Hernia estrangulada. ¿Todavía mortal en el siglo XXI? / Strangulated hernia. Still fatal in the XXI century?

Introducción. El conocimiento de los factores que predisponen a la aparición de complicaciones tras cirugía herniaria urgente es de gran importancia tanto para la priorización de la cirugía electiva como para seleccionar los casos que pueden ser susceptibles de seguimiento clínico. Objetivos. Analizar los factores que condicionan la morbilidad y la mortalidad de la resección intestinal asociada a la reparación herniaria urgente. Pacientes y método. Revisión retrospectiva de las historias clínicas de los pacientes intervenidos urgentemente por afección herniaria desde enero de 2000 hasta diciembre de 2005. Se compararon los resultados obtenidos en función de si fue o no necesaria una resección intestinal. Resultados. De un total de 2.367 pacientes intervenidos por hernias en ese período, en 362 (15,3%; media de edad, 69,5 años; 146 varones y 216 mujeres) fue de forma urgente. Precisaron resección intestinal 60 (16,6%). Presentaron complicaciones 108 (29,8%) y 17 (4,7%) fallecieron tras la intervención. El límite de 70 años discriminó una mortalidad significativamente mayor (el 7 frente al 2%, entre mayores y menores de 70 años, respectivamente; p = 0,01). El grupo de pacientes que precisó resección intestinal tenía una media de edad mayor (75,4 frente a 68,3 años; p = 0,002), más prevalencia de complicaciones totales (el 40,7 frente al 6,2%; p < 0,0001) y una mortalidad significativamente mayor (el 20 frente al 1,6%; p < 0,0001). El análisis de discriminación identificó la resección intestinal como variable independiente predictiva de mortalidad (l de Wilks = 0,89; p = 0,0001; valor predictivo del 85%). Conclusiones. La morbilidad y la mortalidad de la cirugía herniaria urgente que precisa resección intestinal son muy elevadas, especialmente en pacientes de edad avanzada y cuando se trata de hernias crurales (AU)

Introduction. Knowledge of the risk factors that may lead to complications after emergency hernia repair is of great importance, as much for the prioritisation of the elective surgery, as selecting those cases that require clinical follow up. Objectives. To analyse the factors conditioning the morbidity and mortality of bowel resection associated to emergency hernia repair. Patients and method. A retrospective review was carried out on the clinical histories of patients who had emergency operations for hernia problems from January 2000 to December of 2005. The clinical results obtained were compared based on whether or not a bowel resection was required. Results. A total of 2367 patients were operated for hernia in this period, 362 of them (15.3%); for a complicated hernia (mean age 69.5 years; 146 males/216 females); 60 patients needed bowel resection. Complications appeared in 108 patients (29.8%) and 17 (4.7%) died after operation. The limit of 70 years discriminated a significantly greater mortality (> 70: 7% vs < 70 2%; p = 0.01).The group of patients who needed bowel resection showed differences in statistical analysis both in age (75.4 vs 68.3 years; p = 0.002), prevalence of complications (40.7% vs 6.2%; p < 0.0001), and mortality (20% vs 1.6%; p < 0.0001). The discriminant analysis identified bowel resection as the only predictive independent variable of mortality (l Wilks = 0.89; p = 0.0001; predictive value, 85%). Conclusions. Morbidity and the mortality of urgent hernia surgery, when bowel resection was required, are elevated; especially in older patients, and in crural hernias (AU)

[Strangulated hernia. Still fatal in the XXI century?]. / Hernia estrangulada. Todavía mortal en el siglo XXI?

INTRODUCTION: Knowledge of the risk factors that may lead to complications after emergency hernia repair is of great importance, as much for the prioritisation of the elective surgery, as selecting those cases that require clinical follow up. OBJECTIVES: To analyse the factors conditioning the morbidity and mortality of bowel resection associated to emergency hernia repair. PATIENTS AND METHOD: A retrospective review was carried out on the clinical histories of patients who had emergency operations for hernia problems from January 2000 to December of 2005. The clinical results obtained were compared based on whether or not a bowel resection was required. RESULTS: A total of 2367 patients were operated for hernia in this period, 362 of them (15.3%); for a complicated hernia (mean age 69.5 years; 146 males/216 females); 60 patients needed bowel resection. Complications appeared in 108 patients (29.8%) and 17 (4.7%) died after operation. The limit of 70 years discriminated a significantly greater mortality (> 70: 7% vs < 70 2%; p = 0.01). The group of patients who needed bowel resection showed differences in statistical analysis both in age (75.4 vs 68.3 years; p = 0.002), prevalence of complications (40.7% vs 6.2%; p < 0.0001), and mortality (20% vs 1.6%; p < 0.0001). The discriminant analysis identified bowel resection as the only predictive independent variable of mortality (lambda Wilks = 0.89; p = 0.0001; predictive value, 85%). CONCLUSIONS: Morbidity and the mortality of urgent hernia surgery, when bowel resection was required, are elevated; especially in older patients, and in crural hernias.

[Impact of the availability of an external nuclear medicine service in the application of sentinel lymph node biopsy in breast cancer surgery]. / Impacto de la disponibilidad de un servicio externo de medicina nuclear en la aplicación de la biopsia del ganglio centinela en cirugía del cáncer de mama.

