Pre-incisional local infiltration with levobupivacaine in laparoscopic cholecystectomy: a randomized and clinical trial.

OBJECTIVE: Laparoscopic cholecystectomy (LC), despite its minimally invasive nature, requires effective control of post-operative pain. The use of local anesthetics (LA) has been studied, but the level of evidence is low, and there is little information on important parameters such as health-related quality of life (HRQoL) or return to work. The objective of the study was to evaluate the efficacy of 0.50% levobupivacaine infiltration of incisional sites in reducing POP after LC. METHODS: This was a prospective, randomized, double-blind study. Patients undergoing elective LC were randomized into two groups: no infiltration (control group) and port infiltration (intervention group). POP intensity (numerical rating scale, NRS), need for rescue with opioid drugs, PONV incidence, HRQoL, and return to work data, among others, were studied. RESULTS: Two hundred and twelve patients were randomized and analyzed: 105 (control group) and 107 (intervention group). A significant difference was observed in the NRS values (control group mean NRS score: 3.41 ± 1.82 vs. 2.56 ± 1.96) (p < 0.05) and in the incidence of PONV (31.4% vs. 19.6%) (p = 0.049). CONCLUSIONS: Levobupivacaine infiltration is safe and effective in reducing POP, although this does not lead to a shorter hospital stay and does not influence HRQoL, return to work, or overall patient satisfaction.

OBJETIVO: la colecistectomía laparoscópica (CL), a pesar de su carácter mínimamente invasivo, requiere un control efectivo del dolor postoperatorio (POP). El uso de anestésicos locales (AL) ha sido estudiado pero el nivel de evidencia es bajo y existe poca información acerca de parámetros relevantes como la calidad de vida relacionada con la salud (CVRS) o la reincorporación laboral. El objetivo de este estudio es analizar la eficacia de la infiltración de los sitios incisionales con levobupivacaína 0,50% en la reducción del dolor postoperatorio tras la CL. MATERIAL Y MÉTODOS: estudio prospectivo, aleatorizado y doble ciego. Pacientes sometidos a CL programada fueron aleatorizados en dos grupos: sin infiltración (grupo control) y con infiltración preincisional (grupo intervención). La intensidad del dolor (escala de puntuación numérica, NRS), la necesidad de rescates con opioides, la incidencia de náuseas o vómitos postoperatorios (NVPO) y datos de CVRS o reincorporación laboral, entre otros, fueron recogidos. RESULTADOS: 212 pacientes fueron aleatorizados y analizados: 105 en el grupo control y 107 en el grupo de intervención. Se observó una diferencia estadísticamente significativa en la intensidad del dolor (puntuación media NRS: 3.41 ± 1.82 vs. 2.56 ± 1.96) (p < 0.05) y en la incidencia de NVPO (31.4% vs. 19.6%) (p = 0.049). CONCLUSIONES: La infiltración con levobupivacaína es segura y efectiva en la reducción del dolor postoperatorio, aunque esto no conlleva una menor estancia hospitalaria y no influye en los resultados de CVRS, reincorporación laboral o satisfacción del paciente.

Successful outpatient conservative management of chyle leak after laparoscopic left hemicolectomy / Éxito de tratamiento conservador ambulatorio de paciente con ascitis quilosa tras hemicolectomía izquierda laparoscópica

Chyle leak is a pathological extravasation of chyle into the peritoneal cavity after a surgical injury. It is an uncom-mon complication in colorectal surgery. In most cases, conservative treatment is effective, although it often entails prolonged hospital stays.We present the case of a 60-year-old female with chyle leak after laparoscopic left hemicolectomy with complete mesocolic excision who underwent successful outpatient conservative management. We found no other cases of suc-cessful conservative outpatient treatment in the consulted literature. Adequate outpatient management may provide significant benefits by reducing hospital costs and improv-ing patient’s quality of life, while maintaining the possibility of starting adjuvant treatment if indicated (AU)

