Could we reduce adhesions to the intra-abdominal mesh in the first week? Experimental study with different methods of fixation.

BACKGROUND: Adhesion formation is a major problem when a mesh is exposed to intraabodminal viscera, with potential severe complications (bowel occlusion, fistulas or abscesses). New methods for preventing adhesions from a polypropylene mesh placed intra-abdominally or to solve difficult situations, such as when the peritoneum cannot be closed during a TAPP repair for an inguinal hernia, are still being seeked. This study mimics in an animal model a situation that can be found in clinical practice during laparoscopic inguinal hernioplasty. A polypropylene mesh could be exposed to the intra-abdominal cavity even when the peritoneum is closed due to different circumstances, with no options to guarantee the prosthetic material of being exposed to the intrabdominal viscera. Different options have been suggested to solve these situations, being proposed in this study to cover the visceral surface of the mesh with an absorbable sponge containing thrombin, fibrinogen, and clotting factors (Tachosil®, Nycomed, Takeda, Osaka, Japan), to assess its use as a barrier to prevent postoperative adhesion formation. MATERIAL AND METHODS: Thirty Wistar white rats (300-450 mg) were included in this study as experimental animals, being randomized into three groups (A, B, and C). We performed a bilateral prosthetic repair with conventional polypropylene mesh (2 × 2 cm, 82 kD). Prosthesis fixation was performed as follows. Group A: absorbable suture; group B: metal staples; group C: metal tackers. A piece of insulating absorbable sponge (Tachosil® 5 × 5 cm) was placed to cover the visceral surface of mesh placed at the right side of each animal. After 10 days, we performed a gross examination (by laparoscopy and laparotomy), measuring the quantity and the quality of the adhesions. Samples were taken for histopathological analysis. RESULTS: Tachosil®-treated prostheses showed a statistically significant decrease in the quality of the adhesion found (p < 0.05). In addition, a smaller quantity of adhesions was identified in barrier-treated animals, although this lacked statistical significance. The histologic analysis showed no significant differences: more edema with the untreated mesh and increased angiogenesis and a lower degree of necrosis in mesh covered with Tachosil®. CONCLUSIONS: The use of Tachosil® as a barrier material led to the absence of strong adhesions as it prevented direct contact between the mesh and the internal organs, preventing major problems associated with strong adhesions.

Experiencia con phs en cirugía mayor ambulatoria / No disponible

No disponible

La anestesia local con sedación como técnica de primera elección en la cirugía de hernia inguinal en régimen ambulatorio: rápida recuperación postoperatoria, alta seguridad y optimización de recursos / Local anesthesia with sedation as elective procedure in day ucise groin hernioplasty: quick postoperative recovery, high security and saving resources

Introducción: La anestesia local con sedación (ALS) se considera la técnica ‘gold estándar’ en la hernioplastia inguinal unilateral abierta, a pesar de que la anestesia raquídea (AR) sigue siendo la técnica más empleada en la práctica clínica diaria. La ALS parece aportar importantes ventajas con respecto a la AR, especialmente en el ámbito de la cirugía sin ingreso (CSI). El objetivo de este trabajo es demostrar los beneficios de ALS frente a AR en la hernioplastia inguinal en cuanto a los tiempos postoperatorios y las complicaciones postoperatorias en una unidad quirúrgica que realiza el 100 % de su actividad en régimen de Cirugía Mayor Ambulatoria (CMA). Material y método: 25 pacientes sometidos a hernioplastia inguinal con ALS y 25 con AR fueron incluidos en un estudio observacional retrospectivo comparativo. El estado clínico (ASA), el tipo de anestesia, los tiempos de recuperación en la Unidad de Recuperación Postanestésica (URPA), en la Unidad de Readaptación al Medio (URM) y durante su convalecencia en domicilio fueron comparados. Se registró cualquier complicación detectada en el periodo postoperatorio hasta el alta definitiva en ambos grupos. Resultados: Todos los pacientes fueron intervenidos según lo previsto. El tiempo de estancia media en URPA y URM, así como el tiempo transcurrido para recuperar la actividad normal tras la intervención, fueron significativamente inferiores en el grupo ALS. Las complicaciones fueron menos frecuentes y menos severas en el grupo ALS. Conclusión: Este trabajo afianza la ALS como técnica más adecuada que la AR para la intervención de hernia inguinal unilateral abierta en régimen de CMA (AU)

