Manuel López-cano - Academia.edu (original) (raw)

Papers by Manuel López-cano

Incisional hernia (IH) is a health problem of the first order, with a significant impact on the l... more Incisional hernia (IH) is a health problem of the first order, with a significant impact on the lives of patients who suffer from it and with high economic and social costs at all levels. Therefore, it is not surprising that in the last decade many efforts have been dedicated to knowing more and better all the aspects related to its prevention. Most of these aspects are covered with the articles published in this Special Issue about the prevention of IH and they can be divided into general and specific aspects. Among the general aspects: the definition of high-risk patients who may benefit from the prevention of IH (Pereira-Rodríguez et al.); innovations in prostheses for the prevention of IH (Harris); analysis of the best non-mesh closure technique for an elective midline laparotomy (Fortelny) or what is the degree of implementation of prosthetic meshes in the prevention of IH (Durbin et al.). Other more specific aspects can be: IH prevention at trocar sites when using minimally invasive surgical techniques (de Beaux and East); anatomical location in the abdominal wall of a laparotomy and its influence on the opening and/or closure of the abdominal wall (Medina Pedrique et al.) or how can IH be prevented in the context of oncological diseases that require cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) (Wenzelberg et al.). The increase in knowledge about the prevention of IH and how to apply it at general and specific levels may lead to a greater increase in the cost-effectiveness of abdominal surgery, a reduction in morbidity, and better health-related quality-of life of our patients. We are aware that even today the late complications of surgeries that require opening and closing of the abdominal wall (i.e., IH) tend to be relegated to the background when the safety of a specific intraabdominal surgical intervention is evaluated. However, these complications (i.e., IH) play a decisive role in the quality of life of the patient and in the costs of the process and we must prevent them as much as possible. Although this Special Issue does not cover all the aspects that can be considered in the prevention of IH, it does offer a fairly comprehensive overview. We hope it will be helpful to interested readers and help improve the prevention of IH in patients requiring laparotomy.

Hernia, Jul 15, 2020

The first online European Hernia Society (EHS) congress was held on 28th and 29th May 2020 with 1... more The first online European Hernia Society (EHS) congress was held on 28th and 29th May 2020 with 1908 registered attendees from 97 countries from all continents with a minimum of 475 and a maximum of 1079 participants and a mean of more than 800 surgeons banded together at the same time in the same session. After the successful virtual EHS 2020, the positive and/or the negative aspects of online vs. face-to-face congresses were considered (at least from our experience). Certainly, face-to-face conferences takes us out of our usual work area by providing a “refreshing change”. However, beyond the simple excuse for making an interesting trip and having a leisure time with colleagues and friends, face-to-face conferences provide us with the opportunity to interact in first person with other individuals sharing the same “subject” of interest. This interaction allows: exchanging roles with ease; discussing the “presented” and the “not presented” data; sharing “scientific gossip” related to our area of interest; discussing the emergence of new technologies; exploring sources of funding for future projects; establishing groups and working alliances, and much more. In addition, the lectures given by the youngest will make them grow at personal and scientific levels. Surely, many of the activities above-mentioned can be performed through an online connection [1]. However, the qualitative aspects of interpersonal relationships may be lost as a result of the potential technical difficulties of the connections (delays in the images or verbal communications) or from the loss of spontaneity of body expressions or the different elements that are present in the interaction between lecturers or moderators and colleagues [2]. It is also important to analyze the economic advantages for the organizers of online congresses: the physical venue of the congress disappears and the rent paid for it, there are savings in travel, hotel reservations and other expenses that originate in face-to-face congresses. In addition, it is possible to find that online congresses can be accessible to attendees anywhere and at any time, thus greatly facilitating attendance. Also, this type of virtual event can be attended from the attendees’ homes or from the workplace in the middle of normal activity, accessing a specific panel that may be of interest. Finally, they can represent—as in our own case—a formidable alternative when there is a cancellation or it is not possible to hold a face-to-face congress. It is impossible to replace “real life” with “virtual life”. This way, the importance of face-to-face congresses has not been diluted after the technological advances that allow online communication. Face-to-face congresses allow us to “build” societies like the EHS, among other aspects, due to the interpersonal relationships established in them. However, the option of online congresses represents expanding the range of organizational possibilities. We are convinced that, in a very short time, it will be possible to witness an increase in the mix of live and virtual events, even in the context of the same congresses. Time will tell us but online connection serves to reinvent ourselves trying to know when it will be the time to “be online” or the time to “be present”. * M. Lopez-Cano mlpezcano@gmail.com

