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  1. Article ; Online: Three-dimensional endoanal ultrasound to assess the validity of Goodsall's Rule and the Midline Rule in predicting the path of perianal fistula-in-ano and the location of the internal opening.

    Garcia-Botello, S / Martín-Arévalo, J / Martí-Fernández, R / Moro-Valdezate, D / Pla-Martí, V / Espí-Macías, A

    Techniques in coloproctology

    2022  Volume 26, Issue 5, Page(s) 351–361

    Abstract: Background: Correct identification of the internal opening is essential in the management of perianal fistulae. The aim of this study was to assess the validity of Goodsall's Law and the Midline Rule in predicting the path of perianal fistula-in-ano and ...

    Abstract Background: Correct identification of the internal opening is essential in the management of perianal fistulae. The aim of this study was to assess the validity of Goodsall's Law and the Midline Rule in predicting the path of perianal fistula-in-ano and the location of the internal opening using 3-dimensional endoanal ultrasound.
    Methods: An observational study including patients diagnosed with fistula-in-ano, at our institution from January 2006 to December 2020 was performed. Location and distance from the anal verge of the external opening, internal opening, and the path of the fistulous tract were recorded during physical examination and endoanal ultrasound. Goodsall's and Midline rules were applied to all fistulae according to the location of the external opening. The location of the internal opening as predicted by either rule was then compared to the real location of the internal opening identified during endoanal ultrasound examination.
    Results: Nine hundred and nine patients [657 (72.3%) males, mean age 50.78 (49.84-51.72) years] were included. 665 (73.2%) of fistulae were transsphinteric. Concordance between predicted internal opening site and the true internal opening location was 0.601 (good match) for Goodsall's rule, and 0.416 (moderate match) for the Midline rule. Goodsall's rule proved to be more predictive in the anterior plane (p < 0.001). Both rules were more likely to make a correct diagnosis in posterior fistulae located 4.5-7.5 mm from the anal verge.
    Conclusions: Both Midline and Goodsall's rules are highly predictive of the course of fistula tracts located in the posterior plane, and are lower for anterior located fistulae, female patients and when the external opening is located further from the anal verge.
    MeSH term(s) Anal Canal/diagnostic imaging ; Endosonography ; Female ; Humans ; Male ; Middle Aged ; Perineum ; Physical Examination ; Rectal Fistula/diagnostic imaging ; Ultrasonography
    Language English
    Publishing date 2022-02-26
    Publishing country Italy
    Document type Journal Article ; Observational Study
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-022-02592-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: An unusual case of proctalgia: kerosene rectal injury.

    Benítez Riesco, Ana / Pérez Santiago, Leticia / Puente Monserrat, Julieta / Moro Valdezate, David

    Revista espanola de enfermedades digestivas

    2023  

    Abstract: Kerosene has been described as an uncommon burn injury agent(1). We report a case of a 47-year-old male who presented to the Emergency Department with proctalgia after self-administration of an unknown enema in the context of cocaine intoxication. ... ...

    Abstract Kerosene has been described as an uncommon burn injury agent(1). We report a case of a 47-year-old male who presented to the Emergency Department with proctalgia after self-administration of an unknown enema in the context of cocaine intoxication. Physical examination revealed severe perianal inflammation (Figure 1.A) without suppuration and computerized tomography (CT) scan showed free air in mesorectum and retroperitoneum without intraperitoneal free air or fluid (Figure 1.B and 1.C). Rigid rectoscopy demostrated erythematous rectal mucosa without perforation. Subsequently, perineal drainage and debridement were performed. On the fifth postoperative day, the patient reported worsening proctalgia. Examination under anesthesia revealed the presence of new-onsetanal ulcers (Figure 1.D), rigid rectoscopy identified deep ulcers limited to the rectal mucosa and colonoscopy ruled out colon involvement. During reevaluation, the patient disclosed the use of sailboat engine lubrican as the enema, with kerosene being one of its components. These findings were consistent with rectal burn injuries resulting from exposure to kerosene. A laparoscopic end-loop colostomy was performed without any postoperative complications. Follow-up examinations with rigid rectoscopy showed improvement of rectal ulcers (Figure 1.E and 1.F). To our knowledge, this is the first case of rectal burn injuries after kerosene exposure(2,3). Aggressive washout, early colostomy and serial follow-up scopes are key components in the management of these rare injuries.
    Language English
    Publishing date 2023-11-30
    Publishing country Spain
    Document type Journal Article
    ZDB-ID 1070381-0
    ISSN 1130-0108 ; 0212-7512
    ISSN 1130-0108 ; 0212-7512
    DOI 10.17235/reed.2023.10098/2023
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Anatomical sphincteroplasty as a surgical treatment for faecal incontinence: proposal for a global anatomical reconstructive surgical procedure and results from a case series.

