Digestive Surgery Service Research Articles

Assessment of postoperative morbidity in Spanish hospitals: Results from a national survey

BackgroundThe methodology used for recording, evaluating and reporting postoperative complications (PC) is unknown.The aim of the present study was to determine how PC are recorded, evaluated, and reported in General and Digestive Surgery Services (GDSS) in Spain, and to assess their stance on morbidity audits. MethodsUsing a cross-sectional study design, an anonymous survey of 50 questions was sent to all the heads of GDSS at hospitals in Spain. ResultsThe survey was answered by 67 out of 222 services (30.2%). These services have a reference population (RP) of 15 715 174 inhabitants, representing 33% of the Spanish population.Only 15 services reported being requested to supply data on morbidity by their hospital administrators. Eighteen GDSS, with a RP of 3 241 000 (20.6%) did not record PC. Among these, 7 were accredited for some area of training. Thirty-six GDSS (RP 8 753 174 (55.7%) did not provide details on all PC in patients’ discharge reports. Twenty-four (37%) of the 65 GDSS that had started using a new surgical procedure/technique had not recorded PC in any way. Sixty-five GDSS were not concerned by the prospect of their results being audited, and 65 thought that a more comprehensive knowledge of PC would help them improve their results. Out of the 37 GDSS that reported publishing their results, 27 had consulted only one source of information: medical progress records in 11 cases, and discharge reports in 9. ConclusionsThis study reflects serious deficiencies in the recording, evaluation and reporting of PC by GDSS in Spain.

Assessment of postoperative morbidity in Spanish hospitals: Results from a national survey

BackgroundThe methodology used for recording, evaluating and reporting postoperative complications (PC) is unknown.The aim of the present study was to determine how PC are recorded, evaluated, and reported in General and Digestive Surgery Services (GDSS) in Spain, and to assess their stance on morbidity audits. MethodsUsing a cross-sectional study design, an anonymous survey of 50 questions was sent to all the heads of GDSS at hospitals in Spain. ResultsThe survey was answered by 67 out of 222 services (30.2%). These services have a reference population (RP) of 15 715 174 inhabitants, representing 33% of the Spanish population.Only 15 services reported being requested to supply data on morbidity by their hospital administrators. Eighteen GDSS, with a RP of 3 241 000 (20.6%) did not record PC. Among these, 7 were accredited for some area of training. Thirty-six GDSS (RP 8 753 174 (55.7%) did not provide details on all PC in patients’ discharge reports. Twenty-four (37%) of the 65 GDSS that had started using a new surgical procedure/technique had not recorded PC in any way. Sixty-five GDSS were not concerned by the prospect of their results being audited, and 65 thought that a more comprehensive knowledge of PC would help them improve their results. Out of the 37 GDSS that reported publishing their results, 27 had consulted only one source of information: medical progress records in 11 cases, and discharge reports in 9. ConclusionsThis study reflects serious deficiencies in the recording, evaluation and reporting of PC by GDSS in Spain.

Intertwined leukocyte balances in tumours and peripheral blood as robust predictors of right and left colorectal cancer survival.

