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Capybaras are the largest rodents cohabiting with humans within urban and peri-urban green areas and are known by their prolificity. Surgical contraception has been recommended by official organizations as a way to control capybara populations in areas of zoonotic disease transmission, but little data are available concerning surgical anatomy. To obtain objective anatomical descriptions related to reproductive organs, eight female capybaras cadavers were dissected. The stratigraphy of the lateral (flank) and ventral, post-umbilical (on the linea alba) abdominal wall is described as well as the vascular anatomy of reproductive organs and their syntopy with the abdominal viscera. We commented on the access to the uterine tubes and uterine horns for each approach, and for better description of abdominal wall stratigraphy, abdominal ultrasonography was performed in one live female. All of the animals were provenient from "in situ" population management projects that were properly authorized. Similar abdominal wall stratigraphy was found in comparison to domestic mammals, with emphasis on a thick cutaneous muscle, a thin linea alba, and a large, loose cecum. The uterine tubes were easily accessed by bilateral laparotomy, allowing tubal removal/ligation procedures, while uterine horn exposure was more readily reached by a midline post umbilical celiotomy, favoring horn ligature and hysterotomy techniques. This study can help achieve more efficient contraceptive surgeries in capybaras, reducing the total surgical time and enhancing animal welfare.

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ABSTRACT Minimally invasive procedures aim to resolve the disease with minimal trauma to the body, resulting in a rapid return to activities and in reductions of infection, complications, costs and pain. Minimally incised laparotomy, sometimes referred to as minilaparotomy, is an example of such minimally invasive procedures. The aim of this study is to demonstrate the feasibility and utility of laparotomy with minimal incision based on the literature and exemplifying with a case. The case in question describes reconstruction of the intestinal transit with the use of this incision. Male, young, HIV-positive patient in a late postoperative of ileotiflectomy, terminal ileostomy and closing of the ascending colon by an acute perforating abdomen, due to ileocolonic tuberculosis. The barium enema showed a proximal stump of the right colon near the ileostomy. The access to the cavity was made through the orifice resulting from the release of the stoma, with a lateral-lateral ileo-colonic anastomosis with a 25 mm circular stapler and manual closure of the ileal stump. These surgeries require their own tactics, such as rigor in the lysis of adhesions, tissue traction, and hemostasis, in addition to requiring surgeon dexterity - but without the need for investments in technology; moreover, the learning curve is reported as being lower than that for videolaparoscopy. Laparotomy with minimal incision should be considered as a valid and viable option in the treatment of surgical conditions.

RESUMO Procedimentos minimamente invasivos visam resolver a doença com o mínimo de trauma ao organismo, resultando em retorno rápido às atividades, reduções nas infecções, complicações, custos e na dor. A laparotomia com incisão mínima, algumas vezes referida como minilaparotomia, é um exemplo desses procedimentos minimamente invasivos. O objetivo deste trabalho é demonstrar a viabilidade e utilidade das laparotomias com incisão mínima com base na literatura e exemplificando com um caso. O caso descreve uma reconstrução de trânsito intestinal com o uso desta incisão. Paciente masculino, jovem, HIV-positivo, pós-operatório tardio de ileotiflectomia, ileostomia terminal e fechamento do cólon ascendente por abdome agudo perfurativo devido a uma tuberculose íleo-colônica. Enema opaco mostrava coto proximal do cólon direito próximo da ileostomia. O acesso à cavidade foi feito através do orifício resultante da liberação do ostoma-realização de anastomose íleo-colônica látero-lateral com grampeador circular de 25 mm e fechamento manual do coto ileal. Estas cirurgias exigem táticas próprias, como rigor na lise de aderências, tração dos tecidos e hemostasia, além de demandar destreza do cirurgião; contudo, sem necessidade de investimentos em tecnologia e, além disso, a curva de aprendizado é relatada como menor que a da videolaparoscopia. A laparotomia com incisão mínima deve ser considerada como opção válida e viável no tratamento de afecções cirúrgicas.

