Pars plana vitrectomy and visual stimulation for treatment of vitreomacular traction secondary to toxoplasmosis retinochoroiditis in a 5-year-old child / Vitrectomia via pars plana e estimulação visual para tratamento da tração vitreomacular secundária à retinocoroidite por toxoplasmose em criança de 5 anos

ABSTRACT Objective: A unusual case of ocular toxoplasmosis with significant vitreomacular traction is reported. The patient improved significantly following pars plana vitrectomy combined with visual stimulation and occlusion therapy. Methods: The case of a 5-year-old girl with significant unilateral vision loss associated with vitreous condensation and macular traction is described. Results: Pars plana vitrectomy was carried out for vitreomacular traction release. This was followed by visual stimulation and occlusion therapy. Significant improvement was observed. Conclusion: Despite structural damage, the combination of properly indicated surgery and amblyopia management strategies allowed the achievement of maximum vision goals in this case, suggesting structural damage may be associated with functional amblyopia.

RESUMO Objetivo: Relata-se um caso de apresentação atípica de toxoplasmose ocular, com importante tração vitreomacular. A paciente apresentou melhora significativa após vitrectomia via pars plana, com estimulação visual e oclusão. Métodos: Descreve-se o caso de uma menina de 5 anos, com importante perda de visão unilateral associada à condensação vítrea e à tração macular. Resultados: Foi realizada vitrectomia via pars plana para alívio da tração vitreomacular, seguida de estimulação visual e oclusão. Foi observada melhora significativa. Conclusão: Apesar dos danos estruturais, a combinação de cirurgia bem indicada com estratégias de tratamento da ambliopia permitiu alcançar o máximo do potencial visual nesta paciente, sugerindo que os danos estruturais podem estar associados à ambliopia funcional.

Revisão da técnica de abdominoplastia com dissecção reduzida e fixação com pontos de Baroudi / A review of abdominoplasty technique with reduced dissection and fixation with Baroudi sutures

INTRODUÇÃO: Um estudo retrospectivo foi realizado em 500 abdominoplastias tipo incisão transversal pubiana baixa, combinada com lipoaspiração de 2007 a 2014. Em todas, a dissecção do retalho cutâneo abdominal foi restrita, em que foram aplicados pontos de adesão em toda a extensão das regiões dissecadas. Foi ainda avaliado o uso ou não de drenos de sucção a vácuo. Em 33% dos casos não foram utilizados estes drenos e não foram também detectados sinais de seroma, comprovando a eficácia dos pontos de adesão. MÉTODOS: Em todas as abdominoplastias a via de acesso foi da região pubiana transversal baixa estendida até o nível das espinhas ilíacas anterossuperiores bilateralmente, associada à lipoaspiração nas regiões dos flancos. Após a dissecção, plicatura dos músculos retos e ressecção dos excessos cutâneos, foram aplicados pontos de adesão em toda a extensão das regiões dissecadas. RESULTADOS: A conduta com o uso sistemático dos pontos de adesão demonstrou ser eficaz, sem a necessidade do uso de drenos de qualquer natureza dada a inexistência de seroma em todos os casos operados. CONCLUSÃO: Nas abdominoplastias tipo pubiana transversal baixa, a dissecção limitada do retalho cutâneo estendida até o apêndice xifoide, associada a pontos de adesão e lipoaspiração concomitante, tem dispensado o uso de drenos a vácuo, sem a existência de seroma, além de determinar resultados gratificantes.

INTRODUCTION: A retrospective study was carried out on 500 abdominoplasties with lower pubic transverse incision combined with liposuction, performed from 2007 to 2014. In all cases, the dissection of the abdominal skin flap was restricted, with adhesion sutures applied throughout the dissected regions. The use of vacuum suction drains was also evaluated. In 33% of cases, these drains were not used, but no signs of seroma were detected, proving the efficacy of adhesion sutures. METHODS: In all abdominoplasties, the access route was the lower transverse pubic region extended up to the level of the anterior superior iliac spines bilaterally, combined with liposuction in the adjacent regions. After the dissection, plication of the rectus muscles, and resection of excess skin, adhesion sutures were applied throughout the dissected regions. RESULTS: The systematic use of adhesion sutures was efficient, without the need to use drains, given the absence of seroma in all cases. CONCLUSION: In lower pubic transverse abdominoplasty, limited dissection of the cutaneous flap extended up to the xiphoid, combined with adhesion sutures and liposuction, avoided the use of vacuum drains; no seroma developed, and the results were good.

