Indications and Coverage of Metabolic and Bariatric Surgery: A Worldwide IFSO Survey Comparing Different National Guidelines.

INTRODUCTION: Knowing how metabolic and bariatric surgery (MBS) is indicated in different countries is essential information for the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). AIM: To analyze the indications for MBS recommended by each of the national societies that comprise the IFSO and how MBS is financed in their countries. METHODS: All IFSO societies were asked to fill out a survey asking whether they have, and which are their national guidelines, and if MBS is covered by their public health service. RESULTS: Sixty-three out of the 72 IFSO national societies answered the form (87.5%). Among them, 74.6% have some kind of guidelines regarding indications for MBS. Twenty-two percent are still based on the US National Institute of Health (NIH) 1991 recommendations, 43.5% possess guidelines midway the 1991s and ASMBS/IFSO 2022 ones, and 34% have already adopted the latest ASMBS/IFSO 2022 guidelines. MBS was financially covered in 65% of the countries. CONCLUSIONS: Most of the IFSO member societies have MBS guidelines. While more than a third of them have already shifted to the most updated ASMBS/IFSO 2022 ones, another significant number of countries are still following the NIH 1991 guidelines or even do not have any at all. Besides, there is a significant number of countries in which surgical treatment is not yet financially covered. More effort is needed to standardize indications worldwide and to influence insurers and health policymakers to increase the coverage of MBS.

¿Qué hemos aprendido de las encuestas de la AEC, AECP y del Observatorio de Infección en Cirugía? Cumplimiento de las medidas de prevención de infección postoperatoria y comparación con las recomendaciones de la AEC / What have we learned from the surveys of the AEC, AECP and the Observatory of Infection in Surgery? Compliance with postoperative infection prevention measures and comparison with the AEC recommendations

Antes de planificar estrategias de mejora, es crucial conocer el grado de implementación de las medidas preventivas de infección postoperatoria. Se presentan los resultados agregados de 3encuestas realizadas por el Observatorio de Infección en Cirugía a miembros de 11 asociaciones de cirugía y de enfermería quirúrgica. Las preguntas fueron dirigidas a determinar el conocimiento de la evidencia científica, las creencias personales y el uso real de las principales medidas. De 2.295 encuestados, el 45,1% no recibe información de la tasa de infección de su unidad. Se observó un conocimiento insuficiente de algunas de las principales recomendaciones de prevención y unas tasas de utilización, en ocasiones, inquietante. Se indagó sobre las estrategias preferidas para mejorar el cumplimiento de las pautas preventivas y su grado de implementación. Se confirmó la brecha existente entre la evidencia científica y la práctica clínica en la prevención de infecciones en diferentes especialidades quirúrgicas (AU)

Before planning improvement strategies, it is crucial to know the degree of implementation of preventative measures for postoperative infection. The aggregated results of 3surveys carried out by the Observatory of Infection in Surgery to members of 11 associations of surgeons and perioperative nurses are presented. The questions were aimed to determine the knowledge of the scientific evidence, personal beliefs and the actual use of the main measures. Of 2295 respondents, 45.1% did not receive feedback on the infection rate of their unit. Insufficient knowledge of some of the main prevention recommendations and some disturbing rates of use were observed. The preferred strategies to improve compliance with preventive guidelines and their degree of implementation were investigated. A gap between scientific evidence and clinical practice in the prevention of infection in different surgical specialties was confirmed (AU)

5G-assisted telementored surgery.

Safe and effective implementation of remote surgery and telementoring can have significant limitations. Fifth-generation (5G) wireless networks could be useful in overcoming these drawbacks. As a proof of concept, the authors present technical and clinical details of two procedures assisted by telementoring using 5G that were also broadcast live. Secure remote access advice.

[Late ischemic stricture following anterior rectal resection]. / Estenosis isquémica tardía tras resección anterior de recto.

A considerable incidence of colonic strictures after oncologic low anterior resections has been reported. The present paper describes a colonic stricture 5 years after the surgery, and not related to radiotherapy, that required a challenging differential diagnosis with local recurrence of rectal cancer. The role of endoscopy in the management of this condition is discussed.

Estenosis isquémica tardía tras resección anterior de recto / No disponible

Existe una incidencia no despreciable de lesiones de colon deorigen isquémico tras resecciones anteriores bajas por cáncer.Presentamos un caso de estenosis isquémica de colon, no relacionadacon radioterapia, a los 5 años de la cirugía. Se discute la dificultaddel diagnóstico diferencial con recidiva tumoral, así como elimportante papel que desempeña la endoscopia en el abordaje deestos pacientes

A considerable incidence of colonic strictures after oncologiclow anterior resections has been reported. The present paper describesa colonic stricture 5 years after the surgery, and not relatedto radiotherapy, that required a challenging differential diagnosiswith local recurrence of rectal cancer. The role of endoscopyin the management of this condition is discussed

Perianal metastases from lobular breast carcinoma.

Breast cancer gastrointestinal and soft tissue metastases are extremely rare. We present the case of a woman with perianal metastases from a primary lobular breast carcinoma 11 years after mastectomy and local radiotherapy.