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

Introducción El doctorado es el tercer ciclo de estudios universitarios oficiales, que mediante la defensa de la tesis doctoral conduce a la adquisición del título de doctor. El Real Decreto 99/2011 regula los programas de doctorado, con un amplio margen en su exigencia. El objetivo de este estudio ha sido conocer si existe discrepancia de los programas de doctorado entre los departamentos de cirugía de las universidades públicas españolas y establecer una escala de calidad. Métodos Estudio observacional transversal mediante una encuesta enviada por vía telemática a los profesores de los departamentos de cirugía. Resultados Se ha consultado a los 35 departamentos de cirugía, obteniendo respuesta de 29 de ellos (82,9%). La variación en la exigencia se ha observado especialmente en la calidad del proyecto de investigación, sin existir normativa en 25 (86,2%) de los programas. En cuanto a la presentación de la tesis doctoral en forma de compendio de artículos, se exige que sean originales en 15 (51,7%). En 14 (48,4%) de los programas la posición como autor del doctorando debe ser de autor preferente al menos en 2 artículos. En 14 departamentos (48,4%) no existe normativa respecto a la posición por cuartiles de los artículos. Al puntuar los distintos programas según su exigencia, la variabilidad es elevada, oscilando entre 2 y 19 puntos. La financiación para el desarrollo del doctorado fue mínima. Conclusiones Existe una amplia variabilidad en la exigencia de los programas de doctorado. Sería aconsejable definir unos niveles mínimos de exigencia para salvaguardar aquellas tesis de mayor nivel (AU)

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 (AU)

Prioritization criteria of patients on scheduled waiting lists for abdominal wall hernia surgery: a cross-sectional study.

PURPOSE: Long delays in waiting lists have a negative impact on the principles of equity and providing timely access to care. This study aimed to assess waiting lists for abdominal wall hernia repair (incisional ventral vs. inguinal hernia) to define explicit prioritization criteria. METHODS: A cross-sectional single-center study was designed. Patients in the waiting list for incisional/ventral hernia (n = 42) and inguinal hernia (n = 50) repair were interviewed by phone and completed health-related quality of life (HRQoL) questionnaires (EQ-5D, COMI-hernia, HerQLes) as a measure of severity. Priority was measured as hernia complexity, patient frailty using the modified frailty index (mFI-11), and the consumption of analgesics for hernia. RESULTS: The mean (SD) time on the waiting list was 5.5 (3.2) months (range 1-14). Complex hernia was present in 34.8% of the patients. HRQoL was moderately poor in patients with incisional/ventral hernia (mean HerQL score 66.1), whereas it was moderately good in patients with inguinal hernia (mean COMI-hernia score 3.40). The use of analgesics was higher in patients with incisional/ventral hernia as compared with those with inguinal hernia (1.48 [0.54] vs. 1.31 [0.51], P = 0.021). Worst values of mFI were associated with inguinal hernia as compared with incisional/ventral hernia (0.21 [0.14] vs. 0.12 [0.11]; P = 0.010). CONCLUSION: Explicit criteria for prioritization in the waiting lists may be the consumption of analgesics for patients with incisional/ventral hernia and frailty for patients with inguinal hernia. A reasonable approach seems to establish separate waiting lists for incisional/ventral hernia and inguinal hernia repair.

Multivisceral Resection for Locally Advanced Rectal Cancer: Prognostic Factors Influencing Outcome.

AIMS: To assess outcome in patients with locally advanced rectal cancer undergoing multivisceral resection. METHODS: Retrospective study of 30 consecutive patients (mean age 67.8 years) with primary locally advanced rectal cancer undergoing en bloc multivisceral resection of the organs involved with curative intent between 1998 and 2010. Overall survival, local and distal recurrence, and disease-free survival were analyzed by the Kaplan-Meier method. Risk factors for clinical outcome were obtained using a Cox multivariate model. RESULTS: Postoperative complications occurred in 76.7% of patients and the in-hospital mortality rate was 10%. The median follow-up was 28.8 months. A total of 19 patients died at follow-up. Of the 11 patients who were alive, 7 were free of disease. In the multivariate analysis, lymph node involvement, stage II, and lymph vascular invasion were significantly associated with survival, and stage III showed a strong trend towards significance. Suture dehiscence (peritonitis and intra-abdominal abscess) showed a significant trend towards a higher local recurrence. Lymph vascular invasion was associated with a higher distant recurrence. CONCLUSION: Lymph node involvement was associated with worse survival, whereas stage II and absence of lymph vascular invasion were associated with a better survival. Lymph vascular invasion was associated with a higher distant recurrence.

