Revista Argentina de Cirugía最新文献

{"title":"Editorial on New perspectives in the management of low-risk thyroid cancer. Experience with thyroid lobectomy in a cohort of 114 patients.","authors":"J. L. Novelli","doi":"10.25132/raac.v116.n2.edjln","DOIUrl":"https://doi.org/10.25132/raac.v116.n2.edjln","url":null,"abstract":"As the authors of the paper state, the management of low-risk differentiated thyroid cancer (DTC) remains controversial because of the indolent nature of the disease and the challenge of balancing morbidity of treatments with the risk of disease progression. The extent of thyroid resection is still a matter of debate: total thyroidectomy (TT) versus hemithyroidectomy (HT) (lobectomy plus isthmusectomy) using either a conventional neck incision or, in selected patients, a remoteaccess procedure, in this case the Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA)1 . In the article published in this issue, Sacco et al. report the results of an observational study analyzing retrospective data obtained from the electronic medical records of a cohort of 114 patients with low-risk DTC managed with HT though different surgical approaches (neck incision and remote transoral approach) between January 2015 and April 2023. The number of TH proced","PeriodicalId":201340,"journal":{"name":"Revista Argentina de Cirugía","volume":"79 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141395087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MILA (Minimally invasive lipoabdominoplasty) for diastasis recti. Are general surgeons and plastic surgeons fighting or playing together?","authors":"Christiano Claus, E. Palmisano","doi":"10.25132/raac.v115.n4.1774","DOIUrl":"https://doi.org/10.25132/raac.v115.n4.1774","url":null,"abstract":"In recent years, abdominal wall repair has undergone a profound transformation. It all starts with understanding that the abdominal wall, lined with muscles, does much more than just hold the abdominal organs. As such, it has been considered an organ per se. It has even been called CORE Health, a name that is clinically difficult to translate into languages such as Portuguese and Spanish. We now understand that the abdominal wall plays a vital role in maintaining body posture, urinary continence, and bowel function1. Other problems besides hernias can occur in the abdominal wall. Another issue that has attracted the attention of healthcare professionals is the separation of the rectus abdominis muscles, known as diastasis recti abdominis (DRA). This finding is relevant not only because it is a common condition, but also because of its potential impact2.","PeriodicalId":201340,"journal":{"name":"Revista Argentina de Cirugía","volume":"6 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138625516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relative risk and odds ratio: basic concepts","authors":"M. L. Iovaldi","doi":"10.25132/raac.v115.n4.cymmli","DOIUrl":"https://doi.org/10.25132/raac.v115.n4.cymmli","url":null,"abstract":"elative risk (RR) and odds ratio (OR) are wellknown concepts, but often not well understood. The aim of this article is to introduce the basic concepts in a didactic fashion, and to provide clarity on those contents that I consider fundamental for their better understanding. The RR and OR are used to compare how often a specific event happens in two different groups - one exposed to a risk factor and one not - as defined by de la asignación aleatorizada de grupos para un tratamiento u otro. En Epidemiología se crea una base de datos con los individuos incluidos y se observa la ocurrencia o no del evento en forma prospectiva. Los modelos de regresión logística generan OR, o log Odds que deben ser transformados. En los estudios prospectivos es conveniente ajustarlos a RR cuando el riego del evento de interés es mayor de 0,1 (10%) debido a la sobreestimación mencionada antes9. La lectura que se puede hacer no debe ser independiente del riesgo absoluto previamente conocido en la población y, para esto, se usa la prevalencia del evento en la población10. Si el evento es raro, un ejemplo: 0,02%, un RR o OR de 2 elevaría el riesgo de 0,02 a 0,04%. Si el evento es frecuente, por ejemplo, del 20%, al aumento del riesgo con el tratamiento o exposición, se duplica al 40%. De manera que no debemos limitarnos a los análisis de nuestra