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Article: Is prophylactic mesh closure effective to decrease the incidence of incisional hernia after laparotomy in colorectal surgery?

Cano-Valderrama, Oscar / García-Alonso, Mauricio / Sanz-Ortega, Gonzalo / Rojo, Mikel / Catalán, Vanesa / Domínguez-Serrano, Inmaculada / Dziakova, Jana / Sanz-López, Rodrigo / Torres, Antonio J

Acta chirurgica Belgica

2020 Volume 122, Issue 1, Page(s) 29–34

Abstract: Background: few studies have studied prophylactic mesh closure after laparotomy for colorectal surgery.: Methods: a retrospective cohort study was performed to compare patients with and without prophylactic mesh closure after open colorectal surgery.! ...

Abstract	Background: few studies have studied prophylactic mesh closure after laparotomy for colorectal surgery. Methods: a retrospective cohort study was performed to compare patients with and without prophylactic mesh closure after open colorectal surgery. Results: 309 patients were included from January 2014 to December 2016. Prophylactic mesh closure was performed in 98 patients (31.7%). After a mean follow-up of 21.7 months, incisional hernia was developed in 9 and 54 patients in the group with and without mesh respectively (9.2% vs. 25.7%, OR = 0.3, Conclusions: prophylactic mesh closure is effective to decrease the incidence of incisional hernia after colorectal surgery.
MeSH term(s)	Abdominal Wound Closure Techniques ; Colorectal Surgery ; Humans ; Incidence ; Incisional Hernia/epidemiology ; Incisional Hernia/etiology ; Incisional Hernia/prevention & control ; Laparotomy/adverse effects ; Retrospective Studies ; Surgical Mesh
Language	English
Publishing date	2020-11-16
Publishing country	England
Document type	Journal Article
ZDB-ID	210274-2
ISSN	0001-5458
ISSN	0001-5458
DOI	10.1080/00015458.2020.1846938
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Article ; Online: Trocar-site incisional hernia after laparoscopic colorectal surgery: a significant problem? Incidence and risk factors from a single-center cohort.

Cano-Valderrama, Oscar / Sanz-López, Rodrigo / Sanz-Ortega, Gonzalo / Anula, Rocío / Romera, José L / Rojo, Mikel / Catalán, Vanesa / Mugüerza, José / Torres, Antonio J

Surgical endoscopy

2020 Volume 35, Issue 6, Page(s) 2907–2913

Abstract: Background: Trocar-site incisional hernia (TSIH) after laparoscopic surgery has been scarcely studied. TSIH incidence and risk factors have never been properly studied for laparoscopic colorectal surgery.: Methods: A retrospective analytic study in a ...

Abstract	Background: Trocar-site incisional hernia (TSIH) after laparoscopic surgery has been scarcely studied. TSIH incidence and risk factors have never been properly studied for laparoscopic colorectal surgery. Methods: A retrospective analytic study in a tertiary hospital was performed including patients who underwent elective laparoscopic colorectal surgery between 2014 and 2016. Clinical and radiological TSIH were analyzed. Results: 272 patients with a mean age of 70.7 years were included. 205 (75.4%) underwent surgery for a malignant disease. The most common procedure was right colectomy (108 patients, 39.7%). After a mean follow-up of 30.8 months 64 (23.5%) patients developed a TSIH. However, only 7 out of 64 (10.9%) patients with a TSIH underwent incisional hernia repair. That means that 2.6% of all the patients underwent TSIH repair. 44 (68.8%) patients had TSIH in the umbilical Hasson trocar. In the multivariate analysis, the existence of an umbilical Hasson trocar orifice was the only statistically significant risk factor for TSIH development. Conclusions: Incidence of TSIH was high, although few patients underwent incisional hernia repair. Most TSIH were observed in the umbilical Hasson trocar, which was the only risk factor for TSIH development in the multivariate analysis. Efforts should be addressed to avoid TSIH in the umbilical Hasson trocar.
MeSH term(s)	Aged ; Colorectal Surgery ; Humans ; Incidence ; Incisional Hernia/epidemiology ; Incisional Hernia/etiology ; Incisional Hernia/surgery ; Laparoscopy/adverse effects ; Retrospective Studies ; Risk Factors ; Surgical Instruments/adverse effects
Language	English
Publishing date	2020-06-15
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-020-07729-8
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Article ; Online: Extraction-site incisional hernia after laparoscopic colorectal surgery: should we carry out a study about prophylactic mesh closure?

