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Introducción. El neumotórax espontáneo es una patología infrecuente, que afecta tantoa jóvenes como a personas mayores. Puede tener alta tasa de recurrencia, generando morbilidad y, en ocasiones, mortalidad a los pacientes. En nuestro medio no disponemos de datos epidemiológicos de la enfermedad, lo que motivó la realización de este estudio. Métodos. Estudio retrospectivo de una base de datos prospectiva, que incluyó pacientes mayores de 14 años con diagnóstico de neumotórax espontáneo intervenidos quirúrgicamente en el Hospital Pablo Tobón Uribe, de Medellín, Colombia, entre enero de 2018 y diciembre de 2023. Se analizaron variables sociodemográficas, clínicas y desenlaces postquirúrgicos a 30 días de la intervención. Resultados. El sexo masculino fue el más afectado (68,2 %), el neumotórax espontáneo secundario predominó (56,8 %) y el hemitórax derecho fue la localización más común (63,6 %). Se encontró una incidencia similar entre fumadores (45,4 %) y no fumadores (52,3 %). La resección en cuña fue el tratamiento definitivo en el 50 % de los pacientes y la resección en cuña asociada a pleurodesis mecánica en el 31,8 %. La complicación más frecuente fue la fuga persistente de aire. Se registró una recurrencia de neumotórax en un paciente que había sido sometido a resección en cuña. Al final del estudio, cinco pacientes fallecieron: tres habían sido tratados únicamente con toracostomía y dos habían sido llevados a cirugía. Conclusiones. El neumotórax espontáneo es una patología infrecuente. Las causas y la población afectada varían de acuerdo con su clasificación. En nuestro medio, la tuberculosis tiene mayor relevancia por ser una enfermedad endémica.

Introduction. Spontaneous pneumothorax is a rare pathology that affects both young and old people. It can have a high recurrence rate, resulting in morbidity and sometimes mortality of the patients. In our environment we do not have epidemiological data on the disease, which motivated this study to be carried out. Methods. Retrospective study of a prospective database, which included patients over 14 years of age, with a diagnosis of spontaneous pneumothorax who underwent surgery at the Hospital Pablo Tobón Uribe, Medellin, Colombia, between January 2018 and December 2023. Sociodemographic, clinical variables and postoperative outcomes 30 days after the intervention were analyzed. Results. Males were the most affected (68.2%), secondary spontaneous pneumothorax predominated (56.8%) and the right hemithorax was the most common location (63.6%). A similar incidence was found between smokers and non-smokers (45.4% vs. 52.3%, respectively). Wedge resection was the definitive treatment in 50% of patients and wedge resection associated with mechanical pleurodesis in 31.8%. The most common complication was persistent air leak. A recurrence of pneumothorax was recorded in a patient who had undergone wedge resection. At the end of the study, five patients died: three had been treated only with thoracostomy and two had been taken to surgery. Conclusions. Spontaneous pneumothorax is a rare pathology. The causes and the affected population vary according to the classification. In our environment, tuberculosis has greater relevance because it is an endemic disease.

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Introducción. La herniorrafia inguinal es una cirugía ampliamente realizada a nivel mundial, con casi 20 millones de procedimientos anuales. En la literatura no se describen diferencias significativas en las tasas de recurrencia entre las técnicas laparoscópicas, pero estos resultados difieren en cuanto a la fijación de la malla. Métodos. Estudio retrospectivo observacional en el que se incluyeron los pacientes sometidos a herniorrafia inguinal por laparoscopia en una institución de cuarto nivel en Medellín, Colombia, entre enero de 2019 y junio de 2023. Se registraron los datos demográficos, como edad, género y comorbilidades, y los datos del procedimiento, como técnica utilizada, tipo de hernia, tipo de malla y fijación o no de la malla. Los desenlaces posoperatorios evaluados fueron dolor agudo y crónico, recurrencia y otras complicaciones. Resultados. De un grupo de 1106 pacientes sometidos a herniorrafia inguinal por vía laparoscópica, 69,0 % fueron sometidos a la técnica transabdominal preperitoneal, 23,1 % a la técnica totalmente extraperitoneal y 7,9 % a totalmente extraperitoneal extendida. La malla macroporosa de baja densidad fue la más utilizada (56,3 %). A 784 (70,9 %) se les fijó la malla y a 322 (29,1 %) no. La tasa de complicaciones fue menor al 8 %. Al final, 77 (7,0 %) pacientes experimentaron dolor agudo y 26 crónico (2,3 %). Hubo recurrencia de la hernia en 20 pacientes (1,8 %). Conclusión. El uso de prótesis sin fijación en la herniorrafia inguinal por laparoscopia pareciera ser un procedimiento seguro, con una tasa de recidivas equiparables a los procedimientos con fijación y con una leve tendencia a un menor dolor posquirúrgico agudo y crónico.

Introduction. Inguinal herniorrhaphy is a widely performed surgery worldwide, with almost 20 million procedures annually. The literature does not describe significant differences in recurrence rates between laparoscopic techniques, but these outcomes differ in terms of mesh fixation. Methods. Retrospective observational study that included patients undergoing laparoscopic inguinal herniorrhaphy at a fourth-level institution in Medellin, Colombia, between January 2019 and June 2023. Demographic data, including age, gender, and comorbidities were recorded, along with data related to the procedure details, such as technique used, type of hernia, type of mesh, and mesh fixation or not. Postoperative outcomes evaluated were acute and chronic pain, recurrences, and other complications. Results. Of a group of 1106 patients undergoing laparoscopic inguinal herniorrhaphy, 69.0% underwent the preperitoneal transabdominal technique, 23.1% underwent the totally extraperitoneal tecnhique, and 7.9% underwent the extended totally extraperitoneal tecnique. Low-density macroporous mesh was the most used (56.3%); 784 (70.9%) had the mesh fixed and 322 (29.1%) did not. The complication rate was less than 8%. In the end, 77 (7.0%) patients experienced acute pain and 26 (2.3%) developed chronic pain. There was hernia recurrence in 20 patients (1.8%). Conclusion. The use of prostheses without fixation in laparoscopic inguinal herniorrhaphy seems to be a safe procedure, with a recurrence rate comparable to procedures with fixation and with slight tendency towards less acute and chronic postsurgical pain.

