Results of a national survey about the management of patients with acute uncomplicated diverticulitis.

INTRODUCTION: Management of patients diagnosed of acute uncomplicated diverticulitis has evolved lately and according to the latest guidelines, outpatient treatment and management without antibiotherapy may be used in selected patients. The aim of this study is to evaluate the adhesión among national centres to these and others recommendations related to this pathology. METHODS: An online national survey, that has been broadcast by several applications, was performed. The results obtained were statistically analysed. RESULTS: A total of 104 surgeons participated, representing 69 national hospitals. Of those, in 82.6% of the centres, outpatient management is performed for acute uncomplicated diverticulitis. 23.2% of the hospitals have a protocol stablished for treatment without antibiotherapy in selected patients. Centres that do not follow these protocols allege that the mean reasons are the logistic difficulties to set them up (49.3%) and the lack of current evidence for it (44.8%). Significative statistical differences have been found when comparing the establishment of such protocols between centres with advanced accredited units and those who are not, with higher rates of outpatient management and treatment without antibiotics in accredited units (p ≤ .05). CONCLUSIONS: In spite that this a very common disease, there is a huge national heterogeneity in its treatment. This is why it would adviseable to unify diagnostic and treatment criteria by the collaboration of scientific societies and the simplification of the development of hospitalary protocols.

FiLaC procedure for highly selected anal fistula patients: indications,safety and efficacy from an observational study at a tertiary referral center / Procedimiento FiLaC para pacientes con fístula anal altamente seleccionados: indicaciones, seguridad y eficacia de un estudio observacional en un centro de referencia terciario

Background: the ideal clinical profile of patients or fistula features for fistula laser closure (FiLaC®) technique remain to be established. The aim of this study was to analyze clinical outcomes and the safety profile of FiLaC® in search for an ideal setting for this technique. Methods: a retrospective observational study was performed from a prospective database including all consecutive patients who underwent surgery for anal fistula (AF) with FiLaC® in the coloproctology unit of a tertiary referral center, between October 2015 and December 2021. The FiLaC® procedure was offered to AF patients who were considered to be at risk of fecal incontinence. Fistulas were described according to Parks’ classification and categorized as complex or simple according to the American Gastroenterological Association (AGA) guidelines. Healing was defined by the closure of the internal and external openings for at least six months. Predictive factors of AF healing were investigated. Results: a total of 36 patients were included, with a mean age of 48 ± 13.9 years. Twenty patients (55.6 %) were male and 13 patients (36 %) had Crohn’s disease (CD). Fourteen patients (38.8 %) had a complex fistula. The primary and secondary healing rates were 55.6 % and 91.7 %, respectively, during a median follow-up time of 12 months (IQR 7-29). No fecal continence impairment was registered in any case. The proportion of patients with primary healing was significantly higher in CD patients (76.9 % vs 43.5 %, p = 0.048). Conclusions: FiLaC® is a sphincter-preserving procedure with an excellent safety profile and reasonable success rate despite of the strict patient selection. This technique may be attractive for patients with CD due to its higher primary healing rate.(AU)

FiLaC® procedure for highly selected anal fistula patients: indications, safety and efficacy from an observational study at a tertiary referral center.

BACKGROUND: the ideal clinical profile of patients or fistula features for fistula laser closure (FiLaC®) technique remain to be established. The aim of this study was to analyze clinical outcomes and the safety profile of FiLaC® in search for an ideal setting for this technique. METHODS: a retrospective observational study was performed from a prospective database including all consecutive patients who underwent surgery for anal fistula (AF) with FiLaC® in the coloproctology unit of a tertiary referral center, between October 2015 and December 2021. The FiLaC® procedure was offered to AF patients who were considered to be at risk of fecal incontinence. Fistulas were described according to Parks' classification and categorized as complex or simple according to the American Gastroenterological Association (AGA) guidelines. Healing was defined by the closure of the internal and external openings for at least six months. Predictive factors of AF healing were investigated. RESULTS: a total of 36 patients were included, with a mean age of 48 ± 13.9 years. Twenty patients (55.6 %) were male and 13 patients (36 %) had Crohn's disease (CD). Fourteen patients (38.8 %) had a complex fistula. The primary and secondary healing rates were 55.6 % and 91.7 %, respectively, during a median follow-up time of 12 months (IQR 7-29). No fecal continence impairment was registered in any case. The proportion of patients with primary healing was significantly higher in CD patients (76.9 % vs 43.5 %, p = 0.048). CONCLUSIONS: FiLaC® is a sphincter-preserving procedure with an excellent safety profile and reasonable success rate despite of the strict patient selection. This technique may be attractive for patients with CD due to its higher primary healing rate.

