Is video-assisted thoracoscopic diaphragmatic plication a widespread technique for diaphragmatic hernia in adults? Review of the literature and results of a national survey.

Diaphragmatic plication is the most accepted treatment for symptomatic diaphragmatic hernia in adults. The fact that this pathology is infrequent and this procedure not been widespread means that this is an exceptional technique in our field. To estimate its use in the literature, we carried out a review in English and Spanish, to which we added our series. We found only six series that contribute 59 video-assisted mini-thoractomy for diaphragmatic plications in adults, and none in Spanish. Our series will be the second largest with 18 cases. Finally, we conducted a survey in all the Spanish Thoracic Surgery units in Spain: none reported more than 10 cases operated by thoracoscopy in the last 8 years (except our series) and most continue employing thoracotomy as the main approach. We believe that many patients with symptomatic diaphragmatic hernia could benefit from the use of such techniques.

The factors that cause penile shortening after plication surgery in patients with congenital penile curvature: [[es]]Los factores causantes del acortamiento de pene después de la cirugía con plicatura en pacientes con incurvación peneana congénita.

OBJECTIVE: Congenital penile curvature is defined as the non-straightness of the penis without any urethral or penile pathology. We aimed to evaluate the factors that cause penile shortening after plication surgery in patients with congenital penile curvature. METHODS: Between November 2010 and December 2020, we retrospectively reviewed patients with CPC undergoing tunica albuginea plication surgery. Before the procedure, patients' age, curvature location and degrees, as well as penile length were recorded. After the treatment, penile lengths were measured and recorded again. Early and late period results were recorded. RESULTS: Plication surgery was performed in 130 patients. The median age was 24 years. Seventy-six patients had ventral curvature, 22 had dorsal curvature, 32 had lateral curvature. Average shortening of penile length in patients with curvature below 30° was: ventral 8-16 mm, dorsal 6-13 mm, lateral 5-12 mm. Patients with curvatures above 30° were: ventral 12-22 mm, dorsal 8-20 mm, lateral 2-12 mm. CONCLUSION: Penile length shortening after plication is inevitable. Curvature degree and direction are factors affecting penile length after surgery. Therefore, patients and relatives should be informed in more detail about this complication.

Is there any advantage in the use of absorbable sutures in congenital penile curvature surgery performed in childhood?

OBJECTIVE: To compare the long-term outcomes of corporeal plication using absorbable versus nonabsorbable sutures for the treatment of congenital penile curvature in childhood. MATERIALS AND METHODS: Forty seven children who underwent congenital penile curvature repair between 11 and 140 months of age were included in the study. All children were operated on using the incisional plication technique and were divided into two groups: Absorbable-polyglactine (PLG, n=23, 48.93%) and nonabsorbable-polypropilen (PP, n=24, 51.06%) according to the suture material used for plication. Surgical outcomes were compared between groups. RESULTS: Mean follow-up period was 19.02±4.66 months. There was no significant difference between the mean age of the children in two groups included in the study (PLG=41.39±34.63 months vs PP=53.66±37.42 months, p=0.250). There was no significant difference in penile straightening degree between the two groups in the postoperative follow-up (PLG=27.39±6.88 vs PP=31.08±6.38, p=0.06). Similarly, there was no significant difference between two groups in terms of postoperative curvature recurrence (p=0.681). However, palpable suture knots in the plication area was significantly higher in the PP group in the postoperative period (25.0% vs 4.3%, p=0.047). CONCLUSION: The use of absorbable sutures in congenital penile curvature surgery in childhood has similar success rates with the use of nonabsorbable sutures and provides lower complications that are secondary to nonabsorbable sutures.

Complex Peyronie's disease cases: surgery with or without penile prosthesis placement. / Casos complejos. Enfermedad de Peyronie: cirugía sin/con implante de prótesis de pene.

