Safety and feasibility of overlapped delta-shaped anastomosis technique for digestive tract reconstruction during complete laparoscopic right hemicolectomy / 中华肿瘤杂志

Objective: To explore the clinical safety and feasibility of overlapped delta-shaped anastomosis (ODA) in totally laparoscopic right hemicolectomy (TLRHC). Methods: From May 2017 to October 2019, of the 219 patients who underwent TLRHC at the Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 104 cases underwent ODA (ODA group) and 115 cases underwent conventional extracorporeal anastomosis (control group) were compared the surgical outcomes, postoperative recovery, pathological outcomes and perioperative complications. Results: The length of the skin incision in the ODA group was significantly shorter than that in the control group [(5.6±0.9) cm vs. (7.1±1.7) cm, P<0.05], and the time to first flatus and first defecation after surgery in the ODA group was significantly earlier than that in the control group [(1.7±0.7) days vs. (2.0±0.7) days; (3.2±0.6) days vs. (3.3±0.7) days, P<0.05]. While the anastomosis time, operation time, intraoperative blood loss, the time of first ground activities, the number of bowel movements within 12 days after surgery, postoperative hospital stay, tumor size, the distal and proximal margins, the number of lymph node harvested and postoperative TNM stage in the ODA group did not differ from that of the control group (P>0.05). The postoperative complication rates of patients in the ODA group and the control group were 3.8% (4/104) and 4.3% (5/115), respectively, and the difference was not significant (P>0.05). Conclusion: The application of ODA technology in TLRHC can significantly shorten thelength of skin incisionand the recovery time of bowel function, and can obtain satisfactory short-term efficacy.

Disección endoscópica submucosa para el tratamiento del cáncer esofágico / Endoscopic submucosal dissection for the treatment of esophageal cancer

Resumen Introducción: El cáncer de esófago (CE) constituye la sexta causa de muerte por cáncer en el mundo. La disección endoscópica submucosa (DES) es una técnica que permite la resección en bloque de lesiones del tubo digestivo. Tiene rol curativo en pacientes seleccionados y potenciales ventajas sobre la esofagectomía. Objetivo: Describir los resultados perioperatorios y oncológicos de la DES como tratamiento del CE en nuestro centro. Materiales y Método: Estudio retrospectivo de pacientes sometidos a DES por CE entre los años 2010-2020. Resultados: Diez pacientes fueron tratados con DES por CE entre los años 2010 y 2020. El 80% eran hombres y la edad promedio fue de 72 años (63-84). La resección en bloque fue lograda en todos los casos y no se presentó morbimortalidad perioperatoria. Todas las disecciones fueron R0 y el 90% cumplió con estándares de curación. El seguimiento promedio fue de 38 meses (3,5-123). La sobrevida global fue de 90%. La sobrevida específica por cáncer y libre de recurrencia fue de 100%. Discusión: La morbimortalidad asociada a la esofagectomía es alta. La DES sería una alternativa más segura, que permite lograr un R0 y eventualmente la curación en pacientes seleccionados con CE limitado a la mucosa o submucosa. Conclusión: La presente constituye la primera serie reportada de pacientes con cáncer esofágico sometidos a DES en nuestro país. Muestra excelentes resultados oncológicos y seguridad del procedimiento, comparables a las grandes series descritas en la literatura internacional.

Introduction: Esophageal cancer is the sixth leading cause of death by cancer worldwide. Endoscopic submucosal dissection (ESD) is a technique that allows en bloc resection of early lesions of the digestive tract. It has curative potential in selected patients and potential benefits over esophagectomy for the treatment of esophageal cancer (EC). Aim: To report the results of ESD for EC in a high-volume center in Chile. Materials and Method: Retrospective descriptive study of patients who underwent ESD for EC at our center. Results: A total of 10 patients were treated with ESD for EC between 2010 and 2020. Eighty percent were male patients, the average age was 72 years (63-84). En bloc resection was achieved in all cases and there were no complications or mortality. All of the dissections were classified as R0 and 90% met curative standards. The mean follow-up was 38 months (3.5-123). Overall survival was 90%. Cancer-specific survival was 100% and recurrence-free survival was 100%. Discussion: The rate of morbidity and mortality of esophagectomy is high. ESD would be a safer technique, which allows R0 resections and eventually curation in selected patients with EC limited to the mucosa or submucosa. Conclusion: This is the first report of ESD for the treatment of EC in our country, it shows excellent oncologic results and safety of the procedure, comparable to those reported in the larger series published to date.

Avaliação dos efeitos do jejum prolongado no pré e pós-operatórios / Evaluation of the effects of prolonged furniture prior to and after operating / Evaluación de los efectos del jejum prolongado en el pré y post operatorios

Objetivo: Investigar o jejum prolongado em pacientes que submeteram-se a procedimentos cirúrgicos abdominais e do trato gastrointestinal com uso de anestesia geral, e as possíveis complicações no pré, intra e pós-operatório. Método: um estudo exploratório-descritivo, com recorte transversal retrospectivo-documental e abordagem quali-quantitativa, realizado num Hospital Federal do Rio de Janeiro, com análise documental referente ao período de janeiro de 2013 a abril de 2018. Resultado: houve uma grande variação no tempo de jejum pré-operatório, 0,3% dos pacientes fizeram jejum até 8 horas e 11,3% até 12 horas, alguns casos chegaram a fazer mais de 24 horas de jejum. Conclusão: foi perceptível que dentre prontuários analisados, os pacientes permaneceram em jejum perioperatório muito superiores fora dos padrões de segurança estipulados, gerando intercorrências que causam desconforto ao paciente, prejudicam a reabilitação, aumentam o tempo de internação e oneram o sistema

Objective:To investigate prolonged fasting in patients who underwent abdominal and gastrointestinal surgical procedures with general anesthesia, and possible complications in the pre, intra and postoperative periods. Method: an exploratory-descriptive study, with retrospective-documental cross-section and qualitative-quantitative approach, performed at a Federal Hospital of Rio de Janeiro, with documentary analysis from January 2013 to April 2018. Result: there was a great variation in time of preoperative fasting, with 0.3% of patients fasted for up to 8 hours and 11.3% for up to 12 hours, some cases reaching more than 24 hours fasting. Conclusion: Patients were found to be in perioperative fasting far beyond the stipulated safety standards, generating complications that cause discomfort to the patient, impair rehabilitation, increase length of hospital stay, and burden the system

Objetivo: Investigar el ayuno prolongado en pacientes que se sometieron a procedimientos quirúrgicos abdominales y del tracto gastrointestinal con uso de anestesia general, y las posibles complicaciones en el pre, intra y postoperatorio. Metodo: un estudio exploratório y descriptivo, con recorte transversal retrospectivo y documental con el abordaje cuali y cuantitativo, realizado en un Hospital Federal de Rio de Janeiro, con análisis documental referente al período de enero de 2013 a abril de 2018. Resultado:ocorrió una gran variación en el tiempo de ayuno preoperatorio, 0,3% de los pacientes hicieron ayuno hasta 8 horas y 11,3% hasta 12 horas, algunos casos llegaron a hacer más de 24 horas de ayuno. Conclusión: fue notable que entre los prontuarios analizados, los pacientes permanecieron en ayuno perioperatorio muy superiores fuera de los estándares de seguridad estipulados, generando intercurrencias que causan incomodidad al paciente, perjudican la rehabilitación, aumentan el tiempo de internación y el sistema

Experiencia en Tumores Neuroendocrinos del Tracto Gastrointestinal / Experience in Neuroendocrine Tumors of the Gastrointestinal Tract

Antecedentes: Los TNE-GEP son raros y se originan en el sistema endocrino localizado en el tubo gastrointestinal (carcinoides) y en el páncreas (tumores insulares) con una gran variedad de presentaciones clínicas. Diseño: Cooperativo, Retrospectivo y protocolizado Material y Métodos: Entre enero del 2005 y diciembre del 2018, un trabajo cooperativo, con el Servicio de Guardia Central del HNC, Servicio de Cirugía General "Pablo Luis Mirizzi" del HNC y Clínica Privada Caraffa, se intervinieron quirúrgicamente 24 pacientes con TNEGEP. Del total, 14 pertenecían al sexo femenino (58.3 %) y los 10 restantes al masculino (41.6 %), con un rango etario entre 20 y 82 años de edad con un promedio de 55.3 años. Resultados: La localizaciones fueron 4 de estómago (16.6 %), 14 en intestino (58.3 %) y finalmente 6 en la cabeza del páncreas (25 %). En relación al estómago en los 4 pacientes se llevó a cabo una gastrectomía total y la anatomía patológica en tres demostró carcinoma neuroendocrino de bajo grado y el cuarto de alto grado, falleciendo esta última. Las lesiones de intestino 5 de apéndice menores de 1 cm. La anatomía patológica fue apendicitis aguda más, un Carcinoma neuroendocrino de bajo grado. En región ileocecal, en cuatro se realizó hemicolectomía derecha. En tres eran carcinoma de bajo grado que viven y cuarto de alto grado con mtts hepáticas que falleció. En tres de íleon todos fueron oclusivos, llevándose a cabo resecciones intestinales, en dos carcinomas de bajo grado y ultimo de moderado grado con metástasis (mtts) hepáticas que vive. Los tumores de colon fueron, uno ascendente con mtts hepáticas y se realizó colectomía derecha más resecciones hepáticas, siendo la anatomía patológica un carcinoma de alto grado y otro un colon descendente de bajo grado. Las 6 lesiones de páncreas, 3 fueron no funcionantes y otras tres funcionantes. A todos se les practico DPC. Conclusiones: Los TNE-GEP son una patología rara cuya frecuencia es de aparición constante. Con la mejora de los métodos de imágenes, nos encontramos ante un aumento de la presunción preoperatoria y ante sus mejores posibilidades oncológicas, una patología que todo cirujano debe conocer y pensar.

Background: Neuroendocrine tumors (NET) of the gastrointestinal tract (GIT)- are rare and are originated in the endocrine system located in the gastrointestinal tract (carcinoids) and in the pancreas (islet cell tumors) with a variety of clinical presentations. Design: Cooperative, retrospective. Method: Between January 2005 and December 2018, a cooperative work in the Central Guard Service of the HNC, General Surgery Service "Pablo Luis Mirizzi" of the HNC and Caraffa Private Clinic, 24 patients with NET-GIT underwent surgical treatment. Of the total, 14 were females (58.3%) and the remaining 10 (41.6%) were men aged 20 to 82 years, with an average of 55.3 years. Results: The locations were 4 in the stomach (16.6%), 14 in the intestine (58.3%) and finally, 6 in the head of the pancreas (25%). In relation to the stomach, in 4 patients total gastrectomies were performed, and the pathological anatomy in three demonstrated a low-grade of neuroendocrine carcinoma and in the fourth a high degree; the latter. 5 patients died with a clinical presentation of acute appendicitis. The pathological anatomy was further acute appendicitis, a low-grade of neuroendocrine carcinoma.In the ileum-cecal region,and four of it underwent a right colectomy. In three there was a low-grade living and fourth high-grade carcinoma with liver mtts who died. In three of the ileum all were occlusive, carrying out intestinal resections, in two low- and last-grade moderate-grade carcinomas with living liver metastasis (mtts).. The colonic tumors were, one ascending with hepatic mtts and right colectomy more liver resections, with pathological anatomy being a high-grade carcinoma and another a low-grade in the descending colon. From the 6 pancreatic lesions, 3 were non-functioning and three functioning. All patients were operated of CPD. Conclusion: NET-GIT is a rare pathology but whose frequency is in constantly rise With improved imaging methods, we are faced with an increase in preoperative presumption and in the face of its best oncological possibilities, a pathology that every surgeon must know and think about.

Protocolo de rehabilitación multimodal en pacientes sometidos a cirugía electiva del tracto gastrointestinal. Estudio prospectivo comparativo multicéntrico / Multimodal rehabilitation protocol in patients undergoing elective surgery of the gastrointestinal tract. Prospective multicentre comparative study

Los protocolos de rehabilitación multimodal están diseñados para minimizar la disfunción de órganos y lograr la recuperación acelerada en el postoperatorio. Objetivo General: Determinar si la aplicación del protocolo de rehabilitación multimodal favorece la recuperación acelerada en pacientes quirúrgicos electivos en comparación con el manejo tradicional. Metodología: Se realizó un estudio multicéntrico aleatorizado con la participación de cuatro hospitales en diferentes regiones del país. La investigación fue de tipo prospectivo de corte longitudinal, comparativo, donde los pacientes fueron asignados al azar, un grupo estudio (n=142) a quienes se les aplicó el protocolo y un grupo control (n=100) manejados de acuerdo con conductas tradicionales. Resultados: La estancia hospitalaria para el grupo estudio fue de 1,8 ± 1,2 días, mientras que para el grupo control fue de 6,3 ± 3,87 días (p < 0,05). En cuanto a las complicaciones post operatorias el 88,7% de los pacientes del grupo estudio evolucionaron favorablemente y 11,26% presentaron complicaciones menores, mientras que 30% de los pacientes del grupo control presentaron complicaciones tales como infección de sitio quirúrgico 13%, dehiscencia de anastomosis 5% y vómitos 12% (p < 0,05). Conclusión: Con la aplicación del protocolo de rehabilitación multimodal se logró que la tasa de complicaciones fuera significativamente menor en el grupo estudio al compararla con el grupo control, por ello se sugiere la aplicación del mismo dentro de las realidades de nuestros hospitales, además de ser una excelente herramienta para lograr una recuperación más temprana en el post operatorio y disminuir la estancia hospitalaria(AU)

The multimodal rehabilitation protocols are designed to minimize organ dysfunction in the postoperative period and achieve accelerated postoperative recovery. General Objective: To determine whether the application of multimodal rehabilitations protocols promotes rapid recovery in elective surgical patients compared with traditional management. Methodology: A multicenter randomized involving four hospitals in different regions of the country study was conducted. The research was prospective, longitudinal, comparative court, patients were randomized in study group (n = 142) who applied the protocol and a control group (n = 100) managed according to traditional behaviors. Results: The hospital stay for the study group was 1.8 ± 1.2 days, while the control group the average was 6.3 ± 3.87 days (p < 0.05). Regarding postoperative complications, 88.7% of the study group patients evolved favorably and 11.26% presented minor complications, while 30% of the control group patients presented complications such as surgical site infection 13%, anastomotic dehiscence 5 % and vomiting 12% (p < 0.05).Conclusion: With the application of the multimodal rehabilitation protocol, it was achieved that the rate of complications was significantly lower in the study group when compared with the control group, therefore it is suggested to apply it within the realities of our hospitals, in addition to being an excellent tool to achieve an earlier recovery in the postoperative period and reduce hospital stay(AU)

Aplicación del protocolo eras/acerto en pacientes sometidos a cirugía electiva del tracto gastrointestinal / Implementation of the eras/acerto protocol in patients undergoing elective surgery of gastrointestinal tract

El protocolo ERAS/ACERTO, es un programa multimodal diseñadopara minimizar la disfunción de órganos en el post operatorio ydevolver al paciente a la normalidad lo más rápido posible.Objetivo:Determinar si la aplicación del protocolo ERAS/ACERTOproduce mejor recuperación en pacientes tratados con esta terapiamultimodal en comparación con el manejo tradicional. Métodos:Se realizó una investigación de tipo prospectivo de corte longitudi-nal comparativo, los pacientes fueron asignados al azar, un grupoestudio (n=40) a quienes les aplicó el protocolo, y un grupo con-trol (n=40) manejados de forma tradicional. Resultados: La estan-cia hospitalaria para el grupo en estudio estuvo en el rango de 1 a3 días mientras que para el grupo control el promedio fue de 5días. En cuanto a las complicaciones post-operatorias el 92.5%representado por 37 pacientes del grupo estudio no presentaroncomplicaciones, 35% de los pacientes del grupo control presenta-ron complicaciones tipo infección de sitio quirúrgico (17.5%), fístulaenterocutánea (7.5%) y vómitos (10%). Conclusión:La aplicacióndel protocolo ERAS/ACERTO es posible dentro de las realidadesde nuestros hospitales y es una excelente herramienta para lograruna recuperación más temprana en el post operatorio(AU)

ERAS / ACERTO protocol is a multimodal program designed tominimize organ dysfunction in the postoperative period andreturn the patient to normal as quickly as possible. Objective:Todetermine whether the application of ERAS / ACERTO protocolproduces better recovery in patients treated with this multimoda-lity therapy compared with traditional management. Methods:Aresearch prospective slitting comparison was made, patients wererandomly assigned to a study group (n = 40) who applied themto the protocol and a control group (n = 40) treated in the tra-ditional way. Results:The hospital stay for the study group wasin the range of 1-3 days, while the control group the average was5 days. In terms of post-operative complications represented92.5% of 37 patients in the study had no complications, 35% ofpatients in the control group has complications, rate of surgicalsite infection (17.5%), enterocutaneous fistula (7.5%) and vomiting(10%). Conclusion: The application of ERAS / ACERTO protocolis possible within the realities of our hospitals and is an excellenttool to achieve an early recovery in the postoperative(AU)

Pancreatico-Colonic Fistula-Demonstrated by Multidetector-Row CT

No abstract available.

Simplified technique for reconstruction of the digestive tract after total and subtotal gastrectomy for gastric cancer / Técnica simplificada de reconstrução do trato digestivo após gastrectomia para câncer gástrico

BACKGROUND: Laparoscopic surgery has been increasingly applied to gastric cancer surgery. Gastrointestinal tract reconstruction totally done by laparoscopy also has been a challenge for those who developed this procedure. AIM - To describe simplified reconstruction after total or subtotal gastrectomy for gastric cancer by laparoscopy and the results of its application in a series of cases. METHODS - In the last four years, 75 patients were operated with gastric cancer and two with GIST. Thirty-four were women and 43 men. The age ranged from 38 to 77 years with an average of 55 years. In two patients with GIST a total and a subtotal gastrectomy were performed. In the other 75 patients were done 21 total gastrectomies and 54 subtotal. In all cancers, gastrectomy with D2 lymphadenectomy was completed with at least 37 lymph nodes removed. Was used in these operations a modified laparoscopic technique proposed by the authors consisting in a latero lateral esophagojejunal anastomosis with linear stapler in TG as well in STG, and reconstruction of the digestive continuity also in the upper abdomen. RESULTS - The intraoperative and immediate postoperative course were uneventful, except for one case of bleeding due to an opening clip, necessitating re-intervention. The operative time was 300 minutes, with no difference between total or subtotal gastrectomy. The number of lymph nodes removed varied from 28 to 69, averaging 37. Postoperative staging showed one case in T4 N2 M0; 13 in T2 N0 MO; 27 in T2 N1 M0; 24 in T3 N1 M0 and 10 in T3 N2 M0. Complication in only one case was observed on the 10th postoperative day with a small anastomotic leakage in esophagojejunal anastomose with spontaneous closure. CONCLUSION - The patient's evolution with no complications, no mortality and just one small anastomotic leakage with no systemic repercussions is a strong indication of the liability and feasibility of this innovative technical method. .

RACIONAL: Cada vez mais a cirurgia laparoscópica está sendo aplicada no tratamento cirúrgico do câncer gástrico. A reconstrução do trato gastrointestinal totalmente feita por laparoscopia também tem sido um desafio para aqueles que desenvolveram este procedimento. OBJETIVO: Descrever reconstrução simplificada após gastrectomia total ou subtotal para o câncer gástrico por laparoscopia e os resultados de sua aplicação em uma série de casos. MÉTODOS: Nos últimos quatro anos, 75 pacientes foram operados com câncer gástrico e dois com GIST. Trinta e quatro eram mulheres e 43 homens. A idade variou de 38 a 77 anos com média de 55 anos. Nos dois pacientes com GIST em um foi realizada gastrectomia total e no outro gastrectomia subtotal. Nos outros 75 pacientes foram aplicados 21 gastrectomias totais e 54 subtotais. Em todos os cânceres, a gastrectomia foi completada com linfadenectomia D2 com pelo menos 37 linfonodos retirados. Foi utilizada nas operações modificação técnica laparoscópica proposta pelos autores consistindo em anastomose latero-lateral esôfago jejunal em GT e de modo semelhante na GST e restabelecimento da continuidade digestiva também no abdômen superior. RESULTADOS: O intra-operatório e a evolução pós-operatória imediata transcorreu sem intercorrências, exceto por um caso de sangramento devido à abertura de clipe, sendo necessária re-intervenção. O tempo operatório foi de cerca de 300 minutos, não havendo diferença entre GT e GST. O número de nódulos linfáticos retirados variou de 28 a 69, com média de 37. O estadiamento pós-operatório mostrou um caso em T4 N2 M0; 13 em T2 N0 MO; 27 em T2 N1 M0; 24 em T3 N1 M0; e 10 em T3 N2 M0. Como complicação, em apenas ...

Nutritional assessment and hand grip strength of candidates for surgery of the gastrointestinal tract / Avaliação nutricional e força de aperto de mão de candidatos à cirurgia do trato gastrointestinal

BACKGROUND: The assessment of nutritional status in clinical practice must be done with simple, reliable, low cost and easy performance methods. The power of handshake is recognized as a useful tool to evaluate muscle strength, and therefore, it is suggested that can detect malnutrition. AIM: To evaluate the nutritional status by subjective global assessment and power of handshake preoperatively in patients going to gastrointestinal surgeries and to compare the diagnosis obtained by subjective global assessment with traditional anthropometric methods and power of handshake. METHODS: A cross-sectional study was conducted with patients for surgery in the gastrointestinal tract and related organs. Socioeconomic and anthropometric data, applied to subjective global assessment and checked the power of handshake, were collected. The force was obtained by the average of three measurements of the dominant and non-dominant hand and thus compared with reference values ​​of the population by sex and age, for the classification of nutritional risk. RESULTS: The sample consisted of 40 patients, 24-83 years, and most women (52.5%) housewives (37,5%) and diagnosed with cancer (45%). According to subjective global assessment, 37.5% were classified as moderately malnourished; 15% were underweight by BMI measurements; 25% had arm circumference at risk for malnutrition (<percentil 5); 60% reported recent weight loss; and 37.5% low clamping force in power of handshake on non-dominant hand (left). CONCLUSION: A significant association was observed for the diagnosis of nutritional subjective assessment with anthropometric methods and strength of the handshake only at the non-dominant limb. .

RACIONAL: Na prática clínica são necessários métodos simples, confiáveis, de baixo custo e de fácil acesso para a avaliação do estado nutricional. A força do aperto de mão é reconhecida como uma ferramenta útil para avaliar a força muscular, e consequentemente, elemento que pode detectar desnutrição. OBJETIVO: Avaliar o estado nutricional tanto pela avaliação nutricional subjetiva global como pela força do aperto de mão de pacientes em pré-operatório e comparar o diagnóstico obtido por ambas e os tradicionais métodos antropométricos. MÉTODOS: Foi realizado estudo transversal com pacientes internados para operação em trato gastrointestinal e órgãos anexos. Foram coletados dados socioeconômicos, antropométricos, aplicado a avaliação nutricional subjetiva global e verificada a força do aperto de mão. Esta força foi obtida pela média de três medidas da mão dominante e não dominante e dessa forma, comparada com valores de referência da população brasileira, segundo sexo e idade, para a classificação do risco nutricional. RESULTADOS: A amostra foi constituída por 40 pacientes de 24 a 83 anos, a maioria mulheres (52,5%) donas de casa (37,5%) e com diagnóstico de neoplasia (45%). Segundo a avaliação nutricional subjetiva global, 37,5% foram classificados como desnutridos moderados; 15% com baixo peso pelo IMC; 25% com circunferência braquial em risco para desnutrição (<percentil 5); 60% com perda ponderal recente; e pela força do aperto de mão, 37,5% tinham baixa força na mão não dominante (esquerda). CONCLUSÃO: Houve associação significativa do diagnóstico nutricional observado pela avaliação subjetiva com ...

Cáncer colon y recto en pediatría: presentación de casos / Colon and rectal cancer in pediatria age: case report

El cáncer de colon en pediatría es una patología neoplásica rara, infrecuentes en edad pediátrica, 1% de estos tumores son encontrados en personas menores de 30 años, siendo el más frecuente el adenocarcinoma. Su diagnóstico, difícil de verificar precozmente, puesto que, las neoplasias no se consideran diagnóstico diferencial del sangrado rectal, dolor abdominal crónico, u oclusión intestinal en niños. Se describen 2 casos de adenocarcinoma en adolescentes que consultaron el servicio de pediatría oncológica del Instituto Oncológico “Dr. Luis Razetti” en el año 2010. Caso 1: Adolescente femenina 16 años de edad natural y procedente del Estado Guárico, sin antecedentes patológicos conocidos, quien en noviembre de 2010, presenta abdomen agudo quirúrgico, es intervenida quirúrgicamente encontrándose tumor pétreo en colon, ovario, epiplón, el estudio anatomoclínico reportó adenocarcinoma de colon ascendente irresecable, recibió múltiple esquemas de tratamiento con evolución desfavorable, falleciendo la paciente. Caso 2: Adolescente femenina 15 años de edad, con antecedente de poliposis juvenil desde los 8 años de edad, quien presenta cambios en el patrón evacuatorio, en diciembre de 2010, presenta rectorragia se realiza colonoscopia que reporta, adenocarcinoma de recto bajo, recibió quimioterapia concurrente con radioterapia, no hubo respuesta al tratamiento. Ameritó tratamiento quirúrgico, descenso abdominoperineal y colocación de colostomía terminal definitiva, actualmente recibe quimioterapia adyuvante con evolución satisfactoria. Todo niño o adolescente que presente rectorragia y obstrucción intestinal debe realizarse una evaluación minuciosa, puesto que no es frecuente la localización de estas neoplasias.

The colon cancer is a neoplastic disease very rare present in children, 1% of these tumors are founding in people under 30 years old, the most frequent being is the adenocarcinoma. Its diagnosis is difficult to verify early, since the tumors are not considered differential diagnosis of rectal bleeding, chronic abdominal pain or the intestinal obstruction in children. We describe 2 cases of adenocarcinoma in adolescents who consulted at pediatric oncology service of “Dr. Luis Razetti” Cancer Institute in the year 2010. Case 1: Female16 years old from Guarico state, we no known medical history, who in November 2010, she presented acute abdomen, she underwent surgery is stony tumor was found in the colon, the ovary, and the omentum, anatomic clinical study reported no resettable adenocarcinoma of the ascending colon, multiple drugs schemes received the patient with an unfavorable treatment, the patient died. Case 2: Female 15 years old with a history of juvenile polyposis since she was 8 years old, which has changes in bowel movement pattern, in December 2010, presented rectal bleeding, is reported colonoscopy: Low rectal adenocarcinoma. Received chemotherapy concurrent with radiotherapy, there was no response to treatment. Required surgery, and laying down abdominal perineal definitive terminal colostomy, currently she receiving adjuvant chemotherapy with satisfactory outcome. Any child or adolescent consulting and presenting with rectal bleeding and intestinal obstruction should be a thorough assessment, since it is not frequent location of these neoplasms.

Colitis eosinofílica perforada / Perforated eosinophilic colitis

Se presenta el caso de una paciente con colitis eosinofílica perforada que requirió manejo quirúrgico, se confirmó diagnóstico con biopsia y evolucionó satisfactoriamente. La enteritis eosinofílica es un trastorno que compromete el tracto gastrointestinal secundario a la infiltración de sus capas por eosinófilos y forma parte de un complejo de enfermedades emergentes. Fue descrita en forma reciente y presenta una amplia gama de sintomatología, que mimetiza y simula diagnósticos de mayor incidencia y por tanto de mayor sospecha. Actualmente es parte de las posibilidades a evaluar en pacientes con patología gastrointestinal, amplio rango que incluye aquellas que ameritan manejo sintomático y estudios para su determinación etiológica, y en el extremo opuesto aquellas que requieren manejo quirúrgico estableciendo su diagnóstico posteriormente.

This is the presentation of a perforated eosinophilic colitis’s case which required surgical handle and was confirmed the diagnosis with biopsy and had a satisfactory evolution. Eosinophilic enteritis is a disorder that involves the gastrointestinal tract secondary to eosinophils infiltration of its layers and form part of an emerging disease complex. It was described recently and presents a wide range of symptoms, mimics and simulates highest incidence diagnosis and therefore more suspected. Currently, it is one of the possibilities to evaluate in patients with gut pathology, a wide range that include those that need symptomatic handle and studies for its etiological determination, and in the other side those which required surgical treatment establish the diagnosis later on.

Tricobezoar gástrico perforante / Perforated gastrointestinal trichobezoar

Los bezoares del tracto digestivo constituyen una patología infrecuente, son colecciones de material ingerido que se acumula en estómago e intestino. El tricobezoar hace referencia a un cúmulo de pelo, su sospecha clínica se establece en pacientes jóvenes predominantemente mujeres con historia de masa epigástrica, pérdida de peso y síntomas obstructivos. El diagnóstico se puede realizar con imágenes y endoscopia y su tratamiento consiste en su remoción. Se presenta un caso de tricobezoar perforado en paciente femenina joven, el cual es manejado en el servicio de Cirugía General del Hospital Universitario de Santander.

The gastrointestinal tract bezoars are considered an infrequent pathology; they are collections of ingested material that accumulates in the stomach and intestines. Trichobezoar refers to the cumuli of hair; its clinic suspicion is established in young patients, especially women with history of an epigastric mass, weight loss and obstructive symptoms. Diagnosis can be made by imaging and endoscopy and the treatment consists in its removal. It is presented a case of a young female patient with a perforated trichobezoar which was treated at our service of General Surgery of the Hospital Universitario de Santander.

Fatores intervenientes e métodos de avaliação das anastomoses gastrointestinais / Intervening factors and methods to assess gastrointestinal anastomoses

A busca pela anastomose impermeável é preocupação constante nas cirurgias abdominais. A deiscência anastomótica representa a complicação mais temida a que está sujeito o paciente submetido a esse tipo de operação. O processo de cicatrização do aparelho digestivo é similar àquele que ocorre em outros tecidos, apresentando os mesmo princípios básicos no que concerne às alterações celulares e bioquímicas, sendo o colágeno o principal fator determinante no processo cicatricial. Existem, entretanto, nuanças fisiológicas que diferenciam os tecidos gastrointestinais dos demais e diversos fatores estão implicados nesse processo. As técnicas e materiais empregados nas suturas, assim como as particularidades de cada órgão, interferem na cicatrização. Diversos parâmetros podem ser utilizados para analisar as anastomoses, seja clínica ou experimentalmente. Entre estes se destacam os clínicos, histopatológicos, mecânicos, bioquímicos e microbiológicos. Este artigo contém revisão sobre o processo cicatricial, com ênfase no trato digestivo. São apresentadas alterações citocínicas, assim como as mudanças do colágeno durante a evolução da ferida operatória. O conhecimento e o entendimento dos métodos de avaliação das anastomoses são fundamentais para a formação médica, notadamente para o cirurgião.

The search for impermeable anastomosis is a constant concern in abdominal surgery. Anastomotic dehiscence is the most feared complication to which the patient undergoing this type of operation is subjected. The healing of the digestive system is similar to that occurring in other tissues, presenting the same basic principles with respect to the cellular and biochemical alterations, the collagen being the main determining factor in the healing process. However, there are physiological nuances that make the gastrointestinal tissue different from the others and several factors are implied in this process. The techniques and materials used in the sutures, as well as each organ particularities interfere in the healing. Different parameters can be used to analyze the anastomoses, either clinically or experimentally. Among these we highlight the clinical, histopathological, mechanical, biochemical and microbiological tests. This article contains reviews on the healing process, with emphasis on the digestive tract. Cytokine changes are presented, as well as changes of collagen during the development of the surgical wound. The knowledge and understanding of anastomosis evaluation methods are crucial for medical training, especially for surgeons.

A albuminemia no pré e pós-operatório de cirurgias do sistema digestório / Albumin concentration in the pre and postoperative period of digestive system operations

Objetivos: O trauma cirúrgico pode provocar alterações sistêmicas, entre as quais estão incluídas mudanças na síntese hepática de proteínas. O objetivo do presente trabalho foi avaliar a influência das operações de médio e grande porte do sistema digestório na concentração sérica de albumina. Métodos: Foram estudados aleatoriamente 150 pacientes adultos, submetidos a cirurgias eletivas de grande porte (Grupo 1) e de médio porte (Grupo 2) sobre o sistema digestório, identificados de acordo com o sexo, a idade e a cor da pele. As amostras sanguíneas para dosagem da concentração sérica de albumina foram obtidas nos dias anterior e posterior ao procedimento cirúrgico. Resultados: Houve diminuição da albumina sérica tanto no Grupo 1 (p < 0,0001) quanto Grupo 2 (p < 0,0001). Não houve diferença entre os sexos e cores da pele dos pacientes nas cirurgias de grande porte. Entretanto, as mulheres apresentaram menor redução da albumina sérica nas operações de médio porte do que os homens. Ainda em relação às cirurgias de médio porte, a albumina diminuiu menos nos melanodérmicos em relação aos feodérmicos, e nestes menos do que nos leucodérmicos. Em relação às faixas etárias, em ambos os grupos, houve maior redução da albumina nos pacientes acima de 65 anos, seguidos pelos mais jovens (< 45 anos) e, por último, entre 45 e 65 anos. Conclusões: As operações de médio e grande porte sobre o trato gastrintestinal associam-se à redução da albuminemia, logo após o ato cirúrgico. Entretanto, essa diminuição é menor em mulheres, em pessoas melanodérmicas e nos pacientes na faixa etária entre 45 e 65 anos de idade.

Objective: Surgical trauma can provoke systemic alterations including changes in hepatic protein synthesis. Thus, it is important to point out the influence of this phenomenon on serum albumin concentration. The objective of the present work was to assess the effect of surgical trauma on serum albumin concentration during the immediate postoperative period in gastrointestinal procedures. Methods: The study was conducted on 150 randomly chosen adult patients submitted to elective major surgeries (Group 1) and to medium size surgeries (Group 2) of the gastrointestinal system, identified according to sex, age and skin color. Blood samples for the determination of serum albumin concentration were obtained on the day preceding and following the surgical procedure. Results: There was a reduction in serum albumin both in Group 1 (p < 0.0001) and Group 2 (p < 0.0001), with no difference between sexes or patient skin colors for major surgeries. However, women showed a lower reduction in serum albumin than men in mediumsized surgeries. Also, the reduction of albumin was lower in black-skinned patients than in colored and lower in the latter than in white-skinned patients. With respect to age range, a greater reduction of albumin was observed in both groups among patients older than 65 years, followed by younger patients (< 45 years) and finally by patients aged 45 to 65 years. Conclusions: Medium-sized and majors operations provoked an acute reduction in albuminemia, which was less intense among women, among the patients aged 45 to 65 years and among black-skinned patients.

Suboclusión intestinal secundario a melanoma amelánico metastásico / Intestinal subocclusion following metastatic melanoma: case report

El Melanoma Amelánico (MA) es una de las variantes clínicas de Melanoma Melánico (MM), encontrándose aproximadamente en el 2% de los casos de (MM). El melanoma es el tumor con mayor predilección por metastizar en el intestino delgado. El diagnóstico de estas lesiones se hace con la ayuda del examen histopatológico y marcadores de inmunohistoquímica. El pronóstico de (MA) no muestra variación en relación con el (MM) pigmentado y continua dependiendo de la edad del paciente, sexo, localización y espesor de la lesión. Se debe tener en cuenta que el (MA) a menudo tiene un nivel de invasión Clark IV o V en el momento del diagnóstico debido a que sus características clínicas retardan la sospecha diagnóstica. La cirugía se considera útil en pacientes con metástasis de melanoma en el tracto gastrointestinal, ya que, a pesar de una media de superviviencia de 6-12 meses, que proporciona buen alivio con baja morbilidad y mortalidad. Se presenta un caso de un hombre de 56 años de edad que a los 53 años se le resecó nevus en región costal izquierda sin estudio de anatomía patológica, reingresando a dicha edad por cuadro de suboclusión intestinal por melanoma amelánico secundario a lesión primaria cutánea. Se realizó resección radical intestinal cutánea y dacarbacina 5 ciclos de 5 días. Después de unos cuantas semanas, demostró múltiples nódulos dispersos en ambos pulmones y una RM cerebral mostró múltiples nódulos delimitados en ambos hemisferios cerebrales. Su condición clínica comenzó a deteriorarse rápidamente con evidencia de enfermedad metastásica generalizada. El paciente murió 5 meses después de iniciado el diagnóstico.

The Amelanic Melanoma (AM) is one of the clinical variants of the Melanic Melanoma (MM), corresponding to the 2% of the cases of MM. The malanoma is the tumor with major predilection for metastases in the small intestine. The diagnosis of these injuries can be made with the help of the histopathology examination and immunohistochemical markers. The prognosis of the AM does not show change as regards the pigmentate MM and continue depending in the age of the patient, sex, location and thickness of the injury. You must know that the MA often has a level of invacion Clark IV or V at the moment of the diagnostic because his clinical characteristics slow down the diagnostic suspicion. The surgery is useful in patients with gastrointestinal tract metastasis of melanoma, due to provides good mitigation with low morbidity and mortality in the 6-12 months of survival. We present a case of a 56 -year-old man who at the age of 53 was resected a nevus in the left costal region without study of pathological anatomy, re-entering at the above mentioned age for a subocclusion intestinal syndrome for amelanic melanoma secondary to primary cutaneous injury. Radical intestinal resection and cutaneous resection was made and 5 cycles of dacarbacine for 5 days. After few weeks, it demonstrated multiple nodules dispersed in both lungs and a cerebral RM showed multiple nodules delimited in both cerebral hemispheres. His clinical condition began to deteriorate rapidly with evidence of widespread metastatic illness. The patient died 5 months after initiated the diagnosis.

Minimally invasive gastrointestinal surgery current status and future perspective: an evidence based review

The history of laparoscopy started as a primitive diagnostic procedure and it took close to a century before it became an effective therapeutic tool in the management of surgical problems. In this review, we examine the history of laparoscopy, methods of access, and the current application of minimally invasive surgery for the management of common gastrointestinal surgical problems. An evidence based review was utilized with emphasis on systematic reviews published from 1987 to 2009. Following the wide spread use of laparoscopic techniques for gall bladder removal, the benefits of laparoscopic surgery was established in the management of common gastrointestinal surgical problems. Laparoscopic management of colorectal cancer, morbid obesity, and gastroesophageal reflux diseases [GERD] are examined in this review based on the current review of the literature

Laparoscopy in the treatment of a giant [true] epiphrenic diverticulum with migration of the gastrointestinal anastomosis staples

Our case is a 62-year-old diabetic man with a long-standing history of regurgitation, halitosis, recurrent chest infection, and most recently upper gastro-intestinal bleeding. He was diagnosed 10 years earlier with an epiphrenic esophageal diverticulum, and also has a family history of this condition. Barium study revealed a 10x10 cm epiphrenic diverticula with a 4 cm neck, the lower margin of the opening lying 6 cm from the gastro-esophageal junction. Endoscopy confirmed the x-ray findings, and motility studies were within normal limits. The patient underwent laparoscopic excision of the diverticulum via the trans-abdominal approach. Histopathological examination revealed this diverticulum to be of the true type

Early enteral feeding after upper digestive tract surgeries and clinical assessment of post-operative ileus / Nutrição enteral precoce após cirurgias do trato digestivo alto e avaliação clínica de íleos pós-operatórios