Cano-Valderrama, Oscar / Sanz-López, Rodrigo / Domínguez-Serrano, Inmaculada / Dziakova, Jana / Catalán, Vanesa / Rojo, Mikel / García-Alonso, Mauricio / Mugüerza, José M / Torres, Antonio J

Surgical endoscopy

2019 Volume 34, Issue 9, Page(s) 4048–4052

Abstract: Background: Prophylactic mesh closure has only scarcely been studied to avoid extraction-site incisional hernia after laparoscopic colorectal surgery. The aim was to analyze extraction-site incisional hernia incidence after laparoscopic colorectal ... ...

Abstract	Background: Prophylactic mesh closure has only scarcely been studied to avoid extraction-site incisional hernia after laparoscopic colorectal surgery. The aim was to analyze extraction-site incisional hernia incidence after laparoscopic colorectal surgery to assess if prophylactic mesh closure should be studied. Methods: A retrospective analytic cohort study was conducted in patients who had undergone laparoscopic colorectal surgery with an extraction-site incision. Extraction-site incisional hernia was diagnosed during clinical examination or imaging. Risk factors for extraction-site incisional hernia were analyzed. Results: Two hundred and twenty-five patients were included. More than 80% of the patients had a malignant disease. Ninety-two patients (40.9%) underwent right colectomy. Midline extraction-site incision was used in 86 (38.2%) patients. After a mean follow-up of 2.4 years, 39 (17.3%) patients developed an extraction-site incisional hernia. Midline extraction-site incision was associated with incisional hernia when compared to transverse and Pfannenstiel incision (39.5% vs. 3.6%, OR 17.5, p < 0.001). Surgery to repair an extraction-site incisional hernia was also more frequent in the group of patients with a midline incision (10.5% vs. 1.4%, OR 8.0, p = 0.002). In the multivariate analysis, incisional hernia was associated with body mass index, high blood pressure, and midline incision. Conclusions: Extraction-site incisional hernia was mainly related to midline incisions; therefore, midline incision should be avoided whenever possible. Studying prophylactic mesh closure for Pfannesnstiel or transverse incisions is needless, as these incisions have a low incisional hernia risk.
MeSH term(s)	Aged ; Blood Pressure ; Body Mass Index ; Colorectal Surgery/adverse effects ; Confidence Intervals ; Female ; Humans ; Incisional Hernia/epidemiology ; Incisional Hernia/etiology ; Incisional Hernia/physiopathology ; Laparoscopy/adverse effects ; Male ; Multivariate Analysis ; Odds Ratio ; Retrospective Studies ; Risk Factors ; Surgical Mesh/adverse effects
Language	English
Publishing date	2019-10-15
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-019-07194-y
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Article: Mejora de la comunicación entre niveles asistenciales: derivación directa de pacientes a una consulta de alta resolución de cirugía mayor ambulatoria.

Cerdán Carbonero, M T / Sanz López, R / Martínez Ramos, C

Atencion primaria

2004 Volume 35, Issue 6, Page(s) 283–287

Abstract: Objective: To analyze the results obtained with a "one-stop" specialty service designed as part of a collaborative program involving primary and specialized care in order to improve communication between levels of care and reduce the delay in referral ... ...

