eTEP Rives-Stoppa impact on abdominal contour: a retrospective observational and clinical quality improvement study using Ellipse 9 tool.

BACKGROUND: The eTEP Rives-Stoppa (RS) procedure, increasingly used for ventral hernia repair, has raised concerns about postoperative upper abdominal bulging. This study aims to objectively evaluate changes in the abdominal contour after eTEP RS and explore potential causes using a novel analytical tool, the Ellipse 9. METHODS: Thirty patients undergoing eTEP RS without posterior rectus sheath closure were assessed before and 3 months after surgery using CT scan images. Key measurements analyzed included the distance between linea semilunaris (X2), eccentricity over the Cord (c/a Cord), superior eccentricity (c/a Sup), Y2, and the superior perimeter of the abdomen. The Ellipse 9 tool, which provides graphical images and numerical representations, was utilized alongside patient-reported outcomes to assess perceived abdominal changes. RESULTS: The study group exhibited a trend toward a flatter abdomen with reduced distance between linea semilunaris(X2). However, 17% of patients developed upper abdominal bulging (5). Significant differences in c/a Cord, c/a Sup, Y2, and the superior perimeter of the abdomen, confirmed with Bonferroni corrections, were noted between bulging (5 patients) and non-bulging groups (25 patients). There was a notable disparity between patient perceptions and objective outcomes. CONCLUSION: The eTEP RS procedure improved abdominal contour in most patients from a selected cohort. The Ellipse 9 tool was valuable for the objective analysis of these changes. The cause of bulging post-eTEP RS is probably multifactorial. Notably, there was often a discrepancy between patient perceptions of bulging and objective clinical findings.

Impact on Anesthetic Agent Consumption After Autonomic Neural Blockade as Part of a Combined Anesthesia Protocol: A Randomized Clinical Trial.

BACKGROUND: The intraoperative autonomic neural blockade (ANB) was found safe and effective in controlling pain and associated symptoms and reducing analgesic consumption after laparoscopic sleeve gastrectomy (LSG). This study evaluated whether ANB performed at the outset of LSG reduces anesthetic consumption and promotes hemodynamic stability. METHODS: This prospective, double-blinded, randomized trial involved patients undergoing LSG in 2 high-volume institutions. Patients were randomized to receive ANB either at the onset or the end of the procedure. The primary outcome measure was the consumption of remifentanil and sevoflurane. Secondary outcomes included Aldrete scale score differences in the recovery room and hemodynamic stability during the surgery. RESULTS: In total, 80 patients (40 in the ANB at the onset group and 40 in the control group) were included for analysis. The consumption of remifentanil was significantly lower in the onset group compared to the control group (mean difference -0.04 mcg/kg/min, 95% confidence interval [CI], -0.06 to -0.02; P < .0001). There were no differences in the Aldrete scale scores between the 2 groups. Mean heart rate (HR) and mean arterial pressure (MAP) were also significantly less during surgery in the ANB at the onset group. No complications related to the ANB occurred. CONCLUSIONS: Performing ANB at the onset of LSG is a safe and effective approach that reduces remifentanil consumption and promotes hemodynamic stability during the procedure. This technique holds promise for optimizing anesthesia management in LSG and other minimally invasive surgeries.

GRINCIRCAR: una iniciativa para promover la cirugía académica e investigación quirúrgica en el caribe colombiano / GRINCIRCAR: an initiative to promote academic surgery and surgical research in the Colombian Caribbean

Introducción. La investigación quirúrgica es uno de los pilares de la cirugía académica, que integra el microambiente para lograr una adecuada práctica basada en la evidencia, realizar planteamientos y conseguir eventuales soluciones a necesidades quirúrgicas de una población. En el caribe colombiano existen brechas significativas en cuanto al aporte en investigación quirúrgica, comparado con otras regiones del país. Por ende, es necesaria una iniciativa que haga frente a estos retos. Métodos. El Grupo Colaborativo de Investigación en Cirugía General y Subespecialidades del Caribe Colombiano (GRINCIRCAR), es una iniciativa fundada por una colectividad de estudiantes de medicina, médicos residentes de cirugía y cirujanos académicos de universidades del caribe colombiano, que buscan impulsar la investigación quirúrgica y aportar a la resolución de problemas de salud en cirugía de la región. Discusión. De acuerdo al programa de investigación con políticas y prioridades en salud establecidos por el Instituto Nacional de Salud, existen por lo menos dos dimensiones donde se involucra directamente la cirugía. A pesar de esto, no existen datos sobre la distribución de recursos para la investigación quirúrgica en la región del Caribe colombiano, pese a que el acceso al cuidado quirúrgico básico y las enfermedades quirúrgicas, hace parte de las prioridades en salud y cirugía global. Conclusiones. Se necesita promover la cirugía académica y la investigación quirúrgica en la región del caribe colombiano. La investigación colaborativa podría ser una solución al integrar la participación de múltiples centros y participantes

