Is there the same requirement to obtain the PhD degree in all the departments of surgery of the Spanish universities?

INTRODUCTION: The doctorate is the third cycle of official university studies, which, through the defense of the doctoral thesis leads to the acquisition of the title of doctor or PhD from the Anglo-Saxon countries. Royal Decree law 99/2011 regulates doctoral programs, with a wide margin on quality requirements. The objective of this study is to find out if there is this variation in the requirements of the doctorate programs of the different departments of surgery of the Spanish public universities and to establish a quality scale. METHODS: Cross-sectional observational study from 2/22/2021 to 3/3/2021, through a survey sent electronically to the professors of the departments of surgery. RESULTS: Thirty-five departments of surgery were consulted, obtaining a response in 29 of them (82.9%). The observed variation regarding requirements has been basically in the quality of the research project, in fact in 25 (86.2%) there are no regulations on this. When it is presented in the form of a compendium of articles, these are required to be original in 15 (51.7%). Regarding the position as author, the doctoral student must be the preferred author, at least in 2 articles in 14 (48.4%) of the programs. In 14 departments (48.4%) there are no regulations on the position of the articles and quartiles of journals. When scoring the different programs according to their requirements, the variability is high, ranging between 2 and 19 points. Funding for the development of the doctorate is meager. CONCLUSIONS: There is a wide variability in the requirement of doctoral programs. Homogeneous levels of demand must be defined to promote and protect higher-level doctorates.

Analysis of the Management of Cholelithiasis in Bariatric Surgery Patients: a Single-Center Experience.

PURPOSE: Cholelithiasis is an issue in bariatric surgery patients. The incidence of cholelithiasis is increased in morbidly obese patients. After bariatric surgery, the management maybe sometimes challenging. There is no consensus about how to deal with cholelithiasis prior to bariatric surgery. MATERIALS AND METHODS: A retrospective review from our prospectively collected bariatric surgery database. Primary bariatric procedures from 2009 to 2020 were included. Prevalence of cholelithiasis and its management prior to bariatric surgery and the incidence and management of postoperative biliary events were analyzed. RESULTS: Over 1445 patients analyzed, preoperatively cholelithiasis was found in 153 (10.58%), and 68 out of them (44.44%) were symptomatic. Seventy-six patients had a concomitant cholecystectomy. In those cases, the bariatric procedure did not show increased operative time, length of stay, morbidity, or mortality compared to the rest of primary bariatric procedures. Twelve patients (15.58%) with previous cholelithiasis and no concomitant cholecystectomy presented any kind of biliary event and required cholecystectomy. De novo cholelithiasis rate requiring cholecystectomy was 3.86%. Postoperative biliary events both in de novo and persistent cholelithiasis population did not show any difference between the type of surgery, weight loss, and other characteristics. CONCLUSIONS: Cholelithiasis was present in 10.58% of our primary bariatric surgery population. Concomitant cholecystectomy was safe in our series. Non-surgical management of asymptomatic cholelithiasis did not lead to a higher risk of postoperative biliary events. The global postoperative cholecystectomy rate was equivalent to the general population.

Is there the same requirement to obtain the PhD degree in all the departments of surgery of the Spanish universities? / ¿Existe la misma exigencia en la obtención del doctorado (PhD) en todos los departamentos de cirugía de las universidades españolas?

INTRODUCTION: The doctorate is the third cycle of official university studies, which, through the defense of the doctoral thesis leads to the acquisition of the title of doctor or PhD from the Anglo-Saxon countries. Royal Decree law 99/2011 regulates doctoral programs, with a wide margin on quality requirements. The objective of this study is to find out if there is this variation in the requirements of the doctorate programs of the different departments of surgery of the Spanish public universities and to establish a quality scale. METHODS: Cross-sectional observational study from 2/22/2021 to 3/3/2021, through a survey sent electronically to the professors of the departments of surgery. RESULTS: Thirty-five departments of surgery were consulted, obtaining a response in 29 of them (82.9%). The observed variation regarding requirements has been basically in the quality of the research project, in fact in 25 (86.2%) there are no regulations on this. When it is presented in the form of a compendium of articles, these are required to be original in 15 (51.7%). Regarding the position as author, the doctoral student must be the preferred author, at least in 2 articles in 14 (48.4%) of the programs. In 14 departments (48.4%) there are no regulations on the position of the articles and quartiles of journals. When scoring the different programs according to their requirements, the variability is high, ranging between 2 and 19 points. Funding for the development of the doctorate is meager. CONCLUSIONS: There is a wide variability in the requirement of doctoral programs. Homogeneous levels of demand must be defined to promote and protect higher-level doctorates.

