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BACKGROUND: Inguinal hernia surgery is a frequent procedure among general surgeons in Costa Rica, but the management and technique are not uniform. The International Guideline for Groin Hernia management was published in 2018 to standardize the inguinal hernia surgery, but the diffusion of the guidelines and its adherence have been extremely varied. PURPOSE: Collect and analyze the current reality regarding groin hernia management in Costa Rica. Secondly evaluate the diffusion and development comparing it to the guideline's recommendations. METHOD: Questionnaire of 42 single and multiple answer questions according to the topics of the International Guideline directed to general surgeons. Diffusion of the inquiry through surgical and hernia association chats and email. Timeframe June-December 2019. RESULTS: 64 surveys were collected, which is a representative number of the general surgeons national college. The most frequent procedure between these was the abdominal wall surgery. Every surgeon did more than 52 groin hernia surgeries in one year, most of them outpatients. The epidural anesthesia was used the most and Lichtenstein's technique was the most frequently used (64%). 68% of the surgeons know how to perform a minimally invasive inguinal hernia surgery but with variable volumes. 38% of participants considered themselves experts in groin hernia management and 52% did not know the 2018 International Guideline. The recommendations of such guideline are followed only partially. CONCLUSIONS: The 2018 Hernia Surge International Guidelines have low diffusion among Costa Rican surgeons. The laparoscopic approach is widely accepted but there are no studies to assess the results and the quality. There should be protocols and studies adapted to Costa Rica's national situation.

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ResumenJustificación y objetivo:la necrosectomía pancreática abierta es un procedimiento quirúrgico usado en la pancreatitis aguda necrotizante infectada, con una mortalidad variable entre el 6% y el 80%, y una morbilidad que supera el 50% de los casos. En Costa Rica no existen estudios acerca de esta cirugía, por lo cual se hizo uno retrospectivo, observacional, de casos controles, con el objetivo de conocer los resultados quirúrgicos en nuestro centro hospitalario y compararlos con la estadística mundial, para intentar identificar patrones que modifiquen la mortalidad.Métodos:estudio observacional, descriptivo y retrospectivo de casos y controles. Se analizaron todos los pacientes sometidos a necrosectomía pancreática abierta en el hospital "Dr. R. A. Calderón Guardia", desde el 1 de enero de 2006 al 30 junio de 2014. Se definió como caso todo paciente que falleció posterior a una necrosectomía pancreática por pancreatitis necrotizante, y como control, todo paciente que sobrevivió posterior al diagnóstico y cirugía.Resultados:en el período 2006 - 2014 se analizaron 28 casos. La edad promedio de población fue de 47,7 años; 17 hombres y 11 mujeres; pancreatitis agudas severas en el 89,3% de casos, teniendo como principales causas: colelitiasis e ingesta etílica. Indicaciones quirúrgicas utilizadas: colección pancreática o peripancreática infectada y necrosis pancreática; momento quirúrgico promedio de 17,3 días; abordaje por línea media con necrosectomía y empaque más abdomen abierto mayormente usado. En promedio: 6,3 intervenciones quirúrgicas por paciente, con estancias medias en UCI y hospitalaria, de 26,6 y 47,5 días. Complicaciones frecuentes: fístula pancreática enel 53,6% de los casos, abscesos postoperatorios en el 53,6% también, y mortalidad del 35,7%. En cuanto a la mortalidad, se encontró que la perforación intestinal fue la principal condición de riesgo para fallecimiento, y la fístula pancreática, un factor protector.Conclusión:en el hospital del estudio, la necrosectomía pancreática abierta es un procedimiento de alta morbimortalidad.

AbstractBackground and aim:Open pancreatic necrosectomy is a surgical procedure used in infected acute necrotizing pancreatitis with a mortality that varies between studies from 6% to 80% and a morbidity that exceeds 50% of the cases. In Costa Rica there are no studies related to this surgery so a retrospective, observational and control study was done with the objective of knowing the surgical results in our center and comparing it with the world statistics and to identify patterns that modify mortality.Methods:Observational, descriptive and retrospective case-control study. All patients undergoing open pancreatic necrosectomy at the "Dr. R. A. Calderón Guardia" from January 1, 2006 to June 30, 2014 were reviewed. All patients who died after a pancreatic necrosectomy for necrotizing pancreatitis were defined as cases, and as a controls, all patients who survived after diagnosis and surgery.Results:In the period 2006 to 2014 in our tertiary center Hospital Calderón Guardia 28 cases were obtained, with the following results: average age of 47.7 years, 17 men and 11 women, severe acute pancreatitis was found in 89.3% of cases with cholelithiasis and alcohol ingestion as the main causes. Surgical indications were pancreatic and/or peripancreatic infected collection and pancreatic necrosis, surgical time average of 17.3 days, midline approach with necrosectomy and packing, plus open abdomen mostly used. On average, 6.3 surgeries per patient were made, with mean days in ICU and hospital stay of 26.6 and 47.5 days each. Most frequent pancreatic complications were pancreatic fistula in 53.6% of cases, postoperative abscesses in 53.6%, and mortality of 35.7%. Regarding mortality it was found that intestinal perforation was a risk factor fordeath and pancreatic fistula a protective factor.Conclusion:at the study hospital open pancreatic necrosectomy is a high morbidity and mortality procedure.

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