Estado nutricional preoperatorio y complicaciones en cirugía digestiva oncológica: un estudio retrospectivo en un centro de cáncer chileno

Introducción: La desnutrición es una condición frecuente en pacientes oncológicos y puede estar presente en un 40-80% de éstos. En cirugía gastrointestinal, es ampliamente conocida la relación entre la desnutrición preoperatoria y las complicaciones. El objetivo de este estudio es conocer la asociación entre el estado nutricional preoperatorio según el índice de masa corporal (IMC), la valoración global subjetiva (VGS) y la frecuencia de complicaciones postoperatorias en pacientes sometidos a cirugía oncodigestiva electiva. Metodología: Estudio observacional de cohorte retrospectiva. Se incluyeron pacientes sometidos a cirugía digestiva entre abril de 2019 y abril de 2020. Se excluyeron aquellos pacientes con enfermedad fuera de alcance terapéutico curativo. Los pacientes fueron categorizados según el tipo de cáncer, la cirugía realizada, el tratamiento neoadyuvante, los parámetros nutricionales (IMC y VGS) y la albumina preoperatoria. Se registraron las complicaciones postoperatorias de acuerdo con la clasificación de Clavien-Dindo (III-V). Resultados: Se incluyeron 201 pacientes sometidos a cirugía digestiva. El 83,6% calificó en la categoría B o C según VGS. Diecinueve pacientes (9,5%) presentaron complicaciones postoperatorias. Tener una VGS de categoría C se asoció con un mayor riesgo de complicaciones postoperatorias. Otras variables significativas para desarrollar complicaciones fueron recibir tratamiento neoadyuvante combinado (QT + RT) y ser intervenido por una cirugía de alto riesgo nutricional. Conclusión: Tener un estado nutricional deteriorado previo a una cirugía oncológica según VGS, someterse a una cirugía de alto riesgo nutricional y/o someterse a un tratamiento neoadyuvante combinado presentan un mayor riesgo de desarrollar complicaciones postoperatorias. Se destaca la importancia de incorporar protocolos de evaluación y soporte nutricional como parte del tratamiento multimodal impartido desde el diagnóstico oncológico.

Introduction: Malnutrition is a frequent condition in cancer patients and may be present in 40-80% of them. In gastrointestinal surgery, the relationship between preoperative malnutrition and complications has been widely studied, due to the increased risk of postoperative complications. The aim of this study is to determine the association between preoperative nutritional status, according to body mass index (BMI), subjective global assessment (SGA) and the frequency of postoperative complications in patients undergoing elective oncological digestive surgery. Methodology: Observational retrospective cohort study. Patients undergoing elective surgery between April 2019 and April 2020 were included. Patients with disease outside the curative therapeutic scope were excluded. Patients were categorized by type of cancer, surgery performed, neoadjuvant treatment, nutritional parameters (BMI and SGA) and albumin prior to surgery. Postoperative complications were recorded according to the Clavien-Dindo classification (III-V). Results: A total of 201 patients undergoing digestive surgery were included. 83.6% qualified in category B or C according to VGS. Nineteen patients (9.5%) presented postoperative complications. Having a SGA category C is associated with a higher risk of postoperative complications. Other significant variables for developing complications were receiving combined neoadjuvant treatment (CT + RT) and undergoing high nutritional risk surgery. Conclusion: Having a deteriorated nutritional status prior to oncological surgery according to SGA, undergoing high nutritional risk surgery, and/or undergoing combined neoadjuvant treatment significantly increases the risk of developing postoperative complications. The importance of incorporating nutritional assessment and support protocols as part of the multimodal treatment given to the patient from the moment of cancer diagnosis stands out.

Weight and Glucose Control in Rats Submitted to Sleeve Gastrectomy with Cafeteria Diet-Induced Obesity.

