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Papers by Juan Ocaña Jiménez

Research paper thumbnail of Quality Indicators of Transanal Total Mesorectal Excision (TaTME) for Rectal Cancer

Journal of Coloproctology, 2021

Introduction Transanal total mesorectal excision (TaTME) has revolutionized the surgical techniqu... more Introduction Transanal total mesorectal excision (TaTME) has revolutionized the surgical techniques for lower-third rectal cancer. The aim of the present study was to analyze the outcomes of quality indicators of TaTME for rectal cancer compared with laparoscopic TME (LaTME). Methods A cohort prospective study with 50 (14 female and 36 male) patients, with a mean age of 67 (range: 55.75 to 75.25) years, who underwent surgery for rectal cancer. In total, 20 patients underwent TaTME, and 30, LaTME. Every TaTME procedure was performed by experienced colorectal surgeons. The sample was divided into two groups (TaTME and LaTME), and the quality indicators of the surgery for rectal cancer were analyzed. Results There were no statistically significant differences regarding the patients and the main characteristics of the tumor (age, gender, American Society of Anesthesiologists [ASA] score, body mass index [BMI], tumoral stage, neoadjuvant therapy, and distance from the tumor to the extern...

Research paper thumbnail of Magnetic Esophageal Sphincter Migration: Laparoscopic Removal

Research paper thumbnail of Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study

Patient Safety in Surgery, 2022

Background In spite of the global implementation of standardized surgical safety checklists and e... more Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse event...

Research paper thumbnail of An Immunologic Compatibility Testing Was Not Useful for Donor Selection in Fecal Microbiota Transplantation for Ulcerative Colitis

Frontiers in Immunology, 2021

Fecal microbiota transplantation (FMT) is an effective procedure against Clostridioides difficile... more Fecal microbiota transplantation (FMT) is an effective procedure against Clostridioides difficile infection (CDI), with promising but still suboptimal performance in other diseases, such as ulcerative colitis (UC). The recipient’s mucosal immune response against the donor’s microbiota could be relevant factor in the effectiveness of FMT. Our aim was to design and validate an individualized immune-based test to optimize the fecal donor selection for FMT. First, we performed an in vitro validation of the test by co-culturing lymphocytes obtained from the small intestine mucosa of organ donor cadavers (n=7) and microbe-associated molecular patterns (MAMPs) obtained from the feces of 19 healthy donors. The inflammatory response was determined by interleukin supernatant quantification using the Cytometric Bead Array kit (B&D). We then conducted a clinical pilot study with 4 patients with UC using immunocompetent cells extracted from rectal biopsies and MAMPs from 3 donor candidates. We e...

Research paper thumbnail of Laparoscopic sigmoid resection for a giant colonic diverticulum – a video vignette

Colorectal Disease, 2021

A Giant Colonic Diverticulum (GCD) is a rare manifestiation of colonic diverticular disease. It i... more A Giant Colonic Diverticulum (GCD) is a rare manifestiation of colonic diverticular disease. It is more often located in the sigmoid colon. It is defined by a colonic diverticulum greater than 4cm in diameter (medium size 4-9cm). It is usually located at the anti-mesenteric border of the sigmoid colon. It was first described in 1946, although less than 200 cases are reported in the literature, mostly as case reports. While GCD pathophysiology remains unclear, the "Ball-valve" theory is the most accepted. GCD should be managed with surgical excision. If it presents as acute diverticulitis, it should be treated according to clinical guidelines.

Research paper thumbnail of Biological mesh reconstruction versus primary closure for preventing perineal morbidity after extralevator abdominoperineal excision: a multicentre retrospective study

Colorectal Disease, 2020

The aim of the study was to compare the incidence of perineal hernia and the perineal wound morbi... more The aim of the study was to compare the incidence of perineal hernia and the perineal wound morbidity following extralevator abdominoperineal excision (ELAPE) between two groups – primary perineal closure and reconstruction with a biological mesh.

Research paper thumbnail of Manejo de la estenosis anastomótica tras una resección ileocecal en la enfermedad de Crohn con patrón estenótico. Cirugía vs. dilatación endoscópica

Research paper thumbnail of Laparoscopic management of intra‐operative iliac vein injury – a video vignette

Colorectal Disease, 2020

Venous injuries during elective colorectal surgery result in significant morbidity and mortality ... more Venous injuries during elective colorectal surgery result in significant morbidity and mortality [1]. In the minimally invasive era, the management of major vascular injuries represents a formidable challenge to the surgeon, particularly if open laparotomy is to be avoided. In this case, a 74-year-old man with a rectosigmoid carcinoma underwent laparoscopic anterior resection. During the pelvic dissection the left iliac common vein was injured. After laparoscopic bleeding control, successful haemostasis was obtained with the local use of a haemostatic matrix (Flosealâ; Baxter, Hayward, California, USA). The bleeding point was temporarily compressed, and the gauze compression could be removed after 3 min. Finally, the resection procedure was completed successfully. The patient was discharged after 6 days with no complications. The effectiveness of topical haemostatic agents has been proven in a number of reports describing major venous injury [2]. In this video (Video S1 in the online Supporting Information) we demonstrate one of the multiple techniques available for the control of major bleeding during laparoscopy and explain in detail the use of a topical haemostatic agent.

