Mirizzi syndrome: a new insight provided by a novel classification.

BACKGROUNDS/AIMS: Mirizzi syndrome (MS) is an uncommon complication of cholelithiasis. The aim of this study is to evaluate our 15-year experience in this challenging entity and to propose a new classification for this disease. METHODS: A retrospective study including patients diagnosed with Mirizzi syndrome and undergoing surgical procedures for Mirizzi syndrome between January 2000 and October 2015 was conducted. Data collected included clinical, surgical procedure, postoperative morbidity. Patients were evaluated according to the Csendes classification and the proposed system, in which patients were divided into three types and three subtypes. RESULTS: 28 patients were included for analysis. They accounted as the 0.5% of a total of 4853 cholecystectomies performed in the study period. There were 21 women and 7 men. Initial laparotomic approach was performed in 12 patients and in 16 patients laparoscopic procedures were attempted. The procedure was completed in only 6 patients, 5 presenting type I and 1 type II Mirizzi syndrome. Mean postoperative stay was 15±9 days. Postoperative morbidity rate was 28%. Postoperative mortality was none. CONCLUSIONS: Laparoscopic surgery for Mirizzi syndrome has been shown succesful only in early stages. A novel classification is proposed, based on the types of common bile duct injuries and in the presence cholecystoenteric fistula.

One-year follow-up of clinical, metabolic and oxidative stress profile of morbid obese patients after laparoscopic sleeve gastrectomy. 8-oxo-dG as a clinical marker.

Obesity has grown worldwide over the last few decades. In its different degrees, obesity is accompanied by many clinical and biochemical alterations reflecting the pathological condition of various body tissues. Among the mechanisms underlying the pathogenesis of obesity and associated complications, oxidative stress (OS) may be playing an important role. In the present study, we have characterized at systemic level the degree of OS status in a group of morbid obese patients (BMI>40kg/m2) at basal sate and its modulation during one year after bariatric surgery using the laparoscopic sleeve gastrectomy (LSG) technique. As compared with normal weight subjects matched in age, peripheral blood mononuclear cells (PBMc) of obese patients present a significant reduction of the antioxidant enzyme activities superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) as well as a significant increase of the oxidized/reduced glutathione ratio (GSSG/GSH) in these cells. Lipid peroxidation is significantly increased in the patient group as shown by the increased levels of malondialdehyde (MDA) in PBMc and the amount of F2-Isoprostanes (F2-IsoPs) released in urine. In addition, the DNA damage product 8-oxo-7,8-2'-deoxyguanosine (8-oxo-dG) was also observed to be increased in serum and urine of morbid obese patients as compared with the control group. After LSG, an improvement of their ponderal and metabolic profile was accompanied by a progressive recovery of antioxidant enzyme activities and the decline of oxidative byproducts both in PBMc and biological fluids. The observed changes of urinary 8-oxo-dG levels correlate positively with its serum concentration, the lipid peroxidation products MDA and F2-IsoPs, triglycerides, glucose, insulin, HOMA index and body weight and negatively with the percentage of weight and BMI loss and antioxidant activities. We conclude that the analysis of urinary 8-oxo-dG could be validated as a useful marker for the monitoring of ponderal and metabolic status of morbid obese patients.

Laparoscopic surgery and polycystic liver disease: Clinicopathological features and new trends in management.