Introduction: Local anesthesia with sedation (LAS) is the ‘gold standar’ anesthetic technique in open groin hernioplasty, even if raquidea anesthesia (RA) is actually the most frequent anesthesia technique at the moment. LAS could contribute several advantages in this procedure especially in day case surgery. The main goal of this report is to show the benefits of LAS for groin hernioplasty regarding postoperative recovery times and outcomes in an only outpatient surgery unit. Material and methods: A 25 LAS group and a 25 RA group were enrolled in this observational retrospective comparative study. The clinical status (ASA), anesthetic technique, the Postanesthetic recovery Unit (PARU) recovery time, time before discharge, and time required to normal activity were compared. Any postoperative outcome was recorded. Results: All patients were operated as planned. Recovery times were shorter in the LAS group. Outcomes were more infrequent as well less severe in the LAS group. Conclusion: This report demonstrates that LAS is the most suitable anesthetic technique for unilateral open groin herniorraphy in Day case (AU)

Experience in Day Surgery with prolene hernia system (PHS)

Aim: The aim of this study was to evaluate the outcomes of inguinal hernia repair with prolene hernia system (PHS) mesh under local anaesthesia with sedation as a day surgery procedure within a surgical training programme. Patients and Methods: 5450 patients with inguinal herniae were admitted for hernia repair between 1997 and 2005 in our day surgery unit. 1840 inguinal hernias were repaired with PHS during this time, 1002 patients were operated by residents (54,54 %) under staff supervision. Patients were followed-up at five years post-operatively and the outcome measures of pain and complications recorded. Trainees and staff surgeons were assessed by an evaluation of both knowledge and technique. Results: Local anaesthesia with sedation was used in 97.4 % (1793) of patients; regional anaesthesia in 45 (2.49 %): conversion from local to general anaes-thesia was required in two patients (0.2 %). Mean operation time was 40 min, including the anaesthesic preparation. Mean hospital stay for all patients was 6 hours. The evaluation of hernia repair with the PHS system was similar between the staff members and residents. Conclusion: Inguinal hernia repair using the PHS technique under local anaesthesia with sedation is feasible on a day case basis and is a suitable procedure for training in a residency programme (AU)

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¿Es la obesidad un factor de riesgo de complicaciones, ingresos y suspensiones quirúrgicas en cirugía mayor ambulatoria? / Is obesity a risk factor for complications, hospital admissions, and surgical cancellations in ambulatory surgery?

Objetivo: Registrar la incidencia de complicaciones postoperatorias, ingresos inesperados y suspensiones quirúrgicas en pacientes intervenidos en una Unidad de Cirugía mayor ambulatoria estableciendo su relación con los índices de masa corporal (IMC) de los mismos.
Material y métodos: Se realizó un trabajo observacional descriptivo prospectivo en la Unidad de Cirugía mayor ambulatoria del Hospital Universitario Virgen del Rocío en Sevilla. Se incluyó a todos los pacientes adultos ASA I o II propuestos para intervención quirúrgica en régimen de cirugía mayor ambulatoria que precisaban anestesia general o locorregional, con o sin sedación. Se seleccionó a 1.088 pacientes que se clasificaron según su IMC en 4 grupos: no obesidad (IMC < 30), obesidad tipo i (IMC 30-34,9), obesidad tipo ii (IMC 35-39,9) y obesidad tipo iii mórbida (IMC 40-49,9). se analizaron las complicaciones en las 48h posteriores a la intervención, los ingresos inesperados y las suspensiones quirúrgicas en cada grupo de estudio. Resultados: El grupo obesidad tipo ii (IMC 35-39,9) registró la mayor incidencia de complicaciones postoperatorias (7,69%), ingresos (7,69%) y suspensiones quirúrgicas (4,87%), duplicando en el mejor de los casos el registro de estos eventos en el resto de grupos, aunque no se encontró asociación estadísticamente significativa entre la incidencia de estas variables y el grupo de estudio. El tipo de eventos registrados fue similar en todos los grupos de estudio. Conclusiones: Grados de obesidad moderados y severos podrían estar asociados a un aumento de la incidencia de complicaciones postoperatorias, especialmente dolor y náuseas y/o vómitos postoperatorios, ingresos inesperados y suspensiones en los programas de cirugía mayor ambulatoria. Una adecuada selección y preparación preoperatoria por parte de profesionales especializados en programas de cirugía mayor ambulatoria y estrategias encaminadas a la prevención y el control de las complicaciones más prevalentes en este colectivo son las claves para la integración de pacientes con IMC altos en las unidades de cirugía mayor ambulatoria (AU)

