Publications by authors named "Manuel Ferrer-Márquez"

66 Publications

Intracorporeal Versus Extracorporeal Anastomosis in Patients Undergoing Laparoscopic Right Hemicolectomy: A Multicenter Randomized Clinical Trial (The IVEA-study).

Surg Laparosc Endosc Percutan Tech 2021 May 3. Epub 2021 May 3.

Department of General Surgery, Division of Colorectal Surgery, University Hospital of Torrecárdenas, Almeria Department of General Surgery, Division of Colorectal Surgery, University General Hospital, Elche Department of General Surgery, Division of Colorectal Surgery, Hospital Reina Sofia, Murcia, Spain.

Objective: The aim of this study was to evaluate short-term outcomes of performing intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy for right colon neoplasm.

Background: Despite advances in the laparoscopic approach in colorectal surgery and the clear benefit of this approach over open surgery, because of the technical difficulty in performing intracorporeal anastomosis (IA), some continue to perform it extracorporeally in right colon surgery.

Materials And Methods: This study was a prospective multicenter randomized trial with 2 parallel groups on which either IA or extracorporeal anastomosis was performed in laparoscopic right hemicolectomy for right colon neoplasm, carried out between January 2016 and December 2018.

Results: A total of 168 patients were randomized during the study period. At baseline, the 2 groups were comparable for age, sex, body mass index, surgical risk, and comorbidity. The median length of postoperative hospital stay was 7 days with no differences between the groups. About 70% of patients had an uneventful postoperative period without complications. The most common complications were paralytic ileus (20.63%; 33), surgical site infection (SSI) (10%; 16), and anastomotic leakage (6.25%; 10). The results show a lower level of SSI in the IA group (3.65% vs. 16.67%, P=0.008). Other complications do not show statistically significant differences between groups. Likewise, the incision for the extraction of the specimen was smaller in the IA group (P=0.000) and creation of the anastomosis intracorporeally decreased postoperative pain (P=0.000).

Conclusions: In comparison to the extracorporeal technique, IA decreased postoperative pain, incision size, and SSI. Further studies will be needed to verify our findings.
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http://dx.doi.org/10.1097/SLE.0000000000000937DOI Listing
May 2021

[Evaluation of treatment with intra-articular injections in osteoarticular pathology of the shoulder in primary care].

Aten Primaria 2021 Apr 22;53(7):102051. Epub 2021 Apr 22.

Medicina Familiar y Comunitaria, Servicio de Urgencias, Hospital Universitario Torrecárdenas, Almería. Instituto de Investigación Biosanitaria ibs.Granada, Granada, CIBER de Epidemiología y Salud Pública (CIEBERESP), Madrid, España.

Main Objective: To evaluate the clinical response at 24weeks after injection, measured as pain relief and functional recovery, in painful shoulder syndrome (PSS) in primary care (PC).

Design: Longitudinal case series with injection treatment in the scapulohumeral joint, describing functionality and pain evolution before and at 24weeks post injection.

Location: Non-urban primary care centres.

Participants: Patients with osteoarticular shoulder pathology susceptible to injection, failure of pharmacological treatment and rating on the visual analogue scale (VAS) ≥4 or constant score (CS) ≤70.

Interventions: Intra-articular injection of corticosteroid and local anaesthetic into the scapulohumeral joint, describing its evolution at 1, 4, 12 and 24weeks post injection.

Main Measurements: Infiltration response according to EVA before and after, CS before and after, number of infiltrations, side effects, temporary inability to work (TIL).

Results: Sixty-six patients receiving injection, mean age 51.1years (SD 14.7), 57.6% were women and 63.3% were injection in the right shoulder. A 22.7% required TIL and were discharged with a median of 14days (range 7-56days). They required an injection (80.3%) and the most frequent injection pathology was rotator cuff tendinitis (90.9%). They suffered mild side effects (9.4%). We found a decrease in pain from severe to mild and a functional improvement from poor to good. The variables: being retired (OR: 37.82, P=.001) and having an EVA score prior to injection >8 (OR: 15.67, P=.055, almost significant) were associated with poor response.

Conclusions: Intra-articular administration of corticosteroids in PSS reduces pain and provides functional improvement after the first week after injection, and is maintained in the long term. This allows a quick recovery to work after an injection at two weeks reducing recovery time by 50%, with few side effects.
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http://dx.doi.org/10.1016/j.aprim.2021.102051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8093412PMC
April 2021

Impact of exercise training after bariatric surgery on cardiometabolic risk factors: a systematic review and meta-analysis of controlled trials.

Rev Endocr Metab Disord 2021 Apr 16. Epub 2021 Apr 16.

Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.

