Experiencia en colecistectomía laparoscópica ambulatoria / Experience in ambulato ry laparoscopic cholecystectomy

Introducción: la Cirugía Ambulatoria es un modelo organizativo de asistencia quirúrgica, que permite tratar a pacientes bien seleccionados en forma efectiva, segura y eficiente, sin necesidad de contar con una cama de internación. La Colecistectomía laparoscópica es considerada actualmente el tratamiento de elección de la litiasis vesicular sintomática. El uso de la laparoscopía reduce la estadía hospitalaria y el tiempo de recuperación postoperatoria. Objetivo: evaluar la factibilidad, seguridad y beneficios de la realización de Colecistectomías Laparoscópica en Pacientes en una Unidad de Cirugía Ambulatoria. Material y Métodos: el registro de los pacientes durante el peroperatorio de Colecistectomías Laparoscópicas desde Enero del 2012 a Diciembre del 2014, en la Unidad de Cirugía Ambulatoria del Policlínico del Docente. Resultados: Del total de las cirugías, 623 fueron Colecistectomías Laparoscópicas de las cuales 519 se realizaron en forma programadas e ingresaron por U.C.A. y 104 por guardia. El tiempo promedio de permanencia en el área es de 8,25 hs. El índice de ambulatorización es del 83.3%. Conclusión: La realización de la Colecistectomía Laparoscópica en una modalidad ambulatoria en pacientes adecuadamente seleccionados, constituye una opción interesante para aumentar el número de colecistectomías en nuestro medio y modifica positivamente la percepción del paciente sobre su enfermedad y acelera su recuperación.

Introduction: Ambulatory Surgery is a surgical care organizationalmodel that allows selected patients to be treated effectively, safely and efficiently, without taken a bed of admission. Laparoscopic cholecystectomy is now considered the Gold Standard treatmentfor symptomatic gallstones. The laparoscopy surgery reduceshospital stay and postoperative time recovery.Objective: To evaluate the feasibility, safety and benefits ofperforming laparoscopic cholecystectomy in patients in a DaySurgery Unit (D.S.U). Material and Methods: the registration of patients during theperioperative Laparoscopic cholecystectomy from January 2012to December 2014, in the Day Surgery Unit from the Policinico delDocente.Results: Of all the surgeries, Laparoscopic cholecystectomy were623 of which 519 were performed as scheduled and entered byD.S.U. and 104 were admitted at the Urgencys Appartment. The average time spent in the area is 8.25 pm. Ambulatory index is83.3%. Conclusion: The realization of laparoscopic cholecystectomy inan outpatient based in properly selected patients, is an interestingmodel to increase the number of cholecystectomies in ourenvironment and positivel y change the perception of the patientabout his illness and recovery accelerates option.

Concurrent stone stabilization improves ultrasonic and pneumatic efficacy during cystolithopaxy: an in vitro analysis

Objective To identify whether stabilization of larger bladder stones would improve the efficacy of combination (ultrasonic/pneumatic) lithotripsy in a phantom bladder stone model for percutaneous cystolithopaxy. Materials and Methods Using 1cm phantom Bego stones, a spherical model bladder was used to simulate percutaneous bladder access. A UroNet (US Endoscopy, USA) was placed alongside a Swiss Lithoclast probe through the working channel of a Storz 26Fr rigid nephroscope. Using a 30Fr working sheath, the stone was captured, and fragmented for 60seconds. Resulting fragments and irrigation were filtered through a 1mm strainer, and recorded. Five trials were performed with and without the UN. Durability was then assessed by measuring net defects, and residual grasp strength of each instrument. Descriptive statistics (mean, standard deviations) were used to summarize the data, and Student’s t-tests (alpha<0.05) were used to compare trials. Results The mean time to stone capture was 12s (8-45s). After fragmentation with UN stabilization, there were significant improvements in the amount of residual stone (22% dry weight reduction vs 8.1% without UN, p<0.001), number of fragments (17.5 vs 5.0 frag/stone, p=0.0029), and fragment size (3.6mm vs. 7.05 mm, p=0.035). Mesh defects were noted in all nets, ranging from 2-14 mm, though all but one net retained their original grip strength (36.8N). Conclusions Bladder stone stabilization improved fragmentation when used in conjunction with ultrasonic/pneumatic lithotripsy. However, due to limitations in maneuverability and durability of the UN, other tools need to identified for this indication. .

