RESUMEN

Venous thromboembolic disease (VTE) occupies an important place as a cause of morbidity and mortality in surgical patients in all specialties. Despite the existence of guidelines for thrombo prophylaxis in surgery, it is not clear due to the lack of current evidence, how to develop antithrombotic prophylaxis in varicose vein surgery and many questions arise when the surgeon is faced with a patient to be operated on. A comprehensive review of the literature was conducted to examine the evidence about the prevention of the venous thromboembolism in varicose veins surgery patients, and aims to guide the reader through questions that arise in daily practice, discussing the different scenarios presented in the literature for the choice of the most appropriate prophylaxis for each case. The lack of conclusive literature determines that risk should be individualized using available scales and other procedure-related factors, so that the type and duration of prophylaxis can be determined on a case-by-case basis.

Asunto(s)

RESUMEN

Introducción. El cáncer de vesícula biliar es una de las neoplasias más frecuentes de la vía biliar y la mayoría de los casos se diagnostican de forma incidental o en estadios avanzados. En Colombia existen pocas publicaciones acerca de la prevalencia y características clínicas de pacientes con cáncer insospechado de vesícula biliar. El objetivo de este trabajo fue actualizar la información existente. Métodos. Estudio de tipo transversal basado en registros médicos. Como variable de resultado se definió el hallazgo incidental de patología maligna reportado por un patólogo y el subtipo histológico. Se midieron variables demográficas, clínicas y quirúrgicas. Se calcularon OR con sus respectivos intervalos de confianza (IC95%). Resultados. De los 2630 casos analizados, en cuatro se hizo diagnóstico de cáncer incidental de vesícula, con una prevalencia del 0,15 %. Se encontraron como características asociadas al cáncer incidental de vesícula, la edad, el antecedente de cáncer y la presencia de pólipos. Conclusiones. Esta es una patología poco frecuente en la población evaluada, lo que permite afirmar que no es necesario realizar estudios prequirúrgicos más amplios de forma rutinaria, a menos que el paciente presente alguno de los factores asociados.

Introduction. Gallbladder cancer is one of the most common neoplasms of the bile duct and most cases are diagnosed incidentally or in advanced stages. In Colombia, there are few publications about the prevalence and clinical characteristics of patients with unsuspected gallbladder cancer. The objective of this work was to update the existing information. Methods. Cross-sectional study based on medical records. The incidental finding of malignant pathology reported and the histological subtype were defined as the outcome variable. Demographic, clinical and surgical variables were measured. ORs were calculated with their respective 95% CI. Results. Of the 2630 cases analyzed, four were diagnosed with incidental gallbladder cancer, with a prevalence of 0.15%. Characteristics associated with incidental gallbladder cancer were age, history of cancer and the presence of polyps. Conclusions. This is a rare pathology in the population evaluated, which allows us to recommend that it is not necessary to routinely perform more extensive presurgical studies, unless the patient presents any of the associated factors.

Asunto(s)

RESUMEN

Background: Varicose veins are a highly prevalent condition in the general population, generating variable reasons for consultation that can alter the patient's quality of life, with prevalence and associated factors that vary in different series. Objectives: To describe the epidemiological profile of patients who consulted for varicose veins by evaluating main symptoms and associated variables. Methods: Between 2019 and 2020, 1,136 patients attending vascular surgery consultation in a specialized outpatient center were evaluated. Demographic variables, presented symptoms, complications, and associated factors, such as body mass index, parity and family history, were recorded. Results: A total of 1136 patients were evaluated (79.8% women and 20.2% men), with a mean age of 53.51 years. The presence of symptoms was similar in men and women; the most frequent complications were ulcer, varicorrhage, and superficial venous thrombosis. Most patients showed CEAP 1, 2 and 3 (n = 909) and more than half were overweight or obese (n = 679) with a predominance of those classified as C4. Sixty-nine per cent had a positive family history of varicose veins. There was no difference between severity of varicose veins and time working in the standing or sitting position, but there was a greater presence of C5 or C6 ulcer among patients standing for more than 4 hours. Conclusions: Describing the characteristics of patients with varicose veins helps to understand the disease and to focus efforts towards those who are more susceptible. The results of this research are similar to those found in other populations.