Introduction. Surgical research is one of the cornerstones of academic surgery, which integrates the microenvironment to achieve an adequate evidence-based practice, asking the right questions to achieve eventual solutions to the surgical needs of a population. In the Colombian Caribbean, there are significant gaps in the contribution in surgical research, compared to other regions of the country. Therefore, an initiative is needed to address these challenges. Methods. The Collaborative Group for Research in General Surgery and Subspecialties of the Colombian Caribbean (GRINCIRCAR) is an initiative founded by a group of medical students, surgical residents and academic surgeons from Colombian Caribbean universities, who seek to promote surgical research and contribute to solutions of health problems in surgery in the region. Discussion. According to the research program, health policies and priorities established by the National Institute of Health, there are at least two dimensions where surgery is directly involved. Despite this, there are no data on the distribution of resources for surgical research in the Colombian Caribbean region, despite the fact that access to basic surgical care and surgical diseases are part of the priorities in global health and surgery. Conclusions. There is a need to promote academic surgery and surgical research in the Colombian Caribbean region. Collaborative research in the region could be a solution by integrating the participation of multiple centers and participants

Paragastric Autonomic Neural Blockade to Prevent Early Visceral Pain and Associated Symptoms After Laparoscopic Sleeve Gastrectomy: a Randomized Clinical Trial.

BACKGROUND: Visceral pain (VP) following laparoscopic sleeve gastrectomy remains a substantial problem. VP is associated with autonomic symptoms, especially nausea and vomiting, and is unresponsive to traditional pain management algorithms aimed at alleviating somatic (incisional) pain. The present study was performed to evaluate the safety and effectiveness of laparoscopic paragastric autonomic neural blockade (PG-ANB) in managing the symptoms associated with VP following sleeve gastrectomy. STUDY DESIGN: This prospective, double-blinded, randomized clinical trial involved patients undergoing laparoscopic sleeve gastrectomy at two high-volume institutions. The patients were randomized to laparoscopic transversus abdominis plane block with or without PG-ANB. The primary outcome was patient-reported pain scores assessed at 1, 8, and 24 h postoperatively. The secondary outcome measures were analgesic requirements, nausea, vomiting, hiccups, and hemodynamic changes immediately after PG-ANB and postoperatively. RESULTS: In total, 145 patients (block group, n = 72; control group, n = 73) were included in the study. The heart rate and mean arterial pressure significantly decreased 10 min after PG-ANB. The visual analog scale score for pain was significantly lower in the PG-ANB than in the control group at 1 h postoperatively (p < 0.001) and 8 h postoperatively (p < 0.001). Vomiting, nausea, sialorrhea, and hiccups were significantly less prevalent in the PG-ANB group. Patients in the PG-ANB group received fewer cumulative doses of analgesics at 1 h postoperatively (p = 0.003) and 8 h postoperatively (p < 0.001). No differences between the groups were detected at 24 h (p = 0.298). No complications related to PG-ANB occurred. CONCLUSION: PG-ANB safely and effectively reduces early VP, associated autonomic symptoms, and analgesic requirements after laparoscopic sleeve gastrectomy.

Implementation and Validation of a Novel and Inexpensive Training Model for Laparoscopic Inguinal Hernia Repair.

Purpose: The aim of this study was to develop and validate a reproducible low-cost model useful for the development and acquisition of skills and competencies required for endoscopic hernia repairs. Methods: Ten general surgery residents (PGY3) were instructed to construct the model and perform the maneuvers necessary for the simulation of laparoscopic inguinal hernioplasty by the trans-abdominal pre-peritoneal (TAPP) technique. They practiced for 4 weeks in the model, and the time required to perform simulated hernioplasty by the laparoscopic TAPP technique in the initial session was compared to the time required after 4 weeks of training. Results: The time required to perform the exercise was significantly lower than in the initial session (p < 0.01). The time required by residents to complete the exercise in the initial session was significantly longer than that used by expert surgeons in the same task (p < 0.01), and although a significant difference persisted, this difference was substantially reduced to 3.60 min after the residents completed 4-week training in the model (p < 0.01). An independent expert, blinded to the level of training of the person who performed the exercise, could recognize all residents as novices and all experienced surgeons as experts in the initial session of the exercise with the model, but after 4 weeks of training, they did not recognize 4 of the 10 residents as novices (p < 0.05). Conclusion: The routine implementation of training in this model could be very useful in the laparoscopic inguinal hernioplasty teaching-learning process.