Introduction: Sleeve gastrectomy (SG) has been widely disseminated as a surgical treatment for obesity and associated comorbidities, and currently it is one of the most performed surgeries in the world. Experimental research is becoming increasingly relevant to characterize the pathophysiological mechanisms induced by it. Objective: The aim of this study was to standardize an experimental model of SG in rats with obesity induced using a cafeteria diet (CAF) and evaluate variations in weight and glycemic control after vertical SG, maintaining the CAF. Materials and Methods: Twenty Rattus norvegicus albinus rats, Wistar strain, with an average weight of 250 g were used. The animals were randomized into two groups and underwent 4 weeks of obesity induction before the procedure. In 10 animals of the SG group, vertical SG was performed, and in 10 animals of the control/sham (C) group, simulated surgery was performed, consisting of laparotomy and bidigital compression of the stomach. The animals were followed for a total of 8 weeks, with the weight assessed weekly and fasting blood glucose assessed before the start of the CAF, at the time of surgery, and after 4 weeks of the postoperative period, when they were sacrificed. Results: Before obesity induction, the average weight was 257.8 g in the SG group 266.1 g in the C group. After obesity induction, the average weight was 384 g in the vertical sleeve gastrectomy group and 374.8 g in the C group. In the fourth postoperative week, the average weight was 391.6 g in the VSG group and 436.6 g in the C group. The average blood glucose levels were 88.7, 101.8, and 91.3 mg/dL in the VSG group and 86.6, 103.1, and 109.4 mg/dL in the C group, respectively, before the start of the diet, in the fourth preoperative week, and in the fourth postoperative week. Conclusions: Vertical SG in rats is feasible and promotes glycemic control in the postoperative period. CAF allows induction of obesity and changes in blood glucose.

Watch and Wait for rectal cancer in inflammatory bowel disease.

Colorectal cancer is currently the third most frequently diagnosed type of cancer and the second cause of cancer death in the western world. Inflammatory bowel disease patients are 2-6 times more likely to develop CRC than the general population. Patients with CRC arising through Inflammatory Bowel Disease have an indication for surgery. However, in patients without Inflammatory Bowel Disease, the use of organ (rectum) preservation strategies after neoadjuvant treatment is on the rise, which means that patients are able to keep the organ without the need for complete excision, either by treatment with radiotherapy and chemotherapy, or in combination with endoscopic or surgical techniques that allow local excision without the need for resection of the entire organ. The patient management approach known as the Watch and Wait programme was first introduced in 2004 by a team from São Paulo, Brazil. This approach suggested that patients who had an excellent or complete clinical response after neoadjuvant treatment could defer surgery and instead undergo Watch and Wait. This organ preservation technique became popular because it allowed patients to avoid the complications associated with major surgery while achieving similar oncological outcomes to those who underwent both neoadjuvant therapy and radical surgery. Following completion of neoadjuvant treatment, a decision to defer surgery is made based on whether a clinical Complete Response can be achieved, which means there is no evidence of tumour in clinical and radiological examination. The International Watch and Wait Database has published long-term oncological outcomes for patients treated with this strategy, and more patients are showing interest in this treatment option. However, it is important to note that up to 1/3 of patients selected for Watch and Wait may eventually require surgery for local regrowth (also known as 'deferred definitive surgery') at any time during follow-up after an initial 'apparent' clinical Complete Response. Compliance with a strict surveillance protocol ensures early detection of regrowth, which is usually amenable to R0 surgery and provides excellent long-term local disease control. Nonetheless, it is crucial to assess the perioperative consequences of having surgery for regrowth later and whether there are any negative effects from deferring surgery. Currently, the Watch and Wait strategy is recommended in the NCCN guidelines for clinical complete responders and only in specialised multidisciplinary centres.There is no case in the literature that portrays the use of the Watch and Wait programme for patients with inflammatory bowel disease and rectal cancer.The authors intend to present a case that demonstrates the difficulties in the assessment of patients with inflammatory bowel disease, the risks of using radiotherapy in this patients and the challenges of surveillance for patients with colorectal cancer and inflammatory bowel disease.

Huge subcutaneous extraperitoneal pseudocyst after migration of the ventriculoperitoneal shunt catheter.

The formation of an intraperitoneal pseudocyst as a complication of ventriculoperitoneal shunts is well known. However, the formation of a pseudocyst at the subcutaneous extraperitoneal abdominal space is unusual and likely secondary to the migration of the peritoneal catheter. We present a 53-year-old male who had placement of a ventriculoperitoneal shunt for hydrocephalus secondary to a vestibular schwannoma. Five months later, he presented with an enormously distended abdomen. Investigations showed the peritoneal catheter in the extraperitoneal space within a large right lower quadrant abdominal wall pseudocyst. The patient was taken to the operating theatre, and the shunt was externalised at the original abdominal incision. Approximately 3 L of cerebrospinal fluid were aspirated from the distal peritoneal catheter. After negative cultures, a new peritoneal catheter was placed intraperitoneally at the contralateral lower abdominal quadrant. The contralateral quadrant was utilised to prevent fluid accumulation into the old extraperitoneal cavity.

