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Background: Reported data suggest that 4.2 million deaths will occur within 30 days of surgery worldwide each year, half of which are in low- and middle-income countries. Postoperative complications are a leading cause of long-term morbidity and mortality. Patients who survive and leave the hospital after surgical complications regularly experience reductions in long-term survival and functional independence, resulting in increased costs. With a high volume of surgery performed, there is a growing perception of the substantial impact of even minor enhancements in perioperative care. The Latin American Surgical Outcomes Study (LASOS) is an international, multicentre, prospective cohort study of adults submitted to in-patient surgery in Latin America aiming to provide detailed data describing postoperative complications and surgical mortality. Methods: LASOS is a 7 day cohort study of adults undergoing surgery in Latin America. Details of preoperative risk factors, intraoperative care, and postoperative outcomes will be collected. The primary outcome will be in-hospital postoperative complications of any cause. Secondary outcomes include in-hospital all-cause mortality, duration of hospital stay after surgery, and admission to a critical care unit within 30 days after surgery during the index hospitalisation. Results: The LASOS results will be published in peer-reviewed journals, reported and presented at international meetings, and widely disseminated to patients and public in participating countries via mainstream and social media. Conclusions: The LASOS may augment our understanding of postoperative complications and surgial mortality in Latin America. Clinical trial registration: NCT05169164.
ABSTRACT
OBJETIVO: Comparar los resultados de la colecistectomía laparoscópica precoz y tardía en colecistitis aguda litiásica. DISEÑO METODOLÓGICO: Cohorte Prospectiva RESULTADOS: 132 pacientes con colecistitis aguda fueron sometidos a colecistectomía laparoscópica divididos en dos grupos; grupo I de 61 sujetos (46,2 %) operados precozmente y el grupo II de 71 sujetos (53,8 %) operados despues de las 72 hrs (colecistectomia tardia). El promedio de edad global fue de 45 años de los cuales 77 fueron mujeres (58,3 %) y 55 varones (41,7 %). La clasificación de Tokio en base al tipo de colecistitis aguda fue de leve o grado I en 105 sujetos (79,5 %) y moderada o grado II en 27 (20,5 %). Profilaxis antibiotica con cefazolina fue utilizada en 19 sujetos (14,4 %) en global, en el grupo I recibieron 10 sujetos (16,4 %), en cambio en el grupo II recibieron 9 sujetos (12,7 %). El tiempo operatorio global promedio fue de 60 minutos. Si existe derrame de bilis o perforación, esta se asocia a infección del sitio operatorio con un OR de 1,89. El porcentaje global de conversión fue de 9,1 % (12 sujetos). En el grupo I; 4 sujetos de 61 (6,6 %) y en el grupo II; 8 de 71 sujetos (11,3 %) es decir OR de 1,8. Se reportan 8 sujetos (6,1 %), como infección del sitio operatorio superficial. El análisis de complicaciones intraoperatorias arroja un OR de 1,2. En relación a la ISO el OR calculado es de 2,72. CONCLUSIÓN: En Colecistitis Aguda, la colecistectomía laparoscópica precoz tiene ventajas en relación a la tardía.
AIM: To compare the results of early and late laparoscopic cholecystectomy in acute lithiasis cholecystitis. METHODOLOGICAL DESIGN: Prospective Cohort RESULTS: 132 patients with acute cholecystitis underwent laparoscopic cholecystectomy divided into two groups; Group I of 61 subjects (46.2%) operated early and group II of 71 subjects (53.8%) operated after 72 hrs (late cholecystectomy). The overall mean age was 45 years, of which 77 were women (58.3%) and 55 men (41.7%). The Tokyo classification based on the type of acute cholecystitis was mild or grade I in 105 subjects (79.5%) and moderate or grade II in 27 (20.5%). Antibiotic prophylaxis with cefazolin was used in 19 subjects (14.4%) overall, in group I received 10 subjects (16.4%), while in group II received 9 subjects (12.7%). The overall operative time was 60 minutes. If there is bile spilage or perforation, it associated with infection of the operative site with an OR of 1.89. The overall conversion rate was 9.1% (12 subjects). In group I; 4 subjects from 61 (6.6%) and in group II; 8 of 71 subjects (11.3%) with an OR of 1,8. Eight subjects (6.1%) were reported, such as superficial operative site infection. The analysis of intraoperative complications reveals an OR of 1.2. In relation to ISO, the calculated OR is 2.72. CONCLUSION: In acute cholecystitis, early laparoscopic cholecystectomy has advantages over the late laparoscopic cholecystectomy.
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Humans , Middle Aged , Cholecystectomy , CholecystitisABSTRACT
INTRODUCCIÓN: La litiasis de la vía biliar principal (LVBP) es la complicación más frecuente de la colecistolitiasis sintomática. Existe controversia acerca de su prevalencia. El objetivo de este estudio es determinar la prevalencia de LVBP en colecistolitiasis sintomática. Material y Método: Estudio de corte transversal. Se estudiaron mediante colangiografía retrógrada endoscópica (CRE), pacientes con colecistolitiasis sintomática y con sospecha de LVBP atendidos en el Hospital Obrero N 1 de la Caja Nacional de Salud La Paz, Bolivia en el período 2005-2006. El tamaño de la muestra se calculó con base en un nivel de confianza de 95%, poder de 80%, frecuencia esperada de LVBP de 59%, y peor escenario de 54%; escenario que da una muestra de 313 pacientes. Se utilizó estadística descriptiva, se calculó prevalencia de LVBP y se aplicó estadística analítica para estudiar asociaciones. Resultados: De los 2001 pacientes internados por colecistolitiasis sintomática, se solicitaron 435 CRE, identificándose en 175 pacientes LVBP, lo que representa una prevalencia de 40,2%. El promedio de edad de los pacientes estudiados fue de 63,1 años y el 51,9% eran de género femenino. Clínicamente, el dolor abdominal, se presentó en 409 pacientes (94,0%), ictericia en 262 casos (60,2%) y alza térmica en 68 pacientes (15,6%). La CRE no identificó lesiones en 68 pacientes (15,6%) y LVBP en 175 casos (40.2%). La morbilidad asociada a la papilotomía endoscópica fue de 4,4%, y no se registró mortalidad. Se verificó asociación entre LVBP y niveles de fosfatasa alcalina (p=0,04), bilirrubina total (p=0,001) y bilirrubina directa (p=0,01). Conclusión: En pacientes portadores de colecistolitiasis sintomática con sospecha de LVBP, la realización de una CRE preoperatoria es una alternativa a considerar.
Background: Choledocholithiasis is the most common complication of symptomatic cholelithiasis. Aim: To evaluate the prevalence of choledocholithiasis among patients with symptomatic cholelithiasis. Patients and Methods: Patients admitted to the hospital with a symptomatic cholelithiasis confirmed by ultrasonography, were subjected to a endoscopic retrograde cholangiography if there was a clinical suspicion of choledocholithiasis. Results: Two thousand and one patients with symptomatic cholelithiasis were admitted and an endoscopic retrograde cholangiography was requested to 435 (age range 14 to 95 years, 226 females). Of these, 409 (94%) had abdominal pain, 263 (60%) had jaundice and 68 (16%) had fever. In 175 (40%) a choledocholithiasis was diagnosed. Sixteen patients (4%) had bleeding after the endoscopic papillotomy, that was self limited in 14, two had an acute pancreatitits and one had a duodenal perforation. There was an association between the presence of choledocholithiasis and serum alkaline phosphatases and bilirubin. Conclusions: Choledocholithiasis is common in patients with cholelithiasis and a clinical suspicion of common bile duct obstruction.