Treatment for acute uncomplicated diverticulitis without antibiotherapy: systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: Use of antibiotics in selected cases of acute uncomplicated diverticulitis (AUD) has recently been questioned. OBJECTIVE: The aim of this study is to examine the safety and efficacy of treatment regimens without antibiotics compared with that of traditional treatments with antibiotics in selected patients with AUD. DATA SOURCES: PubMed, Medline, Embase, Web of Science, and the Cochrane Library. METHODS: A systematic review was performed according to PRISMA and AMSTAR guidelines by searching through Medline, Embase, Web of Science, and the Cochrane Library for randomized clinical trials (RCTs) published before December 2022. The outcomes assessed were the rates of readmission, change in strategy, emergency surgery, worsening, and persistent diverticulitis. STUDY SELECTION: RCTs on treating AUD without antibiotics published in English before December 2022 were included. INTERVENTION: Treatments without antibiotics were compared with treatments with antibiotics. MAIN OUTCOME MEASURES: The outcomes assessed were the rates of readmission, change in strategy, emergency surgery, worsening, and persistent diverticulitis. RESULTS: The search yielded 1163 studies. Four RCTs with 1809 patients were included in the review. Among these patients, 50.1% were treated conservatively without antibiotics. The meta-analysis showed no significant differences between nonantibiotic and antibiotic treatment groups with respect to rates of readmission [odds ratio (OR)=1.39; 95% CI: 0.93-2.06; P =0.11; I2 =0%], change in strategy (OR=1.03; 95% CI: 0.52-2,02; P =0.94; I2 =44%), emergency surgery (OR=0.43; 95% CI: 0.12-1.53; P =0.19; I2 =0%), worsening (OR=0.91; 95% CI: 0.48-1.73; P =0.78; I2 =0%), and persistent diverticulitis (OR=1.54; 95% CI: 0.63-3.26; P =0.26; I2 =0%). LIMITATIONS: Heterogeneity and a limited number of RCTs. CONCLUSIONS: Treatment for AUD without antibiotic therapy is safe and effective in selected patients. Further RTCs should confirm the present findings.

Acute Uncomplicated Diverticulitis: Updated Evidence for Same Old Questions.

CASE SUMMARY: A 58-year-old man with a previous history of hypertension presented to the emergency department because of acute left lower quadrant pain. Neither nausea nor vomiting was described. At physical examination, he had tenderness to palpation in the left lower quadrant with no signs of peritonitis. The patient's body temperature and heart rate were unremarkable (37.2°C/86 beats per minute). Laboratory blood tests showed minimal leukocytosis (13,000 cells/mm 3 ) with no other relevant findings. An abdominal CT was performed, which confirmed the clinical suspicion of acute uncomplicated diverticulitis (AUD). It was described as the presence of a sigmoid thickening and phlegmon in an area with several diverticula, but no free air, fluid, or abscesses were identified ( Fig. 1 ). After the administration of painkillers, the patient remained completely asymptomatic, with good pain control and no fever, so he was recommended conservative outpatient treatment without antibiotics. One week after the AUD episode, the patient was checked, and he confirmed that the resolution had been uneventful and he had been asymptomatic, confirming that the outpatient treatment was successful. The patient asked for any measures that he could follow to prevent further episodes and showed interest in surgical treatment options.

Ampullary GIST tumor as an incidental finding after a cephalic duodenopancreatectomy due to a suspicion of a nonfunctional neuroendocrine tumor.

