Gonzalo Soto D.

Cirugía laparoscópica electiva en enfermedad diverticular: Un estudio comparativo con la cirugía convencional

Background: Elective surgery in diverticular disease (DD) consists classically in performing an open sigmoidectomy. Laparoscopic surgery of the colon can have results that are comparable to those of open surgery. Aim: To compare the results of laparoscopic and conventional surgery for DD. Materials and Methods: Retrospective review of preoperative, operative and postoperative variables of patients operated by laparoscopic surgery between the years 2000 and 2002. These results were compared with those of patients treated with conventional surgery in the same period. Results: Thirty nine patients, mean age 59 years old, were operated via laparotomy and 18 patients, mean age 47 years old, were treated with laparoscopic surgery. Both groups were comparable in gender, amount of previous laparotomies, type of surgery performed and American Society of Anestesiologists classification. The operative time was significantly higher in the laparoscopic surgery group (230 v/s 130 min), but the opioid requirements, stay in an intensive surgical care ward, postoperative ileus and hospital stay were significantly shorter in the laparoscopic group. Eleven percent of the patients included in the laparoscopic group and 31% of the patients treated with operative surgery had complications (p=0.07). The length of the excised colon, the degree of inflammation and treatment costs were comparable. Conclusions: Laparoscopic surgery in DD is feasible, safe, requires less analgesia and allows a faster recovery of post-operative ileus and a lower hospital stay (Rev Med Chile 2003; 131: 719-26)

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.

Estudio endoscópico en familiares de primer grado de pacientes operados por cáncer colorrectal

Background: First degree relatives of patients with colorectal carcinoma are at a higher risk of having the disease than the general population. Therefore, they should be subjected to screening colonoscopy. Aim: To assess the effectiveness of colonoscopy among first degree relatives of patients with colorectal carcinoma. Material and methods: A free colonoscopy was offered to first degree relatives of patients operated on for colorectal cancer between 1998 and 2000. As inclusion criteria, subjects had to be asymptomatic, older than 40 years or less than 10 years younger than the index case. Each subject was contacted twice, inviting him/her to have a colonoscopy performed. Results: Two hundred forty three relatives were contacted for the study and in 76, a colonoscopy was performed. Among the latter, a neoplasm was found in 13 (17%): One adenocarcinoma and 12 adenomas. Three of these lesions were located in the right colon. The main reason given by the 176 subjects that did not agree to have a colonoscopy was lack of interest. Conclusions: Screening colonoscopy is effective to detect adenoma and adenocarcinomaamong first degree relatives of patients with colorectal carcinoma, however only 31% of all potential relatives agreed to undergo a colonoscopy (Rev Med Chile 2006; 134: 997-1001). (Key words: Colonic neoplasms; Colonoscopy; Rectal neoplasms)

Enfrentamiento médico quirúrgico de la invaginación intestinal: Experiencia de una institución universitaria

Background: Management of intestinal intussusception in children has evolved from exclusively surgical treatments to nonoperative reduction under fluoroscopic monitoring. Aim: To report a 10 year experience in a University Hospital in the management of intestinal intussusception. Patients and methods: Seventy two patients, aged 2 to 72 months of age, with an uncomplicated intussusception, that were treated by barium or air enema, were studied. Results: The success rate was 73% with barium reductions, and 100% with air reductions. In 17 patients (24%), enema reduction was unsuccessful and were subjected to a surgical reduction. Conclusions: Nonsurgical reduction is safe and effective as the initial treatment of uncomplicated intussusception in children

Poliposis familiar: Alternativas terapéuticas y estudio de los familiares

Background: To reduce the mortality associated to Familial Adenomatous Polyposis (FAP), screening of close relatives of patients with the disease is crucial. Aim: To analyze the results of the surgical treatment of patients with FAP, and to evaluate the family screening. Patients and Methods: Clinical records of patients operated in our institution since 1977, were reviewed analyzing surgical and pathological results, and follow up. In their family members, we evaluated and analyzed the performance of screening tests, former surgeries, history of disease-related cancer and mortality, all due to FAP. Results: Between January 1977 and August 2002, 15 patients were operated on. Of these, only 33% consulted on the setting of a familial screening. A proctocolectomy and terminal ileostomy was performed in 27% of patients; 20% had a proctocolectomy and ileal pouch, and 53% underwent a total colectomy with ileo-rectal anastomosis. Morbidity and mortality were 7% and 0%, respectively. Twenty percent had a colorectal cancer. During a median of 68 months follow-up, the disease-related survival was 92%; no cancer of the rectal stump was detected. Of the 122 family members identified, only 33% with clear indication of screening underwent a colonoscopy. Twenty-nine percent had a confirmed FAP and were operated: in 61% of them a colorectal cancer was found, and 91% of these died. Conclusions: The results of the surgical treatment of FAP are satisfactory. Nevertheless, family screening should be improved to reduce the high rates of mortality revealed in the study of other family members (Rev Med Chile 2005; 133: 1043-50).