[Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic]. / Consenso de la sección de cirugía mayor ambulatoria de la Asociación Española de Cirujanos sobre el papel de la cirugía mayor ambulatoria en la pandemia SARS-CoV-2.

The current situation of the SARS-CoV-2 pandemic has paralyzed non-urgent and/or oncological surgery in many hospitals in our country with what it means for the health of citizens who are awaiting a surgical procedure. Outpatient Surgery can afford more than 85% of the surgical procedures that are performed in a surgical department and is presented as a feasible and safe alternative at the present time since it does not require admission and decreases clearly the risk of infection. In addition, it is the tool that should be generalized to solve the accumulation of patients on the waiting list that the pandemic is generating, so it seems appropriate that the Ambulatory Surgery section of the Spanish Association of Surgeons present a series of recommendations for the implementation of outpatient surgery in these exceptional circumstances that we have to live.

General surgery training in Spain: core curriculum and specific areas of training.

The royal decree RD 639/2014 has been published, regulating among others, the core curriculum, and specific areas of training (SAT). It is of great interest for the specialty of General and Digestive Surgery (GS and DS). The aim is to expose and clarify the main provisions and reflect on their implications for the practical application of the core curriculum and SAT in the specialty of General and Digestive Surgery, to promote initiatives and regulations. This RD will be a milestone in our specialty that will test the strength of the specialty, if it does not finally culminate in its degradation against the emergence of new surgical specialties. A new stage begins in which the Spanish Association of Surgeons should be involved to define the conceptual basis of GS and DS in the XXI century, and the creation of new SAT to continue to maintain the "essence of our specialty".

DUCMA 2.0 project: Update on the current situation of the outpatient surgery units in Spain.

INTRODUCTION: Ambulatory surgery is a safe and efficient management system to solve surgical problems, but its implementation and development has been variable. The aim of this study is to describe the characteristics, structure and functioning of ambulatory surgery units (ASU) in Spain. METHODS: Multicenter, cross-sectional, observational study based on an electronic survey, with data collection between April and September 2022. RESULTS: In total, 90 ASUs completed the survey. The mean overall ambulatory index is 63%. More than half of the ASUs (52%) are integrated units. Around half of the units provide training for physicians (51%) and for nurses (55%). The most frequently used quality indicators are suspension rate (87%) and the rate of unplanned admissions (80%). CONCLUSIONS: Greater coordination between administrations is needed to obtain reliable data. It is also necessary to implement quality management systems in the different units, as well as to develop tools for the adequate training of the professionals involved.

Training in ambulatory surgery. A pending subject in our country.

The implementation and generalized use of Ambulatory Surgery worldwide is currently a clear reality. Its progressive growth is expected in the short term, but this globalization can also negatively affect the education and training of future doctors, as well as those who are being trained now, if it is not standardized and regulated, since a significant part of the management of the most common pathology that could be performed in Ambulatory Surgery is completed outside the training circuits of hospitals where resident doctors are trained.

[A prospective, multicentre study on the activity of general and digestive surgery residents based on the use of the computerised logbook]. / Estudio prospectivo, multicéntrico sobre la actividad de los residentes de cirugía general y del aparato digestivo en España a través del libro informático del residente.

INTRODUCTION: There are no quantified data on the real activity carried out by residents during the 5 years of training in the specialty of general and digestive surgery (GGS) in Spain. There are also limited data on programs in other surgical specialities, and in other countries. The aim of the study is to estimate the mean overall surgical activity by specific skill areas and by the level of complexity of the Spanish program in the specialty of GGS. PATIENTS AND METHOD: A prospective, observational, multicentre study was performed on the activity of GGS residents in Spain using the Resident Computerised Logbook of the Spanish Surgeons Association (LIR-AEC). Each of the residents registered their own activity supervised by their tutor. The sample period was 6 months. The medians of the annual activity and the period of residency were calculated from the results. RESULTS: Surgical activity: during the residency, it was estimated that that they attended 1,325 operations, 654 (49%) as lead surgeon. Health care activity: the mean number of times on-call was 5.2±1.8 per month. Activity in outpatient clinics was 548 first visits, and almost double for second visits. Scientific activity: the total number of courses and conferences attended was 34. The estimated mean number of presentations at conferences was 14, with 3 publications. CONCLUSIONS: LIR-AEC is a suitable tool to verify activity in the Spanish GGS Program. These results may be useful for comparing with training programs in other countries and in other surgical specialties.

Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic.

The current situation of the SARS-CoV-2 pandemic has paralyzed non-urgent and/or oncological surgery in many hospitals in our country with what it means for the health of citizens who are awaiting a surgical procedure. Outpatient Surgery can afford more than 85% of the surgical procedures that are performed in a surgical department and is presented as a feasible and safe alternative at the present time since it does not require admission and decreases clearly the risk of infection. In addition, it is the tool that should be generalized to solve the accumulation of patients on the waiting list that the pandemic is generating, so it seems appropriate that the Ambulatory Surgery section of the Spanish Association of Surgeons present a series of recommendations for the implementation of outpatient surgery in these exceptional circumstances that we have to live.

Surgical pathology associated with Meckel´s diverticulum in a tertiary hospital: 12 year review.

OBJECTIVE: We want to present our experience about surgical pathology of Meckel´s diverticulum by means of a retrospective study. MATERIAL AND METHODS: We report a group of patients of our Department of General and Abdominal Surgery and Paediatric Surgery of our Hospital with Meckel´s diverticulum since January 1997 to January 2010. We report the clinical presentation, complementary test, interventions, and the postoperative follow up. RESULTS: 45 patients were operated in total, 33 of them in emergency surgery under the clinical form of acute abdominal pain; and the others 12 in programmed surgery, these cases came up more frequently like a clinical manifestations of latent abdominal pain, rectal bleeding and anemia. The complementary tests were so varied; abdominal ultrasounds were used in 63% of emergency cases and the 40% of programmed cases, in these patients,gammagraphy with Tc99 was the second test in frequency. Laparoscopy was used in 10 cases (22%). The main surgery technique used was diverticulectomy (82%). CONCLUSIONS: The presence of Meckel´s diverticulum has to be clinically suspected in all patients with abdominal pain of unknow naetiology. Access to the abdominal cavity using routine laparoscopy provides essential information on the diagnosis and for the treatment.

Cross-cultural adaptation, analysis of psychometric properties and validation of the Spanish version of a perioperative satisfaction questionnaire (EVAN-G).

BACKGROUND: Patient satisfaction is a reliable and measurable indicator of the quality provided by a healthcare service. There are several questionnaires for measuring it, but only a few have shown good psychometric properties, an outstanding one being the EVAN-G (Evaluation du Vécu de l'Anesthésie Générale) questionnaire, which measures patient satisfaction regarding perioperative care and is validated in French. The aim of this study is the validation of a Spanish version of the EVAN-G questionnaire. METHODS: A translation/back-translation of the questionnaire into Spanish was carried out and the final version obtained was administered to three hundred patients. Its psychometric properties were measured and compared with those of the original EVAN-G questionnaire to verify that they had been maintained after the previous translation process. The questionnaire's content, construct and external validity were measured. To calculate reliability, Cronbach-α coefficient and test-retest method were used. The Global Satisfaction Index was calculated and satisfaction level in our sample was analyzed. RESULTS: Content, construct and external validity were proven with similar results that in the original EVAN-G. The translated version of the questionnaire showed good reliability: Cronbach-α coefficient was 0.92 and intraclass correlation coefficient measured by test-retest method was 0.9. The acceptability was high. The average Global Satisfaction Index in our sample was 73±12. CONCLUSIONS: The translation into Spanish and cross-cultural adaptation of the EVAN-G questionnaire has proven its validity, reliability, and acceptability to measure patient satisfaction in interventions performed under general anesthesia.

