Intracorporeal anastomosis in minimally invasive right hemicolectomy: a nationwide survey of the Korean Society of Coloproctology.

Purpose: We investigated the current practices and perceptions of colorectal surgeons in South Korea regarding intracorporeal ileocolic anastomosis (IIA) in minimally invasive right hemicolectomy (RHC). Methods: Members of the Korean Society of Coloproctology (KSCP) participated in an online survey encompassing demographic information, surgical experiences, methods for IIA, and advantages, barriers, and perceptions of IIA. We performed a statistical analysis of survey results. Results: Among the 1,074 KSCP members contacted, 178 responded to the survey. Most respondents were males aged 40-49 years with >10 years of experience who were affiliated with a tertiary healthcare facility. One hundred fifty-six respondents had performed <100 colorectal cancer surgeries annually. Fifty-nine respondents reported experiences of the IIA technique in minimally invasive RHC. Most respondents favored the isoperistaltic side-to-side (S-S) anastomosis and stapled S-S anastomosis, hand-sewn closure for the common channel, and the periumbilical area for primary specimen extraction. Respondents with IIA experience emphasized the reduction in postoperative complications as the primary reason for performing IIA, whereas respondents without IIA experience cited the lack of benefits as the main deterrent. Respondents commonly cited concerns regarding anastomotic leakage and intraabdominal contamination as the primary reasons for not performing IIA. Respondents with IIA experience demonstrated a more positive response towards attempting or transitioning to IIA than those without. Respondents with IIA experience prioritized self-sufficiency, whereas respondents without IIA experience prioritized proctorship and discussions of the initial cases. Conclusion: Measures to standardize the IIA technique and appropriate training programs must be implemented to enhance its use in minimally invasive RHC.

Comparing extracorporeal, semi-extracorporeal, and intracorporeal anastomosis in laparoscopic right hemicolectomy: introducing a bridging technique for colorectal surgeons.

Purpose: Intracorporeal anastomosis (IA) in laparoscopic right hemicolectomy has been associated with faster recovery in bowel function compared to extracorporeal anastomosis (EA). However, the technical difficulty of laparoscopic suturing technique and intraabdominal fecal contamination hinder many surgeons from implementing such a procedure. We introduce and compare a bridging technique designated as "semi-extracorporeal" anastomosis (SEA), which embraces the advantages and amends the drawbacks of IA and EA. Methods: Between May 2016 and October 2022, 100 patients who underwent laparoscopic right hemicolectomy were analyzed. All patients who received laparoscopic right hemicolectomy underwent one of the 3 anastomosis methods (EA, SEA, and IA) by a single colorectal surgeon at a single tertiary care hospital. Data including perioperative parameters and postoperative outcomes were analyzed by each group. Results: A total of 100 patients were reviewed. Thirty patients underwent EA; 50 and 20 patients underwent SEA and IA, respectively. Operation time (minute) was 170 (range, 100-285), 170 (range, 110-280), and 147.5 (range, 80-235) in EA, SEA, and IA, respectively (P = 0.010). Wound size was smaller in SEA and IA compared to EA (P < 0.001). IA was associated with a shorter time (day) to first flatus compared to SEA and EA (4 [range, 2-13] vs. 4 [range, 2-7] vs. 2.5 [range, 1-4], P < 0.001). Postoperative complication showed no statistical significance between the 3 groups. Conclusion: Semi-extracorporeal was an attractive bridging option for colorectal surgeons worrisome of the technical difficulty of IA while maintaining faster bowel recovery and smaller wound incisions compared to EA.

Uso de ileostomía derivativa en cáncer de ovario. Revisión de la literatura / Use of diverting ileostomy in ovarian cancer. Literature review

Introducción. La ileostomía derivativa de protección se realiza con el objetivo de proteger la anastomosis intestinal después de una resección colorrectal. Esta resección intestinal es el procedimiento extendido más frecuentemente realizado en pacientes con cáncer de ovario, con el fin de lograr una citorreducción completa. Conocer las indicaciones, el uso, las técnicas y las complicaciones de las ileostomías es importante para los grupos multidisciplinarios que tratan estas pacientes. Métodos. Se realizó una búsqueda en PubMed vía Medline y una revisión narrativa actualizada de los principales hallazgos sobre las indicaciones, las técnicas quirúrgicas, complicaciones y el uso de la ileostomía derivativa en el cáncer de ovario. Resultados. El uso de la ileostomía derivativa en cáncer de ovario sigue siendo un tema controvertido. Hasta la fecha, ni la ileostomía de derivación ni la ileostomía fantasma se han asociado con una reducción en la incidencia de la fuga anastomótica, pero ambas técnicas podrían disminuir su gravedad. Conclusión. La ileostomía de derivación en cáncer de ovario se usa para proteger una anastomosis distal tras una resección intestinal, en caso de fuga anastomótica si no se ha realizado una ostomía previa o en caso de obstrucción intestinal.

