ABSTRACT
Introduction: Abdominal ultrasound is the initial diagnosis tool for gallbladder disease and laparoscopic surgery is the gold standard approach. The aim of this study was to validate 10 years after, the ultrasonographic and laparoscopic findings previously proposed by our team to forecast laparoscopic cholecystectomy in terms of difficulties and perioperative complications. Materials and Methods: We evaluated 336 patients operated by laparoscopy between June and ¡December 2007 in our center. Ultrasound findings were classified according to the classification proposed in 1997 based on the thickness of the gallbladder wall, lumen and the presence of gallstones or sonic shadow. Results: Type I and IIA cholecystitis had a lower percentage of intraoperative difficulties (14.9 and 32.8 percent respectively) and conversion to open surgery (1.1 vs 1.7 percent respectively), whereas type LIB and III were associated greater presence of difficulties (51.3 percent and 71.4 percent respectively) and conversion rate (9.2 percent and 23.8 percent respectively). Conclusions: this classification is a useful tool in de correlation of ultrasonographic and laparoscopic findings in acute and chronic cholecystitis, helping the surgeon in predicting surgical problems, complications and risk of conversion to open surgery and supports the results previously published.
Introducción: La ecografia abdominal constituye el examen inicial en la patología vesicular; la cirugía laparoscópica es la vía de abordaje de elección. El objetivo de este estudio fue validar, 10 años después, la clasificación ecográfica y su correlación con los hallazgos laparoscópicos, propuesta previamente por nuestro equipo de trabajo para pronóstico de la colecistectomía laparoscópica en cuanto a dificultades y complicaciones peri operatorias. Materiales y Métodos: Se evaluaron 336 pacientes operados por vía laparoscópica entre junio y diciembre de 2007 en nuestro centro. Los hallazgos ecográficos se clasificaron de acuerdo a la clasificación propuesta en 1997, basada en el grosor de la pared vesicular, la presencia de lumen y de cálculos o sombra sónica. Programa Stata 9.1. Se realizó prueba de comparación de proporciones con p < 0,05. Resultados: Las colecistitis tipo I y IIA tuvieron menor porcentaje de dificultades intraoperatorias (14,9 y 32,8 por ciento) y de conversión a cirugía abierta (1,1 y 1,7 por ciento), mientras que las tipo IIB y III se asociaron a una mayor presencia de dificultades (51,3 por ciento y 71,4 por ciento respectivamente) y porcentaje de conversión (9,2 y 23,8 por ciento respectivamente). Conclusiones: esta clasificación constituye una herramienta útil en la correlación de hallazgos ecográficos y laparoscópicos en colecistitis crónica y aguda, ayudando al cirujano en la predicción de problemas quirúrgicos, complicaciones y riesgo de conversión a cirugía abierta, apoyando los resultados previamente publicados.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged, 80 and over , Cholecystectomy, Laparoscopic/methods , Cholecystitis/surgery , Cholecystitis/classification , Cholecystitis , Chronic Disease , Cholecystectomy, Laparoscopic/adverse effects , Cholecystitis, Acute/surgery , Cholecystitis, Acute/classification , Cholecystitis, Acute , Intraoperative Complications , Postoperative Complications , Prognosis , Prospective Studies , Risk , Severity of Illness IndexABSTRACT
Keloids and hypertrophic scars are frequent observed. These two conditions are considered part of the abnormal wound-healing spectrum. The main difference between keloids and hypertrophic scars is the scar extension in relation to the original incision, where former extends beyond the original incision while the latter respects it. The main issue with both conditions is that treatment modalities used today offer unacceptable high recurrence rates, between 50 to 70 percent, when they are applied as monotherapy. With combined treatment modalities recurrence rates have improved partially depending mainly in the chosen combination and so, this strategy is likely the optimal choice for the management of these lesions. The objective of this review was to highlight the pathophysiology, clinical features, and management of keloids with mono or combined therapy, focusing mainly in the surgical and radiotherapy/brachytherapy modalities.