Estudio prospectivo randomizado comparando anastomosis latero-lateral isoperistáltica versus antiperistáltica tras hemicolectomia derecha laparoscópica por cáncer
- Autores: Noelia Ibáñez Cánovas
- Directores de la Tesis: Juan Antonio Luján Mompeán (dir. tes.), Jesús Abrisqueta (dir. tes.)
- Lectura: En la Universidad de Murcia ( España ) en 2018
- Idioma: español
- Tribunal Calificador de la Tesis: Pascual Parrilla Paricio (presid.), Blas Flor Lorente (secret.), Eduardo García-Granero Ximénez (voc.)
- Programa de doctorado: Programa de Doctorado en Ciencias de la Salud por la Universidad de Murcia
- Materias:
- Enlaces
- Tesis en acceso abierto en: DIGITUM
- Resumen
- español
La principal complejidad de la hemicolectomía derecha se encuentra en la realización de la anastomosis ileocólica debido a la escasa estandarización de la técnica. Existen multitud de artículos comparando la disposición de las asas, técnica de sutura y lugar de realización, pero no existen estudios bien diseñados acerca del papel de la peristalsis en esta anastomosis.
Los objetivos de este estudio son: comparar resultados a corto y largo plazo en términos de morbimortalidad postoperatoria y comparar la calidad de vida entre ambos grupos utilizando para ello el Cuestionario de Calidad de Vida Gastrointestinal (GIQLI).
Para ello se ha realizado un estudio prospectivo aleatorizado, en pacientes intervenidos de forma programada por cáncer de colon derecho con hemicolectomía derecha laparoscópica y anastomosis ileocólica iso o antiperistaltica.
Se han incluido 108 pacientes, 54 por rama de tratamiento. No existieron diferencias significativas en las variables demográficas. En cuanto a las variables quirúrgicas, no se hallaron diferencias en la tasa de conversión (p=0.500) ni tampoco en el tiempo quirúrgico total (130[120-150]min. en isoperistáltica vs 140[127-160] en antiperistaltica, p=0.481)ni en el tiempo anastomótico (19[17-22] vs. 20[16-25], p=0,207). En cuanto a complicaciones posquirúrgicas: un 37,0% de pacientes en el grupo isoperistaltico y un 40,7% en el grupo en antiperistaltico presentaron algún tipo de complicación, sin diferencias entre ambos (p=0.693). Aunque no se encontraron diferencias significativas, el grupo isoperistáltico presentó una mayor tasa de ileo paralitico con respecto al antiperistaltico (14.8% vs. 5.6%). Durante el postoperatorio, el grupo antiperistaltico presentó mejores resultados con menor tiempo hasta el primer flato y hasta la primera deposición (p=0.004 y p=0.017), sin embargo, este hecho no se tradujo en una menor estancia hospitalaria (p=0.236). A largo plazo, no existen diferencias significativas en las complicaciones ni en la tasa de diarrea crónica al año de la cirugía (p=0.541). Las puntuaciones del test GIQLI fueron similares entre ambos grupos al mes, 6 meses y año, sin diferencias entre ambos grupos (p=0,154, p=0.498 y p=0.683 respectivamente). En conclusión la anastomosis ileocólica isoperistáltica y la antiperistáltica son igual de seguras y factibles no encontrándose diferencias en las variables de seguridad postoperatorias ni tampoco en los resultados del test de calidad de vida.
The main complexity of the right hemicolectomy is in the performance of the ileocolic anastomosis due to the scarce standardization of the technique. There are many articles comparing the disposition of bowel loops, suture technique and place of execution, but there are no well-designed studies about the role of peristalsis in this anastomosis.
A prospective randomized study was conducted in patients undergoing scheduled surgery for right colon cancer with laparoscopic right hemicolectomy and reconstruction with iso- or antiperistaltic ileocolic anastomosis. Primary endopoint was to compare short and long term results in terms of postoperative morbidity and mortality. Secondary endpoint was to compare quality of life between both groups using the Gastrointestinal Quality Life Index (GIQLI). One hundred and eight patients were included (54 per treatment branch). There were no significant differences in the demographic variables. Regarding surgical variables, no differences were found in conversion rate (p = 0.500) nor in the total surgical time (130 [120-150] min in isoperistaltic vs 140 [127-160] in antiperistaltic, p = 0.481) or anastomotic time (19 [17-22] vs. 20 [16-25], p = 0.207). Regarding postsurgical complications 37.0% of patients in the isoperistaltic group and 40.7% in the antiperistaltic group had some type of complication, without differences between them (p = 0.693). Although no significant differences were found, the isoperistaltic group presented a higher rate of paralytic ileus compared to the antiperistaltic one (14.8% vs. 5.6%). During the postoperative period, the antiperistaltic group showed better results with shorter time until first flatus and until first deposition (p = 0.004 and p = 0.017). However, this did not mean a shorter hospital stay (p = 0.236). In the term results, there are no significant differences in complications or in chronic diarrhea rates one year after surgery (p = 0.541). GIQLI scores were similar between both groups at month, 6 months and a year after surgery, without differences between both groups (p = 0.154, p = 0.498 and p = 0.683 respectively).
In conclusion, isoperistaltic and antiperistaltic ileocolic anastomosis are as safe and feasible as there are no differences in the postoperative safety variables or in the results of the quality of life test.
- English
The main complexity of the right hemicolectomy is in the performance of the ileocolic anastomosis due to the scarce standardization of the technique. There are many articles comparing the disposition of bowel loops, suture technique and place of execution, but there are no well-designed studies about the role of peristalsis in this anastomosis.
A prospective randomized study was conducted in patients undergoing scheduled surgery for right colon cancer with laparoscopic right hemicolectomy and reconstruction with iso- or antiperistaltic ileocolic anastomosis. Primary endopoint was to compare short and long term results in terms of postoperative morbidity and mortality. Secondary endpoint was to compare quality of life between both groups using the Gastrointestinal Quality Life Index (GIQLI). One hundred and eight patients were included (54 per treatment branch). There were no significant differences in the demographic variables. Regarding surgical variables, no differences were found in conversion rate (p = 0.500) nor in the total surgical time (130 [120-150] min in isoperistaltic vs 140 [127-160] in antiperistaltic, p = 0.481) or anastomotic time (19 [17-22] vs. 20 [16-25], p = 0.207). Regarding postsurgical complications 37.0% of patients in the isoperistaltic group and 40.7% in the antiperistaltic group had some type of complication, without differences between them (p = 0.693). Although no significant differences were found, the isoperistaltic group presented a higher rate of paralytic ileus compared to the antiperistaltic one (14.8% vs. 5.6%). During the postoperative period, the antiperistaltic group showed better results with shorter time until first flatus and until first deposition (p = 0.004 and p = 0.017). However, this did not mean a shorter hospital stay (p = 0.236). In the term results, there are no significant differences in complications or in chronic diarrhea rates one year after surgery (p = 0.541). GIQLI scores were similar between both groups at month, 6 months and a year after surgery, without differences between both groups (p = 0.154, p = 0.498 and p = 0.683 respectively).
In conclusion, isoperistaltic and antiperistaltic ileocolic anastomosis are as safe and feasible as there are no differences in the postoperative safety variables or in the results of the quality of life test.
- español
