Factores epidemiológicos en la conversión de la colecistectomía videolaparoscópica / Epidemiological factors in the conversion of videolaparoscopic cholecystectomy

Introducción: La colecistectomía videolaparoscópica es el proceder más idóneo para tratar la litiasis vesicular y sus complicaciones, pero existen factores epidemiológicos que pueden propiciar la conversión. Objetivo: Determinar los factores epidemiológicos que incidieron en la conversión de la colecistectomía videolaparoscópica. Métodos: Se realizó un estudio de tipo descriptivo y retrospectivo en el Hospital Militar "Octavio de la Concepción y de la Pedraja", desde enero de 2010 hasta mayo de 2019. Fueron estudiados 64 pacientes intervenidos de forma electiva o de urgencia, que fueron convertidos de mínimo acceso a vía convencional. Resultados: Se evidenció mayor número de conversiones urgencias, a predominio de hombres, con rango de edad entre 41 y 55 años. En la cirugía electiva sobresalió el sexo femenino, del mismo grupo etario. La conversión fue más habitual en los pacientes sobrepeso. La litiasis vesicular sintomática (cólico biliar) fue la condición más encontrada como antecedente. La diabetes mellitus fue la enfermedad crónica no trasmisible más asociada a la conversión. Conclusiones: Fue más frecuente la conversión en el grupo de edad entre 41 a 55 años, en pacientes del sexo masculino, sobrepeso, asociado a cólicos biliares y diabetes mellitus(AU)

Introduction: Videolaparoscopic cholecystectomy is the most suitable procedure to treat gallbladder lithiasis and its complications, but there are epidemiological factors that can promote conversion. Objective: To determine the epidemiological factors that influenced the conversion of videolaparoscopic cholecystectomy. Methods: A descriptive and retrospective study was carried out at the Hospital Militar "Octavio de la Concepción y de la Pedraja", from January 2010 to May 2019. 64 patients underwent elective or emergency surgery, who were converted with minimal access to conventional. Results: A greater number of conversions from emergency was evident, predominantly in men, with an age range between 41 and 55 years. In elective surgery, the female sex, from the same age group, stood out. Conversion was more common in overweight patients. Symptomatic gallbladder lithiasis (biliary colic) was the most commonly found condition as an antecedent. Diabetes mellitus was the chronic non-communicable disease most associated with conversion. Conclusions: Conversion was more frequent in the age group between 41 to 55 years, in male patients, overweight, associated with biliary colic and diabetes mellitus(AU)

Caracterización de pacientes con litiasis vesicular operados por mínimo acceso / Characterization of patients with vesicular lithiasis treated with minimal access surgery

Introducción: la litiasis vesicular es la enfermedad del tracto alimentario que más requiere de hospitalización. Objetivo: caracterizar a los pacientes operados por litiasis vesicular mediante cirugía de mínimo acceso. Método: se realizó un estudio observacional descriptivo y retrospectivo de 1 271 pacientes con litiasis vesicular operados por mínimo acceso en el Servicio de Cirugía General del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde enero de 2011 hasta septiembre de 2014. Resultados: en la serie predominaron el sexo femenino (84,1 %), el grupo etario de 45-65 años (47,7 %), así como el coleperitoneo por lesión iatrogénica de la vía biliar como principal complicación y causa de reintervención más frecuente; asimismo, la presencia del plastrón vesicular crónico resultó ser el motivo de las conversiones a cirugía abierta (25,0 %) y solo falleció 0,2 % de los afectados. La estadía hospitalaria fue menor de 24 horas en 96,6 % del total de pacientes y 93,8 % de los integrantes del estudio fueron operados con un tiempo quirúrgico de 60 minutos o menos. Conclusiones: existió baja incidencia de complicaciones, conversiones y reintervenciones, sin tiempos quirúrgicos prolongados y una corta estadía hospitalaria.

