Pub Date : 2025-12-01DOI: 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.
{"title":"Evaluation of textbook outcome in liver transplantation","authors":"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","doi":"10.1016/j.cireng.2025.800255","DOIUrl":"10.1016/j.cireng.2025.800255","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Materials and methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 12","pages":"Article 800255"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 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.
{"title":"Comparison of weight loss and metabolic syndrome parameters between sleeve gastrectomy and Roux-en-Y gastric bypass: A propensity score analysis","authors":"María Asunción Acosta-Mérida , Raquel Bañolas-Suárez , Julia Díaz-Dávila , Pedro Saavedra-Santana , Joaquín Marchena-Gómez","doi":"10.1016/j.cireng.2025.800226","DOIUrl":"10.1016/j.cireng.2025.800226","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> = .693). One month after treatment, there were also no differences in postoperative metabolic syndrome parameters or complication rates (<em>P</em> = .866).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 12","pages":"Article 800226"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 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).
{"title":"Assessing improvements in quality using textbook outcomes in colorectal surgery: A systematic review","authors":"Luis Hurtado-Pardo, Zutoia Balciscueta Coltell, Janine Tabet Almeida, Mº Carmen Martin Diéguez, Manuel López Bañeres, Natalia Uribe Quintana","doi":"10.1016/j.cireng.2025.800223","DOIUrl":"10.1016/j.cireng.2025.800223","url":null,"abstract":"<div><div>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).</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 12","pages":"Article 800223"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.cireng.2025.800238
Víctor López-López , Cándido Alcázar , Ricardo Robles Campos , Jose Manuel Ramia , Pablo Ramírez
{"title":"Generational change in liver transplantation: Challenges and opportunities following a national survey","authors":"Víctor López-López , Cándido Alcázar , Ricardo Robles Campos , Jose Manuel Ramia , Pablo Ramírez","doi":"10.1016/j.cireng.2025.800238","DOIUrl":"10.1016/j.cireng.2025.800238","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 12","pages":"Article 800238"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145427247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 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。
{"title":"Human factors in surgical practice: A national study","authors":"Mireia Verdaguer-Tremolosa, Víctor Rodrigues-Gonçalves, Pilar Martínez-López, Manuel López-Cano","doi":"10.1016/j.cireng.2025.800257","DOIUrl":"10.1016/j.cireng.2025.800257","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 12","pages":"Article 800257"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-22DOI: 10.1016/j.cireng.2025.800261
V D Yagnik, P R Choudhary
{"title":"The TROPIS technique for complex anal fistula: A promising but still evolving approach.","authors":"V D Yagnik, P R Choudhary","doi":"10.1016/j.cireng.2025.800261","DOIUrl":"10.1016/j.cireng.2025.800261","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":" ","pages":"800261"},"PeriodicalIF":0.0,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145598234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-13DOI: 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.
{"title":"Consensus document for the transcystic approach to choledocholithiasis with ultrathin flexible choledochoscope.","authors":"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","doi":"10.1016/j.cireng.2025.800259","DOIUrl":"10.1016/j.cireng.2025.800259","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":" ","pages":"800259"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145531052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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