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Pous-Serrano S, García-Pastor P, Bueno-Lledó J. National survey of colorectal surgery units on abdominal wall closure. Cir Esp 2023; 101:258-264. [PMID: 36108954 DOI: 10.1016/j.cireng.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/08/2022] [Indexed: 04/21/2023]
Abstract
INTRODUCTION The purpose of this study is to assess the current status and knowledge of the Spanish colorectal surgeons on the wall closure. METHODS A single answer questionnaire of 25 closed questions was conducted using specific software for online surveys that was distributed to a cohort of colorectal surgeons. RESULTS 53 surgeons replied to the survey. The vast majority prefer a closure of the midlaparotomy with a very slow absorbing monofilament (67.92%) continuous suture (96.23%) in a single plane (81.13%). Mass stitches, retention systems, and loop sutures continue to be used. The most commonly used suture gauge was USP 1 (United States Pharmacopeia) (58.49%). The most commonly used needle is with a cylindrical body and a trocar tip. Only 50%, routinely perform wall closure after placement of a trocar equal to or greater than 10 mm. Almost everyone knows the 4:1 rule and thinks it should be applied, but the small bites technique is not performed. 50% would never place a prophylactic prosthesis. The closure is usually performed by the same surgeon who has performed the entire procedure. One out of five confesses not knowing the rate of incisional hernias in his unit. CONCLUSION There is a lack of consensus and basic knowledge regarding the technical aspects of closure and the prevention of the appearance of incisional hernias. The use of slow absorbing monofilament continuous suture in a single plane seems well accepted.
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Affiliation(s)
- Salvador Pous-Serrano
- Unidad de Cirugía de Pared, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - Providencia García-Pastor
- Unidad de Cirugía de Pared, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José Bueno-Lledó
- Unidad de Cirugía de Pared, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Safety and efficacy of totally minimally invasive right colectomy in the obese patients: a multicenter propensity score-matched analysis. Updates Surg 2022; 74:1281-1290. [PMID: 35639279 PMCID: PMC9338133 DOI: 10.1007/s13304-022-01298-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/09/2022] [Indexed: 11/25/2022]
Abstract
Despite the well-known benefits of the minimally invasive approach for the right colon cancer treatment, less is known about its feasibility and advantages in morbid obese patients. The aim of this study is to compare the postoperative outcomes after totally minimally invasive right colectomy between the obese and non-obese population. Data derived from a prospectively maintained multicenter colorectal database were analysed, dividing the enrolled patients into two groups: obese (BMI > 29.99) patient group and non-obese patient group. Data about gender, age, American Society of Anesthesiologists (ASA) Score, tumor characteristics, operative time, anastomosis time, extraction site, incision length, intraoperative complications, postoperative complications, postoperative recovery, specimen length and retrieved nodes were taken to assess the achievement of the oncologic standards. After a propensity score matching, a total of 184 patients was included, 92 in each group. No differences were found in terms of demographic data and tumor characteristics. Intraoperative data showed a significant difference in terms of anastomosis time in favour of non-obese group (p < 0.0001). No intraoperative complications were recorded and no conversion was needed in both groups. No differences were found in terms of postoperative complications. There were no differences in terms of first mobilization (p = 0.745), time to first flatus (p = 0.241) time to tolerance to liquid and solid diet (p = 0.241 and p = 0.06) and length of hospital stay (p = 0.817). The analysis of oncologic outcomes demonstrated adequate results in both groups. The results obtained by our study confirmed the feasibility and safety of the totally minimally invasive approach even in obese population.