BACKGROUND: Polycystic liver disease (PLD) has a low frequency overall in the worldwide population. As the patient's symptoms are produced by the expansion of hepatic volume, the different therapeutic alternatives are focused on reducing it. Surgery is still considered the most effective treatment for symptomatic PLD. The aim of this study was to evaluate the long-term outcomes of laparoscopic surgery for PLD. MATERIALS AND METHODS: This study included 14 patients who were diagnosed with symptomatic PLD and underwent surgery by a laparoscopic approach between 2004 and 2012. It involved collecting data on the characteristics of those patients and their liver disease, surgical procedures, intra- and postoperative complications, and the long-term follow-up. RESULTS: Twelve laparoscopic multiple-cyst fenestrations and two segmentary liver resections associated with remaining-cyst fenestration were performed. One procedure required conversion to laparotomy and the other was complicated by anhepatic severe bleeding. The rest of the procedures were uneventful. One patient developed persistent self-limited ascites in the immediate postoperative period. Symptoms disappeared after surgical intervention in all patients. During a median follow-up of 62 months (range 14-113 months), there were two clinical recurrences and one asymptomatic radiological recurrence. One patient required further surgery. CONCLUSION: Laparoscopic cystic fenestration and laparoscopic liver resection are safe and long-term, effective procedures for the treatment of symptomatic PLD. Severity and morphological characteristics of the hepatic disease will determine the surgical indication and the optimal approach for each patient.

Eleven years of primary closure of common bile duct after choledochotomy for choledocholithiasis.

BACKGROUND: The choice of surgical technique to extract stones from the common bile duct (CBD) depends on local experience, anatomical characteristics and also on the size, location and number of stones. Most authors consider choledochotomy an alternative to failed transcystic exploration, although some use it exclusively. Although the CBD is traditionally closed with T-tube drainage after choledochotomy, its use is associated with 11.3-27.5 % morbidity. This study examined the efficacy of laparoscopic CBD exploration (LCBDE) with primary closure for the treatment of CBD stones using intraoperative cholangiography (IOC). METHODS: Retrospective study of 160 patients who underwent LCBDE with primary closure after choledochotomy between January 2001 and December 2012. RESULTS: The diagnosis of choledocholithiasis was definitively made in all cases by IOC. The overall complication rate was 15 % and the biliary complication rate was 7.5 %. Bile leakage was reported in 11 patients (6.8 %). In over half the cases (63.6 %), no further action was required and the leak closed spontaneously. Six patients were reoperated (3.75 %), two for bile peritonitis and four for haemoperitoneum. The success rate for stone clearance was 96.2 %. The mortality rate and CBD stricture rate were 0 %. CONCLUSION: Primary closure after choledochotomy to clear stones from the CBD is a safe technique that confers excellent results and allows one-stage treatment.

Linfoma MALT de vesícula biliar / MALT lymphoma of the gallbladder

No disponible

Relación del estrés oxidativo y la pérdida de peso obtenida en pacientes obesos mórbidos mediante cirugía bariátrica con la técnica del cruce duodenal / Relationship of oxidative stress and weight loss achieved in morbid obese patients by means of bariatric surgery using the duodenal switch technique

Introducción: El estrés oxidativo, presente de forma evidente en los obesos mórbidos, es un indicador del estado inflamatorio crónico que representa la obesidad y posible nexo de unión con sus comorbilidades, algunas de las cuales son un importante factor de riesgo para el desarrollo de enfermedades cardiovasculares, por lo que la atenuación de su intensidad se ha convertido en un objetivo terapéutico. Material y método: Hemos intervenido de forma consecutiva, mediante la técnica quirúrgica del cruce duodenal, a 28 pacientes afectos de obesidad mórbida, realizando un estudio del estrés oxidativo presente en ellos mediante la determinación de productos de oxidación molecular y de antioxidantes, en el preoperatorio y a lo largo de un año tras la cirugía. Se ha controlado la evolución ponderal y la evolución de las comorbilidades presentes. Resultados: Los pacientes de la serie presentaron una media de edad de 43 ± 1 años y un IMC medio de 50,3. El 82% presentó comorbilidad asociada. Tras la cirugía todos los pacientes perdieron peso de forma progresiva a lo largo del periodo estudiado, con mejoría paralela de las comorbilidades y disminución progresiva de los valores del EO y mejoría de los sistemas antioxidantes, siendo los valores de EO al finalizar el estudio similares a los de la población normal. Conclusión: La pérdida de peso obtenida consigue una mejora de las comorbilidades y de los valores de estrés oxidativo de modo que al final del estudio los resultados obtenidos son similares a los de la población normal (AU)

