RESUMEN
BACKGROUND: Despite decennia of experience, ileal pouch anal anastomosis for ulcerative colitis is still associated with high complication rates. The development of automatic vessel sealers has resulted in the revival of a promising surgical alternative to the conventional procedure: close rectal dissection. By preserving the mesorectal layer it is hypothesized that nerve-related and other postoperative complications can be reduced. METHODS: All patients with ulcerative colitis with indication for restorative proctocolectomy at our institution during the pilot study underwent the close rectal pouch procedure with temporary diverting ileostomy. Standardized clinical history, anorectal physiology measurements, and endoscopic and histological examination were carried out before and after surgery. RESULTS: The procedure was technically successful in all 10 patients, with a median age of 41 years and a median postoperative follow-up period of 16 months. There were no cases of pelvic sepsis and bladder or sexual dysfunction. The median daytime defecation frequency was 6.0. Endoscopic and histological examination showed no abnormalities. The anorectal physiology supported the good functional results. CONCLUSION: The preliminary results of the close rectal pouch procedure are promising, with good functional results and a low complication rate after 1 year.
Asunto(s)
Colitis Ulcerosa/cirugía , Proctocolectomía Restauradora/efectos adversos , Proctocolectomía Restauradora/métodos , Recto/cirugía , Adulto , Canal Anal/fisiopatología , Reservorios Cólicos/efectos adversos , Defecación , Femenino , Estudios de Seguimiento , Humanos , Ileostomía , Masculino , Manometría , Persona de Mediana Edad , Proyectos Piloto , Sepsis/etiología , Disfunciones Sexuales Fisiológicas/etiología , Trastornos Urinarios/etiología , Adulto JovenRESUMEN
Acute pancreatitis is a disease with a variety of symptoms. In patients in whom the disease takes a more severe course, stabilization is mandatory, often in a high dependency unit or intensive care unit. When the pancreatitis is of biliary origin and cholangitis and cholestatic changes are proven or suspected, an endoscopic cholangiopancreaticography is indicated. Aggressive organ support and continuation of the prophylactic antibiotics are the mainstay of treatment. When infected necrosis has been proven by CT-guided fine needle biopsy, surgical necrotectomy and debridement with drainage are necessary. Enteral feeding is superior to parenteral feeding even in situations of severe pancreatitis. Further investigation into the role of selective digestive tract decontamination, by controlled randomized trials, is needed.