Delay in the residents' choice for General and Digestive Surgery: Analysis of the period 2018-2022.

INTRODUCTION: Every year hundreds of medical residents choose their specialization in various surgical fields. However, these numbers have been poorly analyzed. The objective of this study was to evaluate the selection of General and Digestive Surgery by medical residents and compare these results with the selection of other surgical specialties. METHODS: Cross-sectional observational study. The data from the selection of the medical residents from surgical specialties and the top 10 most demanded specialties between the years 2018 and 2022 were included. An analysis of adjusted ranking numbers based on the number of available positions was also conducted. RESULTS: The number of available positions in General and Digestive Surgery increased by 17.7% during the study period. However, the selection of our specialty has been delayed, with a median ranking number of 2419 (IQR: 1621-3284) in 2018, and 3484 (IQR: 2306-4156) in 2022 (p: .000). These differences remained significant after adjusting for the number of available positions (p: .000). The choice of Urology, Thoracic Surgery, Cardiovascular Surgery, Gastroenterology, and Paediatrics also declined during this period, while Plastic Surgery, Dermatology, Ophthalmology, Anesthesiology, and Endocrinology improved their numbers. CONCLUSION: The choice of General and Digestive Surgery has been delayed according to the data from the MIR selection of 2018-2022. The increase in the number of available positions has not been associated with a proportional increase in demand.

Analysis of recurrence and risk factors in laparoscopic sandwich technique for parastomal hernia repair.

INTRODUCTION: Parastomal hernias are frequent and highly recurrent. The sandwich technique is a combination of the keyhole and Sugarbaker techniques, using a double intraperitoneal mesh. The objective of this study was to assess the outcomes of the sandwich technique, specifically focusing on recurrence rates. MATERIALS AND METHODS: Observational retrospective study conducted in two tertiary referral centers in Catalonia, Spain. All consecutive patients who underwent parastomal hernia repair using the sandwich technique between 1st January 2016 and 31st December 2021 were included. RESULTS: A total of 38 patients underwent the laparoscopic sandwich technique for parastomal hernia repair. The overall recurrence rate was 7.9% (3/38), with a median follow-up of 39 months (IQR: 12.3-56.5). According to the EHS classification for parastomal hernia, there were 47.4% (18/38) type I defects, 10.5% (4/38) type II defects, 28.9% (11/38) type III defects, and 13.2% (5/38) type IV defects. The used mesh was predominantly TiMesh® (76.3%; 29/38), followed by DynaMesh® IPOM (23.7%; 9/38). Patients with recurrence exhibited higher rates of seroma, hematoma, surgical site infection, and one case of early recurrence attributed to mesh retraction. Consequently, postoperative complications emerged as the primary risk factor for hernia recurrence. CONCLUSION: The sandwich technique demonstrated recurrence rates consistent with those reported in the existing literature.

Parietex™ Composite Ventral Patch for primary and incisional hernia repair.

BACKGROUNDS: Ventral hernia repair with a preformed device is a frequent intervention, but few reports exist with Parietex™ Composite Ventral Patch. The aim was to evaluate the results of this mesh with the open intraperitoneal onlay mesh (open IPOM) technique. METHODS: Observational retrospective single institution study of all consecutive patients intervened for ventral or incisional hernia with a diameter inferior to 4 cm, from January 2013 to June 2020. The surgical repair was performed according to the open IPOM technique with Parietex™ Composite Ventral Patch. RESULTS: A total of 146 patients were intervened: 61.6% with umbilical hernias, 8.2% with epigastric hernias, 26.7% with trocar incisional hernias, and 3.4% with other incisional hernias. The global recurrence rate was 7.5% (11/146). Specifically, it was 7.8% in umbilical hernias, 0% in epigastric hernias, 7.7% in trocar incisional hernias and 20% (1/5) in other incisional hernias. The median time for recurrence was 14 months (IQR: 4.4-18.7). The median indirect follow-up was 36.9 months (IQR: 27.2-49.6), and the median presential follow-up was 17.4 months (IQR: 6.5-27.3). CONCLUSION: The open IPOM technique with a preformed patch offered satisfactory results for the treatment of ventral and incisional hernias.

[Preliminary multicentric study on the nutritional status in hospitalization at home (HaD) with the same informational application of nutritional assessment]. / Estudio multicéntrico preliminar sobre el estado nutricional en hospitalización a domicilio (HaD) con una misma aplicación informática de valoración nutricional.