INTRODUCTION: Oxidative stress (OS), which is overtly present in morbid obesity, is an indicator of a chronic inflammatory state associated to obesity and possibly related with the associated comorbidities, some of which represent an important risk factor for the occurrence of cardiovascular diseases, so that decreasing its intensity has become a treatment priority. MATERIALS AND METHODS: he have consecutively performed the duodenal crossing surgical technique in 28 patients suffering from morbidobesity, assessing the level of oxidative stress by the determination of the products of molecular oxidation and antioxidants before the surgery and throughout one year after the surgery. Weight evolution and the progression of the comorbidities already present were assessed. RESULTS: the mean age of the patients in this series was 43 ± 1 years and the mean BMI 50.3. 82% had associated comorbidities. After the surgery, all the patients progressively lost weight throughout the study period, with a parallel improvement of the comorbidities and a progressive decrease in OS values and improvement of the antioxidant systems, the OS values being similar to those of a normal population at the end of the study. CONCLUSION: The weight loss achieved allows improving the comorbidities and the oxidative stress values so that at the end of the study the results obtained are similar to those of a normal population (AU)

[Oxidative stress; a comparative study between normal and morbid obesity group population]. / Estrés oxidativo; estudio comparativo entre un grupo de población normal y un grupo de población obesa mórbida.

OBJECTIVE: To determine the level of oxidative stress in morbid obese patients by comparing their results to those of a normal population. MATERIAL AND METHODS: We have studied the metabolites most representative of OS, both in the blood (MDA, 8-oxo-dG, GSSG and the ratio GSSG/GSH) and in the urine (8-oxo-dG), as well as the GSH antioxidant. A descriptive analysis of the sample was performed. The Kolmogorv-Smirnov test was used to assess whether the distribution of the different metabolites was normal. In the case of normal distribution, the Student's t test was used to compare the means, the Mann-Whitney U test was used for non-parametric data, with a significance level of p < 0.05 for hypothesis contrast. RESULTS: There were 28 patients in each group, without statistically significant differences regarding age and gender. The group of patients with morbid obesity presented an average BMI of 50.1 ± 4 and 23.9 ± 6 in the group with normal weight. 67.8% of the patients with morbid obesity had other comorbidities. There were no associated pathologies in the control group. All the values for the different OS metabolites were higher in the group of patients with morbid obesity than in the control group, whereas the activity of the antioxidant systems (GSH) was lower in the group with morbid obesity. CONCLUSION: The figures of OS metabolites obtained in the group of patients with morbid obesity confirm the presence of OS in obesity at a pathological level given the differences obtained in the group of normal population.

Objetivo: Determinar el grado de Estrés Oxidativo en pacientes obesos mórbidos comparando los resultados con los de una población normal. Material y método: Hemos estudiado los metabolitos más representativos del EO, tanto en sangre (MDA, 8-oxo-dG, GSSG y la relación GSSG/GSH) como en orina (8-oxo-dG), así como el antioxidante GSH. Realizamos un análisis descriptivo de la muestra. Se realizó la prueba de Kolmogorv-Smirnov para evaluar si la distribución de los distintos metabolitos seguía un modelo de normalidad. En los casos de distribución normal, se empleó la T de Student para comparar medias, utilizando la U de Mann-Whitney para los datos no paramétricos, utilizando en los contrastes de hipótesis el nivel de significación p < 0,05. Resultados: Los pacientes fueron 28 en cada grupo, sin diferencias estadísticamente significativas en cuanto a edad y sexo. El grupo de pacientes con obesidad mórbida presentó un IMC medio de 50,1 ± 4 y de 23,9 ± 6 el grupo normopeso. Un 67,8% de los pacientes obesos mórbidos presentaron comorbilidades. No había patología asociada en el grupo control. Todos los valores de los distintos metabolitos de EO fueron más elevados en el grupo de obesos mórbidos que en el grupo control mientras que la actividad de los sistemas antioxidantes (GSH) fue menor en el grupo de obesos mórbidos. Conclusión: Los valores de los metabolitos de EO obtenidos en el grupo de obesos mórbidos confirma la presencia de EO en la obesidad, de un modo que se puede considerar patológico dadas las diferencias obtenidas en el grupo de población normal.

