Efficacy of amoxicillin/clavulanic acid after surgical drainage of perianal abscess in the prevention of the development of anal fistula (PERIQxA study): study protocol for a multicenter randomized, double-blind clinical trial.

BACKGROUND: Anorectal fistula, which is a relatively common pathology, is the chronic manifestation of the acute perirectal process that forms an anal abscess. The development of a fistula after incision and drainage of an anal abscess is seen in approximately 26-37%. Its treatment is a relevant topic, and the role of the use of antibiotic therapy in its prevention remains controversial, after the publication of several studies with contradictory results and several methodological limitations. Our hypothesis is that the combination of amoxicillin and clavulanic acid will reduce the incidence of anal fistula. METHOD: The aim of this study is to evaluate the efficacy of antibiotherapy after surgical drainage of perianal abscess in the development of perianal fistula. The PERIQxA study is a multicenter, randomized, double-blind controlled trial. The study has been designed to include 286 adult patients who will be randomly (1:1) assigned to either the experimental (amoxicillin/clavulanic acid 875/125 mg TDS for 7 days) or the control arm (placebo). The primary outcome measure is the percentage of patients that develop perianal fistula after surgery and during follow-up (6 months). DISCUSSION: This clinical trial is designed to evaluate the efficacy and safety of amoxicillin/clavulanic in the prevention of perianal fistula. The results of this study are expected to contribute to stablish the potential role of antibiotherapy in the therapeutics for anal abscess. TRIAL REGISTRATION: EudraCT Number: 2021-003376-14. Registered on November 26, 2021.

Non-antibiotic treatment of uncomplicated acute diverticulitis is applicable and safe in our environment. A prospective multicenter study

Introduction: acute diverticulitis is one of the most frequent underlying causes behind individuals attending the Emergency Room with abdominal pain. The most widespread therapy for acute uncomplicated diverticulitis includes outpatient treatment with antibiotics; however, several publications indicate that patients can also be successfully treated without antibiotics. The results of the implementation of this more recent protocol in two hospitals in Madrid are presented. Methods: an observational prospective study was performed. Participants were patients diagnosed with uncomplicated acute diverticulitis at two hospitals in Madrid, Hospital Universitario de Torrejón and Hospital Universitario Puerta de Hierro Majadahonda, between December 2018 and August 2021, treated on an outpatient basis without antibiotic therapy. The study group was compared with a control group, composed of patients diagnosed with uncomplicated acute diverticulitis and treated with outpatient antibiotic therapy at Hospital Universitario Puerta de Hierro between March 2015 and March 2018. Results: three hundred and sixty-one patients were included, 182 in the study group and 179 in the control group. Diverticulitis was persistent in 19 patients (10.4 %) in the study group, who were not treated with antibiotics, and in five patients (2.8 %) in the control group, treated with outpatient antibiotic therapy (p = 0.004). Recurrences occurred in 23 patients (12.6 %) in the study group, and in 53 patients (29.6 %) in the control group (p < 0.0001). The analysis of the complications found no significant differences between both groups (p = 0.109). No urgent surgical intervention or mortality was recorded in the study group. Conclusions: in our environment, symptomatic non-antibiotic treatment of uncomplicated acute diverticulitis cases is safe, without showing a higher rate of complications. Although, there seems to be a worse initial symptom control. (AU)

Non-antibiotic treatment of uncomplicated acute diverticulitis is applicable and safe in our environment. A prospective multicenter study.

INTRODUCTION: Acute diverticulitis is one of the most frequent underlying causes behind individuals attending the Emergency Department with abdominal pain. The most widespread therapy for acute uncomplicated diverticulitis includes outpatient treatment with antibiotics; however, several publications indicate that patients can also be successfully treated without antibiotics. The results of the implementation of this more recent protocol in two hospitals in Madrid are presented. METHODS: An observational prospective study was performed. Participants were patients diagnosed with AUD at two hospitals in Madrid, the University Hospital of Torrejón and the Puerta de Hierro Majadahonda University Hospital, between December 2018 and August 2021, treated on an outpatient basis without antibiotic therapy. The study group was compared with a control group, composed of patients diagnosed with acute uncomplicated diverticulitis and treated with outpatient antibiotic therapy at the Puerta de Hierro University Hospital between March 2015 and March 2018. RESULTS: 361 patients were included, 182 in the study group and 179 in the control group. Diverticulitis was persistent in 19 patients (10.4%) in the study group, who were not treated with antibiotics, and in 5 patients (2.8%) in the control group, treated with outpatient antibiotic therapy (p=0.004). Recurrences occurred in 23 patients (12.6%) in the study group, and in 53 patients (29.6%) in the control group (p<0.0001). The analysis of the complications found no significant differences between both groups, p=0.109. No urgent surgical intervention or mortality was recorded in the study group. CONCLUSIONS: In our environment, symptomatic non-antibiotic treatment of AUD cases is safe, without showing a higher rate of complications. Although, there seems to be a worse initial symptom control.

