Surgical Indications and Techniques to Treat the Pain in Chronic Pancreatitis

Chronic pancreatitis (CP) is a progressive inflammatory process, of the pancreatic gland and leads to damage and decrease in glandular tissue. Clinically, the pain is the most outstanding and incapacitating sign (95% of patients), as well as exocrine pancreatic insufficiency. The two main objectives in CP treatment are pain relief and complication management. Pain is the main surgical treatment indication. Patients with pancreatic duct dilation require surgical drainage, which provides an important pain relief (70–80%). Decompression (drainage), resection and neuroablation are the most commonly used surgical treatment options of CP. Derivative surgical procedures as Puestow-Gillesby or its modification, Partington-Rochelle, are the best options if the Wirsung duct is dilated, and Izbiki procedure if it is not. Resection is the choice when there is an important affectation of the head of pancreas with repercussion in bile duct or duodenum, as well as those patients with suspicion of carcinoma or in those ones who cannot be ruled a malignant tumour. The resection surgical procedures are Whipple, Traverso-Longmire, Frey (resective-derivative) and Beger (resective-derivative). To conclude, surgeon must know not only every surgical procedure indications but also be familiarised with all of them. The surgical procedure must be individualised to the patient and the disease stage

It is time to define an organizational model for the prevention and management of infections along the surgical pathway: a worldwide cross-sectional survey

Background The objectives of the study were to investigate the organizational characteristics of acute care facilities worldwide in preventing and managing infections in surgery; assess participants' perception regarding infection prevention and control (IPC) measures, antibiotic prescribing practices, and source control; describe awareness about the global burden of antimicrobial resistance (AMR) and IPC measures; and determine the role of the Coronavirus Disease 2019 pandemic on said awareness. Methods A cross-sectional web-based survey was conducted contacting 1432 health care workers (HCWs) belonging to a mailing list provided by the Global Alliance for Infections in Surgery. The self-administered questionnaire was developed by a multidisciplinary team. The survey was open from May 22, 2021, and June 22, 2021. Three reminders were sent, after 7, 14, and 21 days. Results Three hundred four respondents from 72 countries returned a questionnaire, with an overall response rate of 21.2%. Respectively, 90.4% and 68.8% of participants stated their hospital had a multidisciplinary IPC team or a multidisciplinary antimicrobial stewardship team. Local protocols for antimicrobial therapy of surgical infections and protocols for surgical antibiotic prophylaxis were present in 76.6% and 90.8% of hospitals, respectively. In 23.4% and 24.0% of hospitals no surveillance systems for surgical site infections and no monitoring systems of used antimicrobials were implemented. Patient and family involvement in IPC management was considered to be slightly or not important in their hospital by the majority of respondents (65.1%). Awareness of the global burden of AMR among HCWs was considered very important or important by 54.6% of participants. The COVID-19 pandemic was considered by 80.3% of respondents as a very important or important factor in raising HCWs awareness of the IPC programs in their hospital. Based on the survey results, the authors developed 15 statements for several questions regarding the prevention and management of infections in surgery. The statements may be the starting point for designing future evidence-based recommendations. Conclusion Adequacy of prevention and management of infections in acute care facilities depends on HCWs behaviours and on the organizational characteristics of acute health care facilities to support best practices and promote behavioural change. Patient involvement in the implementation of IPC is still little considered. A debate on how operationalising a fundamental change to IPC, from being solely the HCWs responsibility to one that involves a collaborative relationship between HCWs and patients, should be opened

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Centrality evolution of the charged-particle pseudorapidity density over a broad pseudorapidity range in Pb-Pb collisions at root s(NN)=2.76TeV

Peer reviewe

Utilidad de los índices de Wisconsin y CaPTHUS para la predicción de enfermedad multiglandular en pacientes con hiperparatiroidismo primario programados para paratiroidectomía