Objectives: To determine the incidence of outcomes, unanticipated admissions and cancella- tions in patients operated in an Ambulatory surgery unit, and to establish the relationships with their body mass index (BMI).
Subjects and methods: An observational descriptive prospective study was conducted in the Ambulatory surgery unit of the University Hospital Virgen del Rocío of Seville, on ASA I or II adult patients proposed for day case surgery with loco-regional or general anesthesia. A cohort of 1,088 patients was classified according to their body mass index into four groups: no obesity (BMI < 30), obesity i (BMI 30-34.9), obesity ii (BMI 35-39.9), and morbid obesity iii (BMI 40-49.9). Postoperative outcomes (48 h), inpatient admissions, and cancellations where calculated. Results: The obesity ii (BMI 35-39.9) group showed a higher incidence of postoperative complications (7.69%), unplanned admissions (7.69%), and surgical cancellations (4.87%), dou- bling, at least, the incidence of adverse events of the other study groups, even when no significant difference was found. Outcomes where similar in all study groups. Conclusions: The results of this study suggest that moderate and severe obesity should be a risk factor for postoperative complications, unplanned admissions, and cancellations in outpatient surgery. Adequate patient selection and preoperative evaluation, as well as strategies for the prevention and control of the most frequents complications in obese patients are the key factors for their integration in major ambulatory surgery programs (AU)

[Is obesity a risk factor for complications, hospital admissions, and surgical cancellations in ambulatory surgery?]. / ¿Es la obesidad un factor de riesgo de complicaciones, ingresos y suspensiones quirúrgicas en cirugía mayor ambulatoria?

OBJECTIVES: To determine the incidence of outcomes, unanticipated admissions and cancellations in patients operated in an Ambulatory surgery unit, and to establish the relationships with their body mass index (BMI). SUBJECTS AND METHODS: An observational descriptive prospective study was conducted in the Ambulatory surgery unit of the University Hospital Virgen del Rocío of Seville, on ASA I or II adult patients proposed for day case surgery with loco-regional or general anesthesia. A cohort of 1,088 patients was classified according to their body mass index into four groups: no obesity (BMI<30), obesity i (BMI 30-34.9), obesity ii (BMI 35-39.9), and morbid obesity iii (BMI 40-49.9). Postoperative outcomes (48h), inpatient admissions, and cancellations where calculated. RESULTS: The obesity ii (BMI 35-39.9) group showed a higher incidence of postoperative complications (7.69%), unplanned admissions (7.69%), and surgical cancellations (4.87%), doubling, at least, the incidence of adverse events of the other study groups, even when no significant difference was found. Outcomes where similar in all study groups. CONCLUSIONS: The results of this study suggest that moderate and severe obesity should be a risk factor for postoperative complications, unplanned admissions, and cancellations in outpatient surgery. Adequate patient selection and preoperative evaluation, as well as strategies for the prevention and control of the most frequents complications in obese patients are the key factors for their integration in major ambulatory surgery programs.

Antibiotic embedded absorbable prosthesis for prevention of surgical mesh infection: experimental study in rats.