Transurethral cystolithotripsy for large vesical calculi

To assess efficacy and safety of transurethral cystolithotripsy in the management of large vesical calculi. Adult patients with large vesical calculi [>2.5cm] were selected for this prospective study. Patients with associated urethral stricture and big adenomas were excluded. Stone size was measured on ultrasound in the largest diameter. Patients were operated under spinal or general anaesthesia. Nephroscope with 28 fr sheath was used transurethrally along with 2 cm lithoclast probe. Initial fragmentation was achieved with Swiss lithoclast. Later bigger fragments were dealt with stone punch. In the end all fragments were evacuated with Ellick evacuator. Bladder was drained with Foley's catheter for 24 hours. TURP [transurethral resection of prostate] was done if required. Patients with bigger glands were excluded to restrict operating time. Patients were followed up for two weeks. Forty patients were selected. Mean age of the patients was 55 years [range 18-73 years]. There were 32 males [80%] and 8 females [20%]. Stone size was 4.72 +/- 2.52 cm with range of 2.5-7.0 cm. Five patients had multiple stones, four of them had associated neurogenic bladder. Procedure time ranged from 20-90 minutes [mean 45.8 minutes]. Complete fragmentation of calculi was achieved in all patients. Twelve patients underwent TURP under same anaesthesia. Time consumed on resection of prostate was not included in procedure time. There were no major complications. Transurethral cystolithotripsy is very effective and safe for large vesical calculi [>2.5cm]. It is time consuming but saves patients from hazards of open surgery.

Percutaneous intervention of large bladder calculi in neuropathic voiding dysfunction

PURPOSE: To report our results and rationale for treating large bladder calculi in patients with neuropathic voiding dysfunction (NVD) using percutaneous cystolithalopaxy. MATERIALS AND METHODS: Ten patients with a previously diagnosed NVD presenting with a large stone burden were identified from our department database and a retrospective review of case notes and imaging was performed. RESULTS: Percutaneous access to remove bladder stones (range 8x7 to 3x2 cm) had a mean surgery length of 150 min and blood loss of 23 mL. Six of the seven patients treated percutaneously were discharged on the day of surgery and suffered no complications, while one patient experienced poor suprapubic tube drainage and required overnight admission with discharge the following day. Transurethral removal of stone burden (range 4x4 to 4x3 cm) had a mean surgery length of 111 min and blood loss of 8 mL. Each of these three patients were under our care for less than 23 hours, and one patient required a second attempt to remove 1x0.5 cm of stone fragments. There was no statistical difference between mean operative times and estimated blood loss, p = 0.5064 and p = 0.0944 respectively, for the two treatment methods. CONCLUSION: In this small series, percutaneous cystolithalopaxy was a safe, effective, and often preferred minimally invasive option for removal of large calculi in patients with NVD. We suggest possible guidelines for best endoscopic approach in this population, although a larger and prospectively randomized series will be ideal for definitive conclusions.

Uso del laser holmium para el manejo de coledocolitiasis compleja en la exploración laparoscópica de las vías biliares / Use of holmium laser for management of complex choledocholithiasis in laparoscopic bile duct exploration

Presentar la primera experiencia nacional con el uso de Holmium Láser en la exploración laparoscópica de las vías biliares para el manejo de cálculos en la vía biliar intrahepática, llevado a acabo en el Hospital Universitario de Caracas, en el Servicio de Cirugía III. Se presenta caso de paciente femenina de 35 años de edad, con clínica de síndrome ictérico obstrutivo, a quien se le realizó colangiopancreatografía retrógrada endoscópica evidenciando cálculos impactados en la vía biliar izquierda, sin lograr la extracción de los mismos, motivo por el cual se decide realizar exploración laparoscópica la vía biliar con el uso del Holmium laser para la litotripsia. Se realizó exploración laparoscópica de las vías biliares y litotripsia con Holmium Laser, logrando la fragmentación y extracción de los mismos. La paciente evolucionó de forma satisfactoria, sin complicaciones, siendo egresada al tercer día de postoperatorio. Cuando la colangiopancreatografía retrograda endoscopica resulta ineficiente en el caso de cálculos intrahepáticos o cálculos grandes impactados en la vía biliar, el siguiente paso es la exploración qurúrgica. La exploración laparoscópica con el uso de Holmium Laser permite la listotripsia a través de ablación fototérmica sin riesgo de lesionar estructuras adyacentes, obteniendo resultados favorables y aumentando la tasa de efectividad del procedimiento cuando se trata de coledocolitiasis compleja.

