Radical cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal sarcomatosis: Results from a reference center and considerations based on current evidence.

INTRODUCTION: Peritoneal sarcomatosis is a rare disease, with multiple histological origins and poor overall prognosis. The option of radical cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is controversial. The results of a surgical team experienced in these procedures are analyzed and discussed based on the available evidence. METHODS: Study on a prospective database of patients with peritoneal sarcomatosis who underwent CRS and HIPEC, from 2016 to 2022, in a national reference center for sarcomas and peritoneal oncological surgery, who met the established inclusion/exclusion criteria. RESULTS: 23 patients were included in the study, with a median age of 53 years (6-68). Recurrent/persistent clinical presentation predominated (78.3%). Visceral origin (including GIST and non-GIST peritoneal) accounted for 47.8% of patients, compared to 43.5% uterine and 8.7% retroperitoneal. The median PCI was 17 (3-36), with CC0 cytoreduction of 87%. Postoperative morbidity (Dindo Clavien III-IV) of 13%, with no postoperative mortality in the series. Overall survival and disease-free survival at 5 years were 64% and 34%, respectively. Histological grade was the most influential prognostic factor for survival. CONCLUSIONS: The results of the series, with low morbidity, support the benefit of radical peritoneal oncological surgery in patients with peritoneal sarcomatosis after adequate selection, as long as it is performed in high-volume centers, experienced surgeons and expert multidisciplinary teams. However, the role of HIPEC remains to be demonstrated and pending future studies.

Laparoscopic common bile duct exploration and antegrade biliary stenting: leaving behind the Kehr tube.

INTRODUCTION: single-stage laparoscopic surgery of cholelithiasis and associated common bile duct stones (CL-CBDS) has shown similar results when compared to laparoscopic cholecystectomy combined with ERCP. Classically, choledochorrhaphy has been protected by a T-tube drain to allow external bypass of bile flow. However, its removal is associated with a significant complication rate. Use of antegrade biliary stents avoids T-tube removal associated morbidity. The aim of this study is to compare the results of choledochorrhaphy plus T-tube drainage versus antegrade biliary stenting in our series of laparoscopic common bile duct explorations (LCBDE). MATERIAL AND METHODS: between 2004 and 2011, 75 patients underwent a LCBDE. Choledochorrhaphy was performed followingKehr tube placements in 47 cases and transpapillary biliary stentingwas conducted in the remaining 28 patients. RESULTS: postoperative hospital stay was shorter in the stent group (5 ± 10.26 days) than in the Kehr group (12 ± 10.6 days), with a statistically significant difference. There was a greater trend to grade B complications in the stent group (10.7 vs. 4.3 %) and to grade C complications in the Kehr group (6.4 vs. 3.6 %). Therewere 3 cases of residual common bile duct stones in the Kehr group (6.4 %) and none in the stent group. CONCLUSIONS: antegrade biliary stenting following laparoscopic common bile duct exploration for CL-CBDS is an effective and safe technique that prevents T-tube related morbidity.

Exploración laparoscópica de la vía biliar y coledocorrafia sobre prótesis biliar: dejando atrás el tubo de Kehr / Laparoscopic common bile duct exploration and antegrade biliary stenting: leaving behind the Kehr tube

