Parastomal hernia prevention with an intraperitoneal prophylactic 3D-funnel mesh: review of the technique and middle-term results.

PURPOSE: Parastomal hernia (PH) stands out as a prevalent complication following end colostomies, significantly affecting patients' quality of life. Various surgical strategies, predominantly involving prophylactic mesh deployment, have been explored with variable outcomes. This study details our experience and mid-term outcomes utilizing a funnel-shaped mesh. METHODS: A single-center, prospective, non-randomized, observational study examined consecutive patients undergoing colorectal surgery with end colostomy, incorporating a 3D-funnel mesh from January 2019 to December 2021 (PM group). A historical cohort of patients with end colostomy without prophylactic mesh served as the comparison (C group). Postoperative morbidity within 30 days was documented, and clinical examinations and radiological tests were employed for parastomal hernia diagnosis during follow-up. RESULTS: Seventy-two patients participated, with thirty-four in the PM group and thirty-eight in the C group. The PM group experienced 16 postoperative complications, unrelated to the mesh, while the C group recorded 20 complications (p = 0.672). Median follow-up was 22.06 months for the PM group and 63.18 months for the C group. The PM group exhibited a lower parastomal hernia incidence during follow-up (8.8%) compared to the C group(68.4%) (p < 0.001). CONCLUSION: Prophylactic use of a 3D-funnel mesh appears effective in reducing parastomal hernia incidence in the short and mid-term, without an associated increase in postoperative morbidity.

Estudio comparativo entre vías de acceso de implantación de Port-A-Cath* / Comparative study of access routes for Port-A-Cath(R) implantation

Introducción: Ha habido un aumento en la implantación de reservorios subcutáneos en los últimos años. El objetivo de este estudio es comparar las técnicas de punción venosa (PV) frente a la disección venosa (DV). Métodos: Estudio de cohortes retrospectivo. Incluyó a pacientes que requirieron un Port-A-Cath*. Se dividió a los pacientes en 2grupos: PV y DV. Los pacientes eran mayores de 18 años, requerían tratamiento intravenoso continuado, sin restricciones de patología. Se excluyó a quienes habían sido portadores de un reservorio previo y pacientes pediátricos. La elección de la técnica se basó en preferencias del cirujano. Se analizaron los parámetros clínicos de edad, sexo, ASA, IMC, motivo de colocación y lateralidad, y los datos referidos a las complicaciones y la tasa de retirada en cada uno de los grupos. El seguimiento medio fue de 2 años. Resultados: Fueron incluidos 386 pacientes durante 5 años: 228 en el grupo DV y 155 en el grupo PV. En 3 casos la técnica no quedó registrada. No hubo diferencias entre ambos grupos en edad, sexo, ASA, IMC y motivo de implantación (p > 0,05). La DV presentó menor cifra de complicaciones y se observó un mayor recambio y retirada de catéter en PV. A pesar de ello, no hubo diferencias estadísticamente significativas (p = 0,113). Conclusiones: Tanto la DV como la PV son técnicas seguras y eficaces. En nuestra experiencia, la DV presentó mejores resultados intraoperatorios y a largo plazo. Se recomienda realizar más estudios para discernir la técnica a utilizar con mayor seguridad

Introduction: There has been an increase in the implantation of subcutaneous reservoirs in recent years. The objective of this study was to compare puncture techniques against venous dissection. Methods: This retrospective cohort study included patients who required a Port-a-Cath and were divided into two groups: venous puncture (PV) and venous dissection (DV). Patients were over 18 years of age, requiring continued intravenous treatment, with no restriction of pathology. Patients with a previous reservoir and < 18 years old were excluded. The choice of the technique was based on the surgeon's preferences. We analyzed the clinical parameters of age, sex, ASA, BMI, reason for placement and laterality, and data related to the complications and withdrawal rate in each of the groups. Results: 386 patients were included for 5 years: 228 DV group and 155 PV group. In three cases, the technique was not documented. There were no differences between the two groups with respect to age, sex, ASA, BMI and reason for implantation (p > 0.05). The average follow-up was two years. The DV group was found to have a lower number of complications, while the PV group had an increased incidence of catheter replacement and removal. However, these differences were not statistically significant (p = 0.113). Conclusions: Both DV and PV are safe and effective techniques. In our experience, DV presented better intraoperative and long-term results. Further studies are recommended to discern which technique to use more safely

Comparative study of access routes for Port-A-Cath® implantation. / Estudio comparativo entre vías de acceso de implantación de Port-A-Cath.

