Ileal reservoir-associated complications in ulcerative colitis versus familial adenomatous polyposis: Impact on patient quality of life | Gastroenterología y Hepatología (English Edition)

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Restorative proctocolectomy with ileal pouch-anal anastomosis &#40;RP-IPAA&#41; was described in the late 1970s as an alternative to total colectomy with Brooke ileostomy&#44; continent ileostomy or ileorectal anastomosis<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; RP-IPAA has become the procedure of choice for the surgical treatment of patients with ulcerative colitis &#40;UC&#41; and familial adenomatous polyposis &#40;FAP&#41;&#44; who account for almost 20&#37; of patients with UC<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; This procedure combines the goals of removing the affected colon and rectum&#44; reducing the risk of cancer and maintaining gastrointestinal continuity&#44; transanal defecation and continence&#46; Although most patients benefit from a significant improvement in quality of life&#44; with good functional outcomes&#44; RP-IPAA surgery can be associated with a significant number of complications leading to pouch removal or permanent diverting colostomy<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Several studies have examined the short- and long-term reasons for ileal pouch failure and have found that unrecognised Crohn&#39;s disease<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#44; indeterminate colitis<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#44; pelvic sepsis<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#44; extension of rectal stump mucosectomy<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44; sclerosing cholangitis<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and fistula formation<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> can contribute to poor functional outcomes and lead to a diverting ileostomy&#44; or excision of the pouch<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a>&#46; There is much debate regarding functional outcomes&#46; While in the short term they are very satisfactory and remain constant<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44; some studies have suggested that functional outcomes deteriorate over time<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The most common complication after an ileal pouch has been created is so-called &#34;pouchitis&#34;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a>&#46; Characteristic&#44; though nonspecific&#44; clinical symptoms include abdominal pain&#44; especially with bowel movements&#44; loose stools with a mixture of mucus and blood&#44; faecal urgency&#44; fever&#44; and diarrhoea that can rapidly lead to severe dehydration<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a>&#46; Pouchitis is more common in patients operated on for UC than for FAP&#46; The incidence of pouchitis is reported in up to 45&#37; of patients undergoing RP-IPAA&#44; with a prevalence of 25&#37;&#44; 32&#37;&#44; 36&#37;&#44; 40&#37; and 45&#37; after one&#44; two&#44; three&#44; four and five years following the procedure&#44; respectively<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;19</span></a>&#46; There are several inflammation rating scales&#59; the most commonly used is the Pouchitis Disease Activity Index &#40;PDAI&#41; that evaluates clinical&#44; endoscopic and histological aspects&#44; presented by the Mayo Clinic group in 1994<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46; This has been modified to suppress the histological aspects&#44; making it more practical and with the same sensitivity and specificity<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This study aims to evaluate not only early and late complications&#44; but also the onset or otherwise of cancer and the functional outcomes and long-term quality of life in patients undergoing RP-IPAA with ileoanal or ileorectal anastomosis for UC or FAP during 25 years of follow-up&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patients and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">Between January 1994 and December 2019&#44; 115 consecutive patients underwent RP-IPAA&#44; 79 for a preoperative diagnosis of UC and 36 for FAP&#46; The surgical procedures were performed in four tertiary-level hospitals in the city of Medell&#237;n&#44; in Colombia&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The surgery was elective in all cases&#46; The ileal pouch was always J-shaped with ileoanal or ileorectal anastomosis made by hand or by double stapling technique according to the surgeon&#39;s preference &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">A temporary protective loop ileostomy &#40;two-stage technique&#41; was performed in all patients&#46; Ileostomy closure was always preceded by radiographic and&#47;or endoscopic examination and digital examination&#44; with digital dilation of the ileoanal anastomosis when necessary&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The patients&#39; outcome was evaluated by reviewing hospital records&#44; telephone interview&#44; or direct approach during the routine examination in the hospital according to the modified &#214;resland questionnaire<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#44; which