Cirugia espanola最新文献

{"title":"Results of manual colo-anal anastomosis for lower rectal cancer. A multicenter cohort study","authors":"Loris Trenti ,&nbsp;David Merino ,&nbsp;Esther Kreisler ,&nbsp;Marcos Gómez ,&nbsp;Nuria Ortega ,&nbsp;Xavier Serra ,&nbsp;Mónica Millan ,&nbsp;Ariadna Cidoncha ,&nbsp;Ana Navio ,&nbsp;Oriana Barrios ,&nbsp;Claudio Lazzara ,&nbsp;Ramon Farres ,&nbsp;Blas Flor ,&nbsp;Bernat Miguel ,&nbsp;Sebastiano Biondo","doi":"10.1016/j.cireng.2026.800314","DOIUrl":"10.1016/j.cireng.2026.800314","url":null,"abstract":"<div><h3>Introduction</h3><div>Manual colo-anal anastomosis (ACAm) is a technique used in patients with lower rectal cancer who are candidates for sphincter-preserving surgery when mechanical anastomosis is not feasible. Long-term outcomes, particularly regarding anastomotic failure and functional results, remain limited. This study analyzes the outcomes achieved with this technique.</div></div><div><h3>Methods</h3><div>Retrospective multicenter study of a cohort of 155 patients with ACAm between 2009 and 2018. The study included 116 cases of conventional ACAm (CAAW) and 39 with two-stage technique (TCA). The primary objective was to analyze stoma-free survival. Secondary objectives included analysis of short-term and long-term complications, oncological, functional, and quality of life outcomes.</div></div><div><h3>Results</h3><div>The median follow-up was 4.8 years. Postoperative morbidity at short- and long-term was 52.3% and 35.5%, respectively. Five-year stoma-free survival was 75.4%, with ACAm-related complications (HR 4.97; 95% CI: 2.04–12.09) and M1 status at diagnosis (HR 3.84; 95% CI: 1.56–9.43) identified as predictive factors for anastomotic failure and permanent stoma. Five-year overall survival and disease-free survival were 89.1% and 79.7%, respectively. Functional questionnaires showed that 19.1% (95% CI: 10.9–26.1) of patients had normal bowel function, 41.5% (95% CI: 33.4–53.2) had moderate function, and 38.3% (95% CI: 30.4–49.9) had poor function.</div></div><div><h3>Conclusions</h3><div>ACAm presents acceptable oncologic outcomes. Defecatory function is suboptimal in a significant proportion of patients, and one in four will require a stoma, highlighting the need for careful patient selection and individualized preoperative counseling.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 6","pages":"Article 800314"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494939","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 stepwise approach to totally robotic pancreas-sparing duodenectomy with intracorporeal duodenojejunostomy","authors":"Giuseppe Serena ,&nbsp;Naib Chowdhury ,&nbsp;Gary Bernard Deutsch ,&nbsp;Sandeep Anantha Sathyanarayana","doi":"10.1016/j.cireng.2025.800273","DOIUrl":"10.1016/j.cireng.2025.800273","url":null,"abstract":"<div><div>While pancreaticoduodenectomy is the standard for duodenal malignancy, pancreas-sparing duodenectomy (PSD) is a surgical option for benign duodenal disease. Robotic surgery for PSD offers advantages, such as enhanced visualization, improved instrument dexterity, and optimized dissection, while maintaining resection quality. After preoperative imaging review, we performed a totally robotic PSD with intracorporeal duodenojejunostomy in a 70-year-old patient with a 2.2-cm sessile polyp and dysplasia in the D3 portion of the duodenum. Although PSD is not indicated for malignancy, a negative intraoperative frozen section is critical before proceeding in select cases. A key learning point is combining robotic visualization with upper endoscopy to accurately define the distance between the ampulla and the lesion, ensuring oncologic margins. This manuscript outlines a stepwise surgical approach in a technically challenging scenario, aiming to preserve patient safety and provide an oncologically sound resection using totally robotic techniques.