RESUMO
It is widely acknowledged that inflammatory bowel disease (IBD) is associated with a high prevalence of sexual dysfunction (SD). However, there is a notable paucity of specific literature in this field. This lack of information impacts various aspects, including the understanding and comprehensive care of SD in the context of IBD. Furthermore, patients themselves express a lack of necessary attention in this area within the treatment of their disease, thus creating an unmet need in terms of their well-being. The aim of this position statement by the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) is to provide a review on the most relevant aspects and potential areas of improvement in the detection, assessment, and management of SD in patients with IBD and to integrate the approach to sexual health into our clinical practice. Recommendations are established based on available scientific evidence and expert opinion. The development of these recommendations by GETECCU has been carried out through a collaborative multidisciplinary approach involving gastroenterologists, gynecologists, urologists, surgeons, nurses, psychologists, sexologists, and, of course, patients with IBD.
Assuntos
Colite Ulcerativa , Doença de Crohn , Disfunções Sexuais Fisiológicas , Humanos , Doença de Crohn/complicações , Doença de Crohn/terapia , Colite Ulcerativa/complicações , Colite Ulcerativa/terapia , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/terapia , Espanha , Feminino , Masculino , Disfunções Sexuais Psicogênicas/etiologia , Disfunções Sexuais Psicogênicas/terapia , Sexualidade , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/terapia , Saúde SexualRESUMO
BACKGROUND: A functional population of adipocyte precursors, termed adipose-derived stromal/stem cells (ASCs), is crucial for proper adipose tissue (AT) expansion, lipid handling, and prevention of lipotoxicity in response to chronic positive energy balance. We previously showed that obese human subjects contain a dysfunctional pool of ASCs. Elucidation of the mechanisms underlying abnormal ASC function might lead to therapeutic interventions for prevention of lipotoxicity by improving the adipogenic capacity of ASCs. METHODS: Using epigenome-wide association studies, we explored the impact of obesity on the methylation signature of human ASCs and their differentiated counterparts. Mitochondrial phenotyping of lean and obese ASCs was performed. TBX15 loss- and gain-of-function experiments were carried out and western blotting and electron microscopy studies of mitochondria were performed in white AT biopsies from lean and obese individuals. RESULTS: We found that DNA methylation in adipocyte precursors is significantly modified by the obese environment, and adipogenesis, inflammation, and immunosuppression were the most affected pathways. Also, we identified TBX15 as one of the most differentially hypomethylated genes in obese ASCs, and genetic experiments revealed that TBX15 is a regulator of mitochondrial mass in obese adipocytes. Accordingly, morphological analysis of AT from obese subjects showed an alteration of the mitochondrial network, with changes in mitochondrial shape and number. CONCLUSIONS: We identified a DNA methylation signature in adipocyte precursors associated with obesity, which has a significant impact on the metabolic phenotype of mature adipocytes.
Assuntos
Adipócitos/patologia , Tecido Adiposo/patologia , Metilação de DNA , Mitocôndrias/patologia , Obesidade/genética , Obesidade/patologia , Células-Tronco/metabolismo , Células-Tronco/patologia , Adipócitos/metabolismo , Adipogenia , Adulto , Feminino , Humanos , Inflamação/genética , Inflamação/patologia , Mitocôndrias/genética , Estresse Oxidativo , Magreza/genética , Magreza/patologiaRESUMO
BACKGROUND: Advantages of laparoscopic approach in colon cancer surgery have been previously demonstrated in controlled, randomized trials and in retrospective analysis of large administrative databases. Nevertheless, evidence of these advantages in prospective, observational studies from real-life settings is scarce. METHODS: This is a prospective, observational study, including a consecutive series of patients that underwent elective colonic resection for cancer in 52 Spanish hospitals. Pre-/intraoperative data, related to patient, tumor, surgical procedure, and hospital, were recorded as well as 60-day post-operative outcomes, including wound infection, complications, anastomotic leak, length of stay, and mortality. A univariate and multivariate analysis was performed to determine the influence of laparoscopy on short-term post-operative outcome. A sub-analysis of the effect of laparoscopy according to patients' pre-operative risk (ASA Score I-II vs. III-IV) was also performed. RESULTS: 2968 patients were included: 44.2% were initially operated by laparoscopy, with a 13.9% conversion rate to laparotomy. At univariate analysis, laparoscopy was associated with a decreased mortality (p = 0.015), morbidity (p < 0.0001), wound infection (p < 0.0001), and post-operative length of stay (p < 0.0001). At multivariate analysis, laparoscopy resulted as an independent protective factor for morbidity (OR 0.7; p = 0.004), wound infection (OR 0.6; p < 0.0001), and length of post-operative stay (Effect-2 days; p < 0.0001), compared to open approach. These advantages were more relevant in high-risk patients (ASA III-IV), even if the majority of them were operated by open approach (67.1%). CONCLUSIONS: In a real-life setting, laparoscopy decreases wound infection rate, post-operative complications, and length of stay, especially in ASA III-IV patients.
