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RESUMEN Introducción: Describimos nuestra experiencia inicial con la utilización del método laparoendoscópico en un solo tiempo ¨RENDEZ-VOUS¨ en el manejo de los pacientes con litiasis vesicular y sospecha de coledocolitiasis. Objetivo: Describir la tasa de éxito, complicaciones, estancia hospitalaria con el método Rendez vous. Metodología: Se aplicó el método de Rendez-vous en 12 pacientes que ingresaron con los diagnósticos de litiasis vesicular y sospecha de coledocolitiasis en forma seleccionada de un muestreo no probabilístico de casos consecutivos con una muestra de 25 pacientes que cumplieron los criterios de inclusión. Resultado: Se realizó la Colangiografía intraoperatoria en 25 pacientes, se confirmó la presencia de coledocolitiasis en 14 pacientes (56 %) y se logró la extracción exitosa de cálculos d|e la vía biliar en 12 pacientes (48 %) a través de la colangiografía retrógrada endoscópica selectiva sobre guía con loop para Rendez-vous por vía trancística. No se reportaron casos de pancreatitis post procedimientos ni casos de litiasis coledociana residual en 6 meses de seguimiento. La media de estadía hospitalaria fue de 5,8 días y de estadía pos operatoria de 1,2 días. Conclusión: El método de Rendez-vous se presenta como una alternativa terapéutica mínima invasiva a los demás tipos de tratamientos para la litiasis coledociana. ASTRACT We describe our initial experience with the use of the single-stage laparoendoscopic method ¨RENDEZ-VOUS¨ in the management of patients with gallstones and suspected choledocholithiasis. Objective: To describe the success rate, complications, and hospital stay with the Rendez vous method. Methodology: The Rendez-vous method was applied in 12 patients who were admitted with the diagnoses of gallstones and suspected choledocholithiasis, selected from a non-probabilistic sampling of consecutive cases with a sample of 25 patients who met the inclusion criteria. Result: Intraoperative cholangiography was performed in 25 patients, the presence of choledocholithiasis was confirmed in 14 patients (56%), and the successful removal of bile duct stones was achieved in 12 patients (48%) through endoscopic retrograde cholangiography. selective on guide with loop for Rendez-vous by transcystic way. No cases of post-procedure pancreatitis or cases of residual choledochal lithiasis were reported in 6 months of follow-up. The mean hospital stay was 5.8 days and the postoperative stay was 1.2 days. Conclusion: The Rendez-vous method is presented as a minimally invasive therapeutic alternative to other types of treatments for choledochal lithiasis.

BACKGROUND & AIMS: The aims of this study were to: (1) assess the performance of the Pancreatitis Activity Scoring System (PASS) in a large intercontinental cohort of patients with acute pancreatitis (AP); and (2) investigate whether a modified PASS (mPASS) yields a similar predictive accuracy and produces distinct early trajectories between severity subgroups. METHODS: Data was prospectively collected through the Acute Pancreatitis Patient Registry to Examine Novel Therapies In Clinical Experience (APPRENTICE) consortium (2015-2018) involving 22 centers from 4 continents. AP severity was categorized per the revised Atlanta classification. PASS trajectories were compared between the three severity groups using the generalized estimating equations model. Four mPASS models were generated by modifying the morphine equivalent dose (MED), and their trajectories were compared. RESULTS: A total of 1393 subjects were enrolled (median age, 49 years; 51% males). The study cohort included 950 mild (68.2%), 315 (22.6%) moderately severe, and 128 (9.2%) severe AP. Mild cases had the lowest PASS at each study time point (all P < .001). A subset of patients with outlier admission PASS values was identified. In the outlier group, 70% of the PASS variation was attributed to the MED, and 66% of these patients were from the United States centers. Among the 4 modified models, the mPASS-1 (excluding MED from PASS) demonstrated high performance in predicting severe AP with an area under the receiver operating characteristic curve of 0.88 (vs area under the receiver operating characteristic of 0.83 in conventional PASS) and produced distinct trajectories with distinct slopes between severity subgroups (all P < .001). CONCLUSION: We propose a modified model by removing the MED component, which is easier to calculate, predicts accurately severe AP, and maintains significantly distinct early trajectories.