Introduction: vesicular lithiasis is the disease of the alimentary tract mostly requiring hospitalization. Objective: to characterize the patients with vesicular lithiasis treated with minimal access surgery. Method: a descriptive and retrospective observational study of 1 271 patients with vesicular lithiasis treated with minimal access surgery at the General Surgery Service from "Saturnino Lora Torres" Teaching Provincial Clinical Surgical Hospital in Santiago de Cuba was carried out from January, 2011 to September, 2014. Results: the female sex (84.1%), the age group 45-65 years (47.7%), as well as the choleperitoneum as iatrogenic lesion of the biliary pathways as main complication and most frequent cause of reintervention prevailed in the series; also, the presence of the chronic vesicular abscess turned out to be the reason of change to open surgery (25.0%) and only 0.2% of the affected patients died. The hospital stay was shorter than 24 hours in 96.6% of the total of patients and 93.8% of the members of the study were operated with a surgical time of 60 minutes or less. Conclusions: there was low incidence of complications, conversions and reinterventions, without prolonged surgical times and a short hospital stay.

Total cost of hospitalization of patients undergoing elective laparoscopic cholecystectomy related to nutritional status / Custo total de internação de pacientes submetidos à colecistectomia videolaparoscópica eletiva relacionado ao estado nutricional

ABSTRACT Background: In the Western world, the population developed an overweight profile. The morbidly obese generate higher cost to the health system. However, there is a gap in this approach with regard to individuals above the eutrofic pattern, who are not considered as morbidly obese. Aim: To correlate nutritional status according to BMI with the costs of laparoscopic cholecystectomy in a public hospital. Method: Data were collected from medical records about: nutritional risk assessment, nutricional state and hospital cost in patients undergoing elective laparoscopic cholecystectomy. Results: Were enrolled 814 procedures. Average age was 39.15 (±12.16) years; 47 subjects (78.3%) were women. The cost was on average R$ 6,167.32 (±1830.85) to 4.06 (±2.76) days of hospitalization; 41 (68.4%) presented some degree of overweight; mean BMI was 28.07 (±5.41) kg/m²; six (10%) individuals presented nutritional risk ≥3. There was a weak correlation (r=0.2) and not significant (p <0.08) between the cost of hospitalization of the sample and length of stay; however, in individuals with normal BMI, the correlation was strong (r=0,57) and significant (p<0.01). Conclusion: Overweight showed no correlation between cost and length of stay. However, overweight individuals had higher cost of hospitalization than those who had no complications, but with no correlation with nutritional status. Compared to those with normal BMI, there was a strong and statistically significant correlation with the cost of hospital stay, stressing that there is normal distribution involving adequate nutritional status and success of the surgical procedure with the consequent impact on the cost of hospitalization.

RESUMO Racional: No mundo ocidental, a população desenvolveu um perfil de excesso de peso corporal. Os obesos mórbidos geram custo mais alto para o sistema de saúde. Entretanto, observa-se um hiato no tocante aos indivíduos acima do eutrofismo, mas não considerados obesos mórbidos. Objetivo: Correlacionar estado nutricional, segundo o IMC, com custo de internação de colecistectomias videolaparoscópicas. Método: Coleta de dados dos prontuários sobre: avaliação de risco nutricional, estado nutricional e custo de internação de pacientes submetidos à colecistectomia videolaparoscópica eletiva no período de janeiro de 2012 a dezembro de 2014. Resultados: Foram analisados 814 procedimentos. A idade média foi de 39,15 (±12,16) anos; 47 (78,3%) eram mulheres. O custo de internação foi, em média, de R$ 6.167,32 (±1.830,85) para 4,06 (±2,76) dias de internação. Quarenta e um (68,4%) pacientes apresentavam algum grau de sobrepeso; o IMC médio foi 28,07 (±5,41) kg/m²; seis (10%) indivíduos apresentavam risco nutricional ≥3. Houve correlação fraca (r=0,2) e não significativa (p<0,08) entre o custo de hospitalização e o tempo de permanência. No entanto, em indivíduos com IMC normal, a correlação foi forte (r=0,57) e significante (p<0,01). Conclusão: Sobrepeso não demonstrou correlação entre custo e tempo de internação. Entretanto, os indivíduos com sobrepeso apresentaram custo maior de internação em relação aos que não tiveram intercorrência, mas sem correlação com o estado nutricional. Em relação aos com IMC normal, houve correlação forte e estatisticamente significante com o custo para tempo de internação, reforçando que há provável distribuição normal envolvendo estado nutricional adequado e sucesso do procedimento cirúrgico com consequente impacto no custo de internação.