3D CAT Scan and Gastric Volumetry in the Planning of Revisional Bariatric Surgery.

Background: The planning of revisional bariatric surgery is a complex process. The availability of accurate anatomical information is especially important for the planning of such challenging surgical procedures, we present our initial experience using three-dimensional-computed tomography (3D-CT) images to preoperatively assess the anatomy of patients before bariatric revisional surgery. Methods: We used 3D reconstructed images of CT scans to assess the anatomy and plan revisional surgery in 144 patients 98 of them had a previous sleeve gastrectomy 41 had a previous gastric by-pass and 4 Vertical banded gastroplasties. An effervescent preparation was used to distend the stomach and the proximal bowel allowing volume estimation. Results: Eleven sleeve patients underwent a re-sleeve gastrectomy and 44 were revised to a "Roux-en-Y" gastric bypass (RYGBP). Forty-two patients with a previous gastric by-pass were revised due to weight regain or other issues and 4 patients with previous vertical banded gastroplasty (VBGP) were revised to RYGBP. 3D-CT scans provided valuable information for the planning of all revisional procedures by offering accurate information about the existing anatomy and measures of the volume of the gastric pouch, the size of the gastro-jejunal anastomosis in gastric by-pass cases, or the volume and shape of the gastric tube in gastric sleeve cases. Conclusion: 3D-CT is a fast, widely available, reliable, and accurate tool to assess the anatomy after bariatric procedures. This noninvasive method can be particularly useful for the evaluation of postbariatric patients with failures, suboptimal results, and complications, and for the planning of revisional surgery.

Vasomotor changes in abdominal skin after endoscopic subcutaneous/Preaponeurotic Repair of Diastasis Recti (REPA).

INTRODUCTION: Diastasis recti is a common condition with functional and cosmetic effects that can occur in both female and male patients. However, it is more prevalent in females after pregnancies and can be associated with midline hernias. The preaponeurotic endoscopic repair (REPA) has become an emerging procedure for the surgical treatment of this condition. CASES REPORT: We present four cases of vasomotor changes in the abdominal skin, during physical activity or heat exposure, limited to the subcutaneous dissection area after REPA. All patients reported occasional skin redness (erythema) in the subcutaneous dissection area, triggered by exposure to heat or sunlight. The skin redness subsided completely in all the patients after a few minutes in a cool environment and after cessation of physical activity. DISCUSSION: Recently, subcutaneous preaponeurotic repair of diastasis recti has gained popularity. Changes in abdominal skin sensitivity have been reported, but to the best of our knowledge, this is the first report of what appears to be vasomotor skin changes after these procedures. CONCLUSION: Vasomotor changes can occur after endoscopic dissections of the abdominal skin and subcutaneous tissue. Incidence and causes remain unclear.

La vagina como sitio de extracción y puerto laparoscópico en NOSE y NOTES / The vagina as an extraction site and laparoscopic port in NOSE and NOTES

El objetivo del presente estudio es evaluar nuestra experiencia inicial utilizando la vagina para el retiro de especímenes quirúrgicos o como puerto laparoscópico en intervenciones de cirugía a través de orificios naturales (NOTES). Métodos: Analizamos retrospectivamente los datos de pacientes femeninos, intervenidos en el Instituto Medico La Floresta, Caracas, Venezuela, desde Junio de 2009 a junio de 2015. Dichos pacientes fueron sometidas a intervenciones involucrando resecciones laparoscópicas de órganos sólidos como pancreatectomías distales, esplenectomías y miomectomías uterinas, utilizando la vagina como sitio de extracción. También incluimos pacientes sometidas a apendicectomía transvaginal híbrida NOTES y a colecistectomía transvaginal híbrida. Reportamos el procedimiento técnico, las complicaciones relacionadas con el acceso transvaginal y el seguimiento clínico. Resultados: Cuatro pacientes fueron sometidas a pancreatectomía distal con esplenectomía, siete a esplenectomía laparoscópica, cuatro casos fueron resecciones de masas anexiales y seis miomectomías uterinas. Tres pacientes fueron intervenidas para apendicectomía laparoscópica hibrida transvaginal y cuatro a colecistectomía hibrida trans-vaginal. En todos los casos el espécimen quirúrgico fue retirado a través de la vagina. Todas las pacientes reportaron manchado vaginal mínimo por un máximo de 14 días (media de 8), sangramiento escaso durante el coito por un máximo de 54 días (media de 32) y ninguna paciente reportó dispareunia u otras molestias relacionadas con el acceso vaginal a los seis meses. Conclusiones: El uso de la vagina como sitio de extracción para especímenes quirúrgicos es posible y seguro, incluso en casos de órganos sólidos o especímenes contaminado(AU)

