Results of laparoscopic cholecystectomy in a third-level university hospital after 17 years of experience.

OBJECTIVE: The aim of the study is to determine the results obtained with laparoscopic cholecystectomy at Ramón y Cajal Hospital after 17 years of experience, comparing current results with those at the beginning of the experience. MATERIAL AND METHODS: Between 1991 and December 2007, 3,933 laparoscopic cholecystectomies were performed at the "Ramón y Cajal Hospital"; 1,849 patients were operated on between 1991 and 2000, and 2,084 between 2001 and 2007. Patients studied included 69.8% of women and 30.2% of men, with a mean age of 56.95 years (range 9-94 years). In all, 54.68% of patients had a concomitant disease before surgery (hypertension, diabetes, ischemic heart disease, respiratory disease). Surgery was performed by a staff surgeon for 58.04% of cases, and by a resident in the remaining 41.96%. Surgical indications were cholelithiasis in 75.5%, pancreatitis in 13.3%, cholecystitis in 6.3%, choledocholithiasis in 3.05%, and others in 1.2% of cases. RESULTS: Mean hospital stay was 3.06 days. Conversion to open surgery was required for 8.3% of cases (331 patients). The major surgical complication rate was 2.34%, with the most frequent being hemoperitoneum (1%). Common bile duct injury occurred in thirteen cases (0.3%), 51 patients (1.3%) were soon re-operated, and 5 patients died (0.13%). When the results of both decades (1991-2000 vs. 2001-2007) were compared, we observed differences in the number of procedures performed by residents (31.7 vs. 51.1%, p = 0.00001), number of laparoscopic cholecystectomies for cholecystitis (4.9 vs. 7.53%, p = 0.001), conversion rate (5.46 vs. 11%, p = 0.000001), and mean hospital stay (2.43 vs. 3.7 days, p = 0.001). CONCLUSION: These results should be interpreted with caution as this is a retrospective study with multiple uncontrolled variables (high number of surgeons and continuous learning curve). The lower conversion rate and mean hospital stay in the first decade of the learning curve are amazing, although this could be related to better patient selection and a lower number of cholecystites operated using a laparoscopic approach in the initial series. In general, these results are acceptable and concur with the rest of the literature.

Resultados de la colecistectomía laparoscópica en un hospital universitario de tercer nivel tras 17 años de experiencia / Results of laparoscopic cholecystectomy in a third-level university hospital after 17 years of experience

Objetivo: el objetivo del estudio es conocer los resultados obtenidos con la colecistectomía laparoscópica en el Hospital Ramón y Cajal en sus 17 años de experiencia, comparando los resultados actuales con los del inicio de la experiencia. Material y métodos: entre enero de 1991 y diciembre de 2007 se efectuaron en el Hospital Ramón y Cajal un total de 3.933 colecistectomías laparoscópicas. Fueron intervenidos 1.849 pacientes entre 1991-2000 y 2.084 entre 2001-2007. Un 69,8% eran mujeres y un 30,2% varones con una edad media de 56,95 años (rango 9-94 años). Un 54,68% de pacientes presentaban antecedentes personales de forma previa a la intervención (hipertensión, diabetes, cardiopatía isquémica, bronquitis...). La cirugía fue efectuada por un personal del staff en el 58,04% de los casos y por un residente de cirugía en el 41,96%. Las indicaciones quirúrgicas fueron colelitiasis 75,5%, pancreatitis 13,3%, colecistitis 6,3%, coledocolitiasis 3,05% y otros 1,2%. Resultados: la estancia media postoperatoria fue de 3,06 días. La tasa de conversión a cirugía abierta de 8,3% (331 pacientes) y la de complicaciones quirúrgicas mayores del 2,34%, siendo la más frecuente el hemoperitoneo (1%). Se produjeron 13 lesiones de la vía biliar durante la cirugía laparoscópica (0,3%), 51 pacientes (1,3%) fueron reintervenidos precozmente tras la cirugía (hemo-/coleperitoneo) y fallecieron un total de 5 pacientes (0,13%). Cuando comparamos los resultados entre ambas décadas (1991-2000 vs. 2001-2007), observamos que existen diferencias estadísticamente significativas en cuanto al número de intervenciones realizadas por el residente (31,7 vs. 51,1%, p = 0,00001), el número de colecistitis abordadas por vía laparoscópica (4,9 vs. 7,53%, p = 0,001), la tasa de conversión (5,46 vs. 11%, p = 0,000001) y la estancia media postoperatoria (2,43 días vs. 3,7 días p = 0,001)...(AU)

