[Complicated renal cyst by fistula from acute appendicitis on an appendicular mucocele. First literature report.] / Quiste renal complicado por fistulización de apendicitis aguda sobre un mucocele apendicular. Primera descripción en la literatura.

We describe the first clinical case in the reviewed literature of a patient with a complicated renal cyst by fistula of an appendicular neoplasm with acute appendicitis, as well as the management performed and the therapeutic options in similar cases.

Se describe el primer caso clínico en la literatura revisada de un paciente con un quiste renal complicado por sobreinfección tras fistulización de una neoplasia apendicular con apendicitis aguda, así como el manejo realizado y las opciones terapéuticas en un caso similar.

Quiste renal complicado por fistulización de apendicitis aguda sobre un mucocele apendicular. Primera descripción en la literatura / Complicated renal cyst by fistula from acute appendicitis on an appendicular mucocele. First literature report

Se describe el primer caso clínico en la literatura revisada de un paciente con un quiste renal complicado por sobreinfección tras fistulización de una neoplasia apendicular con apendicitis aguda, así como el manejo realizado y las opciones terapéuticas en un caso similar

We describe the first clinical case in the reviewed literature of a patient with a complicated renal cyst by fistula of an appendicular neoplasm with acute appendicitis, as well as the management performed and the therapeutic options in similar cases

Aneurismas venosos yuxtaanastomóticos en fístulas arteriovenosas para hemodiálisis / Juxtaanastomotic venous aneurysms in arteriovenous fistulas for hemodialysis

No disponible

Reparación quirúrgica urgente de las fístulas arteriovenosas para hemodiálisis trombosadas. Repercusión económica de la implantación de un protocolo de actuación en un área sanitaria / Economic repercussions of implementing a protocol for urgent surgical repair of thrombosed arteriovenous fistulae

Introducción: Cuando un paciente en hemodiálisis sufre la trombosis de su fístula arteriovenosa (FAV), necesita algún procedimiento urgente para su próxima sesión de diálisis. Existen dos opciones terapéuticas: la colocación de un catéter venoso central (CVC) o la reparación de su FAV. El objetivo de este trabajo es valorar la posibilidad de reparación urgente de las FAV trombosadas dentro de la actividad de urgencias de un servicio de cirugía general y determinar la posible repercusión económica de la implantación de este protocolo de trabajo en un área sanitaria. Método: Se realizó la recogida prospectiva de todas las intervenciones quirúrgicas urgentes realizadas para la reparación de las FAV trombosadas en el período 2000-2011 en nuestro centro. Se analizaron los resultados clínicos mediante dos variables: tasa de trombosis (episodios/paciente/año) y porcentaje de rescate. Se consideró un rescate eficaz si tras la intervención el paciente se pudo dializar con su FAV evitando la colocación de un CVC. Se definió e implantó el proceso clínico «FAV trombosada» y se estudió su coste económico mediante un análisis detallado realizado por el departamento económico financiero de nuestro centro. También se realizó este análisis para el proceso clínico alternativo (nueva FAV) utilizando los datos publicados por el Ministerio de Sanidad (peso del Grupo Relacionado con el Diagnóstico: accesos vasculares para hemodiálisis, unidad de complejidad hospitalaria, precio público de procesos ambulatorios y porcentaje de cirugía ambulatoria). Finalmente se realizó una estimación de la repercusión económica de la implantación de este proceso comparando los costes de ambos procedimientos. Resultados: Durante el período de estudio se produjeron 268 episodios de trombosis, lo que supone una tasa de 0,10 episodios/paciente/año (0,05 en FAV autólogas y 0,43 en injertos). Se atendieron de forma urgente por el servicio de cirugía 203 (75 %), consiguiendo rescatar 168 FAV (82 %). El coste de una reparación urgente de una FAV se estimó en 999 Euro. El precio promedio de una FAV programada más el precio de la colocación y mantenimiento de un CVC se estimó en 6397 Euro. El ahorro producido por la reparación urgente de las FAV en nuestra área de salud es de 107 940 Euros/año. La extrapolación al conjunto del país para una población de 23 000 pacientes en hemodiálisis sería de 9 930 480 Euros/año. Conclusiones: Es posible realizar el rescate quirúrgico urgente de la mayoría de las FAV para hemodiálisis. La implantación de un protocolo multidisciplinar evita la colocación de catéteres en estos pacientes, disminuyendo el gasto asociado a ellos (AU)

