Bile duct injury, experience from 3 years in a tertiary referral center.

OBJECTIVE: The main goal of this research is to determinate the epidemiological characteristics and the experience in the management of patients with the diagnosis of bile duct injury, referred to the Unidad Médica de Alta Especialidad, Centro Médico Nacional Siglo XXI, in the gastrointestinal surgery service and its comparison with the statistics reported worldwide. METHOD: It is a retrospective, observational, descriptive study. The data analysis was performed with the IBM SPSS 26 software platform. Measures of central tendency and dispersion were applied. The Fisher's exact test was used for categorical variables. Statistical significance is accepted if p < 0.05. RESULTS: 70 patients were included, between the period of January 1, 2017 to December 31, 2019. According to the Strasberg-Bismuth system, the distribution was: type A 15.7%, B 1.4%, C 0, D 7.1%, E1 1.4%, E2 21.4%, E3 32.9%, E4 18.6%, E5 1.4%. Management was predominantly surgical (78.3%). Two deaths were reported with a mortality of 2.9%, the registered morbidity was 37.1%. CONCLUSIONS: The referral to a specialized center for proper management is the key to a satisfactory recovery in this type of patients. Establishing protocols for prompt care will help reduce morbidity and mortality.

OBJETIVO: Conocer las características epidemiológicas y la experiencia en el manejo de pacientes con diagnóstico de lesión de vía biliar referidos a la Unidad Médica de Alta Especialidad, Centro Médico Nacional Siglo XXI, al servicio de gastrocirugía, y su comparación con la estadística mundial. MÉTODO: Estudio retrospectivo, observacional y descriptivo. El análisis de los datos se realizó con la plataforma de software IBM SPSS 26. Se aplicaron medidas de tendencia central y dispersión. La prueba exacta de Fisher se utilizó para variables categóricas. La significancia estadística se estableció como p < 0.05. RESULTADOS: Se incluyeron 70 pacientes entre el 1 de enero de 2017 y el 31 de diciembre de 2019. Según el sistema de Strasberg-Bismuth, la distribución por tipos fue: A 15.7%, B 1.4%, C 0%, D 7.1%, E1 1.4%, E2 21.4%, E3 32.9%, E4 18.6% y E5 1.4%. El manejo fue predominantemente quirúrgico (78.3%). Se reportaron dos decesos, con una mortalidad del 2.9%, así como una morbilidad del 37.1%. CONCLUSIONES: El envío a un centro especializado es esencial para el adecuado manejo en sus diferentes modalidades, así como para su recuperación satisfactoria. Establecer protocolos para la pronta atención reducirá la morbimortalidad en estos pacientes.

El papel del cirujano moderno como líder de los equipos de atención sanitaria: una revisión narrativa sobre una facultad ubicua, pero poco definida.

OBJECTIVE: The objective is to describe the role of leadership in the training of the general surgeon and to point out its relevance. METHOD: A search of the medical literature was carried out to identify studies that reported on topics related to leadership in the context of medical education and surgery. We used the search engine of Medline/PubMed databases including related terms such as "leadership" AND "medicine" OR "surgery". RESULTS: Leadership is a valued characteristic in surgery, it implies professionalism, technical competence, motivation, innovation, teamwork, communication skills, decision making, emotional competence, resilience, and effective teaching. Leadership is measurable and can be developed through experience, observation, and education. CONCLUSIONS: Priority must be given to actions that improve leader traits. This has been shown to create a work environment where efficient work is performed, and failures are minimized. The current vision of the leader must be expanded to reduce the gender gap between the positions as leader occupy in this moment.

OBJETIVO: Describir el papel de liderazgo en la formación del cirujano general y puntualizar su relevancia en nuestro entorno. MÉTODO: Se realizó una búsqueda en la literatura médica para identificar estudios que informaran sobre temas relacionados al liderazgo en el contexto de la enseñanza médica y en cirugía. Se utilizó el motor de búsqueda de las bases de datos Medline/PubMed incluyendo términos relacionados como "leadership" AND "medicine" OR "surgery". RESULTADOS: El liderazgo es una característica valorada en cirugía, que implica profesionalismo, competencia técnica, motivación, innovación, trabajo en equipo, habilidades comunicativas, toma de decisiones, competencia emocional, resiliencia y enseñanza eficaz. Es medible y susceptible de desarrollarse a través de la experiencia, la observación y la educación. CONCLUSIONES: En la formación del cirujano general se deben priorizar las acciones que mejoren los rasgos de líder. Se ha demostrado que esto genera un ambiente de trabajo donde se realiza una labor eficiente y se minimizan las fallas. Se debe expandir la visión actual que se tiene de líder y permitir que se disminuya la brecha de género entre los puestos que hoy se ocupan.

Predictive value of preoperative serum C-reactive protein for recurrence after definitive surgical repair of enterocutaneous fistula.

BACKGROUND: Recurrence rates after surgical repair of enterocutaneous fistula (ECF) have not changed substantially. Serum C-reactive protein (s-CRP) has been used as an indicator of postoperative complications in abdominal surgery. ​ The aim of this study was to determine the predictive value of preoperative s-CRP for recurrence after definitive surgical repair of ECF. METHODS: Fifty consecutive patients with ECF persistence submitted electively to definitive surgical repair (ECF resection with primary anastomosis) were included. Among several variables, preoperative s-CRP (primary independent variable) was assessed as a factor related to recurrence (dependent variable). Univariate and multivariate analyses were performed. RESULTS: ECF recurred in 19 patients (38%). Univariate and multivariate analyses disclosed operative blood loss greater than 325 mL (P < .05) and preoperative s-CRP greater than .5 mg/dL (P < .01) as the only risk factors for recurrence. ECF recurrence rates were significantly higher for patients with preoperative s-CRP above this level (53% vs 11%, P < .01). After conservative and surgical management, overall ECF closure was attained in 40 patients (80%). CONCLUSIONS: Our results suggest that s-CRP may serve as a useful parameter to predict potential failure (recurrence) in patients submitted to definitive closure of ECF.

[Disseminated peritoneal hydatidosis manifested as intestinal ischaemia]. / Hidatidosis peritoneal diseminada manifestada como isquemia intestinal.

BACKGROUND: The hydatid disease, or echinococcosis, is endemic in Mediterranean countries, as well as in Australia, Asia, Africa, South America, and Canada. Among its complications is intraperitoneal rupture, a rare form of presentation, with highly variable symptoms. The treatment of choice is surgery plus adjuvant medical treatment in most patients. OBJECTIVE: A case is presented of a patient with disseminated peritoneal hydatidosis manifested as intestinal ischaemia. CLINICAL CASE: A 50-year-old male was admitted to the emergency room with a history of chronic abdominal pain that worsened in the last 24hours. He showed signs of sepsis in the physical examination and was subjected to surgery, in which intestinal ischaemia was found due to a disseminated peritoneal cystic disease, which had led to mesentery retraction. An intestinal resection with an end-ileostomy was performed. The results of the biopsy of the cystic lesions was disseminated peritoneal echinococcosis. Medical treatment was started with albendazole and praziquantel. CONCLUSION: This case shows a rare presentation of disseminated peritoneal hydatidosis, which led to intestinal ischaemia.