BACKGROUNDColorectal cancer (CRC) accounts for 9.4% of overall cancer deaths, ranking second after lung cancer. Despite the large number of factors tested to predict their outcome, most patients with similar variables show big differences in survival. Moreover, right-sided CRC (RCRC) and left-sided CRC (LCRC) patients exhibit large differences in outcome after surgical intervention as assessed by preoperative blood leukocyte status. We hypothesised that stronger indexes than circulating (blood) leukocyte ratios to predict RCRC and LCRC patient outcomes will result from combining both circulating and infiltrated (tumour/peritumour fixed tissues) concentrations of leukocytes.AIMTo seek variables involving leukocyte balances in peripheral blood and tumour tissues and to predict the outcome of CRC patients.METHODSSixty-five patients diagnosed with colon adenocarcinoma by the Digestive Surgery Service of the La Paz University Hospital (Madrid, Spain) were enrolled in this study: 43 with RCRC and 22 with LCRC. Patients were followed-up from January 2017 to March 2021 to record overall survival (OS) and recurrence-free survival (RFS) after surgical interventions. Leukocyte concentrations in peripheral blood were determined by routine laboratory protocols. Paraffin-fixed samples of tumour and peritumoural tissues were assessed for leukocyte concentrations by immunohistochemical detection of CD4, CD8, and CD14 marker expression. Ratios of leukocyte concentration in blood and tissues were calculated and evaluated for their predictor values for OS and RFS with Spearman correlations and Cox univariate and multivariate proportional hazards regression, followed by the calculation of the receiver-operating characteristic and area under the curve (AUC) and the determination of Youden’s optimal cutoff values for those variables that significantly correlated with either RCRC or LCRC patient outcomes. RCRC patients from the cohort were randomly assigned to modelling and validation sets, and clinician-friendly nomograms were developed to predict OS and RFS from the respective significant indexes. The accuracy of the model was evaluated using calibration and validation plots.RESULTSThe relationship of leukocyte ratios in blood and peritumour resulted in six robust predictors of worse OS in RCRC: CD8+ lymphocyte content in peritumour (CD8pt, AUC = 0.585, cutoff < 8.250, P = 0.0077); total lymphocyte content in peritumour (CD4CD8pt, AUC = 0.550, cutoff < 10.160, P = 0.0188); lymphocyte-to-monocyte ratio in peritumour (LMRpt, AUC = 0.807, cutoff < 3.185, P = 0.0028); CD8+ LMR in peritumour (CD8MRpt, AUC = 0.757, cutoff < 1.650, P = 0.0007); the ratio of blood LMR to LMR in peritumour (LMRb/LMRpt, AUC = 0.672, cutoff > 0.985, P = 0.0244); and the ratio of blood LMR to CD8+ LMR in peritumour (LMRb/CD8MRpt, AUC = 0.601, cutoff > 1.485, P = 0.0101). In addition, three robust predictors of worse RFS in RCRC were found: LMRpt (AUC = 0.737, cutoff < 3.185, P = 0.0046); LMRb/LMRpt (AUC = 0.678, cutoff > 0.985, P = 0.0155) and LMRb/CD8MRpt (AUC = 0.615, cutoff > 1.485, P = 0.0141). Furthermore, the ratio of blood LMR to CD4+ LMR in peritumour (LMRb/CD4MRpt, AUC = 0.786, cutoff > 10.570, P = 0.0416) was found to robustly predict poorer OS in LCRC patients. The nomograms showed moderate accuracy in predicting OS and RFS in RCRC patients, with concordance index of 0.600 and 0.605, respectively.CONCLUSIONEasily obtainable variables at preoperative consultation, defining the status of leukocyte balances between peripheral blood and peritumoural tissues, are robust predictors for OS and RFS of both RCRC and LCRC patients.

Impacto de la Pandemia COVID-19 en los Servicios de Cirugía General y Digestiva de los hospitales andaluces. Experiencia durante la primera ola.

Impacto de la Pandemia COVID-19 en los Servicios de Cirugía General y Digestiva de los hospitales andaluces. Experiencia durante la primera ola.

Delivery of digestive surgery services during the COVID-19 pandemic: Indonesian Society of Digestive Surgeons online survey.

During the coronavirus disease 2019 (COVID-19) pandemic, digestive surgery potentially exposes both health-care professionals and vulnerable patients to COVID-19. A survey was conducted with aim to determine the digestive surgery services provided during the COVID-19 pandemic, optimize safety for patients and clinicians, and safeguard health-care services. An online survey was conceived and circulated to members of the Indonesian Society of Digestive Surgeons. The survey was conducted in two phases, in April 2020 and July 2020, to evaluate changes in response to the COVID-19 pandemic. Early in the pandemic (April 2020), the median number of major digestive surgeries performed monthly declined from 20 cases (range. 3-100 cases) to 1 case (range. 0-10 cases) (P < .001; Wilcoxon signed-rank test). Most of the cases in April 2020 addressed emergency problems, but more definitive surgeries were performed during the later period of the survey. The importance of screening for COVID-19 with polymerase chain reaction has increased over time, and a more comprehensive screening methodology incorporating real-time polymerase chain reaction, chest CT, and rapid antibody test were evident in 31.37% of July 2020 responses. Our survey has shown that surgeons adapted to the evolving pandemic and continue to do so only with appropriate safety assurances.

