Subject(s)
Ampulla of Vater/pathology , Duodenal Neoplasms/diagnosis , Neuroendocrine Tumors/diagnosis , Neurofibromatosis 1/complications , Pancreatic Ducts/pathology , Cholangiopancreatography, Endoscopic Retrograde , Duodenal Neoplasms/pathology , Duodenal Neoplasms/physiopathology , Duodenal Neoplasms/surgery , Female , Humans , Lymphatic Metastasis , Middle Aged , Neoplasm Staging , Neuroendocrine Tumors/pathology , Neuroendocrine Tumors/physiopathology , Neuroendocrine Tumors/surgery , Pancreaticoduodenectomy , Treatment OutcomeABSTRACT
CASE REPORT: Gastroschisis is the most frequent congenital abdominal wall defect. When associated with intestinal atresia (complex gastroschisis), short bowel syndrome may occur. Complicated gastroschisis is the most frequent cause of short bowel syndrome in our series. The serial transverse enteroplasty procedure has been used to lengthen the bowel and achieve intestinal rehabilitation in patients with dilated gut. The use of this technique in the newborn period, for tailoring the bowel while preserving absorptive mucosa, has been recently described. We present a video showing the surgical treatment of an intestinal obstruction produced by a complex intestinal atresia in a newborn baby in whom a primary closure of a gastroschisis had been done at birth. During laparotomy at the 21st day of life, a type IVa intestinal atresia was found, associated with a colonic stenosis. Proximal dilated jejunum was tailored with a serial transverse enteroplasty procedure, as shown in the video. End-to-end jejunal-ileal anastomosis was performed. Postoperative entero-cutaneous fistula occurred and was treated with vacuum-assisted therapy. Enteral feedings were initiated at 15 days after surgery. Parenteral nutrition was withdrawn at 30 days. After 16 months follow-up, actual weight was 8.7 kg (percentile 10% to 25%). The patient remained on full enteral feedings. CONCLUSIONS: In cases of intestinal atresia, short bowel syndrome, and proximal dilated bowel, we propose an aggressive surgical approach to preserve bowel mucosal surface while tailoring the jejunal loop to improve motility. The serial transverse enteroplasty procedure is an acceptable alternative to tailoring methods that resect a segment of the bowel wall.
Subject(s)
Digestive System Surgical Procedures/methods , Intestinal Atresia/surgery , Jejunum/surgery , Plastic Surgery Procedures/methods , Short Bowel Syndrome/surgery , Female , Humans , Infant, NewbornABSTRACT
BACKGROUND: The development of intestinal transplant (Tx) programs introduces thymoglobulin donor treatment as well as an almost complete warm dissection of the abdominal organs to allocate them to different recipients. Our aim is to assess the reproducibility and feasibility of the surgical technique of multi-organ procurement with the use of thymoglobulin donor pre-treatment and report the short- and long-term outcomes of every graft harvested as part of multi-organ procurement (MTOp), including the intestine. METHODS: Data were collected of all organs harvested from MTOp, including the intestines allocated to our center from March 2006 to July 2011. Data from 92 recipients and 116 organs procured from 29 MTOp were analyzed. Twelve hearts, 2 lungs, and 1 cardio-pulmonary block were transplanted; primary graft dysfunction developed in 4 of the 12 hearts and in the cardio-pulmonary block. RESULTS: The survival rate was 75% and 100% for hearts and lungs, respectively. Nineteen livers, 9 kidney-pancreas, 19 kidneys, and 29 intestines were transplanted. Delayed graft function (DGF) of the pancreas developed in 3 of 9 kidney-pancreas, and the other 3 exhibited DGF of the kidney; 4 of 19 Tx kidneys had DGF. The survival was 84%, 78%, 95%, and 65.5% for livers, kidney-pancreas, kidneys, and intestines, respectively. CONCLUSIONS: Organs procured during MTOp including the intestine can be safely used, increasing organ availability and transplant applicability without compromising allocation, quality, and long-term results of the non-intestinal-procured organs.
Subject(s)
Organ Transplantation , Tissue and Organ Harvesting/methods , Tissue and Organ Procurement , Adolescent , Adult , Antilymphocyte Serum , Child , Child, Preschool , Feasibility Studies , Female , Graft Survival , Humans , Infant , Intestines/transplantation , Male , Reproducibility of Results , Retrospective Studies , Survival Rate , Tissue and Organ Harvesting/adverse effects , Tissue and Organ Harvesting/mortality , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: The role of intraoperative cholangiography (IOC) in the diagnosis, prevention and management of bile duct injury (BDI) remains controversial. The aim of the present study was to determine the value of routine IOC in the diagnosis and management of BDI sustained during laparoscopic cholecystectomy (LC) at a high-volume centre. METHODS: A retrospective analysis of a single-institution database was performed. Patients who underwent LC with routine IOC between October 1991 and May 2012 were included. RESULTS: Among 11,423 consecutive LCs IOC was performed successfully in 95.7 per cent of patients. No patient had IOC-related complications. Twenty patients (0.17 per cent) sustained a BDI during LC, and the diagnosis was made during surgery in 18 patients. Most BDIs were type D according to the Strasberg classification. The sensitivity of IOC for the detection of BDI was 79 per cent; specificity was 100 per cent. All injuries diagnosed during surgery were repaired during the same surgical procedure. Two patients developed early biliary strictures that were treated by percutaneous dilatation and a Roux-en-Y hepaticojejunostomy with satisfactory long-term results. CONCLUSION: The routine use of IOC during LC in a high-volume teaching centre was associated with a low incidence of BDI, and facilitated detection and repair during the same surgical procedure with a good outcome.
