Prevalencia de Complicaciones clínicas y quirúrgicas en el postrasplante renal inmediato y su impacto a corto plazo en la función renal / Prevalence of clinical and surgical complications in immediate post-renal transplantation and their short-term impact on renal function

INTRODUCCIÓN. La enfermedad renal crónica es definida como la pérdida progresiva, permanente e irreversible de la función renal, uno de los tratamientos es el trasplante renal el mismo que aumenta la calidad de vida de los pacientes que presentan esta patología, sin embargo, a pesar de ser uno de las mejores terapias no está exento de complicaciones especialmente las que se presentan posterior al acto quirúrgico ya que afectan al buen funcionamiento del injerto y afecta la supervivencia del mismo. OBJETIVO. Determinar la prevalencia de complicaciones clínicas y quirúrgicas en el postrasplante renal inmediato con el fin de identificar las principales complicaciones que ocasionan mayor deterioro en la función renal a corto plazo. MATERIAL Y MÉTODOS. Estudio Observacional descriptivo transversal, de pacientes trasplantados que se encuentran en seguimiento desde enero del 2015 hasta diciembre del 2018 en el servicio de Trasplante renal del Hospital de Especialidades Carlos Andrade Marín. La muestra será los 211 pacientes trasplantados de donante cadavérico. Los análisis se realizaron con el paquete estadístico IBM SPSS versión 25, para lo cual se empleó estadísticas descriptivas, utilizando tablas y representando los valores absolutos y relativos de las variables cualitativas, así como medidas de tendencia central y de variabilidad para las variables cuantitativas. RESULTADOS. Se estudiaron 193 pacientes trasplantados de los cuales el 49.66% tuvieron complicaciones, de los mismos el 33.16% fueron complicaciones clínicas y 16,5% complicaciones quirúrgicas; de las clínicas la infección de tracto urinario fueron las más prevalentes con 15%, seguida por el rechazo agudo 6,7%, las infecciones por virus poliomavirus BK fueron un porcentaje de 6,2%, la necrosis tubular aguda el 3,16% terminando con el rechazo hiperagudo en el 1,5% y la toxicidad por calcineurínicos 1,04%. Mientras tanto las complicaciones quirúrgicas las urológicas son las más prevalentes 8,8% seguida por las colecciones liquidas con el 6,74% finalmente la trombosis vascular con el 1,04%. CONCLUSIONES. Las complicaciones más prevalentes son las clínicas vs las quirúrgicas, afectando de igual forma la función renal al año sin diferencia estadísticamente significativa.

INTRODUCTION. Chronic kidney disease is defined as the progressive, permanent and irreversible loss of renal function, one of the treatments is renal transplantation, which increases the quality of life of patients with this pathology, however, despite being one of the best therapies, it is not free of complications, especially those that occur after surgery, since they affect the proper functioning of the graft and affect its survival. OBJECTIVE. To determine the prevalence of clinical and surgical complications in immediate post-renal transplantation in order to identify the main complications that cause greater deterioration in short-term renal function. MATERIAL AND METHODS. Cross-sectional descriptive observational study, of transplanted patients under follow-up from January 2015 to December 2018 in the Renal Transplant service of the Hospital de Especialidades Carlos Andrade Marín. The sample will be the 211 cadaveric donor transplanted patients. The analyses were performed with the IBM SPSS version 25 statistical package, for which descriptive statistics were used, using tables and representing the absolute and relative values of qualitative variables, as well as measures of central tendency and variability for quantitative variables. RESULTS. We studied 193 transplanted patients of whom 49.66% had complications, of which 33. Of the clinical complications, urinary tract infection was the most prevalent with 15%, followed by acute rejection 6.7%, polyomavirus BK infections were 6.2%, acute tubular necrosis 3.16%, ending with hyperacute rejection in 1.5% and calcineurin toxicity 1.04%. Meanwhile, urological surgical complications are the most prevalent 8.8% followed by liquid collections with 6.74% and finally vascular thrombosis with 1.04%. CONCLUSIONS. The most prevalent complications are clinical vs. surgical, affecting renal function at one year with no statistically significant difference.

