Retroperitoneal paragangliomas in obese patients.

Obesity, the most significant metabolic problem in the world today, is associated with a wide range of diseases, including endocrine disorders. Paraganglioma is a rare chromaffin cell tumor that develops from the neural crest cells of the neuroendocrine system. Retroperitoneal paragangliomas can represent a surgical challenge due to their close relation to large vessels. We report two cases of functioning retroperitoneal paraganglioma in type-I obese patients (case 1: female; weight, 77 kg; body mass index, 30.1 kg/m(2); case 2: male; weight, 92 kg; body mass index, 31.1 kg/m(2)) who underwent elective endocrine surgery. The tumors (one interaortocaval and the other above the iliac artery) were completely excised by laparotomy without postoperative complications.

Laparoscopic adrenalectomy for a large pheochromocytoma in a morbidly obese patient.

The high prevalence of obesity is associated with diverse health problems, including endocrine disorders. Laparoscopic adrenalectomy has become the preferred approach for removal of the adrenal gland, but several authors still debate the role of laparoscopic adrenalectomy in pheochromocytoma. We describe a case of a morbidly obese man (weight, 142 kg; body mass index, 40.2 kg/m(2)) who underwent elective laparoscopic adrenalectomy for a large right pheochromocytoma without incidences.

Gastric necrosis: a possible complication of the use of the intragastric balloon in a patient previously submitted to nissen fundoplication.

The temporary use of the bioenterics intragastric balloon in morbid obesity is increasing worldwide. Generally, this is an effective procedure that helps bring about satisfactory weight loss and improvement in comorbidities after 6 months. However, in some cases, it causes complications such as acute abdomen due to gastric perforation and even death. We describe the case of a type II obese female (weight, 88 kg; body mass index, 35.2 kg/m(2)) who underwent emergency surgery for gastric necrosis caused by bioenterics intragastric balloon; the patient required total gastrectomy and intensive care.

Preservación esplénica tras resección de aneurisma de arteria esplénica por rotura / Spleen preservation after a ruptured splenic artery aneurysm resection

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Hepatic evisceration after cholecystectomy in a superobese patient.

Gallbladder pathology, in general, and cholelithiasis, in particular, are more common in the morbidly obese. Obesity is a risk factor for conversion to open surgery in laparoscopic cholecystectomy. Obesity is also a risk factor for evisceration after laparotomy in adults. Hepatic evisceration after cholecystectomy is rare. We describe a case of right liver lobe evisceration diagnosed by abdominal computed tomography in a superobese patient (body mass index 57 kg/m(2)) after emergency laparoscopic surgery for acute calculous cholecystitis converted to open surgery.

Esofagectomía transtorácica y transhiatal mediante técnicas mínimamente invasivas. Experiencia en 50 pacientes

Introducción. Se presenta la experiencia de nuestra unidad de cirugía esofagogástrica en el tratamiento del cáncer de esófago con procedimientos mínimamente invasivos. Se muestra la forma progresiva de introducirla en el proceso terapéutico y las diferentes modalidades técnicas realizadas. Pacientes y metodo. Se presenta una serie inicial de 50 pacientes con tumores esofágicos resecados con procedimientos mínimamente invasivos. La localización ha sido: 18 en esófago supracarinal, 24 en esófago infracarinal y 8 en cardias. Los procedimientos quirúrgicos realizados han sido: esofagectomía en tres campos (laparoscopia, toracoscopia y cervicotomía), esofagectomía transhiatal y procedimiento de Ivor Lewis por laparoscopia y toracoscopia. Resultados. En 48 pacientes se ha realizado la fase abdominal por laparoscopia y en 13, la fase torácica por toracoscopia. En otros 13 se ha seguido la vía transhiatal desde el acceso laparoscópico abdominal. El tiempo operatorio medio ha sido de 281 min. La morbilidad general de la serie fue del 48% y la mortalidad, del 8%. La estancia media fue de 13,2 días y la supervivencia de los pacientes, tras un seguimiento medio de 19 meses, del 82, el 38 y el 24% para los estadios I, II y III, respectivamente. Conclusiones. Los resultados son comparables con los obtenidos por cirugía convencional. Ha sido posible incorporar las diferentes fases sin reflejar en los resultados el período de aprendizaje. Se han mantenido las mismas resecciones y linfadenectomías que realizábamos en cirugía abierta. Los resultados oncológicos a medio y largo plazo no muestran diferencias con los que presentan otros grupos (AU)

