Apendicectomía en pacientes con situs inversus: Serie de tres casos con manejo laparoscópico / Appendectomy in patients with situs inversus: Three cases series with laparoscopic approach

Introducción. La transposición de los órganos debido al situs inversus (SI) es una rara afección que dificulta el diagnóstico de la apendicitis aguda. Esta condición hace que la sintomatología del paciente y los hallazgos al examen físico puedan ser atípicos, lo que demanda el uso de imágenes para la confirmación diagnóstica en la mayoría de los casos. Métodos. Se describieron tres casos de apendicitis en pacientes con diagnóstico de situs inversus. Dos de ellos tenían el antecedente conocido, mientras el tercer caso fue diagnosticado de forma intraoperatoria. Resultados. En dos pacientes se decidió llevar a cirugía vía laparoscópica sin imágenes diagnósticas adicionales. Los pacientes evolucionaron de manera satisfactoria. Conclusión. Siempre se debe considerar la apendicitis dentro de los diagnósticos diferenciales en los pacientes con dolor en fosa ilíaca izquierda. Es fundamental diagnosticar y tratar la apendicitis de manera efectiva para minimizar las complicaciones asociadas. La importancia de la anamnesis y la sospecha clínica del examinador son vitales en estos casos, que se pueden confirmar con las imágenes diagnósticas. Pueden existir casos en donde la condición clínica del paciente no permita la realización de estudios diagnósticos por imágenes; esto apoya cada vez más el uso del abordaje laparoscópico. Se recomienda considerar el abordaje laparoscópico en primera instancia, ya que nos permite la confirmación diagnóstica de situs inversus totalis en caso de que el antecedente sea desconocido y facilita el manejo oportuno de la urgencia.

Introduction. Organ transposition due to situs inversus (SI) is a rare condition that makes the diagnosis of acute appendicitis difficult. This condition entails that the patient' symptoms and physical examination findings may be atypical, which requires the use of images for diagnostic confirmation in most cases. Clinical cases. Three cases of appendicitis in patients diagnosed with situs inversus are described. Two of them had a known medical history, while the third case was diagnosed intraoperatively. Results. In two patients it was decided to undergo laparoscopic surgery without additional diagnostic images. The patients progressed satisfactorily. Conclusion. Appendicitis should always be considered in the differential diagnoses in patients with pain in the left iliac fossa. It is essential to diagnose and treat appendicitis effectively to minimize associated complications. The importance of the anamnesis and the examiner's clinical suspicion are vital in these cases, which can be confirmed with diagnostic images. There may be cases where the patient's clinical condition does not allow diagnostic imaging studies to be performed, increasingly supports the use of the laparoscopic approach. It is recommended to consider the laparoscopic approach in the first instance, since it allows us to confirm the diagnosis of situs inversus totalisin case the history is unknown and facilitates timely management of the emergency.

Hidatidosis esplénica única / Isolated splenic hydatid disease

RESUMEN La hidatidosis es una parasitosis endémica en la Argentina. Los órganos más afectados son hígado y pulmón, pero la afectación esplénica única es infrecuente. El objetivo del trabajo es presentar 2 casos de hidatidosis esplénica única. Su diagnóstico presuntivo se realizó mediante el antecedente epidemiológico y los estudios por imágenes. Las serologías resultaron negativas en ambos casos. El tratamiento fue quirúrgico: se realizó esplenectomía laparoscópica total. Esta patología debe sospecharse en zonas endémicas ante la aparición de quistes esplénicos a pesar de presentar serologías negativas. La esplenectomía total evita la recidiva local y cavidades residuales; se prefiere el abordaje laparoscópico al disminuir la estadía hospitalaria y las complicaciones de la pared abdominal.

ABSTRACT Hydatid disease is an endemic parasitosis in Argentina. The liver and lungs are the organs more commonly affected, but isolated splenic involvement is rare. The aim of this study is to report two cases of isolated splenic hydatid disease. The diagnosis was suspected by epidemiology and imaging tests. The serologic tests were negative in both cases. Surgical management was decided and both patients underwent laparoscopic total splenectomy. This disease should be suspected in endemic areas in the presence of splenic cysts despite negative serologic tests. Total splenectomy prevents local recurrence and complications associated with the residual cavity. The laparoscopic approach is preferred as it results in a shorter length of hospital stay and fewer abdominal wall complications.

Caracterización de los desenlaces quirúrgicos a corto plazo en gastrectomía por laparoscopia en un centro de alto volumen: 10 años de experiencia / Short-term surgical outcomes of laparoscopic gastrectomy in a high-volume center: 10-year experience

Introducción. El cáncer gástrico en Colombia es la segunda neoplasia más común en hombres y la cuarta en mujeres. En los últimos años se han descrito ampliamente los beneficios del abordaje laparoscópico en el cáncer gástrico frente a sangrado, recuperación postoperatoria y complicaciones, sin afectar los resultados oncológicos. Métodos. Estudio observacional retrospectivo de pacientes llevados a gastrectomía laparoscópica en la Clínica Universitaria Colombia durante un período de diez años, entre 2013 y 2023. Se describieron los resultados perioperatorios en cuanto a estancia hospitalaria, sangrado operatorio, duración del procedimiento, complicaciones, causas de reintervención y mortalidad en los primeros 30 días. Resultados. Se incluyeron 418 pacientes, 58,9 % hombres, con una edad promedio de 60,8 años. Se documentó un tiempo quirúrgico promedio de 228,7 minutos, con un sangrado de 150 ml. La media de ganglios linfáticos resecados fue de 26,1 ± 11,4. La estancia hospitalaria en promedio fue de 4 ± 4 días, y se registraron complicaciones en 104 sujetos, con una tasa promedio de 24 %, de las cuales 29 (27,4 %) obtuvieron una clasificación Clavien-Dindo IIIB. Conclusiones. La gastrectomía por laparoscopia en un centro de alto volumen y con cirujanos experimentados en Colombia, tiene resultados perioperatorios similares a lo reportado en la literatura mundial. Aún se requiere de estudios de mayor fuerza de asociación para establecer recomendaciones sobre el uso rutinario de este abordaje en patología maligna avanzada.