Research paper thumbnail of Impact of interval timing to surgery on tumor response after neoadjuvant treatment for gastric cancer

Revista Española de Enfermedades Digestivas, 2020

INTRODUCTION neoadjuvant chemotherapy (NACT) followed by radical surgery is the optimal approach ... more INTRODUCTION neoadjuvant chemotherapy (NACT) followed by radical surgery is the optimal approach for locally advanced gastric cancer (GC). Interval timing to surgery after NACT in GC is controversial. The aim of this study was to evaluate the impact of NACT interval time on tumor response and overall survival. MATERIAL AND METHODS a retrospective analysis from a prospective database was performed at a single referral tertiary hospital, from January 2010 to October 2018. Patients were assigned to three groups according to the surgical interval time after NACT: < 4 weeks, 4-6 weeks and > 6 weeks. Univariate and multivariable analyses were performed in order to clarify the impact of NACT on post-neoadjuvant pathological complete response rate (ypCR), downstaging (DS) and overall survival (OS). RESULTS of the 60 patients analyzed, 18 patients (30 %) had an interval time to surgery < 4 weeks, 26 (43.3 %) between 4-6 weeks and 16 (26.7 %) > 6 weeks. Two patients (3 %) had achieved ypCR and 37 patients (62 %) had achieved DS. There were no differences in DS rates among the interval time groups (p: 0.66). According to the multivariate analysis, only poorly differentiated carcinoma was significantly related to lower DS rates (p: 0.04). Cox regression analysis showed that the NACT interval time had no impact on OS. According to the multivariate analysis, > 25 lymph node harvested (HR: 0.35) and female sex (HR: 5.67) were OS independent predictors. CONCLUSIONS the NACT interval time prior gastrectomy for locally advanced GC is not associated with ypCR or DS and has no impact on overall survival.

Research paper thumbnail of Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

The Lancet, 2020

Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoper... more Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74•0%) had emergency surgery and 280 (24•8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26•1%) patients. 30-day mortality was 23•8% (268 of 1128). Pulmonary complications occurred in 577 (51•2%) of 1128 patients; 30-day mortality in these patients was 38•0% (219 of 577), accounting for 82•6% (219 of 265) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1•75 [95% CI 1•28-2•40], p<0•0001), age 70 years or older versus younger than 70 years (2•30 [1•65-3•22], p<0•0001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (2•35 [1•57-3•53], p<0•0001), malignant versus benign or obstetric diagnosis (1•55 [1•01-2•39], p=0•046), emergency versus elective surgery (1•67 [1•06-2•63], p=0•026), and major versus minor surgery (1•52 [1•01-2•31], p=0•047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery.

Research paper thumbnail of Regarding to Short-term Results of Laparoscopic Near-total (95%) Gastrectomy

Cirugía Española (English Edition), 2019

Research paper thumbnail of Laparoscopic duodenojejunostomy as a treatment for Wilkie�s syndrome. Analysis of a four cases series

Revista Española de Enfermedades Digestivas, 2019

We present 4 cases of Wilkie's syndrome (WS) diagnosis in our Hospital between 2014-2019. WS ... more We present 4 cases of Wilkie's syndrome (WS) diagnosis in our Hospital between 2014-2019. WS is an infrequent disease, whose diagnosis can be challenging for patients suffering recurrent digestive symptoms. Our patients refered a history of chronic postprandial abdominal pain associated with vomiting, intestinal transit disorders or an uncontrolled weight loss. Abdominopelvic angio-CT was part of the research in all the cases, objectifying a decrease in the angle between Superior Mesenteric Artery (SAM) and Aorta below 25°. In case of chronic or refractory cases, the surgical treatment may be an option. Laparoscopic duodenojejunostomy constitutes the treatment of choice due its low rate of complications and acceptable results.

