Efficacy of Sacral Nerve Stimulation in Non-constipated Irritable Bowel Syndrome Patients: A Systematic Review.

BACKGROUND AND AIMS: Irritable bowel syndrome (IBS) is a prevalent disorder with a complex and heterogeneous physiopathology, including a dysregulation of gut-brain axis. Treatment for IBS is targeted to the predominant symptom and requires a multidisciplinary approach. This review aims to evaluate the efficacy and safety of sacral nerve stimulation in non-constipated IBS patients Methods: A literature search was carried out on MEDLINE, The Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science databases for all relevant articles. Quality of included papers was assessed using standardized guidelines Results: Of 129 initial citations, 7 articles met our predefined inclusion criteria, including five randomized trials, a pilot study and a descriptive follow-up study. Five of 7 studies reported a positive effect of sacral nerve stimulation on symptoms and quality of life improvement in non-constipated IBS patients. No study reported serious adverse events. CONCLUSIONS: Despite initial promising results of sacral nerve stimulation in non-constipated IBS patients, studies with larger sample sizes and longer follow-up are required.

Impacto de la pandemia sobre la actividad quirúrgica en cáncer colorrectal en España. Resultados de una encuesta nacional / Impact of the pandemic on surgical activity in colorectal cancer in Spain. Results of a national survey

Introducción: La pandemia ocasionada ha supuesto un impacto sobre la actividad quirúrgica en nuestros hospitales, afectando entre otros al cáncer colorrectal. Para el año 2020 se ha estimado que hasta un 75% de pacientes diagnosticados de cáncer colorrectal precisaría cirugía. No se disponen de datos objetivos del impacto que la pandemia ha tenido sobre la gestión de las listas de espera quirúrgicas. Hemos realizado una encuesta a todas las unidades de cirugía colorrectal con el objetivo de conocer el impacto sobre las listas de espera quirúrgicas por cáncer colorrectal. Método: Los responsables de las unidades de cirugía colorrectal a nivel nacional recibieron una encuesta (febrero-abril, 2020) con 8 preguntas divididas en 3 apartados: cese y fecha de parada de las cirugías por cáncer colorrectal, número de pacientes pendientes de tratamiento y uso de neoadyuvancia como recurso de demora. Resultados: Sesenta y siete unidades participaron (todas las comunidades representadas). El 79,1% realizaron algún tipo de cese de actividad (total 32,8%, parcial 46,3%) y no cese el 20,9%. El 65% ha usado o prolongado la neoadyuvancia en pacientes con cáncer rectal. El 40% ha intervenido, al menos, a 5 pacientes de urgencia por cáncer colorrectal. Se ha estimado que al menos se precisará de un mes de cirugía intensa para ponerse al día. Conclusiones: En el momento actual es preciso redistribuir pacientes de unidades con alta lista de espera. Para el futuro, en caso de repandemia, habría que planificar los recursos de las unidades para obtener un programa efectivo antes del periodo de colapso completo. (AU)

Introduction: The pandemic has had an impact on colorectal cancer surgery in hospitals. In 2020, up to 75% of colorectal cancer patients are estimated to require surgery. No objective data on the impact of the pandemic on the management of surgical waiting lists is available. We conducted a survey in colorectal surgery units to assess the impact on colorectal cancer surgery waiting lists. Method: All personnel in charge of colorectal surgery units nationwide received a survey (from February to April, 2020) with eight questions divided into three sections—cessation date of colorectal cancer surgeries, number of patients waiting for treatment, and use of neoadjuvant therapy to postpone surgery. Results: Sixty-seven units participated in the study, with 79.1% of units ceasing some type of activity (32.8% total and 46.3% partial cessation) and 20.9% continuing all surgical activity. In addition, 65% of units used or prolonged neoadjuvant therapy in rectal cancer patients and 40% of units performed at least five emergency colorectal cancer surgeries. It was estimated that at least one month of intense surgical activity will be required to catch up. Conclusions: Currently, patients from units with a long waiting list must be redistributed, at least within the country. In the future, in the event of a second wave of the pandemic, an effective program to manage each unit's resources should be developed to prevent total collapse. (AU)

Impact of the pandemic on surgical activity in colorectal cancer in Spain. Results of a national survey.