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Background: Non-ST elevation myocardial infarction (NSTEMI) significantly reduces patient survival, a condition that is essential for the optimization of results and the restoration of effective vascular flow multivessel coronary artery disease, Emergency coronary artery bypass grafting (CABG) is frequently contemplated. In the aftermath of NSTEMI, the objective of this investigation is to assess the results of urgent CABG, to prioritize risk stratification through the use of the Global Registry of Acute Coronary Events (GRACE) score Methods: An analysis of 60 consecutive patients who underwent emergent CABG following NSTEMI was conducted retrospectively. Data on patients were obtained from a prospectively compiled database, and the GRACE score was implemented to evaluate the probability of mortality. Patients were divided into three risk categories: low (<10%), intermediate (10-19%), and high (?20%), based on their predicted mortality percentages. Results: Patients in the high-risk group (Group 3) exhibited significantly lower Euro Scores and ejection fractions (EF) than those in the low and intermediate groups, as demonstrated by the study. Additionally, the cross-clamp time was notably longer in Group 3, highlighting the urgency of intervention in this population The postoperative complications' overall incidence did not differ significantly between the groups. Even though Group 3 exhibited an increased in-hospital mortality rate. Conclusions: The findings underscore the importance of timely intervention and tailored management strategies for NSTEMI patients, more specifically, the individuals who have been classified as high-risk by the GRACE score. This study contributes to the growing body of literature supporting urgent CABG as a lifesaving procedure and emphasizes the need for further research to optimize outcomes in this vulnerable patient population. The results advocate for a multidisciplinary approach to enhance perioperative care and improve survival rates among NSTEMI patients undergoing CABG.

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Introduction. Surgery remains the mainstay of treatment for most esophagogastric junction (EGJ) tumors. After the surgical resection of EGJ tumors, the anatomy of the esophageal hiatus of the diaphragm is severely altered, increasing the risk of postoperative hiatal hernia (HH). While HH is more often reported after esophagectomy, HH is a rare complication after laparoscopic total gastrectomy and occurs in only approximately 0.5% of patients. Clinical case. A laparoscopic total gastrectomy with D2 lymphadenectomy was performed on a patient with an esophagogastric junction tumor. No intraoperative complications occurred and the patient had an uneventful postoperative course. Two months after the operation, the patient was admitted to the emergency room due to diffuse abdominal and chest pain, vomiting, and hematemesis. The chest and abdominal CT scan showed herniation of several bowel loops into the right hemithorax. Results. Due to hemodynamic instability, an emergent laparotomy was performed and the hiatal hernia was repaired with mesh. The patient recovered well from the operation and was discharged after 10 days. Conclusions. Clinical presentation is often non-specific and warrants a high level of suspicion. Elective surgical repair is recommended for large and/or symptomatic HH. Emergent repair might be needed for complicated HH with incarceration, strangulation, or bowel perforation. Overall, incarcerated HH after laparoscopic total gastrectomy is rare but should be considered in patients with abdominal pain or vomiting during the postoperative course. A prompt diagnosis and treatment are critical to obtain favorable outcomes.

Introducción. La cirugía sigue siendo el pilar del tratamiento para la mayoría de los tumores de la unión esofagogástrica (UEG). Después de la resección quirúrgica de los tumores de la UEG, la anatomía del hiato esofágico se altera severamente, aumentando el riesgo de hernia hiatal (HH) postoperatoria. Mientras que la HH se informa con mayor frecuencia después de la esofagectomía, la HH es una complicación rara después de una gastrectomía total laparoscópica y ocurre en solo aproximadamente 0,5 % de los pacientes. Caso clínico. Se realizó una gastrectomía total laparoscópica con linfadenectomía D2 en un paciente con un tumor en la UEG. No presentó complicaciones intraoperatorias y cursó su postoperatorio sin incidentes. Dos meses luego de la operación, fue admitido en la sala de emergencias debido a dolor abdominal y torácico difuso, vómitos y hematemesis. La tomografía computarizada de tórax y abdomen mostró herniación de asas intestinales en el hemitórax derecho. Resultados. Debido a la inestabilidad hemodinámica, se realizó una laparotomía de emergencia y se reparó la hernia hiatal con malla. El paciente fue dado de alta después de 10 días. Conclusiones. La presentación clínica suele ser inespecífica y justifica un alto nivel de sospecha. Se recomienda la reparación quirúrgica electiva para HH grandes y/o sintomáticas. La reparación de emergencia puede ser necesaria para HH complicadas con encarcelamiento, estrangulación o perforación intestinal. Generalmente, una HH encarcelada después de la gastrectomía total laparoscópica es infrecuente, pero debe considerarse en pacientes con dolor abdominal o vómitos durante el curso postoperatorio. Un diagnóstico y tratamiento oportunos son críticos para obtener resultados favorables.

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Background: Laparotomy is one of the most commonly performed surgeries by general surgeons, where we open the abdomen and search for any pathology. The Clavien-Dindo classication is an accepted surgical complication classication system that grades complications based on the extent of therapy required for their treatment. The study's main aim was to assess various grades of complications post-laparotomy with respect to the Calvien- Dindo classication. This study was a prospective and descriptive study conducted from June 2023 to July 2024. 180Methods: patients who underwent laparotomy during this period were included and followed up in postoperative period and all the complications developed till discharge/death were recorded. Complications were more common in emergencyResults: laparotomies (40%) as compared to elective laparotomies (30%). In elective laparotomies, 24 patients who had complications, 4 (17%) belonged to grade 1, 13 (54%) were in grade 2, 2 (8%) were in grade 3a, 2 (8%) were in grade 3b, 1 (4%) in grade 4a, 1 (4%) in grade 4b and 1 (4%) in grade 5. In emergency laparotomies, 40 patients who had complications, 8 (20%) belonged to grade 1, 15 (37.5%) were in Grade 2, 3 (7.5%) were in grade 3a, 5 (12.5%) were in grade 3b, 1 (2.5%) in grade 4a and 1 (2.5%) in grade 4b and 7 (17.5%) in grade 5. The Clavien-Dindo classication can be used in all hospital settings as a simple way forConclusion: postoperative complications.