Introduction. Protective diverting ileostomy is performed with the aim of protecting the intestinal anastomosis after a colorectal resection. This intestinal resection is the most frequently performed extended procedure in patients with ovarian cancer, in order to achieve complete cytoreduction. Knowing the indications, use, techniques and complications of ileostomies is important for multidisciplinary groups that treat these patients. Methods. We conducted a search in PubMed via Medline and an updated narrative review of the main findings on the indications, surgical techniques, complications and use of diverting ileostomy in ovarian cancer. Results. The use of diverting ileostomy in ovarian cancer remains a controversial issue. To date, neither diverting ileostomy nor ghost ileostomy have been associated with a reduction in the incidence of anastomotic leak, but both techniques could decrease its severity. Conclusion. The diverting ileostomy in ovarian cancer is used to protect a distal anastomosis after intestinal resection, in case of anastomotic leak if a previous ostomy has not been performed or in case of intestinal obstruction.

Jejunal Diverticulosis: An Atypical Lead Point for Small Bowel Volvulus.

The occurrence of small intestinal diverticula is relatively infrequent compared to its counterpart in the large bowel. Duodenal diverticula exhibit a significantly higher prevalence within the small intestine compared to jejunoileal diverticula, with a ratio of five to one. The occurrence of jejunoileal diverticula exhibits considerable variability and has been documented to range from 0.5% to 2.3% in radiographic series, while autopsy studies have reported rates as high as 7%. We present the clinical details of a 65-year-old male patient who sought medical attention due to a constellation of symptoms, including abdominal pain, vomiting, and obstipation. After adequate resuscitation with IV fluids and preoperative preparation, the patient was transported to the operating room for an emergency exploratory laparotomy. Multiple jejunal diverticuli were identified in the proximal jejunum at the antimesenteric border, less than three feet from the duodenojejunal (DJ) junction. The terminal ileum was found to be 360° rotated counterclockwise around the small bowel mesentery, causing the small intestine to appear congested; however, after clockwise de-rotation, the small bowel regained its normal color. Adhesiolysis and small bowel decompression were performed, and the patient had an uneventful recovery.

Impact of nasogastric tube exclusion after minimally invasive esophagectomy for esophageal cancer: a single-center retrospective study in India.

Purpose: This study examines the impacts of omitting nasogastric tube (NGT) placement following cervical esophagogastric anastomosis (CEGA) in Enhanced Recovery After Surgery (ERAS) protocols, comparing outcomes to those from early NGT removal. Methods: In a retrospective cohort of esophagectomy patients treated for esophageal cancer, participants were divided into two groups: group 1 had the NGT inserted post-CEGA and removed by postoperative day 3, while group 2 underwent the procedure without NGT placement. We primarily investigated anastomotic leak rates, also analyzing hospital stay duration, pulmonary complications, and NGT reinsertion. Results: Among 50 esophageal squamous cell carcinoma patients, 30 in group I were compared with 20 in group II. The baseline demographic and tumor characteristics were similar between both groups. The overall incidence of anastomotic leak was 14.0%, comparable in both groups (16.7% vs. 10.0%, p = 0.63). The postoperative hospital stay was significantly shorter in the no NGT group (median of 7 days vs. 6 days, p = 0.03) with similar major morbidity (Clavien-Dindo grade ≥IIIa; 13.3% vs. 5.0%, p = 0.63). There was no 30-day mortality, and one patient in each group had reinsertion of NGT for conduit dilatation. Conclusion: The exclusion of an NGT across CEGA after esophagectomy did not influence the anastomotic leak rate with comparable complications and a shorter hospital stay.

Insertion Multi-Parachute Suturing and Knotting (IMS-K) Technique for Aortic Surgery.

Successful surgical interventions for aortic surgery, such as hemiarch repair and total arch replacement, pivot on the foundation of optimal anastomosis. We propose an alternative approach to anastomosis. The "insertion multi-parachute suturing and knotting" (IMS-K) technique entails the deployment of two parachute sutures, which can be effectively employed for both proximal and distal anastomoses. The first suture is applied loosely to the posterior half of the anastomosis and subsequently parachuted down, tightening the suture with a nerve hook. The second suture replicates the procedure in the anterior half of the anastomosis, loosely securing it in a similar manner and tightening it with a nerve hook at the end. As a result, the artificial graft is completely inserted into the aorta with a substantial grip. This technique simplifies the aortic anastomosis by ensuring procedural simplicity while minimizing bleeding risk, thus potentially advancing surgical outcomes.