Synovial sarcoma of the transverse colon metastatic to the chest wall after 3 years of follow-up.

We report a fifth case of a transverse colon primary synovial sarcoma. A 31-year-old man with history of grade I obesity presented to an outpatient clinic reporting 6 months of intermittent colicky abdominal pain associated with haematochezia and rectal bleeding. Colonoscopy reported a partially obstructive intraluminal tumour lesion located in the transverse colon. There was no evidence of metastatic disease in the extension studies, so the patient was admitted to the hospital for a laparoscopic subtotal colectomy. Histopathology demonstrated intermediate-grade synovial sarcoma. At the third year of follow-up, the patient presented metastases on the chest wall, which required extensive resection and complementary oncological management.

Bronchobiliary fistula: a rare postoperative complication of spilled gallstones from laparoscopic cholecystectomy.

Bronchobiliary fistula (BBF) is defined as the abnormal connection between the biliary system and the bronchial tree, which presents clinically as an irritant cough with bilioptysis. Many conditions can lead to its development. We present a case of an acquired BBF in a 61-year-old man with a significant history of spilled gallstones from a prior laparoscopic cholecystectomy and subsequent presentation of intermittent right upper quadrant pain and recurrent pneumonia. Imaging studies revealed a liver and subdiaphragmatic abscess with right middle lobe pneumonia and a BBF traversing the right hemidiaphragm. The patient was surgically managed by takedown of fistula with drainage of the abscess and removal of spilled gallstone, followed by a resection of the right middle lobe. While previous studies indicate spilled gallstones are benign, this case demonstrates its potential for serious complications. Therefore, early diagnosis and proper management is essential as BBF has a high morbidity and mortality rate.

Blunt gastric rupture: a plural clinical presentation and literature review.

Blunt trauma is still the leading mechanism of trauma found in patients admitted to trauma centres worldwide. In these patients, the gastric injury is a very rare lesion, occurring in less than 2% of all blunt traumas. Besides the low incidence, gastric rupture mortality is high, which makes the diagnosis an essential step. Thus, this study aims to report two blunt gastric injuries, with different clinical features, prompting the discussion about the main features of clinical suspicion and diagnosis, besides the main therapeutic approaches. Therefore, this study can alert the medical community to the quick diagnosis and assertive therapy, saving patients of unwelcome endpoints.

Right paraduodenal hernia with extensive bowel gangrene treated with staged surgery: a Bogota bag followed by resection in a low-resource setting.

We report a case of right paraduodenal hernia with strangulation of almost the entire small bowel at presentation. Since resection of all bowel of doubtful viability would have resulted in too little residual length to sustain life, a Bogota bag was fashioned using transparent plastic material from an urine drainage bag and the patient monitored intensively for 18 hours. At re-laparotomy, clear demarcation lines had formed with adequate length of viable bowel (100 cm) and resection with anastomosis was done with a good outcome on follow-up, 9 months after surgery. Our description of a rare cause of strangulated intestinal obstruction and a novel method of maximising length of viable bowel is reported for its successful outcome in a low-resource setting.

Subacute Meckel's diverticulum perforation.

Meckel's diverticulum is the most common intestinal congenital defect, its prevalence is 0.2%-4.0% and it occurs more commonly in children younger than 2-year old with intestinal bleeding and abdominal pain. Perforation in the elderly is very rare with no more than 35 articles reported worldwide. Here we report the case of a 62-year-old man who was admitted to hospital with a history of acute abdominal pain with a 20-day onset. The patient was treated with laparotomy and 30 cm ileal resection was performed for an 8×5 cm perforated ileum tumour at 50 from ileocecal valve with a side-to-side mechanical anastomosis for reconstruction. Having morbidity Clavien-Dindo scale I in postsurgical and good outcome in 6-month follow-up. Meckel's diverticulum is an infrequent pathology in paediatric and even rarer in adult population, however, it is always important to keep in mind how to act when is seen either as a finding or as a complication.