Management of Colorectal Cancer, Surgical Experience. Hospital SOLCA, Guayaquil – Ecuador

BACKGROUND: Colorectal cancer is the third most common among malignant neoplasms worldwide. Treatment choice depends on the location of the tumor, among other factors, and varies from local excision to abdominoperineal resection, adjuvant or neoadjuvant therapy can be needed, depending on clinical stage. The purpose of this study was to determine the most common histological type of rectal cancer, establish the most frequent clinical stage at diagnosis, the most common surgical technique and complications. METHODOLOGY: A cross-sectional study was carried out, with 160 patients treated in the digestive surgery service of Hospital SOLCA, Guayaquil – Ecuador, between January 2011 and December 2016, with colorectal cancer histologically diagnosed and treated surgically. RESULTS: Female sex was the most affected, with 65.7%, 63.1% of the patients were diagnosed at stage III, adenocarcinoma was the most common histological type (73.7%), the tumor was more frequently located at a low level, in 67.5% of the patients. Surgery was scheduled for 83.7% of the patients, derivative colostomy was the most common surgical procedure for treatment (48.8%), and the most common complications were those related to the ostomy, in 9.4% of the patients. Immediate mortality was 1.2% and late mortality was 8.1%. CONCLUSION: This study evidenced that colorectal cancer affected with more frequency to women, mainly to people over 60 years old. Most of the patients were diagnosed with advanced clinical stage (III) carcinoma, most frequently adenocarcinoma. Derivative colostomy was the procedure of choice for most of the patients, most of them needed neoadjuvant therapy too. The most common postsurgical complications were those related to ostomies.

Digestive Surgery Services in COVID-19 Pandemic Period: Indonesian Society of Digestive Surgeons Position Statement

Digestive surgery service including surgical management of gastrointestinal disease and digestive cancers are experiencing the impact of COVID-19 pandemic. Therefore it is necessary to formulate recommendation for digestives surgery service, as guidelines to engage in case-by-case assessment of particular patients with digestive diseases. We are aware that the knowledge and science of COVID-19 are still evolving, with new progression every day. This recommendation reflect actual condition and are subject for future adjustment in the future.

SARS-CoV-2 pandemic on the activity and professionals of a General Surgery and Digestive Surgery Service in a tertiary hospital

IntroductionThe rapid spread of SARS-CoV-2 infection has led to a radical reorganization of healthcare resources. Surgical Departments need to adapt to this change. Patients and methodsWe performed a prospective descriptive observational study of the incidence of COVID-19 in patients and surgeons of a General Surgical Department in a high prevalence area, between the 1 st and 31 st of March 2020. ResultsPatients: The incidence of SARS-CoV-2 infection in elective surgery patients was 7% (mean age 59.5 years). All survived. Of 36 patients who underwent emergency surgery, two of them were SARS-CoV-2 positive and one was clinically highly suspicious of COVID-19 (11.1%). All three patients died of respiratory failure (mean age 81 years). Surgeons: There were a total of 12 confirmed SARS-CoV-2+ cases among the surgical department staff (24.4%) (8 out of 34 consultants and 4 out of 15 residents). Healthcare activity: The average number of daily emergency surgical interventions declined from 3.6 in February to 1.16 in March. 42% of the patients who underwent emergency surgery had peritonitis upon presentation. ConclusionsThe fast pace of COVID-19 pandemia, should alert surgical departments of the need of adopting early measures to ensure the safety of patients and staff.

Nosocomial infection with SARS-Cov-2within Departments of Digestive Surgery.

SummaryIntroductionThe COVID-19 pandemic imposed a drastic reduction in surgical activity in order to respond to the influx of hospital patients and to protect uninfected patients by avoiding hospitalization. However, little is known about the risk of infection during hospitalization or its consequences. The aim of this work was to report a series of patients hospitalized on digestive surgery services who developed a nosocomial infection with SARS-Cov-2 virus.MethodsThis is a non-interventional retrospective study carried out within three departments of digestive surgery. The clinical, biological and radiological data of the patients who developed a nosocomial infection with SARS-Cov-2 were collected from the computerized medical record.ResultsFrom March 1, 2020 to April 5, 2020, among 305 patients admitted to digestive surgery departments, 15 (4.9%) developed evident nosocomial infection with SARS-Cov-2. There were nine men and six women, with a median age of 62 years (35–68 years). All patients had co-morbidities. The reasons for hospitalization were: surgical treatment of cancer (n = 5), complex emergencies (n = 5), treatment of complications linked to cancer or its treatment (n = 3), gastroplasty (n = 1), and stoma closure (n = 1). The median time from admission to diagnosis of SARS-Cov-2 infection was 34 days (5–61 days). In 12 patients (80%), the diagnosis was made after a hospital stay of more than 14 days (15–63 days). At the end of the follow-up, two patients had died, seven were still hospitalized with two of them on respiratory assistance, and six patients were discharged post-hospitalization.ConclusionsThe risk of SARS-Cov-2 infection during hospitalization or following digestive surgery is a real and potentially serious risk. Measures are necessary to minimize this risk in order to return to safe surgical activity.

