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Hacia la ambulatorización de la apendicectomía: lecciones aprendidas durante la pandemia 走向阑尾切除术门诊:大流行期间的经验教训
IF 1.3 4区 医学 Q3 SURGERY Pub Date : 2025-07-01 DOI: 10.1016/j.ciresp.2025.800127
Rebeca González Peredo , Víctor Jacinto Ovejero Gómez , Patrizio Petrone , Corrado P Marini , María Dolores Prieto Salceda , José Manuel Bernal Marco , Dieter Morales-García

Background

Acute appendicitis is the most common abdominal surgical emergency worldwide. Researchers from various countries have evaluated the impact of the COVID-19 pandemic on its diagnosis and treatment, as well as a possible change in its management, such as outpatient treatment. The objective of this study was to describe the characteristics of acute appendicitis treated during the COVID-19 State of Emergency (SOE) and to assess whether it could be included in an ambulatory surgery program.

Methods

Retrospective observational study involving patients treated at public hospitals for appendix diseases (K35–K38). We collected sociodemographic and clinical data. The influence of the lockdown on each variable was evaluated with a multivariate analysis.

Results

201 patients were included. The SOE period group comprised 78 patients, and the pre-SOE period (control) included 123 patients who met the same inclusion criteria. The risk of complicated acute appendicitis increased by 1.015 times with age (P=.000). The longer surgery time was associated with a 7.265 times higher risk of postsurgical complications (P=.000). No differences were observed with respect to drain placement (P=.281), although the percentage was higher in 2020 (13.9% vs 19.7%). The length of hospital stay decreased significantly during the lockdown (P=.017).