Title translation	Improving communication between levels of health care: direct referral of patients to a one-stop service for major outpatient surgery.
Abstract	Objective: To analyze the results obtained with a "one-stop" specialty service designed as part of a collaborative program involving primary and specialized care in order to improve communication between levels of care and reduce the delay in referral and surgical treatment for patients eligible for outpatient surgery. Design: Prospective, descriptive, longitudinal study. Setting: Major Outpatient Surgery Unit of the Hospital Clinico San Carlos and health centers serving Health Area 7 in Madrid, central Spain. Participants: Patients more than 14 years of age with a surgical condition involving the abdominal wall, pilonidal sinus, soft-tissue tumor, or proctological disease. Intervention: Direct referral, with completed preoperative work-up, of patients from health centers to the Major Outpatient Surgery Unit of the Hospital Clinico San Carlos according to a protocol developed by consensus. The patient is seen on the same day for surgical work-up and anesthesia work-up, and is given preoperative information. Patients then make only one further visit to the hospital to undergo surgery. Main measures: Number of patients with each diagnosis referred, diagnostic concordance between the health center and hospital, delay from referral to surgical treatment, number of trips made for different appointments, and referral rate. Results: A total of 188 patients were referred. More than two thirds (68.7%) had an abdominal wall condition eligible for direct referral. Diagnostic concordance was 96%. The delay from referral until surgery was reduced by 60%, and the number of trips for appointments was reduced by 66.6%. The overall referral rate was 12.6%. Conclusions: Because of its feasibility, acceptability, and cost-efficiency, the direct referral system has the potential to improve relations between primary and specialized care and enhance the quality of care by shortening the delay to treatment.
MeSH term(s)	Adolescent ; Adult ; Aged ; Ambulatory Surgical Procedures ; Cost-Benefit Analysis ; Feasibility Studies ; Female ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Patient Selection ; Primary Health Care ; Prospective Studies ; Quality of Health Care ; Referral and Consultation ; Spain ; Time Factors
Language	Spanish
Publishing date	2004-10-21
Publishing country	Spain
Document type	Comparative Study ; English Abstract ; Journal Article
ZDB-ID	1200787-0
ISSN	1578-1275 ; 0212-6567
ISSN (online)	1578-1275
ISSN	0212-6567
DOI	10.1157/13073412
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Article ; Online: A multicentre comparison of a fast track or conventional postoperative protocol following laparoscopic or open elective surgery for colorectal cancer surgery.

Esteban, F / Cerdan, F J / Garcia-Alonso, M / Sanz-Lopez, R / Arroyo, A / Ramirez, J M / Moreno, C / Morales, R / Navarro, A / Fuentes, M

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2014 Volume 16, Issue 2, Page(s) 134–140

Abstract: Aim: The introduction of multimodal or fast track (FT) rehabilitation and laparoscopy in colorectal surgery has improved patient recovery and shortened hospital stay (HS). This study aimed to determine the influence of laparoscopic or open surgery on ... ...

Abstract	Aim: The introduction of multimodal or fast track (FT) rehabilitation and laparoscopy in colorectal surgery has improved patient recovery and shortened hospital stay (HS). This study aimed to determine the influence of laparoscopic or open surgery on the postoperative recovery of colorectal cancer patients having a conventional care (CC) or FT protocol in the postoperative period. Method: A multicentre prospective study was controlled with a retrospective group. The prospective group included 300 patients having elective colorectal resection for cancer. The retrospective control group included 201 patients with the same characteristics who were treated before the introduction of the programme. The patients were divided into four groups including laparoscopy + FT, open surgery + FT, laparoscopy + CC, and open surgery + CC. The primary end-points were HS and morbidity. Secondary end-points included mortality and reoperation rates. Results: The overall median HS was 7 days. The median HS for laparoscopy + FT was 5 days, open + FT 6 days, laparoscopy + CC 9 days and open + CC 10 days (P < 0.001). In the regression model the laparoscopy + FT group had the greatest reduction in HS (P < 0.001). A significant reduction in HS was observed in the laparoscopy + FT group compared with laparoscopy + CC (P < 0.001). The overall patient morbidity was 30.6%. The logistic regression model adjusted for propensity score showed no statistically significant differences between the study groups regarding all other end-points. Conclusion: Colorectal cancer patients who underwent laparoscopic surgery within a multimodal rehabilitation protocol experienced the shortest HS and the lowest morbidity.
MeSH term(s)	Aged ; Aged, 80 and over ; Carcinoma/surgery ; Clinical Protocols ; Cohort Studies ; Colectomy/methods ; Colorectal Neoplasms/surgery ; Elective Surgical Procedures ; Female ; Humans ; Laparoscopy ; Length of Stay ; Logistic Models ; Male ; Middle Aged ; Patient Readmission ; Postoperative Care/methods ; Postoperative Complications ; Prospective Studies ; Reoperation ; Retrospective Studies ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2014-02
Publishing country	England
Document type	Comparative Study ; Journal Article ; Multicenter Study
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.12472
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Zs.A 5799: Show issues

