Cirugia espanola最新文献

Introduction: Skin and nipple-sparing mastectomy (NSSM) with immediate reconstruction has become the standard treatment for women requiring a mastectomy. The objective of this article is to describe endoscopic mastectomy (E-NSSM) and analyze the initial results after its implementation in terms of care impact and post-surgical complications.

Patient and methods: Preliminary results of the VideoBreast-24 in terms of safety and feasibility of the technique. VideoBreast-24 is a non-inferiority study that compares MPPP-E with immediate reconstruction with a polyurethane implant versus skin-sparing or skin-and-nipple mastectomy using the open technique (O-NSSM) performed within the framework of the PreQ-20 study.

Results: 60 E-NSSM were performed on 42 women, 92.9% of whom were oncological patients. The average surgery time was 213.7 min. The average implant volume is 322cc, with the largest volume being 545cc. There were no implant losses.

Conclusions: Endoscopic mastectomy is a technique with a low incidence of postoperative complications, surgical reintervention and readmission. Surgical time is longer than that of open mastectomy, although it can be optimized once the learning curve has passed.

Background: Outpatient laparoscopic cholecystectomy has become increasingly common, yet criteria for patient selection remain conservative. We aimed to assess the long-term outcomes of implementing a structured outpatient cholecystectomy protocol in a secondary hospital and explore its applicability in traditionally high-risk populations. Materials and methods After the establishment of our outpatient cholecystectomy protocol in 2018, 1024 consecutive elective cholecystectomy patients were retrospectively analyzed for initial indication for outpatient procedure, unplanned admission rate and complications. Patient factors and operative parameters were assessed.

Results: In 822 patients, the cholecystectomy was initially planned as an outpatient procedure, which was achieved in 673 (81.9%). Both the indication and success rates improved over time (P < .001). Unplanned admissions occurred mainly due to surgical complexity, social factors and timing of the procedure. Age > 70 years of age, BMI > 30, ASA III and complicated cholelithiasis were not found to increase the unplanned admission rate, and the indication for outpatient cholecystectomy in these groups rose over time without significant complications. 90-day readmission and complication rates (mostly Clavien-Dindo grade I-II and no mortality) remained low (1.3% and 3.6%, respectively; P < .001).

Conclusion: A structured protocol enables safe and effective expansion of outpatient cholecystectomy to higher-risk groups, optimizing resource utilization without compromising patient outcomes.

Objective: Obesity is an important, modifiable, independent risk factor for elevated serum uric acid (SUA) levels. A number of studies have shown that weight loss can lead to a decrease in SUA concentrations. However, the existing evidence regarding the effect of a particular type of bariatric surgery (Roux-en-Y gastric bypass, RYGB) on SUA levels is limited and not fully understood. Therefore, the aim of this meta-analysis was to evaluate the effect of RYGB on circulating uric acid levels.

Methods: A comprehensive search was conducted across databases including Embase, PubMed, Web of Science, and Scopus. The overall effect size was assessed through a random-effects meta-analysis and by employing a leave-one-out analytical method.

Results: The random-effects meta-analysis of 18 trials including 1312 individuals confirmed a significant reduction in uric acid following RYGB (WMD: -1.090 mg/dL, 95% CI: -1.429, -0.752, P < .001). In sub-analyses analyzing the duration of follow up, there was a significant reduction in uric acid after ≥12 months (WMD: -1.168, 95% CI: -1.663, -0.673, P < .001), and <12 months (WMD: -0.941, 95% CI: -1.379, -0.503, P < .001). There was no significant change in circulating uric acid concentrations based on the duration of follow-up.

Conclusion: The RYGB type of bariatric surgery significantly decreases SUA levels. This result was not related to the length of follow-up period following bariatric surgery.

Background: Colorectal cancer (CRC) remains a leading cause of cancer-related mortality worldwide, with treatment resistance posing a persistent clinical challenge. Patient-derived organoids (PDO) offer a promising platform for modelling tumour biology and therapeutic responses; however, conventional Matrigel-based PDO lack the immune contexture necessary to capture the full complexity of the tumour microenvironment (TME). In this study, we performed a second model, known as air-liquid interface patient-derived organoids (ALI-PDO), that preserves infiltrating immune cells, evaluating its relative advantages over the classical Matrigel culture in modelling CRC.

Materials and methods: In this study, we present a comparative analysis of 2 organoid systems-Matrigel-PDO and air-liquid interface PDO (ALI-PDO)-generated from CRC surgical biopsies obtained from 5 patients.

Results: Both models recapitulated key histopathological and proliferative features of the original tumours; however, only ALI-PDO preserved native immune infiltrates, including CD45⁺, CD3⁺, and CD68⁺ cells. Functional assays demonstrated that ALI-PDO allowed for the investigation of drug-induced immune dynamics, revealing selective sensitivity of immune cells to 5-fluorouracil (5-FU) treatment. In contrast, Matrigel-PDO, composed solely of neoplastic epithelial cells, failed to reflect these interactions.

Conclusions: Our findings establish ALI-PDO as an advanced preclinical model that more accurately mirrors the immunological and architectural complexity of CRC. This system offers a valuable tool for evaluating immunomodulatory therapies and guiding personalised treatment strategies. Future studies should expand the application of ALI-PDO to immunotherapy and incorporate additional components of the TME to further enhance translational relevance.