Scandinavian Journal of Surgery, Sep 26, 2014

Introduction The oncologic benefit of multivisceral en bloc resections for T4 gastroesophageal tu... more Introduction The oncologic benefit of multivisceral en bloc resections for T4 gastroesophageal tumors has been questioned, given the increased morbidity associated. We thus sought to investigate the surgical and oncologic outcomes of curative-intent en bloc multivisceral resections for T4 gastroesophageal carcinomas. Methods Between 2005 and 2016, 35 of the 525 patients who had gastric or EGJ carcinomas underwent curative-intent multivisceral resections for direct invasion or adhesion to adjacent organs. Results Postoperative complications occurred in 16(46%), 10 of which were Clavien-Dindo ≥ 3 (29%). Ninety-day mortality was 3%. The R0 resection rate was 94% (33). Direct organ invasion (pT4b) was confirmed on pathological analysis in 14 (40%) and did not affect survival. The majority (28, 80%) had lymph node involvement with a high nodal disease burden and was associated with decreased survival. Overall 5-year survival rate was 34%, and the vast majority of recurrences were distant/peritoneal (81%). On multivariate analysis, positive lymph nodes (H.R. 21.2; 95%CI 2.34-192) and R1 resection (H.R. 5.6; 95%CI 1.02-30.9) were predictors of survival. Conclusion Multivisceral resections for T4 gastric and GEJ adenocarcinomas, in combination with effective systemic therapy, result in prolonged long-term survival with acceptable morbidity. Complete resection to negative margins should remain a mainstay of curative-intent treatment in carefully selected patients.

Cirugía Española (english Edition), Dec 1, 2016

Introduction: The aim of this study was to the data from the National Registry of Incisional Hern... more Introduction: The aim of this study was to the data from the National Registry of Incisional Hernia (EVEREG) to determine the reality of the treatment of this condition in Spain. Methods: EVEREG is an online prospective database which has been functioning since July 2012; operations for incisional hernia are anonymously recorded. Results: Up to March 2015, 4501 hernias from 95 of the 113 participating hospitals were registered. The mean age of the patients was 62.7, and 56.5% were women, with a mean BMI of 30.2 kg/m 2 ; 29.8% presented a high surgical risk (ASA III-V). A total of 93.7% were scheduled surgeries, 88.3% open surgery and 22.2% were recurrent incisional hernias. There were 66.9% hernias after a midline laparotomy, and 81.4% of a transverse diameter of less than 10 cm. A mesh was used in 96.2% of cases. Postoperative stay was 5.3 days and 29.1% presented a complication, with a mortality of 0.8%. After a median follow-up of 7.7 months a high rate of recurrence was detected (20.7% per year), especially in hernias that were operated on after a previous repair (18.1% primary vs. 30.6% recurrent; P=.004). Conclusion: The EVEREG registry is a useful tool to know the current situation of incisional hernia treatment. Analysis of the data shows several points that could be improved: a low rate of follow-up and high recurrence rate.

Cirugia Espanola, Apr 1, 2017

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Cirugía Española (english Edition), Jun 1, 2014

The closure of a temporary stoma involves 2 different surgical procedures: the stoma reversal pro... more The closure of a temporary stoma involves 2 different surgical procedures: the stoma reversal procedure and the abdominal wall reconstruction of the stoma site. The management of the abdominal wall has different areas that should be analyzed such us how to avoid surgical site infection (SSI), the technique to be used in case of a concomitant hernia at the stoma site or to prevent an incisional hernia in the future, how to deal with the incision when the stoma reversal procedure is performed by laparoscopy and how to close the skin at the stoma site. The aim of this paper is to analyze these aspects in relation to abdominal wall reconstruction during a stoma reversal procedure.

Cirugia Espanola, 2018

Có mo citar este artículo: Ló pez-Cano M, et al. Una malla profilá ctica funciona en la prevenció... more Có mo citar este artículo: Ló pez-Cano M, et al. Una malla profilá ctica funciona en la prevenció n de la hernia paraestomal. Cir Esp. 2017.

World Journal of Surgery, Aug 22, 2019

Background Systematic reviews play a crucial role in clinical decision making and resource alloca... more Background Systematic reviews play a crucial role in clinical decision making and resource allocation and are expected to be unbiased and consistent. The aim of this study is a review of systematic reviews on the use of prophylactic mesh to prevent parastomal hernia (PH) formation using ROBIS and AMSTAR tools to assess the risk of bias and methodological quality. Methods We included systematic reviews with or without meta-analysis of which the objective was to assess the use of a prophylactic mesh to prevent PH. A systematic search of the literature in five databases from inception until December 2017 was conducted. For each systematic review, methodologic quality and risk of bias were assessed using the AMSTAR and ROBIS tools, respectively. We estimated the inter-rater reliability for individual domains and for the overall methodological quality and risk of bias using Fleiss' k. Results We identified 14 systematic reviews that met the inclusion criteria. Using the AMSTAR scale with a cutoff value, six reviews showed high methodologic quality and eight were of low quality. Using the ROBIS tool, the overall risk of bias was low in 50% of the reviews analyzed. In the remaining studies, the risk of bias was unclear. Conclusions The global evidence in favor of the use of a prophylactic mesh for preventing PH is not uniform regarding quality and risk of bias. Surgeons cannot be equally confident in the results of all systematic reviews published on this topic.

