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Article ; Online: Early diverting stoma closure is feasible and safe: results from a before-and-after study on the implementation of an early closure protocol at a tertiary referral center.

Blanco Terés, L / Cerdán Santacruz, C / Correa Bonito, A / Delgado Búrdalo, L / Rodríguez Sánchez, A / Bermejo Marcos, E / García Septiem, J / Martín Pérez, E

Techniques in coloproctology

2024 Volume 28, Issue 1, Page(s) 32

Abstract: Background: Evidence on early closure (EC) of defunctioning stoma (DS) after colorectal surgery shows a favorable effect when patients are carefully selected. Therefore, a clinical pathway adapted to the implementation of an EC strategy was developed in ...

Abstract	Background: Evidence on early closure (EC) of defunctioning stoma (DS) after colorectal surgery shows a favorable effect when patients are carefully selected. Therefore, a clinical pathway adapted to the implementation of an EC strategy was developed in our center. The aim of this study was to carry out a comparative analysis of time until DS closure and DS-related morbidity before and after the implementation of an EC protocol (ECP). Methods: This study is a before-and-after comparative analysis. Patients were divided into two cohorts according to the observational period: patients from the period before the ECP implementation (January 2015-December 2019) [Period 1] and those from the period after that (January 2020-December 2022) [Period 2]. All consecutive patients subjected to elective DS closure within both periods were eligible. Early closure was defined as the reversal within 30 days from DS creation. Patients excluded from EC or those not closed within 30 days since primary surgery were analyzed as late closure (LC). Baseline characteristics and DS-related morbidity were recorded. Results: A total of 145 patients were analyzed. Median time with DS was shorter in patients after ECP implementation [42 (21-193) days versus 233 (137-382) days, p < 0.001]. This reduction in time to closure did not impact the DS closure morbidity and resulted in less DS morbidity (68.8% versus 49.2%, p = 0.017) and fewer stoma nurse visits (p = 0.029). Conclusions: The ECP was able to significantly reduce intervals to restoration of bowel continuity in patients with DS, which in turn resulted in a direct impact on the reduction of DS morbidity without negatively affecting DS closure morbidity.
MeSH term(s)	Humans ; Colorectal Surgery ; Surgical Stomas/adverse effects ; Tertiary Care Centers
Language	English
Publishing date	2024-02-13
Publishing country	Italy
Document type	Comparative Study ; Journal Article
ZDB-ID	2083309-X
ISSN	1128-045X ; 1123-6337
ISSN (online)	1128-045X
ISSN	1123-6337
DOI	10.1007/s10151-023-02905-z
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Article ; Online: Adult Intestinal Intussusception: Practical Issues and Concerns.

Cerdán Santacruz, Carlos / García Septiem, Javier

Diseases of the colon and rectum

2021 Volume 64, Issue 4, Page(s) 645–648

Abstract: Case summary: A 37-year-old woman with no relevant past medical history presented to the emergency department after a 2-day-long period of crampy abdominal pain with an inability for oral intake because of persistent vomiting. The physical examination ... ...

Abstract	Case summary: A 37-year-old woman with no relevant past medical history presented to the emergency department after a 2-day-long period of crampy abdominal pain with an inability for oral intake because of persistent vomiting. The physical examination was unremarkable. Abdominal CT scan with water-soluble oral contrast revealed an ileocecal intussusception (Fig. 1). Because the patient was hemodynamically stable and no abdominal tenderness was found, a delayed surgical intervention was planned with laparoscopic approach. During intervention, the intestinal invagination was reduced, a cecal neoplasm suspected, and a right hemicolectomy with complete mesocolic excision was performed (Fig. 2). Postoperative recovery was uneventful, with discharge on postoperative day 5. The definite pathological report showed well-differentiated colon adenocarcinoma pT2N1aMx, with 1 of 49 positive lymph nodes.
MeSH term(s)	Adenocarcinoma/complications ; Adenocarcinoma/diagnosis ; Adenocarcinoma/pathology ; Adenocarcinoma/surgery ; Adult ; Cecal Neoplasms/complications ; Cecal Neoplasms/diagnosis ; Cecal Neoplasms/pathology ; Cecal Neoplasms/surgery ; Disease Management ; Female ; Humans ; Ileal Diseases/diagnosis ; Ileal Diseases/etiology ; Ileal Diseases/surgery ; Intussusception/diagnosis ; Intussusception/etiology ; Intussusception/surgery ; Laparoscopy ; Neoplasm Staging ; Tomography, X-Ray Computed
Language	English
Publishing date	2021-03-26
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0000000000002045
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Article ; Online: Results of a national survey about the management of patients with acute uncomplicated diverticulitis.

