Online Education, Was It Here but We Did Not Know?

Background: Online education is not new. Their main options are talks, videos, and virtual courses. The quality and quantity of talks, together with the level of the speakers, is variable and heterogeneous. The arrival of the COVID-19 pandemic accelerated this process. The objective of this study was to analyze the result of a questionnaire on the current state of online education. Methods: Retrospective descriptive observational study based on a questionnaire. The participants consulted were Latin American physicians with different specialties. Results: A total of n = 361 participants were recruited. 26.9% had between 6 and 15 years of work experience. 63.1% carried out teleconsultation with their patients, and 96.1% attended between 1 and 10 talks/courses/webinar during the pandemic, whereas 1.6% did not attend any. "Talks" given received a rating of "Very Good" by 51.2%, and a 59.5% considered that the "Hybrid" option would be the best modality for future medical congresses in the postpandemic era. 84.7% considered that other possibilities of online teaching and online surgical training should be explored. Conclusion: Online education has marked the way of transmitting knowledge in recent years. It has been well accepted by those attending academic meetings.

Acute Gastric Dilation of the Post-Roux-en-Y Gastric Bypass Remnant Stomach: Image-Guided Surgery Approach.

Background: Bariatric surgery is an effective treatment for obesity and its associated morbidities. They are safe surgeries, their general complication rate is 0%-10%. However, acute gastric dilation is an unusual complication. It requires rapid diagnosis and treatment to avoid major complications. Image-guided surgery represents a group of minimally invasive procedures. Acute gastric dilation is a complication that can benefit from the application of this type of procedure. We present a report of patients with acute gastric dilation of the remnant as a complication after bariatric surgery, its resolution through image-guided surgery, and updating. Materials and Methods: A retrospective review of patients who presented postoperative complications after bariatric surgery was carried out. The time period was 10 years. All patients were operated on in a single center by the same surgical team. Results: A total of 3507 bariatric procedures were analyzed (sleeve gastrectomy, 1929-55.1% ± 0.49%; Roux-en-Y gastric bypass [RYGB], 1403-40% ± 0.48%; other techniques, 175-4.9% ± 0.21%). The RYGB branch reported a total of 11 (0.78% ± 0.08%) complications, of which 2 (0.14% ± 0.03%) were reported as acute gastric dilation of the remnant. Conclusions: Acute gastric dilation of the post-RYGB remnant is a rare complication, but it can be serious. It is necessary to have a high suspicion to obtain an early diagnosis and treatment. Percutaneous gastrostomy is an image-guided procedure that can solve the problem temporarily or permanently.

Image-Guided Surgery for Common Bile Duct Stones After Roux-en-Y Gastric Bypass.

Background: The relationship between obesity with common bile duct stone (CBDS) is close and increases after a Roux-en-Y gastric bypass (RYGB). Due to the anatomical modification, direct endoscopic access is not always possible. For this reason, image-guided surgery (IGS) by percutaneous transhepatic biliary drainage (PTBD) of the common bile duct (CBD) could be a first-line approach for the treatment of post-RYGB choledocholithiasis. The aim of this study was to analyze the feasibility and safety of CBDS treatment after RYGB with IGS. Materials and Methods: We present a descriptive retrospective observational multicentric study on the treatment of choledocholithiasis in patients operated on for RYGB using IGS through a minimally invasive approach by PTBD. The diagnosis of CBDS was made according to the symptoms of the patients, supported by blood tests, and medical images. Treatment was planned in two stages: in the first step, a PTBD was performed, and in the second step the choledocholithiasis was removed. Results: Of a total of 1403 post-RYGB patients, 21 presented choledocholithiasis. Of these, n = 18 were included. Symptoms were reported in n = 15 (8 cholestatic jaundice, 7 cholangitis), whereas n = 3 were asymptomatic. Percutaneous treatment was performed in all these patients, treated with a balloon and stone basket. A hyperamylasemia without pancreatitis was observed in 3 patients. No complications or deaths associated with the procedure were reported. The average hospital stay was 8.6 days. Conclusion: IGS is an interesting option for the treatment CBDS after RYGB. For these patients, PTBD is feasible and safe.

What is the Role of Image-Guided Endovascular Surgery in Postbariatric Surgery Bleeding Complications?

Background: Obesity treatment requires surgical procedures included in bariatric surgery. Bleeding complications are reported in 1%-4%. Image-guided surgery (IGS) includes minimally invasive procedures that have the advantage of less aggression to the patient, fewer complications, and a quick recovery. Endovascular therapy by interventional radiology (IR) is a minimally invasive image-guided procedure widely used in central, peripheral, and splanchnic vascular pathology. Treatment of postoperative bleeding in bariatric surgery can be aided by image-guided endovascular procedures. Objectives: The aim of this study is to carry out an update on the application of IR in bariatric surgery bleeding complications. Bleeding Complications: General rate of postoperative complications in bariatric surgery is 0%-10%. Postoperative bleeding (1%-4%) can be gastrointestinal (endoscopic treatment) or intra-abdominal (surgical treatment/relaparoscopy). In the case of arterial vascular lesions that cannot be resolved either endoscopically or surgically, the option of endovascular treatment with IR should be considered. Conclusions: Endovascular approach through IR and IGS in bleeding complications after bariatric surgery is presented as a valid minimally invasive therapy option in this group of patients.