The purpose of this systematic review was to provide updated evidence synthesis of the effectiveness of exercise training in patients with obesity undergoing bariatric surgery to improve cardio-metabolic risk. We systematically searched the MEDLINE, EMBASE, Scopus, Cochrane, and Web of Science databases. The studies selected were those in which an exercise-based intervention was performed after bariatric surgery, a control group was present, and at least one of the following outcomes was investigated: VO or VO, resting heart rate (RHR), blood pressure, lipid profile, glucose, and insulin. The study quality was assessed using the PEDro scale and the data were meta-analyzed with a random effects model, comparing control groups to intervention groups using standardized measurements. Twenty articles were included in the systematic review and fourteen (70%) in the meta-analysis. Significant differences were observed between the control and intervention groups (always in favor of exercise) for absolute VO / VO (ES = 0.317; 95% CI = 0.065, 0.569; p = 0.014), VO / peak relative to body weight (ES = 0.673; 95% CI = 0.287, 1.060; p = 0.001), HDL cholesterol (ES = 0.22; 95% CI = 0.009, 0.430; p = 0.041) and RHR (ES = -0.438; 95% CI = -0.753, -0.022; p = 0.007). No effects were observed for either systolic or diastolic blood pressure. Exercise training for patients undergoing bariatric surgery appears to be effective in improving absolute and relative VO / VO, HDL cholesterol and reducing the RHR. More intervention studies using (better) exercise interventions are needed before discarding their effects on other cardiometabolic risk factors. This systematic review and meta-analysis has been registered in Prospero (CRD42020153398).
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http://dx.doi.org/10.1007/s11154-021-09651-3DOI Listing
April 2021

Missing Jejunal Perforation During Small Bowel Measurement in Patient Operated by Laparoscopic One-Anastomosis Gastric Bypass.

Obes Surg 2021 Jun 6;31(6):2841-2842. Epub 2021 Apr 6.

Department of Bariatric Surgery (ObesidadAlmería), General Surgery, Hospital Mediterráneo, Almería, Spain.

Background: Obesity surgery is justified as it produces sustained weight loss, increases life expectancy, and reduces the complications of obesity. For this reason, increasing numbers of patients are undergoing this surgery [1]. Complications following surgical treatment of severe obesity vary based upon the procedure performed and, although it is currently below 7% in more experienced centers, it may increase in more complex surgeries (such as revision surgery) and can be as high as 40% [2, 3]. Patients with early postoperative complications may be managed in specialist centers by the bariatric surgeon during the hospital stay [4]. Missing bowel injury may occur primarily during insertion of a Veress needle and trocar, use of electrosurgery and laser beams, suturing, and adhesiolysis [5]. Less frequently, the bowel perforation is due to the measurement of the loop and goes unnoticed. Perforation of the intestines due to any reason is a severe condition that can clinically present with free intraabdominal air, purulent or even fecal peritonitis, and abdominal compartment syndrome [6]. High clinical suspicion is crucial for early diagnosis. Early recognition of bowel injury and early intervention is crucial to reduce its morbidity and mortality [5].

Methods: We present a case of a 50-year-old male patient with a BMI of 36.1 kg/m, hypertension, and dyslipidemia who was proposed for bariatric surgery. A laparoscopic one-anastomosis gastric bypass (OAGB) was performed with no intraoperative incidents. Few hours after the surgery, the patient manifests intense abdominal pain and tachycardia (120 bpm) so we decided to order an abdominal CT scan that showed signs of jejunal perforation (pneumoperitoneum, oral contrast extravasation, and small air bubbles next to the jejunum wall).

Results: Emergency laparoscopy was done and showed generalized peritonitis caused by a 4-mm perforation in the mesenteric border of the jejunum with everted mucosa that was located 150 cm from the loop of Treitz. We decided to place three infraumbilical trocars to help us with washing, viewing, and surgical repair. We performed a 2-0 barbed simple suture of the perforation and extensive washing of the entire cavity with 10 L of serum. We left three drains. The patient made an uneventful recovery and was discharged 72 h after surgery with an established oral diet.

Conclusions: Missing intestinal perforation is an uncommon injury during bariatric surgery, but its early diagnosis is important to avoid endangering the patient's life. Simple postoperative tachycardia in obese patients should be taken seriously as it is a warning signal. Laparoscopic reoperation in these early diagnosed cases is safe and effective, since it allows visualization and washing of the entire cavity. Bowel injuries, which may occur as a result of the insertion of an insufflation needle or trocar, are a rare complication of laparoscopy. In the case we present, the perforation occurred during the small bowel measurement so we insist on the extreme caution that surgeons must take during every detail of the surgical technique. The use of atraumatic forceps, handling of the bowel strictly at the antimesenteric side, and the infusion of sufficient methylene blue in the anastomosis testing are gestures that can help reduce the risk.
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http://dx.doi.org/10.1007/s11695-021-05365-2DOI Listing
June 2021

One Anastomosis Gastric Bypass in Patient with Situs Ambiguous.

Obes Surg 2021 May 24;31(5):2346-2347. Epub 2021 Feb 24.

Department of Bariatric Surgery (Obesidad Almería), General Surgery, Hospital Mediterráneo, Almería, Spain.

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http://dx.doi.org/10.1007/s11695-021-05265-5DOI Listing
May 2021

Laparoscopic management of reflux after Roux en Y gastric bypass using technique Hilĺs gastropexy.

Cir Esp 2020 Dec 10. Epub 2020 Dec 10.

Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Torrecárdenas, Almería, España.

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http://dx.doi.org/10.1016/j.ciresp.2020.10.018DOI Listing
December 2020

Sexuality amongst heterosexual men with morbid obesity in a bariatric surgery programme: A qualitative study.

J Clin Nurs 2020 Nov 3;29(21-22):4258-4269. Epub 2020 Sep 3.

Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain.

Aim And Objectives: To describe and understand the experiences of sexuality amongst heterosexual men diagnosed with morbid obesity (MO) who are in a bariatric surgery programme.

Background: Morbid obesity is a chronic metabolic disease that affects men's physical, psychological and sexual health. Evidence suggests that MO could be linked to anxiety, depression, low self-esteem, sexual life and social disorders. Bariatric surgery is a reliable method for weight loss in patients with MO.

