Caracterización de los desenlaces quirúrgicos a corto plazo en gastrectomía por laparoscopia en un centro de alto volumen: 10 años de experiencia / Short-term surgical outcomes of laparoscopic gastrectomy in a high-volume center: 10-year experience

Introducción. El cáncer gástrico en Colombia es la segunda neoplasia más común en hombres y la cuarta en mujeres. En los últimos años se han descrito ampliamente los beneficios del abordaje laparoscópico en el cáncer gástrico frente a sangrado, recuperación postoperatoria y complicaciones, sin afectar los resultados oncológicos. Métodos. Estudio observacional retrospectivo de pacientes llevados a gastrectomía laparoscópica en la Clínica Universitaria Colombia durante un período de diez años, entre 2013 y 2023. Se describieron los resultados perioperatorios en cuanto a estancia hospitalaria, sangrado operatorio, duración del procedimiento, complicaciones, causas de reintervención y mortalidad en los primeros 30 días. Resultados. Se incluyeron 418 pacientes, 58,9 % hombres, con una edad promedio de 60,8 años. Se documentó un tiempo quirúrgico promedio de 228,7 minutos, con un sangrado de 150 ml. La media de ganglios linfáticos resecados fue de 26,1 ± 11,4. La estancia hospitalaria en promedio fue de 4 ± 4 días, y se registraron complicaciones en 104 sujetos, con una tasa promedio de 24 %, de las cuales 29 (27,4 %) obtuvieron una clasificación Clavien-Dindo IIIB. Conclusiones. La gastrectomía por laparoscopia en un centro de alto volumen y con cirujanos experimentados en Colombia, tiene resultados perioperatorios similares a lo reportado en la literatura mundial. Aún se requiere de estudios de mayor fuerza de asociación para establecer recomendaciones sobre el uso rutinario de este abordaje en patología maligna avanzada.

Introduction. Gastric cancer in Colombia is the second most common neoplasm in men and the fourth in women. In recent years, the benefits of the laparoscopic approach in gastric cancer against bleeding, postoperative recovery com and complications have been widely described, without affecting oncological results. Methods. Retrospective observational study of patients undergoing laparoscopic gastrectomy at the Clínica Universitaria Colombia over a period of ten years, between 2013 and 2023. Perioperative results were described in terms of hospital stay, operative bleeding, duration of the procedure, complications, causes of reintervention, and mortality in the first 30 days. Results. 418 patients were included, 58.9% men, with an average age of 60.88 years. An average surgical time of 228.7 minutes was documented, with a blood loss of 150 ml. The mean number of lymph nodes resected was 26.1 ± 11.4. The average hospital stay was 4 ± 4 days, and complications were recorded in 104 subjects, with an average rate of 24%, of which 29 (27.4%) obtained a Clavien-Dindo IIIB classification. Conclusions. Laparoscopic gastrectomy in a high-volume center and with experienced surgeons in Colombia has perioperative results similar to those reported in the world literature. Studies with greater strength of association are still required to establish recommendations on the routine use of this approach in advanced malignant pathology.

Comparación de desenlaces a corto plazo de gastrectomía laparoscópica mínimamente invasiva en adultos mayores con cáncer gástrico localmente avanzado / Comparison of short-term outcomes of minimally invasive laparoscopic gastrectomy in older adults with locally advanced gastric cancer

Introducción. El objetivo de este estudio fue comparar los desenlaces a corto plazo de la gastrectomía laparoscópica en adultos vs. adultos mayores con cáncer gástrico localmente avanzado en una cohorte de un país occidental. Métodos. Estudio de cohorte prospectivo en pacientes sometidos a gastrectomía laparoscópica por cáncer gástrico localmente avanzado, en el Hospital Universitario Erasmo Meoz, de Cúcuta, Colombia, entre noviembre de 2014 y diciembre de 2018. Se realizó análisis descriptivo, de comparación de grupos y bivariado. Resultados. De un total de 116 pacientes, 51 pacientes (44 %) tenían 65 años o más y 63 pacientes (54 %) eran hombres. No se encontró diferencia estadísticamente significativa al comparar los pacientes menores de 65 años con los de 65 años o más. La mediana del tiempo operatorio fue de 240 minutos en ambos grupos (p>0,05), la mediana de los márgenes de resección macroscópica fue 6 cm vs. 5 cm (p>0,05), la mediana de los ganglios linfáticos disecados fue 25 vs. 19 (p>0,05), la mediana de ganglios linfáticos positivos fue 4 vs. 3 (p>0,05), la mediana de estancia fue de 7 días en ambos grupos (p>0,05). La tasa general de complicaciones posoperatorias no difirió significativamente entre adultos (7%) y adultos mayores (11 %) (p>0,05) y no se observaron diferencias significativas en las tasas de complicaciones menores (Clavien-Dindo grado II; 3-5 % vs. 6-12 %; p>0,05) y graves (Clavien-Dindo ≥ IIIa; 3-5 % vs. 4-8 %; p>0,05). Conclusiones. No se encontraron diferencias estadísticamente significativas en los resultados a corto plazo entre los pacientes adultos y adultos mayores con cáncer gástrico localmente avanzado tratados con gastrectomía laparoscópica. Esta técnica es segura en ancianos.

Introduction. The objective of this study was to compare the short-term outcomes of laparoscopic gastrectomy in adults vs. older patients with locally advanced gastric cancer from a Western country cohort. Methods. Prospective cohort study in patients undergoing laparoscopic gastrectomy for locally advanced gastric cancer at the Hospital Universitario Erasmo Meoz, de Cúcuta, Colombia, between November 2014 and December 2018. Descriptive, group comparison and bivariate analysis was performed. Results. Of a total of 116 patients, 51 patients (44%) were 65 years or older and 63 patients (54%) were men. No statistically significant difference was found when comparing patients under 65 years of age with those 65 years of age or older. The median operating time was 240 minutes in both groups (p>0.05), the median macroscopic resection margins were 6 cm vs. 5 cm (p>0.05), the median number of lymph nodes dissected was 25 vs. 19 (p>0.05), the median number of positive lymph nodes was 4 vs. 3 (p>0.05), the median stay was 7 days in both groups (p>0.05). The overall rate of postoperative complications did not differ significantly between adults (7%) and older adults (11%) (p>0.05) and no significant differences were observed in the rates of minor (Clavien-Dindo grade II; 3-5% vs. 6-12%; p>0.05) and severe complications (Clavien-Dindo ≥ IIIa; 3-5% vs. 4-8%; p>0.05). Conclusions. No statistically differences were found in short-term outcomes between adult and older patients with locally advanced gastric cancer treated with laparoscopic gastrectomy. This technique is safe in the elderly.