Objective: the aim of the study is to determine the results obtained with laparoscopic cholecystectomy at Ramón y Cajal Hospital after 17 years of experience, comparing current results with those at the beginning of the experience. Material and methods: between 1991 and December 2007, 3,933 laparoscopic cholecystectomies were performed at the "Ramón y Cajal Hospital"; 1,849 patients were operated on between 1991 and 2000, and 2,084 between 2001 and 2007. Patients studied included 69.8% of women and 30.2% of men, with a mean age of 56.95 years (range 9-94 years). In all, 54.68% of patients had a concomitant disease before surgery (hypertension, diabetes, ischemic heart disease, respiratory disease...). Surgery was performed by a staff surgeon for 58.04% of cases, and by a resident in the remaining 41.96%. Surgical indications were cholelithiasis in 75.5%, pancreatitis in 13.3%, cholecystitis in 6.3%, choledocholithiasis in 3.05%, and others in 1.2% of cases. Results: mean hospital stay was 3.06 days. Conversion to open surgery was required for 8.3% of cases (331 patients). The major surgical complication rate was 2.34%, with the most frequent being hemoperitoneum (1%). Common bile duct injury occurred in thirteen cases (0.3%), 51 patients (1.3%) were soon re-operated, and 5 patients died (0.13%). When the results of both decades (1991-2000 vs. 2001-2007) were compared, we observed differences in the number of procedures performed by residents (31.7 vs. 51.1%, p = 0.00001), number of laparoscopic cholecystectomies for cholecystitis (4.9 vs. 7.53%, p = 0.001), conversion rate (5.46 vs. 11%, p = 0.000001), and mean hospital stay (2.43 vs. 3.7 days, p = 0.001)...(AU)

[Multidisciplinary approach to the treatment of rectal cancer: the benefits of neoadjuvant therapy]. / Abordaje multidisciplinar en el tratamiento del cáncer de recto: eficacia del tratamiento neoadyuvante.

OBJECTIVE: the aim of this study was to assess the impact of neoadjuvant treatment on rectal cancer following involvement of a multidisciplinary team (MDT). MATERIALS AND METHODS: between January 2000 and December 2005, 90 patients with rectal adenocarcinoma were evaluated by a MDT and operated on after receiving neoadjuvant treatment with radiochemotherapy (RTCT) -67% were men and 33% were women, with a mean age of 65.04 years (21-83 years). Surgery was low anterior resection in 50% and abdominoperineal amputation in 42.2%. RESULTS: the rate of complications associated with neoadjuvant treatment was 54.4%, with gastrointestinal complications being most frequent. However, this toxicity was tolerated by most patients. It was severe in two cases (2.2%), leading to chemotherapy discontinuation. A histological analysis of specimens showed a complete pathologic response in 10 cases (11.1%) and a partial response (downstaging of T) in 32 cases (35.6%), hence overall response to neoadjuvant treatment was 46.6%. Postoperative complications included anastomotic leakage in 8.3%, perineal wound complications in 34.2%, and urinary disease in 12.2%. The surgical mortality rate was 0%. Local recurrence occurred in 4.4%, and distant metastases were found in 22.2%. Both overall and disease-free survivals were 80 and 64%, respectively. CONCLUSIONS: neoadjuvant treatment results in low local recurrence rates and optimal survival rates, with no increase in morbidity or mortality. A systematic evaluation by a MDT in the context of a clinical protocol offers better cure rates.

[Causes of conversion in laparoscopic surgery for gastroesophageal reflux disease: an analysis of our experience]. / Causas de conversión en la cirugía laparoscópica de la enfermedad por reflujo gastroesofágico: análisis de nuestra experiencia.

