Gastric ischemia secondary to intestinal occlusion due to gallstone ileus.

Gallstone ileus is a rare complication of cholecystoduodenal fistula. Gastric ischemia due to intestinal obstruction is an extremely rare event that, if not diagnosed in time, can have a fatal outcome. We present the case of a patient with intestinal occlusion due to a gallstone obstructing the middle jejunum in which gastric ischemia was diagnosed intraoperatively due to the distension caused by the intestinal obstruction.

Hernia diafragmática gigante incarcerada postesofaguectomía (McKeown) con dilatación severa de la gastroplastia / Giant incarcerated diaphragmatic hernia post-esophagectomy (McKeown) with severe dilatation of gastric esophagoplasty

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Cirugía mayor ambulatoria del cáncer de mama: factores relacionados con la conversión a hospitalización convencional / Major ambulatory surgery for the treatment of breast cancer: Factors conditioning conversion to conventional hospitalization

Introducción: La realización de cirugía oncológica mamaria en régimen ambulatorio se está convirtiendo en una práctica estándar entre los centros públicos por los distintos beneficios que aporta. En este estudio se analizan los resultados obtenidos con esta modalidad asistencial y se identifican los factores relacionados con su fracaso. Métodos: Se analizaron retrospectivamente los datos de las 206 pacientes intervenidas por cáncer de mama en el año 2016 bajo 3 tipos de régimen: ambulatorio puro, ambulatorio-23 h y hospitalario convencional. Se describen los índices de ambulatorización, éxito y conversión, tanto de forma global como distinguiendo entre cirugía conservadora, mastectomía ± reconstrucción inmediata y cirugía axilar. Se realiza un análisis univariante para hallar aquellos factores relacionados con la conversión a régimen hospitalario. Resultados: Para la muestra global se obtuvo un índice de ambulatorización del 61,2%, con un 16,5% de conversiones y un éxito del 83,4%. Para cirugía conservadora, ambulatorización, éxito y conversión fueron del 78,8, el 88,6 y el 11,4%, respectivamente. En las mastectomías la ambulatorización fue del 28,6%, con un 37,1% de conversión y un éxito del 62,9%. Las 11 cirugías axilares culminaron en régimen ambulatorio. Los factores asociados a una mayor probabilidad de conversión fueron la realización de mastectomía frente a cirugía conservadora y la aparición de complicaciones postoperatorias. Conclusiones: La cirugía del cáncer de mama en régimen ambulatorio es factible y segura. Para la optimización de resultados resultan imprescindibles la cuidadosa selección de las candidatas y el desarrollo de una técnica quirúrgica cuidadosa y lo más conservadora posible

Introduction: The main step in curative treatment for breast cancer is surgery. Its use in an ambulatory setting can contribute towards more efficient healthcare, providing additional benefits for patients. In this study, we analyze the results obtained with this treatment method and identify factors related with conversion to hospitalization.Methods: Results were analyzed from the 206 surgeries performed for breast cancer in 2016, using three different methods: day surgery, overnight ambulatory (23h) and conventional hospitalization. The ambulatory success and conversion rates were calculated for the global sample and stratified, distinguishing between conservative surgery, mastectomy and axillary surgery. A univariate analysis was performed to identify the factors involved in conversion. Results: For the global sample, the ambulatory surgery rate was 61.2%, 16.5% conversions and a success rate of 83.4%. For conservative surgery, ambulatory, success and conversion rates were 78.8%, 88.6 and 11.4%, respectively. For mastectomies, the ambulatory rate was 28.6%, with 62.9% success and 37.1% conversions. The 11 axillary surgeries were performed as day surgeries. Factors associated with conversion were mastectomy vs. vs. conservative surgery and the appearance of postoperative complications. Conclusions: Ambulatory surgery for the surgical treatment of breast cancer should be standard care. Optimized results require adequate patient selection and the performance of surgical technique that needs to be as careful and as conservative as possible

Major ambulatory surgery for the treatment of breast cancer: Factors conditioning conversion to conventional hospitalization. / Cirugía mayor ambulatoria del cáncer de mama: factores relacionados con la conversión a hospitalización convencional.

INTRODUCTION: The main step in curative treatment for breast cancer is surgery. Its use in an ambulatory setting can contribute towards more efficient healthcare, providing additional benefits for patients. In this study, we analyze the results obtained with this treatment method and identify factors related with conversion to hospitalization. METHODS: Results were analyzed from the 206 surgeries performed for breast cancer in 2016, using three different methods: day surgery, overnight ambulatory (23h) and conventional hospitalization. The ambulatory success and conversion rates were calculated for the global sample and stratified, distinguishing between conservative surgery, mastectomy and axillary surgery. A univariate analysis was performed to identify the factors involved in conversion. RESULTS: For the global sample, the ambulatory surgery rate was 61.2%, 16.5% conversions and a success rate of 83.4%. For conservative surgery, ambulatory, success and conversion rates were 78.8%, 88.6 and 11.4%, respectively. For mastectomies, the ambulatory rate was 28.6%, with 62.9% success and 37.1% conversions. The 11 axillary surgeries were performed as day surgeries. Factors associated with conversion were mastectomy vs. vs. conservative surgery and the appearance of postoperative complications. CONCLUSIONS: Ambulatory surgery for the surgical treatment of breast cancer should be standard care. Optimized results require adequate patient selection and the performance of surgical technique that needs to be as careful and as conservative as possible.