Felipe Bellolio R

Pólipos vesiculares: correlación entre hallazgos ecográficos e histopatológicos

BACKGROUND Gallbladder polyps are becoming a common finding. The management of these polyps is complicated considering that they can bear malignant lesions. AIM To analyze the ultrasonographic and histopathologic findings of patients operated due to gallbladder polyps. PATIENTS AND METHODS The records of patients with ultrasonographic diagnosis of gallbladder polyp and that underwent cholecystectomy in a thirteen years period were reviewed, collecting their demographic, ultrasonographic and histopathological data. RESULTS One hundred and twenty three patients were operated. The mean age was 44+/-13 years, and 69% were women. The mean size of polyps in ultrasonography was 7.3+/-5 mm. Histopathology confirmed the presence of polyps in 79% of patients, with a mean size and number of lesions of 5.1+/-3.8 mm and 2.1+/-2, respectively. Nine percent of polyps were greater than 10 mm, and single polyps were significantly larger than the multiple ones (p =0.003). Four cases of adenoma (3.2%) were diagnosed; one of them had in situ carcinoma. All were single and larger than 10 mm. We found a significant correlation between ultrasonographic and histopathological polyp size determination (r =0.47; p =0.002). Polyp size was also a predictor of the presence of adenoma (p =0.043; confidence intervals: 1.006-1.424). CONCLUSIONS There is a good correlation between the size of the gallbladder polyp in ultrasonography and the size in the histopathology report. Gallbladder adenoma is uncommon and it correlates with the size of the polyp. In this series, size was the only predictor of the presence of adenoma.

Modified loose-seton technique for the treatment of complex anal fistulas

Aim  The aim of treatment of anal fistula is to remove the track avoiding while ensuring faecal continence. We report the results of a technique that preserves the external anal sphincter in patients with complex anal fistulas.

Cáncer colorrectal hereditario: análisis molecular de los genes APC y MLH1

Two FAP andone HNPCC families were studied. The APC gene (for FAP patients) and the MLH1 gene (forHNPCC patients), were screened for mutations on genomic DNA. The molecular analysis wasperformed through polymerase chain reaction, Single Strand Conformer Polymorphism (SSCP)and DNA sequencing. Mutations were defined as changes in the DNA sequence leading into a stopcodon and a truncated protein.

Anastomosis ileorrectal en el tratamiento quirúrgico de la colitis ulcerosa: resultados a largo plazo

Background: Total colectomy with ileorectal anastomosis (IRA) is an alternative to the ileoanal pouch for the surgical treatment of ulcerative colitis in a selected group of patients. This technique leaves rectal mucosa liable to develop persistent proctitis, dysplasia and cancer. Aim: To describe short and long-term results of IRA and to assess the presence of dysplasia. Material and methods: Descriptive study of patients treated with IRA. The data were obtained from the clinical records, and the present status was evaluated with an interview. A proctoscopy and biopsy was offered free of cost to the contacted patients. Results: Between 1978 and 2005, 26 patients were operated. One patient presented an anastomotic leakage that was treated with a loop ileostomy. There was no operative mortality. Twenty-three patients were followed for a period of 1 to 23 years. Three patients evolved as Crohn’s disease and two of them needed a proctectomy. Three patients died of non-related diseases. In the remaining 17, the average evacuation rate was 3.7/24 h and all were continent. None developed a rectal cancer. Only two patients had their planned annual endoscopic surveillance. In 2 of the 11 patients who accepted endoscopy and biopsy, a low-grade dysplasia was found. Conclusions: IRA has low morbidity and acceptable functional results in this selected group of patients. No patient present high-grade dysplasia or cancer; however, the adherence to the endoscopic follow-up is poor (Rev Med Chile 2008; 136: 1121-6). (Key words: Colitis, ulcerative; Endoscopy, digestive system; Rectal neoplasms)

Factores asociados a morbilidad precoz en cirugía colorrectal laparoscópica

Factors associated with early morbidity in laparoscopic colorectal surgery Introduction: Different factors have been associated with increased risk of complications in laparosco- pic colorectal surgery. The aim of this study is to identify these factors in our series. Method: Retrospective cohort. All patients undergoing laparoscopic colorectal surgery between January 2000 and June 2012 were included. Patients who had postoperative complications until 30 days postoperatively were identified and analyzed by univariate and multivariate logistic regression. A p value less than 0.2 was used was used as a criteria for entry into the multivariate model. Results: The series consists of 848 patients with a median age of 58 ± 22 years. Main surgical indications were: neoplasia (42.3%), diverticular disease (27.8%) and infla - mmatory bowel disease (8.8%). Most frecuently-performed procedures were: sigmoidectomy (39.5%), ante- rior resection of the rectum (13.4%), right hemicolectomy (13%) and total colectomy (8.7%). On univariate analysis, factors associated with complications were age over 75 years (OR 1.82, 95% CI 1.02 to 3.25) and red blood cell transfusion (OR 8.47, 95% CI 3.69 to 19.43). On multivariate analysis, red blood cell transfusion (OR 7.9 95% CI 1.78 to 35.88) and ASA III or IV (OR 3.26 95% CI 1.01 to 17.23) were independent factors associated with postoperative complications. Conclusion: Intraoperative red blood cell transfusion and ASA score III or IV are independent risk factors associated with complications in laparoscopic colorectal surgery.

