RESUMO
BACKGROUND: Roux-en-y gastric bypass for the management of morbid obesity is currently the safest and more efficient treatment option. the laparoscopic era has shown its benefits in this type of surgery, so some authors advocate its implementation in a practical systematic way. all of which has lead in recent years to the unavoidable change in the surgical approach. OBJECTIVES: To evaluate and compare the complications of laparoscopic gastric bypass and the conventional one in patients with morbid obesity. Application site: self-administration national university hospital. DESIGN: Comparative, prospective no randomized study. POPULATION: Between 2002 and 2011, 420 morbidly obese patients received surgical treatment for the obesity either open (167) or laparoscopic (253) surgery RESULTS: Early postoperative complication rate was 4% in the lbg and 34% in the cbg (p < 05, 95%ci 22-38), mostly represented by seromas (25%) and wall abscesses (5.4%). the percentage of late postoperative complications was 2.8% in the lbg group and 9.6% in the cbg (p=0.004, 95%ci 1.4-12.2), the most frequent being incisional hernias (7.18%). CONCLUSIONS: According to our experience and consulted literature, laparoscopic gastric bypass is a safe, reproducible and with a lower rate of both early and late complications than cbg, and so we consider and offer lbg as the ideal technique for the treatment of patients with morbid obesity.
Antecedentes: el bypass gástrico en y de roux para el tratamiento de la obesidad mórbida representa hoy en día la opción terapéutica más segura y eficiente. la era laparoscópica ha demostrado sus beneficios en este tipo de cirugía, por lo que algunos autores abogan por su implementación en forma casi sistemática, conduciendo en los últimos años al inexorable cambio en la vía de abordaje. Objetivos: evaluar y comparar las complicaciones del bypass gástrico laparoscópico y convencional en pacientes con obesidad mórbida. Lugar de aplicación: hospital nacional universitario de autogestión. Diseño: estudio comparativo, prospectivo no randomizado. Población: entre el 2002 y 2011, 420 pacientes con obesidad mórbida recibieron un tratamiento quirúrgico para la obesidad ya sea en forma laparoscópica (253) o convencional (167). Resultados: el porcentaje de complicaciones postoperatorias tempranas fue del 4% en el grupo bgl y del 34% en el bgc (p <05, ic95% 22 - 38), representadas en su mayoría por seromas (25%) y abscesos de pared (5,4%). el porcentaje de complicaciones postoperatorias tardías fue del 2,8% en el grupo bgl y del 9,6% en el bgc (p= 0.004, ic95% 1,4 - 12,2), siendo las más frecuentes las eventraciones (7,2%). Conclusiones: de acuerdo a nuestra experiencia y a la literatura consultada, el bypass gástrico laparoscópico es un procedimiento seguro, reproducible y con una menor tasa de complicaciones tanto tempranas como tardías que el bg c, por lo que consideramos y ofrecemos al bgl como técnica ideal en el tratamiento de los pacientes con obesidad mórbida.
Assuntos
Anastomose em-Y de Roux/efeitos adversos , Derivação Gástrica/efeitos adversos , Laparoscopia/efeitos adversos , Obesidade Mórbida/cirurgia , Adulto , Feminino , Humanos , Laparoscopia/métodos , Tempo de Internação , Masculino , Complicações Pós-Operatórias , Estudos ProspectivosRESUMO
BACKGROUND: Roux-en-y gastric bypass for the management of morbid obesity is currently the safest and more efficient treatment option. the laparoscopic era has shown its benefits in this type of surgery, so some authors advocate its implementation in a practical systematic way. all of which has lead in recent years to the unavoidable change in the surgical approach. OBJECTIVES: To evaluate and compare the complications of laparoscopic gastric bypass and the conventional one in patients with morbid obesity. Application site: self-administration national university hospital. DESIGN: Comparative, prospective no randomized study. POPULATION: Between 2002 and 2011, 420 morbidly obese patients received surgical treatment for the obesity either open (167) or laparoscopic (253) surgery RESULTS: Early postoperative complication rate was 4
in the lbg and 34
in the cbg (p < 05, 95
ci 22-38), mostly represented by seromas (25
) and wall abscesses (5.4
). the percentage of late postoperative complications was 2.8
in the lbg group and 9.6
in the cbg (p=0.004, 95
ci 1.4-12.2), the most frequent being incisional hernias (7.18
). CONCLUSIONS: According to our experience and consulted literature, laparoscopic gastric bypass is a safe, reproducible and with a lower rate of both early and late complications than cbg, and so we consider and offer lbg as the ideal technique for the treatment of patients with morbid obesity.
