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Resumen: Introducción: El terreno del paciente con cirrosis que requiere una intervención quirúrgica ha sido poco explorado. En México, a la fecha no contamos con un posicionamiento formal o recomendaciones de expertos que ayuden a la toma de decisiones clínicas en este contexto. Objetivos: Revisar la evidencia existente sobre el riesgo, pronóstico, precauciones, cuidados especiales y manejo o proceder específico para los pacientes con cirrosis que requieren ser intervenidos quirúrgicamente o mediante procedimientos invasivos, para emitir recomendaciones por un panel experto, basadas en la mejor evidencia publicada para la atención oportuna, de calidad, eficiente y con el menor riesgo posible en este grupo específico de pacientes. Resultados: Se obtuvieron 27 recomendaciones, en donde se abordan el terreno preoperatorio, el escenario transoperatorio y el seguimiento y cuidados postoperatorios. Conclusiones: La valoración y el cuidado del paciente con cirrosis que requiere un procedimiento quirúrgico o invasivo mayor debe estar a cargo de un equipo multidisciplinario que brinde soporte al cirujano durante todo el perioperatorio; este equipo debe incluir al anestesiólogo, al hepatólogo, al gastroenterólogo y al nutriólogo clínico. En el paciente descompensado puede ser necesario involucrar especialistas en nefrología, ya que la función renal es un parámetro implicado también en el pronóstico de estos pacientes. Abstract: Introduction: Management of the patient with cirrhosis of the liver that requires surgical treatment has been relatively unexplored. In Mexico, there is currently no formal stance or expert recommendations to guide clinical decision-making in this context. Aims: The present position paper reviews the existing evidence on risks, prognoses, precautions, special care, and specific management or procedures for patients with cirrhosis that require surgical interventions or invasive procedures. Our aim is to provide recommendations by an expert panel, based on the best published evidence, and consequently ensure timely, quality, efficient, and low-risk care for this specific group of patients. Results: Twenty-seven recommendations were developed that address preoperative considerations, intraoperative settings, and postoperative follow-up and care. Conclusions: The assessment and care of patients with cirrhosis that require major surgical or invasive procedures should be overseen by a multidisciplinary team that includes the anesthesiologist, hepatologist, gastroenterologist, and clinical nutritionist. With respect to decompensated patients, a nephrology specialist may be required, given that kidney function is also a parameter involved in the prognosis of these patients.

Resumen: Introducción y objetivos: El cáncer colorrectal se encuentra dentro de los 3 primeros cánceres a nivel mundial, el conocimiento e identificación de los factores asociados a los desenlaces no óptimos permiten realizar un manejo integral del paciente. El objetivo de este estudio es presentar los resultados del manejo quirúrgico de enfermedad oncológica colo-rectal en un hospital universitario de cuarto nivel. Materiales y métodos: Se realizó un estudio observacional, analítico de corte transversal, se recolectó la información de una cohorte retrospectiva de pacientes con diagnóstico de cáncer colorrectal entre el año 2013 al año 2017 en el Hospital Universitario Mayor Méderi, Bogotá, Colombia. Resultados: Se recolectaron 452 pacientes durante el periodo de estudio, de estos el 48.5% fueron varones. El porcentaje global de complicaciones fue del 24%, infección del sitio operatorio (ISO) en el 15.38%, dehiscencia de la anastomosis en el 4.18%, sangrado que origina reintervención en el 1.32% y mortalidad intrahospitalaria en el 7.47%. Conclusión: El manejo del cáncer colorrectal en un hospital universitario mostró beneficios y resultados similares y comparables con otros tipos de hospitales con manejo frecuente de esta enfermedad, mostrando una asociación directa en disecciones completas R0, con bajas tasas de complicaciones según lo reportado a nivel mundial y disminución de morbilidad global. Abstract: Introduction and aims: Colorectal cancer is among the three most common cancers worldwide. Knowledge and identification of suboptimal outcome-associated factors enable comprehensive patient management. The aim of the present study was to present the results of the surgical management of colorectal cancer at a quaternary care university hospital. Materials and methods: An observational, analytic, cross-sectional study was conducted. Information was collected on a retrospective cohort of patients diagnosed with colorectal cancer from 2013 to 2017 at the Hospital Universitario Mayor Méderi, Bogotá, Colombia. Results: Data on 452 patients, within the study period, were collected. A total of 48.5% of the patients were men, the overall complication rate was 24%, the surgical site infection (SSI) rate was 15.38%, anastomotic dehiscence occurred in 4.18% of the patients, bleeding required reoperation in 1.32%, and the intrahospital mortality rate was 7.47%. Conclusion: Colorectal cancer management at a university hospital was as beneficial as that provided by other types of hospitals, showing a direct association with complete R0 dissections; low complication rates, according to international reports; and reduced overall morbidity.