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Background: Pancreaticoduodenectomy (PD) is a complex surgical procedure with significant postoperative complications, including pancreatic fistula, delayed gastric emptying, and intra-abdominal infections. This study aims to compare the early postoperative complications of internal versus external pancreatic duct stents in patients undergoing PD. Material & Methods: This prospective observational study was conducted at Dhaka Medical College Hospital from January 1, 2023, to December 27, 2023. A total of 40 patients scheduled for PD were divided into two groups: 20 managed with internal stents and 20 with external stents. Data on demographic characteristics, per-operative factors, and postoperative complications were collected and analyzed. Results: The study population had a mean age of 56.78 years, with males constituting 65%. The most common histopathological diagnosis was periampullary carcinoma (50%). In the internal stenting group, 10% had a soft pancreas, 65% had a firm pancreas, and 25% had a hard pancreas. In the external stenting group, 40% had a soft pancreas, 50% had a firm pancreas, and 10% had a hard pancreas. Wound infections occurred in 10% of the internal stenting group and 15% of the external stenting group. Intra-abdominal collections were found in 5% of the internal stenting group and 10% of the external stenting group. GI bleeding was absent in the internal stenting group but occurred in 5% of the external stenting group. Intra-abdominal bleeding was absent in the internal stenting group but present in 10% of the external stenting group. Delayed gastric emptying was noted in 5% of participants in both groups. Grade A pancreatic fistula was observed in 10% of the internal stenting group and 15% of the external stenting group. Grade B and C pancreatic fistulas were only present in the external stenting group, at rates of 10% and 5%, respectively. Conclusions: Internal pancreatic duct stents are associated with lower incidences of wound infections, intra-abdominal collections, and severe pancreatic fistulas compared to external stents. These findings suggest that internal stents may offer better postoperative outcomes, although stent selection should be individualized based on patient-specific factors. Further research is warranted to confirm these results and guide clinical practice.

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Background Gastric cancer remains a significant public health challenge in Bangladesh, with a high prevalence of habitual risk factors and late-stage diagnoses. This study aims to evaluate the early outcomes and postoperative complications among gastric cancer surgery patients in a resource-limited setting. Material & Methods: This prospective, cross-sectional observational study was conducted from July 2017 to March 2019 at the Department of Surgical Oncology, National Institute of Cancer Research and Hospital, Dhaka. Forty patients with biopsy-proven operable gastric carcinoma were selected using purposive nonrandomized sampling. Data were collected through clinical evaluations, structured interviews, and case record forms, focusing on demographic characteristics, habitual risk factors, tumor-related features, types of surgery, duration of surgery, hospital stay, and postoperative complications. Statistical analyses were performed using SPSS-22. Results: The mean age of participants was 65.16 � 10.28 years, with a male predominance (70%). Smoking (70%) and beetle leaf consumption (90%) were prevalent habitual risk factors. Distal stomach cancer was more common (65%), with a mean tumor size of 5.00 � 2.00 cm. Lower radical gastrectomy was performed in 65% of cases. Most surgeries (60%) were completed within 1 to 1.5 hours. Hospital stay durations varied, with 45% staying 11-15 days. Postoperative complications were noted in 52.50% of patients, including wound infections (20%) and urinary tract infections (15%). Conclusions: This study highlights the critical need for improved early detection, risk factor mitigation, and postoperative care in gastric cancer management within Bangladesh. These findings provide a foundation for future research and clinical strategies aimed at enhancing patient outcomes in similar resource-limited settings.

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Background: Laparoscopic surgery has become a preferred minimally invasive option for colorectal cancer treatment due to its numerous advantages over traditional open surgery. This study aimed to evaluate the short-term outcomes of laparoscopic surgery for colorectal cancer at the National Institute for Cancer Research and Hospital (NICR&H) in Dhaka, Bangladesh. Material & Methods: This was a prospective observational study conducted from September 2018 to October 2019 in the Department of Surgical Oncology at NICR&H. The study included 39 patients diagnosed with colorectal cancer who underwent laparoscopic surgery. Data were collected prospectively from medical records, including demographic information, clinical characteristics, surgical details, and short-term postoperative outcomes. Statistical analysis was performed using SPSS for Windows, with categorical data expressed as numbers and percentages and continuous data as means and standard deviations. Results: The study comprised 23 males (58.97%) and 16 females (41.03%). Most participants had primary education (51.28%) and were housewives (41.03%). A family history of cancer was reported by 25.64% of participants. The most common chief complaint was per-rectal bleeding (48.72%). Colonoscopy findings included ulcer proliferative lesions in 64.10% of patients. The most frequent minor complication was urinary tract infection (30.77%), while surgery conversion (12.82%) was the most common major complication. Other major complications included hemorrhage, respiratory distress, internal hemorrhage, intra-abdominal abscess, acute renal failure, and postoperative mortality, each occurring in 2.56% of patients. Conclusions: Laparoscopic surgery for colorectal cancer in Bangladesh demonstrates significant benefits, including reduced postoperative pain and quicker recovery times, despite certain minor and major complications. These findings support the broader adoption of laparoscopic techniques in similar healthcare settings to improve patient outcomes.

