Browsing by Author "Zárate, Alejandro José"

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    Prevalencia de la incontinencia fecal en centros de salud y casas de reposo
    (2008) Zárate, Alejandro José; López Köstner, Francisco; Vergara Heidke, Flavia Alejandra; Viviani García, Paola
    Fecal and urinary incontinence (FI and UI) are psychologically and socially debilitating and embarrassing conditions. Aim: To determine the prevalence of FI and associated factors in patients assessed in health centers (HC) and nursing home (NH) residents. Material and Methods: Prospective, multicentric survey carried out in 3 HC and 16 NH of Santiago. Patients and residents of NH were interrogated about FI between March and July, 2004. Results: The questionnaire was answered by 618 patients attending health centers aged 18 to 87 years (75% females) and 128 nursing home residents aged 40 to 103 years (80% females). The prevalence of liquid or solid FI in HC and NH was 2.7 and 45%, respectively. Among the latter, the incontinence for liquids and solids was 19% and 42%, respectively. The prevalence of UI was 30.1 and 62.7% in HC patients and NH residents, respectively. Among patients attending HC, multivariable analysis showed a relation between older age and urinary incontinence with liquid or solid FI. Among NH residents, multivariate analysis showed a relation between urinary incontinence and motor disabilities with liquid or solid FI. Conclusions: The prevalence of liquid or solid FI among patients assessed in health center is 2.7%. This figure increases in older people, those with UI and in NH residents.
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    Reservorio ileal con anastomosis reservorio anal por colitis ulcerosa: Complicaciones y resultados funcionales a largo plazo
    (2008) Zárate, Alejandro José; Zuñiga Díaz, Álvaro; Pinedo Mancilla, George; López K, F.; Molina Pezoa, María Elena; Viviani García, Paola
    Background: The ileo anal-pouch-anastomosis (IPAA) is the treatment of choice for patients with ulcerative colitis (UC). Aim: To analyze the surgical outcomes, long term evolution and functional results of IPAA. Material and methods: All patients subjected to an IPAA, from 1984 to 2006 were identified from a prospectively constructed inflammatory bowel disease database. Surgical variables, postoperative complications and functional evaluation, using Öresland score were analyzed. Chi square, Fischer exact test, T Student, Mann Whitney and binary logistic regression were included in the statistical analysis. Results: In the study period 107 patients, aged 14 to 62 years (61 females), subjected to an IPAA, were identified in this period. All patients, except 4, had a J pouch. All were protected with a loop ileostomy. Thirteen patients (12.1%) had specific postoperative complications: pelvic collections in five (4.6%), wound infection in four (3.7%), fistula of the anastomosis in two (1.8%), hemoperitoneum and pouch necrosis in one each. Three (2.7%) patients were reoperated. There was no post-operative (30 days) mortality. A complete follow-up was obtained in 106 of 107 patients: four evolved as Crohn disease; four lost their pouch and two died for other causes. One patient required an ileostomy due to a vaginal fistula. Seventy two patients were followed more than 36 months after ileostomy closure and 92% have a satisfactory intestinal function. In the univariate analysis, poorest intestinal function was related to age of diagnosis of UC and presence of chronic pouchitis. In the multivariate analyses age of diagnosis was associated with poor function. Conclusions: IPAA has a low rate of complications. The long term intestinal function is satisfactory in most patients. A poorer intestinal function was observed in older patients and those with chronic pouchitis (Rev Méd Chile 2008; 136: 467-74).
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    Resultados y eventos adversos de la sigmoidectomía por cáncer: laparoscopia versus laparotomía
    (2008) Zárate, Alejandro José; López Köstner, Francisco; Loureiro Pérez, Carolina Andrea; Pinedo Mancilla, George; Molina Martin, María Paz; Kronberg, Udo; Viviani García, Paola
    Objetivo: Comparar resultados y complicaciones inmediatas al realizar una sigmoidectomía laparoscópica (SL) versus abierta (SA) en pacientes con cáncer de colon sigmoides. Material y método: Inclusión prospectiva y consecutiva, mediante protocolo de estudio de pacientes operados mediante SL entre el 2000 y el 2006. Análisis comparativo caso-control, mediante pareo según edad, sexo y ASA entre pacientes operados mediante SL con SA. Análisis por intención de tratamiento, mediante test t de Student, chi cuadrado, Mann-Withney y exacto de Fischer; consideramos estadísticamente significativo p <0,05. Resultados: Treinta y dos pacientes por grupo fueron comparados. Los grupos (SL v/s SA) fueron similares estadísticamente en edad (65,6 v/s 67,3 años), sexo (femenino 31,25%), y ASA (p> 0,05). La mediana del tiempo operatorio fue mayor en SL (220 v/s 172 minutos, p <0,01). Un 9,3% se convirtió a técnica abierta en SL. El tiempo medio a la expulsión de gases y realimentación con líquidos fue menor en SL (2 v/s 4 días, p<0,01 y 3 v/s 5 días, p< 0,01). La estadía media postquirúrgica (5 v/s 8 días p<0,01) fue menor en SL. Las complicaciones postoperatorias médicas, fueron menores en SL (9,3% v/s 37,5% p<0,01), pero las quirúrgicas fueron iguales (6,25% cada grupo). Los linfonodos resecados y tamaños de piezas operatorias fueron similares (SL v/s SA: 22,7 v/s 22,1 linfonodos p= 0,9 y 21,8 v/s 19,3 cm. p= 0,2). Conclusión: El desarrollo de la cirugía laparoscópica colorrectal mediante un protocolo, permite realizar la SL por cáncer con resultados quirúrgicos similares a la SA.