Tratamiento endovascular con técnica de chimenea para patologías del arco aórtico / Endovascular management with chimney technique for pathologies ofthe aortic arch

Introducción. La patología del arco aórtico se ha tratado principalmente con cirugía por vía abierta, pero con una alta morbimortalidad. Las técnicas endovasculares híbridas y las reconstrucciones en "chimenea" son una técnica válida y segura para disminuir el riesgo y la mortalidad. Métodos. Se presentan dos pacientes con patología del arco aórtico y contraindicación de manejo quirúrgico abierto, atendidos en el Servicio de Cirugía Vascular, Hospital Universitario Clínica de San Rafael, Bogotá, D.C., Colombia. Resultados. Se realizaron dos procedimientos endovasculares del arco aórtico para tratar un aneurisma torácico roto y una úlcera aórtica sintomática, con cubrimiento de los troncos supra aórticos con una endoprótesis y canalización de los vasos supra aórticos con prótesis cubiertas y uso de la "técnica de chimenea", de manera exitosa. Discusión. La patología del arco aórtico es de alta complejidad y se asocia con una morbimortalidad elevada por lo que, en los últimos 20 años se han desarrollado diferentes técnicas utilizando procedimientos percutáneos. Conclusión. La "técnica de chimenea" se puede realizar de una manera mínimamente invasiva en pacientes con patología del arco aórtico, no candidatos para cirugía abierta, con resultados exitosos.

Introduction. Aortic arch pathology has been treated mainly by open surgery, but with high morbidity and mortality. Hybrid endovascular techniques and "chimney" reconstructions are a valid and safe techniques to reduce risk and mortality. Method. Two patients with pathology of the aortic arch and contraindication for open surgical management, treated at the Vascular Surgery Service, Hospital Universitario Clínica de San Rafael, Bogotá, Colombia, are presented. Results. Two endovascular aortic procedures were performed successfully to treat a ruptured thoracic aneurysm and a symptomatic aortic ulcer, with coverage of the supra-aortic trunks with an endoprosthesis and cannulation of the supra-aortic vessels with covered prostheses and use of the "chimney technique". Discussion. The pathology of the aortic arch is highly complex and is associated with high morbidity and mortality, being the reason that during the last 20 years, different techniques have been developed using percutaneous procedures. Conclusions. The "chimney technique" can be performed with successful results in a minimally invasive manner in patients with pathology of the aortic arch, who are not candidates for open surgery

Seguridad de la colecistectomía laparoscópica temprana (<48 h) para pacientes con pancreatitis aguda biliar leve: revisión sistemática de la literatura y metaanálisis / The safety of early laparoscopic cholecystectomy (<48 hours) for patients with mild gallstone pancreatitis: A systematic review of the literature and meta-analysis

INTRODUCCIÓN: En pancreatitis biliar leve, la colecistectomía disminuye el riesgo de recurrencia. Esta debe realizarse durante la hospitalización inicial, pero incluso en esta puede prolongarse la estancia hospitalaria, con aumento de costos y morbilidad. El objetivo de este estudio es comparar las complicaciones entre los pacientes a los que se les realizó colecistectomía temprana (< 48 h) vs. tardía (> 48 h). MATERIALES Y MÉTODOS: Se realizó una búsqueda sistemática en las bases de datos: PubMed, EMBASE, LILACS y Scielo. Se incluyeron artículos de pacientes con pancreatitis aguda biliar leve que fueron llevados a colecistectomía durante la hospitalización inicial de manera temprana comparados con colecistectomía tardía, para evaluar las complicaciones, días de estancia hospitalaria y readmisión. Se evaluaron la calidad de los estudios y el riesgo de sesgos. RESULTADOS: Se identificaron 580 títulos y resúmenes de los cuales se incluyeron 3 estudios observacionales y un experimento clínico aleatorizado. Un total de 636 pacientes fueron incluidos, a los que se les realizó colecistectomía durante la hospitalización inicial. En 10 de 207 (4,83%) se presentó algún tipo de complicación en el grupo de colecistectomía temprana y 19 de 429 (4,42%) en el de colecistectomía tardía, con diferencia de riesgo de -0,0016 IC 95% ([-0.04]-0.04). De los estudios incluidos 3 fueron de baja calidad y uno de alta calidad. No se evidenció sesgo de publicación. CONCLUSIÓN: No se encontró diferencia entre los que son llevados a colecistectomía temprana en comparación con colecistectomía tardía en cuanto a complicaciones, sin embargo se deben realizar más estudios para confirmar o refutar estos hallazgos

BACKGROUND: In mild gallstone pancreatitis, cholecystectomy decreases the risk of recurrence. This should be performed during the initial hospitalization, but even when this is performed, the hospital stay can be prolonged, with an increase in costs and morbidity. The aim of this study is to compare the complication rate between patients who underwent an early cholecystectomy (< 48 hours) vs. a late one (> 48 hours). MATERIALS AND METHODS: A systematic search was performed in the following data bases: PubMed, EMBASE, LILACS and Scielo. Articles on patients with acute, mild gallstone pancreatitis who required a cholecystectomy during their initial hospitalization were included and compared with those undergoing a late cholecystectomy, in order to evaluate the complications, number of days of hospitalization and need for readmission. The quality of the studies and the risks of bias were evaluated. Results A total of 580 articles and summaries were identified which included 3 observational studies and a randomized clinical trial. A total of 636 patients who underwent a cholecystectomy during the initial hospitalization were included. Ten of 207 (4.83%) in the early cholecystectomy group showed some type of complication, and 19 of 429 (4.42%) in the late cholecystectomy group, with a risk difference of -0.0016 IC 95% ([-0.04]-0.04).Three of the included studies should be considered of low quality and one of high quality. No publication bias was evidenced. CONCLUSION: No differences in complication rate were found between patients who underwent an early cholecystectomy versus a late cholecystectomy; nevertheless, further studies should be carried out in order to confirm these findings

[The safety of early laparoscopic cholecystectomy (<48 hours) for patients with mild gallstone pancreatitis: a systematic review of the literature and meta-analysis]. / Seguridad de la colecistectomía laparoscópica temprana (<48 h) para pacientes con pancreatitis aguda biliar leve: revisión sistemática de la literatura y metaanálisis.

BACKGROUND: In mild gallstone pancreatitis, cholecystectomy decreases the risk of recurrence. This should be performed during the initial hospitalization, but even when this is performed, the hospital stay can be prolonged, with an increase in costs and morbidity. The aim of this study is to compare the complication rate between patients who underwent an early cholecystectomy (<48 hours) vs. a late one (>48 hours). MATERIALS AND METHODS: A systematic search was performed in the following data bases: PubMed, EMBASE, LILACS and Scielo. Articles on patients with acute, mild gallstone pancreatitis who required a cholecystectomy during their initial hospitalization were included and compared with those undergoing a late cholecystectomy, in order to evaluate the complications, number of days of hospitalization and need for readmission. The quality of the studies and the risks of bias were evaluated. RESULTS: A total of 580 articles and summaries were identified which included 3 observational studies and a randomized clinical trial. A total of 636 patients who underwent a cholecystectomy during the initial hospitalization were included,. Ten of 207 (4.83%) in the early cholecystectomy group showed some type of complication, and 19 of 429 (4.42%) in the late cholecystectomy group, with a risk difference of -0.0016 IC 95% ([-0.04]-0.04). Three of the included studies should be considered of low quality and one of high quality. No publication bias was evidenced. CONCLUSION: No differences in complication rate were found between patients who underwent an early cholecystectomy versus a late cholecystectomy; nevertheless, further studies should be carried out in order to confirm these findings.