Dr. Julio Estrada – Cirug\u00eda General y Laparosc\u00f3pica<\/title>\n \n \n \n <link\n href=\"https:\/\/cdnjs.cloudflare.com\/ajax\/libs\/font-awesome\/6.4.0\/css\/all.min.css\"\n rel=\"stylesheet\"\n \/>\n\n \n \n\n \n \n <\/head>\n\n <body>\n \n <nav class=\"navbar navbar-expand-lg sticky-top navbar-light\">\n <div class=\"container\">\n <a class=\"navbar-brand\" href=\"https:\/\/drjulioestrada.com\/\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/05\/logo-header.webp\"\n alt=\"logo-header\"\n \/>\n <\/a>\n\n <button\n class=\"navbar-toggler\"\n type=\"button\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#navbarNav\"\n >\n <span class=\"navbar-toggler-icon\"><\/span>\n <\/button>\n\n <div class=\"collapse navbar-collapse\" id=\"navbarNav\">\n <ul class=\"navbar-nav ms-auto align-items-lg-center\">\n <li class=\"nav-item\">\n <a class=\"nav-link\" href=\"https:\/\/drjulioestrada.com\/\"\n >Inicio<\/a\n >\n <\/li>\n\n <li class=\"nav-item\">\n <a class=\"nav-link\" href=\"https:\/\/drjulioestrada.com\/somos\/\"\n >Somos<\/a\n >\n <\/li>\n\n <div class=\"nav-item dropdown\">\n <a\n href=\"#\"\n class=\"nav-link dropdown-toggle active\"\n data-bs-toggle=\"dropdown\"\n >Procedimientos<\/a\n >\n\n <div class=\"dropdown-menu m-0\">\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#apendice\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Cirug\u00eda<\/span> de Apendice<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#vesicula\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Cirug\u00eda<\/span> de Ves\u00edcula<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#hernias\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Cirug\u00eda<\/span> de Hernias\n Abdominales<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#exploracion\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Exploraci\u00f3n<\/span> de la V\u00eda\n Biliar<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#ercp\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">ERCP<\/span> (Endoscopic\n Retrograde Cholangiopancreatography) – Colangiopancreatograf\u00eda\n Retr\u00f3grada Endosc\u00f3pica) – Colangiopancreatograf\u00eda Retr\u00f3grada\n Endosc\u00f3pica<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#colangiografia\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Colangiograf\u00eda<\/span>\n Intraoperatoria<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#emergencia\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Cirug\u00eda<\/span> de Emergencia<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#abdomen-agudo\"\n class=\"dropdown-item\"\n >Abdomen Agudo no\n <span class=\"font-acent-ub\">Traum\u00e1tico<\/span><\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#obstruccion-intestinal\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Obstrucci\u00f3n<\/span> Intestinal<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#perforacion\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Perforaci\u00f3n<\/span> de Viscera\n Hueca<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#pancreatitis\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Pancreatitis<\/span> Aguda\n Grave<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#diverticulitis\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Diverticulitis<\/span> Aguda\n Complicada<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#trauma-abdominal\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Trauma<\/span> Abdominal<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#abdomen-abierto\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Abdomen Abierto<\/span> y\n <span class=\"font-acent-ub\">Cirug\u00eda<\/span> de Control de\n Da\u00f1os<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#catastrofe-abdominal\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Cat\u00e1strofe<\/span> Abdominal<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#abdomen-agudo-pediatria\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Abdomen Agudo<\/span> en\n Pediatr\u00eda<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"nav-item dropdown\">\n <a\n href=\"#\"\n class=\"nav-link dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n >Condiciones quir\u00fargicas<\/a\n >\n\n <div class=\"dropdown-menu m-0\">\n <a\n href=\"https:\/\/drjulioestrada.com\/condiciones-quirurgicas\/condiciones-quirurgicas-apendice\/\"\n class=\"dropdown-item\"\n >Ap\u00e9ndice (Apendicitis)<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/condiciones-quirurgicas\/condiciones-quirurgicas-vesicula\/\"\n class=\"dropdown-item\"\n >Ves\u00edcula Biliar<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/condiciones-quirurgicas\/condiciones-quirurgicas-hernias-de-la-pared-abdominal\/\"\n class=\"dropdown-item\"\n >Hernias de la Pared Abdominal<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/condiciones-quirurgicas\/condiciones-quirurgicas-diastasis-de-rectos\/\"\n class=\"dropdown-item\"\n >Di\u00e1stasis de rectos Abdominales<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/condiciones-quirurgicas\/condiciones-quirurgicas-pie-diabetico\/\"\n class=\"dropdown-item\"\n >Pie diab\u00e9tico<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/condiciones-quirurgicas\/condiciones-quirurgicas-cirugia-menor\/\"\n class=\"dropdown-item\"\n >Cirug\u00eda menor<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/condiciones-quirurgicas\/condiciones-quirurgicas-suturas\/\"\n class=\"dropdown-item\"\n >Suturas<\/a\n >\n <\/div>\n <\/div>\n\n <li class=\"nav-item\">\n <a\n class=\"nav-link\"\n href=\"https:\/\/drjulioestrada.com\/informacion-para-el-paciente\/\"\n >Informaci\u00f3n del paciente<\/a\n >\n <\/li>\n\n <div class=\"nav-item dropdown\">\n <a\n href=\"#\"\n class=\"nav-link dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n >Gu\u00eda para Estudiantes<\/a\n >\n\n <div class=\"dropdown-menu m-0\">\n <a\n href=\"https:\/\/drjulioestrada.com\/guia-para-estudiantes\/abc-de-laparoscopia\/\"\n class=\"dropdown-item\"\n >ABC de Laparoscop\u00eda<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/guia-para-estudiantes\/guia-para-estudiantes-de-pregrado\/\"\n class=\"dropdown-item\"\n >Gu\u00eda para estudiantes de pregrado<\/a\n >\n <\/div>\n <\/div>\n\n <li class=\"nav-item\">\n <a\n class=\"d-tlf nav-link\"\n href=\"https:\/\/drjulioestrada.com\/agendar\/\"\n >Agendar Cita<\/a\n >\n <\/li>\n <\/ul>\n\n <div class=\"btn-head\">\n <a\n class=\"d-desk nav-link btn-nav\"\n href=\"https:\/\/drjulioestrada.com\/agendar\/\"\n >Agendar Cita<\/a\n >\n <\/div>\n <\/div>\n <\/div>\n <\/nav>\n\n \n <section id=\"procedis\">\n <div class=\"container\">\n <div class=\"contain-hero-procedis\">\n <div class=\"row row-hero-procedis\">\n <div class=\"col-hero-procedis col-hero-procedis1\"><\/div>\n\n <div class=\"col-hero-procedis col-hero-procedis2\">\n <h4 class=\"font-creato titu-hero-procedi\">procedimientos<\/h4>\n\n <h3 class=\"font-creato titus-hero-procedi\">Que realizo<\/h3>\n\n <p class=\"font-creato txt-hero-procedi\">\n En este apartado encontrar\u00e1s una gu\u00eda inicial para entender en\n qu\u00e9 consiste cada uno de los principales procedimientos, \u00bfQu\u00e9\n es? \u00bfPor qu\u00e9 se realiza? Y \u00bfCu\u00e1les son los tipos de cirug\u00eda?\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/section>\n\n \n <section id=\"info-procedis\">\n <div class=\"container my-5 py-4\">\n <div class=\"contain-procedis\">\n <div class=\"item-procedis item-procedis1\" id=\"apendice\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n id=\"dropdownInicial\"\n data-bs-display=\"static\"\n data-bs-auto-close=\"outside\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-1.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Cirug\u00eda de Ap\u00e9ndice<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Apendicectom\u00eda<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Tipos de Apendicectom\u00eda<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Apendicectom\u00eda Abierta por Laparotom\u00eda Exploradora<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 1. \u00bfQu\u00e9 es una Apendicectom\u00eda?\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n La apendicectom\u00eda es la cirug\u00eda mediante la cual se\n extirpa el ap\u00e9ndice vermiforme.<br \/>Es el tratamiento\n est\u00e1ndar y definitivo para la apendicitis aguda, una\n inflamaci\u00f3n progresiva que puede complicarse r\u00e1pidamente\n con perforaci\u00f3n, peritonitis y sepsis.<br \/>Es uno de los\n procedimientos m\u00e1s seguros y realizados en todo el mundo,\n con una recuperaci\u00f3n r\u00e1pida cuando se atiende\n oportunamente.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 2. \u00bfPor qu\u00e9 se realiza una Apendicectom\u00eda?\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n La indicaci\u00f3n principal es la apendicitis aguda, pero\n tambi\u00e9n se realiza en:\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Apendicitis no complicada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Apendicitis gangrenosa.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Apendicitis perforada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Absceso apendicular tras manejo inicial con\n antibi\u00f3ticos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Masa apendicular con episodios recurrentes.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Apendicolito sintom\u00e1tico persistente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Diagn\u00f3stico incierto de abdomen agudo, donde la\n evaluaci\u00f3n quir\u00fargica es necesaria.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n Sin cirug\u00eda, la apendicitis puede complicarse gravemente\n en pocas horas.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n \u00bfQu\u00e9 tipos de Apendicectom\u00eda existen?\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n A) Apendicectom\u00eda Laparosc\u00f3pica: Es el est\u00e1ndar moderno y\n la t\u00e9cnica recomendada en la mayor\u00eda de los pacientes.<br \/><br \/><strong\n >\u00bfC\u00f3mo se realiza?<\/strong\n >\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Apendicitis no complicada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Apendicitis gangrenosa.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Apendicitis perforada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Absceso apendicular tras manejo inicial con\n antibi\u00f3ticos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Masa apendicular con episodios recurrentes.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Apendicolito sintom\u00e1tico persistente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Diagn\u00f3stico incierto de abdomen agudo, donde la\n evaluaci\u00f3n quir\u00fargica es necesaria.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>Ventajas de la laparoscop\u00eda:<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Incisiones peque\u00f1as.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Menos dolor.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Recuperaci\u00f3n m\u00e1s r\u00e1pida.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Menor riesgo de infecci\u00f3n de herida.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Menor estancia hospitalaria.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Evaluaci\u00f3n completa del abdomen (clave en mujeres).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Mejor resultado est\u00e9tico.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n B) Apendicectom\u00eda Abierta (Incisi\u00f3n en Fosa Il\u00edaca\n Derecha): Se utiliza en situaciones espec\u00edficas.<br \/><br \/><strong\n >Indicada en:<\/strong\n >\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Colecciones o abscesos localizados severos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Falta de equipo laparosc\u00f3pico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Cicatrices previas complejas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Peritonitis local con dificultad t\u00e9cnica para\n laparoscop\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Pacientes que no pueden recibir anestesia general.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>T\u00e9cnica:<\/strong> Se realiza una incisi\u00f3n peque\u00f1a\n tipo McBurney o Rocky-Davis, se identifica el ap\u00e9ndice, se\n liga y se retira.\n <\/p>\n\n <p class=\"txt-drop-inter\">\n B) Apendicectom\u00eda Abierta (Incisi\u00f3n en Fosa Il\u00edaca\n Derecha): Se utiliza en situaciones espec\u00edficas.<br \/><br \/><strong\n >Indicada en:<\/strong\n >\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Colecciones o abscesos localizados severos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Falta de equipo laparosc\u00f3pico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Cicatrices previas complejas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Peritonitis local con dificultad t\u00e9cnica para\n laparoscop\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Pacientes que no pueden recibir anestesia general.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n C) Apendicectom\u00eda Abierta por Laparotom\u00eda Exploradora: La\n m\u00e1s compleja y reservada para casos graves.<br \/><br \/><strong\n >\u00bfCu\u00e1ndo se realiza?<\/strong\n >\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Peritonitis generalizada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Sospecha de patolog\u00edas alternas mayores.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Pacientes inestables hemodin\u00e1micamente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Masas inflamatorias grandes o plastrones.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Embarazo avanzado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Conversi\u00f3n de laparoscop\u00eda a cirug\u00eda abierta.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Recuperaci\u00f3n Despu\u00e9s de la Apendicectom\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Riesgos y Complicaciones (poco comunes).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter9\">\n \u00bfQu\u00e9 pasa si NO se trata una apendicitis?\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter10\">\n Apendicitis en Mujeres: \u00bfPor qu\u00e9 es importante la\n laparoscop\u00eda?\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter10\">\n Cuidados en casa.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n Apendicectom\u00eda Abierta por Laparotom\u00eda Exploradora\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n La m\u00e1s compleja y reservada para casos graves.<br \/><br \/><strong\n >\u00bfCu\u00e1ndo se realiza?<\/strong\n >\n <\/p>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Peritonitis generalizada:<\/strong> Pus o\n infecci\u00f3n en m\u00faltiples cuadrantes del abdomen. La\n laparoscop\u00eda puede ser limitada o peligrosa.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong\n >Sospecha de patolog\u00edas alternas mayores:<\/strong\n >\n No siempre es apendicitis. Se realiza cuando puede\n tratarse de: Perforaci\u00f3n intestinal, Isquemia\n mesent\u00e9rica, Diverticulitis complicada, Perforaci\u00f3n\n g\u00e1strica o duodenal, Patolog\u00eda ginecol\u00f3gica no\n identificable por laparoscop\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Pacientes inestables hemodin\u00e1micamente:<\/strong>\n En shock s\u00e9ptico, la laparotom\u00eda permite control m\u00e1s\n r\u00e1pido.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong\n >Masas inflamatorias grandes o plastrones:<\/strong\n >\n Cuando existe adherencia severa y la anatom\u00eda est\u00e1\n distorsionada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n <strong>Embarazo avanzado:<\/strong> En el tercer\n trimestre, la laparoscop\u00eda puede ser limitada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n <strong\n >Conversi\u00f3n de laparoscop\u00eda a cirug\u00eda abierta:<\/strong\n >\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >Cuando durante la cirug\u00eda se identifican:<\/strong\n >\n Sangrado persistente, Lesiones intestinales,\n Imposibilidad de progresar, Anatom\u00eda no clara.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong\n >\u00bfQu\u00e9 permite una laparotom\u00eda\n exploradora?:<\/strong\n >\n Control absoluto de la infecci\u00f3n, Lavado completo,\n Revisi\u00f3n de todos los \u00f3rganos, Drenaje amplio,\n Cirug\u00eda segura en abdomen severamente contaminado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Desventajas frente a laparoscop\u00eda:<\/strong>\n M\u00e1s dolor postoperatorio, Incisi\u00f3n m\u00e1s grande, Mayor\n tiempo de recuperaci\u00f3n, Mayor riesgo de infecci\u00f3n y\n eventraci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Aun as\u00ed,\n <strong\n >es la t\u00e9cnica que salva vidas en escenarios\n cr\u00edticos.<\/strong\n >\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n <strong\n >Recuperaci\u00f3n Despu\u00e9s de la Apendicectom\u00eda:<\/strong\n >\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >Laparosc\u00f3pica (la mayor\u00eda de casos):<\/strong\n >\n Caminar el mismo d\u00eda, L\u00edquidos por boca en horas,\n Dieta normal en 24hr, Trabajo de oficina: 3-5 d\u00edas,\n Actividad normal: 7-10 d\u00edas, Ejercicio intenso: 3-4\n semanas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Abierta o por laparotom\u00eda:<\/strong>\n Hospitalizaci\u00f3n 3-7 d\u00edas, Actividad ligera a las 2-3\n semanas, Actividad completa a las 4-6 semanas,\n Ejercicio intenso: 8 semanas.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n <strong\n >Riesgos y Complicaciones (poco comunes):<\/strong\n >\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Infecci\u00f3n de herida.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Absceso intraabdominal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Sangrado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Lesi\u00f3n intestinal (menos del 1%).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Eventraci\u00f3n (en incisiones grandes).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Dolor residual transitorio.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Sepsis (en casos perforados).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Los riesgos disminuyen cuando la cirug\u00eda es temprana\n y realizada por un equipo calificado.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter9\">\n <strong\n >\u00bfQu\u00e9 pasa si NO se trata una apendicitis?<\/strong\n >\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Complicaciones graves:<\/strong> Perforaci\u00f3n\n del ap\u00e9ndice, Peritonitis generalizada, Abscesos\n m\u00faltiples, Shock s\u00e9ptico, Muerte (en casos\n avanzados).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n La apendicitis no se cura con antibi\u00f3ticos. La \u00fanica\n soluci\u00f3n definitiva y segura es la cirug\u00eda.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter10\">\n <strong>Apendicitis en mujeres:<\/strong> \u00bfPor qu\u00e9 es\n importante la laparoscop\u00eda?\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >La laparoscop\u00eda permite descartar patolog\u00edas\n ginecol\u00f3gicas:<\/strong\n >\n Quistes ov\u00e1ricos rotos, Torsi\u00f3n de ovario, Embarazo\n ect\u00f3pico, Endometriosis, Enfermedad p\u00e9lvica\n inflamatoria.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Esto evita cirug\u00edas innecesarias y garantiza\n diagn\u00f3stico certero.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter11\">\n <strong>Cuidados en casa:<\/strong>\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Mantener heridas limpias y secas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Evitar levantar peso por 2-3 semanas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n No sumergir las heridas por 10-14 d\u00edas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Acudir si aparece fiebre, v\u00f3mitos, dolor intenso o\n secreci\u00f3n en la herida.\n <\/li>\n <\/ul>\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Bhangu A, S\u00f8reide K, Di Saverio S, Assarsson JH, Drake\n FT.<strong\n >Acute appendicitis: modern understanding of\n pathogenesis, diagnosis, and management.<\/strong\n >\n Lancet. 2015;386(10000):1278-1287.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Salminen P, Tuominen R, Paajanen H, et al.\n <strong\n >Antibiotic therapy vs appendectomy for treatment of\n uncomplicated acute appendicitis.<\/strong\n >\n JAMA. 2015;313(23):2340-2348.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Di Saverio S, Podda M, De Simone B, et al.\n <strong\n >Diagnosis and treatment of acute appendicitis: 2020\n update of the WSES Jerusalem guidelines.<\/strong\n >\n World J Emerg Surg. 2020;15(1):27.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Andersson RE.\n <strong\n >Meta-analysis of the clinical and laboratory\n diagnosis of appendicitis.<\/strong\n >\n Br J Surg. 2004;91(1):28-37.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Atema JJ, et al.\n <strong\n >Laparoscopic vs open appendectomy in adults and\n children: systematic review and meta-analysis.<\/strong\n >\n Surg Endosc. 2015;29(3):620-640.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Addiss DG, Shaffer N, Fowler BS, Tauxe RV.<strong\n >The epidemiology of appendicitis and appendectomy in\n the United States.<\/strong\n >\n Am J Epidemiol. 1990;132(5):910-925.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis2\" id=\"vesicula\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n data-bs-auto-close=\"outside\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-02.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Cirug\u00eda de Ves\u00edcula Biliar<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Colecistectom\u00eda<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Tipos de Colecistectom\u00eda<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Antes, durante y luego de la cirug\u00eda<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 1. \u00bfQu\u00e9 es una Colecistectom\u00eda?\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n La colecistectom\u00eda es la cirug\u00eda mediante la cual se\n retira la ves\u00edcula biliar.<br \/>Es el tratamiento\n definitivo para la mayor\u00eda de enfermedades vesiculares,\n <strong\n >especialmente c\u00e1lculos (colelitiasis), inflamaci\u00f3n\n (colecistitis)<\/strong\n >\n y lesiones con riesgo de malignidad como\n <strong\n >p\u00f3lipos, ves\u00edcula en porcelana y S\u00edndrome de\n Mirizzi.<\/strong\n ><br \/>La t\u00e9cnica m\u00e1s utilizada en la actualidad es la\n colecistectom\u00eda laparosc\u00f3pica, por ser m\u00e1s segura, menos\n dolorosa y con mejor recuperaci\u00f3n.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 2. \u00bfPor qu\u00e9 se realiza una colecistectom\u00eda? \u2014 Indicaciones\n principales\n <\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Colelitiasis (piedras en la ves\u00edcula)<\/strong>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n C\u00f3lico biliar.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Dolor recurrente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n N\u00e1useas con comidas grasas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Intolerancia alimentaria.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n C\u00e1lculos grandes (>2-3 cm).\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Colecistitis aguda:<\/strong> Inflamaci\u00f3n de la\n ves\u00edcula, usualmente por obstrucci\u00f3n del conducto\n c\u00edstico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong\n >Colecistitis cr\u00f3nica \/ Ves\u00edcula disfuncional\n (Discinesia biliar):<\/strong\n >\n Ves\u00edcula que no contrae bien, incluso sin c\u00e1lculos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong\n >C\u00e1lculos en el col\u00e9doco (coledocolitiasis): Requiere\n manejo combinado: ERCP<\/strong\n >\n \u00b1 cirug\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n <strong>P\u00f3lipos vesiculares:<\/strong> Cirug\u00eda indicada\n cuando:\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n \u226510 mm.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Crecimiento en controles.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n S\u00e9siles (base ancha).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Asociados a c\u00e1lculos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n S\u00edntomas persistentes.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n En pacientes >50 a\u00f1os con p\u00f3lipos \u22658 mm.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n <strong>Ves\u00edcula en porcelana:<\/strong>\n Calcificaci\u00f3n extensa de la pared con riesgo aumentado\n de c\u00e1ncer.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n <strong>S\u00edndrome de Mirizzi:<\/strong>\n C\u00e1lculo impactado que comprime o erosiona el col\u00e9doco.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n <strong>Pancreatitis biliar:<\/strong>\n Una vez estabilizado el cuadro, la colecistectom\u00eda evita\n recurrencias.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter9\">\n <strong>C\u00e1ncer de ves\u00edcula biliar:<\/strong>\n En etapas tempranas puede requerir colecistectom\u00eda\n simple o radical seg\u00fan estadificaci\u00f3n.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n \u00bfQu\u00e9 tipo de Colecistectom\u00eda existen?\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n <strong\n >A) Colecistectom\u00eda Laparosc\u00f3pica (la t\u00e9cnica\n est\u00e1ndar):<\/strong\n >\n La cirug\u00eda se realiza con 3-4 peque\u00f1as incisiones en el\n abdomen.<br \/><br \/><strong>\u00bfC\u00f3mo se realiza?<\/strong>\n <\/p>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Se introduce una c\u00e1mara que permite ver en alta\n definici\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Se identifica la ves\u00edcula y el tri\u00e1ngulo de Calot.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Se obtienen las\n <strong>\u201cCritical View of Safety\u201d<\/strong> para evitar\n complicaciones.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Se clipa y corta el conducto c\u00edstico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Se clipan y cortan los vasos c\u00edsticos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Se libera la ves\u00edcula del h\u00edgado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Se retira por una de las incisiones.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Se revisa la cavidad y se cierran las heridas con puntos\n est\u00e9ticos.\n <\/li>\n <\/ol>\n\n <p class=\"txt-drop-inter\">\n <strong>Ventajas:<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Incisiones peque\u00f1as.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Menos dolor.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Recuperaci\u00f3n r\u00e1pida.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Alta hospitalaria el mismo d\u00eda o siguiente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Menor riesgo de infecci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Menor riesgo de eventraci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Mejor resultado est\u00e9tico\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Por eso es el est\u00e1ndar de oro mundial.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strogn>B) Colecistectom\u00eda Abierta (tradicional):<\/strogn>\n Requiere una incisi\u00f3n subcostal derecha o mediana de entre\n 10 – 15 cm.\n <\/p>\n\n <p class=\"txt-drop-inter\">\n <strong>Indicaciones:<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Anatom\u00eda muy distorsionada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Plastr\u00f3n evero o abscesos m\u00faltiples.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Lesiones vesiculares infiltrantes.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Adherencias intensas de cirug\u00edas previas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Hemorragia durante laparoscop\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Paciente inestable.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n C\u00e1ncer de ves\u00edcula (seg\u00fan caso).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Menos com\u00fan hoy d\u00eda, pero necesaria en escenarios\n complejos.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>C) Colecistectom\u00eda en contextos complejos<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>S\u00edndrome de Mirizzi:<\/strong> Dependiendo del\n grado (I-IV):\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Colecistectom\u00eda parcial.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Reconstrucci\u00f3n biliar.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Hep\u00e1tico-yeyuno anastomosis en casos avanzados.\n <\/li>\n <\/ol>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Ves\u00edcula en porcelana:<\/strong> Colecistectom\u00eda\n recomendada a\u00fan sin s\u00edntomas, por riesgo de c\u00e1ncer.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>C\u00e1ncer de ves\u00edcula:<\/strong> Puede requerir:\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Colecistectom\u00eda simple (T1a).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Colecistectom\u00eda + resecci\u00f3n de segmentos IVb\/V.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Linfadenectom\u00eda hiliar.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Cirug\u00eda oncol\u00f3gica mayor seg\u00fan etapa.\n <\/li>\n <\/ol>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong>Colecistectom\u00eda con coledocolitiasis:<\/strong>\n Manejo combinado:\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n ERCP.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Laparoscop\u00eda con exploraci\u00f3n de v\u00eda biliar.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Cirug\u00eda abierta en casos seleccionados.\n <\/li>\n <\/ol>\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n Apendicectom\u00eda Abierta por Laparotom\u00eda Exploradora\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n La m\u00e1s compleja y reservada para casos graves.<br \/><br \/><strong\n >\u00bfCu\u00e1ndo se realiza?<\/strong\n >\n <\/p>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Peritonitis generalizada:<\/strong> Pus o\n infecci\u00f3n en m\u00faltiples cuadrantes del abdomen. La\n laparoscop\u00eda puede ser limitada o peligrosa.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong\n >Sospecha de patolog\u00edas alternas mayores:<\/strong\n >\n No siempre es apendicitis. Se realiza cuando puede\n tratarse de: Perforaci\u00f3n intestinal, Isquemia\n mesent\u00e9rica, Diverticulitis complicada, Perforaci\u00f3n\n g\u00e1strica o duodenal, Patolog\u00eda ginecol\u00f3gica no\n identificable por laparoscop\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Pacientes inestables hemodin\u00e1micamente:<\/strong>\n En shock s\u00e9ptico, la laparotom\u00eda permite control m\u00e1s\n r\u00e1pido.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong\n >Masas inflamatorias grandes o plastrones:<\/strong\n >\n Cuando existe adherencia severa y la anatom\u00eda est\u00e1\n distorsionada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n <strong>Embarazo avanzado:<\/strong> En el tercer\n trimestre, la laparoscop\u00eda puede ser limitada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n <strong\n >Conversi\u00f3n de laparoscop\u00eda a cirug\u00eda abierta:<\/strong\n >\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >Cuando durante la cirug\u00eda se identifican:<\/strong\n >\n Sangrado persistente, Lesiones intestinales,\n Imposibilidad de progresar, Anatom\u00eda no clara.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong\n >\u00bfQu\u00e9 permite una laparotom\u00eda\n exploradora?:<\/strong\n >\n Control absoluto de la infecci\u00f3n, Lavado completo,\n Revisi\u00f3n de todos los \u00f3rganos, Drenaje amplio,\n Cirug\u00eda segura en abdomen severamente contaminado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Desventajas frente a laparoscop\u00eda:<\/strong>\n M\u00e1s dolor postoperatorio, Incisi\u00f3n m\u00e1s grande, Mayor\n tiempo de recuperaci\u00f3n, Mayor riesgo de infecci\u00f3n y\n eventraci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Aun as\u00ed,\n <strong\n >es la t\u00e9cnica que salva vidas en escenarios\n cr\u00edticos.<\/strong\n >\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n <strong\n >Recuperaci\u00f3n Despu\u00e9s de la Apendicectom\u00eda:<\/strong\n >\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >Laparosc\u00f3pica (la mayor\u00eda de casos):<\/strong\n >\n Caminar el mismo d\u00eda, L\u00edquidos por boca en horas,\n Dieta normal en 24hr, Trabajo de oficina: 3-5 d\u00edas,\n Actividad normal: 7-10 d\u00edas, Ejercicio intenso: 3-4\n semanas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Abierta o por laparotom\u00eda:<\/strong>\n Hospitalizaci\u00f3n 3-7 d\u00edas, Actividad ligera a las 2-3\n semanas, Actividad completa a las 4-6 semanas,\n Ejercicio intenso: 8 semanas.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n <strong\n >Riesgos y Complicaciones (poco comunes):<\/strong\n >\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Infecci\u00f3n de herida.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Absceso intraabdominal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Sangrado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Lesi\u00f3n intestinal (menos del 1%).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Eventraci\u00f3n (en incisiones grandes).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Dolor residual transitorio.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Sepsis (en casos perforados).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Los riesgos disminuyen cuando la cirug\u00eda es temprana\n y realizada por un equipo calificado.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter9\">\n <strong\n >\u00bfQu\u00e9 pasa si NO se trata una apendicitis?<\/strong\n >\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Complicaciones graves:<\/strong> Perforaci\u00f3n\n del ap\u00e9ndice, Peritonitis generalizada, Abscesos\n m\u00faltiples, Shock s\u00e9ptico, Muerte (en casos\n avanzados).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n La apendicitis no se cura con antibi\u00f3ticos. La \u00fanica\n soluci\u00f3n definitiva y segura es la cirug\u00eda.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter10\">\n <strong>Apendicitis en mujeres:<\/strong> \u00bfPor qu\u00e9 es\n importante la laparoscop\u00eda?\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >La laparoscop\u00eda permite descartar patolog\u00edas\n ginecol\u00f3gicas:<\/strong\n >\n Quistes ov\u00e1ricos rotos, Torsi\u00f3n de ovario, Embarazo\n ect\u00f3pico, Endometriosis, Enfermedad p\u00e9lvica\n inflamatoria.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Esto evita cirug\u00edas innecesarias y garantiza\n diagn\u00f3stico certero.