Pub Date : 2025-11-11DOI: 10.1016/j.ciresp.2025.800236
David Ruiz de Angulo, Vicente Munitiz Ruiz
{"title":"«Siewert tipo IV»: una enfermedad del siglo XXI con un tratamiento quirúrgico del siglo XX","authors":"David Ruiz de Angulo, Vicente Munitiz Ruiz","doi":"10.1016/j.ciresp.2025.800236","DOIUrl":"10.1016/j.ciresp.2025.800236","url":null,"abstract":"","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 1","pages":"Article 800236"},"PeriodicalIF":1.3,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145486046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-05DOI: 10.1016/j.ciresp.2025.800231
Laura Comín Novella, Mónica Oset García, Marta González Pérez, El Mostafa el Yaqine er Raoudi, Pedro Pablo Stredel Russian, Francisco Luis Carrillo Trabalón, Sandra Lario Pérez, José Francisco Noguera Aguilar
Introduction
In breast cancer, recommendations for axillary surgery are currently shifting toward omitting SLNB. Studies have shown that not performing axillary staging has no impact on regional control or survival and translates into improved quality of life. We sought to determine whether certain clinical factors such as tumor size or type, immunohistochemical characteristics, tumor grade or Ki-67 value are predictive of metastatic disease in the lymph nodes.
Methods
A retrospective observational study was conducted of patients who underwent breast cancer surgery during the years 2019-2024. Inclusion criteria were: tumor size equal to or less than 2 cm as measured by ultrasound, and axilla that was clinically and ultrasound-negative.
Results
One hundred and fifty-six breasts were operated on, with a mean age of 64.5 years. Regarding immunohistochemistry, tumor grade, and age, no differences were observed. However, patients with tumors > 2 cm and lobular tumors did have greater lymph node involvement (p < 0.05).
Conclusions
There are no variables that predict lymph node involvement before surgery. Today, we are not prepared to lose the information provided by SLNB, and part of the postoperative treatment is determined by its results.
{"title":"Valores predictivos de afectación axilar en cáncer de mama","authors":"Laura Comín Novella, Mónica Oset García, Marta González Pérez, El Mostafa el Yaqine er Raoudi, Pedro Pablo Stredel Russian, Francisco Luis Carrillo Trabalón, Sandra Lario Pérez, José Francisco Noguera Aguilar","doi":"10.1016/j.ciresp.2025.800231","DOIUrl":"10.1016/j.ciresp.2025.800231","url":null,"abstract":"<div><h3>Introduction</h3><div>In breast cancer, recommendations for axillary surgery are currently shifting toward omitting SLNB. Studies have shown that not performing axillary staging has no impact on regional control or survival and translates into improved quality of life. We sought to determine whether certain clinical factors such as tumor size or type, immunohistochemical characteristics, tumor grade or Ki-67 value are predictive of metastatic disease in the lymph nodes.</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted of patients who underwent breast cancer surgery during the years 2019-2024. Inclusion criteria were: tumor size equal to or less than 2<!--> <!-->cm as measured by ultrasound, and axilla that was clinically and ultrasound-negative.</div></div><div><h3>Results</h3><div>One hundred and fifty-six breasts were operated on, with a mean age of 64.5 years. Regarding immunohistochemistry, tumor grade, and age, no differences were observed. However, patients with tumors<!--> <!-->><!--> <!-->2<!--> <!-->cm and lobular tumors did have greater lymph node involvement (p<!--> <!--><<!--> <!-->0.05).</div></div><div><h3>Conclusions</h3><div>There are no variables that predict lymph node involvement before surgery. Today, we are not prepared to lose the information provided by SLNB, and part of the postoperative treatment is determined by its results.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"103 12","pages":"Article 800231"},"PeriodicalIF":1.3,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.ciresp.2025.800225
Hanna Cholewa , Pablo Guerrero-Antolino , David Quevedo , Jorge Sancho-Muriel , Matteo Frasson , Blas Flor-Lorente
The following systematic review aimed to present the current status of immunotherapy in colorectal cancer, in the neoadjuvant, adjuvant and metastatic setting. Pubmed, Cochrane and Embase databases were searched up to April 2024 and the PICO framework, as well as the following inclusion criteria (clinical studies in English published ≥2000 per year, both retrospective and prospective, including abstracts from relevant congresses, yet excluding case reports, letters, phase I clinical trials and radioimmunotherapy) were applied. MINORS and RoB2 were used to assess quality and risk of bias. Due to heterogeneity of the studies, a descriptive analysis was performed. In total, 99 studies (including 11 226 patients) were analysed, concluding that immunotherapy application, although encouraging, still needs refinement, most importantly in terms of patient and treatment regimen selection. The review was registered on the PROSPERO platform (ID: CRD42023417537) and funded by a grant by the Spanish Association of Surgery (AEC).
