Hipoplasia del lóbulo hepático izquierdo asintomático, hallazgo transquirúrgico, tomográfico y patológico. Presentación de una rara entidad / Asymptomatic Hypoplasia of the Left Hepatic Lobe: Surgical Tomographic and Pathological Findings. Presentation of a Rare Entity

Resumen Antecedentes Las anomalías de la morfología hepática son raras, y se dividen en 2 categorías: las que resultan del desarrollo excesivo de tejido hepático, como el lóbulo de Riedel y otros lóbulos accesorios, y las de desarrollo deficiente del hígado, que incluyen agenesia, hipoplasia y aplasia de los lóbulos hepáticos. Presentación del caso Paciente del sexo masculino de 57 años de edad, sometido a plastia inguinal laparoscópica programada, donde se dio el hallazgo de hipoplasia hepática. Conclusión La hipoplasia hepática es poco frecuente, no presenta síntomas, ni repercusiones clínicas a largo plazo, suele ser un hallazgo incidental durante un estudio de imagen o durante un procedimiento quirúrgico abdominal.

Abstract Background: Abnormalities of liver morphology are rare, divided into two categories: those resulting from overgrowth of liver tissue, such as the Riedel lobe and other accessory lobes, and those with poor liver development include agenesis, hypoplasia and aplasia of the hepatic lobes. Presentation of the case 57-year-old man, subjected to laparoscopic programmed inguinal surgery, finding liver hypoplasia. Conclusions Hepatic hypoplasia is rare, has no symptoms or long-term clinical repercussions, is usually an incidental finding during an imaging study or during an abdominal surgical procedure.

Surgical treatment of acute cholecystitis in patients with confirmed COVID-19: Ten case reports and review of literature.

BACKGROUND: Research concerning postoperative outcomes of confirmed coronavirus disease 2019 (COVID-19) patients revealed unfavorable postoperative results with increased morbidity, pulmonary complications and mortality. Case reports have suggested that COVID-19 is associated with more aggressive presentation of acute cholecystitis. The aim of the present study is to describe the perioperative assessment and postoperative outcomes of ten patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with concomitant acute cholecystitis who underwent cholecystectomy. CASE SUMMARY: We report a total of 10 SARS-CoV-2 positive patients with concomitant acute cholecystitis that underwent cholecystectomy. Six patients were males, the mean age was 47.1 years. Nine patients had moderate acute cholecystitis, and one patient had severe acute cholecystitis. All patients were treated with urgent/early laparoscopic cholecystectomy. Regarding the Parkland grading scale, two patients received a Parkland grade of 3, two patients received a Parkland grade of 4, and six patients received a Parkland grade of 5. Eight patients required a bail-out procedure. Four patients developed biliary leakage and required endoscopic retrograde cholangiopancreatography with biliary sphincterotomy. After surgery, five patients developed acute respiratory distress syndrome (ARDS) and required intensive care unit (ICU) admission. One patient died after cholecystectomy due to ARDS complications. The mean total length of stay (LOS) was 18.2 d. The histopathology demonstrated transmural necrosis (n = 5), vessel obliteration with ischemia (n = 3), perforation (n = 3), and acute peritonitis (n = 10). CONCLUSION: COVID-19 patients with acute cholecystitis had difficult cholecystectomies, high rates of ICU admission, and a prolonged LOS.

Laparoscopic appendectomy in complicated appendicitis with compromised appendix base: a retrospective cohort study.

BACKGROUND: Patients with compromised appendix base constitute a subgroup of patients with complicated appendicitis, and there is few available information. OBJECTIVE: To study the frequency of stump leaks and fistulae in patients with complicated appendicitis with compromised stump. METHOD: This is an observational, retrospective study of patients that underwent laparoscopic appendectomy with compromised appendix stump. RESULTS: From 2015 to 2019, 158 patients with complicated appendicitis were operated, of them 54 had compromised base or stump. There were 66.7% men, with a mean age of 38.7 years. For stump closure, a simple knot was employed in 57.4%, and in 42.6% an invaginated suture was employed. Regarding complications, 16.7% developed intraabdominal abscess, 7.4% ileus and 7.4% had wound infection. We found one stump leak and one stump fistula. The mean length of stay was 5.4 days (range: 1-20). There were 5 reoperations, 4 for abscess drainage and 1 for stump leak. CONCLUSIONS: Patients with acute complicated appendicitis with compromised appendicular base, laparoscopic surgery either with simple knot or with invaginated suture resulted in low frequency of stump leaks and fistula.

