Jordi Comajuncosas

Risk factors for umbilical trocar site incisional hernia in laparoscopic cholecystectomy: a prospective 3-year follow-up study.

BACKGROUNDnTrocar site incisional hernia (TSIH) is a common complication after laparoscopic cholecystectomy. The aim of this study was to evaluate the prevalence of TSIH and analyze the influence of several risk factors for this complication in a prospective series.nnnMETHODSnFrom 2007 to 2008, a prospective observational study with 3 years of follow-up was performed including all consecutive patients with cholelithiasis who underwent elective laparoscopic cholecystectomy. A multivariate analysis was performed to identify risk factors for TSIH.nnnRESULTSnOverall, 241 patients were included. During a median follow-up period of 46.8 months, 57 patients (25.9%) were diagnosed with umbilical TSIH by physical exam or ultrasound. The multivariate analysis revealed that incision enlargement (odds ratio [OR], 14.17; 95% confidence interval [CI], 3.61 to 55.51; P < .001), wound infection (OR, 5.62; 95% CI, 2.35 to 13.42; P < .001), diabetesxa0mellitus (OR, 2.79; 95% CI, 1.05 to 7.37; P = .0038), and obesity (OR, 2.71; 95% CI, 1.28 to 5.75; P = .009) contributed to the risk for developing a TSIH.nnnCONCLUSIONSnUmbilical TSIH is highly prevalent. This study identified several factors that could be useful to introduce preventive measures in high-risk patients.

Prospective analysis of clinician accuracy in the diagnosis of benign anorectal pathology: the value of clinical information

AIMnthe prevalence of anorectal disorders in general population is high. The aim of this study was to analyze the influence of clinical symptoms on diagnostic accuracy for benign anorectal pathology among different specialists and evaluate the relationship between diagnostic accuracy and years of professional experience.nnnMETHODSnseven typical cases were selected. In a first interview, participants were shown images and asked to make a diagnosis. Afterwards, images with additional information (clinical symptoms) were used. Two groups (group 1 = general surgeons and group 2 = medical specialists who attended emergency department) completed both phases of the study to analyze the influence of clinical symptoms on the final diagnosis.nnnRESULTSnforty four specialists were interviewed. The percentage of participants making a correct diagnosis in groups 1 and 2, respectively, was as follows: case 1 (perianal abscess): 100 vs. 80.6%, (p = 0.157); case 2 (fissure): 92.3 vs. 51.6% (p = 0.015); case 3 (thrombosed hemorrhoid): 92.3 vs. 74.2% (p = 0.321); case 4 (anal condyloma): 100 vs. 87.1% (p = 0.302); case 5 (rectal prolapse): 100 vs. 83.9% (p = 0.301); case 6 (prolapsed hemorrhoid): 92.3 vs. 29% (p = 0.001), and case 7 (fistula): 100 vs. 67.7% (p = 0.021). There were significant differences in the number of correctly diagnosed cases between groups (p < 0.001). Information about clinical symptoms significantly increased overall and specific accuracy. There was no correlation between experience and accuracy.nnnCONCLUSIONSnclinical symptoms are important for diagnostic accuracy in anorectal pathology. Training in anorectal pathology in medical specialists is warranted.

Trocar site incisional hernia in laparoscopic surgery

Trocar site incisional hernias (TSIH) are the most common complications in laparoscopic surgery. We have carried out a review of the literature with the aim of establishing their incidence, the reasons for them happening, and their prevention. After a search in the MEDLINE PubMed and PubMed CENTRAL data bases from 1991 to 2009, combining the words: hernia, laparoscopy and trocar, we obtained 545 articles, of which we analysed 60 of them. The incidence of TSIH varies between 0.18% and 2.8%. The diameter of the trocar, obesity and age play a fundamental role when proceeding to close the fascia, a closure which is the most important factor to prevent these incisional hernias appearing. The appearance of new laparoscopic material and the increasing more common closure of defects of the fascia means that new and more extensive prospective studies should be performed.

Eventración de los orificios de los trocares en cirugía laparoscópica

Trocar site incisional hernias (TSIH) are the most common complications in laparoscopic surgery. We have carried out a review of the literature with the aim of establishing their incidence, the reasons for them happening, and their prevention. After a search in the MEDLINE PubMed and PubMed CENTRAL data bases from 1991 to 2009, combining the words: hernia, laparoscopy and trocar, we obtained 545 articles, of which we analysed 60 of them. The incidence of TSIH varies between 0.18% and 2.8%. The diameter of the trocar, obesity and age play a fundamental role when proceeding to close the fascia, a closure which is the most important factor to prevent these incisional hernias appearing. The appearance of new laparoscopic material and the increasing more common closure of defects of the fascia means that new and more extensive prospective studies should be performed.

