Camilo Boza W

Pancreatoduodenectomía totalmente laparoscópica: Técnica quirúrgica y experiencia inicial*

Abstract Totally laparoscopic pancreaticoduodenectomy: Surgical technique and initialexperience Introduction: Nowadays the utility of laparoscopic pancreatic surgery is accepted for a wide varietyof indications. However pancreaticoduodenectomy has been considered beyond the possibilities oflaparoscopy by the majority of surgeons. The objective of this report is to show our surgical techniqueand initial experience with totally laparoscopic pancreaticoduodenectomy. Material and Methods: Betweennovember of 2007 and june of 2008, a laparoscopic technique was offered to patients with indication ofpancreaticoduodenectomy for different pathologies. We describe the surgical technique, perioperativecare, intraoperative complications, need for conversion to open technique, mortality, and early postoperativecomplications. Results: A total of three patients were subjected to laparoscopic pancreaticoduodenectomy.The surgical indication was an ampullar adenocarcinoma in a 52 years old woman, a pseudopapilar tumor ofthe pancreatic head in a 17 years old woman, and a duodenal gastrointestinal stromal tumor in a 63 yearsold man. There was no need for conversion to open technique. There was no mortality. The operative timeranged from 300 to 360 min. The first patient presented an upper gastrointestinal bleeding, from pancreaticanastomoses requiring surgical hemostasis. The last patient developed a self-limited biliary fistula, managedsuccessfully with drains. The hospital stay varied from 8 to 25 days.

Necrosectomía laparoscópica en pancreatitis aguda

Laparoscopic necrosectomy in severe pancreatitis. Retrospective analysis of 11 patients Background: Laparoscopic surgery can be used in the treatment of severe acute pancreatitis. Aim: To report the experience with laparoscopic necrosectomy and abscess drainage in severe acute pancreatitis. Material and Methods: Retrospective analysis of medical records of 11 patients aged 13 to 78 years (10 males), with severe pancreatitis, subjected to laparoscopic necrosectomy or abscess drainage between 2006 and 2009. Results: Operative time ranged from 110 to 205 min. In all cases, a satisfactory necrosectomy and collection drainage were performed. No complications were recorded and no patient required to be converted to open surgery. Five patients were reoperated. In three of these, the laparoscopic approach was used again. Conclusions: Laparoscopic necrosectomy is safe and useful for patients with severe pancreatitis.

Epidemiología del traumatismo encefalocraneano en niños del área suroriente de Santiago

Se estudiaron retrospectivamente las caracteristicas epidemiologicas del Iraurnotismo encefalocraneano en 286pacienles ingresados con ese diagnostico a un hospital general del Servicio de Solud Metropolitano Sur-Oriente deSantiago de Chile, entre enero 1993 y abril 1995. La edad promedio de los pacientes era 6,1 anos, 64,7% eran va-rones, 54,5% escolares (5 a 14 aiios), 25,2% preescoiares (2 a rnenos de 5 anos] y 20,3% lactontes (menores de 24meses). En los loctantes y preescolares el acctdente ocurrio con rnas frecuencia en el hogar [78,6% y 60% respective-menre(, en escolares en la via publica (76,7%). En los primeros la principal causa del traurnatismo fueron las caidas,en los escolares los accidentes de Iransito (65,6%). En 64,9% de los casos la consulta fue hecha en la primera hora.El estado de la conciencia al ingresar al hospital (escala de coma de Glasgow), era 1 3 a 15 punfos en 76,9% de lospacientes, 9 a 12 puntos en 10,5% de ellos e igual o menor a 8 puntos en 10,8%, proporciones que son mayoresque las descritas en otras series.(Palabras clave: traumatismo encefalocraneano.]

Dispositivo endoscópico duodeno yeyunal restrictivo en pacientes obesos mórbidos, experiencia inicial en humanos

Initial human experience with a restrictive, duodenal-jejunal by-pass liner for the treatment of morbid obesity Background: The EndoBarrier TM Gastrointestinal Liner creates an endoscopic duodenal-jejunal bypass leading to weight loss in morbidly obese patients. Aim: To evaluate the safety and effi cacy of the EndoBarri- er TM with a 4 mm restrictor in morbidly obese patients. Material and Methods: Ten obese patients aged 18 to 54 years (eight women) with a body mass index (BMI) ranging from 35.8 to 45 kg/m 2 were enrolled. Patients were followed for 12 weeks after the placement of the device, when it was removed. Outcomes measured were percent excess weight loss (%EWL), minor and major adverse events. Results: The mean implant time was 33 ± 4 minutes with a mean fl uoroscopy time of 14.8 ± 3 minutes. There were no major adverse events. Periodic episodes of nausea and vomiting lead to the endoscopic dilation of the restrictor hole with a 6 mm balloon between 2nd and 8th weeks in seven patients (70%). One subject required a second dilation with a 10 mm balloon. The device was endoscopically removed at the 12 th week in all patients. The mean removal time was 47 ± 53.8 minutes (range 10-155 minutes). At week 12, BMI decreased from 40 ± 3.9 to 34.5 ± 3.1 kg/m 2 , and %EWL was 39.8% (range, 21.7% - 65.3%). The mean total weight loss was 16.7 ± 4.4 kg. Conclusions: The EndoBarrier TM Gastrointestinal Liner with the addition of a duodenal restrictor is a safe

