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1.
Cir Esp ; 81(2): 96-8, 2007 Feb.
Article in Spanish | MEDLINE | ID: mdl-17306126

ABSTRACT

OBJECTIVE: To analyze the results obtained in patients undergoing laparoscopic surgery for perforated duodenal ulcer. PATIENTS AND METHOD: From January 2000 to August 2006, 15 consecutive patients with perforated duodenal ulcer underwent laparoscopic surgery after preoperative selection (ASA scores, time since onset of the perforation). RESULTS: The mean age was 44.6 +/- 15.5 years (range, 18-75). There were 10 men and five women. Fourteen patients were ASA I-II. Time since onset of perforation was more than 12 hours in only one patient. Operative time was 70.5 +/- 9.6 minutes. There were two conversions (13.3%) to the open approach and two postoperative complications (prolonged ileus in one patient and self-limiting leakage in another). There were no intra-abdominal collections or mortality in the entire series. The mean length of hospital stay was 6.5 +/- 2.1 days. CONCLUSIONS: In selected patients, laparoscopic treatment of perforated duodenal ulcer is safe and feasible. Technical standardization and appropriate patient selection are essential to define the real role of the laparoscopic approach in perforated duodenal ulcer.


Subject(s)
Duodenal Ulcer/surgery , Laparoscopy , Peptic Ulcer Perforation/surgery , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged
2.
Cir. Esp. (Ed. impr.) ; 81(2): 96-98, feb. 2007.
Article in Es | IBECS | ID: ibc-051749

ABSTRACT

Objetivo. Analizar los resultados obtenidos en los pacientes intervenidos de úlcera duodenal perforada por vía laparoscópica. Pacientes y método. Quince pacientes intervenidos consecutivamente desde enero de 2000 hasta agosto de 2006, previa selección preoperatoria (ASA y tiempo de evolución de la perforación). Resultados. La media de edad del grupo era de 44,6 ± 15,5 (intervalo, 18-75) años; 10 varones y 5 mujeres; 14 pacientes fueron clasificados como ASAI-II. Sólo en un paciente la duración de la clínica de perforación fue > 12 h. El tiempo quirúrgico fue de 70,5 ± 9,6 min. Se han producido 2 (13,3%) conversiones a cirugía abierta y 2 complicaciones postoperatorias: un paciente presentó íleo y el otro caso, una fístula autolimitada. No se han evidenciado dehiscencias de la sutura duodenal o absceso intraabdominal. No se han producido reintervenciones ni mortalidad. La estancia media hospitalaria fue de 6,5 ± 2,1 días. Conclusiones. En casos seleccionados el tratamiento laparoscópico de la úlcera duodenal perforada es seguro y factible. La estandarización de la técnica y una adecuada selección de los casos son las claves que, en un futuro, deberemos desarrollar a fin de establecer cuál es el papel real del tratamiento laparoscópico en la úlcera duodenal perforada (AU)


Objective. To analyze the results obtained in patients undergoing laparoscopic surgery for perforated duodenal ulcer. Patients and method. From January 2000 to August 2006, 15 consecutive patients with perforated duodenal ulcer underwent laparoscopic surgery after preoperative selection (ASA scores, time since onset of the perforation). Results. The mean age was 44.6 ± 15.5 years (range, 18-75). There were 10 men and five women. Fourteen patients were ASA I-II. Time since onset of perforation was more than 12 hours in only one patient. Operative time was 70.5 ± 9.6 minutes. There were two conversions (13.3%) to the open approach and two postoperative complications (prolonged ileus in one patient and self-limiting leakage in another). There were no intra-abdominal collections or mortality in the entire series. The mean length of hospital stay was 6.5 ± 2.1 days. Conclusions. In selected patients, laparoscopic treatment of perforated duodenal ulcer is safe and feasible. Technical standardization and appropriate patient selection are essential to define the real role of the laparoscopic approach in perforated duodenal ulcer (AU)


