Training in ambulatory surgery. A pending subject in our country.

The implementation and generalized use of Ambulatory Surgery worldwide is currently a clear reality. Its progressive growth is expected in the short term, but this globalization can also negatively affect the education and training of future doctors, as well as those who are being trained now, if it is not standardized and regulated, since a significant part of the management of the most common pathology that could be performed in Ambulatory Surgery is completed outside the training circuits of hospitals where resident doctors are trained.

Papel de la reparación muscular en el tratamiento de la incontinencia anal

La incontinencia anal (IA) tiene una alta prevalencia en la sociedad, aumenta con la edad, presenta elevados costes económicos y tiene un importante impacto negativo en la calidad de vida de los pacientes que la padecen. El tratamiento quirúrgico se reserva para aquellos pacientes que no responden a medidas conservadoras. Clásicamente, las técnicas de reparación muscular han jugado un papel principal en el tratamiento de la IA, sobre todo en aquellos casos en los que había un defecto del complejo esfinteriano, siendo la más extendida la esfinteroplastía solapante y reservando técnicas más complejas como la graciloplastía para casos con lesiones esfinterianas catastróficas. Otras técnicas como la reparación total del suelo pélvico se encuentran en desuso por sus pobres resultados.

Anal Incontinence (AI) is a prevalent disease, increases with aging, has high economic costs and a deep impact in the quality of life of the patients who suffer it. Surgical treatment is proposed in patients with no-response to medical therapy. Muscle repair techniques have been the main approach in AI, specially when there is a sphincteric damage. Overlapping sphincteroplasty is the most common technique and graciloplasty is used when there is a wide damage in sphinteric complex. Some other techniques such as postanal or total pelvic floor repair are not used any more because of their poor results.

Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic.

The current situation of the SARS-CoV-2 pandemic has paralyzed non-urgent and/or oncological surgery in many hospitals in our country with what it means for the health of citizens who are awaiting a surgical procedure. Outpatient Surgery can afford more than 85% of the surgical procedures that are performed in a surgical department and is presented as a feasible and safe alternative at the present time since it does not require admission and decreases clearly the risk of infection. In addition, it is the tool that should be generalized to solve the accumulation of patients on the waiting list that the pandemic is generating, so it seems appropriate that the Ambulatory Surgery section of the Spanish Association of Surgeons present a series of recommendations for the implementation of outpatient surgery in these exceptional circumstances that we have to live.

Consenso de la sección de cirugía mayor ambulatoria de la Asociación Española de Cirujanos sobre el papel de la cirugía mayor ambulatoria en la pandemia SARS-CoV-2 / Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic

La situación actual de la pandemia por SARS-CoV-2 tiene paralizada la cirugía no urgente y/u oncológica en muchos hospitales de nuestro país con lo que esto conlleva para la salud de los ciudadanos que están pendientes de una intervención quirúrgica. La cirugía mayor ambulatoria puede abarcar en su cartera de servicios más del 85% de los procedimientos quirúrgicos que se realizan en un servicio de cirugía y se presenta como una alternativa factible y segura en el momento actual ya que no requiere camas de ingreso y disminuye claramente el riesgo de infección. Además, es la herramienta que debería generalizarse para solucionar la acumulación de pacientes en lista de espera que la pandemia está generando, por lo que parece oportuno que desde la sección de Cirugía Mayor Ambulatoria de la Asociación Española de Cirujanos se presente una serie de recomendaciones para la implementación de la misma en estas circunstancias excepcionales que nos toca vivir.(AU)

The current situation of the SARS-CoV-2 pandemic has paralyzed non-urgent and/or oncological surgery in many hospitals in our country with what it means for the health of citizens who are awaiting a surgical procedure. Outpatient Surgery can afford more than 85% of the surgical procedures that are performed in a surgical department and is presented as a feasible and safe alternative at the present time since it does not require admission and decreases clearly the risk of infection. In addition, it is the tool that should be generalized to solve the accumulation of patients on the waiting list that the pandemic is generating, so it seems appropriate that the Ambulatory Surgery section of the Spanish Association of Surgeons present a series of recommendations for the implementation of outpatient surgery in these exceptional circumstances that we have to live.(AU)

[Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic]. / Consenso de la sección de cirugía mayor ambulatoria de la Asociación Española de Cirujanos sobre el papel de la cirugía mayor ambulatoria en la pandemia SARS-CoV-2.

