Veinticinco años de colecistectomía laparoscópica en régimen ambulatorio / Twenty-five years of ambulatory laparoscopic cholecystectomy

Es bien aceptado por la comunidad quirúrgica que la colecistectomía laparoscópica (CL) es la técnica de elección en el tratamiento de la colelitiasis sintomática. Sin embargo, más controvertida es la estandarización de su realización en régimen de cirugía mayor ambulatoria (CMA) por las diversas connotaciones que presenta. Este artículo tiene por objeto actualizar los factores influyentes en la realización de la CL en régimen de cirugía sin ingreso, analizando estos 25 años desde su implantación, incidiendo en la calidad y aceptación del proceso por parte del paciente. Es fundamental la individualización del proceso: un estricto criterio de selección de pacientes y la realización por equipos con experiencia en CL, son factores que aseguran una alta garantía de éxito

It is accepted by the surgical community that laparoscopic cholecystectomy (LC) is the technique of choice in the treatment of symptomatic cholelithiasis. However, more controversial is the standardization of system implementation in Ambulatory Surgery because of its different different connotations. This article aims to update the factors that influence the performance of LC in day surgery, analyzing the 25 years since its implementation, focusing on the quality and acceptance by the patient. Individualization is essential: patient selection criteria and the implementation by experienced teams in LC, are factors that ensure high guarantee of success

Twenty-five years of ambulatory laparoscopic cholecystectomy. / Veinticinco años de colecistectomía laparoscópica en régimen ambulatorio.

It is accepted by the surgical community that laparoscopic cholecystectomy (LC) is the technique of choice in the treatment of symptomatic cholelithiasis. However, more controversial is the standardization of system implementation in Ambulatory Surgery because of its different different connotations. This article aims to update the factors that influence the performance of LC in day surgery, analyzing the 25 years since its implementation, focusing on the quality and acceptance by the patient. Individualization is essential: patient selection criteria and the implementation by experienced teams in LC, are factors that ensure high guarantee of success.

[Prosthetic infection after hernioplasty. Five years experience]. / Infección de la prótesis en la reparación herniaria. Nuestra experiencia en 5 años.

INTRODUCTION: Prosthesis infection is an infrequent but important complication in abdominal wall surgery. The aim of this study is to evaluate the incidence and risk factors for the infection of the prosthesis after hernia repair, as well as the treatment to apply. MATERIAL AND METHOD: Between January 2002 and December 2006, we performed 1055 prosthetic hernia repairs: 761 inguinal hernias (72.1%), 74 umbilical hernias (7%) and 220 ventral hernias (20.9%). We prospectively analysed preoperative, intraoperative and postoperative variables, as well as the incidence of infection of surgical wound and of prosthesis. We used ASA classification for preoperative anaesthetic evaluation. RESULTS: The overall percentage of infection of the prosthesis was 1.3%. Infection was observed in 11 repairs with polypropylene mesh (PPL), in 4 with PTFE mesh, and one case in combined mesh. Risk factors of mesh infection were: obesity (p=0.002), diabetes (p=0.020), the type of repair (p=0.047), emergency surgery (p=0.001), the type and size of mesh (p=0.003; p=0.007) and time of surgery >180 min (p<0.001). Seven of the 11 patients with infection of PPL prosthesis were resolved with conservative treatment, whereas all the cases with PTFE infection or mixed mesh needed removal to solve the problem. CONCLUSIONS: Several factors are involved in producing a prosthesis infection. Whereas antibiotic treatment and surgical drainage of the infection can be sufficient in most PPL mesh infection, PTFE prostheses need to be removed prematurely in order to halt the infection process.

Infección de la prótesis en la reparación herniaria. Nuestra experiencia en 5 años / Prosthetic infection after hernioplasty. Five years experience

Introducción: la infección de la prótesis es una complicación infrecuente pero importante en la cirugía de la pared abdominal. El objetivo de este estudio es valorar la incidencia y los factores de riesgo influyentes en la infección de la prótesis tras la reparación herniaria, así como el tratamiento a aplicar. Material y método: entre enero de 2002 y diciembre de 2006, se realizaron en total 1.055 reparaciones protésicas herniarias: 761 hernias inguinocrurales (72,1%), 74 hernias umbilicales (7%) y 220 eventroplastias (20,9%). Se analizaron de forma prospectiva variables preoperatorias, intraoperatorias y postoperatorias, así como la incidencia de infección de herida quirúrgica y de prótesis. Se utilizó la clasificación ASA para la valoración preoperatoria anestésica. Resultados: el porcentaje de infección del biomaterial en general fue del 1,3%. Observamos infección en 11 reparaciones con prótesis de polipropileno (PPL), en 4 con PTFE-e y 1 caso en prótesis combinada. Fueron factores de riesgo en la infección del biomaterial: la obesidad (p=0,002), la diabetes mellitus (p=0,020), el tipo de reparación (p=0,047), la intervención de urgencia (p=0,001), el tipo y el tamaño de la prótesis (p=0,003 y p=0,007) y el tiempo quirúrgico >180min (p<0,001). De 11 pacientes con infección de prótesis de PPL, 7 respondieron al tratamiento con curas, mientras que todos los casos con infección de PTFE-e o prótesis mixta necesitaron de su extirpación para resolver el problema. Conclusiones: existen numerosos factores de riesgo influyentes en la tasa de infección del biomaterial. Mientras que la terapia antibiótica adecuada y el drenaje quirúrgico de la infección pueden ser suficientes en la mayoría de las infecciones de prótesis de PPL, las de PTFE-e requieren extirpación precoz para acabar con el proceso infectivo (AU)

Introduction: Prosthesis infection is an infrequent but important complication in abdominal wall surgery. The aim of this study is to evaluate the incidence and risk factors for the infection of the prosthesis after hernia repair, as well as the treatment to apply. Material and method: Between January 2002 and December 2006, we performed 1055 prosthetic hernia repairs: 761 inguinal hernias (72.1%), 74 umbilical hernias (7%) and 220 ventral hernias (20.9%). We prospectively analysed preoperative, intraoperative and postoperative variables, as well as the incidence of infection of surgical wound and of prosthesis. We used ASA classification for preoperative anaesthetic evaluation. Results: The overall percentage of infection of the prosthesis was 1.3%. Infection was observed in 11 repairs with polypropylene mesh (PPL), in 4 with PTFE mesh, and one case in combined mesh. Risk factors of mesh infection were: obesity (p=0.002), diabetes (p=0.020), the type of repair (p=0.047), emergency surgery (p=0.001), the type and size of mesh (p=0.003; p=0.007) and time of surgery >180min (p<0.001). Seven of the 11 patients with infection of PPL prosthesis were resolved with conservative treatment, whereas all the cases with PTFE infection or mixed mesh needed removal to solve the problem. Conclusions: Several factors are involved in producing a prosthesis infection. Whereas antibiotic treatment and surgical drainage of the infection can be sufficient in most PPL mesh infection, PTFE prostheses need to be removed prematurely in order to halt the infection process (AU)