RESUMO
Data continue to grow regarding the safety and technical feasibility of laparoscopically assisted total mesorectal excision (TME). As this minimally invasive alternative to open colonic resection becomes more popular, it is inevitable that information on the benefits and complications associated with it will continue to expand. Portal vein thrombosis (PVT) has been reported after a variety of laparoscopic procedures. We report a case of superior mesenteric, splenic and portal vein thrombosis following laparoscopically assisted TME. To our knowledge, this complication of laparoscopic TME has not been previously reported in the literature. PVT should be ruled out in patients who present with vague abdominal symptoms. The course of this complication, while potentially devastating, is usually benign and responds well to lysis and/or anticoagulation.
Assuntos
Adenocarcinoma/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Veia Porta , Neoplasias Retais/cirurgia , Trombose Venosa/etiologia , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico , Trombose Venosa/diagnóstico por imagemRESUMO
In this work we report the results of 27 patients who underwent a second surgical operation for local disease recurrence after colorectal surgery for cancer. We describe the different intervention we performed and for everyone of them we analyze intraoperative mortality and morbidity, long term survival and quality of life related.
Assuntos
Recidiva Local de Neoplasia/cirurgia , Neoplasias Retais/cirurgia , HumanosRESUMO
INTRODUCTION: The goal in the treatment of rectal cancer is the recovery of the disease with the best fecal continence and quality of life. The Authors compared quality of life and manometric results in patients treated with neo-adjuvant chemotherapy and rectal low anterior resection (LRA). METHODS: From January 1998 to March 2002 50 patients with advanced (T3-T4) rectal cancer underwent neo-adjuvant chemotherapy. Subsequently 41 of them underwent LRA with colon pouch (19) or without the pouch (22). After few months the quality of life was evaluated through a questionnaire. Later they underwent manometric evaluation measuring resting, squeeze and rectal compliance. RESULTS: The manometric results and the questionnaire scores agreed in 75% of patients. In detail, patients with hypotonic sphincter had a better (one could say good) quality of life if a LAR with pouch had been performed respect to the patients without pouch. CONCLUSION: Performing LAR with colon pouch after neoadjuvant chemotherapy in patients with hypotonic sphincter improves quality of life. Preoperative anorectal manometry could select patient who would benefit from pouch construction.
Assuntos
Bolsas Cólicas , Manometria , Qualidade de Vida , Neoplasias Retais/fisiopatologia , Neoplasias Retais/cirurgia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Feminino , Humanos , Masculino , Terapia Neoadjuvante , Valor Preditivo dos Testes , Dosagem Radioterapêutica , Radioterapia Adjuvante , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/radioterapia , Inquéritos e Questionários , Resultado do TratamentoRESUMO
The Authors present a case of congenital dilatation of the common bile duct in adult life, selecting this lesion from the cystic dilatations of biliary tract group. The type I of biliary tract cystic dilatations is, in fact, considered a clinical-pathological situation apart, that, because of his frequence and his peculiar characteristics especially present in the adult, puts particular problems regarding his arrangement an treatment. The most recent aspects of etiophatogenetic and therapeutic problems of this lesion are treated. The increased risk of neoplastic degeneration in the adult, the recognition of an anomalous pancreaticobiliary duct junction as etiophatogenetic fondamental cause and the necessity of a radical exeretic treatment in in opposition to the old therapheutic orientations are especi-5ally considered.
Assuntos
Ducto Colédoco/embriologia , Ducto Colédoco/patologia , Colangiopancreatografia Retrógrada Endoscópica , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/cirurgia , Dilatação Patológica/congênito , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The Authors report their experience, referred to the last 10 years (1980-1989), concerning 169 cases of anterior resection of the rectum. Manual and mechanical anastomoses were performed in 83 and 86 cases, respectively. Immediate and long-term complications are evaluated considering the type of anastomosis used, while results are correlated to the stage of the tumor.