Use of vacuum-assisted closure in open incisional hernia repair: a novel approach to prevent seroma formation.

INTRODUCTION: Frequent complications in incisional hernia surgery are re-herniation, wound infection and seroma formation. The use of subatmospheric pressure dressings such as the vacuum-assisted closure (VAC) device has been shown to be an effective way to accelerate healing of various wounds. Here, we describe the application of the VAC device as a postoperative dressing to prevent seroma formation after open incisional hernia repair. METHODS: Three consecutive patients (63, 65 and 60 years of age, respectively) underwent incisional hernia repair. Patient body mass index was 30.9, 26.6 and 29 kg/m(2), respectively. All hernias were complex with a defect size greater than 10 cm and were repaired using the onlay technique. After suture skin closure the incision was covered with a thin VAC sponge (KCI, San Antonio, TX) that was set at -125 mm Hg and left in place for 5 days before removal. RESULTS: An abdominal CT scan performed before discharge from the hospital did not show seroma formation. Physical examination 3 months after surgery was normal with no evidence of seroma (abdominal bulge and/or fluid wave). CONCLUSIONS: This successful preliminary experience in three patients encourages the use of the VAC system in incisional hernia repair, particularly in selected patients with risk factors for seroma formation (e.g., large defects, obesity, patient comorbidities, nutritional status, number of prior abdominal incisions, etc.). Therefore, prevention of seroma formation after incisional hernia repair may be added as a novel application of the VAC device.

An ergonomic study of single-port versus multi-port laparoscopic mesh insertion for ventral hernia repair.

PURPOSE: To assess the mental effort and physical discomfort of placement of a prosthetic mesh into the abdominal cavity with single-incision laparoscopic surgery (SILS) or multi-port laparoscopic access for incisional ventral hernia repair. METHODS: A total of 10 surgeons with previous experience in conventional laparoscopic surgery performed four surgical tasks through a multi-port laparoscopic access and a SILS access in a porcine model during a first 4-hour working session and a second 2-hour working session. These tasks included (a) introduction of a prosthetic mesh for abdominal wall surgery, (b) manipulation of the mesh inside the abdomen, (c) manipulation of the laparoscopic instruments and (d) mesh insertion to the intraperitoneal abdominal wall and fixation with tackers. The level of mental effort was assessed with the Subjective Mental Effort Questionnaire (SMEQ) and physical discomfort with the Local Experienced Discomfort Scale (LED). RESULTS: Seventy percent were men, with a mean age of 45 years and a mean of 18 years of experience in practicing surgery. The SMEQ questionnaire showed a median physical effort of 24.4 (range 9-36.1) points for the multi-port laparoscopic access and 107.4 (range 74.7-128.4) for SILS (p < 0.01). Statistically significant differences between multi-port laparoscopic surgery and SILS were consistently demonstrated in all tasks as well as in both the 4-hour and 2-hour working sessions. The median (interquartile range) score of the LED scale was 12.5 (2-34.5) for tasks during multi-port laparoscopic surgery and 53.5 (29-89.2) for SILS (p < 0.001). All individual tasks were associated with a significantly higher physical effort for SILS than for conventional laparoscopic access, which were also independent of being performed during the 4-hour or 2-hour working periods. CONCLUSIONS: Placement and manipulation of a prosthetic mesh for incisional ventral hernia repair is more difficult with SILS than using multi-port laparoscopic access, independently of previous experience with standard laparoscopic techniques. This greater difficulty was observed both in terms of mental effort and physical discomfort. More experimental and clinical studies are needed to define specific training aspects and clinical advantages of incisional ventral hernia repair through SILS.

Use of a prosthetic mesh to prevent parastomal hernia during laparoscopic abdominoperineal resection: a randomized controlled trial.