In Brazil, surgical intervention in the treatment of dogs heavily infected by Dirofilaria nematode is an uncommon procedure. This is a technique where mechanical removal of the parasite is performed using plenty kinds of recovery tweezers. Removing Dirofilaria using recovery devices, such as grasping forceps, is an efficient and safe therapeutic alternative for treating dogs with a high load of this worm.

Se trataba de una paciente de 71 años de edad y aparente buen estado de salud anterior, quien sufrió un traumatismo abdominal cerrado a causa de un accidente doméstico (caída de sus pies), que lesionó el sigmoide y trastornó el paso de asas intestinales delgadas a través de él, de modo que estas se exteriorizaron por el ano. Fue intervenida con urgencia para reintroducirle las asas por el mismo trayecto de salida y suturar la lesión colónica. La paciente evolucionó favorablemente, comprobado en varias consultas posoperatorias.This is a 71 year-old patient with apparent previous good health state who suffered a blunt abdominal trauma due to a domestic accident (fall on her feet) which injured the sigmoid and it resulted in the passing of thin intestinal loops through it, so that these came out through the anus. She had a surgical emergency for reintroducing her loops through the same place and for suturing the colonic injury. The patient had a favorable clinical course and this was checked in several postoperative outpatient visits.

Se efectuó un estudio descriptivo y transversal para determinar la morbilidad y mortalidad por apendicitis aguda en el Hospital Integral Comunitario del municipio de Monteagudo de la República de Bolivia, desde agosto de 2006 hasta mayo de 2008. Entre los 55 pacientes operados predominaron: el sexo masculino, los menores de 15 años de edad y el estadio gangrenoso. La enfermedad de Chagas constituyó la afección asociada más frecuente y la infección de la herida quirúrgica devino la principal complicación. La mayoría de los integrantes de la serie recibieron anestesia espinal, fueron intervenidos entre 30 minutos y 1 hora y permanecieron hospitalizados entre 5 y 10 días. Hubo un fallecido por choque séptico.A descriptive and cross sectional study was carried out to determine the morbidity and mortality due to acute appendicitis in the Community General Hospital of Monteagudo municipality from the Republic of Bolivia, from August, 2006 to May, 2008. Among the 55 surgically treated patients the male sex, those younger than 15 years old and the gangrenous condition prevailed. The Chagas disease constituted the most frequent associated disorder and the infection of the surgical wound became the main complication. Most of the patients of the series received spinal anesthesia, their surgical treatment lasted between 30 minutes and 1 hour and they were hospitalized from 5 to 10 days. There was a death due to septic shock.

Se describe el caso clínico de una adolescente de 17 años de edad, con malas condiciones sociales, ingresada en el Hospital San Juan de Dios, municipio de Challapata (Bolivia), por presentar epigastralgia, náuseas y vómitos. Se realizó endoscopia digestiva superior y se confirmó un cuadro de oclusión intestinal alta por tricobezoar gástrico en forma de síndrome de Rapunzel, por lo cual fue operada de urgencia. La evolución posoperatoria resultó favorable y egresó a los 7 días, con recomendaciones de asistir a consultas externas de cirugía general y psicología.The case report of a 17 year-old adolescent , with poor social conditions, admitted at San Juan de Dios Hospital, Challapata municipality (Bolivia), for presenting epigastralgia, nauseas and vomits is described . An upper digestive endoscopy was carried out and a case of upper intestinal occlusion due to gastric tricobezoar simulating a Rapunzel syndrome was confirmed, reason why she had an emergent surgery. The postoperative clinical course was favorable and she was discharged after 7 days, with recommendations of attending the out patient department of general surgery and psychology.

