Surgical Wound Complications after Colorectal Surgery with Single-Use Negative-Pressure Wound Therapy Versus Surgical Dressing over Closed Incisions: A Randomized Controlled Trial.

BACKGROUND: Global studies indicate that surgical site infections (SSIs) are a major healthcare challenge within hospitals and can have a profound impact on patient quality of life and healthcare costs. Closed-incision negative-pressure therapy (ciNPT) has been reported to provide positive clinical benefits for patients with various incisions, including those following colorectal surgeries. METHODS: Investigators performed a prospective, randomized, multicenter trial to evaluate complications of surgical incisions in patients who received a ciNPT dressing versus a conventional surgical dressing (control) over their closed incision following colorectal surgery. The incidence of SSI was determined at 7, 15, and 30 days postsurgery. RESULTS: A total of 148 patients participated in the study. Results showed that the SSI rate on day 7 was lower in the ciNPT group versus the control group (10/75 [13.3%] vs 17/73 [23.3%]), but this difference was not statistically significant. On day 15, the SSI rate was 12/75 (16.0%) in the ciNPT group versus 21/73 (28.8%) in the control group; however, this difference was only marginally statistically significant (P = .0621). At 1 month, the SSI rate remained lower in the ciNPT group (13/75 [17.3%] vs 21/73 [28.8%], P = .0983) compared with the control group. CONCLUSIONS: Future studies with larger population sizes are necessary to determine the impact of ciNPT on patients' incisions after colorectal surgery.

Colorectal surgery and surgical site infection: is a change of attitude necessary?

INTRODUCTION: Surgical site infection (SSI) can be as high as 30% in patients undergoing colorectal surgery and is associated with an increase in morbidity and mortality. The aim of this study is to evaluate the impact of a set of simple preventive measures that have resulted in a reduction in surgical site infection in colorectal surgery. APPLIED METHOD: Prospective study with two groups of patients treated in the colorectal unit of the "Clinico Universitario Lozano Blesa" hospital in Zaragoza. One group was subject to our measures from February to May 2015. The control group was given conventional treatment within a time period of 3 months before the set of measures were implemented. RESULTS: One hundred forty-nine patients underwent a major colorectal surgical procedure. Seventy (47%) belonged to the control group and were compared to the remaining 79 patients (53% of the total), who were subject to our treatment bundle in the period tested. Comparing the two groups revealed that our set of measures led to a general reduction in SSI (31.4 vs. 13.6%, p = 0.010) and in superficial site infection (17.1 vs. 2.5%, p = 0.002). As a consequence, the postoperative hospital stay was shortened (10.0 vs. 8.0 days, p = 0.048). However, it did not, the number of readmissions nor the re-operation rate. SSI was clearly related to open surgery. CONCLUSIONS: The preventive set of measures applied in colorectal surgery led to a significant reduction of the SSI and of the length of hospital stay.

[Cancellation in CMA: incidence and causes]. / Cancelación en CMA: incidencia y causas.

INTRODUCTION: Major Ambulatory Surgery (MAS) units are becoming increasingly important and require correct management. One of the principal improvement parameters in hospital management policy is the rate of cancellations of elective surgery. MATERIAL AND METHOD: We designed a retrospective, observational study by selecting all the patients operated on in our MAS unit from 1995 to 2009: 16.934 patients. We analysed the surgical procedures cancelled the day before the operation. RESULTS: A total of 701 patients (4.1%) had a scheduled surgical intervention cancelled. This cancellation occurred the day before the operation in 343 patients (2%) and on the same day of the operation in 358 patients (2.1%). Reasons for the cancellation: acute intercurrent disease in 180 patients (25.7%), personal decision of the patient in 126 (18%), non-appearance of the patient in 28 (4%), incorrect preparation of the patient in 190 (27.1%), lack of resources in 177 (25.2%). Distributing the reasons for cancellation according to the possibility of preventing them; 369 cancellations (52.6%) could be avoidable, 43 (6.2%) potentially avoidable, 177 (25.2%) difficult to avoid, and 112 (16%) unavoidable. CONCLUSIONS: More than half of the cancellations could have been avoided. We recommend improvements in the replacement of already scheduled patients. Information campaigns would be needed to increase the awareness of the population on the real cost of health services. Improvement measures would also be needed to improve the selection-evaluation of patients with pre-operative protocols/assessment units.

