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Introducción. La resonancia magnética nuclear es un estudio ampliamente usado, que se ha convertido actualmente en una herramienta imprescindible para la toma de decisiones terapéuticas en los pacientes con cáncer de recto. El objetivo de este estudio fue esclarecer si los informes actuales cumplen con las recomendaciones internacionales respecto a los ítems que deben incluir para tomar mejores decisiones en el manejo y el seguimiento de los pacientes. Métodos. Estudio observacional, retrospectivo, de una cohorte de seguimiento de pacientes con cáncer de recto a quienes se les realizó resonancia magnética nuclear para estadificación o re-estadificación posterior a una terapia neoadyuvante, entre julio de 2020 y julio del 2022, en 2 centros de referencia de la ciudad de Medellín, Colombia. Resultados. En total se evaluaron 205 informes de resonancia magnética nuclear tomadas en pacientes con cáncer de recto, de los cuales el 50,2 % fueron de diagnóstico inicial sin terapia neoadyuvante y el 49,7 % fueron informes de re-estadificación posterior a terapia neoadyuvante. Se evaluaron 13 ítems de los reportes de las resonancias. Se encontró que un 2 % de los reportes fueron de alta calidad, 14,6 % de moderada calidad y 83,4 % de baja calidad. Conclusiones. La mayoría de los reportes de resonancia magnética nuclear en pacientes con cáncer de recto son de baja calidad, por lo tanto, serán necesarias estrategias que mejoren la comunicación, la estandarización y la calidad de los estudios.

Introduction. Magnetic resonance imaging (MRI) is the widely used study, which today has become an essential tool for therapeutic decisions in patients with rectal cancer. The objective of this study was to clarify whether current reports comply with international recommendations regarding the items they should have to make better decisions in the patients management and follow-up. Methods. Observational, retrospective study of a follow-up cohort of patients with rectal cancer who underwent MRI for staging or re-staging after neoadjuvant therapy, between July 2020 and July 2022, in two reference centers in the city of Medellín, Colombia. Results. In total, 205 MRI reports in patients with rectal cancer were reviewed, of which 50.2% were initial diagnosis without neoadjuvant therapy and 49.7% were reports of restaging after neoadjuvant therapy; 13 items from the MRI reports were evaluated. It was found that 2% of the reports were of high quality, 14.6% of moderate quality and 83.4% of low quality. Conclusions. Most MRI reports in patients with rectal cancer are of low quality; therefore, strategies will be necessary to improve communication, standardization and quality of the studies.

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Introducción. La fuga anastomótica es una complicación que en las últimas tres décadas ha mantenido sus tasas de incidencia entre 1 % y 19 % y ha alcanzado una mortalidad que varía entre 6 % y 22 %. Tiene una alta morbilidad, siendo responsable del 56 % de los estomas definitivos en pacientes sometidos a cirugía colorrectal. El objetivo de este estudio fue identificar los factores asociados con un mayor riesgo de incidencia de fuga anastomótica, para lograr impactar en la morbilidad y mortalidad de los pacientes llevados a cirugía colorrectal. Métodos. Estudio de casos y controles multicéntrico enfocado en los factores de riesgo preoperatorios e intraoperatorios asociados con la fuga anastomótica después de la resección de colon. Resultados. Se incluyeron 480 pacientes llevados a cirugía colorrectal entre enero de 2014 y diciembre de 2019. Se estimó que existe mayor riesgo de presentar dehiscencia de anastomosis con nivel de hemoglobina menor de 9 g/dl (p=0,001; OR=3,2; IC95%: 1,64-6,25), clasificación ASA > 3 (p=0,001; OR=9,96; IC95%: 4,75-20,9), duración prolongada de la cirugía (p=0,005) y necesidad de transfusión intraoperatoria (p=0,001; OR=4,57; IC95%: 2,32-9,01). El reforzamiento de la anastomosis se relacionó a un menor número de fugas anastomóticas (p=0,001; OR=0,14; IC95%: 0,04-0,46). Conclusión. La anemia y la transfusión de glóbulos rojos se relacionaron con un aumento de fuga anastomótica. Por otro lado, el refuerzo de la anastomosis se presenta como una medida potencialmente beneficiosa para mitigar la incidencia de esta complicación. La identificación precisa de estos factores de riesgo ofrece la oportunidad de transformar la fuga anastomótica en una complicación prevenible.

Introduction. Anastomotic leak is a complication that in the last three decades has maintained its incidence rates between 1% and 19% and has reached a mortality rate that varies between 6% and 22%. It has a high morbidity rate, being responsible for 56% of definitive stomas in patients undergoing colorectal surgery. The objective of this study was to identify factors associated with a higher risk of anastomotic leak incidence, in order to impact the morbidity and mortality of patients undergoing colorectal surgery. Methods. Multicentric case-control study focused on preoperative and intraoperative risk factors associated with anastomotic leak after colon resection. Results. 480 patients who underwent colorectal surgery between January 2014 and December 2019 were included. It was estimated that there is a higher risk of anastomotic dehiscence with hemoglobin levels <9 mg/dl (p=0.001; OR=3.2; 95% CI: 1.64-6.25), ASA classification >3 (p=0.001; OR=9.96; 95% CI: 4.75-20.9), prolonged surgery duration (p=0.005), and the need for intraoperative transfusion (p=0.001; OR=4.57; 95% CI: 2.32-9.01). Anastomosis reinforcement was related to fewer anastomotic leaks (p=0.001; OR=0.14; 95% CI: 0.04-0.46). Conclusion. Anemia and red blood cell transfusion were associated with an increased anastomotic leak. On the other hand, anastomosis reinforcement is presented as a potentially beneficial measure to mitigate the incidence of this complication. Accurate identification of these risk factors offers the opportunity to transform anastomotic leak into a preventable complication.