CRITICAL ANALYSIS OF EXPERIMENTAL MODEL FOR STUDY OF ADHESIONS AFTER INCISIONAL HERNIAS INDUCED IN RATS’ AND REPAIR OF ABDOMINAL WALL WITH DIFFERENT BIOMATERIALS / ANÁLISE CRÍTICA DE MODELO EXPERIMENTAL PARA ESTUDO DAS ADERÊNCIAS APÓS HÉRNIAS INCISIONAIS INDUZIDAS EM RATOS E REPARO DA PAREDE ABDOMINAL COM DIFERENTES BIOMATERIAIS

Background: Adhesions induced by biomaterials experimentally implanted in the abdominal cavity are basically studied by primary repair of different abdominal wall defects or by the correction of incisional hernias previously performed with no precise definition of the most appropriate model. Aim: To describe the adhesions which occur after the development of incisional hernias, before the prosthesis implantation, in an experimental model to study the changes induced by different meshes. Methods: Incisional hernias were performed in 10 rats with hernia orifices of standardized dimensions, obtained by the median incision of the abdominal wall and eversion of the defect edges. Ten days after the procedure adhesions of abdominal structures were found when hernias were repaired with different meshes. Results:The results showed hernia sac well defined in all rats ten days after the initial procedure. Adhesions of the greater omentum occurred in five animals of which two also showed adhesions of small bowel loops besides the omentum, and another two showed liver adhesions as well as the greater omentum, numbers with statistical significance by Student's t test (p<0.05). Conclusion:Although it reproduces the real clinical situation, the choice of experimental model of incisional hernia repair previously induced implies important adhesions, with possible repercussions in the evaluation of the second operation, when different implants of synthetic materials are used.

Racional: As aderências induzidas por biomateriais implantados experimentalmente na cavidade abdominal são estudadas basicamente com o reparo primário de diferentes defeitos produzidos na parede abdominal ou com a correção de hérnias incisionais realizadas previamente, sem definição precisa do modelo mais adequado.Objetivo: Descrever as aderências que ocorrem após o desenvolvimento de hérnias incisionais, antes do implante de próteses, em modelo experimental para estudo de alterações induzidas por diferentes biomateriais.Métodos: Foram realizadas hérnias incisionais em 10 ratos, com orifícios herniários de dimensões padronizadas, obtidos pela incisão mediana da parede abdominal e eversão das bordas do defeito. Após 10 dias foram evidenciadas aderências de estruturas abdominais quando as hérnias foram reparadas com diferentes próteses.Resultados: Foi possível evidenciar hérnias com saco herniário bem definido em todos os ratos já no décimo dia após o procedimento inicial. Aderências do omento maior ocorreram em cinco animais, dos quais dois também apresentaram aderências de alças do intestino delgado além do omento, e outros dois aderências do fígado juntamente com o omento maior, números com significância estatística pelo teste t de Student (p<0,05).Conclusão: A opção por modelo experimental de reparo de hérnia incisional previamente induzida, embora mimetize a situação clínica real, implica em aderências importantes, com possível repercussão na avaliação da segunda operação, quando são utilizados diferentes implantes de material sintético.

Efficacy of Percutaneous Epidural Neuroplasty Does Not Correlate with Dural Sac Cross-Sectional Area in Single Level Disc Disease

PURPOSE: Percutaneous epidural neuroplasty (PEN) is a minimally invasive treatment. The efficacy of PEN has been relatively well investigated; however, the relationship between the clinical effectiveness of PEN and the severity of spinal canal stenosis by disc material has not yet been established. The purpose of this study was to compare clinical outcomes of PEN according to the dural sac cross-sectional area in single level disc disease. MATERIALS AND METHODS: This study included 363 patients with back pain from single level disc disease with and without radiculopathy. Patients were categorized into groups according to spinal canal compromise by disc material: Category 1, less or more than 50%; and Category 2, three subgroups with lesser than a third, between a third and two thirds, and more than two thirds. Clinical outcomes were assessed according to the Visual Analog Scale (VAS) score for back pain and leg pain and Odom's criteria at 1, 3, 6, 12, and 24 months after treatment. RESULTS: The demographic data showed no difference between groups according to spinal canal compromise by disc material except age (older age correlated with more spinal canal compromise). The dural sac cross-sectional area did not correlate with the VAS scores for back and leg pain after PEN in single level disc disease in Groups 1 and 2. Odom's criteria after PEN were also not different according to dural sac cross-sectional area by disc material. CONCLUSION: PEN is an effective procedure in treating single level lumbar disc herniation without affecting dural sac cross-sectional area.

