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Background: Coronavirus disease (COVID-19) is currently the main public health problem worldwide. The administration of neutral electrolyzed saline, a solution that contains reactive species of chlorine and oxygen (ROS), may be an effective therapeutic alternative due to its immunomodulating characteristics, in systemic inflammation control, as well as in immune response improvement, promoting control of the viral infection. The present study evaluated the efficacy of treatment with intravenous and/or nebulized neutral electrolyzed saline combined with usual medical care versus usual medical care alone, in ambulatory patients with COVID-19. Methods: A prospective, 2-arm, parallel group, randomized, open-label, phase I-II clinical trial included 39 patients in the control group (usual medical care alone) and 45 patients in the experimental group (usual medical care + intravenous and/or nebulized electrolyzed saline, with dose escalation). Two aspects were evaluated during the twenty-day follow-up: i) the number of patients with disease progression (hospitalization or death); and ii) the Patient Acceptable Symptom State (PASS), a single-question outcome that determines patient well-being thresholds for pain and function. Biochemical and hematologic parameters, as well as adverse effects, were evaluated in the experimental group. Results: The experimental treatment decreased the risk for hospitalization by 92% (adjusted RR=0.08, 95% CI: 0.01–0.50, P=0.007), with a 43-fold increase in the probability of achieving an acceptable symptom state on day 5 (adjusted RR= 42.96, 95% CI: 9.22–200.0, P

ResumenAntecedentesLa cirugía antirreflujo tiene actualmente un lugar establecido en el manejo de la enfermedad por reflujo gastroesofágico. Algunas series han revelado buenos resultados a corto plazo, pero los resultados a largo plazo permanecen aún poco conocidos. Recientemente, los estudios se han centrado en evaluar la sintomatología residual y su impacto en la calidad de vida.ObjetivoDeterminar la calidad de vida en el postoperatorio y la satisfacción en pacientes intervenidos de funduplicatura de Nissen laparoscópica.Pacientes y métodosSe estudió a 100 pacientes (59 mujeres y 41 hombres) postoperados de funduplicatura de Nissen laparoscópica. Las variables fueron grado de satisfacción, calidad de vida (GIQLI), síntomas residuales y escala Visick.ResultadosNo se encontró variación en el sexo, siendo 49 hombres y 51 mujeres; el promedio de edad fue de 49 años. La valoración del grado de satisfacción fue: satisfactoria en 81 pacientes, moderada en 3 y mala en 2 pacientes. Más del 90% se sometería de nuevo o recomendaría la cirugía. En cuanto a la clasificación de Carlsson, se mostró mejoría al final del estudio (p

Background: Today, antireflux surgery has an established position in the management of gastroesophageal reflux disease. Some case series have shown good short-term results, but there is still little information regarding long-term results. Studies have recently focused on evaluating residual symptomatology and its impact on quality of life. Objectives: To determine the postoperative quality of life and degree of satisfaction in patients that underwent laparoscopic Nissen fundoplication. Patients and methods: A total of 100 patients (59 women and 41 men) were studied after having undergone laparoscopic Nissen fundoplication. The variables analyzed were level of satisfaction, gastrointestinal quality of life index (GIQLI), residual symptoms, and the Visick scale. Results: No variation was found in relation to sex; 49 men and 51 women participated in the study. The mean age was 49 years. The degree of satisfaction encountered was: satisfactory in 81 patients, moderate in 3, and bad in 2 patients. More than 90% of the patients would undergo the surgery again or recommend it. The Carlsson score showed improvement at the end of the study (p