Correa Bonito, Alba / Cerdán Santacruz, Carlos / Pellino, Gianluca / Fernández Miguel, Tamara / Bermejo Marcos, Elena / Rodríguez Sánchez, Ana / García Septiem, Javier / Martín-Pérez, Elena

Cirugia espanola

2024 Volume 102, Issue 4, Page(s) 202–208

Abstract: Introduction: Management of patients diagnosed of acute uncomplicated diverticulitis has evolved lately and according to the latest guidelines, outpatient treatment and management without antibiotherapy may be used in selected patients. The aim of this ... ...

Abstract	Introduction: Management of patients diagnosed of acute uncomplicated diverticulitis has evolved lately and according to the latest guidelines, outpatient treatment and management without antibiotherapy may be used in selected patients. The aim of this study is to evaluate the adhesión among national centres to these and others recommendations related to this pathology. Methods: An online national survey, that has been broadcast by several applications, was performed. The results obtained were statistically analysed. Results: A total of 104 surgeons participated, representing 69 national hospitals. Of those, in 82.6% of the centres, outpatient management is performed for acute uncomplicated diverticulitis. 23.2% of the hospitals have a protocol stablished for treatment without antibiotherapy in selected patients. Centres that do not follow these protocols allege that the mean reasons are the logistic difficulties to set them up (49.3%) and the lack of current evidence for it (44.8%). Significative statistical differences have been found when comparing the establishment of such protocols between centres with advanced accredited units and those who are not, with higher rates of outpatient management and treatment without antibiotics in accredited units (p ≤ .05). Conclusions: In spite that this a very common disease, there is a huge national heterogeneity in its treatment. This is why it would adviseable to unify diagnostic and treatment criteria by the collaboration of scientific societies and the simplification of the development of hospitalary protocols.
MeSH term(s)	Humans ; Diverticulitis/therapy ; Anti-Bacterial Agents/therapeutic use ; Ambulatory Care/methods
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2024-02-08
Publishing country	Spain
Document type	Journal Article
ISSN	2173-5077
ISSN (online)	2173-5077
DOI	10.1016/j.cireng.2023.11.023
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Article: A case of Currarino syndrome in an adult female presenting with refractory chronic constipation.

Rojo Aldama, Eukene / Miranda García, Pablo / García Septiem, Javier

Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva

2020 Volume 113, Issue 1, Page(s) 73–74

Abstract: We present the case of a 25-year-old female who presented due to refractory chronic constipation and fecal incontinence. She had bowel movements every 7-30 days with an increased consistency (1-2 Bristol type stools), together with soiling and passive ... ...

