Cirugia espanola最新文献

Sarcopenic obesity (SO) is a new entity whose definition encompasses the diagnosis of overweight in malnourished patients. The aim of the review was to assess the impact of body composition in patients with esophago-gastric tumors (EGT) on perioperative and oncological outcomes. This systematic review was conducted under the PRISMA guidelines. MEDLINE (PubMed), Embase, Web of Science and SCOPUS databases were searched until January 2024. Sixteen articles were identified for analysis analyzing 5,378 patients. The prevalence of SO was 10% (95%CI: 6-16; I² = 94%). Preoperative diagnosis of SO was associated with a twofold increased risk of severe postoperative complications (OR 2.32 [95%CI 1.41-3.82] I² = 70%). Meta-analysis of overall survival outcomes identified that SO was associated with worse overall survival (HR 2.30; 95%CI 1.46-3.61).

Background: This study aims to compare the visualization of the cystic duct-common bile duct junction with indocyanine green (ICG) among 3 groups of patients divided according to the difficulty of elective laparoscopic cholecystectomy.

Methods: Conducted at a single center, this non-randomized, prospective, observational study encompassed 168 patients who underwent elective laparoscopic cholecystectomy and were assessed with a preoperative risk score to predict difficult cholecystectomies, including clinical factors and radiological findings. Three groups were identified: low, moderate, and high risk. A dose of 0.25 mg of IV ICG was administered during anesthesia induction and the different objectives were evaluated.

Results: The visualization of the cystic duct-common bile duct junction was achieved in 28 (100%), 113 (91.1%), and 10 (63%) patients in the low, moderate, and high-risk groups, respectively. The high-risk group had longer total operative time, higher conversion, more complications and longer hospital stay. In the surgeon's subjective assessment, ICG was considered useful in 36% of the low-risk group, 58% in the moderate-risk group, and 69% in the high-risk group. Additionally, there were no cases where ICG modified the surgeon's surgical approach in the low-risk group, compared to 11% in the moderate-risk group and 25% in the high-risk group (p < 0.01).

Conclusions: The results of this study confirm that in the case of difficult cholecystectomies, the visualization of the cystic duct-common bile duct junction is achieved in 63% of cases and prompts a modification of the surgical procedure in one out of four patients.

Purpose: To evaluate the bacterobilia in patients undergoing pancreaticoduodenectomy (PD) based on whether they carry a preoperative biliary drainage or not and to analyse if a targeted perioperative antibiotic treatment based on the expected microbiology leads in no differences in Surgical Site Infections (SSI) between the groups.

Methods: Retrospective observational single-center study of patients undergoing pancreaticoduodenectomy with preoperative biliary stent (group P, Prosthesis) and without stent (group NP, No Prosthesis). Postoperative complications including SSI and its subtypes were analyzed after applying a targeted perioperative antibiotic treatment protocol with cefotaxime and metronidazole (group NP) and piperacillin-tazobactam (group P).

Results: Between January 2014 and December 2021, 127 patients were treated (84 in group NP and 43 in group P). Intraoperative cultures were positive in 16.7% (group NP) vs 76.7% (group P, p < 0.01). Microorganisms isolated in group NP included Enterobacterales (10.7%) and Enterococcus spp. (7.1%) with no Candida detected. In group P: Enterobacterales (51.2%), Enterococcus spp. (48.8%), and Candida (16.3%) were higher (p < 0.01%). No differences in morbidity and mortality were observed between the groups. SSI rate was 17.8% in group NP and 23.2% in group P (ns).

Conclusion: Bacterobilia differs in patients with biliary drainage, showing a higher presence of Enterobacterales, Enterococcus spp., and Candida. There were no differences in SSI incidence after applying perioperative antibiotic treatment tailored to the expected microorganisms in each group. This raises the need to reconsider conventional surgical prophylaxis in patients with biliary stent.

Introduction: Embolization could increase the resectability of pancreatic tumors by supercharging visceral arterial perfusion prior to pancreatic surgery with arterial en-bloc resection. Its indications, however, are controversial.

Methods: We retrospectively analyzed the results of a single-center database of patients undergoing pancreatic surgery with arterial resection (AR) after preoperative arterial embolization (PAE) to increase hepatic vascular flow and spare arterial reconstruction.

