Cirugía Mayor Ambulatoria en un Servicio de Cirugía General: cinco años de experiencia / Five-year experience with major ambulatory surgery in a department of general surgery

RESUMEN Antecedentes: como Cirugía Mayor Ambulatoria (CMA) se designan procedimientos quirúrgicos te rapéuticos o diagnósticos, realizados con anestesia general, locorregional o local, con sedación o sin ella, que requieren cuidados posoperatorios de corta duración, por lo que no necesitan ingreso hos pitalario. Objetivo: analizar la experiencia de la Unidad de Cirugía Mayor Ambulatoria integrada al Servicio de Cirugía del Hospital Avellaneda, de San Miguel de Tucumán, en el período enero 2014- diciembre 2018. Material y métodos: estudio descriptivo, retrospectivo, de corte transversal, de asociación cruzada. Pacientes entre 14 y 75 años. Los datos fueron recolectados de una base prospectiva implementada desde el inicio de una experiencia piloto. Resultados: se realizaron 3827 intervenciones quirúrgicas, de las cuales 2327 fueron procedimientos quirúrgicos bajo la modalidad de CMA; 1514 correspondieron al sexo femenino; prevaleció el rango de 45 a 54 años de edad. Los procedimientos quirúrgicos realizados fueron: colecistectomía laparoscópi ca, patología de la pared abdominal, patologías orificiales, procedimientos combinados. Indicadores de calidad: la tasa de cancelación, valor atribuible a la ausencia del paciente el día de la cirugía, y de suspensión, debido a la modalidad selección del paciente y de infraestructura, ambas tasas mostraron una disminución estadísticamente significativas entre los años 2014 y 2018. La tasa de reintervención fue en el último año de 0,35%; los ingresos y reingresos disminuyeron a 1,6% y 1,07%, respectivamen te al año 2018. Se presentaron 52 complicaciones, 13 mayores y 39 menores. El grado de satisfacción fue elevado: un 99,5%. Conclusión: la CMA es un proceso seguro, con tasas de complicaciones bajas.

ABSTRACT Background: Major ambulatory surgery is defined as therapeutic or diagnostic surgical procedures, performed under general, regional or local anesthesia, with or without sedation, which require short-term postoperative care, and therefore do not require hospital admission Objective: The aim of this study is to analyze the experience of the same day unit integrated to the Department of General Surgery and Gastrointestinal Surgery at Hospital de Clínicas Pte. Avellaneda in San Miguel de Tucumán between January 2014 and December 2018. Material and methods: We conducted a descriptive and retrospective cross-sectional study. Patients between 14 and 75 years were included. Data were collected from a prospective database implemented for the beginning of a pilot experience. Results: A total of 3827 surgeries were performed; 2327 corresponded to MAS procedures; 1514 patients were women, and aged ranged between 45 and 54 years. The surgical procedures corresponded to laparoscopic cholecystectomy, abdominal wall defects, perianal diseases and combined procedures. Quality indicators: the cancellation rate, which indicates the percentage of patients who did not attend the day surgery unit, and the rate of procedures suspended due to issues associated with patient selection and infrastructure, showed a statistically significant reduction between 2014 and 2018. Unplanned repeated surgery rate was 0.35% in 2018, and unplanned admissions and readmissions decreased to 1.6% and 1.07%, respectively, in 2018. Major complications occurred in 13 patients and 39 patients presented minor complications. Patient's satisfaction was 99.5%.. Conclusion: MAS is a safe process, with low rate of complications.

Herramientas de telesalud para el seguimiento posoperatorio de enfermería en servicios de cirugía mayor ambulatoria / Telehealth Tool for Nursing Postoperative Follow-up in Major Ambulatory Surgery Services