Research paper thumbnail of Experiencia, complicaciones y factores pronósticos con el reservorio anal en la colitis ulcerosa. Estudio observacional

Cirugía Española, 2019

INTRODUCTION Ileoanal pouch following restorative proctocolectomy is the treatment for ulcerative... more INTRODUCTION Ileoanal pouch following restorative proctocolectomy is the treatment for ulcerative colitis after failed medical treatment. Our main aim was to evaluate early and late morbidity associated with restorative proctocolectomy. The secondary aim was to assess risk factors for pouch failure. METHODS A retrospective, observational, single-center study was performed. Patients who had undergone restorative proctocolectomy for a preoperative diagnosis of ulcerative colitis from 1983-2015 were included. Early (<30 days) and late (>30 days) adverse events were analyzed. Pouch failure was defined as the need for pouch excision or when ileostomy closure could not be performed. Univariate and multivariate analyses were performed to assess pouch failure risk factors. RESULTS The study included 139 patients. One patient subsequently died in the early postoperative period. Mean follow-up was 23 years. Manual anastomoses were performed in 54 patients (39%). Early adverse events were found in 44 patients (32%), 15 of which (11%) had anastomotic fistula. Late adverse events were found in 90 patients (65%), and pouch-related fistulae (29%) were the most commonly found in this group. Pouch failure was identified in 42 patients (32%). In the multivariate analysis, age >50 years (p<0.01; HR: 5.55), handsewn anastomosis (p<0.01; HR: 3.78), pouch-vaginal (p=0.02; HR: 2.86), pelvic (p<0.01; HR: 5.17) and cutaneous p=0.01; HR: 3.01) fistulae were the main pouch failure risk factors. CONCLUSION Restorative proctocolectomy for a preoperative diagnosis of ulcerative colitis has high morbidity rates. Long-term outcomes could be improved if risk factors for failure are avoided.

Research paper thumbnail of Relevancia del margen de resección positivo en adenocarcinoma ductal de páncreas y otros factores pronósticos

Cirugía Española, 2019

INTRODUCTION Currently, R1 resection is defined by the presence of tumor cells within <1mm of ... more INTRODUCTION Currently, R1 resection is defined by the presence of tumor cells within <1mm of the resection margin. The main aim of this study was to analyze the impact of positive margins (R1) on survival outcomes in pancreatic cancer. METHODS We performed a retrospective analysis with multivariate regression analysis of a prospective database from 2008-2017, which included resection margin status, expanded resection margin (R1<1mm), vascular resection, lymphatic involvement, surgical complications, tumor differentiation grade and adjuvant treatment. RESULTS A total of 80 patients were analyzed: 42 (52%) R1; 38 (48%) R0. No differences were found in the composition of the two groups except for the vascular resection, which was more frequent in the R1 group: 12 (21%) vs 2 (3%). Overall survival in the R0 group was 19 months vs 24 months in the R1 group (p=0.13). Wide R1 (R1<1mm) had an overall survival of 21 months versus 31 months in wide R0 (p=0.55). In the multivariate analysis, only lymph node involvement (p=0.02, HR=2.88), tumor differentiation (p=0.02, HR=3.2) and adjuvant therapy (p<0.01; HR=0.21) were found to be factors related to survival. CONCLUSIONS R1 resection is not an independent risk factor. Lymph node involvement, differentiation grade and adjuvant treatment are prognostic factors. The benefit of expanding the resection margins should be demonstrated. More studies are needed to assess the impact of the resection margin.

Research paper thumbnail of Surgical management of familial adenomatous polyposis: pancreas-sparing duodenectomy or pancreaticoduodenectomy (Whipple procedure)

Revista Española de Enfermedades Digestivas, 2019

Duodenal cancer is the main cause of death for patients with FAP syndrome (familial adenomatous p... more Duodenal cancer is the main cause of death for patients with FAP syndrome (familial adenomatous polyposis) treated with a colectomy. The disease follows the adenoma to carcinoma sequence and is diagnosed during follow-up in 7-36% of patients. Endoscopic treatment is used during the first treatment stage of the disease and surgery is an adequate therapeutic option when endoscopic control is insufficient.

Research paper thumbnail of Role of Negative Pressure Wound Therapy in the Prevention of Surgical Site Infection in Colorectal Surgery

Cirugía Española (English Edition), 2019

BACKGROUND Surgical site infection (SSI) is one of the most frequent complications in colorectal ... more BACKGROUND Surgical site infection (SSI) is one of the most frequent complications in colorectal surgery. It is diagnosed in 10 - 20% of colorectal procedures. Negative Pressure Wound Therapy (NPWT) has shown efficacy in the treatment of chronic and traumatic wounds, wound dehiscence, flaps and grafts. The main objective of this study is to assess NPWT in the prevention of SSI in colorectal surgery. Hospital stay reduction and SSI risk factors are secondary objectives. METHODS We present a prospective case-control study including 80 patients after a colorectal diagnosis and surgical procedure (elective and non-elective) in 2017. Forty patients were treated with prevention NPWT for one week. Forty patients were treated according to the standard postoperative surgical wound care protocol. RESULTS No significant differences were found in demographic variables, comorbidities, surgical approach, elective or non-elective surgery, mechanical bowel preparation and surgical procedure. Three patients has SSI in the NPWT group (8%) (95%CI 0 - 17.5). Ten patients presented SSI in the control group (25%) (95%CI 12.5 - 37.5) (p=0.034); OR 0.7 (95%CI 0.006-0.964). Hospital stay in the NPWT group was 8 days versus 12 days in the non-NPWT group (p=0.22). In the multivariate analysis, mechanical bowel preparation was found to be the only risk factor for SSI (p=0.047; OR: 0.8, CI 0.45-0.93). CONCLUSIONS NPWT is a useful SSI prevention treatment in colorectal surgery.

