RESUMEN
Acute cholecystitis requires a prompt diagnosis and early surgical treatment, either open or laparoscopic surgery. Currently, most of the patients can be treated by laparoscopic surgery.Delayed surgery of acute cholecystitis must be considered only if the patient has other clinical conditions such as congestive heart failure, other uncontrolled disease, and whenever cholecystitis is not complicated (epyema, perforation, gangrene, cholangitis, etc.) Percutaneous cholecystostomy by interventionist radiologist or surgical cholecystostomy must be considered in the therapeutic armamentarium in patients with poor clinical conditions. Acute cholangitis management requires a multidisciplinary team approach of internists, gastroenterologists, interventionist radiologists and surgeons. Each patient requires an integral evaluation with an initial energic medical treatment, followed by drainage of the biliary tract, ideally by endoscopic sphincterectomy or by transhepatic percutaneous drainage. Only if these procedures do not solve the patient's problem, or if its application is not possible, we proceed with an emergency surgery in order to decompress the biliary tree.
RESUMEN
61 patients with malignant and benign pancreatoduodenal diseases were treated with Whipple operation during 1973-1993. 38 patients were males and 23 females. Ages varied between 18 and 74. Malignant tumors were more frequent: adenocarcinoma of the pancreas 27, ampulla of Vater 14, duodenum 5 and distal common duct 3. The other group of patients with benign and malignant tumors as cysto-adenocarcinoma 2, leiomyosarcoma 2, trauma to the pancreas 2, pancreatitis with pseudocyst and insulinoma etc. The morbidity has been reduced from 50% in the first 45 cases to 15% in the last 16. Also the mortality dropped from 17% to 0%. This improvement is related to knowledge the better of the surgical technique and reconstruction varieties, better control of hemorrhage, reduced operative time and good post operative control. We concluded, that this difficult surgery is a reality and should be managed in those hospitals with specialized surgeons and all of the technology must be used in any moment, to be considered a low risk surgery.