Introducción: La cirugía mayor ambulatoria ha experimentado un aumento creciente en los últimos años, la cual ha ido de la mano con nuevos desafíos para los profesionales de enfermería, quienes realizan el seguimiento posoperatorio de estos usuarios con las diferentes herramientas de telesalud. Objetivo: Identificar en las bases de datos científicas las principales herramientas de telesalud utilizadas en el seguimiento de pacientes post operados vía cirugía mayor ambulatoria. Métodos: Revisión integrativa de la literatura de estudios publicados en español, inglés y portugués, desde 2013 hasta 2019 en las bases de datos MEDLINE/PubMed, CINAHL y SciELO. A partir de la metodología PRISMA, se utilizaron las palabras clave "Teleenfermería", "Procedimientos quirúrgicos ambulatorios", "Monitoreo ambulatorio", "Telemedicina", "Cuidados posoperatorios", con los operadores AND y OR. Fueron seleccionados 10 artículos, a los que se realizó análisis de contenido. Conclusiones: Se identificaron las principales herramientas de telesalud utilizadas en el paciente posoperado de cirugía mayor ambulatoria, donde cada una posee ventajas y limitantes para su uso. Se destacan las aplicaciones móviles como una herramienta a seguir innovando por el gran potencial en prestaciones que posee(AU)

Introduction: Major ambulatory surgery has experienced a growing increase in recent years. This modality has gone hand in hand with new challenges for nursing professionals, who carry out postoperative follow-up of these users by using different telehealth tools. Objective: To identify, in scientific databases, the main telehealth tools used in the follow-up of patients who received major ambulatory surgery. Methods: Integrative review of the literature about studies published in Spanish, English and Portuguese, from 2013 to 2019 in the databases MEDLINE/PubMed, CINAHL and SciELO. Using the PRISMA methodology, the keywords Teleenfermería [Tele-nursing], Procedimientos quirúrgicos ambulatorios [ambulatory surgical procedures], Monitoreo ambulatorio [ambulatory monitoring], telemedicine [telemedicine], and Cuidados posoperatorios [postoperative care] were used, with the operators AND and OR. Ten articles were selected and content analysis was carried out with them. Conclusions: The main telehealth tools used in the postoperative patient of major outpatient surgery were identified. Each has advantages and limitations for its use. Mobile applications stand out as a tool to continue innovating due to their great potential regarding benefits(AU)

Tratamiento de la apendicitis aguda / Acute Appendicitis Management

RESUMEN El objetivo del trabajo es profundizar en los diferentes aspectos cognoscitivos sobre las nuevas evidencias concernientes al tratamiento de la apendicitis aguda y comparar los resultados obtenidos con las diferentes técnicas quirúrgicas empleadas actualmente y el tratamiento conservador. Se realizó una revisión bibliográfica y se seleccionaron artículos en las fuentes electrónicas: Web of Science, Scielo, Elsevier, PubMed, Medline y Google, publicadas en la presente centuria en idiomas español e inglés. La apendicetomía mediante laparotomía ha sido siempre la regla de oro para el tratamiento de la apendicitis aguda. En 1982, se introdujo el acceso laparoscópico que ha demostrado ser tan seguro y eficiente como el convencional. En 2004, la cirugía endoscópica a través de orificios naturales; en 2007 por un solo puerto y en 2015 mediante endoscopia retrógrada. La evolución del cuadro clínico es variable por lo que se han propuesto estrategias como la cirugía ambulatoria, el tratamiento conservador seguido o no de cirugía de intervalo, a fin de evitar intervenciones innecesarias con morbilidad y mortalidad similares a las realizadas con urgencia. La apendicetomía mediante laparotomía o laparoscopia aun es la regla de oro del tratamiento de la apendicitis aguda, aunque se impone el acceso laparoscópico, han surgido nuevas técnicas invasivas y la cirugía ambulatoria. La antibioticoterapia es esencial y como tratamiento único tiene como objetivo disminuir los costos y la morbilidad asociada a la cirugía; por tanto, actualmente el tratamiento adecuado de esta enfermedad es controversial y dependerá de los protocolos de actuación establecidos, el estado del paciente y los recursos disponibles(AU)

