Impact of the laparoscopic approach, early closure and preoperative stimulation on outcomes of ileostomy closure after rectal resection.

AIM: To evaluate the clinical outcome of early closure of a protective ileostomy and preoperative stimulation of the efferent limb in a cohort of patients with rectal cancer treated surgically, primarily using the laparoscopic approach. METHODS: We performed an observational retrospective cohort study in a prospectively recorded series of patients with rectal cancer who underwent laparoscopic surgery with a protective loop ileostomy between 2017 and 2022. Ileostomy closure was programmed for within 3 months after surgery. All patients underwent stimulation of the efferent limb. Primary outcomes were morbidity and mortality, length of stay (LOS), and re-admission. RESULTS: Between 2017 and 2022, 108 patients underwent resection for rectal cancer and protective ileostomy. The laparoscopic approach was performed in 84.3% of patients (n = 91). Permanent ileostomy was performed in 5 patients (4.6%). Ileostomy closure was thus performed in 95.4% of patients (n = 103). Median time to closure was 74.5 days (range 57-113). In 63.1% (n = 65) of patients, reconstructive surgery was performed within 90 days. Prior to closure, efferent limb stimulation was performed in 77.8% (n = 84) of patients. Global morbidity was 26.2% (n = 27) (85.19%, n = 23 Clavien-Dindo I and 7.41%, n = 2 Clavien-Dindo II). The main causes of morbidity were postoperative ileus (10.7%, n = 11) and rectal bleeding (8.7%, n = 9). Anastomosis leakage occurred in 2 patients. Median hospital stay was 6 days (5-7). Readmission was needed in 6.8% (n = 7) of patients. CONCLUSION: A previous laparoscopic approach, early closure and stimulation of the efferent limb could be a useful strategy to reduce the morbidity and mortality of temporary ileostomy closure.

Reacreditación o recertificación de los cirujanos generales en España: esa es la cuestión. Resultados de una encuesta nacional / Reaccreditation or recertification of general surgeons in Spain: That's the question. Results of a national survey

Introducción: La Ley de Ordenación de las Profesiones Sanitarias (LOPS) indica que los profesionales sanitarios realizarán a lo largo de su vida profesional una formación continuada y acreditarán regularmente su competencia profesional. El objetivo del estudio ha sido realizar una encuesta nacional para conocer la opinión de los cirujanos españoles y así poder preparar un proyecto de recertificación por la Asociación Española de Cirujanos (AEC).Métodos: Estudio observacional transversal efectuado en junio-julio de 2020 mediante una encuesta remitida a los miembros de la AEC. Resultados: La encuesta tuvo un total de 1.230 visitas y una tasa global de finalización de 784 respuestas (67,3%). El 69,6% desconocían las previsiones de la LOPS, el 83,4% no conocían iniciativas similares en otras especialidades y el 95,5% coincidían en demandar una información adecuada. El 71,4% la creían necesaria, pero solo el 57% opinaban que debería ser obligatoria. El 82,9% estarían de acuerdo que debería ser regulada mediante un procedimiento oficial objetivo y previsible. Conclusiones: El concepto de reacreditación no es bien conocido en nuestra especialidad, y en vista de los resultados obtenidos parece necesaria una información adecuada y fiable. Por ello sería pertinente proponer por la AEC un proyecto específico de evaluación de actividades y competencias(AU)

Introduction: The Law for the Regulation of Health Professions (LOPS) indicates that health professionals will carry out continuous training throughout their professional life, and will regularly prove their professional competence. The objective of the study was to carry out a national survey to find out the opinion of Spanish surgeons and thus be able to prepare a recertification project by the Spanish Association of Surgeons (AEC). Methods: Cross-sectional observational study carried out in June-July 2020, through a survey sent to the members of the AEC. Results: The survey had a total of 1230 visits and an overall completion rate of 784 responses (67.3%). 69.6% were unaware of the LOPS forecasts and 83.4% were unaware of similar initiatives in other specialties and 95.5% agreed to demand adequate information. 71.4% believed it necessary but only 57% believed that it should be mandatory. 82.9% would agree that it should be regulated through an objective and predictable official procedure. Conclusions: he concept of re-accreditation is not well known in our specialty and in view of the results obtained, adequate and reliable information seems necessary. Therefore, it would be pertinent to propose by the AEC a specific project to assess activities and skills(AU)

Reaccreditation or recertification of general surgeons in Spain: That's the question. Results of a national survey.

