Optimizing sacral neuromodulation for low anterior resection syndrome: learning from our experience.

AIM: The aim of this work was to review our institutional series of patients treated with sacral neuromodulation (SNM) for low anterior resection syndrome (LARS) and evaluate possible factors associated with therapeutic success. METHOD: Twenty-five patients were treated with SNM for LARS between 2008 and 2019. SNM was performed as per our institutional protocol. Patients were evaluated with Wexner and LARS scores before and after SNM treatment. A visual analogue scale (1-10) was used to evaluate overall patient satisfaction with SNM. RESULTS: There were significant differences between the mean LARS score values before (37.82) and after (29) SNM therapy (P < 0.004). The mean Wexner score was higher (16.24) before SNM treatment than afterwards (11.13) (P < 0.004). There was a direct relationship between the height of anastomosis and LARS score (P = 0.035): there were big changes in LARS scoring (pre-/post-SNM therapy) in patients with higher anastomoses, and vice versa. Patients who received radiotherapy scored lower in mean satisfaction (6.38) than patients without previous radiotherapy (8.22) (P = 0.008). There was an important positive association between Wexner score and patient satisfaction (P = 0.001): relevant changes in Wexner scoring after SNM therapy were associated with high patient satisfaction, and vice versa. CONCLUSION: Our study showed a relationship between changes in Wexner and LARS scores before and after SNM and overall patient satisfaction with SNM therapy. These findings also suggest patients with previous radiotherapy may have worse results with SNM (based on lower overall satisfaction), and that higher anastomoses have a greater impact on the post-SNM LARS score.

Bloqueo nervioso en el tratamiento del dolor postoperatorio de pacientes intervenidos de hernia inguinal o crural en una unidad de CMA / Nerve block for postoperative pain relief after inguinal or femoral hernia repair in an ambulatory surgical unit

OBJETIVO: E éxito de un programa de Cirugía Mayor Ambulatoria depende en gran medida de un correcto tratamiento del dolor postoperatorio. Nuestro objetivo es presentar los resultados obtenidos con el bloqueo nervioso. MATERIAL Y MÉTODOS: Estudio restrospectivo. Se utiliza la anestesia general con mascarilla laringea combinada con la infiltración local de ropivacaína. La analgesia se completa con Metamizol magnésico. Se evalúa el dolor mediante una escala numérica visual y de forma indirecta, la asistencia a urgencias, el estado emocional al regresar al domicilio,e l grado de satisfacción con el tratamiento y el grado de recomendación de nuestra unidad. RESULTADOS: Se han intervenido 167 enfermos, 158 hombres y 9 mujeres. Edad media 50,6 años. Corresponden a hernias inguinales 155, crurales 7, inguinal mas crural 3, recidivas 2. Técnicas: Gilbert 21, Lichtenstein 38, Rutkow-Robbins 57, Hernioplastia PHS 44, Lichtenstein crural 7. La valoración del dolor fue: Grado 0: 7%, 1: 19,7%, 2: 12,2%, 3: 22,5%, 4: 12,6%,: 11,2%, 6: 5,6%, 7: 4,2%, 8: 4,2%. El 97,1% no necesitó tomar más calmantes. Solo un enfermo necesitó acudir a urgencias por un hematoma. El 95% estuvo tranquilo al alta. El 54,9% se mostraron satisfechos y el 40,8 muy satisfechos con el tratamiento. El 52,!!% no dudarían en recomendar nuestrao programa. Ningún enfermo telefoneó por dolor. Complicaciones: 2 (1,1%) bloqueos del nervio femorocutáneo y 5 (2,9%) del obturador. Representaron 4 (2,3%) ingresos (AU)

OBJECTIVES: The success of a program for ambulatory surgery depends on the correct management of postoperative pain. The objective of this article is to present our results in the use of nerve blocks. MATERIAL AND METHOD: A restrospective study. The general anaesthesia procedure included laryngeal mask and ropivacaine local infiltration. Postoperative anaesthesia was combined with metamizol. Pain was evaluated by a visual numeric scale from 0 (no pain) to 10 (maximum pain). Other stats were evaluated: Emergency attendance required, emotional aspects on reaching home, satisfaction with medical care and if they would recommended our units as a surgical centre to other patients. RESULTS: 167 patients underwent surgery, 158 men and 9 women. Mean age was 50,6 years. We found 71 right inguinal hernias, 84 left inguinal hernias, 7 femoral hernias, 3 right inguinal and femoral combined hernias and 2 right inguinal recurrent hernias. Surgical techniques used for the repair were: Gilbert´s technique, 21; Lichtenstein inguinal hernia repair, 38; Rutkow-Robbins technique, 57; PHS hernioplaty, 44: Lechtenstein´s femoral hernia repair, 7. The analogical pain evaluation scale results were: grade 0: 7%, grade 1: 19,7%, grade 3: 22,5%, grade 4: 12,6%, grade 5: 11,2%, grade 6: 5,6%, grade 7: 4,2%, grade 8: 4,2%. No supplementary post-operative analgesia was required in 97,1% of the patients. Just one required emergency assistance due to a haematoma. Almost 95% of the patients stayed calm at home. 54% were satisfied and 40,8% were highly satisfied with the surgical results. Regarding recommending our surgical program: 52,11% had no doubt about it. No phone calls were received due to pain. The complications were 2 femoro-cutaneous nerve (1,1%) and 5 obturator (2,9%) blocks. Just 4 of the cases required hospital admission (2,3%). DISCUSSION: The postoperative anaesthesia and grade of comfort obtained with this procedure highly satisfactory. There was no hospital admission due to pain (AU)

The use of omentum in mesh repair of ventral hernias.

In mesh repairs of abdominal wall defects, contact of the prosthesis with the abdominal viscera must be prevented. The omentum may be used to complete tension-free repair of these defects when dissection of the peritoneum is difficult or when there is insufficient peritoneum or posterior rectus sheath to close the peritoneal cavity.

[Complete anorectal stenosis due to paracetamol and salicylamide suppositories]. / Estenosis ano-rectal completa por supositorios de paracetamol y salicilamida.

A female patient previously diagnosed of psychiatric disease used a compound of paracetamol-salicilamide-codeine in suppositories, daily, for more than one year, for migraine. She developed a complete recto-anal stenosis and bowel obstruction requiring permanent colostomy. Ulceration and recto-anal stenosis have been described in association with the use of suppositories, mainly ergotamine. However, this is the first case of total recto-anal stenosis.