[Liver resections as radical surgery for hepatic hydatidosis: results in 50 patients]. / Resultados de las resecciones hepáticas como tratamiento radical de la hidatidosis hepatica en 50 pacientes.

INTRODUCTION: Among several regions in the world hepatic hydatidosis can be considered endemic. Currently there are many available treatments for this disease, been surgery the most effective one. Surgical procedures can be divided in two main groups, radical and non-radical procedures. The goal of this work is to evaluate the morbidity, mortality and percentage of recurrence in patients treated with hepatectomies, comparing them with other publications. MATERIAL AND METHODS: This retrospective study was carried out in a series from Spain and Argentina. We analyzed the following data: sex, age, type of resection, associated surgical gestures, presence of liver disease, operative time, blood transfusion, morbidity, mortality, hospital stay, re-hospitalization, recurrence and follow up. Dindo--Clavien classification was used for complications, and International Hepato-Pancreato-Biliary Association (IHPBA) Brisbane classification for hepatectomies. Mortality was considered until 90 days after surgery. To evaluate the recurence we only included patients followed over 6 months. RESULTS: Indications for liver resections were performed in patients with cysts larger than 5 centimeters, multiple cysts, large cysts, with bile duct communicated or suspicion of this communication. Five patients required blood transfusions (10%) with a median for these 5 patients of 740 ml and 74 ml for the complete series. The median operative time was 186 minutes (range 45 to 1,050 minutes). Median hospital stay was 7.7 days. Monitoring more than 6 months was conducted in 38 patients. CONCLUSIONS: We believe that hepatic hydatid disease is a multifaceted disease and requires more than one therapeutic approach. Hepatectomy with complete resection of the parasite offers the possibility of doing so in a controlled and safe way by experienced hands, ensuring good results in the treatment of this disease.

Pure laparoscopic liver resection reduces surgical site infections and hospital stay. Results of a case-matched control study in 50 patients.

BACKGROUND: Laparoscopic resection is an emerging tool in surgical oncology, but its role in liver tumors is far from being universally accepted. METHODS: We designed a case-matched control study, comparing laparoscopic (LAP) vs. open hepatectomies (OP) performed in the same center during the same period of time. Fifty LAP were performed (34 liver metastases, 7 hepatocellular carcinomas, 2 hydatid cysts, and 5 benign tumors). Cases were compared with 100 OP matched according to: diagnosis, number of lesions, type of resection, age, ASA score, and ECOG performance status. We evaluated intraoperative and postoperative parameters, focusing on morbidity and mortality. RESULTS: Preoperative data were comparable in both groups. Operative features were similar in terms of overall morbidity 18 (36 %) vs. 36 (36 %), p = 1; intraoperative bleeding, 401 (18-2192) vs. 475 (20-2000) mL, p = 0.89; pedicle clamping, 37 (74 %) vs. 88 (88 %), p = 0.55; margin, 0.6 (0-5) vs. 0.65 (0-5) cm, p = 0.94, and mortality p = 0.65 for the LAP and OP groups, respectively. There was a significant decrease in surgical site infections 1 (2 %) vs. 18 (18 %) p = 0.007 in the LAP group. Operative time was longer: 295 (120-600) vs. 200 (70-450) min (p = 0.0001), and hospital stay significantly shorter: 4 (1-60) vs. 7 (3-44) days, p = 0.0001 with less readmissions (0 vs. 7 %) in the LAP. DISCUSSION: In adequately selected patients, laparoscopic hepatectomy is feasible, safe, shortens hospital stay, and decreases surgical site infections.

Resultados de las resecciones hepáticas como tratamiento radical de la hidatidosis hepatica en 50 pacientes / [Liver resections as radical surgery for hepatic hydatidosis: results in 50 patients].

