Take a look at the Recent articles

Abstract

Changes in the practice of surgery over the last 40 years have been extraordinary. We want to reflect the progress during this period in the Community Hospital of Alcoy, Spain. Technology and staff training have improved in an extraordinary way allowing that medical assistance in the community hospitals is quite similar to that offered at the most sophisticated centers.

Key words

advances in surgery; general surgery; community hospital

Introduction

The changes in medicine with the creation in 1967 of the National Health System (NHS) in Spain and the Intern and Residents training (IRT) system have been extraordinary. The NHS network of hospitals covers medium-sized cities with Community Hospitals (CH) of less than 300 beds and 250,000 inhabitant’s coverage.

Aim

Reflect the changes and advances in general surgery at a CH during a 40 years period.

Geographical and Historical Context

Alcoy with 60,000 inhabitants, and its health department with 140,000 persons in South-eastern Spain was first served by a magnificent Oliver Civil Hospital donated by a patron in 1868-77, but then faded with time and reflects what happened in other Spanish regions. The city, isolated, is located in mountainous area of the Valencia Region 60 km far from Alicante and 100 km from Valencia.

Alcoy CH was the first Community hospital of the Valencia Region and it was inaugurated in 1972 but the Head of Surgical Service was not appointed until 1974. The training of first IRT residents started in Spain in 1967 and graduated five years later, but many were not attracted to work in a supposedly "distant hospital" far from large centers and big cities, where the endowments were initially precarious. But by 1978 in Alcoy there were five IRT surgeons, and the coverage of other services took four more years to provide minimal services.

The dark years 1974-78

Aniceto Baltasar MD (AB) was appointed in 1974 as Head of Service and started working alone with only one assistant (J. Tomas MD) until 1978. Later on, 7 non specialist fellows (Del Rio, Bou, Fernández, Aracil, Pérez, Carbonell and Llopis) gave us an invaluable support. We opened an Intensive Care Unit (ICU) in 1976 with 3 beds, two pressure and three volumetric ventilators, monitors, PVC, hypothermia blankets, anti-scar mattresses, gas analyzer, cardio conversion and pacemakers. Twelve young nurses were trained with daily classes and the translation of two books on Ventilator and Cardiac Care [1,2]

We abandoned the traditional cut-down venotomies in favor of the subclavian punctures and initiated the use of complex procedures (aortic grafts, femoro-popliteal bypasses, Swiss AEO osteo-synthesis, 52 transverse and Seldinger angiographies (52), bronchoscopies (45), intra-cavitary and epicardial pacemakers (46), lung lobectomies, Comando mandible resection, fibro-gastroscopy (28), mid-sternal thoracotomy for mediastinal tumor, porto-cava shunts, Nyhus pre-peritoneal hernia and pancreatectomies.

The Alcoy's Analysis and Blood Bank Services (a magnificent volunteer institution) were excellent, with all necessary blood transfusions but w derivatives at the time.

Years 78-90. Open surgery

Then in 1978 the four first IRT well trained surgeons (Bengochea, Del Río, Marcote, Escrivá) and by 1987 two more, Bou and Miró, joint us members of the staff. Later on Arlandis and Alonso arrived in 1990, and Serra (current Chief of the Service), Martínez and Cipagauta in 1992 (Figure 1), and by then the surgical team with 11 members was considered complete (Figure 1).

Figure 1. Alcoy CH Surgical staff.

By 1985 other services staffs (Anesthesia, Radiology, Digestive-endoscopies, ICU, Pathology) were filled. In 40 years the Surgical Service have been very fortunate to have an stable staff since only three members left the service to occupy relevant positions in other hospitals and by 1998 obtained the IRT teaching position of one resident per year, and has become an organ donor center, has MRI and an oncology service with radiotherapy.

