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1.
Rev. colomb. cir ; 33(2): 181-188, 2018. tab, fig
Article in Spanish | LILACS | ID: biblio-915655

ABSTRACT

Introducción. El limitar la longitud de la extirpación (stripping) de la vena safena mayor al segmento insuficiente con base en los hallazgos de la ecografía Doppler a color, permite disminuir la morbilidad. Materiales y métodos. Se llevó a cabo un estudio prospectivo y aleatorio de 155 pacientes intervenidos durante 24 meses, de los cuales 74 fueron sometidos a una safenectomía corta y 81 a una safenectomía larga. Las variables evaluadas durante el seguimiento fueron: tipo de anestesia, porcentaje de atención ambulatoria, morbilidad quirúrgica, días de incapacidad temporal y recidivas varicosas. Los síntomas de afectación neurológica ligados a la safenectomía se evaluaron de forma temprana y a largo plazo. Resultados. El 91,6 % de los enfermos fueron intervenidos de forma ambulatoria, con un período de incapacidad temporal menor de tres semanas y 18 % de recidivas. El costo unitario de las intervenciones concertadas con el Sistema Público de Salud fue inferior a USD$ 950. La safenectomía corta tuvo mejores resultados que la larga en casi todos los parámetros estudiados, con menos días de ausencia laboral (18,2 Vs. 22,6; p=0,013), morbilidad (14,9 % Vs. 33,3 %; p=0,036) y secuelas neurológicas a la finalización del estudio (2 % Vs. 11,9 %; p=0,043). Discusión. La safenectomía clásica es una técnica útil, con excelentes resultados clínicos y estéticos, escasas complicaciones y bajo costo. En ausencia de insuficiencia distal del eje safeno, la safenectomía corta es de elección por su menor morbilidad


Background: Limited stripping from the great saphenous vein to the insufficient segment based on the Doppler color echography findings reduces morbidity. Material and methods: A prospective randomized study was conducted on 155 patients who underwent surgery over a 24 months period, of which 74 were subjected to limited saphenectomy and 81 to total saphenectomy. The monitored variables during the followed up were: type of anesthesia, percentage as ambulatory surgery, surgical morbidity, temporary disability days, and recurrent varicose veins. Symptoms of neurological disturbances linked to saphenectomy were evaluated early and also at long term followup. Results: 91.6% were operated on as outpatients, exhibiting shorter period of temporary disability (3 weeks) and 18% recurrence rate. The cost of the actions agreed with the Public Health System interventions tariff, less than $950 USD. The limited saphenectomy procedure appeared better than the total saphenectomy in almost all parameters studied, with fewer days of sick leave (18,2 vs 22,6 p=0.013), morbidity rate (14.9% vs 33.3% p=0.036), and neurological sequelae at completion of the study (2% vs 11.9% p=0.043). Discussion: The classical saphenectomy is a useful technique, with excellent clinical and cosmetic results, few complications and low cost. In the absence of distal saphenous insufficiency axis, the limited saphenectomy appears as the preferred procedure in view of its lower morbidity


Subject(s)
Humans , Saphenous Vein , Varicose Veins , Vascular Surgical Procedures , Venous Insufficiency
2.
Rev. gastroenterol. Perú ; 29(4): 332-340, oct.-dic. 2009. tab
Article in Spanish | LILACS, LIPECS | ID: lil-559294

