Multifactorial mitigation strategy to reduce clinically relevant pancreatic fistula in high-risk pancreatojejunostomy following pancreaticoduodenectomy.

INTRODUCTION: Postoperative pancreatic fistula (POPF) is the most dreadful complication of pancreaticoduodenectomy (PD) and previous literature focused on technical modifications of pancreatic remnant reconstruction. We developed a multifactorial mitigation strategy (MS) and the aim of the study is to assess its clinical impact in patients at high-risk of POPF. METHODS: All patients candidate to PD between 2012 and 2018 were considered. Only patients with a high Fistula Risk Score (FRS 7-10) were included. Patients undergoing MS were compared to patients receiving Standard Strategy (SS). Clinical outcomes were compared between the two groups. Multivariate hierarchical logistic regression analyses were performed to detect independent predictors of POPF. RESULTS: Out of 212 patients, 33 were finally included in MS Group and 29 in SS Group. POPF rate was significantly lower in MS Group (12.1% vs 44.8%, p = 0.005). Delayed gastric emptying, postoperative pancreatitis, complications and hospital stay were also significantly lower in MS Group. Hierarchical logistic regression analyses showed that Body Mass Index (OR = 1.196, p = 0.036) and MS (OR = 0.187, p = 0.032) were independently associated with POPF. CONCLUSION: A multifactorial MS can be helpful to reduce POPF rate in patients with high FRS following PD. Personalized approach for vulnerable patients should be investigated in the future.

Morbidity and mortality of temporary diverting ileostomies in rectal cancer surgery.

INTRODUCTION: A temporary diverting ileostomy is frequently used to reduce the consequences of a distal anastomotic leakage after total mesorectal excision in rectal cancer surgery. This surgical technique is associated with high morbidity and a not negligible mortality. The aim of this study is to evaluate the morbidity and mortality rate associated with an ileostomy and its posterior closure. MATERIAL AND METHODS: Between 2001 and 2012, 96 patients with temporary diverting ileostomy were retrospectively analyzed. Morbidity and mortality were analyzed before and after the stoma closure. The studied variables included age, sex, comorbidities, time to bowel continuity restoration and adjuvant chemotherapy. RESULTS: In 5 patients the stoma was permanent and another 5 died. The morbidity and mortality rates associated with the stoma while it was present were 21 and 1% respectively. We performed a stoma closure in 86 patients, 57% of whom had previously received adjuvant therapy. There was no postoperative mortality after closure and the morbidity rate was 24%. The average time between initial surgery and restoration of intestinal continuity was 152.2 days. This interval was significantly higher in patients who had received adjuvant therapy. No statistically significant difference was found between the variables analyzed and complications. CONCLUSIONS: Diverting ileostomy is associated with low mortality and high morbidity rates before and after closure. Adjuvant chemotherapy significantly delays bowel continuity restoration, although in this study did not influence in the rate of complications.

[Electrocoagulation on a fragment of anterior abdominal rectal muscle for the control of presacral bleeding during rectal resection]. / Electrocoagulación sobre un fragmento de músculo recto anterior abdominal para el control de la hemorragia presacra durante la resección rectal.

INTRODUCTION: Presacral venous haemorrhage during rectal movement is low, but is often massive, and even fatal. Our objective is the "in vitro" determination of the results of electrocoagulation applied to a fragment of muscle on the sacral bone surface during rectal resection due to a malignant neoplasm of the rectum. MATERIAL AND METHOD: Single-pole coagulation was applied "in vitro" with the selector at maximum power on a 2×2 cms muscle fragment, applied to the anterior side of the IV sacral vertebra until reaching boiling point. The method was used on 6 patients with bleeding of the presacral venous plexus. RESULTS: In the "in vitro" study, boiling point was reached in 90 seconds from applying the single-pole current on the muscle fragment. Electrocoagulation was applied to a 2×2 cm rectal muscle fragment in 6 patients with presacral venous haemorrhage, using pressure on the surface of the presacral bone, with the stopping of the bleeding being achieved in all cases. CONCLUSIONS: The use of indirect electrocoagulation on a fragment of the rectus abdominis muscle is a straightforward and highly effective technique for controlling presacral venous haemorrhage.

