[Colorectal anastomosis using a compression device]. / Anastomosis colorrectales por compresión utilizando el dispositivo NiTi.

BACKGROUND: The most severe complication following an intestinal anastomosis is the dehiscence with the consequent development of sepsis, fistulas, stenosis, and death. For this reason the compression anastomosis (NiTi) system was developed, with the aim of reducing these complications. MATERIAL AND METHODS: A retrospective study was conducted, from 1 June 2012 to 30 August 2014, on total of 14 patients operated on the Humanitas Hospital Medical Group Coyoacán, the ASMED, and Clínica Médica Sur. The subjects were predominantly male 65%, a mean age of 58 years, with range 30-79 years. RESULTS: A total of 14 patients were included. The indication for surgery was complicated diverticular disease Hinchey II-III (36%), and the procedures performed were: 6 (43%) left hemicolectomy with primary end to end compression anastomosis, 2 (14%) major complications (dehiscence wall and anastomosis), 1 (7%) minor complication (infection of the soft tissues). There was a mean 98ml (range 20-300ml) of intraoperative bleeding, with start of oral feeding on the second day, a mean hospital stay of 4 days (range 2-10), one patient with ileo-rectal anastomosis dehiscence presented on the 4th post-operative day, and performing anastomosis with stapling device and loop ileostomy. Stenosis developed in 7% during follow-up and was resolved with a new anastomosis stapler. CONCLUSIONS: The NiTi device is an additional alternative for colorectal anastomosis, mainly in low anastomosis, obtaining good results in this study without major complications.

Robotic versus laparoscopic adrenalectomy: a comparative study in a high-volume center.

BACKGROUND: Minimally invasive surgery has become more popular in recent years. The da Vinci robot is one of the new technologies the use of which has gained popularity in a host of different specialties. Originally used in cardiac surgery, marked increases in utilization have been seen in urology, gynecology, and thoracic surgery. Use in general surgical procedures has now become more common. The objective benefits of the robot are unclear compared to those of laparoscopy in many procedures. The aim of this study was to assess the benefits and disadvantages of robot-assisted laparoscopic surgery for adrenalectomy in a high-volume center compared to routine laparoscopic techniques. METHODS: We conducted a retrospective study including consecutive patients who underwent minimally invasive adrenalectomy in a tertiary referral center at the University of Alabama Birmingham. Demographic, clinical, histopathological, and surgical variables were recorded. Patients were divided in two groups: laparoscopic adrenalectomy (LA) and robot-assisted adrenalectomy (RA). Groups were compared using the χ(2) test for categorical variables and Student's t-test for continuous variables. Significance was considered p < 0.05. RESULTS: Sixty patients were included, with 30 patients in each group. There were no significant differences between groups with respect to demographic variables except there were more pheochromocytoma patients in the LA group than in the RA group (13/30 vs. 5/30, respectively; p = 0.02). This study demonstrated increased operative time in the robotic group (190 ± 33 min) versus the laparoscopic group (160 ± 41 min) (p = 0.003). There was a trend for less blood loss in RA versus LA (30 ± 5 ml vs. 55 ± 74 ml; p = 0.07). There was no mortality. Morbidity and length of hospital stay were similar for both groups. CONCLUSIONS: Robotic adrenalectomy is as safe and technically feasible as laparoscopic adrenalectomy. Subjective benefits for the surgeon with robot-assisted surgery include three-dimensional operative view, ergonomically comfortable position, and elimination of the surgeon's tremor. The operating time is significantly longer but patient outcomes are similar to those of the laparoscopic technique.

Demographic factors, outcomes, and complications in abdominal contouring surgery after massive weight loss in a developing country.

Few reports about body contouring surgery after massive weight loss (MWL) have been produced in the developing countries. As Mexico is considered a developing country, we performed a retrospective analysis of medical records of patients who underwent this type of surgery to evaluate their demographic characteristics as well as their outcomes and complications. Results from 684 patients with MWL, 69 (10%) had abdominoplasty; the type of abdominoplasty influenced the operative time, bleeding, and complications (P < 0.05); the body mass index influenced the weight of resected tissue (P < 0.000) and hospital stay (P < 0.020), but did not affect the type of abdominoplasty performed, surgical time, complications, reoperation, or transfusion rates. In contrast with the developed countries, in these procedures, operating time was higher and the patients had more surgical bleeding with higher rates of transfusion and a longer hospital stay, but with the same clinical results and percentage of complications.