Abordaje laparoscópico de la neoplasia mucinosa apendicular de bajo grado / Laparoscopic approach of low-grade appendiceal mucinous neoplasm

RESUMEN Las neoplasias mucinosas apendiculares son infrecuentes y se clasifican en neoplasias mucinosas de bajo grado, de alto grado y adenocarcinoma mucinoso. Se consideran precursoras del pseudomixoma peritoneal, caracterizado por la acumulación de mucina dentro de la cavidad abdominal. Informamos tres casos de neoplasia mucinosa apendicular de bajo grado, dos varones y una mujer, que presentaron dolor abdominal agudo, diagnosticados preoperatoriamente mediante tomografía y que fueron manejados con un abordaje laparoscópico (apendicectomía, resección parcial de ciego y colectomía derecha, respectivamente). Los tres casos tuvieron una buena evolución posoperatoria y no hubo complicaciones. Se concluye que las neoplasias mucinosas apendiculares son raras y no tienen una presentación clínica específica. El abordaje laparoscópico es una opción segura y factible. La frecuencia y la duración del seguimiento de estos pacientes es motivo de controversia.

ABSTRACT Appendiceal mucinous neoplasms are rare and are classified in low-grade mucinous neoplasm, high-grade mucinous neoplasm and mucinous adenocarcinoma. They are considered precursors of pseudomyxoma peritonei, characterized by the accumulation of mucin within the abdominal cavity. We report three cases of low-grade appendiceal mucinous neoplasm, two men and one woman, who presented with acute abdominal pain. The diagnoses were made preoperatively by computed tomography scan and the tumors were managed through laparoscopic approach (appendectomy, partial resection of the cecum and right colectomy, respectively). The three patients evolved with favorable postoperative outcome without complications. Appendiceal mucinous neoplasms are rare without specific clinical presentation. The laparoscopic approach is a safe and feasible option. The frequency and duration of surveillance in these patients are still controversial.

Multiple Jejunal diverticulosis complicated by perforation: case report and a brief literature review

Background: Multiple small-bowel diverticulosis comprises a rare entity with probable underestimated incidence, and that may be the reason why it is sometimes overlooked when managing cases with peritonitis. Case report: In the present paper, we report the case of a 76-year-old male presenting abdominal pain and fever in an acute setting. Computed tomography (CT) scans revealed jejunal thickening and numerous images of saccular addition that were interpreted as jejunoileal diverticulitis. After an initial period of clinical treatment, surgical management was indicated based on a worsening clinical picture and the presence of an extraluminal focus of gas detected in a subsequent CT scan. Through a laparoscopic approach, multiple small-bowel diverticula and a tamponade perforation were found. A segmental intestinal resection was performed, and the patient was discharged after a ten days. Conclusions: Multiple jejunal diverticulosis is a rare condition that should be remembered in the setting of an acute abdomen. As it prevails among older patients, early diagnosis with radiological aid is crucial to establish the most adequate management, including intestinal resection, if necessary. (AU)

Exploración de las vías biliares como tratamiento de la litiasis coledociana: manejo laparoscópico vs. convencional. Estudio prospectivo y comparativo / Common bile duct exploration as treatment of choledocal lithiasis: laparoscopic vs conventional approach. Prospective and comparative study

La litiasis coledociana es una complicación poco frecuente asociada a la litiasis vesicular. Puede ser resuelta mediante colangiopancreatografía retrógrada endoscópica (CPRE) o en su defecto, una exploración de las vías biliares por abordaje convencional (cirugía abierta) o laparoscópico. Objetivos: Determinar la efectividad del abordaje laparoscópico versus el convencional en la exploración de las vías biliares como tratamiento de la litiasis coledociana. Métodos : Se realizó un estudio prospectivo y comparativo con una muestra de 31 pacientes con litiasis coledociana seleccionados de manera no aleatoria. Resultados : Ambos grupos fueron comparables en edad, sexo, frecuencia de litiasis vesicular y CPRE preoperatoria. El tiempo quirúrgico promedio fue 4,52 versus 3,49 horas para los abordajes laparoscópico y convencional respectivamente. En el grupo laparoscópico se usó tubo de Kehr en 21% de los pacientes y en 79 % sutura primaria. En el grupo convencional se usó tubo de Kehr en 29% de los pacientes y en 71 % sutura primaria. La fuga biliar fue la complicación más frecuente. La estancia hospitalaria fue 3,14 días en el grupo laparoscópico versus 5,23 días en el grupo convencional, sin diferencia estadísticamente significativa. Conclusión : No se logró demostrar una superioridad evidente de alguno de los grupos estudiados, sin embargo nuestros pacientes podrían beneficiarse de las ventajas del abordaje laparoscópico en términos de tener menor dolor postoperatorio y una reincorporación más rápida a sus actividades habituales. Estudios similares con mayor número de casos son necesarios para llegar a datos más concluyentes(AU)

