Salvador Morales-Conde

Hospital Universitario Virgen del Rocío, Hispalis, Andalusia, Spain

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Publications (71)108.13 Total impact

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    ABSTRACT: Single-incision laparoscopic surgery poses significant ergonomic limitations. Curved instruments have been developed in order to address the issue of lack of triangulation. Direct comparison between single-incision laparoscopic surgeries with conventional linear and curved instruments has not been performed to date. MEDLINE, CENTRAL and OpenGrey were searched to identify relevant randomized trials. A network meta-analysis was applied to compare operative risks, conversion, duration of surgery and the need for placement of an adjunct trocar in single-incision laparoscopic cholecystectomy with linear and curved instruments. The random-effects model was applied for two sets of comparisons, with conventional laparoscopic cholecystectomy as the reference treatment. Odds ratios, mean differences and 95 % confidence intervals were calculated. Twenty-three randomized trials encompassing 1737 patients were included. The use of curved instruments was associated with increased operative time (mean difference 32.53 min, 95 % CI 24.23-40.83) and higher odds for the use of an adjunct trocar (odds ratio 22.81, 95 % CI 16.69-28.94) compared to the use of linear instruments. Perioperative risks could not be comparatively assessed due to the low number of events. Single-incision laparoscopic cholecystectomy with curved instruments may be associated with an increased level of operative difficulty, as reflected by the need for auxiliary measures for exposure and increased operative time as compared to the use of linear instruments. Current instrumentation requires further improvement, tailored to the features of single-incision laparoscopic surgery (CRD42015015721).
    Surgical Endoscopy 06/2015; DOI:10.1007/s00464-015-4283-x · 3.31 Impact Factor
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    ABSTRACT: Single-incision laparoscopic surgery has been developed with the objective to reduce surgical trauma, decrease associated surgical stress and to improve cosmetic outcome. However, concerns have been raised regarding the risk of trocar-site hernia following this approach. Previous meta-analyses have suggested a trend toward higher hernia rates, but have failed to demonstrate a significant difference between single-incision and conventional laparoscopic surgery. Medline, AMED, CINAHL and CENTRAL were searched up to May 2014. Randomized controlled trials comparing single-incision and conventional laparoscopic surgery were considered for inclusion. Studies with patients aged less than 18 years and those reporting on robotic surgery were disregarded. Pooled odds ratios with 95 % confidence intervals were calculated to measure the comparative risk of trocar-site hernia following single-incision and conventional laparoscopic surgery. Nineteen randomized trials encompassing 1705 patients were included. Trocar-site hernia occurred in 2.2 % of patients in the single-incision group and in 0.7 % of patients in the conventional laparoscopic surgery group (odds ratio 2.26, 95 % confidence interval 1.00-5.08, p = 0.05). Sensitivity analysis of quality randomized trials validated the outcome estimates of the primary analysis. There was no heterogeneity among studies (I (2) = 0 %) and no evidence of publication bias. Single-incision laparoscopic surgery involving entry into the peritoneal cavity through the umbilicus is associated with a slightly higher risk of trocar-site hernia than conventional laparoscopy. Its effect on long-term morbidity and quality of life is a matter for further investigation.
    Hernia 04/2015; DOI:10.1007/s10029-015-1371-8 · 2.09 Impact Factor
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    ABSTRACT: Erratum to: Surg Endosc (2015) 29:289-321 DOI 10.1007/s00464-014-3917-8The name of the 14th author F. Koeckerling is misspelled. The correct spelling is F. Köckerling.
