A novel dissector device that separates anatomic structures during laparoscopic surgery.

OBJECTIVE: To describe a novel dissector device useful in laparoscopy, better definition of anatomic structures to have a better dissection, separation, and cleaning of the structures. METHOD: The endoscopic dissector DisePad was designed and developed at the experimental surgery department of Centro Médico Nacional 20 de Noviembre, and properly patented at Instituto Mexicano de la Propiedad Industrial (title 3512). RESULTS: The tip of the device is the most important component, by its direct contact with the different tissues, consists of a cotton-polyester black cloth impregnated with a special gel immersed into a hot saline solution. Once soaked the tip maintains the solution temperature on itself. CONCLUSIONS: This device has been used in 364 laparoscopic procedures demonstrating, its utility to visualize, separate and clean anatomical structures without thermal lesion, tear, hemorrhage or visceral perforation.

OBJETIVO: Describir un nuevo dispositivo disector en laparoscopia, con una mejor definición de las estructuras anatómicas para obtener una mejor disección,separación y limpieza de las estructuras. MÉTODO: El disector endoscópico DisePad fue diseñado y desarrollado en el servicio de cirugía experimental del Centro Médico Nacional 20 de Noviembre, y patentado ante el Instituto Mexicano de la Propiedad Industrial (registro n.º 3512). RESULTADOS: El componente más importante del disector es la punta que tiene contacto con los tejidos: es una tela de algodón-poliéster negra impregnada en un gel (patentado) que, al ser sumergido en un termo con solución salina caliente, permite retener la temperatura. CONCLUSIONES: Este dispositivo ha sido utilizado en 364 procedimientos quirúrgicos por vía laparoscópica y ha demostrado ser útil para visualizar, separar y limpiar estructuras anatómicas sin producir daño por lesión térmica, desgarre, hemorragia ni perforación visceral.

Robot-assisted surgery and endoscopic management of gastrocolic fistula: A rare complication of acute pancreatitis in a patient who had undergone sleeve gastrectomy.

Ten years after undergoing sleeve gastrectomy, a 39-year-old man developed pancreatitis and, after recovery, presented with severe diarrhea. An image study showed barium contrast passing from the stomach to the colon. Before surgery, initial treatment consisted of parenteral nutrition and antibiotics. The patient then underwent robot-assisted resection of a gastrocolic fistula and omentoplasty. However, 72 h after surgery, the amount of suction drainage suggested that the fistulous track repair was leaking. Therefore, we decided to perform endoscopy to place a self-expanding covered stent at the gastroesophageal junction as well as a nasojejunal tube to continue nutritional supplementation. After the patient had fasted for 2 weeks, there was no evidence of leakage in the image studies. The patient was discharged after he had clinically improved, and the stent was removed at the end of 8 weeks. The combination of robot-assisted surgery and endoscopic management is effective for treating gastrocolic fistula.

[Comparative study between rapid urease test, imprint and histopathological study for Helicobacter pylori diagnosis]. / Estudio comparativo entre las pruebas de ureasa rápida, la impronta y el estudio histopatológico para el diagnóstico de Helicobacter pylori.

Helicobacter pylori infection is relevant, due to its role in different gastric pathologies; there are several diagnostic methods, which are divided into invasive and non-invasive. In the first category histology has been considered the gold standard, while other methods include imprint with Gram stain and rapid urease test, which can produce dependable results. The aim of this study is to compare several available techniques for H. pylori diagnosis to know their sensitivity and specificity. We studied 88 patients, 50 women and 38 men, with age range from 17 to 83 years (48.8+/-14.3) from the Endoscopy Department of the 20 de Noviembre Medical Center; in all five to eight biopsies were taken from gastric mucosa to perform rapid urease test, Gram-stained imprint and histology. Endoscopic findings included gastritis (87.50%), pangastritis (2.30%) and another diagnoses (10.22%). Rapid urease test was positive in 40 patients and negative in 48, while imprint was 34 and 54, respectively. Sensitivity and specificity were as follows: rapid urease test, 84.8 and 78.5%, and imprint 75.8 and 83.6%, respectively. In conclusion, H. pylori diagnosis by rapid urease test is a dependable and quick method. On the other hand, imprint is useful but depends on the ability of the personnel who perform the test.

[Simplified nutritional evaluation system for surgical patients]. / Sistema de evaluación nutricional simplificado para pacientes quirúrgicos.

OBJECTIVE: To determine a simplified method for nutritional status evaluation in surgical patients to identify patients prone to develop complications. METHODS: A prospective study was carried out to determine prognostic index of patients in whom major abdominal surgery was performed, based on nutritional assessment. We proposed a simplified and accessible method for daily evaluation of patients in any hospital even in an emergency setting. The following parameters were used: complete blood count (CBC); blood chemistry (BC); protrombine time (PT); total serum protein (TSP), and anthropometrics. RESULTS: Study population consisted of 200 patients divided in two groups depending on type of surgical intervention, i.e., emergency or elective procedure. Complications associated with different stages of malnourishment were analyzed by simplified nutritional assessment system. Of 200 patients analyzed, 123 had several stages of malnutrition, 62 were malnourished, complicated patients (50.41%), and 77 had adequate nutritional status; of these, 10 also had complications (12.99%). DISCUSSION: We were able to conclude that simplified nutritional assessment system is not a useful absolute predictive indicator of possible complications. However, some parameters could be useful to identify patients with nutritional depletion with tendency for post-surgical complications.

[Manual mechanical anastomosis colorectal surgery]. / Anastomosis manual versus anastomosis mecánica en cirugía colorrectal.

OBJECTIVE: To determine advantages and disadvantages of manual vs mechanical sutures in colon surgery. MATERIAL AND METHODS: A retrospective study of clinical files of 84 colon surgery patients was conducted, to establish morbidity and mortality of these patients with special emphasis in length of surgical procedure and type of suture used during procedure (either manual or mechanical). RESULTS: Of 84 patients included in this study, manual suture was used in 70 (group 1) and mechanical suture in 14 (group 2). Most common preoperative diagnosis was diverticular disease in 22 cases (26.2%), 20 for group with manual suture, and two for group with mechanical suture. Most common surgical procedure was colectomy with ileoproctoanastomosis in group 1 and lower anterior resection with coloproctoanastomosis in group 2. Five cases presented complications (2.85%) with manual suture, while only one case presented complications in group 2 (7.14%). Main complications were dehiscence in group 1 and stenosis in group 2. DISCUSSION: There were no significant differences between both types of suture in terms of time of surgical procedure; there were no statistical differences for both techniques in terms of morbidity and mortality. However, there is shorter time of recovery in patients in whom mechanical suture was used with less tissue edema due to manipulation and less disability period.