Introducción: el tratamiento de la colecisto-coledocolitiasis por vía laparoscópica en un tiempo ha demostrado resultados comparables a la colecistectomía laparoscópica asociada a CPRE. Clásicamente, la coledocorrafia se ha realizado sobre un tubo en T para permitir la derivación externa del flujo biliar. Sin embargo, su retirada está asociada a una significativa tasa de complicaciones. El uso de prótesis biliares anterógradas, evita toda la morbilidad asociada a la retirada del tubo en T. En este estudio, comparamos los resultados entre la coledocorrafia sobre Kehr vs. prótesis biliar en nuestra serie de colédoco-litotomía laparoscópica. Material y métodos: entre 2004 y 2011, hemos intervenido 75 pacientes de colecisto-coledocolitiasis por vía laparoscópica, realizando en 47 casos la coledocorrafia sobre un tubo de Kehr y sobre prótesis biliar transpapilar en los 28 restantes. Resultados: la estancia postoperatoria fue menor en el grupo prótesis (5 ± 10,26 días) que en el grupo Kehr (12 ± 10,6 días), siendo estadísticamente significativa. Se observó una mayor tendencia a las complicaciones grado B en el grupo prótesis (10,7 vs. 4,3 %) y complicaciones grado C en el grupo Kehr (6,4 vs. 3,6 %). La tasa de coledocolitiasis residual fue de 3 casos en el grupo Kehr (6,4 %) y ninguno en el grupo prótesis. Conclusiones: la coledocorrafia sobre prótesis biliar transpapilar por vía laparoscópica es una técnica efectiva y segura para el tratamiento de la colecisto-coledocolitiasis en un único tiempo, evitando todas las complicaciones derivadas del manejo y retirada del tubo de Kehr(AU)

Introduction: single-stage laparoscopic surgery of cholelithiasis and associated common bile duct stones (CL-CBDS) has shown similar results when compared to laparoscopic cholecystectomy combined with ERCP. Classically, choledochorrhaphy has been protected by a T-tube drain to allow external bypass of bile flow. However, its removal is associated with a significant complication rate. Use of antegrade biliary stents avoids T-tube removal associated morbidity. The aim of this study is to compare the results of choledochorrhaphy plus T-tube drainage versus antegrade biliary stenting in our series of laparoscopic common bile duct explorations (LCBDE). Material and methods: between 2004 and 2011, 75 patients underwent a LCBDE. Choledochorrhaphy was performed following Kehr tube placements in 47 cases and transpapillary biliary stenting was conducted in the remaining 28 patients. Results: postoperative hospital stay was shorter in the stent group (5 ± 10.26 days) than in the Kehr group (12 ± 10.6 days), with a statistically significant difference. There was a greater trend to grade B complications in the stent group (10.7 vs. 4.3 %) and to grade C complications in the Kehr group (6.4 vs. 3.6 %). There were 3 cases of residual common bile duct stones in the Kehr group (6.4 %) and none in the stent group. Conclusions: antegrade biliary stenting following laparoscopic common bile duct exploration for CL-CBDS is an effective and safe technique that prevents T-tube related morbidity(AU)

Análisis del tratamiento quirúrgico más apropiado para la colecistitis aguda mediante aplicación del método RAND/UCLA / Analysis of the most appropriate surgical treatment for acute cholecystitis by applying the RAND/UCLA method

Introducción: La colecistitis aguda (CA) constituye una indicación frecuente de colecistectomía. Las circunstancias locales y ciertas características de los pacientes provocan unas altas tasas de fracaso y complicaciones de la colecistectomía laparoscópica (CL) y, a pesar de la experiencia ganada, aún no disponemos de una lista de indicaciones pormenorizada que permita minimizarlas. Material y método Empleamos el análisis de la adecuación RAM para evaluar 2 opciones, la CL y la colecistectomía abierta (OC). Un panel de expertos analizó su idoneidad tras una revisión de la bibliografía, una reunión de consenso y 2 rondas de puntuaciones sobre diferentes situaciones clínicas. Se analizó la puntuación sobre cada escenario para establecer el grado de adecuación de cada opción. Resultados Tras la reunión presencial quedaron definidos 64 escenarios, lográndose un acuerdo en las indicaciones en el 67,18% de ellos. En el 86,04% de los escenarios el acuerdo fue por adecuación de las indicaciones. Cuando la colecistectomía estuvo indicada siempre lo fue por laparoscopia, mientras que solo en ocasiones lo fue por laparotomía. En pacientes con menos de 72 h de evolución se consideró apropiada siempre la CL cuando se presentasen con sepsis, o bien sin ella pero con datos ecográficos de CA complicada. Conclusiones Sigue existiendo incertidumbre respecto al manejo de la CA, en especial respecto al momento de la intervención y la vía de abordaje, particularmente en pacientes frágiles y con evoluciones de la clínica superiores a las 72 h. El método RAND puede ayudar a tomar decisiones sobre la adecuación de distintas opciones terapéuticas (AU)