INTRODUCTION: There has been an increase in the implantation of subcutaneous reservoirs in recent years. The objective of this study was to compare puncture techniques against venous dissection. METHODS: This retrospective cohort study included patients who required a Port-a-Cath and were divided into two groups: venous puncture (PV) and venous dissection (DV). Patients were over 18 years of age, requiring continued intravenous treatment, with no restriction of pathology. Patients with a previous reservoir and <18 years old were excluded. The choice of the technique was based on the surgeon's preferences. We analyzed the clinical parameters of age, sex, ASA, BMI, reason for placement and laterality, and data related to the complications and withdrawal rate in each of the groups. RESULTS: 386 patients were included for 5 years: 228 DV group and 155 PV group. In three cases, the technique was not documented. There were no differences between the two groups with respect to age, sex, ASA, BMI and reason for implantation (p>0.05). The average follow-up was two years. The DV group was found to have a lower number of complications, while the PV group had an increased incidence of catheter replacement and removal. However, these differences were not statistically significant (p=0.113). CONCLUSIONS: Both DV and PV are safe and effective techniques. In our experience, DV presented better intraoperative and long-term results. Further studies are recommended to discern which technique to use more safely.

Resultados de morbimortalidad en cáncer colorrectal en paciente quirúrgico frágil. Implementación de un Área de Atención al Paciente Quirúrgico Complejo / Colorectal carcinoma in the frail surgical patient. Implementation of a Work Area focused on the Complex Surgical Patient improves postoperative outcome

INTRODUCCIÓN: La edad avanzada y la presencia de comorbilidades repercuten en la morbimortalidad postoperatoria del paciente quirúrgico frágil. El objetivo de este estudio es valorar los resultados de morbimortalidad tras cirugía por cáncer colorrectal en el paciente quirúrgico frágil tras la implementación de un Área de Atención al paciente Quirúrgico Complejo (AAPQC). MÉTODOS: Estudio retrospectivo con recogida prospectiva de datos. Un total de 91 pacientes consecutivos considerados como frágiles (ASAIV o ASAIII con Barthel < 80 i/o Pfeiffer>3) fueron intervenidos entre 2013 y 2015 con diagnóstico de cáncer colorrectal con intención curativa. Grupo I (AAPQC): 35 pacientes incluidos en AAPQC durante 2015. Grupo II (No AAPQC): 56 pacientes intervenidos entre 2013 y 2014 previa implementación del AAPQC. Se analizó homogeneidad de grupos, complicaciones, estancia media, mortalidad, reintervenciones, reingresos y costes en función del GRD. RESULTADOS: No se encontraron diferencias significativas en edad, sexo, ASA, índex de masa corporal, estadio tumoral y tipo de intervención quirúrgica entre los dos grupos. Las complicaciones mayores (Clavien-DindoIII-IV) (11,4% vs. 28,5%, p = 0,041), la estancia media (12,6 ± 6 días vs. 15,2 ± 6 días, p = 0,043), los reingresos (11,4% vs. 28,3%, p = 0,041) y el peso específico del episodio (3,29 ± 1 vs 4,3 ± 1, p = 0,008) fueron significativamente menores en el grupo AAPQC. No hubo diferencias en re intervenciones (6,2% vs. 5,3%) ni mortalidad (6,2% vs 7,1%). El 96,9% de pacientes del grupo I manifestó una atención y calidad de vida satisfactoria. CONCLUSIONES: La implementación de una AAPQC en pacientes frágiles que deben ser intervenidos de cáncer colorrectal comporta una reducción de las complicaciones, estancia y reingresos, y es una medida coste-efectiva