The objective of this study is to evaluate our initial experience, using the vagina, for the removal of surgical specimens, or as a laparoscopic port in surgical interventions through natural orifices "NOTES" or (natural orifice translumenal endoscopic surgery). Methods: We retrospectively analyzed data from female patients operated at the La Floresta Medical Institute in Caracas, Venezuela, from June 2009 to June 2015, who underwent interventions involving laparoscopic resections of solid organs, such as distal pancreatectomies, splenectomies, and uterine myomectomies. Using the vagina as an extraction site. We also included patients undergoing hybrid NOTES trans-vaginal appendectomy and hybrid trans-vaginal cholecystectomy. We report the technical procedure, complications related to trans-vaginal access and clinical follow-up. Results: Four patients underwent distal pancreatectomy with splenectomy, seven underwent laparoscopic splenectomy, four cases were resections of adnexal masses and six were uterine myomectomies. Three patients underwent surgery for trans-vaginal hybrid laparoscopic appendectomy and four for trans-vaginal hybrid cholecystectomy. In all cases, the surgical specimen was removed through the vagina. All patients reported minimal vaginal blood spotting for a maximum of 14 days (average of 8), scarce bleeding during intercourse for a maximum of 54 days (average of 32), and no patient reported dyspareunia or other discomfort related to vaginal access after six months. Conclusions: The use of the vagina as an extraction site for surgical specimens is possible and safe, even in cases of solid organs or contaminated specimens(AU)

3D Volumetry and its Correlation Between Postoperative Gastric Volume and Excess Weight Loss After Sleeve Gastrectomy.

BACKGROUND: The volume of the postoperative gastric remnant is a key factor in excess weight loss (EWL) after sleeve gastrectomy (SG). Traditional methods to estimate gastric volume (GV) after bariatric procedures are often inaccurate; usually conventional biplanar contrast studies are used. METHODS: Thirty patients who underwent SG were followed prospectively and evaluated at 6 months after the surgical procedure, performing 3D CT reconstruction and gastric volumetry, to establish its relationship with EWL. The gastric remnant was distended with effervescent sodium bicarbonate given orally. Helical CT images were acquired and reconstructed; GV was estimated with the software of the CT device. The relationship between GV and EWL was analyzed. RESULTS: The study allowed estimating the GV in all patients. A dispersion diagram showed an inverse relationship between GV and %EWL. 55.5% of patients with GV ≤ 100 ml had %EWL 25-75% and 38.8% had an %EWL above 75% and patients with GV ≥ 100 ml had an %EWL under 25% (50% of patients) or between 25 and 75% (50% of this group). The Pearson's correlation coefficient was R = 6.62, with bilateral significance (p ≤ .01). The Chi-square result correlating GV and EWL showed a significance of .005 (p ≤ .01). The 3D reconstructions showed accurately the shape and anatomic details of the gastric remnant. CONCLUSIONS: 3D volumetry CT scans accurately estimate GV after SG. A significant relationship between GV and EWL 6 months after SG was established, seeming that GV ≥ 100 ml at 6 months of SG is associated with poor EWL.

Laparoscopic appendectomy using a polymeric clip to close the appendicular stump.

BACKGROUND: The objectives of this study were to establish whether the occlusion of the appendicular stump by using nonabsorbable polymeric clips is technically feasible and whether differences exist in the postoperative course of patients to whom polymeric clips are applied compared with patients whose appendicular stump is closed with a surgical stapler. METHODS: This was a prospective study in 2 stages. In phase 1, 28 patients operated on for resection of the appendix between March 2002 and September 2003 were assigned to 1 of 2 groups. In 14 patients, the appendicular base was occluded by using an endoscopic linear cutting stapler. In the remaining 14, the appendicular base was ligated by using nonabsorbable polymeric clips (Hem-o-lock). We compared the surgical time, hospital stay, hospital costs, and complications. In phase 2, 250 patients were analyzed who underwent laparoscopic appendectomies performed between March 2002 and 2006 using a Harmonic scalpel for the section and hemostasis of the appendicular mesentery. Ligation of the appendicular stump was performed with Hem-o-lock clips. RESULTS: We found a significant difference in procedure costs, with the endoscopic staplers being more expensive. CONCLUSION: The use of polymeric clips is feasible, safe, and an economic alternative for ligation of the appendicular stump during laparoscopic appendectomies.