Design: This is a qualitative study based on Merleau-Ponty's phenomenology, and the COREQ checklist was employed to report on the current study.

Methods: Convenience and purposive sampling was carried out and included 24 in-depth interviews with heterosexual men with MO in a bariatric surgery programme between October 2018-March 2019 in Spain.

Results: Two main themes emerged from the analysis: (a) a corporality which is judged and condemned; and (b) adapting sexual practices to bariatric surgery.

Conclusions: Men with MO reject a body that limits their physical, social and sexual life. A negative body image and low self-esteem, which do not respond to the traditional masculine role or new masculinities, reduce men's self-concept. Men with MO feel rejection, stigma and isolation. Support from their partner is fundamental to adapt.

Relevance To Clinical Practice: The results of the study draw attention to how heterosexual men with MO experience their sexuality in a bariatric surgery programme and the challenges nurses face. Recognising the problem, helping to develop coping strategies or referring to specialists in sexuality could improve the quality of life in patients and their partners.
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http://dx.doi.org/10.1111/jocn.15461DOI Listing
November 2020

Predictive Model of the Risk of In-Hospital Mortality in Colorectal Cancer Surgery, Based on the Minimum Basic Data Set.

Int J Environ Res Public Health 2020 06 12;17(12). Epub 2020 Jun 12.

Instituto de Investigación Biosanitaria ibs.Granada, 18012 Granada, Spain.

Background: Various models have been proposed to predict mortality rates for hospital patients undergoing colorectal cancer surgery. However, none have been developed in Spain using clinical administrative databases and none are based exclusively on the variables available upon admission. Our study aim is to detect factors associated with in-hospital mortality in patients undergoing surgery for colorectal cancer and, on this basis, to generate a predictive mortality score.

Methods: A population cohort for analysis was obtained as all hospital admissions for colorectal cancer during the period 2008-2014, according to the Spanish Minimum Basic Data Set. The main measure was actual and expected mortality after the application of the considered mathematical model. A logistic regression model and a mortality score were created, and internal validation was performed.

Results: 115,841 hospitalization episodes were studied. Of these, 80% were included in the training set. The variables associated with in-hospital mortality were age (OR: 1.06, 95%CI: 1.05-1.06), urgent admission (OR: 4.68, 95% CI: 4.36-5.02), pulmonary disease (OR: 1.43, 95%CI: 1.28-1.60), stroke (OR: 1.87, 95%CI: 1.53-2.29) and renal insufficiency (OR: 7.26, 95%CI: 6.65-7.94). The level of discrimination (area under the curve) was 0.83.

Conclusions: This mortality model is the first to be based on administrative clinical databases and hospitalization episodes. The model achieves a moderate-high level of discrimination.
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http://dx.doi.org/10.3390/ijerph17124216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7344523PMC
June 2020

Physical Exercise following bariatric surgery in women with Morbid obesity: Study protocol clinical trial (SPIRIT compliant).

Medicine (Baltimore) 2020 Mar;99(12):e19427

Obstetrics and Gynecology Unit, Torrecárdenas University Hospital, Almería.

Background: Severe and morbid obesity are increasing globally, particularly in women. As BMI increases, the likelihood of anovulation is higher. The primary aim of the EMOVAR clinical trial is to examine, over the short (16 weeks) and medium (12 months) term, the effects of a supervised physical exercise program (focused primarily on aerobic and resistance training) on ovarian function in women with severe/morbid obesity who have undergone bariatric surgery. Secondary objectives are to examine the effects of the intervention on chronic inflammation, insulin resistance, arterial stiffness, physical fitness, and health-related quality of life.

Methods: This is a randomized controlled trial in which ∼40 female bariatric surgery patients, aged between 18 and 45 years old, will be included. Participants assigned to the experimental group will perform a total of 48 sessions of supervised concurrent (strength and aerobic) training (3 sessions/week, 60 min/session) spread over 16 weeks. Patients assigned to the control group will receive lifestyle recommendations. Outcomes will be assessed at baseline, week 16 (i.e., after the exercise intervention) and 12 months after surgery. The primary outcome is ovarian function using the Sex-Hormone Binding Globuline, measured in serum. Secondary outcomes are serum levels of anti-mullerian hormone, TSH, T4, FSH, LH, estradiol, prolactine, and free androgen index, as well as oocyte count, the diameters of both ovaries, endometrial thickness, and uterine arterial pulsatility index (obtained from a transvaginal ultrasound), the duration of menstrual bleeding and menstrual cycle duration (obtained by personal interview) and hirsutism (Ferriman Gallwey Scale). Other secondary outcomes include serum markers of chronic inflammation and insulin resistance (i.e., C-reactive protein, interleukin 6, tumor necrosis factor-alpha, leptin, glomerular sedimentation rate, glucose, insulin and the HOMA-IR), arterial stiffness, systolic, diastolic and mean blood pressure, body composition, and total weight loss. Physical fitness (including cardiorespiratory fitness, muscular strength, and flexibility), health-related quality of life (SF-36 v2) and sexual function (Female Sexual Function Index) will also be measured.

Discussion: This study will provide, for the first time, relevant information on the effects of exercise training on ovarian function and underlying mechanisms in severe/morbid obese women following bariatric surgery.