Tratamiento laparoscópico de la obstrucción intestinal por bridas / Laparoscopic treatment of adhesive small bowel obstruction

Background: Treatment options for adhesive small bowel obstruction (ASBO) involve conservative and surgical management, traditionally through open adhesiolysis. Laparoscopic approach has been performed in recent years; however, limited data exist on its safety and results vary considerably. Our aim is to report our experience of laparoscopic treatment for ASBO. Methods: Retrospective study including patients admitted with the diagnosis of adhesive small bowel obstruction and that were submitted to laparoscopic exploration, between June 2003 and April 2013. We analyzed demographic, surgical variables and outcomes in terms of conversion rate, operative time, re-feeding time and length of stay. Non-parametric tests were used for statistical analysis. Results: Series of 38 patients submitted to laparoscopic exploration, mean age: 51 +/- 16 years, 47 percent male. 53 percent had prior intra-abdominal surgeries. Laparoscopic resolution of bowel obstruction was possible in 31 patients (82 percent), with 7 conversions to open surgery. Median operative time was 60 (25-180) minutes, median re-feeding time was 24 (24-192) hours and median length of stay was 4 (2-52) days. Two patients required re-intervention during their hospital stay, one due to persistent bowel obstruction and one due to ischemic colitis. There were no other complications or mortality. Conclusions: Laparoscopy in adhesive small bowel obstruction was a feasible approach in this series, with good results when laparoscopic resolution is achieved. Patients with no prior surgeries seem to be good candidates for this approach.

Introducción: El tratamiento de la Obstrucción Intestinal por Bridas (OIB) incluye alternativas conservadoras y quirúrgicas, esta última tradicionalmente a través de cirugía abierta. El abordaje laparoscópico ha sido incorporado recientemente, sin embargo, existe información limitada sobre su seguridad y sus resultados varían considerablemente. Nuestro objetivo es presentar la experiencia de nuestro centro en el tratamiento laparoscópico de la OIB. Material y Métodos: Estudio retrospectivo incluyendo pacientes con el diagnóstico de OIB que fueron sometidos a cirugía laparoscópica en nuestro centro, entre junio de 2003 y abril de 2013. Análisis de variables demográficas, quirúrgicas y resultados obtenidos en términos de tasa de conversión, tiempo operatorio, tiempo de realimentación y estadía hospitalaria. Análisis estadístico con pruebas no paramétricas. Resultados: Serie de 38 pacientes, edad promedio: 51 +/- 16 años, 47 por ciento sexo masculino. 53 por ciento con antecedente de cirugía abdominal previa. Resolución completa por laparoscopía fue posible en 31 pacientes (82 por ciento), con 7 conversiones a cirugía abierta. La mediana de tiempo operatorio fue de 60 m (25-180), la mediana de tiempo a la realimentación fue de 24 h (24-192) y la mediana de estadía hospitalaria de 4 (2-52) días. Dos pacientes requirieron reoperaciones durante su hospitalización; uno debido a obstrucción intestinal persistente y otro debido a colitis isquémica. No se presentaron otras complicaciones ni mortalidad en esta serie. Conclusiones: El abordaje laparoscópico en OIB es factible de realizar en pacientes seleccionados, logrando buenos resultados en caso de resolución completa por laparoscopía. Pacientes sin cirugías abdominales previas son buenos candidatos para un abordaje laparoscópico inicial.

Mucous membrane grafting for the post-Steven–Johnson syndrome symblepharon: A case report.

