Incisional Negative Pressure Wound Therapy After Revascularisation Surgery in Patients with Peripheral Arterial Disease: A Randomised Trial (PICO-Vasc Study).

OBJECTIVE: This study assessed the potential benefits of using incisional negative pressure wound therapy (iNPWT) for patients undergoing revascularisation due to peripheral arterial disease. METHODS: A prospective randomised controlled trial was conducted to compare the inguinal application of iNPWT vs. standard surgical dressings. Patients were enrolled from February 2021 to November 2022. A total of 133 groin incisions were randomised (66 intervention group, 67 control group). The randomisation sequence was carried out by permuted blocks and allocation assigned by opening opaque envelopes once the revascularisation procedure had finished. Wound healing and complication rates were assessed at post-operative days 5, 14, and 30. Primary and secondary endpoints were: 30 day post-operative surgical site infection (SSI) and surgical site occurrence (SSO) rates, defined as a surgical wound complication other than a SSI. Post-operative SSI was defined according to the US Centers for Disease Control and Prevention criteria. SSO included: wound dehiscence, seroma or lymphocele, haematoma, and lymphorrhagia. The study was registered at ClinicalTrials.gov database (NCT04840576) and reported according to the CONSORT guidelines. RESULTS: iNPWT did not modify the 30 day inguinal SSI and SSO rates (16.7% vs. 20.9% and 37.9% vs. 44.8%; p = .53, relative risk [RR] 0.999, 95% confidence interval [CI] 0.52 - 1.88 and p = .42, RR 1.29, 95% CI 0.89 - 1.86, respectively). It reduced the early SSO rate (19.7% vs. 35.8%; p = .044, RR 1.45, 95% CI 1.047 - 2.013) and post-operative seroma rate (4.6% vs. 19.4%; p = .014, RR 1.73, 95% CI 1.296 - 2.397). CONCLUSION: There were no differences in SSI and SSO rates, although statistically significant reductions in early SSO rates and seroma were found in the intervention group.

Evaluation of bariatric surgery patients at the emergency department of a tertiary referral hospital.

OBJECTIVE: To describe the profile of the bariatric surgery patients that were admitted to the Emergency Department (ED). METHOD: A retrospective review of the reasons why bariatric surgery patients go to our ED. We analyzed the first 30 days after the surgery. We evaluated the number and indications of admissions, the examinations ordered, and final diagnosis and destination of the patients. RESULTS: From January 2010 to July 2012, 320 patients underwent bariatric surgery at our Institution. Fifty three patients (16.6%) were admitted to the ED at least once. We found 58 admissions (1.1 admissions by patient). Patients who had duodenal switch and Roux-en-Y gastric bypass were the most representative (74%). The main indications for admission were abdominal pain (50%), and problems related to the surgical wounds (22.4%). Blood test was the most performed examination (75.9%). The most frequent final diagnosis was unspecific abdominal pain in 27 cases (46.6%), and complications of the surgical wound in 10 patients (17.2%). Nineteen patients (35.84%) were admitted to the surgical ward from the ED, and 5 of them required surgical revision (9.4%). Multivariate analyses showed that the type of surgery was the only predictor variable for the ED admission. CONCLUSIONS: Attending ED after bariatric surgery is not common, and less than a third of the patients required hospital admission. Just a small percentage of the examinations showed any pathological value. Readmission rate is very low. Surgical procedure is the only predictor for ED admission.

Descripción de la asistencia en urgencias de pacientes intervenidos de cirugía bariátrica en un centro de referencia / Evaluation of bariatric surgery patients at the emergency department of a tertiary referral hospital

OBJETIVO: describir el perfil de consulta en el servicio de Urgencias de pacientes intervenidos de cirugía bariátrica (CB). MÉTODO: análisis retrospectivo de las consultas al servicio de Urgencias de pacientes intervenidos de CB. Se analizan las visitas realizadas en los primeros 30 días tras el alta. Se evalúan número y motivos de consulta/reconsulta, exploraciones complementarias realizadas, diagnóstico clínico establecido y destino de los pacientes. RESULTADOS: entre enero de 2010 y julio de 2012 se intervinieron de 320 pacientes de CB, 53 enfermos (16,6 %) consultaron al menos una vez en Urgencias. Se registraron 58 consultas (1,1 visitas/paciente). Los pacientes intervenidos de cruce duodenal y bypass gástrico representaron el 74 %. Los motivos de consulta más frecuentes fueron dolor abdominal (50 %) y problemas relacionados con la herida quirúrgica (22,4 %). La analítica sanguínea fue la exploración complementaria más solicitada (75,9 %). El diagnóstico más frecuente fue dolor abdominal inespecífico en 27 casos (46,6 %), y problemas de herida quirúrgica en 10 casos (17,2 %). Diecinueve pacientes (35,84 %) requirieron ingreso hospitalario desde Urgencias y 5 de ellos precisaron reintervención quirúrgica (9,4 %). El análisis multivariante muestra que la única variable en relación a las visitas a Urgencias es el tipo de cirugía. CONCLUSIONES: las visitas a Urgencias de pacientes intervenidos de cirugía bariátrica son poco frecuentes, menos de un tercio de ellos precisan ingreso hospitalario. Las exploraciones complementarias sólo mostraron resultados patológicos en un pequeño porcentaje de los casos. La tasa de reconsultas es baja. La técnica quirúrgica es el único predictor de consulta en Urgencias

