Antiperistaltic Transverse Coloplasty: A Salvage Procedure in Extensive Bowel and Colorectal Resections to Avoid Intestinal Failure.

INTRODUCTION: After extensive small and colon resections, quality of life can be affected. We propose the antiperistaltic transverse coloplasty as a solution that allows for preservation of the transverse colon after both right and left colectomies while achieving a tension-free colorectal anastomosis slowing the transit and increasing the absorption time, resulting in better stool consistency and quality of life compared with an ileorectal anastomosis. METHODS: This technique was performed in a 41-year-old woman with Goblet cell adenocarcinoma of the appendix with peritoneal metastasis. The transverse colon is rotated anticlockwise over the axis of the middle colic vessels toward the left parietocolic flank and relocated to the usual position of the descending colon. RESULTS: After 1 year of follow-up, the patient led a normal life without parenteral nutrition with five bowel movements per day and a weight gain of 15%. CONCLUSIONS: The use of an antiperistaltic transverse coloplasty may be worthwhile to perform in cases of extensive bowel resections during cytoreductive surgery leading to short-bowel syndrome to avoid a permanent stoma or intestinal failure and improve patient outcomes.

Simultaneous Surgical Approach with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Patients with Concurrent Peritoneal and Liver Metastases of Colon Cancer Origin.

Background: Simultaneous liver resection and peritoneal cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC) remains controversial today. The aim of the study was to analyze the postoperative outcomes and survival of patients with advanced metastatic colon cancer (peritoneal and/or liver metastases). Methods: Retrospective observational study from a prospective maintained data base. Patients who underwent a simultaneous peritoneal cytoreduction and liver resection plus HIPEC were studied. Postoperative outcomes and overall and disease free survival were analyzed. Univariate and multivariate analyses were performed. Results: From January 2010 to October 2022, 22 patients operated with peritoneal and liver metastasis (LR+) were compared with 87 patients operated with peritoneal metastasis alone (LR-). LR+ group presented higher serious morbidity (36.4 vs. 14.9%; p: 0.034). Postoperative mortality did not reach statistical difference. Median overall and disease free survival was similar. Peritoneal carcinomatosis index was the only predictive factor of survival. Conclusions: Simultaneous peritoneal and liver resection is associated with increased postoperative morbidity and hospital stay, but with similar postoperative mortality and OS and disease free survival. These results reflect the evolution of these patients, considered inoperable until recently, and justify the trend to incorporate this surgical strategy within a multimodal therapeutic plan in highly selected patients.

Duodenopancreatectomía por adenocarcinoma ductal de páncreas en ancianos. ¿Podemos asumirla con seguridad? / Cephalic pancreaticoduodenectomy for ductal adenocarcinoma in the elderly. Can we do it safely?

Introducción: La cirugía y la quimioterapia han aumentado la supervivencia de los pacientes con neoplasias pancreáticas. La disminución de la morbimortalidad postoperatoria y el aumento de la esperanza de vida han ampliado las indicaciones de la duodenopancreatectomía cefálica (DPC), aunque sigue siendo controvertida en la población geriátrica. Métodos: Estudio observacional retrospectivo sobre una base de datos prospectiva, de pacientes con adenocarcinoma ductal de páncreas sometidos a una DPC entre 2007-2018. El objetivo principal fue analizar la morbimortalidad y supervivencia asociada a la DPC en pacientes≥75 años (ancianos). Resultados: Se incluyeron 79 pacientes, 21 de ellos mayores de 75 años (27%); dentro de este grupo el 23,9% tenían más de 80 años. El ASA de ambos grupos fue similar. Los pacientes≥75años requirieron más transfusiones. No se observaron diferencias en el tiempo operatorio, aunque en los ancianos se realizaron más resecciones vasculares (26 vs. 8,7%; p=0,037).La morbilidad fue mayor en los ancianos (61,9 vs. 46,6%), aunque sin diferencias. Los≥75años presentaron más complicaciones no quirúrgicas (33,3%; p=0,050) siendo la neumonía la más frecuente. La mortalidad postoperatoria fue superior en los≥75años (9 vs. 0%; p=0,017), constituyendo la resección venosa un factor de riesgo (p=0,01). La supervivencia global y la supervivencia libre de enfermedad no mostraron diferencias significativas en ambos grupos. Conclusiones: Los pacientes ancianos presentaron una mayor mortalidad postoperatoria y más complicaciones no quirúrgicas. La supervivencia no mostró diferencias, por lo que, con una adecuada selección de pacientes, la edad no debe constituirse por sí misma como una contraindicación para la DPC(AU).

