Pharmacological intestinal obstruction because of calcium polystyrene sulfonate administration.

Cation exchange resins are commonly used as treatment for hyperkalaemia in patients with chronic renal disease. There is a relation between cation exchange resins and the development of gastrointestinal adverse effects. A case of an intestinal obstruction at the terminal ileum is presented that underwent an ileocolic resection because of a critical stenosis of the intestine. The pathologist revealed abundant inflammatory cells together with deposits of calcium polystyrene crystals responsible of the intestinal obstruction. A rare cause of intestinal obstruction to bear in mind in chronically medicated patients with cation exchange resins.

La mastectomía como medida de reducción de riesgo de cáncer de mama / Risk-reducing mastectomy in breast cancer

Objetivos: Evaluar las mastectomías reductoras de riesgo realizadas y analizar las indicaciones y resultados según las características individuales, oncológicas y quirúrgicas de nuestras pacientes.MétodosEstudio observacional retrospectivo de todas las mastectomías con reconstrucción inmediata en mamas sanas realizadas desde 2013 a 2019. Se dividieron las pacientes en tres grupos: I) riesgo genético de cáncer de mama, II) cáncer de mama diagnosticado y III) antecedente de cáncer de mama.ResultadosSe realizaron 56 mastectomías reductoras de riesgo a 46 pacientes, 15% grupo I, 50% grupo II y 35% grupo III, pero tras estudios diferidos, 20 pacientes (43%) presentaban mutación genética. La media de edad en este subgrupo fue de 40 años y con predominio de tumores HER2+ (40% frente al 12%, p=0,164). En el grupo III observamos más complicaciones inmediatas (31%, p=0,014) y tardías (69%, p=0,027) relacionadas con la reconstrucción protésica, y más evidente en mamas que tuvieron enfermedad (73% frente al 39% sanas, p=0,002). Se encontró relación entre contractura capsular y la radioterapia postoperatoria (p=0,008) y entre necrosis y radioterapia preoperatoria (p=0,001). Se reintervino al 7% por complicaciones en mastectomías profilácticas. No hemos tenido recidivas locales.ConclusionesConsideramos justificada la mastectomía reductora de riesgo realizada a mujeres jóvenes con mutación genética y a pacientes con cáncer precoz, HER2+ y riesgo familiar. En pacientes ya tratadas por cáncer, el riesgo de complicaciones supera el valor profiláctico de la técnica. La reconstrucción mamaria es la principal responsable de complicaciones postoperatorias y las pacientes deben ser plenamente conscientes de ello. (AU)

Objectives: To evaluate the risk-reducing mastectomies performed and to analyse the indications and results according to the individual, oncological and surgical characteristics of our patients.MethodsRetrospective observational study of all mastectomies with immediate reconstruction in healthy breasts performed from 2013 to 2019. The patients were divided into three groups: I) genetic risk of breast cancer, II) diagnosed breast cancer and III) history of cancer breast.ResultsA total of 56 risk-reducing mastectomies were performed in 46 patients, 15% in group I, 50% in group II and 35% in group III. After deferred studies, 20 (43%) patients had a genetic mutation. This subgroup had an average age of 40 years and a predominance of HER2+ tumours (40% versus 12%, p=0.164). In group III, we observed more immediate (31%, p=0.014) and late (69%, p=0.027) complications related to prosthetic reconstruction, which were more evident in breasts with disease (73% versus 39% healthy, p=0.002). A relationship was found between capsular contracture and postoperative radiotherapy (p=0.008) and between necrosis and preoperative radiotherapy (p=0.001). Reoperation was required in 7% for complications of prophylactic mastectomies. There were no local relapses.ConclusionsWe consider risk-reducing mastectomy to be justified in young women with a genetic mutation and in patients with early cancer, HER2+ and family risk. In patients already treated for cancer, the risk of complications exceeds the prophylactic value of the technique. Breast reconstruction is primarily responsible for postoperative complications and patients should be fully aware of this. (AU)

Evaluation of the effect of triclosan coated sutures in the prevention of surgical site infections in a Spanish hospital setting: A prospective, observational study.

BACKGROUND: Surgical site infections (SSIs) are one of the most frequently reported types of hospital-acquired infection and are associated with substantial clinical and economic burden. AIM: To assess the incidence of SSIs and analyze contributing risk factors in a real-world Spanish hospital setting before and after the implementation of triclosan-coated sutures (TCS). METHODS: A prospective, observational study was conducted at Hospital Clínico Universitario de Santiago de Compostela, Spain. Enrolled patients underwent surgery in the following specialties: general surgery, urology, neurosurgery, gynaecology, and traumatology. The primary outcome of the study was SSI incidence, assessed at a 30-day follow-up. Secondary outcomes were length of hospital stay, and readmission, reintervention, and mortality rates, also at 30 days. FINDINGS: 5,081 patients were included in the study, of which 2,591 were treated using non-coated sutures (NCS) and 2,490 using TCS. After adjusting for potential confounders, TCS significantly reduced SSI rate by 36%, compared with NCS (odds ratio [OR]: 0.64; 95% confidence interval [CI]: 0.48-0.85; P<0.003). When stratified by wound classification, a statistically significant reduction in SSI incidence, in favour of TCS use, was observed for Class IV (dirty) wounds (35.6% versus 22.7% for NCS and TCS, respectively; OR: 0.53; 95% CI: 0.31-0.90). CONCLUSION: The use of TCS reduced SSI risk when compared with NCS. This reduction was significant for Class IV wounds, providing evidence that supports the use of TCS for this type of wound.

