Psychopathological profile before and after bariatric surgery.

Presurgical psychopathological assessment usually focuses on detecting severe mental disorders. However, mild intensity psychopathology and eating behaviour pattern may also influence postsurgical outcomes. The aim was to identify psychopathology and eating behaviour pattern in candidates prepared for bariatric surgery compared to a normative population before and after surgery. A cohort of 32 patients seeking bariatric surgery in a university hospital between March 2016 and March 2017 were evaluated with Personality Assessment Inventory (PAI), 36-item EDE-Q and BES before and after surgery. Thirty-two patients before and 26 one year after surgery were included. The PAI presurgical psychometric profile suggested a mild mixed adjustment disorder focused on somatic complaints. After surgery, patients improved in somatic complaints (p < 0.001), and depression (p = 0.04). Related eating disorders were more common than those of the normative group and improved significantly after surgery in scores for compulsive intake (BES p < 0.001) and overall key behaviours of eating disorders and related cognitive symptoms (EDE-Q/G p < 0.001). In our cohort ready for bariatric surgery a mild psychopathological profile is still present and becomes closer to that of the normative group after surgery. Further studies are needed to evaluate the effects of mild psychopathology on outcomes after bariatric surgery.

Preoperative Diagnostic Uncertainty in T2-T3 Rectal Adenomas and T1-T2 Adenocarcinomas and a Therapeutic Dilemma: Transanal Endoscopic Surgery, or Total Mesorectal Excision?

BACKGROUND: Endorectal ultrasound and rectal magnetic resonance are sometimes unable to differentiate between stages T2 and T3 in rectal adenomas that are possible adenocarcinomas, or between stages T1 and T2 in rectal adenocarcinomas. These cases of diagnostic uncertainty raise a therapeutic dilemma: transanal endoscopic surgery (TES) or total mesorectal excision (TME)? METHODS: An observational study of a cohort of 803 patients who underwent TES from 2004 to 2021. Patients operated on for adenoma (group I) and low-grade T1 adenocarcinoma (group II) were included. The variables related to uncertain diagnosis, and to the definitive pathological diagnosis of adenocarcinoma stage higher than T1, were analyzed. RESULTS: A total of 638 patients were included. Group I comprised 529 patients, 113 (21.4%) with uncertain diagnosis. Seventeen (15%) eventually had a pathological diagnosis of adenocarcinoma higher than T1. However, the variable diagnostic uncertainty was a risk factor for adenocarcinoma above T1 (OR 2.3, 95% CI 1.1-4.7). Group II included 109 patients, eight with uncertain diagnosis (7.3%). Two patients presented a definitive pathological diagnosis of adenocarcinoma above T1. CONCLUSIONS: On the strength of these data, we recommend TES as the initial indication in cases of diagnostic uncertainty. Multicenter studies with larger samples for both groups should now be performed to further assess this strategy of initiating treatment with TES.

Degeneración del esófago de Barrett tras gastrectomía vertical / Degeneration of Barrett's Esophagus after Sleeve Gastrectomy

No disponible

Correction to: Esogastro-Pleuro-Bronchial Fistula: An Unusual Complication After Sleeve Gastrectomy.

Due to a Production error Figs. 1 and 2 were omitted from the original article.

Desgaste profesional o burnout en los residentes de Cirugía General. Encuesta de la Asociación Española de Cirujanos / Burnout in General Surgery Residents. Survey From the Spanish Association of Surgeons

