RESUMEN
BACKGROUND: Since the introduction of laparoscopic colectomy in 1991, experience in laparoscopic bowel surgery has gradually increased. Several reports from specialized centers have demonstrated that laparoscopic colorectal resections are feasible and safe, providing an acceptable alternative to laparotomy for a variety of diseases. Some studies have shown the feasibility, safety, and good functional outcome of the minimally invasive procedures for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). No known studies have investigated laparoscopic proctocolectomy in México. This report aims to describe the first laparoscopic proctocolectomies with ileal pouch anal anastomosis (IPAA) performed at the Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán (INCMNSZ). METHODS: All the patients in the authors' institution who underwent a one- or two-stage laparoscopic total proctocolectomy with IPAA between June 2005 and December 2006 were included in the study. All the operations were performed by the same surgeon, who had already completed the learning curve for colorectal laparoscopic procedures. RESULTS: For the study, 10 patients underwent a laparoscopic proctocolectomy with IPAA by a single surgeon. Eight of the patients underwent a one-stage procedure, whereas two patients with severe colitis underwent a two-step procedure. All the cases were managed with a diverting loop ileostomy. Six patients underwent a standard double-stapled IPAA anastomosis, and two patients with FAP underwent a mucosectomy with a manual IPAA anastomosis. The mean operative time was 187 min, and the mean blood loss was 46 ml. There were two postoperative complications. One patient presented with an early small bowel obstruction due to an internal hernia, which required reoperation. The other complication was a wound infection. The mean return to oral intake was 1.5 days, and the mean length of hospital stay was 3.4 days. CONCLUSION: Although this was not a comparative study and although sample size imposed limitations, with this preliminary data, we conclude that the laparoscopic approach to UC and FAP at our institution is safe, feasible, and effective. However, to achieve the benefits in postoperative outcome, this procedure should be performed only by experienced laparoscopic surgeons.
Asunto(s)
Poliposis Adenomatosa del Colon/cirugía , Colitis Ulcerosa/cirugía , Laparoscopía , Proctocolectomía Restauradora , Adulto , Pérdida de Sangre Quirúrgica , Estudios de Factibilidad , Femenino , Hernia/complicaciones , Humanos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Tiempo de Internación , Masculino , México , Persona de Mediana Edad , Complicaciones Posoperatorias , Proctocolectomía Restauradora/efectos adversos , Proctocolectomía Restauradora/métodos , Reoperación , Infección de la Herida Quirúrgica , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVES: The objectives are obtain the internal consistency, validity and factorial structure of the Self-Efficacy for AIDS scale, which was developed in American population by Kasen, Vaughan and Walter (1992) and adapted in mexican samples for López and Padilla (1999). INSTRUMENTS: It is employed the Self-efficacy to Prevent the AIDS Scale of 27 items of López and Padilla (1999), together with closed questions Likert type, dicotomics and two opened questions on relevant aspects of the sexual conduct to validate the scale, under a format self-applied test of pencil and paper. MATERIAL AND METHODS: It is a correlacional study with a not experimental design of transverse type. It was accomplished with a simple random sample of 962 adolescents wich were taken of 60 public health centers of Monterrey. None went to consult by motives related to the AIDS. RESULTS: The scale was adjusted to a normal distribution (Zk-s(Normal) = 1.369; p = 0.047). It presents a mean of 95.14 and a standard deviation of 25.80. Its reliability, by the alpha of Cronbach, was 0.89. SEA-27 shows a structure of four independent factors that explain 58.47% of the total variance. CONCLUSIONS: Thus, it is concluded that SEA-27 is a reliable and valid scale.