Introduction. Minimally invasive esophagectomy (MIE) can reduce surgical aggression and cardiopulmonary complications while maintaining basic oncological principles. We present the results of our initial experience with this technique in the treatment of esophageal cancer. Patients and method. Fifty patients with a diagnosis of esophageal cancer were selected to undergo MIE. In 18 patients the tumour was located in supracarinal esophagus, in 24 in subcarinal esophagus and in 8 patients in the cardial region. The surgical procedures were: three-field esophagectomy (laparoscopy, thoracostomy and cervicotomy), transhiatal esophagectomy and Ivor Lewis procedure (thoracoscopy and laparoscopy). Results. The laparoscopy approach was used in 48 patients and 13 by the thoracoscopy approach. Transhiatal esophagectomy was performed on 13 patientes. The mean duration of intervention was 281 minutes. Morbidity was 48% and mortality was 8%. The mean hospital stay was 13.2 days. Survival analysis showed: 82% in stage I, 38% in stage II and 24% in stage III. The mean follow-up was 19 months. Conclusions. Minimally invasive techniques to resect the esophagus in patients with cancer were confirmed to be safe and comparable to an open approach with respect to postoperative recovery and cancer survival (AU)

[Transthoracic and transhiatal esophagectomy using minimally invasive techniques. Experience in 50 patients]. / Esofagectomía transtorácica y transhiatal mediante técnicas mínimamente invasivas. Experiencia en 50 pacientes.

INTRODUCTION: Minimally invasive esophagectomy (MIE) can reduce surgical aggression and cardiopulmonary complications while maintaining basic oncological principles. We present the results of our initial experience with this technique in the treatment of esophageal cancer. PATIENTS AND METHOD: Fifty patients with a diagnosis of esophageal cancer were selected to undergo MIE. In 18 patients the tumour was located in supracarinal esophagus, in 24 in subcarinal esophagus and in 8 patients in the cardial region. The surgical procedures were: three-field esophagectomy (laparoscopy, thoracostomy and cervicotomy), transhiatal esophagectomy and Ivor Lewis procedure (thoracoscopy and laparoscopy). RESULTS: The laparoscopy approach was used in 48 patients and 13 by the thoracoscopy approach. Transhiatal esophagectomy was performed on 13 patients. The mean duration of intervention was 281 minutes. Morbidity was 48% and mortality was 8%. The mean hospital stay was 13.2 days. Survival analysis showed: 82% in stage I, 38% in stage II and 24% in stage III. The mean follow-up was 19 months. CONCLUSIONS: Minimally invasive techniques to resect the esophagus in patients with cancer were confirmed to be safe and comparable to an open approach with respect to postoperative recovery and cancer survival.

[Laparoscopic gastrectomy in gastric cancer: experience in a series of 56 patients]. / Gastrectomía por laparoscopia en el cáncer gástrico. Experiencia en una serie de 56 pacientes.

INTRODUCTION: The study presents the experience of the use of minimally invasive surgery in gastric cancer in our unit of Oesophageal-Gastric Pathology Unit. MATERIAL AND METHOD: We present the initial results in 56 patients. The gastric cancer was removed by the use of video-assisted surgery. In 24 patients the tumour was in the lower third of the stomach, in 26 in the middle third, in 3 in gastric fundus and in 3 in cardial region. We perform total or subtotal gastrectomy according to the tumour location and a D2 lymphadenectomy in tumours of the lower third and an extended D1 lymphadenectomy (groups 7, 8, 9 and 11) in the others. RESULTS: We performed a total gastrectomy in 41 patients (73%) and a subtotal gastrectomy in 15 (27%). The patients were staged with: 14 in stage IA, 5 in stage IB, 11 in stage II, 13 in stage IIIA and 5 in stage IV. The mean number of lymph nodes resected was 26.6. The mean duration of intervention was 223 minutes. Morbidity was 19.6% and a mortality of 3.5%. The mean hospital stay was 9.2 days. The 4-year overall survival rate was 66%. The mean follow-up was 19 months. CONCLUSIONS: Postoperative results are similar to conventional surgery. We have incorporated laparoscopic procedures and they have no serious consequences on the results. We performed the same gastric resections and lymphadenectomy as in open surgery. Oncology results in the medium to long-term are similar to open surgery.

Gastrectomía por laparoscopia en el cáncer gástrico. Experiencia en una serie de 56 pacientes / Laparoscopic gastrectomy in gastric cancer: Experience in a series of 56 patients

Introducción. Se presenta la experiencia de nuestra unidad de cirugía esofagogástrica en la gastrectomía por cáncer gástrico con procedimientos mínimamente invasivos. Material y método. Se presenta una serie inicial de 56 pacientes con tumores gástricos localmente resecables (T1 a T3 y N0/+). La localización ha sido: 24 en antro, 26 en cuerpo, 3 en fundus y 3 en cardias. Se efectúa una gastrectomía subtotal o total por laparoscopia según la localización del tumor y linfadenectomía D2 completa en los tumores de antro, y D1 ampliada (grupos 7, 8, 9 y 11), en los de cuerpo, fundus y cardias. Resultados. En 41 (73%) pacientes se ha realizado una gastrectomía total y en 15 (27%), una gastrectomía subtotal. La estadificación de los pacientes ha sido: 14 pacientes en estadio IA, 5 en estadio IB, 11 en estadio II, 13 en estadio IIIA, 5 en estadio IIIB y 5 en estadio IV. El número medio de ganglios extirpado por paciente ha sido 26,6. El tiempo operatorio medio ha sido 223 min. La morbilidad ha sido del 19,6% y la mortalidad, del 3,5%. La estancia postoperatoria media ha sido de 9,2 días. La supervivencia media a 4 años ha sido del 66% con un seguimiento medio de 19 meses. Conclusiones. Los resultados son comparables a los obtenidos por cirugía convencional. Ha sido posible incorporar las diferentes fases sin reflejar en los resultados el período de aprendizaje. Se han mantenido las mismas resecciones y linfadenectomías que realizábamos en cirugía abierta. Los resultados oncológicos a medio y largo plazo no muestran diferencias con los que presentan otros grupos (AU)

