ABSTRACT
OBJECTIVE: To compare the diagnostic and therapeutic accuracy of laparoscopic appendectomy versus open appendectomy. BACKGROUND DATA: Appendectomy is the treatment of choice for acute appendicitis. Open Appendectomy (OA) has its complications rates (10-20%) and negative explorations in young women are about 25-30%. Acute appendicitis has a 3.1% morbidity and with perforation up to 47.2% and a mortality rate less than 1%. Advantages of laparoscopic appendectomy (LA) has been shown in many studies with lower intraoperatory and postoperatory complications, less hospitalization days, lower pain and faster return to daily activities when its compared with OA. METHODS: We perform a retrospective and descriptive trial with 1,883 patients with acute appendicitis between January 2000 to September 2004. Patients smaller than 15 years old and with other postoperatory diagnosis were excluded. Ji2 and t Student statistic tests were performed. RESULTS: We obtained 1,272 patients with acute appendicitis, 49% male and 51% female. LA was performed in 732 patients, 46.1% male and 53.9% female and OA was performed in 541 patients, 52.6% male and 47.3% female. Similar midage patients in both groups. LS was performed in 180 patients with complicated appendicitis and 116 patients by OA. LA was converted to open surgery in 4.5% patients. Morbidity was lower for laparoscopic group with statistical difference. There were no difference in fasting and hospitalization days. CONCLUSIONS: This procedure is a good choice for differential diagnosis overall in young women and complicated appendicitis with lower morbidity than the OA.
Subject(s)
Appendectomy/methods , Appendicitis/surgery , Adolescent , Adult , Appendicitis/diagnosis , Female , Humans , Laparoscopy/methods , Male , Middle Aged , Postoperative Complications , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: We undertook this study to identify the main causes leading to a failed funduplication and to determine the feasibility and effectiveness of reoperation by laparoscopic approach. METHODS: A retrospective and descriptive study was carried out with a review of patient charts. Patients were reoperated for failed antireflux surgery between January 1999 and September 2004. RESULTS: Sixteen patient charts were reviewed, 10 men (62.5%) and 6 women (37.5%), average age 42.1 +/- 15.4 years (21 to 72 years). Main preoperative symptoms were severe reflux in seven patients (43.7%), severe dysphagia in five (31.3%), and dysphagia and pain in four (25%). Thirteen patients (81%) had previous Nissen laparoscopic funduplication (NL), one (6%) open Nissen (ON) and two (13%) open Toupet (OT). Four patients were reoperated with open surgery (two Nissen and two Toupet), and 12 laparoscopically (11 Nissen and 1 Toupet). The main causes of dysfunction were a) in LN: sliding of the funduplication in five patients (38%), angulation of the funduplication in three (23%) and others; b) in ON: sliding of the funduplication in one patient; and c) in OT: posterior sliding of the funduplication in two cases. The hospital stay for the laparoscopic group was 3.5 +/- 1 days (2 to 5 days) and for the open group, 5.2 +/- 1.3 days (4 to 7 days, p < 0.013, Student t-test). Morbidity 1 month postoperatively was 37.5%. Also reported were abdominal distention (19%), occasional distention with dysphagia (12%), reflux (6.5%), with 0% mortality. CONCLUSIONS: Laparoscopic reoperation for failed antireflux surgery is feasible with an acceptable morbidity and good results.
Subject(s)
Gastroesophageal Reflux/surgery , Adult , Aged , Female , Fundoplication/methods , Humans , Laparoscopy , Length of Stay , Male , Middle Aged , Postoperative Complications , Recurrence , Reoperation , Retrospective Studies , Treatment OutcomeABSTRACT
INTRODUCCION. La fisiopatología de la preeclampsia-eclampsia tiene como sustrato común lesión a endotelio vascular, microangiopatía, fuga capilar y conflicto hemorreológico-hemodinámico con daño a órgano blanco como el riñón, clínicamente manifestado por hipertensión arterial y disminución de la función renal. OBJETIVO. Presentar los resultados obtenidos en nuestra unidad en las pacientes con preeclampsia-eclampsia que desarrollaron insuficiencia renal aguda. PACIENTES Y METODO. Hicimos una revisión de expedientes clínicos de pacientes que ingresaron a cuidados intensivos con diagnóstico de preeclampsia-eclampsia y además se documentó insuficiencia renal aguda, describiendo su evolución clínica, el manejo establecido y su morbi-mortalidad.RESULTADOS. Durante 36 meses ingresaron a la Unidad de Cuidados Intensivos (UCI) 220 pacientes con preeclampsia-eclampsia y en 26 pacientes ( 11.8 por ciento) se documentó IRA; de éstas el 19 por ciento requirió diálisis peritoneal, el resto tratamiento médico. El síndrome de Hellp se asoció en 42 por ciento con IRA.Observamos en este estudio una mortalidad fetal del 19 por ciento y la materna en 7.6 por ciento. Las demás pacientes se recuperaron íntegramente y egresaron de UCI con una estancia promedio de once días.CONCLUSIONES. La preeclampsia-eclampsia continúa teniendo en nuestro medio un gran impacto social, sobre todo cuando se asocia a disfunción orgánica como la falla renal aguda, la cual requiere de diagnóstico y manejo temprano y oportuno.
