Evaluación de factores de riesgo asociados a dehiscencia anastomótica en cirugía colorrectal: análisis multivariado de 748 pacientes / Evaluation of the risk factors associated with anastomotic dehiscence in colorectal surgery: multivariate analysis of 748 pacients

INTRODUCCIÓN: La dehiscencia anastomótica (DA) es una complicación severa en cirugía colorrectal con una incidencia que oscila entre 2 y 19%. La literatura internacional muestra numerosos estudios sobre la identificación de factores de riesgo (FR), mientras que en la nacional existen solo dos series que analizan esta complicación. OBJETIVO: Realizar una caracterización descriptiva de resultados institucionales y establecer la tasa de DA, sus factores de riesgo asociados y la mortalidad. MATERIALES Y MÉTODO: Serie de casos no concurrente, cuya muestra son pacientes consecutivos intervenidos de patología colorrectal con anastomosis primaria con o sin ostoma derivativo entre los años 2004 y 2016. Se realiza modelo de regresión logística univariable y multivariable. RESULTADOS: Se obtuvieron 748 pacientes, 50,5% mujeres, media de edad fue 56,2. Las indicaciones quirúrgicas más frecuentes fueron cáncer colorrectal en 381 (50,9%) pacientes y enfermedad diverticular en 163 (21,8%). La DA fue de 5,6% (42/748) y la mortalidad fue de 2% (15/748), siendo de 1% para los electivos (7/681). En el análisis univariado encontramos que los FR que tuvieron significancia estadística fueron la albúmina (p < 0,001), altura anastomosis (p < 0,001), transfusión (p < 0,001), localización (colon derecho > izquierdo) (p = 0,011), mientras que en el análisis multivariado fueron la albúmina (p = 0,002) con un OR 3,64 (IC 95% 1,58-8,35) y transfusión (p = 0,015) con un OR 7,15 (IC 95% 1,46-34,91). CONCLUSIÓN: Nuestra serie es la más grande reportada en Chile, con resultados similares a estudios internacionales y nacionales. Establecemos que la hipoalbuminemia y la presencia de transfusiones intraoperatorias se asocian a alta tasa de DA.

INTRODUCTION: Anastomotic leakage (AL) is a severe complication in colorectal surgery, its incidence ranges from 2 to 19%. In international literature, we found numerous studies on the identification of risk factors (RF), while in the national there are only two series that analyze this complication. AIM: Perform a descriptive characterization of institutional results and establish the AL rate, its associated risk factors and mortality. MATERIALS AND METHOD: Non-concurrent series of cases, whose sample is consecutive patients operated for colorectal pathology with primary anastomosis with or without a derivative ostoma between 2004 and 2016. Univariate and multivariable logistic regression model was performed. RESULTS: There were 748 patients, 50.5% women, mean age was 56.2. The most frequent surgical indications were colorectal cancer in 381 (50.9%) patients and diverticular disease in 163 (21.8%). The AL was 5.6% (42/748) and the mortality was 2% (15/748), being 1% for the electives (7/681). In the univariate analysis, we found that the RF that had statistical significance were albumin (p < 0.001), anastomosis height (p < 0.001), transfusion (p < 0.001), location (right colon > left) (p = 0.011), while that in the multivariate analysis were albumin (p = 0.002) with an OR 3.64 (IC 95% 1.58-8.35) and transfusion (p = 0.015) with an OR 7.15 (IC 95% 1.46-34.91). CONLUSION: Our series is the largest reported in Chile, with similar results to international and national studies. We establish that hypoalbuminemia and the presence of intraoperative transfusions are associated with a high rate of AL.