The current situation of the SARS-CoV-2 pandemic has paralyzed non-urgent and/or oncological surgery in many hospitals in our country with what it means for the health of citizens who are awaiting a surgical procedure. Outpatient Surgery can afford more than 85% of the surgical procedures that are performed in a surgical department and is presented as a feasible and safe alternative at the present time since it does not require admission and decreases clearly the risk of infection. In addition, it is the tool that should be generalized to solve the accumulation of patients on the waiting list that the pandemic is generating, so it seems appropriate that the Ambulatory Surgery section of the Spanish Association of Surgeons present a series of recommendations for the implementation of outpatient surgery in these exceptional circumstances that we have to live.

Carcinoma colorrectal, quimioterapia y pioderma gangrenoso periestomal. Una asociación infrecuente / Colorectal carcinoma, chemotherapy and peristomal pyoderma gangrenosum. A rare association

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Cirugía mayor ambulatoria en patología mamaria / Major ambulatory surgery in breast diseases

Introducción: El tratamiento quirúrgico de la patología mamaria (PM) ha evolucionado aumentando su manejo como cirugía mayor ambulatoria (CMA). El objetivo de este estudio es analizar una serie de pacientes intervenidas de PM en régimen de CMA durante el año 2017 para evaluar su calidad y seguridad. Métodos: Se realiza análisis retrospectivo de las pacientes intervenidas de PM en el Consorcio Hospital General Universitario de Valencia desde enero hasta diciembre del 2017 incluidos en programa de CMA, estudiando el número de pacientes, los motivos de exclusión, el tipo de procedimientos quirúrgicos realizados, el índice de sustitución (IS), la tasa de ingreso (TI) y las causas de conversión al ingreso, complicaciones postoperatorias y el índice de satisfacción. Se compara con un grupo control del año 2013. Resultados: En 2017 se realizaron 396 intervenciones por PM, siendo de PM benigna (PMB) 170 intervenciones y de PM maligna (PMM) 226 intervenciones. El IS para la PM global es del 72,8% y para PMB fue 93,4%. El IS para PMM fue 57,2%, que ha progresado en los últimos años desde el 45,4% en 2013. La TI inesperado de la PMM fue del 14,1%, mientras que en la PMB fue del 0,6%. La PMM con ingreso presentó más morbilidad (17%) que la PMM sin ingreso (8,5%) y la PMB (6,5%). Conclusiones: En PMM del Consorcio Hospital General Universitario de Valencia el IS ha aumentado y la TI depende de la linfadenectomía tras biopsia peroperatoria del ganglio centinela. La CMA para el tratamiento de la PM es segura y eficiente

Introduction: The use of ambulatory surgery (AS) for breast pathology (BP) has increased. The objective of this study is to analyse a group of patients treated surgically for breast pathology in order to evaluate its quality and security in a MAS setting in 2017. Methods: A retrospective review of all patients undergoing breast surgery was conducted within an AS programme from January to December 2017 in Consorcio Hospital General Universitario of Valencia (CHGUV). The study analysed the number of patients, exclusion reasons, type of surgical procedures, evolution of substitution rate (SR), rate and causes of conversion to admission, postoperative complications, motives for not being included in the ambulatory programme and the satisfaction rate of the patients treated with ambulatory surgery. This has been compared with a 2013 group. Results: In 2017, 396 procedures for BP were performed: 170 for benign and 226 for malignant disease. The SR for the global mammary pathology was 72.8%. The SR for benign pathology was 93.4% and the SR for malignant pathology was 57.2%, which has increased in recent years from 45.4% in 2013. The unexpected hospitalization rate (HR) of malignant pathologies was 14.1%, while the HR in benign pathologies was 0.6%. Patients hospitalized for malignant pathologies presented higher complications (17%) than ambulatory patients (8.5%) and benign pathologies (6.5%). Conclusions: At the CHGUV, the SR has steadily increased in malignant pathologies. The unexpected hospitalization rate is determined by perioperative sentinel lymph node biopsy results. AS for the treatment of mammary pathology is efficient and safe

