[Sacral nerve stimulation for the treatment of severe fecal incontinence: long-term quality of life and functional outcomes].

BACKGROUND: The aim is to determine whether good functional and quality of life results of sacral nerve stimulation (SNS) in patients with severe fecal incontinence are maintained in the long-term. MATERIAL AND METHODS: Consecutive cohort of patients with severe fecal incontinence not responding to conservative (drugs and/or biofeedback) or surgical (sphincteroplasty) treatment, undergoing SNS between 2002 and 2013. Patients with a definitive implant were individually assessed in consultation throughout the follow-up, until January 2016. Defeca-tory function was assessed by Wexner score and stool diary, and perceived quality of life by FIQL and EQ-5D question-naires. RESULTS: Acute percutaneous nerve evaluation (PNE) was performed on 93 patients; a temporary electrode was implanted in 91 (79.1% women, mean age 62.5 years), obtaining a good functional response in 64. A permanent implant was per-formed in 61 patients, with a mean follow-up of 78.1 months (SD: 35.4; range 1-161); at the end of the study 42 patients remained in follow-up. A significant decrease was observed in the number of days per week with an incontinent episode, from 4.98 (SD 2.1) to 1.25 (SD 1.7), and in Wexner score from 16.88 (SD 2.74) to 6.95 (SD 3.54). Specific FIQL and generic EQ-5D questionnaires showed a significant improvement in quality of life. CONCLUSION: Long-term functional and quality of life outcomes of SNS for the treatment of severe faecal incontinence is maintained, with individual follow-ups that reach 10 years.

Neuroestimulación de raíces sacras en el tratamiento de la incontinencia fecal grave: resultados de calidad de vida y funcionales a largo plazo / Sacral nerve stimulation for the treatment of severe fecal incontinence: long-term quality of life and functional outcomes

FUNDAMENTO: El objetivo fue conocer si la mejora funcional y de calidad de vida lograda con la neuroestimulación de raíces sacras (SNS) en pacientes con incontinencia fecal grave se mantiene a largo plazo. MATERIAL Y MÉTODOS: Cohorte consecutiva de pacientes con incontinencia fecal grave que no respondieron a manejo conservador (fármacos y/o biofeedback) o quirúrgico (esfinteroplastia); se realizó SNS entre 2002 y 2013. A los pacientes con implante definitivo se les valoró individualmente en consulta a lo largo del seguimiento, hasta enero de 2016. Se valoró la función defecatoria mediante el score Wexner y el diario defecatorio, y la calidad de vida percibida con los cuestionarios FIQL y EQ-5D. RESULTADOS: Se realizó la estimulación aguda a 93 pacientes, y se implantó el electrodo temporal a 91 (79,1% mujeres, edad media 62,5 años) con buen resultado funcional en 64. El generador definitivo se implantó en 61 pacientes seguidos una media de 78,1 meses (DE: 35,4; rango 1-161); al finalizar el estudio, 42 pacientes seguían en seguimiento. Se observó una disminución significativa del número de días con escapes/semana de 4,98 (DE: 2,1) a 1,25 (DE: 1,7) y de las puntuaciones del score Wexner de 16,88 (DE: 2,74) a 6,95 (DE: 3,54). La calidad de vida percibida mejoró de forma significativa, al observarse un aumento de las puntuaciones de los cuestionarios FIQL y EQ-5D. CONCLUSIONES: La SNS mantiene buenos resultados funcionales y de calidad de vida en pacientes con incontinencia fecal grave a largo plazo, con seguimientos individuales que alcanzan los 10 años

BACKGROUND: The aim is to determine whether good functional and quality of life results of sacral nerve stimulation (SNS) in patients with severe fecal incontinence are maintained in the long-term. MATERIAL AND METHODS: Consecutive cohort of patients with severe fecal incontinence not responding to conservative (drugs and/or biofeedback) or surgical (sphincteroplasty) treatment, undergoing SNS between 2002 and 2013. Patients with a definitive implant were individually assessed in consultation throughout the follow-up, until January 2016. Defecatory function was assessed by Wexner score and stool diary, and perceived quality of life by FIQL and EQ-5D questionnaires. RESULTS: Acute percutaneous nerve evaluation (PNE) was performed on 93 patients; a temporary electrode was implanted in 91 (79.1% women, mean age 62.5 years), obtaining a good functional response in 64. A permanent implant was performed in 61 patients, with a mean follow-up of 78.1 months (SD: 35.4; range 1-161); at the end of the study 42 patients remained in follow-up. A significant decrease was observed in the number of days per week with an incontinent episode, from 4.98 (SD 2.1) to 1.25 (SD 1.7), and in Wexner score from 16.88 (SD 2.74) to 6.95 (SD 3.54). Specific FIQL and generic EQ-5D questionnaires showed a significant improvement in quality of life. CONCLUSION: Long-term functional and quality of life outcomes of SNS for the treatment of severe faecal incontinence is maintained, with individual follow-ups that reach 10 years

