Paraesophageal hiatal hernia. Open vs. laparoscopic surgery.

BACKGROUND: paraesophageal hiatal hernia represents 5-10% of hiatal hernias. Its importance is based on the severe complications it may have, including gastric volvulus, and surgical treatment is recommended when a diagnosis is established. MATERIAL AND METHODS: a retrospective study of all patients who underwent surgery for paresophageal hernia between 1985 and 2007. RESULTS: we studied 90 cases, 68 females and 22 males with a median age of 67.6 years (37-96). Forty-five patients reported pyrosis, 34 epigastric postprandial pain, and 15 dysphagia; eight patients were diagnosed with gastric volvulus. Eighty-one patients underwent elective surgery and 9 emergency surgery. Forty-seven cases underwent an open procedure and 43 a laparoscopic one; 5 (11.6%) of them required conversion. The techniques performed were D Or fundoplication in 35 cases, Nissen in 35, Toupet in 14, simple hiatal closure in 2, Narbona in 1, and Lortat-Jakob in 1; in 10 patients a mesh was placed. The complication rate for open procedure was 10.6 and 9.5% for the laparoscopic one (p > 0.05). Median hospital stay was 9.1 days for the open procedure and 3.4 for the laparoscopic one (p < 0.05). As follow-up, we analyzed 84 patients. After a median follow-up of 12 years (1-19), 15 patients were still symptomatic (17.8%), with recurrence in 8 cases (5 required reoperation). The satisfaction rate was 95.5%. CONCLUSION: equivalent results were observed after laparoscopic and open surgery and a significant shorter hospital stay in the laparoscopic one. Therefore, we think that laparoscopic surgery should be considered as the election procedure for paraesophageal hiatal hernia.

Hernia de hiato paraesofágica: cirugía laparoscópica vs. cirugía abierta / Paraesophageal hiatal hernia. Open vs. laparoscopic surgery

Introducción: la hernia hiatal paraesofágica representa el 5-10% de las hernias hiatales. Su importancia radica en las gravescomplicaciones que pueden presentar, como el vólvulo gástrico, yse recomienda el tratamiento quirúrgico una vez establecido eldiagnóstico.Material y métodos: estudio retrospectivo de los pacientesintervenidos en nuestro centro de hernia hiatal paraesofágica entre1985 y 2007.Resultados: estudiamos 90 casos, 68 mujeres y 22 varones,con edad media de 67,6 años (37-96). Cuarenta y cinco pacientespresentaban pirosis, 34 dolor epigástrico postprandial y 15 disfagia;ocho pacientes fueron diagnosticados como vólvulo gástrico.Se realizaron 81 intervenciones programadas y 9 urgentes. En 47casos el abordaje fue abierto y en 43 laparoscópico, de los cuales5 se convirtieron a cirugía abierta. Se realizó funduplicatura D´Oren 35 casos, Nissen en 35, Toupet en 14, cierre simple de pilaresen 2, Narbona en 1 y Lortat-Jakob en 1; en 10 pacientes se colocaronmallas. La tasa de complicaciones en cirugía abierta fue10,6% y en laparoscópica 9,5% (p > 0,05). La estancia media fue9,1 días en cirugía abierta y 3,4 en laparoscópica (p < 0,05). Enel seguimiento, analizamos 84 pacientes, con una mediana de 12años (1-19): 15 continuaban sintomáticos, objetivándose recidivaen 8 (5 fueron reintervenidos). El 95,5% de los pacientes estabansatisfechos con los resultados.Conclusión: se obtuvieron resultados equivalentes tras cirugíalaparoscópica y abierta, con estancia hospitalaria significativamentemenor en los primeros. Por ello creemos que se debe considerarla cirugía laparoscópica como abordaje de elección paratratar la hernia hiatal paraesofágica(AU)

