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INTRODUCTION: The potential benefit of intraoperative wound irrigation (IOWI) in preventing surgical site infection (SSI) remains unclear. The use of antimicrobial agents (AMA) or antiseptic agents (ASA) is controversial worldwide. METHODS: We performed a systematic review and meta-analysis of randomized clinical trials comparing AMA or ASA with saline solution in patients who underwent abdominal surgery. Sub-analyses were performed on the type of surgery, type of intervention agent, and wound classification. RESULTS: Nineteen studies comprising 4915 patients undergoing abdominal surgery were included. SSI was observed in 207 out of 2504 patients in the intervention group (8.26 %) and 344 out of 2411 patients in the control group (14.27%). Overall, intraoperative wound irrigation (IOWI) with AMA or ASA was associated with a lower SSI (Odds ratio (OR) 0.62; 95% CI 0.47, 0.82; p < 0.01; I2 = 50%). Sub-analyses have shown a tendency for decreased SSI in patients from emergency surgery (OR 0.46; 95% CI 0.30, 0.70; p < 0.01; I2 = 23%), patients with contaminated wound (OR 0.48; 95% CI 0.31, 0.74; p < 0.01; I2 = 24%), and either the use of AMA or ASA (OR 0.53 vs. 0.65). CONCLUSION: The overall use of AMA or ASA before skin closure was associated with decreased SSI. Lower rates of SSI were observed in the subgroup analysis. Furthermore, we must consider the critical heterogeneity of the studies.

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BACKGROUND: Prior research has established the effectiveness of magnesium in relieving postoperative pain. This article aims to evaluate magnesium sulfate for perioperative analgesia in adults undergoing general abdominal surgery under general anesthesia. OBJECTIVE: The primary aim was to assess pain scores at 6 and 24 hours postoperatively in patients receiving magnesium sulfate vs. the control group. Secondary outcomes were postoperative opioid consumption, perioperative complications, and time to rescue analgesia. METHODS: A comprehensive database search identified studies comparing magnesium sulfate with control in adults undergoing general anesthesia for general abdominal surgery. Using random-effects models, data were presented as mean ± Standard Deviation (SD) or Odds Ratios (OR) with corresponding 95% Confidence Intervals (95% CI). A two-sided p-value < 0.05 was considered statistically significant. RESULTS: In total, 31 studies involving 1762 participants met the inclusion criteria. The magnesium group showed significantly lower postoperative pain scores at both early (within six hours) and late (up to 24 hours) time points compared to the control group. The early mean score was 3.1 ± 1.4 vs. 4.2 ± 2.3, and the late mean score was 2.3 ± 1.1 vs. 2.7 ± 1.5, resulting in an overall Mean Difference (MD) of -0.72; 95% CI -0.99, -0.44; p < 0.00001. The magnesium group was associated with lower rates of postoperative opioid consumption and shivering and had a longer time to first analgesia administration compared to the saline control group. CONCLUSION: Magnesium sulfate administration was linked to reduced postoperative pain and opioid consumption following general abdominal surgery.

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Background: General Surgery course is a mandatory in medical schools and continuing surgery training is important even to experienced surgeons which they need to maintain and/or improve their surgical skills. Additionally, the models used for that practice are human cadavers, anesthetized porcine, or simulators and are not accessible for medicine schools or physicians in many countries. Therefore, we present a new technical procedure for preparation of frozen experimental animal's cadavers for medical surgical training. Materials and Methods: To perform the study, one porcine slaughtered and frozen at -20°C was used. The porcine cadaver was thawed at room temperature (25°C) and then the pneumoperitoneum test was performed and viscera inspection carried out. Results: The porcine cadaver took 20 hours to completely thaw. The pneumoperitoneum was successfully performed with total distention of the abdominal cavity. All viscera were well preserved maintaining important in vivo characteristics for consistency. Conclusion: The use of thawed porcine cadaver as a model to train many surgical procedures including videolaparoscopy is feasible. The tissues were well preserved by this method and was financially accessible and could be used for different techniques, equipment, and material tests.

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Presentamos el caso de un paciente masculino de 57 años con un leiomiosarcoma retroperitoneal encontrado de manera incidental. Es una patología poco común, la incidencia anual es 2.7 casos por millón de personas. De igual manera, es una enfermedad de evolución silenciosa, por lo que pasa inadvertida hasta que la masa tumoral alcanza un gran tamaño. Los leiomiosarcomas se evidencian como extensas áreas de heterogeneidad y realce heterogéneo, ocasionado por la presencia de necrosis y focos hemorrágicos. Normalmente no hay presencia de calcificaciones y hay ausencia de tejido adiposo, de esta manera que una gran masa retroperitoneal mayor a 10 cm sin contenido graso y necrosis interna variable debe sugerir la posibilidad de un leiomiosarcoma. La eliminación quirúrgica completa es el tratamiento de elección, ésta se debe realizar con márgenes negativos amplios, factor que repercute en el pronóstico, ya que estos tumores tienden a alcanzar un tamaño muy grande y, a menudo, la extirpación amplia es imposible, lo que afecta la supervivencia del paciente. Este tipo de neoplasias tienen un mal pronóstico, pues se sabe que la supervivencia a los 5 años es de aproximadamente 15%, debido a su alta tendencia a la invasión local, metástasis o diagnóstico tardío.

