity in local hospitals, while in university and general hospitals it served to re-launch an initial experience. Among the obstacles that made it difficult to introduce were care load and the availability of a surgeon, particularly in general and university hospitals (P=.001), and in local hospitals it was the availability of patients. The majority of surgeons (70%) believed that specific training was required, preferring a short period in a hospital with experience. CONCLUSIONS: An intensive course on colorectal laparoscopic surgery enabled the activity to be consolidated or increased in this area. Training in colorectal laparoscopic surgery requires additional teaching efforts, which are currently unstructured.


Asunto(s)
Cirugía Colorrectal/educación , Laparoscopía/educación , Pautas de la Práctica en Medicina , Adulto , Educación Médica Continua , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Factores de Tiempo
6.
Eur J Obstet Gynecol Reprod Biol ; 257: 70-75, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33360872

RESUMEN

OBJECTIVES: "Significant" obstetric anal sphincter injuries (OASIS) have been defined as visible defects of at least 30° in at least 4/6 slices using tomographic ultrasound imaging (TUI) with transperineal ultrasound (TPUS). The objective of this study was to assess if TUI is mandatory for the evaluation of OASIS. METHODS: Patients with a history of OASIS were evaluated by performing 3D-endoanal ultrasound (EAUS) and 3D-TPUS with and without TUI. Any damage to the internal (IAS) or external (EAS) anal sphincters was recorded and scored using the Starck's and the Norderval's systems. Intraobserver and inter-techniques correlations were calculated. RESULTS: From September 2012 to May 2015, 63 women, mean age 32.5 ± 4.6 years, with OASIS (3a: 26 pts., 41.3 %; 3b: 26 pts., 41.3 %; 3c: 6 pts., 9.5 %, 4: 4 pts., 6.3 %, "button hole" tear: 1 pt., 1.6 %). Inter-technique and intraobserver correlations were excellent (TUI: k = 0.9; sweeping technique: k = 0.85; EAUS: k = 0.9) in determining OASIS. Using the Starck's Score, excellent correlation was found for both TPUS modalities (TUI: k = 0.86; sweeping technique: k = 0.89). However, for the different individual parameters, the correlation was moderate for EAS depth (TUI: k = 0.44; sweeping technique: k = 0.5) and good for IAS depth (TUI: k = 0.7; sweeping technique: k = 0.78). Similar results were found using the Norderval's classification. CONCLUSIONS: OASIS can be assessed by TPUS without TUI technique, dragging the rendered box and following the anal canal from the anal verge to the anorectal junction in the longitudinal plane and describing findings.


Asunto(s)
Enfermedades del Ano , Incontinencia Fecal , Laceraciones , Adulto , Canal Anal/diagnóstico por imagen , Canal Anal/lesiones , Parto Obstétrico , Incontinencia Fecal/diagnóstico por imagen , Incontinencia Fecal/etiología , Femenino , Humanos , Embarazo , Ultrasonografía
8.
Cir Esp ; 84(6): 318-22, 2008 Dec.
Artículo en Español | MEDLINE | ID: mdl-19087777

RESUMEN

INTRODUCTION: Rectal prolapse is an uncommon disease mainly seen in patients of advanced age. It is treated surgically, although there is still significant controversy as regards the most appropriate technique. In the last few years the laparoscopic route has been shown to be feasible and has the advantage of being a minimally invasive technique. OBJECTIVE: To present the preliminary results of a series of patients with rectal prolapse, the majority of whom were treated by performing a laparoscopic posterior rectopexy. MATERIAL AND METHOD: Between February 1998 and February 2008, 17 patients diagnosed with total rectal prolapse were operated on. In 15 cases, a Wells type posterior rectopexy was performed and in the other two a sigmoidectomy was done. The pre-surgical characteristics, as well as the immediate post-surgical results and the long-term follow up results were analysed. RESULTS: The mean age of the series was 63 (21-87) years, with a mean operation time of 186 (105-240) min and a conversion index of 6.6%. There was no post-surgical morbidity and mortality and the mean hospital stay was 5.2 (3-8) days. The mean follow-up was 39 (6-96) months with no relapses seen. One patient had an intralumen migration of the mesh which was expulsed via the rectum, two years after the surgery. One patient died during follow-up due to his underlying severe cardio-respiratory disease. The prolapse re-occurred in one patient after a sigmoidectomy. Eight patients (53%) previously had constipation and in six cases (40%), incontinence. In the post-surgical reviews, constipation persisted in three patients (20%) and a it was seen de novo in one case (6.6%). The incontinence was resolved in four cases (26%) and persisting in two patients (13%). CONCLUSIONS: Laparoscopic rectopexy is a good technical option with a low morbidity-mortality and a reduced hospital stay, as well as good results in the long-term.