Ureteroileal bypass: a new technic to treat ureteroenteric strictures in urinary diversion

ABSTRACT Objective: To present our technique of ureteroileal bypass to treat uretero-enteric stric- tures in urinary diversion. Materials and Methods: One hundred and forty-one medical records were reviewed from patients submitted to radical cystectomy to treat muscle-invasive bladder cancer between 2013 and 2015. Twelve (8.5%) patients developed uretero-enteric anastomotic stricture during follow-up. Five patients were treated with endoscopic dilatation and double J placement. Four were treated surgically with standard terminal-lateral im- plantation. Three patients with uretero-enteric anastomotic stricture were treated at our institution by "ureteroileal bypass", one of them was treated with robotic surgery. Results: All patients had the diagnosis of uretero-enteric anastomotic stricture via computerized tomography and DTPA renal scan. Time between cystectomy and diag- nosis of uretero-enteric anastomotic stricture varied from five months to three years. Mean operative time was 120±17.9 minutes (98 to 142 min) and hospital stay was 3.3±0.62 days (3 to 4 days). Mean follow-up was 24±39.5 months (6 to 72 months). During follow-up, all patients were asymptomatic and presented improvement in ure-terohydronephrosis. Serum creatinine of all patients had been stable. Conclusions: Latero-lateral ureter re-implantation is feasible by open or even robotic surgery with positive results, reasonable operation time, and without complications.

Prospective evaluation of vesicourethral anastomosis outcomes in robotic radical prostatectomy during early experience in a university hospital

ABSTRACT Purpose: Robotic assisted radical prostatectomy (RARP) presents challenges for the surgeon, especially during the initial learning curve. We aimed to evaluate early and mid-term functional outcomes and complications related to vesicourethral anastomosis (VUA), in patients who underwent RARP, during the initial experience in an academic hospital. We also assessed possible predictors of postoperative incontinence and compared these results with the literature. Materials and Methods: We prospectively collected data from consecutive patients that underwent RARP. Patients with at least 6 months of follow-up were included in the analysis for the following outcomes: time to complete VUA, continence and complications related to anastomosis. Nerve-sparing status, age, BMI, EBL, pathological tumor staging, and prostate size were evaluated as possible factors predicting early and midterm continence. Results were compared with current literature. Results: Data from 60 patients was assessed. Mean time to complete VUA was 34 minutes, and console time was 247 minutes. Continence in 6 months was 90%. Incidence of urinary leakage was 3.3%, no patients developed bladder neck contracture or postoperative urinary retention. On multivariate analysis, age and pathological staging was associated to 3-month continence status. Conclusion: Our data show that, during early experience with RARP in a public university hospital, it is possible to achieve good results regarding continence and other outcomes related to VUA. We also found that age and pathological staging was associated to early continence status.

Postoperative outcomes and functional results after Deloyer's procedure - a retrospective cohort study / Desfechos pós-operatórios e resultados funcionais após o procedimento de Deloyer ­ um estudo de coorte retrospectivo

ABSTRACT Introduction: The objective of our study was to describe surgical outcomes of Deloyers procedure in our referral center, and to compare the results of patients with and without protective ileostomy. Methods: Patients undergoing a Deloyers procedure from 2013 to 2016 were prospectively included. General characteristics, intraoperative variables, postoperative course, and functional outcomes were analyzed. Patients were compared into two groups: group (1) patients undergoing Deloyers procedure without ileostomy, and group (2) Deloyers procedure with protective ileostomy. Results: Sixteen patients undergoing isoperistaltic transposition of the right colon remnant were included, of which 9 (63%) were males with a median age of 47 (range 22-76) years. The main surgical indication was the restoration of bowel transit (62.5%). There was higher major morbidity rate in the Deloyers procedure with protective ileostomy group, but without statistical significance (20% vs. 9%, p = 0.92). No leaks or deaths were reported. The length of hospital stay was 7 days. The mean number of bowel movements per day was 4 at 18 months of follow up. Only four (25%) patients used irregularly loperamide. Conclusions: The Deloyers procedure has satisfactory results and is reproducible with low morbidity. The major and minor morbidity rates were similar between groups, suggesting that the costs and risks of a second procedure can be avoided by providing a safe primary anastomosis.

