RESUMEN
PURPOSE: The advantages offered by structured reporting have already been highlighted in the literature. However, there is still no evidence on the validity of this reporting method for the study of abdominal wall defects. This study aims to show the experience of the Trentino Hernia Team (THT) multidisciplinary group in the development and use of a structured CT scan report for the study of abdominal wall defects. METHODS: A regional multidisciplinary team (THT group) used a Delphi method to identify and select the most important CT scan parameters needed to describe and stage abdominal wall defects for correct preoperative planning. Based on the selected parameters, a CT scan structured report was worked out and collectively accepted. The first 20 structured reports obtained were individually tested for compilation speed and homogeneity of the data reported by five distinct radiologists. The reports were then evaluated by five different surgeons to test the simplicity of interpretation. RESULTS: We produced a model of a structured report for the study of the abdominal wall defects and tested it in our hospital network on the first 20 reports. The average completion time was 18 min (range 12-25). There was no heterogeneity among the reported data. The reports were analysed by five distinct surgeons to evaluate completeness and simplicity of interpretation. Each surgeon used a Likert scale from 0 to 5 to evaluate each report, producing average scores of 4.8 and 4.1 for completeness and comprehensibility respectively, with a mean combined total score of 8.9 out of 10. CONCLUSIONS: Our structured report represents a fundamental tool capable of providing the surgeon with all the measurements of the parameters necessary for correct preoperative planning. At the same time, it is of crucial help for the radiologists representing an easy and fast way to report all the needed parameters using the same standards.
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Pared Abdominal , Cirujanos , Pared Abdominal/diagnóstico por imagen , Pared Abdominal/cirugía , Herniorrafia , Humanos , Radiólogos , Tomografía Computarizada por Rayos X/métodosRESUMEN
INTRODUCTION: Surgical treatment of diastasis recti is still a matter of debate. Open approaches such as abdominoplasty, which offer the possibility to combine reparation of the diastasis with abdominal cosmetic surgery, are challenged by the emerging less-invasive laparoscopic or robotic techniques that offer shorter recovery for patients. However, evidence in favour of one of the two approaches concerning both short- and long-term complications and functional results is still lacking. In this paper, we analysed clinical and functional results of a new endo-laparoscopic technique for midline reconstruction (THT technique) in patients with primary abdominal wall defects associated with diastasis recti. METHODS: Prospective observational study on 110 consecutive patients was submitted to endo-laparoscopic reconstruction of the abdominal wall with linear staplers. Morbidity and relapse rates with clinical and radiological follow-up were recorded at 1, 6, 12, and 24 months after the operation. Data regarding the impact of surgery on patients' quality of life (EuraHSQol) on chronic low back pain (Oswestry Disability Index, ODI) and urinary stress incontinence (Incontinence Severity Index, ISI) were gathered. RESULTS: After a mean follow-up of 14 months, the morbidity rate was 9.1% and no recurrences were recorded. 6-month follow-up ultrasound showed a rectus muscles mean distance of 6.7 mm; EuraHSQol, ODI, and ISI scores significantly improved in 93%, 77%, and 63% of the cases, respectively. CONCLUSIONS: The THT technique proved to be a feasible, safe, and effective alternative for corrective surgery of primary midline hernias associated with diastasis recti. Short- and mid-term results are encouraging but need to be confirmed by further studies with longer follow-up. The achieved midline reconstruction offers a significant improvement of patients' perceived quality of life through reduction of abdominal wall pain, bulging, low back pain, and urinary stress incontinence.
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Pared Abdominal , Abdominoplastia , Diástasis Muscular , Pared Abdominal/cirugía , Humanos , Calidad de Vida , Recto del Abdomen/cirugíaRESUMEN
PURPOSE: Despite the recent growing interest of the scientific community, there is still no consensus on the actual applicability and effectiveness of sentinel lymph node (SL) procedure in colon cancers. This study aims to quantify feasibility, detection rate, negative predictive value, and accuracy of the SL identified with fluorescent dye in early colon cancers (ECC). METHODS: This study conducted a consecutive sampling of 95 patients with non-metastatic colorectal cancer who have been treated with laparoscopic colon resection and complete mesocolic excision after a 25-mg indocyanine green peritumoral laparoscopic injection and SL identification with a near-infrared camera. The SL was later isolated and sent to ultra-staging. RESULTS: Ninety-five patients with an average age of 71 (range 37-90) and a mean BMI of 25 (range 18-39) have been recruited. On the patient sample (92 Pts), an average of 1.49 SL (range 1-5) and a mean time of 4 min were identified. The detection rate was 96.8% and the negative predictive value and accuracy rates were 96.2% and 93.4%, respectively. CONCLUSIONS: Mapping the SL with fluorescent dye can play an important role in the treatment of colon cancers, particularly those at early stages, and can lead to ultra-conservative surgery.