Los objetivos de este trabajo son: evaluar la utilidad y aplicabilidad del modelo de puntuación CaPTHUS y del índice de Wisconsin para la predicción de EMG en pacientes con HPTP programados para cirugía en una Unidad de Cirugía Endocrina de referencia del sur de Europa; determinar la validez del modelo CaPTHUS para la predicción preoperatoria de EMG en nuestra cohorte de pacientes intervenidos por HPTP; determinar la capacidad del índice de Wisconsin para predecir enfermedad paratiroidea adicional durante la PS en nuestra cohorte de pacientes, a partir del peso de las glándulas identificadas y extirpadas; determinar la capacidad de ambos modelos para evitar la necesidad de asociar otros gestos intraoperatorios como la determinación de PTH para la exclusión de EMG en pacientes con HPTP programados para paratiroidectomía.Tesis Univ. Granada

Usefulness of the Wisconsin and CaPTHUS indices for predicting multiglandular disease in patients with primary hyperparathyroidism in a southern European population.

Focused parathyroidectomy is a safe technique for the treatment of primary hyperparathyroidism. The CaPTHUS score and the Wisconsin index are preoperative diagnostic tools designed to distinguish between single- and multigland disease. The aim of the study is to evaluate the usefulness of these models for predicting multiglandular disease in a European population. Retrospective review of a database of patients operated upon for primary hyperparathyroidism at a referral center. The sensitivity, specificity, positive and negative predictive values, and reliability of both scores for the prediction of multiglandular disease, were calculated. Receiver operating characteristic (ROC) curves were constructed to assess the sensitivity and specificity of CaPTHUS score and Wisconsin Index for predicting single-gland disease. A level of P Two hundred and eighty-one patients who underwent successful surgery from January 2001 to December 2018 were included. Single-gland disease was detected in 92.5%, and 73.7% had a CaPTHUS score of ≥3. The sensitivity, specificity, positive and negative predictive values of this model for predicting single-gland disease with a score of ≥3 were 76.9%, 66.7%, 96.6%, and 18.9% respectively. The area under the curve value of the CaPTHUS score for predicting single-gland disease was 0.74. A Wisconsin Index >2,000 and an excised gland weight above one gram presented a positive predictive value for single-gland disease of 92.5%. Despite the good performance of both scales, the established cut-off points did not definitively rule out parathyroid multiglandular disease in our population. In cases with a minimal suspicion of this condition, additional intraoperative techniques must be used, or bilateral neck explorations should be performed