INTRODUCTION: Advanced age and comorbidity impact on post-operative morbi-mortality in the frail surgical patient. The aim of this study is to assess the impact of a comprehensive, multidisciplinary and individualized care delivered to the frail patient by implementation of a Work Area focused on the Complex Surgical Patient (CSPA). METHODS: Retrospective study with prospective data collection. Ninety one consecutive patients, classified as frail (ASAIII or IV, Barthel<80 and/or Pfeiffer>3) underwent curative radical surgery for colorectal carcinoma between 2013 and 2015. GroupI: 35 patients optimized by the CSPA during 2015. Group II: 56 No-CSPA patients, treated prior to CSPA implementation, during 2014-2015. Group homogeneity, complication rate, length of stay, reoperations, readmissions, costs and overall mortality were analyzed and adjusted by Diagnosis-Related Group (DRG). RESULTS: There were no statistically significant differences in term of age, gender, ASA classification, body mass index, tumor staging and type of surgical intervention between the two groups. Major complications (Clavien-DindoIII-IV) (12.5% vs. 28.5%, P = .04), hospital stay (12.6 ± 6 days vs. 15.2 ± 6 days, P = 0.041), readmissions (12.5% vs. 28.3%, P < 0.041), and patient episode cost weighted according to DRG (3.29 ± 1 vs. 4.3 ± 1, P = 0.008) were statistically inferior in Group CSPA. There were no differrences in reoperations (6.2% vs. 5.3%) or mortality (6.2% vs. 7.1%). 96.9% of patients of Group I manifested having received a satisfactory attention and quality of life. CONCLUSIONS: Implementation of a CSPA, delivering surgical care to frail colorectal cancer patients, involves a reduction of complications, length of stay and readmissions, and is a cost-effective arrangement

Colorectal carcinoma in the frail surgical patient. Implementation of a Work Area focused on the Complex Surgical Patient improves postoperative outcome. / Resultados de morbimortalidad en cáncer colorrectal en paciente quirúrgico frágil. Implementación de un Área de Atención al Paciente Quirúrgico Complejo.

INTRODUCTION: Advanced age and comorbidity impact on post-operative morbi-mortality in the frail surgical patient. The aim of this study is to assess the impact of a comprehensive, multidisciplinary and individualized care delivered to the frail patient by implementation of a Work Area focused on the Complex Surgical Patient (CSPA). METHODS: Retrospective study with prospective data collection. Ninety one consecutive patients, classified as frail (ASAIII or IV, Barthel<80 and/or Pfeiffer>3) underwent curative radical surgery for colorectal carcinoma between 2013 and 2015. GroupI: 35 patients optimized by the CSPA during 2015. GroupII: 56 No-CSPA patients, treated prior to CSPA implementation, during 2014-2015. Group homogeneity, complication rate, length of stay, reoperations, readmissions, costs and overall mortality were analyzed and adjusted by Diagnosis-Related Group (DRG). RESULTS: There were no statistically significant differences in term of age, gender, ASA classification, body mass index, tumor staging and type of surgical intervention between the two groups. Major complications (Clavien-DindoIII-IV) (12.5% vs. 28.5%, P=.04), hospital stay (12.6±6days vs. 15.2±6days, P=0.041), readmissions (12.5% vs. 28.3%, P<0.041), and patient episode cost weighted according to DRG (3.29±1 vs. 4.3±1, P=0.008) were statistically inferior in Group CSPA. There were no differrences in reoperations (6.2% vs. 5.3%) or mortality (6.2% vs. 7.1%). 96.9% of patients of GroupI manifested having received a satisfactory attention and quality of life. CONCLUSIONS: Implementation of a CSPA, delivering surgical care to frail colorectal cancer patients, involves a reduction of complications, length of stay and readmissions, and is a cost-effective arrangement.

Tratamiento neoadyuvante con imatinib de un tumor gigante del estroma gastrointestinal rectal / Neoadjuvant treatment with imatinib for a giant tumor of the rectal gastrointestinal stroma

Alrededor de 5 % de los tumores del estroma gastrointestinal (GIST) se localizan en el recto. Cuando se encuentran localmente avanzados, el tratamiento neoadyuvante con imatinib ha demostrado buenos resultados para reducir el volumen de este tipo de tumores. Se presenta el caso de un paciente con diagnóstico de GIST rectal gigante, al que se le administró neoadyuvancia con imatinib y, posteriormente, se sometió a resección anterior baja con anastomosis coloanal. Es imprescindible que la evaluación y el tratamiento sean multidisciplinarios en los GIST rectales, para tratar de obtener los mejores resultados ante esta entidad tan poco frecuente, poder evitar la comorbilidad asociada y practicar cirugías menos agresivas tras una buena reacción terapéutica al imatinib

Less than 5% of gastrointestinal stromal tumors (GIST) are located at the rectum. When these tumors are locally advanced, neoadjuvant therapy with imatinib has shown good results, reducing its volume. We present the case of a patient with a giant rectal GIST tumor, who underwent neoadjuvant imatinib therapy, and posterior low anterior resection with coloanal anastomosis. In rectal GIST tumors it is essential the multidisciplinary evaluation and treatment, in order to obtain the best possible results in this rare entity. After a good response to the treatment with imatinib, aggressive surgeries can be avoided, along with the associated morbidity that comes with it