Isoperistaltic versus antiperistaltic ileocolic anastomosis. Does it really matter? Results from a randomised clinical trial (ISOVANTI).

BACKGROUND: Right hemicolectomy is a very common surgery. Many studies compare different options for laparoscopic ileocolic anastomoses: intra- or extracorporeal; handsewn or stapled; side-to-side or end-to-side. However, there are no studies about the influence that peristalsis could have on this anastomosis. The aim of this study is to compare safety and feasibility of isoperistaltic and antiperistaltic anastomosis in terms of postoperative morbidity and mortality between both groups. The secondary endpoint is to compare long-term functional outcomes (chronic diarrhoea) and quality of life (GIQLI questionnaire) after a 1-year follow-up period. METHODS: A double-blind, randomised, prospective trial in patients undergoing scheduled surgery for right colon cancer with laparoscopic right hemicolectomy and isoperistaltic (ISO) or antiperistaltic (ANTI) ileocolic anastomoses. RESULTS: Hundred and eight patients were included in the study. Patients were randomised either to isoperistaltic or antiperistaltic configuration (54 ISO/ANTI). No significant differences in baseline variables were found. No differences in surgical time (130 [120-150] min ISO vs. 140 [127-160] ANTI, p = 0.481), nor in anastomotic time (19 [17-22] vs. 20 [16-25], p = 0.207) and nor in postoperative complications: 37.0% ISO versus 40.7% ANTI, (p = 0.693) were found. There were no differences in postoperative ileus (p = 0.112) nor in anastomotic leakage (3.7% vs. 5.56%, p = 1.00). Differences in "time to first flatus" and "time to first deposition" were found in favour of the antiperistaltic group (p = 0.004 and p = 0.017). Anastomotic configuration did not influence hospital stay (3 days [2-6] isoperistaltic vs. 3 [2-4] antiperistaltic, p = 0.236). During follow-up, there were no differences between the two groups at 1, 6 and 12 months (p = 0.154, p = 0.498 and p = 0.683), nor in chronic diarrhoea rates in GIQLI scores (24% ISO vs. 31.4% ANTI, p = 0.541). CONCLUSIONS: The isoperistaltic and antiperistaltic ileocolic anastomosis present similar results in terms of performance, safety and functionality. However, further studies must be carried out in order to assess relationship between postoperative ileus and anastomosis configuration. TRIAL REGISTRATION: Randomised Clinical trial (Identifier: NCT02309931).

Right-colon mucinous adenocarcinoma mimicking a hydatid cyst.

Hydatid disease is a fecal-oral transmission zoonosis which is endemically distributed among Mediterranean countries such as Morocco. It usually presents asymptomatically and a diagnosis is made due to cyst complications. It is most frequently located in the liver and lungs and forms large masses. The incidence of colon cancer has increased amongst population under 50 years of age during the last few decades. It has been proposed that young adult cases may have histological characteristics with a more aggressive clinical behavior. These patients are frequently diagnosed in advanced stages and a mucinous histology is frequently detected. Diagnosis is usually delayed due to a low clinical suspicion and the attribution of symptoms to other diseases such as irritable bowel and parasitosis, among others.

V-Y advancement flaps for extensive perianal defect repair. / El colgajo V-Y como método de reparación de defectos perianales extensos.

OBJECTIVES: Some perianal pathologies require aggressive surgery that will need techniques to allow to re-establish the integrity of the perianal region. The purpose is to analyze short and long term results after perineal reconstruction with V-Y flaps. METHODS: A retrospective review of prospectively collected database was conducted at Virgen de la Arrixaca's Hospital in Murcia (España) between January 2000 and December 2013. The study includes all patients who underwent a perineal reconstruction with V-Y flaps. Demographic and surgical data and short-/long- term morbidity was recorded. RESULTS: 10 patients were included, 6 males and 4 females. The average age was 58,1±17,4 years. Surgical indication included both malignant and benign pathologies. Operating time was 143,5±41,3min. R0 resection was performed in all cases although histopathological analysis showed involvement of the deeper margin in 3 cases. Length of hospital stay was 7,8±7,6 days. Regarding complications: 6 patients had partial dehiscence of the flap. None of the patients lost the flap completely. The most frequent late complication was anal stenosis (n=4). Follow up showed total continence in 7 patients. Two patients had variable fecal and/or flatus incontinence. A colostomy was made in one case due to severe incontinence. CONCLUSIONS: V-Y flaps are an effective and feasible technique to cover large perianal defects after aggressive surgeries. However, this technique is not free of postoperative morbidity.