[Relationship of oxidative stress and weight loss achieved in morbid obese patients by means of bariatric surgery using the duodenal switch technique]. / Relación del estrés oxidativo y la pérdida de peso obtenida en pacientes obesos mórbidos mediante cirugía bariátrica con la técnica del cruce duodenal.

INTRODUCTION: Oxidative stress (OS), which is overtly present in morbid obesity, is an indicator of a chronic inflammatory state associated to obesity and possibly related with the associated comorbidities, some of which represent an important risk factor for the occurrence of cardiovascular diseases, so that decreasing its intensity has become a treatment priority. MATERIALS AND METHODS: he have consecutively performed the duodenal crossing surgical technique in 28 patients suffering from morbid obesity, assessing the level of oxidative stress by the determination of the products of molecular oxidation and antioxidants before the surgery and throughout one year after the surgery. Weight evolution and the progression of the comorbidities already present were assessed. RESULTS: the mean age of the patients in this series was 43 ± 1 years and the mean BMI 50.3. 82% had associated comorbidities. After the surgery, all the patients progressively lost weight throughout the study period, with a parallel improvement of the comorbidities and a progressive decrease in OS values and improvement of the antioxidant systems, the OS values being similar to those of a normal population at the end of the study. CONCLUSION: The weight loss achieved allows improving the comorbidities and the oxidative stress values so that at the end of the study the results obtained are similar to those of a normal population.

Introducción: El estrés oxidativo, presente de forma evidente en los obesos mórbidos, es un indicador del estado inflamatorio crónico que representa la obesidad y posible nexo de unión con sus comorbilidades, algunas de las cuales son un importante factor de riesgo para el desarrollo de enfermedades cardiovasculares, por lo que la atenuación de su intensidad se ha convertido en un objetivo terapéutico. Material y método: Hemos intervenido de forma consecutiva, mediante la técnica quirúrgica del cruce duodenal, a 28 pacientes afectos de obesidad mórbida, realizando un estudio del estrés oxidativo presente en ellos mediante la determinación de productos de oxidación molecular y de antioxidantes, en el preoperatorio y a lo largo de un año tras la cirugía. Se ha controlado la evolución ponderal y la evolución de las comorbilidades presentes. Resultados: Los pacientes de la serie presentaron una media de edad de 43 ± 1 años y un IMC medio de 50,3. El 82% presentó comorbilidad asociada. Tras la cirugía todos los pacientes perdieron peso de forma progresiva a lo largo del periodo estudiado, con mejoría paralela de las comorbilidades y disminución progresiva de los valores del EO y mejoría de los sistemas antioxidantes, siendo los valores de EO al finalizar el estudio similares a los de la población normal. Conclusión: La pérdida de peso obtenida consigue una mejora de las comorbilidades y de los valores de estrés oxidativo de modo que al final del estudio los resultados obtenidos son similares a los de la población normal. Palabras clave: estrés oxidativo, obesidad, obesidad mórbida, cruce duodenal, pérdida de peso.

