Modified oncoplastic lift, lymphatic excision, and reconstruction: Introduction of a novel technique in oncoplastic breast surgery with simple surgical principles.

INTRODUCTION: Oncoplastic surgery is an important component of the management of breast cancer. As prognosis has improved, the need for proficient techniques to achieve disease eradication while maintaining cosmesis for naturally appearing breasts has gained importance. This study describes an easy-to-learn modified oncoplastic technique for patients undergoing breast-conserving treatment. DESCRIPTION OF THE TECHNIQUE: Tumor resection is performed through different peri-areolar, inframammary, or radial incisions. To reduce the size of the surgical defect created after tissue resection, an internal purse-string is performed parallel to the chest wall or base of the wound with subsequent staggering in three or more layers as needed, while maintaining the parallel orientation of the needle. This is followed by the creation and overlapping of internal breast tissue flaps that are rearranged to decrease the dead space with the aim of improving cosmesis. The redundant skin is removed for the skin envelope to maintain shape. The wound is closed in layers. We also describe steps in performing sentinel lymph node and tumor extraction through the same periareolar, inframammary, or radial incisions for tumors located in outer quadrants. Following closure, contour and projection of the breast were maintained without indentation or loss of projection, with a symmetrical appearance to the contralateral side. CONCLUSION: This simplified oncoplastic (MOLLER) technique can be easily learned and used by surgeons who treat cancer patients and have limited oncoplastic training. It uses basic known surgical principles to decrease the size of the defect created while minimizing the need for larger incisions/pedicles.

Alagille syndrome: an orphan disease in Colombia and summary of recent advances in treatment and survival - a case report.

Alagille syndrome has been described as a multisystemic clinical spectrum caused by an autosomal dominant genetic disorder. Although it is estimated that there is 1 case per 100 000 live births, the prognosis for survival and quality of life for these patients is varied but tends to be negative. In Colombia, this condition is considered an orphan disease with difficult management due to the lack of specialized centers that have all the medical specialties and subspecialties. Some reports state that no more than 30 cases have been published in this country. Materials and methods: The authors report a case of a male baby who, at 8 days old, he was taken to the general practitioner's outpatient clinic for persistent jaundice. At 3 months of age, he was reviewed by the pediatric gastroenterology department, which requested liver and biliary tract scintigraphy, showing atresia of the biliary tract, hepatomegaly, and the absence of a gallbladder. Results: Liver transplantation is the definitive solution. However, in low- and middle-income countries, where there are no well-established organ transplantation programs, the prognosis for these patients is presumed to be worse. Conclusion: Alagille syndrome is a rare disease that requires an accurate and early diagnosis and timely multidisciplinary management to reduce the impact of multisystemic complications. It is necessary to advance in transplant programs in low- and middle-income countries, to provide a solution to cases where there are no other therapeutic alternatives, and to contribute to the quality of life of the affected patient.

Postoperative outcomes using Lichtenstein open hernioplasty versus Nyhus preperitoneal hernioplasty in inguinal hernia: A comparative analysis with 1-year follow-up.

Background and Aim: Inguinal hernia is the most common defect of the abdominal wall in 75% and their treatment consists of surgical repair. The technique of choice is laparoscopic because of its overall benefits. However, when this is not available, open approaches may be a viable option. Currently, the most commonly used open techniques are Lichtenstein and Nyhus. However, there are few medium- or long-term studies that have compared outcomes between these two techniques. Methods: This is a retrospective comparative study that included patients undergoing open inguinal hernia correction with mesh, using Lichtenstein open hernioplasty versus Nyhus preperitoneal hernioplasty, in two tertiary referral centers in Bogota, Colombia, during a period of 2 years. A bivariate analysis was performed to compare groups, according to the complications presented between the two techniques. Results: A total of 193 patients were included, of whom 53.36% were men and 112 (58.03%) were approached with the Nyhus technique versus 81 patients with the Lichtenstein technique. Nonabsorbable suture fixation was performed in 100% of patients. Among the main complications, seroma (5.18%), pain (4.14%), bleeding (2.07%), recurrence (10.88%), and reoperation (0.51%) were observed, of which only recurrence showed a statistically significant difference, which is lower in the Nyhus approach (3.57% vs. 20.67%; p < 0.001). No patients died. Conclusions: Both Nyhus and Lichtenstein hernioplasty techniques were shown to cause a low incidence of postoperative complications, with significantly lower recurrence using the Nyhus technique up to 1 year postoperatively.

The effect of bariatric surgery on metabolic syndrome: A retrospective cohort study in Colombia.

