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  1. Article ; Online: Necrotizing fasciitis as a complication of late anastomotic leak after anterior resection for rectal cancer.

    Domínguez-Prieto, Víctor / León-Arellano, Miguel / Alvarellos-Pérez, Alicia / Ortega-López, Mario / Pastor, Carlos

    Cirugia y cirujanos

    2021  Volume 89, Issue S2, Page(s) 80–83

    Abstract: Background: Anastomotic leak is a serious complication of rectal cancer surgery that leads to increased morbidity and mortality. Its incidence is 3-21%, usually appearing 5-7 days after surgery, although there are cases of late presentation as chronic ... ...

    Title translation Fascitis necrotizante como complicación secundaria a dehiscencia anastomótica tardía tras resección anterior de recto.
    Abstract Background: Anastomotic leak is a serious complication of rectal cancer surgery that leads to increased morbidity and mortality. Its incidence is 3-21%, usually appearing 5-7 days after surgery, although there are cases of late presentation as chronic anastomotic fistulas or sinuses.
    Case report: We present three cases of patients who underwent anterior resection for rectal cancer and developed necrotizing fasciitis due to late anastomotic leaks.
    Conclusions: We believe that early and resolutive surgical treatment is recommended for chronic anastomotic fistulas or sinuses, even when asymptomatic, because of the associated risk of necrotizing fasciitis.
    MeSH term(s) Anastomosis, Surgical/adverse effects ; Anastomotic Leak/etiology ; Colectomy ; Fasciitis, Necrotizing/etiology ; Humans ; Rectal Neoplasms/surgery ; Rectum/surgery ; Retrospective Studies
    Language English
    Publishing date 2021-10-08
    Publishing country Mexico
    Document type Case Reports ; Journal Article
    ZDB-ID 730699-4
    ISSN 2444-054X ; 0009-7411
    ISSN (online) 2444-054X
    ISSN 0009-7411
    DOI 10.24875/CIRU.20001403
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Implementation barriers for Enhanced Recovery After Surgery (ERAS) in rectal cancer surgery: a comparative analysis of compliance with colon cancer surgeries.

    Tejedor, Patricia / González Ayora, Santiago / Ortega López, Mario / León Arellano, Miguel / Guadalajara, Hector / García-Olmo, Damián / Pastor, Carlos

    Updates in surgery

    2021  Volume 73, Issue 6, Page(s) 2161–2168

    Abstract: We aim to analyze differences in compliance between colon and rectal cancer surgeries under Enhanced Recovery After Surgery (ERAS) for colorectal procedures, and to detect implementation barriers for rectal cancer surgeries. Patients who underwent ... ...

    Abstract We aim to analyze differences in compliance between colon and rectal cancer surgeries under Enhanced Recovery After Surgery (ERAS) for colorectal procedures, and to detect implementation barriers for rectal cancer surgeries. Patients who underwent elective rectal cancer surgeries under ERAS were case-matched based on gender, age, and P-POSSUM with an equal number of patients who underwent colonic surgeries. Achievements of ≥ 70% of ERAS items were considered an acceptable level of compliance. A multivariate analysis was carried out to identify independent risk factors for lower compliance. A total of 434 patients were included over a 5-year period. After matching, there were 111 patients in each group. Overall compliance was significantly lower in the rectal surgery group (73% vs 82%, p = 0.001). A good compliance rate differed from 55% in rectal vs 77.5% in colonic procedures (p = 0.000). We identified three independent risk factors for lower compliance rates: open surgical approach, the use of epidural catheter, and the presence of postoperative ileus. Our data showed that rectal cancer surgeries are more exigent to success on ERAS interventions when compared to colonic resections. There is a need to introduce specific modifications on the protocols for colorectal surgeries when applied to these particular procedures.
    MeSH term(s) Colonic Neoplasms ; Digestive System Surgical Procedures ; Enhanced Recovery After Surgery ; Humans ; Length of Stay ; Postoperative Complications/epidemiology ; Rectal Neoplasms/surgery
    Language English
    Publishing date 2021-06-18
    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/s13304-021-01115-2
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  3. Article ; Online: Baiona's Consensus Statement for Fecal Incontinence. Spanish Association of Coloproctology.

    Cerdán Miguel, Javier / Arroyo Sebastián, Antonio / Codina Cazador, Antonio / de la Portilla de Juan, Fernando / de Miguel Velasco, Mario / de San Ildefonso Pereira, Alberto / Jiménez Escovar, Fernando / Marinello, Franco / Millán Scheiding, Mónica / Muñoz Duyos, Arantxa / Ortega López, Mario / Roig Vila, José Vicente / Salgado Mijaiel, Gervasio

    Cirugia espanola

    2024  Volume 102, Issue 3, Page(s) 158–173

    Abstract: 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 ... ...