[Presacral haemorrhage during rectal cancer resection: morphological and hydrodynamic considerations]. / Hemorragia presacra durante la resección rectal por cáncer. Consideraciones morfológicas e hidrodinámicas.

INTRODUCTION: Our aim is to identify the location and size of the anterior foramina of sacral vertebral bodies and analyse the haemodynamic variables that could influence the haemorrhagic severity of the injury of the presacral venous plexus. MATERIALS AND METHODS: Using computed axial tomography the morphological data of 70 sacral bones in 67 patients with rectal cancer were recorded, as well as measuring the height between the vena cava and S5. After transfemoral catheterisation the inferior vena cava pressure was recorded in 10 patients with rectal cancer. Hydrodynamic principles, according to Bernoulli's Law, were applied to calculate sacral venous plexus pressure, and the flow rate according to the calibre of a hypothetical venous injury. RESULTS: The maximum diameter ranged from 0.5mm to 4mm in 22% of the cases. All foramina of 2 or more millimetres were located in the S4-S5 region. Sacral plexus venous pressure in lithotomy was almost double the inferior vena cava pressure in normal position. Blood flow ranged from 498 to 1,994 ml/min for injuries of sizes between 2 and 4mm, respectively. CONCLUSIONS: Larger calibre foramina are found in vertebral bodies of S4-S5. Venous injury at these levels can reach a flow rate of 2 l/min.

Ischemic colitis. Does right colon location mean worst prognosis?

INTRODUCTION: Most patients with ischemic colitis have a favourable evolution; nevertheless, the location in the right colon has been associated with a worse prognosis. The purpose of this study is to compare the clinical presentation and results of right colon ischemic colitis (CICD) with ischemic colitis of other colonic segments (non-CIDC). METHODS: Retrospective, observational study of patients admitted to our hospital with ischemic colitis between 1993 and 2014, identified through a computerized search of ICD9 codes. They were divided into 2 groups: CICD and non-CICD. Comorbidities, clinical presentation, need for surgery, and mortality were compared. Multivariate analysis was performed using logistic regression adjusting for age and sex. Statistical significance was established at a value of P < 0.05. RESULTS: A total of 204 patients were identified, 61 (30%) with CICD; 61% of CICD patients required surgery compared to 22% of non-CICD patients (P < 0.001). Differences in post-surgical mortality (32% vs 55%) and overall mortality (20% vs 15%) were not statistically significant. CICD patients had more commonly unfavourable outcomes than non-CICD patients (61% vs 25%, P < 0.001). The odds ratio (OR) for surgery was 5.28 and 4.47 for unfavourable outcomes for patients with CICD. CONCLUSIONS: CICD patients have a worse prognosis than non-CICD patients, 5 times more likely to need surgery and 4 times more likely to have unfavourable outcomes.

Ischemic colitis. Does right colon location mean worst prognosis? / Colitis isquémica. ¿La localización en el colon derecho tiene peor pronóstico?

INTRODUCTION: Most patients with ischemic colitis have a favourable evolution; nevertheless, the location in the right colon has been associated with a worse prognosis. The purpose of this study is to compare the clinical presentation and results of right colon ischemic colitis (CICD) with ischemic colitis of other colonic segments (non-CIDC). METHODS: Retrospective, observational study of patients admitted to our hospital with ischemic colitis between 1993 and 2014, identified through a computerized search of the ICD9 codes. They were divided into 2groups: CICD and non-CICD. Comorbidities, clinical presentation, need for surgery, and mortality were compared. Multivariate analysis was performed using logistic regression adjusting for age and sex. Statistical significance was established at a value of P <0.05. RESULTS: A total of 204 patients were identified, 61 (30%) with CICD; 61% of CICD patients required surgery compared to 22% of non-CICD patients (P <0.001). Post-surgical mortality (32 vs. 55%) and overall mortality (20 vs. 15%) differences were not statistically significant. CICD patients had more commonly unfavourable outcomes than non-CICD patients (61 vs. 25%, P <0.001). The odds ratio (OR) for surgery was 5.28 and 4.47 for unfavourable outcomes for patients with CICD. CONCLUSIONS: CICD patients have a worse prognosis than non-CICD patients, 5 times more likely to need surgery and 4 times more likely to have unfavourable outcomes.

