REVISTA VENEZOLANA DE CIRUGÍA

EVALUACIÓN DE LA VIABILIDAD INTRAOPERATORIA DE LAS GLÁNDULAS PARATIROIDES MEDIANTE ANGIOGRAFÍA CON VERDE DE INDOCIANINA EN PACIENTES SOMETIDOS A TIROIDECTOMÍA TOTAL

2025-09-10T15:42:52-04:00

Objective: To evaluate the viability of parathyroid glands using intraoperative indocyanine green (ICG) angiography and its value as a predictor of postoperative hypocalcemia following total thyroidectomy. Material and Methods: A prospective, observational, and descriptive study was conducted. Patients undergoing total thyroidectomy between February and September 2024 were included. Intraoperative evaluation of parathyroid glands was performed using ICG angiography, applying a 0-to-2 colorimetric scale to assess gland viability. Results were compared to a control group operated between February and December 2023 without the use of ICG. Postoperative calcium and parathyroid hormone (PTH) levels were measured, and clinical signs of hypocalcemia were recorded. Statistical analysis included ANOVA, with a significance level set at p<0.05. Results: Forty patients were included (19 in the ICG group, 21 in the control group). In the ICG group, successful visualization of parathyroid glands was achieved in all cases, with 65% of patients showing four glands. The incidence of hypoparathyroidism was lower in the ICG group (11%) compared to the control group (19%), though not statistically significant. Central neck dissection was associated with higher rates of hypocalcemia. Conclusions: Intraoperative angiography with ICG enables objective assessment of parathyroid gland viability. It is a safe and useful technique that contributes to reducing the risk of postoperative hypocalcemia, particularly in complex thyroid surgeries. Keywords: Total thyroidectomy, Indocyanine green, Parathyroid glands, Hypoparathyroidism, Intraoperative angiography, Hypocalcemia

Editorial

2025-07-01T16:06:22-04:00

Estimados usuarios de la Revista Venezolana de Cirugía (RVC) es para mí un gran honor escribir para ustedes mi primera editorial como Jefe Editora de la misma. Escoger un tema que fuera: actual, científico y para cirujanos no me fue fácil, hasta que llamó mi atención lo que es actualmente tendencia mundial, el conflicto bélico Irán-Israel y no menos importante el conflicto Rusia-Ucrania; pero ¿qué tiene que ver estos conflictos con nosotros los cirujanos? mucho, mientras los cielos de Tel Aviv y Teherán, se iluminan con misiles y las sirenas ahogan el silencio de la madrugada, hay una figura que no empuña armas ni pronuncia discursos: el médico. En hospitales colapsados, refugios improvisados o incluso en las calles, los cirujanos se convierten en hilos que unen a la humanidad con la esperanza.

Ambos conflictos han dejado cientos de muertos y heridos. ^1,2Los cirujanos enfrentan una doble batalla salvar vidas bajo fuego cruzado y proteger su propia integridad física mientras alarmas aéreas hacen que interrumpan cirugías de emergencias.

En situaciones de conflicto bélico, los cirujanos tienen un papel crucial en la atención de heridos y enfermos, tanto civiles como combatientes, respetando los principios de ética médica y el derecho internacional humanitario.³ Su labor se centra en la atención imparcial, la confidencialidad y la protección de la vida y la salud, independientemente del bando al que pertenezcan las personas.

Surgical Anatomy in Bariatric Surgery (Part II)

2025-06-30T10:48:59-04:00

In continuation with our first publication, we here reinforce the need to support anatomical knowledge which, combined with physiological and pathophysiological foundations, enables the bariatric surgeon to perform surgical procedures with correct indications and proper technique, thereby minimizing complications. This second part analyzes vital structures such as the spleen, short gastric vessels, lesser sac, related viscera, pylorus, angular incisure, first portion of the duodenum, ligament of Treitz, small intestine, and ileocecal valve. It highlights their functional and surgical importance in relation to the most commonly performed bariatric and metabolic techniques in our setting.