is a structured questionnaire used to assess continence&#44; bowel function and general satisfaction&#44; and consists of 10 categories&#58; the number of bowel movements &#40;day and night&#41;&#44; faecal incontinence &#40;day or night&#41;&#44; perianal pain&#44; presence of faecal urgency&#44; evacuation difficulties&#44; the use of protective pads&#44; dietary restrictions&#44; frequency of medication use&#44; impact on social participation and whether or not the patient feels better after surgery&#46; Each item is scored as 0&#47;1 or 0&#47;1&#47;2&#44; and the sum of all items ranges from 0 to 15 points&#46; A lower score indicates better function&#44; and scores of 8 or higher are associated with poor pouch function &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">During follow-up&#44; a physical examination was performed in the hospital with special attention to the digital examination in order to evaluate the status of the anastomosis&#44; the anal canal&#44; the pouch&#44; the stricturing and the sphincter mechanism&#46; When symptoms of pouchitis were suspected&#44; an endoscopic study with biopsy was added&#44; and when ileoanal stricture was detected&#44; immediate digital dilation was performed&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In the vast majority of patients&#44; endoscopic examinations were performed on an outpatient basis with a high endoscope&#44; which facilitates instrumentation&#46; Pouchitis was diagnosed based on the modified PDAI score&#46; The modified PDAI scale is based on a combined evaluation of the clinical and endoscopic findings&#44; without considering the histological changes &#40;the Moskowitz histological index&#41;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#46; All six endoscopic subcomponent scores &#40;oedema&#44; granularity&#44; friability&#44; loss of vascular pattern&#44; mucus&#44; exudate and ulcer&#41; contributed to the total endoscopic score with a similar degree of magnitude &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">For statistical analysis&#44; functional outcomes were compared using the Yates-corrected &#967;<span class="elsevierStyleSup">2</span> test&#46; A p value &#60;0&#46;05 was considered statistically significant&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The Independent Ethics Committee of the Universidad de Antioquia &#91;University of Antioquia&#93; evaluated the methodological&#44; ethical and legal aspects&#44; in accordance with its objectives of safeguarding the rights&#44; dignity&#44; safety and well-being of both the participants and the investigators&#44; prioritising the well-being of subjects above scientific&#44; academic or community interests&#44; and ensuring that the potential benefits of studies outweigh the expected risks&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">We performed this retrospective observational study on a prospective follow-up basis in 115 patients&#58; 79 with UC and 36 with FAP&#46; Follow-up findings were recorded for a total of 88 patients&#44; 60 with UC and 28 with FAP &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The patients&#44; 48 men &#40;54&#46;4&#37;&#41; and 40 women with a mean age of 44&#46;8&#8239;&#177;&#8239;12&#46;7 years &#40;range 19&#8211;67 years&#41;&#44; underwent the procedure between January 1994 and January 2019 &#40;mean follow-up 84&#46;8 months&#44; range 14&#8211;300 months&#41;&#46; Indications for surgery were intractable disease in 54 patients &#40;47&#37;&#41;&#44; dysplasia&#47;cancer in 43 &#40;37&#37;&#41;&#44; major bleeding in four &#40;4&#37;&#41; and perforation in three &#40;3&#37;&#41;&#46; The time distribution of the procedures for FAP and UC are shown in <a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">At the beginning of the experience&#44; a proctectomy and mucosectomy of the rectal stump anastomosed by hand was performed in 68 patients &#40;59&#37;&#41;&#44; while more recently and according to the surgeon&#39;s preference&#44; the double stapling technique was performed in 47 patients &#40;41&#37;&#41;&#46; In all the patients&#44; the pouch was a J-type pouch&#46; The mean length of hospital stay was 11&#46;6&#8239;&#177;&#8239;5&#46;8 days &#40;range 6&#8211;34 days&#44; median 8&#41;&#46; Ileostomy closure was performed between 37 and 312 days after pouch construction &#40;mean 117&#8239;&#177;&#8239;58 days&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Long-term follow-up data on the 88 patients &#40;76&#46;5&#37;&#41; were obtained by telephone interview or by filling out a questionnaire during the follow-up visit&#46; Early and late postoperative complications are summarised in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">In six patients with late-onset obstruction &#40;22&#46;2&#37;&#41;&#44; laparotomy was required to release adhesions or resect a segment of intestinal stricture &#40;two patients&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The most common late postoperative complication was pouchitis &#40;35&#46;2&#37;&#41;&#46; This complication tends to be mild&#44; with an increase in the frequency of bowel movements&#44; abdominal cramps&#44; tenesmus and partial loss of continence&#44; with discomfort and slight temperature&#46; Antibiotic therapy&#44; usually with a combination of ciprofloxacin and metronidazole&#44; and