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Article ; Online: LIFT procedure: postoperative outcomes, risk factors for fistula recurrence and continence impairment.

Salgado-Nesme, N / Alvarez-Bautista, F E / Mongardini, F M / Docimo, L / Hoyos-Torres, A / Ruiz-Muñoz, E A / Vergara-Fernàndez, O / Suastegui, H O Gómez / Illanes, M F Rojas / Reyes, N D Mitre

Updates in surgery

2024

Abstract: Ligation of the intersphincteric fistula tract has been recently employed as definitive treatment of anal fistulas. However, it carries a potential risk of continence impairment, fistula recurrence, and repeated operations. This study aimed to assess ... ...

Abstract	Ligation of the intersphincteric fistula tract has been recently employed as definitive treatment of anal fistulas. However, it carries a potential risk of continence impairment, fistula recurrence, and repeated operations. This study aimed to assess postoperative outcomes related to this procedure and evaluate the potential influence of preoperative and intraoperative features. Patients who underwent LIFT procedure between June 2012 and September 2021 were retrospectively analyzed. Patients were divided according to whether they developed fistula recurrence and on the history of a surgery prior to the LIFT. Preoperative features, postoperative outcomes, and risk factors adverse outcomes were analyzed. Forty-eight patients were included, of which 25 received primary LIFT, being the high transsphincteric fistula pattern the most frequent (62.5%). The median follow-up was 13.3 months, with a recurrence rate of 20.8%, of which the majority presented an intersphincteric fistula pattern (50%); and continence impairment rate of 16.7%. A higher prevalence of diabetes (p = 0.026) and a trend towards a higher prevalence of patients with a history of high transsphincteric fistula (0.052) were observed in the group with fistula recurrence. The history of diabetes and the operation time with a cut-off value ≥ 69 min showed a trend as a risk factors for developing fistula recurrence (0.06) and postoperative continence impairment (0.07), respectively. The LIFT procedure seems to be safe in terms of morbidity, with a reasonable incidence of recurrences, showing better results when it is primarily performed. Preoperative characteristics should be considered as they may impact outcomes.
Language	English
Publishing date	2024-04-04
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/s13304-024-01818-2
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Article ; Online: Adult intussusception: still a challenging diagnosis for the surgeon.

Álvarez-Bautista, F E / Moctezuma-Velázquez, P / Pimienta-Ibarra, A S / Vergara-Fernández, O / Salgado-Nesme, N

Revista de gastroenterologia de Mexico (English)

2022 Volume 88, Issue 4, Page(s) 315–321

Abstract: Introduction and aim: Intussusception is rare in adults and can occur in the small bowel and colon. Its atypical presentation makes the diagnosis difficult. The aim of the present study was to evaluate the causes, clinical characteristics, and treatment ...

Abstract	Introduction and aim: Intussusception is rare in adults and can occur in the small bowel and colon. Its atypical presentation makes the diagnosis difficult. The aim of the present study was to evaluate the causes, clinical characteristics, and treatment outcomes of adult intussusception and to determine whether there was an association between etiology and clinical presentation. Materials and methods: A retrospective study was carried out on patients above 18 years of age that were treated for intussusception at a tertiary care hospital, between 2000 and 2020. The findings were summarized utilizing descriptive and inferential statistics. Results: Twenty-eight cases were identified. Median patient age was 46 years (18-80) and median symptom duration was 18 days. Abdominal pain was the most frequent symptom (96.42%). The intussusceptions registered were enteroenteric (14), ileocecal (4), ileocolonic (4), colocolonic (5), and colorrectal (1). Intussusception etiology was benign in 15 cases, 9 were associated with malignancy, and 4 were idiopathic. Surgery was performed on 11 patients with enteroenteric intussusception and on all the cases of ileocecal, ileocolonic, colocolonic, and colorectal intussusception. There were 2 events of perioperative mortality (8%) and 8 of postoperative morbidity (32%). No significant differences were found regarding symptom duration or length of hospital stay, when the etiologic groups were compared. Conclusions: Intussusception is rare in adults. Diagnosis is a challenge because of the nonspecific signs and symptoms. Surgical resection should be considered in the definitive treatment and management should be individualized according to the patient's comorbidities, clinical presentation, and risk of malignancy.
MeSH term(s)	Adult ; Humans ; Adolescent ; Young Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Intussusception/diagnosis ; Intussusception/surgery ; Retrospective Studies ; Treatment Outcome ; Surgeons ; Neoplasms
Language	English
Publishing date	2022-07-07
Publishing country	Mexico
Document type	Case Reports ; Journal Article
ZDB-ID	2828765-4
ISSN	2255-534X ; 2255-534X
ISSN (online)	2255-534X
ISSN	2255-534X
DOI	10.1016/j.rgmxen.2022.06.009
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Article ; Online: Colon contrast enema showing the anatomy after a Deloyers procedure.

