Cirugia y cirujanos最新文献

A rare condition, sclerosing encapsulating peritonitis, is characterized by a fibrotic membrane forming over the bowels, leading to intestinal obstruction. In this case of a 56-year-old male patient with a history of laparoscopic gastric bypass, a computed tomography scan showed findings indicative of the condition. Extensive adhesiolysis was performed, and biopsies confirmed the presence of fusiform cells (D2-40 positive on immunochemistry) resembling fibroblasts, within dense collagenous peritoneal tissue sheets, typical of sclerosing encapsulating peritonitis. The prevalence of this condition is uncertain, and diagnosis typically requires a peritoneal biopsy due to the nonspecific clinical presentation.

Objective: Compare the weight loss results between long-term procedures up to 5 years, after undergoing MGL and RYGB in Mexican patients with obesity and associated comorbidity. The most common bariatric surgical procedures worldwide are, laparoscopic gastric sleeve (MGL) and laparoscopic Roux-en-Y gastric bypass (RYGB), as a treatment for weight loss and remission of comorbidity associated with obesity; however, they are the long-term weight loss results in the Mexican population are unknown.

Method: Retrospective, observational cohort of patients with obesity undergoing MGL or RYGB in a private hospital Medica Sur, in Mexico City, in the period from 2013 to 2021. Instrumental variables analysis and standardized mean differences were used to calculate outcomes up to 5 years at 5 follow-up visits (S1-S5), at 7 days, 2 months, 6 months, 10 months and 2-5 years after surgery, to compare results of the groups.

Results: 104 patients were included in two groups: 31 (30.09%) with MG and 73 (70.87%) with RYGB. The last follow-up (S5), the MG group recorded a mean EW 9.61 kg, EW% 12.72% and EWL% 73.50%, and the RYGB group EW 10.1 kg, EW% 14.72% and EWL% 70.41%.

Conclusions: No significant difference was found between groups for long-term EW loss (p = 0.082); however, there is a greater decrease in weight loss in RYGB at 6-12 months compared to MGL.

Objective: This study investigated the relationship of the pre-operative neutrophil/lymphocyte ratio (NLR) to the timing of epidural analgesia administration and post-operative acute and chronic pain in thoracotomy.

Materials and methods: The study was conducted on 60 patients, with NLR ≥ 2 (Group A) and NLR < 2 (Group B). Each group was divided into subgroups pre-emptive analgesia (Group P) and control group (Group C). Epidural analgesic solution was administered as a bolus before the surgical incision in Group P and at the end of the operation in Group C. NRS was questioned postoperatively at the 2^nd, 4^th, 8^th, 12^th, 24^th h, 1^st, and 3^rd months and also additional analgesic needs were recorded.

Results: In Group A, the pain scores of the patients who received pre-emptive epidural analgesia were lower at the post-operative 2^nd, 4^th, and 8^th h and analgesic consumption was less in the post-operative first 24 h.

Conclusion: It was observed that pre-emptive epidural analgesia reduced pain levels and additional analgesic consumption in the acute post-operative period in patients with pre-operative NLR ≥ 2.

Objective: The optimum number of screws in a volar locking plate (VLP) for distal radial fractures (DRF) fixation has not been established. We conducted a retrospective observational study aimed to evaluate the relationship between the number of used screws and the post-operative results provided by the patient-rated wrist evaluation (PRWE) questionnaire.

Method: A total number of 62 surgically treated participants for DRF were included in the study between July 2019 and September 2022. Information was gathered regarding the number and arrangement of screws by examining X-ray images and using health records. We were looking at five variables: the total number of screws, the number of proximal fragment screws, the number of distal fragment screws, the number of locking screws, and finally number of cortical screws.

Results: Our data suggests that the number of screws in VLP for DRF fixation is a weak predictor of post-operative results and is therefore unlikely to influence the PRWE score.

Conclusions: The ability to predict outcome by knowing the number of screws turned out to be an unreliable prognostic sign.

Mucormycosis is a rare deep fungal infection that develops mainly in immunosuppressed patients, being unusual the gastrointestinal presentation. The adequate treatment consists in rapid and aggressive surgical debridement, along with initial adjuvant treatment with liposomal amphotericin B. Despite recent advances in the management of this disease, the prognosis is poor, with a high mortality rate. We will present a case of a 37-year-old male patient, who underwent a combined pancreas and kidney transplant, with gastric perforation secondary to deep mucormycosis.