PURPOSE: Prevention of parastomal hernia represents an important aim when a permanent stoma is necessary. The objective of this work is to assess whether implantation of a prophylactic prosthetic mesh during laparoscopic abdominoperineal resection contributed to reduce the incidence of parastomal hernia. METHODS: Rectal cancer patients undergoing elective laparoscopic abdominoperineal resection with permanent colostomy were randomized to placement of a large-pore lightweight mesh in the intraperitoneal/onlay position by the laparoscopic approach (study group) or to the control group (no mesh). Parastomal hernia was defined radiologically by a CT scan performed after 12 months of surgery. The usefulness of subcutaneous fat thickness measured by CT to discriminate patients at risk of parastomal hernia was assessed by ROC curve analysis. RESULTS: Thirty-six patients were randomized, 19 to the mesh group and 17 to the control group. Parastomal hernia was detected in 50 % of patients in the mesh group and in 93.8 % of patients in the control group (P = 0.008). The AUC for thickness of the subcutaneous abdominal was 0.819 (P = 0.004) and the optimal threshold 23 mm. Subcutaneous fat thickness ≥23 mm was a significant predictor of parastomal hernia (odds ratio 15.7, P = 0.010), whereas insertion of a mesh was a protective factor (odds ratio 0.06, P = 0.031). CONCLUSIONS: Use of prophylactic large-pore lightweight mesh in the intraperitoneal/onlay position by a purely laparoscopic approach reduced the incidence of parastomal hernia formation. Subcutaneous fat thickness ≥23 mm measured by CT was an independent predictor of parastomal hernia.

Intestinal schistosomiasis as unusual aetiology for acute appendicitis, nowadays a rising disease in Western countries.

Intestinal schistosomiasis as unusual aetiology for acute appendicitis, nowadays a rising disease in western countries. Recent changes in global migration has led to an immigration growth in our scenario, upsurging people coming from endemic areas of schistosomiasis. Schistosomal appendicitis, seldom reported in developed countries, is now an expected incrising entity in our hospitals during the near future. Due to this circumstances, we believe that schistosomiasis should be consider as a rising source for acute appendicitis in western countries. In order to illustrate this point, we present a case of a 45-years-old black man, from Africa, was admitted via A&E because of acute abdominal pain, located in right lower quadrant. Acute appendicitis was suspected, and he underwent laparotomy and appendectomy. Pathological study by microscope revealed a gangrenous appendix with abscesses and parasitic ova into the submucosal layer of the appendix, suggesting Schistosomiasis.

Impact of the total number of harvested lymph nodes after colon cancer resections on survival in patients without involved lymph node.

BACKGROUND: The total number of harvested lymph nodes has been demonstrated to be of prognostic significance for colon cancer. Differences can occur in the total number of harvested lymph nodes between different specialists (surgeons and pathologists). OBJECTIVE: The aim of this study was to analyse if, in our centre, the number of analysed lymph nodes in patients with colon cancer that are classified as pN0 is also related to survival. MATERIAL AND METHODS: A retrospective study was designed, where 148 patients with colon adenocarcinoma (pN0 of TNM classification) who underwent elective surgery between 1 January 1995 and 31 December 2001, with curative intent were included. Three groups were created according to the number of analysed lymph nodes ( < 7, 7-14, > 14 lymph nodes). For survival analysis the Kaplan-Meier and CUSUM curves methods were used. RESULTS: The total number of analysed lymph nodes was 1,493 (mean 10.1 lymph nodes per patient). The rate of 5-years survival was 63.0% in the group with < 7 lymph nodes; 7-14 lymph nodes: 80.6% and those with > 14 lymph nodes: 91.8% (p < 0.01). Prognostic significance was also present for multivariate analysis. CONCLUSION: In our centre, harvesting a larger number of lymph nodes is related to improved rates of 5-years survival for patients with colon cancer staged as pN0. It seems reasonable to recommend obtaining as many lymph nodes as possible, and not to establish a minimum number of lymph nodes to be harvested.

Influencia del número total de ganglios analizados tras cirugía de resección en el cáncer de colon sobre la supervivencia en pacientes sin afectación ganglionar / No disponible

Introducción: el número total de ganglios analizados ha demostradosu influencia pronóstica en el cáncer de colon. Puedenexistir grandes diferencias en el número de ganglios obtenidos pordiferentes especialistas (cirujanos y anatomopatólogos).Objetivo: el objetivo del presente estudio fue analizar si, ennuestro medio, el número de ganglios analizados en pacientes concáncer de colon clasificados como pN0 se relaciona también conla supervivencia.Material y métodos: estudio retrospectivo, con inclusión de148 pacientes con adenocarcinoma de colon (pN0 de la clasificaciónTNM) intervenidos de forma programada con intención curativaentre 1 de enero de 1995 y 31 de diciembre de 2001. Se establecieron3 grupos según el número de ganglios analizados (< 7,7-14, > 14 ganglios). Para el análisis de la supervivencia se utilizaronel método de Kaplan Meier y las gráficas CUSUM.Resultados: el número total de ganglios analizados fue 1.493(media 10,1 ganglios por paciente). La supervivencia a 5 años fuedel 63,0% en el grupo con < 7 ganglios; del 80,6% en el grupocon 7-14; y del 91,8% en el grupo con > 14 ganglios analizados(p < 0,01). La influencia pronóstica se mantuvo en el análisis multivariante.Conclusión: en nuestro medio, la obtención de un mayor númerode ganglios analizados se relaciona con una mayor supervivenciaa los 5 años en pacientes con cáncer de colon clasificadoscomo pN0. Parece razonable recomendar la obtención de tantosganglios como sea posible en este tipo de cirugía y no recomendarun número mínimo de ganglios que se deberían analizar(AU)

