ABSTRACT
BACKGROUND: Mirizzi syndrome is a complication of gallbladder stones impacted in Hartmann's pouch or cystic duct with compression of the bile duct. The diagnosis is made by imaging studies, although most of them are found through intraoperative surgical findings. Treatment is cholecystectomy and bile duct restoration when needed. OBJECTIVE: to analyze a series of cases of Mirizzi syndrome and compare the results with those published in the literature. CLINICAL CASE: We report 4 cases with Mirizzi syndrome in a cohort of 1,034 cases studied in the Hospital Español of Veracruz over 21 years. RESULTS: In our series the frequency of Mirizzi syndrome was 0.38%, the average age was 32.1 ± 58.4 years, 50% were male gender and 25% had jaundice with a demonstrable liver profile. In 1 case, ultrasound suggested Mirizzi syndrome and percutaneous cholangiography and computed tomography confirmed the diagnosis. All patients underwent laparoscopic cholecystectomy, and 2 transcystic cholangiographies were performed. One case was classified as Type I-A and three as type I-B. (Beltran and Csendes). The postoperative evolution was satisfactory in all and no mortality was presented. CONCLUSIONS: Mirizzi syndrome should be suspected in patients with gallstones who develop obstructive jaundice and it must be confirmed with imaging studies. The surgeon must take extreme precautions to avoid accidental injury to the bile ducts.
Antecedentes: el síndrome de Mirizzi es una complicación de la litiasis vesicular por cálculos impactados en la bolsa de Hartmann o conducto cístico que comprimen la vía biliar principal; el diagnóstico se establece mediante estudios de imagen, aunque la mayor parte son hallazgos transoperatorios; su tratamiento es la colecistectomía con restauración de la vía biliar. Objetivo: analizar una serie de casos de síndrome de Mirizzi y comparar los resultados con lo publicado en la bibliografía mundial. Casos clínicos: se comunican cuatro casos con síndrome de Mirizzi de una cohorte de 1,034 casos con enfermedad litiásica vesicular del Hospital Español de Veracruz, en 21 años. La frecuencia en esta muestra es de 0.38%, con edad promedio de 32.1 ± 58.4 años; 50% son hombres y 25% tuvo ictericia y coluria con perfil hepático demostrativo. En un caso el ultrasonido sugirió síndrome de Mirizzi; el diagnóstico se corroboró por colangiografía percutánea y tomografía computada. A todos los pacientes se les realizó colecistectomía laparoscópica, y en dos se efectuó colangiografía transcística. Un caso correspondió al tipo I-A y 3 al tipo I-B según la Clasificación de Beltrán y Csendes. La evolución postoperatoria fue satisfactoria y no hubo mortalidad. Conclusiones: el síndrome de Mirizzi debe sospecharse en pacientes con litiasis vesicular con ictericia obstructiva. El cirujano debe extremar las precauciones para evitar lesionar la vía biliar.
Subject(s)
Jaundice, Obstructive/etiology , Mirizzi Syndrome , Adult , Aged , Cholangiocarcinoma/diagnosis , Cholangiography/methods , Cholecystectomy, Laparoscopic , Diagnosis, Differential , Female , Gallbladder Diseases/epidemiology , Gallbladder Diseases/surgery , Humans , Male , Middle Aged , Mirizzi Syndrome/classification , Mirizzi Syndrome/diagnostic imaging , Mirizzi Syndrome/epidemiology , Mirizzi Syndrome/surgery , Retrospective Studies , Sensitivity and Specificity , Spain/epidemiology , Tomography, X-Ray Computed , UltrasonographyABSTRACT
BACKGROUND: Laparoscopic myotomy associated with fundoplication is a useful therapeutic resource for the treatment of achalasia. The aim of the study was to analyze the outcomes of the surgical treatment of achalasia in a group of patients treated at the Hospital Naval de la Secretaría de Marina and at the Hospital Español in Veracruz during a 6-year period. METHODS: Eleven patients were submitted to myotomy and fundoplication. Variables analyzed were age, gender, symptom duration, surgical complications, surgical time, day/stay, and postoperative morbidity. RESULTS: Mean age was 41.7 years ± 7.69 years; 63.64% of the patients were male and 36.36% were female. Average time from symptom onset was 2.5 ± 1.38 years. All patients had received previous unsuccessful medical and endoscopic treatment. Diagnosis was confirmed by esophagogram, endoscopy and manometry. All patients underwent Heller myotomy and fundoplication. Operative time was 140.4 ± 26.2 min. Average days/stay was 3.7 ± 1.4 days. Postoperative course was satisfactory in all patients and there was no perioperative mortality. Average follow-up was 3.8 ± 2.3 years. CONCLUSIONS: In our group, laparoscopic myotomy with fundoplication was a safe procedure offering excellent results comparable with those published in the literature. There is controversy about the type of fundoplication; therefore, the choice is at the discretion of the surgeon.