Uso de vasopresina en el postoperatorio de cirugía de Fontan: inferencias sobre morbimortalidad / Vasopressin use in postoperative Fontan surgery: implications for morbidity and mortality

Introducción: Se ha postulado que el uso de vasopresina tendría efectos beneficiosos en el postoperatorio de cirugía cardiovascular. Objetivo: Evaluar la respuesta a la vasopresina en el postoperatorio (POP) de cirugía de Fontan de nuestra población. Métodos: Estudio de casos y controles anidados en una cohorte retrospectiva. Se incluyeron pacientes con cirugía de Fontan entre 2014 y 2019. Se registraron variables demográficas, datos del cateterismo pre-Fontan, días de asistencia respiratoria mecánica (ARM), necesidad de inotrópicos, diuréticos, diálisis, dieta hipograsa, octreotide, sildenafil y nutrición parenteral total (NPT); balance de fluidos al primer y segundo día POP, necesidad de cateterismo en el POP, días de permanencia de tubo pleural, días de internación, necesidad de reinternación y mortalidad. Se compararon los grupos con y sin vasopresina utilizando la prueba de Mann- Whitney-Wilcoxon test. Se consideró significativa una p < 0.05. Resultados: Del total analizado, 35 pacientes recibieron vasopresina. En el grupo control fueron 58 pacientes con características similares de gravedad sin vasopresina. No se encontraron diferencias en la evolución postoperatoria entre ambos grupos. El grupo con vasopresina recibió en mayor proporción dieta hipograsa. Conclusiones: En nuestra serie el uso de vasopresina no marcó diferencias significativas en términos de morbimortalidad con relación al grupo control (AU)

Introduction: The use of vasopressin has been suggested to have beneficial effects in the postoperative period after cardiovascular surgery. Objective: To evaluate the response to vasopressin in the postoperative period (POP) of Fontan surgery in our population. Methods: Nested case-control study in a retrospective cohort. Patients who underwent Fontan surgery between 2014 and 2019 were included. Demographic variables, pre-Fontan catheterization data, days of mechanical ventilation (MRA), need for inotropics, diuretics, dialysis, low-fat diet, octreotide, sildenafil and total parenteral nutrition (TPN); fluid balance at first and second day POP, need for catheterization at POP, duration of chest tube drainage, days of hospitalization, need for readmission, and mortality were recorded. Groups with and without vasopressin were compared using the Mann-Whitney- Wilcoxon test. A p < 0.05 was considered significant. Results: Of all patients analyzed, 35 received vasopressin. The control group consisted of 58 patients with similar severity characteristics who did not receive vasopressin. No differences were found in the postoperative outcome between the two groups. The vasopressin group received a higher proportion of low-fat diet. Conclusions: In our series the use of vasopressin did not show significant differences in terms of morbidity and mortality compared to the control group (AU)

Rinoplastia secundaria: infección nasal en el postoperatorio / Secondary rhinoplasty: postoperative nasal infection

La rinoplastia es una de las intervenciones más comunes en cirugía plástica. Se opera aquí una rinoplastia secundaria por vía abierta injertando los alares y la punta con cartílagos auriculares, mientras el tabique cartilaginoso fue usado para los spreader grafts. Se describe aquí una infección posoperatoria de su punta nasal. Al 9no día de su posoperatorio comienza con la punta nasal congestiva y levemente inflamada. Se medica con una crema con antibióticos, pero el día 14 aparece con la punta nasal muy inflamada y con colección. Cuando en el consultorio el cirujano la ve, como cualquier absceso, decide realizarle drenaje con un trocar 18G, 3 miniincisiones en la piel debajo de la punta nasal, de la que drena un líquido amarronado. Luego con el mismo trocar se realiza un lavado dentro de la cavidad con rifampicina solución. Se medica con trimetoprima-sulfametoxazol (Bactrimforte®) 2 comp/día. Al otro día se observa una notable mejoría. Se continuó con lavado diario durante 4 días con el mismo antibiótico evolucionando rápidamente bien. El Bactrim se lo continúa por 20 días. Al mes la punta nasal está muy bien, deshinchada con cicatrices apenas visibles. A los cuatro meses, la punta está muy blanda, las alas nasales y las narinas normales, la punta con buena proyección igual que el dorso con los spreader graft.

Rhinoplasty is one of the most common interventions in plastic surgery. A secondary open rhinoplasty was carried out grafting the allae and the tip of the nose with conchae cartilage, while the septum was used for spreader grafts. We are here describing this post operatory with a tip of the nose infection.In the control, at the 9th postoperative day, the nasal tip began to be congested and at the 14th post op day the patient showed a clear inflammatory collection. In the office, the surgeon decided to evacuate it with three punctureslike little incisions at the inferior part of the skin tip with a trocar 18G. Through them, drained brownish purulent secretion. With the same trocar, rifampicin solution was injected through these little incisions, like washing the subdermal area. It was medicated with trimethoprim-sulfamethoxazole (Bactrim forte®) 2 tablets/day. The following day, there was a clear improvement in the congestion and erythema of the nose. This procedure of washing was repeated for four days. There was a quick evolution of the inflammatory process and 20 more days, there was no sign of the infection. Four months later, the tip of the nose was soft and the result was considered optimal by the patient and doctors.

