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Introduction: despite significant medical and technological advances, the incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) is reported to be between 3-45 %. The main objective of this study was to analyze the early post-surgical risk factors for developing POPF after DP., Material and Methods: a retrospective observational study was performed on a prospective basis of patients undergoing DP in a tertiary hospital from January 2011 to December 2021. Sociodemographic, preoperative analytical, tumor-related and postoperative complications variables were analyzed., Results: of the 52 patients analyzed, 71.8 % of the sample had postoperative drains amylase elevation. However, 25.7 % of the total had grade-B and/or grade-C POPF. Univariate logistic regression with the variables studied showed the following as risk factors for B-C or clinically relevant POPF: amylase values in drainage at the 5th postoperative day (POD) (p = 0.097; 1.01 [1-1.01]), preoperative BMI (p = 0.015; 1.27 [1.04-1.55]) and C-reactive protein (CRP) value at the 3rd POD (p = 0.034; 1.01 [1.01-1.02]). The ROC curve of CRP value at the 3rd POD showed an area under the curve of 0.764 (95 % CI: 0.6-0.93) and the best cut-off point was 190 mg/l (sensitivity 89 % and specificity 67 %)., Conclusions: CRP value at the 3rd POD is a predictive factor for POPF after DP. Early detection of patients at risk of POPF based on these characteristics could have an impact on their postoperative management.

Anecdotal evidence suggests that community infection control measures during the COVID-19 outbreak have modified the number and natural history of acute surgical inflammatory processes (ASIP-appendicitis, cholecystitis, diverticulitis and perianal abscesses) admissions. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation and treatment ASIP and quantify the effect of COVID-19 infection on the outcomes of ASIP patients. This was a multicentre, comparative study, whereby ASIP cases from 2019, 2020 and 2021 (March 14th to May 2nd) were analyzed. Data regarding patient and disease characteristics as well as outcomes, were collected from sixteen centres in Madrid, and one in Seville (Spain). The number of patients treated for ASIP in 2019 was 822 compared to 521 in 2020 and 835 in 2021. This 1/3rd reduction occurs mainly in patients with mild cases, while the number of severe cases was similar. Surgical standards suffered a step back during the first wave: Lower laparoscopic approach and longer length of stay. We also found a more conservative approach to the patients this year, non-justified by clinical circumstances. Luckily these standards improved again in 2021. The positive COVID-19 status itself did not have a direct impact on mortality. Strikingly, none of the 33 surgically treated COVID positive patients during both years died postoperatively. This is an interesting finding which, if confirmed through future research with a larger sample size of COVID-19 positive patients, can expedite the recovery phase of acute surgical services., (© 2021. The Author(s).)