Assuntos
Colectomia/métodos , Neoplasias do Colo/cirurgia , Laparoscopia/métodos , Idoso , Colectomia/efeitos adversos , Neoplasias do Colo/mortalidade , Conversão para Cirurgia Aberta , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Idoso Fragilizado , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Morbidade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: The incidence of inflammatory bowel disease (IBD) is increasing in Spain but there is little information on the availability of multidisciplinary care. This study aims to assess surgeon's opinions on the current situation of surgery for IBD in Spain. METHODS: An electronic closed survey was sent to members of the Spanish Association of Surgeons (AEC) from January to March 2015. This was a 52-item anonymised questionnaire with questions about how the treatment of IBD patients is organized in each centre, the existence of specific units, the management strategy in IBD patients, and the opinion of colorectal, general and trainee surgeons about the surgical treatment of IBD in their centre and in Spain. RESULTS: One hundred and ninety-two surgeons responded. Most participants work in tertiary hospitals (45%), most of them from different hospitals, some from the same hospital. Only 50% of hospitals have multidisciplinary teams for IBD. The initial approach is laparoscopic in 56% of cases, and 80% of participants in centres with multidisciplinary teams consider the timing of surgery to be appropriate. The annual number of IBD surgeries in tertiary hospitals is higher than in secondary hospitals in ulcerative colitis (57 vs. 24% 10-15 patients/year, P<.001) and Crohn's disease (68 vs. 28% 3-5 patients/month, P<.001). Most centres operate less than 10 ulcerative colitis patients per year, even larger centres (67%) and they perform ≤3 J-pouches/month (ulcerative colitis and other indications) (P<.001). Ninety-five percent of surgeons consider that centralization of complex cases in specialized units and the creation of national registries should be developed. The majority of participants (70%) believe that there is a deficit in research and educational activities in IBD surgery in Spain. CONCLUSION: This survey suggests that most Spanish hospitals have a low volume of IBD surgery, even large tertiary hospitals, and many centres do not have a multidisciplinary team dedicated to IBD patients. Most survey participants believe it is necessary to develop registries and increase training and research in IBD surgery in Spain.
Assuntos
Atitude do Pessoal de Saúde , Colite Ulcerativa/cirurgia , Doença de Crohn/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Pesquisas sobre Atenção à Saúde , Humanos , EspanhaRESUMO
Necrotizing fasciitis (NF) is a potentially life-threatening surgical emergency. It is a rapidly progressive infection of soft tissues, and mortality is related to the degree of sepsis and the general condition of the patient. It is a rare condition that requires a rapid diagnosis and surgical treatment is aggressive debridement. There are a small number of reported cases of perforation of a rectal malignancy leading to NF of the thigh. We present a case with rectal cancer in which the sciatic foramen had provided a channel for the spread of pelvic infection into the thigh.
La fascitis necrotizante es una emergencia quirúrgica potencialmente mortal. Es una infección de tejidos blandos rápidamente progresiva y la mortalidad está relacionada con el grado de sepsis y el estado general del paciente. Es una condición poco común que requiere un diagnóstico rápido, y el tratamiento quirúrgico consiste en un desbridamiento agresivo. Existe un pequeño número de casos notificados de perforación de neoplasia maligna de recto que conduce a fascitis necrotizante del muslo. Presentamos un caso de cáncer de recto en el cual el foramen ciático fue el canal para la propagación de la infección pélvica al muslo.
