Research focus

The reconstruction of abdominal wall defects is the problem with which surgeons are confronted more often. These defects may have an acute (trauma, cancer, infections) or chronic (hernia pathology) origin. Despite technical advances, the specific pathomechanisms and diverse treatment aspects remain controversial. In this line, surgeons and basic researchers work closely with other specialists (including pathologists, microbiologists, mathematicians and engineers) to better understand the promoting forces that trigger hernia formation and tissue rupture, from a mechanistic point of view. The studies are based on patient-derived tissue samples and primary fibroblasts, as well as on surgically-induced experimental models. Moreover, soft-tissue repair devices are being investigated by means of “in vitro” and “in vivo” experimental models. Quality care and surgical outcomes research studies are also developed.

Sub-lines

Basic Research

1. Extracellular matrix, inflammation and cell death induction in abdominal wall defects. This line focuses on the role of cell-extracellular

matrix (ECM) interactions in the fields of inflammation and tissue repair. Recent data from our laboratory provide compelling evidence on how the local ECM may influence incisional hernia development. They suggest that fascia atrophy may be an active driver of the disease, by means of transducing signals that affect cell survival, functional phenotype, and (probably) gene expression. Also, they identify fibroblasts and cell fragility as major pathogenic contributors to incisional hernia formation. The accumulation of apoptotic-prone defective fascia fibroblasts may not support normal fascial structure and function, and thus enhance proteolytic fascial destruction in a context of low cell proliferation. Currently, we are investigating changes in subsets of genes from incisional hernia derived primary fibroblasts.

2. Biomaterials and soft tissue repair. Current surgical practice supports the use of permanent prosthetic meshes as the best method for hernia repair. Still, no material has gained a preference for universal use and numerous complications are still reported. This line analyzes different new generation materials for soft-tissue (self-)repair. Our approach includes the characterization of the devices surface and biomechanics, as well as the

analyses of host cell-substrate interactions, by means of “in-vitro” (primary fibroblasts derived from control and IH patients) and “in-vivo” (rats)

experimental models. The ultimate goal is to impact on the development of new tailored implants based on fibroblasts and biomimetic materials, which are clinically useful to mend damaged tissues.

Clinical research

3. To improve quality care and outcome procedures in the field of abdominal wall surgery, several aspects are evaluated from a clinical point of view: 1. Quality care procedures after elective and emergency hernia surgery, and patients’ follow-ups (outpatient visits, telephone, utili ty of a postal questionnaire); 2. Prevention and treatment of hernias (periostomal, incisional, and inguinal), and their related complications; Implementation of new technical procedures, such as the use of new-generation prosthetic materials and sutures, components’ separation technique (open/endoscopic); pre-peritoneal prosthetic mesh use in the treatment of inguinal hernia; hernia laparoscopic surgery; application of progressive pneumoperitoneum in the treatment of giant incisional hernias, etc.; 3. Biomaterials: validation of new architectures and designs (polymer scaffolds; extracellular matrix-derived biological implants; biodegradable and bioactive –ie, antibacterial properties- grafts); 4. Virtual Reality (in collaboration with the Universitat Rovira i Virgili, Tarragona, (URV), and the Universitat Politècnica de Catalunya (UPC)): Abdominal’s wall virtual simulation, for clinical and educational purposes; 5. Surgical Sutures (European Project).

Research focus

To develop and promote research in the field of colon, rectum and anus surgery, from its most basic to clinical aspects, in order to improve both the knowledge of the disease and the quality of care.

Sub-lines:

1. Colorectal cancer: 1. Reconstruction of the intestinal tract after rectal surgery; 2. Prognostic factors of disease-free survival and cancer-related mortality in colon cancer: 3. Suture dehiscence; predictive models of morbidity and mortality; 4. Postoperative pelvic sepsis and local recurrence in rectal cancer; 5. Morbidity and mortality in laparoscopic surgery; 6. Mesorectal excision in the treatment of rectal cancer.