Fístula pancreática: una complicación temida. Experiencia en una unidad de cirugía hepatobiliopancreática de cuarto nivel / Pancreatic fistula: A feared complication. Experience in a fourth level hepatobiliopancreatic surgery unit

Introducción. La fístula pancreática postoperatoria es una de las complicaciones más importantes en la cirugía hepatobiliopancreática. Su diagnóstico se hace mediante la presencia de un nivel de amilasa en el líquido de drenaje al menos tres veces por encima del valor de la amilasa en suero a partir del tercer día postoperatorio. El objetivo de este estudio fue caracterizar los pacientes con fístula pancreática postoperatoria en nuestra institución, evaluando la importancia de la detección temprana y el establecimiento de un manejo oportuno. Métodos. Estudio descriptivo, retrospectivo, que incluyó los pacientes sometidos a pancreatoduodenectomía, con diagnóstico de fístula pancreática postoperatoria como complicación de cirugía hepatobiliopancreática, en el Hospital Internacional de Colombia, en Piedecuesta, entre enero del 2017 y diciembre de 2020. Se excluyeron los pacientes con otro tipo procedimiento quirúrgico y aquellos que decidieron no participar en el estudio. Resultados. Se evaluaron 69 pacientes, con un predominio del sexo femenino (n=38; 55,1 %) y mediana de la edad de 57 años. El 33,3 % (n=24) de los pacientes intervenidos desarrollaron fístula pancreática postoperatoria, siendo el 23,2 % fuga bioquímica, grado B 8,7 % y grado C 2,9 %, para quienes se indicaron manejo expectante, control ecográfico y reintervención, respectivamente. Fallecieron 5 pacientes (7,2 %). Conclusiones. La fístula pancreáticapostoperatoria es una complicación para tener en cuenta en todos los pacientes sometidos a pancreatoduodenectomía. Existen estrategias que pueden permitir disminuir la incidencia de esta complicación, con el fin de mejorar el desenlace, el pronóstico y la morbilidad posquirúrgica.

Introduction. Postoperative pancreatic fistula is one of the most important complications in hepatobiliopancreatic surgery. Its diagnosis is made by the presence of an amylase level in the drainage fluid at least three times above the serum amylase value from the third postoperative day. The objective of this study was to characterize patients with postoperative pancreatic fistula at our institution, evaluating the importance of early detection and to establish a timely management. Methods. Descriptive, retrospective study that included patients who underwent pancreatoduodenectomy with a diagnosis of postoperative pancreatic fistula as a complication of hepatobiliopancreatic surgery at the Hospital Internacional Colombia, between January 2017 and December 2020. Patients with another type of procedure performed by this specialty and those who did not decide to participate in the study were excluded. Results. A total of 69 patients were included, the median age was 57 years with a predominance of females (n=38; 55.1%). 33.3% (n=24) of the operated patients developed postoperative pancreatic fistula, with 23.2% having a biochemical leak, grade B in 8.7% and grade C in 2.9%, for whom expectant management, ultrasound control and reintervention were indicated, respectively. Five patients died (7.2%). Conclusions. Pancreatic fistula is a complication to take into account in all patients undergoing pancreatoduodenectomy. There are strategies that can reduce the incidence of this complication and thus improve not only the outcome but also the prognosis and postoperative morbidity.

Edema pulmonar por reexpansión. Reporte de Caso / Pulmonary edema due to re-expansion. Case Report

Introducción. El edema pulmonar por reexpansión es una complicación poco frecuente, secundaria a una rápida reexpansión pulmonar posterior al drenaje por toracentesis o toracostomía cerrada. Al día de hoy, se ha descrito una incidencia menor al 1 % tras toracostomía cerrada, con mayor prevalencia en la segunda y tercera década de la vida. Su mecanismo fisiopatológico exacto es desconocido; se ha planteado un proceso multifactorial de daño intersticial pulmonar asociado con un desequilibrio de las fuerzas hidrostáticas. Caso clínico. Presentamos el caso de un paciente que desarrolló edema pulmonar por reexpansión posterior a toracostomía cerrada. Se hizo una revisión de la literatura sobre esta complicación. Resultados. Aunque la clínica sugiere el diagnóstico, la secuencia de imágenes desempeña un papel fundamental. En la mayoría de los casos suele ser autolimitado, por lo que su manejo es principalmente de soporte; sin embargo, se han reportado tasas de mortalidad que alcanzan hasta el 20 %, por tanto, es importante conocer los factores de riesgo y las medidas preventivas. Conclusión. El edema pulmonar de reexpansión posterior a toracostomía es una complicación rara en los casos con neumotórax, aunque es una complicación que se puede presentar en la práctica diaria, por lo cual debe tenerse en mente para poder hacer el diagnóstico y un manejo adecuado.

Introduction. Re-expansion pulmonary edema is a rare complication secondary to rapid pulmonary re-expansion after drainage by thoracentesis and/or closed thoracostomy. As of today, an incidence of less than 1% has been described after closed thoracostomy, with a higher prevalence in the second and third decades of life. Its exact pathophysiological mechanism is unknown; a multifactorial process of lung interstitial damage associated with an imbalance of hydrostatic forces has been proposed. Clinical case. We present the case of a patient who developed pulmonary edema due to re-expansion after closed thoracostomy, conducting a review of the literature on this complication. Results. Although the clinic suggests the diagnosis, the sequence of images plays a fundamental role. In most cases, it tends to be a self-limited disease, so its management is mainly supportive. However, mortality rates of up to 20% have been recorded. Therefore, it is important to identify patients with major risk factors and initiate preventive measures in these patients. Conclusions. Re-expansion pulmonary edema after thoracostomy is a rare complication in cases with pneumothorax; however, it is a complication that can occur in daily practice. Therefore, it must be kept in mind to be able to make the diagnosis and an adequate management.

