Abordaje laparoscópico del páncreas izquierdo / Laparoscopic approach of the left side of the páncreas

Introducción: La pancreatectomía izquierda laparoscópica (PIL) es una técnica quirúrgica cada vez más utilizada para el tratamiento de lesiones benignas y malignas del páncreas izquierdo. Analizamos los resultados de nuestra serie de PIL para el tratamiento de las lesiones primarias de cuerpo y cola pancreáticos. Métodos: Desde noviembre de 2011 a noviembre de 2017 se han intervenido 18 pacientes por lesiones primarias del páncreas realizándose una pancreatectomía distal laparoscópica. En todos los casos se dejó un drenaje intraabdominal y se siguieron las recomendaciones del International Study Group for Pancreatic Fistula (ISGPF). Resultados: La mediana de edad fue de 66,5 años (RIQ 46-74). De las 18 pancreatectomías izquierdas, cuatro se realizaron con preservación esplénica, una de ellas una pancreatectomía central. Hubo dos conversiones. La mediana del tiempo operatorio fue de 247,5 min (RIQ242-275). La mediana de estancia hospitalaria fue de 7 días (RIQ6-8). A los 90 días se detectaron complicaciones en cinco pacientes: tres grado II, una grado III y una grado V según la clasificación modificada de Clavien-Dindo. Hubo una fístula pancreática grado B y cuatro pacientes reingresaron por colecciones peripancreáticas. La anatomía patológica evidenció malignidad en el 38,9% de los casos, presentando todos ellos márgenes negativos. Conclusiones: La PIL puede ser considerada técnica de elección para el tratamiento de las lesiones pancreáticas benignas y una alternativa al abordaje abierto para pacientes seleccionados diagnosticados de neoplasias malignas, siempre que la realicen cirujanos con experiencia en cirugía pancreática y laparoscópica avanzada

Introduction: Laparoscopic left-sided pancreatectomy (LLP) is an increasingly used surgical technique for the treatment of benign and malignant lesions of the left side of the pancreas. The results of LLP as a treatment for primary pancreatic lesions of the head and tail of the pancreas were evaluated. Methods: From November 2011 to November 2017, 18 patients underwent surgery for primary lesions of the pancreas by means of a laparoscopic distal pancreatectomy. An intra-abdominal drain tube was used in all cases, and the recommendations of the International Study Group for Pancreatic Fistula (ISGPF) were followed. Results: The mean age was 66.5 years (IQR 46-74). Among the 18 left pancreatectomies performed, four were with splenic preservation, and one was a central pancreatectomy. There were two conversions. The median surgical time was 247.5 minutes (IQR 242-275). The median postoperative hospital stay was 7 days (IQR 6-8). After 90 days, complications were detected in five patients: three grade II, one grade III and one grade V according to the modified Clavien-Dindo classification. There was one grade B pancreatic fistula, and four patients had to be readmitted to hospital because of peripancreatic collections. The anatomic pathology diagnosis was malignant neoplasm in 38.9% of cases, all of them with negative resection margins. Conclusions: LLP can be considered the technique of choice in the treatment of primary benign pancreatic lesions and an alternative to the open approach in selected patients diagnosed with malignant pancreatic lesions

Laparoscopic approach of the left side of the pancreas. / Abordaje laparoscópico del páncreas izquierdo.