conventional treatment with 5-ASA and steroids led to the resolution of symptoms in a few days in most cases&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">A mild anastomotic stricture that normally responded to finger dilation was a common finding in 19 patients&#44; whereas a severe stricture&#44; which required at least mechanical dilation with or without anaesthesia&#44; developed in 11 patients&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Other complications of the procedure were impotence with retrograde ejaculation in two men &#40;2&#46;2&#37;&#41; and pouch-vagina fistula in two women &#40;2&#46;2&#37;&#41;&#46; Impotence with retrograde ejaculation only developed in patients who underwent the double stapling technique&#44; but was not detected in our experience in patients who underwent manual proctectomy and mucosectomy of the rectal stump&#44; most likely because resection of the rectal mucosa was performed from inside the rectum&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Long-term follow-up information is available for 88 patients&#44; 60 of 79 patients with UC &#40;75&#46;9&#37;&#41; and 28 of 35 patients with FAP &#40;80&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; The median number of bowel movements was 5&#47;24&#8239;h in patients with UC&#44; and 4&#47;24&#8239;h in patients with FAP&#44; with one per night in both groups&#46; All patients passed stools spontaneously&#46; Dietary restrictions were common in both groups &#40;43&#46;2&#37;&#41;&#44; mainly to alter the timing of their meals in order to avoid bowel movements at inappropriate times &#40;during social activities&#44; at night&#44; etc&#46;&#41;&#46; A total of 85&#46;2&#37; of the patients had full continence during the day&#44; while 75&#37; only had full continence at night&#44; with the use of nappies in 10&#46;2&#37; and faecal urgency in 12&#46;5&#37;&#46; Overall&#44; there were no significant differences in continence between UC and FAP patients&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Patients with RP-IPAA for UC had a better overall &#214;resland score &#40;median&#8239;&#61;&#8239;3&#44; interquartile range &#91;IQR&#93; 2&#8211;5&#41; than patients with RP-IPAA for FAP &#40;median&#8239;&#61;&#8239;10&#44; IQR 5&#8211;15&#41; &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#60;&#8239;0&#46;001&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">UC patients judged their quality of life to be better in 90&#37; of cases&#44; while only 71&#46;4&#37; of FAP patients believed that their quality of life had improved after the operation &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239;0&#46;01&#41;&#46; General satisfaction and adaptation were considered good in 87&#37; of the UC patients&#44; but only in 57&#37; of the FAP group &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#60;&#8239;0&#46;01&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The presence of mild dysplasia in the pouch that did not progress over time was documented in only one patient&#44; and in no case was cancer in the pouch documented&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">The primary objective of the study was to update the follow-up of a cohort of patients that began in 1994&#44; collecting the initial experience with 51 patients who required ileal pouches due to UC or FAP&#44; in whom early and late complications were evaluated<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Due to the complexity of the operation and the relatively high rate of early and late complications&#44; the indications for this type of surgery were initially conservative&#46; With the advent of laparoscopic and robotic techniques<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">24&#44;25</span></a>&#44; and the growing experience with the use of the double-stapled J-pouch and the preservation of the anal transitional zone&#44; the indications for surgery have been extended to higher-risk patients&#44; in selected cases without the need for a protective ileostomy<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">26</span></a>&#44; even for patient over 60 years of age<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">27</span></a> or obese<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">28</span></a>&#44; with satisfactory functional outcomes<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">29</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">A meta-analysis of 53 studies with nearly 15&#44;000 patients who underwent RP-IPAA between 2000 and 2010 suggests that the overall pouch failure rate worldwide was approximately 7&#46;5&#37;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">30</span></a>&#44; a figure that has hardly changed &#40;7&#46;7&#37;&#41; in the most recent reports<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">31</span></a>&#46; These positive outcomes are attributed to more careful patient selection&#44; more definitive preoperative diagnosis&#44; more experienced surgeons with better surgical techniques &#40;laparoscopy or robotic surgery&#41;&#44; better postoperative care and intensive patient follow-up and education&#46; The main causes of adverse outcomes with pouch failure were directly associated with Crohn&#39;s disease or its associated complications&#44; such as fistulas&#44; perianal