[Infección necrotizante de la pared abdominal: ¿qué hacer?] / Necrotizing soft tissue infection on the abdominal wall. How to proceed?

El éxito en el tratamiento de las infecciones necrotizantes de los tejidos blandos (INTB) depende de la precocidad diagnóstica y de la agresividad terapéutica, basada en el desbridamiento quirúrgico, la antibioticoterapia de amplio espectro y el soporte intensivo. Se presenta un caso de INTB secundaria a diverticulitis aguda perforada (Hinchey 4) con el fin de ilustrar las consideraciones particulares en el manejo de la INTB de localización en la pared abdominal, apoyadas en la evidencia disponible en la literatura científica. Se identifican como puntos clave la precocidad y la agresividad del desbridamiento quirúrgico, la antibioticoterapia dirigida por el cultivo y su suspensión guiada por la negativización microbiológica; y el empleo de técnicas combinadas de autoplastia y prótesis apoyadas en la terapia de presión negativa en la restauración de la pared abdominal, con lo que se ha obtenido un buen resultado.Successful treatment of necrotizing soft tissue infections (NSTI) depends on early diagnosis and therapeutical aggressiveness, based on surgical debridement, broad spectrum antibiotics and intensive support. A case of perforated diverticulitis (Hinchey 4)-secondary-NSTI is presented in order to illustrate the particular considerations in the management of abdominal wall located NSTI, supported on the evidence available in scientific literature. Several key points are identified, such as prompt and aggressive surgical debridement; culture-guided antibiotherapy and its suspension based on microbiological negativization; and the utilization of combined techniques of autoplastic repair and replacement, also supported on negative pressure therapy in the abdominal wall restoration, which have shown a good outcome.

Colecistectomía laparoscópica en régimen de cirugía mayor ambulatoria en un hospital comarcal: resultados iniciales de una serie de 110 casos / Laparoscopic cholecystectomy performed as ambulatory major surgery in a regional hospital. Initial results of a series of 110 cases

Introducción El objetivo del estudio es analizar la fiabilidad de la colecistectomía laparoscópica (CL) realizada en el ámbito de cirugía mayor ambulatoria (CMA) para generalizar su uso y conseguir una mejor gestión de los recursos sanitarios. Material y método Estudio retrospectivo en el que se analizan 110 pacientes intervenidos de CL entre septiembre de 2004 y noviembre de 2008. Los criterios de selección fueron ausencia de cirugía abdominal supramesocólica previa, ausencia de ingresos previos por colecistitis aguda, ausencia de litiasis en la vía biliar principal y pruebas de función hepática normales, ausencia de ingesta de anticoagulantes orales o antiagregantes plaquetarios y clasificación I y II de la American Society of Anesthesiologists. Todos los pacientes fuern intervenidos bajo el protocolo de CMA previamente establecido. Resultados Se intervino a 81 mujeres y 29 varones, con una media de edad de 51,03 años (rango: 24–77). Cincuenta y siete pacientes presentaban antecedentes médicos o quirúrgicos. Resultados La morbilidad general fue del 6,36% con una mortalidad del 0%. La tasa de conversión fue del 0,9%. Ochenta y siete pacientes (79,1%) fueron dados de alta a las 6h de la intervención, cumpliendo así el régimen de CMA. La estancia hospitalaria global media fue de 1,49 días (mediana 0). La tasa de reintervenciones fue del 1,81% y la tasa de reingresos tras el alta fue del 0,9%.ConclusionesLa realización de CL en CMA es factible y segura. Debería estar integrada en la actividad de las unidades de CMA, siempre que exista una correcta selección de los pacientes y un especial interés por parte de los cirujanos que la realicen (AU)

Introduction The aim of our study was to analyze the reliability of laparoscopic cholecystectomy (LC) in an Ambulatory Surgery unit, in order to encourage its use and achieve better management of health resources. Material and method Retrospective study of 110 patients operated on for LC between September 2004 and November 2008. The selection criteria were: absence of prior supramesocolic abdominal surgery, no previous admission for acute cholecystitis, absence of stones in the bile ducts and normal liver function tests, no intake of oral anticoagulants or antiplatelet agents and ASA I-II. All patients were operated using a previously established Major Ambulatory Surgery (MAS) protocol. Results The patients included 81 women and 29 men, with a mean age of 51.03 years (range 24–77), of which 57 had a medical and / or surgical history. Results The overall morbidity was 6.36% with a mortality of 0%. The conversion rate was 0.9%. A total of 87 patients (79.1%) were discharged at 6h after surgery, thus fulfilling the criteria of the MAS system. The mean overall hospital stay was 1.49 days (median 0). The reoperation rate WAS 1.81% and the rate of readmission after discharge was0.9%.ConclusionsThe performance of outpatient laparoscopic cholecystectomy is feasible and safe. It should be integrated into the activities of Major Ambulatory Surgery, ensuring careful selection of patients and interest by surgeon who performs it (AU)

[Laparoscopic cholecystectomy performed as ambulatory major surgery in a regional hospital. Initial results of a series of 110 cases]. / Colecistectomía laparoscópica en régimen de cirugía mayor ambulatoria en un hospital comarcal: resultados iniciales de una serie de 110 casos.

INTRODUCTION: The aim of our study was to analyze the reliability of laparoscopic cholecystectomy (LC) in an Ambulatory Surgery unit, in order to encourage its use and achieve better management of health resources. MATERIAL AND METHOD: Retrospective study of 110 patients operated on for LC between September 2004 and November 2008. The selection criteria were: absence of prior supramesocolic abdominal surgery, no previous admission for acute cholecystitis, absence of stones in the bile ducts and normal liver function tests, no intake of oral anticoagulants or antiplatelet agents and ASA I-II. All patients were operated using a previously established Major Ambulatory Surgery (MAS) protocol. RESULTS: The patients included 81 women and 29 men, with a mean age of 51.03 years (range 24-77), of which 57 had a medical and / or surgical history. The overall morbidity was 6.36% with a mortality of 0%. The conversion rate was 0.9%. A total of 87 patients (79.1%) were discharged at 6h after surgery, thus fulfilling the criteria of the MAS system. The mean overall hospital stay was 1.49 days (median 0). The reoperation rate WAS 1.81% and the rate of readmission after discharge was 0.9%. CONCLUSIONS: The performance of outpatient laparoscopic cholecystectomy is feasible and safe. It should be integrated into the activities of Major Ambulatory Surgery, ensuring careful selection of patients and interest by surgeon who performs it.