Introduction. Gastric cancer in Colombia is the second most common neoplasm in men and the fourth in women. In recent years, the benefits of the laparoscopic approach in gastric cancer against bleeding, postoperative recovery com and complications have been widely described, without affecting oncological results. Methods. Retrospective observational study of patients undergoing laparoscopic gastrectomy at the Clínica Universitaria Colombia over a period of ten years, between 2013 and 2023. Perioperative results were described in terms of hospital stay, operative bleeding, duration of the procedure, complications, causes of reintervention, and mortality in the first 30 days. Results. 418 patients were included, 58.9% men, with an average age of 60.88 years. An average surgical time of 228.7 minutes was documented, with a blood loss of 150 ml. The mean number of lymph nodes resected was 26.1 ± 11.4. The average hospital stay was 4 ± 4 days, and complications were recorded in 104 subjects, with an average rate of 24%, of which 29 (27.4%) obtained a Clavien-Dindo IIIB classification. Conclusions. Laparoscopic gastrectomy in a high-volume center and with experienced surgeons in Colombia has perioperative results similar to those reported in the world literature. Studies with greater strength of association are still required to establish recommendations on the routine use of this approach in advanced malignant pathology.

Comparación de desenlaces a corto plazo de gastrectomía laparoscópica mínimamente invasiva en adultos mayores con cáncer gástrico localmente avanzado / Comparison of short-term outcomes of minimally invasive laparoscopic gastrectomy in older adults with locally advanced gastric cancer

Introducción. El objetivo de este estudio fue comparar los desenlaces a corto plazo de la gastrectomía laparoscópica en adultos vs. adultos mayores con cáncer gástrico localmente avanzado en una cohorte de un país occidental. Métodos. Estudio de cohorte prospectivo en pacientes sometidos a gastrectomía laparoscópica por cáncer gástrico localmente avanzado, en el Hospital Universitario Erasmo Meoz, de Cúcuta, Colombia, entre noviembre de 2014 y diciembre de 2018. Se realizó análisis descriptivo, de comparación de grupos y bivariado. Resultados. De un total de 116 pacientes, 51 pacientes (44 %) tenían 65 años o más y 63 pacientes (54 %) eran hombres. No se encontró diferencia estadísticamente significativa al comparar los pacientes menores de 65 años con los de 65 años o más. La mediana del tiempo operatorio fue de 240 minutos en ambos grupos (p>0,05), la mediana de los márgenes de resección macroscópica fue 6 cm vs. 5 cm (p>0,05), la mediana de los ganglios linfáticos disecados fue 25 vs. 19 (p>0,05), la mediana de ganglios linfáticos positivos fue 4 vs. 3 (p>0,05), la mediana de estancia fue de 7 días en ambos grupos (p>0,05). La tasa general de complicaciones posoperatorias no difirió significativamente entre adultos (7%) y adultos mayores (11 %) (p>0,05) y no se observaron diferencias significativas en las tasas de complicaciones menores (Clavien-Dindo grado II; 3-5 % vs. 6-12 %; p>0,05) y graves (Clavien-Dindo ≥ IIIa; 3-5 % vs. 4-8 %; p>0,05). Conclusiones. No se encontraron diferencias estadísticamente significativas en los resultados a corto plazo entre los pacientes adultos y adultos mayores con cáncer gástrico localmente avanzado tratados con gastrectomía laparoscópica. Esta técnica es segura en ancianos.

Introduction. The objective of this study was to compare the short-term outcomes of laparoscopic gastrectomy in adults vs. older patients with locally advanced gastric cancer from a Western country cohort. Methods. Prospective cohort study in patients undergoing laparoscopic gastrectomy for locally advanced gastric cancer at the Hospital Universitario Erasmo Meoz, de Cúcuta, Colombia, between November 2014 and December 2018. Descriptive, group comparison and bivariate analysis was performed. Results. Of a total of 116 patients, 51 patients (44%) were 65 years or older and 63 patients (54%) were men. No statistically significant difference was found when comparing patients under 65 years of age with those 65 years of age or older. The median operating time was 240 minutes in both groups (p>0.05), the median macroscopic resection margins were 6 cm vs. 5 cm (p>0.05), the median number of lymph nodes dissected was 25 vs. 19 (p>0.05), the median number of positive lymph nodes was 4 vs. 3 (p>0.05), the median stay was 7 days in both groups (p>0.05). The overall rate of postoperative complications did not differ significantly between adults (7%) and older adults (11%) (p>0.05) and no significant differences were observed in the rates of minor (Clavien-Dindo grade II; 3-5% vs. 6-12%; p>0.05) and severe complications (Clavien-Dindo ≥ IIIa; 3-5% vs. 4-8%; p>0.05). Conclusions. No statistically differences were found in short-term outcomes between adult and older patients with locally advanced gastric cancer treated with laparoscopic gastrectomy. This technique is safe in the elderly.

Resección laparoscópica de quiste de duplicación gástrica asistida por endoscopia / Laparoscopic resection of gastric duplication cyst assisted by endoscopy

Introducción. Las duplicaciones gástricas son entidades congénitas poco frecuentes que se diagnostican principalmente en las etapas tempranas de la vida, y rara vez en pacientes adultos. El objetivo de este artículo fue presentar el caso de un adulto con esta patología, tratado exitosamente mediante cirugía. Caso clínico. Mujer de 26 años de edad con epigastralgia crónica refractaria a manejo médico, a quien durante endoscopia digestiva superior se le identificó una lesión quística sugestiva de tumor estromal gastrointestinal, confirmada por ultrasonido endoscópico. Resultados. Se realizó una resección quirúrgica laparoscópica asistida por endoscopia, con buena evolución postoperatoria. El estudio anatomo-patológico informó la presencia de un quiste de duplicación gástrica. Conclusiones. A pesar de las ayudas diagnósticas disponibles en la actualidad, esta patología representa un reto diagnóstico importante que, en muchas ocasiones solo puede ser confirmado mediante el estudio anatomo-patológico. En paciente asintomático, continúa la controversia entre observarlo o llevarlo a cirugía, por el riesgo de malignidad. Actualmente, el manejo de las duplicaciones gástricas en adultos se considera eminentemente quirúrgico. Las resecciones laparoscópicas y el uso de endoscopia intraoperatoria permiten garantizar la resección completa de la lesión, preservando la mayor cantidad de tejido sano adyacente y previniendo estenosis o deformidades gástricas que afecten su adecuado funcionamiento.

