Benefica chirurgia. A global surgery project focusing on hernia surgery.

BACKGROUND: The aim of international health cooperation projects is to alleviate the deficiencies in the area of health in low resource settings. Hernia surgery is a procedure that is well suited to these missions, due to its low morbidity, the fact that it can be performed on an outpatient basis, and the improvement in quality of life that it provides. OBJECTIVE: To describe the results of Benefica Chirurgia (BC), a Spanish non-profit humanitarian association in hernia pathology. METHODS: Five one-week surgical campaigns were carried out in Ecuador between 2015 and 2019, involving anesthetists, general and pediatric surgeons. Surgical and medical equipment was provided and transported by BC. ASA I/II patients underwent surgery. RESULTS: Surgery was performed on 240 patients with hernia pathology on 27 days. Sixty-three per cent of patients were male and the mean age was 48.2 years (range: 1-83). Hernia location was inguinal in 113 patients, umbilical in 101, and other in 26. The anesthetic technique used was spinal in 185 patients (77.1%), local plus intravenous sedation in 31 (12.9%), and general in 24 (10%). The surgical technique used was hernioplasty in 191 patients, herniorrhaphy in 31, incisional hernia repair in 15 and herniotomy in three. Surgery was performed on an outpatient basis in 98.4% of cases. Morbidity was 2%. Long-term postoperative evaluation is very complex. CONCLUSION: These campaigns make a significant contribution to health in low resource settings and provide great personal satisfaction for those involved. Standards achieved in the immediate postoperative period were similar to those obtained at the surgeons' centers in Europe. However, it is difficult to establish the rates of recurrence and chronic pain.

[Modified Kasai technique for the treatment of biliary atresia]. / Una modificación de la técnica de Kasai para el tratamiento de la atresia biliar.

Kasai's procedure has changed significantly the prognosis of biliary atresia. However, ascending cholangitis is a relatively frequent postoperative complication with high morbidity and mortality rates. We have developed a modification of that technic consisting in the isolation of a segment of jejunum-with its blood supply carefully preserved, after fashioning an antireflux valve in its distal end. This segment of bowel, less than 10 cm. in length, is anastomosed to the porta hepatis proximally and to the duodenum distally. Using this technic, we have operated upon three infants with biliary atresia and a child with extended rabdosarcoma of the biliary tree. After a follow up of 10 to 17 months with an average of 12.5 months, all children remain free of cholangitis and two of them are anicteric.

Experimental antireflux intestinal valve.

A reflux-preventing valve was obtained by invaginating a 3.5 to 4.5 cm segment of small bowel into the distal lumen, after removing the seromuscular layers at both ends of the segment of bowel. Antiperistaltic pressure resistance, measured at regular intervals during 6 months, showed valves with competence equal or superior to the ileocecal valve. The blood supply to the intussuscepted segment must be carefully preserved.

Hemithyroid agenesis associated with a cervical thymic cyst.

A case is presented of a 7-yr-old boy with left hemithyroid agenesis associated with cervical thymic cyst. No left parathyroid glands were found. The diagnosis was established after surgical excision and histologic examination. Clinical and embryological implications of this condition are briefly discussed. No similar case has been found in the literature.