En cirurgia de còlon, són realment necessaris els antibiòtics orals?

Abans de sotmetre al pacient a una cirurgia de còlon li són administrats sistemàticament antibiòtics orals. És necessària aquesta medicació? Investigadors de l'Hospital Vall d'Hebron i la UAB creuen que no. Aquesta negativa categòrica reflecteix els resultats d'un estudi en què van participar 300 persones sotmeses a aquesta invervenció.Antes de someter al paciente a una cirugía de colon se le administran sistemáticamente antibióticos orales. Pero, ¿realmente es necesaria esta medicación? Investigadores del Hospital Vall d'Hebron y la UAB creen que no. Esta tajante negativa refleja los resultados de un estudio en el que participaron 300 personas sometidas a esta intervención

The colon does not reach! A technical note with tricks to avoid colorectal anastomoses under tension

Deloyers procedure; Colorectal anastomosis; Surgical techniqueProcediment de deloyers; Anastomosi colorectal; Tècnica quirúrgicaProcedimiento Deloyers; Anastomosis colorrectal; Técnica quirúrgicaAim We describe two options for colorectal anastomosis suitable in cases when the colon would reach the pelvis under tension. Method Deloyers procedure and the retro-ileal colorectal anastomosis are presented, focusing on practical tips and tricks to perform them. Insights on patients who underwent the procedures are provided to demonstrate the advantages and feasibility of the techniques. Results Each step of both techniques is detailed. Ten patients underwent Deloyers procedure and nine underwent retro-ileal anastomosis at our unit. A minimally invasive approach was attempted in 13 patients, of whom five required conversion to open surgery due to the technical complexity of the abdominal procedure. Colorectal anastomosis was successfully performed in all patients. There were no major intra-operative complications, although five patients had postoperative complications requiring further treatment. Conclusions Both techniques are effective in patients at risk of receiving a colorectal anastomosis under tension, and a minimally invasive approach can be used. However, owing to the complexity of surgery in this group of patients, the perioperative morbidity is not negligible. Careful postoperative management is advisable, and patients should be informed of the risks. In expert hands, the outcomes are acceptable, avoiding an ileorectal anastomosis and its constraints

Incidence, features, outcome and impact on health system of de-novo abdominal surgical diseases in patients admitted with COVID-19

Objective: to assess the epidemiology and features of de novo surgical diseases in patients admitted with COVID-19, and their impact on patients and healthcare system. Summary background data: gastrointestinal involvement has been described in COVID-19; however, no clear figures of incidence, epidemiology and economic impact exist for de-novo surgical diseases in hospitalized patients. Methods: this is a prospective study including all patients admitted with confirmed SARS-CoV-2 rT-PCR, between 1 March and 15 May 2020 at two Tertiary Hospitals. Patients with known surgical disease at admission were excluded. Sub-analyses were performed with a consecutive group of COVID-19 patients admitted during the study period, who did not require surgical consultation. Results: ten out of 3089 COVID-19 positive patients (0.32%) required surgical consultation. Among those admitted in intensive care unit (ICU) incidence was 1.9%. Mortality was 40% in patients requiring immediate surgery and 20% in those suitable for conservative management. The overall median length of stay (LOS) of patients admitted to ICU was longer in those requiring surgical consultation compared with those who did not (51.5 vs 25 days, p = 0.0042). Patients requiring surgical consultation and treatment for de-novo surgical disease had longer median ICU-LOS (31.5 vs 12 days, p = 0.0004). A median of two post-surgical complications were registered for each patient undergoing surgery. Complication-associated costs were as high as 38,962 USD per patient. Conclusions: incidence of de-novo surgical diseases is low in COVID-19, but it is associated with significant morbidity and mortality. Future studies should elucidate the mechanism underlying the condition and identify strategies to prevent the need for surgery

Surgical management of complex ileocolonic Crohn’s disease: a survey of IBD colorectal surgeons to assess variability in operative strategy

Cirurgia colorectal; Malaltia de Crohn; Resecció ileocecalCirugía colorrectal; Enfermedad de Crohn; Resección ileocecalColorectal surgery; Crohn’s disease; Ileocaecal resectionIntroduction To explore the reported variability in the surgical management of ileocolonic Crohn’ s disease and identify areas of standard practice, we present this study which aims to assess how different colorectal surgeons with a subspecialty interest in inflammatory bowel disease (IBD) surgery may act in different clinical scenarios of ileocolonic Crohn’s disease. Methods Anonymous videos demonstrating the small bowel walkthrough and anonymised patients’ clinical data, imaging and pathological findings were distributed to the surgeons using an electronic tool. Surgeons answered on operative strategy, bowel resections, management of small bowel mesentery, type of anastomosis and use of stomas. Results Eight small bowel walkthrough videos were registered and 12 assessors completed the survey with a questionnaire completion rate of 87.5%. There was 87.7% agreement in the need to perform an ileocolonic resection. However, the agreement for the need to perform associated surgical procedures such as strictureplasties or further bowel resections was only 57.4%. When an anastomosis was fashioned, the side to side configuration was the most commonly used. The preferred management of the mesentery was dissection close to the bowel. Conclusions The decision on the main procedure to be performed had a high agreement amongst the different assessors, but the treatment of multifocal disease was highly controversial, with low agreement on the need for associated procedures to treat internal fistulae and the use of strictureplasties. At the same time, there was significant heterogeneity in the decision on when to anastomose and when to fashion an ileostomy