Asunto(s)
Laparoscopía/métodos , Prolapso Rectal/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
9.
Arch Surg ; 139(12): 1286-96; discussion 1296, 2004 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-15611451

RESUMEN

OBJECTIVE: To analyze the experience acquired to date on the use of prosthetic mesh to prevent recurrence after laparoscopic repair of paraesophageal hernia. DATA SOURCES: Current English-language literature review. STUDY SELECTION: Case reports, series, and opinion articles on the use of mesh for paraesophageal hernia repair. DATA EXTRACTION AND SYNTHESIS: Study type and results were analyzed. Most articles were short case series. Few comparative or randomized trials assessing the procedure have been published to date. The information available showed that the use of a mesh for hiatal repair was safe and prevented recurrence. However, data on the long-term results were lacking, and infrequent but severe complications may arise. CONCLUSIONS: The mesh should be used selectively, and the decision to proceed should be based on clinical experience. In light of the evidence available, however, it appears to be safe, and the fears expressed in the past have not been confirmed.


Asunto(s)
Hernia Hiatal/cirugía , Laparoscopía , Mallas Quirúrgicas , Humanos , Recurrencia , Mallas Quirúrgicas/efectos adversos
10.
Arch Surg ; 138(2): 133-41; discussion 141, 2003 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-12578405

RESUMEN

HYPOTHESIS: Hand-assisted laparoscopic surgery (HALS) has been proposed as a useful alternative to conventional open or laparoscopic surgery. However, most information is fragmented and comes from specific or selective indications. To assess the current situation of HALS, a general overview of the fields of application, results, and quality of the evidence of these results is necessary. DATA SOURCES: Current English-language literature review. STUDY SELECTION: Case reports, series, and opinion articles on HALS. DATA EXTRACTION AND SYNTHESIS: Evaluation of the type of study and results. Most of the articles are short case series. Only a few comparative or randomized comparative trials on HALS for splenectomy and colectomy have been published. CONCLUSIONS: Hand-assisted laparoscopic surgery seems to be a promising technique that has been applied with success in a wide range of digestive tract-related surgical procedures. The main role is to help in difficult cases before conversion is necessary or for training unskilled surgeons, and not as an alternative to pure laparoscopic surgery. However, not enough evidence-based data are available to know exactly the final outcome of this technique in general surgery. Prospective randomized trials with established open or laparoscopic procedures are lacking, and these trials are needed to support the final role of HALS.


Asunto(s)
Laparoscopía , Colectomía/métodos , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Humanos , Laparoscopía/métodos , Nefrectomía/métodos , Esplenectomía/métodos
11.
Surg Laparosc Endosc Percutan Tech ; 13(6): 394-6, 2003 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-14712104

RESUMEN

The term intussusception refers to a spontaneous invagination of a portion of the intestine into another bowel loop. Its incidence is higher in children, but in adults it causes 1% to 5% of intestinal obstructions. The diagnosis of intussusception in the adult is difficult due to the variability of the symptoms. The condition may be chronic, intermittent, or acute. Surgical intervention is necessary in all cases and in up to 90% of cases an organic lesion inside the invaginated part of the bowel is found to be the lead point. The laparoscopic approach offers both a diagnostic and therapeutic option. Laparoscopy may be used as the final diagnostic or therapeutic tool for intussusception in the adult.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Neoplasias del Íleon/cirugía , Intususcepción/cirugía , Laparoscopía/métodos , Anciano , Femenino , Humanos , Neoplasias del Íleon/complicaciones , Intususcepción/etiología , Masculino , Persona de Mediana Edad
12.
J Cancer Res Clin Oncol ; 136(11): 1681-9, 2010 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-20165956

