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Background and Objective: Choledocholithiasis is a frequent pathology, unfortunately when its endoscopic management fails, there is no consensus of how it should be addressed. The aim of this study was to evaluate the safety, feasibility, and long-term outcomes of laparoscopic common bile duct exploration (LCBDE) using electrosurgery (coagulation) for choledochotomy followed by primary closure after endoscopic treatment failure. Materials and Methods: A retrospective cohort study of patients who underwent LCBDE from 2013 to 2018 was conducted in Bogotá, Colombia. Clinical demographics, operative outcomes, recurrence rate of common bile duct stones, and long-term bile duct complications were analyzed. A descriptive analysis was performed. Results: A total of 168 patients were analyzed. Most of the patients were males (53.37%) with a median age of 73 years with no comorbidities (65%). Stone clearance was successful in 167 patients (99.4%). Nonlethal complications were noted in 3 patients during the surgery or in the immediate postoperative (1.79%) and managed with T-tube or endoscopically. No cases of mortality surgery related were observed. There were no signs of any type of biliary injury or stricture observed in any of the patients during the 24-month follow-up period. Conclusions: LCBDE with diathermy and primary closure is a safe and effective treatment option for choledocholithiasis for failed endoscopic retrograde cholangiopancreatography in terms of long-term outcome as well as short-term outcome.
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Colecistectomia Laparoscópica , Coledocolitíase , Diatermia , Laparoscopia , Masculino , Humanos , Idoso , Feminino , Coledocolitíase/cirurgia , Coledocolitíase/diagnóstico , Ducto Colédoco/cirurgia , Estudos Retrospectivos , Tempo de InternaçãoRESUMO
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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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Infecção da Ferida Cirúrgica , Infecção Hospitalar , Centro Cirúrgico HospitalarRESUMO
La exploración laparoscópica de las vías biliares (ELVB) constituye, hoy en día, una herramienta de gran utilidad en el tratamiento de la patología litiásica del árbol biliar, especialmente cuando técnicamente sea imposible realizar una pancreato-colangiografía retrógrada endoscópica (PCRE) o en los casos en los cuales este estudio no esté disponible. Método: Describir mediante un video nuestra técnica de ELVB paso a paso, en una paciente de 41 años quien consultó por presentar tinte ictérico en piel y mucosas, coluria e hipocolia. El ultrasonido abdominal reportó litiasis vesicular, dilatación de vías biliares intra y extra hepáticas, colédoco de 9 mm de diámetro y múltiples imágenes hiperecogénicas sugestivas de litiasis. Al no poder realizarse PCRE se decide practicar ELVB. Se realizó disección del triángulo biliocístico, identificación y ligadura proximal del conducto cístico con la finalidad de evitar la migración de cálculos a la vía biliar durante el procedimiento, coledocotomía, lavado proximal y distal de la vía biliar, exploración con catéter de Fogarty, coledocorrafia primaria, cisticotomía y colocación de catéter para colangiografía intraoperatoria, constatación de plenificación de las vías biliares sin imágenes de defecto y de adecuado paso del contraste al duodeno, colecistectomía y colocación de drenaje subhepático. Resultados: Paciente evoluciona en forma satisfactoria, egresando al tercer día de postoperatorio sin eventualidades. Discusión: La ELVB con coledocorrafia primaria ha sido descrita como una alternativa viable y efectiva para el manejo de la litiasis biliar, destacando su menor morbimortalidad cuando se compara con procedimientos endoscópicos como la PCRE(AU)
Laparoscopic common bile duct exploration (LCBDE) constitutes, nowadays, a very useful tool in the treatment of biliary tree lithiasis, especially when it is technically impossible to perform an endoscopic retrograde pancreatic cholangiography (ERCP) or in cases when this study is not available. Method: Using a video, we describe our LCBDE technique step by step, in a 41-year-old patient who consulted for presenting jaundiced skin and mucosa, coluria and hypocolia. Abdominal ultrasound reported gallstones, intra- and extra-hepatic bile duct dilation, a 9-mm diameter common bile duct (CBD) and multiple hyperechoic images suggestive of lithiasis. Since ERCP could not be performed, it was decided to practice LCBDE. Dissection of