Objective: To determine the variables and predictive factors associated with the administration and frequency of the allogenic blood transfusion (ABT) on patients diagnosed with fracture of femur requiring surgical intervention. The secondary objective was to describe the frequency and quantity of ABT on those patients., Method: A retrospective transversal observational study was performed on patients admitted to the Sagrat Cor hospital of Barcelona with a diagnosis of fractured femur that required surgical intervention in 2016. Several demographic variables were gathered along with the clinical data and outcome of transfused and non-transfused patients, including the type of fracture., Results: The overall sample was 257 patients. Of the patients studied, 52.9% required blood transfusion support. Patients who required ABT had haemoglobin values on admission of 11.01 gdl while those that did not require transfusion had an average value of 12.97 g/dl. Of the patients, 42.8% were on anticoagulant and/or antiplatelet therapy before the fracture occurred., Conclusions: More than half the patients admitted for fracture of femur received blood transfusion. The data collected showed that the hospital transfusion policy offered satisfactory results. Factors associated with the need for ABT were haemoglobin levels on admission and the type of fracture. Age and ASA risk (classification system of the American Society of Anesthesiologists) were also risk factors for ABT. This information could be useful for blood saving protocols. Finally, we think that it is important that all patients that are hospitalised with a diagnosis of fracture of femur and require surgery have a blood reserve request made, given that a high percentage of them, at any time during their stay, will be transfused., (Copyright © 2020 Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: In infective endocarditis (IE), decisions on surgical interventions are challenging and a high percentage of patients with surgical indication do not undergo these procedures. This study aimed to evaluate the short- and long-term prognosis of patients with surgical indication, comparing those who underwent surgery with those who did not., Methods: We included 271 patients with left-sided IE treated at our institution from 2003 to 2018 and with an indication for surgery. There were 83 (31%) surgery-indicated not undergoing surgery patients with left-sided infective endocarditis (SINUS-LSIE). The primary outcome was all-cause death by day 60 and the secondary outcome was all-cause death from day 61 to 3 years of follow-up. Multivariable Cox regression and propensity score matching were used for the analysis., Results: At the 60-day follow-up, 40 (21.3%) surgically-treated patients and 53 (63.9%) SINUS-LSIE patients died (P <.001). Risk of 60-day mortality was higher in SINUS-LSIE patients (HR, 3.59; 95%CI, 2.16-5.96; P <.001). Other independent predictors of the primary endpoint were unknown etiology, heart failure, atrioventricular block, and shock. From day 61 to the 3-year follow-up, there were no significant differences in the risk of death between surgically-treated and SINUS-LSIE patients (HR, 1.89; 95%CI, 0.68-5.19; P=.220). Results were consistent after propensity score matching. Independent variables associated with the secondary endpoint were previous IE, diabetes mellitus, and Charlson index., Conclusions: Two-thirds of SINUS-LSIE patients died within 60 days. Among survivors, the long-term mortality depends more on host conditions than on the treatment received during admission., (Copyright © 2019 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introducción: la gangrena de Fournier es una enfermedad rara y grave, caracterizada por fasciitis necrotizante, sinergística y polimicrobiana, que mantiene alta mortalidad. Objetivo: contribuir a un mayor conocimiento del diagnóstico, tratamiento y pronóstico individual de esta rara enfermedad. Métodos: fueron estudiados siete pacientes tratados entre febrero de 2010 y abril de 2011. Se evaluaron datos demográficos, enfermedades asociadas, etiología, tratamiento, complicaciones y mortalidad, así como tiempo con sonda y estadía hospitalaria. Resultados: Los pacientes fueron hombres con edad media de 43,3 años; el más joven tenía 30 años y el mayor 49. Enfermedades asociadas: síndrome de inmuno deficiencia adquirida (2), diabetes mellitus (1), hipertensión arterial (1). El origen perineal (4) y escrotal (3). Tres pacientes referían fístulas o abscesos perineales. El tiempo de evolución fluctuó entre 6 y 30 días. Las manifestaciones clínicas se caracterizaron por dolor, aumento de volumen en regiones perineal, escrotal o ambas y secreción fétida. Se encontró crepitación cuando la enfermedad invadió regiones inguinales y pared abdominal. El tratamiento quirúrgico comprendió desbridamiento y derivaciones digestivas (colostomía), urológicas (cistotomía) o ambas. El número de intervenciones varió entre tres y siete. Se practicó la reconstrucción quirúrgica del periné y escroto con el uso de injertos de piel a los sobrevivientes. Tres enfermos (42,9 %) tuvieron complicaciones: shock séptico, fallo orgánico múltiple y estenosis uretral tardía (1). Falleció un enfermo (14,3 %), que había ingresado con manifestaciones de shock séptico. Conclusiones: El éxito del tratamiento se logra con el diagnóstico temprano, desbridamiento quirúrgico precoz, agresivo y antibioticoterapia de amplio espectro.