TRATAMIENTO LAPAROSCÓPICO DE LA OBSTRUCCIÓN INTESTINAL POR BRIDAS

Laparoscopic treatment of adhesive small bowel obstruction Background: Treatment options for adhesive small bowel obstruction (ASBO) involve conservative and surgical management, traditionally through open adhesiolysis. Laparoscopic approach has been performed in recent years; however, limited data exist on its safety and results vary considerably. Our aim is to report our experience of laparoscopic treatment for ASBO. Methods: Retrospective study including patients admitted with the diagnosis of adhesive small bowel obstruction and that were submitted to laparoscopic exploration, between June 2003 and April 2013. We analyzed demographic, surgical variables and outcomes in terms of conversion rate, operative time, re-feeding time and length of stay. Non-parametric tests were used for statistical analysis. Results: Series of 38 patients submitted to laparoscopic exploration, mean age: 51 ± 16 years, 47% male. 53% had prior intra-abdominal surgeries. Laparoscopic resolution of bowel obstruction was possible in 31 patients (82%), with 7 conversions to open surgery. Median operative time was 60 (25-180) minutes, median re-feeding time was 24 (24-192) hours and median length of stay was 4 (2-52) days. Two patients required re-intervention during their hospital stay, one due to persistent bowel obstruction and one due to ischemic colitis. There were no other complications or mortality. Conclusions: Laparoscopy in adhesive small bowel obstruction was a feasible approach in this series, with good results when laparoscopic resolution is achieved. Patients with no prior surgeries seem to be good candidates for this approach.

Gastrectomía laparoscópica en cancer gástrico

Introduccion: La cirugia laparoscopica ha sido incorporada como una alternativa de tratamiento curativo en cancer gastrico. El objetivo de este estudio es evaluar los resultados quirurgicos inmediatos de pacientes sometidos a gastrectomia laparoscopica por cancer gastrico incipiente e intermedio en el Hospital Clinico de la Pontificia Universidad Catolica de Chile y en el Hospital Dr. Sotero del Rio. Material y metodo: Se incluyen todos los pacientes sometidos a gastrectomia laparoscopica por cancer gastrico incipiente e intermedio (T1 - T2) en ambas instituciones. Resultados: Desde Mayo de 2005 a Diciembre del 2006, 13 pacientes fueron sometidos a gastrectomia laparoscopica, 9 hombres (70 %). Edad promedio 62+ 12 anos. El tiempo operatorio promedio fue 293 + 51 minutos, la estadia hospitalaria 7,3 + 2,8 dias. No hubo complicaciones quirurgicas. El promedio de ganglios resecados fue de 27 + 18. De acuerdo a la clasificacion TNM-AJCC, 9 pacientes se encontraban en etapa IA y 4 en etapa IB. Discusion: La gastrectomia laparoscopica es una alternativa segura en el tratamiento quirurgico del cancer gastrico incipiente e intermedio

ÚLCERA MARGINAL PERFORADA POST BYPASS GÁSTRICO LAPAROSCÓPICO

Perforated marginal ulcer after laparoscopic gastric bypass introduction: Perforated marginal ulcer is a serious event that usually requires reoperation and is associated with morbidity and mortality. Characterization and management of these patients is still debated. Objective: To describe a series of patients subjected to a laparoscopic gastric bypass (LGBP) that evolved with a perforated marginal ulcer. material and m ethods: Records of patients undergoing a LGBP the last 10 years and evolved with a perforated marginal ulcer were retrospectively reviewed. Clinical features, treatment and perioperative morbidity and mortality were analyzed. results: During this period 2,095 patients were subjected to a LGBP, 12 of them presented a perforated marginal ulcer, corresponding to 10 women and 2 men. Mean age was 39 (21-60) and mean body mass index at the time of initial surgery was 34 (29.3 to 38.6). Ten patients were smoker at the moment of perforation. The occurrence of this happened at a mean of 27 months (range 3-54, median 23.5) after surgery. Eleven cases had a surgical resolution, with a laparoscopic approach in 9 of them and laparotomy on 2. In all cases, a perforated ulcer in the jejunal side of the gastro- jejunal anastomosis was found. There was no mortality or morbidity associated with surgery. conclusions: In our experience the occurrence of perforated marginal ulcer after a LGBP develops in a small percentage of patients. The laparoscopic approach is of choice, presenting a low morbidity and mortality. Smoking was present in most patients.

