Producción científica internacional en cirugía digestiva laparoscópica

Objetivo: obtener datos sobre la investigación en cirugía digestiva laparoscópica, en los años 1991 a 1996. Material y métodos: usamos Medline y Science Citation Index para obtener los datos generales de producción; para los datos específicos (contenidos, etc.) utilizamos muestras aleatorias con nivel de confianza del 99%. Resultados: hay 4.825 publicaciones de cirugía digestiva laparoscópica y 4.085 de otras especialidades; son artículos el 85%, editoriales y cartas el 15%. Los hospitales universitarios publican un 40%. Los países productores son EE.UU. (45%), Francia (8,2%), Reino Unido (7,9%) y Alemania (7,5%). Los pa- íses editores son EE.UU. (41%), Alemania (15,3%), Reino Unido (9,7%) y Francia (6,7%). La mayor influencia la logra el N e w England Journal of Medicine, consiguiendo un factor de impacto total de 589; British Journal of Surgery 436, A r c h i v e s of Surgery 343, American Journal of Surgery 336 y A n n a l s of Surgery 302; el impacto medio relativo es de 1.886. Metodológicamente hay 756 estudios retrospectivos, 275 prospectivos y 43 ensayos clínicos aleatorizados; el resto no son series. Los contenidos mayoritarios son sobre técnicas e instrumental e indicaciones y reflexiones en general. La región anatómica más investigada es la vesícula biliar, seguida de las vías biliares y colon. Las diferencias tienen “z” > 1,645, es decir, p <0,05, por lo que son estadísticamente significativas. Conclusiones: la mayor producción y edición la realiza EE.UU. y la mayor influencia la consigue el New England. Son escasos los estudios metodológicamente importantes, siendo los ensayos clínicos aleatorizados sólo un 1%

The Maternal Education Programme in the Public Health System in Galicia

[Resumen] Objetivos. Los objetivos del presente estudio han sido conocer la presión asistencial de los cursos de Educación Maternal en los centros de salud gallegos, así como su temporalización y las actividades teóricas y prácticas realizadas. Material y métodos. Estudio observacional de prevalencia mediante cuestionario autoadministrado y autofranqueado de todos los Centros de Salud de la Comunidad Autónoma de Galicia que disponen de matrona. El análisis estadístico ha consistido en un estudio descriptivo de todas las variables incluidas en el estudio. En el 81,5 % de las encuestas recibidas se refiere la existencia del Programa de Educación Maternal. En el 93,4 % de los casos las mujeres que inician el programa lo finalizan. Los contenidos teóricos del programa más frecuentemente desarrollados han sido cuidados en el recién nacido, lactancia y cuidados en el puerperio que están presentes en el 100 % de los casos; y el menos frecuentemente abordado ha sido medicación y embarazo. Los contenidos prácticos del programa más frecuentemente desarrollados han sido las técnicas de respiración (100 %), seguida de la preparación física preparto (98,1 %); y el menos desarrollado ha sido la recuperación física posparto. El mes de gestación en el que se inició el programa tuvo como mediana 6,5. La duración del programa tuvo como mediana 10 semanas. En el 100 % de las encuestas recibidas se indica que el responsable del programa es la matrona. Según las respuestas recibidas, existe una buena implementación del Programa de Educación Maternal. En cuanto a los contenidos teóricos y prácticos abordados en el período preparto, se observa una gran homogeneidad entre las distintas Unidades, abarcando gran variedad de aspectos. Parece que se enfatiza el programa preparto respecto al posparto, que cuenta con un menor número de horas semanales y de semanas de duración.[Abstract] Aims of the study. The goals of this study have been to know the number of patients who participate in the Maternal Education Program in the Health Centers in Galicia. Timetable, theoretical and practical activities of the program have been analised. Subject and methods. transversal descriptive study. We have sent by post a survey to all the health centers of Galicia which have midwifes. The statistic analyses has been about a descriptive study of all the variables included in the questionnaire. The maternal Education Program exists in the 81.5 % of the replies we have received. In the 93.4 % of the cases, the women both started and finished the program. The theoretical contents more frequently developed have been the medical care for newborn, breast-feeding and medical care in the postpartum period, which are present in the 100 % of the cases. The less frequently developed has been the medication and pregnancy. The practical contents of the program more frequently developed have been the breathe technics (100 %) followed by physical training during pregnancy (98.1 %). The less developed topic has been the physical training after delivery. The month of pregnancy when the programme begun had as median 6.5. The lenght of the program had as median 10 weeks. The 100 % of the replies showed that the person in charge of the programme was the midwife. According to the replies we have received, there is a high development of the Maternal Education Program. Related to the theoretical and practical contents taught during the pregnancy, there is so much homogeneity about several aspects among the different centers. It seems to be more emphasis in the prepartum compared to the postpartum program, which has less number of hours per week, and also less weeks of length

