Revista Argentina de Cirugía

Management of tooth avulsion: a systematic review

2026-03-15T15:31:44+00:00

Tooth avulsion is one of the most serious traumatic dental injuries (TDIs), and it occurs mainly in pediatric and adolescent patients. Early, evidence-based management is essential to optimize prognosis and preserve dental and periodontal health. This systematic review integrates existing literature that deals with clinical protocols and outcomes related to the treatment of avulsed permanent teeth. It focus specifically on the timing of replantation, use of various storage media, splinting methods, timing and technique of endodontic treatment, and use of regenerative materials. Interventional trials, case reports, and retrospective cohort studies are included, all aimed at elucidating the variables determining prognosis. The review demonstrates superior outcomes through early replantation and illustrates how technological advancements in materials such as platelet-rich fibrin (PRF) and mineral trioxide aggregate (MTA) have expanded the window for delayed replantation therapy. The methodological quality of the included studies was evaluated using standardized critical appraisal instruments. The evidence supports a protocol-based, multidisciplinary approach that incorporates current bioactive materials and early emergency treatment to achieve optimal long-term results. The aim of this review is to help clinicians and stakeholders in the management of dental trauma and guide future research identifying optimized treatment for avulsed permanent teeth.

Retroperitoneal paraganglioma presenting as acute pancreatitis

2026-02-03T19:16:00+00:00

Paragangliomas are rare neuroendocrine tumors that arise from the chromaffin cells of the
autonomic nervous system paraganglia. The estimated incidence is 0.8 per 100,000 people. The
initial manifestation of functioning paragangliomas is hypertension in 90% of cases. We present a rare case of a 55-year-old male patient who was previously asymptomatic and presented with clinical criteria consistent with acute pancreatitis, with no evidence of any other etiology. The imaging tests detected a para-aortic retroperitoneal mass displacing the distal pancreas. During open surgery, a tumor compromising the left adrenal gland was removed. During the tumor manipulation, the patient exhibited a significant increase in blood pressure, which subsided after the tumor was resected.
Histopathological examination confirmed a paraganglioma with a mutation in the SDHB gene. After a two-year period of clinical observation, there was no evidence of local or metastatic tumor recurrence.

De Garengeot hernia: a rare location of the appendix therapeutic approach

2026-03-15T15:41:34+00:00

De Garengeot hernia is defined as a femoral hernia containing the appendix. This report describes a 55-year-old female patient who presented with acute lower abdominal pain radiating to the right lower limb, persisting for 4 days. Physical examination revealed a flat, soft abdomen with tenderness in the lower right quadrant and an irreducible mass below the inguinal ligament. Abdominal ultrasonography demonstrated an irreducible right inguino-femoral hernia. The hernia sac contained free fluid and inflamed adipose tissue, as well as a blind-ending bowel loop. The patient underwent hernia repair via an inguinal incision. A De Garengeot hernia was identified, with the femoral sac containing free fluid and the appendix, which had no signs of acute inflammation.
This is a rare condition, and the surgical approach for repairing the abdominal wall largely depends on the preoperative diagnosis, based on the progression of symptoms.

Comparison between paragastric blockade and intraperitoneal local anesthetic instillation for the treatment of visceral pain and associated autonomic symptoms following sleeve gastrectomy

