Laparoscopic Incisional Hernia Repair After Liver Transplantation: Long-Term Series and Literature Review.

BACKGROUND: Liver transplant (LT) surgery is associated with a high occurrence of hernias, which is related to multiple factors such as body mass index (BMI), diabetes, immunosuppression, corticosteroids, and so on. Laparoscopic ventral hernia repair after LT allows rapid patient recovery with a low postoperative complication rate. METHODS: We conducted a retrospective analysis of all LTs performed since 1998 in patients who underwent laparoscopic hernia repair in our centers. Likewise, we reviewed the literature, including all published studies of the laparoscopic approach to hernia repair after LT. RESULTS: Between 2002 and 2018, 37 patients underwent laparoscopic hernia repair surgery after LT. The majority were men (86%) with a mean age of 51 years (48.5-61) and a BMI of 30.4. All patients underwent laparoscopic surgery, with placement of intraperitoneal mesh with a surface area of 414 cm2 fixed with nonresorbable tackers. The mean hospital stay was 2 days. Morbidity included 3 seroma (8%) and a wound infection (2%); there was no major morbidity with involvement of the liver graft. The median follow-up was 43 (18-93) months, with 2 cases of recurrence (5%). In the published literature, we found 11 articles, among which the largest series was 54 patients; however, the majority had fewer than 20 cases. In all articles, a decrease in the morbidity and mortality rates was described after this surgery and previous LT decompensation. CONCLUSION: Laparoscopic hernia repair in patients with previous LT is safe with a low complication rate and is reproducible and therefore should be the first-choice approach.

Left Diaphragmatic Herniation following Orthotopic Liver Transplantation in an Adult.

Diaphragmatic herniation is an uncommon complication in the postquirurgic follow of the liver transplant. The associated symptoms are unspecific and may not suggest the correct diagnosis. It may explain why in many patients the diagnosis remains unmade or it is made only after a long interval of time. We present the case of a fifty-seven-year-old male who required an orthotopic liver transplant in 2010 due to a trifocal hepatocarcinoma. In postoperatory follow-up the patient showed alimentary regurgitation, vomiting, and dyspepsia. The diagnosis was made by an oesophagogastroduodenal transit with barium and an abdominal CT scan that showed a left diaphragmatic herniation with the gastric fundus into the thorax. With these findings we decided to perform a programmed surgery. After takedown of adhesions and replacement of the stomach into the upper abdomen, the palm-sized diaphragmatic opening was closed with a synthetic material. The patient's condition remained stable throughout the entire operation. The postoperative course was uneventful and he was discharged at the fifth day after surgery with a normal digestive intake. In a 12-month follow-up the patient shows no symptoms.

Laparoscopia colorrectal en Canarias. Estudio multicéntrico en 144 pacientes / Colorectal laparoscopy in the Canary Islands. A multicenter study of 144 patients

Introducción. Analizar los resultados a corto plazo de la cirugía laparoscópica colorrectal (CLCR) en Canarias. Material y métodos. Enviamos una encuesta a los hospitales que realizan esta actividad y obtuvimos retrospectivamente datos sobre las variables demográficas, peroperatorias y anatomopatológicas de 144 pacientes intervenidos de CLCR desde mayo de 1993 hasta mayo de 2003. Resultados. Se intervino quirúrgicamente a 65 varones y 79 mujeres, 68 (47,2%) en los últimos 16 meses del período estudiado. Se realizaron 126 procedimientos colónicos y 18 rectales. El procedimiento más realizado fue la sigmoidectomía, con 85 casos (59%). El adenocarcinoma, con 73 casos (50%), fue el diagnóstico más habitual, y la diverticulosis, con 36 casos (25%), fue el segundo en frecuencia. Los valores medios de las variables estudiadas fueron: índice de masa corporal medio, 27,3 (rango, 22-35); tiempo quirúrgico, 175 min (rango, 60-255), y pérdidas hemáticas, 183,6 ml (rango, 50-500). La peristalsis se presentó a las 45 h, la dieta oral se inició a las 67 h y la estancia hospitalaria media global fue de 7,8 días (rango, 3-30). Los pacientes que presentaban complicaciones tuvieron una estancia significativamente mayor (14,5 frente a 6,4 días; p < 0,01). Hubo 7 conversiones (4,86%). No se registró ninguna muerte. La tasa de morbilidad global fue del 28%. La complicación precoz más frecuente fue la infección de la herida en 9 ocasiones (6,2%). Se detectaron 5 casos de fuga anastomótica (3,4%). Conclusiones. La CLCR se ha mostrado como una técnica segura y eficaz, y su uso se ha incrementado en todos los centros consultados en el último año. La aparición de complicaciones posquirúrgicas fue el factor que más influyó en la estancia hospitalaria (AU)