INTRODUCTION: Ventral hernias are a common problem in a general surgery and hernioplasty is an integral part of a general surgeon's practice. The use of prosthetic material has drastically reduced the risk of recurrence, but has introduced additional potential complications such as surgical wound infections, adhesion formation, graft rejection, etc. The development of a wound infection in a hernia that is repaired with a prosthetic material is a grave complication, often requiring removal of the prosthesis. This experimental study examined efficacy of completely absorbable, hydrophilic, PGA-TMC (polyglycolic acid-trimethylene carbonate) prosthesis impregnated with antibiotic for reduction of infectious complications. METHODS: Antibiotic-impregnated PGA-TMC prostheses were placed intraperitoneally in 90 Wistar white rats that were randomized and distributed into four groups. Group 0 (23 rats): there were placed PGA-TMC prosthesis without antibiotic impregnation (control group). Group 1 (25 rats): meshes were placed and infected later with 1 × 10(8) UFC of S. aureus/1 ml/2 cm(2) (Staphylococcus aureus ATCC 6538 American Type Culture Collection, Rockville, MD). Group 2 (21 rats): cefazolin-impregnated prostheses were placed (1 g × 100 ml, at the rate of 1 ml/cm(2) of prosthesis) and were subsequently infected with the same bacterial inoculate. Group 3 (21 rats): cefazolin-impregnated prostheses with double quantity of cefazolin and infected. A week later these animals were killed and specimens were extracted for bacterial quantification and histological studies. RESULTS: Evident decrease of bacterial colonization was observed in series 2 and 3 [the ones impregnated with cefazolin, in comparison with the group 1 (infected without previous antibiotic impregnation)] with statistically significant results (p < 0.00). Results were really positive when the antibiotic solution had been applied to the mesh. There have been formed adherences to the prosthesis when placing it in contact with intraabdominal viscera. However, cefazolin impregnation of the mesh has reduced an adhesion formation, mostly when the infection reached a minimum, inhibiting the inflammatory answer to the infection in a prosthetic material. CONCLUSION: Impregnation of the absorbable hydrophilic prosthesis PGA-TMC with cefazolin prevents the infection of the prosthesis placed in infected localization. Therefore, we think this option should be considered as a new and useful alternative in case of contaminated and dirty surgical fields or when a replacement of the prosthesis is required.

Hernioplastia inguinal ambulatoria con anestesia local y sedación: análisis de 1.840 pacientes tras 6 años de seguimiento / Inguinal hernia repair in day surgery setting: a 6 years review in 1840 patients

Introducción: Estudio para evaluar a largo plazo la aplicación y los beneficios del tratamiento de la hernia inguinal con la prótesis de prolene hernia system (PHS), con anestesia local y sedación y en programa de cirugía mayor ambulatoria. Pacientes y métodos: En el periodo 1997-2005 fueron tratados 2.138 pacientes con hernia inguinal en la unidad de cirugía mayor ambulatoria. Todos fueron anestesiados con anestesia local, una mezcla en 20 ml de suero fisiológico de 10 ml de lidocaína al 5 % y 10 ml de bupivacaína con adrenalina. Asimismo, todos fueron sedados con midazolan (0,5-2 mg) y propofol (0,5 ml/kg). Las hernioplastias se realizaron según la técnica de Gilbert y no se empleó quimiprofilaxis de forma rutinaria. El dolor postoperatorio fue valorado según una escala analógica visual. El dolor leve y moderado fue tratado con analgésicos antiinflamatorios no esteroideos o paracetamol. El tiempo medio de los pacientes para el alta en la unidad fue de 6 horas. Se realizaron controles postoperatorios a los 30 días, 3 meses y 6 años por teléfono y siempre que fuese necesario. Resultados: Del total de pacientes intervenidos, en 1.840 casos (86,1 %) se realizó un seguimiento y fueron controlados a los 6 años. Todos habían sido intervenidos en circuito sin ingreso, 147 (7,98 %) mujeres y 1.693 (92,02 %) hombres, y no presentaron eventos adversos en el periodo postoperatorio. La edad media fue de 56 (18-82 años). La clasificación de Gilbert fue I: 15 (0,81 %), II: 49 (2,66 %), III: 736 (40 %), IV: 939 (51,03 %) y V: 101 (5,48 %). En el 91,95 % eran hernias primarias y recidivadas el 8,04 %. La revisión a los 6 años mostró curación en 1.824 pacientes (99,13 %), curación con alguna secuela en 6 pacientes (0,32 %) y recidivas herniarias en 10 pacientes (0,54 %). Conclusiones: El estudio presentado demuestra a largo plazo que la técnica de PHS realizada bajo anestesia local y sedación consciente en un programa de cirugía sin ingreso es un procedimiento efectivo con muy escaso número de recidivas (AU)

