información del artículo Historia del artículo: Recibido el 13 de marzo de 2014 Aceptado el 23 de abril de 2014 On-line el 12 de junio de 2014 Palabras clave: Neumoperitoneo Hernia gigante Tratamiento protésico r e s u m e n Objetivo: Valoración de las posibles ventajas del neumoperitoneo preoperatorio en el manejo de las hernias inguinales gigantes. Material y métodos: Estudio prospectivo mediante el seguimiento de 2 casos clínicos de hernias inguinoescrotales gigantes que requirieron neumoperitoneo preoperatorio en nuestro centro, desde octubre de 2013 hasta marzo de 2014.Resultados: Durante los últimos 5 meses, en nuestro centro se han diagnosticado 2 hernias inguinoescrotales gigantes candidatas a neumoperitoneo preoperatorio. Se trataba de 2 varones con una edad media de 60.5 años (55-66). Ninguno presentaba clínica relevante, y acudieron a consultas externas derivados por otros especialistas. En uno de los pacientes la hernia era bilateral, y en el otro, unilateral. Como prueba de imagen preoperatoria se realizó una tomografía computarizada en ambos casos.Los pacientes ingresaron una semana antes de la intervención (rango: 6-8 días) para efectuar un neumoperitoneo preoperatorio mediante la colocación de aguja de Verres, con insuflación diaria de aire ambiente (entre 240-1 000 cc).En ambos casos se realizó como técnica de reparación una hernioplastia con abordaje posterior preperitoneal mediante laparotomía media. Destacó el íleo paralítico como complicación inmediata (2-4 días). La estancia media posoperatoria fue de 17.5 días (15-20 días).Se realizó un mes de seguimiento posquirúrgico, sin que se evidenciaran complicaciones.Únicamente habría que destacar la falta de reducción de tamaño de la bolsa escrotal.Conclusiones: El neumoperitoneo progresivo preoperatorio favorece la reparación de hernias inguinoescrotales gigantes con pérdida de derecho a domicilio. Se trata de un procedimiento seguro y reproducible, con bajo índice de complicaciones y alta tolerabilidad por parte del paciente.
The object of this study was to analyse the results of laparoscopic cholecystectomy (LC) without previous endoscopic retrograde cholangiopancreatography (ERCP) in mild acute biliary pancreatitis (ABP) patients once the acute attack had resolved. Seventy-six patients were operated on after a recent episode of mild ABP, as determined by the presence of three or less positive Ranson-lmrie criteria (ABP-Group). Depending on the proximity of LC to the ABP attack, the ABP-Group was further divided into two subgroups. Forty patients were operated on during the first 2 weeks after the onset of pancreatic symptoms (early-LC subgroup), and 36 were operated on between 16 and 60 days (delayed-LC subgroup). The results are compared with 41 1 patients who underwent LC for uncomplicated cholelithiasis (Control-Group) during the same period. The operative time and incidence of common bile duct stones were significantly superior in the ABP-Group (p
Introduction: Obesity and associated diseases represent an important health and economic problem since pharmacological treatment for many of these pathologies needs lifelong subsidies. Theoretically, bariatric and metabolic surgery decreases the medication requirements of patients for these diseases but may result in other types of pharmacological needs. This study aims to demonstrate whether there is a real decrease in pharmacological expenditure after bariatric surgery. Material and methods: Retrospective cross-sectional analysis of patients who were treated in our centre between 2012 and 2015, comparing different associated comorbidities and pharmacological expenses one month before and 2 years after surgery. Results: A total of 280 patients underwent surgery; 36.8% of patients had diabetes, 50% hypertension, 11.1% cardiovascular disease, 13.9% osteoarticular disease, 13.6% endocrine disorders, 30% non-diabetic metabolic disorders, and 35.4% psychiatric disease. At 2 years after surgery, 12.1% of patients continued medication for diabetes, and 28.2% for arterial hypertension. Additionally, 9.3% of patients still had cardiovascular disease, 7.1% osteoarticular disease, 10.4% endocrine disorder, 13.9% non-diabetic metabolic disorder, and 29.3% psychiatric disease. Median pharmacological expenditure before surgery was 17 euros per month; 2 years after surgery, it was 12 euros a month, resulting in a significant decrease (p<0.001). 2 Conclusions: In a 2-year follow-up after bariatric surgery, a decreased prevalence of obesity-related diseases and associated pharmacological expenditure was observed, showing the efficiency of this intervention over the medium term and potentially over the long term.
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