Research paper thumbnail of Papel de la terapia presión negativa en la prevención de infección del sitio quirúrgico en cirugía colorrectal

Cirugía Española, 2019

BACKGROUND Surgical site infection (SSI) is one of the most frequent complications in colorectal ... more BACKGROUND Surgical site infection (SSI) is one of the most frequent complications in colorectal surgery. It is diagnosed in 10 - 20% of colorectal procedures. Negative Pressure Wound Therapy (NPWT) has shown efficacy in the treatment of chronic and traumatic wounds, wound dehiscence, flaps and grafts. The main objective of this study is to assess NPWT in the prevention of SSI in colorectal surgery. Hospital stay reduction and SSI risk factors are secondary objectives. METHODS We present a prospective case-control study including 80 patients after a colorectal diagnosis and surgical procedure (elective and non-elective) in 2017. Forty patients were treated with prevention NPWT for one week. Forty patients were treated according to the standard postoperative surgical wound care protocol. RESULTS No significant differences were found in demographic variables, comorbidities, surgical approach, elective or non-elective surgery, mechanical bowel preparation and surgical procedure. Three patients has SSI in the NPWT group (8%) (95%CI 0 - 17.5). Ten patients presented SSI in the control group (25%) (95%CI 12.5 - 37.5) (p=0.034); OR 0.7 (95%CI 0.006-0.964). Hospital stay in the NPWT group was 8 days versus 12 days in the non-NPWT group (p=0.22). In the multivariate analysis, mechanical bowel preparation was found to be the only risk factor for SSI (p=0.047; OR: 0.8, CI 0.45-0.93). CONCLUSIONS NPWT is a useful SSI prevention treatment in colorectal surgery.

Research paper thumbnail of Acerca de los resultados a corto plazo de la gastrectomía casi total (95% gastrectomy)

Research paper thumbnail of Surgical Excision of Ischiorectal Fossa Tumors

Surgical Science, 2016

Background: Ischiorectal Fossa Tumors are rare and their management has not been protocolized. Pa... more Background: Ischiorectal Fossa Tumors are rare and their management has not been protocolized. Patients: We retrospectively review four consecutive cases treated in our department, from January 2015 to July 2015. All of them were discussed in a multidisciplinary team meeting. None of them were secondary to an inflammatory process. Results: A Magnetic Resonance Imaging was performed in all the four patients, and as it was not a malignant diagnosis made in any of them, we proceeded to resecate the lesions. None biopsies were performed and the benign diagnoses were confirmed by the pathologist. All the patients underwent a local posterior or perineal approach, because all the lesions (epidermoid cyst, hamartoma, lipoma and an aggressive angiomyxoma) were localized purely in the ischiorectal fossa, under the levator ani muscle and not invading any adjacent structures. In all of them, an R0 resection was performed. Conclusions: Ischiorectal fossa tumors are rare and there are few cases already published. Non-inflammatory lesions located in the ischiorectal fossa, with none invasion of rectum or levator ani muscle, are mainly benign lesions prone to their complete excision by a posterior approach. Biopsy is not always necessary unless there's a suspicion of a malignancy or invasion of adjacent structures, and only in that case a biopsy should be made, because in some of them, a neo-adjuvant treatment can be useful to reduce the tumor and to perform an R0 resection.

Research paper thumbnail of Determination of trovafloxacin in human serum by time resolved terbium-sensitised luminescence

European Journal of Pharmaceutical Sciences, 2001

A sensitive time-resolved luminescence method for the determination of trovafloxacin is described... more A sensitive time-resolved luminescence method for the determination of trovafloxacin is described. The method is based on the time-resolved luminescence signal from the terbium(III)-trovafloxacin complex, in a micellar solution of sodium dodecyl sulfate (SDS), using a chemical deoxygenation agent (Na(2)SO(3)). The method allows the determination of 20-450 ng ml(-1) of trovafloxacin in 7.5 mM SDS solution containing 0.16 M acetic acid-sodium acetate buffer (pH 6.0) and 7.5 mM Na(2)SO(3) with lambda(exc)=270 nm and lambda(em)=546 nm. In these experimental conditions luminescence signal for trovafloxacin increases 20-fold with respect to native fluorescence of the compound in aqueous solution at pH 6.5. Terbium-sensitised luminescence was applied to trovafloxacin determination in human serum, spiked at levels found after drug administration at normal clinical doses. Recovery is 90+/-1% and day-to-day precision is 3.5%. The proposed method tolerates high concentrations of other co-administrated drugs and excipients.

