"Hernia transilíaca". Una original modalidad de eventración probablemente no tan infrecuente / "Iliac hernia", an original form of ventral hernia that is probably not so uncommon

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Pancreatitis aguda recidivante como complicación a largo plazo del quiste congénito de colédoco operado / Recurrent acute pancreatitis as a long-term complication of congenital choledochal cyst surgery

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[Outpatient laparoscopic cholecystectomy: initial results of a series of 200 cases]. / Colecistectomía laparoscópica ambulatoria: resultados iniciales de una serie de 200 casos.

INTRODUCTION: Outpatient laparoscopic cholecystectomy (CL) has not been generalised due to the fear of complications by the surgeon and preference of patients for hospitalisation. This situation could be changed by setting up strict selection criteria and providing hospital home care. The aims of this study are to find out what percentage of our population fulfil these criteria, confirm their validity and find out if the surgical process should be improved before being introduced. MATERIAL AND METHOD: A retrospective analysis was carried out on the first 200 elective CL cases dating from January 2006. The exclusion criteria were as follows: pre-operative criteria (social causes, age $ 70 years, unstable ASA III or ASA IV, an associated pathology or admission due to biliopancreatic patho-logy), intra-operative criteria (conversion, surgical time lasting longer than 90 minutes, non-identification or bleeding of the cystic artery, application of haemostatic material, haemorrhaging in the entrance ports, intra-abdominal bile spillage, drainage, difficulties in removing the gallbladder, anaesthetic and/or surgical complications) and post-operative (haemodynamic instability, excessive pain, nausea, and /or vomiting). RESULTS: Out of the 200 cases, 53 (26.5%) patients fulfilled the criteria. The outpatient system was preferred predominantly by females and by those younger in age. Post-operative incidents occurred in 9.4% of the cases and these were dealt with by the hospital home care team. CONCLUSIONS: Ambulatory CL procedure is safe. Patients of advanced age or with associated pathologies limit the inclusion. Hospital home care can solve any possible complications and contribute to the speedy discharge in those patients without criteria.

Colecistectomía laparoscópica ambulatoria: resultados iniciales de una serie de 200 casos / Outpatient laparoscopic cholecystectomy: initial results of a series of 200 cases

Introducción. La colecistectomía laparoscópica(CL) ambulatoria no se ha generalizado por temor del cirujano a las potenciales complicaciones postoperatorias y preferencia del paciente a la hospitalización. El establecimiento de criterios selectivos estrictos y la hospitalización a domicilio podrían cambiar esta predisposición. Los objetivos de este estudio son averiguar qué porcentaje de nuestra población con colelitiasis cumple dichos criterios, confirmar su validez y descubrir si debe mejorarse el proceso quirúrgico antes de implementarse. Material y método. Se analizan prospectivamente los primeros 200 casos de CL electiva desde enero de 2006. Los criterios de exclusión son: preoperatorios(causas sociales, edad >= 70 años, ASA III inestable o ASA IV, enfermedad concomitante que precisa control hospitalario, ingreso previo por afección biliopancreática), intraoperatorios (conversión a laparotomía, tiempo quirúrgico >= 90 min, sin identificació no sangrado de la arteria cística, aplicación de material hemostático, hemorragia en puertas de entrada, vertido de bilis intraabdominal, drenajes, extracción dificultosa de vesícula, complicaciones anestésicas y/o quirúrgicas) y postoperatorios (inestabilidad hemodinámica, dolor excesivo, náuseas y/o vómitos en la sala de reanimación).Resultados. Cumplieron criterios 53 (26,5%) pacientes. El sexo femenino y la menor edad favorecen el proceso ambulatorio. Se presentaron incidencias postoperatorias en el 9,4% que podrían asumirse por el equipo de hospitalización a domicilio. Conclusiones. La CL en régimen ambulatorio es segura. La edad avanzada y la enfermedad concomitante limitan la inclusión. La hospitalización a domicilio puede solucionar las posibles complicaciones y facilitar el alta precoz de los pacientes sin criterios de CL ambulatoria (AU)

Introduction. Outpatient laparoscopic cholecystectomy (CL) has not been generalised due to the fear of complications by the surgeon and preference of patients for hospitalisation. This situation could be changed by setting up strict selection criteria and providing hospital home care. The aims of this study are to find out what percentage of our population fulfil these criteria, confirm their validity and find out if the surgical process should be improved before being introduced. Material and method. A retrospective analysis was carried out on the first 200 elective CL cases dating from January 2006. The exclusion criteria were as follows: pre-operative criteria (social causes, age $ 70 years, unstable ASA III or ASA IV, an associated pathology or admission due to biliopancreatic patho-logy), intra-operative criteria (conversion, surgical time lasting longer than 90 minutes, non-identification or bleeding of the cystic artery, application of haemostatic material, haemorrhaging in the entrance ports, intra-abdominal bile spillage, drainage, difficulties in removing the gallbladder, anaesthetic and/or surgical complications) and post-operative (haemodynamic instability, excessive pain, nausea, and /or vomiting). Results. Out of the 200 cases, 53 (26.5%) patients fulfilled the criteria. The outpatient system was preferred predominantly by females and by those younger in age. Post-operative incidents occurred in 9.4% of the cases and these were dealt with by the hospital home care team. Conclusions. Ambulatory CL procedure is safe. Patients of advanced age or with associated pathologies limit the inclusion. Hospital home care can solve any possible complications and contribute to the speedy discharge in those patients without criteria (AU)

Two Doses of oxaliplatin with capecitabine (XELOX) in metastatic colorectal cancer.

PURPOSE: Phase II/III studies have shown XELOX to be as effective as FOLFOX in patients with advanced colorectal cancer (CRC). The study was designed to evaluate the activity and tolerability of XELOX in CRC. In August 2002, we began a prospective study of XELOX as first-line therapy for patients with metastatic CRC. Twenty-two patients were enrolled between November 2002 and August 2003 (series I). An interim analysis performed in August 2003 revealed that 32% of patients required a dose reduction of oxaliplatin because of toxicity. From August 2003 to April 2005, an additional 20 patients were included (series II). This second group of patients received oxaliplatin at a lower dose. PATIENTS AND METHODS: The first 22 patients (series I) included received oxaliplatin 130 mg/m(2) on day 1 plus capecitabine 2000 mg/m(2) daily on days 1-15 (3-week cycle). The second set of 20 patients (series II) received oxaliplatin 85 mg/m(2) on day 1; the dose of capecitabine and the frequency of administration were not modified. RESULTS: Patient characteristics were well balanced in the 2 series. Overall response (series I vs. II): 41% vs. 65%; median time to progression was similar: 10.51 vs. 10.92 (log-rank test, P = .79). Median survival was similar in the 2 series: 19.55 vs. 21.18 months (log-rank test, P = .61). Grade 3/4 toxicity (series I vs. II): peripheral neuropathy, 14% vs. 0 (P = .23). CONCLUSION: In patients with advanced CRC, in combination with capecitabine, oxaliplatin 85 mg/m(2) is as effective with lower toxicity when compared with oxaliplatin 130 mg/m(2).