RESUMEN

PURPOSE: Chemoradiotherapy using 5-fluorouracil has shown to be effective treatment for rectal cancer. Thymidylate synthase (TS) is an important target enzyme for the fluoropyrimidines. However, the predictive role of TS levels in early stage rectal cancer is not yet well understood. We analyzed the value of TS gene polymorphisms as a predictive marker in patients with stage II and III rectal cancer treated with preoperative concomitant radiotherapy and fluoropyrimidine-based chemotherapy. METHODS AND MATERIALS: Between 1998 and 2007, blood samples were obtained from 51 patients with stage II/III rectal cancer. Forty patients were T2-3 (78%), 11 were T4 (22%), and 59% were N+. DNA was extracted from peripheral blood, and the genotypes were analyzed using PCR-restriction fragment length polymorphism and automated sequencing techniques. RESULTS: The *3/*3 thymidylate synthase genotype was associated with a higher response rate (pathological complete remission and microfoci residual tumor; 61 vs. 22% in *2/*2 and *2/*3; P = 0.013). In the multivariate analysis, the *3/*3 thymidylate synthase genotype was also an independent prognostic factor for better survival (P < 0.05). CONCLUSIONS: The thymidylate synthase genotype might help to identify patients with stage II/III rectal cancer who could benefit from pre- and postoperative fluorouracil-based chemotherapy.


Asunto(s)
Fluorouracilo/uso terapéutico , Mutación de Línea Germinal , Polimorfismo Genético , Neoplasias del Recto/genética , Timidilato Sintasa/genética , Adulto , Anciano , Anciano de 80 o más Años , Antimetabolitos Antineoplásicos/uso terapéutico , Secuencia de Bases , Terapia Combinada , ADN de Neoplasias/sangre , ADN de Neoplasias/genética , ADN de Neoplasias/aislamiento & purificación , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Repeticiones de Minisatélite , Estadificación de Neoplasias , Selección de Paciente , Reacción en Cadena de la Polimerasa/métodos , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/mortalidad , Neoplasias del Recto/patología , Neoplasias del Recto/radioterapia , Tasa de Supervivencia
13.
Surg Innov ; 12(4): 339-44, 2005 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-16424955

RESUMEN

The development of operative laparoscopic surgery is linked to advances in ancillary surgical instrumentation. Ultrasonic energy devices avoid the use of electricity and provide effective control of small- to medium-sized vessels. Bipolar computer-controlled electrosurgical technology eliminates the disadvantages of electrical energy, and a mechanical blade adds a cutting action. This instrument can provide effective hemostasis of large vessels up to 7 mm. Such devices significantly increase the cost of laparoscopic procedures, however, and the amount of evidence-based information on this topic is surprisingly scarce. This study compared the effectiveness of three different energy sources on the laparoscopic performance of a left colectomy. The trial included 38 nonselected patients with a disease of the colon requiring an elective segmental left-sided colon resection. Patients were preoperatively randomized into three groups. Group I had electrosurgery; vascular dissection was performed entirely with an electrosurgery generator, and vessels were controlled with clips. Group II underwent computer-controlled bipolar electrosurgery; vascular and mesocolon section was completed by using the 10-mm Ligasure device alone. In group III, 5-mm ultrasonic shears (Harmonic Scalpel) were used for bowel dissection, vascular pedicle dissection, and mesocolon transection. The mesenteric vessel pedicle was controlled with an endostapler. Demographics (age, sex, body mass index, comorbidity, previous surgery and diagnoses requiring surgery) were recorded, as were surgical details (operative time, conversion, blood loss), additional disposable instruments (number of trocars, EndoGIA charges, and clip appliers), and clinical outcome. Intraoperative economic costs were also evaluated. End points of the trial were operative time and intraoperative blood loss, and an intention-to-treat principle was followed. The three groups were well matched for demographic and pathologic features. Surgical time was significantly longer in patients operated on with conventional electrosurgery vs the Harmonic Scalpel or computed-based bipolar energy devices. This finding correlated with a significant reduction in intraoperative blood loss. Conversion to other endoscopic techniques was more frequent in Group I; however, conversion to open surgery was similar in all three groups. No intraoperative accident related to the use of the specific device was observed in any group. Immediate outcome was similar in the three groups, without differences in morbidity, mortality, or hospital stay. Analysis of operative costs showed no significant differences between the three groups. High-energy power sources specifically adapted for endoscopic surgery reduce operative time and blood loss and may be considered cost-effective when left colectomy is used as a model.