Incidence and risk factors of delayed development for stoma site incisional hernia after ileostomy closure in patients undergoing colorectal surgery with temporary ileostomy.

BACKGROUND: Stoma site incisional hernias after ileostomy closure are complex hernias that can be associated with abdominal pain, discomfort, and a diminished quality of life. The aim of this study was to determine the incidence of incisional hernia (IH) following temporary ileostomy reversal in patients undergoing colorectal surgery, and the risk factors associated with its development. METHODS: This was a prospective, single-centre, cohort study of patients undergoing ileostomy reversal between January 2010 and December 2016. Comorbidities, operative characteristics, comparison between early and late ileostomy closure and postoperative complications were analysed. RESULTS: A total of 202 consecutive patients were prospectively evaluated (median follow-up 46 months; range: 12-109). Stoma site incisional hernia occurred in 23% of patients (n = 47), diagnosed by physical examination or imaging tests. The reasons for the primary surgery were colorectal cancer (n = 141, 69.8%), inflammatory bowel disease (n = 14, 6.9%), emergency surgery (n = 35, 17.3%), and other conditions (n = 12, 5.9%). Secondary outcomes: a statistically significant risk factors for developing an IH was obesity (higher BMI) (OR 1.15, 95% CI: 1.05-1.26) p = .003). CONCLUSIONS: 23% of patients developed surgical site IH, a higher BMI being the only risk factor found to be statistically significant in the development of an incisional hernia.

Diverticulitis en pacientes inmunodeprimidos: resultados de nuestra unidad en el manejo de pacientes de alto riesgo / No disponible

INTRODUCCIÓN: la diverticulitis aguda es una enfermedad con una gran prevalencia y la necesidad de un manejo más agresivo en pacientes inmunodeprimidos no ha quedado claramente consensuada. OBJETIVOS: valorar la posibilidad de que el manejo conservador en este grupo sea tan válido como en la población inmunocompetente. MÉTODOS: presentamos un estudio analítico retrospectivo llevado a cabo en nuestro hospital. Se analizaron 40 pacientes inmunodeprimidos (trasplantados, tratamiento corticoideo, tratamiento renal sustitutivo, oncológicos, VIH positivos en situación de inmunodepresión) diagnosticados de diverticulitis aguda. Los pacientes siguieron manejo no quirúrgico o tratamiento quirúrgico urgente según su situación clínica al ingreso. Las principales medidas estudiadas han sido la gravedad del cuadro agudo y la necesidad de tratamiento quirúrgico según la causa de inmunodepresión. RESULTADOS: de 40 pacientes estudiados, 32 fueron manejados de forma conservadora en el momento agudo, con necesidad de intervención quirúrgica urgente en ocho casos (siete intervenciones de Hartmann y una resección con anastomosis), siendo el grupo de los trasplantados y los pertenecientes al rango de edad 40-50 años los de mayor riesgo. Tres pacientes requirieron intervención de forma programada por complicaciones posteriores. Veinticuatro pacientes evolucionaron sin complicaciones. CONCLUSIONES: la proporción de diverticulitis aguda complicada es superior que en la población general. El tratamiento no quirúrgico parece tan seguro como en la población inmunocompetente. Los pacientes más jóvenes y los trasplantados constituyen los principales grupos de riesgo para sufrir un cuadro grave que precise un manejo más agresivo de manera inicial

No disponible

Diverticulitis in immunodeficient patients: our experience in the management of high-risk patients.

INTRODUCTION: acute diverticulitis is a very prevalent disease. The need for a more aggressive management in immunodeficient patients has not been established. We present the results of our unit with immunodeficient patients diagnosed with acute diverticulitis and their follow-up. OBJECTIVES: to assess the possibility that a conservative management in this group is as valid as in the immunocompetent population. METHODS: a retrospective analysis study was performed in our hospital. Forty immunodeficient patients (transplant, corticoid treatment, dialysis, oncologic, HIV patients) diagnosed with acute diverticulitis were analyzed. The patients were managed with a surgical or non-surgical treatment according to their status on admission. The main analyzed items were the severity of the acute episode and the need for surgical treatment compared to the cause of immunodeficiency. Other studied variables included follow-up results and recurrences. RESULTS: thirty-two of the 40 patients studied received a non-surgical treatment during the acute episode, eight required emergency surgery (seven had a Hartmann procedure and one underwent a colon resection and anastomosis). Transplant patients and those between 40 and 50 years old proved to be higher risk groups. Three patients subsequently required elective surgery due to complications. Twenty-four patients had uneventful recoveries. CONCLUSIONS: the frequency of complicated acute diverticulitis is higher in immunodeficient patients than that of the general population. Non-surgical treatment seems to be as safe as in immunocompetent patients. Younger and transplanted patients were higher risk groups for severe acute diverticulitis that required a more aggressive management initially.

Localización preoperatoria mediante arpón de recidiva local de adenocarcinoma de recto tras amputación abdominoperineal / Preoperative localization through a harpoon of local recurrence of rectal adenocarcinoma after abdominoperineal amputation

No disponible