Medial incisional ventral hernia repair with Adhesix® autoadhesive mesh: descriptive study.

Nowadays, the gold standard for the surgical treatment of abdominal wall defects is the use of a mesh. There is an extensive variety of meshes, self-adhesive ones being among the most novel technologies. The literature on the self-adhesive mesh Adhesix® (Cousin Biotech Laboratory, 59117 Wervicq South, France) in medial incisional ventral hernia is scarce. We performed a retrospective descriptive study with prospective data collection from 125 patients who underwent prosthetic repair of medial incisional ventral hernia-M1-M5 classification according to European Hernia Society (EHS)-with self-adhesive mesh Adhesix® between 2013 and 2021. Follow-up was performed 1 month and yearly after the surgery. Postoperative complications and hernia recurrences were recorded. Epidemiological results were average BMI 30.5 kg/m2 (SD 5), highlighting that overweight (41.6%) and obesity type 1 (25.6%) were the most represented groups. 34 patients (27.2%) had already undergone a previous abdominal wall surgery. The epigastric-umbilical (M2-M3 EHS classification, 22.4%) and umbilical (M3 EHS classification, 20%) hernias were the predominant groups. The elective surgery technique was Rives or Rives-Stoppa with an associated supraaponeurotic mesh if the closure of the anterior aponeurosis of the rectus sheath was not surgically closed (13 patients). The most frequent postoperative complication was seroma (26.4%). The recurrence rate was 7.2%. The average follow-up length was 2.6 years (SD 1.6 years). According to the results of this study and the literature available, we consider that the self-adhesive mesh Adhesix® is an appropriate alternative mesh option for the repair of medial incisional ventral hernias.

Índice de sustitución en patología herniaria: estudio comparativo / Hernia substitution index: a comparative study

La monitorización y evaluación mediante el índice de sustitución (IS) de la cirugía herniaria debería formar parte de la gestión clínica de las Unidades de Cirugía Mayor Ambulatoria (CMA) en un Servicio de Cirugía General y Digestivo (CGD). En este estudio se evalúa la tendencia evolutiva del Índice de Sustitución (IS) en el proceso hernial en el Servicio de CGD del Hospital Universitario Santa Cristina (HUSC), en comparación con los Indicadores Clave nacionales y autonómicos. Material y métodos: Diseño: estudio descriptivo observacional y comparativo de indicadores del Servicio de CGD del HUSC, con respecto a indicadores de la media de hospitales nacionales y de la Comunidad de Madrid. Análisis estadísticos: todas las variables comparadas son proporciones, por lo que en el análisis estadístico se ha utilizado el método del Chi cuadrado (Chi 2) para comparación de proporciones de muestras independientes. La significación estadística se ha establecido para contraste a dos colas (alpha = 0,05; Beta = 0,2). Resultados: se analizan 5.506 procedimientos de hernias inguinales (hernias inguinales simples, bilaterales y recidivadas) intervenidas en el Servicio de Cirugía General del HUSC en los últimos 9 años (2006-2014). El IS medio fue del 72%. Específicamente, la hernia inguinal unilateral simple alcanzó un IS del 82%. Respecto al indicador clave ‘cirugía ambulatoria de la hernia`, en el HUSC se obtienen resultados superiores a indicadores nacionales (p < 0,05) y de la Comunidad de Madrid. Conclusiones: La CMA en el HUSC está más desarrollada que en promedio del SNS en relación al IS la patología herniaria, situándose como un referente nacional en este capo de la CMA. Existen oportunidades de mejora en el cambio de la modalidad anestésica, incrementando el uso de técnicas anestésicas que permitan una recuperación más rápida, como la anestesia local asociada a sedación (AU)

Introduction: To monitor and to evaluate the Hernia Substitution Index (SI) should be part the clinical management of the Major Ambulatory Surgery (MAS) Units in a General and Digestive Surgery Service. In this study the temporal trend of the SI in hernia process at the General Surgery Service of Santa Cristina University Hospital (SCUH) is evaluated compared with the national and regional key indicators. Material and methods: Design: Observational, descriptive and comparative study of SCUH indicators with respect to Key Indicators of the average of the national and region of Madrid hospitals. Statistical analysis: All variables compared are proportions; consequently, the statistical analysis was based on the chi-square method (Chi 2) to compare proportions of independent samples. Statistical significance was established for two-tailed contrast (alpha 0 0,05; Beta = 0,2). Results: The 5.506 inguinal hernia procedures (simple unilateral, bilateral and recurrent inguinal hernia ) performed by the General Surgery Service of SCUH during the last nine years (2006-2014) were analyzed. The average SI was 72%. Specifically simple unilateral inguinal hernia IS reached 82%. Regarding the Key Indicator `outpatient hernia surgery` the General Surgery Service of SCUH indicators are above those of national (p < 0,005) and the Madrid region. Conclusions: The MAS at General Surgery Service of the SCUH is more developed than the average of the national hospitals regarding the SI of hernia pathology, fact that position the General Surgery Service of SCUH as a national reference in this MAS field. There are opportunities for improvement in the change of anesthetic modality, increasing the use of techniques that allow earlier anesthetic recovery as local anesthesia associated with sedation (AU)

Angiosarcoma in the small intestine. Apropos of a particular case.

Presentation of a case of small intestine primary angiosarcoma in a 70-year-old male. There is question of an extremely rare tumor in the gastrointestinal tract. Its symptomatology is similar to that of other tumors in the small intestine. An immunohistochemical study is usually essential for its anatomopathological diagnosis. The diagnosis is generally arrived at in its advanced stages, and that makes for a bad prognosis. The bibliography has been revised from this case on.

Pancreatic cancer. Management.

Pancreatic cancer still represents a serious medical concern for which no adequate solution has thus far been found. Surgery is the only appropriate therapy, but has a survival rate of around 30-35% at three years, with an operative mortality below 3% and an operative morbidity approaching 10% of radically resected patients, all of which applies to surgery performed by expert teams in highly experienced sites.