{"title":"The current status of immunotherapy in colorectal cancer: A systematic review","authors":"Hanna Cholewa , Pablo Guerrero-Antolino , David Quevedo , Jorge Sancho-Muriel , Matteo Frasson , Blas Flor-Lorente","doi":"10.1016/j.ciresp.2025.800225","DOIUrl":"10.1016/j.ciresp.2025.800225","url":null,"abstract":"<div><div>The following systematic review aimed to present the current status of immunotherapy in colorectal cancer, in the neoadjuvant, adjuvant and metastatic setting. Pubmed, Cochrane and Embase databases were searched up to April 2024 and the PICO framework, as well as the following inclusion criteria (clinical studies in English published ≥2000 per year, both retrospective and prospective, including abstracts from relevant congresses, yet excluding case reports, letters, phase I clinical trials and radioimmunotherapy) were applied. MINORS and RoB2 were used to assess quality and risk of bias. Due to heterogeneity of the studies, a descriptive analysis was performed. In total, 99 studies (including 11 226 patients) were analysed, concluding that immunotherapy application, although encouraging, still needs refinement, most importantly in terms of patient and treatment regimen selection. The review was registered on the PROSPERO platform (ID: CRD42023417537) and funded by a grant by the Spanish Association of Surgery (AEC).</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"103 11","pages":"Article 800225"},"PeriodicalIF":1.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.ciresp.2025.800227
Antonio Ríos , Beatriz Domínguez-Gil
Traditionally, organ transplantation has relied on donation after brain death (DBD). However, the growing demand for organs has driven the search for alternatives to expand the donor pool. In this context, donation after the circulatory determination of death (DCD) has experienced significant growth throughout the current century, particularly in cases of death following the withdrawal of life-sustaining treatments (Maastricht type III donation). Although still limited to a small number of countries, the volume of DCD in Spain is similar to that of DBD, and it is the only country that has successfully transplanted all types of organs from this type of donor. Living organ donation also makes a meaningful contribution to overall transplant activity, and it must be firmly grounded in comprehensive donor protection. In Spain, 10% of kidney transplants are performed using organs from living donors.
{"title":"Más alla del donante en muerte encefálica. La donación en asistolia y de donante vivo. Experiencia y perspectiva española","authors":"Antonio Ríos , Beatriz Domínguez-Gil","doi":"10.1016/j.ciresp.2025.800227","DOIUrl":"10.1016/j.ciresp.2025.800227","url":null,"abstract":"<div><div>Traditionally, organ transplantation has relied on donation after brain death (DBD). However, the growing demand for organs has driven the search for alternatives to expand the donor pool. In this context, donation after the circulatory determination of death (DCD) has experienced significant growth throughout the current century, particularly in cases of death following the withdrawal of life-sustaining treatments (Maastricht type III donation). Although still limited to a small number of countries, the volume of DCD in Spain is similar to that of DBD, and it is the only country that has successfully transplanted all types of organs from this type of donor. Living organ donation also makes a meaningful contribution to overall transplant activity, and it must be firmly grounded in comprehensive donor protection. In Spain, 10% of kidney transplants are performed using organs from living donors.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"103 11","pages":"Article 800227"},"PeriodicalIF":1.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pectus carinatum is a chest wall deformity characterized by a protrusion. For its correction, the flexibility of the chest wall is essential, as it will determine the possibility of correction through orthopedic or surgical treatment.
