Feasibility of quantitative analysis of colonic perfusion using indocyanine green to prevent anastomotic leak in colorectal surgery.

BACKGROUND: The aim of this study was to quantify Fluorescence angiography with indocyanine green (ICG) in colorectal cancer anastomosis, determine influential factors in its temporary intensity and pattern, assessing the ability to predict the AL, and setting the cut-off levels to establish high- or low-risk groups. METHODS: Retrospective analysis of prospectively managed database, including 70 patients who underwent elective surgery for colorectal cancer in which performing a primary anastomosis was in primary plan. In all of them, ICG fluorescence angiography was performed as usual clinical practice with VisionSense™ VS Iridium (Medtronic, Mansfield, MA, USA), in Elevision™ IR Platform (Medtronic, Mansfield, MA, USA). Parameters measured at real time or calculated were T0, Tmax, ∆T, Fmax, %pos, Fpos, and Slope. RESULTS: 70 patients were included, 69 anastomosis were performed and one end colostomy. Arterial hypertension demonstrated higher Fmax, as well as the location of the anastomosis (the nearest to rectum, the most intensity detected). A statistical relationship was found between AL and the lower Fpos and Slope. The decision of changing the subjectively decided point of division did not demonstrate statistical difference on the further development of AL. All parameters were analyzed to detect the cut-off related with AL. Only in case of Fpos lower than 158.3 U and Slope lower than 13.1 U/s p-value were significant. The most valuable diagnostic parameter after risk stratification was the Negative Predictive Value. CONCLUSION: Quantitative analysis of ICG fluorescence in colorectal surgery is safe and feasible to stratify risk of AL. Hypertension and location of anastomosis influence the intensity of fluorescence at the point of section. A change of division place should be considered to avoid AL related to vascular reasons when intensities of fluorescence at the point of section is lower than 169 U or slopes lower than 14.4 U/s.

Evolución del abordaje quirúrgico de la colecistitis aguda en una unidad de cirugía de urgencias / Development of the surgical approach to acute cholecystitis in an emergency surgical unit

Objetivo La aplicación de la técnica laparoscópica en la colecistitis aguda es aún hoy un tema controvertido. El objetivo del estudio es valorar la aplicabilidad, seguridad, beneficios y complicaciones del abordaje laparoscópico en pacientes con colecistitis aguda, así como la evolución y desarrollo de dicha vía en la unidad de cirugía de urgencias de un hospital de tercer nivel, en comparación con la laparotómica. Material y método El estudio consta de 354 pacientes con cuadros de colecistitis aguda intervenidos por vía abierta o laparoscópica desde 2006 a 2009.ResultadosSe han intervenido 253 pacientes por vía laparoscópica, 101 por vía abierta, apreciándose un predominio del sexo masculino (57,67%) y una edad media de 62,83 años. El número de colecistectomía laparoscópica ha pasado del 60% en el 2006, al 79% en 2009. La estancia media (englobando complicadas y no complicadas) hablan a favor del abordaje laparoscópico frente al abierto (mostrando una diferencia de aproximadamente 6 al día). Las complicaciones postoperatorias a lo largo de estos cuatro años en la vía laparoscópica han experimentado un descenso, pasando de un 21,42 a un 11,3%. Las complicaciones locales y globales se correlacionaron significativamente con el tiempo transcurrido entre el inicio de los síntomas agudos y la cirugía, así como con el estado anatomopatológico de la vesícula biliar. Conclusiones El abordaje laparoscópico va adquiriendo un papel cada vez más primordial en el tratamiento de esta dolencia, convirtiéndose en nuestro hospital en la principal opción quirúrgica (AU)

Objective The application of the laparoscopic technique in acute cholecystitis is still subject to controversy. The aim of this study is to asses the applicability, safety, benefits and complications of the laparoscopic approach in patients with acute cholecystitis, as well as the development of this technique in the emergency surgery department of a tertiary hospital, compared to laparotomy. Material and method The study consisted of 354 patients with acute cholecystitis syndromes operated either by open or laparoscopic surgery, during the years 2006 to 2009.ResultsThe laparoscopic method was used in 253 patients, and 101 by the open route, with the slight majority being male (57.67%) and with a mean age of 62.83 years. The number of laparoscopic cholecystectomies increased from 60% in 2006, to 79% in 2009. The mean hospital stay (including those with and without complications) was shorter using the laparoscopic approach, compared to open surgery (showing a difference of approximately 6 days). The postoperative complications in laparoscopy during the four years studied decreased from 21.42 to 11.3%. The local and general complications were significantly associated with time since the start of the acute symptoms and the surgery, as well as the histopathological state of the gall bladder. Conclusions The laparoscopic approach continues to play an increasing role in the treatment of this disease, becoming the main surgical option in our hospital (AU)