An 18-year-old woman was referred with late sequelae of chloroquine-induced Steven–Johnson syndrome. At the time of presentation, the symblepharon was involving the upper lids to almost the whole of the cornea, and part of the lower bulbar conjunctiva with the lower lid bilaterally. Other ocular examinations were not possible due to the symblepharon. B-scan ultrasonography revealed acoustically clear vitreous, normal chorioretinal thickness, and normal optic nerve head, with an attached retina. Conjunctivo-corneal adhesion released by superficial lamellar dissection of the cornea. Ocular surface reconstruction was carried out with a buccal mucous membrane. A bandage contact lens was placed over the cornea followed by the symblepharon ring to prevent further adhesion. The mucosal graft was well taken up along with corneal re-epithelization. Best corrected visual acuity of 20/120 in both sides after 1 month and 20/80 after 3 months was achieved and maintained till the 2.5-year follow-up.

Cirugía endoscópica por monopuerto: reporte de nuestra experiencia en los primeros 175 casos por sils port en Venezuela / Endoscopic surgery by singleport: report of our experience in the first 175 cases by sils port in Venezuela

El último paso hacia el menor grado de invasión después del surgimiento de la cirugía laparoscópica ocurre cuando los cirujanos del mundo se inician en técnicas emergentes, que entre otras, utilizan el ombligo como único puerto de entrada al abdomen quedando camufladas en la cicatriz umbilical, Presentamos la experiencia inicial de nuestro grupo, entre julio de 2009 hasta enero 2011 en variados procedimientos laparoscópicos por monopuerto con el uso del dispositivo SILS® port. Fueron intervenidos 175 pacientes, 163 adultos (93%), 12 niños (7%), todos abordados por un sólo puerto y a través del SILS® port. Se realizaron 102 colecistectomías (58%), 37 apendicectomías (21%), 8 histerectomías (4,6%), 7 ooforectomías (4%), 7 biopsias hepáticas (4%), 6 liberación de bridas y adherencias (3,4%), 4 salpingoclasias (2,3%), 2 esplenectomías (1%), 1 miotomía de Heller con funduplicatura de Dor (0,6%) 1 hiatoplasia esofágica (0.6%). Los procedimientos complejos se efectuaron después de realizados los primeros 50 casos. Todos los procedimientos en niños se completaron por incisión única de manera satisfactoria. En los adultos, 6 requirieron un puerto un adicional, en un paciente fue necesario dos puertos con posterior conversión a laparotomía (hiatoplastia esofágica). Los tiempos promedios resultaron para colecistectomías 42 min (12-72 min), apendicectomía 37,5 min (13-62 min), histerectomías 95 min (65-125 min), ooforectomías 32,5 min (15-50 min), salpingoclasia 18,5 min (12-25 min), miotomía de Heller 182 min, hiatoplastia esofágica 155 min. La cirugía laparoscópica por incisión única es una técnica emergente en franco desarrollo, en niños ha demostrado ser un procedimiento seguro y eficaz, al igual que en adultos. El desarrollo y perfeccionamiento del instrumento hará ampliar el horizonte y abarcar cirugía más complejas y considerarse como alternativa a la cirugía laparoscópica tradicional otorgando el beneficio de menos dolor y mejores resultados estéticos...

We present the initial experience of our work group, between July 2009 and January 2011 in several laparoscopic procedures by monoport with device SILS port. Patients and method: 175 patients underwent surgery, 163 adults (93%), 12 children (7%), all boarded through a single port with SILS port device, 102 cholecystectomies were made (58%), 37 appendectomies (21%) 8 hysterectomies (4.6%), 7 oophorectomies (4%). 7 hepatic biopsies (4%), 6 liberation of bridles and adhesions (3,4%), 4 segmental resection of fallopian tube (2.3%), 2 splenectomies (1%), 1 Heller miotomy with Dor funduplication (0.6%) and 1 hiatal repair (0.6%). The complex procedures were carried out alter made the first 50 cases. All the procedures in children were completed through unique incision. In the adults. 6 required an additional port; in a patient was necessary two port with later conversion to laparotomy (hiatal hernia repair). The operative times averages were for cholecystectomies 42 min (12-72 min), Appendectomies 37,5 min. (13-62 min). Hysterectomies 95 min (65-125 min), Oophorectomies 32.5 min (15-50 min), segmental resection of fallopian tube 18.5 min (12-25 min), Heller miotomy 182 min. Hiatal hernia repair 155 min. The laparoscopic surgery through unique incision is an emergent technique in frank development, in children has demonstrated to be a safe and effective procedure, like in adults. The development and improvement of instruments will make extend the horizon and include more complex surgeries and consider themselves like alternative to the traditional laparoscopic surgery, granting the benefit of less pain and better aesthetic results. The development of skills and abilities to move in a NEW ATMOSPHERE represent a main concern.