Major ambulatory surgery in breast diseases. / Cirugía mayor ambulatoria en patología mamaria.

INTRODUCTION: The use of ambulatory surgery (AS) for breast pathology (BP) has increased. The objective of this study is to analyse a group of patients treated surgically for breast pathology in order to evaluate its quality and security in a MAS setting in 2017. METHODS: A retrospective review of all patients undergoing breast surgery was conducted within an AS programme from January to December 2017 in Consorcio Hospital General Universitario of Valencia (CHGUV). The study analysed the number of patients, exclusion reasons, type of surgical procedures, evolution of substitution rate (SR), rate and causes of conversion to admission, postoperative complications, motives for not being included in the ambulatory programme and the satisfaction rate of the patients treated with ambulatory surgery. This has been compared with a 2013 group. RESULTS: In 2017, 396 procedures for BP were performed: 170 for benign and 226 for malignant disease. The SR for the global mammary pathology was 72.8%. The SR for benign pathology was 93.4% and the SR for malignant pathology was 57.2%, which has increased in recent years from 45.4% in 2013. The unexpected hospitalization rate (HR) of malignant pathologies was 14.1%, while the HR in benign pathologies was 0.6%. Patients hospitalized for malignant pathologies presented higher complications (17%) than ambulatory patients (8.5%) and benign pathologies (6.5%). CONCLUSIONS: At the CHGUV, the SR has steadily increased in malignant pathologies. The unexpected hospitalization rate is determined by perioperative sentinel lymph node biopsy results. AS for the treatment of mammary pathology is efficient and safe.

Valoración del tratamiento del shunt portosistémico congénito en el adulto en función de la sintomatología asociada / Appreciation of the treatment in adult patients with congenital portosystemic connections in relation with their symptoms

Introducción: las comunicaciones porto-sistémicas congénitas intrahepáticas (síndrome de Abernethy) son variantes anatómicas muy poco frecuentes, estando clasificadas en función del tipo de unión que exista entre la vena porta y el sistema venoso central. En el adulto, su diagnóstico suele ser incidental, aunque algunos casos puede presentarse con clínica de encefalopatía en pacientes sin hepatopatía asociada. Casos clínicos: presentamos dos casos de shunt porto-sistémico, uno con desarrollo de encefalopatía y otro hallado de forma casual. Su tratamiento, por medio de radiología intervencionista se decidió en función de si presentaban o no sintomatología. Ambos casos (tratado y control) se presentan al control en consultas externas asintomáticos, sin asociar complicaciones derivadas de la decisión terapéutica. Este control se realiza anualmente con pruebas de imagen (ecografía/TAC) y análisis sanguíneo. Discusión: dada la escasa prevalencia de este tipo de malformación y su diagnóstico habitual en edades más tempranas (asociada a importantes alteraciones cognitivas) su tratamiento en adultos no está protocolizado. En estos casos la decisión del tratamiento estaría condicionada a la sintomatología asociada, siendo el tratamiento mínimamente invasivo mediante radiología intervencionista una opción terapéutica a valorar en el adulto sintomático. Por su parte la observación por medio de pruebas de imagen y control en consultas externas, sin tratamiento asociado, seria de elección en adultos en los que no se presenta sintomatología asociada

