Short-term outcomes of a multicentre prospective study using a "visible" polyvinylidene fluoride onlay mesh for the prevention of midline incisional hernia.

INTRODUCTION: Prophylactic meshes in high-risk patients prevent incisional hernias, although there are still some concerns about the best layer to place them in, the type of fixation, the mesh material, the significance of the level of contamination, and surgical complications. We aimed to provide answers to these questions and information about how the implanted material behaves based on its visibility under magnetic resonance imaging (MRI). METHOD: This is a prospective multicentre observational cohort study. Preliminary results from the first 3 months are presented. We included general surgical patients who had at least two risk factors for developing an incisional hernia. Multivariate logistic regression was used. A polyvinylidene fluoride (PVDF) mesh loaded with iron particles was used in an onlay position. MRIs were performed 6 weeks after treatment. RESULTS: Between July 2016 and June 2022, 185 patients were enrolled in the study. Surgery was emergent in 30.3% of cases, contaminated in 10.7% and dirty in 11.8%. A total of 5.6% of cases had postoperative wound infections, with the requirement of stoma being the only significant risk factor (OR = 7.59, p = 0.03). The formation of a seroma at 6 weeks detected by MRI, was associated with body mass index (OR = 1.13, p = 0.02). CONCLUSIONS: The prophylactic use of onlay PVDF mesh in midline laparotomies in high-risk patients was safe and effective in the short term, regardless of the type of surgery or the level of contamination. MRI allowed us to detect asymptomatic seromas during the early process of integration. STUDY REGISTRATION:  This protocol was registered at ClinicalTrials.gov (NCT03105895).

Conservative management in iatrogenic splenic trauma after chest tube insertion.

Insertar un tubo torácico es una maniobra terapéutica de gran valor, pero no exenta de complicaciones. Nuestro objetivo es poner de manifiesto una nueva opción de tratamiento mediante técnicas radiológicas intervencionistas que eviten los riesgos de una cirugía en pacientes seleccionados. Presentamos el caso de un paciente pluripatológico con diagnóstico de empiema pulmonar izquierdo al que de manera accidental se le insertó un tubo torácico en el polo superior esplénico. La comorbilidad del paciente y la presencia de estabilidad hemodinámica abogaron por un tratamiento conservador mediante cateterización esplénica supraselectiva e introducción de cola quirúrgica en la retirada del tubo.

Inserting a chest tube is a therapeutic tool of great value not without complications. Our objective is to highlight a new treatment option using interventional radiological techniques that avoid the risks of surgery in selected patients. We present the case of a multi-pathological patient with a diagnosis of left pulmonary empyema who accidentally inserted a chest tube into the splenic superior pole. The comorbidities of the patient and the presence of hemodynamic stability advocated conservative treatment through supraselective splenic catheterization and the introduction of surgical glue in the withdrawal of the tube.

Post-nephrectomy diaphragmatic hernia. Increase suspicion and decrease morbi-mortality: two cases report.

Post-nephrectomy diaphragmatic hernia is an extremely rare condition. The symptoms may be acute or latent and will depend on the herniated organ, which makes it difficult to suspect. Therefore, it is necessary to know about this type of iatrogenic hernia to avoid a delay in diagnosis. A radiological confirmation with computed tomography and early surgical treatment greatly decreased the morbidity and mortality. We report two cases: a 76-year-old male, who underwent a right nephrectomy 18 days prior due to a renal carcinoma; and a 59-year-old woman, who underwent the procedure 4 years prior due to left renal atrophy.

[Risk factors in patients older than 70 years with complicated colorectal carcinoma]. / Factores de riesgo en pacientes mayores de 70 años con carcinoma colorrectal complicado.

OBJECTIVE: The aim of this study was to analyze the outcome of patients over 70 years of age who underwent emergency surgery for complicated colorectal carcinoma, as well as to identify the factors that might have some influence on outcome. PATIENTS AND METHOD: A retrospective study of 54 patients older than 70 years who underwent emergency surgery for complicated colorectal cancer (42 with obstruction and 12 with perforation) between 1991 and 2002 was performed. Morbidity and mortality after surgery were studied. To determine prognostic factors of morbidity and mortality a multivariate logistic regression analysis was also performed. RESULTS: Overall and major morbidity rates were 81.5% and 42.6%, respectively. The mortality rate was 27.8%. Multivariate analysis revealed that perioperative transfusion (p = 0.014) was an independent predictive factor of major complications and that a high APACHE II score (p = 0.031) and the presence of perforation proximal to the tumor (p = 0.042) independently predicted mortality. CONCLUSIONS: Emergency surgery for complicated colorectal carcinoma in elderly patients carries elevated morbidity and mortality. The presence of risk factors should be taken into account when choosing the most suitable surgical technique and evaluating the need for intensive postoperative treatment.