INTRODUCTION: The pandemic has had an impact on colorectal cancer surgery in hospitals. In 2020, up to 75% of colorectal cancer patients are estimated to require surgery. No objective data on the impact of the pandemic on the management of surgical waiting lists is available. We conducted a survey in colorectal surgery units to assess the impact on colorectal cancer surgery waiting lists. METHOD: All personnel in charge of colorectal surgery units nationwide received a survey (from February to April, 2020) with eight questions divided into three sections-cessation date of colorectal cancer surgeries, number of patients waiting for treatment, and use of neoadjuvant therapy to postpone surgery. RESULTS: Sixty-seven units participated in the study, with 79.1% of units ceasing some type of activity (32.8% total and 46.3% partial cessation) and 20.9% continuing all surgical activity. In addition, 65% of units used or prolonged neoadjuvant therapy in rectal cancer patients and 40% of units performed at least five emergency colorectal cancer surgeries. It was estimated that at least one month of intense surgical activity will be required to catch up. CONCLUSIONS: Currently, patients from units with a long waiting list must be redistributed, at least within the country. In the future, in the event of a second wave of the pandemic, an effective program to manage each unit's resources should be developed to prevent total collapse.

Feasibility and safety of calcium alginate hydrogel sealant for the treatment of cryptoglandular fistula-in-ano: phase I/IIa clinical trial.

AIM: Complex perianal fistulas pose a challenge to the surgeon since the fistulous tract must be eliminated without impairing continence. Although without strong scientific evidence, some bibliography has demonstrated the efficacy of some sealants in the treatment of anal fistulas. We aimed to assess the feasibility and safety of calcium alginate hydrogel injections into the fistulous tract as treatment for trans-sphincteric cryptoglandular fistulas. METHODS: A prospective, single-centre, case series of this novel technique was conducted in a level 3 Spanish hospital, including patients diagnosed with trans-sphincteric perianal fistulas and treated with a calcium alginate hydrogel sealant. A strict follow-up was performed by an independent surgeon at 1, 3, 6 and 12 months. The main outcome measures were feasibility, safety (number of adverse events) and efficacy of the treatment. RESULTS: Twenty patients were treated. The treatment was performed for all patients. Seven adverse events related to the injection product or the surgical procedure were identified. After a 12-month follow-up, 12 patients were completely cured and eight were not cured, with a greater response in the first 6 months. These findings were confirmed by endoanal ultrasound, with a Cohen's kappa concordance rate of 0.89. No statistically significant differences were observed in pain measured using the visual analogue scale, faecal incontinence measured using the Wexner scoring system, and quality of life analysed by the SF-36 Health Survey. CONCLUSION: The treatment was feasible, safe and with discrete satisfactory healing results. It also demonstrated an acceptable safety profile, without worsening of faecal incontinence, quality of life and pain following treatment.

[Impact of the pandemic on surgical activity in colorectal cancer in Spain. Results of a national survey]. / Impacto de la pandemia sobre la actividad quirúrgica en cáncer colorrectal en España. Resultados de una encuesta nacional.

INTRODUCTION: The pandemic has had an impact on colorectal cancer surgery in hospitals. In 2020, up to 75% of colorectal cancer patients are estimated to require surgery. No objective data on the impact of the pandemic on the management of surgical waiting lists is available. We conducted a survey in colorectal surgery units to assess the impact on colorectal cancer surgery waiting lists. METHOD: All personnel in charge of colorectal surgery units nationwide received a survey (from February to April, 2020) with eight questions divided into three sections-cessation date of colorectal cancer surgeries, number of patients waiting for treatment, and use of neoadjuvant therapy to postpone surgery. RESULTS: Sixty-seven units participated in the study, with 79.1% of units ceasing some type of activity (32.8% total and 46.3% partial cessation) and 20.9% continuing all surgical activity. In addition, 65% of units used or prolonged neoadjuvant therapy in rectal cancer patients and 40% of units performed at least five emergency colorectal cancer surgeries. It was estimated that at least one month of intense surgical activity will be required to catch up. CONCLUSIONS: Currently, patients from units with a long waiting list must be redistributed, at least within the country. In the future, in the event of a second wave of the pandemic, an effective program to manage each unit's resources should be developed to prevent total collapse.

Incontinencia fecal en el paciente anciano. Revisión de conjunto / Fecal incontinence in older patients. A narrative review

La incontinencia fecal representa una de las principales causas de institucionalización en las últimas décadas de la vida de una persona, asociando además gran repercusión psicosocial y económica. La literatura muestra escasa evidencia cuando se trata de analizar de forma específica a este grupo de población, debido a la falta de uniformidad en la consideración de «paciente anciano» y en la dificultad de su detección y diagnóstico. El objetivo de este artículo ha sido realizar una revisión narrativa de los principales aspectos relacionados con la incontinencia fecal en el anciano y facilitar el manejo de estos pacientes. La asistencia para la defecación, las modificaciones dietéticas y el control de la consistencia de las deposiciones o el tratamiento farmacológico son en muchos casos medidas suficientes. No obstante, otras terapias como el biofeedback, la neuromodulación o el tratamiento quirúrgico no deben descartarse y han de ser valoradas de forma selectiva en pacientes ancianos

Fecal incontinence is one of the leading causes for the institutionalization of people in the last decades of life, associated with a great psychosocial and economic burden. The literature is scarce in this population group, due to the absence of universally accepted criteria to define "elderly patients" and difficulties in detection and diagnostic. The aim of this article was to conduct a narrative review of the main aspects related to fecal incontinence in older patients, providing management support. Toileting assistance, dietary change, controlling stool consistency and medical treatment can be used to treat these patients. Nevertheless, other therapies, such as biofeedback, neuromodulation or surgical treatment, can be considered in selected patients

Fecal incontinence in older patients. A narrative review. / Incontinencia fecal en el paciente anciano. Revisión de conjunto.

