Impact on infectious outcomes during laparoscopic cholecystectomy with the use of home-made vs commercial gallbladder retrieval bag: a retrospective comparative study in a high-volume center.

BACKGROUND: Laparoscopic cholecystectomy (LC) is one of the most commonly performed emergency procedures, with approximately 600,000 patients undergoing the procedure every year in the United States. Although LC is associated with fewer complications when compared with open cholecystectomy, the risk for infectious complications, including surgical site infection and intra-abdominal abscess, remains a significant source of postoperative morbidity. The goal of this study is to determine whether the gallbladder retrieval technique during LC affects risk of infectious complications. METHODS AND PROCEDURES: We conducted a retrospective comparative study in a minimally invasive surgery high-volume center in Bogota, Colombia. Patients who underwent LC in 2018 to 2020 were identified. The patients were divided into three groups. One group of LC performed using home-made gallbladder retrieval bag (HMGRB), and another group of LC performed using commercial gallbladder retrieval bag (CGRB). The primary outcomes were infectious complications of superficial site infection and intra-abdominal abscess. RESULTS: A total of 68 (7.58%) patients underwent LC using an HMGRB, and 828 (92.41%) using a CGRB. There was no significant difference in preoperative sepsis, or sex distribution between patient groups. Using t test, we found differences on age distribution among groups (p < 0.01), surgical times (p < 0.01), and length of stay (p = 0.01). When using Chi square, we found differences in Tokyo and Parkland Grading Scale severity (p < 0.01), use of postoperative antibiotics (p < 0.01), and drain use (p < 0.01). Nonetheless, there was no difference in the rate of superficial surgical site infection (p = 0.92). CONCLUSION: HMGRB are not associated with increased risk of postoperative intra-abdominal abscess or superficial surgical site infection in comparison with CGRB but imply longer surgical times and length of stay. The use of HMGRB is safe, feasible, and has lower cost during LC.

Pylephlebitis with splenic abscess following transrectal prostate biopsy: rare complications of intra-abdominal infection.

Pylephlebitis is a rare complication of intra-abdominal infection involving septic thrombosis of the portal system. If the splenic vein is compromised, this can lead to a splenic abscess, an extremely rare complication of pylephlebitis. The pathophysiology behind these clinical entities remains unclear. In both cases, symptoms are highly nonspecific and include fever, malaise and abdominal pain. Here, we discuss a case in which a patient develops both pylephlebitis and a subsequent splenic abscess following a transrectal prostate biopsy. Diagnosis was made by computerized tomography scan; the treatment included broad spectrum antibiotics and laparoscopic splenectomy, after which the patient made a full recovery.

La primipaternidad y el tiempo corto de cohabitación sexual, factores asociados al desarrollo de preeclamsia / The first time paternity and the short time of sexual cohabitation, factors associated to the development of Pre-Eclampsia

Los trastornos hipertensivos son las complicaciones médicas más frecuentes durante el embarazo, siendo un problema de salud pública en todo el mundo. Estudios anteriores han planteado la posibilidad de una asociación entre la exposición corta al esperma paterno de una nueva pareja y el desarrollo de una reacción inmunológica que puede desencadenar la preeclamsia al final del embarazo. Por esta razón estudiamos la relación entre la primipaternidad y el tiempo de cohabitación sexual con la aparición de la preeclamsia. Se diseñó un estudio de casos y controles en un grupo de 140 mujeresque fueron hospitalizadas para la atención del parto en la Clínica el Bosque (Bogotá, Colombia). Para un total de 70 casos y 70 controles. Se observó que aquellas mujeres que tuvieron un tiempo de cohabitación sexual menor a 4 meses, presentaban una probabilidad 7 veces mayor de desarrollar preeclamsia, luego de ajuste por Hipertensión Arterial Crónica y antecedente de Hipertensión Inducida por el Embarazo en embarazos previos OR: 8.75 IC 95 (1, 78-42,88) p <:0,007. La primipaternidad, no demostró ser un factor de riesgo estadísticamente significativo para el desarrollo de preeclamsia OR: 1,18IC95: (0,611-2,306) p <:0,368. Otros factores estudiados que mostraron asociación estadísticamente significativa fueron: Antecedente preeclamsia en el embarazo anterior (OR: 16,638 IC95: 3,742-73,971) p (0,0000..); Hipertensión Arterial Crónica (OR: 5,016 IC95 1,043-24,028p< 0.028).