INTRODUCTION: Among several regions in the world hepatic hydatidosis can be considered endemic. Currently there are many available treatments for this disease, been surgery the most effective one. Surgical procedures can be divided in two main groups, radical and non-radical procedures. The goal of this work is to evaluate the morbidity, mortality and percentage of recurrence in patients treated with hepatectomies, comparing them with other publications. MATERIAL AND METHODS: This retrospective study was carried out in a series from Spain and Argentina. We analyzed the following data: sex, age, type of resection, associated surgical gestures, presence of liver disease, operative time, blood transfusion, morbidity, mortality, hospital stay, re-hospitalization, recurrence and follow up. Dindo--Clavien classification was used for complications, and International Hepato-Pancreato-Biliary Association (IHPBA) Brisbane classification for hepatectomies. Mortality was considered until 90 days after surgery. To evaluate the recurence we only included patients followed over 6 months. RESULTS: Indications for liver resections were performed in patients with cysts larger than 5 centimeters, multiple cysts, large cysts, with bile duct communicated or suspicion of this communication. Five patients required blood transfusions (10

) with a median for these 5 patients of 740 ml and 74 ml for the complete series. The median operative time was 186 minutes (range 45 to 1,050 minutes). Median hospital stay was 7.7 days. Monitoring more than 6 months was conducted in 38 patients. CONCLUSIONS: We believe that hepatic hydatid disease is a multifaceted disease and requires more than one therapeutic approach. Hepatectomy with complete resection of the parasite offers the possibility of doing so in a controlled and safe way by experienced hands, ensuring good results in the treatment of this disease.

Resultados de las resecciones hepáticas como tratamiento radical de la hidatidosis hepatica en 50 pacientes. / [Liver resections as radical surgery for hepatic hydatidosis: results in 50 patients].

INTRODUCTION: Among several regions in the world hepatic hydatidosis can be considered endemic. Currently there are many available treatments for this disease, been surgery the most effective one. Surgical procedures can be divided in two main groups, radical and non-radical procedures. The goal of this work is to evaluate the morbidity, mortality and percentage of recurrence in patients treated with hepatectomies, comparing them with other publications. MATERIAL AND METHODS: This retrospective study was carried out in a series from Spain and Argentina. We analyzed the following data: sex, age, type of resection, associated surgical gestures, presence of liver disease, operative time, blood transfusion, morbidity, mortality, hospital stay, re-hospitalization, recurrence and follow up. Dindo--Clavien classification was used for complications, and International Hepato-Pancreato-Biliary Association (IHPBA) Brisbane classification for hepatectomies. Mortality was considered until 90 days after surgery. To evaluate the recurence we only included patients followed over 6 months. RESULTS: Indications for liver resections were performed in patients with cysts larger than 5 centimeters, multiple cysts, large cysts, with bile duct communicated or suspicion of this communication. Five patients required blood transfusions (10

) with a median for these 5 patients of 740 ml and 74 ml for the complete series. The median operative time was 186 minutes (range 45 to 1,050 minutes). Median hospital stay was 7.7 days. Monitoring more than 6 months was conducted in 38 patients. CONCLUSIONS: We believe that hepatic hydatid disease is a multifaceted disease and requires more than one therapeutic approach. Hepatectomy with complete resection of the parasite offers the possibility of doing so in a controlled and safe way by experienced hands, ensuring good results in the treatment of this disease.

La estenosis del tronco celiaco y duodenopancreatectomía cefálica: ¿un riesgo infravalorado? / Celiac artery stenosis and cephalic duodenopancreatectomy: An undervalued risk?

Introducción La estenosis significativa del tronco celiaco habitualmente cursa de forma asintomática. No obstante, cuando se interrumpe la arcada de las arterias pancreatoduodenales, puede producirse isquemia visceral. El objetivo de este estudio es determinar si la estenosis preoperatoria del tronco celiaco es un factor de riesgo de complicaciones en pacientes sometidos a duodenopancreatectomía (DPC). Material y métodos Hemos analizado retrospectivamente a 58 pacientes consecutivos sometidos a DPC. Hemos relacionado la estenosis significativa del tronco celiaco con la evolución posquirúrgica. En todos los casos se ha realizado un estudio mediante tomografía computarizada multidetector (TCDM) de 16 canales en tres fases hepáticas. Hemos revisado la TCDM prequirúrgica centrándonos en la morfología del tronco celiaco, especialmente la presencia o ausencia de estenosis significativa (> 50%).Resultados Encontramos estenosis del tronco celiaco > 50% en 13 pacientes (22%). La mortalidad total fue de 3 pacientes (5%). La morbilidad total fue del 62%. En 16 pacientes (28%) hubo complicaciones graves, de los que 8 (62%) pertenecen al grupo de estenosis significativa del tronco celiaco (p=0,004); 10 pacientes (17%) presentaron fístula pancreática, 5 (38%) vs. 5 (11%) (p=0,036); 14 pacientes (24%) necesitaron reoperación, 7 (54%) vs. 7 (16%) (p=0,009); 7 pacientes (12%) presentaron hemoperitoneo, 4 (31%) vs. 3 (7%) (p=0,038), en los grupos con y sin estenosis del tronco celiaco respectivamente. Conclusiones La estenosis radiológicamente significativa del tronco celiaco es un factor de riesgo de complicaciones graves tras DPC. El estudio del calibre de la AMS con TCDM debería ser sistemático antes de una DPC. Debería valorarse preoperatoriamente la corrección de la estenosis significativa del tronco celiaco (AU)