Estudio multicéntrico nacional sobre pancreatectomías totales

Members of the Group of participating hospitals: Secanella, Lluis; Sánchez Bueno, Francisco; Serrablo, Alejandro; Ferrer Fabrega, Joana; Sánchez Cabus, S.; Gómez Bravo, Miguel Angel; Padillo, Javier; Blanco, Laia; Balcells, J.; Cugat, Esteban; García Domingo, Maribel; Muñoz Bellvis, Luis; Pérez Diaz, Maria Dolores; Santoyo Santoyo, Julio; Sánchez, Belinda; Georgiev, Tihomir; Villegas, Trinidad; Pacho, Silvino; Diez Valladares, Luis; Rebollar, José; Suárez Muñoz, Miguel Angel; Domínguez, Elias; Falgueras, Laia; Artigas, Vicenc; Sabater, Luis; García Gil, Agustín; Miota de Llama, José Ignacio; Manzanet, Gerardo; Pino, Jose Carlos; Rodríguez Sanjuan, Juan Carlos; Lluis, F.; Ausania, Fabio; Alkorta Zuloaga, Maialen; Escartín, Jorge; Salas, Manel; Domingo, Carlos; Sánchez de Rojas, Enrique Artigues; Barreras Mateos, José Antonio; Fernández Cebrián, José Maria; Pérez Cabrera, Beatriz; Padilla Valverde, D.; Sanjuanbenito, Alfonso; Iturburu Belmonte, Ignacio; Bejarano, Natalia; Garcia Borobia, F.; Toral Guinea, Pablo; Lopez Marcano, Aylhin; Asencio Arana, Francisco; Varo, Evaristo; Esteban, Rafael; Blas, Juan L.; Jover Navalón, José M.; Fernández Martínez, Cristina; Daban Collado, Enrique; Calvo Duran, Antonio; Vicens, J. C.; Romero, J.; Badia, J. M.; Sánchez, Raquel; Miguel Ibáñez, Ricardo de; Pardo, Fernando; Francos von Hunefeld, Carlos; Pereira, Fernando; García Molina, Francisco; Rodríguez Prieto, Ignacio; Alonso Poza, Alfredo; Gilsanz, Carlos; Martinez Albert, Jose Miguel; Angel Morcillo, Miguel; Martinez Cortijo, Sagrario; Martin Fernandez, Jose; Baquedano, Jesús; Castell, José; Aguilo, Javier; Bernal, Juan Carlos[EN]: [Introduction] Total pancreatectomy (TP) is an uncommon operation, with indications that have not been clearly defined and non-standardized postoperative results. We present a national multicentric study on TP and a comparison with the existing literature. [Methods] A prospective observational study using data from the national registry of patients after pancreaticoduodenectomy and TP performed for any indication during the study period: January 1–December 31, 2015. [Results] 1016 patients were included from 73 hospitals, 112 of whom had undergone TP. The percentage of TP from the total number of cases was 11%. The mean age was 63.5 years, and 57.2% were males. The most frequently suspected radiological diagnosis was pancreatic cancer (58/112 cases). The most common TP technique was “mesentery artery first” (43/112 cases). Venous resections were performed in 23 patients (20.5%). The percentage of postoperative complications within 90 days was 50%, but major complications (>IIIA) were only 20.7%. The overall 90-day mortality was 8% (9 patients). The average stay was 20.7 days. The 3 most frequent definitive histological diagnoses were: adenocarcinoma of the pancreas, intraductal papillary mucinous neoplasm and chronic pancreatitis. The R0 rate was 67.8%. [Conclusions] This study shows that the morbidity and mortality results of TP in Spain are similar or superior to previous publications. More precise TP studies are necessary, focused on specific complications such as endocrine insufficiency.[ES]: [Introducción] La pancreatectomía total (PT) es una intervención infrecuente, con unas indicaciones no claramente definidas y unos resultados postoperatorios no estandarizados. Presentamos un estudio multicéntrico nacional sobre PT y una comparación con la literatura existente. [Métodos]Estudio prospectivo observacional realizado mediante el registro nacional de pacientes operados de duodenopancreatectomía cefálica y PT realizadas por cualquier indicación durante el periodo comprendido entre el 1 enero y el 31 diciembre del 2015. [Resultados] Se incluyó a 1.016 pacientes, pertenecientes a 73 centros; de ellos, 112 correspondían a PT. El porcentaje de PT/número total de casos es del 11%. La edad media fue 63,5 años y eran varones un 57,2%. El diagnóstico radiológico de sospecha más frecuente fue cáncer de páncreas (58/112 casos). La técnica de la PT más habitual fue «arteria mesentérica primero» (43/112 casos). Se efectuaron resecciones venosas en 23 pacientes (20,5%). El porcentaje de complicaciones postoperatorias a 90 días fue 50%, pero las complicaciones mayores (>IIIA) solo el 20,7%. La mortalidad global a 90 días fue del 8% (9 pacientes). La estancia media fue 20,7 días. Los 3 diagnósticos histológicos definitivos más frecuentes fueron: adenocarcinoma de páncreas, neoplasia mucinosa papilar intraductal y pancreatitis crónica. La tasa de R0 fue del 67,8%. [Conclusiones] Este estudio demuestra que los resultados de morbimortalidad de la PT en España son similares o superiores a los publicados previamente. Es necesario un estudio más específico sobre PT centrado en complicaciones específicas, como la insuficiencia endocrina