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1.
Clin J Gastroenterol ; 14(1): 258-262, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33216317

RESUMEN

Simple hepatic cysts are very common, but may be difficult to differentiate from a biliary cystadenoma or cystadenocarcinoma. Because the surgical treatment if needed, such as a hepatic fenestration or resection, depends on the diagnosis, the assay of intracystic tumor markers is useful.We report the case of a 67-year-old woman with a large hepatic cyst responsible of pain and inflammation. The combination of imaging findings, serum, and intracystic fluid tumor markers [CA72.4 (carbohydrate hydrogen)] permitted to diagnose a simple hepatic cyst despite an unusual persistent elevated serum CA19.9 level. A laparoscopic cyst fenestration was proposed with an uneventful postoperative course. The pathological findings showed a simple hepatic cyst.In case of hepatic cysts, radiological findings can discriminate between benign and (pre)malignant lesions, but in case of doubtful diagnosis, the serum and intracystic tumor markers can be helpful.The use of serum or intracystic tumor marker allows to choose the correct therapeutic strategy and to use mini-invasive approach when feasible.


Asunto(s)
Quistes , Laparoscopía , Hepatopatías , Anciano , Biomarcadores de Tumor , Quistes/diagnóstico por imagen , Quistes/cirugía , Femenino , Humanos , Hepatopatías/diagnóstico , Hepatopatías/cirugía
2.
Eur J Radiol ; 106: 20-25, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30150046

RESUMEN

PURPOSE: To evaluate the feasibility, safety and usefulness of 3D CBCT with a new injection protocol for targeting the portal vein during TIPS and to determine if it allows decreasing the duration of the procedure. MATERIALS AND METHODS: 3D CBCT was obtained during creation of TIPS in 15 patients (group 2). Portogram quality score was defined using a 5 points scale. The time required to achieve portal puncture was also recorded and results were compared retrospectively in 15 patients who underwent TIPS without 3D CBCT (group 1). RESULTS: The mean time required to puncture the portal vein was shorter when CBCT was used: 15 min versus 24 min (p = 0.156). We recorded 3 failures requiring a second procedure in group 1. There were no complications and no failure in group 2. We recorded 93% of good portography and 80% of good 3D roadmaps. CONCLUSION: 3D CBCT coupled with this new injection protocol provided high rate of good quality portography allowing to bring positional and directional information to improve the needle pass efficiency and to decrease the duration of the procedure.


Asunto(s)
Tomografía Computarizada de Haz Cónico , Hígado/diagnóstico por imagen , Vena Porta/diagnóstico por imagen , Derivación Portosistémica Intrahepática Transyugular , Portografía , Adulto , Anciano , Tomografía Computarizada de Haz Cónico/métodos , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Vena Porta/cirugía , Derivación Portosistémica Intrahepática Transyugular/métodos , Punciones/métodos , Estudios Retrospectivos , Cirugía Asistida por Computador
3.
Surg Obes Relat Dis ; 14(4): 490-497, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29555030

RESUMEN

BACKGROUND: Few series are available concerning repeat sleeve gastrectomy (re-SG), and series have reported contradictory results concerning morbidity rates, with limited data concerning weight loss. OBJECTIVE: Evaluate the short- and medium-term outcomes of re-SG. SETTING: University hospital, France, public practice. METHODS: Between June 2007 and March 2016, all patients undergoing re-SG (n = 46 patients) were included. Re-SG was proposed for patients with insufficient excess weight loss (EWL) (≤50%) or renewed weight gain with excessively high residual gastric volume (>250 mL and/or large gastric pouch). The primary efficacy endpoint was the overall complication rate of re-SG. The secondary efficacy endpoints were operative data, evaluation of weight loss, and correction of co-morbidities, risk factors for gastric leak (GL), by comparing 2 periods (period 1, January 2004-December 2013: blue/green or purple staplers without reinforcement; period 2, after December 2013: black staplers with reinforcement) and comparison of weight loss according to the indication for re-SG. RESULTS: The re-SG group consisted of 46 patients (35 women, mean age: 47.5 yr). The mean body mass index (BMI) before SG was 47.2 kg/m² (35-63.6). The mean time interval between SG and re-SG was 73 months (11-106). The BMI before re-SG was 41.2 kg/m² (29-54.7). Indications for surgery were insufficient weight loss in 25 patients (54.3%) and weight regain in 21 patients (45.7%). A large gastric pouch was visible in 4 patients (8.6%). The mean operating time was 97.6 minutes (45-220). One death (2.1%) and 7 complications (15.2%) were observed. The mean length of hospital stay was 3.6 days (1-30). At last follow-up, mean BMI was 32.1 kg/m2 (20.3-41.3) and mean EWL was 62.3% (18-127.2). When analyzing risk factors for GL, residual gastric volume between 250 and 350 mL was associated with a higher GL rate compared with a volume ≥350 mL, and re-SG performed during period 1 was associated with a higher GL rate than re-SG performed during period 2 (17.4% versus 0%; P = .13). Re-SG performed for weight regain was associated with a significantly higher additional weight loss compared with re-SG performed for insufficient weight loss (mean additional EWL of 45.9%; P = .06). CONCLUSION: Re-SG is feasible, but it requires adaptation of the surgical procedure to decrease complications. Results on weight loss are acceptable, but the best indications for re-SG were a gastric volume>350 mL and in the case of weight regain with the exception of technical failure of the primary SG.