Weight loss, resolution of comorbidities, and current quality of life in patients undergoing Bariatric Surgery. Prospective Study

2025-05-10T17:14:34-04:00

Bariatric surgery is currently the most effective treatment for weight loss, improving comorbidities related to obesity and helping to improve the patient's quality of life. OBJECTIVE: To evaluate weight loss, resolution of comorbidities and current quality of life of patients undergoing bariatric surgery in a health center in Carabobo state, period July 2021–July 2023. MATERIALS: Descriptive, non-experimental, cross-sectional and prospective study, correlational in scope. The sample was intentional non-probabilistic and consisted of 40 patients. RESULTS: Average age was 40.02 years ± 1.48. 42.50% of the sample had been operated on for one year. The predominant surgical technique was Gastric Bypass (90%). A statistically significant decrease in BMI was recorded from the time before surgery to the current measurement (P <0.05). The percentage of weight lost averaged 83.65 ± 2.56, with a median of 88.5%. Of the total major comorbidities presented, 54.16% were resolved and 45.83% were improved. Of the minor comorbidities presented, 80% were resolved. Regarding quality of life after the intervention, 62.50% demonstrated a very good quality of life with no association with the type of surgery (P>0.05). 42.50% of patients showed very good results, followed by those with excellent results (27.50%), with no significant association with the type of procedure applied (P>0.05). CONCLUSIONS: The most frequent comorbidities were arterial hypertension and obstructive sleep apnea, with notable resolution after the intervention. Quality of life improved considerably.

Use of Anticoagulants to prevent Adhesion Syndrome in NMRI Strain Mice: An Experimental Study

2025-06-17T19:23:51-04:00

Abdominal adhesions involve the activation of the coagulation process and a series of enzymatic substrate activation reactions that generate the formation of fibrin from the activation of fibrinogen, leading to complications such as intestinal obstructions. Objective: To determine whether the use of anticoagulants such as Enoxaparin and Rivaroxaban contributes to the prevention of adhesional syndrome in NMRI strain mice undergoing surgery. Methodology: A preclinical, concurrent experimental study with a controlled, randomized, double-blind design was conducted in an animal model, with statistical analysis to determine the efficacy of pharmacological interventions. The sample consisted of 40 NMRI strain mice, divided into 4 surgically treated groups; three groups received a protocol with anticoagulants, and one control group did not. One month later, the mice underwent a second surgery to evaluate the impact on the development of adhesions. Results: are expressed using descriptive, percentage, and inferential statistics. A statistically significant difference (p < 0,005) was found when comparing the case groups (adhesions in 22, 20, and 20%, respectively) with the control group, which showed 100% postoperative adhesions. Conclusions: Rivaroxaban and Enoxaparin inhibit the post-injury peritoneal adhesion process in NMRI strain mice, highlighting the effectiveness of both anticoagulants.

Surgical Anatomy in Bariatric Surgery (Part I)

2025-08-10T14:23:24-04:00

Surgical anatomy is a fundamental pillar that supports the knowledge of every surgeon seeking success in their practice. However, it is not the only one; applying it in isolation, while ignoring elements such as physiology, pathophysiology, and the development of surgical skills, may lead to poor patient outcomes. This first part analyzes key structures in bariatric surgery located in the upper abdomen. The diaphragm, esophageal hiatus, phreno-esophageal membrane, abdominal esophagus, lower esophageal sphincter (LES), angle of His, Belsey fat pad, and gastro-phrenic ligament are described, highlighting their functional and surgical importance in relation to techniques such as sleeve gastrectomy and gastric bypass, with emphasis on implications like reflux and fistulas. This knowledge enables surgeons to optimize outcomes and prevent complications.

How to Become a Bariatric Surgeon: The Role of Bariatric Surgery Training Programs, a Proposal for Modern Times

2025-04-19T16:16:13-04:00

Bariatric surgery, which began in the 1950s, evolved from experimental procedures to laparoscopic techniques pioneered by Wittgrove and the creation of IFSO. The introduction of centers of excellence by ASMBS and national societies standardized training and standards for new professionals in the field. A typical program combines a cognitive component—theoretical curriculum, seminars, and evaluation—and a practical component—pre- and postoperative evaluations, and participation in surgeries. Training resources include simulators, cadaveric models, and animals, organized in a competency pyramid that progresses from inanimate simulation to live surgery. In Venezuela, professional development programs emerged in 2013, with four currently active. These programs enhance safety, profitability, accreditation, research, and professional networks.