Introduction: Acute cholecystitis (AC) is a common indication for cholecystectomy. Local circumstances and certain patient characteristics lead to high failure rates and complications in laparoscopic cholecystectomy (LC), and despite the experience gained, we still do not have a detailed list of indications which could minimise them. Material and method: We used the RAND/UCLA Appropriateness Method (RAM) to evaluate2 options, LC and open cholecystectomy (OC). An expert panel analysed its suitability after a literature review, a consensus meeting, and 2 rounds of scores on different clinical situations. The score of each scenario was analysed to establish the appropriateness level of each option. Results: At the end of the meeting there were 64 defined scenarios, with an agreement being reached on the indications in 67.18% of them. In 86.04% of the scenarios, the agreement was due to the appropriateness of the indications. When cholecystectomy was indicated, it was always by laparoscopy, while it was only occasionally by laparotomy. In patients with less than 72 h of onset, LC was always considered appropriate when there was sepsis, or even without this if the ultrasound data showed complicated AC. Conclusions: There is still uncertainty as regards the management of AC, especially as regards the timing of the operation and the surgical approach, particularly in frail patients and with a clinical onset greater than 72 h. The RAND method can help to make decisions on the appropriateness of different therapeutic options (AU)

[Analysis of the most appropriate surgical treatment for acute cholecystitis by applying the RAND/UCLA method]. / Análisis del tratamiento quirúrgico más apropiado para la colecistitis aguda mediante aplicación del método RAND/UCLA.

INTRODUCTION: Acute cholecystitis (AC) is a common indication for cholecystectomy. Local circumstances and certain patient characteristics lead to high failure rates and complications in laparoscopic cholecystectomy (LC), and despite the experience gained, we still do not have a detailed list of indications which could minimise them. MATERIAL AND METHOD: We used the RAND/UCLA Appropriateness Method (RAM) to evaluate 2 options, LC and open cholecystectomy (OC). An expert panel analysed its suitability after a literature review, a consensus meeting, and 2 rounds of scores on different clinical situations. The score of each scenario was analysed to establish the appropriateness level of each option. RESULTS: At the end of the meeting there were 64 defined scenarios, with an agreement being reached on the indications in 67.18% of them. In 86.04% of the scenarios, the agreement was due to the appropriateness of the indications. When cholecystectomy was indicated, it was always by laparoscopy, while it was only occasionally by laparotomy. In patients with less than 72 h of onset, LC was always considered appropriate when there was sepsis, or even without this if the ultrasound data showed complicated AC. CONCLUSIONS: There is still uncertainty as regards the management of AC, especially as regards the timing of the operation and the surgical approach, particularly in frail patients and with a clinical onset greater than 72 h. The RAND method can help to make decisions on the appropriateness of different therapeutic options.

Control glucémico y riesgo de progresión del estado diabetológico durante el seguimiento clínico tras duodenopancreatectomía cefálica / Blood glucose control and risk of progressing to a diabetic state during clinical follow up after cephalic duodenopancreatectomy

