Incidencia de disfagia persistente, en pacientes postoperados de fundoplicatura laparoscópica de Nissen / Incidence of persistent dysphagia, in postoperative patients of Nissen laparoscopic fundoplication

INTRODUCCIÓN. La fundoplicatura laparoscópica de Nissen es la técnica quirúrgica de elección en el tratamiento de la enfermedad por reflujo gastroesofágico, en la que la disfagia persistente postoperatoria como secuela, está presente con incidencia del 1 al 36% a nivel mundial. OBJETIVO. Determinar la incidencia de disfagia persistente, en pacientes postoperados de fundoplicatura laparoscópica de Nissen. MATERIALES Y MÉTODOS. Estudio observacional, descriptivo; con una población y muestra conocida de 15 Historias Clínicas de pacientes operados de fundoplicatura laparoscópica de Nissen en el Servicio de Cirugía General del Hospital General Dr. Fernando Quiroz Gutiérrez, Ciudad de México, periodo enero 2014 a mayo 2016. Criterios de inclusión: mayores de 18 años de ambos sexos, pos fundoplicatura laparoscópica de Nissen. Los datos se obtuvieron de las Historias Clínicas, y se aplicó un cuestionario vía telefónica. Para el análisis de datos se utilizó el programa Microsoft Excel 2013. RESULTADOS. La incidencia de disfagia persistente fue de 46,6% (7; 15), siendo frecuente en los hombres con un 60% (9; 15), frente a 40% (6; 15) en mujeres, con una incidencia por sexo de 66,6% (4;6) en mujeres y 33,3% (3; 9) en hombres. DISCUSIÓN. La detección de disfagia persistente aún requiere validación y tropicalización del test que evite sesgos al momento de su aplicación por parte de personal calificado. CONCLUSIÓN. Se determinó que la incidencia de disfagia persistente, en pacientes postoperados de fundoplicatura laparoscópica de Nissen a los 3 y 6 meses fue del 46%.

INTRODUCTION. Nissen laparoscopic fundoplication is the surgical technique of choice in the treatment of gastroesophageal reflux disease, in which persistent postoperative dysphagia as a sequel is present with an incidence of 1 to 36% worldwide. OBJECTIVE. To determine the incidence of persistent dysphagia in postoperative patients with Nissen laparoscopic fundoplication. MATERIALS AND METHODS. Observational, descriptive study; with a population and known sample of 15 Clinical Histories of patients operated on for Nissen laparoscopic fundoplication in the General Surgery Service of the General Hospital Dr. Fernando Quiroz Gutiérrez, Mexico City, period january 2014 to may 2016. Inclusion criteria: older than 18 years of both sexes, after Nissen laparoscopic fundoplication. The data were obtained from the Medical Records, and a questionnaire was applied via telephone. For data analysis, the Microsoft Excel 2013 program was used. RESULTS. The incidence of persistent dysphagia was 46,6% (7; 15), being frequent in men with 60% (9; 15), compared to 40% (6; 15) in women, with an incidence by sex of 66,6% (4; 6) in women and 33,3% (3; 9) in men. DISCUSSION. The detection of persistent dysphagia still requires validation and tropicalization of the test to avoid bias at the time of its application by qualified personnel. CONCLUSION. The incidence of persistent dysphagia in postoperative patients with Nissen laparoscopic fundoplication at 3 and 6 months was determined to be 46%.

Laparoscopía y apendicectomía laparoscópica en niños: experiencia nacional / Laparoscopy and laparoscopic appendectomy in children: national experience

Introducción: la apendicitis aguda es la urgencia quirúrgica más frecuente en niños. Las dificultades diagnósticas determinan un porcentaje de apendicitis evolucionadas o de apendicectomías innecesarias. La morbilidad y la incidencia de estos eventos disminuye con la laparoscopía. Objetivo: presentar nuestra experiencia laparoscópica en niños, compararla con los trabajos internacionales y con la laparotomía en nuestro medio. Metodología: se realizó un trabajo retrospectivo de las laparoscopías diagnósticas (LD) y apendicectomías laparoscópicas (AL) en el período 2001-2009 . Se consideró: edad, sexo, tipo de apendicitis, tiempo quirúrgico, conversión, complicaciones, reintervención, estadía hospitalaria, antibioticoterapia, e histología. Se dividió la serie en un primer período de 50 apendicectomías en el que hubo criterios de exclusión, y un segundo de 75 en el que se desarrolló un aprendizaje tutorizado. Se compararon los dos períodos de la serie de AL entre sí, y la serie de AL con una serie local de apendicectomizados por vía abierta (AA). Las variables categóricas de interés se analizaron mediante test de Chi cuadrado, test de Fisher y test t de student, utilizando el programa Epi-info6. Resultados: se realizaron 164 procedimientos: 125 AL y 39 LD. Las primeras 50 AL se realizaron en 60 meses, y las 75 siguientes en 40. En el CHPR se realizaron 91 AL. La media de edad fue 10,2 (DE 1,9). Predominaron el sexo masculino (59%) y la apendicitis simple, que correspondió al 60,8% (76 casos). El índice de conversión en la serie fue de 4,8%, con disminución significativa (p=0,03) del primer período (10%) al segundo (1,3%). Hubo diferencia significativa (p de 0,002) en el tiempo quirúrgico entre el primer período (media 40’, DE 15,8) y el segundo (media 32’, DE 7,7). El índice de infección de la herida operatoria (IHO) en AL fue de 0,8% (un caso) y el de infección abdominal (IA) fue de 1,6% (dos casos)...

