Abstract Objective: Familial Adenomatous Polyposis is a complex hereditary disease that exposes the carrier to a great risk of Colorectal Cancer (CRC). After prophylactic surgery, intra-abdominal desmoid tumors are known to be one the most important cause of death. Therefore, recognition of increased-risk patients and modification of operative strategy may be crucial. Aim: The objective of this study was to estimate the desmoid tumor risk in relation to various surgical and clinical variables. Methods: Patients who had undergone polyposis since 1958 were included in the study. After exclusion criteria were met, those who had developed desmoid tumors were selected to undergo further evaluation. Results: The study revealed that the risk of developing desmoid tumors was associated with various factors such as sex ratio, colectomy, and reoperations. On the other hand, the type of surgery, family history, and surgical approach did not affect the risk of developing desmoid tumors. The data collected from 146 polyposis patients revealed that 16% had desmoid polyps. The sex ratio was 7:1, and the median age at colectomy was 28.6 years. Family history, multiple abdominal operations, and reoperations were some of the characteristics that were common in desmoid patients. Conclusion: Recognition of clinical (female sex) and surgical (timing of surgery and previous reoperations) data as unfavorable variables associated with greater risk may be useful during the decision-making process.

Abstract Background Multiple small-bowel diverticulosis comprises a rare entity with probable underestimated incidence, and that may be the reason why it is sometimes overlooked when managing cases with peritonitis. Case report In the present paper, we report the case of a 76-year-old male presenting abdominal pain and fever in an acute setting. Computed tomography (CT) scans revealed jejunal thickening and numerous images of saccular addition that were interpreted as jejunoileal diverticulitis. After an initial period of clinical treatment, surgical management was indicated based on a worsening clinical picture and the presence of an extraluminal focus of gas detected in a subsequent CT scan. Through a laparoscopic approach, multiple small-bowel diverticula and a tamponade perforation were found. A segmental intestinal resection was performed, and the patient was discharged after a ten days. Conclusions Multiple jejunal diverticulosis is a rare condition that should be remembered in the setting of an acute abdomen. As it prevails among older patients, early diagnosis with radiological aid is crucial to establish the most adequate management, including intestinal resection, if necessary.

Abstract Ingesting food contaminated by pathogens and/or their toxins can cause foodborne illness. In this sense, this study investigated the occurrence of enterotoxigenic S. aureus in frozen cheese bread dough and assessed the production and thermosensitivity of SEA in artificially contaminated cheese dough. E. coli counts were determined by MPN. Confirmation of the presence of S. aureus was carried out by biochemical and molecular identification. The detection of the genes sea, seb, sec, and sed was performed using the PCR. The detection of SEA in artificially contaminated cheese dough, before and after baking at 180 ºC for 35 minutes was performed using the RPLA. All samples contaminated with E. coli had NMP < 5.0×102 CFU / g. None of the isolated S. aureus strains expressed the classical enterotoxin genes sea, seb, sec, and sed. However, as there are 23 serologically distinct staphylococcal enterotoxins, we cannot rule out the possibility that strains expressed other enterotoxin-encoding genes. Laboratory tests showed the presence of SEA in cheese bread dough artificially contaminated with SEA-producing S. aureus after 8 h of incubation at 10 or 20 °C. Heat treatment at 180 °C for 35 minutes was not sufficient to inactivate SEA in artificially contaminated cheese bread previously incubated for 24 h at 10 or 20 °C. These results indicate a potential health risk to consumers of cheese bread and underscore the need for ingredient quality control and measures to prevent the multiplication of S. aureus during product manufacture and storage.