[Surgical training in Spain: results of a national survey]. / Formación quirúrgica en España: resultados de una encuesta nacional.

INTRODUCTION: The aim of the study is to try and find out the state of surgical training in Spain and to determine whether it meets the objectives of the Program. MATERIAL AND METHODS: The results of two surveys carried out on Residents and General Surgery Tutors by the Spanish Surgeons Association, based on the conclusions of the XXVII Congreso Nacional de Cirugía. The questions formulated referred to general aspects of the Service and specific ones related to access, teaching activity, surgery, research and personal perspectives. The responses were defined, adjusted and categorised as quantitative and qualitative variables. The statistics program G Stat 2.0 was used for processing and the descriptive presentation of the results. RESULTS: The surveys were sent to 626 Residents and 142 Tutors, with a response rate of 19% and 29%, respectively. First year residents predominated (32%) compared to later years, with an R-5 response index of 7.2%. A total of 91% knew the speciality Program well, and 76% were satisfied with the training received. CONCLUSIONS: The results obtained as regards surgical activity agree with those established in the Program, both in the number of procedures and in their progression throughout the Residency, although it is not possible to ensure its uniformity. The functions and accreditation of the Tutors which are one of the main foundations of the training process are pending specific regulations.

Consenso de la sección de cirugía mayor ambulatoria de la Asociación Española de Cirujanos sobre el papel de la cirugía mayor ambulatoria en la pandemia SARS-CoV-2 / Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic

La situación actual de la pandemia por SARS-CoV-2 tiene paralizada la cirugía no urgente y/u oncológica en muchos hospitales de nuestro país con lo que esto conlleva para la salud de los ciudadanos que están pendientes de una intervención quirúrgica. La cirugía mayor ambulatoria puede abarcar en su cartera de servicios más del 85% de los procedimientos quirúrgicos que se realizan en un servicio de cirugía y se presenta como una alternativa factible y segura en el momento actual ya que no requiere camas de ingreso y disminuye claramente el riesgo de infección. Además, es la herramienta que debería generalizarse para solucionar la acumulación de pacientes en lista de espera que la pandemia está generando, por lo que parece oportuno que desde la sección de Cirugía Mayor Ambulatoria de la Asociación Española de Cirujanos se presente una serie de recomendaciones para la implementación de la misma en estas circunstancias excepcionales que nos toca vivir.(AU)

The current situation of the SARS-CoV-2 pandemic has paralyzed non-urgent and/or oncological surgery in many hospitals in our country with what it means for the health of citizens who are awaiting a surgical procedure. Outpatient Surgery can afford more than 85% of the surgical procedures that are performed in a surgical department and is presented as a feasible and safe alternative at the present time since it does not require admission and decreases clearly the risk of infection. In addition, it is the tool that should be generalized to solve the accumulation of patients on the waiting list that the pandemic is generating, so it seems appropriate that the Ambulatory Surgery section of the Spanish Association of Surgeons present a series of recommendations for the implementation of outpatient surgery in these exceptional circumstances that we have to live.(AU)

Fibrinogen-thrombin collagen patch reinforcement of high-risk colonic anastomoses in rats.

AIM: To evaluate the effectiveness of human fibrinogen-thrombin collagen patch (TachoSil®) in the reinforcement of high-risk colon anastomoses. METHODS: A quasi-experimental study was conducted in Wistar rats (n = 56) that all underwent high-risk anastomoses (anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group (24 rats) and treatment group (24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil® (a piece of TachoSil® was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS: Overall survival was 71.4% and 57.14% in the TachoSil® group and control group, respectively (P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage (P > 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups (P = 0.066). CONCLUSION: In our study, the use of TachoSil® was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil® has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.

[Appendiceal carcinoid tumors. Evaluation of long-term outcomes in a tertiary level]. / Tumores carcinoides apendiculares. Evaluación de los resultados a largo plazo en un hospital de tercer nive.

