Pulsed field ablation of the right superior pulmonary vein prevents vagal responses via anterior right ganglionated plexus modulation.

BACKGROUND: Pulsed field ablation (PFA) is selective for the myocardium. However, vagal responses and reversible effects on ganglionated plexi (GP) are observed during pulmonary vein isolation (PVI). Anterior-right GP ablation has been proven to effectively prevent vagal responses during radiofrequency-based PVI. OBJECTIVE: The purpose of this study was to test the hypothesis that PFA-induced transient anterior-right GP modulation when targeting the right superior pulmonary vein (RSPV) before any other pulmonary veins (PVs) may effectively prevent intraprocedural vagal responses. METHODS: Eighty consecutive paroxysmal atrial fibrillation patients undergoing PVI with PFA were prospectively included. In the first 40 patients, PVI was performed first targeting the left superior pulmonary vein (LSPV-first group). In the last 40 patients, RSPV was targeted first, followed by left PVs and right inferior PV (RSPV-first group). Heart rate (HR) and extracardiac vagal stimulation (ECVS) were evaluated at baseline, during PVI, and postablation to assess GP modulation. RESULTS: Vagal responses occurred in 31 patients (78%) in the LSPV-first group and 5 (13%) in the RSPV-first group (P <.001). Temporary pacing was needed in 14 patients (35%) in the LSPV-first group and 3 (8%) in the RSPV-first group (P = .003). RSPV isolation was associated with similar acute HR increase in the 2 groups (13 ± 11 bpm vs 15 ± 12 bpm; P = .3). No significant residual changes in HR or ECVS response were documented in both groups at the end of the procedure compared to baseline (all P >.05). CONCLUSION: PVI with PFA frequently induced vagal responses when initiated from the LSPV. Nevertheless, an RSPV-first approach promoted transient HR increase and reduced vagal response occurrence.

Symptom burden guiding invasive electrophysiological study in paroxysmal supraventricular tachycardia: The believe SVT registry.

BACKGROUND AND OBJECTIVE: Patients with palpitations clinically suggestive of paroxysmal supraventricular tachycardia (PSVT) are often managed conservatively until ECG-documentation of the tachycardia, leading to high impact on life quality and healthcare resource utilization. We evaluated results of electrophysiological study (EPS), and ablation when appropriate, among these patients, with special focus on gender differences in management. METHODS: BELIEVE SVT is a European multicenter, retrospective registry in tertiary hospitals performing EPS in patients with palpitations, without ECG-documentation of tachycardia or preexcitation, and considered highly suggestive of PSVT by a cardiologist or cardiac electrophysiologist. We analyzed clinical characteristics, results of EPS and ablation, complications, and clinical outcomes during follow-up. RESULTS: Six-hundred eighty patients from 20 centers were included. EPS showed sustained tachycardia in 60.9% of patients, and substrate potentially enabling AVNRT in 14.7%. No major/permanent complications occurred. Minor/transient complications were reported in 0.84% of patients undergoing diagnostic-only EPS and 1.8% when followed by ablation. During a 3.4-year follow-up, 76.2% of patients remained free of palpitations recurrence. Ablation (OR: 0.34, P < .01) and male gender (OR: 0.58, P = .01) predicted no recurrence. Despite a higher female proportion among patients with recurrence, (77.2% vs 63.5% among those asymptomatic during follow-up, P < .01), 73% of women in this study reported no recurrence of palpitations after EPS. CONCLUSIONS: EPS and ablation are safe and effective in preventing recurrence of nondocumented palpitations clinically suggestive of PSVT. Despite a lower efficacy, this strategy is also highly effective among women and warrants no gender differences in management.

Prehabilitation programs for individuals with cancer: a systematic review of randomized-controlled trials.