Background: portosystemic intrahepatic venous connections (Abernethy syndrome) are rare anatomical variants, which are classified according to the type of union between the portal venous circulation and the central venous system. In adults, the diagnosis is often incidental, although some cases can be presented with an encephalopathy without associated liver disease. Case reports: here we present two cases of portosystemic shunt, one with encephalopathy development, and the other casually caught. Its treatment by interventionist radiology, was decided in function of clinic symptoms. Both patients were asymptomatic at controls in the outpatient consultation. No complications derived from the therapeutic decision. The control is carried out annually with image tests and blood analysis. Discussion: given the low prevalence of malformation and its usual diagnosis at younger ages (associated with important cognitive alterations) its treatment in adults is not protocolized. In these cases the decision of the treatment would be conditioned to the associated symptomatology, being the minimally invasive treatment (by interventional radiology) a therapeutic option in the symptomatic adult. Observation by imaging tests and control in outpatient consultation (without associated treatment) would be a choice in asymptomatic adults

Appreciation of the treatment in adult patients with congenital portosystemic connections in relation with their symptoms.

BACKGROUND: portosystemic intrahepatic venous connections (Abernethy syndrome) are rare anatomical variants, which are classified according to the type of union between the portal venous circulation and the central venous system. In adults, the diagnosis is often incidental, although some cases can be presented with an encephalopathy without associated liver disease. CASE REPORTS: here we present two cases of portosystemic shunt, one with encephalopathy development, and the other casually caught. Its treatment by interventionist radiology, was decided in function of clinic symptoms. Both patients were asymptomatic at controls in the outpatient consultation. No complications derived from the therapeutic decision. The control is carried out annually with image tests and blood analysis. DISCUSSION: given the low prevalence of malformation and its usual diagnosis at younger ages (associated with important cognitive alterations) its treatment in adults is not protocolized. In these cases the decision of the treatment would be conditioned to the associated symptomatology, being the minimally invasive treatment (by interventional radiology) a therapeutic option in the symptomatic adult. Observation by imaging tests and control in outpatient consultation (without associated treatment) would be a choice in asymptomatic adults.

Cirugía mayor ambulatoria de la glándula tiroides y paratiroides: resultados tras 6 años de experiencia / Major outpatient surgery of the thyroid and parathyroid glands: results after 6 years experience

Objetivo: La cirugía mayor ambulatoria (CMA) y con estancia inferior a 24 horas (overnight stay) se ha consolidado en muchas patologías aunque en cirugía tiroidea y paratiroidea resulta controvertido. El objetivo es valorar nuestros resultados en cirugía del tiroides y paratiroides en régimen de CMA durante un periodo de 6 años. Material y Métodos: Estudio observacional prospectivo de pacientes con indicación de hemitiroidectomía o paratiroidectomía enfocada en régimen CMA entre enero de 2011 y diciembre de 2016. Los pacientes cumplían criterios de CMA. En los primeros años se excluyeron los nodulos tiroideos mayores de 3 cm y los pacientes ASA III. Los pacientes ingresaron la mañana de la intervención, tras el acto quirúrgico pasaron a la Unidad de Recuperación Posquirúrgica y posteriormente a sala de hospitalización. Tras 8 h, si cumplían criterios, fueron dados de alta. Resultados: Se intervinieron 270 pacientes, la tasa de aplicabilidad global fue del 59%, la tasa de aceptabilidad global del 83,6% y el índice de sustitución del 49,2%. El índice de ingresos no deseados fue del 10,4% para la paratiroidectomía y del 17,6% en la cirugía del tiroides. Ningún paciente presentó complicaciones mayores en su domicilio. El grado de satisfacción fue alto o muy alto en el 94% de los pacientes. Conclusiones: La paratiroidectomía enfocada y la hemitiroidectomía realizada por cirujanos expertos en pacientes seleccionados, es segura y efectiva en régimen ambulatorio. Es posible mejorar el índice de sustitución ambulatorio aumentando la tasa de aplicabilidad y aceptabilidad.