RISK OF BLEEDING COMPLICATIONS IN PERCUTANEOUS BILIARY DRAINAGE: THE PARADOX OF THE NORMAL HEMOSTASIS.

BACKGROUND: Percutaneous biliary drainage is a safe procedure. The risk of bleeding complications is acceptable. Frequently, patients with biliary obstructions usually have coagulation disorders thus increasing risk of bleeding. For this reason, patients should always fit the parameters of hemostasis. AIM: To determine whether the percentage of bleeding complications in percutaneous biliary drainage is greater in adults with corrected hemostasis prior to the procedure regarding those who did not require any. METHODS: : Prospective, observational, transversal, comparative by independent samples (unpaired comparison). Eighty-two patients with percutaneous biliary drainage were included. The average age was 64±16 years (20-92) being 38 male and 44 female. Patients who presented altered hemostasis were corrected and the presence of bleeding complications was evaluated with laboratory and ultrasound. RESULTS: Of 82 patients, 23 needed correction of hemostasis. The approaches performed were: 41 right, 30 left and 11 bilateral. The amount of punctures on average was 3±2. There were 13 (15.8%) bleeding complications, 12 (20%) in uncorrected and only one (4.34%) in the corrected group with no statistical difference. There were no differences in side, number of punctures and type of drainage, but number of passes and the size of drainage on the right side were different. There was no related mortality. CONCLUSION: Bleeding complications in patients requiring hemostasis correction for a percutaneous biliary drainage was not greater than in those who did not require any.

Percutaneous Image-Guided Abdominal Interventions for Leaks and Fistulas Following Sleeve Gastrectomy and Roux-en-Y Gastric Bypass.

BACKGROUND: Bariatric surgery offers the only effective long-term weight loss therapy for morbidly obese patients. Numerous studies have demonstrated a mortality and morbidity reduction associated with weight loss surgery, but these interventions also have significant rates of complications. It is important for the bariatric surgeons to recognize these complications and acknowledge which of them can be solved in a minimally invasive manner in order to offer to patients the best treatment. The aim of this article was to review factors and success rates associated with percutaneous image guide abdominal interventions to treat the complications of bariatric surgery. MATERIALS AND METHODS: Retrospective descriptive study. Eighty-two patients with complications after bariatric surgery were included. Of these, 56 presented fistula with or without abdominal collection. RESULTS: Of the total patients, 54% are male and 46% female. The average age was 49.4 (range 16-62). Of the 56 cases, 37 (66.1%) occurred after laparoscopic sleeve gastrectomy, and 19 (33.9%) post-Roux-en-Y gastric bypass. The fistula was resolved by percutaneous image guide abdominal interventions in 49 opportunities, of which 67% required only conservative treatment afterwards, the remaining 33% required endoscopic treatment with prostheses, fibrin sealants, and/or clips. No mortality was reported in the series. CONCLUSION: Percutaneous image-guided abdominal interventions play a significant role in the treatment of complications following bariatric surgery. The minimally invasive treatment of fistula after bariatric surgery is safe and effective.

Risk of bleeding complications in percutaneous biliary drainage: the paradox of the normal hemostasis / Risco de complicações de sangramento na drenagem biliar percutânea: o paradoxo da hemostase normal

ABSTRACT Background: Percutaneous biliary drainage is a safe procedure. The risk of bleeding complications is acceptable. Frequently, patients with biliary obstructions usually have coagulation disorders thus increasing risk of bleeding. For this reason, patients should always fit the parameters of hemostasis. Aim: To determine whether the percentage of bleeding complications in percutaneous biliary drainage is greater in adults with corrected hemostasis prior to the procedure regarding those who did not require any. Methods : Prospective, observational, transversal, comparative by independent samples (unpaired comparison). Eighty-two patients with percutaneous biliary drainage were included. The average age was 64±16 years (20-92) being 38 male and 44 female. Patients who presented altered hemostasis were corrected and the presence of bleeding complications was evaluated with laboratory and ultrasound. Results: Of 82 patients, 23 needed correction of hemostasis. The approaches performed were: 41 right, 30 left and 11 bilateral. The amount of punctures on average was 3±2. There were 13 (15.8%) bleeding complications, 12 (20%) in uncorrected and only one (4.34%) in the corrected group with no statistical difference. There were no differences in side, number of punctures and type of drainage, but number of passes and the size of drainage on the right side were different. There was no related mortality. Conclusion: Bleeding complications in patients requiring hemostasis correction for a percutaneous biliary drainage was not greater than in those who did not require any.

