Manejo mínimamente invasivo del síndrome de Mirizzi Va: Reporte de casos y revisión narrativa de la literatura / Minimally invasive management of Mirizzi syndrome Va: Case series and narrative review of the literature

Introducción El síndrome de Mirizzi (SM) es una patología infrecuente que es un reto para el cirujano. En el manejo quirúrgico, el abordaje abierto o el laparoscópico es un punto de discusión debido a la distorsión anatómica que se presenta. El objetivo de este estudio es analizar nuestra experiencia en el manejo laparoscópico de esta condición en el tipo Va. Materiales Realizamos un estudio descriptivo retrospectivo de pacientes con diagnóstico de SM tipo Va y tratados por abordaje laparoscópico, entre el 2014 y 2019, en dos centros de alto volumen de Bogotá, Colombia. Resultados Se evaluaron 1.073 pacientes que presentaron complicaciones por cálculos biliares, de los cuales 16 fueron diagnosticados con SM tipo Va. El 75% eran femeninos y el 25% masculinos; el 80% presentó ictericia y el 90% dolor abdominal. Doce pacientes presentaron fístula colecistoduodenal y cuatro fístula colecistocólica. Todos se manejaron de manera laparoscópica, en el 100% se logró realizar colecistectomía total y resección de fístula con cierre primario. La tasa de conversión fue del 0%, no hubo reingresos ni reintervención. El periodo de seguimiento fue de 18 meses. Conclusión El manejo laparoscópico en el SM es posible y seguro, teniendo en cuenta la experiencia del grupo quirúrgico y realizando una adecuada selección de los pacientes (AU)

Introduction Mirizzi's Syndrome (MS) is a rare pathology, known to be a challenge for the surgeon. In the surgical management, open approach vs laparoscopic is a topic of discussion due to anatomic variations. The aim of this study is to analyze our experience in the laparoscopic management of this condition in Type Va. Methods We made a descriptive retrospective study of patients diagnosed with MS type Va and treated by laparoscopic approach from 2014 to 2019, in two high volume centers of Bogotá, Colombia. Results 1073 patients who presented complications from gallstones were evaluated, of which 16 were diagnosed with MS type Va. 75% were females and 25% males; 80% presented jaundice and 90% abdominal pain; 12 patients showed cholecystoduodenal fistula and 4 cholecystocolic fistula. All patients underwent laparoscopic management, total cholecystectomy and fistula resection with primary closure was possible on a 100% of the patients. Conversion rate was 0%. The follow up was 18 months. Conclusion Laparoscopic management of MS is feasible and safe; the experience of the surgery group and selection of the patients is the key to a successful outcome (AU)

Giant retroperitoneal liposarcoma surgical management.

Retroperitoneal liposarcomas are very infrequent retroperitoneal malignant tumours. Most patients complain of palpable abdominal mass and only half present with abdominal pain. With haematogenous spread they can reach, mainly, lungs and liver, but only in 10% of cases. Here we report the presentation and surgical treatment of a giant massive retroperitoneal liposarcoma in a 53-year-old man.

Giant retroperitoneal liposarcoma surgical management.

Retroperitoneal liposarcomas are very infrequent retroperitoneal malignant tumours. Most patients complain of palpable abdominal mass and only half present with abdominal pain. With haematogenous spread they can reach, mainly, lungs and liver, but only in 10% of cases. Here we report the presentation and surgical treatment of a giant massive retroperitoneal liposarcoma in a 53-year-old man.

Early presentation of post-intubation tracheoesophageal fistula with severe tracheal stenosis in COVID-19 patient.

The current global COVID-19 pandemic is caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Currently, acquired tracheoesophageal fistulas are mainly iatrogenic lesions produced by prolonged tracheal intubation. We present a case of tracheoesophageal fistula with severe tracheal stenosis following tracheal intubation in a patient with SARS-CoV-2 infection.

Preventative laparoscopic repair of Petersen's space following gastric bypass surgery reduces the incidence of Petersen's hernia: a comparative study.

