Cirugía mayor ambulatoria en la fístula perianal asociada a enfermedad de Crohn.

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Bibliographic Details
Title:	Cirugía mayor ambulatoria en la fístula perianal asociada a enfermedad de Crohn.
Alternate Title:	Major outpatient surgery in perianal fistulizing Crohn’s disease.
Authors:	González-Alcolea, Natalia¹ natagoal@hotmail.com, Martín-Arranz, María D.¹, Pascual-Miguelañez, Isabel¹
Source:	Revista de Cirugia. 2025, Vol. 77 Issue 6, p568-574. 7p.
Abstract (English):	Objective: To evaluate the feasibility of major outpatient surgery (MOS) based on the surgical technique used in patients with perianal fistulizing Crohn’s disease (PFCD), traditionally excluded from this approach due to the complexity of the fistulas. Materials and Methods: A prospective, observational, descriptive, single-center study was conducted between January 2020 and January 2022 in a tertiary care hospital. Thirty-eight patients with PFCD, were included and treated according to a multidisciplinary protocol that prioritized the outpatient approach across all surgical techniques. Surgical procedures, outpatient management, and postoperative outcomes-including complications, readmissions, and patient satisfaction-were evaluated. Results: Seventy-two procedures were performed in 38 patients; 94.7% had complex fistulas. The overall outpatient surgery rate was 68.1%. Excluding advancement flaps and LIFT procedures, the rate increased to 74.2%. Stem cell therapy (100%) and fistulotomy (83.3%) showed the highest outpatient completion rates. No reoperations or readmissions occurred within the first 28 days. Among the patients surveyed, 77% preferred outpatient surgery over hospitalization. Discussion: The results suggest that, in a structured setting with proper patient selection, outpatient surgery is feasible even for complex fistulas when less invasive techniques are employed. The low complication rate and high level of patient satisfaction support this therapeutic strategy. Conclusion: Outpatient surgery for PFCD is feasible, safe, and well accepted. The choice of surgical technique appears to be a more decisive factor than fistula complexity in determining suitability for outpatient management. [ABSTRACT FROM AUTHOR]
Abstract (Spanish):	Objetivo: Evaluar la viabilidad de la cirugía mayor ambulatoria (CMA) según la técnica empleada en pacientes con fístula perianal asociada a enfermedad de Crohn (FP-C), tradicionalmente excluidos de este enfoque debido a la complejidad de las fístulas. Material y Métodos: Estudio observacional, descriptivo, prospectivo y unicéntrico realizado entre enero de 2020 y enero de 2022 en un hospital terciario. Se incluyeron 38 pacientes con FP-C, tratados según un protocolo multidisciplinar que priorizó el abordaje ambulatorio en todas las técnicas. Se evaluaron las técnicas quirúrgicas empleadas, la ambulatorización y los resultados postoperatorios, incluyendo complicaciones, reingresos y satisfacción con el régimen ambulatorio. Resultados: Se realizaron 72 procedimientos en 38 pacientes; el 94,7% presentaban fístulas complejas. La tasa global de CMA fue del 68,1%. Excluyendo colgajo de avance y LIFT, la tasa aumentó al 74,2%. La terapia celular (100%) y la fistulotomía (83,3%) presentaron las mayores tasas de ambulatorización. No hubo reintervenciones ni reingresos en los primeros 28 días. Un 77% de los pacientes encuestados prefirieron la cirugía ambulatoria frente al ingreso. Discusión: Los resultados sugieren que, en un entorno estructurado y con adecuada selección de pacientes, la CMA es viable incluso en fístulas complejas si se emplean técnicas menos invasivas. La baja tasa de complicaciones y el alto grado de satisfacción refuerzan esta opción terapéutica. Conclusión: La cirugía ambulatoria en la FP-C es factible, segura y bien aceptada. La selección del procedimiento quirúrgico parece más determinante que la complejidad de la fístula para su inclusión en circuitos de CMA. [ABSTRACT FROM AUTHOR]
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Database:	MedicLatina

Description
Abstract:	Objective: To evaluate the feasibility of major outpatient surgery (MOS) based on the surgical technique used in patients with perianal fistulizing Crohn’s disease (PFCD), traditionally excluded from this approach due to the complexity of the fistulas. Materials and Methods: A prospective, observational, descriptive, single-center study was conducted between January 2020 and January 2022 in a tertiary care hospital. Thirty-eight patients with PFCD, were included and treated according to a multidisciplinary protocol that prioritized the outpatient approach across all surgical techniques. Surgical procedures, outpatient management, and postoperative outcomes-including complications, readmissions, and patient satisfaction-were evaluated. Results: Seventy-two procedures were performed in 38 patients; 94.7% had complex fistulas. The overall outpatient surgery rate was 68.1%. Excluding advancement flaps and LIFT procedures, the rate increased to 74.2%. Stem cell therapy (100%) and fistulotomy (83.3%) showed the highest outpatient completion rates. No reoperations or readmissions occurred within the first 28 days. Among the patients surveyed, 77% preferred outpatient surgery over hospitalization. Discussion: The results suggest that, in a structured setting with proper patient selection, outpatient surgery is feasible even for complex fistulas when less invasive techniques are employed. The low complication rate and high level of patient satisfaction support this therapeutic strategy. Conclusion: Outpatient surgery for PFCD is feasible, safe, and well accepted. The choice of surgical technique appears to be a more decisive factor than fistula complexity in determining suitability for outpatient management. [ABSTRACT FROM AUTHOR]
ISSN:	24524557
DOI:	10.35687/s2452-454920250062769