RESUMEN
BACKGROUND: Gallbladder perforation, with loss of calculi in the abdomen is frequent during laparoscopic cholecystectomy. Recent publications report complications in port sites or in the abdominal cavity. A study of 3686 laparsocopic cholecystectomies performed by 6 surgeons was undertaken. In 627 patients, perforation of the gallbladder occurred and in 254 stones were spilled into the abdominal cavity. In 214 they were retrieved and in 40 left in the abdomen. Twelve patients developed complications. Percutaneous drainage was successful in 2 with serous collections. Two patients with abdominal abscesses were reoperated, stones retrieved and the abdomen drained. One patient developed an intestinal obstruction due to a stone in the ileum. One patient who had a cholecystectomy in another hospital developed a paraumbilical tumor. At reoperation a stone was retrieved. In another six patients, stones were found in port sites. Stones lost into the abdomen should be removed because of their potential morbidity, especially if they are large or if infection is present in the gallbladder at the time of initial surgery. There is no indication for routine conversion to open surgery when stone spillage occurs, although patients should be informed to avoid legal consequence, and to hasten early diagnosis of later complications.
Asunto(s)
Colecistectomía Laparoscópica , Colelitiasis , Complicaciones Intraoperatorias/epidemiología , Complicaciones Posoperatorias/epidemiología , Colelitiasis/cirugía , Humanos , Morbilidad , Estudios RetrospectivosAsunto(s)
Polipéptido Inhibidor Gástrico/sangre , Glucagón/sangre , Insulina/sangre , Islotes Pancreáticos/metabolismo , Trasplante de Páncreas/fisiología , Animales , Duodeno/trasplante , Prueba de Tolerancia a la Glucosa , Rechazo de Injerto , Islotes Pancreáticos/patología , Trasplante de Islotes Pancreáticos , Necrosis , Trasplante de Páncreas/patología , PorcinosRESUMEN
The effect of electrical stimulation of splanchnic and vagal nerve supply to the in vivo isolated porcine LES on the lower esophageal sphincter pressure (LESP) and the secretion of VIP and SP into the venous effluent into the venous effluent of the LES was investigated. Functional integrity of the autonomic nerve supply was assessed by the effect of nerve stimulation on heart rate. Vagal nerve stimulation increased LESP (8-Fold) as well as VIP output (3 Fold) significantly (p less than 0.01) whereas the secretion of SP was unaffected of vagal nerve stimulation. Splanchnic nerve stimulation increased heart rate significantly but was without effect on LESP, VIP, and SP outputs. Atropine partially abolished the effect of vagal nerve stimulation on LESP but the VIP secretion was completely resistant to atropine blockade. Administration of guanethidine was without effect on LESP, VIP, and SP outputs during vagal as well as splanchnic nerve stimulation. It is concluded that VIP acts as a neuro-transmitter since vagal stimulation increase the release of VIP from LESP. However, the finding of a partial atropine resistance of the LESP despite an unchanged release of VIP and SP, suggests that other transmitters participate in vagal activation of LESP.
Asunto(s)
Sistema Nervioso Autónomo/fisiología , Unión Esofagogástrica/fisiología , Sustancia P/metabolismo , Péptido Intestinal Vasoactivo/metabolismo , Animales , Estimulación Eléctrica , Presión , PorcinosRESUMEN
Se presentan 12 hepatectomias derechas, 8 lobares y 4 segmentarias, realizadas desde junio de 1978 hasta diciembre de 1982. De 78 traumatismos hepaticos operados, en el 65,4% la hemostasia habia ocurrido espontaneamente y en el 12% (9 casos) hubo que recurrir a la reseccion. Se practicaron 3 hepatectomias electivas por tumores benignos. La complicaciones mas frecuentes fueron infecciosas. Hubo 3 muertes (25% de mortalidad global) causadas por hemorragia Las 3 corresponden a hepatectomias por traumatismo
