Cirugia espanola最新文献

{"title":"Endoscopic treatment of sacrococcygeal pilonidal sinus (EPSIT): results in 104 patients.","authors":"Cesar Adolfo Calzadilla Narváez, Juan Luis Ney Sotomayor, Ramon Soliva Domínguez, Diana Cubells Manero","doi":"10.1016/j.cireng.2026.800396","DOIUrl":"https://doi.org/10.1016/j.cireng.2026.800396","url":null,"abstract":"<p><strong>Introduction: </strong>Sacrococcygeal pilonidal sinus (PS) is a common condition in young adults, characterised by an inflammatory response due to hair impaction in the gluteal cleft. Optimal treatment remains controversial because of the morbidity and recurrence associated with conventional techniques. The endoscopic EPSIT technique has emerged as a minimally invasive alternative.</p><p><strong>Objective: </strong>To evaluate the recurrence rate of EPSIT and, secondarily, postoperative complications, healing time, and return to daily activities.</p><p><strong>Materials and methods: </strong>Observational study including 104 patients with primary or recurrent sacrococcygeal pilonidal sinus treated with EPSIT between April 2024 and April 2025. The procedure was performed on an outpatient basis under local anaesthesia and intravenous sedation. Demographic variables, operative time, postoperative pain (VAS), analgesic use, complications, healing time, return to activities, and recurrence were recorded.</p><p><strong>Results: </strong>Most patients were male (76.9%), with a mean age of 31 years. Primary disease was present in 83 cases and recurrent in 21. Mean operating time was 14.2 minutes, and all patients were discharged within 3 hours. Mild postoperative pain (VAS 1-3) was reported in 89.4% of patients. Mean return to activities was 5 days, and mean healing time was 24 days. One surgical site infection was recorded. The recurrence rate was 9.62%.</p><p><strong>Conclusions: </strong>EPSIT is a minimally invasive, reproducible technique associated with low morbidity, minimal pain, and rapid recovery, with an acceptable recurrence rate in selected patients.</p>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":" ","pages":"800396"},"PeriodicalIF":0.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139821","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":"“Breast cancer with a good prognosis in elderly patients: is sentinel lymph node biopsy still justified?”","authors":"Carlota López Domínguez,&nbsp;Alejandra García Novoa,&nbsp;Benigno Acea Nebril,&nbsp;Sergio Rodríguez Rojo,&nbsp;Aloia Guerreiro Caamaño","doi":"10.1016/j.cireng.2026.800351","DOIUrl":"10.1016/j.cireng.2026.800351","url":null,"abstract":"<div><h3>Introduction</h3><div>In older women with early-stage, hormone receptor-positive breast cancer, the value of sentinel lymph node biopsy (SLNB) has been questioned due to its limited prognostic and therapeutic impact.</div></div><div><h3>Objective</h3><div>To evaluate the usefulness of SLNB in this population.</div></div><div><h3>Methods</h3><div>A systematic review was conducted in accordance with the PRISMA 2020 guidelines. Studies published between 2014 and 2024 were searched in PubMed, Cochrane Library, and Google Scholar, analyzing the impact of SLNB in women ≥60 years of age with cT1–T2N0, RH+, HER2– tumors undergoing primary surgery, and we performed a meta-analysis by subgroups focused on homogeneous domains.</div></div><div><h3>Results</h3><div>Of the 8,396 studies identified, 35 met the inclusion criteria. Omitting SLNB did not affect survival or increase recurrences, reducing the indication for adjuvant therapies.</div></div><div><h3>Conclusion</h3><div>In older women with low-risk early breast cancer, omitting SLNB is safe and does not compromise survival.