Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Introduction: Acute diverticulitis is the most frequent complication of diverticular colon disease and cause of hospitalizations. Its treatment has been assessed in recent years; there is a tendency to limit surgical treatment and promote conservative treatment instead.Objective: To review the applicability, safety and efficacy of outpatient treatment of acute uncomplicated diverticulitis in selected patients.Methods: A bibliographic review was carried out in sources of information available in the SciELO and Medline (Pubmed) databases, as well as in Google Scholar, by means of which a total of 36 references were selected.Development: Historically speaking, patients diagnosed with acute diverticulitis have been admitted to hospitals for study and dietary, antibiotic and analgesic treatment. In recent years, there has been a growing tendency worldwide to treat these patients on an outpatient basis once it has been proven that the condition is not complicated, which has shown, with level of evidence, that patients present a favorable evolution without the need for admission, with less expenses for the health system.Conclusions: Outpatient treatment of acute uncomplicated diverticulitis is not only effective and safe, but also applicable in most patients, given that they can tolerate oral intake and have an adequate family environment.

Introduction: Chronic anal fissure is a frequent entity that produces discomfort during and after defecation. Its pathophysiology is not clear and its management is varied. Lateral internal sphincterotomy is one of the most used techniques, although its high percentage of incontinence is not accepted; botulinum toxin injection is therefore a tempting alternative.Objective: To compare the results of botulinum toxin type A injection or lateral internal sphincterotomy for treatment of anal fissure in terms of postoperative pain, recurrence, healing and incontinence.Methods: A cohort study was carried out. One group of 40 patients were treated with injection of 50 IU of botulinum toxin type A and another group of 42 patients underwent lateral internal sphincterotomy. The results were statistically compared with a confidence interval of 95% and error of 0.05.Results: Sphincterotomy and botulinum toxin were effective in terms of healing in 85.4% and 77.5% of cases, respectively. Recurrences occurred in 4.8% and 12.5% of cases, respectively. Incontinence occurred in 9.5% and 2.5% of cases, respectively. Postoperative pain was present in 14.8% and 5.0% of cases, respectively.Conclusions: Sphincterotomy was better in terms of healing and recurrence, while botulinum toxin application showed better results regarding fecal incontinence and postoperative pain.

Introduction: Open pancreatic necrosectomy is a surgical technique used in necrosis infection.Objective: To identify the factors related to prognosis in patients operated on under the diagnosis of acute necrotizing pancreatitis.Methods: A prospective cohort study was carried out in patients operated on under the diagnosis of acute necrotizing pancreatitis, in the intensive care unit of Carlos Manuel de Céspedes General University Hospital of Bayamo, Granma, Cuba, in the period 2018-2020. Sixty-one patients with this diagnosis were included. Demographic, clinical, humoral and surgical variables were studied. A bivariate and multivariate strategy was used.Results: In the bivariate analysis, the influence of age (relative risk [RR]=3.34; 95% confidence interval [CI]: 0.17-0.68) and tomographic severity index (RR=1.85; 95% CI: 0.66-2.37), as well as multiple organ dysfunction (RR=5.06; 95% CI: 1.08-2.15), early surgery (RR=2.78; 95% CI: 1.00-3.34) and necrosis infection (RR=6.60; 95% CI: 1.01-5.23) were highlighted. In the multivariate logistic regression model, multiple organ dysfunction (RR=6.58; 95% CI: 2.40-18.08) and infection of necrosis (RR=14.20; 95% CI: 5.93-34.01) were included as independent variables associated with prognosis.Conclusions: Mortality analysis evidenced that the factors that showed significant association were multiple organ dysfunction and necrosis infection.

