Cirugia espanola最新文献

{"title":"Atrioesophageal fistula following atrial fibrillation ablation: A diagnostic and therapeutic challenge","authors":"César Barsén Pérez Izquierdo, Marta Cuadrado Ayuso, José Ramón Foruny Olcina, Julio Galindo Álvarez","doi":"10.1016/j.cireng.2026.800320","DOIUrl":"10.1016/j.cireng.2026.800320","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 7","pages":"Article 800320"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494945","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":"The impact and role of shared decision-making in surgical practice: A systematic review","authors":"Danilo Vinci,&nbsp;Beatriz Febrero,&nbsp;José Ignacio Pérez García,&nbsp;Gianluca Pellino","doi":"10.1016/j.cireng.2026.800328","DOIUrl":"10.1016/j.cireng.2026.800328","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 7","pages":"Article 800328"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","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":"Gallbladder agenesis","authors":"Cándido Alcázar,&nbsp;Celia Villodre,&nbsp;Paola Melgar,&nbsp;Jose M. Ramia","doi":"10.1016/j.cireng.2026.800319","DOIUrl":"10.1016/j.cireng.2026.800319","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 7","pages":"Article 800319"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494904","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":"Conversion bariatric surgery after sleeve gastrectomy: results and resolution of comorbidities. Experience of 209 consecutive patients","authors":"David Merino,&nbsp;Lucía Sobrino,&nbsp;Javier Osorio,&nbsp;Berta Pérez-Grau,&nbsp;Fernando Guerrero,&nbsp;Claudio Lazzara","doi":"10.1016/j.cireng.2026.800318","DOIUrl":"10.1016/j.cireng.2026.800318","url":null,"abstract":"<div><h3>Background</h3><div>Sleeve gastrectomy (SG) has become the most frequently performed bariatric procedure worldwide, however a substantial proportion of patients ultimately require conversion surgery due to complications or suboptimal outcomes. Comprehensive data on the results of the various conversion procedures remain limited.</div></div><div><h3>Objective</h3><div>To evaluate the indications, surgical techniques, safety profile, comorbidity resolution, and effectiveness of conversion bariatric surgery after SG.</div></div><div><h3>Methods</h3><div>Retrospective analysis of 209 patients who underwent conversion surgery after SG at Bellvitge University Hospital between 2015 and 2024. Primary outcomes included weight-loss results, complication rates, and comorbidity resolution. Secondary outcomes included length of hospital stay and achievement of Textbook Outcome.</div></div><div><h3>Results</h3><div>Mean age was 48.1 ± 7.8 years. Median maximum BMI was 54.8 kg/m² (IQR 47.7–60.6). Indications were weight regain (55.5%), insufficient weight loss (32.5%), and GERD (12.0%). Conversion procedures included DS (48.3%), SADI-S (40.7%), and RYGB (11.0%). Overall complication rate was 7.2% with no mortality. Median total weight loss from maximum weight was 36.5% (IQR 27.9–45.0) and from pre-conversion was 14.0% (IQR 6.6–23.1 %). Hypertension prevalence decreased from 40.2% post-SG to 15.8% post-conversion (60.7% improvement). Dyslipidemia improved from 24.4% to 7.2% (70.6% improvement). Type 2 diabetes decreased from 25.4% to 11.5% (54.7% improvement). Obstructive sleep apnea decreased from 47.4% to 17.2% (63.6% improvement).</div></div><div><h3>Conclusion</h3><div>Conversion surgery after SG is safe and effective, achieving excellent outcomes. Hypoabsorptive procedures showed superior metabolic results while maintaining acceptable complication rates.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 7","pages":"Article 800318"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494918","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":"Are we managing desmoid tumors correctly in Spain? Results of the first national survey","authors":"Vicente Olivares-Ripoll,&nbsp;Pablo Lozano Lominchar,&nbsp;Paula Muñoz,&nbsp;Cristina Ballester,&nbsp;Daniel Díaz,&nbsp;Patricia Marrero,&nbsp;Lorena Cambeiro,&nbsp;Irene López,&nbsp;Hugo Vásquez,&nbsp;Cristóbal Muñoz Casares,&nbsp;José Antonio González López,&nbsp;José Manuel Asencio","doi":"10.1016/j.cireng.2026.800333","DOIUrl":"10.1016/j.cireng.2026.800333","url":null,"abstract":"<div><h3>Introduction</h3><div>The management of desmoid tumors has evolved in recent years toward a more conservative approach. Current guidelines prioritize active surveillance over surgery and highlight the role of novel targeted therapies. The aim of this study was to evaluate how well real-world clinical practice in Spain aligns with this evidence.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted using an anonymous survey distributed to members of the Spanish Association of Surgeons (AEC). Initial management strategies according to tumor location and knowledge of tumor biology (spontaneous regression) and emerging therapies (cryoablation, nirogacestat) were analyzed, comparing outcomes between specialized and non-specialized centers.</div></div><div><h3>Results</h3><div>A total of 120 surveys were completed, with nationwide representation. Overall, surgery was the most common initial approach both for abdominal wall desmoids (72.5%) and for other locations (59.2%). Only 30% of respondents opted for active surveillance. Spontaneous regression was unknown to 48% of participants, cryoablation to 56.7%, and nirogacestat® to 70%. In contrast, when stratifying by surgeons from specialized centers, these percentages were almost reversed.