[Retrorectal cystic hamartoma (tailgut cyst): an uncommon cause of recurrent abdominal pain.] / Hamartoma quístico retrorrectal (tailgut cyst): una causa infrecuente de dolor abdominal recurrente.

Retrorectal cystic hamartomas are rare congenital lesions that arise from aberrant remnants of the postanal gut. Most of them appear as asymptomatic lesions in middle-aged women but they can manifest with nonspecific symptoms such as abdominal or pelvic pain, constipation or diarrhoea, genitourinary symptoms, etc. Due to their anatomical position and variable presentation these lesions are often misdiagnosed. Complications include infection and malignant transformation, which is the reason why surgical treatment is always indicated. We report a case of a woman with recurrent episodes of abdominal pain that lasted for many years and increased progressively, conditioning her daily life activities. Image studies showed a non-complicated retrorectal cystic hamartoma. Complete surgical excision was achieved and the patient remains asymptomatic nowadays. Key words. Retrorectal cystic hamartoma. Abdominal pain.

Escaras tras otoplastia de Mustardé: importancia de las curas y seguimiento postoperatorio de los pacientes / Scarring after mustarde otoplasty: importance of cures and post-operative follow-up of the patients

Introducción. En el protocolo de tratamiento de los pacientes conotoplastias de Mustardé incluimos la colocación de cintas elásticas durante 2 meses (el primer mes debe llevarse permanentemente y el segundo mes solo para dormir) para proteger la corrección obtenida y evitar traumatismos. Material y métodos. Describimos los casos de 3 enfermos sometidos a otoplastia de Mustardé que presentaron escaras en el borde anterior del antehelix, secundarias a compresión del vendaje de sujeción. Resultados. En un enfermo intervenido en la oreja derecha aparecieron escaras en la oreja no intervenida, lo que demuestra que las lesiones fueron secundarias al vendaje y no a la intervención. En dos pacientes, las escaras evolucionaron a la formación de cicatrices nodulares hipertróficas que se corrigieron lentamente con apósitos siliconados, corticoides tópicos y cremas hidratantes en uno y debieron ser resecadas en otro. Conclusiones. Es imprescindible explicar detenidamente a los padres la misión y características de las cintas elásticas, así como revisar frecuentemente su colocación, para evitar una complicación que, sin estropear el resultado final de la otoplastia, reduce la satisfacción del paciente y prolonga el tiempo de recuperación (AU)

Introduction. In the treatment protocol for patients with Mustardéotoplasties we use tennis head sweatbands for 2 months (to be worn all the time in the first month and only at night in the second month) to protect the correction obtained and to avoid traumatisms. Material and methods. We describe the cases of 3 patients who underwent Mustardé otoplasty and presented sloughs in the anterior edge of the ante helix that are secondary to the pressure of the compression bandage. Results. One patient operated for unilateral malformation suffered bilateral scars (in the operated ear and in the healthy one). This prove that the scars are secondary to the dressings not to surgery. In two patients the sloughs evolved into the formation of nodular hypertrophic scars, which were slowly corrected with silicone dressings and externally applied corticosteroids and moisturising creams in one patient and had to be resected in the other. Conclusions. It is important to give a detailed explanation to the parents about the mission and characteristics of the sweatbands, and also about the need to frequently check their correct placing. This isto avoid a complication that, without spoiling the final result of the otoplasty, reduces patient satisfaction and extends the recovery period (AU)

[Scarring after Mustarde otoplasty: importance of cures and post-operative follow-up of the patients]. / Escaras tras otoplastia de Mustardé: importancia de las curas y seguimiento postoperatorio de los pacientes.