Introduction. Gastric duplications are rare congenital entities that are diagnosed primarily in early life, and rarely in adult patients. The objective of this article was to present the case of an adult with this pathology, successfully treated by surgery. Clinical case. A 26-year-old woman with chronic epigastralgia refractory to medical management, who during upper digestive endoscopy was identified with a cystic lesion suggestive of gastro-intestinal stromal tumor, confirmed by endoscopic ultrasound. Results. A laparoscopic surgical resection assisted by endoscopy was performed, with good postoperative evolution. The anatomopathological study reported the presence of a gastric duplication cyst. Conclusions. Despite the diagnostic adjuncts currently available, this pathology represents an important diagnostic challenge that, in many cases, can only be confirmed through pathology. In asymptomatic patients, the controversy continues between observing them or taking them to surgery due to the risk of malignancy. Currently, the management of gastric duplications in adults is considered eminently surgical. Laparoscopic resections and the use of intraoperative endoscopy ensure complete resection of the lesion, preserving the greatest amount of adjacent healthy tissue and preventing gastric stenosis or deformities that affect its proper functioning.

Eficacia y seguridad de la técnica americana modificada en un puerto de trabajo para colecistectomía laparoscópica / Efficacy and safety of the modified american technique in a working port for laparoscopic

Objetivo: Evaluar la eficacia y seguridad de la técnica americana modificada con un puerto de trabajo (TAMPT) en línea media para colecistectomía laparoscópica. Métodos: Se elaboró estudio prospectivo, comparativo, descriptivo de corte transversal, en pacientes con litiasis vesicular en el servicio de Cirugía General del Hospital Universitario de Caracas, durante enero-agosto 2022. Resultados: se realizaron 79 colecistectomía laparoscópicas, 34 por técnica americana y 45 con TAMPT. La TAMPT (40.26%) se ejecutó con intervalo de 30-60 min. La estancia hospitalaria promedio global fue 1,75 ± 0,87 días. El promedio global de dolor a las 24 horas fue de 4,43 ± 0,68, según escala visual analógica (EVA). Los procedimientos realizados con TAMPT no presentaron complicaciones, con la técnica americana, se reportó dos: bilioma y lesión de víscera hueca, representando 2.54%. Conclusiones: La TAMPT, ha demostrado ser una técnica segura y eficaz como tratamiento quirúrgico de la litiasis vesicular, tanto para procedimientos electivos como de emergencia(AU)

Objective: To determine the efficacy and safety of the modified American technique in a working port (MATWP) for laparoscopic cholecystectomy. Methods: A prospective, comparative, descriptive, cross-sectional, descriptive study was elaborate. In patients with vesicular lithiasis in the General Surgery Service of the Hospital Universitario de Caracas, during January-August 2022.Results: 79 laparoscopic cholecystectomies were performed, 34 by American technique and 45 with modified technique. The modified technique (40.26%) was performed with an interval of 30-60 min. The overall average hospital stay was 1.75 ± 0.87 days.The global average pain at 24 hours was 4.43 ± 0.68, according to visual analog scale (VAS).The procedures performed with MATWP did notpresent complications; the American technique reported two bilioma and hollow viscera lesion, representing an overall rateof 2.54%. Conclusions: MATWP has proven to be a safe and effective technique for surgical treatment of gallbladder stones, both for elective and emergency procedure(AU)

Resultados perioperatorios de la implementación de la resección completa del mesocolon por vía laparoscópica en cáncer de colon derecho y transverso

Introducción: La técnica de resección completa del mesocolon (RCM) en la hemicolectomía derecha consiste en la disección por planos embriológicos para lograr la resección completa del envoltorio mesocolónico, además de una ligadura vascular central (LVC) con linfadenectomía D3, que no se realiza normalmente con la técnica estándar. Esta técnica se asocia a mejores resultados de sobrevida global y libre de enfermedad que la cirugía convencional en trabajos retrospectivos. Sin embargo, no existen datos de su implementación a nivel nacional. El objetivo de este estudio es evaluar los resultados perioperatorios de la implementación del RCM en un centro universitario en nuestro medio. Materiales y Método: Estudio retrospectivo de cohorte de pacientes consecutivos sometidos a hemicolectomía derecha laparoscópica con técnica de RCM-LVC entre Enero 2022 y Junio 2023. Se recopilaron variables demográficas, perioperatorias, postoperatorias e histopatológicas. Los resultados se analizaron utilizando estadística descriptiva. Resultados: En el periodo, 29 pacientes se sometieron a RCM laparoscópica (mediana de edad 66(57-76) y 15(52%) sexo femenino). La mediana del tiempo quirúrgico fue 202,9 minutos. No hubo casos de conversión, filtración anastomótica, ni mortalidad. Hubo morbilidad en 9 casos (31%) y de estos solo 1(3,4%) fue Clavien-Dindo III (hematoma Pfannenstiel reintervenido). No hubo lesiones vasculares intraoperatorias. Mediana de hospitalización de 3 días. Doce casos (41%) eran etapa II y 8(28%) etapa III. La mediana de linfonodos resecados fue 23(18-28). Conclusión: Esta serie demuestra que la implementación de la RCM-LVC por vía laparoscópica para el tratamiento del cáncer de colon derecho y transverso es factible en centros con experiencia en cirugía colorrectal laparoscópica avanzada.

Introduction: Complete mesocolic excision (CME) consists in the dissection on embryologic planes in order to achieve a complete resection of the mesocolic envelope and performing a central vascular ligation (CVL) with a D3 lymphadenectomy which is not routinely done for standard right colectomies. CME has been associated with better overall survival and disease-free survival in comparison with conventional surgery in retrospective studies. However, there is no data on its implementation in Chile. The aim of this study is to assess the perioperative results of the implementation of CME in our center. Methods: A retrospective cohort study was conducted. Consecutive patients undergoing a laparoscopic right hemicolectomy with CME-CVL between January 2022 and June 2023 were included. Demographic, perioperative, postoperative and histopathological data were collected. Results were analyzed using descriptive statistics. Results: During the study period, 34 patients underwent CME; 29 of them underwent laparoscopic CMECVL (median age 66 (57-76) and 15 (52%) female). The median operating time was 202,9 minutes. There were no cases of conversion, anastomotic leakage or mortality. There was morbidity in 9 cases (31%) and one of these (3,4%) was a Clavien-Dindo III morbidity (reoperation due to a Pfannenstiel haematoma). There were no intraoperative vascular injuries. The median length of stay was 3 days. Twelve cases (41%) were stage II and 8(28%) stage III. The median number of lymph nodes harvested was 23(18-28). Conclusion: This series demonstrate that the implementation of laparoscopic CME-CVL for right and transverse colon cancer is feasible in centers with experience in advanced laparoscopic colorectal cancer.