Asunto(s)
Cirugía Bariátrica/estadística & datos numéricos , Gastrectomía/estadística & datos numéricos , Obesidad Mórbida/cirugía , Fuga Anastomótica/cirugía , Estudios de Factibilidad , Femenino , Gastrectomía/métodos , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Prospectivos , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Pérdida de Peso
5.
Surg Obes Relat Dis ; 13(5): 758-765, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28330791

RESUMEN

BACKGROUND: Gastric leak (GL) is one of the main early-onset postoperative complications of sleeve gastrectomy (SG). Many institutions perform routine upper gastrointestinal (UGI) contrast studies within 24 hours of surgery, looking for GL or gastric stenosis and to determine the need for urgent re-exploration, but this examination delays oral feeding, can cause side effects and is responsible for systematic and probably unnecessary irradiation of the patient. OBJECTIVE: Determine the efficacy of routine UGI contrast studies to predict postoperative complications after SG in a large population. SETTING: University hospital, France, public practice. MATERIAL AND METHODS: This study consisted of retrospective review of a prospective database of a cohort of patients who underwent primary SG between January 2007 and August 2013 (n = 1137). Routine UGI contrast studies, performed on postoperative day 1, were independently reviewed by 2 radiologists. The primary endpoint of the study was the effect of routine UGI contrast study on detecting postoperative complications. The secondary endpoints were comparison of the findings of routine UGI contrast study and abdominal computed tomography (CT) scan, sensitivity, and specificity of different imaging signs on abdominal CT scan in the presence of GL, evaluation of the SG learning curve based on the findings of routine UGI contrast studies. RESULTS: A total of 1137 patients underwent primary SG and 30 GL (2.6%) with a mean time to diagnosis of 23.4 days (1-245) and 15 cases of gastric stenosis (1.3%) were observed during the study period. Routine UGI study was performed in 1108 patients, whereas 29 patients were assessed by first-line CT scan. None of the 1108 UGI studies found a GL or gastric stenosis. In the 30 cases of GL, the most sensitive and specific sign was the presence of perigastric abscess without contrast material leak (sensitivity: 56.6%; specificity: 95%). The mean time interval between routine postoperative UGI contrast study and abdominal CT scan was 12.9 days (0-86). Uniform gastric shape was acquired after 30-32 SG procedures. CONCLUSION: Routine postoperative UGI on postoperative day 1 is of limited value after SG. Abdominal CT scan should be preferred in the presence of clinical suspicion of postoperative complications. Selective UGI contrast study remains indicated when gastric stenosis is suspected and at the beginning of the SG learning curve.


Asunto(s)
Gastrectomía/métodos , Tracto Gastrointestinal/diagnóstico por imagen , Laparoscopía/métodos , Obesidad Mórbida/cirugía , Adolescente , Adulto , Anciano , Constricción Patológica/diagnóstico por imagen , Medios de Contraste , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Cuidados Posoperatorios , Complicaciones Posoperatorias/diagnóstico por imagen , Estudios Prospectivos , Estudios Retrospectivos , Gastropatías/diagnóstico por imagen , Dehiscencia de la Herida Operatoria/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto Joven
6.
Surg Obes Relat Dis ; 13(4): 553-559, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28153488

