Pub Date : 2018-12-01DOI: 10.4067/s0718-40262018000600557
Alejandra de Andrés Gómez, F. V. Ferrer, A. M. Abellán, A. Ismail, Ramón Gómez Contreras, Carla Navarro Moratalla, Javier Precioso Estiguin, C. Fernández
Objetive: Ambulatory or overnight stay surgery have been consolidated in many different procedures. However, its use in thyroid and parathyroid surgery is still controversial. The aim of this report is to present the results of 6 years of ambulatory patients undergoing surgery of the thyroid or parathyroid glands. Material and Methods: Prospective observational study of patients who underwent hemithyroidectomy or selective parathyroidectomy in the ambulatory program from January 2011 to December 2016. All patients included met the general criteria of ambulatory surgery. During the first years nodules bigger than 3cm and patients classified as ASA III were excluded. Patients arrive at hospital the morning of surgery. After the operation, patients pass to the post-anesthesia care unit and then to the hospitalization room. 8 hours after surgery patients are discharged home if they meet the criteria. Results: 270 patients were operated, 159 of them met the inclusion criteria. The overall applicability rate was 59%. The acceptance rate was 83.6% and the substitution index was 49.2%. The unwanted hospital admission was 10.4% for the parathyroidectomy and 17.6% for the hemithyroidectomy. Any patient presented major complications at home. The satisfaction rate was high or very high for 94% of the patients. Conclusion : Selective parathyroidectomy and hemithyroidectomy performed by experienced surgeons in selected patients can be safely and effectively carried out in ambulatory surgery (outpatient). It would be possible to improve the substitution index by increasing the application and acceptability ratios.
{"title":"Cirugía mayor ambulatoria de la glándula tiroides y paratiroides. Resultados tras 6 años de experiencia","authors":"Alejandra de Andrés Gómez, F. V. Ferrer, A. M. Abellán, A. Ismail, Ramón Gómez Contreras, Carla Navarro Moratalla, Javier Precioso Estiguin, C. Fernández","doi":"10.4067/s0718-40262018000600557","DOIUrl":"https://doi.org/10.4067/s0718-40262018000600557","url":null,"abstract":"Objetive: Ambulatory or overnight stay surgery have been consolidated in many different procedures. However, its use in thyroid and parathyroid surgery is still controversial. The aim of this report is to present the results of 6 years of ambulatory patients undergoing surgery of the thyroid or parathyroid glands. Material and Methods: Prospective observational study of patients who underwent hemithyroidectomy or selective parathyroidectomy in the ambulatory program from January 2011 to December 2016. All patients included met the general criteria of ambulatory surgery. During the first years nodules bigger than 3cm and patients classified as ASA III were excluded. Patients arrive at hospital the morning of surgery. After the operation, patients pass to the post-anesthesia care unit and then to the hospitalization room. 8 hours after surgery patients are discharged home if they meet the criteria. Results: 270 patients were operated, 159 of them met the inclusion criteria. The overall applicability rate was 59%. The acceptance rate was 83.6% and the substitution index was 49.2%. The unwanted hospital admission was 10.4% for the parathyroidectomy and 17.6% for the hemithyroidectomy. Any patient presented major complications at home. The satisfaction rate was high or very high for 94% of the patients. Conclusion : Selective parathyroidectomy and hemithyroidectomy performed by experienced surgeons in selected patients can be safely and effectively carried out in ambulatory surgery (outpatient). It would be possible to improve the substitution index by increasing the application and acceptability ratios.","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4067/s0718-40262018000600557","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47233494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-01DOI: 10.4067/s0718-40262018000600580
C. Nazar J., R. Coloma D., José Ignacio Contreras C., Ian Molina P., R. Fuentes H
{"title":"Consideraciones perioperatorias en el paciente obeso","authors":"C. Nazar J., R. Coloma D., José Ignacio Contreras C., Ian Molina P., R. Fuentes H","doi":"10.4067/s0718-40262018000600580","DOIUrl":"https://doi.org/10.4067/s0718-40262018000600580","url":null,"abstract":"","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4067/s0718-40262018000600580","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70194072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-01DOI: 10.4067/S0718-40262018000600535
Nicolás Pereira C., H. Suh, Joon Pio Hong
Diabetic foot ulcers are the main risk factor for non-traumatic amputations in people with diabetes. A succesful intervention requires a thorough understanding of the pathogenesis and a timely and standardized implementation of an effective treatment. A multidisciplinary approach is needed to initially control and treat multiple factors that cause severe diabetic foot ulceration. Debridement, infection control, and revascularization are key steps in wound stabilization and preparation for successful reconstruction. Microsurgery and supermicrosurgery provide a well-vascularized tissue to control infection, an adequate shoe contour, durability and solid anchorage to resist shearing forces during gait. In this way, the salvage of the limb can be achieved, improving the quality of life and increasing the survival rate.