Percepción e impacto en la confianza de los residentes de cirugía general de un curso de anastomosis intestinal abierta en un ambiente simulado

Objetivo: Evaluar el impacto de un curso de anastomosis intestinal abierta simulada en residentes de cirugía general. Materiales y Métodos: Estudio prospectivo no aleatorizado. Se aplicó un curso para residentes del programa de cirugía general del Hospital Clínico Universidad de Chile en 2021 en su primera versión y una segunda vez en 2022. Se evaluó la percepción y confianza con encuestas pre y post curso. Resultados: Participaron diecisiete residentes. De ellos, 16 residentes habían asistido previamente en la técnica básica, 10 nunca habían realizado una anastomosis intestinal a un paciente real como primer cirujano, en su mayoría residentes de segundo y tercer año. El nivel de confianza promedio para realizar una anastomosis intestinal en pacientes previo al curso fue de 1,86/7, 3/7 y 5,38/7 para el primer, segundo y tercer año, respectivamente. De manera global, previo al curso, los residentes promediaron una confianza de 3,09/7. Después del curso, 15/16 residentes estuvieron de acuerdo o muy de acuerdo en que mejoró la confianza en la técnica; que el modelo representa correctamente la situación real, y que los modelos simulados son más efectivos para el aprendizaje que la experiencia clínica por sí sola. Los residentes aumentaron su confianza en 2,47 puntos, alcanzando un promedio de 5,56/7 para la técnica (p = 0,001). Conclusiones: El curso de anastomosis intestinal abierta es percibido por los residentes como efectivo, realista y aumenta, significativamente, la confianza en la realización de esta técnica.

Objective: To evaluate the impact of a simulated open intestinal anastomosis course on general surgery residents. Materials and Methods: Prospective non-randomized study. A course was applied to residents in the general surgery program at the Clinical Hospital of the University of Chile in 2021 for its first version and a second time in 2022. Perception and confidence were evaluated with pre-and post-course surveys. Results: Seventeen residents participated. Of these, 16 residents had previously attended the basic technique, 10 had never performed an intestinal anastomosis as a first surgeon on a real patient, mostly second and third-year residents. The average confidence level for performing an intestinal anastomosis on patients prior to the course was 1.86/7, 3/7, and 5.38/7 for the first, second, and third year, respectively. Overall, prior to the course, residents averaged a confidence of 3.09/7. After the course, 15/16 residents agreed or strongly agreed that it improved their confidence in the technique; that the model accurately represents the real situation, and that simulated models are more effective for learning than clinical experience alone. Residents increased their confidence by 2.47 points, reaching an average of 5.56/7 for the technique (p = 0.001). Conclusions: The open intestinal anastomosis course is perceived by residents as effective, realistic, and significantly increases confidence in performing this technique.

Inferior polar nephrectomy and vesicocalicostomy for complete ureteric stricture following antibody-mediated rejection in ABO-incompatible living donor kidney transplant: a report of a rare case.

Renal transplant recipients are prone to urological complications, the most common of which is stricture of the transplant ureter. We present a rare case of complete ureteric stricture in a 37-year-old man who had undergone spousal living donor kidney transplantation with ABO incompatibility. Initially, treatment involved creating an anastomosis between the native right ureter and the renal pelvis of the transplanted kidney. However, the stricture recurred. Subsequently, the patient was successfully treated with inferior polar nephrectomy and vesicocalicostomy, which entailed anastomosing the lower calyx of the transplanted kidney to the bladder. After 7 months of follow-up, the patient continued to exhibit stable renal function without stricture recurrence.

The influence of preoperative e intraoperative factors in predicting postoperative morbidity and mortality in perforated diverticulitis: a systematic review and meta-analysis.

To determine if preoperative-intraoperative factors such as age, comorbidities, American Society of Anesthesiologists (ASA) classification, body mass index (BMI), and severity of peritonitis affect the rate of morbidity and mortality in patients undergoing a primary anastomosis (PA) or Hartmann Procedure (HP) for perforated diverticulitis. This is a systematic review and meta-analysis, conducted according to PRISMA, with an electronic search of the PubMed, Medline, Cochrane Library, and Google Scholar databases. The search retrieved 614 studies, of which 11 were included. Preoperative-Intraoperative factors including age, ASA classification, BMI, severity of peritonitis, and comorbidities were collected. Primary endpoints were mortality and postoperative complications including sepsis, surgical site infection, wound dehiscence, hemorrhage, postoperative ileus, stoma complications, anastomotic leak, and stump leakage. 133,304 patients were included, of whom 126,504 (94.9%) underwent a HP and 6800 (5.1%) underwent a PA. There was no difference between the groups with regards to comorbidities (p = 0.32), BMI (p = 0.28), or severity of peritonitis (p = 0.09). There was no difference in mortality [RR 0.76 (0.44-1.33); p = 0.33]; [RR 0.66 (0.33-1.35); p = 0.25]. More non-surgical postoperative complications occurred in the HP group (p = 0.02). There was a significant association in the HP group between the severity of peritonitis and mortality (p = 0.01), and surgical site infection (p = 0.01). In patients with perforated diverticulitis, PA can be chosen. Age, comorbidities, and BMI do not influence postoperative outcomes. The severity of peritonitis should be taken into account as a predictor of postoperative morbidity and mortality.