Subject(s)
Humans , Laparoscopy/methods , Duodenal Ulcer/surgery , Peptic Ulcer Perforation/surgery , Patient Selection , Length of Stay/statistics & numerical data , Postoperative Complications/epidemiology , Emergency Treatment/methods
3.
Cir Esp ; 79(4): 231-6, 2006 Apr.
Article in Spanish | MEDLINE | ID: mdl-16753103

ABSTRACT

OBJECTIVE: To present our initial results in the laparoscopic treatment of gastric cancer. MATERIAL AND METHOD: Between March 2002 and June 2005, 12 selected patients with resectable distal gastric cancer and oncological indication for radical treatment underwent laparoscopic gastrectomy. RESULT: There were 9 men and 3 women. The mean age was 62.6 years (range: 45-78). Ten D2 subtotal gastrectomies, with B-II reconstruction in 7 and B-III reconstruction in the remaining 3, were performed. In 6 patients, reconstruction was performed entirely by laparoscopy, while in the remaining 4 patients extracorporeal reconstruction was performed. Two total gastrectomies were performed: one was performed entirely by laparoscopy while in the other, laparoscopic-assisted gastrectomy with extracorporeal esophagojejunal anastomosis was carried out. The mean operating time was 197.6 +/- 36.9 (130-260) minutes, although mean operating time was 142.5 minutes in the subgroup that underwent subtotal gastrectomy with extracorporeal anastomosis compared with 190.8 minutes when totally laparoscopic anastomosis was performed (p < 0.002). There were no intraoperative complications or conversions. Postoperative complications occurred in 3 patients: postoperative ileus for 7 days in 1 patient, intra-abdominal abscess requiring laparotomy in 1 patient and esophagojejunal anastomotic leak that resolved without reintervention in a third patient. Oral intake was reinitiated at 72 hours in 9 patients, while a further 2 required 5 days and the patient with postoperative ileus required 8 days. The mean length of postoperative stay was 10.7 +/- 7.3 (6-28) days. The mean number of resected nodes was 21.3 +/- 5 (16-31). There was 1 locoregional recurrence at 14 months in a patient with stage IIIB tumor after a mean follow-up of 25.8 months (4-73). CONCLUSIONS: Laparoscopic gastrectomy in the treatment of gastric cancer is technically feasible and is an alternative to open surgery in terms of postoperative morbidity and mortality and oncological effectiveness when performed by teams with experience in laparoscopy and with appropriate patient selection.


Subject(s)
Gastrectomy/methods , Laparoscopy , Stomach Neoplasms/surgery , Aged , Female , Humans , Male , Middle Aged
4.
Cir. Esp. (Ed. impr.) ; 79(4): 231-236, abr. 2006. ilus, tab
Article in Es | IBECS | ID: ibc-044357

ABSTRACT

Objetivo. Presentar nuestros resultados iniciales en el tratamiento laparoscópico del cáncer gástrico. Material y método. Durante el período comprendido entre marzo de 2002 y junio de 2005 se ha tratado a 12 pacientes seleccionados que presentaban un cáncer gástrico distal resecable, a los que se ha practicado una gastrectomía laparoscópica con criterios oncológicos de radicalidad. Resultados. Nueve pacientes eran varones y 3, mujeres. La edad media fue de 62,6 años (rango, 45-78). Se han practicado 10 gastrectomías subtotales D2, con reconstrucción B-II en 7 de ellos y B-III en los 3 restantes. En 6 pacientes estas reconstrucciones se realizaron por laparoscopia en su totalidad, mientras en los otros 4 casos ésta se realizó de forma extracorpórea. En cuanto a las 2 gastrectomías totales, una se llevó a cabo íntegramente por laparoscopia, mientras que la otra fue asistida, y se realizó la anastomosis esofagoyeyunal extracorpórea. El tiempo quirúrgico medio fue de 197,6 ± 36,9 (130-260) min, si bien el tiempo del subgrupo de gastrectomía subtotal con anastomosis extracorpórea fue de 142,5 min frente a 190,8 min si se realizaba la anastomosis totalmente laparoscópica (p < 0,002). No se han producido complicaciones intraoperatorias ni conversiones. Tres pacientes han presentado complicaciones postoperatorias: 1 íleo prolongado durante 7 días, 1 absceso intrabdominal que precisó laparotomía y 1 fuga anastomótica esofagoyeyunal que se resolvió sin reintervención. La ingesta oral se reinició a las 72 h en 9 pacientes, mientras que otros 2 precisaron 5 días, y el paciente del íleo prolongado, 8. La estancia media postoperatoria fue de 10,7 ± 7,3 (6-28) días. La media de ganglios extirpados fue de 21,3 ± 5 (16-31). Se ha objetivado una recidiva locorregional a los 14 meses en pacientes en estadio III tras un seguimiento medio de 25,8 meses (4-73). Conclusiones. La gastrectomía laparoscópica en el tratamiento del cáncer gástrico es técnicamente factible, y se perfila como una alternativa a la cirugía abierta en cuanto a morbimortalidad postoperatoria y eficacia oncológica cuando la realizan grupos con experiencia laparoscópica y con una adecuada selección de los casos (AU)