BACKGROUND: Appendiceal tumors are found in about 1% of appendectomies performed and 0.5% of intestinal neoplasias. Appendiceal carcinoids are the predominant histology in this group and are usually casual after appendectomy for other reasons. The prognosis is excellent and survival is 95% at 5 years after surgery. METHODS: Retrospective analysis of all patients with appendiceal carcinoid surgery in our hospital for 20 years (1990-2010) and survival at 5 years. We also discuss the need for additional treatment and testing for follow-up visits. RESULTS: 42 patients underwent surgery for appendiceal carcinoid tumor. 38 of them were operated on urgently, mostly for suspected acute appendicitis, without having reached the carcinoid tumor diagnosed preoperatively in any of them. The predominant symptomatology at admission was abdominal pain. Surgical treatment was appendectomy in 34 patients (12 laparoscopic), 7 patients required colon resections over intraoperatively by colonic involvement; only one patient required reoperation to complete right hemicolectomy. 2 patients had disseminated disease at diagnosis (liver metastases). The 5-year survival is over 95%, with no recurrence. CONCLUSIONS: The appendiceal carcinoid tumor is difficult to diagnose preoperatively. Appendectomy surgical treatment is usually sufficient, although colonic resections may be needed for dissemination. The 5-year survival is over 95%.

Antecedentes: los tumores apendiculares se encuentran en cerca de 1% de las apendicectomías y representan 0.5% de las neoplasias intestinales. El tipo de tumor más frecuente es el carcinoide apendicular, que casi siempre es un hallazgo durante la apendicectomía por otro motivo. Su pronóstico es excelente y la supervivencia es mayor de 95% a cinco años de la intervención. Objetivo: reportar una serie de casos y analizar la supervivencia media a cinco años posteriores a la identificación el tumor. Material y métodos: análisis retrospectivo (1990-2010) de pacientes con tumor carcinoide apendicular intervenidos en el servicio de Cirugía General y del Aparato Digestivo del Hospital Universitario Virgen del Rocío, Sevilla, España. Se analizaron: la supervivencia a cinco años, la necesidad de tratamiento complementario y las pruebas para seguimiento en la consulta. Resultados: se encontraron 42 pacientes intervenidos por tener un tumor carcinoide apendicular. En 38 pacientes la operación fue de urgencia, la mayoría por sospecha de apendicitis aguda, sin que en ninguno se hubiera establecido el diagnóstico de tumor carcinoide antes de la operación. El síntoma predominante al ingreso fue el dolor abdominal. El tratamiento quirúrgico fue: apendicectomía en 34 pacientes (12 por laparoscopia), en el intraoperatorio siete pacientes requirieron resecciones colónicas mayores debido a la afectación del colon; sólo uno requirió la reintervención para completar la hemicolectomía derecha. Al momento del diagnóstico dos pacientes tenían enfermedad diseminada (metástasis hepáticas). La supervivencia a cinco años fue superior a 95%, sin recidivas o tratamiento posterior de la enfermedad. Conclusiones: el tumor carcinoide apendicular difícilmente se diagnostica antes del procedimiento quirúrgico. La apendicectomía suele ser suficiente aunque en algunos pacientes las resecciones colónicas son necesarias por diseminación. La supervivencia a 5 años es superior a 95%.

Proyecto DUCMA 2.0. Puesta al día sobre la situación actual de las unidades de Cirugía Mayor Ambulatoria en España / DUCMA 2.0 project: Update on the current situation of the outpatient surgery units in Spain

Introducción: La cirugía mayor ambulatoria (CMA) es un sistema de gestión seguro y eficiente para resolver los problemas quirúrgicos, pero su implantación y desarrollo ha sido variable. El objetivo de este estudio es describir las características, la estructura y el funcionamiento de las unidades de Cirugía Mayor Ambulatoria (UCMA) en España. Métodos: Estudio observacional, transversal, multicéntrico basado en una encuesta electrónica, con recogida de datos entre abril y septiembre de 2022. Resultados: En total, 90 UCMA completaron la encuesta. La media del índice de ambulatorización (IA) global es de 63%. Más de la mitad de las UCMA (52%) son de tipo integrado. La mitad las unidades imparte formación para médicos (51%) y personal de enfermería (55%). Los indicadores de calidad más utilizados son la tasa de suspensiones (87%) y de ingresos no previstos (80%). Conclusiones: Se necesita mayor coordinación entre administraciones para obtener datos fiables. Asimismo, se deben implementar sistemas de gestión de calidad en las unidades y desarrollar herramientas para la formación adecuada de los profesionales implicados.(AU)