Actualidad y tendencias de la cirugía gastrointestinal robótica / Current news and trends in gastrointestinal robotic surgery

Resumen La cirugía ha pasado de ser una ciencia rudimentaria caracterizada por el padecimiento de insufribles dolores por falta de anestésicos, de realizarse en lugares poco acondicionados y de utilizarse instrumental poco ortodoxo con consecuencias nefastas para el desenlace de los procedimientos debido principalmente a las infecciones, a ser un campo desarrollado donde la tecnología juega un rol trascendental para el objetivo final que es el bienestar del paciente. En las últimas décadas, la cirugía ha pasado del acceso abierto al laparoscópico, cirugía por orificios naturales (NOTES), cirugía laparoscópica de puerto único, hasta la cirugía robótica. Es un hecho que estamos en un momento de la historia de la humanidad en el cual el desarrollo de las tecnologías a cambiado nuestra vida cotidiana, así como también el de nuestra practica quirúrgica diaria y no podemos ser ajenos a esta. El propósito de esta revisión es mostrar la situación actual de la cirugía robótica gastrointestinal y sus perspectivas a futuro. Para esto se realizó una búsqueda en la base de datos medline con las palabras claves "review robotic surgery, robotic digestive surgery, robotic bariatric surgery, robotic esophagectomy, robotic gastrectomy, robotic hepatectomy, robotic pancreatectomy, robotic hernia repair". Además una búsqueda de datos en la web sobre "intutive investorpresentation, future of robotic surgery, digital surgery, new robotic system in surgery, trends in robotic surgery".

It is a fact that we are at a moment in the history of humanity in which the development of technologies has changed our daily lives, as well as that of our daily surgical practice. The fast evolution in technology has allowed surgery to evolve from a rudimentary science characterized by painful, highly invasive procedures, to a rapidly developing and precise field with ever improving patient outcomes. In recent decades, gastrointestinal surgery has gone from open access to laparoscopy, natural orifice transluminal endoscopic surgery (NOTES), single-port laparoscopic surgery, and more recently, robotic assisted surgery. The purpose of this review is to show the current situation of robotic gastrointestinal surgery and its future prospects. A literature review was conducted in the Medline database with the keywords "revision of robotic surgery, robotic digestive surgery, bariatric robotic surgery, robotic esophagectomy, robotic gastrectomy, robotic hepatectomy, robotic pancreatectomy, robotic hernia repair". In addition, online search engine data was conducted using the following key words "intutive investor presentation, future of robotic surgery, digital surgery, new robotic system in surgery, trends in robotic surgery"

Robot-Assisted Laparoscopic and Thoracoscopic Surgery: Prospective Series of 186 Pediatric Surgeries.

Objective: We present the applications and experiences of robot-assisted laparoscopic and thoracoscopic surgery (RALTS) in pediatric surgery. Materials and Methods: A prospective, observational, and longitudinal study was conducted from March 2015 to March 2018 that involved a non-random sample of a pediatric population that was treated with RALTS. The parameters examined were: gender, age, weight, height, diagnoses, surgical technique, elapsed time of console surgery, estimated bleeding, need for hemotransfusion, complications, surgical conversions, postoperative hospital stay, and follow-up. The Clavien-Dindo classification of complications was used. The surgical system used was the da Vinci model, Si version (Intuitive Surgical, Inc., Sunnyvale, CA. U.S.A), with measures of central tendency. Results: In a 36-months period, 186 RALTS cases were performed, in 147 pediatric patients and an adult; 53.23% were male, and the remaining were female. The average age was 83 months, ranging from 3.5 to 204 months, plus one adult patient of 63 years. The stature was an average of 116.6 cm, with a range of 55-185 cm; the average weight was 26.9 kg, with a range of 5-102 kg; the smallest patient at 3.5 months was 55 cm in stature and weighed 5.5 kg. We performed 41 different surgical techniques, grouped in 4 areas: urological 91, gastrointestinal and hepatobiliary (GI-HB) 84, thoracic 6, and oncological 5. The console surgery time was 137.2 min on average, ranging from 10 to 780 min. Surgeon 1 performed 154 operations (82.8%), and the remainder were performed by Surgeon 2, with a conversion rate of 3.76%. The most commonly performed surgeries were: pyeloplasty, fundoplication, diaphragmatic plication, and removal of benign tumors, by area. Hemotransfusion was performed for 4.83%, and complications occurred in 2.68%. The average postoperative stay was 2.58 days, and the average follow-up was 23.5 months. The results of the 4 areas were analyzed in detail. Conclusion: RALTS is safe and effective in children. An enormous variety of surgeries can be safely performed, including complex hepatobiliary, and thoracic surgery in small children. There are few published prospective series describing RALTS in the pediatric population, and most only describe urological surgery. It is important to offer children the advantages and safety of minimal invasion with robotic assistance; however, this procedure has only been slowly accepted and utilized for children. It is possible to implement a robust program of pediatric robotic surgery where multiple procedures are performed.