ANTECEDENTES: Los pacientes con base apendicular comprometida constituyen un subgrupo de pacientes con apendicitis complicada y existe poca información al respecto. OBJETIVO: Conocer la frecuencia de fístulas y fugas fecales en pacientes con apendicitis complicada con base apendicular comprometida. MÉTODO: Se trata de un estudio observacional, retrospectivo y transversal de pacientes operados de apendicectomía laparoscópica con base apendicular comprometida. RESULTADOS: De 2015 a 2019 se encontraron 158 casos de apendicitis complicada, de los cuales 54 tenían la base apendicular comprometida. Hubo predominio de varones (66.7%) y la edad media fue de 38.7 años. En el 57.4% de los casos se realizó un nudo simple y en el 42.6% un punto transfictivo con invaginación del muñón. En relación con las complicaciones, el 16.7% desarrollaron abscesos intraabdominales, el 7.4% íleo y el 7.4% infección de herida. Hubo un paciente con fuga del muñón y un paciente con fístula cecal. El tiempo medio de estancia hospitalaria fue de 5.4 días (rango: 1-20). Se realizaron cinco reintervenciones: cuatro para drenaje de absceso intraabdominal y una por fuga del muñón. CONCLUSIONES: En los pacientes con base apendicular comprometida, el manejo laparoscópico con ligadura simple o con punto transfictivo resulta en una baja frecuencia de fuga y fístula del muñón apendicular.

Peroral endoscopic myotomy as treatment for Zenker's diverticulum (Z-POEM): a multi-center international study.

BACKGROUND: Peroral endoscopic myotomy for the treatment of Zenker's diverticulum (Z-POEM) is a novel technique that has been described in several recent reports. This method utilizes the third space (submucosal layer) to create a tunnel to facilitate complete visualization of the septum and hence cutting it entirely. Conventional endoscopic septotomy carries the risk of recurrence due to incomplete visualization of the septum. While surgical correction is a risky and lengthy procedure in old comorbid patients with Zenker's diverticulum. The aim of this study is to assess the efficacy and safety of Z-POEM. METHODS: The study enrolled 24 patients diagnosed with Zenker's diverticulum (ZD) who underwent Z-POEM at seven independent endoscopy centers in five different countries. RESULTS: Mean patient age ± standard deviation (SD) was 74.3 ± 11 years. Most of the patients were males (n = 20, 83.3%); four (16.7%) were females. More than 50% of the patients (n = 14, 58.3%) had associated comorbidities. The mean size of the diverticula was 4 cm (range 2-7 cm). The Kothari-Haber Score was used to assess clinical symptoms; values ranged from 6 to 14 (median = 9). We achieved 100% technical success with a median procedure time of 61 min and no adverse events. Median hospital stay was 1 day (range 1-5 days). There is a significant reduction in the Kothari-Haber Score after Z-POEM (P < 0.0001). Technical success was achieved in 100% of the patients. Clinical success was achieved in 23/24 (95.8%) of the patients with a median follow-up of 10 months (range 6-24 months). CONCLUSION: Z-POEM is a safe and effective modality for managing ZD.

Sarcopenia predicts worse postoperative outcomes and decreased survival rates in patients with colorectal cancer: a systematic review and meta-analysis.