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Introduction. Incidence of early-onset colorectal cancer (EOCRC), defined as colorectal cancer (CRC) in individuals aged < 50 years, is rising worldwide. Despite the increasing international scientific production on EOCRC, research is limited in Colombia. The objective of this study was to characterize the clinical features of adults with EOCRC and late-onset CRC (LOCRC, CRC in individuals aged ≥ 50 years). Methods. An observational, retrospective, cross-sectional study was conducted with CRC patients ≥ 18 years old at one medical center in Medellín, Colombia. Clinical and pathological data were retrieved from the Institutional Cancer Registry. Two analysis groups were established: EOCRC and LOCRC. The Chi-Square test was applied to compare the variables of interest between both groups. Results. The sample included 1,202 patients, 53.5% were female (N=643) and the median age was 65 years (interquartile range: 55-73). EOCRC represented 15.9% (N=192). LOCRC tended to have more history of cardiometabolic diseases and smoking (p<0.001) than EOCRC. CRC family history was proportionally more frequent in EOCRC (7.3% vs 3.8%; p=0.028) than in LOCRC. Right-sided tumors were more common in LOCRC (30.4% vs 21.9%; p=0.041) and left-sided tumors in EOCRC (30.7% vs 23.2%; p=0.041). Only one patient had inflammatory bowel disease history. Conclusion. EOCRC is clinically distinct from LOCRC regarding pathological and toxicological history as well as tumor location. Our findings provide valuable insights for enhancing clinical decision-making, particularly in relation to age at onset in Colombian CRC patients.

Introducción. La incidencia de cáncer colorrectal (CCR) de aparición temprana (CCR-ATem), definido como CCR en individuos menores de 50 años, está aumentando en todo el mundo. A pesar del incremento en la producción científica internacional sobre CCR-ATem, la investigación es limitada en Colombia. El objetivo de este estudio fue caracterizar clínicamente los adultos con CCR-ATem y CCR de aparición tardía (CCR-ATar, CCR en individuos ≥ 50 años). Métodos. Estudio observacional, retrospectivo, transversal, en el que se incluyeron los pacientes adultos con CCR atendidos en un centro médico de Medellín, Colombia. Los datos se obtuvieron del Registro Institucional de Cáncer. Se establecieron dos grupos de análisis: CCR-ATem y CCR-ATar. Se aplicó la prueba de Chi cuadrado para comparar las variables de interés entre ambos grupos. Resultados. La muestra incluyó 1.202 pacientes, 53,5 % fueron mujeres (N=643), y la mediana de edad fue de 65 años (rango intercuartil: 55-73). CCR-ATem representó el 15,9 % (N=192). CCR-ATar tuvo más casos de enfermedades cardiometabólicas y tabaquismo (p<0,001). El antecedente familiar de CCR fue proporcionalmente más frecuente en CCR-ATem (7,3 % vs. 3,8 %; p=0,028). Los tumores del colon derecho fueron más frecuentes en CCR-ATar (30,4 % vs. 21,9 %; p=0,041) y los del colon izquierdo en CCR-ATem (30,7 % vs. 23,2 %; p=0,041). Solo un paciente tuvo antecedente de enfermedad inflamatoria intestinal. Conclusión. CCR-ATem es clínicamente distinto de CCR-ATar con respecto a antecedentes patológicos y toxicológicos, y localización tumoral. Nuestros hallazgos proporcionan información útil para mejorar la toma de decisiones clínicas, particularmente en relación con la edad de inicio en pacientes colombianos con CCR.

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Introducción. La implementación del protocolo de recuperación mejorada después de cirugía (ERAS) ha demostrado mejorar los desenlaces en cirugía colorrectal. En Colombia su implementación es escasa y se tiene poca evidencia de sus beneficios. Por esa razón, el objetivo de este estudio fue evaluar el efecto de la implementación del protocolo ERAS en los pacientes sometidos a cirugía colorrectal en un hospital de referencia en el suroccidente colombiano. Métodos. Estudio observacional con abordaje de emulación de experimento clínico ideal. Se incluyeron pacientes adultos sometidos a cirugía colorrectal mayor entre los años 2021 y 2023. Se midió días de estancia hospitalaria, ingreso a unidad de cuidado intensivo (UCI) y la presencia de complicaciones globales, reintervenciones o reingreso hospitalario a 30 días. Se realizó un análisis univariado y multivariado para medir el efecto de la implementación del protocolo ERAS en los desenlaces. Resultados. En total,132 pacientes cumplieron los criterios de inclusión, 79 pacientes en el período previo a la implementación de ERAS y 53 pacientes con el protocolo ERAS. En el análisis multivariado, se encontró una reducción relativa del 77 % para ingreso a UCI, del 57 % de complicaciones globales, del 67 % en el reingreso hospitalario y del 92 % para reintervenciones quirúrgicas tras el alta en los pacientes ERAS. Conclusiones. La implementación de las recomendaciones ERAS en nuestra institución demostró mejorar los resultados clínicos en pacientes sometidos a cirugía colorrectal mayor. En Colombia, se necesita de estudios multicéntricos que permitan evidenciar la plausibilidad y beneficios de estas recomendaciones en otras instituciones.