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Introducción. Las complicaciones quirúrgicas son un tema relevante, difícil de abordar e inmerso en una cultura punitiva y vergonzosa hacia el médico. La ausencia de una medición sistemática, confiable y socializada es un desafío para los servicios quirúrgicos. El desconocimiento de las medidas de frecuencia y el impacto de las complicaciones quirúrgicas en las instituciones, y a su vez, dentro de los servicios quirúrgicos, evidencia la necesidad de abordar el tema desde una perspectiva de mejoramiento continuo. Métodos. Se hizo un análisis crítico y reflexivo sobre la conceptualización de las complicaciones quirúrgicas, los avances en su proceso de evaluación y su utilidad como indicador de calidad en los servicios quirúrgicos. Se ilustraron las metodologías con ejemplos clínicos que facilitan su entendimiento y aplicabilidad. Resultados. El trabajo inicial de los doctores Clavien & Dindo se ha fortalecido al considerar integralmente el proceso de atención quirúrgica como un indicador de calidad de la atención en salud. El desarrollo del Índice Integral de Complicaciones (CCI), para los eventos en el período posoperatorio, representa un paso adicional en el abordaje del problema. Su potencialidad en el análisis de los eventos ofrece una oportunidad para la implementación y la investigación en el tema. Conclusiones. Las complicaciones quirúrgicas representan un indicador robusto que permite evaluar el desempeño individual y grupal en un servicio quirúrgico. Hay metodologías recientes que deben ser incorporadas en la actividad asistencial de los cirujanos. Representan un insumo en la educación médica a todo nivel e, igualmente, un elemento de crecimiento personal y académico para todo cirujano.

Introduction. Surgical complications are a relevant topic, difficult to address and immersed in a punitive and shameful culture towards the doctor. The absence of systematic, reliable, and socialized measurement is a challenge for surgical services. The lack of knowledge of frequency measurements and the impact of surgical complications in institutions, and in turn, within surgical services, shows the need to address the issue from a perspective of continuous improvement. Methods. A critical and reflective analysis was carried out on the conceptualization of surgical complications, the advances in their evaluation process and their usefulness as an indicator of quality in surgical services. The methodologies were illustrated with clinical examples that facilitate their understanding and applicability. Results. The initial work of doctors Clavien & Dindo has been strengthened by comprehensively considering the surgical care process as an indicator of quality of health care. The development of the Comprehensive Complication Index (CCI), for events in the postoperative period, represents an additional step in addressing the problem. Its potential in the analysis of events offers an opportunity for implementation and research on the topic. Conclusions. Surgical complications represent a robust indicator that allows evaluating individual and group performance in a surgical service. There are recent methodologies that must be incorporated into the care activity of surgeons. They represent an input in medical education at all levels and equally, an element of personal and academic growth for every surgeon.

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Introducción. Los pacientes octogenarios y nonagenarios conforman un grupo etario en progresivo crecimiento. La hernia inguinal es una patología que aumenta progresivamente con la edad. Este trabajo tuvo como objetivo conocer los resultados quirúrgicos de los pacientes mayores de 80 años a quienes se les realizó herniorrafía inguinal. Métodos. De acuerdo con las guías PRISMA, se realizó una revisión sistemática de PubMed, Embase y Google Scholar. Se incluyeron estudios que reportaron la incidencia de complicaciones y mortalidad después de una herniorrafía inguinal en los pacientes octogenarios y nonagenarios. Se calculó la proporción de pacientes con complicaciones después de una herniorrafía inguinal según los datos presentados, con su respectivo intervalo de confianza del 95 %. Resultados. Catorce estudios reportaron un total de 19.290 pacientes, entre quienes se encontró una incidencia acumulada de infección del sitio operatorio de 0,5 % (IC95% 0,460 - 0,678), seroma de 8,7 % (IC95% 6,212 - 11,842), hematoma de 2,6 % (IC95% 2,397 - 2,893), dolor crónico de 2,1 % (IC95% 0,778 - 4,090) y recidiva de 1,2 % (IC95%0,425 - 2,284), para una morbilidad de 14,7 % (IC95% 9,525 - 20,833). Conclusión. Las complicaciones de la herida quirúrgica, el dolor crónico y la recidiva en los pacientes mayores de 80 años a quienes se les realiza herniorrafia inguinal son comparables con las de la población general.

Introduction. Octogenarian and nonagenarian patients constitute a progressively growing age group. Inguinal hernia is a pathology that increases with age. This study aims to understand the surgical outcomes of inguinal herniorrhaphy in patients over 80 years of age. Methods. A systematic review of PubMed, Embase, and Google Scholar was conducted following PRISMA guidelines. Studies reporting the incidence of complications and mortality after inguinal herniorrhaphy in octogenarian and nonagenarian patients were included. The proportion of patients with complications after inguinal herniorrhaphy was calculated based on the data presented, with its respective 95% confidence interval. Results. Fourteen studies reported a total of 19,290 patients, among whom a cumulative incidence of surgical site infection of 0.5 (95% CI 0.460 ­ 0.678), seroma of 8.7% (95% CI 6.212 ­ 11.842), hematoma of 2.6% (95% CI 2.397 ­ 2.893), chronic pain 2.1% (95% CI 0.778 ­ 4.090), recurrence 1.2% (95% CI 0.425 ­ 2.284), and morbidity 14.7% (95% CI 9.525 ­ 20.833) were found. Conclusion. Surgical wound complications, chronic pain, and recurrence in patients over 80 years of age undergoing inguinal herniorrhaphy are comparable to those in the general population.

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Introducción. El trasplante hepático es el tratamiento indicado en aquellas enfermedades del hígado en las cuales ya se han agotado otras medidas terapéuticas, y es un procedimiento complejo. Las complicaciones postquirúrgicas se relacionan con alta morbimortalidad y pueden llevar a desenlaces fatales; las complicaciones vasculares son las de mayor mortalidad, por lo que es crucial la detección temprana y el tratamiento oportuno. El objetivo de este estudio fue caracterizar los pacientes que presentaron complicaciones vasculares posterior a trasplante hepático. Métodos. Estudio descriptivo, retrospectivo, con seguimiento a los pacientes sometidos a trasplante hepático en la Fundación Cardiovascular, entre los años 2013 y 2023, que presentaron complicaciones vasculares. Se evaluó el tipo de complicación, los factores de riesgo y los desenlaces postquirúrgicos. Resultados. Se incluyeron en total 82 pacientes trasplantados, con un predominio del sexo masculino 59,8 % (n=49); la principal indicación del trasplante fue el alcoholismo (21,9 %). Veinte pacientes presentaron complicaciones vasculares; la más frecuente fue trombosis de arteria hepática, en el 45 % (n=9). En tres de estos casos se requirió nuevo trasplante. Conclusión. Las complicaciones vasculares empeoran la evolución clínica postoperatoria de los pacientes y están relacionadas con alta morbimortalidad, por lo cual es crucial la valoración multidisciplinaria, el diagnóstico oportuno y la intervención temprana para disminuir los desenlaces fatales.

