[Living-donor intestinal transplantation. First report in Latin-American]. / Trasplante intestinal de donador vivo relacionado. Primer reporte en Latinoamérica.

INTRODUCTION: Intestinal transplants as opposed to total parenteral nutrition is more physiological alternative to long term in patients with irreversible intestinal failure. According to the Intestinal Transplant Registry and the Organ Transplant Network there are 32 living-donor and 957 cadaveric-donor intestinal transplants worldwide. In Latin America there are no reports on this subject. We present the first successful case of intestinal transplantation from living donor in Latin America. CASE REPORT: Male patient, 20 years old, with short bowel, secondary to fire gun injuries that irreversibly affected mesenteric circulation so it was necessary to completely remove the small intestine, right and transverse colon. The patient needed ambulatory total parenteral nutrition and had hepatic failure related to it. The 44-year-old father of the patient was the intestinal living donor. Cold ischemia time was 16 min and warm ischemia time of 47 min. Immunosuppression was based on thymoglobulin, methylprednisolone, tacrolimus and mycophenolic acid. One month after the transplantation, the patient is well and the intestinal graft has adequate and functioning state, without evidence of rejection. CONCLUSION: Intestinal transplantation in our country is a procedure that can be performed with good outcome and offers a unique therapeutic alternative for a patient with irreversible intestinal failure.

Prevalence of internal hernias after laparoscopic colonic surgery.

INTRODUCTION: Laparoscopic approach for colorectal resections is gaining popularity. Internal small bowel herniation (SBH) through a mesenteric defect has been described and, although rare, is a severe complication. The aim of this study was to evaluate the incidence and outcome of internal hernias after laparoscopic colorectal resection. MATERIAL AND METHODS: During a 5-year period, all patients who underwent laparoscopic left colon resection were included in the study. A retrospective data base query was performed searching for all patients in whom SBH required surgical reintervention. RESULTS: A total of 436 laparoscopic left colorectal resections were performed from January 2000 to July 2006. Five male patients presented symptomatic internal hernias and required re-operation. Four had a resection for cancer and one for sigmoiditis. The mesenteric defect was not initially closed in three cases. In all cases, we found small bowel hernias through the mesocolon defect. One patient was re-operated on post-op day 2 for mesenteric ischemia and died after 24 h. DISCUSSION: Internal hernia is a rare but fatal complication after laparoscopic colonic resection. Suspicion of this diagnosis requires emergency re-operation because symptoms are nonspecific. CONCLUSION: All mesenteric defects created during colorectal laparoscopy surgery should be meticulously closed.

[Measurement of the development of psychomotor abilities in surgical endoscopy training with the use of a simulator and biological pieces]. / Método de medición del desarrollo de habilidades psicomotoras en las enseñanza de la cirugía endoscópica, con el uso de simulador y piezas biológicas.

INTRODUCTION: Learning laparoscopic surgery skills using a simulator board is one of the new acquired teaching methods. This work seeks an evaluation method to assess, by objective means, the development of psychometric skills during a simulated workshop with biological pieces. MATERIAL AND METHODS: During a 2-month period, 15 students from an endoscopic surgery seminar were evaluated using a simulator board with the objective to assess four specific skills: object mobilization, cutting pattern, sutures and intracorporeal knots. Eight practice procedures with biological pieces were performed in the simulator. Time and precision were measured in the four assignments. RESULTS: Students improved significantly in object mobilization (p = 0.02), precision in cutting pattern (p < 0.01) and suture (p = 0.02), and time and precision to realize intracorporeal knots (p < 0.01). CONCLUSIONS: This method allows the objective evaluation of the degree of development of surgical skills using a simulator board. It is inexpensive and easy to perform, which makes it useful for other institutions.