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PURPOSE Surgical wound infection is the most frequent postoperative complication in abdominal surgery, especially at the colorectal level. The aim of this study is analysing the results of mechanical colon preparation combined with oral antibiotic versus mechanical colon preparation without antibiotic therapy in patients with colorectal cancer undergoing elective surgery. METHODS This retrospective cohort study had been developed from November 2017 to February 2020. We have included a total of 281 consecutive patients undergoing elective colon and rectal oncological surgeries by the same surgical group using laparoscopic and open approaches. Transanal minimally invasive surgery (TAMIS) and transanal total mesorectal excision (TaTME) approaches were excluded. Exposed patients undergoing colon and rectal cancer surgery received mechanical bowel preparation and oral antibiotics with three doses of neomycin 1 g and erythromycin 500 mg the day before surgery. RESULTS The primary outcome was reduction in surgical wound infection rates before and after starting the oral antibiotic therapy from 17 to 6% (p

Resumen Introduccion El tratamiento no operatorio (TNO) de los traumatismos esplenicos es el manejo de eleccion en pacientes estables hemodinamicamente. El objetivo del presente estudio fue valorar la tasa de fracaso del TNO tras la implantacion de un protocolo multidisciplinar para las lesiones esplenicas y comparar los resultados con la literatura. Metodos Estudio retrospectivo, de 16 anos de duracion. Se registro el manejo de estas lesiones segun nuestro protocolo hospitalario, datos demograficos, presion arterial, frecuencia respiratoria, Escala de Coma de Glasgow, Revised Trauma Score, Injury Severy Score, gradacion de las lesiones segun la American Association for the Surgery of Trauma, fracaso del TNO, morbimortalidad. Resultados Se incluyo a 110 pacientes: 90 (81,8%) varones (81,8%), 20 (18,2%) mujeres; edad media de 37 anos; 106 (96,5%) casos fueron contusos y 4 (3,5%) penetrantes por arma blanca. El diagnostico se establecio mediante ECO/TAC. La clasificacion de la American Association for the Surgery of Trauma fue: 14 (13%) pacientes fueron grado I; 24 (22%) grado II; 34 (31%) grado III; 37 (34%) grado IV. Se realizo laparotomia de urgencia en 54 pacientes: 37 por lesiones grado IV y en 17 por inestabilidad hemodinamica. En 56 pacientes se instauro TNO, cirugia conservadora en 16 y esplenectomia en 38. Diez pacientes presentaron complicaciones postoperatorias: 7 en el grupo de esplenectomia, 2 en el grupo de cirugia conservadora y uno en el de TNO (que requirio intervencion por fracaso en TNO). La mortalidad fue de un paciente. Estancia media: 22,8 dias; TNO 17,6 dias; cirugia conservadora 29; esplenectomia 22,4 dias. Conclusiones Si bien continuamos con una estancia hospitalaria elevada, nuestros resultados son comparables a los de la literatura. La implantacion consensuada del protocolo contribuyo al cambio hacia TNO.

