Textbook outcome in gastric surgery, what implications does it have on survival?

INTRODUCTION: The textbook outcome (TO) is a multidimensional measure to assess the quality of healthcare practice. This is reflected as the "ideal" surgical result, attending to a series of indicators or established reference points that are adapted depending on the surgical disease that we want to analyze. There are few references and series published about TO, all of them very recent. OBJECTIVE: We present a series of gastric surgery from the TO perspective and we analyze its impact on survival. METHOD: Retrospective observational study of all gastric neoplasms operated on in our center. PERIOD: January 2015-December 2020. The criteria for TO were: margins R0, >15 lymph nodes in the histological study, no Clavien-Dindo complications > IIIa, hospital stay < 21 days, no mortality or readmission in the 30 postoperative days. A comparative analysis was performed between the TO group versus the non-TO group. RESULTS: 91 patients were operated on. We reached the TO in 34.1% of the patients. The variable >15 lymph nodes was the one that most affected to achieve a TO. When performing the survival analysis, we obtained that the group in which the TO was obtained had a greater survival (p < 0.008). CONCLUSION: In our series, obtaining the TO has an impact on survival which 34,1% of degree of compliance.

Enfermedad diverticular yeyuno-ileal complicada tratada quirúrgicamente: serie de 12 casos y revisión de literatura / Complicated jejunoileal diverticular disease: a 12 cases' serie and literature review

Objetivo: Realizar un análisis retrospectivo de una serie de casos de diverticulitis yeyuno-ileal complicadas tratadas quirúrgicamente en nuestro servicio durante el periodo comprendido entre los años 2002 al 2015. Materiales y métodos: Se trató quirúrgicamente 12 casos de diverticulosis yeyuno-ileal complicadas, 7 mujeres y 5 varones. La edad media fue 76 años. La presentación clínica en todos los casos fue dolor abdominal agudo, uno de ellos con hemorragia digestiva. Todos presentaron leucocitosis, neutrofilia y aumento de reactantes de fase aguda. A todos los pacientes se les realizó TAC abdominal urgente. Resultados: En 11 casos hubo congruencia entre estudio de imagen y hallazgos quirúrgicos. La localización de los divertículos fue yeyuno (9) e íleon (3). Siempre se realizó laparotomía exploradora urgente encontrándose perforación diverticular con peritonitis (7 casos), perforación diverticular con absceso (4 casos) y en un caso un área isquémica con perforación diverticular tras embolización. Se realizó siempre resección intestinal y anastomosis. En ningún caso se conocía previamente el diagnóstico de diverticulosis yeyuno-ileal. Nuestras complicaciones fueron: Clavien I (2), Clavien IIIa (1), Clavien IVb (1), Clavien V (1). Conclusiones: La diverticulitis yetuno-ileal es una entidad infrecuente, suele ser la forma de debut de una enfermedad diverticular no conocida previamente. El TAC abdominal es de gran utilidad diagnóstica. La resección del segmento afecto es el tratamiento de elección

Objective: To perform a retrospective analysis of a series of complicated JID (jejunoileal diverticulitis) cases surgically treated in our service during the period from 2002 to 2015. Materials and methods: We treated 12 cases of jejunoileal complicated diverticulosis. 7 women and 5 men. The mean age was 76 years. The clinical presentation in all cases was acute abdominal pain, one with gastrointestinal bleeding. All cases had leukocytosis, neutrophilia and increased acute phase reactants. All patients underwent emergency abdominal CT. Results: In 11 cases, there was consistency between imaging studies and surgical findings. Diverticula were located: jejunum (9) and ileum (3). Urgent exploratory laparotomy was always done and findings were: diverticular perforation with peritonitis (7 cases), diverticular perforation with abscess (4 cases) and in one case an ischemic area with diverticular perforation after embolization. Intestinal resection and anastomosis was performed in all cases. There were no patients, in which the diagnosis of diverticulosis jejunoileal was previously known. Complications were: Clavien I (2), Clavien IIIa (1), Clavien IVb (1), Clavien V (1). Conclusions: Jejunoileal diverticulitis is a rare entity, usually the first sign of onset of diverticular disease not previously known. Abdominal CT is of great diagnostic value. Resection of the affected segment is the treatment of choice