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BACKGROUND: Acute care surgery decreased during the first wave of the COVID-19 pandemic. OBJECTIVE: To study the evolution of acute care surgery and its relationship with the pandemic severity. METHOD: Retrospective cohort study which compared patients who underwent acute care surgery during the pandemic to a control group. RESULTS: A total of 660 patients were included (253 in the control group, 67 in the first-wave, 193 in the valley, and 147 in the second wave). The median daily number of acute care surgery procedures was 2 during the control period. This activity decreased during the first wave (1/day), increased during the valley (2/day), and didn't change in the second wave (2/day). Serious complications were more common during the first wave (22.4%). A negative linear correlation was found between the daily number of acute care surgery procedures, number of patients being admitted to the hospital each day and daily number of patients dying because of COVID-19. CONCLUSIONS: Acute care surgery was reduced during the first wave of the COVID-19 pandemic, increased during the valley, and returned to the pre-pandemic level during the second wave. Thus, acute care surgery was related to pandemic severity, with fewer surgeries being performed when the pandemic was more severe.

ANTECEDENTES: La cirugía urgente disminuyó durante la primera ola de la pandemia de COVID-19. OBJETIVO: Estudiar la evolución de la cirugía urgente y su relación con la gravedad de la pandemia. MÉTODO: Estudio de cohortes retrospectivo que compara los pacientes intervenidos de forma urgente durante la pandemia con un grupo control. RESULTADOS: Se incluyeron 660 pacientes (253 en el grupo control, 67 en primera ola de la pandemia, 193 en el periodo valle y 147 en la segunda ola). La mediana del número de cirugías urgentes fue de 2 (intervalo intercuartílico: 1-3) durante el periodo control, disminuyó durante la primera ola (1/día), aumentó durante el valle (2/día) y no se modificó en la segunda ola (2/día). Las complicaciones mayores fueron más comunes durante la primera ola (22.4%). Se encontró una correlación lineal negativa entre el número de procedimientos quirúrgicos urgentes diarios y el número de ingresos hospitalarios y fallecimientos diarios por COVID-19. CONCLUSIONES: La cirugía urgente se redujo durante la primera ola, aumentó durante el periodo valle y volvió a niveles prepandémicos durante la segunda ola. Además, la cirugía urgente se relaciona con la gravedad de la pandemia, ya que se realizaron menos cirugías urgentes durante el periodo de mayor gravedad de la pandemia.

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INTRODUCTION AND AIMS: Gastrointestinal perforation is a surgical emergency that is associated with a high mortality rate and requires special care. During the pandemic, there has been competition with COVID-19 patients for health resources, especially ICU bed availability. The primary aim of our study was to compare the incidence of gastrointestinal perforation during the COVID-19 pandemic, with cases registered before the pandemic. MATERIALS AND METHODS: A retrospective, observational, single center, cohort study was conducted that included patients that underwent emergency surgery for gastrointestinal perforation in the periods during the pandemic (6 months) and before the pandemic (12 months). Sociodemographic characteristics, comorbidities, duration of hospital and ICU stay, status at discharge, and perforation site were compared. RESULTS: The study included 67 subjects (33 in the pre-pandemic period and 34 in the pandemic period). There were no significant differences regarding sex, age, or comorbidity. The perforation rate per emergency intervention was 4-times higher during the pandemic. There was an increase in the number of patients that were foreigners (4 [11%]) and nonresidents (6 [17%]). ICU admissions decreased (6 [19%]) but ICU stay increased to 137 h. Hospital stay increased by 5 days and delay in care increased 4.5 h. The number of deaths was higher (from 5 [15.2%] to 10 [29.4%]). Four patients with perforations were positive for COVID-19, were admitted to the ICU, and died. CONCLUSIONS: During the COVID-19 pandemic there was an increase in the incidence of gastrointestinal perforations at our healthcare system area; symptoms were more advanced, and mortality was higher.