Present the first national experience with the use of Holmium Laser in laparoscopic common bile duct exploration for the management of intrahepatic bile duct stones, performed in Surgery Department III at the Hospital Universitario de Caracas. A 35 years old female with obstructive jaundice syndrome who underwent endoscopic retrograde cholangiopancreatography showing impacted stones in the left hepatic duct. Being impossible to clear the stones, a laparoscopic common bile duct exploration with the Holmium Laser was performed. A laparoscopic common bile duct exploration and Holmium Laser was performed, achieving stone clearance. The patient was dischanged with no complication on the third postoperatory day. When endoscopic retrogarade cholangiopancreatography is inefficient in the case of intrahepatic stones or large stones impacted in the common bile, the mext step is surgical exploration. Laparoscopic common bile duct exploration with the Holmium Laser result in photothermal of stones without injury to surrounding structures, obtaining favorable results and increasing the rate of effectiveness of the procedure in the management of complex billary tract caluli.

Dispositivo intrauterino intravesical en expulsión en embarazo de tercer trimestre: reporte de un caso / Intravesical migration of intrauterine device in a pregnant woman

Se estima que en el mundo cerca de 160 millones de mujeres son usuarias de dispositivos intrauterinos (DIU), siendo Chile uno de los países con más alta tasa, con cerca del 70 por ciento de las usuarias en el sistema público. Sin embargo, su uso no está exento de complicaciones. Presentamos un caso infrecuente de DIU intravesical en expulsión en gestante de 28 semanas.

In the world, about 160 million women are users of intrauterine devices (IUD); Chile is one of the countries with the highest rate, with about 70 percent of users in public system. However, its use may be complications. We present an unusual case of intravesical IUD expulsion in 28 weeks pregnant.

Extracorporeal shock wave lithotripsy; outcome in pediatric urolithiasis

[1] To determine the efficacy of extra-corporeal shock wave lithotripsy with reference to stone size, site and radiodensity in children. [2] To determine acute early complications during and following extra-corporeal shock wave lithotripsy in children. Analytical case series study. Fifty patients of either sex below the age fourteen [14 years] having renal, ureteric and bladder stones between 5-20 mm in size along with their long axis presented to department of urology Shaikh Zayed Hospital Lahore during the period of one year extending from 02-02-2008 to 02-02-2009 were included in this study. Children with serum creatinine level greater than or equal to 3mg/dl, obstruction distal to the stone, patient with active bleeding disorders, uncorrected hypertension, patient unfit for general anaesthesia, untreated urinary tract infection and patients with gross anatomical anomaly were excluded from study. All the patients were given shock waves under intravenous sedation or general anaesthesia in a standard manner on out door basis. All the children were evaluated for stone clearance and early complications at first 24-72 hours. At the end of three months ESWL treatment was considered successful, if the patients were stone free or had residual fragments 4 mm or less in size. Out of the fifty patients, 40 [80%] were males and 10 [20%] females with male to female ratio of 4.1. The age range of patients was 2-14 years [mean +/- SD 9.24 +/- 3.48 years]. Thirty three patients [66%] had renal stones, 7 [14%] ureteric and 10 patients [20%] had bladder stones. Single successful treatment session was noted in 22 patients [44%], 18 patients [36%] received two sessions and 10 patients [20%] required three sessions for successful stone fragmentation. Seventeen patients did not show stone clearance even after three sessions within three months follow-up. Twenty one patients [42%] felt pain after lithotripsy session, and they were given injectable analgesia and the pain settled, haematuria in 17 patients [34%], impacted stone in five [10%], ureteric colic and urinary tract infection in three, three cases respectively and only one case developed steinstrasse. Twenty patients [40%] developed minor complications of anaesthesia, like nausea, vomiting which relieved with injectable antiemetics