Introduction. Implementation of the Enhanced Recovery After Surgery (ERAS) protocol has been shown to improve outcomes in colorectal surgery. In Colombia, its implementation is scarce and there is limited evidence of its benefits. For this reason, the objective of this study was to evaluate the effect of ERAS protocol implementation in patients undergoing colorectal surgery in a reference hospital in Southwestern Colombia. Methods. Observational study with ideal clinical experiment emulation approach. Adult patients undergoing major colorectal surgery between 2021 and 2023 were included. Days of hospital stay, admission to the intensive care unit (ICU), and the presence of overall complications, reinterventions, or hospital readmission within 30 days were measured. A univariate and multivariate analysis was performed to measure the effect of the implementation of the ERAS protocol on the outcomes. Results. A total of 132 patients met the inclusion criteria, 79 patients in the period prior to ERAS implementation and 53 patients with the ERAS protocol. In the multivariate analysis, a relative reduction of 77% for ICU admissions, 57% for overall complications, 67% for hospital readmission, and 92% for surgical reinterventions after discharge in ERAS patients was found. Conclusions. Implementation of ERAS recommendations at our institution was shown to improve clinical outcomes in patients undergoing major colorectal surgery, In Colombia, multicenter studies are needed to demonstrate the plausibility and benefits of these recommendations in other institutions.

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Introducción. El cáncer colorrectal es uno de los tipos de cáncer más comunes y mortales a nivel mundial. Aunque los avances médicos han mejorado el manejo, la cirugía sigue siendo fundamental. La resección anterior baja (RAB) de recto ha ganado relevancia, a pesar de que puede llevar al síndrome de resección anterior baja de recto (LARS, por sus siglas en inglés), afectando la calidad de vida. Métodos. Estudio de corte transversal con intención analítica en un centro de referencia en Medellín, Colombia. Los pacientes con cáncer de recto sometidos a RAB entre enero de 2016 y diciembre de 2022 completaron el cuestionario LARS para evaluar disfunción intestinal. Se evaluaron factores relacionados con la presencia de LARS por medio de un análisis bivariado. Resultados. De 234 pacientes elegibles, 110 (47 %) respondieron la encuesta, predominantemente mujeres (58,2 %). La edad promedio fue 62 años. Dos tercios de los pacientes recibieron neoadyuvancia y el 69 % requirieron ileostomía. La prevalencia de LARS fue 47,3 %. El 80,9 % llevaban más de 12 meses desde la cirugía o el cierre del estoma. Factores estadísticamente significativos asociados a LARS fueron edad mayor de 65 años (p=0,03), estadío patológico avanzado (p=0,02) y requerimiento de estoma (p=0,03). Conclusiones. El LARS afecta a casi la mitad de los pacientes en diferentes etapas posquirúrgicas. El LARS scorees una herramienta práctica para evaluar la función intestinal en el seguimiento del paciente. La prevalencia y los factores de riesgo identificados contribuyen a la comprensión del impacto de la cirugía conservadora del esfínter en la calidad de vida de los pacientes.

Introduction. Colorectal cancer is one of the most common and deadly types of cancer worldwide, with a high incidence of rectal cancer. Although medical advances have improved management, surgery remains crucial. Low anterior resection of the rectum (LAR) has gained significance, despite its potential to lead to low anterior resection syndrome (LARS), affecting quality of life. Methods. A cross-sectional study with analytical intent was conducted at a referral center in Medellín, Colombia. Patients with rectal cancer who underwent LAR between January 2016 and December 2022 completed the LARS questionnaire to assess intestinal dysfunction. Factors related to the presence of LARS were analyzed using bivariate analysis. Results. Of 234 eligible patients, 110 (47%) responded, predominantly women (58.2%). The average age was 62 years. Two-thirds of patients received neoadjuvant therapy and 69% required ileostomy. The prevalence of LARS was 47.3%. 80.9% had been more than 12 months post-surgery or stoma closure. Statistically significant factors associated with LARS included age over 65 years (p=0.03), advanced pathological stage (p=0.02), and stoma requirement (p=0.03). Conclusions. LARS affects almost half of the patients in various post-surgical stages. The LARS score is a practical tool for assessing intestinal function in patient follow-up. The prevalence and risk factors identified contribute to the understanding of the impact of sphincter-conserving surgery on patients' quality of life.

