Cirugia espanola最新文献

Background: Retroperitoneal sarcoma (RPS) is a rare malignancy requiring complex surgical management. While Enhanced Recovery After Surgery (ERAS) protocols have improved outcomes in various surgical specialties, their implementation in RPS remains inconsistent.

Objective: This study aimed to evaluate current perioperative care practices for RPS surgery across Spain and Portugal, identifying gaps in protocol standardization and assessing the feasibility of consensus-based approaches.

Methods: A structured online survey was distributed to members of the Spanish and Portuguese Societies of Surgeons. The questionnaire encompassed five domains: demographics, preoperative, intraoperative, and postoperative practices, and attitudes toward perioperative consensus.

Results: Among 266 survey accesses, 37 complete responses were analyzed. Only 27% of respondents reported having a dedicated ERAS protocol for RPS, though 89.2% employed ERAS pathways for other surgeries. Prehabilitation elements - such as smoking cessation (21.6%), nutritional support (73%), and supervised physical therapy (37.8%) - were inconsistently applied. Intraoperatively, goal-directed fluid therapy was used by 51.4%, while 97.3% adhered to restrictive transfusion thresholds. Postoperative variability was notable in diet resumption, mobilization, and nasogastric tube use. All respondents supported the creation of an RPS-specific perioperative care consensus.

Conclusions: There is marked heterogeneity in perioperative care for RPS across Iberian centers. Standardized, evidence-based guidelines are urgently needed to improve consistency and optimize patient outcomes.

Background: This research project is motivated by the increasing prevalence of gallstones and biliary tract diseases in patients of advanced age, while also recognizing that the comorbidity burden of this population may necessitate a tailored treatment approach. Acute cholecystitis can rapidly progress to systemic inflammatory response syndrome, sepsis and even death. Age per se has no bearing on the severity of acute cholecystitis, but the burden of comorbidity in older patients may lead to rapid disease progression.

Methods: The GOLDENEYE study is an international, multicenter, prospective, observational research project designed to compare the outcomes of different management strategies for acute cholecystitis in seniors. The primary aims are to evaluate the efficacy of different treatments-supportive care, percutaneous gallbladder drainage, early or delayed cholecystectomy, and EUS-guided gallbladder drainage-on one-year additional treatment modalities, hospital readmissions, and outpatient care. Secondary outcomes are quality of life and survival rates. The study implements propensity score matching analysis to account for the non-randomized allocation of treatment modalities. Patients ≥ 70 years diagnosed with acute cholecystitis, as per the Tokyo guidelines, are included. Exclusion criteria include prior episodes of cholecystitis or pancreatitis, terminal illness, and concurrent diagnosis of acute pancreatitis, cholangitis, bile duct disease, or digestive malignancy. Data collection is performed with the REDCap platform for data entry and monitoring.

Discussion: The GOLDENEYE study aims to generate evidence-based insights that will significantly influence the management of acute cholecystitis in elderly patients, ultimately improving patient outcomes and healthcare practices in this growing demographic population.

Clinicaltrials: gov, NCT07006298.

Background: There is abundant scientific literature on the use of haemostatics and sealants in liver surgery, however there is a lack of evidence due to the difficulty of applying adequate methodologies without conflicts of interest. The main objective of this prospective randomised study was to determine the efficacy of the local haemostatic Hemopatch® on the incidence of bleeding and biliary fistula in patients undergoing elective liver resection.

Methods: This was a single-centre study where 222 patients were analysed: 115 patients had been randomised to the control group and 107 to the experimental group. After liver resection the patients undergoing liver resection were randomised and assigned either to receive Hemopatch® or no treatment on the liver resection surface. Patients with all types of liver resections and laparotomic and laparoscopic approaches were included. During postoperative follow-up, an abdominal drain was placed, and haemoglobin and bilirubin were analysed over the first three days.

Results: Clinically postoperative bleeding occurred in 3.5% of the patients in the control group and 2.8% of the experimental group (p = 0.409). The incidence of postoperative biliary fistula was 17.4% in the control group and 23.4% in the experimental group (p = 0.269). There were also no differences in the rest of the parameters analysed.

Conclusions: The results on the use of Hemopatch® in liver resection to prevent haemorrhage and biliary fistula were inconclusive. It cannot be routinely recommended and surgeons should be more demanding as regards the scientific evidence to justify the systematic use of haemostatics agents.

Registration number: NCT02769754.

This article provides a detailed description of the robotic approach used to perform an extended left hepatectomy with venous resection in a 65-year-old female patient with a Bismuth-Corlette tumour type 3b infiltrating the portal confluence. A Glissonean pedicle approach was used to achieve total prehepatic vascular control and resection of the left portal confluence, followed by transverse reconstruction according to the Heineke-Mikulicz technique. The parenchymal transection, including the entire caudate lobe, was performed robotically, with left hanging manoeuvre after complete piggybacking of the vena cava. The final pathological result was G3 pT2bN1M0 (2/11) signet ring cell adenocarcinoma. The robotic approach enabled adjuvant treatment to be initiated immediately. No major complications were recorded within 90 days, and the patient was discharged on the 5^th day.

While pancreaticoduodenectomy is the standard for duodenal malignancy, pancreas-sparing duodenectomy (PSD) is a surgical option for benign duodenal disease. Robotic surgery for PSD offers advantages, such as enhanced visualization, improved instrument dexterity, and optimized dissection, while maintaining resection quality. After preoperative imaging review, we performed a totally robotic PSD with intracorporeal duodenojejunostomy in a 70-year-old patient with a 2.2-cm sessile polyp and dysplasia in the D3 portion of the duodenum. Although PSD is not indicated for malignancy, a negative intraoperative frozen section is critical before proceeding in select cases. A key learning point is combining robotic visualization with upper endoscopy to accurately define the distance between the ampulla and the lesion, ensuring oncologic margins. This manuscript outlines a stepwise surgical approach in a technically challenging scenario, aiming to preserve patient safety and provide an oncologically sound resection using totally robotic techniques.