Alteraciones de la pared abdominal: onfalocele / Abdominal wall defects: omphalocele

Introducción: los defectos de la pared son malformaciones congénitas con herniación de algunos órganos de la cavidad abdominal, como es el onfalocele. La prevalencia calculada es 1/10.000 nacimientos en países occidentales, en Colombia se desconoce. El diagnóstico es pre o posnatal requiriendo una serie de exámenes clínicos sistémicos, evaluación diagnóstica secundaria y búsqueda de anomalías asociadas; el tratamiento ha mejorado las tasas de supervivencia entre 70 y 95%. Objetivo: dar a conocer la patología y correlacionar los hallazgos genéticos, ambientales, clínicos y exámenes complementarios para el diagnóstico oportuno, derivando así al paciente a un tratamiento óptimo con disminución de la mortalidad. Materiales y métodos: revisión actualizada de la literatura utilizando buscadores Pubmed, UpToDate y ClinicalKey con énfasis en revisiones sistemáticas, casos clínicos y principales guías clínicas internacionales. Después se envió al jefe del departamento de cirugía pediátrica y a la división de publicaciones para su conocimiento, revisión y aprobación. Resultados: se analizaron 17 artículos publicados en los últimos 5 años, seleccionando los más relevantes y con evidencia clínica actual. Discusión y conclusiones: los estudios recientes han evidenciado nuevos hallazgos que han mejorado la supervivencia y reducido la mortalidad en los últimos 50 años.

Introduction: abdominal wall defects are congenital malformations associated with herniated abdominal organs, such as omphalocele. Its estimated prevalence is 1 per 10.000 live births in western countries. In Colombia the prevalence of omphalocele remains unknown. Omphalocele may be pre or postnatally diagnosed. A series of systemic clinical exams, secondary diagnostic evaluation and assessment for accompanying anomalies, are necessary. Treatment has improved survival rate to 70 and 95%. Objective: to increase awareness of this anomaly and correlate genetic, environmental and clinical findings and complementary exams to enable the early diagnosis and referral of these patients to receive optimal treatment which will reduce mortality. Materials and methods: updated literature review using Pubmed, UpToDate and ClinicalKey search engines, focused on systematic reviews, clinical cases and main international clinical practice guidelines. Found data was submitted to the head of the pediatric surgery department and to the publications division for their information, review and approval Results: 17 articles published in the last 5 years including the most relevant which contained current clinical evidence, were selected. Discussion and conclusions: recent studies have evidenced new findings that have improved survival and reduced mortality in the last 50 years.

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.

Colecistectomía laparoscópica de urgencia experiencia en el Hospital de San José, Bogotá DC / Emergency laparoscopic cholecystectomy Hospital de San José, Bogotá DC

Las técnicas mínimamente invasivas permiten el manejo de cuadros agudos como la colecistitis con buenos resultados en términos de morbimortalidad. Objetivo: analizar los resultados de la colecistectomía laparoscópica en casos agudos atendidos en el Hospital de San José de Bogotá DC, en el período enero 2010 a enero 2011. Materiales y métodos: serie de casos llevados a colecistectomía laparoscópica. Se revisaron variables clínicas y paraclínicas, duración del cuadro clínico, tiempo en ser llevado al acto quirúrgico, duración de la cirugía, necesidad de conversión y complicaciones. Resultados: de 267 pacientes, 173 (64.8%) fueron mujeres, la edad mediana 43 años (RIQ: 33-56). Ingresaron con cuadro clínico de colecistitis moderada 130 (48%) y severa 2 (0.9%). La fase aguda fue el hallazgo intraoperatorio en 142 casos (53.1%). La correlación histopatológica reveló igual número de casos (126; 48%) con colecistitis aguda y crónica, y solo colecistitis crónica. En los primeros tres días 221 (82.7%) fueron llevados a cirugía. La necesidad de conversión fue de 25 (9.3%) y solo se presentó una muerte (0.3%) en el postoperatorio temprano. Conclusiones: la colecistitis aguda y el cólico biliar son las causas más frecuentes de colecistectomía de urgencias, correspondiendo el hallazgo patológico de fase crónica a episodios de cólico biliar. La intervención quirúrgica temprana se asocia con disminución de morbimortalidad...

Acute conditions such as cholecystitis may be treated with minimally invasive techniques with good results in terms of morbidity and mortality. Objective: to analyze the outcome of laparoscopic cholecystectomy for acute cholecystitis performed at Hospital de San José, Bogotá DC, between January 2010 and January 2011. Materials and Methods: series of cases who underwent laparoscopic cholecystectomy. Variables such as, clinical, lab and complementary exams, time period between onset of symptoms and surgery, operative time, conversion rates and complication rates were reviewed. Results: of 267 patients, 173 (64.8%) were females, median age was 43 years (IQR: 33-56). At admission 130 (48%) cases were classified as moderate and 2 (0.9%) as severe cholecystitis. In 142 (53.1%) cases intraoperative findings were interpreted as the acute phase of acute cholecystitis. The histology/pathology correlation revealed an equal number for acute and chronic cholecystitis (126; 48%) and only chronic cholecystitis. 221 (82.7%) patients underwent surgery in the first three days. Conversion was necessary in 25 (9.3%) cases and there was only one death (0.3%) in the early postoperative period. Conclusions: acute cholecystitis and chronic biliary pain are the most frequent causes of emergency cholecystectomy and the pathological finding described as chronic phase corresponded to chronic biliary pain episodes. When performed early, this surgical procedure is associated with reduced morbidity and mortality...