Introduction. The study presents the experience of the use of minimally invasive surgery in gastric cancer in our unit of Oesophageal-Gastric Pathology Unit. Material and method. We present the initial results in 56 patients. The gastric cancer was removed by the use of video-assisted surgery. In 24 patients the tumour was in the lower third of the stomach, in 26 in the middle third, in 3 in gastric fundus and in 3 in cardial region. We perform total or subtotal gastrectomy according to the tumour location and a D2 lymphadenectomy in tumours of the lower third and an extended D1 lymphadenectomy (groups 7, 8, 9 and 11) in the others. Results. We performed a total gastrectomy in 41 patients (73%) and a subtotal gastrectomy in 15 (27%). The patients were staged with: 14 in stage IA, 5 in stage IB, 11 in stage II, 13 in stage IIIA and 5 in stage IV. The mean number of lymph nodes resected was 26.6. The mean duration of intervention was 223 minutes. Morbidity was 19.6% and a mortality of 3.5%. The mean hospital stay was 9.2 days. The 4-year overall survival rate was 66%. The mean follow-up was 19 months. Conclusions. Postoperative results are similar to conventional surgery. We have incorporated laparoscopic procedures and they have no serious consequences on the results. We performed the same gastric resections and lymphadenectomy as in open surgery. Oncology results in the medium to long-term are similar to open surgery (AU)

Hepatic evisceration after cholecystectomy in a super obese patient.

Gallbladder pathology in general and cholelithiasis in particular are more common in the morbidly obese. Obesity is a risk factor for conversion to open surgery in laparoscopic cholecystectomy. Obesity is also a risk factor for evisceration after laparotomy in adults. Hepatic evisceration after cholecystectomy is rare. We describe a case of right liver lobe evisceration diagnosed by abdominal computed tomography (CT) in a super obese patient (BMI 57 kg/m2) after emergency laparoscopic surgery for acute calculous cholecystitis converted to open surgery.

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.

Colecistostomía abierta o percutánea en pacientes de alto riesgo. Análisis de una serie de 30 pacientes / Open or percutaneous cholecystostomy in high-risk patients. Analysis of 30 patients

Introducción. La actitud ante la colecistitis aguda es la colecistectomía laparoscópica si es factible o, en su defecto, la colecistectomía abierta. En pacientes de avanzada edad, con importante comorbilidad y elevado riesgo anestésico, la colecistostomía es una opción terapéutica en la colecistitis aguda grave. Pacientes y método. Presentamos 30 casos tratados mediante colecistostomía en los últimos tres años. Todos los pacientes presentaron un cuadro de colecistitis aguda grave, con importante deterioro de su estado general y un alto riesgo anestésico por la avanzada edad y sus enfermedades asociadas. Resultados. La edad media de los pacientes (18 varones y 12 mujeres) fue de 79 años. En la analítica destacó la leucocitosis con o sin desviación a la izquierda en 28 casos (93 por ciento). El riesgo anestésico fue ASA IV en 25 casos (83 por ciento) y ASA III en los otros 5 (17 por ciento). En todos los casos se instauró tratamiento antibiótico intravenoso. La colecistostomía fue abierta en 12 pacientes y guiada por ecografía en 18. El germen más aislado fue Escherichia coli (16 pacientes, 53 por ciento). La morbilidad y la mortalidad de esta serie fueron del 57 y el 20 por ciento, respectivamente. Las curaciones llegaron al 80 por ciento de los casos. Conclusiones. En los pacientes ancianos y con importante afección de base, que supone un alto riesgo anestésico y quirúrgico en caso de colecistitis aguda grave, para conseguir un tratamiento curativo, se puede plantear la colecistostomía (radiológica o quirúrgica). (AU)

Divertículo epifrénico de grandes dimensiones: resolución mediante toracotomía y sutura mecánica / Giant epiphrenic diverticulum: resolution with thoracotomy and mechanical suture

Los divertículos epifrénicos, a pesar de ser infrecuentes y generalmente asintomáticos, pueden producir sintomatología clínica cuando son de gran tamaño. Se presenta el caso de un varón de 67 años, con molestias de varios años de evolución, que tras realizarle un tránsito baritado y una fibrogastroscopia se le diagnosticó un divertículo epifrénico de gran tamaño. Tras la cirugía el paciente está asintomático (AU)