RESUMO Racional: A drenagem biliar percutânea é procedimento seguro. O risco de complicações hemorrágicas é aceitável. Frequentemente, os pacientes com obstruções biliares apresentam distúrbios de coagulação, aumentando o risco de sangramento. Por esse motivo, eles devem sempre ser adequados aos parâmetros da hemostasia. Objetivo: Determinar se a porcentagem de complicações hemorrágicas na drenagem biliar percutânea é maior em adultos com hemostasia corrigida antes do procedimento em relação àqueles que necessitaram nenhuma. Métodos: Estudo prospectivo, observacional, transversal, comparativo por amostras independentes (comparação não pareada). Oitenta e dois pacientes foram submetidos à drenagem biliar percutânea. A idade média foi de 64±16 anos (20-92), 38 eram homens e 44 mulheres. Os pacientes que apresentaram hemostasia alterada foram corrigidos, e a presença de complicações hemorrágicas foi avaliada com exames laboratoriais e ultrassonográficos. Resultados: Dos 82 pacientes, 23 necessitaram de correção da hemostasia. O acesso à direita foi em 41 casos, 30 à esquerda e 11 bilaterais. A quantidade de punções em média foi de 3±2. Houve 13 (15,8%) complicações hemorrágicas, 12 (20%) no grupo não corrigido e apenas uma (4,34%) no corrigido sem diferença estatística. Não houve diferenças no lado, no número de perfurações e no tipo de drenagem, mas o número de passagens e o tamanho da drenagem no lado direito foram diferentes. Não houve mortalidade. Conclusão: As complicações hemorrágicas em pacientes que necessitam de correção da hemostasia antes da drenagem biliar percutânea não são maiores do que naqueles que não a requerem.

NECROTIZING PANCREATITIS: DESCRIPTION OF VIDEOSCOPIC ASSISTED RETROPERITONEAL DEBRIDEMENT (VARD) TECHNIQUE WITH COVERED METALLIC STENT.

BACKGROUND: Acute pancreatitis is the third most common gastrointestinal disorder requiring hospitalization in the United States, with annual costs exceeding $2 billions. Severe necrotizing pancreatitis is a life-threatening complication developed in approximately 20% of patients. Its mortality rate range from 15% in patients with sterile necrosis to up 30% in case of infected one associated with multi-organ failure. Less invasive treatment techniques are increasingly being used. These techniques can be performed in a so-called step-up approach. AIM: To present the technique for videoscopic assisted retroperitoneal debridement (Vard technique) with covered metallic stent in necrotizing pancreatitis. METHOD: A guide wire was inserted through the previous catheter that was removed in the next step. Afterwards, the tract was dilated over the guide wire. Then, a partially covered metallic stent was deployed. A 30 degrees laparoscopic camera was inserted and the necrosis removed with forceps through the expanded stent under direct vision. Finally, the stent was removed and a new catheter left in place. RESULT: This technique was used in a 31-year-old man with acute pain in the upper abdomen and diagnosed as acute biliary pancreatitis with infected necrosis. He was treated with percutaneous drains at weeks 3, 6 and 8. Due to partial recovery, a left lateral VARD was performed (incomplete by fixed and adherent tissue) at 8th week. As the patient´s inflammatory response was reactivated, a second VARD attempt was performed in three weeks later. Afterwards, patient showed complete clinical and imaging resolution. CONCLUSIONS: Videoassisted retroperitoneal necrosectomy using partially covered metallic stent is a feasible technique for necrotizing pancreatitis.

PERCUTANEOUS RADIOFREQUENCY ASSISTED LIVER PARTITION WITH PORTAL VEIN EMBOLIZATION FOR STAGED HEPATECTOMY (PRALPPS).

BACKGROUND: When a major hepatic resection is necessary, sometimes the future liver remnant is not enough to maintain sufficient liver function and patients are more likely to develop liver failure after surgery. AIM: To test the hypothesis that performing a percutaneous radiofrecuency liver partition plus percutaneous portal vein embolization (PRALPPS) for stage hepatectomy in pigs is feasible. METHODS: Four pigs (Sus scrofa domesticus) both sexes with weights between 25 to 35 kg underwent percutaneous portal vein embolization with coils of the left portal vein. By contrasted CT, the difference between the liver parenchyma corresponding to the embolized zone and the normal one was identified. Immediately, using the fusion of images between ultrasound and CT as a guide, radiofrequency needles were placed percutaneouslyand then ablated until the liver partition was complete. Finally, hepatectomy was completed with a laparoscopic approach. RESULTS: All animals have survived the procedures, with no reported complications. The successful portal embolization process was confirmed both by portography and CT. In the macroscopic analysis of the pieces, the depth of the ablation was analyzed. The hepatic hilum was respected. On the other hand, the correct position of the embolization material on the left portal vein could be also observed. CONCLUSION: "Percutaneous radiofrequency assisted liver partition with portal vein embolization" (PRALLPS) is a feasible procedure.