BACKGROUND: since its introduction in 1991 laparoscopic antireflux surgery has gained great success and popularity among surgeons, and now it is the gold standard for the treatment of gastroesophageal reflux disease (GERD). AIM: to identify and evaluate the causes of conversion in the laparoscopic surgery of GERD and hiatus hernia. MATERIAL AND METHODS: since January 1993 to August 2007 606 laparoscopic antireflux procedures were performed in our hospital. There were 296 women and 310 men with a median age of 53.5 years. The main indication for surgery was evidence of intractable or recurrent GERD symptoms after adequate medical treatment with associated hiatal hernia. The preoperative workup included manometry, pH-metry, oral endoscopy, and barium swallow. The surgical technique was mainly the Nissen-Rossetti procedure. RESULTS: mean postoperative hospital stay was 2.7 days. The operation had to be converted to an open procedure in 43 cases (7%). Conversions were more frequent in the first decade of the learning curve (26 vs. 17, p < 0.016), and fewer among the group of experts in advanced laparoscopic surgery (15 vs. 28, p < 0.017). In 17 cases conversions were due to an intraoperative complication whereas in 26 cases a conversion was done because of technical difficulties. Esophageal perforation and pneumothorax rates were 0.8 and 1%, respectively, and mortality and morbidity rates were 0.1 and 12%. CONCLUSION: the rate of conversion is acceptable and significantly decreases with surgeon experience.

Abordaje multidisciplinar en el tratamiento del cáncer de recto: eficacia del tratamiento neoadyuvante / No disponible

Objetivo: evaluar el papel de la terapia neoadyuvante en eltratamiento del cáncer de recto en nuestro hospital, tras la implantaciónde un grupo multidisciplinar de trabajo (MDT).Material y métodos: desde enero de 2000 hasta diciembrede 2005 se ha evaluado en sesión clínica por el grupo MDT untotal de 90 pacientes diagnosticados de adenocarcinoma de rectoe intervenidos quirúrgicamente tras recibir tratamiento neoadyuvantecon radioquimioterapia (QMRT). La edad media fue de65,04 años (21-83 años), siendo un 67% varones y un 33% mujeres.Los procedimientos quirúrgicos realizados fueron fundamentalmenteresección anterior baja en un 50% y amputación abdominoperinealen un 42,2%.Resultados: la tasa de complicaciones asociada al uso del tratamientoneoadyuvante fue del 54,44%, siendo más frecuenteslas gastrointestinales. Sin embargo, esta toxicidad fue bien toleradaen la mayor parte de los casos, siendo grave y acarreando lasuspensión del tratamiento quimioterápico en 2 pacientes (2,2%).El análisis anatomopatológico de las piezas resecadas demostróuna respuesta completa en 10 casos (11,1%) y una respuesta parcial(disminución del parámetro T de la clasificación TNM) en 32casos (35,6%), con lo que la respuesta global del tratamiento neoadyuvantefue del 46,6%. Entre las complicaciones postoperatoriasse produjeron un 8,3% de dehiscencias anastomóticas, un34,2% de complicaciones de la herida perineal y un 12,2% decomplicaciones urinarias. La mortalidad quirúrgica fue del 0%. Latasa de recidiva pélvica fue del 4,4% y la sistémica del 22,2%. Lasupervivencia actuarial global y libre de enfermedad a los 5 añosfue del 80 y 64% respectivamente.Conclusión: el tratamiento QMRT neoadyuvante proporcionauna cifras bajas de recidiva pélvica junto con buenas tasas desupervivencia, no añadiendo una morbimortalidad importante alacto quirúrgico. La evaluación sistemática por un grupo MDT enel contexto de un protocolo clínico parece ofrecer al paciente mejoresoportunidades de curación

