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BACKGROUND: Endoanal ultrasound for the diagnosis of anal fistulas requires the injection of hydrogen peroxide, but it is often uncomfortable for the patient and possesses potential complications. Novel ultrasound contrast is currently available. OBJECTIVE: We aimed to assess the efficacy and safety of sulfur hexafluoride as an ultrasound contrast agent for the diagnosis of perianal fistula by comparing it with those of 50% diluted hydrogen peroxide. DESIGN: Double-blind superiority study with 4 consecutive visits to perform an ultrasound without contrast, a hydrogen peroxide-enhanced ultrasound, a sulfur hexafluoride-enhanced ultrasound and a rectal exploration in the operating room (the gold standard). The ultrasound images were independently reviewed by three expert surgeon sonographers. CLINICAL SETTING: This study was conducted at a single university hospital. PATIENTS: Data from 176 patients were evaluated. PRIMARY OUTCOME MEASURES: Demographic and exploratory data and the ultrasound findings related to the location of the internal fistula orifice, description of the primary and secondary tracts, and presence of cavities and sphincter defects were analyzed. The complications occurring before and after the contrast agent administration and the presence of pain measured using a score were considered. RESULTS: Eighty-eight patients were included (men: 71.5%; mean age: 48.3 years).62.5% had a complex type and 83.7% had a transsphincteric type. Sulfur hexafluoride-enhanced ultrasounds demonstrated a higher interobserver agreement in determining the secondary tracts (κ= 0.604) and anal fistula height (κ=0.604) compared with other methods. Both hydrogen peroxide-enhanced ultrasound (90.91%) and sulfur hexafluoride-enhanced ultrasound (89.77%) detected the internal orifice more frequently than ultrasounds without contrast (62.5%) (p < 0.001),with no differences between contrast agents (p = 0.810). Sulfur hexafluoride-enhanced ultrasound were less painful than peroxide-enhanced ultrasound (p < 0.001). LIMITATIONS: Most of the patients had transsphincteric anal fistulas. CONCLUSIONS: Sulfur hexafluoride proved comparable to hydrogen peroxide in evaluating fistulous tracts and identifying the internal orifice and additionally reduced significantly pain and discomfort. Furthermore, demonstrated a higher interobserver agreement in determining the secondary tracts and anal fistula height compared with other methods. See Video Abstract.

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AIM: The aim of the study was to evaluate urgent care practice with regard to anorectal abscesses (AA) in a tertiary-level referral hospital. MATERIALS AND METHODS: this was retrospective and unicentric study. Patients who underwent surgery for AA between 2016 and 2017 were included in the study. Demographic variables were analyzed as well as the treatment performed, the need for hospitalization, use of antibiotics, and referral to the coloproctology outpatient department (COD). The recurrence risk factors were also evaluated. RESULTS: A total of 220 evaluations under anesthesia were performed, corresponding to 190 patients, 129 males (mean age 46 ± 14.9 years). The most frequent treatment in the emergency department (ED) was simple drainage (75.8%). Antibiotic therapy was prescribed in 62.9% of the cases. A total of 41.1% of the patients were referred to a specialized COD. The only risk factor associated with recurrence was the presence of an associated anal fistula. CONCLUSIONS: Anorectal abscesses are very frequent in the ED. There is great clinical variability regarding the taking of cultures, prescription of antibiotics, and referral criteria to a specialized coloproctology outpatient department, without clear impact of any of them on the recurrence of the abscess.

OBJETIVO: Evaluar el manejo de los abscesos perianales por parte del servicio de cirugía de urgencias. MÉTODO: Estudio unicéntrico retrospectivo. Se incluyeron pacientes que requirieron manejo quirúrgico de abscesos perianales de 2016 a 2017. Se analizaron variables demográficas, tratamientos realizados, necesidad de ingreso hospitalario, uso de antibióticos y necesidad de derivación a la consulta externa de coloproctología. Así mismo, se evaluaron los factores relacionados con la recurrencia del absceso. RESULTADOS: Durante el periodo de estudio se realizaron 220 exploraciones, correspondientes a 190 pacientes (129 hombres) con una edad media de 46 ± 14.9 años. El tratamiento quirúrgico más frecuentemente realizado fue el drenaje simple (75.8%). Se prescribieron antibióticos en el 62.9% de los casos. El 41.1% de los pacientes fueron remitidos a consulta externa de coloproctología. El único factor de riesgo asociado a la recurrencia fue la presencia de una fístula perianal asociada. CONCLUSIONES: Los abscesos perianales son frecuentes en los servicios de urgencias. Hay una gran variabilidad clínica en su manejo, sobre todo en lo relativo a la realización de cultivos, la prescripción de antibióticos y la derivación a unidades de coloproctología especializadas, sin que ninguna de estas medidas tenga un claro impacto en la recurrencia.