Colostomy irrigation

In 1983 we founded Alcoy Ostomy Club (AOC) and Spanish Ostomy Club (SOC) and organized three meetings in Alcoy. We started colostomy irrigations in Spain [3], a very uncommon therapy and published two videos [4], and a paper with permission from the Mayo Clinic of MN [5]. In this volunteer program a patient with a colostomy visits patients in the pre and postoperative period and shows them what a colostomy is. He teaches the patient and his family the technique of colostomy lavage before discharge and the use of a plugging device that allows him to live "without using a colostomy bag", as a normal person without any psychological traumas, to participate in social events and even to bathe in public swimming pools. All the patients have performed their irrigation every two days for years. Ms. Encarna Nadal has been teaching and caring for all patients with ostomies for 30 years and participated in two National TV programs to publicize the irrigation and received recognition awards by the Alcoy CH in November 1995 and the Rotary Club Alcoy in 2016 for his disinterested dedication.

Vascular surgery

In the years 1970-80 there were no Vascular Surgery Units in the country but this surgery was performed in many hospitals. We started in the country the 1^st use of Inahara [6] technique of eversion retrograde thrombo-endarterectomy (ERTE) that had better results than the vascular grafts. We introduced the technique in National Surgical and Vascular Surgery Congresses. An ERTE video [7] received the Motril Aesculapius Award in 1984, the most important in Spain at that time. We started the use of "Sparks grafts", an ingenious attempt to “create vessels” [8], but without long-term success, since progressive fibrosis of the grafts finally obstructed the vessels.

Major infra-abdominal aorta major surgery, mesenteric vessels, iliac, femoro-popliteal bypass, carotid aneurysms were carried out. Unilateral ERTE from aortic bifurcation to the femoral bifurcation were the most frequent under regional anesthesia.

The Valencia Vascular Surgery Society 1^st Meeting was held in Alcoy in October 1988, attended by Juan Matesanz, a distinguished Boston-trained surgeon and 1^st chief of the Madrid Clinic University Hospital (Figure 2).

Figure 2. 1st Valencia Vascular meeting 1988.

We reported on aortic aneurysms [9], internal carotid aneurysm [10, 11], combined aortoiliac and double bowel revascularization [12], venous aneurysm [13] and anastomotic aneurysm [14]. The Vascular Services in the Valencia community started working and in 1998 and then we abandoned this surgery.

Vascular and Oncologic Surgery

Nine cases of radical oncology and vascular resection were done. The 1^st in 1985 was a sarcoma in the middle third of the right thigh including the femoral vessels. A radical resection of the tumor and vascular reconstruction (arterial with Dacron, femoral veins with two inverted saphenous vein grafts, and the formation of arterial-venous fistula at the ankle to prevent thrombosis of the veins) was done and this patient currently lives [15].

In 1982, a patient had a recurrent retro-peritoneum metastatic disgerminoma involving the infra-renal aorta wall. She had a radical left nephrectomy and infra-renal aortic resection. An Dacron aortic graft was used to reconstruct the aorta, and is currently living [16]. Until then, only one case of aortic resection and vena cava had been published by Crawford and De Bakey [17], 7 cases of 297 sarcomas by Fortner, et al. [18] from the NYC Memorial and 13 cases by Imparato et al. [19] at Roswell Park in Buffalo, NY, both recognized global centers dedicated to cancer.

We then performed four infra-renal aortic resections for retroperitoneal sarcomas [20] and presented a video at the ACS American Congress in Chicago at the Symposium "Spectacular Problems in Surgery" [21] an unusual technique at that time. And the ACS requested to present it again eight years later and it was done by Dr. Serra in San Francisco and is in ACS Video Library.

One of those resected sarcomas recurred at the left iliac vein 2 years later and the left iliac-femoral (left artery and vein) were resected [22], and had a cross-femoral revascularization with two saphenous (for artery and vein) were done. He suffered massive hemorrhage from pelvic veins and was treated with abdominal packing. He remained intubated at the ICU and was re-operated three days later, the pelvis was clean and the abdomen was closed, and both cross-femoral grafts remained permeable.