Colostomy stenosis due to chronic radiation enteritis. Report of clinical case.

ANTECEDENTES: La colitis actínica es una endarteritis obliterante ocasionada por exposición a radiación ionizante. Se manifiesta de manera aguda (primeras semanas) o crónica (hasta 30 años después). CASO CLÍNICO: Paciente tratado por neoplasia rectal mediante quimiorradioterapia y amputación abdominoperineal. En su estudio por cuadros oclusivos se objetiva una estenosis colónica desde la colostomía hasta el ángulo hepático. Se lleva a cabo cirugía resectiva, con resultado favorable. CONCLUSIONES: En los próximos años es previsible un aumento en la incidencia de esta patología. Resultará fundamental establecer un nivel de sospecha que nos permita detectar los casos, así como establecer medidas que prevengan su aparición. BACKGROUND: Radiation colitis is a obliterans endarteritis caused by exposure to ionizing radiation. It manifests early or late in time. CASE REPORT: We present a case of rectal cancer treated with chemoradiotherapy and abdominoperineal resection ten years before. Patient suffered occlusive periods and colonoscopy showed stenotic colon extending from the colostomy up hepatic flexure. Colonic resection surgery was performed. CONCLUSIONS: It will be essential to establish a high level of suspicion that allows us to detect cases and it also will be essential to establish measures to prevent its occurrence.

Surgical treatment for colorectal cancer: analysis of the influence of an enhanced recovery programme on long-term oncological outcomes-a study protocol for a prospective, multicentre, observational cohort study.

INTRODUCTION: The evidence currently available from enhanced recovery after surgery (ERAS) programmes concerns their benefits in the immediate postoperative period, but there is still very little evidence as to whether their correct implementation benefits patients in the long term. The working hypothesis here is that, due to the lower response to surgical aggression and lower rates of postoperative complications, ERAS protocols can reduce colorectal cancer-related mortality. The main objective of this study is to analyse the impact of an ERAS programme for colorectal cancer on 5-year survival. As secondary objectives, we propose to analyse the weight of each of the predefined items in the oncological results as well as the quality of life. METHODS AND ANALYSIS: A multicentre prospective cohort study was conducted in patients older than 18 years of age who are scheduled to undergo surgery for colorectal cancer. The study involved 12 hospitals with an implemented enhanced recovery protocol according to the guidelines published by the Spanish National Health Service. The intervention group includes patients with a minimum implementation level of 70%, and the control group includes those who fail to reach this level. Compliance will be studied using 18 key performance indicators, and the results will be analysed using cancer survival indicators, including overall survival, cancer-specific survival and relapse-free survival. The time to recurrence, perioperative morbidity and mortality, hospital stay and quality of life will also be studied, the latter using the validated EuroQol Five questionnaire. The propensity index method will be used to create comparable treatment and control groups, and a multivariate regression will be used to study each variable. The Kaplan-Meier estimator will be used to estimate survival and the log-rank test to make comparisons. A p value of less than 0.05 (two-tailed) will be considered to be significant. ETHICS AND DISSEMINATION: Ethical approval for this study was obtained from the Aragon Ethical Committee (C.P.-C.I. PI20/086) on 4 March 2020. The findings of this study will be submitted to peer-reviewed journals (BMJ Open, JAMA Surgery, Annals of Surgery, British Journal of Surgery). Abstracts will be submitted to relevant national and international meetings. TRIAL REGISTRATION NUMBER: NCT04305314.

[Devastating surgical complications after aflibercept chemotherapy]. / Devastadora complicación tras tratamiento con aflibercept.

BACKGROUND: The use of a new chemotherapy as adjuvant treatment of colorectal cancer is not free of complications. Monoclonal antibodies are associated with bleeding and intestinal perforations. OBJECTIVE: To report the case of a patient who developed a serious complication after treatment with an antiangiogenic drug for colorectal neoplasm. CLINICAL CASE: The case is presented of a 42-year-old male operated on due to subocclusive rectal cancer with metástasis at the time of diagnosis. Sixteen months after surgery during second-line adjuvant therapy, an intestinal perforation was observed with haemorrhage and intestinal leak to retroperitoneum and left lower extremity. Despite intensive medical and surgical treatment this complication had fatal consequences. CONCLUSIONS: Future research should be directed at obtaining biomarkers for the specific use of antiangiogenic agents in order to decrease the rate of adverse factors.