ABSTRACT BACKGROUND: Plexiform neurofibromas represent a common neoplasia of type 1 neurofibromatosis in which neurofibromas arise from multiple nerves involving connective tissue and skin and rarely affect the colon and rectum. Co-occurrence of plexiform neurofibromas, neuroendocrine tumors with primary involvement of the rectum, and medullary thyroid carcinoma in patients with neurofibromatosis type 1 is a previously undescribed condition. The aim of this manuscript was to present a case of primary plexiform neurofibroma and neuroendocrine tumors of the upper rectum in a patient with neurofibromatosis type 1 whose genetic sequencing found a novel mutation in the neurofibromatosis type 1 gene and to review the literature. CASE REPORT: A 49-year-old woman with a familial history of neurofibromatosis type 1 complained of abdominal cramps for 6 months. She had previously been submitted for a total thyroidectomy due to medullary thyroid carcinoma. She was submitted to a colonoscopy, which identified a submucosa lesion located in the upper rectum. The patient was referred for a laparoscopic rectosigmoidectomy, and the histopathological study of the surgical specimen identified two different tumors. An immunohistochemical panel was done for histopathological confirmation of the etiology of both lesions. The results of the panel showed intense immunoexpression of S100 protein in the largest and superficial lesion, as well as positivity for chromogranin and synaptophysin in the minor and deep lesion confirming the diagnosis of rectal plexiform neurofibromas concomitant with neuroendocrine tumors. The proliferative activity rate using Ki-67 antibodies showed that both tumors had a low rate of mitotic activity (<1%). Genetic sequence panel identified an undescribed mutation in the neurofibromatosis type 1 gene (deletion, exons 2–30). The patient’s postoperative evolution was uneventful, and she remains well, without recurrence, 3 years after surgery. CONCLUSION: The co-occurrence of medullary thyroid carcinoma, plexiform neurofibromas, and neuroendocrine tumors of the rectum in patients with neurofibromatosis type 1 is an exceptional and undescribed possibility, whose diagnosis can be confirmed by the immunohistochemical staining and genetic panel.

RESUMO RACIONAL: Os neurofibromas plexiformes representam uma neoplasia frequente na neurofibromatose tipo 1 onde os neurofibromas surgem de múltiplos nervos envolvendo, também, o tecido conjuntivo e a pele raramente acometendo o cólon e o reto. A co-ocorrência de neurofibromas plexiformes, tumores neuroendócrinos, com envolvimento primário do reto, e carcinoma medular de tireoide em pacientes com neurofibromatose tipo 1 é uma condição ainda não descrita. O objetivo deste manuscrito é descrever um caso de neurofibromas plexiformes e tumores neuroendócrinos primários do reto superior, em paciente com neurofibromatose tipo 1, cujo sequenciamento genético identificou uma nova mutação no gene neurofibromatose tipo 1 e revisar a literatura sobre o tema. DESCRIÇÃO DO CASO: Mulher de 49 anos, com história familiar de neurofibromatose tipo 1 queixava-se de cólicas abdominais há seis meses. Tinha sido previamente submetida a tireoidectomia total por carcinoma medular de tireoide. Foi submetida a colonoscopia, que identificou lesão submucosa localizada no reto superior. A doente foi encaminhada para retossigmoidectomia laparoscópica, cujo estudo histopatológico do espécime cirúrgico identificou dois tumores distintos. Realizou-se painel imuno-histoquímico para confirmação histopatológica da etiologia de ambas as lesões. O resultado do painel mostrou intensa imunoexpressão da proteína S-100 da lesão superficial e de maior tamanho,e positividade para cromogranina e somatofisina da lesão mais profunda e de menores dimensões confirmando o diagnóstico de neurofibromas plexiformes retal e tumores neuroendócrinos. O índice de atividade proliferativa utilizando o anticorpo ant-Ki-67 mostrou que ambos os tumores apresentavam baixa índice mitótico (<1%). O painel genético identificou mutação no gene neurofibromatose tipo 1 (deleção, exons 2–30) ainda não descrita. A doente apresentou evolução pós-operatória sem intercorrências, permanecendo bem, sem recorrência, três anos após a cirurgia. CONCLUSÕES: A co-ocorrência de carcinoma medular de tireoide, neurofibromas plexiformes e tumores neuroendócrinos do reto em pacientes com neurofibromatose tipo 1 é uma possibilidade excepcional e ainda não descrita, cujo diagnóstico pode ser confirmado pela coloração imuno-histoquímica e painel genético.

