Farah Adel

Wrapping in pancreatic surgery: a systematic review

Wrapping in pancreatic surgery involves the use of the omentum or falciform ligament (FL) to wrap the local retroperitoneal vessels, the pancreatojejunal anastomosis or the pancreatic section of distal pancreatectomy. However, there is no clear evidence that wrapping in fact provides benefits. We have performed a systematic review of the literature about this topic.

Frank Intrabiliary Rupture in Liver Hydatidosis Located in the Hilar Plate: A Surgical Challenge

Background: Frank intrabiliary rupture (FIR) is a severe complication that occurs in around 30% of patients with liver hydatidosis. When FIR is present, the contents of the cyst may pass into the common bile duct and cause a variety of complications. If the FIR is located in the hilar confluence, surgical repair is a challenge. Currently there are no data regarding its optimum treatment. Material and Methods: Between May 2007 and December 2012, we treated 59 patients with liver hydatidosis. Four patients, all women, with a mean age of 51.7 years, had hydatid cysts located between segments IVb and V and FIR affecting the hilar plate. In 3 cases, the initial clinical condition was obstructive jaundice. The fourth patient presented recurrence after having undergone two operations as a child. Results: In each patient a major hepatectomy was performed with hilar plate reconstruction (3 left and 1 right). Morbidity included mild biliary fistula (1 patient) and abdominal collection resolved by percutaneous drainage (1 patient). There was no mortality. During follow-up (47 months), no recurrences of the disease or biliary strictures were recorded. Conclusions: FIR is a severe complication of liver hydatidosis. When it is located in the hilar confluence, liver resection may be the best surgical option for definitive resolution of the problem.

Ruta de reconstrucción gastroentérica tras duodenopancreatectomía: antecólica versus retrocólica

INTRODUCTION Delayed gastric emptying (DGE) is a relatively common complication after cephalic pancreaticoduodenectomy (CPD). Its origin is not very clear, and it is believed that its appearance is due to multiple factors (hormones, appearance of other complications, particularly pancreatic fistulas, and the surgical technique). Among the technical aspects associated with DGE, it has been proposed that the route of gastroenteric reconstruction (antecolic or retrocolic) could have an effect on its incidence. MATERIAL AND METHODS A systemic review was made of the literature, searching for articles that compared both reconstruction routes after CPD, finding only 11 articles: 4 randomised clinical trials, one prospective study, and 6 retrospective studies. A meta-analysis could not be performed on them, due to the large methodological differences between them. RESULTS In the 4 randomised studies, 2 were in favour of the antecolic route, and 2 did not observe any differences between either of them. The antecolic route obtained a much lower DGE rate than the retrocolic one in the only prospective study. In 4 of the retrospective studies the antecolic route obtained a very low rate. The results of both routes were similar in another 2 retrospective studies, with the retrocolic route slightly better in one of them. CONCLUSIONS Using the published literature, the gastric reconstruction route associated with less DGE after CPD cannot currently be determined.

Retroperitoneal abscess due to dropped gallstones after laparoscopic cholecystectomy

Complications of dropped gallstones after laparoscopic cholecystectomy are infrequent but retroperitoneal abscess is extremely rare. We present a new case, discuss causes, diagnostic methods, preventive measures and therapeutical options.

Hidatidosis extrahepática y extrapulmonar

BACKGROUND Cystic echinococcosis is a zoonosis caused by larvae of the parasite Echinococcus that is endemic in many countries of the Mediterranean area. It can affect any organ, with the most common sites being liver (70%) and lung (20%). Splenic hydatid disease, despite being rare, is the third most common location. Other locations such as bone, skin, or kidney are exceptional. OBJECTIVE To present our experience in extrahepatic and extrapulmonary hydatidosis. MATERIAL AND METHODS Period: May 2007-December 2014. Health area: 251,000 inhabitants. During that period, a total of 136 patients with hydatid disease were evaluated in our Hepato-pancreatic-biliary Surgery Unit. Extrahepatic and extrapulmonary hydatid disease was found in 18 (13%) patients. A retrospective review was performed on all medical records, laboratory results, serology, diagnostic methods, and therapeutic measurements of all patients. An abdominal ultrasound and CT, as well as hydatid serology was also performed on all patients. RESULTS The mean age of the patients was 44.5 years, with a range of 33-80 years. Half the patients (50%) had concomitant hepatic echinococcosis. Of the 18 patients with hydatid disease, 13 underwent surgery (radical surgery in 12 cases), and one underwent (endoscopic retrograde cholangiopancreatography)+puncture, aspiration, injection and re-aspiration. The remaining 4did not have surgery due to patient refusal (3), or advanced cancer (1). No recurrences have been observed. CONCLUSION The best surgical treatment in these cases is closed total cystectomy to prevent recurrence, except in the spleen where splenectomy is preferred. Conservative techniques are indicated in cases of multiple hydatid disease and in patients with high surgical risk.