Results of colon cancer surgery in patients over 75 years old.

BACKGROUND: Colon cancer is the second most frequent cause of death in both genders. Survival has increased since 1980, although this increase has been lower in patients ≥75 years old. We analyzed the results of surgical treatment for this pathology in this group of patients. METHODS: This retrospective, observational and descriptive study analyzed data relating to 315 patients undergoing colon cancer surgery between January 2010 and December 2011. Surgical results (surgical procedure, mean postoperative stay, isolated lymph nodes, postoperative morbidity and mortality) were compared between patients who were <75 and ≥75 years old. RESULTS: Statistical significance was observed in the percentages of hypertension (P = 0.001), cardiovascular disease (P = 0.006) and bronchopathy (P = 0.005) for the older group. No differences were found between the groups regarding surgical results, except higher postoperative morbidity and mortality in the ≥75 years old age group (P = 0.02 and P = 0.03, respectively). In the multivariate analysis, the factors associated with postoperative morbidity were age and preoperative albumin levels (P < 0.05). Cancer-specific survival (CSS) was lower in older patients (P < 0.05). The multivariate analysis of survival determined that age and tumour stage are independent predictive factors (P = 0.004 and P = 0.039, respectively), unlike American Society of Anesthesiologists score. CONCLUSIONS: Age does not influence the surgical results after colon cancer resection but is associated with increased postoperative morbidity and mortality. CSS is lower in patients who are ≥75 years old.

Efficacy of rectus muscle fragment welding in the control of presacral venous bleeding.

BACKGROUND: The incidence of presacral venous bleeding during rectal resection is low, but this complication can be severe and even lethal. Occasionally, the traditional methods - such as pelvic gauze packing and the use of metallic thumbtacks - are not effective. When combined with their complications and difficulties, these failures have resulted in numerous creative procedures with which to control this complication. In 1994, the indirect electrocoagulation method, which is performed via a fragment of the rectus abdominis muscle of the abdomen, was introduced to control presacral venous bleeding. METHODS: From January 2002 to December 2015, five of 872 patients with rectal cancer and one patient with rectal metastasis of gastric cancer developed presacral venous bleeding, and this technique was used in every case. RESULTS: Haemostasis was permanent in all cases. There were no complications such as infection or rebleeding. CONCLUSION: In our experience, indirect electrocoagulation via a fragment of the rectus abdominis muscle of the abdomen is a rapid, easily executed and effective method for controlling presacral venous bleeding during rectal resection.

Presacral venous bleeding during mobilization in rectal cancer.

AIM: To analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer. METHODS: A review of the databases MEDLINE® and Embase™ was conducted, and relevant scientific articles published between January 1960 and June 2016 were examined. The anatomy of the sacrum and its venous plexus, as well as the factors that influence bleeding, the causes of this complication, and its surgical management were defined. RESULTS: This is a review of 58 published articles on presacral venous plexus injury during the mobilization of the rectum and on techniques used to treat presacral venous bleeding. Due to the lack of cases published in the literature, there is no consensus on which is the best technique to use if there is presacral bleeding during mobilization in surgery for rectal cancer. This review may provide a tool to help surgeons make decisions regarding how to resolve this serious complication. CONCLUSION: A series of alternative treatments are described; however, a conventional systematic review in which optimal treatment is identified could not be performed because few cases were analyzed in most publications.

Hemorragia digestiva por neurosfibromas en íleon / Gastrointestinal bleeding caused by neurosfibroma of the ileum

No disponible

Morbilidad y mortalidad de la ileostomía derivativa temporal en la cirugía por cáncer de recto / Morbidity and mortality of temporary diverting ileostomies in rectal cancer surgery