    Surgical Endoscopy 03/2015; 29(6). DOI:10.1007/s00464-015-4156-3 · 3.31 Impact Factor
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    ABSTRACT: The seroma generated between the abdominal viscera and the prosthesis (retroprosthetic seroma), after laparoscopic ventral hernia repair (LVHR) with the implant of an intraperitoneal mesh is an unknown entity with few references in the literature. Our objective is to analyze its incidence, clinical repercussions and course of retroprosthetic seroma during the first 3 months post-operation and the factors related to its appearance, such as the relationship to preprosthetic seroma, the size of the prosthesis and the patient BMI. Prospective, descriptive study in patients undergoing LVHR using the double crown technique. After surgery, the patients had follow-ups on the seventh day and the first and third months post-operation with clinical examination and abdominal CT scan. The study endpoints were: incidence and volume of retroprosthetic seroma, clinical repercussions, relationship to body mass index (BMI), prosthesis size and the existence of preprosthetic seroma. Fifty patients underwent LVHR using the double crown technique and were included in the study. The incidence of retroprosthetic seroma during the 3-month follow-up was 46 %, there being a progressive process of spontaneous reabsorption. In just one patient (2 %) there were clinical repercussions as a result of the seroma. No statistically significant relationship was found with BMI and preprosthetic seroma. A statistical relationship was found between the size of the prosthesis and the risk of suffering retroprosthetic seroma in the third month post-operation (p = 0.048). Retroprosthetic seroma is an entity produced in 46 % of patients undergoing LVHR with few clinical repercussions (2 %). In most cases it develops in the first week post-operation and then undergoes a reabsorption process that is usually complete by the third month post-operation. The size of the prosthesis delays the reabsorption process.
    Hernia 02/2015; DOI:10.1007/s10029-015-1352-y · 2.09 Impact Factor
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    ABSTRACT: The material and the surgical technique used to close an abdominal wall incision are important determinants of the risk of developing an incisional hernia. Optimising closure of abdominal wall incisions holds a potential to prevent patients suffering from incisional hernias and for important costs savings in health care. The European Hernia Society formed a Guidelines Development Group to provide guidelines for all surgical specialists who perform abdominal incisions in adult patients on the materials and methods used to close the abdominal wall. The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and methodological guidance was taken from Scottish Intercollegiate Guidelines Network (SIGN). The literature search included publications up to April 2014. The guidelines were written using the AGREE II instrument. An update of these guidelines is planned for 2017. For many of the Key Questions that were studied no high quality data was detected. Therefore, some strong recommendations could be made but, for many Key Questions only weak recommendations or no recommendation could be made due to lack of sufficient evidence. To decrease the incidence of incisional hernias it is strongly recommended to utilise a non-midline approach to a laparotomy whenever possible. For elective midline incisions, it is strongly recommended to perform a continuous suturing technique and to avoid the use of rapidly absorbable sutures. It is suggested using a slowly absorbable monofilament suture in a single layer aponeurotic closure technique without separate closure of the peritoneum. A small bites technique with a suture to wound length (SL/WL) ratio at least 4/1 is the current recommended method of fascial closure. Currently, no recommendations can be given on the optimal technique to close emergency laparotomy incisions. Prophylactic mesh augmentation appears effective and safe and can be suggested in high-risk patients, like aortic aneurysm surgery and obese patients. For laparoscopic surgery, it is suggested using the smallest trocar size adequate for the procedure and closure of the fascial defect if trocars larger or equal to 10 mm are used. For single incision laparoscopic surgery, we suggest meticulous closure of the fascial incision to avoid an increased risk of incisional hernias.
    Hernia 01/2015; 19(1). DOI:10.1007/s10029-014-1342-5 · 2.09 Impact Factor
