La unidad de cuidados intensivos en el postoperatorio de cirugía mayor abdominal / The intensive care unit in the postoperative period of major abdominal surgery

A pesar de una baja mortalidad en los pacientes sometidos a procedimientos de cirugía mayor abdominal, el número de pacientes con alto riesgo aumenta cada día, convirtiendo a esta en un problema de salud. En la actualidad la cirugía se entiende como un proceso continuo en el que el resultado final depende de numerosas pautas sumadas a técnicas menos invasivas que ofrezcan menor impacto fisiológico sobre pacientes con graves comorbilidades. La prevención, el reconocimiento y el tratamiento precoz de las complicaciones se hacen tan importantes como el preoperatorio o la técnica quirúrgica.?La instauración de los protocolos Enhaced Recovery After Surgery es la piedra angular para el tratamiento de estos pacientes, dado que la mayoría de las sociedades quirúrgicas reconocen que reduce la mortalidad, la duración del ingreso y los costes hospitalarios. El manejo postoperatorio de estos pacientes en las unidades de cuidados intensivos garantiza la efectividad y la eficiencia para contribuir al mantenimiento de la prestación de servicios de salud

Despite low mortality in patients undergoing major abdominal surgery, the number of high-risk patients is increasing and has become a health problem. At present, surgery is understood as a continuous process, in which numerous guidelines added to less invasive techniques offering a lesser physiological impact upon patients with serious comorbidities are responsible for the final outcome. The prevention, identification and early treatment of complications prove as important as the preoperative or surgical technique.?The introduction of ERAS (enhanced recovery after surgery) protocols is the cornerstone for the management of these patients, and is advocated by most surgical societies for reducing mortality, length of hospital stay and hospital costs. The postoperative management of these patients in postsurgery Intensive Care Units guarantees effectiveness and efficiency in maintaining optimum patient care

Pancreatitis aguda grave y síndrome compartimental abdominal: tratamiento mediante laparotomía descompresiva y cierre abdominal temporal con malla de politetrafluoroetileno expandido / Severe acute pancreatitis and abdominal compartment syndrome: treatment in the form of decompressive laparotomy and temporary abdominal closure with a expanded polytetrafluoroethylene mesh

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Anesthesia and surgical repair of aponeurotic hernias in ambulatory surgery.

The aim of this study was to evaluate our 5 year experience in the surgery of umbilical (UH) and epigastric hernias (EH) on an ambulatory basis. Sixty three point seven of UH (88/138) and 68.4% of EH (13/19) could be successfully operated in our ambulatory unit. Morbid obesity, ASA III-IV and insulin dependent diabetes were exclusion criteria. After a preoperative local anesthesia infiltration with 1% lidocaine a repair was undertaken in all 101 patients under monitored anesthesia care. Most patients underwent a mesh hernioplasty as definite treatment. Only three patients could not be discharged on the day of operation. There has been a 2% recurrence rate in long term follow-up. These results demonstrate that two thirds of primary aponeurotic hernias can be satisfactorily operated on ambulatory basis.