INTRODUCTION: The Law for the Regulation of Health Professions (LOPS) indicates that health professionals will carry out continuous training throughout their professional life, and will regularly prove their professional competence. The objective of the study was to carry out a national survey to find out the opinion of Spanish surgeons and thus be able to prepare a recertification project by the Spanish Association of Surgeons. METHODS: Cross-sectional observational study carried out in June-July 2020, through a survey sent to the members of the Spanish Association of Surgeons. RESULTS: The survey had a total of 1230 visits and an overall completion rate of 784 responses (67.3%). 69.6% were unaware of the LOPS forecasts and 83.4% were unaware of similar initiatives in other specialties and 95.5% agreed to demand adequate information. 71.4% believed it necessary but only 57% believed that it should be mandatory. 82.9% would agree that it should be regulated through an objective and predictable official procedure. CONCLUSIONS: The concept of re-accreditation is not well known in our specialty and in view of the results obtained, adequate and reliable information seems necessary. Therefore, it would be pertinent to propose by the A.E.C. a specific project to assess activities and skills.

Reaccreditation or recertification of general surgeons in Spain: That's the question. Results of a national survey. / Reacreditación o recertificación de los cirujanos generales en España: esa es la cuestión. Resultados de una encuesta nacional.

INTRODUCTION: The Law for the Regulation of Health Professions (LOPS) indicates that health professionals will carry out continuous training throughout their professional life, and will regularly prove their professional competence. The objective of the study was to carry out a national survey to find out the opinion of Spanish surgeons and thus be able to prepare a recertification project by the Spanish Association of Surgeons (AEC). METHODS: Cross-sectional observational study carried out in June-July 2020, through a survey sent to the members of the AEC. RESULTS: The survey had a total of 1230 visits and an overall completion rate of 784 responses (67.3%). 69.6% were unaware of the LOPS forecasts and 83.4% were unaware of similar initiatives in other specialties and 95.5% agreed to demand adequate information. 71.4% believed it necessary but only 57% believed that it should be mandatory. 82.9% would agree that it should be regulated through an objective and predictable official procedure. CONCLUSIONS: The concept of re-accreditation is not well known in our specialty and in view of the results obtained, adequate and reliable information seems necessary. Therefore, it would be pertinent to propose by the AEC a specific project to assess activities and skills.

Hernia diafragmática postraumática / Post-traumatic diaphragmatic hernia

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Fístula colovesical: aplicabilidad del abordaje laparoscópico y resultados según su etiología / Colovesical Fistula: Applicability of the Laparoscopic Approach and Results According to Etiology

INTRODUCCIÓN: Las fístulas colovesicales son una entidad poco frecuente y con una incidencia precisa desconocida. El objetivo de este estudio es describir una serie de casos de pacientes intervenidos por fístula colovesical de origen benigno y maligno y valorar la aplicabilidad del abordaje laparoscópico en ambos grupos. MÉTODOS: Realizamos un estudio descriptivo de 34 pacientes intervenidos en nuestro centro entre enero de 2001 y marzo de 2018 con el diagnóstico de fístula colovesical. Se incluyen pacientes intervenidos de manera electiva (28) y de urgencia (6). Se categorizaron según el diagnóstico mediante pruebas complementarias por TC abdominal, colonoscopia y cistoscopia, y se realizó un abordaje laparoscópico en los pacientes sin infiltración del trígono vesical y plano retroperitoneal y con situación clínica favorable. RESULTADOS: En los casos con patología benigna (13) se realizaron 4 intervenciones vía laparotómica y 9 vía laparoscópica, con 3 conversiones. En todos los casos se realizó sigmoidectomía. En 11 pacientes se realizó cistectomía parcial y en 2 casos el manejo fue conservador con sonda vesical. En los 21 pacientes con patología maligna se realizaron 5 abordajes laparoscópicos y se convirtieron 3, con 16 casos abordados vía laparotómica. Se realizaron sigmoidectomía, hemicolectomía izquierda, resección anterior y exenteración pélvica, y abordaje urológico en todos los casos. Dieciséis pacientes (76%) tuvieron complicaciones, la mayoría menores (I-II según la clasificación de Clavien-Dindo) e intervenidos por abordaje laparotómico. CONCLUSIONES: El tratamiento de elección en las fístulas colovesicales es la cirugía con resección colónica y abordaje urológico según el caso y el diagnóstico etiológico. El abordaje laparoscópico puede ser factible en casos muy bien seleccionados y con una situación clínica favorable, teniendo en cuenta que el umbral de conversión debe ser bajo y la intervención ha de ser llevada a cabo por un equipo con experiencia

