Endoprótesis biliar en el manejo transitorio de la coledocolitiasis / Endoscopic biliary stents for the temporary management of choledocholithiasis

Background: Endoscopic extraction of biliary tract stones is safe and effective. When the procedure is not successful, the use of a temporary stent can be a solution. Aim: To prospectively analyze the usefulness of endoscopic biliary stents in the temporary management of biliary obstruction due to choledocholithiasis. Material and methods: Analysis of 51 consecutive patients (age range 21-88 years, 34 females) with common bile duct stones that, from January 1999 to December 2001, were subjected to an endoscopic insertion of a biliary stent. Results: The indications for stent placement were a large stone in 40 patients (78%), the insecurity of a complete biliary tract cleaning in eight (16%) and technical difficulties in three (6%). Twenty seven patients (52.9%) were jaundiced and 17 (33.3%) had cholangitis. The prostheses remained in place until definitive resolution of the choledocholithiasis in 47 patients (92%) and migrated in 4 (8%). Bilirubin levels became normal in all cases with jaundice and infection resolved in all those with cholangitis. The definitive treatment of choledocholithiasis was done endoscopically in 28 patients (58%) and surgically in 20 (42%). Three patients were lost from follow up. Of these, one patient (2%) died 14 months later due to a recurrent cholangitis. The remaining two patients were asymptomatic and with the prostheses still in place 522 and 560 days post stent placement. Conclusions: When the immediate endoscopic resolution of choledocholithiasis is not possible, temporary stenting is a simple and safe therapeutic alternative that allows patients to be free of obstructive complications until the definitive treatment is carried out.

Prevención de la infección de la herida operatoria post apendicectomía: metronidazol por vía intravenosa versus vía rectal / Prevention of surgical wound infection postappendicectomy: metronidazol by intravenous way versus rectal way

Aim: to compare the efficacy of rectal and intravenous metronidazole in the prevention of anaerobic wound infections after appendicectomy. Patients and methods: one hundred subjected to appendicectomy were randomly assigned to receive, 2 hours before operation, gentamycin 80 mg iv and metronidazole 1 g iv or the same amount of gentamycin and 1 g of metronidazole as a suppository. Surgical wounds were observed for infections until the tenth day of the postoperative period. Results: seven of 45 patients receiving intravenous metronidazole and six of 44 receiving the drug as suppositories had wound infection. The frequency of infection was higher among patients with gangrenous or perforated appendices. They were detected at the fith postoperative day in 8 patients and the most frequently isolated bacteria were E coli and S aureus. Conclusions: rectal metronidazole is equally effective than intravenous metronidazole in the prevention of wound infections after appendicectomy

Colecistectomía laparoscópica: ¿es útil la profilaxis antibiótica en colecistitis crónica? / Laparoscopic cholecystectomy: is it useful the antibiotic prophylaxis in chronic cholecystitis?

En este trabajo se evalúa prospectivamente la utilidad de la profilaxis antibiótica en la prevención de la infección postoperatoria en pacientes portadores de una colecistitis crónica y sometidos a una colecistectomía laparoscópica. Se estudiaron prospectivamente 100 pacientes consecutivos, los que se distribuyeron aleatoriamente en 2 grupos de 50 enfermos cada uno. Grupo I, a los que no se les indicó antibióticos y Grupo II se les administró preoperatoriamente una cefalosporina de tercera generación. Ambos grupos eran similares en edad y sexo, técnica operatoria, patología, etc. En esta serie no hubo complicaciones sépticas intrabdominales. La tasa de infección de la herida operatoria fue similar, 1 caso (2 porciento) para cada grupo (p=0.08). Ambas fueron leves y cedieron rápida y espontáneamente con curaciones. De los resultados de este trabajo se concluye que no se justifica la administración profiláctica de antibióticos a pacientes portadores de una colecistitis crónica y que serán sometidos en forma electiva a una colecistectomía laparoscópica