Cirugia Espanola, Feb 1, 2018

La hernia incisional es una patología muy comú n cuya incidencia se estima en torno al 15-20% de ... more La hernia incisional es una patología muy comú n cuya incidencia se estima en torno al 15-20% de todas las laparotomías. La evisceració n es otro problema importante, con una incidencia menor (2,5-3%) pero con graves consecuencias para el paciente. Por todo ello, la prevenció n de ambas complicaciones surge como un objetivo fundamental para el tratamiento correcto de los pacientes, por la mejora de la calidad de vida y por el ahorro de costes que supondría. Esta revisió n narrativa pretende realizar una puesta al día en la prevenció n de la hernia incisional y la evisceració n. Se analizan los criterios actuales para el cierre correcto de la pared abdominal, seguido de la posibilidad de añ adir refuerzos proté sicos en aquellos pacientes o casos que así lo requieran. Eventraciones especiales, como las originadas tras la inserció n de tró cares de laparoscopia o las secundarias a la realizació n de un estoma, se incluyen tambié n en este trabajo.

Cirugía Española (english Edition), May 1, 2022

Cirugía Española (english Edition), Oct 1, 2021

BMC Surgery, Aug 7, 2019

Background: Recurrence after incisional hernia repair is one of the major problems related with t... more Background: Recurrence after incisional hernia repair is one of the major problems related with this operation. Our objective is to analyze the influence of abdominal wall surgery expertise in the results of the open elective repair of incisional hernia. Methods: We have compiled the data of a cohort of patients who received surgery for an incisional hernia from July 2012 to December 2015 in a University Hospital. Data were collected prospectively and registered in the Spanish Register of Incisional Hernia (EVEREG). The short-and long-term complications between the groups of patients operated on by the Abdominal Wall Surgery (AWS) unit and groups operated on by surgeons outside of the specialized abdominal wall group (GS) were compared. Results: During the study period, a total of 237 patients were operated on by the open approach (114 AWS; 123 GS). One hundred seventy-five patients completed a median follow-up of 36.6 months [standard deviation (SD) = 6]. Groups were comparable in terms of age, sex, body mass index (BMI), comorbidities, and complexity of hernia. Complications were similar in both groups. Patients in the AWS group presented fewer recurrences (12.0% vs. 28.9%; P = 0.005). The cumulative incidence of recurrence was higher in the GS group [log rank 13.370; P < 0.001; odds ratio (OR) = 37.8; 95% confidence interval (CI) = 30.3-45.4]. In the multivariate analysis, surgery performed by the AWS unit was related to fewer recurrences (OR = 0.19; 95%CI = 0.07-0.58; P < 0.001). Conclusion: Incisional hernia surgery is associated with better results in terms of recurrence when it is performed in a specialized abdominal wall unit.

Cirugía Española (English Edition)

Hernia, 2021

The objective was to assess the effectiveness and safety of a bioabsorbable mesh at the time of c... more The objective was to assess the effectiveness and safety of a bioabsorbable mesh at the time of closure of a midline laparotomy for IH prevention. A multicenter, randomized clinical trial including patients undergoing abdominal surgical procedures through a midline laparotomy incision was designed. In the group of mesh (n = 167) the incision was closed using a continuous polydioxanone suture (PDS) plus a bioabsorbable mesh. In the control group (n = 165) a continuous PDS single layer suture was only used. Patients were randomly assigned (1:1) to the two groups. The primary outcome was the incidence of IH at 6, 12 and 24 months. Assessment of IH was done using a CT scan. At 6 months, the rates of IH were 15.2% and 24.8% in the experimental and control groups, respectively (relative risk [RR] 0.66, 95% confidence interval [CI] 0.38-0.98, P = 0.042). At 12 months, the rate of IH continued to be significantly lower in the experimental group (21.4% vs. 33.1%, P = 0.033), but at 24 months, there were no significant differences between the study groups with a follow-up rate of only 37.5%. The number needed to treat (NNT) was 11 and 9 at 6 and 12 months, respectively. The bioabsorbable mesh significantly prevented IH during the first year. Not reliable conclusions can be drawn across the second year. This may suggest that the any of the closing technique assessed in this study would have a “palliative” transient effect for preventing IH in the long-term.