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Article: Roux-en-Y syndrome after surgical treatment of alkaline reflux gastritis.

Martínez-Ramos, C / Núñez Peña, J / Sanz López, R / Tamames Escobar, S

Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva

1999 Volume 91, Issue 11, Page(s) 748–758

Abstract: Objective: to evaluate the possible existence of the so-called ... > in a group of 21 patients who underwent surgery to correct postoperative alkaline reflux gastritis.: Methods: the study group consisted of 15 men and 6 women (mean ... ...

Abstract	Objective: to evaluate the possible existence of the so-called <<Roux-en-Y syndrome>> in a group of 21 patients who underwent surgery to correct postoperative alkaline reflux gastritis. Methods: the study group consisted of 15 men and 6 women (mean age 39.2 years). All had undergone Billroth II subtotal gastrectomy (20 for ulcer and 1 for gastric cancer). Alkaline diversion was done with the Roux-en-Y technique 50-60 cm away from the gastrojejunal anastomosis. In all patients bilateral truncal vagotomy at the hiatus was also done. No mechanical alterations in the gastrojejunal anastomosis were found during surgery. Mean follow-up period was 8.2 years (range 6.5-10.7 years), during which clinical, radiological and endoscopic studies were obtained. Gammagraphic study of gastric remnant emptying was done on postoperative day 30. Results: none of the patients had clinical, radiological or endoscopic manifestations that indicated the presence of Roux-en-Y syndrome. Gammagraphic studies of gastric remnant emptying did not demonstrate significant differences between preoperative (T1/2: 7.3 min) and postoperative values (T1/2: 10.1 min). Conclusions: we found no evidence of disturbances in gastric remnant emptying after Roux-en-Y gastrojejunostomy to treat postoperative alkaline gastric reflux.
MeSH term(s)	Adult ; Anastomosis, Roux-en-Y/adverse effects ; Bile Reflux/prevention & control ; Biliopancreatic Diversion ; Female ; Gastrectomy ; Gastric Emptying ; Gastritis/etiology ; Gastritis/surgery ; Gastroenterostomy ; Humans ; Jejunum/surgery ; Male ; Postoperative Complications ; Stomach Neoplasms/surgery ; Stomach Ulcer/surgery ; Syndrome ; Vagotomy, Truncal
Language	Spanish
Publishing date	1999-11
Publishing country	Spain
Document type	Comparative Study ; Journal Article
ZDB-ID	1070381-0
ISSN	1130-0108 ; 0212-7512
ISSN	1130-0108 ; 0212-7512
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Article: Incisional hernias after laparoscopic vs open cholecystectomy.

Sanz-López, R / Martínez-Ramos, C / Núñez-Peña, J R / Ruiz de Gopegui, M / Pastor-Sirera, L / Tamames-Escobar, S

Surgical endoscopy

1999 Volume 13, Issue 9, Page(s) 922–924

Abstract: Background: The aim of this study was retrospectively to compare the incidence of incisional hernia formation at trocar sites in laparoscopic cholecystectomy with that after conventional open cholecystectomy.: Methods: In all, 271 patients with ... ...