INTRODUCTION AND OBJECTIVE: Surgery is the treatment of choice for patients with Peyronie's disease presenting difficulty in penetration or erectile dysfunction without adequate response to therapy. Several techniques have been described, and urologists must be aware of their possible complications and sequelae in order to offer the patient the best possible alternative. PATIENTS AND METHODS: Three complex cases of patients with Peyronie's disease are presented. The first case exposes a complication after penile plication for the treatment of a major dorsal curve. The second case refers to difficult anal penetration secondary to a problem of erection direction after plaque incision surgery with oral mucosa grafting. The last case is a patient with a late post-operative complication of a three-piece prosthesis placement with plaque incision and equine collagen patch. RESULTS: Surgical options for each case are detailed and discussed. After patients were informed, the decision was taken in a consensual manner. CONCLUSIONS: Surgery for Peyronie's disease requires the urologist's consideration of the functional, aesthetic and psychological spheres. A systematic approach to all of these avoids complications, sequels and improves results.

Abdominoplastia TULUA: modificaciones y aportes personales / TULUA abdominoplasty: personal approach and modifications

Introducción. La abdominoplastia ha evolucionado desde una simple resección en bloque de piel y tejido celular subcutáneo hasta un procedimiento multimodal que combina la corrección de todas las capas del abdomen asociado a una liposucción circunferencial para mejorar el contorno corporal. A pesar de que la combinación de liposucción y abdominoplastia ha demostrado ser segura, aún no hay un consenso en cuanto a la cantidad de volumen que se puede extraer en las diferentes áreas sin aumentar el riesgo. Con el fin de disminuir dichas complicaciones, Villegas desarrolló una modificación a la técnica clásica que denominó abdominoplastia TULUA. A partir de entonces, comenzamos a realizar la técnica con resultados satisfactorios, por lo que el objetivo de este trabajo es presentar dicha experiencia a través de una serie de casos con la técnica de TULUA y las modificaciones realizadas a lo largo de los años. Materiales y métodos. Se realizó un estudio observacional, retrospectivo y descriptivo de todos los pacientes intervenidos de abdominoplastia TULUA desde julio de 2017 hasta julio de 2020. Resultados. Fueron intervenidos 28 pacientes, todos del género femenino. La edad promedio fue de 45,6 años; 26 casos primarios y 2 secundarios; 24 de las cirugías fueron abdominoplastias TULUA convencionales y 4 fueron miniabominoplastias asociadas a mini-TULUA. El 67% de los casos fueron realizados con cirugías concomitantes. El promedio del volumen de liposucción fue de 3,3 litros. El promedio del tamaño de la plicatura fue de 7,5x22,9 cm. El tiempo promedio de cirugía fue de 3,01 horas. Seis pacientes evolucionaron con complicaciones. Conclusiones. La abdominoplastia TULUA es una alternativa a la abdominoplastia convencional que puede ser aplicada tanto en abdómenes primarios como secundarios, con resultados aceptables. Puede ser de gran utilidad en casos con cicatrices abdominales previas o pacientes con riesgo aumentado de complicaciones vasculares, como tabaquistas. La principal ventaja radica en su seguridad vascular al no generar un despegamiento epigástrico lo que permite una liposucción sin restricciones con preservación de perforantes y menor espacio muerto. Además, a través de la plicatura transversal, permite corregir la laxitud de la pared abdominal, disminuir la tensión sobre la cicatriz y ocluir el espacio muerto. El neoombligo, si bien es un desafío, logra resultados aceptables a largo plazo.

Introduction. Since its inception, abdominoplasty has evolved from a simple en-bloc resection of skin and fat to a multimodal approach that combines correction of all abdominal layers with simultaneous circular liposuction for silhouette contouring. Liposuction in combination with abdominoplasty has proven to be safe and effective, however, there is still debates on how much fat can be safely removed without increasing complication rates. To avoid vascular complications, Villegas addressed a set of modifications to abdominoplasty which he named TULUA. Since then, the authors had performed this technique with acceptable cosmetic outcomes. In this paper, we present a clinical series, marking some technical aspects and evaluating the results. Methods. A retrospective study was carried out involving 28 patients who underwent TULUA abdominoplasty between July of 2017 and July of 2020. Technical aspects, main outcomes and complications were reported. Results. Between this period, TULUA abominoplasty was performed in 28 patients by the senior author. Traditional abdominoplasty was performed in 24 patients and mini abdominoplasty in 4; 26 were primary cases. Mean amount of simultaneously aspired lipoaspirate was 3,3 liters, mean duration of surgery was 3,1 hours and mean size of plication was 7,5x22,9 cm. None of the patients had any skin necrosis or seroma; 6 patients presented complications. Conclusions. TULUA abdominoplasty is an alternative technique to classic abdominoplasty that can be perform in primary and secondary cases with acceptable cosmetic outcomes. Some population with increased risk of vascular complications such us smokers, patients with prior abdominal scars or secondary revisions may have an increased benefit from this approach. The main advantage of this technique is regarding vascular safety by limiting undermining and preserving vessels which allows a full liposuction with less risk. Also, by performing a transverse plication, abdominal wall laxity is addressed, tension at the suture line is reduced and limited dead space is obtained, thus reducing the chance of seroma.