ABSTRACT The objective of this work is to study in depth the different cognitive aspects about the new evidences concerning the treatment of acute appendicitis and to compare the results obtained with the different surgical techniques currently used and the conservative treatment. A bibliographic review was carried out and articles were chosen from the electronic sources Web of Science, Scielo, Elsevier, PubMed, Medline, and Google, published in this century in Spanish and in English. Appendectomy by laparotomy has always been the gold standard for the treatment of acute appendicitis. In 1982, laparoscopic access was introduced, which has proven safe and efficient as conventional access. In 2004, endoscopic surgery through natural orifices was used; in 2007, it was performed by a single port, and in 2015, through retrograde endoscopy. The evolution of the clinical picture is variable so strategies have been proposed such as ambulatory surgery, conservative treatment followed or not by interval surgery, in order to avoid unnecessary interventions with morbidity and mortality similar to those performed with urgency. Appendectomy by laparotomy or laparoscopy is still the golden standard of the treatment of acute appendicitis, although laparoscopic access is required, new invasive techniques and outpatient surgery have emerged. Antibiotic therapy is essential and, as a single treatment, aims to reduce costs and morbidity associated with surgery; therefore, the adequate treatment of this disease is currently controversial and will depend on the established protocols of action, patient condition, and the available resources(AU)

Um infusor autônomo para um expansor de pele subcutâneo / An autonomous infuser for a subcutaneous skin expander

Introdução: A expansão da pele é um processo fisiológico definido como a capacidade de aumentar sua área superficial em resposta a uma tensão ou a uma dada deformação. Para realizar a cirurgia reconstrutiva, os expansores de pele são implantados sob a pele e periodicamente infiltrados com uma solução salina para fornecer um retalho extra de pele. Quando o volume interno prescrito do expansor é alcançado, a cirurgia reconstrutiva é realizada. Métodos: Foi desenvolvido um dispositivo semiautomático e portátil para facilitar um procedimento de expansão da pele. O dispositivo tem como objetivo simplificar o processo de infiltração, proporcionando mobilidade e independência para o paciente, e assegurando ao médico a qualidade e a precisão das infiltrações realizadas. O dispositivo também permite expansão contínua em pacientes hospitalizados. Resultados: Usando um código, o médico tem acesso ao menu do dispositivo e define a pressão máxima e/ou o valor máximo para cada expansor do paciente. O paciente pode realizar a infiltração e ter acesso ao controle da velocidade de infiltração, reverter ou parar a operação. Todos os dados são gravados em um SIM Card e incluem data, hora, volumes inicial e final, e pressão inicial e final de cada procedimento para cada expansor. Conclusões: O dispositivo automatiza e otimiza a expansão, de modo que o que o médico possa prescrever um limite para cada expansão, seja uma pressão máxima ou voluma infiltrado. Todos os dados são gravados, fornecendo um importante banco de dados sobre o comportamento de pele relacionado a gênero, raça, idade e local da expansão.

Introduction: Skin expansion is a physiological process defined as the ability of human skin to increase its superficial area in response to a stress or given deformation. In reconstructive surgery, skin expanders are implanted beneath the skin and periodically infiltrated with a saline solution to provide an extra flap of skin. When the prescribed internal volume of the expander is reached, reconstructive surgery is performed. Methods: A semiautomatic and portable device was developed and built to facilitate a skin expansion procedure. The device aims to simplify the infiltration process, providing mobility and independence to the patient and assuring the physician of the infiltration quality and precision. The device also enables continuous expansion in hospitalized patients. Results: Using a code, the doctor accesses the menu of the device and sets the maximum pressure and/or value for each expander of the patient. The patient can control the infiltration velocity and reverse or stop the operation. All data are recorded on a simcard and include date, time, initial and final volumes, and initial and final pressures of each procedure for each expander. Conclusions: The device motorizes and optimizes the expansion, allowing the doctor to prescribe a maximum infiltration pressure or volume. All data are recorded to provide an important database of skin behavior related to sex, race, age, and expansion site.

Cirugía mayor ambulatoria de la glándula tiroides y paratiroides: resultados tras 6 años de experiencia / Major outpatient surgery of the thyroid and parathyroid glands: results after 6 years experience

