Alex Escalona P

Endocarditis infecciosa: análisis de 261 casos y resultados del tratamiento con un enfoque multidisciplinario

Background: Early diagnosis, an effective treatment and prompt recognition of complications are essential to improve the prognosis of infective endocarditis (IE) Aim: To report the results of a multidisciplinary approach to diagnosis and management of patients with IE at the Universidad Catolica de Chile Hospital. Patients and methods: The clinical history, diagnosis, treatment and outcome of 261 episodes (Duke criteria) of IE admitted between January 1980 and January 1999 were analyzed. These included 185 episodes of native, 73 of prosthetic valve and 3 of nonvalvular IE. Results: Sixty nine percent of patients were men and the mean age was 49 ± 16 years. Seventy five percent had a definite diagnosis of IE (Duke). S. viridans, staphylococci and enterococci together constituted 85% of the isolated bacterial strains. Twenty seven had culture-negative IE, related to a high incidence of antibiotic therapy prior to diagnosis. Transesophageal echocardiography was performed in 102 cases and it detected vegetations in 91% of aortic and 96% of mitral IE, rupture or prosthesis dehiscence in 67% of aortic and 52% of mitral IE and abscesses in 51% of aortic and 15% of mitral IE. Fifty one percent developed heart failure and 34% had embolic events. S. aureus IE was associated to a higher incidence of embolic events, complications which contraindicated surgery and increased mortality rate (27%). Of all patients, 40% were treated exclusively with antibiotics, 52% were operated on and 8% had surgical indication but were nonoperable because of serious complications. The overall mortality was 16.3%: 13% in the medical, 9% in the surgical and 81% in the non-operable groups. The type of treatment and mortality rates did not differ between IE of native valves and prosthetic valves. Long term follow up showed survival rates of 73% at 5 years and 66% at 10 years. Conclusion: A multidisciplinary approach may be very helpful to improve the prognosis of IE. (Rev Med Chile 2000; 128: 708-20).

Colecistectomía laparoscópica: experiencia de 10 años en la Pontificia Universidad Católica de Chile

RESUMENLa colecistectomia laparoscopica es actualmente el tratamiento de eleccion de la colelitiasis.Nuestro hospital es un centro docente donde cirujanos en formacion junto a sus docentes han participadoactivamente en el desarrollo de esta tecnica desde su inicio en mayo de 1991. El objetivo de este estudioes comunicar la experiencia de 10 anos con esta tecnica en el Hospital Clinico de la Pontificia UniversidadCatolica de Chile. Se revisaron las fichas clinicas de los pacientes sometidos a colecistectomialaparoscopica desde mayo de 1991 a mayo de 2001. Se registraron los datos demograficos de cadapaciente, presentacion clinica, examenes de laboratorio y radiologicos. Se analizo la informacion tecnicadel procedimiento a estudiar y la evolucion postoperatoria precoz. La serie se compone de 5063 pacien-tes. La edad promedio fue de 46 anos (7 a 88 anos), 3392 de ellos mujeres (67%). El 75% de los pacientesingreso en forma electiva y el 25% de urgencia. El tiempo operatorio promedio fue de 73 min. Se realizoconversion a cirugia abierta en 7% de los pacientes siendo los factores de conversion mas importantesla edad avanzada y la presencia de colecistitis aguda. La estadia postoperatoria promedio fue de 2,9 dias.Complicaciones post operatorias se observaron en el 2%. 0,2% de los pacientes de esta serie necesitaronser reintervenidos. La mortalidad operatoria fue de 0,02%. La colecistectomia laparoscopica demuestraen este estudio ser una forma de tratamiento seguro y efectivo en pacientes con colelitiasis.PALABRAS CLAVE: Colelitiasis, colecistectomia laparoscopica, complicaciones, mortalidad.SUMMARYLaparoscopic cholecystectomy is at present the gold standard for the treatment of gallstones disease.Since May 1991 this technique has been developed at the Hospital Clinico Pontificia Universidad Catolicade Chile in patients under the care of staff surgeons of the Digestive Surgery Department who have beenactively involved in post graduate surgical training. The purpose of this study is to communicate theexperience in 10 years with this technique in our institution. Clinical charts were reviewed of those patientswho underwent laparoscopic cholecystectomy since May 1991 until May 2001. Patient’s demographic data