Minimally invasive lymphocele drainage using the Da Vinci® single port platform: step-by- step technique

ABSTRACT Background: Reports in the literature describe lymphocele formation in up to half of patients following pelvic lymph node dissection (PLND) (1) in robotic-assisted radical prostatectomy (RARP), with 1-2% requiring intervention (2). The advantage of surgical approach is permanent excision of the lymphocele capsule and fewer days with pelvic drains compared to percutaneous drainage. This study aims to describe the step-by-step surgical management of symptomatic lymphoceles using a less invasive robotic platform, the Da Vinci® Single Port (SP). Material and Methods: We describe the technique of lymphocelectomy and marsupialization with the Da Vinci® SP for symptomatic lymphocele. For this study, several treatment modalities for symptomatic lymphoceles were available, including percutaneous drainage, sclerosing agents, and surgical marsupialization. All the data for this study were obtained through the procedure via Da Vinci® SP. Results: Operative time for the case was 84 minutes. Blood loss was 25ml. No intra- or post- operative complications were reported. The patient had his drain removed in under 24 hours after surgery. The mean follow-up period was 7.7 months. There were no complications or lymphocele recurrence. Conclusion: Da Vinci® SP lymphocelectomy is safe and feasible with satisfactory outcomes. The SP enables definitive treatment of the lymphocele sac (3), reducing the number of days with abdominal drains and allows further decrease in surgical invasiveness with fewer incisions and better cosmesis.

Tratamiento supermicroquirúrgico del linfocele inguinal con linfedema intercurrente: restauración de la fisiología linfática / Supermicrosurgical approach to inguinal lymphocele with lymphedema: restoring the lymphatic physiology

Resumen Introducción: El linfocele es una patología que puede ocurrir por la disrupción linfática durante una cirugía, siendo frecuente luego de una linfadenectomía inguinal. Existen diversos enfrentamientos para prevenirlo o minimizarlo, sin embargo, los resultados son inconsistentes. Caso clínico: Reportamos el caso de una mujer, con linfocele recurrente en zona inguinal derecha y linfedema distal de la extremidad secundario a una biopsia ganglionar, tratado exitosamente mediante supermicrocirugía para restaurar el drenaje linfático. La extremidad inferior tenía un exceso de volumen de 7,03%. Se realizaron estudios preoperatorios con linfografía por resonancia magnética y linfografía con verde de indocianina para identificar los vasos linfáticos y realizar anastomosis linfático-venosas (ALV). Se identificaron tres vasos linfáticos aferentes y se realizó una capsulectomía total. Se realizaron tres ALV término-terminales supermicroquirúrgicas en zona inguinal y una ALV distal en pierna. Durante seguimiento no hubo recidiva del linfocele, evidenciándose una reducción del exceso de volumen de la extremidad afectada de un 105,26%. El linfocele inguinal y linfedema pueden ser tratados exitosamente mediante supermicrocirugía, restaurando el flujo linfático de manera fisiológica, evitando la recurrencia de linfocele y mejorando los síntomas del linfedema.

Introduction: Lymphocele may occur after the disruption of lymphatic channels during a surgical procedure. After inguinal lymphadenectomy are very common, and many different approaches have been tried to prevent or minimize the formation of lymphoceles with inconsistent results. Clinical Case: We report a case of a female patient who presented with right recurrent inguinal lymphocele and lower limb lymphedema after lymph-node biopsy that was successfully treated with lymphatic supermicrosurgery restoring the lymph flow. Lower extremity had an excess volume of 7,03% compared to the healthy contralateral limb. Preoperative study with magnetic resonance lymphangiography and indocyanine green lymphography were done to identify intraoperatively lymphocele afferent and distal lymphatic vessels to perform lymphovenous anastomosis (LVA). Three different afferent lymphatics were identified and total capsulectomy was performed. Three end-to- end supermicrosurgical LVA in the groin and one distal LVA on the leg were performed. The surgery was uneventful, and there were no postoperative complications. In the follow-up, no lymphocele was noticed and lymphedema had visibly reduced with a reduction of excess volume of 105.26%. Inguinal lymphocele and lymphedema can be successfully treated with supermicrosurgery since it is a physiological approach to restore the lymphatic flow, in order to avoid lymphocele recurrence and to improve lymphedema symptoms.