INTRODUCTION: Laparoscopic left-sided pancreatectomy (LLP) is an increasingly used surgical technique for the treatment of benign and malignant lesions of the left side of the pancreas. The results of LLP as a treatment for primary pancreatic lesions of the head and tail of the pancreas were evaluated. METHODS: From November 2011 to November 2017, 18 patients underwent surgery for primary lesions of the pancreas by means of a laparoscopic distal pancreatectomy. An intra-abdominal drain tube was used in all cases, and the recommendations of the International Study Group for Pancreatic Fistula (ISGPF) were followed. RESULTS: The mean age was 66.5years (IQR 46-74). Among the 18 left pancreatectomies performed, four were with splenic preservation, and one was a central pancreatectomy. There were two conversions. The median surgical time was 247.5minutes (IQR 242-275). The median postoperative hospital stay was 7days (IQR 6-8). After 90days, complications were detected in five patients: three gradeII, one gradeIII and one gradeV according to the modified Clavien-Dindo classification. There was one gradeB pancreatic fistula, and four patients had to be readmitted to hospital because of peripancreatic collections. The anatomic pathology diagnosis was malignant neoplasm in 38.9% of cases, all of them with negative resection margins. CONCLUSIONS: LLP can be considered the technique of choice in the treatment of primary benign pancreatic lesions and an alternative to the open approach in selected patients diagnosed with malignant pancreatic lesions.

Linfoma MALT de vesícula biliar / MALT lymphoma of the gallbladder

No disponible

Mucocele apendicular: presentación de 31 casos / Mucocele of the appendix: Presentation of 31 cases

El mucocele apendicular es una enfermedad poco frecuente que se estima en el 0,2–0,3% de todas las apendicectomías y que en nuestra serie supone el 0,28%. El término mucocele hace referencia a la dilatación del apéndice por moco, causada tanto por un proceso benigno como maligno (cistoadenoma o adenocarcinoma).Material y métodos Presentamos una serie de 31 casos (17 mujeres) tratados en 18 años y con una edad media de 62 años. El dato clínico mas frecuente fue dolor en la fosa ilíaca derecha de menos de 72h de evolución que simulaba una apendicitis aguda, lo que ocurrió en 14 casos (45%).Resultados En 21 casos el estudio histológico mostró benignidad. En todos los casos se extirpó el apéndice, en 5 casos por laparoscopia, y se añadió resección cecal en 8 casos (uno era un cistoadenocarcinoma) e ileocolectomía derecha en 15 pacientes (9 eran malignos).Conclusiones Se recomienda el seguimiento, no sólo para el control de la enfermedad apendicular, sino por la alta incidencia de procesos tumorales sincrónicos o metacrónicos en otras áreas (AU)

Mucocele of the appendix is a very uncommon disease estimated to be seen in 0.2–0.3% of all appendectomies (0.28% in our series). The term “mucocele” means dilation of the appendix due to mucus, caused either by a benign process or a malignant one (cystadenoma or adenocarcinoma).Material and methods We present a series of 31 cases (17 females) treated over 18 years and with a mean age of 62 years. The most frequent clinical symptom (14 cases, 45%) was pain in the right iliac fossa of less than 72h onset which simulates acute appendicitis. Results The histology results showed that it was benign in 21 cases. The appendix was removed in all cases; five by laparoscopy, with caecal resection in 8 cases (1 was a cystadenocarcinoma) and right ileocolectomy in 15 patients (9 malignant).Conclusion Follow up is recommended, not only to monitor the appendicular disease, but also due to the high incidence of synchronic or metachronic tumour processes in other areas (AU)

[Mucocele of the appendix: Presentation of 31 cases]. / Mucocele apendicular: presentación de 31 casos.

UNLABELLED: Mucocele of the appendix is a very uncommon disease estimated to be seen in 0.2-0.3% of all appendectomies (0.28% in our series). The term "mucocele" means dilation of the appendix due to mucus, caused either by a benign process or a malignant one (cystadenoma or adenocarcinoma). MATERIAL AND METHODS: We present a series of 31 cases (17 females) treated over 18 years and with a mean age of 62 years. The most frequent clinical symptom (14 cases, 45%) was pain in the right iliac fossa of less than 72 h onset which simulates acute appendicitis. RESULTS: The histology results showed that it was benign in 21 cases. The appendix was removed in all cases; five by laparoscopy, with caecal resection in 8 cases (1 was a cystadenocarcinoma) and right ileocolectomy in 15 patients (9 malignant). CONCLUSION: Follow up is recommended, not only to monitor the appendicular disease, but also due to the high incidence of synchronic or metachronic tumour processes in other areas.