    García-Armengol, Juan / Martínez-Pérez, Carolina / Roig-Vila, José V / García-Gausí, María / Pla-Martí, Vicente / García-Coret, María J / Moro-Valdezate, David

    Updates in surgery

    2024  

    Abstract: The aim of this study is to describe the technical details and clinical and functional results of anatomical sphincteroplasty as a global reconstructive surgery for the treatment of faecal incontinence caused by anal sphincter lesions. This was a ... ...

    Abstract The aim of this study is to describe the technical details and clinical and functional results of anatomical sphincteroplasty as a global reconstructive surgery for the treatment of faecal incontinence caused by anal sphincter lesions. This was a prospective, longitudinal study that included patients who underwent the anatomical sphincteroplasty procedure described here to treat complete sphincter damage. We have described the different technical steps in detail. We evaluated the intraoperative and postoperative complications rate, Cleveland Clinic Score (CCS), a modification of the CCS that included soiling (mCCS), the Faecal Incontinence Quality of Life Scale (FIQLS), and patient satisfaction. An endoanal ultrasound and anorectal manometric study were performed in all the patients. Forty-four patients were included with a mean of 40.5 months follow-up. The CCS reduced from 15 to 3.3 points and the mCCS from 18.5 to 4.5 points over the study period; p < 0.001. Excellent or good results were achieved in 93% of cases. Endoanal ultrasounds showed a good sphincter repair in 66% of the cases. Anorectal manometry showed an increase in the mean maximal resting pressure from 27.6 mmHg to 41.7 mmHg and of the maximal squeeze pressure from 57.9 to 93 mmHg (p < 0.001) with respect to the preoperative values. Anatomical sphincteroplasty is a surgical proposal for the global anatomical reconstruction of anal sphincter lesions, even in cases of very severe damage. The procedure is safe and produced excellent clinical and functional results after a medium-term follow-up.
    Language English
    Publishing date 2024-02-17
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-023-01749-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Two-row, three-row or powered circular stapler, which to choose when performing colorectal anastomosis? A systematic review and meta-analysis.

    Martín-Arévalo, José / Pla-Martí, Vicente / Huntley, Dixie / García-Botello, Stephanie / Pérez-Santiago, Leticia / Izquierdo-Moreno, A / Garzón-Hernández, L P / Garcés-Albir, M / Espí-Macías, A / Moro-Valdezate, David

    International journal of colorectal disease

    2024  Volume 39, Issue 1, Page(s) 51

    Abstract: Purpose: Three types of circular staplers can be used to perform a colorectal anastomosis: two-row (MCS), three-row (TRCS) and powered (PCS) devices. The objective of this meta-analysis has been to provide the existing evidence on which of these ... ...

    Abstract Purpose: Three types of circular staplers can be used to perform a colorectal anastomosis: two-row (MCS), three-row (TRCS) and powered (PCS) devices. The objective of this meta-analysis has been to provide the existing evidence on which of these circular staplers would have a lower risk of presenting a leak (AL) and/or anastomotic bleeding (AB).
    Methods: An in-depth search was carried out in the electronic bibliographic databases Embase, PubMed and SCOPUS. Observational studies were included, since randomized clinical trials comparing circular staplers were not found.
    Results: In the case of AL, seven studies met the inclusion criteria in the PCS group and four in the TRCS group. In the case of AB, only four studies could be included in the analysis in the PCS group. The AL OR reported for PCS was 0.402 (95%-confidence interval (95%-CI): 0.266-0.608) and for AB: 0.2 (95% CI: 0.08-0.52). The OR obtained for AL in TRCS was 0.446 (95%-CI: 0.217 to 0.916). Risk difference for AL in PCS was - 0.06 (95% CI: - 0.07 to - 0.04) and in TRCS was - 0.04 (95%-CI: - 0.08 to - 0.01). Subgroup analysis did not report significant differences between groups. On the other hand, the AB OR obtained for PCS was 0.2 (95% CI: 0.08-0.52). In this case, no significant differences were observed in subgroup analysis.
    Conclusion: PCS presented a significantly lower risk of leakage and anastomotic bleeding while TRCS only demonstrated a risk reduction in AL. Risk difference of AL was superior in the PCS than in TRCS.
    MeSH term(s) Humans ; Anastomosis, Surgical/methods ; Colorectal Neoplasms ; Surgical Staplers
    Language English
    Publishing date 2024-04-12
    Publishing country Germany
    Document type Meta-Analysis ; Systematic Review ; Journal Article
    ZDB-ID 84975-3
    ISSN 1432-1262 ; 0179-1958
    ISSN (online) 1432-1262
    ISSN 0179-1958
    DOI 10.1007/s00384-024-04625-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Rectal perforation from a perianal drain repaired with transanal minimally invasive surgery.