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Neoplasias del Colon , Ganglio Linfático Centinela , Anciano , Neoplasias del Colon/patología , Humanos , Verde de Indocianina , Escisión del Ganglio Linfático , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Metástasis Linfática , Estadificación de Neoplasias , Ganglio Linfático Centinela/diagnóstico por imagen , Ganglio Linfático Centinela/patología , Ganglio Linfático Centinela/cirugía , Biopsia del Ganglio Linfático CentinelaRESUMEN
After curative surgery for rectal cancer, the goal of an aggressive surveillance programme is the detection of local recurrence (LR) at an early and potentially curable stage 62 patients (mean age 66.2 years) operated on for rectal cancer were prospectively enrolled in a follow-up study including endorectal ultrasound (EUS), serial CEA levels, digital examination, colonoscopy and pelvic CT. A total of 192 sonographic scans were performed, with a mean of three (range 2-7) for each patient. LR occurred in 11 patients; in all cases this was suggested by EUS. In two patients (18%) other techniques had failed to detect recurrent disease, which was identified solely by EUS. These two were treated radically and the remainder received radiotherapy or other palliative management. Five patients are alive at, on average, 18 months after LR (range 4-26 months). These include both cases treated with salvage surgery and who remain disease free. EUS is a valuable tool in the detection of locally recurrent rectal cancer.
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Endosonografía , Recurrencia Local de Neoplasia/diagnóstico por imagen , Neoplasias del Recto/diagnóstico por imagen , Anciano , Biomarcadores de Tumor/sangre , Antígeno Carcinoembrionario/análisis , Femenino , Estudios de Seguimiento , Humanos , Cuidados a Largo Plazo/métodos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/sangre , Recurrencia Local de Neoplasia/diagnóstico , Estudios Prospectivos , Neoplasias del Recto/sangre , Neoplasias del Recto/diagnóstico , Neoplasias del Recto/cirugía , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Local recurrence of rectal cancer (LR) after "curative" surgery is a major clinical problem, with a low resectability rate and a dismal prognosis. Prediction of LR might permit more targeted postoperative surveillance with earlier diagnosis of recurrent disease and might help in selecting the patients to be assigned to the most suitable adjuvant treatment protocol. To evaluate if a simple multivariate model could predict the LR and survival probability in the single case, we retrospectively evaluated 118 consecutive patients (63 males, 55 females; mean age 62 +/- 12 years) operated on for rectal cancer and followed up for a minimum of 4 years (range 51-111 months). Local recurrence rate was 28%, with a 6% of local + distant failure. Age and sex of patients, type of surgery, location of tumour in the rectum, size, morphology and grading of the tumour were all unrelated to the event under investigation. At Cox regression, the Dukes' stage and the postoperative radiotherapy were the only independent prognostic factors for LR (p < 0.001). The multivariate model was able to correctly reclassify the patients and predict local recurrence in 86.2% of the cases. Prevention of LR by adequate surgery and adjuvant therapy as well as its early detection offer the best prospect of improving the results of surgery for rectal cancer.
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Adenocarcinoma/cirugía , Recurrencia Local de Neoplasia , Neoplasias del Recto/cirugía , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Metástasis de la Neoplasia , Estadificación de Neoplasias , Radioterapia Adyuvante , Neoplasias del Recto/mortalidad , Neoplasias del Recto/patología , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Análisis de SupervivenciaRESUMEN
Functional assessment of pelvic pouch procedures for FAP is not different from that of UC and consists of clinical, manometric and radiologic investigations. Ileo-rectal anastomosis and pelvic pouch operation are equally effective for the disease, but function is still questionable after restorative proctocolectomy. Based on a personal series of 43 patients, relevant technical aspects influencing functional results are discussed and guidelines for a correct follow-up of these patients are presented.
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Poliposis Adenomatosa del Colon/cirugía , Poliposis Adenomatosa del Colon/fisiopatología , Adulto , Defecación , Femenino , Estudios de Seguimiento , Humanos , Ileostomía , Masculino , Proctocolectomía Restauradora , Factores de TiempoRESUMEN
We report a preliminary experience concerning the postoperative assessment of three patients who underwent gracilis neosphincter operation for severe fecal incontinence and were studied by computed tomography and anal endosonography soon after gracilis transposition and later after 6-8 weeks of neuromuscular training. Morphologic assessment was correlated with physiologic testing (manometry). Continence was satisfactorily improved in all patients. Both imaging techniques demonstrated the anatomy of the transposed muscle. Computed tomography also assessed lead placement onto the gracilis nerve root and the completeness of muscle transposition around the anal canal. Anal endosonography provided a more accurate assessment of the relation between the neosphincter and residual external sphincter.
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Canal Anal/diagnóstico por imagen , Terapia por Estimulación Eléctrica , Incontinencia Fecal/cirugía , Músculo Esquelético/trasplante , Tomografía Computarizada por Rayos X , Adulto , Canal Anal/cirugía , Cateterismo/instrumentación , Defecación , Humanos , Masculino , Manometría , Fibras Musculares de Contracción Lenta/fisiología , Husos Musculares/fisiología , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/inervación , Presión , Transductores de Presión , UltrasonografíaRESUMEN
In order to correlate operative findings with external anal sphincter (EAS) defects identified on anal endosonography (AES), 30 faecally incontinent patients undergoing overlapping sphincteroplasty or total pelvic floor repair were investigated by AES before and after surgery. Endosonic findings were correlated with the appearance of EAS at operation. 21 out of 22 defects seen at surgery had been pre-operatively detected by AES (one false negative). Post-operatively the sphincteroplasty was clearly evident on AES. In three cases of failure it showed an extensive hypoechoic area and these patients underwent dynamic graciloplasty. Endosonography is the method of choice for pre-operative imaging of EAS, having an established role in identifying sphincter defects and correlating well with intraoperative findings. Post-operatively, it has the potential to identify breakdown of the previous repair, allowing prompt surgical intervention. Endosonography is helpful in planning the best type of operation following sphincter injury and is useful in auditing the results of surgery.