Objective: the aim of this study was to assess the impact ofneoadjuvant treatment on rectal cancer following involvement of amultidisciplinary team (MDT).Materials and methods: between January 2000 and December2005, 90 patients with rectal adenocarcinoma were evaluatedby a MDT and operated on after receiving neoadjuvant treatmentwith radiochemotherapy (RTCT) –67% were men and33% were women, with a mean age of 65.04 years (21-83 years).Surgery was low anterior resection in 50% and abdominoperinealamputation in 42.2%.Results: the rate of complications associated with neoadjuvanttreatment was 54.4%, with gastrointestinal complicationsbeing most frequent. However, this toxicity was tolerated by mostpatients. It was severe in two cases (2.2%), leading to chemotherapydiscontinuation. A histological analysis of specimens showeda complete pathologic response in 10 cases (11.1%) and a partialresponse (downstaging of T) in 32 cases (35.6%), hence overallresponse to neoadjuvant treatment was 46.6%. Postoperativecomplications included anastomotic leakage in 8.3%, perinealwound complications in 34.2%, and urinary disease in 12.2%.The surgical mortality rate was 0%. Local recurrence occurred in4.4%, and distant metastases were found in 22.2%. Both overalland disease-free survivals were 80 and 64%, respectively.Conclusions: neoadjuvant treatment results in low local recurrencerates and optimal survival rates, with no increase in morbidityor mortality. A systematic evaluation by a MDT in the contextof a clinical protocol offers better cure rates

Causas de conversión en la cirugía laparoscópica de la enfermedad por reflujo gastroesofágico: análisis de nuestra experiencia / No disponible

Introducción: desde su introducción en 1991, la cirugía antirreflujopor vía laparoscópica ha ido adquiriendo gran popularidadhasta convertirse en el procedimiento de elección de la enfermedadpor reflujo gastroesofágico.Objetivo: identificar y analizar de forma retrospectiva las causasde conversión del abordaje laparoscópico en la cirugía de laenfermedad por reflujo gastroesofágico y de la hernia de hiato.Material y métodos: desde 1993 a agosto de 2007 se hanefectuado en nuestro centro 606 cirugías antirreflujo por vía laparoscópica,encontrando 296 mujeres y 310 varones con una edadmedia de 53,3 años. La indicación fundamental fue la existenciade un reflujo gastroesofágico resistente al tratamiento médico conhernia de hiato asociada. De forma preoperatoria se van a efectuarestudios manométricos y pH-métricos, endoscopia oral ytránsito esofagogastroduodenal. La técnica quirúrgica de elecciónfue mayoritariamente la funduplicatura tipo Nissen-Rossetti.Resultados: la estancia media postoperatoria fue de 2,7 días,realizándose conversión a cirugía abierta en 43 casos (7%). Lasconversiones fueron más frecuentes en la primera década de lacurva de aprendizaje (26 vs. 17 p < 0,016), y menores en el grupode cirujanos expertos en cirugía laparoscópica avanzada(15 vs. 28, p < 0,017). En 17 casos la conversión fue debida auna complicación intraoperatoria y en 26 casos a dificultades técnicas.Las tasas de perforación esofágica y de neumotórax fuerondel 0,8 y 1%, mientras que la tasa de mortalidad y morbilidad fuedel 0,1 y 12% respectivamente.Conclusión: la tasa de conversión está dentro de los límitesaceptables y ha disminuido con la experiencia

Background: since its introduction in 1991 laparoscopic antirefluxsurgery has gained great success and popularity amongsurgeons, and now it is the gold standard for the treatment of gastroesophagealreflux disease (GERD).Aim: to identify and evaluate the causes of conversion in thelaparoscopic surgery of GERD and hiatus hernia.Material and methods: since January 1993 to August 2007606 laparoscopic antireflux procedures were performed in ourhospital. There were 296 women and 310 men with a medianage of 53.5 years. The main indication for surgery was evidenceof intractable or recurrent GERD symptoms after adequate medicaltreatment with associated hiatal hernia. The preoperativeworkup included manometry, pH-metry, oral endoscopy, and bariumswallow. The surgical technique was mainly the Nissen-Rossettiprocedure.Results: mean postoperative hospital stay was 2.7 days. Theoperation had to be converted to an open procedure in 43 cases(7%). Conversions were more frequent in the first decade of thelearning curve (26 vs. 17, p < 0.016), and fewer among thegroup of experts in advanced laparoscopic surgery (15 vs. 28,p < 0.017). In 17 cases conversions were due to an intraoperativecomplication whereas in 26 cases a conversion was done becauseof technical difficulties. Esophageal perforation and pneumothoraxrates were 0.8 and 1%, respectively, and mortality andmorbidity rates were 0.1 and 12%.Conclusion: the rate of conversion is acceptable and significantlydecreases with surgeon experience

