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Evaluation of textbook outcome in liver transplantation 肝移植临床疗效评价。
Pub Date : 2025-12-01 DOI: 10.1016/j.cireng.2025.800255
Esther Brea Gómez , Pablo Dabán López , Ana Belén Vico Arias , Antonio Palomeque Jiménez , Natalia Zambudio Carroll , María Trinidad Villegas Herrera , Jesús María Villar del Moral , Mario Serradilla Martín

Introduction

The textbook outcome (TO) is a qualitative measurement tool for surgical procedures that has been tested in a multitude of cases. Liver transplantation (LT) is one of the most complex interventions in our specialty. In this study, we evaluate the achievement of TO in patients undergoing LT. We also propose a definition of specific TO for LT surgery.

Materials and methods

A single-centre retrospective study was conducted between May 2012 and December 2022. Patients whose data were incomplete in the database, patients with retransplantation, transplants for acute liver failure, intraoperative findings of portal vein thrombosis, and patients who received a donor graft after circulatory death were excluded. TO was defined as the absence of mortality and major complications in the first 90 days after surgery, absence of readmission in the first 30 days, and a hospital stay not prolonged > p75.

Results

A total of 132 patients were included. More than half achieved TO (56.8%). Prolonged hospital stay was the variable that most limited the achievement of TO (25% of patients). Pre-transplant hypertension in the recipient and prolonged cold ischaemia time were associated with a lower rate of TO. Survival was higher in the group that achieved TO, although statistical significance could not be demonstrated.

Conclusions

TO is a valuable measure for assessing LT. A universal definition of TO for LT will be necessary given the lack of consensus on the criteria used among the different series published to date.
简介:教科书结果(TO)是一种定性测量工具,用于外科手术,已在众多病例中进行了测试。肝移植(LT)是我们专业中最复杂的干预之一。在本研究中,我们评估了肝移植患者的TO成就。我们还提出了肝移植手术特异性TO的定义。材料和方法:2012年5月至2022年12月进行单中心回顾性研究。排除了数据库中数据不完整的患者、再移植患者、因急性肝衰竭而进行移植的患者、术中发现门静脉血栓形成的患者以及在循环性死亡后接受供体移植的患者。TO的定义是术后90天内无死亡和主要并发症,30天内无再入院,住院时间不延长[p] 75。结果:共纳入132例患者。超过一半的人达到了TO(56.8%)。延长住院时间是最限制TO实现的变量(25%的患者)。移植前受者的高血压和延长的冷缺血时间与较低的TO率相关。虽然无法证明统计学意义,但达到TO的组生存率更高。结论:TO是评估LT的一项有价值的措施。鉴于迄今为止发表的不同系列中使用的标准缺乏共识,有必要对LT的TO进行普遍定义。
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引用次数: 0
Comparison of weight loss and metabolic syndrome parameters between sleeve gastrectomy and Roux-en-Y gastric bypass: A propensity score analysis 袖式胃切除术和Roux-en-Y胃旁路术的体重减轻和代谢综合征参数比较:倾向评分分析。
Pub Date : 2025-12-01 DOI: 10.1016/j.cireng.2025.800226
María Asunción Acosta-Mérida , Raquel Bañolas-Suárez , Julia Díaz-Dávila , Pedro Saavedra-Santana , Joaquín Marchena-Gómez

Introduction

Although laparoscopic sleeve gastrectomy (LSG) has positioned itself as the leading bariatric technique worldwide, surpassing laparoscopic Roux-en-Y gastric bypass (LRYGB), its possible inferiority in terms of weight and metabolic results remains controversial. The of this study was to compare the response of both techniques in terms of weight loss and obesity-related metabolic complications.

Methods

We conducted a retrospective study of all patients who had undergone LSG and LRYGB in our center from 2013 to 2022. Patient characteristics, postoperative complications, postoperative weight loss and evolution of comorbidities were recorded. Propensity score matching (1:1) was performed to homogenize the 2 intervention groups for body mass index (BMI) and preoperative metabolic syndrome.

Results

Out of the 354 patients who met the selection criteria, 309 patients were ultimately included in the study (172 LSG and 137 LRYGB); mean age was 45.8 ± 9.5 years; 205 were women (66.3%). Median BMI was 47 (interquartile range = 42.8–52.9). After propensity score matching, 118 patients remained in each group. BMI trajectories during the first 3 years of follow-up after the 2 types of surgery showed no significant differences (P = .693). One month after treatment, there were also no differences in postoperative metabolic syndrome parameters or complication rates (P = .866).

