Reservorios venosos subcutáneos tipo port-a-cath. Ventajas del acceso quirúrgico mediante venotomía cefálica / Port-A-Cath implantable venous access system. Advantages ofsurgical access by cephalic venotomy

Introducción: La colocación de dispositivos implantables permanentes ha aumentado exponencialmente debido al aumento de indicaciones. El objetivo de este artículo es demostrar las ventajas de la utilización de la disección de vena cefálica para la colocación de sistemas venosos centrales. Métodos: Estudio longitudinal, descriptivo y retrospectivo, en el cual analizamos 265 pacientes consecutivos, recogidos entre enero de 2010 y octubre de 2013, a los que se les colocó un reservorio venoso subcutáneo mediante venotomía de la vena cefálica en el surco deltopectoral como acceso primario. Se detallan complicaciones intraoperatorias y postoperatorias tempranas y tardías. Resultados: En 253 pacientes se canaliza la vena cefálica, representando una tasa de éxito del 95,5 %. No se asocian complicaciones intraoperatorias como neumotórax o hemotórax. La tasa de complicaciones tempranas es el del 4 %, y tardías del 11,5 %, con un seguimiento mínimo de ocho meses. Se asociaron a retirada del sistema en 14 pacientes. Conclusión: El acceso por vena cefálica en régimen de cirugía mayor ambulatoria es seguro, con una alta tasa de éxito en nuestro estudio, y con una tasa de complicaciones tempranas y tardías bajas igual al acceso mediante punción sin riesgo de neumo-hemotórax (AU)

Introduction: The use of totally implantable access ports has increased exponentially due to the increase of indications. The objective of this article is to demonstrate the advantages of using surgical venous cutdowns of the cefalic vein to place central venous systems. Patients and methods: Longitudinal, descriptive and retrospective study, which analyzed 265 consecutive patients, collected between January 2010 and October 2013. In these patients a subcutaneous venous reservoir was placed by opening the cephalic vein in the deltopectoral groove as primary access. Intraoperative and postoperative early and late complications were documented in detail. Results: The primary success rate was 95.5 % for the venous cutdowns. No intraoperative complications such as pneumothorax or haemothorax were associated. The early complication rate is 4 %; late complications rate is 11.5 %, with a minimum follow-up of eight months. In 14 cases the complications were associated with the removal of the system. Conclusion: The surgical venous cutdown in ambulatory surgery is safe, with a high success rate in our study, and a rate of early and late complications like puncture of the subclavian vein approach, without risk of pneumo-haemothorax (AU)

Prosthetic repair of femoral hernia: audit of long term follow-up.

OBJECTIVE: To study the long term results of 93 femoral hernia repairs by cylindrical prothesis with a polypropylene mesh. DESIGN: Prospective open study. SETTING: District hospital, Spain. SUBJECTS: 92 patients who had 93 hernias repaired between 1989 and 1992. INTERVENTIONS: Lichtenstein repair of femoral hernias. MAIN OUTCOME MEASURES: Complications and recurrences. RESULTS: The mean follow up was 64 months (range 43-84). There was one recurrence 4 months postoperatively in a patient who had been operated on as an emergency for an incarcerated hernia, and in one patient the prosthesis had to be removed 10 days after the initial operation. This was subsequently repaired with polypropylene mesh and had not recurred at 4 years. CONCLUSION: Herniorrhaphy with cylindrical prosthesis is our preferred elective technique for repair of primary femoral hernias although other techniques are advisable for incarcerated or recurrent hernias.