Hidatidosis hepática. Cirugía radical vs. no radical: 22 años de experiencia / No disponible

Introducción: la incidencia de la hidatidosis hepática ha disminuidonotablemente en los últimos años gracias a las medidasde prevención adoptadas para interrumpir la transmisión del parásito.Con todo, la cirugía continúa siendo el tratamiento de elección,si bien su modalidad es todavía motivo de controversia.Objetivos: el objetivo de este trabajo es evaluar los resultadosobtenidos en el tratamiento de esta patología a lo largo de más dedos décadas, atendiendo a la modalidad quirúrgica empleada yafuese cirugía radical o no radical.Material y métodos: se analizaron un total de 372 pacientesintervenidos por quiste hepático hidatídico (QHH) entre 1983-2005 en el Hospital Ramón y Cajal. En162 se efectúa una cirugíaradical (43,5%) y en 210 una no radical (56,5%).Resultados: tanto la estancia media hospitalaria (8,65 días vs.14,9 días) como la morbilidad (13,3 vs. 31,4 %, p < 0,001) y lamortalidad (0 vs. 3,8%, p < 0,01) fueron menores en el grupo decirugía radical. La tasa de recidiva fue del 1,85% tras un abordajeradical frente al 11,9% en los abordajes no radicales (p < 0,0001).Conclusión: la cirugía radical se asocia con una menor morbimortalidad,menor estancia hospitalaria y menor recidiva, constituyendola técnica de elección en la hidatidosis hepática. Sin embargo,su aplicación debe atenerse a las características delpaciente, la anatomía del quiste y el grado de experiencia del equipoquirúrgico

Objectives: the incidence of hepatic hydatidosis has remarkablydecreased in the last years due to the preventive measuresadopted to stop the transmission of the parasite. However, surgerycarries on being the treatment of choice, although the surgical procedureis still a matter of controversy. The aim of the study was toevaluate the results obtained with the treatment of this conditionafter two decades according to surgical procedure type.Material and methods: from 1983 to 2005, 372 patientswere operated on for hepatic hydatidic cyst in Hospital Ramón yCajal. Radical surgery was performed for 162 (43.5%) and conservativesurgery for 210 (56.5%).Results: average postoperative hospital stay (8.65 vs. 14.9days), morbidity (13.3 vs. 31.4%, p < 0.001), and mortality (0 vs.3.8%, p < 0.01) were lower in the radical surgery group. Recurrencerate was 1.85% after radical surgery versus 11.9% in theconservative surgery group (p < 0.0001).Conclusion: radical surgery is associated with lower morbidity,mortality, postoperative hospital stay, and recurrence rates,and represents the treatment of choice for hepatic hydatidosis.However, its indication must depend on the patient characteristics,cyst anatomy, and surgical team experience

Littoral cell angioma of the spleen.

Littoral cell angiomas (LCAs) are rare splenic vascular neoplasms that arise from the cells lining the red pulp sinuses. The clinical course is benign and in most cases asymptomatic. However, as has been described in the literature, we have seen an association with malignant neoplasms and haematological disorders. The definitive diagnosis is made on histology and confirmed with immunohistochemistry. The use of percutaneous fine-needle aspiration biopsy (FNA) in preoperative diagnosis is controversial.

Littoral cell angioma of the spleen

Littoral cell angiomas (LCAs) are rare splenic vascular neoplasms that arise from the cells lining the red pulp sinuses. The clinical course is benign and in most cases asymptomatic. However, as has been described in the literature, we have seen an association with malignant neoplasms and haematological disorders. The definitive diagnosis is made on histology and confirmed with immunohistochemistry. The use of percutaneous fine-needle aspiration biopsy (FNA) in preoperative diagnosis is controversial (AU)

[Diagnosis and treatment of pancreatic insulinoma]. / Manejo diagnóstico y terapéutico del insulinoma pancreático.

