Cost-effectiveness of robotic vs laparoscopic distal pancreatectomy. Results from the national prospective trial ROBOCOSTES.

INTRODUCTION: Although several studies report that the robotic approach is more costly than laparoscopy, the cost-effectiveness of robotic distal pancreatectomy (RDP) over laparoscopic distal pancreatectomy (LDP) is still an issue. This study evaluates the cost-effectiveness of the RDP and LDP approaches across several Spanish centres. METHODS: This study is an observational, multicenter, national prospective study (ROBOCOSTES). For one year from 2022, all consecutive patients undergoing minimally invasive distal pancreatectomy were included, and clinical, QALY, and cost data were prospectively collected. The primary aim was to analyze the cost-effectiveness between RDP and LDP. RESULTS: During the study period, 80 procedures from 14 Spanish centres were analyzed. LDP had a shorter operative time than the RDP approach (192.2 min vs 241.3 min, p = 0.004). RDP showed a lower conversion rate (19.5% vs 2.5%, p = 0.006) and a lower splenectomy rate (60% vs 26.5%, p = 0.004). A statistically significant difference was reported for the Comprehensive Complication Index between the two study groups, favouring the robotic approach (12.7 vs 6.1, p = 0.022). RDP was associated with increased operative costs of 1600 euros (p < 0.031), while overall cost expenses resulted in being 1070.92 Euros higher than the LDP but without a statistically significant difference (p = 0.064). The mean QALYs at 90 days after surgery for RDP (0.9534) were higher than those of LDP (0.8882) (p = 0.030). At a willingness-to-pay threshold of 20,000 and 30,000 euros, there was a 62.64% and 71.30% probability that RDP was more cost-effective than LDP, respectively. CONCLUSIONS: The RDP procedure in the Spanish healthcare system appears more cost-effective than the LDP.

Quality of Life and Psychological Changes in Bariatric Surgery: An Observational Study.

INTRODUCTION: Candidates for bariatric surgery may have psychiatric disorders that must be evaluated. The aim of this study was to describe the psychological state and quality of life (QoL) of patients with obesity awaiting bariatric surgery prior to surgical procedure and 1 year after surgery. METHODS: A longitudinal retrospective observational study was carried out in 71 patients awaiting bariatric surgery. Anthropometric data were collected, and the following were evaluated before and 1 year after the intervention: 44 patients were evaluated to rule out personality disorder, using the Salamanca Questionnaire of Personality Disorders; eating disorder, with the Bulimia Test of Edinburgh (BITE); depression, using the Beck Depression Inventory (BDI); and 71 patients were evaluated QoL, with the "36-Item Short Form Health Survey" (SF-36). RESULTS: A total of 34.1% (n = 15) of patients presented personality disorder (group B most frequent). A total of 31.8% (n = 14) obtained scores suggesting anomalous food behavior (6.8%, n = 3 severe). According to the BDI, 43.2% (n = 19) showed low mood prior to the intervention. Lower scores were obtained when evaluating QoL for physical functioning (physical function: 56.81 ± 24.9; physical problems: 66.76 ± 37.64). One year after the intervention, QoL improved in those patients who underwent the sleeve gastrectomy (SG). CONCLUSIONS: Patients with bariatric surgery more frequently presented with type B and C personalities. One year after bariatric surgery, an improvement in QoL test was observed. Patients who underwent SG technique showed better mean scores than those after biliopancreatic diversion.

Type V biliary cyst with cystolithiasis.

We present the case of a 40-year-old female who presented to the General Surgery clinic due to a single episode of abdominal pain which required a visit to the Emergency Department. The patient had undergone surgery during childhood due to the suspicion of a hepatic hydatid cyst. However, an intraoperative cholangiography identified a small, non-complicated biliary cyst. Therefore, a hepatic resection was not performed. The patient did not undergo follow-up of the lesion.

Effect on Body Composition of a Meal-Replacement Progression Diet in Patients 1 Month after Bariatric Surgery.

BACKGROUND: Progression diets after bariatric surgery (BS) are restricted in calories and protein, and they may induce a worsening of body composition. The aim of this study was to evaluate the effect of a modified diet with an oral nutritional supplement that is hyperproteic and normocaloric over the body composition. METHODS: A two-arm ambispective observational cohort study was designed. Forty-four patients who underwent sleeve gastrectomy were included in the study. Thirty patients received a progression diet with a normocaloric, hyperproteic oral nutritional supplement during the first two weeks after surgery (820 kcal, 65.5 g protein). They were compared with a historical cohort of 14 patients treated with a standard progression diet (220 kcal, 11.5 g protein). Anthropometric and body composition (using electrical bioimpedanciometry) data were analyzed before BS and 1 month after the surgery. RESULTS: The mean age was 47.35(10.22) years; 75% were women, and the average presurgical body mass index (BMI) was 45.98(6.13) kg/m2, with no differences between both arms of intervention. One month after surgery, no differences in the percentage of excess weight loss (%PEWL) were observed between patients in the high-protein-diet group (HP) and low-protein-diet group (LP) (HP: 21.86 (12.60)%; LP: 18.10 (13.49)%; p = 0.38). A lower loss of appendicular skeletal muscle mass index was observed in the HP (HP: -5.70 (8.79)%; LP: -10.54 (6.29)%; p < 0.05) and fat-free mass index (HP: 3.86 (8.50)%; LP:-9.44 (5.75)%; p = 0.03), while a higher loss of fat mass was observed in the HP (HP: -14.22 (10.09)%; LP: -5.26 (11.08)%; p < 0.01). CONCLUSIONS: In patients undergoing gastric sleeve surgery, the addition of a normocaloric, hyperproteic formula managed to slow down the loss of muscle mass and increase the loss of fat mass with no differences on total weight loss.

Quiste biliar tipo V con cistolitiasis / Type V biliary cyst with cystolithiasis

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