Contrast radiography before diverting stoma closure in rectal cancer is not necessary on a routine basis. / El estudio radiológico con contraste antes del cierre del estoma derivativo en el cáncer de recto no es necesario de forma rutinaria.

INTRODUCTION: Diverting stomata are recommended in patients with low anterior resection and risk factors in order to reduce the severity of anastomotic leaks. Usually, a radiology study is performed prior to the closure of the stoma to detect subclinical leaks. The aim of the present study is to assess the clinical utility of the radiology study. METHODS: A prospective cohort study of patients undergoing anterior rectal resection for rectal cancer and those who underwent stoma closure without contrast enema. This study was carried out after a retrospective review of radiology study results prior to the closure of the stoma in patients operated from 2007 to 2011. RESULTS: Eighty-six patients met the study criteria. Thirteen patients (15.1%) presented pelvic sepsis. Contrast enema before stoma closure was pathological in 8 patients (9.3%). Five out of the 13 patients with pelvic sepsis had a pathological radiological study, compared to only 3 out of the 73 patients without intra-abdominal complications after rectal resection (38.5% vs. 4.1%; P=.001). Based on these results, we conducted a prospective study omitting the contrast enema in patients with no postoperative complications. Thirty-eight patients had their stoma closed without a prior radiology study. None of the patients presented pelvic sepsis. CONCLUSIONS: Radiology studies of the colorectal anastomosis before reconstruction can safely be omitted in patients without pelvic sepsis after the previous rectal resection.

Bone health in long-term gastric cancer survivors: A prospective study of high-dose vitamin D supplementation using an easy administration scheme.

Bone disease in long-term survivors after gastric cancer resection has received little research attention. This study aimed to investigate bone health after curative resection of gastric cancer and the consequences of high-dose vitamin D supplementation in patients with low levels of 25-(OH)-vitamin D. Disease-free patients at least 24 months after gastric cancer resection represented the study cohort. Serum markers of bone metabolism were assessed at baseline and at 3 and 12 months. Bone mineral density and presence of fractures were assessed by X-ray at baseline. Patients with 25-(OH)-vitamin D ≤30 ng/mL at baseline received 16,000 IU of vitamin D3 every 10 days during the 1-year follow-up. Forty patients were included in the study. Mean time from surgery was 48.9 (24-109) months. Vitamin D insufficiency and secondary hyperparathyroidism were observed in 38 and 20 patients, respectively. Densitometry showed osteoporosis in 14 women and seven men and prevalent fractures in 12 women and six men at baseline. After 3 months of vitamin D supplementation, 35 patients reached values of 25-(OH)-vitamin D over 30 ng/mL. After 12 months, 38 patients were in the normal range of 25-(OH)-vitamin D. At the same time, iPTH levels and markers of bone turnover (C-terminal cross-linked telopeptide of type-I collagen, serum concentrations of bone-specific alkaline phosphatase and osteocalcin) significantly decreased after vitamin D intervention. Oral administration of high doses of vitamin D is easily implemented and restored 25-(OH)-vitamin D and iPTH values, which are frequently disturbed after gastric cancer resection.

An antimicrobial stewardship program reduces antimicrobial therapy duration and hospital stay in surgical wards / Un programa de uso de antimicrobianos reduce la duración de la terapia antimicrobiana y la estancia hospitalaria en salas de cirugía

We report a quasi-experimental study of the implementation of an antimicrobial stewardship program in two surgical wards, with a pre-intervention period with just assessment of prescription and an intervention period with a prospective audit on antibiotic prescription model. There was a significant reduction of length of stay and the total days of antimicrobial administration. There were no differences in mortality between groups. The antimicrobial stewardship program led to the early detection of inappropriate empirical antibiotic treatment and was associated with a significant reduction in length of stay and the total duration of antimicrobial therapy (AU)

Presentamos un estudio cuasi-experimental de la aplicación de un programa de uso de terapia antimicrobiana en dos salas quirúrgicas, con un período de pre-intervención en que se realizó evaluación de la prescripción y un período de intervención con una auditoría prospectiva sobre la prescripción antibiótica siguiendo un modelo de recomendación. Hubo una reducción significativa de la estancia media y del total de días de tratamiento antibiótico. No hubo diferencias en la mortalidad entre los grupos. El programa de uso de terapia antimicrobiana condujo a la detección precoz de tratamiento antibiótico empírico inadecuado y se asoció con una reducción significativa de la estancia media y la duración total de la terapia antimicrobiana (AU)

High-Dose Vitamin D Supplementation is Necessary After Bariatric Surgery: A Prospective 2-Year Follow-up Study.

