Treatment of esophageal perforation: A review of our experience at a tertiary referral hospital spanning the past 19 years.

INTRODUCTION AND AIMS: Esophageal perforation is an uncommon event that is a medical/surgical emergency, with a 15-30% mortality rate. The aim of the present study was to communicate our experience in the management of esophageal perforation, evaluating the different strategies utilized, in an effort to establish measures to guide decision-making in selecting treatment. MATERIALS AND METHODS: A retrospective descriptive study was conducted on patients diagnosed with esophageal perforation at our hospital center, within the time frame of 2000 and 2019. RESULTS: Over the past 19 years, 15 patients were diagnosed with esophageal perforation. Surgical treatment was carried out in 80% of the cases. Primary closure, reinforced with plasty, was performed in 67% of the patients, of whom 62.5% had early diagnosis and a 100% survival rate. Diagnosis was late in 37.5% of the cases, with a 33.3% survival rate. Esophagectomy and gastric pull-up were performed on 25% of the patients, 66.6% of whom had early diagnosis and a 100% survival rate. In the 33.3% that had late diagnosis, the mortality rate was 100%. Esophagectomy, with cervical esophagostomy and feeding jejunostomy, was performed on one of the patients (8.3%) that had early diagnosis and a 100% survival rate. CONCLUSIONS: The main survival predictor in esophageal perforation is the interval of time between the injury and its diagnosis, and in turn, the resulting treatment. Each patient with esophageal perforation should have individualized treatment to adequately manage the condition.

Diagnostic yield of abdominal ultrasonography for the diagnosis of acute appendicitis: A global and subgroup analysis. / Rentabilidad de la ecografía abdominal para el diagnóstico de apendicitis aguda. Análisis global y por subgrupos.

INTRODUCTION AND AIMS: Abdominal ultrasonography is very useful for diagnosing acute appendicitis and has 59-96% sensitivity and 83-98% specificity. The aim of the present study was to determine the diagnostic yield of abdominal ultrasound imaging for acute appendicitis and identify the patient subgroups with the best results. MATERIALS AND METHODS: Patients at a general hospital that underwent appendectomy due to the clinical suspicion of appendicitis, who also had a diagnostic radiologic study, within the time frame of January 2007 to December 2010, were analyzed. Ultrasound studies were considered positive when there were radiologic signs suggestive of acute appendicitis. The sensitivity, specificity, and predictive values of the diagnostic study were determined through the logistic regression method. RESULTS: A total of 646 patients were operated on due to clinical suspicion of acute appendicitis. A diagnostic abdominal ultrasound study was carried out on 383 (59.3%) of those patients, resulting in 79% sensitivity (74-83, 95% CI), 58% specificity (39-75, 95% CI), 95% positive predictive value (92-97, 95% CI), and 20% negative predictive value (13-30, 95% CI). CONCLUSIONS: Abdominal ultrasound imaging in patients with a high suspicion of appendicitis had a mediocre diagnostic yield, but better results could be achieved in different specific subgroups.

[A preliminary experience in the laparoscopic approach to bowel obstruction]. / Experiencia inicial en el abordaje laparoscópico de la obstrucción intestinal.

BACKGROUND: The laparoscopic approach to bowel obstruction is still controversial. OBJECTIVE: To evaluate our initial results in the laparoscopic treatment of bowel obstruction. MATERIAL AND METHODS: A retrospective study on patients diagnosed with bowel obstruction that underwent laparoscopic surgery within the time frame of January 2008 to June 30, 2012. The variables employed were: age, sex, occlusion etiology, previous surgeries, clinical progression, pneumoperitoneum creation, use of an auxiliary incision, anesthesia duration, conversion rate, postoperative hospital stay, time needed to tolerate liquids, and complications. RESULTS: Twenty-six patients, 18 women (69.2%) and 8 men (30.8%), with a mean age of 64.35 years (range: 21-92 years) were analyzed. The most frequent obstruction etiology was secondary to adhesions and presented in 12 cases. Nine patients (34.6%) underwent a completely laparoscopic approach and laparoscopy was complemented by an auxiliary incision in another 9 patients (34.6%), resulting in 18 cases (69.2%) of successful laparoscopic approach. Eight patients (30.8%) required conversion to open surgery. The mean anesthesia duration was 95min (range: 55-165min), mean postoperative hospital stay was 6 days (range: 3-72 days), and the mean amount of time needed to tolerate liquids was 3 days (range: 1-10 days). The patients that underwent complete laparoscopic approach presented with shorter hospital stay, they were able to ingest liquids earlier, and they presented with a lower number of postoperative complications; this latter variable was the only one that was statistically significant. CONCLUSIONS: The initial results of our experience were good, although more patients are needed in order to standardize and extend the use of this technique.

[Laparoscopic apendicectomy vs open approach for the treatment of acute appendicitis]. / Apendicectomía laparoscópica frente al abordaje abierto para el tratamiento de la apendicitis aguda.

BACKGROUND: There is no international consensus on the approach of choice for performing appendectomy. AIMS: To analyze and compare open and laparoscopic approaches in the surgical treatment of acute appendicitis. MATERIAL AND METHODS: A retrospective study was carried out on patients over 14-years-old operated on for suspected acute appendicitis between January 2007 and December 2009. Variables were: age, sex, body mass index, specialized surgeon or resident in training, progression duration, conversion rate, use of drains, abdominal cavity irrigation, macroscopic appearance of the appendix, onset time of anesthesia, ASA classification, postoperative hospital stay, resumption of intake of liquids, and complications. The patients were divided into two groups: laparoscopic approach (LA) and open approach (OA). RESULTS: A total of 533 patients were enrolled (290 LA and 243 OA). Onset time of anesthesia was 75 min (30-190 min) in LA vs 55 min (20-160 min) in OA (p<0,0001). COMPLICATIONS: intraabdominal abscesses in 17 LA cases vs 13 OA cases (p=0,79); surgical wound alterations in 16 LA cases vs 47 OA cases (p=0,0001); incisional hernias in 2 LA cases (1%) vs 10 OA cases (p=0,008). There were no statistically significant differences in postoperative hospital stay (3 days), resumption of intake of liquids (1 day) or readmission rate (8%). CONCLUSIONS: There are fewer surgical wound alterations and incisional hernias with the laparoscopic approach, but there is higher cost, lengthier surgery duration, and a longer learning curve. Our results cannot provide a clear indication for one approach or the other, and therefore each case must be evaluated on an individual basis.