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INTRODUCCIÓN. Las fístulas anales representan una gran afectación a la calidad de vida de los pacientes. Conocer su comportamiento clínico, epidemiológico y el manejo quirúrgico es de gran importancia para optimizar el tratamiento. OBJETIVO. Describir las características clínicas, quirúrgicas y de seguimiento en los pacientes con fístula anal intervenidos quirúrgicamente en la Unidad de Coloproctología del Hospital Carlos Andrade Marín, Quito-Ecuador, entre mayo del 2018 hasta abril de 2023. MATERIALES Y MÉTODOS. Investigación descriptiva y observacional. Población: historias clínicas de todos los pacientes adultos (edad ≥ 18 años) con fístula anal a los que se les realizó tratamiento quirúrgico. Muestra: 159 historias que cumplieron con los criterios de selección. Se utilizó la técnica de revisión documental. Se siguieron las pautas de STROBE para estudios observacionales. Se utilizaron estadísticos descriptivos e inferenciales. Las pruebas χ² se aplicó a los datos categóricos, además de porcentajes y frecuencias. Se consideró significación estadística cuando p<0,05. RESULTADOS. Características clínicas: edad promedio 49,6 años. Sexo masculino (90,6%). Tipo de fístula: Interesfinterica baja (64,8%), Transesfinterica alta (9,4%). Subcutánea (8,2%), Transesfinterica baja (6,2%). Síntomas: secreción (71,1%). Tratamiento: Fistulotomía (40,9%), Fistulectomía con esfinteroplastia (13,2%), Fistulotomia con esfinteroplastia (8,2%), Seton (7,5%). Evolución: complicaciones (15,7%), recidivas (1,3%). Seguimiento: sin incontinencia fecal (73,6%), calidad de vida ≥ 4 puntos (97,5%). Factores relacionados con complicaciones: fístula compleja y técnica quirúrgica utilizada (p<0,05). DISCUSIÓN. Se evidenció una similitud entre las características de este trabajo y la literatura especializada. El tratamiento quirúrgico de elección es la fistulotomía. CONCLUSIÓN. La descripción de las características clínicas, quirúrgicas y de seguimiento de los pacientes con fístula anal en el Hospital Carlos Andrade Marín no difiere de otros reportes consultados. Con este trabajo se sientan las bases para el estudio epidemiológico de las fístulas anales en el Ecuador y, el manejo quirúrgico.

INTRODUCTION. Anal fistulas represent a great impact on the quality of life of patients. Knowing its clinical and epidemiological behavior and surgical management is of great importance to optimize treatment. AIM. To describe the clinical, surgical, and follow-up characteristics of patients with anal fistula who underwent surgery at the Coloproctology Unit of the Carlos Andrade Marin Hospital, Quito, Ecuador, between May 2018 and April 2023. MATERIALS AND METHODS. Descriptive and observational research. Population: medical records of all adult patients (age ≥ 18 years) with anal fistula who underwent surgical treatment. Sample: 159 records that met the selection criteria. The documentary review technique was used. STROBE guidelines for observational studies were followed. Descriptive and inferential statistics were used. The χ² tests were applied to the categorical data, in addition to percentages and frequencies. Statistical significance was considered when p<0.05. RESULTS. Clinical characteristics: average age 49.6 years. Male sex (90.6%). Fistula type: Low intersphincteric (64,8%), High transsphincteric (9.4%), Subcutaneous (8.2%). Low transsphincteric (6.2%). Symptoms: secretion (71.1%). Treatment: fistulotomy (40.9%), fistulectomy with sphincteroplasty (13,2%), Fistulotomy with sphincteroplasty (8,2%), Seton (7,5%). Evolution: complications (15.7%), recurrences (1.3%). Follow-up: no fecal incontinence (73.6%), quality of life ≥ 4 points (97.5%). Factors related to complications: complex fistula and surgical technique used (p<0.05). DISCUSSION. A similarity was demonstrated between the characteristics of this research and the specialized literature. Fistulotomy is the surgical treatment of choice. CONCLUSION. The clinical, surgical, and follow- up characteristics of patients with anal fistula at the Carlos Andrade Marin Hospital do not differ from other consulted reports. This research lays the foundations for the epidemiological study of anal fistulas in Ecuador and their surgical management.

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Introducción. El conjunto de estrategias de recuperación mejorada después de la cirugía (ERAS, por sus siglas en inglés) constituye un enfoque de atención multimodal y multidisciplinario, cuyo propósito es reducir el estrés perioperatorio de la cirugía, disminuir la morbilidad y acortar la estancia hospitalaria. Este estudio tuvo como objetivo describir los resultados clínicos de pacientes sometidos a cirugía por cáncer colorrectal, identificando las complicaciones principales y los factores perioperatorios relacionados con el alta temprana. Métodos. Se analizaron los pacientes consecutivos sometidos a cirugía colorrectal entre los años 2020 y 2023, todos los cuales siguieron el protocolo ERAS institucional. Se evaluaron las características clínicas, los factores perioperatorios, los desenlaces postoperatorios y la tasa global de adherencia al protocolo. Resultados. Un total de 456 pacientes fueron sometidos a cirugía colorrectal, 51% de sexo masculino, con edad media de 60 años. La mayoría de las intervenciones se realizaron por laparoscopia (78 %), con una tasa de conversión del 14,5 %. Las complicaciones postoperatorias incluyeron fuga anastomótica (4,6 %), sangrado, infección intraabdominal y obstrucción intestinal. La estancia hospitalaria promedio fue de 4 días y la mortalidad del 2,8 %. La tasa global de adherencia al protocolo ERAS fue del 84,7 %. Conclusiones. El enfoque combinado de cirugía laparoscópica y protocolo ERAS es factible, seguro y se asocia con una estancia hospitalaria más corta. La implementación y adherencia al protocolo ERAS no solo mejora los resultados postoperatorios, sino que también resalta la importancia de acceder a datos sólidos, permitiendo mejorar la atención perioperatoria local.