Aim: The study is conducted to evaluate long time the feasibility and benefits of inguinal hernia repair with prolene hernia system (PHS) mesh using local anaesthesia with sedation as a day surgery procedure. Patients and methods: 2138 patients with inguinal hernia were attended in the day surgery setting from 1997 to 2005. Patients were sedated with midazolam (0.5-2 mg) and propofol (0.5 ml/kg). Local anaesthesia (20 ml saline solution, 10 ml lidocaine (5 %) and 10 ml bupivacaine with adrenaline. Hernioplasties were performed according to Gilbert technique. No routine chemoprophylaxis. Postoperative pain was assessed using analogical visual scale pain. Mild and moderate postoperative pain was managed with simple analgesics or NSAID or paracetamol. Patients were discharged at 6 hours. Postoperative controls: 30 days, 3 months and 6 years by phone, and always was necessary. Results: 1840 (86,1 %) were controlled 6 years. They were operated as day cases, 147 women (7,98 %) and 1693 men (92,02 %). Mean age was 56 (18-82 years). Gilbert’s classification: I-15 (0.81 %), II-49 (2.66 %), III-736 (40 %), IV-939 (51.03 %) and V-101 (5.48 %). Primary hernias were 1692 (91.95 %) and recurrent 148 (8.04 %). The review at 6 years showed healing in 1824 patients (99.13 %), cure with a sequel in 6 patients (0.32 %) and hernia recurrences in 10 patients (0.54 %). Conclusion: The study presented demonstrates the long term PHS technique performed under local anesthesia and conscious sedation in a program of outpatient surgery is an effective procedure with very low number of relapses (AU)

Consideraciones en torno a la formación del residente en cirugía de pared abdominal en España / Training of residents in abdominal wall surgery in Spain

La formación del residente en cirugía de la pared abdominal constituye un aspecto fundamental en la formación quirúrgica, representando globalmente un 20% de su actividad. En el presente artículo, se analiza el estado actual de la formación del residente en este tipo de cirugía en España teniendo en cuenta el amplio espectro en el que se desarrolla: servicios generales, unidades funcionales específicas, programas de cirugía mayor ambulatoria. Para ello, partiendo de las especificaciones del programa de la especialidad, se han utilizado datos concretos obtenidos de diversas fuentes de información directas, así como una revisión de los resultados obtenidos por los residentes en cirugía herniaria. En general los residentes en nuestro país manifiestan su conformidad con la formación recibida, y los resultados objetivos registrados se adecuan a los planteados en el programa. Sin embargo, sería importante estructurar en sus itinerarios docentes, un periodo de rotación en alguna Unidad específica y su implicación en programas de cirugía mayor ambulatoria (AU)

The training of residents in abdominal wall surgery is a fundamental aspect of surgical training, representing globally 20% of its activity. In this paper, we analyze the current state of resident training in this kind of surgery in Spain, taking into account the broad spectrum it covers: general services, specific functional units, ambulatory surgery programs. To do this, based on the specifications of the specialty program, specific data were used from several different sources of direct information and a review of the results obtained by residents in hernia surgery. In general, our residents agree with their training and the recorded results are in line with objectives outlined in the program. However, it would be important to structure their teaching schedules, a rotation period in any specific unit and their involvement in outpatient surgery programs (AU)

[Training of residents in abdominal wall surgery in Spain]. / Consideraciones en torno a la formación del residente en cirugía de pared abdominal en España.