Seeking an Initial-Weight-Independent Metric in a Mediterranean Cohort of Gastric Bypass Patients: the %AWL Revisited.

BACKGROUND: Most relative weight-loss metrics follow the formula "Weight loss(%) = 100 · (Initial BMI - Final BMI) / (Initial BMI-a)," where a is the reference point that defines the metric. The percentage of total weight loss (%TWL, a = 0) and percentage of excess weight loss (%EWL, a = 25) are influenced by a patient's initial weight. Recently, the percentage of alterable weight loss metric (%AWL, a = 13) has been reported to produce initial-weight-independent outcomes. OBJECTIVES: This study aimed to replicate the methodology used for %AWL determination in a Mediterranean cohort of bariatric patients. SETTINGS: Multicenter study in 10 large hospitals in Spain. METHODS: Two large prospective databases were retrospectively searched for all primary laparoscopic gastric bypass patients with 2 years of follow-up. Outcomes at nadir were expressed and analyzed with 26 different metrics (a from 0 to 25), looking for the metric whose outcomes produced (1) the lowest coefficient of variation, (2) no differences between initially lighter and heavier patients, and (3) no correlation with patients' initial BMI. RESULTS: A cohort of 1793 patients was stratified into 4 gender-age groups: younger women (YW, n = 733), older women (OW, n = 674), younger men (YM, n = 197), and older men (OM, n = 189). The calculations suggested an optimal reference point of 18 kg/m2, defining a new metric (percentage of Mediterranean alterable weight loss, %MAWL). When %TWL, %EWL, %AWL, and %MAWL were tested on the whole sample, only %MAWL produced initial-weight-independent results. CONCLUSIONS: In our Mediterranean cohort of patients, a reference point of 18 (and not 13) yielded initial-weight-independent outcomes.

Transforming a surgical department during the outbreak of new coronavirus pandemic. Clinical implications.

BACKGROUND: The 2019 novel coronavirus (2019-nCoV) has caused an outbreak of the disease now officially named coronavirus disease 2019 (COVID-19). Since then, all hospitals have required a complete restructuring of their usual facilities and the treatments provided. Our goal was to detail the remodeling of a tertiary hospital during the COVID-19 outbreak and analyze pitfalls to avoid increasing surgical department burdens. METHODS: This was a retrospective analysis of data affecting patients during their admission in our institution during March 2020. Data from general admission, intensive care units, and elective and emergency surgeries were collected and analyzed. All patients who underwent a surgical procedure were reviewed to elucidate limitations in the deployment of the hospital transformation to a COVID-19 hospital. RESULTS: A total of 688 patients have been treated in our institution. Of those, 186 required intensive care. More than 120 new intensive care beds have been created during this period, and a decrease in elective surgeries of more than 75% was observed. Inadvertent COVID-19 patients accounted for 70%. Thirty percent of the patients who underwent surgery while infected with COVID-19 died in our institution. CONCLUSIONS: The complete reorganization of surgical departments will be requested during the outbreak and adaptive solutions are needed in order to avoid increased mortality rates and infection among patients and to promote maximal optimization of surgical spaces. Timing, governmental decisions, and scientific society's recommendations may be limitations in the efficient deployment of hospital transformations to COVID-19 facilities.

Mid-Term Results and Responsiveness Predictors After Two-Step Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy.

BACKGROUND: In patients with insufficient weight loss after sleeve gastrectomy (SG) or in super obese individuals, among many surgical options available, a single-anastomosis duodeno-ileal bypass (SADI) after SG (SADI-S) could be considered. Due to the limited information available about the use of SADI as a second-step procedure, the objective of this study was to evaluate the mid-term results and responsiveness of SADI after sleeve gastrectomy. METHODS: We present prospective data from 30 consecutive patients with a mean BMI of 40.1 kg/m2, a mean excess weight of 44.7 kg, and a mean excess weight loss (EWL) of 37.5%, who were submitted to a SADI as a second-step revisional procedure. RESULTS: There were no intraoperative complications. Four early complications (13.34%) occurred within the first 24 postoperative hours. Six, 12, and 24-month follow-up number of patients available was 30 (100%), 22 (73.3%), and 16 (53.34%), respectively. Percent total weight loss (%WL) was 28.1 at the time of revision and 46.26% 24 months after SADI. Global %EWL was 78.93 ± 35.5. The complete remission rate after SG was 50% for diabetes, 33.3% for dyslipidemia, and 25% for hypertension, and 71.4%, 31.2%, and 27.7%, respectively, after SADI. Three (10%) patients required revisional surgery due to hypoalbuminemia. CONCLUSIONS: SADI as a second-step strategy in super obese patients or after failed SG offers a more than satisfactory ponderal weight loss and an acceptable comorbidities resolution. However, the risk of severe malnutrition after distal SADI-S makes necessary a careful patient selection.

