Appraising pancreatic fistula in pancreas transplantation: A comprehensive complication index based analysis of postoperative outcomes and predictors of graft survival.

BACKGROUND: A definition of pancreatic fistula specifically addressing pancreas transplantation (PT) is lacking. This study sought to characterize pancreatic fistula in this setting and to define its clinical relevance on the postoperative course and long-term graft survival (GS). METHODS: Consecutive simultaneous pancreas and kidney transplantations were analysed. The global postoperative course was assessed through the comprehensive complication index (CCI). PF was defined according to the original International Study Group for Pancreatic Surgery (ISGPS) definition. Predictors of poor postoperative course and GS were explored. RESULTS: Seventy-eight patients were analysed. Surgical morbidity was 48.7%, with severe complications occurring in 39.7%. Ninety-day mortality was 2.6%. PF occurred in 56.6% of patients, although its average clinical burden was low and did not correlate with either early or long-term outcomes. Peri-graft fluid collections, postoperative day (POD) 1 drain fluid amylase (DFA) ≥ 2200 U/L, and POD 5 DFA/serum amylase ratio ≥7.0 independently correlated with poor postoperative course. Perigraft fluid collections were associated with reduced GS. CONCLUSION: Conventionally defined pancreatic fistula is frequent following PT, although its clinical impact is negligible. To define clinically relevant PF, novel cut-offs for DFA might be pondered in a future series, while perigraft fluid collections should be strongly considered.

Retroneumoperitoneo masivo secundario a pancreatitis aguda necrotizante / Massive retropneumoperitoneum due to necrotizing acute pancreatitis

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[Phlebectomies or foam sclerosis for treatment of the distal venous segment in the 3-S saphenectomy technique]. / Flebectomías o esclerosis con espuma para el tratamiento del segmento venoso distal en la técnica 3-S safenectomía.

INTRODUCTION: The aim of this study was to compare the recurrent rates of varicose veins after treatment with two surgical techniques: 3-S saphenectomy and 3-S saphenectomy with distal sclerosis. PATIENTS AND METHOD: 105 patients with trunk varicose veins were randomly assigned. The control group consisted of 51 patients who underwent the 3-S saphenectomy technique (the sapheno-femoral junction sclerosis with foam, saphenectomy and distal phlebectomies); test group: 3-S saphenectomy with distal sclerosis technique (the sapheno-femoral junction sclerosis with foam, saphenectomy and distal segment sclerosis). RESULTS: Overall recurrence: group I 35.3%, group II 57.4% (p < 0.001). Trunk recurrence: group I 17.7%, group II 38.9% (p = 0.028). Collateral recurrence: group I 9.8%, group II 11.1% (p = 1). Perforator vein recurrence: group I 5.9%, group II 5.6% (p = 1). Reticulated recurrence: group I 2%, group II 1.9% (p = 1). CONCLUSIONS: The substitution of Müller phlebectomy instead of foam sclerosis, is not a better treatment of the distal venous segment, and has a greater recurrence rate. The 3-S saphenectomy technique is the most suitable for the treatment for trunk varicose veins.

Flebectomías o esclerosis con espuma para el tratamiento del segmento venoso distal en la técnica 3-S safenectomía / Phlebectomies or foam sclerosis for treatment of the distal venous segment in the 3-S saphenectomy technique