Pólipos vesiculares: correlación entre hallazgos ecográficos e histopatológicos

BACKGROUND Gallbladder polyps are becoming a common finding. The management of these polyps is complicated considering that they can bear malignant lesions. AIM To analyze the ultrasonographic and histopathologic findings of patients operated due to gallbladder polyps. PATIENTS AND METHODS The records of patients with ultrasonographic diagnosis of gallbladder polyp and that underwent cholecystectomy in a thirteen years period were reviewed, collecting their demographic, ultrasonographic and histopathological data. RESULTS One hundred and twenty three patients were operated. The mean age was 44+/-13 years, and 69% were women. The mean size of polyps in ultrasonography was 7.3+/-5 mm. Histopathology confirmed the presence of polyps in 79% of patients, with a mean size and number of lesions of 5.1+/-3.8 mm and 2.1+/-2, respectively. Nine percent of polyps were greater than 10 mm, and single polyps were significantly larger than the multiple ones (p =0.003). Four cases of adenoma (3.2%) were diagnosed; one of them had in situ carcinoma. All were single and larger than 10 mm. We found a significant correlation between ultrasonographic and histopathological polyp size determination (r =0.47; p =0.002). Polyp size was also a predictor of the presence of adenoma (p =0.043; confidence intervals: 1.006-1.424). CONCLUSIONS There is a good correlation between the size of the gallbladder polyp in ultrasonography and the size in the histopathology report. Gallbladder adenoma is uncommon and it correlates with the size of the polyp. In this series, size was the only predictor of the presence of adenoma.

Pancreatoduodenectomía totalmente laparoscópica: Técnica quirúrgica y experiencia inicial*

Abstract Totally laparoscopic pancreaticoduodenectomy: Surgical technique and initialexperience Introduction: Nowadays the utility of laparoscopic pancreatic surgery is accepted for a wide varietyof indications. However pancreaticoduodenectomy has been considered beyond the possibilities oflaparoscopy by the majority of surgeons. The objective of this report is to show our surgical techniqueand initial experience with totally laparoscopic pancreaticoduodenectomy. Material and Methods: Betweennovember of 2007 and june of 2008, a laparoscopic technique was offered to patients with indication ofpancreaticoduodenectomy for different pathologies. We describe the surgical technique, perioperativecare, intraoperative complications, need for conversion to open technique, mortality, and early postoperativecomplications. Results: A total of three patients were subjected to laparoscopic pancreaticoduodenectomy.The surgical indication was an ampullar adenocarcinoma in a 52 years old woman, a pseudopapilar tumor ofthe pancreatic head in a 17 years old woman, and a duodenal gastrointestinal stromal tumor in a 63 yearsold man. There was no need for conversion to open technique. There was no mortality. The operative timeranged from 300 to 360 min. The first patient presented an upper gastrointestinal bleeding, from pancreaticanastomoses requiring surgical hemostasis. The last patient developed a self-limited biliary fistula, managedsuccessfully with drains. The hospital stay varied from 8 to 25 days.

HERNIA DIAFRAGMATICA TRAUMATICA COMPLICADA: PRESENTACION COMO ILEO MECANICO DE COLON

: Las lesiones traumaticas del diafragma son consecuencia conocida de un trauma grave, gene-ralmente de tipo contuso. Su incidencia ha aumentado debido al crecimiento en numero y severidad de los accidentes, en especial del transito. Su diagnostico continua siendo un desafio para cirujanos y radiologos, diagnosticandose tardiamente hasta en mas de la mitad de los casos, dejando una hernia diafragmatica latente, que puede manifestarse con sintomas que varian desde inespecificos hasta la estrangulacion de un asa intestinal. Se presenta el caso de un paciente con obstruccion intestinal de colon secundaria a una hernia diafragmatica traumatica atascada, con historia de un traumatismo penetrante toracoabdominal ocurrido siete anos antes. Se revisan los metodos y signos radiologicos de mayor utilidad para el diagnostico de esta patologia

Necrosectomía laparoscópica en pancreatitis aguda

Laparoscopic necrosectomy in severe pancreatitis. Retrospective analysis of 11 patients Background: Laparoscopic surgery can be used in the treatment of severe acute pancreatitis. Aim: To report the experience with laparoscopic necrosectomy and abscess drainage in severe acute pancreatitis. Material and Methods: Retrospective analysis of medical records of 11 patients aged 13 to 78 years (10 males), with severe pancreatitis, subjected to laparoscopic necrosectomy or abscess drainage between 2006 and 2009. Results: Operative time ranged from 110 to 205 min. In all cases, a satisfactory necrosectomy and collection drainage were performed. No complications were recorded and no patient required to be converted to open surgery. Five patients were reoperated. In three of these, the laparoscopic approach was used again. Conclusions: Laparoscopic necrosectomy is safe and useful for patients with severe pancreatitis.