Contexto: As varizes são uma condição altamente prevalente na população em geral, gerando motivos variáveis de consulta que podem alterar a qualidade de vida do paciente, com prevalência e fatores associados variando em diferentes séries. Objetivos: Descrever o perfil epidemiológico dos pacientes que consultaram por varizes, avaliando os principais sintomas e as variáveis associadas. Métodos: Entre 2019 e 2020, foram avaliados 1.136 pacientes que compareceram a uma consulta de cirurgia vascular em um centro ambulatorial especializado. Foram registradas variáveis demográficas, apresentando sintomas, complicações e fatores associados tais como índice de massa corporal, paridade e histórico familiar. Resultados: Foram avaliados 1.136 pacientes (79,8% mulheres e 20,2% homens), com idade média de 53,51 anos. A presença de sintomas foi similar em homens e mulheres; as complicações mais freqüentes foram úlcera, varicorragia e trombose venosa superficial. A maioria dos pacientes apresentava CEAP 1, 2 ou 3 (n = 909), e mais da metade tinha excesso de peso ou obesidade (n = 679), com predominância dos classificados como C4. Sessenta e nove por cento tinham histórico familiar positivo de veias varicosas. Não houve diferença entre a gravidade das varizes e o tempo gasto em pé ou sentado, mas havia uma presença maior de úlcera C5 ou C6 em pacientes que permaneciam em pé por mais de 4 horas. Conclusões: A descrição das características da população com varizes ajuda a entender a doença e a canalizar os esforços para aqueles mais suscetíveis. Os resultados desta investigação são semelhantes aos encontrados em outras populações.

RESUMEN

Resumen Contexto Las várices son una condición altamente prevalente en la población general, generando motivos variables de consulta que pueden alterar la calidad de vida del paciente, con prevalencia y factores asociados variando en diferentes series. Objetivos Describir el perfil epidemiológico de pacientes que consultaron por várices, evaluando los principales síntomas y las variables asociadas. Métodos Entre 2019 y 2020, se evaluaron a 1.136 pacientes que asistieron a una consulta de cirugía vascular en un centro ambulatorio especializado. Se registraron variables demográficas, sintomatología, complicaciones y factores asociados, como índice de masa corporal, paridad e historia familiar. Resultados Se evaluaron 1.136 pacientes (79,8% mujeres y 20,2% hombres), con edad media de 53,51 años. La presencia de síntomas fue similar en hombres y mujeres; las complicaciones más frecuentes fueron úlcera, varicorragia y trombosis venosa superficial. La mayoría de los pacientes presentaba CEAP 1, 2 o 3 (n = 909), y más de la mitad tenía sobrepeso u obesidad (n = 679), con predominancia de los clasificados como C4. Sesenta y nueve por ciento tenían historia familiar positiva de várices. No hubo diferencia entre la severidad de las varices y el tiempo laborado de pies o sentado, pero hubo mayor presencia de úlcera C5 o C6 en pacientes que permanecían de pies por más de 4 horas. Conclusiones La descripción de las características de la población con várices ayuda a entender la enfermedad y a concentrar los esfuerzos en aquellos más susceptibles. Los resultados de esta investigación son semejantes a los de otras poblaciones.

Resumo Contexto As varizes são uma condição altamente prevalente na população em geral, gerando motivos variáveis de consulta que podem alterar a qualidade de vida do paciente, com prevalência e fatores associados variando em diferentes séries. Objetivos Descrever o perfil epidemiológico dos pacientes que consultaram por varizes, avaliando os principais sintomas e as variáveis associadas. Métodos Entre 2019 e 2020, foram avaliados 1.136 pacientes que compareceram a uma consulta de cirurgia vascular em um centro ambulatorial especializado. Foram registradas variáveis demográficas, apresentando sintomas, complicações e fatores associados tais como índice de massa corporal, paridade e histórico familiar. Resultados Foram avaliados 1.136 pacientes (79,8% mulheres e 20,2% homens), com idade média de 53,51 anos. A presença de sintomas foi similar em homens e mulheres; as complicações mais freqüentes foram úlcera, varicorragia e trombose venosa superficial. A maioria dos pacientes apresentava CEAP 1, 2 ou 3 (n = 909), e mais da metade tinha excesso de peso ou obesidade (n = 679), com predominância dos classificados como C4. Sessenta e nove por cento tinham histórico familiar positivo de veias varicosas. Não houve diferença entre a gravidade das varizes e o tempo gasto em pé ou sentado, mas havia uma presença maior de úlcera C5 ou C6 em pacientes que permaneciam em pé por mais de 4 horas. Conclusões A descrição das características da população com varizes ajuda a entender a doença e a canalizar os esforços para aqueles mais suscetíveis. Os resultados desta investigação são semelhantes aos encontrados em outras populações.