Research paper thumbnail of Quality Indicators of Transanal Total Mesorectal Excision (TaTME) for Rectal Cancer

Journal of Coloproctology, 2021

Introduction Transanal total mesorectal excision (TaTME) has revolutionized the surgical techniqu... more Introduction Transanal total mesorectal excision (TaTME) has revolutionized the surgical techniques for lower-third rectal cancer. The aim of the present study was to analyze the outcomes of quality indicators of TaTME for rectal cancer compared with laparoscopic TME (LaTME). Methods A cohort prospective study with 50 (14 female and 36 male) patients, with a mean age of 67 (range: 55.75 to 75.25) years, who underwent surgery for rectal cancer. In total, 20 patients underwent TaTME, and 30, LaTME. Every TaTME procedure was performed by experienced colorectal surgeons. The sample was divided into two groups (TaTME and LaTME), and the quality indicators of the surgery for rectal cancer were analyzed. Results There were no statistically significant differences regarding the patients and the main characteristics of the tumor (age, gender, American Society of Anesthesiologists [ASA] score, body mass index [BMI], tumoral stage, neoadjuvant therapy, and distance from the tumor to the extern...

Research paper thumbnail of Magnetic Esophageal Sphincter Migration: Laparoscopic Removal

Research paper thumbnail of Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study

Patient Safety in Surgery, 2022

Background In spite of the global implementation of standardized surgical safety checklists and e... more Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse event...

Research paper thumbnail of An Immunologic Compatibility Testing Was Not Useful for Donor Selection in Fecal Microbiota Transplantation for Ulcerative Colitis

Frontiers in Immunology, 2021

Fecal microbiota transplantation (FMT) is an effective procedure against Clostridioides difficile... more Fecal microbiota transplantation (FMT) is an effective procedure against Clostridioides difficile infection (CDI), with promising but still suboptimal performance in other diseases, such as ulcerative colitis (UC). The recipient’s mucosal immune response against the donor’s microbiota could be relevant factor in the effectiveness of FMT. Our aim was to design and validate an individualized immune-based test to optimize the fecal donor selection for FMT. First, we performed an in vitro validation of the test by co-culturing lymphocytes obtained from the small intestine mucosa of organ donor cadavers (n=7) and microbe-associated molecular patterns (MAMPs) obtained from the feces of 19 healthy donors. The inflammatory response was determined by interleukin supernatant quantification using the Cytometric Bead Array kit (B&D). We then conducted a clinical pilot study with 4 patients with UC using immunocompetent cells extracted from rectal biopsies and MAMPs from 3 donor candidates. We e...

Research paper thumbnail of Laparoscopic sigmoid resection for a giant colonic diverticulum – a video vignette

Colorectal Disease, 2021

A Giant Colonic Diverticulum (GCD) is a rare manifestiation of colonic diverticular disease. It i... more A Giant Colonic Diverticulum (GCD) is a rare manifestiation of colonic diverticular disease. It is more often located in the sigmoid colon. It is defined by a colonic diverticulum greater than 4cm in diameter (medium size 4-9cm). It is usually located at the anti-mesenteric border of the sigmoid colon. It was first described in 1946, although less than 200 cases are reported in the literature, mostly as case reports. While GCD pathophysiology remains unclear, the "Ball-valve" theory is the most accepted. GCD should be managed with surgical excision. If it presents as acute diverticulitis, it should be treated according to clinical guidelines.

Research paper thumbnail of Biological mesh reconstruction versus primary closure for preventing perineal morbidity after extralevator abdominoperineal excision: a multicentre retrospective study

Colorectal Disease, 2020

The aim of the study was to compare the incidence of perineal hernia and the perineal wound morbi... more The aim of the study was to compare the incidence of perineal hernia and the perineal wound morbidity following extralevator abdominoperineal excision (ELAPE) between two groups – primary perineal closure and reconstruction with a biological mesh.

Research paper thumbnail of Manejo de la estenosis anastomótica tras una resección ileocecal en la enfermedad de Crohn con patrón estenótico. Cirugía vs. dilatación endoscópica

Research paper thumbnail of Laparoscopic management of intra‐operative iliac vein injury – a video vignette

Colorectal Disease, 2020

Venous injuries during elective colorectal surgery result in significant morbidity and mortality ... more Venous injuries during elective colorectal surgery result in significant morbidity and mortality [1]. In the minimally invasive era, the management of major vascular injuries represents a formidable challenge to the surgeon, particularly if open laparotomy is to be avoided. In this case, a 74-year-old man with a rectosigmoid carcinoma underwent laparoscopic anterior resection. During the pelvic dissection the left iliac common vein was injured. After laparoscopic bleeding control, successful haemostasis was obtained with the local use of a haemostatic matrix (Flosealâ; Baxter, Hayward, California, USA). The bleeding point was temporarily compressed, and the gauze compression could be removed after 3 min. Finally, the resection procedure was completed successfully. The patient was discharged after 6 days with no complications. The effectiveness of topical haemostatic agents has been proven in a number of reports describing major venous injury [2]. In this video (Video S1 in the online Supporting Information) we demonstrate one of the multiple techniques available for the control of major bleeding during laparoscopy and explain in detail the use of a topical haemostatic agent.

