Protocolo fast track ("rápida implementación") disminuye el tiempo de estadía hospitalaria, y el tiempo de inicio de la alimentación por vía bucal, en el paciente sometido a cirugía colorectal electiva / Fast track decreases the hospital stay, the time of begining of oral feeding in the patient undergoing, elective colorectal surgery

Introducción: el protocolo "fast track" (rápida implementación) ha revolucionado a la cirugía colorectal. Algunos cirujanos aún efectúan la preparación preoperatoria para los pacientes que serán sometidos a cirugía colorectal. El propósito de este escrito es el de comparar los resultados entre el protocolo "fast track "y la cirugía convencional en la preparación de los pacientes sometidos a cirugía colorectal por afecciones benignas. Métodos: desde enero 2012 hasta agosto 2015, los pacientes operados por cirugía colorectal debido a afecciones benignas se incluyeron en el estudio. El grupo de comparación consistió en pacientes con cirugía colónica mayor con cuidado convencional y el "fast track". Resultados: hubo 86 pacientes en total, 43 para cada grupo. Ambos grupos eran similares. Los pacientes con cuidado convencional tuvieron una estadía hospitalaria mayor y de inicio de la alimentación por boca comparada con los pacientes del protocolo "fast track", p = 0.000 para ambas diferencias. Las complicaciones postoperatorias y las reoperaciones fueron similares en ambos grupos, sin ninguna diferencia significativa, p>0.05. No hubo fallecimientos en los dos grupos. Conclusión: el protocolo "fast track" es efectivo en la cirugía colorectal electiva porque disminuye el tiempo del comienzo de la alimentación por boca y el de la estadía hospitalaria en los pacientes, sin comprometer la seguridad.

Introduction: The Fast-track protocol has revolutionized colorectal surgery. Some surgeons still perform preoperative preparation for patients undergoing colorectal surgery. The aim of this paper is to compare the results between the Fast-track protocol and conventional surgery in preparing patients undergoing colorectal surgery for benign disease. Methods: From January 2012 to August 2015, the patients operated for colorectal surgery for benign diseases were included. The comparison group consisted of patients with major colon surgery with conventional care and Fast-track. Results: There were 86 patients in total, 43 in each group. Both groups were similar. Patients with conventional care had higher hospital stay and start of oral feeding compared to patients in Fasttrack protocol,p = 0.000 for both differences. Postoperative complications and reoperations were similar in both groups, with no significant difference, p> 0.05. There were no deaths in both groups. Conclusion: Fast-track protocol is effective in elective colorectal surgery because it decreases the start time of the oral feeding and the hospital stay of patients without compromising safety.

[Evolution of type 2 diabetes and carbohydrate intolerance following bariatric surgery in a Mexican mestizo population]. / Evolución de los pacientes con diabetes mellitus tipo 2 e intolerancia a los carbohidratos posterior a cirugía bariátrica en la población mexicana.

BACKGROUND: Bariatric surgery continues to be the best treatment for weight loss and control of obesity related comorbidities. Gastric bypass and sleeve gastrectomy have demonstrated to be the most effective surgeries, but this has not been established in a Mexican (non-American) population. OBJECTIVE: To analyse the improvement in type 2 diabetes mellitus and carbohydrate intolerance in obese patients after bariatric surgery. MATERIAL AND METHODS: A retrospective analysis was performed on the data collected prospectively between 2013 and 2015 on every obese patient with diabetes and carbohydrate intolerance submitted for bariatric surgery. Analysis was performed at baseline, and at 1, 3, 6, 9 and 12 months, and included metabolic, clinical, lipid, and anthropometrical parameters. A peri-operative and morbidity and mortality analysis was also performed. Remission rates for patients with diabetes were also established. RESULTS: The analysis included 73 patients, 46 with diabetes and 27 with carbohydrate intolerance. Sixty-two patients were female with a mean age of 42 years. Baseline glucose and glycosylated haemoglobin were 123±34mg/dl and 6.8±1.6%, and at 12 months they were 90.1±8mg/dl and 5.4±0.3%, respectively. Diabetes remission was observed in 68.7% of patients, including 9.3% with partial remission and 21.8% with an improvement. There was also a significant improvement in all metabolic and non-metabolic parameters. CONCLUSIONS: Bariatric surgery safely improves the metabolic status of patients with diabetes mellitus or carbohydrate intolerance during the first year, inducing high rates of complete remission. It has also shown a significant improvement on blood pressure, lipid, and anthropometric parameters during the first year of follow-up.

[Surgical treatment for liver haematoma following endoscopic retrograde cholangiopancreatography; An unusual case]. / Tratamiento quirúrgico para hematoma subcapsular hepático posterior a colangiografía retrógrada endoscópica; caso inusual.

