Browsing by Autor "Ricardo Nassar"

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Appendiceal Phlegmon as an intraoperative finding: A retrospective analysis
(Research Square (United States), 2023) Danny Conde; Lina Rodríguez; David Venegas; C. Rey; Ricardo E. Núñez-Rocha; Ricardo Nassar; Marco Vanegas; Catalina Monsalve; Pablo Pinzón; Felipe Girón
Abstract Background Emergency procedures due to acute surgical abdomen correspond to a great part of emergency surgeries. Appendicitis is the most common abdominal surgical emergency in the world. Intraoperative findings can represent a challenging scenario for the surgical team and its decisions. Appendiceal phlegmon/plastron presents in 3.8-7% of patients with appendicitis and can be considered as a challenging surgical scenario where expertise may gain a fundamental value in terms of decision-making process. Therefore, we present clinical courses and outcomes of 40 patients that underwent emergency surgery with these intraoperative findings from 2016 to 2018. Methods Retrospective study with a prospective database in which we described patients with emergent need for surgical procedure due to peritoneal signs with surgical findings of appendiceal phlegmon. Multivariate analysis was performed to prove the relationship between obesity, diabetes, and surgeon experience with any complication and colonic resection. Results 40 patients underwent surgical procedure due to peritoneal signs with intraoperative findings of appendiceal phlegmon. Mean age was 51.9 (± 20.4). Procedures were performed based on intraoperative findings being appendectomy the most frequent (85%), followed by right hemicolectomy (10%) and partial cecum resection (5%). Three patients required reintervention. No mortalities were documented. Surgeries performed by junior surgeons have a higher probability to require colonic resections (P = 0.05, OR 4.05 ,95% CI), also obesity is associated with complications (P = 0.04, OR 1.44, 95% CI). Conclusion Finding of appendiceal phlegmon constitute a challenging surgical scenario in daily practice. Our patient’s complication rates are similar to those described in literature despite its emergent circumstances. Surgeons' expertise appears to be associated with outcomes. Further studies are needed to give clear recommendations.
Association between clinical and surgical variables with postoperative outcomes in patients treated for intestinal obstruction for non-malignant conditions: a cross-sectional study
(Research Square (United States), 2022) Felipe Girón; Carlos Eduardo Rey Cháves; Lina Rodríguez; Roberto Javier Rueda‐Esteban; Ricardo E. Núñez-Rocha; Juan Daniel Pedraza; Danny Conde; Marco Vanegas; Ricardo Nassar; Juan David Hernández
Abstract Background: Intestinal obstruction is considered a frequent surgical pathology related to previous surgical procedures. Many different factors can lead to different outcomes when surgical management is needed. Therefore, we aim to describe the factors related to morbidity and mortality in surgical management of IO in a single-center experience. Methods: Retrospective observational study with a prospective database, in which we described patients who underwent surgical management due to intestinal obstruction between 2004 and 2015. Demographics, perioperative data, surgical outcomes, morbidity, and mortality were described. Results: 366 patients were included. Female were 54.6%. Mean age was 61.26. Laparoscopic approach was done in 21.8 % and the conversion rate was 17.2%. Intestinal resection was performed in 37.9% of the cases. Postoperative complications were observed in 18.85%. Reintervention and mortality were 9.5% and 4.1% respectively. Laparoscopic approach shows lesser time of intestinal transit (mean 28.67 vs mean 41.95 hours), and restart of oral intake after surgery (mean 96.06 vs mean 119.65) compared with open approach. Increased heart rate and intensive care unit length of stay were related with mortality (p 0.01 and 0.000 respectively). For morbidity, laparotomy and need and duration of ICU stay were related with any complication statistically significant (p 0.02, 0.008, 0.000 respectively). Conclusion: Patients with increased heart rate in the emergency room, decreased amount of intravenous fluids, need and higher length of stay in the intensive care unit, and delay in resuming oral intake after surgery appear to have poor outcomes. Laparoscopic approach seems to be a safe and feasible approach for intestinal obstruction.