Introduction Significant celiac trunk or artery stenosis (CAS) is normally asymptomatic. However, when the arteries of the pancreatoduodenal arcade are occluded, it could trigger avisceral ischaemia. The objective of this study is to determine whether preoperative CAS is a risk factor for developing complications in patients subjected to duodenopancreatectomy(DPC). Material and methods: We have retrospectively analysed 58 consecutive patients subjected to DPC. We have associated significant CAS with post-surgical outcome. In all cases a 16-channel multidetector computed tomography (MDCT) in three hepatic phases was performed. We have reviewed the pre-surgical MDCT focusing on the morphology of the celiacartery (CA), particularly in the presence or absence of significant stenosis (>50%). Results: We found CAS >50% in 13 patients (22%). The overall mortality was 5% (3 patients). Serious complications developed in 16 (28%) patients, 8 (62%) of whom belonged to the group with significant CAS (P = .004). Ten patients (17%) had a pancreatic fistula, 5 (38%) vs. 5 (11%)(P = .036); Fourteen patients (24%) needed new surgery, 7 (54%) vs. 7 (16%) (P = .009); Seven patients (12%) had a haemoperitoneum, 4 (31%) vs. 3 (7%) (P = .038), in the group with and without CAS, respectively. Conclusions: Significant radiological CAS is a risk factor of serious complications after DPC. The study of the calibre of the superior mesenteric artery (SMA) with MDCT should beroutine before a DPC. The correction of a significant CAS should be evaluated preoperatively (AU)

[Celiac artery stenosis and cephalic duodenopancreatectomy: an undervalued risk?]. / La estenosis del tronco celiaco y duodenopancreatectomía cefálica: ¿un riesgo infravalorado?

INTRODUCTION: Significant celiac trunk or artery stenosis (CAS) is normally asymptomatic. However, when the arteries of the pancreatoduodenal arcade are occluded, it could trigger a visceral ischaemia. The objective of this study is to determine whether preoperative CAS is a risk factor for developing complications in patients subjected to duodenopancreatectomy (DPC). MATERIAL AND METHODS: We have retrospectively analysed 58 consecutive patients subjected to DPC. We have associated significant CAS with post-surgical outcome. In all cases a 16-channel multidetector computed tomography (MDCT) in three hepatic phases was performed. We have reviewed the pre-surgical MDCT focusing on the morphology of the celiac artery (CA), particularly in the presence or absence of significant stenosis (>50%). RESULTS: We found CAS >50% in 13 patients (22%). The overall mortality was 5% (3 patients). Serious complications developed in 16 (28%) patients, 8 (62%) of whom belonged to the group with significant CAS (P=.004). Ten patients (17%) had a pancreatic fistula, 5 (38%) vs. 5 (11%) (P=.036); Fourteen patients (24%) needed new surgery, 7 (54%) vs. 7 (16%) (P=.009); Seven patients (12%) had a haemoperitoneum, 4 (31%) vs. 3 (7%) (P=.038), in the group with and without CAS, respectively. CONCLUSIONS: Significant radiological CAS is a risk factor of serious complications after DPC. The study of the calibre of the superior mesenteric artery (SMA) with MDCT should be routine before a DPC. The correction of a significant CAS should be evaluated preoperatively.

[Results of hepatobiliary and pancreatic surgery according to DRG in a level 2 hospital surgery department during the years 2005-2006]. / Resultados de la cirugía hepatobiliopancreática en un servicio de cirugía de un hospital de segundo nivel según los GRD durante el bienio 2005-2006.