INTRODUCCIÓN: La ileostomía derivativa temporal es utilizada frecuentemente para disminuir las consecuencias de una dehiscencia anastomótica distal tras la escisión total del mesorrecto en la cirugía del cáncer rectal. Esta técnica quirúrgica está asociada a una alta morbilidad y a una mortalidad no despreciable. El objetivo de este estudio es evaluar la morbilidad y la mortalidad asociadas a la ileostomía y su posterior cierre. MATERIAL Y MÉTODOS: Entre 2001 y 2012 fueron analizados retrospectivamente 96 pacientes con ileostomía derivativa temporal. Se analizó la morbimortalidad tras la creación de la ileostomía y posteriormente al cierre de la misma, incluyendo como variables la edad, sexo, comorbilidades, tiempo transcurrido hasta la reconstrucción del tránsito y tratamiento adyuvante. RESULTADOS: El estoma fue permanente en 5 pacientes y 5 fueron exitus. La morbimortalidad relacionada con el estoma mientras este estuvo presente fue del 21 y 1% respectivamente. Se realizó el cierre del estoma en 86 pacientes y el 57% había recibido previamente adyuvancia. No hubo mortalidad postoperatoria tras el cierre y la morbilidad fue del 24%. El tiempo medio entre la cirugía inicial y la reconstrucción intestinal fue de 152,2 días. Este intervalo fue significativamente superior en los pacientes que recibieron adyuvancia. No se encontró significación estadísticamente significativa entre las variables analizadas y las complicaciones. CONCLUSIONES: La ileostomía está asociada a una baja mortalidad y a una morbilidad alta antes y después de su cierre. La quimioterapia adyuvante retrasa significativamente la reconstrucción intestinal, aunque en este estudio no ha influido en el índice de complicaciones

INTRODUCTION: A temporary diverting ileostomy is frequently used to reduce the consequences of a distal anastomotic leakage after total mesorectal excision in rectal cancer surgery. This surgical technique is associated with high morbidity and a not negligible mortality. The aim of this study is to evaluate the morbidity and mortality rate associated with an ileostomy and its posterior closure. MATERIAL AND METHODS: Between 2001 and 2012, 96 patients with temporary diverting ileostomy were retrospectively analyzed. Morbidity and mortality were analyzed before and after the stoma closure. The studied variables included age, sex, comorbidities, time to bowel continuity restoration and adjuvant chemotherapy. RESULTS: In 5 patients the stoma was permanent and another 5 died. The morbidity and mortality rates associated with the stoma while it was present were 21 and 1% respectively. We performed a stoma closure in 86 patients, 57% of whom had previously received adjuvant therapy. There was no postoperative mortality after closure and the morbidity rate was 24%. The average time between initial surgery and restoration of intestinal continuity was 152.2 days. This interval was significantly higher in patients who had received adjuvant therapy. No statistically significant difference was found between the variables analyzed and complications. CONCLUSIONS: Diverting ileostomy is associated with low mortality and high morbidity rates before and after closure. Adjuvant chemotherapy significantly delays bowel continuity restoration, although in this study did not influence in the rate of complications

[Morbidity and mortality after a Hartmann operation due to peritonitis originating from a sigmoid diverticulum disease (Hinchey grade III-IV)]. / Morbilidad y mortalidad tras la intervención de Hartmann por peritonitis de origen diverticular (grados III-IV de Hinchey).

INTRODUCTION: Hartmann's operation has occasionally been criticised for its high morbidity-mortality and permanent stomas. To compare risk factors is difficult due to different severity scores for diverticulitis with no standardisation. We attempted to define the morbidity-mortality of Hartmann's operation for sigmoid diverticulitis with peritonitis Hinchey III-IV and to identify some factors associated with morbidity-mortality and non-restoration of intestinal continuity. PATIENTS AND METHOD: Retrospective analysis of 72 patients: age, gender, ASA score, length of time between symptoms and surgery, Hinchey's score, Mannheim index, preoperative creatinine and co-morbidities. RESULTS: Hinchey's score III, 75%. Male, 35. Median age, 66.5 years. Morbidity-mortality: 48.6% and 23.6%, respectively. ASA > 2 (p = 0.03) and age > 65 years (p = 0.03) in bivariate analysis; and ASA > 2 (p = 0.002) and a history of ischaemic cardiac disease (p = 0.04) in multivariate analysis were associated with postoperative complications. In bivariate analysis mortality was associated with ASA > 2 (p = 0.02), age > 65 years (p = 0.02), chronic obstructive pulmonary disease (p = 0.001), Mannhein index >or= 25 (p = 0.01) and pulmonary postoperative complications (p = 0.003). Multivariate analyses were statistical significant: chronic obstructive pulmonary disease (p = 0.001) and postoperative respiratory infection (p = 0.02). Fifty-five patients survived and 65.5% continued to restoration of intestinal continuity. Age > 65 years (p = 0.004) and ASA score > 2 at first operation (p = 0.004) were predictive for non-reversal of Hartmann's procedure. CONCLUSIONS: Hartmann's operation is highly associated with morbidity-mortality in severe peritonitis of sigmoid diverticular origin, Hinchey III-IV. The majority of patients have severe co-morbidities and high-grade risk factors which are related to the incidence of morbidity and mortality.