INTRODUCTION: insulinoma is the most frequent pancreatic endocrine tumor. Its preoperative diagnosis has been controversial for many years. The aim of this study was to evaluate the experience in the management and treatment of this kind of tumor at Hospital Ramón y Cajal. MATERIAL AND METHODS: between January 1999 and July 2006, 12 patients were operated on in our hospital (9 females and 3 males) who had been diagnosed with insulinoma, with a mean age of 56 years (16-72 years). RESULTS: octreotide scintigraphy allowed a diagnosis in 33.3% of cases, abdominal CT in 83.3%, and echoendoscopy in 100%. Intraoperative ultrasonography confirmed the presence of an insulinoma in 100% of cases. In all cases a complete excision was possible, with 9 enucleations and 3 distal pancreatectomies. Two patients developed a pancreatic fistula, and one a pancreatic pseudocyst that healed spontaneously without surgery. The overall cure rate was 100%. After a mean follow-up of 48 months no recurrences have been reported. CONCLUSION: in our experience, we consider advisable that abdominal CT and echoendoscopy be performed before surgery. However, the initial procedure of choice would be pancreas palpation and intraoperative ultrasonography. Surgery cured 100% of cases, and the procedure selected depends on size, location, distance from the main pancreatic duct, and relation to multiple endocrine neoplasm 1 (MEN-1).

Manejo diagnóstico y terapéutico del insulinoma pancreático / Diagnosis and treatment of pancreatic insulinoma

Introducción: el insulinoma es el tumor endocrino pancreático más frecuente. Su diagnóstico preoperatorio ha sido motivo de controversia durante muchos años. El objetivo del trabajo es evaluar la experiencia del Hospital Ramón y Cajal en el manejo diagnóstico y terapéutico de este tipo de tumores. Material y métodos: en el periodo comprendido entre enero de 1999 y julio de 2006 fueron intervenidos en nuestro hospital 12 pacientes (9 mujeres y 3 varones) con el diagnóstico de insulinoma, con una edad media de 56 años (16-72 años). Resultados: la gammagrafía con octreótido nos permitió realizar el diagnóstico en el 33,3% de los casos, el TAC abdominal en el 83,3% y la ecoendoscopia en el 100%. El 100% de los insulinomas fue diagnosticado durante la cirugía gracias al uso de la ecografía intraoperatoria. En todos los casos se realizó la excisión completa del tumor, mediante 9 enucleaciones y 3 pancreatectomías distales. Dos pacientes presentaron una fístula pancreática y otro un pseudoquiste pancreático que se resolvieron de forma conservadora. La tasa de curación fue del 100%. El seguimiento fue de 48 meses, no encontrándose ningún caso de recidiva. Conclusión: en nuestra experiencia, creemos aconsejable la realización de TAC abdominal y ecoendoscopia como pruebas previas a la cirugía. Sin embargo, la técnica de elección sería la palpación del páncreas y la realización de una ecografía intraoperatoria. La cirugía es curativa en el 100% de los casos, y la técnica efectuada dependerá del tamaño, localización y distancia del tumor al conducto pancreático, así como su relación con el síndrome MEN-1

Introduction: insulinoma is the most frequent pancreatic endocrine tumor. Its preoperative diagnosis has been controversial for many years. The aim of this study was to evaluate the experience in the management and treatment of this kind of tumor at Hospital Ramón y Cajal. Material and methods: between January 1999 and July 2006, 12 patients were operated on in our hospital (9 females and 3 males) who had been diagnosed with insulinoma, with a mean age of 56 years (16-72 years). Results: octreotide scintigraphy allowed a diagnosis in 33.3% of cases, abdominal CT in 83.3%, and echoendoscopy in 100%. Intraoperative ultrasonography confirmed the presence of an insulinoma in 100% of cases. In all cases a complete excision was possible, with 9 enucleations and 3 distal pancreatectomies. Two patients developed a pancreatic fistula, and one a pancreatic pseudocyst that healed spontaneously without surgery. The overall cure rate was 100%. After a mean follow-up of 48 months no recurrences have been reported. Conclusion: in our experience, we consider advisable that abdominal CT and echoendoscopy be performed before surgery. However, the initial procedure of choice would be pancreas palpation and intraoperative ultrasonography. Surgery cured 100% of cases, and the procedure selected depends on size, location, distance from the main pancreatic duct, and relation to multiple endocrine neoplasm 1 (MEN-1)

Apendicitis aguda en paciente con malrotación intestinal / Acute appendicitis in a patient with intestinal malrotation

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Endoscopic treatment of oesophageal leiomyoma: four new cases.