Assuntos
Anastomose em-Y de Roux/efeitos adversos , Derivação Gástrica/efeitos adversos , Laparoscopia/efeitos adversos , Obesidade Mórbida/cirurgia , Adulto , Feminino , Humanos , Laparoscopia/métodos , Tempo de Internação , Masculino , Complicações Pós-Operatórias , Estudos ProspectivosRESUMO
BACKGROUND: Roux-en-y gastric bypass for the management of morbid obesity is currently the safest and more efficient treatment option. the laparoscopic era has shown its benefits in this type of surgery, so some authors advocate its implementation in a practical systematic way. all of which has lead in recent years to the unavoidable change in the surgical approach. OBJECTIVES: To evaluate and compare the complications of laparoscopic gastric bypass and the conventional one in patients with morbid obesity. Application site: self-administration national university hospital. DESIGN: Comparative, prospective no randomized study. POPULATION: Between 2002 and 2011, 420 morbidly obese patients received surgical treatment for the obesity either open (167) or laparoscopic (253) surgery RESULTS: Early postoperative complication rate was 4
in the lbg and 34
in the cbg (p < 05, 95
ci 22-38), mostly represented by seromas (25
) and wall abscesses (5.4
). the percentage of late postoperative complications was 2.8
in the lbg group and 9.6
in the cbg (p=0.004, 95
ci 1.4-12.2), the most frequent being incisional hernias (7.18
). CONCLUSIONS: According to our experience and consulted literature, laparoscopic gastric bypass is a safe, reproducible and with a lower rate of both early and late complications than cbg, and so we consider and offer lbg as the ideal technique for the treatment of patients with morbid obesity.
Assuntos
Anastomose em-Y de Roux/efeitos adversos , Derivação Gástrica/efeitos adversos , Laparoscopia/efeitos adversos , Obesidade Mórbida/cirurgia , Adulto , Complicações Pós-Operatórias , Estudos Prospectivos , Feminino , Humanos , Laparoscopia/métodos , Masculino , Tempo de InternaçãoRESUMO
INTRODUCTION: Unsuspected or undiagnosed acute appendicitis could progress to a perforation or could lead to the removal of a normal appendix. OBJECTIVES: using a clinical score system as a diagnostic tool for this pathology and can decrease negative appendectomies. MATERIAL AND METHOD: Prospective and protocolized study. SETTING: National Clinicas Hospital. Córdoba. Argentina. Between May 2007 and June 2007 224 patients were studied of which 117 were male and 107 were female with a mean age of 26.65 years. An Alvarado score was performed on all patients on admission. Based on the clinical evidence and a second assessment with the Alvarado Score, surgical exploration was decided in 207 patients. The remaining 17 were excluded due to other pathology. The diagnosis of acute appendicitis was confirmed by surgical finding and histopathological studies. RESULTS: In the surgical findings it was shown that 189 (91%) patients had acute appendicitis. There was no surgical mortality. As regards morbidity, 3.86% had medical and 27% had surgical complications. The histopathology reports showed a normal caecal appendix in 18. Whereas the incidence of negative appendicectomy was about 8.69%. CONCLUSIONS: The use of the Alvarado Score together with the surgical and histopathology findings confirmed it was sensitive from 6 points for the diagnosis of acute appendicitis.
