M. A. Ciga

Randomized clinical trial of anal fistula plug versus endorectal advancement flap for the treatment of high cryptoglandular fistula in ano

The aim of this randomized study was to compare the results of anal fistula plug and endorectal advancement flap in the treatment of high fistula in ano of cryptoglandular origin.

Length of follow-up after fistulotomy and fistulectomy associated with endorectal advancement flap repair for fistula in ano.

The length of follow‐up required after surgical repair of cryptoglandular fistula in ano has not been established. This prospective study determined the follow‐up time needed to establish that an anal fistula has been cured after elective fistulotomy or fistulectomy associated with endorectal advancement flap (ERAF) repair.

Multicentre propensity score-matched analysis of conventional versus extended abdominoperineal excision for low rectal cancer.

Abdominal perineal excision (APE) was originally described with levator ani removal for rectal cancer. An even wider, more aggressive extralevator resection for APE has been proposed. Although some surgeons are performing a very wide ‘extralevator APE (ELAPE)’, there are few data to recommend it routinely. This multicentre study aimed to compare outcomes of APE and ELAPE.

Sacral nerve stimulation for the treatment of faecal incontinence following low anterior resection for rectal cancer.

Aim  The aim of this study was to assess the effectiveness of sacral nerve stimulation (SNS) in the management of faecal incontinence following neoadjuvant therapy and low anterior resection (LAR) for rectal cancer.

Impact of surgical procedure for gastric cancer on quality of life

The aim was to assess quality of life in a group of patients who had a curative resection for gastric cancer.

Comparative study to determine the need for intraoperative colonic irrigation for primary anastomosis in left‐sided colonic emergencies

Objective  To compare the outcome of resection and primary anastomoses in patients undergoing emergency surgery of the left colon with and without intraoperative colonic irrigation.

Oncological outcome following anastomotic leak in rectal surgery

The influence of anastomotic leak on local recurrence and survival remains debated in rectal cancer.

Profilaxis antibiótica en la hernioplastia inguinal

Resumen Introduccion Evaluar la necesidad de profilaxis antibiotica en el tratamiento de la hernia inguinal con material protesico. Material y metodo Estudio prospectivo y aleatorizado en 250 pacientes intervenidos de forma electiva por hernia inguinal unilateral no complicada. En todos ellos se realizo una hernioplastia sin tension utilizando malla de polipropileno. En 125 pacientes se realizo profilaxis antibiotica con 2 g de amoxicilinaacido clavulanico, administrada entre 15 y 30 min antes de comenzar la cirugia. Los restantes 125 pacientes no recibieron ninguna profilaxis. Los 2 grupos fueron homogeneos respecto a la edad, el sexo, el riesgo anestesico ASA, el tipo de anestesia bajo la que se realizo la cirugia, el tipo de hernia, el tiempo quirurgico y el indice de sustitucion en cirugia mayor ambulatoria. Resultados Solo se registro un caso de infeccion de herida quirurgica que ocurrio en el grupo de pacientes con profilaxis antibiotica. La infeccion se curo tras drenaje y tratamiento antibiotico, y no fue preciso retirar la malla. No se observaron otras complicaciones infecciosas. Conclusiones La tasa de infeccion de herida quirurgica en la cirugia de la hernia inguinal no complicada es muy baja, y el uso de profilaxis antibiotica no parece mejorarla.

Nonobstructive dysphagia and recovery of motor disorder after antireflux surgery

BACKGROUND Changes in motor disorder after Nissen 360 degrees surgery were studied based on clinical signs of preoperative nonobstructive dysphagia. MATERIALS AND METHODS Forty-seven patients undergoing Nissen 360 degrees fundoplication for gastroesophageal reflux were studied with pH recording and esophageal manometry before and 1 year after fundoplication. Amplitude of contraction of the distal third of the esophagus (ACDTE) and the presence of primary propulsive waves were studied. RESULTS Fourteen patients had clinical signs of preoperative dysphagia. Of these, 50% had an ACDTE lower than 30 mm Hg, and 71.4% nonpropulsive waves (P <0.05). Forty-three percent and 30%, respectively, of patients with dysphagia recovered ACDTE and the presence of primary propulsive waves 1 year after the procedure, as compared with 66.6% (P <0.05) and 81.8% (P <0.01%) of patients without dysphagia. CONCLUSIONS A correlation was found between preoperative dysphagia and esophageal motility disorders (P <0.05). One year after fundoplication, recovery was significantly higher in patients without preoperative dysphagia.

Multicenter study of outcome in relation to the type of resection in rectal cancer.

BACKGROUND: A surgical teaching and auditing program has been implemented to improve the results of treatment for patients with rectal cancer. OBJECTIVE: The aim of this study was to assess the treatment and outcome in patients resected for rectal cancer, focusing on differences relating to the type of resection. DESIGN: This was an observational study. SETTINGS: The study took place throughout the network of hospitals that compose the National Health Service in Spain. PATIENTS: This study included a consecutive cohort of 3355 patients from the Spanish Rectal Cancer Project. The data of patients who were operated on electively, with curative intent, by anterior resection (n = 2333 [69.5%]), abdominoperineal excision (n = 774 [23.1%]), and Hartmann procedure (n = 248 [7.4%]) between March 2006 and May 2010 were analyzed. MAIN OUTCOME MEASURES: Clinical, pathologic, and outcome results were analyzed in relation to the type of surgery performed. RESULTS: After a median follow-up time of 37 months (interquartile range, 30–48 months), bowel perforations were found to be more common in the Hartmann procedure (12.6%) and abdominoperineal groups (10.1%) than in the anterior resection group (2.3%; p < 0.001). Involvement of the circumferential resection margin was also more common in the Hartmann (16.6%) and abdominoperineal groups (14.3%) than in the anterior resection group (6.6%; p < 0.001). Multivariate analysis showed a negative influence on local recurrence, metastasis, survival for advanced stage, intraoperative perforation, invaded circumferential margin, and Hartmann procedure. However, abdominoperineal excision did not significantly influence local recurrence (HR, 0.945; 95% CI, 0.571–1.563; p = 0.825). LIMITATIONS: The main weakness of this study was the voluntary nature of registration in the Spanish Rectal Cancer Project. CONCLUSIONS: Although bowel perforation and involvement of the circumferential resection margin were more common after abdominoperineal excision than after anterior resection, this study did not identify abdominoperineal excision as a determinant of local recurrence in the context of 3 years of median follow-up.