Factores de riesgo en pacientes mayores de 70 años con carcinoma colorrectal complicado / Risk factors in patients older than 70 years with complicated colorectal carcinoma

Objetivo. El fin de este estudio fue analizar la evolución clínica de los pacientes mayores de 70 años operados de urgencia por carcinoma colorrectal complicado y, además, evaluar los factores con posible influencia en la evolución clínica. Pacientes y método. Se han revisado retrospectivamente los datos de 54 pacientes mayores de 70 años intervenidos de urgencia por carcinoma colorrectal complicado (42 con obstrucción y 12 con perforación) durante el período 1991-2002. Se estudió la morbimortalidad tras la cirugía y se realizó un análisis de regresión logística multivariable para determinar los factores pronósticos de morbilidad y de mortalidad. Resultados. Las tasas de morbilidad global y mayor, y de mortalidad fueron del 81,5, 42,6 y 27,8%, respectivamente. El análisis multivariable mostró que la transfusión perioperatoria (p = 0,014) fue un factor predictivo independiente de complicación mayor y que un índice APACHE II alto (p = 0,031) y la presencia de perforación a distancia (p = 0,042) fueron factores relacionados con la mortalidad.Conclusiones. La cirugía urgente por carcinoma colorrectal complicado en pacientes de edad avanzada conlleva una elevada morbimortalidad. La presencia de factores de riesgo debería tenerse en cuenta al elegir la técnica quirúrgica más adecuada y al valorar la necesidad de un tratamiento postoperatorio intensivo (AU)

Objective. The aim of this study was to analyze the outcome of patients over 70 years of age who underwent emergency surgery for complicated colorectal carcinoma, as well as to identify the factors that might have some influence on outcome. Patients and method. A retrospective study of 54 patients older than 70 years who underwent emergency surgery for complicated colorectal cancer (42 with obstruction and 12 with perforation) between 1991 and 2002 was performed. Morbidity and mortality after surgery were studied. To determine prognostic factors of morbidity and mortality a multivariate logistic regression analysis was also performed. Results. Overall and major morbidity rates were 81.5% and 42.6%, respectively. The mortality rate was 27.8%. Multivariate analysis revealed that perioperative transfusion (p = 0.014) was an independent predictive factor of major complications and that a high APACHE II score (p = 0.031) and the presence of perforation proximal to the tumor (p = 0.042) independently predicted mortality. Conclusions. Emergency surgery for complicated colorectal carcinoma in elderly patients carries elevated morbidity and mortality. The presence of risk factors should be taken into account when choosing the most suitable surgical technique and evaluating the need for intensive postoperative treatment (AU)

Factores predictivos de malignidad en microcalcificaciones de mama sin lesiones asociadas / Predictive factors for malignancy in breast microcalcifications without associated lesions

Introducción. El cribado mamográfico de cáncer de mama permite la detección y el tratamiento temprano de los carcinomas no palpables. Las microcalcificaciones son un hallazgo mamográfico muy importante para la detección de muchos de estos procesos, pero también están presentes en enfermedad benigna de la mama. En este estudio se analizan los factores clínicos y radiológicos que tienen valor predictivo de malignidad. Material y métodos. Se han recogido retrospectivamente 133 casos de biopsias abiertas realizadas a pacientes con hallazgo mamográfico de microcalcificaciones sin lesión asociada. Las características clínicas y radiológicas se correlacionaron con los hallazgos histológicos. Resultados. El 28,6% de las lesiones analizadas fueron malignas, y entre ellas el 65,8% fueron carcinomas ductales in situ. Un 23,1% de los carcinomas infiltrantes presentaron adenopatías positivas. Ningún factor clínico tuvo valor predictivo de malignidad. En el estudio univariante, los factores radiológicos que presentaron significación estadística fueron: el tipo morfológico, según la clasificación de Le Gal, la irregularidad en el tamaño, la irregularidad en la densidad, el número de microcalcificaciones por grupo, el diámetro de la lesión y la presencia de más de un foco de microcalcificaciones. En el estudio multivariante, los factores con valor predictivo independiente fueron: la irregularidad en la densidad, la concentración ≥ 10 microcalcificaciones por grupo, la presencia de más de un foco de microcalcificaciones y el diámetro de la lesión ≥ 10mm. Conclusiones. Aunque ningún factor clínico fue relevante en la predicción de malignidad, las características radiológicas de las microcalcificaciones fueron determinantes en la indicación de una biopsia (AU)