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Introducción: La apendicitis aguda es la causa más frecuente deabdomen agudo en niños. El objetivo de este trabajo es estudiar lascausas, abordaje y resultados de las complicaciones que requieren in-tervención quirúrgica después de la apendicectomía.Material y métodos: Estudio retrospectivo de las apendicectomíasrealizadas en 3 centros de tercer nivel entre 2015-2019. Se recogieronlas complicaciones, causas y número de reintervenciones, intervalo entreambas cirugías, técnica empleada, hallazgos operatorios según la Clasi-ficación de la American Association for the Surgery of Trauma (AAST)en la apendicectomía inicial y tiempo de ingreso.Resultados: Se intervinieron 3.698 apendicitis, un 76,7% por víalaparoscópica, encontrando un 37,2% evolucionadas (grado II-V de laclasificación AAST). El tiempo medio quirúrgico fue de 50,4 minutos(laparoscopia 49,8 ± 20,1 vs. laparotomía 49,9 ± 20,1, p > 0,05), superioren aquellos pacientes que requirieron reintervención (68,6 ± 27,2 vs.49,1 ± 19,3, p < 0,001).Se realizaron 76 reintervenciones (2,05%). Las causas fueron: infec-ción postoperatoria (n = 46), obstrucción intestinal (n = 20), dehiscencia(n = 4) y otras (n = 6). El abordaje inicial no influyó en el riesgo dereintervención (laparotomía o laparoscopia, OR 1,044, IC 95% 0,57-1,9),pero sí el grado de evolución de la apendicitis (7,8% evolucionadas vs.0,7% incipientes, OR 12,52, IC 95% 6,18-25,3).Hubo una tendencia a reintervenir por el mismo abordaje que laapendicectomía, esto ocurrió en un 72,2% de las apendicectomías lapa-roscópicas y en un 67,7% de las apendicectomías abiertas. El abordajemínimamente invasivo (50/76) fue más frecuente que la laparotomía(27 laparoscopias y 23 drenajes ecoguiados frente a 26 laparotomías)(p < 0,05). El 55% de los pacientes obstruidos se reintervinieron porvía abierta (p > 0,05).

Introduction: Acute appendicitis is the most frequent cause ofacute abdomen in children. The objective of this study was to analyzethe causes, approach, and results of complications requiring surgeryfollowing appendectomy.Materials and methods: A retrospective study of the appendecto-mies conducted in three third-level institutions from 2015 to 2019 wascarried out. Complications, causes, and number of re-interventions, timefrom one surgery to another, surgical technique used, operative findingsat baseline appendectomy according to the American Association forthe Surgery of Trauma (AAST) classification, and hospital stay werecollected.Results: 3,698 appendicitis cases underwent surgery, 76.7%of which laparoscopically, with 37.2% being advanced (grades II-Vof the AAST classification). Mean operating time was 50.4 min-utes (49.8 ± 20.1 for laparoscopy vs. 49.9 ± 20.1 for open surgery,p > 0.05), and longer in patients requiring re-intervention (68.6 ± 27.2vs. 49.1 ± 19.3, p < 0.001).76 re-interventions (2.05%) were carried out. The causes includedpostoperative infection (n = 46), intestinal obstruction (n = 20), dehis-cence (n = 4), and others (n = 6). Re-intervention risk was not impactedby the baseline approach used (open surgery or laparoscopy, OR: 1.044,95% CI: 0.57-1.9), but it was by appendicitis progression (7.8% ad-vanced vs. 0.7% incipient, OR: 12.52, 95% CI: 6.18-25.3).There was a tendency to use the same approach both at baseline ap-pendectomy and re-intervention. This occurred in 72.2% of laparoscopicappendectomies, and in 67.7% of open appendectomies. The minimallyinvasive approach (50/76) was more frequent than the open one (27laparoscopies and 23 ultrasound-guided drainages vs. 26 open surger-ies) (p < 0.05). 55% of obstruction patients underwent re-interventionthrough open surgery (p > 0.05).

