International Delphi Expert Consensus on Safe Return to Surgical and Endoscopic Practice: From the Coronavirus Global Surgical Collaborative.

OBJECTIVE: The aim of this work is to formulate recommendations based on global expert consensus to guide the surgical community on the safe resumption of surgical and endoscopic activities. BACKGROUND: The COVID-19 pandemic has caused marked disruptions in the delivery of surgical care worldwide. A thoughtful, structured approach to resuming surgical services is necessary as the impact of COVID-19 becomes better controlled. The Coronavirus Global Surgical Collaborative sought to formulate, through rigorous scientific methodology, consensus-based recommendations in collaboration with a multidisciplinary group of international experts and policymakers. METHODS: Recommendations were developed following a Delphi process. Domain topics were formulated and subsequently subdivided into questions pertinent to different aspects of surgical care in the COVID-19 crisis. Forty-four experts from 15 countries across 4 continents drafted statements based on the specific questions. Anonymous Delphi voting on the statements was performed in 2 rounds, as well as in a telepresence meeting. RESULTS: One hundred statements were formulated across 10 domains. The statements addressed terminology, impact on procedural services, patient/staff safety, managing a backlog of surgeries, methods to restart and sustain surgical services, education, and research. Eighty-three of the statements were approved during the first round of Delphi voting, and 11 during the second round. A final telepresence meeting and discussion yielded acceptance of 5 other statements. CONCLUSIONS: The Delphi process resulted in 99 recommendations. These consensus statements provide expert guidance, based on scientific methodology, for the safe resumption of surgical activities during the COVID-19 pandemic.

Role of Female Research at the Asociacion Mexicana de Cirugia General Annual Meeting: A Retrospective Analysis From 2013 to 2019.

Background: Academic surgery has been a traditionally male-dominated field. Female contribution remains challenging. In Mexico, there is no published evidence regarding gender disparity in academic surgery. We aimed to analyze the female role in clinical research submitted to the Asociación Mexicana de Cirugía General (AMCG). Methods: Retrospective study evaluating abstracts submitted to AMCG annual meetings from 2013 to 2019. Categorical variables were compared using χ2 test. Univariate logistic regression was performed to calculate odds ratios (OR) followed by a log-binomial logistic regression model to obtain the adjusted relative risk (aRR) for acceptance as an oral presentation. Results: Overall, 7,439 abstracts were analyzed of which 24.2% were submitted by females. Female-submitted abstracts increased from 22.5% to 25.3% during 2013-2019 (p = 0.15). The proportion of 47 abstracts submitted by females was higher in the resident group (27.7% vs. 18.8%; p < 0.001). The percentage of females' abstracts selected for oral presentation was less than the percentage of males' 49 abstracts selected for presentation (9% vs. 11.5%; p = 0.002). Females' abstracts submitted have a 50 23.5% decreased chance of being selected for oral presentation (OR = 0.765, CI 95%, 0.639-0.917, 51 p = 0.003). However, after adjusting for research type and trainee status, the gender of the oral 52 presenting author showed no association (aRR = 0.95, CI 95%, 0.8-1.1, p = 0.56). Conclusion: In Mexico, the female role in academic surgery is still limited. These results should 55 encourage professors and program directors to identify and address factors contributing to gender 56 disparities.

[Jejunal diverticulitis causing an acute abdomen]. / Diverticulitis yeyunal como causa de abdomen agudo.

Jejunal diverticulosis is a rare acquired-disease which courses asymptomatic in most cases. In spite of the fact that there are some publications of this entity in pediatric patients, most symptomatic cases have been found in adults. Reported herein is the case of a patient that presented to the emergency room with signs and symptoms suggestive of an acute abdomen. After diagnostic workup and operative management, presence and complications of a jejunal diverticulum were found to be the cause of the abdominal pain.

Laparoscopic resection of gastric schwannoma: A case report.

INTRODUCTION: Gastric schwannomas are an extremely rare presentation of mesenchymal tumors originating from Schwann cells, accounting for 0.2% of all gastric tumors. Patients are usually asymptomatic, so these tumors are frequently detected incidentally. PRESENTATION OF CASE: 68-year old male patient found to have a 5 cm mass in the lesser curvature of the stomach. After a careful preoperative evaluation, complete laparoscopic resection was performed. Pathology review confirmed a completely resected gastric Schwannoma. The patient's recovery was uneventful. At a one-year follow-up he remains asymptomatic and with no evidence of disease. DISCUSSION: We present the uncommon case of a gastric schwannoma that was appropriately treated with a laparoscopic approach and present a current literature review focusing on diagnostic and treatment methods of these rare tumors. CONCLUSION: Schwannomas should be included in the differential diagnosis of gastric tumors and can be appropriately treated with a laparoscopic approach.

[Jejunal angiodysplasia as a cause of obscure gastrointestinal bleeding]. / Angiodisplasia yeyunal como causa de sangrado de origen desconocido.

BACKGROUND: Obscure gastrointestinal bleeding secondary to jejunal angiodysplasia is uncommon. Diagnostic approach is difficult and represents a challenge for the surgeon because of the inaccessibility of the small bowel for evaluation. When the diagnostic work-up has been completed and the bleeding source has not been found, it is mandatory to perform a surgical exploration with transoperative enteroscopy in order to locate the source of the hemorrhage and for further treatment. CASE REPORT: We report the case of a 24-year-old male with massive gastrointestinal bleeding secondary to jejunal angiodysplasia in whom an intraoperative enteroscopy was done to locate the source of bleeding and subsequently resect the affected small bowel. There are actually some non-surgical therapies for patients with high risk of complications. When patients' conditions are optimal, surgical resection is mandatory to avoid recurrence of future bleeding.