Abstract	We present the case of a 25-year-old female who presented due to refractory chronic constipation and fecal incontinence. She had bowel movements every 7-30 days with an increased consistency (1-2 Bristol type stools), together with soiling and passive fecal incontinence (Wexner Scale: 12/20). She had previously undergone surgery shortly after birth for an anorectal malformation repair. The colonoscopy and histological study of the rectum were normal. A pelvic magnetic resonance imaging (MRI) was performed, which showed a right pararectal mass that compressed the rectum without invading it. This mass was compatible with a presacral teratoma or hamartoma. MRI also revealed coccyx agenesis and hypoplasia of the last sacral vertebrae (Image 1), which were consistent with Currarino syndrome (CS). The patient received 14 sessions of transcutaneous electrostimulation of the posterior tibial nerve, resulting in an increase in bowel movements (every 3 days) and a reduction in fecal incontinence. She was then referred to surgery for presacral mass removal.
MeSH term(s)	Adult ; Anal Canal/abnormalities ; Constipation/diagnostic imaging ; Constipation/etiology ; Digestive System Abnormalities/complications ; Digestive System Abnormalities/diagnostic imaging ; Digestive System Abnormalities/surgery ; Fecal Incontinence ; Female ; Humans ; Rectum/abnormalities ; Rectum/diagnostic imaging ; Rectum/surgery ; Sacrum/abnormalities ; Sacrum/diagnostic imaging ; Sacrum/surgery ; Syringomyelia
Language	English
Publishing date	2020-11-18
Publishing country	Spain
Document type	Case Reports ; Journal Article
ZDB-ID	1070381-0
ISSN	1130-0108 ; 0212-7512
ISSN	1130-0108 ; 0212-7512
DOI	10.17235/reed.2020.7096/2020
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Article ; Online: Adult intussusception: a video vignette.

Gancedo Quintana, Á / Cerdán Santacruz, C / Viamontes Ugalde, F E / Blanco Terés, L / Delgado Búrdalo, L / García Septiem, J / Martín-Pérez, E

Techniques in coloproctology

2021 Volume 26, Issue 3, Page(s) 229–230

MeSH term(s)	Adult ; Humans ; Intussusception/diagnostic imaging ; Intussusception/etiology ; Intussusception/surgery
Language	English
Publishing date	2021-10-02
Publishing country	Italy
Document type	Journal Article ; Video-Audio Media
ZDB-ID	2083309-X
ISSN	1128-045X ; 1123-6337
ISSN (online)	1128-045X
ISSN	1123-6337
DOI	10.1007/s10151-021-02527-3
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Article: FiLaC® procedure for highly selected anal fistula patients: indications, safety and efficacy from an observational study at a tertiary referral center.

Blanco Terés, Lara / Bermejo Marcos, Elena / Cerdán Santacruz, Carlos / Correa Bonito, Alba / Rodríguez Sanchez, Ana / Chaparro, María / Gisbert, Javier P / García Septiem, Javier / Martín-Pérez, Elena

Revista espanola de enfermedades digestivas

2023 Volume 115, Issue 12, Page(s) 700–706

Abstract: Background: the ideal clinical profile of patients or fistula features for fistula laser closure (FiLaC®) technique remain to be established. The aim of this study was to analyze clinical outcomes and the safety profile of FiLaC® in search for an ideal ... ...

Abstract	Background: the ideal clinical profile of patients or fistula features for fistula laser closure (FiLaC®) technique remain to be established. The aim of this study was to analyze clinical outcomes and the safety profile of FiLaC® in search for an ideal setting for this technique. Methods: a retrospective observational study was performed from a prospective database including all consecutive patients who underwent surgery for anal fistula (AF) with FiLaC® in the coloproctology unit of a tertiary referral center, between October 2015 and December 2021. The FiLaC® procedure was offered to AF patients who were considered to be at risk of fecal incontinence. Fistulas were described according to Parks' classification and categorized as complex or simple according to the American Gastroenterological Association (AGA) guidelines. Healing was defined by the closure of the internal and external openings for at least six months. Predictive factors of AF healing were investigated. Results: a total of 36 patients were included, with a mean age of 48 ± 13.9 years. Twenty patients (55.6 %) were male and 13 patients (36 %) had Crohn's disease (CD). Fourteen patients (38.8 %) had a complex fistula. The primary and secondary healing rates were 55.6 % and 91.7 %, respectively, during a median follow-up time of 12 months (IQR 7-29). No fecal continence impairment was registered in any case. The proportion of patients with primary healing was significantly higher in CD patients (76.9 % vs 43.5 %, p = 0.048). Conclusions: FiLaC® is a sphincter-preserving procedure with an excellent safety profile and reasonable success rate despite of the strict patient selection. This technique may be attractive for patients with CD due to its higher primary healing rate.
MeSH term(s)	Humans ; Male ; Adult ; Middle Aged ; Female ; Treatment Outcome ; Tertiary Care Centers ; Anal Canal/surgery ; Rectal Fistula/surgery ; Retrospective Studies ; Crohn Disease/complications
Language	English
Publishing date	2023-06-21
Publishing country	Spain
Document type	Observational Study ; Journal Article
ZDB-ID	1070381-0
ISSN	1130-0108 ; 0212-7512
ISSN	1130-0108 ; 0212-7512
DOI	10.17235/reed.2023.9644/2023
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Article ; Online: Treatment for acute uncomplicated diverticulitis without antibiotherapy: systematic review and meta-analysis of randomized clinical trials.

