Natalia Uribe

Excision and V-Y plasty reconstruction for giant condyloma acuminatum.

Abstract.BackgroundCondyloma acuminata is the most common anorectal lesion in patients infected with human immunodeficiency virus (HIV). Surgical treatment can be challenging in cases where the size and extension into the anal canal make individual excision impossible. These patients require large resections and reconstruction using grafts or local flaps.MethodsSix patients were treated for giant perianal condylomas between 1999 and 2001. Four patients were HIV–positive, and were selected for surgical intervention after achieving a T4 count >350 and low viral replication. In 5 cases, the lesions were circularly resected up to the pectinate line and the defect was reconstructed using a bilateral V–Y plasty. In the remaining case, fulguration was possible on one side and a unilateral V–Y plasty was performed.ResultsThere were no infections or healing delays in this series, and the functional and aesthetic results are satisfactory.ConclusionV–Y plasties are a valid method for perianal reconstruction after resection of giant anal condyloma, with good results in selected patients with HIV infection.

Rectal advancement flap for the treatment of complex cryptoglandular anal fistulas: a systematic review and meta-analysis

PurposeRectal advancement flap is an accepted approach for treating complex fistula-in-ano. However, a diversity of technical modifications have been described. The aim of this study was to evaluate recurrence and fecal continence rates after performing rectal advancement flaps depending upon flap thickness (full-thickness, partial-thickness, or mucosal flaps) and treatment of the fistulous tract (core-out or curettage).MethodsMedline (PubMed, Ovid), the Cochrane Library database, and ClinicalTrials.gov were searched. Studies that involved patients with complex cryptoglandular fistulas who had been treated with rectal advancement flaps were included. The outcomes measured were recurrence and fecal continence. All of the statistical analyses were performed using Comprehensive Meta-Analysis software. A fixed model was used if there was no evidence of heterogeneity; otherwise, a random effects model was used.ResultsTwenty-six studies were included (1655 patients). The pooled rate of recurrence was 21%. Full-thickness flaps showed the best results concerning recurrence (7.4%), partial flaps revealed 19% and mucosal flaps 30.1%. Core-out and curettage had a similar recurrence (19 vs 21%). Regarding anal incontinence, the pooled rate was 13.3%. Mucosal- and partial-thickness flaps showed similar rates (9.3 vs 10.2%), while full-thickness flaps disturbed it in 20.4%. Most of these alterations were minor symptoms. Otherwise, core-out and curettage showed similar rates (14.3 vs 12%).Conclusions1. Full-thickness rectal advancement flaps offer better results regarding the recurrence than mucosal or partial flaps. 2. All flaps cause some incontinence, which increases with the thickness of the flap. 3. The results did not suggest differences in recurrence and incontinence between core-out and curettage.

Exéresis en bloque y marsupialización del sinus pilonidal sacrocoxígeo crónico. ¿Es ésta la técnica ideal?

Resumen Introduccion El objetivo de este trabajo es analizar los resultados obtenidos en el tratamiento de la enfermedad pilonidal cronica mediante la tecnica de exeresis en bloque y marsupializacion. Pacientes y metodos Desde febrero de 1996 a noviembre de 1999 se ha intervenido a un total de 375 pacientes de sinus pilonidal cronico en regimen ambulatorio. Se analizan la tecnica, la morbilidad y la tasa de recurrencia Resultados Las complicaciones fueron hemorragia en un 4% y dolor en el 1,3%. Tras un periodo de seguimiento medio de 4 anos (minimo 2, maximo 6 anos), la tasa de recidivas ha sido del 1,6% (6 pacientes). Conclusiones La marsupializacion es la tecnica mas adecuada para el tratamiento del sinus pilonidal cronico debido a que se producen un menor numero de complicaciones y una menor tasa de recidivas con respecto a otras tecnicas, con un plazo de cicatrizacion relativamente corto, y ademas es posible realizarla de forma ambulatoria.

