RESUMO
AIM: To assess the results of treatment for colorectal (CRA), coloanal (CAA) or ileal pouch-anal (IPAA) anastomotic stenosis (AS). METHOD: All patients operated on for AS from 1995 to 2014 were included. Success was defined as the absence of an additional surgical procedure for AS during 12 months after the last procedure and the absence of a stoma at the end of follow-up. RESULTS: Fifty consecutive patients presenting with AS after CRA (n = 16, 32%), CAA (n = 18, 36%) or IPAA (n = 16, 32%), performed for colorectal cancer (n = 28, 56%), familial adenomatous polyposis (n = 5, 10%), inflammatory bowel disease (n = 8, 16%), diverticulitis (n = 4, 8%), benign colorectal neoplasia (n = 3, 6%) or other (n = 2, 4%) underwent a total of 99 procedures including digital (n = 14, 14%), instrumental (n = 38, 38%) or endoscopic dilatation (n = 5, 5%), transanal AS stricturoplasty (n = 9, 10%), transanal circular stapler resection (n = 11, 11%) or transabdominal redo-anastomosis (n = 22, 22%). Overall the per-procedure success rate was 53% (52/99). Success rates were 36% (5/14) for digital dilatation, 40% (15/38) for instrumental dilatation, 20% (1/5) for endoscopic dilatation, 64% (7/11) for circular stapler resection, 89% (8/9) for stricturoplasty and 73% (16/22) for transabdominal redo-anastomosis. After a mean follow-up of 46 months, 42/50 (84%) patients had treatment that was considered successful. Multivariate analysis identified redo-anastomosis [OR = 5.1 (95% CI: 1.4-18.7), P = 0.003] as the only independent prognostic factor for success. CONCLUSION: AS should be managed according to a step-up strategy. Conservative procedures are associated with acceptable success rates. If these fail, transabdominal redo-anastomosis is associated with the highest probability of success.
Assuntos
Anastomose Cirúrgica , Colectomia , Doenças do Colo/cirurgia , Constrição Patológica/cirurgia , Dilatação/métodos , Complicações Pós-Operatórias/cirurgia , Proctocolectomia Restauradora , Adenoma/cirurgia , Polipose Adenomatosa do Colo/cirurgia , Adolescente , Adulto , Idoso , Canal Anal/cirurgia , Carcinoma/cirurgia , Colo/cirurgia , Neoplasias Colorretais/cirurgia , Doença Diverticular do Colo/cirurgia , Endoscopia do Sistema Digestório , Feminino , Humanos , Doenças Inflamatórias Intestinais/cirurgia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Procedimentos de Cirurgia Plástica , Reto/cirurgia , Estudos Retrospectivos , Adulto JovemRESUMO
Acute diverticulitis of the colon is a frequent pathology especially among elderly people and people of Caucasian origin. The prevalence is higher among sedentary people and in people with low-fiber diet. Its diagnosis is mainly based on computed tomography (CT) that allows guiding the therapeutic management. Over the last few years the treatment of acute diverticulitis has passably changed with in particular an evolution toward a restriction of the elective and emergency surgery indications and a reduction of the antiobiotherapy and hospitalization number. This article reviews the epidemiology, the diagnostic tools, and the management of this frequent digestive pathology.
Assuntos
Doença Diverticular do Colo/terapia , Doenças do Colo Sigmoide/terapia , Doença Aguda , Antibacterianos/uso terapêutico , Colo Sigmoide/patologia , Doença Diverticular do Colo/classificação , Doença Diverticular do Colo/diagnóstico , Drenagem , Humanos , Prevenção Secundária , Doenças do Colo Sigmoide/classificação , Doenças do Colo Sigmoide/diagnósticoAssuntos
Diverticulite/patologia , Idoso , Idoso de 80 Anos ou mais , Diverticulite/cirurgia , Diverticulite/terapia , Feminino , Humanos , MasculinoRESUMO
AIM: According to the French GRECCAR III randomized trial, full mechanical bowel preparation (MBP) for rectal surgery decreases the rate of postoperative morbidity, in particular postoperative infectious complications, but MBP is not well tolerated by the patient. The aim of the present study was to determine whether a preoperative rectal enema (RE) might be an alternative to MBP. METHODS: An analysis was performed of 96 matched cohort patients undergoing rectal resection with primary anastomosis and protective ileostomy at two different university teaching hospitals, whose rectal cancer management was comparable except for the choice of preoperative bowel preparation (MBP or RE). Prospective databases were retrospectively analysed. RESULTS: Patients were well matched for age, gender, body mass index and Charlson index. The surgical approach and cancer characteristics (level above anal verge, stage and use of neoadjuvant therapy) were comparable between the two groups. Anastomotic leakage occurred in 10% of patients having MBP and in 8% having RE (P = 1.00). Pelvic abscess formation (6% vs 2%, P = 0.63) and wound infection (8% vs 15%, P = 0.55) were also comparable. Extra-abdominal infection (13% vs 13%, P = 1.00) and non-infectious abdominal complications such as ileus and bleeding (27% and 31%, P = 0.83) were not significantly different. Overall morbidity was comparable in the two groups (50% vs 54%, P = 0.83). CONCLUSION: A simple RE before rectal surgery seems not to be associated with more postoperative infectious complications nor a higher overall morbidity than MBP.
Assuntos
Colectomia/métodos , Enema/métodos , Cuidados Pré-Operatórios/métodos , Neoplasias Retais/cirurgia , Feminino , Seguimentos , Humanos , Ileostomia , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/mortalidade , Reto , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
Anal pain is a common reason for consultation, whose etiology is varied and should not be limited to the hemorrhoidal disease. The purpose of this article is to conduct a review of the literature on anorectal pathologies most frequently encountered and make recommendations regarding their management.
Assuntos
Dor Aguda/etiologia , Dor Aguda/terapia , Canal Anal , Abscesso/diagnóstico , Abscesso/terapia , Algoritmos , Fissura Anal/diagnóstico , Fissura Anal/terapia , Hemorroidas/diagnóstico , Hemorroidas/terapia , Humanos , Prurido Anal/diagnóstico , Prurido Anal/terapiaRESUMO
Liver vascularization is known to present with several different variations. Generally, a normal vascular anatomy is reported in up to 50-80 % of cases. For this reason, a precise preoperative mapping of the hepatic vascularization prior to pancreatic surgery is essential to avoid injuries and subsequent complications. We report here a case of a young patient scheduled for Whipple procedure, who presented an arterial pattern type Michels IV, variation reported in 0.6 to 3 % in the literature. Another interesting particularity of this case was the fact that the right hepatic artery had a prepancreatic course. We think that every surgeon performing hepatopancreatic surgery should have heard of this special and rare situation.
Assuntos
Artéria Hepática/anormalidades , Pâncreas/irrigação sanguínea , Pancreaticoduodenectomia , Pancreatite/cirurgia , Adulto , Artéria Hepática/diagnóstico por imagem , Humanos , Masculino , Pâncreas/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: The severity and most appropriate treatment of diverticulitis in young patients are still controversial. The aim of this study is to compare young patients (