The case of a patient who had a cephalic duodenopancreatectomy performed because of a nonfunctional neuroendocrine tumour located in the pancreatic head is reported. Such tumour was diagnosed by a CT scan, an echoendoscopy and some punctures of the tumour to take some samples for cytology. The final anatomopathological study informed about the presence of an ampullary GIST tumour, which is a very infrequent entity, so a bibliographical search and a revision of the cases published up to this day was done.

Patients' Perceived Satisfaction Through Telephone-Assisted Tele-Consultation During the SARS-CoV-2 Pandemic Period: Observational Single-Centre Study at a Tertiary-Referral Colorectal Surgery Department.

Introduction: The pandemic produced by SARS-CoV-2 has obliged us to set up the tele-assistance to offer a continuity of care. This implies an innovation, being the degree of satisfaction of patients unknown. Methods: A telephonic survey was conducted with the validated in the Spanish tool Telehealth Usability Questionnaire (Telehealth Usability Questionnaire; rating from 1-7) of all candidate patients assisted consecutively in the Coloproctology Unit. We included demographic variables, education level, job status, diagnosis and consultation type. A descriptive study was done. The relationship between the willingness of consultation model in the future (telemedicine vs traditional) and the categorical variables was analysed through the chi-squared test. Results: A total of 115 patients were included. The average age was 59.9 years, being 60% women. The average score in each of the survey items was higher than 6 in all the questions but 1. 26.1% of the surveyed patients confessed being advocated to tele-assistance in the future. The only factors related to greater willingness to tele-assistance were male gender (37% vs 18.8%; P = .03) and a higher academic preparation level in favour of higher technical studies (35.9%) and university studies (32.4%) opposite to the rest (P = .043). The rest of variables studied, job status, labour regimen, diagnostic group and consultation type did not show any relationship. Conclusions: A vast majority of patients answered favourably to almost all the items of the survey. However, only 26.1% of them would choose a model of tele-assistance without restrictions.

Resección hepática anatómica laparoscópica guiada por imagen / Image-guided laparoscopic anatomic liver resection

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Porocarcinoma de localización mamaria, a propósito de un caso / Porocarcinoma Located in the Breast: A Case Report

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Cirugía electiva durante la pandemia por SARS-CoV-2 (COVID-19): análisis de morbimortalidad y recomendaciones sobre priorización de los pacientes y medidas de seguridad / Elective Surgery During the SARS-CoV-2 Pandemic (COVID-19): A Morbimortality Analysis and Recommendations on Patient Prioritisation and Security Measures

INTRODUCCIÓN: La expansión de la infección por SARS-CoV-2 (COVID-19) ha requerido la adaptación de los hospitales afectados por la pandemia, causando una reducción de la actividad quirúrgica electiva. MÉTODOS: Estudio retrospectivo de pacientes operados durante el mes previo y el pico de la pandemia. Se analizó la tasa de contagio por COVID-19, la gravedad de la infección respiratoria según la Brescia Respiratory COVID-19 Severity Scale, las medidas terapéuticas adoptadas y las complicaciones postoperatorias globales. RESULTADOS: Desde el 17 de febrero hasta el 31 de marzo de 2020 se produjo una reducción progresiva de la actividad quirúrgica, interviniéndose únicamente 213 pacientes: 59 (27,8%) de forma programada por patología tumoral, 97 (45,5%) por patología benigna y 57 (26,7%) de forma urgente. Se produjo un aumento progresivo de la tasa de contagio por COVID-19 con un total de 15 (7%) casos. De los pacientes oncológicos, 10 (16,9%) resultaron afectos; en el grupo de cirugía electiva, un paciente (1%); y en el grupo de cirugía urgente, 4 (7%) (p < 0,001). Cinco pacientes presentaron una infección respiratoria grave de los cuales 4 estaban afectos por enfermedad oncológica. Hubo 3 (1,4%) fallecimientos, todos debidos a progresión de la infección respiratoria. CONCLUSIONES: Los pacientes sometidos a cirugía presentaron una elevada tasa de infección por COVID-19 y de complicaciones postoperatorias, sobre todo en los pacientes oncológicos. La puesta en marcha de la de la actividad quirúrgica debe basarse en una priorización de los casos a operar, respetando unas premisas de seguridad y optimización de los recursos disponibles