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Pous-Serrano S, García-Pastor P, Bueno-Lledó J. Encuesta nacional a unidades de cirugía colorrectal sobre el cierre de pared abdominal. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pereira-Rodríguez JA, Amador-Gil S, Bravo-Salva A, Montcusí-Ventura B, Sancho-Insenser J, Pera-Román M, López-Cano M. Implementing a protocol to prevent incisional hernia in high-risk patients: a mesh is a powerful tool. Hernia 2021; 26:457-466. [PMID: 34724119 PMCID: PMC9012727 DOI: 10.1007/s10029-021-02527-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/17/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE The small bites (SB) technique for closure of elective midline laparotomies (EMLs) and a prophylactic mesh (PM) in high-risk patients are suggested by the guidelines to prevent incisional hernias (IHs) and fascial dehiscence (FD). Our aim was to implement a protocol combining both the techniques and to analyze its outcomes. METHODS Prospective data of all EMLs were collected for 2 years. Results were analyzed at 1 month and during follow-up. The incidence of HI and FD was compared by groups (M = Mesh vs. S = suture) and by subgroups depending on using SB. RESULTS A lower number of FD appeared in the M group (OR 0.0692; 95% CI 0.008-0.56; P = 0.01) in 197 operations. After a mean follow-up of 29.23 months (N = 163; min. 6 months), with a lower frequency of IH in M group (OR 0.769; 95% CI 0.65-0.91; P < 0.0001). (33) The observed differences persisted after a propensity matching score: FD (OR 0.355; 95% CI 0.255-0.494; P < 0.0001) and IH (OR 0.394; 95% CI 0.24-0.61; P < 0.0001). On comparing suturing techniques by subgroups, both mesh subgroups had better outcomes. PM was the main factor related to the reduction of IH (HR 11.794; 95% CI 4.29-32.39; P < 0.0001). CONCLUSION Following the protocol using PM and SB showed a lower rate of FD and HI. A PM is safe and effective for the prevention of both HI and FD after MLE, regardless of the closure technique used.
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Affiliation(s)
- J A Pereira-Rodríguez
- Department of General and Digestive Surgery, Hospital, Universitario del Mar. Parc de Salut Mar, Barcelona, Spain.
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
| | - S Amador-Gil
- Department of Surgery and Morphological Sciences, Parc de Salut Mar, Hospital del Mar, Universitat Autónoma de Barcelona, Passeig Maritim 25-29, 08003, Barcelona, Spain
| | - A Bravo-Salva
- Department of General and Digestive Surgery, Hospital, Universitario del Mar. Parc de Salut Mar, Barcelona, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - B Montcusí-Ventura
- Department of General and Digestive Surgery, Hospital, Universitario del Mar. Parc de Salut Mar, Barcelona, Spain
| | - J Sancho-Insenser
- Department of General and Digestive Surgery, Hospital, Universitario del Mar. Parc de Salut Mar, Barcelona, Spain
- Department of Surgery and Morphological Sciences, Parc de Salut Mar, Hospital del Mar, Universitat Autónoma de Barcelona, Passeig Maritim 25-29, 08003, Barcelona, Spain
| | - M Pera-Román
- Department of General and Digestive Surgery, Hospital, Universitario del Mar. Parc de Salut Mar, Barcelona, Spain
- Department of Surgery and Morphological Sciences, Parc de Salut Mar, Hospital del Mar, Universitat Autónoma de Barcelona, Passeig Maritim 25-29, 08003, Barcelona, Spain
| | - M López-Cano
- Department of Surgery and Morphological Sciences, Parc de Salut Mar, Hospital del Mar, Universitat Autónoma de Barcelona, Passeig Maritim 25-29, 08003, Barcelona, Spain
- Department of General and Digestive Surgery, Hospital Valle de Hebrón, Barcelona, Spain
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Weyhe D, Salzmann D, Gloy K. [Prophylaxis of parastomal, perineal and incisional hernias in colorectal surgery]. Chirurg 2021; 92:621-629. [PMID: 33913011 DOI: 10.1007/s00104-021-01415-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 11/26/2022]
Abstract
This article gives an overview of the relevant evidence from the literature on the topic of prophylactic use of meshes to prevent incisional and parastomal hernias in colorectal surgery. In addition, based on a structured literature search the incidence of hernias in colorectal surgery over the past 5 years was analyzed. A slight majority (54%) of articles recommended the use of prophylactic mesh implantation in colorectal surgery. The prophylactic use of meshes appears to reduce the risk of hernias in colorectal surgery but is associated with a slightly increased perioperative wound infection rate. Parastomal hernias are associated with higher incidence rates compared with incisional hernias and also appear to benefit more from prophylactic mesh implantation. The evidence in the literature is still unclear regarding the use of synthetic or biological implants due to the lack of randomized controlled trials. Perineal hernias were excluded from the analysis due to the incomparability of the mainly casuistic literature. An overview is given in the discussion. The analysis of the literature and also in reflection of our own experience comes to the conclusion that the disrupted integrity of the abdominal wall due to the operation should be prophylactically reinforced with a mesh after colorectal surgery. An evidence-based recommendation is not possible based on the current state of research on implantation techniques, e.g. onlay, sublay intraperitoneal onlay mesh (IPOM) and selection of the implant.