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    ABSTRACT: Introduction Ventral hernias are a common problem in a general surgery and hernioplasty is an integral part of a general surgeon’s practice. The use of prosthetic material has drastically reduced the risk of recurrence, but has introduced additional potential complications such as surgical wound infections, adhesion formation, graft rejection, etc. The development of a wound infection in a hernia that is repaired with a prosthetic material is a grave complication, often requiring removal of the prosthesis. This experimental study examined efficacy of completely absorbable, hydrophilic, PGA–TMC (polyglycolic acid–trimethylene carbonate) prosthesis impregnated with antibiotic for reduction of infectious complications. Methods Antibiotic-impregnated PGA–TMC prostheses were placed intraperitoneally in 90 Wistar white rats that were randomized and distributed into four groups. Group 0 (23 rats): there were placed PGA–TMC prosthesis without antibiotic impregnation (control group). Group 1 (25 rats): meshes were placed and infected later with 1 × 108 UFC of S. aureus/1 ml/2 cm2 (Staphylococcus aureus ATCC 6538 American Type Culture Collection, Rockville, MD). Group 2 (21 rats): cefazolin-impregnated prostheses were placed (1 g × 100 ml, at the rate of 1 ml/cm2 of prosthesis) and were subsequently infected with the same bacterial inoculate. Group 3 (21 rats): cefazolin-impregnated prostheses with double quantity of cefazolin and infected. A week later these animals were killed and specimens were extracted for bacterial quantification and histological studies. Results Evident decrease of bacterial colonization was observed in series 2 and 3 [the ones impregnated with cefazolin, in comparison with the group 1 (infected without previous antibiotic impregnation)] with statistically significant results (p
    Hernia 12/2014; 19(2). DOI:10.1007/s10029-014-1334-5 · 2.09 Impact Factor
  • Cirugía Española 11/2014; 92(9). DOI:10.1016/j.ciresp.2014.02.014 · 0.89 Impact Factor
  • Cirugía Española 06/2014; 92(9). DOI:10.1016/j.cireng.2014.02.018 · 0.89 Impact Factor
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    ABSTRACT: The loss of mobility due to spinal cord injury is a risk factor for weight gain. Despite the well-documented outcomes of bariatric surgery in outpatients, little information is available about the surgery in paraplegic patients. We present two cases of patients with morbid obesity and spinal cord injury. After several attempts to lose weight conservatively, were assessed by the multidisciplinary team of our hospital and finally intervened by laparoscopic gastric bypass. After surgery have been no post-surgical complications. The patient in case 1, after two years of follow-up, a weight of 84 kg (BMI 25.08 kg/m2). Case 2, after a month of surgery has reduced weight and stopped taking antihypertensive therapy. It 's available to bariatric surgery as an important option to consider if all non-surgical interventions fail is highlighted.
    Nutricion hospitalaria: organo oficial de la Sociedad Espanola de Nutricion Parenteral y Enteral 06/2014; 29(n06):1447-1449. DOI:10.3305/nh.2014.29.6.7400 · 1.25 Impact Factor
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    ABSTRACT: In 2009, the European Hernia Society published the EHS Guidelines for the Treatment of Inguinal Hernia in Adult Patients. The Guidelines contain recommendations for the treatment of inguinal hernia from diagnosis till aftercare. The guidelines expired January 1, 2012. To keep them updated, a revision of the guidelines was planned including new level 1 evidence.The original Oxford Centre for Evidence-Based Medicine ranking was used. All relevant level 1A and level 1B literature from May 2008 to June 2010 was searched (Medline and Cochrane) by the Working Group members. All chapters were attributed to the two responsible authors in the initial guidelines document. One new chapter on fixation techniques was added. The quality was assessed by the Working Group members during a 2-day meeting and the data were analysed, especially with respect to any change in the level and/or text of any of the conclusions or recommendations of the initial guidelines. In the end, all relevant references published until January 1, 2013 were included. The final text was approved by all Working Group members.For the following topics, the conclusions and/or recommendations have been changed: indications for treatment, treatment of inguinal hernia, day surgery, antibiotic prophylaxis, training, postoperative pain control and chronic pain. The addendum contains all current level 1 conclusions, Grade A recommendations and new Grade B recommendations based on new level 1 evidence (with the changes in bold).Despite the fact that the Working Group responsible for it tried to represent most kinds of surgeons treating inguinal hernias, such general guidelines inevitably must be fitted to the daily practice of every individual surgeon treating his/her patients. There is no doubt that the future of guideline implementation will strongly depend on the development of easy to use decision support algorithms tailored to the individual patient and on evaluating the effect of guideline implementation on surgical outcome. At the 35th International Congress of the EHS in Gdansk, Poland (May 12–15, 2013), it was decided that the EHS, IEHS and EAES will collaborate from now on with the final goal to publish new joint guidelines, most likely in 2015.
    Hernia 04/2014; 18(3). DOI:10.1007/s10029-014-1252-6 · 2.09 Impact Factor
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    ABSTRACT: 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.
