Cirugia espanola最新文献

Introduction: The intestinal microbiota plays a key role in host homeostasis and has been associated with the development of colon cancer (CC). However, most studies overlook the impact of anatomical topography on microbial composition.

Objective: To evaluate differences in the microbiota profile between healthy mucosa and tumor tissue in CC patients, comparing results by anatomical location (right vs. left colon).

Methods: Cross-sectional observational study including 50 CC patients who underwent surgery at Hospital Virgen del Rocío (Seville, Spain). Paired samples of tumor and healthy mucosal tissue were analyzed using 16S rRNA sequencing via MinION platform and Kraken2 database. Parametric and non-parametric statistical tests were applied.

Results: No significant differences were found in alpha diversity indices (Shannon and Simpson) between right and left colon in either healthy or tumor tissue. In healthy mucosa, the phyla Bacteroidota and Verrucomicrobiota were significantly more abundant in the left colon. In tumor tissue, no statistically significant differences were found; however, the phylum Synergistota showed differences that approached statistical significance (p = 0.058), with higher abundance in the left colon compared to the right colon.

Conclusions: The microbiota of healthy mucosa differs according to tumor topography, while tumor-associated microbiota appears homogenized regardless of location. These findings suggest that the neoplastic process may standardize the microbial environment. This insight could contribute to future research on topography-specific biomarkers and personalized therapeutic strategies.

Introduction: In general surgery (GS), coloproctology (CP) constitutes one of the cornerstones in specialist training; however, it is unclear whether this training is sufficiently comprehensive and how trainees perceive it. In the same way, it's interesting to assess whether advanced accreditation of units may have an influence on this. Our objective was to determine the quality of this training in our community and to compare the results between hospitals with advanced colorectal unit and those without accreditation.

Materials and methods: A cross-sectional study was conducted using the results of anonymous surveys completed by GS trainees in Galicia regarding their training in CP.

Results: A total of 57 residents participated (93.4%). Of them, 82.5% had never been evaluated during their residency. More than half stated that they had not received sufficient scientific training. They operated as first surgeon in proctological and colorectal procedures in 42.2% and 17.2% of cases, respectively. Only 3.7% did so in pelvic floor disorders. In accredited Units, the evaluation was significantly higher in the scientific domain (p = 0.003), in the clinical-care domain (p = 0.002), and in the overall achievement of objectives (p = 0.034). Additionally, there were statistically significant differences in the number of surgeries performed as first surgeon (p = 0.017) in favour of these Units.

Conclusion: There is wide room for improvement in CP training among our trainees, with special emphasis on the scientific domain. We observed that participation as first surgeon decreases in complex surgeries, which makes additional training essential to practice CP independently.

Objective: To evaluate the Failure to Rescue (FTR) rate in a pancreatic surgery unit between 2020 and 2024, and to identify the limitations of this indicator when interpreting successful outcomes.

Material and methods: A retrospective study based on a prospective database. All patients who underwent elective pancreatic surgery with curative intent between January 2020 and December 2024 were included. Preoperative, intraoperative, and postoperative clinical variables were collected. The 30- and 90-day FTR was defined as mortality among patients who experienced at least one major postoperative complication (MPC) (Clavien-Dindo ≥ 3).

Results: Of the 173 patients operated on, 37 (21.39%) developed major complications. The overall FTR rate was 8.11%. The most frequent complication was pancreatic fistula (17.92%), followed by intra-abdominal collections (15.03%), post-pancreatectomy haemorrhage (13.87%), and delayed gastric emptying (5.20%). The reoperation rate was 9.25%, and overall mortality was 1.73%.

Conclusion: The observed FTR rate is comparable to that of high-volume international centres. FTR, being a ratio between mortality and major complications, can be distorted in series with a low rate of such complications, which requires it to be interpreted with caution and not used as a standalone quality indicator of a surgical unit.

Introduction: Obesity represents a growing public health problem with significant clinical and economic implications. Sleeve gastrectomy (SG) is currently the most widely performed bariatric procedure worldwide. This study evaluates its clinical effectiveness and its impact on healthcare resource utilization in a referral hospital.