Thoracic Surgery

From the beginning, we performed thoracic surgeries such as bronchoscopies (from 40 to 68 per year), tracheotomies (8-12), thoracoscopy, pneumo-thorax (12-15), lobectomies and pneumonectomies for cancer (7-11), esophagus (9) and endocavitary pacemakers. We introduced thoracoscopy in 1993 and performed bilateral sympathectomies for hyperhidrosis, emphysematous bullae [23], neurilenoma [24] and the 1^st pericardial window due to effusion in the country [25]. In 2003 all thoracic surgery was transferred to the newly created regional referral center.

Neck

We did treated thyroid and parathyroid tumors, radical neck dissections [26], parotid tumors [27], two rare cases of suffocating retro-pharyngeal cervical lipomas [28,29] and radical surgery for cervical esophagus cancer with gastroplasty [30].

Four esophageal lesions [31] due to autolysis with Salfumant were operated with immediate resection of the esophagus and stomach and then colonic transposition. Subsequently, two of them developed late stenosis at the cervical esophageal-colonic anastomosis and required “vascular-dermo-cutaneous plastic grafts” using as donor the arterial and venous radial grafts from the arm skin to form a tube to treat a residual pharyngeal stenosis, done at the plastic unit of Dr. Viñals at the Barcelona Bellvitge Hospital [32-34] with good functional results (Figure 3). The donor area was covered by an anterior thigh skin graft.

Figure 3. Dermocutaneous graft stomakeuppercervicaleeophagus.

Breast Surgery

The Services of Surgery and Radiology began in 1994 the 1^st center for detection and screening of breast cancer in the Valencia community. We treated phyllodes tumors [32], breast carcinosarcoma [33] and mammary reconstructions with immediate prostheses [35,36].

Marcote [37] published DNA ploidy and S-phase of the cell cycle and active proliferation in 104 patients, flow fuidmetry in 220 patients [38,39] and was Ph.D. "Cum Laude" award in 1990. Serra et al. [40-45] also published in 1990 extensive studies of male breast cancer with determination of the Pepsinogen C and Apolipoprotein D. He received a Ph.D. "Cum Laude" award.

Digestive surgery in the 80's

The 1^st two cases of Kock´s continent ileostomy were done in 1985 after total colectomy for diffuse colonic cancer [46,47]. A Kock double valve urinary continent ileostomy [48] was done in a patient with single kidney and recurrent bladder cancer. We published several surgical corrections of post-traumatic diaphragmatic hernias [49-54].

In the 1980s, gastro-duodenal ulcers were a very prevalent condition and we used the VARY (vagotomy-antrectomy and Y-de-Roux reconstruction) [55,56], in 67 patients with very good results between 1978-85. Two patients suffered mesenteric necrosis, one 11 years later due to mesenteric rotation and another 4 years later [57].

Martínez et al. [58,59] in 1994 obtains her Ph.D. "Cum Laude" for studies on gastric emptying after gastritis of reflux, VARY and duodenal switches. We used sphincteroplasty [60-62] according to Austin Jones [63] in 67 cases with bile duct obstruction of 558 gallbladder operations with a mortality rate of 1.5%.

We performed in 1980 the 1^st cephalic pylorus-preserving in pancreatectomy in Spain [64], with a continuous monoplane posterior pancreato-gastrostomies not usual at the time.

In 1989 we initiated the duodenal preservation in cephalic resection of pancreas by chronic pancreatitis [65,66] according to Beger et al. [67]. A video, the first presented [68] at the ACS in Chicago 2006 is on ACS video library and Martínez et al. [69] made a review of four cases.

Retained foreign bodies in the abdomen are an unpleasant complication and we used compresses with rings [70, 71] as very effective to avoid them and no patient suffered this complication in 40 years (Figure 4).

Figure 4. Lap-pad with ring to avoid forgotten foreign bodies in chest and abdomen.

Continuous sutures were done in abdominal closures and in digestive anastomosis [72,73], and Serra et al. [74] used the 1^st Spanish self-expanding prostheses in colonic obstructions. Pardo et al. [75] publishes in 1996 (Figure 5) the "Index of authors who publish the most" in Spanish Surgery. And Alcoy-CH ranks 1^st among CH and 7^th since 1973-93 among all the country hospitals and the 1^st of all in June 1996.