Protocolo de recuperación mejorada después de cirugía (ERAS) atenúa el estrés y acelera la recuperación en pacientes después de resección radical por cáncer colorrectal: Experiencia en la Clínica Universitaria Colombia / Enhanced Recovery After Surgery (ERAS) protocol attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: Experience at Clínica Universitaria Colombia

Introducción. El conjunto de estrategias de recuperación mejorada después de la cirugía (ERAS, por sus siglas en inglés) constituye un enfoque de atención multimodal y multidisciplinario, cuyo propósito es reducir el estrés perioperatorio de la cirugía, disminuir la morbilidad y acortar la estancia hospitalaria. Este estudio tuvo como objetivo describir los resultados clínicos de pacientes sometidos a cirugía por cáncer colorrectal, identificando las complicaciones principales y los factores perioperatorios relacionados con el alta temprana. Métodos. Se analizaron los pacientes consecutivos sometidos a cirugía colorrectal entre los años 2020 y 2023, todos los cuales siguieron el protocolo ERAS institucional. Se evaluaron las características clínicas, los factores perioperatorios, los desenlaces postoperatorios y la tasa global de adherencia al protocolo. Resultados. Un total de 456 pacientes fueron sometidos a cirugía colorrectal, 51% de sexo masculino, con edad media de 60 años. La mayoría de las intervenciones se realizaron por laparoscopia (78 %), con una tasa de conversión del 14,5 %. Las complicaciones postoperatorias incluyeron fuga anastomótica (4,6 %), sangrado, infección intraabdominal y obstrucción intestinal. La estancia hospitalaria promedio fue de 4 días y la mortalidad del 2,8 %. La tasa global de adherencia al protocolo ERAS fue del 84,7 %. Conclusiones. El enfoque combinado de cirugía laparoscópica y protocolo ERAS es factible, seguro y se asocia con una estancia hospitalaria más corta. La implementación y adherencia al protocolo ERAS no solo mejora los resultados postoperatorios, sino que también resalta la importancia de acceder a datos sólidos, permitiendo mejorar la atención perioperatoria local.

Introduction. The Enhanced Recovery After Surgery (ERAS) protocol is a multimodal, multidisciplinary approach to care, the purpose of which is to reduce the perioperative stress of surgery, decrease morbidity, and shorten hospital stay. This study aimed to describe the clinical outcomes of patients undergoing surgery for colorectal cancer, identifying the main complications and perioperative factors related to early discharge. Methods. Consecutive patients undergoing colorectal surgery between 2020 and 2023 were analyzed, who followed the institutional ERAS protocol. Clinical characteristics, perioperative factors, postoperative outcomes, and overall protocol adherence rate were evaluated. Results. A total of 456 patients underwent colorectal surgery, 51% male, with a mean age of 60 years. Most interventions were performed laparoscopically (78%), with a conversion rate of 14.5%. Postoperative complications included anastomotic leak (4.6%), followed by bleeding, intra-abdominal infection, and intestinal obstruction. The average hospital stay was 4 days and mortality was 2.8%. The overall adherence rate to the ERAS protocol was 84.7%. Conclusions. The combined approach of laparoscopic surgery and ERAS protocol is feasible, safe, and associated with a shorter hospital stay. Implementation and adherence to the ERAS protocol not only improves postoperative outcomes, but also highlights the importance of accessing solid data, allowing for improved local perioperative care.

Epidemiología de la apendicitis aguda en Colombia: Un análisis de las bases de datos administrativas del Ministerio de Salud / Epidemiology of acute appendicitis in Colombia: An Analysis of the Ministry of Health administrative databases

Introducción. La apendicitis aguda es una afección común, con un pico de incidencia entre los 10 y 20 años. La cirugía es el tratamiento preferido y la apendicectomía por laparotomía sigue siendo el estándar, aunque el abordaje laparoscópico ha mostrado menos complicaciones. El objetivo de este artículo fue caracterizar tanto la enfermedad como el tratamiento quirúrgico en Colombia, usando datos de bases oficiales. Métodos. Se accedió a la base de datos del Sistema Integrado de Información para la Protección Social (SISPRO) del Ministerio de Salud de Colombia en febrero de 2023. Se recogieron datos de los pacientes con diagnóstico de apendicitis y con procedimiento de apendicectomía entre 2017 y 2021, y se analizaron por edad, sexo y ubicación geográfica. Resultados. Entre 2017 y 2021 se diagnosticaron 345.618 casos de apendicitis (51,8 % mujeres), con pico de incidencia a los 15-20 años. Se realizaron 248.133 apendicectomías, el 16,7 % por laparoscopia. Los hospitales con más procedimientos reportados estaban en Bogotá, Yopal, Popayán y Florencia. La mortalidad fue de 0,56 % en hombres y 0,51 % en mujeres. Conclusión. La apendicitis es común, con pico a los 10-19 años. Las mujeres tienen mayor probabilidad de apendicectomía, debido a otras afecciones ginecológicas. El acceso a la apendicectomía disminuye la mortalidad; en estos pacientes, el 16 % fue laparoscópica, lo que sugiere que se necesita más entrenamiento y acceso a esta técnica. Este estudio aporta a la comprensión de la epidemiología de la apendicitis y apendicectomías en Colombia.