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PURPOSE: To analyze the complications and costs of minilaparotomies performed by a nephrologist (group A) compared with conventional laparotomies performed by a surgeon (group B) for peritoneal catheter implantation. SETTING: Two university hospitals (Santa Sofia and Caldas) in Manizales, Caldas, Colombia. METHODS: The study included stage 5 chronic kidney disease patients, with indication of renal replacement therapy, who were candidates for peritoneal dialysis and gave informed consent for a peritoneal catheter implant. Minilaparotomies were performed by a nephrologist in a minor surgery room under local anesthesia. Conventional laparotomies were performed by a surgeon in an operating room under general anesthesia. RESULTS: Two nephrologists inserted 157 peritoneal catheters, and seven general surgeons inserted 185 peritoneal catheters. The groups had similar characteristics: the mean age was 55 years, 49.5% were men, and the primary diagnoses were diabetic nephropathy, hypertensive nephropathy, and unknown etiology. The implant was successful for 98.09% of group A and 99.46% of group B. There was no procedure-related mortality. The most frequent complications in the first 30 days postsurgery in group A versus group B, respectively, were: peritonitis (6.37% versus 3.78%), exit-site infection (3.82% versus 2.16%), tunnel infection (0% versus 0.54%), catheter entrapment by omentum (1.27% versus 3.24%), peritoneal effluent spillover (1.91% versus 2.16%), draining failure (4.46% versus 6.49%), hematoma (0% versus 1.08%), catheter migration with kinking (3.18% versus 2.70%), hemoperitoneum (1.27% versus 0%), and hollow viscera accidental puncture (1.91% versus 0.54%). There were no statistically significant differences in the number of complications between groups. In 2013, the cost of a surgeon-implanted peritoneal dialysis catheter in Colombia was US $366 (666,000 COP), whereas the cost of a nephrologist-implanted catheter was US $198 (356,725 COP). CONCLUSION: Nephrologist-performed minilaparotomies had similar effectiveness to surgeon-performed conventional laparotomies and were cost-effective; however, the nonuse of general anesthesia may be related with hollow viscera puncture during the procedure.

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INTRODUCTION: A introdução da técnica laparoscópica em 1985 foi um fator importante na colecistectomia por representar técnica menos invasiva, resultado estético melhor e menor risco cirúrgico comparado ao procedimento laparotômico. AIM: To compare laparoscopic and minilaparotomy cholecystectomy in the treatment of cholelithiasis. METHODS: A systematic review of randomized clinical trials, which included studies from four databases (Medline, Embase, Cochrane and Lilacs) was performed. The keywords used were "Cholecystectomy", "Cholecystectomy, Laparoscopic" and "Laparotomy". The methodological quality of primary studies was assessed by the Grade system. RESULTS: Ten randomized controlled trials were included, totaling 2043 patients, 1020 in Laparoscopy group and 1023 in Minilaparotomy group. Laparoscopic cholecystectomy dispensed shorter length of hospital stay (p<0.00001) and return to work activities (p<0.00001) compared to minilaparotomy, and the minilaparotomy shorter operative time (p<0.00001) compared to laparoscopy. Laparoscopy decrease the risk of postoperative pain (NNT=7) and infectious complications (NNT=50). There was no statistical difference between the two groups regarding conversion (p=0,06) and surgical reinterventions (p=0,27), gall bladder's perforation (p=0,98), incidence of common bile duct injury (p=1.00), surgical site infection (p=0,52) and paralytic ileus (p=0,22). CONCLUSION: In cholelithiasis, laparoscopic cholecystectomy is associated with a lower incidence of postoperative pain and infectious complications, as well as shorter length of hospital stay and time to return to work activities compared to minilaparotomy cholecystectomy. .

INTRODUÇÃO: A introdução da técnica laparoscópica em 1985 foi um fator importante na colecistectomia por representar técnica menos invasiva, resultado estético melhor e menor risco cirúrgico comparado ao procedimento laparotômico. OBJETIVO: Comparar a colecistectomia laparoscópica e a minilaparotômica no tratamento da colecistolitíase. MÉTODOS: Realizou-se busca eletrônica nas bases de dados Medline, Embase, Cochrane e Lilacs. Os descritores utilizados foram "Cholecystectomy", "Cholecystectomy, Laparoscopic" e "Laparotomy". A qualidade metodológica dos estudos primários foi avaliada pelo sistema Grade. RESULTADOS: Foram incluídos dez ensaios clínicos randomizados, totalizando 2043 pacientes, sendo 1020 no grupo Laparoscopia e 1023 no grupo Minilaparotomia. A colecistectomia laparoscópica dispensou menor tempo de permanência hospitalar (p<0,00001) e de retorno às atividades laborais (p<0,00001) comparado à minilaparotomia, e esta menor tempo cirúrgico (p<0,00001) comparado à laparoscopia. A laparoscopia diminuiu o risco de dor pós-operatória (NNT=7) e de complicações infecciosas (NNT=50). Não houve diferença estatística entre os dois grupos em relação à conversão (p=0,06) e reintervenções cirúrgicas (p=0,27), perfuração da vesícula (p=0,98), incidência de injúria do ducto biliar comum (p=1,00), infecção de sítio operatório (p=0,52) e íleo paralítico (p=0,22). CONCLUSÃO: Na colecistolitíase, a colecistectomia laparoscópica está associada à menor incidência de dor pós-operatória e complicações infecciosas, assim como menor tempo de internação hospitalar e tempo de retorno às atividades laborais se comparada ...