Trial Registration Number: ISRCTN registry (ISRCTN27697878).
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http://dx.doi.org/10.1097/MD.0000000000019427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220774PMC
March 2020

Use of barbed suture for the closure of enterocolotomy after laparoscopic right hemicolectomy with intracorporeal anastomosis. A prospective descriptive study.

Cir Esp 2020 Mar 6;98(3):136-142. Epub 2019 Dec 6.

Unidad de Coloproctología, Servicio de Cirugía General y Digestiva, Hospital Universitario Torrecárdenas, Almería, España.

Introduction: Performing intracorporeal anastomoses and sutures is possibly the technique that requires the greatest skill in laparoscopic surgery. The appearance of the new barbed sutures in recent years has seemed to facilitate this surgical step. The aim of our study is to evaluate short-term results in patients with neoplasms of the right colon, after laparoscopic right hemicolectomy with intracorporeal anastomosis using barbed suture at the closure of the enterocolotomy.

Methods: This is a multicenter, prospective, descriptive study that includes patients who underwent laparoscopic right hemicolectomy for neoplastic colonic pathologies between June 2015 and December 2018. In all patients, the intracorporeal anastomosis was performed using the endocutter, and closure of the enterocolotomy was done with a double layer of barbed suture.

Results: A total of 80 patients were treated (47.5% women), with an average age of 70.6±9 (49-92) years. The average operative time was 99.5±38minutes Anastomotic dehiscence was observed in 2.5% of the sample, and 5 patients required re-operation (6.2%) as a result of 2leaks, 2obstructive symptoms and one peritoneal bleeding. Mean hospital stay was 7 (3-173) days.

Conclusions: The use of barbed suture in laparoscopic right hemicolectomy with intracorporeal anastomosis seems to present a morbidity similar to series described in literature. Prospective, controlled and randomized studies with a larger number of patients would be necessary to confirm these findings.
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http://dx.doi.org/10.1016/j.ciresp.2019.10.002DOI Listing
March 2020

Analysis of mid-term weight loss after Roux-en-Y gastric bypass and sleeve gastrectomy: Proposed percentile charts for total weight loss percentages to be used in daily clinical practice.

Cir Esp 2020 Feb 19;98(2):72-78. Epub 2019 Nov 19.

Unidad de Cirugía Endocrina, Bariátrica y Metabólica, Servicio de Cirugía General, Hospital Universitario Vall d'Hebron, Barcelona, España. Electronic address:

Introduction: The aim of this study is to analyze weight evolution after the main bariatric surgical techniques (Roux-en-Y gastric bypass [RYGB] and sleeve gastrectomy [SG]) performed at a representative sample of Spanish hospitals in order to develop percentile charts for the percentage of total weight loss during the first 3 years after surgery.

Methods: A retrospective longitudinal cohort study was conducted based on the data provided by 9 Spanish hospitals. Weight data were analyzed both in % total weight loss and % excess weight lost corresponding to the RYGB (n=1,887) and SG (n=1,210).

Results: RYGB continues to be the most frequently performed technique in our sample. In both surgical techniques, maximum weight loss occurred 18 months after surgery. Both techniques followed the same weight evolution, although the % total weight loss values were lower in the case of the SG after 36 months (29.3±10 vs. 33.6±10). Age and gender are decisive in the weight results (better in younger patients for both techniques and better in women for RYGB).

Conclusions: Percentile charts of % total weight loss after bariatric surgery represent a very useful tool and an important advance in the quality of patient management.
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http://dx.doi.org/10.1016/j.ciresp.2019.09.008DOI Listing
February 2020

Photodynamic Therapy for the Treatment of Complex Anal Fistula.

Lasers Surg Med 2020 07 19;52(6):503-508. Epub 2019 Sep 19.

Colorectal Unit, Department of General Surgery, Alicante University General Hospital, Miguel Hernandez University, Pintor Baeza, 11, Elche, Alicante, 03010, Spain.

Background And Objectives: To validate and analyze the results of intralesional photodynamic therapy in the treatment of complex anal fistula.

Study Design/materials And Methods: This prospective multicentric observational study enrolled patients treated for complex anal fistula who underwent intralesional photodynamic therapy (i-PDT). The included patients were treated from January 2016 to December 2018 with a minimum follow-up of 1 year to evaluate recurrence, continence and postoperative morbidity. Intralesional 5-aminolevulinic acid (ALA) gel (2%) was injected directly into the fistula. The internal and external orifices were closed. After an incubation period of 2 hours, the fistula was irradiated using an optical fiber connected to a red laser (Multidiode 630 PDT) operating at 1 W/cm for 3 minutes (180 J).

Results: In total, 49 patients were included (61.2% male). The mean age was 48 years, and the mean duration of fistula was 13 months. Of the fistulas included, 75.5% were medium transphincteric, and 24.5% were high transphincteric. The median fistula length was 4 ± 1,14 cm (range: 3-5). A total of 41 patients (83.7%) had a previous history of fistula surgery. Preoperatively, some degree of anal incontinence was found in 5 patients (10.2%). No center reported any other procedure-related complications intraoperatively. Phototoxicity was found in one patient. In the first 48 hours after the procedure, fever was reported in 2 patients (4%). At the end of follow-up, total healing was observed in 32/49 patients (65.3%). No patient reported new incontinence postoperatively.

Conclusion: i-PDT could be considered a good choice in patients with complex anal fistulas to avoid surgery and its complications. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/lsm.23162DOI Listing
July 2020

Supervised exercise following bariatric surgery in morbid obese adults: CERT-based exercise study protocol of the EFIBAR randomised controlled trial.