Utilidad diagnostica transoperatoria de la videobroncoscopia en la patología tiroidea, a propósito de un caso: bocio multinodular gigante con síntomas compresivos de la vía área

2025-04-10T13:56:48-04:00

Introduction: Goiter is an abnormal increase in the volume of the thyroid gland. The most important risk factor for its incidence is iodine deficiency in the diet or its low consumption1. Physical examination and imaging studies are used for its diagnosis. Objective: to demonstrate the transoperative diagnostic usefulness of videobronchoscopy in thyroid pathology in cases of giant multinodular goiter. Clinical case: A 65-year-old female was diagnosed with giant multinodular goiter that generated 80% airway obstruction and 50% of the digestive tract. intraoperative a diagnostic videobronchoscopy protocol was performed to demonstrate the tracheal lumina. Video-guided intubation was performed through a flexible armed tube, subsequently resecting the entire goiter. The patient was discharged with supplementary treatment with Eutirox®, calcium, and multidisciplinary management. The final biopsy revealed foci of papillary microcarcinoma with a follicular pattern measuring 0.5 x 0.5 cm with central calcification, which was completely resected. Conclusion: During the transoperative period for total thyroidectomy due to giant multinodular goiter causing airway compression, the use of video-assisted bronchoscopy is highly relevant due to its effectiveness in demonstrating and ruling out infiltration of the pathology that cannot be detected with other imaging studies.

Inguinal Hernia with Lichtenstein Technique: Efficacy of operative cure with mesh fixation with N-Butyl Cyanoacrylate Vs Absorbable Suture

2025-03-04T23:50:44-04:00

Objective: To assess the efficacy of N-butylcyanoacrylate in mesh fixation for inguinal hernia repair using the Lichtenstein technique, compared to absorbable sutures, in patients hospitalized at Dr. Miguel Pérez Carreño General Hospital.
Methods: A comparative, prospective, and descriptive study was conducted with a non-randomized, longitudinal design. Data were collected and stored in a database for analysis. Continuous variables were reported as means and standard deviations, while categorical variables were analyzed using frequencies and percentages. A significance level of p < 0.05 was considered, and statistical analysis was performed using JMP-SAS 11.0 software. Results: A total of 74 patients were included, divided into two groups: N-butylcyanoacrylate and absorbable suture. Both groups were comparable in terms of age, sex, and BMI. N-butylcyanoacrylate fixation was associated with a shorter operative time (39.6 vs. 60.9 min, p < 0.001) and reduced hospital stay (1.61 vs. 2.15 days, p = 0.001). Additionally, fewer postoperative complications were observed, with no cases of hematoma and 78.8% of patients experiencing mild postoperative pain (p < 0.001). Conclusion: Mesh fixation with N-butylcyanoacrylate in Lichtenstein inguinal hernia repair demonstrates superior operative outcomes and a favorable safety profile compared to absorbable sutures, supporting its adoption in clinical practice.

POLAND SYNDROME. A RARE ENTITY.

2025-03-30T15:37:07-04:00

Introduction: Poland syndrome is a rare congenital malformation, resulting in alterations of the thorax, breast and upper limb in varying degrees. We report the case of a patient whose diagnosis was made incidentally in adulthood.Clinical case: A 46 year old female patient consulted for anormal uterine bleeding. The medical evaluation revealed asymmetry in the thorax, breast and ipsilateral upper limb. Imaging studies were requested, which confirmed the musculoskeletal malformations, this establishing the diagnosis. Conclusion: Poland`s syndrome is among the so called rare diseases. It is considered a malformative type, with an etiopathogenesis still unknown. Although the entity does not represent any functional prognosis, the treatment is aimed at reconstructing the deformities, which have a psychological impact on the patient.