Relevancia del antecedente de absceso perirrenal en pacientes sometidos a nefrectomía simple retroperitoneal

Published on Dec 1, 2018in Urología Colombiana
· DOI :10.1055/S-0038-1656555
Luis Daniel Carrillo-Córdova1
Estimated H-index: 1
(HGM: Hospital General de México),
Roberto Carlos Sarabia-Estrada (HGM: Hospital General de México)+ 11 AuthorsMateo Leopoldo Garduño-Arteaga1
Estimated H-index: 1
(HGM: Hospital General de México)
Antecedentes  Las infecciones supurativas del rinon y del espacio peri nefritico son poco comunes. La nefrectomia simple consiste en extraer el rinon contenido dentro de la fascia de Gerota, tecnica usada principalmente para padecimientos no malignos del rinon. Ese termino puede ser potencialmente enganoso ya que el termino “simple” implica que la cirugia para enfermedad benigna, es tecnicamente menos desafiante con menos complicaciones en relacion a su contra parte: la nefrectomia radical. Metodologia  Se analizaron 58 pacientes. Los parametros demograficos de los pacientes con antecedente de absceso perirrenal, fueron comparados con los pacientes sin antecedente de absceso (Edad, genero, peso, localizacion del lito) variables transoperatorias (tiempo quirurgico, sangrado transoperatorio) y variables postquirurgicas (necesidad de terapia intensiva, necesidad de transfusion, infeccion de herida quirurgica y dias de estancia hospitalaria). Resultados  Los pacientes se dividieron en dos grupos, los que contaban con antecedente de absceso (Grupo 1), y aquellos que no tenian antecedente de absceso (Grupo 2). Se encontraron veinte pacientes con antecedente de absceso (34,55%) y treinta y ocho sin antecedente de absceso (65,6%). Al realizar la comparacion entre los dos grupos se encontraron con mayor frecuencia en el grupo diferencias estadisticamente significativas para las variables de tiempo quirurgico (212 minuto (DE 46,6) vs 130.3 minuto (DE 49) p  = 0.0001), dias de estancia hospitalaria (8,6 dias (DE 4,1) vs 5,6 dias (DE 1.9) p  = 0.0003), e infeccion de herida quirurgica (70% vs 31% p  = 0,0008), no existieron diferencias estadisticamente significativas para el sangrado transoperatorio, necesidad de transfusion o necesidad de atencion en unidad de cuidados intensivos. Conclusiones  La realizacion de una nefrectomia retroperitoneal simple abierta secundaria a litiasis en pacientes con antecedente de absceso perirrenal, conlleva a un mayor tiempo quirurgico, secundario a una mayor dificultad tecnica del procedimiento, por la gran cantidad de fibrosis y destruccion de la anatomia producida por el absceso. Los pacientes, tambien presentan un riesgo aumentado de infeccion de la herida quirurgica, lo que conlleva a una mayor estancia hospitalaria y a una mayor inversion de recursos materiales y humanos.
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