ABSTRACT

INTRODUCCIÓN. La colecistitis aguda (CA) en el anciano es una entidad clínica frecuente, caracterizada por la elevada tasa de complicaciones y mortalidad. La elección entre cirugía urgente o tratamiento conservador más cirugía diferida es un motivo de controversia. MATERIAL Y MÉTODOS. Estudio de una cohorte retrospectiva sobre pacientes con edad igual o superior a 70 años tratados de colecistitis aguda entre 2003 y 2009. Se analizaron parámetros epidemiológicos, clínicos, diagnósticos, quirúrgicos y de coste-efectividad. Método estadístico: utilizamos los test Chi-2, ôtõ de Student y ANOVA. El nivel de significación se estableció paravalores p < 0.05. RESULTADOS. Durante los 6 años estudiados fueron tratados 173 episodios de CA en 147pacientes (52 por ciento mujeres), con una edad media de 80.6 años (máximo 101). En 103 episodios (77 pacientes) se adoptó tratamiento médico de los que 31 se operaron de forma electiva conun 100 por ciento de abordajes laparoscópicos, baja tasa de conversión (6.4 por ciento) y morbilidad (9.6 por ciento) sin registrarse mortalidad. Otros 85 pacientes fueron intervenidos de urgencia con un 78.5 por ciento de abordajes laparoscópicos, tasa de conversión del 19.7 por ciento, morbilidad 53 por ciento y mortalidad 3.5 por ciento. CONCLUSIONES. Considerando todas las variables la cirugía urgente y el tratamiento médico seguido de colecistectomía electiva obtienen resultados similares, aunque los enfermos sometidos a colecistectomía laparoscópica precoz fueron los que mejor evolucionaron.


INTRODUCTION. Acute cholecystitis in elderly patients is a frequent disease characterized by a high mortality rate and serious complications. The choice between emergency surgery or conservative therapy in addition to delayed surgery is a controversial issue. PATIENTS AND METHODS. Retrospective cohort study over patients aged 70 years or older undergoing acute cholecystitis treatment between 2003 and 2009. Epidemiological, clinical, diagnostic, surgical and cost effectiveness parameters were analysed. Statistical method: Weuse Chi squared test, Student´s t test and ANOVA. A level of p < 0.05 was accepted as significant. RESULTS. During the six-year period studied 173 episodes of acute cholecystitis were treated on 147 patients (52 percent females), with an average age of 80.6 years (maximum 101). In 103 episodes(77 patients) medical treatment was taken, 31 of them undergone elective surgery by means of 100 percent laparoscopic approach, 6,4 percent conversion rate, 9,6 percent morbidity in absence of mortality. In other 85 patients emergency surgery was performed, 78.5 percent of them through laparoscopy approach with a conversion rate of 19.7 percent , 53 percent morbidity and 3,5 percent mortality. Conclusions. Taking into account all variables, emergency surgery and medical treatment followed by elective cholecistectomy get similar outcomes, making better progress those who underwent early laparoscopic cholecystectomy.


Subject(s)
Aged , Aged, 80 and over , Cholecystectomy, Laparoscopic , Cholecystitis, Acute , Cholecystitis/surgery , Intraoperative Complications , Retrospective Studies
3.
Actas Urol Esp ; 33(4): 436-8, 2009 Apr.
Article in Spanish | MEDLINE | ID: mdl-19579897

ABSTRACT

We report a case of bowel perforation after the accomplishment of a radical prostatectomy, the secondary complications to the peritonitis and the resolution of the same ones.


Subject(s)
Adenocarcinoma/surgery , Colon, Sigmoid/injuries , Intestinal Perforation/etiology , Prostatectomy/adverse effects , Prostatic Neoplasms/surgery , Aged , Humans , Male
4.
Rev Gastroenterol Peru ; 29(1): 61-5, 2009.
Article in Spanish | MEDLINE | ID: mdl-19424411

ABSTRACT

Vernix caseosa peritonitis (VCP) is a complication caused by inflammatory response to amniotic fluid spilled into the maternal peritoneal cavity during a cesarean section.The physiopathology mechanisms are still incompletely understood. However, keratina granulomas could be induced by the squamous cells inside the vernix.In spite of its infrequent condition this entity should be included in the differential diagnosis of abdominal pain and acute abdomen in the post-partum after cesarean section.In this article, we present a case of VCP, and we discuss the clinical and histopathologic findings that allow its prompt recognition as well as to guide us towards the correct surgical and therapeutic technique.