Salgado-Nesme, Noel / Hernández Ortiz, Jorge / Moctezuma-Velázquez, Paulina

ANZ journal of surgery

2022 Volume 93, Issue 1-2, Page(s) 351

MeSH term(s)	Humans ; Colon/diagnostic imaging ; Colon/surgery ; Barium Enema
Language	English
Publishing date	2022-05-02
Publishing country	Australia
Document type	Case Reports
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.17752
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Article: Pelvic Diameter is not Associated with Positive Circumferential Resection Margin in Rectal Cancer: Retrospective Analysis of 78 Cases

Vergara-Fernández, Omar / Ruiz-Muñoz, Erick Alejandro / la Peña, Danilo Tueme-de / Bravo-Ávila, Héctor E. / Hoyos-Torres, Alejandro / Salgado-Nesme, Noel

Journal of Coloproctology

2024 Volume 44, Issue 01, Page(s) e63–e70

Abstract: Objective: To identify if there is an association between pelvic entry and pelvic outlet diameters with increased positive circumferential resection margin (CRM) in rectal cancer.: Introduction: Positive CRM in rectal cancer is a major predictor for ... ...

Abstract	Objective: To identify if there is an association between pelvic entry and pelvic outlet diameters with increased positive circumferential resection margin (CRM) in rectal cancer. Introduction: Positive CRM in rectal cancer is a major predictor for local and distant recurrence. Pelvic diameters may be related to the difficulty of dissection, as well as intrinsic tumor characteristics such as tumor size, location, distance from the anal margin, and T stage, which may compromise the integrity of the mesorectum and circumferential margin involvement. Methods: A retrospective review of the patient's medical records who underwent surgical resection of rectal adenocarcinoma from January 2012 to June 2022 was performed. The patient's preoperative staging, operative characteristics, and histopathologic outcomes were gathered from the medical records. Preoperative MRI scanning was done in all patients. MRI pelvimetry was done by two observers. CRM involvement was recorded as stated in the pathology report. Pelvimetry variables were dichotomized according to their mean values for correlation analysis. The odds ratio (OR) was calculated from a binary logistics regression model to assess the relation between the positive CRM and the independent variables. Results: A total of 78 patients were included in this study. A positive CRM was reported in 10 patients (12.8%). BMI >27.4 + 6.6 ( p = 0.02), positive extramural vascular invasion ( p = 0.027), positive CRM by MRI scanning ( p = 0.004), and anal sphincter involvement ( p = 0.03) were associated with positive CRM. Pelvimetry values were not associated with a positive CRM. Conclusion: No association was found between the pelvic diameters measured by MRI pelvimetry with a positive CRM.
Keywords	magnetic resonance pelvimetry ; pelvic outlet diameter ; pelvimetry ; circumferential resection margin ; rectal cancer
Language	English
Publishing date	2024-03-01
Publisher	Thieme Revinter Publicações Ltda.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2664477-0
ISSN	2317-6423 ; 2237-9363 ; 2317-6423
ISSN (online)	2317-6423
ISSN	2237-9363 ; 2317-6423
DOI	10.1055/s-0044-1782152
Database	Thieme publisher's database

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Article ; Online: Usefulness of a circumferential wound retractor in emergency colorectal surgery as a preventive measure for surgical site infection. Alexis O-Ring® and emergency surgery.

Salgado-Nesme, N / Morales-Cruz, M / Navarro-Navarro, A / Patiño-Gómez, T A / Vergara-Fernández, O

Revista de gastroenterologia de Mexico (English)

2020 Volume 85, Issue 4, Page(s) 399–403

Abstract: Introduction and aims: More than 20% of healthcare-associated infections correspond to those at surgical sites, and there is a higher incidence of infections in colorectal surgery due to the associated bacterial load. Surgical wound protectors are ... ...

