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La apendicitis aguda es una de las primeras causas de abdomen agudo quirúrgico en la mayor parte de los hospitales en México. La perforación del apéndice es una complicación frecuentemente asociada al tiempo de evolución. Objetivo: Describir la técnica con punto transfi ctivo seromuscular para el manejo del muñón en apendicitis con perforación o necrosis del tercio proximal. Material y métodos: Se ha diseñado una técnica que consiste en colocación de un punto transfi ctivo seromuscular en un solo sitio o dos de la base apendicular proximal a la zona de necrosis o perforación. Se diseñó un estudio de cohorte sobre una base de datos prospectiva en la que se evaluaron pacientes con perforación o necrosis de la base del apéndice. Resultados: Se realizaron 20 apendicetomías, de las cuales 11 fueron por vía laparoscópica, nueve casos con técnica abierta con manejo del muñón con colocación de punto de anclaje transfi ctivo seromuscular en la base apendicular. En ningún caso se desarrolló complicación postquirúrgica. Conclusiones: A pesar de los dispositivos modernos para el cierre del muñón apendicular, aún es difícil el cierre de perforaciones en la base del ciego. En apendicitis complicada con perforación a nivel del tercio proximal, la técnica que se utilizó para el abordaje del muñón es una opción efi caz y segura.

Introduction and importance Neurofibromatosis type 1 (NF1), or Von Recklinghausen's disease, is an autosomal dominant condition that affects the central nervous system. Gastrointestinal stromal tumor (GIST) refers to non-epithelial tumors of the gastrointestinal tract lacking smooth muscle structural features and schwann cell immunohistochemical characteristics. The risk of patients with NF1 to develop a GIST is 7%. Case presentation GIST is a soft tissue sarcoma that probably arises from the interstitial Cajal cells of the intestine. GIST associated with NF1 syndrome appears to have a distinct phenotype, occurring in younger patients compared to sporadic GIST. Clinical discussion The clinical presentation can be highly variable, the association of gastrointestinal tumors associated with Von Recklinghausen's disease is up to 7%, postoperative treatment with imatinib is reserved for patients with a high risk of recurrence. Conclusion The treatment of primary GIST is complete surgical resection with free microscopic margins and an intact pseudocapsule.

Introduction: There are three treatment options for choledocholithiasis: endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy; laparoscopic exploration of the main bile duct with concomitant cholecystectomy; and open cholecystectomy with exploration of the main bile duct. Material and methods: A retrospective, descriptive, observational study was taken of patients with a diagnosis of cholecysto-choledocholithiasis that failed ERCP and who underwent laparoscopic cholecystectomy with exploration of the bile duct. Results: From January 2009 to December 2018, 2322 ERCP procedures were performed at Hospital Regional Ignacio Zaragoza, with a failed procedure rate of 3.2% which is equivalent to 75 patients; endoscopic sphincterotomy was performed on all 75 patients and 60 (80%) of these patients had cholelithiasis with choledocholithiasis. Access to the bile duct through choledochotomy was required in all 75 patients, achieving successful stone extraction and bile duct clearance in 95%. Fifteen (20%) of these patients that had had laparoscopic cholecystectomy presented choledocholithiasis de novo more than two years after cholecystectomy. Nine patients underwent laparoscopic cholecystectomy and 6 patients underwent open cholecystectomy. Patients averaged 6 hospital days post-procedure. Surgical times ranged from 150 min to 210 min. Conclusion: Laparoscopic reoperation of the biliary tract is a reasonable alternative for patients with a history of previous biliary surgery who have failed the ERCP approach. Highlights

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