Introduction. Liver transplant is the treatment indicated for those liver diseases in which other therapeutic measures have already been exhausted, and it is a complex procedure. Post-surgical complications are related to high morbidity and mortality and can lead to fatal outcomes. Vascular complications are the ones with the highest mortality, so early detection and timely treatment are crucial. The objective of this study was to characterize patients who presented vascular complications after liver transplantation. Methods. Descriptive, retrospective study, with follow-up of patients undergoing liver transplant at the Fundación Cardiovascular, between 2013 and 2023, who presented vascular complications. The type of complication, risk factors and postsurgical outcomes were evaluated. Results. A total of 82 transplant patients were included, with a predominance of males with 59.8% (n=49); the main indication for transplant was alcoholism (21.9%). Twenty patients presented vascular complications; the most frequent was hepatic artery thrombosis 45% (n=9). In three of these cases a new transplant was required. Conclusion. Vascular complications worsen the postoperative clinical course of patients and are associated with high morbidity and mortality, which is why multidisciplinary assessment, diagnosis and early intervention are crucial to reduce fatal outcomes.

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Introducción. El trasplante hepático es el tratamiento de elección para pacientes con enfermedades hepáticas en estadio terminal de cualquier etiología. El éxito de la intervención depende de la adecuada selección del donante y del receptor. Los determinantes biopsicosociales influyen en la tasa de complicaciones y mortalidad postrasplante. El objetivo de este artículo es identificar las intervenciones y los desenlaces clínicos en pacientes con indicación de trasplante hepático que fueron excluidos de la evaluación pretrasplante por los departamentos de psicología y trabajo social entre enero de 2019 y diciembre de 2021 en un centro de referencia de trasplante hepático en Bogotá. Metodología. Estudio de corte transversal en pacientes mayores de edad con indicación clínica de trasplante hepático que no fueron aptos para evaluación pretrasplante durante la valoración de trabajo social y psicología entre enero de 2019 y diciembre de 2021. Resultados. Se identificaron inicialmente 565 candidatos para evaluación pretrasplante de hígado. De estos, 122 pacientes evaluados por los departamentos de psicología y trabajo social no fueron considerados aptos para continuar con la evaluación, y se incluyeron en el estudio. De este grupo, el 58,2 % (n=71) eran hombres, el 77 % (n=94) estaban afiliados al régimen contributivo, y el 38,5 % (n=47) tenían educación primaria como nivel máximo alcanzado. Además, el 34,4 % (n=42) se encontraban desempleados, con una mediana de ingresos mensuales de $1.000.000 COP (RIC $800.000-$1.950.000). Un total de 32,5 % (n=37) de estos pacientes lograron ser incluidos en el estudio pretrasplante después de recibir alguna intervención. Se observaron diferencias significativas en la activación de la red familiar extensa entre el grupo de pacientes incluidos y no incluidos en el estudio pretrasplante (48,6 % vs 0,0 %). Conclusión. Las intervenciones realizadas por el grupo de soporte multidisciplinario de trasplante permiten aumentar el acceso a la evaluación pretrasplante, el ingreso a la lista de espera y el trasplante de pacientes inicialmente no aptos por diferentes causales modificables con estas herramientas.

Introduction. Liver transplantation is the treatment of choice for patients with end-stage liver disease of any etiology. The success of the intervention depends on the appropriate selection of both donor and recipient. Biopsychosocial determinants influence the rate of complications and post-transplant mortality. The objective of this article is to identify interventions and clinical outcomes in patients indicated for liver transplantation who were excluded from pre-transplant evaluation by the psychology and social work departments between January 2019 and December 2021 at a liver transplant referral center in Bogotá. Methodology. Cross-sectional study conducted on adult patients clinically indicated for liver transplantation who were deemed ineligible for pre-transplant evaluation during the social work and psychology assessments between January 2019 and December 2021. Results. Initially, 565 candidates for liver pre-transplant evaluation were identified. Among these, 122 patients evaluated by the psychology and social work departments were not deemed suitable to proceed with evaluation and were included in the study. Of this group, 58.2% (n=71) were male, 77% (n=94) were affiliated with the contributory regime, and 38.5% (n=47) had only completed primary education. Additionally, 34.4% (n=42) were unemployed, with a median monthly income of $1,000,000 COP (IQR $800,000-$1,950,000). A total of 32.5% (n=37) of these patients were eventually included in the pre-transplant study after receiving some form of intervention. Significant differences were observed in the activation of extended family networks between the group of patients included and not included in the pre-transplant study (48.6% vs 0.0%). Conclusion. Interventions conducted by the multidisciplinary transplant support team increase access to pre-transplant evaluation, waiting list inclusion, and transplantation for initially ineligible patients due to various modifiable causes addressed by these tools.

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Background: Thyroidectomy is a common surgical procedure for various thyroid disorders, but it often leads to complications such as hypocalcemia. Understanding the prevalence and predictors of hypocalcemia post-total thyroidectomy is crucial for improving patient outcomes. Methods: This prospective cross-sectional study was conducted at a tertiary care hospital with 100 patients undergoing thyroid surgery, including total thyroidectomy, completion thyroidectomy, and thyroidectomy with neck dissection. We analyzed the incidence of transient and permanent hypocalcemia, examining correlations with surgery type, demographic variables, and postoperative day of onset. Data were collected through patient records and postoperative follow-ups. Results: The study revealed that 30% of patients experienced hypocalcemia postoperatively. Hypocalcemia was most prevalent among patients undergoing thyroidectomy with neck dissection (58.33%), compared to those undergoing total thyroidectomy (18.18%) and completion thyroidectomy (40.00%). The majority of hypocalcemia cases (66.67%) occurred on the second postoperative day. Most hypocalcemia instances were transient (86.67%), with a smaller fraction being permanent (13.33%). Conclusions: Hypocalcemia remains a significant complication following thyroid surgery, particularly in surgeries involving neck dissection. Early identification and management of at-risk patients could mitigate the severity of this complication. Our findings underscore the importance of vigilant monitoring and tailored postoperative care to minimize the impact of hypocalcemia on patient recovery and quality of life.

