Resumen Introducción y objetivo. Los colgajos libres microquirúrgicos se han convertido en una herramienta indispensable en Cirugía Reconstructiva. El vasoespasmo es una entidad que puede producir fallo del colgajo. El objetivo de este trabajo es evaluar las distintas medidas terapéuticas para la prevención y tratamiento del vasoespasmo y proponer un algoritmo de manejo para esta complicación. Material y método. Revisión bibliográfica de estudios de diseño experimental o cuasi experimental que evalúen el efecto de distintas intervenciones para la prevención y el tratamiento del vasoespasmo. Resultados. Incluimos 31 estudios experimentales, de los cuales 5 analizan intervenciones no farmacológicas y 26 intervenciones farmacológicas. Todos los estudios experimentales fueron realizados en modelos animales. Dentro de las intervenciones no farmacológicas estudiadas, la adventicetomía y el adecuado control de la hemostasia mostraron ser medidas efectivas para la prevención del vasoespasmo. Dentro de las intervenciones farmacológicas tópicas, la lidocaína, la papaverina, el sulfato de magnesio al 10% y el verapamilo demostraron consistentemente su efectividad en la prevención y tratamiento del vasoespasmo. Dentro de las intervenciones farmacológicas sistémicas, la pentoxifilina y la prostaglandina E1 fueron las más efectivas para el manejo del vasoespasmo. Otros fármacos mostraron evidencia controvertida: nifedipino, nicardipino y prostaglandina E1 (todos de aplicación tópica); nicardipino, nifedipino y verapamilo (todos de aplicación sistémica). Conclusiones. La evidencia actual respecto a la efectividad de medidas orientadas al manejo del vasoespasmo en microcirugía se basan principalmente en estudios animales. El algoritmo de manejo del vasoespasmo que presentamos se sustenta en la experiencia clínica acumulada y la mejor evidencia actualmente disponible. Disponer de esta estrategia terapéutica permite estandarizar el manejo en la práctica clínica para una rápida toma de decisiones.

Abstract Background and objective. Microsurgical free flaps have become an indispensable tool in Reconstructive Surgery. Vasospasm is an entity that can cause flap failure. Our objective is to evaluate the different therapies for vasospasm prevention and treatment and to propose a management algorithm for this complication. Methods. Bibliographic review of studies of experimental or quasi-experimental design that assesed the effect of interventions for the prevention and treatment of vasospasm. Results. Thirty one experimental studies were included, of which 5 analyzed non-pharmacological interventions and 26 pharmacological interventions. All experimental studies were performed in animal models. Among the non-pharmacological interventions studied, adventicetomy and adequate control of hemostasis proved to be effective measures for the prevention of vasospasm. Within topical pharmacological interventions, lidocaine, papaverine, 10% magnesium sulfate, and verapamil consistently demonstrated their effectiveness in the prevention and treatment of vasospasm. Within the systemic pharmacological interventions, pentoxifylline and prostaglandin E1 were the most effective interventions for the management of vasospasm. Other drugs showed controversial evidence: nifedipine, nicardipine and prostaglandin E1 (topicallys); nicardipine, nifedipine and verapamil (systemics). Conclusions. The current evidence regarding the effectiveness of measu-res aimed at managing vasospasm in microsurgery is based mainly on animal studies. The vasospasm management algorithm presented is based on accumulated clinical experience and the best currently available evidence. Having this therapeutic strategy makes it possible to standardize management in clinical practice for rapid decision-making.

Background: An informed consent is mandatory to obtain any clinical audiovisual material from patients. Although there are some documents created for this purpose, there are some barriers for their application, such as the context in which they were created, the language and download availability. Aim: To create a proposal for an informed consent form (ICF) for the capture and different uses for audiovisual material from patients. Material and Methods: A bibliographic search was carried out to obtain different ICFs in Spanish and English, which were subjected to a process of translation, counter-translation and fragmentation. Subsequently, a panel of experts was formed by members of the Chilean Society of Plastic Surgery with extensive experience in social networks. Delphi methodology was applied to reach a consensus about the definitive content of the ICF based on the previously selected fragments. Results: ICFs available for download were identified. The panel was made up of seven Plastic Surgeons and two Delphi rounds were carried out through electronic surveys. At the end of the process, an ICF proposal was obtained for therapeutic, academic or scientific purposes and another for dissemination or education in the mass media. Conclusions: The proposed ICFs were liberated for their use among health care professionals in Chile, who could use them, provided that they are approved by the local healthcare ethics committees.