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 10","pages":"Article 800351"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147990533","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":"Inferior gluteal arteriovenous fistula after penetrating trauma: CT angiography and 3D reconstruction findings","authors":"Andrés E. Valera-Montiel,&nbsp;Jaime López-Sánchez,&nbsp;Manuel J. Torres-Jurado,&nbsp;Francisco Blanco-Antona","doi":"10.1016/j.cireng.2026.800368","DOIUrl":"10.1016/j.cireng.2026.800368","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 10","pages":"Article 800368"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876706","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":"Delphi study robot consenso: Strategies for the implementation of robotic surgery in general surgery in the Spanish hospital network","authors":"Sara Gortázar,&nbsp;Ernesto Barzola,&nbsp;Ana Sánchez,&nbsp;Mario Álvarez-Gallego,&nbsp;Jacobo Trébol,&nbsp;Luis Sánchez,&nbsp;Benedetto Ielpo,&nbsp;Asunción Acosta,&nbsp;Iván Arteaga,&nbsp;Jaime Iturbe,&nbsp;Carmen Cagigas,&nbsp;Jaime López,&nbsp;María Caballero,&nbsp;Manuel Lozano,&nbsp;Juan Carlos Gómez Rosado,&nbsp;Juan Bellido,&nbsp;Grupo Colaborativo ROBOT CONSENSO","doi":"10.1016/j.cireng.2026.800378","DOIUrl":"10.1016/j.cireng.2026.800378","url":null,"abstract":"<div><h3>Introduction</h3><div>The implementation of robotic surgery in public hospitals presents multiple logistical, educational, and organizational challenges. In the absence of unified guidelines, a national consensus is required to optimize its safe and efficient adoption.</div><div>This study aimed to establish a set of consensus-based and measurable recommendations for the implementation of robotic surgery programs in hospitals within the Spanish National Health System, based on the experience of centres with established robotic programs and intended to serve as guidance for hospitals that are initiating or planning their implementation.</div></div><div><h3>Methods</h3><div>A national Delphi study was conducted with the participation of robotic surgery experts from 26 public hospitals. The expert panel was composed exclusively of digestive surgeons with experience in robotic surgery. Three iterative rounds of expert panel evaluation were conducted between March 2024 and March 2025. The questions were grouped into five thematic blocks. Consensus was defined as an agreement level of ≥66.7%. Kendall’s W coefficient was used to assess concordance.</div></div><div><h3>Results</h3><div>High levels of consensus were achieved on key aspects related to infrastructure, structured training, cost evaluation, and quality assurance mechanisms. Areas of disagreement were also identified, such as the need for a dedicated anaesthesiologist, purchase of accessory instruments during the initial phase, and official accreditation pathways.</div></div><div><h3>Conclusions</h3><div>This study provides a guideline for developing a national robotic surgery strategy focused on patient safety, program sustainability, and standardized training of surgical teams. These recommendations can guide hospitals at different stages of robotic technology adoption. Given that the consensus was reached from an exclusively surgical perspective, the recommendations focus on patient safety, program sustainability, and standardized training of the surgical team, and should be interpreted in an adaptable manner according to each centre’s context, case volume, and available resources.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 10","pages":"Article 800378"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876161","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":"Response to the Reply to our original: Coloproctology Practice during General and Digestive Surgery Training. Survey by the Galician Coloproctology Group","authors":"Pilar Fernández Veiga,&nbsp;José Enrique Casal Núñez","doi":"10.1016/j.cireng.2026.800369","DOIUrl":"10.1016/j.cireng.2026.800369","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 10","pages":"Article 800369"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868318","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":"Prospective evaluation of clinical and analytical values in the early diagnosis of anastomotic leak after oncological gastric surgery (PROFUGO study)","authors":"Marcos Bruna,&nbsp;Antonio J. Serrano,&nbsp;Rocío Pérez-Quintero,&nbsp;Carla Bettonica,&nbsp;Cristina Alegre,&nbsp;María Tudela,&nbsp;Miriam Menéndez,&nbsp;Adrián Herrero,&nbsp;Alessandro Bianchi,&nbsp;Irene Álvarez,&nbsp;Felipe Parreño,&nbsp;Jennifer Triguero,&nbsp;Sergio Rodríguez,&nbsp;Rocío González,&nbsp;Marta de Vega,&nbsp;Ander Bengoechea,&nbsp;Elena Fernández,&nbsp;Mª Asunción Acosta,&nbsp;Silvia Carbonell,&nbsp;Fernando López,&nbsp;María del Campo","doi":"10.1016/j.cireng.2026.800372","DOIUrl":"10.1016/j.cireng.2026.800372","url":null,"abstract":"<div><h3>Introduction</h3><div>Resective surgery is the cornerstone of gastric cancer treatment, but it carries considerable morbidity and mortality, with anastomotic leak (AL) being the most feared complication. This study aims to describe the prevalence and diagnostic management of AL after oncological gastrectomy, analyzing clinical and laboratory parameters that may facilitate its early diagnosis.