Cirugia espanola最新文献

{"title":"The impact and role of shared decision-making in surgical practice: A systematic review.","authors":"Danilo Vinci, Beatriz Febrero, José Ignacio Pérez García, Gianluca Pellino","doi":"10.1016/j.cireng.2026.800328","DOIUrl":"https://doi.org/10.1016/j.cireng.2026.800328","url":null,"abstract":"<p><strong>Background: </strong>Shared decision-making (SDM) is a collaborative approach that integrates clinical evidence with patient values to guide healthcare decisions. Although widely promoted as a quality indicator, its adoption in surgical care remains variable. Understanding its impact and implementation in surgery is essential to improve patient-centred outcomes.</p><p><strong>Methods: </strong>A systematic review with narrative synthesis was conducted in accordance with PRISMA guidelines and registered in PROSPERO (ID 1145717). MEDLINE, EMBASE, Ovid and Cochrane databases were searched for studies published between 1995 and 2025. Randomized trials and comparative observational studies evaluating shared decision-making (SDM) interventions in adult surgical patients were included. Two reviewers independently performed study screening, data extraction and quality assessment. Primary outcomes were patient-reported measures (satisfaction, perceived involvement, decisional conflict, and knowledge). Secondary outcomes included postoperative complications and length of stay. Risk of bias was assessed using the Newcastle-Ottawa Scale, and certainty of evidence was graded using the GRADE approach. Due to heterogeneity across interventions and surgical subspecialties, a narrative synthesis was performed.</p><p><strong>Results: </strong>The search identified 4119 records, among which 29 studies met inclusion criteria. Most were randomized controlled trials or prospective cohorts, spanning orthopaedic, breast, colorectal, gynaecologic, vascular, and general surgery. SDM interventions were diverse, including decision aids, question prompt lists, smartphone applications, and surgeon-patient communication training. Compared with usual care, SDM consistently improved patient knowledge, involvement, satisfaction, and reduced decisional conflict. Evidence for clinical outcomes, such as complication rates or length of stay, was limited and inconsistent. Quality appraisal showed most studies were of moderate to high quality, although several pilot trials had small samples and limited generalizability.</p><p><strong>Conclusions: </strong>SDM improves patient-centred outcomes in surgical practice, though its effect on clinical endpoints remains uncertain. The evidence highlights stronger benefits in elective than in emergency contexts, where time constraints and patient frailty limit feasibility. Standardized measurement tools, validated surgery-specific decision aids, and integration of digital technologies are needed to strengthen implementation. Broader institutional support and training in SDM communication should be prioritized to embed SDM as a routine component of surgical care.</p>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":" ","pages":"800328"},"PeriodicalIF":0.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A huge exophytic leiomyoma of the rectum","authors":"Wei Yang ,&nbsp;Chendong He","doi":"10.1016/j.cireng.2025.800247","DOIUrl":"10.1016/j.cireng.2025.800247","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 4","pages":"Article 800247"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applications of radiomics in thoracic surgery: Enhancing precision and personalization of treatment","authors":"Alberto Cabañero Sánchez ,&nbsp;Luis Gorospe Sarasúa ,&nbsp;Nicolás Moreno Mata","doi":"10.1016/j.cireng.2025.800245","DOIUrl":"10.1016/j.cireng.2025.800245","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 4","pages":"Article 800245"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleeve gastrectomy with transit bipartition and Roux-en-Y reconstruction: Step-by-step surgical technique","authors":"Sergi Sanchez-Cordero,&nbsp;Ruth Lopez-Gonzalez,&nbsp;Rodrigo Hermoza,&nbsp;Jordi Pujol-Gebellí","doi":"10.1016/j.cireng.2025.800260","DOIUrl":"10.1016/j.cireng.2025.800260","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 4","pages":"Article 800260"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145531059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coloproctology practice during General and Digestive Surgery training. Survey of the Galician Coloproctology Group","authors":"Pilar Fernández-Veiga ,&nbsp;Marta Martínez Míguez ,&nbsp;Marta Paniagua García-Señorans ,&nbsp;José Antonio Romero González ,&nbsp;Fernando Fernández López ,&nbsp;Raquel Vázquez Bouzán ,&nbsp;Ramón López De los Reyes ,&nbsp;Inés Aldrey Cao ,&nbsp;José Enrique Casal Núñez","doi":"10.1016/j.cireng.2026.800288","DOIUrl":"10.1016/j.cireng.2026.800288","url":null,"abstract":"<div><h3>Introduction</h3><div>In general surgery (GS), coloproctology (CP) constitutes one of the cornerstones in specialist training; however, it is unclear whether this training is sufficiently comprehensive and how trainees perceive it. In the same way, it’s interesting to assess whether advanced accreditation of units may have an influence on this. Our objective was to determine the quality of this training in our community and to compare the results between hospitals with advanced colorectal unit and those without accreditation.