BACKGROUND: We assessed the need of vitamin D supplementation to achieve normal 25-hydroxyvitamin D (25[OH]D) levels after bariatric surgery and whether there were differences between laparoscopy sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS: A total of 164 morbid obese patients undergoing bariatric surgery from January 2008 to June 2011 were followed for 2 years. Serum levels of 25(OH)D and intact parathyroid hormone (iPTH) were measured preoperatively and at 3, 6, 9, 12, 18, and 24 months after operation. All patients received 400 IU/day of 25(OH)D. Patients received additional supplementation with 16,000 IU of vitamin D3 (calcifediol) every 2 weeks if 25(OH)D serum levels were < 30 ng/mL (intervention group). RESULTS: Ninety-six (58.5 %) patients underwent LSG and 68 (41.5 %) LRYGB. A total of 106 (64.6 %) patients received calcifediol supplementation (62 in the LSG group and 44 in the LRYGB group). Normal 25(OH)D levels at 24 months were recorded in 69 % of patients in the intervention group and in 48.3 % in the non-intervention group. At 24 months, mean 25(OH)D levels in the non-intervention group were significantly lower among LRYGB patients than among LSG patients (P = 0.009). In the intervention group, normal 25(OH)D levels were achieved in 60 % of patients treated with LSG and in 22.2 % of those treated with LRYGB. Secondary hyperparathyroidism was presented in 49 (29.9 %) patients preoperatively but without significant differences in iPTH levels between the two surgical procedures. CONCLUSION: Patients undergoing bariatric surgery should receive high-dose vitamin D supplementation independently of the surgical technique.

Tratamiento quirúrgico de la úlcera péptica perforada: comparación entre los abordajes laparoscópico y abierto / A comparison of laparoscopic versus open repair for the surgical treatment of perforated peptic ulcers

Objetivo Analizar los resultados del abordaje quirúrgico laparoscópico frente al abierto en el tratamiento de las úlceras pépticas perforadas (UPP).Pacientes y métodos Estudio retrospectivo de todos los pacientes operados de una UPP durante el periodo enero de 2002-marzo de 2012. Se analizaron datos demográficos, tiempo operatorio, complicaciones y estancia hospitalaria. Resultados Se incluyó a 112 pacientes (mediana, 49 años), 60 en el grupo laparoscópico y 52 en el grupo abierto. Los pacientes operados por vía laparoscópica eran significativamente más jóvenes y tenían un mayor consumo de tabaco, alcohol y cannabis. La mediana de duración de los síntomas agudos fue menor en los pacientes del grupo laparoscópico (6 h) en comparación con los del grupo abierto (12 h). La mediana del tiempo operatorio fue significativamente mayor en los pacientes del grupo laparoscópico (104,5 vs. 76 min; p = 0,025). El porcentaje de conversión a cirugía abierta fue del 25%. La morbilidad fue similar en ambos grupos, pero 3 pacientes fallecieron en el grupo abierto. La mediana de estancia hospitalaria fue significativamente menor en el grupo laparoscópico (6 vs. 8 días; p = 0,041).Conclusión El abordaje por vía laparoscópica es una técnica segura y comparable a la cirugía abierta en el tratamiento de la UPP, con la que el paciente se beneficia de una estancia hospitalaria más corta (AU)