Abstract The evaluation of preventivemeasures and risk factors for anastomotic leakage has been a constant concern among colorectal surgeons. In this context, the description of a new way to perform a colorectal, coloanal or ileoanal anastomosis, known as transanal transection and single-stapled (TTSS) anastomosis, deserves an appreciation of its qualities, and a discussion about its properties and technical details. In the present paper, the authors review themost recent efforts aiming to reduce anastomotic dehiscence, and describe the TTSS technique in a patient submitted to laparoscopic total proctocolectomy with ileal pouch-anal anastomosis for familial adenomatous polyposis. Surgical perception raises important advantages such as distal rectal transection under visualization, elimination of double-stapling lines (with cost-effectiveness and potential protection against suture dehiscence), elimination of dog ears, and the opportunity to be accomplished via a transanal approach after open, laparoscopic, or robotic colorectal resections. Future studies to confirm these supposed advantages are needed.

Resumo As recomendações atuais para manuseio das doenças colorretais ainda estão em evolução, devido à limitada experiência nesse tema. Como o novo coronavírus pode ser transmitido em gotículas da respiração, por contato ou por via oro-fecal, ainda não existe consenso de como este fato pode afetar a investigação e o tratamento de doenças anorretais. Assim, são necessários estudos multicêntricos de qualidade para prover melhor informação ao paciente e equipe multiprofissional, possibilitando a formulação de uma resposta efetiva à pandemia em nossa especialidade. Uma vez que o risco operatório de pacientes infectados é maior, o passo subsequente reside em identificar novas estratégias terapêuticas que possam minimizar esse efeito individualmente. Assim, reconhece-se atualmente que a pandemia pelo COVID-19 deve alterar algumas práticas tradicionais. Consequentemente, o tratamento cirúrgico de um doente infectado ou suspeito demanda reflexões específicas. Esse artigo analisa influências potenciais relacionadas ao tratamento do Câncer Colorretal (CCR) e Doenças Inflamatórias Intestinais (DII). No atual momento, cirurgias eletivas devem ser postergadas e o cirurgião colorretal deve avaliar cuidadosamente os riscos e benefícios dessa decisão. Nesse contexto, uma mudança na direção de modalidades não-cirúrgicas e menos agressivas do CCR pode favorecer a prorrogação do tratamento definitivo. Aqui também se discutem as preocupações sobre a infecção viral em pacientes com DII, sua influência sobre os sintomas clínicos e as modificações propostas nos esquemas terapêuticos.

Abstract The current recommendations for management of colorectal diseases are still evolving, due to the limited experience on this issue. As the new coronavirus can be transmitted through breath droplets, by contact and orofecally, there is no consensus of how this fact may affect the investigation and treatment of anorectal diseases. Thus, high-quality multicenter studies are urgently needed to provide better information to both patients and the multiprofessional team, in order to build an effective pandemic response plan in our specialty. As a greater operative risk for infected patients has already been demonstrated, the next step lies on the identification of new therapeutic strategies that could minimize this effect on an individual basis. There is a present understanding that the COVID-19 pandemic should change some traditional practices. Therefore, the surgical treatment of suspected or known COVID-19 case demands specific insights. This article analyses potential influences regarding the treatment of patients with Colorectal Cancer (CRC) and Inflammatory Bowel Diseases (IBD). At present, elective surgery must be avoided, and the colorectal surgeon must carefully evaluate the risks and benefits of such decision. Within this context, a change toward nonsurgical and less aggressive modalities of CRC treatment may help to postpone definitive treatment. We also discuss the concerns regarding the viral infection among the population, the influence on clinical symptoms and the proposed modifications on therapeutic schemes.

Resumo A pandemia pelo COVID-19 colocou o Brasil hoje numa situação de destaque negativo, porque somos o segundo país com maior número de casos no mundo. Ao finalizarmos o período de afastamento social, as atividades profissionais, incluindo as médicas, serão restabelecidas, e o especialista necessita estar atualizado a fim de prover o melhor nível de trabalho, de maneira segura. Apesar de muitas das recomendações estarem baseadas em opiniões e estudos sem muito grau de evidência, sua divulgação nesse momento torna-se necessária, uma vez que a infecção pelo coronavírus afeta os resultados operatórios. De maneira geral, o médico deve assumir medidas preventivas desde o momento em que agenda uma consulta até a realização do procedimento cirúrgico. Além disso, é necessário considerar a necessidade de mudar provisoriamente os critérios de indicação cirúrgica, e até as condutas operatórias. Parece existir um pensamento uniforme no sentido de adiar cirurgias eletivas. Da mesma forma, devemos reconhecer a infecção viral precocemente, antes ou após a cirurgia. Diversas medidas preventivas relacionadas aos procedimentos minimamente invasivos já foram descritas, realçando o poder de disseminação pelo aerossol gerado nesses procedimentos e no uso de instrumentos de energia. O presente artigo visou apresentar ao coloproctologista as recomendações atuais e cuidados gerais para prevenir disseminação da infecção, e como planejar o tratamento cirúrgico com mais segurança em termos de momento da cirurgia e aspectos técnicos específicos.

