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Bellido-Luque J, Bellido-Luque A, Gomez-Rosado JC, Gomez-Menchero J, Suarez-Grau JM, Licardie E, Tejada-Gomez A, Navarro-Morales L, Moreno-Suero F, Sanchez-Matamoros I, Capitán-Morales L, Nogales Muñoz A, Morales-Conde S. Full endoscopic minimally invasive extraperitoneal modified Sugarbaker approach for para-colostomy hernia repair: Technical aspects and 2-year follow-up results of a prospective cohort. Colorectal Dis 2023; 25:2033-2042. [PMID: 37712246 DOI: 10.1111/codi.16734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/11/2023] [Accepted: 07/09/2023] [Indexed: 09/16/2023]
Abstract
AIM This study aimed to assess technical aspects and clinical results of a new minimally invasive technique in parastomal hernia (PSH) repair, full endoscopic retromuscular access, after 2 years of follow-up. METHODS Data from consecutive patients requiring minimally invasive ventral PSH repair were collected from 2019 to 2022. The inclusion criteria were patients aged between 18 and 80 years old with symptomatic PSH. Demographics and perioperative and postoperative data were collected. Postoperative pain and functional recovery were compared with preoperative data. RESULTS Twelve patients with symptomatic PSH were included. The mean PSH defect area was 16.2 cm2 and the mean midline defect was 8.7 cm2 . No intra-operative complications or conversion to open surgery were detected. One patient (8%) required postoperative readmission due to partial bowel obstruction symptoms that required catheterization of the stoma. Pain significantly worsened after the first postoperative day compared to preoperative data but improved after the first postoperative month compared to the first postoperative week and after the 90th postoperative day compared to the first postoperative month, with significant differences. Significant restriction improvement was identified when 30 days after surgery data were compared to preoperative data and when the 180th postoperative day results were compared to 30 days after surgery. The average follow-up was 29 months. During the follow-up no clinical or radiological recurrence was observed. CONCLUSION This paper shows low rate of intra- and postoperative complications with significant improvement in terms of pain activities restriction compared to preoperatory. After 29 months follow-up, no recurrence was identified, confirming that this approach offers good mid-term results.
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Affiliation(s)
- Juan Bellido-Luque
- Minimally Invasive Surgery, QuironSalud Sagrado Corazón Hospital, Seville, Spain
- Gastrointestinal Surgical Department, Virgen Macarena Hospital, Seville, Spain
| | | | | | - Julio Gomez-Menchero
- Minimally Invasive Surgery, QuironSalud Sagrado Corazón Hospital, Seville, Spain
| | | | - Eugenio Licardie
- Minimally Invasive Surgery, QuironSalud Sagrado Corazón Hospital, Seville, Spain
| | - Antonio Tejada-Gomez
- Minimally Invasive Surgery, QuironSalud Sagrado Corazón Hospital, Seville, Spain
| | | | | | | | | | - Angel Nogales Muñoz
- Gastrointestinal Surgical Department, Virgen Macarena Hospital, Seville, Spain
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Bellido-Luque J, Gomez-Rosado JC, Bellido-Luque A, Matamoros IS, Muñoz AN, Mompeán FO, Conde SM. Severe rectus diastasis with midline hernia associated in males: high recurrence in mid-term follow-up of minimally invasive surgical technique. Hernia 2022; 27:335-345. [PMID: 36454301 DOI: 10.1007/s10029-022-02706-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/01/2022] [Indexed: 12/03/2022]
Abstract
PROPOSE The present study aimed to assess clinical results, in terms of postoperative pain, functional recovery and recurrence rates of FESSA (Full Endoscopic Suprapubic Subcutaneous Access) technique compared to endoscopic anterior rectus sheaths plication and mesh, in male patients with midline ventral or incisional hernias and severe rectus diastasis (SRD) associated. Secondary aims were to identify intra- and postoperative complications associated with each technique. METHODS Male patients with midline ventral or incisional hernia and severe rectus diastasis were included in a prospectively maintained databased and retrospectively analyzed from January 2017 to December 2020. From January 2017 to January 2019, male patients underwent to anterior rectus sheaths plication (ARSP) (Control group). From January 2019 to December 2020, male patients underwent to FESSA technique (FT) (Case group). RESULTS 53 patients were finally included. 28 patients (52%) underwent to FT and 25 patients (48%) to ARSP. Regarding intraoperative complications, no significant differences were identified between the groups. Hospital stay was significantly improved in FT group when compared to ARSP group. No significant differences in terms of postoperative seroma or hematomas, were shown. FT group showed significantly less pain on 1st, 7th and 30th postoperative days than ARSP group. Functional recovery was significantly improved in FT group compared to ARSP group on the 30th day and no differences were observed on the 180th day after surgery. The mean follow-up was 17.3 ± 2.6 months in FT group and 24 ± 3 months in ARSP group. During the follow-up, 1(3%) and 9 (36%) diastasis recurrences were identified respectively, with significant differences in favor of FT group. CONCLUSION In males with SRD and symptomatic midlines hernias, ARSP with onlay mesh placement shows high diastasis recurrence rate in mid-term follow-up. We propose FESSA technique in those patients, which decreases the excessive midline tension, improving the postoperative pain, functional recovery and recurrence rate, without increasing postoperative complications.
