RESUMO
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Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Colite/microbiologia , Clostridioides difficile/patogenicidade , Hospitalização , Enterocolite Pseudomembranosa/microbiologiaAssuntos
Clostridioides difficile , Enterocolite Pseudomembranosa/etiologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Colectomia , Enterocolite Pseudomembranosa/tratamento farmacológico , Enterocolite Pseudomembranosa/cirurgia , Hemorragia Gastrointestinal/etiologia , Humanos , Ileostomia , Hospedeiro Imunocomprometido , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Masculino , Megacolo Tóxico/etiologia , Megacolo Tóxico/cirurgia , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Pneumoperitônio/etiologia , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/microbiologia , Neoplasias do Colo Sigmoide/cirurgiaRESUMO
Objetivo El objetivo de este estudio ha sido evaluar de forma prospectiva los resultados funcionales en una serie de colgajos de avance para tratar fístulas anales complejas. Material y métodos Se incluyó a 90 pacientes intervenidos por fístulas anales complejas mediante fistulectomía y colgajo transanal. Los resultados funcionales se valoraron mediante cuestionario de continencia anal (Wexner) y estudio manométrico anorrectal, preoperatorio y postoperatorio. Resultados La fístula recidivó en 7 (7,7%) casos y se repitió la misma técnica quirúrgica en 5, con curación en todos ellos. Después de 3 meses de la cirugía, se produjeron reducciones significativas en la presión máxima basal (83,85±30,96 frente a 46,51±18,67; p<0,001) y en la presión máxima de contracción voluntaria (220,97±100,21 frente a 183,06±75,36; p<0,001). Por lo que respecta al cuestionario de continencia fecal, el 80% de los pacientes mantuvo continencia normal con puntuación 0 en la escala de Wexner postoperatoria, mientras que los demás (20%) manifestaron cambios en la puntuación del cuestionario, la mayoría, menos de 3 puntos y con poca significación clínica. Conclusiones La reparación con colgajo de avance es una técnica efectiva para las fístulas anales complejas, con una tasa de recurrencia baja. El 20% de los pacientes modifican la valoración de su continencia en el postoperatorio (AU)
Objective The aim of this study was the prospective evaluation of the functional results of a series endorectal advancement flaps in the treatment of complex anal fistulas. Material and methods A total of 90 patients were operated on for a complex anal fistula by means of fistulectomy and endorectal advancement flap. The functional results were evaluated using the Wexner continence scale and an anorectal manometry study before and after surgery. Results There were seven patients with fistula recurrence (7.7%) and the same surgical procedure was performed on five of them, resulting in healing in all cases. Significant reductions in maximum resting pressure (83.85±30.96 vs 46.51±18.67; p<0.001) and maximum squeeze pressure (220.97±100.21 vs 183.06±75.36; p<0.001) were seen 3 months after surgery. On the continence scale, 80% of patients had a normal continence with a value of 0 on the postoperative Wexner scale, while 20% recorded changes in continence values, most of them lower than 3 points. Conclusions Endorectal advancement flap is an effective surgical procedure in complex anal fistulas treatment, with a low recurrence rate. Only 20% of the patients showed changes in the continence value (AU)
Assuntos
Humanos , Incontinência Fecal/cirurgia , Retalhos Cirúrgicos , Fístula Retal/cirurgia , Manometria , Estudos Prospectivos , AntibioticoprofilaxiaRESUMO
OBJECTIVE: The aim of this study was the prospective evaluation of the functional results of a series endorectal advancement flaps in the treatment of complex anal fistulas. MATERIAL AND METHODS: A total of 90 patients were operated on for a complex anal fistula by means of fistulectomy and endorectal advancement flap. The functional results were evaluated using the Wexner continence scale and an anorectal manometry study before and after surgery. RESULTS: There were seven patients with fistula recurrence (7.7%) and the same surgical procedure was performed on five of them, resulting in healing in all cases. Significant reductions in maximum resting pressure (83.85+/-30.96 vs 46.51+/-18.67; p<0.001) and maximum squeeze pressure (220.97+/-100.21 vs 183.06+/-75.36; p<0.001) were seen 3 months after surgery. On the continence scale, 80% of patients had a normal continence with a value of 0 on the postoperative Wexner scale, while 20% recorded changes in continence values, most of them lower than 3 points. CONCLUSIONS: Endorectal advancement flap is an effective surgical procedure in complex anal fistulas treatment, with a low recurrence rate. Only 20% of the patients showed changes in the continence value.