Introduction. Screening mammography allows the early detection and treatment of nonpalpable carcinomas. Microcalcifications are highly important for the detection of many of these malignancies but are also present in benign breast disease. In the present study we analyzed the radiologic and clinical factors associated with malignancy. Material and methods. We retrospectively reviewed 133 patients who underwent open biopsy after a mammographic finding of microcalcifications without an associated lesion. Clinical and radiologic characteristics were correlated with histologic findings. Results. A total of 28.6% of the lesions analyzed were malignant. Of these, 65.8% were ductal carcinoma in situ. Among invasive carcinomas, 23.1% presented lymph node metastasis. No clinical criterion was significant for malignancy. On univariate analysis six radiologic criteria were significant: morphologic type (Le Gal's classification), irregularity of size, irregularity of density, number of microcalcifications per cluster, diameter of the lesion, and the presence of more than one cluster. On multivariate analysis the factors with independent predictive value were: irregularity of density, ≥ 10 microcalcifications per cluster, the presence of more than one cluster, and diameter of the cluster ≥ 10 mm. Conclusions: Although none of the clinical factors analyzed was predictive for malignancy, the radiological characteristics of microcalcifications were determining factors in the indication for biopsy (AU)

Presentación y evolución clínica de las hernias externas incarceradas en pacientes adultos / Presentation and outcome of incarcerated external hernias in adults

Objetivo. Estudiar la presentación y la evolución clínica de pacientes adultos con hernias externas incarceradas y tratar de identificar los factores que podrían tener algún efecto en su curso evolutivo. Pacientes y método. Se ha revisado retrospectivamente a 230 pacientes adultos intervenidos de urgencia por una hernia externa incarcerada durante el período 1992-2001. Se estudiaron las características de la presentación clínica, el tipo de anestesia, los métodos quirúrgicos, las complicaciones y la mortalidad. También se realizó un análisis univariable para determinar los factores con posible influencia en la evolución clínica. Resultados. Hubo 77 hernias crurales, 70 inguinales, 43 umbilicales y 40 eventraciones. Un total de 74 enfermos (32,2%) acudió con más de 48 h de evolución. En 135 pacientes (58,7%) había enfermedades asociadas significativas. En 140 pacientes (60,9%) se usó anestesia general, en 86 raquianestesia y en 4 anestesia local. Los métodos quirúrgicos más utilizados fueron la reparación anatómica y la hernioplastia sin tensión. En 31 casos (13,5%) fue necesaria una resección intestinal. Las tasas de morbilidad global y mayor y de mortalidad fueron del 37,8, el 10 y el 3,9%, respectivamente. Los factores asociados de manera significativa con una evolución desfavorable fueron una sintomatología prolongada, la hospitalización tardía, la presencia de enfermedades asociadas y un grado ASA alto. Conclusiones. El tratamiento urgente de las hernias externas conlleva una elevada morbimortalidad, por lo que un diagnóstico precoz y la reparación electiva de las hernias no complicadas deberían ser la estrategia terapéutica adecuada en los pacientes adultos (AU)

Objective. The aim of this study was to determine the clinical presentation and outcome of incarcerated external hernias in adults, as well as to identify the factors that might have some influence on outcome. Patients and method. A retrospective study of 230 adult patients who underwent emergency surgical repair of incarcerated external hernias from 1992 to 2001 was performed. The characteristics of clinical presentation, type of anesthesia, surgical procedures, complications and mortality were studied. To determine clinical factors that might have some influence on outcome, an univariate analysis was also performed. Results. There were 77 femoral hernias, 70 inguinal, 43 umbilical and 40 incisional hernias. Seventy-four patients (32.2%) presented after 48 h of symptom onset. Significant associated diseases were found in 135 patients (58.7%). General anesthesia was used in 140 patients (60.9%), spinal anesthesia in 86 patients and local anesthesia in four patients. The most commonly used procedures were anatomic repair and tension-free hernioplasty. Bowel resection was required in 31 patients (13.5%). Overall and major morbidity and mortality were 37.8%, 10% and 3.9%, respectively. Factors that were significantly associated with unfavorable outcome were longer duration of symptoms, late hospitalization, concomitant diseases, and a high ASA class. Conclusions. External hernias produce elevated morbidity and mortality if treatment is undertaken as an emergency. Thus, early diagnosis and elective repair of uncomplicated hernias should be performed in adults (AU)

[Predictive factors for malignancy in breast microcalcifications without associated lesions]. / Factores predictivos de malignidad en microcalcificaciones de mama sin lesiones asociadas.

