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Resumen Objetivo Caracterizar los episodios adversos relacionados con la asistencia sanitaria en pacientes infectados por SARS-CoV-2 fallecidos en un hospital de tercer nivel. Metodos Estudio observacional retrospectivo en el que se incluyeron los pacientes fallecidos en el centro entre el 16 de marzo y el 10 de abril de 2020. La informacion fue extraida desde la historia clinica electronica. Resultados La mediana de edad de los 164 pacientes analizados fue de 77,5 anos. Mas de 9 de cada 10 pacientes fallecidos presentaban al menos una comorbilidad. El 40,2% de los pacientes presento al menos un episodio adverso (EA) asociado a la atencion sanitaria. Un 23,8% de los pacientes presento alguna reaccion adversa a medicamentos, constituyendo la primera causa de EA entre los pacientes fallecidos. Entre los pacientes que fallecieron en unidades de cuidados intensivos, los problemas relacionados con la ventilacion mecanica han aparecido con una frecuencia del 8,8%. Conclusiones A pesar de que la letalidad asociada a los EA detectados fue muy reducida, es fundamental establecer una vigilancia estrecha de los posibles EA asociados a la asistencia sanitaria, especialmente los farmacologicos, dado que se trata de una enfermedad con un tratamiento terapeutico incierto.

Adherence to Enhanced Recovery Protocols (ERPs) is associated with faster functional recovery, better patient satisfaction, lower complication rates and reduced length of hospital stay. Understanding institutional barriers and facilitators is essential for improving adherence to ERPs. The purpose of this study was to identify institutional factors associated with adherence to an ERP for colorectal surgery.A secondary analysis of a nationwide study was conducted including 686 patients who underwent colorectal surgery across twenty-one institutions in Spain. Adherence to ERPs was calculated based upon the components recommended by the Enhanced Recovery After Surgery (ERAS®) Society. Institutional characteristics (i.e., case volume, ERP duration, anesthesia staff size, multidisciplinary meetings, leadership discipline) were captured from each participating program. Multivariable regression was performed to determine characteristics associated with adherence.The median adherence to ERAS was 68.2% (IQR 59.1%-81.8%). Multivariable linear regression revealed that anesthesiologist leadership (+5.49%, 95%CI +2.81% to +8.18%, P 0.01), duration of ERAS implementation (+0.46% per year, 95%CI +0.06% to +0.86%, P 0.01) and the use of regular multidisciplinary meetings (+4.66%, 95%CI +0.06 to +7.74%, P 0.01) were independently associated with greater adherence. Case volume (-2.38% per 4 cases weekly, 95%CI -3.03 to -1.74, P 0.01) and number of anesthesia providers (-1.19% per 10 providers, 95%CI +2.23 to -8.18%, P 0.01) were negatively associated with adherence.Adherence to ERPs is strongly associated with anesthesiology leadership, regular multidisciplinary meetings, and program duration, whereas case volume and the size of the anesthesia staff were potential barriers. These findings highlight the importance of strong leadership, experience and establishing a multidisciplinary team when developing an ERP for colorectal surgery.

Objective To characterize health care-related adverse events in patients with SARS-CoV-2 infection who died in a tertiary hospital. Methods This is a retrospective, observational study, that included patients who died at HUGTiP hospital between 16 March and 10 April 2020. Data was extracted from the electronic medical record. Results The median age of the 164 SARS-CoV-2 infected patients who died in the center in the study period was 77.5 years and >90% of patients had ≥1 comorbidity. Forty point two percent of patients had at least ≥1 health care-related adverse event. Twenty three point eight of patients had an adverse drug reaction, the leading cause of adverse events in patients who died. Of patients who died in intensive care units, the frequency of problems related to mechanical ventilation was 8.8%. Conclusions Although the case fatality rate associated with the adverse events detected was very low, close monitoring of potential health care-related adverse events, especially drug reactions, as the therapeutic management of the disease remains unclear.