Estrés oxidativo; estudio comparativo entre un grupo de población normal y un grupo de población obesa mórbida / Oxidative stress; a comparative study between normal and morbid obesity group population

Objetivo: Determinar el grado de Estrés Oxidativo en pacientes obesos mórbidos comparando los resultados con los de una población normal. Material y método: Hemos estudiado los metabolitos más representativos del EO, tanto en sangre (MDA, 8-oxo-dG, GSSG y la relación GSSG/GSH) como en orina (8-oxo-dG), así como el antioxidante GSH. Realizamos un análisis descriptivo de la muestra. Se realizó la prueba de Kolmogorv-Smirnov para evaluar si la distribución de los distintos metabolitos seguía un modelo de normalidad. En los casos de distribución normal, se empleó la T de Student para comparar medias, utilizando la U de Mann-Whitney para los datos no paramétricos, utilizando en los contrastes de hipótesis el nivel de significación p < 0,05. Resultados: Los pacientes fueron 28 en cada grupo, sin diferencias estadísticamente significativas en cuanto a edad y sexo. El grupo de pacientes con obesidad mórbida presentó un IMC medio de 50,1 ± 4 y de 23,9 ± 6 el grupo normopeso. Un 67,8% de los pacientes obesos mórbidos presentaron comorbilidades. No había patología asociada en el grupo control. Todos los valores de los distintos metabolitos de EO fueron más elevados en el grupo de obesos mórbidos que en el grupo control mientras que la actividad de los sistemas antioxidantes (GSH) fue menor en el grupo de obesos mórbidos. Conclusión: Los valores de los metabolitos de EO obtenidos en el grupo de obesos mórbidos confirma la presencia de EO en la obesidad, de un modo que se puede considerar patológico dadas las diferencias obtenidas en el grupo de población normal (AU)

OBJECTIVE: To determine the level of oxidative stress in morbid obese patients by comparing their results to those of a normal population. MATERIAL AND METHODS: We have studied the metabolites most representative of OS, both in the blood (MDA, 8-oxo-dG, GSSG and the ratio GSSG/GSH) and in the urine (8-oxo-dG), as well as the GSH antioxidant. A descriptive analysis of the sample was performed. The Kolmogorv-Smirnov test was used to assess whether the distribution of the different metabolites was normal. In the case of normal distribution, the Student's t test was used to compare the means, the Mann-Whitney U test was used for non-parametric data, with a significance level of p < 0.05 for hypothesis contrast. RESULTS: There were 28 patients in each group, without statistically significant differences regarding age and gender. The group of patients with morbid obesity presented an average BMI of 50.1 ± 4 and 23.9 ± 6 in the group with normal weight. 67.8% of the patients with morbid obesity had other comorbidities. There were no associated pathologies in the control group. All the values for the different OS metabolites were higher in the group of patients with morbid obesity than in the control group, whereas the activity of the antioxidant systems (GSH) was lower in the group with morbid obesity. CONCLUSION: The figures of OS metabolites obtained in the group of patients with morbid obesity confirm the presence of OS in obesity at a pathological level given the differences obtained in the group of normal population (AU)

Two staged minimally invasive treatment for acute cholecystitis in high risk patients.

BACKGROUND/AIMS: The most optimal treatment for acute cholecystitis in high risk patients and severe acute cholecystitis remains still controversial. We review the outcomes of a two step treatment with percutaneous cholecystostomy and delayed laparoscopic cholecystectomy (DLC). METHODOLOGY: We collected data prospectively from January 2004 to April 2010 from 26 patients that underwent percutaneous transhepatic CT-guided cholecystostomy and DLC. RESULTS: Percutaneous transhepatic CT-guided cholecystostomy was achieved in all cases with no complications. There was just one catheter dislodgement. Most of patients, 92%, improved after drainage. There was one case of mortality. Laparoscopic cholecystectomy was achieved in 88% of patients with no mortality, and a low rate of morbidity (7.6%) and of conversion to open surgery. Pre-operative percutaneous cholangiogram showed additional and useful information in 55.5% of patients. CONCLUSIONS: Two-step minimally invasive treatment combining percutaneous transhepatic CT-guided cholecystostomy and DLC is safe and feasible and report low morbi-mortality rates.