Hiperplasia nodular regenerativa hepática múltiple asociada a oxaliplatino

Figura 1 – TAC: lesión en segmento VII (flecha). Las lesiones sólidas hepáticas de nueva aparición, en los pacientes oncológicos, nos obliga descartar como primera posibilidad las metástasis hepáticas de su neoplasia primaria. En un pequeño nú mero de pacientes pueden ser otros tumores muy infrecuentes y hacer muy complejo llegar a un diagnóstico diferencial preoperatorio correcto. Presentamos el caso de una paciente con una hiperplasia nodular regenerativa (HNR) hepática mú ltiple asociada a oxaliplatino. Debatimos los efectos secundarios hepáticos del oxaliplatino y el manejo clı́nico de estos pacientes. Mujer de 49 años, con antecedentes de hemicolectomı́a izquierda laparoscópica en 2010 por adenocarcinoma enteroide de colon bien diferenciado de 3 cm, pT3N0M0 con invasión perineural. Fue tratada con XELOX (oxaliplatino 130 mg dı́a 1 y Xeloda 1.000 mg/m/12 h durante 14 dı́as cada 21 dı́as) durante 6 meses. Otros antecedentes: quiste de ovario, obesidad (IMC: 36), diabetes mellitus no insulinodependiente, dislipemia y bocio multinodular. Índice de Premm: 1,2, Riesgo de cáncer hereditario no polipósico: 7%. Fenotipo negativo para inestabilidad de microsatélites (MLH1, MSH2, MSH y PMS2 positivos). A los 30 meses del postoperatorio la TAC objetiva esteatosis hepática, lesión hipervascular focal de nueva aparición de 30 20 mm entre los segmentos VI y VII, y otra en el segmento IV de 8,5 mm que presentan realce en la fase portal y, además, leve trabeculación de la grasa mesentérica compatible con paniculitis mesentérica, no existı́an signos de hipertensión portal (fig. 1). El hemograma, la bioquı́mica hepática y los marcadores tumorales (CEA y CA19-9) eran normales. Se realiza PET que demuestra que las lesiones hepáticas no captan, la zona de paniculitis muestra un SUV de 3,2. Ante los hallazgos no concluyentes se decide realizar laparotomı́a exploradora. Se visualiza la lesión del segmento VII y se observan 2 lesiones de 2-3 mm en los segmentos II y III. Se realiza ecografı́a intraoperatoria donde se detectan otras 5 lesiones intraparenquimatosas de 3-8 mm, una de ellas la observada en el segmento IV en la TAC. El

Punción, aspiración, instilación y re-aspiración en casos complejos de hidatidosis hepática

Cystic echinococcosis (CE) is a zoonosis caused by Echinococcus granulosus larva. The most frequently affected organ is the liver (70%–80% of patients). As there are no randomized trials, it is not clear which is the best treatment for hepatic hydatid cysts (HHC): surgery, percutaneous drainage, medication (albendazole) or observation. In 1985, a published report proposed puncture as a therapeutic option for HHC. Since then, PAIR therapy (HHC puncture, aspiration of the intracystic content, injection of scolicidal solution and reaspiration) has become consolidated as a valid treatment. We present our experience with PAIR in three complex cases of HHC.

Classifications of acute pancreatitis: to Atlanta and beyond

Until Atlanta Classification (AC) made in 1992, there was not any classification of acute pancreatitis (AP). Last twenty years AC let us compare results and papers. But the increasing understanding of the pathophysiology of AP, improvements in diagnostic methods and the development of minimally invasive tools for radiological, endoscopic and surgical management of local complications, several authors have called for the AC to be reviewed. Last months, two new classifications of AP have been published. We made a historical review of AC, the two new classifications and a comparison between them.