Tratamento de linfocele mediante ecoescleroterapia com polidocanol: relato de casos e revisão / Polidocanol echosclerotherapy treatment for lymphocele: case report and review

Resumo A formação de linfocele, resultante da transecção dos canais linfáticos durante procedimentos cirúrgicos ou traumas, é relativamente comum, sendo relatada em aproximadamente 30% dos pós-operatórios de ressecção de linfonodos. Ela pode evoluir assintomática ou pode apresentar complicações, como dor, infecção secundária, compressão de vasos sanguíneos, a qual evolui para estase, trombose e edema. Seu tratamento ainda é de difícil consenso. Este artigo propõe descrever três casos em que o tratamento foi realizado a partir de ecoescleroterapia com polidocanol. Sua relevância está na escassez de relatos na literatura.

Abstract Formation of lymphocele secondary to transection of lymphatic channels during surgical procedures or traumas is relatively common and is reported in the postoperative period of approximately 30% of lymph node resection procedures. The condition may be asymptomatic or can present with complications such as pain, secondary infection, and compression of blood vessels, which can cause stasis, thrombosis, and edema. There is no consensus on treatment. This article describes three cases in which treatment was provided using polidocanol echosclerotherapy. Its relevance lies in the scarcity of reports in the literature.

Influência das complicações pós-operatórias no insucesso da reconstrução de mama imediata com implante de silicone / Influence of postoperative complications on the failure of immediate breast reconstruction with silicone implants

Introdução: A reconstrução da mama imediata pós-mastectomia, com implante de silicone é um método simples, porém, pode evoluir com complicações e remoção do implante. O objetivo do estudo foi analisar as complicações pós-operatórias e buscar relação entre estas e a remoção do implante. Método: No período de 4 anos, foram estudados retrospectivamente 323 casos de reconstrução de mama imediata com implante de silicone após mastectomia total realizados no Institut Gustave-Roussy, França. Resultados: A complicação mais frequente foi a linfocele (34,9%), seguida da necrose cutânea com 22,9%, da infecção com 19,3% e do hematoma, com 13,3% dos casos. A remoção do implante foi mais frequente quando ocorreu algum tipo de complicação cirúrgica e maior quando ocorreu mais de um tipo de complicação. A complicação mais frequente nos casos de remoção do implante foi a infecção (75,0%). O expansor foi o implante que mais teve relação com remoção do implante. O uso de implantes de volume acima de 300 ml teve significativamente mais risco de remoção do implante. Conclusões: 1) A presença de complicação pós-operatória foi fator de risco para a remoção do implante. 2) O risco de remoção foi maior na presença de mais de um tipo de complicação 3) A infecção foi o principal tipo de complicação que se relacionou com a remoção 4) O expansor apresentou maior risco de complicações e de remoção do implante. 5) A utilização de implantes de volume maior do que 300 ml apresentou maior risco de remoção.