Angiodisplasia yeyunal como causa de sangrado de origen desconocido / Jejunal angiodysplasia as a cause of obscure gastrointestinal bleeding

BACKGROUND: Obscure gastrointestinal bleeding secondary to jejunal angiodysplasia is uncommon. Diagnostic approach is difficult and represents a challenge for the surgeon because of the inaccessibility of the small bowel for evaluation. When the diagnostic work-up has been completed and the bleeding source has not been found, it is mandatory to perform a surgical exploration with transoperative enteroscopy in order to locate the source of the hemorrhage and for further treatment. CASE REPORT: We report the case of a 24-year-old male with massive gastrointestinal bleeding secondary to jejunal angiodysplasia in whom an intraoperative enteroscopy was done to locate the source of bleeding and subsequently resect the affected small bowel. There are actually some non-surgical therapies for patients with high risk of complications. When patients' conditions are optimal, surgical resection is mandatory to avoid recurrence of future bleeding.

Mesenteritis esclerosante: Una enfermedad de apariencia maligna / Sclerosing mesenteritis: a disease of malignant appearance

La mesenteritis esclerosante es una enfermedad rara, de etiología desconocida, y que a pesar de su frecuente apariencia neoplásica, es benigna. En el pasado se ha utilizado múltiples términos para referirse a esta entidad que tiene una presentación clínica variable y se caracteriza morfológicamente por un engrosamiento del mesenterio. Actualmente existe poca información acerca de su epidemiología, historia natural y respuesta al tratamiento. A continuación se presenta una revisión de la literautra y se discuten brevemente conceptos relevantes para el diagnóstico y tratamiento de paciente con mesenteritis esclerosante

Carcinoma gástrico en pacientes menores de 35 años / Gastric carcinoma in patients under 35 years old of age

Objetivo. Describir la frecuencia, tipo de presentación tratamiento y pronóstico de los pacientes menores de 35 años con carcinoma gástrico en nuestro medio. Sede. Hospital de Especialidades, Centro Médico Nacional Siglo XXI IMSS, México DF (Hospital de referencia de tercer nivel). Material y métodos. Revisión de los expedientes de pacientes menores de 35 años con diagnóstico de carcinoma gástrico, tratados en el Servicio de Cirugía, entre enero de 1986 y junio de 1990. Seguimiento en la consulta externa hasta enero de 1998 o la muerte del enfermo. Resultados. Se identificaron a 11 enfermos menores de 35 años que representaron 13.7 por ciento de 80 enfermos con cáncer gástrico tratados durante un lapso de cuatro años y medio en nuestro hospital. Los pacientes del sexo femenino fueron afectados con mayor frecuencia, con una relación de 1.7 a 1. Un solo caso correspondió al estadio II (9.0 por ciento) y los 10 restantes se presentaron en estadio III o IV. Se efectuaron cinco resecciones gástricas, una gastroenterostomía paliativa, tres laparotomías exploradoras y dos enfermos no fueron intervenidos. De acuerdo con la clasificación de Lauren, 10 casos fueron adenocarcinomas difusos y uno intestinal. La mediana de supervivencia fue de 15.3 meses, y en este momento sólo vive una paciente libre de enfermedad. Conclusiones. En nuestra serie adenocarcinoma gástrico en menores de 35 años es frecuente, se diagnóstica en forma tardía y por ende, tiene muy mal pronóstico

Estenosis benigna de la vía biliar, secundaria a yatrogenia: tratamiento quirúrgico con sonda trans-hepática, experiencia en el Centro Médico Nacional Siglo XXI / Handling of beningn strictures of the biliary tract with transhepatic tubes

Objetivo: informar la experiencia en el tratamiento de las estenosis benignas de las vías biliares con el empleo de sonda transhepática y anatomosis entre la mucosa intestinal y el endotelio biliar, sin sutura. Diseño: Estudio retrospectivo, longitudinal, observacional, sin grupo control. Sede: Servicio de Gastro-Cirugía del Hospital de Especialidades del Centro Médico Nacional Siglo XXI del IMSS en el D.F. Pacientes: Se estudiaron 33 enfermos, 23 mujeres y 10 varones con edad promedio de 44.6 años, veinte de ellos operados en una ocasión, nueve en 2 y 3 en cuatro. La causa de la lesión yatrógena de la vía biliar fue: colecistectomía en el 67 por ciento (22 pacientes); en 15 enfermos la lesión no se detectó en forma inmediata, en 5 sí. Trece pacientes fueron sometidos a una segunda o tercera operación. Resultados: El sitio de la estenosis se localizó en los conductos hepáticos en 12 sujetos (36 por ciento), en el sitio de la primera anastomosis en 11 (33 por ciento) no se pudo determinar en 9 (27 por ciento). Los procedimientos quirúrgicos para resolver la yatrogenia fueron los siguientes: dilatación de la anastomosis en 4 enfermos, exploración de la vía biliar en 2, hepático-yeyuno-anastomosis en Y de Roux en 3, hepático-yeyuno-anastomosis en Y-Roux con ferulación con sonda transhepática en 13, colocación de sondas transhepáticas en 6 y colocación de guías de nylon en 3. Los pacientes fueron observados por un lapso de 4 semanas en el post-operatorio con un 86.3 por ciento de buenos resultados.