Introduction: Surgery and chemotherapy have increased the survival of pancreatic cancer. The decrease in postoperative morbidity and mortality and increase in life expectancy, has expanded the indications por cephalic pancreaticoduodenectomy (PDC), although it remains controversial in the geriatric population. Methods: Retrospective study on a prospective database of patients with ductal adenocarcinoma of pancreas who underwent PDC between 2007-2018.The main objective was to analyse the morbidity-mortality and survival associated with PDC in patients≥75 years (elderly). Results: 79 patients were included, 21 of them older than 75 years (27%); within this group, 23.9% were over 80 years old. The ASA of both groups was similar. Patients≥75 years required more transfusions. No differences in operating time were observed, although more vascular resection were performed in the elderly (26 vs. 8.7%; P=.037). Morbidity was higher in the elderly (61.9 vs. 46.6%), although without differences. Patients aged≥75 years had more non-surgical complications (33.3%, P=.050), being pneumonia the most frequent. Postoperative mortality was higher in the≥75 years (9 vs. 0%; P=.017). The overall survival and disease-free survival did not show significant differences in both groups. Conclusions: Elderly patients had higher postoperative mortality and more non-surgical complications. Survival did not show differences, so with an adequate selection of patients, age should not be considered itself as a contraindication for PDC(AU).

Cephalic pancreaticoduodenectomy for ductal adenocarcinoma in the elderly. Can we do it safely?

INTRODUCTION: Surgery and chemotherapy have increased the survival of pancreatic cancer. The decrease in postoperative morbidity and mortality and increase in life expectancy, has expanded the indications por cephalic pancreaticoduodenectomy (PDC), although it remains controversial in the geriatric population. METHODS: Retrospective study on a prospective database of patients with ductal adenocarcinoma of pancreas who underwent PDC between 2007-2018. The main objective was to analyse the morbidity-mortality and survival associated with PDC in patients ≥75 years (elderly). RESULTS: 79 patients were included, 21 of them older than 75 years (27%); within this group, 23'9% were over 80 years old. The ASA of both groups was similar. Patients ≥75 years required more transfusions. No differences in operating time were observed, although more vascular resection were performed in the elderly (26 vs. 8.7%; P = .037). Morbidity was higher in the elderly (61.9% vs. 46.6%), although without differences. Patients aged ≥75 years had more non-surgical complications (33.3%, P = .050), being pneumonia the most frequent. Postoperative mortality was higher in the ≥75 years (9 vs. 0%; P = .017). The overall survival and disease-free survival did not show significant differences in both groups. CONCLUSIONS: Elderly patients had higher postoperative mortality and more non-surgical complications. Survival did not show differences, so with an adequate selection of patients, age should not be considered itself as a contraindication for PDC.

Abdominal metastatic melanoma invading the transverse colon and stomach.

Gastrointestinal melanoma metastases are not uncommon, with the jejunum and ileum being the most common locations (58 %), followed by the stomach (26 %), colon (22 %), duodenum (12 %), and rectum (5 %).

Cephalic pancreaticoduodenectomy for ductal adenocarcinoma in the elderly. Can we do it safely? / Duodenopancreatectomía por adenocarcinoma ductal de páncreas en ancianos. ¿Podemos asumirla con seguridad?

INTRODUCTION: Surgery and chemotherapy have increased the survival of pancreatic cancer. The decrease in postoperative morbidity and mortality and increase in life expectancy, has expanded the indications por cephalic pancreaticoduodenectomy (PDC), although it remains controversial in the geriatric population. METHODS: Retrospective study on a prospective database of patients with ductal adenocarcinoma of pancreas who underwent PDC between 2007-2018.The main objective was to analyse the morbidity-mortality and survival associated with PDC in patients≥75 years (elderly). RESULTS: 79 patients were included, 21 of them older than 75 years (27%); within this group, 23.9% were over 80 years old. The ASA of both groups was similar. Patients≥75 years required more transfusions. No differences in operating time were observed, although more vascular resection were performed in the elderly (26 vs. 8.7%; P=.037). Morbidity was higher in the elderly (61.9 vs. 46.6%), although without differences. Patients aged≥75 years had more non-surgical complications (33.3%, P=.050), being pneumonia the most frequent. Postoperative mortality was higher in the≥75 years (9 vs. 0%; P=.017). The overall survival and disease-free survival did not show significant differences in both groups. CONCLUSIONS: Elderly patients had higher postoperative mortality and more non-surgical complications. Survival did not show differences, so with an adequate selection of patients, age should not be considered itself as a contraindication for PDC.