tabla porque perderíamos de vista la perspectiva de la población definida en los criterios de inclusión. Reducción del RR (RRR) Si el RR es mayor de 1 es RR – 1, si es menor de 1, es 1 – RR4,10 En este caso es 2,57 - 1 = 1,57. Eso significa, sin analizar en profundidad, que aumentaría 1,57 veces el efecto beneficioso del tratamiento, lo cual es desmentido por su intervalo de confianza. Del RR al número necesario para tratar (NNT)11 Aunque estamos ante una situación estadística limítrofe, usaré los mismos resultados para agregar otros conceptos. RAR: reducción absoluta del riesgo es la diferencia entre el riesgo de los expuestos y no expuestos, o tratamiento y placebo. Si vamos a la tabla 3, la diferencia de los riesgos absolutos entre los grupos tratamiento y placebo es 0,16 – 0,06 = 0,10. Vamos a asumir que el evento es una respuesta favorable al tratamiento. El NNT es la inversa de la RAR, 1 / RAR = 1/ 0.10 = 10. Diez es el número de pacientes para tratar a fin de lograr un paciente adicional con efecto beneficioso. Si el evento es favorable al paciente, es recomendable usar la sigla NNTB , si es desfavorable, usar NNTD con la “d” de daño (NNTH, number needed to harm). El cálculo del IC del NNT es complejo y se hace a partir del IC del RAR12. Son asimétricos porque no se ajustan a la distribución normal. Los valores están en la tabla 4. TABLA 4 Límite inf Valor Límite sup RAR 0,005 0,10 0,195 NNT 5 10 213 Tabla 4. RAR: reducción absoluta del riesgo. NNT: número necesario para tratar. Se expresan los valores y límites inferiores y superiores del IC del 95%. El NNT se redondeó con números enteros. En este caso, el resultado es r","PeriodicalId":201340,"journal":{"name":"Revista Argentina de Cirugía","volume":" 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138619779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Result of immediate prepectoral implant-based breast reconstruction","authors":"A. Rancati, C. Angrigiani, J. Dorr, Carlos Butto, Gonzalo Lamas, Facundo Alvarado, Eliana Parapar, A. Rancati, Marcelo Bou","doi":"10.25132/raac.v115.n4.1731","DOIUrl":"https://doi.org/10.25132/raac.v115.n4.1731","url":null,"abstract":"Background: Prepectoral implant-based breast reconstruction has recently been added to the armamentarium for breast reconstruction. This technique provides natural-looking breasts, avoids complications, such as animation deformity, and reduces postoperative pain. Objective: The aim of this study was to describe the surgical outcomes in a series of patients undergoing immediate prepectoral breast reconstruction with silicone implants. Material and methods: A descriptive and retrospective study was carried out with review of the medical records and pathology reports of patients who underwent surgery using the described technique for invasive carcinoma, non-invasive carcinoma, and sarcoma of the breast from March 2018 to December 2021. All the patients were evaluated preoperatively with digital mammography and had fat coverage thickness in the operated breast > 2 cm. Results: A total of 52 reconstructions were performed on 40 patients. Mean age was 52 age (range 3076). The nipple sparing mastectomy was undertaken in all the cases. There were no major complications during the 40-month average follow-up. None of the patients experienced animation deformity, implant displacement, or rotation. After one year of follow-up, three patients who underwent postmastectomy radiotherapy showed grades III and IV capsular contracture. The aesthetic results were excellent and good in 40 breasts (80.0%), fair in 8 breasts (12.0%) and insufficient in 4 breasts (8.0%). Four breasts (7.7%) required surgical revision in the immediate postoperative period. Conclusions: Immediate prepectoral implant-based breast reconstruction is a feasible technique with enduring results and high level of satisfaction.","PeriodicalId":201340,"journal":{"name":"Revista Argentina de Cirugía","volume":" 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138615733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic intestinal failure due to short bowel syndrome: current role of surgery, medical rehabilitation, and intestinal transplantation. A progress report after 16 years of multidisciplinary