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  1. Home
  2. Browse by Author

Browsing by Author "Gabrielli, Mauricio"

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    Audio and panoramic video recording in the operating room: legal and ethical perspectives
    (2021) Gabrielli, Mauricio; Valera, Luca; Barrientos, Marcelo
    Introduction The idea of video recording (VR) in the operating room (OR) with panoramic cameras and microphones is a new concept that is changing the approach to medical activities in the OR. However, VR in the OR has brought up many concerns regarding patient privacy and has highlighted legal and ethical issues that were never previously exposed. Aim To review the literature concerning these aspects and provide a better ethical and legal understanding of the new challenges concerning VR in the OR. Conclusions There is a disparity between the two main legal models concerning VR in the OR, namely the European legal system (General Data Protection Regulation (GDPR)) and the American legal framework (Health Insurance Portability and Accountability Act (HIPAA)). This difference mainly deals with two distinct bioethical paradigms: GDPR places a strong emphasis on protecting patients' privacy to improve the public health system, whereas HIPAA indicates the need to generate protocols to safeguard the risks connected to medical activity and patient privacy. Following from this point, we may argue that, at the ethical and bioethical level, GDPR and HIPAA depend mainly on two different ethical models: a perspective based on moral acquaintances and weak proceduralism, respectively. It is worth noting the importance of developing additional guidelines concerning different world regions to avoid the ethical problems that may emerge when simply applying a foreign paradigm to a very different culture.
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    Bariatric Surgery Before and After the SARS-CoV-2 Pandemic: a Comparative Study of Cases Before the Onset of the Pandemic in a High-Volume Academic Center
    (2023) Leon, Paula; Gabrielli, Mauricio; Quezada, Nicolas; Crovari, Fernando; Munoz, Rodrigo
    IntroductionAt the beginning of the pandemic, studies showed a higher risk of severe surgical complications and mortality among patients with perioperative SARS-CoV-2 infection, which led to the suspension of elective surgery. Confinement and lockdown measures were shown to be associated with weight gain and less access to medical and surgical care in patients with obesity, with negative health consequences. To evaluate the safety of bariatric surgery during the pandemic, we compared 30-day complications between patients who underwent bariatric surgery immediately before with those who underwent bariatric surgery during the opening phase of the pandemic.MethodsObservational analytical study of a non-concurrent cohort of patients who underwent bariatric surgery in 2 periods: pre-pandemic March 1 to December 31, 2019, and pandemic March 1 to December 31, 2020. Surgical complications were defined using the Clavien-Dindo classification.ResultsPre-pandemic and pandemic groups included 256 and 202 patients who underwent primary bariatric surgery, respectively. The mean age was 37.6 + 10.3 years. The overall complication rate during the first 30 days of discharge was 7.42%. No differences between groups were observed in severe complications (pre-pandemic 1.56% vs. pandemic 1.98%, p: 0.58). No mortality was reported. Overall 30-day readmission was 3.28% with no differences between groups.ConclusionThe findings of this study did not find a difference in the rate of severe complications, nor also we report severe COVID-19 complications in this high-risk population. During the pandemic, with appropriately implemented protocol, the resumption of bariatric surgery is possible with no increased risk for patients.
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    Mortality due to gallbladder cancer. Retrospective analysis in three Chilean hospitals
    (2010) Gabrielli, Mauricio; Hugo, Sebastian; Dominguez, Angelica; Baez, Sergio; Venturelli, Aliro; Puga, Maria; Diaz, Alfonso; Jarufe, Nicolas; Ferreccio, Catterina
    Background: Chile has the highest gallbladder cancer (GBC) death rate worldwide, affecting mainly Southern areas of the country. Aim: To compare the survival of GBC patients treated in hospitals located in areas with low and high risk for GBC. Material and Methods: Medical records of all patients with GBC admitted to one public hospital located in southern Chile, a public hospital and a private clinic, both located in Metropolitan Santiago, were reviewed. Cases were analyzed by age, sex, stage at diagnosis, ethnicity, socioeconomic status (SES) and rural residence. Survival was calculated using Kaplan Meier method. Results: A total of 598 cases (469 women), were analyzed. No differences in age or sex among hospitals were detected. At the moment of diagnosis, 75, 50 and 44% of cases from the hospital in southern Chile, the public hospital in Santiago and the private clinic in Santiago, were in stage IV respectively. Five years survival was lower in the public hospital in southern Chile than in the public hospital in Santiago (10.7 and 14.4% respectively, p <0.05) but not statistically different from the figure at the private clinic in Santiago (13.0%). However, when adjusting for stage at the moment of diagnosis, no difference in survival between the three hospitals, was found. The median days of survival were 1,559, 188, 70 and 69 for stages I, II, III and IV respectively. Conclusions: GBC mortality is high. The stage at the moment of diagnosis is only significant predictor of survival. (Rev Med Chile 2010; 138: 1357-1364).
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    Safety of Bariatric Surgery During the Opening Phase After the First Wave of the COVID-19 Pandemic: Experience at an Academic Center
    (2021) Crovari, Fernando; Inzunza, Martin; Irarrazaval, Maria J.; Romero, Cecilia; Achurra, Pablo; Quezada, Nicolas; Gabrielli, Mauricio; Munoz, Rodrigo
    Introduction Increased morbimortality in patients with COVID-19 infection who had undergone surgery has raised concerns about bariatric surgery safety during the current COVID-19 pandemic. Currently, there is scarce literature on safety outcomes after bariatric surgery during the COVID-19 pandemic.
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    Small bowel obstruction following laparoscopic Roux-en-Y gastric bypass: is it always necessary to operate? A 5-year, high volume center experience
    (2021) Gabrielli, Mauricio; Jarry, Cristian; Hurtado, Sebastian; Achurra, Pablo; Munoz, Rodrigo; Quezada, Nicolas; Crovari, Fernando
    Purpose This study aims to describe the incidence, associated factors, etiology, and management of small bowel obstructions following laparoscopic Roux-en-Y gastric bypass (LRYGB). Methods A retrospective analysis was conducted between January 15 and December 19 using the surgery database of our hospital. Included LRYGB patients were those that evolved with a prolonged length of stay; readmission; emergency room consult; and re-intervention due to small bowel obstruction (SBO) related symptoms with compatible radiological or intraoperative findings. The LRYGB technique implied an antecolic alimentary limb reconstruction and systematic closure of mesenteric defects. Descriptive and analytical statistics were carried out, using a parametric or non-parametric approach as needed. Results Nine hundred forty-one LRYGB were performed. 9.9% were revisional surgeries of patients with a laparoscopic sleeve gastrectomy. During the study period, 36 SBOs occurred, representing 3.8% of operated patients, with no mortality. 58.3% had successful non-operative management, while 41.7% required surgical exploration, of which 73.3% were treated laparoscopically and 20% needed conversion to open surgery. Etiologies of SBO were jejuno-jejunostomy (JJO) related stenosis (22, 61.1%), internal hernias (6, 16.7%), adherences (3, 8.3%), and other diagnoses (5, 13.9%). Regarding JJO stenosis and internal hernias, median time to diagnosis was 8 days (IQR 7-11) and 12 months (IQR 8.7-16) respectively. Previous sleeve gastrectomy, age, or sex was not associated to the incidence of small bowel obstruction. Conclusions LRYGB is safe when performed by experienced surgeons. SBO due to internal hernias were scarce in this series. JJO stenosis could explain most cases of SBO; under this diagnosis, non-surgical management was successful frequently.

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