Improving the Advantages of Single Port in Right Hemicolectomy: Analysis of the Results of Pure Transumbilical Approach with Intracorporeal Anastomosis

Background. Single-port laparoscopic surgery has recently emerged as a method to improve patient recovery and cosmetic benefits of laparoscopic surgery. The evolution of our technique has led us to move from a periumbilical incision to a transumbilical one, avoiding the use of drain and maintaining a pure single-port approach with intracorporeal anastomosis in order to maintain the incision as smaller as possible. Method. We report a prospective clinical analysis of our first 38 patients. Oncological surgical steps were followed as during the standard laparoscopic approach, performing the anastomosis intracorporeally in all cases. Results. Mean age of 68,39 years old and an average BMI of 27,88%. (range 19,81–41,5). Most lesions were adenocarcinoma (65,8%), while the remaining were polyps (31,5%) and one a mucocele of the appendix. We moved from a periumbilical incision, initial 14 cases, into a transumbilical one, (medium size of the incision 3,25 cm). Average surgical time was 117,42 minutes. Drains was only used in our first 3 cases. Mean hospital stay was 5,2 days, (86,5% stayed less than 5 days). Total morbidity was 13%. Histological exams of the specimens showed that the oncological criteria were preserved. Conclusions. Single-port right hemicolectomy with intracorporeal anastomosis is feasible and safe. The advantages of a total intracorporeal anastomosis include that there is no need to enlarge the umbilical incision and avoid traction of the pedicle of the mesenterium of the transverse colon during the extracorporeal anastomosis. A transumbilical incision offers better cosmetic results, and the use of drains can be avoided, which increase, patient's satisfaction

Fluorescence‐based bowel anastomosis perfusion evaluation: results from the IHU‐IRCAD‐EAES EURO‐FIGS registry

Background Anastomotic leakage (AL) is one of the dreaded complications following surgery in the digestive tract. Near-infrared fluorescence (NIRF) imaging is a means to intraoperatively visualize anastomotic perfusion, facilitating fluorescence image-guided surgery (FIGS) with the purpose to reduce the incidence of AL. The aim of this study was to analyze the current practices and results of NIRF imaging of the anastomosis in digestive tract surgery through the EURO-FIGS registry. Methods Analysis of data prospectively collected by the registry members provided patient and procedural data along with the ICG dose, timing, and consequences of NIRF imaging. Among the included upper-GI, colorectal, and bariatric surgeries, subgroup analysis was performed to identify risk factors associated with complications. Results A total of 1240 patients were included in the study. The included patients, 74.8% of whom were operated on for cancer, originated from 8 European countries and 30 hospitals. A total of 54 surgeons performed the procedures. In 83.8% of cases, a pre-anastomotic ICG dose was administered, and in 60.1% of cases, a post-anastomotic ICG dose was administered. A significant difference (p < 0.001) was found in the ICG dose given in the four pathology groups registered (range: 0.013–0.89 mg/kg) and a significant (p < 0.001) negative correlation was found between the ICG dose and BMI. In 27.3% of the procedures, the choice of the anastomotic level was guided by means of NIRF imaging which means that in these cases NIRF imaging changed the level of anastomosis which was first decided based on visual findings in conventional white light imaging. In 98.7% of the procedures, the use of ICG partly or strongly provided a sense of confidence about the anastomosis. A total of 133 complications occurred, without any statistical significance in the incidence of complications in the anastomoses, whether they were ICG-guided or not. Conclusion The EURO-FIGS registry provides an insight into the current clinical practice across Europe with respect to NIRF imaging of anastomotic perfusion during digestive tract surgery

Small bowel obstruction due to laparoscopic barbed sutures: An unknown complication?