Necrotizing pancreatitis: description of videoscopic assisted retroperitoneal debridement (vard) technique with covered metallic stent / Pancreatite necrosante: descrição da técnica de debridamento videoendoscópico retroperitoneal (vard) assistida com stent metálico recoberto

ABSTRACT Background : Acute pancreatitis is the third most common gastrointestinal disorder requiring hospitalization in the United States, with annual costs exceeding $2 billions. Severe necrotizing pancreatitis is a life-threatening complication developed in approximately 20% of patients. Its mortality rate range from 15% in patients with sterile necrosis to up 30% in case of infected one associated with multi-organ failure. Less invasive treatment techniques are increasingly being used. These techniques can be performed in a so-called step-up approach. Aim: To present the technique for videoscopic assisted retroperitoneal debridement (Vard technique) with covered metallic stent in necrotizing pancreatitis. Method: A guide wire was inserted through the previous catheter that was removed in the next step. Afterwards, the tract was dilated over the guide wire. Then, a partially covered metallic stent was deployed. A 30 degrees laparoscopic camera was inserted and the necrosis removed with forceps through the expanded stent under direct vision. Finally, the stent was removed and a new catheter left in place. Result : This technique was used in a 31-year-old man with acute pain in the upper abdomen and diagnosed as acute biliary pancreatitis with infected necrosis. He was treated with percutaneous drains at weeks 3, 6 and 8. Due to partial recovery, a left lateral VARD was performed (incomplete by fixed and adherent tissue) at 8th week. As the patient´s inflammatory response was reactivated, a second VARD attempt was performed in three weeks later. Afterwards, patient showed complete clinical and imaging resolution. Conclusions : Videoassisted retroperitoneal necrosectomy using partially covered metallic stent is a feasible technique for necrotizing pancreatitis.

RESUMO Racional: A pancreatite aguda é a terceira doença gastrointestinal mais comum que requer hospitalização nos Estados Unidos, com custos anuais superiores a $ 2 bilhões. A pancreatite necrosante grave é uma complicação potencialmente fatal, desenvolvida em aproximadamente 20% dos pacientes. A taxa de mortalidade varia de 15% em pacientes com necrose estéril para 30% no caso de uma infecção infectada com falência multiorgânica. As técnicas de tratamento menos invasivas são cada vez mais utilizadas. Elas podem ser realizadas em uma abordagem chamada "step-up". Objetivo: Apresentar a técnica de desbridamento retroperitoneal assistido com videografia (técnica VARD) com stent metálico coberto em pancreatite necrosante. Método: Um fio guia é inserido através do cateter anterior que foi removido no próximo passo. Depois, o trajeto é dilatado sobre o fio guia. Em seguida, um stent metálico parcialmente coberto é implantado. Uma câmera laparoscópica de 30º é inserida e a necrose removida com fórceps através do stent expandido sob visão direta. Finalmente, o stent é removido e um novo cateter deixado no lugar. Resultado: Esta técnica foi utilizada em um homem de 31 anos com dor aguda na parte superior do abdome e diagnosticado como pancreatite biliar aguda com necrose infectada. Ele foi tratado com drenos percutâneos nas semanas 3, 6 e 8. Devido à recuperação parcial, realizou-se um VARD lateral esquerdo (incompleto por tecido fixo e aderente) na 8ª semana. À medida que a resposta inflamatória do paciente foi reativada, uma segunda tentativa VARD foi realizada em três semanas mais tarde. Posteriormente, o paciente apresentou resolução clínica e de imagem completa. Conclusão: A necrosectomia retroperitoneal assistida em vídeo com stent metálico parcialmente coberto é uma técnica viável para pancreatite necrosante.

Percutaneous radiofrequency assisted liver partition with portal vein embolization for staged hepatectomy (pralpps) / Divisão hepática assistida com embolização da veia porta para hepatectomia regrada usando radiofrequência percutânea

ABSTRACT Background: When a major hepatic resection is necessary, sometimes the future liver remnant is not enough to maintain sufficient liver function and patients are more likely to develop liver failure after surgery. Aim: To test the hypothesis that performing a percutaneous radiofrecuency liver partition plus percutaneous portal vein embolization (PRALPPS) for stage hepatectomy in pigs is feasible. Methods: Four pigs (Sus scrofa domesticus) both sexes with weights between 25 to 35 kg underwent percutaneous portal vein embolization with coils of the left portal vein. By contrasted CT, the difference between the liver parenchyma corresponding to the embolized zone and the normal one was identified. Immediately, using the fusion of images between ultrasound and CT as a guide, radiofrequency needles were placed percutaneouslyand then ablated until the liver partition was complete. Finally, hepatectomy was completed with a laparoscopic approach. Results: All animals have survived the procedures, with no reported complications. The successful portal embolization process was confirmed both by portography and CT. In the macroscopic analysis of the pieces, the depth of the ablation was analyzed. The hepatic hilum was respected. On the other hand, the correct position of the embolization material on the left portal vein could be also observed. Conclusion: "Percutaneous radiofrequency assisted liver partition with portal vein embolization" (PRALLPS) is a feasible procedure.