Results: PAE was planned in 15 patients with arterial involvement due to pancreatic tumors. Three patients were excluded due to the finding of irresectable disease during surgery. Twelve cases were resected because of pancreatic cancer (10), distal cholangiocarcinoma (1), and pancreatic neuroendocrine tumor (1). Arterial involvement in these cases required embolization of the substitute right hepatic artery (RHA) (5), left hepatic artery (1), and common hepatic artery (CHA) (6) to enhance liver vascularization. Two patients presented migration of the vascular plug after PAE. Six pancreatoduodenectomies and 6 distal pancreatectomies were performed, the latter associated with en-bloc celiac trunk and CHA resection. R0 was achieved in 7 out of 12 patients, and pathological vascular involvement was confirmed in 8. Postoperative complications included one patient who developed gastric ischemia and underwent gastrectomy, and one patient who underwent reoperation for acute cholecystitis with liver abscesses.

Conclusion: Preoperative arterial embolization before pancreatic surgery with hepatic arterial resection enables surgeons to precondition hepatic vascularization and prevent hepatic ischemia. In addition, this avoids having to perform arterial anastomosis in the presence of pancreatic suture.

Introduction: Our study aimed to compare the midline abdominal incision with scalpel and diathermy.

Methods: PubMed, EMBASE, and Cochrane were searched through January 2024 following PRISMA guidelines (PROSPERO, ID: CRD42024516771), and only randomized controlled trials were included. Heterogeneity was assessed using Cochran's Q test and the I² heterogeneity index. Statistical analysis was performed using Review Manager 5.4 software.

Results: Six randomized controlled trials were included, from which 469 patients (51.5%) received diathermy incision and 442 patients (48.5%) underwent the scalpel technique. Patients treated with the electrocautery approach had less incision blood loss (MD -17.57 mL; P < .01). No statistically significant differences were found between groups regarding wound infection incidence, incision time, incision area or first-day postoperative pain.

Conclusion: Diathermy use in midline abdominal incision may be advocated as it demonstrated a significant reduction in incision-related blood loss, with no differences in wound infection or early postoperative pain incidences compared to the scalpel.

Introduction: During oncoplastic procedures, the vascularization and perfusion of the skin flaps is modified, thus increasing the possibility of skin necrosis. The objective of this study is to evaluate the effectiveness of indocyanine color green angiography (ICG-A) to determine intraoperative skin necrosis after oncoplastic surgery or skin-sparing or nipple-skin sparing mastectomy (NSSM).

Patients and method: Prospective observational study to evaluate the sensitivity, specificity and positive and negative predictive values ​​of the ICG-A in women with high-risk breast cancer.

Results: 98 women and 156 breasts were included in the study. A total of 20 women (20.4%) presented an image of ischemia in the ICG-A. 21 women (21.4%) presented ischemic events in the postoperative period, 71.4% of these events had been detected in the third ICG-A. Three of these patients (3.1%) presented a serious complication that required reintervention. The sensitivity and specificity of the ICG-A was 71.4% and 93.5%, respectively.

Conclusions: ICG-A has high specificity and negative predictive value for detecting areas of low perfusion. In breast units with highly complex surgery, it can be useful to plan extreme surgeries and identify skin areas of low perfusion.

Introduction: Male breast cancer accounts for 1% of all breast cancers. Its low frequency leads to a lack of awareness, resulting in significant diagnostic delays. Additionally, this limits the available evidence, which primarily uses diagnostic-therapeutic algorithms based on women.

Objectives: To analyze the prevalence, clinical presentation, anatomical and pathological characteristics, and prognosis of male breast cancer using one of the largest series available. Secondarily, to compare our data with studies conducted in women.

Materials and methods: A multicenter, observational, descriptive, retrospective study was conducted in the autonomous community of Aragon, Spain, from 1995 to 2022 including men with a pathological diagnosis of breast cancer.

Results: A total of 148 patients were included, with a prevalence of 1%. The most common clinical presentation was a palpable retroareolar mass. Invasive ductal carcinoma was the most frequent type (88.89%), and luminal B was the predominant subtype (47.76%). Surgery was the most utilized treatment; mastectomy was performed in 90.34% and AL in 46.89%. At diagnosis, 52.46% had extramammary involvement. The recurrence rate was 24.1%, and the mortality attributed to the disease was 14.6%.

Conclusions: There is a high rate of metastatic involvement at diagnosis, a high percentage of mutilating surgeries, and a high number of recurrences compared to available studies on males. Additionally, a worse prognosis is observed compared to breast cancer in women, despite these tumors having a less aggressive molecular subtype. These findings highlight the importance of conducting studies focused on men to develop specific protocols.