La ascitis quilosa es una acumulación patológica de quilo en la cavidad peritoneal tras una lesión quirúrgica. Es una complicación infrecuente de la cirugía colorrectal. En la mayoría de los casos, el tratamiento conservador suele ser eficaz, aunque conlleva estancias hospitalarias prolongadas.Se presenta el caso de una paciente de 60 años que de-sarrolló ascitis quilosa trasuna hemicolectomía izquierda laparoscópica, con escisión completa del mesocolon, que se resolvió con éxito mediante manejo conservador ambu-latorio. No se han encontrado casos exitosos de tratamien-to conservador ambulatorio en la bibliografía consultada. Un manejo ambulatorio como el propuesto puede aportar importantes beneficios en términos de reducción de costes hospitalarios y mejora de la calidad de vida del paciente, manteniendo la posibilidad de iniciar un tratamiento adyu-vante si está indicado (AU)

Successful outpatient conservative management of chyle leak after laparoscopic left hemicolectomy.

Chyle leak is a pathological extravasation of chyle into the peritoneal cavity after a surgical injury. It is an uncommon complication in colorectal surgery. In most cases, conservative treatment is effective, although it often entails prolonged hospital stays. We present the case of a 60-year-old female with chyle leak after laparoscopic left hemicolectomy with complete mesocolic excision who underwent successful outpatient conservative management. We found no other cases of successful conservative outpatient treatment in the consulted literature. Adequate outpatient management may provide significant benefits by reducing hospital costs and improving patient´s quality of life, while maintaining the possibility of starting adjuvant treatment if indicated.

Eosinophilic appendicitis due to Strongyloides stercoralis: a challenging differential diagnosis for clinicians.

A 45-year-old man presents with 48-hour status of high temperature, cough and dyspnoea. In the context of pandemic, the patient is initially diagnosed with COVID-19 syndrome. Later, the laboratory and ultrasound study supported acute appendicitis diagnosis. Appendicectomy was performed. The histopathology study confirmed eosinophilic appendicitis and that a parasitic infection was suspected. The stool sample was positive for Strongyloides stercoralis The diagnosis of a S stercoralis is a rare finding in Spain. S. stercoralis simulates clinical findings of inflammatory bowel disease or eosinophilic gastroenteritis, which may lead to the wrong therapeutic choice. Since in inflammatory diseases corticosteroid treatments are considered the initial choice in many cases, in the case of S. stercoralis infection, the administration of this therapy can be fatal. In Spain, the number of diagnoses is much lower than in the past decade, although it is highly probable that the infection has been underdiagnosed due to low clinical awareness among Spanish population.

Incidence of surgical infection and risk factors in colorectal surgery - A prospective cohort study.

OBJECTIVE: The objective was to measure the incidence of surgical site infection (SSI) and identify risk factors, in patients undergoing elective surgery of the colon and rectum. MATERIALS AND METHODS: A prospective cohort study was performed from January 2017 to December 2018. RESULTS: A total of 130 patients were studied. The cumulative incidence of SSI was 12.3%. The 56.25% were superficial wound infections and the 31.25%, organ-space infection. The risk factors significantly associated with SSI were the non-administration of pre-operative oral nutrition, diabetes mellitus, heart disease, symptomatic state at the diagnosis of colorectal cancer (CRC), and ≥ 2 altered nutritional biochemical parameters at diagnosis. After multivariate , risk factors associated with SSI were: non-administration of preoperative enteral nutrition (odds ratio [OR] = 0.27; 95% confidence interval [CI]: 0.07-1.0), DM (OR = 3.0; 95% CI: 0.9-9.9), the heart disease (OR = 4.6; 95% CI: 1.1-18.6), and laparoscopic surgery (OR = 0.28; 95% CI: 0.08-0.97). The average stay was higher in patients with a diagnosis of SSI (11.9 vs. 9.2 days). CONCLUSIONS: Independent risk factors for SSI in CRC were the non-administration of pre-operative enteral nutrition, the existence of heart disease, and open surgery.