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter11\">\n <strong>Cuidados en casa:<\/strong>\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Mantener heridas limpias y secas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Evitar levantar peso por 2-3 semanas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n No sumergir las heridas por 10-14 d\u00edas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Acudir si aparece fiebre, v\u00f3mitos, dolor intenso o\n secreci\u00f3n en la herida.\n <\/li>\n <\/ul>\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Strasberg SM.\n <strong>Acute calculous cholecystitis.<\/strong> N Engl J\n Med. 2008;358(26):2804-2811.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Lammert F, Gurusamy K, Ko CW, et al.\n <strong>Gallstones.<\/strong> Nat Rev Dis Primers.\n 2016;2:16024.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Yokoe M, Hata J, Takada T, et al.\n <strong\n >Tokyo Guidelines: updated diagnostic criteria and\n severity assessment for acute cholecystitis.<\/strong\n >\n J Hepatobiliary Pancreat Sci. 2018;25(1):41-54.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Pesce A, et al.\n <strong>Current management of Mirizzi syndrome.<\/strong>\n ANZ J Surg. 2020;90(3):434-439.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Wistuba II, Gazdar AF.\n <strong\n >Gallbladder cancer: lessons from a rare\n tumour.<\/strong\n >\n Nat Rev Cancer. 2004;4(9):695-706.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Gurusamy KS, Samraj K.\n <strong\n >Early vs delayed laparoscopic cholecystectomy for\n acute cholecystitis.<\/strong\n >\n Cochrane Database Syst Rev. 2006;(4):CD005440.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Keus F, et al.\n <strong\n >Laparoscopic versus open cholecystectomy for\n symptomatic gallstones.<\/strong\n >\n Cochrane Database Syst Rev. 2006;(4):CD006231.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis3\" id=\"hernias\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-03.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Cirug\u00eda de Hernias Abdominales<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Cirug\u00eda de hernias<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >S\u00edntomas y Diagn\u00f3stico<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Cuando se necesita, Complicaciones, Prevenci\u00f3n y\n Recuperaci\u00f3n<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">1. \u00bfQu\u00e9 es una hernia?<\/h3>\n\n <p class=\"txt-drop-inter\">\n Una hernia ocurre cuando un \u00f3rgano o tejido interno\n protruye a trav\u00e9s de un punto d\u00e9bil de la pared abdominal.\n Puede aparecer como un bulto, dolor, o sensaci\u00f3n de\n \u201cjal\u00f3n\u201d al hacer fuerza, toser o levantar peso.<br \/><br \/>Las\n hernias no se reparan solas. Con el tiempo aumentan de\n tama\u00f1o, causan s\u00edntomas y pueden complicarse con\n encarcelamiento o estrangulaci\u00f3n, lo que constituye una\n emergencia quir\u00fargica.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 2. Tipos de hernias m\u00e1s comunes\n <\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Hernia Inguinal:<\/strong> La m\u00e1s frecuente.\n Ocurre en la ingle por debilidad del canal inguinal. M\u00e1s\n com\u00fan en hombres.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Hernia Femoral:<\/strong> Debajo de la ingle. M\u00e1s\n com\u00fan en mujeres. Mayor riesgo de estrangulaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Hernia Umbilical:<\/strong> En el ombligo. Se\n asocia a embarazos, obesidad o aumento de presi\u00f3n\n abdominal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong>Hernia Epig\u00e1strica:<\/strong> Entre el ombligo y\n el estern\u00f3n. Frecuentes en personas j\u00f3venes o\n deportistas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n <strong>Hernia Ventral \/ Incisional:<\/strong> Aparece en\n una cicatriz de cirug\u00eda previa por debilidad de la pared\n abdominal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n <strong>Hernias raras:<\/strong>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Spiegel.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Lumbar.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Obturatriz.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong>Hernias interparietales.<\/strong>\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n <strong\n >Hernias ventrales e incisionales: t\u00e9cnicas\n avanzadas<\/strong\n >\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>IPOM \/ IPOM Plus (Laparosc\u00f3pica):<\/strong>\n Malla intraperitoneal reforzando desde dentro.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong\n >eTEP (Enhanced View Totally\n Extraperitoneal):<\/strong\n >\n T\u00e9cnica moderna con visi\u00f3n amplia para defectos\n medianos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong\n >TAR (Transversus Abdominis Release):<\/strong\n >\n Liberaci\u00f3n del m\u00fasculo transverso para cerrar\n defectos grandes (>8-10 cm). Es la t\u00e9cnica m\u00e1s\n avanzada en reconstrucci\u00f3n de pared.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong>Liberaci\u00f3n de componentes:<\/strong> Permite\n cerrar grandes hernias con separaci\u00f3n anat\u00f3mica\n correcta.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n <strong>Hernias complicadas:<\/strong>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Encarcelamiento:<\/strong> El contenido no\n regresa al abdomen.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Estrangulaci\u00f3n:<\/strong> P\u00e9rdida del flujo\n sangu\u00edneo (Urgencia quir\u00fargica.)\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Hernias gigantes:<\/strong> Requieren\n planificaci\u00f3n avanzada:\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Neumoperitoneo progresivo.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Reconstrucci\u00f3n por etapas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n TAR o t\u00e9cnicas h\u00edbridas.\n <\/li>\n <\/ul>\n <\/li>\n <\/ol>\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">S\u00edntomas presentes<\/h3>\n\n <p class=\"txt-drop-inter\">\n <strong>S\u00edntomas comunes<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Bulto que aparece o desaparece.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Dolor o ardor.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Sensaci\u00f3n de presi\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Dolor al levantarse, toser o hacer ejercicio.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Molestia persistente o crecimiento progresivo.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>S\u00edntomas de alarma (urgencia):<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Bulto duro o imposible de reducir.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Dolor severo.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n N\u00e1useas\/v\u00f3mitos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">Fiebre.<\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Cambio de color en la piel sobre la hernia.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>Diagn\u00f3stico<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Examen f\u00edsico (lo m\u00e1s \u00fatil).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Ultrasonido (\u00fatil en hernias peque\u00f1as o femorales).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n TAC (est\u00e1ndar para hernias ventrales o incisionales;\n mide el defecto y contenido).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n RMN en casos complejos o atletas.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n \u00bfCu\u00e1ndo se necesita cirug\u00eda?\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n <strong>A). \u00bfCu\u00e1ndo se necesita cirug\u00eda?<\/strong\n ><br \/><br \/>La reparaci\u00f3n quir\u00fargica est\u00e1 indicada\n cuando:\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n La hernia causa dolor.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Aumenta de tama\u00f1o.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Interfiere con actividad f\u00edsica o laboral.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Es femoral (siempre requiere cirug\u00eda).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Est\u00e1 encarcelada o estrangulada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Es ventral\/incisional >2 cm.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Est\u00e1 asociada a riesgo est\u00e9tico o funcional.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Las fajas NO curan las hernias, solo retrasan lo\n inevitable y pueden empeorar el defecto.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong\n >B). Cirug\u00eda laparosc\u00f3pica de hernias (TAPP \/\n TEP)<\/strong\n >\n <\/p>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >T\u00e9cnica moderna \u2014 Est\u00e1ndar actual para hernias\n inguinales y ventrales seleccionadas<br \/>\u00bfC\u00f3mo\n funciona?<\/strong\n >\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Se realizan 2-3 incisiones peque\u00f1as.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Se introduce una c\u00e1maraSe identifica el defecto\n desde dentro.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Se coloca una <strong>malla<\/strong> que refuerza la\n pared.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Se fijan bordes seg\u00fan t\u00e9cnica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Se revisa y se cierra.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>TEP: Totalmente extraperitoneal:<\/strong> No\n entra al abdomen.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>TAPP: Transabdominal preperitoneal:<\/strong>\n Entra al abdomen y luego al espacio preperitoneal.<br \/><strong\n >Ventajas:<\/strong\n >\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Recuperaci\u00f3n m\u00e1s r\u00e1pida.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Mucho menos dolor.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Ideal para <strong>hernias bilaterales<\/strong> o\n <strong>recidivas.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Mejor visi\u00f3n anat\u00f3mica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Regreso temprano al trabajo.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Mejor resultado est\u00e9tico.\n <\/li>\n <\/ol>\n <\/li>\n <\/ol>\n\n <p class=\"txt-drop-inter\">\n <strong>C). Cirug\u00eda abierta de hernias<\/strong\n ><br \/><br \/>Se utiliza cuando la laparoscop\u00eda no est\u00e1\n indicada o en hernias localizadas.<br \/><br \/><strong\n >T\u00e9cnicas comunes:<\/strong\n >\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Lichtenstein:<\/strong> Colocaci\u00f3n de malla sobre\n el defecto (inguinal). Est\u00e1ndar cuando laparoscop\u00eda no\n es posible.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Shouldice:<\/strong> Reparaci\u00f3n sin malla, \u00fatil\n en pacientes seleccionados.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Rives-Stoppa (sublay):<\/strong> Malla colocada\n entre planos musculares. Ideal en ventrales medianas o\n grandes.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong>Onlay:<\/strong> Malla sobre el m\u00fasculo. T\u00e9cnica\n r\u00e1pida pero con mayor riesgo de seroma.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong\n >D). Recuperaci\u00f3n despu\u00e9s de cirug\u00eda de hernia<\/strong\n >\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Laparosc\u00f3pica<\/strong>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Caminar el mismo d\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Trabajo de oficina: 2-5 d\u00edas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Ejercicio moderado: 3-4 semanas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Pesos pesados: 6 semanas.\n <\/li>\n <\/ol>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Abierta<\/strong>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Recuperaci\u00f3n m\u00e1s lenta (3-6 semanas).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Mayor dolor inicial.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Cuidado de suturas mayor.\n <\/li>\n <\/ol>\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>E). Complicaciones (poco frecuentes)<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">Seroma.<\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Infecci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Dolor cr\u00f3nico (menos frecuente en laparoscopia).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Recurrencia.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Lesiones vasculares o nerviosas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Lesi\u00f3n intestinal (ventrales grandes).\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>F). Prevenci\u00f3n de recurrencias<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Evitar levantar peso temprano.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Controlar tos, estre\u00f1imiento u obesidad.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Suspender tabaco.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Usar t\u00e9cnica moderna con malla.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Fortalecer la pared abdominal despu\u00e9s de la\n recuperaci\u00f3n.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Simons MP, Aufenacker T, Bay-Nielsen M, et al.\n <strong\n >European Hernia Society guidelines on inguinal hernia\n treatment.<\/strong\n >\n Hernia. 2009;13(4):343-403.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Bittner R, Schwarz J.\n <strong\n >Inguinal hernia repair: current surgical\n techniques.<\/strong\n >\n Langenbecks Arch Surg. 2012;397(2):271-282.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Muysoms FE, Miserez M, Berrevoet F, et al.\n <strong\n >Classification of primary and incisional abdominal\n wall hernias.<\/strong\n >\n Hernia. 2009;13:407-414.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Miserez M, et al.\n <strong\n >European Hernia Society guidelines on ventral hernia\n repair.<\/strong\n >\n Hernia. 2015;19(1):1-24.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Cobb WS, Warren JA, Ewing JA, et al.\n <strong\n >Open retromuscular (sublay) mesh repair for ventral\n hernia.<\/strong\n >\n Am Surg. 2015;81(8):778-782.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Belyansky I, et al.\n <strong\n >Enhanced-view totally extraperitoneal (eTEP)\n approach.<\/strong\n >\n Hernia. 2018;22:837-845.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Deerenberg EB, et al.\n <strong\n >The use of mesh in hernia repair: evidence\n overview.<\/strong\n >\n Hernia. 2015;19(1):1-7.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Rosen MJ.\n <strong\n >Transversus abdominis release (TAR) for ventral\n hernia repair.<\/strong\n >\n Plast Reconstr Surg. 2016;137(2):636-646.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter9\">\n Kingsnorth A, LeBlanc K.\n <strong>Management of abdominal hernias.<\/strong>\n Springer; 2003.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis4\" id=\"exploracion\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-05.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Exploraci\u00f3n de la Via Biliar<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfQu\u00e9 es y por qu\u00e9 se realiza?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >M\u00e9todos de exploraci\u00f3n<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Estudios, Riesgos, Recuperaci\u00f3n, ECRP, Cu\u00e1ndo consultar<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 1. \u00bfQu\u00e9 estudios se realizan antes de una exploraci\u00f3n de\n v\u00eda biliar?\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n La <strong>exploraci\u00f3n de la v\u00eda biliar<\/strong> es un\n procedimiento quir\u00fargico o m\u00ednimamente invasivo que\n permite\n <strong>visualizar, limpiar y desobstruir<\/strong> los\n conductos biliares cuando existe un c\u00e1lculo, estrechez o\n bloqueo dentro del <strong>col\u00e9doco<\/strong> u otra parte\n del \u00e1rbol biliar.<br \/><br \/>Su objetivo es\n <strong>restablecer el flujo normal de bilis<\/strong>\n desde el h\u00edgado hacia el intestino, evitando infecciones,\n ictericia y pancreatitis.<br \/><br \/>Puede realizarse\n <strong>durante una colecistectom\u00eda<\/strong> o como\n procedimiento independiente.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 2. \u00bfPor qu\u00e9 se realiza? \u2014 Indicaciones principales\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n La exploraci\u00f3n de v\u00eda biliar est\u00e1 indicada cuando se\n sospecha o confirma:\n <\/p>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >Coledocolitiasis (c\u00e1lculos en el col\u00e9doco):<\/strong\n >\n La indicaci\u00f3n m\u00e1s frecuente. Puede ocurrir incluso\n despu\u00e9s de retirar la ves\u00edcula.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Colangitis:<\/strong> Infecci\u00f3n grave de la v\u00eda\n biliar por obstrucci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Pancreatitis biliar:<\/strong> Los c\u00e1lculos\n migran y bloquean la ampolla de Vater.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong\n >Dilataci\u00f3n de la v\u00eda biliar en estudios de\n imagen:<\/strong\n >\n Sospecha de c\u00e1lculo, tap\u00f3n de barro biliar o estenosis.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n <strong>Ictericia obstructiva sin causa clara.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n <strong>Sospecha de tumor o estenosis benigna:<\/strong>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Estenosis inflamatoria.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Estenosis postquir\u00fargicas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n S\u00edndrome de Mirizzi.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n <strong\n >C\u00e1lculos residuales despu\u00e9s de ERCP o cirug\u00eda\n previa.<\/strong\n >\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <p class=\"txt-drop-inter\">\n Dependiendo del caso cl\u00ednico y la infraestructura\n disponible, existen tres principales enfoques:\n <\/p>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >ERCP – Colangiopancreatograf\u00eda Retr\u00f3grada\n Endosc\u00f3pica:<\/strong\n >\n Es un procedimiento combinado endosc\u00f3pico y radiol\u00f3gico\n que permite:\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Ver la v\u00eda biliar desde dentro.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Extraer c\u00e1lculos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Colocar stents.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Tratar estrecheces.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Drenar infecciones.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n El ERCP es <strong>terap\u00e9utico<\/strong>, no solo\n diagn\u00f3stico, y muchas veces evita la cirug\u00eda.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong\n >Exploraci\u00f3n laparosc\u00f3pica de la v\u00eda biliar\n (ELVB):<\/strong\n >\n Es la t\u00e9cnica m\u00e1s moderna, realizada\n <strong>durante la colecistectom\u00eda.<\/strong>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>\u00bfCu\u00e1ndo se hace laparosc\u00f3pica?<\/strong>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n C\u00e1lculos confirmados en el col\u00e9doco.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n C\u00e1lculos detectados en colangiograf\u00eda\n intraoperatoria.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Pacientes j\u00f3venes o sin contraindicaciones.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Hospitales con equipo y experiencia adecuados.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>\u00bfC\u00f3mo se realiza?<\/strong>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Se introduce una c\u00e1mara laparosc\u00f3pica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Se identifica el conducto c\u00edstico o el col\u00e9doco.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Se introduce un peque\u00f1o endoscopio o canastilla.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Se extraen los c\u00e1lculos mediante: Canastillas\n tipo Dormia. Lavados a presi\u00f3n. Balones de\n extracci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Se confirma la limpieza de la v\u00eda biliar.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Se deja drenaje selectivo si es necesario.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Ventajas<\/strong>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Todo se resuelve en una sola cirug\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Menor estancia hospitalaria.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Menor riesgo global que m\u00faltiples\n procedimientos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Excelente visualizaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Menor da\u00f1o tisular que cirug\u00eda abierta.\n <\/li>\n <\/ul>\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Exploraci\u00f3n abierta de la v\u00eda biliar:<\/strong>\n Se realiza mediante <strong>laparotom\u00eda<\/strong> en\n casos seleccionados.\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Anatom\u00eda muy distorsionada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Coledocolitiasis compleja o m\u00faltiples c\u00e1lculos\n grandes.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n V\u00eda Biliar muy inflamada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Lesiones iatrog\u00e9nicas biliares.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Fracaso del ERCP o laparoscop\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Sospecha de tumor o estenosis severa.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n S\u00edndrome de Mirizzi avanzado (tipos III y IV).\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong\n >\u00bfQu\u00e9 se hace durante la exploraci\u00f3n abierta?<\/strong\n >\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Incisi\u00f3n adecuada (subcostal o mediana).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Apertura del col\u00e9doco\n <strong>(coledocotom\u00eda)<\/strong>.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Extracci\u00f3n directa de los c\u00e1lculos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Lavado y revisi\u00f3n completa.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Colocaci\u00f3n de <strong>T-tube<\/strong> (sonda en T)\n en casos necesarios.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Reparaci\u00f3n biliar o derivaci\u00f3n bilioent\u00e9rica (ej.\n hep\u00e1tico-yeyunostom\u00eda) en casos complejos.\n <\/li>\n <\/ul>\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Ultrasonido hepatobiliar.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Pruebas de funci\u00f3n hep\u00e1tica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Amilasa\/lipasa.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n MRCP (Resonancia magn\u00e9tica biliar).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n TAC abdominal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Colangiograf\u00eda intraoperatoria.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Laboratorios generales.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Evaluaci\u00f3n anest\u00e9sica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter9\">\n MRCP es especialmente \u00fatil porque\n <strong>no es invasiva<\/strong> y muestra todo el \u00e1rbol\n biliar con gran detalle.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 2. Riesgos y complicaciones (poco comunes)\n <\/h3>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Infecci\u00f3n de heridas o del sistema biliar.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Pancreatitis postmanipulaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Fuga biliar.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Estenosis biliar a largo plazo.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Sangrado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Abscesos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Necesidad de procedimientos adicionales (ERCP o\n cirug\u00eda).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Con experiencia adecuada, la tasa de complicaciones es\n baja.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">3. Recuperaci\u00f3n<\/h3>\n\n <p class=\"txt-drop-inter\">\n Depende del m\u00e9todo utilizado:<br \/><br \/><strong\n >ERCP<\/strong\n >\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Alta el mismo d\u00eda o siguiente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Dieta suave.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Dolor leve y transitorio.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>Exploraci\u00f3n laparosc\u00f3pica<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Recuperaci\u00f3n similar a colecistectom\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Actividad normal en 3-5 d\u00edas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Menor dolor que procedimientos abiertos.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>Exploraci\u00f3n abierta<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Hospitalizaci\u00f3n 3-7 d\u00edas\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Recuperaci\u00f3n total: 4-6 semanas\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Mayor restricci\u00f3n f\u00edsica inicial\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 4. \u00bfCu\u00e1ndo consultar despu\u00e9s de una exploraci\u00f3n biliar?\n <\/h3>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">Fiebre.<\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Ictericia.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Dolor abdominal intenso.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n P\u00e9rdida de apetito marcada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Heces claras u orina muy oscura.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n V\u00f3mitos persistentes.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Inflamaci\u00f3n severa en heridas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Secreci\u00f3n biliar por drenajes.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Williams E, Beckingham I, El Sayed G, et al.\n <strong\n >Updated guideline on the management of common bile\n duct stones (CBDS).<\/strong\n >\n Gut. 2017;66(5):765-782.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n ASGE Standards of Practice Committee. Maple JT,\n Ben-Menachem T, et al.\n <strong\n >The role of endoscopy in the evaluation of suspected\n choledocholithiasis.<\/strong\n >\n Gastrointest Endosc. 2010;71(1):1-9.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Dasari BV, et al.\n <strong\n >Laparoscopic exploration of the common bile\n duct.<\/strong\n >\n Surg Clin North Am. 2014;94(2):297-321.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Gurusamy KS, Samraj K, et al.\n <strong\n >Surgical versus endoscopic treatment of bile duct\n stones.<\/strong\n >\n Cochrane Database Syst Rev. 2007;(2):CD003327.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Freeman ML.\n <strong\n >Complications of endoscopic biliary sphincterotomy: a\n review.<\/strong\n >\n Endoscopy. 1997;29(4):288-297.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n LaGreca G, et al.\n <strong>Management of Mirizzi syndrome.<\/strong> ANZ J\n Surg. 2014;84(1-2):5-10.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis5\" id=\"ercp\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"https:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/05\/nvo-proce-01.webp\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">\n ERCP (Endoscopic Retrograde Cholangiopancreatography) –\n Colangiopancreatograf\u00eda Retr\u00f3grada Endosc\u00f3pica\n <\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfQu\u00e9 es y para qu\u00e9 se sirve?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfCu\u00e1ndo est\u00e1 indicado un ERCP?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Como se realiza, Prepararse, Riesgos, Recuperaci\u00f3n<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Contraindicaciones, Cuando se combina con cirug\u00eda<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis5\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">1. \u00bfQu\u00e9 es un ERCP?<\/h3>\n\n <p class=\"txt-drop-inter\">\n El <strong>ERCP<\/strong> (Endoscopic Retrograde\n Cholangiopancreatography) es un procedimiento\n <strong>endosc\u00f3pico y radiol\u00f3gico<\/strong> que permite\n <strong>visualizar, desobstruir y tratar<\/strong>\n problemas en:\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n V\u00eda biliar (conductos que llevan la bilis del h\u00edgado al\n intestino).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Ves\u00edcula (si est\u00e1 presente).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Conducto pancre\u00e1tico\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n Se realiza introduciendo un endoscopio por la boca,\n pasando por el es\u00f3fago y est\u00f3mago, hasta la\n <strong>ampolla de Vater,<\/strong> donde se accede a la\n v\u00eda biliar.<br \/><br \/>El ERCP es\n <strong>terap\u00e9utico,<\/strong> no \u00fanicamente diagn\u00f3stico.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">2. \u00bfPara qu\u00e9 sirve el ERCP?<\/h3>\n\n <p class=\"txt-drop-inter\">\n El ERCP se usa para <strong>resolver<\/strong> enfermedades\n biliares y pancre\u00e1ticas, no solo para detectarlas. Entre\n sus funciones:\n <\/p>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Extraer c\u00e1lculos del col\u00e9doco<\/strong>: La\n indicaci\u00f3n m\u00e1s frecuente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong\n >Abrir el conducto biliar mediante\n esfinterotom\u00eda<\/strong\n >: Se corta el esf\u00ednter de Oddi para permitir salida de\n bilis o piedras.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Colocar stents (pr\u00f3tesis):<\/strong> En casos de:\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Estenosis benignas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Tumores.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Inflamaci\u00f3n severa.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Obstrucci\u00f3n por Mirizzi.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Lesiones biliares quir\u00fargicas.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong\n >Drenar infecciones de la v\u00eda biliar\n (colangitis)<\/strong\n >: Urgencia m\u00e9dica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n <strong>Dilatar estrecheces:<\/strong> Por inflamaci\u00f3n,\n cirug\u00eda previa o causas malignas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n <strong>Obtener biopsias o cepillados:<\/strong> Para\n diagn\u00f3stico de tumores biliares o pancre\u00e1ticos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n <strong>Tratar complicaciones postquir\u00fargicas:<\/strong>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Fugas biliares.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Estenosis de anastomosis.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n C\u00e1lculos residuales.\n <\/li>\n <\/ul>\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <p class=\"txt-drop-inter\">\n <strong>Indicaciones principales<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n C\u00e1lculos confirmados en el col\u00e9doco\n <strong>(coledocolitiasis).<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Colangitis (infecci\u00f3n grave de la v\u00eda biliar).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Pancreatitis biliar con obstrucci\u00f3n persistente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Dilataci\u00f3n de v\u00eda biliar con ictericia.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Estenosis benignas (post cirug\u00eda, inflamatorias).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Estenosis malignas (c\u00e1ncer de p\u00e1ncreas,\n colangiocarcinoma).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Sospecha de ampuloma o tumores periampulares.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Fugas biliares post colecistectom\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter9\">\n C\u00e1lculos residuales luego de cirug\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter10\">\n Complicaciones de cirug\u00edas hepatobiliares\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong\n >ERCP NO debe usarse como estudio diagn\u00f3stico\n inicial.<\/strong\n ><br \/><br \/>Para diagn\u00f3stico puro se prefiere\n <strong>MRCPC.<\/strong> o <strong>TAC.<\/strong>\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 1. \u00bfC\u00f3mo se realiza el ERCP? – Explicaci\u00f3n clara y\n profesional\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n El procedimiento se realiza en una sala endosc\u00f3pica con\n equipo de fluoroscopia.<br \/><br \/><strong\n >Paso a paso<\/strong\n >\n <\/p>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n El paciente recibe <strong>sedaci\u00f3n profunda<\/strong> o\n anestesia general.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Se introduce un endoscopio por la boca.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Se avanza hasta el duodeno.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Se identifica la ampolla de Vater.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Se canula la v\u00eda biliar con una gu\u00eda y contraste.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Se visualiza la anatom\u00eda mediante rayos X.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Seg\u00fan el problema, se realiza:\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Extracci\u00f3n de c\u00e1lculos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Esfinterotom\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Colocaci\u00f3n de stent.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Dilataci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Cepillado o biopsia.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Se retira el endoscopio y el paciente pasa a\n recuperaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter9\">\n Duraci\u00f3n: <strong>20-60 minutos<\/strong> seg\u00fan\n complejidad.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 2. \u00bfC\u00f3mo prepararse para un ERCP?\n <\/h3>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Ayuno m\u00ednimo 6-8 horas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Suspender anticoagulantes seg\u00fan indicaci\u00f3n m\u00e9dica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Revisar alergias a anestesia o contraste.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Realizar estudios previos (USG, TAC, MRCP,\n laboratorios).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Acompa\u00f1ante para el alta (sedaci\u00f3n profunda).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Control de glucosa y presi\u00f3n en diab\u00e9ticos\/hipertensos.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 3. Riesgos del ERCP (explicados con honestidad y\n precisi\u00f3n)\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n El ERCP es un procedimiento seguro cuando lo realiza un\n equipo experimentado, pero tiene riesgos particulares:\n <\/p>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Pancreatitis post-ERCP (3-7%):<\/strong> Es el\n riesgo m\u00e1s frecuente. Usualmente leve, pero puede ser\n grave en menos del 1%.