The training of residents in abdominal wall surgery is a fundamental aspect of surgical training, representing globally 20% of its activity. In this paper, we analyze the current state of resident training in this kind of surgery in Spain, taking into account the broad spectrum it covers: general services, specific functional units, ambulatory surgery programs. To do this, based on the specifications of the specialty program, specific data were used from several different sources of direct information and a review of the results obtained by residents in hernia surgery. In general, our residents agree with their training and the recorded results are in line with objectives outlined in the program. However, it would be important to structure their teaching schedules, a rotation period in any specific unit and their involvement in outpatient surgery programs.

Dolor persistente tras hernioplastia inguinal: estudio descriptivo a largo plazo / No disponible

Introducción: Dolor crónico es aquel que permanece tras 3 meses desde la intervención quirúrgica. De etiología multifactorial, puede llegar a ser invalidante para el paciente. Objetivos: Conocer, en nuestro medio, la prevalencia del dolor crónico posthernioplastia inguinal en cirugía programada y régimen ambulatorio. Material y métodos: Estudio descriptivo retrospectivo de los pacientes diagnosticados de hernia inguinal e intervenidos de manera programada en cirugía mayor ambulatoria entre enero de 2000 y diciembre de 2006. Dolor inmediato: primeras 72 horas; dolor agudo: 3 primeros meses; dolor crónico: más de 3 meses. Seguimiento: llamada telefónica a las 24 y 48 horas del alta, revisión en consulta al mes y llamada telefónica al año. Resultados: 3.649 pacientes (81,70% hombres), edad media 54,15 años. ASA II 63,55%. Dolor inmediato en el 85% delos pacientes, que cedió con la analgesia pautada; dolor agudo en el 3%, inyectándose corticoide y anestésico local cuando el dolor no cedía pasadas 4 semanas en 3 pacientes; dolor crónico en el 0% de los pacientes seguidos durante un año. Discusión: Durante el primer mes del postoperatorio sólo están indicados analgésicos orales. Pasado este periodo y ante la permanencia de dolor, u na alternativa a la analgesia pautada puede ser la inyección de corticoide y anestésico local en lazona intervenida. Conclusión: El dolor inmediato tras la hernioplastia inguinal programada en régimen ambulatorio así como el producido en los 3 primeros meses, precisa únicamente analgesia oral. Es nula la prevalencia de dolor crónico en nuestra serie (AU)

Introduction: Chronic pain is pain that persists 3 months after the surgical procedure. Of multifactorial etiology, it can be disabling for the patient. Objetives: To determine, in our environment, the prevalence of chronic pain after inguinal hernioplasty scheduled as ambulatory surgery. Material and methods: A retrospective study of patients diagnosed with inguinal hernia and who underwent ambulatory surgery between January 2000 and December 2006. Immediate pain: at 72hours; severe pain: up to 3 months; chronic pain: more than 3months. Follow-up: telephone call at 24 and 48 hours after discharge, clinical visit one month after and phone call one year later. Results: 3,649 patients (81.70% male), mean age 54.15years. ASA II 63.55%. Immediate pain in the first 48 hours in 85% of patients, which was controlled with analgesia; severe pain in 3%, in which steroids and local anaesthetic injected in 1-2 sessions were given when the pain did not abate after 4 weeks in 3 patients; chronic pain in 0% of the patients followed for one year. Discussion: During the first month after surgery only oral analgesics are indicated. After this period and if there is persistence of pain, an alternative to analgesia may be the injection of corticosteroids and a local anaesthetic. Conclusion: The immediate pain after inguinal hernia in elective and ambulatory surgery as well as until the first 3 months require only oral analgesia. Is zero the prevalence of chronic pain in our series (AU)

Implantación de catéteres de diálisis peritoneal: Nuestra experiencia a corto y largo plazo / No disponible