El cáncer de recto es actualmente una de las enfermedades que implican una mayor morbimortalidad en la sociedad, tanto para la persona que lo sufre como para la esfera que lo rodea. La evolución en este tipo de tumores permiten abandonar el concepto clásico de grandes incisiones y extensas resecciones, para acercarnos al abordaje mínimamente invasivo, y a realizar la resección que sea únicamente necesaria, buscando preservar la integridad esfintérica en el paciente, y tratando de evitar en la medida de lo posible la confección de ostomías. La mayoría de las investigaciones que se realizan sobre el cáncer de recto, van encaminadas a la mejora en los tratamientos complementarios a la cirugía, como los tratamientos quimioterápicos neoadyuvantes, y los fármacos posteriores a la cirugía, es decir, la quimioterapia adyuvante. Únicamente un tercio de los estudios que se llevan a cabo son para mejorar la técnica quirúrgica. En este apartado, la aparición de la cirugía laparoscópica, el uso de dispositivos a través de orificios naturales para realizar cirugía local, la aparición de la cirugía combinada TaTME, y el auge de la cirugía robótica, parecen ser la antesala de lo que se desarrollará en un futuro respecto a las mejoras quirurgicas. En esta revisión, queremos poner de manifiesto un resumen del tratamiento quirúrgico del cáncer de recto, haciendo especial hincapié en las nuevas técnicas y avances, con una breve reseña histórica y anatómica, sin olvidar la importancia y seguridad para el paciente, tanto en la misma cirugía, como en los resultados oncológicos posteriores., Rectal cancer is currently one of the diseases that imply greater morbidity and mortality in society, both for people suffering and for the people around. The evolution in this type of tumors allows us to leave the classic concept of large incisions and extensive resections towards the minimally invasive approach, and to perform the resection that is only necessary, seeking to preserve the sphincteric integrity in the patient, and trying to avoid as much as possible ostomies. Most of rectal cancer research is aimed to improving complementary treatments to surgery, such as neoadjuvant chemotherapeutic treatments, and post-surgery drugs. Only one third of the studies carried out are focused on improvig the surgical technique. In this section, the appearance of laparoscopic surgery, the use of devices through natural holes to perform local surgery, the appearance of TaTME combined surgery, and the rise of robotic surgery, seem to be the prelude to what will be developed. in the future regarding surgical improvements. In this review, we want to highlight a summary of the surgical treatment of rectal cancer, with special emphasis on new techniques and advances and also a brief historical and anatomical review, also including the importance and safety for the patient both in the surgery and subsequent cancer follow-up.

Introduction Non-operative treatment (NOM) of splenic trauma is the management of choice in hemodynamically stable patients. Aim of the present study was to assess the failure rate of the NOM after implantation of a multidisciplinary protocol for splenic injuries comparing the results with the literature. Methods 16-year retrospective study. Management of these lesions was recorded according to our hospital protocol: demographic data, blood pressure, respiratory rate, Glasgow Coma Scale(GCS), Revised Trauma Score(RTS), Injury Severity Score(ISS), grades of injuries according to the American Association for the Surgery of Trauma(AAST), failure of the NOM, morbidity and mortality. Results 110 patients were included, 90 (81.8%) men, 20 (18.2%) women; mean age 37 years; 106 (96.5%) cases were blunt and four (3.5%) penetrating by knife. The diagnosis was established by US/CT. AAST classification: 14 (13%) patients were grade I; 24 (22%) grade II; 34 (31%) grade III; 37 (34%) grade IV. Emergency laparotomy was performed in 54 patients: 37 due to grade IV injuries, 17 due to hemodynamic instability. NOM was established in 56, conservative surgery in 16 and splenectomy in 38. Ten patients presented postoperative complications: seven in the splenectomy group, two in the conservative surgery group and one in non-operative group. One patient died. Average hospital stay: 22.8 days- TNO 17.6 days, conservative surgery 29, splenectomy 22.4 days. Conclusions Although we continue with a high hospital stay, our results are comparable to the literature. The implementation of the protocol by consensus contributed to the change towards NOM.

The congenital dilation of the bile duct is an infrequent pathology in western countries and is associated with the female sex. It is usually diagnosed clinically with complementary tests and evaluated at an early age and also appears frequently in adults. These dilatations are grouped into five types according to Todani's classification, including type Ic (Figure 1). The treatment of choice for dilatations of the biliary duct Todani type I is the complete excision of the biliary tract due to the susceptibility of malignant degeneration. A reconstruction is performed via a hepaticojejunostomy with a Roux-en-Y loop. Although in non-malignant cases, a papillotomy with prophylactic stent placement using ERCP can be performed as an alternative. We present the case of a 54-year-old female with a history of high blood pressure, she was examined due to generalized abdominal pain which was unrelated to food intake. The blood test did not identify any alterations of interest. Ultrasound identified a fusiform dilation of the common bile duct occupied by lithiasis. ERCP was attempted due to choledocholithiasis, but the procedure was abandoned as it was not feasible to channel the duodenal papilla. The study was completed with NMR cholangiography (transverse plane [Figure 2] and coronal plane [Figure 3]), identifying a diffuse fusiform dilatation of the common bile duct and common hepatic duct, compatible with congenital cystic lesion Todani type Ic. Finally, the patient underwent a hepaticojejunostomy after sectioning of the main bile duct and extraction of choledocholithiasis.

