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Introduction Radical Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC), has been proposed as the current standard of treatment for metastatic peritoneal disease by several tumors. Despite its widely utilization, there seems to be a great variability in their organization, clinical practice, and safety among centers. Aim of the study To obtain updated information on clinical practice in different perioperative areas of the CRS-HIPEC. Patients and methods All 25 members of the Spanish Surface Peritoneal Malignancy (GECOP), were invited to answer an online survey, to describe their usual practice in different perioperative areas of the CRS-HIPEC. Results Survey was responded by 100% of centers. This study represents more than 800 patients treated annually. Seventy per cent of respondents perform CRS-HIPEC for more than 5 years. The most frequent technique was Coliseum (88%). Routinely non-invasive monitoring of cardiac output is used by 92% of centers. More than 50% of centers administer oxaliplatin (74%), or mitomycin-C (65%) in colorectal cancer; cisplatin in gastric cancer (73%) and mesothelioma (74%). Ovarian cancer is treated with cisplatin and various combinations, in 64% or paclitaxel in 54.5%. Spillage protocol was available in 100% centers. Conclusions Data showed an important variability in volume of patients per center, selection of cytostatic agents, professional training and safety measures applied. The standardization of CRS/HIPEC procedures based on the best available evidence, the individualization of patients and the consensus among professionals, constitute an important part of the basis that will allow us to improve results of this complex procedure.

Aim Reports detailing the morbidity-mortality after left colectomy are sparse and do not allow definitive conclusions to be drawn. We aimed to identify risk factors for anastomotic leakage, perioperative mortality and complications following left colectomy for colonic malignancies. Method We undertook a STROBE-compliant analysis of left colectomies included in a national prospective online database. Forty-two variables were analysed as potential independent risk factors for anastomotic leakage, postoperative morbidity and mortality. Variables were selected using the 'least absolute shrinkage and selection operator' (LASSO) method. Results We analysed 1111 patients. Eight per cent of patients had a leakage and in 80% of them reoperation or surgical drainage was needed. A quarter of patients (24.9%) experienced at least one minor complication. Perioperative mortality was 2%, leakage being responsible for 47.6% of deaths. Obesity (OR 2.8, 95% CI 1.00-7.05, P = 0.04) and total parenteral nutrition (TPN) (OR 3.7, 95% CI 1.58-8.51, P = 0.002) were associated with increased risk of leakage, whereas female patients had a lower risk (OR 0.36, 95% CI 0.18-0.67, P = 0.002). Corticosteroids (P = 0.03) and oral anticoagulants (P = 0.01) doubled the risk of complications, which was lower with hyperlipidaemia (OR 0.3, P = 0.02). Patients on TPN had more complications (OR 4.02, 95% CI 2.03-8.07, P = 0.04) and higher mortality (OR 8.7, 95% CI 1.8-40.9, P = 0.006). Liver disease and advanced age impaired survival, corticosteroids being the strongest predictor of mortality (OR 21.5, P = 0.001). Conclusion Requirement for TPN was associated with more leaks, complications and mortality. Leakage was presumably responsible for almost half of deaths. Hyperlipidaemia and female gender were associated with lower rates of complications. These findings warrant a better understanding of metabolic status on perioperative outcome after left colectomy.

New strategies for the treatment of cancer in the rectum should be directed towards the improvement of micrometastatic disease and the reduction of long-term sequelae, without prejudice to good local control. To achieve this, in the last decade, new strategies have been postulated. Treatment with preoperative chemotherapy (CT) alone or induction CT followed by chemoradiation CRT/short course radiation (CRT/SCPRT) or CRT/SCPRT and consolidative CT is being planned. We currently have data from phase II studies with results of stimulating efficacy and/or compliance. New single-arm and randomized trial is underway and will allow us to know the impact on survival outcomes and long-term sequelae of these strategies.

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are currently the most accepted treatment for peritoneal metastases from colorectal cancer. Restrictive selection criteria are essential to obtain the best survival benefits for this complex procedure. The most widespread score for patient selection, the peritoneal surface disease severity score (PSDSS), does not include current biological factors that are known to influence on prognosis. We investigated the impact of including RAS mutational status in the selection criteria for these patients. Methods: We studied the risk factors for survival by multivariate analysis using a prospective database of consecutive patients with carcinomatosis from colorectal origin treated by CRS and HIPEC in our unit from 2009 to 2017. The risk factors obtained were validated in a multicentre, international cohort, including a total of 520 patients from 15 different reference units. Results: A total of 77 patients were selected for local análisis. Only RAS mutational status (HR: 2.024; p = 0.045) and PSDSS stage (HR: 2.90; p = 0.009) were shown to be independent factors for overall survival. Early PSDSS stages I and II associated to RAS mutations impaired their overall survival with no significant differences with PSDSS stage III overall survival (p > 0.05). These results were supported by the international multicentre validation. Conclusions: By including RAS mutational status, we propose an updated RAS-PSDSS score that outperforms PSDSS alone providing a quick and feasible preoperative assessment of the expected overall survival for patients with carcinomatosis from colorectal origin undergone to CRS + HIPEC.

