RESUMEN
INTRODUCTION: The authors present anatomical division of the rectum and then give a short overview of the rectal surgery development. Currently, even in departments specialized in colorectal surgery, 25-30% of the rectal carcinoma cases must be managed by abdominoperineal amputations. COMPLICATIONS OF AMPUTATION PROCEDURES: The study deals with complications following extirpation of the rectum, like bleeding and its management, inflammatory complications during the healing process or following healing of the perineum. However, pelvic relapses, which in most cases cannot be managed surgically, remain the major therapeutic problem. These cases are indicated for systemic treatment with combinations of cytostatic drugs, eventually for radiotherapy. RESULTS: 324 patients with rectal carcinomas were operated at the 1st Surgical Clinic of the VFN in Prague. In 230 cases, resection was completed, in 94 cases, the rectum was amputated. In 78 cases, sutures of the pelvic floor was conducted, 64 cases healed per primam within 3 weeks, 11 healed per secundam within 3 months. In 16 cases, tamponade with surgical cover sheets and longettes was applied. 70% of these patients healed within 12 weeks of the surgery. In 3 cases, chronic fistules persisted for over 6 months. In 11 cases, locoregional relapses occurred. In 2 cases, radical excision was conducted, the other underwent systemic chemotherapy. CONCLUSION: Good preoperative care of the intestine, ATB prophylaxis and saving surgical technique were the precautions taken with the aim to prevent inflammatory complications. With respect to management difficulties of local relapses following amputations of the rectum, a requirement for total excisioning of the mesorectum on the first operation is substantial.
Asunto(s)
Complicaciones Posoperatorias , Neoplasias del Recto/cirugía , Recto/cirugía , Absceso/etiología , Adulto , Anciano , Procedimientos Quirúrgicos del Sistema Digestivo , Femenino , Humanos , Inflamación , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Diafragma Pélvico/patología , Diafragma Pélvico/cirugía , Cicatrización de HeridasRESUMEN
A fistule is defined as a canal or a cavity, created by necrotic degradation of the tissue, which may, (but not necessarily has to) communicate directly with the digestive tract via an internal orifice. In case of the Crohn's disease, the abscesi and fistules result from the same pathological process and are caused by penetration of the inflammatory process through the wall of the digestive tube and to its outer side. The authors, having initially described the types and the pathogenesis of the anal fistules in the Crohn's disease, present a brief examination algorithm including examination of the whole digestive tract, based on the pan-entero-colitic character of the disorder. Sound diagnostics and establishment of the disease activity is very important, beacuse the treatment strategy differs from that of other perianal inflammatory affections. Furthermore, options for both the surgical and conservative treatment are listed in this work, including experience with use of the advancement flap. According to some authors, the success-rate of this treatment reaches up to 80%.