Fecal incontinence is one of the leading causes for the institutionalization of people in the last decades of life, associated with a great psychosocial and economic burden. The literature is scarce in this population group, due to the absence of universally accepted criteria to define "elderly patients" and difficulties in detection and diagnostic. The aim of this article was to conduct a narrative review of the main aspects related to fecal incontinence in older patients, providing management support. Toileting assistance, dietary change, controlling stool consistency and medical treatment can be used to treat these patients. Nevertheless, other therapies, such as biofeedback, neuromodulation or surgical treatment, can be considered in selected patients.

Factibility and security study of the PICS-AF™ plug for the treatment of cryptoglandular anal fistula. / Estudio de factibilidad y seguridad del plug de colágeno (PICS-AF™) en el tratamiento de la fístula anal criptoglandular.

INTRODUCTION: The PICS-AF™ (Curaseal Inc.) device is a new plug made of collagen that has a retention system in the internal orifice. This pilot study was designed to assess both the feasibility and safety of this plug in the treatment of trans-sphincteric anal fístulas. METHODS: A total of 44 patients (34 men), with a mean age of 54.68±7.3, with trans-sphincteric anal fístulas were included in the study; 34 of them were analyzed. All patients were examined according to a strict preoperative protocol and until 6 months after surgery. The feasibility of the procedure and the adverse events were analyzed. RESULTS: Finally, 34 patients were operated on, and in 30 of them the plug was used. Therefore, the feasibility was calculated at 88%. There was a total of 16 adverse events, 4recorded as not related (3 mild and one moderate) and 12 related to the procedure or to the device implanted. Of these, 5were mild, 5moderate and 2severe. The majority of the events reported were related to proctalgia (4 patients) or infection at the implant site (4 patients). CONCLUSIONS: The present study indicates that the new collagen plug can be placed effectively and with an acceptable complication rate.

Estudio de factibilidad y seguridad del plug de colágeno (PICS-AF(TM)) en el tratamiento de la fístula anal criptoglandular / Factibility and security study of the PICS-AF(TM) plug for the treatment of cryptoglandular anal fistula

INTRODUCCIÓN: El dispositivo PICS-AF(TM) es un nuevo tapón hecho de colágeno que tiene un sistema de retención en el orificio fistuloso interno. Este estudio piloto ha sido diseñado para evaluar la factibilidad y seguridad de este dispositivo en el tratamiento de las fístulas anales criptoglandulares transesfinterianas. MÉTODOS: Un total de 44 pacientes (34 hombres) con diagnóstico de fístula transesfinteriana fueron incluidos en el estudio, de los cuales 34 fueron seleccionados. Todos los pacientes fueron examinados según un protocolo estricto antes de la cirugía y hasta 6 meses después. Se analizaron la factibilidad del procedimiento y los acontecimientos adversos. RESULTADOS: El dispositivo se colocó sin incidencias en 30 de los 34 pacientes (factibilidad del 88%). Se evidenciaron un total de 16 acontecimientos adversos, 4registrados como no relacionados con el procedimiento (3 leves y uno moderado) y 12 relacionados con el procedimiento o el dispositivo implantado. De ellos, 5fueron leves, 5moderados y 2graves. La mayoría de los efectos adversos reportados fueron proctalgia (4 pacientes) o infección en el sitio del implante (4 pacientes). CONCLUSIONES: El presente estudio indica que el nuevo tapón de colágeno puede ser colocado de forma efectiva y con una tasa de complicaciones aceptable

INTRODUCTION: The PICS-AF(TM) (Curaseal Inc.) device is a new plug made of collagen that has a retention system in the internal orifice. This pilot study was designed to assess both the feasibility and safety of this plug in the treatment of trans-sphincteric anal fístulas. METHODS: A total of 44 patients (34 men), with a mean age of 54.68±7.3, with trans-sphincteric anal fístulas were included in the study; 34 of them were analyzed. All patients were examined according to a strict preoperative protocol and until 6 months after surgery. The feasibility of the procedure and the adverse events were analyzed. RESULTS: Finally, 34 patients were operated on, and in 30 of them the plug was used. Therefore, the feasibility was calculated at 88%. There was a total of 16 adverse events, 4recorded as not related (3 mild and one moderate) and 12 related to the procedure or to the device implanted. Of these, 5were mild, 5moderate and 2severe. The majority of the events reported were related to proctalgia (4 patients) or infection at the implant site (4 patients). CONCLUSIONS: The present study indicates that the new collagen plug can be placed effectively and with an acceptable complication rate