    Cirugía Española 02/2014; 92(6). DOI:10.1016/j.ciresp.2014.01.003 · 0.89 Impact Factor
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    ABSTRACT: Objective To prospectively evaluate the effect of weight loss after bariatric surgery on microvascular function in morbidly obese patients with and without metabolic syndrome (MetS).MethodsA cohort of morbidly obese patients with and without MetS was studied before surgery and after 12 months of surgery. Healthy lean controls were also examined. Microvascular function was assessed by postocclusive reactive hyperemia (PORH) at forearm skin evaluated by laser Doppler flowmetry (LDF). Cutaneous vascular conductance (CVC) was calculated from laser-Doppler skin blood flow and blood pressure. Regression analysis was performed to assess the contribution of different clinical, metabolic and biochemical parameters to microvascular functionResultsBefore surgery, 62 obese patients, 39 with MetS and 23 without MetS, and 30 lean control subjects were analyzed. The absolute area under the hyperaemic curve (AUCH) CVC of PORH was significantly decreased in obese patients compared to lean control subjects. One year after surgery, AUCH CVC significantly increased in patients free of MetS, including patients that had MetS before surgery. In contrast, AUCH CVC did not significantly change in patients in whom MetS persisted after surgery. Stepwise multivariate regression analysis showed that only changes in HDL cholesterol and oxLDL independently predicted improvement of AUCH after surgery. These two variables together accounted for 40.9% of the variability of change in AUCH CVC after surgery.Conclusions Bariatric surgery could significantly improve microvascular dysfunction in obese patients, but only in patients free of MetS after surgery. Improvement of microvascular dysfunction is strictly associated to postoperative increase in HDL-C levels and decrease in OxLDL levels.International Journal of Obesity accepted article preview online, 28 January 2014; doi:10.1038/ijo.2014.15.
    International journal of obesity (2005) 01/2014; 38(11). DOI:10.1038/ijo.2014.15 · 5.39 Impact Factor
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    ABSTRACT: The introduction of laparoscopic surgery (LS) can be considered the most important advancement in our specialty in the past 25 years. Despite its advantages, implementation and consolidation has not been homogenous, especially for advanced techniques. The aim of this study was to analyse the level of development and use of laparoscopic surgery in Spain at the present time and its evolution in recent years. During the second half of 2012 a survey was developed to evaluate different aspects of the implementation and development of LS in our country. The survey was performed using an electronic questionnaire. The global response rate was 16% and 103 heads of Department answered the survey. A total of 92% worked in the public system. A total of 99% perform basic laparoscopic surgery and 85,2% advanced LS. Most of the responders (79%) consider that the instruments they have available for LS are adequate and 71% consider that LS is in the right stage of development in their environment. Basic laparoscopic surgery has developed in our country to be considered the standard performed by most surgeons, and forms part of the basic surgical training of residents. With regards to advanced LS, although it is frequently used, there are still remaining areas of deficit, and therefore, opportunities for improvement.
    Cirugía Española 01/2014; 92(4). DOI:10.1016/j.ciresp.2013.11.007 · 0.89 Impact Factor
  • María Socas · Salvador Morales-Conde · Isaias Alarcón
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    ABSTRACT: Enterocutaneous fistula is a dreaded complication following surgery, constituting an abnormal communication between an intestinal segment and the skin. It usually is brought about by drainage wounds but sometimes is brought through the laparotomy wound. The challenge becomes solving the fistula as well as closing the abdominal wall during the same surgical procedure.
    Case Studies of Postoperative Complications after Digestive Surgery, 01/2014: pages 555-558; , ISBN: 978-3-319-01612-2
  • Antonio Barranco · Carlos Bernardos · María Socas · Salvador Morales-Conde
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    ABSTRACT: The compartment syndrome (CS) is defined as an increase in the pressure inside the abdominal cavity over 12 mmHg. Already known in the nineteenth century, its treatment remains controversial. Recent increasing interest is due to the improvement in surgical techniques over abdominal closure, the availability of damage control surgery, and support measures, leading to a decrease in the associated mortality of CS—even though it still is high in critically ill patients.
    Case Studies of Postoperative Complications after Digestive Surgery, 01/2014: pages 551-554; , ISBN: 978-3-319-01612-2
  • Maria Dolores Casado · Gianluca Sciannamea · María Socas · Salvador Morales-Conde
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    ABSTRACT: Evisceration is a rare (incidence vary from 0.3 to 3.5 %) but very severe complication of abdominal surgery, with a high rate of morbidity and mortality. Risk factors of abdominal wound dehiscence are elderly, immunosuppression, cancer, obesity, hemodynamic instability, diseases increasing abdominal pressure, emergency surgery, bowel surgery, hypoproteinemia, anemia, abdominal trauma, wound infection, vertical incisions, and improper closure techniques. The mortality and the possibility of dehiscence seem to correlate directly with the number of risk factors, so we could minimize the risk of its occurrence. We report two different cases: the first with an evisceration of a median incision and the second with a subcostal one.