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Introducción. Comunicar un caso clínico poco habitual y revisar el manejo. Material y Métodos. Presentación de un caso clínicoResultados. El íleo biliar es una etiología poco habitual de obstrucción intestinal, aunque su incidencia aumenta con la edad. Sudiagnóstico requiere una alta sospecha clínica ya que menos del 50% de los pacientes tienen clínica biliar previa. La cirugía urgentees mandatoria para la resolución del cuadro obstructivo. Conclusiones. La resucitación del paciente y la extracción quirúrgicaurgente del cálculo biliar es el tratamiento de elección. Existe controversia sobre el manejo de la fístula colecistoduodenal. (AU)

Introduction. Report an unusual clinical case and review the management. Material and methods. Presentation of a clinical case.Results. Gallstone ileus is an unusual etiology of intestinal obstruction, although its incidence increases with age. Its diagnosisrequires a high clinical suspicion since less than 50% of patients have previous biliary symptoms. Urgent surgery is mandatory forthe resolution of the obstructive condition. Conclusions. Patient resuscitation and urgent surgical removal of the gallstone is thetreatment of choice. There is controversy about the management of cholecystoduodenal fistula. (AU)

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Introducción: A raíz de la aparición del virus respiratorio SARS-CoV-2 en Wuhan en diciembre de 2019, el Gobierno de España decretóel estado de alarma con medidas que han incluido el confinamiento do-miciliario. El objetivo de este trabajo es analizar la actividad urgente deun Servicio de Cirugía Pediátrica referente en su Comunidad Autónomay comprobar si ha existido disminución o no en la patología quirúrgica. Métodos: Estudio retrospectivo de los pacientes pediátricos queacudieron a Urgencias y fueron derivados a Cirugía Pediátrica entre losperiodos del 14 de marzo hasta el 20 de abril de 2020, comparándoloscon aquellos que acudieron en las mismas fechas del año previo. Seanalizaron variables demográficas, la patología y el tipo de manejoen cada caso. Se analizó también el número de pacientes con dolorabdominal que precisaron valoración quirúrgica. Resultados: Se incluyeron 161 pacientes, de los que 91 acudieronen 2019 y 70 acudieron en 2020. De estos últimos, 62 (88,6%) fue-ron intervenidos y 8 (11,4%) fueron hospitalizados, mientras que en2019 fueron 67 (73,6%) y 24 (26,4%), respectivamente, observandoun menor número de ingresos en 2020 (p= 0,018). El número de horasde evolución hasta la consulta en Urgencias del total de pacientes nodemostró diferencias, únicamente existió un aumento en los pacientescon patología apendicular en el periodo de 2020, 24 [23-48] respectoal periodo del año previo 24 [12-30] (p= 0,045). Conclusión: La situación actual de pandemia no ha provocadouna disminución del número de intervenciones quirúrgicas urgentes.Únicamente aumentó el tiempo hasta la consulta en los pacientes conpatología apendicular.(AU)

Introduction: As a result of the emergence of the SARS-CoV-2respiratory virus in Wuhan in December 2019, the Spanish Governmentdeclared the state of emergency with restrictions such as stay-at-homelockdown. The objective of this study was to analyze emergency activityat a referral pediatric surgery unit in its territory and determine whethersurgical pathologies had decreased or not. Methods: A retrospective study of pediatric patients presentingat the emergency department and referred to the pediatric surgery unitfrom March 14, 2020 to April 20, 2020 was carried out. The resultswere compared with those from the same dates of the previous year.Demographic variables, pathologies, and management strategies werestudied for each case. The number of patients with abdominal painrequiring surgical assessment was also analyzed. Results: 161 patients were included – 91 from 2019 and 70 from2020. Of the 2020 patients, 62 (88.6%) underwent surgery and 8 (11.4%)were admitted, whereas in 2019, patient distribution was 67 (73.6%)and 24 (26.4%), which means there were fewer admissions in 2020(p= 0.018). There were no differences in terms of hours to emergencydepartment consultation – just an increase in the case of appendicularpathologies in the 2020 period, with 24 [23-48] hours vs. 24 [12-30]hours (p = 0.045). Conclusion: The current pandemic has not caused emergency sur-geries to decrease. It has only increased time to consultation in patientswith appendicular pathologies.(AU)