Introducción La resección pancreática supone un riesgo teórico de desarrollo de diabetes; no obstante, son escasos los estudios que han mostrado el efecto de la duodenopancreatectomía cefálica en el control glucémico postoperatorio. Material y métodos Se revisó el seguimiento clínico postoperatorio de 70 pacientes sometidos a duodenopancreatectomía cefálica entre marzo de 1993 y noviembre de 2009 en nuestro hospital. La indicación quirúrgica se debió a enfermedad primaria pancreática en 30 casos (21 adenocarcinomas de páncreas, 6 pancreatitis crónicas, 1 carcinoma endocrino, 1 cistoadenoma y 1 seudoquiste complicado). En los restantes 40 pacientes el páncreas no estaba afectado (24 carcinomas ampulares, 11 colangiocarcinomas, 3 carcinomas duodenales, 1 adenoma de la papila y 1 hiperplasia adenomiomatosa de la vía biliar). Se recogieron los datos del estado diabetológico pre y postoperatorio. Resultados Antes de la resección, 49 pacientes (70,0%) eran normoglucémicos sin necesidad de tratamiento. Diecisiete pacientes requerían tratamiento antidiabético oral, 3 insulina subcutánea y sólo uno era tratado mediante dieta. La duodenopancreatectomía deterioró el control glucémico en el 47,1% de los pacientes (23 de los previamente no diabéticos y 10 de los tratados con antidiabéticos orales). El control glucémico fue peor cuando la indicación quirúrgica se debió a una afección primaria de la glándula (progresión del 63,3%) en comparación con los pacientes con patología (progresión del 35,0) (p<0,05).Conclusiones Nuestro estudio revela que la resección de la cabeza pancreática favorece la aparición de diabetes postoperatoria, especialmente cuando la indicación quirúrgica se debe a una afección primaria del páncreas (AU)

Introduction: Pancreatic resection carries a theoretical risk of developing diabetes; however few studies have demonstrated the effect of a cephalic duodenopancreatectomy on postoperativeblood glucose control. Material and methods: An analysis was made of the post-operative clinical follow up of 70patients subjected to a cephalic duodenopancreatectomy in our Hospital between March1993 and November 2009. The surgical indication was due to primary pancreatic disease in30 patients (21 adenocarcinoma of the pancreas, 6 chronic pancreatitis, 1 endocrinecarcinoma, 1 cystadenoma and 1 complicated pseudocyst). The pancreas was not affected in the other 40 patients (24 ampullary carcinomas, 11 cholangiocarcinomas, 3 duodenalcarcinomas, 1 papillary adenoma and 1 adenomatous hyperplasia of the bile duct). Data onthe pre- and post-operative diabetic state were collected. Results: Before resection, 49 patients (70.0%) had a normal glucose without the need fortreatment. Seventeen patients required oral diabetic treatment, 3 subcutaneous insulin, and only one was treated by diet. The duodenopancreatectomy worsened glucose control in47.1% of the patients (23 of the previously non-diabetics and 10 of those treated with oraldiabetics). Glucose control was worse when the surgical indication was due to primary involvement of the gland (progression of 63.3%) compared with patients with disease(progression of 35.0%) (P < .05).Conclusions: Our results show that resection of the head of the pancreas favours the appearance of post-operative diabetes, particularly when the surgical indication is due to primary pancreatic involvement (AU)

[Blood glucose control and risk of progressing to a diabetic state during clinical follow up after cephalic duodenopancreatectomy]. / Control glucémico y riesgo de progresión del estado diabetológico durante el seguimiento clínico tras duodenopancreatectomía cefálica.

INTRODUCTION: Pancreatic resection carries a theoretical risk of developing diabetes; however few studies have demonstrated the effect of a cephalic duodenopancreatectomy on post-operative blood glucose control. MATERIAL AND METHODS: An analysis was made of the post-operative clinical follow up of 70 patients subjected to a cephalic duodenopancreatectomy in our Hospital between March 1993 and November 2009. The surgical indication was due to primary pancreatic disease in 30 patients (21 adenocarcinoma of the pancreas, 6 chronic pancreatitis, 1 endocrine carcinoma, 1 cystadenoma and 1 complicated pseudocyst). The pancreas was not affected in the other 40 patients (24 ampullary carcinomas, 11 cholangiocarcinomas, 3 duodenal carcinomas, 1 papillary adenoma and 1 adenomatous hyperplasia of the bile duct). Data on the pre- and post-operative diabetic state were collected. RESULTS: Before resection, 49 patients (70.0%) had a normal glucose without the need for treatment. Seventeen patients required oral diabetic treatment, 3 subcutaneous insulin, and only one was treated by diet. The duodenopancreatectomy worsened glucose control in 47.1% of the patients (23 of the previously non-diabetics and 10 of those treated with oral diabetics). Glucose control was worse when the surgical indication was due to primary involvement of the gland (progression of 63.3%) compared with patients with disease (progression of 35.0%) (P<.05). CONCLUSIONS: Our results show that resection of the head of the pancreas favours the appearance of post-operative diabetes, particularly when the surgical indication is due to primary pancreatic involvement.