Objective To analyse the outcomes of laparoscopic versus open repair for perforated peptic ulcers (PPU).Methods All patients undergoing PPU repair between January 2002 and March 2012 were included in the study. Demographic characteristics, operation time, complications, and length of hospital stay were evaluated. Results Two hundred and twelve patients (median age, 49 years) were included, 60 in the laparoscopic group and 52 in the open group. Patients operated laparoscopically were significantly younger and had a higher consumption of tobacco, alcohol and cannabis. Median acute symptoms time was shorter in the laparoscopic group (6 h) compared to the open group (12 h; P=.025) Symptoms time was shorter in the laparoscopic group. Median operating time was significantly longer in the laparoscopic group (104.5 min vs. 76 min, P=.025). The percentage of conversion to open repair was 25%. There was no difference in morbidity between 2 groups, but there were 3 deaths in the open group. Median hospital stay was significantly shorter in patients treated laparoscopically when compared with the open group (6 days vs. 8 days; P=.041).Conclusion Laparoscopic and open repair are equally safe in the management of PPU. A shorter hospital stay can be achieved in the laparoscopic group (AU)

[A comparison of laparoscopic versus open repair for the surgical treatment of perforated peptic ulcers]. / Tratamiento quirúrgico de la úlcera péptica perforada: comparación entre los abordajes laparoscópico y abierto.

OBJECTIVE: To analyse the outcomes of laparoscopic versus open repair for perforated peptic ulcers (PPU). METHODS: All patients undergoing PPU repair between January 2002 and March 2012 were included in the study. Demographic characteristics, operation time, complications, and length of hospital stay were evaluated. RESULTS: Two hundred and twelve patients (median age, 49 years) were included, 60 in the laparoscopic group and 52 in the open group. Patients operated laparoscopically were significantly younger and had a higher consumption of tobacco, alcohol and cannabis. Median acute symptoms time was shorter in the laparoscopic group (6h) compared to the open group (12h; P=.025) Symptoms time was shorter in the laparoscopic group. Median operating time was significantly longer in the laparoscopic group (104.5min vs. 76min, P=.025). The percentage of conversion to open repair was 25%. There was no difference in morbidity between 2 groups, but there were 3 deaths in the open group. Median hospital stay was significantly shorter in patients treated laparoscopically when compared with the open group (6 days vs. 8 days; P=.041). CONCLUSION: Laparoscopic and open repair are equally safe in the management of PPU. A shorter hospital stay can be achieved in the laparoscopic group.

Tratamiento del dolor anal por patología anorrectal aguda en urgencias: ¿baños de asiento con agua fría o caliente? resultados de un ensayo clínico aleatorizado / Cold or hot sitz baths in the emergency t

Introducción: La creencia popular propugna el uso de baños de asiento con agua fría para el tratamiento del dolor anal agudo, pero las guías de práctica clínica recomiendan el uso de agua caliente por su efecto conocido sobre la presión anal de reposo. Objetivo: El objetivo fue estudiar el efecto analgésico, sobre la calidad de vida, datos de manometría y evolución clínica, de 2 temperaturas en los baños de asiento en enfermos con dolor anal. Material y métodos: Ensayo clínico aleatorizado en pacientes con dolor anal agudo por enfermedad hemorroidal o fisura anal divididos en Grupo 1: baños de asiento con agua a Ta inferior a 15°C y Grupo 2: baños con agua a Tasuperior a 30°C. La analgesia fue la misma en ambos grupos. Se analizó: el dolor durante 7 días (escala visual analógica), calidad de vida (SF-36), presión anal de reposo y evolución de la enfermedad. Resultados: De 27 pacientes elegibles, 24 fueron aleatorizados (Grupo 1: n=12 y Grupo 2: n=12). El dolor no mostró diferencias estadísticamente significativas, pero se mantuvo estable en el Grupo 1 y por el contrario fue disminuyendo progresivamente en los pacientes del Grupo 2, siendo la diferencia en los valores del dolor del primer día respecto al séptimo superior en el Grupo 2 (p=0,244). El resto de variables fueron similares. Conclusión: No hubo diferencias estadísticamente significativas en el control del dolor del 1.er al 7 día en el Grupo con baños de asiento con agua caliente (AU)