INTRODUCTION: Screening mammography allows the early detection and treatment of nonpalpable carcinomas. Microcalcifications are highly important for the detection of many of these malignancies but are also present in benign breast disease. In the present study we analyzed the radiologic and clinical factors associated with malignancy. MATERIAL AND METHODS: We retrospectively reviewed 133 patients who underwent open biopsy after a mammographic finding of microcalcifications without an associated lesion. Clinical and radiologic characteristics were correlated with histologic findings. RESULTS: A total of 28.6% of the lesions analyzed were malignant. Of these, 65.8% were ductal carcinoma in situ. Among invasive carcinomas, 23.1% presented lymph node metastasis. No clinical criterion was significant for malignancy. On univariate analysis six radiologic criteria were significant: morphologic type (Le Gal's classification), irregularity of size, irregularity of density, number of microcalcifications per cluster, diameter of the lesion, and the presence of more than one cluster. On multivariate analysis the factors with independent predictive value were: irregularity of density, > or = 10 microcalcifications per cluster, the presence of more than one cluster, and diameter of the cluster > or = 10 mm. CONCLUSIONS: Although none of the clinical factors analyzed was predictive for malignancy, the radiological characteristics of microcalcifications were determining factors in the indication for biopsy.

[Presentation and outcome of incarcerated external hernias in adults]. / Presentación y evolución clínica de las hernias externas incarceradas en pacientes adultos.

OBJECTIVE: The aim of this study was to determine the clinical presentation and outcome of incarcerated external hernias in adults, as well as to identify the factors that might have some influence on outcome. PATIENTS AND METHOD: A retrospective study of 230 adult patients who underwent emergency surgical repair of incarcerated external hernias from 1992 to 2001 was performed. The characteristics of clinical presentation, type of anesthesia, surgical procedures, complications and mortality were studied. To determine clinical factors that might have some influence on outcome, an univariate analysis was also performed. RESULTS: There were 77 femoral hernias, 70 inguinal, 43 umbilical and 40 incisional hernias. Seventy-four patients (32.2%) presented after 48 h of symptom onset. Significant associated diseases were found in 135 patients (58.7%). General anesthesia was used in 140 patients (60.9%), spinal anesthesia in 86 patients and local anesthesia in four patients. The most commonly used procedures were anatomic repair and tension-free hernioplasty. Bowel resection was required in 31 patients (13.5%). Overall and major morbidity and mortality were 37.8%, 10% and 3.9%, respectively. Factors that were significantly associated with unfavorable outcome were longer duration of symptoms, late hospitalization, concomitant diseases, and a high ASA class. CONCLUSIONS: External hernias produce elevated morbidity and mortality if treatment is undertaken as an emergency. Thus, early diagnosis and elective repair of uncomplicated hernias should be performed in adults.

Abdomen agudo secundario a pica / Acute abdomen due to pica

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Adenocarcinoma gástrico en pacientes mayores de 80 años / Gastric adenocarcinoma in patients older than 80 years

Introducción. El objetivo del trabajo es analizar, mediante la comparación de distintas variables, el comportamiento del adenocarcinoma gástrico en pacientes de 80 años o más respecto a los de menor edad. Métodos. Estudio retrospectivo sobre 212 pacientes con adenocarcinoma gástrico entre enero de 1988 y diciembre de 1998, de los que 27 tenían 80 años o más (grupo A) y 185 menos de 80 (grupo B). Se compararon el sexo, la edad, las enfermedades asociadas, el tiempo de evolución, las manifestaciones clínicas, la localización, el aspecto macroscópico, la intervención, el estadio TNM, la morbimortalidad postoperatoria, la reintervención, la estancia y la supervivencia. Resultados. El porcentaje de complicaciones en el grupo A y B fue del 65 y el 45 por ciento, respectivamente. La mortalidad hospitalaria global fue de 15 pacientes y la postoperatoria de nueve. Al comparar ambos grupos se halló que en el grupo A había mayor presencia de vómitos (p = 0,05), de masa palpable (p = 0,004), operabilidad inferior (p = 0,01), diseminación extragástrica abdominal superior (p = 0,03), peor estadio TNM (p = 0,02), mayor presencia de estadios N1-N2 (p = 0,01), mayor número de complicaciones sistémicas (p = 0,05) y menor supervivencia (p = 0,008). El resto de variables no presentaron diferencias significativas. Conclusiones. Los pacientes octogenarios presentaron tasas superiores de enfermedad localmente avanzada que indujeron peor estadio TNM y menor supervivencia (AU)