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Introducción: En los últimos años ha habido una gran difusión de la cirugía laparoscópica para el manejo de la patología colorrectal. La dehiscencia anastomótica es una de las complicaciones más graves, con una elevada morbi-mortalidad. La reoperación por vía laparoscópica podría ser una opción válida para tratar esta complicación, manteniendo ciertos beneficios del abordaje miniinvasivo. Objetivos: Evaluar la factibilidad y seguridad del abordaje laparoscópico en el manejo de la dehiscencia anastomótica en cirugía colorrectal y en forma secundaria comparar los resultados con la reoperación por vía convencional. Materiales y Método: Se analizó una serie retrospectiva, completada en forma prospectiva, se incluyeron 1693 pacientes (junio 2000 - septiembre 2018). Los pacientes que fueron reoperados por dehiscencia anastomótica se dividieron en dos grupos según el abordaje de la reoperación: laparoscópico (Grupo 1, G1) y laparotómico (Grupo 2, G2). Se compararon ambos grupos teniendo en cuenta factores demográficos, estadía hospitalaria, complicaciones, morbilidad y mortalidad. Las complicaciones se estratificaron según la clasificación de Dindo y Clavien, y se tuvieron en cuenta las más graves (categorías 3, 4 y 5). Para el análisis estadístico se utilizó el T student y chi cuadrado. Resultados: Ciento seis (6,26%) pacientes fueron reoperados por dehiscencia anastomótica. Ochenta y cinco (80%) fueron incluidos en el grupo 1 y 21 (20%) en el grupo 2. La única diferencia demográfica entre ambos grupos fue una mayor cantidad de pacientes obesos en el grupo laparoscópico (G1: 17 (20%) vs. G2: 0, p: 0,02). Hubo una tendencia hacia un intervalo menor entre la cirugía inicial y la reexploración, pero sin diferencias estadísticamente significativas (5,18 días vs. 6,23 días, p: 0,22). En 84 (79%) la conducta quirúrgica fue lavado y confección de ostomía proximal de protección (G1: 74 vs. G2: 10, p: 0,001). El desmonte de la anastomosis y la confección de ostomía terminal debió realizarse en 8 pacientes (G1: 4 vs G2: 4, p: 0,02). Nueve pacientes en G1 y 3 pacientes en G2 requirieron más de una cirugía (p: 0,63). Las complicaciones fueron similares entre ambos grupos, sólo se incluyeron los grados 3, 4 y 5 (G1: 21,2% vs G2: 28,6% p: 0,34). El promedio de estadía hospitalaria disminuyó con el abordaje laparoscópico (10,71 días vs. 11,57 días, p: 0,66), a pesar de que no hubo diferencia estadística entre ambos grupos. Conclusiones: La reintervención laparoscópica es un tratamiento válido y seguro para el manejo de la dehiscencia anastomótica en cirugía laparoscópica colorrectal. (AU)

Introduction: In recent years there has been a great diffusion of laparoscopic surgery for the management of colorectal pathology. Anastomotic dehiscence is one of the most serious complications, with high morbidity and mortality. Laparoscopic reoperation could be a valid option to treat this complication, maintaining certain benefits of the minimally invasive approach. Objectives: To evaluate the viability and safety of the laparoscopic approach in the management of anastomotic dehiscence in colorectal surgery and as a secondary end point to compare the results with those of reoperation by conventional approach. Material and Methods: A series of 1693 patients that underwent laparoscopic colorectal surgery was analyzed, from a prospective database (June 2000 - September 2018). Patients were divided into two groups according to the approach performed in the reoperative surgery: laparoscopy (G 1) or laparotomy (G 2). Demographic data, hospital stay, type of complication, morbidity and mortality were analyzed. Dindo-Clavien classification was used to stratify postoperative complications and only categories 3, 4 and 5 were included. Data were statistically analyzed with Student ́s t test and chi-square test.Results: A hundred six patients (6.26%) were reoperated because of AL, 85 (80%) by laparoscopy and 21 (20%) by conventional surgery. The only demographic difference between both groups was that more obese patients were included in G1 (G1: 17, 20% vs. G2: 0, p=0.02). Interval of time between surgeries was lower in G1 without statistical difference (5.18 vs. 6.23 days, p=0.22). In 84 patients (79%) abdominal lavage and loop ostomy was performed (G1: 74 vs. G2: 10, p=0.001). Anastomosis takedown was required in 8 patients (G1: 4 vs. G2: 4, p=0.02). 9 patients in G1 and 3 in G2 needed more than one reexploration (p= 0.63). Postoperative complications were similar in both groups, grades 3, 4 and 5 were included (G1: 21, 2% vs. G2: 28.6%, p= 0.34). In average hospital stay was decreased in G1 (10.7 vs. 11.6 days, p=0.66), without statistical difference. Conclusion: Laparoscopic reintervention can be a safe treatment for anastomotic leakage after laparoscopic colorectal surgery. (AU)