Research paper thumbnail of Impact of interval timing to surgery on tumor response after neoadjuvant treatment for gastric cancer

Revista Española de Enfermedades Digestivas, 2020

INTRODUCTION neoadjuvant chemotherapy (NACT) followed by radical surgery is the optimal approach ... more INTRODUCTION neoadjuvant chemotherapy (NACT) followed by radical surgery is the optimal approach for locally advanced gastric cancer (GC). Interval timing to surgery after NACT in GC is controversial. The aim of this study was to evaluate the impact of NACT interval time on tumor response and overall survival. MATERIAL AND METHODS a retrospective analysis from a prospective database was performed at a single referral tertiary hospital, from January 2010 to October 2018. Patients were assigned to three groups according to the surgical interval time after NACT: < 4 weeks, 4-6 weeks and > 6 weeks. Univariate and multivariable analyses were performed in order to clarify the impact of NACT on post-neoadjuvant pathological complete response rate (ypCR), downstaging (DS) and overall survival (OS). RESULTS of the 60 patients analyzed, 18 patients (30 %) had an interval time to surgery < 4 weeks, 26 (43.3 %) between 4-6 weeks and 16 (26.7 %) > 6 weeks. Two patients (3 %) had achieved ypCR and 37 patients (62 %) had achieved DS. There were no differences in DS rates among the interval time groups (p: 0.66). According to the multivariate analysis, only poorly differentiated carcinoma was significantly related to lower DS rates (p: 0.04). Cox regression analysis showed that the NACT interval time had no impact on OS. According to the multivariate analysis, > 25 lymph node harvested (HR: 0.35) and female sex (HR: 5.67) were OS independent predictors. CONCLUSIONS the NACT interval time prior gastrectomy for locally advanced GC is not associated with ypCR or DS and has no impact on overall survival.

Research paper thumbnail of Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

The Lancet, 2020

Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoper... more Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74•0%) had emergency surgery and 280 (24•8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26•1%) patients. 30-day mortality was 23•8% (268 of 1128). Pulmonary complications occurred in 577 (51•2%) of 1128 patients; 30-day mortality in these patients was 38•0% (219 of 577), accounting for 82•6% (219 of 265) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1•75 [95% CI 1•28-2•40], p<0•0001), age 70 years or older versus younger than 70 years (2•30 [1•65-3•22], p<0•0001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (2•35 [1•57-3•53], p<0•0001), malignant versus benign or obstetric diagnosis (1•55 [1•01-2•39], p=0•046), emergency versus elective surgery (1•67 [1•06-2•63], p=0•026), and major versus minor surgery (1•52 [1•01-2•31], p=0•047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery.

Research paper thumbnail of Regarding to Short-term Results of Laparoscopic Near-total (95%) Gastrectomy

Cirugía Española (English Edition), 2019

Research paper thumbnail of Laparoscopic duodenojejunostomy as a treatment for Wilkie�s syndrome. Analysis of a four cases series

Revista Española de Enfermedades Digestivas, 2019

We present 4 cases of Wilkie's syndrome (WS) diagnosis in our Hospital between 2014-2019. WS ... more We present 4 cases of Wilkie's syndrome (WS) diagnosis in our Hospital between 2014-2019. WS is an infrequent disease, whose diagnosis can be challenging for patients suffering recurrent digestive symptoms. Our patients refered a history of chronic postprandial abdominal pain associated with vomiting, intestinal transit disorders or an uncontrolled weight loss. Abdominopelvic angio-CT was part of the research in all the cases, objectifying a decrease in the angle between Superior Mesenteric Artery (SAM) and Aorta below 25°. In case of chronic or refractory cases, the surgical treatment may be an option. Laparoscopic duodenojejunostomy constitutes the treatment of choice due its low rate of complications and acceptable results.