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Infecci\u00f3n (colangitis):<\/strong> Si la v\u00eda est\u00e1\n completamente obstruida.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Sangrado:<\/strong> M\u00e1s com\u00fan despu\u00e9s de\n esfinterotom\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong>Perforaci\u00f3n:<\/strong> Rara (<0.6%).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n <strong\n >Reacciones al\u00e9rgicas o efectos de sedaci\u00f3n:<\/strong\n >\n Los beneficios superan ampliamente los riesgos cuando el\n procedimiento est\u00e1 correctamente indicado.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 4. Recuperaci\u00f3n despu\u00e9s del ERCP\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n <strong>Primeras horas<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Observaci\u00f3n en sala.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Dolor leve abdominal es normal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n N\u00e1useas transitorias por sedaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Si hay pancreatitis, dolor m\u00e1s intenso \u2014 vigilancia.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\"><strong>Altas t\u00edpicas<\/strong><\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Mismo d\u00eda o siguiente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Dieta suave.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Analg\u00e9sicos simples seg\u00fan necesidad.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Suspender esfuerzos f\u00edsicos 24-48 h.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>Consultar si aparece:<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Dolor abdominal progresivo.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">Fiebre.<\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Ictericia.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n V\u00f3mitos constantes.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Orina oscura o heces claras.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 1. Contraindicaciones del ERCP\n <\/h3>\n\n <p class=\"txt-drop-inter\"><strong>Absolutas<\/strong><\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Paciente inestable sin soporte cr\u00edtico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Falta de disponibilidad de equipo adecuado.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\"><strong>Relativas<\/strong><\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Coagulopat\u00eda no corregida.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Embarazo (se realiza solo si es imprescindible).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Cirug\u00edas g\u00e1stricas previas complejas (aunque existen\n t\u00e9cnicas adaptadas).\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 2. \u00bfCu\u00e1ndo se combina ERCP con cirug\u00eda?\n <\/h3>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >En colecistectom\u00eda por c\u00e1lculos en col\u00e9doco:<\/strong\n >\n Secuencia habitual:\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>En s\u00edndrome de Mirizzi o estenosis:<\/strong> Se\n coloca un stent previo a la cirug\u00eda para disminuir\n riesgo de lesi\u00f3n biliar.\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n ERCP para limpiar la v\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Colecistectom\u00eda laparosc\u00f3pica en los siguientes\n d\u00edas.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>En fugas biliares post cirug\u00eda:<\/strong> El ERCP\n permite cerrar la fuga sin necesidad de reoperar.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter5\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n ASGE Standards of Practice Committee; Testoni PA,\n Mariani A, Aabakken L, et al.\n <strong>Guidelines for ERCP.<\/strong> Gastrointest\n Endosc. 2016;83(2):279-289.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Cotton PB, et al.\n <strong\n >Risk factors for complications after ERCP: a\n prospective multicenter study.<\/strong\n >\n Gastroenterology. 2009;136(7):1804-1812.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Freeman ML.\n <strong\n >Complications of endoscopic biliary\n sphincterotomy.<\/strong\n >\n Endoscopy. 1997;29:288-297.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Williams EJ, Green J, Beckingham I, et al.\n <strong\n >Guidelines on the management of common bile duct\n stones.<\/strong\n >\n Gut. 2008;57(7):1004-1021.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Lehman GA.\n <strong\n >Therapeutic ERCP: current status and future\n directions.<\/strong\n >\n Gastrointest Endosc Clin N Am. 2003;13(4):735-752.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Maple JT, et al.\n <strong\n >Role of endoscopy in choledocholithiasis.<\/strong\n >\n Gastrointest Endosc. 2011;74(4):731-744.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis6\" id=\"colangiografia\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"https:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/05\/nvo-proce-02.webp\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Colangiograf\u00eda Intraoperatoria (CIO)<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfQu\u00e9 es y para qu\u00e9 sirve?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfC\u00f3mo se realiza la colangiograf\u00eda intraoperatoria?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Ventajas de la CIO<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Riesgos (m\u00ednimos)<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis5\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS \u2014 Vancouver<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 1. \u00bfQu\u00e9 es la colangiograf\u00eda intraoperatoria?\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n La\n <strong>colangiograf\u00eda intraoperatoria (CIO)<\/strong> es\n un estudio radiol\u00f3gico que se realiza\n <strong>durante una cirug\u00eda<\/strong>, generalmente durante\n una <strong>colecistectom\u00eda laparosc\u00f3pica<\/strong>, para\n visualizar en tiempo real el\n <strong>\u00e1rbol biliar<\/strong> y detectar:\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n C\u00e1lculos ocultos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Estrechamientos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Variantes anat\u00f3micas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Lesiones biliares.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Obstrucciones.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n Es una herramienta de seguridad que ayuda a prevenir\n lesiones de la v\u00eda biliar.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 2. \u00bfPara qu\u00e9 sirve? \u2014 Indicaciones\n <\/h3>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Sospecha de c\u00e1lculos en el col\u00e9doco.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Pruebas hep\u00e1ticas alteradas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Ves\u00edcula muy inflamada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Anatom\u00eda dif\u00edcil o distorsionada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Cirug\u00eda complicada (Mirizzi temprano, flegm\u00f3n).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Confirmar integridad de la v\u00eda biliar despu\u00e9s de una\n reparaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Pacientes con dilataci\u00f3n de col\u00e9doco en ultrasonido o\n TAC.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Pacientes j\u00f3venes donde se quiere evitar\n reintervenciones.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Durante la colecistectom\u00eda, se canula el conducto\n c\u00edstico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Se introduce medio de contraste.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Se toma una serie de radiograf\u00edas en tiempo real.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Se visualiza el col\u00e9doco, hep\u00e1ticos y ampolla.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n El cirujano eval\u00faa si existen:\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n C\u00e1lculos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Obstrucciones.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n V\u00eda biliar estrecha.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Lesiones.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Anatom\u00eda variante (conducto c\u00edstico an\u00f3malo, doble\n c\u00edstico, etc.).\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Si se detectan c\u00e1lculos, el cirujano decide:\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >Exploraci\u00f3n laparosc\u00f3pica de v\u00eda biliar<\/strong\n >, o.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Enviar al paciente a ERCP<\/strong> en las\n siguientes 24-72h.\n <\/li>\n <\/ul>\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Incrementa la seguridad de la colecistectom\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Reduce lesiones de v\u00eda biliar.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Permite decisiones inmediatas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Visualiza variantes anat\u00f3micas raras.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Evita cirug\u00edas adicionales.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Diagn\u00f3stico preciso en minutos.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>\u00bfEs obligatorio hacerla siempre?<\/strong> No. Pero\n muchos cirujanos la utilizamos:\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n De forma selectiva en casos dif\u00edciles, o\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n De forma rutinaria para m\u00e1xima seguridad\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Ambos enfoques son v\u00e1lidos y respaldados por evidencia.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Exposici\u00f3n m\u00ednima a radiaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Espasmo del conducto.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Riesgo leve de fuga biliar.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Casi siempre sin complicaciones.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter5\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Buddingh KT, et al. Routine intraoperative\n cholangiography during laparoscopic cholecystectomy.\n Surg Endosc. 2011;25(7):2203-2210.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Halbert C, et al. Cholangiography and prevention of bile\n duct injury. Surg Clin North Am. 2014;94(2):413-435.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Ford JA, et al. Systematic review of intraoperative\n cholangiography. Br J Surg. 2012;99(2):160-167.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Tornqvist B, et al. Fatal bile duct injury after\n cholecystectomy: preventive role of intraoperative\n cholangiography. Ann Surg. 2015;261:162-167.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Pesce A, et al. Management of Mirizzi syndrome. ANZ J\n Surg. 2020;90(3):434-439.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis7\" id=\"emergencia\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-08.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Cirug\u00eda de Emergencia<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfQu\u00e9 es?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Indicaciones principales de cirug\u00eda de emergencia<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfC\u00f3mo es el proceso?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Enfoque moderno, Riesgos<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis5\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n \u00bfQu\u00e9 es la cirug\u00eda de emergencia?\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n La <strong>cirug\u00eda de emergencia<\/strong> se realiza\n cuando un paciente presenta una condici\u00f3n\n <strong>aguda, cr\u00edtica y potencialmente mortal,<\/strong>\n que requiere intervenci\u00f3n inmediata para salvar la vida,\n controlar una hemorragia, detener una infecci\u00f3n severa o\n reparar un \u00f3rgano vital.<br \/>Tu papel como cirujano\n general es clave, porque abarca la mayor\u00eda de emergencias\n abdominales.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">1. Abdomen agudo<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Apendicitis perforada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Peritonitis.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Obstrucci\u00f3n intestinal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Estrangulaci\u00f3n herniaria.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Isquemia intestinal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Perforaci\u00f3n de v\u00edscera hueca (\u00falcera g\u00e1strica o\n duodenal).\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">2. Infecciones graves<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Abscesos abdominales extensos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Colangitis severa.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Pancreatitis complicada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Fascitis necrotizante (pocas horas de evoluci\u00f3n).\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">3. Hemorragias<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Hemoperitoneo traum\u00e1tico o no traum\u00e1tico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Sangrado digestivo que no responde a endoscopia.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Ruptura de bazo o h\u00edgado.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">4. Traumas<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Trauma abdominal penetrante.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Trauma cerrado con sangrado activo.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n \u00d3rganos lesionados.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 5. Complicaciones quir\u00fargicas previas\n <\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Fugas anastom\u00f3ticas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Abdomen abierto.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Estenosis aguda traum\u00e1tica o postquir\u00fargica.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">6. Emergencias biliares<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Colangitis fulminante.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n S\u00edndrome de Mirizzi complicado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Ves\u00edcula gangrenosa.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Evaluaci\u00f3n r\u00e1pida (ABCDE).<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Estabilidad hemodin\u00e1mica.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Laboratorios y estudios urgentes.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong\n >Imagen r\u00e1pida (US\/TAC si el tiempo lo\n permite).<\/strong\n >\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n <strong>Decisi\u00f3n de intervenci\u00f3n inmediata.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n <strong\n >Cirug\u00eda laparosc\u00f3pica o abierta seg\u00fan el\n caso.<\/strong\n >\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n <strong>Control de fuente (source control):<\/strong>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Detener sangrado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Controlar infecci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Retirar \u00f3rganos perforados.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Lavado peritoneal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Drenajes.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Ostom\u00edas si son necesarias\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n <strong>Cuidados intensivos postoperatorios.<\/strong>\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n Enfoque moderno: Damage Control Surgery\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n En pacientes inestables o s\u00e9pticos severos se aplica\n cirug\u00eda abreviada:\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Control del sangrado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Control de contaminaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Reanimaci\u00f3n intensiva.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Cierre diferido del abdomen.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n Esto aumenta la supervivencia en casos cr\u00edticos.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">Riesgos<\/h3>\n\n <p class=\"txt-drop-inter\">\n Dependen de la patolog\u00eda, pero pueden incluir:\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Infecciones.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Abscesos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Falla org\u00e1nica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Sangrado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Lesiones asociadas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Necesidad de reoperaci\u00f3n.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter5\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Sartelli M, et al.\n <strong\n >WSES Guidelines for management of intra-abdominal\n infections.<\/strong\n >\n World J Emerg Surg. 2013;8:3.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Di Saverio S, et al.\n <strong\n >WSES Jerusalem guidelines for acute\n appendicitis.<\/strong\n >\n World J Emerg Surg. 2020;15:27.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Moore EE, et al.\n <strong>Damage control surgery.<\/strong> World J Surg.\n 1998;22:1184-1190.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Montravers P, et al.\n <strong>Management of severe abdominal sepsis.<\/strong>\n Crit Care. 2016;20:85.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis8\" id=\"abdomen-agudo\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-09.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">\n Abdomen Agudo no Traum\u00e1tico \u2014 Conceptos Generales\n <\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfQu\u00e9 es?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Causas principales<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Diagn\u00f3stico, Manejo Inicial<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\u00bfQu\u00e9 es el abdomen agudo?<\/h3>\n\n <p class=\"txt-drop-inter\">\n Es un <strong>s\u00edndrome cl\u00ednico<\/strong> caracterizado por\n <strong>dolor abdominal de inicio s\u00fabito<\/strong>,\n progresivo y de intensidad variable, asociado a riesgo de\n requerir <strong>cirug\u00eda urgente.<\/strong><br \/>Es la\n puerta de entrada a m\u00faltiples patolog\u00edas potencialmente\n letales.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Viscerales:<\/strong> apendicitis, colecistitis,\n pancreatitis, obstrucci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Vasculares<\/strong>: isquemia mesent\u00e9rica,\n aneurisma roto.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Infecciosas:<\/strong> peritonitis,\n diverticulitis.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong>Urol\u00f3gicas:<\/strong> c\u00f3lico renal, torsi\u00f3n\n testicular.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">Diagn\u00f3stico<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Historia y examen f\u00edsico dirigidos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n SIGNOS DE ALARMA: fiebre, defensa, taquicardia,\n hipotensi\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Laboratorios: BH, PCR, creatinina, amilasa\/lipasa.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Imagen:\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inte item-drop-inte1\">\n <strong>TAC con contraste:<\/strong> estudio de\n elecci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inte item-drop-inte2\">\n US para ves\u00edcula y ginecolog\u00eda.\n <\/li>\n\n <li class=\"item-drop-inte item-drop-inte3\">\n Radiograf\u00eda en obstrucci\u00f3n.\n <\/li>\n <\/ul>\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">Manejo inicial<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Reanimaci\u00f3n con l\u00edquidos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Analgesia.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Antibi\u00f3ticos temprano en sospecha de infecci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Cirug\u00eda inmediata si hay:\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inte item-drop-inte1\">\n Peritonitis.\n <\/li>\n\n <li class=\"item-drop-inte item-drop-inte2\">\n Isquemia.\n <\/li>\n\n <li class=\"item-drop-inte item-drop-inte3\">\n Obstrucci\u00f3n estrangulada.\n <\/li>\n <\/ul>\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Cartwright SL, Knudson MP. Evaluation of acute abdominal\n pain in adults. Am Fam Physician. 2008.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Kamin RA et al. Diagnosis of acute abdominal pain in\n adults. Am J Roentgenol. 2010.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Makary MA. Abdominal emergencies. Surg Clin North Am.\n 2008.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis9\" id=\"obstruccion-intestinal\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-10.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Obstrucci\u00f3n Intestinal<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfQu\u00e9 es?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Causas, Signos de Estrangulaci\u00f3n, Diagn\u00f3sitco<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Manejo<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n \u00bfQu\u00e9 es la obstrucci\u00f3n intestinal?\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n Interrupci\u00f3n parcial o completa del paso del contenido\n intestinal.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">1. Causas<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Bridas \/ adherencias<\/strong> (60%).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Hernias encarceladas.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">Tumores<\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n V\u00f3lvulo de sigmoides o ciego.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Ileo biliar.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 2. Signos de estrangulaci\u00f3n (quir\u00fargicos)\n <\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">Fiebre.<\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Dolor intenso persistente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Taquicardia.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Leucocitosis marcada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Acidosis.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Dolor desproporcionado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Gas en pared (neumatosis).\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">3. Diagn\u00f3stico<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n TAC con contraste \u2014 sensibilidad >95%.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Radiograf\u00eda (menos precisa).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Examen f\u00edsico clave para hernias.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n Conservador (si no hay estrangulaci\u00f3n)\n <\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Sonda nasog\u00e1strica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n L\u00edquidos IV.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Electrolitos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Observaci\u00f3n 24-48h.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">Quir\u00fargico<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Estrangulaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Hernia incarcerada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Falta de mejor\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Peritonitis.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n V\u00f3lvulo \u2014 desvolvulaci\u00f3n \/ colectom\u00eda seg\u00fan caso.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Catena F. Bowel obstruction: a review. World J Emerg\n Surg. 2019.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Biondo S, et al. Small bowel obstruction clinical\n practice. Am J Surg. 2016.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis10\" id=\"perforacion\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-11.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Perforaci\u00f3n de V\u00edscera Hueca<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfQu\u00e9 es?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Causas, Diagn\u00f3sitco<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Tratamiento<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">Definici\u00f3n<\/h3>\n\n <p class=\"txt-drop-inter\">\n Ruptura del est\u00f3mago, intestino delgado o colon,\n provocando <strong>peritonitis.<\/strong>\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">1. Causas<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n \u00dalcera p\u00e9ptica perforada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n \u00dalcera p\u00e9ptica perforada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Diverticulitis perforada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n C\u00e1ncer perforado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Cuerpo extra\u00f1o.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Isquemia intestinal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Trauma cerrado (poco com\u00fan).\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">2. Diagn\u00f3stico<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n TAC contrastado: sensibilidad >98%.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Radiograf\u00eda: aire subdiafragm\u00e1tico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Laboratorios: leucocitosis, acidosis.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Cirug\u00eda inmediata.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Lavado de cavidad.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Cierre primario o resecci\u00f3n (seg\u00fan patolog\u00eda).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Hartmann en diverticulitis grave.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Antibi\u00f3ticos amplio espectro.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Drenajes selectivos.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n S\u00f8reide K. Perforated peptic ulcer. Lancet. 2015.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Andeweg CS. Perforated diverticulitis management. World\n J Surg. 2013.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis11\" id=\"pancreatitis\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-12.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Pancreatitis Aguda Grave<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfQu\u00e9 es?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Causas, Indicaciones quirurg\u00edcas \/ Intervencionistas<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Opciones de Intervenci\u00f3n<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">Definici\u00f3n<\/h3>\n\n <p class=\"txt-drop-inter\">\n Inflamaci\u00f3n del p\u00e1ncreas que puede evolucionar a necrosis,\n falla org\u00e1nica y muerte.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">1. Causas<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n C\u00e1lculos biliares.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">Alcohol.<\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Hipertrigliceridemia.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n F\u00e1rmacos.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 2. Indicaciones quir\u00fargicas \/ intervencionistas\n <\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Necrosis infectada.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>S\u00edndrome compartimental abdominal.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Pseudoquistes sintom\u00e1ticos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Colecciones purulentas.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Necrosectom\u00eda laparosc\u00f3pica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Necrosectom\u00eda abierta.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Drenajes percut\u00e1neos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Lavados seriados.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Colecistectom\u00eda temprana cuando es biliar.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Banks PA. Classification of acute pancreatitis. Gut.\n 2013.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n van Santvoort H. Step-up approach. N Engl J Med. 2010.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis12\" id=\"diverticulitis\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-13.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Diverticulitis Aguda Complicada<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Clasificaci\u00f3n de Hinchey<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Diagn\u00f3stico, Manejo<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n I: Absceso peric\u00f3lico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n II: Absceso p\u00e9lvico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n III: Peritonitis purulenta.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n IV: Peritonitis fecaloidea.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">1. Diagn\u00f3stico<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n TAC con contraste: gold standard\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">2. Manejo<\/h3>\n\n <p class=\"txt-drop-inter\">\n <strong>Hinchey I-II:<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Antibi\u00f3ticos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Drenaje percut\u00e1neo si >3-4 cm.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>Hinchey III-IV:<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Cirug\u00eda urgente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Hartmann vs anastomosis primaria dependiendo de\n estabilidad y contaminaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Lavado laparosc\u00f3pico selectivo.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Feingold D. ASCRS guidelines for diverticulitis. Dis\n Colon Rectum. 2014.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Sartelli M. WSES guidelines for diverticulitis. World J\n Emerg Surg. 2020.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis13\" id=\"trauma-abdominal\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-14.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">\n Trauma Abdominal (Cerrado y Penetrante)\n <\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Evaluaci\u00f3n Inicial<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Diagn\u00f3stico, Manejo<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">ATLS.<\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n V\u00eda a\u00e9rea, respiraci\u00f3n, circulaci\u00f3n.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">1. Diagn\u00f3stico<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>FAST:<\/strong> R\u00e1pido y \u00fatil para l\u00edquido libre.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>TAC contrastado:<\/strong> Gold standard en\n pacientes estables.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">2. Manejo<\/h3>\n\n <p class=\"txt-drop-inter\">\n <strong>Trauma hep\u00e1tico<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Manejo no operatorio si estable.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Embolizaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Packing en cirug\u00eda.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>Trauma espl\u00e9nico<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n NOM en estables.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Esplenectom\u00eda en inestables.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>Trauma intestinal<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Reparaci\u00f3n primaria\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Resecci\u00f3n anastomosis\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Ostom\u00eda si hay inestabilidad\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>Indicaciones de laparotom\u00eda<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Inestabilidad hemodin\u00e1mica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Peritonitis.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Evisceraci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Sangrado activo en TAC.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Moore EE, et al. J Trauma Acute Care Surg.\n 2015;78(6):1187-1196.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Feliciano DV. Surg Clin North Am. 1991;71(2):241-256.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Rozycki GS, et al. J Trauma. 1998;45:87-94.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis14\" id=\"abdomen-abierto\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-15.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">\n Abdomen Abierto y Cirug\u00eda de Control de Da\u00f1os\n <\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfQu\u00e9 es?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Fases<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <p class=\"txt-drop-inter\">\n T\u00e9cnica usada en pacientes cr\u00edticos con sepsis, sangrado o\n inestabilidad severa.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 1. Primera cirug\u00eda – Control de da\u00f1os\n <\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Control de hemorragia.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Control de contaminaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Empaquetamiento.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">2. Reanimaci\u00f3n en UCI<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Soporte hemodin\u00e1mico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Correcci\u00f3n de acidosis, hipotermia y coagulopat\u00eda.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">3. Reoperaci\u00f3n (24-48h)<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Retiro de paquetes.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Reparaci\u00f3n definitiva.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Ostom\u00edas si es necesario.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">4. Cierre de pared<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Cierre primario tard\u00edo.\n <\/li>\n <li class=\"item-drop-inter item-drop-inter2\">\n T\u00e9cnica de vac o mallas temporales.\n <\/li>\n <li class=\"item-drop-inter item-drop-inter3\">\n Prevenci\u00f3n de hernias gigantes.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Rotondo MF, et al. J Trauma. 1993;35(3):375-382.