[Retropneumoperitoneum due to endoscopic dilation. Is conservative management possible?]. / Retroneumoperitoneo secundario a dilatación endoscópica de anastomosis colorrectal: ¿permite un manejo conservador?

BACKGROUND: The incidence of anastomotic stricture varies due to the different definitions given to the condition. In most cases they are asymptomatic, and if there are symptoms, they are usually those of a partial intestinal obstruction. CASE REPORT: The case is presented of an 80 year old patient who underwent a lower anterior resection for rectal neoplasm. After ileostomy closure, he presented with subocclusive symptoms caused by stenosis of colorectal anastomosis. This stenosis was managed with endoscopic dilations, and one of these dilations produced an anastomotic perforation with pneumoperitoneum, retropneumoperitoneum, and pneumothorax. Once the patient was clinically and haemodynamically stable, the perforation was treated with conservative measures, resolving the complication satisfactorily. CONCLUSIONS: The literature describes several management options for colorectal anastomoses strictures, such as surgical resection, rubber dilators, endoscopic dilation, all of which might produce colonic perforation. Its management ranges from conservative measures to surgical intervention.

¿Podemos prevenir la dehiscencia anastomótica en cirugía oncológica colorrectal mediante el empleo de la angiografía de fluorescencia con verde de indocianina? / Could we pevent anastomotic leak in colorectal oncological surgery by using indocyanine green fluorescence angiography?

Resumen Objetivo La dehiscencia anastomótica (DA) en cirugía colorrectal es una de las complicaciones más devastadoras. El empleo de la angiografía de fluorescencia con verde de indocianina, se ha introducido en este campo como una herramienta prometedora para reducir la incidencia de DA. El objetivo de este estudio es valorar en nuestro medio, los resultados de la introducción de esta técnica en cuanto a prevención de DA. Materiales y Método: Se llevó a cabo un estudio prospectivo, incluyendo 59 pacientes sometidos a cirugía colorrectal resectiva a los que se les realizó una evaluación mediante angiografía con verde de indocianina intraoperatoria de la vascularización anastomótica. Resultados: Tras la aplicación de la técnica, se modificó el punto de sección en 9 pacientes (15,25%); en los cuales no se registró ninguna DA. La tasa de complicaciones global fue de 35,59% (n = 21) objetivando 3 dehiscencias anastomóticas en la serie. Conclusión: Esta técnica se perfila como una estrategia adicional en la prevención de la aparición de DA. Serán necesarios estudios randomizados con inclusión de mayor número de pacientes para obtener resultados concluyentes.

Aim: Anastomotic leakage (AL) following colorectal surgery is one of the most devastating complication. The use of indocyanine green fluorescence angiography has been developed as a promising tool to reduce the incidence of AL. The aim of this study is to evaluate the impact of this technique on the prevention of AL. Materials and Method: A prospective study was carried out, including 59 patients undergoing resective colorectal surgery. It was performed intraoperatively indocyanine green angiography evaluation of the anastomotic perfusión in all of then. Results: The section point was modified in 9 patients (15.25%); in which no AL was registered. The overall complication rate was 35.59% (n = 21), founding 3 anastomotic dehiscences in the serie. Conclusion: In conclusion, in our experience this technique is an additional strategy in the prevention of the AL. Randomized control trial including more patients will be necessary to obtain conclusive results.

Vertical banded gastroplasty: is it a durable operation for morbid obesity?

BACKGROUND: Long-term follow-up is important in the evaluation of results of bariatric operations. The authors followed vertical banded gastroplasty (VBG) in an ongoing database. METHODS: From 1986 to 1999, 123 VBGs were performed in one surgical ward. The series comprises 105 females and 18 males, with mean age 37 years and mean preoperative BMI 48.39 kg/m(2). The authors evaluated long-term results (patients followed, patients who underwent revisional surgery, success rate and complications), analyzed in 2000 and again in 2002. RESULTS: With time, the percentage of patients in the follow-up decreased from 65 to 53%, the success-rate decreased from 46.16 to 32.79%, and revisional surgery for inadequate weight loss or complications increased from 9.61 to 29.51% in only 2 years. CONCLUSION: The weight loss of VBG was frequently not maintained in the long-term. However, we have previously found maintained improvements in comorbidities.