PURPOSE: Previous studies have shown an association of sarcopenia with adverse short- and long-term outcomes in multiple gastrointestinal cancer types. We aimed to investigate the prognostic value of sarcopenia on the postoperative outcomes and survival rates of patients with colorectal cancer (CRC). METHODS: A systematic literature search was performed using the PubMed, Embase, Cochrane, Google Scholar, and Scopus databases. We included studies that compared postoperative outcomes or survival rates in sarcopenic and non-sarcopenic patients with CRC. RESULTS: A total of 44 observational studies, comprising 18,891 patients, were included. The pooled prevalence of sarcopenia was 37% (n = 7009). The pooled analysis revealed an association between sarcopenia and higher risk of total postoperative complications (23 studies, OR = 1.84; 95% CI 1.35-2.49), postoperative severe complications (OR = 1.72; 95% CI 1.10-2.68), postoperative mortality (OR = 3.21; 95% CI 2.01-5.11), postoperative infections (OR = 1.40; 95% CI 1.12-1.76), postoperative cardiopulmonary complications (OR = 2.92; 95% CI 1.96-4.37), and prolonged length of stay (MD = 0.77; 95% CI 0.44-1.11) after colorectal cancer surgery. However, anastomotic leakage showed comparable occurrence between sarcopenic and non-sarcopenic patients (OR = 0.99; 95% CI 0.72 to 1.36). Regarding survival outcomes, sarcopenic patients had significantly shorter overall survival (25 studies, HR = 1.83; 95% CI = 1.57-2.14), disease-free survival (HR = 1.55; 95% CI = 1.29-1.88), and cancer-specific survival (HR = 1.77; 95% CI 1.40-2.23) as compared with non-sarcopenic patients. CONCLUSION: Among patients with colorectal cancer, sarcopenia is a strong predictor of increased postoperative complications and worse survival outcomes.

Síndrome de Mallory-Weiss. Reporte de caso y breve revisión de la literatura / Mallory-Weiss syndrome. Case report and brief review of the literature

Resumen Introducción El síndrome de Mallory-Weiss se caracteriza por el desgarro longitudinal de la mucosa de la unión gastroesofágica. En el presente trabajo hemos realizado una breve revisión de la literatura de utilidad para el estudiante de medicina y la hemos acompañado de un caso clínico para ilustrar el contenido aquí desarrollado. Caso Paciente del sexo masculino, de 40 años de edad, que acudió al servicio de urgencias de nuestra institución por presentar hematemesis, melena, datos de hipovolemia, e hipo de 2 días de evolución. Como antecedentes de importancia refirió consumo de alcohol a razón de 15 copas cada tercer día. Durante la endoscopía diagnóstica se identificó en la unión esofagogástrica, un coágulo adherente a la mucosa de 5 mm, con lo que se diagnosticó un desgarro de Mallory-Weiss. El tratamiento se realizó mediante endoscopía. Se optó por una inyección local de adrenalina con colocación posterior de liga. El paciente fue dado de alta sin complicaciones. Conclusión Los estudios realizados sobre el síndrome de Mallory-Weiss han permitido actualizar la información que se tiene al respecto. El avance tecnológico y científico ha incrementado las tasas de éxito del manejo de esta identidad.

Abstract Introduction Mallory-Weiss syndrome is characterized by the longitudinal tear of the mucosa of the gastroesophageal junction. In the present work we have made a brief review of the literature useful for the medical student and we have accompanied a clinical case to illustrate the content developed here. Case A 40-year-old male attended the emergency department of our institution due to hematemesis, melena, hypovolemia, and 2-day history of hiccups. The patient referred alcohol consumption at a rate of 15 drinks every third day. During diagnostic endoscopy, a mucosal adherent clot of 5 mm was identified in the gastric esophageal junction, and a Mallory-Weiss tear was diagnosed. The treatment was performed by endoscopy. We opted for a local injection of Adrenaline with subsequent endoscopic ligation. The patient was discharged without complications. Conclusion The studies carried out on the Mallory-Weiss Syndrome have made it possible to update the information available. The technological and scientific advance has increased the success rates of the management of this identity.

Ambulatory versus conventional laparoscopic appendectomy: a systematic review and meta-analysis.

PURPOSE: Ambulatory laparoscopic appendectomy has gained popularity due to the improved understanding of patient selection criteria, the application of enhanced recovery pathways, and the potential for improving healthcare resource utilization. The aim of the review was to compare the morbidity and readmission rates between ambulatory and conventional laparoscopic appendectomy (LA). METHODS: A systematic search was undertaken using PubMed, Embase, Cochrane, and Web of Science. Studies from 2014 to 2018, on adult patients undergoing ambulatory LA, were considered. Meta-analyses were conducted to pool the total number of complications and readmission events in the ambulatory and conventional groups. RESULTS: A total of 5 studies met our inclusion criteria accounting for 7079 total of patients with acute appendicitis treated by ambulatory LA and 6370 patients treated by conventional LA. We included four observational studies (two prospective and two retrospective) and one randomized controlled trial. Length of stay was significantly lower in the ambulatory group (mean difference = - 15.63 h, 95% CI = - 21.78 to - 9.49, P = < 0.00001). The relative risk (RR) of reoperation was 0.49 (95% CI = 0.12-1.95, P = 0.31). The results demonstrated a pooled RR of overall morbidity of 0.79 (95% CI = 0.65-0.97, P = 0.02) and a pooled RR of readmission of 0.72 (95% CI = 0.59-0.88, P = 0.002), both results favoring the ambulatory LA group. CONCLUSION: There is a lack of high-quality comparative studies making conclusive recommendations not possible at this time. Based on current data, ambulatory LA may be safe and feasible as compared with conventional LA.