We present the case of a 57-year-old male patient with a retroperitoneal leiomyosarcoma found incidentally. It is a rare disease, with an annual incidence of 2.7 cases per million people. Likewise, it is a disease with a silent evolution, so it goes unnoticed until the tumor mass reaches a large size. Leiomyosarcomas appear as extensive areas of heterogeneity and heterogeneous enhancement, caused by the presence of necrosis and hemorrhagic foci. Normally, there is no presence of calcifications and there is an absence of adipose tissue, so a large retroperitoneal mass greater than 10 cm with no fat content and variable internal necrosis should suggest the possibility of a leiomyosarcoma. Complete surgical removal is the treatment of choice, and should be performed with wide negative margins, a factor that affects the prognosis, since these tumors tend to reach a very large size and wide excision is often impossible, which affects the patient's survival. This type of neoplasm has a poor prognosis, since it is known that the 5-year survival rate is approximately 15%, due to its high tendency to local invasion, metastasis or late diagnosis.

Apresentamos o caso de um paciente do sexo masculino, 57 anos, comleiomiossarcoma retroperitoneal encontrado incidentalmente. É umapatologia rara, a incidência anual é de 2,7 casos por milhão de pessoas. Da mesma forma, é umadoença de evolução silenciosa, por issopassadespercebida até que a massa tumoral atinja umtamanho grande. Os leiomiossarcomasaparecem como extensas áreas de heterogeneidade e realce heterogêneo, causadas pela presença de necrose e focos hemorrágicos. Normalmente nãohápresença de calcificações e háausência de tecido adiposo, portantouma grande massa retroperitoneal maior que 10 cm semconteúdo de gordura e necrose interna variáveldeve indicar a possibilidade de leiomiossarcoma. A remoçãocirúrgica completa é o tratamento de escolha, este deve ser realizado com amplas margens negativas, fator que afeta o prognóstico, poisesses tumores tendem a atingir tamanhomuito grande e, muitasvezes, a remoção ampla é impossível, o que prejudica a sobrevida do paciente. Esse tipo de neoplasia apresentamauprognóstico, pois sabe-se que a sobrevida em 5 anos é de aproximadamente 15%, devido à sua alta tendência à invasão local, metástaseou diagnóstico tardio.

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Introducción: La biopsia ganglionar retroperitoneal es un procedimiento frecuentemente requerido en el estudio de neoplasias; resulta deseable optimizar su rendimiento con baja morbilidad. Este artículo describe la utilidad y complicaciones de biopsias ganglionares retroperitoneales por laparoscopia en una institución oncológica de Latinoamérica. Material y Métodos: Cohorte retrospectiva de pacientes con biopsia ganglionar retroperitoneal o mesentérica laparoscópica entre 2011 y 2021 en el Instituto Nacional de Cancerología, en Bogotá, Colombia. Se recogieron datos demográficos, quirúrgicos, complicaciones y mortalidad a 30 días, resultados histopatológicos y su rol en la clínica. Resultados: Se incluyeron 41 pacientes; 73% con diagnóstico de malignidad, principalmente linfoma. La indicación fue mayormente sospecha de recaída, seguida por sospecha de enfermedad hematológica de novo. Siempre se obtuvo tejido adecuado y suficiente para diagnóstico histológico. Requirieron conversión a laparotomía cinco pacientes (12%). No hubo complicaciones Clavien-Dindo III /IV ni mortalidad a 30 días. Se presentó morbilidad grado I o II en 3 casos (7%) y un incidente intraoperatorio grado III. Conclusión: La naturaleza invasiva y el carácter diagnóstico de la biopsia retroperitoneal laparoscópica, constituyen un desafío frecuente en la práctica del cirujano general. La planeación estratégica e individualizada y la técnica quirúrgica depurada son las claves para lograr el máximo rendimiento, con baja morbimortalidad.

