Cirugía colorrectal: justificación de un área de conocimiento específico / Colorectal surgery: justification for a specific area of knowledge

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Mild acute biliary pancreatitis vs cholelithiasis: are there differences in the rate of choledocholithiasis?

The rate of choledocholithiasis at the time of elective surgery after mild acute biliary pancreatitis is still unclear because it decreases rapidly after the onset. The aims of this study are as follows: (1) To investigate whether the incidence of choledocholithiasis in mild biliary pancreatitis is higher than in patients with symptomatic cholelithiasis. (2) To evaluate the usefulness of intraoperative cholangiography in the diagnosis of unsuspected choledocholithiasis in mild pancreatitis. Prospective study including 130 patients undergoing laparoscopic surgery and classified into two groups: mild biliary pancreatitis (n = 44) and symptomatic cholelithiasis (n = 86). Choledocholithiasis was evaluated by endoscopic cholangiopancreatography, magnetic resonance, and intraoperative cholangiography. Preoperatively, choledocholithiasis was identified in five patients with symptomatic cholelithiasis and two with biliary pancreatitis (5.81 vs 4.54%; p = 0.472). In 117 cases (90%), intraoperative cholangiography was successfully performed, identifying unsuspected choledocholithiasis in five patients of the colelithiasis group and in three in the group of pancreatitis (5.81 vs 6.81%; p = 0.492). The total number of patients with choledocholithiasis in the whole series was 15 (11.5%); 11.6% in colelithiasis group vs 11.4% in biliary pancreatitis group; p = 0.605. The rate of choledocholithiasis was not significantly different between the groups of patients with mild acute biliary pancreatitis and symptomatic cholelithiasis. Intraoperative cholangiography identified unsuspected choledocholithiasis in 6.81% of patients with mild acute biliary pancreatitis.

[Randomized clinical study of polydioxanone and nylon sutures for laparotomy clousure in high-risk patients]. / Estudio clínico aleatorizado entre sutura de polidioxanona y de naylon en el cierre de laparotomía en pacientes de riesgo.

INTRODUCTION: The complications of surgical wound closure in patients with risk factors significantly increases morbidity and mortality. The aim of the present study was to evaluate differences in abdominal wall closure in patients with risk factors with the same closure technique and slow-absorbable or non-absorbable sutures. MATERIAL AND METHODS: We performed a prospective, multicenter, comparative study of polydioxanone versus nylon sutures. Laparotomies performed for intestinal diseases and hepatobiliopancreatic procedures in patients with at least one risk factor were included. Exclusions criteria were eventrations, interventions for obesity, the need for reinforcement sutures, uncommon incisions, life expectancy of less than 1.5 years and deaths unrelated to the wound. Closure was performed with monoplane, extracutaneous, continuous, en bloc, loop sutures. Infection, evisceration, dehiscence, extrusion, sinus, eventration, intolerance, and pain were evaluated. Postoperative follow-up was performed at 10 and 30 days, 3 and 6 months, and at 1 and 1.5 years. RESULTS: A total of 770 patients were included (451 in the polydioxanone group and 319 in the nylon group). A total of 78.05% were midline incisions, with a mean length of 23.3 cm. Caliber 1 sutures were most frequently used (85.45%), and 1.7 sutures were used per patient. No complications occurred in 94.03% with no differences between groups (94.7% polydioxanone and 93.1% nylon). The results were similar throughout follow-up. The surgical infection rate was 10%. No differences were found in any of the follow-up assessments in any of the variables analyzed. CONCLUSIONS: Abdominal wall closure should be performed with continuous slow-absorption sutures such as polydioxanone since this type of suture has a similar complication rate to reabsorbable sutures and presents greater biocompatibility.

Estudio clínico aleatorizado entre sutura de polidioxanona y de naylon en el cierre de laparotomía en pacientes de riesgo / Randomized clinical study of polydioxanone and nylon sutures for laparotomy clousure in high-risk patients