The colon is the organ most commonly used for esophageal reconstruction after severe caustic injury. Complications of cervical anastomosis are very common. Fibrin sealant may reduce the incidence of complications in this high-risk anastomosis. The purpose of the present study was to assess the role of fibrin glue in the prevention of leakage and stricture at cervical coloesophageal anastomoses in children treated with esophageal reconstruction after caustic injury. This was a case–control study of children with caustic esophageal injury treated surgically with esophageal reconstruction over a 10-year period. In the study group 3–4 ml of fibrin glue was placed over the anastomosis. The following variables were assessed: age, sex, weight, leakage or stricture at the cervical anastomosis, morbidity, and mortality. The study group included 14 children, and the control group included 24 children. There were no differences in the distributions of sex, age, anthropometric variables, or preoperative laboratory test results. All children underwent esophageal replacement with colon substitution through the retrosternal space. Dehiscence and leakage at the cervical anastomosis were observed in 50% of children in the control group and 28.5% of children in the study group (P = 0.17). Strictures were observed in 7.15% of the study group and 20.8% of the control group, and 5 and 17 children, respectively, developed cervical complications (P = 0.03). There were no differences in major complications, and mortality was similar in the two groups (P = 0.60). Fibrin glue, when used as a sealant for cervical coloesophageal anastomosis, can reduce the risk of leakage and stricture.

The changes in recent decades in the training of medical student seem to agree that the educational model for professional skills is most appropriate. The virtual simulator translates skills acquired the operating room, in the Faculty of Medicine of the University of Colima noticed the need to prepare the students of pregrade transferring surgical trainees' skills in basic laparoscopic activities that require a simple cognitive effort.The hypothesis in this study was to evaluate the acquisition of skills in laparoscopic simulator in students of pregrade.Educational research, analytical comparison, which was conducted within the activities of the program of Problem Based Learning in the program of Education and Surgical Technique, Faculty of Medicine of the University of Colima.All participants in the simulator achieved a significantly better during the task one after three repetitions (p= 0.001). The evaluation of final students calcification, we observed significant differences in means being lower during the initial assessment (8.60 ± 0.76) compared to the end (8.96 ± 0.58) p= 0.001.The acquisition of skills in the simulator is longer but at the end is better than the acquisition of skills from the traditional method, showing that leads to the acquisition of skills that promote the transfer of skills to the surgical environment.Antecedentes: la educación basada en competencias señala que el estudiante debe dominar tres rubros: saber, saber hacer y ser. El primero se refiere al conjunto de conocimientos teórico-prácticos, el segundo a las habilidades psicomotrices y el tercero al comportamiento profesional. El estudiante de Medicina adquiere las primeras destrezas en cirugía laparoscópica a través de modelos animales y simuladores virtuales. Sin embargo, no hemos evaluado la trascendencia de esta capacitación. Objetivo: evaluar en alumnos de pregrado las destrezas en cirugía laparoscópica obtenidas después de un curso con un simulador virtual. Material y métodos: estudio de investigación educativa, analíticocomparativo efectuado como parte de las actividades del programa de Aprendizaje Basado en Problemas de la asignatura de Educación y Técnica Quirúrgica de la Facultad de Medicina de la Universidad de Colima. Resultados: todos los participantes alcanzaron en el simulador un mejor nivel durante la tarea 1 después de tres repeticiones (p= 0.001). En la evaluación de la calificación final de los alumnos se observaron diferencias significativas en las medias que fueron más bajas durante la evaluación inicial (8.60 ± 0.76) en comparación con la final (8.96 ± 0.58) p= 0.001. Conclusiones: la adquisición de habilidades en el simulador es más prolongada y al final es superior a la adquisición de habilidades basada en el método tradicional; demuestra que conduce a la adquisición de competencias que favorecen la transferencia de habilidades al entorno quirúrgico.

