Lesión intraoperatoria de nervio periférico en cirugía colorrectal. Revisión de conjunto / Intraoperative peripheral nerve injury in colorectal surgery. An update

La lesión de nervio periférico durante procedimientos de cirugía colorrectal constituye una complicación potencialmente grave a menudo infravalorada durante el postoperatorio. La posición de Trendelenburg, la colocación de topes y las abducciones de los brazos han demostrado favorecer el desarrollo de plexopatía braquial durante los procedimientos laparoscópicos. En cirugía colorrectal abierta las lesiones nerviosas son menos frecuentes, afectan preferentemente al plexo femoral y se asocian a la posición de litotomía y al uso de autorretractores. Aunque en la mayoría de los casos la recuperación es completa, el tratamiento consiste en fisioterapia para prevenir la atrofia muscular, protección de las zonas con hipoestesia y analgésicos frente al dolor neuropático. El objetivo del presente artículo es realizar una revisión de la literatura existente sobre incidencia, prevención y manejo de la lesión intraoperatoria de nervio periférico

Intraoperative peripheral nerve injury during colorectal surgery procedures is a potentially serious complication that is often underestimated. The Trendelenburg position, use of inappropriately padded armboards and excessive shoulder abduction may encourage the development of brachial plexopathy during laparoscopic procedures. In open colorectal surgery, nerve injuries are less common. It usually involves the femoral plexus associated with lithotomy position and self-retaining retractor systems. Although in most cases the recovery is mostly complete, treatment consists of physical therapy to prevent muscular atrophy, protection of hypoesthesic skin areas and analgesics for neuropathic pain. The aim of the present study is to review the incidence, prevention and management of intraoperative peripheral nerve injury

[Heterotopic gastric mucosa in the rectum: Report of a case]. / Mucosa gástrica heterotópica en el recto: reporte de un caso.

BACKGROUND: Ectopic gastric mucosa has been described in different locations of the digestive tract, but that of the rectum is the least frequent. CLINICAL CASE: The case is described of a 48 year-old woman being investigated by the gastrointestinal department due to rectal bleeding and rectal tenesmus. Colonoscopy showed a diverticular cavity 3 cm, which was reported by histology as fundic-type heterotopic gastric mucosa. Barium enema and abdominopelvic CT showed a diverticular image at level of the right posterolateral wall of the rectal ampulla. Trans-rectal diverticulectomy was performed with primary closure of the resulting mucosal defect. The surgical specimen showed areas of gastric epithelium with no signs of atypia. CONCLUSIONS: It is not known whether the origin of heterotopic gastric mucosa occurs during foetal development or is the result of abnormal regeneration under inflammatory conditions. It is usually clinically asymptomatic or presents as haematochezia, especially in cases where gastric acid is being produced. In these cases there must be an initial treatment with proton pump inhibitors, although the definitive treatment is always surgical or endoscopic excision of the mucosa.

Intraoperative peripheral nerve injury in colorectal surgery. An update.

Intraoperative peripheral nerve injury during colorectal surgery procedures is a potentially serious complication that is often underestimated. The Trendelenburg position, use of inappropriately padded armboards and excessive shoulder abduction may encourage the development of brachial plexopathy during laparoscopic procedures. In open colorectal surgery, nerve injuries are less common. It usually involves the femoral plexus associated with lithotomy position and self-retaining retractor systems. Although in most cases the recovery is mostly complete, treatment consists of physical therapy to prevent muscular atrophy, protection of hypoesthesic skin areas and analgesics for neuropathic pain. The aim of the present study is to review the incidence, prevention and management of intraoperative peripheral nerve injury.

Adenoma quístico de paratiroides: a propósito de un caso / Cystic parathyroid adenoma: report of a case

No disponible

[Splenic artery aneurysm. Report of a case]. / Aneurisma de arteria esplénica. A propósito de un caso.

BACKGROUND: The incidence of splenic artery aneurysm is not well known because they are often asymptomatic. CLINICAL CASE: The case is presented of a 40 year-old woman diagnosed with a splenic artery aneurysm. She was clinically asymptomatic. A three-dimensional angiographic study was performed. The artery embolisation was rejected, according to the results of the study; thus it was decided to perform a laparoscopic splenic-aneurysmectomy. CONCLUSIONS: Splenic artery aneurysms may present with non-specific symptoms, such as abdominal pain or anorexia. However 2-10% of aneurysms debut as spontaneous rupture. For this reason treatment is indicated in symptomatic aneurysms or those with rupture risk factors. In these cases there are different possibilities, such as therapeutic embolisation, endovascular stenting or surgery. Surgical approach varies depending on the location of the aneurysm in the splenic artery, enabling aneurysmectomy, splenic-aneurysmectomy, or aneurysm exclusion to be performed.

Factores predictores de resolución de la resistencia a la insulina con la cirugía de banda gástrica ajustable / Predictive factors of insulin resistance resolution with adjustable gastric band surgery

INTRODUCCIÓN: El objetivo del estudio ha sido evaluar factores preoperatorios relacionados con remisión de la diabetes y pérdida de peso tras cirugía de banda gástrica ajustable por vía laparoscópica. MATERIAL Y MÉTODOS: Se incluye una cohorte retrospectiva de 95 pacientes a los que se colocó banda gástrica ajustable. Se realizó un estudio preliminar descriptivo de factores pronósticos mediante el modelo de regresión logística con SPSS 17.0. Las variables independientes fueron edad, sexo, índice de masa corporal (IMC), estado de diabetes y grado de obesidad; las variables dependientes fueron proporción de peso perdido, variación del diabetes status score y porcentajes de variación en la glucemia basal y en la hemoglobina glucosilada. RESULTADOS: Las variables que presentaron relación estadísticamente significativa con los porcentajes de variación en la glucemia basal y en la hemoglobina glucosilada fueron: el grado de obesidad durante el primer año y el estado preoperatorio de diabetes respectivamente. El análisis de las necesidades de tratamiento antidiabético mediante el diabetes status score modificado señala al IMC preoperatorio, la edad y el sexo como factores predictores significativos. CONCLUSIONES: En pacientes intervenidos de cirugía con banda gástrica la pérdida de peso contribuye a mejorar la sensibilidad a insulina. Esta mejoría del metabolismo glucídico se ve influida por factores tales como el sexo, la edad, el tratamiento insulínico, el tiempo de evolución de la diabetes y el grado de obesidad preoperatorio