BACKGROUND: Prehabilitation programs focusing on exercise training as the main component are known as a promising alternative for improving patients' outcomes before cancer surgery. This systematic review determined the benefits and harms of prehabilitation programs compared with usual care for individuals with cancer. METHODS: We searched CENTRAL, MEDLINE, and EMBASE from inception to June 2022, and hand searched clinical trial registries. We included randomized-controlled trials (RCTs) in adults, survivors of any type of cancer, that compared prehabilitation programs that had exercise training as the major component with usual care or other active interventions. Outcome measures were health-related quality of life (HRQL), muscular strength, postoperative complications, average length of stay (ALOS), handgrip strength, and physical activity levels. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias and the certainty of the evidence. RESULTS: Twenty-five RCTs (2682 participants) published between 2010 and 2022 met our inclusion criteria. Colorectal and lung cancers were the most common diagnoses. The studies had methodological concerns regarding outcome measurement, selective reporting, and attrition. Five prehabilitation programs were compared to usual care (rehabilitation): combined training, aerobic training, respiratory muscle training plus aerobic training, respiratory muscle training plus resistance training, and pelvic floor training. The studies provided no clear evidence of an effect between groups. We assessed the overall certainty of the evidence as very low, downgraded due to serious study limitations and imprecision. CONCLUSION: Prehabilitation programs focusing on exercise training may have an effect on adults with cancer, but the evidence is very uncertain. We have very little confidence in the results and the true effect is likely to be substantially different from these. Further research is needed before we can draw a more certain conclusion. SYSTEMATIC REVIEW REGISTRATION: CRD42019125658.

Pulmonary rehabilitation for acute exacerbations of COPD: A systematic review.

INTRODUCTION AND OBJECTIVES: This systematic review summarized the evidence on the effects (benefits and harms) of pulmonary rehabilitation for individuals with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). MATERIAL AND METHODS: We included randomized controlled trials comparing pulmonary rehabilitation to either active interventions or usual care regardless of setting. In March 2022, we searched MEDLINE, Scopus, CENTRAL, CINAHL and Web of Sciences, and trial registries. Record screening, data extraction and risk of bias assessment were undertaken by two reviewers. We assessed the certainty of the evidence using the GRADE approach. RESULTS: This systematic review included 18 studies (n = 1465), involving a combination of mixed settings (8 studies), inpatient settings (8 studies), and outpatient settings (2 studies). The studies were at high risk of performance, detection, and reporting biases. Compared to usual care, pulmonary rehabilitation probably improves AECOPD-related hospital readmissions (relative risk 0.56, 95% CI 0.36 to 0.86; moderate certainty evidence) and cardiovascular submaximal capacity (standardized mean difference 0.73, 95% CI 0.48 to 0.99; moderate certainty evidence). Low certainty evidence suggests that pulmonary rehabilitation may be beneficial on re-exacerbations, dyspnoea, and impact of disease. The evidence regarding the effects of pulmonary rehabilitation on health-related quality of life and mortality is very uncertain (very low certainty evidence). CONCLUSION: Our results indicate that pulmonary rehabilitation may be an effective treatment option for individuals with AECOPD, irrespective of setting. Our certainty in this evidence base was limited due to small studies, heterogeneous rehabilitation programs, numerous methodological weaknesses, and a poor reporting of findings that were inconsistent with each other. Trialists should adhere to the latest reporting standards to strengthen this body of evidence. REGISTRATION: The study protocol was registered in Open Science Framework (https://osf.io/amgbz/).

Using evidence to decision frameworks led to guidelines of better quality and more credible and transparent recommendations.

BACKGROUND AND OBJECTIVES: To determine whether the use of Evidence to Decision (EtD) frameworks is associated to higher quality of both guidelines and individual recommendations. METHODS: We identified guidelines recently published by international organizations that have methodological guidance documents for their development. Pairs of researchers independently extracted information on the use of these frameworks, appraised the quality of the guidelines using the Appraisal of Guidelines, Research and Evaluation II Instrument (AGREE-II), and assessed the clinical credibility and implementability of the recommendations with the Appraisal of Guidelines for REsearch & Evaluation Recommendations Excellence (AGREE-REX) tool. We conducted both descriptive and inferential analyses. RESULTS: We included 66 guidelines from 17 different countries, published in the last 5 years. Thirty guidelines (45%) used an EtD framework to formulate their recommendations. Compared to those that did not use a framework, those using an EtD framework scored higher in all domains of both AGREE-II and AGREE-REX (P < 0.05). Quality scores did not differ between the use of the The Grading of Recommendations Assessment, Development and Evaluation-EtD framework (17 guidelines) or another EtD framework (13 guidelines) (P > 0.05). CONCLUSION: The use of EtD frameworks is associated with guidelines of better quality, and more credible and transparent recommendations. Endorsement of EtD frameworks by guideline developing organizations will likely increase the quality of their guidelines.

Effects of resistance training on C-reactive protein in menopausal and postmenopausal women: a systematic review and meta-analysis of randomized controlled trials.