Introduction: Up to 40% of all initial operations for soft tissue sarcoma (STS) are unplanned, which would leave residual macroscopic tumor in more than 50% of the cases. The effect this has on local recurrence rate, metastases rate and survival has never been fully established, due to the lack of randomized studies., Methods: Retrospective review of patients with STS treated in our unit between January 2001-January 2016. We classified them whether they had been treated by initial planned or unplanned operation. Outcomes were compared in both groups globally and stage-matched. Endpoints were local recurrence and distant metastases., Results: Twenty-three patients of STS underwent a planned excision and 16 an unplanned excision, 13 of them underwent further re-excision. 40% of patients with planned excision had an advanced stage in regard to the unplanned excision group which presented earlier stages. 77% of patients with unplanned excision had residual tumor identified after surgical re-excision. Local recurrence rate in the unplanned excision group was considerably higher 73,5% vs. 43,8%. Metastases rate was lower in planned excision group, 45,5% vs 56,3% (P > .05). The recurrence pattern in the unplanned excision group was unstable, with worse outcomes in earlier stages., Conclusion: The unplanned excision of a soft tissue sarcoma may compromise disease local control, with higher rates of local recurrence and metastases, and worse functional out- comes, despite further oncological treatment. We need to recognize the clinical features for malignancy risk in soft tissue lumps for a safe diagnosis to avoid inadequate resections., (Copyright © 2019 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Esophageal perforation constitutes a surgical emergency. Despite its gravity, no single strategy has been described as sufficient to deal with most situations to date. The aim of this study was to assess the etiology, management, and outcome of esophageal perforation over a 28-year period, to characterize optimal treatment options in this severe disease. A retrospective clinical review of all patients treated for esophageal perforation at Ramón y Cajal Hospital between January 1987 and December 2015 was performed (n = 57). Iatrogenic injury was the most frequent cause of esophageal perforation (n = 32). Abdominal esophagus was the main location (23 patients; 40.4%). Eight patients (14%) were managed with antibiotics and parenteral nutrition. In seven patients (12.3%), an endoscopic stent was implanted. Surgical therapy was performed in 38 patients (66.7%). Morbidity and 90-day mortality rates were 61.4 and 28 per cent, respectively. Five patients were reoperated (8.8%). Median hospital stay was 23.5 days. The mortality rate was higher among patients with spontaneous and tumoral perforation (54.5 and 100%; P = 0.009), delayed diagnosis (>24 hours; P = 0.0001), and abdominal/thoracic location (37.5%; P = 0.05). No statistical differences were found between surgical and conservative/endoscopic management (31% vs 20%; P = 0.205) although hospital staying was longer in surgical group (36.30 days vs 15.63 days; P = 0.029). Esophageal perforation was associated with high morbidity and mortality rates. Global outcomes depend on etiology, site of perforation, and delay in diagnosis. An individualized approach for each patient should be chosen to prevent septic complications of this potentially fatal disease.

The treatment of rectal cancer has evolved over the last few decades from surgery alone to treatments with trimodal therapy for high-risk patients. The involvement of a multidisciplinary team of radiologists, pathologists, surgeons, radiotherapists and medical oncologists is now fundamental for decision-making and outcomes. The evolution of different diagnostic and therapeutic techniques has optimised the therapeutic rate. Future studies will determine the optimal regimen for inducing complete responses in locally advanced disease and whether the intensification of local treatments could enable the use of more conservative treatments, as for other tumour locations. The study of biomarkers will be essential in this respect.

Introduction: The aim of the study is to try and find out the state of surgical training in Spain and to determine whether it meets the objectives of the Program., Material and Methods: The results of two surveys carried out on Residents and General Surgery Tutors by the Spanish Surgeons Association, based on the conclusions of the XXVII Congreso Nacional de Cirugía. The questions formulated referred to general aspects of the Service and specific ones related to access, teaching activity, surgery, research and personal perspectives. The responses were defined, adjusted and categorised as quantitative and qualitative variables. The statistics program G Stat 2.0 was used for processing and the descriptive presentation of the results., Results: The surveys were sent to 626 Residents and 142 Tutors, with a response rate of 19% and 29%, respectively. First year residents predominated (32%) compared to later years, with an R-5 response index of 7.2%. A total of 91% knew the speciality Program well, and 76% were satisfied with the training received., Conclusions: The results obtained as regards surgical activity agree with those established in the Program, both in the number of procedures and in their progression throughout the Residency, although it is not possible to ensure its uniformity. The functions and accreditation of the Tutors which are one of the main foundations of the training process are pending specific regulations.

Objective: To assess the results of percutaneous transparieto-hepatic dilation of benign biliary stenosis achieved over a period of 5 years., Design: A retrospective study to assess the technique, complications and the clinical, analytical and radiology results., Patients: Data was gathered on 13 patients diagnosed in our Hospital between the years 2002 and 2006 with benign biliary stenosis and who had been treated using percutaneous dilation. Patients diagnosed with malignant disease and those who had a prosthesis were excluded. Seven of the patients had received a liver transplant. One patient had an endoscopic dilation on two occasions, with the stenosis persisting., Results: A clinical and radiological improvement was observed in 60% of the cases, and an analytical improvement in 69% (61% normal). Re-stenosis occurred in 30% of the cases, of which 50% were rescue support using re-dilation. The complications presented (30.7%) were resolved conservatively. No significant differences were observed between the transplanted and the non-transplanted groups., Conclusions: Transparieto-hepatic dilation of benign biliary stenosis is a fairly safe technique and has a high rate of resolution in the medium term, and avoids the use of surgery in 75% of patients. The results need to be confirmed in larger samples., (Copyright 2009 AEC. Published by Elsevier Espana. All rights reserved.)

