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Interview Jordi Bombardó Juncà

Jordi Bombardó Juncà

MD degree granted in 1979 by the University of Barcelona.

Worked as a surgeon in training at the Nª. Sra. de Déu de la Salut Mercy hospital in Sabadell.

Obtained his specialist degree in General and Digestive Surgery from the Autonomous University of Barcelona in 1983.

Has, since 1987, held the post of adjunct of surgery at the Coloproctology Unit of the Parc Tauli Hospital Consortium.

Has, since 2005, been coordinator of the Coloproctology Unit.

Participated in clinical training stages at Vrije University in Amsterdam (prof. M. A. Cuesta), at Baptist Hospital in Miami (Drs. M. Jacobs, Plasencia) and at S. Mark’s Hospital in London (prof. R. Philips).

You have been doing colorectal surgery for many years. What made you choose this subspecialty of general surgery?

For the last twenty years I have been devoting myself almost exclusively to coloproctology because I find it very interesting, highly prevalent, multisdisciplinary, and with constant technological innovations that make you stay updated permanently. At the beginning, mastery is always important, and in this case my thanks go to Dr. Montané, who introduced me to this specialty.

Coming back to the present, what advantages do you see in superspecialization in surgery?

The advantages of superspecialization in surgery are obvious. By embracing less we can achieve a much higher level of qualification. However, I am also of the opinion that a young surgeon should perform general surgery for half his professional life (40-45 years) and then specialize in a more specific field.

Coming back to colorectal surgery, what technical advances have there been in this surgery since you started your professional practice?

In my opinion, the most important technical advances have been automatic sutures for anastomosis and laparoscopic surgery. The large improvement and sophistication of imaging diagnostic techniques has also been essential.

Could you explain what TEM/TEO is?

TEM= Transanal Endoscopy Surgery
TEO= Transanal Endoscopy Operation
It is a transanal endoscopic surgical technique that enables us to remove both benign and malignant anal-rectal lesions. This technique was described by a German surgeon during the 1990s, and received relative acceptance in spite of the cost of the equipment it required and its technical difficulty Nowadays laboratories seek technical simplification and bring down costs, and it seems that it is now more accepted and has a brighter future. Just remember that the Taulí hospital of Sabadell is one of the most advanced centres nationwide.

This technique avoids having to perform an open abdominal surgery. Can it be performed in all rectal tumours? What limitations does it have, tumour size, location inside the rectal ampulla?

It is a technique that is indicated for the removal of benign rectal tumours and for low stage malignant pathology. We have now commenced a multicenter study for the treatment of T2-3s NO rectal neoplasms measuring no more than 4 cm with preparatory chemo and radiation therapy. Laparotomy would usually be the procedure used for all of these lesions, and also given the low morbimortality of this technique, it is a large step for these patients. Like all techniques, it has limitations with regards to size, depending on whether it is a benign or malignant pathology, the height at which the tumour is located up to 12-15 cm depending on its localization.

What follow-up is needed in patients on whom this technique has been performed?

The most important thing to perform the procedure on these patients is to carry out a pre-operative study that is as thorough as possible, using fibrocolonoscopy and biopsies, endorectal ultrasound, pelvic magnetic resonance imaging and rigid rectoscopy. If the operated patient has a benign pathology, usually fibrocolonoscopy is performed at 6 months and after that on a yearly basis. If it is a malignant pathology, conventional follow-up of neoplastic pathologies is performed by surgery and oncology, with special attention to the established endoscopic follow-up.

It is obvious that colorectal surgery has evolved a lot in the past few years. In your opinion, what should researchers aim for?

I specifically believe that the future of colorectal surgery lies in the advance towards minimally invasive surgery, proctologic surgery should involve less pain, and in the field of oncology, genetics and improved biological and chemotherapeutic treatments will help reduce the incidence of this pathology and improve final outcomes.