RESUMO Racional: Quando grande ressecção hepática é necessária, às vezes, o fígado remanescente não é suficiente para manter a função hepática e os pacientes são mais propensos a desenvolver insuficiência hepática após a operação. Objetivo: Testar a hipótese de que a realização de uma divisão do fígado com radiofreqüência percutânea mais a embolização percutânea da veia porta (PROPS) para a hepatectomia regrada em porcos é viável. Métodos: Quatro porcos (Sus scrofa domesticus) ambos os sexos com pesos entre 25 a 35 kg foram submetidos à embolização percutânea da veia porta com espirais da veia porta esquerda. Por TC contrastada, a diferença entre o parênquima hepático correspondente à zona embolizada e a normal foi identificada. Imediatamente, usando a fusão de imagens entre ultrassom e CT guiada, as agulhas de radiofrequência foram colocadas percutaneamente e depois foram cortando até a partição do fígado estar completa. Finalmente, a hepatectomia foi completada com abordagem laparoscópica. Resultados: Todos os animais sobreviveram aos procedimentos, sem complicações. O sucesso do processo de embolização do portal foi confirmado por portografia e CT. Na análise macroscópica das peças, analisou-se a profundidade da ablação. O hilo hepático foi respeitado. Por outro lado, a posição correta do material de embolização na veia porta esquerda também pôde ser observada. Conclusão: "Partição do fígado assistida por radiofrequência percutânea com embolização da veia porta" (PRALLPS) é um procedimento viável.

BIODEGRADABLE BILIARY STENTS: A NEW APPROACH FOR THE MANAGEMENT OF HEPATICOJEJUNOSTOMY STRICTURES FOLLOWING BILE DUCT INJURY. PROSPECTIVE STUDY.

BACKGROUND: Once a biliary injury has occurred, repair is done by a hepaticojejunostomy. The most common procedure is to perform a dilatation with balloon with a success of 70 %. Success rates range using biodegradable stents is from 85% to 95%. Biodegradable biliary stents should change the treatment of this complication. AIM: To investigate the use of biodegradable stents in a group of patients with hepaticojejunonostomy strictures. METHODS: In a prospective study 16 biodegradable stents were placed in 13 patients with hepaticojejunostomy strictures secondary to bile duct repair of a biliary surgical injury. Average age was 38.7 years (23-67), nine were female and four male. All cases had a percutaneous drainage before at the time of biodegradable stent placement. RESULTS: In one case, temporary haemobilia was present requiring blood transfusion. In another, pain after stent placement required intravenous medication. In the other 11 patients, hospital discharge was the next morning following stent placement. During the patient´s follow-up, none presented symptoms during the first nine months. One patient presented significant alkaline phosphatase elevation and stricture recurrence was confirmed. One case had recurrence of cholangitis 11 months after the stent placement. 84.6% continued asymptomatic with a mean follow-up of 20 months. CONCLUSION: The placement of biodegradable stents is a safe and feasible technique. Was not observed strictures caused by the stent or its degradation. It could substitute balloon dilation in strictures of hepaticojejunostomy.

RACIONAL: Uma vez que lesão biliar ocorreu, o reparo é feito por hepaticojejunostomia. O procedimento mais comum é efetuar dilatação com balão com sucesso de 70%. As taxas de sucesso utilizando stents biodegradáveis ​​é de 85% a 95%. Stents biliares biodegradáveis ​​devem mudar o tratamento desta complicação. OBJETIVO: Investigar o uso de stents biodegradáveis em um grupo de pacientes com estenose hepaticojejunal. MÉTODOS: Em estudo prospectivo 16 stents biodegradáveis ​​foram colocados em 13 pacientes com estenose de hepaticojejunostomia secundárias usados para reparação do ductos biliares de lesão cirúrgica. A média de idade foi de 38,7 anos (23-67), nove pacientes eram homens e quatro mulheres. Todos os casos tiveram drenagem percutânea antes do momento da colocação de stent biodegradável. RESULTADOS: Em um caso, haemobilia temporária estava presente com necessidade de transfusão de sangue. Em outro, dor após a colocação do stent necessitou de medicação intravenosa. Nos outros 11 pacientes, alta hospitalar foi na manhã seguinte após o procedimento. Durante o seguimento, nenhum apresentou sintomas durante os primeiros nove meses. Um paciente apresentou significativa elevação da fosfatase alcalina por recidiva da estenose. Um caso teve recorrência de colangite 11 meses após a colocação do stent. Continuaram assintomáticos 84,6% com média de acompanhamento de 20 meses. CONCLUSÃO: A colocação de stents biodegradáveis ​​é técnica segura e viável. Não foram observadas restrições causadas pelo stent ou pela sua degradação. Stent pode substituir dilatação com balão na estenose de hepaticojejunostomia.