    Pérez Santiago, L / Moro Valdezate, D / Lapeña Rodríguez, M / Pla Martí, V / Martín Arévalo, J / Espí Macías, A

    Techniques in coloproctology

    2020  Volume 24, Issue 11, Page(s) 1219–1221

    MeSH term(s) Anal Canal/surgery ; Humans ; Minimally Invasive Surgical Procedures ; Rectal Diseases ; Rectal Neoplasms ; Transanal Endoscopic Surgery/adverse effects
    Language English
    Publishing date 2020-07-02
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-020-02278-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Sequencing paired tumor DNA and white blood cells improves circulating tumor DNA tracking and detects pathogenic germline variants in localized colon cancer.

    Gimeno-Valiente, F / Martín-Arana, J / Tébar-Martínez, R / Gambardella, V / Martínez-Ciarpaglini, C / García-Micó, B / Martínez-Castedo, B / Palomar, B / García-Bartolomé, M / Seguí, V / Huerta, M / Moro-Valdezate, D / Pla-Martí, V / Pérez-Santiago, L / Roselló, S / Roda, D / Cervantes, A / Tarazona, N

    ESMO open

    2023  Volume 8, Issue 6, Page(s) 102051

    Abstract: Background: In the setting of localized colon cancer (CC), circulating tumor DNA (ctDNA) monitoring in plasma has shown potential for detecting minimal residual disease (MRD) and predicting a higher risk of recurrence. With the tumor-only sequencing ... ...

    Abstract Background: In the setting of localized colon cancer (CC), circulating tumor DNA (ctDNA) monitoring in plasma has shown potential for detecting minimal residual disease (MRD) and predicting a higher risk of recurrence. With the tumor-only sequencing approach, however, germline variants may be misidentified as somatic variations, precluding the possibility of tracking in up to 11% of patients due to a lack of known somatic mutations. In this study, we assess the potential value of adding white blood cells (WBCs) to tumor tissue sequencing to enhance the accuracy of sequencing results.
    Patients and methods: A total of 148 patients diagnosed with localized CC were prospectively recruited at the Hospital Clínico Universitario in Valencia (Spain). Employing a custom 29-gene panel, sequencing was conducted on tumor tissue, plasma and corresponding WBCs. Droplet digital PCR and amplicon-based NGS were performed on plasma samples post-surgery to track MRD. Oncogenic somatic variants were identified by annotating with COSMIC, OncoKB and an internal repository of pathogenic mutations database. A variant prioritization analysis, mainly characterized by the match of oncogenic mutations with the evidence levels defined in OncoKB, was carried out to select specific targeted therapies.
    Results: Utilizing paired tumor and WBCs sequencing, we identified somatic mutations in all patients (100%) within our cohort, compared to 89% using only tumor tissue. Consequently, the top 10 most frequently mutated genes for plasma monitoring were altered. The sequencing of WBCs identified 9% of patients with pathogenic mutations in the germline, with APC and TP53 being the most frequently mutated genes. Additionally, mutations in genes related to clonal hematopoiesis of indeterminate potential were detected in 27% of the cohort, with TP53, KRAS, and KMT2C being the most frequently altered genes. There were no observed differences in the sensitivity of monitoring MRD using ddPCR or amplicon-based NGS (p = 1). Ultimately, 41% of the patients harbored potentially targetable alterations at diagnosis.
    Conclusion: The germline testing method not only enhanced sequencing results and raised the proportion of patients eligible for plasma monitoring, but also uncovered the existence of pathogenic germline variations, thereby aiding in the identification of patients at a higher risk of hereditary cancer syndromes.
    MeSH term(s) Humans ; Circulating Tumor DNA/genetics ; High-Throughput Nucleotide Sequencing/methods ; DNA, Neoplasm/genetics ; Colonic Neoplasms/genetics ; Colonic Neoplasms/pathology ; Germ Cells/pathology
    Chemical Substances Circulating Tumor DNA ; DNA, Neoplasm
    Language English
    Publishing date 2023-11-10
    Publishing country England
    Document type Journal Article
    ISSN 2059-7029
    ISSN (online) 2059-7029
    DOI 10.1016/j.esmoop.2023.102051
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Does delaying curative surgery for colorectal cancer influence long-term disease-free survival? A cohort study.