OBJECTIVE: To assess the results of the hepatobiliary and pancreatic surgery of a surgery department during 2005-2006 using the diagnostic related groups. MATERIALS AND METHOD: The data were obtained from the CMBD-HA of the Catalan Health Service. We assessed the frequency, hospital stay and mortality of the surgical procedures. The results were compared with the 63 public hospitals, and the 8 of them belonging to the Catalan Health Institute. RESULTS: In our area, a clear trend is observed in referrals for certain types of complex procedures on the liver, pancreas and biliary system excluding cholecystectomy with or without associated morbidities (7-11%) without exceeding the population percentage (12%). In our centre, the impact on hospital stay is more evident in complex procedures. The total savings in our centre during the years 2005-2006 compared with the XHUP hospitals group were 2212 days of hospital stay with an equivalent cost saving of more than one million euro. The frequency and the results of hospital stay and mortality of laparoscopic and open cholecystectomy were those expected for the population covered by a general hospital. The mortality in complex procedures was half of that of the whole public network or the ICS centres. CONCLUSIONS: In the complex hepatobiliary-pancreatic pathology, the mortality, and cost savings in our centre appear to be the result of, not only the high volume of procedures, but also to specialisation and factors related to the structure of the department, and surgeon training.

Resultados de la cirugía hepatobiliopancreática en un servicio de cirugía de un hospital de segundo nivel según los GRD durante el bienio 2005-2006 / Results of hepatobiliary and pancreatic surgery according to DRG in a level 2 hospital surgery department during the years 2005-2006

Objetivo. Evaluar los resultados de la cirugía hepatobiliopancreática de un servicio de cirugía durante el bienio 2005-2006, mediante los grupos relacionados por el diagnóstico. Materiales y método. Los datos se han obtenido del Registro del Conjunto Mínimo Básico de Datos de los Hospitales de Agudos del CatSalut. Se ha valorado la frecuencia, la estancia y la mortalidad. Los resultados han sido comparados con los 63 hospitales públicos de Cataluña (XHUP) y con los 8 de ellos que pertenecen al Instituto Catalán de la Salud (ICS). Resultados. Se observa, en nuestra área de influencia, una clara tendencia a la referencia para cierto tipo de procedimientos complejos (7-11%), sin superarla proporción poblacional (12%). En nuestro centro, el impacto en las estancias hospitalarias es más evidente en los procedimientos complejos. El ahorro total de recursos de nuestro servicio en el bienio2005-2006 en relación con el grupo de hospitales de la XHUP fue de 2.212 días de estancia hospitalaria, cuyo coste equivale a más de un millón de euros. La frecuencia y los resultados sobre las estancias hospitalarias y la mortalidad de la colecistectomía son los esperados para la población que se atiende como hospital general. La mortalidad en los procedimientos complejos fue la mitad que la observada para el conjunto de hospitales de la XHUP o del ICS. Conclusiones. En la patología hepatobiliopancreática compleja, creemos que la mortalidad y el ahorro de recursos en nuestro centro se deben no sólo al volumen, sino a la especialización y los factores relacionados con la estructura del servicio y el entrenamiento de los cirujanos (AU)

Objective. To assess the results of the hepatobiliary and pancreatic surgery of a surgery department during2005-2006 using the diagnostic related groups. Materials and method. The data were obtained from the CMBD-HA of the Catalan Health Service. We assessed the frequency, hospital stay and mortality of the surgical procedures. The results were compared with the 63 public hospitals, and the 8 of them belonging to the Catalan Health Institute. Results. In our area, a clear trend is observed in referrals for certain types of complex procedures on the liver, pancreas and biliary system excluding cholecystectomy with or without associated morbidities(7-11%) without exceeding the population percentage(12%). In our centre, the impact on hospital stay is more evident in complex procedures. The total savings in our centre during the years 2005-2006 compared with the XHUP hospitals group were 2212 days of hospital stay with an equivalent cost saving of more than one million euro. The frequency and the results of hospital stay and mortality of laparoscopic and open cholecystectomy were those expected for the population covered by a general hospital. The mortality in complex procedures was half of that of the whole public network or the ICS centres. Conclusions. In the complex hepatobiliary-pancreatic pathology, the mortality, and cost savings in our centre appear to be the result of, not only the high volume of procedures, but also to specialization and factors related to the structure of the department, and surgeon training (AU)

