Pub Date : 2024-11-01DOI: 10.1016/j.cireng.2024.08.002
Benigno Acea-Nebril, Alejandra García-Novoa, Sergio Rodríguez-Rojo, Carlota Díaz-Carballada, Alberto Bouzón-Alejandro
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.
{"title":"Evaluation of the efficacy and concordance of indocianine color green angiography in oncoplastic and reconstructive breast surgery. Preliminary results of the gBREAST-22 prospective study","authors":"Benigno Acea-Nebril, Alejandra García-Novoa, Sergio Rodríguez-Rojo, Carlota Díaz-Carballada, Alberto Bouzón-Alejandro","doi":"10.1016/j.cireng.2024.08.002","DOIUrl":"10.1016/j.cireng.2024.08.002","url":null,"abstract":"<div><h3>Introduction</h3><div>During oncoplastic procedures, the vascularization and perfusion of the skin flaps is modified, thus increasing the possibility of skin necrosis.</div><div>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).</div></div><div><h3>Patients and method</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"102 11","pages":"Pages 573-581"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.cireng.2024.06.004
David Hernández-Bermejo , Celia García-Vega , Juan Jesús Rubio-García , Celia Villodre-Tudela , Silvia Carbonell-Morote , José Manuel Ramia
Introduction
Cholelithiasis is the most common hospital diagnosis of the digestive system, and its treatment, if symptomatic, is laparoscopic cholecystectomy. There is a growing need for comprehensive determination of postoperative outcomes and the efficiency of healthcare facilities. The “textbook outcome”(TO) indicates the quality of care commonly used in oncological procedures, obtained by adding several postoperative parameters, which informs whether a perfect result has been obtained. The main objective of this study is to determine the TO for cholecystectomy and to see the factors that influence its achievement.
Methods
Retrospective observational unicentric cohort study on patients who underwent cholecystectomy between 2018–2020. We defined TO as those patients who met the following premises: Clavien-Dindo complications < III, postsurgical stay less than the 75th percentile (<3 days), and no readmissions or mortality in the first ninety days. Perioperative characteristics were analyzed, and the patients were divided into two groups according to whether or not they achieved TO. We defined criteria for difficult cholecystectomy according to the operative report.
Results
The percentage of TO was 72% (342/475) (82.6% in elective surgery and 60.5% in urgent surgery). The univariate analysis showed that the following factors are associated with achieving TO: female sex, age <63 years, ASA risk < III, elective surgery, laparoscopic approach, and not difficult cholecystectomy. After multivariate analysis ASA < III (OR 2.39 CI95% 1.37–4.16), elective surgery (OR 2.77 CI95% 1.64–4.67), laparoscopic approach (OR 5.71 CI95% 2.89–11.30) and not to be difficult cholecystectomy (OR 0.42 CI95% 0.259–0.71) remained statistically significant.
Conclusions
The TO is a healthcare quality tool that is simple to perform, easily interpretable, and helpful for evaluating quality in healthcare and comparing centers. It applies not only to oncological procedures but also to cholecystectomy.