Plicatura gástrica laparoscópica: seguimiento a largo plazo / Laparoscopic gastric plication: long-term follow-up

Resumen Introducción: La experiencia internacional no ha logrado reproducir los resultados de los primeros trabajos de plicatura gástrica laparoscópica (PGL). Objetivo: Analizar los resultados a largo plazo de pacientes sometidos a PGL. Materiales y Método: Estudio prospectivo y descriptivo, se incluyeron pacientes obesos adultos que cumplieron criterios universales para cirugía bariátrica. Se registraron datos epidemiológicos, comorbilidades, tiempo operatorio, estadía hospitalaria, porcentaje de pérdida de exceso de IMC (% PEIMC), complicaciones posoperatorias y resolución de comorbilidades. El seguimiento se efectuó con controles periódicos anuales hasta el año 2020. Resultados: Se inició la selección de pacientes durante el año 2010. Se realizaron 26 intervenciones desde enero de 2011 hasta mayo de 2012. Todas las pacientes fueron de género femenino. El IMC preoperatorio promedio fue 38,8 kg/m2 (DS 3,8). El % PEIMC promedio al año, 3 años y 9 años de posoperado, fue 62,2% (DS 27,1), 40,2% (DS 24,5) y 28% (DS 31,9), respectivamente. Las complicaciones, basadas en la clasificación de Clavien-Dindo (CD), durante los primeros 30 días de posoperatorio fueron 21 pacientes con tipo I, 1 con tipo II, y 2 pacientes con complicaciones tipo IVa. A los 9 años de posoperado, 9 pacientes presentaban efectos adversos tipo I. No hubo mortalidad. Hasta los 3 años hubo corrección de comorbilidades. Se objetivaron 3 pacientes diabéticas al final del estudio, 2 de ellas previamente sanas. Conclusiones: El % PEIMC a largo plazo fue insuficiente. El porcentaje de complicaciones es mayor que en otras técnicas. No recomendamos la realización de la PGL.

Background: The international experience has failed to reproduce the first studies of laparoscopic gastric plication (LGP). Aim: The objective is to analyze the outcomes after 10 years of follow-up of patients subjected to LGP. Materials and Method: Prospective and descriptive study, in which obese adult patients who met universal criteria for bariatric surgery were included. Epidemiological data, comorbidities, operating time, hospital stay, percentage of excess BMI loss (% EBMIL) and resolution of comorbidities were collected. The follow-up was realized by annual periodic controls until 2020. Results: Patient selection began in 2010. A total of 26 interventions were performed from January 2011 to May 2012. All patients were female. The average preoperative Body Mass Index (BMI) was 38.8 kg/m2 (SD 3.8). The average % EBMIL at 1st, 3rd and 9 th postoperative years was 62.2% (SD 27.1), 40.2% (SD 24.5) and 28% (SD 31.9), respectively.Complications, based in Clavien Dindo classification, during the first 30 postoperative days was: 21 patients with type I, 1 type II, and 2 patients with complications type IVa. At 9 th postoperative year, 9 patients presented adverse effect type I. There was no mortality. Until the 3rd year there was correction of comorbidities. Three diabetic patients were observed at the end of the study, 2 previously healthy. Conclusions: The long term % EBMIL was insufficient. The percentage of complications is higher than in other techniques. We do not recommend the LGP.