Journal of Gastrointestinal Surgery, 2020

Background The prognostic value of sarcopenic obesity in gastric cancer surgery remains debated. ... more Background The prognostic value of sarcopenic obesity in gastric cancer surgery remains debated. We aimed to evaluate the impact on outcomes of body composition and sarcopenic obesity after gastrectomy for gastric cancer. Methods A retrospective review of prospectively maintained database of patients undergoing gastrectomy for gastric cancer from 2010 to 2017 was performed. Skeletal muscle mass and visceral adipose tissue were evaluated by preoperative computed tomography to define sarcopenia and obesity. Patients were classified in body composition groups according to the presence or absence of sarcopenia and obesity. Prognostic factors for survival were assessed by multivariate Cox analysis. Results Of the 198 patients undergoing gastrectomy for gastric cancer, 90 (45.4%) patients were sarcopenic, 130 (67.7%) obese, and in the subclassification for body composition categories: 33 (17%) nonsarcopenic nonobesity, 75 (38%) non sarcopenic obesity, 35 (17%) sarcopenic nonobesity, and 55 (28%) sarcopenic obesity. No category of body composition was a predictor of postoperative complications and worse overall and disease-free survival outcomes. Multivariable analysis identified ASA III classification, preoperative weight loss > 10%, postoperative surgical re-intervention, and advanced tumor stage as independent prognostic factors for overall survival, and patients aged 75 years or older, preoperative weight loss > 10%, elevated netrophillymphocyte ratio, and advanced tumor stage as independent prognostic factors for disease-free survival. Conclusions Sarcopenia, obesity, and sarcopenic obesity were not associated with worse outcomes after gastric cancer surgery.

Hernia, 2018

Purpose The use of extraperitoneal mesh in place of intra-peritoneal mesh is gaining popularity i... more Purpose The use of extraperitoneal mesh in place of intra-peritoneal mesh is gaining popularity in laparoscopic ventral hernia repair. We have adopted a robotic assisted laparoscopic technique using a lateral single-dock robotic access with retromuscular mesh placement after opening the ipsilateral posterior rectus fascia. In this study, we wanted to evaluate the changes in operative times during the initial experience with this novel technique. Methods The initial consecutive patients undergoing robotic assisted transabdominal retromuscular umbilical prosthetic repair (r-TARUP) using a 15 × 15 cm self-fixating mesh were prospectively entered in the study and the operative times during the separate steps of the surgical procedure were recorded. Complications were reported up to 4 week post operatively and quality of life was assessed using the EuraHS-QoL score. Results Over a 5 month inclusion period, 41 patients with either a primary (n = 34) or a trocar site hernia (n = 7) at the umbilicus were identified. All hernias had a mean diameter of less than 4 cm. The total OR time decreased significantly during the learning curve (tertile 1: 126 min versus tertile 3: 102 min; p = 0.002) due to a decrease in the skin-to-skin operating time (tertile 1: 81 min versus tertile 3:61 min; p = 0.002). The decrease in the retromuscular dissection time was the most significant of all the steps that comprised the console time (p = 0.004). The non-surgical time did not decrease (p = 0.15). The operation was performed on an outpatient basis in 68% of patients and with a one-night-stay in 29%. No complications related to the introduction of the robotic technique for this approach were observed and the early outcome is promising, with favorable quality-of-life evaluation at 4 weeks. Conclusions The decrease in operative time during the adoption of r-TARUP was mainly related to the improved efficiency in the dissection phase of the procedure. The technique is reproducible and safe and the operative time compares favorably to published operative times for laparoscopic and open retromuscular umbilical hernia repair.

BMJ Open

IntroductionIncisional hernia has an incidence of up to 20% following laparotomy and is associate... more IntroductionIncisional hernia has an incidence of up to 20% following laparotomy and is associated with significant morbidity and impairment of quality of life. A variety of surgical strategies including techniques and mesh types are available to manage patients with incisional hernia. Previous works have reported significant heterogeneity in outcome reporting for abdominal wall herniae, including ventral and inguinal hernia. This is coupled with under-reporting of important clinical and patient-reported outcomes. The lack of standardisation in outcome reporting contributes to reporting bias, hinders evidence synthesis and adequate data comparison between studies. This project aims to develop a core outcome set (COS) of clinically important, patient-oriented outcomes to be used to guide reporting of future research in incisional hernia.MethodsThis project has been designed as an international, multicentre, mixed-methods project. Phase I will be a systematic review of current literat...

British Journal of Surgery, Oct 1, 2022