Wednesday, 14 September 2016

Laparoscopic Colostomy in ASA: An Advanced Rectum Cancer Option


Innovation laparoscopy started in 1902 by German doctor Kelling performing laparoscopic pneumoperitoneum exploration applied to a canine. It was not until 1983 that the first laparoscopic appendectomy is awarded by Semm. In 1985 Dr. Erich Muhe makes the first laparoscopic cholecystectomy, historical fact disputed and lost by the French surgeon Phillipe Mouret in 1987. In recent decades, laparoscopic surgery has been gaining place, and the opportunity to develop and be applied in most diseases or surgical pathologies; becoming the gold standard in cholecystitis, gastroesophageal reflux disease and morbid obesity. Moses Jacobs introduced laparoscopic colectomy for the treatment of colorectal cancer and benign pathologies. The first description of a laparoscopic colon resection is reported in the year 1990. In consequence a race began for de-scriptions of laparoscopic surgeries assisted since 1991, regarding to colorectal diseases. There are advantages of laparoscopic surgery of the colon and rectum, regarding to the open one; such as a dose reduction in postoperative analgesic. The Best immune and inflammatory response after surgery, a big recovery time reduction and hospital discharge with a superior cosmetic result. 

We can add other advantages: less postoperative ileus, less intraoperative bleeding, early oral tolerance, low pulmonary complication rate as well as a quick surgical wound healing. It also presents a lower incidence of postoperative adhesions at the same time decreasing the frequency of reoperations because of the intestinal occlusion. Talking about the disadvantages we can describe many situation as the following: technical complexity, cost of instruments, the need for adequate learning curve, uncertainty on the radicality in oncologic resection, the inability to mobilize large organ (surgical specimen) and a prolonged surgical time.Our objective is to describe our experience in mortality, morbidity, clinical efficacy and surgical technique for palliative treatment in patients with unresectable rectal cancer or regionally advanced, with the surgical approach of laparoscopic colostomy in asa (LCA) in the last 3 years in the Surgery of Colon and Rectal service.

Descriptive, observational, retrospective and cross-sectional study; conducting a review of clinical records diagnosed with an inoperable rectal cancer loco regionally advanced with or without metastases and / or adhesions; which are treated with LCA at the General Hospital “Dr. Gaudencio González Garza “of the Medical Unit of High Specialty of the National Medical Center “ La Raza “, of the “Instituto Mexicano del Seguro Social”, during the period from May 2012 to October 2015. It was obtained from each patient record: sex, age, chronic degenerative medical history, surgical and oncology; specific clinical diagnosed with rectal cancer occlusive or with an approaching of occlusive, operative time, operative bleeding, hospital stay, local and general complications. Conversion to open surgery, via oral begin, overall morbidity and mortality.All patients met the criteria with the pre surgical protocol consisted of: Medical history with a physical examination completed. 

General laboratories which included carcinoembryonic antigen and alpha fetoprotein, chest radiography, computed tomography (CT) scans, liver ultrasound, colonoscopy (partial to biopsy, intraoperative or postoperative seeking synchronous or another hereditary syndrome); finally, histologic confirmation of “Rectum Adenocarcinoma”. LCA is projected with a prior review of the stoma, patient’s informed consent, once patients were discharged from hospital they were observed during 21 days, removing surgical sutures and the conduit used in the patients. With referral to Oncology to keep handling with neoadyudancia (a likely option for curative resection post) and / or palliative. 

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