OBJETIVO: Estudiar la incidencia de infección del sitio quirúrgico y evaluar sus factores de riesgo en pacientes intervenidos de cirugía colorrectal electiva. MÉTODO: Se realizó un estudio de cohortes prospectivo desde enero de 2017 hasta diciembre de 2018. RESULTADOS: Se incluyeron 130 pacientes. La incidencia acumulada de infección del sitio quirúrgico fue del 12,3% (n = 16), siendo el 56,25% infecciones de herida y el 31,25% infecciones órgano-espacio. Los factores de riesgo asociados a infección del sitio quirúrgico con significación estadística fueron la no administración de nutrición oral preoperatoria, la diabetes mellitus, la enfermedad cardiaca, la presencia de síntomas en el momento del diagnóstico de cáncer colorrectal y tener al menos dos parámetros bioquímicos nutricionales alterados. Tras el análisis multivariante se asociaron la no administración de nutrición enteral preoperatoria (odds ratio [OR] = 0,27; intervalo de confianza del 95% [IC95%]: 0,07-1,0), la diabetes mellitus (OR = 3,0; IC95%: 0,9-9,9), la enfermedad cardiaca (OR = 4,6; IC95%: 1,1-18,6) y la cirugía laparoscópica (OR = 0,28; IC95%: 0,08-0,97). La estancia media fue mayor en los pacientes con diagnóstico de infección del sitio quirúrgico (11,9 frente a 9,2 días). CONCLUSIONES: Los factores de riesgo independientes para el desarrollo de infección del sitio quirúrgico en los pacientes con cáncer colorrectal fueron la no administración de nutrición oral preoperatoria, la enfermedad cardiaca y la cirugía abierta.

Hemoperitoneum due to splenic injury after colonoscopy-Perhaps not a so uncommon a complication.

We have read with interest in your journal the article "Splenic rupture as an endoscopic complication: as rare as it appears?" and we would like to contribute a case handled in our hospital. We present the case of a 72-year-old male smokerto whom an elective colonoscopy was performed with conscious sedation (midazolam and pethidine). The bowel preparation was appropriate. Diverticula and several pedunculated polyps were observed.

Impacto de la implantación de un programa nutricional preoperatorio en pacientes de cirugía colorrectal / No disponible

INTRODUCCIÓN: el paciente oncológico presenta un estado de hipermetabolismo generalizado que, sumado a los efectos sistémicos del acto quirúrgico, lo convierten en un paciente con riesgo aumentado de padecer complicaciones. OBJETIVO: el objetivo de este estudio fue evaluar el efecto de la implantación de un Programa de Evaluación y Soporte Nutricional en pacientes intervenidos de cirugía colorrectal con diagnóstico de neoplasia. MATERIAL Y MÉTODOS: se realizó un estudio cuasiexperimental con análisis antes y después de la implantación del Programa de Evaluación y Soporte Nutricional. Se incluyeron pacientes intervenidos de neoplasia de colon o recto. Se estudiaron la incidencia de las complicaciones y la estancia media. Se evaluó el efecto de la intervención con la odds ratio (OR) ajustada con un método de regresión logística. RESULTADOS: se incluyó un total de 130 pacientes, 65 en el periodo 2016-2017 (antes del programa) y 65 durante el año 2018 (después del programa). La incidencia de infección de sitio quirúrgico descendió del 18,5 % al 6,2 % (OR = 0,29; IC 95 %: 0,09-0,95) (p = 0,033). También se evidenció una reducción en el registro de fiebre postoperatoria del 50 % (OR = 0,41; IC 95 %: 0,17-0,96) (p = 0,037). Se redujo la estancia hospitalaria de 11,3 días (DE = 8) a 7,18 días (DE = 2,5) (p = 0,02). Hubo un mayor registro de información clínica y analítica referente al estado y riesgo nutricional de los pacientes. CONCLUSIÓN: la implantación de un Programa de Evaluación y Soporte Nutricional en pacientes intervenidos de cirugía colorrectal ha presentado diferencias estadísticamente significativas en la reducción de infección de sitio quirúrgico, reducción de fiebre postoperatoria y de estancia hospitalaria

No disponible

Impact of the implementation of a preoperative nutritional program for colorectal surgery patients.

