[Expert opinion on the basic surgical technique for laparoscopic ventral hernia repair]. / Técnica quirúrgica básica consensuada para el tratamiento por vía laparoscópica de las hernias ventrales.

Laparoscopic ventral hernia repair is currently the subject of intense debate, even though it provides a series of advantages over open surgery and is feasible and safe. Various studies have shown this technique to be as effective as open repair with a lower recurrence rate. Despite the excellent results of laparoscopic repair of ventral hernias, there are numerous controversies associated with this procedure. These controversies concern the indications and contraindications of the procedure, and technical aspects such as how to create the pneumoperitoneum, perform adhesiolysis, manage the hernia sac, and insert and fix the mesh to the anterior abdominal wall. Also controversial are outcome, complications related to postoperative seroma, and which type and size of mesh should be used. The present article aims primarily to address many of these issues, based on the experience of distinct surgeons with expertise in this approach, in order to provide data to establish a consensus on how laparoscopic ventral hernia repair should be performed.

[Xanthogranulomatous cholecystitis]. / Colecistitis xantogranulomatosa.

Ten cases of xanthogranulomatous cholecystitis are presented, 5 women and 5 men, from a total of 439 cholecystectomies (2.2%). In 50% of cases the clinical course was consistent with acute cholecystitis; in 30%, gallbladder cancer was suspected preoperatively; and in 70% of cases cancer was suspected during surgery but intraoperative biopsies showed no malignancy. Definitive pathological findings included early carcinoma of the gallbladder in two patients, and a cholecystocolic fistula in one patient. A perforated gallbladder was found in one patient. The incidence of postoperative septic complications was 18.1%, a figure that doubles that of elective biliary surgery in our hospital.

[Prevention of thromboembolic disease and post-transfusional complications using normovolemic hemodilution in arthroplasty surgery of the hip]. / Prévention de la maladie thrombo-embolique et des complications post-transfusionnelles par l'hémodilution normovolémique en chirurgie arthroplastique de la hanche.

A prospective randomized study was conducted to evaluate the effect of moderate normovolemic haemodilution in arthroplastic surgery of the hip, to prevent postoperative deep vein thrombosis and the need for postoperative transfusion. The patients (n = 151) were divided into three groups: 48 patients received Dextran + Acetylsalicylic Acid as a prevention of the thromboembolic complications (Group I). 57 patients received a low dose of Heparin according to the Kakkar protocol (Group II). 52 patients were operated under Haemodilution (Group III). In Group I and II homologous blood transfusions were necessary in 83% of the cases, and in two cases posttransfusional hepatitis were observed. In Group III haemodilution avoided the use of homologous blood. Therefore of the three methods this study showed that haemodilution is the best way to prevent postoperative thrombo-embolism, significantly more effective than Heparin and Dextran, in arthroplastic hip surgery.

Renal function in patients undergoing major surgery under moderate normovolemic hemodilution.

A prospective randomized study on 100 patients with cholelithiasis, who were scheduled for cholecystectomy was carried out. 50 patients were hemodiluted (Hctr. 29-27%). In both groups, hemodiluted and non-hemodiluted patients, the following parameters were studied: renal function as regards glomerular filtration (creatine clearance, etc.) and also with reference to the concentrative capacity of the kidneys (free water and osmolar clearances). The results obtained show that M.N.H. significantly improves renal function. From the practical point of view we can conclude that the improved "performance" of the kidney in hemodiluted patients minimizes the nephrotoxis effects of many drugs and anaesthetic agents.

Hemodynamic response of elderly patients undergoing major surgery under moderate normovolemic hemodilution.

Moderate normovolemic hemodilution (MNH) is used in general surgery not only when major blood loss is anticipated but also as a prophylactic measure for the prevention of postoperative deep vein thrombosis. The hemodynamic effects of MNH (hematocrit value 27-29%) with dextran 70 as diluent were evaluated in 50 patients undergoing major surgery (cholecystectomy or total hip arthroplasty). They were divided into two groups according to age: I less than 60; II greater than 60 years. Comparison of the results obtained in the two groups shows no significant difference between them, either before or after hemodilution. Our study shows that MNH is a safe procedure, not only in young patients but also in those over 60 years.

[Normovolemic hemodilution and cerebral edema]. / Normovolämische Hämodilution und Hirnödem.

For the purpose of an experimental study a cerebral oedema was produced in dogs by means of a criogenic wound. The dogs were divided into 4 groups. There was no treatment in the first group. The standard treatment with corticoids was applied in series 2 and 3. Moderate normovolaemic haemodilution was applied in the 4th group. In all cases we studied the evolution of the intracranial pressure, Na and K in C.S.F. and the Na-K ratio in the urine. The results obtained demonstrate that moderate normovolaemic haemodilution represents a valid alternative treatment in cases of cerebral oedema.