Orthopedic treatment has experienced a boom in recent years thanks to the development of a dynamic compression system (vest) that applies pressure to the area.
This effect can be limited by the rigidity of the chest wall (which increases with age) or by the presence of pronounced depressions of abnormally positioned cartilage (limiting cartilage). In these cases, we propose combining the use of the vest with limited partial chondrectomies to facilitate the vest's effect after this surgery. We have called th
is combination of vest-chondrectomy-vest the “3 Cs” technique.
We present a description of the technique and its application in the first patients we have treated this way.
{"title":"Innovación en la corrección del pectus carinatum: combinación de tratamiento ortopédico y quirúrgico (técnica de las 3 «C»)","authors":"José Marcelo Galbis Caravajal , Miriam Estors Guerrero , Nestor Martinez Hernández , Inmaculada Sabariego Arenas","doi":"10.1016/j.ciresp.2025.800240","DOIUrl":"10.1016/j.ciresp.2025.800240","url":null,"abstract":"<div><div><em>Pectus carinatum</em> is a chest wall deformity characterized by a protrusion. For its correction, the flexibility of the chest wall is essential, as it will determine the possibility of correction through orthopedic or surgical treatment.</div><div>Orthopedic treatment has experienced a boom in recent years thanks to the development of a dynamic compression system (vest) that applies pressure to the area.</div><div>This effect can be limited by the rigidity of the chest wall (which increases with age) or by the presence of pronounced depressions of abnormally positioned cartilage (limiting cartilage). In these cases, we propose combining the use of the vest with limited partial chondrectomies to facilitate the vest's effect after this surgery. We have called th</div><div>is combination of vest-chondrectomy-vest the “3 Cs” technique.</div><div>We present a description of the technique and its application in the first patients we have treated this way.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"103 11","pages":"Article 800240"},"PeriodicalIF":1.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145520788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.ciresp.2025.800235
Enrique Javier Grau Talens , Ángel Alois Osorio Manyari , Desirée Diestro Gallego , Carlos A Celis Pinilla , Octavio López Sánchez , Osama Aburedwan , Enrique del Cojo Peces , Francisco Gabriel Onieva González , Javier Arias Díaz
Introduction
Laparoscopic cholecystectomy is widely performed in ambulatory surgery, whereas minilaparotomy approaches remain underreported. This study evaluates the outcomes of transcylindrical cholecystectomy (TCC), performed with a cylindrical retractor, in an outpatient setting under different anesthetic techniques.
Methods
Prospective observational study of 1,626 patients with cholelithiasis or related complications who underwent right transrectal epigastric minilaparotomy (4.5 cm), using a cylindrical retractor with a methacrylate plunger for direct visualization and stable exposure of the hepatocystic triangle. Anesthetic modality (general, supraglottic device, local with sedation, or spinal) was tailored to each patient. Intraoperative cholangiography was selectively performed.
Results
A total of 1,626 patients underwent TCC: 916 with orotracheal intubation, 152 with supraglottic device, 503 under local anesthesia with sedation, and 55 with spinal anesthesia. Mean age: 59 years; BMI: 30; operative time: 40 minutes. The substitution index was 69%. Conversion occurred in 15 cases (0.9%), with 90 unplanned admissions (5.5%), 8 postoperative bile leaks (0.5%), 37 wound infections (2.2%), 2 deaths (0.1%), and 1 major bile duct injury (0.06%). There were 15 readmissions (0.9%) and 8 reoperations (0.5%). At 24 hours, 78% of patients reported good or excellent physical condition.
