Laparoscopic colorectal surgery in ChileThe development of laparoscopic colorectal surgery began 20 years ago; however it took several years before gaining its acceptance by the international surgical community. The fi rst report in Chile was published in 1995. However, were necessary many years, until the middle of this decade, to know the fi rst prospective series experiences. Out of these reports, no reliable data exist regarding the development of laparoscopic colorectal surgery in Chile, related to the number of centers performing laparoscopic colorectal surgery or the number of procedures performed. For record these data, a standardized questionnaire was send to colorectal chairmans of all hospitals that had reported to be developing laparoscopic colorectal surgery in our country. Ten of 15 hospitals responded to the survey. Most of the procedures performed were hemicolectomies, principally for cancer and diverticular disease. The average conversion rate was 7% and hospital stay was 5 days. Morbidity and mortality rates were 12% and 0.4% respectively. In the last year was seen an increase in the number of laparoscopic procedures in relation to the previous period. In conclusion, laparoscopic colorectal surgery is a recent technique in Chile, which is being implemented progressively, with good overall results. ResumenEl desarrollo de la cirugía laparoscópica colorrectal (CLCR) se inició en la década de los 90, sin embargo, pasaron varios años antes de lograr su aceptación por la comunidad quirúrgica internacional. En Chile, los primeros relatos en congresos datan del año 1995 y las primeras experiencias de series prospectivas fueron Rev.
Cecal appendix invagination Cecal appendix invagination was first described by Mc Kidd in 1858, however, due to its low frequency and nonspecific presentation, it is usually a radiological or intraoperative finding. During surgery, the therapeutic approach may vary from an appendectomy to a right hemicolectomy. The selected technique will depend of the suspected diagnosis, which will undoubtedly also influenced by surgeon experience. We present a case of a male patient aged 57 years old, with the intraoperative finding of appendiceal intussusception. The laparoscopic dissection of the cecum revealed an inflammatory appendix, soft to palpation with graspers. A large section of the appendix base with linear stapler was made. The final biopsy and surgical specimen showed an appendiceal inflammation without atypia.
Enlarged cecostomy as an alternative for the protection of low colorrectal anastomoses Background: Loop ileostomy, usually used as protection for low colorrectal anastomoses, has a significant number of complications. Aim: To assess the results of a new technique, called enlarged cecostomy for anastomotic protection. Material and Methods: The enlarged cecostomy technique, described herein, was applied to 12 consecutive patients, subjected to a radical resection for a low rectal cancer. Most procedures were performed after a neo-adjuvant therapy. The results obtained in these patients were compared with similar series of patients in whom a loop ileostomy was performed. Results: 4 low anterior resections and 8 ultra-low anterior resections were performed among patients subjected to enlarged cecostomy (11 laparoscopic). Among patients subjected to loop ileostomy, 8 low anterior resections and 4 ultra-low anterior resections were performed (4 laparoscopic). The execution lapse for enlarged cecostomy was 15 minutes and for loop ileostomy, 25 minutes. Patients subjected to cecostomy had a lower hospitalization time. This was because 4 patients had a dysfunction of the loop ileostomy. The degree of diversion was complete in 11 patients subjected to enlarged cecostomy. The ostomy was closed in 7 patients subjected to loop ileostomy and the same number of patients subjected to enlarged cecostomy. Conclusions: Enlarged cecostomy is a valid protection alternative for patients operated for low rectal cancer. It is easier to perform than loop ileostomy.
La incontinencia anal o fecal se define como la incapacidad de postergar la defecación en forma voluntaria, produciéndose una pérdida recurrente e involuntaria de las heces (líquidas y/o sólidas) y/o gases a través del canal anal. Incluso en los casos leves, donde sólo se produce pérdida ocasional de gases y/o escurrimiento menor ("soiling"), esta patología se asocia en mayor o menor grado con compromiso en la calidad de vida de los pacientes en todos los ámbitos de su quehacer 1 . La incontinencia anal es una patología multicausal que está presente en un porcentaje cada vez más importante de nuestra sociedad, debido al sostenido envejecimiento de la población. En series internacionales y nacionales, se estima que el 2 al 7% de los mayores de 18 años pueden presentar incontinencia anal, cifra que se eleva hasta el 35% en pacientes de la tercera edad, especialmente en casas de reposo y hogares de ancianos 2 . Los principales factores de riesgo son: edad, menopausia, cirugías previas, parto traumático, fórceps, enfermedades del aparato conectivo, alteraciones neurológicas degenerativas y obesidad 3,4 . El estudio de esta patología incluye una completa anamnesis para evaluar factores de riesgo y antecedentes mórbidos, evaluación del tipo de tránsi-to intestinal y consistencia de las heces, alimentación y medicamentos de uso habitual.Dentro del algoritmo de estudio, se debe evaluar la integridad anatómica y funcional del aparato esfinteriano, lo cual se logra con endosonografía anorrectal y manometría anal. Asimismo se puede complementar con estudio neurológico y electromiografía anal y tiempo de latencia de nervios pudendos. Debe descartarse además patologías como enfermedades inflamatorias intestinales, presencia de diarreas crónicas y pólipos o tumores secretores de moco realizando una colonoscopia completa.En los pacientes en que se demuestra una alteración anatómica (sección) del esfínter externo en la endosonografia anal, la esfinteroplastía (plastia muscular) anal es hoy en día una de las mejores alternativas de tratamiento. Sin embargo, esta cirugía presenta un porcentaje de recurrencia, no menor al 40% a largo plazo 5 . Los pacientes que no presentan daño esfinteriano, o quienes han sido reparados sin éxito, pueden verse beneficiados con la implantación de un esfínter artificial, uso de neuromodulación sacra, o en casos muy adversos, con una ostomia definitiva. Lamentablemente la im-
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