Objective. To present our initial results in the laparoscopic treatment of gastric cancer. Material and method. Between March 2002 and June 2005, 12 selected patients with resectable distal gastric cancer and oncological indication for radical treatment underwent laparoscopic gastrectomy. Results. There were 9 men and 3 women. The mean age was 62.6 years (range: 45-78). Ten D2 subtotal gastrectomies, with B-II reconstruction in 7 and B-III reconstruction in the remaining 3, were performed. In 6 patients, reconstruction was performed entirely by laparoscopy, while in the remaining 4 patients extracorporeal reconstruction was performed. Two total gastrectomies were performed: one was performed entirely by laparoscopy while in the other, laparoscopic-assisted gastrectomy with extracorporeal esophagojejunal anastomosis was carried out. The mean operating time was 197.6 ± 36.9 (130-260) minutes, although mean operating time was 142.5 minutes in the subgroup that underwent subtotal gastrectomy with extracorporeal anastomosis compared with 190.8 minutes when totally laparoscopic anastomosis was performed (p < 0.002). There were no intraoperative complications or conversions. Postoperative complications occurred in 3 patients: postoperative ileus for 7 days in 1 patient, intra-abdominal abscess requiring laparotomy in 1 patient and esophagojejunal anastomotic leak that resolved without reintervention in a third patient. Oral intake was reinitiated at 72 hours in 9 patients, while a further 2 required 5 days and the patient with postoperative ileus required 8 days. The mean length of postoperative stay was 10.7 ± 7.3 (6-28) days. The mean number of resected nodes was 21.3 ± 5 (16-31). There was 1 locoregional recurrence at 14 months in a patient with stage IIIB tumor after a mean follow-up of 25.8 months (4-73) Conclusions. Laparoscopic gastrectomy in the treatment of gastric cancer is technically feasible and is an alternative to open surgery in terms of postoperative morbidity and mortality and oncological effectiveness when performed by teams with experience in laparoscopy and with appropriate patient selection (AU)


Subject(s)
Male , Female , Middle Aged , Humans , Gastrectomy/methods , Anastomosis, Surgical/methods , Gastroscopy/methods , Tomography, Emission-Computed/methods , Laparoscopy/methods , Anastomosis, Roux-en-Y/methods , Postoperative Complications/diagnosis , Postoperative Complications/therapy , Stomach Neoplasms/complications , Stomach Neoplasms/surgery , Gastrectomy/ethics , Gastrectomy/trends , Anastomosis, Surgical/standards , Anastomosis, Surgical/trends , Abdomen/pathology , Abdomen/surgery , Abdomen , Lymph Node Excision/methods
5.
Surg Innov ; 13(4): 231-7, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17227921