Introduction: Immediate breast reconstruction with silicone implants following mastectomy is a simple method, but can develop complications culminating in implant removal. The aim of this study was to analyze postoperative complications and evaluate their correlation with implant removal. Method: In a period of 4 years, 323 cases of immediate breast reconstruction with silicone implants following total mastectomy were retrospectively studied in the Institut Gustave-Roussy, France. Results: The most frequent complication was lymphocele (34.9%), followed by cutaneous necrosis (22.9%), infection (19.3%), and hematoma (13.3%). Implant removal was more frequent when a surgical complication occurred, and even more frequent when there was more than one type of complication. The most frequent complication leading to implant removal was infection (75.0%). The expander was the implant that had the highest correlation with implant removal. The use of implants with a volume greater than 300 ml was associated with a significantly higher risk of implant removal. Conclusions: 1) The presence of postoperative complications was a risk factor for implant removal. 2) The risk of removal was higher when more than one complication was present. 3) Infection was the main type of complication associated with implant removal. 4) The expander presented a higher risk of complications and implant removal. 5) The use of implants with a volume greater than 300 ml had a greater risk of need for removal.

Laparoscopic treatment of lymphoceles after renal transplantation

OBJECTIVE: Lymphocele formation following renal transplantation is a frequent complication and may affect as many as 49% of patients. Operative treatment of symptomatic post transplant lymphocele (PTL) consists of wide drainage of the fluid collection into the abdominal cavity by excising its wall, connecting the lymphocele cavity to the intraperitoneal space. Laparoscopic fenestration seems to be the best treatment as it combines satisfying success rates with a minimally invasive approach. The aim of the study was to review a single center experience on the laparoscopic treatment of symptomatic PTL and detail relevant aspects of the surgical technique. MATERIALS AND METHODS: The data of 25 patients who underwent laparoscopic surgical treatment for a symptomatic lymphocele following kidney transplantation were retrospectively reviewed. Demographic data and surgical results were assessed. Detailed surgical technique is provided. RESULTS: Between 1996 and 2008, 991 patients received a kidney transplant at our institution. Twenty-five patients (2.52%) developed a symptomatic lymphocele and laparoscopic drainage was performed. The indications for surgical drainage were graft dysfunction (84%), local symptoms (16%) or both (32%). The mean time until surgical therapy was 14.2 ± 6 weeks. Mean hospital stay was 1.5 ± 0.2 days. Postoperative complications occurred in only 2 patients (8%) (one ureteral injury and one incisional hernia) and required reoperation. After a mean follow-up of 36.2 ± 4 months, only 1 patient had a symptomatic recurrence. CONCLUSIONS: Laparoscopic fenestration is an effective surgical technique to treat symptomatic lymphocele following kidney transplantation with low recurrence rate and long standing results.

Uni- vs. multiloculated pelvic lymphoceles: differences in the treatment of symptomatic pelvic lymphoceles after open radical retropubic prostatectomy

PURPOSE: To evaluate the treatment of symptomatic pelvic lymphoceles (SPL) after performing radical retropubic prostatectomy (RRP) and pelvic lymphadenectomy (PLA) simultaneously. MATERIAL AND METHODS:We analyzed, in a retrospective study, 250 patients who underwent RRP with PLA simultaneously. Only patients with SPL were treated using different non- and invasive procedures such as percutaneous aspiration, percutaneous catheter drainage (PCD) with or without sclerotherapy, laparoscopic lymphocelectomy (LL) and open marsupialization (OM). RESULTS: Fifty-two patients (21 percent) had postoperative subclinical pelvic lymphoceles. Thirty patients (12 percent) developed SPL. Fifteen patients with noninfected uniloculated lymphocele (NUL) healed spontaneously after performing PCD. The remaining seven patients required sclerotherapy with additional doxycycline. After performing PCD, NUL healed better and faster than noninfected multiloculated lymphocele (NML) (success rate: 80 percent vs. 16 percent, respectively). Twenty-seven percent of patients treated initially with PCD, with or without sclerotherapy had persistent lymphocele. All patients were successfully treated with LL. Only one patient had an abscess as a major complication of a persistent SPL after PCD and sclerotherapy and was treated via an open laparotomy. CONCLUSIONS: Symptomatic NUL can be treated using PCD with or without sclerotherapy. If this therapy fails as first-line treatment, laparoscopic lymphocelectomy should be considered within a short period of time in order to achieve successful treatment. NML should be treated using a laparoscopic approach in centers where this type of expertise is available. Infected lymphoceles are drained externally. In these cases, percutaneous or open external drainage with adequate antibiotic coverage is preferable.

