Establishing consensus on the perioperative management of cholecystectomy in public hospitals: a Delphi study with an expert panel in Mexico.

BACKGROUND: Several guidelines have put forward recommendations about the perioperative process of cholecystectomy. Despite the recommendations, controversy remains concerning several topics, especially in low- and middle-income countries. The aim of this study was to develop uniform recommendations for perioperative practices in cholecystectomy in Mexico to standardize this process and save public health system resources. METHODS: A modified Delphi method was used. An expert panel of 23 surgeons anonymously completed two rounds of responses to a 29-item questionnaire with 110 possible answers. The consensus was assessed using the percentage of responders agreeing on each question. RESULTS: From the 29 questions, the study generated 27 recommendations based on 20 (69.0%) questions reaching consensus, one that was considered uncertain (3.4%), and six (20.7%) items that remained open questions. In two (6.9%) cases, no consensus was reached, and no recommendation could be made. CONCLUSIONS: This study provides recommendations for the perioperative management of cholecystectomy in public hospitals in Mexico. As a guide for public institutions in low- and middle-income countries, the study identifies recommendations for perioperative tests and evaluations, perioperative decision making, postoperative interventions and institutional investment, that might ensure the safe practice of cholecystectomy and contribute to conserving resources.

[Laparoscopic Roux-en-Y gastric bypass surgery for morbid obesity. Experience at the Nacional de Ciencias Médicas y Nutrición Salvador Zubirán]. / Bypass gástrico laparoscópico en Y de Roux y obesidad mórbida. Experiencia en el Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.

INTRODUCTION: Morbid obesity is a serious health problem associated to a significant reduction in life expectancy. OBJECTIVE: To evaluate the anthropometric and metabolic changes observed in obese patients, 3, 6 and 12 months after laparoscopic Roux-en-Y gastric bypass surgery and the complications associated with the procedure. MATERIAL AND METHODS: Retrospective study that included 128 consecutive obese patients submitted for bariatric surgery at the INCMNSZ (2004-2006). RESULTS: Their mean age was 38 +/- 10 years, 83% were women with a BMI of 48 +/- 6 Kg/m2. 65% were hypertensives, 55% had hypertriglyceridemia and 34% diabetes. A year after surgery all patients had at least reduced 20% their body weight and the percentage of excess body weight loss was 73%. The prevalence of hypertension, hypertrigliceridemia and diabetes was reduced to 24%, 17% and 12%, respectively (p < 0.001). Four patients died (3%), all of them had a leak of the anastomosis and intra-abdominal abscess. One died because pulmonary embolism, another with a myocardial infarction (after surgical reinterventions) and the other two with sepsis. CONCLUSIONS: Laparoscopic Roux-en-Y gastric bypass surgery in morbid obese patients favors significant reductions in body weight and associated co morbidities. This surgery is not free of complications and mortality, reason why it must be done only by surgical and interdisciplinary groups with experience in these procedures.

Transoral Endoscopic Thyroidectomy by Vestibular Approach-Initial Experience and Comparative Analysis in the First Reported Mexican Cohort.

Introduction: Transoral endoscopic thyroidectomy by vestibular approach (TOETVA) is a relatively new technique for the surgical treatment of thyroid diseases. We present the initial experience of a reference hospital of Mexico with TOETVA. Materials and Methods: This is a comparative retrospective study of cases (TOETVA) and controls (open thyroidectomy) treated by the endocrine surgeons between July 2017 and April 2019. Cases were patients of any gender, older than 18 years of age, with malignant thyroid nodules <2 cm or undetermined <5 cm without extrathyroidal extension and no lymph node or distant metastasis. Demographic, operative, and postoperative data were obtained and analyzed. Results: Twenty patients were surgically treated by TOETVA during the study period. Controls were paired based on type of surgery and dominant thyroid nodule. Ninety percent of the patients had a definitive diagnosis of malignancy. No statistically significant differences were found in age, BMI, length of stay, thyroid lobes size, and complication rates. Operative time was longer in TOETVA (216.7 ± 62.5 vs. 153.9 ± 49.25 minutes; t test P < .0001) and intraoperative blood loss was lesser for the TOETVA group (38.25 ± 38.9 vs. 101.8 ± 126.6 mL; t test P < .04). Conclusions: TOETVA is a feasible and relatively safe surgical technique for patients with benign and malignant thyroid diseases. Complication rates seem to be comparable with conventional open technique with lesser intraoperative bleeding; nevertheless, it requires longer operative times.

Patología quirúrgica de las neoplasias foliculares de la tiroides en el Centro Médico ABC / Surgical pathology of follicularthyroid tumors in the ABC Medical Center

Se realizó un estudio retrospectivo, observacional y longitudinal de tiroidectomías efectuadas en el Centro Médico ABC durante el periodo comprendido de enero de 1998 a julio del 2001. Se efectuaron un total de 156 cirugías tiroideas, 22 (14. 1 por ciento) de ellas fueron por neoplasias foliculares. En 16 (72.72 por ciento) casos se tomó biopsia por aspiración con aguja fina, el diagnóstico se reportó como indeterminado. A diez (45.45 por ciento) se les practicó garmmagrama, todos con nódulo frío. Cuatro (18.18 por ciento) pacientes fueron diagnosticados con ultrasonido convencional. A uno (4.54 por ciento) se le hizo el diagnóstico de nódulo tiroideo mediante palpación. A dieciocho (81.8 1 por ciento) pacientes se les realizó estudio transoperatorio; de éstos, diez (55.55 por ciento) casos fueron reportados como neoplasia folicular, cinco (27.77 por ciento) como adenoma folicular y dos (11. 11 por ciento) como carcinoma folicular. Un estudio (5.55 por ciento) fue diferido. Diecinueve (86.36 por ciento) de los diagnósticos definitivos correspondieron a neoplasias benignas y tres (13.63 por ciento) malignas. No hubo mortalidad perioperatoria. El estudio transoperatorio es ampliamente usado por los cirujanos del Centro Médíco ABC. La correlación entre los casos que se diagnosticaron como carcinoma o adenoma folicular fue perfecta. El manejo de las neoplasias foliculares de la tiroides en el Centro Médico ABC es seguro, no se ha registrado mortalidad perioperatoria y la morbilidad es mínima.