Infection nosocomiale à SARS-Cov-2 dans les services de chirurgie digestive

RésuméIntroductionLa pandémie de COVID-19 a imposé une diminution radicale de l’activité chirurgicale afin de répondre à l’afflux de patients hospitalisés et protéger les patients non infectés en leur évitant une hospitalisation. Toutefois, le risque d’infection lors de l’hospitalisation et ses conséquences sont encore très peu connus. Le but de ce travail était de rapporter une série de patients hospitalisés en chirurgie digestive chez qui une infection nosocomiale à SARS-Cov-2 a été diagnostiquée.MéthodesÉtude rétrospective non-interventionnelle réalisée au sein de 3 services de chirurgie digestive. Les données cliniques, biologiques et radiologiques des patients ayant développé une infection nosocomiale au SARS-Cov-2 ont été collectées à partir des dossiers informatisés.RésultatsDu 1er mars 2020 au 5 avril 2020, parmi 305 patients admis en chirurgie digestive, 15 (4,9 %) ont présenté une infection nosocomiale à SARS-Cov-2. Il s’agissait de 9 hommes et 6 femmes, d’un âge médian de 62 ans (35-68 ans). Tous les patients avaient une comorbidité. Les motifs d’hospitalisation étaient : traitement chirurgical d’un cancer (n = 5), urgences complexes (n = 5), traitement de complications liées au cancer ou à son traitement (n = 3), reconstruction par gastroplastie (n = 1), fermeture de stomie (n = 1). Le délai médian entre l’admission et le diagnostic d’infection à SARS-Cov-2 était de 34 jours (5-61 jours). Chez 12 (80 %) patients, le diagnostic a été posé après une durée d’hospitalisation de plus de 14 jours (15-63 jours). À l’issue du suivi, 2 patients sont décédés, 7 étaient encore hospitalisés dont 2 sous assistance respiratoire et 6 patients étaient sortis d’hospitalisation.ConclusionsLe risque d’infection au SARS-Cov-2 au cours d’une hospitalisation ou dans les suites d’une intervention de chirurgie digestive est un risque réel et potentiellement grave. Des mesures sont nécessaires afin de minimiser ce risque dans la perspective d’une reprise de l’activité chirurgicale en toute sécurité.

Spectrum of Acute Non Traumatic Diffuse Secondary Peritonitis in the Tropics

Background: Peritonitis is one of the most common surgical emergency in tropical countries. It is still a significant cause of mortality and morbidity. This study aimed to describe the aetiology of acute non traumatic diffuse secondary peritonitis (ANDSP) and to report the outcome after treatment. Material and Methods: A retrospective survey of patients with ANDSP was carried out from January 2007 to December 2016 in the Digestive and General Surgery Service of Bouaké Teaching Hospital in the central part of Côte d’Ivoire. The hospital is a tertiary referral centre and serves urban and rural population from Bouaké’s agglomeration but also from the whole central and northern parts of the country. During the study period, all patients found to have at laparotomy ANDSP were included. The analysed variables include epidemiologic charts, clinical presentation, cause of peritonitis, surgical treatment, postoperative outcome and prognostic factors. Results: Over the studied period 626 cases of ANDSP were operated on. The main aetiologies were gastroduodenal peptic ulcer perforation (n = 252, 41.1%), typhoid ileal perforation (n = 207, 33%) and appendicular peritonitis (n = 123, 19.6%). The mean duration of hospital stay was 13.8 ± 9.6 days (range 8 - 87 days). The length of hospital stay was significantly influenced by postoperative complications (23.5 ± 5.4 days versus 10.8 ± 2.7 days P = 0.000000). Two hundred and sixty one postoperative complications were recorded in 242 patients (38.6%) with wound infection being the commonest postoperative complication. A repeat laparotomy was indicated in 73 patients. Eigthy (n = 80) patients died (mortality 11.2%). Risk factors for death were hemodynamic shock, ASA > II, Age ≥ 60 years, M PI > 29 and digestive sutures performed in septic environment below the transverse mesocolon. Conclusion: The spectrum of aetiology of ANDSP in this tropical area is different from the one observed in the Western countries. Proper treatment of typhoid fever and amoebiasis can reduce the incidence of peritonitis. Early consultation together with adequate resuscitation and surgical management can improve the prognostic which still remains poor.