[Laparoscopic evaluation for chronic post operative abdominal pain]

Approximately 20% of patients undergoing laporotomy experience chronic postprandial abdominal pain for months after operation. Most surgeons are wary of re-operation in this condition, and opt for conservative treatment with analgesics and sedatives. This study was performed to determine the cause of this chronic abdominal pain by means of laparoscopy. Elective laparoscopic surgery was performed on 76 patients suffering from chronic post-operative abdominal pain. They did not have any signs and/or symptoms of acute intestinal obstruction; the most common complaints were: abdominal pain in 100%, nausea in 30%, vomiting in 10%. Diagnostic laparoscopy was performed and cases with positive findings were treated by laporoscopic surgery. In 81% of patients the cause of pain was obvious intestinal adhesions, 10% had adhesions without any correlation to patient's symptoms and the remaining 9% did not have any positive finding on diagnostic laparoscopy. Adhesiolysis, [sharp release with scissors] is the treatment of choice. 95% of those patients who underwent Adhesiolysis became pain free for a mean average of 11 months follow up [pre-operative average of pain episode was 4 time per week]. Laparoscopic diagnosis and treatment of chronic post-laparotomy pain is the gold standard method, it is minimally invasive and has good results

Preputial adhesions – A misunderstood entity.

Objective. To assess the trends and outcomes in referrals of ‘phimosis for circumcision’ to a tertiary care pediatric surgical department. Methods. This is a prospective study of 100 consecutive children of presumed phimosis referred for circumcision. They were assessed and classified by the senior author as having either preputial adhesions or phimosis. The patients in the former group underwent outpatient preputial adhesiolysis while those in the latter group were offered circumcision primarily. All were followed up till resolution. Results. All 100 were referred with a non-retractile prepuce and an additional reason – preputial ballooning at voiding, dysuria or suspect UTI. Eight (mean age -58 months, referred for preputial ballooning at voiding -6/8 and dysuria -2/8) had phimosis and were primarily offered circumcision. The remaining 92 (mean age – 22 months, referred for preputial ballooning at voiding -52/92, dysuria -28/92 and suspect UTI -12/92) had preputial adhesions. In the latter group, none has a documented urinary infection on specific investigations. These 92 underwent outpatient preputial adhesiolysis. Seventy three (79 %) required a single sitting, 11 (12%) required 2 -4 sittings and 4(4.5%) required 5-8 sittings over a follow up period of 1 -24 months (median -3 weeks). 4/92(4.5%) were deemed non-responders to adhesiolysis and were circumcised later. Conclusion. The majority of children referred with ‘phimosis for circumcision’ to this tertiary pediatric surgical centre were actually physiologic preputial adhesions that were managed with outpatient preputial adhesiolysis. This study underscores a lack of awareness amongst referring primary care physicians regarding preputial adhesions and the potential for an erroneous diagnosis of phimosis translating into unnecessary circumcisions in many young boys.

Neodymium YAG Laser and Surgical Synechiolysis of Iridocapsular Adhesions

PURPOSE: Several articles have been published on the successful elimination of iridolenticular synechiae after cataract extraction with a neodymium YAG laser (Nd:YAG laser) and surgical synechiolysis during cataract surgery, but the indications recommending which method is proper to use for specific kinds of adhesions have not yet been established. METHODS: We retrospectively reviewed the medical records of 106 patients who had undergone Nd:YAG laser or surgical synechiolysis between January 2002 and December 2007 in our clinic. Laser synechiolysis was performed in the synechiae not exceeding the extent of one clock hour and reaching only to the iris sphincter, whereas surgical synechiolysis was performed in other diffuse and/or thick synechiae. RESULTS: Surgical synechiolysis was performed in 93 eyes, and YAG laser synechiolysis was done in 21 eyes. Increases in best-corrected visual acuity (BCVA) were observed in 61 eyes (53.51%). Intraocular pressure spikes after the procedure were present in only 4 eyes, and all of them were transient except for 1 eye, which needed additional glaucoma eyedrops. CONCLUSIONS: With suitable indications, laser or surgical synechiolysis can be performed safely, and a small rise in visual acuity may also be expected.