Objetivo: La cirugía mayor ambulatoria (CMA) y con estancia inferior a 24 horas (overnight stay) se ha consolidado en muchas patologías aunque en cirugía tiroidea y paratiroidea resulta controvertido. El objetivo es valorar nuestros resultados en cirugía del tiroides y paratiroides en régimen de CMA durante un periodo de 6 años. Material y Métodos: Estudio observacional prospectivo de pacientes con indicación de hemitiroidectomía o paratiroidectomía enfocada en régimen CMA entre enero de 2011 y diciembre de 2016. Los pacientes cumplían criterios de CMA. En los primeros años se excluyeron los nodulos tiroideos mayores de 3 cm y los pacientes ASA III. Los pacientes ingresaron la mañana de la intervención, tras el acto quirúrgico pasaron a la Unidad de Recuperación Posquirúrgica y posteriormente a sala de hospitalización. Tras 8 h, si cumplían criterios, fueron dados de alta. Resultados: Se intervinieron 270 pacientes, la tasa de aplicabilidad global fue del 59%, la tasa de aceptabilidad global del 83,6% y el índice de sustitución del 49,2%. El índice de ingresos no deseados fue del 10,4% para la paratiroidectomía y del 17,6% en la cirugía del tiroides. Ningún paciente presentó complicaciones mayores en su domicilio. El grado de satisfacción fue alto o muy alto en el 94% de los pacientes. Conclusiones: La paratiroidectomía enfocada y la hemitiroidectomía realizada por cirujanos expertos en pacientes seleccionados, es segura y efectiva en régimen ambulatorio. Es posible mejorar el índice de sustitución ambulatorio aumentando la tasa de aplicabilidad y aceptabilidad.

Objetive: Ambulatory or overnight stay surgery have been consolidated in many different procedures. However, its use in thyroid and parathyroid surgery is still controversial. The aim of this report is to present the results of 6 years of ambulatory patients undergoing surgery of the thyroid or parathyroid glands. Material and Methods: Prospective observational study of patients who underwent hemithyroidectomy or selective parathyroidectomy in the ambulatory program from January 2011 to December 2016. All patients included met the general criteria of ambulatory surgery. During the first years nodules bigger than 3 cm and patients classified as ASA III were excluded. Patients arrive at hospital the morning of surgery. After the operation, patients pass to the post-anesthesia care unit and then to the hospitalization room. 8 hours after surgery patients are discharged home if they meet the criteria. Results: 270 patients were operated, 159 of them met the inclusion criteria. The overall applicability rate was 59%. The acceptance rate was 83.6% and the substitution index was 49.2%. The unwanted hospital admission was 10.4% for the parathyroidectomy and 17.6% for the hemithyroidectomy. Any patient presented major complications at home. The satisfaction rate was high or very high for 94% of the patients. Conclusion: Selective parathyroidectomy and hemithyroidectomy performed by experienced surgeons in selected patients can be safely and effectively carried out in ambulatory surgery (outpatient). It would be possible to improve the substitution index by increasing the application and acceptability ratios.

Minilifting fronto-temporal para suspensão de cauda de supercílio: técnica minimamente invasiva de Reis-Sundfeld / Frontotemporal minilifting for eyebrow tail suspension: Minimally invasive Reis-Sundfeld technique

INTRODUÇÃO: Um sinal importante do envelhecimento facial é a queda da cauda da sobrancelha. O minilifting frontotemporal visa reposicionar a sobrancelha e amenizar as marcas de expressão, restaurando uma aparência mais jovial. Descrever uma técnica cirúrgica, ambulatorial, capaz de elevar a cauda da sobrancelha, com cicatriz mínima e camuflada na linha capilar, melhorando o aspecto de envelhecimento facial. MÉTODO: Foram arregimentados dez pacientes sequenciais do ambulatório de cirurgia plástica da UNIFESP, que após diagnóstico de queda de supercílio foram submetidos ao minilifting. RESULTADOS: Como resultados preliminares, não houvera nenhuma complicação importante, todos pacientes eram mulheres, um caso apresentara pequena deiscência em linha de sutura após 15 dias de cirurgia. 90% apresentaram índice de imagem corporal em extremamente satisfeitos ou satisfeitos. A média de elevação da cauda do supercílio foi de 5 mm. A média de queda de supercílio pré-operatória foi de 13,3 mm, tendo sua elevação média e manutenção em 12 meses de 18,2 mm. CONCLUSÃO: A técnica sugerida pelos autores é de fácil reprodutibilidade, produz resultados comparáveis às demais técnicas da literatura com as vantagens de apresentar baixo custo, ser realizada ambulatorialmente e ter um efeito rejuvenescedor periocular, pois atenua também as rugas, marcas de expressão e flacidez da região lateral da fissura orbitária e glabelar com significativo tempo de manutenção de resultados.