Conclusion

The lockdown did not influence the outcome of complicated acute appendicitis from the standpoint of morbidity and mortality, reducing the hospital stay, facilitating the path towards outpatient treatment.
背景:急性阑尾炎是世界范围内最常见的腹部外科急症。来自各国的研究人员评估了COVID-19大流行对其诊断和治疗的影响,以及门诊治疗等管理方式可能发生的变化。本研究的目的是描述COVID-19紧急状态(SOE)期间治疗的急性阑尾炎的特征,并评估是否可以将其纳入门诊手术计划。方法回顾性观察性研究纳入公立医院阑尾疾病患者(K35-K38)。我们收集了社会人口学和临床数据。通过多变量分析评估封城对各变量的影响。结果共纳入201例患者。SOE组包括78例患者,SOE前期(对照组)包括123例患者,符合相同的纳入标准。并发急性阑尾炎的风险随年龄增长增加1.015倍(P= 0.000)。手术时间越长,术后并发症风险增加7.265倍(P= 0.000)。尽管2020年的比例更高(13.9% vs 19.7%),但在排水管放置方面没有观察到差异(P= 0.281)。在封锁期间,住院时间显著减少(P= 0.017)。结论从发病率和死亡率的角度来看,封锁对复杂性急性阑尾炎的预后没有影响,减少了住院时间,为门诊治疗提供了便利。
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引用次数: 0
Mastectomía asistida por robot combinada con reconstrucción inmediata con implante prepectoral 机器人辅助乳房切除术结合立即重建与预植入
IF 1.3 4区 医学 Q3 SURGERY Pub Date : 2025-06-01 DOI: 10.1016/j.ciresp.2025.800113
Manuel García García, Carlos Roberto Estrada López, José Manuel Domínguez Carrera, Lucía Rigueiro López, Purificación Fernández Souto
Robot-assisted sparing mastectomy combined with immediate reconstruction using a prepectoral breast implant is a novel technique that provides good aesthetic results and high patient satisfaction. It was described for the first time by Antonio Toesca in 2015. In Spain, it is currently carried out in very few places. The results of this technique have been reported in multiple studies with low conversion and complication rates. It is indicated in patients with genetic risk and in patients with early breast cancer presenting no evidence of skin, chest wall or nipple-areolar complex involvement. In order to advocate the robotic approach, we give a step-by-step explanation so that it can be reproduced safely. However, we are aware that the technique entails a long learning curve and requires the availability of robotic equipment as well as experience in open breast cancer surgery.
机器人辅助保留乳房切除术结合乳房前植入物的即时重建是一种新颖的技术,提供了良好的美学效果和高患者满意度。安东尼奥·托斯卡(Antonio Toesca)在2015年首次描述了它。在西班牙,目前很少有地方实施。该技术的结果已在多个研究中报道,转换率低,并发症发生率低。它适用于有遗传风险的患者和没有皮肤、胸壁或乳头-乳晕复合物受累迹象的早期乳腺癌患者。为了提倡机器人的方法,我们给出了一步一步的解释,以便它可以安全地复制。然而,我们意识到这项技术需要很长的学习曲线,需要机器人设备的可用性以及开放式乳腺癌手术的经验。
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引用次数: 0
Ventajas del abordaje robótico en el manejo de complicaciones biliares tardías tras el trasplante hepático 机器人方法在管理肝移植后的晚期胆汁并发症方面的优势
IF 1.3 4区 医学 Q3 SURGERY Pub Date : 2025-06-01 DOI: 10.1016/j.ciresp.2025.800102
Víctor López-López, Pedro Cascales-Campos, Francisco Sánchez-Bueno, Pablo Ramírez, Ricardo Robles-Campos
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引用次数: 0
Evaluación del PreopScore® en pacientes trasplantados hepáticos por carcinoma hepatocelular 肝细胞癌肝移植患者的PreopScore®评估
IF 1.3 4区 医学 Q3 SURGERY Pub Date : 2025-06-01 DOI: 10.1016/j.ciresp.2025.800104
Adrián Paredes , Celia Villodre , Paola Melgar , Sonia Pascual , José M. Ramia
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引用次数: 0
El robot en el cáncer de recto: ¿ventajas para el cirujano o para el paciente? 直肠癌中的机器人:对外科医生或患者有好处吗?
IF 1.3 4区 医学 Q3 SURGERY Pub Date : 2025-06-01 DOI: 10.1016/j.ciresp.2025.800115
Marcos Gómez Ruiz , Eloy Espin Basany
Although robotic surgery has been implemented for 2 decades, evidence is limited regarding its clinical and economic benefits compared to traditional laparoscopic approaches. Studies like ROLARR have shown no significant differences, often due to biases related to the surgeons’ experience.
The treatment of rectal cancer is complex, and robotic surgery promises to facilitate embryological dissection, potentially improving oncological and functional outcomes. However, solid evidence is still scarce. The advantages of robotic surgery for surgeons include improved view, better ergonomics, precision in movements, and the possible connectivity between systems for telementoring. Despite current limitations, robotic surgery offers promising future prospects for both patients and surgeons.
尽管机器人手术已经实施了20年,但与传统腹腔镜手术相比,其临床和经济效益的证据有限。像ROLARR这样的研究没有显示出明显的差异,这通常是由于与外科医生的经验有关的偏见。直肠癌的治疗是复杂的,机器人手术有望促进胚胎解剖,潜在地改善肿瘤和功能结果。然而,确凿的证据仍然很少。对于外科医生来说,机器人手术的优点包括改善视野、更好的人体工程学、运动精度以及远程监控系统之间可能的连接。尽管目前的限制,机器人手术为病人和外科医生提供了充满希望的未来前景。
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引用次数: 0
Liderazgo: ¿qué es un líder y cómo se entrena? 领导力:什么是领导力,如何培养领导力?
IF 1.3 4区 医学 Q3 SURGERY Pub Date : 2025-06-01 DOI: 10.1016/j.ciresp.2025.800106
María Magdalena Llompart, Miguel Pera
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引用次数: 0
Emergency inguinal hernia surgery: A proposed update to the clinical guidelines algorithm 紧急腹股沟疝手术:临床指南算法的建议更新
IF 1.3 4区 医学 Q3 SURGERY Pub Date : 2025-06-01 DOI: 10.1016/j.ciresp.2025.800098
Victor Rodrigues-Gonçalves , Mireia Verdaguer-Tremolosa , Alejandro Bravo-Salva , Pilar Martínez-López , José Antonio Pereira-Rodríguez , Manuel López-Cano

Introduction

Management strategies for acute irreducible hernias vary, with recent debates on the role of manual reduction versus immediate surgery. This study aimed to identify preoperative risk factors for bowel resection in acute irreducible inguinal hernias.

Methods

A retrospective cohort study included patients from 2 university hospitals who underwent emergency surgery for acute irreducible hernias between January 2010 and December 2018.

Results

Out of a total of 652 patients, 15% required intestinal resection; females, older individuals, and those with comorbidities were more likely to undergo resection. Multivariate analysis identified patients with femoral hernia (OR 2.272; 95%CI 1.275–4.047; P = .005) and preoperative intestinal obstruction (OR 8.071; 95%CI 4.331–15.043; P < .001). Patients needing resection experienced higher postoperative complication rates and longer hospital stays.

