Situación actual de la cirugía endocrina en régimen ambulatorio en España. Revisión sistemática de la literatura existente / Current situation of outpatient endocrine surgery in spain. Systematic review of the existing literature

En los últimos 20 años la cirugía en régimen ambulatorio se ha impuesto como una realidad cotidiana. Se ha convertido en un estándar para ciertas cirugías en casos seleccionados. La cirugía tiroidea y paratiroidea han sido unos de los procedimientos que se han implantado en muchas unidades de CMA, pero todavía hay reticencias a su realización y no existen muchas publicaciones al respecto en el ámbito nacional. Por ello, revisamos la literatura publicada en revistas indexadas respecto a la cirugía tiroidea y paratiroidea en régimen ambulatorio en España en los últimos 20 años (AU)

In the last 20 years ambulatory surgery has established itself as a daily reality. It has become a standard for certain surgeries in selected cases. Thyroid and parathyroid surgery have been one of the procedures that have been implemented in many units, but there is still reluctance to carry them out and there are not many publications on the matter at the national level. For this reason, we reviewed the literature published in indexed journals regarding thyroid and parathyroid surgery in outpatient settings in Spain in the last 20 years (AU)

Three-dimensional endoanal ultrasound to assess the validity of Goodsall's Rule and the Midline Rule in predicting the path of perianal fistula-in-ano and the location of the internal opening.

BACKGROUND: Correct identification of the internal opening is essential in the management of perianal fistulae. The aim of this study was to assess the validity of Goodsall's Law and the Midline Rule in predicting the path of perianal fistula-in-ano and the location of the internal opening using 3-dimensional endoanal ultrasound. METHODS: An observational study including patients diagnosed with fistula-in-ano, at our institution from January 2006 to December 2020 was performed. Location and distance from the anal verge of the external opening, internal opening, and the path of the fistulous tract were recorded during physical examination and endoanal ultrasound. Goodsall's and Midline rules were applied to all fistulae according to the location of the external opening. The location of the internal opening as predicted by either rule was then compared to the real location of the internal opening identified during endoanal ultrasound examination. RESULTS: Nine hundred and nine patients [657 (72.3%) males, mean age 50.78 (49.84-51.72) years] were included. 665 (73.2%) of fistulae were transsphinteric. Concordance between predicted internal opening site and the true internal opening location was 0.601 (good match) for Goodsall's rule, and 0.416 (moderate match) for the Midline rule. Goodsall's rule proved to be more predictive in the anterior plane (p < 0.001). Both rules were more likely to make a correct diagnosis in posterior fistulae located 4.5-7.5 mm from the anal verge. CONCLUSIONS: Both Midline and Goodsall's rules are highly predictive of the course of fistula tracts located in the posterior plane, and are lower for anterior located fistulae, female patients and when the external opening is located further from the anal verge.