Oclusión intestinal por íleo biliar, tratamiento quirúrgico / Bowel obstruction for gall stone ileus, surgical management

Resumen Antecedentes: El íleo biliar es una rara complicación de la colecistitis crónica litiásica que representa del 1 al 3% de los casos de oclusión intestinal. Primera vez descrito por Bartolin en 1654, el íleo biliar ocurre por obstrucción crónica del conducto cístico y necrosis de la vesícula biliar, lo que puede desarrollar una fistula colecisto-entérica. Rigler en 1941 describió la tríada clásica del íleo biliar. Caso clínico: Mujer de 56 años de edad con diagnóstico de insuficiencia hepática que súbitamente presentó distención abdominal con ausencia de evacuaciones y canalización de gases. La tomografía abdominal mostró datos que sugieren el diagnóstico de oclusión intestinal, por lo que se realizó laparotomía exploradora con presencia de distención de asas. Se retiraron 2 litos por medio de enterolitotomía; evolución posquirúrgica adecuada hasta lograr estabilización hemodinámica y alta hospitalaria. Conclusiones: La presencia de íleo biliar es una rara causa de colusión intestinal que requiere de tratamiento quirúrgico para su resolución. Ee necesita un alto nivel de sospecha para su diagnóstico y manejo.

Abstract Background: Gall-stone ileus is a weird complication of the lithiasic cholecyst since it represents only 1 to 3% of the bowel obstuccion cases. It was described for the first time by Bartoin in 1654, the gall-stone ileus happens due to a cronic obstruccion in the cistic duct than causes gallbladder necrosis and a bile enteric fistula. In 1941, Rigler described the classic triad for the gall-stone ileus. Clinical case: A 56-year-old woman that had a diagnosis of hepatic failure, suddenly presented abdominal distension, constipation and obstipation. The abdominal tomography showed data that suggested a bowel occlusion, therefore, we performed an exploratory laparotomy and found distension of the bowel loops and the presence of three gall stones, that were removed with enterolitotomy. The pacient had a good posquirurgic evolution and was discharged from hospital. Conclusions: The gall-stone ileus is a rare cause for bowel occlusion that requires surgical treatment; it needs a high level of suspicion for its diagnoses and management.

Laparoscopic cholecystectomy after endoscopic treatment of choledocholithiasis: a retrospective comparative study.

Patients with combined choledocholithiasis and cholecystitis require treatment of both diseases. The aim of our study was to analyze perioperative results of next-day (< 24 h) vs. early (> 24 h) laparoscopic cholecystectomy (LC) after endoscopic clearance of common bile duct stones. We conducted a retrospective study of patients that underwent LC after endoscopic treatment of choledocholithiasis, with combined diagnoses of common bile duct stones (with or without acute cholangitis) and gallbladder stones (with acute or chronic cholecystitis). From January 2014 to May 2017, 87 patients underwent LC after endoscopic sphincterotomy: 40 patients within 24 h (NDLC) and 47 after 24 h (ELC). Regarding pre-ERCP diagnosis, 29 (72.5%) of patients in the NDLC group and 33 (70.2%) of patients in the ELC group had high-risk of choledocholithiasis (p = 0.814), acute cholecystitis (32.5 vs. 25.5%, p = 0.474) and acute cholangitis (17.5 vs. 17%, p = 0.953). The median time from ERCP to LC was 23 h (IQR 22-23) in the NDLC group and 72 h (IQR 48-80) in the ELC group (p < 0.001). No statistically significant differences were found in regard to operative time, estimated blood loss, overall morbidity and rate of conversion to open surgery. Patients in the NDLC group had a shorter total length of stay (2 vs. 4 days, p < 0.001). Laparoscopic cholecystectomy performed within the first 24 h after endoscopic treatment of choledocholithiasis is safe and feasible, without increased postoperative morbidity and associated with reduction of the hospital length of stay.