Introduction. The Enhanced Recovery After Surgery (ERAS) protocol is a multimodal, multidisciplinary approach to care, the purpose of which is to reduce the perioperative stress of surgery, decrease morbidity, and shorten hospital stay. This study aimed to describe the clinical outcomes of patients undergoing surgery for colorectal cancer, identifying the main complications and perioperative factors related to early discharge. Methods. Consecutive patients undergoing colorectal surgery between 2020 and 2023 were analyzed, who followed the institutional ERAS protocol. Clinical characteristics, perioperative factors, postoperative outcomes, and overall protocol adherence rate were evaluated. Results. A total of 456 patients underwent colorectal surgery, 51% male, with a mean age of 60 years. Most interventions were performed laparoscopically (78%), with a conversion rate of 14.5%. Postoperative complications included anastomotic leak (4.6%), followed by bleeding, intra-abdominal infection, and intestinal obstruction. The average hospital stay was 4 days and mortality was 2.8%. The overall adherence rate to the ERAS protocol was 84.7%. Conclusions. The combined approach of laparoscopic surgery and ERAS protocol is feasible, safe, and associated with a shorter hospital stay. Implementation and adherence to the ERAS protocol not only improves postoperative outcomes, but also highlights the importance of accessing solid data, allowing for improved local perioperative care.

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Introduction: Gender inequality occurs in all spheres of society, which is no different in the medical field. Abstract presentations in congress are the vanguard of scientific knowledge, an integral part of topic discussion, and, ideally, culminate in the publication of these works as complete manuscripts. Objective: The objective of this study is to evaluate the role played by women in the presentation of scientific works at the Brazilian Society of Coloproctology congress and in the works published from these presentations. Methods: The bibliometric evaluation of the presented abstracts in the editions from 2015 to 2018 of the Brazilian Congress of Coloproctology was used, along with the works later published from these presentations. Gender identification data was extracted from the authors of the abstracts through their names and research for conference on the Lattes and Google Scholar platforms. The collected data was on the number of female participants and their order of authorship of abstracts and publications, evaluating possible changes when publication occurs. Results: A total of 1,336 abstracts were analyzed, with 91.6% of female authors. When publication occurs, women's presence dropped to 75.2% and suffered a change of order in the position of authorship to one of lesser relevance in 38.1%. Conclusion: Women's participation occurs in most abstracts. However, this proportion undergoes unfavorable changes when these works are published, either by changing the order of authorship, when women leave main positions and become coauthors, or are removed from the complete manuscript's publication. (AU)

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La estenosis del canal anal es una forma infrecuente de malformación anorrectal, representando el 1%. Existen pocos casos registrados sobre esta patología.1 Se trata de una entidad donde el ano presenta una estenosis de longitud variable, se encuentra normo-implantado, de apariencia normal, rodeado de complejo esfinteriano adecuado. Se debe descartar la presencia de malformaciones asociadas, cardiovasculares, renales, osteoarticulares, y especialmente se debe evaluar la presencia de masa pre-sacra, pudiendo presentarse teratomas, mielomeningocele anterior, entre otras. El tratamiento quirúrgico consiste en resecar el sector estenótico, realizar anoplastia respetando el complejo esfinteriano mediante un abordaje posterior, sin disección de la cara anterior del recto Debido a la presencia de un complejo esfinteriano circundante normal, el pronóstico funcional intestinal de estos pacientes es excelente. Presentamos el primer caso clínico en nuestro país de un paciente con estenosis del canal anal, su forma de presentación, tratamiento quirúrgico y evolución.

Anal canal stenosis is a rare form of anorectal malformation, representing 1%. There are few registered cases and there is little literature on this entity. It is an entity where the anus presents a stenosis of variable length, is normo-implanted, with a normal appearance, surrounded by an adequate sphincter complex. The presence of associated cardiovascular, renal, and osteoarticular malformations must be ruled out, and especially the presence of a presacral mass must be evaluated, which may present teratomas, anterior myelomeingocele, among others. Surgical treatment consists of respecting the sphincter complex through a posterior approach, without dissection of the anterior face of the rectum. Due to the presence of a normal surrounding sphincter complex, the intestinal functional prognosis of these patients is excellent. We present the first clinical case in our setting of a patient with stenosis of the anal canal, its form of presentation, surgical treatment and evolution.

A estenose do canal anal é uma forma rara de malformaçãoanorretal, representando 1%. Existempoucos casos registados e hápouca literatura sobre esta entidade. É umaentidade onde o ânusapresentaestenose de comprimentovariável, é normo-implantado, de aspecto normal, circundado por um complexo esfincterianoadequado. Deve-se descartar a presença de malformações cardiovasculares, renais e osteoarticulares associadas e, principalmente, avaliar a presença de massapré-sacral, que pode apresentar teratomas, mielomeingocele anterior, entre outros. O tratamentocirúrgico consiste em respeitar o complexo esfincteriano por via posterior, semdissecção da face anterior do reto. Devido à presença de um complexo esfincteriano circundante normal, o prognóstico funcional intestinal destes pacientes é excelente. Apresentamos o primeiro caso clínico em nossomeio de paciente comestenose do canal anal, sua forma de apresentação, tratamentocirúrgico e evolução.