Subject(s)
Peritonitis/etiology , Puerperal Disorders/etiology , Vernix Caseosa , Adult , Female , Humans
5.
Cir. Esp. (Ed. impr.) ; 85(4): 246-251, abr. 2009. tab
Article in Spanish | IBECS | ID: ibc-59658

ABSTRACT

Introducción: En el presente artículo analizamos los resultados y complicaciones de la colecistectomía laparoscópica en octogenarios. Pacientes y método: Estudio retrospectivo sobre pacientes con edad ≥80 años, sometidos a una colecistectomía laparoscópica entre enero de 2002 y agosto de 2007. Los parámetros analizados fueron: presentación, estado general, riesgo anestésico, tasa de conversión, morbilidad y estancia hospitalaria. Se realizó una comparación con pacientes geriátricos de entre 70 y 79 años. Para el análisis estadístico utilizamos la prueba de la χ2 y la t de Student. La significación se estableció para valores de p<0,05. Resultados: Se intervino a 64 pacientes (el 63%, mujeres), con una media de edad de 83,7 años. La cirugía fue programada en 40 (62,5%) casos y urgente en 24. La tasa de conversión fue del 10,9% y la media de estancia hospitalaria, 3,9 días. Dos enfermos fueron reoperados y hubo dos decesos. Conclusiones: La colecistectomía laparoscópica es la técnica de elección para el tratamiento de la colelitiasis sintomática en octogenarios. La colecistitis aguda del anciano debe ser tratada mediante abordaje laparoscópico, salvo contraindicación, preferentemente antes de que aparezcan complicaciones (AU)


Introduction: In the current article, we analyse the results and complications of laparoscopic cholecystectomy in octogenarian patients. Patients and method: Retrospective study in patients older than 80 years, who underwent laparoscopic cholecystectomy between January 2002 and August 2007. Variables analysed were presentation, physical condition, anaesthetic risk, conversion rate, morbidity and hospital stay. A comparison was made with patients aged between 70 and 79 years old. The χ2 and Student's t tests were used for statistical analysis. The level of significance was defined as a p value less than 0.05. Results: A total of 64 patients were operated on, of which 39 (63%) were women and 25 men, with a mean age 83.7 years. Surgery was scheduled in 40 (62.5%) cases and urgent in 24 cases. The conversion rate to open cholecystectomy was 10.9% and the average hospital stay was 3.9 days. Two patients required re-intervention and two patients died. Conclusions: Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis in octogenarians. The laparoscopic approach should be considered for the management of acute cholecystitis in the very old (except where contraindicated) before the development of complications (AU)


Subject(s)
Humans , Female , Male , Middle Aged , Aged , Cholecystectomy, Laparoscopic/instrumentation , Cholecystectomy, Laparoscopic/methods , Cholelithiasis/epidemiology , Cholelithiasis/surgery , Cholecystitis, Acute/epidemiology , Cholecystitis, Acute/surgery , Intraoperative Complications/epidemiology , Intraoperative Complications/surgery , Cholecystectomy, Laparoscopic/trends , Cholecystectomy, Laparoscopic , Cholelithiasis/complications , Retrospective Studies , /instrumentation , /methods , Postoperative Complications/epidemiology , Postoperative Complications/surgery
6.
Actas urol. esp ; 33(4): 436-438, abr. 2009. ilus
Article in Spanish | IBECS | ID: ibc-60060

ABSTRACT

Presentamos un caso clínico en el que un paciente presentó una perforación intestinal intraperitoneal tras la realización de un prostatectomía radical, las complicaciones secundarias a la peritonitis fecaloidea y la resolución de las mismas (AU)


We report a case of bowel perforation after the accomplishment of a radical prostatectomy, the secondary complications to the peritonitis and the resolution of the same ones (AU)