INTRODUCTION: Internal hernias (IH) are late complications of bariatric surgery, specifically gastric bypass and manifest with diffuse abdominal pain and/or intestinal obstruction. They have a low incidence, however, are increasingly common in patients undergoing laparoscopic gastric bypass (LGBP). Petersen's internal hernia is one of the most frequent internal hernias following Bariatric surgery. METHODS: We describe our experience at a third-level surgical center using a prophylactic Petersen's space herniorrhaphy immediately following LGBP as a preventative strategy for post-bariatric internal hernias. In addition, we perform a retrospective descriptive study with 667 patients undergoing LGBP under which we divided into two groups. In the first group, the Petersen's space was not closed, and in the second group, the Petersen´s space closure was performed using non-absorbable polypropylene non-interrupted sutures. RESULTS AND CONCLUSIONS: 667 patients were taken to LGBP, and of which 5 presented internal hernias. From the 346 patients who had Petersen´s herniorrhaphy performed, one developed signs of an internal hernia at 22 months follow-up and was subsequently confirmed later with laparoscopy (0.02%). Of the 321 patients not having had Petersen's space closure, 4 developed Petersen's internal hernia at an average of 22-month post-op, incidence of 0.1%. We analyzed and compared our results with those reported in the literature. Petersen's space closure immediately after a LGBP with an alimentary loop in the anterior colic position (prophylactic herniorrhaphy) with non-interrupted non-absorbable suture is a useful, safe, and effective technique to prevent the development of Petersen's IH during the post-operative period following LGBP.

Training farmworkers about pesticide safety: issues of control.

Farmworkers experience a lack of control over the conditions of their work environment. In trying to reduce the effects of exposure to pesticides, most health care providers give instructions to farmworkers about how to protect themselves. Outreach programs that target farmworkers focus on health education and recommend washing hands, wearing appropriate clothing, and avoiding direct contact. The research reported in this paper shows that farmworkers in North Carolina perceive many of these preventive measures to be outside their control. The ability of farmworkers to engage in safe practices depends on their capability to communicate with their employer, have positive work relationships, and the availability of protective equipment. The perceptions of control identified in this paper are issues that service providers and policy makers should consider to provide programs that will effectively promote pesticide safety and healthier farmworkers.

Preventing occupational exposure to pesticides: using participatory research with latino farmworkers to develop an intervention.

Pesticide exposure is an occupational health hazard for migrant farmworkers. The US-EPA Worker Protection Standard (WPS) mandates training programs to prevent or reduce exposure. WPS implementation in a local context requires understanding individual, workplace, and community environmental factors that lead to exposure and influence intervention effectiveness. Participatory research within the PRECEDE-PROCEED planning framework was used to design a WPS training program for Mexican farmworkers in North Carolina cucumber and tobacco production. Research with farmworkers, farmers, health care providers, and Cooperative Extension agents identified modifiable behaviors and environmental factors, as well as structural and regulatory barriers requiring intervention. Data were gathered and analyzed through individual and group interviews, community forums, an advisory board, and a partnership between academic researchers and a community-based organization. The intervention's dominant features are (a) focus on key health behaviors, (b) relevance to local conditions, and (c) attention to issues of control in the workplace. Participatory research is effective for designing a health intervention where diverse social, cultural, political, and regulatory issues affect farmworkers' risk of exposure.

Implementation of EPA's Worker Protection Standard training for agricultural laborers: an evaluation using North Carolina data.

The US Environmental Protection Agency has promulgated a Worker Protection Standard which requires that farmworkers receive pesticide safety training. The implementation of these regulations has not been evaluated. Using data collected through personal interviews with 270 Hispanic farmworkers recruited from 35 labor sites in an eight-county area, the authors analyzed the extent to which farmworkers received pesticide safety training, characteristics of the training, and variations in knowledge and safety behavior. Approximately a third of the farmworkers reported having ever received information or training on pesticide safety, and 25.6% reported having received training in the year in which they were interviewed. Workers with H2A visas were significantly more likely to have received training than workers without these visas. The training received varied in location, duration, and language. Most included the use of a video, as well as verbal presentation, and most included printed materials. However, few workers knew the ways in which they could be exposed to pesticides or reported using any method to protect themselves from pesticide exposure.