[Teres ligament hemangioma: laparoscopic approach]. / Hemangioma del ligamento redondo: resección laparoscópica.

Hemangiomas are benign vascular tumors, whose origin comes from the embryonic mesodermal tissue remains. The liver is the most common location. Its location in the teres ligament is extremely rare. This is a 59 years old male admitted because of episodes of epigastric pain for six months. A CT scan and MRI demostrated a 2 cm diameter lesion located near the Teres ligament. Laparoscopic resection was performed. Hemangiomas are the most common benign solid tumors located in the liver. They represents 73% of all benign liver tumors. MRI is the imaging of greater certainty for diagnosis. The Teres ligament (ligamentum teres hepatis) is a fibrous cord resulting in obliteration of the umbilical vein. The location of hemangiomas in this region is extremely rare but should be considered and should make the differential diagnosis with a pedicled hepatic hemangioma or gastointestinal stromal tumors.

Biodegradable biliary stents: a new approach for the management of hepaticojejunostomy strictures following bile duct injury. prospective study / Stent biliar biodegradável: uma nova abordagem para as estenoses hepaticojejunais após lesão do ducto biliar. estudo prospectivo

ABSTRACT Background: Once a biliary injury has occurred, repair is done by a hepaticojejunostomy. The most common procedure is to perform a dilatation with balloon with a success of 70 %. Success rates range using biodegradable stents is from 85% to 95%. Biodegradable biliary stents should change the treatment of this complication. Aim: To investigate the use of biodegradable stents in a group of patients with hepaticojejunonostomy strictures. Methods: In a prospective study 16 biodegradable stents were placed in 13 patients with hepaticojejunostomy strictures secondary to bile duct repair of a biliary surgical injury. Average age was 38.7 years (23-67), nine were female and four male. All cases had a percutaneous drainage before at the time of biodegradable stent placement. Results: In one case, temporary haemobilia was present requiring blood transfusion. In another, pain after stent placement required intravenous medication. In the other 11 patients, hospital discharge was the next morning following stent placement. During the patient´s follow-up, none presented symptoms during the first nine months. One patient presented significant alkaline phosphatase elevation and stricture recurrence was confirmed. One case had recurrence of cholangitis 11 months after the stent placement. 84.6% continued asymptomatic with a mean follow-up of 20 months. Conclusion: The placement of biodegradable stents is a safe and feasible technique. Was not observed strictures caused by the stent or its degradation. It could substitute balloon dilation in strictures of hepaticojejunostomy.

RESUMO Racional: Uma vez que lesão biliar ocorreu, o reparo é feito por hepaticojejunostomia. O procedimento mais comum é efetuar dilatação com balão com sucesso de 70%. As taxas de sucesso utilizando stents biodegradáveis ​​é de 85% a 95%. Stents biliares biodegradáveis ​​devem mudar o tratamento desta complicação. Objetivo: Investigar o uso de stents biodegradáveis em um grupo de pacientes com estenose hepaticojejunal Métodos: Em estudo prospectivo 16 stents biodegradáveis ​​foram colocados em 13 pacientes com estenose de hepaticojejunostomia secundárias usados para reparação do ductos biliares de lesão cirúrgica. A média de idade foi de 38,7 anos (23-67), nove pacientes eram homens e quatro mulheres. Todos os casos tiveram drenagem percutânea antes do momento da colocação de stent biodegradável. Resultados: Em um caso, haemobilia temporária estava presente com necessidade de transfusão de sangue. Em outro, dor após a colocação do stent necessitou de medicação intravenosa. Nos outros 11 pacientes, alta hospitalar foi na manhã seguinte após o procedimento. Durante o seguimento, nenhum apresentou sintomas durante os primeiros nove meses. Um paciente apresentou significativa elevação da fosfatase alcalina por recidiva da estenose. Um caso teve recorrência de colangite 11 meses após a colocação do stent. Continuaram assintomáticos 84,6% com média de acompanhamento de 20 meses. Conclusão: A colocação de stents biodegradáveis ​​é técnica segura e viável. Não foram observadas restrições causadas pelo stent ou pela sua degradação. Stent pode substituir dilatação com balão na estenose de hepaticojejunostomia.

Prevalence of cholelithiasis in Buenos Aires, Argentina.