Gastric Plication Failure: A retrospective analysis
(Research Square (United States), 2022) Ricardo Nassar; Felipe Girón; Lina Rodríguez; Carlos Eduardo Rey Cháves; David Venegas; Marco Vanegas; Danny Conde; Alberto Ricaurte; Ricardo E. Núñez-Rocha; Juan David Hernández
Abstract Background Obesity has evolved into a worldwide disease affecting millions of patients. This condition is related to a wide variety of health problems such as diabetes, hypertension, aterosclerotic disease, among others. There is a wide range of methods for managing obesity, varying from medical to surgical interventions. Even though bariatric surgery is not a one size fits all solution, since its advenment it has become an excellent option for those living with obesity. Although its low cost is very appealing, the high need of re-intervention and complications (70% according to literature) have led to controversy surrounding the use of gastric plication. The aim of this study is to describe the characteristics, experience and outcomes of patients with history of gastric fundoplication that required reintervention between 2014 and 2020 in our institution. Methods We conducted a retrospective observational study with a prospective database. We included patients that developed complications from a previous gastric plication. Revision to laparoscopic sleeve gastrectomy was made. Data regarding baseline and evolution were obtained and analyzed. Revision cause, perioperative outcomes, intraoperative characteristics, complications and weight loss were variables included in the surgical analysis. Post-operative follow-up was done up to 5 years. Results Seventeen patients required revisional surgery. Mean age of the patients was 39.71 years, 52.9% were men and 47.1% were women. In the first consultation the main concerns were weight regain (88.2%), and abdominal pain (82.3%). 47% of the patients reported dyspepsia and 47.1% had symptoms related to nausea and emesis. Mean body mass index in the group was 31.2 kg/m² before reintervention, 27.6 kg/m² 6 months after surgery and 24.1 kg/m² 5 year after surgery. All the patients had abdominal adhesions as intraoperative findings, 41.17% had severe inflammation and 1 patient (5.8%) had a gastroesophageal fistula. Conclusions In our series, gastric plication failure was mainly associated with abdominal pain and weight regain. Revisional surgery proved to be a safe and effective alternative for management of complications after this procedure.
How I do It: Knot Placement Technique for Self-Gripping Mesh in Totally Extraperitoneal (TEP) Inguinal Hernia Repair
(Research Square (United States), 2022) Ricardo Nassar; Felipe Girón; Ricardo E. Núñez-Rocha; Carlos Eduardo Rey Cháves; Lina Rodríguez; Agustín Pérez; Mario Alberto Latiff; Juan David Hernández
Abstract Background Surgical Inguinal hernia repair techniques are constantly evolving. Mesh fixation and placement remain cornerstones of the procedures. The use of self-gripping mesh has shown a significant reduction in postoperative pain and complications. However, technical difficulties arise, and multiple deployment methods have been described, with no consensus. Therefore, in this study, we present a novel preparation, deployment, and placement technique for self-gripping mesh during laparoscopic inguinal hernia repair, with its consequent outcomes and follow-up. Methods The self-gripping mesh is folded in half, non-absorbable sutures are placed in each distal portion and in the middle of the mesh, making sure the knot lies in the non-adherent surface. Corners are rounded. Mesh is rolled using the “tobacco technique”. The mesh is then placed with the laparoscopic grasper inside the preperitoneal cavity and is unrolled from medial to lateral. Results 142 patients underwent totally extraperitoneal (TEP) inguinal hernia repair. Self-gripping mesh (ProgripTM) was used in all cases. 48.6% had bilateral defects. 33 patients underwent additional procedures. Mean time for mesh deployment was 180 seconds. Mean in-hospital stay was 1.6 days. No conversion was necessary. 88.9%, 86% and 36.7% of patients completed one year, 2 years, and 5 years of follow-up respectively. Chronic pain was present in two patients. Conclusion We introduce a new technique for self-gripping mesh preparation, deployment and placement for inguinal hernia repair using the TEP approach. Our technique seems to have satisfactory results regarding long-term follow-up complications.
Intermediate Risk of Choledocholithiasis: Are we on the right path?