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La rehabilitación multimodal quirúrgica (ERAS) constituye la aplicación de una serie de medidas perioperatorias basadas en la evidencia, con el fin de lograr una mejor recuperación del paciente y una disminución de las complicaciones y la mortalidad. Estos programas de rehabilitación multimodal inicialmente demostraron sus ventajas en el ámbito de la cirugía colorrectal siendo adoptados progresivamente por otras áreas quirúrgicas dentro de la cirugía general y por otras especialidades quirúrgicas. El factor excluyente principal para la aplicación de este tipo de programas ha sido la presentación clínica urgente, lo que ha provocado que a pesar del gran volumen de literatura existente sobre ERAS en cirugía electiva, existan pocos estudios que hayan investigado la efectividad de estos programas en pacientes quirúrgicos en urgencias. El objetivo de este artículo es mostrar las medidas de recuperación intensificada de que disponemos en la actualidad según la evidencia existente para cirugía urgente. (AU)

Enhanced Recovery After Surgery (ERAS) constitutes the application of a series of perioperative measures based on the evidence, in order to achieve a better recovery of the patient and a decrease of the complications and the mortality. These ERAS programs initially proved their advantages in the field of colorectal surgery being progressively adopted by other surgical areas within the general surgery and other surgical specialties. The main excluding factor for the application of such programs has been the urgent clinical presentation, which has caused that despite the large volume of existing literature on ERAS in elective surgery, there are few studies that have investigated the effectiveness of these programs in surgical patients in emergencies. The aim of this article is to show ERAS measures currently available according to the existing evidence for emergency surgery. (AU)

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Introducción. Comunicar un caso clínico poco habitual y revisar el manejo. Material y Métodos. Presentación de un caso clínicoResultados. La obstrucción intestinal es una urgencia frecuente. La impactación de un bezoar es una etiología poco habitual.Cuando el bezoar intestinal asocia un bezoar gástrico se generan dudas sobre la etiología del bezoar intestinal, fragmentación y migración versus formación primaria en intestino delgado, y sobre la actitud a tomar con el bezoar gástrico, que generalmente es asintomático. Conclusiones. La enterotomía y extracción del bezoar intestinal es el tratamiento de elección. Debe asociar la extracción de los bezoares en otras localizaciones. (AU)

Introduction. Report an unusual clinical case and review the management. Material and methods. Presentation of a clinical caseResults. Bowel obstruction is a common emergency. Bezoar impaction is an unusual etiology. When the intestinal bezoar associates a gastric bezoar, doubts are raised about the etiology of the intestinal bezoar, fragmentation and migration versus primary formation in the small intestine, and about the attitude to take with the gastric bezoar, which is generally asymptomatic. Conclusions. Enterotomy and removal of the intestinal bezoar is the treatment of choice. It must associate the extraction of the bezoars in other locations. (AU)

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Enhanced Recovery After Surgery (ERAS) constitutes the application of a series of perioperative measures based on the evidence, in order to achieve a better recovery of the patient and a decrease of the complications and the mortality. These ERAS programs initially proved their advantages in the field of colorectal surgery being progressively adopted by other surgical areas within the general surgery and other surgical specialties. The main excluding factor for the application of such programs has been the urgent clinical presentation, which has caused that despite the large volume of existing literature on ERAS in elective surgery, there are few studies that have investigated the effectiveness of these programs in surgical patients in emergencies. The aim of this article is to show ERAS measures currently available according to the existing evidence for emergency surgery.

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Introducción: La colecistectomía videolaparoscópica es el proceder más idóneo para tratar la litiasis vesicular y sus complicaciones, pero existen factores epidemiológicos que pueden propiciar la conversión. Objetivo: Determinar los factores epidemiológicos que incidieron en la conversión de la colecistectomía videolaparoscópica. Métodos: Se realizó un estudio de tipo descriptivo y retrospectivo en el Hospital Militar "Octavio de la Concepción y de la Pedraja", desde enero de 2010 hasta mayo de 2019. Fueron estudiados 64 pacientes intervenidos de forma electiva o de urgencia, que fueron convertidos de mínimo acceso a vía convencional. Resultados: Se evidenció mayor número de conversiones urgencias, a predominio de hombres, con rango de edad entre 41 y 55 años. En la cirugía electiva sobresalió el sexo femenino, del mismo grupo etario. La conversión fue más habitual en los pacientes sobrepeso. La litiasis vesicular sintomática (cólico biliar) fue la condición más encontrada como antecedente. La diabetes mellitus fue la enfermedad crónica no trasmisible más asociada a la conversión. Conclusiones: Fue más frecuente la conversión en el grupo de edad entre 41 a 55 años, en pacientes del sexo masculino, sobrepeso, asociado a cólicos biliares y diabetes mellitus(AU)