IMPORTANCE: Menopause is a biological stage associated with increased cardiovascular morbidity and mortality due to changes in sex hormone levels. OBJECTIVE: This systematic review aimed to investigate the benefits and harms of RT in menopausal and postmenopausal women. EVIDENCE REVIEW: We searched PubMed, Embase, CENTRAL, Scopus, and Web of Science from inception to 2021, and clinical trial registries. Randomized controlled trials (RCT) in menopausal and postmenopausal women that compared women undergoing RT programs with a control group were included. The primary outcomes were C-reactive protein level and adverse events; and, the secondary outcomes were lipid profile and waist circumference. Two reviewers independently selected the studies, extracted data, and assessed the completeness of RT programs, risk of bias, and quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach (GRADE). A random-effects model was used. Statistical significance was set at P < 0.05. FINDINGS: Twelve RCTs published from 2012 to 2020 met the inclusion criteria (n = 482). Four follow-up periods were assessed. RT caused reductions in C-reactive protein levels compared to those in the control group in postmenopausal women in the short- to long-term follow-up (mean difference, -0.47 mg/dL; 95% confidence interval, -0.66 to -0.29; P < 0.00001). Furthermore, RT may reduce C-reactive protein levels even at moderate and moderate-to-high intensity ( P < 0.0001 and P = 0.0005, respectively). Similar findings were found for lipid profiles in the short- to long-term follow-up ( P < 0.05). RT may have had little to no effect on waist circumference. The certainty of the body of evidence was assessed as very low and downgraded owing to serious study limitations, inconsistency, imprecision, and publication bias. CONCLUSIONS AND RELEVANCE: There was very low-quality evidence supporting the benefits of RT compared with control for C-reactive protein levels and lipid profile. No benefits were found for the outcome of waist circumference in postmenopausal women with different comorbidities or risk factors. Safety data were scarce. We have little confidence in the results, and the true effect is likely to be substantially different. Further well-conducted and well-reported RCTs are warranted to strengthen the evidence. PROTOCOL REGISTRATION: PROSPERO CRD42020213125.

The presence of a large patent foramen ovale reduces acute and chronic success in atrial fibrillation ablation.

PURPOSE: In this study, we analyzed PFO implications in atrial fibrillation (AF) ablation. METHODS: Six hundred and twenty-five consecutive patients with AF undergoing PV isolation were included. We considered that a large and/or compliant PFO was present if the catheters advanced gently into the LA without puncturing the septum. Atrial tachyarrhythmias after the 3-month blanking period were classified as a recurrence. RESULTS: Out of the 625 patients included, 36 (5.8%) were found to have PFO. No significant differences were observed in the clinical characteristics of patients with PFO compared with patients without PFO. Nevertheless, patients with PFO had lower acute success in PV isolation compared with patients without PFO (98.2% vs. 88.5%; p = 0.006) even after adjusting for age, sex, type of AF, LA area, cardiomyopathy, time from AF diagnosis to the ablation, and ablation technique (odds ratio: 0.1; 95% confidence interval (CI): 0.02-0.9; p = 0.039). In 546 patients followed more than 6 months, the recurrence rate of any atrial tachyarrhythmia after 18.6 ± 11.9 months was significantly higher in patients with PFO compared with patients without PFO (41.9 vs. 70%; p = 0.012). This difference remained significant after adjusting for age, sex, type of AF, LA area, cardiomyopathy, time from AF diagnosis to the ablation, and ablation technique (hazard ratio: 1.9; 95% CI: 1.1-3.3; p = 0.015). CONCLUSIONS: The presence of a large and/or compliant PFO is an independent factor for PV isolation failure and arrhythmia recurrence rate after the ablation.

Resistance Training with Blood Flow Restriction Compared to Traditional Resistance Training on Strength and Muscle Mass in Non-Active Older Adults: A Systematic Review and Meta-Analysis.