Tratamento de linfocele inguinal pós-operatória com injeção de cola de fibrina: relato de caso / Treatment of postoperative inguinal lymphocele with fibrin glue injection: case report

O paciente desenvolveu linforragia na região inguinal direita, depois de ponte aorto-bifemoral com enxerto de dácron®. Não respondeu ao tratamento conservador com cuidados locais e compressão. Foi realizado exame de ultra-sonografia Doppler, que evidenciou grande linfocele (6,4 x 3,36 x 6,1 cm), tratada pelo esvaziamento da loja por aspiração e injeção de cola de fibrina (1,6 mL) em seu interior. O paciente se recuperou sem intercorrências e sem recidiva, após 3 meses de seguimento.

The patient developed lymphatic drainage in the right groin after an aortobifemoral bypass with Dacron® graft. Conservative treatment with local wound care and compression was unsuccessful. Duplex scan showed a 6.4 x 3.36 x 6.1 cm lymphocele, which was treated by aspiration and injection of fibrin glue (1.6 mL). The patient recovered uneventfully and without recurrence after a 3-month follow-up.

Surgical complications after renal transplantation in grafts with multiple arteries

INTRODUCTION: Renal transplantation with multiple arteries appears, in literature, associated to a major index of surgical complications. This study compared the surgical complications and short-term outcome renal transplants with multiple arteries and single artery grafts. MATERIALS AND METHODS: The data of 64 renal transplants with multiple arteries performed between January 1995 and December 1999 were compared to the ones of 292 transplants with single renal artery. The aspects analyzed were number of arteries of the graft, donor type, vascular reconstruction technique, the occurrence of surgical complications, the incidence of delayed graft function, graft function 1 month after transplantation, graft loss and the patients' deaths. RESULTS: The incidence of surgical complications in grafts with multiple arteries and single renal artery was respectively: vascular - 3.1 percent and 3.1 percent; urological - 6.3 percent and 2.7 percent and other surgical complications - 15.6 percent and 10.6 percent, respectively. The incidence of lymphoceles was 3.1 percent in grafts with a single artery and 12.5 percent in grafts with more than 1 artery (p = 0.0015). The incidence of delayed graft function in grafts with multiple arteries and with a single renal artery was respectively 35.1 and 29.1 percent (p = 0.295). Mean serum creatinine at the 30th postoperative day was 2.46 and 1.81 in grafts with multiple and with 1 artery, respectively (p=0.271). CONCLUSIONS: Kidney transplantation using grafts with single and multiple arteries present similar indexes of surgical complications and short-term outcome; lymphoceles were more frequent among grafts with multiple arteries.

Compromiso de las glándulas salivales en la enfermedad HIV/Sida / Salivary glands involvement in HIV/AIDS disease

La enfermedad de las glándulas salivales asociada al HIV es definida como la presencia de aumento del tamaño de la glándula asociado o no a xerostomía. Esta patología es más habitual en niños que en adultos. La enfermedad de las glándulas salivales asociada al HIV incluye lesiones linfoepiteliales y quistes que comprometen el tejido glandulas y/o los ganglios linfáticos, síndrome símil-Sjogren, síndrome de linfocitosis T CD8 difuso y neoplasias. Este artículo incluye una revisión de la epidemiología, la fisiopatología, las manifestaciones clínicas, la metodololgía diagnóstica y los diagnósticos diferenciales de la enfermedad de las glándulas salivales asociada al HIV

Assessment of lymphocele incidence following 450 renal transplantations

OBJECTIVE: To determine the incidence of lymphocele in the follow-up of patients who underwent renal transplantation, as well as potential factors responsible or associated to its development. MATERIALS AND METHODS: All records from patients who were treated for lymphocele in our institution between May 1989 and December 2002 were reviewed, as well as their clinical outcome following treatment. RESULTS: Among 450 patients who underwent renal transplantation in the period, only 3 required treatment, with 2 of them treated due to the collection volume, and the other due to symptoms (pain), representing an incidence of only 0.6 percent. COMMENTS: The occurrence of perirenal fluid collections following renal transplantation is frequent. In cases where treatment is required, this can generate an excessive morbidity for the patient, which motivates the development of preventive methods, such as minimally invasive therapy, for such cases. CONCLUSION: Careful ligation of lymphatic vessels both during graft preparation and during its implantation, added to post-operative drainage can significantly contribute to reducing the incidence of lymphocele following renal transplantation.

