Hepatocarcinoma originado en el lóbulo caudado. Estrategia quirúrgica para su resección. A propósito de un caso

ResumenAntecedentesEl hepatocarcinoma originado en el lóbulo caudado tiene un peor pronóstico que otros originados en otros sitios del hígado. La resección aislada del lóbulo caudado hepático representa un reto técnico importante y puede ser realizada junto con una lobectomía hepática o una resección aislada del mismo. De esta última existen muy pocos reportes al respecto. Presentamos el caso de una resección aislada exitosa de hepatocarcinoma en el lóbulo caudado con sobrevida a largo plazo.Caso clínicoMujer de 74 años, con lesión ocupante de 8cm en el lóbulo caudado, sin datos clínicos o bioquímicos de cirrosis hepática, alfafetoproteína sérica 3.7 U/l, y serologías de hepatitis negativas. Resección completa de la lesión en 270min con maniobra de Pringle por 13min, evolución satisfactoria, y alta al décimo día posquirúrgico. Asintomática, sin deterioro de la función hepática y sobrevida sin actividad tumoral 48 meses después del procedimiento.ConclusiónLa resección aislada del lóbulo caudado es un procedimiento infrecuente y técnicamente posible. Para realizarse de forma exitosa, se debe de tener un conocimiento detallado de la anatomía hepática completa y en especial de este lóbulo. Se deben obtener márgenes negativos tumorales para otorgar la mayor sobrevida a los pacientes que tienen una neoplasia en esta localización anatómica.AbstractBackgroundHepatocellular carcinoma originating from the caudate lobe has a worse prognosis than other hepatocellular carcinomas in another segment of the liver. An isolated caudate lobe resection of the liver represents a significant technical challenge. Caudate lobe resection can be performed along with a lobectomy, or as an isolated liver resection. There are very few reports about isolated caudate lobe liver resection. The case is reported here of a successful isolated resection of hepatocellular carcinoma in the caudate lobe with excellent long-term survival.Clinical caseA 74 year-old female with 8 cm mass lesion in the caudate lobe with no clinical or biochemical evidence of liver cirrhosis (serum alpha-foetoprotein 3.7 U/L, and negative hepatitis serology), was evaluated for surgery. A complete resection of the lesion in 270 minutes, with Pringle manoeuvre for 13 minutes, was satisfactorily performed. The patient was discharged ten days after surgery without complications, and is currently asymptomatic, with no deterioration of liver function and 48 months tumour-free survival after the procedure.ConclusionIsolated caudate lobe resection is an uncommon, but technically possible procedure. In order to achieve a successful resection, detailed knowledge of complete liver anatomy is essential. Tumour free margins must be obtained to provide long survival for these patients that have a malignancy in this anatomic location

Surgical treatment of liver haemangiomas in a third level hospital in south-east Mexico

AbstractBackgroundLiver haemangiomas are the most common benign tumours, commonly presented in women and considered giant when their diameter surpasses 4cm. They are mostly asymptomatic and incidentally found. They manifest with abdominal pain and mass effect. These tumours can be managed by observation, enucleation, resection, and embolisation.ObjectiveTo determine the experience in our unit as regards the treatment and post-surgical outcomes of patients with liver haemangiomas.Materials and methodsA retrospective study was performed on 14 patients with a histopathological diagnosis of liver haemangioma. An analysis was made using the sociodemographic, tumour-related and surgical related variables, as well as any complications.ResultsOf the 14 patients analyse, there were 7 males and 7 females, with a median age of 43.43±15.03 years, and a mean tumour size of 6.86±3.5cm. Eight (51.7%) of the tumours were located in the right lobe, 3 (21.4%) in the left lobe, and 3 (21.4%) in the caudate lobe. Resection was performed in 7 patients (50%), enucleation in 5 patients (35.7%), and biopsy in 2 patients (14.3). No relationship was found between sex, pathology, or tumour location. No morbidity or mortality was found.ConclusionsLiver haemangiomas in our unit have similar characteristics to those described in other studies. Surgical treatment in our hospital offers a positive outcome

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Recursos Humanos III (para administradores)

Apunte digital SUA, Licenciatura en Administración, Cuarto semestre, 1455, Plan de estudios 200

Valor predictivo de mortalidad del índice de peritonitis de Mannheim en el Hospital Regional de Alta Especialidad de Veracruz.

Objetivo: Determinar el valor predictlvo de mortalidad del índice de peritonitis de Mannheim (IPM) en pacientes posoperados del Hospital Regional de Alta Especialidad de Veracruz

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study (vol 46, pg 2021, 2022)

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Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2