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Affiliation(s)
- J Bellido-Luque
- Minimally Invasive Gastrointestinal Surgery, General and Digestive Surgical Department, Virgen Macarena Hospital, Seville, Spain.
- Gastrointestinal Surgical Department, QuirónSalud Sagrado Corazón Hospital, Seville, Spain.
| | - J C Gomez-Rosado
- Minimally Invasive Gastrointestinal Surgery, General and Digestive Surgical Department, Virgen Macarena Hospital, Seville, Spain
| | - A Bellido-Luque
- Gastrointestinal Surgical Department, QuirónSalud Sagrado Corazón Hospital, Seville, Spain
| | - I Sanchez Matamoros
- Minimally Invasive Gastrointestinal Surgery, General and Digestive Surgical Department, Virgen Macarena Hospital, Seville, Spain
| | - A Nogales Muñoz
- Minimally Invasive Gastrointestinal Surgery, General and Digestive Surgical Department, Virgen Macarena Hospital, Seville, Spain
| | - F Oliva Mompeán
- Minimally Invasive Gastrointestinal Surgery, General and Digestive Surgical Department, Virgen Macarena Hospital, Seville, Spain
| | - S Morales Conde
- Gastrointestinal Surgical Department, QuirónSalud Sagrado Corazón Hospital, Seville, Spain
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Valdes-Hernandez J, Cintas-Catena J, Del Rio-Lafuente FJ, Cano-Matias A, Torres-Arcos C, Perez-Sanchez A, Capitan-Morales L, Oliva-Mompean F, Gomez-Rosado JC. Initial experience with intraoperative testing and repair of colorectal anastomosis using a TAMIS approach after a positive leak test. Tech Coloproctol 2022; 26:901-904. [PMID: 35727427 DOI: 10.1007/s10151-022-02635-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/30/2022] [Indexed: 11/29/2022]
Abstract
Anastomotic leak is one of the most feared complications of colorectal anastomosis. Different techniques have been described for intraoperative testing of anastomotic integrity. These include air insufflation, methylene blue and endoscopic visualisation. If an anastomotic leak is identified intraoperatively, there are various management options. Redo anastomosis is a possibility, but may be difficult in some cases. Defunctioning is another option, but there is an associated morbidity and signficant detrimental effect on quality of life. Direct transanal repair is only possible when a low anastomosis has been performed. When the anastomotic leak occurs high in the rectum or a partial mesorectal excision is performed a transanal approach is technically very challenging. We present our experience with transanal minimally invasive surgery (TAMIS) approach for anastomotic assessment and repair in four patients. In all cases, a colorectal anastomosis was performed and the air insufflation test was positive. We assessed the anastomosis with TAMIS. In three cases, a defect was found and subsequently sutured. In one case, a scar in the rectal mucosa was found and reinforced with a suture. A protective ileostomy was performed in two cases, while in the other two cases, no stoma was added. All four patients were discharged with no further complications. Both protective ileostomies were taken down after radiological and endoscopic confirmation of anastomotic integrity and all 4 anastomoses remain intact after follow-up. TAMIS intraoperative assessment and repair of anastomotic leak is a safe and feasible technique whcih may avoid the need for a defunctioning stoma.
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Affiliation(s)
- J Valdes-Hernandez
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Dr Fedriani s/n 41003, Seville, Spain.