Antecedentes: la educación basada en competencias señala que el es- tudiante debe dominar tres rubros: saber, saber hacer y ser. El primero se refiere al conjunto de conocimientos teórico-prácticos, el segundo a las habilidades psicomotrices y el tercero al comportamiento profesional. El estudiante de Medicina adquiere las primeras destrezas en cirugía laparoscópica a través de modelos animales y simuladores virtuales. Sin embargo, no hemos evaluado la trascendencia de esta capacitación. Objetivo: evaluar en alumnos de pregrado las destrezas en cirugía laparoscópica obtenidas después de un curso con un simulador virtual. Material y métodos: estudio de investigación educativa, analítico- comparativo efectuado como parte de las actividades del programa de Aprendizaje Basado en Problemas de la asignatura de Educación y Técnica Quirúrgica de la Facultad de Medicina de la Universidad de Colima. Resultados: todos los participantes alcanzaron en el simulador un mejor nivel durante la tarea 1 después de tres repeticiones (p= 0.001). En la evaluación de la calificación final de los alumnos se observaron diferencias significativas en las medias que fueron más bajas durante la evaluación inicial (8.60 ± 0.76) en comparación con la final (8.96 ± 0.58) p= 0.001. Conclusiones: la adquisición de habilidades en el simulador es más prolongada y al final es superior a la adquisición de habilidades basada en el método tradicional; demuestra que conduce a la adquisición de competencias que favorecen la transferencia de habilidades al entorno quirúrgico.

Surgical management of umbilical hernias is proposed in the vast majority of cases. The typical approaches make a semilunar incision above the umbilicus. The aim of this study is evaluate the surgical approach with two different incisions, the transumbilical approach and the infra-umbilical approach.Included in the study were 82 consecutive patients with diagnosis of umbilical hernia. Variables related to demographic characteristics, surgical operation, and cosmetic results were evaluated. Patients were randomized into two groups; transumbilical or infra-umbilical approach. Statistical analysis was carried out to evaluate complications, recurrences and aspects of the surgical scar.The study included group A (42 patients) and group B (40 patients). The most frequent symptom was pain in both groups. Complications were similar in both groups with four (9.5%) in group A and eight (19%) in group B (RR 0.53, 95% CI 0.17-1.61, p = 0.24). Cosmetic results were classified as good in the vast majority of patients in group A (p 0.001). No recurrences or mortality have been reported so far in both studied groups.We described an uncommon technique of incision with the aim of improving cosmetic results. Our results are in concordance with randomized clinical trials with the same technique with no recurrence or mortality to date. Cosmetic results in our patients using the transumbilical approach were clearly superior.

Intraperitoneal meshes produce adhesions and intestinal fistula. Composite materials with an antiadherent barrier prevent that complication. There are no studies using gel products in intraperitoneal meshes to keep in contact with viscera.Two groups of 20 rats each were used. Polypropylene mesh was placed intraperitoneally in both groups adding hyaluronic acid/carboxymethylcellulose gel to the mesh in the study group. At 28 days, rats were sacrificed and evaluated using the Diamond adhesions scale.There were 20 rats in the study group and 19 rats in the control group (one postoperative death). Control group all had adhesions: six (32%)50% of the mesh surface. In the study group one rat (5%) showed no adhesions, and in 14 (70%)25% of the mesh surface. Severity showed strong and cohesive adhesions in 11 (58%) control group rats and thin, avascular adhesions in 11 (55%) study group rats. For density, in the study group there were two rats (10%) where adhesions were released spontaneously by separating the flap. There was mild to moderate traction in 16 (80%) study group rats and six (32%) control group rats. Adhesiolysis with scissors was used in the study group (5%) and in 13 (68%) control group rats (p0.05).Hyaluronic acid/carboxymethylcellulose gel appears to be effective in reducing the percentage of adhesions to segments of intraperitoneal mesh implants.

