Abstract Introduction: Biliary pathology is a common disorder during pregnancy and its complications can put the pregnancy at risk. Material and methods: A retrospective study of laparoscopic cholecystectomies in pregnant women was carried out during the period from January 2017 to April 2020 at Hospital Universitario “Dr. José Eleuterio González”. Results: A total of 46 cases were obtained, only 3 patients had product loss, 1 immediately after surgery, second at 8 weeks’ gestation, and the third due to complications of gestational hypertension. Conclusion: Pancreatic-biliary cases during pregnancy are high risk for gestation, so it is preferable to perform laparoscopic cholecystectomy in selected cases were arising complications.

Resumen Introducción: La patología biliar es un trastorno muy común durante el embarazo y sus complicaciones pueden poner en riesgo el embarazo. Material y métodos: Se realizó un estudio retrospectivo de las colecistectomías laparoscópicas en embarazadas durante el período de enero del 2017 a abril del 2020 en el Hospital Universitario “Dr. José Eleuterio González”. Resultados: Se obtuvieron 46 casos en total, de los cuales solo 3 pacientes se obtuvo pérdida del producto, 1 inmediatamente posterior a la cirugía, la segunda a las 8 semanas de gestación y la tercera por complicaciones de la hipertensión gestacional. Conclusiones: Los cuadros pancreato-biliares en el embarazo son de alto riesgo para la gestación, por lo que es preferible realizar colecistectomía laparoscópica en cuadros seleccionados en vías de complicación.

Aim: To evaluate the safety of laparoscopic cholecystectomy during pregnancy, reporting complications and obstetric and perinatal outcomes in our institution. Materials and Method: Retrospective, observational study. Pregnant patients with a diagnosis of biliary pathology undergoing laparoscopic cholecystectomy were included. Sociodemographic, obstetric variables, complications or postoperative death were described. Results: 46 laparoscopic cholecystectomies were performed, mean age 25 years; 82.6% were in the second trimester of pregnancy; showing a complication rate of 4.4% directly related to the procedure with zero maternal mortality. Discussion: Biliary surgery is associated with a high rate of complications during pregnancy, however, there is more evidence supporting the idea of early intervention in symptomatic biliary disease, with a higher risk of fetal death under conservative management than under a laparoscopic approach, 14 as well as a higher recurrence ratecd. Surgery has been shown not to increase the risk of mortality for the mother and the fetus and its delay may result in an increase in morbidity in the short and long term. Conclusión: We observed a low rate of complications associated with the surgical procedure, as well as no maternal mortality.

Resumen Objetivo: Evaluar la seguridad de la colecistectomía laparoscópica durante el embarazo, reportando complicaciones y desenlaces obstétricos y perinatales en nuestra institución. Materiales y Método: Estudio retrospectivo, observacional. Se incluyeron pacientes embarazadas, con diagnóstico de patología biliar sometidas a colecistectomía laparoscópica. Se describieron variables sociodemográficas, obstétricas, complicaciones o muerte posoperatoria. Resultados: Se realizaron 46 colecistectomías laparoscópicas, edad media de 25 años; 82,6% cursaban el segundo trimestre de embarazo; mostrando tasa de complicaciones de 4,4% directamente relacionadas con el procedimiento sin mortalidad materna. Discusión: Se asocia a la cirugía biliar a una tasa elevada de complicaciones durante el embarazo, sin embargo, existe mayor evidencia que apoya la idea de la intervención temprana en enfermedad biliar sintomática, con un mayor riesgo de muerte fetal bajo manejo conservador que bajo un abordaje quirúrgico, así como mayor tasa de recurrencia. Se ha demostrado que la cirugía no aumenta el riesgo de mortalidad para la madre y el feto y su retraso puede resultar en un incremento de morbilidad a corto y largo plazo. Conclusiones: Observamos una baja tasa de complicaciones asociadas al procedimiento quirúrgico, así como una nula mortalidad materna.