Figure 5. List of producers in Cir. Esp 1997.

Laparoscopic surgery: 1992

Starting in 1992 laparoscopy has been the biggest surgery revolution in these forty years. We were spectator in the 1^st laparoscopic gallbladder at the Ruber International Sanatorium in Madrid in 1990. We started our 1^st gallbladder by lap in 1991, oophorectomy in1992, resection of lung bullae in 1992. mediastinal tumor in 1992, pulmonary tuberculosis in 1994, splenic rupture in 1994. Pericardial window in 1994. Nissen-1996. Splenectomy-1996. Inguinal hernia -1997. Left colectomy-1997. TAPP-1997. TEP-1998. Colectomy-1998. Adrenalectomy-1998. Heller-1998. Abdominoperineal-1999. Thoracic sympathectomy-2000. Use of intra-abdominal meshes after a visit to Dr Carbajo-2000. Currently the service perform standard intra-abdominal laparoscopy and the "laparoscopic" group does colon, adrenal, spleen, abdominoperineal resections, noninvasive endo-anal resection (TAMIS), TAMIS- TME, and distal pancreatectomies.

Bariatric Surgery (BS)

Alcoy-CH is recognized as a pioneer bariatric center [76]. We funded SECO (Spanish Society for Obesity Surgery) in 1997, the BMI-Latin magazine (www.bmilatina.com) in 2011 and had the IFSO Presidency and World Congress in 2003. We performed in 1977 the 1^st RNY gastric bypass in Spain [77], 1^st metabolic surgery for hyper cholesterolemia [78], 1^st VGB separation of the vertical line [79,80], 1^st open DS in 1995 [81], 1^st lap RNY in Europe 1977 [82,83] and 1^st world report of internal hernias after RNY-GB [84], 1^eu lap LDS [85] in 2001. The paper on Sleeve Gastrectomy was one of the 1^st in Europe [86] has the 61^st higher bariatric citation index in the world [87]. Non-removable Wall-stents for leaks [88,89] were used before the removable ones were developed, 1^w RNY diversion for SG leaks [90], 1^st diabetes surgery 2004 [91], 1^st and adolescent bariatric surgery (ABS) 2008 [92] and developed the concept of Expected BMI after BS [93]. cofounded the European Centers of Excellence in 2013.

Associations and Congresses

Founders Video-Revista de Cirugía (VRC) with Dr Ballesta-1987 in four languages (French, Italian Spanish and Portuguese) www.bmiltina.com

2021 Copyright OAT. All rights reserv

Founder of the European Association of Video Surgery.1988

Organized the I National Congress of Video Surgery. Alcoy-Alicante 1989.

For 20 years (1987-2007) organized the Alicante Meetings of Surgery, every year in Alcoy

1984-2004 Detailed Memories (Annual Reports) of the Service.

Posters. 46. Two first prizes Milan 1994 and Valencia SECO 2010

Videos: The HC-Alcoy has 25 videos published.

101 in Spanish-. 3 first Prizes and 12 winners in Videomed and Video-Surgery Valencia

44 in English-. 2 First prizes and 3 more prizes

http://www.youtube.com/channel/UCEpwVhQEohunxKOhNqC71zg

273 articles published in surgery and 109 in bariatric.

We have the Maximum number of citations in the province of Alicante by Research Gate: Publication downloads 10,878. Views 8,631, 1.99 per publication, 1,154 citations.

