Hernias hiatales verdaderas: tratamiento quirúrgico por vía laparoscópica / True hiatal hernias: laparoscopic surgical treatment

Las hernias hiatales se clasifican en 3 tipos: I. Axiales por deslizamiento; II. Paraesofágicas; III. Mixtas. Desde 1991 se ha incorporado el acceso laparoscópico para el reflujo gastroesofágico y hernias hiatales con buenos resultados. Se presentan 15 casos de hernias hiatales grandes con 1/3 de estómago intratorácico, que fueron operados por vía lapatoscópica, los cuales correspondieron a: Tipo I=10, Tipo II=1; Tipo III=4. Una de éstas correspondió a una hernia hiatal tipo I recidivada postcirugía antirreflujo operada 4 años antes. Todos estos pacientes presentaron síntomas de reflujo. Durante la cirugía se realizó disección del saco, reducción de la hernia y del estomago herniario, hiatoplasia y, cirugía antirreflujo. Al control radiológico postoperatorio se confirmó reducción completa de la hernia con desaparición de los síntomas de RGEP. El abordaje laparoscópico para las grandes hernias hiatales es factible, seguro y con buenos resultados clínicos y radiológicos

Desfibrilador implantable en el manejo de taquiarritmias ventriculares malignas: experiencia del Centro Nacional de Arritmias / Implantable defibrillators in the management of malignant ventricular tachyarrhythmias

Background: Implantable defibrillators are the most effective means to prevent sudden death in patients with malignant ventricular tachyarrhythmias. The availability of this type of devices is limited in Chile, due to their high price. Aim: To report the first patients treated with implantable defibrillators in our hospital. Patients and methods: Nine males and one female aged 13 to 65 years old are reported. Three presented with ventricular fibrillation (presenting out of the hospital in three) and the rest had ventricular tachycardia resistant to drugs or radiofrequency ablation. Results: All implantswere performed using intracardiac electrodes. The generator was implanted in the pectoral region in nine and in the abdomen in one. A successful defibrillation was obtained with less than 15 J in four patients, with 20 J in three and with 24 J in three. There were no complications during the procedure. After a 12 months follow up, four patients have been treated by the implantable device. One of these subjects had a ventricular fibrillation in two occasions. One patient died of a bronchopneumonia two years after the implant. Conclusions: Implantable defibrillators are an effective therapy for the treatment of malignant ventricular arrhythmias with a high risk of sudden death