¿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

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)

Second case of neurocysticercosis in a patient with liver transplantation (first case in Spain): a case report.

BACKGROUND: Neurocysticercosis (NCC) is a disorder caused by the Taenia solium larva. It is the most common parasitosis of the central nervous system (CNS). Its distribution is universal, but it is endemic in many developing countries and in the third world. In Spain most patients come from countries where the condition is endemic. However, sporadic cases occur among the population of rural regions. NCC in transplant recipients is uncommon. One renal transplant recipient developed NCC but responded to treatment with praziquantel. Recently, it has been reported to complicate a liver transplantation. CASE REPORT: The patient was a 49-year-old Ecuatorian man who received a cadaveric donor liver graft in June 2001 due to acute liver failure induced by toadstool and was under treatment with FK506. In January 2006, the patient presented with a generalized onset of a tonic-clonic seizure for 1 minute without sphincter incontinence, headache, fever, or previous brain trauma. Neurological evaluation did not show evidence of organic brain dysfunction. The neuroimaging findings (brain) computed tomography scan, magnetic resonance imaging were compatible with NCC: many cystic lesions intra- and extraparenchymatous with a scolex visible in three of them. Serology for cysticercosis in plasma was initially indeterminate but positive afterward. The patient was treated with anticonvulsivants (valproic acid) and albendazole. Systemic steroids were added in order to reduce the edema produced upon death of the cyst. Treatment lasted 3 weeks and it was completed without complications or neurological symptoms. Liver function was not affected. One year later the patient remained asymptomatic. CONCLUSION: NCC is a condition that must be included in the differential diagnosis of patients with CNS involvement and cystic lesions on neuroimaging investigations in transplant recipients, especially patients originating from or traveling to endemic areas. First-line therapy for active cysts includes antiparasitic drugs (albendazole or praziquantel) as well as steroids and anticonvulsivants. In our patient, this therapy was effective.

Simultaneous liver-kidney transplant for combined renal and hepatic end-stage disease.

INTRODUCTION: After the first combined liver-kidney transplantation (CLKT) reported by Margreiter in 1984, it became clear that renal failure was no longer an absolute contraindication. OBJECTIVE: Our goal was to assess our results with combined liver-kidney transplant. Among 875 liver transplants performed between May 1986 and October 2002, there were 17 cases (1.96%) of combined liver-kidney transplant. RESULTS: With a mean follow-up of 42.2+/-29 months (range, 1-90), six patients had died (mortality: 37.5%). There were four (25%) operative in-hospital deaths, and two late mortality cases (beyond the month 6 after hospital discharge). The causes were sepsis (four cases, three postoperative and one in later follow-up), refractory heart failure (one postoperative), and recurrent liver disease (HCV-induced severe recurrence) during follow-up one). Actuarial survival (calculated for those who survived the postoperative period) was 80%, 71%, and 60% at 12, 36, and 60 months. Actuarial mean survival time was 60 months (95%IC:47-78). Neither the sex, the UNOS status, the etiology of liver disease, the etiology of renal failure, the type of hepatectomy (piggy back vs others) or the type of immunosuppression (P=.83) were related to long-term survival according to the log-rank test. A control group of 48 patients was constructed with subjects who underwent liver transplantation immediately before or after the combined transplant. A total (two cases after the CLKT and one case prior to). There were no differences in survival. CONCLUSION: Combined liver-kidney transplant represents a proper therapeutic option for patients with simultaneously failing organs based on long- and short-term outcomes.