sepsis&#44; the presence of sinuses&#44; etc&#46; Pelvic sepsis is almost always due to some degree of leakage from the ileoanal anastomosis&#46; In our study&#44; 7&#46;9&#37; of patients developed early postoperative sepsis of pelvic origin&#44; and 9&#46;1&#37; developed anastomotic leaks&#44; all of whom responded to percutaneous drainage and antibiotic therapy&#46; The causes of a new ileostomy in three patients in our study were recurrent severe pouchitis that did not respond to conservative therapy in two patients&#44; and anal sphincter incontinence in one patient&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Pouchitis is the most common complication of RP-IPAA in UC and its management requires a sequential and personalised approach<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">32</span></a>&#46; The aetiology of pouchitis is unclear&#44; and pouchitis may well represent a further manifestation of idiopathic inflammatory bowel disease&#46; Diagnosis of the disease depends mainly on symptoms&#44; endoscopy and histology&#46; An 18-point pouchitis disease activity index was recently developed&#44; which was later simplified by omitting histological evaluation&#44; with similar sensitivity and specificity<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#46; Mild pouchitis is a long-term complication that occurred cumulatively in up to 35&#46;2&#37; of patients&#44; with severe pouchitis unresponsive to conservative therapy in 9&#46;1&#37;&#46; Mild pouchitis occurred in both UC and FAP patients&#44; while severe pouchitis with complications occurred only in UC patients&#46; This is probably due to the inflammatory nature of UC compared to FAP&#46; Patients with FAP may exhibit incomplete evacuation&#44; dyschezia and increased bowel movement frequency and urgency<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">33</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Postoperative quality of life has become an important measure of the functional outcome of RP-IPAA in patients with UC and FAP&#46; Functional outcome has been reported to be significantly correlated with quality of life after surgery<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">34&#44;35</span></a>&#46; It has been observed that a considerable number of UC patients who underwent surgery enjoy a significant improvement in postoperative quality of life&#44; with scores sometimes comparable to those of the general population&#44; while the functional outcome in patients with FAP is usually considerably worse compared to preoperative function and to the general population<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">36&#44;37</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The expectations of patients after ileal pouch surgery recently reported in a Delphi consensus study represents the first patient-focused effort in the surgical literature that has sought to identify which functional outcomes patients consider important after pouch surgery&#44; thus defining the amalgamation of symptoms that are specific to an ileal pouch<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">29</span></a>&#46; The symptoms that previous studies focused on&#44; such as faecal incontinence&#44; spotting&#44; excessive bowel movements and urgency&#44; are important to patients&#46; However&#44; the cited consensus also highlighted several additional key symptoms that were not consistently reported in previous studies&#44; including unpredictable bowel movements&#44; altered patterns of bowel function &#40;fragmentation&#44; incomplete evacuation&#41;&#44; nocturnal symptoms and perianal pain&#46; The next challenge is to develop a clinically useful scoring system that can quantify the range and severity of symptoms experienced by patients after ileoanal pouch surgery and its correlation with quality of life parameters&#46; This score would theoretically help to identify in which patients their pouch function symptoms will have a severe negative impact on their quality of life&#46; The proposed score will help identify patients with ileal pouch syndrome who meet a designated threshold score and will also be able to assess the efficacy of medical and surgical interventions in improving quality of life in patients with ileal pouch syndrome&#46; This initiative has received support from the Crohn&#39;s and Colitis Foundation and is currently ongoing<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">29</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In this study&#44; only 79 of the 115 patients &#40;68&#46;7&#37;&#41; who underwent RP-IPAA responded to our questionnaire&#46; During the more than 20 years of follow-up since the first operated patient &#40;1994&#41;&#44; no significant differences were found between patients with UC or FAP in terms of long-term medication use&#44; dietary restrictions or the average number of bowel movements during the day or night&#46; Although we were unable to detect a significant difference in long-term functional outcomes between the two groups&#44; the quality of life assessment was significantly higher in UC patients compared to FAP patients &#40;86&#46;7&#37; vs 57&#46;2&#37;&#44; <span class="elsevierStyleItalic">p</span>&#8239;&#60;&#8239;0&#46;01&#41;&#46; This is easily explained by the fact that most patients with FAP were