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.

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.

Colitis pseudomembranosa letal en paciente inmunocompetente / Lethal pseudomembranous colitis in an immunocompetent patient

No disponible

Impacto económico del uso de un nuevo apósito postoperatorio en la herida incisional abdominal / Economic impact of the use of new post-surgical dressing in incisional abdominal wounds

OBJETIVO: conocer el coste de las curas quirúrgicas de laparotomías cerradas por primera intención y estimar el impacto económico del uso de un apósito que no precise curas diarias en el postoperatorio de cirugía abdominal. MATERIAL Y MÉTODOS: estudio prospectivo observacional en 30pacientes sometidos a una laparotomía divididos en dos grupos, Ay B, dependiendo de si la cura se realizó con un apósito convencional o con el apósito Mepilex Border Post-Op®, respectivamente. RESULTADOS: calculado el coste de una cura hospitalaria con el material habitualmente utilizado, se estima en 4,92 € (apósito no incluido). El coste del tiempo de trabajo de Enfermería sin complementos en euros/minuto fue de 0,14 €/min. El coste total (apósito+ coste de la cura + coste de Enfermería) fue mayor en el grupo A que en el grupo B, siendo de 402,70 € y de 233,61 € respectivamente, ahorrándose un total de 169,09 €. El coste de Enfermería representó el 11% del total del gasto de la cura en el grupo A yel 2% en el grupo B. El coste medio cura/paciente fue de 26,85 € (grupo A) y 15,57 € (grupo B) con un ahorro de 11,31 € por paciente. CONCLUSIONES: un apósito que no precise cambios diarios y permita revisar la herida quirúrgica garantiza un buen control de la evolución de la herida, siendo más económico en el coste total que sise realizan curas convencionales

OBJECTIVE: to ascertain the cost of surgical wound dressing in primary intention closed la parotomies and to estimate the economic impact of a dressing that does not required daily wound treatment in the post-surgical phase of abdominal surgery MATERIAL AND METHODS: prospective observational study of 30patients undergoing a laparotomy divided into 2 groups -A and B- according to whether wound treatment was performed using conventional dressing or using the Mepilex Border Post-Op®dressing respectively. RESULTS: having calculated the cost of a hospital wound treatment using the material normally used, the cost is estimated at €4.92(dressing not included). The cost of working time of a nurse without overtime in euros/minute was of €0.14 /min. The total cost(dressing + cost of wound care + cost of nurse) was higher in group A than in group B, being of €402.70 and €233.61 respectively, with total savings of €169.09. The cost of nursing accounted for 11% of the overall cost of the wound care in group A and 2% in group B. The average cost wound care/patient was of €26.85 (group A) and of€15.57 (group B) with a savings of €11.31 per patient. CONCLUSIONS: a dressing which does not require daily changes and allows for inspection of the surgical wound guarantees good control of the evolution of the wound, being more economical in terms of overall cost than using conventional post-surgical wound care