Effect of vertical banded gastroplasty on hypertension, diabetes and dyslipidemia.

BACKGROUND: Operations for morbid obesity that are effective in inducing weight loss improve blood pressure, glycemic control and dyslipidemia. Our purpose was to study the effectiveness of VBG in improving hypertension, diabetes and dyslipidemias in morbidly obese patients. METHODS: Retrospective analysis of a cohort of 80 morbidly, obese patients was conducted. Characteristics of patients were: mean age 37 years; gender: women 65, men 15; mean initial BMI 49.5 kg/m2; follow-up > 5 years in 52 patients. Blood pressure, cholesterol and triglyceride levels and glycemia were assessed preoperatively and 1, 3, 6, 12, 18 months and every year after VBG. RESULTS: Hypertension resolved in 65.5% of patients (38 of 58), serum cholesterol level became normal in 34.28% of patients (12 of 35), triglyceride level became normal in 77.77% (7 of 9) and diabetes resolved in 55.55% (5 of 9). CONCLUSION: Weight loss induced by VBG improves blood pressure, triglyceride levels and glycemia. The beneficial changes occur early in the postoperative period and last 5 years or more, despite of the trend to regain some weight. Improvements in risk factors were greater in patients with higher preoperative values.

Results of biliopancreatic diversion after five years.

BACKGROUND: Gastric restrictive procedures, currently the most popular surgical operations for morbid obesity, have proved to be effective in initiating weight loss, but questions regarding their long-term efficacy in weight maintenance have arisen. Biliopancreatic diversion (BPD) is a mixed and complex technique that has shown good long-term results. There are no series with long-term follow-up of BPD in Spain. We present >5 year results (average 67.9 +/- 15 SD mons, range 48-96), evaluating weight loss, morbidity and mortality after BPD. METHODS: 74 patients who underwent BPD and completed 5 or more years of follow-up were studied. The results have been analyzed in terms of weight loss (classification of Reinhold), improvement in morbidity, and improvement in quality of life (BAROS). RESULTS: 78.6% were women. Mean age was 38 +/- 11 years (18-61). Mean preoperative body mass index (BMI) was 54 +/- 8 kg/m(2). Progression of BMI: 1 year 34 +/- 6, 2 years 31 +/- 6, 5 years 33 +/- 7 and 7 years 31 +/- 3 kg/m(2). Excess weight loss at 1 year follow-up was 67%, at 2 years 75%, at 5 years 70% and at 7 years 71%. There were significant differences between morbidly obese (BMI <50 kg/m(2)) and super-obese (BMI >50 kg/m(2) ), with better results in the morbidly obese group. CONCLUSION: BPD shows long-term effectiveness in weight loss, co-morbidity improvement and quality of life. Protein, vitamin and oligoelement deficits may appear in the long-term, so that strict follow-up and supplementation of deficiencies are necessary.

Complicaciones postratamiento del prolapso apical: a propósito de un caso / Complications after the treatment of apical prolapse: A case report

Resumen ANTECEDENTES: El prolapso de órganos pélvicos es un problema que puede resolverse con una diversidad de técnicas quirúrgicas según su tipo y características personales de la paciente. CASO CLÍNICO: Paciente de 81 años, originaria de Zaragoza, España, con índice de masa corporal de 41 kg/m2, hipertensión moderada y arritmia cardiaca, en tratamiento con acenocumarol y antihipertensivos de manera crónica. Antecedentes ginecológicos: tres embarazos de término que finalizaron en partos espontáneos, del segundo nació un niño de 4200 g. La paciente acudió a consulta por rectocele, corregido mediante la colocación de un pesario de anillo. El prolapso se complicó con rectoenterocele, que precisó corrección quirúrgica. Como consecuencia de la técnica quirúrgica elegida y por tratarse de una complicación frecuente de la vía de acceso (hematoma de la cúpula vaginal), la paciente sufrió una apertura vaginal a través de la que se hernió contenido intestinal. Después de evaluar el caso se decidió efectuar una nueva corrección quirúrgica que permitiera solucionar, simultáneamente, la hernia a través de la pared vaginal y la recidiva del prolapso apical. Hoy día se encuentra con adecuada evolución (12 meses del procedimiento quirúrgico), asintomática y sin complicaciones aparentes. CONCLUSIÓN: La cirugía del prolapso apical es compleja, debido a su amplia variedad de técnicas quirúrgicas y alto índice de recidiva. Es necesario conocer las diferentes vías de acceso para ofrecer la mejor solución a las pacientes.