Introduction. Acute appendicitis is a common condition, with a peak incidence between 10 and 20 years of age. Surgery is the preferred treatment and laparotomy appendectomy remains the standard, although the laparoscopic approach has shown fewer complications. The objective of this article was to characterize both the disease and the surgical treatment in Colombia, using data from official databases. Methods. The Integrated Information System for Social Protection (SISPRO) database of the Ministry of Health was accessed in February 2023. Data with diagnosis of apendicitis and with appendectomy between 2017 and 2021 were collected. Analysis was done by age, gender, and geographic location. Results. Between 2017 and 2021, 345,618 cases of appendicitis were diagnosed (51.8% females), with peak incidence at 15-20 years of age. A total of 248,133 appendectomies were performed, 16.7% by laparoscopy. The hospitals with most reported procedures were located in Bogotá, Yopal, Popayán, and Florencia. Mortality was 0.56% in men and 0.51% in women. Conclusion. Appendicitis is common, peaking at ages 10-19. Women are more likely undergo appendectomy due to other gynecological conditions. Access to appendectomy improves mortality. In these patients, 16% were laparoscopic, suggesting that more training and access to this technique is needed. This study contributes to the understanding of the epidemiology of appendicitis and appendectomies in Colombia.

Malformación linfática quística gigante del hígado: dos casos pediátricos con diferente abordaje quirúrgico / Giant cystic lymphatic malformation of the liver: two pediatric cases with different surgical approach

Introducción. Las malformaciones linfáticas quísticas, también llamadas linfangiomas quísticos, aparecen muy raramente de forma aislada en el hígado. Casos clínicos. Se presentan dos pacientes femeninas de edad preescolar con marcada hepatomegalia, dependiente de lesiones quísticas multitabicadas, secundarias a malformación linfática quística gigante del hígado, que fueron tratadas en el Hospital Pediátrico Universitario William Soler, La Habana, Cuba. Resultados. En ambos casos el diagnóstico se apoyó en los estudios de imágenes, la laparoscopia y el análisis histopatológico. En un caso el tratamiento fue la hepatectomía derecha, mientras que en el otro se empleó la escleroterapia, ambas con evolución favorable. Conclusión. A pesar de su rareza, este diagnóstico no debe obviarse ante un paciente pediátrico con lesiones hepáticas quísticas. El tratamiento de elección es la resección quirúrgica, pero su indicación y envergadura debe valorarse de forma individualizada

Introduction. Cystic lymphatic malformations, also called cystic lymphangiomas, are very rarely found in the liver. Clinical cases. Two pediatric female preschool-age patients. presented with hepatomegaly due to multi-septated cystic lesions of the liver, who received treatment at Hospital Pediátrico Universitario William Soler, La Habana, Cuba. Results. We report two pediatric cases with giant cystic lymphatic malformation of the liver. In both cases, the diagnosis were based on imaging, laparoscopy and pathology. In one case the treatment was right hepatectomy, whereas in the other, sclerotherapy was performed, both with a favorable outcome. Conclusion. Despite its rarity, this diagnosis should be considered in pediatric patients with hepatic cystic lesions. The recommended treatment is surgical resection, but its indication and extent should be assessed individually for each patient.

The value of preemptive analgesia in older adult patients undergoing laparoscopic hepatectomy / 中国基层医药

Objective:To investigate the efficacy and value of preemptive analgesia in older adult patients undergoing laparoscopic hepatectomy.Methods:A total of 150 older adult patients with liver cancer, who underwent laparoscopic hepatectomy at The 2 nd Affiliated Hospital of Wenzhou Medical University between July 2019 and April 2020, were randomly assigned to two groups: a control group ( n = 75) and an observation group ( n = 75) using the random number table method. The control group received postoperative analgesia with parecoxib sodium, while the observation group received preemptive analgesia with parecoxib sodium. A comparative analysis was conducted between the control and observation groups in terms of the Numerical Rating Scale (NRS) scores at 8, 12, and 24 hours postoperatively, postoperative recovery, length of hospital stay, and overall cost. Results:There were no statistically significant differences in operation time, dosage of Sufentanil 24 hours postoperatively, or the total and effective usage counts of patient-controlled intravenous analgesia with Sufentanil between the control and observation groups (both P > 0.05). However, the NRS scores of the observation group were significantly lower than those of the control group at 8, 12, and 24 hours postoperatively. Specifically, the NRS scores of the observation group were (4.38 ± 1.24) points, (3.41 ± 0.19) points, and (2.90 ± 0.17) points, respectively, while those of the control group were (5.24 ± 1.01) points, (4.65 ± 1.24) points, and (3.32 ± 1.00) points, respectively ( t = 4.66, 8.56, 3.59, all P < 0.001). Patients in the observation group exhibited significantly more frequent off-bed activities [(2.62 ± 1.24) times], a notably longer cumulative duration of off-bed activities [(1.36 ± 0.20) hours], and a significantly shorter duration of first anal exhaust [(13.50 ± 1.27) hours] compared with those in the control group [(1.06 ± 0.12) times, (0.36 ± 0.09) hours, (20.10 ± 2.16) hours, t = -10.84, -39.49, 22.81, all P < 0.001]. Furthermore, the observation group demonstrated a shorter postoperative hospital stay [(8.90 ± 1.34) days], lower hospitalization costs [(55.8 ± 2.1) thousand yuan], and higher patient satisfaction scores [(88.98 ± 5.64) points] compared with the control group [(11.15 ± 1.29) days, (59.4 ± 6.2) thousand yuan, (72.16 ± 3.26) points, t = 10.48, 4.76, -22.36, all P < 0.001]. Conclusion:The implementation of preemptive analgesia intervention among older adult patients undergoing laparoscopic hepatectomy effectively enhances analgesic outcomes, accelerates postoperative recovery, reduces hospitalization duration, and markedly decreases hospitalization costs.

Clinical efficacy of biofeedback and electrical stimulation on pelvic organ prolapse after laparoscopic uterine suspension / 局解手术学杂志

