Cirugia espanola最新文献

Introduction: The treatment of pilonidal sinus (PS) is usually surgical, but no procedure is considered the gold standard. The Karydakis (K) technique is widely used, and unroofing and marsupialization (UM) is a simple surgery with good results.

Primary objective: To evaluate early postoperative complications (EPC) 30 days after UM surgery compared to the K technique.

Secondary objectives: To evaluate surgical time, postoperative pain, patient satisfaction, return to daily activity and early recurrence within 3 months.

Method: Prospective, single-center, randomized study in patients who underwent surgery for primary PS with no abscess between June 2016 and November 2017. They were randomized using a computer-generated block method. To analyze the main objective, a non-inferiority analysis was performed.

Results: 122 patients with symptomatic primary PS were randomized: 60 in the K group and 62 in the UM group. Both groups were homogeneous. There were statistically significant differences between surgery and postoperative complications at 15 and 30 days in favor of UM. There were also differences in favor of UM in surgical time and return to daily activity. During the 90-day follow-up, there were 3 recurrences in the UM group and 0 in the K group.

Conclusions: UM is a simple, minimally invasive, easily reproducible technique that has a lower rate of early complications, with a shorter operative time and an earlier return to daily activity.

Introduction: Specific training at surgical super-specialities and its objective evaluation is a challenge nowadays in order to measure the potential benefits that it might add.

Material and methods: An online survey addressed by the "Grupo Joven de la Asociación Española de Coloproctología" has been performed in order to evaluate the level of formation achieved specifically at colorectal surgery.

Results: 128 surgeons participated, representing 81 colorectal surgery units. Mean satisfaction after the period of formation was moderate to high in 84% of the ones polled. The main points of improvement were the realization of advanced surgical techniques (52%) and academic questions (45%). The big part of the respondents has performed simple proctologic procedures (98%) and oncological open colic resections (100%) during their training period, observing the scarcity of related pelvic floor procedures (20%) and diagnosis techniques (10-45%). Scientific production (31,5%) and presentation of studies at congresses (82,8%) have been moderated. No differences between accredited units and non-accredited units have been observed.

Conclusions: Specific formation in colorectal surgery is appropriate, with a high level of simple procedures and open surgery performed by personal at formation. In view of these results, it seems logical to think that even though is necessary a progress in the formation of minimal invasive and diagnosis techniques.

Introduction: Proper management of thoracic drainages is essential in the recovery of patients after lung resection. This study evaluates the concordance in decision-making for drain removal depending on the type of drainage system used and the previous experience of the personnel.

Material and methods: Prospective, comparative, and stratified randomization study on interobserver variability between senior specialist doctors and inexperienced healthcare personnel in the removal of thoracic drains in patients undergoing lung resection connected to conventional systems (CS) or digital systems (DS) with continuous recording. The withdrawal criteria were established before the study, and decisions were recorded during three postoperative days.

Results: 75 patients were included, 38 CS and 37 DS, with no statistically significant differences in sex distribution, age, intervention performed, presence of pleuropulmonary adhesions, drain time, or post-extraction complications between the groups. The overall concordance in drain removal decisions was moderate (kappa = 0.452), with notable variations in concordance depending on the drainage system used: CS (kappa = 0.188) with an overall agreement rate of 61.7% compared to DS (kappa = 0.716) with an overall agreement rate of 86.4%. Digital systems showed substantial concordance regardless of the operator's experience, with kappa values indicating high concordance on all postoperative days.

Conclusions: The use of digital systems for managing thoracic drains significantly improves concordance in clinical decision-making regardless of the experience level. These findings suggest that adopting digital systems not only optimizes patient safety but also reduces the dependence on highly specialized healthcare professionals.