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Introducción: El desarrollo de los protocolos de recuperación acelerada en cirugía colorrectal ha revalorizado los cuidados que conforman la recuperación perioperatoria de los pacientes sometidos a cirugía. Se persigue una reducción del stress quirúrgico y por tanto alta precoz y menor morbilidad, sin embargo, la literatura aporta pocos resultados respecto a su aplicación en países en desarrollo. Objetivo: analizar los resultados a corto y mediano plazo de un protocolo de recuperación acelerada en un hospital de alta complejidad de nuestro medio. En el periodo comprendido entre enero 2015 y marzo 2017 se incluyeron pacientes de manera prospectiva y consecutiva con indicación deAñadir colaborador/a cirugía colorrectal laparocopica electiva y bajo estricto seguimiento según protocolo creado por la institución. Fueron excluidos pacientes mayores de 80 años, ASA IV, cirugías de urgencia y abordaje convencional. Se analizaron datos demográficos indicación de cirugía, tipo de intervención, estadía hospitalaria en días, complicaciones, readmisiones y reintervenciones a los 30 días de postoperatorio. Resultados: Fueron incluidos 64 pacientes con una edad media de 62 años. El promedio de internación en días fue de 4,9, con 10,9% de reinternaciones y 4,7% de reintervenciones. El 69% de los pacientes no presento complicaciones, registrándose 5 complicaciones mayores (8%). Conclusión: A partir de la adecuación de los lineamientos internacionales a nuestra realidad sanitaria, es factible la creación de un protocolo de recuperación acelerada aplicable en nuestro medio, con baja tasa de complicaciones y alta precoz.

Solid pseudopapillary tumor of the pancreas is a rare entity, more frequent in women between the 2El tumor sólido-quístico de páncreas es poco frecuente y predomina en mujeres entre la segunda y la cuarta décadas de la vida. Los pacientes son generalmente asintomáticos. El diagnóstico se realiza por imágenes con tomografía o resonancia magnética, y con la posterior confirmación patológica para poder ofrecer un tratamiento adecuado. Presentamos una serie de seis casos. Todas las pacientes fueron de sexo femenino, de entre 14 y 56 años. El 50% fueron un hallazgo incidental. Tuvimos tres casos localizados en la cabeza y tres en el cuerpo del páncreas. Se realizaron tres duodenopancreatectomías cefálicas y tres pancreatectomías distales con preservación esplénica, con buena evolución y sin recidiva.

Solid pseudopapillary tumor of the pancreas is a rare entity, more frequent in women between the 2nd and 4th decades. The diagnosis is usually incidental and it can be reached by computed tomography or magnetic resonance imaging. Subsequent pathological confirmation is necessary for an adequate treatment. A retrospective study of six cases was carried out. All the patients were female, between 14 and 56 years of age, in which 50% the tumor were an incidental finding. We had three cases located in the head and three in the body of the pancreas. We performed three pancreaticoduodenectomies and three distal pancreatectomies with splenic preservation, without disease recurrence.

Improvement of dyslipidemia is an important benefit of bariatric surgery. The benefits of laparoscopic sleeve gastrectomy (LSG) among dyslipidemia are still a matter of debate. We conducted a retrospective descriptive study between 2010 and 2013. Obese patients undergoing LSG, with recorded dyslipidemia at admission and a follow-up for at least 1 year, were included for analysis. Demographic characteristics, medication in use, and a complete lipid profile were collected before surgery. After surgery, weight was controlled at 1, 3, 6, and 12 months. Lipid profile was re-evaluated 1 year after surgery. Patients were divided according to weight loss into two groups: (A) adequate weight loss and (B) inadequate weight loss. Lipid profile evolution was then compared between groups. One hundred seven patients met the inclusion criteria. Pre-op mean BMI was 45.13 ± 7.5 kg/m2. One year after LSG, mean BMI was 30.6 ± 7.1 kg/m2 with a change in BMI of 11.5 ± 6.6 kg/m2, a %TWL of 26.9 ± 13.5%, and a %EWL of 60.3 ± 36.6%. Hypercholesterolemia and hypertriglyceridemia remission was achieved in 45 and 86% of the patients and improved in another 19 and 4% respectively. Seventy-four percent improved HDL levels. LDL levels improved in 39% and remitted in 37%. Medication was discontinued in 43.7%. HDL increase and LDL, TG, and non-HDL-C decrease were significantly greater in group A. LSG produces an improvement in lipid profile, with a significant increase in HDL and a decrease in LDL, triglycerides, and non-HDL-C.