Objective To analyze the clinical efficacy of biofeedback and electrical stimulation on pelvic organ prolapse(POP)after laparoscopic uterine suspension.Methods A total of 102 cases of POP patients admitted to our hospital were selected and divided into the control group and the observation group according to the random number table method,with 51 cases in each group.The patients in the control group were treated with laparoscopic uterine suspension,and the patients in the observation group were treated with biofeedback and electrical stimulation on the basis of the control group.The total effective rate,pelvic floor distress inventory-20(PFDI-20)score,pelvic floor impact questionnaire-7(PFIQ-7)score,female sexual function index(FSFI)score,pelvic incontinence sexual questionnaire(PISQ)score,and recurrence rate of the patients in the two groups were compared.A neuromuscular electrical stimulation therapy instrument was used to detect the recovery of pelvic floor muscle for patients before and after treatment.Results Compared with the control group,the efficacy of patients in the observation group was superior(P<0.05).The PFDI-20 and PFIQ-7 scores after treatment of patients in the two groups were decreased compared with those before treatment(P<0.05),and the PFDI-20 and PFIQ-7 scores after treatment of patients in the observation group were lower than those in the control group(P<0.05).The pelvic floor muscle strength,maximal muscle contraction force and sustained contraction time after treatment of patients in the two groups were significantly stronger/longer than those before treatment(P<0.05),and the pelvic floor muscle strength,maximal muscle contraction force and sustained contraction time after treatment of patients in the observation group were stronger/longer than those in the control group(P<0.05).The FSFI and PISQ scores after treatment of patients in the two groups were significantly increased compared with those before treatment(P<0.05),and the FSFI and PISQ scores after treatment in the observation group were higher than those in the control group(P<0.05).The recurrence rate after treatment of patients in the observation group was significantly lower than that in the control group(P<0.05).Conclusion Biofeedback and electrical stimulation can enhance the clinical efficacy of laparoscopic uterine suspension in the treatment of POP,improve the pelvic floor muscle strength and POP of patients,and improve their quality of life.

Application of pneumoperitoneum-free single-hole endoscopy com-bined with ropivacaine in pregnancy with ovarian tumor / 中国临床药理学与治疗学

AIM:To evaluate the clinical efficacy and safety of pneumoperitoneum-free single-hole endoscopy combined with ropivacaine local infiltra-tion anesthesia in pregnancy with ovarian tumor.METHODS:Twenty-eight pregnant women with ovarian tumor were randomly divided into two groups:observation group(n=16)and control group(n=12).The first time out of bed,ventilation time,postoperative hospital stay,non-invasive blood pressure,heart rate(HR),respiratory fre-quency(RR)and blood oxygen saturation(SpO2)were compared between the two groups.Pain score,Ramsay sedation score,SAS anxiety score,postoperative complications,patient satisfaction and recovery quality scale QoR15 were evaluated at 6,24 and 48 hours after operation.RESULTS:There was no significant difference in postopera-tive hospital stay,Ramsay score,RR,SpO2 and the incidence of complications between the two groups(P>0.05),but the time of getting out of bed and ventilation time were shortened,the scores of non-invasive blood pressure,HR,pain and anxiety in the observation group were lower than those in the control group,and the scores of patient satisfac-tion and QoR15 in the observation group were bet-ter than those in the control group(P<0.05).CON-CLUSION:The application of pneumoperitoneum-free single-hole endoscope combined with ropiva-caine local infiltration anesthesia in pregnancy with ovarian tumor can reach satisfactory clinical re-sults,including reducing postoperative pain and anxiety,which is worth popularizing.

Effects of Nalbuphine combined with Sufentanil on postoperative analgesia and stress response in patients undergoing laparoscopic colorectal cancer surgery / 中国内镜杂志

Objective To investigate the impacts of Nalbuphine combined with Sufentanil on postoperative analgesia and stress response in patients undergoing laparoscopic colorectal cancer surgery.Methods 86 patients who underwent laparoscopic colorectal cancer surgery from August 2020 to April 2022 were collected and grouped into an experimental group and a control group according to the analgesic plan,with 43 patients in each group.The control group was given Sufentanil after surgery,and the experimental group was given Nalbuphine + Sufentanil.The analgesic and sedative effects at different time points after surgery(1,6,12,24 and 48 h),and the changes in serum pain mediator and stress response indicators were observed and compared.The time of getting out of bed after surgery,the number of patient-controlled analgesia,the number of cases of remedial analgesia,the recovery of gastrointestinal function,and the occurrence of adverse reactions within 48 hours after surgery were recorded in both groups.Results Compared with the control group,the experimental group had a shorter time to get out of bed for the first time after surgery(t = 3.29,P = 0.001),and had fewer instances of patient-controlled analgesia(Z = 4.53,P = 0.000)and cases of remedial analgesia(χ2 = 4.48,P = 0.034);Postoperative 12,24 and 48 h after surgery,the visual analogue scale(VAS)in the experimental group was obviously lower than that in the control group(t = 2.86,t = 2.55,t = 0.10,P<0.05);Postoperative 1 and 6 h,the Ramsay sedation score in the experimental group patients was lower than that in the control group(t = 2.10,t = 2.07,P<0.05);Postoperative 6,12 and 24 h,the serum substance P(SP)(t = 3.63,t = 5.51,t = 3.46,P<0.05)and prostaglandin E2(PGE2)(t = 2.34,t = 3.56,t = 0.33,P<0.05)levels in the experimental group were obviously lower than those in the control group;Postoperative 6,12 and 24 h,the serum cortisol(Cor)level in the experimental group was obviously lower than that in the control group(t = 4.65,t = 6.50,t = 6.52,P<0.05);Postoperative 6,12,24 and 48 h,the serum norepinephrine(NE)(t = 5.49,t = 7.85,t = 7.70,t = 2.18,P<0.05),tumor necrosis factor-α(TNF-α)(t = 5.43,t = 7.83,t = 5.27,t = 2.32,P<0.05),and hypersensitivity C-reactive protein(hs-CRP)(t = 3.39,t = 9.241,t = 4.87,t = 2.37,P<0.05)levels in the experimental group were obviously lower than those in the control group.There was no statistically obvious difference between the two groups in terms of postoperative exhaust time,defecation time,bowel sounds occurrence time,and incidence of adverse reactions(P>0.05).Conclusion Nalbuphine combined with Sufentanil is effective in postoperative analgesia of laparoscopic colorectal cancer patients,and can effectively regulate the post-traumatic stress response of the body after surgery.