Methods: Retrospective study of a prospective series of 321 patients who underwent SG between 2011 and 2020, with a minimum follow-up of five years. Anthropometric variables, comorbidities, and healthcare resource utilisation were analysed. For the economic assessment, 42 patients with complete data were included, applying a bottom-up real-costing approach. Comparisons were stratified by age, sex, and baseline BMI.

Results: The percentage of excess BMI loss at 5 years was 62.4%. Significant remission was observed in metabolic syndrome (64%), type 2 diabetes (63.5%), and hypertension (52.7%), with a lower impact on dyslipidaemia. The economic analysis showed a mean reduction of 1.6 primary care visits, 2.7 hospital visits, and an average saving of €673 per patient per year. In multimorbid patients, savings reached €1,262 per year.

Conclusions: Sleeve gastrectomy is an effective and safe intervention, providing sustained clinical benefits and a significant reduction in healthcare expenditure, particularly among patients with multiple comorbidities. These findings support its inclusion in public health strategies aimed at ensuring the sustainability of the healthcare system.

Obesity is a complex metabolic disease associated with alterations in the gut microbiota and the metabolism of fatty acids and bile acids. Bariatric surgery can modify this axis, contributing to benefits beyond weight loss, and the response may differ between surgical techniques. This study investigates this differential impact in an experimental model of obesity. Both surgical procedures reduced body weight, although gastric bypass (GB) induced a more sustained weight loss and deeper metabolic changes. GB significantly decreased butyrate levels while increasing bile acids and the abundance of beneficial bacteria such as Akkermansia muciniphila and Bacteroides. Only GB reduced serum TMAO levels, a metabolite linked to cardiovascular risk, possibly through modulation of the hepatic enzyme FMO3. The results indicate that GB exerts a markedly distinct metabolic impact compared to sleeve gastrectomy (SG), which may largely explain its greater clinical efficacy.

Introduction: Food satisfaction and the relationship with food are key determinants of quality of life after bariatric surgery; however, the factors that modulate them remain poorly defined. The objective of this study was to analyse the eating experience of bariatric surgery patients and identify the clinical, behavioural, and psychosocial factors that influence it.

Methods: A cross-sectional study was conducted with 63 patients (71.4% women; age 42.6 ± 9.7 years) who underwent gastric bypass or gastric sleeve surgery (25.3 ± 17.2 months). Sociodemographic data, postoperative time, and self-reported variables were collected: eating satisfaction (Likert 1-5), relationship with food (VAS 1-10), self-esteem, physical activity, and eating patterns. ANOVA and multiple linear regression (α = 0.05) were applied.

Results: 47.6% reported being able to eat any food. These patients showed greater food satisfaction than those reporting restrictions (4.20 ± 0.68 vs. 3.48 ± 0.87; F = 12.96; p < 0.001; η² < p  = 0.18). The timing of the main meal was associated with the relationship with food (F = 3.49; p = 0.037): lunch (7.62 ± 1.89) > dinner (5.38 ± 2.77). The multivariate model explained 45% of the variance in the relationship with food (R² = 0.454): self-esteem (β = 0.53; p < 0.001) and physical activity (β = 0.23; p = 0.043) were independent predictors, while postoperative time was not significant (p = 0.232).

Conclusions: Perceived dietary flexibility, self-esteem, and regular physical activity are the main determinants of a satisfactory eating experience after bariatric surgery, above and beyond the mere passage of time. These results support the inclusion of psychological interventions and structured physical exercise in multidisciplinary postoperative follow-up.

Anal fistula remains a therapeutic challenge due to the limited efficacy of current treatments. This limitation has prompted the development of animal models that replicate human anatomy and physiology to explore new therapeutic strategies. The pig has emerged as the reference preclinical model. In this study, Landrace-Large White pigs were used owing to their rapid growth, controllable weight, availability, and close anatomical similarity to humans. Three transsphincteric tracts were created per animal using 16-18 French Foley catheters with reinforced fixation, maintained for six weeks. Representative clinical and histological features were obtained. Four critical factors were identified to ensure model reproducibility: catheter calibre, fixation method, dwell time, and the interval between catheter removal and sacrifice. The optimized Landrace-Large White porcine model represents a robust translational platform for the preclinical evaluation of novel local therapies in anal fistula.