ABSTRACT
Background: The single-port (SPL) and multi-port (MPL) laparoscopic approach are the gold standard of management of acute appendicitis, due to its multiple advantages over open surgery, mainly because of its direct effects on recovery, esthetics and costs of the procedure. However, in third-world countries, the laparoscopic approach is not yet fully reproducible due to the costs of the technique. The surgical-glove port single incision laparoscopic appendectomy (SGP-SILA) has been proposed as a viable option. However, it has never been studied in Colombia. Objective: To evaluate the cost-effectiveness and reliability of SGP-SILA in the management of complicated acute appendicitis, compared to traditional MPL approach. Materials and methods: A retrospective case control study was carried out comparing patients undergoing laparoscopic appendectomy by SGP-SILA vs. MPL, evaluating operating costs associated with intraoperative and postoperative variables in two tertiary centers in Bogota, Colombia. The data were analyzed and expressed according to their nature and distribution. Results: 116 patients were included (SGP-SILA: 62 and MPL: 54). The median surgical time for SGP-SILA was 60 min vs. 39 min for MPL. SGP-SILA was shown to cause lower frequency of surgical site infection (4 vs. 8 patients; p = 0.047). It was found a significant correlation between Grade III surgical site infection and surgery time (p = 0.047) in the MPL group; also, with hospital stay (p < 0.001). Also, a lower risk of surgical site infection was found with the SGP-SILA technique (22% vs. 31%). SGP-SILA generated a reduction in both direct and indirect operating costs of approximately 10% (616 USD vs. 683 USD). Conclusion: SGP-SILA and MPL are feasible and comparable procedures in the resolution of complicated acute appendicitis. SGP-SILA turns out to be more cost-effective compared to MPL, due to the use of more easily accessible instruments. This may be a reproducible technique in low- and middle-income countries.
ABSTRACT
Introducción. La ingestión accidental de cuerpos extraños como espinas de pescado es muy poco frecuente; en ocasiones, pueden alojarse en el esófago y es posible su migración extraluminal. Este accidente se presenta principalmente en países asiáticos por el gran consumo de pescado. La migración extraluminal de una espina de pescado desde el esófago a la glándula tiroides es aún más infrecuente, con pocos reportes en la literatura.Objetivo. Presentar nuestra experiencia en el diagnóstico y manejo quirúrgico de un paciente con un cuerpo extraño (espina de pescado) alojado en la glándula tiroides y, asimismo, hacer una revisión de la literatura científica.Caso clínico. Se presenta una paciente de 53 años, sin antecedentes de importancia y con un cuadro clínico de tres meses de evolución consistente en odinofagia posterior a la ingestión accidental de una espina de pescado. En la ecografía practicada en otra institución se observó un cuerpo extraño alojado en el lóbulo tiroideo izquierdo en relación con la musculatura del esófago. En la tomografía de cabeza y cuello se apreciaba una imagen hiperdensa lineal de 2,6 cm de longitud en la misma localización. En la exploración quirúrgica se encontró tejido fibrótico en la región posterior del lóbulo tiroideo izquierdo y se procedió a practicar una tiroidectomía subtotal izquierda. La evolución posoperatoria fue adecuada.Conclusiones. La migración extraluminal de cuerpos extraños en el tubo digestivo es factible, sobre todo la de las espinas de pescado por su morfología. La tomografía es la herramienta diagnóstica más confiable para detectar cuerpos extraños alojados en la glándula tiroides. Es necesario conocer las posibles complicaciones y, asimismo, optimizar las posibles intervenciones, pues de eso depende el pronóstico clínico del paciente
Introduction: Accidental ingestion of foreign bodies such as fish bones is very rare; sometimes they may lodge in the esophagus, and extraluminal migration is possible. This accident occurs mainly in Asian countries due to the large fish consumption. Extraluminal migration of a fish bone from the esophagus to the thyroid gland is even more infrequent, with few reports in the literature.Objective: To present our experience in the diagnosis and surgical management of a patient with a foreign body (fish bone) lodged in the thyroid gland and to review the scientific literature.Clinical Case: A 53-year-old patient is presented, without a significant history and with a clinical picture of three months of evolution consisting of odynophagia after accidental ingestion of a fish bone. In the ultrasound performed at another institution, a foreign body was observed lodged in the left thyroid lobe in relation to the musculature of the esophagus. Head and neck tomography showed a linear 2.6 cm long hyperdense image at the same location. On surgical exploration, fibrotic tissue was found in the posterior region of the left thyroid lobe and a left subtotal thyroidectomy was performed. Postoperative evolution was adequate.Conclusions: Extraluminal migration of foreign bodies in the digestive tract is feasible, especially that of fish bones due to their morphology. Tomography is the most reliable diagnostic tool to detect foreign bodies lodged in the thyroid gland. It is necessary to know the possible complications and to optimize the possible interventions, since the clinical prognosis of the patient depends on it