The study of the Sentinel Lymph Node (SLN) in Melanoma is a procedure that aims the identification of the first node to which the affected cutaneous sector drains in order to avoid unnecessary lymphadenectomies. The present study documents the frequency of identification of SLN; the relationship between positive SLN (PSLN) and recurrence, between the Breslow index (BI) and PSLN, and between BI and disease recurrence.We analyzed the records of 148 patients with melanoma stages I and II undergoing lymphatic mapping and GC biopsy from 1999 to 2017 in a third level institution in Córdoba, Argentina. We performed preoperative lympho centellography, lymphatic mapping with combined technique and SLN biopsy. Postoperative controls were established in order to detect recurrences.SLN was identified in 145 patients (97.9%), being positive in 25 cases (17.2%). Recurrence was detected in 10 (8.3%) patients with negative SLN (NSLN), and in 2 (9.09%) with PSLN (p = 0.188). The median BI was 2 mm in PCG patients and 1.2 mm in GCN patients (p = 0.002). The mean BI in patients with recurrence was 2.77 mm, and 2.01 mm in those who did not show relapse (p = 0.311).The combined technique allows a high GC identification rate. A greater tendency to recurrence was observed in the presence of CPG. A statistically significant relationship between GCP and IB was found. The GC technique is effective and replicable in our environment.El estudio del ganglio centinela (GC) en el melanoma maligno es un procedimiento que busca la identificación del primer ganglio al cual drena el sector cutáneo comprometido a fin de evitar linfadenectomías innecesarias. El presente estudio documenta la frecuencia de identificación del GC y la relación entre GC positivo (GCP) y recurrencia, entre el índice de Breslow (IB) y GCP, y entre el IB y la recurrencia de la enfermedad.Se analizaron los registros de 148 pacientes con melanoma maligno en estadios I y II sometidos a mapeo linfático y biopsia de GC desde 1999 hasta 2017 en una institución de tercer nivel de Córdoba, Argentina. Se realizaron linfocentellografía preoperatoria, mapeo linfático con técnica combinada y biopsia de GC. Se establecieron controles posoperatorios reglados a fin de detectar recurrencias.Se identificó el GC en 145 pacientes (97.9%) y resultó positivo en 22 (17.2%). Se detectó recurrencia en 10 pacientes (8.3%) con GC negativo (GCN), y en 2 (9.09%) con GCP (p = 0.188). La mediana del IB fue de 2 mm en los pacientes con GCP y de 1.2 mm en los pacientes con GCN (p = 0.002). La media del IB en los pacientes con recurrencia fue de 2.77 mm, y en los que no mostraron recaída fue de 2.01 mm (p = 0.311).La técnica combinada permite una alta tasa de identificación del GC. Se observó una mayor tendencia a la recurrencia en presencia de GCP. Se comprobó una relación estadísticamente significativa entre GCP e IB. La técnica del GC es efectiva y replicable en nuestro medio.

Introduction The study of the Sentinel Lymph Node (SLN) in Melanoma is a procedure that aims the identification of the first node to which the affected cutaneous sector drains in order to avoid unnecessary lymphadenectomies. The present study documents the frequency of identification of SLN; the relationship between positive SLN (PSLN) and recurrence, between the Breslow index (BI) and PSLN, and between BI and disease recurrence. Method We analyzed the records of 148 patients with melanoma stages I and II undergoing lymphatic mapping and GC biopsy from 1999 to 2017 in a third level institution in Cordoba, Argentina. We performed preoperative lympho centellography, lymphatic mapping with combined technique and SLN biopsy. Postoperative controls were established in order to detect recurrences. Results SLN was identified in 145 patients (97.9%), being positive in 25 cases (17.2%). Recurrence was detected in 10 (8.3%) patients with negative SLN (NSLN), and in 2 (9.09%) with PSLN (p = 0.188). The median BI was 2 mm in PCG patients and 1.2 mm in GCN patients (p = 0.002). The mean BI in patients with recurrence was 2.77 mm, and 2.01 mm in those who did not show relapse (p = 0.311). Conclusions The combined technique allows a high GC identification rate. A greater tendency to recurrence was observed in the presence of CPG. A statistically significant relationship between GCP and IB was found. The GC technique is effective and replicable in our environment.