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Introduction: Scientific studies in Brazil grew around 10.7% compared to previous years. However, the level of quality of evidence has been decreasing. The aim in our study is to examine the meeting abstracts of the Brazilian congress of coloproctology and analyze the level of evidence in trends and variables. Methods: A descriptive bibliometric study, working with secondary data to review scientific abstracts in the annals of the coloproctology congress from 2015 to 2019. Results: A total of 1756 abstracts of the Brazilian Congress of Coloproctology were analyzed for 5 years (2015-2019). There was a higher trend of abstracts presented with lower levels of evidence (level of evidence 5: 52.3% and 3: 30%), being the majority composed of case reports (49.4%) and retrospective studies (30.4%). The last two years analyzed (2018: 55.2% and 2019: 59.3%) had a predominance above average of case reports. From 2017 to 2019 there was a significant decrease in the number of level 2 evidence studies (18.10%,11.80% and 5.50%), while the number of studies with level 5 evidence showed an increase (45.60%, 56.60% and 61.40%). Statistical analysis occurred in only 17%, with an important decrease for the last two years (2018: 13.6%; 2019: 12.1%). Conclusions: Although the data of this study is from the Brazilian coloproctology point of view, they are important for the global scientific community, as they allow a quantitative evaluation of the relative contribution from the level of evidence of Brazilian coloproctology researchers to the scientific scenario. (AU)

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Introduction: The purpose of this retrospective bibliometric study was to assess the discrepancies between coloproctology surgery meeting abstracts and subsequent full-length manuscript publications. Methods: Abstracts presented at the Brazilian Congress of Coloproctology Surgery from 2015 to 2019 were compared with matching manuscript publications. Discrepancies between the abstract and therefore the subsequent manuscript were categorized as major (changes within the purpose, methods, study design, sample size, statistical analysis, results, and conclusions) and minor (changes within the title, authorship, and number of female authors) variations. Results: The conversion rate of abstracts in published manuscripts was 6,9% (121 abstracts). There were inconsistencies between the study title (66,1%), authorship (69,5%), study design (3,3%), sample size (39,2%), statistical analysis (24,8%), results (25,6%), and conclusions (12,4%) of manuscripts compared with their corresponding meeting abstracts. Conclusion: As changes occur before manuscript publication of coloproctology surgery meeting abstracts, caution should be exercised in referencing abstracts or altering surgical practices based on abstracts content. (AU)

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La fisura anal es una de las enfermedades más antiguamente descritas, la misma que, ha tenido hasta el momento múltiples tratamientos tanto médicos como quirúrgicos, existiendo controversias en su algoritmo terapéutico. Constituye una de las patologías cuyo diagnóstico y tratamiento corresponde a la Especialidad de Coloproctología, afecta a ambos sexos y a cualquier edad y puede ser aguda o crónica. Proponemos el presente Protocolo para un adecuado manejo de la patología, de manera que sirva de guía en la toma correcta de decisiones basadas en la evidencia y el consenso de quienes integramos la Unidad Técnica de Coloproctología del Hospital de Especialidades Carlos Andrade Marín.

Anal fissure is one of the oldest described diseases, which has so far had multiple medical and surgical treatments, with controversies in its therapeutic algorithm. It is one of the pathologies whose diagnosis and treatment corresponds to the Coloproctology Specialty, it affects both sexes and any age and can be acute or chronic. We propose the present Protocol for an adequate management of the pathology, so that it serves as a guide in the correct decision making based on evidence and consensus of those who integrate the Technical Unit of Coloproctology of the Hospital de Especialidades Carlos Andrade Marín.

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Introduction: The presentation of abstracts in a congress is an important step for the dissemination of scientific information. The American Congress of Coloproctology is promoted by the American Society of Colon & Rectal Surgeons (ASCRS), and it is the largest in number of participants within the specialty, followed by the Brazilian Congress of Coloproctology. The present study aims to evaluate variables related to the quality of the scientific production of the abstracts presented in these two events and their conversion rate to published manuscripts. Materials and Methods: The present bibliometric study assesses secondary data from the review of abstracts presented in these 2 important conferences in 2016, followed by a research of the publications from these congress presentations. Results: The total number of abstracts evaluated was 854. The rate of articles containing statistical analyses was of 73.7% in the American congress, and of 34.1% in the Brazilian congress. Multicentric studies were more prevalent in the American congress (23.1%). Regarding study design, the most common were case reports in the Brazilian (44.8%) congress and retrospective studies in the American congress (67.7%). As for the works presented, the rate of conversion into full manuscripts in the American congress was of 24.2% compared with 10.6% in the Brazilian congress. Most papers from the American congress (93.7%) have citations compared with 68.6% of the other event evaluated. Conclusion: The scientific performance demonstrated by the conversion rate of abstracts into publications is below ideal, mainly in relation to the Brazilian meeting; yet, there were significant differences between the two events in terms of the profile of the presentations and several variables analyzed. (AU)