BACKGROUND/OBJECTIVES: The relationship between pre-existing diabetes mellitus (DM) and acute pancreatitis (AP) severity has not been established. We assessed the impact of pre-existing DM on AP severity in an international, prospectively ascertained registry. METHODS: APPRENTICE registry prospectively enrolled 1543 AP patients from 22 centers across 4 continents (8 US, 6 Europe, 5 Latin America, 3 India) between 2015 and 2018, and collected detailed clinical information. Pre-existing DM was defined a diagnosis of DM prior to AP admission. The primary outcome was AP severity defined by the Revised Atlanta Classification (RAC). Secondary outcomes were development of systemic inflammatory response syndrome (SIRS) or intensive care unit (ICU) admission. RESULTS: Pre-existing DM was present in 270 (17.5%) AP patients, of whom 252 (93.3%) had type 2 DM. Patients with pre-existing DM were significantly (p

RESUMEN Introducción: El abdomen abierto es una técnica quirúrgica que consiste en dejar abierta la cavidad abdominal tras realizar el acto quirúrgico como alternativa de manejo en ciertas situaciones como la sepsis abdominal, evitando así la formación de focos sépticos y el síndrome compartimental secundario al cierre con tensión. Objetivo: Describir la morbimortalidad en pacientes con abdomen abierto en el Hospital Nacional de Itauguá. Materiales y métodos: Tipo observacional, descriptivo, de corte transversal realizado en pacientes con abdomen abierto en el periodo de enero de 2016 a junio de 2018 en el Hospital Nacional de Itauguá. Resultados: En 42 pacientes manejados con abdomen abierto se encontró que la frecuencia fue mayor en el sexo masculino y esta condición se dio mayoritariamente en la edad adulta media. La etiología no traumática se presentó en 31 pacientes, de los cuales en el 48,4% el motivo fue la peritonitis aguda; la frecuencia de mortalidad fue mayor en este grupo con respecto a los de etiología traumática. En 14 pacientes fue necesaria la utilización de algún tipo de ostomía. En el 100% de los casos fue utilizada la bolsa de Bogotá como manejo inicial de la pared, con un promedio de intervenciones quirúrgicas de 5,6. El método más utilizado para la resolución final de la pared fue la reparación de la misma sin separación de componentes. De nuestros pacientes, 22 presentaron alguna patología de base, siendo la hipertensión arterial asociada a otras patologías, la más frecuente. El 83,3% presento alguna complicación medica durante su estadía hospitalaria, y el 31% se complicó con fistulas. La nutrición enteral asociada a la parenteral fue la más utilizada (40,4%). El promedio de estadía hospitalaria fue de 40,5 días, el promedio de estadía en Unidad de Cuidados Intensivos fue de 17 días. La mortalidad en el grupo de estudio fue elevada (52,4%), siendo la causa más frecuente de la misma el shock séptico a punto de partida abdominal. ABSTRACT Introduction: The open abdomen is a surgical technique that consists of leaving the abdominal cavity open after performing the surgical act as an alternative management in certain situations such as abdominal sepsis, thus avoiding the formation of septic foci and the secondary compartment syndrome when closing with tension. Objective: To describe the morbidity and mortality in patients with open abdomen in the Hospital Nacional de Itauguá. Materials and methods: Observational, descriptive type, cross section made in patients with open abdomen in the period from January 2016 to June 2018 in the Hospital Nacional de Itauguá. Results: in 42 patients managed with open abdomen it was found that the frequency was higher in the male sex and this condition occurred mostly in the middle adult age. The non-traumatic etiology was present in 31 patients, of which 48.4% were acute peritonitis. The frequency of mortality was higher in this group compared to those of traumatic etiology. In 14 patients it was necessary to use some type of ostomy. In 100% of the cases, the Bogotá bag was used as the initial wall management, with an average of 5.6 surgical interventions. The most used method for the final resolution of the wall was the repair of the wall without separation of components. Of our patients, 22 had some underlying pathology, the arterial hypertension associated with other pathologies, was the most frequent. 83.3% presented some medical complication during their hospital stay, and 31% were complicated by fistulas. Enteral nutrition associated with parenteral nutrition was the most used (40.4%). The average hospital stay was 40.5 days; the average stay in the Intensive Care Unit was 17 days. The mortality in the study group was high (52.4%), being the most frequent cause the abdominal septic shock.