the Calot's triangle was performed, identification and proximal ligation of the cystic duct in order to avoid migration of stones to the common bile duct during the procedure, choledochotomy, proximal and distal lavage of the bile duct, exploration with a Fogarty catheter, primary closure of CBD, cysticotomy and placement of catheter for intraoperative cholangiography, verification of fullness of the bile ducts without defect images and adequate passage of contrast to the duodenum, cholecystectomy and placement of subhepatic drainage. Results: Patient progressed satisfactorily, being discharged on the third postoperative day, uneventfully. Discussion: LCBDE with primary closure of CBD has been described as a viable and effective alternative for the management of biliary stones, highlighting its lower morbidity and mortality when compared with endoscopic procedures such as ERCP(AU)
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Humanos , Feminino , Adulto , Ductos Biliares , Cálculos Biliares , Laparoscopia , Ducto Colédoco , Patologia , Exame Físico , Colecistectomia , LitíaseRESUMO
Introducción: Las amputaciones parciales del pie diabético requieren un prolongado período de cicatrización. La presencia de angiopatía y neuropatía periférica y la ausencia de actividad del factor de crecimiento epidérmico entorpecen dicho proceso. Objetivos: Evaluar la evolución de las amputaciones parciales del pie diabético con el uso del Heberprot-P® mediante un procedimiento quirúrgico de cierre total diferido a un segundo tiempo. Métodos: Se realizó un estudio descriptivo, longitudinal y retrospectivo, en 52 pacientes operados de amputación de los artejos del pie atendidos en el Hospital Provincial Universitario Manuel Ascunce Domenech de la provincia de Camagüey, en el período comprendido desde enero 2015 hasta septiembre de 2016 y en los que fue factible realizar este procedimiento. Resultados: El sexo femenino representó el 59,6 por ciento, con mayor número de casos en el intervalo de 61-70 años. Se realizaron 30 operaciones los artejos centrales y 22 entre el primero y el quinto. El 94,6 por ciento cicatrizó entre los 16 y los 20 días. Ninguno fue reintervenido. Conclusiones: La terapia con Heberprot-P® abre nuevos caminos para lograr mayor efectividad en el tratamiento y cicatrización del pie diabético. El procedimiento empleado mejoró el resultado funcional y estético de los pies operados(AU)
Introduction: Partial amputation of diabetic foot requires a long cicatrization period. The presence of angiopathy and peripheral neuropathy, and the lack of epidermal growth factor activity dull the process. Objective: To evaluate the evolution of partial amputations of diabetic foot using Heberprot-P® through a surgical procedure based in a total deffered closure to a second time. Methods: A descriptive, longitudinal and retrospective study was in a total of 52 patients operated on foot knuckles amputations in Manuel Ascunce Domenech University Provincial Hospital of Camagüey Province, from January 2015 to September 2016. In this patients was feasible to carry out the so above mentioned surgical procedure. Results: The female gender represented the 59, 6 percent with major number of cases from 61 to 70 years old. 30 surgeries were performed on the central knuckle and 22 between the first and fifth knuckle. 94,6 percent healed within 16 to 20 days. None of the patients was reoperated. Conclusions: Heberprot-P® therapy opens new ways to achieve better effectiveness in the treatment and cicatrization of diabetic foot. The procedure used improved the functional and aesthetical results in the operated feet(AU)
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Pé Diabético/cirurgia , Medicamentos de Referência , Técnicas de Fechamento de Ferimentos , Amputação Cirúrgica , Epidemiologia Descritiva , Estudos Retrospectivos , Estudos LongitudinaisRESUMO
ABSTRACT Acute free perforation of the sigmoid diverticulitis is an emergency surgical intervention required condition. Although the sigmoid resection and temporary end colostomy or abdominal lavage and drainage are the most commonly used surgical methods for its treatment, the most effective surgical method has not been established yet. We applied a different surgical method for the surgical treatment of free perforation of acute sigmoid diverticulitis outside of these surgical procedures. A double row epiploicoplasty was performed for surgical treatment of free perforated sigmoid diverticulitis with surgical success in a patient who had concominant serious diseases.