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Affiliation(s)
- Dirk Weyhe
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinik für Viszeralchirurgie, Pius Hospital Oldenburg, Medizinischer Campus Universität Oldenburg, Georgstraße 12, 26121, Oldenburg, Deutschland.
| | - Daniela Salzmann
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinik für Viszeralchirurgie, Pius Hospital Oldenburg, Medizinischer Campus Universität Oldenburg, Georgstraße 12, 26121, Oldenburg, Deutschland
| | - Kilian Gloy
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinik für Viszeralchirurgie, Pius Hospital Oldenburg, Medizinischer Campus Universität Oldenburg, Georgstraße 12, 26121, Oldenburg, Deutschland
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Ahmed J, Hasnain N, Fatima I, Malik F, Chaudhary MA, Ahmad J, Malik M, Malik L, Osama M, Baig MZ, Khosa F, Bhora F. Prophylactic Mesh Placement for the Prevention of Incisional Hernia in High-Risk Patients After Abdominal Surgery: A Systematic Review and Meta-Analysis. Cureus 2020; 12:e10491. [PMID: 32953367 PMCID: PMC7497772 DOI: 10.7759/cureus.10491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background and objectives In high-risk populations, the efficacy of mesh placement in incisional hernia (IH) prevention after elective abdominal surgeries has been supported by many published studies. This meta-analysis aimed at providing comprehensive and updated clinical implications of prophylactic mesh placement (PMP) for the prevention of IH as compared to primary suture closure (PSC). Materials and methods PubMed, Science Direct, Cochrane, and Google Scholar were systematically searched until March 3, 2020, for studies comparing the efficacy of PMP to PSC in abdominal surgeries. The main outcome of interest was the incidence of IH at different follow-up durations. All statistical analyses were carried out using Review Manager version 5.3 (The Nordic Cochrane Centre, The Cochrane Collaboration, 2014) and Stata 11.0 (Stata Corporation LP, College Station, TX). The data were pooled using the random-effects model, and odds ratio (OR) and weighted mean differences (WMD) were calculated with the corresponding 95% confidence interval (CI). Results A total of 3,330 were identified initially and after duplicate removal and exclusion based on title and abstract, 26 studies comprising 3,000 patients, were included. The incidence of IH was significantly reduced for PMP at follow-up periods of one year (OR= 0.16 [0.05, 0.51]; p=0.002; I2=77%), two years (OR= 0.23 [0.12, 0.45]; p<0.0001; I2=68%), three years (OR= 0.30 [0.16, 0.59]; p=0.0004; I2= 52%), and five years (OR=0.15 [0.03, 0.85]; p=0.03; I2=87%). However, PMP was associated with an increased risk of seroma (OR=1.67 [1.10, 2.55]; p= 0.02; I2=19%) and chronic wound pain (OR=1.71 [1.03, 2.83]; p= 0.04; I2= 0%). No significant difference between the PMP and PSC groups was noted for postoperative hematoma (OR= 1.04 [0.43, 2.50]; p=0.92; I2=0%), surgical site infection (OR=1.09 [0.78, 1.52]; p= 0.62; I2=12%), wound dehiscence (OR=0.69 [0.30, 1.62]; p=0.40; I2= 0%), gastrointestinal complications (OR= 1.40 [0.76, 2.58]; p=0.28; I2= 0%), length of hospital stay (WMD= -0.49 [-1.45, 0.48]; p=0.32; I2=0%), and operating time (WMD=9.18 [-7.17, 25.54]; p= 0.27; I2=80%). Conclusions PMP has been effective in reducing the rate of IH in the high-risk population at all time intervals, but it is associated with an increased risk of seroma and chronic wound pain. The benefits of mesh largely outweigh the risk, and it is linked with positive outcomes in high-risk patients.