Introduction: Retroperitoneal lymph node biopsy is a frequently required procedure in the study of neoplasms; it is desirable to optimize its performance with low morbidity. This paper describes the usefulness and complications of retroperitoneal lymph node biopsies by laparoscopy in a cancer institution in Latin America. Material and Methods: Retrospective cohort of patients with laparoscopic retroperitoneal or mesenteric lymph node biopsy between 2011 and 2021 at the National Cancer Institute, in Bogotá, Colombia. Demographic and surgical data, complications and 30-day mortality, histopathological results and their clinical role were collected. Results: 41 patients were included; 73% diagnosed with malignancy, mainly lymphoma. The indication was mostly suspected relapse, followed by suspected de novo hematologic disease. Adequate and sufficient tissue was always obtained for histological diagnosis. Five patients (12%) required conversion to laparotomy. There were no Clavien-Dindo III/IV complications or 30-day mortality. Grade I or II morbidity occurred in 3 cases (7%) and a grade III intraoperative incident. Conclusion: The invasive nature and diagnostic character of laparoscopic retroperitoneal biopsy constitute a frequent challenge in the practice of the general surgeon. Strategic and individualized planning and a refined surgical technique are the keys to achieving maximum performance, with low morbidity and mortality.

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Introducción. El quiste hidatídico puede localizarse en cualquier órgano del cuerpo. El quiste hidatídico en el páncreas (QHP)se presenta con una prevalencia menor a 1%, la localización más frecuente es la cabeza en 61% a 69%, en el cuerpo y cola en 31% a 39%. No es fácil diferenciar el quiste hidatídico pancreático de otros tumores quísticos del páncreas, por lo que esta patología debe tenerse en cuenta en el diagnóstico diferencial de lesiones quísticas pancreáticas. Caso Clínico. Paciente femenino de 66 años quien desde el año 2016 se encontraba en control por una tumoración quística de la cola pancreática de 1,7 cm, diagnosticada en forma incidental. La paciente cursó asintomática y se controló en forma anual. El año 2021 la lesión alcanzó un tamaño de 4,7 cm. En este contexto se decide la resección quirúrgica por vía laparoscópica. Se resecó una pieza quirúrgica de 8 cm de longitud que incluye la cola del páncreas y el quiste. La histología describe la membrana prolígera y múltiples escólex viables. Conclusión. La localización primaria en la cola del páncreas de un quiste hidatídico confunde el diagnóstico con un tumor quístico mucinoso. El tratamiento quirúrgico actual en los quistes distales debería ser la resección laparoscópica.

Introduction. The hydatid cyst can be located in any organ of the body. The hydatid cyst in the pancreas occurs with a prevalence of less than 1%, the most frequent location is the head in 61% to 69%, the body and tail in 31% to 39%. It is not easy to differentiate the pancreatic hydatid cyst from other cystic tumors of the pancreas, so this pathology must be taken into account in the differential diagnosis of pancreatic cystic lesions. Clinical Case. The present report discusses a 66-year-old female patient who had been in control since 2016 for a 1.7 cm cystic tumor of the pancreatic tail. The patient was asymptomatic and was controlled annually. In 2021, the lesion reached a size of 4.7 cm. In this context, laparoscopic surgical resection was decided. An 8 cm long surgical specimen was resected, including the tail of the pancreas and the cyst. Histology describes prolific membrane and multiple viable scolexes. Conclusion. The primary location in the tail of the pancreas of a hydatid cyst confuses the diagnosis with a mucinous cystic tumor. The current surgical treatment for distal cysts should be laparoscopic resection.

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Objetivo: Determinar la efectividad de la colecistectomía laparoscópica de puerto único asistida por imanes bajo anestesia espinal en el tratamiento quirúrgico de la colecistopatía litiásica crónica. Material y Métodos: Estudio prospectivo de cohorte en 51 pacientes entre octubre de 2019 y febrero de 2021. 17 pacientes fueron sometidos a colecistectomía laparoscópica de puerto único asistida por imanes y 34 a colecistectomía laparoscópica convencional por un mismo equipo quirúrgico. Se aplicó la técnica quirúrgica descrita por Dominguez et al y SAGES, bajo anestesia espinal. Se realizó estadística descriptiva e inferencial, analizando el dolor postoperatorio a las 3, 6, 12, 24 y 72 h y la satisfacción de los pacientes. Resultados: Se encontró diferencia significativa en el dolor postoperatorio en el grupo de estudio a las 6 h (p = 0,022), 12 h (p = 0,039), 24 h (p = 0,025) y 72 h (p < 0,001). En la satisfacción se encuentra un RR de 3 (p = 0,001), sin diferencia significativa en el tiempo operatorio y horas de hospitalización postquirúrgicas. Conclusiones: La colecistectomía laparoscópica de puerto único asistida por imanes, bajo anestesia espinal, ha demostrado efectividad en la reducción importante del dolor postoperatorio a partir de las 6 h, y en la superación de las expectativas en los intervenidos, sin aumento significativo de tiempo operatorio ni estancia hospitalaria.