Abstract The COVID-19 pandemic has shown our country in an unfavorable light, as Brazil has reported the second highest number of deaths to date. When the social isolation phase is finished, professional activities (including the medical ones) will resume their routines and the specialist must be updated in order to provide effective and safe care. Although many published recommendations are based on low levels of evidence, disclosing them has become necessary, since the coronavirus infection may affect operative outcomes. Overall, it is suggested that physicians adopt preventive measures, starting with the medical appointment, and extending them to the surgical procedure. Furthermore, it is also necessary to provisionally change criteria for operative indications and conducts. Currently, postponing elective surgeries seems to be a universally agreed decision. Moreover, we need to establish the early diagnosis of the viral infection, before or after the surgery. Several safety measures related to minimally-invasive procedures have been reported, disclosing the risks of aerosol dissemination by the pneumoperitoneum and smoke from energy-powered devices. The present article aimed to bring to the colorectal surgeon the current recommendations and general safety measures in order to prevent infection dissemination, to improve surgical planning in terms of timing and specific technical aspects.

Abstract This study assessed the performance of two pilot units, a conventional activated sludge (CAS) and an Integrated Fixed-Film Activated Sludge (IAS), in the treatment of leachate from sanitary landfill combined with domestic sewage, with the aim of removing organic substances. In order to assess the possible impacts on treatment, three experimental phases were designed using influent leachate contributions of 5%, 10%, and 20% of the total BOD load. Overall, the results showed that no significant changes in the behavior of biological processes. The IAS unit presented average BOD removal efficiencies of above 88%, 87% and 80% for the three leachate load contributions of 5%, 10% and 20% studied. The CAS unit presented lower average efficiency with a 5% leachate contribution (64%), but displayed a similar performance to the IAS unit in the other phases (82% and 80%); similar quantitative aspects were observed for both treatment processes with regards to biomass composition analysis. The kinetic coefficients related to heterotrophic metabolism did not indicate negative effects on treatment efficiency as a result of the increase in leachate addition, with values of 2.8; 2.8 and 2.7 d-1 obtained respectively for each phase with the CAS unit, and 2.0; 1.5 and 1.6 d-1 with the IAS unit, representing similar values to those found in the literature (1.5 a 5.0 d-1). The results reinforced the conclusion that the leachate load introduced did not cause inhibition or significant alterations to heterotrophic metabolism, and, therefore, to the removal of organic matter.

Abstract The aim of this study was to analyze the effects of genetic group and sex on residual feed intake, performance, testicular size, carcass and morphometric traits in Santa Ines purebred and Dorper ´ Santa Ines crossbred lambs. A total of 32 lambs, with initial body weight of 18±3.7 kg were used. Analysis of variance, considering the interaction between sex and genetic group of all the traits were performed. Crossbred females (-0.018±0.06) and purebred males (-0.018±0.05) were more efficient (p<0.001) in residual feed intake than crossbred males (0.018±0.04) or purebred females (0.018±0.04). The most efficient animal in residual feed intake consumed 37.9% less feed (1.179 kg/day) than the least efficient animal (1.899 kg/day). Crossbred, when compared to purebred, showed higher values for body weight, average daily gain, testicle size, carcass traits; had greater muscle accumulation, were more compact and with more aptitude to beef. Purebred were taller, but with lower body length and thoracic perimeter than crossbred. Males had greater muscle accumulation, were more compact and with more aptitude to meat. Crossing of native (Santa Ines) with exotic breed (Dorper) is an alternative to align efficiency in feed use, testicular size, compactness, aptitude for meat and ability for muscle accumulation.

