RESUMO
Transanal access is one of many currently used procedures for rectal cancer treatment. The techniques used for local excision include conventional transanal excision, posterior access, therapeutic colonoscopy and transanal endoscopic approaches. The aim of the present study was to present a new surgical proctoscope for the endoscopic transanal excision of rectal lesions. A cylindrical proctoscope with a diameter of 4 cm was devised and built. The end inserted into the anus has a bevelled aspect and rounded borders, allowing correct exposure of the anal lesion. The rectoscope is fixed to the anal border with surgical thread through perforations in the external end. A base screw holds a fibre-light which illuminates the operative field. Part of the equipment is a guide which is positioned inside the rectoscope on insertion into the anus. In operations utilizing this proctoscope, 17 adenomas, 25 adenocarcinomas, 1 carcinoid and 1 endometrioma were excised. The diameter of the lesions varied from 1 to 6 cm. The range of procedures that are possible with this new proctoscope are similar to those achieved with conventional techniques which, however, require more expensive equipment. Hence, the present study demonstrates that this newly devised low-cost proctoscope is an efficient tool for the transanal endoscopic excision of rectal lesions.
Assuntos
Adenocarcinoma/cirurgia , Adenoma/cirurgia , Proctoscópios , Neoplasias Retais/cirurgia , Endoscopia Gastrointestinal/métodos , Desenho de Equipamento , HumanosRESUMO
A apendicite crônica e a apendicite recorrente säo condiçöes patológicas que diferem da apendicite aguda, a afecçäo mais comum do apêndice vermiforme. O propósito desse artigo é decifrar com critério os aspectos clínicos, o diagnóstico e a histopatologia da apendicite crônica e da apendicite recorrente. Os dados da literatura e as experiências clínica e cirúrgica dos autores, demonstradas por 10 pacientes com idade média entre 40 e 45 anos, com distribuiçäo similar quanto ao sexo, sendo 6 pacientes com apendicite recorrente e 4 com apendicite crônica, permitem concluir que a apendicite crônica e a recorrente já näo devem ser mais uma controvérsia ou dúvida, mas um fato inequívoco de importâncias clínica e acadêmica. Portanto, seus conceitos merecem difusäo na literatura científica e nas escolas médicas.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Apendicite , Apendicectomia , Apendicite , Doença CrônicaRESUMO
A técnica cirúrgica mais utilizada no tratamento do prolapso retal é a sacropromontofixaçäo do reto por via abdominal, porém nos últimos anos a proctossigmoidectomia via perineal tem sido retomada como alternativa para pacientes idosos com comorbidades. Revisamos 14 casos operados pela proctossigmoidectomia via perineal (cirurgia de Altemeier), sendo 13 mulheres e 1 homem. Destes pacientes havia 50 por cento de obstipados, 14,2 por cento tinham diarréia crônica e 64,2 por cento eram previamente incontinentes. Idade média de 72,2 anos, 64,2 por cento com anastomose manual e 35,8 por cento mecânica, além de 42,9 por cento com reparo anal posterior no mesmo tempo operatório. O tempo médio de internaçäo foi de 3,8 dias, näo houve complicaçöes imediatas ou precoces e apenas ocorreu recidiva em 01 paciente, 7,1 por cento. Pelos bons resultados, baixa morbi-mortalidade e recidiva aceitável e de acordo com a literatura nos encorajamos à utilizaçäo desta técnica para correçäo do prolapso retal.
Assuntos
Humanos , Masculino , Feminino , Idoso , Colo Sigmoide , Cirurgia Colorretal , Prolapso Retal , Anastomose Cirúrgica/métodos , Procedimentos Cirúrgicos do Sistema Digestório , RecidivaRESUMO
We report two cases of massive lower gastrointestinal (LGI) bleeding occurring in young adult men, as the first manifestation of pseudocyst of the pancreas. Despite the rarity of such a complication, pancreatic pseudocyst should be kept in mind as a possible source of massive LGI bleeding requiring immediate surgical treatment.
Assuntos
Hemorragia Gastrointestinal/etiologia , Pseudocisto Pancreático/complicações , Adulto , Colo/patologia , Constrição Patológica/etiologia , Humanos , Masculino , Ruptura Espontânea , Artéria Esplênica/lesõesRESUMO
Two types of single-layer sutures in intestinal anastomoses were compared in female dogs regarding safety, time of execution of anastomoses, amount of thread used, histopathology, impermeability and resistance to tension. Two colon anastomoses were carried out in each animal with either continuous or separate-stitch suture (monofilament nylon 4-0 thread). Before surgery the animals underwent intestinal cleaning and they were sacrificed on day 28 after the operation. Impermeability and resistance to tension by gaseous insufflation were tested, in five animals, immediately after surgery. Regarding safety, impermeability, border coaptation, inflammatory reaction and cicatrization in both types of suture presented similar results. Time of execution of the anastomosis was shorter for continuous suture and amount of thread used was smaller than for separate-stitch suture, representing lower cost for this type of anastomosis.
Assuntos
Animais , Feminino , Cães , Anastomose Cirúrgica/métodos , Colo/cirurgia , Técnicas de Sutura , Permeabilidade , Resistência à TraçãoRESUMO
Of 34 patients with massive lower intestinal bleeding, 17 (11 men and 6 women, age range 33-85 years; mean 64.8 years) were diagnosed as having angiodysplasia of the colon. The diagnosis was made by colonoscopy and the lesions were treated successfully by fulguration in 13 (86.6 per cent) of 15 patients. Two of the 17 patients underwent surgical resection of the involved intestinal segment. One patient still has sporadic intestinal haemorrhage, and another patient died from bleeding of the left colon after blind right colectomy. The remaining 13 patients have had no further bleeding in the 1-7 years following colonoscopic fulguration. Colonoscopy is a useful method of diagnosing angiodysplasia of the colon and affords the possibility of treatment.