Alternativas de manejo de colecciones en pancreatitis aguda / Alternatives in the treatment of collections in acute pancreatitis

Acute pancreatitis is a disease that presents heterogeneously with varying severity depending on pancreatic parenchyma and peripancreatic fat. The aim of this publication is to present the nomenclature in use in the different collections that develop in the evolution of acute pancreatitis, and management options of these collections, focusing on the management of infected pancreatic necrosis; emphasizing the benefits, results and limitations of each technique and describing some techniques under development.

La pancreatitis aguda es una enfermedad que se presenta en forma heterogénea con distinta gravedad según el compromiso del parénquima pancreático y de la grasa peripancreática. El objetivo de esta publicación es dar a conocer la nomenclatura en uso en las distintas colecciones que se manifiestan en la evolución de la pancreatitis aguda y las opciones de manejo de estas colecciones, enfocándose en el manejo de la necrosis pancreática infectada; enfatizando las ventajas, resultados y limitaciones de cada técnica, además de describir algunas técnicas en desarrollo.

Open ureterolithotomy via lumbotomy incision vs laparoscopic ureterolithotomy for upper ureteric calculi.

To compare the efficacy and morbidity of laparoscopic ureterolithotomy and open ureterolithotomy via the posterior lumbar approach. Meterials and Methods: A retrospective study was performed by reviewing patient records. Ten patients in the laparoscopic ureterolithotomy group were compared with 15 patients in the open ureterolithotomy via lumbotomy incision group. Twelve patients who had flank ureterolithotomy comprised a control group. Details of age, sex, size and site of the stone, haematocrit, blood urea nitrogen, serum creatinine, degree of hydronephrosis of the affected kidney, contralateral renal function, operative time, operative complication, the amount of postoperative analgesics and length of hospital stay were all compared. Statistical analysis was carried out by the Chi- square test, Anova and LSD multiple comparisons. Results: The preoperative status of the three groups were similar. When the ureterolithotomy via lumbotomy group was compared with the control group (flank ureterolithotomy) the results were similar except that ureterolithotomy via lumbotomy required less analgesics postoperatively (mean 50 mg vs 104, p < 0.001). Ureterolithotomy via lumbotomy patients required the same analgesics as laparoscopic ureterolithotomy. However, laparoscopic ureterolithotomy had a longer operating time (mean 181.5 min vs 88, p < 0.001) and longer period of urine leak postoperatively (mean 6.6 days vs 2.4, p < 0.003) when compared with ureterolithotomy via lumbotomy. Conclusion: Ureterolithotomy via lumbotomy offers similar low discomfort postoperatively compared with laparoscopic ureterolithotomy but had a shorter operating time and less complications.

Posterior Lumbotomy Approach in Pyeloplasty / 대한비뇨기과학회지

Since January 1986, we have performed 25 dismembered pyeloplasties on 20 children with ureteropelvic junction obstruction. The posterior lumbotomy approach was used in 11 cases and their intraoperative course and postoperative status were compared to those who had operation through the standard flank incision. The surgical steps are described and the limitations of this approach are discussed.

Dorsovertical Lumbotomy for Surgery of Upper Urinary Tract Calculi / 대한비뇨기과학회지

The posterior surgical approach allows certain operations on the upper urinary tract to be performed more rapidly, with optimum exposure and with diminished morbidity. In particular, the lumbotomy incision was excellent for open renal biopsy, simple nephrectomy for benign disease, pyelolithotomy, nephropexy, pyeloplasty and upper third ureterolithotomy. Twenty four patients underwent pyelolithotomy or upper ureterolithotomy through the dorsovertical lumbotomy approach, and the intraoperative and postoperative course were compared to the patients operated upon using the standard flank incision. Our analysis established the superiority of the dorsovertical lumbotomy incision for all factors evaluated, especially postoperative analgesic use and ambulation, hospital stay.

Clinical Experience of Upper Ureterolithotomy by Posterior Lumbotomy / 대한비뇨기과학회지

The posterior lumbotomy was a useful approached for removal of a small kidney, for bilateral nephrectomy in patients with chronic renal failure, for pyeloplasty, for pyelolithotomy when a stone was filled the pelvis and was not able to migrated, or for an upper ureterolithotomy when the stone was firmly impacted. During a 32 month interval 19 patients underwent upper ureterolithotomy through the posterior lumbotomy approach. The intraoperative course and postoperative performance were compared to the patients operated upon using the standard flank incision. Our analysis established the superiority of the posterior lumbotomy incision for all factors evaluated, especially postoperative drainage, analgesic use and postoperative hospitalization.