Congenital fusion of the jaws.

Congenital fusion of the jaws is quite rare. It may be unilateral or bilateral and involves only the soft tissues or both the hard and soft tissues. This anomaly may be seen separately or in association with syndromes. Maxillomandibular fusion restricts mouth opening causing problems in feeding, swallowing and respiration. This condition can be easily treated. However, in long-standing cases, growth anomalies from TMJ ankylosis may occur.

efficacy of hysteroscopic adhesiolysis in Asherman's syndrome

To determine the prevalence of Asherman's syndrome in the south of Iran and assess the safety and efficacy of hysteroscopic adhesiolysis in restoration of menstrual function and fertility, a prospective study was done from 1997 to 1999. Among 2300 couples with infertility referring to the infertility clinic of a Shiraz University hospital, 30 patients were proven to have Asherman's syndrome by diagnostic hysterosalpingography [HSG] and then hysteroscopy. The prevalence of this syndrome was 1.3%. Hysteroscopic adhesiolysis was performed in all 30 patients. Adhesion reformation postoperatively was absent in stage 1 patients, 15% in stage II and 66% in stage III. Normal menstrual flow was restored in all patients [100%], and 19 patients [63.3%] conceived after surgery that resulted in term infants in 15 patients [50%]. Hysteroscopic adhesiolysis is a safe and effective operation for restoring the normal menstrual pattern and fertility, and the severity of the adhesions appear to correlate best with the reproductive outcome

Laparoscopy and small bowel obstruction in children

Three issues are studied: 1. What is well-known about post-operative small bowel obstructions. The cost of this pathology, the complications associated [blood loss, enterocutaneous fistulas, major bowel resections, abdominal wall damages, death], the distribution of adhesions in the abdominal cavity, and previous surgeries. 2. Small bowel obstructions happen after laparoscopy and the incidence is more than 1% of patients: herniation of the small bowel through a trocar site, herniation of the omentum through a trocar site, peritoneal defect, spillage of stones and stercolitis. Suggestions to avoid small bowel obstruction after laparoscopy include the use of smaller trocars whenever possible, repairing the fascia under direct vision, carefully desufflating the abdominal cavity, avoiding bleeding, spilled stones and staples and washing the abdominal cavity at the end of the surgical procedure. 3. The treatment of small obstruction is feasible by laparoscopy, reliability, and results are studied with a multicentric GECI [Groupe dEtude en Coelioscopie Infantile] and literature series. We obtained good results for 2/3 children

Evaluación de la eficacia de la plicación mesentérica simplificada de Magdiel / An assessment of mesenteric plicature simplified of Magdiel

Para analizar la utilidad de la plicatura transmesentérica simplificada con sondas de polietileno, se estudió una población de 110 pacientes con diagnóstico de obstrucción intestinal durante el período de 1992 a 1997. Se practicó la técnica quirúrgica a 65 de los 110 pacientes (59.09 por ciento), que cumplían con los criterios de inclusión, con antecedentes de intervenciones previas a la causa de la obstrucción fue, en su totalidad, debido a adherencias previas. La plicatura con esta técnica tomó un tiempo de realización de 15 minutos o menos en el 100 por ciento de los pacientes; con un promedio de 13'23". No hubo decesos ni recidiva de la obstrucción intestinal. Cuarenta y ocho pacientes (73.85 por ciento) no presentaron complicaciones y sólo 4 pacientes (6.16 por ciento) fueron reintervenidos por otras complicaciones. La estadía hospitalaria fue de 10 días o menos para el (83.23 por ciento) de los pacientes y en promedio fue de 6 días. Se realizó transito digestivo a un mes de operados, previo retiro del catéter de polietileno, (sondas de soporte), demostrando que el (93.85 por ciento) de los pacientes conservaron una disposición ordenada de las asas de intestino delgado. La motilidad fue normal, ya que la plenificación intestinal ocurrió antes de las 6 horas, desde el momento en que se administró el contraste

Salpingooforolisis en pacientes con infertilidad por factor tuboperitoneal / Salpingo-oophorolysis in patients with infertility by tuboperitoneal factor