INTRODUCTION: In the treatment protocol for patients with Mustardé otoplasties we use tennis head sweatbands for 2 months (to be worn all the time in the first month and only at night in the second month) to protect the correction obtained and to avoid traumatisms. MATERIAL AND METHODS: We describe the cases of 3 patients who underwent Mustardé otoplasty and presented sloughs in the anterior edge of the antehelix that are secondary to the pressure of the compression bandage. RESULTS: One patient operated for unilateral malformation suffered bilateral scars (in the operated ear and in the healthy one). This prove that the scars are secondary to the dressings not to surgery. In two patients the sloughs evolved into the formation of nodular hypertrophic scars, which were slowly corrected with silicone dressings and externally applied corticosteroids and moisturising creams in one patient and had to be resected in the other. CONCLUSIONS: It is important to give a detailed explanation to the parents about the mission and characteristics of the sweatbands, and also about the need to frequently check their correct placing. This is to avoid a complication that, without spoiling the final result of the otoplasty, reduces patient satisfaction and extends the recovery period.

[Correction of recurrent pectus excavatum post-Ravitch with the Nuss technique]. / Corrección de la recidiva del pectus excavatum post-Ravitch con la técnica de Nuss.

INTRODUCTION: For one decade, the minimally invasive technique (MIRPE) of Nuss has been used in our Service as the elective technique for correction of Pectus Excavatum. If recurrences occur in patients that underwent open surgery, a new surgery of the same characteristics entails important technical problems, long surgical times and poor outcome. For this reason, we think that one specific indication for the MIRPE technique may be this type of patients. MATERIAL AND METHODS: Based on our experience with four patients with a recurrence of pectus excavatum after an open surgery "Ravitch type", we illustrate the fundamental aspects for the development of the Nuss technique, adapted to this type of patients. The factors to be consider are: Systematic bilateral thoracoscopy with a suitable position of the two towers to guarantee a good visualisation of the passage of the introducer clamp by the mediastino. Use of thoracoscope with work channel on the right side, that allows the releasing of adherences and with a 5 mm lens on the left side. Use of a large introducer clamp more length for adolescent patients, The rest of the material is the usual one in this protocol surgery. Our patients did not present any remarkable incidences, with very satisfactory results. COMMENTS AND CONCLUSIONS: We found of great importance for the good development of the technique to establish a correct strategy prior to surgery and to dispose a good organisation of the surgery room. The surgery must be carried out in a spacious surgical room, given the great amount of material that is used. It is important to be familiarized with the procedure, because even if performed in a regulated way, variations in the positioning and fixation of the bar are frequently needed.

Corrección de la recidiva del pectus excavatum post-Ravitch con la técnica de Nuss / Correction of recurrent pectus excavatum post-ravitch with the nuss technique

Introducción. Desde hace una década, la técnica mínimamente invasiva (MIRPE) de Nuss es la que empleamos en nuestro servicio para la corrección del pectus excavatum. En los casos de recidiva de pacientes operados por cirugía abierta, una nueva cirugía de las mismas características, conlleva importantes problemas técnicos, mucho tiempo quirúrgico y resultados poco satisfactorios. Es por ello que una de las indicaciones específicas de la MIRPE sea este tipo de pacientes. Material y métodos. Basados en la experiencia de cuatro pacientes con una recurrencia del pectus excavatum después de una cirugía abierta “tipo Ravitch”, comentamos en este trabajo los aspectos fundamentales del desarrollo de la técnica de Nuss, adaptada a este tipo de pacientes. Los factores a tener en cuenta son:- Realización sistemática de una toracoscopia bilateral con una adecuada colocación de las dos torres para garantizar una buena visión (..) (AU)

Introduction. For one decade, the minimally invasive technique(MIRPE) of Nuss has been used in our Service as the elective technique for correction of Pectus Excavatum. If recurrences occur in patients that underwent open surgery, a new surgery of the same characteristics entails important technical problems, long surgical times and poor outcome. For this reason, we think that one specific indication for the MIRPE technique may be this type of patients. Material and methods. Based on our experience with four patient swith a recurrence of pectus excavatum after an open surgery “Ravitchtype”, we illustrate the fundamental aspects for the development of the Nuss technique, adapted to this type of patients. The factors to be consider are:- Systematic bilateral thoracoscopy with a suitable position of the two towers to guarantee a good visualisation of the passage of the (..) (AU)