Introducción. El objetivo de este estudio es comparar la tasa de recidiva de las varices operadas mediante dos técnicas quirúrgicas diferentes: la 3-S safenectomía y la 3-S safenectomía más esclerosis distal. Pacientes y método. Se distribuyó aleatoriamente a 105 pacientes con varices tronculares: grupo I o control (n = 51), técnica 3-S safenectomía (esclerosis del cayado con espuma, safenectomía y flebectomías del segmento distal); grupo II o estudio (n = 54), técnica 3-S safenectomía más esclerosis distal (esclerosis del cayado con espuma, safenectomía y esclerosis del segmento distal). Resultados. Recidivas en total: grupo I, 35,3%; grupo II, 57,4% (p < 0,001). La recidiva troncular fue en el grupo I del 17,7% y en el grupo II, del 38,9% (p = 0,028). La recidiva colateral fue en el grupo I del 9,8% y en el grupo II, del 11,1% (p = 1). La recidiva tipo vena perforante fue en el grupo I del 5,9% y en el grupo II, del 5,6% (p = 1). La recidiva reticular fue en el grupo I del 2% y en el grupo II, del 1,9% (p = 1). Conclusiones. La sustitución de la flebectomía de Müller por la esclerosis con microespuma no permite un mejor tratamiento del lecho venoso distal, y se objetiva un mayor número de recidivas a este nivel, por lo que la técnica 3-S safenectomía es la más adecuada para el tratamiento de las varices tronculares (AU)

Introduction. The aim of this study was to compare the recurrent rates of varicose veins after treatment with two surgical techniques: 3-S saphenectomy and 3-S saphenectomy with distal sclerosis. Patients and method. 105 patients with trunk varicose veins were randomly assigned. The control group consisted of 51 patients who underwent the 3-S saphenectomy technique (the sapheno-femoral junction sclerosis with foam, saphenectomy and distal phlebectomies); test group: 3-S saphenectomy with distal sclerosis technique (the sapheno-femoral junction sclerosis with foam, saphenectomy and distal segment sclerosis). Results. Overall recurrence: group I 35.3%, group II 57.4% (p < 0.001). Trunk recurrence: group I 17.7%, group II 38.9% (p = 0.028). Collateral recurrence: group I 9.8%, group II 11.1% (p = 1). Perforator vein recurrence: group I 5.9%, group II 5.6% (p = 1). Reticulated recurrence: group I 2%, group II 1.9% (p = 1). Conclusions. The substitution of Müller phlebectomy instead of foam sclerosis, is not a better treatment of the distal venous segment, and has a greater recurrence rate. The 3-S saphenectomy technique is the most suitable for the treatment for trunk varicose veins (AU)

[Classical surgery versus 3-S saphenectomy in the treatment of lower extremity varices]. / Cirugía clásica frente a 3-S safenectomía para el tratamiento de las varices del miembro inferior.

INTRODUCTION: The rate of recurrence requiring redo surgery after primary surgical treatment of varicose veins is between 20 and 30%. Several techniques to reduce the high rate of recurrence after stripping have been designed over the years, especially reticulated recurrences at the sapheno-femoral junction. The aim of this study was to compare the recurrence rates of varices after treatment with two surgical techniques: stripping and 3-S saphenectomy. PATIENTS AND METHOD: One hundred patients with leg varicose veins were randomly assigned to two groups. Group I consisted of 50 patients who underwent classical surgery (ligature and section at the sapheno-femoral junction and collateral veins, with saphenectomy). Group II consisted of 50 patients who underwent the 3-S saphenectomy technique (sclerosis injection at the sapheno-femoral junction with microfoam through a catheter, with saphenectomy and distal phlebectomies). The rate and type of recurrences were evaluated through echo-Doppler 12 months after the procedure. RESULTS: Overall recurrence: group I: 78%, group II: 44% (P< .05). Trunk recurrence: group I 12%, group II 16% (P=NS). Collateral recurrence: group I 16%, group II 6% (P=NS). Perforator vein recurrence: group I 18%, group II 18% (P=NS). Reticulated recurrence: group I 32%, group II 4% (P=.002). CONCLUSIONS: The 3-S saphenectomy technique decreases the overall rate of recurrence, particularly reticulated type recurrences. We recommend avoidance of surgery of the branches at the sapheno-femoral junction.