(Research Square (United States), 2022) Felipe Girón; Lina Rodríguez; Danny Conde; Carlos Eduardo Rey Cháves; Marco Vanegas; David Venegas; Fernando R. Gutiérrez; Ricardo Nassar; Daniel Rosselló-Jiménez; Susana Rojas
Abstract Background Risk of choledocholithiasis should be assessed in every patient who must undergo cholecystectomy to define the next step. American Society for Gastrointestinal endoscopy (ASGE) proposed a stratified predictor scale of choledocholithiasis. Methods To describe our experience managing patients with intermediate risk of choledocholithiasis according to the ASGE guidelines and actual presence of bile duct stones in magnetic resonance cholangiopancreatography. A retrospective observational study with a prospective database was conducted. Analysis included socio demographic data, laboratory values and imaging. Bivariate, multivariate and ROC analysis was performed. Results 327 patients had intermediate risk for choledocholithiasis. Half the patients were at least 65 years old. 24.8% were diagnosed with choledocholithiasis. Bile duct dilation was documented in only 3.06% of cases. Diagnosis of choledocholithiasis is associated with age OR: 1.87 (p 0.02), alkaline phosphatase OR: 2.44 (p 0.02) and bile duct dilation > 6 mm OR: 14.65 (p 0.00). Conclusions High variability in accuracy of imaging techniques results in a large number of patients classified as intermediate risk without choledocholithiasis in cholangio-resonance. Therefore, enhancing the criteria to define intermediate risk for patients in order to optimize resources is of paramount importance.
Intermediate risk of choledocholithiasis: are we on the right path?
(Wolters Kluwer, 2023) Felipe Girón; Lina Rodríguez; Danny Conde; Carlos Eduardo Rey Cháves; Marco Vanegas; David Venegas; Fernando R. Gutiérrez; Ricardo Nassar; Juan David Hernández; Daniel Jiménez
High variability in the accuracy of imaging techniques results in a large number of patients classified as intermediate risk without choledocholithiasis in cholangioresonance. Therefore, enhancing the criteria to define intermediate risk for patients in order to optimize resources is of paramount importance.
Intermediate Risk of Choledocolithiasis: Are We on the Right Path?
(Research Square (United States), 2021) Felipe Girón; Lina Rodríguez; Danny Conde; Marco Vanegas; Carlos Eduardo Rey Cháves; David Venegas; Laura Niño Torres; Fernando R. Gutiérrez; Ricardo Nassar; Daniel Rosselló-Jiménez
Abstract Background Choledocolithiasis is the presence of stones in the bile duct, commonly associated with cholelithiasis, with an incidence of 5-18%. Risk of choledocolithiasis should be assessed in every patient who must undergo cholecystectomy to define the next step, which can be either surgical or endoscopic. The American Gastroenterology Society (ASGE) proposed a predictor scale of choledocolithiasis based on ultrasound findings, liver function tests, and the presence of pancreatitis and/or cholangitis. Therefore we aim to describe our experience managing patients with intermediate risk of choledocolithiasis according to the ASGE guidelines and actual presence of bile duct stones in magnetic resonance cholangiopancreatography. Methods A retrospective observational study with a prospective database was conducted. Patients over 18 years old who complied with inclusion criteria between January and December 2019, were registered. Descriptive statistics of all study parameters were provided. Analysis included socio demographic data, laboratory values and imaging. Bivariate, multivariate and ROC analysis was performed. Results 327 patients with biliary disease were classified as having intermediate risk for choledocolithiasis. Half the patients were at least 65 years old (iqr 20). All patients underwent MRI cholangiography. 24.77% were diagnosed with choledocolithiasis. Bile duct dilation was documented in only 3.06% of cases. Diagnosis of choledocolithiasis is associated with age OR: 1.87 (p 0.02), alkaline phosphatase OR: 2.44 (p 0.02) and bile duct dilation < 6 mm OR: 14.65 (p 0.00). Conclusions There is a high proportion of patients classified as intermediate risk who did not have choledocolithiasis by colangioresonance. There is a persistently high variability in accuracy of imaging techniques in intermediate risk patients. Therefore, enhancing the criteria to define intermediate risk for patients in order to optimize resources is of paramount importance.