Consenso Baiona sobre Incontinencia Fecal: Asociación Española de Coloproctología / Baiona's Consensus Statement for Fecal Incontinence. Spanish Association of Coloproctology

La incontinencia fecal (IF) constituye un importante problema sanitario, tanto a nivel individual como para los diferentes sistemas de salud, lo que origina una preocupación generalizada para su resolución o, al menos, disminuir en lo posible los numerosos efectos indeseables que provoca, al margen del elevado gasto que ocasiona. Existen diferentes criterios relacionados con las pruebas diagnósticas a realizar, y lo mismo acontece con relación al tratamiento más adecuado, dentro de las numerosas opciones que han proliferado durante los últimos años, no siempre basadas en una rigurosa evidencia científica. Por dicho motivo, desde la Asociación Española de Coloproctología (AECP) nos propusimos elaborar un Consenso que sirviese de orientación a todos los profesionales sanitarios interesados en el problema, conscientes, no obstante, de que la decisión terapéutica debe tomarse de manera individualizada: características del paciente/experiencia del terapeuta. Para su elaboración optamos por la técnica de grupo nominal. Los niveles de evidencia y los grados de recomendación se establecieron de acuerdo a los criterios del Oxford Centre for Evidence-Based Medicine. Por otra parte, en cada uno de los ítems analizados se añadieron, de forma breve, recomendaciones de los expertos.(AU)

Faecal incontinence (FI) is a major health problem, both for individuals and for health systems. It is obvious that, for all these reasons, there is widespread concern for healing it or, at least, reducing as far as possible its numerous undesirable effects, in addition to the high costs it entails. There are different criteria for the diagnostic tests to be carried out and the same applies to the most appropriate treatment, among the numerous options that have proliferated in recent years, not always based on rigorous scientific evidence. For this reason, the Spanish Association of Coloproctology (AECP) proposed to draw up a Consensus to serve as a guide for all health professionals interested in the problem, aware, however, that the therapeutic decision must be taken on an individual basis: patient characteristics/experience of the care team. For its development it was adopted the Nominal Group Technique methodology. The Levels of Evidence and Grades of Recommendation were established according to the criteria of the Oxford Centre for Evidence-Based Medicine. In addition, expert recommendations were added briefly to each of the items analysed.(AU)

Baiona's Consensus Statement for Fecal Incontinence. Spanish Association of Coloproctology.

Faecal incontinence (FI) is a major health problem, both for individuals and for health systems. It is obvious that, for all these reasons, there is widespread concern for healing it or, at least, reducing as far as possible its numerous undesirable effects, in addition to the high costs it entails. There are different criteria for the diagnostic tests to be carried out and the same applies to the most appropriate treatment, among the numerous options that have proliferated in recent years, not always based on rigorous scientific evidence. For this reason, the Spanish Association of Coloproctology (AECP) proposed to draw up a consensus to serve as a guide for all health professionals interested in the problem, aware, however, that the therapeutic decision must be taken on an individual basis: patient characteristics/experience of the care team. For its development it was adopted the Nominal Group Technique methodology. The Levels of Evidence and Grades of Recommendation were established according to the criteria of the Oxford Centre for Evidence-Based Medicine. In addition, expert recommendations were added briefly to each of the items analysed.

Carcinoma escamoso de ano en enfermedad de Crohn perianal severa de larga evolución / Anal squamous cell carcinoma in chronic severe perianal Crohn's disease

No disponible

Cáncer de ciego obstructivo en paciente centenaria: tratamiento quirúrgico / Obstructive cecal cancer in a centennial patient: surgical management

No disponible

Estado actual de la prevención y tratamiento de las complicaciones de los estomas. Revisión de conjunto / Current status of the prevention and treatment of stoma complicacions. A narrative review

El objetivo es realizar una revisión del estado actual de la prevención y tratamiento de las complicaciones de los estomas. Se ha realizado una búsqueda de la literatura en Medline-PubMed, EMBASE y Cochrane Library hasta diciembre de 2012.Las complicaciones de los estomas son frecuentes e implican una peor calidad de vida y un aumento del costo para el sistema sanitario. Muchas están en relación con la técnica quirúrgica y son susceptibles de prevención con una correcta cirugía realizada por cirujanos con experiencia. El uso de mallas reduce el riesgo de hernia paraestomal y la tasa de recurrencia después de su reparación. Es fundamental el papel de la enfermera estomaterapeuta para elegir la localización del estoma en la fase preoperatoria, y en la fase de seguimiento, para conseguir una mejor adaptación e independencia de los pacientes ostomizados, lo que redundará en una mayor calidad de vida

The aim of our study was to perform a review of the literature to assess the results of prevention and treatment of stoma complications. Medline, EMBASE medical database and the Cochrane Library were searched up to December 2012.Stomal complications are prevalent and associated with a worse quality of life and increased health-economic burdens. The most common complications are attributed to stoma construction. Attention to the finer technical points performed by experienced surgeons reduces morbidity. The use of mesh reduces the risk of parastomal hernia and recurrence rates in hernia repair. Preoperative stoma site marking and postoperative care by a stomatherapist are crucial for the patients’ successful adaption, improving quality of life, promoting their independence and reducing the rates of complications

[Current status of the prevention and treatment of stoma complications. A narrative review]. / Estado actual de la prevención y tratamiento de las complicaciones de los estomas. Revisión de conjunto.