Procalcitonin (PCT) and C-Reactive Protein (CRP) are acute-phase reactants that indicate the presence and severity of an infection. The aim of this study was to verify the utility of CRP and PCT as tools for early diagnosis of anastomotic leakage (AL) in patients undergoing elective colorectal surgery. A prospective observational study including 95 patients undergoing elective colorectal surgery with anastomosis, where patients were divided into two groups according to whether or not AL happened. Different variables were compared using a uni- and multivariate analyses to identify the risk factors for AL. Receiver Operating Characteristic (ROC) curves were added to establish a cut-off point for CRP and PCT. The inflammatory marker levels were analysed in other complications different from AL. AL was detected in 11 patients (14%), 7 required an emergency reoperation. The overall morbidity rate was 42.1% and the mortality was 3.2%. In the univariate study, increased CRP on days 3 and 5, male sex and intraoperative complications were significantly associated with AL. In the multivariate study, CRP on day 5 was the only factor related to AL. AUC at ROC curves showed that CRP results ≥ 15.3 mg/dL on day 3 and 9.1 mg/dL on day 5 were predictors of AL. Normal CRP and PCT values had a high negative predictive value. CRP on postoperative day 5 is a reliable marker for early detection of anastomotic leakage in colorectal surgery. Both CRP and PCT on days 3 and 5 have a high negative predictive value. Trial registration: The study has been registered at ClinicalTrials.gov. Code: NCT04632446.

Diagnostic errors have to be recognised as a possible adverse event inherent to clinical activity and incorporate them as another quality indicator. Different sources of information report their frequency, although they may still be underestimated. Contrary to what one could expect, in most cases, it does not occur in infrequent diseases. Causes can be complex and multifactorial, with individual cognitive aspects, as well as the health system. These errors can have an important clinical and socioeconomic impact. It is necessary to learn from diagnostic errors in order to develop an accurate and reliable system with a high standard of quality.

Resumen Debemos reconocer el error diagnostico como un episodio adverso posible e inherente al acto clinico, e incorporarlo con normalidad al resto de los indicadores de calidad asistencial. Por diferentes fuentes de informacion podemos conocer su frecuencia, aunque probablemente todavia esta subestimada. En contra de lo que se podria suponer, en la mayoria de los casos no acontece en enfermedades infrecuentes. Sus causas suelen ser complejas y multifactoriales, con aspectos tanto cognitivos individuales como del sistema. Estos errores pueden tener un gran impacto clinico y socioeconomico. Es necesario aprender de los errores diagnosticos para desarrollar un sistema seguro, propio de una cultura de calidad.

Population-based screening programmes for colorectal cancer (CRC) allow an early diagnosis, even before the onset of symptoms, but there are few studies and none in Spain on the influence they have on patient survival. The aim of the present study is to show that patients receiving surgery for CRC following diagnosis via a screening programme have a higher survival and disease-free survival rate than those diagnosed in the symptomatic stage.Prospective study of all the patients undergoing programmed surgery for CRC at the JM Morales Meseguer Hospital in Murcia (Spain) between 2004 and 2010. The patients were divided into two groups: (a) those diagnosed through screening (125 cases); and (b) those diagnosed in the symptomatic stage (565 cases). Survival and disease-free survival were analysed and compared for both groups using the Mantel method.The screen-detected CRC patients show a higher rate of survival (86.3% versus 72.1% at 5 years, p0.05) and a lower rate of tumour recurrence (73.4% versus 88.3% at 5 years, p0.05).Population-based screening for CRC is an effective strategic measure for reducing mortality specific to this neoplasia.

