Anatomía quirúrgica de la vascularización mesocólica aplicada a la colectomía oncológica mínimamente invasiva

La evolución de la cirugía oncológica en el cáncer de colon plantea la necesidad de resecciones más amplias y radicales, que pueden aumentar el riesgo de complicaciones intraoperatorias, principalmente vasculares. El conocimiento detallado de la anatomía vascular del colon y sus posibles variaciones se ha vuelto crucial para el cirujano laparoscopista. El objetivo principal de este trabajo es analizar la variabilidad en la vascularización del colon derecho y del ángulo esplénico, así como su aplicabilidad en la cirugía mínimamente invasiva del cáncer de colon. MATERIAL Y MÉTODOS Estudio anatómico en 27 cadáveres humanos dividido en dos apartados: - Estudio anatómico del colon derecho: se ha realizado la disección y descripción anatómica del tronco gastrocólico de Henle (TGCH) y de la vena cólica derecha superior (VCDS) en 17 especímenes. Tras completar una hemicolectomía derecha, se ha simulado la exteriorización del colon transverso que serviría para realizar la teórica anastomosis (CTA), con el objetivo de identificar la estructura vascular que limita su extracción. Se ha medido la longitud de extracción antes y después de seccionar el vaso causante de la tensión y se ha realizado una descripción de la vascularización indemne una vez finalizado el estudio. - Estudio anatómico del ángulo esplénico del colon: disección y descripción anatómica de los arcos vasculares presentes en el mesocolon del ángulo esplénico en 27 especímenes, midiendo la distancia al borde inferior del páncreas y el espacio avascular del ángulo esplénico (SFAS). RESULTADOS La VCDS estaba presente en el 100% de los especímenes del estudio. Durante su recorrido en el mesocolon no presenta una arteria satélite y drena en la VMS, en la mayoría de los casos, a través del TGCH (88%). La rama izquierda de la VCDS fue la responsable de la tensión a nivel del CTA y el origen de un posible sangrado intraoperatorio ante tracciones excesivas a este nivel. La ligadura de la VCDS en su raíz, aumenta la longitud de exteriorización del CTA en aproximadamente 3 cm, sin afectar la vascularización del CTA. Se han identificado tres arcos vasculares a nivel del ángulo esplénico del colon: la arteria marginal de Drummond, de localización periférica y constante, el arco de Riolan y la arteria de Moskowitz, ambos de localización central en el mesocolon e inconstantes (18.5% y 11% respectivamente). La distancia media desde el borde inferior del páncreas hasta el arco de Drummond fue de 6,8 cm (DE 1,25), hasta el arco de Riolan de 4,5 centímetros (DE 0,5 cm) y de tan solo 0,3 cm (DE 0,04) hasta la arteria de Moskowitz. CONCLUSIONES Tanto el área quirúrgica del tronco gastrocólico de Henle como las arcadas vasculares del ángulo esplénico del colon presentan una gran variabilidad anatómica. El conocimiento de ambas regiones aporta al cirujano una gran ventaja durante el abordaje mínimamente invasivo en la cirugía colorrectal. La VCDS es una estructura anatómica constante en el drenaje venoso del ángulo hepático del colon y su ligadura en la raíz facilitaría una anastomosis extracorpórea libre de tensión. La presencia de una arteria de Moskowitz implica la ausencia del SFAS, lo que contraindicaría el abordaje medial en su liberación laparoscópica

Desarrollo de contenidos en realidad virtual inmersiva para el aprendizaje de ciencias de la salud

Memoria ID-0167. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2017-2018

Stoma-free survival after anastomotic leak following rectal cancer resection : worldwide cohort of 2470 patients

Funding Information: The TENTACLE-Rectum study was funded by Medtronic External Research Program. The authors declare no other conflict of interest.Peer reviewedPublisher PD

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Evaluación de la eficacia y seguridad del sellante hemostático Hemopatch® en la reducción de la incidencia de la hemorragia y la fístula biliar tras la cirugía de resección hepática programada.

La morbilidad, mortalidad y los costes tras la cirugía hepática están influenciados en gran medida por las pérdidas hemáticas y las fístulas biliares que se producen durante la cirugía de resección hepática, por lo que es fundamental conseguir una buena hemostasia y bilioestasia durante el procedimiento. Los agentes hemostáticos tópicos se han hecho populares por mejorar la hemostasia perioperatoria y prevenir la fístula biliar, sin embargo el uso ampliamente difundido en cirugía hepática contrasta con la escasez de estudios comparativos de calidad que avalen su eficacia clínicamente relevante. Por todo ello considero de gran relevancia la realización de un estudio prospectivo y aleatorizado en el que tras la resección hepática con las medidas de hemostasia según la práctica clínica habitual se aplicará o no un sellante hemostático tópico sobre la superficie cruenta del hígado. El objetivo principal del estudio es determinar la eficacia de la utilización del hemostático local Hemopatch® en la incidencia de fístula biliar y hemorragia postoperatoria en pacientes sometidos a Cirugía Hepática programada durante los 30 +/- 10 días tras la realización de la misma

Early colorectal cancer diagnosed after endoscopic resection: Conservative treatment is safe in most of the cases. Proposal for a risk-based management

Endoscopic resection offers advantages over surgical resection for early colorectal cancer (ECC). However, there might be a presumed risk of recurrence. We aimed to determine the risk of recurrence after endoscopic removal of ECC