Face à l’agroécologie transformatrice qui induit des changements sociaux et politiques structurels, l’« agroécologie bidon », portée par de grands groupes privés de l’agrobusiness et des organisations intergouvernementales, repeint en vert, moyennant quelques adaptations technologico-écologiques visant des hausses de productivité et l’atténuation des dégâts de l’agro-industrie, un même modèle inique et destructeur qui tend à se perpétuer.

Se presenta un paciente masculino de 63 años que consulta por vómitos de 48 horas de evolución, con 10 episodios por día, a predominio posprandial, acompañados de distensión y dolor abdominal. Como antecedentes patológicos de relevancia presentaba una internación 15 días antes debido a un abdomen agudo secundario a un adenocarcinoma moderadamente diferenciado de colon, por lo que se le realizó una hemicolectomía izquierda. En ese contexto había presentado una pérdida de peso de 8 kilos.

Background: laparoscopic cholecystectomy is one of the most common procedures performed in general surgery. The anatomical differences of the gallbladder and the presence of factors related to inflammation can cause technical issues during surgery. Objective: the aim of the present study was to determine the value of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) as predictors of difficult cholecystectomy and to evaluate their application during presurgical planning within a university residency program. Material and methods: we conducted a retrospective and analytical study in a tertiary university hospital. A total of 104 adult patients undergoing laparoscopic cholecystectomy due to symptomatic cholelithiasis between January and July 2019 were included. The patients were categorized into two groups: difficult cholecystectomy and non-difficult cholecystectomy. Results: there were statistically significant differences in ESR and CRP values between both groups (p < 0.001). Sensitivity of ESR was 100%, specificity was 45%, with a PPV of 40% and NPV of 100%. Sen- sitivity of CRP was 87.5%, specificity was 86.3%, with a PPV of 70% and NPV of 95%. Both parameters were elevated in 14 of 16 difficult cholecystectomies and in 2 of 44 non-difficult cholecystectomies. Sensitivity of CRP was 87.5%, specificity was 86.3%, with a PPV of 70% and NPV of 95%. Conclusion: measuring ESR and CRP has proved to be a reliable method to predict difficult chole- cystectomies due to symptomatic cholelithiasis. This could be applied for surgical planning within a university residency program.