Subject(s)
Humans , Male , Aged , Prostatic Neoplasms/pathology , Prostatectomy/methods , Urinary Fistula/complications , Urinary Fistula/surgery , Intestinal Perforation/complications , Peritonitis/complications , Colostomy/methods
7.
Cir Esp ; 85(4): 246-51, 2009 Apr.
Article in Spanish | MEDLINE | ID: mdl-19303069

ABSTRACT

INTRODUCTION: In the current article, we analyse the results and complications of laparoscopic cholecystectomy in octogenarian patients. PATIENTS AND METHOD: Retrospective study in patients older than 80 years, who underwent laparoscopic cholecystectomy between January 2002 and August 2007. Variables analysed were presentation, physical condition, anaesthetic risk, conversion rate, morbidity and hospital stay. A comparison was made with patients aged between 70 and 79 years old. The chi(2) and Student's t tests were used for statistical analysis. The level of significance was defined as a p value less than 0.05. RESULTS: A total of 64 patients were operated on, of which 39 (63%) were women and 25 men, with a mean age 83.7 years. Surgery was scheduled in 40 (62.5%) cases and urgent in 24 cases. The conversion rate to open cholecystectomy was 10.9% and the average hospital stay was 3.9 days. Two patients required re-intervention and two patients died. CONCLUSIONS: Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis in octogenarians. The laparoscopic approach should be considered for the management of acute cholecystitis in the very old (except where contraindicated) before the development of complications.


Subject(s)
Cholecystectomy, Laparoscopic , Cholelithiasis/surgery , Age Factors , Aged, 80 and over , Cholecystectomy, Laparoscopic/adverse effects , Female , Humans , Male , Retrospective Studies
8.
Rev Gastroenterol Peru ; 29(4): 332-40, 2009.
Article in Spanish | MEDLINE | ID: mdl-20066018

ABSTRACT

INTRODUCTION: Acute cholecystitis in elderly patients is a frequent disease characterized by a high mortality rate and serious complications. The choice between emergency surgery or conservative therapy in addition to delayed surgery is a controversial issue. PATIENTS AND METHODS: Retrospective cohort study over patients aged 70 years or older undergoing acute cholecystitis treatment between 2003 and 2009. Epidemiological, clinical,diagnostic, surgical and cost-effectiveness parameters were analysed. STATISTICAL METHOD: We use Chi squared test, Student's t test and ANOVA. A level of p < 0.05 was accepted as significant. RESULTS: During the six-year period studied 173 episodes of acute cholecystitis were treated on 147 patients (52% females), with an average age of 80.6 years (maximum 101). In 103 episodes (77 patients) medical treatment was taken, 31 of them undergone elective surgery by means of 100% laparoscopic approach, 6,4% conversion rate, 9,6% morbidity in absence of mortality. In other 85 patients emergency surgery was performed, 78.5% of them through laparoscopy approach with a conversion rate of 19.7%, 53% morbidity and 3,5% mortality. CONCLUSIONS: Taking into account all variables, emergency surgery and medical treatment followed by elective cholecistectomy get similar outcomes, making better progress those who underwent early laparoscopic cholecystectomy.


Subject(s)
Cholecystitis, Acute/therapy , Aged , Aged, 80 and over , Cholecystectomy , Cholecystitis, Acute/surgery , Cohort Studies , Emergency Treatment , Female , Humans , Male , Retrospective Studies , Time Factors
9.
Rev. colomb. cir ; 23(3): 136-145, jul.-sept. 2008. tab, graf
Article in Spanish | LILACS | ID: lil-497132