Asunto(s)
Colectomía/métodos , Enfermedades del Colon/cirugía , Electrocirugia/economía , Laparoscopía/métodos , Cirugía Asistida por Computador/economía , Terapia por Ultrasonido/economía , Adulto , Anciano , Anciano de 80 o más Años , Colectomía/economía , Costos y Análisis de Costo , Disección/economía , Femenino , Humanos , Laparoscopía/economía , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
14.
Semin Laparosc Surg ; 11(3): 161-9, 2004 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-15510311

RESUMEN

The success of laparoscopic fundoplication has extended the use of the laparoscopic approach to treating more difficult situations such as paraesophageal hernias (PEHs) or type III (mixed) hiatal hernia. The results have shown that laparoscopic repair is feasible and safe. However, several series have shown recurrence rates of up to 42% as a result of difficulty in the closure of the hiatal gap. Some authors recommend the use of prosthetic mesh to reinforce the hiatal closure. This review analyses the different techniques proposed to prevent recurrence after laparoscopic repair of PEHs. The information currently available shows that the use of a mesh for hiatal repair is safe and prevents recurrence. However, data on the long-term results are lacking, and infrequent but severe complications may arise. The mesh should be used selectively, and the decision to proceed should be based on clinical experience.


Asunto(s)
Hernia Hiatal/cirugía , Laparoscopía , Fundoplicación , Humanos , Politetrafluoroetileno , Complicaciones Posoperatorias , Recurrencia , Mallas Quirúrgicas
15.
Langenbecks Arch Surg ; 389(5): 396-9, 2004 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-15243744

RESUMEN

BACKGROUND: Situs inversus (SI) is a rare autosomal recessive congenital defect in which the position of abdominal and/or thoracic organs is a "mirror image" of the normal one, in the sagittal plain. In 25% of these cases, SI is part of the Kartagener syndrome, together with bronchiectasis and chronic sinusitis. METHODS: We present a case of a patient with Kartagener syndrome and complete SI that was laparoscopically operated on for diverticulitis. We also review the published English information available on this rare condition. RESULTS: A review of the literature revealed another single case of laparoscopic sigmoidectomy and 27 cases of other laparoscopic interventions in the presence of SI. Those laparoscopic procedures included basic procedures such as explorations and cholecystectomies, as well as advanced procedures such as gastrectomy and gastric bypass. CONCLUSION: The laparoscopic approach is feasible in cases of SI, although technically more complicated because of the different position of the organs and the different laparoscopic view of the anatomy.


Asunto(s)
Colectomía , Diverticulitis del Colon/cirugía , Síndrome de Kartagener , Laparoscopía , Enfermedades del Sigmoide/cirugía , Situs Inversus , Adulto , Diverticulitis del Colon/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Enfermedades del Sigmoide/diagnóstico por imagen , Situs Inversus/diagnóstico por imagen , Factores de Tiempo , Tomografía Computarizada por Rayos X
16.
Dig Surg ; 21(4): 282-6, 2004.
Artículo en Inglés | MEDLINE | ID: mdl-15308868

RESUMEN

BACKGROUND: Obstruction of the left colon may be the first manifestation of colorectal cancer. Resection of the colonic segment involved and the construction of an end colostomy (Hartman's procedure) is the most frequent treatment. Alternatives to the placement of a stoma are subtotal colectomy or intraoperative lavage of the colon and primary anastomosis, but their application depends on intraoperative findings and the availability of a skilled surgeon. The use of an expandable stent (SEMS) can enhance the feasibility of laparoscopic colectomy, avoiding the need for a colostomy and offering the advantages of a combination of two minimally invasive procedures. STUDY DESIGN: Between 1997 and 2004, an SEMS was placed in 11 cases of left colonic obstruction due to cancer, the obstruction being successfully resolved in each case. Seven patients were approached by laparoscopy to attempt the definitive colectomy. We evaluated the location and pathological characteristics of the tumor, effectiveness and complications of SEMS insertion, time interval between the insertion of SEMS and laparoscopic surgery, and postoperative data. RESULTS: The tumors were situated in the recto-sigma (1 case), sigma (3 cases) and descending colon (3 cases). Immediate relief of the obstruction was achieved in all cases after SEMS insertion of the stent, and oral diet was started at 24 h. The 7 patients were operated on an average of 8 days (range 6-14) after insertion of the stent. Conversion to open surgery was necessary in one case for reasons not related to the stent. CONCLUSIONS: Preliminary results of the combination of SEMS and elective laparoscopic surgery demonstrate that the procedure is feasible and that it presents all the clinical advantages of a minimally invasive approach. The procedure is a valid alternative to traditional major urgent surgery.


Asunto(s)
Colectomía/métodos , Neoplasias del Colon/complicaciones , Neoplasias del Colon/cirugía , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Stents , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Resultado del Tratamiento
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA