ABSTRACT
AIM: Transanal minimal invasive surgery (TAMIS) of rectal lesions is increasingly being used, but the technique is not yet standardized. The aims of this study were to evaluate peri-operative complications and long-term functional outcome of the technique and to analyse whether or not the rectal defect needs to be closed. METHOD: Consecutive patients undergoing TAMIS using the SILS port (Covidien) and standard laparoscopic instruments were studied. RESULTS: Seventy-five patients (68% male) of mean age 67 (± 15) years underwent single-port transanal surgery at three different centres for 37 benign lesions and 38 low-risk cancers located at a mean of 6.4 ± 2.3 cm from the anal verge. The median operating time was 77 (25-245) min including a median time for resection of 36 (15-75) min and for closure of the rectal defect of 38 (9-105) min. The defect was closed in 53% using interrupted (75%) or a running suture (25%). Intra-operative complications occurred in six (8%) patients and postoperative morbidity was 19% with only one patient requiring reoperation for Grade IIIb local infection. There was no difference in the incidence of complications whether the rectal defect was closed or left open. Patients were discharged after 3.4 (1-21) days. At a median follow-up of 12.8 (2-29) months, the continence was normal (Vaizey score of 1.5; 0-16). CONCLUSION: Transanal rectal resection can be safely and efficiently performed by means of a SILS port and standard laparoscopic instruments. The rectal defect may be left open and at 1 year continence is not compromised.
Subject(s)
Adenocarcinoma/surgery , Adenoma/surgery , Carcinoid Tumor/surgery , Intestinal Neoplasms/surgery , Laparoscopy/methods , Rectal Neoplasms/surgery , Surgical Wound Infection , Transanal Endoscopic Surgery/methods , Wound Closure Techniques , Aged , Aged, 80 and over , Cohort Studies , Databases, Factual , Female , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures , Operative Time , Postoperative Complications , Prospective Studies , Rectum/surgery , Suture TechniquesSubject(s)
Abdominal Injuries , Laparoscopy , Humans , Iliac Vein/diagnostic imaging , Iliac Vein/surgery , PelvisABSTRACT
The authors report that TEM with a single-incision laparoscopic surgery (SILS) port can be facilitated by the use of a colonoscope instead of a conventional laparoscopic camera. The colonoscope can be inserted through one of the SILS channels and has the added benefit of flexibility, insufflation, irrigation, suction, and an operative port.
Subject(s)
Colonoscopy , Laparoscopy/methods , Rectal Neoplasms/surgery , Anal Canal , Humans , Minimally Invasive Surgical Procedures , Treatment OutcomeABSTRACT
Male-to-female reassignment surgery or vaginoplasty includes those surgical procedures that aim to recreate a functional and cosmetically acceptable female perineum with minimal scarring. The technique of choice at our center is penile inversion vaginoplasty with or without scrotal skin grafts. We present 4 cases diagnosed with rectoneovaginal fistulas treated at our center with favorable evolution. The first patient was diagnosed in the late postoperative period during dilation. She underwent 2 failed vaginal repair attempts. Finally, a temporary colostomy and a rectal flap were performed. The second patient was diagnosed 2 weeks after the initial surgery due to aggressive dilation and was treated with a temporary colostomy and secondary wound closure. The third patient was diagnosed on the fifth post-operative day after removal of the vaginal packing. Dietary restriction was indicated, and a rectal flap was performed. A fourth patient was diagnosed within the late postoperative period; she was submitted to surgical exploration and a rectal wall flap was created. Rectoneovaginal fistulas after sex reassignment surgery has an incidence of about 2-17% and they are the most common type of fistula after this procedure. In most cases, it is secondary to rectal injury during the initial surgery. The management of these fistulas ranges from primary closure, diverting colostomies, conservative management, or the performance of flaps. A multidisciplinary team approach is recommended for the diagnosis and treatment of this complication.
Subject(s)
Postoperative Complications , Rectal Fistula , Sex Reassignment Surgery , Vagina/surgery , Vaginal Fistula , Female , Humans , Postoperative Complications/diagnosis , Postoperative Complications/therapy , Rectal Fistula/diagnosis , Rectal Fistula/therapy , Vaginal Fistula/diagnosis , Vaginal Fistula/therapyABSTRACT
Breast cancer gastrointestinal and soft tissue metastases are extremely rare. We present the case of a woman with perianal metastases from a primary lobular breast carcinoma 11 years after mastectomy and local radiotherapy.