Enhanced recovery after surgery protocol allows ambulatory laparoscopic appendectomy in uncomplicated acute appendicitis: a prospective, randomized trial.

BACKGROUND: Previous observational studies have demonstrated the safety of discharging patients after laparoscopic appendectomy within the same day without hospitalization. The application of Enhanced Recovery After Surgery (ERAS) guidelines has resulted in shorter length of stay, fewer complications, and reduction in medical costs. The aim of this study was to investigate if ERAS protocol implementation in patients with acute uncomplicated appendicitis decreases the length of stay enough to allow for ambulatory laparoscopic appendectomy. METHODS: In this prospective, randomized controlled clinical trial, 108 patients were randomized into two groups: laparoscopic appendectomy with ERAS (LA-E) or laparoscopic appendectomy with conventional care (LA-C). The primary endpoint was postoperative length of stay. The secondary end points were time to resume diet, postoperative pain, postoperative complications, re-admission rate, and reoperation rate. RESULTS: From January 2016 through May 2017, 50 patients in the LA-E group and 58 in the LA-C were analyzed. There were no significant differences in preoperative data. Regarding the primary end point of the study, the ERAS protocol significantly reduced the postoperative length of stay with a mean of 9.7 h (SD: 3.1) versus 23.2 h (SD: 6.8) in the conventional group (p < 0.001). The ERAS protocol allowed ambulatory management in 90% of the patients included in this group. There was a significant reduction in time to resume diet (110 vs. 360 min, p < 0.001) and less moderate-severe postoperative pain (28 vs. 62.1%, p < 0.001) in the LA-E versus LA-C group. The rate of complications, readmissions, and reoperations were comparable in both groups (p = 0.772). CONCLUSIONS: ERAS implementation was associated with a significantly shorter length of stay, allowing for the ambulatory management of this group of patients. Ambulatory laparoscopic appendectomy is safe and feasible with similar rates of morbidity and readmissions compared with conventional care.

A New Era of Bile Duct Repair: Robotic-Assisted Versus Laparoscopic Hepaticojejunostomy.

BACKGROUND: Despite scientific evidence of the safety, efficacy, and in some cases superiority of minimally invasive surgery in hepato-pancreato-biliary procedures, there are scarce publications about bile duct repairs. The aim of this study was to compare the outcomes of robotic-assisted surgery versus laparoscopic surgery on bile duct repair in patients with post-cholecystectomy bile duct injury. METHODS: This is a retrospective comparative study of our prospectively collected database of patients with bile duct injury who underwent robotic or laparoscopic hepaticojejunostomy. RESULTS: Seventy-five bile duct repairs (40 by laparoscopic and 35 by robotic-assisted surgery) were treated from 2012 to 2018. Injury types were as follows: E1 (7.5% vs. 14.3%), E2 (22.5% vs. 14.3%), E3 (40% vs. 42.9%), E4 (22.5% vs. 28.6%), and E5 (7.5% vs. 0), for laparoscopic hepaticojejunostomy (LHJ) and robotic-assisted hepaticojejunostomy (RHJ) respectively. The overall morbidity rate was similar (LHJ 27.5% vs. RHJ 22.8%, P = 0.644), during an overall median follow-up of 28 (14-50) months. In the LHJ group, the actuarial primary patency rate was 92.5% during a median follow-up of 49 (43.2-56.8) months. While in the RHJ group, the actuarial primary patency rate was 100%, during a median follow-up of 16 (12-22) months. The overall primary patency rate was 96% (LHJ 92.5% vs. RHJ 100%, log-rank P = 0.617). CONCLUSION: Our results showed that the robotic approach is similar to the laparoscopic regarding safety and efficacy in attaining primary patency for bile duct repair.

Intraoperative endoscopy prevents technical defect related leaks in laparoscopic Roux-en-Y gastric bypass: A randomized control trial.

