RESUMEN
BACKGROUND: Pelvic organ prolapse (POP) is an increasing medical problem with complex diagnostics and controversial surgical management. It causes a series of dysfunctions in the gynecological, urinary, and anorectal organs. Numerous procedures have been proposed to treat these conditions, but in recent years, ventral mesh rectocolposacropexy (VMRCS) has emerged as the procedure of choice for the surgical treatment of POP, especially by a laparoscopic approach. This surgical technique limits the risk of autonomic nerve damage, and the colpopexy allows the correction of concomitant prolapse of the middle compartment. However, symptoms derived from anterior compartment prolapse remain a major morbidity and sometimes require an additional procedure. The aim of this study is to evaluate the results of laparoscopic prosthetic rectocolposacropexy (LRCS) and colposacropexy (LCS) procedures performed to manage combined multicompartmental POP. METHODS: Between November 2008 and December 2017, 38 patients with symptomatic POP underwent rectocolposacropexy (RCS) or colposacropexy (CS) by a laparoscopic approach. Demographics, mortality, morbidity, hospital stay, and functional outcomes were retrospectively analyzed. RESULTS: The median operating time was 200 min (IQR 160-220). Additional simultaneous surgery for POP was performed in nine cases: five suburethral slings and four hysterectomies were performed. No mortality was recorded. The conversion rate was 7.89%. There were two intraoperative complications (5.26%): one enterotomy and one urinary bladder tear. Late complications occurred in 5.26% of cases. After a mean follow-up of 20 months, constipation was completely resolved or improved in 83.33% of patients, urinary stress incontinence was resolved or improved in 52.94%, and gynecological symptomatology was resolved or improved in 93.75%. The recurrence rate was 5.26%. CONCLUSIONS: Laparoscopic mesh rectocolposacropexy and colposacropexy are safe and effective techniques associated with very low morbidity. In the medium term, they provide good results for POP and associated symptoms, but urinary symptomology has a worse outcome.
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Procedimientos Quirúrgicos Ginecológicos/métodos , Prolapso de Órgano Pélvico/cirugía , Mallas Quirúrgicas , Anciano , Estreñimiento/etiología , Estreñimiento/cirugía , Femenino , Humanos , Histerectomía , Complicaciones Intraoperatorias , Laparoscopía/métodos , Tiempo de Internación , Persona de Mediana Edad , Tempo Operativo , Prolapso de Órgano Pélvico/complicaciones , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Mallas Quirúrgicas/efectos adversos , Resultado del Tratamiento , Incontinencia Urinaria de Esfuerzo/etiología , Incontinencia Urinaria de Esfuerzo/cirugíaRESUMEN
Introducción. La apendicitis aguda (AA) tradicionalmente se ha considerado una patología de gente joven. Con el envejecimiento progresivo de la población, aparece más frecuentemente a partir de los 65 años. El diagnóstico precoz y el tratamiento mínimamente invasivo evitarían una elevada morbi-mortalidad en estos pacientes. Material y métodos. Se realizó un estudio retrospectivo de las apendicectomías realizadas en un Hospital de Nivel 1 durante 2010-2016. Se seleccionaron los pacientes con edad mayor o igual a 65 años. Se efectuó un análisis descriptivo de la cohorte y después un análisis univariante, comparando AA complicada (plastrón, gangrenosa, perforada) frente a AA no complicada. Con las variables estadísticamente significativas (p<0,050) de éste, se realizó un análisis multivariante (método de Wald), para hallar factores predictores independientes para AA complicada. Resultados. De los 458 pacientes, 51 tenían edad ≥65 años. El 47,06% (24) tuvieron AA complicada. La mediana de edad fue 77 años [70,8-79,0]. El 70,8% eran varones. Edad, sexo, cirugía laparoscópica, evolución del dolor en horas, PCR mayor a 18 mg/ml y leucocitos mayor a 10.000/mL, fueron factores estadísticamente significativos en el análisis univariante. En el análisis multivariante, resultaron estadísticamente significativas: PCR>18mg/ml [OR=14,35(1,49-141,52)] y Leucocitos>10.000/mL [OR=11,70(1,15-119,26)]. Conclusiones. La apendicitis aguda es una entidad cada vez más frecuente en ancianos. Las escalas de probabilidad diagnóstica no son buenos predictores en ancianos. La PCR>18 mg/ml y los Leucocitos>10.000/mL demostraron ser factores predictores independientes para AA complicada. La apendicetomía laparoscópica se consolida como un tratamiento idóneo, seguro y con buenos resultados también en ancianos
Introduction. Acute appendicitis (AA) has traditionally been considered a pathology of young people. With the progressive aging of the population, it appears more frequently after 65 years of age. Early diagnosis and minimally invasive treatment would avoid a high morbidity and mortality in these patients. Material and methods. A retrospective study of appendectomies performed in a Level 1 Hospital during 2010-2016 was conducted. Patients older than or equal to 65 years were selected. A descriptive analysis of the cohort was made and then a univariate analysis, comparing complicated AA (plastron, gangrenous, perforated) versus uncomplicated AA. With the statistically significant variables (p <0.050) of this, a multivariate analysis (Walds method) was performed to find independent predictors for complicated AA. Results. Of the 458 patients, 51 were aged to 65 years. 47.06% (24) had complicated AA. The median age was 77 years [70.8-79.0]. 70.8% were males. Age, sex, laparoscopic surgery, pain evolution in hours, CRP greater than 18 mg / ml and leukocytes greater than 10,000 / mL were statistically significant factors in the univariate analysis. In the multivariate analysis, they were statistically significant: CRP> 18mg / ml [OR = 14.35 (1.49-141.52)] and Leukocytes > 10,000 / (L [OR = 11.70 (1.15-119, 26)]. Conclusions. Acute appendicitis is an increasingly common entity in the elderly. Diagnostic probability scales are not good predictors in the elderly. CRP> 18 mg / ml and Leukocytes> 10,000 / μL proved to be independent predictors for complicated AA. Laparoscopic appendectomy is consolidated as a suitable, safe treatment with good results also in the elderly