Objective: To analyze if there are urodynamic differences in patients with neurogenic detrusor overactivity (NDO) secondary to spinal cord injury (SCI) depending on whether the SCI is complete or incomplete according to the American Spinal Injury Association (ASIA) classification. Methods: A retrospective and comparative study was carried out, including 194 patients with suprasacral SCI and NDO. Maximum cystometric capacity (MCC), volume at first involuntary contraction (VIC), compliance, maximum pressure of the detrusor during filling cystometry (MaxDetP), detrusor leak point pressure (LeakDetP) and postvoid residual urine volume (PVR) were analysed. Means were compared with Student t test for independent samples, with statistical significance p < 0.05. Results: SCI was complete (ASIA A) in 51 patients (26.3%) and incomplete (ASIA B–E) in 143 (73.7%). The comparison of means showed significant differences regarding MCC (278.5 ± 102.6 mL in ASIA A vs. 321.6 ± 127.1 mL in ASIA B–E; p = 0. 018) and VIC (161 ± 85.1 and 210 ± 114.4 mL ­respectively; p = 0.006). There were no differences regarding MaxDetP (58.8 ± 26.9 vs. 49.3 ± 35.6 cm H2O), LeakDetP (44.6 ± 25.3 vs. 48.3 ± 26.7 cm H2O), PVR (155.3 ± 94.2 vs. 118.5 ± 129.8) or compliance (29.9 ± 25.3 vs. 48.3 ± 26.7 cm H2O). Conclusions: In our serie incomplete SCI (ASIA B–E) showed differences from complete ones (ASIA A) regarding MCC and VIC, but not regarding LeakDetP, MaxDetP, PVR or compliance.

Introduction: Urinary lithiasis involves a major source of morbidity and economic costs. The aim of this study was to evaluate the adherence to the European Association of Urology Guidelines on Urolithiasis with regard to treatment among Spanish urologists. Methods: A total of 723 patients were included in a prospective study between May 1, 2014, and July 31, 2014. The study involved 8 hospitals responsible of urolithiasis in a geographical area of Spain (Comunidad Valenciana) with approximately 4,500,000 inhabitants. Data were collected about the demographic characteristics of the patients, the characteristics of the stones, and the indicated treatment, in order to analyze the adherence to the clinical guidelines. A 90% threshold was used in concordance with the indications in the guidelines. Results: Adherence to guidelines was poor in chemolysis, distal and ureteral calculi, and >2 cm renal calculi. Adherence was high in Conclusions: In our study, the overall adherence to the clinical guidelines regarding the therapeutic indication for urinary lithiasis has been low. In the case of both renal and ureteral stones, the adherence in small lithiasis has been greater, compared with larger ones. In our survey, a trend has been observed in favor of endoscopic procedures even in large lithiasis.

Introduction: Urinary lithiasis involves a major source of morbidity and economic costs. The aim of this study was to evaluate the adherence to the European Association of Urology Guidelines on Urolithiasis with regard to treatment among Spanish urologists. Methods: A total of 723 patients were included in a prospective study between May 1, 2014, and July 31, 2014. The study involved 8 hospitals responsible of urolithiasis in a geographical area of Spain (Comunidad Valenciana) with approximately 4,500,000 inhabitants. Data were collected about the demographic characteristics of the patients, the characteristics of the stones, and the indicated treatment, in order to analyze the adherence to the clinical guidelines. A 90% threshold was used in concordance with the indications in the guidelines. Results: Adherence to guidelines was poor in chemolysis, distal and ureteral calculi, and >2 cm renal calculi. Adherence was high in

Introduction Endoscopic resection is the common treatment in pT1 colorectal adenocarcinoma whenever possible. The presence of adverse histological factors requires subsequent lymph node evaluation. Materials and methods We selected 29 colorectal pT1 adenocarcinoma including endoscopic polypectomies and the corresponding surgical specimens. All histologic parameters associated with N+ were evaluated by 2 pathologists, including: tumour differentiation grade, depth of invasion in the submucosa, angiolymphatic invasion (ALI), perineural invasion, chronic inflammation, tumour budding, poorly differentiated cluster, pre-existing adenoma, tumour border, and endoscopic resection margin. Univariate and multivariate logistic regression analysis was performed to assess the individual capacity of each variable to predict N+. Results In the univariate analysis, rectal tumour localization, ALI and poorly differentiated cluster were significantly associated with N+. Among the significant parameters, ALI had the highest area under the ROC curve (0.875). Multivariate analysis showed no independent variables associated with N+. Conclusions We confirm that ALI and the presence of poorly differentiated cluster are frequently associated with N+ in early colorectal cancer. Consequently, these parameters should be routinely evaluated by pathologists.

