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Resumen Objetivo: El objetivo de este estudio es comparar los resultados perioperatorios del abordaje abierto (AA) con el abordaje laparoscópico (AL) para la reconstitución de tránsito (RT), y determinar factores de riesgo asociados a morbilidad posoperatoria. Material y Métodos: Se estudiaron pacientes consecutivos sometidos a RT entre enero de 2007 y diciembre de 2016 en nuestro centro. Se excluyeron aquellos con grandes hernias incisionales que requirieran reparación abierta simultánea. Se consignaron variables demográficas y perioperatorias, y se compararon ambos grupos. Además, se realizó una regresión logística para la identificación de factores de riesgo asociados a morbilidad posoperatoria en la serie. Resultados: Se realizaron 101 RT en el período. Se excluyeron 14 casos por hernia incisional, por lo que se analizaron 87 casos (46 AA y 41 AL). Diez pacientes en el grupo AL (24,4%) requirieron conversión, principalmente por adherencias. La morbilidad total de la serie fue de 36,8%, siendo mayor en el AA (50% vs 21,9%, p = 0,007). Hubo una filtración anastomótica en cada grupo. La estadía posoperatoria fue de 5 (3-52) días para el AL y 7 (4-36) días para el AA (p < 0,001). En la regresión logística, sólo el AA fue un factor de riesgo independientemente asociado a morbilidad posoperatoria (OR 2,89, IC 95% 1,11-7,49; p = 0,029). Conclusión: El abordaje laparoscópico se asocia a menor morbilidad y estadía posoperatoria que el abordaje abierto para la reconstitución del tránsito pos-Hartmann. En nuestra serie, el abordaje abierto fue el único factor independientemente asociado a morbilidad posoperatoria.

Introduction: Hartmann's reversal (HR) is considered a technically demanding procedure and is associated with high morbidity rates. Aim: The aim of this study is to compare the perioperative results of the open approach (OA) with the laparoscopic approach (LA) for HR, and to determine the risk factors associated with postoperative morbidity. Material and Methods: Consecutive patients undergoing HR between January 2007 and December 2016 at a university hospital were included. Patients with large incisional hernias that required an open approach a priori were excluded from the analysis. Demographic and perioperative variables were recorded. Analytical statistics were carried out to compare both groups, and a logistic regression was performed to identify risk factors associated with postoperative morbidity in the series. Results: A hundred and one HR were performed during the study period. Fourteen cases were excluded due to large incisional hernias, so 87 cases (46 OA and 41 LA) were analyzed. Ten patients in the LA group (24.4%) required conversion, mainly due to adhesions. The total morbidity of the series was 36.8%, being higher in the OA group (50% vs. 21.9%, p = 0.007). There was one case of anastomotic leakage in each group. The length of stay was 5 (3-52) days for LA and 7 (4-36) days for OA (p < 0.001). In the logistic regression, the OA was the only independent risk factor associated with postoperative morbidity in HR (OR 2.89, IC 95% 1.11-7.49; p = 0.029). Conclusion: A laparoscopic approach is associated with less morbidity and a shorter length of stay compared to the open approach for Hartmann's reversal. An open approach was the only factor independently associated with postoperative morbidity in our series.

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Resumen Introducción: Una terapia emergente para el cáncer de colon es la neoadyuvancia, en casos seleccionados. Dicha selección se basa en el análisis preoperatorio de imágenes mediante tomografía computada. Objetivo: Nuestro objetivo es determinar la exactitud diagnóstica del examen para estadificar el cáncer de colon y su correlación entre radiólogos expertos. Materiales y Método: Estudio de exactitud diagnóstica. Previo cálculo muestral se seleccionaron aleatoriamente 47 pacientes con adenocarcinoma colónico resecado con intención curativa e imágenes hasta 60 días previo cirugía. Se evaluó profundidad de invasión tumoral e invasión linfonodal por 2 radiólogos expertos y ciegos entre sí. Las diferencias fueron auditadas por un tercer radiólogo experto. Se compararon resultados con la biopsia, calculando la sensibilidad, especificidad, valor predictivo negativo, valor predictivo positivo y exactitud diagnóstica del examen. Se calculó la concordancia entre radiólogos mediante el índice de kappa. Resultados: La exactitud para diferenciar tumores T3-T4 de T1-T2 fue del 89,4%. En cambio, la capacidad para diferenciar tumores T4 de los T3 fue de un 65,9%. La exactitud para determinar un N (+) fue de un 66%. La concordancia entre radiólogos fue de 0,929 para identificar tumores T1-2, de 0,602 para T3, de 0,584 para T4. Para determinar un N (+), la concordancia fue de 0,521. Conclusión: La exactitud diagnóstica de la tomografía computada en cáncer de colon es adecuada para distinguir tumores avanzados. Sin embargo, su capacidad para discriminar entre T3 y T4, los N (+) y la baja concordancia entre radiólogos, sugiere la necesidad de buscar técnicas imagenológicas complementarias.