ABSTRACT

Introducción. En el presente artículo analizamos los resultados y complicaciones de la colecistectomía laparoscópica en pacientes octogenarios. El objetivo es establecer si la cirugía endoscópica, programada o urgente, es el tratamiento electivo de la colelitiasis en edades extremas.Materiales y métodos. Realizamos un estudio retrospectivo sobre pacientes con edad igual o superior a 80 años, sometidos a una colecistectomía laparoscópica entre enero de 2002 y junio de 2008. Los principales parámetros analizados fueron: epidemiología, forma de presentación, valoración del estado general y del riesgo anestésico, tasa de conversión, morbilidad y estancia hospitalaria.Resultados. En el periodo estudiado se intervinieron 75 pacientes, 46 mujeres (61 porciento) y 29 hombres con una edad media de 84,1 años (máxima, 94). La cirugía fue programada en 48 casos (64 porciento) y urgente en 27. La tasa de conversión a colecistectomía abierta fue de 9,3 porciento y, la estancia hospitalaria media, de 3,8 días. Dos enfermos precisaron de una reintervención y se contabilizaron dos decesos.Conclusiones. La colecistectomía laparoscópica es la técnica de elección para el tratamiento de la colelitiasis sintomática en octogenarios. La colecistitis aguda del anciano debe ser tratada mediante abordaje laparoscópico, salvo contraindicación, preferentemente antes de aparezcan complicaciones.


Subject(s)
Cholecystectomy , Cholecystitis, Acute , Cholelithiasis , Laparoscopy
10.
Rev Gastroenterol Peru ; 28(1): 15-21, 2008.
Article in Spanish | MEDLINE | ID: mdl-18418453

ABSTRACT

INTRODUCTION: The Mirizzi Syndrome (MS) is a rare variation of cholelitiasis, in which a calculus impacted in the Hartmann Pouch compresses the biliary pathway triggering an obstructive jaundice, frequently followed by inflammatory phenomenon and a number of complications. OBJECTIVE: To establish the frequency of the Mirizzi Syndrome in complicated cholelitiasis in the elderly patient and analyze the most suitable diagnosis and treatment options. PATIENTS AND METHOD: Cases of Mirizzi Syndromes in symptomatic inflammatory biliary lithiasis were selected in a five-year period among patients older than 70, who had undergone urgent operation. Epidemiology, private hospital, diagnosis, operating variables, morbility and hospitalization were analyzed. RESULTS: Twelve (12) patients with Mirizzi Syndrome were detected, with an average age of 77.2 in 197 cases of complicated cholelitiasis. A laparoscopic examination was made in 67% of the cases, with a conversion rate of 50%. The most frequent finding was the biliary extrinsic compression without Csendes-I fistula (58%). The postsurgical morbility was of 58%, including two deaths (17%) and the medium-term postoperative hospital stay was of 9.5 days. CONCLUSIONS: This research emphasizes the importance of the Mirizzi Syndrome (MS) in the symptomatic cholelitiasis in geriatric patients. This syndrome usually acts like a biliar surgical emergency and the early diagnosis of an elderly patient with jaundice is the key that enables immediate biliary decompression through a cholecystectomy. Management choices are in debate; however, due to its advantages in cases of elderly patients, a laparoscopic treatment is proposed, unless strictly contraindicated.


Subject(s)
Cholelithiasis/diagnosis , Cholelithiasis/surgery , Jaundice, Obstructive/diagnosis , Jaundice, Obstructive/surgery , Laparoscopy , Aged , Aged, 80 and over , Cholelithiasis/complications , Female , Humans , Jaundice, Obstructive/etiology , Male , Retrospective Studies , Syndrome
11.
Rev. multidiscip. gerontol ; 17(1): 13-17, ene.-mar. 2007. tab, ilus
Article in Spanish | IBECS | ID: ibc-80696