References

1. Bean S, Brown N, Chey A (1977) Physiologic bases for respiratory care. Mountain Pres Publishing Co. Missoula, MT.
2. Hamilton A (1978) Selected subjects for critical care nurses. Mountain Pres Publishing Co. Missoula, MT.
3. Baltasar A, Del Río J, Herrera GR (1984) Irrigación de las colostomías. Boletín de la AEC (Asociación española de ostomizados) 1: 1-3.
4. Baltasar A, Del Río J, Herrera GR (1984) Colostomy washouts. VRC 1: 10-11.
5. Baltasar A, Jao S, Beart R (1985) Cuidados de irrigación en las colostomías sigmoideas. Arch Surg 120: 916-917.
6. Inahara T (1972) Endarterectomy for occlusive disease of the aortoiliac and common femoral arteries. Evaluation of results of the eversion technic endarterectomy. Am J Surg 124: 235-243. [Crossref]
7. Baltasar A, Herrera GR (1987) Trombo-endarterectomía retrógrada aorto-femoral bilateral. VRC 4: 1-4.
8. Noël R, Thévenet HP, King A, Guidoin M (1984) The Sparks-Mandril arterial prosthesis. An ingenious concept, a total failure. What can we learn from it? J Des Maladies Vasculaires 9: 277-283.
9. Blanquer JJ, Rapa M, Adam A, Ortola P, Aracil C, et al. (1992) [Aneurysm of the abdominal aorta]. Aten Primaria 10: 916-919. [Crossref]
10. Marcote E, Arlandis F, Baltasar A (1993) Aneurisma de carótica interna. Cir Esp 5: 455-457.
11. Baltasar A, Marcote E, Arlandis (1994) Aneurisma de carótida interna. Video. VCR 11: 15-24.
12. Marcote E, Baltasar A, Arlandis F (1991) Revacularización combinada aortoiliaca e intestinal doble. CTV 9: 543-548.
13. Marcote E, Arlandis F, Baltasar A (1994) Aneurisma venoso primario de safena. Cir Esp 55: 440-441.
14. Marcote E, Arlandis F, Martínez R (1994) Aneurisma anastomótico de arteria femoral. Cir Andaluza 5: 52-56.
15. Baltasar A, Escrivá C, Marcote E (1980) Un caso de cirugía vascular reconstructiva para salvar la extremidad inferior por sarcoma. Rev Quir Esp 7: 326-330.
16. Baltasar A, Marcote E, Barnés JJ, Bengochea M (1985) Resección de aorta abdominal por disgermino-ma retroperitoneal metastá-sico. CTV 5: 224-228.
17. Crawford ES, De Bakey M (1956) Wide excision including involved aorta and vena cava and replacement with artic homograft for retroperitoneal malignant tumors. Cancer 9: 1085.
18. Fortner JG, Kim DK, Shiu MH (1977) Limb-preserving vascular surgery for malignant tumors of the lower extremity. Arch Surg 112: 391-394. [Crossref]
19. Imparato AM, Roses DF, Francis KC, Lewis MM (1978) Major vascular reconstruction for limb salvage in patients with soft tissue and skeletal sarcomas of the extremities. Surg Gynecol Obstet 147: 891-896. [Crossref]
20. Baltasar A, Arlandis F, Bou R (1995) Reconstrucción vascular en la cirugía oncológica radical. Cir Esp 58: 345-349.
21. Martínez R, Arlandis F, Baltasar A (1999) Reconstrucción vascular in retroperitoneal sarcomas I. VRC 16: 15-17.
22. Martínez R, Arlandis F, Baltasar A (1999) Reconstrucción vascular in retroperitoneal sarcomas II. VRC 16: 31-34.
23. Baltasar A, Escrivá C, Bou R (1993) Resección de bullas enfisematosas por toracoscopia. VCR 10: 16-19.
24. Baltasar A, Miró J, Bou R (1994) Resección por toracoscopia de Neurilenoma mediastínico. VCR 11: 35-38.
25. Arlandis F, Baltasar A, Del Río (1995) Creación de ventana pericardio-pleural por video toracoscopia. VCR 12: 43-46.
