[Training of residents in abdominal wall surgery in Spain]. / Consideraciones en torno a la formación del residente en cirugía de pared abdominal en España.

The training of residents in abdominal wall surgery is a fundamental aspect of surgical training, representing globally 20% of its activity. In this paper, we analyze the current state of resident training in this kind of surgery in Spain, taking into account the broad spectrum it covers: general services, specific functional units, ambulatory surgery programs. To do this, based on the specifications of the specialty program, specific data were used from several different sources of direct information and a review of the results obtained by residents in hernia surgery. In general, our residents agree with their training and the recorded results are in line with objectives outlined in the program. However, it would be important to structure their teaching schedules, a rotation period in any specific unit and their involvement in outpatient surgery programs.

The SARS-CoV-2 first wave impact in the acute inflammatory surgical pathologies.

Anecdotal evidence suggests that community infection control measures during the COVID-19 outbreak have modified the number and natural history of acute surgical inflammatory processes (ASIP-appendicitis, cholecystitis, diverticulitis and perianal abscesses) admissions. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation and treatment ASIP and quantify the effect of COVID-19 infection on the outcomes of ASIP patients. This was a multicentre, comparative study, whereby ASIP cases from 2019, 2020 and 2021 (March 14th to May 2nd) were analyzed. Data regarding patient and disease characteristics as well as outcomes, were collected from sixteen centres in Madrid, and one in Seville (Spain). The number of patients treated for ASIP in 2019 was 822 compared to 521 in 2020 and 835 in 2021. This 1/3rd reduction occurs mainly in patients with mild cases, while the number of severe cases was similar. Surgical standards suffered a step back during the first wave: Lower laparoscopic approach and longer length of stay. We also found a more conservative approach to the patients this year, non-justified by clinical circumstances. Luckily these standards improved again in 2021. The positive COVID-19 status itself did not have a direct impact on mortality. Strikingly, none of the 33 surgically treated COVID positive patients during both years died postoperatively. This is an interesting finding which, if confirmed through future research with a larger sample size of COVID-19 positive patients, can expedite the recovery phase of acute surgical services.

Pseudomyxoma peritonei secondary to epithelial appendicular neoplasms. Experience in a non-specialised centre.

INTRODUCTION: Pseudomyxoma peritonei is an infrequent entity, defined by collections of gelatinous material in the abdomen and pelvis and mucinous implants on peritoneum, secondary to the rupture of a mucinous lesion, usually of ovarian or appendiceal origin. MATERIALS AND METHODS: We present our experience of 11 cases (6 males and 5 females) diagnosed with pseudomyxoma peritonei secondary to epithelial appendicular neoplasms over 27 years. The mean age of the patients was 68 years. Clinical manifestations were abdominal distension (55%), right lower quadrant pain (45%) suggesting acute appendicitis and constitutional syndrome (36%). An abdominal mass was detected at physical examination in 4 patients. CT scan revealed a tumour in right iliac fossa in 4 patients, peritoneal enlargement in 1 and a liquid collection in 1. Preoperative diagnosis was acute abdomen in 5 patients, peritoneal carcinomatosis in 3 and undetermined abdominal mass in 3. RESULTS: Surgical findings suggested pseudomyxoma peritonei in 8 patients and peritoneal carcinomatosis in 3. Appendicectomy was performed in 9 patients, and in 3 of them bilateral anexectomy was also performed. One patient underwent ileocaecal resection and another a right hemicolectomy. In all the cases, mucinous material was eliminated as much as possible. Pathology revealed mucinous cystoadenoma in 6 cases, mucinous cystoadenocarcinoma in 3 and epithelial hyperplasia in 2 patients. Median survival was 54 months, with a 5- year survival rate of 40%. The last case we treated was sent to a reference centre for the treatment of pseudomyxoma peritonei. CONCLUSIONS: There is no consensus on the best treatment for pseudomyxoma peritonei. We recommend avoiding incomplete surgical resections in non-reference centres and submitting patients to a reference centre to undergo adequate treatment.