INTRODUCTION: An important sign of facial aging is the fall of the eyebrow tail. Frontotemporal minilifting aims to reposition the brow and soften the expression marks to restore youthful appearance. To describe an ambulatory surgical technique capable of eyebrow tail lift with minimal scarring and wound camouflage in the capillary line that reduces the facial signs of aging. METHOD: The study included 10 consecutive patients who attended the Plastic Surgery outpatient clinic of the UNIFESP and submitted to minilifting after receiving the diagnosis of eyebrow fall. RESULTS: Preliminary results did not show the occurrence of major complications. All patients were women. One patient presented with small suture line dehiscence 15 days after surgery. A total of 90% of the patients scored their body image index as extremely satisfied or satisfied. The average eyebrow tail lift was 5 mm. The average preoperative eyebrow fall was 13.3 mm, with a mean elevation and maintenance of 18.2 mm in 12 months. CONCLUSION: The technique is easily reproducible, provides outcomes comparable to those of other procedures published in the literature, and presents the following advantages: is low cost; can be performed in an outpatient clinic; provides a rejuvenating periocular effect since it also reduces wrinkles, expression marks, and sagging of the lateral region of the orbital and glabellar fissure; and achieves significant long-lasting results.

Fuego quirúrgico: un incidente prevenible / Surgical fire: an avoidable incident

Introduction: surgical fire requires the presence of three components, known as the "fire triad": a fuel, an ignition source and an oxidizer. Clinical case: we report a patient who, during an ambulatory surgery, suffered a facial burn from a fire. The use of an electrosurgical unit and supplementary oxygen through nasal cannula were important factors in this case. We describe how and why fire start, which are the high-risk surgeries and the strategies to reduce the risk of fire in surgical patients.

Introducción: el fuego quirúrgico requiere tres elementos para que se produzca, conocidos como "triada de fuego": un combustible, una fuente de ignición y un oxidante. Caso clínico: presentamos el caso de una paciente que sufrió una quemadura facial por fuego durante una cirugía ambulatoria, en la que fueron factores importantes el uso de una unidad electroquirúrgica y la administración de oxígeno a través de una cánula nasal. Describimos cómo y por qué se puede producir fuego, cuáles son las cirugías de alto riesgo y las estrategias para reducir el riesgo de fuego en pacientes quirúrgicos.

Pediatric day case surgery: Experience from a tertiary health institution in Nigeria

Background : The general observation that children achieve better convalescence in the home environment supports the need for adoption of day case surgery, which is gaining considerable acceptance in developing countries. Pediatric surgical service is in great demand in developing countries, and in-patient beds and surgical supplies are insufficient. Method : A prospective collection of data on all pediatric day surgeries (PDSs) by the pediatric surgical unit University of Ilorin Teaching Hospital (UITH, Ilorin, was done. Parents had pre-operative outpatient briefing and postoperative interviews on the second and ninth days for consultation regarding post-operative complications and events at home. Study period was between April 2005 and September 2007 (2½ years). Results : Of the 660 elective cases, 449 (68.02%) children were recruited as day cases. The male-to-female ratio was 14.3:1. Age ranged between 20 days and 15 years with a mean of 37.6 months and standard deviation (SD) of 34.4 months. Congenital hernias/ hydroceles were the highest indications (71.2%), followed by lump/ masses (12.9%), undescended testes (8.7%), umbilical hernias (4.8%) and thyroglossal duct cyst (2.5%). In 98.9% of cases, the parents resided within 20 km radius of the hospital, and 91.5% of them could reach the hospital within 1 hour. Fathers and mothers of 80.1% and 77.1% of children, respectively, had above-primary education. More than half of the fathers (55%) were civil servants, while 30% were self-employed. The mothers were civil servants in 37.3% of cases, and 34% were self-employed. The average number of outpatient clinic visits before surgery was 2-3 visits (41.2%) with mean interval to surgery of 4-5 weeks (60.3%). Logistics (investigations and availability of operation list) and patient's fitness for surgery were statistically significant delay factors (P= 0.001). Conclusion : Parents reported 14 children to be irritable at home due to pain, while the others reported satisfactory day case experience. No unplanned admission or mortality was recorded, and only 3 (0.8%) parents would not recommend day case surgery to other people. Conclusion: Pediatric day case surgery is feasible for well-selected and monitored cases in our environment. Term neonates with informed parents are suitable for pediatric day case surgery. There is a need for a day case center to reduce waiting list at UITH