A expansão da mancha urbana na junção dos municípios de Serra e Cariacica, Grande Vitória - ES (Brasil), área territorial que compreende boa parte do Corredor Ecológico Duas Bocas - Mestre Álvaro, é algo relativamente recente e evidencia a necessidade de debates que coloquem em relevo as discussões e problematizações acerca dos formatos de gestão territorial, tanto no plano municipal, quanto no metropolitano ou estadual. Nosso exercício, nesse artigo, consiste em tentativas de se problematizar os zoneamentos contidos nos Planos Diretores Municipais de Cariacica e Serra, no limite entre esses municípios, dentro do corredor ecológico, questionando a eficácia desse instrumento enquanto estratégia de preservação ambiental, apontando conflitos territoriais entre os zoneamentos urbanos municipais e as diretrizes ambientais.

The expansion of urban spot at the junction of the municipalities of Serra and Cariacica, Grande Vitória - ES (Brazil), a territorial area that comprises much of the Duas Bocas - Mestre Álvaro Ecological Corridor, is relatively recent and evidences the need for debates that place I highlight the discussions and problematizations about the formats of territorial management, in the municipal, metropolitan or state level, are highlighted. Our exercise, in this article, consists of attempts to problematize the zoning contained in the Cariacica and Serra Municipal Master Plans, at the boundary between these municipalities, within the ecological corridor, questioning the effectiveness of this instrument as an environmental preservation strategy, pointing territorial conflicts between municipal urban zoning and environmental guidelines.

RESUMO Este trabalho teve como objetivo a determinação dos parâmetros cinéticos que descrevem o crescimento das bactérias heterotróficas e autotróficas nitrificantes em três sistemas de lodos ativados com aeração prolongada, operados com baixa aeração, a fim de se obter a remoção de nitrogênio de esgoto sanitário pelo processo de nitrificação e desnitrificação simultâneas (NDS). Em relação às remoções de matéria orgânica e nitrogênio, aplicando-se idade do lodo na faixa de 12 a 20 dias e concentrações de oxigênio dissolvido (OD) nos reatores em torno de 0,5 mg O2.L-1, foi possível obter eficiências superiores a 90% e um esgoto tratado com concentrações de nitrato inferiores a 7,0 mg N.L-1. Os experimentos realizados comprovam que, nas condições operacionais adotadas durante os testes respirométricos, as bactérias heterotróficas e autotróficas presentes nos lodos ativados estavam ativos e, ainda que baixa, a concentração de OD não foi limitante para o desenvolvimento da cinética dos processos envolvidos na remoção de materiais orgânico e nitrogenado.

ABSTRACT The objective of this work was to determine the kinetic parameters that describe the growth of heterotrophic and autotrophic nitrifying bacteria in three systems of activated sludge with prolonged aeration, operated with low aeration, with the objective of obtaining nitrogen removal of sanitary sewage by simultaneous nitrification and denitrification (SND). In relation to the removal of organic matter and nitrogen, by using sludge ages ranging from 12 to 20 days and OD concentrations in the reactors around 0.5 mgO2.L-1, it was possible to obtain efficiencies higher than 90% and a sewer treated with nitrate concentrations below 7.0 mgN.L-1. The experiments carried out prove that, under the operating conditions adopted during the respirometric tests, heterotrophic and autotrophic bacteria present in activated sludge were active and, although the low concentration of OD was not limiting for the development of the kinetics of the processes involved in the removal of organic and nitrogenous material.