Estado del arte de la plicatura de rectos / State-of-art of rectus shealth plication

Introducción. La abdominoplastia es un procedimiento que se utiliza para definir el contorno corporal actuando sobre todas las capas de la pared mediante la resección del exceso de piel y grasa subcutánea y la reparación del sistema músculo-aponeurótico. Uno de los componentes a tratar en toda abdominoplastia es la diastasis abdominal, que se logra a través de la plicatura de rectos. Muchas controversias han surgido acerca de la efectividad y duración de la corrección, del mejor tipo de sutura y las consecuencias sobre la presión intraabdominal y el embarazo. Materiales y metodos. Se llevó a cabo una revisión sistemática de la literatura utilizando las bases de datos MEDLINE, LILACS, MEDES y SciELO. Tanto artículos de habla inglesa como hispana fueron tenidos en cuenta. Las palabras clave utilizadas para la búsqueda inicial fueron rectus plication, rectus shealth plication, diastasis, abdominal closure, plicatura abdominal. Resultados. Luego de la búsqueda, 58 artículos fueron seleccionados y revisados. En base a la información obtenida, se dividió la información y se desarrollaron de manera objetiva en puntos separados. Conclusiones. A pesar de que la bibliografía muestra conclusiones disímiles y variables, la plicatura es un procedimiento seguro y potencialmente benefi cioso para la salud tanto en dolores lumbares como incontinencia urinaria, y puede usarse en aquellos casos intratables. Tanto suturas de reabsorción lenta como el PDS y las suturas no absorbibles pueden ser utilizadas para el cierre de la diastasis abdominal con excelentes resultados a largo plazo y sin riesgo de recurrencia

Introduction. Abdominoplasty is a body-contouring procedure for functional and aesthetic improvement that addresses deformity from excess skin and fat and musculofascial laxity. Diastasis repair by plication of the rectus sheath is an integral part of most abdominoplasty procedures. There is no consensus regarding what suture material is best and contradictory information about long term durability, changes in the intraabdominal pressure and pregnancy is seen in the literature. Material and methods. A systematic review of current available literature was performed using the MEDLINE, LILACS, MEDES and SciELO databases. Key words used for initial data bank searches included "rectus plication", "rectus shealth plication" "diastasis" "abdominal closure", "plicatura abdominal". Furthermore, bibliographies and individual plastic surgery journals were searched for additional reference information. Results. Fifty-eight articles met the criteria and were analyzed critically for inclusion. From this information, a narrative synthesis of data was undertaken. Conclusions. Although current literature shows diff erent conclusions, rectus shelth plication can be consider a safe and pottencially benefi tial procedure with signifi cant improvements in posture and quality of life. Absorbable and non absorbable sutures seems to be reliable sutures for the correction of rectus diastasis.

Rotation of the corpora cavernosa for the treatment of congenital penile curvature.

INTRODUCTION: Congenital penile curvature (CPC) is caused by a disorder in the embryonic development of the urethra and corpora cavernosa. The condition causes difficulty for penetration, requiring surgical correction when it prevents intercourse. MATERIAL AND METHODS: We present the cases of 2 men in their 40s who had ventral curvature greater than 60° of 2 years of evolution, with maintained erections. The patients underwent surgery for rotation of the corpora cavernosa. After the complete denudation of the penis, athermal release of the neurovascular bundle of the penis from the ventral side to the dorsal was performed. Once the curvature was verified using artificial erection, an incision was performed in the tunica albuginea of both corpora cavernosa, continuously suturing both internal and external margins with resorbable monofilament. The rectification of the curvature was then checked, and the mucocutaneous plane was reconstructed. RESULTS: The surgical time was 120minutes and there were no intraoperative complications. Both patients were discharged 24h after the surgery. At 1 week, the patients experienced spontaneous night-time erections and were able to maintain sexual relations 1 month after the surgery. At 6 months, the residual curvature was less than 20°, the penile shortening was less than 1 centimeter and the International Index of Erectile Function-5 was 25 for both cases. CONCLUSIONS: Surgery for rotation of the corpora cavernosa helps correct CPC without significant penile shortening or erectile dysfunction. In our opinion, the procedure is an appropriate treatment for patients with CPC but requires studies with long-term follow-up in order to consider it the technique of choice.