Postoperative small bowel and colonic anastomotic bleeding. Therapeutic management and complications.

INTRODUCTION: Postoperative small bowel or colic anastomotic bleeding (PSCAB) is often a mild complication and is generally treated by a conservative approach. Other therapeutic options are surgery, endoscopic management and angiographic embolization. Our aim is to review our cases of postoperative anastomotic bleeding in patients with small bowel or colic anastomosis, with special attention to their treatment and complications. PATIENTS AND METHODS: Observational retrospective study including patients with PSCAB in the department of General and Digestive Surgery in Vall d'Hebron University Hospital, between 2007 and 2012. Demographic and bleeding characteristics as well as therapeutic management were reviewed, including complications derived from the different therapeutic options. RESULTS: There were 44 cases of bleeding after performing small bowel or colic anastomosis, 25 patients were men (56.8%), with a mean age of 68.2 years (R: 28-92). The mean hematocrit decrease was 8 points (R: 0-17), and hemodynamic instability was detected in 13 patients (29.5%). A conservative management was undertaken in 27 patients (61.3%), surgery in 6 (13.6%), endoscopic treatment in 2 (4.5%) and embolization in 9 (20.5%). 4 patients of cases treated with embolization presented anastomotic leak (44.5%). Mortality was 13.6% (6 patients). A total of 4 of 6 deaths were in the group of patients treated with embolization. CONCLUSIONS: Most patients with PSCAB have a good response to conservative management. When there is failure of this approach, there are different therapeutic options, including angiographic embolization. In our series, we have seen a high incidence of post embolization anastomotic leak; further trials will be necessary to provide valuable evidence of the risk of this therapeutic option.

¿Es el índice de masa corporal un factor pronóstico de supervivencia en el cáncer de colon? Análisis multivariable / Is Body Mass Index a prognostic factor of survival in colonic cancer? A multivariate analysis

Introducción La supervivencia a largo plazo de los pacientes intervenidos por cáncer de colon depende de múltiples factores. La obesidad disminuye la expectativa de vida de la población general que la padece, pero no está claro si la obesidad, medida con el índice de masa corporal (IMC), es un factor pronóstico de supervivencia para los pacientes intervenidos por cáncer de colon. Material y métodos Hemos incluido en este estudio a pacientes en estadios TNM I, II y III, sometidos a cirugía electiva por cáncer de colon en el Hospital Universitari de Girona entre 1990 y 2001. El IMC se ha categorizado siguiendo la clasificación de la OMS. Hemos estudiado 38 parámetros distintos realizando un estudio bivariable con el IMC. El modelo de Cox ha sido construido posteriormente con los parámetros más clínicamente relevantes y con los más fuertemente asociados con la supervivencia en el estudio bivariable. Resultados El IMC no se asoció con la supervivencia en el análisis bivariable. El análisis multivariable tampoco mostró que el IMC sea un factor pronóstico independiente de supervivencia a largo plazo en el cáncer de colon sin metástasis, pero sí lo fueron el estadio TNM, la puntuación ASA, la técnica quirúrgica, la edad a la cirugía y la respuesta inmunitaria celular. Conclusiones El IMC no es un factor pronóstico de supervivencia a largo plazo en pacientes con cáncer de colon (AU)

Introduction: The long-term survival of patients operated on for colonic cancer depends on many factors. Obesity decreases the life expectancy of the general population who suffer from it, but it is not clear whether obesity, measured by the Body Mass Index (BMI), is a prognostic factor of survival for patients operated on for colonic cancer. Material and methods: The patients included in this study had TNM stage I, II y III, and were subjected to elective surgery for cancer of the colon in the Girona University Hospital between 1990 and 2001. The BMI was classified according to the WHO classification. A total of 38 different variables were studied using a bivariate analysis with BMI. A Cox model was subsequently constructed with the most clinically relevant parameters, and with those most strongly associated with survival in the bivariate analysis. Results: BMI was not associated with survival in the bivariate analysis. Neither did the multivariate analysis show that BMI was an independent prognostic factor of long-term survival in cancer of the colon without metastasis, but it did show that the TNM stage, ASA score, surgical technique, age at surgery, and the immune cell response were prognostic factors (AU)

[Is body mass index a prognostic factor of survival in colonic cancer? A multivariate analysis]. / ¿Es el índice de masa corporal un factor pronóstico de supervivencia en el cáncer de colon? Análisis multivariable.