Abstract	Background: The aim of this study was retrospectively to compare the incidence of incisional hernia formation at trocar sites in laparoscopic cholecystectomy with that after conventional open cholecystectomy. Methods: In all, 271 patients with cholelithiasis underwent either laparoscopic cholecystectomy (LC group, n = 142) or open cholecystectomy (OC group, n = 129). In the OC group, the surgical approach was to use a right subcostal incision in 20.2%, right transrectal laparotomy in 73.6%, and midlaparotomy in 6.2%. Laparotomy closure was performed by continuous absorbable suture for the peritoneum and discontinuous absorbable stitches for muscle and fascia. Laparoscopic access was achieved by use of four trocars (two 10 mm and two 5 mm). Umbilical port closure was performed by suture of fascia using discontinuous stitches. Closure of the remaining ports was performed by suture of the skin. Results: Both patient groups were statistically similar with respect to general risk factors. Follow-up was performed in 84 (65.1%) OC and 123 (86.6%) LC patients and ranged from 2 to 10 years (mean, 8 years) and 1 to 5 years (mean, 3 years) respectively. Five (5.9%) OC and two (1.6%) LC patients developed incisional hernias, although the difference between groups was not significant. All hernias in OC patients appeared after transrectal laparotomy. The LC hernias appeared at the umbilical port, and one of the patients developed an additional xiphoides port-associated hernia. Conclusions: The laparoscopic technique showed a lower (although not significantly) incidence of incisional hernias than the open procedure.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Cholecystectomy/adverse effects ; Cholecystectomy, Laparoscopic/adverse effects ; Female ; Follow-Up Studies ; Hernia, Ventral/etiology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors
Language	English
Publishing date	1999-09
Publishing country	Germany
Document type	Comparative Study ; Journal Article
ZDB-ID	639039-0
ISSN	0930-2794
ISSN	0930-2794
DOI	10.1007/s004649901135
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Article ; Online: Resultados de la implantación de un protocolo de fast-track en una unidad de cirugía colorrectal: estudio comparativo.

Esteban Collazo, Fernando / Garcia Alonso, Mauricio / Sanz Lopez, Rodrigo / Sanz Ortega, Gonzalo / Ortega Lopez, Mario / Zuloaga Bueno, Jaime / Jimenez Escovar, Fernando / Cerdán Miguel, F Javier

Cirugia espanola

2012 Volume 90, Issue 7, Page(s) 434–439

Abstract: Objective: To implement a fast-track (FT) protocol in a colorectal surgery unit, checking its safety when applied to patients subjected to elective colorectal surgery, by evaluating the differences in morbidity and hospital stay compared to a control ... ...

Title translation	Results of applying a fast-track protocol in a colorectal surgery unit: comparative study.
Abstract	Objective: To implement a fast-track (FT) protocol in a colorectal surgery unit, checking its safety when applied to patients subjected to elective colorectal surgery, by evaluating the differences in morbidity and hospital stay compared to a control group with traditional care. We also analyse the functional recovery of the FT group. Material and method: A prospective cohort study with non-concurrent control, was conducted on a group of 108 patients operated on for colorectal cancer between 2008 and 2009, to which the FT protocol was applied, and a control group (CG) of 147 patients subjected to surgery between 2005 and 2007 with similar characteristics, with traditional postoperative care. Results: The demographic characteristics, anaesthetic risk, and the surgical procedures performed were similar, with a higher number of patients with laparoscopic approach in the FT group. The compliance with the items in our FT protocol was high (72.2-92.6%). Complications were observed in 77 patients (52%) in the GC compared to 30 (27.8%) in the FT group (P<.001), mainly due to the decrease in surgical wound infection (P<.001). Mortality and the number of readmissions were less in the FT group, with no statistically significant differences. The median hospital stay was 14 days in the CG and 8 in the FT group (P<.001). Conclusions: The applying of an FT program in colorectal surgery is safe, leading to a significant decrease in morbidity and hospital stay, without increasing the number of readmissions.
MeSH term(s)	Aged ; Clinical Protocols ; Colorectal Neoplasms/surgery ; Colorectal Surgery/adverse effects ; Colorectal Surgery/methods ; Female ; Humans ; Male ; Prospective Studies ; Time Factors
Language	Spanish
Publishing date	2012-08
Publishing country	Spain
Document type	Comparative Study ; English Abstract ; Journal Article
ZDB-ID	730701-9
ISSN	1578-147X ; 0009-739X
ISSN (online)	1578-147X
ISSN	0009-739X
DOI	10.1016/j.ciresp.2012.02.012
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Article: Alteraciones de la gastrinemia en el postoperatorio tardío tras vagotomía gástrica proximal.