Aim: To determine the effectiveness of magnet-assisted single-port laparoscopic cholecystectomy under spinal anesthesia in surgical treatment of chronic lithiasic cholecystopathy. Materials and Method: Prospective cohort study in 51 patients between October 2019 and February 2021. 17 patients underwent magnet-assisted single-port laparoscopic cholecystectomy and 34 underwent conventional laparoscopic cholecystectomy by the same surgical team. The surgical technique described by Dominguez and SAGES was used, under spinal anesthesia. Descriptive and inferential statistics were performed, analyzing postoperative pain at 3, 6, 12, 24 and 72 hours and patient satisfaction. Results: A significant difference in postoperative pain was found in the study group at 6 h (p = 0.022), 12 h (p = 0.039), 24 h (p = 0.025) and 72 h (p < 0.001). In satisfaction, there is an RR of 3 (p = 0.001), with no significant difference in operative time and postoperative hospitalization hours. Conclusions: Magnet-assisted single-port laparoscopic cholecystectomy under spinal anesthesia has shown effectiveness in significantly reducing postoperative pain after 6h, associated with significantly exceeding expectations in those operated on, without a significant increase in operative time or hospital stay.

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Objetivo: Se presenta un caso de rotura esplénica atraumática. Caso Clínico: Mujer joven que estando ingresada y con reposo relativo por colección intraabdominal cercana a la colostomía presenta rotura de bazo. Se realiza esplenectomía urgente evidenciando gran hemoperitoneo y rotura esplénica. Discusión y conclusiones: El diagnóstico de rotura esplénica atraumática debe tenerse en cuenta en los pacientes con dolor abdominal de aparición súbita ya que un retraso en el diagnóstico puede conducir a un aumento de la tasa de mortalidad.

Objective: A case of idiopathic atraumatic splenic rupture is presented. Clinical case: A young woman was admitted to hospital with relative rest due to an intra-abdominal collection near the colostomy and presented with a ruptured spleen. An urgent splenectomy was performed, revealing large haemoperitoneum and splenic rupture. Discussion and conclusions: the diagnosis of atraumatic splenic rupture should be taken into account in patients with sudden onset abdominal pain, as a delay in diagnosis may lead to an increased mortality rate.

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Introducción: El situs inversus totalis es una condición congénita en la cual los órganos torácicos y abdominales se encuentran en posición contraria a la posición habitual. En la literatura quirúrgica internacional se encuentran publicados no más de 55 casos de colecistectomía en pacientes con situs inversus totalis. La resolución laparoscópica de una paciente en nuestra Institución nos permite revisar esta particular condición patológica. Caso Clínico: Paciente femenino de 43 años de edad hospitalizada por una colecistitis aguda la cual es resuelta por vía laparoscópica sin incidentes. Material y Método: Se resume la literatura actual mediante una extensa revisión en PubMed de los reportes más relevantes. Considerando que todos los artículos publicados son casos clínicos o pequeñas series de casos, se presentan los resultados de esta revisión en tablas con estadística descriptiva básica. Discusión: Se discuten las características generales de estos pacientes, la presentación clínica, diagnóstico y técnica quirúrgica. Conclusión: La colecistectomía laparoscópica constituye el estándar de oro en pacientes con situs inversus y patología biliar, la cual debe ser realizada por un cirujano experimentado acomodando los trocares apropiadamente, debido a las dificultades técnicas que se encuentran en estos pacientes por las anomalías anatómicas propias de esta condición. El diagnóstico radiológico actual permite la planificación del abordaje y del procedimiento quirúrgico apropiado para cada paciente.

Introduction: Situs inversus totalis is a congenital condition in which the thoracic and abdominal organs are in the opposite position from normal anatomy. We found no more than 55 cases of cholecystectomy in patients with situs inversus totalis published in the international surgical literature. The laparoscopic resolution of a patient in our Institution allows us to review this particular pathological condition. Clinical Case: A 43-year-old female patient was admitted for acute cholecystitis and was resolved laparoscopically without any incidents. Material and Method: We summarized the current literature through an extensive PubMed review of the most relevant reports. Considering that all published articles are clinical cases or small case series, we present the results of this review in a table with basic descriptive statistics. Discussion: We discuss the general characteristics of these patients, clinical presentation, diagnosis, and surgical technique. Conclusions: Laparoscopic cholecystectomy is the gold standard in patients with situs inversus and biliary pathology, which must be performed by an experienced surgeon, properly accommodating the trocars due to the technical difficulties in these patients secondary to anatomical anomalies typical of this condition. Current radiological diagnosis allows planning the appropriate approach and surgical procedure for each patient.