Robot-assisted pelvic floor reconstructive surgery: an international Delphi study of expert users

Delphi consensus; Pelvic organ prolapse; Robotic surgeryConsenso Delphi; Prolapso de órganos pélvicos; Cirugía robóticaConsens Delphi; Prolapse d'òrgans pèlvics; Cirurgia robòticaBackground Robotic surgery has gained popularity for the reconstruction of pelvic floor defects. Nonetheless, there is no evidence that robot-assisted reconstructive surgery is either appropriate or superior to standard laparoscopy for the performance of pelvic floor reconstructive procedures or that it is sustainable. The aim of this project was to address the proper role of robotic pelvic floor reconstructive procedures using expert opinion. Methods We set up an international, multidisciplinary group of 26 experts to participate in a Delphi process on robotics as applied to pelvic floor reconstructive surgery. The group comprised urogynecologists, urologists, and colorectal surgeons with long-term experience in the performance of pelvic floor reconstructive procedures and with the use of the robot, who were identified primarily based on peer-reviewed publications. Two rounds of the Delphi process were conducted. The first included 63 statements pertaining to surgeons’ characteristics, general questions, indications, surgical technique, and future-oriented questions. A second round including 20 statements was used to reassess those statements where borderline agreement was obtained during the first round. The final step consisted of a face-to-face meeting with all participants to present and discuss the results of the analysis. Results The 26 experts agreed that robotics is a suitable indication for pelvic floor reconstructive surgery because of the significant technical advantages that it confers relative to standard laparoscopy. Experts considered these advantages particularly important for the execution of complex reconstructive procedures, although the benefits can be found also during less challenging cases. The experts considered the robot safe and effective for pelvic floor reconstruction and generally thought that the additional costs are offset by the increased surgical efficacy. Conclusion Robotics is a suitable choice for pelvic reconstruction, but this Delphi initiative calls for more research to objectively assess the specific settings where robotic surgery would provide the most benefit.Open access funding provided by Università di Pisa within the CRUI-CARE Agreement. The project was funded with research funds from the University of Pisa to Tommaso Simoncini

Robotic surgery in emergency setting: 2021 WSES position paper

Emergency surgery; Robotic surgeryCirugía de emergencia; Cirugía robóticaCirurgia d'urgència; Cirurgia robòticaBackground Robotics represents the most technologically advanced approach in minimally invasive surgery (MIS). Its application in general surgery has increased progressively, with some early experience reported in emergency settings. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a systematic review of the literature to develop consensus statements about the potential use of robotics in emergency general surgery. Methods This position paper was conducted according to the WSES methodology. A steering committee was constituted to draft the position paper according to the literature review. An international expert panel then critically revised the manuscript. Each statement was voted through a web survey to reach a consensus. Results Ten studies (3 case reports, 3 case series, and 4 retrospective comparative cohort studies) have been published regarding the applications of robotics for emergency general surgery procedures. Due to the paucity and overall low quality of evidence, 6 statements are proposed as expert opinions. In general, the experts claim for a strict patient selection while approaching emergent general surgery procedures with robotics, eventually considering it for hemodynamically stable patients only. An emergency setting should not be seen as an absolute contraindication for robotic surgery if an adequate training of the operating surgical team is available. In such conditions, robotic surgery can be considered safe, feasible, and associated with surgical outcomes related to an MIS approach. However, there are some concerns regarding the adoption of robotic surgery for emergency surgeries associated with the following: (i) the availability and accessibility of the robotic platform for emergency units and during night shifts, (ii) expected longer operative times, and (iii) increased costs. Further research is necessary to investigate the role of robotic surgery in emergency settings and to explore the possibility of performing telementoring and telesurgery, which are particularly valuable in emergency situations. Conclusions Many hospitals are currently equipped with a robotic surgical platform which needs to be implemented efficiently. The role of robotic surgery for emergency procedures remains under investigation. However, its use is expanding with a careful assessment of costs and timeliness of operations. The proposed statements should be seen as a preliminary guide for the surgical community stressing the need for reevaluation and update processes as evidence expands in the relevant literature

Cohort profile: the Spanish Early-onset Colorectal Cancer (SECOC) cohort: a multicentre cohort study on the molecular basis of colorectal cancer among young individuals in Spain

