Efecto de la aplicación de un protocolo para pie diabético en un servicio de cirugía general / Effect of the application of a diabetic protocol in a general surgery service

Resumen Objetivo: El fin principal en el paciente con pie diabético es evitar la amputación, por ello, este estudio pretendió analizar el efecto que produjo la instauración de un protocolo de actuación para el pie diabético en nuestro departamento de salud. Materiales y Método: Se trata de un estudio retrospectivo. Se evaluó la edad, el sexo, la tasa de amputaciones y re-amputaciones en el primer mes, la estancia media y la añadida por reingreso para reamputación, la solicitud de pruebas analíticas y radiológicas complementarias específicas (analítica de sangre completa con hemoglobina glicosilada y angioTC/RWdoppler arterial de miembros inferiores), y pacientes derivados al centro de referencia para valorar revascularización. Todos estos datos se analizaron comparando los pacientes ingresados con diagnóstico de pie diabético en el periodo previo a la implantación del protocolo (años 2010 a 2013), con los del periodo posterior (años 2014 a 2018). Resultados: Se compararon grupos homogéneos en cuanto a edad y sexo. El resultado del análisis fue una reducción estadísticamente significativa de la tasa de amputaciones (172 frente a 111, media de 22,2 ± 9,9), reamputaciones (41 frente a 15) y de reingreso (18 frente a 7) por mala evolución en el primer mes. No se encontraron cambios en el número de pruebas complementarias radiológicas realizadas y el número de pacientes remitidos a hospital de referencia para valorar revascularización. Conclusiones: Dentro del manejo multidisciplinar, el cirujano general es uno de los pilares importantes. La implantación de un protocolo de actuación para el pie diabético reduce de forma significativa la tasa de amputaciones.

Aim: The main objective in the patient with diabetic foot is to avoid amputation, thus, this study pretended to analyze the effect produced by the introduction of a protocol for the diabetic foot in our Department of Health. Materials and Method: It is a retrospective study. Age, sex, amputation and re-amputations rate in the first month, the average stay and the hospital re-entry were evaluated, the request for specific complementary analytical and radiological tests (blood test analytics with glycosylated hemoglobin and CT/MR/doppler arterial limb angiography) and patients remitted to the reference center to assess revascularization. All these data were analyzed comparing the patients admitted with diagnosis of diabetic foot in the period before to the implementation of the protocol (years 2010 to 2013) with those of the subsequent period (years 2014 to 2018). Results: Homogeneous groups were compared by age and sex. The result of the analysis was a significant reduction in the rate of amputations (172 versus 111, average of 22.2 ± 9.9), re-amputations (41 versus 15) and re-entry due to poor evolution in the first month (18 versus 7). No changes were found in the number of complementary radiological tests performed and the number of patients remitted to the reference hospital to assess revascularization. Conclusions: In the multidisciplinary management, the general surgeon is one of the important pillars. The implementation of an action protocol for the diabetic foot significantly reduces the amputation rate.

Úlcera rectal solitaria en paciente con prolapso rectal / Solitary rectal ulcer in a patient with rectal prolapse

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Cirugía endoscópica transanal con material convencional de laparoscopia, ¿es factible? / Transanal endoscopic surgery with conventional laparoscopy materials: is it feasible?

Introducción La cirugía endoscópica transanal con material convencional de laparoscopia puede ser una alternativa a la microcirugía endoscópica transanal (TEM) para la exéresis de lesiones rectales susceptibles de extirpación local. Material y método Analizamos prospectivamente 27 pacientes incluidos de forma consecutiva entre 1999 y 2009 a los que se les practicó una operación endoscópica transanal (TEO), mediante resección de pared total rectal. Todos los procedimientos se realizaron con un rectoscopio de 40mm inicialmente diseñado por nosotros y posteriormente con el rectoscopio de Storz, utilizando el equipo y el material convencional de laparoscopia. Resultados Hemos intervenido a 27 pacientes con una edad media de 69,4 años. 23 por lesiones benignas y 4 malignas. La distancia media del tumor a los márgenes anales ha sido de 8,2cm (rango 5-15) y el diámetro medio tumoral de 3,38±1,2cm. Se presentaron 4 complicaciones postoperatorias, 3 por sangrado y un caso de perforación. La estancia hospitalaria promedio fue de 6±3,75 días. No hubo mortalidad perioperatoria ni se han demostrado recidivas. Conclusión Es factible la realización de cirugía endoscópica transanal con material convencional de laparoscopia, con reducción de costes y accesible a cirujanos laparoscopistas (AU)

Introduction Transanal endoscopic surgery with conventional laparotomy materials may be an alternative to transanal endoscopic microsurgery (TEM) for the excision of rectal lesions susceptible to local resection. Material and method We prospectively analysed 27 patients included consecutively between 1999 and 2009, on whom a Transanal endoscopic operation (TEO) was performed by total resection of the rectal wall. All procedures were performed with a 40mm rectoscope, initially designed by us and later with the Storz rectoscope, using conventional laparoscopic tools and material. Results We operated on 27 patients with a mean age of 69.4 years: 23 due to benign lesions and 4 malignant. The medium distance of the tumour to the anal margins was 8.2cm (range 5-15) and a mean tumour diameter of 3.38±1.2cm. There were 4 postoperative complications, 3 due to bleeding and one case of perforation. The mean hospital stay was 6±3.75 days. There was no perioperative mortality or recurrences..Conclusion Performing transanal endoscopic surgery with conventional laparoscopy material is feasible, with a reduction in costs and accessible to laparoscopy surgeons (AU)

[Transanal endoscopic surgery with conventional laparoscopy materials: is it feasible?]. / Cirugía endoscópica transanal con material convencional de laparoscopia, ¿es factible?

INTRODUCTION: Transanal endoscopic surgery with conventional laparotomy materials may be an alternative to transanal endoscopic microsurgery (TEM) for the excision of rectal lesions susceptible to local resection. MATERIAL AND METHOD: We prospectively analysed 27 patients included consecutively between 1999 and 2009, on whom a Transanal endoscopic operation (TEO) was performed by total resection of the rectal wall. All procedures were performed with a 40mm rectoscope, initially designed by us and later with the Storz rectoscope, using conventional laparoscopic tools and material. RESULTS: We operated on 27 patients with a mean age of 69.4 years: 23 due to benign lesions and 4 malignant. The medium distance of the tumour to the anal margins was 8.2cm (range 5-15) and a mean tumour diameter of 3.38 ± 1.2cm. There were 4 postoperative complications, 3 due to bleeding and one case of perforation. The mean hospital stay was 6 ± 3.75 days. There was no perioperative mortality or recurrences.. CONCLUSION: Performing transanal endoscopic surgery with conventional laparoscopy material is feasible, with a reduction in costs and accessible to laparoscopy surgeons.