Tratamiento endoscópico subcutáneo de la diastasis de músculos rectos y de otros defectos de línea media / Subcutaneous endoscopic repair of diastasis recti and other midline defects

Antecedentes: la diastasis de rectos constituye la separación de la línea media o línea alba, originada en una laxitud de las fibras entrecruzadas de la aponeurosis de ambos músculos rectos. En la actualidad se discute su corrección quirúrgica, existiendo una multiplicidad de factores que lo justifican. Objetivo: analizar la factibilidad y la seguridad del abordaje endoscópico subcutáneo para efectuar la plicatura de músculos rectos, y la corrección de otros defectos de la línea media, en pacientes sin lipodistrofia abdominal. Material y métodos: entre marzo de 2014 y febrero de 2017 fueron abordados por esta vía 42 pacientes con diastasis asociada a otros defectos de línea media. Se analizaron datos demográficos, características de la diastasis, tamaño de los defectos, tiempo operatorio, estadía hospitalaria y complicaciones. El dolor posoperatorio se midió mediante una escala visual análoga, y se valoró la morbilidad y recurrencia mediante ultrasonografía. Resultados: 42 pacientes fueron intervenidos por vía endoscópica. Un 76% fueron de sexo femenino, con una edad promedio de 39 años. En el 93% de los casos, la diastasis fue supraumbilical e infraumbilical, y su tamaño promedio fue de 5,5 cm. Los defectos asociados en su mayoría fueron hernia umbilicales. No se registraron complicaciones intraoperatorias, con un tiempo quirúrgico promedio de 80 minutos. La intensidad de dolor posoperatorio fue de 4,1 puntos. La morbilidad más asociada fue el seroma. Conclusiones: la reparación endoscópica subcutánea de la diastasis de rectos, asociada a otros defectos de la línea media, es factible y segura de realizar. Aporta ventajas estéticas considerables, permitiendo su corrección con complicaciones mínimas.

Background: Diastasis recti is the separation of the midline or linea alba due to laxity of the intercrossed fibers of both aponeurosis of the rectus abdominis muscles. Although the surgical correction of this condition is still under debate, many factors justify it. Objective: The aim of this study was to analyze the feasibility and safety of the endoscopic subcutaneous approach for plication of the rectus muscles associated with other midline defects repair in patients without abdominal lipodystrophy. Material and methods: Between March 2014 and February 2017, 42 patients underwent subcutaneous endoscopic repair of diastasis recti and other midline defects. The demographic data, the characteristics and size of the defects, the surgical time, hospital stay and complications were analyzed. Postoperative pain was measured using a visual analogue scale. Ultrasound was used to evaluate morbidity and recurrence. Results: A total of 42 patients underwent the endoscopic approach; 76% were women and mean age was 39 years. In 93% of the cases, diastasis was supraumbilical and infraumbilical, with a mean size of 5.5 cm. Umbilical hernias were the most common associated defects. No intraoperative complications were reported. Mean surgical time was 80 minutes; the intensity of posoperative pain was 4.1 points and seroma was the most common complications. Conclusions: Subcutaneous endoscopic repair of diastasis recti and other midline defects is a feasible and safe procedure that allows the simultaneous correction of both conditions with minimal complications and esthetic benefits.

Eventración diafragmática en el recién nacido / Diaphragmatic Hernia in the Newborn

La eventración diafragmática es una anomalía relativamente rara, se presenta con una elevación anormal de todo o una parte del hemidiafragma intacto. Se presentó un recién nacido de 41 semanas de edad gestacional, sin diagnóstico prenatal de malformación congénita, parto por cesárea por sufrimiento fetal agudo que se realizó en el Hospital Provincial Docente Carlos Manuel de Céspedes de Bayamo, Granma, nació deprimido, y en su evolución requirió intubación endotraqueal y ventilación mecánica. Se realizó radiografía de tórax, se interpretó como una hernia diafragmática derecha, se adoptaron las medidas correspondientes para su estabilización y se trasladó al Centro Regional de Cirugía Neonatal en Holguín. Se realizó ultrasonido toracoabdominal, y toracotomía derecha, se encontró una eventración diafragmática. Se realizó plicatura del músculo diafragma. A las 48 h presentó trastornos en la perfusión y la radiografía de tórax mostró imagen de neumoperitoneo, se reintervino y se encontró perforación puntiforme en el yeyuno que se suturó. La evolución postoperatoria fue satisfactoria.

