Perioperative and oncologic outcomes of interval colectomy performed by acute care surgeons after stenting as a bridge to surgery for left-sided malignant colonic obstruction are non-inferior to the outcomes of colorectal surgeons in the elective setting: single center experience.

PURPOSE: To analyze if perioperative and oncologic outcomes with stenting as a bridge to surgery (SEMS-BS) and interval colectomy performed by acute care surgeons for left-sided occlusive colonic neoplasms (LSCON) are non-inferior to those obtained by colorectal surgeons for non-occlusive tumors of the same location in the full-elective context. METHODS: From January 2011 to January 2021, patients with LSCON at University Regional Hospital in Málaga (Spain) were directed to a SEMS-BS strategy with an interval colectomy performed by acute care surgeons and included in the study group (SEMS-BS). The control group was formed with patients from the Colorectal Division elective surgical activity dataset, matching by ASA, stage, location and year of surgery on a ratio 1:2. Stages IV or palliative stenting were excluded. Software SPSS 23.0 was used to analyze perioperative and oncologic (defined by overall -OS- and disease free -DFS-survival) outcomes. RESULTS: SEMS-BS and control group included 56 and 98 patients, respectively. In SEMS-BS group, rates of technical/clinical failure and perforation were 5.35% (3/56), 3.57% (2/56) and 3.57% (2/56). Surgery was performed with a median interval time of 11 days (9-16). No differences between groups were observed in perioperative outcomes (laparoscopic approach, primary anastomosis rate, morbidity or mortality). As well, no statistically significant differences were observed in OS and DFS between groups, both compared globally (OS:p < 0.94; DFS:p < 0.67, respectively) or by stages I-II (OS:p < 0.78; DFS:p < 0.17) and III (OS:p < 0.86; DFS:p < 0.70). CONCLUSION: Perioperative and oncologic outcomes of a strategy with SEMS-BS for LSCON are non-inferior to those obtained in the elective setting for non-occlusive neoplasms in the same location. Technical and oncologic safety of interval colectomy performed on a semi-scheduled situation by acute care surgeons is absolutely warranted.

Risk factors associated with prolonged postoperative ileus after elective colon resection.

BACKGROUND: There is a coordinated inhibition of motility of the colon after its surgical manipulation that contributes to the accumulation of fluids and gas, in turn characterized by nausea,vomiting, pain, abdominal distension, and constipation. Motility is recovered in the majority of patients within the first 72 hours. A delay in its resolution is known as prolonged postoperative ileus. AIMS: To study the preoperative, intraoperative, and postoperative risk factors for developing prolonged ileus in patients that underwent elective colon resection.Materials and methods: The association between 25 perioperative variables and the presentation of prolonged ileus was analyzed in 85 patients that underwent colon resection at Hospital Christus Muguerza Alta Especialidad within the time frame of 2011 and 2014. RESULTS: Postoperative ileus occurred in 22.3% of the patients. The statistically significant predictors of ileus were obesity (OR 1.119, P=.048) and admission to the intensive care unit (OR3.571, P=.050). The use of peridural anesthesia during the surgical act was found to be a protective factor (OR 0.363, P=.050). CONCLUSIONS: The presence of these risk factors can alert the physician to the need for a closer follow-up in patients at high risk for postoperative ileus, and the use of peridural anesthesiacan possibly lower the incidence of ileus.

[Risk factors for the occurrence of sporadic Campylobacter, Salmonella and rotavirus diarrhea in preschool children]. / Factores de riesgo de los casos esporádicos de diarrea por Campylobacter, Salmonella y rotavirus en niños preescolares.

BACKGROUND: Sporadic cases of diarrhea in preschool children are highly frequent, especially those caused by rotavirus, Campylobacter and Salmonella. The aim of this study was to identify some of the factors associated with these processes. MATERIAL AND METHODS: A case-control study of hospitalized incident cases aged less than 3 years old was performed. Questionnaires were administered at admission, before the results of stool tests were known. Susceptibility, food exposure, and environmental factors were investigated. Infants aged less than 1 year were analyzed separately. RESULTS: A total of 117 patients (rotavirus in 31, Campylobacter in 228 and Salmonella in 21, negative results in 37) and 84 controls were studied. Several protective factors, such as breast feeding and prior antibiotic use, were identified. Risk factors for diarrhea were exposure to meat products (eating or environmental exposure in the kitchen), some kinds of pets, and attendance at day care. Differences were found by etiology and age. In the culture-negative group, no risk factors were identified. CONCLUSION: The problems posed by epidemiological study of this issue are discussed. The main findings in each group of cases are interpreted and proposals are made for their application in the control and prevention of these diseases.