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Kirkpatrick AW, et al. World J Surg.\n 2009;33(6):1154-1167.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Roberts DJ, et al. Ann Surg. 2017;265(3):523-532.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis15\" id=\"catastrofe-abdominal\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-16.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Cat\u00e1stofre Abdominal<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Concepto<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Diagn\u00f3stico, Tratamiento<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <p class=\"txt-drop-inter\">\n Es un s\u00edndrome de fracaso multiorg\u00e1nico causado por una\n infecci\u00f3n o isquemia abdominal severa que conduce a:\n <\/p>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Shock s\u00e9ptico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Hipoperfusi\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Acidosis.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">Anuria.<\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n S\u00edndrome compartimental abdominal.\n <\/li>\n <\/ol>\n\n <p class=\"txt-drop-inter\">\n Es la etapa final de muchas patolog\u00edas si no se tratan a\n tiempo.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">1. Diagn\u00f3stico<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n TAC urgente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Elevaci\u00f3n de lactato.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n SIRS y falla org\u00e1nica.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">2. Tratamiento<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Cirug\u00eda inmediata.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Abdomen abierto.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Drenajes m\u00faltiples.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Control de foco infeccioso.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Reanimaci\u00f3n agresiva.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">UCI.<\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Malbrain ML, et al. Intensive Care Med.\n 2006;32:1722-1732.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Kirkpatrick AW. Crit Care Med. 2010;38:151-152.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Sartelli M, et al. World J Emerg Surg. 2013;8:3.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div\n class=\"item-procedis item-procedis16\"\n id=\"abdomen-agudo-pediatria\"\n >\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-17.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Abdomen Agudo en Pediatr\u00eda<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Concepto<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Diagn\u00f3stico, Tratamiento<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Apendicitis:<\/strong>\n La m\u00e1s frecuente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Invaginaci\u00f3n intestinal:<\/strong>\n Cl\u00e1sico en <3 a\u00f1os.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Obstrucci\u00f3n intestinal:<\/strong>\n Bridas, hernias inguinales encarceladas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong>Perforaci\u00f3n por cuerpo extra\u00f1o:<\/strong>\n Frecuente en ni\u00f1os exploradores.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n <strong>Patolog\u00eda infecciosa:<\/strong>\n Gastroenteritis severa (diagn\u00f3stico diferencial\n importante).\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">1. Diagn\u00f3stico<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n US abdominal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n TAC en casos complejos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Examen f\u00edsico dirigido.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Signos vitales y estado general.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">2. Manejo<\/h3>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n L\u00edquidos IV.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Enema neum\u00e1tico para invaginaci\u00f3n (si no hay\n peritonitis).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Apendicectom\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Reducci\u00f3n urgente de hernias incarceradas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Cirug\u00eda en obstrucci\u00f3n o perforaci\u00f3n.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Fallon SC, et al. Pediatr Clin North Am.\n 2013;60(6):1169-1186.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Blakelock R, et al. J Pediatr Surg. 1999;34:1493-1497.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Strouse PJ. Radiology. 2012;263(1):19-32.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/section>\n\n \n <section id=\"contacto\">\n <div class=\"container\">\n <div class=\"row row-contain-agendar justify-content-evenly\">\n <div class=\"col-lg-6 col-agendar col-agendar1\">\n <div\n class=\"cont-horario-agendar d-flex justify-content-evenly align-items-center\"\n >\n <div class=\"col-horario-agenda col-horario-agenda1\">\n <p class=\"font-creato txt-dias-agenda\">\n Lunes \u2014 Viernes<br \/>Emergencia\n <\/p>\n <\/div>\n\n <div class=\"col-horario-agenda col-horario-agenda2\">\n <p class=\"font-creato txt-horas-agenda\">10AM – 5PM<br \/>24\/7<\/p>\n <\/div>\n <\/div>\n\n <div class=\"cont-horario-img\"><\/div>\n <\/div>\n\n <div class=\"col-lg-6 col-agendar col-agendar2\">\n <h4 class=\"titu-agendar\">AGENDAR UNA CITA<\/h4>\n\n <h3 class=\"titus-agendar\">\n PanaMed – Panajachel<br \/>El Pimental – Antigua Guatemala\n <\/h3>\n\n <div class=\"cont-formulario\"><script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 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9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg width='640' height='640' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style>\n <div class='gform_heading'>\n <h2 class=\"gform_title\">citas dr julio<\/h2>\n <p class='gform_description'><\/p>\n <\/div><form method='post' enctype='multipart\/form-data' id='gform_1' action='\/en\/wp-json\/wp\/v2\/pages\/12432' data-formid='1' novalidate>\n <div class='gform-body gform_body'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_1_1\" class=\"gfield gfield--type-name gfield--input-type-name field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nombre completo<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_1'>\n \n <span id='input_1_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n <input type='text' name='input_1.3' id='input_1_1_3' value='' aria-required='false' placeholder='Nombre' \/>\n <label for='input_1_1_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label>\n <\/span>\n \n <span id='input_1_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n <input type='text' name='input_1.6' id='input_1_1_6' value='' aria-required='false' placeholder='Apellido' \/>\n <label for='input_1_1_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last<\/label>\n <\/span>\n \n <\/div><\/fieldset><div id=\"field_1_3\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" ><label class='gfield_label gform-field-label' for='input_1_3'>Correo electr\u00f3nico<\/label><div class='ginput_container ginput_container_email'>\n <input name='input_3' id='input_1_3' type='email' value='' class='large' placeholder='Correo' aria-invalid=\"false\" \/>\n <\/div><\/div><div id=\"field_1_9\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" ><label class='gfield_label gform-field-label' for='input_1_9'>Tel\u00e9fono<\/label><div class='ginput_container ginput_container_phone'><input name='input_9' id='input_1_9' type='tel' value='' class='large' placeholder='Su n\u00famero' aria-invalid=\"false\" \/><\/div><\/div><div id=\"field_1_4\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" ><label class='gfield_label gform-field-label' for='input_1_4'>Procedimiento<\/label><div class='ginput_container ginput_container_select'><select name='input_4' id='input_1_4' class='large gfield_select' aria-invalid=\"false\" ><option value='Consulta' >Consulta<\/option><option value='Agendar cirug\u00eda' >Agendar cirug\u00eda<\/option><\/select><\/div><\/div><div id=\"field_1_6\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" ><label class='gfield_label gform-field-label' for='input_1_6'>Fecha<\/label><div class='ginput_container ginput_container_date'>\n <input name='input_6' id='input_1_6' type='text' value='' class='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon' placeholder='dd\/mm\/yyyy' aria-describedby=\"input_1_6_date_format\" aria-invalid=\"false\" \/>\n <span id='input_1_6_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n <\/div>\n <input type='hidden' id='gforms_calendar_icon_input_1_6' class='gform_hidden' value='https:\/\/drjulioestrada.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_1_8\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Hora<\/legend><div class=\"ginput_container ginput_complex gform-grid-row\">\n <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_1_8'>\n <input type='number' maxlength='2' name='input_8[]' id='input_1_8_1' value='' min='0' max='12' step='1' placeholder='HH' aria-required='false' \/> \n <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_1_8_1'>Hours<\/label>\n <\/div>\n <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n <input type='number' maxlength='2' name='input_8[]' id='input_1_8_2' value='' min='0' max='59' step='1' placeholder='MM' aria-required='false' \/>\n <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_1_8_2'>Minutes<\/label>\n <\/div>\n <div class='gfield_time_ampm ginput_container ginput_container_time below gform-grid-col' >\n \n <select name='input_8[]' id='input_1_8_3' >\n <option value='am' >AM<\/option>\n <option value='pm' >PM<\/option>\n <\/select> \n <label class='gform-field-label gform-field-label--type-sub am_pm_label screen-reader-text' for='input_1_8_3'>AM\/PM<\/label> \n <\/div>\n <\/div><\/fieldset><div id=\"field_1_7\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" ><label class='gfield_label gform-field-label' for='input_1_7'>Cl\u00ednica<\/label><div class='ginput_container ginput_container_select'><select name='input_7' id='input_1_7' class='large gfield_select' aria-invalid=\"false\" ><option value='clinicas_panamed' >PanaMed Cl\u00ednicas y Hospital de Especialidades<\/option><option value='clinicas_pimental' >Cl\u00ednicas de Especialidades M\u00e9dicas El Pimental<\/option><\/select><\/div><\/div><div id=\"field_1_5\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" ><label class='gfield_label gform-field-label' for='input_1_5'>Motivo de la consulta<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_5' id='input_1_5' class='textarea medium' placeholder='Explique el motivo de la consulta' aria-invalid=\"false\" rows='10' cols='50'><\/textarea><\/div><\/div><\/div><\/div>\n <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_1' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Agendar' \/> \n <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_1' value='postback' \/>\n <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_1' id='gform_theme_1' value='orbital' \/>\n <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_1' id='gform_style_settings_1' value='[]' \/>\n <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n <input type='hidden' class='gform_hidden' name='gform_submit' value='1' \/>\n \n <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n <input type='hidden' class='gform_hidden' name='state_1' 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data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseOne\"\n aria-expanded=\"false\"\n aria-controls=\"collapseOne\"\n >\n Tengo dolor, pero no s\u00e9 si realmente necesito un cirujano.<br \/>\u00bfPuedo\n consultarte igual?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseOne\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingOne\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n S\u00ed, claro. No todo dolor termina en cirug\u00eda. La consulta sirve\n precisamente para evaluar qu\u00e9 est\u00e1 pasando y decidir si se\n trata de algo quir\u00fargico o no, y cu\u00e1l es el mejor manejo en tu\n caso.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingTwo\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseTwo\"\n aria-expanded=\"false\"\n aria-controls=\"collapseTwo\"\n >\n Me dijeron que \u201ctengo piedras en la ves\u00edcula\u201d, pero no<br \/>siempre\n me duele. \u00bfIgual deber\u00eda operarme?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseTwo\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingTwo\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Es v\u00e1lido. Mi trabajo es explicarte las opciones, los riesgos\n y beneficios de cada una. La decisi\u00f3n final siempre la tomas\n t\u00fa, con informaci\u00f3n clara y honesta.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingThree\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseThree\"\n aria-expanded=\"false\"\n aria-controls=\"collapseThree\"\n >\n \u00bfY si prefiero no operarme por ahora?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseThree\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingThree\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n No siempre es obligatorio operar de inmediato. Todo depende de\n tus s\u00edntomas, la frecuencia del dolor y el riesgo de\n complicaciones. En consulta evaluamos si es momento de operar\n o si a\u00fan es seguro observar.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingFour\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseFour\"\n aria-expanded=\"false\"\n aria-controls=\"collapseFour\"\n >\n \u00bfC\u00f3mo s\u00e9 si mi caso es urgente o puede esperar?\n <\/button>\n <\/h5>\n <\/div>\n\n <div\n id=\"collapseFour\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingFour\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Hay s\u00edntomas que indican urgencia, como dolor intenso y\n persistente, fiebre, v\u00f3mitos continuos o empeoramiento r\u00e1pido.\n Si tienes duda, lo mejor es evaluarte a tiempo para no correr\n riesgos innecesarios.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingFive\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseFive\"\n aria-expanded=\"false\"\n aria-controls=\"collapseFive\"\n >\n Me da miedo la anestesia, \u00bfes normal?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseFive\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingFive\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Es completamente normal. Antes de cualquier cirug\u00eda se hace\n una evaluaci\u00f3n anest\u00e9sica para reducir riesgos al m\u00e1ximo y\n resolver todas tus dudas. No est\u00e1s solo en ese proceso.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingSix\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseSix\"\n aria-expanded=\"false\"\n aria-controls=\"collapseSix\"\n >\n \u00bfDespu\u00e9s de la cirug\u00eda voy a tener mucho dolor?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseSix\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingSix\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n La mayor\u00eda de pacientes refiere dolor leve a moderado,\n especialmente cuando se utiliza cirug\u00eda m\u00ednimamente invasiva.\n Adem\u00e1s, el manejo del dolor forma parte importante del\n tratamiento.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingSeven\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseSeven\"\n aria-expanded=\"false\"\n aria-controls=\"collapseSeven\"\n >\n \u00bfCu\u00e1ntos d\u00edas tendr\u00eda que estar hospitalizado?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseSeven\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingSeven\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Depende del procedimiento y de tu evoluci\u00f3n. Muchas cirug\u00edas\n laparosc\u00f3picas permiten egreso temprano, incluso el mismo d\u00eda\n o al d\u00eda siguiente.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingEight\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseEight\"\n aria-expanded=\"false\"\n aria-controls=\"collapseEight\"\n >\n \u00bfCu\u00e1ndo podr\u00eda volver a trabajar o hacer mi vida normal?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseEight\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingEight\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Var\u00eda seg\u00fan la cirug\u00eda y tu tipo de trabajo, pero en general\n la recuperaci\u00f3n es m\u00e1s r\u00e1pida con t\u00e9cnicas m\u00ednimamente\n invasivas. En consulta te doy tiempos realistas para tu caso.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingNine\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseNine\"\n aria-expanded=\"false\"\n aria-controls=\"collapseNine\"\n >\n \u00bfSi ya me dijeron que necesito cirug\u00eda, igual tengo que\n consultarte?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseNine\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingNine\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n S\u00ed. Cada cirujano eval\u00faa el caso de forma individual. La\n consulta permite confirmar el diagn\u00f3stico, discutir opciones y\n resolver dudas antes de tomar una decisi\u00f3n.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingTen\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseTen\"\n aria-expanded=\"false\"\n aria-controls=\"collapseTen\"\n >\n \u00bfQu\u00e9 pasa si dejo pasar el tiempo y no me opero?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseTen\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingTen\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Depende del diagn\u00f3stico. Algunas condiciones pueden mantenerse\n estables, pero otras pueden complicarse. Por eso es importante\n valorar riesgos y no decidir solo con miedo o suposiciones.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingEleven\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseEleven\"\n aria-expanded=\"false\"\n aria-controls=\"collapseEleven\"\n >\n \u00bfPuedo hacerte preguntas sin sentir que \u201cmolesto\u201d?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseEleven\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingEleven\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Por supuesto. Entender tu diagn\u00f3stico y sentirte tranquilo es\n parte del tratamiento. No hay preguntas incorrectas cuando se\n trata de tu salud.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingTwelve\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseTwelve\"\n aria-expanded=\"false\"\n aria-controls=\"collapseTwelve\"\n >\n \u00bfLa cirug\u00eda siempre es la primera opci\u00f3n?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseTwelve\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingTwelve\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n No. Muchas veces se puede intentar manejo m\u00e9dico o\n conservador. La cirug\u00eda se indica cuando realmente aporta\n beneficio o evita complicaciones.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingThirtee\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseThirtee\"\n aria-expanded=\"false\"\n aria-controls=\"collapseThirtee\"\n >\n \u00bfQu\u00e9 pasa si durante la cirug\u00eda encuentran algo diferente?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseThirtee\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingThirtee\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Antes del procedimiento se habla de los posibles escenarios.\n Las decisiones se toman pensando siempre en tu seguridad y en\n resolver el problema de la mejor manera posible.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingFourtee\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseFourtee\"\n aria-expanded=\"false\"\n aria-controls=\"collapseFourtee\"\n >\n \u00bfPuedo operarme aunque tenga otras enfermedades?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseFourtee\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingFourtee\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n S\u00ed, pero primero se hace una evaluaci\u00f3n completa. El objetivo\n es optimizar tu estado de salud antes de la cirug\u00eda para\n reducir riesgos.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingFiftee\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseFiftee\"\n aria-expanded=\"false\"\n aria-controls=\"collapseFiftee\"\n >\n \u00bfQui\u00e9n me explica todo antes de operarme?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseFiftee\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingFiftee\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Yo mismo. Me tomo el tiempo para explicarte el diagn\u00f3stico, el\n procedimiento, los riesgos y el proceso de recuperaci\u00f3n, de\n forma clara y sin prisas.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingSixtee\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseSixtee\"\n aria-expanded=\"false\"\n aria-controls=\"collapseSixtee\"\n >\n \u00bfY si cambio de opini\u00f3n despu\u00e9s de la consulta?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseSixtee\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingSixtee\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n No hay problema. La consulta es para informarte y orientarte.\n Puedes tomarte el tiempo que necesites para decidir.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingSeventee\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseSeventee\"\n aria-expanded=\"false\"\n aria-controls=\"collapseSeventee\"\n >\n \u00bfPuedo escribir si despu\u00e9s de la consulta me surgen m\u00e1s dudas?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseSeventee\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingSeventee\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n S\u00ed. Es normal que surjan preguntas despu\u00e9s. Mi equipo y yo\n estamos para orientarte durante todo el proceso.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingEightee\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseEightee\"\n aria-expanded=\"false\"\n aria-controls=\"collapseEightee\"\n >\n \u00bfEste chat sirve para saber si me tengo que operar ya?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseEightee\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingEightee\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Este chat ayuda a orientarte, pero no reemplaza una valoraci\u00f3n\n m\u00e9dica. Para tomar decisiones importantes siempre es necesaria\n una consulta presencial.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingNinetee\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseNinetee\"\n aria-expanded=\"false\"\n aria-controls=\"collapseNinetee\"\n >\n \u00bfAtiendes casos que otros m\u00e9dicos consideran \u201cdif\u00edciles\u201d?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseNinetee\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingNinetee\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Cada caso merece una evaluaci\u00f3n individual. En consulta\n revisamos tu situaci\u00f3n con calma para definir la mejor\n estrategia.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingTwen\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseTwen\"\n aria-expanded=\"false\"\n aria-controls=\"collapseTwen\"\n >\n \u00bfQu\u00e9 es lo m\u00e1s importante que deber\u00eda saber antes de una\n cirug\u00eda?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseTwen\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingTwen\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Que la cirug\u00eda es solo una parte del proceso. La evaluaci\u00f3n,\n la preparaci\u00f3n, el seguimiento y la recuperaci\u00f3n son igual de\n importantes para un buen resultado.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingTwen1\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseTwen1\"\n aria-expanded=\"false\"\n aria-controls=\"collapseTwen1\"\n >\n \u00bfLa anestesia es diferente si la cirug\u00eda es abierta o\n laparosc\u00f3pica?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseTwen1\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingTwen1\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n S\u00ed, puede variar seg\u00fan el tipo de cirug\u00eda y tu condici\u00f3n de\n salud. En ambos casos la anestesia se elige pensando en tu\n seguridad, comodidad y una buena recuperaci\u00f3n.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingTwen2\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseTwen2\"\n aria-expanded=\"false\"\n aria-controls=\"collapseTwen2\"\n >\n \u00bfVoy a estar completamente dormido durante la cirug\u00eda?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseTwen2\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingTwen2\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n En la mayor\u00eda de cirug\u00edas abdominales s\u00ed, utilizamos anestesia\n general para que no sientas dolor ni tengas recuerdos del\n procedimiento. El anestesi\u00f3logo te eval\u00faa previamente y te\n explica todo con detalle.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingTwen3\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseTwen3\"\n aria-expanded=\"false\"\n aria-controls=\"collapseTwen3\"\n >\n \u00bfEs m\u00e1s riesgosa la anestesia que la cirug\u00eda?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseTwen3\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingTwen3\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n En pacientes evaluados correctamente, el riesgo anest\u00e9sico\n suele ser bajo. Por eso es tan importante la valoraci\u00f3n\n previa, donde se revisan tus antecedentes y se optimiza todo\n antes del procedimiento.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingTwen4\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseTwen4\"\n aria-expanded=\"false\"\n aria-controls=\"collapseTwen4\"\n >\n \u00bfPuedo despertarme durante la cirug\u00eda?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseTwen4\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingTwen4\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Es una preocupaci\u00f3n com\u00fan, pero extremadamente rara. La\n anestesia moderna se monitoriza de forma continua para\n mantenerte dormido y seguro durante todo el procedimiento.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingTwen5\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseTwen5\"\n aria-expanded=\"false\"\n aria-controls=\"collapseTwen5\"\n >\n \u00bfDespu\u00e9s de la anestesia me sentir\u00e9 muy mal o desorientado?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseTwen5\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingTwen5\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Al despertar puedes sentir somnolencia, mareo leve o n\u00e1useas,\n pero suele ser temporal. El equipo se encarga de controlar\n estos s\u00edntomas para que tu recuperaci\u00f3n sea lo m\u00e1s c\u00f3moda\n posible.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n \n\n <button\n class=\"btn-colapso btn\"\n type=\"button\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseExample\"\n aria-expanded=\"false\"\n aria-controls=\"collapseExample\"\n >\n <div class=\"row row-tooltip justify-content-center align-items-center\">\n <div class=\"col-tooltip1 col-tooltip\">\n <i class=\"fa-regular fa-comment-dots\" style=\"color: white\"><\/i>\n <\/div>\n <div class=\"col-tooltip2 col-tooltip\">\n <p class=\"font-creato\">Chatea con nosotros<\/p>\n <\/div>\n <\/div>\n <\/button>\n <\/div>\n\n \n <footer>\n <div class=\"container\">\n <div class=\"row g-4 mb-4 row-footer-top\">\n <div class=\"col-footer col-footer1\">\n <a class=\"logo-footer\" href=\"#\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/05\/logo-footer.webp\"\n alt=\"logo-header\"\n \/>\n <\/a>\n <\/div>\n\n <div class=\"col-footer col-footer2\">\n <h5>Mi web<\/h5>\n\n <ul class=\"list-unstyled list-footer\">\n <li>\n <a href=\"#\" class=\"small font-creato\">Inicio<\/a>\n <\/li>\n\n <li>\n <a href=\"#\" class=\"small font-creato\">Somos<\/a>\n <\/li>\n\n <li>\n <a href=\"#\" class=\"small font-creato\">Procedimientos<\/a>\n <\/li>\n\n <li>\n <a href=\"#\" class=\"small font-creato\"\n >Condiciones quir\u00fargicas<\/a\n >\n <\/li>\n\n <li>\n <a href=\"#\" class=\"small font-creato\"\n >Informaci\u00f3n para el paciente<\/a\n >\n <\/li>\n\n <li>\n <a href=\"#\" class=\"small font-creato\">Gu\u00eda para estudiantes<\/a>\n <\/li>\n\n <li>\n <a href=\"#\" class=\"small font-creato\">Agendar cita<\/a>\n <\/li>\n <\/ul>\n <\/div>\n\n <div class=\"col-footer col-footer3\">\n <h5 class=\"font-creato\">Mis redes<\/h5>\n\n <ul class=\"list-unstyled list-footer\">\n <li>\n <a href=\"#inicio\" class=\"small font-creato\"\n ><i class=\"fa-brands fa-instagram\"><\/i>\n @cirujanodrjulioestrada<\/a\n >\n <\/li>\n\n <li>\n <a href=\"#sobre-mi\" class=\"small font-creato\"\n ><i class=\"fa-brands fa-facebook-f\"><\/i> Dr Julio Estrada<\/a\n >\n <\/li>\n\n <li>\n <a href=\"#servicios\" class=\"small font-creato\"\n ><i class=\"fa-brands fa-youtube\"><\/i> Dr Julio Estrada<\/a\n >\n <\/li>\n <\/ul>\n <\/div>\n\n <div class=\"col-footer col-footer4\">\n <div class=\"cont-contacto-foot cont-contacto-foot1\">\n <h5 class=\"font-creato\">Cont\u00e1ctame<\/h5>\n\n <ul class=\"list-unstyled list-footer\">\n <li>\n <a href=\"#\" class=\"small font-creato\">+502 77620324<\/a>\n <\/li>\n\n <li>\n <a href=\"#\" class=\"small font-creato\">+502 78321756<\/a>\n <\/li>\n <\/ul>\n <\/div>\n\n <div class=\"cont-contacto-foot cont-contacto-foot2\">\n <h5 class=\"font-creato\">Mi correo<\/h5>\n\n <ul class=\"list-unstyled list-footer\">\n <li>\n <a href=\"#\" class=\"small font-creato\"\n >drjulioestrada@panamed.com.gt<\/a\n >\n <\/li>\n <\/ul>\n <\/div>\n <\/div>\n <\/div>\n\n <hr class=\"border-footer opacity-50\" \/>\n\n <div\n class=\"row row-footer-bot justify-content-evenly align-items-center\"\n >\n <div class=\"col-foot-bot col-foot-bot1\">\n <p class=\"small font-creato text-muted mb-0 txt-foot txt-foot1\">\n © 2025-2026 Dr. Julio Estrada. Todos los derechos reservados.