BMC Surg 2019 Sep 5;19(1):127. Epub 2019 Sep 5.

Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.

Background: There is increasing evidence of weight regain in patients after bariatric surgery (BS), generally occurring from 12 to 24 months postoperatively. Postoperative exercise has been suggested to ad long-term weight maintenance and to improve physical function in BS patients. However, there are a limited number of intervention studies investigating the possible benefits of exercise in this population. The aim of the current report is to provide a comprehensive CERT (Consensus on Exercise Reporting Template)-based description of the rationale and details of the exercise programme implemented in the EFIBAR Study (Ejercicio FÍsico tras cirugía BARiátrica), a randomised controlled trial investigating the effects of a 16-week supervised concurrent (aerobic and strength) exercise intervention program on weight loss (primary outcome), body composition, cardiometabolic risk, physical fitness, physical activity and quality of life (secondary outcomes) in patients with severe/morbid obesity following bariatric surgery.

Methods: A total of 80 BS patients [60-80% expected women, aged 18 to 60 years, body mass index (BMI) ≥ 40 kg/m or ≥ 35 kg/m with comorbid conditions)] will be enrolled in the EFIBAR Randomized Control Trial (RCT). Participants allocated in the exercise group (n = 40) will undertake a 16-week supervised concurrent (strength and aerobic) exercise programme (three sessions/week, 60 min/session), starting 7 to 14 days after surgery. The rationale of the exercise programme will be described following the CERT criteria detailing the 16 key items. The study has been reviewed and approved by the Ethics Committee of the Torrecárdenas University Hospital (Almería, Spain) (ref. N° 76/2016).

Discussion: The present study details the exercise programme of the EFIBAR RCT, which may serve: 1) exercise professionals who would like to implement an evidence-based exercise programme for BS patients, and 2) as an example of the application of the CERT criteria.

Trial Registration: The trial was prospectively registered at Clinicaltrials.gov NCT03497546 on April 13, 2018.
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http://dx.doi.org/10.1186/s12893-019-0566-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6729089PMC
September 2019

Correction to: Effects of Exercise Training on Weight Loss in Patients Who Have Undergone Bariatric Surgery: a Systematic Review and Meta-Analysis of Controlled Trials.

Obes Surg 2019 Nov;29(11):3778

Department of Education, Faculty of Education Sciences, University of Almería, Ctra. Sacramento s/n, La Cañada de San Urbano, 04120, Almería, Spain.

In the original article the name of author Enrique G. Artero was misspelled.
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http://dx.doi.org/10.1007/s11695-019-04130-wDOI Listing
November 2019

Effects of Exercise Training on Weight Loss in Patients Who Have Undergone Bariatric Surgery: a Systematic Review and Meta-Analysis of Controlled Trials.

Obes Surg 2019 10;29(10):3371-3384

Department of Education, Faculty of Education Sciences, University of Almería, Ctra. Sacramento s/n, La Cañada de San Urbano, 04120, Almería, Spain.

The combination of bariatric surgery and physical exercise has been suggested as a promising strategy to positively influence obesity, not only body weight but also all associated comorbidities. An electronic search of intervention studies was carried out in which an exercise training program was implemented after bariatric surgery. The quality of each study was assessed and the data were meta-analyzed using a random effect model. Twenty-six articles were included in the systematic review and 16 in the meta-analysis. As the main conclusion, exercise in patients who have undergone bariatric surgery does not seem to be effective in enhancing weight loss (SMD = 0.15; 95% CI = - 0.02, 0.32; p = 0.094). However, the variability in the protocols used makes it too early to reach a definite conclusion.
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http://dx.doi.org/10.1007/s11695-019-04096-9DOI Listing
October 2019

Replicability of exercise programs following bariatric surgery.

Atherosclerosis 2018 11 26;278:330-331. Epub 2018 Aug 26.

Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain; SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain.

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http://dx.doi.org/10.1016/j.atherosclerosis.2018.08.026DOI Listing
November 2018

[Cambios en la salud sexual de los pacientes obesos tras cirugía bariátrica].

Cir Cir 2018 ;86(3):255-260

Servicio de Urgencias. Complejo Hospitalario Torrecárdenas. Almería, España.

Introducción: Los objetivos del estudio fueron: 1) evaluar la salud sexual en pacientes con obesidad grave/mórbida candidatos a cirugía bariátrica; y 2) valorar la evolución de la salud sexual tras 12 meses de la cirugía.

Método: Estudio descriptivo, prospectivo desde febrero de 2011 hasta junio de 2014. Se valoró la actividad sexual en los hombres a través del cuestionario EVAS-H y la función sexual en la mujer a través de la escala FSM (44 pacientes).

Resultados: Durante el estudio basal en los hombres, un 21% de la muestra presentó disfunción sexual en diferentes dimensiones, mientras que un 43% presentó problemas de eyaculación precoz. Tras 12 meses de la intervención, se observó un incremento de la actividad sexual global (p = 0.026). En torno al 70-89% de las mujeres, previamente a la cirugía, no presentaban trastorno. En la evolución no se observaron cambios medios relevantes (p > 0.05).

Conclusiones: Los pacientes con obesidad grave/mórbida candidatos a cirugía bariátrica presentan alteraciones considerables en diversas dimensiones de la salud sexual. Después de 12 meses de seguimiento, la salud sexual parece mejorar en los hombres.