Subject(s)
Esophageal Achalasia/surgery , Esophageal Sphincter, Lower/surgery , Fundoplication/methods , Laparoscopy/methods , Adult , Esophageal Achalasia/diagnostic imaging , Esophagoscopy , Female , Humans , Male , Manometry , Middle Aged , Postoperative Complications/epidemiology , Radiography , Retrospective Studies , Treatment OutcomeABSTRACT
Objetivo: Evaluar los resultados del tratamiento quirúrgico de pacientes con enfermedad diverticular complicada en un periodo de 9 años. Sede: Hospital Español de Veracruz (tercer nivel de atención). Diseño: Observacional, descriptivo, transversal, retrospectivo. Análisis estadístico: Medidas de frecuencia relativa y tendencia central. Pacientes y métodos: Estudio de 41 pacientes operados por enfermedad diverticular del colon complicada. Variables analizadas: Características sociodemográficas, factores de riesgo, indicaciones quirúrgicas, técnica quirúrgica empleada, complicaciones y evolución postoperatoria. Resultados: La edad promedio fue 66 ± 12.3 años, con predominio del género femenino (51.22%). Las principales indicaciones quirúrgicas fueron: perforación (43.90%), diverticulitis de repetición (21.95%), hemorragia (19.51%), fístula de colon a vejiga y vagina (9.76%) y obstrucción (4.88%). La obesidad fue el factor de riesgo más frecuente (24.39%). En el 56.10% de los casos la cirugía fue electiva. En el 92.69% se efectuó resección primaria con anastomosis y en 7.31% procedimiento de Hartmann. La evolución de los pacientes fue satisfactoria en el 78.05%. La mortalidad del grupo fue de 2.44%. Conclusiones: La experiencia de nuestro grupo en el manejo de la enfermedad diverticular complicada revela una elevada morbilidad, con mortalidad similar a la reportada en la literatura mundial. Es recomendable que el manejo sea realizado por cirujanos expertos y en hospitales de concentración.
Objective: To assess the results of surgical treatment of patients with complicated diverticular disease in a 9-year period. Setting: Hospital Español de Veracruz (third level health care). Design: Observational, descriptive, cross-sectional, retrospective study. Statistical analysis: Relative frequency and central tendency measures. Patients and methods: We studied 41 patients with complicated colonic diverticular disease. Analyzed variables were: sociodemographic characteristics, risk factors, surgical indications, surgical technique used, complications, and postoperative evolution. Results: Average age was of 66 ± 12.3 years, predominating women (51.22%). The main surgical indications were: perforation (43.90%), recurring diverticulitis (21.95%), hemorrhage (19.51%), colon fistula toward the bladder and vagina (9.76%), and obstruction (4.88%). Obesity was the most frequent risk factor (24.39%). Surgery was elective in 56.10% cases. Primary resection with anastomoses was performed in 92.69% of the cases and Hartman's procedure in 7.31%. Evolution of patients was satisfactory in 78.05%, and mortality in the group was of 2.44%. Conclusions: Our experience in the management of complicated diverticular disease reveals a high morbidity, with mortality similar to that reported in the worldwide literature. It is advisable that management be performed by experienced surgeons and at concentration hospitals.