    Abstract 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.
    MeSH term(s) Humans ; Electric Stimulation Therapy/methods ; Fecal Incontinence/diagnosis ; Fecal Incontinence/therapy ; Anal Canal ; Evidence-Based Medicine
    Language English
    Publishing date 2024-01-17
    Publishing country Spain
    Document type Journal Article
    ISSN 2173-5077
    ISSN (online) 2173-5077
    DOI 10.1016/j.cireng.2023.07.008
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  4. Article: Quality of life and 3D-EUS assessment for anal incontinence after childbirth.

    Tejedor, Patricia / Bodega-Quiroga, Ignacio / Plaza, Javier / Ortega López, Mario / Gutierrez, Carlos / García Olmo, Damian / Pastor, Carlos

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

    2019  Volume 111, Issue 6, Page(s) 453–459

    Abstract: Background: the incidence of obstetric sphincter tears has risen to 15-30% and the prevalence of anal incontinence (AI) symptoms after childbirth may be as high as 40%. The present study evaluates the correlation between obstetric injuries detected by ... ...

    Abstract Background: the incidence of obstetric sphincter tears has risen to 15-30% and the prevalence of anal incontinence (AI) symptoms after childbirth may be as high as 40%. The present study evaluates the correlation between obstetric injuries detected by endoanal ultrasound (3D-EUS) and AI symptoms, as well as their impact on the quality of life (QOL) of women after childbirth.
    Methods: a prospective observational study was performed of pregnant women evaluated before (baseline) and three months after childbirth to ensure the integrity of the anal sphincters and to evaluate possible injuries. The Fecal Incontinence Quality of Life (FIQL) questionnaire and the Cleveland Clinic Score of Incontinence (Wexner) were completed before and after childbirth. The questionnaire results were correlated with an assessment of sphincter defects performed by 3D-EUS.
    Results: a total of 56 females were included in the study. Overall, 48% developed symptoms of AI after childbirth, with a significant decrease in their FIQL compared to the initial evaluation, 3.9 (0.05) vs 3.4 (0.8), respectively (p = 0.000). In addition, 42% of the cohort presented with some kind of obstetric sphincter defect on the 3D-EUS. Instrumental assisted delivery and the sphincter defects were the only two significant factors identified via multivariate analysis that were associated with a decrease in QOL (0.4, 95% CI, 0.07-0.8).
    Conclusions: AI after childbirth was associated with a huge impact on QOL, especially in patients with sphincter injuries. A complete clinical evaluation, including 3D-EUS, is recommended to prevent, manage or treat AI in primiparous females.
    MeSH term(s) Adult ; Anal Canal/diagnostic imaging ; Anal Canal/injuries ; Delivery, Obstetric/adverse effects ; Endosonography ; Fecal Incontinence/etiology ; Female ; Humans ; Imaging, Three-Dimensional ; Pregnancy ; Prospective Studies ; Quality of Life
    Language English
    Publishing date 2019-04-25
    Publishing country Spain
    Document type Journal Article ; Observational Study
    ZDB-ID 1070381-0
    ISSN 1130-0108 ; 0212-7512
    ISSN 1130-0108 ; 0212-7512
    DOI 10.17235/reed.2019.6040/2018
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    Zs.B 199: Show issues Location:
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  5. Article ; Online: The Role of Three-Dimensional Endoanal Ultrasound on Diagnosis and Classification of Sphincter Defects After Childbirth.

    Tejedor, Patricia / Plaza, Javier / Bodega-Quiroga, Ignacio / Ortega-López, Mario / García-Olmo, Damián / Pastor, Carlos

    The Journal of surgical research

    2019  Volume 244, Page(s) 382–388

    Abstract: Background: Diagnostic tests for fecal incontinence have been improved over time. This study aims to evaluate the role of Three-dimensional endoanal ultrasound (3D-EUS) and the Starck's score in the assessment and treatment of obstetric sphincter ... ...

