José E. Quiñones

Ambispective comparative study of two surgical strategies for liver hydatidosis

AIM To investigate the morbidity, mortality, recurrence and technical aspects of two distinct surgical strategies that were implemented in successive periods. METHODS Ninty-two patients with 113 cysts underwent surgical procedures. The study was divided into 2 periods. Data from first period (P1) were compiled retrospectively. The surgical strategy was conservative surgery. The second period (P2) included a prospective study conducted according to a protocol following the criterion that radical procedures should be performed whenever it is technically feasible. RESULTS Patients of both periods showed no statistically significant differences in age, gender, cyst location or mortality. Among the P2 group, patients exhibited more preoperative jaundice, and cyst size was smaller (P < 0.05). Changes in surgical strategy increased the rate of radical surgery, decreases morbidity and in-hospital stay (P < 0.001). A negative result in P2 was the death of two old patients (4.8%) who had undergone conservative treatments. The rate of radical surgery in P2 was around 75%. CONCLUSION Radical surgery should be the technique of choice whenever it is feasible, because it diminishes morbidity and in-hospital stay. Conservative surgery must be employed only in selected cases.

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.

Three trocars laparoscopic resection of angiomyolipoma of the liver.

Angiomyolipoma of the liver (AML) is an infrequent neoplasm composed of three tissues (adipose, muscle and vessels). In spite of advances in radiology, preoperative correct diagnosis is difficult. Clasically, a conservative management strategy was adopted in patients with asymptomatic tumors less than 5 cm with undoubtful diagnosis. But after publishing some few cases of malignant angiomyolipoma a more radical has been advocated. Laparoscopic resection of liver tumors is becoming a excellent approach for operating on benign liver tumors. Usually is performed using five trocars but in some cases a less invasive technique with three trocars could be used. We present a laparoscopic resection of liver angiomyolipoma in a 65 year-old male using only three trocars and also discuss the optimal management of AML and technical tips of three-trocar technique.

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.

Traumatismo hepático grave y rotura diafragmática en encierro taurino

Bull gore injuries (cornadas) are the most frequent injuries caused by bulls during bull-related events. Blunt trauma caused by being struck by the bull’s horns and/or head (known as varetazos) usually causes less serious injuries. We present the case of a patient who received blunt trauma from a bull horn, that caused diaphragm rupture and right hepatic avulsion requiring right hepatectomy, vena cava repair and diaphragm suture.

Resección hepática menor y fenestración mediante abordaje laparoscópico con tres trócares

Pringle no se empleó en ningú n paciente. Se comprobó histológicamente el margen en los pacientes tumorales de forma intraoperatoria. Las pérdidas sanguı́neas fueron 32 cc (rango: 10-80 cc). Se dejó drenaje en 3 pacientes. El peso medio de las lesiones sólidas fue 36 g (rango: 17-68 g). El diagnóstico histológico definitivo figura en la tabla 1. No hubo morbilidad. La estancia media fue de 2,1 dı́as (rango: 1-3 dı́as). La CHL se ha consolidado como una técnica segura y factible. Algunos procedimientos como la seccionectomı́a lateral izquierda laparoscópica se considera un gold standard. La CHL habitualmente se realiza mediante cinco trócares, aunque puede realizarse con cuatro. Probablemente se hayan realizado cirugı́as por tres trócares pero la bibliografı́a sobre este tema es reducida y solo hemos encontrado dos referencias sobre esta variante técnica. Los teóricos beneficios de reducir el nú mero de puertos o su tamaño son: disminución del dolor postoperatorio, recuperación más rápida, menor requerimiento de analgesia y mejorı́a estética, pero no pueden acompañarse de disminución en la seguridad. Los metaanálisis realizados comparando la colecistectomı́a laparoscópica clásica con la realizada por Resección hepática menor y fe laparoscópico con tres trócares