A diaphragmatic hernia is a relatively rare condition with an abnormal elevation of the intact diaphragm. A newborn, of 41 weeks of gestation, without prenatal diagnosis of congenital malformation was presented; cesarean delivery was done in “Carlos M. de Céspedes” provincial hospital. Endotraqueal intubation and mechanical ventilation were required. Chest radiography showed diaphragmatic hernia, the patient was stabilized and referred to the Regional Neonatal Surgery Center. Sonographic scan was done and right thoracotomy, diaphragmatic hernia was found. The patient was operated on again in the next 48 hours; a yeyunal perforation was done and closed. The post operatory evolution was satisfactory.

Presentación de un paciente con eventración diafragmática / Presentation of a Patient with Diaphragmatic Eventration

La eventración diafragmática constituye una rara anomalía congénita del diafragma que se presenta debido a una embriogénesis deficiente con atrofia de las fibras musculares del diafragma, transformación de conjuntiva y pérdida del tono muscular. Se presentó el caso de un paciente de 45 años de edad, mestizo, con antecedente de sufrir asma bronquial que acudió a Consulta de Cirugía del Centro Integral de Salud Salvador Allende, Caracas, en septiembre de 2011, refirió episodios de disnea y dolor torácico que se incrementaba con el ejercicio físico. Al examen clínico se detectaron ruidos hidroaéreos en hemitórax izquierdo lo que motivó la indicación de estudios radiográficos que evidenciaron la presencia de una eventración diafragmática de grandes proporciones; fue sometido a intervención quirúrgica con plicatura diafragmática con excelentes resultados.

The diaphragmatic eventration is a rare congenital anomaly of the diaphragm due to a deficient embryogenesis of the diaphragm, with atrophy of muscular fibers, conjunctive transformation and loss of the muscular tone. A 45- year-old male patient with history of asthma who came to Surgery Consultation of Salvador Allende Health Center, Caracas, in September 2011, with episodes of dyspnea and thoracic pain that was increasing with physical exercise. The examination revealed hydroaerial noises to the left hemithorax and radiographic exams were done, the diaphragmatic eventration diagnosis of big proportions was revealed. The surgical treatment was determined by diaphragmatic plication with excellent results.

Parálisis diafragmática en el post operatorio de cirugía cardiovascular, trasplantes cardíaco y pulmonar / Diaphragmatic paralysis in the postoperative period after cardiovascular surgery, and heart and lung transplantation

Objetivo principal: Describir la incidencia, evolución y tratamiento de los pacientes con parálisis diafragmática (PD) en los postoperatorios (POP) de cardiopatías congénitas (CC), trasplante cardiaco (TC) y trasplante pulmonar (TP) en la Unidad de Cuidados Intensivos 35 (UCI 35) del Hospital de Pediatría Juan P. Garrahan. Método: Se estudiaron 43 pacientes POP de CC, TC y TP que cursaron con PD durante los años 2010 al 2013. Se estudiaron datos demográficos como edad expresada en meses, sexo, peso en kilos, la existencia de sindromes genéticos, internación prequirúrgica, mala condición previa presencia de cirugía, circulación extracorpórea (CEC), días en ARM, fracaso de extubación, plicatura diafragmática, defecto residual cardiaco, obstrucción de VAS post extubación, atelectasias (ATL), episodios en ventilación no invasiva (VNI), traqueotomía (TQT), entre otros días de internación, tipo de egreso y sobrevida. Resultados: La incidencia de PD fue del 2,35%, de los 43, 22 fueron niñas, la edad M = 9 meses (0,5-204), con un peso M = 6,8 (2,3-65); 34 pacientes POP de CC, 4 POP de TC y 5 de TP. El 95% de la cirugías fue con CEC, 18 pacientes tenían cirugía previa, 21 con mala condición preoperatoria, los días de ARM M = 10 (0-109), el 55% tuvo al menos un fracaso de extubación, se realizaron 21 plicaturas, dentro de los 5 días del diagnóstico de PD en un 50%, se practicaron 6 TQT, el 83% de los pacientes tuvo por lo menos un episodio en VNI, la sobrevida al alta, de 88%. Conclusiones: Si bien la PD es poco frecuente en nuestra población, aumenta considerablemente la morbilidad de estos pacientes.