2. Robotic colorectal surgery: 1. Applicability and safety of robotic surgery in colorectal diseases; 2. Application of new techniques in the pathology of the pelvic floor.

3. TEM (Transanal Endoscopic Microsurgery): Role of TEM in the treatment of early rectal cancer.

4. Perioperative management: 1. Antibiotic prophylaxis for surgical site infection in colorectal cancer surgery; 2. Recovery of gastrointestinal motility after surgery.

5. Anal fissure: Role of botulinum toxin and HCL Diltiazem in the treatment of acute anal fissure.

6. Anal fistula: Application of platelet growth factors in the treatment of anal fistula.

7. Diverticular disease: 1. Outpatient treatment of mild acute diverticulitis; 2. Role of prophylactic treatment of diverticulitis, and response prognostic factors.

8. Inflammatory Bowel Disease: 1. Prognostic factors of response to treatment in patients undergoing surgery for inflammatory bowel disease. 2. The cell as the central axis of the dendritic response to bacteria in the mucosa of patients with inflammatory bowel disease.

9. Pelvic floor: 1. Transanal approach in the surgical treatment of obstructed defecation syndrome; 2. Sacral neuromodulation in the treatment of fecal incontinence and in low anterior resection syndrome.

Research focus

The endocrine, bariatric and metabolic surgery research group seeks to improve knowledge of the diseases included in this general surgery subspecialty. Therefore, knowledge of aspects of relationships with endocrine diseases like thyroid disease, adrenal and obesity are part of the interest of its members.

Sub-lines:

1. Surgery for morbid obesity: 1. Longitudinal expression analyses of genes related to lipid metabolism within the liver, visceral and subcutaneous adipose, gastric mucosa and intestine tissues from morbidly obese patients undergoing bariatric surgery; Evaluation of the associated comorbidities; 2. Analysis of sexual dysfunction in patients with morbid obesity; 3. Pressure changes evaluation in  gastric sleeve and its possible implications; 4. Expression of tumour growth factors in morbidly obese patients (tumour necrosis factor (TNF)-a, granulocyte-macrophage Colony-Stimulating Factor, Interferon-?, interleukin (IL)-1b, IL-2, IL-4, IL -5, IL-6, IL-8, IL-10, vascular endothelial growth factor, hepatocyte growth factor, TNF-receptors I and II (TNF-RI, TNF-RII), death receptor 5, Leptin and adiponectin), and study of their evolution with changes related to weight loss.

2. Metabolic Surgery: Fat features’ changes in morbidly obese patients.

3. Thyroid gland surgery: 1. Utility of the neuronal neuromonitorization during in thyroid surgery; 2. Cervical ultrasound done by the surgeon: does it bring something?; 3. Utility of the cervicoscopy in the pathology of thyroid and parathyroid; 4. Thyroid cancer; 5. Evaluation and clinical validity of the selective sentinel node biopsy in the diagnosis of extension of papillary thyroid cancer; 6. rTSH mRNA usefulness in the diagnosis of follicular thyroid carcinoma.

4. Parathyroid glands surgery: Analysis of the usefulness of determining PTH concentrations intra-operatively in hyperparathyroidism treatment.

5. Adrenal gland surgery: Adrenal metastases treatment (techniques and indications).

6. Robotic Surgery: 1. Applicability and safety of robotic surgery in obese pathology (study carried out in collaboration with the Colorectal Surgery Unit and the Gynecology, Urology and Pediatric Surgery Divisions, and coordinated by the HUVH CAHTA).

7. Transumbilical surgery: Transumbulical surgery in acute appendicitis (multicenter study conducted in collaboration with the Department of Surgery Faculty of Medicine of Istanbul, Turkey, and the General Surgery Division of the University Hospital of Cairo, Egypt).

8. Transumbilical cholecystectomy: Multicenter study conducted in conjunction with the Department of Surgery Faculty of Medicine of Istanbul (Turkey).