Tis work was supported by the ‘Acción Transversal del Cancer’, approved by the Spanish Ministry Council on the 11th October 2007, by the Instituto de Salud Carlos III, co-founded by FEDER funds –‘a way to build Europe’ (grants PI08/1770, PI08/0533, PI08/1359, PI09/00773, PI09/01286, PI09/01903, PI09/02078, PI09/01662, PI11/01403, PI11/01889, PI11/00226, PI11/01810, PI11/02213, PI12/00488, PI12/00265, PI12/01270, PI12/00715, PI12/00150, PI14/01219, PI14/00613, and PI15/00069). Support was also provided by the Fundación Marqués de Valdecilla (grant API 10/09); the Junta de Castilla y León (grant LE22A10–2); the Consejería de Salud of the Junta de Andalucía (2009-S0143); the Conselleria de Sanitat of the Generalitat Valenciana (grant AP 061/10); the Recercaixa (grant 2010ACUP 00310); the Regional Government of the Basque Country; the Consejería de Sanidad de la Región de Murcia; European Commission grants FOOD-CT-2006-036224-HIWATE; the Fundación Científca Asociación Española Contra el Cáncer (AECC); the Catalan Government DURSI (grant This work was supported by the 'Accion Transversal del Cancer', approved by the Spanish Ministry Council on the 11th October 2007, by the Instituto de Salud Carlos III, co-founded by FEDER funds -'a way to build Europe' (grants PI08/1770, PI08/0533, PI08/1359, PI09/00773, PI09/01286, PI09/01903, PI09/02078, PI09/01662, PI11/01403, PI11/01889, PI11/00226, PI11/01810, PI11/02213, PI12/00488, PI12/00265, PI12/01270, PI12/00715, PI12/00150, PI14/01219, PI14/00613, and PI15/00069). Support was also provided by the Fundacion Marques de Valdecilla (grant API 10/09); the Junta de Castilla y Leon (grant LE22A10-2); the Consejeria de Salud of the Junta de Andalucia (2009-S0143); the Conselleria de Sanitat of the Generalitat Valenciana (grant AP 061/10); the Recercaixa (grant 2010ACUP 00310); the Regional Government of the Basque Country; the Consejeria de Sanidad de la Region de Murcia; European Commission grants FOOD-CT-2006-036224-HIWATE; the Fundacion Cientifica Asociacion Espanola Contra el Cancer (AECC); the Catalan Government DURSI (grant 2014SGR647); the Fundacion Caja de Ahorros de Asturias; the University of Oviedo; Societat Catalana de Digestologia; and COST action BM1206 Eucolongene., Ibáñez-Sanz, G., Díez-Villanueva, A., Vilorio-Marqués, L., Gracia, E., Aragonés, N., Olmedo-Requena, R., Llorca, J., Vidán, J., Amiano, P., Nos, P., Fernández-Tardón, G., Rada, R., Chirlaque, M.D., Guinó, E., Dávila-Batista, V., Castaño-Vinyals, G., Pérez-Gómez, B., Mirón-Pozo, B., Dierssen-Sotos, T., Etxeberria, J., Molinuevo, A., Álvarez-Cuenllas, B., Kogevinas, M., Pollán, M., Moreno, V.

