Browsing by Author "Ochoa G."

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    Latin American formal consensus on the appropriate indications of extra-articular lateral procedures in primary anterior cruciate ligament reconstruction
    (Springer, 2023) Barahona M.; Mosquera M.; De Padua V.; Galan H.; Del Castillo J.; Mejias S.; Bacarreza F.; Araya O.; Kuhn A.; Vaisman A.; Graieb A.; Almazan A.; Helito C.; Fuentes C.; Collazo C.; Esquivel D.; Gigante F.; Motta F.; Ochoa G.; Arteaga G.; Ferrer G.; Zvietcovich G.; Cardona J.; Hurtado J.; Erlund L.; Costa-Paz M.; Roby M.; Ponzo N.; Sarmiento P.; Yanez R.; Urbieta S.; Marques de Olivera V.; Zamorano A.; Radice F.; Nardin L.; Gelink A.; Hernandez R.; Rosa A.D.L.; Irarrazaval S.; Cordivani F.; Canuto S.; Gravini G.; CEDEUS (Chile)
    © 2022 The Author(s)Objectives: To create a practice guideline for the appropriate indications of an extra-articular procedure in primary anterior cruciate ligament reconstruction (ACLR). Methods: The formal consensus method described by the Haute Autorité de Santé was used. The Latin American Society of Arthroscopy, Articular Replacement, and Sports Injuries (SLARD) recruited three groups of experts on ACLR. Initially, the steering group, consisting of eight surgeons, performed a systematic review of the literature and elaborated on 192 scenarios for primary ACLR. The rating group, composed of 23 surgeons, rated each scenario in two rounds, with an in-between in-person meeting for discussion. Median scores and agreement levels were estimated to classify each scenario as inappropriate, uncertain or appropriate for adding anterolateral reconstruction. Finally, the lecture group, consisting of 10 surgeons, revised each stage of the method, results and interpretation. Results: Of the scenarios, 11.97% were rated as appropriate for adding an extra-articular lateral procedure, 7.81% as inappropriate and 80.21% as uncertain. The key recommendations for the addition of extra-articular lateral techniques were as follows: it is appropriate when the patient is under 25 years of age, has high-grade physical examination findings, practises a pivoting sport and has hyperlaxity; meanwhile, it is inappropriate when the patient has low-grade physical examination findings, has normal laxity and does not practise a pivoting sport. Conclusions: The appropriate indications of extra-articular lateral procedures in primary ACLR were determined on the basis of the best available evidence and expert opinion following a formal consensus method. Level of evidence: V.
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    Roux-en-Y biliary reconstruction as a definitive treatment for serious complications of portal biliopathy. Case series
    (2023) Ochoa G.; Marino C.; Dib M.; Briceno E.; Martinez J.A.; Jarufe N.
    © 2023 The AuthorsIntroduction and importance: Portal biliopathy (PB) is an abnormality of the biliary tree wall due to extrahepatic portal hypertension. Among the complications of portal biliopathy are digestive bleeding, jaundice, and cholangitis. Surgical treatment is an exception when medical management is not possible. Case presentation: This is a case series study of four patients with severe PB complications requiring surgical management in our center from 2005 to 2016. Two of them had previous surgical procedures related to portal hypertension. All presented with severe biliary stenosis and recurrent cholangitis, and two also had massive upper gastrointestinal bleeding. Because of endoscopic management failure, a Roux-en-Y hepaticojejunostomy was performed in all cases. Two patients presented morbidity Clavien-Dindo>IIIA, requiring reoperation. During follow-up, no one developed other complications related to PB. Discussion: Surgical treatment for PB complications is a challenge and mainly implies a portosystemic shunt as a first step. When it fails, an alternative is perform a biliodigestive anastomoses, with high risk of bleeding given the prominent collaterals present in the hepatoduodenal pedicle secondary to portal cavernomatosis. Conclusion: Our patients after YRGB didn't present new complications due to PB. The surgery could be a definite solution for PB complications. It has only been made for selective cases because it implies high complexity and risk.