Cirugia espanola最新文献

英文中文

Massive cervical dilatation: Risks and challenges in managing complications of retrosternal coloplasty 大规模宫颈扩张：处理胸骨后结肠成形术并发症的风险和挑战。

Cirugia espanola

Pub Date : 2025-10-01 DOI: 10.1016/j.cireng.2025.800192

Lucía Lavín Montoro, Elías Rodríguez Cuéllar, Inés Marcos Cortés, Eduardo Ferrero Herrero

引用次数: 0

Bowel obstruction due to adhesions of the appendix 阑尾粘连引起的肠梗阻。

Cirugia espanola

Pub Date : 2025-10-01 DOI: 10.1016/j.cireng.2025.800194

Héctor Aguado López, Francisco Javier Ruescas García, Andrés García Marín, Beatriz Aguado Rodríguez

引用次数: 0

Management of inguinoscrotal hernia in Spain: Results of a national survey 西班牙腹股沟腹股沟疝的治疗：一项全国调查的结果。

Cirugia espanola

Pub Date : 2025-10-01 DOI: 10.1016/j.cireng.2025.800210

Luisana Riba-Combatti , Alejandro Bravo-Salvá , Montserrat Juvany-Gómez , José Antonio Pereira Rodríguez

Introduction

Inguinoscrotal hernia (ISH) represents an advanced form of inguinal hernia, with greater technical complexity and higher risk of complications. Despite its significant prevalence, its management remains heterogeneous in Spain. This study evaluates clinical practice and adherence to the recommendations of the European Hernia Society (EHS).

Methods

A cross-sectional observational study was conducted through an online survey distributed among members of the Spanish Association of Surgery (AEC). Demographic variables and specific data on the diagnostic and therapeutic management of ISH were collected. Subgroup analyses were performed based on age and specialization in abdominal wall surgery.

Results

Out of 3014 surveys distributed, 392 complete responses were obtained (13%). While 60.2% had an Abdominal Wall Unit, only 11.7% centralized all inguinal hernia cases. Open surgery remains the most frequent approach (96.4%). In ISH cases, the use of minimally invasive surgery (MIS) is lower (38.6%), with TAPP being the predominant technique. Surgeons specialized in abdominal wall procedures used more posterior and endoscopic techniques. Adherence to EHS guidelines was partial (58.8%).

Conclusions

The treatment of ISH in Spain lacks proper centralization in specialized units, which limits the adoption of advanced techniques and adherence to international guidelines. Promoting specific training, European certification, and the creation of specialized units could improve clinical outcomes and the quality of life for these patients.

腹股沟腹股沟疝（ISH）是腹股沟疝的一种晚期形式，其技术复杂性和并发症风险较高。尽管其显著流行，其管理仍然是异质在西班牙。本研究评估临床实践和遵守欧洲疝学会（EHS）的建议。方法：通过在西班牙外科协会（AEC）成员中进行的在线调查进行横断面观察性研究。收集了ISH诊断和治疗管理的人口学变量和具体数据。根据年龄和腹壁手术专业进行亚组分析。结果：在分发的3014份调查中，获得392份完整回复（13%）。60.2%的腹股沟疝有腹壁装置，只有11.7%的腹股沟疝集中在所有病例中。开放手术仍然是最常见的方法（96.4%）。在ISH病例中，微创手术（MIS）的使用率较低（38.6%），TAPP是主要技术。专门从事腹壁手术的外科医生更多地使用后路和内窥镜技术。对EHS指南的遵守是部分的（58.8%）。结论：西班牙ISH的治疗缺乏适当的专科集中，这限制了采用先进技术和遵守国际指南。促进专门培训、欧洲认证和创建专门单位可以改善这些患者的临床结果和生活质量。

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引用次数: 0

Immunomarkers could predict overall survival and disease-free survival after neoadjuvant therapy and surgery due to locally advanced rectal cancer 免疫标志物可以预测局部晚期直肠癌新辅助治疗和手术后的总生存期和无病生存期。

Cirugia espanola

Pub Date : 2025-10-01 DOI: 10.1016/j.cireng.2025.800199

Miguel A. Bonilla-Cozar , Anabel Garcia-Leon , Carlos J. Garcia-Sanchez , M. Luisa Reyes-Diaz , Irene Ramallo-Solis , Fernando De la Portilla , Javier Padillo , Rosa M. Jimenez-Rodriguez

Background

In daily clinical practice, patients with similar risk profiles often show varied oncologic outcomes, including differing responses to neoadjuvant therapy and surgery. In this study, we seek to analyze the relationship of neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), and monocyte-to-lymphocyte (MLR) ratios with survival and recurrence in patients treated for locally advanced rectal cancer.