Background: In recent years there has been an increasing uptake in the use of barbed sutures, particularly in minimally invasive and laparoscopic procedures where they may reduce operating time and improve surgical efficiency. However, little is known about the adverse events associated with these new materials and concerns have arisen regarding their safety in certain procedures. Methods: We performed a search of electronic databases (PubMed, EMBASE, and Cochrane Database). We reveal up to 15 cases of small bowel obstruction (SBO) complicating laparoscopic pelvic surgery that have been reported to date adding two cases of SBO in our own practice following the use of barbed sutures in laparoscopic operations, both requiring surgical re-intervention in the early post-operative period. Results: Fifteen similar cases of small bowel obstruction were identified, all of which occurred in patients undergoing surgery below the transverse colon. Surgical re-intervention was required in all cases although 60% of these were performed laparoscopically. Conclusions: These cases highlight that although barbed sutures provide an attractive means to allow easier and faster laparoscopic suturing, they should be used carefully in inframesocolic surgery and the suture end cut and buried to avoid inadvertent attachment to the small bowel or its mesentery. Barbed suture entanglement should be considered as an uncommon yet potentially serious differential cause for SBO presenting in the early period after laparoscopic surgery where a barbed suture has been used

Intragastric Endoscopic Assisted Single Incision Surgery for Gastric Leiomyoma of the Esophagogastric Junction

Single port laparoscopic surgery is becoming an alternative to conventional laparoscopic surgery as a new approach where all the conventional ports are gathered in just one multichannel port through only one incision. Appling this technical development, we have developed a new technique based on an intragastric approach using a single port device assisted by endoscopy (I-EASI: intragastric endoscopic assisted single incision surgery) in order to remove benign gastric lesions and GIST tumors placed in the posterior wall of the stomach or close to the esophagogastric junction or the gastroduodenal junction. We present a patient with a submucosal gastric tumor placed near the esophagogastric junction removed with this new approach

Hérnia U: desafios e oportunidades de uma plataforma online para educação cirúrgica

The internet has become an essential tool for education1 . Nowadays, it is widely used by physicians for obtaining medical information. There was no website for surgical education before the year 2000. The pioneer website was WebSurg, from IRCAD, France2 . There are different types of distant education: telesurgery (live or edited), live lectures, case discussions and so on2,3. These new learning methods are considered as distant education and can be integrated in the surgical curriculum2 . There are many online tools used to share knowledge: websites, mobile programs for cell phones or even social media4,5. The aim of this study is to describe an online and free surgical education tool for students, residents and surgeons who want to update their knowledge in abdominal wall surgery.A internet se tornou ferramenta essencial para a educação1 . Atualmente, é amplamente utilizada por médicos para obtenção de informações em distintas áreas de conhecimento. Não existia nenhum site para educação cirúrgica antes de 2000. O pioneiro foi o WebSurg, do IRCAD, França2 . Existem diferentes tipos de educação à distância: telecirurgia (ao vivo ou editada), palestras ao vivo, discussão de casos e assim por diante2,3. Esses novos métodos de aprendizagem são considerados educação à distância e, podem ser integrados ao currículo cirúrgico2 . Existem muitas ferramentas online utilizadas para compartilhar conhecimento: sites, aplicativos para telefones celulares ou até mesmo mídias sociais4,5. O objetivo deste estudo é descrever ferramenta online gratuita de educação cirúrgica para estudantes, residentes e cirurgiões que desejam atualizar seus conhecimentos em cirurgia da parede abdominal