Fenestración videolaparoscópica de un linfocele sintomático posterior a un trasplante / Videolaparoscopic fenestration of symptomatic lymphocele after kidney transplation

Este trabajo tiene el objetivo de describir un caso tratado por videolaparoscopia, de un linfocele sintomático posterior a trasplante renal. Se refiere a una mujer de 54 años con insuficiencia renal crónica terminal, secundaria a hipertensión arterial severa, la cual se le realizó en el 2001 un trasplante renal de donante cadáver. Presenta, 3 meses después, molestias en la zona del trasplante, sin síntomas urinarios por la presencia de un catéter ureteral utilizado como férula y en tiempo para ser retirado. Se diagnostica un linfocele sintomático. Posterior al chequeo preoperatorio se efectúa drenaje interno por vía videolaparoscópica sin accidentes ni complicaciones quirúrgicas inmediatas y el retirado del catéter ureteral y el alta a las 24 y 48 h de la operación, respectivamente. Después de 10 meses de evolución no se ha encontrado ninguna complicación. El abordaje videolaparoscópico del linfocele sintomático posterior al trasplante renal constituye la terapéutica de elección(AU)

This paper is aimed at describing a case of symptomatic lymphocele after kidney transplantation, which was treated with videolaparoscopy. It was a 54 years-old woman with terminal chronic renal failure secondary to several blood hypertension, who was transplanted a kidney from a dead donor in 2001. She presented with some discomfort in the transplant area, without urinary symptoms, owing to a urethral catheter used as rod and due to be withdrawn. The diagnosis was symptomatic lymphocele. After pre-operative checking, internal drainage by videolaparoscopy was performed, with no accidents or immediate surgical complications; the urethral catheter was withdrawn at 24 hours and the patient was discharged at 48 hours. Ten months later, no complication was found. The videolaparoscopic treatment of symptomatic lymphocele after kidney transplantation is the therapy of choice(AU)

Complicaciones quirúrgicas en trasplante renal: experiencia Hospital Militar de Santiago / Surgical complications in kidney transplant: experience at the Hospital Militar de Santiago