INTRODUCCIÓN: El desgaste profesional o burnout afecta significativamente a los médicos y, concretamente, a los cirujanos. El exceso de horas de trabajo, así como la discriminación, abuso y acoso sexual, pueden contribuir al desgaste profesional. Recientemente se ha publicado un estudio sobre este tema en residentes de Estados Unidos que demuestra una elevada incidencia de burnout. El objetivo de nuestro estudio es conocer cuál es la situación en España y compararla con lo que sucede en aquel país. MÉTODOS: Estudio observacional, transversal, efectuado en enero-febrero del 2020, a través de una encuesta validada remitida a todos los residentes de Cirugía General y del Aparato Digestivo (CGAD) de España. RESULTADOS: De los 931 residentes de CGAD, 739 accedieron a la encuesta y 452 (61,2%) la cumplimentaron. En alguna ocasión durante la residencia, el 55,1% de los residentes se han sentido discriminados por su género, el 8,8% por su país de origen, el 73,9% afirman haber experimentado abuso verbal/psicológico, el 7,1% abuso físico y el 16,4% acoso sexual. Los cirujanos adjuntos son la causa más frecuente de acoso sexual, abuso físico y verbal. Los pacientes son el origen más común de la discriminación por género. El 47,6% ha tenido síntomas de desgaste profesional y el 4,6% ha presentado ideas suicidas. El 98% ha excedido su jornada laboral y el 47% no libra las guardias. Estos dos últimos puntos son factores predictivos de desgaste profesional. CONCLUSIONES: Durante el periodo de residencia en nuestro país, los residentes de CGAD han sufrido episodios de maltrato en forma de discriminación, abuso y acoso. Todos los tipos de maltrato son más frecuentes en España que en Estados Unidos, excepto la discriminación racial. Con ello se asocia el incumplimiento significativo en las horas de trabajo semanal. Es necesario reconocer estas anomalías y evitarlas para favorecer un ambiente adecuado para la formación profesional especializada en CGAD

INTRODUCTION: Physicians, especially surgeons, are significatively affected by burnout. Duty-hour violation, as well as discrimination, abuse and sexual harassment may contribute to burnout. A study about this topic has been published in residents from United States, demonstrating a high incidence of burnout. Our objective is to know which is the situation in Spain and to compare it with United States. METHODS: Cross-sectional observational study carried out in January-February 2020, based on the responses to a validated survey administered to General Surgery residents in Spain. RESULTS: There are 931 General Surgery Residents. 739 have entered in the survey and 452 (61.2%) eventually responded to it. In any occasion during the training period, 55.1% reported discrimination based on their gender, 8.8% reported racial discrimination, 73.9% reported verbal/psychological abuse, 7.1% reported physical abuse and 16.4% reported sexual harassment. Attending surgeons are the most frequent source of sexual harassment and physical and verbal abuse, whereas patients are the most frequent cause of gender discrimination. Burnout symptoms were reported by 47.6% of residents and 4.6% reported suicidal thoughts. 98% of residents reported duty-hour violations and 47% of them do not have the day off after to be on call. Both of these issues are burnout predictive factors. CONCLUSIONS: Mistreatment (discrimination, abuse and harassment) occurs among General Surgery residents during their training period in our country. Every kind of mistreatment is more frequent in Spain than in the United States, with the exception of racial discrimination. It is associated with exceeding weekly duty-hour. It is necessary to know these problems and to avoid them in order to improve work environment of General Surgery training period

Longitudinal changes in telomere length in a cohort of obese patients submitted to bariatric surgery: a 2-year follow-up.

BACKGROUND: Telomere length (TL) is one biomarker of cell aging used to explore the effects of the environment on age-related pathologies. Obesity and high body mass index have been identified as a risk factors for shortened TL. OBJECTIVE: To evaluate TL in different subtypes of obese patients, and to examine changes in TL in relation to weight loss after bariatric surgery. SETTING: University Hospital in Spain. METHODS: A cohort of 94 patients submitted to bariatric surgery were followed-up during 24 months (t24m: lost to follow-up = 0%). All patients were evaluated before surgery (t0) and during the postoperative period (t6m, t12m, and t24m) for body mass index and metabolic variables. We assessed TL at each timepoint using quantitative polymerase chain reactions and the telomere sequence to single-copy gene sequence ratio method. RESULTS: Patients with class III obesity showed significantly shorter TL at baseline than those patients with class II obesity (P = .027). No differences in TL were found between patients with or without type 2 diabetes or metabolic syndrome. Longitudinal analysis did not show an effect of time, type of surgery, age, or sex on TL. However, a generalized estimating equation model showed that TL was shorter amongst class III obesity patients across the time course (P = .008). Comparison between patients with obesity class II and class III showed differences in TL at t6m (adjusted P = .024), whereby class II patients had longer TL. However, no difference was observed at the other evaluated times. CONCLUSION: Obesity severity may have negative effects on TL independently of type 2 diabetes or metabolic syndrome. Although TL is significantly longer in class II obesity patients relative to class III 6 months after bariatric surgery. This difference is not apparent after 24 months.

