Endoscopic retrograde cholangiopancreatography results for the treatment of symptomatic choledocholithiasis in pregnant patients: A recent experience at a secondary care hospital in Mexico City. / Resultados de la colangiopancreatografía retrógrada endoscópica para el tratamiento de la coledocolitiasis sintomática en pacientes embarazadas: Experiencia reciente de un hospital de segundo nivel de la Ciudad de México.

INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) is the treatment of choice for symptomatic choledocholithiasis during pregnancy. In pregnant patients, aside from the risks inherent in the procedure and sedation, there is the added concern of the potentially damaging effects of ionizing radiation on the fetus. AIM: To describe the maternal and fetal results of ERCP performed to resolve symptomatic choledocholithiasis in pregnant patients. MATERIALS AND METHODS: A retrospective, descriptive, observational, and cross-sectional study was conducted. It included pregnant patients with choledocholithiasis that underwent ERCP within the time frame of June 2017 and June 2018. RESULTS: The study included 9 pregnant patients, with a mean gestational age of 24.1 weeks, that underwent ERCP. There were no maternal or fetal complications associated with sedation, mean fluoroscopy time was 26.7seconds, and one patient (11.1%) presented with mild post-ERCP pancreatitis that was resolved through medical management. Pregnancy progression was normal in 100% of the cases, resulting in the birth of neonates with a normal Apgar score, a mean weight of 3,120g, a mean length of 49.94cm, and a mean gestational age of 38.37 weeks. At follow-up at 6 months, the infants had a mean weight of 7.1kg and a mean length of 66.94cm. CONCLUSIONS: The results from our hospital center were similar to those described in the international literature, showing that ERCP in our medical environment is a feasible, safe, and efficacious method for both the mother and fetus. When performed by an experienced endoscopist, it should be considered the treatment of choice for choledocholithiasis in pregnant patients.

Laparoscopic management of pancreatic pseudocysts: experience at a general hospital in Mexico City.

BACKGROUND: Invasive management of pancreatic pseudocysts (PP) is currently indicated in those patients with symptoms or complications. Treatment options are classified as surgical (open and laparoscopic) and non-surgical (endoscopic and radiologic). AIM: To describe the morbidity, mortality, and efficacy in terms of technical and clinical success of the laparoscopic surgical approach in the treatment of patients with PP in the last 3 years at our hospital center. METHODS: We included patients with PP treated with laparoscopic surgery within the time frame of January 2012 and December 2014. The morbidity and mortality associated with the procedure were determined, together with the postoperative results in terms of effectiveness and recurrence. RESULTS: A total of 38 patients were diagnosed with PP within the last 3 years, but only 20 of them had invasive treatment. Laparoscopic surgery was performed on 17 of those patients (mean pseudocyst diameter of 15.3, primary drainage success rate of 94.1%, complication rate of 5.9%, and a 40-month follow-up). CONCLUSIONS: The results obtained with the laparoscopic technique used at our hospital center showed that this approach is feasible, efficacious, and safe. Thus, performed by skilled surgeons, it should be considered a treatment option for patients with PP.

C-reactive protein level in morbidly obese patients before and after bariatric surgery.

BACKGROUND: Human obesity is associated with a proinflammatory state and an elevated level of mediators, such as C-reactive protein (CRP). OBJECTIVES: To establish CRP levels as baseline preoperative values and then at 6 months after bariatric surgery, as well as to determine the changes in weight, body mass index (BMI), leukocytes, and glycemia. MATERIALS AND METHODS: An observational, analytical, retrospective, longitudinal, and open study was conducted. Serum CRP values were measured in 36 adults presenting with morbid obesity, and their baseline relation to weight, BMI, leukocytes, and glycemia was determined; the relation to the same parameters was established again, 6 months after bariatric surgery. RESULTS: The mean and standard deviation of preoperative and postoperative CRP (mg/L) was 1.15±0.86 and 0.34±0.28, respectively with p<0.0001; weight (kg) 112.10±22.91 and 84.82±17.11, p=0.0443; BMI (kg/m(2)) 42.48±5.97 and 32.2±4.79, p=0.0988; glucose (mg/dL) 100.58±17.82 and 87.11±8.49, p<0.0001, and leukocytes (× 10(3)/mm(3)) 8.62±1.69 and 6.99±1.56, p=0.3192. Baseline CRP only correlated with weight and BMI (p=0.047 and p=0.027 respectively) and there was no correlation between postoperative CRP and the evaluated parameters. CONCLUSIONS: Preoperative CRP had a significant lineal relation to weight and body mass index. Patients who underwent bariatric surgery had a significant decrease in CRP, weight, and fasting glucose at 6 months after surgery.

[Peroral endoscopic full and partial-thickness myotomy. A viability study in an animal model]. / Miotomía endoscópica por vía oral de espesor total y parcial. Estudio de factibilidad en un modelo animal.

