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Background: Today, antireflux surgery has an established position in the management of gastroesophageal reflux disease. Some case series have shown good short-term results, but there is still little information regarding long-term results. Studies have recently focused on evaluating residual symptomatology and its impact on quality of life., Objectives: To determine the postoperative quality of life and degree of satisfaction in patients that underwent laparoscopic Nissen fundoplication., Patients and Methods: A total of 100 patients (59 women and 41 men) were studied after having undergone laparoscopic Nissen fundoplication. The variables analyzed were level of satisfaction, gastrointestinal quality of life index (GIQLI), residual symptoms, and the Visick scale., Results: No variation was found in relation to sex; 49 men and 51 women participated in the study. The mean age was 49 years. The degree of satisfaction encountered was: satisfactory in 81 patients, moderate in 3, and bad in 2 patients. More than 90% of the patients would undergo the surgery again or recommend it. The Carlsson score showed improvement at the end of the study (p<0.05). In relation to the GIQLI, a median of 100.61 points±21.624 was obtained. Abdominal bloating, regurgitation, and early satiety were the most frequent residual symptoms. The effect on lifestyle measured by the Visick scale was excellent., Conclusions: The level of satisfaction and quality of life obtained were comparable with reported standards; and the residual symptoms after antireflux surgery were easily controlled., (Copyright © 2013. Published by Masson Doyma México S.A.)

Background: The changes in recent decades in the training of medical student seem to agree that the educational model for professional skills is most appropriate. The virtual simulator translates skills acquired the operating room, in the Faculty of Medicine of the University of Colima noticed the need to prepare the students of pregrade transferring surgical trainees' skills in basic laparoscopic activities that require a simple cognitive effort., Objective: The hypothesis in this study was to evaluate the acquisition of skills in laparoscopic simulator in students of pregrade., Methods: Educational research, analytical comparison, which was conducted within the activities of the program of Problem Based Learning in the program of Education and Surgical Technique, Faculty of Medicine of the University of Colima., Results: All participants in the simulator achieved a significantly better during the task one after three repetitions (p= 0.001). The evaluation of final students calcification, we observed significant differences in means being lower during the initial assessment (8.60 ± 0.76) compared to the end (8.96 ± 0.58) p= 0.001., Conclusions: The acquisition of skills in the simulator is longer but at the end is better than the acquisition of skills from the traditional method, showing that leads to the acquisition of skills that promote the transfer of skills to the surgical environment.

Background: Surgical management of umbilical hernias is proposed in the vast majority of cases. The typical approaches make a semilunar incision above the umbilicus. The aim of this study is evaluate the surgical approach with two different incisions, the transumbilical approach and the infra-umbilical approach., Methods: Included in the study were 82 consecutive patients with diagnosis of umbilical hernia. Variables related to demographic characteristics, surgical operation, and cosmetic results were evaluated. Patients were randomized into two groups; transumbilical or infra-umbilical approach. Statistical analysis was carried out to evaluate complications, recurrences and aspects of the surgical scar., Results: The study included group A (42 patients) and group B (40 patients). The most frequent symptom was pain in both groups. Complications were similar in both groups with four (9.5%) in group A and eight (19%) in group B (RR 0.53, 95% CI 0.17-1.61, p = 0.24). Cosmetic results were classified as good in the vast majority of patients in group A (p 0.001). No recurrences or mortality have been reported so far in both studied groups., Conclusion: We described an uncommon technique of incision with the aim of improving cosmetic results. Our results are in concordance with randomized clinical trials with the same technique with no recurrence or mortality to date. Cosmetic results in our patients using the transumbilical approach were clearly superior.

Background: The use of open tension-free techniques in hernia surgery seems to be superior to those techniques that apply tension to the suture line. However, the cost-effectiveness of tension vs. tension-free repairs has not been investigated before., Methods: This study is a cost-effectiveness analysis within a randomized controlled clinical trial that compared open-tension (OT) versus mesh-plug tension-free (MPTF) hernia repair, with a 2-year follow-up for each patient. Between July 2002 and June 2003, 106 patients with inguinal hernia were randomized to either procedure. Main outcome measures included average surgical time, time to full recovery, pain visual analog scale, amount of analgesics required, off-work time, hospital stay, and heath-care costs., Results: The average cost was $885.15 (95% CI $843.56-$926.74) and $837.66 (95% CI $796.42-878.89) USD for the OT and the MPTF herniorrhaphy, respectively (P < 0.05). Average yearly savings with the MPTF repair were calculated as $7,598.84 USD. Surgery time, time to full recovery, pain visual-analog scale, use of analgesics, off-work time, and hospital stay were significantly lower for the MPTF repair. Disability-adjusted life-years were reduced 56% with the MPTF repair, which represented a total savings of $12,656.60 USD with this procedure., Conclusion: This controlled clinical trial demonstrates that the MPTF technique significantly decreases care costs in patients operated on for inguinal hernias.