    Garcia-Botello, Stephanie / Martín-Arevalo, J / Cozar-Lozano, C / Benitez-Riesco, A / Moro-Valdezate, D / Pla-Martí, V / Espí-Macías, A

    Langenbeck's archives of surgery

    2021  Volume 406, Issue 7, Page(s) 2383–2390

    Abstract: Background: Surgical wait list time is a major problem in many health-care systems and its influence on survival is unclear. The aim of this study is to assess the impact of wait list time on long-term disease-free survival in patients scheduled for ... ...

    Abstract Background: Surgical wait list time is a major problem in many health-care systems and its influence on survival is unclear. The aim of this study is to assess the impact of wait list time on long-term disease-free survival in patients scheduled for colorectal cancer resection.
    Materials and methods: A prospective study was carried out in patients with colorectal cancer scheduled for surgery at a tertiary care center. Wait list time was defined as the time from completion of diagnostic workup to definitive surgery and divided into 2-week intervals from 0 to 6 weeks. The outcome variables were 2-year and 5-year disease-free survival.
    Results: A total of 602 patients, 364 (60.5%) male, median age 73 years (range = 71) were defined. The median wait list time was 28 days (range = 99). Two and 5-year disease-free survival rates were 521 (86.5%) and 500 (83.1%) respectively. There were no differences in 2-year or 5-year disease-free survival for the whole cohort or by tumor stage between wait list time intervals except for AJCC stage II tumors which showed a higher 5-year disease-free survival for the 2-4 and 4-6-week wait list time interval (p = 0.021).
    Conclusions: Time from diagnosis to definitive surgery up to 6 weeks is not associated with a decrease in 2-year or 5-year disease-free survival (DFS) in AJCC stage I through III colorectal cancer patients. These are important findings in the light of the COVID-19 pandemic and offer a window of opportunity for preoperative optimization and prehabilitation.
    MeSH term(s) Aged ; COVID-19 ; Cohort Studies ; Colorectal Neoplasms/surgery ; Disease-Free Survival ; Humans ; Male ; Pandemics ; Prospective Studies ; Retrospective Studies ; SARS-CoV-2
    Language English
    Publishing date 2021-07-11
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1423681-3
    ISSN 1435-2451 ; 1435-2443
    ISSN (online) 1435-2451
    ISSN 1435-2443
    DOI 10.1007/s00423-021-02251-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Does month of birth influence colorectal cancer prognosis?

    Martín-Arévalo, José / Moro-Valdezate, David / Pla-Martí, Vicente / García-Botello, Stephanie / Moya-Marcos, Pablo / Izquierdo-Moreno, Ana / Pérez-Santiago, Leticia / Casado-Rodrigo, David / Roselló-Keränen, Susana / Espí-Macías, Alejandro

    Langenbeck's archives of surgery

    2023  Volume 408, Issue 1, Page(s) 419

    Abstract: Purpose: The main aim of this study was to identify a possible association between month of birth of colorectal cancer (CRC) patients and overall survival (OS) or disease-free survival (DFS).: Methods: This observational study included all ... ...