RESUMO Neste estudo, foi avaliado o desempenho de um reator em bateladas sequenciais com biofilme de leito móvel operado pelo processo anaeróbio-anóxico-óxico (A2O), aplicado à remoção simultânea de material orgânico, nitrogênio e fósforo de esgoto sanitário. Utilizaram-se dois reatores com volume útil de 36 L cada, sendo que um deles recebeu anéis plásticos móveis do tipo Kaldnes®, com área superficial específica estimada em 310 m2/m3 que ocuparam 50% do volume útil do reator (denominado aqui de MBSBBR). O estudo foi conduzido com tempo de retenção de sólidos (TRS) de 12 dias, tempo de retenção hidráulico (TRH) de 6 horas, taxa de alimento/microrganismo (A/M) de 0,4 a 0,5 gDQO/SSV.d, oxigênio dissolvido (OD) na faixa de 0,3-0,8 mgO2/L e taxas de aplicação de carga orgânica, nitrogênio e fósforo de 47,2 gDQO/L.d, 5,4 gNTK/L.d e 0,4 gP/L.d, respectivamente. Os resultados de eficiência de remoção de demanda química de oxigênio (DQO), N-NH3 e fósforo foram de 91,1, 90,5 e 85,4% para o reator MBSBBR e de 89,5, 91,6 e 84,4% para o reator RBS, respectivamente. Os resultados do teste estatístico de ANOVA foram aplicados às principais variáveis estudadas, e os valores convergiram para valores de f observado < f crítico . Dessa forma, considera-se que houve similaridade de desempenho nos reatores MBSBBR e RBS. Conclui-se que a introdução do meio suporte não trouxe benefícios ao tratamento em termos de remoção de nutrientes. No entanto, o estudo mostrou que é possível de se obter elevada remoção de nitrogênio, em baixas concentrações de OD, o que se torna vantajoso para o tratamento de esgoto com elevada concentração de nitrogênio.

ABSTRACT In this study, the performance of a reactor in sequential batch with mobile bed biofilm operated by the anaerobic-anoxic-oxic (A2O) process, applied to the simultaneous removal of organic material, nitrogen and phosphorus from sanitary sewage was evaluated. Two reactors with a useful volume of 36 liters each were used, one of them receiving Kaldnes® type mobile plastic rings, with a specific surface area estimated at 310 m2/m3, which occupied 50% of the reactor’s useful volume (MBSBBR). The study was conducted with 12-day solid retention time (SRT), 6 hour hydraulic retention time (HRT), food/microorganism (F/M) ratio of 0.4 to 0.5 gCOD/VSS.d, dissolved oxygen (DO) in the range of 0.3-0.8 mgO2/L and application rates of organic load, nitrogen and phosphorus of 47.2 gCOD/L.d, 5.4 gTNK/L.d and 0.4 gP/L.d, respectively. The efficiency of chemical oxygen demand (COD), N-NH3 and Phosphorus removal was of 91.1%, 90.5% and 85.4% for the MBSBBR reactor and 89.5%, 91.6% and 84.4% for the RBS reactor, respectively. The results of the statistical ANOVA test were applied to the main variables studied and the values converged to values of f observed < f critical . In this way, it is considered that there was a similarity of performance between the MBSBBR and RBS reactors. It is concluded that the introduction of the support medium did not bring benefits to the treatment in terms of nutrient removal. However, the study showed that it is possible to obtain high nitrogen removal at low concentrations of DO, which is advantageous for the sewage treatment with high nitrogen concentration.

Abstract This research investigated the performance of two pilot-scale treatment plants: an activated sludge and a hybrid model type IFAS (Integrated Fixed-Film Activated Sludge), combining sanitary landfill leachate with domestic sewage treatment with the objective of removing organic substances. In order to assess the possible impacts on the treatment, three experimental phases were developed with leachate inputs in the influent composition: 5%, 10% and 20% of the total load of BOD. As can be seen from the results, even with the highest levels of leachate input, there were no significant changes in the behavior of the biological processes. Regarding the oxidation of nitrogen compounds, expressed in terms of TKN, approximately 90% removals were observed for the IFAS process in all the phases. In the Activated Sludge process, removal rates during the study were approximately 70%, indicating poor performance. The kinetic coefficients for the autotrophic metabolism related to the Activated Sludge process remained stable, while a progressive decrease was observed for each stage in the IFAS process. In general, the IFAS process presented better performance than the Activated Sludge process in terms of removal efficiency of nitrogen matter, as well as higher operating stability.