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Background: Effective postoperative pain management is crucial for patient recovery and satisfaction. Despite advances in pain management techniques, patient satisfaction remains a significant indicator of healthcare quality and effectiveness. Methods: A cross-sectional study was conducted at SRM Medical College Hospital, Bhawanipatna, Odisha, India. A total of 380 postoperative patients were surveyed using a standardized questionnaire that assessed demographic information, pain intensity, pain management interventions, and satisfaction with pain management. Pain intensity was measured using a Visual Analog Scale (VAS), and satisfaction was assessed through a Likert scale. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression to identify predictors of satisfaction. Results: Most patients (68%) reported moderate to severe pain in the immediate postoperative period. Overall, 72% of patients expressed satisfaction with their pain management. Factors significantly associated with higher satisfaction included effective communication with healthcare providers (p<0.001), timely administration of pain relief (p=0.002), and multimodal pain management approaches (p=0.004). The patients who received patient-controlled analgesia (PCA) reported higher satisfaction levels than those who did not (p=0.015). However, dissatisfaction was noted among patients experiencing prolonged pain or side effects from analgesics. Conclusion: The study highlights the importance of effective communication, timely pain relief, and multimodal pain management strategies in enhancing patient satisfaction with postoperative pain management. These findings can inform strategies to improve pain management practices and patient outcomes in tertiary care settings

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Introducción. La implementación del protocolo de recuperación mejorada después de cirugía (ERAS) ha demostrado mejorar los desenlaces en cirugía colorrectal. En Colombia su implementación es escasa y se tiene poca evidencia de sus beneficios. Por esa razón, el objetivo de este estudio fue evaluar el efecto de la implementación del protocolo ERAS en los pacientes sometidos a cirugía colorrectal en un hospital de referencia en el suroccidente colombiano. Métodos. Estudio observacional con abordaje de emulación de experimento clínico ideal. Se incluyeron pacientes adultos sometidos a cirugía colorrectal mayor entre los años 2021 y 2023. Se midió días de estancia hospitalaria, ingreso a unidad de cuidado intensivo (UCI) y la presencia de complicaciones globales, reintervenciones o reingreso hospitalario a 30 días. Se realizó un análisis univariado y multivariado para medir el efecto de la implementación del protocolo ERAS en los desenlaces. Resultados. En total,132 pacientes cumplieron los criterios de inclusión, 79 pacientes en el período previo a la implementación de ERAS y 53 pacientes con el protocolo ERAS. En el análisis multivariado, se encontró una reducción relativa del 77 % para ingreso a UCI, del 57 % de complicaciones globales, del 67 % en el reingreso hospitalario y del 92 % para reintervenciones quirúrgicas tras el alta en los pacientes ERAS. Conclusiones. La implementación de las recomendaciones ERAS en nuestra institución demostró mejorar los resultados clínicos en pacientes sometidos a cirugía colorrectal mayor. En Colombia, se necesita de estudios multicéntricos que permitan evidenciar la plausibilidad y beneficios de estas recomendaciones en otras instituciones.

Introduction. Implementation of the Enhanced Recovery After Surgery (ERAS) protocol has been shown to improve outcomes in colorectal surgery. In Colombia, its implementation is scarce and there is limited evidence of its benefits. For this reason, the objective of this study was to evaluate the effect of ERAS protocol implementation in patients undergoing colorectal surgery in a reference hospital in Southwestern Colombia. Methods. Observational study with ideal clinical experiment emulation approach. Adult patients undergoing major colorectal surgery between 2021 and 2023 were included. Days of hospital stay, admission to the intensive care unit (ICU), and the presence of overall complications, reinterventions, or hospital readmission within 30 days were measured. A univariate and multivariate analysis was performed to measure the effect of the implementation of the ERAS protocol on the outcomes. Results. A total of 132 patients met the inclusion criteria, 79 patients in the period prior to ERAS implementation and 53 patients with the ERAS protocol. In the multivariate analysis, a relative reduction of 77% for ICU admissions, 57% for overall complications, 67% for hospital readmission, and 92% for surgical reinterventions after discharge in ERAS patients was found. Conclusions. Implementation of ERAS recommendations at our institution was shown to improve clinical outcomes in patients undergoing major colorectal surgery, In Colombia, multicenter studies are needed to demonstrate the plausibility and benefits of these recommendations in other institutions.

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Introducción. El cáncer colorrectal es uno de los tipos de cáncer más comunes y mortales a nivel mundial. Aunque los avances médicos han mejorado el manejo, la cirugía sigue siendo fundamental. La resección anterior baja (RAB) de recto ha ganado relevancia, a pesar de que puede llevar al síndrome de resección anterior baja de recto (LARS, por sus siglas en inglés), afectando la calidad de vida. Métodos. Estudio de corte transversal con intención analítica en un centro de referencia en Medellín, Colombia. Los pacientes con cáncer de recto sometidos a RAB entre enero de 2016 y diciembre de 2022 completaron el cuestionario LARS para evaluar disfunción intestinal. Se evaluaron factores relacionados con la presencia de LARS por medio de un análisis bivariado. Resultados. De 234 pacientes elegibles, 110 (47 %) respondieron la encuesta, predominantemente mujeres (58,2 %). La edad promedio fue 62 años. Dos tercios de los pacientes recibieron neoadyuvancia y el 69 % requirieron ileostomía. La prevalencia de LARS fue 47,3 %. El 80,9 % llevaban más de 12 meses desde la cirugía o el cierre del estoma. Factores estadísticamente significativos asociados a LARS fueron edad mayor de 65 años (p=0,03), estadío patológico avanzado (p=0,02) y requerimiento de estoma (p=0,03). Conclusiones. El LARS afecta a casi la mitad de los pacientes en diferentes etapas posquirúrgicas. El LARS scorees una herramienta práctica para evaluar la función intestinal en el seguimiento del paciente. La prevalencia y los factores de riesgo identificados contribuyen a la comprensión del impacto de la cirugía conservadora del esfínter en la calidad de vida de los pacientes.