The potential protective effect of renin?angiotensin system (RAS) inhibitors is a subject of increasing interest due to their possible role as chemopreventive agents against colorectal cancer (CRC). To evaluate this association, we conducted a case-control study with 2165 cases of colorectal cancer, diagnosed between 2007 and 2012, and 3912 population controls frequency matched (by age, sex and region) fromthe Spanishmulticenter case-control studyMCCSpain. We found a significant protective effect of the angiotensin-converting enzyme Inhibitors (ACEIs) against CRC, limited to the under-65 years group (OR=0.65 95%CI (0.48?0.89)) and to a lesser degree tomen (OR=0.81 95%CI (0.66?0.99). In contrast, the angiotensin receptor blockers (ARBs) did not show a significant effect. Regarding the duration of use, a greater protection was observed in men as the length of consumption increases. In contrast, in the under-65 stratum, the strongest association was found in short-term treatments. Finally, by analyzing ACEIs effect by colon subsite, we found no differences, except for under 65 years old, where the maximum protection was seen in the proximal intestine, descending in the distal and rectum (without statistical significance). In conclusion, our study shows a protective effect on CRC of the ACEis limited to males and people under 65 years old, which increases in proximal colon in the latter. If confirmed, these resultsmay suggest a novel approach to proximal CRC prevention, given the shortcomings of colonoscopy screening in this location. This work was supported by the “Accion Transversal del Cancer”, approved on the Spanish Ministry Council on the 11th October 2007, by the Instituto de Salud Carlos III-FEDER (PI08/1770, PI08/0533, PI08/1359, PI09/00773, PI09/01286, PI09/01903, PI09/02078, PI09/01662, PI11/01403, PI11/01889-FEDER, PI11/00226, PI11/01810, PI11/02213, PI12/00488, PI12/00265, PI12/01270, PI12/00715, PI12/00150, PI14/01219, PI14/0613), PI15/00069, PI15/01032, PI15/00914, by the Fundación Marqués de Valdecilla (API 10/09), by the ICGC International Cancer Genome Consortium CLL (The ICGC CLL-Genome Project is funded by Spanish Ministerio de Economía y Competitividad (MINECO) through the Instituto de Salud Carlos III (ISCIII) and Red Temática de Investigación del Cáncer (RTICC) del ISCIII (RD12/0036/0036)), by the Junta de Castilla y León (LE22A10-2), by the Consejería de Salud of the Junta de Andalucía (2009-S0143), by the Conselleria de Sanitat of the Generalitat Valenciana (AP_061/10), by the Recercaixa (2010ACUP 00310), by the Regional Government of the Basque Country, by the Consejería de Sanidad de la Región de Murcia, by the European Commission grants FOOD-CT-2006-036224-HIWATE, by the Spanish Association Against Cancer (AECC) Scientific Foundation, by the Catalan Government DURSI grant 2014SGR647, by the Fundación Caja de Ahorros de Asturias and by the University of Oviedo.

Introducción: Los pacientes sometidos a cirugía de recto con anastomosis bajas y que portan ileostomías de protección, ven prolongado el intervalo entre la realización del estoma y la cirugía de reconstrucción a veces durante meses, mientras dure el tratamiento adyuvante. El objetivo de este estudio es valorar el impacto de la calidad de vida, modificaciones en la morbimortalidad y el gasto sanitario ante el cierre de la ileostomía previo al tratamiento adyuvante. Material y métodos: Revisión retrospectiva. Se analizaron los pacientes sometidos a cierre de ileostomía entre enero 2012 y diciembre de 2013. El número de pacientes estudiado ha sido de 55: 41 varones (74,54%) y 14 mujeres (25,45%). En 27 pacientes se realizó cierre de ileostomía al año de su creación y en 28 al mes. En ambos grupos se analizó la morbimortalidad, coste sanitario y calidad de vida, este último parámetro mediante la aplicación del cuestionario GIQLI de calidad de vida. Resultados: El número de pacientes estudiado es 55. La edad media 63,83 años. Los pacientes con cierre precoz de ileostomía presentaron una estancia media hospitalaria menor, 11,87 días respecto a los pacientes con cierre anual, 14,96 días, descendiendo así el coste sanitario. El 18,33 % de los pacientes con cierre precoz de ileostomía presentó íleo postoperatorio frente a un 65,3% del cierre tardío. La calidad de vida (bienestar total) valorada en pacientes con cierre precoz ha sido de un 61, 2% frente a un 33,44 % en pacientes con cierre tardío. Conclusiones: La realización de ileostomías de protección en las anastomosis rectales bajas ha demostrado ser una medida preventiva eficaz para disminuir la morbimortalidad de las dehiscencias de las mismas. El cierre precoz de la ileostomía reduce el íleo postoperatorio, la estancia media hospitalaria, mejora la calidad de vida y el coste sanitario., Introduction: Patients undergoing rectal surgery with low anastomosis and carrying ileostomy protection, can see extended the interval between placing the stoma and the reconstructive surgery, sometimes during months, while the adjuvant treatment is being developed. The aim of this study was to assess the impact on the Quality of Life, changes in morbidity and mortality and health costs before the closure of the ileostomy prior to the adjuvant treatment. Material and methods: Retrospective study. 55 patients underwent closure of the ileostomy between January 2012 and December 2013 were studied. The sample consisted on 41 (74.54%) men and 14 (25.45%) women. In 27 Patients the closure of the ileostomy was performed in 1 year from its creation and in 28 patients was closed in one month. Morbidity and mortality, medical cost and Quality of Life were analyzed. Results: The average age was 63.83 years. Patients with early closure of ileostomy had a mean hospital stay lower, 11.87 days compared to patients with annual closure, 14.96 days, and so descending health costs. 18, 33% of patients with early closure of ileostomy presented postoperative ileus against the 65.3% of late closure. Quality of Life in Patients with early closure has been assessed 61, 2% compared to 33.44% in patients with late closure. Conclusions: Performing protection ileostomy in low rectal anastomosis has proven to be a preventive effective measure in reducing morbidity and mortality dehiscence. Early closure of the ileostomy reduces postoperative ileus, the average of hospital stay, and improves quality of life and health costs.

espanolObjetivo: el objetivo de este estudio es evaluar la resecabilidad y efectividad de las rehepatectomias en metastasis hepaticas de origen colorrectal recidivadas en terminos de morbimortalidad, supervivencia global y libre de enfermedad. Metodos: se realizo un estudio retrospectivo de una cohorte prospectiva de pacientes con metastasis hepaticas de origen colorrectal con cirugia de repeticion en el Hospital Universitario San Cecilio de Granada de marzo de 2003 hasta junio de 2013. Las variables principales de resultado fueron la supervivencia y la morbilidad antes de los 30 dias del postoperatorio. Resultados: un total de 147 pacientes con metastasis hepaticas de origen colorrectal se sometieron a la extirpacion quirurgica durante el periodo de estudio; 61 pacientes presentaron una recidiva hepatica de los cuales 34 se sometieron a una cirugia de repeticion. La tasa global de supervivencia a 5 y 10 anos para los pacientes resecados fue del 48 y el 48%. La estancia media hospitalaria fue de 8,9 ± 3,5 dias, la morbilidad del 9% y la mortalidad del 0%. Conclusion: las resecciones hepaticas repetidas para las metastasis hepaticas de origen colorrectal constituyen una operacion segura y eficaz, con resultados similares a los obtenidos tras una primera reseccion hepatica. EnglishObjective: The purpose of this study was to assess the resectability and effectiveness of repeat hepatectomy for relapsing liver metastases of colorectal origin in terms of morbidity, mortality, overall survival, and disease-free survival. Methods: A retrospective study was performed on a prospective cohort of patients with colorectal liver metastases who underwent repeat surgery at Hospital Universitario San Cecilio, Granada (Spain), from March 2003 to June 2013. Primary outcome variables included survival and morbidity within 30 days post-surgery. Results: A total of 147 patients with colorectal liver metastases underwent surgical excision during the study period; 61 patients had liver recurrence, and 34 of these received repeat surgery. The overall survival rate at 5 and 10 years for resected patients (n = 27/34) was 48% and 48%. Mean hospital stay was 8.9 ± 3.5 days, morbidity was 9%, and mortality was 0%. Conclusion: Repeat liver resection for colorectal liver metastases is a safe, effective surgical procedure whose results are similar to those obtained after initial liver resection.