Invasive ductal adenocarcinoma arising from heterotopic pancreas in the jejunum: case report and literature review / Adenocarcinoma ductal invasivo sobre páncreas heterotópico en yeyuno: caso clínico y revisión de la literatura

Although the presence of pancreatic tissue outside of the usual anatomical location of the pancreas is not an uncommon incidental finding, the risk of malignancy is extremely low. We report a case of ductal adenocarcinoma arising within a focus of heterotopic pancreas, occurring in the jejunum of an 81 year old woman. The patient presented with a history of progressive gastrointestinal occlusive symptoms. Computerized tomography showed a mass in the jejunum, which was surgically removed. Histopathology revealed an invasive pancreatic ductal adenocarcinoma from pancreatic tissue with no connection with the original gland (Heinrich type II). At the 12-month follow-up, there were no signs of recurrence. Despite the low risk of malignancy in heterotopic pancreas, adenocarcinoma is the most frequent histological type, and the prognosis is still not clear. Lesions incidentally detected during surgery and in symptomatic patients need to be removed by conservative procedures in order to exclude malignant disease

Aunque la presencia de tejido pancreático fuera del páncreas es un hallazgo incidental no infrecuente, el riesgo de malignidad es extremadamente bajo. Presentamos el caso de una mujer de 81 años de edad con historia progresiva de síntomas oclusivos gastrointestinales, que presentó en el estudio por tomografía computarizada una lesión oclusiva localizada en yeyuno. El estudio histológico reveló la presencia de un adenocarcinoma ductal invasivo de tipo pancreático sobre tejido pancreático sin conexión con la glándula original (Heinrich tipo II). En el seguimiento posterior de la paciente a 12 meses, no se observaron signos de recurrencia. A pesar de que el riesgo de malignización del páncreas heterotópico es raro, el tipo histológico más frecuente es el adenocarcinoma. El pronóstico es aún incierto. Es necesaria la resección quirúrgica de estas lesiones en el momento del diagnóstico con el fin de descartar la presencia de enfermedad maligna

Invasive ductal adenocarcinoma arising from heterotopic pancreas in the jejunum: Case report and literature review.

Although the presence of pancreatic tissue outside of the usual anatomical location of the pancreas is not an uncommon incidental finding, the risk of malignancy is extremely low. We report a case of ductal adenocarcinoma arising within a focus of heterotopic pancreas, occurring in the jejunum of an 81 year old woman. The patient presented with a history of progressive gastrointestinal occlusive symptoms. Computerized tomography showed a mass in the jejunum, which was surgically removed. Histopathology revealed an invasive pancreatic ductal adenocarcinoma from pancreatic tissue with no connection with the original gland (Heinrich type II). At the 12-month follow-up, there were no signs of recurrence. Despite the low risk of malignancy in heterotopic pancreas, adenocarcinoma is the most frequent histological type, and the prognosis is still not clear. Lesions incidentally detected during surgery and in symptomatic patients need to be removed by conservative procedures in order to exclude malignant disease.

Seudoquiste pancreático intrahepático bilateral / Bilateral intrahepatic pancreatic pseudocyst

No disponible

Colangiopancreatografía retrógrada endoscópica transgástrica por laparoscopia tras derivación biliopancreática / Laparoscopic transgastric endoscopic retrograde cholangiopancreatography after biliopancreatic diversion

En los pacientes a los que se les ha realizado una cirugía gástrica en Y-de-Roux, la realización de una colangiopancreatografía retrógrada endoscópica (CPRE) es muy dificultosa. Debido al aumento de la prevalencia de la obesidad mórbida y a la realización de cirugías laparoscópicas para su tratamiento, la incidencia de problemas biliares en pacientes con anatomía modificada también es creciente. Presentamos una técnica quirúrgica laparoscópica para acceder a la vía biliar por endoscopio, a través del estómago excluido

Endoscopic retrograde cholangiopancreatography may be difficult in patients that have undergone Roux-en-Y gastric bypass. Due to the fact that prevalence of morbid obesity is increasing, and laparoscopic procedures for its treatment have increased, the incidence of biliary tract problems in patients of altered anatomy is also growing. We describe a laparoscopic technique to access the biliary tree by endoscope, through the excluded stomach

Resultados de la rehabilitación multimodal en la duodenopancreatectomía cefálica / Outcomes of an enhanced recovery after surgery programme for pancreaticoduodenectomy

