[Accelerated recovery in elective laparoscopic colorectal surgery: two years of experience. ] / Recuperación acelerada en cirugía colorrectal laparoscópica electiva: dos años de experiencia.

Background: Accelerated recovery protocols in colorectal surgery have enhanced the perioperative cares optimizing recovery in this group of patients. A reduction in surgical stress and therefore early hospital discharge and lower morbidity is pursued, however, the literature offers few outcomes regarding its application in developing countries. Objective: to analyze short- and medium-term outcomes of the application of an accelerated recovery protocol in a terciary care hospital in Argentina. Methods: In the period between January 2015 and March 2017 patients were included prospectively and consecutively with indication of elective laparoscopic colorectal surgery and under strict follow-up according to the protocol created by the institution. Patients older than 80 years, ASA IV, emergency surgeries and conventional approach were excluded. We analyzed demographic data, diagnosis of surgery, type of intervention, hospital stay, complications, readmissions and reinterventions at 30 postoperative days. Results: Sixty-four patients with a mean age of 62 years were included. The mean hospitalization was 4.9 days, with 10.9% readmissions and 4.7% of reinterventions. We recorded 69% of the patients whit not complications at all and 5 major complications (8%) . Conclusion: Based on the adaptation of the international guidelines to our health reality, it is feasible to create an accelerated recovery protocol applicable in our country, with a low complication rate and early discharge.

Introducción: El desarrollo de los protocolos de recuperación acelerada en cirugía colorrectal ha revalorizado los cuidados que conforman la recuperación perioperatoria de los pacientes sometidos a cirugía. Se persigue una reducción del stress quirúrgico y por tanto alta precoz y menor morbilidad, sin embargo, la literatura aporta pocos resultados respecto a su aplicación en países en desarrollo. Objetivo: analizar los resultados a corto y mediano plazo de un protocolo de recuperación acelerada en un hospital de alta complejidad de nuestro medio. En el periodo comprendido entre enero 2015 y marzo 2017 se incluyeron pacientes de manera prospectiva y consecutiva con indicación deAñadir colaborador/a cirugía colorrectal laparocopica electiva y bajo estricto seguimiento según protocolo creado por la institución. Fueron excluidos pacientes mayores de 80 años, ASA IV, cirugías de urgencia y abordaje convencional. Se analizaron datos demográficos indicación de cirugía, tipo de intervención, estadía hospitalaria en días, complicaciones, readmisiones y reintervenciones a los 30 días de postoperatorio. Resultados: Fueron incluidos 64 pacientes con una edad media de 62 años. El promedio de internación en días fue de 4,9, con 10,9% de reinternaciones y 4,7% de reintervenciones. El 69% de los pacientes no presento complicaciones, registrándose 5 complicaciones mayores (8%). Conclusión: A partir de la adecuación de los lineamientos internacionales a nuestra realidad sanitaria, es factible la creación de un protocolo de recuperación acelerada aplicable en nuestro medio, con baja tasa de complicaciones y alta precoz.

Risk factors for surgical site infection in colon surgery in our population.

BACKGROUND: Surgical site infection (SSI) is the most common nosocomial infection in surgical patients with an incidence that varies between 5-30%. OBJECTIVE: Identify the risk factors for SSI in colonic surgery in our population. The secondary aims are to determine the incidence and type of SSI, as well as the incidence of an anastomotic leakage (AL). METHODS: Case-control study of patients undergoing colectomy between 2010-2014 at the Hospital Privado Univeristario de Córdoba and Hospital Raúl Ferreyra. Conventional and laparoscopic interventions, with a 30-day postoperative follow up, between 20-85 years and an ASA I-III were included. Patients undergoing emergency surgery and recto-anal resections were excluded. SSI was defined as an infection that occurred within 30 days after surgery. RESULTS: We included 238 patients. SSI was diagnosed in 27.7% (n=66) of the patients of which 12.2% were superficial, 4.6% deep incisional and 10.9% organ/space. Multivariate analysis showed that SSI was independently associated with male sex (odds ratio [OR] 3.15; IC95%:1.43-6.92; p=0.004), having undergone previous chemotherapy (OR 6.72; IC95%:1.48-30.93; p=0.01), need for conversion (OR 3.32; IC95%:1.13-9.77; p=0.02), reintervention within the 30 postoperative days (OR 12.34; IC95%:2.65-57.37, p=0.001) and AL (OR 12.83; IC95%:2.97- 55.5; p=0.001). AL had an incidence of 9.6%, of which 91% presented SSI and all were organ/space. CONCLUSION: We found that male sex, having undergone previous chemotherapy, conversion, reintervention within 30 postoperative days and AL are risk factors for SSI in our population. These results should be considered in implementing preventive measures for SSI.

Laparoscopic Repair of Giant Bochdalek Hernia in Adults.

INTRODUCTION: Bochdalek hernia is a congenital diaphragmatic defect that results from improper fusion of the septum transversum and the pleuroperitoneal folds. It rarely persists asymptomatic until adulthood. The reported incidence is as low as 0.17%. Surgical repair of the defect can be performed through the abdomen or through the chest, and in both cases open or through laparoscopy/thoracoscopy. CASE REPORT: We present 2 cases of fully laparoscopic repair of giant Bochdalek hernia in adults. In both cases we used a GORE® DUALMESH® and we had neither complications nor recurrence. It is worthy of mention that hernia sac was not found in any of the cases. This has been described as a distinct characteristic that confirms diagnosis. CONCLUSION: Bochdalek hernia in the adult is a rare entity that requires surgical treatment to avoid complications. CT scan of the abdomen and chest with oral and IV contrast is the gold standard for diagnosis.