Assuntos
Fasciite Necrosante , Perfuração Intestinal , Neoplasias Retais , Coxa da Perna , Humanos , Fasciite Necrosante/etiologia , Fasciite Necrosante/cirurgia , Neoplasias Retais/cirurgia , Neoplasias Retais/complicações , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Masculino , Desbridamento , Adenocarcinoma/complicações , Adenocarcinoma/cirurgia , Pessoa de Meia-Idade , Nervo Isquiático/lesões , Infecção Pélvica/etiologiaRESUMO
Faecal incontinence (FI) is a major health problem, both for individuals and for health systems. It is obvious that, for all these reasons, there is widespread concern for healing it or, at least, reducing as far as possible its numerous undesirable effects, in addition to the high costs it entails. There are different criteria for the diagnostic tests to be carried out and the same applies to the most appropriate treatment, among the numerous options that have proliferated in recent years, not always based on rigorous scientific evidence. For this reason, the Spanish Association of Coloproctology (AECP) proposed to draw up a consensus to serve as a guide for all health professionals interested in the problem, aware, however, that the therapeutic decision must be taken on an individual basis: patient characteristics/experience of the care team. For its development it was adopted the Nominal Group Technique methodology. The Levels of Evidence and Grades of Recommendation were established according to the criteria of the Oxford Centre for Evidence-Based Medicine. In addition, expert recommendations were added briefly to each of the items analysed.
Assuntos
Terapia por Estimulação Elétrica , Incontinência Fecal , Humanos , Terapia por Estimulação Elétrica/métodos , Incontinência Fecal/diagnóstico , Incontinência Fecal/terapia , Canal Anal , Medicina Baseada em EvidênciasAssuntos
Colite Ulcerativa/complicações , Colite Ulcerativa/cirurgia , Cálculos Biliares/etiologia , Íleus/etiologia , Obstrução Intestinal/etiologia , Idoso , Colite Ulcerativa/diagnóstico , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/terapia , Humanos , Ileostomia , Íleus/diagnóstico por imagem , Íleus/terapia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/terapia , Masculino , Tomografia Computadorizada por Raios XRESUMO
Despite recent advances in the medical treatment of ulcerative colitis (UC), approximately 25-40% of patients will need surgery during their disease. The aim of elective surgical treatment of UC is to remove the colon/and rectum with minimal postoperative morbidity, and to offer a good long-term quality of life. There are several technical options for the surgical treatment of UC; at present, the most frequently offered is restorative proctocolectomy and ileal pouch-anal anastomosis. Both the surgeon and patient should be aware of the risks associated with a technically demanding procedure and possible postoperative complications, including the possibility of infertility, permanent stoma, or several surgical procedures for pouch-related complications. A precise knowledge of each surgical technique, and its indications, complications, long-term risks and benefits is useful to offer the best surgical option tailored to each patient. We searched in PubMed, MEDLINE, and EMBASE for all kinds of articles (all the publications until April 2012). Papers on Crohn's disease, indeterminate colitis, or other forms of colitis were excluded from the review. We reviewed the abstracts and identified potentially relevant articles. MeSH words were used as search, "ulcerative colitis", "surgery", "indications", "elective surgery", "colectomy," "proctocolectomy," "laparoscopy", "Complications," "outcome", "results" "quality of life". One hundred and four articles were included in this review.