RESUMEN Antecedentes La Colangiografia es el principal método de exploración de las vías Biliares durante el acto quirurgico; no obstante se limita a criterios para la realización de la misma los cuales se dividen en criterios pre operatorios y per operatorios. Objetivos: describir nuestros resultados aplicando los criterios de exploración. Pacientes y métodos: adultos con diagnósticos de patología biliopancreatica benigna en tratamiento curativo en el servicio de cirugía general del hospital Nacional de Julio del 2015 a Julio del 2017. Es un estudio retrospectivo de datos recolectados en forma prospectiva. Resultados: fueron estudiados 103 pacientes. El hallazgo positivo de cálculo coledociano fue del 10%; siendo la principal indicación pre operatoria el diagnóstico de pancreatitis aguda. Los pacientes estudiados comprenden un rango etario de 19 a 80 años, con una media de 44,3 años. Las indicaciones más frecuentes de la CIO corresponden a pacientes con pancreatitis aguda litiásica en remisión (n=48, 45,8 %), seguida de pacientes con ictericia presente y/o pasada (n=27, 25,4 %).La mayor frecuencia de hallazgo de cálculo coledociano fue en pacientes con ictericia presente 45 % (n=5), y pancreatitis aguda en remisión del 36 % (n=4). Laboratorialmente el comportamiento de la bilirrubina en pacientes con hallazgo de litiasis en la Colangiografía fue del 64% (n=7) bilirrubina aumentada y el 36% (n=4) con bilirrubina normal. La conducta tras el hallazgo positivo para cálculo correspondió a la extracción de los mismos por vía trancística 36% (n=4); coledocotomía 18% (n=2) y un caso de extracción del cálculo en un segundo tiempo. Conclusiones: la utilización de criterios para realizar la exploración de la vía biliar durante el intraoperatorio contribuye a limitar el uso de la misma en pacientes con real indicación y la resolucion de los hallazgos positivos para cálculo en un solo tiempo quirurgico. ABSTRACT Background: Cholangiography is the main method of exploration of the biliary tract during the surgical act; however, it is limited to criteria for carrying it out, which are divided into pre-operative and per-operative criteria. Objectives: describe our results applying the exploration criteria. Patients and methods: adults with diagnoses of benign biliopancreatic pathology in curative treatment in the general surgery service of the National Hospital from July 2015 to July 2017. It is a retrospective study of data collected prospectively. Results: 103 patients were studied. The positive finding of coledocia calculation was of 10%, being the main pre-operative indication the diagnosis of acute pancreatitis. The patients studied comprise an age range of 19 to 80 years, with an average of 44.3 years. The most frequent indications of the IOC correspond to patients with acute lithiasic pancreatitis in remission n 48, 45.8%), followed by patients with present and / or past icterici (n 27, 25.4% The highest frequency of finding of calculus choledochano was in patients with present iciency 45% (n - 5) and acute pancreatitis in remission of 36% (n - 4). The behavior of bilirubin in patients with lithiasis finding in cholangiography was 64% (n - 7). ) increased bilirubin and 36% (n - 4) with normal bilirubin The behavior after the positive finding for calculation corresponded to choledochotomy 18% (n - 2) and a case of extraction of the stone in a second time the extraction of the same via transcistica 36% (n - 4);: the use of criteria to perform the exploration of the bile duct during or contributes to limit the use of it in patients with real indication and the intraoperatori resolution of the positive find for calculation in a single surgical time.