INTRODUCTION: Colovesical fistulae have significant morbidity. The aim of our study was to describe a case series of benign and malignant colovesical fistulae, focusing on the viability of the laparoscopic approach. METHODS: We reviewed the characteristics of 34 patients with diverticular and colon adenocarcinoma-related colovesical fistulae treated surgically from January 2001 to March 2018, 28 with elective surgery and 6 by urgent surgery. The diagnosis was established by abdominal CT scan, colonoscopy and cystoscopy. Clinically stable patients, with no retroperitoneal or bladder trigone invasion, were approached laparoscopically. RESULTS: There were 13 benign cases (all of them approached by sigmoidectomy), 9 performed by laparoscopy with 3 conversions. Partial cystectomy was done in 11 cases, and in two cases conservative management with urinary catheter. Five laparoscopic approaches were performed in 21 patients diagnosed with malignant colovesical fistula, with 3 conversions and 16 laparotomies. The procedures were sigmoidectomy, left colectomy, anterior resection and pelvic exenteration. All of them required partial or total cystectomy. Sixteen patients had complications, most of which were minor (Clavien-Dindo classificationI-II) and with laparotomy approach. CONCLUSIONS: The laparoscopic approach can be feasible in well-selected and stable patients, but we have to take into consideration that the conversion rate can be high and this surgery should be performed by experienced surgeons

Colovesical Fistula: Applicability of the Laparoscopic Approach and Results According to Etiology. / Fístula colovesical: aplicabilidad del abordaje laparoscópico y resultados según su etiología.

INTRODUCTION: Colovesical fistulae have significant morbidity. The aim of our study was to describe a case series of benign and malignant colovesical fistulae, focusing on the viability of the laparoscopic approach. METHODS: We reviewed the characteristics of 34 patients with diverticular and colon adenocarcinoma-related colovesical fistulae treated surgically from January 2001 to March 2018, 28 with elective surgery and 6 by urgent surgery. The diagnosis was established by abdominal CT scan, colonoscopy and cystoscopy. Clinically stable patients, with no retroperitoneal or bladder trigone invasion, were approached laparoscopically. RESULTS: There were 13 benign cases (all of them approached by sigmoidectomy), 9 performed by laparoscopy with 3 conversions. Partial cystectomy was done in 11 cases, and in two cases conservative management with urinary catheter. Five laparoscopic approaches were performed in 21 patients diagnosed with malignant colovesical fistula, with 3 conversions and 16 laparotomies. The procedures were sigmoidectomy, left colectomy, anterior resection and pelvic exenteration. All of them required partial or total cystectomy. Sixteen patients had complications, most of which were minor (Clavien-Dindo classificationI-II) and with laparotomy approach. CONCLUSIONS: The laparoscopic approach can be feasible in well-selected and stable patients, but we have to take into consideration that the conversion rate can be high and this surgery should be performed by experienced surgeons.

Periodontal and dental conditions of a school population in a volcanic region of Tanzania with highly fluoridated community drinking water.

INTRODUCTION: Dental fluorosis is endemic in the Rift Valley in Africa, especially around volcanic areas, due to the high fluoride content in daily drinking water. OBJECTIVE: This study evaluates the oral health status and types of occlusion in a school population, and to assess the possible association between dental fluorosis and other pathologies such as decay, gingivitis and periodontitis. MATERIAL AND METHODS: An observational study of 581 individuals recruited from a public secondary school in Arusha, Northern Tanzania was undertaken. The indices used were: the Silness & Löe Plaque Index, the Community Periodontal Index and the Decayed/Missing/Filled index. Descriptive statistical analyses were performed and a chi-square test was used to assess the associations between independent variables. RESULTS: Almost all the school children evaluated (96.73%) presented Angle class I dental occlusion, and 75.22% presented some degree of dental fluorosis. Most of the population (511, 87.95%) showed bleeding on probing. A moderate/high degree of some dental pathology (DMF score) was recorded in 14.46%. The association between dental fluorosis, gingival bleeding and tooth decay indicated a higher concentration of pathology in groups with more severe fluorosis (p<0.05). CONCLUSION: In this large population sample, both tooth decay and gingivitis were significantly associated with moderate or severe dental fluorosis.

