RESUMO
Desde la Asociación Española de Coloproctología y la Sección de Coloproctología de la Asociación Española de Cirujanos se propone un documento de consenso sobre el algoritmo de actuación en el tratamiento de la fisura anal que pueda ser de utilidad en la toma de decisiones. En él se expone la actualidad en el tratamiento conservador, médico y quirúrgico, finalizando con un algoritmo de recomendación ante una fisura anal. La metodología utilizada ha sido: creación de un grupo de expertos, búsqueda en PubMed, MEDLINE y Biblioteca Cochrane de las publicaciones de los últimos 10 años sobre fisura anal, presentación en la XXI Reunión Nacional de la Fundación Asociación Española de Coloproctología 2017 con votación de cada conclusión entre los asistentes, y revisión por el comité científico de la Asociación Española de Coloproctología
The Spanish Association of Coloproctology and the Coloproctology Division of the Spanish Association of Surgeons propose this consensus document with a treatment algorithm for anal fissure that could be used for decision making. Non-surgical therapy and surgical treatment of anal fissure are explained, and the recommended algorithm is provided. The methodology used was: creation of a group of experts; search in PubMed, MEDLINE and the Cochrane Library for publications from the last 10 years about anal fissure; presentation at the 21st National Meeting of the Spanish Association of Coloproctology Foundation 2017 with voting for/against each conclusion by the attendees and review by the scientific committee of the Spanish Association of Coloproctology
Assuntos
Humanos , Algoritmos , Fissura Anal/terapia , Canal Anal/cirurgia , Sociedades Médicas/organização & administração , Sociedades Médicas/normasRESUMO
The Spanish Association of Coloproctology and the Coloproctology Division of the Spanish Association of Surgeons propose this consensus document with a treatment algorithm for anal fissure that could be used for decision making. Non-surgical therapy and surgical treatment of anal fissure are explained, and the recommended algorithm is provided. The methodology used was: creation of a group of experts; search in PubMed, MEDLINE and the Cochrane Library for publications from the last 10 years about anal fissure; presentation at the 21st National Meeting of the Spanish Association of Coloproctology Foundation 2017 with voting for/against each conclusion by the attendees and review by the scientific committee of the Spanish Association of Coloproctology.
Assuntos
Algoritmos , Fissura Anal/terapia , HumanosRESUMO
BACKGROUND: Obesity constitutes a clear risk factor for cholelithiasis, especially if it is associated with a rapid weight loss, as is the case of patients following bariatric surgery. Prophylactic cholecystectomy is indicated in biliopancreatic diversions due to the high incidence of postoperative cholelithiasis. However, there is no agreement on gastric bypass. This study was conducted to establish the incidence of cholecystopathy demonstrated by histology and to assess the indication for prophylactic cholecystectomy in a systematic way on patients undergoing gastric bypass. METHODS: The evaluation is based on 100 consecutive morbidly obese patients undergoing open gastric bypass surgery with concomitant prophylactic cholecystectomy. Variables studied were: age, gender, body mass index, preoperative ultrasound and the anatomopathologic analysis of the gallbladder that was removed. RESULTS: Of the 100 patients who took part in the trial, 11 had had a previous cholecystectomy. Among the 89 patients remaining, preoperative ultrasound diagnosis of cholelithiasis was 16.8%, and the actual postoperative incidence was 24.7%. Other histologic alterations were: cholesterolosis 46.1%, chronic unspecified cholecystitis 22.5%, and granulomatous cholecystitis 1.1%. The total incidence of cholecystopathy was 93.3%. The morbi-mortality related to cholecystectomy was 0%. CONCLUSIONS: Based on these results and given the absence of morbidity, we believe that prophylactic cholecystectomy is suitable during open gastric bypass.