espanolIntroduccion: la endometriosis es una patologia relativamente frecuente en mujeres en edad fertil y poco prevalerte en mujeres prepuberes o postmenopausicas. Caso clinico: presentamos el caso clinico de una mujer de 57 anos, con antecedentes de histerectomia y doble anexectomia por endometriosis ovarica, diagnosticada de neoplasia de recto T3N1. Se realizo neoadyuvancia preoperatoria y reseccion anterior baja, sin complicaciones. La anatomia patologica describia infiltracion de la pared rectal por adenocarcinoma pobremente diferenciado de origen ginecologico. Discusion: la endometriosis tiene una prevalencia estimada del 10-20% y su lugar de aparicion puede ser variado, tanto gonadal como extragonadal. La frecuencia de endometriosis extragonadal de localizacion intestinal se estima en un 3-37% de mujeres con endometriosis pelvica, y de estas la mayoria se localizan en colon sigmoide y recto. La transformacion maligna de un foco de endometriosis se estima entre el 0,3 y el 1%. El gold estandar para el diagnostico es la reseccion y estudio histologico. La radioterapia y quimioterapia adyuvante todavia no ha demostrado su clara utilidad. EnglishBackground: Endometriosis is a relatively common disease among women with child-bearing potential, and rare before puberty or following menopause. It consists of the presence of hormoneresponsive endometrium outside the endometrial cavity. Case report: We report the case of a patient with a rectal lesion, initially approached as a primary rectal malignancy, where histopathology eventually revealed an adenocarcinoma arising from endometrial tissue in the colonic wall. Discussion: Endometriosis has an estimated rated of 10-20%. Sites may be split up into two larger categories - gonadal and extragonadal. The frequency of extragonadal endometriosis in the bowel is estimated to involve 3%-37% of women with pelvic endometriosis, and most lesions are found in the sigmoid colon and rectum. The malignant transformation of endometriotic lesions is estimated between 0.3% and 1% of cases. The gold standard in the diagnosis of intestinal endometriosis is exploratory laparotomy and the pathological study of specimens. Adjuvant radiotherapy and chemotherapy, although used for some patients, have not proven effective

Diagnosis of colorectal cancer (CRC) based on clinical symptoms is usually established in its advanced stages. One strategy for reducing mortality is the early detection and removal of preneoplastic and initial neoplastic lesions, even before the first symptoms appear, by means of population-based screening campaigns. The aim of the present study is to determine whether CRC diagnosed via a screening campaign has more favourable histopathological prognostic factors than when diagnosed in the symptomatic phase.The prospective study of all the patients undergoing programmed CRC surgery at the JM Morales Meseguer Hospital (Spain) is between 2004 and 2010. The patients were divided into two groups: one diagnosed from clinical symptoms and one through a screening campaign. The following factors were compared: tumour size; degree of tumour invasion of the wall; lymph node, perineural and lymphovascular involvement; tumour stage; and grade of differentiation.Compared to the symptomatic group, the screen-detected patients had smaller-sized tumours (lesions of less than 5 cm in 84 vs 69.55%, p0.001), a lower degree of colorectal wall invasion (T0-1 in 36 vs 9.02%, p0.001), less lymph node involvement (N0 in 72 vs 58.76%, p0.05), less vascular invasion (7.20 vs 15.22%, p = 0.79) and less perineural invasion (6.4 vs 20.70%, p0.001). The TNM staging in the screening group was lower than in the symptomatic group (stage 0-1 in 50.40 vs 18.58%, p0.001).CRC diagnosed through a population-based screening programme presents more favourable histopathological characteristics than that diagnosed from the appearance of symptoms.