usually asymptomatic or had minimal preoperative symptoms and normal bowel habits&#44; and the indication for surgery was most often to detect multiple polyposis or for genetic counselling&#46; Overall satisfaction with the surgical procedure was also significantly better in the group of UC patients&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The strength of this study lies in the significant number of patients who were operated on more frequently by only two surgeons and who have had long-term follow-up&#44; while the limitations lie in its retrospective nature&#44; where memory bias is important when filling out the form to assess satisfaction with the procedure&#44; in addition to not having criteria for pouchitis activity or biochemical markers such as calprotectin from the start of the series&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In summary&#44; when comparing the parameters studied between the two groups of patients who underwent RP-IPAA&#44; the clinical course of these patients is very similar&#46; However&#44; inflammatory manifestations of the ileal pouch are more common in patients with UC than in those with FAP&#46; This translates into a better acceptance of surgery and a better quality of life in UC patients over patients with ileal pouches due to FAP&#46; Inflammation of the pouch did not lead to the appearance of more dysplasia or cancer in these patients&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusions</span><p id="par0170" class="elsevierStylePara elsevierViewall">Restorative proctocolectomy with ileal pouch-anal anastomosis provides more satisfactory quality of life and functional outcomes in patients with UC than in those with FAP&#46; Pouchitis continues to be the most common complication&#44; occurring in 61&#37; of patients&#44; with severe pouchitis occurring in 9&#46;6&#37;&#46; This procedure was followed by a significant number of complications&#44; but the number and severity of these have decreased in recent years&#44; with better functional outcomes&#44; a median of four to five bowel movements per day and a significant improvement in quality of life&#44; especially in patients with UC&#46; No cancer occurred in the pouch&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Funding</span><p id="par0175" class="elsevierStylePara elsevierViewall">No funding was received for this study&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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            0 => "Proctocolectomy"
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            2 => "Pouchitis"
            3 => "Familial adenomatous polyposis"
            4 => "Ulcerative colitis"
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          "palabras" => array:5 [
            0 => "Proctocolectom&#237;a"
            1 => "Bolsa ileal"
            2 => "Reservoritis"
            3 => "Poliposis adenomatosa familiar"
            4 => "Colitis ulcerosa"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">proctocolectomy with ileal reservoir is the surgical procedure of choice for patients with ulcerative colitis and familial adenomatous polyposis&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">To evaluate long-term postoperative complications &#40;1994&#8211;2019&#41; in patients operated for familial adenomatous polyposis &#40;FAP&#41; and ulcerative colitis &#40;UC&#41; and the degree of satisfaction with the procedure&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Observational study based on the analysis of a retrospective database with prospective follow-up in 115 consecutive patients&#58; 79 with UC and 36 with FAP&#46; A total of 88 patients were followed up&#44; 60 with UC and 28 with PFA&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">48 males &#40;54&#46;4&#37;&#41; with a mean age of 44&#46;8&#8239;&#177;&#8239;10&#46;6 years were evaluated&#46; Indications for surgery were intractable disease in 54 patients &#40;47&#37;&#41;&#44; dysplasia&#47;cancer in 43 &#40;37&#37;&#41;&#44; severe bleeding in 4 &#40;4&#37;&#41; and perforation in 3 &#40;3&#37;&#41;&#46; A proctectomy and mucosectomy of the rectal stump was performed in 67 &#40;76&#46;1&#37;&#41;&#44; and a double stapling technique in 21&#46; A protective ileostomy was performed in all patients with UC and FAP&#46; No differences were found in early complications between the two groups&#46; Late complications showed a higher rate of reservoritis in UC patients compared to FAP &#40;44&#46;9&#37; vs 14&#46;3&#37; <span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239;0&#46;001&#41;&#44; with more refractory reservoritis in the UC group &#40;13&#46;3&#37; vs 0&#37; <span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239;0&#46;04&#41; with no differences in bowel obstruction&#44; strictures&#44; or anastomotic fistulas&#46; Overall satisfaction and adaptation were considered good in 87&#37; of UC patients and only 57&#37; in the FAP group &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#60;&#8239;0&#46;01&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Proctocolectomy with ileal reservoir has comparable morbidity and mortality&#44; except for the higher rate of reservoritis in patients with a history of UC&#44; despite this contingency there is a better quality of life and greater acceptance of surgery in UC patients than in FAP patients&#46;</p></span>"
