Indicaciones resultados alejados del tratamiento quirúrgico electivo de la enfermedad diverticular del colon sigmoides

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Results of surgical treatment of colovesical fistulas of diverticular originBackground: The main causes of colovesical fistulas are diverticular disease of the colon and colon carcinoma. Aim: To analyze the results of the surgical treatment of colovesical fistulas of diverticular origin. Material and Methods: Retrospective analysis of all patients operated for a colovesical fistula of diverticular origin. Results: From a total of 141 patients subjected to a colon excision for diverticular disease, 18 had a colovesical fistula. The latter, compared to patients without fistulas were male in a higher proportion, were younger and had more concomitant diseases. Pneumaturia was reported in 83% and urine fecal soiling in 56%. In two thirds of patients, the fistula appeared in the absence of a diverticular crisis. Abdominal CAT scan demonstrated the fistula in 80% of cases. It was complemented with barium enema and cystoscopy. Excision with immediate anastomosis was the surgical procedure used in 94% of patients, without sequelae or relapse, after a mean follow up of 74 months. No patient died during the procedure or required a new intervention. Conclusions: Colovesical fistulas are most common in young men with associated diseases and their treatment of choice, with good long term results, is primary excision.Key words: Colovesical fistula, diverticular disease of colon, surgical treatment. ResumenAntecedentes: El objetivo de este estudio es analizar los resultados del tratamiento quirúrgico de la Fístula ColoVesical (FCV) de origen diverticular, los que se comparan con la enfermedad diverticular no fistulizada. Pacientes y Método: Análisis retrospectivo de todos los pacientes intervenidos por una FCV de origen diverticular en forma consecutiva. Resultados: De un total de 141 pacientes resecados por una enfermedad diverticular del colon sigmoides, la indicación quirúrgica en 27 (19,3%) fue la presencia de una fístula, de las cuales 18 corresponden a una FCV. El grupo con FCV tiene predominio de hombres (p = 0,0001), más joven (p = 0,027) y con mayor incidencia de enfermedades asociadas (p = 0,0001). La neumaturia se presentó en el 83% y la fecaluria en el 56%. En dos tercios de los casos la FCV se estableció en ausencia de una crisis diverticular previa. El estudio más relevante para demostrar la presencia de una FCV

Section: Resultsunclassified

Fístula colovesical de origen diverticular

et al. 2010

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“…El porcentaje de reconstitución de tránsito intestinal, su mortalidad y MPO asociada en sujetos tratados con PH [61][62][63] , son hechos a considerar en la toma de decisiones por alguna alternativa terapéutica en caso de obtener diferencias significativas en los promedios ponderados de las variables de resultado primarias. Sin embargo, su reporte también es incompleto (sólo el 25% de los artículos lo reporta).…”

Section: Discussionunclassified

Procedimiento de Hartmann vs resección y anastomosis primaria en peritonitis diverticular de colon izquierdo por cirugía abierta: Revisión sistemática de la literatura

2013

Hartmann's procedure and resection with primary anastomosis in diverticular peritonitis Introduction: Colonic diverticulosis, as diverticulitis, is a frequent disease in different stages of evolution. There is uncertainty about treatment options that are used in secondary peritonitis. The aim of this study is to determine the best treatment option for patients with peritonitis secondary to diverticulitis of the left colon in terms of postoperative morbidity (POM) and mortality, comparing Hartmann's procedure (HP) and resection with primary anastomosis (RPA). Material and Methods: Systematic review. Studies in adults with peritonitis secondary to diverticulitis of the left colon treated with HP and RPA published between 1990 and 2011 were analyzed. TRIPDATABSE, IWO, MEDLINE, SciELO and LILACS databases were consulted and search strategies were applied using MeSH and free terms. Selected studies were analyzed using a score of methodological quality (MQ). The following variables were considered: mortality, POM, hospital stay, percentage of bowel transit reconstitution in patients undergoing HP and MQ of primary studies. Results: 26 primary studies were analyzed (47 series). There were no significant differences in the variable mortality (p = 0.0805), but significant difference was observed in POM (incompletely reported) (p = 0.0187). The median of MQ of the studies was 11 points for HP series and 10 for RPA series. Conclusion: The available evidence to determine the best treatment option in terms of mortality and POM in this kind of patients is insufficient. Studies with better level evidence and MQ are needed to clarify the uncertain.

“…El Dr. Manterola en una revisión del 2005 refiere una hospitalización de 10 días para cirugía abierta y de 6 días para la laparoscópica 28 . Trabajos publicados en Chile por el grupo del Dr. Bannura muestran una estadía intrahospitalaria de 9,8 días para pacientes sometidos a cirugía de colon abierto en forma electiva por enfermedad diverticular 29 . Boza, en su publicación en relación al tratamiento quirúrgico electivo del cáncer de colon, refiere un promedio de hospitalización de 12 días 30 .…”

Section: Discussionunclassified

“…Al evaluar los resultados desde el punto de vista de morbilidad, mortalidad y dehiscencia de anastomosis no presentan diferencias con lo reportado clásicamente en la literatura. En nuestra serie no hubo mortalidad durante el período estudiado y el porcentaje de filtración de la anastomosis fue de un 2,5%, valor dentro de lo esperado en centros dedicados a la cirugía colo-rectal [27][28][29][30] .…”

Section: Discussionunclassified

Cirugía de colon abierta con "Fast Track" o recuperación acelerada

2009

Fast Track" large bowel surgery Introduction: Large Bowel resective surgery requires 6 to 10 days in-hospital stay. Recently the multimodality rehabilitation concept or "fast track" surgery, a combination of different techniques in order to reduce surgical stress, increase recuperation and decrease in-hospital stay, has become an option. Objective: Evaluate postoperative evolution of patients submitted for elective large bowel and rectum resection using "Fast Track" protocol. Material and Method: Prospective Fast track protocol includes all patients submitted for elective large bowel and rectum resection in Military Hospital of Santiago during August 2004 to November 2005. Outcomes concerning postoperative ileus, in-hospital stay, complications and patient satisfaction were recorded. Results: 40 patients, 19 male (48%) and 21 female (52%) consecutive patients were included. Average age 66 years (39-87), 24 patients (60%) were classified ASA II and 38% ASA I. During the first 48 hrs 97.5% had anal flatulence. First defecation occurred before 48 hrs in 47.5% and in 37.5% at 72 hrs. Hospital discharge at 4 th day was possible in 78%. Pain visual analogical scale at 24 hrs was less than 2 in 95%. Satisfaction rate was very good in 70%. Morbidity was 18% without mortality. Anastomotic dehiscence was 2.5%. Conclusions: Fast Track protocol reduces in-hospital stay, pain and postoperative ileus.