BACKGROUND AND STUDY AIMS: The advent of endoscopic techniques in the last decades has produced a change in the approach of the oesophageal leiomyoma. The aim of the study is to explain our experience in the laparoscopic surgery of the oesophageal leiomyoma. MATERIALS AND METHODS: We realised a retrospective study of the oesophageal leiomyoma operated on in our centre by the endoscopic approach between 2001 and 2004. There were two females and two males. All were symptomatic and pyrosis was the most frequent symptom. The preoperative study was an oral endoscopy and barium swallow. In all the cases enucleation was performed, two by thoracoscopy and two by laparoscopy approach. RESULTS: The mean operating time was 230 min. No deaths or intraoperative complications occurred and there were no cases of conversion to open surgery either. The mean postoperative hospital stay was 3.25 days (range 2-4 days). There was no case of recurrence. CONCLUSIONS: The enucleation is an easier procedure and constitutes the therapy of choice of the oesophageal leiomyoma. We think that muscle borders should be closed after enucleation and that biopsy is not indicated preoperatively.

Endoscopic treatment of oesophageal leiomyoma: four new cases

BACKGROUND AND STUDY AIMS: The advent of endoscopic techniques in the last decades has produced a change in the approach of the oesophageal leiomyoma. The aim of the study is to explain our experience in the laparoscopic surgery of the oesophageal leiomyoma. MATERIALS AND METHODS: We realised a retrospective study of the oesophageal leiomyoma operated on in our centre by the endoscopic approach between 2001 and 2004. There were two females and two males. All were symptomatic and pyrosis was the most frequent symptom. The preoperative study was an oral endoscopy and barium swallow. In all the cases enucleation was performed, two by thoracoscopy and two by laparoscopy approach. RESULTS: The mean operating time was 230 min. No deaths or intraoperative complications occurred and there were no cases of conversion to open surgery either. The mean postoperative hospital stay was 3.25 days (range 2-4 days). There was no case of recurrence. CONCLUSIONS: The enucleation is an easier procedure and constitutes the therapy of choice of the oesophageal leiomyoma. We think that muscle borders should be closed after enucleation and that biopsy is not indicated preoperatively (AU)

Hematoma subcapsular hepático tras CPRE / Subcapsular liver hematoma after ERCP

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Isquemia del tronco celíaco y mesentérica superior tras ingesta de cocaína / Tittle

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Surgical treatment of esophageal leiomyoma: an analysis of our experience.

INTRODUCTION: leiomyoma is the most common benign esophageal neoplasm. Surgical treatment (enucleation) has traditionally been the therapy of choice. The advent of minimally invasive techniques has produced an increase in endoscopic approaches to the detriment of open surgery. OBJECTIVE: the aim of this study was to compare the results obtained with open surgery and with laparoscopic surgery in this kind of pathology. MATERIAL AND METHODS: we performed a retrospective study of all leiomyomas operated for in our center between 1986 and 2004, and obtained 9 cases of esophageal leiomyoma. Four were women and five men, between the ages of 40 and 70, with a mean age of 53.5 years. The most frequent symptoms were heartburn (5 cases), dysphagia (3 cases), and retrosternal pain (3 cases). Surgery was in all the cases an enucleation. An open approach was performed in 5 cases (3 thoracotomies and 2 laparotomies), and an endoscopic approach in 4 (2 thoracoscopies and 2 laparoscopies). RESULTS: the mean postoperative hospital stay was 5.12 days (range 2-8 days). This was shorter for endoscopic approaches versus open surgery (3.25 vs. 7 days). There was no case of esophageal mucosal perforation or reconversion. No death, intraoperative complication, or tumor relapse was described. Only 2 patients had complications: post-surgical thoracic pain, and intestinal obstruction by adhesions 8 years after surgery. CONCLUSION: enucleation is an easier procedure and constitutes the therapy of choice for esophageal leiomyoma. This approach has to be laparoscopic. We think that muscle borders should be closed after enucleation, and that biopsy is not indicated preoperatively.