Introduction: When a patient undergoing haemodialysis suffers from arteriovenous fistula (AVF) thrombosis, (s)he needs an urgent procedure before the next dialysis session. Two different treatment options are available: placing a central venous catheter (CVC) or repairing the AVF. The objective of this study is to assess the possibility of urgent repair of thrombosed AVFs within the emergency care activity of a general surgery department and to determine the possible economic repercussions of implementing this working protocol in an area of healthcare. Method: We completed the prospective collection of all the urgent surgical interventions made to repair thrombosed AVFs for the period 2000-2011 at our centre. The clinical results were analysed using two variables: rate of thrombosis (episodes/patient/year) and percentage of recovery. Recovery was deemed effective if after the surgery the patient was able to undergo dialysis of his/her AVF without the need to place a CVC. The "thrombosed AVF" clinical process was defined and implemented, and its economic cost was analysed via a detailed analysis conducted by our centre's Financial Department. This analysis was also conducted for the alternative clinical process (new AVF), using the data published by the Ministry of Health (weight of the Diagnosis-Related Group: vascular accesses for haemodialysis, hospital complexity unit, public cost of outpatient procedures and percentage of economic repercussions of the implementation of this process, comparing the costs of both procedures). Results: During the study period 268 episodes of thrombosis occurred, a rate of 0.1 episodes/patient/year (0.05 on autologous AVFs and 0.43 on grafts). 203 (75%) were treated urgently by the surgery department, of which 168 AVFs (82%) were recovered. The cost of urgently repairing an AVF was estimated at Euros999. The average cost of a scheduled AVF intervention, plus the cost of placing and maintaining a CVC, was estimated at Euros6,397. The saving made by urgent repair of AVFs in our area of healthcare is Euros107,940/year. Extrapolating this to the entire country for a population of 23,000 patients on haemodialysis, the total would be Euros9,930,480/year. Conclusions: It is possible to perform urgent surgical recovery on the majority of AVFs for haemodialysis. Implementing multidisciplinary protocol avoids fitting these patients with catheters, reducing the cost this entails (AU)

Economic repercussions of implementing a protocol for urgent surgical repair of thrombosed arteriovenous fistulae.

INTRODUCTION: When a patient undergoing haemodialysis suffers from arteriovenous fistula (AVF) thrombosis, (s)he needs an urgent procedure before the next dialysis session. Two different treatment options are available: placing a central venous catheter (CVC) or repairing the AVF. The objective of this study is to assess the possibility of urgent repair of thrombosed AVFs within the emergency care activity of a general surgery department and to determine the possible economic repercussions of implementing this working protocol in an area of healthcare. METHOD: We completed the prospective collection of all the urgent surgical interventions made to repair thrombosed AVFs for the period 2000-2011 at our centre. The clinical results were analysed using two variables: rate of thrombosis (episodes/patient/year) and percentage of recovery. Recovery was deemed effective if after the surgery the patient was able to undergo dialysis of his/her AVF without the need to place a CVC. The "thrombosed AVF" clinical process was defined and implemented, and its economic cost was analysed via a detailed analysis conducted by our centre's Financial Department. This analysis was also conducted for the alternative clinical process (new AVF), using the data published by the Ministry of Health (weight of the Diagnosis-Related Group: vascular accesses for haemodialysis, hospital complexity unit, public cost of outpatient procedures and percentage of economic repercussions of the implementation of this process, comparing the costs of both procedures). RESULTS: During the study period 268 episodes of thrombosis occurred, a rate of 0.1 episodes/patient/year (0.05 on autologous AVFs and 0.43 on grafts). 203 (75%) were treated urgently by the surgery department, of which 168 AVFs (82%) were recovered. The cost of urgently repairing an AVF was estimated at €999. The average cost of a scheduled AVF intervention, plus the cost of placing and maintaining a CVC, was estimated at €6,397. The saving made by urgent repair of AVFs in our area of healthcare is €107,940/year. Extrapolating this to the entire country for a population of 23,000 patients on haemodialysis, the total would be €9,930,480/year. CONCLUSIONS: It is possible to perform urgent surgical recovery on the majority of AVFs for haemodialysis. Implementing multidisciplinary protocol avoids fitting these patients with catheters, reducing the cost this entails.