Resumen: Antecedentes: Poder aprender de sus errores supone para los clínicos un elemento de gran interés. Esta función la plantea la retroinformación clínica en sentido formativo (feedback), reconocida como un elemento útil en la mejora de la calidad asistencial y la seguridad clínica. Objetivos: Describir nuestra experiencia en feedback formativo, analizando las características de los casos clínicos incorporados, así como la opinión de los profesionales que recibieron la formación. Material y métodos: Estudio descriptivo, que recoge la experiencia de un año, en la práctica de feedback formativo sobre incidentes clínicos. Se determinó: fuente de notificación, descripción del incidente e impacto clínico, mensajes clave y tipo de feedback (grupal y/o individual). Así mismo, se planteó una encuesta de opinión al grupo de facultativos. Resultados: Se incluyeron 27 casos, que suponen un 0,06% de las asistencias. Las fuentes de notificación fueron: el propio SUH en 19 (70,3%) casos, unidad de atención a la ciudadanía en 3 (11,1%), dirección de calidad en 2 (7,4%), unidad de admisiones en 2 (7,4%) y servicio de microbiología en uno (3,7%). Los casos correspondían en un 7,4% a aspectos de carácter diagnóstico, 40,7% terapéutico, y 55,5% de ambos. La encuesta a los profesionales, aunque con una participación del 36%, mostró unas valoraciones positivas en todos los aspectos planteados. Conclusiones: Incorporar el feedback formativo para los profesionales resulta factible, parece ser bien recibido y podría representar una herramienta útil en la mejora de la seguridad clínica. Abstract: Background: To learn from one's mistakes is an element of great interest for clinicians. This strategy is proposed as clinical feedback in a training sense, recognized as a useful element for the improvement of healthcare quality and clinical safety. Objectives: To describe our experience in training feedback, analysing the characteristics of the clinical cases included, as well as the opinion of the professionals who received the training. Material and methods: A descriptive study, which gathers the experience of one year in the practice of educational feedback on clinical incidents. Source of notification, description of the incident and clinical impact, key messages and type of feedback (individual and / or group level) were determined. In addition, an opinion survey was proposed to all the doctors. Results: 27 cases were included, which represent .06% of the total medical care provided. The sources of notification were the emergency department in 19 (70.3%) cases, citizenship unit 3 (11.1%), quality management 2 (7.4%), admissions unit 2 (7.4%) and microbiology department 1 (3.7%). Of the cases, 7.4% corresponded to aspects related to diagnosis, 40.7% to therapy, and 55.5% to both. The survey for professionals showed a predominance of positive assessments in all aspects raised, although participation was 36%. Conclusions: Incorporating training feedback for professionals is feasible, seems to be well accepted and could prove a useful tool for improving clinical safety. Palabras clave: Feedback formativo, Seguridad clínica, Urgencias, Keywords: Training feedback, Clinical safety, Emergency

Background Body contouring surgery is in high demand following the increase in bariatric surgery. But these types of procedures are associated with high complication rates that cause long hospital stays and have a negative effect on patient satisfaction. The purpose of this study is to identify predictors of complications in order to optimize outcomes in these patients and find a relationship between complication rate and satisfaction. Materials and methods Out of a group of 175 post-bariatric patients, 72 patients underwent body contouring surgery following massive weight loss from 2003 to 2008. They were reviewed retrospectively for demographic data, pre- and postoperative weight status, co-morbidities and complications and reoperation rate. Patient satisfaction was evaluated. Results (a) Complications: The overall complication rate was 45.8%. The most frequent were seromas (23.6%); infection (13.9%), bleeding (11.1%), hematoma (6.9%) (needing transfusions [6.9%]), skin necrosis (6.9%) and umbilical necrosis (4.2%). A total of 8 patients required reoperation (11.1%). (b) Satisfaction rating: (1) very satisfied: 51.4%, (2) satisfied: 31.9%, (3) dissatisfied: 8.3%, (4) very dissatisfied: 8.3%. (c) The presence of complications was significantly associated with patients’ satisfaction, reoperation rate and longer hospital stays ( P 001). Conclusions Post operative complications were frequent. No predictors could be found to prevent these complications and optimize patient selection and appropriate timing of surgery. Patients with complications had a significantly higher reoperation rate, longer hospital stay and more dissatisfaction. The patients’ satisfaction was negatively influenced by complication occurrence and not by the esthetic results.