</div></div><div><h3>Materials and methods</h3><div>A cross-sectional study was conducted using the results of anonymous surveys completed by GS trainees in Galicia regarding their training in CP.</div></div><div><h3>Results</h3><div>A total of 57 residents participated (93.4%). Of them, 82.5% had never been evaluated during their residency. More than half stated that they had not received sufficient scientific training. They operated as first surgeon in proctological and colorectal procedures in 42.2% and 17.2% of cases, respectively. Only 3.7% did so in pelvic floor disorders. In accredited Units, the evaluation was significantly higher in the scientific domain (<em>p</em> = 0.003), in the clinical-care domain (<em>p</em> = 0.002), and in the overall achievement of objectives (<em>p</em> = 0.034). Additionally, there were statistically significant differences in the number of surgeries performed as first surgeon (<em>p</em> = 0.017) in favour of these Units.</div></div><div><h3>Conclusion</h3><div>There is wide room for improvement in CP training among our trainees, with special emphasis on the scientific domain. We observed that participation as first surgeon decreases in complex surgeries, which makes additional training essential to practice CP independently.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 4","pages":"Article 800288"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structured outpatient cholecystectomy protocol leads to improving results and expanding indications","authors":"Pablo Ezequiel Finno ,&nbsp;Santiago González-Ayora ,&nbsp;María Fraile Vilarrasa ,&nbsp;Tihomir Georgiev-Hristov","doi":"10.1016/j.cireng.2026.800301","DOIUrl":"10.1016/j.cireng.2026.800301","url":null,"abstract":"<div><h3>Background</h3><div>Outpatient laparoscopic cholecystectomy has become increasingly common, yet criteria for patient selection remain conservative. We aimed to assess the long-term outcomes of implementing a structured outpatient cholecystectomy protocol in a secondary hospital and explore its applicability in traditionally high-risk populations.</div></div><div><h3>Materials and methods</h3><div>1024 consecutive elective cholecystectomy patients were retrospectively analyzed for initial indication for outpatient procedure, unplanned admission rate and complications since 2018, when our outpatient cholecystectomy protocol was established. Patient factors and operative parameters were assessed.</div></div><div><h3>Results</h3><div>In 822 patients, the cholecystectomy was initially planned as an outpatient procedure, which was achieved in 673 (81.9%). Both the indication and success rates improved over time (<em>P</em> &lt; .001). Unplanned admissions occurred mainly due to surgical complexity, social factors and timing of the procedure. Age &gt; 70 years of age, BMI &gt; 30, ASA III and complicated cholelithiasis were (except for prior acute cholecystitis) not found to increase the unplanned admission rate, and the indication for outpatient cholecystectomy in these groups rose over time without significant complications. 90-day readmission and complication rates (mostly Clavien-Dindo grade I–II and no mortality) remained low (1.3% and 3.6%, respectively; <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>A structured protocol enables safe and effective expansion of outpatient cholecystectomy to higher-risk groups, optimizing resource utilization without compromising patient outcomes.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 4","pages":"Article 800301"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is failure to rescue an appropriate quality indicator in a pancreatic surgery unit?","authors":"Francisco Castillejos-Ibáñez,&nbsp;Marina Garcés-Albir,&nbsp;Isabel Mora-Oliver,&nbsp;Elena Muñoz-Forner,&nbsp;Dimitri Dorcaratto,&nbsp;Luis Sabater Ortí","doi":"10.1016/j.cireng.2026.800289","DOIUrl":"10.1016/j.cireng.2026.800289","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the Failure to Rescue (FTR) rate in a pancreatic surgery unit between 2020 and 2024, and to identify the limitations of this indicator when interpreting successful outcomes.