{"title":"Úlceras del pie diabético: importancia del manejo multidisciplinario y salvataje microquirúrgico de la extremidad","authors":"Nicolás Pereira C., H. Suh, Joon Pio Hong","doi":"10.4067/S0718-40262018000600535","DOIUrl":"https://doi.org/10.4067/S0718-40262018000600535","url":null,"abstract":"Diabetic foot ulcers are the main risk factor for non-traumatic amputations in people with diabetes. A succesful intervention requires a thorough understanding of the pathogenesis and a timely and standardized implementation of an effective treatment. A multidisciplinary approach is needed to initially control and treat multiple factors that cause severe diabetic foot ulceration. Debridement, infection control, and revascularization are key steps in wound stabilization and preparation for successful reconstruction. Microsurgery and supermicrosurgery provide a well-vascularized tissue to control infection, an adequate shoe contour, durability and solid anchorage to resist shearing forces during gait. In this way, the salvage of the limb can be achieved, improving the quality of life and increasing the survival rate.","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4067/S0718-40262018000600535","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44953912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-01DOI: 10.4067/S0718-40262018000600501
J. F. Reoyo-Pascual, C. Cartón-Hernández, Guillermo Cabriada-García, Raquel León-Miranda, Gregorio Moral-Moral, Francisco Javier Sánchez-Manuel
{"title":"Linfoma no Hodgkin y carcinomatosis peritoneal: una imagen a recordar","authors":"J. F. Reoyo-Pascual, C. Cartón-Hernández, Guillermo Cabriada-García, Raquel León-Miranda, Gregorio Moral-Moral, Francisco Javier Sánchez-Manuel","doi":"10.4067/S0718-40262018000600501","DOIUrl":"https://doi.org/10.4067/S0718-40262018000600501","url":null,"abstract":"","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45935070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-01DOI: 10.4067/S0718-40262018000600551
Lucas N. Pina, C. Villa, María Laprovitta, Gonzalo Carles
Introduction: The imaging test have become an important piece on the diagnosis of the acute abdomen in emergency, nevertheless medical conduct should be based on contextualized iconographic findings. The tomographic “whirlpool sign” establishes a surgical paradigm for its association with the bowel volvulus. Objetive: To register patients with diagnosis of acute abdomen looking for the “whirlpool sign” in the computed tomography and identify who needed surgical intervention. Methods: Analytical cross-sectional study. 115 tomographies of acute obstructive abdomen have being evaluated. Results: 15 tomographies were excluded. The prevalence of the whirlpool sign was 5%. Diagnoses were intestinal malrotation (2%), midgut volvulus (1%), sigmoid volvulus (1%) and enterocolitis (1%). Only 60% of the patients required surgery. Discussion: The presence of the “whirlpool sign” not always determines a surgical resolution. It is not a pathognomonic sign of a punctual entity; it could represent an ordinary finding in the context of several pathologies. To apply the correct treatment, surgical or medical, for these patients it was important to recognize “whirlpool sign” variants.