INTRODUCTION: To perform sentinel lymph node biopsy (SLNB), nuclear medicine services that have previously undergone a validation phase are required. The aim of the present study was to analyze the possibility of performing this technique with a previously validated, external nuclear medicine service and to study its impact on the indication for radical axillary lymphadenectomy (RAL) and on length of postoperative hospital stay. PATIENTS AND METHODS: We performed a prospective study in a cohort of patients with breast cancer starting from the introduction of SLNB in our center, which was made possible by collaboration with an external nuclear medicine service that performed lymphoscintigraphy and sentinel node detection. Intraoperative detection was performed through a portable probe. The feasibility of the project and its clinical impact were analyzed, taking a reduction in the number of lymphadenectomies and length of hospital stay as endpoints. RESULTS: A total of 196 patients with 201 breast carcinomas were treated. The most frequent interventions were tumorectomy (TC) with SLNB in 124 patients (62%), and TC with SLNB and RAL in 62 patients (31%). Sentinel node visualization on lymphoscintigraphy was achieved in 187/201 carcinomas (93.1%) and sentinel nodes were detected during the intervention in 182/187 carcinomas (97.4%). Sentinel node detection in the internal mammary chain was achieved in 23/201 carcinomas (11.4%). RAL was avoided in 131 of the 201 carcinomas (65%). Days of postoperative hospital stay with or without RAL showed a mean difference of 1.8 days (3.1 vs. 1.3; P < .001). CONCLUSION: SLNB is feasible with the collaboration of an external nuclear medicine service. This technique avoids 65% of RAL and reduces length of postoperative stay by 1.8 days.

Impacto de la disponibilidad de un servicio externo de medicina nuclear en la aplicación de la biopsia del ganglio centinela en cirugía del cáncer de mama / Impact of the availability of an external nuclear medicine service in the application of sentinel lymph node biopsy in breast cancer surgery

Introducción. La realización de la técnica de la biopsia selectiva del ganglio centinela (BSGC) en el tratamiento del cáncer de mama requiere disponer de un servicio de medicina nuclear (SMN) y de la validación de su técnica. El objetivo del presente estudio es analizar la posibilidad de realizar esta técnica con un SMN externo ya validado, y estudiar su impacto en la indicación de la linfadenectomía axilar radical (LAR) y en la estancia postoperatoria. Pacientes y métodos. Estudio prospectivo en una cohorte de pacientes con cáncer de mama a partir de la implantación en nuestro centro de la técnica de la BSGC gracias a la colaboración de un SMN externo que realizaba la linfogammagrafía y la detección del ganglio centinela (GC), en tanto que su identificación intraoperatoria se llevaba a cabo mediante una sonda portátil. Se analiza la viabilidad del proyecto y su impacto clínico tomando como resultados finales la disminución del número de linfadenectomías y la estancia hospitalaria. Resultados. Se ha tratado a 196 pacientes, con 201 carcinomas de mama. Las intervenciones mayoritarias fueron la tumorectomía (TC) con BSGC en 124 casos (62%), y la TC con BSGC y LAR en 62 casos (31%). La visualización del GC en la linfogammagrafía se obtuvo en 187 de 201 casos (93,1%) y se ha detectado el GC durante la intervención en 182 de los 187 (97,4%) casos. La detección de GC en la cadena mamaria interna se ha producido en 23 de los 201 casos (11,4%). Se ha evitado la LAR en 131 de los 201 casos (65%). La diferencia de días de ingreso postoperatorio con o sin LAR fue de una media de 1,8 días (3,1 frente a 1,3; p < 0,001). Conclusiones. La técnica de BSGC ha sido factible con la colaboración de un SMN externo; se evitó el 65% de las LAR y disminuyó la estancia media en 1,8 días (AU)

Introduction. To perform sentinel lymph node biopsy (SLNB), nuclear medicine services that have previously undergone a validation phase are required. The aim of the present study was to analyze the possibility of performing this technique with a previously validated, external nuclear medicine service and to study its impact on the indication for radical axillary lymphadenectomy (RAL) and on length of postoperative hospital stay. Patients and methods. We performed a prospective study in a cohort of patients with breast cancer starting from the introduction of SLNB in our center, which was made possible by collaboration with an external nuclear medicine service that performed lymphoscintigraphy and sentinel node detection. Intraoperative detection was performed through a portable probe. The feasibility of the project and its clinical impact were analyzed, taking a reduction in the number of lymphadenectomies and length of hospital stay as endpoints. Results. A total of 196 patients with 201 breast carcinomas were treated. The most frequent interventions were tumorectomy (TC) with SLNB in 124 patients (62%), and TC with SLNB and RAL in 62 patients (31%). Sentinel node visualization on lymphoscintigraphy was achieved in 187/201 carcinomas (93.1 %) and sentinel nodes were detected during the intervention in 182/187 carcinomas (97.4%). Sentinel node detection in the internal mammary chain was achieved in 23/201 carcinomas (11.4%). RAL was avoided in 131 of the 201 carcinomas (65%). Days of postoperative hospital stay with or without RAL showed a mean difference of 1.8 days (3.1 vs. 1.3; P<.001). Conclusion. SLNB is feasible with the collaboration of an external nuclear medicine service. This technique avoids 65% of RAL and reduces length of postoperative stay by 1.8 days (AU)