Benefit of video-assisted thoracic surgery in the emergency of a complicated postpartum diaphragmatic hernia.

Diaphragmatic hernia during pregnancy or puerperium are rare entities that, in the event of a complication, represent a life-threatening emergency for both mother and the unborn child. Resolution in many cases requires a combined access through the thoracic and abdominal cavity to manage the complications of necrosis and/or perforation of an abdominal viscera. To treat the thoracic cavity, thoracotomy is the most described approach. Even more, the minimally invasive access by video-assisted thoracic surgery (VATS) is not widely referenced in the literature despite its clear benefits of this technique in the recovery of patients, even in emergencies. We present the case of a postpartum right diaphragmatic hernia, complicated by necrosis of the colonic wall, treated by combined VATS approach and laparotomy in the emergency.

Las hernias diafragmáticas durante el embarazo o puerperio son entidades raras que, en caso de complicación, representan una emergencia potencialmente mortal tanto para la madre como para el feto. La resolución en muchos casos requiere un acceso combinado a través de la cavidad torácica y abdominal para manejar las complicaciones de la necrosis o perforación de las vísceras abdominales. Para tratar la cavidad torácica, la toracotomía es la vía más descrita. Más aún, el acceso mínimamente invasivo mediante cirugía torácica video-asistida (VATS) no está ampliamente referenciado en la literatura a pesar de los claros beneficios de esta técnica en la recuperación de los pacientes, incluso en emergencias. Presentamos el caso de una hernia diafragmática derecha posparto, complicada por necrosis de la pared colónica, tratada combinado VATS y laparotomía en la urgencia.

Benefit of video-assisted thoracic surgery in the emergency of a complicated postpartum diaphragmatic hernia / Beneficio de la cirugía torácica video-asistida en la emergencia de una hernia diafragmática posparto complicada

Abstract Diaphragmatic hernia during pregnancy or puerperium are rare entities that, in the event of a complication, represent a life-threatening emergency for both mother and the unborn child. Resolution in many cases requires a combined access through the thoracic and abdominal cavity to manage the complica tions of necrosis and/or perforation of an abdominal viscera. To treat the thoracic cavity, thoracotomy is the most described approach. Even more, the minimally invasive access by video-assisted thoracic surgery (VATS) is not widely referenced in the literature despite its clear benefits of this technique in the recovery of patients, even in emergencies. We present the case of a postpartum right diaphragmatic hernia, complicated by necrosis of the colonic wall, treated by combined VATS approach and laparotomy in the emergency.

Resumen Las hernias diafragmáticas durante el embarazo o puerperio son entidades raras que, en caso de complicación, representan una emergencia potencialmente mortal tanto para la madre como para el feto. La resolución en muchos casos requiere un acceso combinado a través de la cavidad torácica y abdominal para manejar las complicaciones de la necrosis o perforación de las vísceras abdominales. Para tratar la cavidad torácica, la toracotomía es la vía más descrita. Más aún, el acceso mínimamente invasivo mediante cirugía torácica video-asistida (VATS) no está ampliamente referenciado en la literatura a pesar de los claros beneficios de esta técnica en la recuperación de los pacientes, incluso en emergencias. Presentamos el caso de una hernia diafragmática derecha posparto, complicada por necrosis de la pared colónica, tratada combinado VATS y laparotomía en la urgencia.

[Video-assisted horacic surgery in the management of pulmonary sequestration t: case report]. / Cirugía torácica video-asistida en el manejo de secuestro pulmonar.

Pulmonary sequestration (SP), is a rare condition, which requires a high index of suspicion for appropriate diagnosis. Clinical manifestations usually simulate banal respiratory diseases, so the diagnosis always tends to be delayed. Surgical treatment by video-assisted, thoracic surgery is a safe option for the management of pulmonary sequestration. The extensive evaluation of the images and knowledge of certain anatomical details are necessary to prevent accidents during surgery. Surgery at an early age helps surgical resection with fewer complications. Here are three cases of SP, which demonstrate clear and simple forms of presentation of the pathology and surgical management by our group in treating it.

[Early Video-Assisted Thoracic Surgery (VATS) improves quality of life In complicated Neoplastic Pleural Effusions.] / La cirugía torácica video-asistida (VATS) temprana, mejora la calidad de vida en los derrames pleurales neoplásicos complicados.