\n <\/p>\n <\/div>\n\n <div class=\"col-foot-bot col-foot-bot2\">\n <p class=\"small font-creato text-muted mb-0 txt-foot txt-foot2\">\n Desarrollado por\n <a href=\"#\" class=\"text-muted\">Enfoca2’s Studios<\/a>\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n <\/footer>\n\n \n \n\n \n \n\n <script>\n \/\/ Soluci\u00f3n JS para m\u00faltiples dropdowns con sub\u2011men\u00fas animados\n \/\/ SIN modificar la estructura HTML. Funciona con cualquier n\u00famero de .item-procedis\n\n document.addEventListener(\"DOMContentLoaded\", function () {\n \/\/ Selecciona todos los contenedores principales de cada dropdown\n const items = document.querySelectorAll(\".item-procedis\");\n\n items.forEach((item) => {\n \/\/ Obtener el toggle principal (el que abre el men\u00fa Bootstrap)\n const mainToggle = item.querySelector(\".btn-procedi\");\n if (!mainToggle) return;\n\n \/\/ El men\u00fa principal (dropdown-menu) es el siguiente hermano del toggle\n const parentMenu = mainToggle.nextElementSibling;\n if (!parentMenu || !parentMenu.classList.contains(\"dropdown-menu\"))\n return;\n\n \/\/ Buscar todos los sub\u2011toggles y sus respectivos sub\u2011men\u00fas dentro de .contain-drops\n const subToggles = parentMenu.querySelectorAll(\n \".sub-dropdown-toggle\",\n );\n const subMenus = parentMenu.querySelectorAll(\n \".contain-drops .drop-inter\",\n );\n\n \/\/ Funci\u00f3n para quitar la clase 'activo' de todos los .btn-inter-procedi dentro de este men\u00fa padre\n function removeActivoFromAll() {\n const allBtns = parentMenu.querySelectorAll(\".btn-inter-procedi\");\n allBtns.forEach((btn) => btn.classList.remove(\"activo\"));\n }\n\n \/\/ Funci\u00f3n para cerrar todos los sub\u2011men\u00fas y quitar la clase activo\n function closeAllSubMenus() {\n subMenus.forEach((menu) => menu.classList.remove(\"show\"));\n removeActivoFromAll();\n }\n\n \/\/ Asignar evento a cada sub\u2011toggle\n subToggles.forEach((toggle, index) => {\n \/\/ Eliminar eventos previos para evitar duplicados\n toggle.removeEventListener(\"click\", toggle._handler);\n const handler = function (e) {\n e.preventDefault();\n e.stopPropagation(); \/\/ Evita que Bootstrap cierre el dropdown padre\n\n const targetMenu = subMenus[index];\n if (!targetMenu) return;\n\n if (targetMenu.classList.contains(\"show\")) {\n \/\/ Si ya est\u00e1 abierto: lo cerramos y quitamos la clase activo de este toggle\n targetMenu.classList.remove(\"show\");\n toggle.classList.remove(\"activo\");\n } else {\n \/\/ Cerramos cualquier otro y abrimos el actual\n closeAllSubMenus();\n targetMenu.classList.add(\"show\");\n \/\/ Agregamos la clase 'activo' al enlace que abri\u00f3 el sub\u2011dropdown\n toggle.classList.add(\"activo\");\n }\n };\n toggle.addEventListener(\"click\", handler);\n toggle._handler = handler; \/\/ Guardar referencia para posible remoci\u00f3n\n });\n\n \/\/ Cerrar sub\u2011men\u00fas al hacer clic en el men\u00fa padre (pero no sobre los sub\u2011toggles ni los sub\u2011men\u00fas)\n parentMenu.addEventListener(\"click\", function (e) {\n if (\n !e.target.closest(\".sub-dropdown-toggle\") &&\n !e.target.closest(\".drop-inter\")\n ) {\n closeAllSubMenus();\n }\n });\n\n \/\/ Cuando el dropdown principal se cierra (por clic fuera o ESC), limpiar sub\u2011men\u00fas y clases activo\n mainToggle.addEventListener(\"hidden.bs.dropdown\", closeAllSubMenus);\n });\n });\n <\/script>\n <\/body>\n<\/html>\n\n","protected":false},"excerpt":{"rendered":"<p>Dr. Julio Estrada – Cirug\u00eda General y Laparosc\u00f3pica Inicio Somos Procedimientos Cirug\u00eda de Apendice Cirug\u00eda de Ves\u00edcula Cirug\u00eda de Hernias […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":2,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"site-sidebar-layout":"no-sidebar","site-content-layout":"","ast-site-content-layout":"full-width-container","site-content-style":"unboxed","site-sidebar-style":"unboxed","ast-global-header-display":"disabled","ast-banner-title-visibility":"disabled","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"disabled","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center 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{"id":12432,"date":"2026-05-28T21:55:28","date_gmt":"2026-05-28T21:55:28","guid":{"rendered":"https:\/\/drjulioestrada.com\/stage\/?page_id=12432"},"modified":"2026-06-02T22:18:30","modified_gmt":"2026-06-02T22:18:30","slug":"procedimientos","status":"publish","type":"page","link":"https:\/\/drjulioestrada.com\/en\/procedimientos\/","title":{"rendered":"Procedures"},"content":{"rendered":"\n\n\n \n \n \n Dr. Julio Estrada – Cirug\u00eda General y Laparosc\u00f3pica<\/title>\n \n \n \n <link\n href=\"https:\/\/cdnjs.cloudflare.com\/ajax\/libs\/font-awesome\/6.4.0\/css\/all.min.css\"\n rel=\"stylesheet\"\n \/>\n\n \n \n\n \n \n <\/head>\n\n <body>\n \n <nav class=\"navbar navbar-expand-lg sticky-top navbar-light\">\n <div class=\"container\">\n <a class=\"navbar-brand\" href=\"https:\/\/drjulioestrada.com\/\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/05\/logo-header.webp\"\n alt=\"logo-header\"\n \/>\n <\/a>\n\n <button\n class=\"navbar-toggler\"\n type=\"button\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#navbarNav\"\n >\n <span class=\"navbar-toggler-icon\"><\/span>\n <\/button>\n\n <div class=\"collapse navbar-collapse\" id=\"navbarNav\">\n <ul class=\"navbar-nav ms-auto align-items-lg-center\">\n <li class=\"nav-item\">\n <a class=\"nav-link\" href=\"https:\/\/drjulioestrada.com\/\"\n >Inicio<\/a\n >\n <\/li>\n\n <li class=\"nav-item\">\n <a class=\"nav-link\" href=\"https:\/\/drjulioestrada.com\/somos\/\"\n >Somos<\/a\n >\n <\/li>\n\n <div class=\"nav-item dropdown\">\n <a\n href=\"#\"\n class=\"nav-link dropdown-toggle active\"\n data-bs-toggle=\"dropdown\"\n >Procedimientos<\/a\n >\n\n <div class=\"dropdown-menu m-0\">\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#apendice\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Cirug\u00eda<\/span> de Apendice<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#vesicula\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Cirug\u00eda<\/span> de Ves\u00edcula<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#hernias\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Cirug\u00eda<\/span> de Hernias\n Abdominales<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#exploracion\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Exploraci\u00f3n<\/span> de la V\u00eda\n Biliar<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#ercp\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">ERCP<\/span> (Endoscopic\n Retrograde Cholangiopancreatography) – Colangiopancreatograf\u00eda\n Retr\u00f3grada Endosc\u00f3pica) – Colangiopancreatograf\u00eda Retr\u00f3grada\n Endosc\u00f3pica<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#colangiografia\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Colangiograf\u00eda<\/span>\n Intraoperatoria<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#emergencia\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Cirug\u00eda<\/span> de Emergencia<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#abdomen-agudo\"\n class=\"dropdown-item\"\n >Abdomen Agudo no\n <span class=\"font-acent-ub\">Traum\u00e1tico<\/span><\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#obstruccion-intestinal\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Obstrucci\u00f3n<\/span> Intestinal<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#perforacion\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Perforaci\u00f3n<\/span> de Viscera\n Hueca<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#pancreatitis\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Pancreatitis<\/span> Aguda\n Grave<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#diverticulitis\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Diverticulitis<\/span> Aguda\n Complicada<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#trauma-abdominal\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Trauma<\/span> Abdominal<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#abdomen-abierto\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Abdomen Abierto<\/span> y\n <span class=\"font-acent-ub\">Cirug\u00eda<\/span> de Control de\n Da\u00f1os<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#catastrofe-abdominal\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Cat\u00e1strofe<\/span> Abdominal<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/procedimientos\/#abdomen-agudo-pediatria\"\n class=\"dropdown-item\"\n ><span class=\"font-acent-ub\">Abdomen Agudo<\/span> en\n Pediatr\u00eda<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"nav-item dropdown\">\n <a\n href=\"#\"\n class=\"nav-link dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n >Condiciones quir\u00fargicas<\/a\n >\n\n <div class=\"dropdown-menu m-0\">\n <a\n href=\"https:\/\/drjulioestrada.com\/condiciones-quirurgicas\/condiciones-quirurgicas-apendice\/\"\n class=\"dropdown-item\"\n >Ap\u00e9ndice (Apendicitis)<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/condiciones-quirurgicas\/condiciones-quirurgicas-vesicula\/\"\n class=\"dropdown-item\"\n >Ves\u00edcula Biliar<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/condiciones-quirurgicas\/condiciones-quirurgicas-hernias-de-la-pared-abdominal\/\"\n class=\"dropdown-item\"\n >Hernias de la Pared Abdominal<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/condiciones-quirurgicas\/condiciones-quirurgicas-diastasis-de-rectos\/\"\n class=\"dropdown-item\"\n >Di\u00e1stasis de rectos Abdominales<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/condiciones-quirurgicas\/condiciones-quirurgicas-pie-diabetico\/\"\n class=\"dropdown-item\"\n >Pie diab\u00e9tico<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/condiciones-quirurgicas\/condiciones-quirurgicas-cirugia-menor\/\"\n class=\"dropdown-item\"\n >Cirug\u00eda menor<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/condiciones-quirurgicas\/condiciones-quirurgicas-suturas\/\"\n class=\"dropdown-item\"\n >Suturas<\/a\n >\n <\/div>\n <\/div>\n\n <li class=\"nav-item\">\n <a\n class=\"nav-link\"\n href=\"https:\/\/drjulioestrada.com\/informacion-para-el-paciente\/\"\n >Informaci\u00f3n del paciente<\/a\n >\n <\/li>\n\n <div class=\"nav-item dropdown\">\n <a\n href=\"#\"\n class=\"nav-link dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n >Gu\u00eda para Estudiantes<\/a\n >\n\n <div class=\"dropdown-menu m-0\">\n <a\n href=\"https:\/\/drjulioestrada.com\/guia-para-estudiantes\/abc-de-laparoscopia\/\"\n class=\"dropdown-item\"\n >ABC de Laparoscop\u00eda<\/a\n >\n\n <a\n href=\"https:\/\/drjulioestrada.com\/guia-para-estudiantes\/guia-para-estudiantes-de-pregrado\/\"\n class=\"dropdown-item\"\n >Gu\u00eda para estudiantes de pregrado<\/a\n >\n <\/div>\n <\/div>\n\n <li class=\"nav-item\">\n <a\n class=\"d-tlf nav-link\"\n href=\"https:\/\/drjulioestrada.com\/agendar\/\"\n >Agendar Cita<\/a\n >\n <\/li>\n <\/ul>\n\n <div class=\"btn-head\">\n <a\n class=\"d-desk nav-link btn-nav\"\n href=\"https:\/\/drjulioestrada.com\/agendar\/\"\n >Agendar Cita<\/a\n >\n <\/div>\n <\/div>\n <\/div>\n <\/nav>\n\n \n <section id=\"procedis\">\n <div class=\"container\">\n <div class=\"contain-hero-procedis\">\n <div class=\"row row-hero-procedis\">\n <div class=\"col-hero-procedis col-hero-procedis1\"><\/div>\n\n <div class=\"col-hero-procedis col-hero-procedis2\">\n <h4 class=\"font-creato titu-hero-procedi\">procedimientos<\/h4>\n\n <h3 class=\"font-creato titus-hero-procedi\">Que realizo<\/h3>\n\n <p class=\"font-creato txt-hero-procedi\">\n En este apartado encontrar\u00e1s una gu\u00eda inicial para entender en\n qu\u00e9 consiste cada uno de los principales procedimientos, \u00bfQu\u00e9\n es? \u00bfPor qu\u00e9 se realiza? Y \u00bfCu\u00e1les son los tipos de cirug\u00eda?\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/section>\n\n \n <section id=\"info-procedis\">\n <div class=\"container my-5 py-4\">\n <div class=\"contain-procedis\">\n <div class=\"item-procedis item-procedis1\" id=\"apendice\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n id=\"dropdownInicial\"\n data-bs-display=\"static\"\n data-bs-auto-close=\"outside\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-1.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Cirug\u00eda de Ap\u00e9ndice<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Apendicectom\u00eda<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Tipos de Apendicectom\u00eda<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Apendicectom\u00eda Abierta por Laparotom\u00eda Exploradora<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 1. \u00bfQu\u00e9 es una Apendicectom\u00eda?\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n La apendicectom\u00eda es la cirug\u00eda mediante la cual se\n extirpa el ap\u00e9ndice vermiforme.<br \/>Es el tratamiento\n est\u00e1ndar y definitivo para la apendicitis aguda, una\n inflamaci\u00f3n progresiva que puede complicarse r\u00e1pidamente\n con perforaci\u00f3n, peritonitis y sepsis.<br \/>Es uno de los\n procedimientos m\u00e1s seguros y realizados en todo el mundo,\n con una recuperaci\u00f3n r\u00e1pida cuando se atiende\n oportunamente.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 2. \u00bfPor qu\u00e9 se realiza una Apendicectom\u00eda?\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n La indicaci\u00f3n principal es la apendicitis aguda, pero\n tambi\u00e9n se realiza en:\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Apendicitis no complicada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Apendicitis gangrenosa.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Apendicitis perforada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Absceso apendicular tras manejo inicial con\n antibi\u00f3ticos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Masa apendicular con episodios recurrentes.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Apendicolito sintom\u00e1tico persistente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Diagn\u00f3stico incierto de abdomen agudo, donde la\n evaluaci\u00f3n quir\u00fargica es necesaria.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n Sin cirug\u00eda, la apendicitis puede complicarse gravemente\n en pocas horas.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n \u00bfQu\u00e9 tipos de Apendicectom\u00eda existen?\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n A) Apendicectom\u00eda Laparosc\u00f3pica: Es el est\u00e1ndar moderno y\n la t\u00e9cnica recomendada en la mayor\u00eda de los pacientes.<br \/><br \/><strong\n >\u00bfC\u00f3mo se realiza?<\/strong\n >\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Apendicitis no complicada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Apendicitis gangrenosa.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Apendicitis perforada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Absceso apendicular tras manejo inicial con\n antibi\u00f3ticos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Masa apendicular con episodios recurrentes.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Apendicolito sintom\u00e1tico persistente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Diagn\u00f3stico incierto de abdomen agudo, donde la\n evaluaci\u00f3n quir\u00fargica es necesaria.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>Ventajas de la laparoscop\u00eda:<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Incisiones peque\u00f1as.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Menos dolor.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Recuperaci\u00f3n m\u00e1s r\u00e1pida.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Menor riesgo de infecci\u00f3n de herida.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Menor estancia hospitalaria.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Evaluaci\u00f3n completa del abdomen (clave en mujeres).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Mejor resultado est\u00e9tico.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n B) Apendicectom\u00eda Abierta (Incisi\u00f3n en Fosa Il\u00edaca\n Derecha): Se utiliza en situaciones espec\u00edficas.<br \/><br \/><strong\n >Indicada en:<\/strong\n >\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Colecciones o abscesos localizados severos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Falta de equipo laparosc\u00f3pico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Cicatrices previas complejas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Peritonitis local con dificultad t\u00e9cnica para\n laparoscop\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Pacientes que no pueden recibir anestesia general.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>T\u00e9cnica:<\/strong> Se realiza una incisi\u00f3n peque\u00f1a\n tipo McBurney o Rocky-Davis, se identifica el ap\u00e9ndice, se\n liga y se retira.\n <\/p>\n\n <p class=\"txt-drop-inter\">\n B) Apendicectom\u00eda Abierta (Incisi\u00f3n en Fosa Il\u00edaca\n Derecha): Se utiliza en situaciones espec\u00edficas.<br \/><br \/><strong\n >Indicada en:<\/strong\n >\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Colecciones o abscesos localizados severos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Falta de equipo laparosc\u00f3pico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Cicatrices previas complejas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Peritonitis local con dificultad t\u00e9cnica para\n laparoscop\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Pacientes que no pueden recibir anestesia general.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n C) Apendicectom\u00eda Abierta por Laparotom\u00eda Exploradora: La\n m\u00e1s compleja y reservada para casos graves.<br \/><br \/><strong\n >\u00bfCu\u00e1ndo se realiza?<\/strong\n >\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Peritonitis generalizada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Sospecha de patolog\u00edas alternas mayores.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Pacientes inestables hemodin\u00e1micamente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Masas inflamatorias grandes o plastrones.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Embarazo avanzado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Conversi\u00f3n de laparoscop\u00eda a cirug\u00eda abierta.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Recuperaci\u00f3n Despu\u00e9s de la Apendicectom\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Riesgos y Complicaciones (poco comunes).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter9\">\n \u00bfQu\u00e9 pasa si NO se trata una apendicitis?\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter10\">\n Apendicitis en Mujeres: \u00bfPor qu\u00e9 es importante la\n laparoscop\u00eda?\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter10\">\n Cuidados en casa.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n Apendicectom\u00eda Abierta por Laparotom\u00eda Exploradora\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n La m\u00e1s compleja y reservada para casos graves.<br \/><br \/><strong\n >\u00bfCu\u00e1ndo se realiza?<\/strong\n >\n <\/p>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Peritonitis generalizada:<\/strong> Pus o\n infecci\u00f3n en m\u00faltiples cuadrantes del abdomen. La\n laparoscop\u00eda puede ser limitada o peligrosa.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong\n >Sospecha de patolog\u00edas alternas mayores:<\/strong\n >\n No siempre es apendicitis. Se realiza cuando puede\n tratarse de: Perforaci\u00f3n intestinal, Isquemia\n mesent\u00e9rica, Diverticulitis complicada, Perforaci\u00f3n\n g\u00e1strica o duodenal, Patolog\u00eda ginecol\u00f3gica no\n identificable por laparoscop\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Pacientes inestables hemodin\u00e1micamente:<\/strong>\n En shock s\u00e9ptico, la laparotom\u00eda permite control m\u00e1s\n r\u00e1pido.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong\n >Masas inflamatorias grandes o plastrones:<\/strong\n >\n Cuando existe adherencia severa y la anatom\u00eda est\u00e1\n distorsionada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n <strong>Embarazo avanzado:<\/strong> En el tercer\n trimestre, la laparoscop\u00eda puede ser limitada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n <strong\n >Conversi\u00f3n de laparoscop\u00eda a cirug\u00eda abierta:<\/strong\n >\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >Cuando durante la cirug\u00eda se identifican:<\/strong\n >\n Sangrado persistente, Lesiones intestinales,\n Imposibilidad de progresar, Anatom\u00eda no clara.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong\n >\u00bfQu\u00e9 permite una laparotom\u00eda\n exploradora?:<\/strong\n >\n Control absoluto de la infecci\u00f3n, Lavado completo,\n Revisi\u00f3n de todos los \u00f3rganos, Drenaje amplio,\n Cirug\u00eda segura en abdomen severamente contaminado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Desventajas frente a laparoscop\u00eda:<\/strong>\n M\u00e1s dolor postoperatorio, Incisi\u00f3n m\u00e1s grande, Mayor\n tiempo de recuperaci\u00f3n, Mayor riesgo de infecci\u00f3n y\n eventraci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Aun as\u00ed,\n <strong\n >es la t\u00e9cnica que salva vidas en escenarios\n cr\u00edticos.<\/strong\n >\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n <strong\n >Recuperaci\u00f3n Despu\u00e9s de la Apendicectom\u00eda:<\/strong\n >\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >Laparosc\u00f3pica (la mayor\u00eda de casos):<\/strong\n >\n Caminar el mismo d\u00eda, L\u00edquidos por boca en horas,\n Dieta normal en 24hr, Trabajo de oficina: 3-5 d\u00edas,\n Actividad normal: 7-10 d\u00edas, Ejercicio intenso: 3-4\n semanas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Abierta o por laparotom\u00eda:<\/strong>\n Hospitalizaci\u00f3n 3-7 d\u00edas, Actividad ligera a las 2-3\n semanas, Actividad completa a las 4-6 semanas,\n Ejercicio intenso: 8 semanas.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n <strong\n >Riesgos y Complicaciones (poco comunes):<\/strong\n >\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Infecci\u00f3n de herida.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Absceso intraabdominal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Sangrado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Lesi\u00f3n intestinal (menos del 1%).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Eventraci\u00f3n (en incisiones grandes).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Dolor residual transitorio.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Sepsis (en casos perforados).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Los riesgos disminuyen cuando la cirug\u00eda es temprana\n y realizada por un equipo calificado.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter9\">\n <strong\n >\u00bfQu\u00e9 pasa si NO se trata una apendicitis?<\/strong\n >\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Complicaciones graves:<\/strong> Perforaci\u00f3n\n del ap\u00e9ndice, Peritonitis generalizada, Abscesos\n m\u00faltiples, Shock s\u00e9ptico, Muerte (en casos\n avanzados).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n La apendicitis no se cura con antibi\u00f3ticos. La \u00fanica\n soluci\u00f3n definitiva y segura es la cirug\u00eda.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter10\">\n <strong>Apendicitis en mujeres:<\/strong> \u00bfPor qu\u00e9 es\n importante la laparoscop\u00eda?\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >La laparoscop\u00eda permite descartar patolog\u00edas\n ginecol\u00f3gicas:<\/strong\n >\n Quistes ov\u00e1ricos rotos, Torsi\u00f3n de ovario, Embarazo\n ect\u00f3pico, Endometriosis, Enfermedad p\u00e9lvica\n inflamatoria.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Esto evita cirug\u00edas innecesarias y garantiza\n diagn\u00f3stico certero.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter11\">\n <strong>Cuidados en casa:<\/strong>\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Mantener heridas limpias y secas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Evitar levantar peso por 2-3 semanas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n No sumergir las heridas por 10-14 d\u00edas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Acudir si aparece fiebre, v\u00f3mitos, dolor intenso o\n secreci\u00f3n en la herida.\n <\/li>\n <\/ul>\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Bhangu A, S\u00f8reide K, Di Saverio S, Assarsson JH, Drake\n FT.<strong\n >Acute appendicitis: modern understanding of\n pathogenesis, diagnosis, and management.<\/strong\n >\n Lancet. 2015;386(10000):1278-1287.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Salminen P, Tuominen R, Paajanen H, et al.\n <strong\n >Antibiotic therapy vs appendectomy for treatment of\n uncomplicated acute appendicitis.<\/strong\n >\n JAMA. 2015;313(23):2340-2348.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Di Saverio S, Podda M, De Simone B, et al.\n <strong\n >Diagnosis and treatment of acute appendicitis: 2020\n update of the WSES Jerusalem guidelines.<\/strong\n >\n World J Emerg Surg. 2020;15(1):27.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Andersson RE.\n <strong\n >Meta-analysis of the clinical and laboratory\n diagnosis of appendicitis.<\/strong\n >\n Br J Surg. 2004;91(1):28-37.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Atema JJ, et al.\n <strong\n >Laparoscopic vs open appendectomy in adults and\n children: systematic review and meta-analysis.<\/strong\n >\n Surg Endosc. 2015;29(3):620-640.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Addiss DG, Shaffer N, Fowler BS, Tauxe RV.<strong\n >The epidemiology of appendicitis and appendectomy in\n the United States.<\/strong\n >\n Am J Epidemiol. 1990;132(5):910-925.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis2\" id=\"vesicula\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n data-bs-auto-close=\"outside\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-02.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Cirug\u00eda de Ves\u00edcula Biliar<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Colecistectom\u00eda<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Tipos de Colecistectom\u00eda<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Antes, durante y luego de la cirug\u00eda<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 1. \u00bfQu\u00e9 es una Colecistectom\u00eda?\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n La colecistectom\u00eda es la cirug\u00eda mediante la cual se\n retira la ves\u00edcula biliar.<br \/>Es el tratamiento\n definitivo para la mayor\u00eda de enfermedades vesiculares,\n <strong\n >especialmente c\u00e1lculos (colelitiasis), inflamaci\u00f3n\n (colecistitis)<\/strong\n >\n y lesiones con riesgo de malignidad como\n <strong\n >p\u00f3lipos, ves\u00edcula en porcelana y S\u00edndrome de\n Mirizzi.<\/strong\n ><br \/>La t\u00e9cnica m\u00e1s utilizada en la actualidad es la\n colecistectom\u00eda laparosc\u00f3pica, por ser m\u00e1s segura, menos\n dolorosa y con mejor recuperaci\u00f3n.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 2. \u00bfPor qu\u00e9 se realiza una colecistectom\u00eda? \u2014 Indicaciones\n principales\n <\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Colelitiasis (piedras en la ves\u00edcula)<\/strong>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n C\u00f3lico biliar.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Dolor recurrente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n N\u00e1useas con comidas grasas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Intolerancia alimentaria.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n C\u00e1lculos grandes (>2-3 cm).\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Colecistitis aguda:<\/strong> Inflamaci\u00f3n de la\n ves\u00edcula, usualmente por obstrucci\u00f3n del conducto\n c\u00edstico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong\n >Colecistitis cr\u00f3nica \/ Ves\u00edcula disfuncional\n (Discinesia biliar):<\/strong\n >\n Ves\u00edcula que no contrae bien, incluso sin c\u00e1lculos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong\n >C\u00e1lculos en el col\u00e9doco (coledocolitiasis): Requiere\n manejo combinado: ERCP<\/strong\n >\n \u00b1 cirug\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n <strong>P\u00f3lipos vesiculares:<\/strong> Cirug\u00eda indicada\n cuando:\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n \u226510 mm.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Crecimiento en controles.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n S\u00e9siles (base ancha).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Asociados a c\u00e1lculos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n S\u00edntomas persistentes.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n En pacientes >50 a\u00f1os con p\u00f3lipos \u22658 mm.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n <strong>Ves\u00edcula en porcelana:<\/strong>\n Calcificaci\u00f3n extensa de la pared con riesgo aumentado\n de c\u00e1ncer.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n <strong>S\u00edndrome de Mirizzi:<\/strong>\n C\u00e1lculo impactado que comprime o erosiona el col\u00e9doco.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n <strong>Pancreatitis biliar:<\/strong>\n Una vez estabilizado el cuadro, la colecistectom\u00eda evita\n recurrencias.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter9\">\n <strong>C\u00e1ncer de ves\u00edcula biliar:<\/strong>\n En etapas tempranas puede requerir colecistectom\u00eda\n simple o radical seg\u00fan estadificaci\u00f3n.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n \u00bfQu\u00e9 tipo de Colecistectom\u00eda existen?\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n <strong\n >A) Colecistectom\u00eda Laparosc\u00f3pica (la t\u00e9cnica\n est\u00e1ndar):<\/strong\n >\n La cirug\u00eda se realiza con 3-4 peque\u00f1as incisiones en el\n abdomen.<br \/><br \/><strong>\u00bfC\u00f3mo se realiza?<\/strong>\n <\/p>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Se introduce una c\u00e1mara que permite ver en alta\n definici\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Se identifica la ves\u00edcula y el tri\u00e1ngulo de Calot.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Se obtienen las\n <strong>\u201cCritical View of Safety\u201d<\/strong> para evitar\n complicaciones.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Se clipa y corta el conducto c\u00edstico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Se clipan y cortan los vasos c\u00edsticos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Se libera la ves\u00edcula del h\u00edgado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Se retira por una de las incisiones.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Se revisa la cavidad y se cierran las heridas con puntos\n est\u00e9ticos.\n <\/li>\n <\/ol>\n\n <p class=\"txt-drop-inter\">\n <strong>Ventajas:<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Incisiones peque\u00f1as.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Menos dolor.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Recuperaci\u00f3n r\u00e1pida.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Alta hospitalaria el mismo d\u00eda o siguiente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Menor riesgo de infecci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Menor riesgo de eventraci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Mejor resultado est\u00e9tico\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Por eso es el est\u00e1ndar de oro mundial.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strogn>B) Colecistectom\u00eda Abierta (tradicional):<\/strogn>\n Requiere una incisi\u00f3n subcostal derecha o mediana de entre\n 10 – 15 cm.\n <\/p>\n\n <p class=\"txt-drop-inter\">\n <strong>Indicaciones:<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Anatom\u00eda muy distorsionada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Plastr\u00f3n evero o abscesos m\u00faltiples.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Lesiones vesiculares infiltrantes.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Adherencias intensas de cirug\u00edas previas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Hemorragia durante laparoscop\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Paciente inestable.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n C\u00e1ncer de ves\u00edcula (seg\u00fan caso).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Menos com\u00fan hoy d\u00eda, pero necesaria en escenarios\n complejos.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>C) Colecistectom\u00eda en contextos complejos<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>S\u00edndrome de Mirizzi:<\/strong> Dependiendo del\n grado (I-IV):\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Colecistectom\u00eda parcial.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Reconstrucci\u00f3n biliar.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Hep\u00e1tico-yeyuno anastomosis en casos avanzados.\n <\/li>\n <\/ol>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Ves\u00edcula en porcelana:<\/strong> Colecistectom\u00eda\n recomendada a\u00fan sin s\u00edntomas, por riesgo de c\u00e1ncer.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>C\u00e1ncer de ves\u00edcula:<\/strong> Puede requerir:\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Colecistectom\u00eda simple (T1a).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Colecistectom\u00eda + resecci\u00f3n de segmentos IVb\/V.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Linfadenectom\u00eda hiliar.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Cirug\u00eda oncol\u00f3gica mayor seg\u00fan etapa.\n <\/li>\n <\/ol>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong>Colecistectom\u00eda con coledocolitiasis:<\/strong>\n Manejo combinado:\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n ERCP.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Laparoscop\u00eda con exploraci\u00f3n de v\u00eda biliar.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Cirug\u00eda abierta en casos seleccionados.\n <\/li>\n <\/ol>\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n Apendicectom\u00eda Abierta por Laparotom\u00eda Exploradora\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n La m\u00e1s compleja y reservada para casos graves.<br \/><br \/><strong\n >\u00bfCu\u00e1ndo se realiza?<\/strong\n >\n <\/p>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Peritonitis generalizada:<\/strong> Pus o\n infecci\u00f3n en m\u00faltiples cuadrantes del abdomen. La\n laparoscop\u00eda puede ser limitada o peligrosa.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong\n >Sospecha de patolog\u00edas alternas mayores:<\/strong\n >\n No siempre es apendicitis. Se realiza cuando puede\n tratarse de: Perforaci\u00f3n intestinal, Isquemia\n mesent\u00e9rica, Diverticulitis complicada, Perforaci\u00f3n\n g\u00e1strica o duodenal, Patolog\u00eda ginecol\u00f3gica no\n identificable por laparoscop\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Pacientes inestables hemodin\u00e1micamente:<\/strong>\n En shock s\u00e9ptico, la laparotom\u00eda permite control m\u00e1s\n r\u00e1pido.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong\n >Masas inflamatorias grandes o plastrones:<\/strong\n >\n Cuando existe adherencia severa y la anatom\u00eda est\u00e1\n distorsionada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n <strong>Embarazo avanzado:<\/strong> En el tercer\n trimestre, la laparoscop\u00eda puede ser limitada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n <strong\n >Conversi\u00f3n de laparoscop\u00eda a cirug\u00eda abierta:<\/strong\n >\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >Cuando durante la cirug\u00eda se identifican:<\/strong\n >\n Sangrado persistente, Lesiones intestinales,\n Imposibilidad de progresar, Anatom\u00eda no clara.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong\n >\u00bfQu\u00e9 permite una laparotom\u00eda\n exploradora?:<\/strong\n >\n Control absoluto de la infecci\u00f3n, Lavado completo,\n Revisi\u00f3n de todos los \u00f3rganos, Drenaje amplio,\n Cirug\u00eda segura en abdomen severamente contaminado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Desventajas frente a laparoscop\u00eda:<\/strong>\n M\u00e1s dolor postoperatorio, Incisi\u00f3n m\u00e1s grande, Mayor\n tiempo de recuperaci\u00f3n, Mayor riesgo de infecci\u00f3n y\n eventraci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Aun as\u00ed,\n <strong\n >es la t\u00e9cnica que salva vidas en escenarios\n cr\u00edticos.<\/strong\n >\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n <strong\n >Recuperaci\u00f3n Despu\u00e9s de la Apendicectom\u00eda:<\/strong\n >\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >Laparosc\u00f3pica (la mayor\u00eda de casos):<\/strong\n >\n Caminar el mismo d\u00eda, L\u00edquidos por boca en horas,\n Dieta normal en 24hr, Trabajo de oficina: 3-5 d\u00edas,\n Actividad normal: 7-10 d\u00edas, Ejercicio intenso: 3-4\n semanas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Abierta o por laparotom\u00eda:<\/strong>\n Hospitalizaci\u00f3n 3-7 d\u00edas, Actividad ligera a las 2-3\n semanas, Actividad completa a las 4-6 semanas,\n Ejercicio intenso: 8 semanas.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n <strong\n >Riesgos y Complicaciones (poco comunes):<\/strong\n >\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Infecci\u00f3n de herida.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Absceso intraabdominal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Sangrado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Lesi\u00f3n intestinal (menos del 1%).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Eventraci\u00f3n (en incisiones grandes).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Dolor residual transitorio.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Sepsis (en casos perforados).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Los riesgos disminuyen cuando la cirug\u00eda es temprana\n y realizada por un equipo calificado.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter9\">\n <strong\n >\u00bfQu\u00e9 pasa si NO se trata una apendicitis?<\/strong\n >\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Complicaciones graves:<\/strong> Perforaci\u00f3n\n del ap\u00e9ndice, Peritonitis generalizada, Abscesos\n m\u00faltiples, Shock s\u00e9ptico, Muerte (en casos\n avanzados).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n La apendicitis no se cura con antibi\u00f3ticos. La \u00fanica\n soluci\u00f3n definitiva y segura es la cirug\u00eda.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter10\">\n <strong>Apendicitis en mujeres:<\/strong> \u00bfPor qu\u00e9 es\n importante la laparoscop\u00eda?\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >La laparoscop\u00eda permite descartar patolog\u00edas\n ginecol\u00f3gicas:<\/strong\n >\n Quistes ov\u00e1ricos rotos, Torsi\u00f3n de ovario, Embarazo\n ect\u00f3pico, Endometriosis, Enfermedad p\u00e9lvica\n inflamatoria.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Esto evita cirug\u00edas innecesarias y garantiza\n diagn\u00f3stico certero.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter11\">\n <strong>Cuidados en casa:<\/strong>\n\n <ul class=\"minilist-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Mantener heridas limpias y secas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Evitar levantar peso por 2-3 semanas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n No sumergir las heridas por 10-14 d\u00edas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Acudir si aparece fiebre, v\u00f3mitos, dolor intenso o\n secreci\u00f3n en la herida.