Abdominal compartment syndrome: Current concepts and management. / Síndrome compartimental abdominal: conceptos actuales y manejo.

Abdominal compartment syndrome occurs when 2 or more anatomic compartments have a sustained intra-abdominal pressure >20mmHg, associated with organ failure. Incidence is 2% and prevalence varies from 0% to 36.4%. A literature search was conducted utilizing different databases. Articles published from 1970 to 2018 were included, in English or Spanish, to provide the concepts, classifications, and comprehensive management in the approach to abdominal compartment syndrome, for its treatment and the prevention of severe complications associated with the entity. Intravesical pressure measurement is the standard diagnostic method. Treatment is based on evacuation of the intraluminal content, identification and treatment of intra-abdominal lesions, improvement of abdominal wall compliance, and optimum administration of fluids and tissue perfusion. Laparotomy is generally followed by temporary abdominal wall closure 5 to 7 days after surgery. Reconstruction is performed 6 to 12 months after the last operation. Abdominal compartment syndrome should be diagnosed and operated on before organic damage from the illness occurs. Kidney injury can frequently progress and is a parameter for considering abdominal decompression. Having a biomarker for early damage would be ideal. Surgical treatment is successful in the majority of cases. A multidisciplinary focus is necessary for the intensive care and reconstructive needs of the patient. Thus, efforts must be made to define and implement strategies for patient quality of life optimization.

[High-risk biliary surgery. Study of 108 patients operated using the tradition method]. / Cirugía biliar de alto riesgo. Estudio de 108 pacientes operados por el método tradicional.

This study is to inform the patients outcomes from biliary tract surgery, with surgical risk higher than normal, in a general hospital. It was observational, retrospective, longitudinal and descriptive study. Among 1989-1992 were studied 108 patients with a 30 days follow up, operated from one or more risk surgical factors, 63 cases were included because had one high risk factor, 31 had two factors, 11 with three and three with four or more. 88 patients (81%) had good outcomes, while 20 (19%) had bad outcomes, 18 were women and two men, with two deaths and two reoperations. The good outcomes were in majority of patients with one high risk factor (57/63 = 90.5%); there were statistic difference with the two, three or four high risk factors cases.

[The local complications of appendicitis]. / Complicaciones locales de la apendicitis.

In order to find out the predisposing factors of local complications after appendectomy in two general hospitals, 268 charts of patients with acute appendicitis confirmed by surgery were reviewed. There were 142 males and 126 females. All wounds were closed and prophylactic antibiotics were not used. Sixty patients (22 per cent) developed local complications; 49 (81.7 per cent) surgical wound infection and 11 (18.3 per cent) with intra-abdominal abscess. In the wound infection group 25 per cent had complicated acute appendicitis and only one per cent non-complicated acute appendicitis. The correlation between the preoperative period and wound sepsis showed, the longer period the higher incidence of wound infection, 1.7 per cent with less than 24 hr. 11 per cent with less than 72 hr. and 78.9 per cent with more than 96 hr.

[Reoperations in appendicitis]. / Reoperaciones en apendicitis.

We present our experience in reoperations after appendectomy. From 276 patients were operated for acute appendicitis, we found 70 who presented appendicular abscess, only 13 needed reoperation because of residual abscess, (three cases), evisceration (four cases), and cecum perforation (two cases). All had history of more than four days of preoperative evolution (range 4-45 days) in those eleven patients (six men, and five women) were done 13 reoperations. We had no mortality after successful recovery in all of theme. Our experience in reported from the surgical services of Hospital General de México an Hospital Juárez, both located in México City.