Subject(s)
Anal Canal , Breast Neoplasms/pathology , Carcinoma, Lobular/pathology , Intestinal Neoplasms/secondary , Anal Canal/pathology , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Carcinoma, Lobular/radiotherapy , Carcinoma, Lobular/surgery , Female , Humans , Middle Aged , Neoplasm InvasivenessSubject(s)
Catheters/adverse effects , Colonoscopy , Foreign-Body Migration/surgery , Peritoneal Cavity , Urinary Diversion/instrumentation , Carcinoma, Transitional Cell/surgery , Colon, Sigmoid/surgery , Cystectomy , Device Removal/methods , Emergencies , Female , Foreign-Body Migration/diagnostic imaging , Foreign-Body Migration/etiology , Humans , Middle Aged , Peritonitis/etiology , Tomography, X-Ray Computed , Ureter/surgery , Urinary Bladder Neoplasms/surgeryABSTRACT
BACKGROUND: We sought to assess the relationship between tissue concentration of erb -b-2 or neu oncogene-encoded protein (p185(neu)) with overall survival in patients with non-small cell lung cancer. METHODS: Levels of protein p185(neu) were determined in 102 patients with the diagnosis of non-small cell lung cancer. Concentration of p185(neu) protein was determined by using enzyme immunoassay and evaluated by using several variables. The relative prognostic importance of this marker and its influence on other prognostic factors was evaluated by using the Cox regression model. RESULTS: The mean p185(neu) value in these samples was 250 +/- 200 U/mg (95% confidence interval, 210-290). This distinguished two groups within the tumoral population: those with less than 350 U/mg and those with 350 U/mg or greater (80th percentile). Multivariable analysis established an independent prognostic value for protein p185(neu). Patients with p185(neu) values of the 80th percentile or greater had a risk of death that was 2.11-fold (95% confidence interval, 1.10-4.05) that of patients with values of less than 350 U/mg (P =.03), and increases in the neu oncogene of 100 U/mg increased the probability of death by 17% (P =.02; 95% confidence interval, 1.04-1.31). CONCLUSION: This study shows that the p185(neu) expression is an objective and comparable variable for the assessment of phenotypic aggressivity in non-small cell lung cancer, and in the future, it could be included in daily clinical practice.
Subject(s)
Carcinoma, Non-Small-Cell Lung/metabolism , Lung Neoplasms/metabolism , Receptor, ErbB-2/biosynthesis , Adult , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/chemistry , Carcinoma, Non-Small-Cell Lung/mortality , Female , Humans , Lung Neoplasms/chemistry , Lung Neoplasms/mortality , Male , Middle Aged , Prognosis , Receptor, ErbB-2/analysis , Survival RateABSTRACT
BACKGROUND/AIMS: The development of new techniques for palliation of esophageal carcinoma with lower morbidity and mortality than surgical procedures. METHODOLOGY: Between 1981 and 1994, 258 patients with esophageal and cardiac cancer were treated in our Department. We selected two groups: Group A, 25 patients underwent a by-pass with an isoperistaltic gastric tubular (Postlethwait technique) and, group B, in 30 patients we placed 35 autoexpandable esophageal stents. We subsequently performed a retrospective study. RESULTS: In group A, dysphagia was not relieved in 6 patients (24%) and we found no complications in 18 patients (72%). The hospitalization period ranged from 18-50 days. Hospital mortality rate was 24% (6 patients). Mean survival was 5.4 months (range: 3-9 months). All patients in group B, except for 2, were relieved of dysphagia. Two patients (6.6%) died in the immediate post-intubation period though none of the deaths were related to technical complications. Hospitalization period ranged from 5-12 days. Mean survival was 6 months (range: 12 days to 9 months). CONCLUSIONS: Currently, surgical by-pass procedures are restricted to the patient with an incurable disease not identified until operation time.
Subject(s)
Esophageal Neoplasms/therapy , Esophageal Stenosis/therapy , Palliative Care , Stents , Aged , Aged, 80 and over , Cardia , Deglutition Disorders/mortality , Deglutition Disorders/therapy , Esophageal Neoplasms/mortality , Esophageal Stenosis/mortality , Female , Humans , Male , Middle Aged , Prosthesis Design , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
A 65-year-old man was admitted to our hospital with gastrointestinal bleeding. Seventeen years previously, he had a Billroth II procedure for a bleeding duodenal ulcer. A gastroscopy performed on admission showed a stomal ulcer with signs of recent haemorrhage. In the proximal end of the afferent loop, we saw retained gastric mucosa. Histological evaluation confirmed the existence of antrum gastric mucosa. Other diagnostic test for retained gastric antrum were normal. The different approaches in the diagnosis of retained gastric antrum, the importance of our findings and the clinic implications are discussed. We conclude that endoscopic management may be the first diagnostic method in the assessment of retained gastric antrum, and it's possible to find gastric mucosa in the proximal end of the afferent loop (antrum retained), without clinic manifestations.