\n <\/li>\n <\/ul>\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Strasberg SM.\n <strong>Acute calculous cholecystitis.<\/strong> N Engl J\n Med. 2008;358(26):2804-2811.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Lammert F, Gurusamy K, Ko CW, et al.\n <strong>Gallstones.<\/strong> Nat Rev Dis Primers.\n 2016;2:16024.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Yokoe M, Hata J, Takada T, et al.\n <strong\n >Tokyo Guidelines: updated diagnostic criteria and\n severity assessment for acute cholecystitis.<\/strong\n >\n J Hepatobiliary Pancreat Sci. 2018;25(1):41-54.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Pesce A, et al.\n <strong>Current management of Mirizzi syndrome.<\/strong>\n ANZ J Surg. 2020;90(3):434-439.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Wistuba II, Gazdar AF.\n <strong\n >Gallbladder cancer: lessons from a rare\n tumour.<\/strong\n >\n Nat Rev Cancer. 2004;4(9):695-706.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Gurusamy KS, Samraj K.\n <strong\n >Early vs delayed laparoscopic cholecystectomy for\n acute cholecystitis.<\/strong\n >\n Cochrane Database Syst Rev. 2006;(4):CD005440.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Keus F, et al.\n <strong\n >Laparoscopic versus open cholecystectomy for\n symptomatic gallstones.<\/strong\n >\n Cochrane Database Syst Rev. 2006;(4):CD006231.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis3\" id=\"hernias\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-03.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Cirug\u00eda de Hernias Abdominales<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Cirug\u00eda de hernias<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >S\u00edntomas y Diagn\u00f3stico<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Cuando se necesita, Complicaciones, Prevenci\u00f3n y\n Recuperaci\u00f3n<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">1. \u00bfQu\u00e9 es una hernia?<\/h3>\n\n <p class=\"txt-drop-inter\">\n Una hernia ocurre cuando un \u00f3rgano o tejido interno\n protruye a trav\u00e9s de un punto d\u00e9bil de la pared abdominal.\n Puede aparecer como un bulto, dolor, o sensaci\u00f3n de\n \u201cjal\u00f3n\u201d al hacer fuerza, toser o levantar peso.<br \/><br \/>Las\n hernias no se reparan solas. Con el tiempo aumentan de\n tama\u00f1o, causan s\u00edntomas y pueden complicarse con\n encarcelamiento o estrangulaci\u00f3n, lo que constituye una\n emergencia quir\u00fargica.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 2. Tipos de hernias m\u00e1s comunes\n <\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Hernia Inguinal:<\/strong> La m\u00e1s frecuente.\n Ocurre en la ingle por debilidad del canal inguinal. M\u00e1s\n com\u00fan en hombres.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Hernia Femoral:<\/strong> Debajo de la ingle. M\u00e1s\n com\u00fan en mujeres. Mayor riesgo de estrangulaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Hernia Umbilical:<\/strong> En el ombligo. Se\n asocia a embarazos, obesidad o aumento de presi\u00f3n\n abdominal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong>Hernia Epig\u00e1strica:<\/strong> Entre el ombligo y\n el estern\u00f3n. Frecuentes en personas j\u00f3venes o\n deportistas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n <strong>Hernia Ventral \/ Incisional:<\/strong> Aparece en\n una cicatriz de cirug\u00eda previa por debilidad de la pared\n abdominal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n <strong>Hernias raras:<\/strong>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Spiegel.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Lumbar.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Obturatriz.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong>Hernias interparietales.<\/strong>\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n <strong\n >Hernias ventrales e incisionales: t\u00e9cnicas\n avanzadas<\/strong\n >\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>IPOM \/ IPOM Plus (Laparosc\u00f3pica):<\/strong>\n Malla intraperitoneal reforzando desde dentro.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong\n >eTEP (Enhanced View Totally\n Extraperitoneal):<\/strong\n >\n T\u00e9cnica moderna con visi\u00f3n amplia para defectos\n medianos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong\n >TAR (Transversus Abdominis Release):<\/strong\n >\n Liberaci\u00f3n del m\u00fasculo transverso para cerrar\n defectos grandes (>8-10 cm). Es la t\u00e9cnica m\u00e1s\n avanzada en reconstrucci\u00f3n de pared.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong>Liberaci\u00f3n de componentes:<\/strong> Permite\n cerrar grandes hernias con separaci\u00f3n anat\u00f3mica\n correcta.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n <strong>Hernias complicadas:<\/strong>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Encarcelamiento:<\/strong> El contenido no\n regresa al abdomen.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Estrangulaci\u00f3n:<\/strong> P\u00e9rdida del flujo\n sangu\u00edneo (Urgencia quir\u00fargica.)\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Hernias gigantes:<\/strong> Requieren\n planificaci\u00f3n avanzada:\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Neumoperitoneo progresivo.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Reconstrucci\u00f3n por etapas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n TAR o t\u00e9cnicas h\u00edbridas.\n <\/li>\n <\/ul>\n <\/li>\n <\/ol>\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">S\u00edntomas presentes<\/h3>\n\n <p class=\"txt-drop-inter\">\n <strong>S\u00edntomas comunes<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Bulto que aparece o desaparece.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Dolor o ardor.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Sensaci\u00f3n de presi\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Dolor al levantarse, toser o hacer ejercicio.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Molestia persistente o crecimiento progresivo.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>S\u00edntomas de alarma (urgencia):<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Bulto duro o imposible de reducir.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Dolor severo.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n N\u00e1useas\/v\u00f3mitos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">Fiebre.<\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Cambio de color en la piel sobre la hernia.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>Diagn\u00f3stico<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Examen f\u00edsico (lo m\u00e1s \u00fatil).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Ultrasonido (\u00fatil en hernias peque\u00f1as o femorales).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n TAC (est\u00e1ndar para hernias ventrales o incisionales;\n mide el defecto y contenido).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n RMN en casos complejos o atletas.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n \u00bfCu\u00e1ndo se necesita cirug\u00eda?\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n <strong>A). \u00bfCu\u00e1ndo se necesita cirug\u00eda?<\/strong\n ><br \/><br \/>La reparaci\u00f3n quir\u00fargica est\u00e1 indicada\n cuando:\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n La hernia causa dolor.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Aumenta de tama\u00f1o.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Interfiere con actividad f\u00edsica o laboral.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Es femoral (siempre requiere cirug\u00eda).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Est\u00e1 encarcelada o estrangulada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Es ventral\/incisional >2 cm.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Est\u00e1 asociada a riesgo est\u00e9tico o funcional.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Las fajas NO curan las hernias, solo retrasan lo\n inevitable y pueden empeorar el defecto.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong\n >B). Cirug\u00eda laparosc\u00f3pica de hernias (TAPP \/\n TEP)<\/strong\n >\n <\/p>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >T\u00e9cnica moderna \u2014 Est\u00e1ndar actual para hernias\n inguinales y ventrales seleccionadas<br \/>\u00bfC\u00f3mo\n funciona?<\/strong\n >\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Se realizan 2-3 incisiones peque\u00f1as.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Se introduce una c\u00e1maraSe identifica el defecto\n desde dentro.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Se coloca una <strong>malla<\/strong> que refuerza la\n pared.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Se fijan bordes seg\u00fan t\u00e9cnica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Se revisa y se cierra.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>TEP: Totalmente extraperitoneal:<\/strong> No\n entra al abdomen.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>TAPP: Transabdominal preperitoneal:<\/strong>\n Entra al abdomen y luego al espacio preperitoneal.<br \/><strong\n >Ventajas:<\/strong\n >\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Recuperaci\u00f3n m\u00e1s r\u00e1pida.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Mucho menos dolor.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Ideal para <strong>hernias bilaterales<\/strong> o\n <strong>recidivas.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Mejor visi\u00f3n anat\u00f3mica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Regreso temprano al trabajo.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Mejor resultado est\u00e9tico.\n <\/li>\n <\/ol>\n <\/li>\n <\/ol>\n\n <p class=\"txt-drop-inter\">\n <strong>C). Cirug\u00eda abierta de hernias<\/strong\n ><br \/><br \/>Se utiliza cuando la laparoscop\u00eda no est\u00e1\n indicada o en hernias localizadas.<br \/><br \/><strong\n >T\u00e9cnicas comunes:<\/strong\n >\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Lichtenstein:<\/strong> Colocaci\u00f3n de malla sobre\n el defecto (inguinal). Est\u00e1ndar cuando laparoscop\u00eda no\n es posible.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Shouldice:<\/strong> Reparaci\u00f3n sin malla, \u00fatil\n en pacientes seleccionados.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Rives-Stoppa (sublay):<\/strong> Malla colocada\n entre planos musculares. Ideal en ventrales medianas o\n grandes.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong>Onlay:<\/strong> Malla sobre el m\u00fasculo. T\u00e9cnica\n r\u00e1pida pero con mayor riesgo de seroma.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong\n >D). Recuperaci\u00f3n despu\u00e9s de cirug\u00eda de hernia<\/strong\n >\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Laparosc\u00f3pica<\/strong>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Caminar el mismo d\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Trabajo de oficina: 2-5 d\u00edas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Ejercicio moderado: 3-4 semanas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Pesos pesados: 6 semanas.\n <\/li>\n <\/ol>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Abierta<\/strong>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Recuperaci\u00f3n m\u00e1s lenta (3-6 semanas).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Mayor dolor inicial.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Cuidado de suturas mayor.\n <\/li>\n <\/ol>\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>E). Complicaciones (poco frecuentes)<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">Seroma.<\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Infecci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Dolor cr\u00f3nico (menos frecuente en laparoscopia).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Recurrencia.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Lesiones vasculares o nerviosas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Lesi\u00f3n intestinal (ventrales grandes).\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>F). Prevenci\u00f3n de recurrencias<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Evitar levantar peso temprano.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Controlar tos, estre\u00f1imiento u obesidad.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Suspender tabaco.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Usar t\u00e9cnica moderna con malla.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Fortalecer la pared abdominal despu\u00e9s de la\n recuperaci\u00f3n.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Simons MP, Aufenacker T, Bay-Nielsen M, et al.\n <strong\n >European Hernia Society guidelines on inguinal hernia\n treatment.<\/strong\n >\n Hernia. 2009;13(4):343-403.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Bittner R, Schwarz J.\n <strong\n >Inguinal hernia repair: current surgical\n techniques.<\/strong\n >\n Langenbecks Arch Surg. 2012;397(2):271-282.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Muysoms FE, Miserez M, Berrevoet F, et al.\n <strong\n >Classification of primary and incisional abdominal\n wall hernias.<\/strong\n >\n Hernia. 2009;13:407-414.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Miserez M, et al.\n <strong\n >European Hernia Society guidelines on ventral hernia\n repair.<\/strong\n >\n Hernia. 2015;19(1):1-24.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Cobb WS, Warren JA, Ewing JA, et al.\n <strong\n >Open retromuscular (sublay) mesh repair for ventral\n hernia.<\/strong\n >\n Am Surg. 2015;81(8):778-782.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Belyansky I, et al.\n <strong\n >Enhanced-view totally extraperitoneal (eTEP)\n approach.<\/strong\n >\n Hernia. 2018;22:837-845.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Deerenberg EB, et al.\n <strong\n >The use of mesh in hernia repair: evidence\n overview.<\/strong\n >\n Hernia. 2015;19(1):1-7.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Rosen MJ.\n <strong\n >Transversus abdominis release (TAR) for ventral\n hernia repair.<\/strong\n >\n Plast Reconstr Surg. 2016;137(2):636-646.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter9\">\n Kingsnorth A, LeBlanc K.\n <strong>Management of abdominal hernias.<\/strong>\n Springer; 2003.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis4\" id=\"exploracion\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-05.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Exploraci\u00f3n de la Via Biliar<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfQu\u00e9 es y por qu\u00e9 se realiza?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >M\u00e9todos de exploraci\u00f3n<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Estudios, Riesgos, Recuperaci\u00f3n, ECRP, Cu\u00e1ndo consultar<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 1. \u00bfQu\u00e9 estudios se realizan antes de una exploraci\u00f3n de\n v\u00eda biliar?\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n La <strong>exploraci\u00f3n de la v\u00eda biliar<\/strong> es un\n procedimiento quir\u00fargico o m\u00ednimamente invasivo que\n permite\n <strong>visualizar, limpiar y desobstruir<\/strong> los\n conductos biliares cuando existe un c\u00e1lculo, estrechez o\n bloqueo dentro del <strong>col\u00e9doco<\/strong> u otra parte\n del \u00e1rbol biliar.<br \/><br \/>Su objetivo es\n <strong>restablecer el flujo normal de bilis<\/strong>\n desde el h\u00edgado hacia el intestino, evitando infecciones,\n ictericia y pancreatitis.<br \/><br \/>Puede realizarse\n <strong>durante una colecistectom\u00eda<\/strong> o como\n procedimiento independiente.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 2. \u00bfPor qu\u00e9 se realiza? \u2014 Indicaciones principales\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n La exploraci\u00f3n de v\u00eda biliar est\u00e1 indicada cuando se\n sospecha o confirma:\n <\/p>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >Coledocolitiasis (c\u00e1lculos en el col\u00e9doco):<\/strong\n >\n La indicaci\u00f3n m\u00e1s frecuente. Puede ocurrir incluso\n despu\u00e9s de retirar la ves\u00edcula.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Colangitis:<\/strong> Infecci\u00f3n grave de la v\u00eda\n biliar por obstrucci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Pancreatitis biliar:<\/strong> Los c\u00e1lculos\n migran y bloquean la ampolla de Vater.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong\n >Dilataci\u00f3n de la v\u00eda biliar en estudios de\n imagen:<\/strong\n >\n Sospecha de c\u00e1lculo, tap\u00f3n de barro biliar o estenosis.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n <strong>Ictericia obstructiva sin causa clara.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n <strong>Sospecha de tumor o estenosis benigna:<\/strong>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Estenosis inflamatoria.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Estenosis postquir\u00fargicas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n S\u00edndrome de Mirizzi.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n <strong\n >C\u00e1lculos residuales despu\u00e9s de ERCP o cirug\u00eda\n previa.<\/strong\n >\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <p class=\"txt-drop-inter\">\n Dependiendo del caso cl\u00ednico y la infraestructura\n disponible, existen tres principales enfoques:\n <\/p>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >ERCP – Colangiopancreatograf\u00eda Retr\u00f3grada\n Endosc\u00f3pica:<\/strong\n >\n Es un procedimiento combinado endosc\u00f3pico y radiol\u00f3gico\n que permite:\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Ver la v\u00eda biliar desde dentro.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Extraer c\u00e1lculos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Colocar stents.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Tratar estrecheces.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Drenar infecciones.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n El ERCP es <strong>terap\u00e9utico<\/strong>, no solo\n diagn\u00f3stico, y muchas veces evita la cirug\u00eda.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong\n >Exploraci\u00f3n laparosc\u00f3pica de la v\u00eda biliar\n (ELVB):<\/strong\n >\n Es la t\u00e9cnica m\u00e1s moderna, realizada\n <strong>durante la colecistectom\u00eda.<\/strong>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>\u00bfCu\u00e1ndo se hace laparosc\u00f3pica?<\/strong>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n C\u00e1lculos confirmados en el col\u00e9doco.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n C\u00e1lculos detectados en colangiograf\u00eda\n intraoperatoria.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Pacientes j\u00f3venes o sin contraindicaciones.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Hospitales con equipo y experiencia adecuados.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>\u00bfC\u00f3mo se realiza?<\/strong>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Se introduce una c\u00e1mara laparosc\u00f3pica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Se identifica el conducto c\u00edstico o el col\u00e9doco.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Se introduce un peque\u00f1o endoscopio o canastilla.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Se extraen los c\u00e1lculos mediante: Canastillas\n tipo Dormia. Lavados a presi\u00f3n. Balones de\n extracci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Se confirma la limpieza de la v\u00eda biliar.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Se deja drenaje selectivo si es necesario.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Ventajas<\/strong>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Todo se resuelve en una sola cirug\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Menor estancia hospitalaria.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Menor riesgo global que m\u00faltiples\n procedimientos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Excelente visualizaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Menor da\u00f1o tisular que cirug\u00eda abierta.\n <\/li>\n <\/ul>\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Exploraci\u00f3n abierta de la v\u00eda biliar:<\/strong>\n Se realiza mediante <strong>laparotom\u00eda<\/strong> en\n casos seleccionados.\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Anatom\u00eda muy distorsionada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Coledocolitiasis compleja o m\u00faltiples c\u00e1lculos\n grandes.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n V\u00eda Biliar muy inflamada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Lesiones iatrog\u00e9nicas biliares.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Fracaso del ERCP o laparoscop\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Sospecha de tumor o estenosis severa.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n S\u00edndrome de Mirizzi avanzado (tipos III y IV).\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong\n >\u00bfQu\u00e9 se hace durante la exploraci\u00f3n abierta?<\/strong\n >\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Incisi\u00f3n adecuada (subcostal o mediana).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Apertura del col\u00e9doco\n <strong>(coledocotom\u00eda)<\/strong>.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Extracci\u00f3n directa de los c\u00e1lculos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Lavado y revisi\u00f3n completa.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Colocaci\u00f3n de <strong>T-tube<\/strong> (sonda en T)\n en casos necesarios.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Reparaci\u00f3n biliar o derivaci\u00f3n bilioent\u00e9rica (ej.\n hep\u00e1tico-yeyunostom\u00eda) en casos complejos.\n <\/li>\n <\/ul>\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Ultrasonido hepatobiliar.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Pruebas de funci\u00f3n hep\u00e1tica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Amilasa\/lipasa.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n MRCP (Resonancia magn\u00e9tica biliar).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n TAC abdominal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Colangiograf\u00eda intraoperatoria.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Laboratorios generales.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Evaluaci\u00f3n anest\u00e9sica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter9\">\n MRCP es especialmente \u00fatil porque\n <strong>no es invasiva<\/strong> y muestra todo el \u00e1rbol\n biliar con gran detalle.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 2. Riesgos y complicaciones (poco comunes)\n <\/h3>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Infecci\u00f3n de heridas o del sistema biliar.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Pancreatitis postmanipulaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Fuga biliar.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Estenosis biliar a largo plazo.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Sangrado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Abscesos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Necesidad de procedimientos adicionales (ERCP o\n cirug\u00eda).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Con experiencia adecuada, la tasa de complicaciones es\n baja.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">3. Recuperaci\u00f3n<\/h3>\n\n <p class=\"txt-drop-inter\">\n Depende del m\u00e9todo utilizado:<br \/><br \/><strong\n >ERCP<\/strong\n >\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Alta el mismo d\u00eda o siguiente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Dieta suave.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Dolor leve y transitorio.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>Exploraci\u00f3n laparosc\u00f3pica<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Recuperaci\u00f3n similar a colecistectom\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Actividad normal en 3-5 d\u00edas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Menor dolor que procedimientos abiertos.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>Exploraci\u00f3n abierta<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Hospitalizaci\u00f3n 3-7 d\u00edas\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Recuperaci\u00f3n total: 4-6 semanas\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Mayor restricci\u00f3n f\u00edsica inicial\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 4. \u00bfCu\u00e1ndo consultar despu\u00e9s de una exploraci\u00f3n biliar?\n <\/h3>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">Fiebre.<\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Ictericia.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Dolor abdominal intenso.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n P\u00e9rdida de apetito marcada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Heces claras u orina muy oscura.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n V\u00f3mitos persistentes.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Inflamaci\u00f3n severa en heridas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Secreci\u00f3n biliar por drenajes.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Williams E, Beckingham I, El Sayed G, et al.\n <strong\n >Updated guideline on the management of common bile\n duct stones (CBDS).<\/strong\n >\n Gut. 2017;66(5):765-782.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n ASGE Standards of Practice Committee. Maple JT,\n Ben-Menachem T, et al.\n <strong\n >The role of endoscopy in the evaluation of suspected\n choledocholithiasis.<\/strong\n >\n Gastrointest Endosc. 2010;71(1):1-9.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Dasari BV, et al.\n <strong\n >Laparoscopic exploration of the common bile\n duct.<\/strong\n >\n Surg Clin North Am. 2014;94(2):297-321.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Gurusamy KS, Samraj K, et al.\n <strong\n >Surgical versus endoscopic treatment of bile duct\n stones.<\/strong\n >\n Cochrane Database Syst Rev. 2007;(2):CD003327.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Freeman ML.\n <strong\n >Complications of endoscopic biliary sphincterotomy: a\n review.<\/strong\n >\n Endoscopy. 1997;29(4):288-297.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n LaGreca G, et al.\n <strong>Management of Mirizzi syndrome.<\/strong> ANZ J\n Surg. 2014;84(1-2):5-10.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis5\" id=\"ercp\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"https:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/05\/nvo-proce-01.webp\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">\n ERCP (Endoscopic Retrograde Cholangiopancreatography) –\n Colangiopancreatograf\u00eda Retr\u00f3grada Endosc\u00f3pica\n <\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfQu\u00e9 es y para qu\u00e9 se sirve?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfCu\u00e1ndo est\u00e1 indicado un ERCP?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Como se realiza, Prepararse, Riesgos, Recuperaci\u00f3n<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Contraindicaciones, Cuando se combina con cirug\u00eda<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis5\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">1. \u00bfQu\u00e9 es un ERCP?<\/h3>\n\n <p class=\"txt-drop-inter\">\n El <strong>ERCP<\/strong> (Endoscopic Retrograde\n Cholangiopancreatography) es un procedimiento\n <strong>endosc\u00f3pico y radiol\u00f3gico<\/strong> que permite\n <strong>visualizar, desobstruir y tratar<\/strong>\n problemas en:\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n V\u00eda biliar (conductos que llevan la bilis del h\u00edgado al\n intestino).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Ves\u00edcula (si est\u00e1 presente).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Conducto pancre\u00e1tico\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n Se realiza introduciendo un endoscopio por la boca,\n pasando por el es\u00f3fago y est\u00f3mago, hasta la\n <strong>ampolla de Vater,<\/strong> donde se accede a la\n v\u00eda biliar.<br \/><br \/>El ERCP es\n <strong>terap\u00e9utico,<\/strong> no \u00fanicamente diagn\u00f3stico.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">2. \u00bfPara qu\u00e9 sirve el ERCP?<\/h3>\n\n <p class=\"txt-drop-inter\">\n El ERCP se usa para <strong>resolver<\/strong> enfermedades\n biliares y pancre\u00e1ticas, no solo para detectarlas. Entre\n sus funciones:\n <\/p>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Extraer c\u00e1lculos del col\u00e9doco<\/strong>: La\n indicaci\u00f3n m\u00e1s frecuente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong\n >Abrir el conducto biliar mediante\n esfinterotom\u00eda<\/strong\n >: Se corta el esf\u00ednter de Oddi para permitir salida de\n bilis o piedras.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Colocar stents (pr\u00f3tesis):<\/strong> En casos de:\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Estenosis benignas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Tumores.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Inflamaci\u00f3n severa.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Obstrucci\u00f3n por Mirizzi.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Lesiones biliares quir\u00fargicas.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong\n >Drenar infecciones de la v\u00eda biliar\n (colangitis)<\/strong\n >: Urgencia m\u00e9dica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n <strong>Dilatar estrecheces:<\/strong> Por inflamaci\u00f3n,\n cirug\u00eda previa o causas malignas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n <strong>Obtener biopsias o cepillados:<\/strong> Para\n diagn\u00f3stico de tumores biliares o pancre\u00e1ticos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n <strong>Tratar complicaciones postquir\u00fargicas:<\/strong>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Fugas biliares.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Estenosis de anastomosis.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n C\u00e1lculos residuales.\n <\/li>\n <\/ul>\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <p class=\"txt-drop-inter\">\n <strong>Indicaciones principales<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n C\u00e1lculos confirmados en el col\u00e9doco\n <strong>(coledocolitiasis).<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Colangitis (infecci\u00f3n grave de la v\u00eda biliar).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Pancreatitis biliar con obstrucci\u00f3n persistente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Dilataci\u00f3n de v\u00eda biliar con ictericia.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Estenosis benignas (post cirug\u00eda, inflamatorias).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Estenosis malignas (c\u00e1ncer de p\u00e1ncreas,\n colangiocarcinoma).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Sospecha de ampuloma o tumores periampulares.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Fugas biliares post colecistectom\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter9\">\n C\u00e1lculos residuales luego de cirug\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter10\">\n Complicaciones de cirug\u00edas hepatobiliares\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong\n >ERCP NO debe usarse como estudio diagn\u00f3stico\n inicial.<\/strong\n ><br \/><br \/>Para diagn\u00f3stico puro se prefiere\n <strong>MRCPC.<\/strong> o <strong>TAC.<\/strong>\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 1. \u00bfC\u00f3mo se realiza el ERCP? – Explicaci\u00f3n clara y\n profesional\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n El procedimiento se realiza en una sala endosc\u00f3pica con\n equipo de fluoroscopia.<br \/><br \/><strong\n >Paso a paso<\/strong\n >\n <\/p>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n El paciente recibe <strong>sedaci\u00f3n profunda<\/strong> o\n anestesia general.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Se introduce un endoscopio por la boca.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Se avanza hasta el duodeno.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Se identifica la ampolla de Vater.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Se canula la v\u00eda biliar con una gu\u00eda y contraste.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Se visualiza la anatom\u00eda mediante rayos X.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Seg\u00fan el problema, se realiza:\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Extracci\u00f3n de c\u00e1lculos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Esfinterotom\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Colocaci\u00f3n de stent.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Dilataci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Cepillado o biopsia.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Se retira el endoscopio y el paciente pasa a\n recuperaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter9\">\n Duraci\u00f3n: <strong>20-60 minutos<\/strong> seg\u00fan\n complejidad.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 2. \u00bfC\u00f3mo prepararse para un ERCP?\n <\/h3>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Ayuno m\u00ednimo 6-8 horas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Suspender anticoagulantes seg\u00fan indicaci\u00f3n m\u00e9dica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Revisar alergias a anestesia o contraste.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Realizar estudios previos (USG, TAC, MRCP,\n laboratorios).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Acompa\u00f1ante para el alta (sedaci\u00f3n profunda).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Control de glucosa y presi\u00f3n en diab\u00e9ticos\/hipertensos.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 3. Riesgos del ERCP (explicados con honestidad y\n precisi\u00f3n)\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n El ERCP es un procedimiento seguro cuando lo realiza un\n equipo experimentado, pero tiene riesgos particulares:\n <\/p>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Pancreatitis post-ERCP (3-7%):<\/strong> Es el\n riesgo m\u00e1s frecuente. Usualmente leve, pero puede ser\n grave en menos del 1%.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Infecci\u00f3n (colangitis):<\/strong> Si la v\u00eda est\u00e1\n completamente obstruida.