Abstract BACKGROUND: Pelvic organ prolapse is a pathology that offers a variety of surgical techniques depending on the type of prolapse and the characteristics of the patient. CLINICAL CASE: Patient of 81 years born in Zaragoza (Spain) with a body mass index of 41kg / m2. It presents moderate hypertension and cardiac arrhythmia in treatment with anticoagulants. Requires treatment with acenocoumarol and antihypertensive in a chronic manner. Among the gynecological antecedents, there are three full-term pregnancies that ended with spontaneous deliveries, the second of them with a birth weight of 4,200gr. In this case, we present an elderly patient who initially presented a rectocele corrected initially using a pessary of the ring. The prolapse evolved presenting a rectoenterocele that required surgical correction. As a consequence of the chosen surgical technique and a frequent complication of the vaginal approach, such as a vaginal cuff hematoma, the patient suffered a vaginal opening through which intestinal contents were herniated. After evaluating the case, a new surgical correction was required that would allow the simultaneous resolution of the hernia through the vaginal wall that presented and the recurrence of the apical prolapse. Today is the right evolution (12 months of the surgical event), asymptomatic and without apparent complications. CONCLUSION: Prolapse surgery is complex due to its wide variety of surgical techniques and its high rate of recurrence. It is necessary to be aware of the different approaches to be able to offer the best solutions to our patients.

Fascitis necrosante clostridial asociada a neoplasia colónica perforada: importancia de un diagnóstico precoz / Necrotizing fasciitis following colon neoplasm perforation: the clue of an early detection

Introducción: La gangrena espontánea por Clostridium septicum es una entidad poco frecuente con una alta mortalidad que se asocia a pacientes neoplásicos y/o inmunodeprimidos. Caso clínico: Presentamos un caso de gangrena clostridial en un paciente con neoplasia de colon ascendente perforada a retroperitoneo. Discusión-conclusiones: Aunque es poco común deberemos pensar en una infección clostridial en pacientes sépticos y sospecha de neoplasia colónica. En ausencia de diagnóstico y tratamiento precoz, el pronóstico es fatal.

Introduction: Spontaneous gangrene due to Clostridium septicum is a low frequency pathology with a high mortality rate. It is related to neoplasic and/or immunodeficient patients. Case report: We present the case of a patient who presented clostridial gangrene associated with a perforated colon neoplasm. Discussion-conclusions: Although it is not very common it must supposed a clostridial infection in septic patients with colon neoplasm suspect. If diagnosis and treatment are delayed the prognostic of the patient is fatal.

Tratamiento de la base apendicular por laparoscopia mediante el uso de endograpadoras: análisis de nuestros resultados / Appendicular stump laparoscopic management: our results analysis

Objetivo: El objetivo de este estudio es analizar los resultados de nuestro centro en cuanto al cierre del muñón apendicular en la apendicectomía laparoscópica, mediante el empleo de endograpadora. Material y método: Análisis retrospectivo de las apendicectomías laparoscópicas con sección de la base apendicular con endograpadora, llevadas a cabo entre enero de 2013 y marzo de 2015, recogiendo variables demográficas, clínicas y de técnica quirúrgica. Resultados: Se incluyeron en el análisis 238 pacientes. Se registraron complicaciones en 41 pacientes, con una tasa de reingreso del 5% y un 2,5% de pacientes reintervenidos. La estancia media posquirúrgica fue de 3,64 días. Discusión y conclusiones: En el cierre del muñón apendicular, la endograpadora se presenta como una técnica adecuada en cuanto a estancia postoperatoria y complicaciones posquirúrgicas. A pesar de las ventajas de su uso, debe valorarse en apendicectomías no complicadas el empleo de otras técnicas como endoloops.

