Fernando Crovari E

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.

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.

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.

Prevención de la recurrencia peritoneal en el tratamiento quirúrgico del cáncer gástrico

Prevention of peritoneal recurrence of gastric cancer The peritoneal cavity is the main site of gastric cancer recurrence after curative surgery. When this re currence occurs, patients may experience bowel obstruction, dehydration and multiple hospital admissions. The therapeutic options that may decrease the rate of peritoneal recurrence and increase five years survival are intraoperative hyperthermic chemotherapy, extensive intraoperative peritoneal lavage and routine bursectomy. We herein review the oncological results of curative surgery for gastric cancer, its failure patterns and the risk factors for peritoneal recurrence. We also review the studies aiming to prevent peritoneal carcinomatosis.

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.

Metástasis hepática de origen no colorrectal ni neuroendocrino. Tratamiento quirúrgico

Surgical excision of non colorectal liver metastases Background: Thebenefitsofhepaticresectionsforcolorectallivermetastasesarewellknown.�Thisis� notthecaseforexcisionsinthetreatmentofnon-colorectal,�nonneuroendocrinelivermetastases.�Aim: To assesstheresultsofliverresectioninthetreatmentofpatientswithnon-colorectal,�nonneuroendocrineliver� metastases. Material and Methods: Electronicdatabaseanalysisofpatientswithnoncolorectalnon-endocrine� livermetastasesundergoingtohepatectomybetween�2000-2009. Results: Seventeen patients aged 22 to 78 years,�ninewomen,�wereoperated.�Themostcommonprimarytumorswerestomach,�liver,�adrenalglands� anduterus.�Intwocases,�asynchronicprimarytumorandmetastasisexcisionwasperformed.�Anatomicseg- mentectomywasperformedin�10�cases�(58.8%)�andamayorsurgicalresectionin�7�patients�(41.2%).�In�15� cases�(88.2%)�thetumormarginswerenegative.�Threepatientspresentedpostoperativecomplicationsand� threepatientshadhepatictumorrecurrence.�Nopatientdiedintheperi-operativeperiod.�One,�twoandthree� yearssurvivalwere�85,�51�and�51%�respectively,�afterafollow-uprangingfrom�9�to�56�months.�Conclusions: Thesurgicaltreatmentofpatientswithnon-colorectalnon-endocrinelivermetastasesissafeandbeneficial� inselectedpatients,�withalowrateofcomplicationsandgoodsurvivalrates.

Malformación arteriovenosa del páncreas: caso clínico

SUMMARY Pancreatic arteriovenous malformations are uncommon and generally asymptomatic. Their complications can be bleeding, pain or portal hypertension. Angiography gives the definitive diagnosis and also can be used as the initial treatment. Surgery is the definitive treatment. We report a 35 years old with epigastric pain. Abdominal CAT scan, magnetic resonance and angiography showed a pancreatic arteriovenous malformation. He was subjected to a pancreatoduodenectomy with complete resolution of symptoms.