PURPOSE: The main objective of this study was to assess the impact on quality of life after rubber band ligation (RBL) in patients with symptomatic grade II-III haemorrhoids who did not improve after 6 months of conservative treatment, using quality of life scores. METHODS: This was a prospective cohort observational study where patients with haemorrhoidal disease and indication for RBL were included between December 2019 and December 2020. RBL was offered as first-line treatment in this group. Patient´s quality of life was assessed by scores: HDSS (Hemorrhoidal Disease Symptom Score) and SHS (Short Health Scale).Secondary objectives were: to evaluate the rate of patients requiring one or more RBL procedures, to establish the overall success rate of RBL and to analyse complications. RESULTS: A total of 100 patients were finally included. Regarding the impact on quality of life after RBL, a significant reduction was found in the HDSS and SHS scores (p < 0.001). The main improvement was found in the first month and it was maintained until the sixth month. A high degree of satisfaction with the procedure was reported by 76% of patients. The overall success rate of banding was 89%. A 12% complication rate was detected, the most frequent complication was severe anal pain (58.3%) and self-limiting bleeding (41.7%). CONCLUSION: Rubber band ligation, as a treatment for symptomatic grade II-III haemorrhoids that do not respond to medical treatment, leads to a significant improvement in patients' symptoms and quality of life. It also has a high degree of satisfaction between patients.
Hemorrhoids , Humans , Hemorrhoids/surgery , Quality of Life , Prospective Studies , Neoplasm Recurrence, Local , Ligation/methods , Pain/etiology
Introducción: La infección del sitio quirúrgico (SSI) es una de las principales complicaciones quirúrgicas, con una incidencia del 10-20% en cirugía colorrectal. Las terapias basadas en presión negativa (NPWT) han mostrado su eficacia en el tratamiento de heridas crónicas, traumáticas, en las dehiscencias de piel, en el uso de colgajos o injertos. El objetivo principal del estudio es valorar la eficacia de NPWT en la prevención de SSI en cirugía colorrectal. Los objetivos secundarios son valorar la reducción del ingreso hospitalario y analizar los factores de riesgo de SSI. Métodos: Estudio casos y controles prospectivo. Ochenta pacientes intervenidos tras diagnóstico de enfermedad colorrectal, de forma programada o urgente durante el año 2017. Cuarenta pacientes fueron tratados con NPWT preventivo durante una semana. Cuarenta pacientes fueron tratados según protocolo habitual postoperatorio de cuidado de herida quirúrgica. Resultados: No se encontraron diferencias entre NPWT y grupo control en variables demográficas, comorbilidades, abordaje quirúrgico, indicación urgente o programada, preparación colónica o procedimiento quirúrgico. Se objetivó SSI con el empleo de NPWT en 3 (8%) pacientes (IC del 95%, 0-17,5). SSI en 10 (25%) pacientes (IC del 95%, 12,5-37,5) (p = 0,034); OR 0,7 (IC del 95% 0,006-0,964). La estancia hospitalaria en el grupo NPWT fue de 8 días vs. 12 días en el grupo control (0 p= 0,22). En el análisis multivariante se encontró como único factor relacionado con SSI la preparación colónica (p = 0,047; OR: 0,8, IC 0,45-0,93). Conclusiones: El uso de dispositivos NPWT para la cobertura de incisiones cerradas tras cirugía colorrectal puede disminuir la incidencia de SSI
Background: Surgical site infection (SSI) is one of the most frequent complications in colorectal surgery. It is diagnosed in 10 - 20% of colorectal procedures. Negative Pressure Wound Therapy (NPWT) has shown efficacy in the treatment of chronic and traumatic wounds, wound dehiscence, flaps and grafts. The main objective of this study is to assess NPWT in the prevention of SSI in colorectal surgery. Hospital stay reduction and SSI risk factors are secondary objectives. Methods: We present a prospective case-control study including 80 patients after a colorectal diagnosis and surgical procedure (elective and non-elective) in 2017. Forty patients were treated with prevention NPWT for one week. Forty patients were treated according to the standard postoperative surgical wound care protocol. Results: No significant differences were found in demographic variables, comorbidities, surgical approach, elective or non-elective surgery, mechanical bowel preparation and surgical procedure. Three patients has SSI in the NPWT group (8%) (95%CI 0 - 17.5). Ten patients presented SSI in the control group (25%) (95%CI 12.5 - 37.5) (p = 0.034); OR 0.7 (95%CI 0.006-0.964). Hospital stay in the NPWT group was 8 days versus 12 days in the non-NPWT group (p = 0.22). In the multivariate analysis, mechanical bowel preparation was found to be the only risk factor for SSI (p = 0.047; OR: 0.8, CI 0.45-0.93). Conclusions: NPWT is a useful SSI prevention treatment in colorectal surgery
Humans , Male , Female , Adult , Middle Aged , Aged , Colorectal Surgery , Negative-Pressure Wound Therapy/methods , Surgical Wound Infection/prevention & control , Length of Stay/statistics & numerical data , Case-Control Studies , Prospective Studies , Risk Factors
BACKGROUND: Surgical site infection (SSI) is one of the most frequent complications in colorectal surgery. It is diagnosed in 10 - 20% of colorectal procedures. Negative Pressure Wound Therapy (NPWT) has shown efficacy in the treatment of chronic and traumatic wounds, wound dehiscence, flaps and grafts. The main objective of this study is to assess NPWT in the prevention of SSI in colorectal surgery. Hospital stay reduction and SSI risk factors are secondary objectives. METHODS: We present a prospective case-control study including 80 patients after a colorectal diagnosis and surgical procedure (elective and non-elective) in 2017. Forty patients were treated with prevention NPWT for one week. Forty patients were treated according to the standard postoperative surgical wound care protocol. RESULTS: No significant differences were found in demographic variables, comorbidities, surgical approach, elective or non-elective surgery, mechanical bowel preparation and surgical procedure. Three patients has SSI in the NPWT group (8%) (95%CI 0 - 17.5). Ten patients presented SSI in the control group (25%) (95%CI 12.5 - 37.5) (p=0.034); OR 0.7 (95%CI 0.006-0.964). Hospital stay in the NPWT group was 8 days versus 12 days in the non-NPWT group (p=0.22). In the multivariate analysis, mechanical bowel preparation was found to be the only risk factor for SSI (p=0.047; OR: 0.8, CI 0.45-0.93). CONCLUSIONS: NPWT is a useful SSI prevention treatment in colorectal surgery.