Burnout in General Surgery Residents. Survey From the Spanish Association of Surgeons. / Desgaste profesional o burnout en los residentes de Cirugía General. Encuesta de la Asociación Española de Cirujanos.

INTRODUCTION: Physicians, especially surgeons, are significatively affected by burnout. Duty-hour violation, as well as discrimination, abuse and sexual harassment may contribute to burnout. A study about this topic has been published in residents from United States, demonstrating a high incidence of burnout. Our objective is to know which is the situation in Spain and to compare it with United States. METHODS: Cross-sectional observational study carried out in January-February 2020, based on the responses to a validated survey administered to General Surgery residents in Spain. RESULTS: There are 931 General Surgery Residents. 739 have entered in the survey and 452 (61.2%) eventually responded to it. In any occasion during the training period, 55.1% reported discrimination based on their gender, 8.8% reported racial discrimination, 73.9% reported verbal/psychological abuse, 7.1% reported physical abuse and 16.4% reported sexual harassment. Attending surgeons are the most frequent source of sexual harassment and physical and verbal abuse, whereas patients are the most frequent cause of gender discrimination. Burnout symptoms were reported by 47.6% of residents and 4.6% reported suicidal thoughts. 98% of residents reported duty-hour violations and 47% of them do not have the day off after to be on call. Both of these issues are burnout predictive factors. CONCLUSIONS: Mistreatment (discrimination, abuse and harassment) occurs among General Surgery residents during their training period in our country. Every kind of mistreatment is more frequent in Spain than in the United States, with the exception of racial discrimination. It is associated with exceeding weekly duty-hour. It is necessary to know these problems and to avoid them in order to improve work environment of General Surgery training period.

Reparación de eventración lumbar gigante mediante técnica sándwich / Giant lumbar incisional hernia reparation by "sandwich" technique

No disponble

Perforation in the peritoneal cavity during transanal endoscopic microsurgery for rectal tumors: a real surgical complication with a challenging prognosis?

BACKGROUND: Perforation in the peritoneal cavity during transanal endoscopic microsurgery represents a major challenge. It is usually treated by primary suture, though some authors propose laparoscopic repair with or without ostomy. It is unclear whether perforation increases the risk of tumor dissemination. AIM: The purpose of the study is to assess the safety of primary suture of peritoneal perforation and the long-term risk of dissemination, also, to determine risk factors for perforation and to propose a predictive model for lesions with risk of perforation. METHOD: This is an observational study with prospective data collection at Parc Taulí University Hospital, Sabadell, of patients undergoing transanal surgery with perforation into the peritoneal cavity from June 2004 to September 2017. The main variable is postoperative morbidity and mortality. The long-term follow-up of local recurrence and peritoneal tumor dissemination is described, and a quantitative predictive model for peritoneal cavity perforation is proposed. RESULTS: Forty-five patients out of 686 (6.6%) presented perforation into the peritoneal cavity. Ten patients (22.2%) in the perforation group had morbidity, a rate similar to the non-perforated group. There was no peritoneal dissemination in patients with adenoma or with carcinoma treated with curative intent. In the quantitative predictive model, risk factors for perforation were proximal edge of tumor > 14 cm from anal verge (6 points), size ≥ 6 cm (2), age ≥ 85 years (4), anterior quadrant (3) , and sex (2). Total scores of ≥ 6 points predicted perforation. CONCLUSIONS: Primary suture after peritoneal cavity perforation during transanal surgery is safe and does not increase the risk of recurrence or peritoneal dissemination. Our predictive model provides guidance regarding the risk of perforation and the need to suture the defect after transanal surgery resection.

