Acute appendicitis in an overweight and obese Mexican population: A retrospective cohort study.

INTRODUCTION: México is the second place in overweight and obese adults. Acute appendicitis (AA), is the most common indication for an emergency surgery around the world, with an estimated lifetime incidence of 7-14%. Laparoscopic appendectomy (LA) has been described as a safe and good surgery approach for this group of patients. Nevertheless, in México, there is not any evidence supporting these outcomes in our population. METHODS: All the patients that came to the ER from July to December 2014 with age >16-year, body mass index (BMI) > 25 kg/m(2) (overweight) and, BMI >30 kg/m(2) (obese) were included in the study. We recorded the age, gender, BMI, grade of appendicitis, complications classified by the Clavien-Dindo Classification, and a follow-up period of 7-day, 30-day, 6-month, and 1-year. RESULTS: 27 patients met the inclusion criteria, five had overweight (18.5%), and twenty-two were obese (81.5%). No surgical conversion was needed. The overall complications rate was 29.6%%, with 22.2% mild complications and 7.4% of moderate complication. The average in-hospital cost for the procedure was $15,860 MXN (range $12,860-$22,860 MXN). The surgical time was ≈53.7 ± 19.93 h and the LOS ≈1.6 ± 0.6 days. CONCLUSION: The outcomes in the Mexican adult obese population with acute appendicitis when a laparoscopic appendectomy is performed are as good as reported in other countries.

Treatment of choledochal cyst in a pediatric population. A single institution experience of 15-years. Case series.

BACKGROUND: Choledochal cyst (CC) is a rare congenital anomaly of the bile duct that approximately 75% of the patients are diagnosed in childhood. Without a standardized surgical procedure for the biliary reconstruction, we present our experience over the last 15 years and show the differences between the biliary reconstructions techniques in our population. METHODS: We did a retrospective hospital archive search for patients admitted to the pediatric surgery department with the diagnosis of a choledochal cyst from January 2000 to June 2015. RESULTS: We found 15 patients, of which, 1 was excluded because of missing data from the hospital record. Of the remaining 14, eight had hepaticojejunal (HY) anastomosis in Roux-en-Y, with a 25% rate of complications; six had hepatoduodenal (HD) anastomosis with a rate of complications of 16.6%. The average hospital length of stay in the group of HD vs. HY was 14 ± 1.6-days vs. 19 ± 8.2-days respectively. DISCUSSION: There are no standardized surgical reconstruction techniques of the biliary tract after the CC excision, there is literature that supports the biliary reconstruction with an HY and an HD without a distinct advantage over one or the other. CONCLUSION: In our series HD anastomosis represents a safe procedure with fewer complications than HY.