HERNIOPLASTÍA VENTRAL LAPAROSCÓPICA

Laparoscopic repair of ventral hernias Background: Ventral hernias are defects of the anterior abdominal wall, the laparoscopic repair has shown some advantages compared to open repair. Aim: To evaluate perioperative outcomes of the laparosco- pic ventral hernia repair and to describe risk factors associated to recurrence. Methods: Non-concurrent pros- pective cohort study, clinical data of all patients who underwent laparoscopic ventral hernia repair between June�2006�andMay�2013�werereviewed.�Univariateanalyseswereperformedusingchi-squareforcategorical� variablesandUMann-Whitneytestforcontinuousvariables.�Multivariateanalysiswasperformedusinga� logistic regression model. Results: 127 patients underwent laparoscopic ventral hernia, 52% female, age of 58.1 ± 1.2 years old. Mean Body Mass Index (BMI) was 31 ± 0.5 kg/m 2 and 67.7% were incisional hernias. Median operative time was 80 minutes (ranging from 30-350) and the median defect size was 6 cm (ranging from 2-20). Conversion to open surgery was necessary in 4 cases (3.9%). Median of hospital stay was 2 days (ranging from 1-15). Recurrence rate was 14.2% and the median to recurrence was 9 months. Recurrence rate was associated positively to defect size > 10 cm (p = 0.002), previous recurrence (p = 0.029) and operative time�>�90�minutes�(p�=�0.017)�intheunivariateanalyses.�However,�itwasonlyassociatedtothefirsttwoin� the multivariate analysis (OR 3.906; IC 1.734-13.058 y OR 5.93; IC 1.546-22.976, respectively). Conclu- sions: Laparoscopic repair of ventral hernia is a safe procedure with acceptable perioperative complication rates. Defect size and previous recurrence are associated to a higher recurrence rate.

Gastrectomía laparoscópica en carcinoide gástrico

Laparoscopic gastrectomy in gastric carcinoid Introduction: Gastric carcinoid is a very low frequency tumor. A proportion of them require surgery to control the disease. The ideal surgical treatment is controversial. Aim: To describe the perioperative and follow-up course of patients with gastric carcinoid subjected to laparoscopic gastrectomy. Materials and Methods: Retrospective study of patients undergoing some type of laparoscopic gastrectomy for gastric carcinoid the last 10 years. We collected demographic background, preoperative evaluation, type of surgery, complications and follow-up. Results: During the study period were operated 7 patients, 5 were men. The average age was 54 years. In three patients the diagnosis was a finding, while the rest had abdominal pain associated with nonspecific symptoms. Four patients had a type I gastric carcinoid associated with chronic gastritis and hypergastrinemia, and the others had a type III gastric carcinoid. Six patients underwent lapa- roscopic total gastrectomy while in the remaining patient (type III) was subtotal. There were no postoperative complications. During follow-up one patient required a reoperation for mechanical ileus secondary to adhe- sions and one patient required endoscopic dilatation because esophagoyeyunostomy stenosis. At 32 months of median follow-up (1-52) no patient has relapsed. Conclusion: Laparoscopic gastrectomy is an alternative in the surgical treatment of patients with gastric carcinoid. Its safe and represent adequate oncological results in the short and medium term.

Reparación de hernia incisional por vía laparoscópica: Resultados iniciales

Introduccion: La hernia incisional (HI) es una de las complicaciones mas frecuentes en cirugia abdominal abierta, siendo una alternativa para su correccion la hernioplastia por via laparoscopica. El objetivo de este trabajo fue evaluar la factibilidad y eficacia de la reparacion laparoscopica de la HI con seguimiento a corto plazo, dando a conocer nuestra experiencia inicial. Material y Metodo: Estudio retrospectivo de pacientes sometidos a hernioplastia incisional laparoscopica entre marzo de 2006 y octubre de 2008 en el Hospital Clinico de la Pontificia Universidad Catolica de Chile. Se evaluo variables demograficas, perioperatorias, morbilidad y recidiva. Resultados: Fueron operados 21 pacientes en este periodo, 16 de genero femenino, con un promedio de edad e indice de masa corporal de 54 ± 13 anos y 32,2 ± 6,5 kg/m2, respectivamente. Uno de ellos se convirtio a cirugia abierta. El diametro mayor del anillo hemiario fue en promedio 8,4 ±3,9 cm (rango 3-17) y la mediana de tiempo operatorio fue de 92 minutos (rango 45-300). La estadia hospitalaria fue 3,0 ±1,6 dias, en promedio. Durante la misma cirugia se realizo en dos pacientes gastrectomia en manga y colecistectomia. Se presentaron complicaciones precoces menores en dos pacientes (10%), una atelectasia pulmonar y un seroma, y complicaciones tardias menores en otros dos pacientes (10%), que correspondio a dolor prolongado en la zona operatoria en ambos. No hubo mortalidad en la serie. El seguimiento fue 100%, con un promedio de 14 meses (rango 4-36), sin recidiva en este periodo. Conclusiones: La hernioplastia incisional laparoscopica es una tecnica factible de realizar en nuestro medio, sin complicaciones mayores en esta serie y buenos resultados a un ano de seguimiento.