Resumen Introduccion Las abdominoplastias se han convertido en un proceso quirurgico frecuente en pacientes con perdida masiva de peso tras cirugia bariatrica. Este tipo de procedimientos no estan exentos de complicaciones que afectan a la calidad de vida y satisfaccion del paciente. El objetivo de este estudio es encontrar los factores de riesgo para desarrollar dichas complicaciones y evaluar la satisfaccion de nuestros pacientes. Material y metodos A un total de 72 pacientes, de los 175 intervenidos de cirugia bariatrica, se les realizo una abdominoplastia entre 2003 y 2008. Fueron revisados, retrospectivamente: datos demograficos, estado pre- y poscirugia, comorbilidades, tasa de complicaciones y reintervencion. El nivel de satisfaccion fue medido mediante una encuesta expresada en una escala tipo Likert. Se realizo un analisis comparativo de las distintas variables entre pacientes con y sin complicaciones. Resultados a) Complicaciones: tasa global del 45,5%. La mas frecuente fue el seroma (23,6%); infeccion (13,9%), sangrado (11,1%), hematoma (6,9%) (requiriendo transfusion [6,9%]), necrosis de piel (6,9%) y necrosis umbilical (4,2%). Se reintervino a 8 pacientes (11,1%). b) Satisfaccion: 1) muy satisfecho: 51,4%; 2) satisfecho: 31,9%; 3) insatisfecho: 8,3%; 4) muy insatisfecho: 8,3%. c) Se encuentra una relacion estadisticamente significativa entre complicaciones, reintervencion, estancia media y satisfaccion (p Conclusion Las complicaciones son relativamente frecuentes en este tipo de pacientes, alargando la estancia media y posteriores controles ambulatorios. No hemos identificado factores de riesgo que ayuden a prevenir este tipo de complicaciones. El grado de insatisfaccion esta en relacion con las complicaciones postoperatorias del procedimiento quirurgico y no con el resultado estetico.

Introduccion La incontinencia fecal (IF) es un trastorno de elevada prevalencia, que afecta gravemente a la calidad de vida relacionada con la salud (CVRS), de los pacientes que la padecen. La neuromodulacion es un tratamiento minimamente invasivo que ha demostrado su eficacia en el tratamiento de los sintomas de IF durante los ultimos 10 anos. El objetivo de nuestro trabajo es comprobar si existe una mejora en la calidad de vida, utilizando el EuroQuol 5D (EQ-5D) en los pacientes con incontinencia fecal tratados con neuromodulacion de raices sacras. Metodologia Estudio observacional con recogida prospectiva de datos de calidad de vida, antes y despues, utilizando el EQ-5D sobre una serie de pacientes con diagnostico de IF moderada o intensa con esfinter integro o reparado a los que se ha implantado de forma definitiva el neuroestimulador MEDTRONIC Interstim® 3023 tras una fase de estimulacion subcronica con buena respuesta. Resultados El numero medio de escapes inicial es de 3,1±1 y el final 0,5±0,6. El numero medio de escapes por semana se reduce en 2,6 escapes (IC 95%: 2,1-3,1) tras el implante definitivo del estimulador de raices sacras (p

Faecal incontinence (FI) is a highly prevalent disorder that severely affects the health related quality of life (HRQOL) of the patients who suffer from it. Neuromodulation is a minimally invasive treatment that has demonstrated its efficacy in the treatment of FI symptoms over the past 10 years. The aim of this study is to check whether there is an improvement in the quality of life, using EuroQuol (EQ-5D), in patients with faecal incontinence treated with sacral root neuromodulation.An observational study with prospective recording of quality of life data, before and after, using the EQ-5D on a series of patients diagnosed with moderate to severe FI with a complete or repaired sphincter who had a definitive MEDTRONIC Interstim(®) 3023 implant after a subchronic stimulation phase with a good response.The initial mean number of leaks was 3.1±1, and the final was 0.5±0.6. The mean number of escapes per week decreased to 2.6 escapes (CI 95%: 2.1-3.1) after the definitive implant of the sacral root stimulator (P.001). The mean baseline health status score was 55.9±13, and after neuromodulation it was 63.1±13. Thus, the visual analogue scale score increased by 7.1 points (CI 95%: 0.37-14) after the definitive implant of the sacral root stimulator (P.05). In the HRQOL variables studied with the EQ-5D questionnaire, we found an improvement with neuromodulation in the mobility and the presence of anxiety and/or depression variables. On the other hand we found an improvement with the neurostimulator implant, which was not significant, in personal care, performing daily activities and the presence of pain and/or discomfort. The current health was better in 11 patients (57.9%), the same in 7 (36.8%) and worse in 1 (5.3%).Neuromodulation is a therapy that has demonstrated a significant improvement in HRQOL measured with the EQ-5D.