Detection of the sentinel node using a magnetic tracer in thyroid cancer. A technical pilot study. / Detección del ganglio centinela mediante trazador paramagnético en el cáncer de tiroides. Estudio piloto técnico.

INTRODUCTION: There is no standard procedure for the detection of the sentinel node (SN) in thyroid disease. However, the recent detection of the SN using a paramagnetic tracer is proving to be useful in breast cancer and melanoma. The objective was to assess the utility of super paramagnetic iron oxide tracer for the intraoperative detection of the SN in patients with papillary thyroid cancer without nodal involvement in the preoperative study. METHOD: A single center, prospective pilot study of a class IIa medical device (a paramagnetic tracer). The study included thyroid cancers which were T1-T2 tumors in the cytohistological analysis with a negative preoperative nodal assessment, operated on consecutively during scheduled treatment. For the localization of the SN, an interlesional injection of 2mL of super paramagnetic iron oxide was administered. After ten minutes, ferromagnetic activity was detected in the adjacent nodes. Once the node had been detected, we proceeded by extracting it for intraoperative analysis. The effectiveness of the procedure for detecting the SN was assessed, with the main variable being whether it was detected or not. RESULTS: The project was assessed after the first cases had been carried out. The SN was located in all cases, which was done easily in the first four, but in the fifth case the SN detection was complicated by the interference of the reusable neurostimulation electrodes with the ferromagnetic signal. Intraoperative histology revealed the SN was positive in 80% (n=4) of cases (20% [n=1] were macrometastases and 60% [n=3] micrometastases). Total thyroidectomies were carried out, with central lymph node dissection in 4 of the patients and lateral in one due to the result of the detected SN. The histology showed the carcinoma was papillary, a classic type, in 80% (n=4) and a follicular variant in 20% (n=1). Forty percent (n=2) were multifocal, 40% (n=2) had vascular infiltration, and 60% (n=3) had extrathyroidal extension. Staging determined the application of radioactive iodine therapy (150mCi) in 80% of cases (n=4). CONCLUSIONS: A paramagnetic tracer can be useful for detecting the SN and correctly staging papillary carcinoma.

Reoperation after laparoscopic colorectal surgery. Does the laparoscopic approach have any advantages? / Reintervención tras complicaciones en cirugía laparoscópica colorrectal. ¿Aporta ventajas el abordaje laparoscópico?

INTRODUCTION: The laparoscopic approach in colorectal complications is controversial because of its difficulty. However, it has been proven that it can provide advantages over open surgery. The aim of this study is to compare laparoscopic approach in reoperations for complications after colorectal surgery with the open approach taking into account the severity of the patient prior to reoperation. METHODS: Patients who underwent laparoscopic colorectal surgery from January 2006 to December 2015 were retrospectively reviewed. Patients requiring urgent surgical procedures for complications in the postoperative period were divided in two groups: laparoscopic surgery (LS) and open surgery (OS). To control clinical severity prior to reoperation, The Mannheim Peritonitis Index (MPI) was calculated. RESULTS: A total of 763 patients were studied, 40 required urgent surgery (24 OS/16 LS). More ileostomies were performed in the LS group (68.7% vs. 29.2%) and more colostomies in the OS group (37.5% vs. 6.2%), p<0.05. MPI was higher in OS group (27.31±6.47 [19-35] vs. 18.36±7.16 [11-24], p<0.001). Hospital stay after re-intervention, oral tolerance and surgical wound infection, were favorable in LS (p<0.05 in all cases). In patients with MPI score ≤26, laparoscopic approach showed shorter hospital stay after re-intervention, less stay in the critical care unit after re-intervention, earlier start of oral tolerance and less surgical wound infection (p<0.05). CONCLUSIONS: A laparoscopic approach in re-intervention for complications after laparoscopic colorectal surgery associates a faster recovery reflected in a shorter hospital stay, earlier start of oral tolerance and a lower abdominal wall complication rate in patients with low severity index.