2026-02-01T23:17:04+00:00

Background: Visceral pain (VP) and its associated autonomic symptoms (AAS) are common in the immediate postoperative period following sleeve gastrectomy (SG). Intraperitoneal local anesthetic instillation (IPLA) is often used to treat VP. Promising results with paragastric autonomic neural blockade (PG-ANB) were reported in 2022.
Objective: The aim of this study was to compare the efficacy PG-ANB with IPLA and a control group in managing visceral pain and associated autonomic symptoms following SG.
Material and methods: We conducted a prospective, double-blind, randomized clinical trial in a highvolume center over a 9-month period. A total of 192 patients undergoing SG were included (101 women and 91 men) and assigned to three groups: PG-ANB (n = 85), IPLA (n = 96), and NIAT (n = 11). Pain scores, nausea, and vomiting at 8 and 24 hours after surgery were investigated.
Results: At 8 hours, the PG-ANB group experienced less pain than the control group (85.9% vs. 54.5%, Fisher’s exact test 0.023; p < 0.05), with no significant differences compared to the IPLA group (85.9% vs. 80.2%, Fisher’s exact test 0.3308; p > 0.05). The occurrence of associated autonomic symptoms was significantly lower in the PG-ANB group compared to the IPLA group (2.4% vs. 21.9%, Fisher’s exact test = 0.0001; p < 0.05). No differences were observed at 24 hours. There were no complications associated with PG-ANB or IPLA. The control group was terminated for ethical reasons.
Conclusion: PG-ANB was a safe and effective technique for preventing VP and AAS after SG.

Adrenalectomies in a department of general surgery

2026-02-16T23:08:09+00:00

Background: Adrenal tumors account for 0.6 to 1.5% of all abdominal neoplasms. The evaluation of adrenal tumors requires specific imaging tests, clinical evaluation, and endocrine workup. Laparoscopic adrenalectomy is the preferred technique.
Objective: The aim of this study was to describe the results of laparoscopic adrenalectomies performed in a general surgery department for the treatment of adrenal gland disease.
Material and methods: We conducted an observational, descriptive and retrospective study of patients undergoing surgery between January 2014 and April 2025.
Results: A total of 15 patients were included; mean age was 58.5 years (SD 15.6), and 9 (60%) were women. The preoperative diagnosis was made by clinical evaluation in 7 cases (46.7%), during cancer workups in 4 cases (26.7%), and incidentally in 4 cases (26.7%). The surgical approach was performed using transperitoneal laparoscopic technique. Conversion to open surgery was necessary in 1 patient (6.7%). Mean operative time was 183.6 minutes (SD 51.3). There were 2 complications (13.3%), both grade 4a of the Clavien-Dindo classification. Mean hospital length of stay was 5 days (range: 2-30).
The pathology reports documented 5 cases (33.5%) of pheochromocytoma, 3 cases (20%) of adrenal cortical adenoma, 2 cases (13.3%) of metastasis, and 5 cases (33.5%) of other diagnoses.
Conclusion: Most diagnoses were made during clinical evaluation or cancer workups, and the transperitoneal laparoscopic approach was a safe option with an acceptable conversion rate (6.7%) and favorable postoperative outcomes.

Comparison between patients younger or older than 50 years of age undergoing surgery for colorectal cancer

2026-03-15T15:46:53+00:00

Background: The incidence of colorectal cancer (CRC) is increasing in people < 50 years, a group that has traditionally been excluded from screening programs and is characterized by the presence of more aggressive tumors. This trend poses diagnostic, therapeutic, and social challenges.
Objectives: The aim of this study was to compare the characteristics of patients aged 50 or younger versus those over 50 who underwent surgery for CRC.
Material and methods: We conducted a cross-sectional, analytical and retrospective study. The following variables were recorded: demographic data, American Society of Anesthesiologists (ASA) physical status classification, and histopathological and therapeutic characteristics of patients undergoing CCR surgery between January 2019 and December 2024. The variables were compared using Pearson’s chi-square test or Fisher’s exact test.
Results: A total of 155 patients were included and assigned to two groups: those ≤ 50 years (n = 36) and those > 50 years (n = 119). Younger patients exhibited a higher proportion of men (p = 0.016), cases classified as ASA grade 1 (p = 0.004) and rectal cancer (p = 0.026). There were no significant differences in the histological characteristics, recurrence rate (p = 0.407), or overall mortality (p = 1.0). There was a non-significant trend among young patients to present poorly differentiated tumors (11.1% vs. 6.7%; p = 0.202) and to receive chemotherapy at stage II (30% vs. 15%; p = 0.358).
Conclusion: Patients aged 50 years or younger showed differences in demographics, ASA physical status classification, and tumor location