management","authors":"G. Gondolesi, D. Terán, M. Ortega, C. Rumbo, D. Ramisch, H. Solar","doi":"10.25132/raac.v115.n4.1724","DOIUrl":"https://doi.org/10.25132/raac.v115.n4.1724","url":null,"abstract":"decades, medical treatments and surgical procedures have been incorporated, developed and improved under the name intestinal rehabilitation. When performed by multi- and interdisciplinary teams, these treatments have high success rates. Objective: The aim of present study is to describe the 16-year outcomes in the management of patients with CIF secondary to short bowel syndrome (SBS) and the role of surgery, medical rehabilitation, and transplantation. Material and methods: We conducted a retrospective analysis on a prospective database of patients treated with chronic intestinal failure due to SBS between February 2006 and March 2022. Results: A total of 492 patients (368 adults (Group A) and 124 pediatric patients (Group B)] were included. Group A: 111 patients underwent autologous gastrointestinal reconstruction surgery (AGIRS), 16 were treated with semisynthetic glucagon-like peptide-2 (sGLP2); 83% achieved rehabilitation, with 77% survival at 10 years; 6.8% (17 patients) required intestinal transplantation (ITx), with 89% independence from parenteral nutrition (PN) at 1 year and post-ITx survival of 29% at 10 years. Group B: 18 patients underwent AGIRS; 9 underwent serial transverse enteroplasty (STEP); and 6 received sGLP2; 52% were rehabilitated, with 69% survival at 10 years; 28 patients received ITx, with 69% independence from PN at 1 year and 39% survival at 10 years. Conclusion: These results highlight the central role of surgery and medical rehabilitation in the recovery of intestinal function.","PeriodicalId":201340,"journal":{"name":"Revista Argentina de Cirugía","volume":" 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138619309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated pulmonary metastases from pancreatic ductal adenocarcinoma: a population with prolonged survival","authors":"Mateo Lendoire de Undurraga, Gabriel Weber, Cristian A. Angeramo, Pablo Capitanich","doi":"10.25132/raac.v115.n4.1681","DOIUrl":"https://doi.org/10.25132/raac.v115.n4.1681","url":null,"abstract":"The incidence of isolated pulmonary metastases in pancreatic ductal adenocarcinoma is about 13%. Resection of these metastases is uncommon; however, patients presenting only with pulmonary metastases have better survival compared to those with metastases on other locations. We report the case of a female patient who underwent lobectomy for metastases from pancreatic ductal adenocarcinoma. After resection, disease-free interval and specific diseases-free survival were 84 and 152 moths, respectively. We consider that the next step in the treatment of this subpopulation of patients is to select those patients with favorable tumor biology who would benefit from a more aggressive approach.","PeriodicalId":201340,"journal":{"name":"Revista Argentina de Cirugía","volume":" 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138618395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rivera’s condom technique for the management of enteroatmospheric fistula","authors":"Sebastián Fraga","doi":"10.25132/raac.v115.n4.1634","DOIUrl":"https://doi.org/10.25132/raac.v115.n4.1634","url":null,"abstract":"Many devices have been described to collect the effluent from an enteroatmospheric fistula. We can summarize that devices can be manufactured or handmade, expensive or affordable, or vacuum assisted or not. Additionally, they may allow the patient to ambulate or may not assist with postoperative mobility. When facing this condition, several attempts are typically made to obtain a suitable device before discovering the right one for each individual patient. We present the case of a 60-yearold woman with an enteroatmospheric fistula successfully managed using Rivera’s condom technique.","PeriodicalId":201340,"journal":{"name":"Revista Argentina de Cirugía","volume":" 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138618531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: laparoscopic liver resections: a descriptive study of our 16-year experience","authors":"Pablo Barros Schelotto","doi":"10.25132/raac.v115.n4.edpbs","DOIUrl":"https://doi.org/10.25132/raac.v115.n4.edpbs","url":null,"abstract":"Laparoscopic liver resections (LLRs) are steadily evolving. Any liver resection can be performed