Introduction: The increase of anal cancer in high-risk populations leads to the implementation of protocols to perform early diagnosis and follow-up of anal intraepithelial neoplasia.Objective: To evaluate the results of the application of the national consensus for anal cancer prevention in Cuba.Methods: A prospective longitudinal study was conducted with 43 patients at high risk of intraepithelial anal neoplasia cared for in the coloproctology consultation at Comandante Manuel Fajardo Clinical Surgical University Hospital, from 2018 to 2019. They were evaluated at the time of diagnosis and at six months. Anal cytology studies (normal, low- and high-degree lesions, and atypical epidermoid cells of uncertain significance), anorectal digital examination and high resolution anoscopy (normal, types I-II and III) were performed.Results: 53.5 % of the results were normal. In abnormal anal cytology findings, low-degree lesion had the highest percentage (50 %). Anal intraepithelial neoplasia type I was the most frequent (52.9 %). Of the patients followed up at six months, the majority had abnormal anal cytology results (55.6 %); 70 % had low-degree lesions. The anorectal digital examination was normal in all cases. The predominant risk factors were anal penetrative sex and male-to-male sex, including that all had had human papillomavirus.Conclusions: The protocol allowed the identification of primarily low-degree lesions. Risk factors influence the appearance of this neoplasm.

Introduction: Inguinal hernia surgery is one of the most common procedures worldwide. 80 % of them are estimated to be performed under regional or general anesthesia; while 20 % are performed under local anesthesia, contrary to the recommendation of international societies, which accept that most of the patients are candidates for this method.Objectives: To describe the local anesthetic technique applied by the surgeon himself, exposing its advantages and disadvantages supported by the relevant evidence available.Methods: A hybrid narrative review was carried out. The anesthetic method used by our group was described. At the same time, a search was performed in the main databases to identify the research supporting and defending the technical aspects and the taken clinical decisions.Development: There are no absolute contraindications for the selection of local anesthesia; most of them are relative. The anesthetic to be used is lidocaine, although adjuvants can be taken into account. Pre- or intraoperative sedation is not recommended. The anesthetic method involves the subcutaneous phase with a field block technique and the deep incisional phase with tumescent infiltration.Conclusions: The use of local anesthesia for inguinal hernia surgery though an anterior approach can be considered as the first choice; it is more economical, while urinary and cardiovascular complications are reduced. To achieve a surgery of equal quality to another method of anesthesia, it is important to master the anesthetic technique

Introduction: Trauma is the pandemic that every year claims many lives; technological advances have not been able to stop it, but have contributed with the more effective assessment of patients. Ultrasound performed by non-radiologists physicians has become a necessary tool in the assessment of the trauma patient.Objective: To describe the knowledge that the general surgeon should acquire to perform ultrasound for assessing trauma.Methods: A bibliographic review of the subject was carried out in the PubMed, BVS-BIREME and Cochrane databases. The elements that the general surgeon must know in order to perform ultrasound in the assessment of trauma were described. The search considered all types of studies published from January 1971 to December 2019 and that could be accessed; the internal validity of the evidence was assessed, together with its overall quality. The languages used in the search were English and Spanish.Development: Most studies accept ultrasound as an assessment tool in trauma and its systematic use by non-radiologist physicians.Conclusions: The basic principles of ultrasound in trauma have to be part of the tools of a general surgeon of the twenty-first century. The most frequent errors are due to lack of systematic use and lack of training. Contraindications of ultrasound in trauma are progressively less frequent, but there is a marked dependence on the person who operates.

Introduction: The reduction of the width and definition of the nasal tip is one of the main objectives of aesthetic rhinoplasty. The endonasal route, with a transcartilaginous incision, is mainly used when there are no significant alterations in the cartilaginous structure of the nasal tip.Objective: To determine the morphological changes that occur in the nasal tip after transcartilaginous rhinoplasty.Methods: A descriptive, prospective, longitudinal study was carried out in 15 patients with aesthetic deformity of the nasal tip, who were operated by transcartilaginous rhinoplasty at Hermanos Ameijeiras Hospital, from 2016 to 2020. The variables studied were nasolabial angle, width of the nasal tip, percentage of reduction in the width of the nasal tip, relationship between the nasal length and the projection of the nasal tip, and the patients' satisfaction status.Results: There was a narrowing of the nasal tip, starting from a preoperative mean width of 64.8% in relation to the nasal base, to a postoperative mean of 60.1%, resulting in a mean percentage reduction in width of the postoperative nasal tip of 7.3%. No variation was observed regarding the predominance of the ideal categories in the rest of the variables studied, even when there were individual changes, as a group.Conclusions: Postoperative modifications were produced that contributed to a refinement of the nasal tip, with a high degree of satisfaction of the operated patients.Keywords: endonasal rhinoplasty; modification of the nasal tip; anthropometric measurements.

