bluuebunny/crossref_metadata_2025 huggingface dataset:
EFFECT OF EMPIRICAL ANTIBIOTIC THERAPY ON THE CLINICAL OUTCOME OF ACUTE CALCULOUS CHOLECYSTITIS
Authors: de Miguel Palacio M , González Castillo A M , Membrilla Fernández E , Pons Fragero M J , Grande Posa l , Pera Román M , Sancho Insenser J J
Published: May 2021

INTRODUCTION

Acute calculous cholecystitis (ACC) is the second surgical cause of emergency consultation in the Western world. According to the Tokyo International Guidelines 2018 (TIG18), the treatment of choice is laparoscopic cholecystectomy in patients with mild or moderate cholecystitis. However, in severe cases there is a great variability of therapeutic options. We analyzed the adequacy of antibiotic therapy by studying intraoperative cultures (bile and peritoneal fluid) and preoperative blood cultures, to identify the effect of this antibiotic therapy on complication and mortality rates.

MATERIAL AND METHODS

A retrospective unicentric study on a prospective database of 725 ACCs between 2012 and 2016. More than 200 general, clinical, postoperative and microbiological variables are collected, including the antibiogram of the isolated germs in order to determine the adequacy of each administered antibiotic.

RESULTS

Cultures were performed in 76.1% of the cases, with a greater tendency to cultivate in older patients, men or with greater severity according to TIG18 (p < 0.001). Cultured patients had a higher rate of postoperative complications (p = 0.001). Patients who received adequate empirical antibiotic therapy had a lower rate of complications (50% vs 64%;p=0.037) and lower mortality (2.8% vs 11.8%;p=0.003) compared to patients with resistant germs to the antibiotic therapy given, especially important in severe ACC (3.7% vs 15.7%;p=0.022).

CONCLUSIONS

Adequate empirical antibiotic therapy is associated with fewer complications, as well as a lower mortality rate, especially in severe ACCs. Patients with severe ACC will probably require empirical broad-spectrum antibiotic coverage.
IMPACT OF COVID-19 ON PEDIATRIC SURGERY
Authors: Núñez García B , Álvarez García N , Jiménez Gómez J , Betancourth Alvarenga J E , Esteva Miró C , Santiago Martínez S , Jiménez Arribas P , Güizzo J R
Published: May 2021

INTRODUCTION

The pandemic caused by the SARS-CoV-2 virus has led to an unprecedented situation, with population lockdowns, congestion of healthcare resources, cancellation of scheduled surgical activity, fear of contagion, and delays in patient care. The objective of this study was to analyze its impact on pediatric surgical activity at a reference healthcare facility.

MATERIAL AND METHODS

A comparative study of activity in the pediatric surgery environment at a Spanish reference healthcare facility was carried out. It included outpatient consultations, scheduled surgeries, and activity at the emergency department during the lockdown period in Spain (March-May 2020) vs. the same 2019 period. Number of consultations and surgeries, type of surgery performed and/or cancelled, and stage of the pathologies treated were collected.

RESULTS

A 98% decrease in scheduled surgeries, an 84% decrease in healthcare burden from the pediatric emergency department, a 55.24% decrease in urgent surgeries, an 82% decrease in outpatient activity at external consultations, and a 94% decrease in inter-hospital referrals, along with a 66% increase in urgent pathology severity, were found.

CONCLUSIONS

The COVID-19 pandemic cancelled virtually all pediatric surgery activity, which caused treatment delays in severe pathologies and increased morbidity in regular urgent procedures.
RESULTS OF THE IMPLEMENTATION OF A MULTIMODAL REHABILITATION SYSTEM IN ELECTIVE COLORECTAL SURGERY IN OUR CENTER
Authors: Pérez Prudencio E , Arango Bravo A , Rodríguez Morala A , Álvarez Rodríguez M , Fresnedo Pérez R M , Carrocera Cabal A C , Fernández Fernández J C , Albaladejo Magdalena J
Published: May 2021

INTRODUCTION

The results obtained from the establishment of a multimodal rehabilitation program in elective colorectal surgery by a multidisciplinary team at our center are presented. Protocols are carried out to achieve optimization of perioperative care and the analysis of the rates of complications and morbidity and mortality.

MATERIAL AND METHODS

Through a retrospective study, a control group of patients who underwent elective colorectal surgery prior to the implantation of the rehabilitation program, included during a period from May and October 2018, with a total of 68 patients, were compared with the group of optimized patients, who were operated between December 2018 and June 2019, with a total of 80 patients.

RESULTS

The readmission rate 30 days after discharge between the two groups is analyzed, showing a decrease in the multimodal rehabilitation group, with a readmission rate of 5.9%, compared to the control group, which was 8.8%. A decrease was observed in both surgical complications (35.3%) and medical complications (22.1%) in the multimodal rehabilitation group compared to the control group. A decrease in the mortality rate is observed in the multimodal rehabilitation group, being 1.5% with respect to the control group, which was 2.9%.

CONCLUSIONS

The multimodal rehabilitation system is a feasible and safe method that requires the implementation of protocols that must be carried out by a multidisciplinary team, and that presents satisfactory results with improved morbidity and mortality.
ENHANCERS OF LIVER REGENERATION IN ONCOLOGICAL SURGERY
Authors: Osorio Capitan M , Rose S , Novo Sukia I , Herrero de la Parte B , Ruiz Montesinos I , Garcia-Alonso I
Published: May 2021

INTRODUCTION

Chemotherapy hinders liver function and probably its regenerating capacity, forcing to delay it after surgery. Our objective has been to verify this effect in an experimental model and to see if a hepatotrophic agent can prevent it.