26. Arlandis F, Serra C, Baltasar A (1997) Bilateral functional dissection of the neck. VCR 13: 6-11.
27. Martínez R, Baltasar A, Serra C (1997) Total parotidectomy preserving the facial nerve “Conservative parotidectomy). VCR 11: 35-39.
28. Serra C, Baltasar A, Arlandis F (1997) Suffocating retrophayngeal lipomas. VCR 14: 7-13.
29. Baltasar A, Nuñez R, Arlandis F (1997) Lipomas retrofaríngeos sofocantes. Cir Esp 62: 516-518.
30. Serra C, Baltasar A, Bou R (1999) Radical surgery in cervical esophageal cancer. Cirugía radical en cancer de esófago cervical. VRC 14: 31-33.
31. Serra C, Arlandis F, Martínez R, Baltasar A (1996) Lesiones faringo-esofágicas por ingestión de Salfumant. Cir Esp 59: 77-80.
32. Marcote E, Arlandis F, Baltasar A (1993) Tumores phyllodes de mama. Cir Andaluza 10: 42-48.
33. Farran Teixidor L, Viñals Viñals JM, Miró Martín M, Higueras Suñé C, Bettónica Larrañaga C, et al. (2011) [Supercharged ileocoloplasty: an option for complex oesophageal reconstructions]. Cir Esp 89: 87-93. [Crossref]
34. Dewever M, Gomes T, Madrazo Z , López A, Farrán L, et al. (2014) Failed colonic interposition after esophago-gastrectomy:What’s the next step? Cir Esp 10: 1.
35. Martínez R, Baltasar A, Manzano (1996) Carcinosarcoma de mama. Cir Esp 60: 515-517.
36. Serra C, Arlandis F, Del Río J, Baltasar A (1999) Reconstrucción inmediata con prótesis tras mastectomía en la enfermedad benigna y maligna de la mama. Cir Esp 65: 130-134.
37. Marcote E, Campos A, Baltasar A (1993) Significación pronóstica de la ploidía del ADN y de la fase S en el cáncer de mama. Cir Esp 53: 89-96.
38. Marcote E, Campos A, Baltasar A (1993) Ploidy, proliferative activity and other prognostic factors in breast cancer. Res in Surg 5: 121-126.
39. Marcote E, Campos A, Bauza (1993) The prognostic significance of DNA ploidy and S-phase in breast cancer. Res in Surg 5: 184-188.
40. Serra C, Martínez R, Cipagauta L (1995) Carcinoma de mama sincrónico bilateral en un paciente varón. Cir Esp 5: 368-369.
41. Serra C, Vizoso F, Medrano J (1998) Estudio multicéntrico de 70 pacientes varones diagnosticados de cáncer de mama. Cir Esp 64: 213-220.
42. Serra Díaz C, Vizoso F, Rodríguez JC, Merino AM, González LO, et al. (1999) Expression of pepsinogen C in gynecomastias and male breast carcinomas. World J Surg 23: 439-445. [Crossref]
43. Serra Díaz C, Vizoso F, Lamelas ML, Rodríguez JC, González LO, et al. (1999) Expression and clinical significance of apolipoprotein D in male breast cancer and gynaecomastia. Br J Surg 86: 1190-1197. [Crossref]
44. Serra C, Vizoso F, Lamelas ML (2000) Comparative study of two androgen-induced markers (Apolipoprotein D and Pepsinogen C) in female and male breast cancer. J Surg Investig 3: 183-192.
45. Serra C, Quintela I, Vizoso F, Baltasar A (2001) Inmuno-histochemical study of Pepsinogen C expression in cutaneous malignant melanoma: association with clinicopathological parameters. Int J Biol Markers 4: 240-244.
46. Baltasar A, Del Río J, Bengochea M (1985) Ileostomía continente de Kock. VRC 2: 12-13.
47. Bengochea M, Del Río J, Baltasar A (1985) Carcinomas múltiples de colon y recto. Rev. Quir Esp 12: 122-125
48. Alonso M, Baltasar A, Arlandis F (1988) Kock urinario. Válvula continente tras extirpación de vejiga urinaria. VCR 5: 17-32.