Colon surgery comprises a high number of patients treated in a gastrointestinal surgery department. Like any major surgery, it may present diverse surgical and medical postoperative complications. In this article we review the most frequent surgical complications of colon surgery: abdominal sepsis, postoperative ileus, bleeding, fistula, evisceration, ureteral lesion, colostomy problems and damage to upper mesenteric vessels. Every colorectal surgeon must know all the possible complications of colon surgery to achieve an early diagnosis and correct management.

On 8 may 2007, the Official Bulletin (BOE) published the new Specialist Training Program. The Post-Graduate Training Section of the Spanish Surgeons Association (AEC), conscious of the importance of this situation, has carried out a reflective analysis of this Program and proposes a series of objectives. The new plan coordinates a training program that sets out three general objectives as regards, knowledge, skills and attitudes that the resident must assimilate and develop, it strictly defines the final product, without substantially changing the previous program and emphasises two fundamental aspects: training in minimally invasive surgery and research training, although the inclusion of previously unpublished new rotations and the continuation of the current assessment model. The logic in the definition of general surgery as "a major discipline paradigm" should lead to important structural changes. Aspects such as regulating work and training times, European Directives, lack of professional motivation and changes in the vocational spectrum of new residents, will make the optimisation of the results difficult a priori. The year 2017 will be the time to judge the results after five groups of surgeon graduates have been trained by this program.

Pelvic lipomatosis is a rare disease of unknown etiology characterized by benign proliferation of fat in the pelvis. We describe a 27-year-old man with pelvic and retroperitoneal lipomatosis causing a severe urinary and fecal obstruction. The diagnosis was evaluated by barium enema, intravenous urogram, computerized tomography and magnetic resonance imaging. The therapeutic approach is described and discussed.

Introduction: Transrectal ultrasound is a useful exploration in the assessment of local spread of rectal tumors., Aim: The aim of this study has been the knowledge of the results of transrectal ultrasound in perirectal abscesses., Patients and Methods: Forty patients suffering from perianal septic disease were examined with endoanal echography before surgical approach. The endorectal probe used was initially of 5 MHz and in the last 25 patients of 7.5 MHz., Results: The examination could not be done in 8 patients because severe pain originated by the introduction of the probe in the anal canal. The echographic findings show the exact location and extension of the abscesses as confirmed by the surgical exploration. In three patients we suspected a perirectal abscess due to fever and anal pain but the anal exploration was normal; the ultrasonography showed the collection in all patients and two of them were treated by echoguided drainage., Conclusions: Transrectal ultrasonography localizes and defines the extension of perirectal abscesses. It is a very important diagnostic and therapeutic tool in patients with clinical presumption, but not confirmation, of what kind of abscesses.

Objects: A retrospective study on patients operated on for intestinal ischemia., Patients and Methods: We have carried out a retrospective study on 21 patients suffering from intestinal embolism, in whom an embolectomy was performed at the origin of the superior mesenteric artery. The diagnosis was based on angiography in 12 patients before operation. In the other nine patients the diagnosis was confirmed during operation., Results: After embolectomy the viability of the gut was achieved in 43% of patients (100% if the duration of the symptomathology was less than 12 hours, 56% if it was between 12 and 24 hours, and 18% if it was more than 24). The mortality correlated with the duration of the symptoms. Overall mortality was 57%., Conclusions: The only way to improve the survival rate is to obtain an early diagnosis, which could be achieved by performing a mesenteric angiography on all patients with sudden and vague abdominal pain and with a history of cardiovascular disease.