Tratamiento quirúrgico de la fibromatosis agresiva en relación con cesárea previa / Surgical treatment of aggressive fibromatosis in relation to previous cesarean section

Introducción. Los tumores desmoides son lesiones de los tejidos blandos, histológicamente benignas, poco frecuentes y con gran agresividad local y carencia de potencial metastásico. Se relacionan estrechamente con antecedentes traumáticos o quirúrgicos, como la cesárea, y su tratamiento generalmente es quirúrgico. Métodos. Presentamos una serie de tres pacientes intervenidas en nuestro centro durante el año 2020. Se revisan sus antecedentes y se describe su tratamiento. Resultados. En todas nuestras pacientes se encontró algún antecedente quirúrgico, dos cesáreas y una resección de un disgerminoma. El tratamiento empleado fue la resección quirúrgica con márgenes libres y reparación del defecto mediante malla. Conclusiones. El tumor desmoide es una patología poco frecuente, su diagnóstico se realiza mediante exámenes imagenológicos y se confirma con el estudio histológico; es importante hacer el diagnóstico diferencial con el sarcoma. La cirugía radical sigue siendo el tratamiento de elección, aunque algunos autores proponen el tratamiento conservador.

Introduction. Desmoid tumors are soft tissue lesions, histologically benign, rare and with great local aggressiveness and lack of metastatic potential. They are closely related to traumatic or surgical history such as caesarean section. Their treatment is generally surgical. Methods. We present a case series of three patients operated on in our center during the year 2020. Their history is reviewed and their type of treatment is presented. Results. In all our patients, surgical history was found (two caesarean sections and one resection of a dysgerminoma). The treatment used was surgical resection with free margins and mesh repair of the defect. Conclusions. Desmoid tumor is a rare pathology; its diagnosis is made by imaging studies, and confirmed by histology. It is important to make a differential diagnosis with sarcoma. Radical surgery remains the treatment of choice, although some authors propose conservative treatment.

Cystic lesion of pectoralis minor muscle: learning from mistakes

Hydatidosis is a frequent infestation in large endemic areas, caused by helminths. Primary localization within the muscle or bone tissues is rare. We report the case of a 52-year-old woman with a cystic lesion located in the right pectoralis minor muscle, who was initially diagnosed with cystic lymphangioma by imaging examination. She was submitted for surgical treatment; in block resection of the tumor along with the involved muscle was performed. The histopathological diagnosis was of hydatid cyst. The contribution of the ancillary lab tests is analyzed for a precise preoperative diagnostic approach. This case well illustrates that the most likely is not always what it appears to be. Facing of a cystic lesion in the lungs, liver or muscle, clinicians should always think on hydatid disease, particularly in endemic areas.

Tratamiento de la base apendicular por laparoscopia mediante el uso de endograpadoras: análisis de nuestros resultados / Appendicular stump laparoscopic management: our results analysis

Objetivo: El objetivo de este estudio es analizar los resultados de nuestro centro en cuanto al cierre del muñón apendicular en la apendicectomía laparoscópica, mediante el empleo de endograpadora. Material y método: Análisis retrospectivo de las apendicectomías laparoscópicas con sección de la base apendicular con endograpadora, llevadas a cabo entre enero de 2013 y marzo de 2015, recogiendo variables demográficas, clínicas y de técnica quirúrgica. Resultados: Se incluyeron en el análisis 238 pacientes. Se registraron complicaciones en 41 pacientes, con una tasa de reingreso del 5% y un 2,5% de pacientes reintervenidos. La estancia media posquirúrgica fue de 3,64 días. Discusión y conclusiones: En el cierre del muñón apendicular, la endograpadora se presenta como una técnica adecuada en cuanto a estancia postoperatoria y complicaciones posquirúrgicas. A pesar de las ventajas de su uso, debe valorarse en apendicectomías no complicadas el empleo de otras técnicas como endoloops.

Objective: The objective of this study is to analyse the results in our centre as regards the closure of the appendix stump in laparoscopic appendectomy using an endo-stapler. Material and methods: A retrospective analysis, collecting the demographic, clinical, and surgical technique variables, was conducted on laparoscopic appendectomies with section of the appendix base with an endo-stapler performed between January 2013 and March 2015. Results: A total of 239 patients were included in the analysis. Complications were recorded in 41 patients, with a re-admission rate of 5%, and 2.5% of patients received further surgery. The mean post-surgical stay was 3.64 days. Discussion and conclusions: The endo-stapler is a suitable technique in the closure of the appendix stump, as regards post-surgical hospital stay and complications. Despite the advantages of its use, the employment of other techniques, such as endo-loops, should be evaluated in non-complicated appendectomies.