Reporte de lesión en vena femoral: ¿reparación o ligadura? / Report of injury in the femoral vein: repair or ligation?

Introducción: en el contexto del trauma vascular, la ligadura de estructuras venosas periféricas es una prácticahabitual en su manejo, pero no está exenta de complicaciones y de secuelas; además, algunos estudios realizadosen las últimas guerras y en centros de trauma civil muestran los beneficios de realizar una reparación venosa. Casos clínicos: se presentan dos casos de traumas inciso-contusos en accidentes de tráfico en población pediátrica, uno de ellos con compromiso de la vena femoral común de forma aislada y un segundo caso con lesión de laarteria femoral superfi cial y de la vena femoral, ambos casos llevados a reconstrucción venosa con una evoluciónsatisfactoria. Discusión: aunque el manejo clásico de las lesiones venosas es la ligadura de la estructura, la literatura médica escontradictoria, ya que la evidencia actual sugiere una tendencia a favorecer la reconstrucción venosa. en pacienteshemodinámicamente inestables debe realizarse una ligadura o shunt de las grandes estructuras venosas; en lospacientes estables con lesiones en miembros inferiores, en especial los que presentan lesiones arteriales concomitantes, debe intentarse la reparación de la lesión venosa para disminuir el riesgo de amputación y las complicaciones secundarias a la hipertensión venosa.(AU)

Introduction: in the context of vascular trauma, the ligation of peripheral venous structures is a common practicein management, it is not exempt from complications and sequelae, in addition, some studies carried out in recentwars and in civilian trauma centers show benefits of performing a venous repair. Cases reports: two cases of blunt force trauma in traffic accidents in the pediatric population are presented, oneof them with isolated involvement of the common femoral vein and a second case with injury to the superficialfemoral artery and femoral vein, both cases led to venous reconstruction with an adequate outcome.Discussion: the classic management of venous injuries is the ligation of the structure, however, the current evidence has shown a tendency to favor venous reconstruction, but the current information is controversial. in hemodynamically unstable patients, a ligation or shunt of the large venous structures should be performed. in stablepatients with injuries to the lower limbs, especially those with concomitant arterial injuries, repair of the venous injury should be attempted to reduce the risk of amputation and complications secondary to venous hypertension.(AU)

Neumoperitoneo secundario a neumatosis intestinal masiva: un reporte de caso / Pneumoperitoneum secondary to massive intestinal pneumatosis: a case report

Introducción. La neumatosis intestinal se define como la presencia de quistes aéreos en la pared del tracto digestivo, a nivel submucoso o subseroso, que comprometen principalmente el intestino delgado. Las manifestaciones clínicas son inespecíficas y los hallazgos imagenológicos son fundamentales en el enfoque diagnóstico. El manejo puede ser médico o quirúrgico, dependiendo del compromiso intestinal y las complicaciones asociadas. Caso clínico. Hombre de 78 años, que ingresó por cuadro de dolor abdominal crónico, con hallazgos imagenológicos de neumoperitoneo. Al ser llevado a intervención quirúrgica se encontró neumatosis intestinal masiva del íleon, requiriendo resección intestinal. Resultado. El paciente presentó una evolución postoperatoria satisfactoria y fue dado de alta, sin complicaciones. Conclusión. La neumatosis intestinal es una enfermedad poco frecuente, que se presenta principalmente en hombres. La sospecha diagnóstica se confirma con imágenes tomográficas. Los pacientes candidatos para el manejo médico deben presentar causas con curso benigno, sin compromiso hemodinámico ni complicaciones. El manejo quirúrgico se reserva para pacientes con abdomen agudo o signos de sepsis.

Introduction. Intestinal pneumatosis is defined as the presence of air cysts in the wall of the digestive tract at the submucosal or subserosal level, mainly compromising the small intestine. The clinical manifestations of the disease are nonspecific, and the imaging findings are essential in the diagnostic approach. Management can be conservative and/or surgical depending on the intestinal compromise and associated complications. Clinical case. The following is the case of a 78-year-old man, who was admitted due to chronic abdominal pain with imaging findings of pneumoperitoneum. Patient underwent surgery and a massive ileum pneumatosis was found, requiring intestinal resection. Results. The patient ́s postoperative course was uneventful, and he was discharged without further complications. Conclusions. Intestinal pneumatosis is an uncommon disease, which mostly affect men population. Clinical suspicion of this condition should be confirmed with abdominal tomography. Candidates for medical management are those with benign course pathologies without hemodynamic compromise and/or complications. Surgical management should be reserved for patients with acute abdomen or sepsis.