Complicaciones quirúrgicas en bypass gástrico laparoscópico

El bypass gastrico laparoscopico es actualmente una de las alternativas de eleccion en el tratamiento quirurgico de la obesidad morbida. El objetivo de este estudio es evaluar el tratamiento y resultado de las complicaciones quirurgicas en pacientes sometidos a bypass gastrico laparoscopico en nuestra institucion. La informacion se obtuvo de la base de datos prospectiva de todos los pacientes sometidos a este procedimiento desde agosto de 2001 a marzo de 2005. En este periodo so operaron 641 pacientes. La edad promedio fue de 37 ± 11 anos, y el 76 % de los pacientes fueron de sexo femenino. El indice de masa corporal (IMC) promedio fue de 42 ± 15 (Kg/m2). Hipertension arterial, diabetes mellitus tipo II y dislipidemia presentaban en el preoperatorio el 30, 12 y 48% de los pacientes respectivamente. Conversion a cirugia abierta fue necesaria en 10 pacientes (1,56%). El tiempo operatorio promedio fue de 118 ± 49 minutos. La estadia hospitalaria promedio fue de 4 ± 3 dias. Complicaciones postoperatorias se observaron en 57 pacientes (8,9%). Dieciseis de ellos (2,5%) fueron reoperados. No hubo mortalidad postoperatoria. El bypass gastrico laparoscopico es una buena alternativa de tratamiento quirurgico de la obesidad morbida

Dispositivo endoscópico duodeno yeyunal restrictivo en pacientes obesos mórbidos, experiencia inicial en humanos

Initial human experience with a restrictive, duodenal-jejunal by-pass liner for the treatment of morbid obesity Background: The EndoBarrier TM Gastrointestinal Liner creates an endoscopic duodenal-jejunal bypass leading to weight loss in morbidly obese patients. Aim: To evaluate the safety and effi cacy of the EndoBarri- er TM with a 4 mm restrictor in morbidly obese patients. Material and Methods: Ten obese patients aged 18 to 54 years (eight women) with a body mass index (BMI) ranging from 35.8 to 45 kg/m 2 were enrolled. Patients were followed for 12 weeks after the placement of the device, when it was removed. Outcomes measured were percent excess weight loss (%EWL), minor and major adverse events. Results: The mean implant time was 33 ± 4 minutes with a mean fl uoroscopy time of 14.8 ± 3 minutes. There were no major adverse events. Periodic episodes of nausea and vomiting lead to the endoscopic dilation of the restrictor hole with a 6 mm balloon between 2nd and 8th weeks in seven patients (70%). One subject required a second dilation with a 10 mm balloon. The device was endoscopically removed at the 12 th week in all patients. The mean removal time was 47 ± 53.8 minutes (range 10-155 minutes). At week 12, BMI decreased from 40 ± 3.9 to 34.5 ± 3.1 kg/m 2 , and %EWL was 39.8% (range, 21.7% - 65.3%). The mean total weight loss was 16.7 ± 4.4 kg. Conclusions: The EndoBarrier TM Gastrointestinal Liner with the addition of a duodenal restrictor is a safe

Reseccion hepática laparoscópica en modelo porcino: Desarrollo de un modelo experimental

Resumen es: Introduccion: La segmentectomia lateral izquierda (SL) (segmentos II y III de Couinaud) es la reseccion hepatica mas frecuentemente realizada por via lap...

Gastrectomía laparoscópica en cancer gástrico

Introduccion: La cirugia laparoscopica ha sido incorporada como una alternativa de tratamiento curativo en cancer gastrico. El objetivo de este estudio es evaluar los resultados quirurgicos inmediatos de pacientes sometidos a gastrectomia laparoscopica por cancer gastrico incipiente e intermedio en el Hospital Clinico de la Pontificia Universidad Catolica de Chile y en el Hospital Dr. Sotero del Rio. Material y metodo: Se incluyen todos los pacientes sometidos a gastrectomia laparoscopica por cancer gastrico incipiente e intermedio (T1 - T2) en ambas instituciones. Resultados: Desde Mayo de 2005 a Diciembre del 2006, 13 pacientes fueron sometidos a gastrectomia laparoscopica, 9 hombres (70 %). Edad promedio 62+ 12 anos. El tiempo operatorio promedio fue 293 + 51 minutos, la estadia hospitalaria 7,3 + 2,8 dias. No hubo complicaciones quirurgicas. El promedio de ganglios resecados fue de 27 + 18. De acuerdo a la clasificacion TNM-AJCC, 9 pacientes se encontraban en etapa IA y 4 en etapa IB. Discusion: La gastrectomia laparoscopica es una alternativa segura en el tratamiento quirurgico del cancer gastrico incipiente e intermedio