Background: COVID-19 is highly transmissible, thus requiring strict measures to prevent its propagation. Aim: To report a survey about self-reported adherence to recommendations aimed to reduce the transmission of COVID-19, among health care personnel. Material and Methods: A cross-sectional survey among health professionals about adherence to recommendations to prevent COVID-19 transmission was carried out in a public hospital in Chile. The survey had 11 questions and was developed using Delphi methodology, according to the recommendations of the World Health Organization and the Centers for Disease Control. Results: The survey was answered by 137 of 155 invited workers. Hand washing, use of personal protection equipment, use of the elbow or tissue to sneeze, out-of-hospital hand washing and exclusive use of the uniform in the hospital, had an adherence of over 90%. The adherence to face touching avoidance during working hours, and face mask use in the public areas, was over 50%. No statistical differences were observed between gender or professionals. Conclusions: The adherence reported by health care workers was adequate in most of the evaluated recommendations.

RESUMO Racional: Residência em Cirurgia Geral pode durar entre 2-6 anos, dependendo do país. Residência mais curta deve otimizar a exposição dos residentes às cirurgias. Sabe-se que o treinamento cirúrgico simulado encurta as curvas de aprendizado, mas a informação relacionada à como isso afeta a residência em relação à exposição clínica é escassa. Objetivo: Analisar o efeito da introdução de um programa de treinamento laparoscópico simulado validado em procedimentos abdominais realizados por residentes em um programa de Residência em Cirurgia Geral de três anos. Métodos: Um estudo de coorte não simultâneo foi desenhado. Quatro gerações (2012-2015) de cirurgiões graduados foram incluídos. Apenas os procedimentos abdominais em que os cirurgiões graduados foram o cirurgião principal foram descritos e analisados. O grupo controle foi de cirurgiões graduados de 2012 sem programa de treinamento laparoscópico simulado. Procedimentos cirúrgicos por ano de programa, técnica cirúrgica, intervenção de emergência ou eletiva e local do hospital (hospitais principais/comunitários) foram descritos. Resultados: Intervenções de 28 cirurgiões graduados foram analisadas (controle=5; programa de treinamento simulado=23). Os cirurgiões graduados realizaram média de 372 procedimentos abdominais, com maior número médio de procedimentos de médio a complexo no grupo de programa de treinamento simulado (48 vs. 30, p=0,02). Cirurgiões graduados treinados com programa de treinamento simulado realizaram número maior de procedimentos abdominais totais (384 vs. 319, p=0,04) e procedimentos laparoscópicos (183 vs. 148, p<0,05). Conclusões: A introdução do programa de treinamento laparoscópico simulado pode aumentar o número e a complexidade dos procedimentos totais e laparoscópicos na Residência em Cirurgia Geral de três anos.

ABSTRACT Background: A General Surgery Residency may last between 2-6 years, depending on the country. A shorter General Surgery Residency must optimize residents’ surgical exposure. Simulated surgical training is known to shorten the learning curves, but information related to how it affects a General Surgery Residency regarding clinical exposure is scarce. Aim: To analyze the effect of introducing a validated laparoscopic simulated training program in abdominal procedures performed by residents in a three-year General Surgery Residency program. Methods: A non-concurrent cohort study was designed. Four-generations (2012-2015) of graduated surgeons were included. Only abdominal procedures in which the graduated surgeons were the primary surgeon were described and analyzed. The control group was of graduated surgeons from 2012 without the laparoscopic simulated training program. Surgical procedures per program year, surgical technique, emergency/elective intervention and hospital-site (main/community hospitals) were described. Results: Interventions of 28 graduated surgeons were analyzed (control group=5; laparoscopic simulated training program=23). Graduated surgeons performed a mean of 372 abdominal procedures, with a higher mean number of medium-to-complex procedures in laparoscopic simulated training program group (48 vs. 30, p=0.02). Graduated surgeons trained with laparoscopic simulated training program performed a higher number of total abdominal procedures (384 vs. 319, p=0.04) and laparoscopic procedures (183 vs. 148, p<0.05). Conclusions: The introduction of laparoscopic simulated training program may increase the number and complexity of total and laparoscopic procedures in a three-year General Surgery Residency.