Resección de GIST rectal mediante cirugía transanal mínimamente invasiva (TAMIS) tras neoadyuvancia con imatinib / Resection of a rectal gastrointestinal stromal tumour by transanal minimally invasive surgery (TAMIS) after neoadjuvant treatment with Imatinib

Resumen El tratamiento primario de elección para los pacientes con una tumoración GIST localizada es la extirpación quirúrgica completa con márgenes microscópicos negativos. Sin embargo, en un espacio tan reducido como el de la pelvis, la resección completa de una tumo-ración rectal grande es difícil y necesita en ocasiones una amputación abdomino-perienal. En nuestro caso, con la finalidad de reducir el tamaño del tumor y la morbilidad asociada a procedimientos quirúrgicos más agresivos se introdujo el tratamiento con imatinib, con intención neoadyuvante monitorizando la respuesta mediante ecoendoscopia. La respuesta obtenida, rediciendo el volumen tumoral, modificó la estrategia quirúrgica inicial y fue posible conseguir una resección satisfactoria mediante cirugía transanal mínimamente invasiva (TAMIS), preservando los esfínteres anales y soslayando la morbilidad genitourinaria asociada a la excisión mesorectal.

Abstract The primary treatment of choice for patients with a localised gastro-intestinal stromal tumour (GIST) is complete surgical excision with negative microscopic margins. However, in a space as small as that of the pelvis, complete resection of a large rectal tumour is difficult, and sometimes requires an abdominoperineal amputation. In order to reduce the size of the tumour, as well as the morbidity associated with more aggressive surgical procedures, neoadjuvant treatment with Imatinib was introduced in this case, with the response being monitored by of endoscopic ultrasound. The response obtained by reducing the tumour volume modified the strategy, making it possible to obtain a satisfactory resection using transanal minimally invasive surgery (TAMIS), preserving the anal sphincters and avoiding the genitourinary morbidity associated with the mesorectal excision.

Cirugía oncológica de la mama y reconstrucción inmediata con prótesis directa / Oncologic breast surgery and immediate breast reconstruction with direct prosthesis

Objetivo. La reconstrucción mamaria con prótesis directa responde al deseo de las pacientes de no perder su imagen corporal tras la mastectomía y a evitar reoperaciones. Intentamos comprobar si esta técnica es segura y si ofrece similares resultados a la reconstrucción con expansores. Pacientes y métodos. Análisis retrospectivo de 98 pacientes intervenidas consecutivamente entre 2007 y 2015 con mastectomía y reconstrucción inmediata. Se comparan los datos clínicos, las complicaciones, las reintervenciones, los ingresos y los días de estancia entre las pacientes reconstruidas con prótesis directas (61) y reconstruidas con expansores (37). Resultados. No hubo diferencias en el tipo de pacientes incluidas en ambos grupos, salvo el mayor peso de las mamas extirpadas en el grupo de los expansores (277,64 g/462,75 g, p=0,011). Este grupo tuvo mayor número de ingresos (1,46/1,92, p=0,029), pero no hubo diferencias significativas en los días de estancia global, complicaciones, asimetrías secundarias, capsulitis o reoperaciones. No hubo complicaciones oncológicas. Recibieron radioterapia 37 pacientes, y de ellas el 29,7% presentó capsulitis frente al 16,3% de pacientes no radiadas (p=0,089). Conclusiones. La reconstrucción mamaria inmediata con prótesis directa es oncológicamente segura y no incrementa las tasas de complicaciones ni la estancia hospitalaria. La radioterapia aumenta el riesgo de capsulitis, pero no contraindica la técnica (AU)

Objective. Immediate breast reconstruction with direct prosthesis attempts to fulfil patients’ wishes to retain their body image after mastectomy and to avoid reoperations. The aim of this study was to determine the safety of this technique and whether it provides similar results to those of reconstruction with expanders. Patients and methods. A retrospective analysis was conducted of 98 patients who underwent surgery consecutively between 2007 and 2015 with mastectomy and immediate reconstruction. Clinical data, complications, reoperation rates, admissions and days of stay were compared between patients who underwent immediate reconstruction (n=61) and those who underwent reconstruction with expanders (n=37). Results. There were no differences in the type of patients included in the two groups, except the greater weight of the breast removed in the expanders group (277.64 g/462.75 g, P=.011). This group had a higher number of admissions (1.46 1.92, P=.029), but there was no significant difference in overall days of hospital stay, complications, secondary asymmetries, capsulitis, or reoperations. There were no oncological complications. Thirty-seven patients received radiotherapy and 29.7% had capsulitis compared with 16.3% of patients not receiving radiotherapy (P=.089). Conclusions. Immediate breast reconstruction with direct prosthesis is safe and does not increase complication rates or length of hospital stay. Radiotherapy increases the risk of capsulitis, but does not contraindicate the technique (AU)

