Tratamiento de la hernia inguinal bilateral con malla autoadhesiva en régimen de cirugía ambulatoria. ¿Un nuevo estándar? / Bilateral inguinal hernia repair with self-gripping mess in Day Surgery setting: a new standard?

Introducción: El empleo de mallas confeccionadas con materiales parcialmente reabsorbibles y un diseño que permite que se fijen al tejido sin suturas se plantea como estándar terapéutico en la hernioplastia inguinal bilateral, disminuyendo los tiempos quirúrgicos y mejorando el dolor y la recuperación postoperatoria y, por tanto, favoreciendo la ambulatorización del proceso. Material y métodos: Estudio retrospectivo a través de la historia clínica electrónica (IANUS) de 58 pacientes intervenidos en nuestro servicio en el periodo comprendido entre enero de 2011 y marzo de 2013. Resultados: Se han intervenido en la unidad de cirugía mayor ambulatoria (UCMA) 34 pacientes (58,6 %) y 24 (41,4 %) en régimen de cirugía de tarde. De los pacientes intervenidos en UCMA, solo 3 (8,8 %) precisaron ingreso. De los operados de tarde, 14 (58 %) tuvieron más de una pernocta. Sufrieron dolor agudo intenso 8 pacientes, 4 intervenidos en programa de cirugía ambulatoria y 4 en cirugía de tarde. Presentaron hematomas postoperatorios 8 pacientes, la mayoría intervenidos en cirugía de tarde, estado físico ASA III y tratados con antiagregantes o anticoagulantes. Conclusiones: La hernioplastia inguinal bilateral con malla autoadhesiva en UCMA es un procedimiento ambulatorizable casi al 100 %. Puede plantearse como nuevo estándar en el tratamiento ambulatorio de las hernias inguinales bilaterales (AU)

Introduction: The use of meshes made with partially absorbable materials and a design that allows the tissue to be fixed without sutures, is considered as a therapeutic standard in the bilateral inguinal hernia repair, decreasing surgery time and improving the pain and the postoperative recovery, and for that, helping the ambulatorization of the process. Material and methods: A retrospective study using the electronic medical record (IANUS) of 58 patients operated in our Service in the period between January 2011 and March 2013. Results: The patients are males in 95 % of the cases. 58.6 % underwent surgery in our outpatient surgery unit, 8.8 % needed to be admitted to hospital 41.4 % were operated in the regime of evening surgery, having to sleep overnight 58 %. 8 patients suffered severe acute pain, 4 were operated in ambulatory surgery and 4 in evening surgery. 8 patients had postoperative haematomas, the majority had been operated the evening before, were ASA III and treated with antiplatelet drugs or anticoagulants. Conclusion: The bilateral inguinal hernia repair with self-gripping mesh in our outpatient surgery unit is a day-case episode nearly 100 %. It can be considered as a new standard in the outpatient treatment of the bilateral inguinal hernias (AU)

Papel del tratamiento quirúrgico por vía laparoscópica de la achalasia de cardias: análisis de 50 casos / Role of Laparoscopic Surgery in the Treatment of Achalasia: An Analysis of 50 Cases

La achalasia es un trastorno motor esofágico infrecuente, con un manejo terapéutico controvertido. Objetivo Analizar nuestra experiencia en el manejo de la achalasia, valorando la repercusión de la cirugía mínimamente invasiva, sus complicaciones y resultados a corto y medio plazo. Métodos Estudio descriptivo reprospectivo incluyendo los pacientes intervenidos desde 1999 a 2010 con diagnóstico de achalasia. Analizamos las pruebas diagnósticas previas, la duración de la sintomatología previa al diagnóstico, las terapéuticas no quirúrgicas previas, la vía de abordaje quirúrgico, el tipo de intervención antirreflujo, la duración y las complicaciones perioperatorias. Resultados Fueron intervenidos 50pacientes por vía laparoscópica, 24varones y 26mujeres. La edad media fue de 47años. La media del tiempo de evolución de la enfermedad fue de 2años. Un 22% de los pacientes habían recibido entre 1 y 4sesiones de tratamiento endoscópico previo a la cirugía con recidiva sintomática. En 48 se asoció una funduplicatura tipo Dor y en 2, tipo Toupet. La media de tiempo quirúrgico fue de 123minutos. Se produjeron 9complicaciones intraoperatorias (5perforaciones gástricas mucosas, 2hemorragias, 1laceración hepática y 1broncoaspiración) y 4complicaciones postoperatorias (3cuadros de dolor escapular y 1colección subfrénica). El seguimiento medio fue de 28meses. En el 84% de los pacientes el resultado fue bueno o excelente a largo plazo, en el 12%, regular y en el 4%, malo. Conclusiones Dado el éxito a corto y largo plazo con una mínima morbilidad, la miotomía de Heller laparoscópica es el tratamiento de elección en los pacientes seleccionados para cirugía (AU)