Absceso retroperitoneal secundario a litiasis residual intraperitoneal tras una colecistectomía laparoscópica / Retroperitoneal abscess secondary to residual intraperitoneal lithiasis after laparoscopic cholecystectomy

El derrame biliar y la caída de cálculos a la cavidad abdominal es una complicación menor de las colecistectomías laparoscópicas. Sin embargo, puede asociarse a graves complicaciones posoperatorias si no se lava la cavidad y se extraen los cálculos. Se documenta el caso de una paciente operada mediante colecistectomía laparoscópica por litiasis vesicular, en la que se decidió la conversión a cirugía abierta dada la caída de cálculos hacia la cavidad abdominal. En el posoperatorio presentó infección de la herida y fístula cutánea, con salida de cálculos por la herida quirúrgica. Cuatro años después presentó síndrome febril y dolor lumbar, y se diagnosticó entonces un absceso del psoas cuya causa fue la presencia de cálculos biliares que se desplazaron hacia ese sitio. Se intervino quirúrgicamente y se le drenó el absceso por vía posterior. La evolución fue satisfactoria. Estas complicaciones refuerzan la necesidad de una extracción exhaustiva de todos los cálculos que caen a cavidad durante las colecistectomías laparoscópicas(AU)

The biliary effusion and stones falling into the abdominal cavity is a minor complication of laparoscopic cholecystectomy. However, it may be associated to severe postoperative complications if the cavity is not washed and the stones are not removed in a proper way. This is a female patient who underwent laparoscopic cholecystectomy for gallstones, and this time it was decided to resort to open surgery after the falling of stones into the abdominal cavity. In the postoperative phase, she suffered wound infection and cutaneous fistula, with the stones coming out of the surgical wound. Four years after the initial intervention, she presented with fever and back pain. Psoas abscess was then diagnosed; the cause was the presence of gallstones that migrated to that site. He was operated on and abscess drainage was performed through posterior approach. Her subsequent progress was satisfactory. This type of complications necessarily requires the complete removal of all the stones falling into a cavity during laparoscopic cholecystectomies(AU)

Lesiones de la vía biliar en colecistectomías laparoscópicas / Bile duct injures from laparoscopic cholecystectomy

Introducción: en febrero de 1991, se realizó la primera colecistectomía laparoscópica en Cuba. No obstante sus beneficios, las lesiones de la vía biliar parecen ser más frecuentes. Objetivo: describir el comportamiento de las lesiones de la vía biliar en 6 centros de 5 provincias del país, a fin de detectar deficiencias al ser corregidas. Métodos: se realizó un estudio multicentros, descriptivo y retrospectivo de 27 lesiones de la vía biliar ocurridas en 17 288 colecistectomías laparoscópicas realizadas en 6 hospitales universitarios. Se colectó el dato primario a través de un cuestionario de 13 puntos, aplicado a cada paciente lesionado, y común para todos los centros. Resultados: el porcentaje de lesiones de la vía biliar en esta serie fue bajo (0,15 por ciento). En 59,2 por ciento, el diagnóstico fue posoperatorio y casi el 63 por ciento fueron graves lesiones tipo E de Strasberg. Las técnicas de reparación más empleadas fueron las derivaciones biliodigestivas, pero las lesiones diagnosticadas durante el transoperatorio fueron en la mayoría de los casos tratados con reparación sobre sonda. Se presentaron complicaciones mayores en 25,9 por ciento. Conclusiones: el porcentaje de lesiones en nuestro estudio es bajo, pero predominan las de caracter grave. Las estenosis posquirúrgicas, estuvieron predominantemente relacionadas con la elección errónea de la técnica primaria de reparación(AU)

Introduction: On February 1991 the first laparoscopic cholecistectomy (LC) was performed in Cuba. Despite the benefits of this approach, bile ducts injuries (BDI) seem to be more frequent. Objective: To describe the behavior of the bile duct injuries in six hospitals located in 5 provinces throughout the country so as to detect deficiencies to be corrected. Methods: A retrospective, multicenter and descriptive study of 27 bile duct injuries on 17288 LC performed in 6 university hospitals throughout the country. The primary data was collected through a 13 point-questionnaire applied to every injured patient, and equal for all the centers. Results: The percentage of BDI in this series was low (0.15 percent). In 59.2 percent of cases, the diagnosis was made postoperatively and almost 63 percent were severe Strasberg's type E lesions. The most used repair techniques were bile digestive derivations, but lesions identified transoperatively were in most of the cases treated with T tube repairs. Major complications occurred in 25.9 percent of patients. Conclusions: The percentage of lesions in our study is low, but they were mostly severe. The postsurgical stenosis was mainly related with the wrong selection of the primary repair technique(AU)