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Sangrado:<\/strong> M\u00e1s com\u00fan despu\u00e9s de\n esfinterotom\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong>Perforaci\u00f3n:<\/strong> Rara (<0.6%).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n <strong\n >Reacciones al\u00e9rgicas o efectos de sedaci\u00f3n:<\/strong\n >\n Los beneficios superan ampliamente los riesgos cuando el\n procedimiento est\u00e1 correctamente indicado.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 4. Recuperaci\u00f3n despu\u00e9s del ERCP\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n <strong>Primeras horas<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Observaci\u00f3n en sala.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Dolor leve abdominal es normal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n N\u00e1useas transitorias por sedaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Si hay pancreatitis, dolor m\u00e1s intenso \u2014 vigilancia.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\"><strong>Altas t\u00edpicas<\/strong><\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Mismo d\u00eda o siguiente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Dieta suave.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Analg\u00e9sicos simples seg\u00fan necesidad.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Suspender esfuerzos f\u00edsicos 24-48 h.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>Consultar si aparece:<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Dolor abdominal progresivo.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">Fiebre.<\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Ictericia.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n V\u00f3mitos constantes.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Orina oscura o heces claras.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 1. Contraindicaciones del ERCP\n <\/h3>\n\n <p class=\"txt-drop-inter\"><strong>Absolutas<\/strong><\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Paciente inestable sin soporte cr\u00edtico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Falta de disponibilidad de equipo adecuado.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\"><strong>Relativas<\/strong><\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Coagulopat\u00eda no corregida.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Embarazo (se realiza solo si es imprescindible).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Cirug\u00edas g\u00e1stricas previas complejas (aunque existen\n t\u00e9cnicas adaptadas).\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 2. \u00bfCu\u00e1ndo se combina ERCP con cirug\u00eda?\n <\/h3>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >En colecistectom\u00eda por c\u00e1lculos en col\u00e9doco:<\/strong\n >\n Secuencia habitual:\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>En s\u00edndrome de Mirizzi o estenosis:<\/strong> Se\n coloca un stent previo a la cirug\u00eda para disminuir\n riesgo de lesi\u00f3n biliar.\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n ERCP para limpiar la v\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Colecistectom\u00eda laparosc\u00f3pica en los siguientes\n d\u00edas.\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>En fugas biliares post cirug\u00eda:<\/strong> El ERCP\n permite cerrar la fuga sin necesidad de reoperar.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter5\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n ASGE Standards of Practice Committee; Testoni PA,\n Mariani A, Aabakken L, et al.\n <strong>Guidelines for ERCP.<\/strong> Gastrointest\n Endosc. 2016;83(2):279-289.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Cotton PB, et al.\n <strong\n >Risk factors for complications after ERCP: a\n prospective multicenter study.<\/strong\n >\n Gastroenterology. 2009;136(7):1804-1812.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Freeman ML.\n <strong\n >Complications of endoscopic biliary\n sphincterotomy.<\/strong\n >\n Endoscopy. 1997;29:288-297.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Williams EJ, Green J, Beckingham I, et al.\n <strong\n >Guidelines on the management of common bile duct\n stones.<\/strong\n >\n Gut. 2008;57(7):1004-1021.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Lehman GA.\n <strong\n >Therapeutic ERCP: current status and future\n directions.<\/strong\n >\n Gastrointest Endosc Clin N Am. 2003;13(4):735-752.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Maple JT, et al.\n <strong\n >Role of endoscopy in choledocholithiasis.<\/strong\n >\n Gastrointest Endosc. 2011;74(4):731-744.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis6\" id=\"colangiografia\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"https:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/05\/nvo-proce-02.webp\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Colangiograf\u00eda Intraoperatoria (CIO)<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfQu\u00e9 es y para qu\u00e9 sirve?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfC\u00f3mo se realiza la colangiograf\u00eda intraoperatoria?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Ventajas de la CIO<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Riesgos (m\u00ednimos)<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis5\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS \u2014 Vancouver<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 1. \u00bfQu\u00e9 es la colangiograf\u00eda intraoperatoria?\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n La\n <strong>colangiograf\u00eda intraoperatoria (CIO)<\/strong> es\n un estudio radiol\u00f3gico que se realiza\n <strong>durante una cirug\u00eda<\/strong>, generalmente durante\n una <strong>colecistectom\u00eda laparosc\u00f3pica<\/strong>, para\n visualizar en tiempo real el\n <strong>\u00e1rbol biliar<\/strong> y detectar:\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n C\u00e1lculos ocultos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Estrechamientos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Variantes anat\u00f3micas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Lesiones biliares.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Obstrucciones.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n Es una herramienta de seguridad que ayuda a prevenir\n lesiones de la v\u00eda biliar.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 2. \u00bfPara qu\u00e9 sirve? \u2014 Indicaciones\n <\/h3>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Sospecha de c\u00e1lculos en el col\u00e9doco.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Pruebas hep\u00e1ticas alteradas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Ves\u00edcula muy inflamada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Anatom\u00eda dif\u00edcil o distorsionada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Cirug\u00eda complicada (Mirizzi temprano, flegm\u00f3n).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Confirmar integridad de la v\u00eda biliar despu\u00e9s de una\n reparaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Pacientes con dilataci\u00f3n de col\u00e9doco en ultrasonido o\n TAC.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n Pacientes j\u00f3venes donde se quiere evitar\n reintervenciones.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Durante la colecistectom\u00eda, se canula el conducto\n c\u00edstico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Se introduce medio de contraste.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Se toma una serie de radiograf\u00edas en tiempo real.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Se visualiza el col\u00e9doco, hep\u00e1ticos y ampolla.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n El cirujano eval\u00faa si existen:\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n C\u00e1lculos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Obstrucciones.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n V\u00eda biliar estrecha.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Lesiones.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Anatom\u00eda variante (conducto c\u00edstico an\u00f3malo, doble\n c\u00edstico, etc.).\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Si se detectan c\u00e1lculos, el cirujano decide:\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong\n >Exploraci\u00f3n laparosc\u00f3pica de v\u00eda biliar<\/strong\n >, o.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Enviar al paciente a ERCP<\/strong> en las\n siguientes 24-72h.\n <\/li>\n <\/ul>\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Incrementa la seguridad de la colecistectom\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Reduce lesiones de v\u00eda biliar.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Permite decisiones inmediatas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Visualiza variantes anat\u00f3micas raras.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Evita cirug\u00edas adicionales.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Diagn\u00f3stico preciso en minutos.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>\u00bfEs obligatorio hacerla siempre?<\/strong> No. Pero\n muchos cirujanos la utilizamos:\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n De forma selectiva en casos dif\u00edciles, o\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n De forma rutinaria para m\u00e1xima seguridad\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Ambos enfoques son v\u00e1lidos y respaldados por evidencia.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Exposici\u00f3n m\u00ednima a radiaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Espasmo del conducto.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Riesgo leve de fuga biliar.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Casi siempre sin complicaciones.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter5\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Buddingh KT, et al. Routine intraoperative\n cholangiography during laparoscopic cholecystectomy.\n Surg Endosc. 2011;25(7):2203-2210.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Halbert C, et al. Cholangiography and prevention of bile\n duct injury. Surg Clin North Am. 2014;94(2):413-435.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Ford JA, et al. Systematic review of intraoperative\n cholangiography. Br J Surg. 2012;99(2):160-167.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Tornqvist B, et al. Fatal bile duct injury after\n cholecystectomy: preventive role of intraoperative\n cholangiography. Ann Surg. 2015;261:162-167.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Pesce A, et al. Management of Mirizzi syndrome. ANZ J\n Surg. 2020;90(3):434-439.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis7\" id=\"emergencia\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-08.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Cirug\u00eda de Emergencia<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfQu\u00e9 es?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Indicaciones principales de cirug\u00eda de emergencia<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfC\u00f3mo es el proceso?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Enfoque moderno, Riesgos<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis5\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n \u00bfQu\u00e9 es la cirug\u00eda de emergencia?\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n La <strong>cirug\u00eda de emergencia<\/strong> se realiza\n cuando un paciente presenta una condici\u00f3n\n <strong>aguda, cr\u00edtica y potencialmente mortal,<\/strong>\n que requiere intervenci\u00f3n inmediata para salvar la vida,\n controlar una hemorragia, detener una infecci\u00f3n severa o\n reparar un \u00f3rgano vital.<br \/>Tu papel como cirujano\n general es clave, porque abarca la mayor\u00eda de emergencias\n abdominales.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">1. Abdomen agudo<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Apendicitis perforada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Peritonitis.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Obstrucci\u00f3n intestinal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Estrangulaci\u00f3n herniaria.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Isquemia intestinal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Perforaci\u00f3n de v\u00edscera hueca (\u00falcera g\u00e1strica o\n duodenal).\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">2. Infecciones graves<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Abscesos abdominales extensos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Colangitis severa.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Pancreatitis complicada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Fascitis necrotizante (pocas horas de evoluci\u00f3n).\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">3. Hemorragias<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Hemoperitoneo traum\u00e1tico o no traum\u00e1tico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Sangrado digestivo que no responde a endoscopia.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Ruptura de bazo o h\u00edgado.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">4. Traumas<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Trauma abdominal penetrante.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Trauma cerrado con sangrado activo.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n \u00d3rganos lesionados.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 5. Complicaciones quir\u00fargicas previas\n <\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Fugas anastom\u00f3ticas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Abdomen abierto.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Estenosis aguda traum\u00e1tica o postquir\u00fargica.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">6. Emergencias biliares<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Colangitis fulminante.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n S\u00edndrome de Mirizzi complicado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Ves\u00edcula gangrenosa.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Evaluaci\u00f3n r\u00e1pida (ABCDE).<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Estabilidad hemodin\u00e1mica.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Laboratorios y estudios urgentes.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong\n >Imagen r\u00e1pida (US\/TAC si el tiempo lo\n permite).<\/strong\n >\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n <strong>Decisi\u00f3n de intervenci\u00f3n inmediata.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n <strong\n >Cirug\u00eda laparosc\u00f3pica o abierta seg\u00fan el\n caso.<\/strong\n >\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n <strong>Control de fuente (source control):<\/strong>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Detener sangrado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Controlar infecci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Retirar \u00f3rganos perforados.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Lavado peritoneal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Drenajes.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Ostom\u00edas si son necesarias\n <\/li>\n <\/ul>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter8\">\n <strong>Cuidados intensivos postoperatorios.<\/strong>\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n Enfoque moderno: Damage Control Surgery\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n En pacientes inestables o s\u00e9pticos severos se aplica\n cirug\u00eda abreviada:\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Control del sangrado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Control de contaminaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Reanimaci\u00f3n intensiva.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Cierre diferido del abdomen.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n Esto aumenta la supervivencia en casos cr\u00edticos.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">Riesgos<\/h3>\n\n <p class=\"txt-drop-inter\">\n Dependen de la patolog\u00eda, pero pueden incluir:\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Infecciones.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Abscesos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Falla org\u00e1nica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Sangrado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Lesiones asociadas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Necesidad de reoperaci\u00f3n.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter5\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Sartelli M, et al.\n <strong\n >WSES Guidelines for management of intra-abdominal\n infections.<\/strong\n >\n World J Emerg Surg. 2013;8:3.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Di Saverio S, et al.\n <strong\n >WSES Jerusalem guidelines for acute\n appendicitis.<\/strong\n >\n World J Emerg Surg. 2020;15:27.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Moore EE, et al.\n <strong>Damage control surgery.<\/strong> World J Surg.\n 1998;22:1184-1190.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Montravers P, et al.\n <strong>Management of severe abdominal sepsis.<\/strong>\n Crit Care. 2016;20:85.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis8\" id=\"abdomen-agudo\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-09.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">\n Abdomen Agudo no Traum\u00e1tico \u2014 Conceptos Generales\n <\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfQu\u00e9 es?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Causas principales<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Diagn\u00f3stico, Manejo Inicial<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\u00bfQu\u00e9 es el abdomen agudo?<\/h3>\n\n <p class=\"txt-drop-inter\">\n Es un <strong>s\u00edndrome cl\u00ednico<\/strong> caracterizado por\n <strong>dolor abdominal de inicio s\u00fabito<\/strong>,\n progresivo y de intensidad variable, asociado a riesgo de\n requerir <strong>cirug\u00eda urgente.<\/strong><br \/>Es la\n puerta de entrada a m\u00faltiples patolog\u00edas potencialmente\n letales.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Viscerales:<\/strong> apendicitis, colecistitis,\n pancreatitis, obstrucci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Vasculares<\/strong>: isquemia mesent\u00e9rica,\n aneurisma roto.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Infecciosas:<\/strong> peritonitis,\n diverticulitis.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong>Urol\u00f3gicas:<\/strong> c\u00f3lico renal, torsi\u00f3n\n testicular.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">Diagn\u00f3stico<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Historia y examen f\u00edsico dirigidos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n SIGNOS DE ALARMA: fiebre, defensa, taquicardia,\n hipotensi\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Laboratorios: BH, PCR, creatinina, amilasa\/lipasa.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Imagen:\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inte item-drop-inte1\">\n <strong>TAC con contraste:<\/strong> estudio de\n elecci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inte item-drop-inte2\">\n US para ves\u00edcula y ginecolog\u00eda.\n <\/li>\n\n <li class=\"item-drop-inte item-drop-inte3\">\n Radiograf\u00eda en obstrucci\u00f3n.\n <\/li>\n <\/ul>\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">Manejo inicial<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Reanimaci\u00f3n con l\u00edquidos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Analgesia.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Antibi\u00f3ticos temprano en sospecha de infecci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Cirug\u00eda inmediata si hay:\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inte item-drop-inte1\">\n Peritonitis.\n <\/li>\n\n <li class=\"item-drop-inte item-drop-inte2\">\n Isquemia.\n <\/li>\n\n <li class=\"item-drop-inte item-drop-inte3\">\n Obstrucci\u00f3n estrangulada.\n <\/li>\n <\/ul>\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Cartwright SL, Knudson MP. Evaluation of acute abdominal\n pain in adults. Am Fam Physician. 2008.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Kamin RA et al. Diagnosis of acute abdominal pain in\n adults. Am J Roentgenol. 2010.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Makary MA. Abdominal emergencies. Surg Clin North Am.\n 2008.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis9\" id=\"obstruccion-intestinal\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-10.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Obstrucci\u00f3n Intestinal<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfQu\u00e9 es?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Causas, Signos de Estrangulaci\u00f3n, Diagn\u00f3sitco<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Manejo<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n \u00bfQu\u00e9 es la obstrucci\u00f3n intestinal?\n <\/h3>\n\n <p class=\"txt-drop-inter\">\n Interrupci\u00f3n parcial o completa del paso del contenido\n intestinal.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">1. Causas<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Bridas \/ adherencias<\/strong> (60%).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Hernias encarceladas.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">Tumores<\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n V\u00f3lvulo de sigmoides o ciego.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Ileo biliar.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 2. Signos de estrangulaci\u00f3n (quir\u00fargicos)\n <\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">Fiebre.<\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Dolor intenso persistente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Taquicardia.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Leucocitosis marcada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Acidosis.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Dolor desproporcionado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter7\">\n Gas en pared (neumatosis).\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">3. Diagn\u00f3stico<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n TAC con contraste \u2014 sensibilidad >95%.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Radiograf\u00eda (menos precisa).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Examen f\u00edsico clave para hernias.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n Conservador (si no hay estrangulaci\u00f3n)\n <\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Sonda nasog\u00e1strica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n L\u00edquidos IV.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Electrolitos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Observaci\u00f3n 24-48h.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">Quir\u00fargico<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Estrangulaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Hernia incarcerada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Falta de mejor\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Peritonitis.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n V\u00f3lvulo \u2014 desvolvulaci\u00f3n \/ colectom\u00eda seg\u00fan caso.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Catena F. Bowel obstruction: a review. World J Emerg\n Surg. 2019.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Biondo S, et al. Small bowel obstruction clinical\n practice. Am J Surg. 2016.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis10\" id=\"perforacion\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-11.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Perforaci\u00f3n de V\u00edscera Hueca<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfQu\u00e9 es?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Causas, Diagn\u00f3sitco<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Tratamiento<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">Definici\u00f3n<\/h3>\n\n <p class=\"txt-drop-inter\">\n Ruptura del est\u00f3mago, intestino delgado o colon,\n provocando <strong>peritonitis.<\/strong>\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">1. Causas<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n \u00dalcera p\u00e9ptica perforada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n \u00dalcera p\u00e9ptica perforada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Diverticulitis perforada.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n C\u00e1ncer perforado.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Cuerpo extra\u00f1o.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Isquemia intestinal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Trauma cerrado (poco com\u00fan).\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">2. Diagn\u00f3stico<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n TAC contrastado: sensibilidad >98%.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Radiograf\u00eda: aire subdiafragm\u00e1tico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Laboratorios: leucocitosis, acidosis.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Cirug\u00eda inmediata.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Lavado de cavidad.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Cierre primario o resecci\u00f3n (seg\u00fan patolog\u00eda).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Hartmann en diverticulitis grave.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Antibi\u00f3ticos amplio espectro.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">\n Drenajes selectivos.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n S\u00f8reide K. Perforated peptic ulcer. Lancet. 2015.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Andeweg CS. Perforated diverticulitis management. World\n J Surg. 2013.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis11\" id=\"pancreatitis\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-12.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Pancreatitis Aguda Grave<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfQu\u00e9 es?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Causas, Indicaciones quirurg\u00edcas \/ Intervencionistas<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Opciones de Intervenci\u00f3n<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis4\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">Definici\u00f3n<\/h3>\n\n <p class=\"txt-drop-inter\">\n Inflamaci\u00f3n del p\u00e1ncreas que puede evolucionar a necrosis,\n falla org\u00e1nica y muerte.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">1. Causas<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n C\u00e1lculos biliares.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">Alcohol.<\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Hipertrigliceridemia.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n F\u00e1rmacos.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 2. Indicaciones quir\u00fargicas \/ intervencionistas\n <\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Necrosis infectada.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>S\u00edndrome compartimental abdominal.<\/strong>\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Pseudoquistes sintom\u00e1ticos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Colecciones purulentas.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Necrosectom\u00eda laparosc\u00f3pica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Necrosectom\u00eda abierta.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Drenajes percut\u00e1neos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Lavados seriados.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Colecistectom\u00eda temprana cuando es biliar.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter4\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Banks PA. Classification of acute pancreatitis. Gut.\n 2013.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n van Santvoort H. Step-up approach. N Engl J Med. 2010.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis12\" id=\"diverticulitis\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-13.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Diverticulitis Aguda Complicada<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Clasificaci\u00f3n de Hinchey<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Diagn\u00f3stico, Manejo<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n I: Absceso peric\u00f3lico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n II: Absceso p\u00e9lvico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n III: Peritonitis purulenta.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n IV: Peritonitis fecaloidea.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">1. Diagn\u00f3stico<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n TAC con contraste: gold standard\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">2. Manejo<\/h3>\n\n <p class=\"txt-drop-inter\">\n <strong>Hinchey I-II:<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Antibi\u00f3ticos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Drenaje percut\u00e1neo si >3-4 cm.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>Hinchey III-IV:<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Cirug\u00eda urgente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Hartmann vs anastomosis primaria dependiendo de\n estabilidad y contaminaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Lavado laparosc\u00f3pico selectivo.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Feingold D. ASCRS guidelines for diverticulitis. Dis\n Colon Rectum. 2014.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Sartelli M. WSES guidelines for diverticulitis. World J\n Emerg Surg. 2020.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis13\" id=\"trauma-abdominal\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-14.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">\n Trauma Abdominal (Cerrado y Penetrante)\n <\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Evaluaci\u00f3n Inicial<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Diagn\u00f3stico, Manejo<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">ATLS.<\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n V\u00eda a\u00e9rea, respiraci\u00f3n, circulaci\u00f3n.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">1. Diagn\u00f3stico<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>FAST:<\/strong> R\u00e1pido y \u00fatil para l\u00edquido libre.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>TAC contrastado:<\/strong> Gold standard en\n pacientes estables.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">2. Manejo<\/h3>\n\n <p class=\"txt-drop-inter\">\n <strong>Trauma hep\u00e1tico<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Manejo no operatorio si estable.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Embolizaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Packing en cirug\u00eda.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>Trauma espl\u00e9nico<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n NOM en estables.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Esplenectom\u00eda en inestables.\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>Trauma intestinal<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Reparaci\u00f3n primaria\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Resecci\u00f3n anastomosis\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Ostom\u00eda si hay inestabilidad\n <\/li>\n <\/ul>\n\n <p class=\"txt-drop-inter\">\n <strong>Indicaciones de laparotom\u00eda<\/strong>\n <\/p>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Inestabilidad hemodin\u00e1mica.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Peritonitis.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Evisceraci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Sangrado activo en TAC.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Moore EE, et al. J Trauma Acute Care Surg.\n 2015;78(6):1187-1196.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Feliciano DV. Surg Clin North Am. 1991;71(2):241-256.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Rozycki GS, et al. J Trauma. 1998;45:87-94.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis14\" id=\"abdomen-abierto\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-15.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">\n Abdomen Abierto y Cirug\u00eda de Control de Da\u00f1os\n <\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >\u00bfQu\u00e9 es?<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Fases<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <p class=\"txt-drop-inter\">\n T\u00e9cnica usada en pacientes cr\u00edticos con sepsis, sangrado o\n inestabilidad severa.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">\n 1. Primera cirug\u00eda – Control de da\u00f1os\n <\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Control de hemorragia.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Control de contaminaci\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Empaquetamiento.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">2. Reanimaci\u00f3n en UCI<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Soporte hemodin\u00e1mico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Correcci\u00f3n de acidosis, hipotermia y coagulopat\u00eda.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">3. Reoperaci\u00f3n (24-48h)<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Retiro de paquetes.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Reparaci\u00f3n definitiva.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Ostom\u00edas si es necesario.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">4. Cierre de pared<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Cierre primario tard\u00edo.\n <\/li>\n <li class=\"item-drop-inter item-drop-inter2\">\n T\u00e9cnica de vac o mallas temporales.\n <\/li>\n <li class=\"item-drop-inter item-drop-inter3\">\n Prevenci\u00f3n de hernias gigantes.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Rotondo MF, et al. J Trauma. 1993;35(3):375-382.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Kirkpatrick AW, et al. World J Surg.\n 2009;33(6):1154-1167.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Roberts DJ, et al. Ann Surg. 2017;265(3):523-532.