{"title":"Manejo del espacio residual pleural post resección pulmonar: bloqueo del nervio frénico, neumoperitoneo y pleurodesis química2 casos clínicos","authors":"","doi":"10.31837/cir.urug/4.2.4","DOIUrl":"https://doi.org/10.31837/cir.urug/4.2.4","url":null,"abstract":"","PeriodicalId":34734,"journal":{"name":"Cirugia del Uruguay","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42586653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"¿ Estamos operando pacientes asintomáticos pero infectados por Covid19?:análisis retrospectivo de pacientes operados en el Hospital Maciel","authors":"","doi":"10.31837/cir.urug/4.2.7","DOIUrl":"https://doi.org/10.31837/cir.urug/4.2.7","url":null,"abstract":"","PeriodicalId":34734,"journal":{"name":"Cirugia del Uruguay","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48545572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mario Almada, Fernando Bonilla, José Martínez, Andrés Pouy, R. Misa
Splenic abscess is a rare clinical entity that is most often associated with infective endocarditis. Heart valve replacement in the setting of an untreated splenic abscess is associated with a high incidence of prosthetic valve infection and death. A patient with infectious endocarditis and splenic abscess treated by laparoscopic splenectomy followed by valve replacement is described.
{"title":"Esplenectomía laparoscópica por absceso esplénico secundario a endocarditis infecciosa","authors":"Mario Almada, Fernando Bonilla, José Martínez, Andrés Pouy, R. Misa","doi":"10.31837/cir.urug/4.2.3","DOIUrl":"https://doi.org/10.31837/cir.urug/4.2.3","url":null,"abstract":"Splenic abscess is a rare clinical entity that is most often associated with infective endocarditis. Heart valve replacement in the setting of an untreated splenic abscess is associated with a high incidence of prosthetic valve infection and death. A patient with infectious endocarditis and splenic abscess treated by laparoscopic splenectomy followed by valve replacement is described.","PeriodicalId":34734,"journal":{"name":"Cirugia del Uruguay","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42406286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-07DOI: 10.31837/cir.urug/4.2.10
Javier Chinelli, Gustavo Rodríguez Temesio
Introduction: Laparoscopy is currently the approach of choice for oncological resections of the colon and rectum, since it does not compromise their quality and offers the advantages of minimally invasive surgery. Description of contents: The main tactical aspects of the anterior resection of the rectum are described: patient positioning and surgical equipment, positioning of the trocars and technical steps. Medial dissection of the mesocolon identifying retroperitoneal structures, vascular control of the superior rectal artery and inferior mesenteric vein, lateral mobilization of the colon, meso-rectal dissection, distal rectal section, exteriorization and section of the piece, intracorporeal anastomosis, and drains. In all the steps emphasis is placed on the prophylaxis of accidents and / or intraoperative adverse events.
{"title":"Aspectos tácticos de la resección de recto laparoscópica","authors":"Javier Chinelli, Gustavo Rodríguez Temesio","doi":"10.31837/cir.urug/4.2.10","DOIUrl":"https://doi.org/10.31837/cir.urug/4.2.10","url":null,"abstract":"Introduction: Laparoscopy is currently the approach of choice for oncological resections of the colon and rectum, since it does not compromise their quality and offers the advantages of minimally invasive surgery. \u0000Description of contents: The main tactical aspects of the anterior resection of the rectum are described: patient positioning and surgical equipment, positioning of the trocars and technical steps. Medial dissection of the mesocolon identifying retroperitoneal structures, vascular control of the superior rectal artery and inferior mesenteric vein, lateral mobilization of the colon, meso-rectal dissection, distal rectal section, exteriorization and section of the piece, intracorporeal anastomosis, and drains. In all the steps emphasis is placed on the prophylaxis of accidents and / or intraoperative adverse events.","PeriodicalId":34734,"journal":{"name":"Cirugia del Uruguay","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41783600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. R. Martínez, Gustavo Rodríguez Temesio, Mauro Perdomo, Eduardo Olivera Pertusso, G. Bruno, D. González, María Ángeles Rodríguez, Eduardo Camejo, José Crestanello, R. Charlone, Ricardo Fernández Casas, L. Mouro, M. Piñeyrúa, A. Tarigo, Felipe Viacava