Objetive: Ambulatory or overnight stay surgery have been consolidated in many different procedures. However, its use in thyroid and parathyroid surgery is still controversial. The aim of this report is to present the results of 6 years of ambulatory patients undergoing surgery of the thyroid or parathyroid glands. Material and Methods: Prospective observational study of patients who underwent hemithyroidectomy or selective parathyroidectomy in the ambulatory program from January 2011 to December 2016. All patients included met the general criteria of ambulatory surgery. During the first years nodules bigger than 3 cm and patients classified as ASA III were excluded. Patients arrive at hospital the morning of surgery. After the operation, patients pass to the post-anesthesia care unit and then to the hospitalization room. 8 hours after surgery patients are discharged home if they meet the criteria. Results: 270 patients were operated, 159 of them met the inclusion criteria. The overall applicability rate was 59%. The acceptance rate was 83.6% and the substitution index was 49.2%. The unwanted hospital admission was 10.4% for the parathyroidectomy and 17.6% for the hemithyroidectomy. Any patient presented major complications at home. The satisfaction rate was high or very high for 94% of the patients. Conclusion: Selective parathyroidectomy and hemithyroidectomy performed by experienced surgeons in selected patients can be safely and effectively carried out in ambulatory surgery (outpatient). It would be possible to improve the substitution index by increasing the application and acceptability ratios.

Hipoplasia de vesícula biliar con cuadro colestásico como primera manifestación clínica / Cholestasis as the first symptom of gallbladder hypoplasia

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Randomized clinical trial of a new cyanoacrylate flexible tissue adhesive (Adhflex) for repairing surgical wounds.

UNLABELLED: The use of synthetic adhesives such as cyanoacrylates for closing surgical wounds remains controversial. In a multicenter, prospective and randomized clinical trial, we compared a new cyanoacrylate elastic tissue adhesive, Adhflex, with standard suturing methods for repairing surgical wounds. Sixty patients who underwent surgery for inguinal hernia were randomly chosen for Adhflex or standard silk suture. We evaluated wound closure time and parameters related to wound healing and complications using the Hollander Scale; overall surgeon, patient, and independent evaluator satisfaction with scar appearance using a visual analog scale; and scar cosmesis and cosmetic outcome using the Patient and Observer Scar Assessment Scale. The major finding of this study was that surgical wound closure time (minutes) was significantly lower (p < 0.05) when using Adhflex (1.50 ± 0.63) than when using sutures (2.23 ± 0.66), reducing surgery costs. Patient, surgeon and independent evaluator satisfaction was greater with Adhflex (p < 0.05). No differences were found in the final cosmetic outcome of surgical wounds (p > 0.05). The results of this clinical trial showed that Adhflex could be considered a promising and suitable wound closure method. Undoubtedly, lower operating room times will reduce overall surgical costs. Cosmetic outcomes in the medium term are comparable to those seen with sutures, yet there is no need for dressing changes, postoperative wound checks, or removal of stitches or clips. The comfort of the patient is an important factor when considering wound closure methods. REGISTRATION NUMBER: Eudra CT2012-002701-22.

Endoscopic and histological evaluations of a newly designed inguinal hernia mesh implant: Experimental studies on porcine animal model and human cadaver.

PURPOSE: Conventional prostheses used for inguinal hernia repair are static and passive. This feasibility-study shows the features of a new 3D tension-free prosthesis in an experimental model. METHODS: This study was divided into two-phases: 1) aimed to test the physics intrinsic features and the anatomical adaptability of a new 3D designed mesh, and 2) aimed to evaluate the inflammatory reaction associated with different materials used. On phase-1 implantations were performed in pigs. During the first trial phase, the prostheses were also implanted on human cadavers. On phase-2, implantation was carried out on large swine. Follow-up was of 60-days, after which the animals were anaesthetized for laparoscopic assessment, and for sample collection of mesh implantation site for histological analysis. RESULTS: All animals showed good 3D mesh tolerance, and the follow-up period was uneventful. The laparoscopy showed no inflammatory lesions on the internal surface of the peritoneum. Macroscopic observation of implantation site revealed some local fibrosis and reorganization of tissue, no signs of infection, and no changes on original implant positioning. Histological analysis on phase-1 showed in most sample segments the deferent duct maintaining its central position and surrounded by vascular and nervous structures. On phase-2 differences in inflammatory lesion score could be found between subjects. CONCLUSIONS: This new 3D mesh can be placed appropriately and from this preliminary animal study no untoward complications were noted over a 60 day period.