Multidisciplinary approach to hemodialysis graft dysfunction and thrombosis.

PURPOSE: Top analize the clinic results of the implantation of a multidisciplinary protocol to maintain permeability of the arteriovenous hemodialysis grafts (AVG). METHOD: Prospective recording of all interventions (radiological and surgical) on AVG dysfunction in the 1999-2007 period. The AVG stenosis were always treated by percutaneous angioplasty (PA) except stenosis recurrence in less than three months or persistence after PA. The AVG thromboses were always treated by surgical thrombectomy plus PTFE bridge if necessary. Complications, primary and secondary AVG patency were reviewed. RESULTS: Ninety six dysfunction AVG were collected for study. All of them were 6x40 mm standard wall PTFE (Gore-Tex®). Thirty six of them were humero-basilic antebraquial loop and sixty were humero-axillary upper arm curve configuration. During the study, 52 PTFE bridges, 109 surgical thrombectomies, 131 PA, and 15 stents were needed to maintain FAVP permeability. Primay patency was 73.68%, 60.21% and 37.52% at one, two and three years respectively. Secondary patency was 89.49%, 84.07% and 66.84% at one, two and three years respectively. We avoid a central venous catheter (CVC) in the 80% of intervention for thrombosis dysfunction. No surgical or radiological related deaths occurred. Median hospital admission related with AVG thrombosis was 0.03/patient/year. CONCLUSION: The application of a combined protocol for the treatment of AVG dysfunction and thrombosis, according to DOQI recomendations obtains good results in AVG patency in our experience.

Tratamiento multidisciplinar de la disfunción y la trombosis de las fístulas arteriovenosas protésicas para hemodiálisis / Multidisciplinary approach to hemodialysis graft dysfunction and thrombosis

Objetivo: Análisis de la aplicación de un protocolo multidisciplinar para el mantenimiento de las fístulas arteriovenosas para hemodiálisis protésicas. Método: Recogida prospectiva de todas las intervenciones realizadas para el tratamiento de la disfunción de las fístulas arteriovenosas protésicas (FAVP) en el período 1999-2007 siguiendo un protocolo multidisciplinario. Las estenosis se trataron mediante angioplastia, (ATP) excepto en casos de persistencia o recurrencia antes de tres meses. Las trombosis fueron tratadas siempre mediante trombectomía quirúrgica y puente de PTFE si fue necesario. Se analizan el número y el tipo de procedimientos, las complicaciones, la permeabilidad primaria y secundaria de las FAVP. Resultados: Se completó el seguimiento de 96 FAVP. Todas fueron prótesis de PTFE de 6x40 mm (Gore-Tex®). Treinta y seis se colocaron en el antebrazo con anastomosis humerobasílica en asa y 60 en el brazo con anastomosis humeroaxilar curva. Durante el período de estudio fueron necesarios 131 angioplastias transluminales percutáneas, 15 stents, 109 trombectomías y 52 puentes a vena proximal para el mantenimiento de la permeabilidad de las FAVP. La permeabilidad primaria fue del 73,68 %, 60,21 % y 37,52 % a 1, 2 y 3 años, respectivamente. La permeabilidad secundaria fue del 89,49 %, 84,07 % y 66,84 % a 1, 2 y 3 años, respectivamente. Se consiguió evitar la colocación de un catéter central en el 80 % de las intervenciones por trombosis. No se produjeron muertes relacionadas con los procedimientos. La tasa de ingresos hospitalarios relacionados con la trombosis de las FAVP fue de 0,03 paciente/año. Conclusiones: La aplicación de un protocolo multidisciplinar en el tratamiento de las disfunciones de las FAVP siguiendo las recomendaciones de las guías internacionales prolonga la permeabilidad de las FAVP y disminuye el uso de catéteres centrales (AU)

