Effectivity of the PGA rapid Atramat® and PGA Atramat® sutures for the closure of minimal invasion and abdominal-inguinal wounds in surgery

Background: The use of suture materials for the closure of wounds is a practice described in Egyptian parchments since 3500 b.C. through the use of linen, animal hair, vegetable fiber, silk, leather and others. The election of the ideal suture material has to be based in the appropriate resistance to traction, tissue biocompatibility and resorption rates..Methods: An open longitudinal clinical trial was performed with data recollection in a prospective way, in which was calculated the incidence of complications; dehiscence, wound seroma, surgical site infection hemorrhage and abscess when PGA Atramat® and PGA rapid Atramat® was employed in laparoscopic and open surgery for treatment of inguinal and umbilical plasties.Results: During the period from January 2016 to August 2016, the procedures included: 31 laparoscopic cholecystectomies, 18 laparoscopic fundoplications, 45 laparoscopic appendicectomies, 12 abdominal plasties and 16 inguinal plasties. This series shows the null incidence of complications in 31 cholecystectomies, 18 fundoplications, 16 inguinal plasties and 12 abdominal plasties.Conclusions: The employment of the PGA Atramat® and PGA rapid Atramat® sutures maintains the features of a braided, absorbable suture, and it also results a feasible and secure resource for its use in minimal invasion surgery, abdominal and inguinal plasties, showing low incidence of surgical site infection

Synchronous Resection of Colon Adenocarcinoma and Bisegmentectomy of Liver Metastases

Colorectal cancer is one of the main neoplasms worldwide; at the time of diagnosis about 25% of cases already have an advanced stage with the presence of metastases. A 58-year-old female presented with nausea, vomiting, and black stools and diffuse abdominal pain associated with 7% weight loss. She was referred to our hospital with signs of digestive tract bleeding and anemic syndrome. Panendoscopy revealed body and fundus gastropathy and presence of Helicobacter pylori, and colonoscopy showed a neoplastic lesion at the ascending colon level. A synchronous resection was performed in a single surgical time of colorectal cancer and liver metastases with a duration of 4 h and bleeding of 900 mL. The oral feeding started 24 h after surgery, presenting gas channeling at 24 h and evacuations at 48 h. The total intrahospital stay was 5 days. Synchronous resection of hepatic metastases in colorectal cancer is still rarely performed, despite the fact that in recent years the number of cases has increased because of better surgical techniques. Synchronous resection of colorectal cancer and liver metastases can be performed safely, without increasing transoperative mortality when performed in specialized centers with a multidisciplinary team; however, it is essential to emphasize the importance of negative surgical margins (R0) of the primary tumor and later to be complemented with adjuvant treatment with chemotherapy

Neurophysiology of learning in basic skills of laparoscopic surgery in undergraduate students

Background: The development and progress in laparoscopic surgery requires greater emphasis on surgical skills, developing skills in undergraduate students allows them to be at the forefront in health demands.Methods: An experimental and descriptive study of a group of 30 undergraduate students of the Faculty of Medicine. They attended 30 hours of theoretical and practical sessions distributed by 10 sessions, supported by basic simulators minimally invasive, being evaluated by checklist. Their brain activity was monitored with an electroencephalography before and after the development of skills.Results: It was observed that the average necessary for the acquisition of skills is 5 sessions. The competition in which further progress was observed is video assistance. There is an increase in the activity of the prefrontal cortex on the electroencephalography.Conclusions: A series of neurophysiologic processes involved in learning of laparoscopic surgery are described. Laparoscopic skills development lies in keeping them updated on the teaching-learning, where the use of simulators is growing