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 6","pages":"Article 800273"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752456","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":"Comparison between robotic-assisted cholecystectomy and laparoscopic cholecystectomy using a systematic registry of adverse events. Is the robotic approach safe?","authors":"Núria Llorach-Perucho ,&nbsp;Natalia Bejarano-Gonzalez ,&nbsp;Neus García-Monforte ,&nbsp;Andreu Romaguera-Monzonis ,&nbsp;Anna Nonell-Amill ,&nbsp;Pau Farré-Alins ,&nbsp;Laura Mora-López ,&nbsp;Francisco Javier García-Borobia","doi":"10.1016/j.cireng.2026.800331","DOIUrl":"10.1016/j.cireng.2026.800331","url":null,"abstract":"<div><h3>Background</h3><div>Robotic-assisted cholecystectomy (RC) is a minimal invasive surgery technique. It is not available at every hospital, and higher complication rates have been described in larger series.</div></div><div><h3>Methods</h3><div>A prospective and descriptive study of patients with only elective cholecystectomies since the implementation of robotic surgery at our institution. Patients with urgent procedures were excluded.</div><div>Primary endpoint: to compare postoperative complications between laparoscopic cholecystectomies (LC) and RC. Secondary endpoint: to determine the existence of differences between both groups in demographic, surgical and postoperative variables.</div></div><div><h3>Results</h3><div>Between March 2022 and November 2024, 391 patients underwent cholecystectomy (75.7% LC, 24.3% RC). Three LC were converted to open surgery, and 9 patients were readmitted (7-LC, 2-RC). Only one patient was reoperated.</div><div>Median operative time (in minutes) was significantly longer (<em>P</em> = .001) in RC than LC (73 vs 59). Although the console time in RC was shorter (66) the difference was still significant (<em>P</em> = .02).</div><div>There were no significant differences in hospital stay or the CCI (Comprehensive Complication Index). However, significant differences in Clavien Dindo were found in favor of RC (<em>P</em> = .042) (LC: 3 IIIa, one IVa, RC: one IIIa, one IVa). There were 4 abscesses (3 LC, one RC) and 2 biliary fistulas in LC (one drained percutaneously, one reoperated). In the RC group, one patient presented myocardial infarction and another residual choledocholithiasis.</div></div><div><h3>Conclusions</h3><div>RC needs a longer operative time but seems to be as safe as LC in terms of the number of adverse events. It can be considered a safe technique for cholecystectomies.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 6","pages":"Article 800331"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147535208","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":"Intraoperative management of iatrogenic bile duct injury during robotic Whipple procedure","authors":"Aram Rojas ,&nbsp;Sarah B. Hays ,&nbsp;Syed Mehdi ,&nbsp;Melissa E. Hogg","doi":"10.1016/j.cireng.2026.800300","DOIUrl":"10.1016/j.cireng.2026.800300","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 6","pages":"Article 800300"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044505","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":"Epiploic efferent loop colostomy prolapse","authors":"José Richard Tenazoa-Villalobos ,&nbsp;Edgar Fermín Yan-Quiroz","doi":"10.1016/j.cireng.2026.800317","DOIUrl":"10.1016/j.cireng.2026.800317","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 6","pages":"Article 800317"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494903","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":"Pseudoaneurysm of the cystic artery: A rare complication","authors":"Jordi Seguí Orejuela ,&nbsp;Juan Jesús Rubio ,&nbsp;Celia Villodre ,&nbsp;María Marco ,&nbsp;José M. Ramia","doi":"10.1016/j.cireng.2026.800275","DOIUrl":"10.1016/j.cireng.2026.800275","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 6","pages":"Article 800275"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949527","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":"Dexketoprofen-mediated attenuation of ischemia-reperfusion injury in a rat model of lower limb ischemia","authors":"Pablo Martínez-Rubio ,&nbsp;Ignacio García-Alonso ,&nbsp;Amador García Ruiz de Gordejuela ,&nbsp;Daniel Alonso-Alconada ,&nbsp;Sira Iturrizaga ,&nbsp;Iñigo Cearra ,&nbsp;Inmaculada Ruiz-Montesinos ,&nbsp;Borja Herrero de la Parte","doi":"10.1016/j.cireng.2026.800302","DOIUrl":"10.1016/j.cireng.2026.800302","url":null,"abstract":"<div><div>Lower