Correa Bonito, Alba / Cerdán Santacruz, Carlos / Di Martino, Marcello / Blanco Terés, Lara / Gancedo Quintana, Álvaro / Martín-Pérez, Elena / Biondo, Sebastiano / García Septiem, Javier

International journal of surgery (London, England)

2023 Volume 109, Issue 5, Page(s) 1412–1419

Abstract: Background: Use of antibiotics in selected cases of acute uncomplicated diverticulitis (AUD) has recently been questioned.: Objective: The aim of this study is to examine the safety and efficacy of treatment regimens without antibiotics compared with ...

Abstract	Background: Use of antibiotics in selected cases of acute uncomplicated diverticulitis (AUD) has recently been questioned. Objective: The aim of this study is to examine the safety and efficacy of treatment regimens without antibiotics compared with that of traditional treatments with antibiotics in selected patients with AUD. Data sources: PubMed, Medline, Embase, Web of Science, and the Cochrane Library. Methods: A systematic review was performed according to PRISMA and AMSTAR guidelines by searching through Medline, Embase, Web of Science, and the Cochrane Library for randomized clinical trials (RCTs) published before December 2022. The outcomes assessed were the rates of readmission, change in strategy, emergency surgery, worsening, and persistent diverticulitis. Study selection: RCTs on treating AUD without antibiotics published in English before December 2022 were included. Intervention: Treatments without antibiotics were compared with treatments with antibiotics. Main outcome measures: The outcomes assessed were the rates of readmission, change in strategy, emergency surgery, worsening, and persistent diverticulitis. Results: The search yielded 1163 studies. Four RCTs with 1809 patients were included in the review. Among these patients, 50.1% were treated conservatively without antibiotics. The meta-analysis showed no significant differences between nonantibiotic and antibiotic treatment groups with respect to rates of readmission [odds ratio (OR)=1.39; 95% CI: 0.93-2.06; P =0.11; I2 =0%], change in strategy (OR=1.03; 95% CI: 0.52-2,02; P =0.94; I2 =44%), emergency surgery (OR=0.43; 95% CI: 0.12-1.53; P =0.19; I2 =0%), worsening (OR=0.91; 95% CI: 0.48-1.73; P =0.78; I2 =0%), and persistent diverticulitis (OR=1.54; 95% CI: 0.63-3.26; P =0.26; I2 =0%). Limitations: Heterogeneity and a limited number of RCTs. Conclusions: Treatment for AUD without antibiotic therapy is safe and effective in selected patients. Further RTCs should confirm the present findings.
MeSH term(s)	Humans ; Acute Disease ; Randomized Controlled Trials as Topic ; Diverticulitis/drug therapy ; Anti-Bacterial Agents/therapeutic use
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2023-05-01
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1097/JS9.0000000000000307
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Article ; Online: Author response to: Comment on: Patterns of acute surgical inflammatory processes presentation of in the COVID-19 outbreak (PIACO Study): surgery may be the best treatment option.

Guadalajara, H / Muñoz de Nova, J L / Fernandez Gonzalez, S / Yiasemidou, M / Recarte Rico, M / Juez, L D / García Septiem, J / Galindo Jara, P / García Virosta, M / Lobo Martínez, E / Martín-Pérez, E / García-Olmo, D

The British journal of surgery

2021 Volume 108, Issue 1, Page(s) e42–e43

MeSH term(s)	COVID-19 ; Disease Outbreaks ; Humans ; Inflammation ; SARS-CoV-2
Language	English
Publishing date	2021-02-26
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znaa022
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Article ; Online: The SARS-CoV-2 first wave impact in the acute inflammatory surgical pathologies.