MATERIAL AND METHODS

Four groups of 6 WAG/RijHsd rats (males, 3-4 months) were submitted to ligation of the portal branch to the left lateral and left paramedian lobes. They were sacrificed 36 h later to quantify the percentage of liver corresponding to the ligated lobes (weight), the number of hepatocyte’s nuclei (nº/100 µm2) and their mean size (µm2). One group received no treatment (control); another folic acid (2.5 mg/kg ip, during surgery); other 5-Fluorouracil (5-FU 50 mg/kg ip 48 h before); and the fourth received folic&5-FU.

RESULTS

The animals treated with folic acid showed a greater number of hepatocyte’s nuclei (24.4 ± 2.77 vs 15.2 ± 1.51) and their mean size was also greater (121 ± 2.34 vs 111 ± 1.8). However, the reduction in weight of the ligated parenchyma was less than in control group (33.4 ± 1.08 vs 29.5 ± 1.08). 5-FU did not modify the number of nuclei (15.6 ± 18.4), although they were smaller in size (104 ± 1.7). The addition of folic acid to 5-FU increased the number of nuclei (21.7 ± 2.8) and normalized their size (111 ± 3.2).

CONCLUSIONS

5-FU exerts a depressant effect on livers regeneration, and folic acid overcomes it. Thus, folic acid could allow early application of chemotherapy without affecting liver regeneration.
DEVELOPMENT OF HUMAN DERIVED ACELLULAR DERMAL MATRIX: NOVEL TECHNIQUE IN PANDEMIC TIMES
Authors: Salinas Rámila F , Robla Costales D , Junquera Gutiérrez L M , Pevida López M , Llames S , Martínez Magide G , Sánchez Nuño C , Martín Suárez L
Published: May 2021

INTRODUCTION

Tissue support is capital to achieve good results in reconstructive and aesthetic surgery. Radiotherapy, infection and trauma among others are frequent predictors of surgery failure as they decrease tissue healing capacity. Tissue mobilization is not always an eligible option as raising comorbidities in general population and elder patients are often seen in daily practice. Furthermore, the possibility of sequels in donor zones makes many surgeons be reluctant to use flaps, especially in aesthetic surgery. In aesthetic breast surgery, ADMs provide well known benefits such as reduced capsule contracture rate and improved inframammary fold in breast augmentation procedures

METHODS

A decellularization protocol is proposed by our group to obtain biocompatible ADMs from cadaveric donors. An experimental animal study is designed to assess the histocompatibility of the samples and the influence of the storage method. Biomechanical tests are also done to evaluate tissue performance after decellularization.

RESULTS

Histopathological studies showed no signs of acute nor chronic inflammatory response in experimental group. Normal fibroblasts growth without early apoptosis signs are seen in samples. Biomechanical properties ensure optimal load and tensile strength for most reconstructive procedures.

CONCLUSIONS

Current protocol proposed by our group include all steps from harvesting samples from cadaveric donors till matrix storage after decellularization process. The result is a high valued biomaterial in terms of biocompatibility and security profile available in pandemic times. Local production of this biomaterial leads to cost minimization derived from harvesting and manufacturing matrices in our center and avoid out-of-stock and storage issues.
THREE CASES OF BOWEL OBSTRUCTION BY BROAD LIGAMENT HERNIA
Authors: Soto Dopazo M , Pérez Prudencio E , Arango Bravo A , Nuño Iglesias C , Mateos Palacios C , Sosa Rodríguez M V , Fernández Fernández J C
Published: May 2021

INTRODUCTION

Internal hernias caused by broad ligament defects are an infrequent cause of bowel obstruction. These defects may be congenital or acquired mainly by gynecological antecedents. Small bowel is the most common affected and the diagnosis is difficult due to nonspecific symptoms and absences of characteristic radiological signs.

MATERIAL AND METHODS

We report the cases of three women aged from 43 to 56 years old, who came to the emergency with abdominal pain, vomiting and bloating of hours duration. One patient has a history of laparoscopic appendectomy, the rest of them with no surgical history. In all of the cases, x-rays showed dilatation of small bowel loops and air-fluid levels and the abdominal TC revealed a generalized distention of bowel loops with transition point in the terminal ileum with no identifiable cause compatible with small bowel obstruction.

RESULTS

We decided to perform an urgent surgery with an exploratory laparotomy in one case and the rest by laparoscopic approach, finding an internal hernia occasioned by incarceration of small bowel through a broad ligament defect. In all cases, the hernia content was liberated without evidence of ischemia with no need for intestinal resection, and the defect was closed. All patients had a favourable postoperative course without complications.

DISCUSSION

Broad ligament defects are a rare cause of internal hernias. These are difficult to diagnose clinically as well as radiologically for an absence of characteristic signs. A high level of clinical suspicion allows early diagnosis and the treatment should be performed as soon as possible to reduce the chances of intestinal necrosis.
RISK FACTORS ASSOCIATED WITH POOR PROGNOSIS IN PATIENTS WITH SECONDARY PERITONITIS ADMITTED TO THE INTENSIVE CARE UNIT (ICU)
Authors: Abella Álvarez A , López de la Oliva Calvo L , Enciso Calderón V , Conejo Márquez I , San Miguel Méndez C , Cruz Cidoncha A , García Manzanedo S , Gordo Vidal F
Published: May 2021

INTRODUCTION

Secondary peritonitis is still associated mortality higher than 20% and the risk factors associated with mortality are different and variable according to the different studies. The objective is to analyse clinical, analytical, surgical, microbiological and physiological factors associated with poor prognosis, within a cohort of ICU patients with the diagnosis of secondary peritonitis.

