Peritoneal cystic mesothelioma.

A 43-year-old man complained that during the previous 2 years he had experienced a number of episodes of hepatic colic. After examination, we diagnosed a symptomatic cholelithiasis with a sclerosed and atrophic gallbladder. He underwent laparoscopic surgery. During the operation, we observed multiple peritoneal tumors that appeared to be metastases of a gallbladder cancer. The histological study demonstrated a benign chronic cholecystitis accompanied by multiple peritoneal cystic mesotheliomas, an extremely rare tumor in men. The etiology of cystic mesothelioma is still unclear. It has been suggested that they are really multiple inclusion cysts that result from a proliferative reaction within the peritoneal tissue; their continued proliferation might be caused by the continued persistence of an inciting factor. However, in our patient, the proliferation appeared to be related to an extensive peritoneal tissue reaction to the chronic gallbladder inflammatory process. We did not use sclerosing therapy because we had resected the gallbladder and most of the visible lesions laparoscopically; therefore, we had most likely eliminated the potential source of the inciting factor. Because it is very difficult during laparascopy to differentiate these benign quistic mesotheliomas from peritoneal metastases or tuberculous lesions, it is debatable whether the surgeon should continue or terminate the laparoscopic procedure in these ambivalent and potentially risky circumstances.

Nuestra experiencia en el tratamiento de la hernia hiatal paraesofágica por vía laparoscópica / Our experience in the laparoscopic repair of paraesophageal hiatal hernia

Introducción. Las complicaciones potenciales de la hernia hiatal tipo II o paraesofágica (vólvulo, úlcera, hemorragia, perforación, etc.) hacen que el tratamiento de elección para esta enfermedad sea el quirúrgico. Las vías clásicas para su abordaje son la abdominal y la torácica. Ambas tienen una importante morbimortalidad por la amplitud de las incisiones, las posibles complicaciones pulmonares y la lenta recuperación, entre otras. La laparoscopia ofrece una alternativa quirúrgica con grandes ventajas frente a la técnica abierta. Pacientes y métodos. Intervenimos a 10 pacientes, 6 varones y 4 mujeres, que sufrían una hernia paraesofágica. Se practicó neumoperitoneo con aguja de Verres y se colocaron 5 trocares de 10 mm según la disposición de Bayley. Redujimos la hernia y resecamos el saco, no siempre totalmente. Con posterioridad, reparamos el defecto de los pilares con suturas no reabsorbibles. Nunca usamos malla de material sintético. Finalizamos la intervención siempre con una técnica antirreflujo, ya sea una funduplicatura de Nissen o un Dor. Resultados. El tiempo operatorio medio fue de 90 min. Los enfermos abandonaron el hospital al cuarto día de la intervención. Todos los pacientes comenzaron con tolerancia oral a dieta a las 24 h. No encontramos recidivas en los controles radiográficos a los 6 meses de la operación. Conclusiones. La vía laparoscópica ofrece una excelente alternativa terapéutica a las técnicas abiertas clásicas, con ventajas como la más rápida recuperación postoperatoria, menor morbilidad, menor estancia hospitalaria, además de una menor incisión, pérdida hemática y mejor visualización de las estructuras anatómicas (AU)

Eosinophilic gastroenteritis: diagnostic laparoscopy.

We report a case of eosinophilic gastroenteritis. The initial diagnosis was made by laparoscopic inspection of the lesion during exploration of the abdomen. We immediately carried out an extracorporeal resection using a laparoscopic surgical technique. Pathological examination confirmed our diagnosis. Eosinophilic gastroenteritis is an infrequent condition, and this definitive description of a lesion as seen in the magnified field of the laparoscope demonstrates the effectiveness of laparoscopy as a diagnostic tool to diagnose the cause of ill-defined abdominal discomfort with inconclusive laboratory findings that formerly would have needed a more surgically aggressive laparotomy to resolve.

[Intestinal cystic lymphangiomas]. / Linfagiomas quísticos intestinales.

Lymphangiomas are benign tumors of the lymphatic system. Their abdominal location is infrequent. We report two cases, one in the first jejunal loop and the other one in the mesentery. The latter was removed by laparoscopic surgery, technique that allows a wider resection.

[Rupture of aneurysm of anomalous hepatic artery (right unfolding)]. / Ruptura de un aneurisma de arteria hepática anómala (desdoblamiento derecho).

Un uncommon case of aneurysm located in an aberrant hepatic artery is described. It was the cause of massive hemoperitoneum. It was treated by ligation and excision without post-operative complications. In spite of the complex vascular malformation, there was no hepatic insufficiency. We have not been able to find a similar case in the literature.

[100 cases of laparoscopic cholecystectomy]. / 100 casos de colecistectomías laparoscópicas.

The first one-hundred cases of laparoscopic cholecystectomy performed in this department are reviewed. The patients are grouped according to the classification of McSherry: type I: 5%; type II: 50%; type III; 27%; and type IV: 18%. Our technique, which is similar to the one of Troidl, except for entry of the number 4 port, is described. The results are analyzed according the classification of Troidl and 83% of the cases had no complications. There were technical incidents which had no repercussion for the patient in 7% of the cases. In 3% of the patients there were minor complications. There was no mortality.