Guadalajara, H / Muñoz de Nova, J L / Yiasemidou, M / Recarte Rico, M / Juez, L D / García Septiem, J / Galindo Jara, P / García Virosta, M / Lobo Martínez, E / Martín-Pérez, E / Fernandez Gonzalez, S / Lopez-Fernandez, O / García-Olmo, D

Scientific reports

2021 Volume 11, Issue 1, Page(s) 19645

Abstract: Anecdotal evidence suggests that community infection control measures during the COVID-19 outbreak have modified the number and natural history of acute surgical inflammatory processes (ASIP-appendicitis, cholecystitis, diverticulitis and perianal ... ...

Abstract	Anecdotal evidence suggests that community infection control measures during the COVID-19 outbreak have modified the number and natural history of acute surgical inflammatory processes (ASIP-appendicitis, cholecystitis, diverticulitis and perianal abscesses) admissions. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation and treatment ASIP and quantify the effect of COVID-19 infection on the outcomes of ASIP patients. This was a multicentre, comparative study, whereby ASIP cases from 2019, 2020 and 2021 (March 14th to May 2nd) were analyzed. Data regarding patient and disease characteristics as well as outcomes, were collected from sixteen centres in Madrid, and one in Seville (Spain). The number of patients treated for ASIP in 2019 was 822 compared to 521 in 2020 and 835 in 2021. This 1/3rd reduction occurs mainly in patients with mild cases, while the number of severe cases was similar. Surgical standards suffered a step back during the first wave: Lower laparoscopic approach and longer length of stay. We also found a more conservative approach to the patients this year, non-justified by clinical circumstances. Luckily these standards improved again in 2021. The positive COVID-19 status itself did not have a direct impact on mortality. Strikingly, none of the 33 surgically treated COVID positive patients during both years died postoperatively. This is an interesting finding which, if confirmed through future research with a larger sample size of COVID-19 positive patients, can expedite the recovery phase of acute surgical services.
MeSH term(s)	Adult ; Aged ; Appendicitis/complications ; Appendicitis/epidemiology ; Appendicitis/pathology ; Appendicitis/surgery ; COVID-19/complications ; COVID-19/epidemiology ; COVID-19/pathology ; COVID-19/virology ; Cholecystitis/complications ; Cholecystitis/epidemiology ; Cholecystitis/pathology ; Cholecystitis/surgery ; Diverticulitis/complications ; Diverticulitis/epidemiology ; Diverticulitis/pathology ; Diverticulitis/surgery ; Female ; Humans ; Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Pandemics ; SARS-CoV-2/isolation & purification ; Severity of Illness Index ; Spain/epidemiology
Language	English
Publishing date	2021-10-04
Publishing country	England
Document type	Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-021-98878-w
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Article ; Online: Patterns of acute surgical inflammatory processes presentation of in the COVID-19 outbreak (PIACO Study): Surgery may be the best treatment option.

The British journal of surgery

2020 Volume 107, Issue 11, Page(s) e494–e495

MeSH term(s)	Abscess/epidemiology ; Abscess/therapy ; Anus Diseases/epidemiology ; Anus Diseases/therapy ; Appendicitis/epidemiology ; Appendicitis/therapy ; COVID-19/diagnosis ; COVID-19/epidemiology ; Case-Control Studies ; Cholecystitis/epidemiology ; Cholecystitis/therapy ; Conservative Treatment ; Digestive System Surgical Procedures/statistics & numerical data ; Diverticulitis/epidemiology ; Diverticulitis/therapy ; Humans ; Logistic Models ; Pandemics ; Severity of Illness Index ; Spain/epidemiology ; Time-to-Treatment
Keywords	covid19
Language	English
Publishing date	2020-08-21
Publishing country	England
Document type	Letter ; Multicenter Study
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1002/bjs.11950
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