Publisher: Elsevier   (Total: 3200 journals)

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Showing 1 - 200 of 3200 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 40, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 27, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Hybrid Journal   (Followers: 107, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 30, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 47, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 10)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acta Astronautica     Hybrid Journal   (Followers: 469, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 30, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 351, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 3, SJR: 1.793, CiteScore: 6)
Acta Psychologica     Hybrid Journal   (Followers: 27, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access   (Followers: 1)
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 9)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 20, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 15, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 206, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 14, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 20, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 31, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 12, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 25, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 35, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 7)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 15)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 28, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 11, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 27, SJR: 1.562, CiteScore: 3)
Advances in Clinical Radiology     Full-text available via subscription   (Followers: 2)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 22, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 15, SJR: 0.205, CiteScore: 1)
Advances in Cosmetic Surgery     Full-text available via subscription   (Followers: 2)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 15)
Advances in Digestive Medicine     Open Access   (Followers: 15)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 8)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 45, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 32, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 10)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 54, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 2)
Advances in Family Practice Nursing     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 70, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 20, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 12, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 9, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 4, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 41, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 12, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 12, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 22, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 17, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 9, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 27)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Pathology     Hybrid Journal   (Followers: 1)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Ophthalmology and Optometry     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 19, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 6, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 21)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription   (Followers: 1)
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 6)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 73)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 3, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 7)
Advances in Space Research     Full-text available via subscription   (Followers: 447, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 6)
Advances in Surgery     Full-text available via subscription   (Followers: 12, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 37, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 21)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 59, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 414, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 486, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 32, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 47, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 60, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 7, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 8, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 12)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 2)
Alexandria Engineering J.     Open Access   (Followers: 3, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 11, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 60, SJR: 4.66, CiteScore: 10)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 60, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 68, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 52, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 13)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 17, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 43, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 36, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 38, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 50)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics & Gynecology MFM     Hybrid Journal   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 284, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 68, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 33, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 30, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 40, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 8)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 71, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 27, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 7, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 234, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 14, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)

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Similar Journals
Journal Cover
EMC - Técnicas Quirúrgicas - Aparato Digestivo
Number of Followers: 0  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 1282-9129
Published by Elsevier Homepage  [3200 journals]
  • Cirugía del colangiocarcinoma intrahepático y perihiliar
    • Abstract: Publication date: February 2019Source: EMC - Técnicas Quirúrgicas - Aparato Digestivo, Volume 35, Issue 1Author(s): N. Golse, E. VibertEl término de colangiocarcinoma engloba un grupo heterogéneo de tumores epiteliales primarios de las vías biliares con pronóstico desfavorable. Se distinguen los colangiocarcinomas intrahepáticos, perihiliares y los de la vía biliar principal (que no se describen en este artículo). Se trata de patologías raras, cuya incidencia es variable según los países. Afectan sobre todo a personas de edad avanzada, con un discreto predominio masculino. El colangiocarcinoma intrahepático suele ser voluminoso en el momento del diagnóstico y se descubre por un síndrome de masa y/o una alteración del estado general. El colangiocarcinoma perihiliar es menos voluminoso y se descubre por una ictericia debida a la obstrucción de la confluencia biliar. El diagnóstico de colangiocarcinoma se sospecha en las pruebas de imagen por la presencia de un tumor hipervascular, retráctil, que rodea los vasos sin obstruirlos. Aunque es difícil de obtener en el colangiocarcinoma perihiliar, es conveniente contar con información histológica del hígado no tumoral y tumoral para el colangiocarcinoma intrahepático, con el fin de identificar una hepatopatía crónica y descartar los diagnósticos diferenciales. El tratamiento debe realizarse en un centro especializado cuando se sospecha el diagnóstico, antes de efectuar cualquier drenaje. El tratamiento quirúrgico, que sólo es posible en menos del 40% de los casos, es el único tratamiento curativo en presencia de márgenes sanos y de ausencia de extensión ganglionar. Este procedimiento suele implicar una hepatectomía mayor y siempre una resección de la confluencia biliar en las formas perihiliares, precedida a menudo de un drenaje biliar y/o de una embolización portal. En las principales series quirúrgicas, se describen supervivencias del 30-40% a los cinco años. Aparte de la mortalidad postoperatoria del 8-10%, estos malos resultados se deben a la extensión ganglionar, a nódulos satélites o a invasión vascular. El trasplante hepático, precedido de radioquimioterapia, es el tratamiento de referencia de los colangiocarcinomas perihiliares menores de 3 cm no resecables. En los demás casos, y cuando no hay posibilidades quirúrgicas, la quimioterapia con gemcitabina y cisplatino es el tratamiento de referencia.
       