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"item-procedis item-procedis15\" id=\"catastrofe-abdominal\">\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-16.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Cat\u00e1stofre Abdominal<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Concepto<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Diagn\u00f3stico, Tratamiento<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <p class=\"txt-drop-inter\">\n Es un s\u00edndrome de fracaso multiorg\u00e1nico causado por una\n infecci\u00f3n o isquemia abdominal severa que conduce a:\n <\/p>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Shock s\u00e9ptico.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Hipoperfusi\u00f3n.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Acidosis.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">Anuria.<\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n S\u00edndrome compartimental abdominal.\n <\/li>\n <\/ol>\n\n <p class=\"txt-drop-inter\">\n Es la etapa final de muchas patolog\u00edas si no se tratan a\n tiempo.\n <\/p>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">1. Diagn\u00f3stico<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n TAC urgente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Elevaci\u00f3n de lactato.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n SIRS y falla org\u00e1nica.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">2. Tratamiento<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Cirug\u00eda inmediata.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Abdomen abierto.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Drenajes m\u00faltiples.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Control de foco infeccioso.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Reanimaci\u00f3n agresiva.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter6\">UCI.<\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Malbrain ML, et al. Intensive Care Med.\n 2006;32:1722-1732.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Kirkpatrick AW. Crit Care Med. 2010;38:151-152.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Sartelli M, et al. World J Emerg Surg. 2013;8:3.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n <div\n class=\"item-procedis item-procedis16\"\n id=\"abdomen-agudo-pediatria\"\n >\n <a\n href=\"#\"\n class=\"btn-procedi dropdown-toggle\"\n data-bs-toggle=\"dropdown\"\n data-bs-display=\"static\"\n >\n <div class=\"int-procedi int-procedi1\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/03\/procedi-17.svg\"\n alt=\"#\"\n class=\"img-procedis\"\n \/>\n <\/div>\n\n <div class=\"int-procedi int-procedi2\">\n <p class=\"txt-procedis\">Abdomen Agudo en Pediatr\u00eda<\/p>\n <\/div>\n <\/a>\n\n <div class=\"dropdown-menu m-0\">\n <div class=\"row row-int-procedis\">\n <div class=\"col-int-procedis col-int-procedis1\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Concepto<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis2\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >Diagn\u00f3stico, Tratamiento<\/a\n >\n <\/div>\n\n <div class=\"col-int-procedis col-int-procedis3\">\n <a\n href=\"#\"\n class=\"dropdown-toggle-inter sub-dropdown-toggle btn-inter-procedi\"\n >REFERENCIAS BIBLIOGR\u00c1FICAS<\/a\n >\n <\/div>\n <\/div>\n\n <div class=\"contain-drops\">\n <div class=\"dropdown-menu drop-inter drop-inter1\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n <strong>Apendicitis:<\/strong>\n La m\u00e1s frecuente.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n <strong>Invaginaci\u00f3n intestinal:<\/strong>\n Cl\u00e1sico en <3 a\u00f1os.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n <strong>Obstrucci\u00f3n intestinal:<\/strong>\n Bridas, hernias inguinales encarceladas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n <strong>Perforaci\u00f3n por cuerpo extra\u00f1o:<\/strong>\n Frecuente en ni\u00f1os exploradores.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n <strong>Patolog\u00eda infecciosa:<\/strong>\n Gastroenteritis severa (diagn\u00f3stico diferencial\n importante).\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter2\">\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">1. Diagn\u00f3stico<\/h3>\n\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n US abdominal.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n TAC en casos complejos.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Examen f\u00edsico dirigido.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Signos vitales y estado general.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n\n <div class=\"cont-drop-inter\">\n <h3 class=\"titu-drop-inter\">2. Manejo<\/h3>\n\n <ul class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n L\u00edquidos IV.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Enema neum\u00e1tico para invaginaci\u00f3n (si no hay\n peritonitis).\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Apendicectom\u00eda.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter4\">\n Reducci\u00f3n urgente de hernias incarceradas.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter5\">\n Cirug\u00eda en obstrucci\u00f3n o perforaci\u00f3n.\n <\/li>\n <\/ul>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"dropdown-menu drop-inter drop-inter3\">\n <div class=\"cont-drop-inter\">\n <ol class=\"list-drop-inter\">\n <li class=\"item-drop-inter item-drop-inter1\">\n Fallon SC, et al. Pediatr Clin North Am.\n 2013;60(6):1169-1186.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter2\">\n Blakelock R, et al. J Pediatr Surg. 1999;34:1493-1497.\n <\/li>\n\n <li class=\"item-drop-inter item-drop-inter3\">\n Strouse PJ. Radiology. 2012;263(1):19-32.\n <\/li>\n <\/ol>\n\n <div class=\"borde-inter\"><\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/section>\n\n \n <section id=\"contacto\">\n <div class=\"container\">\n <div class=\"row row-contain-agendar justify-content-evenly\">\n <div class=\"col-lg-6 col-agendar col-agendar1\">\n <div\n class=\"cont-horario-agendar d-flex justify-content-evenly align-items-center\"\n >\n <div class=\"col-horario-agenda col-horario-agenda1\">\n <p class=\"font-creato txt-dias-agenda\">\n Lunes \u2014 Viernes<br \/>Emergencia\n <\/p>\n <\/div>\n\n <div class=\"col-horario-agenda col-horario-agenda2\">\n <p class=\"font-creato txt-horas-agenda\">10AM – 5PM<br \/>24\/7<\/p>\n <\/div>\n <\/div>\n\n <div class=\"cont-horario-img\"><\/div>\n <\/div>\n\n <div class=\"col-lg-6 col-agendar col-agendar2\">\n <h4 class=\"titu-agendar\">AGENDAR UNA CITA<\/h4>\n\n <h3 class=\"titus-agendar\">\n PanaMed – Panajachel<br \/>El Pimental – Antigua Guatemala\n <\/h3>\n\n <div class=\"cont-formulario\"><script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 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9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg width='640' height='640' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style>\n <div class='gform_heading'>\n <h2 class=\"gform_title\">citas dr julio<\/h2>\n <p class='gform_description'><\/p>\n <\/div><form method='post' enctype='multipart\/form-data' id='gform_1' action='\/en\/wp-json\/wp\/v2\/pages\/12432' data-formid='1' novalidate>\n <div class='gform-body gform_body'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_1_1\" class=\"gfield gfield--type-name gfield--input-type-name field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nombre completo<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_1'>\n \n <span id='input_1_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n <input type='text' name='input_1.3' id='input_1_1_3' value='' aria-required='false' placeholder='Nombre' \/>\n <label for='input_1_1_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label>\n <\/span>\n \n <span id='input_1_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n <input type='text' name='input_1.6' id='input_1_1_6' value='' aria-required='false' placeholder='Apellido' \/>\n <label for='input_1_1_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last<\/label>\n <\/span>\n \n <\/div><\/fieldset><div id=\"field_1_3\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" ><label class='gfield_label gform-field-label' for='input_1_3'>Correo electr\u00f3nico<\/label><div class='ginput_container ginput_container_email'>\n <input name='input_3' id='input_1_3' type='email' value='' class='large' placeholder='Correo' aria-invalid=\"false\" \/>\n <\/div><\/div><div id=\"field_1_9\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" ><label class='gfield_label gform-field-label' for='input_1_9'>Tel\u00e9fono<\/label><div class='ginput_container ginput_container_phone'><input name='input_9' id='input_1_9' type='tel' value='' class='large' placeholder='Su n\u00famero' aria-invalid=\"false\" \/><\/div><\/div><div id=\"field_1_4\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" ><label class='gfield_label gform-field-label' for='input_1_4'>Procedimiento<\/label><div class='ginput_container ginput_container_select'><select name='input_4' id='input_1_4' class='large gfield_select' aria-invalid=\"false\" ><option value='Consulta' >Consulta<\/option><option value='Agendar cirug\u00eda' >Agendar cirug\u00eda<\/option><\/select><\/div><\/div><div id=\"field_1_6\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" ><label class='gfield_label gform-field-label' for='input_1_6'>Fecha<\/label><div class='ginput_container ginput_container_date'>\n <input name='input_6' id='input_1_6' type='text' value='' class='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon' placeholder='dd\/mm\/yyyy' aria-describedby=\"input_1_6_date_format\" aria-invalid=\"false\" \/>\n <span id='input_1_6_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n <\/div>\n <input type='hidden' id='gforms_calendar_icon_input_1_6' class='gform_hidden' value='https:\/\/drjulioestrada.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_1_8\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Hora<\/legend><div class=\"ginput_container ginput_complex gform-grid-row\">\n <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_1_8'>\n <input type='number' maxlength='2' name='input_8[]' id='input_1_8_1' value='' min='0' max='12' step='1' placeholder='HH' aria-required='false' \/> \n <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_1_8_1'>Hours<\/label>\n <\/div>\n <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n <input type='number' maxlength='2' name='input_8[]' id='input_1_8_2' value='' min='0' max='59' step='1' placeholder='MM' aria-required='false' \/>\n <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_1_8_2'>Minutes<\/label>\n <\/div>\n <div class='gfield_time_ampm ginput_container ginput_container_time below gform-grid-col' >\n \n <select name='input_8[]' id='input_1_8_3' >\n <option value='am' >AM<\/option>\n <option value='pm' >PM<\/option>\n <\/select> \n <label class='gform-field-label gform-field-label--type-sub am_pm_label screen-reader-text' for='input_1_8_3'>AM\/PM<\/label> \n <\/div>\n <\/div><\/fieldset><div id=\"field_1_7\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" ><label class='gfield_label gform-field-label' for='input_1_7'>Cl\u00ednica<\/label><div class='ginput_container ginput_container_select'><select name='input_7' id='input_1_7' class='large gfield_select' aria-invalid=\"false\" ><option value='clinicas_panamed' >PanaMed Cl\u00ednicas y Hospital de Especialidades<\/option><option value='clinicas_pimental' >Cl\u00ednicas de Especialidades M\u00e9dicas El Pimental<\/option><\/select><\/div><\/div><div id=\"field_1_5\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" ><label class='gfield_label gform-field-label' for='input_1_5'>Motivo de la consulta<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_5' id='input_1_5' class='textarea medium' placeholder='Explique el motivo de la consulta' aria-invalid=\"false\" rows='10' cols='50'><\/textarea><\/div><\/div><\/div><\/div>\n <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_1' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Agendar' \/> \n <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_1' value='postback' \/>\n <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_1' id='gform_theme_1' value='orbital' \/>\n <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_1' id='gform_style_settings_1' value='[]' \/>\n <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n <input type='hidden' class='gform_hidden' name='gform_submit' value='1' \/>\n \n <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n <input type='hidden' class='gform_hidden' name='state_1' 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data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseOne\"\n aria-expanded=\"false\"\n aria-controls=\"collapseOne\"\n >\n Tengo dolor, pero no s\u00e9 si realmente necesito un cirujano.<br \/>\u00bfPuedo\n consultarte igual?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseOne\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingOne\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n S\u00ed, claro. No todo dolor termina en cirug\u00eda. La consulta sirve\n precisamente para evaluar qu\u00e9 est\u00e1 pasando y decidir si se\n trata de algo quir\u00fargico o no, y cu\u00e1l es el mejor manejo en tu\n caso.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingTwo\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseTwo\"\n aria-expanded=\"false\"\n aria-controls=\"collapseTwo\"\n >\n Me dijeron que \u201ctengo piedras en la ves\u00edcula\u201d, pero no<br \/>siempre\n me duele. \u00bfIgual deber\u00eda operarme?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseTwo\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingTwo\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Es v\u00e1lido. Mi trabajo es explicarte las opciones, los riesgos\n y beneficios de cada una. La decisi\u00f3n final siempre la tomas\n t\u00fa, con informaci\u00f3n clara y honesta.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingThree\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseThree\"\n aria-expanded=\"false\"\n aria-controls=\"collapseThree\"\n >\n \u00bfY si prefiero no operarme por ahora?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseThree\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingThree\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n No siempre es obligatorio operar de inmediato. Todo depende de\n tus s\u00edntomas, la frecuencia del dolor y el riesgo de\n complicaciones. En consulta evaluamos si es momento de operar\n o si a\u00fan es seguro observar.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingFour\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseFour\"\n aria-expanded=\"false\"\n aria-controls=\"collapseFour\"\n >\n \u00bfC\u00f3mo s\u00e9 si mi caso es urgente o puede esperar?\n <\/button>\n <\/h5>\n <\/div>\n\n <div\n id=\"collapseFour\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingFour\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Hay s\u00edntomas que indican urgencia, como dolor intenso y\n persistente, fiebre, v\u00f3mitos continuos o empeoramiento r\u00e1pido.\n Si tienes duda, lo mejor es evaluarte a tiempo para no correr\n riesgos innecesarios.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingFive\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseFive\"\n aria-expanded=\"false\"\n aria-controls=\"collapseFive\"\n >\n Me da miedo la anestesia, \u00bfes normal?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseFive\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingFive\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Es completamente normal. Antes de cualquier cirug\u00eda se hace\n una evaluaci\u00f3n anest\u00e9sica para reducir riesgos al m\u00e1ximo y\n resolver todas tus dudas. No est\u00e1s solo en ese proceso.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingSix\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseSix\"\n aria-expanded=\"false\"\n aria-controls=\"collapseSix\"\n >\n \u00bfDespu\u00e9s de la cirug\u00eda voy a tener mucho dolor?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseSix\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingSix\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n La mayor\u00eda de pacientes refiere dolor leve a moderado,\n especialmente cuando se utiliza cirug\u00eda m\u00ednimamente invasiva.\n Adem\u00e1s, el manejo del dolor forma parte importante del\n tratamiento.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingSeven\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseSeven\"\n aria-expanded=\"false\"\n aria-controls=\"collapseSeven\"\n >\n \u00bfCu\u00e1ntos d\u00edas tendr\u00eda que estar hospitalizado?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseSeven\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingSeven\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Depende del procedimiento y de tu evoluci\u00f3n. Muchas cirug\u00edas\n laparosc\u00f3picas permiten egreso temprano, incluso el mismo d\u00eda\n o al d\u00eda siguiente.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingEight\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseEight\"\n aria-expanded=\"false\"\n aria-controls=\"collapseEight\"\n >\n \u00bfCu\u00e1ndo podr\u00eda volver a trabajar o hacer mi vida normal?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseEight\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingEight\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Var\u00eda seg\u00fan la cirug\u00eda y tu tipo de trabajo, pero en general\n la recuperaci\u00f3n es m\u00e1s r\u00e1pida con t\u00e9cnicas m\u00ednimamente\n invasivas. En consulta te doy tiempos realistas para tu caso.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingNine\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseNine\"\n aria-expanded=\"false\"\n aria-controls=\"collapseNine\"\n >\n \u00bfSi ya me dijeron que necesito cirug\u00eda, igual tengo que\n consultarte?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseNine\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingNine\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n S\u00ed. Cada cirujano eval\u00faa el caso de forma individual. La\n consulta permite confirmar el diagn\u00f3stico, discutir opciones y\n resolver dudas antes de tomar una decisi\u00f3n.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingTen\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseTen\"\n aria-expanded=\"false\"\n aria-controls=\"collapseTen\"\n >\n \u00bfQu\u00e9 pasa si dejo pasar el tiempo y no me opero?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseTen\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingTen\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Depende del diagn\u00f3stico. Algunas condiciones pueden mantenerse\n estables, pero otras pueden complicarse. Por eso es importante\n valorar riesgos y no decidir solo con miedo o suposiciones.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingEleven\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseEleven\"\n aria-expanded=\"false\"\n aria-controls=\"collapseEleven\"\n >\n \u00bfPuedo hacerte preguntas sin sentir que \u201cmolesto\u201d?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseEleven\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingEleven\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Por supuesto. Entender tu diagn\u00f3stico y sentirte tranquilo es\n parte del tratamiento. No hay preguntas incorrectas cuando se\n trata de tu salud.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingTwelve\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseTwelve\"\n aria-expanded=\"false\"\n aria-controls=\"collapseTwelve\"\n >\n \u00bfLa cirug\u00eda siempre es la primera opci\u00f3n?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseTwelve\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingTwelve\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n No. Muchas veces se puede intentar manejo m\u00e9dico o\n conservador. La cirug\u00eda se indica cuando realmente aporta\n beneficio o evita complicaciones.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingThirtee\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseThirtee\"\n aria-expanded=\"false\"\n aria-controls=\"collapseThirtee\"\n >\n \u00bfQu\u00e9 pasa si durante la cirug\u00eda encuentran algo diferente?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseThirtee\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingThirtee\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Antes del procedimiento se habla de los posibles escenarios.\n Las decisiones se toman pensando siempre en tu seguridad y en\n resolver el problema de la mejor manera posible.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingFourtee\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseFourtee\"\n aria-expanded=\"false\"\n aria-controls=\"collapseFourtee\"\n >\n \u00bfPuedo operarme aunque tenga otras enfermedades?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseFourtee\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingFourtee\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n S\u00ed, pero primero se hace una evaluaci\u00f3n completa. El objetivo\n es optimizar tu estado de salud antes de la cirug\u00eda para\n reducir riesgos.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingFiftee\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseFiftee\"\n aria-expanded=\"false\"\n aria-controls=\"collapseFiftee\"\n >\n \u00bfQui\u00e9n me explica todo antes de operarme?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseFiftee\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingFiftee\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Yo mismo. Me tomo el tiempo para explicarte el diagn\u00f3stico, el\n procedimiento, los riesgos y el proceso de recuperaci\u00f3n, de\n forma clara y sin prisas.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingSixtee\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseSixtee\"\n aria-expanded=\"false\"\n aria-controls=\"collapseSixtee\"\n >\n \u00bfY si cambio de opini\u00f3n despu\u00e9s de la consulta?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseSixtee\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingSixtee\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n No hay problema. La consulta es para informarte y orientarte.\n Puedes tomarte el tiempo que necesites para decidir.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingSeventee\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseSeventee\"\n aria-expanded=\"false\"\n aria-controls=\"collapseSeventee\"\n >\n \u00bfPuedo escribir si despu\u00e9s de la consulta me surgen m\u00e1s dudas?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseSeventee\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingSeventee\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n S\u00ed. Es normal que surjan preguntas despu\u00e9s. Mi equipo y yo\n estamos para orientarte durante todo el proceso.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingEightee\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseEightee\"\n aria-expanded=\"false\"\n aria-controls=\"collapseEightee\"\n >\n \u00bfEste chat sirve para saber si me tengo que operar ya?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseEightee\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingEightee\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Este chat ayuda a orientarte, pero no reemplaza una valoraci\u00f3n\n m\u00e9dica. Para tomar decisiones importantes siempre es necesaria\n una consulta presencial.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingNinetee\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseNinetee\"\n aria-expanded=\"false\"\n aria-controls=\"collapseNinetee\"\n >\n \u00bfAtiendes casos que otros m\u00e9dicos consideran \u201cdif\u00edciles\u201d?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseNinetee\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingNinetee\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Cada caso merece una evaluaci\u00f3n individual. En consulta\n revisamos tu situaci\u00f3n con calma para definir la mejor\n estrategia.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingTwen\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseTwen\"\n aria-expanded=\"false\"\n aria-controls=\"collapseTwen\"\n >\n \u00bfQu\u00e9 es lo m\u00e1s importante que deber\u00eda saber antes de una\n cirug\u00eda?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseTwen\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingTwen\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Que la cirug\u00eda es solo una parte del proceso. La evaluaci\u00f3n,\n la preparaci\u00f3n, el seguimiento y la recuperaci\u00f3n son igual de\n importantes para un buen resultado.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingTwen1\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseTwen1\"\n aria-expanded=\"false\"\n aria-controls=\"collapseTwen1\"\n >\n \u00bfLa anestesia es diferente si la cirug\u00eda es abierta o\n laparosc\u00f3pica?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseTwen1\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingTwen1\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n S\u00ed, puede variar seg\u00fan el tipo de cirug\u00eda y tu condici\u00f3n de\n salud. En ambos casos la anestesia se elige pensando en tu\n seguridad, comodidad y una buena recuperaci\u00f3n.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingTwen2\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseTwen2\"\n aria-expanded=\"false\"\n aria-controls=\"collapseTwen2\"\n >\n \u00bfVoy a estar completamente dormido durante la cirug\u00eda?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseTwen2\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingTwen2\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n En la mayor\u00eda de cirug\u00edas abdominales s\u00ed, utilizamos anestesia\n general para que no sientas dolor ni tengas recuerdos del\n procedimiento. El anestesi\u00f3logo te eval\u00faa previamente y te\n explica todo con detalle.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingTwen3\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseTwen3\"\n aria-expanded=\"false\"\n aria-controls=\"collapseTwen3\"\n >\n \u00bfEs m\u00e1s riesgosa la anestesia que la cirug\u00eda?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseTwen3\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingTwen3\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n En pacientes evaluados correctamente, el riesgo anest\u00e9sico\n suele ser bajo. Por eso es tan importante la valoraci\u00f3n\n previa, donde se revisan tus antecedentes y se optimiza todo\n antes del procedimiento.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingTwen4\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseTwen4\"\n aria-expanded=\"false\"\n aria-controls=\"collapseTwen4\"\n >\n \u00bfPuedo despertarme durante la cirug\u00eda?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseTwen4\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingTwen4\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Es una preocupaci\u00f3n com\u00fan, pero extremadamente rara. La\n anestesia moderna se monitoriza de forma continua para\n mantenerte dormido y seguro durante todo el procedimiento.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card carta-faq\">\n <div class=\"card-header\" id=\"headingTwen5\">\n <h5 class=\"mb-0\">\n <button\n class=\"btn_faq btn btn-link font-creato collapsed\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseTwen5\"\n aria-expanded=\"false\"\n aria-controls=\"collapseTwen5\"\n >\n \u00bfDespu\u00e9s de la anestesia me sentir\u00e9 muy mal o desorientado?\n <\/button>\n <\/h5>\n <\/div>\n <div\n id=\"collapseTwen5\"\n class=\"collapse colapso-faq\"\n aria-labelledby=\"headingTwen5\"\n data-bs-parent=\"#accordion\"\n >\n <div class=\"card-body\">\n <p class=\"font-creato\">\n Al despertar puedes sentir somnolencia, mareo leve o n\u00e1useas,\n pero suele ser temporal. El equipo se encarga de controlar\n estos s\u00edntomas para que tu recuperaci\u00f3n sea lo m\u00e1s c\u00f3moda\n posible.\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n \n\n <button\n class=\"btn-colapso btn\"\n type=\"button\"\n data-bs-toggle=\"collapse\"\n data-bs-target=\"#collapseExample\"\n aria-expanded=\"false\"\n aria-controls=\"collapseExample\"\n >\n <div class=\"row row-tooltip justify-content-center align-items-center\">\n <div class=\"col-tooltip1 col-tooltip\">\n <i class=\"fa-regular fa-comment-dots\" style=\"color: white\"><\/i>\n <\/div>\n <div class=\"col-tooltip2 col-tooltip\">\n <p class=\"font-creato\">Chatea con nosotros<\/p>\n <\/div>\n <\/div>\n <\/button>\n <\/div>\n\n \n <footer>\n <div class=\"container\">\n <div class=\"row g-4 mb-4 row-footer-top\">\n <div class=\"col-footer col-footer1\">\n <a class=\"logo-footer\" href=\"#\">\n <img decoding=\"async\"\n src=\"http:\/\/drjulioestrada.com\/wp-content\/uploads\/2026\/05\/logo-footer.webp\"\n alt=\"logo-header\"\n \/>\n <\/a>\n <\/div>\n\n <div class=\"col-footer col-footer2\">\n <h5>Mi web<\/h5>\n\n <ul class=\"list-unstyled list-footer\">\n <li>\n <a href=\"#\" class=\"small font-creato\">Inicio<\/a>\n <\/li>\n\n <li>\n <a href=\"#\" class=\"small font-creato\">Somos<\/a>\n <\/li>\n\n <li>\n <a href=\"#\" class=\"small font-creato\">Procedimientos<\/a>\n <\/li>\n\n <li>\n <a href=\"#\" class=\"small font-creato\"\n >Condiciones quir\u00fargicas<\/a\n >\n <\/li>\n\n <li>\n <a href=\"#\" class=\"small font-creato\"\n >Informaci\u00f3n para el paciente<\/a\n >\n <\/li>\n\n <li>\n <a href=\"#\" class=\"small font-creato\">Gu\u00eda para estudiantes<\/a>\n <\/li>\n\n <li>\n <a href=\"#\" class=\"small font-creato\">Agendar cita<\/a>\n <\/li>\n <\/ul>\n <\/div>\n\n <div class=\"col-footer col-footer3\">\n <h5 class=\"font-creato\">Mis redes<\/h5>\n\n <ul class=\"list-unstyled list-footer\">\n <li>\n <a href=\"#inicio\" class=\"small font-creato\"\n ><i class=\"fa-brands fa-instagram\"><\/i>\n @cirujanodrjulioestrada<\/a\n >\n <\/li>\n\n <li>\n <a href=\"#sobre-mi\" class=\"small font-creato\"\n ><i class=\"fa-brands fa-facebook-f\"><\/i> Dr Julio Estrada<\/a\n >\n <\/li>\n\n <li>\n <a href=\"#servicios\" class=\"small font-creato\"\n ><i class=\"fa-brands fa-youtube\"><\/i> Dr Julio Estrada<\/a\n >\n <\/li>\n <\/ul>\n <\/div>\n\n <div class=\"col-footer col-footer4\">\n <div class=\"cont-contacto-foot cont-contacto-foot1\">\n <h5 class=\"font-creato\">Cont\u00e1ctame<\/h5>\n\n <ul class=\"list-unstyled list-footer\">\n <li>\n <a href=\"#\" class=\"small font-creato\">+502 77620324<\/a>\n <\/li>\n\n <li>\n <a href=\"#\" class=\"small font-creato\">+502 78321756<\/a>\n <\/li>\n <\/ul>\n <\/div>\n\n <div class=\"cont-contacto-foot cont-contacto-foot2\">\n <h5 class=\"font-creato\">Mi correo<\/h5>\n\n <ul class=\"list-unstyled list-footer\">\n <li>\n <a href=\"#\" class=\"small font-creato\"\n >drjulioestrada@panamed.com.gt<\/a\n >\n <\/li>\n <\/ul>\n <\/div>\n <\/div>\n <\/div>\n\n <hr class=\"border-footer opacity-50\" \/>\n\n <div\n class=\"row row-footer-bot justify-content-evenly align-items-center\"\n >\n <div class=\"col-foot-bot col-foot-bot1\">\n <p class=\"small font-creato text-muted mb-0 txt-foot txt-foot1\">\n © 2025-2026 Dr. Julio Estrada. Todos los derechos reservados.\n <\/p>\n <\/div>\n\n <div class=\"col-foot-bot col-foot-bot2\">\n <p class=\"small font-creato text-muted mb-0 txt-foot txt-foot2\">\n Desarrollado por\n <a href=\"#\" class=\"text-muted\">Enfoca2’s Studios<\/a>\n <\/p>\n <\/div>\n <\/div>\n <\/div>\n <\/footer>\n\n \n \n\n \n \n\n <script>\n \/\/ Soluci\u00f3n JS para m\u00faltiples dropdowns con sub\u2011men\u00fas animados\n \/\/ SIN modificar la estructura HTML. Funciona con cualquier n\u00famero de .item-procedis\n\n document.addEventListener(\"DOMContentLoaded\", function () {\n \/\/ Selecciona todos los contenedores principales de cada dropdown\n const items = document.querySelectorAll(\".item-procedis\");\n\n items.forEach((item) => {\n \/\/ Obtener el toggle principal (el que abre el men\u00fa Bootstrap)\n const mainToggle = item.querySelector(\".btn-procedi\");\n if (!mainToggle) return;\n\n \/\/ El men\u00fa principal (dropdown-menu) es el siguiente hermano del toggle\n const parentMenu = mainToggle.nextElementSibling;\n if (!parentMenu || !parentMenu.classList.contains(\"dropdown-menu\"))\n return;\n\n \/\/ Buscar todos los sub\u2011toggles y sus respectivos sub\u2011men\u00fas dentro de .contain-drops\n const subToggles = parentMenu.querySelectorAll(\n \".sub-dropdown-toggle\",\n );\n const subMenus = parentMenu.querySelectorAll(\n \".contain-drops .drop-inter\",\n );\n\n \/\/ Funci\u00f3n para quitar la clase 'activo' de todos los .btn-inter-procedi dentro de este men\u00fa padre\n function removeActivoFromAll() {\n const allBtns = parentMenu.querySelectorAll(\".btn-inter-procedi\");\n allBtns.forEach((btn) => btn.classList.remove(\"activo\"));\n }\n\n \/\/ Funci\u00f3n para cerrar todos los sub\u2011men\u00fas y quitar la clase activo\n function closeAllSubMenus() {\n subMenus.forEach((menu) => menu.classList.remove(\"show\"));\n removeActivoFromAll();\n }\n\n \/\/ Asignar evento a cada sub\u2011toggle\n subToggles.forEach((toggle, index) => {\n \/\/ Eliminar eventos previos para evitar duplicados\n toggle.removeEventListener(\"click\", toggle._handler);\n const handler = function (e) {\n e.preventDefault();\n e.stopPropagation(); \/\/ Evita que Bootstrap cierre el dropdown padre\n\n const targetMenu = subMenus[index];\n if (!targetMenu) return;\n\n if (targetMenu.classList.contains(\"show\")) {\n \/\/ Si ya est\u00e1 abierto: lo cerramos y quitamos la clase activo de este toggle\n targetMenu.classList.remove(\"show\");\n toggle.classList.remove(\"activo\");\n } else {\n \/\/ Cerramos cualquier otro y abrimos el actual\n closeAllSubMenus();\n targetMenu.classList.add(\"show\");\n \/\/ Agregamos la clase 'activo' al enlace que abri\u00f3 el sub\u2011dropdown\n toggle.classList.add(\"activo\");\n }\n };\n toggle.addEventListener(\"click\", handler);\n toggle._handler = handler; \/\/ Guardar referencia para posible remoci\u00f3n\n });\n\n \/\/ Cerrar sub\u2011men\u00fas al hacer clic en el men\u00fa padre (pero no sobre los sub\u2011toggles ni los sub\u2011men\u00fas)\n parentMenu.addEventListener(\"click\", function (e) {\n if (\n !e.target.closest(\".sub-dropdown-toggle\") &&\n !e.target.closest(\".drop-inter\")\n ) {\n closeAllSubMenus();\n }\n });\n\n \/\/ Cuando el dropdown principal se cierra (por clic fuera o ESC), limpiar sub\u2011men\u00fas y clases activo\n mainToggle.addEventListener(\"hidden.bs.dropdown\", closeAllSubMenus);\n });\n });\n <\/script>\n <\/body>\n<\/html>\n\n","protected":false},"excerpt":{"rendered":"<p>Dr. Julio Estrada – Cirug\u00eda General y Laparosc\u00f3pica Inicio Somos Procedimientos Cirug\u00eda de Apendice Cirug\u00eda de Ves\u00edcula Cirug\u00eda de Hernias 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