Núñez Peña, J R / Martínez Ramos, C / Sanz López, R / Ruiz de Gopequi, M / Jorgensen, T W / Tamames, E S

Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva

1994 Volume 86, Issue 4, Page(s) 717–721

Abstract: Changes in serum gastrin levels in the late postoperative period have been studied in 24 patients with non-stenotic duodenal ulcer who underwent proximal gastric vagotomy. Twenty healthy volunteers were used as a control group. Serum gastrin levels were ... ...

Title translation	Blood gastrin changes in the late postoperative period after proximal gastric vagotomy.
Abstract	Changes in serum gastrin levels in the late postoperative period have been studied in 24 patients with non-stenotic duodenal ulcer who underwent proximal gastric vagotomy. Twenty healthy volunteers were used as a control group. Serum gastrin levels were determined under basal conditions and after a high protein meal stimulation. Both measurements were done in the preoperative, early postoperative (12th day) and late postoperative periods (X = 5.5 yrs.). Regarding basal serum gastrin levels, the results show mean values of 46.2 pg/ml in the preoperative, 61.6 pg/ml in the early postoperative, 73.9 pg/ml in the late postoperative and 51 pg/ml in the control group. Early and late postoperative period values show statistical significant differences when compared with preoperative values (p < 0.05), but not with the control group ones. Stimulated gastrin levels show mean values of 75.7 pg/ml in the preoperative, 99.1 pg/ml in the early postoperative, 134.1 pg/ml in the late postoperative and 73.4 pg/ml in the control group. Late postoperative values show statistical significant differences when compared with preoperative and early postoperative values (p < 0.05), and also when compared with the control group (p < 0.05). Possible causes and the physiopathological effects of these variations are discussed.
MeSH term(s)	Adolescent ; Adult ; Aged ; Dietary Proteins ; Duodenal Ulcer/blood ; Duodenal Ulcer/surgery ; Elective Surgical Procedures ; Female ; Gastrins/blood ; Humans ; Male ; Middle Aged ; Postoperative Period ; Time Factors ; Vagotomy, Proximal Gastric
Chemical Substances	Dietary Proteins ; Gastrins
Language	Spanish
Publishing date	1994-10
Publishing country	Spain
Document type	Comparative Study ; English Abstract ; Journal Article
ZDB-ID	1070381-0
ISSN	1130-0108 ; 0212-7512
ISSN	1130-0108 ; 0212-7512
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Article: La cirugía en el tratamiento del linforma primitivo de intestino.

Sanz López, R / Martínez Ramos, C / Núñez Peña, J R / Ruiz de Gopegui, M / Jorgensen, T / Tamames, E S

Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva

1994 Volume 85, Issue 5, Page(s) 405–407

Title translation	Surgery in the treatment of primary lymphoma of the intestine.
MeSH term(s)	Adult ; Humans ; Ileal Neoplasms/surgery ; Lymphoma, B-Cell/surgery ; Male
Language	Spanish
Publishing date	1994-05
Publishing country	Spain
Document type	Case Reports ; Letter
ZDB-ID	1070381-0
ISSN	1130-0108 ; 0212-7512
ISSN	1130-0108 ; 0212-7512
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