How to Reduce the Laparoscopic Colorectal Learning Curve

Producción CientíficaThe laparoscopic approach for colorectal pathologies is becoming more widely used, and surgeons have had to learn how to perform this new technique. The purpose of this work is to study the indicators of the learning curve for laparoscopic colectomy in a community hospital and to find when the group begins to improv

Manejo laparoscópico de las hernias ventrales mediante abordaje totalmente extraperitoneal (eTEP): experiencia inicial y resultados a corto plazo

Introduction. Managing ventral hernia remains a challenge for surgeons. Repairing it using minimally invasive techniques, such as laparoscopic totally extraperitoneal (eTEP), which allows for a wide dissection of the space to be repaired, faster postoperative recovery, less postoperative pain and shorter hospital stay. The eTEP approach is a novel technique that focus on the uses of the retromuscular space to place prosthetic material and strengthen the abdominal wall. The objective is to describe the short-term results of our initial experience with the eTEP technique in the management of ventral hernias. Methodology. Observational, descriptive, retrospective, study, which included patients with a diagnosis of ventral hernia, undergoing laparoscopic eTEP surgery, between July-2021 and June-2022. Results. Of a total of 21 patients, 61.9% were men. 47.6% were overweight and 52.4% were obese. Average hospital stay: 1.6 days. 66.7% were incisional hernias. The surgical techniques performed were: Rives-Stoppa (71.4%) with associated transversus abdominis muscle release in 28.6%. 19% of the patients presented global complications and only one was severe, requiring surgical reintervention. The presence of clinical seroma was observed in 9.5% and ultrasound in 57.1%. There was no evidence of hematomas, surgical wound infection or cases of hernia recurrence. Discussion and conclusions. The laparoscopic-eTEP Rives-Stoppa approach, associated or not with posterior separation of components, in the management of ventral hernias offers good results with a low incidence of postoperative complications, short hospital stay, low incidence of hernia recurrences, so it could be considered a safe and effective technique in the treatment of ventral hernias.Introducción. El manejo de la hernia ventral sigue siendo un desafío para los cirujanos. Su reparación mediante técnicas mínimamente invasivas, como la totalmente extraperitoneal (eTEP) laparoscópica, permite una amplia disección del espacio a reparar, una recuperación postoperatoria más rápida, menor dolor postoperatorio y estancia hospitalaria. El abordaje eTEP es un enfoque novedoso que utiliza el espacio retromuscular para colocar material protésico y fortalecer la pared abdominal. El objetivo es describir los resultados a corto plazo de nuestra experiencia inicial con la técnica eTEP en el manejo de las hernias ventrales. Metodología. Estudio observacional, descriptivo, retrospectivo, donde se incluyen pacientes con el diagnóstico de hernia ventral, sometidos a cirugía laparoscópica-eTEP, entre julio-2021 y junio-2022. Resultados. De un total de 21 pacientes, el 61.9% fueron hombres. El 47.6% tenían sobrepeso y el 52.4% obesidad. Estancia hospitalaria media: 1.6 días. El 66.7% fueron hernias incisionales. Las técnicas quirúrgicas realizadas fueron: Rives-Stoppa (71.4%) asociándose liberación del músculo transverso en el 28.6%. El 19% de los pacientes presentaron complicaciones globales y solo uno fue grave, requiriendo reintervención quirúrgica. Se observó la presencia de seroma clínico en el 9.5% y ecográfico en 57.1%. No se evidenciaron hematomas, infección de herida quirúrgica ni casos de recidiva herniaria. Discusión y conclusiones. El abordaje laparoscópico eTEP Rives-Stoppa, asociado o no a separación posterior de componentes, en el manejo de las hernias ventrales ofrece buenos resultados asociando una baja incidencia de complicaciones postoperatorias, corta estancia hospitalaria, baja incidencia de recidivas herniarias, por lo que podría considerarse una técnica segura y efectiva en el tratamiento de las hernias ventrales

Complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in primary health care (EIRA study): study protocol for a hybrid trial

CDATA[CDATA[Background: Health promotion is a key process of current health systems Primary Health Care (PHC) is the ideal setting for health promotion but multifaceted barriers make its integration difficult in the usual care. The majority of the adult population engages two 01 more risk behaviours, that is why a multiple intervention might be more effective and efficient The primary objectives are to evaluate the effectiveness, the cost effectiveness and an implementation strategy of a complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in PHC. CDATA[CDATA[Methods: This study is a cluster randomised controlled hybrid type 2 trial with two parallel groups comparing a complex multiple risk behaviour intervention with usual care It will be carried out in 26 PHC centres in Spam The study focuses on people between 45 and 75 years who carry out two or more of the following unhealthy behaviours tobacco use, low adherence to the Mediterranean dietary pattern or insufficient physical activity level The intervention is based on the Transtheoretical Model and it will be made by physicians and nurses in the routine care of PHC practices according to the conceptual framework of the ''5A''s" It will have a maximum duration of 12 months and it will be carried out to three different levels (individual, group and community) Incremental cost per quality adjusted life year gamed measured by the tanffs of the EuioQo! 5D questionnaire will be estimated. The implementation strategy is based on the ''Consolidated Framework for Implementation Research, a set of discrete implementation strategies and an evaluation framework. CDATA[CDATA[Discussion: EIRA study will determine the effectiveness and cost effectiveness of a complex multiple risk intervention and will provide a better understanding of implementation processes of health promotion interventions in PHC setting. It may contribute to increase knowledge about the individual and structural barriers that affect implementation of these interventions and to quantify the contextual factors that moderate the effectiveness of implementation