MATERIAL AND METHODS

Retrospective single-centre observational cohort study from January 2015 to June 2018. Patients included suffered secondary peritonitis due to hollow viscera perforation. Multivariate analysis with binary backward stepwise logistic regression was performed. Odds ratio of the predictor variables of ICU mortality and bad prognosis are shown.

RESULTS

130 patients were recruited. Median age of 65 years (55-74). 45% were women. SAPS 3 median of 53.5 (43 - 65), ICU median stay 7 days (4 - 12) and ICU hospital stay 14 days (8 - 21). Readmission rate of 6.2%. ICU mortality 5.4% and hospital mortality 9.2%. In the multivariate analysis, endocrine comorbidity showed an OR 3.611 (CI 95%: 1.217-10.715; p = 0.021), need for mechanical ventilation OR 12.275 (CI 95%: 1.974-76.327; p = 0.007), need for parenteral nutrition OR 5.747 (CI 95%: 1. 565-21,101; p = 0.008), faecal peritonitis OR 2,908 (CI 95%: 1,176- 7,192; p = 0.021), need for new surgery after peritonitis OR 79,746 (CI 95%: 6,718- 946,643; p = 0.001) and SOFA at day 1 above 7 OR 6,939 (CI 95%: 2,208-21,814; p = 0.001). Microbiological variables showed no correlation with bad prognosis.

CONCLUSIONS

Clinical, physiological and surgical characteristics showed a relationship with poor prognosis of patients with secondary peritonitis. Microbiological variables didńt.
3D PRINTING PREOPERATIVE PLANNING AND CUSTOMIZED SURGICAL GUIDES ASSOCIATED WITH O-ARM NAVIGATION SYSTEM FOR MULTIPLANAR OSTEOTOMY OF COMPLEX PELVIC DEFORMITY
Authors: Fernández Álvarez M , Garcés Zarzalejo C , Adeba García M , Pernia Gomez P , A. Martínez Agüeros J , Estellés Marcos de León L , Busta Vallina B
Published: May 2021

INTRODUCTION

3D printing technology is penetrating the healthcare field at an astonishing rate. The reduction of its costs, makes it more accessible to everyone.

MATERIAL AND METHODS

35-year-old woman who had functional limitation in her right hip due to pelvic ring fracture in her childhood. She had dysmetria of lower limbs and femoral anteversion of 40 degrees. Imaging tests showed vicious consolidation of the right hemipelvis associated with antero-medial displacement.

RESULTS

Preoperative, we performed her 3D printing pelvic ring model. Osteotomies were digital planned (iliac crest, superior pubic ramus, incomplete of inferior pubic ramus, and semicircular of posterior column) and also how many degrees we would need for rotation the osteotomized fragment. Posterior column osteotomy was the most difficult, so we designed 3D surgical printing cutting guide able to being inserted into the iliac fossa. We used it to introduced four Kirschnner wires that leads us as a guide to avoid the greater sciatic notch. O-arm navigation system helped us make sure to achieve more precision. 3D printing pelvic ring model was sterilized to pre-contouring osteosynthesis plates. After two years of follow-up, good functional results were observed, without gait claudication either limb dysmetria. Her range of motion is 105 degrees of hip flexion, 20 degrees of internal hip rotation and 40 degrees of external hip rotation. Complete radiological consolidation was observed.

CONCLUSION

Digital planning and 3D printing technology allows to improve three-dimensional compression of bone pathology leading to a higher likelihood of a predictable ideal outcome compared to conventional techniques.
PERIOPERATIVE MANAGEMENT AND OUTCOME OF HIP FRACTURES DURING THE COVID-19 PANDEMIC
Authors: Camblor Valladares A , Lanuza Lagunilla L , Suárez-Anta Rodríguez P J , Meneses Gutiérrez A , García Arias A , Cabria Fernández J , Riera Campillo M , Mateo Negreira J
Published: May 2021

INTRODUCTION

The pandemic caused by the SARS-Cov-2 coronavirus has generated unprecedented pressure on healthcare systems. Higher mortality rates have been reported in elderly patients. Those with a hip fracture are especially vulnerable.

MATERIAL AND METHODS

Retrospective study in which we analyzed the management and associated perioperative complications rate in patients aged over 65 years who attended a tertiary hospital in Spain with hip fracture during the COVID-19 first alarm status decree . We compared the results with a cohort of similar patients treated during the same period in 2019.

RESULTS

A total of 102 hip fractures were recorded in 2019, with a mean age of 85 years. 87.5% were treated surgically in our hospital, with mean waiting time of 4.6 days and mean stay of 11.3 days.

In 2020, 107 hip fractures were recorded, with a mean age of 86 years. A total of 74.6% underwent surgery in our center, with a mean waiting time of 2.8 days and a mean hospital stay of 10.9 days. The rate of major complications and exitus was 8.9% and 6.7% respectively in 2019, and 9.4% and 7.8% in 2020.

CONCLUSIONS

The number of hip fractures increased despite the declaration of the state of alarm in comparison with the decrease in the rest of the trauma emergencies. During this period the mean waiting time for surgery was shorter. There was no relevant variation in the demographic characteristics of the patients, nor in the rate of complications and reported exitus.
IMPACT OF COVID-19 ON SURGICAL ACTIVITY OF AN ORTHOPAEDIC SURGERY AND TRAUMATOLOGY SERVICE IN A SECONDARY HOSPITAL
Authors: García Arias A , Lanuza Lagunilla L , García Cuello L , Suárez-Anta Rodríguez P , Camblor Valladares A , Meneses Gutiérrez A , Cabria Fernández J , Mateo Negreira J
Published: May 2021

INTRODUCTION

COVID-19 has changed the behavior of health care in the world, and consequently, it has affected surgical activity. Related to orthopedic surgery and traumatology, a decrease of up to a third has been observed according to published series. But a secondary center may need more adjustments than a first level one.