Introduction: Neoadjuvant therapy is an emerging treatment for selected cases of colon cancer. The decision is based on the analysis of preoperative images taken by computed tomography. However, its ability to discriminate those who could benefit from this therapy is unknown. Aim: Our objective is to determine the diagnostic accuracy of computed tomography to evaluate the colon cancer stage and its correlation among expert radiologists. Materials and Method: Diagnostic accuracy study. After sample size calculation, we randomly selected 47 patients who underwent a colonic adenocarcinoma resection with curative intent and had available images up to 60 days after surgery. The depth of tumor and lymph nodal invasion were evaluated by two expert radiologists, blinded to each other. The differences between radiologists were audited by a third one. The results were correlated with biopsy as the gold standard. We calculated sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy of computed tomography. The agreement between radiologists was calculated using the kappa index. Results: The accuracy to differentiate T3-T4 tumors from T1-T2 was 89.4%. In contrast, ability to differentiate T4 tumors from T3 tumors was 65.9%. The accuracy to determine an N (+) was 66%. Agreement between radiologists was 0.929 to identify T1-2, 0.602 for T3, 0.584 for T4 tumors. To determine an N (+), the concordance was 0.521. Conclusion: Diagnostic computed tomography accuracy in colon cancer is adequate to differentiate advanced tumors. However, its ability to discriminate between T3 and T4, N (+) and the low agreement between radiologists suggests the need for complementary imaging techniques.

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En los últimos 30 años el tratamiento del cáncer del recto ha mejorado significativamente gracias al manejo multidisciplinario y a la introducción del concepto de resección total del mesorrecto (RTM), logrando disminuir las tasas de recidiva local y aumentar la sobrevida. Si bien los avances oncológicos y técnicos en términos de tasas de conservación del esfínter anal son innegables, las secuelas funcionales son significativas, especialmente las relacionadas a la función intestinal, sexual y urinaria. Hasta un 90% de los pacientes sometidos a una RTM refiere secuelas intestinales cuyos síntomas se conocen como el síndrome de la resección anterior baja (SRAB). Recientemente se han diseñado sistemas de valoración específicos que han evidenciado su alta incidencia y prevalencia. En esta revisión se entrega una mirada actualizada de la fisiopatología, factores de riesgo, formas de presentación, evaluación clínica y las distintas alternativas de prevención y tratamiento del SRAB.

In the last 30 years, oncologic outcomes of rectal cancer treatment have been significantly improved due to multimodal management and the introduction of the concept of total mesorectum excision. Although the improvements in oncological treatment and surgical techniques are undeniable, multimodal treatment results in the onset of disorders of the intestinal, sexual and urinary function in a high proportion of these patients. Up to 90% of patients undergoing a low anterior resection refer bowel disorders such as fecal incontinence, urgency, increased frequency and fragmentation of defecation. These elements are included in an entity known as the low anterior resection syndrome and specific assessment tools have been designed recently, evidencing the high incidence and prevalence of this syndrome. In the present review, we update the pathophysiology, risk factors, clinical presentation, evaluation and the alternatives of prevention and treatment of low anterior resection syndrome.

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BACKGROUND: Exclusive involvement of the colon or rectum in Crohn's disease, called Crohn's colitis, (CC) occurs in about 25% of these patients. AIM: To analyze early surgical results and long-term outcomes of patients undergoing surgery for CC. MATERIAL AND METHODS: Review of a prospective database, identifying patients with Crohn's disease operated between 2003 and 2015 and excluding those with ileocecal disease. We analyzed demographic data, pre and postoperative pharmacological treatment, operations, morbidity and the need for a second bowel resection at follow-up. RESULTS: We reviewed data from 28 patients aged 17 to 72 years (15 men). Twenty-seven (96.4%) had previous pharmacological treatment, 11 received monoclonal antibodies. The most common indications for surgical treatment were failure of medical treatment in 15 cases, acute severe colitis in 12 and anemia/malnutrition in eight. Total colectomy was performed in 17 (61%) patients, proctocolectomy in 8 (29%) and segmental colectomies in 3 (11%). Sixteen (57%) were operated laparoscopically. Major postoperative complications were observed in 5 (18%). Four needed a reintervention. There was no operative mortality. During a 55 months median follow-up of 27 patients, seven (26%) required a second bowel resection, one of them for recurrence. Nineteen (70%) patients had an ostomy, which was permanent in 11. Fifteen patients are without medical treatment. CONCLUSIONS: Most of the reviewed patients required total colectomy for the control of the disease with a low surgical morbidity. Two-thirds required an ileostomy, which became permanent in half of them.