OBJECTIVES: To determine among adult patients with type-2 diabetes mellitus the proportion diagnosed with diabetic polyneuropathy (DPN) by clinical evaluation and by the Hoffmann reflex (H-reflex). In addition, the predictive value of the H-reflex in the diagnosis of DPN was evaluated. METHODS: Studies were carried out on 150 adult patients referred for neuropathy screening. Diagnostic criteria for DPN were at least two abnormalities in clinical neurophysiological examinations and electrophysiological testing (H-reflex and nerve conduction velocity). Logistic regression analysis was performed to identify unique contributions of study characteristics to positive versus negative outcomes. RESULTS: H-reflex was absent in 39.3% (59/150) and latency was prolonged in 43.3% (65/150) of patients. Ulnar nerve motor branch nerve conduction showed prolonged latency in 9.3% (14/150) of patients. Logistic regression analysis indicated that the H-reflex was significantly associated with positive outcomes. CONCLUSION: The H-reflex could have a predictive value in DPN, providing more quantitative information regarding diagnosis than conventional nerve conduction studies.

Introducción: el tratamiento quirúrgico de la hernia umbilical es el manejo de elección en la gran mayoría de los casos. En el abordaje clásico se realiza una incisión semilunar por debajo del ombligo. El objetivo de este estudio es evaluar la técnica quirúrgica con dos incisiones diferentes: los abordajes transumbilical e infraumbilical. Material y métodos: se incluyeron 82 pacientes consecutivos con diagnóstico de hernia umbilical; las variables estudiadas fueron: características demográficas, tipo de cirugía y resultados cosméticos. Los pacientes fueron aleatorizados en dos grupos: abordaje transumbilical vs. infraumbilical. El análisis estadístico se realizó para evaluar complicaciones, recidivas y el aspecto de la cicatriz quirúrgica. Resultados: el estudio incluyó al grupo A con 42 pacientes y al grupo B con 40 pacientes. El síntoma más frecuente en ambos grupos fue el dolor. Las complicaciones fueron similares en ambos grupos, 4 (9.5%) en el grupo A y 8 (19%) en el grupo B (RR 0.53, IC 95% 0.17-1.61, p = 0.24). Los resultados cosméticos fueron clasificados como buenos en la gran mayoría de los pacientes del grupo A (p 0.001). No se han presentado recidivas ni muertes, hasta el momento, en ninguno de los grupos de estudio. Conclusiones: describimos una técnica poco común de incisión con la idea de mejorar los resultados cosméticos. Nuestros resultados concuerdan con los de otros ensayos clínicos aleatorios que utilizaron la misma técnica. No hay recurrencia ni mortalidad hasta el momento y los resultados estéticos del abordaje transumbilical en nuestros pacientes fueron claramente superiores.

Introducción: las mallas colocadas intraperitonealmente originan adherencias y fístulas intestinales. Los materiales compuestos con barrera antiadherente evitan este problema. No existen estudios utilizando productos antiadherentes en gel aplicado a mallas intraperitoneales para evaluar su eficacia en segmentos pequeños de malla en contacto con las vísceras. Material y métodos: utilizamos dos grupos de 20 ratas cada uno. A las del grupo control se les colocó un segmento de malla de polipropileno intraperitonealmente y a las del grupo en estudio idéntica malla pero cubierta de gel de ácido hialurónico + carboximetilcelulosa. Los animales fueron sacrificados a los 28 días y se evaluaron las adherencias según la escala de Diamond. Resultados: se evaluaron 20 ratas del grupo en estudio y 19 del grupo control (una muerte posoperatoria). Extensión: en el grupo control todas las ratas presentaron adherencias a la malla, 6 de ellas (32%) más de 50% de la superficie de la malla. De los animales del grupo en estudio 1 (5%) sin adherencias, 14 (70%) menos de 25% de la superficie de la malla (p = 0.02). Severidad:adherencias firmes y cohesivas en 11 (58%) del grupo control y en 0 del grupo en estudio (p = 0.001). Adherencias delgadas, avasculares en 11 (55%) del grupo en estudio. Densidad: del grupo en estudio 2 (10%) se liberaron espontáneamente al separar el colgajo; con tracción de suave a moderada en 16 (80%) del grupo en estudio y en 6 (32%) del grupo control. Liberación de las adherencias con tijeras en 1 individuo del grupo en estudio (5%) y en 13 (68%) del grupo control (p 0.05). Conclusiones: el gel de ácido hialurónico + carboximetilcelulosa parece ser efectivo para reducir el porcentaje de adherencias y su firmeza a segmentos de malla intraperitoneal.