Achalasia is an uncommon oesophageal motor disorder, with a controversial therapeutic management. Aim The aim of our study was to analyse our experience in the management of achalasia, assessing the impact of minimally invasive surgery, its complications, and its outcomes in the short and medium term. Methods A retrospective and descriptive study was designed, including all patients operated on between 1999 and 2010 with the diagnosis of achalasia. Previous diagnostic tests, duration of symptoms, previous non-surgical treatment, surgical approach, associated antireflux intervention, surgical time, and perioperative complications were analysed. Results A total of 50 patients, 24 males, and 26 females, with a mean age of 47 years underwent laparoscopic surgery. The mean duration of the disease was 2 years. Eleven (22%) patients had received endoscopic treatment (1–4 sessions) prior to the surgery, with 100% of symptomatic recurrence. The surgery was accompanied by a Dor fundoplication in 48 patients, and Toupet fundoplication in the remaining 2. The mean surgical time was 123min. There were 9intraoperative complications (5 gastric mucosal perforations, 2 bleeding, 1 liver injury, and 1 aspiration); 4 postoperative complications (3 scapular pain and 1 sub-phrenic collection) were reported. The long-term subjective symptomatic response was excellent/good in 84% of patients, intermediate in 12%, and poor in 4%. The mean follow-up was 28 months. Conclusions Heller cardiomyotomy should be the treatment of choice in selected Achalasia patients, because of its short and long term outcomes, and its low morbidity (AU)

Valganciclovir-induced leukopenia in liver transplant recipients: influence of concomitant use of mycophenolate mofetil.

INTRODUCTION: An increased incidence and magnitude of leukopenia during concomitant treatment with valganciclovir (VGC) and mycophenolate mofetil (MMF) has been reported. OBJECTIVE: To evalute the incidence and severity of leukopenia and neutropenia among liver recipients treated with VGC and related factors. PATIENTS AND METHODS: Retrospective analysis of clinical and analytical data related to leukopenia (<3000 leukocytes/mm(3)) and neutropenia (<900 neutrophils/mm(3)) in liver transplant patients who were treated with VGC from 2003 to 2007. We examined the influence of concomitant administration of MMF and development of subsequent infections. RESULTS: Among 209 liver transplants, 40 treatments with VGC were prescribed in 37 patients (17.7%), 12 of which (30%) were associated with MMF. The patients has an average age of 49.7 +/- 12.7, body mass index (BMI) of 27.28 +/- 5.17, and Model for End-stage Liver Disease Score (MELD) 12.45 +/- 7.5. The daily average dose of VGC was 1440 +/- 446.5 mg and MMF, 1454.5 +/- 350.3 mg. We observed a decrease of 30% in initial leukocyte count (5353.7 +/- 2706.6) and 40% in neutrophil count (3600 +/- 2182.1). With no relationship to total dose or BMI-adjusted dose of VGC nor concomitant administration of MMF. The initial leukocyte count was significantly lower (4411 +/- 1930 vs 6206 +/- 3053; P = .03) and underwent a main drop (2344.7 +/- 1974.3 vs 898.1 +/- 2435.6; P = .04) when leukopenia developed. In the induced neutropenia group, previous leukocyte count (3797.1 +/- 1223.9 vs 5683.9 +/- 2829.3; P = .01), MELD (18.7 +/- 8.8 vs 11.1 +/- 6.6; P = .01), and the creatinine pretreatment (1.44 +/- 0.4 vs 1.09 +/- 0.3; P = .01) were significantly different. Subsequent infections induced by the leukopenia were not observed. CONCLUSIONS: In our series, the concomitant use of VGC and MMF was not associated with a greater incidence of leukopenia and/or neutropenia than VGC administration alone. Previous leukocyte count was associated with them. MELD and renal dysfunction are factors related to severe neutropenia. Leukopenia was not associated with a greater incidence of infections.

Quiste linfoepitelial: una causa muy infrecuente de masa pancreática / No disponible

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Absceso subfrénico con extensión pleural y subcutánea como complicación de un cálculo vertido al peritoneo durante la colecistectomía laparoscópica: implicaciones terapéuticas / Subfrenic abscess with pleural and subcutaneous involvement as complication of peritoneal gallstone dropped during laparoscopic cholecystectomy: therapeutic implications

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Evolución favorable con tratamiento conservador de la rotura esplénica espontánea durante una mononucleosis infecciosa / Favorable evolution with conservative therapy in spontaneous spleen rupture during infectious mononucleosis

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[Epidermoid cyst: a rare cause of cystic liver disease]. / Quiste epidermoide: una causa infrecuente de patología quística hepática.

We present the case of a 42-year-old male patient with a large hepatic cyst, simulating a hydatid cyst. Subtotal cystectomy was performed. Thirteen months after this procedure the patient relapsed and a second laparotomy and total cystectomy were performed. A histopathological diagnosis of epidermoid cyst of the liver was made. The differential diagnosis of epidermoid cysts of the liver is broad and definitive diagnosis is usually only obtained after pathological examination of the surgical specimen. For this reason, and because of the potential for neoplasia, complete resection of the hepatic lesion should be attempted.

[Prognosis of acute pancreatitis: Ranson or APACHE II?]. / Pronóstico de la pancreatitis aguda: Ranson o Apache II?

OBJECTIVE: The aim of this paper is to determine which is the best early prognostic score in acute pancreatitis among those we have studied. DESIGN: Prospective study of acute pancreatitis cases during a 5 year period. PATIENTS: 113 patients, biliary etiology in 93 cases, (average age: 63 years) and 66% females. The diagnostic accuracy of Ranson, Imrie, Osborne and apache II scores was analyzed. RESULTS: There were complications in 12%, and mortality was 8%. Among all the systems analyzed the Ranson criteria achieved the highest sensitivity (79%), although sensitivity was improved with Apache II at admission to the hospital (86%). We have obtained the best specificity with the Apache II (89%) and with the Osborne criteria (88%). The modification of Ranson's criteria for biliary etiology didn't improve the sensitivity (56%) to detect severe cases of acute pancreatitis. CONCLUSIONS: The Apache II system was the best for the early detection of severe acute pancreatitis. Its diagnostic sensitivity was higher than the multiple laboratory criteria analyzed.