Conclusions

Our data suggest that sleeve gastrectomy provides a similar weight and metabolic response to Roux-en-Y gastric bypass in patients with similar BMI and metabolic syndrome characteristics.
导论:尽管腹腔镜袖胃切除术(LSG)已经超越腹腔镜Roux-en-Y胃旁路手术(LRYGB),成为全球领先的减肥技术,但其在体重和代谢结果方面可能存在的劣势仍然存在争议。本研究的目的是比较两种技术在减肥和肥胖相关代谢并发症方面的反应。方法:对2013年至2022年在我中心接受LSG和LRYGB治疗的所有患者进行回顾性研究。记录患者特征、术后并发症、术后体重减轻和合并症的演变情况。采用倾向评分匹配(1:1)对体重指数(BMI)和术前代谢综合征进行均一化。结果:在符合选择标准的354例患者中,309例患者最终被纳入研究(172例LSG和137例LRYGB);平均年龄45.8±9.5岁;205例为女性(66.3%)。BMI中位数为47(四分位数范围为42.8 - 52.9)。倾向评分匹配后,每组保留118例患者。两种手术后3年随访的BMI轨迹差异无统计学意义(P = .693)。治疗1个月后,两组患者的术后代谢综合征参数及并发症发生率也无差异(P = .866)。结论:我们的数据表明,在BMI和代谢综合征特征相似的患者中,套筒胃切除术提供了与Roux-en-Y胃旁路术相似的体重和代谢反应。
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引用次数: 0
Assessing improvements in quality using textbook outcomes in colorectal surgery: A systematic review 使用教科书结果评估结直肠手术质量的改善:一项系统综述。
Pub Date : 2025-12-01 DOI: 10.1016/j.cireng.2025.800223
Luis Hurtado-Pardo, Zutoia Balciscueta Coltell, Janine Tabet Almeida, Mº Carmen Martin Diéguez, Manuel López Bañeres, Natalia Uribe Quintana
Textbook outcome is a composite measure of several clinically important perioperative outcomes that are included in the definition of ideal surgical care. The aim of this study is to summarize the different definitions concerning textbook outcome in colorectal surgery. A systematic review of the literature according to PRISMA guidelines was carried out until April 2025. Primary studies on adult patients undergoing colon or rectal resection and assessing the textbook outcomes of the procedure were included. Twenty-one studies were included for review. Textbook outcomes achieved varied from 41.8% to 80.8%. The most prevalent variables were “no mortality” and “length of stay” (85.7%). The variable that contributed mostly to not meeting the definition of textbook outcome was “no complications” (42.9%), with 6 possible definitions. As a result of the variability described, a consensus is to be reached in order to validate the extension of this tool. The proposed definition for textbook outcomes in colorectal surgery would be the following: no complications (>III Clavien-Dindo), length of stay (<75th percentile), no readmissions (<30 days), no mortality (<30 days), and oncological surgery (R0 resection and >12 lymph nodes).
教科书结果是几种临床重要围手术期结果的综合测量,包括在理想手术护理的定义中。本研究的目的是总结关于结直肠手术的不同定义。根据PRISMA指南对文献进行了系统的审查,直到2025年4月。包括对接受结肠或直肠切除术的成年患者的初步研究,并评估该手术的教科书结果。21项研究被纳入审查。教科书完成率从41.8%到80.8%不等。最常见的变量是“无死亡率”和“住院时间”(85.7%)。导致不符合教科书结果定义的变量主要是“无并发症”(42.9%),有6种可能的定义。由于所描述的可变性,为了验证该工具的扩展,需要达成共识。建议的结直肠手术预后的教科书定义如下:无并发症(>III Clavien-Dindo),住院时间(百分位数),无再入院(12个淋巴结)。
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引用次数: 0
Does obtaining textbook outcome influence the survival rates of patients undergoing surgery for hepatocellular carcinoma? 获得教科书结局是否会影响肝细胞癌手术患者的生存率?
Pub Date : 2025-12-01 DOI: 10.1016/j.cireng.2025.800239
Jose M. Ramia , A Paredes , Cándido Alcazar , Silvia Carbonell-Morote , Paola Melgar , Celia Villodre
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引用次数: 0
Generational change in liver transplantation: Challenges and opportunities following a national survey 肝移植的代际变化:一项全国调查的挑战和机遇。
Pub Date : 2025-12-01 DOI: 10.1016/j.cireng.2025.800238
Víctor López-López , Cándido Alcázar , Ricardo Robles Campos , Jose Manuel Ramia , Pablo Ramírez
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引用次数: 0
Human factors in surgical practice: A national study 外科实践中的人为因素:一项全国性研究。
Pub Date : 2025-12-01 DOI: 10.1016/j.cireng.2025.800257
Mireia Verdaguer-Tremolosa, Víctor Rodrigues-Gonçalves, Pilar Martínez-López, Manuel López-Cano

Introduction

In the surgical setting, stress, burnout and non-technical skills are increasingly recognized as factors influencing quality of care, workplace well-being and economic costs. However, these issues have been scarcely studied among general and digestive surgery in Spain. This study aims to assess burnout, stress and non-cognitive aspects in this specific professional group in Spain.

Methods

A 28-item survey was designed to evaluate different dimensions of burnout and non-cognitive factors. Participation was voluntary and it was distributed through the Spanish association of surgeons (Asociación Española de Cirugía).