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AIM: To analyze the results of laparoscopic colectomy in complicated diverticular disease. METHODS: This was a retrospective cohort study conducted at an academic teaching hospital. Data were collected from a database established earlier, which comprise of all patients who underwent laparoscopic colectomy for diverticular disease between 2000 and 2013. The series was divided into two groups that were compared: Patients with complicated disease (abscess, perforation, fistula, or stenosis) (G1) and patients undergoing surgery for recurrent diverticulitis (G2). Recurrent diverticulitis was defined as two or more episodes of diverticulitis regardless of patient age. Data regarding patient demographics, comorbidities, prior abdominal operations, history of acute diverticulitis, classification of acute diverticulitis at index admission and intra and postoperative variables were extracted. Univariate analysis was performed in both groups. RESULTS: Two hundred and sixty patients were included: 28% (72 patients) belonged to G1 and 72% (188 patients) to G2. The mean age was 57 (27-89) years. The average number of episodes of diverticulitis before surgery was 2.1 (r 0-10); 43 patients had no previous inflammatory pathology. There were significant differences between the two groups with respect to conversion rate and hospital stay (G1 18% vs G2 3.2%, P = 0.001; G1: 4.7 d vs G2 3.3 d, P < 0.001). The anastomotic dehiscence rate was 2.3%, with no statistical difference between the groups (G1 2.7% vs G2 2.1%, P = 0.5). There were no differences in demographic data (body mass index, American Society of Anesthesiology and previous abdominal surgery), operative time and intraoperative and postoperative complications between the groups. The mortality rate was 0.38% (1 patient), represented by a death secondary to septic shock in G2. CONCLUSION: The results support that the laparoscopic approach in any kind of complicated diverticular disease can be performed with low morbidity and acceptable conversion rates when compared with patients undergoing laparoscopic surgery for recurrent diverticulitis.

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Introducción: Estudios prospectivos randomizados demostraron que la técnica "Procedimiento para Prolapso y Hemorroides" (PPH) es eficaz. Si bien esta cirugía reduce el dolor postoperatorio pocas publicaciones la incluyen como procedimiento ambulatorio. El objetivo de este trabajo es evaluar la factibilidad, la seguridad y los resultados del uso de PPH en forma ambulatoria para el tratamiento de la enfermedad hemorroidal. Diseño: Observacional retrospectivo. Pacientes y métodos: Se analizó una base de datos completada en forma prospectiva que incluía todos los pacientes operados de hemorroides con técnica PPH entre mayo del 2005 y mayo del 2009 bajo anestesia general con alta programada el mismo día del procedimiento. Resultados: En este período de 4 años de 74 pacientes operados con técnica PPH, 63 ingresaron bajo Cirugía Mayor Ambulatoria (85,1 por ciento). 41 pacientes (65 por ciento) fueron de sexo masculino. La edad promedio fue de 55 (28-79) años. El tiempo quirúrgico promedio fue 48,1 (20-120) minutos. 53 pacientes (84 por ciento) cumplieron con éxito el régimen ambulatorio, con internación promedio de 5,2 (2.2-9.2) horas. 10 pacientes (16 por ciento) debieron pernoctar en el hospital por diferentes causas: 4 por dolor intenso, 2 por vómitos, 1 por retención aguda de orina, 1 por hipotensión, 1 por eritema perianal y 1 por sangrado postoperatorio que requirió reoperación. 7 pacientes (11 por ciento) presentaron complicaciones postoperatorias tempranas (entre día 1 y 28 postoperatorio): 3 hematoma perianal, 1 trombosis externa, 1 fisura anal, 1 tenesmo rectal por edema de sutura y 1 dehiscencia de la hemorroideopexia. Con un seguimiento postoperatorio promedio de 24 (12 a 14) meses se han registrado 2 estenosis (3,1 por ciento) que se resolvieron con dilataciones y 7 recidivas (11.1 por ciento) que se resolvieron 6 con bandas elástica y 1 con PPH...

