Resultados de una encuesta nacional dirigida a especialistas sobre la evaluación clínica de pacientes con incontinencia fecal

Introduction

Faecal incontinence is a high prevalence disease in the general population. The aims of this study were to analyse which severity grading systems of faecal incontinence are used in Spain and to find out if there are differences in their use among specialists who manage these patients.

Material and methods

A postal questionnaire survey was sent to all hospitals of the National Health Service in Spain in order to study the attitudes and opinions of general surgery and gastroenterology specialists regarding the clinical evaluation of patients with faecal incontinence.

Results

Ninety-nine questionnaires were returned fully completed (65 surgeons and 34 gastroenterologists). Only 41.8% of responders used a diary card systematically (46.8% surgeons vs. 32.3% gastroenterologists; p=0.05). The Wexner score is the most widely grading system used in clinical practice (85.8% surgeons vs. 50% gastroenterologists; p=0.01). The most relevant issues in the evaluation of these patients were considered: Type of faecal incontinence, frequency of leakage and quality of life. Finally, 85.5% of those questioned said that the universal acceptance of severity grading systems by all specialists would be an improvement, and 98.9% considered it useful to start a national plan of information regarding clinical evaluation of faecal incontinence in Spain.

Conclusions

There is variability in how faecal incontinence is evaluated among specialists in Spain.     

Uso de terapia con presión negativa en heridas con fístulas entéricas

Objective

Negative pressure therapy (VAC, vacuum assisted closure) is a method used still in our country. It consists of a system of aspirating a wound by means of a piece of foam and a few adhesive films. It allows the treatment of complex wounds, included (although this is still controversial) those with intestinal fistulas. We present 3 cases of treatment with VAC in this situation and a review of the published literature.

Patients and method

We have treated 10 patients, since VAC therapy was introduced into our centre of which 3 of whom had a fistula in the bed of the surgical wound. We describe the clinical information of the patients and the therapy that followed in each of the cases.

Results

Significant local clinical improvement of the disease, with control of the symptoms, was achieved in all 3 cases. We were able to re-operate to close the fistula in one of the patients, with subsequent good progression of the wound. In the other two cases it gave them a better quality of life although both died due to the overall complexity of their situation.

Conclusions

VAC therapy, although controversial in the treatment of intestinal fistulas, can help to improve the local situation of the wounds, the comfort of the patients and their general situation.