Assuntos
Colite Ulcerativa/cirurgia , Procedimentos Cirúrgicos Eletivos , Bolsas Cólicas , Humanos , Ileostomia , Proctocolectomia RestauradoraRESUMO
INTRODUCTION: The Law for the Regulation of Health Professions (LOPS) indicates that health professionals will carry out continuous training throughout their professional life, and will regularly prove their professional competence. The objective of the study was to carry out a national survey to find out the opinion of Spanish surgeons and thus be able to prepare a recertification project by the Spanish Association of Surgeons. METHODS: Cross-sectional observational study carried out in June-July 2020, through a survey sent to the members of the Spanish Association of Surgeons. RESULTS: The survey had a total of 1230 visits and an overall completion rate of 784 responses (67.3%). 69.6% were unaware of the LOPS forecasts and 83.4% were unaware of similar initiatives in other specialties and 95.5% agreed to demand adequate information. 71.4% believed it necessary but only 57% believed that it should be mandatory. 82.9% would agree that it should be regulated through an objective and predictable official procedure. CONCLUSIONS: The concept of re-accreditation is not well known in our specialty and in view of the results obtained, adequate and reliable information seems necessary. Therefore, it would be pertinent to propose by the A.E.C. a specific project to assess activities and skills.
Assuntos
Cirurgiões , Atitude do Pessoal de Saúde , Estudos Transversais , Humanos , Espanha , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Gammadelta T lymphocytes are an important component of innate immunity. Previous studies have shown their role in the development of Crohn's-like colitis in mice. AIMS: The aim of this study was to measure the γδ T lymphocyte levels in Crohn's disease (CD) patients. METHODS: A prospective study of 40 patients with CD compared with 40 healthy subjects (control group) matched by age and sex was undertaken. Lennard-Jones criteria were used for the diagnosis of CD. Disease activity was measured with the Crohn's disease activity index (CDAI). New patients, patients in remission, and patients with active disease were evaluated. Lymphocytic populations of CD3+, CD4+, CD8+, CD56+, CD19+, and αß and γδ subsets were measured in the peripheral blood of all participants. RESULTS: The levels of CD3+, CD4+, CD8+, and CD19+ lymphocytes were decreased in CD patients compared with the control group (P = 0.002, 0.049, 0.003, and 0.023, respectively). Although both γδ and αß T lymphocytes were lower in patients with CD, γδ T subsets showed the lowest levels in CD patients (mean 0.0259 × 10(9)/l) versus healthy controls (mean 0.0769 × 10(9)/l), P < 0.001. In particular, γδ CD8+ T subsets (mean 0.0068 × 10(9)/l) had the largest difference compared to the control group (mean 0.0199 × 10(9)/l), P = 0.008. CONCLUSIONS: There is a decrease in the global lymphocyte population in the peripheral blood of patients with CD compared to healthy controls. This decrease is more evident in γδ T lymphocytes, especially γδ CD8+ T subsets. Our conclusion is that these results support the theory that a complex alteration of immune responses that affects the total numbers and function of γδ T cells is present in CD.
Assuntos
Antígenos CD/metabolismo , Doença de Crohn/sangue , Subpopulações de Linfócitos T/metabolismo , Adulto , Estudos de Casos e Controles , Doença de Crohn/tratamento farmacológico , Feminino , Humanos , Imunidade Inata , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: The Law for the Regulation of Health Professions (LOPS) indicates that health professionals will carry out continuous training throughout their professional life, and will regularly prove their professional competence. The objective of the study was to carry out a national survey to find out the opinion of Spanish surgeons and thus be able to prepare a recertification project by the Spanish Association of Surgeons (AEC). METHODS: Cross-sectional observational study carried out in June-July 2020, through a survey sent to the members of the AEC. RESULTS: The survey had a total of 1230 visits and an overall completion rate of 784 responses (67.3%). 69.6% were unaware of the LOPS forecasts and 83.4% were unaware of similar initiatives in other specialties and 95.5% agreed to demand adequate information. 71.4% believed it necessary but only 57% believed that it should be mandatory. 82.9% would agree that it should be regulated through an objective and predictable official procedure. CONCLUSIONS: The concept of re-accreditation is not well known in our specialty and in view of the results obtained, adequate and reliable information seems necessary. Therefore, it would be pertinent to propose by the AEC a specific project to assess activities and skills.