Introduction. Colorectal cancer is one of the most common and deadly types of cancer worldwide, with a high incidence of rectal cancer. Although medical advances have improved management, surgery remains crucial. Low anterior resection of the rectum (LAR) has gained significance, despite its potential to lead to low anterior resection syndrome (LARS), affecting quality of life. Methods. A cross-sectional study with analytical intent was conducted at a referral center in Medellín, Colombia. Patients with rectal cancer who underwent LAR between January 2016 and December 2022 completed the LARS questionnaire to assess intestinal dysfunction. Factors related to the presence of LARS were analyzed using bivariate analysis. Results. Of 234 eligible patients, 110 (47%) responded, predominantly women (58.2%). The average age was 62 years. Two-thirds of patients received neoadjuvant therapy and 69% required ileostomy. The prevalence of LARS was 47.3%. 80.9% had been more than 12 months post-surgery or stoma closure. Statistically significant factors associated with LARS included age over 65 years (p=0.03), advanced pathological stage (p=0.02), and stoma requirement (p=0.03). Conclusions. LARS affects almost half of the patients in various post-surgical stages. The LARS score is a practical tool for assessing intestinal function in patient follow-up. The prevalence and risk factors identified contribute to the understanding of the impact of sphincter-conserving surgery on patients' quality of life.

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RESUMEN La gastrostomía endoscópica percutánea (GEP) es un procedimiento importante para suministro de nutrición, y que con frecuencia se asocia a complicaciones. La formación de tejido de granulación o granuloma periostomal es una complicación menor crónica asociada a gastrostomía, siendo más frecuente en pacientes geriátricos, pero de la que se conoce mejor la experiencia terapéutica en pacientes pediátricos. Se presenta el caso de una paciente femenina de 94 años, con diagnóstico de demencia de Alzheimer con gran afectación motora y cognitiva, quien presenta importante grado de desnutrición y disfagia severa. En tratamiento con rivastigmina, sertralina, y trazodona, además de relajante muscular. Usuaria de gastrostomía desde hace 2 años por compromiso motor y deglutorio severo. Desde hace 1 año con presencia de granuloma en anillo, sin sangrado. Se decidió tratar con sal común como primera línea de tratamiento al no sangrar. Se instruyó a la cuidadora principal sobre los detalles de cómo aplicar sal común en el granuloma en su domicilio. La paciente mostró una resolución completa del granuloma en tres días de aplicación sin recidiva en el seguimiento posterior a 12 meses de la evaluación inicial, y sin requerir cambio de sonda. El granuloma asociado a GEP es una complicación crónica menor frecuente en adultos usuarios de gastrostomía. El uso de sal común es una alternativa terapéutica eficaz, rápida y segura a considerar en estos pacientes.

ABSTRACT Percutaneous endoscopic gastrostomy (PEG) is an important procedure for nutrition delivery, and one that is often associated with complications. The formation of granulation tissue or periostomal granuloma is a chronic minor complication associated with gastrostomy, being more frequent in geriatric patients, but the therapeutic experience in pediatric patients is better known. We present the case of a 94-year-old female patient, diagnosed with Alzheimer's dementia with severe motor and cognitive impairment, who presents significant malnutrition and severe dysphagia. In treatment with rivastigmine, sertraline, and trazodone, in addition to muscle relaxant. She has been a gastrostomy user for 2 years due to severe motor and swallowing compromise. In the past 1 year ago with presence of ring granuloma, without bleeding. It was decided to treat with common salt as the first line of treatment since there was no bleeding. The primary caregiver was instructed on the details of how to apply common salt on the granuloma at home. The patient showed complete resolution of the granuloma within three days of application with no recurrence at follow-up 12 months after the initial evaluation, and without requiring a tube change. PEG-associated granuloma is a frequent minor chronic complication in adult gastrostomy users. The use of common salt is an effective, rapid and safe therapeutic alternative to consider in these patients.

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Background : In developing countries, emergency laparotomy have very high morbidity and mortality rates. The aim of the present study was to evaluate and find out various determinants for safe outcome in emergency laparotomy in terms of decreased morbidity and mortality. Materials and Methods : A non-randomized retrospective study with collected data from 300 patients with emergency laparotomy. Data from various preoperative and operative factors, surgical technique and complications were recorded. The output was measured as better and worse, as per the Clavien朌indo classification. Results : The study enrolled 300 patients with a male:female ratio of 4.5:1. The majority of patients presented with the history of abdominal pain (98%), abdominal distension (62%) and altered bowel habit (62%). Perforation peritonitis constituted 231 cases followed by intestinal obstruction in 60 cases, rupture liver abscess with peritonitis in 9 cases. Using the Clavien朌indo classification, 30% patients had no complications 27% had Grade I, 12% had Grade II, 16% had Grade III, 11% had Grade IV and 4% had Grade V complication rates. Conclusion : Postoperative complications increase patient morbidity and mortality and are target for quality improvement programs. Many complications may be prevented by thorough preoperative evaluation preceded by adequate aggressive resuscitation, broad spectrum antibiotics, correction of electrolyte imbalances, early minimum & sound surgical technique and careful follow-up care. The Clavien朌indo classification can be adapted to assess the severity of postoperative complications following emergency laparotomy.