Low-intensity training with blood flow restriction (LI-BFR) has been suggested as an alternative to high-intensity resistance training for the improvement of strength and muscle mass, becoming advisable for individuals who cannot assume such a load. The systematic review aimed to determine the effectiveness of the LI-BFR compared to dynamic high-intensity resistance training on strength and muscle mass in non-active older adults. A systematic review was conducted according to the Cochrane Handbook and reportedly followed the PRISMA statement. MEDLINE, EMBASE, Web of Science Core Collection, and Scopus databases were searched between September and October 2020. Two reviewers independently selected the studies, extracted data, assessed the risk of bias and the quality of evidence using the GRADE approach. Twelve studies were included in the qualitative synthesis. Meta-analysis pointed out significant differences in maximal voluntary contraction (MVC): SMD 0.61, 95% CI [0.10, 1.11], p = 0.02, I2 71% p < 0.0001; but not in the repetition maximum (RM): SMD 0.07, 95% CI [-0.25, 0.40], p = 0.66, I2 0% p < 0.53; neither in the muscle mass: SMD 0.62, 95% CI [-0.09, 1.34], p = 0.09, I2 59% p = 0.05. Despite important limitations such as scarce literature regarding LI-BFR in older adults, the small sample size in most studies, the still differences in methodology and poor quality in many of them, this systematic review and meta-analysis revealed a positive benefit in non-active older adults. LI- BFR may induce increased muscular strength and muscle mass, at least at a similar extent to that in the traditional high-intensity resistance training.

The effect of exercise training on blood pressure in menopause and postmenopausal women: A systematic review of randomized controlled trials.

The prevalence of hypertension is higher in postmenopausal than in premenopausal women. Regular exercise training has been shown to be effective in addressing hypertension. The aim of this systematic review was to synthesize the effect of exercise training on systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) in menopausal and postmenopausal women. This review was reported according to the PRISMA statement and registered in PROSPERO. The literature search was done in MEDLINE, Embase, Cochrane CENTRAL and ClinicalTrials. Randomized controlled trials involving menopausal and postmenopausal women undergoing exercise training were included. Two blinded reviewers assessed risk of bias in the included studies by using the Cochrane Risk of Bias tool. A random-effects model was used for all analyses. Significance was set at P < 0.05. Compared with the control group, exercise training resulted in clinically significant reductions on SBP (MD -3.43 mmHg; 95% CI, -5.16, -1.71; P < 0.0001), DBP (MD, -2.25 mmHg; 95% CI, -3.40, -1.11; P = 0.0001) and MAP (MD, -3.48 mmHg; 95% CI, -5.84, -1.11; P = 0.004). Aerobic training (AT) did not produce a significant reduction in SBP, DBP and MAP (P >0.05). Combined training (CT) generated larger reductions. Exercise training generated small but clinically relevant reductions in SBP, DBP and MAP in menopausal and postmenopausal women, younger or older than 65 years, with prehypertension or hypertension. AT did not lead to a clinically relevant improvement in blood pressure (BP) in this population. In addition, CT showed the largest reductions in SBP, DBP and MAP.

The Effects of Resistance Training on Blood Pressure in Preadolescents and Adolescents: A Systematic Review and Meta-Analysis.

The aim was to systematically review and meta-analyze the current evidence for the effects of resistance training (RT) on blood pressure (BP) as the main outcome and body mass index (BMI) in children and adolescents. Two authors systematically searched the PubMed, SPORTDiscus, Web of Science Core Collection and EMBASE electronic databases. Inclusion criteria were: (1) children and adolescents (aged 8 to 18 years); (2) intervention studies including RT and (3) outcome measures of BP and BMI. The selected studies were analyzed using the Cochrane Risk-of-Bias Tool. Eight articles met inclusion criteria totaling 571 participants. The mean age ranged from 9.3 to 15.9 years and the mean BMI of 29.34 (7.24) kg/m2). Meta-analysis indicated that RT reduced BMI significantly (mean difference (MD): -0.43 kg/m2 (95% CI: -0.82, -0.03), P = 0.03; I2 = 5%) and a non-significant decrease in systolic BP (SBP) (MD: -1.09 mmHg (95% CI: -3.24, 1.07), P = 0.32; I2 = 67%) and diastolic BP (DBP) (MD: -0.93 mmHg (95% CI: -2.05, 0.19), P = 0.10; I2 = 37%). Limited evidence suggests that RT has no adverse effects on BP and may positively affect BP in youths. More high-quality studies are needed to clarify the association between RT and BP in light of body composition changes throughout childhood and adolescence.

Is Low-Intensity Isometric Handgrip Exercise an Efficient Alternative in Lifestyle Blood Pressure Management? A Systematic Review.