Adverse events and readmissions after day-case urological surgery

OBJECTIVE: The literature lacks of studies on postoperative outcomes after urological ambulatory surgery. Our study aims to identify parameters associated with postoperative complications within 30 days after ambulatory urological surgery. MATERIALS AND METHODS: Adjusted and unadjusted comparisons between clinical features and postoperative outcome (complicated and uncomplicated). RESULTS: Postoperative course was complicated in 5 percent of the patients. Discharge schedule was not completed in 1.1 percent while unplanned visits resulted in admission in 0.5 percent. Multivariate analyses could only confirm the independent effect of type of anesthesia and diagnosis-related group (DRG) relative weight. CONCLUSIONS: Ambulatory urological surgery can be safe in terms of postoperative complications. In the present study surgery under general anesthesia, or a higher DRG relative weight procedure, increased the risk of complications compared to surgery under regional or local anesthesia or lower DRG relative weight operations. Patients scheduled for general anesthesia or undergoing complex urological procedures should be warned about an increased risk of postoperative incidents and/or readmission.

Readmisión hospitalaria en un centro ambulatorio quirúrgico / Readmission to an ambulatory surgery center

Introducción: La readmisión hospitalaria de pacientes ambulatorios se ha convertido en una importante medición de la calidad de un centro ambulatorio. Estudiando sus causas y los factores que la predisponen, evaluamos el objetivo principal del centro, los equipos profesionales y la organización operativa. La incidencia de readmisión en cirugía ambulatoria varía del 0,11 por ciento al 2,4 por ciento. Objetivo: Determinar la incidencia, las causas y los factores predictivos de readmisión hospitalaria en cirugía ambulatoria. Material y métodos: Durante 9 años, se analizaron en forma retrospectiva y consecutiva todos los pacientes sometidos a cirugía en un centro de atención ambulatoria. Resultados: Se incluyeron 2495 pacientes ambulatorios. El índice de readmisión fue del 0,76 por ciento (19/2495 pacientes). Las causas de readmisión fueron divididas en cuatro categorías: quirúrgicas 42,10 por ciento, anestésicas 36,85 por ciento, falta de tiempo de recuperación 15,80 por ciento y sociales 5,25 por ciento. En el análisis multivariado, los factores predictivos independientes de readmisión hospitalaria, con significancia estadística fueron: tiempo quirúrgico, cirugía general y anestesia general [OR e IC95 por ciento 1,02, (1,02-1,03); 3,52, (1,24-9,97); y lO, (1,21-82,49), respectivamente]. Conclusión: La incidencia de readmisiones es baja y aceptable para una unidad quirúrgica ambulatoria. Las complicaciones que exigen el rápido traslado en ambulancia desde el quirófano hasta una unidad de cuidados intensivos de otra institución tienen una alta probabilidad de originar demandas legales, sea por su gravedad y también por la falta de contención de los familiares del paciente, quienes cuestionan abiertamente la capacidad operativa del centro ambulatorio en estos tipos de complicaciones.

Umbilical hernia in adults: day case local anaesthetic repair.

INTRODUCTION: The waiting times for elective surgery of Umbilical hernia (UH) in adults are unacceptably long in some cases. During this period, irreducibility and strangulation are possible. We operate on adult patients under local anaesthesia (LA) as day cases to avoid this delay and describe our experience in this paper. AIMS: The aims of our study were to look at the age and sex distribution, body weight, type and amount of local anaesthetic used, morbidity, admission and readmission rates, and waiting times of adult patients operated on for UH under LA. MATERIALS AND METHODS: It was a retrospective study covering a 4 year period from July 1996 to June 2000 including all adult patients undergoing the above procedure under the care of a single consultant general surgeon. A standard Mayo repair using non absorbable material was used without a mesh or a drain. RESULTS: 32 patients with UH were operated on under LA, 23 males and 9 females with a median age of 51 years (range 20 to 86 years). The body weight ranged from 63 to 120 (median 87) kg. The average duration of the procedure was 30 (range 22-40) minutes. Sedation was needed in 4 patients. Two patients developed wound infections, one superficial and one deep. There was no mortality. The median period of follow-up was 24 (range 4-48) months and there was no recurrence. The median waiting time for the operation was 6 weeks. CONCLUSIONS: Day case local anaesthetic repair of UH in adults seems to be safe and feasible with an acceptable morbidity. Suture repair in the right patient has excellent results and the waiting times are acceptable.

