Modified Rosi-Cahill technique after left extended colectomy for splenic flexure advanced tumors.

Advanced splenic flexure tumors are uncommon and have a higher risk of relapse. To ensure that the resection includes the entire area of lymphatic drainage with a complete mesocolic excision (CME), a left extended colectomy is needed. In peritoneal carcinomatosis, there is often extensive involvement of the sigma and splenic flexure of the colon. In many instances, total colectomies are chosen for these patients, even when a significant portion of the colon could be preserved. The potential impact on quality of life after splenic flexure colon resection is discussed, as well as the importance of anatomical knowledge and expertise in performing this type of surgery. Overall, this work presents a modified technique that aims to improve the outcomes and quality of life for patients with splenic flexure colon cancer. Creating a tension-free anastomosis after extended left-sided colorectal resection is challenging. There is a negative impact on quality of life when an ileorectal anastomosis is created. The colorectal anastomosis performed after modified Rosi-Cahill or Deloyers' technique allows reduced small bowel bacterial overgrowth, achieves better water and sodium absorption, and altogether permits improved stool consistency. There are potential advantages of the Rosi-Cahill technique over other popular options such as Deloyers' procedure as there is no torsion of the ileocolic vessels and no mesenteric windows. A video was recorded showing a potential pitfall during Deloyers' technique resulting in the creation of a mesenteric window. The proper rotation of the colon during the modified Rosi-Cahill procedure was also filmed. Overall, this work presents a modified technique for reconstruction after left extended colectomy that aims to improve the outcomes and quality of life for patients with splenic flexure colon cancer.

Implantación de catéteres de diálisis peritoneal: Nuestra experiencia a corto y largo plazo / No disponible

Introducción: Experiencia a corto y a largo plazo en la implantación de catéteres de diálisis peritoneal y objetivos establecidos para instaurar la técnica en régimen de cirugía mayor ambulatoria(CMA).Material y métodos: Estudio retrospectivo durante ocho años. Dos grupos: catéteres tipo Tenckhoff con dos cuff y catéteres tipo Tenckhoff con dos cuff y un lastre final. Peculiaridad quirúrgica: introducción del catéter en una solución antibiótica. Las complicaciones se han dividido en corto y largo plazo en función de que aparecieran o no en la primera semana de implantación. Resultados: Causa más frecuente conocida de insuficiencia renal crónica: diabetes mellitus (9,8%). En el 33,1% (41 catéteres)no hubo ninguna complicación, y destacan el dolor a corto plazo(8,9%) y la peritonitis a largo plazo (8,1%). El 78,4% de los inicialmente implantados no precisaron ser recambiados. Conclusiones: La colocación del catéter peritoneal debe ser realizada en quirófano. La diálisis peritoneal es una técnica segura, eficaz y simple tanto para el cirujano como para el paciente. Presenta escasas complicaciones, fundamentalmente dolor y peritonitis. El catéter se recambia cuando funciona mal o fuga. No existen en la literatura estudios que reflejen la introducción del catéter en una solución antibiótica previo a su colocación. Puede implantarse en régimen de CMA (AU)

Introduction: Our short and long term experience in the implantation of peritoneal catheters is exposed in this study and whether the aims established for ambulatory surgery are fulfilled. Material and methods: An eight year retrospective study. Two groups: catheters type Tenckhoff with two cuffs and catheters type Tenckhoff with two cuffs and a ballast on the end. Surgical peculiarity: the introduction of the catheter in an antibiotic solution. The complications were divided in short and long term depending on when they appeared during the first week of implantation or not. Results: The most frequent reason for chronic renal insufficiency was: diabetes mellitus (9.8%). In 33.1% of cases (41catheters) there were no complications, and only pain on the short-term (8.9%) and peritonitis on the long-term (8.1%).78.43% of the initially implanted catheters did not need to be replaced. Conclusions: The placement of the peritoneal catheter must be done in the operating room.Peritoneal dialysis is a sure, effective and simple technique for the surgeon and for the patient. It presents few complications,mainly pain and peritonitis. The catheter is replaced when it works badly or leaks. There are no studies in the literature that reflectthe introduction of the catheter in an antibiotic solution before its placement. It can be implanted as an AS procedure (AU)

Diagnóstico y tratamiento de complicaciones biliares tras traumatismo hepático / No disponible

No disponible