Traitement Chirurgical Des Eventrations Abdominales Avec Pose De Prothese: Experience A Court Terme Du Chu Yalgado Ouedraogo

Title: Surgical management of abdominal incisional hernia with mesh placement: short- term experience of the University Hospital Yalgado Ouedraogo Introduction: The incisional hernia repair has several variants depending on the implantation site of the mesh. It may be intraperitoneal, preperitoneal, pre-mucosal or pre-musculoskeletal. Objective: The aim of the work was to report at short term the experience of the general and digestive surgery service of the Yalgado Ouédraogo University Hospital Center for the surgical management of abdominal incisional hernia with mesh placement in retro-muscular prefascial Patients and methods: This was a cross-sectional and descriptive study with a review of the files and a survey of 17 patients operated on for voluminous abdominal incisional hernia (diameter greater than 10 cm) from September 1, 2014 to August 31, 2015. Results: The mean duration of hospitalization was 7 days with extremes of 4 and 15 days. The dressings lasted on average 7 days with extremes of 4 and 15 days. The suction drains remained in place on average 8.56 days with extremes of 5 and 14 days and the mean duration of the abdominal wall contusion was 24.5 days with extremes of 10 and 40 days. The early postoperative complications were minor: 8 seromas, 1 hematomas, 1 superficial infection of the wall. Patients were followed for an average duration of 9.47 months with extremes of 4 and 14 months. The complications during this period were: 3 minor residual pain (limited to the scar) and 1 recurrence. Thirteen patients (76.5%) were satisfied with the intervention. Mortality was zero. Conclusion: Short time complications related to the surgical management of abdominal incisional hernia with mesh placement in retro-muscular prefascial in CHUYO are mainly minor.

Stoma and shame: engaging affect in the adaptation to a medical device

Objective: The objective is to understand difficulties some patients have with their adaptation to a medical device, specifically a stoma and an ostomy appliance, following gastro-enterologic surgery. A partial or total colectomy is typically performed in cases of digestive cancers, Crohn’s disease, or anal incontinence. A psychotherapeutic application deduced from this understanding is described. The therapeutic approach is informed by Lacanian psychoanalysis. Setting: The setting is the digestive surgery services section of a large public teaching hospital in France. The clinical team conducting the interventions described perform their work with patients post-operatively. Subjects: Selected cases are chosen to provide brief illustrations of the analysis and the psychotherapeutic approach developed. Primary argument: This study focuses on the impact of the stoma and the ostomy appliance on the subjectivity of the patient and shows how the affect of shame can appear. It is noted that the affect of shame in the adaptation to an ostomy appliance has not been investigated to date. This affect can in turn have psychological effects on the gastroenterologist treatment itself, even to the point of the patient’s abandonment of ongoing care. The analysis reported here explores the recognition of shame when it might be present, and the process of accompanying the patient therapeutically, engaging the logic of the transference. Conclusion: Shame cannot be treated by ignorance or by indifference. A psychotherapeutic application engaging the transference between the patient and members of the nursing and psychotherapeutic team, helps patients support shame and adapt well to the ostomy bag.

The evaluation of quality indicators in distal pancreatectomy (DP)

Introduction: The DP presents high morbidity rates in the literature, exceeding 50%. The evaluation of quality indicators is an important tool to improve the procedure. Objective: To present the quality indicators in the DP in the Digestive Surgery Service at São Rafael Hospital – Salvador – Bahia. Patients and methods: A total of 44 patients had their datas collected, through standardized forms, prospectively between 2010 and 2015. Half the patients were operated laparoscopically. There were evaluated complications related or unrelated to the surgical site, blood transfusion, length of hospital stay, readmission, reoperation, 30 days mortality. Results: Total 44 patients, 29 (66%) were female, with a mean age of 49 years. 25 patients had complications (56.8%): (Clavien I and II), 19 (76%) and 6 (24%) Clavien–Dindo III. Mortality rate was (2%). Respiratore infection (2%). One patient (2%) received blood transfusion after surgery. The average length of stay was 5 days. Five patients were readmitted (12.5%): Four patients had abscesses, two were drained by radiointervention, 1 was drained by laparotomy and 1 had conservative approach. One case of pseudo aneurysm of the splenic artery, initially treated by embolization has failured and was necessary a laparotomy. Conclusion: The quality indicators are within the literature patterns.

