Multicenter Evaluation with Eckardt Score of Laparoscopic Management with Heller Myotomy and Dor Fundoplication for Esophageal Achalasia in a Pediatric Population in Colombia.

Background: Esophageal achalasia is a rare, chronic, and progressive neurodegenerative motility disorder that is characterized by a lack of relaxation of the lower esophageal sphincter. Laparoscopic Heller myotomy (LHM) is the ideal in our population. Multiple surgical and medical treatments have been raised. However, there has been a need to expand studies and generate a clear algorithm for an ideal therapeutic algorithm. Methods: Clinical record was retrospectively analyzed of patients who underwent LHM and Dor fundoplication evaluated with Eckardt score, at four Colombian medical centers between February 2008 and December 2018. Results: There were a total of 21 patients (12 males and 9 females, ages 8 months to 16 years). The time from onset of symptoms to surgery was between 5 months and 14 years. One patient had esophageal mucosa perforation, 2 patients were converted to open surgery, and 1 patient had a postoperative fistula. All patients were discharged 3 to 9 days postoperatively, at which time they tolerated normal oral feeding. During follow-up, all the patients had an improvement in nutritional status and a greater functional recovery; 4 had reflux and 1 had reflux-like symptoms. Conclusion: LHM with Dor-type fundoplication maintains the effectiveness of open surgery with low postoperative morbidity and mortality and good functional results according to Eckardt score evaluation.

Experience of a Colombian center in the endovascular management of lifethreatening postpartum hemorrhage / Experiencia de un centro colombiano en el tratamiento endovascular de la hemorragia posparto que amenaza la vida

Introduction: Postpartum hemorrhage is a world-leading cause of morbidity and mortality. Lacerations are the second most frequent cause. Early management with appropriate treatment is essential to obtain adequate outcomes; the endovascular occlusion of pelvic vessels is among the management options. Objective: To describe the management experience with the arterial embolization of pelvic vessels. Materials and methods: We conducted a retrospective case series study based on the institutional registry of Fundación Valle del Lili (Cali, Colombia), which included patients with postpartum hemorrhage admitted between January 1st, 2011 and October 31st, 2016. Results: Out of 430 patients diagnosed with PPH, 11 were subject to embolization of pelvic vessels. Within our group, 10 patients had a vaginal delivery with severe vaginal lacerations; most of them (9 cases, 82%) were referred from other lower-complexity institutions after 20.5 hours. Occlusion was more frequent in the superior vaginal and the internal pudendal arteries. No patients showed complications associated with the procedure and only 2 showed recurrent bleeding while 3 required a hysterectomy, but no deaths occurred. Conclusion: Percutaneous management is a safe and effective third-line method for difficult-management bleedings control in patients with postpartum hemorrhage after a severe perineal tear. These results are similar to case reports published in the worldwide literature available to date.

Introducción. La hemorragia posparto es la primera causa de morbimortalidad materna en el mundo y las laceraciones son la segunda causa en frecuencia. Su tratamiento temprano y apropiado es clave para obtener buenos resultados, y la oclusión endovascular de los vasos pélvicos se cuenta entre las opciones terapéuticas. Objetivo. Describir la experiencia del tratamiento con la 'embolización' (sic) arterial de los vasos pélvicos. Materiales y métodos. Se trató de un estudio retrospectivo del tipo de serie de casos basado en el registro institucional de la Fundación Valle del Lili, Cali, Colombia, en el que se incluyeron las pacientes con hemorragia posparto atendidas entre el 1º de enero del 2011 y el 31 de octubre del 2016. Resultados. De las 430 pacientes con diagnóstico de hemorragia posparto, 11 fueron sometidas a la 'embolización' de los vasos pélvicos. De este grupo, 10 pacientes tuvieron parto vaginal con laceraciones vaginales complejas, y la mayoría (9 casos, 82 %) fue remitida por otras instituciones de menor complejidad después de 20,5 horas. Las arterias ocluidas frecuentemente fueron la vaginal superior y la pudenda interna. Ninguna paciente presentó complicaciones asociadas al procedimiento y solo dos presentaron sangrado recurrente. Tres pacientes requirieron histerectomía y ninguna murió. Conclusión. El manejo percutáneo es un método de tercera línea, seguro y efectivo para el control de los sangrados de difícil manejo en las pacientes con hemorragia pospartopor desgarros perineales complejos. Estos resultados son similares a los reportados en la literatura científica mundial disponible hasta la fecha.

Experiencia de un centro colombiano en el tratamiento endovascular de la hemorragia posparto que amenaza la vida / Experience of a Colombian center in the endovascular management of life-threatening postpartum hemorrhage

Resumen Introducción. La hemorragia posparto es la primera causa de morbimortalidad materna en el mundo y las laceraciones son la segunda causa en frecuencia. Su tratamiento temprano y apropiado es clave para obtener buenos resultados, y la oclusión endovascular de los vasos pélvicos se cuenta entre las opciones terapéuticas. Objetivo. Describir la experiencia del tratamiento con la 'embolización' (sic) arterial de los vasos pélvicos. Materiales y métodos. Se trató de un estudio retrospectivo del tipo de serie de casos basado en el registro institucional de la Fundación Valle del Lili, Cali, Colombia, en el que se incluyeron las pacientes con hemorragia posparto atendidas entre el 1º de enero del 2011 y el 31 de octubre del 2016. Resultados. De las 430 pacientes con diagnóstico de hemorragia posparto, 11 fueron sometidas a la 'embolización' de los vasos pélvicos. De este grupo, 10 pacientes tuvieron parto vaginal con laceraciones vaginales complejas, y la mayoría (9 casos, 82 %) fue remitida por otras instituciones de menor complejidad después de 20,5 horas. Las arterias ocluidas frecuentemente fueron la vaginal superior y la pudenda interna. Ninguna paciente presentó complicaciones asociadas al procedimiento y solo dos presentaron sangrado recurrente. Tres pacientes requirieron histerectomía y ninguna murió. Conclusión. El manejo percutáneo es un método de tercera línea, seguro y efectivo para el control de los sangrados de difícil manejo en las pacientes con hemorragia posparto por desgarros perineales complejos. Estos resultados son similares a los reportados en la literatura científica mundial disponible hasta la fecha.

Abstract Introduction: Postpartum hemorrhage is a world-leading cause of morbidity and mortality. Lacerations are the second most frequent cause. Early management with appropriate treatment is essential to obtain adequate outcomes; the endovascular occlusion of pelvic vessels is among the management options. Objective: To describe the management experience with the arterial embolization of pelvic vessels. Materials and methods: We conducted a retrospective case series study based on the institutional registry of Fundación Valle del Lili (Cali, Colombia), which included patients with postpartum hemorrhage admitted between January 1st, 2011 and October 31st, 2016. Results: Out of 430 patients diagnosed with PPH, 11 were subject to embolization of pelvic vessels. Within our group, 10 patients had a vaginal delivery with severe vaginal lacerations; most of them (9 cases, 82%) were referred from other lower-complexity institutions after 20.5 hours. Occlusion was more frequent in the superior vaginal and the internal pudendal arteries. No patients showed complications associated with the procedure and only 2 showed recurrent bleeding while 3 required a hysterectomy, but no deaths occurred. Conclusion: Percutaneous management is a safe and effective third-line method for difficult-management bleedings control in patients with postpartum hemorrhage after a severe perineal tear. These results are similar to case reports published in the worldwide literature available to date.