Manejo endoscópico de una fístula tras gastrectomía vertical mediante el sistema 'over-the-scope-clip' (Ovesco(R)) / Endoscopic management of a gastric leak after laparoscopic sleeve gastrectomy using the over-the-scope-clip (Ovesco(R)) system

La gastrectomía tubular laparoscópica se realiza hoy en día como procedimiento para el tratamiento de la obesidad. La fístula gástrica es la principal complicación que puede comprometer la vida del paciente y cuya resolución es un gran reto para el cirujano. Existen múltiples opciones de tratamiento que van desde un tratamiento conservador hasta medidas endoscópicas con clips o prótesis e incluso reintervenciones quirúrgicas que implican una gastrectomía total o la conversión a otra técnica bariátrica. La aplicabilidad de cada una de ellas va a depender del tipo de fístula y del estado general del paciente. Se presenta un caso clínico de un paciente varón de 29 años de edad con índice de masa corporal de 49% que tras una gastrectomía vertical laparoscópica presenta una fístula gástrica tardía que fracasó al manejo conservador y cuya resolución se consiguió mediante el sistema «over-the-scope clip» (Ovesco(R)) (AU)

Laparoscopic sleeve gastrectomy is currently used for the management of morbid obesity. Gastric fistula is the primary life-threatening complication, and its resolution continues to be a strong challenge for surgeons. Multiple treatment options are available, ranging from conservative therapy to endoscopic use of clips or stents, and even surgical reoperation involving total gastrectomy or conversion to a different bariatric technique. The applicability of each individual option will depend on the type of fistula and the patient clinical status. A clinical case is reported of a 29-year-old male patient with a body mass index at 49% who following laparoscopic sleeve gastrectomy had a delayed gastric fistula that failed to respond to conservative management but was successfully treated using the over-the-scope clip (Ovesco(R)) system (AU)

Endoscopic management of a gastric leak after laparoscopic sleeve gastrectomy using the over-the-scope-clip (Ovesco®) system.

Laparoscopic sleeve gastrectomy is currently used for the management of morbid obesity. Gastric fistula is the primary life-threatening complication, and its resolution continues to be a strong challenge for surgeons. Multiple treatment options are available, ranging from conservative therapy to endoscopic use of clips or stents, and even surgical reoperation involving total gastrectomy or conversion to a different bariatric technique. The applicability of each individual option will depend on the type of fistula and the patient clinical status. A clinical case is reported of a 29-year-old male patient with a body mass index at 49% who following laparoscopic sleeve gastrectomy had a delayed gastric fistula that failed to respond to conservative management but was successfully treated using the over-the-scope clip (Ovesco®) system.

The value of thyroperoxidase as a prognostic factor for differentiated thyroid cancer -- a long-term follow-up study.

BACKGROUND: Thyroperoxidase (TPO) is a membrane-bound protein essential for the production of thyroid hormones; because of this, TPO expression may be impaired in selected thyroid diseases. The goal of this study is to analyze TPO immune expression in differentiated thyroid cancer, and to determine whether TPO has any prognostic value. METHODS: A total of 139 patients who required surgery due to a thyroid nodule with signs or symptoms suspicious for malignancy during their physical, ultrasound and/or cytology examination were consecutively selected for the study. A study of TPO immunohistochemical expression was carried out on these patients using the MoAb47 monoclonal antibody. In addition, cell proliferation marker Ki67 and tumor suppressor p53 were also measured for comparison. RESULTS: A total of 139 cases, 43 benign tumors, 42 papillary carcinomas, 38 follicular carcinomas, 8 undifferentiated carcinomas, and 8 sporadic medullary carcinomas were analyzed. The relationship between TPO expression and disease was statistically significant (p <0.001), and decreased with tumor dedifferentiation extent. Increased TPO expression in benign lesions as compared to decreased expression in papillary carcinomas and undifferentiated tumors is outstanding. Differences in TPO expression were observed in minimally invasive follicular carcinoma (MIFC) compared to widely invasive follicular carcinoma (WIFC). TPO expression decreases in undifferentiated malignancies in contrast with p53 and Ki67 expression, which increases in that setting. TPO, p53 and Ki67 expression was significantly related to TNM stage (p <0.001). Survival rate was 72 % after a 20-year follow-up, and 100 % for subjects with higher TPO expression. CONCLUSIONS: TPO may be useful in confirming or ruling out benign diseases from differentiated thyroid carcinoma, with the exception of low-risk carcinoma such as MIFC. It could be used as a prognostic factor for differentiated thyroid cancer and patient follow-up, together with other markers.

Bariatric Surgery: Does It Play a Role in Fertility-Preserving Treatment Among Obese Young Women With Endometrial Cancer?

We present the case of a 17-year-old nulliparous woman with a history of obesity (body mass index 36.2 kg/m(2)), type 2 diabetes, and polycystic ovary syndrome, who was diagnosed with grade 1 endometrioid adenocarcinoma without radiological evidence of myometrial invasion or metastatic disease. After failure of a fertility-preserving treatment with a levonorgestrel-releasing intrauterine device, bariatric surgery was proposed to treat the obesity and improve control of her type 2 diabetes in an attempt to increase the chances of obtaining response to local treatment. Nine months after laparoscopic sleeve gastrectomy and 18 months after insertion of the intrauterine device, the patient reached normal body weight (body mass index 20.3 kg/m(2)) and showed complete response to treatment. As far as we know, this is the first published case of an adolescent obese patient treated with bariatric surgery concomitantly with fertility-preserving management of endometrial cancer. We propose that bariatric surgery may play a role as an adjuvant therapy in fertility-preserving treatment of endometrial cancer with local progestin, in which it could enhance remission rates and reduce recurrence.

Recurso técnico para el tubo de Kehr de difícil extracción / Technical resource for hazardous Kehr T-tube withdrawal

No disponible

[Implementation of laparoscopic rectal cancer surgery]. / Implementación de la cirugía del cáncer de recto por laparoscopia.

INTRODUCTION: The integration of laparoscopic surgery for rectal cancer in clinical practice is one of the challenges faced by surgical societies. The aim of the present study was to analyze the results obtained during the implementation phase of this technique. PATIENTS AND METHOD: From January 2003 to June 2005, 40 patients with rectal carcinoma underwent laparoscopic surgery in our center. Clinical and pathological variables were prospectively collected for statistical analyses. RESULTS: A total of 27 men and 13 women underwent surgery: 11 high (HAR) and 20 low anterior resections (LAR) and 9 abdominoperineal resections (APR) were performed. Operative time was 240.4 +/- 200 min and was greater in the LAR group (259.7 vs 201.5 min; p=.02). The intraoperative complication rate was 22.5% (9% HAR vs 25% LAR; p=NS). The mean length of hospital stay was 8.7 +/- 4.8 days. The rate of postoperative complications was 32.5%. The conversion rate was 15% (6 patients), and was greater in the LAR group (25% vs 0% HAR vs 11.1% APR; p=0.02). The most common intraoperative complication and the most frequent cause of conversion consisted of stapling problems (4 patients). Surgery was considered curative in 34 patients (85%). One case of positive radial margins was encountered (3.3%). The mean distal and radial margins were 3.6 +/- 2.7 cm and 1.1 +/- 0.9 cm respectively. CONCLUSIONS: The overall results during the implementation stage of laparoscopic surgery for rectal surgery were satisfactory. Conversion rates were highest in LAR, which proved to be the most demanding procedure.

Resección de insulinoma de cola de páncreas por laparoscopia con preservación esplénica / Laparoscopic resection of insulinoma of the pancreatic tail with spleen preservation

No disponible