RESUMO Introdução: O objetivo de nosso estudo foi descrever os resultados cirúrgicos do procedimento de Deloyer em nosso centro de referência e comparar os resultados de pacientes com e sem ileostomia de proteção. Métodos: Pacientes submetidos ao procedimento de Deloyer de 2013 a 2016 foram incluídos prospectivamente. Foram analisadas as características gerais, as variáveis intraoperatórias, o curso pós-operatório e os desfechos funcionais. Os pacientes foram comparados em dois grupos: Grupo 1) pacientes submetidos ao procedimento de Deloyer (PD) sem ileostomia, e grupo 2) procedimento de Deloyer com ileostomia de proteção (IP). Resultados: Foram incluídos 16 pacientes submetidos à transposição isoperistáltica da porção remanescente do cólon direito, dos quais 9 (63%) eram do sexo masculino com idade média de 47 anos (variação de 22-76) anos. A principal indicação cirúrgica foi a restauração do trânsito intestinal (62,5%). Houve maior morbidade maior no grupo IP, mas sem significância estatística (20% vs. 9%, p = 0,92). Nenhum vazamento ou óbito foi relatado. A duração da hospitalização foi de 7 dias. O número médio de evacuações por dia foi 4, aos 18 meses de seguimento. Apenas quatro (25%) pacientes utilizaram irregularmente a loperamida. Conclusões: O procedimento de Deloyer tem resultados satisfatórios e é reprodutível com baixa morbidade. As taxas de morbidades maiores e menores foram semelhantes entre os grupos, sugerindo que os custos e riscos de um segundo procedimento podem ser evitados proporcionando-se uma anastomose primária segura.

Efficacy and safety of a NiTi CAR 27 compression ring for end-to-end anastomosis compared with conventional staplers: A real-world analysis in Chinese colorectal cancer patients

OBJECTIVES: This study aimed to evaluate the safety and efficacy of a new nickel-titanium shape memory alloy compression anastomosis ring, NiTi CAR 27, in constructing an anastomosis for colorectal cancer resection compared with conventional staples. METHODS: In total, 234 consecutive patients diagnosed with colorectal cancer receiving sigmoidectomy and anterior resection for end-to-end anastomosis from May 2010 to June 2012 were retrospectively analyzed. The postoperative clinical parameters, postoperative complications and 3-year overall survival in 77 patients using a NiTi CAR 27 compression ring (CAR group) and 157 patients with conventional circular staplers (STA group) were compared. RESULTS: There were no statistically significant differences between the patients in the two groups in terms of general demographics and tumor features. A clinically apparent anastomotic leak occurred in 2 patients (2.6%) in the CAR group and in 5 patients (3.2%) in the STA group (p=0.804). These eight patients received a temporary diverting ileostomy. One patient (1.3%) in the CAR group was diagnosed with anastomotic stricture through an electronic colonoscopy after 3 months postoperatively. The incidence of postoperative intestinal obstruction was comparable between the two groups (p=0.192). With a median follow-up duration of 39.6 months, the 3-year overall survival rate was 83.1% in the CAR group and 89.0% in the STA group (p=0.152). CONCLUSIONS: NiTi CAR 27 is safe and effective for colorectal end-to-end anastomosis. Its use is equivalent to that of the conventional circular staplers. This study suggests that NiTi CAR 27 may be a beneficial alternative in colorectal anastomosis in Chinese colorectal cancer patients.

Colorectal anastomotic leakage at the University Hospital of the West Indies an analysis of risk factors / Fuga anastomótica colorrectal en el Hospital Universitario de West Indies un análisis de los factores de riesgo

BACKGROUND: Anastomotic leakage remains a concern in general surgical practice. The significance lies in the resultant abdominal sepsis, related morbidity and mortality, risk of anastomotic loss, permanent stoma creation and the effect on local recurrence and overall patient survival in colorectal cancer cases. OBJECTIVES: This study serves to determine the leak rates and the mortality thereof related to colonic and rectal anastomoses at the University Hospital of the West Indies (UHWI) in Kingston, Jamaica. Independent factors contributing to anastomotic leaks in these patients will also be assessed and correlations determined. METHODS: A review of the medical records of one hundred and thirty-three cases of colonic and rectal anastomoses identified retrospectively over a three-year period provided relevant information for analysis. RESULTS: Anastomotic leaks were identified in twelve patients, providing a leak rate of 9.0%. No 30-day mortality related to anastomotic leakage was noted. Based on a multivariate analysis, male gender was identified as the sole independent factor related to anastomotic leakage. CONCLUSION: Colorectal anastomotic leak rates at UHWI fell at the upper limit of leak rates typically quoted in the literature. No modifiable risk factor appeared to contribute to this leak rate. Early identification and intervention is critical in limiting mortality associated with colorectal anastomotic leakage.