OBJECTIVE: To describe the profile of the bariatric surgery patients that were admitted to the Emergency Department (ED). METHOD: A retrospective review of the reasons why bariatric surgery patients go to our ED. We analyzed the first 30 days after the surgery. We evaluated the number and indications of admissions, the examinations ordered, and final diagnosis and destination of the patients. RESULTS: From January 2010 to July 2012, 320 patients underwent bariatric surgery at our Institution. Fifty three patients (16.6 %) were admitted to the ED at leas t once. We found 58 admissions (1.1 admissions by patient). Patients who had duodenal switch and Roux-en-Y gastric bypass were the most representative (74 %). The main indications for admission were abdominal pain (50 %), and problems related to the surgical wounds (22.4 %). Blood test was the most performed examination (75.9 %). The most frequent final diagnosis was unspecific abdominal pain in 27 cases (46.6 %), and complications of the surgical wound in 10 patients (17.2 %). Nineteen patients (35.84 %) were admitted to the surgical ward from the ED, and 5 of them required surgical revision (9.4 %). Multivariate analyses showed that the type of surgery was the only predictor variable for the ED admission. CONCLUSIONS: Attending ED after bariatric surgery is not common, and less than a third of the patients required hospital admission. Just a small percentage of the examinations showed any pathological value. Readmission rate is very low. Surgical procedure is the only predictor for ED admission

Anemia, hierro, transfusión y alternativas terapéuticas. Revisión desde una perspectiva quirúrgica / Anaemia, iron, transfusion and therapeutic alternatives. A review from a surgical perspective

La anemia representa una entidad o comorbilidad extremadamente frecuente dentro de la población de pacientes quirúrgicos. Su manejo implica un abordaje multidisciplinar con el fin de optimizar los recursos terapéuticos disponibles de forma individualizada en cada situación clínica. El uso racional por parte del clínico de transfusiones sanguíneas, ferroterapia (oral y endovenosa), agentes estimuladores de la eritropoyesis y otras alternativas terapéuticas ha de proporcionar el máximo beneficio a nuestros pacientes con las mínimas complicaciones posibles. El presente artículo de revisión resume las principales características de la anemia, metabolismo férrico, eritropoyesis y alternativas terapéuticas desde una perspectiva quirúrgica, a la luz de los conocimientos actuales (AU)

Anemia is very common entity or comorbidity in surgical patients. Its management involves a multidisciplinary approach with the aim of optimizing the available therapeutic resources with individualized care for each clinical situation. Rational use of blood transfusions, iron therapy (oral and intravenous), erythropoiesis stimulating agents and other therapeutic alternatives by physicians must achieve maximal benefit with minimal complications for our patients. This review article summarizes the main characteristics of anemia, iron metabolism, erythropoiesis and therapeutic alternatives from a surgical perspective in the light of present knowledge (AU)

Tratamiento preoperatorio de las alteraciones de la coagulación en urgencias quirúrgicas / Preoperative treatment of coagulation disorders in emergency surgery

No disponible

No disponible

Transporte intraabdominal y endovaginal de paquetes de droga (body packer y body pusher) / Intra-abdominal and endovaginal transport of drug packets (body packer and body pusher)

El transporte endovaginal de paquetes de droga (body pusher) es una variedad poco frecuente de tráfico intracorporal de sustancias ilegales (body packer). Presentamos 2 casos de transporte simultáneo intraabdominal (body packer) y endovaginal (body pusher) de envoltorios de droga. El manejo conservador, basado en la administración de medicación laxante, extracción cuidadosa de los paquetes intravaginales y observación clínica estrecha -junto a pruebas radiológicas de confirmación- representa una aproximación terapéutica segura y eficaz para este tipo de pacientes. La sospecha y tratamiento tempranos de los body pusher, con importantes complicaciones potenciales -principalmente, intoxicación grave por cocaína-resultan esenciales(AU)

Vaginal smuggling of drug containers (body pusher) is a relatively uncommon subtype of intraabdominal trafficking of illicit substances (body packer). We report two cases of drug smuggling by simultaneous internal (body packer) and vaginal (body pusher) concealment of drug packages. Conservative management, based on laxative treatment, careful extraction of endovaginal packets and close clinical observation -with radiological tests for confirmation- is a safe and useful therapeutic approach for these patients. Early suspicion and treatment of body pusher, with severe potential complications -mainly, acute cocaine intoxication-, remains essential(AU)

Hierro intravenoso / Intravenous iron

El hierro intravenoso representa una medida terapéutica eficaz y segura para corregir la anemia, y constituye una alternativa respecto a la transfusión sanguínea clínicamente demostrada. El presente artículo de revisión resume las principales características de los distintos preparados de hierro parenteral, sus ventajas, indicaciones, dosificación y efectos adversos. Asimismo, se analizan algunos de los principales estudios publicados sobre ferroterapia parenteral en Cirugía General y especialidades quirúrgicas afines, y se avanzan algunos datos sobre las nuevas formulaciones próximamente disponibles (AU)

Parenteral iron is a useful and safe therapeutic measure to treat anaemia, and is a proven clinical alternative to blood transfusion. This review article summarises the main characteristics of the different formulations of parenteral iron, their advantages, indications, dosages and adverse effects. Moreover, we analyse some of the most important published articles on parenteral iron therapy in General Surgery and other surgical specialties, as well as providing information about new formulations that will soon be available (AU)

[Intravenous iron]. / Hierro intravenoso.

Parenteral iron is a useful and safe therapeutic measure to treat anaemia, and is a proven clinical alternative to blood transfusion. This review article summarises the main characteristics of the different formulations of parenteral iron, their advantages, indications, dosages and adverse effects. Moreover, we analyse some of the most important published articles on parenteral iron therapy in General Surgery and other surgical specialties, as well as providing information about new formulations that will soon be available.