MATERIAL AND METHODS

Retrospective study, comparing data from the first Sate of Alarm (03/14/20 – 06/21/20) with the same period of 2019. The number of surgeries, hospitalizations and diagnoses were selected as primary outcomes, and injury mechanisms, kind of surgeries and differences in time to surgery as secondary outcomes.

RESULTS

Surgical activity went from 462 cases in 2019 to 190 cases in 2020 (59% less). The main reason for intervention during the State of Alarm was fractures, with 129 cases out of the total (compared to 167 in 2019); being orthopedics in 2019 (178 cases compared to 40).The most frequent fracture in both groups was the hip fracture, with 71 cases in 2019 compared to 59 in 2020.Accidents on public places, associated with sports practice and related to traffic, were reduced by 1/3.

CONCLUSIONS

A more striking reduction in surgical activity is observed than that reflected in other series, probably due to the case of programmed surgery. Perhaps in centers with greater capacity this measure is not that necessary. In the same circumstances, up to 50% of the ORTR staff could be used to treat other pathologies safely.
PROFILATIC TREATMENT WITH FOLIC ACID FOR LOWER LIMB ISCHAEMIA-REPERFUSION INJURY IN AGED RATS
Authors: Roa Esparza J , Rodeño Casado M , Cearra Guezuraga I , Iturrizaga S , Mar Medina C , García-Alonso I , Herrero de la Parte B
Published: May 2021

INTRODUCTION

Lower limb ischemia-reperfusion injury (IRI-LL) is a common major complication in orthopaedic surgery, especially in elderly patients. We previously demonstrated that folic acid reduced IRI-LL damage in 3–4-month-old rats. Current work analyses the effect of folic acid in the prevention of IRI-LL in elderly animals.

MATERIAL AND METHODS

Thirty-six 12-month-old male WAG/RijHsd rats were subjected to 3 hours of ischaemia. Eighteen animals received folic acid (2.5 mg/kg, ip) 20 minutes before the end of ischaemia period; the other half received the same volume of saline. Animals were sacrificed after 3 hours, 24 hours, and 14 days of reperfusion for biochemical (tissue damage markers and electrolytes), histopathological studies of gastrocnemius muscle, and daily assessment of limb function by Rotarod test, respectively.

RESULTS

The administration of folic acid prior to the end of ischaemia period reduced by 30-40% the increase in LDH and CK observed in non-treated animals (p < 0.0001). When histological sections were analysed, folic acid was found to reduce by 20% the number of damaged muscle fibbers per field (60±17.1 vs 80.7±16.4, p < 0.0001). Rotarod test revealed that folic acid also led to an improvement in muscle function, assessed by the time the animals spend running on the rod, when comparing to untreated animals.

CONCLUSIONS

The administration of folic acid, prior to the end of ischemic period, decreases the damaged induced by IRI-LL, also achieving a faster recovery of mobility.
INTRAOPERATIVE ICG FLUORESCENCE ANGIOGRAPHY: ANALYSIS OF FIRST RESULTS IN OUR SINGLE-CENTER
Authors: Soto Dopazo M , Pérez Prudencio E , Arango Bravo A , Nuño Iglesias C , Mateos Palacios C , Carrocera Cabal A C , Díaz González M D , Fernández Fernández J C
Published: May 2021

INTRODUCTION

Anastomosis dehiscence is one of the most serious complications in colorectal surgery, influenced by many factors, especially the anastomotic ischemia. Intraoperative Indocyanine Green (ICG) Fluorescence Angiography allows to assess the vascular perfusion of the ends anastomotic and anastomosis thus seeking to decrease the number of sutures failure.

MATERIAL AND METHODS

A retrospective and descriptive study of patients undergoing colorectal surgery in our centre using intraoperative indocyanine green fluorescence angiography. We analysed a total of 45 patients, including 40 cases of colorectal cancer and 5 cases with a benign pathology (4 diverticular disease and 1 Crohńs disease).

RESULTS

After administration of ICG, the site of resection was changed in 6 cases due to bad perfusion findings. 5 patients presented anastomotic leakage during the postoperative period. The medium hospital stay length was 10 days, increasing to 29,2 days medium stay in patients with postoperative dehiscence respect to 7’72 days in patients without postoperative complications. No deaths or adverse reactions associated with the ICG were detected.

CONCLUSIONS

The technique with ICG seems to be a promising tool for the colorectal surgery as a predictor of suture failure. It allows a reduction of hospital stay length and postoperative morbidity and mortality from this cause and it can serve as a good help for making decisions in the course of a surgery.
TOWARDS AN UNIFIED FRAMEWORK FOR VALIDATING DEEP LEARNING METHODS FOR COLORECTAL POLYPS: FIRST STEPS
Authors: Sánchez Peralta L F , Ortega Morán J F , Saratxaga Cr L , Pagador J B , Picón A , Mündermann L , Polo F , Sánchez Margallo F M
Published: May 2021

INTRODUCTION

Deep learning techniques have significantly contributed to the field of medical imaging analysis. In case of colorectal cancer, they have shown a great utility for increasing the adenoma detection rate at colonoscopy, but a common validation methodology is still missing. In this study, we present preliminary efforts towards the definition of a validation framework.

MATERIAL AND METHODS

Different models based on different backbones and encoder-decoder architectures have been trained with a publicly available dataset that contains white light and NBI colonoscopy videos, with 76 different lesions from colonoscopy procedures in 48 human patients. A computer aided detection (CADe) demonstrator has been implemented to show the performance of the models.