INTRODUCTION: The aim of the study was to evaluate preoperative factors associated with remission of diabetes and weight loss after laparoscopic gastric band surgery. MATERIAL AND METHODS: A retrospective cohort of 95 patients who had an adjustable gastric band placed were included. A preliminary descriptive study of prognostic factors was performed using the logistic regression model with SPSS 17.0. The independent variables were age, sex, body mass index (BMI), diabetes status and degree of obesity; dependent variables were the proportion of weight loss, change in diabetes status score and percent changes in fasting sugar and glycosylated hemoglobin. RESULTS: The variables that were significantly associated with the percentage of changes in fasting blood sugar and glycated hemoglobin were: the degree of obesity in the first year; preoperative and diabetes status respectively. The analysis of the need for antidiabetic treatment using the modified diabetes status score showed preoperative BMI, age and gender as significant predictors. CONCLUSIONS: In patients undergoing gastric band surgery, weight loss is the fundamental mechanism by which insulin sensitivity increases. This improvement in glucose metabolism is influenced by factors such as sex, age, insulin treatment, duration of diabetes and degree of preoperative obesity

Predictive factors of insulin resistance resolution with adjustable gastric band surgery.

INTRODUCTION: The aim of the study was to evaluate preoperative factors associated with remission of diabetes and weight loss after laparoscopic gastric band surgery. MATERIAL AND METHODS: A retrospective cohort of 95 patients who had an adjustable gastric band placed were included. A preliminary descriptive study of prognostic factors was performed using the logistic regression model with SPSS 17.0. The independent variables were age, sex, body mass index (BMI), diabetes status and degree of obesity; dependent variables were the proportion of weight loss, change in diabetes status score and percent changes in fasting sugar and glycosylated hemoglobin. RESULTS: The variables that were significantly associated with the percentage of changes in fasting blood sugar and glycated hemoglobin were: the degree of obesity in the first year; preoperative and diabetes status respectively. The analysis of the need for antidiabetic treatment using the modified diabetes status score showed preoperative BMI, age and gender as significant predictors. CONCLUSIONS: In patients undergoing gastric band surgery, weight loss is the fundamental mechanism by which insulin sensitivity increases. This improvement in glucose metabolism is influenced by factors such as sex, age, insulin treatment, duration of diabetes and degree of preoperative obesity.

New surgical approach of retrorectal cystic hamartoma using transanal minimally invasive surgery (TAMIS) / Nova abordagem cirúrgica do hamartoma cístico retrorretal usando cirurgia transanal minimamente invasiva (TAMIS)

Introduction: Tailgut cysts or cystic hamartomas are rare developmental tumors of the pre-sacral space. Their true incidence is not well known but we must think on it when we have a patient with a multicystic uncapsulated tumor at presacral space. Tailgut cysts are often asymptomatic, and in other cases present with chronic perineal pain, constipation or rectal tenesmus. They must be treated to avoid complications such as infections (perianal fistula or abscess) and malignant degenerations (usually adenocarcinoma). Case report: One patient with anal pain was diagnosed with a perianal abscess. He was operated but at the second month review a MRI revealed a multilocular lesion in the presacral suggesting the presence of a retrorectal cystic hamartoma. An elective operation was performed by endoanal surgical approach using TAMIS. En bloc resection of the cyst was achieved with safe margins. The pathology result reported retrorectal cystic hamartoma. The patient was asymptomatic with no signs of recurrence in subsequent controls. Our experience, despite being based on one case, is evidence that TAMIS (Transanal Minimally Invasive Surgery) allows a minimally invasive dissection with similar benefits as the use of TEM/TEO devices. (AU)

Introdução: Tail gut cysts ou hamartomas císticos são tumores raros de desenvolvimento do espaço pré-sacral. Sua verdadeira incidência não é bem conhecida, mas devemos pensarnele quando temos um paciente com um tumor uncapsulated multicística no espaço présacral. Hamartomas císticos são muitas vezes assintomáticas, em outros casos, apresentase com dor perineal crônica, constipação ou tenesmo retal. Eles devem ser tratados para evitar complicações, como infecções (fístula perianal ou abscesso) e degenerações malignas (geralmente adenocarcinoma). Relato de Caso: Um paciente com dor anal foi diagnosticado com um abscesso perianal. Ele foi operado, mas na revisão do segundo mês uma ressonância magnética revelou uma lesão multilocular no pré-sacral, sugerindo a presença de um hamartoma cístico retrorretal. Uma operação eletiva foi realizada por abordagem cirúrgica endoanal usando TAMIS. A resseção em bloco do cisto foi conseguido com margens seguras. O resultado do exame patológico relatou hamartoma cístico retrorretal. O paciente encontrava-se assintomático, sem sinais de recidiva em controles posteriores. A nossa experiência, apesar de ser baseado em um dos casos, as provas que TAMIS (cirurgia transanal minimamente invasiva) permite um esvaziamento minimamente invasivo com benefícios similares como o uso de dispositivos de MET/TEO. (AU)