</div></div><div><h3>Material and methods</h3><div>A retrospective study based on a prospective database. All patients who underwent elective pancreatic surgery with curative intent between January 2020 and December 2024 were included. Preoperative, intraoperative, and postoperative clinical variables were collected. The 30- and 90-day FTR was defined as mortality among patients who experienced at least one major postoperative complication (MPC) (Clavien-Dindo ≥3).</div></div><div><h3>Results</h3><div>Of the 173 patients operated on, 37 (21.39%) developed major complications. The overall FTR rate was 8.11%. The most frequent complication was pancreatic fistula (17.92%), followed by intra-abdominal collections (15.03%), post-pancreatectomy haemorrhage (13.87%), and delayed gastric emptying (5.20%). The reoperation rate was 9.25%, and overall mortality was 1.73%.</div></div><div><h3>Conclusion</h3><div>The observed FTR rate is comparable to that of high-volume international centres. FTR, being a ratio between mortality and major complications, can be distorted in series with a low rate of such complications, which requires it to be interpreted with caution and not used as a standalone quality indicator of a surgical unit.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 4","pages":"Article 800289"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of bariatric surgery on the gut microbiota and metabolomic profile of the enterohepatic axis in an experimental model of obesity","authors":"Elisabet Homs ,&nbsp;Margarida Vives ,&nbsp;Helena Torrell ,&nbsp;Daniel Del Castillo ,&nbsp;Antonio Sánchez ,&nbsp;Fátima Sabench","doi":"10.1016/j.cireng.2026.800297","DOIUrl":"10.1016/j.cireng.2026.800297","url":null,"abstract":"<div><div>Obesity is a complex metabolic disease associated with alterations in the gut microbiota and the metabolism of fatty acids and bile acids. Bariatric surgery can modify this axis, contributing to benefits beyond weight loss, and the response may differ between surgical techniques. This study investigates this differential impact in an experimental model of obesity. Both surgical procedures reduced body weight, although gastric bypass (GB) induced a more sustained weight loss and deeper metabolic changes. GB significantly decreased butyrate levels while increasing bile acids and the abundance of beneficial bacteria such as Akkermansia muciniphila and Bacteroides. Only GB reduced serum TMAO levels, a metabolite linked to cardiovascular risk, possibly through modulation of the hepatic enzyme FMO3. The results indicate that GB exerts a markedly distinct metabolic impact compared to sleeve gastrectomy (SG), which may largely explain its greater clinical efficacy.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 4","pages":"Article 800297"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence, predictive modelling and robotics in minimally invasive surgery: Towards precision surgery","authors":"Francisco Miguel Sánchez-Margallo ,&nbsp;Daniel Caballero ,&nbsp;Juan Alberto Sánchez-Margallo","doi":"10.1016/j.cireng.2026.800295","DOIUrl":"10.1016/j.cireng.2026.800295","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 4","pages":"Article 800295"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consensus document for the transcystic approach to choledocholithiasis with ultrathin flexible choledochoscope","authors":"Alejandra García-Botella ,&nbsp;Juan Pablo Arjona Trujillo ,&nbsp;Sofía de la Serna ,&nbsp;Pedro José Gil Vázquez ,&nbsp;Santos Jiménez-Galanes Marchán ,&nbsp;Erik Llàcer-Millán ,&nbsp;Ana Belén Martín Arnau ,&nbsp;David Martínez-Cecilia ,&nbsp;Alba Zárate Pinedo ,&nbsp;Alberto Martínez-Isla","doi":"10.1016/j.cireng.2025.800259","DOIUrl":"10.1016/j.cireng.2025.800259","url":null,"abstract":"<div><div>The transcystic laparoscopic approach to manage choledocholithiasis using ultrathin flexible choledochoscopes is aimed at reducing complications linked to ERCP and transductal techniques when treating common bile duct stones with gallbladder in situ. Despite their advantages, transcystic techniques are not being widely adopted, highlighting the need for structured protocols, a multidisciplinary approach, and adequate resource allocation to optimize outcomes.</div><div>This consensus document addresses key issues to standardize the approach, based on the responses to the 25 questions posed to the panel of experts.</div><div>The recommendations issued, based on the evidence and expert opinion, cover the key factors for the success of the technique, including appropriate patient selection, technical characteristics of the approach, advanced equipment required, etc.</div><div>This comprehensive guide aims to standardize the technique in order to improve patient outcomes and ensure safe, effective treatment of choledocholithiasis.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 4","pages":"Article 800259"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145531052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}