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PURPOSE: The aim of this study is to investigate whether previous abdominal surgery (PAS) affected stage I-III colorectal cancer (CRC) patients who underwent radical resection. METHODS: Stage I-III CRC patients who received surgery at a single clinical center from Jan 2014 to Dec 2022 were retrospectively included in this study. Baseline characteristics and short-term outcomes were compared between the PAS group and the non-PAS group. Univariate and multivariate logistic regression analyses were used to find risk factors for overall complications and major complications. A 1:1 ratio propensity score matching (PSM) was used to minimize the selection bias between the two groups. Statistical analysis was performed using SPSS (version 22.0) software. RESULTS: A total of 5895 stage I-III CRC patients were included according to the inclusion and exclusion criteria. The PAS group had 1336 (22.7%) patients, and the non-PAS group had 4559 (77.3%) patients. After the PSM, there were 1335 patients in each group, and no significant difference was found in all baseline characteristics between the two groups (P > 0.05). After comparing the short-term outcomes, the PAS group had a longer operation time (before PSM, P < 0.01; after PSM, P < 0.01) and more overall complications (before PSM, P = 0.027; after PSM, P = 0.022) whether before or after PSM. In univariate and multivariate logistic regression analyses, PAS was an independent risk factor for overall complications (univariate analysis, P = 0.022; multivariate analysis, P = 0.029) but not for major complications (univariate analysis, P = 0.688). CONCLUSION: Stage I-III CRC patients with PAS might experience longer operation time and have a higher risk of postoperative overall complications. However, it did not appear to significantly affect the major complications. Surgeons should take steps to improve surgical outcomes for patients with PAS.

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Objetivo: Reporte de caso clínico de una presentación poco común de apendicitis aguda sin reporte en la literatura actual. Material y Método: revisión de expediente clínico en hospital general regional 196 del instituto mexicano del seguro social. Resultados: Masculino de 47 años con dolor abdominal en epigastrio. Clínicamente se palpa defecto hemiario, encontrando apéndice vermiforme edematosa en saco herniario. Discusión: La presentación de apendicitis aguda en sacos hemiarios epigástricos es extremadamente rara encontrando, solamente, un reporte de caso en la literatura.

Objective: Clinical case report of an uncommon presentation of acute appendicitis with no report in the current literature. Material and Method: review of the clinical record at Hospital General Regional 196 of the Mexican Social Security Institute. Results: 47 year old male with abdominal pain in epigastrium clinically palpated hernial defect, finding edematous vermiform appendix in hernial sac. Discussion: The presentation of acute appendicitis in epigastric hernial sac is extremely rare finding only one case report in the literature.

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Objetivo: Realizar caracterización clínica-epidemiológica de quiste de colédoco en la población infantil atendida en el Hospital Materno Infantil. Material y Método: Estudio transversal, retrospectivo, descriptivo. La población del estudio consistió en los expedientes con diagnóstico de quiste de colédoco (QC) en el servicio de cirugía pediátrica. Criterios de inclusión: desde el nacimiento hasta los 18 años, operados en este hospital, diagnóstico clínico e imagenológico. Análisis estadístico: base de datos Epi Info.12.0, usando medidas de frecuencia, como la media y varianza. Resultados: Un total de 12 pacientes, la relación entre mujer hombre fue de 3:1, con predominio en mujeres. El grupo etario con mayor frecuencia fue el preescolar con 41,7%. El síntoma más frecuente fue el dolor abdominal con 83,3%; el tipo de QC más frecuente fue el tipo I con 75%, todos fueron resecados y la reconstitución de tránsito más utilizada fue la hepaticoyeyuno anastomosis en Y de Roux (HYYR) con 83,3%. Discusión: El grupo etario, el sexo y el tipo de QC en este estudio, coincide con la literatura citada. El ultrasonido puede ser suficiente para el diagnóstico de QC, la colangiopancreatografia por resonancia magnética permite identificar el subtipo de quiste y planificar la intervención quirúrgica. Conclusión: en nuestro hospital hay poca experiencia en la realización de hepaticoduodeno anastomosis (HD) y ninguna experiencia en la realización de HD y HYYR laparoscópicas, por lo cual, se plantea la necesidad de mejorar las opciones terapéuticas según estándares internaciones. Además, tomando este estudio como base, se deben realizar investigaciones posteriores con mayor complejidad metodológica.

Objective: To perform a clinical-epidemiological characterization of choledochal cyst in the pediatric population attended at the Hospital Materno Infantil. Material and Methods: Cross-sectional, retrospective, descriptive study. The study population consisted of records with a diagnosis of choledochal cyst (CC) in the pediatric surgery service. Inclusion criteria: from birth to 18 years of age, operated in this hospital, clinical and imaging diagnosis. Statistical analysis: Epi Info.12.0 database, using frequency measures, such as mean and variance. Results: A total of 12 patients, female to male ratio was 3:1, with female predominance. The age group with the highest frequency was preschool with 41.7%. The most frequent symptom was abdominal pain with 83.3%, the most frequent type of CC was type I with 75%, all of them were resected and the most frequent reconstruction was Roux-en-Y hepaticojejunostomy (HJ) with 83.3%. Discussion: The age group, sex and type of CC in this study coincides with the literature cited. Ultrasound may be sufficient for the diagnosis of CC, magnetic resonance cholangiopancreatography allows identification of the subtype of cyst and planning of surgical intervention. Conclusion: In our hospital there is little experience in performing hepaticoduodenostomy (HD) and no experience in performing laparoscopic HD and HJ, therefore, there is a need to improve the therapeutic options according to international standards. Furthermore, taking this study as a basis, further research with greater methodological complexity should be carried out.