INTRODUCTION: generalized hypermetabolism is common in cancer patients and increases the risk of complications when combined with the systemic effects of surgery. OBJECTIVE: the aim of this study was to clinically assess the implementation of a Nutritional Assessment and Support Program for patients undergoing colorectal surgery with a diagnosed neoplasia. MATERIAL AND METHODS: a quasi-experimental study was performed with analyses before and after the implementation of the Nutritional Assessment and Support Program. Patients who underwent surgery for colon or rectal neoplasia were included. The incidence of complications and the average hospital stay were studied. The effect of the intervention was evaluated using a logistic regression analysis to yield adjusted odds ratios (OR). RESULTS: a total of 130 patients were included in the study, 65 from 2016-2017 (pre-program) and 65 in 2018 (post-program). The incidence of surgical site infection decreased from 18.5 % to 6.2 % (OR = 0.29; 95 % CI: 0.09-0.95) (p = 0.033). Postoperative fevers were also reduced by 50 % (OR = 0.41; 95 % CI: 0.17-0.96) (p = 0.037). Average hospital stay was reduced from 11.3 days (DE = 8) to 7.18 days (DE = 2.5) (p = 0.02). More clinical and analytical information was logged about the patients' nutritional status and risk. CONCLUSION: the implementation of a Nutritional Assessment and Support Program for patients undergoing colorectal surgery has shown statistically significant differences in the reduction of surgical site infection, postoperative fever and the length of hospital stay.

Eosinophilic colitis: an infrequent disease with difficult diagnose.

Eosinophilic colitis (EC) is a rare entity. It is part of eosinophilic gastroenteritis, a rare inflammatory disorder characterised by eosinophilic infiltration of tissues that can affect any segment of the digestive tract. The diagnosis is established by the presence of an increased eosinophilic infiltrate in the colon wall in symptomatic patients. There is no characteristic clinical picture of EC. It can be associated with abdominal pain, changes in bowel movements, diarrhoea and rectal bleeding. Biopsies are mandatory if EC is suspected and despite visualising a normal mucosa. Although there are no protocol guidelines in this regard, steroid treatment is the first option in controlling the disease. Increasing the knowledge of clinicians and pathologists of this disorder and the recording its real incidence and population impact, could improve the understanding and treatment of the disease.

Altered Preoperative Nutritional Status in Colorectal Cancer: A Not So Infrequent Issue.

INTRODUCTION: Malnutrition and weight loss in cancer patients is a common problem that affects the prognosis of the disease. In the case of CRC, malnutrition rates range between 30 and 60%. OBJECTIVES: Description of the preoperative nutritional status of patients diagnosed with colorectal neoplasia who will undergo surgery. MATERIALS AND METHODS: A prospective observational study is performed. RESULTS: Of 234 patients studied, we observed that 139 (59%) had some degree of nutritional risk. Of all of them, 44.9% (N = 47) had 1-2 points according to MUST and 25% (N = 27) had more than 2 points. No differences were found when studying nutritional risk according to the location of the neoplasm. It was observed that 2.15% of the patients were underweight, 51% overweight, and 23% obese. 19.4% of patients lost less than 5 kg in the 3-6 months prior to diagnosis, 20.7% lost between 5 and 10 kg, and 2.1% lost more than 10 kg. In asymptomatic patients, the weight loss was lower than in symptomatic patients, loss <5 kg, 8.2% vs. 22.8%, and loss 5-10 kg, 16.2% vs. 29.3%, with a value of p = 0.016. 5% (N = 7) of the patients had hypoalbuminemia record. 16.5% (N = 23) had some degree of prealbumin deficiency and 20.9% (N = 29) of hypoproteinemia. Symptomatic patients had more frequent analytical alterations, 1-2 altered parameters in 48.8% (N = 20) of asymptomatic vs. 61.2% (N = 22) in the symptomatic, p = 0.049.