Comparação dos níveis plasmáticos de grelina nos períodos pré e pós-operatório em pacientes submetidos à plicatura gástrica associada à fundoplicatura / Comparison of ghrelin plasma levels between pre and postoperative period in patients submitted to gastric plication associated with fundoplication

RACIONAL: A doença do refluxo gastroesofágico e sua recidiva podem estar relacionadas ao ganho de peso tardio após a cirurgia bariátrica, aumentando a incidência de metaplasia colunar e neoplasia. A plicatura gástrica associada à fundoplicatura pode ser empregada com o objetivo de se tratar a doença do refluxo e o sobrepeso. OBJETIVOS: Avaliar o hormônio grelina no pré e pós-operatório, bem como a perda de peso e o controle da doença do refluxo em pacientes submetidos à gastroplicatura com fundoplicatura. MÉTODOS: Foi realizada gastroplicatura com fundoplicatura videolaparoscópica em oito pacientes. Os exames endoscópicos foram realizados no pré e no pós-operatório, bem como a coleta de sangue para a dosagem do hormônio grelina. RESULTADOS: Houve melhora dos sintomas do refluxo e das alterações na mucosa em todos os pacientes. A perda de peso foi significativa. Não houve significância na redução dos níveis plasmáticos de grelina. CONCLUSÕES: Com a plicatura gástrica e fundoplicatura: 1) não houve redução significativa no hormônio grelina, apesar do relato de diminuição da fome e aumento da saciedade pelos pacientes; 2) o procedimento foi eficaz no tratamento da doença do refluxo; 3) obteve-se perda de peso significativa.

BACKGROUND: The recurrence of the gastroesophageal reflux disease may be related to later postoperative weight gain, therefore increasing the chances of developing columnar metaplasia and cancer. The gastric plication associated with fundoplication can be employed in order to be treating the two issues. AIM: To evaluate the serum ghrelin hormone in preand postoperatively as well as weight loss and control of reflux disease in patients undergoing gastroplication associated with fundoplication. METHODS: Was performed laparoscopic gastric plication with fundoplication in eight patients; endoscopic examinations were performed pre and postoperatively as well as blood collection for ghrelin hormonal dosage. RESULTS: There was control of reflux symptoms and mucosal lesions. Weight loss was significant. Since the change of the hormone ghrelin was not of great significance. CONCLUSIONS: Gastric plication associated with fundoplication was effective in treating reflux disease with surgical indication and for weight loss in obese patients. Appetite control occurs, but not due to ghrelin, because no significant decrease of its plasmatic levels was observed.

Técnicas restrictivas en cirugía bariátrica: evolución y tendencias actuales / Restrictive bariatric surgery techniques: evolution and current trends

La cirugía bariátrica ha demostrado ser más efectiva que el tratamiento médico para el control del peso y las comorbilidades asociadas. Se han descrito múltiples técnicas, las cuales pueden ser divididas en tres grupos: cirugías restrictivas, en las que el objetivo principal es disminuir el volumen de la ingesta calórica; cirugías malabsortivas, en las que se limita la absorción a nivel intestinal; y una combinación de ambas. Dentro de las técnicas restrictivas, la gastroplastía fue uno de los primeros procedimientos descritos. Inicialmente horizontal y luego la gastroplastía vertical anillada, mostraban buenos resultados a corto plazo, pero con una importante tasa de fracaso a largo plazo, por lo que estas técnicas fueron abandonadas paulatinamente. La banda gástrica ajustable tiene la ventaja de ser mínimamente invasiva y reversible, la baja de peso es adecuada pero menos efectiva que en el bypass gástrico. Las complicaciones postoperatorias son pocas inicialmente, sin embargo aumentan con los años de seguimiento. La gastrectomía vertical tubular es un procedimiento efectivo para bajar de peso, que puede ser realizado en forma segura como procedimiento primario único o como primera etapa de otro procedimiento. Esto se refleja en una excelente baja de peso y control de las comorbilidades, lo cual la hace comparable a otros procedimientos bariátricos aceptados. Finalmente en los últimos años han aparecido reportes promisorios de una nueva técnica, la plicatura gástrica.