RESUMEN

BACKGROUND: Recent series have shown the lack of value of routine upper gastrointestinal (UGI) contrast studies on postoperative day 1 or 2 for the detection of gastric leak (GL) after sleeve gastrectomy (SG). Despite this finding, many centers still perform routine early UGI contrast studies after SG. No series has evaluated the impact of eliminating this examination on the overall management of patients undergoing SG. OBJECTIVES: To evaluate the impact of UGI contrast studies on SG management. SETTING: University hospital, France, public practice. METHODS: This study was an ambispective study of a cohort of patients who underwent primary SG between January 2014 and December 2014 (n = 267). Two consecutive groups were compared: patients with routine UGI contrast studies on postoperative day 1 (UGI+group, n = 154) and patients without routine UGI contrast studies (UGI-group, n = 113). The efficacy endpoint of the study was the overall impact of not performing routine UGI contrast studies (length of hospital stay, radiological data, rehospitalization data, and economic assessment). RESULTS: The overall complication rate was 9.3% and no deaths were observed. The GL rate was 1.5%. The mean hospital stay was 1.8 days (2.1 days versus 1.5 days; P = .57). Routine UGI contrast studies did not detect any cases of GL or gastric stenosis. After UGI contrast studies, 56 patients complained of events related to UGI contrast studies (36.4%). A total of 27 computed tomography scans were performed during the first 3 postoperative months (16 in the UGI+group (10.4%) versus 11 in the UGI-group (9.7%); P = .52). Twelve patients were rehospitalized (7 and 5; P = .6). The median length of rehospitalization was 7 days (7 and 5 days; P = .6). Overall cost per patient during SG hospitalization was $5,219 in the UGI+group and $3,678 in the UGI-group (P = .01). CONCLUSION: Eliminating routine UGI contrast studies was associated with decreased length of hospital stay and cost of SG procedures. Larger series are required to show that not performing routine UGI contrast studies has no impact on the postoperative complication rate and the management of these complications.


Asunto(s)
Medios de Contraste/administración & dosificación , Gastrectomía/economía , Costos de Hospital , Hospitalización/economía , Hospitales Universitarios , Obesidad Mórbida/cirugía , Radiografía Abdominal/economía , Adolescente , Adulto , Anciano , Femenino , Estudios de Seguimiento , Francia/epidemiología , Gastrectomía/métodos , Humanos , Incidencia , Laparoscopía/economía , Laparoscopía/métodos , Tiempo de Internación/economía , Tiempo de Internación/tendencias , Masculino , Persona de Mediana Edad , Obesidad Mórbida/economía , Complicaciones Posoperatorias/economía , Complicaciones Posoperatorias/epidemiología , Periodo Preoperatorio , Radiografía Abdominal/métodos , Estudios Retrospectivos , Adulto Joven
7.
J Am Coll Surg ; 223(5): 694-703, 2016 11.
Artículo en Inglés | MEDLINE | ID: mdl-27544690

RESUMEN

BACKGROUND: Day case surgery (DCS) for uncomplicated acute appendicitis (NCAA) is evaluated. The objective of this prospective, single-center, descriptive, nonrandomized, intention-to-treat cohort study was to assess the feasibility of DCS for NCAA with a critical analysis of the reasons for exclusion and treatment failures and a focus on patients discharged to home and admitted for DCS on the following day. STUDY DESIGN: From April 2013 to December 2015, NCAA patients meeting the inclusion criteria were included in the study. The primary end point was the success rate for DCS (length of stay less than 12 hours) in the intention-to-treat population (all NCAA) and in the per-protocol population (no pre- or perioperative exclusion criteria). The secondary end points were morbidity, DCS quality criteria, predictive factors for successful DCS, patient satisfaction, quality of life, and reasons for pre- or perioperative exclusion. A subgroup of patients discharged to home the day before operation was also analyzed. RESULTS: A total of 240 patients were included. The success rate of DCS was 31.5% in the intention-to-treat population and 91.5% in the per-protocol population. The rates of unplanned consultations, hospitalization, and reoperation were 13%, 4%, and 1%, respectively. An analysis of the reasons for DCS exclusion showed that 73% could have been modified. For the 68 patients discharged to home on the day before operation, the DCS success rate was 91%. CONCLUSIONS: Day case surgery is feasible in NCAA. A critical analysis of the reasons for exclusion from DCS showed that it should be possible to dramatically increase the eligible population.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Apendicectomía/métodos , Apendicitis/cirugía , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Factibilidad , Femenino , Humanos , Análisis de Intención de Tratar , Masculino , Persona de Mediana Edad , Selección de Paciente , Estudios Prospectivos , Insuficiencia del Tratamiento
8.
Surg Obes Relat Dis ; 12(1): 84-93, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26070397