Tratamiento quirúrgico del leiomioma esofágico: análisis de nuestra experiencia / Surgical treatment of esophageal leiomyoma: an analysis of our experience

Introducción: el leiomioma es el tumor benigno más frecuentedel esófago. Tradicionalmente el tratamiento quirúrgico de estospacientes consistía en la enucleación. El avance en las técnicasmínimamente invasivas ha provocado un aumento del abordajeendoscópico en detrimento de la cirugía abierta.Objetivo: el objetivo del trabajo fue comparar los resultadosobtenidos por vía abierta y por vía laparoscópica en este tipo depatología.Material y métodos: realizamos un estudio retrospectivo delos leiomiomas intervenidos en nuestro centro entre 1986-2004,obteniéndose 9 leiomiomas esofágicos. Cuatro eran mujeres ycinco varones, con unas edades comprendidas entre los 40-70años, siendo la edad media de 53,5 años. Los síntomas más frecuenteseran pirosis (5 casos), disfagia (3 casos) y dolor retroesternal(3 casos). El tratamiento quirúrgico fue en todos los casos laenucleación. En cinco pacientes se realizó un abordaje abierto (3toracotomías y 2 laparotomías) y en 4 casos se realizó una laparoscopia(2 toracoscopias y 2 laparoscopias).Resultados: la estancia hospitalaria postoperatoria oscila entrelos 2-8 días, con una media de 5,12 días, siendo esta menor en elgrupo en el que se realizó cirugía laparoscópica en comparacióncon el grupo de cirugía abierta (3,25-7 días). No existe ningún casode perforación de la mucosa esofágica ni de reconversión. Tampocose describe ningún caso de mortalidad, complicación intraoperatoriani de recidiva tumoral. Dos pacientes presentan algún tipo decomplicaciones: dolor torácico post cirugía, obstrucción intestinalpor bridas 8 años después de la cirugía.Conclusión: la enucleación es un procedimiento fácilmenterealizable y constituye el tratamiento de elección del leiomiomaesofágico. Actualmente el abordaje debe ser laparoscópico. Somospartidarios del cierre de la muscular y bajo nuestro punto devista la biopsia preoperatoria no está indicada

Introduction: leiomyoma is the most common benign esophagealneoplasm. Surgical treatment (enucleation) has traditionallybeen the therapy of choice. The advent of minimally invasivetechniques has produced an increase in endoscopic approaches tothe detriment of open surgery.Objective: the aim of this study was to compare the resultsobtained with open surgery and with laparoscopic surgery in thiskind of pathology.Material and methods: we performed a retrospective studyof all leiomyomas operated for in our center between 1986 and2004, and obtained 9 cases of esophageal leiomyoma. Four werewomen and five men, between the ages of 40 and 70, with amean age of 53.5 years. The most frequent symptoms were heartburn(5 cases), dysphagia (3 cases), and retrosternal pain (3 cases).Surgery was in all the cases an enucleation. An open approachwas performed in 5 cases (3 thoracotomies and 2laparotomies), and an endoscopic approach in 4 (2 thoracoscopiesand 2 laparoscopies).Results: the mean postoperative hospital stay was 5.12 days(range 2-8 days). This was shorter for endoscopic approaches versusopen surgery (3.25 vs. 7 days). There was no case of esophagealmucosal perforation or reconversion. No death, intraoperativecomplication, or tumor relapse was described. Only 2 patientshad complications: post-surgical thoracic pain, and intestinal obstructionby adhesions 8 years after surgery.Conclusion: enucleation is an easier procedure and constitutesthe therapy of choice for esophageal leiomyoma. This approachhas to be laparoscopic. We think that muscle borders shouldbe closed after enucleation, and that biopsy is not indicated preoperatively