Objective: The aim of this study was to analyze the reliability of agreement between surgeons when using the Parkland Grading Scale for Acute Cholecystitis (PGS-AC).

Methods: A total of 43 images taken out of videos of laparoscopic cholecystectomies (LCs) were collected, they were used to frame an online questionnaire that was sent to 18 surgeons and resident doctors who classified the images according to the Parkland scale criteria, followed by the evaluation of concordance between observers applying the Fleiss κ test.

Results: A global Fleiss' κ value of 0.213 was obtained, which corresponds to a low interobserver concordance. Factors such as being a surgical resident, having more than 10 years of experience performing this type of procedure, or performing more than 2 LCs per week, were related to greater concordance in diagnosis.

Conclusions: The low concordance found when using the Parkland grading scale, translates into a high interobserver variation related to multiple variables, which is why, we are not seeing the same.

Objective: The purpose of this study was to examine the surgical treatment of two-part and three-part proximal humerus fractures utilizing two approaches.

Method: Study involved a total of 40 individuals. Twenty patients were treated with plates and screws and 20 with intramedullary locking nail osteosynthesis. We created 10 pairs of patients that were matched in age, gender, and fracture type, with the sole difference being the osteosynthetic material used. The mean follow-up was 4 years (1-9 years). We evaluated the results of treatment using Constant's scoring scale.

Results: The mean value of Constant's scoring scale was 78.05 for patients treated with plates and screws and 67.55 for those treated with intramedullary stabilization. There was no statistically significant difference between the groups nor were there statistically significant differences in post-operative range of motion (ROM).

Conclusions: The results of Constant's scoring scale were higher for patients whose fractures were stabilized with a plate and screws. The same group of patients had a higher degree of mobility and better ROM. Even while there was a general tendency toward better outcomes when using plates and screws for fixation, there was no indication as to which surgical technique offers the best results.

Objective: To investigate the value of endoscopic duodenal papillary sphincterotomy combined with balloon dilatation in the treatment of duodenal papilloplasty with titanium clip after choledocholithiasis in post-operative complications.

Materials and methods: One hundred and twenty-five patients (69 males and 56 females) with a median age of 65 (32-81) years were included. The treatment plan was randomly divided into Group A (n = 59) and Group B (n = 66) according to the random number table. Patients in Group A were treated with endoscopic sphincterotomy (EST) combined with endoscopic papillary large balloon dilation (EPLBD), followed by a titanium clip for duodenal papilloplasty and then indwelling nasobiliary drainage, whereas those in Group B were treated with EST combined EPLBD to remove stones and then indwelling nasobiliary drainage.

Results: In patients with choledocholithiasis or with anatomical changes that make stone extraction difficult, this prospective study attempted to perform duodenal papilloplasty with titanium clips after EST and EPLBD lithotripsy to compare and observe post-operative papillary healing, biliary reflux, and complication rates.

Conclusions: The use of endoscopic duodenal papilloplasty with a titanium clip can improve biliary reflux after lithotripsy and reduce the incidence of post-operative cholangitis complications.

Objective: To know, analyze and compare kidney transplant programs; considering the survival of recipients at 1 and 5 years, from hospitals in Mexico.

Method: A systematic review was carried out whose search focused on the survival of kidney transplant recipients. All publications found in PubMed and Google from 1963 to 2021 were included. The expectation-maximization algorithm was applied, proposing a mixture of normals, and hierarchical grouping to establish if there is any type of pattern and determine if there is a difference between the percentages. of survival at 1 and 5 years between the groups formed.

Results: Eight hospitals that published the survival of kidney transplant recipients were found. Survival rates ranged, at 1 year, from 94.7% to 100%, and at 5 years, from 85% to 96.2%. The methods used for their comparison indicated that there is a difference between survival at 1 and 5 years.

Conclusions: In Mexico there is little information on the results of kidney transplant programs, and the information found shows great heterogeneity in said programs. Some strategies and actions are proposed to improve survival underreporting.