Effect of bag extraction to prevent wound infection on umbilical port site wound on elective laparoscopic cholecystectomy: a prospective randomised clinical trial

BackgroundLaparoscopic cholecystectomy is the gold standard treatment for gallbladder stones. Complications due to laparoscopic procedure are rare, but rate of wound infection in some studies is about 8xa0%. From January 2007 to December 2008, 320 laparoscopic cholecystectomies were performed at our hospital, and in 4.7xa0% of them, wound infection of the umbilical trocar was identified. We believe that this infection rate could be lower and that it is necessary to implement a new technique to reduce the wound infection. The aim of the study was to evaluate the benefits of bag extraction of gallbladder to prevent the wound infection.MethodsTwo-arm, parallel, 1:1, randomised controlled trial (ISRCTN38095251). All patients suffering from symptomatic gallbladder stones of low risk were enrolled for this study and were divided into two groups in basics gallbladder extraction: with (80 patients) or, as usually, without bag (76 patients). All patients with cholecystitis or accidental gallbladder perforation were excluded. We compared all the results to establish whether meaningful differences were found.ResultsThe final sample analysed (156 patients) consisted of 121 women and 35 men; there were 80 in the control group and 76 in the study group. There were 15 (9.6xa0%) diagnosed wound infections, eight cases in the study group and seven in the control group. There were no statistically significant differences.ConclusionsThe determinant of wound infection in elective laparoscopic cholecystectomy is not the direct contact of the gallbladder with the wound; therefore, bag extraction is not necessary.

Variación en las reclamaciones dirigidas a un Servicio de Cirugía General y del Aparato Digestivo tras un cambio estructural y funcional hospitalario

OBJECTIVEnThe complaints to a medical service are a measure of the quality of health care perceived by the patients. The aim of this study was to analyse the differences found in the percentage of complaints made to the General and Gastrointestinal Surgery Department (GGSD) with the changes made due to moving to a new hospital.nnnMATERIAL AND METHODSnA longitudinal study of the percentage of complaints made to the GGSD in two 6 month periods in the same year (periods A and B). The Department was moved to a new hospital between the two periods. The percentage complaints associated with the hospital and outpatient activity is compared.nnnRESULTSnThe percentage complaints made to the GGSD was 3.02% directed at the hospital service and 0.44% to outpatient care. When both periods were compared, a statistically significant difference was observed in the hospital complaints (A: 3.74% vs B: 2.20%, P=.006) and in the outpatient complaints (A: 0.53% vs. B: 0.34%, P=.005). It could also be shown that there was a continuous significant correlation in the parallel decrease in the hospital and outpatient complaints (R:0.988 P<.001).nnnCONCLUSIONSnThe structural and functional change due to moving to a new hospital showed that the percentage of complaints made to the GGSD changed significantly in the period studied. Prospective multicentre studies are required to evaluate whether these results can be extrapolated to other services.

Return to work after general surgery: A comparative study

PURPOSESnThere is scarce information on the time to return to work after general surgery. The aim of this study was to analyze time off work after elective cholecystectomy and to compare the results with those in patients undergoing other surgical interventions.nnnMETHODSnObservational and comparative study. Inclusion criteria were: being of working age and undergoing elective laparoscopic cholecystectomy (group 1) or unilateral inguinal hernia or haemorrhoidectomy (group 2).nnnRESULTSn36 patients were included: 18 patients in each group. Overall, return to work occurred at a mean of 35.7 days, with no significant differences (p=0.656) between groups (group 1: 36.6 days vs. group 2: 35.44 days). The reasons for not returning to work earlier were fear of complications (37.5%), pain control (37.5%), surgeon recommendation (12.5%), and general practitioner recommendation (12.5%).nnnCONCLUSIONSnTime to recovery after laparoscopic cholecystectomy is prolonged. No statistically significant differences with less complex surgical procedures were detected.

Lesion quistica de pancreas con antecedentes de traumatismo abdominal hace 20 años

A 35-year-old male came to the Emergency Department with epigastric pain and fever. On abdominal CT (Fig. 1), a cystic lesion suggestive of lymphangioma was observed. The lesion was diagnosed intraoperatively as a pancreatic pseudocyst, and a cyst jejunostomy was performed. At a later date, we were provided with a CT of the patient taken after a previous abdominal trauma caused by bicycle handlebars (Fig. 2), where a small pancreatic lesion was observed. Traumatic pancreatic injuries are rare (2%–4%) and can have serious complications. One possible complication is the formation of pseudocysts; diagnosis requires knowledge of the patient’s prior history of trauma. The amount of time elapsed since the injury and the fact that the previous CT was not available hindered the preoperative diagnosis. With an earlier diagnosis, endoscopic treatment could have been performed. c i r e s p . 2 0 1 3 ; 9 1 ( 2 ) : e 7