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El angiomixoma agresivo pélvico es un tumor de partes blandas extremadamente raro, del cual se han reportado alrededor de 350 casos hasta la fecha. A continuación se reporta el caso clínico de una paciente que presentó dicho tumor y se describe el proceso diagnóstico y su tratamiento quirúrgico. Por otro lado, se realiza una breve revisión de la literatura disponible hasta el momento sobre el tema.

Aggressive pelvic angiomyxoma is an extremely rare soft tissue tumor, of which around 350 cases have been reported to date. This article aims at reporting the case of a patient presenting said tumor, as well as describing its diagnostic approach and its surgical treatment. On the other hand, it aims at briefly reviewing the available literature on the subject.

O angiomixoma pélvico agressivo é um tumor extremamente raro dos tecidos moles, tendo sido descritos até à data cerca de 350 casos. Relatamos o caso de uma doente que apresentava este tumor e descrevemos o processo de diagnóstico e tratamento cirúrgico. É também feita uma breve revisão da literatura disponível até à data sobre o assunto.

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Las infecciones del sitio operatorio representan un desafío en el entorno hospitalario. El cierre primario diferido ha surgido como técnica para prevenirlas. Esta investigación busca explorar los beneficios del cierre primario diferido en la reducción de infecciones, estancia hospitalaria y costos, mejorando los resultados clínicos en cirugías abdominales. Objetivos. Evaluar el cierre primario diferido en pacientes laparotomizados de emergencia que acuden Hospital Universitario de Mérida ­Venezuela, con índice SENIC ≥ 3 puntos. Métodos. Se llevó a cabo un estudio experimental prospectivo para evaluar los efectos del cierre primario diferido en comparación con el cierre primario en laparotomías exploradoras. La muestra consistió en 160 pacientes. Se analizaron la presencia de infecciones, la duración de la estancia hospitalaria y la evolución temporal de las infecciones como desenlaces del estudio. Resultados. Se encontró que el cierre primario diferido redujo la presencia de infecciones en comparación con el cierre primario. La limpieza trans-operatoria y el diagnóstico de abdomen agudo quirúrgico infeccioso fueron factores beneficiosos. La antibioticoterapia continua en el postoperatorio también fue más efectiva. Se observó una disminución del riesgo de infección en el grupo experimental en un 37% en comparación con el grupo de control. Conclusiones. El cierre primario diferido de la herida reduce significativamente la probabilidad de infección del sitio operatorio en cirugías abdominales con heridas contaminadas. Es una técnica beneficiosa para pacientes con abdomen agudo quirúrgico infeccioso. Además, el cierre primario diferido resulta rentable al disminuir tanto la incidencia de ISO como la duración de la estancia hospitalaria

Surgical site infections pose a challenge in the hospital setting. Delayed primary closure has emerged as a technique to prevent such infections. This research aims to explore the benefits of delayed primary closure in reducing infections, hospital stay, and costs, thus improving clinical outcomes in abdominal surgeries. Objectives. To evaluate delayed primary closure in emergency laparotomized patients with SENIC index ≥ 3 points at the University Hospital of Mérida, Venezuela. Methods. A prospective experimental study was conducted to assess the effects of delayed primary closure compared to primary closure in exploratory laparotomies. The sample consisted of 160 patients. The presence of infections, duration of hospital stay, and temporal evolution of infections were analyzed as study outcomes. Results. Delayed primary closure was found to reduce the presence of infections compared to primary closure. Transoperative cleaning and the diagnosis of infectious surgical acute abdomen were beneficial factors. Continuous postoperative antibiotic therapy was also more effective. A 37% reduction in the risk of infection was observed in the experimental group compared to the control group. Conclusions. Delayed primary closure significantly reduces the probability of surgical site infection in abdominal surgeries with contaminated wounds. It is a beneficial technique for patients with infectious surgical acute abdomen. Additionally, delayed primary closure proves cost-effective by reducing both the incidence of surgical site infections and the duration of hospital stay(AU)

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BACKGROUND: In other countries, researchers have noticed diverse variations in the features of patients undergoing emergency surgery during the COVID-19 pandemic. In Mexico, there is not information about this issue. METHODS: Workers of the Mexican Government, who required emergency surgeries were studied by the general surgery service of a General Hospital administered by the Institute of Social Security and Services for State Workers Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), through the periods from March-August 2019 (non-exposed) and March-August 2020 (exposed). The analysis included: demographic data, laboratory information, post-operative diagnoses, symptoms' length, days of emergency stay, and post-operative stay. RESULTS: One hundred and ninety-three emergency surgeries were analyzed; 106 in 2019 and 87 in 2020 (a decrease of 18%). Throughout the pandemic, the number of days between the symptoms' onset and surgery was greater: 2019, 7.6 ± 4.6 days; 2020, 14 ± 6.7 days (p < 0.0001). In addition, cases of acute appendicitis decreased (2019-60.3%; 2020-42.5%), and those of acute calculous cholecystitis increased (2019-12.2%; 2020-24.1%). CONCLUSION: Through the COVID-19 pandemic, there were notable changes in the characteristics of Mexican Government's workers who warranted emergency surgery.