RESUMO A perfuração livre aguda da diverticulite de sigmoide é um problema que exige intervenção cirúrgica de emergência. Embora a ressecção de sigmoide e a colostomia de extremidade temporária ou a lavagem e drenagem abdominal sejam os métodos cirúrgicos mais comumente utilizados para o seu tratamento, o método cirúrgico mais eficaz ainda não foi estabelecido. Aplicamos um método cirúrgico diferente para o tratamento cirúrgico de perfuração livre de diverticulite de sigmoide aguda fora desses procedimentos cirúrgicos. Uma epiploicoplastia de duas fileiras foi realizada para o tratamento cirúrgico de diverticulite perfurada livre de sigmoide com sucesso cirúrgico em um paciente com doenças graves concomitantes.
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Humanos , Feminino , Doença Diverticular do Colo/cirurgia , Doença Diverticular do Colo/patologia , Colo Sigmoide , Cirurgia Geral/métodos , Doenças do Colo , Perfuração IntestinalRESUMO
BACKGROUND: Proper defect closure during abdominal wall reconstruction (AWR) is a key to improving cosmetic and functional results, and reducing morbidity. We have completed the initial prospective evaluation of a technique we previously described and published: endoscopic subcutaneous anterior component separation (ACS) as an adjunct to mainly laparoscopic AWR. We now present the long-term clinical and imaging follow-up results. STUDY DESIGN: Data were prospectively collected over a 3-year period (2012-2015) on patients who underwent AWR with endoscopic ACS. Inclusion criteria included the following: defects of 6-15 cm that are longer than wider; no skin dystrophy; no loss of domain; no active infection; no previous multiple, complex repairs; no previous multiple mesh repairs; and no high probability of severe adhesions. All patients were followed up clinically at 3, 6, and 12 months postoperatively and then annually. All patients underwent CT scanning of the abdominal wall (sagittal, axial, coronal, and 3D reconstruction) at 3 months and 1 year postoperatively and then annually. RESULTS: Twenty consecutive patients underwent adjunctive endoscopic ACS: 17 laparoscopic AWRs, 2 open repairs, and 1 hybrid repair. Up to 38 months (mean 21 months) of follow-up, there were no ventral hernia recurrences or de novo hernias at the ACS site. One patient experienced partial primary closure failure. Morbidity consisted in one case each of hematoma, seroma, and transient neuralgia. Cosmetic results and patient satisfaction were excellent. CONCLUSION: We confirmed that endoscopic subcutaneous ACS is a safe, effective, reliable, reproducible technique that facilitates primary closure of defects during AWR in selected patients.