导言：胆石症是消化系统最常见的医院诊断，如果有症状，其治疗方法是腹腔镜胆囊切除术。对术后疗效和医疗机构效率的综合判定需求日益增长。教科书式疗效"（TO）指的是肿瘤手术中常用的护理质量，它是通过添加多个术后参数而获得的，可告知是否获得了完美的疗效。本研究的主要目的是确定胆囊切除术的 "教科书结果"，并了解影响其实现的因素：对 2018-2020 年间接受胆囊切除术的患者进行回顾性观察单中心队列研究。我们将 TO 定义为满足以下前提条件的患者：Clavien-Dindo并发症 结果：TO的比例为72%（342/475）（82.6%为择期手术，60.5%为紧急手术）。单变量分析表明，以下因素与实现 TO 有关：女性性别、年龄 结论：TO 是一种医疗质量工具，操作简单，易于解释，有助于评估医疗质量和比较医疗中心。它不仅适用于肿瘤手术，也适用于胆囊切除术。
{"title":"The textbook outcome for cholecystectomy: Is it a good quality tool for a low-morbidity procedure?","authors":"David Hernández-Bermejo , Celia García-Vega , Juan Jesús Rubio-García , Celia Villodre-Tudela , Silvia Carbonell-Morote , José Manuel Ramia","doi":"10.1016/j.cireng.2024.06.004","DOIUrl":"10.1016/j.cireng.2024.06.004","url":null,"abstract":"<div><h3>Introduction</h3><div><span><span>Cholelithiasis is the most common hospital diagnosis of the digestive system, and its treatment, if symptomatic, is </span>laparoscopic cholecystectomy. There is a growing need for comprehensive determination of postoperative outcomes and the efficiency of healthcare facilities. The “textbook outcome”(TO) indicates the quality of care commonly used in </span>oncological procedures<span>, obtained by adding several postoperative parameters, which informs whether a perfect result has been obtained. The main objective of this study is to determine the TO for cholecystectomy and to see the factors that influence its achievement.</span></div></div><div><h3>Methods</h3><div>Retrospective observational unicentric cohort study<span> on patients who underwent cholecystectomy between 2018–2020. We defined TO as those patients who met the following premises: Clavien-Dindo complications < III, postsurgical stay less than the 75th percentile (<3 days), and no readmissions or mortality in the first ninety days. Perioperative characteristics were analyzed, and the patients were divided into two groups according to whether or not they achieved TO. We defined criteria for difficult cholecystectomy according to the operative report.</span></div></div><div><h3>Results</h3><div><span>The percentage of TO was 72% (342/475) (82.6% in elective surgery and 60.5% in urgent surgery). The </span>univariate analysis<span> showed that the following factors are associated with achieving TO: female sex, age <63 years, ASA risk < III, elective surgery, laparoscopic approach, and not difficult cholecystectomy. After multivariate analysis ASA < III (OR 2.39 CI95% 1.37–4.16), elective surgery (OR 2.77 CI95% 1.64–4.67), laparoscopic approach (OR 5.71 CI95% 2.89–11.30) and not to be difficult cholecystectomy (OR 0.42 CI95% 0.259–0.71) remained statistically significant.</span></div></div><div><h3>Conclusions</h3><div>The TO is a healthcare quality tool that is simple to perform, easily interpretable, and helpful for evaluating quality in healthcare and comparing centers. It applies not only to oncological procedures but also to cholecystectomy.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"102 11","pages":"Pages 582-589"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141441252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.cireng.2024.04.018
Salvador Morales-Conde , Juan Carlos Gómez Rosado , Stavros A. Antoniou
{"title":"Network meta-analysis: concept and value in practical application","authors":"Salvador Morales-Conde , Juan Carlos Gómez Rosado , Stavros A. Antoniou","doi":"10.1016/j.cireng.2024.04.018","DOIUrl":"10.1016/j.cireng.2024.04.018","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"102 11","pages":"Pages 607-608"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141023290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Results of the implementation of a specialized cervical tracheal surgery program","authors":"Usue Caballero-Silva, Sara Fra-Fernández, C.ristina Cavestany García-Matres, Albarto Cabañero-Sánchez, Nicolás Moreno-Mata","doi":"10.1016/j.cireng.2024.05.014","DOIUrl":"10.1016/j.cireng.2024.05.014","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"102 11","pages":"Pages 617-619"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141441250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.cireng.2024.05.013
Andrea Norte, Carmen Martínez, Ana Pasalodos, Ivette Tort, Anna Sánchez, Pilar Hernández, Jesús Bollo, Eduard Maria Targarona
Aim
To evaluate the clinical outcome of early closure of a protective ileostomy and preoperative stimulation of the efferent limb in a cohort of patients with rectal cancer treated surgically, primarily using the laparoscopic approach.
