Bernabé M. Quesada

Minimally Invasive Management of Acute Biliary Tract Disease during Pregnancy

Background. Acute biliary diseases during pregnancy have been classically managed conservatively. Advances in minimally invasive surgery and the high recurrence rate of symptoms observed changed this management. Methods. This is a prospective observational study. Initial management was medical. Unresponsive patients were treated with minimally invasive techniques including gallbladder percutaneous aspiration or cholecystostomy, endoscopic retrograde cholangiography, and laparoscopic cholecystectomy, depending on the pregnancy trimester and underlying diagnosis. Results. 122 patients were admitted. 69 (56.5%) were unresponsive to medical treatment. Recurrent gallbladder colic was the most frequent indication for minimally invasive intervention, followed by acute cholecystitis, choledocholithiasis, and acute biliary pancreatitis. 8 patients were treated during the first trimester, 54 during the second, and 7 during the last trimester. There was no fetal morbidity or mortality. Maternal morbidity was minor with no mortality. Conclusion. Acute biliary tract diseases during pregnancy may be safely treated with minimally invasive procedures according to the underlying diagnosis and to the trimester of pregnancy.

Closure of a contained open abdomen using a bipedicled myofascial oblique rectus abdominis flap technique

A contained open abdomen is commonly used during damage control laparotomy and consists of the temporary coverage of the abdomen for protection of the viscera and reduction of intra-abdominal pressure. Definitive closure of a contained open abdomen is technically difficult due to the inability to obtain primary fascial suture. The insertion of a prosthetic mesh can be complicated with enterocutaneous fistula, and other definitive closure techniques need several surgical procedures. We describe a low cost technique that allows definitive closure of large abdominal wall defects avoiding the risk of intestinal fistula.

Tratamiento de la coledocolitiasis en un tiempo por videolaparoscopia. Análisis de 10 años de experiencia

Resumen Introduccion El manejo de los pacientes con litiasis vesicular y coledociana plantea controversias. El tratamiento en uno o en dos tiempos son las principales opciones. Material y metodo Analisis retrospectivo de la experiencia de 10 anos en el tratamiento en un tiempo de la coledocolitiasis en un centro terciario de alto volumen. Resultados Se trato inicialmente por laparoscopia a 569 pacientes; se resolvieron con un abordaje transcistico 412 (76,3%); mediante coledocotomia laparoscopica, 128 (23,7%) y se convertio a cirugia abierta a 29 (5%). La morbilidad y la mortalidad general fueron del 2,46 y el 0,52%, respectivamente. Conclusiones En centros de alto volumen el tratamiento en un tiempo y por laparoscopia de la coledocolitiasis es factible y seguro, con una alta proporcion de pacientes que solo necesitan de un abordaje transcistico.