The aim of our study was to perform a review of the literature to assess the results of prevention and treatment of stoma complications. Medline, EMBASE medical database and the Cochrane Library were searched up to December 2012. Stomal complications are prevalent and associated with a worse quality of life and increased health-economic burdens. The most common complications are attributed to stoma construction. Attention to the finer technical points performed by experienced surgeons reduces morbidity. The use of mesh reduces the risk of parastomal hernia and recurrence rates in hernia repair. Preoperative stoma site marking and postoperative care by a stomatherapist are crucial for the patients' successful adaption, improving quality of life, promoting their independence and reducing the rates of complications.

Resultados de la implantación de un protocolo de fast-track en una unidad de cirugía colorrectal: estudio comparativo / Results of applying a fast-track protocol in a colorectal surgery unit: comparative study

Objetivo: Implantar un protocolo de fast-track (FT) en una unidad de cirugía colorrectal, comprobando la seguridad de aplicación del mismo, en pacientes sometidos a cirugía colorrectal electiva, mediante la evaluación de las diferencias de morbilidad y estancia hospitalaria con respecto a un grupo control (GC) con cuidados tradicionales. Analizamos también la recuperación funcional del grupo FT. Material y método Se compararon mediante un estudio de cohorte prospectivo con control no concurrente, un grupo de 108 pacientes intervenidos por cáncer colorrectal entre 2008 y 2009, a los que se les aplicó el protocolo FT y un GC de 147 pacientes intervenidos entre 2005 y 2007 de similares características, con cuidados postoperatorios tradicionales. Resultados Fueron similares en ambos grupos las características demográficas, el riesgo anestésico y los procedimientos quirúrgicos realizados, con un mayor número de pacientes con abordaje laparoscópico en el grupo FT. El cumplimiento de los ítems incluidos en nuestro protocolo FT fue elevado (72,2-92,6%).Se observaron complicaciones en 77 pacientes (52%) del GC frente a 30 (27,8%) en el grupo FT (p<0,001), debido fundamentalmente a la disminución de la infección de la herida quirúrgica (p<0,001). Mortalidad y número de reingresos fueron menores en el grupo FT, sin diferencias estadísticamente significativas. La mediana de estancia hospitalaria fue de 14 días en el GC y de 8 en el FT (p<0,001).Conclusiones La aplicación de un programa de FT en cirugía colorrectal es segura, permitiendo una disminución significativa de la morbilidad y la estancia hospitalaria, sin aumentar el número de reingresos (AU)

Objective: To implement a fast-track (FT) protocol in a colorectal surgery unit, checking its safety when applied to patients subjected to elective colorectal surgery, by evaluating the differences in morbidity and hospital stay compared to a control group with traditional care. We also analyse the functional recovery of the FT group. Material and method: A prospective cohort study with non-concurrent control, was conducted on a group of 108 patients operated on for colorectal cancer between 2008 and 2009,to which the FT protocol was applied, and a control group (CG) of 147 patients subjected to surgery between 2005 and 2007 with similar characteristics, with traditional postoperative care. Results: The demographic characteristics, anaesthetic risk, and the surgical procedures performed were similar, with a higher number of patients with laparoscopic approach in the FT group. The compliance with the items in our FT protocol was high (72.2-92.6%).Complications were observed in 77 patients (52%) in the GC compared to 30 (27.8%) in the FT group (P<.001), mainly due to the decrease in surgical wound infection (P<.001). Mortality and the number of readmissions were less in the FT group, with no statistically significant differences. The median hospital stay was 14 days in the CG and 8 in the FT group (P<.001).Conclusions: The applying of an FT program in colorectal surgery is safe, leading to a significant decrease in morbidity and hospital stay, without increasing the number of readmissions (AU)

[Results of applying a fast-track protocol in a colorectal surgery unit: comparative study]. / Resultados de la implantación de un protocolo de fast-track en una unidad de cirugía colorrectal: estudio comparativo.

OBJECTIVE: To implement a fast-track (FT) protocol in a colorectal surgery unit, checking its safety when applied to patients subjected to elective colorectal surgery, by evaluating the differences in morbidity and hospital stay compared to a control group with traditional care. We also analyse the functional recovery of the FT group. MATERIAL AND METHOD: A prospective cohort study with non-concurrent control, was conducted on a group of 108 patients operated on for colorectal cancer between 2008 and 2009, to which the FT protocol was applied, and a control group (CG) of 147 patients subjected to surgery between 2005 and 2007 with similar characteristics, with traditional postoperative care. RESULTS: The demographic characteristics, anaesthetic risk, and the surgical procedures performed were similar, with a higher number of patients with laparoscopic approach in the FT group. The compliance with the items in our FT protocol was high (72.2-92.6%). Complications were observed in 77 patients (52%) in the GC compared to 30 (27.8%) in the FT group (P<.001), mainly due to the decrease in surgical wound infection (P<.001). Mortality and the number of readmissions were less in the FT group, with no statistically significant differences. The median hospital stay was 14 days in the CG and 8 in the FT group (P<.001). CONCLUSIONS: The applying of an FT program in colorectal surgery is safe, leading to a significant decrease in morbidity and hospital stay, without increasing the number of readmissions.