The evidence in this study that spans a 22-year period questions much surgical technical dogma and raises the possibility that parastomal hernias may, like inguinal hernias, represent a failure in the transversalis fascia that might technically be avoidable.

Disruption of the anal sphincter results from obstetric injury, ano-rectal operations or external trauma. Obstetric or surgical division of the sphincteric mechanism may not be immediately apparent and the clinical presentation of incontinence may occur several years later [1, 2]. Reconstruction of the sphincter using a fascial sling or direct end-to-end repair of the disrupted sphincter result in a high failure rate. Failure after direct end-to-end repair is usually caused by break down of the suture line owing to retraction of the muscle ends [3]. Parks advocated an overlapping repair [4] in which the disrupted ends of the sphincter were mobilised and wrapped around each other. This paper reports the results of overlapping sphincter repair for faecal incontinence resulting from trauma, after a 5 year follow-up period.

Introducción: la enfermedad inflamatoria intestinal (EII) es una enfermedad inmunomediada, cuya incidencia en Latinoamérica ha aumentado en los últimos años. Objetivo: analizar las características demográficas y clínicas de los pacientes con EII tratados en un hospital universitario y presentar los datos epidemiológicos con respecto a otros centros en Colombia. Pacientes y métodos: estudio descriptivo de pacientes con EII (1996-2019) en el Hospital Universitario Fundación Santa Fe de Bogotá. Análisis de datos de centros de Medellín, Cali, Bogotá y Cartagena. Resultados: de 386 pacientes, 277 presentaron colitis ulcerativa (CU), 102 enfermedad de Crohn (EC) y 7 colitis no clasificable. La EII fue más frecuente en mujeres (53 %). La mortalidad fue menor de 1 %. El compromiso de la CU fue principalmente la pancolitis (42,6 %). Entre mayor la extensión de la enfermedad, más alta fue la tasa de hospitalización y cirugías (OR 3,70; p < 0,01). El 13 % de los pacientes con CU recibió biológicos. El compromiso por la EC fue principalmente ileocolónico (43,6 %) e ileal (43,6 %). El patrón clínico predominante de la EC fue estenosante (50%). El 45 % recibió biológicos y 56% cirugía. La colangitis esclerosante primaria (CEP) se encontró en 4 % de los pacientes (n = 15). Dos pacientes con CEP desarrollaron cáncer colorrectal (OR 4,18; p 0,008), mientras que 13 pacientes con CU desarrollaron cáncer de colon y 7 cambios displásicos. 3 pacientes con EC desarrollaron cáncer de colon. Conclusiones: se compararon los resultados en relación con otros centros de referencia. Encontramos tendencias similares en el comportamiento clínico y en el tratamiento de la EII, con mayores tazas de hospitalizaciones y cirugías en nuestros casos.

Background Inflammatory Bowel Disease (IBD) includes Ulcerative Colitis (UC) and Crohn Disease (CD). In the last decade, there have been introduced therapeutic changes that have revolutionised the pharmacologic and surgical management of patients with IBD. The incidence of UC and CD has been increasing in Latin America but the exact prevalence is unknown. Our objective is to describe the demographic characteristics, clinical and therapeutic aspects of the IBD in patients that have presented in the University Hospital Fundación Santa Fe de Bogotá (UH-FSFB), Colombia. Methods Retrospective Descriptive Cohort Study. Clinical histories, pathology reports, and endoscopic results from data base HI-ISIS of the UH-FSFB and medical data between January 1996 and February 2019 were recollected, stored in Excel and analysed using IBM SPSS Statistics Visor. Patients with diagnosis of IBD were included. Patients with incomplete clinical histories were excluded. Results From 398 patients included in this study, 72.1% had UC, 25.6% CD and 2.3% Indeterminate Colitis. The average age of diagnosis was 43.54 years (range: 12–91). In both patients with UC and CD there were smaller proportions of men than women (0.9:1 for UC and 0.7:1 for CD). Of the patients with UC, 46.3% had been hospitalised. 37.2% presented with proctitis, 23.8% left colitis and 39% with pancolitis. 13.5% had an asymptomatic clinical disease, 22.4% mild, 15.3% moderate, and 48.8% severe. 12.9% received biological therapy (BT). 24.3% of patients received a second line BT. Fifteen per cent required surgical interventions (SI), of which there were no mortalities. 27% who were receiving BT required SI. Of the patients with CD, 82.4% required hospitalisation. 43.1% had an ileal, 9.8% colonic, 39.2% ileal- colonic, 0% isolated upper digestive and 21.6% perianal compromise. 34.3% had non-stenosing behaviour, 49% stenosing and 16.7% penetrating. 44.1% of patients with CD received BT of which 40% required a second line BT. 55.9% required SI, of which 1 mortality was reported. 71.1% who were receiving BT required a SI. Conclusion Our study contributes to the epidemiology and integral management required by patients with IBD in our environment. More studies are recommended that replicate our methodology in the population with IBD in both Colombia and Latin America.