CONTEXT: High blood pressure is one of the leading preventable causes of cardiovascular death worldwide. In this regard, several studies have shown interest in the benefits of isometric exercise on blood pressure regulation. OBJECTIVE: To assess whether low-intensity isometric handgrip exercise (LI-IHE) is an effective strategy to lower blood pressure levels in prehypertensive and hypertensive patients. DATA SOURCE: This study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and registered with PROSPERO. Potentially eligible studies were identified after a systematic search conducted on 4 international databases: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), PEDro, and SPORTDiscus. STUDY SELECTION: We included randomized controlled trials that comprised patients who received LI-IHE. STUDY DESIGN: Systematic review with meta-analysis. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: Data related to patient characteristics, exercise programs, risk-of-bias assessment, and outcomes of interest were systematically reviewed independently by 2 authors. RESULTS: The following reductions (mean differences) were observed after LI-IHE: systolic blood pressure (SBP), (MD) = -5.43 mm Hg; (95% CI, -8.47 to -2.39; P = 0.0005); diastolic blood pressure (DBP), -2.41 mm Hg (95% CI, -4.33 to -0.48; P = 0.01); mean arterial pressure (MAP), -1.28 mm Hg (95% CI, -2.99 to 0.44; P = 0.14). CONCLUSION: LI-IHE seems to lower SBP, DBP, and MAP values in prehypertensive and hypertensive adults. It appears that LI-IHE reduces, in greater magnitude, blood pressure levels in hypertensive patients, specifically in patients aged <45 years, those who are overweight, and those on medications. Nevertheless, substantial heterogeneity in the main results and in the analyses by subgroups generated uncertainty about the real reduction magnitude that LI-IHE can produce on blood pressure.

Effect of Isometric Resistance Training on Blood Pressure Values in a Group of Normotensive Participants: A Systematic Review and Meta-analysis.

CONTEXT: Cardiovascular diseases cause 17 million deaths annually worldwide, of which hypertension is responsible for 9.4 million and a 7% burden of disease. High blood pressure is responsible for 45% of deaths from heart disease and 51% of deaths from stroke. OBJECTIVE: The aim of this systematic review and meta-analysis was to quantify the effect of isometric resistance training on systolic, diastolic, and mean arterial blood pressure (SBP, DBP, and MAP, respectively) values in normotensive adult participants. DATA SOURCES: This study was registered with the PROSPERO database. Eligible studies were identified after performing a systematic search within the following databases: PubMed, Scielo, BioMed Central, Clinical Trials, EMBASE, Cochrane Central Register of Controlled Trials, and EBSCO. STUDY SELECTION: Randomized controlled trials that categorized participants as normotensive according to the guidelines of the American Heart Association and the American College of Cardiology were included. STUDY DESIGN: Systematic review with meta-analysis. LEVEL OF EVIDENCE: Level 1. DATA EXTRACTION: Data related to participant characteristics, exercise programs, level of evidence, risk of bias, Consensus on Exercise Reporting Template, and outcomes of interest were systematically reviewed independently by 2 authors. RESULTS: A total of 6 randomized controlled trials were included. The following reductions in blood pressure (compared with the control group) were generated by isometric resistance training: SBP (mean difference [MD], -2.83 mm Hg; 95% CI, -3.95 to -1.72; P < 0.00001), DBP (MD, -2.73; 95% CI, -4.23 to -1.24; P = 0.0003), and MAP (MD, -3.07; 95% CI, -5.24 to -0.90; P = 0.005). CONCLUSION: It appears that isometric resistance training reduces SBP, DBP, and MAP in normotensive young adults in a statistically significant and clinically relevant manner. This type of exercise could be considered effective in preventing arterial hypertension.

Prehabilitation programs for cancer patients: a systematic review of randomized controlled trials (protocol).

BACKGROUND: Around twenty million new cases and ten million of deaths were attributed to cancer in 2018. Physical exercise, as main component of prehabilitation programs, has been associated with clinical improvements in aerobic capacity, muscular strength, gait speed, and fewer postoperative complications. This systematic review aims to determine the benefits and harms of prehabilitation programs, mainly composed of physical exercise, compared with standard care for cancer patients. METHODS/DESIGN: A librarian will systematically search for randomized controlled trials in the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), and EMBASE. Two independent reviewers will independently screen the retrieved references, appraise the methodological quality of the included studies, and extract data. If possible, we will pool the data. We will evaluate the completeness of reporting of prehabilitation programs by using the CERT checklist, and the GRADE approach will be used to evaluate the quality of the evidence. DISCUSSION: This systematic review will determine the benefits and harms of prehabilitation programs for cancer patients. We will provide a complete appraisal of the quality of the evidence, our confidence in the results, and completeness of reporting of the exercise interventions evaluated in the prehabilitation programs. Findings from this review will assist health care providers, patients, decision-makers, and international organizations to make informed decisions in this field. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019125658.