Laparoscopic Deloyers Procedure as a Salvage Technique for Colorectal Anastomosis: An Alternative to Total Colectomy

Introduction: The Deloyers procedure is a valuable technique used in reconstructing bowel transit following an extended left colectomy, a Hartmann-type colostomy, or repeated colon resections. It enables the creation of a tension-free colorectal or coloanal anastomosis. Case presentation: A 60-year-old female patient presented for consultation regarding the closure of a colostomy. Her medical history included segmental colectomy of the sigmoid and descending colon, resulting in a Hartmann-type colostomy due to complicated diverticulitis. The patient underwent laparoscopic surgery, during which a segment of the transverse colon with a short mesocolon was identified. Due to the complete release of the colon, a colorectal anastomosis could not be performed. As an alternative to preserving the ileocecal valve and achieving a tension-free colorectal anastomosis, the patient underwent the Deloyers procedure. Discussion: The Deloyers procedure involves tension-free anastomosis between the right colon and the rectum or anus. It includes complete mobilization and a 180° counterclockwise rotation of the hepatic angle and the right colon. The right and middle colic vessels are divided, while preserving the ileocolic pedicle and the ileocecal valve, thus avoiding the need for total colectomy and ileorectal anastomosis, which may yield unsatisfactory functional outcomes. Conclusion: The Deloyers procedure represents a viable alternative to ileorectal or ileoanal anastomosis, offering satisfactory functional outcomes.

Introducción: el procedimiento de Deloyers es una técnica útil en la reconstrucción del tránsito intestinal posterior a una colectomía izquierda ampliada, colostomía tipo Hartmann o resecciones colónicas iterativas, pues asegura una anastomosis colorrectal o coloanal sin tensión. Presentación del caso: una mujer de 60 años acudió a consulta para el cierre de una colostomía, con antecedente de colectomía segmentaria del sigmoides y colon descendente derivada con colostomía tipo Hartmann por diverticulitis complicada. Fue llevada a cirugía laparoscópica, en la que se encontró un segmento de colon transverso con meso corto y al liberarse completamente no se logró realizar la anastomosis colorrectal, por lo que se decidió realizar el procedimiento de Deloyers como alternativa para conservar la válvula ileocecal y obtener la anastomosis colorrectal libre de tensión. Discusión: el procedimiento de Deloyers consiste en la unión del colon derecho y recto o ano libre de tensión después de realizar la movilización completa y rotación de 180° en sentido antihorario del ángulo hepático y el colon derecho, en el que se seccionan los vasos cólicos derecho y medio, con preservación del pedículo ileocólico y la válvula ileocecal, para evitar la necesidad de una colectomía total y una anastomosis ileorrectal, para la cual los resultados funcionales pueden ser insatisfactorios. Conclusión: el procedimiento de Deloyers es una alternativa viable a la anastomosis ileorrectal o ileoanal con resultados funcionales satisfactorios.

Uso de plasma rico en fibrina y leucocitos (PRF-L) para la prevención de fuga anastomótica en anastomosis colorrectal grapada, ensayo clínico aleatorizado

Introducción: La tasa de dehiscencia anastomótica en cirugía colorrectal se estima entre un 4% a 20%. El plasma rico en fibrina y leucocitos (PRF-L) es un concentrado plaquetario de segunda generación y su aplicación en anastomosis colorrectales en animales ha evidenciado interesantes resultados que suponen una menor tasa. El objetivo de este estudio fue evaluar la viabilidad de aplicar L-PRF en cirugía colorrectal y determinar la incidencia de fuga anastomótica después de una anastomosis colorrectal. Materiales y Métodos: El estudio tuvo lugar en el Hospital Clínico Regional de Concepción Chile, en el periodo 2018-2021. Se realizó un ensayo clínico randomizado a 1 ciego. Se incluyeron a 106 pacientes sometidos a anastomosis colorrectal termino-terminal grapada. Se formó un grupo experimental con 53 pacientes y otro control con 53 pacientes. Resultados: A todos se les realizó anastomosis termino-terminal grapada. la indicación de cirugía fue cáncer en 79% y se realizó cirugía video-laparoscópica en 46%. No hubo diferencias estadísticamente significativas en variables socio-demográficas, ni relacionadas con la cirugía. Hubo dehiscencia anastomótica en 5 pacientes (9,4%) del grupo control y 1 (1,9%) en el grupo experimental sin diferencias estadísticamente significativas (p = 0,24). Conclusiones: A pesar de que no hubo diferencias con significación estadística entre los grupos, se apreció una tendencia en favor del PRF-L. Se logró establecer la seguridad de la aplicación de PRF-L en anastomosis colorrectales.