Resumen Introduccion El tratamiento habitual del adenocarcinoma colorrectal pT1 consiste en la reseccion endoscopica siempre que sea posible. Se requiere la evaluacion de los ganglios linfaticos locorregionales cuando se detectan factores histologicos adversos en las polipectomias endoscopicas. Materiales y metodos Se seleccionaron 29 adenocarcinomas colorrectales pT1 incluyendo las polipectomias endoscopicas y piezas quirurgicas correspondientes. Se evaluaron por 2 patologos todos los parametros histologicos asociados a N+, incluyendo: grado de diferenciacion tumoral, profundidad de invasion en submucosa, invasion angiolinfatica (IAL), invasion perineural, inflamacion cronica, gemaciones tumorales, grupos de tumor pobremente diferenciados, adenoma preexistente, borde tumoral y margen de reseccion endoscopico. Se realizo un analisis de regresion logistica univariante y multivariante para evaluar la capacidad individual de cada variable para predecir N+. Resultados En el analisis univariante, la localizacion rectal, la presencia de IAL y la presencia de grupos de tumor pobremente diferenciados se asociaron significativamente con metastasis ganglionares. De todas estas variables, la presencia de IAL presento la mayor area bajo la curva ROC (0,875). El analisis multivariante no encontro ninguna variable independiente asociada a N+. Conclusiones La IAL y la presencia de grupos de tumor pobremente diferenciados se asocia frecuentemente con N+ en cancer colorrectal precoz, por lo que se debe implementar rutinariamente la evaluacion de estos parametros histologicos.

Background: Local relapse and peritoneal carcinomatosis (PC) for pT4 colon cancer is estimated in 15,6% and 36,7% for 12 months and 36 months from surgical resection respectively, achieving a 5 years overall survival of 6%. There are promising results using prophylactic HIPEC in this group of patients, and it is estimated that up to 26% of all T4 colon cancer could benefit from this treatment with a minimal morbidity. Adjuvant HIPEC is effective to avoid the possibility of peritoneal seeding after surgical resection. Taking into account these results and the cumulative experience in HIPEC use, we will lead a randomized controlled trial to determine the effectiveness and safety of adjuvant treatment with HIPEC vs. standard treatment in patients with colon cancer at high risk of peritoneal recurrence (pT4). Methods/Design: The aim of this study is to determine the effectiveness and safety of adjuvant HIPEC in preventing the development of PC in patients with colon cancer with a high risk of peritoneal recurrence (cT4). This study will be carried out in 15 Spanish HIPEC centres. Eligible for inclusion are patients who underwent curative resection for cT4NxM0 stage colon cancer. After resection of the primary tumour, 200 patients will be randomized to adjuvant HIPEC followed by routine adjuvant systemic chemotherapy in the experimental arm, or to systemic chemotherapy only in the control arm. Adjuvant HIPEC will be performed simultaneously after the primary resection. Mitomycin C will be used as chemotherapeutic agent, for 60 min at 42-43 degrees C. Primary endpoint is loco-regional control (LC) in months and the rate of loco-regional control (%LC) at 12 months and 36 months after resection. Discussion: We assumed that adjuvant HIPEC will reduce the expected absolute risk of peritoneal recurrence from 36% to 18% at 36 months for T4 colon-rectal carcinoma., The HIPECT4 trial is funded by Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Spain. IMIBIC has not played a role in designing the study, nor in the collection, analysis and interpretation of data. IMIBIC neither influenced the writing process of the manuscript nor the desition to submit the manuscript for publication. All the other authors have not received funding for their contribution to the HIPECT4 trial.

Introducción: La hernia paraestomal o estomal es una complicación a largo plazo de los estomas que limita la calidad de vida de los pacientes. No está establecido cuál es la mejor técnica ni la mejor vía de abordaje para su reparación. Describimos una nueva técnica usada en casos de eventración paraestomal con eventración de línea media asociada o sin ella. Material y métodos: Fueron intervenidos 15 pacientes con esta técnica (9 con colostomía y 6 con urostomía), que se realiza con abordaje abierto y que combina el uso de una malla intraperitoneal (IPST®) y una separación de componentes con malla de polipropileno supraaponeurótica y nuevas inserciones musculares.Esta técnica ha sido desarrollada por el Servicio de Cirugía del Instituto Valenciano de Oncología (IVO), por lo que los autores la han denominado «Técnica IVO para reparación de hernia paraestomal». Resultados: La estancia media fue 5.6 días. Dos pacientes (13.3 %) presentaron un seroma de herida. No hubo casos de infección de herida quirúrgica, necrosis cutánea ni recidiva de la eventración. El seguimiento medio fue de 16 meses (2-48 meses).Conclusiones: La técnica IVO es segura y reproducible, y permite cerrar los defectos sin tensión, restablecer la biomecánica de la pared y reforzar la zona paraestomal y la línea media. Es necesario un mayor número de casos y mayor tiempo de seguimiento para evaluar su defi nitiva efi cacia a largo plazo.

Resumen Los leiomiosarcomas pancreaticos son neoplasias altamente agresivas con muy mal pronostico. Se describe un caso de un paciente masculino de 78 anos de edad que presenta un tumor abdominal en el que los estudios radiologicos confirmaron el origen primario en el pancreas. El estudio morfologico mostro un sarcoma con morfologia fusocelular y epitelioide, con un perfil inmunohistoquimico positivo para actina musculo liso y desmina con negatividad para miogenina, h-caldesmon, CD117, DOG-1, S100, MyoD1, cromogranina-A, HMB-45, Melan A y EBV, confirmando el diagnostico de leiomiosarcoma fusocelular y epitelioide. Se discute el diagnostico diferencial con otras neoplasias mesenquimales pancreaticas.