Methods
We performed an observational retrospective cohort study in a prospectively recorded series of patients with rectal cancer who underwent laparoscopic surgery with a protective loop ileostomy between 2017 and 2022. Ileostomy closure was programmed for within 3 months after surgery. All patients underwent stimulation of the efferent limb. Primary outcomes were morbidity and mortality, length of stay (LOS), and re-admission.
Results
Between 2017 and 2022, 108 patients underwent resection for rectal cancer and protective ileostomy. The laparoscopic approach was performed in 84.3% of patients (n = 91). Permanent ileostomy was performed in 5 patients (4.6%). Ileostomy closure was thus performed in 95.4% of patients (n = 103). Median time to closure was 74.5 days (range 57–113). In 63.1% (n = 65) of patients, reconstructive surgery was performed within 90 days. Prior to closure, efferent limb stimulation was performed in 77.8% (n = 84) of patients. Global morbidity was 26.2% (n = 27) (85.19%, n = 23 Clavien-Dindo I and 7.41%, n = 2 Clavien-Dindo II). The main causes of morbidity were postoperative ileus (10.7%, n = 11) and rectal bleeding (8.7%, n = 9). Anastomosis leakage occurred in 2 patients. Median hospital stay was 6 days (5–7). Readmission was needed in 6.8% (n = 7) of patients.
Conclusion
A previous laparoscopic approach, early closure and stimulation of the efferent limb could be a useful strategy to reduce the morbidity and mortality of temporary ileostomy closure.
{"title":"Impact of the laparoscopic approach, early closure and preoperative stimulation on outcomes of ileostomy closure after rectal resection","authors":"Andrea Norte, Carmen Martínez, Ana Pasalodos, Ivette Tort, Anna Sánchez, Pilar Hernández, Jesús Bollo, Eduard Maria Targarona","doi":"10.1016/j.cireng.2024.05.013","DOIUrl":"10.1016/j.cireng.2024.05.013","url":null,"abstract":"<div><h3>Aim</h3><div>To evaluate the clinical outcome of early closure of a protective ileostomy and preoperative stimulation of the efferent limb in a cohort of patients with rectal cancer treated surgically, primarily using the laparoscopic approach.</div></div><div><h3>Methods</h3><div>We performed an observational retrospective cohort study in a prospectively recorded series of patients with rectal cancer who underwent laparoscopic surgery with a protective loop ileostomy between 2017 and 2022. Ileostomy closure was programmed for within 3 months after surgery. All patients underwent stimulation of the efferent limb. Primary outcomes were morbidity and mortality, length of stay (LOS), and re-admission.</div></div><div><h3>Results</h3><div>Between 2017 and 2022, 108 patients underwent resection for rectal cancer and protective ileostomy. The laparoscopic approach was performed in 84.3% of patients (n = 91). Permanent ileostomy was performed in 5 patients (4.6%). Ileostomy closure was thus performed in 95.4% of patients (n = 103). Median time to closure was 74.5 days (range 57–113). In 63.1% (n = 65) of patients, reconstructive surgery was performed within 90 days. Prior to closure, efferent limb stimulation was performed in 77.8% (n = 84) of patients. Global morbidity was 26.2% (n = 27) (85.19%, n = 23 Clavien-Dindo I and 7.41%, n = 2 Clavien-Dindo II). The main causes of morbidity were postoperative ileus (10.7%, n = 11) and rectal bleeding (8.7%, n = 9). Anastomosis leakage occurred in 2 patients. Median hospital stay was 6 days (5–7). Readmission was needed in 6.8% (n = 7) of patients.</div></div><div><h3>Conclusion</h3><div>A previous laparoscopic approach, early closure and stimulation of the efferent limb could be a useful strategy to reduce the morbidity and mortality of temporary ileostomy closure.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"102 11","pages":"Pages 590-598"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141441247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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