ANTECEDENTES: La fuga anastomótica sigue siendo una preocupación en la práctica quirúrgica general. La importancia radica en la sepsis abdominal resultante, la morbilidad y mortalidad asociadas, el riesgo de pérdida anastomótica, la creación de estomas permanentes, y el efecto sobre la recidiva local así como en la supervivencia de los pacientes en general, en los casos de cáncer colorrectal. OBJETIVOS: Este estudio sirve para determinar las tasas de fuga y la mortalidad asociadas con ellas, en relación con las anastomosis colónicas y rectales en el Hospital Universitario de West Indies (HUWI) en Kingston, Jamaica. Asimismo, se evaluaran los factores independientes que contribuyen a las fugas anastomóticas en estos pacientes, y se determinaran las correlaciones. MÉTODOS: Una revisión de los registros médicos de ciento treinta y tres casos de anastomosis colónicas y rectales identificados retrospectivamente durante un período de más de tres años, proporcionaron la información relevante para el análisis. RESULTADOS: Se identificaron fugas anastomóticas en doce pacientes para una tasa de fuga de 9.0% . No se observó ninguna mortalidad de 30 días relacionada con fugas anastomóticas. Basado en un análisis multivariante, se identificó el género masculino como el único factor independiente relacionado con la fuga anastomótica. CONCLUSIÓN: Las tasas de fuga anastomótica colorrectal en UHWI cayeron al límite superior de las tasas de fuga típicamente citadas en la literatura. Ningún factor de riesgo no modificable pareció contribuir a esta tasa de fuga. La intervención e identificación temprana es esencial a la hora de limitar la mortalidad asociada con la pérdida anastomótica colorrectal.

Surgical treatment of familial adenomatous polyposis: ileoretal anastomosis or restorative proctolectomy? / Tratamento cirúrgico da polipose adenomatosa familiar: anastomose íleo-retal ou bolsa ileal?

Context: Controversy regarding the best operative choice for familial adenomatous polyposis lays between the morbidity of restorative proctocolectomy and the supposed mortality due to rectal cancer after ileorectal anastomosis. OBJECTIVES: To evaluate operative complications and oncological outcome after ileorectal anastomosis and restorative proctocolectomy. Methods: Charts from patients treated between 1977 and 2006 were retrospectively analyzed. Clinical and endoscopic data, results of treatment, pathological reports and information regarding early and late outcome were recorded. Results: Eighty-eight patients - 41 men (46.6 percent) and 47 women (53.4 percent) - were assisted. At diagnosis, 53 patients (60.2 percent) already had associated colorectal cancer. Operative complications occurred in 25 patients (29.0 percent), being 17 (19.7 percent) early and 8 (9.3 percent) late complications. There were more complications after restorative proctocolectomy (48.1 percent) compared to proctocolectomy with ileostomy (26.6 percent) and ileorectal anastomosis (19.0 percent) (P = 0,03). There was no operative mortality. During the follow-up of 36 ileorectal anastomosis, cancer developed in the rectal cuff in six patients (16,6 percent). Cumulative cancer risk after ileorectal anastomosis was 17.2 percent at 5 years, 24.1 percent at 10 years and 43.1 percent at 15 years of follow-up. Age-dependent cumulative risk started at 30 years (4.3 percent), went to 9.6 percent at 40 years, 20.9 percent at 40 years and 52 percent at 60 years. Among the 26 patients followed after restorative proctocolectomy, it was found cancer in the ileal pouch in 1 (3.8 percent). Conclusions: 1. Operative complications occurred in about one third of the patients, being more frequently after the confection of ileal reservoir; 2. greater age and previous colonic carcinoma were associated with the development of rectal cancer after ileorectal anastomosis; 3. patients treated...