Assessment of risk factors for leakage after repair of perforated peptic ulcer with omental patch. Retrospective study / Evaluación de factores de riesgo de fuga después de la reparación de una úlcera péptica perforada con parche de epiplón. Estudio retrospectivo

Introduction. Perforated peptic ulcer remains one of the critical abdominal conditions that requires early surgical intervention. Leakage after omental patch repair represents one of the devastating complications that increase morbidity and mortality. Our study aimed to assess risk factors and early predictors for incidence of leakage. Methods. Retrospective analysis of data of the patients who underwent omental patch repair for perforated peptic ulcer in the period between January 2019 and January 2022 in Mansoura University Hospital, Egypt. Pre, intra and postoperative variables were collected and statistically analyzed. Incriminated risk factors for leakage incidence were analyzed using univariate and multivariate analysis. Results. This study included 123 patients who met inclusion criteria. Leakage was detected in seven (5.7%) patients. Although associated comorbidities (p=0.01), postoperative intensive care unit admission (p=0.03), and postoperative hypotension (p=0.02) were significant risk factors in univariate analysis, septic shock (p=0.001), delayed intervention (p=0.04), preoperative hypoalbuminemia (p=0.017), and perforation size >5mm (p= 0.04) were found as independent risk factors for leakage upon multivariate analysis. Conclusion. Delayed presentation in septic shock, preoperative hypoalbuminemia, prolonged perforation, operation interval, and large perforation size > 5mm were detected as independent risk factors for leakage. Postoperative tachypnea and tachycardia with increased levels of C-reactive protein and total leucocytic count are alarming signs for incidence of leakage

Introducción. La úlcera péptica perforada es una de las afecciones abdominales críticas que requiere una intervención quirúrgica temprana. La fuga después de la reparación con parche de epiplón representa una de las complicaciones más devastadoras, que aumentan la morbilidad y la mortalidad. Nuestro estudio tuvo como objetivo evaluar los factores de riesgo y los predictores tempranos de fugas. Métodos. Análisis retrospectivo de los datos de los pacientes sometidos a reparación con parche de epiplón por úlcera péptica perforada, en el período comprendido entre enero de 2019 y enero de 2022, en el Hospital Universitario de Mansoura, Egipto. Se recogieron y analizaron estadísticamente variables pre, intra y postoperatorias. Los factores de riesgo asociados a la incidencia de fugas se analizaron mediante análisis univariado y multivariado. Resultados. Este estudio incluyó 123 pacientes que cumplieron con los criterios de inclusión. Se detectó fuga en siete (5,7 %) pacientes. Aunque las comorbilidades asociadas (p=0,01), el ingreso postoperatorio a la unidad de cuidados intensivos (p=0,03) y la hipotensión postoperatoria (p=0,02) fueron factores de riesgo en el análisis univariado, el shock séptico (p=0,001), el retraso en la intervención (p=0,04), la hipoalbuminemia preoperatoria (p=0,017) y el tamaño de la perforación mayor de 5 mm (p=0,04) se encontraron como factores de riesgo de fuga independientes en el análisis multivariado. Conclusión. Se detectaron como factores de riesgo independientes de fuga la presentación tardía en shock séptico, la hipoalbuminemia preoperatoria, la perforación prolongada, el intervalo operatorio y el tamaño de la perforación mayor de 5 mm. La taquipnea posoperatoria y la taquicardia con niveles elevados de proteína C reactiva y recuento leucocitario total son signos de alarma sobre la presencia de fuga.

Estomas: complicaciones, manejo y prevención. Una revisión actual / Stomas: complications, management, and prevention. An updated review

Introducción. La resección segmentaria del intestino y su derivación temporal o definitiva es un procedimiento frecuente en la práctica quirúrgica, que implica la construcción de un estoma. La enfermedad que lleva a la cirugía, las condiciones clínicas del paciente y los aspectos técnicos en la construcción de la ostomía son puntos claves en la evolución posoperatoria. Métodos. Se realizó una revisión de la literatura identificando las complicaciones asociadas a la construcción de estomas, con el objetivo de ofrecer herramientas de tratamiento y toma de decisiones al personal médico involucrado en la atención de estos pacientes. Resultados. La cirugía de urgencia, la inmunosupresión, la obesidad y la técnica en la apertura del orificio en la pared abdominal, favorecen la aparición de complicaciones tempranas que requieren manejo médico o reintervención quirúrgica. Conclusiones. Todo paciente con estoma debe ser valorado minuciosamente por el cirujano y la terapista enterostomal en las primeras 72 horas luego de la cirugía.

Introduction. Segmental resection of the intestine and its temporary or permanent bypass is a frequent procedure in surgical practice, which involves the construction of a stoma. The disease that leads to surgery, the clinical conditions of the patient and the technical aspects in the construction of the ostomy are key points in the postoperative evolution. Methods. A review of the literature was performed, identifying the complications associated with the construction of stomas, with the aim of offering treatment and decision-making tools to the medical personnel involved in the care of these patients. Results. Emergency surgery, immunosuppression, obesity, and the technique used to open the orifice in the abdominal wall favor the appearance of early complications that require medical management or surgical reintervention. Conclusions. Every patient with a stoma must be carefully evaluated by the surgeon and the enterostomal therapist in the first 72 hours after surgery.

Characteristics and therapeutic strategies of Pott's puffy tumor / 临床耳鼻咽喉头颈外科杂志

Objective:To explore the characteristics and therapeutic strategies of Pott's puffy tumor（PPT）. Methods:The clinical data of two patients with PPT were retrospectively analyzed and combined with the literature, focusing on the comprehensive analysis of perioperative diagnosis and treatment strategies. Both patients underwent muti-disciplinary treatment, including timely administration of sufficient antibiotics capable of penetrating the blood-brain barrier. Early removal of PPT lesions was performed using a combined internal and external approach under nasal endoscopic guidance. Results:After standardized perioperative management, the symptoms of the two patients were completely relieved, with no recurrence after one=year follow=up. Postoperative complications such as frontal pain, numbness, local depression, or scar hyperplasiawere not present. Conclusion:PPT, being relatively rare and severe, requires careful attention. Key strategies for standardized perioperative management include multi-disciplinary consultation, timely and adequate antibiotic administration, and surgical intervention using a combined intranasal and extranasal endoscopic approach for lesion removal.