Reconstrução cirúrgica da estenose cicatricial de vias biliares pós-colecistectomia / Surgical reconstruction of post-cholecistectomy cicatricial biliary stenosis

OBJETIVO: Avaliar uma série de casos de estenose cicatricial de vias biliares pós-colecistectomia submetidos à reconstrução cirúrgica. MÉTODOS: Foi realizado estudo retrospectivo de 27 pacientes submetidos à reconstrução cirúrgica da via biliar por estenose cicatricial. O tipo de colecistectomia que resultou na lesão, idade e sexo, sinais e sintomas, o momento do diagnóstico, se precoce ou tardio, presença de cirurgias prévias na tentativa de reconstruir a árvore biliar, classificação das estenoses, e tipo de operação empregada para o tratamento da injúria foram analisados. RESULTADOS: Vinte e seis lesões ocorreram durante laparotomia e uma durante vídeolaparoscopia. Dezesseis pacientes (59%) tiveram as lesões diagnosticadas no transoperatório ou nos primeiros dias de pós-operatório, sete (26%) dos quais já submetidos à reoperação no hospital de origem, evoluindo mal; nove pacientes desse grupo (33%) não tinham reoperação. Onze pacientes (41%) apresentaram a forma clássica de estenose cicatricial, sem acidentes transoperatórios aparentes, com desenvolvimento de obstrução biliar tardia. Todos os pacientes foram submetidos à anastomose hepático-jejunal em "Y" de Roux, sendo que em dois casos os ductos hepáticos direito e esquerdo foram implantados separadamente na alça exclusa de jejuno. Vinte e seis pacientes (96,3%) evoluíram bem inicialmente, um paciente teve fístula biliar e foi a óbito. Uma paciente com bom resultado inicial apresentou recidiva da anastomose, cirrose secundária e está aguardando transplante hepático. CONCLUSÃO: A maioria das lesões foi diagnosticada durante a colecistectomia ou nos primeiros dias de pós-operatório, sete pacientes já tinham sido operados na tentativa de reconstruir o trato biliar. A hepaticojejunostomia em "Y" de Roux empregada mostrou-se segura e efetiva em recanalizar a via biliar a curto e longo prazos.

OBJECTIVE: To evaluate a series of cases of cicatricial stenosis of the biliary tract after cholecystectomy undergoing surgical reconstruction. METHODS: We conducted a retrospective study with 27 patients who underwent surgical reconstruction of the biliary tree for cicatricial stenosis. We analyzed the type of cholecystectomy that resulted in injury, age, gender, signs and symptoms, time of diagnosis, early or late, presence of previous surgery in an attempt to reconstruct the biliary tree, classification of stenosis and type of operation used for treatment of the injury. RESULTS: Twenty-six injuries occurred during a laparotomy and one during laparoscopy. Sixteen (59%) lesions were diagnosed intraoperatively or within the first postoperative day, seven (26%) havinh been submitted to reoperation at the local hospital, with poor results; nine patients in this group (33%) had no reoperation. Eleven patients (41%) had the classic form of cicatricial stenosis, without apparent intraoperative accidents and late development of biliary obstruction. All patients underwent Roux-en-Y hepatic-jejunal anastomosis; in two cases the right and left hepatic ducts were implanted separately in the excluded jejunal loop. Twenty-six patients (96.3%) had no early complications; one patient had biliary fistula and died. One patient presented with stenosis recurrence, secondary cirrhosis and is awaiting liver transplantation. CONCLUSION: Most injuries were diagnosed during cholecystectomy within the first postoperative days; seven patients had been reoperated in an attempt to reconstruct the biliary tract. Roux-en-Y hepaticojejunostomy proved safe and effective in draining the bile duct in the short and long term.

