[A prospective, randomised, controlled study on the need to mechanically prepare the colon in scheduled colorectal surgery]. / Estudio prospectivo controlado y aleatorizado sobre la necesidad de la preparación mecánica de colon en la cirugía programada colorrectal.

INTRODUCTION: Mechanical preparation of the colon (MPC) in colorectal surgery has been a dogma that has been questioned over the last few years. The objective of this study is to demonstrate that morbidity in scheduled colorectal surgery is the same or lower without MPC. MATERIAL AND METHOD: Patients subjected to scheduled left colon and rectal surgery with primary anastomosis randomised into two groups. The "Preparation" group (MPC) received MPC and the "non-preparation" group (No-MPC) had only cleaning enemas. The variables collected were: demographic, oncological, nutritional, risk prediction models and morbidity-mortality. RESULTS: Of the 193 patients included: 69 received MPC and 71 did not; 89 patients with colocolic anastomosis (MPC, 38; no MPC, 51) and 50 colorectal (MPC, 31; no MPC, 19). Statistically significant differences were seen in the overall analysis in favour of "no preparation" as regards morbidity (43.55 % with MPC and 27% with No MPC) and nosocomial infection (27.5% and 11.4%). There was 11.6% wound infections in the MPC compared to 5.7% in the no MPC, which was not statistically significant. The only mortalities were in the MPC group 2/69 (2.9% of patients). As regards the location of the anastomosis, in the colocolics the differences were more pronounced, with statistically significant differences in the morbidity, anastomosis dehiscence, and nosocomial infection variables. The effect of no MPC was not so evident in colorectal anastomosis. CONCLUSIONS: Our results suggest that there is no benefit in MPC before surgery in colocolic anastomosis. No-MPC is not associated with a higher morbidity in wound infection or anastomotic dehiscence. In colorectal anastomosis the differences are not so evident, therefore a much bigger series needs to be studied.

Estudio prospectivo controlado y aleatorizado sobrela necesidad de la preparación mecánica de colonen la cirugía programada colorrectal / A prospective, randomised, controlled study on the need to mechanically prepare the colon in scheduled colorectal surgery

Introducción: la preparación mecánica de colon (PMC) en la cirugía colorrectal es un dogma que se ha cuestionado en los últimos años. El objetivo de este estudio es demostrar que la morbilidad en cirugía programada colorrectal es igual o menor sin la PMC. Material y método: pacientes sometidos a cirugía programada de colon izquierdo y recto con anastomosis primaria fueron aleatorizados en dos grupos. Al grupo PMC se le practicó la preparación y al grupo sin PMC, sólo enemas de limpieza. Se recogieron variables demográficas, oncológicas, nutricionales y quirúrgicas, modelos de predicción de riesgo y morbimortalidad. Resultados: se incluyó a 193 pacientes, 69 con PMC y 71 sin ella; 89 pacientes con anastomosis colocólica (PMC, 38; sin PMC, 51) y 50 con anastomosis colorrectal (PMC, 31; sin PMC,19). En el análisis general, se apreciaron diferencias estadísticamente significativas a favor de no preparar en cuanto a la morbilidad (el 43,5% en el PMC y el 27% en los sin PMC) e infección nosocomial (el 27,5 y el 11,4%). En la infección de herida, sin diferencias estadísticamente significativas, se obtuvo el 11,6% en el PMC, frente al 5,7% en el sin PMC. Las únicas muertes fueron 2/69 (2,9%) pacientes en el grupo PMC. Según localización de anastomosis, en las colocólicas las diferencias fueron más acusadas y estadísticamente significativas en las variables morbilidad, dehiscencia de anastomosis e infección nosocomial. en las anastomosis colorrectales no fue tan evidente el efecto de no preparar. Conclusiones: nuestros resultados indican que no existe un beneficio de la PMC en la cirugía ante anastomosis colocólicas. No preparar no tiene relación con más morbilidad en infección de herida ni dehiscencia anastomótica. En anastomosis colorrectales, las diferencias no tan evidentes hacen necesarias series más amplias (AU)

Introduction: Mechanical preparation of the colon (MPC) in colorectal surgery has been a dogma that has been questioned over the last few years. The objective of this study is to demonstrate that morbidity in scheduled colorectal surgery is the same or lower without MPC. Material and method: Patients subjected to scheduled left colon and rectal surgery with primary anastomosis randomised into two groups. The “Preparation” group (MPC) received MPC and the “non-preparation” group (No-MPC) had only cleaning enemas. The variables collected were: demographic, oncological, nutritional, risk prediction models and morbidity-mortality. Results: Of the 193 patients included: 69 received MPC and 71 did not; 89 patients with (..) (AU)

[Anorectal disorders in the immediate and late postoperative period after transanal endoscopic microsurgery]. / Valoración de las alteraciones de la función anorrectal en el postoperatorio inmediato y tardío tras la microcirugía transanal endoscópica.