Introduction. To analyze the short-term results of laparoscopic colorectal surgery (LCRS) in the Canary Islands. Material and methods. A questionnaire was sent to hospitals performing laparoscopy and retrospective data on demographic, perioperative and pathological variables in 144 patients who underwent LCRS between May 1993 and May 2003 were obtained. Results. Sixty-five men and 79 women underwent colon (n=126) and rectal (n=18) surgery in the last 16 months of the study period. The most frequently performed procedure was sigmoidectomy in 85 patients (59%). The most frequent diagnosis was colon adenocarcinoma in 73 patients (50%), followed by diverticular disease in 36 patients (25%). The mean values of the variables studied were: body mass index, 27.3 (range, 22-35); operating time, 175 min (range, 60-255); blood loss, 183.6 ml (range, 50-500). Peristalsis reinitiated at 45 h; oral diet was introduced at 67 h and the overall mean length of hospital stay was 7.8 days (range, 3-30). The length of hospital stay was significantly longer in patients with complications (14.5 vs 6.4; p <.01). There were 7 conversions (4.86%). There were no perioperative deaths. The overall morbidity rate was 28%. The most frequent early complication was surgical wound infection in 9 patients (3.4%). Conclusions. LCRS has been shown to be a safe and effective technique that has recently increased in the centers surveyed. The factor with the greatest influence on length of hospital stay was the development of postoperative complications (AU)

[Colorectal laparoscopy in the Canary Islands. A multicenter study of 144 patients]. / Laparoscopia colorrectal en Canarias. Estudio multicéntrico en 144 pacientes.

INTRODUCTION: To analyze the short-term results of laparoscopic colorectal surgery (LCRS) in the Canary Islands. MATERIAL AND METHODS: A questionnaire was sent to hospitals performing laparoscopy and retrospective data on demographic, perioperative and pathological variables in 144 patients who underwent LCRS between May 1993 and May 2003 were obtained. RESULTS: Sixty-five men and 79 women underwent colon (n=126) and rectal (n=18) surgery in the last 16 months of the study period. The most frequently performed procedure was sigmoidectomy in 85 patients (59%). The most frequent diagnosis was colon adenocarcinoma in 73 patients (50%), followed by diverticular disease in 36 patients (25%). The mean values of the variables studied were: body mass index, 27.3 (range, 22-35); operating time, 175 min (range, 60-255); blood loss, 183.6 ml (range, 50-500). Peristalsis reinitiated at 45 h; oral diet was introduced at 67 h and the overall mean length of hospital stay was 7.8 days (range, 3-30). The length of hospital stay was significantly longer in patients with complications (14.5 vs 6.4; p <.01). There were 7 conversions (4.86%). There were no perioperative deaths. The overall morbidity rate was 28%. The most frequent early complication was surgical wound infection in 9 patients (6.2%). Anastomotic leak was detected in 5 patients (3.4%). CONCLUSIONS: LCRS has been shown to be a safe and effective technique that has recently increased in the centers surveyed. The factor with the greatest influence on length of hospital stay was the development of postoperative complications.