RESUMEN
We performed a retrospective study in patients undergoing mayor elective surgery of the upper gastrointestinal tract for benign disease receiving perioperative total parenteral nutrition (TPN). We analyzed the clinical charts from patients admitted to the Hospital de Especialidades del Centro Médico de Occidente for this purpose from January 1983 to March 1987, selecting those who had clinical or laboratory criteria of severe malnutrition. They were divided in two groups depending on whether TPN was being indicated as preoperative preparation and continued through the postoperative period (GE = 32 patients), or initiated after surgery (GC = 13 patients). The results show statistical differences in morbidity (GC = 100%, GE = 27%), mortality (GC = 30%, GE = none), need of reoperation (GC = 30%, GE = none) and costs (higher in GE). Complications related to TPN in GC were 23% and 15% in GE, and there were no deaths related on either group. Based on our results, we consider the need of a good selection of candidates to receive preoperative and postoperative TPN when undergoing major elective surgery, which should be continued until they are able to cover their nutritional requirements by oral or enteral route. This applies whenever there is sufficient clinical and laboratory data of severe malnutrition.
Asunto(s)
Enfermedades del Esófago/cirugía , Nutrición Parenteral Total/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Gastropatías/cirugía , Adulto , Enfermedades del Esófago/complicaciones , Enfermedades del Esófago/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Nutricionales/epidemiología , Trastornos Nutricionales/etiología , Trastornos Nutricionales/terapia , Complicaciones Posoperatorias/terapia , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Gastropatías/complicaciones , Gastropatías/mortalidadRESUMEN
From 1977 to 1987, 20 patients (18 men and 2 women) with left post-traumatic diaphragmatic rupture, were managed by the General Surgery Service of the Hospital de Especialidades, Centro Médico de Occidente, IMSS; 13 as urgencies (65%) and 7 as elective procedures (35%). Hernia was due to closed trauma in 80% of the cases. Predominant symptoms were chest pain (85%) and dyspnea (50%). The Stomach was the herniated viscus in 16 instances. CXR showed suggestive data in 95% of the cases. Primary closure was achieved in 95% of the cases, in 8 patients thoraco-abdominal aproach was necessary. There were 50% morbidity (35% athelectasis, 30% wound sepsis) and 10% mortality rates.
Asunto(s)
Hernia Diafragmática Traumática , Adolescente , Adulto , Anciano , Femenino , Hernia Diafragmática Traumática/complicaciones , Hernia Diafragmática Traumática/diagnóstico , Hernia Diafragmática Traumática/etiología , Hernia Diafragmática Traumática/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
The complications presented by 36 patients submitted to anti-reflux procedures that were treated in our Hospital in a 10 year period, from September 1978 to May 1988, are analyzed. The patients were divided in 2 groups depending on the initial treatment being performed inside or outside our Hospital. The indication for the initial operation was reflux esophagitis in all patients, 4 or whom, had developed a shortened esophagus with stenosis. The selected procedures were of several types with a clear predilection for the Nissen type fundoplication with its variants. Different kinds of complications were observed; mortality was associated with gastric or esophageal leak, with a fatal outcome in 11 patients, another one died of postoperative pancreatitis and abdominal sepsis (33.3 percent mortality rate).