Electrocoagulación sobre un fragmento de músculo recto anterior abdominal para el control de la hemorragia presacra durante la resección rectal / Electrocoagulation on a fragment of anterior abdominal rectal muscle for the control of presacral bleeding during rectal resection

Introducción La hemorragia venosa presacra durante la movilización del recto es baja, pero a menudo masiva e incluso letal. Nuestro objetivo conocer in vitro el resultado de la electrocoagulación aplicada a un fragmento de músculo sobre la superficie del hueso sacro y comunicar nuestros resultados en el control del sangrado venoso presacro durante la resección rectal por neoplasia maligna de recto. Material y Método In vitro se aplicó coagulación monopolar con selector al máximo de potencia sobre un fragmento muscular de 2×2cm aplicado a la cara anterior de la IV vértebra sacra hasta conseguir el punto de ebullición. Este método fue usado en 6 pacientes con hemorragia del plexo venoso presacro. Resultados En el estudio in vitro se alcanzó el punto de ebullición a los 90s. de la aplicación de corriente monopolar sobre el fragmento muscular. En 6 pacientes con hemorragia venosa presacra se aplicó electrocoagulación a un fragmento de músculo recto abdominal de 2×2cm presionado sobre la superficie del hueso sacro, logrando el cese del sangrado en todos los casos. Conclusiones El uso de electrocoagulación indirecta sobre un fragmento de músculo recto abdominal es una técnica sencilla y altamente efectiva en el control de la hemorragia venosa presacra (AU)

Introduction Presacral venous haemorrhage during rectal movement is low, but is often massive, and even fatal. Our objective is the "in vitro" determination of the results of electrocoagulation applied to a fragment of muscle on the sacral bone surface during rectal resection due to a malignant neoplasm of the rectum. Material and method Single-pole coagulation was applied "in vitro" with the selector at maximum power on a 2×2cms muscle fragment, applied to the anterior side of the IV sacral vertebra until reaching boiling point. The method was used on 6 patients with bleeding of the presacral venous plexus. Results In the "in vitro" study, boiling point was reached in 90seconds from applying the single-pole current on the muscle fragment. Electrocoagulation was applied to a 2×2cm rectal muscle fragment in 6 patients with presacral venous haemorrhage, using pressure on the surface of the presacral bone, with the stopping of the bleeding being achieved in all cases. Conclusions The use of indirect electrocoagulation on a fragment of the rectus abdominis muscle is a straightforward and highly effective technique for controlling presacral venous haemorrhag (AU)

Hemorragia presacra durante la resección rectal por cáncer. Consideraciones morfológicas e hidrodinámicas / Presacral haemorrhage during rectal cancer resection: Morphological and hydrodynamic considerations

Introducción Nuestro objetivo ha sido identificar la localización y tamaño de los forámenes anteriores de sus cuerpos vertebrales y analizar las variables hemodinámicas que pudiesen influir en la gravedad hemorrágica por lesión del plexo venoso sacro. Material y método Se registraron los datos morfológicos de 70 huesos sacros. En 67 pacientes con cáncer rectal, mediante tomografía axial computarizada, se registran las mediciones de altura entre vena cava y S5. Tras cateterización transfemoral se registró la presión de la vena cava inferior en 10 pacientes con cáncer rectal. Aplicamos los principios generales de la hidrodinámica, según la Ley de Bernoulli, calculando la presión venosa del plexo sacro en posición de litotomía y el caudal de flujo según el calibre de una hipotética lesión venosa. Resultados En el 22% de los cuerpos vertebrales sacros existían forámenes cuyo diámetro máximo oscilaba entre 0,5 y 4mm. Todos los forámenes de 2 o más de 2mm estaban localizados en S4-S5. La presión venosa del plexo sacro en posición de litotomía se aproxima al doble de la presión venosa de la vena cava en posición normal. El caudal oscila entre 498 y 1.994ml/m. para lesiones de calibre entre 2mm y 4mm respectivamente. Conclusiones Los forámenes de mayor calibre se sitúan en los cuerpos vertebrales de S4-S5. La lesión venosa a esos niveles puede alcanzar un caudal de flujo de 2 l/m (AU)