The Haemorrhoids’ Pathology: Epidemiological, Diagnostic, Therapeutic and Evolutionary Aspects

Background: Hemorrhoidal disease is most frequently encountered in proctology affection; it is defined by signs or symptoms attributed to hemorrhoids. Its pathogenesis is based on old theories and vascular mechanical which are nevertheless based on the current therapeutic approach. General Aim of the Study: To study haemorrhoids’ pathology in order to improve its management. Methodology: A retrospective cross-sectional study was conducted over a period of two (2) years from 1 January 2012 to 31 December 2013. Data were collected from outpatients records in hepato-gastroenterology and digestive surgery services at “Polyclinique Notre Dame de la Paix” in Ouagadougou (2294 files). Results: 140 cases of haemorrhoids were recorded during our study period. The frequency was 6.1% of consultations. Males predominated with 75.71% of patients (sex ratio = 3.12). The average age was 39.58 years. Civil servants were most affected by this disease (60%). Rectal bleeding was the most common reason of consultation (52.14%). The crown shape was predominated (59%). The frequency of external haemorrhoids was the highest (65.71%) and stage 4 (40.79%) was the most represented. Anal fissure was the proctologic pathology, the most associated to haemorrhoids (17.14%). Medical treatment concerned 89.28% of patients with 69.6% of favorable short-term evolution. No instrumental treatment was performed. Surgical treatment consisted of 10.71% of patients and the technique used was the Milligan-Morgan performed under spinal anesthesia. The postoperative complications were mainly represented by anal intense pain and acute urinary retention. The healing period of wounds was on average 6 weeks. Conclusion: The hemorrhoid has often underestimated in our regions. The instrumental treatment is nonexistent and should take an important place; it must be an indication before surgery.

Isolated gastric outlet obstruction due to corrosive ingestion

To analyze the diagnostic and therapeutic aspects of isolated gastric outlet obstruction secondary to corrosive ingestion. Retrospective chart review of eight patients who developed gastric stricture following corrosive ingestion and were treated in the Digestive and General Surgery Service of Yopougon Teaching Hospital in Abidjan from 1991 to 2009. Six men and two women (mean age of 34.3 [range 21 to 48 years]) had isolated gastric outlet obstruction following accidental (n=2) or suicidal (n=6) acid ingestion. Two patients sought hospital medical attention two days after ingestion, whereas six patients came to hospital with a mean delay of 60.8 days (range 12 and 96 days). Patients sought medical attention for poor general status (n=6), postprandial vomiting (n=4), early satiety (n=2) and retrosternal pain (n=2). Two patients, who presented early to hospital, underwent upper gastrointestinal tract endoscopy the day after admission and then received a feeding jejunostomy whereas the esogastroduodenal barium swallow and feeding jejunostomy were performed after a mean delay of 2 days (range 1 and 3 days) and 3 days (range 1 and 5 days), respectively. The findings at upper endoscopy and barium swallow were: microgastria (n=2), midgastric stricture (n=1), antropyloric stricture (n=4) and gastric body stricture (n=1). One patient died preoperatively as the result of severe nutritional depletion. A follow-up endoscopy and barium swallow were performed respectively 21 and 35 days later. Definitive surgery was performed after a mean delay of 85 days (range 74 to 123 days) in the remaining seven patients. Gastric lesions were managed by total gastrectomy with Roux-en-Y esophagojejunostomy (n=2), partial gastrectomy with gastrojejunostomy (n=2) or simple gastrojejunostomy (n=3). During the mean follow-up period of 4 years (range 1 to 7 years), all patients were free of symptoms. Isolated corrosive gastric stricture is relatively rare. Surgery tailored according to the extent of gastric stricture provides excellent results.