Conclusions
Transcylindrical cholecystectomy is a fast, safe, and cost-effective technique for treating cholelithiasis in the ambulatory setting. It is feasible under minimally invasive anesthesia, with low complication rates, and may be particularly valuable in resource-limited environments.
{"title":"Colecistectomía transcilíndrica ambulatoria por minilaparotomía bajo diferentes técnicas anestésicas","authors":"Enrique Javier Grau Talens , Ángel Alois Osorio Manyari , Desirée Diestro Gallego , Carlos A Celis Pinilla , Octavio López Sánchez , Osama Aburedwan , Enrique del Cojo Peces , Francisco Gabriel Onieva González , Javier Arias Díaz","doi":"10.1016/j.ciresp.2025.800235","DOIUrl":"10.1016/j.ciresp.2025.800235","url":null,"abstract":"<div><h3>Introduction</h3><div>Laparoscopic cholecystectomy is widely performed in ambulatory surgery, whereas minilaparotomy approaches remain underreported. This study evaluates the outcomes of transcylindrical cholecystectomy (TCC), performed with a cylindrical retractor, in an outpatient setting under different anesthetic techniques.</div></div><div><h3>Methods</h3><div>Prospective observational study of 1,626 patients with cholelithiasis or related complications who underwent right transrectal epigastric minilaparotomy (4.5<!--> <!-->cm), using a cylindrical retractor with a methacrylate plunger for direct visualization and stable exposure of the hepatocystic triangle. Anesthetic modality (general, supraglottic device, local with sedation, or spinal) was tailored to each patient. Intraoperative cholangiography was selectively performed.</div></div><div><h3>Results</h3><div>A total of 1,626 patients underwent TCC: 916 with orotracheal intubation, 152 with supraglottic device, 503 under local anesthesia with sedation, and 55 with spinal anesthesia. Mean age: 59 years; BMI: 30; operative time: 40<!--> <!-->minutes. The substitution index was 69%. Conversion occurred in 15 cases (0.9%), with 90 unplanned admissions (5.5%), 8 postoperative bile leaks (0.5%), 37 wound infections (2.2%), 2 deaths (0.1%), and 1 major bile duct injury (0.06%). There were 15 readmissions (0.9%) and 8 reoperations (0.5%). At 24<!--> <!-->hours, 78% of patients reported good or excellent physical condition.</div></div><div><h3>Conclusions</h3><div>Transcylindrical cholecystectomy is a fast, safe, and cost-effective technique for treating cholelithiasis in the ambulatory setting. It is feasible under minimally invasive anesthesia, with low complication rates, and may be particularly valuable in resource-limited environments.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"103 11","pages":"Article 800235"},"PeriodicalIF":1.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145419567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.ciresp.2025.800233
Enrique Biel , Luis Grande , Manuel Pera
Background
Main treatment options for pharyngoesophageal diverticulum are the surgical excision or fixation, always associated with a myotomy, and the endoscopic peroral myotomy. The aim of this study was to describe the outcomes of a consecutive surgical series.
Methods
Observational study of patients who underwent open surgery (2004-2024) and who had a 2-years structured follow-up. Main outcome were symptom resolution and postoperative complications. Baseline characteristics, surgical technique, reinterventions, readmission and recurrence were also analyzed. Descriptive statistics was used, including percentages, mean and standard deviations, and medians with complete ranges.
Results
During the study period, 40 patients (73% male) were operated on, with a mean age of 72 ± 11 years. Ninety-five percent presented dysphagia and/or regurgitation, while 2 patients were referred due to a history of pneumonia to bronchoaspiration. The most frequent surgical technique was cricopharyngeal myotomy combined with diverticulectomy. Postoperative morbidity was 15%, with no cases of esophageal fistula. There was no mortality, and the median hospital stay was 3 days. Initial symptom resolution was achieved in 95% of patients. During follow-up (median 7 years [1-20]), 2 recurrences were observed at 18 and 24 months, respectively, both successfully managed endoscopically.