Background: the total number of harvested lymph nodeshas been demonstrated to be of prognostic significance forcolon cancer. Differences can occur in the total number of harvestedlymph nodes between different specialists (surgeons andpathologists).Objective: the aim of this study was to analyse if, in our centre,the number of analysed lymph nodes in patients with coloncancer that are classified as pN0 is also related to survival.Material and methods: a retrospective study was designed,where 148 patients with colon adenocarcinoma (pN0 of TNMclassification) who underwent elective surgery between 1 January1995 and 31 December 2001, with curative intent were included.Three groups were created according to the number of analysedlymph nodes (< 7, 7-14, > 14 lymph nodes). For survival analysisthe Kaplan-Meier and CUSUM curves methods were used.Results: the total number of analysed lymph nodes was1,493 (mean 10.1 lymph nodes per patient). The rate of 5-years survival was 63.0% in the group with < 7 lymph nodes;7-14 lymph nodes: 80.6% and those with > 14 lymph nodes:91.8% (p < 0.01). Prognostic significance was also present formultivariate analysis.Conclusion: in our centre, harvesting a larger number oflymph nodes is related to improved rates of 5-years survival forpatients with colon cancer staged as pN0. It seems reasonableto recommend obtaining as many lymph nodes as possible, andnot to establish a minimum number of lymph nodes to be harvested(AU)

[Neuroendocrine carcinomas of the colon and rectum. A unit's experience over six years]. / Carcinomas neuroendocrinos de colon y recto. Experiencia de una unidad en seis años.

INTRODUCTION: Neuroendocrine tumours of the colon and rectum are infrequent. They are usually undifferentiated, easy to diagnose for the pathologist and are especially aggressive in their clinical behaviour. Prognosis is usually poor and they have a high tendency to metastase early. MATERIAL AND METHODS: We have reviewed our experience in a Colorectal Unit during a period of six years. Patients with neuroendocrine tumours have been reviewed retrospectively. Carcinoid tumours have not been included in this study. RESULTS: During this period, 2,155 patients have been operated for colorectal cancer and in five patients a neuroendocrine tumour has been found in the specimen. Mean age was 66 years, three male and two female. One tumour was located in the caecum, two in the rectum and two in the sigmoid colon. Two patients had hepatic metastasis at diagnosis. Surgery was performed in all patients and two patients received adjuvant quimiotherapy. A patient died because of post-operative hepatic insufficiency, another at 2 months and another after one year. Two patients are still alive after eight months follow-up. CONCLUSIONS: Neuroendocrine tumours appear to be rare in the colon and rectum. Clinical manifestations are not different from standard adenocarcinoma. When these tumours are diagnosed, they have distance disease, as in two of the five cases, related to a poor prognosis for the patient. Surgery is the treatment that can offer a greater chance of survival to these patients.

Carcinomas neuroendocrinos de colon y recto. Experiencia de una unidad en seis años / No disponible

Introducción: los tumores neuroendocrinos de colon y rectoson poco frecuentes. Suelen ser tumores poco diferenciados,diagnosticados por el patólogo y de especial agresividad en sucomportamiento clínico. El pronóstico suele ser malo, con tendenciaa la rápida metastatización.Material y métodos: se ha revisado la experiencia de unaUnidad de Coloproctología durante un periodo de seis años. Se hanrevisado de manera retrospectiva los pacientes con un tumor de estirpeneuroendocrina. Se han excluido los tumores carcinoides.Resultados: durante este periodo, se han intervenido 2.155pacientes por cáncer de colon y recto y se han hallado cinco pacientescon tumores neuroendocrinos. La edad media fue de 66años, tres varones y dos hembras. Se localizaron uno en ciego,dos en recto y dos en sigma. Dos pacientes presentaban diseminacióndel tumor a distancia. Se realizó cirugía en todos los pacientescon quimioterapia posterior en dos de ellos. Un pacientefalleció por insuficiencia hepática postoperatoria, otro a los dosmeses y otro al año. Dos pacientes siguen vivos con un seguimientomedio de ocho meses.Conclusiones: los tumores neuroendocrinos son unos tumoresde aparición rara en el colon y recto. La clínica de presentaciónno difiere de la que podrían tener los adenocarcinomas. En elmomento del diagnóstico estos tumores suelen presentar enfermedada distancia, como en dos de los cinco casos presentados,relacionándose con un mal pronóstico para el enfermo. El tratamientoquirúrgico y quimioterápico combinado es el que puedealargar más la supervivencia de los pacientes