Title translation	Utilidad del separador circunferencial para herida en cirugía colorrectal de urgencia como medida preventiva para infección del sitio quirúrgico. El Alexis O-Ring® y la cirugía de urgencia.
Abstract	Introduction and aims: More than 20% of healthcare-associated infections correspond to those at surgical sites, and there is a higher incidence of infections in colorectal surgery due to the associated bacterial load. Surgical wound protectors are designed to prevent contamination and mechanical trauma. Our aim was to demonstrate the usefulness of a circumferential wound retractor/protector for the prevention of surgical site infections (SSIs) in emergency colorectal surgery. Methods: Forty-one patients that underwent emergency open surgery at a tertiary care hospital were randomized into 2 groups: 20 cases without the retractor (group A) and 21 cases with the retractor (group B). Subjects were assigned to a group in a 1:1 randomization allocation ratio. The chi-square and Fisher's exact tests were employed for the quantitative variables, and the statistical analysis was performed using the IBM Statistical Package for the Social Sciences software for Mac, version 16.0 (IBM SPSS Inc., Chicago, IL, USA). Results: The SSI rate was 17%. Six group A patients developed SSI versus one group B patient. The use of a circumferential wound retractor/protector was statistically significant for the prevention of surgical wound infections, with a P=.031 and an OR of 8.5. In addition, preoperative blood glucose levels below 200mg/dl provided a 3.2-times higher protective effect, compared with glucose levels above 200mg/dl. Conclusions: In the present prospective randomized pilot study, the use of the circumferential wound retractor/protector significantly decreased the likelihood of SSI in emergency colorectal surgery.
Language	Spanish
Publishing date	2020-05-26
Document type	Journal Article
ISSN	2255-534X
ISSN (online)	2255-534X
DOI	10.1016/j.rgmx.2019.08.009
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Article: Sarcopenia in patients with colorectal cancer: A comprehensive review.

Vergara-Fernandez, Omar / Trejo-Avila, Mario / Salgado-Nesme, Noel

World journal of clinical cases

2020 Volume 8, Issue 7, Page(s) 1188–1202

Abstract: Colorectal cancer (CRC) is the third most commonly diagnosed cancer globally and the second cancer in terms of mortality. The prevalence of sarcopenia in patients with CRC ranges between 12%-60%. Sarcopenia comes from the Greek "sarx" for flesh, and " ... ...

Abstract	Colorectal cancer (CRC) is the third most commonly diagnosed cancer globally and the second cancer in terms of mortality. The prevalence of sarcopenia in patients with CRC ranges between 12%-60%. Sarcopenia comes from the Greek "sarx" for flesh, and "penia" for loss. Sarcopenia is considered a phenomenon of the aging process and precedes the onset of frailty (primary sarcopenia), but sarcopenia may also result from pathogenic mechanisms and that disorder is termed secondary sarcopenia. Sarcopenia diagnosis is confirmed by the presence of low muscle quantity or quality. Three parameters need to be measured: muscle strength, muscle quantity and physical performance. The standard method to evaluate muscle mass is by analyzing the tomographic total cross-sectional area of all muscle groups at the level of lumbar 3rd vertebra. Sarcopenia may negatively impact on the postoperative outcomes of patients with colorectal cancer undergoing surgical resection. It has been described an association between sarcopenia and numerous poor short-term CRC outcomes like increased perioperative mortality, postoperative sepsis, prolonged length of stay, increased cost of care and physical disability. Sarcopenia may also negatively impact on overall survival, disease-free survival, recurrence-free survival, and cancer-specific survival in patients with non-metastatic and metastatic colorectal cancer. Furthermore, patients with sarcopenia seem prone to toxic effects during chemotherapy, requiring dose deescalations or treatment delays, which seems to reduce treatment efficacy. A multimodal approach including nutritional support (dietary intake, high energy, high protein, and omega-3 fatty acids), exercise programs and anabolic-orexigenic agents (ghrelin, anamorelin), could contribute to muscle mass preservation. Addition of sarcopenia screening to the established clinical-pathological scores for patients undergoing oncological treatment (chemotherapy, radiotherapy or surgery) seems to be the next step for the best of care of CRC patients.
Language	English
Publishing date	2020-03-30
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2307-8960
ISSN	2307-8960
DOI	10.12998/wjcc.v8.i7.1188
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Article ; Online: Deloyers procedure compared to ileorectal anastomosis as restoration techniques of bowel continuity after extended left colon resection.