Contexto: As controvérsias quanto a melhor forma de tratamento da polipose adenomatosa familiar confrontam a morbidade da proctocolectomia restauradora contra a suposta mortalidade decorrente de câncer retal após íleo-reto anastomose. OBJETIVOS: Avaliar as complicações operatórias e a evolução oncológica dos pacientes submetidos a íleo-reto anastomose ou proctocolectomia restauradora. Métodos: Analisaram-se os dados dos doentes tratados entre 1977 e 2006, procedendo ao levantamento de dados clínicos gerais, endoscópicos, resultados do tratamento cirúrgico, dados anatomopatológicos e informações sobre a evolução precoce e tardia dos pacientes. Resultados: Foram tratados 88 pacientes, sendo 41 homens (46,6 por cento) e 47 mulheres (53,4 por cento). Por ocasião do diagnóstico, 53 pacientes (60,2 por cento) já tinham câncer colorretal associado à polipose. Registraram-se complicações operatórias em 25 doentes (29,0 por cento) dentre os 86 operados, sendo 17 (19,7 por cento) precoces e 8 (9,3 por cento) tardias. Houve mais complicações após proctocolectomia restauradora (48,1 por cento) em comparação às proctocolectomias com ileostomia (26,6 por cento) e íleo-reto anastomose (19,0 por cento) (P = 0,03). Não houve mortalidade operatória. O risco cumulativo de câncer retal após íleo-reto anastomose foi de 17,2 por cento após 5 anos, 24,1 por cento após 10 anos e 43,1 por cento após 15 anos de seguimento pós-operatório. Já o risco cumulativo idade-dependente começou a existir a partir de 30 anos (4,3 por cento), passando para 9,6 por cento aos 40 anos, 20,9 por cento aos 40 anos e 52 por cento aos 60 anos. Entre os pacientes submetidos a bolsa ileal com seguimento (26), apenas 1 doente (3,8 por cento) desenvolveu câncer na bolsa ileal. Conclusões: 1. Ocorreram complicações operatórias em cerca de 1/3 dos pacientes, sendo mais frequentes após a confecção de bolsa ileal; 2. idade maior, tempo de seguimento e câncer colônico prévio se associaram...

Factores asociados a la dehiscencia clínica de una anastomosis intestinal grapada: análisis multivariado de 610 pacientes consecutivos / Analysis of risk factors for clinical dehiscence of stapled anastomosis in 610 patients

Propósito: La dehiscencia de una anastomosis intestinal (DA) es una complicación grave, lo que ha motivado la búsqueda de factores de riesgo asociados con ella. El propósito de este estudio es analizar los factores predictivos de DA en una serie consecutiva de pacientes con una anastomosis grapada. Material y Método: Estudio longitudinal prospectivo de 610 pacientes (54 por ciento mujeres) con un promedio de edad de 58,9 años (extremos 14-88). Las principales indicaciones quirúrgicas fueron el cáncer colorrectal (55 por ciento), la enfermedad diverticular (16 por ciento) y el megacolon (11 por ciento). Se utilizó un modelo de regresión logística para estudiar la posible asociación entre la DA y 17 variables. Resultados: La DA ocurrió en 23 pacientes (3,8 por ciento). Hubo un 3 por ciento (9/300) de DA en el grupo de las anastomosis colo-rectales altas y 12 por ciento (9/73) en el grupo de anastomosis bajas (p=0.001). De los 23 pacientes con DA, 14 requieren una reintervención y 9 fueron manejadas en forma conservadora. La mortalidad global fue 1 por ciento (6/610), la mitad debido a complicaciones sépticas de la DA. Al comparar los pacientes sin y con DA, la tasa de reoperaciones fue 6,4 por ciento y 61 por ciento (p<0.0001), la tasa de infección de herida operatoria fue 6,6 por ciento y 61 por ciento (p<0.0001), el tiempo de hospitalización promedio fue 11 y 29,9 días (p<0.0001) y la mortalidad operatoria fue 0,5 por ciento y 13 por ciento (p<0.0001), respectivamente. En el análisis univariado el género, la altura de la anastomosis, el diámetro de la grapadora circular, el tiempo operatorio, el drenaje a la pelvis y el antecedente de radioterapia fueron significativas. En el análisis multivariado sólo el género (masculino), la altura de la anastomosis al margen anal y el antecedente de radioterapia pélvica se mantienen como variables independientes asociadas al riesgo de DA. Conclusión: Las anastomosis bajas, la radioterapia preoperatoria y el género...