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Parede Abdominal/cirurgia , Abdominoplastia/métodos , Endoscopia/métodos , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Tela Subcutânea/cirurgia , Telas Cirúrgicas , Parede Abdominal/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hematoma/epidemiologia , Hérnia Ventral/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Procedimentos de Cirurgia Plástica/métodos , Recidiva , Seroma/epidemiologia , Tomografia Computadorizada por Raios X , Técnicas de Fechamento de FerimentosRESUMO
La Gastrosquisis y el Onfalocele son los defectos congénitos de la pared abdominal más frecuentes e importantes que afectan al recién nacido. En nuestro país son muy pocos los centros hospitalarios que cuentan con la infraestructura necesaria para atender a estos neonatos. Muchos de ellos tienen que esperar un tiempo valioso para poder ser operados mientras se ubica la institución en donde van a ser recibidos, aumentando el riesgo de Síndrome Compartimental Abdominal (SCA) y sepsis. Objetivo: Comparar los procedimientos quirúrgicos de Parche de Cordón Umbilical versus el Cierre Primario Convencional de la pared abdominal en recién nacidos. Método: En total se analizaron 20 pacientes los cuales fueron divididos en 2 grupos. El Grupo A, pacientes a los cuales se les realizó cierre de pared mediante la utilización de Parche de Cordón Umbilical (10). El Grupo B, pacientes a los cuales se les realizó Cierre Primario Convencional (10). Resultado: No hubo diferencia estadística significativa en cuanto a tiempo de hospitalización y a las complicaciones. La presión intraabdominal (PIA), inicio de la vía oral y la sobrevida si mostraron diferencia estadística significativa entre los dos procedimientos. Conclusiones: El uso de Parche de Cordón Umbilical pareciera ofrecer ventajas a estos neonatos en los que se ha retardado en cierre de la pared abdominal, ya que la técnica crea una superficie mesotelial en contacto con el intestino, es un material autologo, disponible, fácil de aplicar; y en nuestro estudio demostró mayores ventajas en cuanto al poco aumento de la PIA, inicio más precoz de la vía oral y mayor porcentaje de sobrevida comparándolo con el Cierre Primario Convencional.
Gastroschisis and Omphalocele are the most frequent and important birth defects of the abdominal wall in the newborn period. In our country there are few hospitals with the necessary infrastructure to care for these infants. Many of them have to wait valuable time to be operated while the institution where they will be transfered is located, increasing the risk of Abdominal Compartment Syndrome and sepsis. Objective: To compare the surgical outcome between the use of the Umbilical Cord Patch versus the Conventional Primary Closure of the abdominal wall in newborns. Methods: Twenty patients were equally divided into 2 groups. Group A patients underwent abdominal closure using the Umbilical Cord Patch and Group B patients underwent a Conventional Primary Closure of the abdominal wall (10). Results: No statistically significant difference was seen in hospitalization time and complications. Where as significant statistical difference was seen in intra-abdominal pressure (IAP), onset of oral intake and survival between the two procedures. Conclusion: The Umbilical Cord Patch seems to offer advantages to those infants with delayed closure of the abdominal wall because the technique creates a mesothelial surface in contact with the intestine, it is an autologous tissue, available for use at birth and easly applied. The study showed greater benefits in terms of lower increase of IAP, early onset of oral fedding, and higher survival rate compared with Conventional Primary Closure.
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La Gastrosquisis es una malformación congénita caracterizada por salida de vísceras a través de un defecto paraumbilical de la pared abdominal. Los órganos eviscerados permanecen en contacto con el líquido amniótico durante la vida intrauterina, sufriendo una reacción inflamatoria crónica. Objetivo: comparar los procedimientos quirúrgicos de Símil-Exit versus el cierre primario de la pared abdominal en recién nacidos. Método: En total se analizaron 9 pacientes los cuales fueron divididos en 2 grupos. El grupo A pacientes a los cuales se les realizó el procedimiento Símil-Exit (n=4). El grupo B pacientes a los cuales se les realizó cierre primario (n=5). Resultados: No hubo diferencia significativa en cuanto a tiempo de hospitalización, tiempo inicio de la vía oral y complicaciones. En la sobrevida de los pacientes si hubo diferencia significativa entre los dos procedimientos, debido a que en el grupo de Símil-Exit la sobrevida fue del 100% versus 40% en el grupo B (p<0.05). Conclusiones: La resolución de la Gastrosquisis por Símil-Exit facilita la reducción de las asas intestinales a la cavidad abdominal manteniendo la circulación feto-placentaria, sin necesidad de anestesia general, disminuye el tiempo de exposición de las asas intestinales al ambiente y obvia el uso de ventilación mecánica.