Continuous Surgical Decompression for Solitary Bone Cyst of the Jaw in a Teenage Patient.

BACKGROUND: A solitary bone cyst or simple bone cyst is a nonneoplastic osseous lesion, with no epithelial lining, also considered as a pseudocyst. These lesions, with an intact bony wall and fluid-filled, are frequently discovered by chance in radiological studies. The etiopathogenesis has not been studied in depth, and the management remains controversial. CASE PRESENTATION: We present a clinical case of a 15-year-old boy who underwent an orthopantomography to assess the development and position of the third molars during a routine postorthodontic check-up. By chance, the X-ray identified an asymptomatic radiolucent image in the left jaw, measuring 12.0 mm × 17.8 mm and compatible with a solitary bone cyst involving teeth 35 and 36. We describe our technique for performing minimally invasive decompression of the lesion using a microperforated catheter. We describe the entire course of the follow-up, both clinical and radiological, until complete cure. CONCLUSIONS: This straightforward continuous decompression technique poses no problems for the patient, has a low risk of sequelae, and is clearly cost-effective. In view of the highly satisfactory evolution, whenever possible, we favor this minimally invasive technique for the treatment of solitary bone cysts in the jaw.

Uso de las redes sociales por parte de los cirujanos generales. Resultados de la encuesta nacional de la Asociación Española de Cirujanos / Use of social networks by general surgeons. Results of the national survey of the Spanish Association of Surgeons

Introducción: Se desconoce el uso y utilidad de las redes sociales (RR.SS.) entre los cirujanos generales españoles. Métodos: Entre octubre y diciembre de 2017 se realizó una encuesta online a los socios de la Asociación Española de Cirujanos, en la que se recogieron datos de perfil de uso y de opinión sobre RR. SS. Resultados: Se obtuvo respuesta de 360 cirujanos, de los cuales 310 tenían presencia en RR.SS. Las redes más populares fueron: Facebook (86%), LinkedIn (61.6%), YouTube (60,6%) y Twitter (54,2%). LinkedIn y Twitter destacaron como las RR.SS. más empleadas con fines profesionales. Los cirujanos con presencia en RR.SS. eran más jóvenes (42,4 ± 11 años frente a 51,6 ± 8 años; p < 0,001), existiendo a menor edad mayor frecuencia de acceso a las mismas. El género no mostró influencia sobre la presencia en RR.SS. La mayoría de los encuestados tiene perfil en más de una red (3,6 ± 1 cuentas) y el 73,5% comunicó acceder a ellas diariamente. El 19,7% de los servicios de cirugía al que pertenecen los encuestados tiene perfil en RR. SS. Entre las utilidades profesionales destacan las actividades formativas (87%) y el contacto con otros profesionales (84%). El 14,1% de los encuestados utilizan RR. SS. para relacionarse con los pacientes. Conclusiones: Las RR.SS. son útiles para la divulgación de información sobre eventos científicos y actividades formativas, la actualización y adquisición de conocimientos y la comunicación entre profesionales. Aspectos como la privacidad o la relación con los pacientes representan una barrera en el uso de RR. SS

Introduction: The use and utility of social media (SM) among Spanish general surgeons is unknown. Methods: Between October and December 2017 an online survey was carried out to the members of the Spanish Association of Surgeons, in which data on the profile of use and opinion on the usefulness of SM were collected. Results: 360 valid responses were obtained, 310 from surgeons who had an active SM profile. The most popular networks were: Facebook (86%), LinkedIn (61,6%), YouTube (60,6%) and Twitter (54,2%). LinkedIn and Twitter stood out as the most used SM for professional purposes. Surgeons with a SM profile were younger (42.4 ± 11 years versus 51.6 ± 8 years; P < .001). Gender did not show influence on presence in SM. The majority of respondents have profiles in more than one network (3.6 ± 1 accounts) and 73.5% reported daily access to them; 19.7% of the surgery departments to which the respondents belong have a SM account. Among SM utilities in the professional field, training activities (87%) and connectivity among professionals (84%) were the most outstanding; 14.1% of respondents use SM to interact with patients. Conclusions: SM is useful as a tool for the acquisition, updating and dissemination of scientific knowledge, also proving valuable as a new form of interaction among surgeons. Other issues such as privacy or surgeon-patient relationship represent a barrier to its use

Use of social networks by general surgeons. Results of the national survey of the Spanish Association of Surgeons. / Uso de las redes sociales por parte de los cirujanos generales. Resultados de la encuesta nacional de la Asociación Española de Cirujanos.