Intercostal celiotomy for removal of proventriculus foreign body in muscovy duck (Cairina moschata): case report / Celiotomia intercostal para remoção de corpo estranho do proventrículo de pato-do-mato (Cairina Moschata): relato de caso]

Ducks, geese and swans are included in the Anatidae family, Anseriformes order. The leading injuries causes to waterfowl are tangling in fishing materials and foreign bodies ingestion. A muscovy duck (Cairina moschata) was referred for treatment at Veterinary Teaching Hospital and a radiographic examination showed the presence of a hook in the coelom. Surgical exposure and incision of the proventriculus was made through left intercostal access and the hook along with a fishing line were gently removed. The animal began to feed voluntarily at the fourth post-operative day and two weeks after the procedure the patient was clinically well and was released to wild. This surgical approach differs in some aspects from the listed techniques in the known literature. It proved to be a viable and appropriate alternative to treat this affection since it did not cause any trans- or post-operative complications and enabled rapid recovery and subsequent patient release.(AU)

Patos, gansos e cisnes estão incluídos na família Anatidae, ordem Anseriformes. Entre as principais causas de ferimentos em aves aquáticas, o embaraço com materiais de pesca e a ingestão de corpos estranhos são os mais citados. Um pato-do-mato (Cairina moschata) foi encaminhado para tratamento no Hospital Veterinário e, mediante exame radiográfico, verificou-se a presença de um anzol na cavidade celomática, provavelmente no proventrículo. Utilizando-se o acesso intercostal esquerdo, foi feita a exposição e a incisão do proventrículo. Por meio dessa incisão, o anzol com um segmento de linha de pesca foi delicadamente retirado. O animal começou a se alimentar voluntariamente no quarto dia pós-operatório e duas semanas após o procedimento o paciente se encontrava clinicamente bem e apto à soltura. Esta abordagem cirúrgica difere, em alguns aspectos, das técnicas listadas na literatura e provou ser uma alternativa viável e adequada ao caso, não causando complicações e permitindo recuperação rápida, com posterior soltura do animal.(AU)

Intercostal celiotomy for removal of proventriculus foreign body in muscovy duck (Cairina moschata): case report / Celiotomia intercostal para remoção de corpo estranho do proventrículo de pato-do-mato (Cairina Moschata): relato de caso]

Ducks, geese and swans are included in the Anatidae family, Anseriformes order. The leading injuries causes to waterfowl are tangling in fishing materials and foreign bodies ingestion. A muscovy duck (Cairina moschata) was referred for treatment at Veterinary Teaching Hospital and a radiographic examination showed the presence of a hook in the coelom. Surgical exposure and incision of the proventriculus was made through left intercostal access and the hook along with a fishing line were gently removed. The animal began to feed voluntarily at the fourth post-operative day and two weeks after the procedure the patient was clinically well and was released to wild. This surgical approach differs in some aspects from the listed techniques in the known literature. It proved to be a viable and appropriate alternative to treat this affection since it did not cause any trans- or post-operative complications and enabled rapid recovery and subsequent patient release.(AU)