Material and methods

We have conducted a retrospective analysis of patients operated on due to rectal cancer with neoadjuvant long-course radiotherapy and sensitizing chemotherapy. After neoadjuvant therapy and before surgery, these immunomarker indices were analyzed. Each index was assigned a cut-off point to assess their association with overall survival (OS) and disease-free survival (DFS).

Results

A total of 156 patients were analyzed with a median follow-up of 71.5 months (51–89). The NLR index was identified as an independent predictor of 5-year OS and DFS. Values above the 6.3 cut-off point showed an OS of 58.9% (P = .019); in patients with values above 4.72, DFS was 57.4% (P = .034). Patients whose 3 indices (NLR, PLR, MLR) were elevated had a 5-year OS of 25% (HR 3.16, 95% CI [1.45−6.87], P = .004); and a 5-year DFS of 39.4% (HR 2.88, 95% CI [1.35–6.17], P = .006).

Conclusions

Elevated preoperative immunomarker values are related to worse outcomes in terms of OS and DFS in those patients with locally advanced rectal cancer after neoadjuvant therapy. The combination of the three indices is more accurate in predicting OS and DFS. These immunomarkers may be useful in choosing an individualized therapeutic strategy.

背景：在日常临床实践中，具有相似风险特征的患者往往表现出不同的肿瘤预后，包括对新辅助治疗和手术的不同反应。在这项研究中，我们试图分析中性粒细胞与淋巴细胞（NLR）、血小板与淋巴细胞（PLR）和单核细胞与淋巴细胞（MLR）比例与局部晚期直肠癌患者的生存率和复发率的关系。材料和方法：我们回顾性分析直肠癌手术患者接受新辅助长期放疗和增敏化疗的情况。在新辅助治疗后和手术前对这些免疫指标进行分析。每个指标被分配一个截止点来评估它们与总生存期（OS）和无病生存期（DFS）的关联。结果：共分析了156例患者，中位随访时间为71.5个月（51-89）。NLR指数被确定为5年OS和DFS的独立预测因子。高于6.3分界点的OS为58.9% (P = 0.019)；高于4.72的患者，DFS为57.4% （P = 0.034）。3项指标（NLR、PLR、MLR）升高的患者5年OS为25% (HR 3.16, 95% CI [1.45-6.87]， P= 0.004)；5年DFS为39.4% （HR 2.88, 95% CI [1.35-6.17]， P= 0.006）。结论：局部晚期直肠癌患者接受新辅助治疗后，术前免疫标志物升高与较差的OS和DFS相关。3个指标联合应用预测OS和DFS更为准确。这些免疫标记物可能有助于选择个体化治疗策略。

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引用次数: 0

Prevalence of burnout dimensions among general surgeons. A systematic review and meta-analysis 普通外科医生职业倦怠各维度的患病率。系统回顾和荟萃分析。

Cirugia espanola

Pub Date : 2025-10-01 DOI: 10.1016/j.cireng.2025.800186

Miguel Gili-Miner , Lucas Giner , Enrique Gili-Ortiz , Dolores Franco-Fernández , Juan Luís Cabanillas-Moruno , Gonzalo Germán-Castellani , Luís Béjar-Prado

Our aim was to summarize global prevalence rates of the burnout subscales emotional exhaustion (EE) and depersonalization (DP) among general surgeons, as well as potential contributing factors. A systematic literature search was performed to identify studies reporting EE and DP prevalence and associated potential stressors. Heterogeneity was assessed by I² statistic and tau² statistic. We also performed subgroup analysis, meta-regression analysis and funnel plot asymmetry tests. A total of 21 cross-sectional studies were included in this meta-analysis, totaling 3325 subjects. Analysis of EE and DP indicated burnout in 43% and 41% of general surgeons, respectively. The moderators used in the meta-regression analysis did not account for significant heterogeneity. The Egger and Peters tests did not detect publication bias due to small studies. The prevalences of EE and DP in general surgeons are very high, and further studies are needed to clarify the discrepancies observed in certain results.