O-arm navigation versus C-arm navigation for guiding percutaneous long sacroiliac screws placement in treatment of Denis type Ⅱ sacral fractures / 中国修复重建外科杂志

OBJECTIVE@#To compare the effectiveness of O-arm navigation and C-arm navigation for guiding percutaneous long sacroiliac screws in treatment of Denis type Ⅱ sacral fractures.@*METHODS@#A retrospective study was conducted on clinical data of the 46 patients with Denis type Ⅱ sacral fractures between April 2021 and October 2022. Among them, 19 patients underwent O-arm navigation assisted percutaneous long sacroiliac screw fixation (O-arm navigation group), and 27 patients underwent C-arm navigation assisted percutaneous long sacroiliac screw fixation (C-arm navigation group). There was no significant difference in gender, age, causes of injuries, Tile classification of pelvic fractures, combined injury, the interval from injury to operation between the two groups ( P>0.05). The intraoperative preparation time, the placement time of each screw, the fluoroscopy time of each screw during placement, screw position accuracy, the quality of fracture reduction, and fracture healing time were recorded and compared, postoperative complications were observed. Pelvic function was evaluated by Majeed score at last follow-up.@*RESULTS@#All operations were completed successfully, and all incisions healed by first intention. Compared to the C-arm navigation group, the O-arm navigation group had shorter intraoperative preparation time, placement time of each screw, and fluoroscopy time, with significant differences ( P<0.05). There was no significant difference in screw position accuracy and the quality of fracture reduction ( P>0.05). There was no nerve or vascular injury during screw placed in the two groups. All patients in both groups were followed up, with the follow-up time of 6-21 months (mean, 12.0 months). Imaging re-examination showed that both groups achieved bony healing, and there was no significant difference in fracture healing time between the two groups ( P>0.05). During follow-up, there was no postoperative complications, such as screw loosening and breaking or loss of fracture reduction. At last follow-up, there was no significant difference in pelvic function between the two groups ( P>0.05).@*CONCLUSION@#Compared with the C-arm navigation, the O-arm navigation assisted percutaneous long sacroiliac screws for the treatment of Denis typeⅡsacral fractures can significantly shorten the intraoperative preparation time, screw placement time, and fluoroscopy time, improve the accuracy of screw placement, and obtain clearer navigation images.

Seguridad de la cirugía de luxofracturas vertebrales toracolumbares según la oportunidad quirúrgica / Safety of surgical treatment for thoracolumbar fracture-dislocations according to surgical timing

Introducción: Las luxofracturas vertebrales toracolumbares se producen por traumatismos de alta energía, representan el 10% de las lesiones traumáticas de la columna vertebral y se asocian frecuentemente con otras lesiones. El objetivo de este estudio fue comparar las complicaciones tempranas en pacientes con una luxofractura toracolumbar según la oportunidad quirúrgica, antes o después de las 24 h del trauma. Materiales y métodos: Estudio multicéntrico, analítico, observacional y retrospectivo de una cohorte de pacientes operados por una luxofractura toracolumbar, desde el 1 de enero de 2014 hasta el 1 de enero de 2023. Se inclu-yó a pacientes de ambos sexos, >18 años, operados por una luxofractura vertebral de alta energía. Se los agrupó según si habían sido operados de columna antes o después de las 24 h del trauma. Se registraron las complicaciones totales y agrupadas. Resultados: Se evaluó a 72 pacientes, 64 hombres (88,9%) y 8 mujeres (11,1%), con una edad promedio de 35.94 años. Predominaron las instituciones laborales (n = 60; 83,3%). El mecanismo de lesión más frecuente fueron los accidentes de tránsito (n = 42; 58,3%), seguidos de las caídas de altura (n = 26; 36,1%). El 86% sufrió una o más lesiones asociadas. Se registraron 283 complicaciones en 67 (93,1%) pacientes y 45 complicaciones quirúrgicas en 26 pacientes (36,1%). La mediana de complicaciones fue mayor en pacientes operados tardíamente (p = 0,004). Conclusiones:Los pacientes con luxofractura toracolumbar operados después de las primeras 24 h presentaron una mediana de complicaciones totales significativamente mayor que los operados precozmente. Nnivel de Evidencia: IV

Introduction: Thoracolumbar fracture-dislocations account for 10% of traumatic spinal injuries and typically occur in the context of high-energy trauma. Our objective is to compare early complications in patients with thoracolumbar fracture-dislocation based on surgical timing, either before or after 24 hours from the trauma.materials and methods: This is a multicenter, retrospective cohort study of patients surgically treated for thoracolumbar dislocations, from January 1, 2014 to January 1, 2023. We included adult patients (>18 years old) of any gender, surgically treated for high-energy thoracolumbar fracture-dislocations. Patients were grouped based on when they underwent spinal surgery: before or after 24 hours following trauma. Total and grouped complications were recorded. Results: Our sample comprised 72 patients, with 64 men (88.9%) and 8 women (11.1%) at an average age of 35.94 years. Occupational health care centers were predominant (n=60; 83.3%). Road traffic accidents (n=42; 58.3%) were the most frequent cause of injury, followed by falls from height (n=26; 36.1%). Furthermore, 86% of patients had one or more associated injuries. In total, 283 complications were recorded, with 67 patients (93.1%) suffering at least one complication, and 26 patients (36.1%) experiencing surgical complications. The median number of complications was significantly higher in late-operated patients (p=0.004). Conclusions: Patients with thoracolumbar dislocations who underwent surgery after the first 24 hours following trauma had a significantly higher median rate of complications than those who underwent early surgery. Level of Evidence: IV

Complicaciones asociadas a la artrodesis intersomática lumbar por vía lateral. Revisión narrativa de la bibliografía / Complications of lateral lumbar interbody fusion (XLIF). Narrative literature review