Discussion

Femoral hernia and preoperative intestinal obstruction were independent predictors of bowel resection in acute irreducible hernias. Incorporating these factors into decision-making algorithms may improve patient outcomes and optimize surgical management.
急性不可复位疝的治疗策略各不相同,最近关于手工复位与立即手术的争论。本研究旨在确定急性腹股沟疝肠切除术的术前危险因素。方法回顾性队列研究纳入2010年1月至2018年12月间2所大学附属医院急诊手术治疗急性无法切除疝的患者。结果652例患者中,15%需要肠切除术;女性、老年人和那些有合并症的人更有可能接受切除。多因素分析确定了股疝患者(OR 2.272;95%可信区间1.275 - -4.047;P = .005)和术前肠梗阻(OR 8.071;95%可信区间4.331 - -15.043;P & lt; 措施)。需要切除的患者术后并发症发生率更高,住院时间更长。讨论股疝和术前肠梗阻是急性不可切除疝肠切除术的独立预测因素。将这些因素纳入决策算法可以改善患者预后并优化手术管理。
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引用次数: 0
Laparoscopic resection of splenic artery aneurysm with splenic preservation 保留脾的腹腔镜脾动脉瘤切除术
IF 1.3 4区 医学 Q3 SURGERY Pub Date : 2025-06-01 DOI: 10.1016/j.ciresp.2025.800100
Alberto Gallego Vela , Jose Luis Guerrero Ramírez , María Fernández Ramos , Jesús Cañete Gómez
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引用次数: 0
Respuesta a la carta al editor sobre nuestro artículo «Eficacia al año de la técnica TROPIS en la fístula perianal compleja» 对我们的文章《TROPIS技术在复杂肛周瘘中的年度有效性》致编辑的信的回复
IF 1.3 4区 医学 Q3 SURGERY Pub Date : 2025-06-01 DOI: 10.1016/j.ciresp.2025.800119
Fernando de la Portilla de Juan , María Luisa Reyes Díaz , Fátima Hinojosa Ramirez
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引用次数: 0
Estudio retrospectivo sobre el Delta Shock Index asociado a la edad y al Glasgow Coma Score (dSIAG) como escala pronóstica de mortalidad en el paciente politraumatizado 关于与年龄相关的Delta休克指数和格拉斯哥昏迷评分(dSIAG)作为多创伤患者死亡率预测指标的回顾性研究
IF 1.3 4区 医学 Q3 SURGERY Pub Date : 2025-06-01 DOI: 10.1016/j.ciresp.2025.800111
Ana Victoria Juárez San Juan , Paula Juárez San Juan , Manuel Artiles Armas , Laura Cano Contreras , Paula Beltrán Calero , Carlos Jorge Ripper , Pedro Rodríguez Suárez , Jorge L Freixinet Gilart

Introduction

This study aims to analyze differences between the prognostic scales in the initial assessment of severe trauma, (Shock Index × Age [SIAG)]/Glasgow Coma Scale) upon arrival at the hospital and at the scene of the trauma (dSIAG). It has been compared with other prognostic scales, including the Shock Index (SI), Revised Trauma Score (RTS) and Injury Severity Score (ISS), given that these scales may underestimate the risk of mortality in some polytrauma patients.

Methods

We have conducted a retrospective, observational study with a cohort of patients admitted to the Critical Care Unit of a tertiary center with a diagnosis of trauma from 2018-2020. The SI, dSI, SIAG, dSIAG, RTS and ISS scales were calculated. The area under the receiver operating characteristic curve (AUC ROC) of each one was compared for mortality in the first 24 hours (M24) and hospital mortality (HM).

Results

Out of the 113 patients included, 11 died (9.7%), 9 in the first 24 h (8%). All scores were related to mortality. The dSIAG had the best AUC ROC for M24 (0.88; 95% CI: 0.80-0.96) and MH (0.84; 95% CI: 0.71-0.96), although the results between dSIAG and SIAG were similar. The dSIAG value of 0.3 points showed a sensitivity of 77% and specificity of 78% for HM and 89% and 77% for M24. The AUC ROC of the dSIAG for HM was higher than the classic RTS and ISS scores.

Conclusion

The dSIAG is similar to the SIAG and higher than the classic ISS and RTS scores as a predictor of HM in the initial assessment of polytrauma patients.
本研究旨在分析重症外伤患者抵达医院时与创伤现场(dSIAG)初步评估预后量表(休克指数×年龄[SIAG]/格拉斯哥昏迷量表)的差异。考虑到这些量表可能低估了一些多发创伤患者的死亡风险,将其与其他预后量表,包括休克指数(SI)、修订创伤评分(RTS)和损伤严重程度评分(ISS)进行了比较。方法:我们对2018-2020年在某三级医疗中心重症监护病房确诊为创伤的患者进行了回顾性观察性研究。计算SI、dSI、SIAG、dSIAG、RTS和ISS量表。比较两组患者24小时内死亡率(M24)和住院死亡率(HM)的受试者工作特征曲线下面积(AUC ROC)。结果113例患者中,11例(9.7%)死亡,其中9例(8%)在发病前24 h死亡。所有得分均与死亡率相关。dSIAG的AUC ROC最佳值为M24 (0.88;95% CI: 0.80-0.96)和MH (0.84;95% CI: 0.71-0.96),尽管dSIAG和SIAG的结果相似。dSIAG值为0.3点,HM的敏感性为77%,特异性为78%,M24的敏感性为89%,特异性为77%。HM设计的AUC ROC高于经典RTS和ISS得分。结论dSIAG与SIAG相似,且高于经典的ISS和RTS评分,可作为多重创伤患者HM的初步评估指标。
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Cirugia Espanola
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