ABSTRACT
Paraesophageal hernia (PEH) repair is one of the most challenging upper gastrointestinal operations. Its high rate of recurrence is due mostly to the low quality of the crura and size of the hiatal defect. In an attempt to diminish the recurrence rates, some clinical investigators have begun performing mesh-reinforced cruroplasty with nonabsorbable meshes like polypropylene or polytetrafluoroethylene. The main problem with these materials is the occurrence, in some patients, of serious mesh-related morbidities, such as erosions into the stomach and the esophagus, some of which necessitate subsequent esophagectomy or gastrectomy. Absorbable meshes can be synthetic or biological and were introduced in recent years for PEH repair with the intent of diminishing the recurrence rates observed after primary repair alone but, theoretically, without the risks of morbidities presented by the nonabsorbable meshes. The current role of absorbable meshes in PEH repair is still under debate, since there are few data regarding their long-term efficacy, particularly in terms of recurrence rates, morbidity, need for revision, and quality of life. In this opinion review, we analyze all the presently available evidence of reinforced cruroplasty for PEH repair using nonabsorbable meshes (synthetic or biological), focusing particularly on recurrence rates, mesh-related morbidity, and long-term quality of life.
ABSTRACT
Bariatric surgery is performed usually in a videolaparoscopic form. This involves that surgeons must have the abilities of advanced laparascopy. The learning curve was previously analyzed in numerous reports. This curriculums for the fellowships include the development of cognitive abilities and clinicotechnical training. Through the Course of Specialists for Metabolic and Bariatric Surgery from the Buenos Aires University, four fellows have been formed. In this study, the training modality is described
La cirugía bariátrica se realiza generalmente de forma videolaparoscópica. Esto implica que los cirujanos tengan habilidades de laparoscopía avanzada. La curva de aprendizaje se ha analizado en numerosos trabajos. Las currículas para los fellowship incluyen el desarrollo de habilidades cognitivas y clínico-técnicas. A través de la Carrera de Especialista en Cirugía Bariátrica y Metabólica de la UBA se han formado cuatro fellows. En este trabajo se describe la modalidad de aprendizaje
Subject(s)
Humans , Obesity, Morbid/surgery , Laparoscopy/education , Educational Measurement , Health Postgraduate Programs , Bariatric Surgery/education , Fellowships and Scholarships , Learning CurveABSTRACT
PURPOSE: PET/CT has been considered limited for the evaluation of mucinous colorectal tumors due to low (18)F-FDG uptake. The aim of our study was to compare PET/CT variables in mucinous (MC) and nonmucinous (NMC) rectal adenocarcinomas. METHODS: Consecutive patients with cT2-4N0-2M0 rectal cancer included in a prospective clinical trial were reviewed. PET/CT was performed for primary baseline staging. Visual and quantitative analysis included SUVmax and SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG). PET/CT parameters were compared according to histological subtypes. RESULTS: Overall, 73 patients were included (18 mucinous and 55 nonmucinous). SUVmax values were similar between MC and NMC (19.7 vs. 16.6; p = 0.5). MTV and TLG values were greater in the MC group (103.9 vs. 54.1; p = 0.007 and 892.5 vs. 358.8; p = 0.020) due to larger tumor volumes of MC. CONCLUSIONS: Metabolic parameters at baseline PET/CT for patients with rectal cancer are similar in mucinous and nonmucinous histological subtypes.