Abstract Background Varicose veins are a highly prevalent condition in the general population, generating variable reasons for consultation that can alter the patient's quality of life, with prevalence and associated factors that vary in different series. Objectives To describe the epidemiological profile of patients who consulted for varicose veins by evaluating main symptoms and associated variables. Methods Between 2019 and 2020, 1,136 patients attending vascular surgery consultation in a specialized outpatient center were evaluated. Demographic variables, presented symptoms, complications, and associated factors, such as body mass index, parity and family history, were recorded. Results A total of 1136 patients were evaluated (79.8% women and 20.2% men), with a mean age of 53.51 years. The presence of symptoms was similar in men and women; the most frequent complications were ulcer, varicorrhage, and superficial venous thrombosis. Most patients showed CEAP 1, 2 and 3 (n = 909) and more than half were overweight or obese (n = 679) with a predominance of those classified as C4. Sixty-nine per cent had a positive family history of varicose veins. There was no difference between severity of varicose veins and time working in the standing or sitting position, but there was a greater presence of C5 or C6 ulcer among patients standing for more than 4 hours. Conclusions Describing the characteristics of patients with varicose veins helps to understand the disease and to focus efforts towards those who are more susceptible. The results of this research are similar to those found in other populations.

RESUMEN

Introducción: La insuficiencia venosa impacta en la calidad de vida de los pacientes y del sistema de salud de países poco desarrollados, donde las técnicas endovasculares tienen uso limitado por su alto costo, lo que favorece el amplio uso de los métodos quirúrgicos convencionales. Objetivo: Valorar la utilidad de la safeno-varicectomía como alternativa de tratamiento en Colombia para la enfermedad por várices. Métodos: Se realizó un estudio observacional, descriptivo y retrospectivo de corte transversal en 477 pacientes sometidos a stripping superior y/o flebo-extracción en un centro especializado para el manejo de patologías venosas en la ciudad de Medellín, Colombia, entre 2016 y 2018. Las variables estudiadas se dividieron en perioperatorias y posoperatorias, y sus valores se resumieron en las frecuencias absoluta y relativa. Resultados: El 70,4 por ciento de los pacientes correspondió al sexo femenino, el 48 por ciento tenía más de 51 años, y la mayoría se encontraba en sobrepeso (49,5 por ciento) y el 15,1 por ciento en obesidad. El procedimiento más realizado fue la extracción de la safena mayor más varicectomía (72,3 por ciento), principalmente del lado izquierdo (43,8 por ciento). La mayoría de los pacientes refirió dolor moderado y 92,7 por ciento tuvo adherencia a la media compresiva. La mejoría global y estética resultó satisfactoria en el 86,6 por ciento. El 64,7 por ciento reinició sus actividades diarias entre el primer y el tercer día; y el 72,5 por ciento tuvo incapacidad laboral entre 8 y 12 días. Conclusiones: La cirugía convencional tiene excelentes resultados clínicos con poca tasa de complicaciones, lo que puede ser una alternativa de manejo en países con recursos limitados(AU)

Introduction: Venous insufficiency impacts the quality of life of patients and the health system of less developed countries, where endovascular techniques are limitedly used, due to their high cost, which favors the wide usage of conventional surgical methods. Objective: To identify the usefulness of saphenous varicectomy as an alternative treatment in Colombia for varicose vein disease. Methods: An observational, descriptive and retrospective cross-sectional study was carried out with 477 patients undergoing superior stripping and/or phlebextraction in a specialized center for the management of venous pathologies in Medellín City, Colombia, between 2016 and 2018. The variables studied were divided into perioperative and postoperative ones, and their values ​​were summarized in absolute and relative frequencies. Results: 70.4 percent of the patients were female, 48 percent were over 51 years old, the majority were overweight (49.5 percent), and 15.1 percent were obese. The most performed procedure was extraction of the greater saphenous vein plus varicectomy (72.3 percent), mainly on the left side (43.8 percent). Most of the patients reported moderate pain and 92.7 percent had adherence to compression stocking. Overall and aesthetic improvement was satisfactory in 86.6 percent. 64.7 percent resumed their daily activities between the first and third days, and 72.5 percent had a work disability of 8-12 days. Conclusions: Conventional surgery showed excellent clinical outcomes with a low rate of complications, a reason why it can be a management alternative in countries with limited resources(AU)

Asunto(s)