Efficacy of the Egyptian pneumatic lithotriptor using cystoscopy in vesical calculi treatment

Objective The majority of vesical calculi in adults can now be treated transurethrally with the use of different lithotriptors. The aim of this article was to study the effectiveness of the Egyptian pneumatic lithotriptor through a rigid cystoscope in the treatment of vesical calculi. Patients and Methods Fourteen adult patients (12 males and 2 females) had single urinary bladder stones. Mean stone diameter was 20 mm. Through a cystoscopic sheath; a modified ureteric catheter was introduced into the bladder. Using the Egyptian pneumatic lithotriptor - KH. YG2; the pneumatic probes (rigid or flexible) were passed through the catheter for stone disintegration. Results Successful stone disintegration was recorded in 13 patients (92.9) where the patients were stone-free at the end of the procedure. Failure of stone fragmentation occurred in one case (7.1). The stone was removed surgically. Its chemical composition was found to be calcium oxalate monohydrate. The average time of cystolithotripsy was 35 minutes. Hospitalization ranged from 12 to 24 hours which was longer (2 to 4 days) for those patients who had undergone other procedures. Minor complications such as mild hematuria (100) and cystitis (21.4) were observed. No major complications were noted. Conclusion The use of the Egyptian lithotriptor during cytoscopy has been found to be an effective; easy; safe and economical method for the treatment of vesical stones

Rehabilitación de vejiga neurogénica en pacientes con lesión medular ingresados al Hospital de Rehabilitación Aldo Chavarría sept 2002-oct-2003 / Bladder rehabilitation neurogénica in patient with medullary injury entered Rehabilitation Hospital Aldo Chavarría sept 2002-oct- 2003

El presente estudio es descriptivo, de corte transversal, con el objetivo de determinar la Rehabilatación de Vejiga Neurogénica en pacientes con lesión medular del Hospital de Rehabilitación Aldo Chavarría ingresados al servicio asistencial, en el período septiembre 2002 a octubre 2003. Sometidos a estudio 49 pacientes, las variables fueron procesadas en programas estadísticos SSPS 7.5 y analizadas en procentajes. Se describió edad, con predominio 20-29 años, 40 pacientes del sexo masculino y 9 femenino. La mayoría originarios de Managua, nivel de escolaridad primaria, estancia hospitalaria 4-10 y 11-17 semanas. La causa más frecuente de lesión medular fue traumática; Clasificación Frankel A y B, nivel de lesión esquelético C5-T11 prevaleciendo en este último vejiga neurogénica espástica. En resultado de reeducación vesical el mayor porcentaje logró micción espontánea y cateterismo intermitente cada 4 horas, correspondiendo al 79.6 porciento del total de pacientes. La complicación más frecuente durante la reeducación vesical fue la infección de vías urinarias, asociadas en un caso litiasis vesical...

Colangiografia fluoroscópica transoperatoria: una mejor alternativa en cirugía laparoscópica / Fluoroscopic transoperative cholangiograpy: a better alternative in laparoscopy surgery

La endoscolecistectomia es la cirugía que se realiza más frecuentemente. La colangiografía trasoperatoria se realiza en todo paciente con sospecha de coledocolitiasis. La colangiografía estática convencional es usada entre los cirujanos de vías biliares. Nuestro objetivo es dar a conocer las ventajas de la fluoroscopia tales como menor irradiación, reducción del tiempo operatorio, mejor relación costo beneficio, mayor fidelidad para el diagnóstico de espasmo del esfinter de Oddi así como la facilidad para descartar artefactos. Presentamos la experiencia en 13 pacientes sometidos a endocolecistectomía en el Centro Clínico San Cristobal a quienes se les realizó colangiografía fluoroscópica transoperatoria

Colecistectomía laparoscópica: en una paciente con situs inversus totalis / Cholecystectomy laparoscopy: in patient with situs inversus totalis