Research paper thumbnail of Experiencia, complicaciones y factores pronósticos con el reservorio anal en la colitis ulcerosa. Estudio observacional

Cirugía Española, 2019

INTRODUCTION Ileoanal pouch following restorative proctocolectomy is the treatment for ulcerative... more INTRODUCTION Ileoanal pouch following restorative proctocolectomy is the treatment for ulcerative colitis after failed medical treatment. Our main aim was to evaluate early and late morbidity associated with restorative proctocolectomy. The secondary aim was to assess risk factors for pouch failure. METHODS A retrospective, observational, single-center study was performed. Patients who had undergone restorative proctocolectomy for a preoperative diagnosis of ulcerative colitis from 1983-2015 were included. Early (<30 days) and late (>30 days) adverse events were analyzed. Pouch failure was defined as the need for pouch excision or when ileostomy closure could not be performed. Univariate and multivariate analyses were performed to assess pouch failure risk factors. RESULTS The study included 139 patients. One patient subsequently died in the early postoperative period. Mean follow-up was 23 years. Manual anastomoses were performed in 54 patients (39%). Early adverse events were found in 44 patients (32%), 15 of which (11%) had anastomotic fistula. Late adverse events were found in 90 patients (65%), and pouch-related fistulae (29%) were the most commonly found in this group. Pouch failure was identified in 42 patients (32%). In the multivariate analysis, age >50 years (p<0.01; HR: 5.55), handsewn anastomosis (p<0.01; HR: 3.78), pouch-vaginal (p=0.02; HR: 2.86), pelvic (p<0.01; HR: 5.17) and cutaneous p=0.01; HR: 3.01) fistulae were the main pouch failure risk factors. CONCLUSION Restorative proctocolectomy for a preoperative diagnosis of ulcerative colitis has high morbidity rates. Long-term outcomes could be improved if risk factors for failure are avoided.

Research paper thumbnail of Relevancia del margen de resección positivo en adenocarcinoma ductal de páncreas y otros factores pronósticos

Cirugía Española, 2019

INTRODUCTION Currently, R1 resection is defined by the presence of tumor cells within <1mm of ... more INTRODUCTION Currently, R1 resection is defined by the presence of tumor cells within <1mm of the resection margin. The main aim of this study was to analyze the impact of positive margins (R1) on survival outcomes in pancreatic cancer. METHODS We performed a retrospective analysis with multivariate regression analysis of a prospective database from 2008-2017, which included resection margin status, expanded resection margin (R1<1mm), vascular resection, lymphatic involvement, surgical complications, tumor differentiation grade and adjuvant treatment. RESULTS A total of 80 patients were analyzed: 42 (52%) R1; 38 (48%) R0. No differences were found in the composition of the two groups except for the vascular resection, which was more frequent in the R1 group: 12 (21%) vs 2 (3%). Overall survival in the R0 group was 19 months vs 24 months in the R1 group (p=0.13). Wide R1 (R1<1mm) had an overall survival of 21 months versus 31 months in wide R0 (p=0.55). In the multivariate analysis, only lymph node involvement (p=0.02, HR=2.88), tumor differentiation (p=0.02, HR=3.2) and adjuvant therapy (p<0.01; HR=0.21) were found to be factors related to survival. CONCLUSIONS R1 resection is not an independent risk factor. Lymph node involvement, differentiation grade and adjuvant treatment are prognostic factors. The benefit of expanding the resection margins should be demonstrated. More studies are needed to assess the impact of the resection margin.

Research paper thumbnail of Surgical management of familial adenomatous polyposis: pancreas-sparing duodenectomy or pancreaticoduodenectomy (Whipple procedure)

Revista Española de Enfermedades Digestivas, 2019

Duodenal cancer is the main cause of death for patients with FAP syndrome (familial adenomatous p... more Duodenal cancer is the main cause of death for patients with FAP syndrome (familial adenomatous polyposis) treated with a colectomy. The disease follows the adenoma to carcinoma sequence and is diagnosed during follow-up in 7-36% of patients. Endoscopic treatment is used during the first treatment stage of the disease and surgery is an adequate therapeutic option when endoscopic control is insufficient.

Research paper thumbnail of Role of Negative Pressure Wound Therapy in the Prevention of Surgical Site Infection in Colorectal Surgery

Cirugía Española (English Edition), 2019

BACKGROUND Surgical site infection (SSI) is one of the most frequent complications in colorectal ... more BACKGROUND Surgical site infection (SSI) is one of the most frequent complications in colorectal surgery. It is diagnosed in 10 - 20% of colorectal procedures. Negative Pressure Wound Therapy (NPWT) has shown efficacy in the treatment of chronic and traumatic wounds, wound dehiscence, flaps and grafts. The main objective of this study is to assess NPWT in the prevention of SSI in colorectal surgery. Hospital stay reduction and SSI risk factors are secondary objectives. METHODS We present a prospective case-control study including 80 patients after a colorectal diagnosis and surgical procedure (elective and non-elective) in 2017. Forty patients were treated with prevention NPWT for one week. Forty patients were treated according to the standard postoperative surgical wound care protocol. RESULTS No significant differences were found in demographic variables, comorbidities, surgical approach, elective or non-elective surgery, mechanical bowel preparation and surgical procedure. Three patients has SSI in the NPWT group (8%) (95%CI 0 - 17.5). Ten patients presented SSI in the control group (25%) (95%CI 12.5 - 37.5) (p=0.034); OR 0.7 (95%CI 0.006-0.964). Hospital stay in the NPWT group was 8 days versus 12 days in the non-NPWT group (p=0.22). In the multivariate analysis, mechanical bowel preparation was found to be the only risk factor for SSI (p=0.047; OR: 0.8, CI 0.45-0.93). CONCLUSIONS NPWT is a useful SSI prevention treatment in colorectal surgery.