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Introdução: A reconstrução mamária pós-tratamento cirúrgico do câncer de mama (um dos principais cânceres que acometem as mulheres) tem sido progressivamente mais indicada, haja vista o benefício da recuperação psicológica e da qualidade de vida, seja utilizando implantes e/ou tecidos autólogos. O presente trabalho visa demonstrar a experiência da equipe, discutir técnicas operatórias e complicações em relação aos dados da literatura mundial, além de verificar a aplicabilidade da técnica na prática clínica da equipe. Método: Estudo observacional retrospectivo desenvolvido em hospital universitário em Juiz de Fora a partir da revisão de prontuários de pacientes submetidas a mastectomia com reconstrução mamária entre 2010 e 2020. Resultados: Das 860 mamas abordadas, 84% foram imediatas à cirurgia oncológica e 16% foram tardias; o principal acesso ao tecido mamário foi a incisão de Stewart, seguido de incisões inframamárias estendidas, periareolares e T invertido; quanto às técnicas reconstrutoras, destaca-se 35% dos casos com retalho com músculo grande dorsal, 25% com prótese pré-peitoral, 20% com retalho miocutâneo transverso do músculo reto abdominal e 10% com retalho muscular local. As complicações mais incidentes foram deiscência de sítio cirúrgico, seguida de necrose cutânea, seroma, infecção de sítio cirúrgico e hematoma, além de outros menos comuns como dor crônica e ruptura de prótese após mamografia. Conclusão: A reconstrução mamária pós-mastectomia é indispensável para a recuperação física e emocional da mulher, sendo as técnicas utilizadas nos últimos dez anos consistentes, confiáveis, de baixa morbidade e com ótimos resultados estéticos quando bem indicadas.

Introduction: Breast reconstruction after surgical treatment for breast cancer (one of the main cancers that affect women) has been progressively more recommended, given the benefits of psychological recovery and quality of life, whether using implants and/or autologous tissues. The present work aims to demonstrate the team's experience, and discuss operative techniques and complications concerning data from the world literature, in addition to verifying the applicability of the technique in the team's clinical practice. Method: Retrospective observational study developed at a university hospital in Juiz de Fora based on a review of medical records of patients who underwent mastectomy with breast reconstruction between 2010 and 2020. Results: Of the 860 breasts treated, 84% underwent immediate oncological surgery and 16% were late; the main access to the breast tissue was the Stewart incision, followed by extended inframammary, periareolar, and inverted T incisions; regarding reconstructive techniques, 35% of cases used a latissimus dorsi muscle flap, 25% used a prepectoral prosthesis, 20% used a transverse rectus abdominis myocutaneous flap and 10% used a local muscle flap. The most common complications were surgical site dehiscence, followed by skin necrosis, seroma, surgical site infection, and hematoma, in addition to other less common complications such as chronic pain and prosthesis rupture after mammography. Conclusion: Postmastectomy breast reconstruction is essential for a woman's physical and emotional recovery, with the techniques used in the last ten years being consistent, reliable, with low morbidity, and with excellent aesthetic results when correctly indicated.

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Introdução: A fissura labiopalatina é a malformação congênita craniofacial mais comum. Dificuldades na alimentação, fala e audição são comuns nestes pacientes, necessitando de tratamento multidisciplinar, o que dificulta a criação e manutenção de serviços especializados. A diversidade de classificações e o grande número de técnicas cirúrgicas utilizadas nas cirurgias primárias (queiloplastia e palatoplastia) dificultam a comparação de dados epidemiológicos e de complicações entre os serviços, existindo carência de estudos avaliando centros especializados em fissuras labiopalatinas recém-criados. Método: Foi realizado estudo do tipo coorte prospectiva com pacientes com diagnóstico de fissura labiopalatina submetidos a procedimentos cirúrgicos primários, no Hospital de Clínicas da Universidade Federal de Uberlândia, entre julho de 2017 e fevereiro de 2023. Foram incluídos pacientes menores de 18 anos com acompanhamento pós-operatório de pelo menos 3 meses. Resultados: Participaram do estudo 79 pacientes, que foram submetidos a 115 cirurgias primárias (54 queiloplastias e 61 palatoplastias). Foram relatadas 11 complicações neste período: 2 deiscências em queiloplastia (3,70%), 1 cicatriz hipertrófica em queiloplastia (1,85%), 6 fístulas em palatoplastia (9,83%) e 2 deiscências em palatoplastia (3,28%). A incidência de complicações foi de 9,56% quando analisado o total de cirurgias, sendo 5,55% nos pacientes submetidos a queiloplastia e 13,11% nos pacientes submetidos a palatoplastia. Conclusão: A incidência de complicações durante os anos iniciais de estruturação do serviço foi semelhante a outros estudos da literatura.

Introduction: Cleft lip and palate is the most common congenital craniofacial malformation. Difficulties in eating, speaking, and hearing are common in these patients, requiring multidisciplinary treatment, which makes it difficult to create and maintain specialized services. The diversity of classifications and the large number of surgical techniques used in primary surgeries (cheiloplasty and palatoplasty) make it difficult to compare epidemiological data and complications between services, and there is a lack of studies evaluating newly created specialized centers for cleft lip and palate. Method: A prospective cohort study was carried out with patients diagnosed with cleft lip and palate who underwent primary surgical procedures at the Hospital de Clínicas of the Universidade Federal de Uberlândia, between July 2017 and February 2023. Patients under 18 years of age with follow-up were included. post-operative period of at least 3 months. Results: 79 patients participated in the study, who underwent 115 primary surgeries (54 cheiloplasties and 61 palatoplasties). 11 complications were reported in this period: 2 dehiscences in cheiloplasty (3.70%), 1 hypertrophic scar in cheiloplasty (1.85%), 6 fistulas in palatoplasty (9.83%) and 2 dehiscences in palatoplasty (3.28%). The incidence of complications was 9.56% when analyzing the total number of surgeries, being 5.55% in patients undergoing cheiloplasty and 13.11% in patients undergoing palatoplasty. Conclusion: The incidence of complications during the initial years of structuring the service was similar to other studies in the literature.