    Abstract Purpose: The main aim of this study was to identify a possible association between month of birth of colorectal cancer (CRC) patients and overall survival (OS) or disease-free survival (DFS).
    Methods: This observational study included all consecutive adult patients diagnosed with CRC undergoing oncological surgery from January 2005 to December 2019 with a minimum follow-up of 10 years. The outcome variables were locoregional recurrence, death due to cancer progression, OS and DFS. Non-supervised learning techniques (K-means) were conducted to identify groups of months with similar oncologic outcomes. Finally, OS and DFS were analysed using Kaplan-Meier and Cox regression tests. The model was calibrated with resampling techniques and subsequently a cross-validation was performed.
    Results: A total of 2520 patients were included. Three birth month groups with different oncologic outcomes were obtained. Survival analysis showed between-group differences in OS (p < 0.001) and DFS (p = 0.03). The multivariable Cox proportional hazards model identified the clusters obtained as independent prognostic factors for OS (p < 0.001) and DFS (p = 0.031).
    Conclusion: There is an association between month of birth and oncologic outcomes of CRC. Patients born in the months of January, February, June, July, October and December had better OS and DFS than those born in different months of the year.
    MeSH term(s) Adult ; Humans ; Prognosis ; Disease-Free Survival ; Research Design ; Colorectal Neoplasms/surgery
    Language English
    Publishing date 2023-10-26
    Publishing country Germany
    Document type Observational Study ; Journal Article
    ZDB-ID 1423681-3
    ISSN 1435-2451 ; 1435-2443
    ISSN (online) 1435-2451
    ISSN 1435-2443
    DOI 10.1007/s00423-023-03161-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Impact of the novel powered circular stapler on risk of anastomotic leakage in colorectal anastomosis: a propensity score-matched study.

    Pla-Martí, V / Martín-Arévalo, J / Moro-Valdezate, D / García-Botello, S / Mora-Oliver, I / Gadea-Mateo, R / Cozar-Lozano, C / Espí-Macías, A

    Techniques in coloproctology

    2020  Volume 25, Issue 3, Page(s) 279–284

    Abstract: Background: Several risk factors for anastomotic leakage (AL) following colorectal surgery have been described. Improvement in devices for performing anastomosis is a modifiable factor that could reduce AL rates. The aim of this study was to assess the ... ...

    Abstract Background: Several risk factors for anastomotic leakage (AL) following colorectal surgery have been described. Improvement in devices for performing anastomosis is a modifiable factor that could reduce AL rates. The aim of this study was to assess the impact of technical improvements in the Echelon Circular™ powered stapler (ECPS) on the left-sided colorectal AL rate compared to current manual circular staplers (MCS).
    Methods: A cohort study was carried out on consecutive patients between January 2017 and February 2020 in whom left-sided stapled colorectal anastomosis above 5 cm from anal verge was performed. The primary end point was the risk of AL depending on the type of circular stapler used. The ECPS cases were matched to MCS cases by propensity score matching to obtain comparable groups of patients.
    Results: Two hundred seventy-nine patients met the inclusion criteria. A MCS anastomosis was performed in 218 patients and ECPS anastomosis in 61 (21.9%). Overall, AL was observed in 25 (9%) cases. Factors significantly associated with AL were American Society of Anesthesiologists score (p = 0.025) and type of circular stapler used (p = 0.021). After adjusting the cases with propensity score matching (119 cases MCS versus 60 ECPS), AL was observed in 14 (11.8%) patients in MCS group and in 1 (1.7%) patient in the ECPS group (p = 0.022). AL in the MCS group required reoperation in seven cases (5.8%), the remaining seven patients were treated conservatively. The patient in the ECSP group required an urgent Hartmann's procedure CONCLUSIONS: The ECPS device could have a positive impact by reducing AL rates in left-sided colorectal anastomosis. Multicenter controlled trials are needed for stronger evidence to change practice.
    MeSH term(s) Anastomosis, Surgical/adverse effects ; Anastomotic Leak/epidemiology ; Anastomotic Leak/etiology ; Anastomotic Leak/prevention & control ; Cohort Studies ; Colorectal Neoplasms/surgery ; Humans ; Propensity Score ; Surgical Stapling/adverse effects
    Language English
    Publishing date 2020-09-10
    Publishing country Italy
    Document type Journal Article ; Multicenter Study
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-020-02338-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Transvaginal rectocele repair reinforced with biological mesh - a video vignette.

    Pla-Martí, Vicente / García-Botello, Stephanie / Pérez-Santiago, Leticia / Martín-Arévalo, José / Moro-Valdezate, David / Espí-Macías, Alejandro

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2021  Volume 23, Issue 7, Page(s) 1938

    MeSH term(s) Abdomen ; Humans ; Rectocele/surgery ; Rectum ; Surgical Mesh ; Treatment Outcome
    Language English
    Publishing date 2021-04-24
    Publishing country England
    Document type Letter ; Video-Audio Media
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.15664
    Database MEDical Literature Analysis and Retrieval System OnLINE

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