Introducción: El abordaje lateral de la columna lumbar en la artrodesis intersomática está descrito para tratar varias enfermedades. Si bien es un procedimiento seguro, a medida que la técnica ha ganado popularidad, se han publicado diversas complicaciones asociadas. El objetivo de este artículo es presentar una revisión narrativa de la bibliografía para proveer al lector de un resumen organizado de las complicaciones comunicadas más frecuentes relacionadas con esta técnica. Materiales y métodos: Se llevó a cabo una revisión narrativa de la bibliografía obtenida en las bases de datos PubMed, Web of Science, Scopus y LILACS para identificar artículos que detallen complicaciones relacionadas con el abordaje lateral de la columna lumbar. Resultados: Luego del análisis de los resultados de la búsqueda bibliográfica, se seleccionaron 18 artículos para esta revisión. Conclusiones: Las complicaciones más frecuentes directamente relacionadas con este abordaje son la cruralgia y el déficit motor para la flexión de la cadera o la extensión de la pierna que, en su gran mayoría, son transitorias y reversibles. Hay escasos reportes de lesiones vasculares severas o fatales. Nivel de Evidencia: III

Introduction: The lateral approach for lumbar interbody fusion has been described for the treatment of diverse pathologies. Although it is a safe procedure, its popularity has led to an increase in reports of complications associated with it. The objective of this work is to conduct a narrative review of the literature on the most frequently reported complications associated with this surgical approach. Materials and methods: We performed a narrative review of the literature based on the publications obtained from the following databases: PubMed.gov, Web of Science, Scopus and Lilacs to identify published articles that detail complications related to the lateral approach to the lumbar spine. Results: After analyzing the results of the bibliographic search, 18 articles were selected to carry out this review. Conclusions: The most frequent complications directly related to this approach are thigh pain and motor deficit for hip flexion and/or leg extension, which are mostly temporary and reversible. Severe or fatal vascular injuries have rarely been reported. Level of Evidence: III

Investigating preoperative myoglobin level as predictive factor for acute kidney injury following cardiac surgery with cardiopulmonary bypass: a retrospective observational study

Abstract Background: Early identification of patients at risk of AKI after cardiac surgery is of critical importance for optimizing perioperative management and improving outcomes. This study aimed to identify the association between preoperative myoglobin levels and postoperative acute kidney injury (AKI) in patients undergoing valve surgery or coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass. Methods: This retrospective study included 293 patients aged over 17 years who underwent valve surgery or CABG with cardiopulmonary bypass. We excluded 87 patients as they met the exclusion criteria. Therefore, 206 patients were included in the final analysis. The patients' demographics as well as intraoperative and postoperative data were collected from electronic medical records. AKI was defined according to the Acute Kidney Injury Network classification system. Results: Of the 206 patients included in this study, 77 developed AKI. The patients who developed AKI were older, had a history of hypertension, underwent valve surgery with concomitant CABG, had lower preoperative hemoglobin levels, and experienced prolonged extracorporeal circulation (ECC) times. Multivariate logistic regression analysis revealed that preoperative myoglobin levels and ECC time were correlated with the development of AKI. A higher preoperative myoglobin level was an independent risk factor for the development of cardiac surgery-associated AKI. Conclusions: Higher preoperative myoglobin levels may enable physicians to identify patients at risk of developing AKI and optimize management accordingly.

Eight years experience of transanal endoscopic microsurgery

Introduction: Transanal Endoscopic Microsurgery (TEM) is a minimally invasive method for management of different proctologic conditions. Despite widespread use of this method, it is not used widely in Iran. This report is about to describe the application of TEM in managing different proctologic conditions in a tertiary colorectal referral center in Iran regarding methods and complications. Methods: All of the patients' documents such as procedure, method, early postop complications and further operations were actively reviewed and the data were entered in to the database. Results: Since 2012 till the end of 2020 chart review was done and 150 cases of TEM operation were found. The most frequent procedure that was done was resection procedure. Using different energy devices during surgery or suturing versus not suturing the defect were not associated with complication. There was a case of in hospital mortality and one case delayed perianal fistula following TEM. Measurement of lesion distance from anal verge was not significantly different using TEM or colonoscopy. Villous adenomas detected in colonoscopy were mostly associated with malignancy. In evaluated resected lesions most of cases had free base and distance from anal verge or using different energy devices were not associated with obtaining free base. Conclusion: TEM is a safe minimal invasive procedure with acceptable complications that could be helped in managing different proctologic conditions and the results of reviewing our patients revealed the same results that is reported from other colorectal centers. (AU)

Laparoscopic cecectomy for diseases of the appendix and cecum

Introduction: The cecum is the first part of the large bowel. Cecectomy is a sufficient treatment for some patients, avoiding overtreatment by ileocolic resection. Purpose:The goal of this study was to review a surgeon's experience with laparoscopic cecectomy and provide a technical video demonstration of this uncommon operation. Methods: A retrospective chart review was conducted of all consecutive patients treated with laparoscopic cecectomy over a 16-year period. All operations were performed using a 3-trocar technique. The cecum was transected with 1 to 2 firings of a 60 millimeters linear stapler, preserving the ileocecal valve and ascending colon. Results: 19 patients were identified including 12 females (63.2%). Median age was 42 years (range 16-84). Indication for surgery included appendiceal pathology in 12 patients (63.2%) and cecal abnormality in 7 (38.9%). There was no conversion to open surgery. Median intraoperative blood loss was 25 ml (range 0-150 ml) and no patient received a blood transfusion. No intraoperative or postoperative complication was noted. The median length stay was 1 day (range 0-6). Readmission rate was 0%. Final appendiceal histopathology revealed acute/chronic appendicitis in 5 patients, mucinous cystadenoma in 4 patients. Cecal histopathology revealed adenoma in 4 patients. Median follow-up was 16 months (range 4-53). Conclusions: Laparoscopic cecectomy is a sufficient treatment for some patients with benign conditions of the appendix and cecum. It carries minimal morbidity. It should be considered as an alternative to segmental bowel resection in a select group of patients. (AU)