49. Baltasar A (1976) [Post-traumatic diaphragmatic hernia with complete pneumothorax caused by colonic perforation]. Rev Clin Esp 141: 93-96. [Crossref]
50. Del Río J, Baltasar A, Herrera GB (1984) Hernia diafragmática postraumática. VCR 1: 12-13.
51. Marcote E, Baltasar A (1990) Late presentation of post-traumatic diaphragmatic hernias. Chirurgie d´urgences 1: 272-274.
52. Marcote E, Baltasar A, Serrano M (1999) Rotura diafragmática trau-mática derecha. CTV 9: 341-345.
53. Arlandis F, Baltasar A, Marcote E (1991) Vólvulo gástrico que complica en hernia diafragmática incarcerada con deslizamiento. Cir Andaluza 6: 212-216.
54. Martínez R, Baltasar A, Cipagauta L (1994) Fomas de presentación tardía de la hernia diafragmática pos-traumática. Cir Es 6: 477-480.
55. Baltasar A, Del Río J, Escrivá C (1987) Vagotomía troncular, gastrec-tomía parcial y reconstrucción con Y de Roux en el ulcus gastroduodenal. Cir Esp 4: 564-555.
56. Baltasar A (1988) Ulcus gastroduodenal, VARY o Billroth-III? Video. VRC 5: 3.
57. Baltasar A, Marcote E, Del Río J (1995) Necrosis intestinal masiva tardía después de VARY: Billroth-III. Cir Esp 57: 270-273.
58. Martínez Castro R, Pérez-Mateo Regadera M, Baltasar Torrejón A, Martínez Egea A, Sánchez Cuenca J, et al. (1995) [Value of endoscopy in the diagnosis of postoperative gastritis caused by alkaline reflux]. Rev Esp Enferm Dig 87: 564-568. [Crossref]
59. Martínez R, Vidal V, Baltasar A (1995) Nuevo método de estudio del vaciado gástrico en pacientes gastrectomizados. REEAD 97: 769-773.
60. Martínez Castro R, Baltasar A, Vidal V, Sánchez Cuenca J, Lledó JL (1997) [Gastric emptying in patients with morbid obesity treated with a duodenal switch]. Rev Esp Enferm Dig 89: 413-414. [Crossref]
61. Baltasar A, Tomás J, Bengochea M (1986) Esfinteroplastia (no esfinterectomía) en patología biliar. Cir Esp 4: 874-880.
62. Baltasar A, Tomás J, Bengochea M (1986) Sphinteroplasty (no sphinterotomy) in biliary surgery. VRC 3: 26-28.
63. Jones A (2000) Sphinteroplasty (no sphinterotomy) versus latero-latero choledoco-duodenostomy. Varco. Saunders. Philadelphia Pp. 241-256.
64. Baltasar A, Tomás J, Miralles J (1983) [Pylorus preservation in pancreatoduodenectomy]. Rev Esp Enferm Apar Dig 63: 507-512. [Crossref]
65. Bengochea M, Baltasar A, Marcote E (1989) Duodenopancreatectomía cefálica con preservación de píloro. Pancreato-gastrostomía posterior. VCR 6: 29-34.
66. Baltasar A, Marcote E, Del Río J (199) Preservación duodenal en la resección cefálica de páncreas por pancreatitis crónica. Cir Esp 2: 225-232.
67. Beger HG, Buchler M, Bottner R (1988) Duodenum-preserving resection of the head of the pancreas in severe chronic pancreatitis. Early and late results. Ann Surg 209: 273-278.
68. Baltasar A (1992) Duodenum-preserving cephalic pancreatectomy. VCR 9:35-40
69. Martínez R, Baltasar A, Del Río J (1996) Preservación duodenal en la pancreatectomía cefálica por pancreatitis crónica. Cir Esp 60: 90-92.
70. Marcote E, Arlandis F, Baltasar A (1993) Cuerpo extraño textil olvidado en el abdomen. A propósito de dos casos. Cir Esp 54: 181-184.
71. Baltasar A, Marcote E, Arlandis F (1996) Cuerpos extraños olvidados en el abdomen. Una forma eficaz de detección. Cir Esp 60: 150-151.