Objective: The objective of this study is to analyse the results in our centre as regards the closure of the appendix stump in laparoscopic appendectomy using an endo-stapler. Material and methods: A retrospective analysis, collecting the demographic, clinical, and surgical technique variables, was conducted on laparoscopic appendectomies with section of the appendix base with an endo-stapler performed between January 2013 and March 2015. Results: A total of 239 patients were included in the analysis. Complications were recorded in 41 patients, with a re-admission rate of 5%, and 2.5% of patients received further surgery. The mean post-surgical stay was 3.64 days. Discussion and conclusions: The endo-stapler is a suitable technique in the closure of the appendix stump, as regards post-surgical hospital stay and complications. Despite the advantages of its use, the employment of other techniques, such as endo-loops, should be evaluated in non-complicated appendectomies.

Apendicitis y parásitos: a propósito de 2 casos / Appendicitis and parasites: Reporting of 2 cases

Objetivo: Enfatizar la importancia de sospechar esta etiología en la patogenia de la apendicitis aguda, especialmente en pacientes procedentes de países endémicos. Casos clínicos: Presentamos dos casos, con cursos clínicos divergentes.

Aim: We would like to emphasize the importance of having a high grade of suspect about the parasitic etiology of appendicitis acute, especially in patients from endemic countries. Case report: We present two cases with divergent clinical evolution.

[Prevalence of anal diseases after Scopinaro's biliopancreatic bypass for super-obese patients]. / Prevalencia de afección anal en el paciente superobeso mórbido tras bypass biliopancreático de Scopinaro.

INTRODUCTION: Biliopancreatic diversion by Scopinaro (BD) is a mixed (malabsortive and restrictive) bariatric technique that is successful in achieving long lasting weight lost in super obese patients. In fact, the diarrhoea (steatorrhea) that is expected after any malabsortive technique can sometimes cause significant nutritional changes and anal disease: these patients are frequently referred to our coloproctology outpatient clinic due to haemorrhoids, fissures, anal sepsis and fistula basically due to changes in quality and quantity of their faeces. The aim of this paper is to find out not only the prevalence of anal disease in our series of super obese surgical patients but also to compare the incidence between the two surgical techniques we perform in our department. MATERIAL AND METHOD: We analyzed 263 consecutive patients operated on BD of Scopinaro (50-200 cm) and modified-BD (75-225 cm) in our Department. Patients who had previously suffered from anal surgery were excluded. RESULTS: There were 45 patients (18%) who suffered from anal problems of which 38 cases (84.4%) were BD-S and only 7 cases with BD-M complained of anal disorders (p < 0.05). Overall, at the 18th month review, the mean number of motions per day was 3.5 (range, 1-15). Patients with BD-S had 5 motions per day as a mean. The mean number of motions for BD-M was 2. The frequency order of anal pathology observed was: anal fissure, haemorrhoids, abscess and fistula. CONCLUSIONS: Higher incidence of anal pathology after BD of Scopinaro is another factor to take into account to avoid performing classic Scopinaro BD as opposed to modified BD for the treatment of morbid super obesity. It is mandatory to be conservative when facing anal problems in these patients, and firstly we must modify eating habits and the nutritional status. Surgery must be highly respectful to anal sphincters to avoid incontinence.

Cancelación en CMA: Incidencia y causas / Cancellation in CMA: Incidence and causes

Introducción: Las Unidades de Cirugía Mayor Ambulatoria (UCMA) cada día cobran más relevancia precisando una correcta gestión. Uno de los principales parámetros a mejorar en la política de gestión hospitalaria es el índice de cancelaciones sobre procesos electivos. Material y método Diseñamos un estudio retrospectivo observacional, seleccionando todos los pacientes intervenidos en nuestra UCMA desde 1995 hasta 2009: un total de 16.934 pacientes. Analizamos las intervenciones quirúrgicas canceladas el día anterior a la intervención y las cancelaciones en el día de la intervención. Resultados Un total de 701 pacientes (4,1%) sufrieron la cancelación de la intervención quirúrgica programada. En 343 pacientes (2%) la cancelación se produjo el día anterior a la intervención y en 358 pacientes (2,1%) la cancelación se produjo el día de la intervención. Causas de la cancelación enfermedad aguda intercurrente 180 pacientes (25,7%), decisión personal del paciente 126 (18%), no comparecencia del paciente 28 (4%), preparación incorrecta del paciente 190 (27,1%), falta de recursos 177 (25,2%). Distribuyendo las causas de cancelación según la (..) (AU)