Analgesia infiltrativa na videocolecistectomia: ensaio clínico randomizado / Infiltrative analgesy in videocolecistectomy: a randomized clinical trial

RACIONAL: Grande parte dos pacientes cirúrgicos experimenta dor intensa no pós-operatório. OBJETIVO: Avaliar a eficácia analgésica da infiltração das incisões da colecistectomia laparoscópica com ropivacaína, bem como seu efeito sobre o consumo de opióides. MÉTODOS: Foi realizado estudo prospectivo duplo-cego randomizado, em que 70 pacientes submetidos a colecistectomia laparoscópica foram divididos em dois grupos, I (infiltração) e C (controle). Após 12 horas de pós-operatório os pacientes foram entrevistados e responderam a Escala Visual e Analógica da Dor. O consumo de opióides foi avaliado através dos prontuários médicos, no momento da entrevista. RESULTADOS: Notou-se melhora da dor no grupo intervenção sendo que 44,4 por cento revelaram dor leve, 50 por cento dor moderada e 5,6 por cento dor intensa. Já no grupo C os respectivos valores foram 38,2 por cento, 50 por cento, e 11,8 por cento (P=0,622). O grupo I apresentou menor média de dor, 2,75, comparada com o grupo C, 3,75, mas esse resultado não foi estatisticamente significante (P=0,319). Da mesma forma o grupo infiltrado consumiu menos opióides que o grupo controle, 47,2 por cento e 52,9 respectivamente, embora sem significância estatística (P=0,632). CONCLUSÃO: A infiltração das incisões da videocolecistectomia com ropivacaína, conferiu diminuição na dor pós-operatória, bem como reduziu o consumo de opióides após 12 horas de pós-operatório.

BACKGROUND: Large proportion of surgical patients experience severe pain postoperatively. AIM: To evaluate the analgesic efficacy of infiltration on incision of laparoscopic cholecistectomy with ropivacaine and the effect on opioids consumption. METHODS: A prospective, randomized, double-blind study was conducted, where 70 patients undergoing laparoscopic cholecistectomy were divided into two groups, I (infiltration) and C (control). After 12 hours of post-operative patients were interviewed and answered the Visual Analogue Scale. The consumption of opioids was evaluated through medical records at the time of interview. RESULTS: When comparing the intensity of pain in both groups, was noticed a better profile of pain in the intervention group, with 44.4 percent reported mild pain, moderate pain 50 percent and 5.6 percent severe pain. In group C the respective values were 38.2 percent, 50 percent and 11.8 percent (P = 0.622). The group I had lower average pain, 2.75, compared with group C, 3.75, but this result was not statistically significant (P = 0.319). Similarly group I opioids had a lower consumption than group C, 47.2 percent and 52.9 percent respectively, although with no statistical significance (P = 0.632). CONCLUSION: The infiltration of the incisions with ropivacaine, although without statistical significance, produced reduction in the postoperative pain, as well as reduced the consumption of opioids after 12 hours.

Colecistectomía notes transvaginal en humanos: primera serie de casos en Costa Rica / Transvaginal notes cholecystectomy in humans: first series of cases in Costa Rica

OBJETIVO. Reportar la primera serie de casos de colecistectomía NOTES transvaginal en humanos en Costa Rica y su potencial clínico en el abordaje de patologías abdominales en este país. PACIENTES Y MÉTODOS. Presentamos una serie de tres casos de pacientes femeninas adultas de 44, 58 y 69 años (promedio 57 años), asintomáticas, con diagnóstico de pólipo vesicular por un ultrasonido abdominal, sometidas a una colecistectomía por vía transvaginal modificada con técnica laparoscópica. Se insertó un trócar de 5 mm a través del ombligo para creación y monitoreo del pneumoperitoneo, así mismo posibilitando visión endoscópica durante la introducción intravaginal de un endoscopio y una pinza para retracción cefálica de la vesícula. A través del trócar intraumbilical se insertó un dispositivo laparoscópico de gancho convencional para disección del pedículo y cama hepática, y posteriormente una clipadora laparoscópica para clipeo de la arteria y conducto cístico. La extracción de la vesícula se realizó por vía transvaginal. RESULTADOS. Los tres casos fueron realizados con éxito, sin presentar ninguna complicación intra o postoperatoria. El tiempo operatorio promedio fue de 107 minutos (rango 100-115 minutos). Las pacientes fueron egresadas al cabo de 24 horas. En el control postoperatorio al mes, ninguna paciente refirió dolor incisional ni dispareunia. CONCLUSIÓN. La colecistectomía NOTES transvaginal combinada con técnica laparoscópica es viable, segura, reproducible y constituye un paso más en el desarrollo de la cirugía NOTES pura. Mayores esfuerzos en investigación tecnológica y dedicación se requieren para generalizar esta técnica a otros procedimientos más complejos.