Background: Therapeutic pain is one of the most important outcome measures in surgery. Comparative studies investigating ketorolac efficiency in ambulatory surgery have generally been restricted to IV administration. We compared analgesic effectiveness of sublingual ketorolac and metamizole in short stay surgery., Methods: This was a randomized single-blind clinical trial. All patients received either a three-dose (30 mg) of sublingual ketorolac or 1 g of IV metamizole, respectively. We evaluated pain with a visual/analog scale (VAS). Side effects were also recorded. Statistical analysis included t-test or Mann-Whitney U test and Fisher exact test or chi(2). Absolute risk reduction (ARR), odds ratio (OR), confidence interval (CI), relative risk ratio (RRR) and numbers needed to treat (NNT) were also evaluated., Results: Rescue doses of analgesics were greater in patients receiving metamizole although the difference was not significant (p = 0.286). Mean VAS score was lower in the ketorolac group at 8 h after surgery, with no statistical difference (p = 0.06). ARR for severe pain score was almost 5% (OR = 1.78). Adverse effects did not show differences between groups (p = 0.642)., Conclusions: Ketorolac and metamizole have comparable effects and can be safely used in ambulatory settings.

Purpose: The purpose of our study was to evaluate the possibility of the reduction of peritoneal adhesions to a polypropylene mesh with fibrin glue., Methods: Forty Wistar rats were assigned to two treatment groups: Group 1) hernioplasty with polypropylene mesh plus fibrin glue sealant, and Group 2) hernioplasty with polypropylene mesh without fibrin glue sealant. The variables evaluated were: presence and density of adhesion, organs or abdominal structures adhered to the polypropylene mesh, inflammatory tissular reaction and cell recount., Results: Group 1 presented a statistically lower adhesion percentage than Group 2 (40% versus 100%, P = 0.0003). The mean areas of mesh patch surfaces covered with adhesions were statistically different between Groups 1 and 2 (0.67 +/- 0.65 cm2 versus 1.60 +/- 0.51 cm2; P = 0.00001). Twelve rats presented with adhesions in Group 1; eleven were adhesions to the epiploon and one to the colon. In Group 2 there were 16 adhesions to the epiploon, 2 to the colon, 1 to the small intestine and 1 to the stomach. Tissular reaction comparison showed a significant difference (21 +/- 4.9 versus 17 +/- 4.1; P = 0.006)., Conclusions: Fibrin glue sealant significantly reduced the frequency and severity of intra-abdominal adhesions.

Purpose: The purpose of this study is to compare the safety and complications of direct trocar insertion without pneumoperitoneum (DTI) with Veress needle (VN) in laparoscopic cholecystectomy (LC)., Methods: We studied 84 patients admitted to our hospital for LC, in a random simple blind design, 42 patients were assigned to DTI and 42 to VN. The variables analysed were : procedure complications, laparoscope insertion time and duration of surgery., Results: Complication percentages between the groups were significantly different (DTI 2.3% versus VN 23.8%, p = 0.009). The duration of surgery between the two groups was also significantly different (DTI 56+/-31 versus VN 71+/-28 minutes, p < 0.02). Finally, laparoscope insertion time between the two techniques was significantly different (DTI 1.5+/-0.5 versus VN 3.0+/-0.4 minutes p < 0.001)., Conclusions: Our results show DTI to be a safe, efficient, rapid and easily-learned alternative technique, reducing the number of procedure-related complications.

Purpose: To show the effectiveness of tension-free hernioplasty for inguinal hernia repair., Methods: We studied 106 patients who underwent inguinal hernia repair, as conventional hernioplasty in 52 and as tension-free hernioplasty in 54. We analyzed the operation time, postoperative complications, pain, time to resume daily activities, and frequency of recurrence in the short and long term., Results: The average age of the patients was 46.2 years. The operation time was significantly shorter in the tension-free group than in the conventional group, at 33 +/- 11.1 versus 49 +/- 8.8 min, respectively (P < 0.05). The overall complication rate was 10%, being 1.5% in the tension-free group and 13% in the conventional group (P = 0.4). The visual-analogue pain scores after surgery were lower in the tension-free group than in the conventional group (P = 0.01). Patients in the tension-free group returned to their normal activities sooner than those in the conventional group (P < 0.05)., Conclusions: Tension-free hernioplasty resulted in less pain and allowed patients to return to their daily activities sooner than conventional hernioplasty.