Background: Simulation is a useful training tool for undergraduate medical students. A valid instrument is needed to assess students’ perception of simulation workshops. Aim: To adapt and validate an instrument to assess the undergraduate medical student’s perception of simulation workshops of clinical procedures. Material and Methods: Delphi Methodology was used to adapt the instrument. Exploratory and confirmatory analyses were performed to determine the construct validity and Cronbach’s Alpha (0 to 1) for internal consistency of the instrument. Results: A Delphi panel of 10 experts adapted a seven-item questionnaire (Likert scale 1-5; ranging from 7 to 35) and four open-questions. After 3-delphi-rounds, the instrument was administered to 210 students in six simulation training programs (Paracentesis, Cardiopulmonary Resuscitation, Airway management, Sutures, Thoracentesis and Nursing Procedures). The instrument was considered unidimensional in the factorial analysis. The overall median (Q1-Q3) score was 34 ranging from 32 to 35 and the Cronbach Alpha coefficient was 0.72, indicating a good reliability. Conclusions: The perception questionnaire is a useful and reliable instrument to assess students’ perceptions of clinical simulations.

Abstract Introduction: Laparoscopic cholecystectomy (LC) is one of the most common surgical procedures in our country. Postcholecystectomy diarrhea is an unrecognized entity, with a reported prevalence between 0.9 and 35.6%, nonetheless in Chile this has not been clearly defined. Objective: To determine the prevalence and characteristics of diarrhea following elective laparoscopic cholecystectomy in our institution. Material and methods: A structured questionnaire about consistency and defecation frequency was applied to adult patients summited to an elective LC between December 2014 and February 2015, by a telephone survey within 4 and 6 months after the surgical procedure. Postcholecystectomy diarrhea was defined as the presence of liquid or unusually disrupted faecal material beginning after LC. Persistent diarrhea was established when diarrhea continued for a period longer than four weeks. Results: One hundred patients were included (73% women). The overall prevalence of postcholecystectomy diarrhea was 35% (n = 35). The prevalence of patients with persistent diarrhea was 15% (n = 15). In the group of patients with persistent diarrhea, complete resolution was observed on 57% of the cases (n = 8) within an average period of 99 ± 29 days. Conclusion: Post cholecystectomy diarrhea is a frequent condition in our population, with a high prevalence within the first 28 days after LC. In most patients it resolved within 6 months.

Resumen Introducción: La colecistectomía laparoscópica es una de las intervenciones quirúrgicas más frecuentes en nuestro país. La diarrea poscolecistectomía es una entidad poco reconocida, con una prevalencia descrita entre el 0,9 y 35,6%, sin embargo, en Chile esto no ha sido claramente definido. Objetivo: Determinar la prevalencia y características de la diarrea poscolecistectomía laparoscópica electiva en una muestra de pacientes chilenos. Material y métodos: Se aplicó una encuesta telefónica estructurada sobre consistencia y frecuencia de deposiciones, entre 4 y 6 meses después de la intervención, a los pacientes adultos operados de colecistectomía laparoscópica electivamente entre diciembre de 2014 y marzo de 2015. Se definió como «diarrea poscolecistectomía» la presencia de deposiciones líquidas o inusualmente disgregadas que hubiesen comenzado posteriormente a la intervención y se estableció el término de «diarrea prolongada» como la duración de síntomas mayor de 4 semanas. Resultados: Se encuestó a 100 pacientes (73% de mujeres). La prevalencia global de diarrea poscolecistectomía fue del 35% (n = 35). La prevalencia de pacientes con diarrea prolongada fue del 15% (n = 15). En el grupo con diarrea prolongada, se observó resolución completa de esta en el 57% de los pacientes (n = 8) en un plazo medio de 99 ± 29 días. Conclusión: La diarrea poscolecistectomía es una entidad frecuente en nuestra población, con una alta prevalencia dentro de los primeros 28 días posteriores a la intervención. En la mayoría de los pacientes se resuelve en los primeros 6 meses.