Introduction: Malignant pleural effusion (MPE) involves advanced cancer disease. Pleural biopsy for endoscopic thoracic surgery allows diagnosis in more than 90% of cases and instrumentation of the pleural space, improving the results of the technique. Material and Method: We performed a retrospective analysis of patients with MPE who underwent a talc chemical pleurodesis. Two groups were formed, one with complicated malignant pleural effusion (CMPE) and another with uncomplicated malignant pleural effusion (NCMPE). In the group with CMPE, "release - expansion maneuvers" were performed. The variables between the two groups were compared for the relevant analysis. Results: We analyzed 28 patients with MPE treated with chemical pleurodesis by endoscopic thoracic surgery. The average age was 62.64 years. Pleural involvement due to breast disease was the most frequent form (46.4%). There was no difference between complication rate (p = 0.31) and the risk of death at 30 days (p = 1.09) with aggressive management of pleural space. The delay pleurodesis indication was related to a higher rate of complications (p = 0.002) and a higher probability of death within 30 days (p = 0.008). The majority of patients return to their daily tasks, with good tolerance to dyspnea following the procedure. Conclusion: In patients with complicated MPE, the "lung-release maneuvers" described above would increase the chances of improving outcomes at low risk. Early chemical pleurodesis improves the quality of life of patients with PND.

Introducción: El derrame pleural neoplásico (DPN) implica una enfermedad oncológica avanzada. La biopsia pleural por cirugía torácica endoscópica permite el diagnóstico en más del 90% de los casos y la instrumentación del espacio pleural complicado, mejorando los resultados de la técnica. MATERIAL Y METODO: Se realizó un análisis retrospectivo de pacientes con DPN operados para la realización de una pleurodesis química con talco. Se formaron dos grupos, uno con derrame pleural neoplásico complicado (DPNC) y otro con derrame pleural neoplásico no complicado (DPNNC). En el grupo con DPNC se realizó "maniobras de liberación ­ expansión". Se compararon las variables entre ambos grupos para el análisis pertinente. RESULTADOS: Se analizaron 28 pacientes con DPN tratados con pleurodesis química por cirugía torácica endoscópica. La edad promedio fue de 62,64 años. El compromiso pleural por patología mamaria fue la forma más frecuente (46,4%). No se hubo diferencia en cuanto a complicaciones (p= 0,31) y riesgo de defunción a los 30 días (p=1,09) con el manejo agresivo del espacio pleural. La demora en la indicación de pleurodesis se relacionó con un mayor índice de complicaciones (p=0,002) y mayor probabilidad de defunción dentro de los 30 días (p=0,008). La mayoría de pacientes se reinsertó a sus tareas diarias, con buena tolerancia a la disnea luego del procedimiento. CONCLUSION: En los pacientes con DPNC, las "maniobras de liberación - expansión pulmonar" descriptas, aumentarían las chances de mejorar los resultados con bajo riesgo. La pleurodesis química temprana mejora la calidad de vida de los pacientes portadores de un DPN.

Tumor fibroso solitario intrapulmonar: ¿benigno o maligno? / Intrapulmonary Solitary Fibrous Tumors: Benign or Malignant?

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[Complications of conventional and laparoscopic gastric bypass. Prospective and comparative study]. / Complicaciones del bypass gástrico convencional y laparoscópico. Estudio prospectivo y comparativo.

BACKGROUND: Roux-en-y gastric bypass for the management of morbid obesity is currently the safest and more efficient treatment option. the laparoscopic era has shown its benefits in this type of surgery, so some authors advocate its implementation in a practical systematic way. all of which has lead in recent years to the unavoidable change in the surgical approach. OBJECTIVES: To evaluate and compare the complications of laparoscopic gastric bypass and the conventional one in patients with morbid obesity. Application site: self-administration national university hospital. DESIGN: Comparative, prospective no randomized study. POPULATION: Between 2002 and 2011, 420 morbidly obese patients received surgical treatment for the obesity either open (167) or laparoscopic (253) surgery RESULTS: Early postoperative complication rate was 4% in the lbg and 34% in the cbg (p < 05, 95%ci 22-38), mostly represented by seromas (25%) and wall abscesses (5.4%). the percentage of late postoperative complications was 2.8% in the lbg group and 9.6% in the cbg (p=0.004, 95%ci 1.4-12.2), the most frequent being incisional hernias (7.18%). CONCLUSIONS: According to our experience and consulted literature, laparoscopic gastric bypass is a safe, reproducible and with a lower rate of both early and late complications than cbg, and so we consider and offer lbg as the ideal technique for the treatment of patients with morbid obesity.