Subject(s)
Postgastrectomy Syndromes/diagnosis , Pyloric Antrum , Aged , Biopsy , Duodenal Ulcer/diagnosis , Duodenal Ulcer/etiology , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Gastroscopy , Humans , Male , Postgastrectomy Syndromes/etiology , Pyloric Antrum/pathology , RecurrenceABSTRACT
We present a patient with acute and severe abdominal pain, fever and mild tenderness elicited on deep palpation in the right lower quadrant. X-ray films of the chest and abdomen were normal. The ultrasonographic study, barium enema examination and colonoscopic study avoided a diagnostic laparotomy. A purified protein skin test (PPD) and the cultures on Lowestein medium were negative. The final diagnosis was ulcero-hipertrophic tuberculosis of the ascending colon, and was confirmed by the finding of positive acid fast facilli and granulomas with Langerhans cells in the colonic biopsy material. The colonic lesions disapplared at the end of the antituberculous treatment.
Subject(s)
Colonic Diseases/diagnosis , Colonoscopy , Tuberculosis, Gastrointestinal/diagnosis , Aged , Humans , MaleABSTRACT
La cirugía de reasignación de sexo masculino a femenino o vaginoplastia incluye aquellos procedimientos quirúrgicos cuyo objetivo es recrear un perineo femenino funcional y estéticamente aceptable con una formación mínima de cicatrices. La técnica de elección en nuestro centro es la vaginoplastia con inversión peneana con o sin injertos escrotales. Presentamos 4 casos diagnosticados con fístulas rectoneovaginales tratados en nuestro centro con evolución favorable. La primera paciente fue diagnosticada en el postoperatorio tardío durante las dilataciones. Se sometió a 2 intentos de reparación vaginal sin éxito. Finalmente, se realizó una colostomía temporal y un colgajo rectal. La segunda paciente fue diagnosticada 2 semanas después de la cirugía inicial debido a una dilatación agresiva, siendo tratada con una colostomía temporal y cierre por segunda intención. La tercera paciente se diagnostica en el quinto día postoperatorio, después de la extracción del taponamiento vaginal. Se indicó restricción dietética y se realizó un colgajo rectal. Una cuarta paciente fue diagnosticada durante el postoperatorio tardío, realizando una exploración quirúrgica y un colgajo de pared rectal. Las fístulas rectoneovaginales después de la cirugía de reasignación de sexo tienen una incidencia de alrededor del 2-17%, siendo el tipo más común de fístulas después de este procedimiento. La causa más común es secundaria a lesiones rectales durante la cirugía inicial. Para el manejo de estas fístulas se plantean opciones que van desde el cierre primario a las colostomías de descarga, pasando por un manejo conservador o la confección de colgajos. Se recomienda el abordaje por un equipo multidisciplinario para el diagnóstico y tratamiento de esta complicación. (AU)
Male-to-female reassignment surgery or vaginoplasty includes those surgical procedures that aim to recreate a functional and cosmetically acceptable female perineum with minimal scarring. The technique of choice at our center is penile inversion vaginoplasty with or without scrotal skin grafts. We present 4 cases diagnosed with rectoneovaginal fistulas treated at our center with favorable evolution. The first patient was diagnosed in the late postoperative period during dilation. She underwent 2 failed vaginal repair attempts. Finally, a temporary colostomy and a rectal flap were performed. The second patient was diagnosed 2 weeks after the initial surgery due to aggressive dilation and was treated with a temporary colostomy and secondary wound closure. The third patient was diagnosed on the fifth post-operative day after removal of the vaginal packing. Dietary restriction was indicated, and a rectal flap was performed. A fourth patient was diagnosed within the late postoperative period; she was submitted to surgical exploration and a rectal wall flap was created. Rectoneovaginal fistulas after sex reassignment surgery has an incidence of about 2-17% and they are the most common type of fistula after this procedure. In most cases, it is secondary to rectal injury during the initial surgery. The management of these fistulas ranges from primary closure, diverting colostomies, conservative management, or the performance of flaps. A multidisciplinary team approach is recommended for the diagnosis and treatment of this complication. (AU)