Purpose: To analize the clinic results of the implantation of a multidisciplinary protocol to maintain ermeability of the arteriovenous hemodialysis grafts (AVG). Methods: Prospective recording of all interventions (radiological and surgical) on AVG dysfunction in the 1999-2007 period. The AVG stenosis were always treated by percutaneous angioplasty (PA) except stenosis recurrence in less than three months or persistence after PA. The AVG thromboses were always treated by surgical thrombectomy plus PTFE bridge if necessary. Complications, primary and secondary AVG patency were reviewed. Results: Ninety six dysfunction AVG were collected for study. All of them were 6x40mm standard wall PTFE (Gore-Tex®). Thirty six of them were humero-basilic antebraquial loop and sixty were humero-axillary upper arm curve configuration. During the study, 52 PTFE bridges, 109 surgical thrombectomies, 131 PA, and 15 stents were needed to maintain FAVP permeability. Primay patency was 73.68%, 60.21% and 37.52% at one, two and three years respectively. Secondary patency was 89.49%, 84.07% and 66.84% at one, two and three years respectively. We avoid a central venous catheter (CVC) in the 80% of intervention for thrombosis dysfunction. No surgical or radiological related deaths occurred. Median hospital admission related with AVG thrombosis was 0.03/patient/year. Conclusion: The application of a combined protocol for the treatment of AVG dysfunction and thrombosis, according to DOQI recomendations obtains good results in AVG patency in our experience (AU)

Tratamiento quirúrgico de las estenosis yuxtaanastomóticas en las fístulas arteriovenosas radiocefálicas de hemodiálisis. Nueva anastomosis proximal / Surgical treatment of juxta-anastomotic stenosis in radiocephalic fistula. A new proximal radiocephalic anastomosis

Introducción: Las estenosis yuxtaanastomóticas son la causa más frecuente de disfunción en las fístulas radiocefálicas (FAV RC) para hemodiálisis. Estas estenosis provocan bajo flujo de la fístula con mala calidad de la diálisis y pueden evolucionar a la trombosis del acceso. El tratamiento de estas lesiones puede ser radiológico o quirúrgico; la elección de uno u otro es tema de discusión. En nuestro centro se utilizó por consenso el tratamiento quirúrgico de forma sistemática. Método: Hemos realizado un estudio prospectivo desde 1998 hasta 2009. Se incluyeron todas las FAV RC con disfunción o trombosis secundaria a una estenosis yuxtaanastomótica. El diagnóstico se realizó mediante fistulografía, salvo en los casos de trombosis, en los que fue clínico. El tratamiento en todos los casos fue quirúrgico, realizándose una nueva anastomosis radiocefálica proximal a la estenosis (RC PROX). Se analizó la permeabilidad (primaria y secundaria) tanto para las FAV RC iniciales como para las RC PROX (..) (AU)