BACKGROUND: Postoperative anastomotic leaks, bleeding and stenosis are major causes of morbidity after laparoscopic Roux-en-Y gastric bypass (LRYGB). Retrospective studies suggest that intraoperative endoscopy reduces the incidence of these complications. METHODS: We conducted a prospective randomized controlled trial in a single institution between March 2013 and January 2016. Patients were assigned to one of two groups: LRYGB with Intraoperative Endoscopy (IOE) or LRYGB without IOE. Patient selection criteria were morbidly obese patients, 18 years or older who were candidates to LRYGB. The primary outcome was the frequency of technical defect related anastomotic leaks. Secondary outcomes were operative time, length of hospital stay, anastomotic related complications, reoperations and 30-day mortality. RESULTS: 50 patients were randomly assigned in the IOE group and 50 in the control group. The IOE group had statistically significant lower rate of anastomotic leak (0 vs. 8%, p = .0412), and lower need for reoperation (0 vs. 8%, p = .0412). The IOE group had longer operative time (194.10 vs. 159 min, p < .001), and shorter mean length of hospital stay (2.44 vs. 3.46 days, p = .025). No differences were found in the rate of bleeding of the anastomosis, narrow anastomosis and 30-day mortality. CONCLUSION: This study specifically provides evidence that air leak test performed by intraoperative endoscopy is superior to simple visual inspection in preventing technical defect related leaks after laparoscopic Roux-en-Y gastric bypass.

Laparoscopic Versus Open Surgery for Abdominal Trauma: A Case-Matched Study.

BACKGROUND: The use of laparoscopic surgery in abdominal emergencies, such as in trauma, has had a slow acceptance. The advantages described with this approach include less postoperative pain, faster recovery, quicker return to everyday activities, and fewer wound complications. The aim of this retrospective study was to compare outcomes following laparoscopic versus open surgery for abdominal trauma (either blunt or penetrating). MATERIALS AND METHODS: Nineteen patients with abdominal trauma who underwent laparoscopic surgery from January 2013 to May 2016 were compared with 19 patients undergoing open surgery during the same time period. Patients were matched (1:1) for age, gender, body-mass index, American Society of Anesthesiologists score, hemodynamic stability, and injury mechanism. Intra- and postoperative variables were compared between groups. RESULTS: Laparoscopic group displayed a significantly shorter operative time (93.3 versus 134.2 minutes; P < .009), lower estimated blood loss (100 versus 600 mL; P < .019), faster return to normal diet (1.6 versus 2.4 days; P < .039), and shorter hospital length of stay (LOS) (3.8 versus. 5.6 days; P < .042). There were no statistical significant differences in 30-day mortality between both groups. CONCLUSIONS: Laparoscopic surgery for abdominal trauma, either blunt or penetrating, is safe and technically feasible in hemodynamically stable patients. We found in our study that laparoscopic surgery was associated with shorter operative time, lower estimated blood loss, faster return to normal diet, and shorter hospital LOS.

[Skills comparison using a 2D vs. 3D laparoscopic simulator]. / Comparación de destrezas en simulador de laparoscopia: imagen en 2D vs. 3D.

BACKGROUND: The development and application of 3D images in laparoscopic surgery has brought the benefit of in-depth perception that traditional laparoscopic surgery lacked. Previous studies in surgical populations have demonstrated the advantages of 3D technology. To limit bias of the previous experiences of participants, this study was performed in a population without any experience in this area. MATERIAL AND METHODS: An experimental, open, cross-sectional, comparative study between surgical skills achievements using 2D and a 3D laparoscopy equipment, using each subject as their own control. Six skills were evaluated in 2D and 3D modalities. RESULTS: Of the 40 participants included, 20 began the skills in the 2D modality and then performed them in 3D, and the other 20 began in 3D. Of the 118 skills evaluated there was a time improvement in 72% in the 3D group compared to 37% in the 2D modality (P=.000). The accomplishment percentage using the 3D laparoscopy was greater for both groups. There was a statistically significant difference in the better time for the 3D performed tasks. Just over half (52.5%) of participants preferred 3D laparoscopy, 15% preferred 2D, and 32.5% had no preferences. DISCUSSION: As other studies have demonstrated, there was improvement in the overall performance using the 3D laparoscope. Bias was limited by using a population without surgical experience. CONCLUSIONS: 3D laparoscopic surgical skills showed superior to 2D, with higher percentages of tasks completion, less time in performing them, and a shorter learning curve.

[Robotic surgery]. / Cirugía robótica.