INTRODUCTION AND OBJECTIVE: Transanal endoscopic microsurgery (TEM) is a new technique for local excision of benign and incipient malignant rectal lesions. This technique offers technological advantages over other procedures and is associated with lower morbidity and mortality. TEM involves prolonged dilatation of the anal sphincter with a large-diameter (4 cm) operating rectoscope. The aim of the present study was to assess the effects of TEM on anorectal function. MATERIAL AND METHODS: All patients undergoing TEM were included. Continence was scored by a numeric scale and anorectal manometry before surgery and 3 weeks and 4 months after surgery. Variations in anal resting pressure, maximal anal resting pressure and the anal continence questionnaire were evaluated. RESULTS: Sixty-eight patients underwent TEM between June 2004 and August 2006. Mean anal resting pressure (ARP) and maximal anal resting pressure (MARP) were significantly reduced at 3 weeks after surgery (ARP/MARP before surgery: 38.89/126.28; 3 weeks after surgery: 26.61/104.75). No significant change was found in the mean continence score. No association was found between variation in pressures and operating time. CONCLUSION: TEM produced statistically significant alterations in anorectal physiology studies which returned to normal at 4 months. The technique did not affect continence scores in the immediate or late postoperative period and consequently can be considered a safe procedure that does not produce significant alterations in anorectal function.

Valoración de las alteraciones de la función anorrectal en el postoperatorio inmediato y tardío tras la microcirugía transanal endoscópica / Anorectal disorders in the immediate and late postoperative period after transanal endoscopic microsurgery

Introducción y objetivo. La microcirugía transanal endoscópica (TEM) es una técnica innovadora que permite la escisión local de lesiones rectales, benignas y malignas en fase inicial con mayores ventajas técnicas y menor morbimortalidad que mediante las técnicas habituales. Precisa de un utillaje específico; destaca un rectoscopio de 4 cm de diámetro que provoca una dilatación anal mantenida. El objetivo de nuestro estudio es comprobar los efectos de la TEM en la funcionalidad anorrectal. Material y métodos. Se incluyó a todos los pacientes intervenidos por vía TEM a los que se les realizó una manometría y un cuestionario de continencia anal preoperatoria y a las 3 semanas y 4 meses postoperatorios. Se valoraron las variaciones en la presión basal (PB) y en la presión de contracción voluntaria (PCV); también las variaciones en el cuestionario de continencia anal. Resultados. Se intervino a 68 pacientes entre junio de 2004 y agosto de 2006. Al analizar la PB y la PCV preoperatorias (38,89; 126,28) se observó una disminución estadísticamente significativa de ambas presiones a las 3 semanas (26,61; 104,75) que retorna a valores basales a los 4 meses (33,81; 118,9). No hubo variaciones en la prueba de continencia anal ni relación entre la variación de las presiones y el tiempo quirúrgico. Conclusión. La TEM produce una alteración manométrica estadísticamente significativa que se normaliza a los 4 meses y que no se traduce en ninguna alteración clínica en el postoperatorio inmediato ni en el tardío y, por tanto, es una técnica segura que no produce alteraciones en la funcionalidad anorrectal (AU)

Introduction and objective. Transanal endoscopic microsurgery (TEM) is a new technique for local excision of benign and incipient malignant rectal lesions. This technique offers technological advantages over other procedures and is associated with lower morbidity and mortality. TEM involves prolonged dilatation of the anal sphincter with a large-diameter (4 cm) operating rectoscope. The aim of the present study was to assess the effects of TEM on anorectal function. Material y methods. All patients undergoing TEM were included. Continence was scored by a numeric scale and anorectal manometry before surgery and 3 weeks and 4 months after surgery. Variations in anal resting pressure, maximal anal resting pressure and the anal continence questionnaire were evaluated. Results. Sixty-eight patients underwent TEM between June 2004 and August 2006. Mean anal resting pressure (ARP) and maximal anal resting pressure (MARP) were significantly reduced at 3 weeks after surgery (ARP/MARP before surgery: 38.89/126.28; 3 weeks after surgery: 26.61/104.75). No significant change was found in the mean continence score. No association was found between variation in pressures and operating time. Conclusion. TEM produced statistically significant alterations in anorectal physiology studies which returned to normal at 4 months. The technique did not affect continence scores in the immediate or late postoperative period and consequently can be considered a safe procedure that does not produce significant alterations in anorectal function (AU)