limb ischemia/reperfusion injury (IRI-LL) triggers a systemic inflammatory response after restoring blood flow to an ischemic limb. This study evaluated whether dexketoprofen (DEX) given before reperfusion mitigates IRI-LL. Fifty-six male WAG/RijHsd rats were assigned to one control, 3 vehicles, and 3 DEX-treated groups. After 3 h of hindlimb ischemia, reperfusion lasted 3 h, 24 h, or 14 days. Either DEX (1 mg/kg, po) or saline was administered 30 min before reperfusion. Biochemical markers, limb circumference, and motor performance (rotarod and treadmill) were assessed. DEX significantly reduced serum markers of muscle and hepatic injury but had no effect on renal parameters or edema. Functional recovery improved from day 5 onwards in treated animals. Prophylactic DEX administration effectively attenuated biochemical and functional damage secondary to IRI-LL, supporting its potential as a protective therapy against reperfusion injury.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 6","pages":"Article 800302"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146198370","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":"Analysis of the national situation of right hemicolectomy with complete mesocolic excision in ascending and proximal traverse colon cancer","authors":"Mayra Rebeka Abad Camacho ,&nbsp;Marta Jiménez-Toscano ,&nbsp;Álvaro García-Granero ,&nbsp;Sandra Alonso-Gonçalves ,&nbsp;Silvia Salvans ,&nbsp;Clara Tellez ,&nbsp;Blanca Montcusí Ventura ,&nbsp;Marta Pascual Damieta","doi":"10.1016/j.cireng.2026.800313","DOIUrl":"10.1016/j.cireng.2026.800313","url":null,"abstract":"<div><h3>Introduction</h3><div>Complete mesocolic excision (CME) has been associated in some series with lower local recurrence and improvements in selected oncological outcomes in colon cancer, based on preservation of mesocolic integrity and central vascular ligation. In contrast, D3 lymphadenectomy (D3-LND) involves resection of lymphoadipose tissue adjacent to the superior mesenteric vein. Although both concepts coexist, they are not equivalent, which hampers outcome comparison and contributes to heterogeneity in clinical practice. In Spain, the extent of CME implementation has not been well characterized.</div></div><div><h3>Methods</h3><div>A descriptive cross-sectional study was conducted using an online survey addressed to Spanish centers performing oncological colon surgery. The questionnaire collected information on training pathways, surgical indication, technical approach, preoperative radiological planning, pathological assessment of the specimen, and the availability and recording of perioperative morbidity and long-term oncological follow-up.</div></div><div><h3>Results</h3><div>A total of 67 centers from across the country responded, 79% of which reported having a colorectal surgery unit. CME/D3-LND was performed in 52.2% of centers. Training was mainly based on literature review (49%) and mentorship (34.5%). Preoperative vascular anatomy was not systematically assessed in 61% of centers. Although 62% had pathologists specialized in colorectal cancer, only 18% had received specific training in CME. Approximately half of the respondents reported not having detailed information on procedure-related morbidity, and 86% did not know their long-term oncological outcomes.</div></div><div><h3>Conclusions</h3><div>CME implementation in Spain is heterogeneous and lacks uniform standardization regarding multidisciplinary training, preoperative planning, and pathological assessment. Despite the limitations inherent to a voluntary survey, this study provides a first national overview and highlights the need for consensus-based definitions and structured, multidisciplinary training programs to support a safer and more homogeneous implementation of CME.