Tratamiento del vólvulo gástrico agudo mediante abordaje laparoscópico / Laparoscopic treatment of acute gastric volvulus

Introducción El vólvulo gástrico es una entidad clínica poco frecuente y se asocia a hernias hiatales tipo ii-iii. Su presentación aguda constituye una urgencia quirúrgica. Pese a su baja frecuencia, ya se han publicado resultados sobre el tratamiento laparoscópico. Material y métodos Estudio retrospectivo de todos los casos diagnosticados de vólvulo gástrico agudo intervenidos por vía laparoscópica desde 1998 a 2010. Se describe la técnica quirúrgica, la evolución postoperatoria y el seguimiento clínico. Resultados Se identificaron 10 casos, uno era un vólvulo primario y el resto secundarios. A 7 pacientes se les realizó una gastropexia anterior como único procedimiento. En los 3 restantes se llevó a cabo fundoplicatura de Nissen y cierre de los pilares con refuerzo protésico. La evolución postoperatoria fue favorable en 9 pacientes, con inicio precoz de la dieta y alta en 48-72h. Con un seguimiento medio de 18 meses, solo hemos constatado una recidiva herniaria radiológica y ninguna recidiva del vólvulo. Conclusión La gastropexia anterior por laparoscopia es, en nuestra experiencia, un procedimiento efectivo y con baja morbilidad para el tratamiento del vólvulo gástrico agudo en pacientes con elevado riesgo quirúrgico (AU)

Introduction Gastric volvulus is an uncommon clinical condition and is associated with type ii-iii hiatal hernias. Its acute presentation constitutes a surgical emergency. Despite its low frequency, results of laparoscopic treatment have already been published. Material and methods A retrospective study was performed on all cases diagnosed with gastric volvulus undergoing laparoscopic surgery between 1998 and 2010. The surgical technique, the post-operative outcome, and the clinical follow-up are described. Results A total of 10 cases were identified, one was a primary gastric volvulus, and the remainder were secondary. A laparoscopic anterior gastropexy as the sole procedure was performed on 7 patients. A Nissen fundoplication with mesh reinforcement of the crural closure was performed on the 3 remaining cases. Postoperative outcome was uneventful in 9 patients, with an early start of the diet, and hospital discharge between 48-72h. After a mean follow-up period of 18 months, radiological hernia recurrence occurred in one case but recurrence of the volvulus was not observed. Conclusion Laparoscopic anterior gastropexy is, in our experience, an effective and safe procedure with a low morbidity, for the treatment of acute gastric volvulus in patients with high surgical risk (AU)

Alteraciones metabólicas tras cirugía de la obesidad mórbida mediante la técnica del cruce duodenal. Seguimiento a largo plazo / Metabolic changes after morbid obesity surgery using the duodenal switch technique. Long term follow-up

Introducción La técnica del cruce duodenal (CD) es considerada una cirugía compleja y con serias complicaciones metabólicas por su carácter malabsortivo, lo que hace que su uso no se haya extendido entre los cirujanos bariátricos. A pesar de ello la consideramos una técnica adecuada en superobesos. Pacientes y métodos Estudio prospectivo de 110 pacientes con obesidad mórbida intervenidos consecutivamente con la técnica del CD y seguidos durante un período mínimo de cuatro años tras la cirugía. Hemos evaluado la pérdida de peso, evolución de las comorbilidades y las complicaciones metabólicas. Resultados La pérdida del exceso de peso fue superior al 50% en el 75% de los pacientes después de 12 meses de seguimiento. Un total de 68 pacientes (75,5%) experimentaron completa corrección de las comorbilidades que presentaban. Las alteraciones metabólicas más frecuentes fueron el déficit de hierro y la elevación de la PTH. Conclusiones El CD es una técnica segura y eficaz para el tratamiento de la obesidad mórbida, con buenos resultados ponderales, elevado porcentaje de remisión de las comorbilidades, morbimortalidad similar a otras técnicas y con alteraciones nutricionales corregibles y por tanto asumibles (AU)