Introduction: The popular belief advocates the use of sitz (sitting) baths with cold water for the treatment of acute anal pain, but clinical practice guides recommend the use of hot water for its known effect on the at-rest anal pressure. Aim: The objective of the study was to examine the analgesic effect on the quality of life, manometer data and clinical progress, of the two temperatures in sitz baths in patients with anal pain. Material and methods: A randomised clinical trial on patients with acute anal pain due to haemorrhoids or anal fissures, divided into Group 1: Sitz baths with water at a temperature of less than 15°C, and Group 2: Baths with a water temperature above 30°C. The analgesia was the same in both groups. An analysis was made of the pain at 7 days (visual analogue scale), quality of life (SF-36), anal at-rest pressure and disease progress. Results: Of the 27 eligible patients, 24 were randomised (Group 1: n=12 y Group 2: n=12). There were no statistical differences in pain, but it remained stable in Group 1, but gradually decreased in the patients of Group 2, the difference being in the pain scores on the first day compared to the seventh in Group 2 (p=0.244). The rest of the variables were similar. Conclusion: There were no statistically significant differences in pain control from day 1 to day 7 in the Group with sitz baths with hot water (AU)

[Cold or hot sitz baths in the emergency treatment of acute anal pain due to anorectal disease? Results of a randomised clinical trial]. / Tratamiento del dolor anal por patología anorrectal aguda en urgencias: ¿baños de asiento con agua fría o caliente? resultados de un ensayo clínico aleatorizado.

INTRODUCTION: The popular belief advocates the use of sitz (sitting) baths with cold water for the treatment of acute anal pain, but clinical practice guides recommend the use of hot water for its known effect on the at-rest anal pressure. AIM: The objective of the study was to examine the analgesic effect on the quality of life, manometer data and clinical progress, of the two temperatures in sitz baths in patients with anal pain. MATERIAL AND METHODS: A randomised clinical trial on patients with acute anal pain due to haemorrhoids or anal fissures, divided into Group 1: Sitz baths with water at a temperature of less than 15 degrees C, and Group 2: Baths with a water temperature above 30 degrees C. The analgesia was the same in both groups. An analysis was made of the pain at 7 days (visual analogue scale), quality of life (SF-36), anal at-rest pressure and disease progress. RESULTS: Of the 27 eligible patients, 24 were randomised (Group 1: n=12 y Group 2: n=12). There were no statistical differences in pain, but it remained stable in Group 1, but gradually decreased in the patients of Group 2, the difference being in the pain scores on the first day compared to the seventh in Group 2 (p=0.244). The rest of the variables were similar. CONCLUSION: There were no statistically significant differences in pain control from day 1 to day 7 in the Group with sitz baths with hot water. (ISRCTN Number: 50105150).

[Treatment of severe chronic constipation through the antegrade continent enema procedure]. / Tratamiento del estreñimiento crónico grave mediante la técnica del enema anterógrado continente.

The antegrade continent enema procedure was first described in 1990 by Malone for the treatment of severe fecal neurogenic incontinence in children. Since then, this technique has been successfully carried out in adults, as well as in patients with refractory constipation. The procedure provides a continent and catheterizable channel, generally an appendicostomy, through which antegrade washouts are given to produce colonic emptying. We describe the case of a 23-year-old man with severe constipation and overflow fecal incontinence who underwent an appendicostomy. There were no immediate postoperative complications and saline washouts were started on the fourth day. Since then, the patient has had a bowel movement between 1 and 3 hours after each washout, has recovered continence, and no longer wears an absorbent pad.

Aplicabilidad, seguridad y eficacia de un protocolo de tratamiento ambulatorio de la diverticulitis aguda no complicada / Applicability, safety and efficacy of an ambulatory treatment protocol in patients with uncomplicated acute diverticulitis