{"title":"Signo del remolino: cirugía de urgencia o falacia ad populum","authors":"Lucas N. Pina, C. Villa, María Laprovitta, Gonzalo Carles","doi":"10.4067/S0718-40262018000600551","DOIUrl":"https://doi.org/10.4067/S0718-40262018000600551","url":null,"abstract":"Introduction: The imaging test have become an important piece on the diagnosis of the acute abdomen in emergency, nevertheless medical conduct should be based on contextualized iconographic findings. The tomographic “whirlpool sign” establishes a surgical paradigm for its association with the bowel volvulus. Objetive: To register patients with diagnosis of acute abdomen looking for the “whirlpool sign” in the computed tomography and identify who needed surgical intervention. Methods: Analytical cross-sectional study. 115 tomographies of acute obstructive abdomen have being evaluated. Results: 15 tomographies were excluded. The prevalence of the whirlpool sign was 5%. Diagnoses were intestinal malrotation (2%), midgut volvulus (1%), sigmoid volvulus (1%) and enterocolitis (1%). Only 60% of the patients required surgery. Discussion: The presence of the “whirlpool sign” not always determines a surgical resolution. It is not a pathognomonic sign of a punctual entity; it could represent an ordinary finding in the context of several pathologies. To apply the correct treatment, surgical or medical, for these patients it was important to recognize “whirlpool sign” variants.","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44400294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-01DOI: 10.4067/s0718-40262018000600571
C. Muñoz C., G. Sepulveda D., Alvaro Tapia V., Gloria Vergara A., Marcelo Santelices B., Rodrigo Vega F., Hernán Araya M.
{"title":"Hepatectomía en 2 tiempos con técnica de ALPPS (Asociación de bipartición hepática con ligadura portal para hepatectomía en 2 tiempos). Experiencia y resultados iniciales del Hospital Regional de Talca","authors":"C. Muñoz C., G. Sepulveda D., Alvaro Tapia V., Gloria Vergara A., Marcelo Santelices B., Rodrigo Vega F., Hernán Araya M.","doi":"10.4067/s0718-40262018000600571","DOIUrl":"https://doi.org/10.4067/s0718-40262018000600571","url":null,"abstract":"","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4067/s0718-40262018000600571","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70193524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-01DOI: 10.4067/S0718-40262018000600523
R. Franco-Herrera, Marta Cuadrado-Ayuso, Alejandro Sánchez-Arteaga, David Alías-Jiménez, Jaime Ruíz-Tovar, Jesús Lago-Oliver
Introduction: The incidence of anal cancer has increased in recent years. It is mediated by HPV and preceded by precancerous changes, raising the possibility of directing preventive efforts towards high-risk groups. The indication of screening remains controversial and which methods would be the ideal ones. Objective: To validate the screening tests established actually, comparing it with the biopsy considered as the “gold standard”. Materials and Methods: A cross-sectional study was performed, with prospective data collection in a cohort of VIH+ patients, who have male homosexual anal relations, belonging to Gregorio Marañón and Infanta Leonor Hospitals in a period of 2 years. Results: A total of 179 patients were selected with 286 visits to the screening Outpatient Clinic in which 3 parallel screening tests were performed (anal cytology, HPV genotyping and high resolution anoscopy (AAR) with a biopsy directed on a suspicious or random area). The sensitivity and specificity for the detection of high-grade dysplasia and cancer and their degree of agreement with the biopsy was as follows: cytology 3.23%/94.43% (k: 0.03), high HPV genotyping. risk 90.32%/27.45% (k: 0.05), AAR 32.26%/87.45 (k: 0, 17), the diagnostic accuracy of the three tests being very low. Conclusion: Cytology shows a very low diagnostic accuracy compared to the genotype that represents the highest one. In light of our results, clinical protocols as they are currently being developed should be abandoned.
