María José Gil

Resultados clínicos del cierre de ileostomías en asa en pacientes intervenidos de cáncer de recto. Efecto de la quimioterapia en el tiempo de espera

INTRODUCTION The introduction of sphincter preservation surgery in rectal cancer has led to an increase in the number of low resections protected with a loop ileostomy. This requires subsequent closure of the stoma, a surgical procedure which is not devoid of morbidity or mortality. The aims of the study were to analyse the clinical results of the passage reconstruction surgery and to find out the interval between both surgeries, as well as the role chemotherapy plays in this. PATIENTS AND METHOD The prospective data of patients previously operated on for rectal cancer were used retrospectively with those whose ileostomy was closed between May 2004 and September 2008. Data associated to chemotherapy indication, interval between surgeries and complications were collected and analysed. RESULTS A total of 54 consecutive patients with a mean age of 66 years were analysed. The mean interval between surgeries was 178 days, being significantly less in the patient group that did not receive chemotherapy (p=0.008). The post-operative stay was 6.3 days (SD=4.1). Mortality due to respiratory failure was 1.8% and the morbidity was 22.2%, with 7.4% requiring further surgery. CONCLUSIONS The mortality and morbidity of ileostomy closures are not inconsiderable, although its advantages in the protection of the stoma justify its use. The ileostomy construction interval appears to be significantly affected by post-operative chemotherapy.

Descripción de los hallazgos de la ecografía endoanal en pacientes con incontinencia fecal mediante un sistema de puntuación

INTRODUCTION The main aim of the study was to apply a severity classification of sphincter lesions detected by endoanal ultrasound using Starck score in patients who suffered faecal incontinence. MATERIAL AND METHOD Data were analysed on 133 patients with faecal incontinence. Those in whom anal sphincter lesions were detected by endoanal ultrasound are described and their corresponding scores according to Starck classification calculated. This system scores severity of detected sphincter lesions from 0 to 16, involving the three axes of the anal canal. Patient demographic characteristics and anorectal manometry results were also analysed. The relationship between this score, patient gender and age, and anorectal manometric results were also analysed. RESULTS A total of 83 (62.4%) patients had some type of anal sphincter lesion. The presence of sphincter defects was not related to gender (P=0.172), although it did correlate with younger ages (P=0.028). The severity of anal sphincter damage by Starck score did not show significant correlation to gender (P=0.327) or to the age (P=0.350) of patients. However, a significant correlation was detected between Starck score and anal resting pressure (P=0.008) or anorectal squeeze pressure (P=0.011). CONCLUSIONS The presence of anal sphincter injuries could be well defined by Starck score in patients with faecal incontinence. Severity of damage scored by Starck correlated with anorectal manometric results.

Estudio ecográfico y manométrico del esfínter anal interno en individuos con fisura anal crónica

Resumen Introduccion El aumento de la presion en reposo es uno de los factores implicados en la patogenia de la fisura anal cronica. Se desconoce, sin embargo, si esta anormalidad en la funcion del esfinter anal interno (EAI) se corresponde con alteraciones en su morfologia. Los objetivos son determinar el grosor del EAI en pacientes con fisura anal cronica e investigar la correlacion entre el grosor del EAI y la presion en reposo. Pacientes y metodo Estudio observacional prospective (noviembre de 1999-diciembre de 2002). Se incluyo a pacientes con fisura anal cronica y se excluyo a los que tenian antecedentes de enfermedad inflamatoria, cirugia anal y tratamiento previo con nitroglicerina topica o toxina botulinica. Se practicaron una ecografia endoanal y una manometria. Se considero que el grosor del EAI estaba aumentado cuando era > 2,5 mm en pacientes 3 mm en pacientes ≥ 50 anos. Se considero que la presion en reposo estaba aumentada cuando superaba los 80 mmHg. Resultados Se analizo a 63 pacientes. El EAI estaba aumentado de grosor en 58 (92%) pacientes. El grosor medio del EAI fue de 3,7 ± 0,7 mm. La presion en reposo estaba aumentada en 47 (66%) pacientes. La presion en reposo media fue de 91 ± 28 mmHg. No encontramos ninguna correlacion positiva entre el grosor del EAI y la presion en reposo (r = 0,05; p Conclusiones La mayoria de los pacientes con fisura anal presenta una hipertrofia del EAI. El aumento del grosor del EAI no se correlaciona con un aumento de la presion en reposo.

Clinical results of loop ileostomy closures in rectal cancer surgical patients. Effect of chemotherapy in the waiting period

Abstract Introduction The introduction of sphincter preservation surgery in rectal cancer has led to an increase in the number of low resections protected with a loop ileostomy. This requires subsequent closure of the stoma, a surgical procedure which is not devoid of morbidity or mortality. The aims of the study were to analyse the clinical results of the passage reconstruction surgery and to find out the interval between both surgeries, as well as the role chemotherapy plays in this. Patients and method The prospective data of patients previously operated on for rectal cancer were used retrospectively with those whose ileostomy was closed between May 2004 and September 2008. Data associated to chemotherapy indication, interval between surgeries and complications were collected and analysed. Results A total of 54 consecutive patients with a mean age of 66 years were analysed. The mean interval between surgeries was 178 days, being significantly less in the patient group that did not receive chemotherapy (P=.008). The post-operative stay was 6.3 days (SD=4.1). Mortality due to respiratory failure was 1.8% and the morbidity was 22.2%, with 7.4% requiring further surgery. Conclusions The mortality and morbidity of ileostomy closures are not inconsiderable, although its advantages in the protection of the stoma justify its use. The ileostomy construction interval appears to be significantly affected by post-operative chemotherapy.

Tratamiento de la fisura anal crónica

La fisura anal crónica (FAC) es uno de los problemas proctológicos más frecuentes en la población occidental que afecta con mayor frecuencia a pacientes jóvenes. Produce una clínica de proctalgia y rectorragia, lo que conlleva una alteración en la vida laboral del paciente junto con una alarma y preocupación personal. En nuestro medio, su alta frecuencia de presentación incapacitante y su lenta solución definitiva, principalmente por falta de quirófanos, dadas las listas de espera quirúrgicas y la priorización de otros procesos más graves, crea un grave problema socioeconómico. Por ello, su solución rápida y eficaz a través de un diagnóstico y tratamiento adecuados constituye uno de los retos más importantes y prioritarios de los cirujanos-proctólogos del siglo XXI. El tratamiento de la FAC ha Revisión de conjunto