我们的目的是总结普外科医生中情绪耗竭（EE）和人格解体（DP）的全球流行率，以及潜在的影响因素。进行了系统的文献检索，以确定报告情感表达和DP患病率以及相关潜在压力源的研究。采用I2统计量和tau2统计量评价异质性。我们还进行了亚组分析、meta回归分析和漏斗图不对称检验。本荟萃分析共纳入21项横断面研究，共计3325名受试者。普通外科医生的EE和DP分别有43%和41%的人出现过劳。meta回归分析中使用的调节因子没有考虑到显著的异质性。Egger和Peters检验没有发现由于小型研究而导致的发表偏倚。普通外科医生的EE和DP患病率非常高，需要进一步的研究来澄清某些结果中观察到的差异。

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引用次数: 0

Patient with hereditary syndrome, pheochromocytoma and paraganglioma type I 患者有遗传综合征，嗜铬细胞瘤和I型副神经节瘤。

Cirugia espanola

Pub Date : 2025-10-01 DOI: 10.1016/j.cireng.2025.800190

Luisa Paola Garzón Hernández, Rosa Martí Fernández, Maria Lapeña Rodríguez, Norberto Cassinello Fernández

引用次数: 0

Conditioning of the abdominal wall with progressive pneumoperitoneum in hernias with loss of domain. A consensus proposal 腹壁的调节与进行性气腹疝丧失领域。协商一致的建议。

Cirugia espanola

Pub Date : 2025-10-01 DOI: 10.1016/j.cireng.2025.800212

Salvador Pous-Serrano , Jose Bueno-Lledó , Jesús Martínez-Hoed , Omar Carreño-Sáenz , Providencia García-Pastor , Santiago Bonafé-Diana , Belén Porrero Guerrero , Guillermo Lillo-Albert , Member of the AEC Abdominal Wall Division

The performance of progressive pneumoperitoneum in hernias with loss of domain is a common practice in surgical units with a special focus on abdominal wall surgery. The main objective of this article is to describe a consensus proposal on the utility of the procedure, its indications, contraindications, the description of the different catheter placement techniques for insufflation, the recommendation of insufflation protocols, and the potential complications arising from the procedure. Additionally, an informed consent proposal endorsed by the Abdominal Wall Group of the Spanish Association of Surgeons (AEC) is included.

进行性气腹在疝失去领域的表现是一种常见的做法，在外科单位特别关注腹壁手术。本文的主要目的是描述关于该手术的用途，其适应症，禁忌症，不同导管置入技术的描述，充气方案的推荐，以及该手术引起的潜在并发症的共识建议。此外，西班牙外科医生协会腹壁小组（AEC）批准的知情同意建议也包括在内。

引用次数: 0

Impact of an abdominal wall surgery specialist on incisional hernia outcomes: A registry-based analysis 腹壁外科专家对切口疝结果的影响：一项基于登记的分析。

Cirugia espanola

Pub Date : 2025-10-01 DOI: 10.1016/j.cireng.2025.800211

Manuel López-Cano , Carles Olona Casas , Pilar Hernández-Granados , José A. Pereira Rodriguez , on behalf of the EVEREG group

Introduction

General surgery is undergoing progressive super-specialization with conditions previously managed by general surgeons now being treated by super-specialists (SS). No universal criteria currently exist to define abdominal wall surgery super-specialization (AWS-SS), and the designation remains a self-reported classification. The aim of our paper is to evaluate the outcomes of incisional hernia (IH) procedures in the context of super-specialization or not, focusing on complications and recurrence rates.

Methods

All patients who underwent elective and emergency IH repair with mesh between 2017 and 2022 were included in the Spanish IH registry (EVEREG database). At the time of data inclusion, surgeons self-identified as either super-specialists or not (SS vs NSS), using no predefined criteria. Patients were divided into 2 groups: those performed by SS or NSS. Using a 1:1 matched analysis, differences in the incidence of complications and recurrence rates within 30 days, 6 months, one year, or 2 years of follow up were compared.

Results

A total of 6231 IH procedures were analyzed, 3441 (55.2%) of which were recorded as having been performed in the presence of a super-specialist. After matching, 4680 IH procedures were included in the final analysis. IH repairs performed in the presence of a super-specialist were associated with a lower incidence of surgical site occurrences (SSO), reduced recurrence rates within the first 2 years of follow-up, and lower rates of bulging and overall complications.

Conclusions

Involvement of a super-specialist in the repair of an IH can be associated with lower complication rates and reduced recurrence.