Background: Stapled haemorrhoidopexy has been shown in randomized controlled trials to be associated with less postoperative pain and an earlier return to normal activities. Given the decreased postoperative pain and no need for wound care, stapled haemorrhoidectomy should be feasible as a day surgery procedure. The objective of this study is to assess the safety, feasibility and results of stapled haemorrhoidopexy as day surgery procedure. Study design: Descriptive retrospective evaluation. Patients and methods: This is a retrospective study based on a prospective collected database. All consecutive patients with haemorrhoids who underwent stapled haemorrhoidopexy as day surgical procedure between May 2005 and May 2009 were included. Pre and perioperative parameters, early and late postoperative complications and long term results were analyzed. Results: In this period, PPH was performed in 74 patients. Of these, 63 (85 per cent) patients were considered appropriate candidates for day case surgery. 41 (65 per cent) were men and average age was 55 (28-79) years. Average operative time was 48 (20-120) minutes. 53 patients (84 per cent) successfully underwent stapled haemorrhoidopexy on a day case basis and the average hospital stay was 5.2 (2.2-9.2) hours. Ten patients (16 per cent) did not complete successfully the day case surgery and require staying at the hospital. Indications for admission were acute postoperative complications were as follow: four for analgesia, two for vomits, one for urinary retention, one for hypotension, one for perianal erythema and one for early postoperative bleeding who need reoperation. 7 patients (11 per cent) had early postoperative complications (1-28 days after surgery): 3 perianal hematoma, 1 thrombosis of the external haemorrhoidal plexus, 1 anal fissure, 1 tenesmus and 1 anastomotic dehiscence...

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BACKGROUND: Iatrogenic perforation due to colonoscopy is the most serious complication of this procedure. Usually, resolution of this event requires segmental resection. The laparoscopic approach could be an option to minimize the outcome of this complication. The aim of the present study was to assess the effectiveness of the laparoscopic approach in treating colonic perforations due to colonoscopy. METHODS: Between July 1997 and November 2008 data were collected retrospectively on all patients who underwent colonoscopy and had a perforation caused by the procedure. Patients with other complications after colonoscopy as well as other colonic perforations were excluded. According to the method employed for the approach, the series was divided in two groups: those treated by the laparoscopic approach (group I; GI) and those treated via laparotomy (group II; GII). Morbidity and recovery parameters were compared between the two groups. Statistical analysis was performed using Student's t-test and the chi square test. RESULTS: A total of 14,713 colonoscopies were performed during the study period. Of these, 10,299 (73 %) were diagnostics and 4,414 (27%) were therapeutics. There were 20 (0.13%) iatrogenic perforations (GI = 14 versus GII = 6). The mean age of the patients was 62 +/- 12.1 years. There were no differences in patient demographics, co-morbidities, and American Society of Anesthesiologists (ASA) grades between the groups. Seventeen patients had segmental colectomy with primary anastomosis (GI: 13 versus GII: 4). One patient in each group had simple suture with diverting ileostomy, and one patient from GII underwent a Hartmann's procedure. Patients from GI had a shorter hospital stay (GI: 4.2 +/- 2.06 days versus GII 11.5 +/- 8.8 days; P = 0.007) and there were no differences in complication rate compared with GII (GI: 3 versus GII: 5; P = 0.058). CONCLUSIONS: Laparoscopic colectomy is effective in resolving colonic perforation due to colonoscopy, and it might offer benefits over the open approach.

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La alternativa quirúrgica de elección para los pacientes con colitis ulcerosa (CU) refractaria al tratamiento médico es la proctocolectomía total con una reconstrucción a través de la confección de un reservorio ileal y una anastomosis ileo-anal. Esta cirugía permite la curación de la enfermedad con buen resultado funcional. A pesar de las demostradas ventajas, no está exenta de complicaciones. Una de las complicaciones es la inflamación sintomática del remanente rectal o cuffitis. Esta genera controversias importantes acerca de la técnica que debe utilizarse para la anastomosis ileo-anal debido a la asociación que presenta con la preservación de mucosa rectal en técnicas de sutura mecánica. El presente trabajo propone la revisión del tema y el análisis del enfoque actual de tratamiento, basada en un caso clínico.

Restorative proctocolectomy with ileal pouch is the treatment of choice in the majority of patients with ulcerative colitis (UC) refractory to medical treatment. This surgery can cure the disease with good functional outcome. Despite the proven benefits, is not without complications. One of the complications is symptomatic inflammation of the rectal remnant or cuffitis. This generates significant controversy about the technique to be used for the Ileo-anal anastomosis because of the association presented to the preservation of rectal mucosa in mechanical suture techniques. This paper proposes the review of the topic and analysis of the current approach to treatment based on one case.

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