Introduction Our aim is to identify the location and size of the anterior foramina of sacral vertebral bodies and analyse the haemodynamic variables that could influence the haemorrhagic severity of the injury of the presacral venous plexus. Materials and methods Using computed axial tomography the morphological data of 70 sacral bones in 67 patients with rectal cancer were recorded, as well as measuring the height between the vena cava and S5. After transfemoral catheterisation the inferior vena cava pressure was recorded in 10 patients with rectal cancer. Hydrodynamic principles, according to Bernoulli's Law, were applied to calculate sacral venous plexus pressure, and the flow rate according to the calibre of a hypothetical venous injury. Results The maximum diameter ranged from 0.5mm to 4mm in 22% of the cases. All foramina of 2 or more millimetres were located in the S4-S5 region. Sacral plexus venous pressure in lithotomy was almost double the inferior vena cava pressure in normal position. Blood flow ranged from 498 to 1,994ml/min for injuries of sizes between 2 and 4mm, respectively. Conclusions Larger calibre foramina are found in vertebral bodies of S4-S5. Venous injury at these levels can reach a flow rate of 2 l/min (AU)

Resección abdominoperineal en cáncer anal: reconstrucción del periné con colgajo miocutáneo de músculo recto anterior abdominal / Abdominoperineal resection in anal cancer: Reconstruction of the perineum with a myocutaneous flap from the anterior rectus abdominis muscle

Introducción La resección abdominoperineal tras radioterapia se acompaña de una alta tasa de complicaciones de la herida perineal. El propósito de este estudio retrospectivo fue evaluar los resultados de la reconstrucción perineal con un colgajo miocutáneo de músculo recto abdominal en pacientes con cáncer anal recurrente o persistente. Pacientes y método Entre 2006 y 2010, 6 pacientes varones VIH+ fueron tratados después del fracaso del tratamiento inicial con quimio-radioterapia. Tras amputación abdominoperineal, se realizó un colgajo miocutáneo de recto anterior.Resultados La media de edad fue de 36,3 años (rango: 30-42). La curación primaria de la herida perineal se consiguió en los primeros treinta días. No hubo complicaciones mayores en el postoperatorio inmediato o tras un seguimiento medio de 26,5 meses. Hubo 2 complicaciones menores (33,3%) relacionadas con la herida perineal. No hubo complicaciones de la pared abdominal. Conclusión La utilización de un colgajo miocutáneo del recto anterior del abdomen, en pacientes con cáncer anal recurrente o persistente, se asoció con un bajo índice de complicaciones perineales (AU)

Introduction Abdominoperineal resection after radiotherapy has a high rate of perineal wound complications. The aim of this retrospective study was to evaluate the results of perineal reconstruction with a rectus abdominis muscle myocutaneous flap in patients with recurrent or persistent anal cancer. Patients and method Between 2006 and 2010, six male HIV+ patients were treated after initial treatment failure with chemotherapy. An anterior rectal myocutaneous flap was performed after abdominal-perineal excision. Results The mean age was 36.3 years (range: 30-42). Primary healing of the perineal wound was achieved in the first thirty days. There were no major complications in the immediate post-surgical period or after a mean follow up of 26.5 months. There were 2 (33.3%) minor complications associated with the perineal wound. There were no complications of the abdominal wall. Conclusion The use of an anterior rectus abdominis myocutaneous flap in patients with recurrent or persistent anal cancer is associated with a low rate of perineal complications (AU)

Morbilidad y mortalidad tras la intervención de Hartmann por peritonitis de origen diverticular (grados III-IV de Hinchey) / Morbidity and mortality after a Hartmann operation due to peritonitis originating from a sigmoid diverticulum disease (Hinchey grade III-IV)