Apendicitis aguda causada por cuerpo extraño / Acute appendicitis caused by a foreign body

No disponible

Hemoperitoneo tras estallido vesicular diferido como consecuencia de traumatismo abdominal / Hemoperitoneum due to delayed gallbladder rupture after abdominal trauma

No disponible

Tumor mucinoso de colon simulando un quiste hidatídico / Right-colon mucinous adenocarcinoma mimicking a hydatid cyst

No disponible

Reintervención tras complicaciones en cirugía laparoscópica colorrectal. ¿Aporta ventajas el abordaje laparoscópico? / Reoperation after laparoscopic colorectal surgery. Does the laparoscopic approach have any advantages?

Introducción: El abordaje laparoscópico en la cirugía por complicaciones colorrectales es controvertido. Sin embargo, puede proporcionar ventajas sobre la cirugía abierta. El objetivo del estudio es comparar el abordaje laparoscópico vs. el abordaje abierto en la reintervención por complicaciones tras cirugía colorrectal. Métodos: Se han analizado de forma retrospectiva, sobre una base de datos prospectiva, los pacientes intervenidos mediante cirugía laparoscópica colorrectal desde enero de 2006 a diciembre de 2015. Los pacientes que requirieron reintervenciones urgentes por complicaciones en el postoperatorio se dividieron según el abordaje (cirugía laparoscópica [CL] y cirugía abierta [CA]) y según su gravedad clínica (en función del índice de peritonitis de Mannheim [IPM]). Resultados: De 763 pacientes, 40 requirieron cirugía urgente (24 CA/16 CL). Se realizaron más ileostomías en el grupo CL (68,7% vs. 29,2%) y más colostomías en el grupo CA (37,5% vs. 6,2%), p<0,05. El IPM fue mayor en el grupo CA (27,31±6,47 [19-35] vs. 18,4±7,2 [11-24], p<0,001). La estancia hospitalaria tras la reintervención, tolerancia oral e infección de herida quirúrgica fueron favorables en CL (p<0,05). En pacientes con un IPM≤26, el abordaje laparoscópico mostró menor estancia hospitalaria, menor permanencia en unidad de críticos, tolerancia oral más temprana y menor infección de herida quirúrgica (p<0,05). Conclusiones: El abordaje laparoscópico en la reintervención por complicaciones tras cirugía colorrectal laparoscópica asocia una recuperación más rápida objetivada en un inicio precoz de tolerancia oral, menor estancia hospitalaria y menor tasa de hernia incisional en pacientes con bajo índice de gravedad (AU)

Introduction: The laparoscopic approach in colorectal complications is controversial because of its difficulty. However, it has been proven that it can provide advantages over open surgery. The aim of this study is to compare laparoscopic approach in reoperations for complications after colorectal surgery with the open approach taking into account the severity of the patient prior to reoperation. Methods: Patients who underwent laparoscopic colorectal surgery from January 2006 to December 2015 were retrospectively reviewed. Patients requiring urgent surgical procedures for complications in the postoperative period were divided in two groups: laparoscopic surgery (LS) and open surgery (OS). To control clinical severity prior to reoperation, The Mannheim Peritonitis Index (MPI) was calculated. Results: A total of 763 patients were studied, 40 required urgent surgery (24 OS/16 LS). More ileostomies were performed in the LS group (68.7% vs. 29.2%) and more colostomies in the OS group (37.5% vs. 6.2%), p<0.05. MPI was higher in OS group (27.31±6.47 [19-35] vs. 18.36±7.16 [11-24], p<0.001). Hospital stay after re-intervention, oral tolerance and surgical wound infection, were favorable in LS (p<0.05 in all cases). In patients with MPI score ≤26, laparoscopic approach showed shorter hospital stay after re-intervention, less stay in the critical care unit after re-intervention, earlier start of oral tolerance and less surgical wound infection (p<0.05). Conclusions: A laparoscopic approach in re-intervention for complications after laparoscopic colorectal surgery associates a faster recovery reflected in a shorter hospital stay, earlier start of oral tolerance and a lower abdominal wall complication rate in patients with low severity index (AU)

Torsión e infarto omental: una infrecuente complicación tardía del bypass gástrico / Omenal torsion and infarction: An unusual complication after Roux-en-Y Gastric Bypass

No disponible

El colgajo V-Y como método de reparación de defectos perianales extensos / V-Y advancement flaps for extensive perianal defect repair