Background: The impact of enteral nutrition (EN) on surgical risk in Crohn's disease (CD) patients suffering from spontaneous intra-abdominal abscess (IAA) was evaluated. Methods: CD patients diagnosed with spontaneous IAA from 2008 to 2015 were included in the study. The impact of EN on surgical risk was evaluated using both univariate and multivariate analyses. Results: A total of 87 patients were enrolled, 66 (75.9%) were male. The mean age at the development of an abscess was 30.2 ± 10.1 years and the median duration of illness from CD diagnosis until the development of an abscess was three (2-6) years. After a median follow-up of 1.9 (1.1-2.9) years, surgical intervention was performed in 42 patients (48.3%). Patients treated with EN were less likely to require surgical intervention (26.1% vs 56.3%, p = 0.01). Multivariate analysis showed that EN was an independent protective factor for the risk of surgery with a hazard ratio of 0.27 (95% confidence interval: 0.11-0.65, p = 0.004) after adjusting for abdominal pain, history of abdominal surgery, concomitant intestinal stenosis and prior use of antibiotics within three months. Conclusions: Surgical intervention is common for CD patients with IAA. Appropriate application of EN may help obviate the need for surgical treatment.

JUSTIFICATIVA E OBJETIVOS: O tratamento da dor neuropática é difícil e muitos pacientes apresentam alívio parcial e incompleto da dor com o tratamento farmacológico. Em casos de dor neuropática de origem traumática deve ser considerada a possibilidade de tratamento com a exploração cirúrgica, pois existe a possibilidade da dor ser causada por compressão nervosa devida a fibrose de tecidos adjacentes ou espessamento de bainha. O objetivo deste estudo foi apresentar um caso de sucesso no tratamento cirúrgico de dor neuropática causada por espessamento da bainha no nervo ciático esquerdo causado por ferimento de arma de fogo. RELATO DO CASO: Paciente do sexo masculino, alvejado por tiro de arma de fogo na região glútea esquerda, evoluiu com dor em queimação na região posterior da coxa esquerda, com irradiação para face posterior da coxa, perna e pé, que foi parcialmente controlada por tratamento farmacológico com oxicodona, gabapentina e amitriptilina. Com a persistência das dores, foi feita a exploração cirúrgica no local de entrada do projétil que evidenciou a presença de bulbo em nervo ciático esquerdo e espessamento da bainha, sendo feita endoneurólise para a descompressão de fibrose intraneural. Após a cirurgia fez uso de pregabalina, morfina e amitriptilina, e depois de 10 meses da cirurgia estava assintomático, sem uso das medicações. CONCLUSÃO: O tratamento cirúrgico com endoneurólise para a descompressão de fibrose intraneural no nervo ciático esquerdo associado ao tratamento com amitriptilina e pregabalina, controlou com sucesso a dor neuropática causada por ferimento de arma de fogo.