La incidencia de complicaciones quirúrgicas (CQX) en el trasplante renal (TXR) fluctúa entre 3,7 y 15 porciento, causando ocasionalmente un deterioro de la función renal (FXR) o incluso la pérdida del injerto. El objetivo de este trabajo es presentar nuestra experiencia en las CQX, su impacto en la FXR y su relación con rechazo agudo (RA) y necrosis tubular aguda (NTA). Revisión retrospectiva de 153 trasplantes renales realizados entre mayo de 1983 y mayo de 2002 en el Hospital Militar de Santiago. Se evalúa la FXR durante la complicación y a largo plazo, y se estudia la relación entre RA o NTA (definida como la necesidad de diálisis) y la aparición de CQX. Con una mediana de 48 meses (1-217), identificamos 45 complicaciones en 33 pacientes, que incluyen 11 linfoceles (7,2 porciento), 7 hematomas perirrenales (4,6 porciento), 1 hemoperitoneo (0,6 porciento), 3 obstrucciones ureterales (1,9 porciento), 4 fístulas urinarias (2,6 porciento), 7 complicaciones vasculares (4,6 porciento) (2 trombosis arteriales, 4 estenosis arteriales y 1 trombosis venosa profunda) y 12 complicaciones de herida operatoria (7,8 porcientociones,4 hematomas, 1 dehiscencia y 1 seroma). El índice de CQX fue mayor en donante cadáver (20,1 porciento)que en donante vivo (11,1 porciento) (p=0,11). En los pacientes que sufrieron complicaciones, el promedio de tiempo en diálisis pretrasplante fue mayor que el de los que no se complicaron (25,9 m versus 18,8 m, p=0,09). El promedio de edad de los complicados fue mayor que el de los no complicados (43,2 versus 38,2 años, p= 0,09). No observamos una correlación significativa entre RA y CQX. Por otro lado, pacientes con NTA tuvieron un mayor índice de CQX (32 porciento versus 12 porciento, p= <0,05), específicamente para linfocele. La FXR se vio afectada durante la complicación en 14 de 33 pacientes (42,4 porciento), en 9 se recuperó a cortoplazo y en 5 de ellos, el riñón se perdió por esta causa. En el seguimiento de estos 33 pacientes complicados, 6 han fallecido, pero en ningún caso debido a la CQX. La edad pareciera ser un factor de riesgo de CQX. La complicación quirúrgica produce un deterioro de la función renal, que en la gran mayoría de los casos, se recupera a corto plazo. La necrosis tubular aguda influiría en una mayor incidencia de linfoceles.

Drenaje laparoscópico de linfocele post-trasplante renal / Laparoscopic drainage of lymphocele following renal transplantation

El trasplante renal es el tratamiento ideal para lospacientes con insuficiencia renal crónica, el cual, como todo procedimiento tiene una incidencia de complicaciones entre las que se mencionan el linfocele osea, la acumulación de líquido linfático peri-renal misma que se reporta entre el 2-10 por ciento. Complicación que si no se trata tempranamente puede causar disfunción del injerto. El presente reporte tiene como finalidzad presentar nuestra experiencia inicial en la Unidad de Trasplante Renal del Instituto Guatemalteco de Seguridad Social para el manejo de linfocele mediante una ventana peritoneal por videolaparoscopía. Se presentan 2 casos resueltos adecuadamente por esta vía; actualmente 1 año pos-trasplante con función renal adecuada

Linfocele retroperitoneal: complicación de cirugía aórtica abdominal / Retroperitoneal lymphocele: a complication of abdominal aortic surgery

El linfocele retroperitoneal luego de cirugia aórtica abdominal es poco frecuente y grave. La extravasación de la linfa determina una desnutrición severa y aumento de la mortalidad operatoria. Estos linfoceles se observan más frecuentemente luego de cirugia aórtica de urgencia o emergencia. El tratamiento médico se basa en una alimentacion parenteral total; siendo la fenestración peritoneal quirúrgica una alternativa terapéutica sencilla y eficaz

Lymphocele: a possible relationship with acute cellular rejection in kidney transplantation

CONTEXT: The incidence of lymphocele after renal transplantation varies between 0.6 and 18 percent of cases, and many factors have been associated to its etiology. Cellular rejection of the kidney allograft has been described as a possible causal factor of lymphocele. OBJECTIVE: To analyze the possible relationship between lymphocele and acute cellular rejection. DESIGN: A retrospective study. SETTING: A referral hospital center. SAMPLE: 170 patients submitted to kidney transplantation from March 1992 to January 1997. A standard technique for renal transplantation was used. RESULTS: Of the 19 patients that developed lymphocele, 16 presented at least one episode of acute cell rejection (84 percent), and were treated with methylprednisolone. The relation between lymphocele and rejection was statistically significant (p = 0.04). Treatment of lymphocele consisted of peritoneal marsupialization in 3 patients (15.3 percent), percutaneous drainage in 7 (36.8 percent), laparascopic marsupialization in 2 (10.5 percent), and conservative treatment in 7 patients (36.8percent. Evolution was favorable in 15 patients (78.9 percent), 1 patient (5.3 percent) died due to a cause unrelated to lymphocele, and 3 (15.8 percent) lost the graft due to immunological factors. The average follow-up period was 24.5 months. CONCLUSION: The high incidence of acute cell rejection in patients with lymphocele suggests a possible causal relationship between both conditions