简介：普外科正在经历逐步的超级专业化，以前由普通外科医生管理的疾病现在由超级专家（SS）治疗。目前还没有统一的标准来定义腹壁手术超专业化（AWS-SS），其名称仍然是自我报告的分类。本文的目的是评估切口疝（IH）手术在超专业化或非超专业化背景下的结果，重点关注并发症和复发率。方法：2017年至2022年期间所有接受选择性和紧急补片IH修复的患者均纳入西班牙IH登记处（EVEREG数据库）。在纳入数据时，外科医生自我认定为超级专家或非超级专家（SS vs NSS），没有使用预定义的标准。患者分为两组：SS组和NSS组。采用1:1匹配分析，比较随访30天、6个月、1年、2年并发症发生率和复发率的差异。结果：共分析了6231例IH手术，其中3441例（55.2%）记录为在超级专家在场的情况下进行的。匹配后，4680例IH程序被纳入最终分析。在超级专家在场的情况下进行IH修复与较低的手术部位发生率（SSO）、较低的前2年随访复发率、较低的肿胀率和整体并发症发生率相关。结论：超级专家参与IH修复可以降低并发症发生率和减少复发率。

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引用次数: 0

Intestinal obstruction secondary to uterine broad ligament hernia 子宫宽韧带疝继发肠梗阻。

Cirugia espanola

Pub Date : 2025-09-01 DOI: 10.1016/j.cireng.2025.800154

Lucas Rodríguez-Carreño Díaz, Luis Cadaval Moreno, Ismael Mora-Guzmán

引用次数: 0

Esophageal advancement jejunoplasty (JAE) in the treatment of cervical esophageal strictures 食管前移空肠成形术治疗颈段食管狭窄。

Cirugia espanola

Pub Date : 2025-09-01 DOI: 10.1016/j.cireng.2025.800195

Leandre Farran Teixidó , Mònica Miró Martín , Anna López Ojeda , Cristóbal Cañete Cabanillas , Fernando Estremiana García , Oriol Bermejo Segu , Humberto Aranda Danso , Joan Gornals Soler

Introduction

Cervical esophageal stenosis is a complex surgical problem when endoscopic treatment fails. The distance between the stenosis and the dental arch (AD) determines the need for a longer flap, with an increased risk of ischemia.

Our group proposed the use of an esophageal advancement jejunoplasty (JAE) in patients with esophageal stenosis less than 17 cm from the AD to “lengthen” the residual esophagus and, in a second stage, complete the reconstruction of digestive transit with a gastroplasty or coloplasty.

Material and method

Descriptive and retrospective analysis of a prospective database of patients who had esophageal stenosis less than 17 cm from the dental arch (DA), who were indicated a JAE between November 2020 and May 2024.

Results

A total of 16 patients with a mean age of 52 years were included. In 13 cases the stenosi was secundary to càustics and 3 to radiotherapy; the mean distance between AD and stenosis was 14 cm. Five cases were reoperated and two esophageal-jejunal fistulas were diagnosed. There was no mortality.

The second stage of reconstruction was completed in 10 patients (5 gastroplasties and 5 coloplasties). Two jejuno-ileal stenosis and one esophageal-jejunal stenosis were diagnosed. Functionally, 5 patients are exclusively nourished orally, 2 through a mixed diet and 3 exclusively enterally.

Conclusion

We believe that JAE can be a technically feasible option, with acceptable morbidity, in patients with upper esophageal stenosis to minimize the risk of ischemia that involves a longer flap.

颈椎食管狭窄是一个复杂的手术问题，当内镜治疗失败。狭窄和牙弓（AD）之间的距离决定了需要更长的皮瓣，增加了缺血的风险。本组建议对食管狭窄距AD小于17厘米的患者采用食管前移空肠成形术（JAE）“延长”残留食管，并在第二阶段通过胃成形术或结肠成形术完成消化通道的重建。材料和方法：对2020年11月至2024年5月期间食管狭窄距离牙弓（DA）小于17厘米的患者的前瞻性数据库进行描述性和回顾性分析。结果：共纳入16例患者，平均年龄52岁。13例继发于càustics， 3例继发于放疗；AD与狭窄的平均距离为14 cm。5例再次手术，诊断为2例食管空肠瘘。没有死亡。10例患者完成第二期重建（5例胃成形术，5例结肠成形术）。2例为空肠-回肠狭窄，1例为食管-空肠狭窄。功能上，5例患者完全口服营养，2例通过混合饮食，3例完全肠内营养。结论：我们相信，对于上食管狭窄患者，JAE是一种技术上可行的选择，并且具有可接受的发病率，可以最大限度地减少涉及较长皮瓣的缺血风险。

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