Introduction: Anastomotic leak rate in colorectal surgery is estimated between 4 and 20 percent. Leukocyte and and platelet-rich fibrin plasma (L-PRF) is second generation platelet concentrate whose application in colorectal anastomosis in animals has shown promising results that suppose a lower leakage rate. Aim: The objective of this study was to assess the feasibility of using L-PRF in colorectal surgery and to determine the incidence of anastomotic leak after colorectal anastomosis. Methods: This study took place in Hospital Clínico Regional de Concepción Chile, between years 2018 and 2021. A randomized and one-blinded experimental design was used, that included 106 patients that underwent end-to-end stapled colorectal anastomosis, 53 of them received L-PRF during anastomosis (experimental group). Results: Surgical indication in 79% was cancer and laparoscopic procedure was performed in 46% of patients. There were no statistically significant differences in sociodemographic nor surgery related variables. Anastomotic leak occurred in 5 patients of the control group (9.4%) and 1 patient from de experimental group (1.9%), with no statistically significant differences (p = 0.24). Conclusion: Although we did not detect significant differences among both groups, we observed a tendency favoring L-PRF treatment. We were able to stablish the safety of L-PRF use in colorectal anastomosis.

Uso de stent en estenosis colorrectal benigna / Stent utilization in benign colorectal stenosis

Introducción. La estenosis colorrectal benigna hace referencia a una condición anatómica caracterizada por una disminución del diámetro de la luz intestinal distal a la válvula ileocecal, ocasionando una serie de signos y síntomas de tipo obstructivo. Es una entidad poco frecuente, secundaria en la gran mayoría de veces a la realización de anastomosis intestinales al nivel descrito. El objetivo de esta investigación fue determinar la utilidad del stentcolónico en estenosis secundaria a patología colorrectal no neoplásica. Métodos. Estudio descriptivo de una cohorte de pacientes que desarrolló estenosis colorrectal de origen benigna confirmada por colonoscopía, en 3 hospitales de alta complejidad de la ciudad de Medellín, Colombia, entre los años 2007 y 2021. Resultados. Se incluyeron 34 pacientes con diagnóstico de estenosis colorrectal de origen benigno, manejados con stents metálicos autoexpandibles. La mediana de seguimiento fue de 19 meses y se obtuvo éxito clínico en el 73,5 % de los casos. La tasa de complicación fue del 41,2 %, dada principalmente por reobstrucción y migración del stent, y en menor medida por perforación secundaria a la colocación del dispositivo. Conclusión. Los stents metálicos autoexpandibles representan una opción terapéutica en pacientes con obstrucción colorrectal, con altas tasas de mejoría clínica en pacientes con patología estenosante no maligna. Cuando la derivación por medio de estoma no es una opción, este tipo de dispositivos están asociados a altas tasas de éxito clínico y mejoría de la calidad de vida de los pacientes

Introduction. Benign colorectal stenosis refers to an anatomical condition characterized by a decrease in the diameter of the intestinal lumen distal to the ileocecal valve, which might cause a series of obstructive signs and symptoms. It is a rare entity, caused in the vast majority of cases due to intestinal anastomosis at the described level. The purpose of this study is to determine the performance of colonic stents in the management of non-malignant colorectal strictures. Methods. Descriptive study of a cohort of patients who developed a benign colorectal stenosis confirmed by colonoscopy in three high-complexity hospitals in the city of Medellín, Colombia, between 2007 and 2021. Results. Thirty-four patients diagnosed with benign colorectal stenosis managed with self-expanding metal stents were included in the study. Median follow-up was 19 months, obtaining clinical success in 73.5% of cases, with a complication rate of 41.2%, mainly due to reobstruction and migration of the stent, and to a lesser extent due to perforation secondary to device placement.Conclusion. Self-expanding metallic stents represent a therapeutic option in patients with colorectal obstruction caused by non-malignant stenosing pathology. When diversion through a stoma is not an option, this type of device is associated with high rates of clinical success and improvement in the patients' quality of life

Proteína C reactiva y su progresión en el tiempo para la detección de las fugas anastomóticas / C-reactive protein and its progression over time for the detection of anastomotic leaks