Research paper thumbnail of Papel de la terapia presión negativa en la prevención de infección del sitio quirúrgico en cirugía colorrectal

Cirugía Española, 2019

BACKGROUND Surgical site infection (SSI) is one of the most frequent complications in colorectal ... more BACKGROUND Surgical site infection (SSI) is one of the most frequent complications in colorectal surgery. It is diagnosed in 10 - 20% of colorectal procedures. Negative Pressure Wound Therapy (NPWT) has shown efficacy in the treatment of chronic and traumatic wounds, wound dehiscence, flaps and grafts. The main objective of this study is to assess NPWT in the prevention of SSI in colorectal surgery. Hospital stay reduction and SSI risk factors are secondary objectives. METHODS We present a prospective case-control study including 80 patients after a colorectal diagnosis and surgical procedure (elective and non-elective) in 2017. Forty patients were treated with prevention NPWT for one week. Forty patients were treated according to the standard postoperative surgical wound care protocol. RESULTS No significant differences were found in demographic variables, comorbidities, surgical approach, elective or non-elective surgery, mechanical bowel preparation and surgical procedure. Three patients has SSI in the NPWT group (8%) (95%CI 0 - 17.5). Ten patients presented SSI in the control group (25%) (95%CI 12.5 - 37.5) (p=0.034); OR 0.7 (95%CI 0.006-0.964). Hospital stay in the NPWT group was 8 days versus 12 days in the non-NPWT group (p=0.22). In the multivariate analysis, mechanical bowel preparation was found to be the only risk factor for SSI (p=0.047; OR: 0.8, CI 0.45-0.93). CONCLUSIONS NPWT is a useful SSI prevention treatment in colorectal surgery.

Research paper thumbnail of Acerca de los resultados a corto plazo de la gastrectomía casi total (95% gastrectomy)

Research paper thumbnail of Surgical Excision of Ischiorectal Fossa Tumors

Surgical Science, 2016

Background: Ischiorectal Fossa Tumors are rare and their management has not been protocolized. Pa... more Background: Ischiorectal Fossa Tumors are rare and their management has not been protocolized. Patients: We retrospectively review four consecutive cases treated in our department, from January 2015 to July 2015. All of them were discussed in a multidisciplinary team meeting. None of them were secondary to an inflammatory process. Results: A Magnetic Resonance Imaging was performed in all the four patients, and as it was not a malignant diagnosis made in any of them, we proceeded to resecate the lesions. None biopsies were performed and the benign diagnoses were confirmed by the pathologist. All the patients underwent a local posterior or perineal approach, because all the lesions (epidermoid cyst, hamartoma, lipoma and an aggressive angiomyxoma) were localized purely in the ischiorectal fossa, under the levator ani muscle and not invading any adjacent structures. In all of them, an R0 resection was performed. Conclusions: Ischiorectal fossa tumors are rare and there are few cases already published. Non-inflammatory lesions located in the ischiorectal fossa, with none invasion of rectum or levator ani muscle, are mainly benign lesions prone to their complete excision by a posterior approach. Biopsy is not always necessary unless there's a suspicion of a malignancy or invasion of adjacent structures, and only in that case a biopsy should be made, because in some of them, a neo-adjuvant treatment can be useful to reduce the tumor and to perform an R0 resection.

Research paper thumbnail of Determination of trovafloxacin in human serum by time resolved terbium-sensitised luminescence

European Journal of Pharmaceutical Sciences, 2001

A sensitive time-resolved luminescence method for the determination of trovafloxacin is described... more A sensitive time-resolved luminescence method for the determination of trovafloxacin is described. The method is based on the time-resolved luminescence signal from the terbium(III)-trovafloxacin complex, in a micellar solution of sodium dodecyl sulfate (SDS), using a chemical deoxygenation agent (Na(2)SO(3)). The method allows the determination of 20-450 ng ml(-1) of trovafloxacin in 7.5 mM SDS solution containing 0.16 M acetic acid-sodium acetate buffer (pH 6.0) and 7.5 mM Na(2)SO(3) with lambda(exc)=270 nm and lambda(em)=546 nm. In these experimental conditions luminescence signal for trovafloxacin increases 20-fold with respect to native fluorescence of the compound in aqueous solution at pH 6.5. Terbium-sensitised luminescence was applied to trovafloxacin determination in human serum, spiked at levels found after drug administration at normal clinical doses. Recovery is 90+/-1% and day-to-day precision is 3.5%. The proposed method tolerates high concentrations of other co-administrated drugs and excipients.