ABSTRACT

Fundamentos. En el presente artículo analizamos los resultados y complicaciones de la colecistectomía laparoscópica en pacientes octogenarios. El objetivo es establecer si la cirugía endoscópica, programada o urgente, es el tratamiento electivo de la colelitiasis en edades extremas. Métodos: Realizamos un estudio retrospectivo sobre pacientes con edad igual o superior a 80 años, sometidos a una colecistectomía laparoscópica entre enero de 2002 y enero de 2006. Los principales parámetros analizados fueron: epidemiología, forma de presentación, valoración del estado general y del riesgo anestésico, tasa de conversión, morbilidad y estancia hospitalaria. Resultados: En el periodo estudiado se intervinieron 43 pacientes, 27 mujeres (63%) y 16 hombres con una edad media de 83.5 años (máxima 92). La cirugía fue programada en 28 casos (65%) y urgente en 15. La tasa de conversión a colecistectomía abierta fue del 11.6% y la estancia hospitalaria media de 3.9 días. Dos enfermos precisaron de una reintervención y hubo un fallecido. Conclusiones: La colecistectomía laparoscópica es la técnica de elección para el tratamiento de la colelitiasis sintomática en octogenarios. La colecistitis aguda del anciano debe ser tratada mediante abordaje laparoscópico, salvo contraindicación, preferentemente antes de aparezcan complicaciones (AU)


Background: In the current article, we analyse the results and complications of laparoscopic cholecystectomy in octogenarian patients. The aim is to determine whether the open procedure (either programmed or emergent surgery) is the elective treatment of cholelithiasis in extremely elderly patients. Methods: We implement a retrospective study in patients aged 80 years or older. They under went laparoscopic cholecystectomy between January 2002 and January 2006. Variables analysed were epidemiology, initial presentation, assessment of physical condition and anesthetic risk, conversion rate, morbidity and hospital stay. Results: The study group consisted of 43 patients, 27 women (63%) and 16 men, mean age 83.5 years (maximum 92). Programmed surgery was attempted in 28 cases (65%) and emergent 15 cases. The conversion rate to open cholecystectomy was 11.6% and the average hospital stay was 3.9 days. Two patients required reintervention and one patient died. Conclusions: Laparoscopic cholecystectomy is elective treatment for symptomatic cholelithiasis in octogenarian people. The management of acute cholecystitis in the extremely elderly should be considered for laparoscopic approach (except contraindication) before the development of complications (AU)


Subject(s)
Humans , Male , Female , Aged, 80 and over , Cholecystitis/surgery , Cholecystectomy, Laparoscopic , Retrospective Studies , Postoperative Complications , Risk Factors
12.
An. cir. card. cir. vasc ; 12(3): 126-132, mayo-jun. 2006. ilus, tab
Article in Es | IBECS | ID: ibc-049511

ABSTRACT

Objetivo: analizar las complicaciones y resultados de la esclerosis y la esclero-microcirugía en el tratamiento estético de las varices en las extremidades inferiores. Método: Se realizó un estudio prospectivo, observacional y no randomizado a pacientes sometidos a esclerosis de varices entre enero de 2001 y enero de 2006. el esclerosante elegido fue polidocanol y la técnica francesa. Como técnicas quirúrgicas complementarias se practicaron desconexiones selectivas y flebectomías. Se registraron todas las complicaciones y se valoró estéticamente el resultado final, por el paciente y el facultativo, mediante una escala subjetiva. Resultados: Fueron tratados 141 pacientes, 95 mediante esclerosis pura y 46 con esclero-microcirugía, todos del sexo femenino, con una edad media de 41.5 años. En un 42% de los casos habían recibido terapia hormonal anticonceptiva o sustitutiva y un 325 tratamiento previo de sus varices. El número medio de sesiones fue de 5 (máximo 21). La complicación más frecuente fue la presencia de tenues hiperpigmentaciones postesclerosis (16%). Se revisó a los enfermos dos meses después de la finalización de la terapia. Los resultados fueron buenos o muy buenos para un 94% de los pacientes encuestados. Durante el seguimiento a largo plazo un 24% presentaron recidivas varicosas subsidiarias de un nuevo tratamiento. conclusiones: La esclerosis, con o sin microcirugía, es un buen tratatmiento estético para las varices conexcelente tolerancia y baja morbilidad


