[Sacral neuromodulation. Long-term results]. / Neuromodulación. sacra. Resultados a largo plazo.

Sacral neuromodulation involves electrical stimulation of af­ferent nerve roots to restore the balance between inhibitory and excitatory reflexes who improve the functional activity of the pelvic floor. With benefits in patients with fecal inconti­nence, constipation and chronic anorectal pain. Objective. The aim of this study is present the results obtained with sacral neuromodulation for the treatment of patients with fecal incontinence, severe and intractable chronic constipa­tion and chronic anorectal pain. Patients and methods. 33 patients had indication for transitory electrical sacral stimu­lation, 25 patients performed transitory electrical stimula­tion for fecal incontinence, 5 with refractary constipation and 3 with chronic anorectal pain. In cases of fecal inconti­nence, the patients performed previous anorectal manometry and ultrasonography examination of anal sphincters. When the constipation is the indication, we performed stimulation in patients with severe and refractary constipation like step before total colectomy. In cases of chronic anorectal pain, the electrical transitory test was performed according to our treatment algorithm for management of functional anorectal pain. In all cases, if the patients had satisfactory results after 2 weeks period the definitive implant was placed. Results. Mean follow-up was 69 months (range 6-130). Definitve implant was placed for treatment of fecal incontinence in 23 patients with a decrease in fecal incontinence scores in 98%, with an average success rate of 66% (range: 45-92). In cases of constipation, 3 definitive implants were placed, the mean follow-up was 77 months (range: 51-96) with a success rate between 50%-80% as measured by bowel frequency. We performed definitive electrical stimulation in 3 patients wit chronic and intractable anorectal pain. Response rates as measured by visual analog scale were between 40%-70%. Conclusions. Sacral neuromodulation is an area in constant growth, with more indications. The success depends on the correct indication and the patients need to be treated with other therapeutic options before sacral neuromodulation.

[Anorectal manometry and ultrasound in the study of patients with fecal incontinence]. / Ecografía anorrectal y manometría en el estudio de pacientes con incontinencia fecal.

INTRODUCTION: Fecal incontinence is a complex disease that affects the quality of life of patients suffering from it. Anorectal manometry and endoanal ultrasound 360 grades are included among the studies used. There are no clear agreement about the relevance and usefulness of this studies and their role as apart of diagnostic procedures. OBJECTIVE: To describe the relationship between the clinical severity score in patients with fecal incontinence and the findings of anorectal manometry and endoanal ultrasound. Another objective of this study is to describe the degree of agreement of both methods of study. MATERIAL AND METHODS: The study population includes 74 patients who underwent endoanal ultrasonography and anorectal manometry for fecal incontinence. The presence or absence of ultrasound injury, the pressures obtained by anorectal manometry and its relationship with clinical severity of patients were described. An analysis of the degree of agreement between both methods was performed. RESULTS: The mean age of patients was 53 years old (range 19-84 years). Pressures of anorectal manometry were reduced in 59 patients (79.7%) and normal in 15 (20.3%). The assessment of the degree of agreement or concordance between ultrasound and anorectal manometry yielded a kappa coefficient of 0.25 (acceptable) (P = 0.0001). CONCLUSION: There is a level of acceptable agreement between endoanal ultrasound findings and anorectal manometry when patients with fecal incontinence are evaluated.

Abordaje anatómico del sector ilíaco / Anatomical access for iliac area

Se describe una vía de abordaje anatómico, de excepción, del sector vascular ilíaco externo, interno y primitivo, basado en disecciones anatómicas. Material y métodos: Se realizaron 52 disecciones de región inguino-crural con extensión al flanco, en cadáveres. Se utilizó esta vía de abordaje en 30 casos quirúrgicos, y en patología vascular se utilizó en 10 pacientes. Resultados: Se constató en cirugía los hallazgos anatómicos. Brindó una vía de abordaje amplia y suficiente para la operación planeada, no siendo necesario cambiar dicho acceso en ningún caso, así como tampoco se han registrado eventraciones. Conclusiones: 1) Se trata de una vía de excepción. 2) Puede ser utilizada en pacientes de alto riesgo cardiológico y/o respiratorio. 3) En traumatismos abiertos o cerrados que comprometen el sector femoral con el fin de efectuar hemostasia transitoria. 4) Ofrece una alternativa, en casos seleccionados, al by pass axilo-bifemoral. 5) Los riesgos de lesión de los elementos nerviosos de la región, se obvian fácilmente con la clara exposición de los mismos (AU)

Abordaje anatómico del sector ilíaco / Anatomical access for iliac area

Se describe una vía de abordaje anatómico, de excepción, del sector vascular ilíaco externo, interno y primitivo, basado en disecciones anatómicas. Material y métodos: Se realizaron 52 disecciones de región inguino-crural con extensión al flanco, en cadáveres. Se utilizó esta vía de abordaje en 30 casos quirúrgicos, y en patología vascular se utilizó en 10 pacientes. Resultados: Se constató en cirugía los hallazgos anatómicos. Brindó una vía de abordaje amplia y suficiente para la operación planeada, no siendo necesario cambiar dicho acceso en ningún caso, así como tampoco se han registrado eventraciones. Conclusiones: 1) Se trata de una vía de excepción. 2) Puede ser utilizada en pacientes de alto riesgo cardiológico y/o respiratorio. 3) En traumatismos abiertos o cerrados que comprometen el sector femoral con el fin de efectuar hemostasia transitoria. 4) Ofrece una alternativa, en casos seleccionados, al by pass axilo-bifemoral. 5) Los riesgos de lesión de los elementos nerviosos de la región, se obvian fácilmente con la clara exposición de los mismos