RESUMO
INTRODUCTION: Fournier's gangrene is a rapidly progressing necrotizing fascitis that affects the perineal and genital area. Mortality still remains high. The aim of this study was to evaluate the epidemiological progression and morbidity-mortality of Fournier's gangrene at our centre over the past 10 years. METHODS: Retrospective study of 41 patients treated for Fournier's gangrene between 1998 and 2007. Variables studied included, demographic variables, aetiology, microbiology, surgical and antibiotic treatment, morbidity, and mortality. RESULTS: The mean age of the patients was 60, and 93% were male. The most common co-morbidity was diabetes (49%), followed by alcoholism (46%) and immunosuppression or neoplasia (34%). The origin was perianal in 66% of cases, followed by a urological origin (32%). The median time from the onset of symptoms to diagnosis was 3 days. Several surgical debridements were required in 49% of the patients, and the mortality rate was 29%. Most cases had positive cultures (93%), and in 76% more than one microorganism was isolated (enterobacteriaceae and anaerobic flora). In the bivariate analysis, antimicrobial treatment with carbapenems and the absence of systemic complications were associated with lower mortality. CONCLUSIONS: Fournier's gangrene continues to be a severe surgical emergency, with a high mortality rate. Early diagnosis and aggressive surgical and antibiotic therapy are necessary for adequate management.
Assuntos
Gangrena de Fournier/cirurgia , Adulto , Idoso , Anti-Infecciosos/uso terapêutico , Feminino , Gangrena de Fournier/tratamento farmacológico , Genitália Feminina , Genitália Masculina , Humanos , Masculino , Pessoa de Meia-Idade , Períneo , Estudos Retrospectivos , Adulto JovemRESUMO
Introducción: La Ley de Ordenación de las Profesiones Sanitarias (LOPS) indica que los profesionales sanitarios realizarán a lo largo de su vida profesional una formación continuada y acreditarán regularmente su competencia profesional. El objetivo del estudio ha sido realizar una encuesta nacional para conocer la opinión de los cirujanos españoles y así poder preparar un proyecto de recertificación por la Asociación Española de Cirujanos (AEC).Métodos: Estudio observacional transversal efectuado en junio-julio de 2020 mediante una encuesta remitida a los miembros de la AEC. Resultados: La encuesta tuvo un total de 1.230 visitas y una tasa global de finalización de 784 respuestas (67,3%). El 69,6% desconocían las previsiones de la LOPS, el 83,4% no conocían iniciativas similares en otras especialidades y el 95,5% coincidían en demandar una información adecuada. El 71,4% la creían necesaria, pero solo el 57% opinaban que debería ser obligatoria. El 82,9% estarían de acuerdo que debería ser regulada mediante un procedimiento oficial objetivo y previsible. Conclusiones: El concepto de reacreditación no es bien conocido en nuestra especialidad, y en vista de los resultados obtenidos parece necesaria una información adecuada y fiable. Por ello sería pertinente proponer por la AEC un proyecto específico de evaluación de actividades y competencias(AU)
Introduction: The Law for the Regulation of Health Professions (LOPS) indicates that health professionals will carry out continuous training throughout their professional life, and will regularly prove their professional competence. The objective of the study was to carry out a national survey to find out the opinion of Spanish surgeons and thus be able to prepare a recertification project by the Spanish Association of Surgeons (AEC). Methods: Cross-sectional observational study carried out in June-July 2020, through a survey sent to the members of the AEC. Results: The survey had a total of 1230 visits and an overall completion rate of 784 responses (67.3%). 69.6% were unaware of the LOPS forecasts and 83.4% were unaware of similar initiatives in other specialties and 95.5% agreed to demand adequate information. 71.4% believed it necessary but only 57% believed that it should be mandatory. 82.9% would agree that it should be regulated through an objective and predictable official procedure. Conclusions: he concept of re-accreditation is not well known in our specialty and in view of the results obtained, adequate and reliable information seems necessary. Therefore, it would be pertinent to propose by the AEC a specific project to assess activities and skills(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Atitude do Pessoal de Saúde , Cirurgiões , Acreditação , Inquéritos e Questionários , Estudos Transversais , EspanhaRESUMO