</div></div><div><h3>Methods</h3><div>A prospective, multicentre, national study was conducted between 2023 and 2024. 435 patients who underwent surgery for gastric cancer at 43 centres were included. Sociodemographic variables and diagnostic and therapeutic management data were described, comparing the postoperative evolution of clinical and laboratory variables in patients with and without anastomotic leak.</div></div><div><h3>Results</h3><div>The overall prevalence of AL was 10.5%, with patients exhibiting a significantly higher heart rate from the second postoperative day. In the group of patients with AL, C-reactive protein, procalcitonin, and interleukin-6 showed higher levels from the first postoperative day. Other markers, such as leukocytes and the neutrophil-to-lymphocyte ratio, were also significantly higher in the AL group. The diagnosis of AL was established at a median of 6 days post-surgery, with a resolution rate of 80% using endoscopic therapies, interventional radiology and surgery.</div></div><div><h3>Discussion</h3><div>Although the diagnosis of AL is often delayed until the sixth postoperative day, the differences in the values of variables such as C-reactive protein, procalcitonin, and interleukin-6 between patients with and without AL become noticeable earlier. These findings support the creation of predictive models based on the variables studied to diagnose this complication early.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 10","pages":"Article 800372"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876849","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":"Reply – Coloproctology practice during General and Digestive Surgery training. Survey of the Galician Coloproctology Group","authors":"Antonio Ríos","doi":"10.1016/j.cireng.2026.800370","DOIUrl":"10.1016/j.cireng.2026.800370","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 10","pages":"Article 800370"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868332","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":"Mode of presentation and severity of cervical anastomotic leak after McKeown esophagectomy in the era of endoscopic therapies","authors":"Julieta Puente Montserrat,&nbsp;M-Carmen Fernández-Moreno,&nbsp;Georgy Kadzhaya,&nbsp;Ricardo Gadea Mateo,&nbsp;María Eugenia Barrios Carvajal,&nbsp;Fernando López Mozos","doi":"10.1016/j.cireng.2026.800387","DOIUrl":"10.1016/j.cireng.2026.800387","url":null,"abstract":"<div><h3>Introduction</h3><div>Cervical drainage has been used to facilitate the diagnosis of anastomotic dehiscence (AD) and its local control. The aim of this study has been to analyse the association between the initial mode of presentation of cervical AD after McKeown esophagectomy (ME) and its overall clinical severity.</div></div><div><h3>Materials and methods</h3><div>This retrospective study included patients with oesophageal neoplasia who underwent ME between 2010 and 2024, developed cervical AD, and had a cervical drain in place. The mode of diagnosis (clinical presentation vs drainage output), treatment, and severity of AD were analysed using the Comprehensive Complication Index (CCI). A temporal analysis comparing the periods before and after 2020 was performed following the introduction of new endoscopic therapies. Multivariable linear regression was used to identify factors associated with CCI.</div></div><div><h3>Results</h3><div>A total of 31 patients with cervical AL were included. Diagnosis was established through the cervical drain in 14 patients (45.2%) and through clinical manifestations in 17 (54.8%). No significant differences were observed in time to diagnosis between the groups (<em>p</em> = 0.49). Temporal analysis showed a reduction in surgical treatment of AD after 2020 (<em>p</em> = 0.039). In the multivariable analysis, the independent factors associated with CCI were the mode of diagnosis (<em>p</em> = 0.043) and diagnostic delay (<em>p</em> = 0.041).