Current perspective in the treatment of bile duct injuries

The laparoscopic cholecystectomy is considered the gold standard for the treatment of benign gallbladder disease, which is associated with an increased incidence of biliary injuries. These types of injuries are multicausal, and anatomical variations or anatomical perception errors are the most common risk factors. The objective of this study is to describe the evolution in the management of bile duct injuries and actual, diagnostic tools, incidence, prognosis and treatment. A literature research about diagnosis and treatment of iatrogenic bile duct injuries as well as their impact on the incidence of morbidity and mortality, based on a 30-year period, was performed on Medline, Cochrane, Embase, MedScape and PubMed database, for all studies that met the eligibility criteria. A thorough quality assessment of all included studies was performed. Synthesis of the results was achieved by narrative review. The bile duct injury is a complication that requires a complex therapy and multidisciplinary management. Reconstruction and treatment techniques have been evolving. The selection of adequate treatment will impact on the patient´s quality of life. The results of the existing studies reporting on iatrogenic bile duct injuries are useful; because the iatrogenic bile duct injuries are complex alterations and constitute one of the most serious complications of a cholecystectomy and require a comprehensive approach, immediate repair, proper drainage and timely referral to adequate treatment to improve long-term prognosis. According to the literature review, currently there better treatments such as absorbable prosthesis, which improve the prognosis and patient´s quality of life, and represent less risk of complications in short/long term.

Acute abdomen secondary to dependent rectus sheath hematoma: a case report

The rectus sheath hematoma as a rare clinical entity and self-limited, resulting from the accumulation of blood within the sheath of the rectus abdominis, secondary to breakage the epigastric artery higher or lower, or direct damage by fiber tear of rectus abdominis muscle. Female patient, 37 years old, enters the service of emergencies by refer abdominal pain of sudden onset, diffuse, with 5 hours of evolution with irradiation to lumbar region ipsilateral. In the CT scan in single stage and with IV contrast, it was reported an asymmetry in the thickness of the muscles of the anterior wall at the expense of a lesion of occupying space dependent anterior rectus muscle, as diagnostic impression is concluded a intramuscular injury dependent of the right anterior abdominal straight; likely bruising of the sheath of the straight abdominal by what is being decided its income to operating room to perform surgical drainage and epigastric vessel ligation. for the general doctor, specialist and it is important to take into account the pathology, symptoms, diagnostic and therapeutic strategy for a hematoma dependent of the rectus abdominis muscle, due to the high percentage of error diagnosis in patients who are admitted to the emergency department with acute abdominal pain, because you can Confused with other abdominal pathologies, which shows the importance of an appropriate differential diagnosis, and treatment prescribed, which optimize and reduce unnecessary intervention as well as morbidity and mortality of this disease

Open radical nephrectomy for early treatment of renal cell carcinoma: a case report and review

We report the case of a 46-year-old male with no previous medical background. He complained of abdominal right-sided flank pain, spreading to ipsilateral flank, thermal hikes, hematuria, and positive giordano. The ultrasound found a 5 x 5 cm mass located in right kidney upper pole, which did not compromised renal capsule and presented a fresh bruise, suggesting a malignant tumor. Radical nephrectomy was satisfactory performed; sending the whole kidney to pathology and the patient was discharged within 72 hours. The histopathologic report concluded a conventional clear cell renal cell carcinoma tumor (5.5 x 4.8 cm) Fuhrman grade II, limited to the renal parenchyma. We concluded that the best treatment for this type of cancer is the radical nephrectomy even though you lose a part of the renal function. Radical nephrectomy guarantees the extraction of the whole tumor and avoids dissemination, one of the most common complications

Effectivity of the PGA rapid Atramat® and PGA Atramat® sutures for the closure of minimal invasion and abdominal-inguinal wounds in surgery

Background: The use of suture materials for the closure of wounds is a practice described in Egyptian parchments since 3500 b.C. through the use of linen, animal hair, vegetable fiber, silk, leather and others. The election of the ideal suture material has to be based in the appropriate resistance to traction, tissue biocompatibility and resorption rates..Methods: An open longitudinal clinical trial was performed with data recollection in a prospective way, in which was calculated the incidence of complications; dehiscence, wound seroma, surgical site infection hemorrhage and abscess when PGA Atramat® and PGA rapid Atramat® was employed in laparoscopic and open surgery for treatment of inguinal and umbilical plasties.Results: During the period from January 2016 to August 2016, the procedures included: 31 laparoscopic cholecystectomies, 18 laparoscopic fundoplications, 45 laparoscopic appendicectomies, 12 abdominal plasties and 16 inguinal plasties. This series shows the null incidence of complications in 31 cholecystectomies, 18 fundoplications, 16 inguinal plasties and 12 abdominal plasties.Conclusions: The employment of the PGA Atramat® and PGA rapid Atramat® sutures maintains the features of a braided, absorbable suture, and it also results a feasible and secure resource for its use in minimal invasion surgery, abdominal and inguinal plasties, showing low incidence of surgical site infection