Updated European guidelines for clinical management of familial adenomatous polyposis (FAP), MUTYH-associated polyposis (MAP), gastric adenocarcinoma, proximal polyposis of the stomach (GAPPS) and other rare adenomatous polyposis syndromes: a joint EHTG-ESCP revision.

BACKGROUND: Hereditary adenomatous polyposis syndromes, including familial adenomatous polyposis and other rare adenomatous polyposis syndromes, increase the lifetime risk of colorectal and other cancers. METHODS: A team of 38 experts convened to update the 2008 European recommendations for the clinical management of patients with adenomatous polyposis syndromes. Additionally, other rare monogenic adenomatous polyposis syndromes were reviewed and added. Eighty-nine clinically relevant questions were answered after a systematic review of the existing literature with grading of the evidence according to Grading of Recommendations, Assessment, Development, and Evaluation methodology. Two levels of consensus were identified: consensus threshold (≥67% of voting guideline committee members voting either 'Strongly agree' or 'Agree' during the Delphi rounds) and high threshold (consensus ≥ 80%). RESULTS: One hundred and forty statements reached a high level of consensus concerning the management of hereditary adenomatous polyposis syndromes. CONCLUSION: These updated guidelines provide current, comprehensive, and evidence-based practical recommendations for the management of surveillance and treatment of familial adenomatous polyposis patients, encompassing additionally MUTYH-associated polyposis, gastric adenocarcinoma and proximal polyposis of the stomach and other recently identified polyposis syndromes based on pathogenic variants in other genes than APC or MUTYH. Due to the rarity of these diseases, patients should be managed at specialized centres.

A Risk-Based Screening Approach to Patients Needing Surgery During the De-Escalation Phase of COVID-19 Pandemic.

Since the outbreak of COVID-19 pandemic, many national and international surgical societies have produced guidelines regarding the management of surgical patients. During the mitigation phase of the pandemic, most documents suggested to consider postponing elective procedures, unless this might have impacted the life expectancy of patients. As awareness and knowledge about COVID-19 are gradually increasing, and as we enter a phase when surgical services are resuming their activities, surgical strategies have to adapt to this rapidly evolving scenario. This is particularly relevant when considering screening policies and the associated findings. We herein describe a risk-based approach to the management of patients with surgical diseases, which might be useful in order to limit the risks for healthcare workers and patients, while allowing for resuming elective surgical practice safely.

How to make an impact in surgical research: a consensus summary from the #SoMe4Surgery community.

Understanding and interpreting medical literature through critical thinking and applying this knowledge to evidence-based practice is an integral part of surgical training. Participating in research accelerates this process; however, young doctors' involvement in research may be suboptimal. Our aim was to provide young surgeons with recommendations on how to properly engage in surgical research. An online twitter conversation focused on recommendations about how a young physician can succeed in research was undertaken. Twitter activity for that conversation and hashtags was analyzed. A consensus based on the recommendations extracted from the discussion is summarized. Key opinion leaders were engaged to promote the conversation. Discussion was opened to all participants related to surgery or surgical research, including surgeons, medical students, nurses, patients, and healthcare workers. A total of 244 participants engaged in the Twitter conversation. The highest tweeted hashtags were #SoMe4Surgery and #SurgicalResearch with 855 and 847 tweets, respectively. Themes that came out of the conversation included 'Mentorship', which was the most essential recommendation. 'International collaboratives' and 'foreign research fellowship' were also deemed important factors for a successful path in research. Additionally, routine read of online journals, use of social media for scientific purposes, often engagement in manuscript drafting and proper time management were also recommended. Research is demanding and time consuming but an essential part of surgical education. We believe that any young surgeon can have greater chances to succeed in surgical research by following our recommendations and by academically using social media platforms.

Ligamentum Teres Cardiopexy as a Late Alternative for Gastroesophageal Reflux Disease in a Patient with Previous Reversal of Gastric Bypass to Sleeve Gastrectomy and Hiatal Hernia Repair.

An important percentage of the patient, undergoing primary or revisional bariatric surgery after sleeve gastrectomy, presents symptomatic gastroesophageal reflux disease (GERD). When and how surgical reinforcement of the lower esophageal sphincter should be performed to prevent acid reflux is still controversial. Here, we describe laparoscopic ligamentum teres cardiopexy, a surgical technique that reinforces the lower esophageal sphincter and restores its competence with a new valve, in patients with the previous conversion of gastric bypass to sleeve gastrectomy and hiatal hernia repair. We present the surgical technique performed on a patient with initial gastric bypass who underwent sleeve gastrectomy for hypoglycemia and hiatoplasty for severe GERD. Persistent GERD requested to undergo ligamentum teres cardiopexy. Ligamentum teres cardiopexy combined with the closure of the gastric crus is a late alternative treatment for GERD in patients with previous sleeve gastrectomy and hiatal hernia.

Respuesta de autores a: A propósito de la carta científica «Sospecha de abdomen agudo como manifestación extrapulmonar de infección COVID-19» / Authors response to: «About the scientific letter: Suspected Acute Abdomen as an Extrapulmonary Manifestation of Covid-19 Infection»

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Sospecha de abdomen agudo como manifestación extrapulmonar de infección por Covid-19 / Suspected acute abdomen as an extrapulmonary manifestation of Covid-19 infection

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