72. Arlandis F, Baltasar A, Marcote E (1992) Cierre de laparotomías con sutura continúa reabsorbible monofilamento. Cir Andaluza 3: 11-14.
73. Baltasar A, Del Río J, Marcote E (1993) Sutura continúa monoplano con poligluconato monofilar en anastomosis digestivas. Cir Esp 53: 182-185.
74. Serra C, Bengochea M, Camps J (1997) Utilización de prótesis metálicas auto-expandibles en el tratamiento inicial de la neoplasias obstructivas del colon izquierdo. Cir Esp 62: 234-236.
75. Pardo JL, Sáez JM, Domingo P (1993) La productividad de loa autores nacionales de cirugía. Análisis bibliométrico a través de la revista Cirugía española en el periodo 1974-1993. Cir Esp 60: 21-25.
76. Shikora S, Torres A (2016) Aniceto Baltasar, MD. Obes Surg 26: 477-478. [Crossref]
77. Baltasar A, Del Rio J, Bengochea M (1980) [Gastric bypass in morbid obesity]. Rev Clin Esp 157: 395-399. [Crossref]
78. Baltasar A, Marcote E, Bou R (1991) Exclusión ileal parcial en la hipercolesterinemia. Cir Esp 49: 475-478.
79. Baltasar A (1989) Modified vertical banded gastroplasty. Technique with vertical division and serosal patch. Acta Chir Scand 155: 107-112. [Crossref]
80. Baltasar A, Bou R, Arlandis F, Martínez R, Serra C, et al. (1998) Vertical banded gastroplasty at more than 5 years. Obes Surg 8: 29-34. [Crossref]
81. Baltasar A, Bou R, Marcote E (1995) Hybrid bariatric surgery: Biliopancreatic diversion and duodenal switch. Obes Surg 5: 419-423.
82. Baltasar A, Bou R, Bengochea M, Miró J, Arlandis F.: Lap Roux-Y gastric bypass. Obes Surg. 1998;8:393.
83. Baltasar A, Bou R, Miró J (2000) Laparoscopic gastric bypass. Bypass gástrico laparoscópico. Rev Esp Enferm Ap Dig 10: 661-664.
84. Serra C, Baltasar A, Bou R, Miró J, Cipagauta LA (1999) Internal hernias and gastric perforation after a laparoscopic gastric bypass. Obes Surg 9: 546-549. [Crossref]
85. Baltasar A, Bou R, Miró J, Bengochea M, Serra C, et al. (2002) Laparoscopic biliopancreatic diversion with duodenal switch: technique and initial experience. Obes Surg 12: 245-248. [Crossref]
86. Baltasar A, Serra C, Pérez N, Bou R, Bengochea M, et al. (2005) Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg 15: 1124-1128. [Crossref]
87. Ahmad SS, Ahmad SS, Kohl S, Ahmad S, Ahmed AR (2015) The hundred most cited articles in bariatric surgery. Obes Surg 25: 900-909. [Crossref]
88. Baltasar A, Pérez N, Bou R, Miro J, Bengochea M, et al. (2000) Wall-stent prosthesis for severe leak and obstruction of the duodenal switch Gastric tube. Obes Surg 10: 309.
89. Serra C, Baltasar A, Andreo L, Pérez N, Bou R, et al. (2007) Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy. Obes Surg 17: 866-872. [Crossref]
90. Baltasar A, Bou R, Bengochea M, Serra C, Cipagauta L (2007) Use of a Roux limb to correct esophagogastric junction fistulas after sleeve gastrectomy. Obes Surg 17: 1408-1410. [Crossref]
91. Baltasar A (2015) Historical note: First diabetes metabolic operation in Spain. Integr Obesity Diabetes 2: 180-182.
92. Baltasar A, Serra C, Bou R, Bengochea M, Andreo L (2008) Sleeve gastrectomy in a 10-year-old child. Obes Surg 18: 733-736. [Crossref]
93. Baltasar A, Perez N, Serra C, Bou R, Bengochea M, et al. (2011) Weight loss reporting: predicted body mass index after bariatric surgery. Obes Surg 21: 367-372. [Crossref]