Resumen Objetivo Presentamos la experiencia de nuestro centro con la inyeccion de la toxina botulinica tipo A (TB) en el esfinter urinario de los pacientes con disfuncion de vaciado. Material y metodo Se inyecto TB en el esfinter urinario a 20 pacientes entre diciembre de 2003 y agosto de 2011 para el tratamiento de distintas disfunciones de vaciado refractarias a tratamiento convencional. Se utilizaron 4 vias de inyeccion: transuretral, parameatal en mujeres, transrectal en varones y transvaginal. Las dosis utilizadas oscilaron entre 50 y 200 U. Resultados Obtuvimos resultados satisfactorios en 11 pacientes (55%) segun criterios clinicos. La duracion del efecto oscilo entre los 3 y 7 meses. No registramos complicaciones significativas relacionadas con la inyeccion, y la tolerancia al dolor fue buena. Conclusiones La inyeccion de TB en el esfinter urinario es una tecnica segura y eficaz para el tratamiento de diversos trastornos del tracto urinario inferior, pero sus resultados deben interpretarse cautelosamente, sobre todo en funcion de los parametros utilizados para medir la eficacia.

Introduction: Interstitial cystitis (IC)/painful bladder syndrome (PBS) is a difficult disease to manage and creates critical limitations in patients' daily lives. Our objective was to determine the efficacy of hyperbaric oxygen (HBO) therapy in the maintenance of response after the administration of intravesical dimethyl sulfoxide (DMSO). Materials and Methods: We conducted an open, prospective, randomized, comparative pilot study with women diagnosed with IC/PBS according to the European Society for the Study of Interstitial Cystitis criteria. In the first phase, DMSO was given to all patients. In the second phase, we used 1:1 randomization and administered HBO to 10 women. The evaluated variables were pain (through a visual analog scale), frequency and urgency of voids, nocturia, and quality of life using the O'Leary-Sant Interstitial Cystitis Score/Problem Index and the King's Health Questionnaire. In the second phase, we measured the length of time that clinical improvement was maintained. Results: The mean age was 47.6 years (SD 18.4). Out of 20 patients, 14 experienced clinical improvement after DMSO in all of the evaluated symptoms (p < 0.05; 95% CI). After the second phase, all patients who received HBO had a more substantive and prolonged maintenance of the effects of DMSO. Conclusions: In this study, HBO improved the maintenance of the beneficial effects of DMSO among women with IC/PBS.

Resumen Objetivo Presentamos nuestros resultados con el uso de mallas biologicas para la cobertura de los implantes en la reconstruccion mamaria posmastectomia. Pacientes y metodos Se intervino a 40 pacientes consecutivas. La indicacion fue de cancer de mama en 29 casos y de forma profilactica en 11. Se administro neoadyuvancia en 12 pacientes. Resultados Hubo 8 necrosis cutanea, 8 seroma-derrames periprotesicos, 5 hematomas, 3 abscesos, 2 con dolor y 1 extrusion. Se reintervino a 12 pacientes (30%), y en 8 casos (20%) se llevo a cabo la retirada de malla y protesis/expansor. La radioterapia previa tras una cirugia conservadora de inicio obligo a retirar la malla y la protesis en todos los casos. Conclusion La radioterapia y el volumen del implante son factores importantes para la aparicion de complicaciones.

Objective To evaluate the prognostic value of venous tumor thrombus in renal cell carcinoma. Material and methods A retrospective study of 167 patients with renal cell carcinoma and stage pT3 who underwent radical nephrectomy and extended lymphadenectomy from July 1969 to May 2008 was conducted. Patients with any kind of venous involvement were selected for the analysis (73 patients; 43.7%). The Kaplan–Meier survival curves and log-rank test for comparisons were used for the survival analysis. Multivariate analysis was done by Cox regression. Results Lymph node involvement was present in 30 patients (41.1%) and metastatic disease in 9 patients (12.3%). The most frequent histologic renal cell carcinoma subtype was 50 (68.5%) conventional carcinoma, followed by nondifferentiated in 11 (15.5%), and chromophobe in 9 (12.3%). High-grade tumors (Furhman 3–4) were present in 57% of the cases. Venous thrombus level extended to renal vein in 61 patients (83.6%), to inferior vena cava in 9 patients (12.3%) and to the cardiac right atrium in 3 cases (4.1%). The survival analysis showed worse survival in those patients with venous tumor thrombosis ( p = 0.001) and with vein wall invasion ( p = 0.0042), but not in function on the level of the thrombus ( p = 0.12). The multivariate analysis identified the Furhman grade and venous tumor thrombosis as independent survival prognostic factors. Conclusions In our series, venous tumor thrombosis, together with the Furhman nuclear grade, is an independent survival prognostic factor. However, neither cephalic extension of the thrombus nor the invasion of the vein wall showed independent prognostic value.