Duodenopancreatectomía cefálica en tumores periampulares. Disección de la arteria mesentérica superior como abordaje inicial. Descripción de la técnica y evaluación de nuestra experiencia inicial / Cephalic duodenopancreatectomy in periampullary tumours. Dissection of the superior mesenteric artery as aninitial approach. Description of the technique and an assessment of our initial experience

Introducción. La duodenopancreatectomía cefálica (DPC) con abordaje inicial de la arteria mesentérica superior (AMS) ha sido descrita como una técnica útil para reducir las pérdidas de sangre y evitar una intervención inútil si hay afectación arterial. Objetivos. Analizar los resultados de dos modificaciones recientes en la técnica quirúrgica de la DPC introducidas en nuestro grupo: disección primaria de la AMS y la gastroenterostomía antecólica. Pacientes y método. Se dividió a los pacientes en 2 grupos, según hayan recibido o no disección inicial de la AMS. También se analizaron los resultados según el tipo de reconstrucción gástrica. Se comparan los resultados perioperatorios y a largo plazo. Resultados. La mortalidad general fue del 5% sin diferencias entre la DPC con abordaje inicial de la AMS y la técnica convencional. La tasa de transfusión (p < 0,001), el volumen transfundido (p = 0,001) y la incidencia general de complicaciones fue menor (p = 0,01) en el grupo con disección de la AMS. La estancia postoperatoria también fue significativamente menor (p # 0,001). A pesar de que la afectación ganglionar fue más frecuente en los pacientes operados con abordaje inicial de la AMS (p = 0,001), la tasa de recidiva fue la misma que con la técnica convencional. Dentro del grupo con disección inicial de la AMS, aquellos con reconstrucción antecólica presentaron con menor frecuencia retraso en el vaciamiento gástrico (p = 0,008). Conclusiones. La DPC con abordaje inicial de la AMS es una técnica segura. La transfusión, las complicaciones y la estancia hospitalaria son mejores. Cuando se asocia a reconstrucción duodenoyeyunal antecólica, los retrasos de vaciamiento gástrico son menos frecuentes (AU)

Introduction. Pancreatoduodenectomy (PD) with initial dissection of the superior mesenteric artery (SMA) has been described as a useful technical variant to reduce blood loss and to avoid an unnecessary intervention in those cases with arterial involvement. Objectives. To analyse the results of two recent technical modifications of PD introduced by our group: initial dissection of SMA and antecolic gastroenterostomy. Patients and method. Patients were divided into two groups: with and without initial dissection of the SMA. The results were also analysed according to the type of gastric reconstruction. Perioperative and long-term results are compared. Results. The overall mortality was 5%, with no significant differences between the initial SMA dissection and conventional PD. The transfusion rate (p < 0.001), the volume of blood products transfused (p = 0.001), and the overall complication rate were lower (p = 0.01) in the initial SMA dissection group. Also the postoperative hospital stay was significantly lower (p # 0.001). Despite a higher frequency of lymph node involvement in patients treated with initial SMA dissection (p = 0.001), the recurrence rate was similar between both groups. Among patients with initial SMA dissection, those who received antecolic reconstruction had a lower rate of delayed gastric emptying (p = 0.008). Conclusions. Initial SMA dissection PD is a safe technique. The transfusion rate, morbidity and postoperative hospital stay are better when compared with conventional CPD. When an antecolic duodenal-jejunal reconstruction is associated, delayed gastric emptying cases are less frequent (AU)

[Cephalic duodenopancreatectomy in periampullary tumours. Dissection of the superior mesenteric artery as aninitial approach. Description of the technique and an assessment of our initial experience]. / Duodenopancreatectomía cefálica en tumores periampulares. Disección de la arteria mesentérica superior como abordaje inicial. Descripción de la técnica y evaluación de nuestra experiencia inicial.