Carpinteyro-Espín, Paulina / Santes, Oscar / Moctezuma-Velazquez, Paulina / Navarro-Iñiguez, Julio A / Navarro-Navarro, Adolfo / Salgado-Nesme, Noel

ANZ journal of surgery

2022 Volume 93, Issue 4, Page(s) 956–962

Abstract: Background: Restoration of bowel continuity after left extended colectomy may be challenging because the remaining colon may not reach the rectal stump without tension to perform a safe anastomosis. Performing a total colectomy with ileorectal ... ...

Abstract	Background: Restoration of bowel continuity after left extended colectomy may be challenging because the remaining colon may not reach the rectal stump without tension to perform a safe anastomosis. Performing a total colectomy with ileorectal anastomosis (IRA) is an option, but the quality of life can be significantly impaired due to loose stools and an increase in bowel frequency. In contrast, the preservation of the right colon and ileocaecal valve in the Deloyers procedure (DP) might ensure a better stool consistency and bowel transit, and therefore a superior quality of life. Materials and methods: A transverse study comparing patients that underwent DP versus patients with an IRA was performed. Postoperative morbidity, mortality, functional outcomes, and quality of life were analysed between groups. Quality of life after the surgical procedure was assessed with the SF-36 V2® health survey. Results: A total of 16 patients with DP and 32 with IRA were included. The groups had similar demographic characteristics concerning age, sex, body mass index, ASA classification, diagnosis and Charlson comorbidity index. The median follow-up was 55 months for DP and 99 months for IRA. Postoperative complications were similar in both groups. Patients in the DP group had fewer bowel movements (P = 0.01), tenesmus (P = 0.04) and use of loperamide (P = 0.03). DP patients achieved better scores in physical pain (P = 0.02) and general health (P < 0.01) than IRA patients. Conclusions: DP for intestinal continuity restoration after extended left colon resection is a safe and feasible alternative, possibly achieving better functional outcomes and quality-of-life compared to IRA.
MeSH term(s)	Humans ; Quality of Life ; Rectum/surgery ; Colon/surgery ; Anastomosis, Surgical/methods ; Colectomy/methods ; Ileum/surgery
Language	English
Publishing date	2022-10-05
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.18084
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Article ; Online: The Mexican consensus on fecal incontinence.

Remes-Troche, J M / Coss-Adame, E / García-Zermeño, K R / Gómez-Escudero, O / Amieva-Balmori, M / Gómez-Castaños, P C / Charúa-Guindic, L / Icaza-Chávez, M E / López-Colombo, A / Morel-Cerda, E C / Pérez Y López, N / Rodríguez-Leal, M C / Salgado-Nesme, N / Sánchez-Avila, M T / Valdovinos-García, L R / Vergara-Fernández, O / Villar-Chávez, A S

Revista de gastroenterologia de Mexico (English)

2023 Volume 88, Issue 4, Page(s) 404–428

Abstract: Fecal incontinence is the involuntary passage or the incapacity to control the release of fecal matter through the anus. It is a condition that significantly impairs quality of life in those that suffer from it, given that it affects body image, self- ... ...