Assuntos
Apendicite/diagnóstico , Dor/diagnóstico , Dor/etiologia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Diagnóstico Diferencial , Feminino , Humanos , Ílio , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos ProspectivosRESUMO
Introducción. La apendicitis aguda no sospechada ni diagnosticada puede evolucionar hacia la perforación o, por el contrario, conduce a la remoción de un apéndice normal. El objetivo del estudio fue utilizar un sistema de clasificación, desde un punto de vista clínico, para el diagnóstico de esta enfermedad y lograr disminuir las apendicectomías negativas. Material y método. Estudio prospectivo y protocolizado, que se aplicó en el Hospital Nacional de Clínicas, Córdoba (Argentina). Comprende a 224 pacientes estudiados entre mayo de 2004 y junio de 2007. De ellos, 117 eran varones y 107, mujeres, con una edad promedio de 26,65 años. A todos los pacientes se les realizó al ingreso el Score de Alvarado. Según la clínica y una segunda valoración con el Score se decidió la exploración quirúrgica en 207 pacientes. Se excluyó a los 17 restantes por otras enfermedades. El diagnóstico de apendicitis aguda fue confirmado por los hallazgos quirúrgicos y la anatomía patológica. Resultados. En los hallazgos operatorios hubo 189 (91,3%) pacientes que tenían apendicitis aguda. No hubo mortalidad postoperatoria. En relación con la morbilidad hubo un 3,86% de complicaciones médicas y un 27% quirúrgicas. El informe anatomopatológico mostró en 18 pacientes un apéndice cecal normal. Por lo tanto, la incidencia de las apendicectomías negativas fue del 8,69%. Conclusiones. La utilización del Score en relación con los hallazgos quirúrgicos y anatomopatológicos confirma que fue sensible a partir de 6 puntos para el diagnóstico de apendicitis aguda (AU)
Introduction. Unsuspected or undiagnosed acute appendicitis could progress to a perforation or could lead to the removal of a normal appendix. Objectives: using a clinical score system as a diagnostic tool for this pathology and can decrease negative appendectomies. Material and method. Prospective and protocolized study. Setting: National Clinicas Hospital. Córdoba. Argentina. Between May 2007 and June 2007 224 patients were studied of which 117 were male and 107 were female with a mean age of 26.65 years. An Alvarado score was performed on all patients on admission. Based on the clinical evidence and a second assessment with the Alvarado Score, surgical exploration was decided in 207 patients. The remaining 17 were excluded due to other pathology. The diagnosis of acute appendicitis was confirmed by surgical finding and histopathological studies. Results. In the surgical findings it was shown that 189 (91%) patients had acute appendicitis. There was no surgical mortality. As regards morbidity, 3.86% had medical and 27% had surgical complications. The histopathology reports showed a normal caecal appendix in 18. Whereas the incidence of negative appendicectomy was about 8.69%. Conclusions. The use of the Alvarado Score together with the surgical and histopathology findings confirmed it was senstive from 6 points for the diagnosis of acute appendicitis (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Escala Crescente/classificação , Dor Abdominal/diagnóstico , Apendicite/diagnóstico , Apendicite/terapia , Apendicectomia/métodos , Protocolos Clínicos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/cirurgia , Sensibilidade e Especificidade , Estudos Prospectivos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Apendicectomia/estatística & dados numéricos , Apendicectomia/tendênciasRESUMO
La diabetes mellitus es una enfermedad crónica muy prevalente, que suele alterar el sistema inmunológico y generar complicaiones tardías de tipo vascular y neurológico. Estas se localizan con mayor predilección en ciertas áreas corporales, como son las extremidades inferiores. Agentes bacterianos suelen infectar con frecuencia las lesiones iniciales, generadas o inducidas por las alteraciones vasculoneurológicas. Todo ello origina el denominado cuadro del "pié diabético". Este se considera como una emergencia médica, por sus repercusiones en la salud, economía y futuro del afectado. El presente trabajo, fruto de nuestra experiencia y de revisión bibliográfica, analiza los tipos de lesión que puede presentar el pie diabético, sus factores predisponentes y agravantes, además de su evolución y tratamiento correspondientes; concluyéndose con recomendaciones para su prevención.
