[Measurement of the development of psychomotor abilities in surgical endoscopy training with the use of a simulator and biological pieces]. / Método de medición del desarrollo de habilidades psicomotoras en las enseñanza de la cirugía endoscópica, con el uso de simulador y piezas biológicas.

INTRODUCTION: Learning laparoscopic surgery skills using a simulator board is one of the new acquired teaching methods. This work seeks an evaluation method to assess, by objective means, the development of psychometric skills during a simulated workshop with biological pieces. MATERIAL AND METHODS: During a 2-month period, 15 students from an endoscopic surgery seminar were evaluated using a simulator board with the objective to assess four specific skills: object mobilization, cutting pattern, sutures and intracorporeal knots. Eight practice procedures with biological pieces were performed in the simulator. Time and precision were measured in the four assignments. RESULTS: Students improved significantly in object mobilization (p = 0.02), precision in cutting pattern (p < 0.01) and suture (p = 0.02), and time and precision to realize intracorporeal knots (p < 0.01). CONCLUSIONS: This method allows the objective evaluation of the degree of development of surgical skills using a simulator board. It is inexpensive and easy to perform, which makes it useful for other institutions.

[Complications of the management of secondary peritonitis with contained-open abdomen. Comparison of the Bogota's bag vs polypropylene mesh]. / Complicaciones del manejo de la peritonitis secundaria con abdomen abierto contenido. Comparación de la "bolsa" de Bogotá versus malla de polipropileno.

BACKGROUND: Surgery is the cornerstone regarding the treatment of secondary peritonitis, although the complications of the contained-open abdomen are common, and are usually severe. OBJECTIVES: To identify the complications with the use of the "Bogotá's bag" compared with polypropylene mesh in contained-open abdomen. To identify other possible morbidity and mortality risk factors, independently of the mesh type usage. METHODS: One hundred patients with secondary peritonitis were included in this retrospective cohort study. They were treated from January 2000 to March 2002. Fifty subjects were operated on with the "Bogota's bag " (50%) and 50 with the polypropylene mesh (50%). Mannheim's peritonitis severity index, complications and mortality using central tendency and dispersion means, the logistic regression analysis, prevalence and prevalence-ratios were analyzed. RESULTS: Most frequent etiologies of secondary peritonitis were intestinal anastomosis dehiscence, hollow viscera perforation, and severe pancreatitis. Observed complications were: perforation and intestinal fistula in 13 cases (13%); 10 (20%) out of these belonged to the polypropylene mesh group, and 3 (6%) to the Bogota's bag group (p = 0.036). Evisceration was observed in 8 cases (8%); 2 (4%) in the polypropylene mesh group, and 6 (12%) in the Bogota's bag group (p = 0.140). Hemorrhage was present in 30 cases (30%); 16 (32%) in the polypropylene mesh group, and 14 (28%) in the Bogota's bag group (p = 0.662). Colonization was present in 24 cases (24%); and this was mainly evident in the polypropylene mesh group (p = 0.019). Mortality reached 42% (42 cases), and was associated to postoperative bleeding (p = 0.004), peritonitis' severity (p = 0.0012), and surgical reinterventions. CONCLUSIONS: The contained-open abdomen is the best surgical option to treat infection and the compartmental abdominal syndrome in secondary peritonitis, however, complications may be relevant. These results demonstrated a direct relationship between peritonitis severity, the need for surgical re-interventions and mortality. The use of polypropylene mesh was related to an increased risk of intestinal fistulization and prothesis-associated infection.