    Case Studies of Postoperative Complications after Digestive Surgery, 01/2014: pages 539-543; , ISBN: 978-3-319-01612-2
  • María Socas · Salvador Morales-Conde · María Sánchez Ramírez · Antonio Barranco
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    ABSTRACT: Lightweight large-porous mesh philosophy takes into consideration all of the recent data regarding physiology and mechanics of the abdominal wall. The new mesh concept reveals an optimized foreign body reaction based on reduction of the amounts of mesh material needed and, in particular, a significantly small area of the large-porous model coming into contact with the recipient hosts tissues Moreover, recent data demonstrate that alterations in the extracellular matrix of hernia patients play a crucial role in the development of hernia recurrence. In particular, long-term recurrences—often occurring months or even years after surgery and implantation of mesh—can be explained by the extracellular matrix hypothesis. However, if the altered extracellular matrix proves to be the weak area, the decisive question becomes whether the amount of material as well as mechanical and tensile strength of the surgical mesh significantly impact the development of recurrent hernia. All experimental evidence and first clinical data indicate the superiority of the lightweight large-porous mesh concept with regard to a reduced number of long-term complications and particularly, an increased comfort, and quality of life after hernia repair.
    Case Studies of Postoperative Complications after Digestive Surgery, 01/2014: pages 545-549; , ISBN: 978-3-319-01612-2
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    ABSTRACT: Single port laparoscopic surgery is becoming an alternative to conventional laparoscopic surgery as a new approach where all the conventional ports are gathered in just one multichannel port through only one incision. Appling this technical development, we have developed a new technique based on an intragastric approach using a single port device assisted by endoscopy (I-EASI: intragastric endoscopic assisted single incision surgery) in order to remove benign gastric lesions and GIST tumors placed in the posterior wall of the stomach or close to the esophagogastric junction or the gastroduodenal junction. We present a patient with a submucosal gastric tumor placed near the esophagogastric junction removed with this new approach.
    12/2013; 2013:391430. DOI:10.1155/2013/391430
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    Surgical Endoscopy 11/2013; Surg Endosc (2014) 28:353–379(2). DOI:10.1007/s00464-013-3171-5 · 3.31 Impact Factor
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    ABSTRACT: Guidelines are increasingly determining the decision process in day-to-day clinical work. Guidelines describe the current best possible standard in diagnostics and therapy. They should be developed by an international panel of experts, whereby alongside individual experience, above all, the results of comparative studies are decisive. According to the results of high-ranking scientific studies published in peer-reviewed journals, statements and recommendations are formulated, and these are graded strictly according to the criteria of evidence-based medicine. Guidelines can therefore be valuable in helping particularly the young surgeon in his or her day-to-day work to find the best decision for the patient when confronted with a wide and confusing range of options. However, even experienced surgeons benefit because by virtue of a heavy workload and commitment, they often find it difficult to keep up with the ever-increasing published literature. All guidelines require regular updating, usually every 3 years, in line with progress in the field. The current Guidelines focus on technique and perioperative management of laparoscopic ventral hernia repair and constitute the first comprehensive guidelines on this topic. In this issue of Surgical Endoscopy, the first part of the Guidelines is published including sections on basics, indication for surgery, perioperative management, and key points of technique. The next part (Part 2) of the Guidelines will address complications and comparisons between open and laparoscopic techniques. Part 3 will cover mesh technology, hernia prophylaxis, technique-related issues, new technologic developments, lumbar and other unusual hernias, and training/education. Electronic supplementary material The online version of this article (doi:10.1007/s00464-013-3170-6) contains supplementary material, which is available to authorized users.
    Surgical Endoscopy 10/2013; 28(1). DOI:10.1007/s00464-013-3170-6 · 3.31 Impact Factor

Publication Stats

694 Citations
108.13 Total Impact Points

Institutions

  • 2009–2014
    • Hospital Universitario Virgen del Rocío
      • Department of General and Digestive Surgery
      Hispalis, Andalusia, Spain
    • Universidad de Sevilla
      Hispalis, Andalusia, Spain
  • 2013
    • AZ Maria Middelares
      Gand, Flanders, Belgium
  • 2003–2010
    • Mexican Association of Laparoscopic Surgery
      Miguel Hidalgo, The Federal District, Mexico
  • 2001–2006
    • Hospital Universitario Virgen Macarena
      Hispalis, Andalusia, Spain