Benefit of video-assisted thoracic surgery in the emergency of a complicated postpartum diaphragmatic hernia / Beneficio de la cirugía torácica video-asistida en la emergencia de una hernia diafragmática posparto complicada

Abstract Diaphragmatic hernia during pregnancy or puerperium are rare entities that, in the event of a complication, represent a life-threatening emergency for both mother and the unborn child. Resolution in many cases requires a combined access through the thoracic and abdominal cavity to manage the complica tions of necrosis and/or perforation of an abdominal viscera. To treat the thoracic cavity, thoracotomy is the most described approach. Even more, the minimally invasive access by video-assisted thoracic surgery (VATS) is not widely referenced in the literature despite its clear benefits of this technique in the recovery of patients, even in emergencies. We present the case of a postpartum right diaphragmatic hernia, complicated by necrosis of the colonic wall, treated by combined VATS approach and laparotomy in the emergency.

Resumen Las hernias diafragmáticas durante el embarazo o puerperio son entidades raras que, en caso de complicación, representan una emergencia potencialmente mortal tanto para la madre como para el feto. La resolución en muchos casos requiere un acceso combinado a través de la cavidad torácica y abdominal para manejar las complicaciones de la necrosis o perforación de las vísceras abdominales. Para tratar la cavidad torácica, la toracotomía es la vía más descrita. Más aún, el acceso mínimamente invasivo mediante cirugía torácica video-asistida (VATS) no está ampliamente referenciado en la literatura a pesar de los claros beneficios de esta técnica en la recuperación de los pacientes, incluso en emergencias. Presentamos el caso de una hernia diafragmática derecha posparto, complicada por necrosis de la pared colónica, tratada combinado VATS y laparotomía en la urgencia.

Complicaciones del bypass gástrico convencional y laparoscópico. Estudio prospectivo y comparativo / [Complications of conventional and laparoscopic gastric bypass. Prospective and comparative study].

BACKGROUND: Roux-en-y gastric bypass for the management of morbid obesity is currently the safest and more efficient treatment option. the laparoscopic era has shown its benefits in this type of surgery, so some authors advocate its implementation in a practical systematic way. all of which has lead in recent years to the unavoidable change in the surgical approach. OBJECTIVES: To evaluate and compare the complications of laparoscopic gastric bypass and the conventional one in patients with morbid obesity. Application site: self-administration national university hospital. DESIGN: Comparative, prospective no randomized study. POPULATION: Between 2002 and 2011, 420 morbidly obese patients received surgical treatment for the obesity either open (167) or laparoscopic (253) surgery RESULTS: Early postoperative complication rate was 4

in the lbg and 34

in the cbg (p < 05, 95

ci 22-38), mostly represented by seromas (25

) and wall abscesses (5.4

). the percentage of late postoperative complications was 2.8

in the lbg group and 9.6

in the cbg (p=0.004, 95

ci 1.4-12.2), the most frequent being incisional hernias (7.18

). CONCLUSIONS: According to our experience and consulted literature, laparoscopic gastric bypass is a safe, reproducible and with a lower rate of both early and late complications than cbg, and so we consider and offer lbg as the ideal technique for the treatment of patients with morbid obesity.