BACKGROUND: Cholelithiasis is an important cause of morbidity in the world and it varies significantly depending on the region of study. OBJECTIVE: To assess the prevalence of cholelithiasis in Buenos Aires. MATERIAL AND METHODS: This is a cross-sectional, descriptive, observational study performed in a public hospital with tertiary care in Gastrointestinal Surgery. From July 2010 to December 2011, 1,875 healthy volunteers who underwent liver, gallbladder and pancreas ultrasound imaging were included and a questionnaire containing the individual's medical history was administered. The presence of cholelithiasis and its eventual risk factors were studied. RESULTS: Of 1,875 individuals, 866 were males (46.2%) and 1,009 females (53.8%), older than 20 years old with an average age of 46.1 + 16.7 years. Cholelithiasis was found in 410 inidviduals (21.9%); 285 (15.2%) diagnosed at the time of the study and 125 (67%) who had already undergone a cholecystectomy due to gallstones. CONCLUSIONS: The prevalence of cholelithiasis in Buenos Aires, capital city of Argentina, is 21.9%. A significant association was found between cholelithiasis and female gender, age, body mass index, history of colic pain, family history of cholelithiasis, smoking, fatty liver and number of pregnancies.

Prevalence of cholelithiasis in Buenos Aires, Argentina. / Prevalence of cholelithiasis in Buenos Aires, Argentina.

BACKGROUND: Cholelithiasis is an important cause of morbidity in the world and it varies significantly depending on the region of study. OBJECTIVE: To assess the prevalence of cholelithiasis in Buenos Aires. MATERIAL AND METHODS: This is a cross-sectional, descriptive, observational study performed in a public hospital with tertiary care in Gastrointestinal Surgery. From July 2010 to December 2011, 1,875 healthy volunteers who underwent liver, gallbladder and pancreas ultrasound imaging were included and a questionnaire containing the individuals medical history was administered. The presence of cholelithiasis and its eventual risk factors were studied. RESULTS: Of 1,875 individuals, 866 were males (46.2

) and 1,009 females (53.8

), older than 20 years old with an average age of 46.1 + 16.7 years. Cholelithiasis was found in 410 inidviduals (21.9

); 285 (15.2

) diagnosed at the time of the study and 125 (67

) who had already undergone a cholecystectomy due to gallstones. CONCLUSIONS: The prevalence of cholelithiasis in Buenos Aires, capital city of Argentina, is 21.9

. A significant association was found between cholelithiasis and female gender, age, body mass index, history of colic pain, family history of cholelithiasis, smoking, fatty liver and number of pregnancies.

Prevalence of cholelithiasis in Buenos Aires, Argentina / Prevalence of cholelithiasis in Buenos Aires, Argentina.

BACKGROUND: Cholelithiasis is an important cause of morbidity in the world and it varies significantly depending on the region of study. OBJECTIVE: To assess the prevalence of cholelithiasis in Buenos Aires. MATERIAL AND METHODS: This is a cross-sectional, descriptive, observational study performed in a public hospital with tertiary care in Gastrointestinal Surgery. From July 2010 to December 2011, 1,875 healthy volunteers who underwent liver, gallbladder and pancreas ultrasound imaging were included and a questionnaire containing the individual’s medical history was administered. The presence of cholelithiasis and its eventual risk factors were studied. RESULTS: Of 1,875 individuals, 866 were males (46.2

) and 1,009 females (53.8

), older than 20 years old with an average age of 46.1 + 16.7 years. Cholelithiasis was found in 410 inidviduals (21.9

) diagnosed at the time of the study and 125 (67

) who had already undergone a cholecystectomy due to gallstones. CONCLUSIONS: The prevalence of cholelithiasis in Buenos Aires, capital city of Argentina, is 21.9

. A significant association was found between cholelithiasis and female gender, age, body mass index, history of colic pain, family history of cholelithiasis, smoking, fatty liver and number of pregnancies.

Lesión asintomática de la arteria hepática derecha en pacientes con lesión quirúrgica de la vía biliar, ¿ mito o realidad? / Asymptomatic lesion of right hepatic artery injury in patients with biliary tract surgery, myth or reality?

Antecedentes: Los avances en la técnica quirúrgica y en los métodos de diagnóstico por imágenes redujeron los riesgos de colecistectomía. Sin embargo, tanto la técnica laparoscópica como la convencional pueden asociarse a lesiones de estructuras del hilio hepático. Objetivo:Presentar una serie de injurias vasculares derechas asintomáticas asociadas a lesiones canaliculares. Lugar de aplicación: Práctica hospitalaria y privada. Diseño: Observacional,prospectivo. Población: 39 pacientes con antecedentes de lesión quirúrgica de la vía biliar a los que se les realizó arteriografía previo al drenaje percutáneo. Método: Realizamos arteriografías a 39 pacientes con antecedentes de lesión quirúrgica de la vía biliar previo al drenaje pecutáneo. Practicamos ecodoppler previo a la arteriografía en 18 oportunidades. El seguimiento fue de 10 meses. Diagnosticamos 7 estenosis del colédoco, 15 a nivel del carrefour biliar y 17 por encima de la confluencia de los hepáticos. 29 pacientes presentaban estenosis de hepático yeyuno anastomosis, se les realizó biopsia hepática sistemática. Medidas de Evaluación:Se utilizó el test de Pearson y el test de Fisher. Resultados: La artgeriografía mostró variantes anatómicas en el 12,8% de los casos. Se observó lesión de la arteria hepática derecha sin sospecha clínica en el 33% de los casos. El ecodoppler fue patológico en sólo un caso. Conclusiones: Es imprescindible un angiografía digital o angiotomografía multicorte en el caso de una lesión quirúrgica de la vía biliar asociada a lesión vascular, especialmente cuando deba efectuarse una anastomosis biliodigestiva intrahepática, en canales separados, una hepatectomía central o izquierda.