laparoscopically, depending on the experience of the surgical team and the hospital environment in which the practice is performed. There is scientific evidence that LLRs has better surgical outcomes than conventional hepatectomies, and the oncological results are noninferior1-3. The study presented by Alesandrini A et al. shows the experience of a pioneering team in our country in minimally invasive liver surgery4. One of the most significant findings is the 75% applicability rate of the method. This percentage is really very high and is one of the highest in our region. We must keep in mind that these results cover the initial stage of their experience. According to a publication by J. Pekolj some years ago, reviewing the experience in South America, the average applicability rate of LLRs in the region ranges from 4 to 85%5.","PeriodicalId":201340,"journal":{"name":"Revista Argentina de Cirugía","volume":"95 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138622278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic liver resections: a descriptive study of our 16-year experience","authors":"Agustín A. Alesandrini, Fernanda V. Bersano, Miguel A. Statti, Enrique Canepa Mukdise","doi":"10.25132/raac.v115.n4.1736","DOIUrl":"https://doi.org/10.25132/raac.v115.n4.1736","url":null,"abstract":"Background: Improvements in laparoscopic surgery have led to more rapid progress in laparoscopic liver resections. The indications of this approach are still matter of debate. Objectives: The aim of the present study is to describe the results obtained in series of patients undergoing laparoscopic liver resections. Material and methods: We conducted a descriptive, observational and analytical study. We evaluated a series of patients undergoing laparoscopic liver resection categorized by Iwate criteria between January 2005 and October 2021. The demographic variables, diagnosis, type of approach, intraoperative findings, clinical and technical aspects and complications, were analyzed. Results: Of 159 patients undergoing hepatectomies, 120 procedures were performed laparoscopically (applicability rate 75%) and were divided into four groups according to the Iwate scoring system: low (difficulty index 0–3), 23 patients (19%); intermediate (difficulty index 4–6), 48 patients (40%); advanced (difficulty index 7–9), 33 patients (28%); and expert (difficulty index 10–12). 16 patients (13%). Median age was 62 years. The rate of Clavien-Dindo complications ≥ grade 3 was 14.28% and mortality rate was 2.5%. In resections of colorectal liver metastases disease-free survival was 75%, 59%, 46% at 1, 3 and 5 years, respectively, and overall survival was 93%, 79% and 69%, at 1, 3 and 5 years, respectively. Conclusions: Laparoscopic liver resection resulted a feasible and safe technique and should be performed by trained surgeons, in specialized centers and with long learning curves to increase the applicability rate from the simplest resections to the most complex ones. Careful selection of patients is required to ensure their safety.","PeriodicalId":201340,"journal":{"name":"Revista Argentina de Cirugía","volume":" 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138620977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver resection for the treatment of complex bile duct injury","authors":"José G. Cervantes, E.G. Quiñonez, M. C. Beltrame, M. del Bueno, M.E. Lenz Virreira, F. J. Mattera","doi":"10.25132/raac.v115.n4.1679","DOIUrl":"https://doi.org/10.25132/raac.v115.n4.1679","url":null,"abstract":"Bile duct injury represents a serious health problem, with its incidence doubling since the advent of laparoscopic cholecystectomy. In cases of complex lesions affecting the hepatic confluence, association with vascular injuries, hepatic atrophy, cholangitis or failed repair, treatment is often challenging. We report the case of a female patient with a complex bile duct injury due to vascular involvement of the right hepatic pedicle who developed right liver atrophy. In the presence of septic complications, hepatectomy was necessary, along with a definitive repair of the biliary tract, resulting in positive outcomes.","PeriodicalId":201340,"journal":{"name":"Revista Argentina de Cirugía","volume":"30 48","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138624803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}