Introduction. In Uruguay, the start of the pandemic was decreed by Covid. 19 on March 13, 2020, In this context, the Maciel Hospital (HM) established guidelines and recommendations to face the disease that radically modified its usual benefits. The objective of this communication is to present the surgical experience developed in the care context of a sustained phase 2 of Covid infection.19 Material and methods The surgical activity of the HM is retrospectively analyzed from its record of Operative Descriptions, during the period between 13.3.2020 and 30.4.2020 (49 days) and performs a critical analysis from the governing documents of our surgical conduct. Results: 403 cases, 149 coordination and 254 emergency were operated. 287 patients with multiple etiologies, although predominantly oncological (27%) and infectious / inflammatory processes (19%), were operated by the general and specialty surgery services. Laparoscopy involved 62 cases, 43 of which were urgent, mostly due to infectious / inflammatory pathologies: appendicitis (35%), cholecystectomies (24%), and diagnostic laparoscopies (11%). 55% of the cases underwent surgery for cancer and the rest cholecystectomies and others. Conclusions: The HM operated three times more than the rest of the public system; Even so, with respect to its usual production, the number of surgeries decreased significantly (35%), especially coordination (59%). Covid.19 positive patients were not operated. A high number of justified operations were carried out in terms of quantity and type of pathology, using the protocol for maximum protection against Covid.19 rationally, within the established sanitary guidelines and without infectious impact by the coronavirus
{"title":"COVID 19 en fase 2 sostenida. Experiencia quirúrgica inicial en el Hospital Maciel","authors":"L. R. Martínez, Gustavo Rodríguez Temesio, Mauro Perdomo, Eduardo Olivera Pertusso, G. Bruno, D. González, María Ángeles Rodríguez, Eduardo Camejo, José Crestanello, R. Charlone, Ricardo Fernández Casas, L. Mouro, M. Piñeyrúa, A. Tarigo, Felipe Viacava","doi":"10.31837/CIR.URUG.4.2.6","DOIUrl":"https://doi.org/10.31837/CIR.URUG.4.2.6","url":null,"abstract":"Introduction. In Uruguay, the start of the pandemic was decreed by Covid. 19 on March 13, 2020, In this context, the Maciel Hospital (HM) established guidelines and recommendations to face the disease that radically modified its usual benefits. The objective of this communication is to present the surgical experience developed in the care context of a sustained phase 2 of Covid infection.19 Material and methods The surgical activity of the HM is retrospectively analyzed from its record of Operative Descriptions, during the period between 13.3.2020 and 30.4.2020 (49 days) and performs a critical analysis from the governing documents of our surgical conduct. Results: 403 cases, 149 coordination and 254 emergency were operated. 287 patients with multiple etiologies, although predominantly oncological (27%) and infectious / inflammatory processes (19%), were operated by the general and specialty surgery services. Laparoscopy involved 62 cases, 43 of which were urgent, mostly due to infectious / inflammatory pathologies: appendicitis (35%), cholecystectomies (24%), and diagnostic laparoscopies (11%). 55% of the cases underwent surgery for cancer and the rest cholecystectomies and others. Conclusions: The HM operated three times more than the rest of the public system; Even so, with respect to its usual production, the number of surgeries decreased significantly (35%), especially coordination (59%). Covid.19 positive patients were not operated. A high number of justified operations were carried out in terms of quantity and type of pathology, using the protocol for maximum protection against Covid.19 rationally, within the established sanitary guidelines and without infectious impact by the coronavirus","PeriodicalId":34734,"journal":{"name":"Cirugia del Uruguay","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43460209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
68-year-old patient, with no surgical history.He was admitted to the Emergency Department with a clinical picture of intestinal occlusion. A simple abdominal radiograph was requested (only obtained in decubitus), observing the presence of Rigler's radiological triad, pathognomonic of the biliary ileum. The 3 elements are indicated: dilated thin handles (black arrow), aerobilia (white arrow) and the ectopic calcified stone in the right iliac fossa (yellow arrow). Gallstone ileus is intestinal occlusion as a consequence of the migration of a gallstone through a bilio-digestive fistula and its impaction, frequently at the level of the ileo-cecal valve. Usually it is a cholecysto-duodenal fistula, although it can also be a cholecysto-colonic fistula. The classically described clinical picture is that of intermittent occlusion, being more frequent in elderly patients, with a long history of symptomatic biliary lithiasis.