Introducción. Las complicaciones del cierre de la herida quirúrgica en enfermos con factores de riesgo aumentan significativamente su morbimortalidad. El objeto del estudio es valorar la presencia de diferencias en el cierre de la pared abdominal en pacientes con criterios de riesgo, con la misma técnica de cierre entre sutura de reabsorción lenta y sutura no absorbible. Material y métodos. Estudio prospectivo multicéntrico, comparativo entre polidioxanona y nailon. Se incluyen laparotomías por enfermedad intestinal y hepatobiliopancreática, con un factor de riesgo añadido. Se excluyen eventraciones, intervención por obesidad, cierre con puntos totales, incisiones de escasa incidencia, pronóstico vital menor de 1,5 años o fallecimiento sin relación con la herida. El cierre fue con sutura continua en bloque con lazo, monoplano extracutánea. Se evalúa la infección, la evisceración, la dehiscencia, la extrusión, el sinus, la eventración, la intolerancia y el dolor. Controles: postoperatorio, 10 y 30 días, 3 y 6 meses, 1 año y 1,5 años. Resultados. Se incluyó a 770 pacientes, 451 en el grupo de polidioxanona y 319 en el grupo de nailon El 78,05% eran incisiones medias, con 23,3 cm de longitud media. El calibre de la sutura más utilizado era de 1 (85,45%). Se utilizaron 1,7 suturas por paciente. En el 94,03% no hubo complicaciones, y se obtuvieron los mismos resultados en ambos grupos (94,7% en la polidioxanona y el 93,1% en el nailon). En controles posteriores, los resultados fueron similares a lo largo del tiempo. La tasa de infección quirúrgica fue del 10%. No hay diferencias en ninguno de los controles para ninguna de las variables analizadas. Conclusiones. El cierre de la pared abdominal debería realizarse con sutura continua de material de absorción lenta, como la polidiaxonona, al presentar una incidencia similar de complicaciones y una mayor biocompatibilidad que las suturas irreabsorbibles (AU)

Introduction. The complications of surgical wound closure in patients with risk factors significantly increases morbidity and mortality. The aim of the present study was to evaluate differences in abdominal wall closure in patients with risk factors with the same closure technique and slow-absorbable or non-absorbable sutures. Material and methods. We performed a prospective, multicenter, comparative study of polydioxanone versus nylon sutures. Laparotomies performed for intestinal diseases and hepatobiliopancreatic procedures in patients with at least one risk factor were included. Exclusions criteria were eventrations, interventions for obesity, the need for reinforcement sutures, uncommon incisions, life expectancy of less than 1.5 years and deaths unrelated to the wound. Closure was performed with monoplane, extracutaneous, continuous, en bloc, loop sutures. Infection, evisceration, dehiscence, extrusion, sinus, eventration, intolerance, and pain were evaluated. Postoperative follow-up was performed at 10 and 30 days, 3 and 6 months, and at 1 and 1.5 years. Results. A total of 770 patients were included (451 in the polydioxanone group and 319 in the nylon group). A total of 78.05% were midline incisions, with a mean length of 23.3 cm. Caliber 1 sutures were most frequently used (85.45%), and 1.7 sutures were used per patient. No complications occurred in 94.03% with no differences between groups (94.7% polydioxanone and 93.1% nylon). The results were similar throughout follow-up. The surgical infection rate was 10%. No differences were found in any of the follow-up assessments in any of the variables analyzed. Conclusions. Abdominal wall closure should be performed with continuous slow-absorption sutures such as polydioxanone since this type of suture has a similar complication rate to reabsorbable sutures and presents greater biocompatibility (AU)

Laparoscopic treatment of endoscopic sigmoid colon perforation: a case report and literature review.

Perforation of the colon after colonoscopy is a rare but potentially lethal complication. It usually occurs when endoscopy is performed for therapeutic purposes. In these cases the election of the best treatment is difficult and still controversial. Laparoscopy is a new approach for diagnosis and treatment of this condition. We report a case of a patient who was initially treated laparoscopically after a colonoscopic perforation. A postoperative leak was detected and the patient underwent open surgery. Possible therapeutic approaches and a literature review are discussed.

Seudoquiste de páncreas y rotura de seudoaneurisma de la arteria esplénica / Pancreatic pseudocyst and rupture of a splenic artery pseudoaneurysm

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Tratamiento quirúrgico y resultados del cáncer de recto / Surgical treatment and results of rectal cancer

Las experiencias acumuladas en los últimos años han modificado la táctica y la técnica quirúrgicas en el tratamiento del cáncer de recto, existiendo una evidencia científica en la mejoría de los resultados en grupos especializados. El objetivo del presente trabajo es describir las distintas opciones técnicas, indicaciones y los resultados del tratamiento quirúrgico actual del cáncer de recto. El cáncer de recto puede tratarse con intención curativa con cualquiera de las siguientes opciones quirúrgicas: resección local, resección anterior con sus distintas variantes y amputación abdominoperineal. Se deben mantener unos criterios de selección correctos, fundamentalmente en relación con la localización y extensión del tumor y con el factor paciente. El progreso actual de la cirugía del cáncer de recto viene condicionado por la adopción y la correcta realización de la escisión del mesorrecto popularizada por Heald y con recidivas locales inferiores al 5 per cent en resecciones curativas. La adopción de la técnica por diversos grupos de trabajo ha llevado a una reducción media de las recidivas locales del 19 al 6 per cent, a expensas de la especialización y la creación de unidades de cirugía colorrectal (AU)