Lesión asintomática de la arteria hepática derecha en pacientes con lesión quirúrgica de la vía biliar, ¿ mito o realidad? / Asymptomatic lesion of right hepatic artery injury in patients with biliary tract surgery, myth or reality?

Antecedentes: Los avances en la técnica quirúrgica y en los métodos de diagnóstico por imágenes redujeron los riesgos de colecistectomía. Sin embargo, tanto la técnica laparoscópica como la convencional pueden asociarse a lesiones de estructuras del hilio hepático. Objetivo:Presentar una serie de injurias vasculares derechas asintomáticas asociadas a lesiones canaliculares. Lugar de aplicación: Práctica hospitalaria y privada. Diseño: Observacional,prospectivo. Población: 39 pacientes con antecedentes de lesión quirúrgica de la vía biliar a los que se les realizó arteriografía previo al drenaje percutáneo. Método: Realizamos arteriografías a 39 pacientes con antecedentes de lesión quirúrgica de la vía biliar previo al drenaje pecutáneo. Practicamos ecodoppler previo a la arteriografía en 18 oportunidades. El seguimiento fue de 10 meses. Diagnosticamos 7 estenosis del colédoco, 15 a nivel del carrefour biliar y 17 por encima de la confluencia de los hepáticos. 29 pacientes presentaban estenosis de hepático yeyuno anastomosis, se les realizó biopsia hepática sistemática. Medidas de Evaluación:Se utilizó el test de Pearson y el test de Fisher. Resultados: La artgeriografía mostró variantes anatómicas en el 12,8% de los casos. Se observó lesión de la arteria hepática derecha sin sospecha clínica en el 33% de los casos. El ecodoppler fue patológico en sólo un caso. Conclusiones: Es imprescindible un angiografía digital o angiotomografía multicorte en el caso de una lesión quirúrgica de la vía biliar asociada a lesión vascular, especialmente cuando deba efectuarse una anastomosis biliodigestiva intrahepática, en canales separados, una hepatectomía central o izquierda. (AU)

Patología obstructiva de la vía biliar: análisis bacteriológico / Patología obstructiva de la vía biliar: análisis bacteriológico

Introducción: La infección del árbol biliar constituye una de las complicaciones más serias que afectan a pacientes con patología hepatobiliopancreática. El estudio bacteriológico de la bilis, sumado a la fisiopatología de obstrucción canalicular y su realización con diferentes parámetros, permite instrumentar mediante la confección de protocolos de procedimientos, distintas conductas terapéuticas. Objetivo: Analizar nuestra experiencia en el estudio bacteriológico de la bilis en los enfermos con patología obstructiva canalicular. Lugar de aplicación: Práctica hospitalaria y extrahospitalaria. Diseño: Observacional retrospectivo. Material y métodos: Entre julio de 2002 y febrero de 2003, se analizaron 97 pacientes con Síndrome de Hipertensión canalicular de diversa etiología. En todos los casos se efectúo drenaje percutáneo de la vía biliar como tratamiento de la obstrucción canalicular y se obtuvo, como primer gesto, bilis para cultivo y antibiograma. Resultados: El análisis de las muestras enviadas a cultivo demostró desarrollo bacteriano en el 42,2% de los pacientes (41 cultivos positivos). Los cultivos fueron positivos en el 37,5% de los pacientes con patología maligna (30 casos). Se obtuvo desarrollo bacteriano en el 65% de los pacientes con enfermedad benigna (11 casos), siendo la Klebsiella el micro organismo más frecuente, seguido de enterococo y E. coli. El 41% de los pacientes con Tumor de Klatskin tuvieron cultivos positivos. Por otra parte, en el 86% de los pacientes con instrumentación biliar percutánea previa, el cultivo fue positivo para enterococo y E. coli. Conclusión: Consideramos que ante un paciente con patología obstructiva de la vía biliar de cualquier etiología en quien se efectúa una instrumentación percutánea debe realizarse profilaxis antibiótica y antibioticoterapiagía en quien se fectúa una instrumentación percutánea debe realizarse profilaxis antibiótica y antibioterapia inicial en los grupos de riesgo...