  • Tratamiento de las perforaciones esofágicas
    • Abstract: Publication date: February 2019Source: EMC - Técnicas Quirúrgicas - Aparato Digestivo, Volume 35, Issue 1Author(s): V. De Moor, J. Lemaire, A. Rosière, L. MichelUna perforación esofágica es una patología rara y muy grave, que puede deberse a muchas etiologías. El pronóstico depende de la rapidez del diagnóstico y de un tratamiento adecuado. Las opciones terapéuticas son múltiples y no existe unanimidad a la hora de elegirlas. Se debe tener en cuenta la duración de la perforación, el estado general del paciente, la existencia de patologías esofágicas subyacentes y la experiencia de cada equipo. Los objetivos del tratamiento son cerrar la perforación, drenar las colecciones existentes, combatir la sepsis y garantizar el soporte nutricional. Se puede realizar un tratamiento médico conservador siempre que se cumplan unas condiciones muy estrictas. El desarrollo de la endoscopia terapéutica, gracias a la adición de clips o de prótesis, ha permitido un tratamiento mínimamente invasivo. Existen diversas opciones quirúrgicas, como la sutura esofágica reforzada en ocasiones por un colgajo, la fistulización dirigida, la resección o, en los casos desesperados, la exclusión esofágica. Si existe una afección esofágica subyacente, es necesario tratarla.
       
  • Tratamiento quirúrgico de las fístulas rectovaginales no
           traumáticas
    • Abstract: Publication date: April 2018Source: EMC - Técnicas Quirúrgicas - Aparato Digestivo, Volume 34, Issue 4Author(s): A. Kane, P. Atienza, J. Safi, A. Egal, E. Bailly, R. Villet, E. VincensLa fístula rectovaginal es una comunicación anormal entre el recto (por extensión, el conducto anal) y la vagina a través del tabique rectovaginal. El parto y la enfermedad de Crohn son las dos etiologías más frecuentes y suponen dos tercios de las fístulas rectovaginales, seguidas de las fístulas postirradiación (10-20% de los casos), las infecciones criptoglandulares y las fístulas posquirúrgicas. Su tratamiento es esencialmente quirúrgico, pero requiere un estudio preoperatorio completo, que conste como mínimo de una anoscopia y de una ecografía endoanal. La primera etapa del tratamiento suele ser un drenaje con sedal antes de la exploración bajo anestesia. Se han descrito muchas técnicas quirúrgicas, con tasas de éxito del 40-80% dependiendo de la complejidad de la fístula y de su etiología. La enfermedad de Crohn conlleva una tasa de recidiva elevada. La elección de la técnica debe realizarse en una reunión de concertación pluridisciplinaria y depende del tamaño de la fístula, de su trayecto, de su etiología, de su localización y de la existencia de lesiones esfinterianas o perineales asociadas.
       
  • Cirugía de las complicaciones anorrectales de la enfermedad de Crohn
    • Abstract: Publication date: April 2018Source: EMC - Técnicas Quirúrgicas - Aparato Digestivo, Volume 34, Issue 4Author(s): J.-L. Faucheron, S. Barbois, E. Girard, P.-Y. Sage, B. TrillingLa enfermedad de Crohn se complica frecuentemente con lesiones anorrectales, perineales y a veces vaginales, cuya incidencia varía en la literatura. En todos los casos, constituyen una complicación grave, ya que tienen una repercusión importante sobre la calidad de vida. Además de las lesiones inflamatorias difusas y de las lesiones primarias como las ulceraciones, fisuras y seudoexcrecencias, de tratamiento esencialmente médico, hay que identificar las complicaciones secundarias, cuyo tratamiento es mixto médico y quirúrgico. El cirujano puede intervenir de urgencia para drenar un absceso y, casi siempre, colocar un drenaje con sedal, ya que una fistulotomía conllevaría un riesgo demasiado elevado de incontinencia por sección del esfínter. También puede intervenir en las complicaciones crónicas. Una fístula anorrectal en la enfermedad de Crohn puede tratarse mediante un drenaje con sedal prolongado si el trayecto es alto o mediante fistulotomía si el trayecto es transesfinteriano bajo o subcutáneo. Las recidivas suelen requerir una opinión especializada, porque puede ser necesario establecer la indicación de la mejor técnica posible según diversos criterios, como el grado de inflamación, el grado de estenosis, la localización de los orificios, el trayecto de la fístula, la calidad del esfínter, el número de fístulas y la asociación o no de una estenosis, corta o larga. Se dispone de varios métodos quirúrgicos para tratar una fístula: colgajo de descenso rectal, inyección de adhesivo biológico, inserción de tapón (plug) o de colágeno, ligadura interesfinteriana del trayecto fistuloso, realización de un colgajo de Martius o de una graciloplastia; la inyección de células mesenquimatosas autólogas y la utilización de clips metálicos son métodos aún demasiado recientes para utilizarlos de rutina. Las estenosis anales o rectales requieren dilataciones repetidas y, en caso de recidiva, el especialista valorará la oportunidad de una plastia. En algunos casos de enfermedad de Crohn avanzada, es posible que se proponga al paciente una ostomía temporal y, si las lesiones son irreversibles, una amputación abdominoperineal. El carácter crónico e invalidante de la enfermedad, así como la variedad de tratamientos quirúrgicos propuestos para una misma lesión, hacen que el paciente tenga que participar en la decisión del tratamiento médico-quirúrgico. La asociación de una ostomía al tratamiento inmunosupresor y con anti-TNF alfa puede permitir obtener mejor calidad de vida que la que se lograría tras repetidas intervenciones bajo anestesia general.
       
 
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