Resident training in colorectal laparoscopic surgery: A retrospective morbidity, mortality and survival analysis of 408 cases in our environment.

INTRODUCTION: Colorectal cancer has a growing incidence in our society. However, the performance of laparoscopic interventions in this field is still not included in the National Training Program. Given the lack of references, our objective was to analyze the resident's participation in laparoscopic colorectal surgery and its possible effect on morbidity and mortality and oncological prognosis. METHODS: A retrospective longitudinal single-center study that included all laparoscopic colorectal surgical procedures performed by residents (R group) and by attending surgeons (A group) between 01/01/2009 and 12/31/2017, maintaining follow-up until 12/31/2018. Postoperative morbidity and mortality, overall survival (OS) and disease- free survival (DFS), as well as their relationship with the resident involvement as first surgeon were analyzed. RESULTS: 408 patients were analyzed, of which 138 (33.8%) were operated by a supervised resident and 270 (66.2%) by the attending surgeon. No differences were detected in the rate of postoperative complications between both groups (OR: 1.536; 95% CI: 0.947-2.409; p = 0.081). Furthermore, resident participation had no influence on tumor recurrence rate (R Group: 14.2% vs. A Group: 16.9%; p = 0.588) or on overall (p = 0.562) or disease-free survival (p = 0.305). CONCLUSION: Resident involvement in laparoscopic colorectal surgery had no influence on morbidity and mortality or oncological prognosis in our center. Conducting prospective studies in this regard will provide greater knowledge, enabling a progressive improvement of the training program.

Resident training in colorectal laparoscopic surgery: A retrospective morbidity, mortality and survival analysis of 408 cases in our environment. / Formación del residente en cirugía laparoscópica en coloproctología: análisis retrospectivo de morbimortalidad y pronóstico oncológico sobre 408 pacientes en nuestro centro.

INTRODUCTION: Colorectal cancer has a growing incidence in our society. However, the performance of laparoscopic interventions in this field is still not included in the National Training Program. Given the lack of references, our objective was to analyze the resident's participation in laparoscopic colorectal surgery and its possible effect on morbidity and mortality and oncological prognosis. METHODS: A retrospective longitudinal single-center study that included all laparoscopic colorectal surgical procedures performed by residents (R group) and by attending surgeons (A group) between 01/01/2009 and 12/31/2017, maintaining follow-up until 12/31/2018. Postoperative morbidity and mortality, overall survival (OS) and disease-free survival (DFS), as well as their relationship with the resident involvement as first surgeon were analyzed. RESULTS: 408 patients were analyzed, of which 138 (33.8%) were operated by a supervised resident and 270 (66.2%) by the attending surgeon. No differences were detected in the rate of postoperative complications between both groups (OR: 1.536; 95% CI: 0.947-2.409; p=0.081). Furthermore, resident participation had no influence on tumor recurrence rate (R Group: 14.2% vs. A Group: 16.9%; p=0.588) or on overall (p = 0.562) or disease-free survival (p = 0.305). CONCLUSION: Resident involvement in laparoscopic colorectal surgery had no influence on morbidity and mortality or oncological prognosis in our center. Conducting prospective studies in this regard will provide greater knowledge, enabling a progressive improvement of the training program.

Upper gastrointestinal bleeding due to hepatic artery aneurysm: Case report and literature review.

INTRODUCTION: Aneurysm of the hepatic artery is most of the time a rare and asymptomatic pathology, but in case of complication it shows high morbidity and mortality requiring in many cases an urgent treatment. PRESENTATION OF CASE: A 92-year-old male presented at the emergency department with high gastrointestinal bleeding and abdominal pain. Gastroscopy showed a submucosal lesion with active bleeding that was controlled through this approach. The study was expanded with a CT angiogram and a complicated hepatic aneurysm with duodenal fistulization was observed. DISCUSSION: After reviewing the case, surgical treatment is proposed as the first option but it is rejected by the patient. Thus, aneurysm embolization with coils and thrombin is performed, without further complications. CONCLUSION: Selective embolization of the hepatic artery aneurysm is a therapeutic alternative in cases that implies large comorbidities, being an increasingly used technique.

Tratamiento mínimamente invasivo de la fístula rectovesical: a propósito de un caso / Minimally invasive treatment of rectovesical fistula: a case report

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Minimally invasive treatment of rectovesical fistula: A case report.

Management of rectovesical fistulas poses a significant challenge where a definitive surgical treatment is necessary in the majority of the patients. The application of transanal endoscopic surgery is an useful option, adding the adventages of a minimally invasive surgery. We report our first case of transanal endoscopic surgical treatment of RVF with a successful outcome.

Gastritis enfisematosa con gas venoso portal: tratamiento conservador en abdomen agudo de causa infrecuente / Emphysematous gastritis associated with portal venous gas: Medical management to an infrequent acute abdominal pain

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Stoppa procedure in bilateral inguinal hernia.

The Stoppa procedure is a very safe repair of bilateral inguinal hernia, but it requires a learning period to achieve optimal results. We present a study with our experience and learning curve for this technique. Two hundred and ten patients with bilateral inguinal hernia (420 hernias) were repaired with Stoppa procedure from January 1995 to December 2003 with an average age of 57.2 years (range 28-89 years), with 8 women and 202 men (96%). Emergency surgery was performed for incarcerated hernia in six cases (2.8%). The rates of recurrent hernias, concomitant disease and associated surgical techniques were similar in all the years. Operative time decreased from 100 min (1995) to 61-66 min (2001-2003). Drain remained in place in 100% (1995), and 0% (2003). Regional anaesthesia was performed in 25% (1995) and 80-90% in the last years; hospital stay decreased from 5.1 to 1.2 days (2003), and morbidity from 50% (1995) to 12-16% (P<0.0001). There were three recurrences, two in the first 30 cases (6.6%), and one in the remaining 180 (0.5%) (4-92 months follow-up). The procedure was introduced in 1995 by one surgeon, performing 100% of cases, being accepted progressively by other surgeons. The first 25-30 cases of a surgical technique are the learning curve, with the highest rate of morbidity, time, technical and operative difficulties, and long hospital stay. As a result of the first surgeon's experience, some modifications of the technique are developed and results improved.