Se exponen los casos de 62 pacientes infértiles sometidas a salpingolisis y/u ooforolisis secundarias a proceso, con el objetivo de conocer sus resultados y establecer un pronóstico. El 40,3 por ciento se manejó por laparotomía, mientras que el resto fue intervenido por vía laparoscópica, sin diferencias en los resultados. El promedio de edad del grupo 33,3 años con un rango de edad que fluctúa entre 22 y 44 años. Dentro de los antecedentes destacan: uso de DIU 29 por ciento, cirugía pélvica previa 56,4 por ciento, endometriosis 12,9 por ciento, sapingectomía por tubario previo 9,7 por ciento y otro factor de infertilidad asociado en un 27,4 por ciento. Se realizó cirugía bilateral en 56,5 por ciento y unilateral en el 43,5 por ciento. La tasa global de embarazos obtenida fue del 32,3 por ciento (embarazos a términos 24,2 por ciento, abortos 4,8 por ciento y embarazos ectópico 3,2 por ciento). Sólo el antecedente de gestación ectópica previa fue de mal pronostico para embarazo, no existiendo diferencias para otros datos analizados. Creemos que las técnicas microquirúrgicas siguen siendo la primera aproximación terapéutica para el manejo de la infertilidad por factor tuboperitoneal, usando preferentemente la cirugía laparoscópica

Cirugía laparoscópica en ginecología / Laparoscopic surgery in gynecology

Se presenta la experiencia acumulada en cirugía laparoscópica ginecológica en el Hospital Clínico Regional Valdivia. Se analizaron los procedimientos efectuados, las complicaciones observadas y los resultados en términos de embarazo en la mujer infértil. Se concluye que por esta vía puede resolverse la mayor parte de la cirugía anexial y la de la mujer infértil, con una baja incidencia de complicaciones; pero los resultados en términos reproductivos, son dependientes de la patología tubo-peritoneal

Tratamiento laparoscópico de la obstrucción intestinal por bridas / Laparoscopic surgical treatment of obstructive intestinal due to adhesions

Antecedentes: La vía laparoscópica ha sido poco empleada para el tratamiento de la obstrucción intestinal por bridas hasta la actualidad. La laparotomía para esta eventualidad se acompaña de sus inconvenientes habituales en los casos agudos y es de indicación controvertida en las subobstrucciones crónicas recurrentes. Objetivos: Analizar los resultados de una serie de operados por esta patología por vía laparoscópica. Lugar de aplicación: Hospital de Comunidad. Diseño: Estudio observacional retrospectivo basados en criterios básicos. Población: 21 pacientes seleccionados con obstrucción intestinal. Método: Se revisaron las historias clínicas de los operados y se analizaron las características de la población, tipo de obstrucción (aguda o crónica recurrente), realización de enterolisis laparoscópica, tiempo operatorio, inicio de la tolerancia oral, morbilidad y tiempo de internación, y se efectuó el seguimiento personalizado de todos los casos posibles. Resultados: De los 21 casos, 11 fueron intervenidos en agudo y 10 en forma programada luego de subobstrucciones reiteradas. Se convirtió a cirugía abierta a 4 pacientes, en 3 por dificultad operatoria debido a las adherencias y en uno para realizar la resección de un asa delgada necrosada por estrangulación de su meso, todos ellos casos agudos. En los casos no complicados operados ni convertidos la realimentación oral comenzó a las 12 horas promedio. No hubo mortalidad y se observaron 2 complicaciones, una de ellas directamente relacionada con el procedimiento laparoscópico: perforación instrumental de asa intestinal. El tiempo operatorio fue de 72 minutos promedio (20 a 130 minutos) y el tiempo de internación de 1 a 23 días, debido al caso con la complicación mencionada, con una media de 4,7 días. El seguimiento de 12 de los 15 operados totalmente por vía laparoscópica durante un mínimo de 18 meses y un promedio de 25 meses para los casos de suboclusiones reiteradas, mostró que el tratamiento había sido efectivo. Conclusiones: El abordaje laparoscópico es ventajoso en el tratamiento de la obstrucción intestinal por bridas, tanto en su forma aguda como crónica recurrente. Sus resultados están en relación con la experiencia del equipo quirúrgico y las características del paciente

Induction of intrabdominal adhesion formation by a polypropylene mesh prosthesis: an experimental study in rats

A correção de hernias na virilha através de método videolaparoscópico está se tornando procedimento comum que pode, entretanto, levar ao aumento da incidência de aderências...