Valor diagnóstico de la laparoscopia en la linfomatosis peritoneal / Diagnostic value of laparoscopy in Peritoneal Lymphomatosis

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Sistema de cierre asistido por vacío en heridas complejas. Estudio retrospectivo / A vacuum assisted closure system in complex wounds: a retrospective study

Introducción La terapia de cierre asistido por vacío (VAC) es un sistema no invasivo y dinámico que ayuda a promover la cicatrización mediante la aplicación de presión negativa en el lugar de la herida, favoreciendo la reducción del área de la herida, eliminando el exceso de fluidos y estimulando la angiogénesis. Introducción El objetivo de este trabajo ha sido describir nuestra experiencia con la terapia VAC en heridas complejas. Material y método Analizamos de forma retrospectiva nuestra experiencia entre abril del 2007 y agosto del 2008. Empleamos 2 tipos de terapia VAC, la «suprafascial» y el dispositivo para abdomen abierto o «intraabdominal». Se aplicó estadística descriptiva con cálculo de porcentajes y medias. Resultados La terapia VAC fue empleada en un total de 20 pacientes con heridas complejas, de las cuales 16 (80%) tenían una localización abdominal y el resto 4 (20%) otras localizaciones. En 17 (85%) pacientes el dispositivo VAC empleado fue «suprafascial», mientras que en los otros 3 (15%) se utilizó el dispositivo VAC «intraabdominal». Durante la terapia VAC tuvimos 2 casos (10%) de fístula, una urinaria y otra entérica. En ambos casos, la modalidad VAC empleada fue la «intraabdominal» y las fístulas se resolvieron antes de la retirada de la terapia VAC. La estancia media hospitalaria fue de 38,3 días (7–136). No hubo mortalidad directamente relacionada con la terapia VAC. Dos pacientes (10%) fallecieron en situación de shock séptico refractario, mientras que el resto (90%) vive en la actualidad. El dispositivo VAC «suprafascial» se mantuvo una media de 29,17 días (1–77), y el «intraabdominal» 18 días (7–49). El coste por paciente se estimó en 3.197,97 € (119,1–10.780,25).Conclusiones La terapia VAC puede mejorar y acelerar la cicatrización de las heridas abdominales complicadas también en presencia de contaminación grave o fístulas intestinales (AU)

Introduction Vacuum-assisted closure (VAC) therapy is a dynamic and non-invasive system for improving wound healing. This novel therapy is based on applying air suction at a controlled sub-atmospheric pressure. The most important benefits of this therapy include, a reduction in the wound area together with induction of new granulation tissue formation, effective wound cleansing (removal of small tissue by suction), and the continuous removal of wound exudate. Introduction The aim of this study was to describe our experience with VAC therapy for complex wounds. Material and method We retrospectively evaluated our experience with VAC therapy between April 2007 and August 2008. We employed a “suprafascial” VAC system and an open abdomen VAC system. Descriptive statistical techniques were applied and percentages and means were calculated. Results VAC therapy was applied in 20 patients, of whom 16(80%) had abdominal complex wounds, and 4(20%) in other locations. We employed a “suprafascial” VAC system in 17 patients (85%) and an “intra-abdominal” VAC system in 3 patients (15%). Two patients (10%) developed fistula during “intra-abdominal” VAC therapy (urinary and enteric) but the closure was achieved before therapy was finished. Mean hospital stay was 38.3 days (7–136). No mortality was directly due to the VAC system. Two patients (10%) died due to their septic condition and the rest are still alive. Mean therapy length was 29.17 days (1–77) in the “suprafascial” group and 18 days (7–49) in the “intra-abdominal” group. Average costs were 3197.97 € (119.1–10780.25) per patient. Conclusions VAC therapy can improve and accelerate abdominal wound healing also in the presence of infection and bowel fistula (AU)

[A vacuum assisted closure system in complex wounds: a retrospective study]. / Sistema de cierre asistido por vacío en heridas complejas. Estudio retrospectivo.