{"title":"Tríada de Rigler","authors":"Javier Chinelli, Gustavo Rodríguez Temesio","doi":"10.31837/cir.urug/4.2.9","DOIUrl":"https://doi.org/10.31837/cir.urug/4.2.9","url":null,"abstract":"68-year-old patient, with no surgical history.He was admitted to the Emergency Department with a clinical picture of intestinal occlusion. A simple abdominal radiograph was requested (only obtained in decubitus), observing the presence of Rigler's radiological triad, pathognomonic of the biliary ileum. \u0000The 3 elements are indicated: dilated thin handles (black arrow), aerobilia (white arrow) and the ectopic calcified stone in the right iliac fossa (yellow arrow). \u0000Gallstone ileus is intestinal occlusion as a consequence of the migration of a gallstone through a bilio-digestive fistula and its impaction, frequently at the level of the ileo-cecal valve. Usually it is a cholecysto-duodenal fistula, although it can also be a cholecysto-colonic fistula. \u0000The classically described clinical picture is that of intermittent occlusion, being more frequent in elderly patients, with a long history of symptomatic biliary lithiasis.","PeriodicalId":34734,"journal":{"name":"Cirugia del Uruguay","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43006607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Few cases of nontraumatic rupture of the spleen in diffuse B-cell lymphoma have been reported. We present a case of a 73-year-old man, multiple comorbidities that hours before biopsy puncture of the liver nodule installed abdominal pain and hypovolemic shock. An emergency operation was performed. A pathological spleen was found with a ruptured nodule, bleeding and moderate hemoperitoneum. Splenectomy was performed. At 96 hours, he installed abdominal pain and shock. The liver node and hemoperitoneum rupture and bleeding, hemodynamic instability and intraoperative death were reoperated and confirmed. The pathological anatomic study diagnosed diffuse large B-cell lymphoma.
{"title":"Rotura no traumática de bazo como presentación de un linfoma difuso de células grandes B.","authors":"Daniel González González","doi":"10.31837/cir.urug/4.2.5","DOIUrl":"https://doi.org/10.31837/cir.urug/4.2.5","url":null,"abstract":"Few cases of nontraumatic rupture of the spleen in diffuse B-cell lymphoma have been reported. \u0000 \u0000We present a case of a 73-year-old man, multiple comorbidities that hours before biopsy puncture of the liver nodule installed abdominal pain and hypovolemic shock. \u0000An emergency operation was performed. A pathological spleen was found with a ruptured nodule, bleeding and moderate hemoperitoneum. \u0000Splenectomy was performed. At 96 hours, he installed abdominal pain and shock. The liver node and hemoperitoneum rupture and bleeding, hemodynamic instability and intraoperative death were reoperated and confirmed. \u0000The pathological anatomic study diagnosed diffuse large B-cell lymphoma.","PeriodicalId":34734,"journal":{"name":"Cirugia del Uruguay","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48640650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Raúl Perdomo, Mauricio Pontillo, Gabriel Massaferro, Gustavo Rodríguez Temesio
Nodular Hyperplasia is an infrequent benign liver tumor, which generally affects young women. It is asymptomatic, so its presentation is usually an imaging finding. Its management is expectant in most cases. The objective of this article is to present a clinical case whose presentation and resolution were atypical.
{"title":"Hiperplasia nodular focal hepática","authors":"Raúl Perdomo, Mauricio Pontillo, Gabriel Massaferro, Gustavo Rodríguez Temesio","doi":"10.31837/cir.urug/4.2.1","DOIUrl":"https://doi.org/10.31837/cir.urug/4.2.1","url":null,"abstract":"Nodular Hyperplasia is an infrequent benign liver tumor, which generally affects young women. It is asymptomatic, so its presentation is usually an imaging finding. Its management is expectant in most cases. \u0000 The objective of this article is to present a clinical case whose presentation and resolution were atypical.","PeriodicalId":34734,"journal":{"name":"Cirugia del Uruguay","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47999615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicolás Giroff, M. Bentancur, Pablo Valsangiácomo, Daniel González
Introduction Ventral hernia management in patients undergoing surgery bari atrica is controversial, not there is consensus in the literature current about the optimal time of hernia repair in relationship to the procedure baric, as well as the choice of the repair method hernial. Every bariatric patient with a defect of the abdominal wall should be addressed individually, taking into account account for factors such as the presence of symptoms, size of the parietal defect and hernia reductibility. Description of contents In the video it exposes the realization of a laparoscopic gastric sleeve in a patient morbidly obese with a recurrence of an umbilical hernioplasty. In the same act it takes Perform parietal repair laparoscopically, highlighting the closure of the defect with extracorporeal stitches, ending with the intra-abdominal placement of a Composite mesh (polyester / collagen) with an overflap of 5cm.