Common bile duct (CBD) lithiasis are an unusual complication associated to gallbladder stones. It can be resolved by endoscopic retrograde cholangiopancreatography (ERCP) or, alternatively, a CBD exploration by conventional (open surgery) or laparoscopic approach.Objectives : To determine the effectiveness of laparoscopic approach versus conventional approach in CBD exploration as a treatment for choledochal lithiasis.Methods : A prospective and comparative study was carried out with a non-random intentionally selected sample consisting of 31 patients with CBD stones.Results : Both groups had no statistical differences regarding age, sex, frequency of gallbladder stones, and preoperatory ERCP. The average surgical time was 4.52 versus 3.49 hours for the laparoscopic and conventional approaches, respectively. In laparoscopic group, Kehr tube was used in 21% of patients and primary closure in 79%. In conventional group, Kehr tube was used in 29% of patients versus 71% of patients with primary closure. Biliary leak was the most frequent complication. Hospital stay was 3.14 days in the laparoscopic group versus 5.23 days in the conventional group, with no statistically significant difference.Conclusion : It was not possible to demonstrate an evident superiority of any of the groups studied, however our patients could benefit from the advantages of the laparoscopic approach in terms of less postoperative pain and faster return to their usual activities. Similar and larger studies are necessary to achieve stronger and conclusive data(AU)

Tratamiento laparoscópico de hernia incisional con malla biocompatible de ptfe intraperitoneal / Laparoscopic treatment of incisional hernia with ptfe biological mesh

Una hernia Incisional (HI) puede definirse como cualquier defecto de la pared abdominal, con o sin aumento de volumen, en el área de una cicatriz postoperatoria, perceptible o palpable por el examen clínico o imagenológico(1). La hernioplastía intraperitoneal laparoscópica constituye una opción segura para el tratamiento de hernias incisionales de la pared abdominal, asociada a una baja tasa de recurrencia que alcanza a 6,25% a largo plazo(1). Se presenta un caso de Hernioplastia laparoscópica con colocación de malla de PTFE intraperitoneal, como una alternativa válida para la reparación de hernias incisionales.

An incisional hernia can be defined a s a ny d efect o f t he abdominal wall, with or without an increase in volume, in the area of a postoperative scar, perceptible or palpable by clinical or imaging examination. The l aparoscopic i ntraperitoneal h ernioplasty is a safe option for the treatment of incisional hernias of the abdominal wall, associated with a low recurrence rate that reaches 6.25% in the long term. In this time, a case of laparoscopic hernioplasty with placement of a intraperitoneal PTFE mesh is presented as a valid alternative for the repair of incisional hernias.

Laparoscopic repair of perforated peptic ulcer: Our experience.

Laparoscopy is an important milestone in the history of surgery. Almost all abdominal surgeries can now be approached laparoscopically. Laparoscopic perforated duodenal ulcer (DU) repair has been shown to be feasible. However, whether its superior to open repair is yet to be established and has not become the standard of care. Laparoscopy offers better visualization and early recovery.

Reconstrucción anatómica laparoscópica en útero unicorne no comunicante / Laparoscopic approach for unicornuate uterus

Las alteraciones congénitas de los conductos de Müller son un amplio grupo de patología, siendo el útero unicorne una de sus manifestaciones.Se relaciona con un aumento de complicaciones obstétricas y a su vez la presencia de un cuerno rudimentario no comunicante, es causa de dolor pélvico crónico. Presentamos una paciente de 14 años aquejada de intensa dismenorrea. Mediante técnicas de imagen se evidencia la presencia de útero unicorne con cuerno rudimentario derecho no comunicante. Se realizó abordaje laparoscópico en la que se procedió a exéresis del cuerno rudimentario y posterior reconstrucción anatómica. La paciente cursó un postoperatorio sin complicaciones, obteniendo una mejoría clínica satisfactoria en sus controles posteriores. El abordaje laparoscópico a las pacientes afectas de útero unicorne no comunicante permite restablecer de forma óptima la anatomía y mejorar la sintomatología asociada. Mediante una correcta técnica laparoscópica se consigue disminuir el riesgo de adherencias posteriores, asegurando una baja tasa de complicaciones y una recuperación funcional postoperatoria precoz.

Congenital anomalies of the Müllerian ducts are a large group of pathology, and unicornuate uterus is one of its manifestations. It is associated with increased obstetric complications and the presence of cavitated non communicating rudimentary uterine which cause chronic pelvic pain. We report a 14 years old patient suffering severe dysmenorrhea. Using imaging techniques showed the presence of unicornuate uterus with non communicating rudimentary right horn. Laparoscopy was performed in which we proceeded to resection of rudimentary horn and subsequent reconstruction of the anatomy. The patient had an uneventful postoperative course, obtaining a satisfactory clinical improvement in subsequent tests. The laparoscopic approach in patients with advanced non-communicating unicornuate uterus can optimally restore the anatomy and improving associated symptoms. A proper laparoscopic approach can lower the risk of subsequent adhesions, and ensure few complications and early postoperative functional recovery.

Two Cases of Primary Splenic Hydatid Cyst in Greece

Cystic disease of the spleen is an uncommon entity in general population. Most cases result from parasitic infection by Echinococcus granulosus, a form called splenic hydatid disease (SHD), with a reported frequency of 0.5-6.0% within abdominal hydatidosis. On the contrary, an isolated splenic involvement of hydatid disease is very uncommon even in endemic regions. Two cases of primary SHD managed with open and laparoscopic radical surgery in our department are reported herein. Primary SHD is a rare entity with non-specific symptoms underlying clinical suspicion by the physician for prompt diagnosis. Surgical treatment is the mainstay therapy, while laparoscopic approach when feasible is safe, offering the advantages of laparoscopic surgery.