{"title":"¿Permiten la citología, el genotipado y la anoscopia de alta resolución establecer un protocolo para la detección precoz del carcinoma epidermoide de canal anal en población de riesgo?","authors":"R. Franco-Herrera, Marta Cuadrado-Ayuso, Alejandro Sánchez-Arteaga, David Alías-Jiménez, Jaime Ruíz-Tovar, Jesús Lago-Oliver","doi":"10.4067/S0718-40262018000600523","DOIUrl":"https://doi.org/10.4067/S0718-40262018000600523","url":null,"abstract":"Introduction: The incidence of anal cancer has increased in recent years. It is mediated by HPV and preceded by precancerous changes, raising the possibility of directing preventive efforts towards high-risk groups. The indication of screening remains controversial and which methods would be the ideal ones. Objective: To validate the screening tests established actually, comparing it with the biopsy considered as the “gold standard”. Materials and Methods: A cross-sectional study was performed, with prospective data collection in a cohort of VIH+ patients, who have male homosexual anal relations, belonging to Gregorio Marañón and Infanta Leonor Hospitals in a period of 2 years. Results: A total of 179 patients were selected with 286 visits to the screening Outpatient Clinic in which 3 parallel screening tests were performed (anal cytology, HPV genotyping and high resolution anoscopy (AAR) with a biopsy directed on a suspicious or random area). The sensitivity and specificity for the detection of high-grade dysplasia and cancer and their degree of agreement with the biopsy was as follows: cytology 3.23%/94.43% (k: 0.03), high HPV genotyping. risk 90.32%/27.45% (k: 0.05), AAR 32.26%/87.45 (k: 0, 17), the diagnostic accuracy of the three tests being very low. Conclusion: Cytology shows a very low diagnostic accuracy compared to the genotype that represents the highest one. In light of our results, clinical protocols as they are currently being developed should be abandoned.","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4067/S0718-40262018000600523","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44258676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-01DOI: 10.4067/S0718-40262018000600589
C. Pereira, Isao Koshima
Lymphedema is the accumulation of protein-rich fluid in the interstitium, secondary to abnormalities in the lymphatic transport system. In developed countries it is more often related to surgical treatment of cancer. The clinical diagnosis and through imaging techniques is fundamental to evaluate the functional status of the lymphatic system. The main objectives in managing lymphedema are to limit patient morbidity, improve functionality and quality of life. Surgical treatment is an option when conservative measures are no longer sufficient. There are procedures that seek to prevent the development of lymphedema, and techniques that include physiological (reconstructive) and resective procedures that are used when lymphedema is already established. Success depends on a good selection of patients and the completion of an individualized treatment. The following is a review article of the latest diagnostic strategies and update in surgical techniques with emphasis on microsurgical treatment.
{"title":"Linfedema: actualización en el diagnóstico y tratamiento quirúrgico","authors":"C. Pereira, Isao Koshima","doi":"10.4067/S0718-40262018000600589","DOIUrl":"https://doi.org/10.4067/S0718-40262018000600589","url":null,"abstract":"Lymphedema is the accumulation of protein-rich fluid in the interstitium, secondary to abnormalities in the lymphatic transport system. In developed countries it is more often related to surgical treatment of cancer. The clinical diagnosis and through imaging techniques is fundamental to evaluate the functional status of the lymphatic system. The main objectives in managing lymphedema are to limit patient morbidity, improve functionality and quality of life. Surgical treatment is an option when conservative measures are no longer sufficient. There are procedures that seek to prevent the development of lymphedema, and techniques that include physiological (reconstructive) and resective procedures that are used when lymphedema is already established. Success depends on a good selection of patients and the completion of an individualized treatment. The following is a review article of the latest diagnostic strategies and update in surgical techniques with emphasis on microsurgical treatment.","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4067/S0718-40262018000600589","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46973152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-20DOI: 10.4067/S0718-40262018000500448
F. L. Begliardo, Milagros Corpacci, R. H. Gil, Fernando Martínez-Lascano
Objective: Describe a case report of a hydatid splenic cyst of one year of evolution, treated by laparoscopy. Materials and Methods: A 36-year-old woman with left upper quadrant pain for 1 year. The topographic study showed a 67mm splenic cystic lesion. Laparoscopic splenectomy was performed without incident. Result: Favorable post-operative evolution. Histology compatible with splenic hydatidosis. Discussion: The incidence of splenic hydatidosis is low, even in endemic areas, approaching 1-2%. Surgery is the therapeutic strategy of choice, given the risks of rupture. However, there is no consensus regarding the technique. Conclusion: Laparoscopic splenectomy is a safe procedure supported by the literature.