Background: paraesophageal hiatal hernia represents 5-10%of hiatal hernias. Its importance is based on the severe complicationsit may have, including gastric volvulus, and surgical treatmentis recommended when a diagnosis is established.Material and methods: a retrospective study of all patientswho underwent surgery for paresophageal hernia between 1985and 2007.Results: we studied 90 cases, 68 females and 22 males with amedian age of 67.6 years (37-96). Forty-five patients reported pyrosis,34 epigastric postprandial pain, and 15 dysphagia; eightpatients were diagnosed with gastric volvulus. Eighty-one patientsunderwent elective surgery and 9 emergency surgery. Forty-sevencases underwent an open procedure and 43 a laparoscopicone; 5 (11.6%) of them required conversion. The techniques performedwere D´Or fundoplication in 35 cases, Nissen in 35,Toupet in 14, simple hiatal closure in 2, Narbona in 1, and Lortat-Jakob in 1; in 10 patients a mesh was placed. The complicationrate for open procedure was 10.6 and 9.5% for the laparoscopicone (p > 0.05). Median hospital stay was 9.1 days for theopen procedure and 3.4 for the laparoscopic one (p < 0.05). Asfollow-up, we analyzed 84 patients. After a median follow-up of12 years (1-19), 15 patients were still symptomatic (17.8%), withrecurrence in 8 cases (5 required reoperation). The satisfactionrate was 95.5%Conclusion: equivalent results were observed after laparoscopicand open surgery and a significant shorter hospital stay inthe laparoscopic one. Therefore, we think that laparoscopicsurgery should be considered as the election procedure for paraesophagealhiatal hernia(AU)

Pseudomyxoma peritonei secondary to epithelial appendicular neoplasms. Experience in a non-specialised centre.

INTRODUCTION: Pseudomyxoma peritonei is an infrequent entity, defined by collections of gelatinous material in the abdomen and pelvis and mucinous implants on peritoneum, secondary to the rupture of a mucinous lesion, usually of ovarian or appendiceal origin. MATERIALS AND METHODS: We present our experience of 11 cases (6 males and 5 females) diagnosed with pseudomyxoma peritonei secondary to epithelial appendicular neoplasms over 27 years. The mean age of the patients was 68 years. Clinical manifestations were abdominal distension (55%), right lower quadrant pain (45%) suggesting acute appendicitis and constitutional syndrome (36%). An abdominal mass was detected at physical examination in 4 patients. CT scan revealed a tumour in right iliac fossa in 4 patients, peritoneal enlargement in 1 and a liquid collection in 1. Preoperative diagnosis was acute abdomen in 5 patients, peritoneal carcinomatosis in 3 and undetermined abdominal mass in 3. RESULTS: Surgical findings suggested pseudomyxoma peritonei in 8 patients and peritoneal carcinomatosis in 3. Appendicectomy was performed in 9 patients, and in 3 of them bilateral anexectomy was also performed. One patient underwent ileocaecal resection and another a right hemicolectomy. In all the cases, mucinous material was eliminated as much as possible. Pathology revealed mucinous cystoadenoma in 6 cases, mucinous cystoadenocarcinoma in 3 and epithelial hyperplasia in 2 patients. Median survival was 54 months, with a 5- year survival rate of 40%. The last case we treated was sent to a reference centre for the treatment of pseudomyxoma peritonei. CONCLUSIONS: There is no consensus on the best treatment for pseudomyxoma peritonei. We recommend avoiding incomplete surgical resections in non-reference centres and submitting patients to a reference centre to undergo adequate treatment.

Peritoneal carcinomatosis secondary to carcinoid tumour.

Carcinoid tumours are neuroendocrine neoplasms that can appear in every location of the digestive tract. They are low aggressive tumours, although they often produce local invasion and hepatic metastases, whose resection allows long-term survival. We report a case of a 64-year-old man with ileal carcinoid tumour, that underwent ileal resection and metastasectomy of one lesion in liver segment II. Surgical findings indicated peritoneal carcinomatosis. Carcinoid dissemination as peritoneal carcinomatosis has been rarely described in the literature. Cytoreductive surgery, always when complete resection is aimed, achieves asymptomatic long-term survivals.

Peritoneal carcinomatosis secondary to carcinoid tumour

Carcinoid tumours are neuroendocrine neoplasms that can appear in every location of the digestive tract. They are low aggressive tumours, although they often produce local invasion and hepatic metastases, whose resection allows long-term survival. We report a case of a 64-year-old man with ileal carcinoid tumour, that underwent ileal resection and metastasectomy of one lesion in liver segment II. Surgical findings indicated peritoneal carcinomatosis. Carcinoid dissemination as peritoneal carcinomatosis has been rarely described in the literature. Cytoreductive surgery, always when complete resection is aimed, achieves asymptomatic long-term survivals (AU)

Pseudomyxoma peritonei secondary to epithelial appendicular neoplasms. Experience in a non-specialised centre