ANTECEDENTES: En otros países, han notado diversos cambios en las características de los pacientes sometidos a cirugía de emergencia durante la pandemia de COVID-19. En México no existe información sobre este tema. MÉTODO: Estudiamos a los trabajadores del gobierno mexicano que requirieron tratamiento quirúrgico de emergencia por el servicio de cirugía general de un Hospital General del Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado (ISSSTE), durante los periodos de marzo-agosto de 2019 (no expuestos) y marzo-agosto de 2020 (expuestos). El análisis incluyó: datos demográficos, datos de laboratorio, diagnósticos postoperatorios, duración de los síntomas, días de estancia en emergencias y estadía postoperatoria. RESULTADOS: Se analizaron 193 cirugías de emergencia; 106 en 2019 y 87 en 2020 (una disminución del 18%). En la pandemia, el número de días entre el inicio de los síntomas y la cirugía fue mayor: 2019, 7.6 ± 4.6 días; 2020, 14 ± 6.7 días (p < 0.0001). Además, disminuyeron los casos de apendicitis aguda (2019-60,3%; 2020-42,5%) y aumentaron los de colecistitis litiásica aguda (2019-12,2%; 2020-24,1%). CONCLUSIÓN: Durante la pandemia de COVID-19, hubo cambios notables en las características de los trabajadores del gobierno mexicano que ameritaron cirugías de emergencia.

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Introdução: Pacientes submetidos a grandes cirurgias abdominais apresentam riscos de complicações pós-operatórias. A mobilização precoce vem sendo implementada e cada vez mais aplicada, no intuito de prevenir esses eventos. Objetivo: Demonstrar se a mobilização precoce está associada à melhor funcionalidade no pós-operatório de cirurgias abdominais. Métodos: Revisão integrativa de literatura realizada por meio de uma busca bibliográfica junto aos bancos de dados: BVS, Scielo, PedRO e Pubmed por meio dos descritores: mobilização precoce, deambulação precoce, cuidados pós-operatórios, período pós-operatório, estado funcional, exercício físico, reabilitação, funcionalidade e cirurgia abdominal, nos idiomas inglês, português e espanhol. Resultados: A amostra final foi constituída por 08 artigos científicos, que foram estruturados em forma de quadro para apresentação de suas principais características, dos métodos e os principais resultados. Conclusão: A mobilização precoce está associada ao retorno rápido à funcionalidade da linha de base pré- operatória, as atividades de vida diária, independência funcional, além do tempo de internação mais curto e menor duração dos desagradáveis sintomas pós-operatórios.

Introduction: Patients undergoing major abdominal surgery are at risk of postoperative complications. Early mobilization has been implemented and increasingly applied in order to prevent these events. Objective: to demonstrate whether early mobilization is associated with better functionality in the postoperative period of abdominal surgeries. Methods: an integrative literature review carried out through a literature search in the following databases: BVS, Scielo, PedRO and Pubmed using the descriptors: early mobilization, early ambulation, postoperative care, postoperative period, functional status, physical exercise, rehabilitation, functionality and abdominal surgery, in English, Portuguese and Spanish. Results: The final sample consisted of 08 scientific articles, which were structured in the form of a table to present their main characteristics, methods and main results. Conclusion: Early mobilization interferes with the rapid return to preoperative baseline functionality, activities of daily living, functional independence, in addition to a shorter hospital stay and shorter duration of unpleasant postoperative symptoms.

Introducción: Los pacientes sometidos a cirugías abdominales mayores corren el riesgo de sufrir complicaciones postoperatorias. La movilización temprana se ha implementado y aplicado cada vez más para prevenir estos eventos. Objetivo: Demostrar si la movilización temprana se asocia con una mejor funcionalidad después de la cirugía abdominal. Métodos: Revisión bibliográfica integrativa realizada a través de una búsqueda bibliográfica en las siguientes bases de datos: BVS, Scielo, PedRO y Pubmed utilizando los descriptores: early mobilisation, early ambulation, postoperative care, postoperative period, functional status, physical exercise, rehabilitation, functionality and abdominal surgery, en inglés, portugués y español. Resultados: La muestra final consistió en 08 artículos científicos, que se estructuraron en forma de tabla para presentar sus principales características, los métodos y los principales resultados. Conclusión: La movilización temprana se asocia con un rápido retorno a la funcionalidad de base preoperatoria, a las actividades de la vida diaria, a la independencia funcional, así como a una estancia hospitalaria más corta y a una menor duración de los síntomas postoperatorios desagradables.