OBJETIVO: Avaliar a variabilidade do controle glicêmico em pacientes com diabetes tipo1 (DM1) em acompanhamento ambulatorial. PACIENTES E MÉTODOS: Foram estudados 100 pacientes com DM1 (55 do sexo feminino), com idade de 18,6±9 anos, idade de diagnóstico de 12 anos (1-35) e duração do diabetes de 5 anos (0,09-40), com tempo de seguimento de 4,3 anos (2-8,5). A HbA1c foi determinada por cromatografia de troca iônica (valor de referência: 2,4-6,2%). RESULTADOS: Foram analisados os dados de 94 pacientes. A HbA1c inicial e final foi de 7,6±1,8% e 8,7±2,1, com aumento absoluto de 1,1% (-7; 7,2) e anual de 0,22% (-3,5; 3,6). A HbA1c permaneceu inalterada em 2 pacientes (2,1%), aumentou em 64 (68,1%) e diminuiu em 28 (29,8%). Do grupo geral, 48 pacientes (51,1%) tiveram deterioração, 12 (12,8%) melhora, 21 (22,3%) permaneceram com controle bom ou excelente e 13 (13,8%) com controle glicêmico regular ou péssimo. O número de HbA1c realizadas no acompanhamento foi de 6 (3-10) por paciente. Houve diferença significativa quanto ao número de HbA1c realizadas entre o grupo que apresentou piora no controle glicêmico (7,2±2,1) e o que manteve controle regular ou péssimo (4,7±1) (p=0,003). A diferença intra-individual entre a maior e a menor HbA1c foi de 3,1% (0,3-9,5). O coeficiente de variação e o desvio padrão da HbA1c foi de 15,5±8,1 e 1,2±0,7%, respectivamente, sendo menor nos pacientes que mantiveram controle excelente ou bom. A correlação entre a HbA1c final e a inicial foi de r= 0,37 (p=0,000) e entre a HbA1c média durante o estudo e a inicial foi r= 0,71 (p=0,000). CONCLUSÃO: A maioria dos pacientes desta amostra apresentou piora do controle glicêmico durante acompanhamento ambulatorial de rotina havendo também grande variabilidade intra-individual do controle glicêmico. A HbA1c inicial do paciente mostrou-se um importante preditor do controle glicêmico.

AIM: to evaluate the variability of glycemic control in type 1 diabetes (DM1) patients under routine clinical care. PATIENTS AND METHODS: 100 patients (55 female), mean age of 18.6±9 years, age at diagnosis 12 (1-35) years and DM duration of 5 years (0.09-40), with a follow-up period of 4.3 (2-8.5) years. Glycated hemoglobin (HbA1c) was determined by HPLC (reference values: 2.4-6.2%). RESULTS: Data from 94 patients were analyzed. Baseline and final HbA1c were 7.6±1.8% and 8.7±2.1%, with an absolute increase of 1.1% (-7; 7.2) and an annual increase of 0.22% (-3.5; 3.6). On follow-up 6 (3-10) HbA1c were measured per patient. A significant difference in the number of HbA1c determinations was seen in the group whose glycemic control worsened (7.2±2.1) as compared to that whose glycemic control remained regular or bad (4.7±1) (p=0.003). HbA1c levels remained unchanged in 2 (2.1%), increased in 64 (68.1%) and decreased in 28 (29.8%) patients. 48 of the 94 patients (51.1%) worsened, 12 (12.8%) improved, 21 (22.3%) maintained good or excellent control and 13 (13.8%) remained with regular or bad control. The intra-individual difference between the highest and the lowest HbA1c during the study was 3.1% (0.3-9.5). The coefficient of variability and the SD of the HbA1c was 15.5±8.1% and 1.2±0.7%, respectively, and was lower in patients who remained with good or excellent control. The correlation between the final and initial HbA1c was r= 0.37 (p=0.000) and between the mean and initial HbA1c was r= 0.71 (p=0.000). CONCLUSION: The majority of our patients worsened the glycemic control during the follow-up. There was also a great intra-individual variability of the glycemic control. Baseline HbA1c has shown to be an important predictor of the glycemic control.