Introduction: neuroendocrine tumours of the colon and rectumare infrequent. They are usually undifferentiated, easy to diagnosefor the pathologist and are especially aggressive in theirclinical behaviour. Prognosis is usually poor and they have a hightendency to metastase early.Material and methods: we have reviewed our experience ina Colorectal Unit during a period of six years. Patients with neuroendocrinetumours have been reviewed retrospectively. Carcinoidtumours have not been included in this study.Results: during this period, 2,155 patients have been operatedfor colorectal cancer and in five patients a neuroendocrine tumourhas been found in the specimen. Mean age was 66 years,three male and two female. One tumour was located in the caecum,two in the rectum and two in the sigmoid colon. Two patientshad hepatic metastasis at diagnosis. Surgery was performedin all patients and two patients received adjuvant quimiotherapy.A patient died because of post-operative hepatic insufficiency, anotherat 2 months and another after one year. Two patients arestill alive after eight months’ follow-up.Conclusions: neuroendocrine tumours appear to be rare inthe colon and rectum. Clinical manifestations are not differentfrom standard adenocarcinoma. When these tumours are diagnosed,they have distance disease, as in two of the five cases, relatedto a poor prognosis for the patient. Surgery is the treatmentthat can offer a greater chance of survival to these patients (AU)

Metástasis intestinal de cáncer de pulmón no microcítico / No disponible

No disponible

[Surgical treatment of pancreatic and periampullary carcinoma in a specialized unit: a decade later]. / Tratamiento quirúrgico de la neoplasia de páncreas y región periampular en una unidad especializada: una década después.

INTRODUCTION: Results of surgical treatment for pancreatic and periampullary carcinoma have improved in recent years owing to several factors, particularly the concentration of these patients in specialised surgical units. MATERIAL AND METHODS: Retrospective-prospective comparative study of results in 2 groups of patients treated over 2 different periods of time and with different surgical policy: group A, which included 80 patients treated from 1982 to 1992 in a general surgery unit, and group B, which comprised 151 patients treated from 1998 to 2003 in a specialised hepato-biliary-pancreatic surgery unit. RESULTS: Surgical treatment in patients of groups A and B, respectively, was: resection in 20% and 53.6% and by-pass in 62.5% and 36.4%. Postoperative morbidity after resection was similar (75% vs 74.1%) but higher after by-pass in group B (41.8% vs 34%). Postoperative mortality after surgical resection and by-pass was 25% and 14.1%, respectively, for group A and 3.7% and 16.3%, respectively, for group B. Mean survival for all patients was 7.0 +/- 7.1 months for group A and 14.1 +/- 15.3 months for group B. Mean survival for patients with surgical resection was 11.8 +/- 9.8 months and 18.7 +/- 15.8 months for groups A and B, respectively. CONCLUSIONS: Pancreatic and periampullary carcinoma should be surgically treated in specialised pancreatic surgery units in order to offer the best outcome to patients.

Tratamiento quirúrgico de la neoplasia de páncreas y región periampular en una unidad especializada: una década después / Surgical treatment of pancreatic and periampullary carcinoma in a specialized unit: a decade on