Fundamentals and objectives: Frozen section (FS) constitutes a diagnostic procedure in patients following hemithyroidectomy. It is used to diagnose malignant lesions and to avoid reoperations. Our objective is to confirm this test as useless to rule out cancer. Patients and methods: Retrospective and comparative trial between two series of patients following hemithyroidectomy. G I: 179 patients operated in 1995–2002. In this period we performed systematic FS. Sensitivity (S), specificity (E) and predictive values (PPV, NPV) are analyzed. G II: 126 patients were operated between 2003–2008. Selective FS was performed (23 patients). Both groups are compared: hospital stay, number of FS, percentage of cancer, definitive biopsy and reoperations. Results: Data analyzed in the first period: S: 48%, E: 100%, PPV: 100%, NPV: 90%, positive likelihood ratio 410, negative likelihood ratio 0.52. When both periods are compared no significant differences between reoperations are found. Conclusion: FS during hemithyroidectomy does not reduce reoperations for cancer.

Background The treatment of complex incisional hernias is still difficult and controversial. With technologic developments we can modify and update the operative techniques described for treating complex abdominal wall hernias. Methods This is a prospective study of 50 patients with complex incisional hernias undergoing complex abdominal wall herniorrhaphy at a university hospital. All patients were evaluated in a multidisciplinary clinic dedicated to abdominal wall reconstruction. All patients underwent pre-operative computed tomography. Complex incisional hernias were regarded as those with multiple recurrences (>3 times), a previous mesh complicated by fistula and chronic infection, giant diffuse lumbar hernias, an associated parastomal hernia, or hernias developing after bariatric surgery. The operative technique was a double reconstruction prosthetic mesh. The type of repair as well as clinical, operative, and follow-up data were analyzed. Results Eight patients had considerable loss of tissue, 5 had trophic skin lesions, and 2 had chronic suppurative infection. The mean size of the defects was 18.2 cm. Morbidity included 5 cases of seroma, 2 neuralgias, and 2 cutaneous necroses. The mean duration of hospital stay was 5 days (range, 2–9). Complete follow-up (mean, 48 months; range, 12–108) showed no recurrent hernias. Conclusion While awaiting a longer follow-up to confirm the results, we conclude that complex incisional hernias can be repaired safely and with a low morbidity and recurrence rate by means of a double prosthetic repair technique.

The management of incisional hernias remains a challenge for the general surgeon. Repairing by using prosthetic materials has reduced the relapse rate, but intra-abdominal mesh placement continues to be a source of controversy.An evaluation is made of the results of treating incisional hernias with a new intra-abdominal low-density composite mesh through both the open and the laparoscopic approach.A prospective analysis was made on the first 50 patients operated upon for incisional hernia through the open (n=20) or laparoscopic route (n=30), with intra-abdominal repair using the Proceed composite mesh, composed of low-density polypropylene and a hydrophilic antiadherent membrane of oxidized regenerated cellulose.There were no patient deaths. Reintervention proved necessary in one case due to hemoperitoneum caused by a trocar. The mean duration of stay was 3 days, and all patients recovered bowel transit within 24 hours. During follow-up there were no intra-abdominal complications associated with the use of the mesh (intestinal occlusion or subocclusion, prolonged ileus, infections, rejection, fistulas, or relapses).Incision hernia repair using the intra-abdominal low-density composite mesh is safe and well tolerated. Proceed mesh facilitates laparoscopic hernioplasty maneuvering.

