¿Es segura la coleciestectomía laparoscópica ambulatoria en turno de tarde? / Is ambulatory laparoscopic cholecystectomy safe to perform on the afternoon shift?

INTRODUCCIÓN: La colecistectomía laparoscópica (CL) se considera el tratamiento quirúrgico recomendable para los pacientes portadores de esta entidad clínica. Uno de los beneficios es la pronta recuperación. Objetivos: El objetivo general de este estudio fue el de determinar la utilidad del régimen ambulatorio en pacientes sometidos a CL, bajo control perioperatorio. MATERIAL Y MÉTODOS: Se realizó un estudio de serie de casos en 150 pacientes programados para CL. Se analizaron las variables hemodinámicas en dos fases: Chi cuadrado, con p < 0,05. También se abordó el análisis del tiempo de duración de la intervención quirúrgica, el tiempo de recuperación posoperatoria y la valoración de Aldrete para cirugía ambulatoria. RESULTADOS: Fueron evaluados como: ASA I = 87 (58 %), ASA II = 63 (42 %). Las variables antropométricas: edad: X = 37,7 ± 15 DE. Peso: X = 70,88 ± 26. La duración de la cirugía fue: X = 66,5 ± 22 minutos. El tiempo de estancia posoperatoria fue: X = 5,55 ± 1,2 horas. Las variables hemodinámicas analizadas con T Pareada no muestran diferencias estadísticamente significativas. La valoración de Aldrete para pacientes ambulatorios fue de X = 19 puntos. CONCLUSIONES: El 100 % de los pacientes controló el dolor y fueron ambulatorios. De acuerdo con nuestros hallazgos, nos permitimos proponer a la colecistectomía laparoscópica para su adecuación en el régimen ambulatorio bajo manejo perioperatorio

INTRODUCTION: Laparoscopic Cholecystectomy (LC) is considered the recommended surgical treatment for patients with this clinical entity. One of the benefits is the speedy recovery.Objectivs: The general objective of this study was to determine the utility of the ambulatory regimen in patients undergoing CL, under perioperative control. MATERIAL AND METHOD: A case series study was carried out on 150 patients scheduled for LC. The hemodynamic variables were analyzed in two phases; when entering the unit and being discharged (through Paired T, with p < 0,05), the presence of pain (analysed visual scale) was also analyzed using Chi Square (X2), with p < 0,05. The analysis of the duration of the surgical intervention, the postoperative recovery time and the evaluation of Aldrete for Ambulatory Surgery were also addressed. RESULTS: They were evaluated as: ASA I = 87 (58 %), ASA II = 63 (42 %). The anthropometric variables: age: X = 37.7 years ± SD 15. Weight: X = 70,88 kg ± SD 26. The duration of the surgery was: X = 66.5 ± 22 minutes. The postoperative stay time was: X = 5.55 ± SD 1.2 hours. The hemodynamic variables analyzed with Paired T, do not show statistically significant differences. The Aldrete assessment for outpatients was X = 19 points. CONCLUSIONS: 100 % of the patients had pain control and were ambulatory. According to our findings, we allow us to propose laparoscopic cholecystectomy for its adaptation in the ambulatory regimen under perioperative managemen

Histopathological changes associated to an absorbable fibrin patch (Tachosil®) covering in an experimental model of high-risk colonic anastomoses.

BACKGROUND: TachoSil® is a fibrin sponge that contains fibrinogen and thrombin and is a useful adjuvant to enhance control of air leaks in thoracic surgery and to control bleeding in vascular and general surgery. Its use in intestinal surgery to prevent suture dehiscence is currently under investigation. MATERIAL AND METHODS: We report the results of a prospective randomized experimental study on 33 large white pigs in which a high-risk suture was created by induction of ischemia. We randomly employed TachoSil® to cover the anastomosis in half of the animals compared to a control group of uncovered anastomosis. After euthanasia, postmortem analysis was performed describing the findings related to anastomotic leakage, peritonitis and grade of adhesions. The entire anastomosis was resected in bloc and sent for histopathological analysis. A single blinded-pathologist evaluated the histopathological features of the specimens. RESULTS: We found statistically significant differences favouring the patch in decreasing leakage in the covered group. The healing process did not show significant differences between groups, although a higher rate of microscopic abscess was observed in the covered group. CONCLUSION: The use of fibrin sealants covering high-risk intestinal sutures has a positive effect in avoiding macroscopic anastomotic leakage. The patch did not have any influence in the anastomotic healing process, however, as a result of the effect in containing the inflammatory response, it may increase the rate of abscess.

