Urgent care practice in anorectal abscess. Still a pending task.

AIM: The aim of the study was to evaluate urgent care practice with regard to anorectal abscesses (AA) in a tertiary-level referral hospital. MATERIALS AND METHODS: this was retrospective and unicentric study. Patients who underwent surgery for AA between 2016 and 2017 were included in the study. Demographic variables were analyzed as well as the treatment performed, the need for hospitalization, use of antibiotics, and referral to the coloproctology outpatient department (COD). The recurrence risk factors were also evaluated. RESULTS: A total of 220 evaluations under anesthesia were performed, corresponding to 190 patients, 129 males (mean age 46 ± 14.9 years). The most frequent treatment in the emergency department (ED) was simple drainage (75.8%). Antibiotic therapy was prescribed in 62.9% of the cases. A total of 41.1% of the patients were referred to a specialized COD. The only risk factor associated with recurrence was the presence of an associated anal fistula. CONCLUSIONS: Anorectal abscesses are very frequent in the ED. There is great clinical variability regarding the taking of cultures, prescription of antibiotics, and referral criteria to a specialized coloproctology outpatient department, without clear impact of any of them on the recurrence of the abscess.

OBJETIVO: Evaluar el manejo de los abscesos perianales por parte del servicio de cirugía de urgencias. MÉTODO: Estudio unicéntrico retrospectivo. Se incluyeron pacientes que requirieron manejo quirúrgico de abscesos perianales de 2016 a 2017. Se analizaron variables demográficas, tratamientos realizados, necesidad de ingreso hospitalario, uso de antibióticos y necesidad de derivación a la consulta externa de coloproctología. Así mismo, se evaluaron los factores relacionados con la recurrencia del absceso. RESULTADOS: Durante el periodo de estudio se realizaron 220 exploraciones, correspondientes a 190 pacientes (129 hombres) con una edad media de 46 ± 14.9 años. El tratamiento quirúrgico más frecuentemente realizado fue el drenaje simple (75.8%). Se prescribieron antibióticos en el 62.9% de los casos. El 41.1% de los pacientes fueron remitidos a consulta externa de coloproctología. El único factor de riesgo asociado a la recurrencia fue la presencia de una fístula perianal asociada. CONCLUSIONES: Los abscesos perianales son frecuentes en los servicios de urgencias. Hay una gran variabilidad clínica en su manejo, sobre todo en lo relativo a la realización de cultivos, la prescripción de antibióticos y la derivación a unidades de coloproctología especializadas, sin que ninguna de estas medidas tenga un claro impacto en la recurrencia.

Diverticulectomía y miotomía del cricofarígeo para el tratamiento del divertículo de Zenker. Presentación de una serie de 33 casos / Diverticulectomy and cricopharyngeal myotomy for the treatment of Zenker‘s diverticulum. a presentation of 33 cases

IntroducciónEl tratamiento clásico del divertículo de Zenker (DZ) ha sido la miotomía del cricofaríngeo (MCF), discutiéndose la necesidad o no de resecarlo (diverticulectomía versus diverticulopexia). Sin embargo, la evolución de las técnicas endoscópicas está obligando a replantear las estrategias de tratamiento. Analizamos las complicaciones y los resultados clínicos de nuestra serie con la miotomía del cricofaríngeo y diverticulectomía en pacientes con DZ.MétodoEstudio observacional retrospectivo y descriptivo de 33 pacientes a los que se realizó, entre enero de 1998 y diciembre de 2010, diverticulectomía y MCF en los hospitales universitarios Virgen del Rocío de Sevilla y Carlos Haya de Málaga. Se analiza la morbilidad y variables demográficas y operatorias que pueden asociarse con esta.ResultadosDiecisiete pacientes fueron tratados en el hospital Carlos Haya de Málaga y dieciséis en el hospital Virgen del Rocío de Sevilla. Aunque no hubo mortalidad, la tasa de morbilidad de la serie fue del 27% (9 casos), siempre relacionada con fístula esófago-cutánea. Ninguna de las variables estudiadas se asoció significativamente con la aparición de morbilidad. Tras un seguimiento medio de 44 meses (rango 6-192) ningún paciente ha presentado recidiva clínica ni radiológica del DZ.ConclusionesLa diverticulectomía asociada a MCF es una buena técnica para el tratamiento del DZ, con excelentes resultados clínicos y funcionales a medio y largo plazo, pese a que la morbilidad mayor en forma de fístula esófago-cutánea ha sido alta (AU)

IntroductionThe classic treatment of Zenker‘s diverticulum (ZD) has been cricopharyngeal myotomy (CPM), with the need or not to resect it being argued (diverticulectomy versus diverticulopexy). However, the advance of endoscopic techniques requires new treatment strategies to be established. We analyse the complications and clinical results of our series with cricopharyngeal myotomy and diverticulectomy in patients with ZD.MethodA retrospective, observational and descriptive study was conducted on 33 patients who, between January 1998 and December 2010, had a diverticulectomy and CPM performed in the university hospitals Virgen del Rocío in Seville and Carlos Haya in Malaga. Demographic and operative variables that might be associated with morbidity were analyzed.ResultsSeventeen patients were treated in the Carlos Haya Hospital, Málaga and sixteen in the Virgen del Rocío Hospital, Seville. Although there were no deaths, the morbidity rate of the series was 27% (9 cases), all associated with an oesophageal-cutaneous fistula. None of the variables studied were significantly associated with the appearance of morbidity. None of the patients had a clinical or radiological recurrence of ZD after a mean follow up of 44 months (range, 6 -192).ConclusionsDiverticulectomy combined with CPM is a good technique for the treatment of ZD, with excellent clinical and functional results in the medium to long term, despite the high morbidity in the form of an oesophageal-cutaneous fistula (AU)

[Diverticulectomy and cricopharyngeal myotomy for the treatment of Zenker's diverticulum. a presentation of 33 cases]. / Diverticulectomía y miotomía del cricofarígeo para el tratamiento del divertículo de Zenker. Presentación de una serie de 33 casos.

INTRODUCTION: The classic treatment of Zenker's diverticulum (ZD) has been cricopharyngeal myotomy (CPM), with the need or not to resect it being argued (diverticulectomy versus diverticulopexy). However, the advance of endoscopic techniques requires new treatment strategies to be established. We analyse the complications and clinical results of our series with cricopharyngeal myotomy and diverticulectomy in patients with ZD. METHOD: A retrospective, observational and descriptive study was conducted on 33 patients who, between January 1998 and December 2010, had a diverticulectomy and CPM performed in the university hospitals Virgen del Rocío in Seville and Carlos Haya in Malaga. Demographic and operative variables that might be associated with morbidity were analyzed. RESULTS: Seventeen patients were treated in the Carlos Haya Hospital, Málaga and sixteen in the Virgen del Rocío Hospital, Seville. Although there were no deaths, the morbidity rate of the series was 27% (9 cases), all associated with an oesophageal-cutaneous fistula. None of the variables studied were significantly associated with the appearance of morbidity. None of the patients had a clinical or radiological recurrence of ZD after a mean follow up of 44 months (range, 6 -192). CONCLUSIONS: Diverticulectomy combined with CPM is a good technique for the treatment of ZD, with excellent clinical and functional results in the medium to long term, despite the high morbidity in the form of an oesophageal-cutaneous fistula.