Introduction: Videolaparoscopic cholecystectomy is the most suitable procedure to treat gallbladder lithiasis and its complications, but there are epidemiological factors that can promote conversion. Objective: To determine the epidemiological factors that influenced the conversion of videolaparoscopic cholecystectomy. Methods: A descriptive and retrospective study was carried out at the Hospital Militar "Octavio de la Concepción y de la Pedraja", from January 2010 to May 2019. 64 patients underwent elective or emergency surgery, who were converted with minimal access to conventional. Results: A greater number of conversions from emergency was evident, predominantly in men, with an age range between 41 and 55 years. In elective surgery, the female sex, from the same age group, stood out. Conversion was more common in overweight patients. Symptomatic gallbladder lithiasis (biliary colic) was the most commonly found condition as an antecedent. Diabetes mellitus was the chronic non-communicable disease most associated with conversion. Conclusions: Conversion was more frequent in the age group between 41 to 55 years, in male patients, overweight, associated with biliary colic and diabetes mellitus(AU)

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INTRODUCTION: Delirium is a frequent complication in elderly patients after urgent abdominal surgery. METHODS: Prospective study of consecutive patients aged ≥65years who had undergone urgent abdominal surgery from 2017-2019. The following variables were recorded: age, sex, ASA, physiological state, cognitive impairment, frailty (FRAIL Scale), functional dependence (Barthel Scale), quality of life (Euroqol-5D-VAS), nutritional status (MNA-SF), preoperative diagnosis, type of surgery (BUPA Classification), approach and diagnosis of postoperative delirium (Confusion Assessment Method). Univariate and multivariate analyses were performed to analyze the correlation of these variables with delirium. RESULTS: The study includes 446 patients with a median age of 78years, 63.6% were ASA ≥III and 8% had prior cognitive impairment. 13.2% were frail and 5.4% of the patients had a severe or total degree of dependence. 13.6% developed delirium in the postoperative period. In the univariate analysis, all the variables were statistically significant except for sex, type of surgery (BUPA) and duration. In the multivariate analysis the associated factors were: age (P<.001; OR: 1,08; 95%CI: 1,038-1,139), ASA (P=.026; OR: 3.15; 95%CI: 1.149-8.668), physiological state (P<.001; OR: 5.8; 95%CI: 2.176-15.457), diagnosis (P=.006) and cognitive impairment (P<.001; OR: 5.8; 95%CI: 2.391-14.069). CONCLUSION: The factors associated with delirium are age, ASA, physiological state in the emergency room, preoperative diagnosis and prior cognitive impairment.

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Laryngeal cysts are largely asymptomatic and typically described in the context of incidental discovery on routine laryngoscopy. These cysts, in adults are even rarer and can have catastrophic consequences in an anaesthetized patient if airway management is inappropriate. We describe a case of difficult endotracheal intubation and the treatment of an adult patient with an asymptomatic, giant vallecular cyst that was discovered during rapid-sequence induction of general anesthesia in urgent surgery. In conclusion, vallecular cysts can cause extreme problems in securing the airway. It is important to avoid complications associated with repeated attempts at intubation, airway loss, or cyst rupture causing difficulty visualizing vocal cords and aspiration. The use of King Vision® videolaryngoscope is a good alternative in these cases. Close attention to logistics and the immediate availability of an otolaryngologist is vital.

