Cirugía con ingreso y ambulatoria: Tasas de infección en cirugía limpia / Rate of infection in clean prcedures in ambulatory surgery and patients with saty in the hospital

INTRODUCCIÓN. La cirugía mayor ambulatoria (CMA) es un modelo asistencial que permite tratar a un grupo de pacientes seleccionados, obteniendo la misma efectividad en la intervención quirúrgica sin necesidad de hospitalización. MATERIAL Y MÉTODOS. Se estudiaron 843 pacientes mediante un estudio prospectivo desde octubre de 2.000 hasta marzo de 2.005, analizando los factores de riesgo, tipos de patologías y técnicas realizadas, así como distintos aspectos relacionados con la cirugía. Realizamos una comparación entre los datos obtenidos de los pacientes sometidos a CMA y aquellos que estuvieron ingresados más de 24 horas. RESULTADOS. En ambos grupos de pacientes la patología más prevalente fue la hernia inguinal (44´5% del total de la CMA y 46´6% de la cirugía con ingreso). En los pacientes ingresados la tasa de infección fue del 2´3%, mientras que no hubo ninguna infección en la CMA. En ambos grupos se realizó un seguimiento de los pacientes durante los 30 días siguientes a la intervención quirúrgica. CONCLUSIONES. la CMA se relaciona con una menor tasa de infección de la herida, menor morbi-mortalidad, así como con una reducción de las estancia (AU)

INTRODUCTION. The ambulatory greater surgery (CMA) is a welfare model that allows to deal with a group selected patients, obtaining the same effectiveness in the operation with no need of hospitalization. MATERIAL AND METHODS. 843 patients by means of a prospective study studied from October of 2,000 to March of 2.005, analyzing the factors of risk, types of pathologies and made techniques, as well as different aspects related to the surgery. We made a comparison between the collected data of the patients submissive CMA and those that were entered more than 24 hours. RESULTS. In both groups of patients the prevalent pathology was hernia inguinal (44´5% of the total of CMA and 46´6% of the surgery with entrance). In the entered patients the rate of infection was of 2´3%, whereas there was no infection in the CMA. In both groups a pursuit of the patients was made during the 30 following days to the operation. CONCLUSIONS. the CMA is related to a smaller rate of infection of the wound, minor morbi-mortality, as well as with a reduction of the stay (AU)

Fístula pancreaticobronquial como primera manifestación de seudoquistes pancreáticos / Pancreaticobronchial fistula as the first manifestation of pancreatic pseudocysts

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Reoperations after choledochoduodenostomy: a new approach.

Reoperation after choledochoduodenostomy was performed in seven cases. Stenosis of the anastomosis, bile duct stones, cholangitis and stump syndrome were found in five cases. In the first two cases, disconnection of the choledochoduodenostomy and sphincteroplasty were performed: one patient died of duodenal leakage. In the third case, retrograde sphincteroplasty was performed with lethal failure. In the following four cases, a new approach which consisted of antropyloroduodenotomy, catheter guided sphincteroplasty, extraction of stones and debris, and reconstruction with a Finney gastroduodenostomy was used. Endoluminal suture of previous choledochoduodenostomy was also performed in three cases and vagotomy in two. This approach resulted in no mortality and the results were excellent in all cases. The patients were followed up for from nine months to three and a half years. The authors found this endoluminal approach an easier and safer surgical procedure.