Objective: To analyse complications and results of sclerotherapy and sclero-microsurgery in the cosmetic varicose veins treatment placed on lower limbs. Method: We made a prospective, observational and non-randomised study addressed to patients submitted to sclerotherapy for varicose veins between January 2001 and January 2006. We choose polydocanol as sclerosant and the French technique. the complementary surgical tecniques were selective disconnections and phlebectomies. all complications were recorded and the final outcome was evaluated in aesthetic terms by both, patients and clinician through a subjective rating scale. Results: A total of 141 patients were treated, 95 by means of pure sclerotherapy and 46 with microsurgery. all of them were female patients with a mean age of 41.5 years, 42% of whom had received contraceptive or replacement hormonetherapy and another 32% had already been treated for varicose veins. The average number of sclerotherapy sessions was 5 (with a maximum of 21). the most frequent complication was the presence of faint hyperpigmentation following sclerotherapy (16%). Patients were reviewed two months after therapy had finished. Results were good or very good in 94% of the patients surveyed. During the long term follow-up 24%presented recurrent varicose veins that could benefit from renewed treatment. Conclusions: Sclerotherapy, with or without microsurgery, is good cosmetic therapy for varicose veins with high tolerance and low morbidity rates


Subject(s)
Female , Adult , Aged , Adolescent , Middle Aged , Humans , Varicose Veins/therapy , Sclerosing Solutions/administration & dosage , Microsurgery/methods , Telangiectasis/therapy , Bandages
13.
An. cir. card. cir. vasc ; 12(3): 148-157, mayo-jun. 2006. ilus, tab
Article in Es | IBECS | ID: ibc-049514

ABSTRACT

El tratamiento de la insuficiencia venosa crónica mediante safenectomía sin ingreso mejora la calidad del proceso quirúrgico: menos morbilidad, elevada satisfacción del paciente y contención del gasto sanitario. El desarrollo de una trayectoria clínica específica dentro de la Vía Clínica de la Safenectomía permite una buena selección de candidatos para la cirugía sin hospitalización y estandarizar las diversas actuaciones médicas, administrativas y logísticas. En el presente artículo realizamos una revisión de nuetras pautas terapéuticas actuales y estudiamos el desarrollo de una trayectoria clínica para la safenectomía ambulatoria en nuestro centro hospitalario


Treatment of chronic venous insufficiency by means of ambulatory saphenectomy improves the quality of surgical process: low morbidity, great patient satisfaction and the most cost-effective way. Implementation of an Anticipated Recovery Pathway allows a good selection of candidates for Day surgery and hte standarization of different medical, administrative and logistical actions. In this article, we study the development of an anticipated Recovery pathway of ambulatory saphenectomy in our hospital


Subject(s)
Humans , Saphenous Vein/surgery , Venous Insufficiency/surgery , Ambulatory Surgical Procedures/methods , Varicose Veins/surgery , Patient Satisfaction/statistics & numerical data , Patient Selection , Quality Assurance, Health Care , Health Expenditures
14.
Rev. multidiscip. gerontol ; 15(4): 222-226, oct.-dic. 2005. tab, graf
Article in Es | IBECS | ID: ibc-045952

ABSTRACT

Fundamentos: La demanda de cirugía de la catarata haaumentado considerablemente, suponiendo un problemaal que se ha intentado responder aplicando los criteriosde alta precoz. En este artículo, valoramos los resultadosclínicos y económicos de un programa de cirugíaoftalmológica y la repercusión de los progresivos avancesanestésicos y operatorios (anestesia tópica,facoemulsificación, lente pleglable intraocular) en lamorbilidad e ingresos hospitalarios.Métodos: Se seleccionaron para el estudio los pacientesintervenidos de catarata en la Unidad de Cirugía MayorAmbulatoria del Hospital Comarcal de Jaca entre enerode 2001 y enero de 2005.Resultados: Se intervinieron 815 pacientes (448 mujeresy 367 varones, con una edad media de 73 años). Un95% fueron operados ambulatoriamente y el resto enmodalidad de alta precoz. El porcentaje de ingresos noprevistos fue del 3%. La complicación más frecuente fuela crisis de hipertensión ocular que apareció en un 12,4%de los casos.Conclusiones: Los programas de alta precoz y cirugía siningreso de la catarata nos han permitido solucionar lalista de espera quirúrgica con una baja tasa de complicaciones,excelente aceptación por los mayores y un ahorroeconómico moderado con respecto a la cirugíaoftalmológica clásica