Introducción: Experiencia a corto y a largo plazo en la implantación de catéteres de diálisis peritoneal y objetivos establecidos para instaurar la técnica en régimen de cirugía mayor ambulatoria(CMA).Material y métodos: Estudio retrospectivo durante ocho años. Dos grupos: catéteres tipo Tenckhoff con dos cuff y catéteres tipo Tenckhoff con dos cuff y un lastre final. Peculiaridad quirúrgica: introducción del catéter en una solución antibiótica. Las complicaciones se han dividido en corto y largo plazo en función de que aparecieran o no en la primera semana de implantación. Resultados: Causa más frecuente conocida de insuficiencia renal crónica: diabetes mellitus (9,8%). En el 33,1% (41 catéteres)no hubo ninguna complicación, y destacan el dolor a corto plazo(8,9%) y la peritonitis a largo plazo (8,1%). El 78,4% de los inicialmente implantados no precisaron ser recambiados. Conclusiones: La colocación del catéter peritoneal debe ser realizada en quirófano. La diálisis peritoneal es una técnica segura, eficaz y simple tanto para el cirujano como para el paciente. Presenta escasas complicaciones, fundamentalmente dolor y peritonitis. El catéter se recambia cuando funciona mal o fuga. No existen en la literatura estudios que reflejen la introducción del catéter en una solución antibiótica previo a su colocación. Puede implantarse en régimen de CMA (AU)

Introduction: Our short and long term experience in the implantation of peritoneal catheters is exposed in this study and whether the aims established for ambulatory surgery are fulfilled. Material and methods: An eight year retrospective study. Two groups: catheters type Tenckhoff with two cuffs and catheters type Tenckhoff with two cuffs and a ballast on the end. Surgical peculiarity: the introduction of the catheter in an antibiotic solution. The complications were divided in short and long term depending on when they appeared during the first week of implantation or not. Results: The most frequent reason for chronic renal insufficiency was: diabetes mellitus (9.8%). In 33.1% of cases (41catheters) there were no complications, and only pain on the short-term (8.9%) and peritonitis on the long-term (8.1%).78.43% of the initially implanted catheters did not need to be replaced. Conclusions: The placement of the peritoneal catheter must be done in the operating room.Peritoneal dialysis is a sure, effective and simple technique for the surgeon and for the patient. It presents few complications,mainly pain and peritonitis. The catheter is replaced when it works badly or leaks. There are no studies in the literature that reflectthe introduction of the catheter in an antibiotic solution before its placement. It can be implanted as an AS procedure (AU)

Complicaciones tras el alta a domicilio: seguimiento durante 24 meses en una unidad de cirugía mayor ambulatoria / No disponible

Introducción: El periodo postoperatorio es indiscutiblemente uno de los aspectos clave en los circuitos de cirugía mayor ambulatoria. Tanto la selección del paciente como las técnicas anestésicas y quirúrgicas aplicadas en cada ocasión se enfocan a que la recuperación postquirúrgica se lleve a cabo en régimen extrahospitalario de forma segura y satisfactoria para el paciente. Material y métodos: La estancia en casa de nuestros pacientes es supervisada mediante llamadas telefónicas desde la unidad por personal capacitado o seguimiento por parte del cirujano encita a consulta 24 ó 48 horas tras la cirugía. Los pacientes o sus cuidadores cuentan asimismo con un teléfono de contacto de forma continua e ilimitada en el tiempo al que pueden llamar si detectan alguna complicación o les surge cualquier duda durante su restablecimiento. En nuestra unidad se lleva a cabo un registro sistemático de las llamadas recibidas a este teléfono de contacto, en las que se señala la intervención a la que se había sometido el paciente, el motivo de su llamada y el tiempo transcurrido desde la intervención. En este trabajo se lleva a cabo un análisis retrospectivo de las llamadas registradas desde enero del 2006 hasta diciembre de2007. Resultados: De 6.224 pacientes intervenidos durante los 24 meses que incluye el estudio, 224 recurrieron al teléfono de contacto facilitado al alta. En 85 casos (38,39%) el dolor fue el motivo principal de consulta. El sangrado de la herida fue la causa de llamada en 42 casos (18,75%) y la fiebre en 37 (16,7%). El mayor volumen de llamadas se recibe a partir de 72 horas tras la cirugía, un 75,87% del total de las mismas. Conclusiones: Aportar un método del contacto directo del paciente con la personal cualificado de la unidad permite detectar y analizar complicaciones en postoperatorio y establecer estrategias de prevención y tratamiento para mejorar los índices de calidad (AU)