INTRODUCTION: the prevalence of hospital malnutrition is high and involves an increase in health care costs. Home hospitalization (HH) allows better clinically stable patient control after an acute illness by a highly specialized health care team. OBJECTIVE: to know the nutritional condition of home hospitalization patients using a computer application that allows the implementation of early nutritional measures at home and improves post-hospital control of these patients. MATERIAL AND METHODS: prospective multicenter study of the nutritional condition of patients in four different home hospitalization centers during a period of two consecutive months in 2016. Variables were collected: home hospitalization, age, gender, reason for admission, associated morbidity, origin, diagnosis, social assessment, previous nutritional support, height, weight, weight loss, time of weight loss, total proteins, albumin, lymphocytes, cholesterol, body mass index (BMI), nutritional condition, type and degree of malnutrition. Nutritional condition was assessed using the application HEN-Persan and results were statistically analyzed using the SPSS 21.0 software. RESULTS: no significant differences were found between the four centers. In home hospitalization patients, 36% presented a normal nutritional screening and 87% presented some degree of malnutrition, while combined malnutrition prevailed (63%). Depending on the nutritional degree, 36% of patients had mild malnutrition, 27% presented moderate malnutrition and 35% had severe malnutrition. CONCLUSIONS: a computer application allows for an immediate, secure and reliable nutritional assessment in home hospitalization that helps introduce early nutritional measures and improve post-hospital control of patients.

INTRODUCCIÓN: la malnutrición hospitalaria tiene una elevada prevalencia y comporta un incremento del coste sanitario. La hospitalización a domicilio (HaD) permite el control en el domicilio de un episodio hospitalario agudo estable clínicamente por un equipo sanitario especializado.Objetivo: conocer el estado nutricional de los pacientes que ingresen en HaD con una misma aplicación informática (app) para poder instaurar medidas nutricionales precoces en el domicilio y mejorar la evolución posthospitalaria de los pacientes. MATERIAL Y METODOLOGÍA: estudio multicéntrico prospectivo y descriptivo del estado nutricional en cuatro unidades de HaD, durante un periodo de dos meses consecutivos durante el año 2016. Se recogieron las variables: unidad de HaD, edad, sexo, motivo de ingreso, patología asociada, procedencia, diagnóstico, valoración social, soporte nutricional previo, talla, peso, pérdida de peso, tiempo de la pérdida de peso, proteínas totales, albúmina, linfocitos, colesterol, índice de masa corporal (IMC), estado nutricional según el IMC, riesgo nutricional, tipo y grado de desnutrición. Se realizó la valoración nutricional con la app HEN-Persan y se analizaron los resultados estadísticamente con el programa informático SPSS 21.0. RESULTADOS: no existen diferencias significativas entre las cuatro unidades. Globalmente, el 36% de pacientes ingresados en HaD presentaban un estado nutricional normal. El 87% presentaba algún tipo de malnutrición, predominando la desnutrición de tipo mixta (63%). Según el grado,fue leve (36%), moderada (27%) y grave (35%). CONCLUSIONES: la utilización de una app permite tener una valoración nutricional inmediata, de manera fácil, segura y fiable en HaD, para poder introducir medidas nutricionales precoces y mejorar la evolución posthospitalaria de los pacientes.

Prospective, randomized comparative study between single-port laparoscopic appendectomy and conventional laparoscopic appendectomy.

INTRODUCTION: Laparoscopic appendectomy is probably the technique of choice in acute appendicitis. Single port laparoscopic surgery (SILS) has been proposed as an alternative technique. The objective of this study is to compare the safety and efficacy of SILS against conventional laparoscopic appendectomy (LA). MATERIAL AND METHODS: From January 2011 to September 2012, 120 patients with acute appendicitis were prospectively randomized; 60 for SILS and 60 for LA. Patients between 15 to 65 years were selected, with onset of symptoms less than 48h. We compared BMI, surgery time, start of oral intake, hospital stay, postoperative pain, pathology and costs. RESULTS: The median age, BMI, sex and time of onset of symptoms to diagnosis were similar. There were no statistically significant differences in the operative time, start of oral intake or hospital stay. There was a significant difference in postoperative pain being higher in SILS (4±1.3) than in LA (3.3±0.5) with a P=.004. Flemonous appendicitis predominated in both groups in a similar percentage. A total of 3 cases with intra-abdominal abscess (SILS 2, LA 1) required readmission and resolved spontaneously with intravenous antibiotic treatment. One case of SILS required assistance by a 5mm trocar in the RLC for drainage placement. The cost was higher in SILS due the single port device. CONCLUSION: SILS appendectomy is safe, effective and has similar results to LA in selected patients, and although the cost is greater, the long term results will determine the future of this technique.

[Giant esophageal lipoma]. / Lipoma esofágico gigante.

Esophageal lipomas are uncommon benign tumors. The main symptom of this type of tumor is dysphagia due to esophageal obstruction. The diagnostic studies of choice are endoscopy, radiological investigation with contrast administration, computed tomography, and echoendoscopy. We present an unusual case of giant pediculated esophageal lipoma which manifested clinically with dysphagia. Management was surgical.