BACKGROUND: Even in expert hands, there can be serious complications when performing an endoscopic retrograde cholangiopancreatography. The most frequent complications are pancreatitis, cholangitis, bleeding, perforation, and acute cholecystitis. The hepatic subcapsular haematoma is a rare complication, with few cases described worldwide. OBJECTIVE: A case is presented of an extremely rare complication of endoscopic retrograde cholangiopancreatography, which required surgical treatment for its resolution without success. This is second case of mortality reported in the literature. CLINICAL CASE: Female patient of 30 years old, with indication for endoscopic retrograde cholangiopancreatography due to benign strictures. A hydro-pneumatic dilation and stent placement of 2 gauge 10 fr was performed. She presented abdominal pain after the procedure and significant decline in haemoglobin with no evidence of haemodynamic instability so an abdominal tomography scan was performed, showing no evidence of liver injury. The patient was haemodynamic unstable within 72 h. A laparotomy was required for damage control, with fatal outcome in the intensive care unit due to multiple organ failure. CONCLUSION: Subcapsular hepatic haematoma after endoscopic retrograde cholangiopancreatography is a rare complication, with few cases reported in the literature. Treatment described in the literature is conservative, resulting in a satisfactory resolution.

[Emphysematous gastritis secondary to gastric mucormycosis]. / Gastritis enfisematosa secundaria a mucormicosis gástrica.

BACKGROUND: Mucormycosis is a rare fungal infection of the mucorales order, which affects mostly immunocompromised patients. The association with emphysematous gastritis is rare and often fatal produced by gas -forming bacteria. We report the case of a trauma patient with type 1 diabetes mellitus, and diabetic ketoacidosis complicated with gastric mucormycosis associated with emphysematous gastritis. CLINICAL CASE: A male aged 32 who is involved in a car accident, who suffered head trauma, is admitted to the Intensive Care Unit, presenting diabetic ketoacidosis and upper gastrointestinal bleeding. An endoscopy was performed and an erosive esophagitis Class C, ischemia and gastric necrosis was found. A computed tomography scan showed emphysematous gastritis and gastric necrosis. He underwent total gastrectomy with a histopathology report of gastric mucormycosis. After the surgical procedure the patient died because of sepsis secondary to pulmonary mucormycosis DISCUSSION: Mucormycosis is a rare fungical disease which infrequently affects the gastrointestinal tract, being the stomach the most affected site. The mortality is high if the diagnosis is not done promptly and appropriate treatment is given. CONCLUSION: Suspecting its existence is necessary in patients with immunocompromised status to diagnose and provide timely treatment to increase survival, because of its high mortality.

[Zenker's diverticulum: election of surgical treatment and outcome. Case presentation]. / Divertículo de Zenker, elección del tratamiento quirúrgico y resultado. Presentación de un caso.

BACKGROUND: Zenker's diverticulum is a protrusion of the pharyngeal mucosa through a weak area of the posterior wall. It is a rare disorder with an incidence in Mexico of ~0.04% of the population. Its pathophysiology is not yet completely understood. Treatment is surgical and is performed in case of complications. Clinic case: We present the case of a 67 year-old male patient without comorbidities. Symptoms appeared 15 months prior to admission with occasional dysphagia to solids and liquids, breathing difficulty at night, drooling, halitosis, 3 kg weight loss in 2 months, and adequate appetite. Diagnosis of Zenker's diverticulum was established by imaging method and endoscopy. A diverticulectomy with cricopharyngeal muscle myotomy was successfully performed. Liquid diet was started the third postoperative day and progressed without complications; the patient was discharged on the sixth postoperative day without complications. Follow-up at 1 year was successful without recurrence. CONCLUSION: Minimally invasive procedures are useful in patients with comorbidities and for the short anesthesia time and hospitalization. Referring to our field of work, the open treatment is best to relieve symptoms rather than endoscopic procedures because the training for advanced endoscopic procedures is a problem due to lack of infrastructure and specialized personnel.

Antecedentes: los divertículos de Zenker son protrusiones de la mucosa faríngea a través de una zona débil de su pared posterior. Es un padecimiento raro, con una incidencia en México de aproximadamente 0.04% de la población. El tratamiento indicado es quirúrgico. Caso clínico: paciente masculino de 67 años de edad, que 15 meses antes del diagnóstico experimentó síntomas de: disfagia a sólidos y ocasionalmente a líquidos, ahogo por las noches, sialorrea, halitosis, pérdida de 3 kg en dos meses y aumento del apetito. El diagnóstico se confirmó a través de métodos de imagen y endoscopia. Se realizó exitosamente una diverticulectomía con miotomía de músculo cricofaríngeo. Al tercer día de operado pudo ingerir líquidos sin complicaciones, y fue dado de alta al sexto día. Un año después no había mostrado recurrencias. Conclusión: los procedimientos de invasión mínima son útiles en pacientes con comorbilidades porque requieren corto tiempo de anestesia y de hospitalización. En este medio, el tratamiento abierto es la mejor técnica para su resolución, ya que la capacitación para efectuar procedimientos endoscópicos representa un problema por la falta de infraestructura y personal especializado.