Cholecystocholedocholithiasis is a common disease worldwide; however, there is still no consensus regarding a gold standard therapy for its management. Nowadays, the preferred method is a “two-step” process, starting with an endoscopic common bile duct (CBD) stone extraction (endoscopic retrograde cholangiopancreatography [ERCP]) followed by a laparoscopic cholecystectomy (LC). Nevertheless, this “two-step” approach has shown some difficulties over time (i.e., need for two hospital admissions, need of at least two anesthesia inductions, higher rate of post-procedural pancreatitis, longer hospitalizations and thus, increased costs). On the other hand, the laparo-endoscopic rendezvous (LER), which is a simultaneous combined procedure for removing the gallbladder laparoscopically and clearing the CBD endoscopically, is another valid treatment modality that involves a “single-step�...

The present article on acute postsurgical pain reviews the positive and negative effects of pain, in the short and long terms, in surgical patients; describes the diverse types of pain according to their physiopathology, and the use of the various types of analgesic pharmaceuticals, such as the opioids, non steroidal anti-inflammatory drugs (NSAIDs) and local anesthetics. The indications and contraindications of analgesia with opioids and subcutaneous analgesia, as well as appropriate precautions and adverse effects are described. The subjects of patient controlled analgesia (PCA), and continuous epidural analgesia (CEA) are discussed. On comparing these two methods, it was possible to conclude that the latter one, continuous epidural analgesia, was better than PCA in the first 72 hours of pain management. Finally the diverse conventional postoperative pain therapies are reviewed, multim...

The present article on acute postsurgical pain reviews the positive and negative effects of pain, in the short and long terms, in surgical patients; describes the diverse types of pain according to their physiopathology, and the use of the various types of analgesic pharmaceuticals, such as the opioids, non steroidal anti-inflammatory drugs (NSAIDs) and local anesthetics. The indications and contraindications of analgesia with opioids and subcutaneous analgesia, as well as appropriate precautions and adverse effects are described. The subjects of patient controlled analgesia (PCA), and continuous epidural analgesia (CEA) are discussed. On comparing these two methods, it was possible to conclude that the latter one, continuous epidural analgesia, was better than PCA in the first 72 hours of pain management. Finally the diverse conventional postoperative pain therapies are reviewed, multim...

Las úlceras solitarias de ciego no específicas son raras en frecuencia, existen reportes de casos y pequeñas series en la literatura pero en el Perú aún no se han descrito. Son de etiología desconocida y diagnóstico diferencial amplio, presentamos el caso de un interno de medicina con historia de hemorragia digestiva baja y una úlcera cecal única a descartar neoplasia maligna, realizándose una hemicolectomía derecha laparoscópica de emergencia, luego de un amplio estudio, se concluye que se trata de una úlcera cecal idiopática.

El angiosarcoma hepático es una neoplasia rara cuya incidencia se reporta del 0,5 – 2% de las tumoraciones hepáticas primarias. Es de difícil diagnóstico debido a lo inespecífico de su presentación. Habitualmente el diagnóstico es tardío, cuando el órgano ya está muy comprometido y no es posible el tratamiento quirúrgico. A pesar de ello la laparoscopía es la técnica indicada debido a las limitaciones del estadiaje por tomografía, porque nos permite una visión directa de la cavidad y nos brinda información del estadío y pronóstico del tumor. El diagnóstico definitivo es anatomo-patológico y requiere confirmación por marcadores inmunohistoquímicos como el CD-31 y CD-34. La quimioterapia no ha demostrado mejorar la supervivencia al igual que la radioterapia. La supervivencia de estos pacientes sin tratamiento es de 6 meses aproximadamente desde el momento del diagn�...