Introducción: Los resultados de la cirugía de la neoplasia de páncreas y región periampular han mejorado en los últimos años por diversos motivos, entre los que destaca el tratamiento de esta enfermedad en unidades especializadas. Material y métodos: Estudio retrospectivo-prospectivo de 2 grupos de pacientes tratados en períodos y contextos de unidades de cirugía distintos: grupo A (80 pacientes), tratado entre 1982 y 1992 en un servicio de cirugía general, y grupo B (151 pacientes), tratado entre 1998 y 2003 en una unidad de cirugía hepatobiliopancreática. Resultados: La resección se realizó en el 20 y el 53,6% de los pacientes y la derivación, en el 62,5 y el 36,4% de los pacientes de los grupos A y B, respectivamente. Las complicaciones postoperatorias fueron similares después de la resección (el 75 frente al 74,1%) y más elevadas después de la derivación en el grupo B (el 41,8 frente al 34%). La mortalidad postoperatoria fue del 25 y el 3,7% después de la resección, y del 14,1 y el 16,3% después de la derivación, respectivamente, para los grupos A y B. La supervivencia global media (± desviación estándar) fue de 7,0 ± 7,1 y de 14,1 ± 15,3 meses para los grupos A y B, respectivamente, y la supervivencia después de la resección, de 11,8 ± 9,8 y de 18,7 ± 15,8 meses. Conclusiones: La cirugía de la neoplasia de la región pancreática debería realizarse en unidades quirúrgicas especializadas para ofrecer a los pacientes los mejores resultados

Introduction: Results of surgical treatment for pancreatic and periampullary carcinoma have improved in recent years owing to several factors, particularly the concentration of these patients in specialised surgical units. Material and methods: Retrospective-prospective comparative study of results in 2 groups of patients treated over 2 different periods of time and with different surgical policy: group A, which included 80 patients treated from 1982 to 1992 in a general surgery unit, and group B, which comprised 151 patients treated from 1998 to 2003 in a specialised hepato-biliary-pancreatic surgery unit. Results: Surgical treatment in patients of groups A and B, respectively, was: resection in 20% and 53.6% and by-pass in 62.5% and 36.4%. Postoperative morbidity after resection was similar (75% vs 74.1%) but higher after by-pass in group B (41.8% vs 34%). Postoperative mortality after surgical resection and by-pass was 25% and 14.1%, respectively, for group A and 3.7% and 16.3%, respectively, for group B. Mean survival for all patients was 7.0 ± 7.1 months for group A and 14.1 ± 15.3 months for group B. Mean survival for patients with surgical resection was 11.8 ± 9.8 months and 18.7 ± 15.8 months for groups A and B, respectively. Conclusions: Pancreatic and periampullary carcinoma should be surgically treated in specialised pancreatic surgery units in order to offer the best outcome to patients

Anthropometric characteristics of the pubic arch and proper function of the defense mechanisms against hernia formation.

In 33 inguinal regions, we determined the anthropometric characteristics of the pubic arch and the anatomic structures of the suprainguinal space and assessed whether there is a relationship between anatomic features and function of the defense mechanisms. There was a low position of the pubic arch (pubic tubercle and interspinal line distance >75 mm) in 23 cases. The low-pubic-arch group showed a significantly longer inguinal ligament and a greater angle made by the superior border of the suprainguinal space and the inguinal ligament at its medial insertion. The position of the pubic arch correlated significantly with the diameter of the internal ring, the length of the inguinal ligament, and the angle made by the superior border of the suprainguinal space and the medial insertion of the inguinal ligament. A low pubic arch would represent an unfavorable condition for an adequate function of the anatomic defense mechanism against hernia.

Complicaciones de la cirugía de la pancreatitis aguda / Complications in acute pancreatitis surgery

La pancreatitis aguda grave constituye en la actualidad un reto terapéutico todavía sin resolver. Un 20 por ciento de los pacientes afectados de pancreatitis aguda presentan numerosas complicaciones, tanto locales como sistémicas, con elevada mortalidad. Es fundamental identificar las formas graves para indicar la monitorización y el tratamiento en unidades de cuidados intensivos, a fin de detectar y tratar precozmente el fracaso multiorgánico. En la actualidad se acepta que, en fase aguda, la cirugía queda restringida a las complicaciones regionales de la enfermedad, en su mayor parte de carácter séptico, ya que la intervención indiscriminada inicial se asocia a una mayor morbimortalidad, superior al 60 por ciento. Incluso el fracaso multiorgánico precoz sin infección demostrada no se beneficia de tratamiento quirúrgico. Cuando se ha establecido el diagnóstico de infección pancreática, las técnicas de necrosectomía, desbridamiento y drenaje abierto de la cavidad abdominal se asocian con menor mortalidad (12 por ciento), infección recurrente y necesidad de reintervención. En los pacientes a los que se indica intervención se siguen detectando numerosas complicaciones, tanto asociadas a la pancreatitis, como al propio tratamiento quirúrgico. Las más frecuentes son la infección residual o recurrente, la hemorragia, las necrosis y fístulas intestinales y pancreáticas, que contribuyen con una gran frecuencia al fracaso multiorgánico y la muerte (AU)