La incontinencia fecal (IF) constituye un importante problema sanitario, tanto a nivel individual como para los diferentes sistemas de salud, lo que origina una preocupación generalizada para su resolución o, al menos, disminuir en lo posible los numerosos efectos indeseables que provoca, al margen del elevado gasto que ocasiona. Existen diferentes criterios relacionados con las pruebas diagnósticas a realizar, y lo mismo acontece con relación al tratamiento más adecuado, dentro de las numerosas opciones que han proliferado durante los últimos años, no siempre basadas en una rigurosa evidencia científica. Por dicho motivo, desde la Asociación Española de Coloproctología (AECP) nos propusimos elaborar un Consenso que sirviese de orientación a todos los profesionales sanitarios interesados en el problema, conscientes, no obstante, de que la decisión terapéutica debe tomarse de manera individualizada: características del paciente/experiencia del terapeuta. Para su elaboración optamos por la técnica de grupo nominal. Los niveles de evidencia y los grados de recomendación se establecieron de acuerdo a los criterios del Oxford Centre for Evidence-Based Medicine. Por otra parte, en cada uno de los ítems analizados se añadieron, de forma breve, recomendaciones de los expertos.(AU)
Faecal incontinence (FI) is a major health problem, both for individuals and for health systems. It is obvious that, for all these reasons, there is widespread concern for healing it or, at least, reducing as far as possible its numerous undesirable effects, in addition to the high costs it entails. There are different criteria for the diagnostic tests to be carried out and the same applies to the most appropriate treatment, among the numerous options that have proliferated in recent years, not always based on rigorous scientific evidence. For this reason, the Spanish Association of Coloproctology (AECP) proposed to draw up a Consensus to serve as a guide for all health professionals interested in the problem, aware, however, that the therapeutic decision must be taken on an individual basis: patient characteristics/experience of the care team. For its development it was adopted the Nominal Group Technique methodology. The Levels of Evidence and Grades of Recommendation were established according to the criteria of the Oxford Centre for Evidence-Based Medicine. In addition, expert recommendations were added briefly to each of the items analysed.(AU)
Assuntos
Humanos , Masculino , Feminino , Incontinência Fecal/diagnóstico , Incontinência Fecal/tratamento farmacológico , Incontinência Fecal/economia , Incontinência Fecal/cirurgia , Técnicas e Procedimentos Diagnósticos , Consenso , Espanha , Cirurgia Geral , Esfincterotomia TransduodenalRESUMO
INTRODUCCIÓN: La incidencia de la enfermedad inflamatoria intestinal (EII) está aumentando en España, pero existe poca información sobre su abordaje multidisciplinar, en particular sobre su manejo quirúrgico. El objetivo de este estudio es evaluar la opinión de los cirujanos españoles sobre la situación actual de la cirugía de la EII en nuestro país. MÉTODOS: Se realizó un estudio descriptivo del tipo encuesta cerrada que se envió a través de correo electrónico a los miembros de la Asociación Española de Cirujanos (AEC) durante los meses de enero a marzo de 2015. El cuestionario constaba de 52 ítems con preguntas sobre estructura y proceso, sobre el tratamiento quirúrgico y sobre la opinión de los cirujanos acerca de la calidad, satisfacción e investigación sobre la EII en su centro y en España. RESULTADOS: Un total de 192 cirujanos respondieron a la encuesta, la mayoría procedentes de hospitales de tercer nivel (45%), la mayoría de diferentes hospitales, algunos del mismo centro. Solo el 48,5% de los hospitales tienen equipos multidisciplinares de EII. El planteamiento quirúrgico inicial es laparoscópico en el 56,1% de los casos y el 80% de los participantes en los centros con equipos multidisciplinares considera el timing apropiado. El número de intervenciones anuales de EII en hospitales de tercer nivel es ma's alto que en hospitales de segundo nivel tanto en colitis ulcerosa (57 vs. 24% operan 10-15 pacientes/año, p < 0,001) como en enfermedad de Crohn (68 vs. 28% operan 3-5 pacientes/mes, p < 0,001). La mayoría de los centros, incluso los grandes hospitales, operan a menos de 10 pacientes con colitis ulcerosa al año y realizan _3 reservorios en J o pouch al año (por colitis ulcerosa y otras indicaciones) (p < 0,001). El 95% de los cirujanos considera que debe promoverse la centralización de casos complejos en unidades especializadas y la creación de registros nacionales. CONCLUSIONES: Según esta encuesta, parece que el volumen de cirugías de EII en España por centro no es elevado, ni siquiera en grandes hospitales, y muchos centros no cuentan con un equipo multidisciplinar de EII. No existen protocolos claros de derivación quirúrgica a centros de referencia o especializados. La mayoría de los participantes creen necesario el desarrollo de registros y aumentar la formación y la investigación en la cirugía de la EII en nuestro país