    Abstract Background: Diagnostic tests for fecal incontinence have been improved over time. This study aims to evaluate the role of Three-dimensional endoanal ultrasound (3D-EUS) and the Starck's score in the assessment and treatment of obstetric sphincter injuries.
    Methods: A prospective observational study was performed including primiparous women who were evaluated at 20 wk of pregnancy and 3 mo after childbirth. Sphincter defects were classified according to the Starck's and Obstetrical Anal Sphincter Injuries classifications. Patients also completed the Fecal Incontinence Quality of Life and the Wexner questionnaires before and after childbirth.
    Results: Sphincter defects were detected in 45% of the 56 women included, although 85% had an uneventful delivery. Most defects were found isolated to the external anal sphincter except for two cases, classified by a Starck's score >8. Fecal Incontinence Quality of Life and Wexner questionnaires showed a rate of symptomatic patients of around 46%. We observed that 30% of patients with sphincter injuries remained asymptomatic.
    Conclusions: The 3D-EUS is a useful test in assessing sphincter defects after childbirth. This method makes it possible to detect small sphincter defects that otherwise would have gone unnoticed, as 30% of patients with sphincter injuries were asymptomatic. In addition, both the 3D-EUS and the Starck's score were valuable in establishing an algorithm for the treatment of obstetric sphincter injuries.
    MeSH term(s) Adult ; Anal Canal/diagnostic imaging ; Anal Canal/injuries ; Endosonography/methods ; Fecal Incontinence/diagnostic imaging ; Female ; Humans ; Imaging, Three-Dimensional/methods ; Obstetric Labor Complications/diagnostic imaging ; Pregnancy ; Prospective Studies
    Language English
    Publishing date 2019-07-17
    Publishing country United States
    Document type Journal Article ; Observational Study
    ZDB-ID 80170-7
    ISSN 1095-8673 ; 0022-4804
    ISSN (online) 1095-8673
    ISSN 0022-4804
    DOI 10.1016/j.jss.2019.06.080
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  6. Article ; Online: Short-term outcomes and benefits of ERAS program in elderly patients undergoing colorectal surgery: a case-matched study compared to conventional care.

    Tejedor, Patricia / Pastor, Carlos / Gonzalez-Ayora, Santiago / Ortega-Lopez, Mario / Guadalajara, Hector / Garcia-Olmo, Damian

    International journal of colorectal disease

    2018  Volume 33, Issue 9, Page(s) 1251–1258

    Abstract: Purpose: The aim of the study was to evaluate the benefits of implementing Enhanced Recovery After Surgery (ERAS) protocols in elderly patients undergoing elective colorectal surgery.: Methods: A retrospective non-randomized cohort study was ... ...

    Abstract Purpose: The aim of the study was to evaluate the benefits of implementing Enhanced Recovery After Surgery (ERAS) protocols in elderly patients undergoing elective colorectal surgery.
    Methods: A retrospective non-randomized cohort study was conducted from September 2012 to December 2016. We included patients ≥ 70 years undergoing elective colorectal surgery. Outcome measures, compliance with interventions, and postoperative complications of patients treated under ERAS were case-matched (based on gender, age, type of surgery, and the presence/absence of a temporal stoma) to a retrospective group of patients ≥ 70 years treated under conventional care.
    Results: A total of 312 patients (156 ERAS vs. 156 non-ERAS) were included in the study. The ERAS group had a significant reduction of grade III/IV Dindo-Clavien's postoperative complications when compared with conventional care. ERAS had a positive effect in reducing anastomotic leakage (14.7% non-ERAS vs. 9%) and postoperative mortality (11.5% non-ERAS vs. 1.9% ERAS; p = 0.001). A reduction of 2 days in length of hospital stay was achieved after implementing ERAS (8 (6.75) vs. 6 (5.25); p < 0.0001), while readmission rates remained unaffected. The average of global compliance (GC) with all ERAS interventions was 42%. GC was significantly lower in patients with permanent/temporary stomas and in patients in whom an open approach was performed.
    Conclusion: In our experience, ERAS should be implemented without reservations in elderly patients expecting the same goals and benefits as with other age groups. Barriers in achieving a high compliance rate are common and will require a great effort in patient's education, an intensive perioperative care, and sometimes a change in the surgeons' practice.
    MeSH term(s) Aged ; Aged, 80 and over ; Colorectal Surgery ; Digestive System Surgical Procedures ; Female ; Humans ; Length of Stay ; Male ; Perioperative Care ; Postoperative Care ; Postoperative Complications ; Recovery of Function ; Retrospective Studies ; Spain
    Language English
    Publishing date 2018-05-03
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 84975-3
    ISSN 1432-1262 ; 0179-1958
    ISSN (online) 1432-1262
    ISSN 0179-1958
    DOI 10.1007/s00384-018-3057-z
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  7. Article ; Online: Prevalence of anal incontinence in a working population within a healthcare environment.

    Cerdán Santacruz, Carlos / Santos Rancaño, Rocío / Vigara García, Marta / Fernández Pérez, Cristina / Ortega López, Mario / Cerdán Miguel, Javier

    Scandinavian journal of gastroenterology

    2017  Volume 52, Issue 12, Page(s) 1340–1347

    Abstract: Objectives: Anal incontinence is a devastating affliction with several considerations that make it difficult to define in terms of epidemiology with good precision. The aim of the present work is to study the prevalence of an important disorder such as ... ...