Introduction: The juxta-anastomotic stenosis is the most frequent cause of dysfunction in radiocephalic fistulas for haemodialysis. This adversity can cause low flow or thrombosis. The appropriate treatment of these lesions is under debate. Method: A prospective study was performed from 1998 to 2009. All dysfunctional radiocephalic fistulas due to juxta-anastomotic stenosis were included (n=96). The diagnosis was made by fistulografy in low flow cases and clinical evidence in cases of thrombosis. The repair was performed using a new proximal radiocephalic anastomosis in all cases. Patency following surgical intervention was estimated with the Kaplan-Meier method. Results: A total of 96 proximal radiocephalic anastomoses were performed during the study period. Mean surveillance time was 57.27 months (95% CI: 47.53-67.02). Sixty-six patients were male, and the mean age was 67 years. Scheduled surgery was performed in 70.5% of cases and 29.5% were emergency procedures, 92% of which were ambulatory. Technical success was achieved in 100% without any complications. Mean primary patency at 1, 2, 3, 4, and 5 years was 89.4%, 75%, 70.4%, 65%, and 56%, respectively. Additional procedures (n=16) were required in 14 cases (twelve new proximal anastomoses and four cases of arteriovenous graft placement), resulting in mean secondary patency at 1, 2, 3, 4, and 5 years of 93.7%, 92.1%, 89.6%, 87%, and 82.6%, respectively. Mean secondary patency of initial dysfunctional radiocephalic fistulas at 1, 2, 3, 4, and 5 years was 95%, 95%, 93.2%, 89.1%, and 86.6%, respectively. Conclusions: In our experience the proximal radiocephalic anastomosis can significantly extend fistula functionality in patients with juxta-anastomotic stenosis (AU)

Surgical treatment of juxta-anastomotic stenosis in radiocephalic fistula. A new proximal radiocephalic anastomosis.

INTRODUCTION: The juxta-anastomotic stenosis is the most frequent cause of dysfunction in radiocephalic fistulas for haemodialysis. This adversity can cause low flow or thrombosis. The appropriate treatment of these lesions is under debate. METHOD: A prospective study was performed from 1998 to 2009. All dysfunctional radiocephalic fistulas due to juxta-anastomotic stenosis were included (n=96). The diagnosis was made by fistulografy in low flow cases and clinical evidence in cases of thrombosis. The repair was performed using a new proximal radiocephalic anastomosis in all cases. Patency following surgical intervention was estimated with the Kaplan-Meier method. RESULTS: A total of 96 proximal radiocephalic anastomoses were performed during the study period. Mean surveillance time was 57.27 months (95% CI: 47.53-67.02). Sixty-six patients were male, and the mean age was 67 years. Scheduled surgery was performed in 70.5% of cases and 29.5% were emergency procedures, 92% of which were ambulatory. Technical success was achieved in 100% without any complications. Mean primary patency at 1, 2, 3, 4, and 5 years was 89.4%, 75%, 70.4%, 65%, and 56%, respectively. Additional procedures (n=16) were required in 14 cases (twelve new proximal anastomoses and four cases of arteriovenous graft placement), resulting in mean secondary patency at 1, 2, 3, 4, and 5 years of 93.7%, 92.1%, 89.6%, 87%, and 82.6%, respectively. Mean secondary patency of initial dysfunctional radiocephalic fistulas at 1, 2, 3, 4, and 5 years was 95%, 95%, 93.2%, 89.1%, and 86.6%, respectively. CONCLUSIONS: In our experience the proximal radiocephalic anastomosis can significantly extend fistula functionality in patients with juxta-anastomotic stenosis.

Initial surgical experience in laparoscopic total mesorectal excision for middle and lower third rectal cancer: short-term results.