</div></div><div><h3>Conclusions</h3><div>There is considerable variability and lack of knowledge regarding the initial management of desmoid tumors in Spain, with marked differences between specialized and non-specialized centers. Surgery remains the predominant option in non-specialized centers, contrary to current guideline recommendations. Given the complexity of modern desmoid tumor management, there is an urgent need to promote education and referral of these patients to specialized reference centers.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 7","pages":"Article 800333"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576119","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":"Letter to the Editor on the article Retrospective study on the age-related Delta Shock Index and the Glasgow Coma Score (dSIAG) as a prognostic scale for mortality in the polytrauma patient","authors":"Perla Arenas Guerrero,&nbsp;Cristhian Avilez Muñoz,&nbsp;Nicole Bazán Ravines","doi":"10.1016/j.cireng.2026.800293","DOIUrl":"10.1016/j.cireng.2026.800293","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 7","pages":"Article 800293"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101214","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":"Textbook outcomes in pancreatic surgery: a systematic review","authors":"A. Sánchez-Mayoral Moris,&nbsp;A. Sarriugarte Lasarte,&nbsp;J. Larrea Oleaga,&nbsp;H. Marín Ortega,&nbsp;J. Uriarte González,&nbsp;M. Albiz Segurola,&nbsp;B. Villota Tamayo,&nbsp;M. San Martín Murillo,&nbsp;R. Saa Álvarez","doi":"10.1016/j.cireng.2026.800315","DOIUrl":"10.1016/j.cireng.2026.800315","url":null,"abstract":"<div><div>Pancreatectomy is associated with high morbidity and mortality, making the evaluation of surgical outcomes essential. The textbook outcome in pancreatic surgery (TOPS) combines multiple quality metrics into a single composite endpoint, providing a more representative assessment of optimal surgical care.</div><div>Following PRISMA guidelines, a literature search was conducted for studies on postoperative TOPS after pancreatectomy, analyzing methodology, rates, associated factors, inter-hospital variability, and overall findings.</div><div>Of 82 publications identified, 18 observational studies were included, encompassing a total of 173.995 pancreatic resections. TOPS definitions were heterogeneous, and rates ranged from 17% to 70%. TOPS was associated with patient, hospital, and surgery-related factors.</div><div>This systematic review summarizes the contemporary international experience with TOPS as a patient-centered composite metric, suitable for quantifying “ideal” care and comparing outcomes among centers performing pancreatic surgery.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 7","pages":"Article 800315"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494920","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":"Aero-digestive fistula after esophagectomy: A challenging postoperative complication.","authors":"Ángela Santana Valenciano, Marta Cuadrado Ayuso, Gustavo Adolfo Díaz García, José María Fernández Cebrián, Julio Galindo Álvarez","doi":"10.1016/j.cireng.2026.800361","DOIUrl":"10.1016/j.cireng.2026.800361","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":" ","pages":"800361"},"PeriodicalIF":0.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148321079","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":"Shared decision-making and the management of surgical ignorance: A short proposal for classification.","authors":"Manuel López-Cano, José A Pereira Rodríguez, Josep M Garcia-Alamino","doi":"10.1016/j.cireng.2026.800362","DOIUrl":"10.1016/j.cireng.2026.800362","url":null,"abstract":"<p><p>Surgery is an irreversible, invasive intervention associated with immediate and long-term risks, which make surgical decision-making particularly complex. In recent decades, Shared Decision-Making (SDM) has emerged as the ethical and practical standard, replacing traditional paternalism and addressing the limitations of informed consent. However, the actual implementation of SDM in surgery faces a fundamental challenge: the inevitable presence of surgical ignorance. This article aims to analyze the role of ignorance in SDM and propose a brief conceptual classification to facilitate its identification, communication, and ethical management. Four types of surgical ignorance are described: ignorance based on known evidence (Type I), unpredictable ignorance (Type II), strategic ignorance (Type III), and ignorance due to unknown evidence (Type IV). We argue that an authentic SDM process should not be limited to the communication of probabilistic risks but should explicitly incorporate different forms of ignorance, tailoring decision-making to the patient's values, preferences, and goals.</p>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":" ","pages":"800362"},"PeriodicalIF":0.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148321151","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":"The TROPIS technique for complex anal fistula: A promising but still evolving approach","authors":"V.D. Yagnik ,&nbsp;P.R. Choudhary","doi":"10.1016/j.cireng.2025.800261","DOIUrl":"10.1016/j.cireng.2025.800261","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 6","pages":"Article 800261"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145598234","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}