Complicaciones de cirugía de Whipple en un paciente pediátrico con tumor pseudopapilar de páncreas / Complications of Whipple procedure in a pediatric patient with pseudopapillary tumor of the pancreas

Las neoplasias de páncreas son una entidad poco frecuente en pediatría; el tumor pseudopapilar de páncreas (TSP) es el más comúnmente diagnosticado. Habitualmente, se localizan en la cabeza del páncreas. La cirugía de Whipple o pancreatoduodenectomía es la técnica elegida para el tratamiento de los tumores benignos o malignos de páncreas. Si bien la mortalidad conocida ha descendido en los últimos años, debido a la mayor experiencia de los cirujanos y al mejor cuidado pre- y posoperatorio, la morbilidad se ha mantenido elevada secundaria a las complicaciones asociadas. Dentro de estas se destacan retardo en el vaciamiento gástrico, colecciones intraabdominales, fístula pancreática, reestenosis del sitio quirúrgico y hemorragia pospancreatectomía. Se presenta el caso clínico de una niña de 13 años con diagnóstico de TSP que recibió tratamiento quirúrgico efectivo desde el punto de vista oncológico, pero que requirió una internación prolongada secundaria a las complicaciones quirúrgicas.

Pancreatic neoplasms are rare in pediatrics; the pseudopapillary tumor (PPT) of the pancreas is the most common. PPTs of the pancreas are usually located in the head of the pancreas. A pancreaticoduodenectomy or Whipple procedure is the technique of choice for the treatment of benign or malignant pancreatic tumors. Although mortality for this cause has decreased in recent years, due to the greater experience of surgeons and improved pre- and postoperative care, morbidity has remained high secondary to associated complications. These include delayed gastric emptying, intra-abdominal collections, pancreatic fistula, surgical site restenosis, and post-pancreatectomy hemorrhage. Here we describe the clinical case of a 13-year-old girl diagnosed with PPT of the pancreas who underwent an effective surgery in terms of cancer treatment, but who required a prolonged hospitalization secondary to surgical complications.

Early vs. Standard Loop Ileostomy Closure: An Unmatched Case-Control Study / Cierre Temprano vs Estándar de Ileostomía en Asa. Estudio de Casos y Controles no Emparejado

SUMMARY: Early closure of a loop ileostomy (ECI) is a relatively new practice, for which there is insufficient evidence regarding its effectiveness in relation to closure at conventional times. The aim of this study was to report postoperative complications (POC) and hospital mortality in patients with loop ileostomy (LI) who underwent ECI, compared with patients with LI who underwent late closure. Un- matched case-control study. Patients with LI who underwent surgery at Clínica RedSalud Mayor Temuco (2010-2022) were included. Cases were defined as patients with LI who underwent early closure and controls as subjects who underwent closure at the usual times. No matching was performed, but a 1:1 relationship between cases and controls was considered. Outcome variables were postoperative complications and hospital mortality. Other variables of interest were surgical time and hospital stay. Descriptive statistics were applied with calculation of proportions and measures of central tendency. Subsequently, t-test and Pearson Chi2 for comparison of averages and proportions was applied, and odds ratios and their respective 95 % CI were calculated. In this study 39 patients with AI were operated on (18 cases and 21 controls). Age and BMI average of the studied subjects was 71.3±7.1 years and 27.3±19.8 kg/m2 respectively. Mean LI closure time, surgical time, and hospitalization were: 10.0±0.7 months; 62.5±10.6min; 3.8±0.1 days respectively. POC were only surgical site infections. Three in cases (16.7 %) and 3 in controls (14.3 %). No anastomotic dehiscence or hospital mortality was observed in either cases or controls. There were no differences in comorbidities or surgical site infection between cases and controls (OR of 0.6 and 1.2 respectively) In this experience, the results of performing the CTI were similar to the late closing in relation to the variables studied.

El cierre temprano de una ileostomía en asa (IA), es una práctica relativamente nueva, sobre la que no hay suficiente evidencia respecto de su efectividad en relación con el cierre en tiempos convencionales. El objetivo de este estudio fue verificar diferencias en la tasa de complicaciones postoperatorias (CPO) y de mortalidad hospitalaria en pacientes con IA sometidos a cierre temprano comparados con pacientes con IA sometidos a cierre tardío. Estudio de casos y controles sin emparejamiento. Se incluyeron pacientes con IA que fueron sometidos a cirugía en la Clínica RedSalud Mayor Temuco (2010-2022). Los casos se definieron como pacientes con IA sometidos a cierre temprano y los controles como sujetos con IA sometidos a cierre en tiempos habituales. No se realizó emparejamiento. Se consideró una relación 1:1 entre casos y controles. Las variables de resultado fueron CPO y mortalidad hospitalaria. Otras variables de interés fueron: tiempo quirúrgico y hospitalización. Se aplicó estadísticas descriptivas (cálculo de proporciones y medidas de tendencia central). Posteriormente, se aplicó prueba t-test y Chi2 para comparación de promedios y proporciones; y se calcularon odds ratios e intervalos de confianza del 95 %. Se operaron 39 pacientes con IA (18 casos y 21 controles). El promedio de edad e IMC fue 71,3±7,1 años y 27,3±19,8 kg/m2, respectivamente. El tiempo promedio de cierre de IA, tiempo quirúrgico y hospitalización fueron: 10,0±0,7 meses; 62,5±10,6 minutos; 3,8±0,1 días, respectivamente. Las CPO fueron infecciones del sitio quirúrgico (3 casos; 16,7 % y 3 controles; 14,3 %). No se observó dehiscencia anastomótica ni mortalidad hospitalaria en casos ni controles. No hubo diferencias en comorbilidades ni en infecciones del sitio quirúrgico entre casos y controles (OR de 0,6 y 1,2, respectivamente). No se evidenciaron diferencias entre realizar cierre temprano o tardío de IA, respecto de las variables CPO y de mortalidad hospitalaria.

