[Cecal perforation secondary to surgical drainage. A case report]. / Perforación de ciego secundaria a drenaje quirúrgico. Reporte de un caso.

BACKGROUND: The use of surgical drains in abdominal surgery is still today controversial. While accepting their role in certain circumstances, their systematic use advocated by other schools, is not fully accepted. We present a case of secondary blind drilling drainage tube perineum following an abdominoperineal amputation of the rectum that forced a surgical repair in a neoplastic patient CLINICAL CASE: This is a patient who underwent abdomino perineal resection for rectal neoplasia. It was decided to leave a silicone-type drain tube for perineum and in late postoperative he presented cecum perforation due to traumatic introduction thereof into the cecal light, which forced his reoperation and surgical repair. DISCUSSION: There is a tendency to use less and less drains in abdominal surgery, although there are certain occasions when it becomes inevitable. On the other hand it entails morbidity associated with its use that significantly complicates and delays the recovery of the patient. It is accepted that is not useful to prevent the occurrence of fistulas, although it contributes to its early detection. CONCLUSIONS: The cecal perforation due to drain is a rare complication which must always be taken into account, and that perhaps could be avoided by using soft and less rigid drains.

Impacto de los colgajos transanales de avance en la continencia fecal / Impact of endorectal advancement flaps in fecal incontinence

Objetivo El objetivo de este estudio ha sido evaluar de forma prospectiva los resultados funcionales en una serie de colgajos de avance para tratar fístulas anales complejas. Material y métodos Se incluyó a 90 pacientes intervenidos por fístulas anales complejas mediante fistulectomía y colgajo transanal. Los resultados funcionales se valoraron mediante cuestionario de continencia anal (Wexner) y estudio manométrico anorrectal, preoperatorio y postoperatorio. Resultados La fístula recidivó en 7 (7,7%) casos y se repitió la misma técnica quirúrgica en 5, con curación en todos ellos. Después de 3 meses de la cirugía, se produjeron reducciones significativas en la presión máxima basal (83,85±30,96 frente a 46,51±18,67; p<0,001) y en la presión máxima de contracción voluntaria (220,97±100,21 frente a 183,06±75,36; p<0,001). Por lo que respecta al cuestionario de continencia fecal, el 80% de los pacientes mantuvo continencia normal con puntuación 0 en la escala de Wexner postoperatoria, mientras que los demás (20%) manifestaron cambios en la puntuación del cuestionario, la mayoría, menos de 3 puntos y con poca significación clínica. Conclusiones La reparación con colgajo de avance es una técnica efectiva para las fístulas anales complejas, con una tasa de recurrencia baja. El 20% de los pacientes modifican la valoración de su continencia en el postoperatorio (AU)

Objective The aim of this study was the prospective evaluation of the functional results of a series endorectal advancement flaps in the treatment of complex anal fistulas. Material and methods A total of 90 patients were operated on for a complex anal fistula by means of fistulectomy and endorectal advancement flap. The functional results were evaluated using the Wexner continence scale and an anorectal manometry study before and after surgery. Results There were seven patients with fistula recurrence (7.7%) and the same surgical procedure was performed on five of them, resulting in healing in all cases. Significant reductions in maximum resting pressure (83.85±30.96 vs 46.51±18.67; p<0.001) and maximum squeeze pressure (220.97±100.21 vs 183.06±75.36; p<0.001) were seen 3 months after surgery. On the continence scale, 80% of patients had a normal continence with a value of 0 on the postoperative Wexner scale, while 20% recorded changes in continence values, most of them lower than 3 points. Conclusions Endorectal advancement flap is an effective surgical procedure in complex anal fistulas treatment, with a low recurrence rate. Only 20% of the patients showed changes in the continence value (AU)

[Impact of endorectal advancement flaps in fecal incontinence]. / Impacto de los colgajos transanales de avance en la continencia fecal.

OBJECTIVE: The aim of this study was the prospective evaluation of the functional results of a series endorectal advancement flaps in the treatment of complex anal fistulas. MATERIAL AND METHODS: A total of 90 patients were operated on for a complex anal fistula by means of fistulectomy and endorectal advancement flap. The functional results were evaluated using the Wexner continence scale and an anorectal manometry study before and after surgery. RESULTS: There were seven patients with fistula recurrence (7.7%) and the same surgical procedure was performed on five of them, resulting in healing in all cases. Significant reductions in maximum resting pressure (83.85+/-30.96 vs 46.51+/-18.67; p<0.001) and maximum squeeze pressure (220.97+/-100.21 vs 183.06+/-75.36; p<0.001) were seen 3 months after surgery. On the continence scale, 80% of patients had a normal continence with a value of 0 on the postoperative Wexner scale, while 20% recorded changes in continence values, most of them lower than 3 points. CONCLUSIONS: Endorectal advancement flap is an effective surgical procedure in complex anal fistulas treatment, with a low recurrence rate. Only 20% of the patients showed changes in the continence value.