Background: Endoscopic polypectomy is an accepted procedure for prevention of colorectal cancer. Yet, large and difficult polyps present a technical and medical challenge to correct treatment. Objective: The aim of this study was to report and analyze the experience in the treatment of large colon polyps. Material and methods: We analyzed the endoscopic resection of large colon polyps performed between January 2006 and March 2018. Results: Of 3397 lower gastrointestinal endoscopies, 22 patients underwent resection of 25 large polyps (0.64%). There were no complications or deaths in the series. Conclusions: Endoscopic resection of large colon polyps is feasible and safe in lesions > 20 mm in diameter. The procedure serves both as biopsy or definite treatment and is an additional tool for the surgeon who has the capability of dealing with the complications or completing with surgery.
Los autores declaran no tener conflictos de interés. Conflicts of interest None declared.
Introduction: The safety of colonoscopies performed by surgeons and the management of their complications has not been analyzed in depth in the low number of national publications. Objective: The primary endpoint of this study was to analyze the outcomes of colonoscopies performed by colorectal surgeons, in terms of complications. and their resolution. The secondary endpoint was to compare the results between a university hospital and different centers nationwide staffed with colorectal surgeons who had received formal training during a residency program in the surgical subspecialty. Material and methods: We conducted a multicenter, prospective and consecutive national study. The colonscopies performed between 2011 and 2016 were included. The variables analyzed included complications, age, sex, type of endoscopy, diagnosis, treatment, location were the procedure was performed and surgeon’s training. The results were expressed as mean, percentage and range. The statistical analysis was performed using Fisher’s exact test. A p value < 0.05 was considered statistically significant. Results: A total of 24,907 procedures were performed, 17,283 corresponded to diagnostic colonoscopies and 17,202 were made in provincial centers. Forty-four complications were recorded (0.17%), of which 35 were procedure-related complications: 19 perforations, 8 bleeding events, 5 post-polypectomy syndromes and three related with the technique; all were diagnosed and solved by the same team without morbidity and mortality. There were no differences in the incidence of complications and how they were treated according to the center or type of colonoscopy. All the surgeons received colonoscopy training during a residency program in the surgical subspecialty. Conclusions: The results obtained in colonoscopies performed by surgeons trained in institutions with residency programs in surgical subspecialties are similar t Safe colonoscopies can be performed by surgeons who have been trained in institutions with a residency program in a surgical subspecialty and with a formal training program in colonoscopy.
La presencia de hernia perineal secundaria supone un reto para el cirujano cuando requiere reparación quirúrgica ya que no hay una vía de abordaje o técnica superior a otra. Mostramos nuestra experiencia con esta entidad, secundaria a Operación de Miles. Entre 2005 y 2021, de 23 resecciones radicales llevadas a cabo, 2 pacientes (8,6%) presentaron hernia perineal secundaria sintomática que requirieron reparación. De nuestros pacientes reconstruidos, un hombre fue abordado por vía perineal y una mujer por vía abdominal laparoscópica. En ambos casos se reforzó el piso pelviano con malla con buena evolución postoperatoria, sin presentar recurrencia a 12 meses. Esta entidad es infrecuente, sinembargo su incidencia parece aumentar. Cuando necesita resolución se puede abordar por vía perineal, abdominal o combinada con similares resultados. El uso de mallas reemplazó a la sutura primaria de la brecha. La profilaxis es importante, aunque faltan estudios que determinen su real utilidad
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