Aprendizaje de las prácticas de laboratorio de Química Farmacéutica del Grado en Farmacia y Doble Grado en Farmacia y Nutrición a través del aula virtual

Depto. de Química en Ciencias FarmacéuticasFac. de FarmaciaFALSEsubmitte

Mid- and Long-Term Outcomes of Totally Laparoscopic Gastrectomy for Gastric Cancer. Prospective Study

Abstract Purpose. The laparoscopic approach for gastric carcinoma (GC) is being increasingly implemented. surgeons. Although recent evidence suggests that this surgical approach is associated with improvements in short-term outcomes, mid- and long-term outcomes have not been well studied. This study aimed to evaluate the mid- and long-term outcomes of laparoscopic gastrectomy (LG) with D1-D2 lymph node dissection for all stages of GC.Methods. A prospective study of GC treated by laparoscopic approach between January 2004 and December 2019 was performed. The demographics, perioperative data, operation details, length of hospital stay, morbid­ity, mortality and pathologic and oncological outcomes were analyzed.Results. A total of 70 patients met the inclusion criteria. The median age was 73 years old. Subtotal gastrectomy was performed in 52 cases (74.3%), and total gastrectomy was performed in 18 cases (25.7%). The median operative time was 270 minutes. The median postoperative stay was 10 days. Morbidity was 35.7%, with a mortality of 7.1%. The disease-free survival (DFS) was 61.2% at three years and 52.3% at five years.Conclusions: LG is a feasible and secure surgical procedure for GC with good mid- and long-term results. Advanced age should not be considered a contraindication for LG.</jats:p

Clinical Prediction Rules in acute appendicitis: Which combination of variables is more effective at predicting?

Abstract Background: Clinical prediction rules have been designed to reduce diagnostic variability and improve the effectiveness of the diagnostic process. However, there are no unanimous criteria regarding which of them is the most efficient for the diagnosis of right iliac fossa pain. Aim: The primary aim of this study was to assess the diagnostic efficacy of the most commonly used clinical prediction rules. The second aim was to identify the combination of the smallest number of clinical and analytical variables that would allow a cost-effective diagnostic approach to assess the right iliac fossa pain. Methods: A retrospective observational study was conducted of 458 patients who were evaluated for right iliac fossa pain between January 2010 and December 2016. The selected scores (Alvarado, AIR, RIPASA, and AAS) were applied to all cases to validate their effectiveness and simultaneously establish the smallest number of variables that were needed for an efficient diagnosis. Univariate and multiple regressions were used for validation. Results: Of the four scores tested, the Alvarado score was the most efficient diagnostic approach. However, the most reduced and predictive combination of the evaluated variables included anorexia, white blood cell count&gt; 8275 leukocytes/μL, neutrophilia (&gt;75%), abdominal pain &lt; 48 hours, migrating pain to the right lower quadrant and axillary temperature out the range of 37-39ºC. Conclusions: A new and effective score for predicting appendicitis in patients presenting with right iliac fossa pain has been established.</jats:p

Factors for Predicting Morbidity and Mortality of Gastric Cancer Patients After Laparoscopic Surgery: A Retrospective Study

Background/Objectives: Gastric cancer is a major global health concern and a leading cause of cancer-related death. While surgical resection remains the cornerstone of curative treatment, postoperative morbidity and mortality are significant issues. This study aimed to identify factors associated with postoperative morbidity and mortality in patients undergoing laparoscopic gastrectomy for gastric adenocarcinoma. Results: The median age was 73 years. Eighteen total gastrectomies (15%) and eighty-eight subtotal gastrectomies (66.6%) were performed. Major complications (Clavien-Dindo &ge; III) occurred in 22.3% of patients, and the hospital mortality rate was 7.5%. Independent predictors of morbidity included anemia (OR 2.49, p = 0.047), extended lymphadenectomy (OR 5.09, p = 0.002), and conversion to open surgery (OR 9.40, p = 0.031). Coagulopathy was a significant predictor of mortality (OR 5.01, p = 0.049). Methods: A retrospective, single-center observational study was conducted on 120 patients who underwent laparoscopic surgery between January 2004 and December 2022. Preoperative assessments included endoscopy, imaging, and staging according to the TNM classification. Risk factors were analyzed using univariate and multivariate logistic regression. Conclusions: Laparoscopic gastrectomy is a technically challenging procedure with substantial risks of morbidity and mortality. Identifying modifiable risk factors, such as anemia and coagulopathy, provides opportunities for improved outcomes through preoperative prehabilitation and optimized patient selection