Epicardial Connections Involving Pulmonary Veins: The Prevalence, Predictors, and Implications for Ablation Outcome.

BACKGROUND: The presence of epicardial connections (ECs) between pulmonary veins (PVs) and other anatomic structures may hinder PV isolation. In this study, we analyzed their prevalence, location, associated factors, and clinical implications. METHODS: Five hundred thirty-four consecutive patients with atrial fibrillation undergoing radiofrequency ablation were included. We considered that an EC was present if: (1) the first pass around the PV antrum did not produce PV isolation and (2) subsequent atrial activation during PV pacing showed that the earliest site was located away from the ablation line and later activation sites were observed near the ablation line. Clinical and electrophysiological variables were collected from all patients. Patients were followed during 12.9±9.4 months, and any documented atrial tachyarrhythmia after the 3-month blanking period was classified as a recurrence. RESULTS: Out of the 534 patients included, 72 (13.5%) were found to have 81 ECs. There was a significant association between the presence of ECs and structural heart disease (15.3% in patients without ECs versus 36.5% in patient with ECs; P<0.001) and patent foramen ovale (4.6% versus 13.5%; P=0.002). The presence of a left common trunk was significantly associated with the absence of ECs (29.6% in patients without ECs versus 16.2% in patients with ECs; P=0.014). Patients with ECs had lower acute success in PV isolation compared with patients without ECs (99.1% versus 86.1%; P<0.001). After adjusting for age, sex, type of atrial fibrillation, left atrium area, hypertension, structural heart disease, presence of left common trunk, patent foramen ovale, and time for atrial fibrillation diagnosis to the ablation, we found a significantly higher risk of atrial tachyarrhythmia recurrences in patients with ECs compared with patients without ECs (hazard ratio, 1.7 [95% CI, 1.1-2.9]; P=0.04). CONCLUSIONS: ECs between PVs and other adjacent structures are frequent in patient with atrial fibrillation (prevalence: 13.5%). Structural heart disease and a patent foramen ovale are strongly associated with the presence of ECs. ECs reduce the acute and chronic success of PV isolation.

Electro-optic THz dual-comb architecture for high-resolution, absolute spectroscopy.

An absolute-frequency terahertz (THz) dual-frequency comb spectrometer based on electro-optic modulators for tunable, high-resolution, and real-time rapid acquisition is presented. An optical line of a master frequency comb (filtered via optical injection locking) serves as the seed to electro-optically generate a pair of new frequency combs (probe and local oscillator). Photomixing both combs with another coherent line from the same original master comb generates a narrow linewidth THz dual-comb with teeth frequencies that can be referenced to a radio-frequency standard. The system is validated with a proof-of-principle measurement of a microwave filter in the W-band.

Lesiones de la vía biliar durante la colecistectomía laparoscópica. Factores técnicos, anatómicos y educacionales / Bile duct lesions during laparoscopic cholecystectomy. Technical, anatomic and educational factors

Hipótesis: El aprendizaje de la técnica de colecistectomía laparoscópica durante los programas de entrenamiento de cirugía general disminuye la incidencia de lesiones de la vía biliar, si se compara con la incidencia de estas lesiones en cirujanos que aprendieron dicha técnica luego de graduados.Materiales y métodos: Trabajo descriptivo, con una muestra de 64 cirujanos, miembros de la Asociación Colombiana de Cirugía, con título formal en Cirugía General, avalado por el ICFES con práctica corriente y permanente de la cirugía en el país.Criterios de exclusión: lesiones biliares menores: Se realizó una encuesta, diseñada por el Departamento de Epidemiología de la Universidad CES, acompañada de un instructivo para su diligenciamiento de carácter confidencial.Se separó al total de encuestados en dos: grupo A, cirujanos sin entrenamiento en laparoscopia durante la residencia; grupo B, cirujanos con entrenamiento durante la residencia. Se evaluaron otras variables como: edad, sexo, tiempo de práctica y lugar, número de colecistectomías realizadas al año y durante el tiempo de práctica, práctica o no de colangiografía intraoperatoria, número y tipo de lesiones mayores de la vía biliar, momento del diagnóstico, manejo inicial, definitivo, necesidad de remisión...