1er Semestre

[lC(95%): 54.9- 72.0%] de los pacientes era mayor de 60 años. El 59.8% [lC(95%l: 51.l-68.5%l eran mujeres. las correspondientes tasas de desnutrición fueron de 33.9% [IC195%l: 27.2 – 40.7%] (cohorte retrospectiva) y 20,7% [lC(95%(: 16.4 – 25.0%l (cohorte prospectiva). Las correspondientes tasas de complicaciones posquirúrgicas fueron de 41.5% [lC95%): 34.5-48.5%l (cohorte retrospectiva) y 37.9% [IC(95%): 32,8- 43.5%] (cohorte prospectiva). En la cohorte retrospectiva, las complicaciones se presentaron en el 77.7% [lC(95%): 76.0 1 -79.5%l de los pacientes desnutridos. Por el contrario, en la cohorte prospectiva las complicaciones afectaron al 33.3% [lC(95%): 31.1 – 35.ó%] de los desnutridos. Se registraron 6 (11 .3%) fallecidos en la cohorte retrospectiva. Los fallecidos presentaban un estado nutricional prequirúrgico deteriorado. Los pacientes desnutridos que no recibieron la intervención alimentaria consumieron hasta 6 días/cama más que sus Contrapartes que sí la recibieron. La intervención nutricional redujo en 2.4 veces la probabilidad del paciente desnutrido de complicarse, e hizo cero la probabilidad del paciente desnutrido complicado de fallecer. La intervención nutricional no modificó la probabilidad del paciente bien nutrido de complicarse, ni de fallecer en caso de complicarse. Se concluye que la adopción de un programa de intervención alimentaria, nutrimental y metabólica disminuye las complicaciones posquirúrgicas, la mortalidad y la estadía hospitalaria de los pacientes desnutridos enfermos de cáncer colorrectal.

Abstract

We present in this article the post-operatory morbimortality rates and the length of stay of 29 patients operated upon after a diagnosis of a malignant colorectal discase, at the Coloproctology Service, “Hermanos Ameijeiras” Hospital, during 1999 and 2000 lfirst half) (Prospective Cohort) after a metabolic, nutrient and food intervention in two stages: Preooeratory: A low-residue diet, ovoalbumine supplements as 3 eggs whites (when serum Albumine -c 35 g/L), and a fiberfree, fiquid, entera] diet (when serum Albumine < 35 gIL, a detefiorated nutritional status, and an impending laparotomy to be due in no more than 15 days; Postoperatorv:

Reasumption of the oral feeding 48 hours alter the laparotomy, first with the enteral diet, and with a low-fiber diet afterwards, before recommending a fuil diet. The natural post-operatory morbimortality rates and the length of stay (in the abscense of the metabolic, nutrient and food interventioní were estimated after retrospectiva analysis of clinical data collected from 53 patients essisted for the saíne motive at “Hermanos Ameijeiras” during 1998, 1999 y 2000(first hall) (Retrospective cohort). 63.4% [CI(95%): 54.9 – 72.0%] of the patients was older than

60 years. 59.8% ICI(95%(: 51.1 – 68.5%l were women. The corresponding mainutrition rates were 33.9% [CI(95%): 27.2 -40.7%] Retrospective cohortí and 20.7%[CI(95%l: 16.4 – 25.0%l (Prospective cohort). The corresponding postoperatory complication rates were 41.5% [CI(95%(: 34.5 – 48.5%] (Retrospective cohortí and 37.9% [CI(95%): 32.8 – 43.5%] (Prospective cohortí. In the Retrospective cohort, complications were seen in 77.7% [CI(95%): 76.0 – 79.5%l of the malnourished patients. Qn the contrary, in the Prospective cohort, complications aflected 33.3% [Cl(95%): 31.1 – 35.6%] of the undemourished ones. 6 III .3%) deaths occurred in the Retrospective cohort. Ah of the deceased had a deteriorated preoperatory nutritional status. Those undemourished patients who did not receive the nutrient intervention spent up to 6 days/bed more than their counterparts who did received it. Nutrient intervention reduced 2.4 times the probability of the undemourished patient to get complicates, and made the probability of the complicated, undernourished patient of dying equal lo zero. Nutrient intervention did not after the probabiiity of the wellnourished patient to get complicated, nor the probability of dying in case of complications. It is concluded that the inception of an nutrient, metabolic and food intervention program lowers the post-operatory complications, the mortaihy and the length of stay of the malnourished patients affected mith colorectal cancer.

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PROLAPSO RECTAL E INCONTINENCIA FECAL,
Conducta después del procedimiento de Frykman

Resumen

El prolapso rectal es un problema poco común, pero en ocasiones es de difícil abordaje, en especial cuando el paciente reporta incontinencia después de la operación restauradora. Se realizó en nuestra unidad de coloproctología un estudio retrospectivo de nuestra experiencia para corroborar la efectividad del Procedimiento de Frykman, para controlar la incontinencia, asimismo se intenta conocer el resultado de los pacientes que se sometieron a una segunda intervención (Parks) para el control de la incontinencia fecal. Se reportan doce pacientes sometidos a cirugía para reparación del prolapso rectal, de los que, dos pacientes finalmente reportaron incontinencia a pesar del procedimiento de Parks, llegando a la conclusión que la neuropatía puede ser una causa importante en su incontinencia fecal.

Summary

The rectal prolapse is a not very common problem, but in occasions of difficult boarding, especially when the patient reports incontinence alter restoring operation. It was carried out in our Coloproctologic Unit a retrospective study of our experience to corroborate the effectiveness of the Frykman Procedure, to control the rectal prolapse, likewise it is tried to know the result of the patients that underwent a second intervention (Parks Procedure), for the control of the fecal incontinence. 12 subjected patients are reported to surgery for repair of the rectal prolapse, of those that, 2 patients are reported to surgery for repair the rectal prolapse, of those that, two patients finally reported incontinence in spite of the Parks procedure, reaching the conclusion that the pudendal alteration can be an important factor in the failure of the Park´s procedure.