In general, feeding after a gastrointestinal surgery should only occur after resolution of the postoperative ileus. However, early enteral feeding has shown such advantages (i) as faster recovery of the gastrointestinal motility, (ii) a shorter hospital stay and (iii) a better nitrogen balance. Our aim is to demonstrate that early feeding does provide these advantages and is also tolerable. The patients submitted to surgeries of the upper digestive tract were randomly distributed in two groups: the control group, with oral feeding 72h after surgery, and the test group with enteral feeding through a nasojejunal catheter 24h after surgery. The following were assessed: abdominal diameter, abdominal aspect, bowel sounds, flatulence and stools elimination, presence or absence of reflux, diarrhoea, abdominal pain, náuseas and/or vomits, all of which on a daily basis. On the fourth post-operative day, the nitrogen balance was assessed for all patients. The date of discharge from hospital was also recorded. Patients in both the test group and the control group did not show any difference as to the period of hospital stay, recovery time of post-operative ileus and diet tolerance. The nitrogen balance was statistically significant (p<0.000) and better in the test group. Early enteral feeding after surgeries of the upper digestive tract is tolerable and enables a better nitrogen balance.

É comum que a realimentação precoce após cirurgias do trato gastrointestinal ocorra somente após a resolução do íleo pós-operatório. A nutrição enteral precoce tem demonstrado vantagens como recuperação mais rápida da motilidade gastrointestinal, menor tempo de permanência hospitalar e melhor balanço nitrogenado. Objetiva-se demonstrar que a alimentação precoce proporciona essas vantagens, além de ser tolerável. Os pacientes submetidos a cirurgias do trato digestório alto foram distribuídos aleatoriamente em dois grupos: o controle com início da dieta por via oral a partir de 72H após a cirurgia, e o estudo com introdução de dieta enteral via cateter nasojejunal 24H após a cirurgia. Foram coletados: diâmetro abdominal, aspecto do abdome, ruídos hidroaéreos intestinais, eliminação de flatos e fezes, presença ou ausência de regurgitação, diarréia, dor abdominal, náuseas e/ou vômitos diariamente. No quarto dia de pós-operatório foi calculado o balanço nitrogenado em todos os pacientes. A data de alta hospitalar dos pacientes foi também registrada. Os pacientes do grupo estudo (8) e controle (8) não apresentaram diferenças quanto ao tempo de permanência hospitalar, tempo de recuperação do íleo pós-operatório e tolerância à dieta. O balanço nitrogenado foi estatisticamente significativo (p<0,000) e melhor no grupo controle. A introdução precoce de dieta após cirurgias do trato digestório alto é tolerável e permite um melhor balanço nitrogenado.

Factores de riesgo relacionados con las relaparotomías después de cirugía gastrointestinal / Risk factors related to relaparotomies after gastrointestinal surgery

Se realizó un estudio retrospectivo y descriptivo de 73 pacientes que requirieron relaparotomías, de un total de 3 070 intervenciones gastrointestinales para un índice de 2,73. El objetivo fue identificar los factores de riesgo relacionados con las relaparotomías. Los datos se obtuvieron de las historias clínicas y de los informes de necropsias de los pacientes, y se procesaron estadísticamente. Predominaron los pacientes mayores de 50 años de edad y aquellos en que la operación inicial fue por oclusión intestinal durante una cirugía de urgencia. Las causas más frecuentes de reintervenciones fueron los procesos sépticos, seguidos de las eviseraciones y los sangramientos digestivos respectivamente. Los hallazgos encontrados en las reintervenciones estuvieron relacionados en su mayoría con dificultades en la técnica quirúrgica inicial. El índice de mortalidad global fue de 52,05 por ciento y estuvo directamente relacionado con el número de reintervenciones.

A retrospective and descriptive study was conducted among 73 patients that required relaparotomies of a total of 3 070 gastrointestinal interventions, accounting for 2.73. The objective was to identify the risk factors related to relaparotomies. The data were obtained from the medical histories and from the reports of the necropsies, and they were statistically processed. It was observed a prevalence of patients over 50 and of those whose initial operation was due to intestinal occlusion during an emergency surgery. The most frequent causes of surgical reintervention were mostly connected with difficulties in the initial surgical technique. The index of global mortality was 52.05 percent, and it was directly related to the number of surgical reinterventions.

[Laparoscopic abdominal surgeries: a review]

Laparoscopic technique in recent years has tremendously being used as a non invasive surgery to perform different operation in abdominal and thoracic cavities. This technique has been used from 1987 in different aspect of human surgery. In addition to diagnosis, biopsy, visualizing adhesion and neoplastic structure, recently cholecystectomy and ovariohysterectomy were also commonly being used as a therapeutic measure. Different investigations using laparoscope, indicate superiority of this technique as compare to that of conventional open surgery method in areas of pain, time, hospitalization, anatomical dissection, immunity reaction, cosmetic appearance, adhesion and wound involved. Veterinary laparoscopic technique use now a days is also being extensively increasing in different organs Gasterointestinal laparoscopic surgery is routinely being performed to remove foreign body, neoplasia, obstruction, duodenal and pyloric wound. Looking to future light for improving usage of laparoscopic technique in research and clinical aspect plus improving the concept of reducing pain and surgical complications, It is extremely necessary to take proper decision/action to improve research outcome in near future for application of laparoscopic tools in abdominal surgery. Laparoscopic surgeries in gastrointestinal tract have several advantages. Reduction in the period of postoperative intestinal paralysis so that gastrointestinal function returns more rapidly to normal status following minimally invasive surgery. It also involves a reduced immune response compared with open surgery. Reduced tissue desiccation and foreign body contamination and also fewer intra-abdominal adhesion. It has gained wide clinical acceptance in surgical practice in comparison to open surgery