Abstract	Fecal incontinence is the involuntary passage or the incapacity to control the release of fecal matter through the anus. It is a condition that significantly impairs quality of life in those that suffer from it, given that it affects body image, self-esteem, and interferes with everyday activities, in turn, favoring social isolation. There are no guidelines or consensus in Mexico on the topic, and so the Asociación Mexicana de Gastroenterología brought together a multidisciplinary group (gastroenterologists, neurogastroenterologists, and surgeons) to carry out the «Mexican consensus on fecal incontinence» and establish useful recommendations for the medical community. The present document presents the formulated recommendations in 35 statements. Fecal incontinence is known to be a frequent entity whose incidence increases as individuals age, but one that is under-recognized. The pathophysiology of incontinence is complex and multifactorial, and in most cases, there is more than one associated risk factor. Even though there is no diagnostic gold standard, the combination of tests that evaluate structure (endoanal ultrasound) and function (anorectal manometry) should be recommended in all cases. Treatment should also be multidisciplinary and general measures and drugs (lidamidine, loperamide) are recommended, as well as non-pharmacologic interventions, such as biofeedback therapy, in selected cases. Likewise, surgical treatment should be offered to selected patients and performed by experts.
MeSH term(s)	Humans ; Fecal Incontinence/diagnosis ; Fecal Incontinence/therapy ; Fecal Incontinence/etiology ; Consensus ; Mexico/epidemiology ; Quality of Life ; Loperamide/therapeutic use
Chemical Substances	Loperamide (6X9OC3H4II)
Language	English
Publishing date	2023-12-13
Publishing country	Mexico
Document type	Practice Guideline
ZDB-ID	2828765-4
ISSN	2255-534X ; 2255-534X
ISSN (online)	2255-534X
ISSN	2255-534X
DOI	10.1016/j.rgmxen.2023.08.003
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Article ; Online: Meta-analysis of botulinum toxin injection for chronic anal fissure: healing rates controversies.

Vergara-Fernández, O / Salgado-Nesme, N / Navarro-Navarro, A / Rangel-Ríos, H A

Techniques in coloproctology

2017 Volume 21, Issue 2, Page(s) 169

Language	English
Publishing date	2017
Publishing country	Italy
Document type	Letter ; Comment
ZDB-ID	2083309-X
ISSN	1128-045X ; 1123-6337
ISSN (online)	1128-045X
ISSN	1123-6337
DOI	10.1007/s10151-016-1563-y
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Article ; Online: Multivariate analysis of risk factors for complications after loop ileostomy closure.

Vergara-Fernández, Omar / Trejo-Avila, Mario / Salgado-Nesme, Noel

Cirugia y cirujanos

2019 Volume 87, Issue 3, Page(s) 337–346

Abstract: Background: Despite the advantages of diverting loop ileostomy construction, it is related to complications.: Objective: The aim of the study was to determine the risk factors for complications after loop ileostomy closure.: Methods: Patients who ... ...

Title translation	Análisis multivariable de los factores de riesgo asociados a complicaciones posterior al cierre de ileostomía en asa.
Abstract	Background: Despite the advantages of diverting loop ileostomy construction, it is related to complications. Objective: The aim of the study was to determine the risk factors for complications after loop ileostomy closure. Methods: Patients who underwent loop ileostomy closure from January 2010 to March 2018 were retrospectively analyzed. Multivariate logistic regression was used to determine the effect of the potential risk factors on the rate of each complication. Results: A total of 136 patients underwent reversal. Indications for the initial operation were colorectal cancer (39.7%), diverticulitis (25.7%), idiopathic chronic ulcerative colitis (ICUC) (8.1%), familial adenomatous polyposis (FAP) (7.4%), and others (19.1%). Multivariate analysis identified the following risk factors: type of incision (midline laparotomy) (odds ratio [OR] = 6.5) for wound infection; treatment with immunomodulator (OR = 12.5) for anastomotic leak; history of FAP (OR = 9.8) for intestinal obstruction; previous use of immunomodulator (OR = 10.0) and performing reversal through midline incision (OR = 18.9) for reoperation; and ≥ 65 years old (OR = 3.5) for medical complications. The rate of incisional hernia was 11%, and the risk factors were time to closure < 3 months (OR = 6.4) and parastomal hernia (OR = 13.2). Conclusions: Several patient-related and surgical technique factors should be considered at the time of loop ileostomy closure to reduce post-operative morbidity.
MeSH term(s)	Aged ; Female ; Humans ; Ileostomy/adverse effects ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Care ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Retrospective Studies ; Risk Factors
Language	English
Publishing date	2019-04-25
Publishing country	Mexico
Document type	Journal Article
ZDB-ID	730699-4
ISSN	2444-054X ; 0009-7411
ISSN (online)	2444-054X
ISSN	0009-7411
DOI	10.24875/CIRU.18000611
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