Pentoxifylline protects the small intestine after severe ischemia and reperfusion.

OBJECTIVES: Pentoxifylline, a methylxanthine derivative with significant hemorheologic properties, is used for claudication in patients with peripheral vascular disease, and experimentally for ischemic injury to organs because of its antioxidant and antiinflammatory effects. We used a rat model of severe small intestinal ischemia and reperfusion to determine the ability of pentoxifylline in improving survival, molecular response, and pathological protection. MATERIALS AND METHODS: We used 6 groups of male Wistar rats (n=25 each). The superior mesenteric artery was occluded for 120 minutes. Laboratory and tissue studies were done on 5 animals, 1 hour after reperfusion, and animal survival was assessed at 7 days. There were 2 control groups that received normal saline, either before ischemia or during reperfusion. The 4 treated groups received pentoxifylline 1 or 10 mg/kg at the same times mentioned above. Laboratory studies included measuring serum lactic acid dehydrogenase, tumor necrosis factor-α, interleukin-1ß, and interleukin-6.Intestinal tissue malondialdehyde and myeloperoxidase in small intestine tissue also were measured. Histology and laser vascular blood flow at baseline and reperfusion were obtained, and survival was determined 7 days after ischemia. RESULTS: A significant survival benefit in the animals treated with 10 mg/kg of pentoxifylline at reperfusion was noted. This coincided with a reduction in biochemical markers of cell damage - specifically, serum lactic acid dehydrogenase, and tissue malondialdehyde, ischemia, and reperfusion. Additionally, we saw decreased levels of tumor necrosis factor-α, interleukin-1ß, and interleukin-6. Improved postreperfusion blood flow shown by laser Doppler technology also was seen in the treated groups. Histologically, we observed less neutrophil infiltration in the intestine of ischemic-treated rats. Also seen in the control animals were increased necrotic lesions in the microvilli with a higher presence of lysozyme in the Paneth cells. Survival was significantly better at 7 days (70% vs 40%) when we compared the pentoxifylline group treated at reperfusion (10 mg/kg) to the ischemic controls. CONCLUSIONS: Pentoxifylline had a significant protective effect on severely ischemic bowel when administered during reperfusion at a dosage of 10 mg/kg. Better survival, improved histology, and molecular response should urge consideration of the consideration of applying these findings in some general surgery and transplant conditions.

Tratamiento quirúrgico ambulatorio de la incontinencia urinaria de esfuerzo femenina / Outpatient surgical treatment of female stress urinary incontinence