ABSTRACT

Gastrointestinal stromal tumors (GISTs) account for 5% of all gastric tumors. Preoperative diagnosis is relatively difficult because biopsy samples are rarely obtained during fibergastroscopy. Surgical radical resection is the gold standard treatment, allowing pathologic study for both diagnosis and prognosis. Laparoscopic resection has become an alternative to the open approach, but long-term results are not well known. The aim of this study is to report experience with laparoscopic resection, placing special emphasis on preoperative diagnosis and describing long-term results. A retrospective analysis was made of all patients undergoing a laparoscopic resection for clinically suspected gastrointestinal stromal tumors between November 1998 and August 2006 at 2 tertiary hospitals. The medical records of all participants were reviewed regarding surgical technique, clinicopathologic features, and postoperative long-term outcome. Laparoscopic gastric resection was attempted in 22 patients (13 women and 9 men) with a mean age of 66.7 years (range, 29-84 years). One patient had 2 gastric tumors. Tumor localization was upper gastric third in 6 patients, mid-gastric third in 7, and distal third in 10. Surgical techniques were transgastric submucosal excision (n = 1), wedge resection (n = 13), partial gastrectomy with Y-en-Roux reconstruction (n = 6), and total gastrectomy with Y-en-Roux reconstruction (n = 2). Two patients (9.1%) required conversion to the open procedure because of tumor size. Postoperative morbidity was delayed gastric emptying in 3 patients. Median postoperative stay was 6 days (range, 4-32 days). Pathologic and immunohistochemical study confirmed gastrointestinal stromal tumors in 18 cases. The other 4 cases were adenomyoma, hamartoma, plasmocytoma, and parasitic tumor (anisakis). Median tumor size was 5.6 cm (range, 2.5-12.5 cm) in cases of gastrointestinal stromal tumors. Malignant risk of gastrointestinal stromal tumors assessed according to mitotic index and size was low (n = 8), intermediate (n = 6), or high (n = 4). After a median follow-up of 32 months (range, 1-72 months), there was 1 case of recurrence of GIST. Definitive preoperative diagnosis of gastric submucosal tumors is frequently difficult. The laparoscopic approach to surgical treatment of these tumors seems safe and is associated with acceptable intermediate-term results, especially in cases of gastrointestinal stromal tumors.


Subject(s)
Gastrectomy/methods , Gastrointestinal Stromal Tumors/surgery , Laparoscopy , Stomach Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Anastomosis, Roux-en-Y , Female , Gastrectomy/adverse effects , Gastrointestinal Stromal Tumors/pathology , Humans , Laparoscopy/adverse effects , Length of Stay , Male , Middle Aged , Retrospective Studies , Stomach Neoplasms/pathology , Treatment Outcome
6.
J Laparoendosc Adv Surg Tech A ; 14(6): 362-7, 2004 Dec.
Article in English | MEDLINE | ID: mdl-15684783

ABSTRACT

BACKGROUND: This study evaluates the results obtained in recurrent inguinal hernia repair over the past ten years in a general hospital using laparoscopic (LAP) and open tension-free mesh (Lichtenstein) procedures. METHODS: A prospective controlled study with 258 recurrent inguinal hernias in 235 patients over a ten-year period. The main outcome measurements were recurrence rate, operating time, hospital stay, postoperative complications, and cost. RESULTS: There were 10 recurrences (4.3%): 7 in the Lichtenstein group (5.7%) and 3 (2.2%) in the LAP group (P = nonsignificant [NS]). There were 15 (12.2%) postoperative complications in the Lichtenstein group and 6 (4.4%) in the LAP group (P =0.04). The operating room costs were higher in the LAP group, but this difference was offset by a significantly shorter hospital stay, shorter operating time, and earlier return to work. CONCLUSION: Laparoscopic repair is an effective option for the treatment of recurrent inguinal hernia. The TEP approach combines the advantages of minimal invasive surgery and those of tension-free mesh repair, reducing operating time, postoperative morbidity, and recurrence rate.