INTRODUCCIÓN: Algunas enfermedades perianales precisan cirugías agresivas que crean la necesidad de recurrir a técnicas reparadoras para reconstruir la integridad de esta región. El objetivo de este estudio es analizar los resultados a corto y largo plazo tras reconstrucción perianal con colgajos V-Y. MÉTODO: Se ha revisado retrospectivamente nuestra base de datos institucional prospectiva (2000-2013), y se ha incluido en el presente análisis a todos los pacientes a los que se ha realizado una reconstrucción perianal con colgajo V-Y, tras escisión amplia perianal por enfermedad benigna o maligna. Se recogieron datos demográficos, quirúrgicos y la morbilidad a corto y largo plazo. RESULTADOS: Se analizó a un total de 10 pacientes, 6 varones y 4 mujeres, con edad media de 58,1 ± 17,4 años. El tiempo quirúrgico fue 143,5 ± 41,3 min y la estancia hospitalaria media tras la cirugía 7,8 ± 7,7 días. En 8 pacientes aparecieron complicaciones postoperatorias: dehiscencia parcial del colgajo (n = 6) y estenosis anal tardía (n = 4). En ningún caso se produjo la pérdida del colgajo. Siete pacientes presentaron buenos resultados en cuanto a la continencia anal, 2 pacientes incontinencia variable y en un caso se realizó una colostomía terminal por incontinencia grave. CONCLUSIÓN: Los colgajos V-Y son una técnica factible y efectiva para cubrir grandes defectos tras cirugías perianales agresivas; sin embargo, no están exentos de morbilidad postoperatoria

OBJECTIVES: Some perianal pathologies require aggressive surgery that will need techniques to allow to re-establish the integrity of the perianal region. The purpose is to analyze short and long term results after perineal reconstruction with V-Y flaps. OBJECTIVES: Some perianal pathologies require aggressive surgery that will need techniques to allow to re-establish the integrity of the perianal region. The purpose is to analyze short and long term results after perineal reconstruction with V-Y flaps. METHODS: A retrospective review of prospectively collected database was conducted at Virgen de la Arrixaca's Hospital in Murcia (España) between January 2000 and December 2013. The study includes all patients who underwent a perineal reconstruction with V-Y flaps. Demographic and surgical data and short-/long- term morbidity was recorded. RESULTS: 10 patients were included, 6 males and 4 females. The average age was 58,1 ± 17,4 years. Surgical indication included both malignant and benign pathologies. Operating time was 143,5 ± 41,3 min. R0 resection was performed in all cases although histopathological analysis showed involvement of the deeper margin in 3 cases. Length of hospital stay was 7,8 ± 7,6 days. Regarding complications: 6 patients had partial dehiscence of the flap. None of the patients lost the flap completely. The most frequent late complication was anal stenosis (n = 4). Follow up showed total continence in 7 patients. Two patients had variable fecal and/or flatus incontinence. A colostomy was made in one case due to severe incontinence. CONCLUSIONS: V-Y flaps are an effective and feasible technique to cover large perianal defects after aggressive surgeries. However, this technique is not free of postoperative morbidity

Detección del ganglio centinela mediante trazador paramagnético en el cáncer de tiroides. Estudio piloto técnico / Detection of the sentinel node using a magnetic tracer in thyroid cancer. A technical pilot study