Resumen Objetivo Analizar el valor pronostico de la trombosis tumoral venosa en el carcinoma de celulas renales (CCR). Material y metodos Estudio retrospectivo de 167 pacientes con carcinoma de celulas renales (estadio pT3) intervenidos mediante nefrectomia radical y linfadenectomia (julio de 1969 a mayo de 2008). Para el analisis se seleccionaron los pacientes con afectacion venosa (73 pacientes; 43,7%). Para el analisis de supervivencia, se utilizaron las curvas de Kaplan-Meyer y el test de log-rank. El analisis multivariante se realizo mediante regresion de Cox. Resultados En 30 pacientes (41,1%) existia afectacion ganglionar, y en 9 pacientes (12,3%) enfermedad metastasica. El subtipo histologico mas frecuente fue el carcinoma convencional en 50 pacientes (68,5%), seguido del indiferenciado en 11 pacientes (15,5%) y el cromofobo en 9 pacientes (12,3%). El 57% de los tumores fueron de alto grado (Furhman 3-4). El nivel de trombo tumoral se extendia hasta la vena renal en 61 pacientes (83,6%), hasta la cava infradiafragmatica en 9 pacientes (12,3%), y en 3 casos (4,1%) al atrio. El analisis de supervivencia mostro peor supervivencia en aquellos pacientes con trombosis tumoral venosa (p=0,001) y con invasion de la pared venosa (p=0,0042) pero no en funcion del nivel del trombo (p= 0,12). El analisis multivariante identifico el grado de Furhman y la trombosis tumoral venosa como factores pronosticos independientes de supervivencia. Conclusiones En nuestra serie la trombosis tumoral venosa es un factor pronostico independiente de supervivencia, junto al grado nuclear de Furhman. Ni el nivel de extension cefalica del trombo ni la invasion de la pared venosa mostraron valor pronostico independiente.

Objetivos: La retención aguda de orina (RAO) es poco frecuente en mujeres y puede relacionarse con distintas patologías. Sólo algunas pacientes son remitidas a una Unidad de Urodinámica para un estudio más exhaustivo. Se pretende describir las características y causas de RAO en las mujeres derivadas a nuestra unidad y analizar su evolución a medio plazo. Material y métodos: Estudio descriptivo retrospectivo (enero 1982- diciembre 2006) incluyendo las mujeres derivadas a la Unidad de Urodinámica tras sufrir una RAO. Se revisaron las historias clínicas con especial énfasis en antecedentes personales, exploración física, así como estudio urodinámico completo durante el episodio de RAO y una vez superado este. Resultados: Se incluyeron 202 mujeres, con una mediana de edad de 57 años (12- 87). Previamente 59 pacientes (28,7%) presentaban síntomas de vaciado. Los patrones urodinámicos que se encontraron fueron: 65 hipocontractilidad vesical (32,2%), 64 estudio normal (31,7%), 37 acontractilidad (18,3%), 21 obstrucción infravesical (10,4%) y 15 ausencia de relajación de suelo pélvico (7,4%). Las principales causas de RAO fueron: 53 neurológica (26,2%); 46 causa desconocida (22,8%); 19 ginecológica (9,4%); 22 diabetes mellitus (10,9%); y 16 urológica (7,9%). Deterioraron la función renal 14 mujeres (6,9%). Tras la RAO 106 mujeres (52,4%) necesitaron continuar con algún tipo de tratamiento. Conclusiones: En nuestra serie la RAO en mujeres suele ser consecuencia de una enfermedad neurológica o uroginecológica subyacente, aunque en un porcentaje importante de pacientes no se logra filiar la causa. La mitad de las pacientes se recuperaron totalmente y no precisaron ningún tipo de tratamiento. Objectives: Acute urinary retention (AUR) is uncommon in women and can be related to different conditions. Only some patients are referred to the urodynamics units for a more extensive study. We intend to describe the charcteristics and causes of AUR in women referred to our unit and to analyze their middle term evolution. Material and Methods: We performed a descriptive retrospective study (January 1982-December 2006), including the women referred to our Uro-Neurology and Urodynamics Unit after suffering an AUR. Medical charts were reviewed with special emphasis on medical history, physical examination, and also complete urodynamics study during the AUR event and after its resolution. Results: A total of 202 women were included, median age of 57 years (12-87 years). Prior to the AUR, 59 women (28.7%) reported voiding symptoms. The urodynamics findings were: 65 (32.2%) detrusor hypocontractility; 64 (31.7%) normal study; 37 (18.3%) detrusor acontractility; 21 (10.4%) bladder outlet obstruction; 15 (7.4%) poor pelvic floor relaxation. The causes of the AUR were: 53 neurological (26.2%); 46 unknown (22.8%); 19 gynecological (9.4%); 22 diabetes mellitus (10.9%); 16 urological (7.9%). Renal insufficiency was observed in 14 patients (6.9%). After the AUR 106 women (52.4%) needed some kind of prolonged treatment. Conclusions: In our experience, AUR in the female is mainly related to underlying neurologic/urogynecologic disease, even though the etiology could not be known in a significant percentage of patients. Half of the patients recovered completely and did not require any treatment.