Effects of PEEP on Residual Vascularization in Oesophageal Substitution Gastroplasty by Surface Oximetry-Capnometry and Photoplethysmography

Objective: To evaluate the effects of positive end-expiratory pressure (PEEP) on residual vascularization in gastric tubes for oesophageal replacement. Design: Experimental open study. Materials: Eleven mongrel dogs. Methods: Intestinal parietal blood flow was evaluated by photoplethysmography (PPG) and measurement of surface oxygen (PsO2) and carbon dioxide (PsCO2) tensions under basal conditions. After Akiyama’s tubular gastroplasty, three levels of PEEP were administered. At each level, fluids were infused to counter the drop in cardiac output. PPG, surface gas tensions, arterial pressure, cardiac output and arterial blood gas tensions were monitored. Control sections of the bowel were also monitored by PPG. Results: Cardiac output dropped for each level of PEEP and returned to basal levels on volume restabilization and on removal of PEEP. Central venous pressure and pulmonary arterial and capillary pressures increased for each level of PEEP and only returned to basal levels on removal of PEEP. PsO2 values dropped for each level of PEEP and returned to basal levels on volume restabilization and on removal of PEEP. PsCO2 levels rose, and PPG wave amplitude dropped, for each level of PEEP; these two variables only returned to basal levels on removal of PEEP. PPG values for the control sections reflected those of the anastomotic area. Conclusions: PEEP affects surface oxygen values at the level of the gastroplasty by means of its effect on cardiac output. PEEP also creates a venous return compromise and PPG wave amplitude and surface carbon dioxide values are related to this compromise. All three variables could be significant in anastomotic wound healing.

Reconstrucción de la continuidad digestiva tras cirugía de la diverticulitis aguda complicada. Estudio retrospectivo multicéntrico

INTRODUCTION THE AIM: was to analyse the stoma reversal rate after surgery for complicated acute diverticulitis (CAD), and more specifically the end-stoma-reversal, as well as the delay, feasibility, complications and risk factors for stoma maintenance. METHODS A multicentre retrospective study of patients who had undergone urgent surgery for CAD with stoma formation in ten hospitals during a period of 6 years. The frequency of reversal over time and the factors affecting the decision for reversal were analysed. RESULTS Out of 385 patients operated for CAD, 312 underwent stoma creation: 292 end colostomies and 20 diverting stomas. During follow-up, stoma reversal surgery was performed in 161 patients (51.6%) after a median of 9 months. The main causes for not performing stoma reversal were comorbidities and the death of the patient. Advanced age was an adverse factor in the multivariate analysis, and the actuarial rate of reversal was higher in men and in patients with no previous Hartmanns operation. Stoma reversal surgery was completed in all but one patient, and a loop ileostomy was associated in four. Morbidity and mortality rates were 35.7% and 1.9%, respectively. A total of 8.4% of patients underwent re-operation, and 6% experienced an anastomotic leak. Twelve patients remained with a stoma after the attempted reconstruction surgery. CONCLUSIONS Surgery for CAD is frequently associated with an end stoma, which will ultimately not be reversed in almost 50% of patients. Moreover, reversal surgery is frequently delayed and is associated with significant morbidity and mortality.

Fístula interesfinteriana sin orificio externo y con reentrada en el recto

A 43-year-old woman was under study due to intermittent anal suppuration, diagnosed by ultrasound and magnetic resonance imaging with high intersphincteric fistula and no external fistula orifice (Parks classification). The patient was operated on in the jackknife position, at which time an anterior internal fistula orifice was observed at the pectineal line with an ascending intersphincteric tract and reentry into the rectum through a secondary orifice, as described by Parks in rare cases. Fig. 1 is a diagram of the anatomy of the fistula along with images of the pathway of the fistulous tract (A) and marsupialization (B), after the flattening and curettage of the tract. The patient progress was satisfactory, and the lesion healed. c i r e s p . 2 0 1 8 ; 9 6 ( 3 ) : 1 6 9