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Introducción: las infecciones posoperatorias favorecen la ocurrencia de otras complicaciones, en ocasiones letales, razón por la que elevan los índices de morbilidad y mortalidad. Objetivo: identificar diferentes factores relacionados con la aparición de las infecciones posoperatorias que están asociados con la mortalidad por sus efectos. Métodos: se realizó un estudio descriptivo, de serie de casos, basado en 258 pacientes operados de forma urgente o electiva durante el trienio 2012-2014 en el Servicio de Cirugía General del Hospital Provincial "Saturnino Lora" de Santiago de Cuba. Estos pacientes presentaron infecciones posquirúrgicas, de los cuales 27 (10,5 por ciento) fallecieron.Resultados: la aparición de la infección posquirúrgica estuvo asociada a las intervenciones contaminadas en la cirugía urgente seguida por las limpias y limpias contaminadas para la electiva, así como la infección del sitio operatorio superficial y en otras localizaciones en ambos grupos. La mortalidad estuvo relacionada con la edad mayor de 60 años, el estado físico preoperatorio ASA ≥ III, la cirugía abdominal urgente, contaminada, el tiempo quirúrgico mayor de una hora y las reintervenciones. Conclusiones: en todos los fallecidos repercutieron los factores de predicción para la ocurrencia de infecciones posoperatorias y como consecuencia de la correlación de cada uno de ellos, se acrecentó el riesgo de morir(AU)

Introduction: postoperative infections cause other complications, sometimes lethal ones, a reason why they raise morbidity and mortality rates. Objective: to identify different factors related to the occurrence of postoperative infection and which, because of their effects, they are associated with mortality. Methods: a descriptive study of case series was carried out, based on 258 patients who had emergency or elective surgery in the Department of Surgery of Saturnino Lora Provincial Hospital of Santiago de Cuba (2012-2014). These patients had postoperative infections, and 27 of them (10.5 percent) died. Results: the occurrence of postoperative infection was associated with contaminated interventions in emergency surgery, followed by clean and clean-contaminated for the elective one, as well as surface surgical site infection and in other locations in both groups. Mortality was associated with age (over 60 years), preoperative fitness ASA≥III, contaminated emergency abdominal surgery, operating time longer than an hour and second interventions.Conclusions: In all the deceased patients there was a repercussion of predicting factors for the occurrence of postoperative infections and, as a result of the correlation of each of them, the risk of dying increased(AU)

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Introducción: las infecciones posoperatorias favorecen la ocurrencia de otras complicaciones, en ocasiones letales, razón por la que elevan los índices de morbilidad y mortalidad. Objetivo: identificar diferentes factores relacionados con la aparición de las infecciones posoperatorias que están asociados con la mortalidad por sus efectos. Métodos: se realizó un estudio descriptivo, de serie de casos, basado en 258 pacientes operados de forma urgente o electiva durante el trienio 2012-2014 en el Servicio de Cirugía General del Hospital Provincial Saturnino Lora de Santiago de Cuba. Estos pacientes presentaron infecciones posquirúrgicas, de los cuales 27 (10,5 por ciento) fallecieron. Resultados: la aparición de la infección posquirúrgica estuvo asociada a las intervenciones contaminadas en la cirugía urgente seguida por las limpias y limpias contaminadas para la electiva, así como la infección del sitio operatorio superficial y en otras localizaciones en ambos grupos. La mortalidad estuvo relacionada con la edad mayor de 60 años, el estado físico preoperatorio ASA ≥ III, la cirugía abdominal urgente, contaminada, el tiempo quirúrgico mayor de una hora y las reintervenciones. Conclusiones: en todos los fallecidos repercutieron los factores de predicción para la ocurrencia de infecciones posoperatorias y como consecuencia de la correlación de cada uno de ellos, se acrecentó el riesgo de morir(AU)

Introduction: postoperative infections cause other complications, sometimes lethal ones, a reason why they raise morbidity and mortality rates. Objective: to identify different factors related to the occurrence of postoperative infection and which, because of their effects, they are associated with mortality. Methods: a descriptive study of case series was carried out, based on 258 patients who had emergency or elective surgery in the Department of Surgery of Saturnino Lora Provincial Hospital of Santiago de Cuba (2012-2014). These patients had postoperative infections, and 27 of them (10.5 percent) died. Results: the occurrence of postoperative infection was associated with contaminated interventions in emergency surgery, followed by clean and clean-contaminated for the elective one, as well as surface surgical site infection and in other locations in both groups. Mortality was associated with age (over 60 years), preoperative fitness ASA≥III, contaminated emergency abdominal surgery, operating time longer than an hour and second interventions. Conclusions: In all the deceased patients there was a repercussion of predicting factors for the occurrence of postoperative infections and, as a result of the correlation of each of them, the risk of dying increased(AU)