Se reporta el caso de una paciente de 28 años con litiasis vesicular sintomática y situs inversus totalis a quien se les práctico colecistectomía por laparoscopia. Adicionalmente la paciente presentaba el diagnóstico de leiomiomatosis uterina con hemorragias anemizantes por lo que se realizó en el mismo acto anestésico y en segundo tiempo quirúrgico, histerectomía abdominal total a través de una incisión de Pfannenstiel practicándose también apendicectomía incidental. La paciente evolucionó satisfactoriamente sin complicaciones. Se revisa la literatura y se concluye que la colecistectomía laparoscópica en pacientes con situs inversus es un procedimiento seguro. Se recomienda en estos casos una disección cuidadosa para identificar con detalles los elementos anatómicos involucrados en el procedimiento y evitar así posibles lesiones iatrógenas

Quiste de vesícula seminal con litiasis / Seminal vesicle cyst with lithiasis

Presentamos un caso de quiste de vesícula seminal (VS) con macrolitiasis en un paciente prepúber. Se trata de un niño de 11 años de edad, que consulta por IUR asociadas con dolor perineal, con antecedentes de epididimitis aguda derecha; descubriendo como hallazgo en los estudios por imágenes, agenesia de riñon derecho y una formación litiásica en vesícula seminal derecha. Se realiza la exéresis de la vesícula seminal derecha con la litiasis en su interior, evolucionando sa-tisfactoriamente. Se analizan los distintos métodos diagnósticos para evaluar las vesículas semi-nales y las opciones de tratamiento, haciendo hincapié en los distintos abordajes quirúrgicos.

Reduction of urinary stone in children from north-eastern Thailand.

Bladder stones in children have decreased now compared with the previous decade. If we promote good nutrition for children, bladder stones will decrease and might be eradicated in the future. A seminar of doctors and health personnel from 19 hospitals in the north-eastern provinces of Thailand was conducted to survey bladder stones in children by weighting and interviewing bladder stone symptoms then giving supplementary diet milk and vitamins and teaching health education about nutrition and urinary stones through referring children with bladder stones to hospitals in north-eastern Thailand for surgery. The findings of the stone patients from October 1995 to June 1996 from hospitals in northern Thailand were: Total number of patients was 6671 of which 287 patients (4.3%) were 10 years old or younger. Of these children there were 135 renal stone operations (2.0%), 29 ureteric stone operations (0.4%), 106 bladder stone operations (1.6%) and 17 urethral stone operations (0.3%). There were 6384 patients aged more than 10 years. (95.7%) The total number of operations was 5373.

Estudio de costo en el tratamiento de la litiasis vesical por el método endoscópico versus cistolitotomía

Se hizo un estudio comparativo para estimar el costo-beneficio de dos métodos terapeúticos de la litiasis vesical: la cistolitotomía y la litotricia endóscopica, para lo cual se evaluaron 16 parámetros en 23 pacientes operados con la primera en el Hospital General Santiago e igual cifra de intervenidos con la segunda en el Hospital Provincial "saturnino Lora"de donde se derivó que el procedimiento endóscopico es mucho más ventajoso que el cistolitotómico desde los puntos de vista clínico y económico

Litíase vesical endêmica: relato de um caso e revisão da literatura / Litiase endemic vesical: case report and revision of the literature

Relata-se um caso de uma paciente de 8 anos, portadora de litíase vesical endêmica. E feita uma breve revisão quanto aos aspectos epidemiológicos, fisiopatológicos e clínicos desta entidade que é considerada pouco frequente em nosso meio, principalmente no sexo feminino, assim como aspectos diagnósticos e terapêuticos

Aspectos celulares e moleculares da interaçäo entre cristais de oxalato de cálcio e células tubulares renais / Cell and molecular aspects of the interaction between calcium oxalate crystals and the kidney tubular cells

Nos últimos anos o emprego de técnicas de biologia celular e molecular permitiu que conceitos acerca da origem da litíase do trato urinário mudassem consideravelmente. A interaçao entre cristais de oxalato de cálcio e o epitélio tubular renal exerce importante papel na gênese dos cálculos renais. Os aspectos envolvendo a adesao destes cristais às células tubulares, desencadeando internalizaçao dos mesmos e uma resposta celular proliferativa expressiva sao aqui revistos e podem representar um novo caminho para a prevençao e o tratamento da nefrolitíase.