Introducción. Las fugas anastomóticas son una complicación común y crítica en cirugía gastrointestinal, por lo que su identificación y tratamiento temprano son necesarios para evitar resultados adversos. El uso convencional con un valor límite de la proteína C reactiva ha demostrado una utilidad limitada. El objetivo de este estudio fue determinar la utilidad de la medición seriada de la proteína C reactiva en la detección de fugas anastomóticas. Métodos. Revisión prospectiva de base de datos retrospectiva de pacientes sometidos a cirugía abdominal mayor con al menos una anastomosis intestinal. Se midió la proteína C reactiva al tercer y quinto día posoperatorio. Las complicaciones se categorizaron según la clasificación de Clavien-Dindo. La precisión diagnóstica fue evaluada por el área bajo la curva. Resultados. Se incluyeron 157 pacientes, el 52 % mujeres. La edad promedio fue de 63,7 años. El mayor número de cirugías correspondió a gastrectomía (36,3 %), resección anterior de recto (15,3 %) y hemicolectomía derecha (13,4 %). El 25,5 % tuvieron alguna complicación postoperatoria y el 32,5 % (n=13) presentaron fuga en la anastomosis. El aumento de la proteína C reactiva tuvo un área bajo la curva de 0,918 con un punto de corte de aumento en 1,3 mg/L, sensibilidad de 92,3 % (IC95% 78 ­ 100) y una especificidad de 92,4 % (IC95% 88 ­ 96). Conclusiones. El aumento de 1,3 mg/L en la proteína C reactiva entre el día de la cirugía y el quinto día fue un predictor preciso de fugas anastomóticas en pacientes con cirugía abdominal mayor

Introduction. Anastomotic leaks are a common and critical complication in gastrointestinal surgery. Their identification and early treatment are necessary to avoid adverse results, and conventional use with a cutoff value of C-reactive protein has shown limited utility. The objective of this study was to determine the usefulness of serial measurement of C-reactive protein in the detection of anastomotic leaks. Methods. Prospective review of a retrospective database of patients undergoing major abdominal surgery with at least one intestinal anastomosis. C-reactive protein was measured on the third and fifth postoperative days. Complications were classified according to the Clavien-Dindo classification. Diagnostic accuracy was evaluated by the area under the curve.Results. 157 patients were included, 52% were females. The average age was 63.7 years. The largest number of surgeries corresponded to gastrectomies (36.3%), anterior resection of the rectum (15.3%) and right hemicolectomies (13.4%). 25.5% had some postoperative complication and 32.5% (n=13) had anastomosis leaks. The increase in C-reactive protein had an area under the curve of 0.918 with an increase cut-off point of 1.3 mg/L, sensitivity of 92.3% (95% CI 78-100) and specificity of 92.4%. (95% CI 88-96). Conclusions. The 1.3 mg/L increase in C-reactive protein between the day of surgery and the fifth day was an accurate predictor of anastomotic leaks in patients with major abdominal surgery

Proteína C reactiva como biomarcador predictivo de fuga anastomótica en cirugía oncológica colorrectal: estudio de cohorte retrospectivo / C-reactive protein as a predictive biomarker of anastomotic leak in colorectal cancer surgery: A retrospective cohort study

Introducción. La fuga anastomótica es la complicación más grave del tratamiento quirúrgico del cáncer de colon por su alta morbimortalidad. El diagnóstico evidente, manifestado por la salida de contenido intestinal por drenajes o la herida quirúrgica, ocurre tardíamente (entre el 6º y 8º día). El objetivo de este trabajo fue estudiar la variación de los valores de la proteína C reactiva postoperatoria para hacer un diagnóstico precoz. Métodos. Estudio observacional, analítico, retrospectivo, de una cohorte de pacientes con neoplasia, en quienes se realizó cirugía oncológica con anastomosis intestinal, entre enero de 2019 y diciembre de 2021. Se midieron los valores en sangre de proteína C reactiva postoperatoria (1°, 3° y 5° días). Resultados. Se compararon 225 casos operados que no presentaron fuga con 45 casos con fuga. En los casos sin fuga, el valor de proteína C reactiva al 3º día fue de 148 mg/l y al 5º día de 71 mg/l, mientras en los casos con fuga, los valores fueron de 228,24 mg/l y 228,04 mg/l, respectivamente (p<0,05). Para un valor de 197 mg/l al 3º día la sensibilidad fue de 77 % y para un valor de 120 mg/l al 5º día la sensibilidad fue de 84 %. Conclusión. El mejor resultado de proteína C reactiva postoperatoria para detectar precozmente la fuga anastomótica se observó al 5º día. El valor de 127 mg/l tuvo la mejor sensibilidad, especificidad y valor predictivo negativo, lo cual permitiría el diagnóstico temprano y manejo oportuno de esta complicación