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Introducción. La cirugía es la base del tratamiento curativo del cáncer de recto. La escisión meso-rectal total ha permitido mejorar los desenlaces oncológicos, disminuyendo las tasas de recurrencia locorregional e impactando en la supervivencia global. El empleo de esta técnica en los tumores de recto medio o distal es un reto quirúrgico, en el que la vía trans anal, permite superar las dificultades técnicas. Método. Se realizó un estudio observacional retrospectivo, recolectando la información de los pacientes con cáncer de recto medio y distal llevados a cirugía con esta técnica, en dos instituciones de cuarto nivel en Medellín, Colombia, entre enero de 2017 y marzo de 2022. Se analizaron sus características demográficas, la morbilidad perioperatoria y la pieza quirúrgica. Resultados. Se incluyeron 28 pacientes sometidos al procedimiento trans anal y laparoscópico de forma simultánea; al 57 % se les realizó una ileostomía de protección. Hubo complicaciones en el 60,7 % de los pacientes; ocurrieron cuatro casos de fuga anastomótica. No se presentó ninguna mortalidad perioperatoria. Conclusiones. La tasa de morbilidad perioperatoria es acorde con lo reportado en la literatura. Se resalta la importancia de la curva de aprendizaje quirúrgica y de incluir la calificación de la integridad meso-rectal dentro del informe patológico. Se requiere seguimiento a largo plazo para determinar el impacto en desenlaces oncológicos, calidad de vida y morbilidad

Introduction. Surgery is the pillar of curative treatment for rectal cancer. Total meso-rectal excision has improved oncological outcomes, decreasing locoregional recurrence rates and impacting overall survival. The use of this technique in tumors of the middle or distal rectum is a surgical challenge, in which the trans anal route allows overcoming technical difficulties. Method. A retrospective observational study was carried out, collecting information from patients with middle and distal rectal cancer undergoing surgery with this technique, in two level 4 institutions in Medellín, Colombia, between January 2017 and March 2022. Results. Twenty-eight patients were included; their demographic characteristics, perioperative morbidity, and surgical specimen were analyzed. All patients underwent the trans anal and laparoscopic procedures simultaneously; 57% underwent a protective ileostomy. There was no perioperative mortality. Complications occurred in 60.7% of the patients. Only four cases of anastomotic leak occurred. Conclusions. The perioperative morbidity rate is consistent with that reported in the literature; the importance of the surgical curve and to include the qualification of the meso-rectal integrity within the pathological report is highlighted. Long-term follow-up is required to determine the impact on oncological outcomes, quality of life, and morbidity

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Abstract Background The effect of regional analgesia on perioperative infectious complications remains unknown. We therefore tested the hypothesis that a composite of serious infections after colorectal surgery is less common in patients with regional analgesia than in those given Intravenous Patient-Controlled Analgesia (IV-PCA) with opiates. Methods Patients undergoing elective colorectal surgery lasting one hour or more under general anesthesia at the Cleveland Clinic Main Campus between 2009 and 2015 were included in this retrospective analysis. Exposures were defined as regional postoperative analgesia with epidurals or Transversus Abdominis Plane blocks (TAP); or IV-PCA with opiates only. The outcome was defined as a composite of in-hospital serious infections, including intraabdominal abscess, pelvic abscess, deep or organ-space Surgical Site Infection (SSI), clostridium difficile, pneumonia, or sepsis. Logistic regression model adjusted for the imbalanced potential confounding factors among the subset of matched surgeries was used to report the odds ratios along with 95% confidence limits. The significance criterion was p < 0.05. Results A total of 7811 patients met inclusion and exclusion criteria of which we successfully matched 681 regional anesthesia patients to 2862 IV-PCA only patients based on propensity scores derived from potential confounding factors. There were 82 (12%) in-hospital postoperative serious infections in the regional analgesia group vs. 285 (10%) in IV-PCA patients. Regional analgesia was not significantly associated with serious infection (odds ratio: 1.14; 95% Confidence Interval 0.87‒1.49; p-value = 0.339) after adjusting for surgical duration and volume of intraoperative crystalloids. Conclusion Regional analgesia should not be selected as postoperative analgesic technique to reduce infections.

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OBJECTIVE@#Surgical site infection (SSI) is one of the most common healthcare-associated infections. This study aimed to determine SSI rate and the associated factors among colorectal surgery patients.@*METHODS@#This included adult patients who underwent surgery under the Division of Colorectal Surgery from January to May 2018. Clinico-demographic, operative, and SSI outcome data were reviewed. Occurrence of SSI during admission until discharge, and up to 30 days after the surgery was analyzed. @*RESULTS@#A total of 172 surgeries were performed. Majority were elective procedures (68.0%), and performed via open approach (67.4%). Most were malignant cases (62.6%). Sixty-three colorectal resections were done (41 colon and 22 rectal). SSI rate prior to discharge was 6.4%, and 15.7% at 30 days. Among colorectal resections, 18 (28.6%) patients had SSI at 30 days. SSI rates were significantly higher among patients who were ASA 2 or 3; received chemotherapy 12 weeks prior to surgery; had malignant pathology; underwent emergency surgery; received perioperative transfusion; had stapled skin closure; had low anterior resection for rectal cancer; and had multivisceral resection. @*CONCLUSION@#The Division of Colorectal Surgery at the Philippine General Hospital had a higher SSI rate as compared to literature. Although this could be partly explained by the differences in patient and surgeon population, improving on SSI rates will be the unit's goal. Continued SSI surveillance with more patient accrual may provide better insight to the associated risk factors.