Càncer colorectal; Base molecularCáncer colorrectal; Base molecularColorectal cancer; Molecular basisPurpose The Spanish Early-onset Colorectal Cancer (SECOC) study is a multicentre prospective cohort established in Spain to investigate the molecular basis of early-onset colorectal cancer (EOCRC), including metabolic alterations. Participants 220 patients with EOCRC have been enrolled since January 2019 through 18 centres across Spain. Individual-level data were collected by questionnaire, including lifestyle and other colorectal cancer-related factors. Medical record review was performed to capture clinical, histopathological and familial cancer history data. Biospecimen collection (blood, stool, tissue) at diagnosis and at various time points across treatment, as applicable, is also completed. Findings to date Participants had a median age of 44 years (range 14–49), and the majority are men (60%), with individuals age 40–49 years at EOCRC diagnosis being over-represented. Forty-three per cent of participants were diagnosed with a tumour in the rectosigmoid junction/rectum. Nearly two-thirds of EOCRC cases (64%) were diagnosed with advanced stage (III–IV) disease, and 28% of cases had no reported familial history of cancer. Future plans We are actively recruiting and observing participants; we plan to administer follow-up questionnaires and perform additional biospecimen collection. This prospective cohort offers a unique, rich resource for research on EOCRC aetiologies and will contribute to larger international efforts to disentangle the rising disease burden.This work was funded by Projects PI16/01650 and PI20/00974 to JP, from the Spanish Ministry of Health and Consumer Affairs and FEDER. ANH was supported by the National Institutes of Health (NIH) K12 HD043483 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. This work was also supported by the American Cancer Society (#IRG-19-139-59) to ANH

Long-term outcomes of a bioactive matrix enriched with an autologous platelet concentrate for the treatment of complex anal fistulae

Complex anal fistulae; Complications; Regenerative fistula treatmentFístulas anales complejas; Complicaciones; Tratamiento regenerativo de fístulasFístules anal complexes; Complicacions; Tractament regeneratiu de la fístulaBackground: Treating complex anal fistulae (CAF) remains a clinical challenge. Regenerative fistula treatment (RFT) with a bioactive matrix enriched with autologous platelet concentrate (Obsidian RFT®) has shown potential in healing CAF while preserving continence, but its long-term efficacy is still debated. This study aims to report the outcomes of RFT in patients with CAF. Methods: A retrospective analysis of a prospective database of patients with CAF treated with RFT between February 2021 and November 2023 at a single center was conducted. Patients were included if they completed at least a 6-month follow-up. The primary outcome was fistula healing at last available follow-up. Secondary outcomes included unscheduled reoperation and anorectal function. Results: A total of 31 patients were treated with Obsidian RFT, 17 of whom completed the 6-month follow-up. Nine of the patients were women. The median age was 47 (24-63) years, and eight had inflammatory bowel disease. High transsphincteric fistulae were observed in 52.9% of patients. At a median follow-up of 21.8 (8-36) months, a 53% success rate was achieved. Approximately half of patients required at least one additional procedure owing to CAF persistence or recurrence. There were no reports of morbidity or mortality, and no worsening of continence was observed. Conclusions: This pilot study demonstrated that nearly half of the patients treated with RFT for CAF achieved long-term healing, with no adverse effects on continence and an excellent safety profile. Larger studies are needed to draw definitive conclusions

Early outcomes from the Minimally Invasive Right Colectomy Anastomosis study (MIRCAST)

Anastomosis; ColectomyAnastomosi; ColectomiaAnastomosis; ColectomíaBackground The impact of method of anastomosis and minimally invasive surgical technique on surgical and clinical outcomes after right hemicolectomy is uncertain. The aim of the MIRCAST study was to compare intracorporeal and extracorporeal anastomosis (ICA and ECA respectively), each using either a laparoscopic approach or robot-assisted surgery during right hemicolectomies for benign or malignant tumours. Methods This was an international, multicentre, prospective, observational, monitored, non-randomized, parallel, four-cohort study (laparoscopic ECA; laparoscopic ICA; robot-assisted ECA; robot-assisted ICA). High-volume surgeons (at least 30 minimally invasive right colectomy procedures/year) from 59 hospitals across 12 European countries treated patients over a 3-year interval The primary composite endpoint was 30-day success, defined by two measures of efficacy—absence of surgical wound infection and of any major complication within the first 30 days after surgery. Secondary outcomes were: overall complications, conversion rate, duration of operation, and number of lymph nodes harvested. Propensity score analysis was used for comparison of ICA with ECA, and robot-assisted surgery with laparoscopy. Results Some 1320 patients were included in an intention-to-treat analysis (laparoscopic ECA, 555; laparoscopic ICA, 356; robot-assisted ECA, 88; robot-assisted ICA, 321). No differences in the co-primary endpoint at 30 days after surgery were observed between cohorts (7.2 and 7.6 per cent in ECA and ICA groups respectively; 7.8 and 6.6 per cent in laparoscopic and robot-assisted groups). Lower overall complication rates were observed after ICA, specifically less ileus, and nausea and vomiting after robot-assisted procedures. Conclusion No difference in the composite outcome of surgical wound infections and severe postoperative complications was found between intracorporeal versus extracorporeal anastomosis or laparoscopy versus robot-assisted surgery.The MIRCAST Study Group has received research intensification grants from the Regional Government of Cantabria, Spain, and a research grant from Intuitive Surgical (Sunnyvale, CA, USA). MIRCAST was designed and conducted independently at the Valdecilla Biomedical Research Institute (IDIVAL). The funding institutions had no influence in the design or conduct of the study