Resumen Introduccion Pese a no haberse evidenciado ventajas de su empleo, la preparacion mecanica anterograda (PMA) sigue siendo usual en cirugia colorrectal. Nuestro objetivo es analizar el impacto de su empleo selectivo respecto a confort y resultados en pacientes de un programa de rehabilitacion multimodal perioperatoria (RHMM) o con cuidados convencionales (CC). Material y metodos Estudio prospectivo de 108 pacientes propuestos para cirugia electiva, asignados consecutivamente 2:1 a un protocolo de RHMM que incluyo emplear solamente PMA en cirugia rectal con anastomosis baja o a CC en los que se empleo PMA, salvo en cirugia del colon derecho. Ademas se estudiaron dos grupos (A y B) en funcion de si se uso o no PMA. Se analizaron su tolerabilidad, sus resultados y las variables de recuperacion postoperatoria. Resultados Se incluyo a 39 pacientes en el grupo A y a 69 en el B; 69 siguieron el protocolo de RHMM. Los pacientes del grupo A presentaron mas dolor abdominal, malestar anal, nauseas y sed, pero no hubo diferencias en lo que respecta a la tasa de muertes, complicaciones globales o su tipo, mientras que si tuvieron menos complicaciones, fallos de sutura y muertes los pacientes del grupo RHMM (p Conclusiones La restriccion de la PMA a casos seleccionados es segura, y asociada a un programa de RHMM contribuye a una recuperacion mas rapida y comoda sin incrementar las complicaciones.

Complex data analysis methods require optimisation techniques such as evolutionary algorithms in order to generate reliable results. The objective of this study is to analyse the relationships of particular perioperative care in colorectal surgery (CRS) with surgeon epidemiological data, performing partition grouping to look for significant relationships. Methods Data were used from a survey of members of Spanish coloproctology associations on perioperative care in colorectal surgery, and analysing the responses associated with mechanical bowel preparation (MBP), nasogastric intubation (NGI), drainages (D), and early feeding (EF), over the existing scientific evidence (SE) which shows that the first ones are unnecessary and the importance of the last one. We applied a variant of particle swarm optimization (PSO), to group data conglomerates, optimising variables with statistical grouping criteria. Results A total of 130 surveys were analysed, finding 2 clear groups which included 21.5% and 78.5% of the sample, respectively. Sixty eight per cent of the surgeons in Group A belonged to the European Board in Coloproctology, compared to none in Group B, and the former performed 80% of the coloproctology activity, compared to 60% of the rest. A responded homogeneously to questions on MBP, NGI, D and EF, those of group A following the SE, while the others did it randomly and without following it. Age, work position or academic range were not significant in the grouping. Conclusions The evolutionary algorithm was shown to be able to identify groups according to the use of perioperative care in CRS. Accreditation and dedication was associated with behaviour based on the SE.

Despite there being no evidence of the advantages of its use, mechanical bowel preparation (MBP) continues to be routine in colorectal surgery. Our objective is to analyse the impact of its selective use, as regards patient comfort and results, comparing a perioperative multimodal rehabilitation program (MMRH) with conventional care (CC).A prospective study of 108 patients proposed for elective surgery, assigned consecutively 2:1 to an MMRH protocol which only included MBP in rectal surgery with low anastomosis, or to CC in whom MBP was used except in right colon surgery. We also studied two Groups (A and B) with and without the use of MBP. Their tolerance, results and postoperative recovery variables were analysed.Thirty-nine patients were included in Group A, and 69 in Group B. A MMRH protocol was used in another 69 patients. The Group A patients had more abdominal pain, anal discomfort, nausea and thirst, but there were no differences as regards, death, overall or local complications, whilst there was less complications, suture failures and death in the MMRH when compared with CC Group (P.05). There were no advantages observed in the use of MBP as regards the start of bowel movements, tolerance to diet or hospital stay, but these parameters were favourable to the MMRH when compared with CC Group.The restriction of MBP is safe, and associated with an MMRH program, contributes to a faster and more comfortable recovery, without increasing complications.

Objetivo: Evaluar si el uso sistemático de catéter ureteral doble J en las ureteroneocistostomías de los trasplantes renales reduce la tasa de complicaciones. Material y métodos: Estudio prospectivo comparativo no aleatorizado de grupos paralelos, en 194 trasplantes renales. Se establecieron dos grupos homogéneos: 111 pacientes con catéter doble J y otro de 83 pacientes sin catéter. Analizamos la incidencia de complicaciones entre ambos grupos, mediante análisis univariante comparativo (test de χ²) y el análisis multivariante (regresión logística). Resultados: En el grupo con catéter las complicaciones globales aparecieron en el 22,2% frente al 43,3% del grupo sin catéter (p=0,04). En función del reimplante ureteral aparecieron complicaciones en el 38,12% del reimplante tipo Paquin frente al 20,3% en Lich-Gregoir (p=0,09). En el grupo con catéter se evidenció una (0,9%) fístula urinaria frente a 5 (6%) del grupo sin catéter (p=0,08), y 3 (2,7%) estenosis de la anastomosis ureterovesical en el grupo con catéter frente a 7 (8,4%) del grupo sin él (p=0,13). El análisis multivariante demostró que la no utilización de catéter aumenta el riesgo de sufrir complicaciones relacionadas con el reimplante (OR 2,55; IC 95%: 1,37-4,75). El riesgo de fístula aumentó significativamente al no colocar catéter (OR: 9,19; IC 95%: 1,01-84,7). No hubo diferencias entre ambos grupos en cuanto a las infecciones del tracto urinario, produciéndose tres (2,7%) en el grupo con catéter y una (1,2%) en el grupo sin catéter (p=0,63). Conclusiones: La colocación de catéter doble J reduce las complicaciones relacionadas con el reimplante ureteral sin aumentar la morbilidad asociada a su uso. Objective: To assess if the systematic use of double J ureteral catheters in ureteroneocystostomies of kidney transplants reduces the rate of complications. Materials and methods: Non-randomized prospective, comparative study of parallel groups in 194 kidney transplants. We established two equal groups, 111 patients with double J catheter and another of 83 catheter-free patients. We studied the incidence of complications between both groups by means of a univariate comparative study (χ² test)and a multivariate analysis (logistic regression). Results: In the catheter group, the overall complications appeared in 22.2% as opposed to 43.3% of the catheter-free group (p=0.04). Depending on the ureteral transplant, complications appeared in 38.12% of the Paquin type reimplantation as opposed to the 20.3% in Lich-Gregoir (p=0.09). There was evidence of 1 (0.9%) urinary fistula in the catheter group as opposed to 5 (6%) in the catheter-free group (p=0.08), and 3 (2.7%) ureterovesical anastomosis stricture in the group with catheter against 7 (8.4%) of the catheter-free group (p=0.13). The multivariate analysis showed that not using the catheter increases the risk of suffering complications related to reimplantation (OR: 2.55; IC 95%, 1.37-4.75). The risk of fistula increased significantly when a catheter was not placed (OR 9.19, IC 95%, 1.01-84.7). There were no differences between the two groups as regards urinary tract infections; there were 3 (2.7%) in the catheter group and 1 (1.2%) in the catheter-free group (p=0,63). Conclusions: The placement of a double J catheter reduces complications related to ureteral reimplantation without increasing the morbidity associated with their use.