{"title":"Manga gástrica y reparación parietal laparoscópica","authors":"Nicolás Giroff, M. Bentancur, Pablo Valsangiácomo, Daniel González","doi":"10.31837/cir.urug/4.2.2","DOIUrl":"https://doi.org/10.31837/cir.urug/4.2.2","url":null,"abstract":"Introduction \u0000Ventral hernia management in patients undergoing surgery bari atrica is controversial, not there is consensus in the literature current about the optimal time of hernia repair in relationship to the procedure baric, as well as the choice of the repair method hernial. Every bariatric patient with a defect of the abdominal wall should be addressed individually, taking into account account for factors such as the presence of symptoms, size of the parietal defect and hernia reductibility. \u0000Description of contents \u0000In the video it exposes the realization of a laparoscopic gastric sleeve in a patient morbidly obese with a recurrence of an umbilical hernioplasty. In the same act it takes Perform parietal repair laparoscopically, highlighting the closure of the defect with extracorporeal stitches, ending with the intra-abdominal placement of a Composite mesh (polyester / collagen) with an overflap of 5cm.","PeriodicalId":34734,"journal":{"name":"Cirugia del Uruguay","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47174508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Moreira, G. Espinosa, Javier Chinelli, Cecilia Laguzzi, F. Sarriés, M. Martínez, Valentina Ximénez, V. Irigoyen, Soledad Brandolino, V. Ramírez
Introduction: Since March 2020, COVID-19 infection was declared a pandemic with consequent impact on the health system. A particular case is the surgery service with the risk linked to transmission by microdrops or pneumoperitoneum. To reduce the risk of contagion, non-oncological coordination surgeries have been suspended. The objective of this study was to assess the proportion of asymptomatic patients at the time of surgery and who developed the disease after surgery. Materials and methods: This is an observational, descriptive and retrospective study. A search was made in the operative descriptions system of the Maciel Hospital, identifying the surgical procedures of all the specialties performed from March 16 to April 16, 2020. Demographic variables, variables related to surgery, complications and respiratory symptoms were recorded. Results: 128 patients were included, on which 165 procedures were performed. 42.2% of the coordination procedures, 52.1% of urgency and 5.5% of emergency were performed. It is highlighted that 73.4% of the patients did not present complications and a mortality of only 7.8% was found. 9 (7.0%) swabs were performed in the period, none of them was positive. Conclusions: COVID-19 infection is linked to an increase in postoperative mortality compared to pre-epidemic mortality, which requires strict triage to minimize risk. We highlight in our center the absence of surgery in asymptomatic patients with the infection.
{"title":"¿ Estamos operando pacientes asintomáticos pero infectados por Covid19?: análisis retrospectivo de pacientes operados en el Hospital Maciel","authors":"E. Moreira, G. Espinosa, Javier Chinelli, Cecilia Laguzzi, F. Sarriés, M. Martínez, Valentina Ximénez, V. Irigoyen, Soledad Brandolino, V. Ramírez","doi":"10.31837/CIR.URUG.4.2.7","DOIUrl":"https://doi.org/10.31837/CIR.URUG.4.2.7","url":null,"abstract":"Introduction: Since March 2020, COVID-19 infection was declared a pandemic with consequent impact on the health system. A particular case is the surgery service with the risk linked to transmission by microdrops or pneumoperitoneum. To reduce the risk of contagion, non-oncological coordination surgeries have been suspended. The objective of this study was to assess the proportion of asymptomatic patients at the time of surgery and who developed the disease after surgery. \u0000Materials and methods: This is an observational, descriptive and retrospective study. A search was made in the operative descriptions system of the Maciel Hospital, identifying the surgical procedures of all the specialties performed from March 16 to April 16, 2020. Demographic variables, variables related to surgery, complications and respiratory symptoms were recorded. \u0000Results: 128 patients were included, on which 165 procedures were performed. 42.2% of the coordination procedures, 52.1% of urgency and 5.5% of emergency were performed. It is highlighted that 73.4% of the patients did not present complications and a mortality of only 7.8% was found. 9 (7.0%) swabs were performed in the period, none of them was positive. \u0000Conclusions: COVID-19 infection is linked to an increase in postoperative mortality compared to pre-epidemic mortality, which requires strict triage to minimize risk. We highlight in our center the absence of surgery in asymptomatic patients with the infection.","PeriodicalId":34734,"journal":{"name":"Cirugia del Uruguay","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47539981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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