Background and Objectives: The aim of this study is to evaluate the usefulness of Magnetic Resonance Imaging (MRI) for planning surgery and postoperative control of complex cases of abdominal wall hernia. Methods: Included in a prospective data base with more than 350 patients treated in two centers, a prospective study over ten patients with complex incisional hernias was designed. In all cases, preoperative diagnosis study and postoperative imaging control by MR Imaging were established. In the early and late follow-up controls, local and general complications were specifically noted and studied by MRI in each case. Results: The preoperative MRI was effective method for an adequate understanding of the defects and hernia sack content. In the postoperative control, the MRI was useful in the follow-up of the mesh integration, detection of complications and diagnosis of the relapsing. Conclusion: In our experience the MRI test is specially recommended in the preoperative workup of complex cases of incisional hernia.

Background:The laparoscopic approach for colorectal pathologies is becoming more widely used, and surgeons have had to learn how to perform this new technique. The purpose of this work is to study the indicators of the learning curve for laparoscopic colectomy in a community hospital and to find when the group begins to improve.Methodology:From January 1 2005 to December 31 2012, 313 consecutive laparoscopic colorectal surgeries were performed (105 rectal and 208 colonic) by at least 60% of the same surgical team (6 members) in each operation. We evaluate the learning curve by moving averages and cumulative sums (CUSUM) for different variables related to the surgery outcomes.Results:Moving average curves for postoperative stay, fasting, and second step analgesia show a stabilizing trend toward improvement as we get more experience. However, intensive care unit stay, number of lymph nodes achieved, and operating time did not show a clear decreasing tendency. CUSUM curves of conversion, specimens <12 lymph nodes, and complications all show a clear turning point marked on all the charts around the procedure 60, accumulating a positive trend toward improvement. The CUSUM curve of the “learning variable” shows this improvement point at procedure 70.Conclusions:The laparoscopic colectomy learning curve accelerates with a collective team involvement in each procedure. The CUSUM and moving average curves are useful for initial and ongoing monitoring of new surgical procedures. The markers of the learning curve evidenced in our study are the conversion rate, postoperative surgical morbidity, and the number of patients with a lymph node count <12.What is new in this paper?The significance of this study is the evaluation of the learning curve, in laparoscopic colorectal surgery, of a surgical team in a community hospital, using moving average and CUSUM curves. This study demonstrated that the number of patients needed to achieve skilful practice decreased when there is collective team involvement in each procedure.

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Background: Clinical prediction rules have been designed to reduce diagnostic variability and improve the effectiveness of the diagnostic process. However, there are no unanimous criteria regarding which of them is the most efficient for the diagnosis of right iliac fossa pain. Aim: The primary aim of this study was to assess the diagnostic efficacy of the most commonly used clinical prediction rules. The second aim was to identify the combination of the smallest number of clinical and analytical variables that would allow a cost-effective diagnostic approach to assess the right iliac fossa pain. Methods: A retrospective observational study was conducted of 458 patients who were evaluated for right iliac fossa pain between January 2010 and December 2016. The selected scores (Alvarado, AIR, RIPASA, and AAS) were applied to all cases to validate their effectiveness and simultaneously establish the smallest number of variables that were needed for an efficient diagnosis. Univariate and multiple regressions were used for validation. Results: Of the four scores tested, the Alvarado score was the most efficient diagnostic approach. However, the most reduced and predictive combination of the evaluated variables included anorexia, white blood cell count> 8275 leukocytes/μL, neutrophilia (>75%), abdominal pain < 48 hours, migrating pain to the right lower quadrant and axillary temperature out the range of 37-39ºC. Conclusions: A new and effective score for predicting appendicitis in patients presenting with right iliac fossa pain has been established.

Purpose. The laparoscopic approach for gastric carcinoma (GC) is being increasingly implemented. surgeons. Although recent evidence suggests that this surgical approach is associated with improvements in short-term outcomes, mid- and long-term outcomes have not been well studied. This study aimed to evaluate the mid- and long-term outcomes of laparoscopic gastrectomy (LG) with D1-D2 lymph node dissection for all stages of GC.Methods. A prospective study of GC treated by laparoscopic approach between January 2004 and December 2019 was performed. The demographics, perioperative data, operation details, length of hospital stay, morbid­ity, mortality and pathologic and oncological outcomes were analyzed.Results. A total of 70 patients met the inclusion criteria. The median age was 73 years old. Subtotal gastrectomy was performed in 52 cases (74.3%), and total gastrectomy was performed in 18 cases (25.7%). The median operative time was 270 minutes. The median postoperative stay was 10 days. Morbidity was 35.7%, with a mortality of 7.1%. The disease-free survival (DFS) was 61.2% at three years and 52.3% at five years.Conclusions: LG is a feasible and secure surgical procedure for GC with good mid- and long-term results. Advanced age should not be considered a contraindication for LG.