Introduccion: El azul de metileno, se ha venido utilizando desde el siglo XIX para el tratamiento de diversas enfermedades y tambien como metodo de ayuda diagnostica en varias situaciones. Su empleo para tenir peroperatoriamente los trayectos fistulosos y las zonas afectas de las protesis con una infeccion cronica utilizadas en la reparacion de la pared abdominal es de una gran ayuda. Hasta donde conocemos no hay ningun articulo que recoja esta opcion. Demostramos su utilidad hoy. Material y metodo: A lo largo de la practica quirurgica como cirujanos especializados en pared abdominal, en el hospital publico y privado, desde 2000 a diciembre de 2017 hemos recogido 52 casos de infeccion cronica de protesis con sinus y supuracion cronica en la piel de la pared abdominal tanto de hernias primarias como de eventraciones operadas previamente con colocacion de mallas sinteticas de diferentes materiales. Resultados: En todos los casos estudiados el azul de metileno nos ha permitido reconocer el material sintetico infectado, asi como los tejidos circundantes afectos y el trayecto fistuloso. En el 60 % de los casos la protesis estaba en el espacio supra aponeurotico, de polipropileno de diferente tamano de poro y peso. Conclusion: La retirada del material protesico utilizado en cirugia de la pared abdominal para reparacion de hernias y los tejidos con una infeccion cronica por una biocapa es el tratamiento adecuado para curar esta complicacion. La tincion con azul de metileno desde el sinus supurativo en la piel, es un metodo sencillo y eficaz que permite identificar la parte afectada y resecarla en su totalidad.

Resumen Introduccion La enuresis nocturna es un trastorno con un interes historico mantenido, no solo en cuanto a su patogenia, probablemente multifactorial pero todavia hoy desconocida, sino tambien en cuanto a su frecuencia. Objetivo Nos planteamos revisar la literatura medica al respecto para conocer la problematica en el calculo de su casuistica. Material y metodo Realizamos una busqueda en la base de datos PubMed, mediante los terminos Mesh «enuresis», «nocturnal enuresis» y «bedwetting», e incluimos en el cuadro de busqueda los terminos «epidemiology OR prevalence». Incluimos todos los trabajos en lengua inglesa o espanola. Seleccionamos los trabajos con una muestra mayor de 1.000 pacientes, e incluimos estos y los articulos de revision. Procedemos al analisis de la metodologia empleada por los grupos mas relevantes, asi como los resultados globales de frecuencia; ademas, cuando es posible, estratificamos los resultados por edad, sexo y frecuencia de los escapes. Resultados La metodologia de los trabajos analizados es heterogenea y las comparaciones se hacen, por tanto, dificiles. La prevalencia global es dificil de estimar y dar resultados globales carece de interes pues para interpretarlos es necesario pormenorizar la metodologia, la muestra y los criterios diagnosticos. Conclusiones Se hace necesario un estudio epidemiologico propio que resuelva nuestra problematica.

La hernia perineal tras la amputación abdominoperineal es una complicación que puede asociarse a hernia paraestomal y eventración de línea media. Se han descrito distintas técnicas y abordajes para su reparación, sin que ninguna haya demostrado su superioridad. Describimos la reparación en dos tiempos de una triple hernia en una misma paciente: primero la cirugía perineal, a través del periné, usando una malla compuesta con anclajes óseos. Unos meses después la reparación paraestomal y de línea media, usando la técnica IVO previa inyección de toxina botulínica en la pared abdominal.