Gastroschisis is a congenital anomaly distinguished by herniated mid-gut through a lateral umbilicus defect. The herniated organs remain in contact with the amniotic fluid during the intrauterine life suffering a chronic inflammatory reaction. Objective: To compare the surgical procedures of Simil-Exit management versus the primary closure of the abdominal walls in newborn with gastroschisis. Methods: Nine newborn with gastroschisis were studied, they were divided into 2 groups; group A included 4 patients which were managed with the Simil-Exit procedure and group B comprised of 5 patients in whom primary closure of the abdominal walls was performed. Results: There was no significant difference according to the hospitalization stay, beginning of enteral feeding nor complications. According to the survival of the patients we could observe a significant difference between the procedures, in the Simil-Exit group the survival was 100% versus 40% in group B (p<0.05). Conclusion: The Simil-Exit resolution for gastroschisis favours bowel reduction into the abdominal cavity maintaining the placental support without the need of general anesthesia, decreases the exposure of the bowel and obviates the use of mechanical ventilation.
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OBJECTİVE: Pilonidal sinus is characterized by high operative morbidity mainly due to wound problems. We aimed to compare the quality of health, comfort and psychological status in patients who underwent surgery for pilonidal sinus. METHODS: A total of 205 pilonidal sinus patients operated on with either primary closure or Limberg flap reconstruction were compared in terms of depression, anxiety, and long-term quality of health by using Short Form 36, Beck Depression Inventory, and Beck Anxiety Inventory scales. RESULTS: There were 107 patients in the primary closure group with a mean follow-up of 29.6±7.7 months and 98 patients in the Limberg flap group with a mean follow-up of 34.1±7.3 months. In the SF-36 analysis, the mental health and bodily pain scores (59±6 and 56±11 in the primary closure group and 62±8 and 61±10 in the Limberg flap group) were significantly higher in the Limberg flap group (p = 0.014 and p = 0.002, respectively). The mean Beck Depression Inventory (19±6.13 vs. 16±4.90 p<0.001) and Beck Anxiety Inventory (19±6.27 vs. 16±4.90 p<0.001) scores were lower in the Limberg flap group. CONCLUSION: Limberg flap reconstruction produced better quality of health scores according to the SF 36, especially in terms of mental health and bodily pain. There was a higher tendency towards anxiety and depression in the primary closure group. .
Assuntos
Adulto , Feminino , Humanos , Masculino , Ansiedade/psicologia , Depressão/psicologia , Seio Pilonidal/psicologia , Seio Pilonidal/cirurgia , Retalhos Cirúrgicos , Seguimentos , Satisfação do Paciente , Fatores de Tempo , Resultado do TratamentoRESUMO
Objetivo: Comparar la seguridad del cierre primario de la vía biliar versus cierre sobre tubo en "T", luego de la exploración laparoscópica de la vía biliar (ELVB). Método: Estudio prospectivo, controlado, no aleatorio, de pacientes con indicación de ELVB, resueltos a través de coledocotomía en un periodo de 9 años. A 15 pacientes se les realizó cierre sobre tubo en "T", mientras que a 20 pacientes se les realizó cierre primario de la vía biliar común.Resultados: No se observaron diferencias en cuanto a sexo, edad o indicación de la cirugía entre los dos grupos. Si bien el tiempo quirúrgico de los pacientes a los cuales se les colocó el tubo en "T" fue mayor (ï: 145 minutos vs. ï: 110 minutos), esta diferencia no fue estadísticamente significativa. El 80% de los pacientes con tubo en "T presentó salida de bilis a través del dren subhepático por un periodo menor a 3 días versus 30% de los pacientes con cierre primario (p < 0.05). Una paciente en el grupo de cierre sobre tubo en "T" presentó abdomen agudo debido a biliperitoneo posterior a la extracción de tubo, requiriendo reintervención laparoscópica para lavado y drenaje. No se presentaron complicaciones en el grupo de cierre primario. No se han reportado casos de litiasis residual. El tiempo de hospitalización fue comparable. Conclusión: El cierre primario del colédoco sin inserción de tubo en "T", luego de ELVB para tratamiento de la coledocolitiasis,es un procedimiento seguro y efectivo(AU)
