Cirugia espanola最新文献

Objective: To evaluate whether a radioguided approach allows a higher intraoperative detection rate of adenoma and a minimally invasive parathyroidectomy (MIP), with the same or better cure rate of hyperparathyroidism secondary to parathyroid adenoma.

Methods: This was an observational, prospective, single-center study involving 254 consecutive patients with primary hyperparathyroidism, between 2017 and 2022. A total of 258 procedures were performed: 129 non radioguided (NRS) and 129 radioguided (RS) (112 with intravenous 99mTc- MIBI and 17 with ultrasound-guided intralesional 99mTc-MAA injection) with an intraoperative gamma probe and gamma camera. Follow-up was performed for at least one year.

Results: There were no differences between the groups in terms of age, sex, preoperative calcium or parathyroid hormone levels, adenoma localization with 99mTc-MIBI-gammagraphy and ultrasound, and surgical morbidity. Intraoperative surgical localization was 97.7% in both groups. Statistically significant differences supported RS: It allowed to perform MIP (RS: 96.9%, NRS 88.4%; p = 0.015), also in patients with previous neck surgery (RS: 75%, NRS: 28%; p = 0.019) and with ectopic adenomas (RS: 93.3%, NRS: 71.4%; p = 0.012). The operative time was significantly shorter (RS: 51 min, NRS: 59.79 min; p = 0.005). There were no significant differences in the postoperative complications between the groups. Biochemical cure at six months was achieved in RS: 97.7% and NRS: 93.8% (p = 0.12).

Conclusions: Radioguided MIP is useful in ectopic adenomas and in patients with previous cervical surgery and allows a minimally invasive approach more frequently. It is a safe surgery, easily reproducible by an endocrine surgeon and requires usual equipment found in operating rooms.

The aim of this work is to establish recommendations for the preoperative evaluation and selection of patients with malignant oesophageal neoplasms, who are candidates for surgical resection with curative intent, based on the consensus established by a group of experts. Using the Delphi methodology and after 2 rounds of evaluation, responses were obtained from 37 experts to 47 questions about the preoperative management of oesophageal cancer, considering consensus if there was a mean score greater than 8 (range between 0-10). Of the respondents, 54% were women, with a mean age of 50.2 years, with more than 15 years of average experience in oesophageal surgery. In the preoperative evaluation, agreement was obtained on most of the recommendations, with the indication of a staging laparoscopy being the only one where it was not reached. In the preoperative optimisation, agreement was reached on nutritional, anaemia, physical status, respiratory and comorbidities evaluation, but no agreement was reached on recommending immunonutrition or echocardiography routinely. In the inoperability criteria were included ECOG greater than 1, impaired lung function, and/or Child B or C liver cirrhosis. Agreement was reached on considering unresectable tumours with invasion of the tracheobronchial tract, large vessels, and spinal column, multivisceral metastases, and/or peritoneal carcinomatosis. Therefore, the recommendations established in this manuscript may be useful to support decision-making in daily clinical practice, with a high degree of consensus that decisions regarding the management of these patients should be made on an individual basis and within a multidisciplinary committee of experts.

Introduction: It is a priority to find surgical techniques that guarantee acceptable healing rates without sequelae in the treatment of complex anal fistula. The concept of the deep intersphincteric space as the origin of perianal sepsis has provided a new perspective, allowing the emergence of techniques such as TROPIS (Transanal Opening of Intersphincteric Space), with few published series to date. The aim of this study is to evaluate the healing rate and complications one year after the TROPIS technique as a treatment for complex anal fistula without hospitalization.

Method: Prospective, observational study from January 2021 to January 2023. Patients with complex anal fistulas who met the inclusion criteria were treated using the TROPIS technique. A one-year follow up review was conducted, assessing healing rates, recurrence, continence, and complications.

Results: A total of 23 patients with cryptoglandular complex perianal fistula were included (87% male, mean age 54.7 ± 9.6 years). 78.3% were treated for recurrent fistulas with an average of 3.3 ± 3.2 previous interventions. At one month, 82.6% of the patients had complete healing. At three, six, and twelve months, complete healing occurred in 63.6%, 61.9%, and 55.6%, respectively. One patient developed an abscess at one month. Continence was altered in 8.7%.

Conclusions: The treatment of cryptoglandular complex anal fistula with this procedure was safe and showed acceptable healing rates.