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There is an almost unanimous consensus on the management of the direct new oral anticoagulants, dabigatran, rivaroxaban, and apixaban in elective surgery. However, this general consensus does not exist in relation with the direct new oral anticoagulants use in emergency surgery, especially in the bleeding patient. For this reason, a literature review was performed using the MEDLINE-PubMed. An analysis was made of the journal articles, reviews, systematic reviews, and practices guidelines published between 2000 and 2014 using the terms "monitoring" and "reversal". From this review, it was shown that the routine tests of blood coagulation, such as the prothrombin time and activated partial thromboplastin time, have a limited efficacy in the perioperative control of blood coagulation in these patients. There is currently no antidote to reverse the effects of these drugs, although the possibility of using concentrated prothrombin complex and recombinant activated factor vii has been suggested for the urgent reversal of the anticoagulant effect.

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EN: Bleeding is the most serious adverse effect of oral anticoagulants. Emergency surgery requires the rapid reversion of coagulation disorder though the use of such products as prothrombin complex, vitamin K, or activated recombinant factor VII. We analyze the cases of 5 patients on oral anticoagulants (vitamin K antagonists) who required emergency surgery in our hospital in the past year. We describe patient characteristics, laboratory findings before and after correction of anticoagulant effects, preoperative treatment of coagulation disorder, surgical interventions, and outcomes.

ES: La hemorragia es el efecto adverso más grave secundario al tratamiento con anticoagulantes. Es necesario revertir rápidamente la anticoagulación en enfermos que van a ser intervenidos de urgencia. Para la reversión se utilizan productos como complejo protrombínico, vitamina K y factor VII activado recombinante. En el último año, en nuestro hospital han sido intervenidos cinco pacientes que necesitaban una cirugía urgente y estaban en tratamiento con anticoagulantes orales (antagonistas de la vitamina K). Presentamos sus datos demográficos, la analítica antes y después de corregir los efectos anticoagulantes, el tratamiento preoperatorio de la anticoagulación, las intervenciones quirúrgicas y los resultados.

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Introducción: la videolaparoscopia realizada de urgencia es uno de los avances tecnológicos más importantes para el diagnóstico precoz y el tratamiento oportuno de las afecciones abdominales agudas que incluyen las de causa traumática. Objetivo: caracterizar a pacientes con trauma abdominal sometidos a videolaparoscopia de urgencia, según variables seleccionadas, e identificar algunos aspectos concernientes a la aplicación de esta técnica en nuestro medio. Métodos: se realizó un estudio observacional descriptivo de 18 pacientes ingresados por trauma abdominal en el servicio de Cirugía General del Hospital Universitario "Saturnino Lora", de Santiago de Cuba, durante los años 2006-2007, a los que se les realizó videolaparoscopia de urgencia. Resultados: predominaron los hombres jóvenes y los traumas abiertos. La ecografía y la punción abdominales fueron los métodos diagnósticos más utilizados. En los dos tercios de la serie la videolaparoscopia fue negativa o diagnosticó violación peritoneal simple. El hígado fue la víscera más frecuentemente lesionada. Para el acceso videolaparoscópico se necesitaron dos puertos en la mayoría de la serie. Dos pacientes requirieron laparotomía convencional, para un índice de conversión de 11,1 por ciento, por lo que se evitaron 16 laparotomías innecesarias. El tiempo quirúrgico y la estadía hospitalaria posoperatoria fueron menores en la cirugía videolaparoscópica que en la laparotomía convencional. Conclusiones: la videolaparoscopia realizada con urgencia puede considerarse una herramienta de probada utilidad para el diagnóstico y tratamiento de los pacientes con traumatismos abdominales, porque evita un número considerable de laparotomías innecesarias y permite un aceptable margen de seguridad en la medida en que el cirujano perfeccione y domine esta tecnología(AU)