Objetive: To compare the safety of common bile duct primary closure vs "t" tube drainage in laparoscopic common bile duct exploration (LCBDE).Method: This is a prospective, controlled, no randomized study, of patients undergoing laparoscopic common bile duct exploration through choledochotomy, in a nine years period. In15 patients we placed tube "T" drainage. In 20 cases a primary closure of the common bile duct was performed.Results: No difference in age, sex or surgery indication was observed. The operative time of patients with "t" tube insertion was longer than patients with primary closure (ï: 145 minutes vs. ï:11 0 m i n u t e s ) , h o w e v e r t h i s d i f f e r e n c e h a s n o t s t a t i s t i c a l s i g n i f i c a n -ce. 80% of patients with "t" tube had bile leakage of three days or less versus 30% of patients with primary closure (p<0.05). Onepatient with "T" tube had an acute abdomen due to biliary peritonitis after tube removal, requiring laparoscopic reintervention for lavage and drainage. There were no complications in the primary closure group. No cases of residual stones have been reported. Postoperative hospitalization time shows no difference between groups. Conclusion: Primary closure of the common bile duct without "T" tube insertion, after LCBDE for treatment of choledo-cholithiasis, is an effective and safe procedure(AU)
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Humanos , Masculino , Feminino , Ductos Biliares , Colecistectomia , Laparoscopia , Ducto Colédoco , Abdome Agudo , Bile , Drenagem , Colangiopancreatografia Retrógrada Endoscópica , HospitalizaçãoRESUMO
Introducción: la gastrosquisis y el onfalocele son malformaciones de la pared abdominal en neonatos que, a pesar de sus grandes diferencias, tienen en común el hecho de ser enfermedades graves caracterizadas por la herniación de las vísceras intrabdominales a través de un defecto de la pared abdominal. Los niños con estas enfermedades se presentan como emergencias quirúrgicas que plantean un reto difícil para el cirujano tratante. Tienen una tasa de mortalidad que oscila entre 20- 40%, aun con el tratamiento apropiado y se asocian a un amplio rango de malformaciones, principalmente en los niños con onfalocele. Objetivo: el objetivo de la presente revisión retrospectiva es describir el tratamiento de los pacientes con gastrosquisis y onfalocele, y los resultados con él obtenidos, entre 1998 y 2006, en la Sección de Cirugía Pediátrica del Hospital Universitario San Vicente de Paúl (HUSVP), de Medellín. Pacientes y métodos: se evaluaron todos los pacientes que ingresaron al Servicio de Cirugía Pediátrica del HUSVP con diagnóstico de gastrosquisis u onfalocele, entre el 1 de enero de 1998 y el 31 de diciembre de 2006. Se definió el tipo de tratamiento llevado a cabo y, de acuerdo con este, se revisaron los resultados: las complicaciones posquirúrgicas, tales como infección del sitio operatorio, evisceración, sepsis, íleo e hipertensión intrabdominal; el tiempo de inicio de la vía oral y de la nutrición parenteral total (NPT); la permanencia en la unidad de cuidados intensivos (UCI) y la duración de la estancia hospitalaria Resultados: se identificaron 55 pacientes, 32 con gastrosquisis y 23 con onfalocele; en todos se hizo tratamiento quirúrgico. En 31 pacientes (56,4%) se hizo cierre primario y en 24 (43,6%), cierre por etapas; en esta última modalidad el procedimiento más utilizado fue el silo (12 niños; 50%). En 42 pacientes (76,4%) se presentaron complicaciones la más frecuente de las cuales fue la sepsis. La frecuencia de complicaciones asociadas...