Introduction: Ambulatory surgery is a safe and efficient management system to solve surgical problems, but its implementation and development has been variable. The aim of this study is to describe the characteristics, structure and functioning of ambulatory surgery units (ASU) in Spain. Methods: Multicenter, cross-sectional, observational study based on an electronic survey, with data collection between April and September 2022. Results: In total, 90 ASUs completed the survey. The mean overall ambulatory index is 63%. More than half of the ASUs (52%) are integrated units. Around half of the units provide training for physicians (51%) and for nurses (55%). The most frequently used quality indicators are suspension rate (87%) and the rate of unplanned admissions (80%). Conclusions: Greater coordination between administrations is needed to obtain reliable data. It is also necessary to implement quality management systems in the different units, as well as to develop tools for the adequate training of the professionals involved.(AU)

Formación en cirugía mayor ambulatoria. Una asignatura pendiente en nuestro país / Training in ambulatory surgery. A pending subject in our country

La implantación y generalización a nivel mundial de la cirugía mayor ambulatoria (CMA) es una realidad patente en la actualidad y se espera un crecimiento progresivo de la misma a corto plazo, pero esta globalización también puede afectar de forma negativa a la docencia y el entrenamiento de los futuros médicos y aquellos que están en formación, si no se estandariza y regula, ya que una parte importante de la gestión de la patología más frecuente subsidiaria de ser realizada en CMA, acaba fuera de los circuitos del hospital donde el médico residente se está formando. (AU)

The implantation and generalization of ambulatory surgery worldwide is currently a clear reality and its progressive growth is expected in the short term, but this globalization can also negatively affect the teaching and training of future doctors and those who are in training, if it is not standardized and regulated, since an important part of the management of the most common pathology that could be performed in ambulatory surgery finish outside the circuits of the hospital where the resident doctor is training. (AU)

Malignant degeneration in pilonidal disease.

BACKGROUND: Pilonidal disease is one of the most frequent entities in our daily surgical activity. Although it is a benign disease, malignant degeneration is likely to occur in pilonidal disease. We reviewed surgical interventions for pilonidal diseases performed from January 1, 1995 to December 31, 2008. CLINICAL CASE: We reviewed all 3729 histology reports obtained after surgical removal of pilonidal disease. There were three cases of squamous cell carcinoma and one case of basal cell carcinoma. Patients affected by squamous cell carcinoma had a mean age of 54.2 years and a mean time of evolution of the lesions of 20.6 years. We found local recurrence and lymph node recurrence. Mean follow-up period was 5 years and there was no mortality. The patient with basal cell carcinoma had 1 year of pilonidal disease evolution. There were no recurrences. CONCLUSIONS: Malignancy can arise in pilonidal diseases with a long evolution time. There is a high rate of recurrence and morbimortality in cases of squamous cell carcinomas. Adjuvant radiotherapy in addition to complete local excision has demonstrated a decrease in the rate of local recurrence.

