ABSTRACT
BACKGROUND: Transcylindrical cholecystectomy (TC) can be performed under local anaesthesia and sedation (LAS) in ambulatory surgery (AS). The aim of this study was to assess the feasibility and results of TC under LAS. METHODS: TC under LAS was proposed to 583 consecutive patients with cholelithiasis in an AS unit. For the TC procedure, a cylindrical retractor with a transparent plunger was inserted into the hepatocystic triangle, and cholecystectomy was performed through the retractor with reusable open instruments. Pre-, intra-, and post-operative variables were prospectively registered, including complications, reasons for conversion to general anaesthesia (GA), non-programmed admissions, readmissions, pain assessments, and satisfaction with the procedure. RESULTS: Five hundred patients were eligible for LAS, with GA being required in 128 (25.6%) of them. AS was programmed for 447 patients. The rates of non-programmed admissions, readmissions, and conversion to laparotomy were 8.7% (39), 0.8% (4), and 2.6% (13), respectively. There was no main bile duct injury. At 24 h, physical status was good or excellent in 80.4% of the patients. A history of acute cholecystitis, male sex, a body mass index (BMI) ≥ 39.5 kg/m2, and non-suspected acute cholecystitis were found to be independent variables associated with conversion to GA. CONCLUSIONS: TC under LAS is a safe procedure in AS and is feasible in 74% of cholelithiasis patients. Male sex, BMI, gallbladder wall thickness, and a history of acute cholecystitis are factors that increase the probability of conversion to GA. This prospective study was approved by the ethics committee of Badajoz for patient protection for biomedical research and has been retrospectively registered under the research registry UIN: researchregistry3979.
Subject(s)
Cholecystectomy/methods , Cholelithiasis/surgery , Adult , Aged , Anesthesia, Local , Cholecystectomy/instrumentation , Conscious Sedation , Feasibility Studies , Female , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures/instrumentation , Minimally Invasive Surgical Procedures/methods , Prospective Studies , Surgical WoundABSTRACT
OBJECTIVE: We report a prospective study of repairs using the Rives technique of the more difficult primary inguinal hernias, focusing on the immediate post-operative period, clinical recurrence, testicular atrophy, and chronic pain. A mesh placed in the preperitoneal space can reduce recurrences and chronic pain. METHODS: For the larger primary inguinal hernias (Types 3, 4, 6, and some 7), we favour preperitoneal placement of a mesh, covering the myopectineal orifice by means of a transinguinal (Rives technique) approach. The Rives technique was performed on 943 patients (1000 repairs), preferably under local anaesthesia plus sedation in ambulatory surgery. RESULTS: The mean operative time was 31.8 min. Pain assessment after 24 h with an Andersen scale and a categorical scale gave two patients with intense pain on the Andersen scale, and four patients who thought their state was bad. Surgical wound complications were below 1%, and urinary retention was 1.2% mostly associated with spinal anaesthesia and, in one case, bladder perforation. There was spermatic cord and testicular oedema with some degree of orchitis in 17 patients. The clinical follow-up of 849 repairs (86.4%), mean (range) 30.0 (12-192) months, gave five recurrences (0.6%), three cases (0.4%) of testicular atrophy, and 37 (4.3%) of post-operative chronic pain (8 patients with visual analogue scale of 3-10). CONCLUSIONS: The Rives technique requires a sound knowledge of inguinal preperitoneal space anatomy, but it is an excellent technique for the larger and difficult primary inguinal hernias, giving a low rate of recurrences and chronic pain.
Subject(s)
Edema/etiology , Hernia, Inguinal/surgery , Herniorrhaphy/adverse effects , Herniorrhaphy/methods , Orchitis/etiology , Testis/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Atrophy/etiology , Chronic Pain/etiology , Female , Herniorrhaphy/statistics & numerical data , Humans , Male , Middle Aged , Operative Time , Pain Measurement , Pain, Postoperative/etiology , Postoperative Complications , Prospective Studies , Recurrence , Surgical Mesh/adverse effects , Urinary Retention/etiology , Young AdultABSTRACT
No disponible
Subject(s)
Female , Humans , Middle Aged , Perivascular Epithelioid Cell Neoplasms/diagnosis , Liver Neoplasms/diagnosis , Antigens, Tumor-Associated, Carbohydrate/analysis , Biomarkers, Tumor/analysisABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Postcholecystectomy Syndrome/diagnosis , Cholecystectomy/adverse effects , Choledocholithiasis/diagnosis , Postoperative Complications , Urinary Bladder Calculi/surgeryABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Abdominal Cavity , Foreign-Body Migration , Prosthesis Failure/adverse effects , Stents , Foreign-Body Migration/diagnosis , Foreign-Body Migration/etiology , Foreign-Body Migration/surgerySubject(s)
Cystic Duct/abnormalities , Congenital Abnormalities/diagnosis , Female , Humans , Middle Aged , SyndromeABSTRACT
La endometriosis en una afección de patrón inflamatorio, con prevalencia en aumento, que puede afectar a cualquier mujer en edad fértil con un amplio abanico de presentaciones clínicas que van desde dismenorrea hasta un cuadro de obstrucción secundario a síndrome adherencial e incluso perforación intestinal. La endometriosis apendicular es una afección poco frecuente, siendo en múltiples ocasiones diagnosticada como apendicitis aguda, que se manifiesta como dolor abdominal recurrente, pudiendo ser la primera manifestación de esta enfermedad ginecológica y que debe ser tenida en cuenta a la hora de realizar el amplio diagnóstico diferencial de dolor abdominal (AU)
Endometriosis is an inflammatory disease that can affect any woman of childbearing age. The incidence of this disease is increasing. Clinical presentations vary widely, ranging from dysmenorrhea to obstructive symptoms, adhesions, and even bowel perforation. Appendiceal endometriosis is rare and is frequently diagnosed as acute appendicitis, which manifests as recurrent abdominal pain. Acute abdomen may be the first manifestation of this gynecological disorder and should be taken into account when making the broad differential diagnosis of abdominal pain (AU)