{"title":"Esplenectomía laparoscópica por quiste hidatídico primario de bazo","authors":"F. L. Begliardo, Milagros Corpacci, R. H. Gil, Fernando Martínez-Lascano","doi":"10.4067/S0718-40262018000500448","DOIUrl":"https://doi.org/10.4067/S0718-40262018000500448","url":null,"abstract":"Objective: Describe a case report of a hydatid splenic cyst of one year of evolution, treated by laparoscopy. Materials and Methods: A 36-year-old woman with left upper quadrant pain for 1 year. The topographic study showed a 67mm splenic cystic lesion. Laparoscopic splenectomy was performed without incident. Result: Favorable post-operative evolution. Histology compatible with splenic hydatidosis. Discussion: The incidence of splenic hydatidosis is low, even in endemic areas, approaching 1-2%. Surgery is the therapeutic strategy of choice, given the risks of rupture. However, there is no consensus regarding the technique. Conclusion: Laparoscopic splenectomy is a safe procedure supported by the literature.","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":"35 1","pages":"449-452"},"PeriodicalIF":0.0,"publicationDate":"2018-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73299608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-20DOI: 10.4067/S0718-40262018000500432
N. Pérez, M. González, Alberto Pérez-Castilla, Nicolás Campaña Weitz, Gonzalo Alfredo Campaña Villegas
Introduction: Right hemicolectomy with ileocolic anastomosis is a frequent surgery with many ways to perform it. Objective: To evaluate which is the best ileocolic anastomosis in terms of morbidity and mortality and to make a comparative evaluation of the postoperative clinical evolution according to the type of anastomosis. Patients and Method: Analytical observational study, with defined inclusion and exclusion criteria. The variables to be studied are divided into two groups, those related to the surgical technique and its anastomotic configuration, and the variables related to the results of the surgical intervention, creating a contingency table that crosses the data. Data analysis with STATA 13.0. Results: 216 patients with ileocolic anastomosis, highlighting statistical significance when crossing: A) reoperation and type of suture (p = 0.044), with UN or 3.4 (95% CI 0.94 to 18.6), being of greater risk the mechanics; B) mortality and urgency (p = 0.001) with an OR 7.76 (95% CI 1.56-49.29), with emergency surgery being of greater risk. Isoperistaltic anastomosis with gas elimination (p < 0.001), intestinal transit (p = 0.009) and solid intake (p = 0.005) earlier. There is earlier expulsion of gases in the laparoscopic approach, manual suture, end-to-side and isoperistaltic of the anastomosis and elective surgery. Conclusion: There is great variability of techniques to perform the ileocolic anastomosis. Manual anastomosis is less likely to require surgical reoperation, elective surgery has a lower mortality than that of emergency surgery. We suggest performing it laparoscopically, with manual suture, lateral term, isoperistaltic and electively, for having a shorter recovery.
{"title":"Análisis de variables relacionadas con la morbimortalidad de la anastomosis ileocólica después de hemicolectomía derecha","authors":"N. Pérez, M. González, Alberto Pérez-Castilla, Nicolás Campaña Weitz, Gonzalo Alfredo Campaña Villegas","doi":"10.4067/S0718-40262018000500432","DOIUrl":"https://doi.org/10.4067/S0718-40262018000500432","url":null,"abstract":"Introduction: Right hemicolectomy with ileocolic anastomosis is a frequent surgery with many ways to perform it. Objective: To evaluate which is the best ileocolic anastomosis in terms of morbidity and mortality and to make a comparative evaluation of the postoperative clinical evolution according to the type of anastomosis. Patients and Method: Analytical observational study, with defined inclusion and exclusion criteria. The variables to be studied are divided into two groups, those related to the surgical technique and its anastomotic configuration, and the variables related to the results of the surgical intervention, creating a contingency table that crosses the data. Data analysis with STATA 13.0. Results: 216 patients with ileocolic anastomosis, highlighting statistical significance when crossing: A) reoperation and type of suture (p = 0.044), with UN or 3.4 (95% CI 0.94 to 18.6), being of greater risk the mechanics; B) mortality and urgency (p = 0.001) with an OR 7.76 (95% CI 1.56-49.29), with emergency surgery being of greater risk. Isoperistaltic anastomosis with gas elimination (p < 0.001), intestinal transit (p = 0.009) and solid intake (p = 0.005) earlier. There is earlier expulsion of gases in the laparoscopic approach, manual suture, end-to-side and isoperistaltic of the anastomosis and elective surgery. Conclusion: There is great variability of techniques to perform the ileocolic anastomosis. Manual anastomosis is less likely to require surgical reoperation, elective surgery has a lower mortality than that of emergency surgery. We suggest performing it laparoscopically, with manual suture, lateral term, isoperistaltic and electively, for having a shorter recovery.","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":"11 1","pages":"432-438"},"PeriodicalIF":0.0,"publicationDate":"2018-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86661408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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