OBJECTIVES. To report the first case series of transvaginal NOTES cholecystectomy in humans in Costa Rica and its clinical potential in the treatment of abdominal diseases in this country. PATIENTS AND METHODS. We present a series of three cases of adult female patients of 44, 58 and 69 years of age (average 57 years), asymptomatic, with a gall bladder polyp diagnosed by an abdominal ultrasound, who underwent a transvaginal cholecystectomy modified with laparoscopic technique. A 5 mm trocar was inserted through the umbilicus to create and to monitor the pneumoperitoneum, as well as to possibilitate endoscopic vision during the intravaginal introduction of an endoscope and a forceps device for cephalic retraction of the gall bladder. Through the intraumbilical trocar a conventional laparoscopic hook device was also inserted for dissection of the pedicle and hepatic bed, and also a laparoscopic clip applier for clipping of the cystic artery and duct. The gall bladder was extracted through the vagina. RESULTS. The three cases were successfully performed without intra- or postoperative complications. The average operative time was 107 minutes (range 100-115 minutes). The patients were discharged within 24 hours. At the 1-month follow-up, none of the patients complained neither of incisional pain nor dyspareunia. CONCLUSION. The transvaginal NOTES cholecystectomy combined with laparoscopic technique is feasible, safe, reproducible, and constitutes one step further in the development of pure NOTES procedures. More effort in technological investigation and dedication is to be required to apply this technique to other more complex procedures.

Anestesia espinal para colecistectomia / Spinal anesthesia for cholecystectomy

Introducción: La anestesia espinal o subaracnoidea brinda al paciente calidad y múltiples ventajas. Sin embargo, en procedimientos quirúrgicos que comprometen al abdomen superior ha sido poco empleada, como en la colecistectomía. En estas cirugías, ya sean laparoscópicas o abiertas, se ha empleado de forma rutinaria la anestesia general. Objetivo: Describir la aplicación de anestesia espinal para la realización de colecistectomía abierta. Materiales y métodos: Es un estudio retrospectivo, serie de casos, que evaluó 32 pacientes ASA I y II a los que se les realizó colecistectomía abierta, bajo anestesia espinal, en el tiempo comprendido entre junio de 2002 y junio de 2004, en un Hospital Nivel II de la ciudad de Popayán, previo consentimiento aprobado por el Comité Científico del Hospital. Resultados: En 25 mujeres y 7 hombres, con edad media de 33,6 años, se observó que la frecuencia cardiaca y la presión arterial sistólica, diastólica y media disminuyeron durante los primeros 20 minutos; luego, sus valores se incrementaron hasta estabilizarse por debajo de los parámetros iniciales respectivos. El 34,3% de la población presentó eventos transoperatorios como hipotensión, bradicardia, náusea, vómito, dolor en hombro o dolor torácico. En dos de estos pacientes fue necesario cambiar a anestesia general. En el postoperatorio, 21,7% de los pacientes presentaron efectos adversos: náusea, vómito y cefalea. El 90 % egresaron del hospital en las primeras 48 horas. No se reportó mortalidad intra o postoperatorio inmediata. Conclusiones: La anestesia espinal es una alternativa a tener en cuenta para procedimientos como la colecistectomía abierta.