INTRODUCTION: Vacuum-assisted closure (VAC) therapy is a dynamic and non-invasive system for improving wound healing. This novel therapy is based on applying air suction at a controlled sub-atmospheric pressure. The most important benefits of this therapy include, a reduction in the wound area together with induction of new granulation tissue formation, effective wound cleansing (removal of small tissue by suction), and the continuous removal of wound exudate. The aim of this study was to describe our experience with VAC therapy for complex wounds. MATERIAL AND METHOD: We retrospectively evaluated our experience with VAC therapy between April 2007 and August 2008. We employed a "suprafascial" VAC system and an open abdomen VAC system. Descriptive statistical techniques were applied and percentages and means were calculated. RESULTS: VAC therapy was applied in 20 patients, of whom 16(80%) had abdominal complex wounds, and 4(20%) in other locations. We employed a "suprafascial" VAC system in 17 patients (85%) and an "intra-abdominal" VAC system in 3 patients (15%). Two patients (10%) developed fistula during "intra-abdominal" VAC therapy (urinary and enteric) but the closure was achieved before therapy was finished. Mean hospital stay was 38.3 days (7-136). No mortality was directly due to the VAC system. Two patients (10%) died due to their septic condition and the rest are still alive. Mean therapy length was 29.17 days (1-77) in the "suprafascial" group and 18 days (7-49) in the "intra-abdominal" group. Average costs were 3197.97 euro (119.1-10780.25) per patient. CONCLUSIONS: VAC therapy can improve and accelerate abdominal wound healing also in the presence of infection and bowel fistula.

Appropriate management of common bile duct stones: a RAND Corporation/UCLA Appropriateness Method statistical analysis.

BACKGROUND: Bile duct stones affect 10% of patients who undergo a cholecystectomy and therefore represent a major health problem. Laparoscopic common bile duct exploration, endoscopic sphincterotomy, and open surgical choledocholithotomy are the three available methods for dealing with choledocholithiasis. Though many trials and reviews have compared all three strategies, a list of indications for defined patient profiles is lacking. METHODS: We employed the RAND Corporation/UCLA Appropriateness Method (RAM) to evaluate the three procedures for bile duct stone clearance. An expert panel judged appropriateness after a comprehensive bibliography review, a first-round private rating of 108 different clinical situations, a consensus meeting, and a second round of definitive rating. A list of indications for each procedure was statistically calculated. RESULTS: A consensus was reached for 41 indications (38%). The endoscopic approach was always appropriate for preoperatively diagnosed bile duct stones and inappropriate for patients with single intraoperative detected stones causing cholangitis and bile duct dilatation. Laparoscopic bile duct exploration was appropriate for preoperatively diagnosed choledocholithiasis if patients had not undergone a previous cholecystectomy and no signs of cholangitis were detected. The laparoscopic approach was also appropriate for intraoperatively incidentally detected stones, except for septic patients with poor performance status and multiple calculi. Laparoscopic bile duct clearance was judged inappropriate for septic patients with poor performance status and absence of bile duct dilatation. Open surgery was appropriate in all patients with intraoperative diagnosis of choledocholithiasis and cholangitis and in septic patients with bile duct dilatation. There was no clinical situation in which open surgery was appropriate when bile duct stones were preoperatively diagnosed. CONCLUSIONS: There is still uncertainty with respect to the management of choledocholithiasis, showing the need for further investigation. The RAM helps to elucidate appropriateness for the different treatment options in specific clinical settings.