Impact of spectrum irradiation combined with operative laparoscopy on inflammatory reaction and immune function in children with appendicitis / 中国内镜杂志

Objective To study the effect of spectrum irradiation combined with operative laparoscopy on inflammatory reaction and immune function in children with appendicitis.Methods 120 children with appendicitis from January 2022 to January 2023 were selected as the study subjects,randomly divided them into two groups using a random number table method:the control group(n = 60)and the study group(n = 60).The control group underwent laparoscopic minimally invasive appendectomy,and the study group underwent spectrum irradiation combined with laparoscopic minimally invasive appendectomy.The two groups compared perioperative recovery,procalcitonin(PCT),C-reactive protein(CRP)level,cellular immune function(CD4+,CD8+,and CD4+/CD8+),humoral immune function[immunoglobulin M(IgM),immunoglobulin G(IgG),C3,and C4],pain visual analogue scale(VAS),Alvarado score,and treatment effect and postoperative complication rate.Results Compared with the control group,the study group showed a significant reduction in the time to first anal exhaust and hospital stay after surgery,the differences were statistically significant(P<0.05).Compared with preoperative levels,the levels of PCT and CRP in both groups of patients increased at 12 and 24 h postoperatively,with the highest levels occurring at 12 h postoperatively;The PCT and CRP levels in the study group were lower than those in the control group at 12 and 24 h after surgery,the differences were statistically significant(P<0.05).Compared with preoperative data,the CD4+,CD8+,and CD4+/CD8+ levels decreased in both groups at 12 and 24 h postoperatively,with the lowest levels observed at 12 h postoperatively;The CD4+,CD8+,and CD4+/CD8+ levels in the study group were higher than those in the control group at 12 and 24 h after surgery,the differences were statistically significant(P<0.05).Compared with preoperative levels,the levels of IgM,IgG,C3,and C4 in both groups of patients decreased after surgery,with the lowest levels occurring 12 h after surgery;The levels of IgM,IgG,C3,and C4 in the study group were higher than those in the control group at 12 and 24 h after surgery,the differences were statistically significant(P<0.05).Compared with preoperative conditions,the VAS and Alvarado scores in both groups of patients decreased at 12 and 24 h after surgery.The VAS and Alvarado scores of the study group were lower than those of the control group at 12 and 24 h after surgery,the differences were statistically significant(P<0.05).Compared with the control group,the study group had a higher overall effective rate and a lower total incidence of complications,the differences were statistically significant(P<0.05).Conclusion Spectrum irradiation combined with operative laparoscopy can reduce postoperative inflammatory reaction,and improve immune function in children with appendicitis,shorten inflammatory reaction and immunosuppression time,reduce pain,and have a low incidence of postoperative complications,with ideal effect.

The effect of different concentrations of ropivacaine ultrasound-guided transverse abdominis plane block on postoperative pain and stress response in patients undergoing laparoscopic sleeve gastrectomy / 中国医师杂志

Objective:To explore the effects of different concentrations of ropivacaine ultrasound-guided transverse abdominis plane block on postoperative pain and stress response in patients undergoing laparoscopic sleeve gastrectomy.Methods:A prospective study was conducted on 120 obese patients who underwent laparoscopic sleeve gastrectomy at the Puren Hospital Affiliated to Wuhan University of Science and Technology from July 2020 to July 2022. According to the random number table method, all patients were divided into a control group, a low concentration group, and a high concentration group, with 40 cases in each group. All three groups underwent ultrasound-guided transverse abdominis plane block after general anesthesia induction. The control group was injected with physiological saline, while the low concentration group and high concentration group were injected with 0.25% and 0.50% ropivacaine, respectively. Stress response indicators before and after surgery in three groups [adrenaline (E), cortisol (Cor), free thyroxine (FT4), and C-reactive protein (CRP)], hemodynamic indicators [mean arterial pressure (MAP) and heart rate (HR)], glucose and lipid metabolism indicators [fasting blood glucose (FBG), 2-hour postprandial blood glucose (2-hour PBG), glycated hemoglobin (HbA 1c), total cholesterol (TC), and triglycerides (TG)] and Visual Analog Scale (VAS) score were compared before and after surgery. Results:On the 1st day after surgery, the levels of E, Cor, FT4, CRP, FBG, 2-hour PBG, HbA 1c, TC, and TG in the high concentration group were lower than those in the control group and low concentration group (all P<0.05); 15 minutes after anesthesia and 2 hours after surgery, the MAP and HR of the high concentration group were higher than those of the control group and the low concentration group (all P<0.05); At 6, 12, and 24 hours after surgery, the VAS score of the high concentration group was lower than that of the control group and the low concentration group (all P<0.05); There was no statistically significant difference in the incidence of airway reactions during anesthesia induction among the three groups ( P>0.05). Conclusions:In laparoscopic sleeve gastrectomy, administering 0.50% concentration of ropivacaine ultrasound-guided plane block of the transverse abdominis muscle has a strong postoperative analgesic effect, which can improve E, Cor, FT4, and CRP levels, and is worthy of clinical application.

Comparison of clinical characteristics and long-term prognosis between patients with deep infiltrating endometriosis and those without deep infiltrating endometriosis / 中国医师杂志

Objective:To compare and analyze the clinical characteristics and long-term prognosis of patients with deep infiltrating endometriosis (DIE) and non deep infiltrating endometriosis.Methods:A retrospective analysis was conducted on the data of 178 patients with endometriosis who underwent laparoscopic surgery at the General Hospital of Northern Theater Command from January 2016 to January 2018. Among them, 95 patients with DIE were treated as the observation group, and 83 patients with non deep infiltration were treated as the control group. Both groups were followed up for at least 5 years after surgery. Perform statistical analysis on the general clinical data, intraoperative and postoperative follow-up data of the two groups.Results:Compared with the control group, the observation group had significantly older age [(33.8±5.5)years vs (32.0±5.2)years], moderate to severe dysmenorrhea [72.6%(69/95) vs 55.4%(46/83)], chronic pelvic pain [24.2%(23/95) vs 8.4%(7/83)], higher proportion of elevated blood carbohydrate antigen 125 (CA125) [80.0%(76/95) vs 65.1%(54/83)], and higher Visual Analogue Scale (VAS) [(5.4±1.2)points vs (4.3±0.9)points]; At the same time, the surgery time was longer [(75.1±20.1)min vs (56.0±18.9)min], the patient′s intraoperative bleeding was also greater [(79.2±23.0)ml vs (57.8±16.3)min], bilateral cysts [54.7%(52/95) vs 34.9%(29/83)], severe pelvic adhesions [90.5%(86/95) vs 53.0%(44/83)], and the proportion of concurrent adenomyosis [41.1%(39/95) vs 22.9%(19/83)] was higher, with higher Revised American Fertility Society (rAFS) scores [(61.8±22.1) vs (39.4±19.1)]. The proportion of rAFS stage Ⅳ [71.6%(68/95) vs 43.4%(36/83)] was higher, and the proportion of postoperative medication was higher [98.9%(94/95) vs 92.8%(7/83)]. The above indicators showed statistically significant differences between the two groups (all P<0.05 or P<0.01). There was no statistically significant difference in the recurrence rate [21.1%(20/95) vs 15.7%(13/83)] and live birth rate [100%(35/35) vs 92.1%(35/38)] between the observation group and the control group (all P>0.05). Conclusions:Compared to non DIE patients, DIE patients have more severe pain symptoms and pelvic adhesions, higher rAFS scores, and a higher proportion of stage Ⅳ. However, there was no significant difference in postoperative recurrence rate, and there was no significant impact on fertility outcomes.