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PIP: Female sterilization is the method of family planning most preferred by women in the Dominican Republic. For the past 20 years, minilaparotomy has been successfully performed under local anesthesia by hundreds of trained general practitioners throughout the country. As such, minilaparotomy has become an important family planning option for Dominican women. Given this success with the procedure in the Dominican Republic, AVSC and its partners in the country plan to share their knowledge and expertise with the world by offering international training in the delivery of the method. The senior director of AVSC's technical resources worldwide believes the program has succeeded because of its focus upon meeting clients' needs and its strong commitment to the technique by all who are involved. AVSC continues to be a catalyst for positive change in the Dominican Republic.^ieng

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The first 1000 cases of tubal sterilization post-delivery by minilaparotomy with sedation and local anesthetic, were reviewed; these procedures were realized at the Hospital of Zona Francisco del Paso y Troncoso of the IMSS, in México City, during the period comprehended between December 1990 and October 1991. The greatest group of cases by age corresponded to the period between 20 to 29 years in 52.3%. 65% of the women had 3 or 4 children alive. The range of the diastolic blood pressure was between 70-80 mmHg in 66.3%. 19.7% with a value of hemoglobin less than 10 g. 2.3% of the patients with 100-120 kgs. of weight. The contraceptive method used previously with greatest frequency was the DIU in 40.6%. In all of the cases the indication was satisfied parenthood. In 100% of the cases the same drug was used for sedation, diazepam (oral) and chlorhydrate of nalbulfine, with simple lidocaine as a local anesthetic. Likewise in all the cases the Pomeroy technique was performed. The time between the childbirth and the surgery was less than 12 hours in 92.9% of the cases. And the time between the surgery and the recuperation reset was of 12-34 hours in 96%. In 0.8% of the cases the transoperatory complication of the surgery was the bleeding as a result of tearing of the mesosalpinx. The postoperatory complications after one week were the formation of hematoma and/or abscess at the site of the incision representing 0.5% of the cases. All these procedures are realized at a unit that was created especially for this kind of surgery and treatment.

PIP: The first 1000 postpartum tubal occlusions by minilaparotomy under sedation and local anesthesia performed at a Mexican Institute of Social Security hospital in Mexico City were retrospectively reviewed. The operations took place between December 1990 and October 1991. The youngest patient was 17 and five patients were under 20. 52.3% were aged 20-29, 31.9% were aged 30-34, and 13.8% were aged 35-40. 65% of the women had three or four live births and 16.8% had two. The diastolic blood pressure was between 81 and 90 for 12.1%, between 91 and 100 for 8.9%, and between 101 and 120 for 3.7%. 19.7% had hemoglobin levels below 10 g. 37 women with hemoglobin levels between 4 and 8 g were sterilized; all received transfusions before discharge. 66.7% of the women weighed between 50 and 70 kg, but 2.3% weighed 100-120 kg. 40.6% used IUDs, 16.8% oral contraceptives, and 14.2% injectable methods. 24.8% had never used a contraceptive method. The Pomeroy technique was used in all cases. All patients were given Lidocaine. The operation was performed within 12 hours of delivery in 92.8% of cases. 96.3% of the women were discharged within 24 hours. Bleeding, resulting from tearing of the mesosalpinx, occurred in 0.8% of cases. A hematoma or abscess at the site of the incision was observed in 0.5% at one week follow-up. The data indicate that bilateral tubal occlusion by postpartum minilaparotomy under local anesthesia and sedation, rather than general anesthesia, is a rapid and safe procedure, even for obese and hypertensive women.

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Two-hundred-ninety-seven women at a Panamanian center and 148 women at a Philippine center had their tubal sterilization performed during their postpartum hospital stay after an uncomplicated vaginal delivery of a live birth. The sterilizations were all performed with the use of the Filshie clip via minilaparotomy. The timing of the sterilization varied from two hours to six days after delivery. At each of the two centers, women sterilized within 48 hours after delivery were compared with those sterilized at 49 or more hours with respect to surgical difficulties, tubal injuries, complications/complaints, technical failures and lengths of hospitalization after sterilization and before discharge. The one-year gross cumulative pregnancy rates were also compared. No significant differences were detected in any of the above outcome variables between the two timing groups at each center. While the data suggest that tubal sterilizations by the Filshie clip performed two to six days following childbirth are as safe and effective as those performed within 48 hours of delivery, further studies are urged.