Background: Postoperative recovery is, possibly, the most important period in ambulatory surgery. Patient-selection, anaesthetic and surgical techniques are geared for a safe post-dischagestay at home and satisfaction of patients and their family. Material and methods: Follow-up at home is supervised by telephone calls to the patients made by the hospital nurses after 24-48 h or by visits to the hospital the first postoperative day. The hospital provided all patients or family with a telephone number to ring at any time for advice on outcome, difficulties or to contact their physicians. These phone calls by patients to the hospital are recorded by nurses of the ambulatory unit. This study is a retrospective analysis of these calls recorded from January 1st 2006 to December 31st 2007.Results: Of the 6,242 patients who underwent ambulatory surgery, 224 called our unit after discharge. Severe to moderate pain was the main reason for the call in 85 (38.39%) cases, bleeding in 42 cases (18.75%) and fever in 37 cases (16.7%).Most of the calls to the unit were made after 72 h following discharge from the outpatient unit (75.87%).Conclusions: Providing a means of direct contact of patients with qualified personnel helps us detect and analyze postoperative complications and treatments and establish strategies to prevent them as well as improve our quality indicators (AU)

Indicadores de calidad: ingresos no esperados y reingresos en una unidad de cirugía mayor ambulatoria / No disponible

Introducción: Los índices de ingresos no esperados y reingresos son dos importantes marcadores de calidad de una unidad de cirugía mayor ambulatoria. Unidades especializadas en esta forma de cirugía establecen índices de ingresos no esperados de entre 0,28 y 1,42% y de reingresos tras el alta hospitalaria del1%. Material y métodos: Mediante análisis retrospectivo evaluamos la incidencia de ingresos no esperados y reingresos en nuestra unidad analizando sus causas durante un periodo de tiempo de 12 meses. Resultados: De un total de 8.534 pacientes intervenidos en nuestra unidad, 84 (0,98%) requirieron ingreso tras la cirugía. El dolor no controlado es la causa en 26 de estos casos, un 30,95% del total de ingresos en la unidad, y como segundo motivo más frecuente encontramos el sangrado postoperatorio, 19 casos, un 22,6% de los ingresos. Tras el alta a domicilio 9 pacientes intervenidos en nuestra unidad precisaron reingreso (0,10%) siendo el motivo de reingreso más frecuente el sangrado postquirúrgico. En nuestro análisis observamos que 26 pacientes permanecieron ingresados en la unidad porque la intervención no pudo llevarse a cabo en régimen de cirugía sin ingreso debido a las características del procedimiento quirúrgico, las necesidades anestésicas o por la situación clínica o social del paciente. Conclusiones: Nuestros índices de ingreso y reingreso se pueden considerar bajos y comparables con los publicados hasta el momento. Actuaciones que incidan de forma eficaz en el control del dolor y una adecuada selección de los pacientes propuestos para ser intervenidos en nuestra unidad podrían disminuir la frecuencia de estos dos factores (AU)

Introduction: The index of unanticipated hospital admissions and readmissions are two important quality indicators in an Ambulatory Surgery Unit. Specialized units for ambulatory surgery have unanticipated admission indexes of 0.28% to 1.42% and readmission indexes after discharge of 1%.Material and methods: Using a retrospective analysis, we studied the index of unanticipated admissions and readmissions in our unit, and analyzed the reasons for these over the last 12 months. Results: Of a total of 8,534 patients who underwent surgery in our Unit, 84 (0.98%) required hospital admission after surgery. Uncontrolled pain was the reason for 26 of these cases, a 30.95% of the total of admissions; the second reason was postoperative bleeding, in 19 cases, 22.6% of admissions. Nine patients operated on in our unit were readmitted (0.10%), in most cases due to postoperative bleeding. In our study, 26 patients were admitted to hospital due to the complexity of the surgery, for an aesthetic reasons or due to the patient’s clinical or social situation. Conclusions: Our index of admissions and readmissions is considered low and similar to those published until now. Measures to control pain as well as careful selection of patients for ambulatory surgery could reduce the frequency of these two factors (AU)

Íleon perforado y fistulizado a piel contenido en gran hernia umbilical incarcerada / Perforated, fistulized-to-skin ileum within a large incarcerated umbilical hernia

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