The objective of the study was to evaluate tamsulosin (TAM) efficacy in distal ureteral stone expulsion in Mexican patients. A double-blind clinical trial was carried out for a period of 4 weeks on 65 patients assigned to the following treatment groups: Group A, 32 patients receiving conventional treatment + TAM; and Group B, 33 patients receiving conventional treatment + placebo. Patients of both groups were checked every 14 days to evaluate treatment adherence and clinical progression through plain abdominal film and abdominal ultrasonogram. There was no significant difference in stone expulsion percentage between groups: Group A 69% (n = 22) versus Group B 70% (n = 23), P = 0.9. There was no significant difference in mean expulsion time comparison between groups: Group A 22 ± 6.7 days (11–30 days interval) versus Group B 23 ± 6.3 days (11–30 days interval), P = 0.3. Tamsulosin did not demonstrate greater efficacy in distal ureteral stone expulsion in Mexican patients.

Objetivo Determinar la frecuencia y factores de riesgo para sobrepeso y obesidad en jóvenes universitarios. Métodos Se realizó un estudio transversal analítico en 821 alumnos inscritos de la Universidad de Colima. Entre las variables analizadas se encuentran: edad, género, alcoholismo, tabaquismo y utilización de medicamentos o sustancias para control de peso. Resultados Se estudiaron 821 alumnos (380 hombres y 441 mujeres) con una edad promedio de 20,9±2,5 años. Las frecuencias de sobrepeso y obesidad en hombres fueron de 27,8 % y 14,7 % y en mujeres de 17 % y 5,2 %. En hombres el tabaquismo (OR 2,1, IC 95 % 1,4-3,8;p=0,01) y etilismo (OR 2,1, IC 95 % 1,2-3,6;p=0,003), estuvieron asociados a sobrepeso y obesidad. Fueron factores protectores en ambos géneros el uso de sustancias para control de peso (OR 0,4, IC 95 % 0,2-0,8;p=0,01); mientras que el control dietético fue un factor protector sólo en las mujeres (OR 2,2, IC 95 % 1,1- 3,4;p=0,01). Conclusiones En estudiantes universitarios, el 31,6 % presentó sobrepeso y obesidad. En hombres, el tabaquismo y etilismo se asociaron a sobrepeso y obesidad. El uso de sustancias para bajar de peso y control dietético fueron factores protectores.

Determining risk factor frequency regarding obesity and being overweight in university students.A cross-sectional analytic study was carried out on 821 students from the University of Colima. Some variables analysed were age, gender, alcoholism, smoking and weight-control drug use.821 students were included (380 male, 441 female), 20.9±2.5 average age. 27.8 % of males were overweight and 14.7 % suffered from obesity; this was 17 % and 5.2 % in females, respectively. Smoking (2.1 OR; 1.4-3.8 95 % CI; p=0.01) and alcoholism (2.1 OR; 1.2-3.6 95 % CI; p=0.003) were associated with being overweight and being obese. Weight-control drug use was a protective factor in both genders (0.4 OR; 0.2-0.8 95 % CI; p=0.01); diet control was only a protective factor in women (2.2. OR; 1.1-3.4 95 % CI; p=0.01).31.6 % of university students were overweight and suffered from obesity. Smoking and alcoholism in males were associated with being overweight and suffering from obesity. Weight-control and diet-control drug use were protective factors.