OBJETIVO: Evaluar los resultados obtenidosen el tratamiento quirúrgico ambulatorio de laincontinencia urinaria de esfuerzo genuina (IUE), durantelos cinco años de integración del Servicio deUrología en la Unidad de Cirugía Mayor Ambulatoria(UCMA) de nuestro Consorcio Hospital GeneralUniversitario de Valencia (CHGUV).MÉTODO: Entre enero de 2000 y diciembre de2004, hemos intervenido en la UCMA del CHGUV a26 pacientes (49-78; media 69,8 años) afectas deIUE, mediante la colocación de cabestrillo suburetral sintensión (TVT), realizado con anestesia local-sedación yen régimen estrictamente ambulatorio. Todas laspacientes fueron evaluadas mediante clínica y urodinamia,excluyéndose a las que presentaron algún tipo deprolapso concomitante genital, urinario o entérico y lasque no cumplían requisitos sociales para CMA. No seexcluyeron las que habían recibido con anterioridad alguna otra técnica quirúrgica antiincontinencia. Seevalúan los criterios de inclusión y alta, así como losresultados obtenidos y el grado de satisfacción mediantela elaboración de un cuestionario.RESULTADOS: En 22 pacientes (85%) se evidenció unaIUE pura y en 4 (15%) una mixta con predominio deesfuerzo. El 54% (14 pacientes) fueron ASA I, 8 (31%)ASA II y el 15% restante (4) ASA III bien compensada.La tolerancia a la intervención bajo anestesia local (20-30 ml. lidocaína al 1%) fue buena en todas las pacientes,habiéndose utilizado sedoanalgesia adicional (perfusiónde propofol y remifentanilo) en 10 de ellas (38%). El tiempo medio de intervención fue de 30 minutos(25-45) y el de permanencia en la UCMA hasta el altade 100 minutos (80-140). Todas fueron dadas de altatras la intervención. Ninguna precisó ingreso ni presentóretención urinaria tras la retirada de la sonda. Entodas desapareció la IUE. Tres pacientes presentaronurgencia miccional postoperatoria que respondieron alos anticolinérgicos orales. Los resultados obtenidosson superponibles a los alcanzados con anestesia epidurale ingreso, siendo el grado de satisfacción con eltratamiento recibido superior al 95%.CONCLUSIONES: El desarrollo de nuevos sistemasrevolucionarios en el tratamiento de la IUE ha simplificadola cirugía de esta entidad de tal manera quepodemos afirmar que un elevado porcentaje de pacientesafectas son candidatas a ser incluidas en un programade CMA, mejorando ostensiblemente la relacióncosto-eficacia, no disminuyendo por ello la calidadasistencial ni el grado de satisfacción de las pacientes

OBJECTIVES: To evaluate the results of the outpatient surgical treatment of genuine female stress urinary incontinence (SUI) over a five year period since the integration of the Department of Urology in the Ambulatory Surgery Unit at our hospital “Consorcio Hospital General Universitario de Valencia” (CHGUV). METHODS: Between January 2000 and December 2004 26 patients (ages 49-78; mean age 69.8 yr.) with the diagnosis of SUI underwent tension-free suburethral mesh sling (TVT) outpatient operations under local anesthesia-sedation at the ambulatory surgery unit of the CHGUV. All patients had clinical and urodynamic evaluation, excluding those presenting genital prolapse or non compliance with the social requirements for ambulatory surgery. Previous anti-incontinence surgery was not an exclusion criterion. We evaluate inclusion and discharge criteria, results and satisfaction degree measured by a questionnaire. RESULTS: 22 patients (85%) had genuine SUI and 4 (15%) had mixed UI with predominance of the stress component. 54% (14 ) of the patients were ASA I, 31% (8) ASA II, and 15% (4) well compensated ASA III. Operation tolerance under local anesthesia (20-30 ml 1% lidocaine) was good in all patients, having used additional sedation-analgesia (propofol-remifentanil IV perfusion) in 10 of them (38%). Mean operative time was 30 minutes (25-45) and stay at the unit discharge was 100 min. (80-140). All patients were discharged the same day. None of them required readmission or presented urinary retention after catheter removal. SUI disappeared in all of them. Three patients presented postoperative urge incontinence responsive to oral anticolinergic drugs. Our results are similar to those obtained with epidural anesthesia and hospital admission, being the degree of satisfaction with treatment higher than 95%. CONCLUSIONS: The development of new, revolutionary systems for the treatment of SUI has simplified the surgical treatment of this entity, so that we can say a high percentage of patients may be included in an ambulatory surgery program, significantly improving cost-efficacy without diminishment of health-care quality or patient satisfaction

[The treatment of hydrocele as ambulatory surgery]. / Tratamiento del hidrocele en cirugia mayor ambulatoria.