RESUMEN

BACKGROUND: Gastric leak (GL) represents one of the main early-onset postoperative complication of sleeve gastrectomy (SG). Most studies of GL featured short series and no data on the time to reoperation for persistent GL. OBJECTIVES: Characterize the time between discovery of persistent post-SG GL and the implementation of reoperation. SETTING: University hospital, France, public practice. METHODS: All patients treated for post-SG GL between November 2004 and December 2013 were included. The primary efficacy criterion was the time interval between discovery of a persistent GL and reoperation. The secondary efficacy criteria were demographic, surgical, and endoscopic data; mortality rate; time to GL healing; treatment success rate; and risk factors for failure treatment. RESULTS: Eighty-six patients were treated for post-SG GL. Forty patients (46.5%) had early-onset GL (postoperative day ≤ 7). Two patients (2.3%) presented primary gastrobronchial fistula. Fifty-six patients (70%) underwent immediate reoperation. Endoscopic treatment was required to treat the GL in 92.7% of the cases (n = 77). The mortality rate was 1.2% (n = 1). The treatment success rate was 89.1%. The median time to healing GL was 84 days (14-423 d). Eighty percent of the GLs had healed 120 days after discovery. After 120 days, the incidence of complications related to GL increased and few additional GLs healed. The only identified risk factor for treatment failure was large retained gastric fundus (P ≤ .05). CONCLUSIONS: Most cases of GL can be adequately treated by incorporating endoscopic stenting. Surgery for persistent GL should be performed within 120 days of discovery; after this cut-off, the incidence of GL-related complications increases. Large retained gastric fundus is a risk factor for treatment failure and may prompt the surgeon to consider earlier reoperation.


Asunto(s)
Gastrectomía/efectos adversos , Fístula Gástrica/etiología , Laparoscopía/efectos adversos , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias , Adulto , Femenino , Francia/epidemiología , Fístula Gástrica/epidemiología , Fístula Gástrica/cirugía , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Reoperación , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Resultado del Tratamiento , Adulto Joven
9.
Hepatobiliary Pancreat Dis Int ; 14(5): 543-7, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26459732

RESUMEN

Mirizzi syndrome, a rare complication of gallstones, is defined by obstruction of the main bile duct. This obstruction may worsen and thus result in cholecystobiliary fistula. Surgical management of Mirizzi syndrome is complicated by the presence of inflamed tissue around the hepatic pedicle, making it impossible to distinguish between the main bile duct and the gallbladder. The surgeon's first task is to perform subtotal cholecystotomy (from the fundus of the gallbladder to the neck) without trying to locate the cystic duct. In a second step, the gallstones are extracted and the main bile duct is then repaired. In most cases, a T-tube is used to drain the main bile duct, and abdominal drainage is left in place (in case a bile fistula forms). This study concluded that preoperative drainage of the main bile duct in the treatment of Mirizzi syndrome types II and III is feasible and might help to decrease the postoperative complication rate.


Asunto(s)
Fístula Biliar/cirugía , Colangiopancreatografia Retrógrada Endoscópica , Enfermedades del Conducto Colédoco/cirugía , Drenaje , Cálculos Biliares/cirugía , Síndrome de Mirizzi/cirugía , Anciano , Fístula Biliar/etiología , Enfermedades del Conducto Colédoco/etiología , Femenino , Cálculos Biliares/complicaciones , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Síndrome de Mirizzi/etiología , Estudios Retrospectivos , Adulto Joven
16.
Surg Endosc ; 28(5): 1528-34, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24337192

RESUMEN

BACKGROUND: Despite improvements in surgical techniques and postoperative care, morbidity associated with pancreatoduodenectomy (PD) is still high. Grade B pancreatic fistula (PF) requires a specific combination of radiologically guided external drainage and medical support. This treatment is effective but requires prolonged hospitalization and maintenance of external drainage. The objective of this study was to evaluate the feasibility and efficacy of a double-pigtail stent (DPS) to treat grade B PF after PD with pancreatogastric anastomosis. METHODS: Between January 2008 and October 2011, all patients who presented grade B PF after PD (n = 6) were included in the study. The PF was diagnosed according to the criteria of the International Study Group on Pancreatic Fistula. Endoscopic treatment was standardized with a DPS. The primary efficacy end point was the feasibility and efficacy of DPS placement. Secondary end points included data on the PF, the DPS placement procedure, and long-term outcome. RESULTS: Endoscopic DPS placement was achieved in all patients with no complications. The median time to onset of PF after PD was 14 days. Closure of the external PF was obtained 7 days after the introduction of the DPS. The median time to external drain removal was 7 days after DPS placement, and the median time to oral refeeding was 7 days after DPS placement for all patients. The median time to DPS removal was 60 days. The median length of hospital stay after DPS placement was 10 days. During a median follow-up period of 21 months, there was no recurrence of PF after removal of the DPS. CONCLUSION: Endoscopic treatment of grade B PF after PD appears to be effective and safe and is associated with shorter hospitalization.