[Experience with the Bogota bag technique for temporary abdominal closure]. / Experiencia con la técnica de la bolsa de Bogotá para el cierre temporal del abdomen.

INTRODUCTION: The Bogota bag technique is a reliable method for open abdominal closure. The aim of this study was to describe our experience with this technique. MATERIAL AND METHOD: We retrospectively evaluated our experience with the Bogota Bag technique between January 2000 and March 2006. Descriptive statistical techniques were applied and percentages and means were calculated. RESULTS: The Bogota bag technique was applied in 12 patients. The technique was the preferred closure system to prevent abdominal compartment syndrome in 11 patients (91.66%) and was required to treat abdominal compartment syndrome in one patient (8.34%). No complications occurred in relation to placement or withdrawal of the Bogota bag. There were no intestinal fistulas or intra-abdominal abscesses. The mean length of hospital stay was 46.33 days and the mean length of stay in the intensive care unit was 16.58 days. The survival rate was 41.66%. CONCLUSIONS: In our experience, the Bogota bag is a useful technique and is the preferred closure system to prevent or treat abdominal compartment syndrome. The high mortality rates described are due to the underlying diseases leading to open abdominal closure and not directly to the Bogota bag technique itself.

Experiencia con la técnica de la bolsa de Bogotá para el cierre temporal del abdomen / Experience with the Bogota bag technique for temporary abdominal closure

Introducción. La bolsa de Bogotá es uno de los dispositivos que se han descrito para el cierre temporal del abdomen. El objetivo de este trabajo ha sido describir nuestra experiencia con la técnica de la bolsa de Bogotá. Material y método. Analizamos retrospectivamente nuestra experiencia entre enero de 2000 y marzo de 2006. Se aplicó estadística descriptiva con cálculo de porcentajes y medias. Resultados. En un total de 12 pacientes se empleó la bolsa de Bogotá. En 11 (91,66%) se colocó de forma preventiva por presentar riesgos de hipertensión intraabdominal y síndrome compartimental abdominal. En un paciente (8,34%) la descompresión con bolsa de Bogotá se realizó una vez el síndrome compartimental se había instaurado. No hemos tenido ninguna complicación en relación con la colocación ni la retirada de la bolsa de Bogotá. En ningún caso aparecieron fístulas intestinales ni colecciones infectadas intraabdominales. La estancia media hospitalaria fue de 46,33 días y en la unidad de cuidados intensivos, de 16,58 días. En la actualidad 7/12 (58,34%) han fallecido y 5/12 (41,66%) viven. Conclusiones. La bolsa de Bogotá para el open abdomen en nuestra serie ha sido un método útil para evitar o tratar el síndrome compartimental abdominal. La gran mortalidad descrita viene dada por el proceso inicial que presentan los pacientes y no por las complicaciones derivadas de la colocación de la bolsa de Bogotá (AU)

Introduction. The Bogota bag technique is a reliable method for open abdominal closure. The aim of this study was to describe our experience with this technique. Material and method. We retrospectively evaluated our experience with the Bogota Bag technique between January 2000 and March 2006. Descriptive statistical techniques were applied and percentages and means were calculated. Results. The Bogota bag technique was applied in 12 patients. The technique was the preferred closure system to prevent abdominal compartment syndrome in 11 patients (91.66%) and was required to treat abdominal compartment syndrome in one patient (8.34%). No complications occurred in relation to placement or withdrawal of the Bogota bag. There were no intestinal fistulas or intra-abdominal abscesses. The mean length of hospital stay was 46.33 days and the mean length of stay in the intensive care unit was 16.58 days. The survival rate was 41.66%. Conclusions. In our experience, the Bogota bag is a useful technique and is the preferred closure system to prevent or treat abdominal compartment syndrome. The high mortality rates described are due to the underlying diseases leading to open abdominal closure and not directly to the Bogota bag technique itself (AU)

Leiomioma de localización perineal / Perineal leiomyoma

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