Retrorectal or presacral space is occupied during embryological stem cell development and therefore may contain a heterogeneous group of tumors.We report the case of a 22-year-old male with a pilonidal cyst operated due to recurrent pilonidal sinus cyst. Final diagnosis after pelvic computed tomography is large retrorectal cystic tumor and magnetic resonance diagnosis of a presacral cystic compatible wtih germ cell tumor. The tumor was removed surgically through the abdomen and diagnosis of cystic teratoma was established.Retrorectal tumors are rare lesions whose presence must be ruled out in case of recurrent sinus.Antecedentes: durante el desarrollo embriológico, el espacio retrorrectal o presacro está ocupado por células pluripotenciales y, por tanto, puede contener un grupo heterogéneo de tumores. Caso clínico: se comunica el caso de un paciente masculino de 22 años de edad, intervenido de sinus pilonidal recidivado. Con estudios de tomografía computada de pelvis y resonancia magnética nuclear se sospechó la existencia de un tumor quístico presacro compatible con tumor germinal; la lesión se extirpó quirúrgicamente por vía abdominal y se estableció el diagnóstico definitivo de teratoma quístico. Conclusiones: los tumores retrorrectales son lesiones poco habituales que es necesario descartar en caso de sinus recidivantes.

INTRODUCTION Transanal endoscopic microsurgery is a widely used and valid technique with established indications. However, the cost of surgical anoscopes is not available in all centers. Many authors have described transanal resection of rectal tumors through a single laparoscopy port such as the SILS system. MATERIALS AND METHODS We analyzed 5 cases of patients undergoing transanal resection with an SILS device. The clinical, surgical, and oncological data were assessed. RESULTS The median distance to the anal margin was 7.2 cm (range, 5 to 10 cm) and median tumor size was 3 cm (range, 1 to 6 cm). Median operating time was 75 minutes (range, 60 to 120 min). A postsurgical rectorrhagia occurred in 1 of the case. Two cases were adenocarcinoma, 2 were adenomas, and the other was a mucosa without any tumor remnants. The margins were negative in all cases. CONCLUSIONS Transanal resection of rectal tumors using the SILS technique is a feasible procedure. Longer series and prospective studies are necessary.

Introduction: diverting loop ileostomies are widely used in colorectal surgery to protect low rectal anastomoses. However, they may have various complications, among which are those associated with the subsequent stoma closure. The present study analyses our experience in a series of patients undergoing closure of loop ileostomies. Method: retrospective study of all the patients undergoing ileostomy closure at our hospital between 2006-2010. There were 89 patients: 56 males (63%) and 33 females (37%) with a mean age of 55 (38-71) years. The most common indication for ileostomy was protection of a low rectal anastomosis, 81 patients (91%). The waiting time until stoma closure, type and frequency of the complications, length of hospital stay and mortality rate are analysed. Results: waiting time before surgery was 8 (1-25) months. Forty-one patients (45,9%) developed some type of complication, three were reoperated (3.37%) and one patient died (1.12%). The most important complications were intestinal obstruction (32.6%), diarrhoea (6%), surgical wound infection (6%), enterocutaneous fistula (4.5%), rectorrhagia (3.4%) and anastomotic leak (1.12%). The mean length of patient stay was 7.54 (2-23) days. Conclusions: protective ostomies in low rectal anastomoses have proved to be the only preventive measure for reducing the morbidity and mortality rates for anastomotic leakage. However, creation means subsequent closure, which must not be considered a minor procedure but an operation with possibly significant complications, including death, as has been shown in publications on the subject and in our own series.