Objective Antibiotic prophylaxis (AP) and mechanical bowel preparation (MBP) previous to surgery have classically been regarded as important in colorectal surgery. The latter has recently been questioned. We evaluated opinion of Spanish surgeons about the use of these measures. Method E-mail survey among all members of Spanish Coloproctologic Associations. Results Of 413 participants in the survey, 131 (31.7%) responded; 87% of surgeons used cathartics (70%), enemas (2%) or both (28%) for MBP. MBP was used 60% in right colon surgery, 90% in left colon and 99% in rectal surgery. Surgeons with more case load or those who specialized in colorectal surgery used significantly less MBP; 60% of the surgeons thought that MBP made surgery easier and reduced contamination; 35% thought that it decreased wound infection (WI) and 17% thought that it prevented anastomotic leaks. For 77%, it was regarded as useful or very useful. AP was used by 99.3% of surgeons including systemic alone in 86.2% and combined with oral in 16.8%. The first dose was given 2 h before surgery by 20.2% of the surgeons, at the anaesthetic induction by 78.3% and postoperatively by 1.5%; 43% used single dose only, 44.5% extended to 24 h and 12.5% for two or more days; 95% thought that AP reduced WI and 96% considered that it was useful. Conclusion There is general agreement on AP. MBP remained a common practice among Spanish colorectal surgeons except for right colonic resection. Surgeons with more case load and specialization used it significantly less.

Resumen Objetivo Valorar actitudes y opiniones de los cirujanos espanoles respecto del uso de sonda nasogastrica (SNG) y drenajes tras cirugia colorrectal. Material y metodo Encuesta efectuada a los miembros de la Asociacion Espanola de Coloproctologia y de la Seccion de Coloproctologia de la Asociacion Espanola de Cirujanos, y se comparan los resultados con los de otra realizada a cirujanos espanoles en 1996. Resultados Se recibieron 131 (31,7%) de las encuestas remitidas, y se las comparo con 190 de 1996. La SNG la usa de forma sistematica el 22%; selectivamente, el 35%, y nunca, el 43%, frente al 62, el 31 y el 7% en 1996 (p Conclusiones Hay tendencia a reducir el empleo de SNG, aunque los drenajes se sigue usandolos ampliamente.

Resumen Introduccion Evaluacion prospectiva de los resultados de la anupexia grapada en el tratamiento de las hemorroides de grados III-IV en regimen ambulatorio. Metodo Estudio prospectivo de 85 pacientes con hemorroides de grados III-IV, tratados ambulatoriamente mediante la tecnica de anopexia grapada con PPH01 en el Servicio de Cirugia Ambulatoria del Hospital General de Valencia. Se incluyo a pacientes sintomaticos, ASA I-II, que aceptaran del metodo ambulatorio (vehiculo, acompanante adulto, domicilio con telefono, ascensor e higiene basica). Resultados El 39% eran mujeres y el 61%, varones, con una media de edad de 47,6 anos. El 85,9% presento hemorroides de grado IV y el 14,1%, de grado III. El tiempo medio quirurgico fue de 29,81 ± 12 min, con una media de estancia hospitalaria de 168,88 ± 88 min. Intraoperatoriamente observamos 16 (18,8%) hemorragias de la linea de grapado y 5 hemorragias por desgarro mucoso. Durante los primeros 8 dias la complicacion mas frecuente fue el dolor (45,9%), y solo el 7,1% necesito el uso de opiaceos; 1 paciente debio ingresar durante 24 h. En 10 pacientes hubo hemorragia; en 5 de ellos fue leve con la defecacion y cedio espontaneamente, y los otros 5 requirieron ingreso tras revision quirurgica, con alta en 24 h. Ingresaron 9 (10,6%) pacientes, 3 por hemorragia intraope-ratoria, 5 por hemorragia postoperatoria y 1 por dolor. En el 8,2% fue necesaria una nueva intervencion. Conclusiones La anupexia grapada es un procedimiento aplicable en regimen ambulatorio. Aunque tecnicamente sencillo y con una curva de aprendizaje corta, no esta exento de complicaciones. Una adecuada seleccion de pacientes, una correcta informacion perioperatoria y un seguimiento estricto son necesarios en el manejo ambulatorio de esta afeccion.

Resumen La endometriosis incisional es una patologia poco frecuente hallada en cirugia general, muchas veces confundida con otras entidades clinicas mas presentes en nuestro ambito quirurgico, como la hernia incarcerada, el lipoma o el cuerpo extrano. Su diagnostico es fundamentalmente clinico, sobre todo si la presentacion es ciclica en relacion con la menstruacion. El tratamiento definitivo es quirurgico y, en ocasiones, requiere una exeresis con margenes de seguridad seguida de una plastia con malla para cubrir el defecto aponeurotico. Presentamos 3 casos clinicos nuevos, de mujeres en dad fertil, con antecedentes quirurgicos ginecologicos previos que presentan tumoraciones incisionales en la cicatriz de un Pfannenstiel; en el primero de ellos se planteo el diagnostico diferencial entre granuloma a cuerpo extrano y hernia incarcerada, pero en los restantes, debido al caracter ciclico del dolor asociado a la tumoracion, se penso en una posible endometriosis incisional. Los diagnosticos definitivos los proporciono la anatomia patologica tras la exeresis de los tumores. En dos casos se requirio una plastia con malla.