Introduction: Gastroschisis and omphalocele are neonatal malformations of the abdominal wall. Despite thei r great di f ferences , both are severe di seases characterized by herniation of viscera through the defect in the abdominal wall. Children with these defects present as surgical emergencies that pose a difficult challenge to the attending surgeon. Even with appropriate management, the mortality rate is between 20-40%.Omphalocele and, to a lesser degree gastroschisis, are associated with a wide range of malformations. Objective: The aim of this retrospective review was to describe the management of children with gastroschisis or omphalocele, and the results obtained with it, at the Pediatric Surgery Section, Hospital Universitario San Vicente de Paúl, in Medellin, Colombia.Patients and methods: We evaluated the charts of all patients admitted to the Pediatric Surgery Section, between January 1, 1998 and December 31, 2006, with a diagnosis of gastroschisis or omphalocele. The type of treatment was defined as either primary closure or closure by stages; accordingly, we reviewed the results of the operation, the surgical complications (surgical site infection, evisceration, sepsis, ileus and intraabdominal hypertension), the time of onset of oral and total parenteral nutrition (TPN), and the duration of hospital and UCI stay Results: 55 patients were identified, 32 with gastroschisis and 23 with omphalocele, all of whom were surgically treated. In 31 patients (56.4%) primary closure was carried out, while in 24 (43.6%) the closure was done by stages; in the latter modality silo was most frequently used (12 cases). Complications, mostly sepsis, occurred in 42 patients (76.4%). The frequency of complications associated...
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Recém-Nascido , Gastrosquise/cirurgia , Gastrosquise/mortalidade , Hérnia Umbilical , Parede Abdominal/anormalidades , Parede Abdominal/patologia , Terapêutica/métodos , Gastrosquise , Pacientes , Recém-NascidoRESUMO
Introducción: El colon es el segundo órgano más frecuentemente lesionado en las heridas por trauma penetrante de abdomen. En México, las lesiones por arma blanca o de fuego van en aumento. Nuestro objetivo fue evaluar el principal manejo para las lesiones traumáticas de colon. Material y métodos: Estudio retrospectivo y aleatorizado de 178 pacientes con trauma abdominal y lesiones de colon, en un lapso de cinco años (enero de 2003 a junio de 2008) en el Hospital General de Balbuena. Se comparó el uso del cierre primario y cirugía derivativa con colostomía. Se analizó sexo, grupo de edad, tipo de herida, grado de lesión y mortalidad. Resultados: De 178 pacientes, 156 fueron hombres (87.6 %) y 22 mujeres (12.4 %). El grupo de edad con mayor afección fue el de 21 a 30 años; 74 pacientes (41.6 %) presentaron heridas por instrumento punzocortante y 104 pacientes (58.4 %) heridas por arma de fuego. El principal manejo fue mediante cierre primario: 92 casos (51.7 %) versus 86 (48.3 %) para cirugía derivativa; sin embargo, en las heridas por arma de fuego el principal manejo fue la colostomía (67 casos). La mortalidad fue de 17 casos (9.55 %) debido a causas diversas como lesiones a múltiples órganos de manera asociada. Conclusiones: En las lesiones colónicas debe individualizarse el tratamiento, según la etiopatogenia, grado de lesión y lesiones asociadas.
BACKGROUND: Colon trauma is frequent and its prevalence is difficult to establish because of the different factors that intervene in its origin. In Mexico, traumatic colon injuries, albeit stab wounds or gunshot wounds, are on the rise. Our objective was to evaluate the most appropriate management for traumatic colon injuries. METHODS: We conducted a retrospective study of 178 case files of patients with abdominal trauma and colon lesions during a 5-year period from January 2003 to June 2008 from the General Hospital of Balbuena, Mexico City. The study compared the use of primary closure vs. colostomy, analyzing variables such as sex, age, type of wound, severity of lesion and mortality. RESULTS: There were a total of 178 patients; 156 were male (87.6%) and 22 were female (12.4%). The most affected age group was between 21 and 30 years; 74 patients (41.6%) had stab wounds and 104 patients (58.4%) had gunshot wounds. Management consisted mainly of primary closure in 92 cases (51.7%) vs. colostomy in 86 patients (48.3%). However, 64% of gunshot wounds were treated with colostomy. Reported mortality was 9.55% and this was due to different factors such as multiple organ injury. CONCLUSIONS: Treatment of traumatic colon injury should be case specific, taking into account the mechanism of the lesion, its severity and associated injuries.