PIP: 297 women at a Panamanian center and 148 women at a Philippine center had their tubal sterilizations performed during their postpartum hospital stays after uncomplicated vaginal deliveries of livebirths. The sterilizations were all performed with the use of the Filshie clip via minilaparotomy. The timing of the sterilizations varied from 2 hours-6 days after delivery. At each of the 2 centers, women sterilized within 48 hours after delivery were compared with those sterilized at 49 or more hours with respect to surgical difficulties, tubal injuries, complications/complaints, technical failures, and lengths of hospitalization after sterilizations and prior to discharge. The 1 year grossed cumulative pregnancy rates were also compared. No significant differences were detected in any of the above outcome variables between the 2 timing groups at each center. While the data suggest that tubal sterilizations by Filshie clip performed between 2-6 days postpartum are as safe and effective as those performed within 48 hours of delivery, further studies are necessary.

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This is a review of 209 cases of salpingochlasia by minilaparotomy, post-partum. Frequency was 13.2%. The larger group was 20 to 29 years of age, 52%; 14.3% were unmarried. Multiparae were most frequent, 52.2%. One previous section 3.5%; with four to six live children, 54%. No previous anticonceptive method, 91%; pre-natal control, 69%. With anemia, Hb less than 10 g, 11%, and only 3.5% required blood transfusion. Eutocic delivery, 89%. Ruptured membranes, before delivery, less than six hours, 97%. Anesthesia during delivery, 59.1%; it was epidural anesthesia, as well as for the salpingochlasia in 100%, without complications. The indication was completed parity in 100%, the technique mostly used was Pomeroy's in 77.3%. There were no pre, trans or post-operative complications. The interval between delivery and salpingochlasia in first 12 hours, 98% and from surgery to hospital discharge, 12 to 24 hours, 89.2%. Hospital stay was two days, 90%. Pomeroy's technique failure, 0.6% and for Kroener's, 2.1%. Two pregnancies occurred out of 1,238 months-woman observation.

PIP: This is a review of 209 cases of salpingochlasia by postpartum mini laparotomy. 52% of the group were between 20-29 years of age and 14.3% were unmarried. 52.2% of the group were multipara. 3.5% had had a previous cesarean section and 54% had 4-6 live children. No previous contraceptive had been used by 91% of the population and 69% had used prenatal control. 11% had anemia with an Hb 10 g and only 3.5% required blood transfusions. A eutocic delivery was seen in 89% and 97% experienced ruptures membranes less than 6 hours before delivery. 59.1% of the women received epidural anesthesia during delivery without complications. The indication was that there was completed parity in 100% and the technique used most widely was the Pomeroy technique in 77.3%. There were no pre-, trans-, or postoperative complications. The interval between delivery and salpingochlasia was 12 hours for 98% of the group, and from surgery to hospital discharge 12-24 hours for 89.2%. 90% experienced a hospital stay of 2 days, 0.6% experienced Pomeroy techniques failure, and 2.1% experienced similar problems with the Kroener method. 2 pregnancies occurred out of 1238 woman-months of observation. (author's modified)

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This study was undertaken to assess the effects of different tubal occlusion procedures on ovarian function. Three groups of subjects randomized to tubal occlusion by laparoscopy and Yoon ring (24 subjects), minilaparotomy and Yoon ring (19 subjects) and minilaparotomy and Pomeroy (22 subjects), and one separate control group of 26 healthy subjects not using any form of contraception were studied in a prospective design. The characteristics of the menstrual patterns were studied for one year after sterilization. Determination of the circulating progesterone levels were made on days 15, 20 and 25 of menstrual cycles initiated 1, 3, 6 and 12 months following the tubal ligation. In the analysis of the bleeding pattern there was a statistically significant difference in the mean segment length and in the longest bleeding-free interval in the subjects who had been sterilized by minilaparotomy with Yoon ring, when compared to the other two study groups and to the control group. However, the magnitude of this difference in number of days was not considered clinically significant. There was no statistically significant difference in the percentage of ovulatory cycles within the study and the control groups, or when the results of the study groups were compared with each other or to the control group.

PIP: This study was undertake to assess the effects of different tubal occlusion procedures on ovarian function. 3 groups of subjects randomized to tubal occlusion by laparoscopy and Yoon ring (24 subjects), minilaparotomy and Yoon ring (19 subjects) and minilaparotomy and Pomeroy (22 subjects), and 1 separate control group of 26 healthy subjects not using any form of contraception were studied in a prospective design. The characteristics of the menstrual patterns were studied for 1 year after sterilization. Determination of the circulating progesterone levels were made on days 15, 20, and 25 of menstrual cycles initiated 1,3,6 and 12 months following the tubal ligation. In the analysis of the bleeding pattern there was a statistically significant difference in the mean segment length and in the longest bleeding-free interval in the subjects who had been sterilized by minilaparotomy with Yoon ring, when compared to the other 2 study groups and to the control group. However, the magnitude of this difference in number of days was not considered clinically significant. There was no statistically significant difference in the % of ovulatory cycles within the study and the control groups, or when the results of the study groups were compared with each other or to the control group. (Author's).

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