Laparoscopic Appendectomy in the Setting of Clinical Prediction Rules.

PURPOSE: Acute appendicitis (AA) is the most frequent surgical entity in the emergency department, but its correct diagnosis remains challenging. To improve diagnosis, clinical prediction rules (CPRs) have been created to establish objective scores for the probability of suffering AA. In this study, we establish scores indicating whether laparoscopy would be superior to clinical observation or repeat diagnostic test. METHODS: A retrospective observational study was conducted with 433 patients submitted to surgery for suspected AA using a laparoscopic approach. The Alvarado, Raja Isteri Pengiran Anak Saleha Appendicitis, appendicitis inflammatory response, and adult appendicitis score scales were applied in each case to establish a high, medium, or low probability of suffering AA. RESULTS: Of the 433 patients analyzed, 381 (88.0%) had AA. Twelve (2.8%) were converted to open surgery, and complications were observed in 54 (12.5%) cases. The CPRs studied showed statistically significant differences between AA and negative appendectomies. However, in patients with intermediate probability scores, the diagnostic accuracy of the CPRs evaluated was not adequate. CONCLUSIONS: Laparoscopic surgery can serve as a diagnostic tool for patients with intermediate AA probability scores because of its low associated morbidity and mortality and because it affords a direct diagnosis of the problem, allowing determination of the appropriate treatment.

Relación entre los hallazgos ecográficos, laparoscópicos e histológicos en pacientes con esteatosis hepática no alcohólica / Relationship between echographical, laparoscopic and histological findings in patients with non-alcoholic steatohepatitis

Se realizó un estudio descriptivo y transversal de 34 pacientes con esteatosis hepática no alcohólica, atendidos en el Servicio de Gastroenterología del Policlínico de Especialidades del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde octubre del 2011 hasta igual mes del 2013, con vistas a caracterizarles según algunos factores clinicoepidemiológicos y diagnósticos seleccionados, además de estimar la magnitud de la relación entre los hallazgos ecográficos, laparoscópicos y anatomopatológicos de los afectados. Se evidenció una estrecha relación de esta hepatopatía con el sobrepeso, la dislipidemia y la diabetes mellitus, así como una adecuada relación entre las alteraciones hísticas correspondientes a hígado graso no alcohólico con los hallazgos ecográficos y laparoscópicos.

A descriptive and cross-sectional study of 34 patients with non-alcoholic steato-hepatitis, assisted in the Gastroenterology Service of "Saturnino Lora Torres" from the Specialties Polyclinic of the Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba was carried out from October, 2011 to same month of 2013, with the aim of characterizing them according to some clinical and epidemiological factors and selected diagnoses, besides estimating the magnitude of the relationship among the echographical, laparoscopic and pathological findings of those affected. A close relationship of this hepatopathy was evidenced with the overweight, dyslipidemia and diabetes mellitus, as well as an appropriate relationship among the hystic changes corresponding to non-alcoholic fatty liver with the echographical and laparoscopic changes.