Peritoneal carcinomatosis secondary to carcinoid tumour.

Carcinoid tumours are neuroendocrine neoplasms that can appear in every location of the digestive tract. They are low aggressive tumours, although they often produce local invasion and hepatic metastases, whose resection allows long-term survival. We report a case of a 64-year-old man with ileal carcinoid tumour, that underwent ileal resection and metastasectomy of one lesion in liver segment II. Surgical findings indicated peritoneal carcinomatosis. Carcinoid dissemination as peritoneal carcinomatosis has been rarely described in the literature. Cytoreductive surgery, always when complete resection is aimed, achieves asymptomatic long-term survivals.

[Embolectomy in mesenteric ischemia]. / Embolectomía en la isquemia mesentérica.

OBJECTS: A retrospective study on patients operated on for intestinal ischemia. PATIENTS AND METHODS: We have carried out a retrospective study on 21 patients suffering from intestinal embolism, in whom an embolectomy was performed at the origin of the superior mesenteric artery. The diagnosis was based on angiography in 12 patients before operation. In the other nine patients the diagnosis was confirmed during operation. RESULTS: After embolectomy the viability of the gut was achieved in 43% of patients (100% if the duration of the symptomathology was less than 12 hours, 56% if it was between 12 and 24 hours, and 18% if it was more than 24). The mortality correlated with the duration of the symptoms. Overall mortality was 57%. CONCLUSIONS: The only way to improve the survival rate is to obtain an early diagnosis, which could be achieved by performing a mesenteric angiography on all patients with sudden and vague abdominal pain and with a history of cardiovascular disease.

Endoanal ultrasound in perirectal abscesses.

INTRODUCTION: Transrectal ultrasound is a useful exploration in the assessment of local spread of rectal tumors. AIM: The aim of this study has been the knowledge of the results of transrectal ultrasound in perirectal abscesses. PATIENTS AND METHODS: Forty patients suffering from perianal septic disease were examined with endoanal echography before surgical approach. The endorectal probe used was initially of 5 MHz and in the last 25 patients of 7.5 MHz. RESULTS: The examination could not be done in 8 patients because severe pain originated by the introduction of the probe in the anal canal. The echographic findings show the exact location and extension of the abscesses as confirmed by the surgical exploration. In three patients we suspected a perirectal abscess due to fever and anal pain but the anal exploration was normal; the ultrasonography showed the collection in all patients and two of them were treated by echoguided drainage. CONCLUSIONS: Transrectal ultrasonography localizes and defines the extension of perirectal abscesses. It is a very important diagnostic and therapeutic tool in patients with clinical presumption, but not confirmation, of what kind of abscesses.

[Pelvic lipomatosis: a case report with diagnostic and therapeutic approach]. / Lipomatosis pélvica: un caso con enfoque diagnóstico y terapéutico.

Pelvic lipomatosis is a rare disease of unknown etiology characterized by benign proliferation of fat in the pelvis. We describe a 27-year-old man with pelvic and retroperitoneal lipomatosis causing a severe urinary and fecal obstruction. The diagnosis was evaluated by barium enema, intravenous urogram, computerized tomography and magnetic resonance imaging. The therapeutic approach is described and discussed.

Consideraciones en torno a la formación del residente en cirugía de pared abdominal en España / Training of residents in abdominal wall surgery in Spain

La formación del residente en cirugía de la pared abdominal constituye un aspecto fundamental en la formación quirúrgica, representando globalmente un 20% de su actividad. En el presente artículo, se analiza el estado actual de la formación del residente en este tipo de cirugía en España teniendo en cuenta el amplio espectro en el que se desarrolla: servicios generales, unidades funcionales específicas, programas de cirugía mayor ambulatoria. Para ello, partiendo de las especificaciones del programa de la especialidad, se han utilizado datos concretos obtenidos de diversas fuentes de información directas, así como una revisión de los resultados obtenidos por los residentes en cirugía herniaria. En general los residentes en nuestro país manifiestan su conformidad con la formación recibida, y los resultados objetivos registrados se adecuan a los planteados en el programa. Sin embargo, sería importante estructurar en sus itinerarios docentes, un periodo de rotación en alguna Unidad específica y su implicación en programas de cirugía mayor ambulatoria (AU)