Morbidity after transanal endoscopic microsurgery: risk factors for postoperative complications and the design of a 1-day surgery program.

BACKGROUND: Transanal endoscopic microsurgery (TEM) is a minimally invasive procedure with low morbidity. The definition of risk factors for postoperative complications would help to identify the patients likely to require more care and surveillance in an ambulatory or 1-day surgery (A-OdS) program. The main endpoints are overall 30-day morbidity and relevant morbidity. The secondary objectives are to detect risk factors for complications, rehospitalization, and the time of occurrence of the postoperative complications, and to describe the adverse effects following hospitalization that the A-OdS program would avoid. METHODS: This is an observational study of consecutive patients undergoing TEM between June 2004 and December 2016. Overall and relevant morbidity based on the Clavien-Dindo (Cl-D) classification were recorded, as were demographic, preoperative, surgical, and pathology variables. Univariate and multivariate analyses of the risk factors were carried out. RESULTS: Six hundred and ninety patients underwent surgery, of whom 639 were included in the study. Overall morbidity rate was 151/639 patients (23.6%); the clinically relevant morbidity rate was 36/639 (Cl-D > II) (5.6%) and mortality 2/639 (0.3%). The most frequent complication was rectal bleeding, recorded in 16.9% (108/639 patients) and grade I in 86/108 patients (78. 9%). The period with the greatest risk of complications was the first 2 days. The rehospitalization rate after 48 h was 7%. The risk factors for complications were as follows: tumor size > 6 cm (OR 3.2, 95% CI 1.3-7.8), anti-platelet medication (OR 2.3, 95% CI 1.1-5.1), and surgeon's experience < 150 procedures (OR 2.0, 95% CI 1-4.1). CONCLUSIONS: TEM is a safe procedure. The low rates of morbidity, re-hospitalization, and postoperative complications in the first 2 days after surgery make the procedure suitable for A-OdS.

Analysis of quality of life after major trauma: a spanish follow-up cohort study.

PURPOSE: Study objectives are to determine whether quality of life is recovered completely after major injury and to identify determinants associated with a worse quality of life. METHODS: Prospective 12-month follow-up of injured patients admitted to the intensive care unit in a Spanish level 1 trauma centre. The main outcome (quality of life) was measured using the EQ-5D-5L. The relationships between sociodemographic factors, injury severity and location, and quality of life scores were evaluated. Mean comparison analysis (95% confidence interval) was performed with the student "t" test for quantitative variables and with chi-squared for proportion comparison (qualitative variables). A multivariate logistic regression (odds ratio and 95% confidence interval) was performed to identify determinants of each dimension, and a multivariate linear regression (regression coefficient and 95% confidence interval) to identify the determinants of EQus and EQvas. RESULTS: Over a 2-year period, 304 patients who met the inclusion criteria were identified, and 200 patients (65.8%) were finally included. Most of patients suffered blunt trauma (91.5%), 72.5% were men, mean age was 47.8, mean ISS was 15.2. The overall health index (EQvas) improved slightly, but its mean value at 12 months was below the Spanish population norm (P < 0.001). In the multivariate analysis, age ≥ 55, female gender and unskilled employment were risk factors for a lower EQvas. Also in the multivariate analysis, having a severe extremity injury was associated with a lower score on the mobility dimension (OR 6.56 95% CI 2.00, 21.55) while age ≥ 55 years was associated with a lower score on the usual activities dimension (OR 3.52 95% CI 1.17, 10.57). Female gender was the most important factor associated with suffering pain (OR 4.54, 95% CI 2.01, 10.27) and depression/anxiety (OR 4.04, 95% CI 1.88, 8.65). In the univariate and multivariate analyses, female gender, age ≥ 55 years, ISS ≥ 25 and severe extremity injury were associated with a lower EQ utility score (EQus). CONCLUSIONS: The quality of life score improves during the first year after major trauma. However, it does not return to the reference levels for the normal population. Female gender and age ≥ 55 years are statistically significant determinants of poorer EQvas and EQus.