Subject(s)
Bile Ducts/injuries , Cholangiography/methods , Cholecystectomy, Laparoscopic/adverse effects , Intraoperative Complications/prevention & control , Adolescent , Adult , Aged , Aged, 80 and over , Biliary Tract Diseases/surgery , Female , Humans , Intraoperative Care/methods , Intraoperative Complications/surgery , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
Antecedentes: La termoablación por radiofrecuencia ocupa un lugar importante actualmente en el tratamiento de los tumores malignos de hígado. Objetivo: Comunicar nuestra experiencia con el uso de la radiofrecuencia en el tratamiento de los tumores de hígado. Lugar de aplicación: Hospital privado de comunidad. Diseño: Serie de casos, retrospectivo. Material y método: 44 pacientes tratados con radiofrecuencia entre enero de 1999 y diciembre de 2002. Población: Fue dividida según el origen tumoral en: 1. primario, 2. metástasis colorrectal, 3. metástasis neuroendocrina y 4. metástasis no colorrectal no neuroendocrina. La radiofrecuencia fue utilizada: 1. como única modalidad, 2. asociada a cirugía y 3. combinada con otro procedimiento. Se evaluaron la vía de abordaje, la morbilidad, mortalidad, control local, recurrencia local y supervivencia. Resultados: Media de edad 64 años. Masculinos 65 por ciento. Origen del tumor: colorrectal 50 por ciento, hepatocarcinoma 32 por ciento y no colorrectal no neuroendocrino 18 por ciento. Vía de abordaje: Laparotómica 82 por ciento, percutánea 13,5 por ciento y laparoscópica en 4,5 por ciento. Estadía hospitalaria promedio: 4 días. Complicaciones: 8 pacientes (18 por ciento). No hubo mortalidad, ni necesidad de reoperación. Se observó una recidiva parietal luego del abordaje percutáneo. En 8 pacientes (18 por ciento) se indicó radiofrecuencia por segunda vez. Supervivencia actuarial global: 28 por ciento a los 4 años. Conclusiones: La radiofrecuencia es un procedimiento válido y seguro en pacientes seleccionados. Puede ser considerada un tratamiento alternativo en pacientes con imposibilidad o rechazo al tratamiento quirúrgico. En pacientes seleccionados la radiofrecuencia se puede indicar asociada a tratamiento quirúrgico resectivo
Subject(s)
Humans , Male , Middle Aged , Female , Catheter Ablation/instrumentation , Carcinoma, Hepatocellular , Liver Neoplasms , Catheter Ablation/adverse effects , Catheter Ablation/methods , Colorectal Neoplasms , Liver Neoplasms , Minimally Invasive Surgical Procedures , Postoperative Complications , Retrospective StudiesABSTRACT
Antecedentes: La termoablación por radiofrecuencia ocupa un lugar importante actualmente en el tratamiento de los tumores malignos de hígado. Objetivo: Comunicar nuestra experiencia con el uso de la radiofrecuencia en el tratamiento de los tumores de hígado. Lugar de aplicación: Hospital privado de comunidad. Diseño: Serie de casos, retrospectivo. Material y método: 44 pacientes tratados con radiofrecuencia entre enero de 1999 y diciembre de 2002. Población: Fue dividida según el origen tumoral en: 1. primario, 2. metástasis colorrectal, 3. metástasis neuroendocrina y 4. metástasis no colorrectal no neuroendocrina. La radiofrecuencia fue utilizada: 1. como única modalidad, 2. asociada a cirugía y 3. combinada con otro procedimiento. Se evaluaron la vía de abordaje, la morbilidad, mortalidad, control local, recurrencia local y supervivencia. Resultados: Media de edad 64 años. Masculinos 65 por ciento. Origen del tumor: colorrectal 50 por ciento, hepatocarcinoma 32 por ciento y no colorrectal no neuroendocrino 18 por ciento. Vía de abordaje: Laparotómica 82 por ciento, percutánea 13,5 por ciento y laparoscópica en 4,5 por ciento. Estadía hospitalaria promedio: 4 días. Complicaciones: 8 pacientes (18 por ciento). No hubo mortalidad, ni necesidad de reoperación. Se observó una recidiva parietal luego del abordaje percutáneo. En 8 pacientes (18 por ciento) se indicó radiofrecuencia por segunda vez. Supervivencia actuarial global: 28 por ciento a los 4 años. Conclusiones: La radiofrecuencia es un procedimiento válido y seguro en pacientes seleccionados. Puede ser considerada un tratamiento alternativo en pacientes con imposibilidad o rechazo al tratamiento quirúrgico. En pacientes seleccionados la radiofrecuencia se puede indicar asociada a tratamiento quirúrgico resectivo (AU)