Antecedentes: el bypass gástrico en y de roux para el tratamiento de la obesidad mórbida representa hoy en día la opción terapéutica más segura y eficiente. la era laparoscópica ha demostrado sus beneficios en este tipo de cirugía, por lo que algunos autores abogan por su implementación en forma casi sistemática, conduciendo en los últimos años al inexorable cambio en la vía de abordaje. Objetivos: evaluar y comparar las complicaciones del bypass gástrico laparoscópico y convencional en pacientes con obesidad mórbida. Lugar de aplicación: hospital nacional universitario de autogestión. Diseño: estudio comparativo, prospectivo no randomizado. Población: entre el 2002 y 2011, 420 pacientes con obesidad mórbida recibieron un tratamiento quirúrgico para la obesidad ya sea en forma laparoscópica (253) o convencional (167). Resultados: el porcentaje de complicaciones postoperatorias tempranas fue del 4% en el grupo bgl y del 34% en el bgc (p <05, ic95% 22 - 38), representadas en su mayoría por seromas (25%) y abscesos de pared (5,4%). el porcentaje de complicaciones postoperatorias tardías fue del 2,8% en el grupo bgl y del 9,6% en el bgc (p= 0.004, ic95% 1,4 - 12,2), siendo las más frecuentes las eventraciones (7,2%). Conclusiones: de acuerdo a nuestra experiencia y a la literatura consultada, el bypass gástrico laparoscópico es un procedimiento seguro, reproducible y con una menor tasa de complicaciones tanto tempranas como tardías que el bg c, por lo que consideramos y ofrecemos al bgl como técnica ideal en el tratamiento de los pacientes con obesidad mórbida.

Complicaciones del bypass gástrico convencional y laparoscópico. Estudio prospectivo y comparativo / [Complications of conventional and laparoscopic gastric bypass. Prospective and comparative study].

BACKGROUND: Roux-en-y gastric bypass for the management of morbid obesity is currently the safest and more efficient treatment option. the laparoscopic era has shown its benefits in this type of surgery, so some authors advocate its implementation in a practical systematic way. all of which has lead in recent years to the unavoidable change in the surgical approach. OBJECTIVES: To evaluate and compare the complications of laparoscopic gastric bypass and the conventional one in patients with morbid obesity. Application site: self-administration national university hospital. DESIGN: Comparative, prospective no randomized study. POPULATION: Between 2002 and 2011, 420 morbidly obese patients received surgical treatment for the obesity either open (167) or laparoscopic (253) surgery RESULTS: Early postoperative complication rate was 4

in the lbg and 34

in the cbg (p < 05, 95

ci 22-38), mostly represented by seromas (25

) and wall abscesses (5.4

). the percentage of late postoperative complications was 2.8

in the lbg group and 9.6

in the cbg (p=0.004, 95

ci 1.4-12.2), the most frequent being incisional hernias (7.18

). CONCLUSIONS: According to our experience and consulted literature, laparoscopic gastric bypass is a safe, reproducible and with a lower rate of both early and late complications than cbg, and so we consider and offer lbg as the ideal technique for the treatment of patients with morbid obesity.

Complicaciones del bypass gástrico convencional y laparoscópico. Estudio prospectivo y comparativo. / [Complications of conventional and laparoscopic gastric bypass. Prospective and comparative study].

BACKGROUND: Roux-en-y gastric bypass for the management of morbid obesity is currently the safest and more efficient treatment option. the laparoscopic era has shown its benefits in this type of surgery, so some authors advocate its implementation in a practical systematic way. all of which has lead in recent years to the unavoidable change in the surgical approach. OBJECTIVES: To evaluate and compare the complications of laparoscopic gastric bypass and the conventional one in patients with morbid obesity. Application site: self-administration national university hospital. DESIGN: Comparative, prospective no randomized study. POPULATION: Between 2002 and 2011, 420 morbidly obese patients received surgical treatment for the obesity either open (167) or laparoscopic (253) surgery RESULTS: Early postoperative complication rate was 4

in the lbg and 34

in the cbg (p < 05, 95

ci 22-38), mostly represented by seromas (25

) and wall abscesses (5.4

). the percentage of late postoperative complications was 2.8

in the lbg group and 9.6

in the cbg (p=0.004, 95

ci 1.4-12.2), the most frequent being incisional hernias (7.18

). CONCLUSIONS: According to our experience and consulted literature, laparoscopic gastric bypass is a safe, reproducible and with a lower rate of both early and late complications than cbg, and so we consider and offer lbg as the ideal technique for the treatment of patients with morbid obesity.