Asunto(s)
Drenaje/métodos , Endoscopía del Sistema Digestivo/métodos , Páncreas/cirugía , Fístula Pancreática/cirugía , Pancreaticoduodenectomía/efectos adversos , Stents , Estómago/cirugía , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica/efectos adversos , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Fístula Pancreática/diagnóstico , Fístula Pancreática/etiología , Complicaciones Posoperatorias , Diseño de Prótesis , Reoperación , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
17.
Case Rep Gastroenterol ; 7(3): 396-403, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24163652

RESUMEN

The preoperative management of hilar cholangiocarcinoma (HC) with jaundice focuses on decreasing the total serum bilirubin level (SBL) by performing preoperative biliary drainage (PBD). However, it takes about 6-8 weeks for the SBL to fall at a sufficient extent. The objective of this preliminary study was to evaluate the impact of Molecular Adsorbent Recirculating System (MARS(®)) dialysis (in association with PBD) on SBL decrease. From January 2010 to January 2011, we prospectively selected all jaundiced patients admitted to our university hospital for resectable HC and requiring PBD prior to major hepatectomy. The PBD was followed by 3 sessions of MARS dialysis over a period of 72 h. A total of 10 patients with HC were screened and two of them were included (Bismuth-Corlette stage IIIa, gender ratio 1, median age 68 years). The initial SBL in the two patients was 328 and 242 µmol/l, respectively. After three MARS dialysis sessions, the SBL had fallen by 30 and 52%, respectively. After the end of each session, there was a SBL rebound of about 10 µmol/l. The MARS decreased the serum creatinine level, the platelet count and the prothrombin index, but did not modify the serum albumin level. Pruritus disappeared after one and two sessions, respectively. MARS-related morbidity included hypotension (n = 1), tachycardia (n = 1), thrombocytopenia (n = 2) and anaemia (n = 1). When combined with PBD, MARS dialysis appears to accelerate the decrease in SBL and thus may enable earlier surgery. This hypothesis must be validated in a larger study.

18.
Surg Obes Relat Dis ; 9(5): 660-6, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23452922

RESUMEN

BACKGROUND: Causes of failure after laparoscopic sleeve gastrectomy (LSG) are not known but may include a high residual gastric volume (RGV). The aim of this study was to use gastric computed tomography volumetry (GCTV) to investigate the RGV and relate the latter parameter to the outcome of LSG. METHODS: A single-center, prospective study included patients with>24 months of follow-up after LSG. The RGV was measured with a unique GCTV technique. We determined the LSG outcomes according to a variety of criteria and examined potential relationships with the RGV. When the RGV was>250 cc, we offered a repeat LSG (RLSG). RESULTS: Seventy-six patients were included. The mean RGV was 255 cc but differed significantly when comparing "failure" and "success" subgroups, regardless of whether the latter were defined by a percentage of excess weight loss>50 (309 cc versus 225 cc, respectively; P = .0003), a BAROS score>3 (312 cc versus 234 cc; P = .005), the Reinhold criteria (290 cc versus 235 cc; P = .019), or the Biron criteria (308 cc versus 237 cc; P = .008). The RGV threshold (corresponding to the volume above which the probability of failure after LSG is high) was 225 cc. Fifteen RLSGs were performed during the inclusion period. CONCLUSION: A high RGV 34 months after LSG is a risk factor for failure. Knowledge of the RGV can be of value in the management of failure after LSG.