Results

A total of 325 surgeons completed the survey. Women accounted for 57.5% of respondents and 95.1% worked in public hospitals. Up to 21.8% habitually experienced anxiety in daily situations, and 63% indicated a lack of training in these areas. Moreover, 22.8% acknowledged seeking professional assistance for related issues occasionally or frequently. Nearly 48% reported regularly exceeding their standard working hours, 69% experienced difficulties in achieving work-life balance, and a marked perception of insufficient institutional support was noted. These issues were significantly more prevalent among women and younger surgeons.

Conclusions

The prevalence of anxiety, burnout, work-life balance difficulties and perceived lack of institutional support is high among general and digestive surgeons. These findings underscore the need to develop targeted strategies addressing these factors within the specialty.
导论:在外科环境中,压力、倦怠和非技术技能越来越被认为是影响护理质量、工作场所幸福感和经济成本的因素。然而,这些问题在西班牙的普通外科和消化外科中几乎没有研究。本研究旨在评估倦怠,压力和非认知方面在这一特定的专业群体在西班牙。方法:设计28项问卷调查,对倦怠的不同维度及非认知因素进行评估。参与是自愿的,并通过西班牙外科医生协会(Asociación Española de Cirugía)分发。结果:共325名外科医生完成调查。女性占应答者的57.5%,95.1%在公立医院工作。高达21.8%的人在日常生活中习惯性地感到焦虑,63%的人表示缺乏这些方面的培训。此外,22.8%的人承认偶尔或经常为相关问题寻求专业帮助。近48%的人报告说他们经常超过标准工作时间,69%的人在实现工作与生活的平衡方面遇到困难,并且注意到明显感觉到机构支持不足。这些问题在女性和年轻外科医生中更为普遍。结论:焦虑、倦怠、工作与生活平衡困难和缺乏机构支持的患病率在普通外科医生和消化外科医生中较高。这些发现强调了在专业范围内制定有针对性的策略解决这些因素的必要性。
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引用次数: 0
Administrative harm in clinical practice: Beyond the bureaucracy 临床实践中的行政危害:超越官僚主义。
Pub Date : 2025-12-01 DOI: 10.1016/j.cireng.2025.800232
Manuel López Cano , Josep M. García-Alamino
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引用次数: 0
The TROPIS technique for complex anal fistula: A promising but still evolving approach. 复杂肛瘘的TROPIS技术:一个有前途但仍在发展的方法。
Pub Date : 2025-11-22 DOI: 10.1016/j.cireng.2025.800261
V D Yagnik, P R Choudhary
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引用次数: 0
Sleeve gastrectomy with transit bipartition and Roux-en-Y reconstruction: Step-by-step surgical technique. 套筒胃切除术与中转双隔和Roux-en-Y重建:一步一步的手术技术。
Pub Date : 2025-11-13 DOI: 10.1016/j.cireng.2025.800260
Sergi Sanchez-Cordero, Ruth Lopez-Gonzalez, Rodrigo Hermoza, Jordi Pujol-Gebellí
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引用次数: 0
Consensus document for the transcystic approach to choledocholithiasis with ultrathin flexible choledochoscope. 超薄柔性胆道镜经囊入路治疗胆总管结石的共识文献。
Pub Date : 2025-11-13 DOI: 10.1016/j.cireng.2025.800259
Alejandra García-Botella, Juan Pablo Arjona Trujillo, Sofía de la Serna, Pedro José Gil Vázquez, Santos Jiménez-Galanes Marchán, Erik Llàcer-Millán, Ana Belén Martín Arnau, David Martínez-Cecilia, Alba Zárate Pinedo, Alberto Martínez-Isla

The transcystic laparoscopic approach to manage choledocholithiasis using ultrathin flexible choledochoscopes is aimed at reducing complications linked to ERCP and transductal techniques when treating common bile duct stones with gallbladder in situ. Despite their advantages, transcystic techniques are not being widely adopted, highlighting the need for structured protocols, a multidisciplinary approach, and adequate resource allocation to optimize outcomes. This consensus document addresses key issues to standardize the approach, based on the responses to the 25 questions posed to the panel of experts. The recommendations issued, based on the evidence and expert opinion, cover the key factors for the success of the technique, including appropriate patient selection, technical characteristics of the approach, advanced equipment required, etc. This comprehensive guide aims to standardize the technique in order to improve patient outcomes and ensure safe, effective treatment of choledocholithiasis.

采用超薄柔性胆道镜经囊腹腔镜治疗胆总管结石的目的是在原位治疗胆总管结石时减少与ERCP和转导技术相关的并发症。尽管有其优势,但经囊技术并没有被广泛采用,这突出表明需要结构化的协议、多学科的方法和充分的资源分配来优化结果。这份共识文件基于对向专家小组提出的25个问题的回答,解决了标准化方法的关键问题。根据证据和专家意见提出的建议涵盖了该技术成功的关键因素,包括适当的患者选择、方法的技术特征、所需的先进设备等。本综合指南旨在规范该技术,以改善患者预后,确保胆总管结石的安全有效治疗。
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引用次数: 0
期刊
Cirugia espanola
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