Dr. Víctor Hugo Asquel - Cirugía General y Laparoscópica

09/12/2025

08/12/2025

Lesión de la vía biliar post-colecistectomía: qué hacer según la Guía SAGES–AHPBA 2025 🔧🟡

🌍 ¿Por qué importa esta guía?

La lesión de la vía biliar (LVB) sigue siendo una de las complicaciones más temidas de la colecistectomía:
• Morbilidad alta
• Mortalidad entre 3–20%
• Impacto severo en calidad de vida y reinserción laboral

La guía 2025 revisa la evidencia y entrega recomendaciones prácticas para el momento de reparación, técnica quirúrgica, rol del manejo no operatorio y tipo de anastomosis bilioentérica.

🕒 1) ¿Reparación temprana o diferida?

La guía sugiere reparación diferida >6 semanas.
(Condicional, evidencia muy baja)

✔ ¿Por qué diferir?
• Menos estenosis
• Menos reintervenciones
• Mejor calidad de vida
• Menos complicaciones mayores

✔ ¿Cuándo considerar reparación temprana (

06/12/2025

The Ligament of Treitz marks the anatomical transition between:
A. Jejunum and ileum
B. Duodenum and jejunum
C. Ileum and cecum
D. Stomach and duodenum

03/12/2025

🔬 BILIARY STONES MAP

INTRAHEPATIC (hepatolithiasis)
• Mainly brown pigment + cholesterol stones

→ GALLBLADDER (cholecystolithiasis)
• Cholesterol or black pigment stones

EXTRAHEPATIC (choledocholithiasis)
• Primary: brown pigment
• Secondary: cholesterol

Pro tip: Brown stones in CBD → check for stricture with balloon sweep; clears 85% on-table.

29/11/2025

TRA ARTE E CHIRURGIA: LA LAPAROTOMIA

🟢 La laparotomia è un'incisione chirurgica della parete addominale che consente l'accesso alla cavità addominale e agli organi interni a scopo diagnostico o terapeutico.
🖼 In questo quadro in pittura ad olio, del 1898, identifichiamo il chirurgo principale, il dr. Manuel Candela (1847-1919), ginecologo ed accademico delle Università di Valencia e Madrid. Alla sua destra si identifica il dr. Cogollos.
L’unico assistente che appare seduto è l’anestesista, mentre alla sinistra del dr Candela troviamo il primo assistente. Lo strumentista è il dr. López Sancho.
👉 L’autore dell’opera, intitolata appunto ‘La Laportomia‘, è il pittore spagnolo Vicente Castell (1871-1934). Il quadro è conservato al “Museo de Bellas Artes de Castellón“, sito nella Comunidad Valenciana.
Vicente Castell è stato un pittore di stile costumbrista, ossia un interprete della vita quotidiana della Spagna dei suoi tempi.

28/11/2025

🚨 Monthly focus on general surgery
🎥 Check it out: https://irc.ad/0OiX

This month, we're focusing on cutting-edge techniques and challenging cases in general surgery, with a strong emphasis on advanced laparoscopic approaches.

Explore a comprehensive collection of video contributions and case reports covering complex procedures, including laparoscopic total gastrectomy with lymph node mapping for gastric cancer, challenging vascular resections (IVC leiomyosarcoma, MALS), specialized management of rare gastrointestinal syndromes (Wilkie's syndrome), and various other advanced minimally invasive techniques.

21/11/2025

Stapfer classification for perforations during ERCP

Source: S. Mee Park, Clin Endosc 2016;49:376-382

19/11/2025

Surgical procedures led to a 16% increase in financial hardship and an 8-fold rise in out-of-pocket spending for US working-age adults, especially the uninsured and those with private insurance. https://ja.ma/47Zc5NT

19/11/2025

19/11/2025

ACUTE CHOLECYSTITIS - Timing of Surgery Changes Everything

DIAGNOSIS: Gallstone obstruction causes 90-95% of cases. Ultrasound shows 81% sensitivity, 83% specificity.

Early vs late laparoscopic cholecystectomy

EARLY SURGERY (1-3 days):
- 11.8% complications
- 5.4 day hospital stay
- Lower costs

LATE SURGERY (>3 days):
- 34.4% complications
- 10.0 day hospital stay
- Higher costs

BOTTOM LINE: Early lap chole cuts complications by two-thirds and halves length of stay.

SOURCE: J. Gallaher and A. Charles. JAMA. 2022;327(10):965-975

Read the full review: https://www.newsletter.endocollab.com/p/acute-cholecystitis-nice-review-ofhttps://substackcdn.com/image/fetch/$s_!3NlZ!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F811ceef4-6d96-407a-9bff-a65a1b678a21_1400x863.png