The training of residents in abdominal wall surgery is a fundamental aspect of surgical training, representing globally 20% of its activity. In this paper, we analyze the current state of resident training in this kind of surgery in Spain, taking into account the broad spectrum it covers: general services, specific functional units, ambulatory surgery programs. To do this, based on the specifications of the specialty program, specific data were used from several different sources of direct information and a review of the results obtained by residents in hernia surgery. In general, our residents agree with their training and the recorded results are in line with objectives outlined in the program. However, it would be important to structure their teaching schedules, a rotation period in any specific unit and their involvement in outpatient surgery programs (AU)

Endometriosis intestinal / No disponible

No disponible

Multidisciplinary management in rectal cancer

The treatment of rectal cancer has evolved over the last few decades from surgery alone to treatments with trimodal therapy for high-risk patients. The involvement of a multidisciplinary team of radiologists, pathologists, surgeons, radiotherapists and medical oncologists is now fundamental for decision-making and outcomes. The evolution of different diagnostic and therapeutic techniques has optimised the therapeutic rate. Future studies will determine the optimal regimen for inducing complete responses in locally advanced disease and whether the intensification of local treatments could enable the use of more conservative treatments, as for other tumour locations. The study of biomarkers will be essential in this respect (AU)

Pseudomyxoma peritonei secondary to epithelial appendicular neoplasms. Experience in a non-specialised centre

INTRODUCTION: Pseudomyxoma peritonei is an infrequent entity, defined by collections of gelatinous material in the abdomen and pelvis and mucinous implants on peritoneum, secondary to the rupture of a mucinous lesion, usually of ovarian or appendiceal origin. MATERIALS AND METHODS: We present our experience of 11 cases (6 males and 5 females) diagnosed with pseudomyxoma peritonei secondary to epithelial appendicular neoplasms over 27 years. The mean age of the patients was 68 years. Clinical manifestations were abdominal distension (55%), right lower quadrant pain (45%) suggesting acute appendicitis and constitutional syndrome (36%). An abdominal mass was detected at physical examination in 4 patients. CT scan revealed a tumour in right iliac fossa in 4 patients, peritoneal enlargement in 1 and a liquid collection in 1. Preoperative diagnosis was acute abdomen in 5 patients, peritoneal carcinomatosis in 3 and undetermined abdominal mass in 3. RESULTS: Surgical findings suggested pseudomyxoma peritonei in 8 patients and peritoneal carcinomatosis in 3. Appendicectomy was performed in 9 patients, and in 3 of them bilateral anexectomy was also performed. One patient underwent ileocaecal resection and another a right hemicolectomy. In all the cases, mucinous material was eliminated as much as possible. Pathology revealed mucinous cystoadenoma in 6 cases, mucinous cystoadenocarcinoma in 3 and epithelial hyperplasia in 2 patients. Median survival was 54 months, with a 5- year survival rate of 40%. The last case we treated was sent to a reference centre for the treatment of pseudomyxoma peritonei. CONCLUSIONS: There is no consensus on the best treatment for pseudomyxoma peritonei. We recommend avoiding incomplete surgical resections in non-reference centres and submitting patients to a reference centre to undergo adequate treatment (AU)

Peritoneal carcinomatosis secondary to carcinoid tumour

Carcinoid tumours are neuroendocrine neoplasms that can appear in every location of the digestive tract. They are low aggressive tumours, although they often produce local invasion and hepatic metastases, whose resection allows long-term survival. We report a case of a 64-year-old man with ileal carcinoid tumour, that underwent ileal resection and metastasectomy of one lesion in liver segment II. Surgical findings indicated peritoneal carcinomatosis. Carcinoid dissemination as peritoneal carcinomatosis has been rarely described in the literature. Cytoreductive surgery, always when complete resection is aimed, achieves asymptomatic long-term survivals (AU)