Factibilidad de la cirugía ambulatoria en el medio rural / Ambulatory surgery in the country side

Determinar la factibilidad de la cirugía ambulatoria en una población rural. Estudio prospectivo de campo; desde septiembre a diciembre de 1997, cuyos criterios de inclusión fueron: edad comprendida entre 12 y 70 años, clasificado como ASA o II, intervención no mayor del segundo nivel, laboratorio dentro de límites normales, sin intervenciones intraabdominales previas, acompañante mayor de edad el día de la intervención. Además se tomó en cuenta para el análisis, tipo de anestesia, lugar de procedencia, tiempo entre 1 consulta e intervención y período posoperatorio intrahospitalario. Anexo quirúrgico, AR II, Mene de Mauroa, Estado Falcón. Se intervinieron 62 pacientes con solo una complicación, prevaleció el sexo femenino con 67,75 por ciento sobre un 32,25 por ciento del masculino, 2/3 de los pacientes se encuentran entre los 25 y 49 años, fue utilizada anestesia local en un 37,05 por ciento y conductiva en 62,95 por ciento no se utilizó anestesia general. El 46,8 eran procedentes de la localidad y 24,2 por ciento procedentes de áreas de no influencia del centro asistencial incluyendo otro estado. El 75,8 por ciento se intervinieron en un lapso menor o igual a 15 días después de la primera consulta, el 100 por ciento fueron dados de alta de las 24 horas. La cirugía practicada en un medio rural con las condiciones mínimas necesarias es factible, segura y eficaz

Anestesia en cirugía ambulatoria / Anesthesia in ambulatory surgery

Entre enero de 1993 y diciembre de 1997, el Servicio de Cirugía General del Hospital I IPSS Florencia de Mora, de la Gerencia Departamental La Libertad, realizó 868 intervenciones quirúrgicas de cirugía ambulatoria en 854 pacientes, 484 (56.7 por ciento) mujeres, 370 (43.3 por ciento) varones, con predominancia de la cuarta y quinta década de la vida. Las intervenciones más frecuentes fueron herniorrafías (49.8 por ciento) seguidas por colecistectomías (22.9 por ciento). Se utilizaron diversas técnicas anestésicas, siendo el bloqueo regional: raquídea 32.5 por ciento y epidural 30.6 por ciento, las más frecuentes, seguida de anestesia general inhalatoria con 26.7 por ciento. No hubieron fallecidos en el presente estudio, 12 pacientes (2.2 por ciento) que presentaron complicaciones dep;endientges del procedimiento anestésico, siendo la cefalea p;ostraquídea la más frecuente (1.2 por ciento) seguida p;or dolor en el sitio de la punción epidural (0.5 por ciento). Estas complicaciones son comparadas favorablemente con la literatura internacional

Hemorroides: Tratamiento ambulatorio por medio de ligadura con banda elástica / Ambulatory treatment of symptomatic hemorrhoids with rubber band ligation

Se presentan 108 pacientes portadores de hemorroides sintomáticas grado I, II y III que fueron tratados por medio de ligadura con banda elástica en forma ambulatoria entre 1982 y 1990. Los resultados alejados fueron evaluados a través de un cuestionario que respondieron 72 pacientes y del cual se deduce que el 79 por ciento de éstos experimentaron "curación clínica" o mejoría de los síntomas. En el 10 por ciento de los casos se observaron complicaciones como dolor, disuria, trombosis, hemorragia, etc. Se concluye que el método es ideal para tratar hemorroides de estos grados por no requerir anestesia, ser ambulatorio, bien tolerado por los pacientes y de bajo costo operativo