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Background: Exclusive involvement of the colon or rectum in Crohn's disease, called Crohn's colitis, (CC) occurs in about 25% of these patients. Aim: To analyze early surgical results and long-term outcomes of patients undergoing surgery for CC. Material and Methods: Review of a prospective database, identifying patients with Crohn's disease operated between 2003 and 2015 and excluding those with ileocecal disease. We analyzed demographic data, pre and postoperative pharmacological treatment, operations, morbidity and the need for a second bowel resection at follow-up. Results: We reviewed data from 28 patients aged 17 to 72 years (15 men). Twenty-seven (96.4%) had previous pharmacological treatment, 11 received monoclonal antibodies. The most common indications for surgical treatment were failure of medical treatment in 15 cases, acute severe colitis in 12 and anemia/malnutrition in eight. Total colectomy was performed in 17 (61%) patients, proctocolectomy in 8 (29%) and segmental colectomies in 3 (11%). Sixteen (57%) were operated laparoscopically. Major postoperative complications were observed in 5 (18%). Four needed a reintervention. There was no operative mortality. During a 55 months median follow-up of 27 patients, seven (26%) required a second bowel resection, one of them for recurrence. Nineteen (70%) patients had an ostomy, which was permanent in 11. Fifteen patients are without medical treatment. Conclusions: Most of the reviewed patients required total colectomy for the control of the disease with a low surgical morbidity. Two-thirds required an ileostomy, which became permanent in half of them.

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La hipocalcemia es una complicación metabólica común en la tiroidectomía total y en el bypass gástrico. El mecanismo que la provoca es diferente en ambas entidades clínicas. La incidencia de esta complicación es variable, la presentación clínica es inespecífica y el manejo farmacológico no está estandarizado. Se presenta el caso clínico de una paciente de 40 años, a la cual se le realizaron ambas cirugías con el desarrollo de hipocalcemia sintomática post-operatoria.

Hypocalcemia is a common metabolic complications in total thyroidectomy and gastric bypass. The mechanism that causes it is different in both clinical entities. The incidence of this complication is variable, the clinical presentation is nonspecific and pharmacological management is not standardized. A case report of a patient of 40 years which were performed both surgeries with the development of postoperative symptomatic hypocalcemia.

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La enfermedad diverticular es una patología frecuente en nuestra población, la cual corresponde a la herniación de la mucosa a través de puntos de debilidad en la pared colónica. La inflamación y/o perforación de los divertículos suele provocar un cuadro clínico de urgencia, el cual debe ser diagnosticado y resuelto de forma óptima. El diagnóstico clínico se confirma con la tomografía computada de abdomen y pelvis, y de acuerdo a los hallazgos se clasifica y decide la terapeútica adecuada. En los casos de diverticulitis simple donde solo ocurre la inflamación del divertículo, el reposo intestinal y los antibióticos endovenosos son la terapia más efectiva. Ante la presencia de diverticulitis complicada (absceso, peritonitis purulenta o fecaloidea) existen múltiples opciones que comprenden desde el drenaje del absceso vía percutánea, operación de Hartmann, resección y anastomosis primaria, y lavado laparoscópico. En el presente artículo se expone la etiopatogenia, diagnóstico, tratamiento médico y las múltiples alternativas quirúrgicas en los pacientes con diverticulitis aguda complicada.

Diverticular disease of the colon is a quite frecuent pathology in our population, this refers to small outpouchings from the colonic lumen due to mucosal herniation through the colonic wall .Inflammation and/or perforation of the diverticula usually cause a clinical emergency which must be diagnosed and solved optimally. Clinical diagnosis must be confirmed by an abdominal and pelvic computed tomography scanning, according to the findings should be classified and decide on appropriate treatment. Patients with simple diverticulitis, inflammation of diverticulum only, should be hospitalized and treated with bowel rest and intravenous antibiotics. In the presence of complicated diverticulitis (abscess, purulent or fecaloid peritonitis) there are multiple options ranging from: percutaneous abscess drainage, laparoscopic lavage, resection and primary anastomosis, and Hartmann resection. The following article describes the pathogenesis, diagnosis, medical treatment and surgical options for patients with complicated acute diverticulitis.

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Los catéteres venoso centrales son sondas intravasculares que se insertan en los grandes vasos venosos del tórax y abdomen. Estos se instalan en pacientes que requieren la administración de fluidos, fármacos, nutrición parenteral, o para la determinación de constantes fisiológicas. La técnica de elección para la inserción es la descrita por Seldinger, la cual, a través de una guía metálica, dirige el catéter hasta su ubicación final. Actualmente la punción se puede realizar bajo visión ultrasonográfica, siendo éste el gold standard debido a la importante disminución de las complicaciones. Los vasos más utilizados son la vena yugular interna, subclavia y femoral. Para la elección de la vena se debe considerar las tasas de complicaciones, existiendo las mecánicas, trombóticas e infecciosas. En la presente revisión analizamos las indicaciones, contraindicaciones, técnica de inserción, uso de la ultrasonografía, complicaciones y cómo prevenirlas.

Central venous catheters are intravascular catheters which are inserted into the large venous vessels of the thorax and abdomen. These are installed in patients requiring the administration of fluids, drugs, parenteral nutrition, or for determining physiological constants. The preferred technique for installation is that described by Seldinger, which through a catheter guide wire leads to the final location. Currently puncture can be performed under ultrasonographic view, being gold standard because of the significant reduction in complications. The veins most commonly used are the internal jugular, subclavian and femoral. For the election of the vein must be considered complication rates, existing mechanical, thrombotic and infectious. In this review we analyze indications, contraindications, insertion technique, use of ultrasound, and how to prevent complications.

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