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The theory of membrane anatomy has been widely used in the field of colorectal surgery. The key point to perform high quality total mesorectal excision (TME) and complete mesocolic excision (CME) is to identify the correct anatomical plane. Intraoperative identification of the various fasciae and fascial spaces is the key to accessing the correct surgical plane and surgical success. The landmark vessels refer to the small vessels that originate from the original peritoneum on the surface of the abdominal viscera during embryonic development and are produced by the fusion of the fascial space. From the point of view of embryonic development, the abdominopelvic fascial structure is a continuous unit, and the landmark vessels on its surface do not change morphologically with the fusion of fasciae and have a specific pattern. Drawing on previous literature and clinical surgical observations, we believe that tiny vessels could be used to identify various fused fasciae and anatomical planes. This is a specific example of membrane anatomical surgery.

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The SARS-Cov-2 pandemic and its immediate public health impact has caused severe disruption of regular medical care provision. The morbimortality of other diseases continues to affect people regardless of the viral infection. Indeed, it would be reasonable to assume that they have been aggravated by the period of most restrictive public health measures that were adopted against the virus. Recovery and maintenance of healthcare provision is required despite the ongoing threat. Therefore, it is critical to resume services in a structured and safe way, otherwise greater harm could come to our patients and to ourselves. The present article proposes to be a broad guide to the recovery and maintenance of elective outpatient, surgical and lower endoscopic services, aiding the colorectal surgeon in identifying risks, assessing their multiple dimensions, and implementing risk management strategies in a pragmatic and efficacious way. (AU)

A pandemia de SARS-Cov-2 e suas imediatas consequências para a saúde coletiva causaram enormes restrições ao atendimento médico-hospitalar normal. A despeito disso, os riscos de morbimortalidade relacionados a outras doenças e agravos à saúde são incessantes. E é razoável de presumi-los como aumentados pela falta de atendimento regular no período restrições mais severas decorrentes das medidas sanitárias contra a epidemia. A retomada do atendimento é necessária, ainda que o vírus permaneça uma ameaça. Portanto, é crítico que esta seja feita de forma estruturada e segura, sob pena de causar mal adicional aos nossos pacientes e a nós mesmos. O presente artigo se propõe a servir como guia para a retomada e manutenção dos atendimentos eletivos ambulatorial, cirúrgico e endoscópico baixo, auxiliando o coloproctologista a identificar os riscos, avaliar a suas dimensões e implementar medidas de controle de forma pragmática e eficaz. (AU)

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Introducción: El conocimiento obtenido a partir de las experiencias de los pacientes favorece una atención de calidad. El objetivo de este estudio cualitativo es conocer la percepción de los pacientes sobre su realimentación tras una cirugía colorrectal, y los factores condicionantes en relación con dicho proceso. Material y Método: En base a la directriz de Standards for Reporting Qualitative Research, se realiza un estudio cualitativo a partir de una entrevista de 8 preguntas de término abierto realizada a 20 pacientes seleccionados por un método de variación máxima de muestreo. Se realizó análisis temático. Resultados: Se identificaron cuatro dimensiones principales (con subtemas respectivos) que condicionan la alimentación en el postoperatorio: 1. propósitos del paciente tras la alimentación (búsqueda de alta, hidratación, búsqueda de salud, finalizar ayuno, deambulación); 2. propiedades y características de los alimentos (sazón, presentación, temperatura, porciones, consistencia, favoritos); 3. factores del paciente (físicos, psicológicos); y 4. relación equipo de salud-paciente (confianza, complacencia, información, agradecimiento). Conclusión: El proceso de ingesta de alimentos en este contexto está condicionado por las cuatro dimensiones mencionadas. Sería importante considerarlas al momento de crear y ejecutar pautas y guías de alimentación adaptadas a los pacientes.

Introduction: Knowledge obtained from the experiences of patients favors quality care. The aim of this study is to know the perception of patients regarding refeeding after colorectal surgery, and particular factors that condition postoperative intake from their perspective. Materials and Method: Based on the guideline of Standards for reporting qualitative Research, a qualitative study was constructed from an interview with 8 open-ended questions to 20 patients selected by a maximum sampling variation method. Thematic analysis was carried out. Results: Four main dimensions were identified that determine feeding in the postoperative period: 1. patient's goals after feeding (search for discharge, hydration, search for health, end fasting, ambulation); 2. properties and characteristics of food (seasoning, presentation, temperature, portions, consistency, favorites); 3 patient factors (physical, psychological); and 4. health team-patient relationship (trust, complacency, information, gratitude). Conclusion: The process of food intake in this context is conditioned by the four dimensions mentioned. It would be important to consider them when creating and executing feeding guidelines adapted to patients.