Colorectal Surgery , Negative-Pressure Wound Therapy/methods , Surgical Wound Infection/prevention & control , Adult , Aged , Case-Control Studies , Female , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Prospective Studies , Risk Factors
La amiloidosis es un síndrome poco frecuente, constituido por un conjunto de trastornos que tienen en común el depósito extracelular de proteínas fibrilares. De ello resultan alteraciones funcionales y estructurales de los órganos afectados, dependientes de la localización e intensidad del depósito.La infiltración amiloide del tiroides puede verse en el 50% de la amiloidosis primaria y hasta en el 80% de la forma secundaria. El bocio amiloide (BA) es una verdadera rareza, habitualmente asociado a la forma secundaria. El BA puede tener indicación quirúrgica, generalmente justificada por problemas compresivosComunicamos el caso de un paciente con un gran BA en el curso de una amiloidosis secundaria asociada a una artritis idiopática juvenil de inicio poliarticular, al que se le practicó una tiroidectomía total. Revisamos la literatura, intentando aportar pautas de actuación y algunas consideraciones quirúrgicas sobre esta rara afección (AU)
Amyloidosis is an uncommon syndrome consisting of a number of disorders having in common an extracellular deposit of fibrillary proteins. This results in functional and structural changes in the affected organs, depending on deposit location and severity.Amyloid infiltration of the thyroid gland may occur in 50% and up to 80% of patients with primary and secondary amyloidosis respectively. Amyloid goiter (AG) is a true rarity, usually found associated to secondary amyloidosis. AG may require surgical excision, usually because of compressive symptoms.We report the case of a patient with a big AG occurring in the course of a secondary amyloidosis associated to polyarticular onset juvenile idiopathic arthritis who underwent total thyroidectomy. Current literature is reviewed, an attempt is made to provide action guidelines, and some surgical considerations on this rare condition are given (AU)
Humans , Amyloidosis/surgery , Goiter/surgery , Thyroidectomy , Arthritis, Juvenile/complications , Risk Factors
Amyloidosis is an uncommon syndrome consisting of a number of disorders having in common an extracellular deposit of fibrillary proteins. This results in functional and structural changes in the affected organs, depending on deposit location and severity. Amyloid infiltration of the thyroid gland may occur in 50% and up to 80% of patients with primary and secondary amyloidosis respectively. Amyloid goiter (AG) is a true rarity, usually found associated to secondary amyloidosis. AG may require surgical excision, usually because of compressive symptoms. We report the case of a patient with a big AG occurring in the course of a secondary amyloidosis associated to polyarticular onset juvenile idiopathic arthritis who underwent total thyroidectomy. Current literature is reviewed, an attempt is made to provide action guidelines, and some surgical considerations on this rare condition are given.
Amyloidosis/surgery , Goiter/surgery , Adult , Amyloidosis/complications , Goiter/complications , Humans , Male
INTRODUCTION: We retrospectively analyze our experience in conservative treatment for infiltrating advanced breast cancer before implementation of selective sentinel node biopsy, specially focusing on characteristics, incidence, treatment and evolution of local-regional recurrences, disease-free survival time, overall survival and patient's satisfaction. MATERIAL AND METHODS: From January 1984 to 31st December 1998, 739 female patients were operated in our institution, diagnosed as having infiltrating breast cancer. One hundred and eighty-eight patients (25.43%) received conservative treatment and they were followed up until December 2003. RESULTS: Average age when diagnosed was 50.42 years old (24-87 years). 53.19% of the patients were premenopausal. After a median follow-up of 129 months (60-198 months), 13 women (6.91%) presented local -regional recurrence and the disease-free time was 48.4 months (8-108 months). Global survival rate was 83.5% and disease free survival rate was 80.85%. CONCLUSIONS: The management of choice for early stage (I and II) infiltrating breast cancer is nowadays conservative, with a low local-regional recurrence rate and survival rate that are comparable to radical mastectomy, according to the literature. It's a safe and efficient method that let us preserve the breast with a good esthetical result. In selected cases, when a regional recurrence occurs, a second conservative management is possible with a good control of the disease, although the most widely accepted treatment in these cases is total mastectomy.
Breast Neoplasms/mortality , Breast Neoplasms/therapy , Carcinoma, Ductal, Breast/mortality , Carcinoma, Ductal, Breast/therapy , Adult , Aged , Aged, 80 and over , Antineoplastic Agents , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/secondary , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Mastectomy , Middle Aged , Patient Satisfaction , Radiotherapy Dosage , Retrospective Studies , Survival Analysis , Treatment Outcome