RESULTS

This CADe demonstrator shows the areas detected as polyp by overlapping the predicted mask on the endoscopic image. It allows selecting the video to be used, among those from the test set. Although it only present basic features such as play, pause and moving to the next video, it easily loads the model and allows for visualization of results. The demonstrator is accompanied by a set of metrics to be used depending on the aimed task: polyp detection, localization and segmentation.

CONCLUSIONS

The use of this CADe demonstrator, together with a publicly available dataset and predefined metrics will allow for an easier and more fair comparison of methods. Further work is still required to validate the proposed framework.
TREATMENT OF PRESSURE ULCERS IN PATIENTS WITH SPINAL CORD INJURY: CONVENTIONAL SURGERY vs. CELLULAR THERAPY
Authors: Burgos Gutiérrez C , Álvarez-Buylla Álvarez P , Álvarez Viejo M , Pérez López S , Pérez Basterrechea M , Bea Muñoz M , Pérez Arias A , De Vicente Rodríguez J C
Published: May 2021

INTRODUCTION

Relapse rates of pressure ulcers (PUs) are very high in spinal cord injured patients. That is the reason why alternative therapies, such as using stem cells derived from bone marrow, have been developed. The objective of our study is to compare this technique of infiltration - infusion of mononuclear cells with conventional surgery.

MATERIAL AND METHODS

A retrospective study was carried out in patients with spinal cord injuries who had PUs, category III / IV, in the pelvic area, during a 14-year follow-up period. One group was treated with conventional surgery and, in the other group, mononuclear cells were infused. The statistical analysis was done using the R program and level of significance used was <0.05.

RESULTS

One hundred and forty-nine patients were registered, 42.3% in the conventional surgery group and 57.7% in the mononuclear cell group. There were no significant differences in terms of ulcer healing in the first six months, but 6 months and one year post-treatment, it were found significant differences. At 6 months, no patient in the conventional surgery group presented dehiscence of the wound and, one year after surgery, only 3.17% recurred in the conventional group In addition, it was shown that there was a statistically significant relationship between days of hospitalization and type of bacterial contamination and the intervention group.

CONCLUSIONS

Use of bone marrow mononuclear cell infusion-infiltration is an alternative treatment for PUs during the first 6 months, instead of conventional surgery. However, in the medium-long term, conventional surgery is more effective.
REVIEW OF 5 YEARS RESULTS AFTER SURGERY FOR GASTRO-OESOPHAGEAL REFLUX DISEASE: NISSEN VS TOUPET
Authors: Alonso Batanero E , Rodríguez Uría R , Amoza Pais S , Rodicio Miravalles J L , Moreno Gijón M , Sanz Navarro S , Turienzo Santos E , Sanz Álvarez L
Published: May 2021

INTRODUCTION

Multiple studies attempt to demonstrate the superiority of Toupet fundoplication over the classic Nissen technique in the treatment of gastro- oesophageal reflux disease (GERD). In our study we compared the results of both techniques.

MATERIAL AND METHODS

A retrospective descriptive study of patients operated because of GERD using laparoscopic Nissen and Toupet fundoplication in our centre between January 1, 2015 and December 31, 2019.

RESULTS

80 patients were operated, 56 Nissen (70%) versus 24 Toupet (30%). Both groups are comparable in terms of mean age, distribution by sex, obesity, toxic habits, the prevalence of typical symptoms, DeMeester, and presurgical lower oesophagal sphincter pressure; although there are differences regarding the presence of associated hiatal hernia and within them the type. A similar surgical time (136.59 vs 132.71 minutes) and mean stay (4.02 vs 5 days) were observed. In the Nissen group, 12 patients (21.42%) presented initial postoperative dysphagia, requiring 2 endoscopic dilations and 5 reoperations, compared to 5 patients (20.83%) in the Toupet group, that did not require dilation and with 1 reoperation. The conversion and mortality rate was 0% in both groups, with a variable follow-up of 22.08 versus 14.45 months.

CONCLUSIONS

Both techniques present similar results, including the rate of postoperative dysphagia, which is one of the most feared complications. However, it would be necessary to increase the size and longer follow-up to establish long-term results.
ARE SYMMETRICAL BARBED SUTURES AN ADVANTAGE IN KNEE ARTHROPLASTIES? PROSPECTIVE ANALYSIS
Authors: Suárez-Anta Rodríguez P J , Lanuza Lagunilla L , Camblor Valladares A , Meneses Gutiérrez A , García Arias A , Cabria Fernández J , García Cuello L , Riera Campillo M
Published: May 2021

INTRODUCTION

The number of knee replacements has increased significantly, and is projected to increase further by 2030. Wound closure is one of the research areas. Arthroplasties require a large incision to achieve adequate exposure. This implies long closure and healing times. Barbed sutures are not new as they were introduced in 1964. Since then, multiple improvements have been made to these sutures and their use has expanded to various fields. Despite the potential advantages, barbed sutures are not commonly used in knee replacements. This may be due to the higher cost and uncertain clinical benefits. The objective is to determine the effect of barbed sutures compared to traditional braided sutures in knee arthroplasties by analyzing certain clinical results.

MATERIAL AND METHODS

A prospective observational study was carried out analyzing the arthroplasties operated during one year.

Those in which the barbed suture was used for the closure of the arthrotomy and/or subcutaneous cellular tissue were compared with those in which a traditional braided suture was used.

RESULTS

No statistically significant differences were observed between both sutures in terms of range of motion, functional status, and surgical complications. Regarding the time of surgery, a difference of 10 minutes was observed in favor of barbed sutures, the closure time being statistically significant.