OBJECTIVES: To evaluate the results of this surgical treatment of hydrocele over the first four years of integration of the Urology Department in the Major Ambulatory Surgery Unit in our Hospital. METHODS: From January 2000 to July 2004 we have performed 167 hydrocelectomies as ambulatory surgery in 152 patients (15 cases bilateral) with ages ranging from 16-87 years (mean 52.6). All procedures were performed under local anesthesia, using between 10-15ml of 1% lidocaine. The Lord's vaginalis plication technique was employed in 92% of the cases, leaving resection techniques for the remaining 8%, which presented certain degree of enlargement of the tunica vaginalis. We evaluated inclusion and discharge criteria, results, and degree of satisfaction by means of a questionnaire. RESULTS: Results are equivalent to those of inpatient surgery. Only one patient required admission to the hospital due to a postoperative complication, which was clearly independent of the ambulatory character of the process. Satisfaction with treatment was higher than 95%. CONCLUSIONS: Almost all patients with hydrocele are candidates to ambulatory surgery, significantly improving the cost-efficacy rate, without diminishing the quality of care or patient satisfaction.

Tratamiento del hidrocele en cirugía mayor ambulatoria / The treatment of hydrocele as ambulatory surgery

OBJETIVO: Evaluar los resultados obtenidosen el tratamiento quirúrgico del hidrocele durantelos cuatro primeros años de integración del Servicio deUrología en la Unidad de Cirugía Mayor Ambulatoria(CMA) de nuestro Hospital.MÉTODO: Desde enero de 2000 hasta julio de 2004,hemos realizado 167 hidrocelectomías con carácterambulatorio a 152 pacientes (en 15 casos bilateral),con edades comprendidas entre 16 y 87 años (media52,6). Todos los pacientes fueron intervenidos bajoanestesia local, precisando entre 10 y 15 ml de lidocaínaal 1%. La técnica de plicatura vaginal de Lord fueempleada en el 92% de los casos, reservándose lastécnicas resectivas para el 8% restante que presentabancierto grado de paquivaginalitis. Se evalúan los criteriosde inclusión y alta, así como los resultados obtenidosy el grado de satisfacción mediante la elaboraciónde un cuestionario.RESULTADOS: Los resultados obtenidos son superponiblesa los de la cirugía con ingreso. Tan solo uno de lospacientes precisó ingreso por complicación postoperatoria,la cual fue claramente independiente del régimende ambulatorización del proceso. El grado de satisfaccióncon el tratamiento recibido ha sido superior al95%.CONCLUSIONES: La práctica totalidad de los pacientesafectos de hidrocele son candidatos a ser incluidosen un programa de CMA, mejorando ostensiblementela relación costo-eficacia, no disminuyendo por ello lacalidad asistencial ni el grado de satisfacción de lospacientes

OBJECTIVES: To evaluate the results of this surgical treatment of hydrocele over the first four years of integration of the Urology Department in the Major Ambulatory Surgery Unit in our Hospital. METHODS: From January 2000 to July 2004 we have performed 167 hydrocelectomies as ambulatory surgery in 152 patients (15 cases bilateral) with ages ranging from 16-87 years (mean 52.6). All procedures were performed under local anesthesia, using between 10-15ml of 1% lidocaine. The Lord’s vaginalis plication technique was employed in 92% of the cases, leaving resection techniques for the remaining 8%, which presented certain degree of enlargement of the tunica vaginalis. We evaluated inclusion and discharge criteria, results, and degree of satisfaction by means of a questionnaire. RESULTS: Results are equivalent to those of inpatient surgery. Only one patient required admission to the hospital due to a postoperative complication, which was clearly independent of the ambulatory character of the process. Satisfaction with treatment was higher than 95%. CONCLUSIONS: Almost all patients with hydrocele are candidates to ambulatory surgery, significantly improving the cost-efficacy rate, without diminishing the quality of care or patient satisfaction