INTRODUCTION: Total mesorectal excision (TME) of the rectum has been advocated as the gold standard surgical treatment of middle and lower third rectal cancer. Laparoscopy has gained acceptance among surgeons in the treatment of colon malignancies, while scepticism exists about laparoscopic TME in terms of safety and its oncological adequacy. OBJECTIVE: To evaluate the impact of laparoscopic TME on surgical and oncological outcome in a group of consecutive unselected patients. METHODS: One hundred and thirty-two patients with middle or inferior rectal cancer were admitted to our unit and underwent TME from December 1998 to February 2008. Eighty-nine patients were approached with laparoscopy. Patients staged cT3/4 cTxN+ or uTxN+ were submitted to neoadjuvant treatment. Postoperative complications and oncological outcomes were registered. RESULTS: In the laparoscopic group 80 anterior resections (including 4 intersphincteric resections and manual colo- anal anastomosis) and 9 abdominal-perineal resections were performed. 33.3% of patients were enrolled in "long-course" neoadjuvant chemo-radiotherapy (partial and complete response rates 88.2% and 11.8%, respectively). Protective lateral ileostomy was performed in 72% of patients. Mean operative time was 254.3+/-38.3 min and mean blood loss was 215+/-180 ml. Conversion rate was 12.7%. Morbidity rate was 39.3% without mortality. The rate of anastomotic leaks was 13.48%, reoperation rate 13.48%, recovery rate 3.1+/-1.4 days and hospital stay 10.4+/-4.6 days. Concerning adequacy of oncologic resection, mean distance of the tumour from the anal verge was 4.3+/-2.2 cm. Nodal sampling of 12.4+/-4.8 were obtained. Six patients (6/89, 6.74%) had a R1 margin: 3 distal and 3 circumferential. Median follow-up was 29 months and local recurrence rate was 5.79%. Four-year cumulative overall survival was 78% and disease-free survival was 63% (Kaplan-Meier method). CONCLUSIONS: Laparoscopic approach for rectal tumour is a technically demanding procedure, but it is oncologically safe.

Definición de procesos e indicadores para la gestión de accesos vasculares para hemodiálisis / Definition of processes and indicators for the management of vascular accesses for hemodialysis

Introducción. La prevalencia del tratamiento renal sustitutivo ha aumentado hasta 885 pacientes por millón de habitantes. Más del 50% de estos pacientes necesitan hemodiálisis (HD) con acceso vascular (AVH) permanente. En nuestro centro se organizó un grupo multidisciplinar para gestionar los procesos relacionados con el AVH. Objetivos. Definición y evaluación de procesos para gestionar los AVH. Material y método. Ámbito: hospital de tercer nivel de la Comunidad de Madrid, referencia para 550.000 habitantes. Período de estudio: 2002-2004. Método: se constituyó un grupo de trabajo multidisplinario. Definición y descripción de los 3 procesos más frecuentes. Se utilizaron flujogramas para representación gráfica. Se definieron criterios e indicadores de calidad, con monitorización prospectiva en la historia clínica electrónica, diseño de protocolo quirúrgico específico y análisis retrospectivo. Resultados. Comparación de resultados con los de la literatura: Primer acceso vascular: porcentaje de pacientes con fístulas arteriovenosas (FAV) desarrollado al comenzar HD; porcentaje de pacientes prevalentes con AVH autólogo/protésico/ catéter. Mantenimiento del acceso: tasa de trombosis FAV autóloga-protésica, porcentaje de AVH rescatadas tras trombosis, tasa de catéteres temporales. Gestión de recursos: porcentaje de intervenciones ambulatorias, tasa de ingresos relacionados con AVH. Conclusiones. Los AVH son la fuente de morbilidad e ingresos hospitalarios principal de los pacientes con insuficiencia renal crónica en programas de HD. La gestión multidisciplinar ha permitido conseguir resultados por encima de los estándares descritos en la bibliografía. No parece que haya otros factores determinantes de estos resultados, ya que los procedimientos técnicos realizados no difieren de los descritos en la bibliografía (AU)