    Abstract Objectives: Anal incontinence is a devastating affliction with several considerations that make it difficult to define in terms of epidemiology with good precision. The aim of the present work is to study the prevalence of an important disorder such as anal incontinence in a healthy working population within a sanitary environment.
    Material and methods: A cluster of easy understanding and filling inquiry forms are distributed to 910 apparently healthy individuals at our hospital. This questionnaires include filiation data, passed medical history, presence or not of Incontinence and other symptoms such as urgency. The Cleveland Clinic Incontinence Score is also registered.
    Results: Anal incontinence is present in a 21.2% of subjects when considered in any of it forms (flatus, liquid or solid faeces). A Clevleand Clinic Incontinence Score higher than 6 was obtained in a 7.3% of the sample and higher than 10 in 1.2%. No gender predominance has been identified. A slightly higher severity is recognised with increasing age. Obstetric and anal surgical background are the only related factors identified in the studied sample.
    Conclusions: Faecal incontinence is a high prevalent affliction, even among apparently healthy population. Considering the aetiologic factors that have been established, prevention during obstetric and anal surgical procedures is absolutely mandatory.
    Language English
    Publishing date 2017-12
    Publishing country England
    Document type Journal Article
    ZDB-ID 82042-8
    ISSN 1502-7708 ; 0036-5521
    ISSN (online) 1502-7708
    ISSN 0036-5521
    DOI 10.1080/00365521.2017.1378713
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  8. Article ; Online: Obstructive cecal cancer in a centennial patient: Surgical management.

    Cerdán Santacruz, Carlos / Vigara García, Marta / Jiménez Escovar, Fernando / Ortega López, Mario / Cerdán Miguel, Javier

    Cirugia espanola

    2015  Volume 93, Issue 10, Page(s) e149–51

    MeSH term(s) Cecal Neoplasms/surgery ; Humans ; Intestinal Obstruction/surgery
    Language Spanish
    Publishing date 2015-12
    Publishing country Spain
    Document type Journal Article
    ZDB-ID 730701-9
    ISSN 1578-147X ; 0009-739X
    ISSN (online) 1578-147X
    ISSN 0009-739X
    DOI 10.1016/j.ciresp.2014.03.010
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  9. Article ; Online: Resultados de la implantación de un protocolo de fast-track en una unidad de cirugía colorrectal: estudio comparativo.

    Esteban Collazo, Fernando / Garcia Alonso, Mauricio / Sanz Lopez, Rodrigo / Sanz Ortega, Gonzalo / Ortega Lopez, Mario / Zuloaga Bueno, Jaime / Jimenez Escovar, Fernando / Cerdán Miguel, F Javier

    Cirugia espanola

    2012  Volume 90, Issue 7, Page(s) 434–439

    Abstract: Objective: To implement a fast-track (FT) protocol in a colorectal surgery unit, checking its safety when applied to patients subjected to elective colorectal surgery, by evaluating the differences in morbidity and hospital stay compared to a control ... ...

    Title translation Results of applying a fast-track protocol in a colorectal surgery unit: comparative study.
    Abstract Objective: To implement a fast-track (FT) protocol in a colorectal surgery unit, checking its safety when applied to patients subjected to elective colorectal surgery, by evaluating the differences in morbidity and hospital stay compared to a control group with traditional care. We also analyse the functional recovery of the FT group.
    Material and method: A prospective cohort study with non-concurrent control, was conducted on a group of 108 patients operated on for colorectal cancer between 2008 and 2009, to which the FT protocol was applied, and a control group (CG) of 147 patients subjected to surgery between 2005 and 2007 with similar characteristics, with traditional postoperative care.
    Results: The demographic characteristics, anaesthetic risk, and the surgical procedures performed were similar, with a higher number of patients with laparoscopic approach in the FT group. The compliance with the items in our FT protocol was high (72.2-92.6%). Complications were observed in 77 patients (52%) in the GC compared to 30 (27.8%) in the FT group (P<.001), mainly due to the decrease in surgical wound infection (P<.001). Mortality and the number of readmissions were less in the FT group, with no statistically significant differences. The median hospital stay was 14 days in the CG and 8 in the FT group (P<.001).
    Conclusions: The applying of an FT program in colorectal surgery is safe, leading to a significant decrease in morbidity and hospital stay, without increasing the number of readmissions.
    MeSH term(s) Aged ; Clinical Protocols ; Colorectal Neoplasms/surgery ; Colorectal Surgery/adverse effects ; Colorectal Surgery/methods ; Female ; Humans ; Male ; Prospective Studies ; Time Factors
    Language Spanish
    Publishing date 2012-08
    Publishing country Spain
    Document type Comparative Study ; English Abstract ; Journal Article
    ZDB-ID 730701-9
    ISSN 1578-147X ; 0009-739X
    ISSN (online) 1578-147X
    ISSN 0009-739X
    DOI 10.1016/j.ciresp.2012.02.012
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