CONCLUSIONS

Barbed sutures contribute to greater surgical effectiveness, cost savings, surgical time, and comparable complication rates.
MEDIUM-TERM PROGNOSIS OF THE CONTRALATERAL HIP AFTER A PRIMARY ARTHROPLASTY
Authors: Suárez-Anta Rodríguez P J , Climent Peris V , Suárez Vázquez A J , Lanuza Lagunilla L , Camblor Valladares A , Meneses Gutiérrez A , García Arias A , Cabria Fernández J
Published: May 2021

INTRODUCTION

Coxarthrosis is one of the most frequent and disabling pathologies. 20% of those over 60 years of age will develop symptomatic coxarthrosis and 10% end with a hip replacement. Hip arthroplasty is an alternative because it increases the quality of life. When we recommend arthroplasty in clinical practice, patients often ask about the prognosis of their other hip. Will it deteriorate in the same way? Will it be necessary to operate it? When? The objective is to determine if there is any variable or radiological sign that predicts the medium-term prognosis of the contralateral hip after total hip arthroplasty.

MATERIAL AND METHODS

A retrospective study of patients who underwent Total Hip Arthroplasty in our hospital during 2011 and 2012 was carried out, with a total of 543 patients.

The degree of coxarthrosis was determined at the time of the first arthroplasty and at regular intervals during follow-up, according to the JOA and Tónnis classifications, analyzing each of the items included in these classifications.

RESULTS

A progression of osteoarthritis of the contralateral hip could be expected in the next 3 years in 10% of patients. This progression will be greater and faster in those with grade II-III and, especially, in those with greater joint narrowing and greater alteration of the femoral head, and can reach between 25 and 30% of patients.

CONCLUSIONS

The degree of initial JOA is a predictive factor for requiring a hip replacement on the contralateral side.
TELEMENTORING IN TIMES OF COVID-19 FOR TRAINING IN GENERAL SURGERY
Authors: Suárez Sánchez A , Diaz Vico T , Fernández Hevia M , García Munar M , Ramos Montes C , Rodríguez García I , Otero Diez J l , García Florez l J
Published: May 2021

INTRODUCTION

Telemedicine applied to surgery is called telementorization (TM). It allows remote assistance by expert surgeons to others with less experience in certain techniques, thus guaranteeing learning that overcomes the barriers of time and location without being associated with a higher rate of complications. The objective is to publicize the use of this type of technology in our surgical department, particularly needed with the current restrictions.

MATERIAL AND METHODS

In our center, the Proximie platform (www.proximie.com) is used as a tool for TM. It allows to remotely broadcast live procedures performed by expert surgeons, as well as to create a virtual library of our own procedures that can be used as study and teaching tool by residents. This platform transmits not only bidirectional image and sound, but it also allows the active participation of a remote assistant with interactive features that are projected directly on the screen of the local surgeon.

RESULTS

The Proximie platform is being used frequently (and more intensively during this time of greatest restrictions) in advanced colorectal surgeries, with TM by remote experts and in our department for the continuing training program for residents. It also offers the possibility of conducting multidisciplinary sessions and webinars with subsequent availability control online.

CONCLUSIONS

TM and digital platforms such as Proximie provide important benefits in the practical learning and training of surgeons, especially with the current restrictions, being a safe technique and a teaching tool to be exploited.
SURGICAL AND PROGNOSTIC IMPLICATIONS IN GASTRIC ADENOCARCINOMA BY THE INTEGRATION OF PROTEOMIC MOLECULAR ANALYSIS
Authors: Ugarte Sierra B , Losada J , Losada I , Sarria R , Losada M A , Grandes P
Published: May 2021

INTRODUCTION

Despite a steady decline in the incidence of gastric cancer (GC) over recent decades, the prognosis remains poor with 5-year survival rates of 21.9% in Europe. The AJCC Cancer Staging Manual (8th Edition) establishes the necessity to evaluate personalized survival models. These models would help in the decision-making process. Proteomic and genomic molecular analyses have provided a more in-depth knowledge of GC.

MATERIAL AND METHODS

19 patients affected by 21 tumors operated between 2012-2014 were prospectively included. Healthy tissue and tumor samples were taken from each case and deposited in a tissue biobank for subsequent proteomic analysis by Proteomics Department.

RESULTS

The following histopathological types were identified: (73.69%) intestinal, (10.52%) diffuse, and (15.78%) undetermined, poorly differentiated, and mixed neuroendocrine of the classification WHO. According to the size and extent of tumor invasion, the percentages of the sample were T1 or T2 (26.31%) and T3 or T4 (73.68%). Furthermore, 57.89% of the patients were found to have lymph-node metastases (N 1, 2, 3 +). After the differences in protein intensities in healthy tissue and tumor tissue were analyzed, it was found that in the healthy tissue, EGFR1, MAPK1 and MAPK3 were predictive variables of overall survival when the tumor stage was T3 or T4

CONCLUSIONS

It would be convenient to redefine the classification and treatment plan in gastric cancer by integrating the study at a molecular level.
EVALUATION OF THE RELEASE RATE OF A CHEMOTHERAPEUTIC AGENT INCORPORATED AS A COATING ON A BIODEGRADABLE URETERAL STENT. IN VITRO STUDY
Authors: Soto Gallardo M , de la Cruz Conty J E , Aznar Cervantes S D , Cenis Anadón J L , Sánchez Margallo F M , Rioja Zuazu J , Soria Gálvez F
Published: May 2021

INTRODUCTION

To assess the release rate of Mitomycin C (MMC) after its adherence to a biodegradable ureteral stent (BraidStent™-MMC) by dip coating in order to evaluate its potential application as an adjuvant treatment for upper tract urothelial carcinoma.

