Hernia de Morgagni asociada a hernia de hiato. Reparación de la vía laparoscópica / Morgagni hernia associated to hiatus hernia. Laparoscopic repair

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Laparoscopic cholecystectomy in patients over 70 years of age: review of 176 cases.

INTRODUCTION: We assessed the results of laparoscopic cholecystectomy in 176 patients over the age of 70 years. PATIENTS AND METHODS: The study included all patients older than 70 years of age who underwent laparoscopic surgery cholelithiasis during the previous ten years. Variables studied included age, sex, type of operation (programmed/emergency), comorbidity, anesthetic risk, intraoperative cholangiography, conversion to open surgery, number of trocars, reoperation, residual choledocholithiasis, postoperative hospital stay, morbidity and mortality. RESULTS: The study included 176 patients (23.29% men and 76.71% women). The mean age was 74.86 years. The mean hospital stay was 1.27 days, with 16.98% morbidity and 0.56% mortality. CONCLUSIONS: Laparoscopic cholecystectomy is a safe procedure in older patients. It results in faster recovery, a shorter postoperative stay and lower rates of morbidity and mortality than open bile duct surgery.

Colecistectomía laparoscópica en pacientes mayores de 70 años: nuestra experiencia en 176 casos / Laparoscopic cholecystectomy in patients over 70 years of age: review of 176 cases

Objetivo: el objetivo de nuestro estudio es el de evaluar los resultadosobtenidos en 176 pacientes mayores de 70 años intervenidosmediante colecistectomía laparoscópica.Pacientes y métodos: se incluyen en el estudio todos los pacientesmayores de 70 años diagnosticados de colelitiasis intervenidospor laparoscopia en los diez últimos años. Analizamos los siguientesparámetros: edad, sexo, tipo de intervención(programada/urgente), comorbilidad, riesgo anestésico, colangiografíaintraoperatoria, conversión a cirugía abierta, número detrócares, reintervención, coledocolitiasis residual, estancia hospitalariapostoperatoria y morbimortalidad.Resultados: incluimos en el estudio un total de 176 pacientes,de los cuales el 23,29% son varones y 76,71%, tienen unaedad media de 74.86 años. En los resultados globales la estanciamedia hospitalaria es de 1,27 días, morbilidad 16,98% y mortalidadde 0,57%.Conclusiones: la colecistectomía laparoscópica es un procedimientoseguro en pacientes mayores, ofreciendo una más tempranarecuperación, menor estancia postoperatoria, y una menortasa de morbimortalidad que la cirugía biliar abierta

Introduction: we assessed the results of laparoscopic cholecystectomyin 176 patients over the age of 70 years.Patients and methods: the study included all patients olderthan 70 years of age who underwent laparoscopic surgerycholelithiasis during the previous ten years. Variables studied includedage, sex, type of operation (programmed/emergency), comorbidity,anesthetic risk, intraoperative cholangiography, conversionto open surgery, number of trocars, reoperation, residual choledocholithiasis,postoperative hospital stay, morbidity and mortality.Results: the study included 176 patients (23.29% men and76.71% women). The mean age was 74.86 years. The mean hospitalstay was 1.27 days, with 16.98% morbidity and 0.56% mortality.Conclusions: laparoscopic cholecystectomy is a safe procedurein older patients. It results in faster recovery, a shorter postoperativestay and lower rates of morbidity and mortality thanopen bile duct surgery

Treatment of cholecystoduodenal fistula in the era of laparoscopy.

INTRODUCTION: At first, laparoscopic cholecystectomy was considered unsuitable for patients presenting biliary tract diseases. This study seeks to demonstrate cholecystoduodenal fistula is not a contraindication for laparoscopic cholecystectomy, and it can be performed without a higher risk for the patient. PATIENTS AND METHODS: A retrospective study has been completed on laparoscopic biliary pathology from 1992 to 1999 (191 urgent and 877 elective choice surgeries). 302 cases (28%) are of complicated biliary pathology. We report on 14 cholecystoduodenal fistulae, 3 cholecystocolonic fistulae, and 2 cholecystogastric fistulae. RESULTS: Only in 5 patients with cholecystoduodenal fistula was the operation successfully completed by laparoscopy. Conversion to open surgery was because of bleeding (5 cases), difficulty for colon suture (2 cases), and inflammation of the gallbladder with the duodenum (7 cases). An endo-GIA 35 was used to transect the fistula. All patients were discharged after 4 or 5 days without wound infection, and they have been evaluated at 3 and 12 months, without problems. CONCLUSION: Cholecystoduodenal fistula can no longer be considered a contraindication for laparoscopic treatment, and it does not increase morbidity risk.

[Analysis of surgery of gastroesophageal reflux by laparotomy and laparoscopy approach]. / Análisis de la cirugía del reflujo gastroesofágico por vía laparotómica y laparoscópica.

UNLABELLED: The development of the laparoscopic surgery has allowed its use in the treatment of gastroesophageal reflux. PATIENTS AND METHODS: We have reviewed the results and follow-up of 30 patients treated with open procedure (group A) and 30 patients with laparoscopic surgery (group B). The most frequent indication for surgery was failure of medical therapy and the Nissen fundoplication was the method most commonly used. RESULTS: The average surgical time was shorter in group A (66 minutes) than in group B (140 minutes). Intraoperative complications were: in group A, 2 patients with splenic injury; in group B, 3 patients required conversion to the open procedure (pneumothorax, gastric perforation, technical problems) and 1 patient with pneumothorax which didn't require conversion. Postoperative morbidity and mortality occurred in 20% (26% group A, 13% group B); the most common complications were: respiratory (4 patients), gas bloat syndrome (2 patients) and esophageal perforation (1 patient). At follow-up we observed complete heartburn relief in 95%, 4 patients in group A had mild dysphagia, 3 patients with recurrent hiatal hernia (2 in group A and 1 in group B) and 2 patients required reintervention in group A (intestinal occlusion caused by adherence and laparotomic hernia). Mortality occurred in a patient with esophageal perforation in group B. CONCLUSIONS: Treatment for gastroesophageal reflux is feasible with similar effectiveness with open and laparoscopic procedures. The results are advantageous with the laparoscopic procedure relative to postoperative morbidity and follow-up.