Introduction: Spinal anaesthesia offers patients quality as well as several advantages; however in surgical procedures which involve the upper abdomen it had been less employed in procedures such as cholecistectomy by laparoscopic technique or via opening the abdomen where the general anaesthesia is the common procedure. Objective: To describe the application of spinal anaesthesia for open cholecistectomy procedures. Material and methods: This is a retrospective study, based on case reports, which evaluated 32 patients ASA I y II which underwent open cholecistectomy under spinal anaesthesia , from June, 2002 to, June, 2004, in a second level hospital in Popayan, Colombia, and with the corresponding consent of the scientific committee. Results: The study included 25 women and 7 men, with a mean age of 33,6 years. The homodynamic profile was measured by monitoring patients heart rate, systolic and diastolic blood pressure. These values diminished during the first 20 minutes, however, afterwards they increased until reaching stability below the initial parameters. In 34.3% of the population evaluated exhibited adverse intra-operative events such as hypotension and /or bradicardia, nausea, vomiting, thoracic or shoulder pain. There are no reports of postoperative mortality. In two of the cases, it was necessary to revert the technique to the use of general anaesthesia. During the postoperative period 21,7% of the patients showed some adverse events, such as nausea and vomiting. In the study, 90% of the patients were released from the hospital within the first 48 hours after the procedure. No intra or immediate post- operatory mortality was reported. Conclusions: Spinal anaesthesia is an alternative to keep in mind for procedures such as open cholecistectomy.

Correlación entre el protocolo preoperatorio y los hallazgos quirúrgicos en pacientes programados para colecistectomía por colelitiasis: estudio realizado en el hospital Luis Vernaza, de la ciudad de Guayaquil en el período entre mayo de 2005 a enero de 2006 / Correlation between preoperative protocol and surgical findings in patients programmed for cholecistectomy due to cholelithiasis: study carried out in the Luis Vernaza hospital, in Guayaquil from may/2005 to january/2006

Tipo de estudio: prospectivo y descriptivo con 82 pacientes elegidos al azar, período: mayo, 2005- enero, 2006. Objetivo: Comprobar la sensibilidad y especificidad del protocolo preoperatorio utilizado en pacientes sometidos a colecistectomía por colelitiasis. Criterios de inclusión: diagnóstico único colelitiasis con protocolo preoperatorio completo programadas para colecistectomía. Criterios de exclusión: colecistectomía previa, colelitiasis con otras alteraciones de vías biliares, pacientes sin diagnóstico de colelitiasis. Protocolo preoperatorio: historia clínica, enzimas hepáticas y ecografía. Resultados: 14.6 ictericia, 12.2 coluria y 2.4 acolia; paredes vesiculares finas (65.8), gruesas (30.5) y escleroatróficas (3.6); valores anormales de bilirrubina 20.6, GOT 31.6, GPT 39, FA 34.1 y GT 50; hallazgos quirúrgicos: paredes vesiculares finas, 57.3, gruesas 37.8 y escleroatróficas, 4.8; 29.26 presentaron PAC; Pacientes con PAC, el 38 tuvo manifestaciones clínicas y DUC, 9. Pacientes con manifestaciones clínicas detectamos PAC en 64, y sin manifestaciones 22 (p=0.00157). Pacientes con PAC alterada γ GT 66.7. Valores enzimáticos significativamente superiores en PAC. Ecografía: precisión 70 al observar pared vesicular y 81-82 al determinar tamaño y cantidad de cálculos.

Study type: prospective and descriptive with 82 patients randomly selected from May/2005 to January/2006. Objective: To verify the sensitivity and specificity of the preoperative protocol used in patients who has had a cholecistectomy due to cholelithiasis. Criteria to be included: Single diagnosis: cholelithiasis with preoperative protocol and programmed for cholecistectomy. Criteria to be excluded: Prior cholecistectomy, cholelithiasis with other abnormalities of the bile ducts, patients without a diagnosis of cholelithiasis. Preoperative protocol: medical record, hepatic enzymes, and echography. Results: 14.6 jaundice, 12.2 choluria, and 2.4 acholia; gallbladder walls: thin (65.8), thick (30.5), and scleroatrophic (3.6); abnormal levels: bilirubin, 20.6; GOT, 31.6; GPT, 39; AP, 34.1 y γGT, 50; surgical findings: gallbladder walls: thin 57.3, thick 37.8, and scleroatrophic 4.8; 29.26 presented PAC; Patients with PAC: 38 had clinical symptoms and DUC, 9. Patients with clinical symptoms: in 64 PAC was found and without symptoms 22 (p=0.00157). Patients with PAC, abnormal γGT: 66.7. Enzimes levels significantly higher in PAC. Echography: accuracy 70 watching the gallblader wall, and 81-82 setting size and amount of gallstones.