Reseccion hepática laparoscópica en modelo porcino: Desarrollo de un modelo experimental

Resumen es: Introduccion: La segmentectomia lateral izquierda (SL) (segmentos II y III de Couinaud) es la reseccion hepatica mas frecuentemente realizada por via lap...

Exactitud de la endosonografía rectal en la estadificación tumoral en pacientes con cáncer de recto sin quimio-radioterapia preoperatoria

Introduccion: La estadificacion tumoral (T) preoperatoria es esencial para el tratamiento del cancer de recto. La endosonografia rectal (ER) es una de las modalidades disponibles. La exactitud de esta tecnica para la estadificacion tumoral es variable en la literatura, y se sospecha que esta inconsistencia se debe a la neoadyuvancia, por el descenso de estadio que esta produce. Objetivo: Analizar la exactitud de la endosonografia rectal para la estadificacion tumoral en pacientes con cancer de recto medio o inferior que no hayan recibido neoadyuvancia. Material y Metodo: Se estudio a los pacientes sometidos a endosonografia rectal entre los anos 2001-2009 en el Hospital Clinico de la Pontificia Universidad Catolica de Chile. De un total de 2.120 pacientes, 294 fueron evaluados por cancer de recto en tercio medio o inferior. Se analizo el examen de aquellos que no recibieron quimio-radioterapia preoperatoria y se encontraba disponible la anatomia patologica para su comparacion. Resultados: Se obtuvo informacion de 69 pacientes. La exactitud global del examen para la determinacion del T fue 85%. Para la determinacion de T1 los valores de sensibilidad, especificidad y exactitud fueron 82%, 96% y 94% respectivamente. Para T2 los valores de sensibilidad, especificad y exactitud fueron 72%, 83% y 78% respectivamente. Para T3 los valores de sensibilidad, especificidad y exactitud fueron 82%, 83% y 83% respectivamente. Conclusion: La endosonografia rectal sigue siendo un valioso examen para la determinacion de la profundidad de invasion tumoral en cancer de recto con una exactitud global de 85%.

Enteroplastía transversa seriada como alternativa en el tratamiento del síndrome de intestino corto: Caso clínico

Among patients with short bowel syndrome, surgical small intestine lengthening techniques are employed to increase the absorptive surface. Among these, serial transverse enteroplasty involves transecting the bowel transversally, preserving the blood supply of the small intestine and creating a longer segment of bowel. We report a 51-year-old woman with a short bowel syndrome and multiple hospital admissions for complications. She was subjected to a serial transverse enteroplasty, increasing small intestinal length from 140 to 180 cm. During the postoperative period, she presented intra abdominal blood collections and a septic episode with bacterial endocarditis. One month after the operation, total parenteral nutrition was discontinued and nutritional and fluid balances were achieved using exclusively the oral route. During the ambulatory follow up, the patient continues with exclusive oral feeding and five bowel movements per day.

Colitis de Crohn: Resultados del tratamiento quirúrgico y evolución alejada.

BACKGROUND Exclusive involvement of the colon or rectum in Crohns disease, called Crohns colitis, (CC) occurs in about 25% of these patients. AIM To analyze early surgical results and long-term outcomes of patients undergoing surgery for CC. MATERIAL AND METHODS Review of a prospective database, identifying patients with Crohns disease operated between 2003 and 2015 and excluding those with ileocecal disease. We analyzed demographic data, pre and postoperative pharmacological treatment, operations, morbidity and the need for a second bowel resection at follow-up. RESULTS We reviewed data from 28 patients aged 17 to 72 years (15 men). Twenty-seven (96.4%) had previous pharmacological treatment, 11 received monoclonal antibodies. The most common indications for surgical treatment were failure of medical treatment in 15 cases, acute severe colitis in 12 and anemia/malnutrition in eight. Total colectomy was performed in 17 (61%) patients, proctocolectomy in 8 (29%) and segmental colectomies in 3 (11%). Sixteen (57%) were operated laparoscopically. Major postoperative complications were observed in 5 (18%). Four needed a reintervention. There was no operative mortality. During a 55 months median follow-up of 27 patients, seven (26%) required a second bowel resection, one of them for recurrence. Nineteen (70%) patients had an ostomy, which was permanent in 11. Fifteen patients are without medical treatment. CONCLUSIONS Most of the reviewed patients required total colectomy for the control of the disease with a low surgical morbidity. Two-thirds required an ileostomy, which became permanent in half of them.

PLATAFORMAS DE ACCESO TRANSANAL EN CIRUGÍA COLORRECTAL: DE LA RESECCIÓN LOCAL A LA RESECCIÓN TOTAL DEL MESORRECTO

transanal access platforms in colorectal surgery: from local resection to total mesorectal excision Transanal access platforms have been an important contribution since their creation over 30 years ago, yielding high quality, full-thickness rectal resections in more proximal locations, with excellent visibility compared to classical transanal excision and some endoscopic techniques, in both benign and malignant lesions. Laparoscopic surgery has contributed to the emergence of new platforms that integrate conventional laparoscopic instruments into transanal resections reporting good initial results. These platforms are the present and future of natural orifice transluminal endoscopic surgery (nOTES). In this review we discuss about the different available platforms, their indications and results.