        "secciones" => array:5 [
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            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objectives"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Methods"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
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            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La proctocolectom&#237;a con reservorio es el procedimiento quir&#250;rgico de elecci&#243;n para los pacientes con colitis ulcerosa y poliposis adenomatosa familiar&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Evaluar las complicaciones postoperatorias a largo plazo &#40;1994&#8211;2019&#41; en pacientes operados por poliposis familiar adenomatosa &#40;PFA&#41; y colitis ulcerativa &#40;CU&#41; y el grado de satisfacci&#243;n con la intervenci&#243;n&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional basado en el an&#225;lisis de una base de datos retrospectiva con seguimiento prospectivo en 115 pacientes consecutivos&#58; 79 con CU y 36 con PFA&#46; Se ha realizado el seguimiento de un total de 88 pacientes&#44; 60 con CU y 28 con PFA&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Se evaluaron 48 varones &#40;54&#44;4&#37;&#41; con una edad media de 44&#44;8&#8239;&#177;&#8239;10&#44;6 a&#241;os&#46; Las indicaciones para la cirug&#237;a fueron enfermedad intratable en 54 pacientes &#40;47&#37;&#41;&#44; displasia&#47;c&#225;ncer en 43 &#40;37&#37;&#41;&#44; sangrado severo en 4 &#40;4&#37;&#41; y perforaci&#243;n en 3 &#40;3&#37;&#41;&#46; Se realiz&#243; una proctectom&#237;a y mucosectom&#237;a del mu&#241;&#243;n rectal en 67 &#40;76&#44;1&#37;&#41;&#44; y una t&#233;cnica de doble grapado en 21&#46; Se realiz&#243; una ileostom&#237;a protectora en todos los pacientes con CU y PFA&#46; No se encontraron diferencias en las complicaciones tempranas entre los dos grupos&#46; Las complicaciones tard&#237;as mostraron una mayor tasa de reservoritis en los pacientes de la CU respecto a la PFA &#40;44&#44;9&#37; vs 14&#44;3&#37; p&#8239;&#61;&#8239;0&#44;001&#41;&#44; con m&#225;s reservoritis refractaria en el grupo de la CU &#40;13&#44;3&#37; vs 0&#37; p&#8239;&#61;&#8239;0&#44;04&#41; sin diferencias en cuanto a obstrucci&#243;n intestinal&#44; estenosis o f&#237;stulas anastom&#243;ticas&#46; La satisfacci&#243;n general y la adaptaci&#243;n se consideraron buenas en el 87&#37; de los pacientes con CU y s&#243;lo en el 57&#37; del grupo de PFA &#40;p&#8239;&#60;&#8239;0&#44;01&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">La proctocolectom&#237;a con reservorio ileal tiene una morbilidad y mortalidad comparables&#44; excepto por la mayor tasa de reservoritis en los pacientes con antecedentes de CU&#44; a pesar de esta contingencia hay una mejor calidad de vida y mayor aceptaci&#243;n de la cirug&#237;a en los pacientes con CU que en los pacientes con PFA&#46;</p></span>"
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            "titulo" => "Objetivos"
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            "identificador" => "abst0040"
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            "titulo" => "Conclusiones"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Construction of the ileal pouch&#46; A&#46; First stapling line B&#46; Ileal J-pouch&#46; C&#46; Preparing the anastomosis D&#46; Ileorectal anastomosis with circular stapler&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Endoscopic aspects of pouchitis&#58; &#40;a&#44;b&#41; Endoscopic appearance of mild pouchitis&#46; &#40;a&#41; Loss of vascularity and &#40;b&#41; mild redness are seen relatively frequently in patients without pouchitis&#46; &#40;c&#44;d&#41; The endoscopic appearance of moderate pouchitis includes aphthous lesions&#44; erosions&#44; shallow ulcers and mucous exudates&#46; &#40;e&#44;f&#41; The endoscopic appearance of severe pouchitis includes &#40;e&#41; multiple deep ulcers and &#40;f&#41; spontaneous bleeding&#46; Modified from Hata<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">38</span></a>&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">Function&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">Bowel movements</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8804;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#8211;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8805;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Night&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Faecal incontinence</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#62;1 time&#47;week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Night&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;1 time&#47;week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Perianal pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Occasional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Permanent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Faecal urgency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Difficult evacuation<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of perianal protective pad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;1 time&#47;week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dietary restrictions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of medications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Worse health&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Worse after surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">At least once a week a bowel movement takes more than 15&#8239;min&#46;</p>"
            ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Modified &#214;resland score to assess ileal pouches&#46;</p>"
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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          0 => array:3 [
            "identificador" => "at0030"
            "detalle" => "Table "
            "rol" => "short"
          ]
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        "tabla" => array:1 [
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            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ulcerative colitis &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Familial polyposis &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Early complications</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wound infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;21&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;10&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;214&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anastomosis leak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;10&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;664&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pelvic sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;514&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intestinal obstruction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;6&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;409&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ileostomy dysfunction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;6&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;6&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;162&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="9" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Late complications</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pouchitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;14&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;35&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Refractory pouchitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;13&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;043&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intestinal obstruction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;26&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;39&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;30&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;236&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anastomosis stricture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;14&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;21&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;196&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anastomosis fistula&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;6&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;409&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Loss of the pouch&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;6&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;162&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">New ileostomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;5&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;3&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;228&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mild dysplasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;328&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Most prevalent early &#40;&#8804;30 days&#41; and late &#40;&#62;30 days&#41; postoperative complications&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0035"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ulcerative colitis &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Familial polyposis &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;76&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88 &#40;76&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Medications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;23&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;17&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;20&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;560&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dietary restrictions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;43&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;32&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;43&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;966&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bowel movements &#40;day&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bowel movements &#40;night&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Continence &#40;day&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">52 &#40;86&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">75 &#40;85&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Feels better after the operation&nbsp;\t\t\t\t\t\t\n
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