Introduction: the video-laparoscopy carried out with emergency is one of the more important technological advances for an early diagnosis and the timely treatment of acute abdominal affections including those of traumatic cause. Objective: to characterize patients with abdominal trauma submitted to videolaparoscopia of urgency according to the selected variables and to identify some features related to the implementation of this technique in our context. Methods: a descriptive and observational study was conducted in 18 patients admitted due to abdominal trauma in the service of general surgery of the "Saturnino Lora" University Hospital of Santiago de Cuba province from 2006 to 2007, who underwent emergency video-laparoscopy. Results: there was predominance of young men and of open traumata. The echography and the abdominal puncture were the more used diagnostic methods. In the two third of the series, the video-laparoscopy was negative or diagnosed a simple peritoneal violation. The liver was the more frequent injured viscus. For the videolaparoscopy access are necessary two ports in most of series. Two patients required conventional laparotomy for a conversion rate of 11,1 percent avoinding 16 unnecessary laparotomies. The surgical time and the postoperative hospital stay were less in the videolaparoscopy surgery than in the conventional laparotomy. Conclusions: the videolaparoscopy carried out with emergency may be considered a tool of usefulness demonstrated for diagnosis and treatment of patients presenting with abdominal traumata because of it avoids many unnecessary laparotomies and allows an acceptable degree of certainty insofar as the surgeon improve and dominate this technology(AU)

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Introducción: la videolaparoscopia realizada de urgencia es uno de los avances tecnológicos más importantes para el diagnóstico precoz y el tratamiento oportuno de las afecciones abdominales agudas que incluyen las de causa traumática. Objetivo: caracterizar a pacientes con trauma abdominal sometidos a videolaparoscopia de urgencia, según variables seleccionadas, e identificar algunos aspectos concernientes a la aplicación de esta técnica en nuestro medio. Métodos: se realizó un estudio observacional descriptivo de 18 pacientes ingresados por trauma abdominal en el servicio de Cirugía General del Hospital Universitario Saturnino Lora, de Santiago de Cuba, durante los años 2006-2007, a los que se les realizó videolaparoscopia de urgencia. Resultados: predominaron los hombres jóvenes y los traumas abiertos. La ecografía y la punción abdominales fueron los métodos diagnósticos más utilizados. En los dos tercios de la serie la videolaparoscopia fue negativa o diagnosticó violación peritoneal simple. El hígado fue la víscera más frecuentemente lesionada. Para el acceso videolaparoscópico se necesitaron dos puertos en la mayoría de la serie. Dos pacientes requirieron laparotomía convencional, para un índice de conversión de 11,1 por ciento, por lo que se evitaron 16 laparotomías innecesarias. El tiempo quirúrgico y la estadía hospitalaria posoperatoria fueron menores en la cirugía videolaparoscópica que en la laparotomía convencional. Conclusiones: la videolaparoscopia realizada con urgencia puede considerarse una herramienta de probada utilidad para el diagnóstico y tratamiento de los pacientes con traumatismos abdominales, porque evita un número considerable de laparotomías innecesarias y permite un aceptable margen de seguridad en la medida en que el cirujano perfeccione y domine esta tecnología(AU)

Introduction: the video-laparoscopy carried out with emergency is one of the more important technological advances for an early diagnosis and the timely treatment of acute abdominal affections including those of traumatic cause. Objective: to characterize patients with abdominal trauma submitted to videolaparoscopia of urgency according to the selected variables and to identify some features related to the implementation of this technique in our context. Methods: a descriptive and observational study was conducted in 18 patients admitted due to abdominal trauma in the service of general surgery of the "Saturnino Lora" University Hospital of Santiago de Cuba province from 2006 to 2007, who underwent emergency video-laparoscopy. Results: there was predominance of young men and of open traumata. The echography and the abdominal puncture were the more used diagnostic methods. In the two third of the series, the video-laparoscopy was negative or diagnosed a simple peritoneal violation. The liver was the more frequent injured viscus. For the videolaparoscopy access are necessary two ports in most of series. Two patients required conventional laparotomy for a conversion rate of 11,1 percent avoinding 16 unnecessary laparotomies. The surgical time and the postoperative hospital stay were less in the videolaparoscopy surgery than in the conventional laparotomy. Conclusions: the videolaparoscopy carried out with emergency may be considered a tool of usefulness demonstrated for diagnosis and treatment of patients presenting with abdominal traumata because of it avoids many unnecessary laparotomies and allows an acceptable degree of certainty insofar as the surgeon improve and dominate this technology(AU)

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