Introduction: Minimally invasive pancreatic surgery is framed within the current history of surgery with great impact and development, especially in the field of distal pancreatectomies.Objective: To update the general and current aspects of minimally invasive surgery in pancreatic disorders.Methods: A systematic review was carried out based on the consultation of scientific articles about the subject, indexed in the Pubmed, Ebsco and SciELO databases. The information was analyzed and articles published up to 2020 were selected, related to the indications for laparoscopic and robotic surgery in pancreatic conditions, the variability of laparoscopic surgical procedures, as well as morbidity and mortality.Development: Minimally invasive pancreatic surgery has reached considerable levels of complexity and safety (from diagnostic laparoscopy to large pancreatic resections). The indications for laparoscopic and robotic surgery in pancreatic disorders, together with the variability of laparoscopic surgical procedures, are identified, and the procedures performed at the National Center for Minimally Access Surgery during the last three years by the group dedicated to this entity are presented.Conclusions: Minimally invasive surgery and robotic surgery in pancreatic affections can offer satisfactory outcomes, as long as they are performed by surgeons with experience in hepatobiliopancreatic surgery and laparoscopic surgery. It guarantees a much lower risk of intervention and optimal recovery in the shortest possible time, with similar outcomes in terms of morbidity and mortality to conventional surgery. 

Introduction: Pylephlebitis, septic thrombosis of the portal system due to acute abdominal inflammatory conditions, it presents with variable clinical signs depending on the cause of origin and the affected portal branch. Diagnosis includes normal or mildly impaired liver function with leukocytosis, positive blood cultures, Doppler echocardiography, or computed tomography confirming the disease.Objective: To describe pylephlebitis as an unusual complication in a pregnant patient with acute appendicitis, referring to its concept, pathophysiology, clinical presentation, diagnosis and therapeutic measures.Clinical case report: This is the case of an 18-year-old female pregnant patient, who had severe abdominal pain, accompanied by vomiting, diarrhea and jaundiced stools. For such reasons, she was transferred to the Ambato General Teaching Hospital. Sepsis of abdominal origin was diagnosed due to acute perforated appendicitis, generalized peritonitis complicated with pylephlebitis. Surgical intervention was performed and the clinical condition was solved.Conclusions: Pylephlebitis represents a great diagnostic difficulty, hence tools such as Doppler ultrasound and computed tomography are helpful in these cases. The mainstays of treatment include control of the abdominal septic focus and treating pylephlebitis.Keywords: appendicitis; pregnancy; pylephlebitis; tomography.

Introduction: Wilkie syndrome is a rare cause for upper intestinal obstruction, due to a compression of the duodenum between the abdominal aorta and the superior mesenteric artery, of difficult preoperative diagnosis. Barium study and arteriography are the gold-standard diagnostics. Conservative management has been preferred in individuals with short time of evolution. However, those with chronic disease usually require correction by surgical intervention.Objective: To present the management of a patient diagnosed with Wilkie syndrome.Case report: A 57-year-old male patient with emetic syndrome and weight loss of more than three months of evolution. Gastroduodenoscopy showed dilatation of the second duodenal portion due to probable extrinsic compression, while the contrast series revealed stop at the duodenojejunal junction. A transmesocolic latero-lateral duodenojejunostomy was performed, without neighboring drainage and with favorable evolution.Conclusions: A high index of suspicion is required for an accurate diagnosis of this entity. Duodenojejunostomy is the surgical procedure that offers the best outcomes.