Introduction: The aims of the study were: 1) to assess sexual health patients severe/morbid obesity patients candidates for bariatric surgery; and 2) to assess sexual health evolution after 12 months of surgery.

Method: Descriptive, prospective study from February 2011 to June 2014. Sexual activity in men was valued through EVAS-H questionnaire and through FSM scale on women (44 patients).

Results: During the basal study in men, a 21% of the sample showed sexual disfunction in different dimensions, while a 43% showed problems with premature ejaculation. 12 months after surgery, global sexual activity was improved significantly (p = 0,026). Approximately 70-89% of women presented no disturbance before surgery. No average relevant changes were observed within the evolution (p > 0.05).

Conclusions: Morbid/severe obesity patients candidates to bariatric surgery, show considerable alterations on diverse sexual health dimensions. After 12 months following bariatric surgery, men’s sexual health appears to improve.
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http://dx.doi.org/10.24875/CIRU.M18000039DOI Listing
January 2019

Analysis and description of disease-specific quality of life in patients with anal fistula.

Cir Esp 2018 Apr 13;96(4):213-220. Epub 2018 Feb 13.

Departamento de Enfermería, Fisioterapia y Medicina, Facultad de Fisioterapia, Enfermería y Ciencias de la Educación, Universidad de Almería, España; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile; Adult, Child and Midwifery Department, School of Health and Education, Middlesex University, Londres, Reino Unido.

Introduction: In patients diagnosed with anal fistula, knowing the quality of life specifically related to the disease can help coloproctology specialists to choose the most appropriate therapeutic strategy for each case. The aim of our study is to analyzse and describe the factors related to the specific quality of life in a consecutive series of patients diagnosed with anal fistula.

Methods: Observational, cross-sectional study carried out from March 2015 to February 2017. All patients were assessed in the colorectal surgery unit of a hospital in southeast of Spain. After performing an initial anamnesis and a physical examination, patients diagnosed with anal fistula completed the Quality of Life in Ppatients with Anal Fistula Questionnaire (QoLAF-Q). This questionnaire specifically measures quality of life in people with anal fistula and its score range is the following: zero impact = 14 points, limited impact = 15 to 28 points, moderate impact = 29 to 42 points, high impact = 43 to 56 points, and very high impact = 57 to 70 points.

Results: A total of 80 patients were included. The median score obtained in the questionnaire for the sample studied was 34.00 (range=14-68). Statistically significant differences between patients with "primary anal fistula" (n=65) and "recurrent anal fistula" (n=15) were observed (mean rank=42.96 vs. mean rank=29.83, p=0.048). Furthermore, an inverse proportion (P=.016) between "time with clinical symptoms" and "impact on quality of life" was found (<6 months: mean rank = 45.55; 6-12 months: mean rank = 44.39; 1-2 years: mean rank = 37.83; 2-5 years: mean rank = 22; >5 years: mean rank = 19.00). There were no statistically significant differences (P=.149) between quality of life amongst patients diagnosed with complex (mean rank = 36.13) and simple fistulae (mean rank = 43.59).

Conclusions: Anal fistulae exert moderate-high impact on patients' quality of life. "Shorter time experiencing clinical symptoms" and the "presence of primary fistula" are factors that can be associated with worse quality of life.
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http://dx.doi.org/10.1016/j.ciresp.2017.12.003DOI Listing
April 2018

Sexual satisfaction following bariatric surgery: A prospective exploratory study.

Cir Esp 2017 Nov 31;95(9):521-528. Epub 2017 Oct 31.

Departamento de Educación, Facultad de Ciencias de la Educación, Universidad de Almería, Almería, España; Centro de Investigación CERNEP, Universidad de Almería, Almería, España.

Introduction: Bariatric surgery improves sexual function in obese individuals, although the extent to which sexual satisfaction is improved following surgery is unknown. The aims of this study were 1) to describe sexual satisfaction in severely/morbidly obese men and women candidates for bariatric surgery; 2) to assess the effects of bariatric surgery on sexual satisfaction at 12-months follow-up; and 3) to assess whether weight changes at follow-up following bariatric surgery are associated with changes in sexual satisfaction.

Methods: We conducted a prospective observational study from February 2011 to June 2014. A total of 44 patients with severe/morbid obesity participated in the study. Sexual satisfaction was assessed (at baseline and 12-months follow-up) through the Index of Sexual Satisfaction (ISS) questionnaire.

Results: Of 44 patients who completed the ISS at baseline (mean age 40.3 [SD=9.4] years and BMI 46.9 [SD=6.2] kg/m), 17 were lost to follow-up. The baseline ISS total scores were 32.0 (SD=20.1) in women and 24.4 (SD=16.0) in men (P>0.05). The proportion of sexually satisfied men and women at baseline was 62.5% and 46.4%, respectively (P=0.360). At follow-up, sexual satisfaction improved significantly in women (average difference 13.7 units; P=0.032) but not in men (average difference 3.6 units; P=0.717). The percentage of women with sexual satisfaction problems was reduced by 33% at follow-up (P=0.038).

Conclusions: A relatively large percentage of severely/morbidly obese women and men present clinically significant sexual satisfaction problems before undergoing bariatric surgery. Sexual satisfaction improves significantly 12 months following bariatric surgery, particularly in women.
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http://dx.doi.org/10.1016/j.ciresp.2017.08.013DOI Listing
November 2017

Design and Psychometric Evaluation of the Quality of Life in Patients With Anal Fistula Questionnaire.