Formación en cirugía general en España: troncalidad y áreas de capacitación específica / General surgery training in Spain: Core curriculum and specific areas of training

Se ha publicado el R.D. 639/2014 que regula la troncalidad y las áreas de capacitación específica (A.C.E.) que constituyen una norma de gran interés en la especialidad de Cirugía General y del Aparato Digestivo (C.G. y del A.D.)Se pretende exponer y concretar las principales disposiciones y reflexionar sobre sus implicaciones en la especialidad de C.G. y del A.D., para promover iniciativas y regulaciones. Después de una gestación compleja, este R.D. supondrá un hito en nuestra especialidad, que pondrá a prueba su fortaleza, si no es que culmina finalmente con su degradación frente a la emergencia de nuevas especialidades quirúrgicas, como ya sucedió en el pasado. Se inicia una etapa en la que la Asociación Española de Cirujanos deberá implicarse, para definir las bases conceptuales de la C.G. y del A.D. en el siglo XXI, y la creación de las nuevas A.C.E., para seguir manteniendo la «esencia de nuestra especialidad»

The royal decree RD 639/2014 has been published, regulating among others, the core curriculum, and specific areas of training (SAT). It is of great interest for the specialty of General and Digestive Surgery (GS and DS).The aim is to expose and clarify the main provisions and reflect on their implications for the practical application of the core curriculum and SAT in the specialty of General and Digestive Surgery, to promote initiatives and regulations. This RD will be a milestone in our specialty that will test the strength of the specialty, if it does not finally culminate in its degradation against the emergence of new surgical specialties. A new stage begins in which the Spanish Association of Surgeons should be involved to define the conceptual basis of GS and DS in the XXI century, and the creation of new SAT to continue to maintain the «essence of our specialty»

[Mesh fixation with sutures versus fibrin sealant in hernioplasty with re-absorbable prosthesis (polyglycolic acid and trimethylene carbonate). Experimental study in animals]. / Fijación con sutura frente a sellante de fibrina en hernioplastia con prótesis reabsorbible (ácido poliglicólico y carbonato trimetileno). Estudio experimental en animales.

INTRODUCTION: Current studies have shown the validity of the atraumatic fixation with fibrin glue (Tissucol) compared to conventional sutures in polypropylene mesh fixation. We propose to study the behaviour of absorbable mesh. MATERIAL AND METHODS: We used 20 Wistar white rats. Two hernia defects were made in the abdominal wall, which were repaired using absorbable PGA-TMC preperitoneal mesh. The right side of the mesh was fixed with Tissucol and left side with conventional suture attached to the muscle fascia. One group of 10 rats were sacrificed at day 14 (Series A) and the other 10 rats at 28 days (Series B). We used two tests to assess the contingency of the abdominal wall; Pressure Test: pneumoperitoneum more than 40mmHg maintained for 1min, Traction Test: dynamometry of the affected area more than 300mg per cm(2) of traction. Abdominal wall was analysed to determine the integration of the new generation mesh. RESULTS: The fixation of the mesh after the pressure and traction tests showed no statistically significant changes in either group. The integration of the mesh and vessel neoformation was higher in the cases of fixation with fibrin glue. CONCLUSIONS: Biological fixation with fibrin glue is similar to the conventional. Absorbable mesh was suitably integrated and vascular neoformation and integration of the mesh was also found to be better than conventional sutures when fibrin sealant was applied.

[General surgery and the digestive system: new program, same challenges]. / Formación en cirugía general y del aparato digestivo: nuevo programa, mismos retos.

On 8 may 2007, the Official Bulletin (BOE) published the new Specialist Training Program. The Post-Graduate Training Section of the Spanish Surgeons Association (AEC), conscious of the importance of this situation, has carried out a reflective analysis of this Program and proposes a series of objectives. The new plan coordinates a training program that sets out three general objectives as regards, knowledge, skills and attitudes that the resident must assimilate and develop, it strictly defines the final product, without substantially changing the previous program and emphasises two fundamental aspects: training in minimally invasive surgery and research training, although the inclusion of previously unpublished new rotations and the continuation of the current assessment model. The logic in the definition of general surgery as "a major discipline paradigm" should lead to important structural changes. Aspects such as regulating work and training times, European Directives, lack of professional motivation and changes in the vocational spectrum of new residents, will make the optimisation of the results difficult a priori. The year 2017 will be the time to judge the results after five groups of surgeon graduates have been trained by this program.