Subject(s)
Hernia, Inguinal/surgery , Female , Follow-Up Studies , Humans , Laparoscopy , Length of Stay , Male , Middle Aged , Postoperative Complications , Prospective Studies , Recurrence , Surgical Mesh , Time Factors
7.
Cir. Esp. (Ed. impr.) ; 73(4): 227-232, abr. 2003. tab
Article in Es | IBECS | ID: ibc-21388

ABSTRACT

Objetivo. Conocer el coste económico del tratamiento laparoscópico de la hernia inguinal recidivada en nuestro medio comparándolo con la técnica de Lichtenstein. Material y métodos. Estudio prospectivo realizado en 204 hernias inguinales recidivadas intervenidas en 184 pacientes durante el período comprendido entre enero de 1992 y enero de 2001. Los pacientes se dividieron en 2 grupos: a) grupo LAP (se les practicó una reparación protésica preperitoneal por vía laparoscópica), y b) grupo LICHT (reparación protésica anterior tipo Lichtenstein).Las variables analizadas fueron: coste del material quirúrgico, estancia hospitalaria postoperatoria y tiempo de baja laboral. Resultados. El material quirúrgico de un Lichtenstein ha costado 89,41 frente a los 353,22 de un procedimiento laparoscópico.El grupo LAP precisó 124,08 días de estancias hospitalarias, mientras el grupo LICHT ha requerido 279,36. Esta disminución de estancias, junto al ahorro por la reducción de la ILT (9.891,46 ), ha permitido un ahorro global de 13.934,26 en el grupo LAP. El coste medio total de un procedimiento laparoscópico ha sido de 1.291,61 , mientras un Lichtenstein ha costado 1.514,46. Conclusiones. Los resultados de este estudio demuestran que el tratamiento laparoscópico de la hernia inguinal recidivada, además de presentar mejores resultados clínicos, es económicamente más rentable que la cirugía abierta protésica si se analiza el proceso en su totalidad (AU)


Subject(s)
Adult , Aged , Female , Male , Middle Aged , Humans , Hernia, Inguinal/surgery , Laparoscopy/economics , Health Care Costs/statistics & numerical data , Recurrence , Surgical Equipment/economics , Digestive System Surgical Procedures/economics
8.
Cir. Esp. (Ed. impr.) ; 71(5): 244-246, mayo 2002. tab
Article in Es | IBECS | ID: ibc-11876

ABSTRACT

Introducción. El objetivo de este estudio es la evaluación de nuestros resultados obtenidos con el tratamiento laparoscópico precoz en la colecistitis aguda. Pacientes y método. Se estudió a los pacientes intervenidos de colecistitis aguda mediante colecistectomía laparoscópica precoz durante el período comprendido entre julio de 1993 y enero de 2002. Con anterioridad al estudio se establecieron 5 criterios de selección para su acceso laparoscópico: a) diagnóstico clínico-analítico-ecográfico de colecistitis aguda; b) inicio de los síntomas no superior a las 72 h; c) analítica hepática normal y vía biliar principal no dilatada y sin imágenes sugestivas de litiasis coledocal en la exploración ecográfica; d) estado general del paciente sin contraindicación para la laparoscopia, y e) ausencia de cirugía supramesocólica. Resultados. Un total de 158 pacientes fueron tratados por colecistitis aguda. De ellos, en 73 enfermos (46,2 por ciento) se llevó a cabo colecistectomía laparoscópica precoz y en 12 casos fue preciso realizar conversión a cirugía abierta (16,4 por ciento). Presentaron complicaciones 9 pacientes (12,3 por ciento), y cuatro precisaron reintervención, uno de ellos por una lesión de la vía biliar principal, dos por hemoperitoneo por hemorragia del lecho hepático y uno por absceso intraabdominal. La estancia media fue de 5,6 días. Conclusiones. Los resultados de este estudio han demostrado que el uso de la colecistectomía laparoscópica precoz en la colecistitis aguda es seguro y factible (AU)


Subject(s)
Adult , Aged , Female , Male , Middle Aged , Humans , Cholecystitis/surgery , Cholecystitis/diagnosis , Laparoscopy/methods , Gallstones/surgery , Gallstones/complications , Laparoscopy/methods , Laparoscopy/trends , Laparoscopy , Epidemiology, Descriptive , Prospective Studies , Laparoscopy , Laparoscopy/adverse effects , Laparoscopy/instrumentation
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