Desarrollo y evolución de la suprarrenalectomía laparoscópica en una unidad especializada: de los casos iniciales al hospital de día

BackgroundAfter the first reports in 1992, laparoscopic adrenalectomy (LA) has evolved technically until becoming the standard approach for the treatment of most of the adrenal gland diseases. Material y methodsRetrospective and descriptive study of 67 patients who underwent 68 LA between January-1998 and December-2008 in the Laparoscopic Surgery Unit of the General and Digestive Surgery Service in a third level hospital (only one case of bilateral LA). The group was divided in 2 periods, P-1 (1998-2003, 22 cases) and P-2 (2004-2008, 45 cases), which have been compared to evaluate the evolution of the LA technique. ResultsIndications for LA were: 19 incidentalomas, 19 primary hyperaldosteronism, 18 pheocromocitoms, 5 cases of symptomatic and non-functioning adrenal masses, 4 Cushing adenomas and 2 metastases. There was no mortality, only 4 patients had minor complications (6%) and conversion rate was only 3% (2 cases). Mean size of adrenal glands resected was 3,83 cm and the mean operative time was 86 minutes. Mean postoperative hospital stay was 3 days and in P-2 seventeen patients were discharged on an outpatient basis (hospital stay less than 23 hours). Conclusionsin our experience, LA for the treatment of adrenal diseases has shown to be safe, effective and reproducible with low complications and excellent tolerance by patients. When the learning curve is overcome, hospital stay and operative time clearly decrease. As a consequence, LA can be planned in selected cases as outpatient surgery with good results.

Are the general and digestive surgery services prepared to offer quality training according to the new teaching plans?

IntroductionIn recent months we have witnessed an update of the residents training program and the regulation of important training aspects. Teaching units are an important aspect of the training process, which should be required to comply with the prerequisites adapted to changing times as a guarantee of quality. AimTo identify areas for improvement in training, and the baseline resources of the units to deal with the implementation of the new training program. Material and methodsThe study was carried out in all units with accredited educational programs in the Valencian Community with questionnaires answered by tutors and residents, and meetings held with them. ResultsThe participation rate was high (100% of tutors and 92% of residents). Some deficiencies in the requirements of the surgical units and in the quality of the training felt by the residents are detected, mainly in the research and educational activity fields. Huge differences between hospitals are found. ConclusionsMore attention must be paid to fulfilling all the requirements needed for the accreditation of the teaching units, with an emphasis on educational and research activities.The implementation of the new training program requires monitoring to minimise the differences found between the units.

Evaluation of underreported surgical site infection evidenced by post-discharge surveillance

The Surgical Site Infection (SSI) has been pointed as one of the most important infection sites. This study aimed to determine the surgical site infection incidence during hospitalization and the impact of notification after discharge through two methods. This prospective study was carried out in the digestive system surgery service (DSS) of two general hospitals of São Paulo, in the period from August, 2001 to March, 2002. Incidence levels of 6.7% and 4.5% were notified in the institutions A and B respectively. The incidence of SSI after discharge in the institution A was 27% and 13.4% in the institution B. Surveillance after discharge evidenced global rates of 33.7% and 17.9% for institutions A and B respectively. The rates of infection increased 5.02 and 3.98 times respectively in institutions A and B.

Abscesso esplênico causado por Salmonella

OBJETIVO: Relatar as características demográficas, clínicas, diagnóstica e terapêutica de pacientes com abscesso esplênico (AE) causado por Salmonella. MÉTODO: Análise retrospectiva de dados de pacientes atendidos no Serviço de Cirurgia Geral e Aparelho Digestivo do Hospital Universitário Gaffrée-Guinle no período de janeiro de 2001 a dezembro de 2005, a estes se incluiu um caso tratado em outro hospital em época anterior. RESULTADOS: Dentre 4823 pacientes recentemente atendidos, dois apresentaram AE causado por Salmonella enteritidis, enquanto o caso mais antigo o agente responsável foi a Salmonella typhi. Todos eram homens, com idade média de 45 anos. Em nenhum deles foi identificada condição predisponente à formação do abscesso; os exames de imagem foram capazes de diagnosticar o AE. Todos foram tratados por esplenectomia e antibioticoterapia e evoluíram para cura. CONCLUSÕES: A Salmonella, apesar de infrequente, pode ser o agente causal do AE. Caracteristicamente os abscessos eram grandes e apresentavam material necrótico em seu interior. Nesta condição, a esplenectomia associada a antibioticoterapia mostrou-se eficaz no tratamento.