[Prevention of surgical infection using reabsorbable antibacterial suture (Vicryl Plus) versus reabsorbable conventional suture in hernioplasty. An experimental study in animals]. / Prevención de la infección quirúrgica utilizando sutura reabsorbible antibacteriana (Vicryl Plus) en lugar de la sutura reabsorbible convencional en hernioplastias. Estudio experimental en animales.

INTRODUCTION: Surgical site infections are frequent in daily surgical practice. One of the main challenges currently facing surgeons is the prevention and treatment of infections, especially those involving prosthetic material. A new suture (Vicryl Plus) has become available. In vitro studies and experimental models have demonstrated the ability of this suture to inhibit bacterial growth and consequently prevent postsurgical infection. OBJECTIVES: To compare infections provoked in prosthetic implants fixed with reabsorbable conventional sutures with those in meshes fixed with reabsorbable sutures with antiseptic impregnation. MATERIAL AND METHOD: Twenty white Wistar rats were used. In each rat, two hernioplasties were performed: one fixed with Vicryl Plus and the other with normal Vicryl. Subsequently, each polypropylene mesh was infected with S. aureus, and the rats remained in individual cages for a week. After 1 week, the rats were sacrificed and the meshes were extracted for macroscopic, microscopic and microbiologic study. RESULTS: Most of the meshes fixed with the new suture (Vicryl Plus) showed macroscopically fewer infections than those fixed with conventional suture, without abscesses and without dehiscence of the hernioplasty. In the microbiological quantitative bacterial study, the number of bacteria quantified per gram of sample was also lower in prostheses fixed with Vicryl Plus. Pathological analysis showed lesser colonization of the mesh and lower inflammatory response with Vicryl Plus than with normal Vicryl. In the statistical analysis, comparison of the medians of both groups and the interquartile ranges of microbial quantification revealed a lower infection rate in the Vicryl Plus group. CONCLUSIONS: The infection rate in the surgical site can be reduced by mesh fixation using the new antimicrobial suture (Vicryl Plus). We believe that this type of suture constitutes a new weapon in the fight against postoperative infection, especially in hernioplasty, emergency surgery, and dirty or potentially contaminated surgery.

[Randomized clinical study of polydioxanone and nylon sutures for laparotomy clousure in high-risk patients]. / Estudio clínico aleatorizado entre sutura de polidioxanona y de naylon en el cierre de laparotomía en pacientes de riesgo.

INTRODUCTION: The complications of surgical wound closure in patients with risk factors significantly increases morbidity and mortality. The aim of the present study was to evaluate differences in abdominal wall closure in patients with risk factors with the same closure technique and slow-absorbable or non-absorbable sutures. MATERIAL AND METHODS: We performed a prospective, multicenter, comparative study of polydioxanone versus nylon sutures. Laparotomies performed for intestinal diseases and hepatobiliopancreatic procedures in patients with at least one risk factor were included. Exclusions criteria were eventrations, interventions for obesity, the need for reinforcement sutures, uncommon incisions, life expectancy of less than 1.5 years and deaths unrelated to the wound. Closure was performed with monoplane, extracutaneous, continuous, en bloc, loop sutures. Infection, evisceration, dehiscence, extrusion, sinus, eventration, intolerance, and pain were evaluated. Postoperative follow-up was performed at 10 and 30 days, 3 and 6 months, and at 1 and 1.5 years. RESULTS: A total of 770 patients were included (451 in the polydioxanone group and 319 in the nylon group). A total of 78.05% were midline incisions, with a mean length of 23.3 cm. Caliber 1 sutures were most frequently used (85.45%), and 1.7 sutures were used per patient. No complications occurred in 94.03% with no differences between groups (94.7% polydioxanone and 93.1% nylon). The results were similar throughout follow-up. The surgical infection rate was 10%. No differences were found in any of the follow-up assessments in any of the variables analyzed. CONCLUSIONS: Abdominal wall closure should be performed with continuous slow-absorption sutures such as polydioxanone since this type of suture has a similar complication rate to reabsorbable sutures and presents greater biocompatibility.