Introduction: acute appendicitis is the most common surgical emergency in children. The diagnostic difficulties determine a percentage of evolved appendicitis or unnecessary appendectomies. The morbidity and the incidence of these events diminishes with laparoscopy. Objective: to present our experience with laparoscopy in children, compared with international papers and laparotomy in our country.Method: we conducted a retrospective study of diagnostic laparoscopy (DL) and laparoscopic appendectomy (LA) in the period 2001-2009. Were considered: age, sex, type of appendicitis, surgical time, conversion, complications, reoperation, hospital stay, antibiotic therapy, and histology. We divided the series into a first period of 50 appendectomies in which there were exclusion criteria, and another 75 in which supervised learning was developed. We compared two periods of the AL series between themselves, and the number of AL with a local number with open appendectomy (AA). The categorical variables of interest were analyzed by Chi square, Fisher test and Student t test, using Epi-info 6.Results: 164 procedures were conducted: 125 AL and 39 LD. The first 50 were done in 60 months, and the following 75 in 40. The 91 were held CHPR AL. The mean age was 10.2 (SD 1.9). Males (59%) and simple appendicitis, which corresponded to 60.8% (76 cases), predominated. The conversion rate in the range was 4.8%, with significant reduction (p=0.03) from the first period (10%) to second (1.3%). There were significant reduction (p=0.002) in surgical time between the first period (average 40, DE 15.8) and second (mean 32', DE 7.7). The rate of surgical wound infection (SWI) in LA was 0.8% (one case) and abdominal infection (AI) was 1.6% (two cases). The AI and SWI in the series of AL was lower compared to the number of AA, with a significant reduction in SWI (p 0.001)...

Avaliação da utilização de sistema de suspensão abdominal mecânica: estudo experimental em cães / Evaluation of abdominal wall lifting system utilization: experimental study in dogs

Com o intuito de avaliar sistema de suspensão mecânica da parede abdominal, elaborou-se protocolo experimental, estudando-se trinta cães, distribuídos em três grupos experimentais de maneira aleatória: grupo pneumoperitônio com gás carbônico, grupo suspensão pela cavidade peritoneal e grupo suspensão abdominal (intraperitoneal) pela tela subcutânea, para documentar alterações metabólicas, hemodinâmicas e respiratórias em cada grupo, compará-las e verificar possíveis vantagens ou desvantagens dos métodos. Os animais foram monitorizados com eletrocardiograma, cateter de Swan-Ganz e pressão arterial invasiva, sendo colhidas amostras de sangue arterial e venoso misto nos momentos basal, 0, 15, 30, 60, 90, 120 minutos e 30 minutos após o término do procedimento, anotando-se para cada momento os parâmetros hemodinâmicos. Calculouse a média e o desvio padrão dos parâmetros, sendo os diferentes grupos comparados pelo teste de Kruskal-Wallis, e nos momentos em que se encontrou diferença estatística entre os três grupos, comparou-se os grupos dois a dois pelo teste de Mann-Whitney. Observou-se, no grupo pneumoperitônio em relação aos grupos suspensão, queda significativa do pH sangüíneo, elevação do bicarbonato, elevação da pressão venosa central e elevação da pressão parcial de gás carbônico, diferenças estas estatisticamente significativas, com p<0,05, não havendo diferenças estatísticas entre os grupos suspensão abdominal e subcutânea.

With the purpose of evaluate abdominal wall lifting system, a experimental protocol was elaborated, and thirty dogs, distributed randomly in three experimental groups, pneumoperitoneum with carbon dioxide gas, abdominal (intraperitoneal) suspension and subcutaneous suspension, were studied to document metabolic, hemodynamic and respiratory alterations, compare then and verify if there are some advantage or disadvantage in each method. The animals were monitored with electrocardiogram, Swan-Ganz catheter and invasive arterial blood pressure, and samples of arterial and venous blood were collected at the moments basal, 0, 15, 30, 60, 90 and 120 minutes, and 30 minutes after the end of procedure, registering at each moment the hemodynamical parameters. The three groups were statically compared with Kruskal-Wallis test and, at the moments with statistical differences, the groups were compared two by two with Mann-Whitney test. At the group pneumoperitoneum was observed significant decrease of blood pH, raising of bicarbonate, central venous pressure, and partial carbon dioxide blood pressure in relation to suspension groups, and those differences were statistically significant with p<0.05, without significant differences between abdominal and subcutaneous suspension groups.