Introduction: Major Ambulatory Surgery (MAS) units are becoming increasingly important and require correct management. One of the principal improvement parameters in hospital management policy is the rate of cancellations of elective surgery. Material and method: We designed a retrospective, observational study by selecting all the patients operated on in our MAS unit from 1995 to 2009: 16.934 patients. We analysed the surgical procedures cancelled the day before the operation. Results: A total of 701 patients (4.1%) had a scheduled surgical intervention cancelled. This cancellation occurred the day before the operation in 343 patients (2%) and on the same day of the operation in 358 patients (2.1%). Reasons for the cancellation: acute intercurrent disease in 180 patients (25.7%), personal decision of the patient in 126 (18%), non-appearance of the patient in 28 (4%), incorrect preparation of the patient in 190 (27.1%), lack of resources (..) (AU)

Prevalencia de afección anal en el paciente superobeso mórbido tras bypass biliopancreático de Scopinaro / Prevalence of anal diseases after Scopinaro’s biliopancreatic bypass for super-obese patients

Introducción. El bypass biliopancreático de Scopinaro es una técnica bariátrica mixta. Los efectos secundarios indeseables derivados de las diarreas y los cambios de composición cualitativa típicos de las heces esteatorreicas observados con mayor frecuencia en este tipo de pacientes son: hemorroides, fisuras, abscesos y fístulas de ano. El objetivo de esta publicación es valorar la prevalencia de afección anal en los superobesos operados, así como comparar su incidencia entre ambas variantes de bypass biliopancreático practicadas en nuestro servicio. Material y método. Analizamos la afección anal que presentaron 263 pacientes intervenidos de obesidad mórbida en nuestro servicio (1995-2005) tras bypass biliopancreático clásico (BD-C) y bypass biliopancreático modificado (BD-M). Resultados. Un 18% (n = 45) de los pacientes presentó afección anal: BD-C, 38 pacientes, y BD-M, 7 pacientes (p < 0,05). La media de deposiciones diarreicas fue de 3,5 (intervalo, 1-15) deposiciones/día. Los pacientes del grupo BD-C realizaban 5 deposiciones de media frente a 2 del grupo BD-M. Por orden de frecuencia fueron: fisura, hemorroides, absceso y fístula. Conclusiones. La mayor incidencia de afección anal tras BD-C es otro factor que nos debe hacer abandonar esta técnica a favor del BD-M para el tratamiento de la superobesidad mórbida. Además, es fundamental ser conservadores en el tratamiento de la afección anal en este grupo de pacientes; siempre se debe corregir primero las alteraciones digestivas y el estado nutricional y no olvidar que la anatomía del canal anal debe ser preservada al máximo para evitar la incontinencia (AU)

Introduction. Biliopancreatic diversion by Scopinaro (BD) is a mixed (malabsortive and restrictive) bariatric technique that is successful in achieving long lasting weight lost in super obese patients. In fact, the diarrhoea (steatorrhea) that is expected after any malabsortive technique can sometimes cause significant nutritional changes and anal disease: these patients are frequently referred to our coloproctology outpatient clinic due to haemorrhoids, fissures, anal sepsis and fistula basically due to changes in quality and quantity of their faeces. The aim of this paper is to find out not only the prevalence of anal disease in our series of super obese surgical patients but also to compare the incidence between the two surgical techniques we perform in our department. Material and method. We analyzed 263 consecutive patients operated on BD of Scopinaro (50-200 cm) and modified-BD (75-225 cm) in our Department. Patients who had previously suffered from anal surgery were excluded. Results. There were 45 patients (18%) who suffered from anal problems of which 38 cases (84.4%) were BD-S and only 7 cases with BD-M complained of anal disorders (p < 0.05). Overall, at the 18th month review, the mean number of motions per day was 3.5 (range, 1-15). Patients with BD-S had 5 motions per day as a mean. The mean number of motions for BD-M was 2. The frequency order of anal pathology observed was: anal fissure, haemorrhoids, abscess and fistula. Conclusions. Higher incidence of anal pathology after BD of Scopinaro is another factor to take into account to avoid performing classic Scopinaro BD as opposed to modified BD for the treatment of morbid super obesity. It is mandatory to be conservative when facing anal problems in these patients, and firstly we must modify eating habits and the nutritional status. Surgery must be highly respectful to anal sphincters to avoid incontinence (AU)