Clinical results after external reinforcement of colorectal anastomosis: a systematic review.

OBJECTIVE: The aim of this review is to describe and assess the existing methods to cover colorectal anastomoses with biomaterials and their clinical impact in reducing anastomotic leakage (AL). SUMMARY BACKGROUND DATA: The most serious complication in colorectal surgery is AL. Despite improvements in its diagnosis and management, AL remains an unresolved issue. To prevent its appearance and clinical consequences, different external reinforcement techniques with synthetic or biomaterials have been described. METHODS: A systematic review search of the available literature until June 2022 was performed, looking for all literature regarding external reinforcement of colonic or colorectal anastomoses. After the review process, a classification of materials was proposed into solid and liquid materials, and an assessment of their clinical impact was performed. The study protocol has been registered at PROSPERO and has been reported in the line with PRISMA and AMSTAR Guidelines 11,12 . RESULTS: Ninety-seven articles that fulfilled inclusion criteria, were identified and revised. Overall, 18 of the selected articles focused on human clinical trials and 79 on animal models. Only fibrin sealants, collagen patches, and omentoplasty have shown positive results in humans. CONCLUSIONS: Fibrin sealants, collagen patches, and omentoplasty are, so far, the most studied biomaterials. However, further studies are required to confirm these findings before definite recommendations can be made.

Early and late anastomotic leak after colorectal surgery: A systematic review of the literature / Dehiscencia de anastomosis temprana y tardía en cirugía colorrectal: revisión sistemática de la literatura

The aim of this study was to review and to assess the quality of the scientific articles regarding early and late anastomotic leak (AL) after colorectal surgery and their risk factors.An electronic systematic search for articles on Colorectal Surgery, AL and its timing was undertaken using the MEDLINE database via PubMed, Cochrane and Embase. The selected articles were thoroughly reviewed and assessed for methodological quality using a validated methodology quality score (MINCIR score). This review was registered in the PROSPERO registry under ID: CRD42022303012. 9 articles were finally reviewed in relation to the topic of early and late anastomotic leak.There is a lack of consensus regarding the exact cut-off in time to define early and late anastomotic leak, but it is clear that they are two differentiated entities. The first, occurring in relation to technical factors; whereas the latter, is related to impaired healing. (AU)

El objetivo de este estudio fue revisar y evaluar la calidad de los artículos científicos sobre la dehiscència anastomótica temprana y tardía después de cirugía colorrectal y sus factores de riesgo.Se realizó una búsqueda sistemática electrónica de artículos sobre Cirugía colorrectal, dehiscència de anastomoiis colorectal utilizando la base de datos MEDLINE a través de PubMed, Cochrane y Embase. La calidad metodológica de los artículos seleccionados se revisó minuciosamente y se evaluó mediante una puntuación de calidad metodológica validada (puntuación MINCIR). Este estudio fue registrado en PROSPERO con el ID: CRD42022303012. Despues de una seleccion basada en los criterios de búsqueda, finalmente se revisaron 9 artículos en relación al tema la revisión.Se pudo observar que existe una falta de consenso en cuanto al tiempo de corte exacto para definir la fuga anastomótica temprana y tardía, pero está claro que son dos entidades diferenciadas. La primera, ocurriendo en relación a factores técnicos; mientras que la segunda situación clinica se relaciona con una cicatrización alterada. (AU)

Early and late anastomotic leak after colorectal surgery: A systematic review of the literature / Dehiscencia de anastomosis temprana y tardía en cirugía colorrectal: revisión sistemática de la literatura

The aim of this study was to review and to assess the quality of the scientific articles regarding early and late anastomotic leak (AL) after colorectal surgery and their risk factors.An electronic systematic search for articles on Colorectal Surgery, AL and its timing was undertaken using the MEDLINE database via PubMed, Cochrane and Embase. The selected articles were thoroughly reviewed and assessed for methodological quality using a validated methodology quality score (MINCIR score). This review was registered in the PROSPERO registry under ID: CRD42022303012. 9 articles were finally reviewed in relation to the topic of early and late anastomotic leak.There is a lack of consensus regarding the exact cut-off in time to define early and late anastomotic leak, but it is clear that they are two differentiated entities. The first, occurring in relation to technical factors; whereas the latter, is related to impaired healing. (AU)

El objetivo de este estudio fue revisar y evaluar la calidad de los artículos científicos sobre la dehiscència anastomótica temprana y tardía después de cirugía colorrectal y sus factores de riesgo.Se realizó una búsqueda sistemática electrónica de artículos sobre Cirugía colorrectal, dehiscència de anastomoiis colorectal utilizando la base de datos MEDLINE a través de PubMed, Cochrane y Embase. La calidad metodológica de los artículos seleccionados se revisó minuciosamente y se evaluó mediante una puntuación de calidad metodológica validada (puntuación MINCIR). Este estudio fue registrado en PROSPERO con el ID: CRD42022303012. Despues de una seleccion basada en los criterios de búsqueda, finalmente se revisaron 9 artículos en relación al tema la revisión.Se pudo observar que existe una falta de consenso en cuanto al tiempo de corte exacto para definir la fuga anastomótica temprana y tardía, pero está claro que son dos entidades diferenciadas. La primera, ocurriendo en relación a factores técnicos; mientras que la segunda situación clinica se relaciona con una cicatrización alterada. (AU)

Pneumoendoscopic single port approach to breast cancer. How we do it?

Endoscopic procedures have not become the gold standard in breast surgery. In order to improve today's outcomes we have developed a pilot study in the Breast Pathology Unit of Hospital Germans Trias i Pujol. A surgical procedure was performed creating a pneumoendoscopic cavity by using a Single Incision Laparoscopic Surgery (Single port) approach with a follow up of four years. Four patients underwent pneumoendoscopic single-port breast surgery receiving skin-sparing quadrantectomy and axillary surgery requiring lymphadenectomy in all of them. All patients had immediate reconstruction with a Latisimus Dorsi flap. No perioperative complications appeared. Mean operative time was 290 min (range 240-315 min) and mean hospital stay was 3,2 days. Surgical margins of all cases were pathologically negative and all patients were disease free after four years of monitoring. All patients were satisfied with the cosmetic outcome in the immediate postoperative and during the follow up. Although all innovative techniques generate hesitation on their beginnings and are liable to improve, we believe that pneumoendoscopic single-port breast surgery can be suitable for breast cancer, offering better cosmetic outcomes with oncological safety.

Compresión esofágica por divertículo de Zenker gigante / Esophageal compression by giant Zenker's diverticulum

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