RESUMO
A 74-year-old man with primary aldosteronism had a small tumor (27 x 23 mm) of his right adrenal gland successfully removed by a transperitoneal laparoscopy. Despite absence of malignancy in the resected tumor and complete relief of all symptoms in the immediate postoperative period, recurrence occurred 6 months later. The tumor behaved as a carcinoma spread in the peritoneal cavity, and the patient eventually died with peritoneal carcinomatosis. We suggest that the laparoscopic technique coupled with pneumoperitoneum may have favored this recurrence.
Assuntos
Adenoma/patologia , Adenoma/cirurgia , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Laparoscopia , Neoplasias Peritoneais/secundário , Adenoma/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Idoso , Humanos , Hiperaldosteronismo/complicações , Masculino , Neoplasias Peritoneais/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Open and laparoscopic hernia repairs have both their advantages and their indications. Both techniques are evaluated in relation to technical aspects, complications, recurrence rates and cost effectiveness.
Assuntos
Hérnia Inguinal/cirurgia , Laparoscopia/métodos , Procedimentos Cirúrgicos Operatórios/métodos , Anestesiologia/normas , Bélgica , Análise Custo-Benefício , Estudos de Avaliação como Assunto , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/economia , Prognóstico , Recidiva , Fatores Socioeconômicos , Procedimentos Cirúrgicos Operatórios/efeitos adversosRESUMO
The aim of this study is to assess the long-term results of an original surgical technique for the treatment of patients suffering from painful chronic pancreatitis. From 1981 to 1994, 54 patients with chronic painful pancreatitis were operated, by means of an original duct drainage procedure, named by the authors "double drainage" because it consists of a large transduodenal sphincterotomy and a long pancreatic duct, accompanied by repermeabilization of the cephalic pancreatic duct. This procedure was used exclusively for type I pancreatitis with major lesions in the head of the gland (calcified stones, narrowing of the ducts, inflammatory process). There were 40 men and 14 females in this series. No perioperative mortality and a low morbidity (22%) were observed. Mean follow-up in 52 patients was 56 months (median: 59.5 months). The 5- year actuarial survival was 85.2% and 81% were free of pain (91% when the pancreatic duct was dilated to > 6 mm) versus 63% when the pancreatic duct was (6 mm) (p < 0.01). These excellent results should serve as a baseline for any alternative treatment of this category of painful chronic pancreatitis patients.