INTRODUCTION: Pseudomyxoma peritonei is an infrequent entity, defined by collections of gelatinous material in the abdomen and pelvis and mucinous implants on peritoneum, secondary to the rupture of a mucinous lesion, usually of ovarian or appendiceal origin. MATERIALS AND METHODS: We present our experience of 11 cases (6 males and 5 females) diagnosed with pseudomyxoma peritonei secondary to epithelial appendicular neoplasms over 27 years. The mean age of the patients was 68 years. Clinical manifestations were abdominal distension (55%), right lower quadrant pain (45%) suggesting acute appendicitis and constitutional syndrome (36%). An abdominal mass was detected at physical examination in 4 patients. CT scan revealed a tumour in right iliac fossa in 4 patients, peritoneal enlargement in 1 and a liquid collection in 1. Preoperative diagnosis was acute abdomen in 5 patients, peritoneal carcinomatosis in 3 and undetermined abdominal mass in 3. RESULTS: Surgical findings suggested pseudomyxoma peritonei in 8 patients and peritoneal carcinomatosis in 3. Appendicectomy was performed in 9 patients, and in 3 of them bilateral anexectomy was also performed. One patient underwent ileocaecal resection and another a right hemicolectomy. In all the cases, mucinous material was eliminated as much as possible. Pathology revealed mucinous cystoadenoma in 6 cases, mucinous cystoadenocarcinoma in 3 and epithelial hyperplasia in 2 patients. Median survival was 54 months, with a 5- year survival rate of 40%. The last case we treated was sent to a reference centre for the treatment of pseudomyxoma peritonei. CONCLUSIONS: There is no consensus on the best treatment for pseudomyxoma peritonei. We recommend avoiding incomplete surgical resections in non-reference centres and submitting patients to a reference centre to undergo adequate treatment (AU)

Reparación de las fístulas vaginales rádicas mediante cierre e interposición de tejido bulbocavernoso (Técnica de Martius) / Radical vaginal fistula repair involving closure and interposition of bulbocavernous tissue (the Martius technique)

Introducción. Se describe el tratamiento de la fístula vaginal rádica mediante la interposición de tejido bulbocavernoso (técnica de Martius).Pacientes y métodos. Desde 1990 hasta 1998 se han intervenido 6 pacientes (5 fístulas rectovaginales y una vesicovaginal), en 4 casos la enfermedad inicial fue cáncer de cérvix, en uno un cáncer de endometrio y en otro un adenocarcinoma de recto medio. En 4 pacientes, la aparición de la fístula fue espontánea, y en el resto inducida tras manipulación instrumental. En todos los casos, antes de la reparación quirúrgica se realizó detección de enfermedad tumoral recurrente o persistente mediante biopsias y estudio de extensión, y colostomía derivativa previa durante al menos 6 meses. En 5 casos se realizó interposición de tejido bulbocavernoso excepto en uno en el que se realizó una modificación de la técnica original mediante autoinjerto pediculado miocutáneo. Resultados. Todas las fístulas cerraron y permanecen cerradas tras un seguimiento medio de 34 meses. En 3 fístulas con más de 4 años de seguimiento no se han observado recurrencias tardías. Todas las pacientes con fístulas rectovagina les permanecen libres de enfermedad tumoral. La paciente con fístula vesicovaginal también curó, aunque falleció a los 14 meses por progresión metastásica de su enfermedad. Entre las complicaciones locales destacan 2 hematomas bulbares y una infección de herida quirúrgica. Conclusiones. La técnica de Martius es una excelente solución para pacientes bien seleccionadas con fístulas vaginales de origen actínico, con una mínima morbilidad y escasas secuelas posquirúrgicas (AU)

[Colorectal carcinoma. Multifactorial analysis of prognostic factors following curative resection]. / Carcinoma colorrectal. Análisis multifactorial de factores pronósticos tras resección curativa.

Cox regression analysis was used in the study of 151 cases of surgically treated colorrectal carcinoma. A "curative" resection was performed in all of them. Clinical data from medical records, histology, biochemical determinations, and intraoperative findings were assessed. Four of the studied variables were significantly related to tumor recurrence: Dukes stage, tumor spread, histological variety and preoperative CEA level. Age, sex, tumor location, surgical technique, lymphocytes in the peripheral blood, preoperative levels of acute phase reactants and hepatic enzymes did not provide information about the final outcome of these patients. An index of prognosis was statistically obtained in order to identify a high risk of recurrence group of patients, who may benefit from adjuvant therapy.