The late results of primary repair of accidental injuries to the common bile duct occurring during cholecystectomy were evaluated in 53 cases. These lesions occurred in 20 patients who had distal perforation produced by the Bakes dilator, in 17 cases with accidental tearing of the anterior or posterior wall of the common bile duct, and in 16 cases in whom the common bile duct was accidentally ligated or sutured. In cases of perforation, choledochostomy plus suturing of the perforation had a high operative mortality and 4 out of 6 cases developed benign stricture soon after surgery. When sphincteroplasty or choledochoduodenostomy was added, a stricture developed in only 1 out of 7 cases. In cases with accidental tears, suturing of the lesion plus choledochostomy produced very good late results. In patients with accidental ligation or suturing of the common bile duct, two different postoperative complications were seen: seven cases had biliary fistula and all developed benign stricture 2 years after surgery. In nine cases jaundice appeared 6 months after surgery, and a benign stricture developed in 7 of them. The most important "treatment" of these lesions is to prevent them from occurring during cholecystectomy by employing a meticulous surgical technique.
Introduccion: El uso de drenajes abdominales en cirugia gastrica ha sido una practica habitual desde hace mucho tiempo. Objetivos: Determinar el debito diario de los drenajes colocados alrededor del sitio quirurgico en pacientes con obesidad morbida sometidos a cirugia laparotomica. Material y Metodo: Estudio prospectivo, descriptivo que analizo a 359 pacientes con obesidad morbida sometidos a bypass gastrico con reseccion del segmento gastrico distal. Se midio el debito diario en ml/24 a traves del drenaje que se coloca a derecha e izquierda de la anastomosis. Se excluyeron pacientes con fistula anastomotica u otra complicacion abdominal. Resultados: El drenaje colocado a la derecha de la anastomosis presento un volumen inicial de 50 ml/24, que al 5 dia fue menor a 20 ml/24, retirandolo en ese momento. El drenaje izquierdo tuvo un mayor volumen inicial, siempre de tipo seroso o serohematico, retirandolo en promedio al 6 dia postop. No hubo ninguna complicacion derivada del uso de estos drenajes. Conclusiones: La colocacion y uso rutinario de drenajes abdominales despues de un bypass gastrico abierto no produce ninguna complicacion derivada de su empleo. Por otra parte, permite determinar el volumen diario y el tipo de secrecion que se obtiene, permitiendo eventualmente manejar alguna complicacion sin necesidad de una reoperacion
Laparoscopic antireflux surgery is a minimally invasive procedure that should have similar results than classical surgical treatment.To report the results of a prospective study of laparoscopic antireflux surgery in patients with gastroesophageal reflux.Thirty two patients with gastroesophageal reflux and without Barret's esophagus, were subjected to endoscopy, manometry and measurement of intraesophageal pH before and after laparoscopic surgery.There were no postoperative deaths or complications. Gastroesophageal sphincter pressure and abdominal sphincter length increased from 9.1 +/- 3.9 to 13.0 +/- 3.5 mm Hg and from 8.1 +/- 6.2 to 13.5 +/- 5.4 cm after surgery (p < 0.01). There was a decrease in acid reflux in 82% of patients.Laparoscopic antireflux surgery reproduces exactly the results of open surgical procedures.
Introduccion: La obesidad esta asociada a multiples comorbilidades, entre ellas la patologia respiratoria, que puede verse incrementada despues de realizar cirugia bariatrica. Objetivo: Evaluar en forma prospectiva las alteraciones en la funcion pulmonar pre y postoperatorias, de pacientes obesos morbidos operados con bypass gastrico por via laparotomica y laparoscopica. Material y Metodo: 39 pacientes consecutivos con obesidad morbida sometidos a bypass gastrico, divididos en 2 grupos: el primero formado por 24 pacientes operados por via laparotomica y el segundo por 15 pacientes operados por via laparoscopica, con evaluacion pre y postoperatorias de radiografia de torax, espirometria y gases arteriales. Resultados: En el postoperatorio un incremento significativo de atelectasias, presentandose en el 1er grupo con cirugia abierta en 45,8% de casos y en el 2° grupo con cirugia laparoscopica en el 33,3%. Aumento del patron restrictivo a 41,7% en el 1er grupo y 33,3% de casos en el 2° grupo. Una disminucion en ambos grupos de la capacidad vital forzada (CVF) y alteraciones en los gases arteriales con descenso mantenido de PaC02 en 36,5 mmHg en el 1er grupo y 33,8 mmHg en el 2° grupo. Conclusiones: Con la cirugia del bypass gastrico en obesos morbidos, por via laparotomica o laparoscopica se producen cambios en la funcion pulmonar postoperatoria, presentandose atelectasia, patrones espirometricos restrictivos, capacidad vital forzada disminuida y alteraciones en la Pa02 y PaC02. Esta ultima tiene significacion estadistica.
Computational Structural Dynamics (CSD) simulations, Computational Fluid Dynamics (CFD) simulation, and Fluid Structure Interaction (FSI) simulations were carried out in an anatomically realistic model of a saccular cerebral aneurysm with the objective of quantifying the effects of type of simulation on principal fluid and solid mechanics results. Eight CSD simulations, one CFD simulation, and four FSI simulations were made. The results allowed the study of the influence of the type of material elements in the solid, the aneurism’s wall thickness, and the type of simulation on the modeling of a human cerebral aneurysm. The simulations use their own wall mechanical properties of the aneurysm. The more complex simulation was the FSI simulation completely coupled with hyperelastic Mooney-Rivlin material, normal internal pressure, and normal variable thickness. The FSI simulation coupled in one direction using hyperelastic Mooney-Rivlin material, normal internal pressure, and normal variable thickness is the one that presents the most similar results with respect to the more complex FSI simulation, requiring one-fourth of the calculation time.
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