RESUMO
Laparoscopic common bile duct exploration (LCBDE) remains underutilized in the management of common bile duct (CBD) stones. The exact cause of this under-utilization remains unclear; however, identified barriers to LCBDE implementation include lack of training and unavailability of dedicated instruments. LCBDE is an attractive alternative for stone retrieval in patients with Roux-en-Y gastric bypass given the anatomical difficulty in endoscopic retrograde cholangiopaneatography (ERCP). Direct visualization through choledochoscopy is the method of choice for LCBDE. However, dedicated choledoscopes are expensive and not widely available, which may lead surgeons to seek for alternatives at their particular environment. With the COVID-19 pandemic, disposable bronchoscopes have become widely accessible at our institution, raising the possibility of using one for direct vision of the biliary tract. We present the case of a 61-year-old male with past medical history of Roux-en-Y gastric bypass, who presented to the emergency department with a CBD stone. Successful LCBDE was achieved with the aid of a disposable bronchoscope for direct visualization of the biliary tract. Supplementary Information: The online version contains supplementary material available at 10.1007/s12262-022-03642-7.
RESUMO
In late December 2019, COVID-19, a new emerging disease, quickly spread in Wuhan, China. The WHO formally declared it a pandemic and a health emergency on March 11th, 2020. The objective of this article is to specify and list key points in relation to the recommendations issued by the different colleges, and global surgical societies, for the benefit of the Mexican medical and surgical community. Based on scientific evidence, we make recommendations for medical consultations, surgical and endoscopic procedures, hospital infrastructure, and surgical services, in addition to a proposal to reopen surgical services and elective procedures related to the COVID-19 pandemic. The time to take leadership in healthcare where the national health system together with academic societies, universities and private initiative join forces to combat the pandemic has arrived. It is convenient to form collaboration groups of experts in the different specialties that through innovation in health and education, with evidence-based medicine, efficiency of operational costs and tools such as telemedicine, allow us to return to daily surgical procedures, reestablishing the surgery services as soon as possible.
A finales de diciembre de 2019, la COVID-19, una nueva enfermedad emergente, rápidamente se propagó en Wuhan, China. La Organización Mundial de la Salud la declaró formalmente una pandemia y emergencia sanitaria el 11 de marzo de 2020. El objetivo de este artículo es precisar y enumerar los puntos clave en relación a las recomendaciones emitidas por los distintos colegios, y sociedades quirúrgicas globales, para beneficio de la comunidad médica y quirúrgica mexicana. De acuerdo con la evidencia científica, se realizan recomendaciones para las consultas médicas, los procedimientos quirúrgicos y endoscópicos, la infraestructura hospitalaria y los servicios de cirugía, además de una propuesta a la reapertura para procedimientos quirúrgicos en torno a la pandemia de COVID-19. El momento de tomar el liderazgo en salud en el que el sistema nacional de salud y las sociedades académicas, las universidades y la iniciativa privada sumen esfuerzos para combatir la pandemia ha llegado. Es conveniente formar grupos de colaboración de expertos en las distintas especialidades que, por medio de innovación en salud y educación, apego a la medicina basada en la evidencia, eficiencia de costos operacionales y herramientas como la telemedicina, permitan regresar a los procedimientos quirúrgicos cotidianos y la operación de los servicios de cirugía se reestablezca a la brevedad.