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IntroducciónEl tratamiento clásico del divertículo de Zenker (DZ) ha sido la miotomía del cricofaríngeo (MCF), discutiéndose la necesidad o no de resecarlo (diverticulectomía versus diverticulopexia). Sin embargo, la evolución de las técnicas endoscópicas está obligando a replantear las estrategias de tratamiento. Analizamos las complicaciones y los resultados clínicos de nuestra serie con la miotomía del cricofaríngeo y diverticulectomía en pacientes con DZ.MétodoEstudio observacional retrospectivo y descriptivo de 33 pacientes a los que se realizó, entre enero de 1998 y diciembre de 2010, diverticulectomía y MCF en los hospitales universitarios Virgen del Rocío de Sevilla y Carlos Haya de Málaga. Se analiza la morbilidad y variables demográficas y operatorias que pueden asociarse con esta.ResultadosDiecisiete pacientes fueron tratados en el hospital Carlos Haya de Málaga y dieciséis en el hospital Virgen del Rocío de Sevilla. Aunque no hubo mortalidad, la tasa de morbilidad de la serie fue del 27% (9 casos), siempre relacionada con fístula esófago-cutánea. Ninguna de las variables estudiadas se asoció significativamente con la aparición de morbilidad. Tras un seguimiento medio de 44 meses (rango 6-192) ningún paciente ha presentado recidiva clínica ni radiológica del DZ.ConclusionesLa diverticulectomía asociada a MCF es una buena técnica para el tratamiento del DZ, con excelentes resultados clínicos y funcionales a medio y largo plazo, pese a que la morbilidad mayor en forma de fístula esófago-cutánea ha sido alta (AU)

IntroductionThe classic treatment of Zenker‘s diverticulum (ZD) has been cricopharyngeal myotomy (CPM), with the need or not to resect it being argued (diverticulectomy versus diverticulopexy). However, the advance of endoscopic techniques requires new treatment strategies to be established. We analyse the complications and clinical results of our series with cricopharyngeal myotomy and diverticulectomy in patients with ZD.MethodA retrospective, observational and descriptive study was conducted on 33 patients who, between January 1998 and December 2010, had a diverticulectomy and CPM performed in the university hospitals Virgen del Rocío in Seville and Carlos Haya in Malaga. Demographic and operative variables that might be associated with morbidity were analyzed.ResultsSeventeen patients were treated in the Carlos Haya Hospital, Málaga and sixteen in the Virgen del Rocío Hospital, Seville. Although there were no deaths, the morbidity rate of the series was 27% (9 cases), all associated with an oesophageal-cutaneous fistula. None of the variables studied were significantly associated with the appearance of morbidity. None of the patients had a clinical or radiological recurrence of ZD after a mean follow up of 44 months (range, 6 -192).ConclusionsDiverticulectomy combined with CPM is a good technique for the treatment of ZD, with excellent clinical and functional results in the medium to long term, despite the high morbidity in the form of an oesophageal-cutaneous fistula (AU)

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INTRODUCTION: The classic treatment of Zenker's diverticulum (ZD) has been cricopharyngeal myotomy (CPM), with the need or not to resect it being argued (diverticulectomy versus diverticulopexy). However, the advance of endoscopic techniques requires new treatment strategies to be established. We analyse the complications and clinical results of our series with cricopharyngeal myotomy and diverticulectomy in patients with ZD. METHOD: A retrospective, observational and descriptive study was conducted on 33 patients who, between January 1998 and December 2010, had a diverticulectomy and CPM performed in the university hospitals Virgen del Rocío in Seville and Carlos Haya in Malaga. Demographic and operative variables that might be associated with morbidity were analyzed. RESULTS: Seventeen patients were treated in the Carlos Haya Hospital, Málaga and sixteen in the Virgen del Rocío Hospital, Seville. Although there were no deaths, the morbidity rate of the series was 27% (9 cases), all associated with an oesophageal-cutaneous fistula. None of the variables studied were significantly associated with the appearance of morbidity. None of the patients had a clinical or radiological recurrence of ZD after a mean follow up of 44 months (range, 6 -192). CONCLUSIONS: Diverticulectomy combined with CPM is a good technique for the treatment of ZD, with excellent clinical and functional results in the medium to long term, despite the high morbidity in the form of an oesophageal-cutaneous fistula.

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