Dis Colon Rectum 2017 Oct;60(10):1083-1091

1 Departamento de Cirugía Colorectal, Servicio de Cirugía General y Digestiva, Hospital Torrecárdenas, Almería, Spain 2 Nursing, Physiotherapy, and Medicine Department, Faculty of Health Sciences, University of Almeria, Almería, Spain 3 Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile 4 Adult, Child, and Midwifery Department, School of Health and Education, Middlesex University, London, United Kingdom.

Background: Quality of life is often considered when deciding and evaluating the treatment strategy for patients diagnosed with anal fistula.

Objective: The purpose of this study was to develop and psychometrically test the Quality of Life in Patients with Anal Fistula Questionnaire.

Design: This was an observational cross-sectional study for the development and validation of a psychometric tool.

Settings: The study was conducted at a general hospital in the southeast of Spain.

Patients: A convenience sample included 54 patients diagnosed with anal fistula.

Main Outcomes Measures: The reliability of the tool was assessed through its internal consistency (Cronbach α) and temporal stability (Spearman correlation coefficient (r) between test-retest). The content validity index of the items and the scale was calculated. Correlation analysis and an ordinal regression analysis between the developed tool and the Short Form 12 Health Survey examined its concurrent validity. Principal component analysis and known-group analysis using the Kruskal-Wallis test examined its construct validity.

Results: The reliability of the developed questionnaire was very high (α = 0.908; r = 0.861; p < 0.01). Its content validity was excellent (all-item content validity index = 0.79-1.00; scale validity index = 0.92). Evidence of its concurrent validity included strong correlation between the developed tool and Short Form 12 Health Survey (r = 0.734; p < 0.001), and participant scores on the developed tool explained ≈46.2% of the between-subject variation for the participant scores on Short Form 12 Health Survey (Nagelkerke R = 0.462). Confirming its construct validity, principal component analysis revealed that 2 factors explained 81.63% of the total variance found. Known-group analysis evidenced the ability of the questionnaire to detect expected differences in patients presenting with different symptomatology.

Limitations: The major limitations of this study were the use of a small sample of Spanish-speaking patients, not including patients in the initial development of the questionnaire, and developing the scoring system using a summation method.

Conclusions: The Quality of Life in Patients with Anal Fistula Questionnaire has proven to be a valid, reliable, and concise tool that could contribute to the evaluation of quality of life among patients with an anal fistula. See Video Abstract at http://links.lww.com/DCR/A368.
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http://dx.doi.org/10.1097/DCR.0000000000000877DOI Listing
October 2017

Perianal eccrine hydroadenocarcinoma in the context of a fistulising Crohn's disease.

Gastroenterol Hepatol 2018 Aug - Sep;41(7):450-452. Epub 2017 Aug 18.

Servicio de Anatomía Patológica, Hospital Torrecárdenas, Almería, España.

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http://dx.doi.org/10.1016/j.gastrohep.2017.07.002DOI Listing
August 2019

Influence of psychological variables in morbidly obese patients undergoing bariatric surgery after 24 months of evolution.

Cir Esp 2017 Aug - Sep;95(7):378-384. Epub 2017 Jul 24.

Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO).

Background: Bariatric surgery is considered a more effective means of achieving weight loss than non-surgical options in morbid obesity. Rates of failure or relapse range from 20 to 30%. The study aims to analyse the influence of psychological variables (self-esteem, social support, coping strategies and personality) in the maintenance of weight loss after bariatric surgery.

Methods: A cohort study was conducted involving 64 patients undergoing bariatric surgery for 24 months. At the end of the follow-up period, patients were divided into 2sub-cohorts classified as successes or failures. Success or favorable development was considered when the value of percent excess weight loss was 50 or higher.

Results: No statistically significant differences were observed between the 2groups in any variable studied. All patients had high self-esteem (87,3 those who failed and 88,1 those who are successful) and social support (90,2 and 90,9). Patients who succeed presented higher scores for cognitive restructuring (57,1) and were more introverted (47,1), while those who failed scored more highly in desiderative thinking (65,7) and were more prone to aggression (50,7) and neuroticism (51,7).

Conclusions: High self-esteem and social support does not guarantee successful treatment. The groups differed in how they coped with obesity but the data obtained do not justify the weight evolution. In the absence of psychopathology, personality trait variability between patients is insufficient to predict the results.
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http://dx.doi.org/10.1016/j.ciresp.2017.06.002DOI Listing
July 2018

Transanal endoscopic microsurgery for the treatment of uncommon rectal lesions.

Cir Esp 2017 Jun - Jul;95(6):335-341. Epub 2017 Jun 21.

Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Torrecárdenas, Almería, España.

Introduction: Transanal endoscopic microsurgery (TEM) was developed as a less aggressive alternative treatment for rectal lesions (mainly adenomas and adenocarcinomas). However, its use for other rectal lesions has become more frequent, trying to reduce the morbidity associated with more invasive techniques. The aim of this study is to describe our experience in the use of TEM in other rectal lesions.

Methods: Retrospective and descriptive study including patients operated with TEM (from June 2008 to December 2016) for the treatment of rectal lesions different from adenomas or adenocarcinomas.