Abstract Introduction: Iatrogenic bile duct injuries (BDI) during a cholecystectomy are a serious complication with significant morbidity and mortality. The aim of this study is to analyze the results BDI's repair post cholecystectomy which was performed between the years 2000-2015. Methods: Case series study. Demographic variables, the center where the cholecystectomy was performed, repair pathway, the type of bile duct injury, the type of reparation performed, postoperative complications, operative mortality and survival were entered in a database. For statistical analysis, software SPSS 22 was used. Results: Thirty-six patients were studied; 33 (92%) were women; mean age 48.5 ± 14 years. The Cholecystectomy that originated the iatrogenia was laparoscopic in 24 (67%) cases. BDI was identified intraoperatively in 9 patients (25%). The most common BDI was located less than 2 cm to confluence (Bismuth-Strasberg type E2) in 14 (39%) patients. The biliodigestive Roux-Y bypass was the most used technique in the repair of the BDI in 26 (72%) cases. In the long term, stenosis was observed in 7 (19%) patients with the need of a new repair. Operative mortality of 1 patient (3%). Conclusions: BDI post cholecystectomy were successfully repaired preferably with a biliodigestive Roux-Y bypass in our center.

Introducción: Las lesiones de la vía biliar (LVB) iatrogénicas durante una colecistectomía constituyen una complicación grave, con una significativa morbimortalidad. El objetivo del estudio es analizar los resultados de la reparación de las LVB poscolecistectomía realizadas entre los años 2000 y 2015. Métodos: Estudio de serie de casos. Se consignaron en una base de datos: variables demográficas, el centro donde se realizó la colecistectomía, la vía de reparación, el tipo de LVB, el tipo de reparación efectuada, las complicaciones postoperatorias, la mortalidad operatoria y la sobrevida. Para el análisis estadístico se utilizó el software SPSS 22 (SPSS Inc., Chicago, IL, EE. UU.). Resultados: Se estudiaron 36 pacientes, de los cuales 33 (92%) fueron mujeres; la edad promedio fue de 48,5 ± 14 años. La colecistectomía que originó la iatrogenia fue laparoscópica en 24 (67%) casos. La LVB fue identificada en el intraoperatorio en 9 pacientes (25%). La LVB más frecuente se localizó a menos de 2cm de la confluencia (Bismuth-Strasberg tipo E2) en 14 (39%) pacientes. La derivación biliodigestiva con asa en Y de Roux fue la técnica más utilizada en la reparación de las LVB en 26 (72%) casos. A largo plazo, se observó una estenosis en 7 (19%) pacientes, con necesidad de una nueva reparación. Hubo mortalidad operatoria de un paciente (3%). Conclusiones: Las LVB poscolecistectomía fueron satisfactoriamente reparadas preferentemente con una derivación biliodigestiva con Y de Roux en nuestro centro.

Liver involvement by multiple arterio-venous shunts in hereditary hemorrhagic telangiectasia can lead to severe heart failure. Total hepatectomy with liver transplantation has emerged as a therapeutic option for severe cases where other therapies have failed. We report a 51-year-old male who underwent a liver transplant for this condition, with full cardiac recovery within the first year after receiving the allograft. Nine years after transplantation, he remains with normal functional capacity and normal liver function tests.

Background: Determination of Alanine aminotransferase serum levels ([ALT]s) is a sensitive ana reliable test for liver diseases. Aim: To report the prevalence of abnormal [ALT]s in Chilean population and to identify associated variables. Methods: We analyzed data from a random sub-sample of 2,794 adults surveyed during the second Chilean National Health Survey. Abnormal [ALT]s were defined by using three different cut-off values (COV), two fixed COV (COV1: > 30 IU/L in men and > 19 IU/L in women and COV2 pre-defined by the performing laboratory) and a COV adjusted by age, weight and sex (COV3 > 31 IU/L for women and > 44 IU/L and men > 42 IU/L and > 66 IU/L with a BMI > 23). Logistic regression analysis was performed to determine risk factors for elevated [ALT]s Results: Mean [ALT]s values were 30.14 I U/L in men and 22.03 IU/L in women. The observed prevalence of abnormal [ALT]s defined by different COV were 38%, 11.5%, and 8.1% for COV1, COV2 and COV3 respectively. Variables independently associated to abnormal [ALT]s in a multivariate analysis were the following: serum gamma-glutamyl-transpeptidase (OR: 1.055 [95% CI 1.033-1.078]) and body mass index (OR:1.13 [95% CI 1.09-1.17]). Variables inversely associated with abnormal [ALT]s (COV1) were mole gender (OR-.0.976 [95% CI 0.96-0.99) and HDL-cholesterol (OR:0979 [95% CI 0.96-0.99]). Conclusions: Independently of the COV used, Chilean population exhibits a high prevalence of abnormal [ALT]s which may reflect a significant burden of liver disease. Non-alcoholic fatty liver disease could be a major contributor to elevated [ALT]s considering the association of abnormal [ALT]s and metabolic variables.