Cirugía clásica frente a 3-S safenectomía para el tratamiento de las varices del miembro inferior / Classical surgery versus 3-S saphenectomy in the treatment of lower extremity varices

Introducción. Se estima que aproximadamente entre un 20 y un 30% de las varices operadas necesitarán ser reintervenidas. A lo largo de estos años, se han diseñado diferentes técnicas con la pretensión de reducir la elevada tasa de recidivas que se produce tras el clásico stripping, y de modo especial la recidiva del tipo reticular que se genera en la unión safenofemoral. El objetivo de este estudio es comparar la tasa de recidiva de las varices operadas con dos opciones técnicas: la safenectomía clásica y la 3-S safenectomía. Pacientes y método. Se distribuyó a 100 pacientes con varices de la extremidad inferior de forma aleatoria en 2 grupos: grupo I: 50 pacientes sometidos a cirugía clásica (ligadura y sección en la unión safenofemoral y venas colaterales, más safenectomía); grupo II: 50 pacientes sometidos a la técnica 3-S safenectomía (esclerosis del cayado con esclerosante en forma de espuma a través de un catéter, safenectomía más flebectomías del segmento distal). A los 12 meses de la intervención, se evaluó a los pacientes mediante eco-Doppler para determinar la tasa y el tipo de recidiva en cada técnica. Resultados. La recidiva global fue: grupo I: 78% y grupo II: 44% (p < 0,05). La recidiva troncular fue en el grupo I del 12% y en el grupo II del 16% (p = NS). La recidiva colateral fue en el grupo I del 16% y en el grupo II del 6% (p = NS). La recidiva de la vena perforante fue en el grupo I del 18% y en el grupo II del 18% (p = NS). La recidiva tipo variz reticular fue en el grupo I del 32% y en el grupo II del 4% (p = 0,002). Conclusiones. La técnica 3-S safenectomía disminuye la tasa global de recidivas, y especialmente las de tipo reticular. Se aconseja evitar el abordaje quirúrgico de las ramas colaterales del cayado de la vena safena (AU)

Introduction. The rate of recurrence requiring redo surgery after primary surgical treatment of varicose veins is between 20 and 30%. Several techniques to reduce the high rate of recurrence after stripping have been designed over the years, especially reticulated recurrences at the sapheno-femoral junction. The aim of this study was to compare the recurrence rates of varices after treatment with two surgical techniques: stripping and 3-S saphenectomy. Patients and method. One hundred patients with leg varicose veins were randomly assigned to two groups. Group I consisted of 50 patients who underwent classical surgery (ligature and section at the sapheno-femoral junction and collateral veins, with saphenectomy). Group II consisted of 50 patients who underwent the 3-S saphenectomy technique (sclerosis injection at the sapheno-femoral junction with microfoam through a catheter, with saphenectomy and distal phlebectomies). The rate and type of recurrences were evaluated through echo-Doppler 12 months after the procedure. Results. Overall recurrence: group I: 78%, group II: 44% (P<.05). Trunk recurrence: group I 12%, group II 16% (P=NS). Collateral recurrence: group I 16%, group II 6% (P=NS). Perforator vein recurrence: group I 18%, group II 18% (P=NS). Reticulated recurrence: group I 32%, group II 4% (P=.002). Conclusions. The 3-S saphenectomy technique decreases the overall rate of recurrence, particularly reticulated type recurrences. We recommend avoidance of surgery of the branches at the sapheno-femoral junction (AU)

Perforación colónica secundaria a distrofiamiotónica de Steinert / Colonic perforation secondary to Steinert's myotonic dystrophy

La enfermedad de Steinert es una rara miopatía hereditaria caracterizada por debilidad muscular generalizada, miotonía y afección multisistémica. Aunque los síntomas gastrointestinales pueden presentarse en alguna etapa del desarrollo de la enfermedad, la seudoobstrucción intestinal representa una complicación infrecuente. Presentamos el caso de un paciente afectado de distrofia miotónica, con historia de seudoobstrucción colónica crónica, que requirió laparotomía exploradora urgente por cuadro de perforación cecal. (AU)