RESUMO Durante as últimas décadas, a incorporação de técnicas minimamente invasivas no tratamento de doenças colorretais testemunhou um progresso lento e firme, principalmente após o reconhecimento da segurança oncológica e melhor evolução. A adoção rotineira na prática clínica e na Residência Médica no Brasil ainda não amplamente avaliada até agora. Objetivos: O presente estudo visou avaliar a adoção e as limitações relativas ao uso de técnicas laparoscópicas entre cirurgiões colorretais brasileiros. Métodos: um questionário foi enviado a 1870 membros filiados à Sociedade Brasileira de Coloproctologia (SBCP) em 2006. As questões foram enviadas por email, incluindo dados pessoais (sexo, idade) e profissionais (tempo e local de prática, filiação à SBCP, número mensal de procedimentos laparoscópicos, tratamento de câncer e limitações para realizar laparoscopia na rotina. Resultados: Entre os 1870 membros, 418 (22.4%) mandaram sua resposta, com uma maior participaçãoo de homens (80%) em comparação às mulheres (20%). A idade média foi de 43 (28-80) anos. A distribuição entre membros titulares e não titulares foi semelhantes (48% vs. 52%). As atividades profissionais foram desenvolvidas em clínica privada (84%), hospitais privados (73%), hospitais públicos (50%) e hospitais universitários (53%). Entre os que responderam (418), 110 (26.3%) não realizavam procedimentos laparoscópicos, enquanto 308 (73.7%) já haviam adotado o acesso laparoscópico rotineiramente na prática clínica. Um número médio de 7.6 procedimentos colorretais laparoscópicos são realizados por mês (1-40). Cerca de 13% dos cirurgiões iniciaram sua experiência laparoscópica diretamente com procedimentos colorretais, enquanto a maioria (87%) começaram por outros procedimentos no trato digestivo. A adoção da laparoscopia foi positivamente influenciada pela idade jovem dos membros (46% vs. 28%) e pela filiação a hospitais universitários (p = 0,01). Inversamente, cirurgiões trabalhando na prática privada demonstraram uma menor tendência em adotar o método. A maioria dos cirurgiões (93%) que adoraram a laparoscopia afirmou incluir pacientes com câncer colorretal em suas indicações operatórias. Entre os que responderam 106 (34,4%) já realizaram mais de 100 procedimentos laparoscópicos, e 167 (54,2%) reportaram experiência maior que 50 casos. Dentre aqueles que não adotaram técnicas minimamente invasivas, a falta de treinamento (73,6%) ou a indisponibilidade de instrumental laparoscópico (27,3%) foram incriminadas como os principais fatores limitantes. Conclusões: o índice de adoção de técnicas laparoscópicas no tratamento de doenças intestinais ainda é baixo (pelo menos 17%) entre cirurgiões colorretais brasileiros. Esforços futuros de nossa Sociedade Médica devem focar na provisão de treinamento supervisionado, na criação de oportunidades para preceptoria durante a experiência inicial e na obtenção de instrumental em centros que queiram mudar sua rotina e perspectivas.

ABSTRACT Routine adoption of laparoscopy in clinical practice and Medical Residency has not been widely evaluated in Brazil so far. Aim: To take an overview on the adoption and limitations concerning the use of laparoscopic techniques among Brazilian colorectal surgeons. Methods: A questionnaire was sent to 1870 SBCP filiated members, containing personal and professional data such as sex, age, length and local of practice, SBCP filliation, number of procedures, treatment of cancer and laparoscopy limitations. Results: 418 members (22.4%) sent their response (80% men and 20% women). 110 members (26.3%) affirmed they don't perform any laparoscopic procedure, while 308 (73.7%) have already adopted laparoscopy as a routine. An average number of 7.6 laparoscopic colorectal procedures were declared to be performed per month (1 to 40 procedures). Laparoscopic adoption rates were favourably influenced by young age members (46% vs. 28%) and affiliation to University hospitals (p = 0.01). Conversely, surgeons from private clinic showed a greater tendency of no adoption. Among the 308 responders, 106 (34.4%) have already surpassed more than 100 laparoscopic cases, and 167 (54.2%) reported an experience of more than 50 operated patients. The group of surgeons not using minimally invasive techniques incriminated lack of training (73.6%) and laparoscopic instruments availability (27.3%) as the main reasons for no adoption. Conclusions: Adoption rate of laparoscopic techniques to treat colorectal diseases is still low (at least 17%). Future efforts should focus on providing supervised training, proctorship during the initial experience and help instrumental acquisition in centers willing to change their routine and perspectives.