Introducción: La detección del ganglio centinela (GC) no se ha generalizado en la enfermedad tiroidea. Sin embargo, la recientemente detección del GC mediante trazador paramagnético está siendo útil en la cirugía del cáncer de mama y melanoma. El objetivo es evaluar la utilidad del trazador superparamagnetic iron oxide para la detección intraoperatoria del GC en el cáncer papilar de tiroides sin afectación ganglionar en el estudio preoperatorio. Método: Estudio piloto unicéntrico y prospectivo con un producto sanitario de clase IIa (trazador paramagnético). Se incluyen cánceres de tiroides que tras el análisis cito-histológico son tumores T1-T2 con resultado negativo en la evaluación ganglionar preoperatoria, intervenidos de forma programada y consecutiva. Para la localización del GC se realiza una inyección intralesional de 2 ml de superparamagnetic iron oxide. A los 10 minutos se procede a detectar actividad ferromagnética en los ganglios adyacentes. Una vez detectado el ganglio se procede a su extracción y análisis intraoperatorio. Se evalúa la efectividad del procedimiento con la detección de GC, siendo la variable principal la detección o no de mismo. Resultados: Se evalúa el proyecto realizados los 5 primeros casos. Se localiza el CG en todos ellos, en los 4 primeros fácilmente, pero en el quinto fue dificultosa por su localización paratraqueal, que dio interferencias con el tubo endotraqueal con electrodos de neuroestimulación recurrencial. La histología intraoperatoria informó de GC positivo en el 80% (n = 4) de los casos (20% [n = 1] macrometástasis y 60% [n = 3] micrometástasis). Se realizó una tiroidectomía total y el GC condicionó la realización de vaciamientos centrales (n = 4) y un vaciamiento lateral. La histología informa de carcinoma papilar, tipo clásico en el 80% (n = 4) y en el 20% (n = 1) variante folicular. El 40% (n = 2) eran multifocales, el 40% (n = 2) presentaban afectación vascular y el 60% (n = 3) extensión extratiroidea. La estadificación condicionó la aplicación de yodoterapia (150 mCi) en el 80% de los casos (n = 4). Conclusiones: El tratador paramagnético puede ser útil para detectar el GC y estadificar correctamente el carcinoma papilar

Introduction: There is no standard procedure for the detection of the sentinel node (SN) in thyroid disease. However, the recent detection of the SN using a paramagnetic tracer is proving to be useful in breast cancer and melanoma. The objective was to assess the utility of super paramagnetic iron oxide tracer for the intraoperative detection of the SN in patients with papillary thyroid cancer without nodal involvement in the preoperative study. Method: A single center, prospective pilot study of a class IIa medical device (a paramagnetic tracer). The study included thyroid cancers which were T1-T2 tumors in the cytohistological analysis with a negative preoperative nodal assessment, operated on consecutively during scheduled treatment. For the localization of the SN, an interlesional injection of 2 mL of super paramagnetic iron oxide was administered. After ten minutes, ferromagnetic activity was detected in the adjacent nodes. Once the node had been detected, we proceeded by extracting it for intraoperative analysis. The effectiveness of the procedure for detecting the SN was assessed, with the main variable being whether it was detected or not. Results: The project was assessed after the first cases had been carried out. The SN was located in all cases, which was done easily in the first four, but in the fifth case the SN detection was complicated by the interference of the reusable neurostimulation electrodes with the ferromagnetic signal. Intraoperative histology revealed the SN was positive in 80% (n = 4) of cases (20% [n = 1] were macrometastases and 60% [n = 3] micrometastases). Total thyroidectomies were carried out, with central lymph node dissection in 4 of the patients and lateral in one due to the result of the detected SN. The histology showed the ca rcinoma was papillary, a classic type, in 80% (n = 4) and a follicular variant in 20% (n =1). Forty percent (n = 2) were multifocal, 40% (n = 2) had vascular infiltration, and 60% (n = 3) had extrathyroidal extension. Staging determined the application of radioactive iodine therapy (150 mCi) in 80% of cases (n = 4). Conclusions: A paramagnetic tracer can be useful for detecting the SN and correctly staging papillary carcinoma

Genetic parameters for canalisation analysis of litter size and litter weight traits at birth in mice.

The aim of this research was to explore the genetic parameters associated with environmental variability for litter size (LS), litter weight (LW) and mean individual birth weight (IW) in mice before canalisation. The analyses were conducted on an experimental mice population designed to reduce environmental variability for LS. The analysed database included 1,976 records for LW and IW and 4,129 records for LS. The total number of individuals included in the analysed pedigree was 3,997. Heritabilities estimated for the traits under an initial exploratory approach varied from 0.099 to 0.101 for LS, from 0.112 to 0.148 for LW and from 0.028 to 0.033 for IW. The means of the posterior distribution of the heritability under a Bayesian approach were the following: 0.10 (LS), 0.13 (LW) and 0.03 (IW). In general, the heritabilities estimated under the initial exploratory approach for the environmental variability of the analysed traits were low. Genetic correlations estimated between the trait and its variability reached values of -0.929 (LS), -0.815 (LW) and 0.969 (IW). The results presented here for the first time in mice may suggest a genetic basis for variability of the evaluated traits, thus opening the possibility to be implemented in selection schemes.