BACKGROUND: Peroral endoscopic myotomy has recently been developed and performed on patients with good results. AIMS: To evaluate the technical feasibility of peroral endoscopic full-thickness and partial thickness myotomy in a porcine model. MATERIAL AND METHODS: Eighteen criollo pigs were randomly assigned to 2 groups: group A (partial-thickness myotomy) and group B (full-thickness myotomy). The mucosal defect proximal to the myotomy site was left open. On the seventh postoperative day the pig was euthanized and follow-up surgical exploration was performed. The duration of each procedure, postoperative progression of the animal, complications, and anatomopathologic findings were registered. RESULTS: The procedure was viable in all the pigs. The mean surgery duration was 81±35.3min (group A 51.11±11.12, group B 111±22.61; P<.05). The main complication during myotomy was subcutaneous emphysema (16%). The histopathologic study of the group A surgical specimens reported complete circular myotomy in all cases, and complete circular and longitudinal myotomy was reported in 100% of the group B sample. CONCLUSIONS: The endoscopic myotomy technique is feasible. Endoscopic partial-thickness myotomy was associated with shorter surgery duration and better results during the intraoperative period and the 7-day follow-up.

[Laparoscopic drainage of a pancreatic pseudocyst: a case report]. / Drenaje laparoscópico de un seudoquiste pancreático: reporte de caso.

Pancreatic pseudocysts are defined as homogeneous pancreatic or peripancreatic collections that are not associated with necrotic tissue and are surrounded by granulated or fibrous tissue with no epithelium. Management has been classified as surgical (conventional and laparoscopic) and nonsurgical (endoscopic and radiologic). The aim of this report is to describe our initial experience in the management of a pancreatic pseudocyst by means of laparoscopic posterior cyst-gastrostomy anastomosis, performed at the Pancreas Clinic of the Hospital General "Dr. Manuel Gea González" in Mexico City. New techniques and instrumentation have contributed to the relatively recent development of laparoscopic pancreatic surgery. Our technique has practical advantages that have been confirmed by other authors, such as simple hemostasis, a wide viewing angle enabling adequate necrosectomy, anastomosis that does not require the use of staples, and the possibility of resolving other associated intra-abdominal pathologies, as in this case.

Laparoscopic transabdominal preperitoneal approach to place a polypropylene mesh on the abdominal wall: an experimental swine model of a technique that can be used for incisional hernia repair.

BACKGROUND: The placement of intraabdominal polypropylene mesh entails risks of adhesions and fistulas that can be avoided by preperitoneal placement. METHODS: This comparative, open, experimental, prospective, randomized, and transversal study randomized pigs into two groups of 11 each for intraperitoneal (IPOM) or preperitoneal (TAPP) polypropylene mesh placement by laparoscopy. Diagnostic laparoscopy and tissue en-bloc resection was performed 28 days postoperatively for histopathologic analysis. RESULTS: The following data were observed for the two study groups: surgical time (IPOM: 35.73 +/- 4.22 min; TAPP: 58.09 +/- 6.28 min; p = or < 0.0001); adhesions (IPOM: 81.81%; TAPP: 27.27%; p = 0.032), grade III for IPOM and grade II for TAPP (p = 0.001); and interloop adhesions (IPOM: 81.81%; TAPP: 9.09%; p = 0.003). No fistulas were found in either group. The TAPP procedure showed better integration of mesh, without lesion to abdominal organs. Two complications, occurred with IPOM, and one with TAPP (p = 1.0, not significant). CONCLUSIONS: The perperitoneal technique requires more time, but has fewer adhesions and less intraabdominal inflammatory response. It is a feasible technique that may diminish risks in the laparoscopic treatment of incisional hernias with polypropylene mesh.

Multimedia article: management of duodenal ulcer perforation with combined laparoscopic and endoscopic methods.

In the past, primary closes for perforated duodenal ulcer were not effective because of the high incidence of recurrence (42%), therefore most surgeons preferred definitive procedures to control acid production. Since the association of Helicobacter pylori with peptic ulcers and the effectiveness of the medication for acid control, definitive surgery is less frequently used. Today, primary closes of the perforation are the immediate alternative. Furthermore laparoscopic repair allows to perform the same technique than open surgery but with the benefits of the minimum invasion. The video shows the management of a 51-year-old woman who came to the emergency room with acute abdomen, leukocytosis, and fever. Laparoscopy showed peritonitis with apparent gastric perforation. Duodenal perforation was confirmed by endoscopy. Primary closes of the perforation, cavity cleaning, and placement of drainages were performed by laparoscopy. Evolution was excellent; the patient left the hospital 3 days after surgery. The contribution of laparoscopic and endoscopic surgery were shown to be highly beneficial for the patient, since an endoscopic view of the stomach and the duodenum was the pertinent approach to assure the correct perforation closes as well as to obtain diagnostic biopsy.