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Abstract Takayasu's arteritis is a type of primary systemic vasculitis that affects medium and large arteries, including the aorta and its main branches, as well as the pulmonary and coronary arteries. Although rare in children, it is the third most common vasculitis in the pediatric population, often with delayed diagnosis due to the nonspecific presentation of clinical symptoms in its initial phase. This is a case of a 16-year-old girl with a giant ruptured abdominal aortic aneurysm, who needed surgery on an emergency basis. The etiological aspects involved in aneurysms in young patients are also addressed.

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PURPOSE: To compare the adaptation processes of the remaining jejunum or ileum after extensive intestinal resection in a growing animal model. MATERIALS AND METHODS: Forty 21-day old rats were divided into four groups: JG: remaining jejunum group - ileal enterectomy; IG: ileum remaining group - jejunum enterectomy; SHAM: sham-operated group - open-and-close laparotomy; and NO: non-operated animals. RESULTS: After 3 weeks, JG and IG animals had decreased weights comparing to SHAM and NO animals (p = 0.017 and p = 0.005, respectively). The histomorphometric analysis showed that in JG animals the villi were higher than in SHAM, NO, and IG animals (p = 0.007, p = 0.008, and p = 0.01), the depth of crypts in JG and IG animals was greater than in NO and SHAM animals (p = 0.03, p = 0.002, and p = 0.003 respectively), and muscle layer thickness of the jejunum of JG animals had values greater than SHAM and NO animals (p = 0.01 and p = 0.02, respectively). The Ki-67 expression in the ileum was higher in comparison with the jejunum (p = 0.014). The pro-apoptotic gene (Bax) expression was decreased in JG animals compared to IG, SHAM, and NO animals (p = 0.013, p = 0.024, and p = 0.021). The anti-apoptotic gene (Bcl-XL) expression was decreased in JG animals in comparison to IG and NO animals (p = 0.002 and p = 0.046) although it was increased in the colon of IG animals in comparison to JG, SHAM, and NO animals (p = 0.002, p = 0.001, and p = 0.001, respectively). The Bax/Bcl-XL ratio was higher in JG than in IG animals (p = 0.011). CONCLUSION: Adaptive responses seemed to be more effective in the ileum than in the jejunum.

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A 55-year-old woman was investigated for occasional epigastric pain and weight loss. T2-weighted abdominal magnetic resonance imaging and magnetic resonance cholangiography revealed a multilocular cyst with multiple septa and a solid component in the liver, measuring 6.1 × 4.8 × 6.5 cm. Given the patient's symptoms and malignant potential, a laparoscopic segmentectomy with partial resection of segments IV B and V was performed to completely remove the cystic lesion, associated with cholecystectomy. Histopathology demonstrated a cyst lined by columnar mucinous epithelium. Therefore, the diagnosis was mucinous cystic neoplasm of the liver. This article presents a case report and literature review of this entity.

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ABSTRACT BACKGROUND: Hypoxemia and pulmonary complications are common after upper abdominal surgery (UAS). OBJECTIVE: To examine whether inclusion of autogenic drainage (AD) in chest physiotherapy after UAS confers additional benefits in improving blood gases and reducing postoperative pulmonary complications (PPCs). DESIGN AND SETTING: Randomized controlled study conducted at Kasr Al-Ainy teaching hospital, Egypt. METHODS: A randomized controlled trial was conducted on 48 subjects undergoing elective UAS with high risk of developing PPCs. The study group received AD plus routine chest physiotherapy (deep diaphragmatic breathing, localized breathing and splinted coughing) and the control group received routine chest physiotherapy only. The outcomes included arterial blood gases measured at the first and seventh postoperative days, incidence of PPCs within the first seven days and length of hospital stay. RESULTS: Baseline characteristics were similar between groups. In the AD group, SaO2, PaO2, PaCO2 and HCO3 significantly improved (P < 0.05) while in the physiotherapy group, only SaO2 and PaO2 significantly improved (P < 0.05). Nonetheless, significant differences in post-treatment SaO2 and PaO2 between the groups were observed. The overall incidence of PPCs was 16.66% (12.5% in the AD group and 20.8% in the physiotherapy group) (absolute risk reduction -8.3%; 95% confidence interval, CI, -13.5 to 29.6%), with no significant difference between the groups. The AD group had a significantly shorter hospital stay (P = 0.0001). CONCLUSION: Adding AD to routine chest physiotherapy after UAS provided a favorable blood gas outcome and reduced the length of hospital stay. It tended to reduce the incidence of PPCs. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04446520.

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