Factores de riesgo de los casos esporádicos de diarrea por Campylobacter, Salmonella y rotavirus en niños preescolares / Risk factors for the occurrence of sporadic Campylobacter, Salmonella and rotavirus diarrhea in preschool children

Antecedentes: Los casos esporádicos de diarrea en niños pequeños son muy frecuentes, sobre todo por rotavirus, Campylobacter y Salmonella. Se pretende identificar los factores asociados con estos procesos. Material y métodos: Estudio de casos y controles. Casos de diarrea hospitalizados menores de 3 años. Entrevista realizada inmediatamente al ingreso, antes de conocer el resultado del coprocultivo. Se investigaron factores de susceptibilidad, de alimentación y ambientales. Se ha distinguido en niños mayores y menores de 1 año. Resultados: Un total de 117 pacientes (rotavirus, 31; Campylobacter, 28; Salmonella, 21; negativos, 37) y 84 controles. Se identificaron varios factores protectores como lactancia materna y toma previa de antibiótico. Factores de riesgo relacionados como la exposición a productos cárnicos (por ingesta o ambiental en la cocina), a algunos animales domésticos o asistencia a guarderías. Hubo diferencias por tipo de germen y por grupo de edad. En el grupo de pacientes con el coprocultivo negativo no se identificaron factores de riesgo. Conclusión: Se discuten las dificultades que plantea el estudio epidemiológico de este tipo de casos. Se interpretan los hallazgos por grupos de microorganismos, por grupo de edad, y se plantea su aplicación en el control y prevención de estos procesos

Background: Sporadic cases of diarrhea in preschool children are highly frequent, especially those caused by rotavirus, Campylobacter and Salmonella. The aim of this study was to identify some of the factors associated with these processes. Material and methods: A case-control study of hospitalized incident cases aged less than 3 years old was performed. Questionnaires were administered at admission, before the results of stool tests were known. Susceptibility, food exposure, and environmental factors were investigated. Infants aged less than 1 year were analyzed separately. Results: A total of 117 patients (rotavirus in 31, Campylobacter in 228 and Salmonella in 21, negative results in 37) and 84 controls were studied. Several protective factors, such as breast feeding and prior antibiotic use, were identified. Risk factors for diarrhea were exposure to meat products (eating or environmental exposure in the kitchen), some kinds of pets, and attendance at day care. Differences were found by etiology and age. In the culture-negative group, no risk factors were identified. Conclusion: The problems posed by epidemiological study of this issue are discussed. The main findings in each group of cases are interpreted and proposals are made for their application in the control and prevention of these diseases

[Factors associated with sporadic cases of salmonellosis in 1- to 7-year-old children. Study of cases and controls]. / Factores asociados con casos esporádicos de salmonelosis en niños de 1 a 7 años. Estudio de casos y controles.

BACKGROUND: Knowledge about salmonellosis risk factors mainly comes from foodborne outbreaks, and we know little about sporadic cases epidemiology. However most of the cases are sporadic, specially children. This study aims to find out some of determinants of these cases. METHODS: A case-control study with incident cases and controls from the same base population (laboratory diagnosed cases). Cases were children 1-7 years old, affected by diarrhea with culture stools positive to Salmonella between december 1994 and december 1995. Controls from the same source, but positive culture to Campylobacter or viruses. We study food and other environmental risk factors. Odds ratio (OR) are calculated adjusted for age, sex, and year period (cool and cold) by logistic regression. RESULTS: Eating minced meat during three days before symptoms, OR 4.07 (1.20-13.8) and OR 5.63 (1.34-23.6); pets, OR 8.27 (1.96-34.9), and antibiotics the week before symptoms, OR 4.75 (0.84-27.0) were epidemiologically associated with salmonellosis diarrhea. CONCLUSIONS: Epidemiology of salmonellosis sporadic cases in children seems different to the foodborne associated cases and is more complex. Minced meat tree days before symptoms, antibiotics the week before symptoms, and pets could be a risk for this kind of cases. Future studies must also take account of this factors.