Prone Versus Supine Position in Abdominoperineal Resection: Outcomes in the Laparoscopic Era.

Background: It is unclear whether the supine or prone approach for abdominoperineal resection (APR) influences outcomes. Methods: In a retrospective study of patients with rectal cancer who underwent curative laparoscopic APR from 2005 to 2018, we compared perioperative data, postoperative outcomes, oncological outcomes, and survival between the two approaches. Results: We recruited 123 patients (58 for the supine group and 65 for the prone group), with a median age of 72 (41-93) years. Mean follow-up was 67.4-45.7 months (28-169) in the supine group and 47.8-30.9 months (13-158) in the prone group (P = .026). Duration of surgery was longer in the prone group at 237 ± 52.3 minutes versus 210 ± 56.6 minutes in the supine group (P = .007). The incidence of tumor perforation during surgery was 9% in the supine group versus 3% in the prone group (P = .208). The incidence of perineal wound infection did not differ significantly between groups (supine 22% versus prone 20%, P = .93). The mesorectum was incomplete in 25% cases in the supine group and 14% cases in the prone group (P = .175). Circumferential resection margin positivity was 21% in the supine group and 14% in the prone group (P = .374). Local and distant recurrence was higher in patients with adenocarcinoma in the supine group at 10% and 31% versus 4% and 17% in the prone group (P = .177). Overall survival was higher in the prone group: 4% of patients died due to disease progression compared with 24% in the supine group (P = .034). Conclusions: Our results suggest that morbidity is similar with both laparoscopic techniques, but long-term outcomes seem better with the prone approach.

Colovesical Fistula: Applicability of the Laparoscopic Approach and Results According to Etiology. / Fístula colovesical: aplicabilidad del abordaje laparoscópico y resultados según su etiología.

INTRODUCTION: Colovesical fistulae have significant morbidity. The aim of our study was to describe a case series of benign and malignant colovesical fistulae, focusing on the viability of the laparoscopic approach. METHODS: We reviewed the characteristics of 34 patients with diverticular and colon adenocarcinoma-related colovesical fistulae treated surgically from January 2001 to March 2018, 28 with elective surgery and 6 by urgent surgery. The diagnosis was established by abdominal CT scan, colonoscopy and cystoscopy. Clinically stable patients, with no retroperitoneal or bladder trigone invasion, were approached laparoscopically. RESULTS: There were 13 benign cases (all of them approached by sigmoidectomy), 9 performed by laparoscopy with 3 conversions. Partial cystectomy was done in 11 cases, and in two cases conservative management with urinary catheter. Five laparoscopic approaches were performed in 21 patients diagnosed with malignant colovesical fistula, with 3 conversions and 16 laparotomies. The procedures were sigmoidectomy, left colectomy, anterior resection and pelvic exenteration. All of them required partial or total cystectomy. Sixteen patients had complications, most of which were minor (Clavien-Dindo classificationI-II) and with laparotomy approach. CONCLUSIONS: The laparoscopic approach can be feasible in well-selected and stable patients, but we have to take into consideration that the conversion rate can be high and this surgery should be performed by experienced surgeons.

[Metric properties of WOMAC questionnaires-original and reduced versions-to measure symptoms and Physical Functional Disability]. / Propiedades métricas del cuestionario WOMAC y de una versión reducida para medir la sintomatología y la discapacidad física.

OBJECTIVES: To determine the metric properties of the WOMAC questionnaire filled in over the telephone; and to obtain a reduced version of this questionnaire. DESIGN: Descriptive study. SETTING: "La Merced" (Osuna. Seville) and "Torrecárdenas" (Almeria) Hospitals. PARTICIPANTS: People suffering from hip and knee osteoarthritis and awaiting surgical intervention from October 2004 to November 2006. MAIN MEASUREMENTS: Telephone interview, sociodemographic variables and Symptoms and Physical Functional Disability (WOMAC questionnaire) were collected. RESULTS: A total of 311 people suffering from hip or knee osteoarthritis were included. Subjects were mostly women (82.63%) with a mean age of 70 years. Metric properties of the original and reduced WOMAC were as follows: All WOMAC items obtained a maximum value of 67.4% on endorsement frequency. Main components factorial analysis resulted in a communality of over 0.5 and 71.73% of total explained variance, with 5 factors -no conceptual meaning-. With a communality cut-off point of 0.8; 13 items were rejected and the total explained variance increased to 87.74% with 4 factors -conceptually sensible-. Varimax rotations were performed due to low correlation factors. Pearson correlation between the original and reduced WOMAC versions were 0.92. Reliability analysis obtained a Cronbach alpha value of 0.92 for original WOMAC and 0.82 for the reduced version. CONCLUSION: The original WOMAC questionnaire showed adequate metric properties to be used over the telephone on people suffering from hip and knee osteoarthritis. Furthermore, a reduced version of WOMAC with 11 items had better metric properties than the full version.