INTRODUCCIÓN: La rehabilitación multimodal precoz (RMP) ha demostrado en la cirugía colorrectal una reducción de la morbilidad y de la hospitalización sin comprometer la seguridad de los pacientes. La experiencia de la RMP en la duodenopancreatectomía cefálica (DPC) es más limitada. Los objetivos de este estudio fueron analizar la aplicabilidad de un programa RMP en los pacientes intervenidos mediante una DPC en nuestro medio y evaluar los resultados postoperatorios. MÉTODOS: Estudio retrospectivo utilizando una base de datos prospectiva de 41 pacientes a los que se realizó DPC y fueron incluidos en un programa de RMP. Se evaluaron 3 elementos clave: retirada precoz de sondas y drenajes, ingesta oral y movilización precoz. Las variables analizadas fueron la mortalidad, morbilidad, datos perioperatorios, estancia hospitalaria, reintervenciones y reingresos. Este grupo de pacientes fue comparado con un grupo control de 44 pacientes consecutivos, en los que se realizó una DPC con manejo postoperatorio estándar. RESULTADOS: Se estudió a 85 pacientes intervenidos con DPC (41 pacientes en el grupo RMP y 44 pacientes en el grupo control). La mortalidad global fue del 2,4%: 2 pacientes pertenecientes al grupo control. No encontramos diferencias significativas en la mortalidad, ingreso en Reanimación, reintervenciones ni reingresos. El grupo RMP presentó una morbilidad menor que el grupo control (32 vs. 48%; p = 0,072), y una estancia hospitalaria menor (14,2 vs. 18,7 días; p = 0,014). Todos los elementos clave propuestos fueron conseguidos. CONCLUSIONES: La RMP en la DPC puede implantarse con seguridad en nuestro medio. Permite unificar los cuidados perioperatorios, disminuir la variabilidad clínica y la estancia media y como consecuencia, el coste hospitalario

BACKGROUND: Enhanced recovery after surgery (ERAS) has demonstrated in colorectal surgery a reduction in morbidity and length of stay without compromising security. Experience with ERAS programs in pancreatoduodenectomy (PD) is still limited. The aims of this study were first to evaluate the applicability of an ERAS program for PD patients in our hospital, and second to analyze the postoperative results. METHODS: A retrospective study using a prospectively maintained database identified 41 consecutive PD included in an ERAS program. Key elements studied were early removal of tubes and drainages, early oral feeding and early mobilization. Variables studied were mortality, morbidity, perioperative data, length of stay, re-interventions and inpatient readmission. This group of patients was compared with an historic control group of 44 PD patients with a standard postoperative management. RESULTS: A total of 85 pancreatoduodenectomies were analyzed (41 patients in the ERAS group, and 44 patients in the control group. General mortality was 2.4% (2 patients) belonging to the control group. There were no statistical differences in mortality, length of stay in intensive care, reoperationss, and readmissions. ERAS group had a lower morbidity rate than the control group (32 vs. 48%; P=.072), as well as a lower length of stay (14.2 vs. 18.7 days). All the key ERAS proposed elements were achieved. CONCLUSIONS: ERAS programs may be implemented safely in pancreaticoduodenectomy. They may reduce the length of stay, unifying perioperative care and diminishing clinical variability and hospital costs

Outcomes of an enhanced recovery after surgery programme for pancreaticoduodenectomy.

BACKGROUND: Enhanced recovery after surgery (ERAS) has demonstrated in colorectal surgery a reduction in morbidity and length of stay without compromising security. Experience with ERAS programs in pancreatoduodenectomy (PD) is still limited. The aims of this study were first to evaluate the applicability of an ERAS program for PD patients in our hospital, and second to analyze the postoperative results. METHODS: A retrospective study using a prospectively maintained database identified 41 consecutive PD included in an ERAS program. Key elements studied were early removal of tubes and drainages, early oral feeding and early mobilization. Variables studied were mortality, morbidity, perioperative data, length of stay, re-interventions and inpatient readmission. This group of patients was compared with an historic control group of 44 PD patients with a standard postoperative management. RESULTS: A total of 85 pancreatoduodenectomies were analyzed (41 patients in the ERAS group, and 44 patients in the control group. General mortality was 2.4% (2 patients) belonging to the control group. There were no statistical differences in mortality, length of stay in intensive care, reoperationss, and readmissions. ERAS group had a lower morbidity rate than the control group (32 vs. 48%; P=.072), as well as a lower length of stay (14.2 vs. 18.7 days). All the key ERAS proposed elements were achieved. CONCLUSIONS: ERAS programs may be implemented safely in pancreaticoduodenectomy. They may reduce the length of stay, unifying perioperative care and diminishing clinical variability and hospital costs.

Laparoscopic transgastric endoscopic retrograde cholangiopancreatography after biliopancreatic diversion.

Endoscopic retrograde cholangiopancreatography may be difficult in patients that have undergone Roux-en-Y gastric bypass. Due to the fact that prevalence of morbid obesity is increasing, and laparoscopic procedures for its treatment have increased, the incidence of biliary tract problems in patients of altered anatomy is also growing. We describe a laparoscopic technique to access the biliary tree by endoscope, through the excluded stomach.