| | - J Cintas-Catena
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Dr Fedriani s/n 41003, Seville, Spain
| | - F J Del Rio-Lafuente
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Dr Fedriani s/n 41003, Seville, Spain
| | - A Cano-Matias
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Dr Fedriani s/n 41003, Seville, Spain
| | - C Torres-Arcos
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Dr Fedriani s/n 41003, Seville, Spain
| | - A Perez-Sanchez
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Dr Fedriani s/n 41003, Seville, Spain
| | - L Capitan-Morales
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Dr Fedriani s/n 41003, Seville, Spain
| | - F Oliva-Mompean
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Dr Fedriani s/n 41003, Seville, Spain
| | - J C Gomez-Rosado
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Dr Fedriani s/n 41003, Seville, Spain
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Ayuso-Fernandez MA, Gomez-Rosado JC, Barrientos-Trigo S, Rodríguez-Gómez S, Porcel-Gálvez AM. Impact of the patient-nurse ratio on health outcomes in public hospitals of the Andalusian Health Service. Ecological study. Enferm Clin (Engl Ed) 2021; 31:344-354. [PMID: 34756238 DOI: 10.1016/j.enfcle.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/17/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To analyse the patient-nurse ratio and its association with health outcomes in public hospitals of the Andalusian Health Service (SAS). METHOD Cross-sectional ecological study carried out in adult units of 26 Andalusian public hospitals. Data on structure (beds, type of unit, nursing control), management (average stay, index of use of stays, complexity index) and nursing staff were collected. They were extracted from official sources: CMBDA, SAS/Health Council (CS) publications and specific respondents to Nursing Directorates. The patient-nurse ratio was calculated and related to 19 indicators of hospital quality, safety, and mortality. Measures of central tendency and Spearman's correlation coefficient were used for statistical analysis. RESULTS A response was obtained from 100% of the Andalusian hospitals. The average patient-nurse ratio in the three shifts was lower in hospitals with a broader portfolio of services-regional scope (11.6), followed by those with a medium portfolio-specialties (12.7) and hospitals with a basic portfolio-county (13.5). By type of unit, the medical units were 11.8 (SD = 1.8) lower than the surgical ones 13.5 (SD = 2.7). Significant differences were only found in medical units of regional hospitals 10.5 (SD = 1.4) and district hospitals 13.03 (SD = 1.46) (p = .001). In critical care, the ratio was greater than 2 patients per nurse in the three groups. When relating the ratio to health outcomes, 5 significant associations were found: pressure ulcers (p = .005), prevalence of nosocomial infections (p = .036), postoperative sepsis (p = .022), zero bacteraemia verification (p = .045) and mortality from heart failure (p = .004). CONCLUSIONS The results indicate a high patient-nurse ratio in adult hospitalization units and that there is a positive association between the patient-nurse ratio and worse results related to nursing care.
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Affiliation(s)
| | - Juan Carlos Gomez-Rosado
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen Macarena, Sevilla, Spain.
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Ayuso-Fernandez MA, Gomez-Rosado JC, Barrientos-Trigo S, Rodríguez-Gómez S, Porcel-Gálvez AM. Impact of the patient-nurse ratio on health outcomes in public hospitals of the Andalusian Health Service. Ecological Study. Enferm Clin (Engl Ed) 2021; 31:S1130-8621(20)30554-4. [PMID: 33446438 DOI: 10.1016/j.enfcli.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 10/29/2020] [Accepted: 11/17/2020] [Indexed: 11/21/2022]
Abstract
AIM To analyse the patient-nurse ratio and its association with health outcomes in public hospitals of the Andalusian Health Service (SAS). METHOD Cross-sectional ecological study carried out in adult units of 26 Andalusian public hospitals. Data on structure (beds, type of unit, nursing control), management (average stay, index of use of stays, complexity index) and nursing staff were collected. They were extracted from official sources: CMBDA, SAS/Health Council (CS) publications and specific respondents to Nursing Directorates. The patient-nurse ratio was calculated and related to 19 indicators of hospital quality, safety, and mortality. Measures of central tendency and Spearman's correlation coefficient were used for statistical analysis. RESULTS A response was obtained from 100% of the Andalusian hospitals. The average patient-nurse ratio in the three shifts was lower in hospitals with a broader portfolio of services-regional scope (11.6), followed by those with a medium portfolio-specialties (12.7) and hospitals with a basic portfolio- county (13.5). By type of unit, the medical units were 11.8 (SD=1.8) lower than the surgical ones 13.5 (SD=2.7). Significant differences were only found in medical units of regional hospitals 10.5 (SD=1.4) and district hospitals 13.03 (SD=1.46) (p=.001). In critical care, the ratio was greater than 2 patients per nurse in the three groups. When relating the ratio to health outcomes, 5 significant associations were found: pressure ulcers (p=.005), prevalence of nosocomial infections (p=.036), postoperative sepsis (p=.022), zero bacteraemia verification (p=.045) and mortality from heart failure (p=.004). CONCLUSIONS The results indicate a high patient-nurse ratio in adult hospitalization units and that there is a positive association between the patient-nurse ratio and worse results related to nursing care.
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Affiliation(s)
| | - Juan Carlos Gomez-Rosado
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen Macarena, Sevilla, España.
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Valdes-Hernandez J, Gomez-Rosado JC, Cintas-Catena J, Perez-Sanchez A, Torres C, Del Rio F, Oliva F, Capitan-Morales LC. TAMIS resection of a large colonic polyp 20 cm from the anal verge: could endo-stapling be the solution to peritoneal entry? Tech Coloproctol 2019; 23:279. [PMID: 30778785 DOI: 10.1007/s10151-019-01942-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 02/01/2019] [Indexed: 10/27/2022]
Affiliation(s)
- J Valdes-Hernandez
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Seville, Spain.
| | - J C Gomez-Rosado
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Seville, Spain
| | - J Cintas-Catena
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Seville, Spain
| | - A Perez-Sanchez
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Seville, Spain
| | - C Torres
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Seville, Spain
| | - F Del Rio
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Seville, Spain
| | - F Oliva
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Seville, Spain
| | - L C Capitan-Morales
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Seville, Spain
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