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 6","pages":"Article 800313"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147492298","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":"One-year outcomes by index treatment in older patients with acute cholecystitis. Protocol of the international, prospective, observational GOLDENEYE study","authors":"Núria Lluís ,&nbsp;Sara Pérez-Brotons ,&nbsp;Isabel de Castro ,&nbsp;Belén Martínez ,&nbsp;José R Aparicio ,&nbsp;Pedro Zapater ,&nbsp;Fèlix Lluís ,&nbsp;Enrique de-Madaria","doi":"10.1016/j.cireng.2025.800282","DOIUrl":"10.1016/j.cireng.2025.800282","url":null,"abstract":"<div><h3>Background</h3><div>This research project is motivated by the increasing prevalence of gallstones and biliary tract diseases in patients of advanced age, while also recognizing that the comorbidity burden of this population may necessitate a tailored treatment approach. Acute cholecystitis can rapidly progress to systemic inflammatory response syndrome, sepsis and even death. Age <em>per se</em> has no bearing on the severity of acute cholecystitis, but the burden of comorbidity in older patients may lead to rapid disease progression.</div></div><div><h3>Methods</h3><div>The GOLDENEYE study is an international, multicenter, prospective, observational research project designed to compare the outcomes of different management strategies for acute cholecystitis in seniors. The primary aims are to evaluate the efficacy of different treatments—supportive care, percutaneous gallbladder drainage, early or delayed cholecystectomy, and EUS-guided gallbladder drainage—on one-year additional treatment modalities, hospital readmissions, and outpatient care. Secondary outcomes are quality of life and survival rates. The study implements propensity score matching analysis to account for the non-randomized allocation of treatment modalities. Patients ≥ 70 years diagnosed with acute cholecystitis, as per the Tokyo guidelines, are included. Exclusion criteria include prior episodes of cholecystitis or pancreatitis, terminal illness, and concurrent diagnosis of acute pancreatitis, cholangitis, bile duct disease, or digestive malignancy. Data collection is performed with the REDCap platform for data entry and monitoring.</div></div><div><h3>Discussion</h3><div>The GOLDENEYE study aims to generate evidence-based insights that will significantly influence the management of acute cholecystitis in elderly patients, ultimately improving patient outcomes and healthcare practices in this growing demographic population. ClinicalTrials.gov, NCT07006298.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 6","pages":"Article 800282"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835491","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":"Green light for safer biliary surgery: The expanding role of fluorescent cholangiography","authors":"Jaime López-Sánchez ,&nbsp;José E. Quiñones Sampedro ,&nbsp;Pedro A. Montalbán Valverde ,&nbsp;Luis M. González Fernández ,&nbsp;Manuel J. Iglesias Iglesias ,&nbsp;María C. Esteban Velasco ,&nbsp;Francisco Blanco Antona","doi":"10.1016/j.cireng.2026.800278","DOIUrl":"10.1016/j.cireng.2026.800278","url":null,"abstract":"<div><div>Near-infrared fluorescent cholangiography (NIFC) has emerged as a promising technique in laparoscopic cholecystectomy (LC), enabling accurate anatomical identification of the biliary tract. Its use has been associated with improved visualisation of critical structures, reduced incidence of complications, lower conversion rates to open surgery, and shorter operative times and hospital stays. Key advantages include its easy integration into routine practice, a short learning curve, and straightforward interpretation of images, provided that appropriate protocols are followed. Nevertheless, several limitations currently hinder its widespread standardization. The absence of high-quality evidence prevents consensus on the optimal indocyanine green dose and timing of administration, while the need for specialized imaging systems restricts universal adoption. Future research should focus on defining uniform protocols, validating their impact on LC outcomes, and consolidating the role of NIFC as an intraoperative reference technique for enhancing safety and efficiency in biliary surgery.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"104 6","pages":"Article 800278"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949522","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}