Resultados del tratamiento laparoscópico de los quistes hidatídicos hepáticos no complicados / Results of laparoscopic treatment of uncomplicated hepatic hydatid cysts

Introducción: La cirugía es el tratamiento más efectivo para los pacientes portadores de quistes hidatídicos hepáticos (QHH). Actualmente no existe consenso si la cirugía abierta o laparoscópica es la mejor vía de tratamiento. El objetivo del presente estudio es describir la técnica quirúrgica y los resultados de la cirugía radical (periquistectomía) por vía laparoscópica. Materiales y métodos: Estudio de cohorte no concurrente. Se incluyeron a los pacientes portadores de QHH no complicados en los que se realizó periquistectomía radical laparoscópica entre los años 2007 y 2015 en el Hospital Clínico de la Pontificia Universidad Católica de Chile. Se consignaron variables demográficas, clínicas, características del QHH, morbimortalidad y recurrencia en el seguimiento. Resultados: Se operaron 24 pacientes. La mediana de edad fue de 35 años (3-79). La mediana de tamaño del QHH fue de 8 cm (3-15). Las complicaciones postoperatorias se presentaron en 4 casos (16%); un paciente presentó una fístula biliar (4,1%). No hubo mortalidad en este estudio y la estadía hospitalaria fue de 3 días (2-25). La mediana de seguimiento fue de 57,5 meses (9-106); se observó un caso de recurrencia a nivel hepático que requirió otra cirugía. Conclusiones: El tratamiento radical de los QHH no complicados por vía laparoscópica es factible y seguro; al compararlo con la literatura existente no se aprecian diferencias en la morbimortalidad ni recurrencia.

Introduction: Surgery is the most effective treatment for patients with hepatic hydatid cysts (HHC). Currently there is no consensus whether open or laparoscopic surgery is the best treatment. The aim of this study is to describe the surgical technique and the results of laparoscopic radical surgery (pericystectomy). Material and methods: Non-concurrent cohort study. We included patients with uncomplicated HHC in which it was performed a laparoscopic radical pericystectomy between 2007 and 2015 at the Clinical Hospital of the Pontificia Universidad Catolica de Chile. Demographic and clinical variables, HHC characteristics, morbi-mortality and recurrence at follow-up were recorded. Results: Twenty-four patients were operated. The median age was 35 years (3-79). The median HHC size was 8 centimeters (3-15). Postoperative complications occurred in 4 cases (16%); one patient had a biliary fistula (4.1%). There was no mortality in this study and the hospital stay was 3 days (2-25). Median follow-up was 57.5 months (9-106); a case of hepatic recurrence requiring another surgery was observed. Conclusions: The radical treatment of uncomplicated HHC by laparoscopic surgery is feasible and safe; when compared with existing literature there is no differences in morbi-mortality or recurrence.

Disección submucosa endoscópica en cáncer gástrico incipiente: experiencia inicial en el Hospital Clínico de la Pontificia Universidad Católica de Chile / Endoscopic submucosal dissection in early gastric cancer: Experience in 16 patients

Background: Endoscopic submucosal dissection (ESD) is a minimally invasive procedure that allows curative treatment of early gastric cancer (EGC) in selected patients. Aim: To report our initial experience with ESD. Material and Methods: Analysis of prospective data from 16 patients aged 61 to 84 years, who underwent ESD between December 2011 and June 2014. Tumor type, operative time, hospitalization length, oncologic outcomes, complications and short-term follow up were registered. Results: En-block resection was achieved in all cases. The median operative time was 135 min (range: 50-320 min). Specimens' median size was 3.5 cm (range: 3-10). All the resections were R0. In 14 patients ESD was considered curative. In two patients, ESD was considered potentially non-curative due to the presence pathological risk factors for lymph-node metastases in the biopsy specimen. Both patients underwent laparoscopic gastrectomy with lymph-node dissection. There was one case of gastric wall perforation that was repaired by laparoscopic suture. There was no mortality. The median follow-up time was 15 months (range: 2-30 months). Conclusions: ESD is a feasible and safe procedure in our institution with good results in this initial experience.