Introduction. The prevalence of renal replacement therapy has increased, affecting 885 patients per million inhabitants. More than 50% of these patients require hemodialysis with permanent vascular access. In our center a multidisciplinary group was organized to manage processes related to vascular access for hemodialysis. Objectives. To define processes for the management of vascular access for hemodialysis and to evaluate these processes. Material and method. Setting. Level III hospital in the autonomous community of Madrid serving 485,000 inhabitants. Study period: 2002-2004. Methodology: A multidisciplinary working group was set up. The three most frequent processes were defined and described. Flow charts were used for graphical representation. Quality criteria and indicators were defined with prospective monitoring of electronic medical records, design of a specific surgical protocol, and retrospective analysis. Results. Comparison of the results with the literature. First vascular access. The percentage of patients with arteriovenous fistulas on starting hemodialysis. Percentage of prevalent patients with venous access (autologous fistula, prosthetic device, catheter). Maintenance of access: Rate of thrombosis in autologous-prosthetic arteriovenous fistulas. Percentage of rescued arteriovenous fistulas after thrombosis. Rate of temporary catheters. Resource management. Percentage of ambulatory interventions. Rate of admissions related to arteriovenous fistulas. Conclusions. Arteriovenous fistulas are the main source of morbidity and hospital admission in patients with chronic renal failure in hemodialysis programs. Multidisciplinary management achieves results above the standards described in the literature. There do not appear to be other determining factors for these results, since the technical procedures performed do not differ from those described in the literature (AU)

Hemorroidectomía con bisturí armónico (Ultracision®) frente a electrocauterio: ¿disminuye el dolor postoperatorio? / Harmonic scalpel (Ultracision®) versus electrocautery hemorrhoidectomy: does it reduce postoperative pain?

Objetivo. Evaluar el efecto sobre el dolor postoperatorio, las complicaciones derivadas de su manejo y los efectos sobre la cicatrización de las heridas en hemorroidectomías con bisturí armónico en comparación con el electrocauterio. Diseño. Estudio prospectivo, aleatorizado. Pacientes y método. Se aleatorizó a 72 pacientes consecutivos con hemorroides de grado 3-4 sintomáticas en 2 grupos: grupo 1 (bisturí armónico) y grupo 2 (electrocauterio). Se evaluaron las diferencias en ambos grupos en cuanto al dolor postoperatorio, el tiempo de cicatrización de la herida y la incontinencia. Resultados. El dolor postoperatorio fue significativamente menor en el grupo 1 en los días 1, 2 y 30 y similar al grupo 2 en los días 7 y 15. El número de analgésicos requeridos en 24 h fue también menor en el grupo 1 en los días 1, 2 y 7 (p = 0,037; p = 0,042; p = 0,049). No hubo diferencias significativas entre ambos grupos en los días 15 y 30. Solamente 2 pacientes del grupo 1 necesitaron analgesia de rescate con petidina, frente a 8 pacientes del grupo 2. El tiempo de cicatrización de la herida fue menor en el grupo 1 (26,3 ñ 3,2 días) que en el grupo 2 (35,2 ñ 2,4 días) (p = 0,049). Las complicaciones postoperatorias fueron similares en ambos grupos. Cuatro pacientes del grupo 1 presentaron retención urinaria y 1, una fisura anal. En el grupo 2, 4 pacientes presentaron retención urinaria y 2, impactación fecal. El grado de incontinencia posquirúrgica medida a los 7 días fue similar en ambos grupos, un 15,23 por ciento de los pacientes del grupo 1 y un 17,26 por ciento del grupo 2, presentaron escape ocasional de gas o moco menos de una vez a la semana (grado A1 de Pescatori). A las 4 semanas poscirugía todos los pacientes de ambos grupos estaban continentes. Conclusión. El estudio muestra que la hemorroidectomía realizada con bisturí armónico produjo menos dolor postoperatorio que la realizada con electrocauterio, sobre todo durante las primeras 48 h postoperatorias, sin afección significativa de la continencia anal y una rápida cicatrización de las heridas (AU)