Bariatric surgery has proved to be more effective than medical therapy in the treatment for obesity. Multiple techniques have been described and can be divided into three main groups: Restrictive surgery, where the main objective is to decrease the volume of caloric intake; malabsortive surgery, where a portion of the absortive circuit is bypassed and thus limiting the caloric absortion; and a combination of both. Among the restrictive techniques, gastroplasty was one of the first procedures described. First horizontal gastroplasty and then vertical banded gastroplasty showed good short-term results but with poor long-term outcomes. These techniques have been gradually abandoned. Adjustable gastric banding is a minimally invasive technique and has the advantage of being reversible. Weight loss is adequate, but less effective than gastric bypass. Postoperative complications are low at short-term, but increase per year at long-term follow-up. Sleeve gastrectomy is an effective weight loss procedure that can be performed safely as a first stage or primary procedure. This results in excellent weight loss and co-morbidity reduction that exceeds, or is comparable to, that of other accepted bariatric procedures. Gastric plicature is a relatively new procedure and has reported good short-term outcomes in weight loss with few short-term complications. However, long-term outcomes are yet to be demonstrated.

Plicatura gástrica laparoscópica, un nuevo procedimiento bariátrico: a propósito de un caso clínico / Laparoscopic gastric plication, a new bariatric procedure: report of one case

Bariatric surgery is an effective treatment for morbid obesity. Various techniques have been developed with different outcomes and complications. A new technique with promising results recently described in the literature: the gastric plication, which would not have the complications of using mechanical suture and would imply a reduction of costs. We report the first case in Chile under this technique.

La cirugía bariátrica es un tratamiento efectivo para la obesidad mórbida. Diversas técnicas se han desarrollado con diferentes resultados y complicaciones. Una nueva técnica con resultados prometedores se ha descrito recientemente en la literatura: la plicatura gástrica, la cual no tendría las complicaciones del uso de sutura mecánica e implicaría una reducción de los costos. Presentamos el caso clínico del primer paciente en Chile sometido a esta técnica.

Eventración diafragmática congénita, hospital Doctor Abel Gilbert Pontón / Congenital diaphragmatic eventration, Abel Gilbert Pontón hospital

Se presenta el caso de un lactante menor, masculino, de un mes de edad que ingresa al servicio de pediatría del hospital “Dr. Abel Gilbert Pontón” con insuficiencia respiratoria grave. La radiología demostró la elevación del diafragma derecho y su evolución satisfactoria inmediata posterior a la intervención quirúrgica de plicatura del diafragma. Con lo que se corrigió el defecto del diafragma que limitaba la capacidad torácica (pulmonar).

Operación de Burch en tratamiento de incontinencia urinaria de esfuerzo / Burch technique in treatment of effort urinary incontinence

La incontinencia urinaria de esfuerzo (IUE) es la más frecuente de las incontinencias urinarias (IU); se define como pérdida involuntaria de orina por aumento de la presión abdominal; están involucrados múltiples factores predisponentes que originan falla de soporte del suelo pélvico; puede o no asociarse a relajación pélvica.Se realizó estudio retrospectivo en el servicio de Ginecología del Hospital Teodoro Maldonado Carbo del IESS; el universo lo constituyó 82 casos (Nov 1994-Abril 2000), cuya edad media fue de 47.8 años; 13 (15.86%) pacientes presentaron colpoperineorrafia previa. La técnica de Burch no presentó complicación operatoria; se retiró sondaje vesical a los 2 días promedio, colocándose nuevamente por retención urinaria, en 15 pacientes; esta es la complicación hospitalaria más frecuente, con esta técnica.Alta médica fue dada a 63 (76.82%) pacientes, 17 (20.74%) no acudieron a ningún control o lo abandonaron y 2 continúan en consulta por recidiva.

Effort urinary incontinence (EUI) is the most frequent variant of the UI. It’s defined as the involuntary loss of urine for elevation of abdominal pressure; multiple predisponent factors are involved.A retrospective study was done at the Gyn Service of Teodoro Maldonado Carbo Hospital.The universe was 82 cases (Nov 94 – Apr 2000); the average age was 47.8 years; 13 patients (15.86%) showed previous colpoperineorraphy.Burch technique didn’t present any amplication; vesical probe was retired in 2 days (average), placing again in 15 patients with incontinence, being this the most frequent hospitalary complication.Discharge was given to 63 patients (76.82%), 17 patients didn’t go to any follow-up and 2 continue the visits for recidivances.