Introduction. Anastomotic leak is the most serious complication of surgical treatment of colon cancer due to its high morbidity and mortality. The obvious diagnosis manifested by the exit of intestinal content through drains or the operative wound, occurs late (between the 6th and 8th day). The objective of this work was to study the postoperative C-reactive protein values to make an early diagnosis. Methods. Observational, analytical, retrospective study of a cohort of patients undergoing colorectal surgery for neoplasia, between January 2019 and December 2021, who underwent oncological surgery with intestinal anastomosis and measured CRP blood values on 1st, 3rd and 5th post-operative days. Results. Two-hundred-twenty-five operated cases that did not present leaks were compared with 45 cases with leaks, with CRP values on the 3rd and 5th day of 148mg/l and 71mg/l in cases without leakage and CRP values of 228.24mg/l and 228.04 mg/l in cases with leakage on the 3rd and 5th day, respectively (p<0.05), CRP value of 197mg/l on the 3rd day has a sensitivity of 77%; CRP value of 120mg/l on the 5th day, has a sensitivity of 84%. Conclusions. The best result for CPR to early diagnosis of anastomotic leak was observed on the 5th day, having the value of 127 mg/l the best sensitivity, specificity and NPV, which would allow early diagnosis and timely management

Direct Anastomosis of Persistent Left Superior Vena Cava to Right Superior Vena Cava in a Pediatric Patient with Tetralogy of Fallot: an Alternative Technique

ABSTRACT The presence of persistent left superior vena cava to the left atrium connection without an innominate vein may give rise to technical challenges during intracardiac repair. In this report, the end-to-side anastomosis technique of the persistent left superior vena cava to the right superior vena cava is discussed in a patient with tetralogy of Fallot associated with persistent left superior vena cava draining directly into the left atrium. A successful end-to-side anastomosis between the persistent left superior vena cava and the right superior vena cava was performed and short-term anastomosis patency was documented via angiography.

Endoluminal Vacuum Therapy (EVAC) in Managing Esophagogastric Anastomosis Fistula / Terapia de vacío endoluminal (Endo-Vac) en el manejo de la fístula de anastomosis esofagogástrica

Abstract Endoluminal vacuum therapy (EVAC) is a promising alternative for the endoscopic management of gastrointestinal fistulas or perforations that do not respond to endoscopic procedures using clips and stents or are even refractory to surgical procedures. In this case report, we describe the successful endoscopic closure of an esophagogastric anastomotic fistula using EVAC, connected to a vacuum system through a probe in the cavity, which did not close with clip management given the friability and edema of the peri-wound tissue. In conclusion, it is a successful alternative to treat these complications, which are sometimes difficult to resolve.

Resumen La terapia de vacío endoluminal (Endo-Vac) es una alternativa promisoria en el manejo endoscópico de las fístulas o perforaciones gastrointestinales, que no responden a procedimientos endoscópicos cuando se utilizan técnicas como clips, stents o incluso refractarias a procedimientos quirúrgicos. En este reporte de caso describimos el cierre endoscópico exitoso de una fístula anastomótica esofagogástrica, utilizando la terapia Endo-Vac, conectada a un sistema de vacío mediante una sonda en la cavidad, que no presentó cierre inicial a manejo con clips, dada la friabilidad y el edema del tejido perilesional. Se concluye que esta es una alternativa exitosa en el cierre de estas complicaciones, que en ocasiones son de difícil resolución.

Ultrashort anisoperistaltic end-to-side ureteroureterostomy in renal transplantation / Anastomose uretero-ureteral término-lateral anisoperistáltica ultracurta no transplante renal

ABSTRACT The improvement of surgical techniques in kidney transplantation aims to reduce the incidence of post-transplant complications, contributing to the reduction of hospital stay, related costs, morbidity and mortality, in addition to improving the quality of life of patients. The choice of the best technique is influenced by several factors and the most common technique for urinary tract reconstruction in transplants is performed with implantation of the ureter of the graft in the caudal position, with the anastomosis performed in the bladder. However, the kidney pole can be inverted and the graft ureter anastomosis can be performed directly on the recipient's ureter, facilitating venous and ureteral anastomoses and reducing urological complications.

RESUMO O aprimoramento das técnicas cirúrgicas no transplante renal tem o objetivo de reduzir a incidência de complicações pós-transplante, contribuindo com a redução do tempo de internamento hospitalar, os custos relacionados, a morbidade e a mortalidade, além de melhorar a qualidade de vida dos pacientes. A escolha da melhor técnica é influenciada por diversos fatores e a técnica mais comum de reconstrução do trato urinário nos transplantes é a realizada com implante do ureter do enxerto na posição caudal, com a anastomose feita na bexiga. No entanto, pode-se inverter o polo do rim, posicionando o polo inferior cranialmente e realizar a anastomose do ureter do enxerto diretamente no ureter do receptor, facilitando a anastomose ureteral e diminuindo as complicações urológicas.