Malla profiláctica versus sutura simple en el cierre del trocar umbilical tras colecistectomía laparoscópica en pacientes de alto riesgo para eventración

El uso de material protésico en el tratamiento de hernias y eventraciones se encuentra actualmente estandarizado y considerado como técnica gold standard. Sin embargo, el cierre mediante colocación de prótesis profiláctica para la prevención de la eventración de los orificios de los trocares (EOT) se encuentra todavía en debate. Por ello nos planteamos definir un grupo de pacientes de alto riesgo para la aparición de eventración, que podría beneficiarse de un cierre diferente a nivel de la aponeurosis, para comparar el cierre del orificio umbilical con malla, con el cierre convencional con puntos sueltos, respecto a la aparición de eventración postoperatoria

Effect of preoperative immunonutrition on postoperative major morbidity after cytoreductive surgery and HIPEC in patients with peritoneal metastasis

The effect of preoperative immunonutrition intake on postoperative major complications in patients following cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) was assessed. The accuracy of C-Reactive Protein (CRP) for detecting postoperative complications was also analyzed. Patients treated within a peritoneal carcinomatosis program in which a complete or optimal cytoreduction was achieved were retrospectively analyzed. They were divided into two groups based on whether preoperative immunonutrition (IMN) or not (non-IMN) were administered. Clinical and surgical variables and postoperative complications were gathered. Predictive values of major morbidity of CRP during the first 3 postoperative days (POD) were also evaluated. A total of 107 patients were included, 48 belonging to the IMN group and 59 to the non-IMN group. In multivariate analysis immunonutrition (OR 0.247; 95%CI 0.071–0.859; p = 0.028), and the number of visceral resections (OR 1.947; 95%CI 1.086–3.488; p = 0.025) emerged as independent factors associated with postoperative major morbidity. CRP values above 103 mg/L yielded a negative predictive value of 84%. Preoperative intake of immunonutrition was associated with a decrease of postoperative major morbidity and might be recommended to patients with peritoneal carcinomatosis following CRS. Measuring CRP levels during the 3 first postoperative days is useful to rule out major morbidity