Introducción. El objetivo de este estudio es evaluar la aplicabilidad, la seguridad y la eficacia de un protocolo de tratamiento ambulatorio de la diverticulitis aguda no complicada. Pacientes y métodos. Estudio prospectivo longitudinal. Se incluyó a todos los pacientes diagnosticados mediante tomografía computarizada abdominal de diverticulitis aguda no complicada durante un período de 2 años. Se excluyó a los pacientes que no toleraban la ingesta oral, que presentaban comorbilidades importantes o que no disponían de un entorno familiar adecuado. El tratamiento ambulatorio consistió en antibióticos por vía oral durante 1 semana (amoxicilina-clavulánico 1 g/8 h o ciprofloxacino 500 mg/12 h y metronidazol 500 mg/8 h en pacientes con alergia a la penicilina). Además se les indicó una dieta líquida durante los primeros 2 días y paracetamol 1 g/8 h por vía oral. Resultados. Se diagnosticó a 53 pacientes con diverticulitis aguda no complicada. Trece pacientes presentaban algún criterio de exclusión, por lo que se inició el tratamiento ambulatorio en 40 pacientes. Tan sólo 2 pacientes (5%) precisaron ingreso hospitalario después de haber iniciado el tratamiento domiciliario, en un caso por persistencia del dolor y en otro por vómitos. En ambos casos, el tratamiento antibiótico intravenoso resolvió el proceso inflamatorio. En los 38 pacientes restantes (95%) se completó el tratamiento de forma satisfactoria y sin complicaciones. Conclusiones. El tratamiento ambulatorio de la diverticulitis aguda no complicada no sólo es eficaz y seguro, sino también aplicable en la mayoría de los pacientes, siempre que toleren la ingesta oral y dispongan de un entorno familiar adecuado (AU)

Introduction. The aim of this study was to evaluate the applicability, safety and efficacy of an ambulatory treatment protocol in patients with uncomplicated acute diverticulitis. Patients and methods. All patients diagnosed with uncomplicated acute diverticulitis based on abdominal computed tomography findings during a 2-year period were prospectively included. Patients with vomiting, severe comorbidities, or without an appropriate family environment were excluded. Ambulatory treatment consisted of oral antibiotics for 1 week (amoxicillin-clavulanic 1 g t.i.d. or ciprofloxacin 500 mg b.i.d. plus metronidazole 500 mg t.i.d. in patients with penicillin allergy). A clear liquid diet for the first 2 days and pain control with oral acetaminophen 1 g t.i.d. were also recommended. Results. Fifty-three patients were diagnosed with uncomplicated acute diverticulitis and 13 patients were excluded. Therefore, ambulatory treatment was initiated in 40 patients. Only two patients (5%) required admission after outpatient therapy was started due to vomiting and persistent abdominal pain, respectively. In both patients, the inflammatory process was successfully resolved by intravenous antibiotic treatment. In the remaining 38 patients (95%), ambulatory treatment was completed without complications. Conclusions. Ambulatory treatment of uncomplicated acute diverticulitis is safe, effective and applicable in most patients with tolerance to oral intake and with an appropriate family environment (AU)

Tratamiento del estreñimiento crónico grave mediante la técnica del enema anterógrado continente / Treatment of severe chronic constipation through the antegrade continent enema procedure

La técnica del enema anterógrado continente fue descrita por primera vez por Malone en 1990 para el tratamiento de la incontinencia fecal grave de origen neurogénico en niños, y posteriormente se ha utilizado con éxito también en adultos y en pacientes con estreñimiento que no responde al tratamiento médico. El procedimiento consiste en la formación de un conducto continente, generalmente una apendicostomía, que permita la cateterización intermitente para la irrigación y la limpieza rápida y controlada del colon. Presentamos el caso de un paciente de 23 años con estreñimiento grave y encopresis al que se le practicó una apendicostomía. No hubo complicaciones postoperatorias inmediatas y las irrigaciones se iniciaron con suero salino el cuarto día después de la intervención. Desde entonces, el paciente realiza deposiciones entre 1 y 3 h después del lavado, ha recuperado la continencia y ha dejado de llevar pañales (AU)

The antegrade continent enema procedure was first described in 1990 by Malone for the treatment of severe fecal neurogenic incontinence in children. Since then, this technique has been successfully carried out in adults, as well as in patients with refractory constipation. The procedure provides a continent and catheterizable channel, generally an appendicostomy, through which antegrade washouts are given to produce colonic emptying. We describe the case of a 23-year-old man with severe constipation and overflow fecal incontinence who underwent an appendicostomy. There were no immediate postoperative complications and saline washouts were started on the fourth day. Since then, the patient has had a bowel movement between 1 and 3 hours after each washout, has recovered continence, and no longer wears an absorbent pad (AU)

Tratamiento de la fisura anal crónica / No disponible

No disponible