MATERIAL AND METHODS

The dip coating technique is applied to a total of 10 fragments of the BraidStent™ catheter which has a polymeric matrix as a coating. Each 3 cm fragment is immersed 10 times in pure MMC crystallising in methanol and finally obtaining the formation of microlayers on its surface. After drying, each fraction of the stent is immersed in 5 ml of artificial urine to study its interaction with this medium. The samples remain in an orbital shaker at 36ºC and the medium is exchanged under sterile conditions after 12, 24, 48, 48, 72, 96 and 120h. At each replacement, the remaining urine is analysed by HPLC-DAD to quantify the presence of the cytotoxic agent.   

RESULTS

During the first 12h, MMC is completely released reaching a mean concentration of 52.22 mg/L. Comparing this result with those previously obtained with the first BraidStent ™ -MMC formulation (10.82mg/L), it is determined that this technique allows to increase the release rate up to 5 times.

CONCLUSIONS

The release rate of Mitomycin C from a biodegradable ureteral stent is increased by integrating a polymeric matrix with microlayers in its coating. Further trials are needed to achieve the therapeutic dose for clinical application in oncology patients.
CYTOREDUCTION SURGERY WITH HIPEC IN PERITONEAL CARCINOMATOSIS OF GASTRIC ORIGIN: A HOPEFUL TREATMENT?
Authors: García Munar M , Merayo Álvarez M , Moreno Gijón M , Rodríguez Uría R , Rodicio Miravalles J L , Suárez Sánchez A , Turienzo Santos E , Sanz Álvarez L
Published: May 2021

INTRODUCTION

The incidence of peritoneal metastases in gastric cancer are frequent and are associated with very poor median survival rates. The multimodal treatment of cytoreduction surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) could offer a better prognosis in selected cases although it is not currently contemplated in clinical practice guidelines.

MATERIAL AND METHODS

Of the 100 patients operated on for peritoneal carcinomatosis in our centre between May 2014 and December 2020, we selected those of gastric origin. Multidisciplinary CRS treatment with HIPEC was indicated in those patients with positive cytology and/or preoperative PCI <7.

RESULTS

Four men and one woman with a mean age of 63 years underwent surgery. The mean preoperative PCI was 2 and complete cytoreduction was achieved in all cases (CC-0). Complications included a biliary leak, a postoperative collection and a bronchoaspirative pneumonia. One patient died at 34 months. The other four are still alive: one with recurrence at 18 months and the rest without disease with a mean follow-up of 25 months. In one of the cases CRS surgery with HIPEC was performed as surgical salvage after initial surgery and in the rest as the only treatment.

CONCLUSIONS

Palliative systemic chemotherapy is considered the treatment of gastric cancer with peritoneal involvement, however, treatment based on CRS and HIPEC in selected cases could improve survival rates, disease-free interval and even be considered as salvage treatment in resectable oligometastatic recurrences.
IS CONSERVATIVE AND MINIMALLY INVASIVE LIVER SURGERY SAFE IN THE APPROACH TO HEPATOCARCINOMA? ANALYSIS OF THE RESULTS IN OUR CENTER
Authors: Camarero E , García-Botella A , Avellana R , Pizarro M J , de la Serna S , Otero J , Díez-Valladares L , Torres A J
Published: May 2021

INTRODUCTION

We present the results of liver resection surgery for hepatocarcinoma (HCC), comparing morbidity, mortality, and survival data based on the type of surgical approach (open vs. laparoscopic) and the type of liver resection (anatomical vs. limited).

MATERIAL AND METHODS

Descriptive, prospective, and comparative study of 49 patients who underwent liver resection for HCC during the period 2013-2018 in our centre.

RESULTS

16 laparoscopic resections were performed (32.7%) compared to 33 open surgeries (67.3%). Morbidity and mortality results according to the Clavien-Dindo classification (I 38 (77.6%); II 9 (18.4%), III 1 (2%), IV 1 (2%).

Among the risk factors, the relationship between the preoperative Apri Index and the observed survival has been studied in our population, without observing statistically significant differences (p = 0.915).

No statistically significant differences have been found between the laparoscopic versus the open approach (p = 0.78) or in anatomical surgery versus limited resections (p = 0.26) in terms of time to tumor recurrence.

In our series, no significant differences in survival were found depending on the type of surgery (open vs laparoscopic, p = 0.57).

CONCLUSIONS

In our study, we have not been able to demonstrate the greater oncological safety of performing limited versus anatomic resections. The results of the laparoscopic approach are comparable, in terms of overall survival and time to recurrence, to the results of open surgery.
POSTOPERATIVE DYSPHAGIA AFTER LAPAROSCOPIC FUNDOPLICATION AS A TREATMENT FOR GASTROESOPHAGEAL REFLUX DISEASE
Authors: Carrasco Aguilera B , Amoza Pais S , Diaz Vico T , Turienzo Santos E O , Moreno Gijon M , Del Val Ruiz P , Martínez Izquierdo G , Sanz Álvarez L
Published: May 2021

INTRODUCTION

Laparoscopic Fundoplication (LF) as a treatment for gastroesophageal reflux disease (GERD) has positive clinical outcomes. However, postoperative dysphagia (PD) may appear as a side effect. Our objective is to analyze PD in patients operated on for LF in our center.

MATERIAL AND METHODS

Retrospective and descriptive study of patients operated on for GERD from September 1997 to February 2019.

RESULTS

248 patients (60.5% men), with a mean age of 49.7 (21-82), were operated. 66.1% of the patients presented associated comorbidities, highlighting obesity (19.8%). 75% manifested typical symptoms, 19% presenting with Barrett’s esophagus. Sliding hiatal, paraesophageal, mixed and complex hernia were diagnosed in 151 (60.9%), 23 (9.3%), 12 (4.8%), and 4 (1.6%) patients, respectively. The LF Nissen was the most frequent technique (91.5%), using a caliper in 46% of the cases. PD was the most frequent symptom, present in 57 (23%) patients. It was resolved with dilation in 9 patients, requiring 6 patients surgical reintervention. In those PD cases, a caliper was used in 28 (49.1%) patients, without finding significant differences between them (P = .586). Nor were there significant differences between PD and obesity (P = .510), type of hiatal hernia (P = .326), or surgical technique (P = .428). After a median follow-up of 50.5 months, quality of life was classified as Visick I-II, III, and IV in 76.6%, 6.9% and 1.2% of the cases, respectively.

