ABSTRACT
RESUMEN Antecedentes: la existencia de la pandemia infectocontagiosa COVID-19 puede afectar a los equipos quirúrgicos y pacientes. Objetivo: describir los cambios introducidos en la estructura y los procesos de una planta quirúrgica a fin de adaptarla a la atención segura de pacientes positivos y sospechosos, así como los resultados iniciales de su implementación. Material y métodos: se realizó un estudio prospectivo, descriptivo, observacional entre el 1° de abril y el 31 de mayo de 2020. Fueron registrados los cambios estructurales y en los procesos de funciona miento adaptados a la atención de pacientes sospechosos y COVID-19 positivos, así como las activida des desarrolladas en dicha área. Resultados: se registró una disminución en el número de cirugías programadas y de urgencia en el período. Entre 173 cirugías de urgencia, hubo 17 pacientes sospechosos (9,8%) y 3 positivos (1,7%), confirmados por la prueba de PCR. No hubo pacientes con resultados ni sospechosos ni confirmados en 136 cirugías programadas. La adhesión al cumplimiento de la lista de verificación fue del 100%. No se registraron contagios entre el personal actuante. Conclusiones: los cambios implementados en la planta quirúrgica permitieron la atención adecuada de pacientes tanto sospechosos como confirmados durante el período, con completa adhesión a las recomendaciones y disminución en el riesgo de transmisión de la enfermedad para dar seguridad a los pacientes y al equipo de salud.
ABSTRACT Background: COVID-19 pandemic may affect the surgical teams and patients. Objective: The aim of this report was to describe the changes introduced in the structure and proces ses of a surgical facility for the safe care of suspected and positive COVID-19 patients, and to describe the initial results of their implementation. Material and methods: We conducted a prospective, descriptive and observational study between April 1 and May 31, 2020. The structural changes and the modifications introduced in the functioning processes within the surgical area of a university hospital adapted to the care of suspected and positi ve COVID-19 patients, and the activities developed in such area were documented. Results: There was a reduction in the number of scheduled and emergency surgeries performed du ring the study period. Of the 173 emergency surgeries, 17 (9.8%) were suspected cases and 3 (1.7%) resulted positive COVID-19 patients confirmed by PCR tests. None of the 136 patients undergoing scheduled surgeries were suspected or confirmed cases. Compliance with the checklist was 100%. There were no infections among the personnel working in the facility. Conclusions: The changes implemented in the surgical facility allowed for adequate care of suspected and confirmed COVID-19 patients during the period, with complete adherence to recommendations and reduced risk of disease transmission in order to provide safety to patients and the health care team.
Subject(s)
Operating Rooms/standards , COVID-19/prevention & control , Surgical Procedures, Operative/standards , Epidemiology, Descriptive , Prospective Studies , Personal Protective Equipment/standards , Hospitals, University/standardsABSTRACT
BACKGROUND: After improvements in antireflux surgery (ARS), a percentage of reherniations still has cause of failure attributed to a reopening of the hiatal closure or to an untreated short esophagus. However, the existence of short esophagus and its treatment results still are matters of debate. METHODS: The consecutive medical records containing prospective collective data for patients with gastroesophageal reflux disease (GERD) during the period 2001-2009 were analyzed retrospectively. Every patient considered to be a candidate for ARS was studied with a dynamic contrast radiologic study (DCRxS) in which the esophageal length was evaluated. The choice of surgical technique takes into account the motility status of the esophagus and its estimated length. In the postoperative period, every patient had a DCRxS and an endoscopy 1 year after surgery and then after 3 years. Satisfaction with the procedure was surveyed. RESULTS: The consecutive medical records of 437 GERD patients showed that 171 underwent ARS. During the preoperative DCRxS, a short esophagus was suspected in 26 patients. A short esophagus was confirmed for 11 patients (6.4% of the surgically treated patients), and a Collis procedure plus a funduplication was performed. At the preoperative endoscopy, two patients had a normal mucosa, four patients had esophagitis, and five patients had Barrett's esophagus (BE). In the postoperative period, seven patients presented with a healthy mucosa, one BE had disappeared, and the remaining four BEs remained unchanged. During an average follow-up period of 43 months, no reherniations occurred. The 11 patients achieved good symptoms control and would choose surgery again. CONCLUSIONS: Short esophagus can be suspected during preoperative studies, and in this series, it was confirmed in 6.4% of the patients who had surgery. A Collis fundoplication procedure seems to be an adequate operation to control reflux symptoms and to avoid reherniation over the long-term follow-up period.