Introduction The duodenal switch (DS) technique is considered to be complex surgery with a series of metabolic complications due to its malabsorptive character. For these reasons, it has not been extensively used by bariatric surgeons. Despite this, we consider it to be a suitable technique for the grossly obese. Patients and methods A retrospective study was performed on 110 patients with morbid obesity operated on using the DS technique and who were followed up for a minimum period of four years after surgery. We evaluated the weight loss, the outcomes of the comorbidities, and the metabolic complications. Results The loss of excess weight was greater than 50% in 75% of the patients after 12 months follow up. The comorbidities suffered by 68 patients (75.5%) were completely resolved. The most frequent metabolic complications were iron (Fe) deficiency and an increased parathyroid hormone (PTH).Conclusions DS is a safe and effective technique for the treatment of morbid obesity, with good weight loss results, a high percentage of remission of the comorbidities, a similar morbidity and mortality to other techniques, and with correctable nutritional changes, and thus acceptable (AU)

[Metabolic changes after morbid obesity surgery using the duodenal switch technique. Long term follow-up]. / Alteraciones metabólicas tras cirugía de la obesidad mórbida mediante la técnica del cruce duodenal. Seguimiento a largo plazo.

INTRODUCTION: The duodenal switch (DS) technique is considered to be complex surgery with a series of metabolic complications due to its malabsorptive character. For these reasons, it has not been extensively used by bariatric surgeons. Despite this, we consider it to be a suitable technique for the grossly obese. PATIENTS AND METHODS: A retrospective study was performed on 110 patients with morbid obesity operated on using the DS technique and who were followed up for a minimum period of four years after surgery. We evaluated the weight loss, the outcomes of the comorbidities, and the metabolic complications. RESULTS: The loss of excess weight was greater than 50% in 75% of the patients after 12 months follow up. The comorbidities suffered by 68 patients (75.5%) were completely resolved. The most frequent metabolic complications were iron (Fe) deficiency and an increased parathyroid hormone (PTH). CONCLUSIONS: DS is a safe and effective technique for the treatment of morbid obesity, with good weight loss results, a high percentage of remission of the comorbidities, a similar morbidity and mortality to other techniques, and with correctable nutritional changes, and thus acceptable.

¿Están los servicios de cirugía general y del aparato digestivo preparados para ofrecer docencia de calidad acorde con los nuevos planes de formación? / Are the general and digestive surgery services prepared to offer a quality training according to the new teaching plans?

Introducción En los últimos meses se ha asistido a una actualización del programa formativo de los residentes y a una regulación de los aspectos importantes de su formación. Un elemento fundamental del proceso de formación son las unidades docentes, a las que se debe exigir que cumplan con los requisitos indispensables adaptados a los nuevos tiempos, como garantía de calidad. Objetivo Identificar los aspectos mejorables en la formación y conocer con qué recursos parten las unidades docentes para afrontar el cumplimiento del nuevo programa de formación. Material y método El estudio se ha realizado en todas las unidades docentes acreditadas para la formación de residentes en la Comunidad Valenciana mediante formularios enviados tanto a los tutores como a los residentes y reuniones mantenidas con los residentes. Resultados La tasa de participación fue elevada (el 100% de tutores y el 92% de residentes). Se han detectado deficiencias en los requisitos de las unidades docentes y en la calidad de la formación percibida por los residentes, sobre todo en los campos de la investigación y en la actividad docente. Se constatan importantes diferencias entre hospitales. Conclusiones Se debe incidir en el cumplimiento de todos los requisitos necesarios para la acreditación de las unidades docentes y hacer hincapié en la actividad docente e investigadora. La implementación de los nuevos planes de formación requiere de una supervisión que corrija las diferencias encontradas entre los distintos servicios (AU)

Introduction In 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. Aim To 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 methods The 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. Results T he 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. Conclusions More 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 (AU)