Therapeutic pain is one of the most important outcome measures in surgery. Comparative studies investigating ketorolac efficiency in ambulatory surgery have generally been restricted to IV administration. We compared analgesic effectiveness of sublingual ketorolac and metamizole in short stay surgery.This was a randomized single-blind clinical trial. All patients received either a three-dose (30 mg) of sublingual ketorolac or 1 g of IV metamizole, respectively. We evaluated pain with a visual/analog scale (VAS). Side effects were also recorded. Statistical analysis included t-test or Mann-Whitney U test and Fisher exact test or chi(2). Absolute risk reduction (ARR), odds ratio (OR), confidence interval (CI), relative risk ratio (RRR) and numbers needed to treat (NNT) were also evaluated.Rescue doses of analgesics were greater in patients receiving metamizole although the difference was not significant (p = 0.286). Mean VAS score was lower in the ketorolac group at 8 h after surgery, with no statistical difference (p = 0.06). ARR for severe pain score was almost 5% (OR = 1.78). Adverse effects did not show differences between groups (p = 0.642).Ketorolac and metamizole have comparable effects and can be safely used in ambulatory settings.

Introducción: El dolor posquirúrgico es uno de los retos más importantes en cirugía, los estudios comparativos con ketorolaco en pacientes con cirugía de corta estancia se han restringido generalmente a la administración intravenosa. Por lo tanto, comparamos la eficacia analgésica de ketorolaco sublingual y metamizol en cirugía de corta estancia. Material y métodos: Ensayo clínico controlado ciego simple; los pacientes recibieron 30 mg de ketorolaco sublingual o 1 g de metamizol endovenoso, cada ocho horas, durante las primeras 24 horas posoperatorio. Se evaluó dolor con la escala análoga visual (EVA). También fueron evaluados los efectos colaterales. Para el análisis estadístico se utilizó t de dos colas o U de Mann-Whitney y la prueba exacta de Fisher o x2, además del cálculo de reducción de riesgo absoluto, razón de momios (OR), intervalo de confianza a 95 %, reducción del riesgo relativo y número necesario a tratar. Resultados: El consumo de analgésico suplementario fue mayor en el grupo de metamizol pero sin diferencia significativa (p = 0.286). Durante el estudio, la EVA promedio fue menor para ketorolaco que para metamizol, sobre todo a las ocho horas de posoperatorio, pero sin diferencia estadística (p = 0.06). La reducción del riesgo absoluto para cuadros de dolor severo fue de casi 5 % (OR = 1.78). No hubo diferencia en la presentación de efectos adversos (p = 0.642). Conclusiones: Tanto ketorolaco como metamizol demostraron un efecto comparable y pueden ser utilizados con seguridad.

Cystic neoplasms of the pancreas represent between 5% and 10% of all pancreatic tumors. Due to their malignant potential, surgery is indicated. Because of the uncommon nature of this pathology, the aim of this study was to present a series of six patients who were operated on for a cystic tumor and to analyze the morphological characteristics, surgical experience and follow-up.This was a retrospective study. Clinical files were studied, as well as surgical and pathological registries from patients diagnosed with cystic neoplasms of the pancreas. Five females and one male were included with a mean age of 54 +/- 15 years. The main symptom was abdominal pain.Clinical course and CT scan results were the criteria for suspecting the diagnosis. In 4/6 patients, the tumor was located within the body and tail of the pancreas. The most frequent intervention was distal pancreatectomy. There was no mediate operative mortality in a 30-day period. Histopathological diagnoses were three serum cystadenomas, two mucinous cystadenomas and one cystadenocarcinoma. After a 4-year follow-up, no tumor recurrences have been reported in the surviving patients.The natural history of cystic neoplasms of the pancreas is generally benign, but complications may occur by direct invasion of neighboring structures. Clinical course, tomography, pancreatography and punction are fundamental for its treatment.