INTRODUCTION: The use and utility of social media (SM) among Spanish general surgeons is unknown. METHODS: Between October and December 2017 an online survey was carried out to the members of the Spanish Association of Surgeons, in which data on the profile of use and opinion on the usefulness of SM were collected. RESULTS: 360 valid responses were obtained, 310 from surgeons who had an active SM profile. The most popular networks were: Facebook (86%), LinkedIn (61,6%), YouTube (60,6%) and Twitter (54,2%). LinkedIn and Twitter stood out as the most used SM for professional purposes. Surgeons with a SM profile were younger (42.4±11 years versus 51.6±8 years; P<.001). Gender did not show influence on presence in SM. The majority of respondents have profiles in more than one network (3.6±1 accounts) and 73.5% reported daily access to them; 19.7% of the surgery departments to which the respondents belong have a SM account. Among SM utilities in the professional field, training activities (87%) and connectivity among professionals (84%) were the most outstanding; 14.1% of respondents use SM to interact with patients. CONCLUSIONS: SM is useful as a tool for the acquisition, updating and dissemination of scientific knowledge, also proving valuable as a new form of interaction among surgeons. Other issues such as privacy or surgeon-patient relationship represent a barrier to its use.

The Periodontium as a Potential Cause of Orofacial Pain: A Comprehensive Review.

INTRODUCTION: Orofacial pain of periodontal origin has a wide range of causes, and its high prevalence and negative effect on patients' quality of life make intervention mandatory. This review provides a periodontological overview of the field of orofacial pain, focusing on the entities which involve the periodontal tissues and may be the cause of this pain or discomfort. METHODS: The study comprised a literature search of these pathologies conducted in the MEDLINE/PubMed Database. Acute infectious entities such as gingival and periodontal abscesses are emergencies that require a rapid response. Periodontitis associated with endodontic processes, necrotizing periodontal disorders, desquamative gingivitis, gingival recession, and mucogingival herpetic lesions, cause mild to severe pain due to tissue destruction and loss. Other lesions that lead to periodontal discomfort include gingival enlargement and periodontal ligament strains associated with occlusal trauma, parafunctional habit and the impaction of food or foreign bodies. CONCLUSION: A range of therapeutic, pharmacological and surgical alternatives are available for the management of these injuries. However, the wide variety of causes of orofacial pain or periodontal discomfort may confuse the clinician during diagnosis and may lead to the wrong choice of treatment.

Tratamiento mediante microcirugía endoscópica transanal de un hamartoma quístico retrorrectal birrecidivado / Transanal endoscopic microsurgery treatment of twice recurred tail-gut

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In-vivo compatibility between pacemakers and dental equipment.

In-vitro studies suggest that electromagnetic interference can occur under specific conditions involving proximity between electronic dental equipment and pacemakers. At present, in-vivo investigations to verify the effect of using electronic dental equipment in clinical conditions on patients with pacemakers are scarce. This study aimed to evaluate, in vivo, the effect of three commonly used electronic dental instruments - ultrasonic dental scaler, electric pulp tester, and electronic apex locator - on patients with different pacemaker brands and configurations. Sixty-six consecutive non-pacemaker-dependent patients were enrolled during regular electrophysiology follow-up visits. Electronic dental tools were operated while the pacemaker was interrogated, and the intracardiac electrogram and electrocardiogram were recorded. No interferences were detected in the intracardiac electrogram of any patient during the tests with dental equipment. No abnormalities in pacemaker pacing and sensing function were observed, and no differences were found with respect to the variables, pacemaker brands, pacemaker configuration, or mode of application of the dental equipment. Electromagnetic interferences affecting the surface electrocardiogram, but not the intracardiac electrogram, were found in 25 (37.9%) patients, especially while using the ultrasonic dental scaler; the intrinsic function of the pacemakers was not affected. Under real clinical conditions, none of the electronic dental instruments tested interfered with pacemaker function.

Reparación laparoscópica de una hernia de Morgagni y hemicolectomía derecha ampliada por neoplasia de colon / Laparoscopic assisted repair of Morgagni hernia and extended right colectomy for colon cancer

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