Introducción. La intervención de Hartmann está sujeta a numerosas críticas por su elevada morbimortalidad y el índice de estomas permanentes. Comparar factores de riesgo es difícil debido a los diferentes grados de severidad de la diverticulitis y que éstos no están estandarizados. Pretendemos definir la morbimortalidad de la intervención de Hartmann por diverticulitis sigmoidea con peritonitis III-IV de Hinchey e identificar factores para la morbimortalidad y para no ralizar la reconstrucción del tránsito. Pacientes y método. En 72 pacientes analizamos retrospectivamente: edad, sexo, ASA, tiempo entre el inicio de síntomas y la cirugía, escala de Hinchey, índice de Mannheim, creatinina preoperatoria y comorbilidades. Resultados. Grado III de Hinchey, el 75%. Varones, 35. Media de edad, 66,5 años. Morbilidad del 48,6% y mortalidad del 23,6%. ASA > 2 (p = 0,03) y edad > 65 años (p = 0,03) en el análisis bivariable y ASA > 2 (p = 0,002) y antecedentes de cardiopatía isquémica (p = 0,04) en el multivariable se asociaron con complicaciones postoperatorias. La mortalidad estaba relacionada, en el análisis bivariable, con ASA > 2 (p = 0,002), edad > 65 años (p = 0,02), enfermedad pulmonar obstructiva crónica (p = 0,001), Mannhein $ 25 (p = 0,01) y complicaciones respiratorias postoperatorias (p = 0,003). En el multivariable se relacionaron con significación estadística: enfermedad pulmonar obstructiva (p = 0,001) e infección respiratoria postoperatoria (p = 0,02). Sobrevivieron 55 pacientes, con reconstrucción del tránsito en el 65,5%. La edad > 65 años (p = 0,004) y ASA > 2 en la primera intervención (p = 0,004) fueron predictivos para no realizar la reconstrucción. Conclusiones. La intervención de Hartmann está asociada a morbimortalidad importante en pacientes con peritonitis de origen diverticular sigmoideo de grados III-IV de Hinchey. La mayoría tiene severas comorbilidades y alto grado de factores de riesgo, lo cual condiciona la incidencia de morbilidad y mortalidad (AU)

Introduction. Hartmann’s operation has occasionally been criticised for its high morbidity-mortality and permanent stomas. To compare risk factors is difficult due to different severity scores for diverticulitis with no standardisation. We attempted to define the morbidity-mortality of Hartmann’s operation for sigmoid diverticulitis with peritonitis Hinchey III-IV and to identify some factors associated with morbidity-mortality and non-restoration of intestinal continuity. Patients and method. Retrospective analysis of 72 patients: age, gender, ASA score, length of time between symptoms and surgery, Hinchey’s score, Mannheim index, preoperative creatinine and co-morbidities. Results. Hinchey’s score III, 75%. Male, 35. Median age, 66.5 years. Morbidity-mortality: 48.6% and 23.6%, respectively. ASA > 2 (p = 0.03) and age > 65 years (p = 0.03) in bivariate analysis; and ASA > 2 (p = 0.002) and a history of ischaemic cardiac disease (p = 0.04) in multivariate analysis were associated with postoperative complications. In bivariate analysis mortality was associated with ASA > 2 (p = 0.02), age > 65 years (p = 0.02), chronic obstructive pulmonary disease (p = 0.001), Mannhein index $ 25 (p = 0.01) and pulmonary postoperative complications (p = 0.003). Multivariate analyses were statistical significant: chronic obstructive pulmonary disease (p = 0.001) and postoperative respiratory infection (p = 0.02). Fifty-five patients survived and 65.5% continued to restoration of intestinal continuity. Age > 65 years (p = 0.004) and ASA score > 2 at first operation (p = 0.004) were predictive for non-reversal of Hartmann’s procedure. Conclusions. Hartmann’s operation is highly associated with morbidity-mortality in severe peritonitis of sigmoid diverticular origin, Hinchey III-IV. The majority of patients have severe co-morbidities and high-grade risk factors which are related to the incidence of morbidity and mortality (AU)