Cirugia espanola最新文献

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.

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.