INTRODUCTION: The incidence of inflammatory bowel disease (IBD) is increasing in Spain but there is little information on the availability of multidisciplinary care. This study aims to assess surgeon's opinions on the current situation of surgery for IBD in Spain. METHODS: An electronic closed survey was sent to members of the Spanish Association of Surgeons (AEC) from January to March 2015. This was a 52-item anonymised questionnaire with questions about how the treatment of IBD patients is organized in each centre, the existence of specific units, the management strategy in IBD patients, and the opinion of colorectal, general and trainee surgeons about the surgical treatment of IBD in their centre and in Spain. RESULTS: One hundred and ninety-two surgeons responded. Most participants work in tertiary hospitals (45%), most of them from different hospitals, some from the same hospital. Only 50% of hospitals have multidisciplinary teams for IBD. The initial approach is laparoscopic in 56% of cases, and 80% of participants in centres with multidisciplinary teams consider the timing of surgery to be appropriate. The annual number of IBD surgeries in tertiary hospitals is higher than in secondary hospitals in ulcerative colitis (57 vs. 24% 10-15 patients/year, P<.001) and Crohn's disease (68 vs. 28% 3-5 patients/month, P<.001). Most centres operate less than 10 ulcerative colitis patients per year, even larger centres (67%) and they perform _3 J-pouches/month (ulcerative colitis and other indications) (P<.001). Ninetyfive percent of surgeons consider that centralization of complex cases in specialized units and the creation of national registries should be developed. The majority of participants (70%) believe that there is a deficit in research and educational activities in IBD surgery in Spain. CONCLUSION: This survey suggests that most Spanish hospitals have a low volume of IBD surgery, even large tertiary hospitals, and many centres do not have a multidisciplinary team dedicated to IBD patients. Most survey participants believe it is necessary to develop registries and increase training and research in IBD surgery in Spain
Assuntos
Humanos , Masculino , Feminino , Doenças Inflamatórias Intestinais/metabolismo , Doenças Inflamatórias Intestinais/patologia , Cirurgia Geral/educação , Colite Ulcerativa/metabolismo , Doença de Crohn/patologia , Cirurgiões/educação , Laparoscopia/métodos , Epidemiologia Descritiva , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/diagnóstico , Cirurgia Geral/classificação , Espanha/etnologia , Colite Ulcerativa/diagnóstico , Doença de Crohn/metabolismo , Cirurgiões/normas , Laparoscopia/instrumentaçãoRESUMO
OBJECTIVE: The aim of this study was the prospective evaluation of the functional results of a series endorectal advancement flaps in the treatment of complex anal fistulas. MATERIAL AND METHODS: A total of 90 patients were operated on for a complex anal fistula by means of fistulectomy and endorectal advancement flap. The functional results were evaluated using the Wexner continence scale and an anorectal manometry study before and after surgery. RESULTS: There were seven patients with fistula recurrence (7.7%) and the same surgical procedure was performed on five of them, resulting in healing in all cases. Significant reductions in maximum resting pressure (83.85+/-30.96 vs 46.51+/-18.67; p<0.001) and maximum squeeze pressure (220.97+/-100.21 vs 183.06+/-75.36; p<0.001) were seen 3 months after surgery. On the continence scale, 80% of patients had a normal continence with a value of 0 on the postoperative Wexner scale, while 20% recorded changes in continence values, most of them lower than 3 points. CONCLUSIONS: Endorectal advancement flap is an effective surgical procedure in complex anal fistulas treatment, with a low recurrence rate. Only 20% of the patients showed changes in the continence value.