Asunto(s)
Gastrectomía/métodos , Muñón Gástrico , Laparoscopía/métodos , Obesidad Mórbida/cirugía , Adulto , Anciano , Femenino , Estudios de Seguimiento , Muñón Gástrico/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Dosis de Radiación , Factores de Riesgo , Tomografía Computarizada por Rayos X , Insuficiencia del Tratamiento
19.
Surg Endosc ; 27(8): 2849-55, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23392987

RESUMEN

BACKGROUND: Gastric fistula (GF) is the most serious complication after longitudinal sleeve gastrectomy (LSG), with an incidence ranging from 0 to 5 %. In this context, concomitant upper gastrointestinal bleeding (UGIB) has never been described. Here, we describe our experience of this situation and suggest a procedure for the standardized management of this life-threatening complication. METHODS: We retrospectively analyzed all patients having been treated for post-LSG UGIB in our university medical center between November 2004 and February 2012. Data on GF and UGIB (time to onset, diagnosis and management) were assessed. RESULTS: Forty patients were treated for post-LSG GF in our institution, 18 of whom (45 %) had been referred by tertiary centers. Four patients presented UGIB (10 %): two had undergone primary LSG, one had undergone simultaneous gastric band removal and LSG, and one had undergone repeat LSG. The median time interval between GF and UGIB was 15 days. The four cases of UGIB included three pseudoaneurysms (75 %, with two affecting the left gastric artery and one affecting the upper pole of the splenic artery) and one case of bleeding related to stent-induced gastric ulceration. Computed tomography enabled diagnosis of the pseudoaneurysm in all cases. Two of the four patients (50 %) were treated with selective embolization during arteriography, and two (50 %) were treated surgically with arterial ligation. One of the surgically treated patients died during follow-up. CONCLUSIONS: UGIB after LSG was investigated in the context of a postoperative GF and was found to have been caused by a pseudoaneurysm in 75 % of cases. When looking for a pseudoaneurysm, a primary angiography should be preferred to endoscopy allowing selective arterial embolization in hemodynamically stable patients, whereas surgery should be reserved for treatment failures or hemodynamically instability.


Asunto(s)
Aneurisma Falso/complicaciones , Gastrectomía/efectos adversos , Fístula Gástrica/complicaciones , Arteria Gastroepiploica , Hemorragia Gastrointestinal/etiología , Gastroplastia/efectos adversos , Obesidad Mórbida/cirugía , Adulto , Aneurisma Falso/diagnóstico , Angiografía , Diagnóstico Diferencial , Embolización Terapéutica/métodos , Femenino , Estudios de Seguimiento , Gastrectomía/métodos , Fístula Gástrica/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Gastroscopía , Humanos , Laparoscopía , Ligadura , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos
20.
Abdom Imaging ; 38(2): 285-9, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22684488

RESUMEN

AIM: Percutaneous drainage of abdominal and pelvic abscesses is a first-line alternative to surgery. Anterior and lateral approaches are limited by the presence of obstacles, such as the pelvic bones, bowel, bladder, and iliac vessels. The objective of this study was to assess the feasibility, safety, tolerability, and efficacy of a percutaneous, transgluteal approach by reviewing our clinical experience and the literature. MATERIALS AND METHODS: We reviewed demographic, clinical and morphological data in the medical records of 30 patients having undergone percutaneous, computed tomography (CT)-guided, transgluteal drainage. In particular, we studied the duration of catheter drainage, the types of microorganisms in biological fluid cultures, complications related to procedures and the patient's short-term treatment outcome. RESULTS: From January 2005 to October 2011, 345 patients underwent CT-guided percutaneous drainage of pelvis abscesses in our institution. A transgluteal approach was adopted in 30 cases (10 women and 20 men; mean age: 52.6 [range 14-88]). The fluid collections were related to post-operative complications in 26 patients (86.7 %) and inflammatory or infectious intra-abdominal disease in the remaining 4 patients (acute diverticulitis: n = 2; appendicitis: n = 1; Crohn's disease: n = 1) (13.3 %). The mean duration of drainage was 8.7 days (range 3-33). Laboratory cultures were positive in 27 patients (90 %) and Escherichia coli was the most frequently present microorganism (in 77.8 % of the positive samples). A transpiriformis approach (n = 5) was more frequently associated with immediate procedural pain (n = 3). No major complications were observed, either during or after the transgluteal procedure. Drainage was successful in 29 patients (96.7 %). One patient died from massive, acute cerebral stroke 14 days after drainage. CONCLUSION: When an anterior approach is unfeasible, transgluteal, percutaneous, CT-guided drainage is a safe, well tolerated and effective procedure. Major complications are rare. This type of drainage is an alternative to surgery for the treatment of deep pelvic abscesses (especially for post-surgical collections).


Asunto(s)
Absceso/cirugía , Absceso/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Drenaje/métodos , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pelvis , Radiografía , Radiología Intervencionista , Estudios Retrospectivos , Cirugía Asistida por Computador , Adulto Joven
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