[How are resident physicians evaluated? The residents' computerized activity record]. / 'Cómo evaluamos la actividad de los médicos internos residentes? El libro informático del residente.

INTRODUCTION: Because of the developments that have occurred in surgery in the last few years, updates are required not only in the content of resident physicians' training but also in evaluation of the knowledge acquired. The present article aims to present our experience of an integral evaluation model. This model is based on evaluation of theoretical knowledge and surgical skills. MATERIAL AND METHOD: The training program for resident physicians (medico interno residente [MIR]) has four main branches: clinical work, continuing training, research (doctorate) and evaluation of the activity performed (computerized activity record). This record allows the theoretical knowledge and skills acquired to be evaluated at the end of each rotation. Through 6-monthly evaluations, each resident's activity can be quantified over time and compared with that of other residents. RESULTS: The system was introduced in July 2004. Each resident was given his or her own database. All the activities performed were then introduced into the database. The results of overall activity and that of each resident are presented. CONCLUSIONS: The method used allows residents' integral progress to be followed-up and a completely objective evaluation to be made at the end of each year and at the end of the residency period. Widespread use of this system, or a similar system, would enable comparisons with other centers to be made under similar premises. This system could also help to unify criteria and identify deviations in training.

¿Cómo evaluamos la actividad de los médicos internos residentes? El libro informático del residente / How are resident physicians evaluated? The residents’ computerized activity record

Introducción. La evolución de nuestra especialidad en los últimos años obliga a realizar actualizaciones no sólo en contenidos, sino en una evaluación de los conocimientos aprendidos. El objetivo de este artículo es presentar nuestra experiencia en un modelo de evaluación integral. Se basa en una valoración de los conocimientos teóricos y las habilidades quirúrgicas. Material y método. El programa de formación para los MIR que hemos aplicado está fundamentado en 4 apartados: asistencial, formación continuada, investigación (doctorado) y control de la actividad realizada (libro informático del residente). Permite una evaluación de los conocimientos teóricos y las habilidades aprendidas al final de cada rotación. Mediante la creación del libro informático del residente que presentamos, se practica cada 6 meses una cuantificación de la actividad de forma continua y comparada. Resultados. En julio de 2004, iniciamos la puesta en marcha de este sistema de evaluación de la actividad de los residentes. Se entregó a cada uno de ellos su propia base de datos para que iniciara su desarrollo mediante la introducción de todas las actividades realizadas. Se presentan los resultados de la actividad global y particular de cada residente. Conclusiones. El método que utilizamos permite seguir la evolución integral del residente y realizar, al final de cada año y de la residencia, una valoración totalmente objetiva. La generalización de este método o uno similar facilitará la realización de comparaciones con otros centros y bajo premisas similares. Por otra parte, podría unificar criterios y determinar desviaciones de formación (AU)

Introduction. Because of the developments that have occurred in surgery in the last few years, updates are required not only in the content of resident physicians' training but also in evaluation of the knowledge acquired. The present article aims to present our experience of an integral evaluation model. This model is based on evaluation of theoretical knowledge and surgical skills. Material and method. The training program for resident physicians (medico interno residente [MIR]) has four main branches: clinical work, continuing training, research (doctorate) and evaluation of the activity performed (computerized activity record). This record allows the theoretical knowledge and skills acquired to be evaluated at the end of each rotation. Through 6-monthly evaluations, each resident's activity can be quantified over time and compared with that of other residents. Results. The system was introduced in July 2004. Each resident was given his or her own database. All the activities performed were then introduced into the database. The results of overall activity and that of each resident are presented. Conclusions. The method used allows residents' integral progress to be followed-up and a completely objective evaluation to be made at the end of each year and at the end of the residency period. Widespread use of this system, or a similar system, would enable comparisons with other centers to be made under similar premises. This system could also help to unify criteria and identify deviations in training (AU)