Bouveret syndrome is a rare entity consisting of duodenal obstruction due to a gallstone from the gallbladder.We present two patients with very different ages and comorbidities whose conditions were resolved in two different ways: a 41-year-old female with right upper quadrant pain and vomiting who underwent surgical correction of obstruction and fistula, and an 81-year-old female with a high bowel obstruction, only treating the obstruction without intervention of the fistula.It is important to include high gastrointestinal obstruction in the differential diagnosis. Diagnosis can be made either by radiological or endoscopic techniques and therapeutic options are diverse, ranging from endoscopic removal to surgery (with the resolution of obstruction and fistula in the same surgical procedure). This condition usually affects elderly patients with high comorbidities and high surgical risk; therefore, most authors recommend using the most conservative possible treatment.

The aims of this preintervention and postintervention study were to monitor and evaluate the clinical pathway (CP) for colorectal cancer (CRC) over a 5-year period and to compare 2 groups of patients (before and after the intervention) with regard to different variables of effectiveness. Group I comprised 68 patients who underwent planned surgery between January 2002 and January 2003. Group II comprised a sample of 202 patients who underwent surgery between January 2004 and December 2008. No significant differences were found in the majority of the parameters measured: postoperative stay, compliance with antibiotic prophylaxis, compliance with the staging study, mortality, rate of infection, and reoperations. The mean length of stay (±standard deviation) for patients without complications was reduced significantly (9.2 ± 3.6 in group I versus 7.7 ± 1.7 in group II, P = .031). The CP for CRC did not achieve most of the objectives for which it was designed.

Aims To analyze diagnostic and therapeutic options depending on the clinical symptoms, location, and lesions associated with intussusception, together with their follow-up and complications. Patients and methods Patients admitted to the Morales Meseguer General University Hospital (Murcia) between January 1995 and January 2009, and diagnosed with intestinal invagination. Data related to demographic and clinical features, complementary explorations, presumptive diagnosis, treatment, follow-up, and complications were collected. Results There were 14 patients (7 males and 7 females; mean age: 41.9 years-range: 17-77) who presented with abdominal pain. The most reliable diagnostic technique was computed tomography (8 diagnoses from 10 CT scans). A preoperative diagnosis was established in 12 cases. Invaginations were ileocolic in 8 cases (the most common), enteric in 5, and colocolic in 2 (coexistence of 2 lesions in one patient). The etiology of these intussusceptions was idiopathic or secondary to a lesion acting as the lead point for invagination. Depending on the nature of this lead point, the cause of the enteric intussusceptions was benign in 3 cases and malignant in 2. Ileocolic invaginations were divided equally (4 benign and 4 malignant), and colocolic lesions were benign (2 cases). Conservative treatment was implemented for 4 patients and surgery for 10 (7 in emergency). Five right hemicolectomies, 3 small-bowel resections, 2 left hemicolectomies, and 1 ileocecal resection were performed. Surgical complications: 3 minor and 1 major (with malignant etiology and subsequent death). The lesion disappeared after 3 days to 6 weeks in patients with conservative management. Mean follow-up was 28.25 months (range: 5-72 months). Conclusions A suitable imaging technique, preferably CT, is important for the diagnosis of intussusception. Surgery is usually necessary but we favor conservative treatment in selected cases.

FUNDAMENTALS AND OBJECTIVES: Frozen section (FS) constitutes a diagnostic procedure in patients following hemithyroidectomy. It is used to diagnose malignant lesions and to avoid reoperations. Our objective is to confirm this test as useless to rule out cancer.Retrospective and comparative trial between two series of patients following hemithyroidectomy. G I: 179 patients operated in 1995-2002. In this period we performed systematic FS. Sensitivity (S), specificity (E) and predictive values (PPV, NPV) are analyzed. G II: 126 patients were operated between 2003-2008. Selective FS was performed (23 patients). Both groups are compared: hospital stay, number of FS, percentage of cancer, definitive biopsy and reoperations.Data analyzed in the first period: S: 48%, E: 100%, PPV: 100%, NPV: 90%, positive likelihood ratio10, negative likelihood ratio 0.52. When both periods are compared no significant differences between reoperations are found.FS during hemithyroidectomy does not reduce reoperations for cancer.