Absceso isquiorrectal con extensión intra y preperitoneal / Isquiorectal abscess with intra and preperitoneal dissemination

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Úlcera gástrica penetrante en el hígado / Gastric ulcer penetrating the liver

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Cáncer de recto localmente avanzado. La necesidad de la superespecialización / Locally advanced rectal cancer. The need for further specialization

Presentamos un caso que por sus connotaciones diagnósticas y terapéuticas resulta especialmente didáctico e ilustrativo, pues aborda el cómo, el quién y dónde debe realizarse la cirugía de cáncer de recto localmente avanzado. Ilustra el manejo diagnóstico y la estadificación del cáncer de recto en el momento actual. Este caso se aborda en el comité de forma multidisciplinar, y reúne los distintos avances en la cirugía de cáncer de recto de los últimos años (escisión total mesorrectal, abordaje laparoscópico, radioterapia intraoperatoria, resección perineal extendida, reparación del suelo pélvico con material protésico). Todo ello aunado a la opinión de que deben ser instituciones y grupos muy especializados y dedicados al tratamiento de esta patología los que deberían centralizar su atención médica.

We present a case, which due to its diagnostic and therapeutic connotations makes it especially educational, as it addresses the how, the who and where should the surgery be performed for locally advanced rectal cancer. It illustrates the diagnostic management and staging of rectal cancer at the present time. The case is approached in a multidisciplinary committee manner, and binds the various advances in surgery of rectal cancer in recent years (total meso-rectal excision, laparoscopy, intraoperative radiotherapy, extended perineal resection, pelvic floor repair with prosthetic material). This serves to underline the view that there must be highly specialized institutions and groups dedicated to the treatment of this condition in order to centralize its health care.

Cáncer colorrectal en pacientes mayores de 90 años: ¿cuál es el mejor tratamiento? / Colorectal cancer in a nonagenarian. What is the best treatment?

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Utilidad de la canulación de la aorta torácica con perfusión anterógrada en la extracción de órganos abdominales / Thoracic aortic cannulation with antegrade perfusion for the procurement of abdominal organs

La aceptación definitiva de un órgano como válido depende del equipo quirúrgico que realiza la extracción multiorgánica, que tendrá de enfrentarse en muchas situaciones a dificultades inesperadas. Las características demográficas de los donantes han cambiado, se aceptan donantes de órganos que hace no muchos años considerábamos subóptimos, lo que implica muchas veces una técnica quirúrgica difícil y una toma de decisión acerca de la validez del órgano u órganos muy arriesgada. Se propone un método alternativo a la canulación de la aorta abdominal cuando se evidencie enfermedad de la aorta infra-renal durante la realización de la extracción multiorgánica. Se realiza la canulación de la aorta torácica descendente retrocardíaca con una perfusión anterógrada, esta técnica permite aumentar el número de órganos a trasplantar

The definitive acceptance of an organ as valid for transplant depends on the surgical team performing the multiorgan recovery; and unexpected difficulties can occur. The demographic characteristics of donors has changed, and some accepted donors can present difficulties in surgical technique and risky decisions on the validity of the retrieved organ or organs. An alternative method to the cannulation of the abdominal aorta is proposed when there is evidence of disease in the infrarenal aorta during the multiorgan procurement. The retrocardiac descending thoracic aorta is cannulated using an antegrade perfusion; this technique allows an increase in organ recovery

Thoracic aortic cannulation with antegrade perfusion for the procurement of abdominal organs.

The definitive acceptance of an organ as valid for transplant depends on the surgical team performing the multiorgan recovery; and unexpected difficulties can occur. The demographic characteristics of donors has changed, and some accepted donors can present difficulties in surgical technique and risky decisions on the validity of the retrieved organ or organs. An alternative method to the cannulation of the abdominal aorta is proposed when there is evidence of disease in the infrarenal aorta during the multiorgan procurement. The retrocardiac descending thoracic aorta is cannulated using an antegrade perfusion; this technique allows an increase in organ recovery.

Duplicación de vena cava inferior / Inferior vena cava duplication

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Masa abdominal gigante de origen indeterminado, ¿es el carcinoma de células cromófobas un diagnóstico a tener en cuenta? / Giant abdominal mass of undetermined origin: Should the diagnosis of chromophobe carcinoma be considered?

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