ABSTRACT
BACKGROUND: In 1980, nonalcoholic fatty liver disease (NALFD) was described. It is related to the genesis of gallstones and is considered as a manifestation of the metabolic syndrome. In order to determine the frequency, anatomoclinical characteristics and biochemical and histological alterations in NAFLD, patients underwent cholecystectomy (GD). For this reason, we considered carrying out this study. METHODS: This was a prospective and observational study. The study population was comprised of patients with gallstone disease who were treated at the "Hospital Español" in Veracruz, Mexico from January 1, 2005 to November 30, 2006 and underwent cholecystectomy and liver biopsy. Analyzed variables were anthropometric characteristics and risk factors, and in each patient biochemical tests, abdominal ultrasound (US) and histological liver study were performed. RESULTS: In 95 patients, according to liver biopsy diagnoses, we found a frequency of 54.74% of NAFLD associated with gallstones. Females were more affected (71.15%) and the average age was 55.6 +/- 17.87 years. Risk factors were obesity (67.3%), diabetes mellitus (17.3%), and dyslipidemia (76.92%). Patients with NAFLD had elevated levels of glucose, glycosylated hemoglobin, cholesterol, triglycerides and HDLcholesterol, and aminotransferases. Abdominal US did not show sufficient specificity and sensitivity to detect NAFLD. Histological findings showed stage I steatosis in 51.93%, stage II in 28.84% and stage III in 19.23%. Cirrhosis was found in 3.15%. DISCUSSION: Results of our study confirm the high frequency of NAFLD in association with gallstone disease. We consider this the first work to analyze and describe the primary clinical, biochemical and morphological characteristics.
Subject(s)
Cholelithiasis/epidemiology , Fatty Liver/epidemiology , Adult , Aged , Aged, 80 and over , Anthropometry , Biopsy , Cholecystectomy , Cholelithiasis/surgery , Cholesterol/metabolism , Comorbidity , Fatty Liver/diagnostic imaging , Fatty Liver/metabolism , Fatty Liver/pathology , Female , Humans , Liver/metabolism , Liver/pathology , Liver Cirrhosis/epidemiology , Liver Cirrhosis/etiology , Male , Metabolic Syndrome/epidemiology , Metabolic Syndrome/metabolism , Mexico/epidemiology , Middle Aged , Prevalence , Prospective Studies , Risk Factors , Ultrasonography , Young AdultABSTRACT
OBJECTIVE: We assessed the experience and safety of cholecystectomy through laparoscopic approach in patients with complicated biliary gallbladder disease who were attended at the Hospital Español, Veracruz, Mexico, during a 10-year period. MATERIAL AND METHODS: A prospective, longitudinal, comparative study with a control group was designed. We studied a group of patients with complicated cholelithiasis disease (Group I) and compared them with patients without complicated diseases. We analyzed the following variables: age, gender, risk factors, associated trans-operative pathology and accidents, surgical time, rate of conversion to open procedure, length of hospital stay, complications and evolution. RESULTS: During the 10-year period, 733 cholecystectomies were performed, 245 (33.42%) to treat complicated cholelithiasis and 488 (66.58%) uncomplicated. There were no differences regarding gender, age, risk factors, hospital stay, complications, morbidity and mortality, and iatrogenic lesions of the biliary tree, postoperative morbidity and mortality. In all patients of Group I (245), we found complications of cholelithiasis (acute cholecystitis, choledochal gallstones, vesicular adherences, and cholecystocolonic fistula). Surgical time was longer in Group I and surgical accidents made the surgical procedure more difficult. CONCLUSIONS: The overall results established that laparoscopic cholecystectomy in our institution is a safe procedure in patients with complicated gallbladder disease and can be performed by experienced surgeons.
Subject(s)
Cholecystectomy, Laparoscopic/adverse effects , Cholelithiasis/complications , Cholelithiasis/surgery , Adult , Aged , Female , Humans , Male , Middle Aged , Postoperative Complications/epidemiology , Prospective StudiesABSTRACT
Se presenta la experiencia de siete casos de quiste hepático no parasitario, atendidos en un periodo de siete años, comprendido de 1992 a 1998 en el Hospital Español de Veracruz. Se describen las manifestaciones clínicas, de las cuales la más importantes fue el dolor por compresión sobre los órganos adyacentes, la sensación de tumoración abdominal, y a la exploración, hepatomegalia de grado variable. El diagnóstico se realizó por ultrasonido y se confirmó por tomografía axial computada. El tamaño de los quistes fue en promedio de 14 cm, y se detectaron en 28.57 por ciento de los casos otros quistes adicionales pequeños. El tratamiento quirúrgico consistió en resección de la pared libre del quiste y electrocoagulación del interior de la cápsula residual, mediante técnica laparoscópica. No se presentaron incidentes transoperatorios, ni existió morbilidad o mortalidad relacionada al procedimiento en sí, además en todos los casos la evolución fue satisfactoria. Autores extranjeros, han reportado el tratamiento de esta entidad con técnica laparoscópica y en México, aunque se ha publicado experiencia de algunos autores con técnica abierta, no existe ninguno con cirugía de mínima invasión
