Doble lesión de pared abdominal: hernia incisional lumbar izquierda y seudohernia por denervación y atrofia muscular derecha. Manejo laparoscópico conjunto

ResumenIntroducciónLos defectos incisionales de la pared abdominal posterolateral son un reto para cualquier cirujano. El manejo quirúrgico de estos pacientes no se ha estandarizado aún.ObjetivoPresentación de un caso excepcional de una paciente con 2 lesiones incisionales en la pared abdominal posterolateral: una hernia lumbar izquierda y una seudohernia gigante derecha por denervación. Planteamiento de su manejo quirúrgico en un tiempo mediante doble laparoscopia.Caso clínicoUna mujer de 65 años, tras un accidente de tráfico, precisa 4 cirugías de columna y otras 4 por litiasis renal derecha. Un tac confirma la existencia de una hernia incisional lumbar izquierda y una seudohernia con intensa atrofia muscular lateral. Se plantea un abordaje laparoscópico único: plastia transabdominal retroperitoneal (izquierda) y plastia mixta, intraabdominal anterior y retroperitoneal posterior, de la hemipared abdominal lateral (derecha) con fijación en límites óseos (12.a costilla y cresta ilíaca). El seguimiento a un año no muestra recurrencia alguna en la hernia lumbar, pero sí ausencia de mejoría en la seudohernia, pues presentaba similar perímetro abdominal y eje costoilíaco.DiscusiónLa cirugía laparoscópica para tratar los defectos de pared abdominal laterales es una opción todavía controvertida ya que no reproduce los pasos del abordaje abierto. La reparación laparoscópica parece ser beneficiosa en los casos de hernia lumbar, pero en el caso de las pseudohernias la documentación disponible es muy limitada.ConclusiónLa hernia y la seudohernia lumbar son frecuentes complicaciones de una cirugía previa. Es necesario un tac para asegurar el diagnóstico y plantear el correcto tratamiento. El abordaje laparoscópico es eficaz en el tratamiento de la hernia lumbar (plastia retroperitoneal), pero ineficaz para tratar la seudohernia (plastia mixta, intraabdominal en la mitad anterior y retroperitoneal en la mitad posterior, de toda la hemipared lateral del abdomen).AbstractIntroductionIncisional defects of the posterolateral abdominal wall are a challenge for any surgeon. No standard surgical treatment has been set for these patients.ObjectiveThe aim of this study is present the unusual case of a patient with 2 incisional lesions, a left lumbar hernia and a giant right-sided pseudohernia, and to develop their surgical treatment at the same time using double laparoscopy.Clinical caseA 65-year-old woman, who after a car accident needed 4 spinal surgeries, and another 4 for right renal lithiasis. A tomography confirmed the existence of a left lumbar incisional hernia and a pseudohernia with intense lateral muscular atrophy. A single laparoscopic approach is set out: transabdominal retroperitoneal hernioplasty (left), and intra-abdominal hernioplasty of the left hemiabdominal wall (right) with fixation to the osseous margins (12th rib and the iliac crest). Follow-up over one year shows no recurrence of the lumbar hernia but no clear improvement of the pseudohernia, which had a similar abdominal perimeter and costoiliac axis.DiscussionLaparoscopic surgery for the treatment of posterolateral abdominal wall defects is still a controversial choice as it does not reproduce the open technique. Laparoscopic repair seems to be the most beneficial choice for the patient with lumbar hernia, but for incisional pseudohernias the documentation available is limited.ConclusionLumbar hernias and pseudohernias are frequent complications after previous surgery. Laparoscopic approach is an effective treatment for the lumbar hernia, but ineffective for the pseudohernia

Dominique-Jean y Félix-Hippolyte Larrey: el legado de dos cirujanos (padre e hijo)

ResumenObjetivoDescribir las contribuciones de Dominique-Jean y Félix-Hippolyte Larrey a la cirugía.MétodoRevisión de la literatura. Análisis crítico de los artículos, libros y monografías que mencionan a ambos cirujanos de Napoleón.ResultadosSe exponen datos biográficos y del contexto social de la época, así como publicaciones y contribuciones quirúrgicas de mayor relevancia. Se comprueba la ausencia de Félix-Hippolyte en numerosos tratados, y se corrigen errores en la literatura.ConclusiónAmbos cirujanos franceses, padre e hijo, forman parte de la historia de la cirugía por méritos propios. El legado del hijo merece ser recordado por su interés científico y académico.AbstractObjectiveTo describe the contributions of Dominique-Jean and Félix-Hippolyte Larrey to surgery.MethodReview of the literature. Critical analysis of the manuscripts referring to the life and works of the French surgeons Dominique-Jean and Félix-Hippolyte Larrey.ResultsBiographical data and the social context of the time are reported, as well as publications and surgical contributions of most relevance. The absence of Félix-Hippolyte has been determined in numerous treaties, and errors in the literature have been corrected.ConclusionsBoth French surgeons, father and son, are part of the history of surgery by their own merits. The legacy of the child deserves to be remembered for his scientific and academic interest

Adherencias peritoneales postoperatorias : descripción de un nuevo método para su cuantificación y análisis de los factores etiológicos implicados en su génesis. Estudio experimental en ratas / Alfredo Moreno Egea ; directores Pascual Parrilla Paricio, José Luis Aguayo Albasini

Tesis-Universidad de Murcia.MEDICINA ESPINARDO. DEPOSITO. MU-Tesis 251.Consulte la tesis en: BCA. GENERAL. ARCHIVO UNIVERSITARIO. T.M.-775

Reduction in inappropriate hospital use based on analysis of the causes

<p>Abstract</p> <p>Background</p> <p>To reduce inappropriate admissions and stays with the application of an improvement cycle in patients admitted to a University Hospital. The secondary objective is to analyze the hospital cost saved by reducing inadequacy after the implementation of measures proposed by the group for improvement.</p> <p>Methods</p> <p>Pre- and post-analysis of a sample of clinical histories studied retrospectively, in which the Appropriateness Evaluation Protocol (AEP) was applied to a representative hospital sample of 1350 clinical histories in two phases. In the first phase the AEP was applied retrospectively to 725 admissions and 1350 stays. The factors associated with inappropriateness were analysed together with the causes, and specific measures were implemented in a bid to reduce inappropriateness. In the second phase the AEP was reapplied to a similar group of clinical histories and the results of the two groups were compared. The cost of inappropriate stays was calculated by cost accounting. Setting: General University Hospital with 426 beds serving a population of 320,000 inhabitants in the centre of Murcia, a city in south-eastern Spain.</p> <p>Results</p> <p>Inappropriate admissions were reduced significantly: 7.4% in the control group and 3.2% in the intervention group. Likewise, inappropriate stays decreased significantly from 24.6% to 10.4%. The cost of inappropriateness in the study sample fell from 147,044 euros to 66,642 euros. The causes of inappropriateness for which corrective measures were adopted were those that showed the most significant decrease.</p> <p>Conclusions</p> <p>It is possible to reduce inadequacy by applying measures based on prior analysis of the situation in each hospital.</p