RESUMO
RESUMEN Introducción: son múltiples las complicaciones de la derivación ventrículo peritoneal, entre ellas la infección de la derivación, obstrucción y desconexión, son las más frecuentes. Por otro lado, el pseudoquiste de líquido cefalorraquídeo, hernia inguinal, hidrocele y perforación intestinal, son ocasionales. Objetivo: describir la cirugía laparoscópica como método de tratamiento de la extrusión anal del catéter como complicación de la derivación ventrículo peritoneal. Presentación del caso: se presenta un caso de un paciente neurointervenido a causa de un colesteatoma del clivus, al cual se le realiza una derivación ventrículo peritoneal debido a una hidrocefalia secundaria a compresión del suelo del tercer ventrículo, por el crecimiento supraselar de la lesión. Acude al servicio de Neurocirugía a causa de extrusión del extremo distal del catéter a través del ano. Después de confirmar esta complicación a través de colonoscopia, se realizó cirugía laparoscópica para retirar el extremo extruido. Conclusiones: el paciente evolucionó sin complicaciones posquirúrgicas y dado de alta hospitalaria. La cirugía por mínimo acceso ofrece ventajas con respecto a la laparotomía en la resolución de esta complicación.
ABSTRACT Introduction: there are multiple complications of peritoneal ventricle shunt, including infection of the shunt, obstruction and disconnection, are the most frequent. On the other hand, cerebrospinal fluid pseudo cyst, inguinal hernia, hydrocele and intestinal perforation are rare. Objective: to describe a laparoscopic surgery as a method of treatment of anal catheter extrusion as a complication of peritoneal ventricular bypass. Case report: a patient with a neurosurgery because of a cholesteatoma of the clivus, to which a peritoneal ventricle derivation is made due to a hydrocephalus secondary to the compression of the floor of the third ventricle, by the suprasellar growth of the lesion. The patient came to the Neurosurgery Service because of extrusion of the distal end of the catheter through the anus. After confirming this complication through colonoscopy, laparoscopic surgery was performed to remove the extruded end. Conclusions: the patient evolved without post-surgical complications and was discharged from the hospital. Minimal access surgery offers advantages over laparotomy in the resolution this complication.
RESUMO
BACKGROUND: Transanal endoscopic operation (TEO) may be the technique of choice for the treatment of rectal lesions, both benign and selected malignant lesions, with similar survival rates to conventional surgery but with lower morbidity. METHODS: In this article we present a series of 70 patients operated on with this procedure (TEO) in our center. The indications were benign rectal lesions and malignant lesions at early stages (T1) 86%. The surgical procedure was performed with the the transanal endoscopic operation platform (TEO; Karl Storz, Tüttlingen, Germany) and ultrasonic scalpel (Harmonic scalpel, Ethicon Endo-surgery, ). RESULTS: The indication in 43 patients was a benign lesion (adenoma), in the other 27 the diagnosis was adenocarcinoma. After the resection, 61% of the series had a malignant lesion in the pathology report: 13 patients of the 43 with a benign lesion initially had a malignant lesion in the pathology report. Postoperative morbidity was 36%, Clavien III (5,7%). 3 patients (4%) needed emergency surgery. All of the benign lesions were completely excised, but 7 malignant lesions had resection margin involvement The median follow-up time was 26,4 months (range, 1-71 months), the overall recurrence for benign tumors was 9%, 8% for malignant pT1 and 12,5% for malignant pT2. Early salvage surgery was performed on 8 patients. CONCLUSIONS: TEO allows us to excise benign rectal lesions that could not be excised with a conventional approach (endoscopic or transanal resection) with a low morbidity rate. TEO can be used for malignant rectal tumors in early stages (pT1) with pathological confirmation.