Conclusions
Surgical treatment achieves symptoms resolution in the vast majority of cases, with limited morbidity and recurrence.
{"title":"Tratamiento quirúrgico del divertículo faringoesofágico: serie consecutiva de 20 años","authors":"Enrique Biel , Luis Grande , Manuel Pera","doi":"10.1016/j.ciresp.2025.800233","DOIUrl":"10.1016/j.ciresp.2025.800233","url":null,"abstract":"<div><h3>Background</h3><div>Main treatment options for pharyngoesophageal diverticulum are the surgical excision or fixation, always associated with a myotomy, and the endoscopic peroral myotomy. The aim of this study was to describe the outcomes of a consecutive surgical series.</div></div><div><h3>Methods</h3><div>Observational study of patients who underwent open surgery (2004-2024) and who had a 2-years structured follow-up. Main outcome were symptom resolution and postoperative complications. Baseline characteristics, surgical technique, reinterventions, readmission and recurrence were also analyzed. Descriptive statistics was used, including percentages, mean and standard deviations, and medians with complete ranges.</div></div><div><h3>Results</h3><div>During the study period, 40 patients (73% male) were operated on, with a mean age of 72<!--> <!-->±<!--> <!-->11 years. Ninety-five percent presented dysphagia and/or regurgitation, while 2 patients were referred due to a history of pneumonia to bronchoaspiration. The most frequent surgical technique was cricopharyngeal myotomy combined with diverticulectomy. Postoperative morbidity was 15%, with no cases of esophageal fistula. There was no mortality, and the median hospital stay was 3 days. Initial symptom resolution was achieved in 95% of patients. During follow-up (median 7 years [1-20]), 2 recurrences were observed at 18 and 24 months, respectively, both successfully managed endoscopically.</div></div><div><h3>Conclusions</h3><div>Surgical treatment achieves symptoms resolution in the vast majority of cases, with limited morbidity and recurrence.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"103 11","pages":"Article 800233"},"PeriodicalIF":1.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-29DOI: 10.1016/j.ciresp.2025.800232
Manuel López Cano , Josep M García-Alamino
{"title":"Daño administrativo en la práctica clínica: más allá de la burocracia","authors":"Manuel López Cano , Josep M García-Alamino","doi":"10.1016/j.ciresp.2025.800232","DOIUrl":"10.1016/j.ciresp.2025.800232","url":null,"abstract":"","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"103 12","pages":"Article 800232"},"PeriodicalIF":1.3,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145384431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-28DOI: 10.1016/j.ciresp.2025.800230
Natalia González Alcolea , M Dolores Martín Arranz , Blanca Monje Vera , Mario Álvarez Gallego , Jesús Díez Sebastián , Isabel Pascual Miguelañez
Introduction
Perianal fistula is a common and disabling complication of Crohn's disease, with a significant impact on patients’ quality of life. Although structured protocols exist in some centers, no universally accepted management guideline is currently available. In this context, we developed and implemented a protocol in our center aimed at reducing suppuration, preserving continence, and improving quality of life.
Methods
A single-center prospective study was conducted, including 38 patients treated at Hospital Universitario La Paz between January 2020 and January 2022. The protocol combined surgical drainage, seton placement, and biological therapy for at least one year. Indications for curative surgery were based on clinical and radiological criteria. Clinical outcomes, continence (Wexner score), perianal disease activity (Perianal Disease Activity Index [PDAI]), and quality of life (Inflammatory Bowel Disease Questionnaire-9 [IBDQ-9], and a specific 20-item questionnaire) were assessed.
Results
Curative surgery was performed in 55.2% of patients, with a clinical recurrence rate of 31.6%, and no worsening of continence. The IBDQ-9 score was significantly improved (from 59 to 65.4; P < .001). The disease-specific questionnaire revealed a significant impact on social, occupational, emotional, and sexual aspects, particularly among women. Fear of chronic seton use and incontinence was common, and symptomatic control more closely associated with better quality of life than complete fistula healing.