Tratamiento videolaparoscopico del linfocele postransplante renal / Videolaparoscopic treatment of postransplant lymphocele

El desarrollo de linfocele postrasplante renal es una complicación que ocurre con relativa frecuencia y se considera la marsupialización peritoneal dentro de las alternativas más efectivas. Se realiza el análisis del tratamiento videolaparoscópico del linfocele postrasplante en 5 pacientes. El tiempo operatorio promedio fue de 40 minutos, con una estadía hospitalaria promedio de 2 días. No se registraron complicaciones inherentes al procedimiento. Se concluye que el mismo es seguro y efectivo y se lo considera el tratamiento de elección de esta patología

Linfadenectomía axilar en cáncer de mama: técnica y resultados / Axillary lymph node dissection for breast cancer: surgical technique and results

Objetivo: Se presenta la experiencia con la técnica de la linfadenectomía axilar para el tratamiento del cáncer de mama. Lugar de aplicación: Servicio de Patología Mamaria del Hospital Británico de Buenos Aires. Población: Se seleccionaron las historias clínicas de 1086 pacientes tratadas en forma consecutiva por céncer de mama en estadios operables, durante los últimos diez años. Métodos: Se describe la técnica quirúrgica empleada para la linfadenectomía axilar completa. Resultados: El promedio de ganglios extirpados fue de 17,7 y no hubo diferencias estadísticamente significativas en la cantidad de ganglios obtenidos según las diferentes operaciones efectuadas (mastectomías radicales, radicales modificadas o cirugía conservadora). Las complicaciones observadas fueron: Linfocele axilar; 52 por ciento; linfedema braquial leve ; 6,3 por ciento; flebitis cordonal del miembro superior; 4 por ciento; escápula alada; 0,6 por ciento. No se observaron recidivas axilares. Conclusiones: Preconizamos la linfadenectomía de los 3 niveles de axila en las pacientes con carcinomas invasores de mama, dado que esto permite una correcta estadificación, no requiere irradiación posterior de la axila, disminuyendo el edema braquial, evita la recidiva axilar y, no aumenta el tiempo ni la morbilidad operatoria

Complicaçöes cirúrgicas de 366 transplantes renais / Surgical complications of 366 renal transplantation

Com a finalidade de analisar as complicaçöes cirúrgicas verificadas após a realizaçäo de 366 transplantes renais, foram revisados e estudados os prontuários dos pacientes submetidos a este tipo de intervençäo no Hospital de Clínicas da UFPr e na Santa Casa de Curitiba, pela mesma equipe cirúrgica, no período compreendido entre novembro de 1973 e janeiro de 1997. As complicaçöes cirúrgicas encontradas consistiram em 13 (3,5 por cento) casos de fístula urinária, 4 (1,1 por cento) casos de obstruçäo ureteral, 3 (0,8 por cento) casos de refluxo vesicoureteral, 5 (1,4 por cento) casos de estenose da artéria renal, 1 (0,2 por cento) caso de trombose de artéria renal, 5 (1,4 por cento) casos de linfocele, 7 (1,9 por cento) casos de hematoma e 7 (1,9 por cento) casos de deiscëncia/infecçäo de parede. Säo comentados os dados clínicos, laboratoriais e de imagem considerados para o diagnóstico das complicaçöes, bem como as formas de tratamento e os resultados alcançados, concluindo-se que a correçäo das fístulas deve ser adaptada para as particularidades de cada caso, podendo optar-se pelo reimplante vesicoureteral ou quando possível, pela utilizaçäo da via excretora primitiva do receptor, na forma de pielopielostomia ou pieloureterostomia. Linfoceles e hematomas necessitam ampla drenagem cirúrgica e as estenoses de artéria renal säo melhor conduzidas por angioplastia(AB)