Aims: Corrective surgery cataract has been in great demandlast years, criteria day surgery have been applied on thisissue. This article tries to value the clinical and economicoutcomes of an one day ophthalmological surgeryprogram. It also shows the new developments in theanesthetic and operative techniques (topical anesthesia,phacoemulsification, foldable intraocular lens), and theirrepercussions for the morbidity and hospitalizations.Methods: Every patient operated on for catararact betweenJanuary 2001 and January 2005 at the AmbulatorySurgical Unit of Jaca Hospital was selected for the study.Results: Finally, 815 patients were operated on in ourdepartment, 448 women and 367 men, the average was73 years old. An 95% underwent ambulatory surgeryand the rest of them under outpatient surgery. Thepercentage of unexpected admissions was 3%. The mostfrequent complication was the crisis of ocularhypertension that appeared on a 12.4% of the cases.Conclusions: The one day and outpatient surgery cataractprograms have allowed us to sort out the surgical waitinglistwith a low rate of complications, excellent acceptanceof the elderly people and a moderate economic savingwith regard to the classic oftalmological surgery


Subject(s)
Male , Female , Aged , Aged, 80 and over , Humans , Outcome and Process Assessment, Health Care , Quality of Health Care , Patient Satisfaction , Cataract Extraction/economics , Cataract Extraction/methods , Spain/epidemiology
15.
An. Fac. Med. (Perú) ; 65(4): 267-272, oct. 2004. tab, graf
Article in Spanish | LILACS, LIPECS | ID: biblio-1105926

ABSTRACT

En la presente revisión, y apoyándonos en nuestra experiencia en el Hospital Comarcal de Jaca, intentaremos poner de relieve y discutir los beneficios y los problemas que generan las unidades de cirugía sin ingreso. Analizaremos los distintos tipos de programas ambulatorios y los modelos de unidad quirúrgica, mostrando sus ventajas e inconvenientes. Por último, intentaremos proponer diversas líneas para mejorar la calidad ofertada, la satisfacción del usuario y la relación coste / efectividad de los procesos quirúrgicos.


In this paper we will try to stand out and discuss the benefits and difficulties generated by outpatient units according to our experience. We will analyse the different types of surgical programs, showing advantages and drawbacks. Finally, we will propose several ways in order to improve quality assurance, user’s satisfaction and cost / effectiveness relation of surgical processes.


Subject(s)
Surgery Department, Hospital , Ambulatory Surgical Procedures , Quality of Health Care , Diagnostic Techniques, Surgical
17.
An. Fac. Med. (Perú) ; 62(3): 183-192, jul. 2001. ilus
Article in Spanish | LILACS, LIPECS | ID: lil-357080

ABSTRACT

En el presente artículo presentamos la experiencia de nuestro Servicio en la disección del cayado de la vena safena externa en el transcurso de intervenciones por várices esenciales (47 cayados disecados en 41 pacientes entre 1990 y 2001), junto con una amplia revisión bibliográfica acerca de la anatomía del confluente safenopoplíteo. Igualmente detallamos nuestros hallazgos operatorios y se muestra la progresiva evolución que han experimentado las exploraciones preoperatorias y la técnica quirúrgica. También intentamos delinear la influencia que en la calidad de los diagnósticos anatómicos intraoperatorios han tenido la eco-Doppler (1998) y la instauración de un protocolo operatorio estándar a partir del año 1996.


Subject(s)
Saphenous Vein , Anatomy , Dissection , Diagnostic Techniques, Surgical
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