The use of open tension-free techniques in hernia surgery seems to be superior to those techniques that apply tension to the suture line. However, the cost-effectiveness of tension vs. tension-free repairs has not been investigated before. This study is a cost-effectiveness analysis within a randomized controlled clinical trial that compared open-tension (OT) versus mesh-plug tension-free (MPTF) hernia repair, with a 2-year follow-up for each patient. Between July 2002 and June 2003, 106 patients with inguinal hernia were randomized to either procedure. Main outcome measures included average surgical time, time to full recovery, pain visual analog scale, amount of analgesics required, off-work time, hospital stay, and heath-care costs. The average cost was $885.15 (95% CI $843.56–$926.74) and $837.66 (95% CI $796.42–878.89) USD for the OT and the MPTF herniorrhaphy, respectively (P

Background: Cystic neoplasms of the pancreas represent between 5% and 10% of all pancreatic tumors. Due to their malignant potential, surgery is indicated. Because of the uncommon nature of this pathology, the aim of this study was to present a series of six patients who were operated on for a cystic tumor and to analyze the morphological characteristics, surgical experience and follow-up. Methods: This was a retrospective study. Clinical files were studied, as well as surgical and pathological registries from patients diagnosed with cystic neoplasms of the pancreas. Five females and one male were included with mean ages of 54 ± 15 years. The main symptom was abdominal pain. Results: Clinical course and CT scan results were the criteria for suspecting the diagnosis. In four out of six patients, the tumor was located within the body and tail of pancreas. The most frequent intervention was distal pancreatectomy. There was no mediate operative mortality in a 30-day period. Histopatological diagnoses were three serum cystoadenomas, two mucinous cystoadenomas and one cystoadenocarcinoma. After a 4-year follow-up, no recurrences of tumor have been reported in the surviving patients. Conclusions: The natural history of cystic neoplasms of the pancreas is generally benign, but complications may occur by direct invasion of neighboring structures. Clinical course, tomography, pancreatography and punction are fundamental for its treatment.

Purpose: The purpose of this study is to compare the safety and complications of direct trocar insertion without pneumoperitoneum (DTI) with Veress needle (VN) in laparoscopic cholecystectomy (LC). Methods: We studied 84 patients admitted to our hospital for LC, in a random simple blind design, 42 patients were assigned to DTI and 42 to VN. The variables analysed were: procedure complications, laparoscope insertion time and duration of surgery. Results: Complication percentages between the groups were significantly different (DTI 2.3% versus VN 23.8%, p = 0.009). The duration of surgery between the two groups was also significantly different (DTI 56 ± 31 versus VN 71 ± 28 minutes, p < 0.02). Finally, laparoscope insertion time between the two techniques was significantly different (DTI 1.5 ± 0.5 versus VN 3.0 ± 0.4 minutes p < 0.001). Conclusions: Our results show DTI to be a safe, efficient, rapid and easily-learned alternative technique, reducing the number of procedure-related complications.

Facultad de Medicina

Facultad de Medicina

PURPOSE The purpose of our study was to evaluate the possibility of the reduction of peritoneal adhesions to a polypropylene mesh with fibrin glue. METHODS Forty Wistar rats were assigned to two treatment groups: Group 1) hernioplasty with polypropylene mesh plus fibrin glue sealant, and Group 2) hernioplasty with polypropylene mesh without fibrin glue sealant. The variables evaluated were: presence and density of adhesion, organs or abdominal structures adhered to the polypropylene mesh, inflammatory tissular reaction and cell recount. RESULTS Group 1 presented a statistically lower adhesion percentage than Group 2 (40% versus 100%, P = 0.0003). The mean areas of mesh patch surfaces covered with adhesions were statistically different between Groups 1 and 2 (0.67 +/- 0.65 cm2 versus 1.60 +/- 0.51 cm2; P = 0.00001). Twelve rats presented with adhesions in Group 1; eleven were adhesions to the epiploon and one to the colon. In Group 2 there were 16 adhesions to the epiploon, 2 to the colon, 1 to the small intestine and 1 to the stomach. Tissular reaction comparison showed a significant difference (21 +/- 4.9 versus 17 +/- 4.1; P = 0.006). CONCLUSIONS Fibrin glue sealant significantly reduced the frequency and severity of intra-abdominal adhesions.