Conclusions
Implementation of the protocol led to improved quality of life. We emphasise the importance of incorporating disease-specific patient-reported outcome measures (PROMs) and adopting a comprehensive perspective, including the patient's experience as a core component of the therapeutic process.
肛瘘是克罗恩病常见的致残性并发症，严重影响患者的生活质量。虽然在一些中心存在结构化协议，但目前还没有普遍接受的管理指南。在这种情况下，我们在我们的中心制定并实施了一项旨在减少化脓、保持自制和提高生活质量的方案。方法采用单中心前瞻性研究，纳入2020年1月至2022年1月在拉巴斯大学医院（Hospital Universitario La Paz）治疗的38例患者。该方案结合手术引流，塞顿放置和生物治疗至少一年。治疗性手术的指征以临床和放射学标准为基础。评估临床结局、尿失禁（Wexner评分）、肛周疾病活动性（PDAI）和生活质量（炎症性肠病问卷-9 （IBDQ-9）和一份特定的20项问卷）。结果55.2%的患者行手术治疗，临床复发率为31.6%，尿失禁无恶化。IBDQ-9得分显著提高（从59分提高到65.4分；P < 0.001）。针对特定疾病的调查问卷显示了对社会、职业、情感和性方面的重大影响，特别是在妇女中。对长期使用阴道瘘和尿失禁的恐惧是常见的，症状控制比完全瘘管愈合与更好的生活质量更密切相关。结论方案的实施提高了患者的生活质量。我们强调纳入疾病特异性患者报告结果测量（PROMs）和采用综合视角的重要性，包括将患者经验作为治疗过程的核心组成部分。
{"title":"Implementación y resultados de un protocolo multidisciplinar para el manejo de la fístula perianal en la enfermedad de Crohn: impacto clínico y en la calidad de vida","authors":"Natalia González Alcolea , M Dolores Martín Arranz , Blanca Monje Vera , Mario Álvarez Gallego , Jesús Díez Sebastián , Isabel Pascual Miguelañez","doi":"10.1016/j.ciresp.2025.800230","DOIUrl":"10.1016/j.ciresp.2025.800230","url":null,"abstract":"<div><h3>Introduction</h3><div>Perianal fistula is a common and disabling complication of Crohn's disease, with a significant impact on patients’ quality of life. Although structured protocols exist in some centers, no universally accepted management guideline is currently available. In this context, we developed and implemented a protocol in our center aimed at reducing suppuration, preserving continence, and improving quality of life.</div></div><div><h3>Methods</h3><div>A single-center prospective study was conducted, including 38 patients treated at Hospital Universitario La Paz between January 2020 and January 2022. The protocol combined surgical drainage, seton placement, and biological therapy for at least one year. Indications for curative surgery were based on clinical and radiological criteria. Clinical outcomes, continence (Wexner score), perianal disease activity (Perianal Disease Activity Index [PDAI]), and quality of life (Inflammatory Bowel Disease Questionnaire-9 [IBDQ-9], and a specific 20-item questionnaire) were assessed.</div></div><div><h3>Results</h3><div>Curative surgery was performed in 55.2% of patients, with a clinical recurrence rate of 31.6%, and no worsening of continence. The IBDQ-9 score was significantly improved (from 59 to 65.4; <em>P</em> <!--><<!--> <!-->.001). The disease-specific questionnaire revealed a significant impact on social, occupational, emotional, and sexual aspects, particularly among women. Fear of chronic seton use and incontinence was common, and symptomatic control more closely associated with better quality of life than complete fistula healing.</div></div><div><h3>Conclusions</h3><div>Implementation of the protocol led to improved quality of life. We emphasise the importance of incorporating disease-specific patient-reported outcome measures (PROMs) and adopting a comprehensive perspective, including the patient's experience as a core component of the therapeutic process.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"103 11","pages":"Article 800230"},"PeriodicalIF":1.3,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145374639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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