Drenaje endoscópico de un quiste hidatídico fistulizado a la vía biliar intrahepática / Endoscopic drainage of a liver hydatic cyst open to intrahepatic bile ducts

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[Laparoscopic treatment for Crohn's disease]. / Trattamento laparoscopico del morbo di Crohn.

AIM: Several studies have demonstrated the feasibility and safety of laparoscopic surgery for Crohn's disease. A trend towards less morbidity as compared to laparotomy has been suggested. However, problems noted early in the experience may have prevented the optimal benefit from having been conferred. Accordingly, the aim of this study was to evaluate perioperatively those patients. METHODS: All 51 patients with Crohn's disease who underwent an intestinal resection at Cleveland Clinic Florida between January 1997 and December 1998 were analyzed. RESULTS: Seventeen patients underwent laparoscopic treatment: there were no significant differences between the 2 groups as to age, gender, incidences of comorbidity, prior laparotomy, or the use of anti-inflammatory and immunosuppressive agents. Similarly, there were no significant differences between the 2 groups as to either surgical indication, intraoperative findings, or procedure performed. Moreover, there were no significant differences concerning total anesthetic time or surgical operative time, the incidence of intraoperative morbidity or need for enterolysis or stoma construction, use of intraoperative endoscopy, or need for transfusion. Significant differences were noted in the duration of patient controlled analgesic usage (3.1 days in the laparoscopic group vs 3.9 days, respectively; p = 0.03), the incidence of postoperative morbidity (7/17 patients in the laparoscopic group vs 27/34 patients: p = 0.01), and length of hospital stay (6.4 days in the laparoscopic group vs 9.6 days, respectively; p = 0.05). CONCLUSIONS: In this retrospective cohort comparative study, laparoscopic intestinal resection for Crohn's disease, when compared to laparotomy, was associated with a short duration of patient controlled analgesic usage, a lower incidence of postoperative morbidity and a shorter hospital stay, without significantly increased operative time.

[Laparoscopic surgery for colon diverticulitis]. / Chirurgia laparoscopica per diverticolite del colon.

BACKGROUND: Laparoscopic surgery is used with increasing frequency to treat colorectal pathologies and some groups have also attempted to treat the complicated forms of diverticulitis (abscesses and/or fistulas). The results reported in the international literature are still controversial, especially in terms of the duration of surgery, the frequency of laparotomic conversions and postoperative morbidity. The aim of this study was to analyse the results of laparoscopic or laparotomic treatment of diverticular disease of the colon in patients admitted to the Department of Colorectal Surgery at the Cleveland Clinic in Florida over a three-year period. METHODS: A retrospective analysis was made of 57 patients with diverticular disease of the colon who were admitted to CCF (Cleveland Clinic Florida) between January 1996 and December 1998 and underwent elective laparoscopic or laparotomic surgery. A comparative analysis was made of the results in the two groups. RESULTS: Of the 57 patients treated only 15 underwent laparoscopic surgery; the majority were treated for uncomplicated diverticulitis. 22 out of 42 patients (53%) undergoing laparotomic surgery presented complicated diverticulitis (abscesses, fistulas or stenosis), whereas 12 out of 15 patients undergoing laparoscopic surgery (80%) were treated for uncomplicated diverticulitis. Statistically significant differences were found in relation to the duration of surgery: 152 min in the laparotomic group vs 209 in the laparoscopic group. No differences were found in the frequency of intraoperative complications, transfusions and the number of drainages inserted (p=0.66). The postoperative period showed significant differences in terms of the reappearance of intestinal peristalsis, use of PCA and postoperative stay. CONCLUSIONS: This retrospective study confirms that the laparoscopic treatment of colon diverticulitis offers a number of advantages: reduced postoperative pain, more rapid recovery of intestinal peristalsis and shorter postoperative stay. Laparoscopic sigma colectomy represents the treatment of choice for diverticulitis in uncomplicated cases.

Tumor desmoide de pared abdominal. Reconstrucción con doble prótesis de PTFE y polipropileno / Demoid tumor or the abdominal wall. Reconstruction using both PTFE and polypropylene prostheses

Los autores presentan un caso de tumor desmoide de pared abdominal originado en una cicatriz quirúrgica antigua en una mujer de 32 años. Precisó varias intervenciones para la reconstrucción de la pared abdominal, por infección inicial del material protésico con Staphylococcus aureus, logrando eventualmente la reparación del defecto aponeurótico con la colocación combinada de una malla de politetrafluoroetileno expandido intraperitoneal y de polipropileno extraperitoneal por debajo del tejido subcutáneo (AU)

Neumatosis portal hepática secundaria a diverticulitis del colon sigmoide / Hepatic portal pneumatosis secondary to sigmoid colon diverticulitis 299

Los autores presentan un caso de neumatosis del sistema portal y venoso hepático como consecuencia de una diverticulitis del colon sigmoide en un varón de 59 años. La enfermedad se inició con fiebre en agujas de origen incierto durante 3 semanas. El diagnóstico se sospechó al realizar una TAC que puso de manifiesto gas en el parénquima hepático, en la vena mesentérica inferior y en el mesocolon sigmoide. La laparotomía confirmó la presencia de un absceso entre las hojas del meso del sigma con fistulización a los vasos sigmoideos y tromboflebitis séptica de la vena mesentérica inferior (AU)

Laparoscopic treatment of large paraesophageal hernias: both excision of the sac and gastropexy are imperative for adequate surgical treatment.

BACKGROUND: We set out to evaluate the results of the laparoscopic treatment of large paraesophageal hernias in 22 patients. METHODS: Between 1993 and 1998, we operated on 22 consecutive patients. Preoperative assessment consisted of endoscopy, barium esophagogram, 24-h pH testing, manometry, and gastric emptying times. RESULTS: In the first three patients, the sac was not excised and gastropexy was not performed. Because of recurrences, we decided to change the technique in an attempt to avoid further complications. During middle- to long-term follow-up, only three recurrences were seen in the subsequent 19 patients. There were no deaths in this series. CONCLUSIONS: Laparoscopic treatment of large paraesophageal hernias is feasible. Because recurrences may occur after successful laparoscopic treatment, both resection of the sac and some form of gastropexy are imperative.

[Acute abdomen as a complication of a duodenal duplication cyst]. / Abdomen agudo como complicación de un quiste de duplicación duodenal.

The authors report an exceptional case of acute abdomen caused by the necrosis and perforation of a duodenal duplication cyst in a 23 year-old-patient. The cyst was located at the anterior and lateral surface of the duodenum, between its first and second portion. The patient underwent a cephalic duodenopancreatectomy (Whipple's procedure) because of the intimate adherence of the necrotic and inflammatory mass to duodenum and head of the pancreas. The histological examination of surgical specimen confirmed the diagnosis, showing a cystic structure lined with an epithelium and a common muscle wall shared by the cyst and the duodenum. There was no communication between the cyst and duodenal lumen.