INTRODUCTION: The spread of the SARS-CoV-2 infection (COVID-19) has required adaptation by hospitals affected by the pandemic, which has caused a reduction in elective surgical activity. METHODS: Retrospective study of patients operated on in the previous month and during the peak of the pandemic. We analysed the COVID-19 infection rate, the severity of respiratory infection according to the Brescia respiratory COVID-19 severity scale, the adopted therapeutic measures and the overall postoperative complications. RESULTS: From 17th February to 31st March 2020, there was a progressive decrease in surgical activity, with only 213 patients operated on. This comprised 59 (27.8%) elective operations for oncological diseases, 97 (45.5%) elective operations for benign diseases and 57 (26.7%) as urgent procedures. There was a progressive increase in the rate of infection by COVID-19, with a total of 15 cases (7%). This included 10 patients (16.9%) in the elective group for oncological disease, 1 (1%) in the elective surgery group for benign disease and 4 (7%) in the urgent surgery group (P < .001). Five patients presented with a severe respiratory infection, of which 4 were affected by oncological disease. There were 3 deaths (1.4%), which were all due to the worsening of a respiratory infection. CONCLUSIONS: The patients undergoing the surgical procedures showed high rates of COVID-19 infection and postoperative complications, especially the patients with oncological diseases. Local resumption of surgical activity must be based on the prioritisation of the cases to be operated on, respecting certain premises of security and optimisation of the available resources

Síndrome de Flood: una grave complicación de la hernia umbilical / Flood syndrome: A severe complication of umbilical hernia

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[Elective surgery during the SARS-CoV-2 pandemic (COVID-19): a morbimortality analysis and recommendations on patient prioritisation and security measures]. / Cirugía electiva durante la pandemia por SARS-CoV-2 (COVID-19): análisis de morbimortalidad y recomendaciones sobre priorización de los pacientes y medidas de seguridad.

INTRODUCTION: The spread of the SARS-CoV-2 infection (COVID-19) has required adaptation by hospitals affected by the pandemic, which has caused a reduction in elective surgical activity. METHODS: Retrospective study of patients operated on in the previous month and during the peak of the pandemic. We analysed the COVID-19 infection rate, the severity of respiratory infection according to the Brescia respiratory COVID-19 severity scale, the adopted therapeutic measures and the overall postoperative complications. RESULTS: From 17th February to 31st March 2020, there was a progressive decrease in surgical activity, with only 213 patients operated on. This comprised 59 (27.8%) elective operations for oncological diseases, 97 (45.5%) elective operations for benign diseases and 57 (26.7%) as urgent procedures.There was a progressive increase in the rate of infection by COVID-19, with a total of 15 cases (7%). This included 10 patients (16.9%) in the elective group for oncological disease, 1 (1%) in the elective surgery group for benign disease and 4 (7%) in the urgent surgery group (p < 0.001). Five patients presented with a severe respiratory infection, of which 4 were affected by oncological disease. There were 3 deaths (1.4%), which were all due to the worsening of a respiratory infection. CONCLUSIONS: The patients undergoing the surgical procedures showed high rates of COVID-19 infection and postoperative complications, especially the patients with oncological diseases. Local resumption of surgical activity must be based on the prioritisation of the cases to be operated on, respecting certain premises of security and optimisation of the available resources.

Fallo hepático fulminante por carcinoma ductal mamario de tipo inflamatorio / Acute liver failure due to inflammatory ductal carcinoma of the breast

Presentamos el caso de una paciente intervenida de mastectomía radical modificada por carcinoma ductal infiltrante de tipo inflamatorio, que durante el postoperatorio inmediato presenta un empeoramiento clínico generalizado secundario a un fallo hepático fulminante desencadenado por la aparición de múltiples metástasis. La paciente fallece a las horas del comienzo del cuadro por fallo multiorgánico

We present the case of a woman who underwent a modified radical mastectomy due to an infiltrating inflammatory ductal carcinoma and who, during the immediate postoperative period showed clinical deterioration due to acute liver failure caused by the presence of multiple metastases. The patient died a few hours after the onset of multiorgan failure