Medicine has experienced greater scientific and technological advances in the last 50 years than in the rest of human history. The article describes relevant events, revises concepts and advantages and clinical applications, summarizes published clinical results, and presents some personal reflections without giving dogmatic conclusions about robotic surgery. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) defines robotic surgery as a surgical procedure using technology to aid the interaction between surgeon and patient. The objective of the surgical robot is to correct human deficiencies and improve surgical skills. The capacity of repeating tasks with precision and reproducibility has been the base of the robot´s success. Robotic technology offers objective and measurable advantages: - Improving maneuverability and physical capacity during surgery. - Correcting bad postural habits and tremor. - Allowing depth perception (3D images). - Magnifying strength and movement limits. - Offering a platform for sensors, cameras, and instruments. Endoscopic surgery transformed conceptually the way of practicing surgery. Nevertheless in the last decade, robotic assisted surgery has become the next paradigm of our era.

[Sigmoid diverticulitis in adolescent. Case report]. / Diverticulitis de sigmoides en adolescente. Reporte de caso.

BACKGROUND: Few cases have been reported in children and adolescents of sigmoid diverticulitis. Most of the case reports in medical literature are associated with true congenital diverticula and genetic diseases of collagen synthesis. CLINICAL CASE: 13 year-old female who was admitted to General and Endoscopic Surgery service with diagnosis of complicated appendicitis. Laparotomy was performed finding complicated sigmoid diverticular disease. Lavage, sigmoidectomy and primary anastomosis were performed. The histopathological findings reported a perforated pseudo-diverticulum of the sigmoid colon with peritonitis. The patient was discharged 72 hours after surgery and no complications were reported. CONCLUSION: There are only case reports about colonic diverticulitis in children and adolescents, and its etiology has not yet been well established. This patient had sigmoid pseudo-diverticula and did not present genetic concomitant disease. This case is an exception to data reported on literature about diverticular disease in this population.

Antecedentes: la enfermedad diverticular colónica en niños y adolescentes es poco frecuente y sólo existen reportes de casos aislados en la bibliografía. La mayoría de los casos reportados se asocian con divertículos verdaderos congénitos y enfermedades genéticas de producción de la colágena. Caso clínico: paciente femenina de 13 años de edad, que ingresó a la División de Cirugía General y Endoscópica con diagnóstico de apendicitis aguda complicada. En la laparotomía se encontró enfermedad diverticular complicada de colon sigmoides. Se le practicó sigmoidectomía y colorrecto-anastomosis. El reporte histopatológico evidenció perforación de pseudodivertículo de colon sigmoides y peritonitis. La paciente fue dada de alta del hospital 72 horas posteriores a la cirugía, sin complicaciones. Conclusión: existen sólo reportes de casos aislados de niños y adolescentes con diverticulitis colónica, y su etiología no ha sido aún debidamente establecida. Esta paciente tuvo diverticulitis de sigmoides, similar a la enfermedad en adultos, sin padecimientos genéticos concomitantes. El caso es una excepción a lo reportado en la bibliografía de las diverticulitis en niños y adolescentes.

[Contributions of Herodotus to surgery within the historiographic analysis of his Histories]. / Contribuciones de Herodoto a la cirugía en el análisis historiográfico de sus Historias.

During the splendor of Athens, Herodotus of Helicarnasus develops his life and work in the V century B.C. that led him to be considered the father of history. The available knowledge of ancient medicine and surgery is based on the descriptions of authors such as Homer, Herodotus, Hippocrates, and Plinius. Herodotus, a contemporary of Hippocrates, in his Histories, defines the limit between the epic narratives of Homer and the beginning of scientific history based on observation, reflection, and analysis. He develops an erudite, objective, and clear narrative of facts that allow him to discover the causes in order to determine their consequences in society. He describes the magic-religious model of the health-disease process, etiology, diagnostic methods, and treatment for diseases in ancient towns. He makes a description of Egyptian medicine, particularly about medical specialization, embalmment, and common diseases. He emphasizes surgical procedures: circumcision, castration, amputations of ears, nose and hands, ocular evisceration and mastectomies (punishments) and describes traumatic wounds, their prognosis and treatment. He also mentions the names and actions of the most famous physicians of the time. Herodotus lived the cultural decadence of Ionia, his native land, at the time of economic and intellectual hegemony of Athens. His work is universal and has the purposes of projection to the future and to seek causes.