INTRODUCTION: Pancreatoduodenectomy (PD) with initial dissection of the superior mesenteric artery (SMA) has been described as a useful technical variant to reduce blood loss and to avoid an unnecessary intervention in those cases with arterial involvement. OBJECTIVES: To analyse the results of two recent technical modifications of PD introduced by our group: initial dissection of SMA and antecolic gastroenterostomy. PATIENTS AND METHOD: Patients were divided into two groups: with and without initial dissection of the SMA. The results were also analysed according to the type of gastric reconstruction. Perioperative and long-term results are compared. RESULTS: The overall mortality was 5%, with no significant differences between the initial SMA dissection and conventional PD. The transfusion rate (p < 0.001), the volume of blood products transfused (p = 0.001), and the overall complication rate were lower (p = 0.01) in the initial SMA dissection group. Also the postoperative hospital stay was significantly lower (p

Cirugía laparoscópica en el cáncer de esófago / Laparoscopic surgery in cancer of the esophagus

Introducción. Desde hace un año hemos sustituido la laparotomía por la laparoscopia para realizar la fase abdominal de la cirugía del cáncer de esófago. Presentamos nuestra experiencia con la introducción de la cirugía videoasistida en el tratamiento quirúrgico del cáncer de esófago. Pacientes y método. Aportamos nuestra experiencia con 9 pacientes diagnosticados de cáncer de esófago. En 7 la laparoscopia estuvo precedida de una toracotomía derecha y una disección esofágica. Mediante una cervicotomía lateral izquierda se extrajo la pieza y se elaboró la anastomosis. En otros 2 pacientes, la laparoscopia fue previa y la técnica de Ibor Lewis se completó mediante toracotomía derecha. Resultados. Los resultados son aún poco valorables, dado el reducido número de pacientes operados. La morbilidad se sitúa en el 38,3%. La duración media de la intervención efectuada por laparoscopia se fija en 4 h y 50 min. Constatamos unos valores reducidos en requerimientos de sangre perioperatoria, complicaciones postoperatorias, analgesia y estancia hospitalaria. Conclusiones. La esofagectomía mínimamente invasiva puede ser realizada de una manera tan segura como la convencional y tiene grandes ventajas perioperatorias. La introducción de la laparoscopia representa para nosotros un primer paso para llegar a un procedimiento videoasistido en todas sus fases (AU)

Introduction. For the last year we have substituted laparotomy with laparoscopy for the abdominal stage of esophageal cancer surgery. We report our experience of the introduction of video-assisted surgery in the treatment of esophageal cancer. Patients and method. We report our experience of nine patients diagnosed with esophageal cancer. In seven patients laparoscopy was preceded by right thoracotomy and esophageal dissection. Then, a left anterolateral cervicotomy was performed to remove the specimen and to construct the esophagogastroanastomosis. In two patients the laparoscopic technique was performed first and the Ivor Lewis procedure was completed by right thoracotomy. Results. Due to the reduced number of operated patients, the results are of little significance. Morbidity was 38.3%. The mean duration of the surgical procedure in laparoscopic patients was 4h 50min. However, perioperative blood loss, postoperative complications, analgesic requirements and mean length of hospital stay were reduced. Conclusions. Video-assisted esophagectomy can be performed as safely as conventional esophagectomy and has considerable perioperative advantages. The introduction of the laparoscopic procedure is the first step in using video-assisted surgery at all stages of esophageal cancer surgery (AU)

[Laparoscopic surgery in cancer of the esophagus]. / Cirugía laparoscópica en el cáncer de esófago.

INTRODUCTION: For the last year we have substituted laparotomy with laparoscopy for the abdominal stage of esophageal cancer surgery. We report our experience of the introduction of video-assisted surgery in the treatment of esophageal cancer. PATIENTS AND METHOD: We report our experience of nine patients diagnosed with esophageal cancer. In seven patients laparoscopy was preceded by right thoracotomy and esophageal dissection. Then, a left anterolateral cervicotomy was performed to remove the specimen and to construct the esophagogastroanastomosis. In two patients the laparoscopic technique was performed first and the Ivor Lewis procedure was completed by right thoracotomy. RESULTS: Due to the reduced number of operated patients, the results are of little significance. Morbidity was 38.3%. The mean duration of the surgical procedure in laparoscopic patients was 4 h 50 min. However, perioperative blood loss, postoperative complications, analgesic requirements and mean length of hospital stay were reduced. CONCLUSIONS: Video-assisted esophagectomy can be performed as safely as conventional esophagectomy and has considerable perioperative advantages. The introduction of the laparoscopic procedure is the first step in using video-assisted surgery at all stages of esophageal cancer surgery.