</div></div><div><h3>Conclusion</h3><div>Diagnosis through cervical drainage was not associated with earlier detection of AD. Severity was mainly related to diagnostic delay and the mode of clinical presentation. The introduction of endoscopic therapies has reduced the need for surgery.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 10","pages":"Article 800387"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889709","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":"Morbidity and mortality of inguinal hernia surgery in patients aged 80 years or older","authors":"Alba María Serrano Molina,&nbsp;Omar Carreño Sáenz,&nbsp;Carmen Gutiérrez Sánchez,&nbsp;José Bueno Lledó,&nbsp;Santiago Bonafé Diana,&nbsp;Providencia García Pastor,&nbsp;Victoria Pareja Ibars,&nbsp;Salvador Pous Serrano","doi":"10.1016/j.cireng.2026.800388","DOIUrl":"10.1016/j.cireng.2026.800388","url":null,"abstract":"<div><h3>Objective</h3><div>To analyse morbidity, mortality, and outcomes of inguinal hernia surgery in patients aged 80 years or older.</div></div><div><h3>Methods</h3><div>A retrospective descriptive study was conducted including patients aged ≥80 years who underwent inguinal hernia repair at a tertiary referral centre between April 2021 and April 2024. Demographic, clinical, and surgical variables were analysed, as well as intraoperative and postoperative complications, mortality, follow-up, and hernia recurrence.</div></div><div><h3>Results</h3><div>A total of 104 patients were included, accounting for 113 inguinal hernias. Mean age was 84 ± 3.2 years, and 76% of patients were male. Most procedures were performed electively (80.8%). Open mesh hernioplasty was the most frequently used technique (95.6%). Intraoperative complications occurred in 3.8% of cases, and mild postoperative complications were observed in 13.5%, with haematoma being the most common. No reoperations or postoperative mortality were recorded. Mean hospital stay was 1.55 days. During follow-up, two hernia recurrences and four de novo contralateral inguinal hernias were identified.</div></div><div><h3>Conclusion</h3><div>Inguinal hernia surgery in patients aged 80 years or older is associated with low morbidity and mortality when performed electively. Advanced age alone should not be considered a contraindication for surgical treatment.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 10","pages":"Article 800388"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889722","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":"Self-locking knot for thoracic wall closure in trauma anterolateral thoracotomy: a retrospective cohort study.","authors":"Luis Felipe Cabrera Vargas, Isabella Garavis Montagut, María Isabella Zúñiga Velasquez, Ana Gabriela Ayala, Carlos José Perez Rivera, Mauricio Pedraza Ciro, Diego Salcedo","doi":"10.1016/j.cireng.2026.800392","DOIUrl":"10.1016/j.cireng.2026.800392","url":null,"abstract":"<p><strong>Background: </strong>Thoracic trauma is one of the most frequent reasons for consultation in emergency departments worldwide. Surgical management of unstable injuries remains a challenge for trauma surgeons, as current evidence regarding chest wall closure techniques does not yet support a clear consensus. Although multiple techniques have been described, no single approach has been universally adopted.</p><p><strong>Methods: </strong>We performed a retrospective cohort study comparing the results for operative time, surgical site infection and postoperative pain between closures using the self-locking knot versus the rib approximator.</p><p><strong>Results: </strong>Our results demonstrate a difference between the 2 techniques analyzed that could be significant in terms of postoperative pain (18% for the self-locking knot group vs 65% for the rib approximator), surgical site infections (0% vs 9%, respectively) and operative time (100 versus 110 min, respectively).</p><p><strong>Conclusion: </strong>The self-locking knot technique could be considered a promising option for the intercostal space after anterolateral thoracotomy closure. Further studies are needed to confirm these results.</p>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":" ","pages":"800392"},"PeriodicalIF":0.0,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972226","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}