Uso de clips poliméricos (Hem-O-Lock) para el cierre del muñón apendicular como alternativa en apendicectomía laparoscópica / Use of polymeric clips (Hem-O Lock) for the closure of appendicular stump as an alternative in laparoscopic appendectomy

El objetivo, evaluar la utilización de los clips poliméricos (Hem-o-lockR) para el manejo del muñón apendicular, como una técnica que ofrece rapidez, seguridad y bajo costo. Estudio comparativo y descriptivo en 2 fases, durante la primera fase se evaluaron 28 pacientes que ingresaron al Instituto Médico la Floresta entre marzo de 2002 y septiembre 2003 con el diagnóstico de apendicitis aguda. En 14 pacientes se empleó una aplicación de engrapadora lineal cortante endoscópia para el engrapado y sección tanto del mesenterio apendicular como de la base del apéndice, mientras que en los restantes se utilizó bisturí armónico para la hemostasia y sección del mesoapéndice y clips poliméricos Hem-o-lock, para el cierre del muñón apendicular. En la segunda fase se evaluaron 250 pacientes que fueron sometidos a una apendicectomía laparoscópica entre marzo de 2002 y marzo 2006 en el mismo centro. Se utilizó bisturí armónico para la hemostasia y sección del mesoapéndice y clips poliméricos Hem-o-lock, para el cierre del muñón apendicular. En el grupo de la primera fase, no encontramos diferencia significativa en tiempo quirúrgico (p= 0,094) y estancia hospitalaria (p= 0,53) y se encontró diferencia significativa en los costos siendo mas económica la aplicación de clips poliméricos (p= 0,01414). No se presentaron complicaciones. En la segunda fase obtuvimos que el tiempo quirúrgico fue de 20-60 min (media de 45 min). La estancia hospitalaria promedio fue de 1 días (1 a 2 días). En este grupo tampoco se reportaron complicaciones. El uso del clips poliméricos (Hem-o-lock) es una alternativa económica y segura para el cierre del muñón apendicular durante la apendicectomía laparoscópica

Comparación del tratamiento de la fisura anal con toxina botulínica vs esfinterotomía lateral interna abierta / Comparison between botulinum toxin in anal fisure treatment vs open lateral sphincterotomy

La esfinterotomía lateral interna constituye el estándar entre las opciones terapéuticas de la fisura anal crónica, con tasas de curación de hasta un 97 por ciento. La toxina botulínica ha sido en los últimos años una de las sustancias más estudiadas para el tratamiento de esta entidad. Las tasas de curación varían entre 50 por ciento y 96 por ciento con seguimiento de dos a seis meses. Se estudiaron 18 pacientes con fisura anal que fueron divididos en dos grupos. A un grupo se le administró toxina botulínica en dosis de 10 Uds. a cada lado del esfínter anal y al otro se practicó esfinterotomía lateral interna abierta. Se evaluó la respuesta clínica de ambas opciones terapéuticas mediante el uso de escala analógica del dolor y la utilización de manometría para determinar la presión del esfínter anal. La respuesta clínica después de un mes con ambos tratamientos fué del 88.8 por ciento y la disminución de la presión basal del esfínter anal fue del 28 por ciento en los dos grupos. Ningún paciente presentó incontinencia anal. La presión basal del esfínter anal postramiento disminuyó en iguales proporciones en ambos grupos. La toxina botulínica constituye una opción eficaz y segura para el tratamiento de la fisura anal

Schwanoma pancreático: a propósito de un caso / Pancreatic schwannoma: a clinical case

Se presenta el caso de una paciente femenina de 85 años con diagnóstico previo de pseudoquiste pancreático en estudio por el servicio de Gastroenterología durante un año y medio, quien sufrió traumatismo abdominal cerrado motivo por el cual ingresó de emergencia y se realizó laparotomía exploradora, donde se evidenció ruptura del pseudoquiste pancreático. Se realizó cistoyeyunoanastomosis en Y y de Roux y toma de biopsia en la pared del pseudoquiste cuyo resultado histológico reportó: Neurilemoma Pancreático. Evolucionó tórpidamente por lo que se realizó drenaje transgástrico endoscópico con colocación de dos prótesis, las cuales se obstruyeron a las dos semanas. Es intervenida para exéresis del tumor; pero debido a las múltiples adherencias se decidió practiar cistogastroanastomosis. El diagnóstico definitivo de estas lesiones es pr evaluación inmunohistoquímica. Se reconoce como el tratamiento adecuado a la resección completa del mismo y en presencia de una alta tasa de morbi-mortalidad según el caso by-pass de la lesión.