CONCLUSION

No association between PD and the use of calipers, surgical technique or type of hiatal hernia was found in our series.
IMPACT OF A STATE OF EMERGENCY IN TRAUMATOLOGY EMERGENCIES
Authors: Lanuza Lagunilla L , Suárez-Anta Rodríguez P , Camblor Valladares A , Meneses Gutiérrez A , García Arias A , Cabria Fernández J , Riera Campillo M , García Cuello L
Published: May 2021

INTRODUCTION

In March 2020 the Government of Spain imposed a strict national closure to suppress the COVID-19 outbreak. The implementation of various measures during the different phases of confinement and de-escalating, led to a significant decrease in public mobility, modifying the daily life and activities of citizens.

MATERIAL AND METHODS

A retrospective cohort study was carried out including patients evaluated and diagnosed in the Traumatology Emergency Department of our centre during that period, and compared with 2019. The profile of the patients and the injuries treated based on the established diagnoses were analyzed. The weeks considered were divided into total confinement, de-escalation phase 0, 1, 2 and 3. 8511 patients were reviewed.

RESULTS

The measures established during the first wave of the Covid-19 outbreak showed a tremendous impact on the activity of the Traumatology Emergency Department. The number of patients cared for decreased by 59% in 2020. Despite a significant reduction compared to the previous year, the only fractures that remained constant were those of the femur. The cases of minor trauma and pain that do not necessarily require access to an emergency room are progressively reduced to 71% and 61%, respectively.

CONCLUSIONS

The study findings could help in future pandemics to formulate a protocol for patient management, identify areas for improvement and resource planning. It is important to understand which presentations are less common during a state of emergency and which presentations occur with it, or even more frequently.
ADIPOFASCIAL FLAP FOR BONE DEFECTS COVERAGE IN COMPLEX HAND INJURIES: A CASE REPORT AND LITERATURE REVIEW
Authors: Fernández Ortega , Camporro Lara , Daniel Fernández
Published: May 2021

INTRODUCTION

Hand injuries are often accompanied by defects in bone, tendon, and neurovascular structures that require complex repairs and an adequate skin coverage. Occasionally, this requires using different reconstructive techniques. Reverse flow adipofascial flaps are an option for the coverage of dorsal defects of the hand and fingers, basically. Its vascular supply allows to prevent, in case of fractures or bone defects, subsequent complications (osteomyelitis, pseudoarthrosis or adhesions).

MATERIAL AND METHODS

We present a patient with complex saw wounds in hand with extensor tendons injuries of the 4th and 5th fingers and an intercalary bone defect measuring 1.3cm x 0.9cm at the base of the proximal phalanx of the 4th finger, which is stabilized with Kirschner wires and cement.

This structure is covered by an adipofascial flap based on 2nd, 3rd and 4th intermetacarpal dorsal perforators. Additionally, literature review was conducted in PubMed database with the search terms "Adipofascial flap AND ostheosynthesis".

RESULTS

Bone stabilization and coverage is achieved without any problems. Subsequently, bone cement and wires are replaced by an autologous radial graft and by plate and screws. Six articles are reviewed that reported the capability of these flaps to prevent bone infections, adhesions and nonunions.

CONCLUSION

Adipofascial flaps are a safe, low-morbidity and versatile reconstructive option to take into account for urgent or delayed reconstruction of complex dorsal hand defects.

These dońt require microsurgical techniques and resources that may not be available in many centers and dońt sacrifice main vascular axis or future reconstructive options.
BARBED SUTURE FOR LAPAROTOMY CLOUSURE IN URGENCY PROCEDURES. RETROSPECTIVE ANALYSIS
Authors: Bosch-Ramírez M , Lillo-García C , Sánchez-Guillén L , Fernández-Candela A , Curtis-Martínez C , Lario-Pérez S , Oller-Navarro I , Arroyo A
Published: May 2021

INTRODUCTION

Urgency surgeries are often performed in a stressful setting, out of hours and with critical patient involved. In this context, laparotomy closure can sometimes be deficient.

Suture recommended by European Hernia Society is slowly absorbable monofilament continuous suture with a “small bites” technique. Barbed sutures appear as an alternative to conventional suture, frequently used in laparoscopic procedures due to its’ intrinsic maintenance of traction.

The aim of this study is to describe the results in terms of short and mid-term rate of incisional hernia after urgency midline laparotomy, according to the suture utilized.

MATERIAL AND METHODS

A single-center retrospective cohort study was performed including patients with urgency midline laparotomy during 2018. Group A was represented by patients with slowly absorbable monofilament continuous suture. Group B included patients with barbed suture laparotomy closure.

Main variables were hernia rates one month and one year after surgery, diagnosed by physical exploration and/or imaging.

RESULTS

A total of 68 of patients (36 on group A; 32 Group B) were included.

On Group A, 13.9% (5) patients presented incisional hernia on the month follow-up, whereas none did on Group B. After a year, Group A only had 1 new case, but 12.5% of patients did herniate on group B; with no significantly relation with obesity neither underlying neoplasm.

CONCLUSIONS

Midline laparotomy closure must be performed within quality standards, as “small bites” technique with the ratio at least 4/1. Barbed suture appears as a promising closure option, especially in emergency procedures, but needs further study.