Introduction and Objective: Metabolic syndrome (MetS) represents a group of metabolic abnormalities. It is currently a pandemic, and its prevalence is on the rise. MetS has a direct relationship with obesity, for this reason, bariatric and metabolic surgery has been proposed as a method to simultaneously control obesity and MetS. However, in Colombia the results of this intervention are unknown. This study aims to compare metabolic syndrome before and after bariatric surgery in a Colombian population. Methods: Retrospective cohort study conducted in a highly complex institution in Colombia, where comparing the prevalence of metabolic syndrome in patients who underwent bariatric surgery during a 1-year follow-up period, between January 2015 and December 2019. Of these patients, 48 underwent Roux-en-Y gastric bypass, and 32 underwent sleeve gastrectomy by laparoscopic technique. Results: A total of 80 patients were included, of which 67.5% were women and the mean age was 42.8 ± 12.9 years. The most frequent preprocedure comorbidities were arterial hypertension (36.2%), dyslipidemia (32.4%), and sleep apnea (20%). After bariatric surgery, the prevalence of metabolic syndrome decreased from 66.2% to 3.7% (p < 0.05). In addition, a reduction in the Homeostatic Model Assessment for Insulin Resistance score from 77.5% to 22.5% was observed during the follow-up period. HbA1c, creatinine, and thyroid-stimulating hormone, were the only parameters without significant changes. Conclusions: Metabolic and bariatric surgery is an effective treatment for weight reduction, with a high impact in reducing the prevalence of metabolic syndrome and insulin resistance in the short and medium term in the Colombian population.

Predicting mortality in penetrating cardiac trauma in developing countries through a new classification: Validation of the Bogotá classification.

Introduction: Penetrating chest trauma (PCT) represents 10% of worldwide mortality, with developing countries counting as some of the most affected by high mortality rates due to cardiac trauma. Colombia is considered one of the most violent countries due to the high mortality rate associated with war and crime, hence the validation of an own classification for penetrating cardiac injuries (PCI) is mandatory. Methods: Retrospective cross-sectional study which included adult patients with PCIs at a level 4 trauma center in Colombia, between January 2018 and April 2020. We used our own system (Bogotá Classification) and compared it with traditional systems (e.g., Ivatury's, OIS-AAST), by analyzing the mechanism of injury (MOI), the hemodynamic status of the patient at admission, the inpatient management, the individual outcomes, and some demographic variables. Bivariate statistical analysis, spearman correlation, and logistic regression were performed. Results: Four hundred and ninety-nine patients were included. Bivariate analysis demonstrated a significant relationship between mortality and hemodynamic state, MOI, its location and degree of lesion, cardiac/vessel injury, cardiac tamponade, time between injury and medical care, fluid reanimation, as well as the Ivatury's classification and the new classification (p < 0.005). The adequate correlation between Ivatury's and Bogotá classification supports the latter's clinical utility for patients presenting with PCI. Likewise, logistic regression showed a statistically significant association among mortality rates (p < 0.005). Conclusions: The Bogotá classification showed similar performance to the Ivatury's classification, correlating most strongly with mortality. This scale could be replicated in countries with similar social and economic contexts.

Does Breast-Conserving Surgery with Radiotherapy have a Better Survival than Mastectomy? A Meta-Analysis of More than 1,500,000 Patients.

BACKGROUND: There have been conflicting studies reporting on survival advantages between breast-conserving surgery with radiotherapy (BCS) in comparison with mastectomy. Our aim was to compare the efficacy of BCS and mastectomy in terms of overall survival (OS) comparing all past published studies. METHODS: We performed a comprehensive review of literature through October 2021 in PubMed, Scopus, and EMBASE. The studies included were randomized controlled trials (RCTs) and cohorts that compare BCS versus mastectomy. We excluded studies that included male sex, stage 0, distant metastasis at diagnosis, bilateral synchronous cancer, neoadjuvant radiation/chemotherapy, and articles with incomplete data. We performed a meta-analysis following the random-effect model with the inverse variance method. RESULTS: From 18,997 publications, a total of 30 studies were included in the final analysis: 6 studies were randomized trials, and 24 were retrospective cohorts. A total of 1,802,128 patients with a follow-up ranging from 4 to 20 years were included, and 1,075,563 and 744,565 underwent BCS and mastectomy, respectively. Among the population, BCS is associated with improved OS compared with mastectomy [relative risk (RR) 0.64, 95% confidence interval (CI) 0.55-0.74]. This effect was similar when analysis was performed in cohorts and multi-institutional databases (RR 0.57, 95% CI 0.49-0.67). Furthermore, the benefit of BCS was stronger in patients who had less than 10 years of follow-up (RR 0.54, 95% CI 0.46-0.64). CONCLUSIONS: Patients who underwent BCS had better OS compared with mastectomy. Such results depicting survival advantage, especially using such a large sample of patients, may need to be included in the shared surgical decision making when discussing breast cancer treatment with patients.

Laparoscopy has better performance than laparotomy in the treatment of stable penetrating abdominal trauma: A retrospective cross-sectional study in a trauma referral hospital in Colombia.