Malla suburetral retropúbica (TVT): experiencia clínica y análisis de datos en el Hospital El Carmen de Maipú / Retropubic suburethral mesh (TVT): clinical experience and data analysis at the Hospital El Carmen de Maipú

La incontinencia urinaria de esfuerzo es la pérdida involuntaria de orina durante una maniobra de esfuerzo físico, ejercicio, estornudo o tos. Afecta aproximadamente al 15% de las mujeres de 30-60 años y su prevalencia es del 30-41%. Aunque existen terapias conservadoras para su manejo, muchas pacientes terminarán necesitando cirugía para su resolución. Las mallas suburetrales son alternativas para el manejo quirúrgico, existiendo dos vías de instalación, la transobturadora (TOT o TVT-O) y la retropúbica (del inglés tension-free vaginal tape o TVT), siendo esta última la que presenta mejores resultados y menos complicaciones posoperatorias. Objetivo: evaluar la tasa de efectividad y las complicaciones de la TVT en la Unidad de Piso Pélvico Femenino del Hospital El Carmen de Maipú entre los años 2015 y 2020. Materiales y Métodos: Se obtuvieron 715 registros de pacientes que fueron sometidas a TVT y se logró contactar telefónicamente con el 60,69% de ellas. Resultados: Los resultados muestran una tasa de efectividad del 94,8% y una tasa de complicaciones del 2,3%. Conclusión: Este estudio aporta evidencia local de los resultados posoperatorios en la IOE en pacientes que requirieron la instalación de una malla suburetal retropúbica, demostrando ser una cirugía altamente efectiva y segura.

Stress urinary incontinence is the involuntary loss of urine during physical exertion, exercise, sneezing, or coughing. It affects approximately 15% of women aged 30-60, with a prevalence of 30-41%. Although there are conservative therapies for its management, many patients will eventually require surgery for resolution. Suburethral sling are considered for surgical management, and there are two installation alternatives, transobturator (TOT or TVT-O) and retropubic (tension-free vaginal tape or TVT), with the latter presenting better results and fewer postoperative complications. Objetive: to evaluate effectiveness rate and complications of the TVT in the Female Pelvic Floor Unit of Hospital El Carmen de Maipú between 2015 and 2020. Materials and Methods: A total of 715 patient records were obtained for those who underwent TVT, and 60.69% of them were successfully contacted by telephone. Results: The results show an effectiveness rate of 94.8% and a complication rate of 2.3%. Conclusion: This study provides local evidence for the results of stress urinary incontinence that required the placement of a retropubic suburethral sling, proving to be a highly effective and safe surgery.

Prevalencia de Complicaciones de Post Exodoncia de Terceros Molares / Prevalence of Post-Extraction Complications of Third Molars

El Centro de Salud Familiar (CESFAM) de San Pedro de Atacama, es el único establecimiento de Atención de salud en la comuna y alrededores, se hace imperativo para los Cirujanos Dentistas ser resolutivos y entregar una solución efectiva a la demanda local. El objetivo de este trabajo consistió en determinar prevalencia de complicaciones postexodoncia de terceros molares de pacientes atendidos en CESFAM San Pedro de Atacama entre enero y octubre de 2020. Estudio descriptivo de corte transversal entre enero y octubre 2020, se realizó revisión retrospectiva de fichas clínicas manuales y base de datos electrónica de atenciones odontológicas realizadas en CESFAM. Se incluyeron en el estudio pacientes mayores 18 años, sistémicamente sanos o ASA II compensados, que se hayan realizado exodoncia de tercer molar superior o inferior y que hayan asistido a control clínico a los 7 días. Se excluyeron fichas clínicas ilegibles o sin evolución, pacientes que tuvieran antecedentes de pericoronaritis hasta 7 días previos y pacientes inmunocomprometidos. La frecuencia de complicaciones postoperatorias se relacionó según dificultad de la intervención (leve/moderada/alta) y si el diente era maxilar o mandibular. Se realizó un análisis descriptivo y estadístico de los datos obtenidos mediante prueba exacta de Fisher para evaluar asociación entre las variables utilizando programa estadístico STATA v. 15. Entre enero y octubre de 2020 se realizaron 146 exodoncias de terceros molares; 61 fueron de dificultad leve (41,7 %), 58 dificultad moderada (39,8 %) y 21 dificultad alta (18,5 %). El total de complicaciones postexodoncia alcanza 5,4 % (n=8) donde la complicación más frecuente es alveolitis. Las complicaciones postexodoncia se relacionan significativamente con el nivel de dificultad leve (p0,05).

The Communnity Health Center (CESFAM) of San Pedro de Atacama, is the only establishment of health assistance in the community and surroundings, it is imperative for Dental Surgeons to be decisive and deliver an effective solution to local demand. Determinate the prevalence of post-extraction complications of third molars in patients treated at CESFAM San Pedro de Atacama between January and October 2020. Descriptive cross- sectional study between January and October 2020. It has been done a retrospective review of manual clinical records and electronic database of dental care performed at CESFAM. Patients over 18 years old, systemically healthy or compensated ASA II, who had extracted an upper or lower third molar and who had attended a 7-day clinical check-up were included in the study. Were excluded Illegible or no follow up clinical records, patients with a history of pericoronitis up to 7 days previously, and immunocompromised patients. The frequency of postoperative complications was related to the difficulty of the intervention (mild / moderate / high) and whether the tooth was maxillary or mandibular. A descriptive and statistical analysis of the data obtained by Fisher's exact test was carried out to evaluate the association between the variables using the statistical program STATA v. 15. Between January and October 2020, 146 third molar extractions were performed; 61 were of mild difficulty (41.7 %), 58 of moderate difficulty (39.8 %) and 21 of high difficulty (18.5 %). The result of post-extraction complications reached 5.4 % (n = 8), where the most frequent complication was alveolitis. Post-extraction complications are significantly related to the level of mild difficulty (p 0,05).