Use of an experimental model to evaluate infection resistance of meshes in abdominal wall surgery.

BACKGROUND: Staphylococcal species are the most common organisms causing prosthetic mesh infections, however, infections due to rapidly growing mycobacteria are increasing. This study evaluates the resistance of biomaterial for abdominal wall prostheses against the development of postoperative infection in a rat model. MATERIAL AND METHODS: In 75 rats, we intramuscularly implanted three different types of prostheses: (1) low-density polypropylene monofilament mesh (PMM), (2) high-density PMM, and (3) a composite prosthesis composed of low-density PMM and a nonporous hydrophilic film. Meshes were inoculated with a suspension containing 108 colony-forming units of Staphylococcus aureus, Staphylococcus epidermidis, Mycobacterium fortuitum, or Mycobacterium abscessus before wound closure. Animals were sacrificed on the eighth day postoperatively for clinical evaluation, and the implants were removed for bacteriologic analyses. RESULTS: Prostheses infected with S aureus showed a higher bacterial viability, worse integration, and clinical outcome compared with infection by other bacteria. Composite prostheses showed a higher number of viable colonies of both M fortuitum and Staphylococcus spp., with poorer integration in host tissue. However, when the composite prosthesis was infected with M abscessus, a lower number of viable bacteria were isolated and a better integration was observed compared with infection by other bacteria. CONCLUSIONS: Considering M abscessus, a smaller collagen-free contact surface shows better resistance to infection, however, depending on the type of bacteria, prostheses with a large surface, and covered with collagen shows reduced resistance to infection, worse integration, and worse clinical outcome.

Resultados de la aplicación de un protocolo de alta ambulatorización en patología hemorroidal en un hospital general desde el punto de vista del paciente / Results of a high ambulatory rate protocol on the treatment of hemorrhoidal pathology from the patient point of view

El tratamiento quirúrgico de las hemorroides ha sido asociado a un periodo postoperatorio doloroso e incómodo que, clásicamente, se ha asociado a una hospitalización prolongada con el único objetivo de controlar el dolor. Actualmente, la técnica más utilizada es hemorroidectomía de Milligan-Morgan clásica, a pesar de que la tasa de ambulatorización de la patología hemorroidal va en aumento, lo que se puede traducir en un mejor control de los síntomas postoperatorios más modificaciones en la técnica quirúrgica. Nuestro centro es una joven institución con gran vocación professional y apoyo a la cirugía ambulatoria. En este contexto se ha puesto en marcha un nuevo protocolo para la ambulatorización de los procedimientos proctológicos. En este campo, la patología hemorroidal es un gran reto. Presentamos los resultados de la aplicación de este protocolo, centrándonos en el punto de vista del paciente (AU)

The surgical treatment of hemorrhoids is been associated with a postoperative painful and uncomfortable time, that classically associated a prolong hospitalization with the only objective of pain control1 . Today the classic Milligan-Morgan resection remains as the most frequent technique2 , despite this the ambulatory rate keep increasing on time, what can be indirectly explained by a better pain control plus recent technique modifications3 . Our centre is a young institution with a great professional vocation and institutional support on the “day-case” or major ambulatory surgery. In this context we initiate a protocol trying to do almost all the proctology surgery on a ambulatory or day-case way, in this onset the hemorrhoidal pathology is a great challenge. We present the data of this protocol, focusing in the patient point of view of the whole experience (AU)