INTRODUCTION: The long-term survival of patients operated on for colonic cancer depends on many factors. Obesity decreases the life expectancy of the general population who suffer from it, but it is not clear whether obesity, measured by the Body Mass Index (BMI), is a prognostic factor of survival for patients operated on for colonic cancer. MATERIAL AND METHODS: The patients included in this study had TNM stage I, II y III, and were subjected to elective surgery for cancer of the colon in the Girona University Hospital between 1990 and 2001. The BMI was classified according to the WHO classification. A total of 38 different variables were studied using a bivariate analysis with BMI. A Cox model was subsequently constructed with the most clinically relevant parameters, and with those most strongly associated with survival in the bivariate analysis. RESULTS: BMI was not associated with survival in the bivariate analysis. Neither did the multivariate analysis show that BMI was an independent prognostic factor of long-term survival in cancer of the colon without metastasis, but it did show that the TNM stage, ASA score, surgical technique, age at surgery, and the immune cell response were prognostic factors. CONCLUSIONS: The body mass index is not a prognostic factor of the long-term survival of patients with colonic cancer.

Endoscopic Management of Drain Inclusion in the Gastric Pouch after Gastrojejunal Leakage after Laparoscopic Roux-en-Y Gastric Bypass for the Treatment of Morbid Obesity (LRYGBP).

Background. Drain inclusion inside the gastric pouch is rare and can represent an important source of morbidity and mortality associated with laparocopic Roux-en-Y gastric bypass (LRYGBP). These leaks can become chronic and challenging. Surgical options are often unsuccessful. We present the endoscopic management of four patients with drain inclusion. Patients. All four obese morbidly patients underwent LRYGBP and presented a gastro-jejunal fistula after acute anastomotic leakage. During follow-up endoscopy the drain was found inside the gastric pouch. It was moved into the abdominal cavity. Fistula debit reduced significantly and closed. Results. Gastric leak closure in less than 24 hours was achieved in all, with complete resolution of symptoms. These patients benefited exclusively from endoscopic treatment. Conclusions. Endoscopy is useful and technically feasible in chronic fistulas. This procedure is a less invasive alternative to traditional surgical revision. Other therapeutic strategies can be used such as clips and fibrin glue. Drains should not be placed in contact with the anastomosis or stapled lines. Drain inclusion must be suspected when fistula debit suddenly arises. If so, endoscopy is indicated for diagnostic accuracy. Under endoscopy vision, the drain is gently removed from the gastric reservoir leading to sudden and complete resolution of the fistula.

Rotura intraperitoneal traumática de quiste hidatídico hepático / Traumatic intraperitoneal rupture of a hepatic hydatid cyst

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La robótica y la cirugía al alcance de nuestras manos virtuales / Robotics and the surgery within the reach of virtual hands

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[Leiomyomatosis peritonealis disseminata]. / Leiomiomatosis peritoneal diseminada.

Leiomyomatosis peritonealis disseminata is an uncommon condition characterized by subperitoneal proliferation of benign nodules mainly composed of benign smooth muscle cells. This entity generally appears in premenopausal women and hormonal influences may play a role in its pathogenesis. The macroscopic appearance mimics peritoneal carcinomatosis. The characteristic clinical course is asymptomatic and diagnosis is only feasible after microscopic examination. To date, less than 100 cases have been reported in the literature. We report the case of a 40-year-old woman who underwent surgery in our department.

Leiomiomatosis peritoneal diseminada / Leiomyomatosis peritonealis disseminata

La leiomiomatosis peritoneal diseminada es una entidad rara que se caracteriza por la proliferación subendotelial de nódulos básicamente compuestos de células de músculo liso. Aparece de forma general en mujeres premenopáusicas y su patogenia tiene gran influencia hormonal. Simula macroscópicamente una carcinomatosis peritoneal. De forma característica cursa de forma indolente y el diagnóstico es sólo posible tras el examen histológico. Se han descrito menos de 100 casos en la literatura científica hasta la fecha. Presentamos un caso de una paciente de 40 años intervenida en nuestro servicio (AU)

Leiomyomatosis peritonealis disseminata is an uncommon condition characterized by subperitoneal proliferation of benign nodules mainly composed of benign smooth muscle cells. This entity generally appears in premenopausal women and hormonal influences may play a role in its pathogenesis. The macroscopic appearance mimics peritoneal carcinomatosis. The characteristic clinical course is asymptomatic and diagnosis is only feasible after microscopic examination. To date, less than 100 cases have been reported in the literature. We report the case of a 40-year-old woman who underwent surgery in our department (AU)

Manejo quirúrgico del estreñimiento crónico grave / Surgical management of severe chronic constipation

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