Background: The dehiscence of an intestinal anastomosis is a devastating complication. Aim: To analyze risk factors for dehiscence of stapled anastomosis in a consecutive series of patients. Material and methods: Prospective study of 610 patients (age range 14-88 years, 329 females) subjected to a stapled intestinal anastomosis. The main diagnoses that motivated surgery were colorectal cancer in 55 percent, diverticular disease in 16 percent and megacolon in 11 percent. A logistic regression model was used to study the association between the risk of dehiscence and 17 independent variables. Results: Twenty three patients had a dehiscence of the anastomosis. The complication occurred in nine of 300 patients (3 percent) subjected to a high colorectal anastomosis and in nine of 73 patients (12 percent) subjected to a low colorectal anastomosis. Fourteen patients with dehiscence required a new surgical intervention and nine were managed conservatively. Six patients (1 percent) died due to septic complications of the dehiscence. Among patients with and without dehiscence, the rate of re-operations was 61 and 6.4 percent respectively, p < 0.001, the rate of surgical wound infections was 61 and 6.6 percent respectively, p< 0.001, and the hospital stay was 29.9 and 11 days respectively, p< 0.01. The factors significantly associated with dehiscence determined by univariate analysis were gender, the height of the anastomosis, the diameter of the circular stapler, operative time, the drainage to the pelvis and the history of radiotherapy. In the multivariate analysis, only the male gender, the height of the anastomosis, using the anal margin as landmark and the history of pelvic radiation, remained as significant predictors. Conclusions: A low anastomosis, previous radiation therapy and male gender are risk factors for clinical dehiscence of stapled anastomosis. A protective ostomy should be considered in patients with multiple risk factors.

Dilatación de la estenosis benigna de la anastomosis colo-rectal mediante bujías de Savary-Gilliard / Dilation of benign anastomotic colorectal strictures using Savary-Gilliard bougies

Antecedentes: La estenosis cicatricial de una anastomosis colorrectal (CRA) ocurre aproximadamente en un 20 por ciento de los pacientes, la mayoría son asintomáticos y menos del 5 por ciento de los casos requiere algún procedimiento de corrección. Este estudio analiza la técnica y los resultados de la dilatación endoscópica con bujías de una estenosis de una CRA grapada. Pacientes y método: Revisión retrospectiva de todas las dilataciones de una CRA efectuadas en el periodo 1997-2004 por una estrechez cicatricial crítica (<10 mm), con o sin síntomas. La dilatación se efectuó mediante bujías de Savary-Gilliard bajo visión fluoroscópica. Resultados: De un total de 349 CRA con suturas mecánicas realizadas en forma consecutiva en dicho periodo, 15 pacientes (4,3 por ciento) requirieron de una o más sesiones de dilatación. La altura promedio de la estenosis desde el margen anal fue 12,7 cm (extremos 7-17). El diámetro promedio de la estrechez fue 7 mm (extremos 2-10). El intervalo entre la confección de la CRA y el diagnóstico de la complicación fue de 19 meses como promedio (extremos 2-67). Once pacientes (73 por ciento) presentaban síntomas obstructivos, los que progresaron a una obstrucción mecánica en 5. Se efectuó 18 dilataciones en los 15 pacientes, logrando una dilatación hasta 15 mm y mejoría del cuadro clínico en forma definitiva en 12 pacientes. Tres pacientes presentan una re-estenosis que requiere un nuevo procedimiento de dilatación, logrando éxito en 2 de ellos. Un paciente debió operarse por una perforación luego de la segunda sesión, quedando con una ileostomía transitoria. Conclusión: En nuestra experiencia logramos una corrección de la estrechez benigna de la CRA con una sesión de dilatación en el 80 por ciento de los casos, cifra que se eleva al 93 por ciento con dos sesiones. La técnica de dilatación con bujías es una técnica reproducible, de bajo costo, simple y eficiente.