Aumento de la presión intra-abdominal como parámetro de reintervención en el trauma abdominal / Increase of intra-abdominal pressure as a parameter of reoperation in abdominal trauma

Demostrar que el aumento de la presión intra-abdominal postoperatoria, a través de la medición de la presión intravesical es un parámetro útil para el diagnóstico de la hipertensión abdominal y permite decidir la intervención en los pacientes con trauma abdominal. Se realizó un estudio descriptivo , prospectivo, comparativo de una muestra de 63 pacientes admitidos a la emergencia del "Hospital Miguel Pérez Carreño", por trauma abdominal por los cuales se practicó la medición de la presión intravesical entre julio de 2000 a julio de 2001. Del total de la muestra, 12 pacientes (19 poe ciento) presentaron presiones intravesicales elevadas con un valor promedio de 29, 17 cmH2O, los 51 pacientes restantes presentaron presiones intravesicales bajas con un promedio de 8,5 cmH2O. El estado hemodinámico preoperatorio del paciente demostró ser factor de riesgo para la aparición de hipertensión abdominal postoperatoria. Las lesiones vasculares predominaron en los pacientes con presiones intravesicales elevadas, así como un aumento de los niveles de creatinina con valores estadísticamente significativos (p<0,025). La medición de la presión intravesical en pacientes postoperados por trauma abdominal es un parámetro útil que refleja la presión intraabdominal, y nos permite decidir, la reintervención del paciente, evitatando la aparición del síndrome compartimental abdominal

Esplenectomía parcial con autosuturadora / Splenectomy partial with autosuturated

La descripción de la infección fulminante pos-esplenectomía, en 1952, permitió considerar el manejo conservador de las lesiones esplénicas y la esplenectomía parcial representa una alternativa importante dentro de la cirugía preservadora del bazo. Desde principio de los 80, se describe la utilización de máquinas de autosutura en parénquima esplénico para diversas lesiones. El presente trabajo prospectivo demostró la efectividad del procedimiento de esplenectomía parcial en perros mediante el uso de las máquinas autosuturadas de 90 mm con dimensiones de cierre de 4.0 x 4.5 mm, y evaluó las complicaciones derivadas de su uso. Se realizan esplenectomías parciales en 20 perros de experimentación, distribuidos en dos grupos de 10 animales cada uno. En el grupo A por técnica convencional y en el grupo B con máquina autosuturadora. Se registraron las complicaciones intra y posoperatorias derivadas del procedimiento. Instituto de Cirugía Experimental Escuela de Medicina Luis Razetti, Universidad Central de Venezuela. Se evidenció menor promedio de tiempo operatorio (3 min) en el grupo de esplenectomías parciales con máquinas autosuturadas con respecto al grupo de esplenectomías parciales por técnica convencional, siendo esta diferencia estadísticamente significativa. La única complicación que se presentó en ambos grupos fue el sangramiento intraoperatorio del parénquima esplénico seccionado, no estableciéndose diferencia estadísticamente significativas entre los mismos. La esplenectomía parcial con máquinas autosuturadas es un método seguro y rápido como alternativa en la cirugía esplénica conservadora

Lesiones de vena cava inferior infrarrenal. Experiencia en el servicio de cirugía IV, Hospital Dr. Miguel Pérez Carreño / Inferior cava injury infrarenal experence in the service of surgery IV Hospital Dr. Miguel Pérez Carreño

LA vena Cava inferior representa uno de los vasos abdominales que se lesiona con frecuencia en heridas penetrantes de abdomen. Presentamos 14 casos de lesiones de vena cava inferior infrarrenal en pacientes operados en el lapso enero 1993- octubre 1994. Todas las lesiones se presentaron en hombres a consecuencia de heridas por arma de fuego, fue necesaria la ligadura simple en el 78,5 por ciento y rafia en el 21 por ciento de los casos. La mortalidad fue del 21,5 por ciento