Results: Among the 138 patients treated by TEM in our department, 10 patients were operated on for rectal lesions other than adenomas or adenocarcinomas. Rectal lesions were 3neuroendocrine tumours, a neuroendocrine tumour metastasis, a rectal stenosis, a cloacogenic polyp, an endometrioma, a retrorrectal tumour, a presacral abscess and a lesion in the rectovaginal septum. Mean operative time was 72min and postoperative stay was 4.2 days. Only one patient needed a reoperation, due to rectal bleeding.

Conclusions: TEM could be a useful tool for the treatment of rectal lesions different from adenomas or adenocarcinomas, potentially decreasing the morbidity associated with more aggressive surgical techniques.
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http://dx.doi.org/10.1016/j.ciresp.2017.05.003DOI Listing
May 2018

Complicated diverticular disease: Position statement on outpatient management, Hartmann's procedure, laparoscopic peritoneal lavage and laparoscopic approach. Consensus document of the Spanish Association of Coloproctology and the Coloproctology Section of the Spanish Association of Surgeons.

Cir Esp 2017 Aug - Sep;95(7):369-377. Epub 2017 Apr 14.

Servicio de Cirugía General y del Aparato Digestivo, Hospital Nisa 9 de Octubre, Valencia, España.

The Spanish Association of Coloproctology (AECP) and the Coloproctology Section of the Spanish Association of Surgeons (AEC), propose this consensus document about complicated diverticular disease that could be used for decision-making. Outpatient management, Hartmann's procedure, laparoscopic peritoneal lavage, and the role of a laparoscopic approach in colonic resection are exposed.
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http://dx.doi.org/10.1016/j.ciresp.2017.03.008DOI Listing
July 2018

Pain and Physical Function Following Bariatric Surgery.

JAMA 2016 Aug;316(7):770-1

Area of Physical Education and Sport, University of Almería, Almería, Spain.

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http://dx.doi.org/10.1001/jama.2016.8590DOI Listing
August 2016

Retraction Note: Use of Barbed Sutures in Bariatric Surgery. Review of the Literature.

Obes Surg 2016 10;26(10):2552

Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.

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http://dx.doi.org/10.1007/s11695-016-2334-6DOI Listing
October 2016

When Will Physical Activity be Routinely Measured in the Clinical Setting? The Case for Bariatric Surgery.

Am J Hypertens 2016 09;29(9):e1

Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.

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http://dx.doi.org/10.1093/ajh/hpw058DOI Listing
September 2016

Changes in Gastric Volume and Their Implications for Weight Loss after Laparoscopic Sleeve Gastrectomy.

Obes Surg 2017 02;27(2):303-309

Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.

Background: Laparoscopic sleeve gastrectomy (LSG) is a relatively new surgical technique for the treatment of morbid obesity. It is unclear whether the volume of the gastric remnant can expand after surgery as a result of intraluminal pressure maintained over time. If this were the case, the increased volume could affect weight loss and the improvement in comorbidities. This study aims to assess the evolution of residual gastric volume (RGV) during the first year after LSG and its relationship with weight loss.

Material And Methods: We conducted a prospective study of 112 patients who underwent LSG from February 2009 to December 2013. In order to measure the RGV after surgery, all patients were evaluated radiologically by an esophagogastroduodenal (EGD) transit at 1 and 12 postoperative months.

Results: All patients showed a significant reduction in BMI compared with the preoperative measurement (33.48 ± 5.78 vs. 50.54 ± 6.69 kg/m; p < 0.001). Increased RGV was observed when comparing the results obtained by EGD transit at 1 (68.39 ± 25.89 cm) and 12 postoperative months (122.58 ± 38.76 cm; p < 0.001). There was no association between increase in gastric volume and weight loss at 1-year follow-up (r = 0.01; p = 0.910).

Conclusions: The volume of the gastric remnant increased significantly during the first year after LSG. However, this increase was not associated with weight loss. Further prospective research with longer follow-up periods is needed to confirm or contrast the present results.
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http://dx.doi.org/10.1007/s11695-016-2274-1DOI Listing
February 2017

[Revision bariatric surgery after endoscopic sleeve gastroplasty].

Cir Cir 2017 Sep - Oct;85(5):428-431. Epub 2016 Jul 14.

Equipo Obesidad Almería, Hospital Mediterráneo, Almería, España.

Background: Attempts are being made in recent years to replace open surgery with endoscopic techniques in some obese patients when medical treatment fails, as they are considered to be less-invasive procedures. To date, there is little scientific evidence regarding their effectiveness.

Clinical Cases: The cases are reported of 2 patients who attended our surgery looking for an effective bariatric surgical treatment after failed endoscopic sleeve gastroplasty.

Conclusions: Laparoscopic sleeve gastrectomy after failure of an endoscopic technique does not offer great variation from the standard technique.
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http://dx.doi.org/10.1016/j.circir.2016.05.011DOI Listing
July 2018

Use of Barbed Sutures in Bariatric Surgery. Review of the Literature.

Obes Surg 2016 08;26(8):1964-9

Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.

Performing intracorporeal anastomoses and sutures is possibly the technique that requires the greater skill in laparoscopy. The emergence of new barbed sutures seems to facilitate the practice, with bariatric surgery (mainly in mixed and malabsorptive techniques) being one of the specialties that can most benefit from them. This review aims to evaluate barbed sutures' use and safety in bariatric surgery. Barbed sutures might facilitate the practice by improving some aspects of surgery such as reproducibility and operative time, although further research is needed.
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http://dx.doi.org/10.1007/s11695-016-2263-4DOI Listing
August 2016