Background: Benign strictures occur in up to 22 percent of patients following anterior resection, most of them presenting no symptoms and less than 5 percent needing some correcting procedure. This study was conducted to assess the efficacy of dilation using Savary-Gilliard bougies. Patients and method: From 1997 to 2004, 349 consecutive patients underwent anterior resection. Fifteen patients (4,3 percent) developed a critical stricture of colorectal anastomosis (<10 mm). Dilation was carried out under fluoroscopic guidance using Savary-Gilliard bougies of increasing diameters up to 15 mm. Results: Mean height of stenosis to anal verge was 12,7 cm (range 7-17). The strictures had a mean diameter of 7 mm (range 2-10). Four patients were diagnosed during routine follow up. In eleven patients, symptoms developed at a mean of 19 months after surgery (range 2-67). Five patients complained of pain and abdominal distension which, in one case, progressed to intestinal obstruction. The total number of dilation sessions was 21 and the average number per patient was 1.4 (range 1-4). Immediate symptomatic relief was achieved in 12 cases in one session and good long-term dilation was achieved in 14 patients (93 percent) after a 22 (range 7-44) mean follow-up period. There was one case of bowel perforation with the guide wire who needed a temporary ileostomy. Conclusion: Endoscopic dilation with Savary bougies is an inexpensive, simple, safe and efficient method of treating benign colorectal anastomotic strictures.

Revascularización de accesos vasculares para hemodiálisis crónica: resultados inmediatos y seguimiento a mediano plazo / Revascularization of vascular accesses for chronica hemodialysis

La hemodiálisis, uno de los tratamientos supletorios de la insuficiencia renal crónica, implica la depuración sanguínea periódica, a través de un acceso vascular (AV). La principal complicación de los AV son la estenosis y la obstrucción. El objetivo del presente trabajo es presentar nuestra experiencia en el tratamiento percutáneo de las disfunciones de los AV. Entre enero de 1993 y julio de 1995, se trataron por angioplastia (ATP), trombolisis (T-LIS) y trongoaspiración (T-ASP), 34 pacientes con insuficiencia en sus AV para hemodiálisis crónica. De éstos, 19 eran portadores de estenosis y 15 con oclusión del AV. El tratamiento percutáneo de las disfunciones de los AV es el procedimiento de elección ya que ofrece muy buenos resultados. Realizado precozmente, en etapa de estenosis, ofrece mejores resultados que aquellos con oclusión, mejorando significativamente su sobrevida

Revascularización percutánea en accesos vasculares para hemodiálisis / Percutaneous revascularization in vascular access for hemodialysis

Se trataron por angioplastia percutánea transluminal, trombolisis y/o tromboaspiración, veinticinco pacientes con insuficiencia en sus accesos vasculares para hemodiálisis crónica. Fueron éxitos iniciales 11 (85 por ciento) de 13 pacientes portadores de estenosis y 6 (50 por ciento) de 12 portadores de oclusiones del acceso vascular. En tres pacientes (3 oclusiones) se produjo reestenosis del acceso vascular requiriendo un segundo procedimiento de revascularización por angioplastia en un plazo medio de 4 meses (rango 2 - 8 meses). En los 13 pacientes portadores de estenosis la tasa de permeabilidad fue de 75 por ciento a los 6 meses, de 75 por ciento al año y del 75 por ciento a los 2 años. En los 12 pacientes portadores de oclusiones las tasas de permeabilidad fueron de 42 por ciento, 15 por ciento y 15 por ciento respectivamente. El tratamiento de las estenosis de accesos vasculares es el procedimiento de elección, realizándolo precozmente previene la oclusión del mismo mejorando significativamente su sobrevida