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Affiliation(s)
- Jawad Ahmed
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Nimra Hasnain
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Iayla Fatima
- General Surgery, St. Luke's General Hospital, Killenny, IRL
| | - Farheen Malik
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Muhammad A Chaudhary
- Center for Surgery and Public Health, Harvard Medical School/Harvard T. H. Chan School of Public Health, Boston, USA.,Family Medicine, WellSpan Good Samaritan Hospital, Lebanon, USA
| | - Junaid Ahmad
- Liaquat Medical College, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | | | - Laraib Malik
- Pediatrics, Abbasi Shaheed Hospital, Karachi, PAK
| | - Muhammad Osama
- General Surgery, Dow University of Health Sciences, Karachi, PAK
| | | | - Faisal Khosa
- Radiology, Vancouver General Hospital, Vancouver, CAN
| | - Faiz Bhora
- Thoracic Surgery, Health Quest System, New York, USA
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Bravo-Salva A, González-Castillo AM, Vela-Polanco FF, Membrilla-Fernández E, Vila-Domenech J, Pera-Román M, Sancho-Insenser JJ, Pereira-Rodríguez JA. Incidence of Incisional Hernia After Emergency Subcostal Unilateral Laparotomy: Does Augmentation Prophylaxis Play a Role? World J Surg 2019; 44:741-748. [PMID: 31741074 DOI: 10.1007/s00268-019-05282-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Few data are available about the frequency of incisional hernia in an emergency subcostal laparotomy. Our objective is to analyze the incidence of incisional hernia after emergency subcostal laparotomy and evaluate if prophylactic mesh could help prevent it. METHODS This study is a monocentric retrospective analysis following STROBE guideline statements of all patients who underwent an emergency subcostal laparotomy between January 2011 and July 2017 in our University Hospital. We compared complications and incidence of incisional hernia between patients who received sutures (Group S; N = 203) and patients with prophylactic onlay mesh (Group M; N = 80). A multivariate risk factor analysis of incisional hernia was performed. An incisional hernia-estimated risk calculator equation was created. RESULTS A total of 283 patients were analyzed. There were 80 patients in Group M and 203 in Group S. In short-term outcomes, length of surgery (213 ± 115 min vs 165 ± 73.3 min, P = 0.001) and hospital stay (16.4 ± 18.7 vs 11.6 days ± 13.4, P = 0.038) were longer in Group M. Long-term follow-up was conducted in 207 patients with a mean follow-up time of 39.3 ± 23 months. Incisional hernia was detected in 29 (19.1%) patients in Group S but in only two (3.8%) patients in Group M (P = 0.008). In the multivariate analysis, a risk factor analysis included wound infection (4.91 HR (2.12-11.4); P < 0.001), previous hernia repair (2.86 HR (1.24-6.61); P = 0.014), and shock (2.64 HR (1.01-6.93); P = 0.048). CONCLUSIONS The incidence of incisional hernia after emergency subcostal laparotomy is high. Risk factors are wound infection, shock, and previous hernia surgery. The use of prophylactic mesh augmentation was safe and reduced the incidence of incisional hernia.
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Affiliation(s)
- A Bravo-Salva
- Servicio de Cirugía General y del Aparato Digestivo, Parc de Salut Mar, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain. .,Departament de Ciències, Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain.
| | - A M González-Castillo
- Servicio de Cirugía General y del Aparato Digestivo, Parc de Salut Mar, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - F F Vela-Polanco
- Servicio de Cirugía General y del Aparato Digestivo, Parc de Salut Mar, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - E Membrilla-Fernández
- Servicio de Cirugía General y del Aparato Digestivo, Parc de Salut Mar, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.,Departament de Cirurgia, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain
| | - J Vila-Domenech
- IMIM-Institut de Recerca Hospital del Mar, Barcelona, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - M Pera-Román
- Servicio de Cirugía General y del Aparato Digestivo, Parc de Salut Mar, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.,Departament de Cirurgia, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain
| | - J J Sancho-Insenser
- Servicio de Cirugía General y del Aparato Digestivo, Parc de Salut Mar, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.,Departament de Cirurgia, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain
| | - J A Pereira-Rodríguez
- Servicio de Cirugía General y del Aparato Digestivo, Parc de Salut Mar, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.,Departament de Ciències, Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
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Cano-Valderrama O, Sanz-López R, Domínguez-Serrano I, Dziakova J, Catalán V, Rojo M, García-Alonso M, Mugüerza JM, Torres AJ. Extraction-site incisional hernia after laparoscopic colorectal surgery: should we carry out a study about prophylactic mesh closure? Surg Endosc 2019; 34:4048-4052. [PMID: 31617098 DOI: 10.1007/s00464-019-07194-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/09/2019] [Indexed: 11/26/2022]
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.
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Affiliation(s)
- Oscar Cano-Valderrama
- Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain.
- Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain.
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain.
| | - Rodrigo Sanz-López
- Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain
- Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
| | - Inmaculada Domínguez-Serrano
- Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain
- Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
| | - Jana Dziakova
- Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Vanesa Catalán
- Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Mikel Rojo
- Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Mauricio García-Alonso
- Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain
- Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
| | - José M Mugüerza
- Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain
- Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
| | - Antonio J Torres
- Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain
- Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
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