Evolución del abordaje quirúrgico de la colecistitis aguda en una unidad de cirugía de urgencias / Development of the surgical approach to acute cholecystitis in an emergency surgical unit

Objetivo La aplicación de la técnica laparoscópica en la colecistitis aguda es aún hoy un tema controvertido. El objetivo del estudio es valorar la aplicabilidad, seguridad, beneficios y complicaciones del abordaje laparoscópico en pacientes con colecistitis aguda, así como la evolución y desarrollo de dicha vía en la unidad de cirugía de urgencias de un hospital de tercer nivel, en comparación con la laparotómica. Material y método El estudio consta de 354 pacientes con cuadros de colecistitis aguda intervenidos por vía abierta o laparoscópica desde 2006 a 2009.ResultadosSe han intervenido 253 pacientes por vía laparoscópica, 101 por vía abierta, apreciándose un predominio del sexo masculino (57,67%) y una edad media de 62,83 años. El número de colecistectomía laparoscópica ha pasado del 60% en el 2006, al 79% en 2009. La estancia media (englobando complicadas y no complicadas) hablan a favor del abordaje laparoscópico frente al abierto (mostrando una diferencia de aproximadamente 6 al día). Las complicaciones postoperatorias a lo largo de estos cuatro años en la vía laparoscópica han experimentado un descenso, pasando de un 21,42 a un 11,3%. Las complicaciones locales y globales se correlacionaron significativamente con el tiempo transcurrido entre el inicio de los síntomas agudos y la cirugía, así como con el estado anatomopatológico de la vesícula biliar. Conclusiones El abordaje laparoscópico va adquiriendo un papel cada vez más primordial en el tratamiento de esta dolencia, convirtiéndose en nuestro hospital en la principal opción quirúrgica (AU)

Objective The application of the laparoscopic technique in acute cholecystitis is still subject to controversy. The aim of this study is to asses the applicability, safety, benefits and complications of the laparoscopic approach in patients with acute cholecystitis, as well as the development of this technique in the emergency surgery department of a tertiary hospital, compared to laparotomy. Material and method The study consisted of 354 patients with acute cholecystitis syndromes operated either by open or laparoscopic surgery, during the years 2006 to 2009.ResultsThe laparoscopic method was used in 253 patients, and 101 by the open route, with the slight majority being male (57.67%) and with a mean age of 62.83 years. The number of laparoscopic cholecystectomies increased from 60% in 2006, to 79% in 2009. The mean hospital stay (including those with and without complications) was shorter using the laparoscopic approach, compared to open surgery (showing a difference of approximately 6 days). The postoperative complications in laparoscopy during the four years studied decreased from 21.42 to 11.3%. The local and general complications were significantly associated with time since the start of the acute symptoms and the surgery, as well as the histopathological state of the gall bladder. Conclusions The laparoscopic approach continues to play an increasing role in the treatment of this disease, becoming the main surgical option in our hospital (AU)

[Development of the surgical approach to acute cholecystitis in an emergency surgical unit]. / Evolución del abordaje quirúrgico de la colecistitis aguda en una unidad de cirugía de urgencias.

OBJECTIVE: The application of the laparoscopic technique in acute cholecystitis is still subject to controversy. The aim of this study is to asses the applicability, safety, benefits and complications of the laparoscopic approach in patients with acute cholecystitis, as well as the development of this technique in the emergency surgery department of a tertiary hospital, compared to laparotomy. MATERIAL AND METHOD: The study consisted of 354 patients with acute cholecystitis syndromes operated either by open or laparoscopic surgery, during the years 2006 to 2009. RESULTS: The laparoscopic method was used in 253 patients, and 101 by the open route, with the slight majority being male (57.67%) and with a mean age of 62.83 years. The number of laparoscopic cholecystectomies increased from 60% in 2006, to 79% in 2009. The mean hospital stay (including those with and without complications) was shorter using the laparoscopic approach, compared to open surgery (showing a difference of approximately 6 days). The postoperative complications in laparoscopy during the four years studied decreased from 21.42 to 11.3%. The local and general complications were significantly associated with time since the start of the acute symptoms and the surgery, as well as the histopathological state of the gall bladder. CONCLUSIONS: The laparoscopic approach continues to play an increasing role in the treatment of this disease, becoming the main surgical option in our hospital.