Background: Abdominal trauma is one of the leading causes of death. In Colombia, few studies have evaluated the results on related factors and outcomes when comparing laparotomy versus laparoscopy in the management of penetrating abdominal trauma. Therefore, the aim of this study was to investigate the feasibility and safety of laparoscopy in the treatment of stable penetrating abdominal trauma in a limited resources environment in a middle-income country. Methods: Retrospective cross-sectional study was conducted in Bogota, Colombia from January 2018 to October 2020. Patients over 18 years old, hemodynamically stable with penetrating abdominal trauma without other body parts injuries, that underwent laparoscopy and/or laparotomy surgical exploration and treatment were included. Frequencies, percentages, correlations, and odds ratio were calculated. Results: A total of 52 patients were analyzed (26 laparoscopy vs. 26 laparotomy). Stabbing injuries were more frequent in both groups (76.9%), as well as involvement of the anterior abdomen. None missed enterotomies were reported in the laparoscopy group. Surgical time and bleeding were significantly lower in the laparoscopic approach group (63 vs. 115 min and 65 vs. 992 cc, respectively). The time to oral intake and length of stay in the intensive care unit was significantly shorter in the laparoscopic management group (2 vs. 3 days and 1 vs. 4 days, respectively). Conclusions: Surgical results found a safe scenario in a limited resources environment for the application of the laparoscopic technique to approach penetrating abdominal trauma in stable patients without missed injuries, low threshold of conversion to open approach, and additionally not presenting a higher percentage of complications compared with the laparotomy group in Colombia. Operative time, oral intake, and length of hospital stay were lower in the fully therapeutic laparoscopy group.

Refractory traumatic intracranial hypertension: the role of decompressive craniectomy.

Traumatic brain injury according to the World Health Organization estimates that by 2020 will be the third leading cause of morbidity and mortality worldwide. Intracranial hypertension refractory to medical management is the cause of increased mortality in neurotrauma. There are various measures to control intracranial hypertension, including surgical. Decompressive craniectomy has been routinely used to treat intracranial hypertension secondary to cerebral infarction, subarachnoid hemorrhage, intracerebral hemorrhage and trauma. We review the literature to describe the mechanisms, types and indications for this procedure.

El trauma craneoencefálico, según la Organización Mundial de la salud, se estima que para el año 2020 será la tercera causa de morbimortalidad en el mundo. La hipertensión intracraneal refractaria al manejo médico es la causante de la mayor mortalidad en esta población de pacientes. Existen diversas medidas para el control de la hipertensión intracraneal, entre ellas las quirúrgicas. La craniectomía descompresiva ha sido utilizada sistemáticamente para tratar la hipertensión intracraneal secundaria al infarto cerebral, la hemorragia subaracnoidea, la hemorragia intracerebral y el trauma. Se hace una revisión de la literatura para describir los mecanismos fisiopatológicos de la lesión cerebral traumática, así como también los tipos y las indicaciones de este procedimiento.

[Hidrocefalia congénita-neonatal: alternativas terapéuticas a la derivación. Una mirada a la terapia celular]. / Congenital-neonatal hydrocephalus: therapeutic alternatives to derivation. A look at cell therapy.

INTRODUCCIÓN: La hidrocefalia de inicio fetal, perinatal y neonatal representa un gran reto terapéutico y a menudo cursa con un pronóstico neurológico pobre, debido a su etiología heterogénea, que incluye alteraciones del neurodesarrollo. OBJETIVO: Realizar una recopilación de los avances en terapia celular como propuesta que permite ampliar el espectro de tratamiento en la hidrocefalia congénita-neonatal. DESARROLLO: Las intervenciones terapéuticas disponibles actualmente, como la derivación ventrículo-peritoneal y la tercera ventriculostomía, son insuficientes para resolver por completo la hidrocefalia y para prevenir o revertir los daños neurológicos asociados. Es por esto por lo que ha surgido la necesidad de crear nuevas alternativas terapéuticas a partir del conocimiento de los mecanismos fisiopatológicos que participan en el desarrollo de esta condición. Particularmente, la terapia celular con células madre neuronales y células madre mesenquimales ha demostrado, en estudios con animales y en estudios preclínicos con humanos, ser eficiente y segura para prevenir la hidrocefalia originada a partir de la disrupción de la zona ventricular y secundaria a la hemorragia intraventricular, con la consiguiente prevención de las secuelas neurológicas sensoriomotoras y cognitivas. CONCLUSIONES: Hasta el momento no tenemos un tratamiento eficiente que ofrezca calidad de vida a los pacientes con hidrocefalia, y que esa alternativa terapéutica sea efectiva. INTRODUCTION: Fetal hydrocephalus, perinatal and neonatal represents a major therapeutic challenge and often has with poor neurological prognosis, due to its heterogeneous aetiology, including neurodevelopmental disorders. OBJECTIVE: To make a collection of advances in cell therapy as a proposal that can extend the spectrum of treatment in congenita-neonatal hydrocephalus. DEVELOPMENT: Therapeutic interventions available at present as the ventricle-peritoneal shunt and third ventriculostomy, are insufficient to fully resolve the hydrocephalus and to prevent or reverse the associated neurological damage. This is why what has emerged the need for new therapeutic alternatives based on the knowledge of physiopathological mechanisms involved in the development of this condition. In particular, cell therapy with neural stem cells and mesenchymal stem cells has proven in animal studies and preclinical studies with humans, efficiently and safely to prevent hydrocephalus originated from the disruption of the ventricular zone and secondary to intraventricular hemorrhage, with the consequent prevention of neurological sequelae sensorimotor and cognitive. CONCLUSIONS: So far, we do not have an efficient treatment that offers quality of life to patients with hydrocephalus, and that alternative therapy to be effective.