[Laparoscopic management of a congenital diaphragmatic hernia]. / Manejo laparoscópico de la hernia diafragmática congénita.

Morgagni diaphragmatic hernia is a birth defect whose presentation in adults is rare. Diagnosis is usually made as an incidental finding through image studies; infrequently, patients may present with symptoms such as dyspnea or retrosternal pain. Open surgical repair has been the preferred management method of symptomatic presentation. In this paper we present the case of a 42 year-old-male with symptoms of retrosternal pain and dyspnea. Diaphragmatic hernia diagnosis was made ​​by CT and it was managed by laparoscopic repair of the diaphragmatic hernia.

[Laparoscopic appendectomy. Present situation. ABC medical center experience during the last five years]. / Apendicectomia laparoscópica. Lugar actual. Experiencia del Centro Médico ABC en los ultimos cinco años.

OBJECTIVE: To compare the diagnostic and therapeutic accuracy of laparoscopic appendectomy versus open appendectomy. BACKGROUND DATA: Appendectomy is the treatment of choice for acute appendicitis. Open Appendectomy (OA) has its complications rates (10-20%) and negative explorations in young women are about 25-30%. Acute appendicitis has a 3.1% morbidity and with perforation up to 47.2% and a mortality rate less than 1%. Advantages of laparoscopic appendectomy (LA) has been shown in many studies with lower intraoperatory and postoperatory complications, less hospitalization days, lower pain and faster return to daily activities when its compared with OA. METHODS: We perform a retrospective and descriptive trial with 1,883 patients with acute appendicitis between January 2000 to September 2004. Patients smaller than 15 years old and with other postoperatory diagnosis were excluded. Ji2 and t Student statistic tests were performed. RESULTS: We obtained 1,272 patients with acute appendicitis, 49% male and 51% female. LA was performed in 732 patients, 46.1% male and 53.9% female and OA was performed in 541 patients, 52.6% male and 47.3% female. Similar midage patients in both groups. LS was performed in 180 patients with complicated appendicitis and 116 patients by OA. LA was converted to open surgery in 4.5% patients. Morbidity was lower for laparoscopic group with statistical difference. There were no difference in fasting and hospitalization days. CONCLUSIONS: This procedure is a good choice for differential diagnosis overall in young women and complicated appendicitis with lower morbidity than the OA.

Utilidad de los estudios preoperatorios en cirugía electiva / The velue of pre-operative studies for elective surgery

Los estudios preoperatorios tienen como objetivo principal apoyar los hallazgos detectados por interrogatorio y exploración física previos a cirugía electiva. El presente estudio tiene como finalidad demostrar la utilidad de los estudios preoperatorios convencionales apoyados por una historia clínica apropiada que pueda simplificarlos en función de costo-benefico para los pacientes. Se analizaron 1000 pacientes sometidos a cirugía electiva previa valoración preanestésica, los exámenes preoperatorios fueron: biometría hemática, glicemia, nitrógeno ureico en sangre, creatinina, electrólito séricos, pruebas de coagulación, examen general de orina, proteínas séricas, electrocardiograma y radiografía tele de tórax. Se analizaron los datos obtenidos en función a complicaciones por órganos y sistemas así como la correlación entre estos mediante análisisi univeriado con el método de Chi cuadrada de Pearson, así como significancia estadística con la prueba de Bonferroni considerándose como datos significativos p< 0.05