Oncological outcomes of laparoscopic radical trachelectomy for early stage cervical cancer / 中华妇产科杂志

Objective:To analyze and summarize the oncological outcomes after laparoscopic radical trachelectomy (LRT) for early stage cervical cancer.Methods:The clinical data and follow-up results of 148 patients with early stage cervical cancer who underwent LRT in Renji Hospital, School of Medicine, Shanghai Jiao Tong University from July 2014 to June 2023 were collected, while tumor outcomes and postoperative pregnancy were analyzed retrospectively.Results:(1) General situation: the median age of 148 patients with LRT was 33 years (range: 19-42 years). Pathological type: 111 cases of squamous cell carcinoma, 36 cases of adenocarcinoma, 1 case of adenosquamous carcinoma. International Federation of Gynecology and Obstetrics (2018) stage: 17 cases of stage Ⅰa1 with lympho-vascular space invasion, 25 cases of stage Ⅰa2, 102 cases of stage Ⅰb1, and 4 cases of stage Ⅰb2. (2) Tumor outcomes: 148 patients were followed up regularly after LRT, and the median follow-up time was 59 months (range: 2-104 months). During the follow-up period, 5 cases of tumor recurred (including 1 death), and the median recurrence time was 10 months (range: 4-33 months). Among them, there were 3 cases of pelvic metastasis, 1 case of distant metastasis, and 1 case of both pelvic and distant metastasis. Both 3-year and 5-year disease-free survival rates of 148 patients were 94.5%, and the 5-year overall survival rate was 98.9%. (3) Postoperative pregnancy: among 148 patients with LRT, 67 patients had pregnancy requirements, followed up for 1 year, and 20 of them were pregnant, with a pregnancy rate of 29.9% (20/67). Among the 20 pregnant patients, 2 cases early abortion, 1 case mid-term abortion, and 17 cases gave birth (including 4 cases of premature birth and 13 cases of full-term birth).Conclusion:Under the condition of strict control of surgical indications, guaranteed surgical scope and tumor-free operation, LRT in patients with early cervical cancer has a good outcome.

Clinical effect of indocyanine green fluorescence navigation combined with modified pancreaticogastrostomy in laparoscopic duodenum-preserving pancreatic head resection / 中华肝胆外科杂志

Objective:To evaluate the feasibility, safety and efficacy of indocyanine green (ICG) fluorescence imaging navigation combined with modified pancreaticogastrostomy in laparoscopic duodenum-preserving pancreatic head resection.Methods:The clinical data of 14 patients undergoing laparoscopic duodenum-preserving pancreatic head resection with indocyanine green fluorescence navigation technique combined with modified pancreaticogastrostomy from January 2019 to January 2022 in the Department of Hepatobiliary and Pancreatic Surgery, the First Hospital of Hebei Medical University were retrospectively analyzed, including 4 males and 10 females, aged (40.6±7.1) years. The operation time, intraoperative blood loss, postoperative complications and follow-up were recorded.Results:All 14 operations were successfully completed, and there was no intraoperative ICG allergic reaction. The intraoperative ICG staining facilitated the identification of common bile duct. The operation time was (325.71±23.00) min, and the time of modified pancreaticogastrostomy was (18.32±1.52) min. Intraoperative blood loss was 200 (150, 300) ml. There were no case of intraoperative blood transfusion. Postoperative complications include three cases of grade A pancreatic fistula, one of biliary fistula, and one of biliary stricture. All patients were followed up for one to 18 months, and the median follow-up time was 10 months. One patient had intermittent fever after operation. Magnetic resonance cholangiopancreatography showed biliary stricture in one patient one month after operation, which was managed by endoscopic biliary stent implantation.Conclusion:Indocyanine green fluorescence navigation is safe and feasible in laparoscopic duodenum-preserving pancreatic head resection. Combined with modified pancreaticogastrostomy, it helps skip the jejunal anastomosis and improve the efficiency of surgery.

Effect of lung recruitment maneuvers combined with individualized positive end-expiratory pressure on degree of postoperative atelectasis in elderly patients undergoing laparoscopic surgery / 中华麻醉学杂志

Objective:To evaluate the effect of lung recruitment maneuvers combined with individualized positive end-expiratory pressure(PEEP) on the degree of postoperative atelectasis in elderly patients undergoing laparoscopic surgery.Methods:One hundred and forty-three elderly patients, aged ≥65 yr, with body mass index of 18.5-30.0 kg/m 2, scheduled for elective laparoscopic surgery, were assigned to either individualized PEEP combined with recruitment maneuvers (group Ⅱ) or fixed PEEP (group Ⅰ) using a random number table method. PEEP was maintained at 6 cmH 2O starting from the beginning of procedure until the end of the procedure in group I. Individualized PEEP titration was performed after induction of anesthesia in group Ⅱ. The primary outcome measure was the 12-zone lung ultrasound score at 15 min after tracheal extubation. Other outcome measures were the occurrence of postoperative pulmonary complications within 7 days after surgery, Quality of Recovery-15 scale score on 3rd day after surgery, rate of unplanned admission to intensive care units, length of hospital stay, incidence of intraoperative hypoxemia, usage rate of intraoperative vasoactive drugs, and incidence of postoperative hypotension. Results:Compared with group Ⅰ, the lung ultrasound score, driving pressure and postoperative pulmonary complications were significantly decreased, the dynamic lung compliance was increased ( P<0.05 or 0.01), and no significant changes were found in the other parameters in group Ⅱ ( P>0.05). Conclusions:Individualized PEEP combined with recruitment maneuvers can reduce the degree of postoperative atelectasis in elderly patients undergoing laparoscopic surgery.