Patos, gansos e cisnes estão incluídos na família Anatidae, ordem Anseriformes. Entre as principais causas de ferimentos em aves aquáticas, o embaraço com materiais de pesca e a ingestão de corpos estranhos são os mais citados. Um pato-do-mato (Cairina moschata) foi encaminhado para tratamento no Hospital Veterinário e, mediante exame radiográfico, verificou-se a presença de um anzol na cavidade celomática, provavelmente no proventrículo. Utilizando-se o acesso intercostal esquerdo, foi feita a exposição e a incisão do proventrículo. Por meio dessa incisão, o anzol com um segmento de linha de pesca foi delicadamente retirado. O animal começou a se alimentar voluntariamente no quarto dia pós-operatório e duas semanas após o procedimento o paciente se encontrava clinicamente bem e apto à soltura. Esta abordagem cirúrgica difere, em alguns aspectos, das técnicas listadas na literatura e provou ser uma alternativa viável e adequada ao caso, não causando complicações e permitindo recuperação rápida, com posterior soltura do animal.(AU)

Protocol for fast postoperative improvement (FPOI) in gastrointestinal surgery.

INTRODUCTION: Peroperative treatment has required multimodal protocols that stimulate patient evolution and shorten hospital stay. OBJECTIVE: Identify the type of pathology, intervention performed and evaluate the effectiveness of the Rapid Postoperative Improvement Protocol (RAMPO) in patients undergoing elective gastrointestinal surgery. METHOD: A total of 122 patients were evaluated, a group of 61 patients received the RAMPO protocol and the other group of equal number of patients were treated with traditional protocols (Controls). RESULTS: Both groups were admitted for colorectal cancer, colostomy due to benign pathology and gastric cancer. The interventions performed were: colorectal resections (35.25%), intestinal transit restitution (29.51%) and gastrectomy (15.57%). In the RAMPO group, postoperative glycemia values (116.49 vs. 167.08 mg/dl) reflected better metabolic control with shorter hospital stay (5.49 vs. 14.11 days), obtaining a higher degree of satisfaction (91.80 vs. 19.67%) when compared to the control group (p < 0.005). CONCLUSION: The RAMPO protocol presented relevant aspects to the traditional management of patients undergoing elective surgeries of the gastrointestinal tract, being safe, acceptable in our environment, with faster hospital discharge, significantly improving the evolution of patients, a lower percentage of complications and a high degree of satisfaction without increasing morbidity and mortality.

INTRODUCCIÓN: El tratamiento peroperatorio ha requerido protocolos multimodales que estimulen la evolución del paciente y acorten la estancia hospitalaria. OBJETIVO: Identificar el tipo de patología y la intervención realizada, y evaluar la efectividad del protocolo de rápida mejoría posoperatoria (RAMPO) en pacientes sometidos a cirugía electiva gastrointestinal. MÉTODO: Se evaluaron 122 pacientes; a un grupo de 61 se les aplicó el protocolo RAMPO y en el otro grupo de igual número de pacientes se siguieron protocolos tradicionales (controles). RESULTADOS: Ambos grupos ingresaron por cáncer colorrectal, colostomía por patología benigna y cáncer gástrico. Las intervenciones realizadas fueron resecciones colorrectales (35.25%), restitución del tránsito intestinal (29.51%) y gastrectomía (15.57%). En el grupo RAMPO, los valores de glucemia posoperatoria (116.49 vs. 167.08 mg/dl) reflejaron un mejor control metabólico con menor estancia hospitalaria (5.49 vs. 14.11 días), con un mayor grado de satisfacción (91.80% vs. 19.67%) al compararse con el grupo control (p < 0.005). CONCLUSIÓN: El protocolo RAMPO presentó aspectos relevantes al manejo tradicional de los pacientes sometidos a cirugías electivas del tracto gastrointestinal, siendo seguro, aceptable en nuestro medio y con egreso hospitalario más rápido, mejorando de manera significativa la evolución de los enfermos, con menos complicaciones y un alto grado de satisfacción, sin aumentar la morbimortalidad.

Rare case of adult pancreatic haemangioma and literature review.

Pancreatic haemangiomas are benign vascular tumours very rare in adults. Twenty-two cases are described in the literature. The symptoms are non-specific, and therefore rarely clinically suspected, and the vast majority are incidental findings in imaging tests such as ultrasound, CT, angiography or MRI. They appear on CT as a cystic lesion with contrast enhancement in the arterial phase. We present the case of a 36-year-old male patient with no history of disease, referred with lumbar pain and suspected renal calculus after tomography showing hypervascular enhancement in the pancreatic body and infiltrative lesion (possible neuroendocrine neoplasia) on MRI and biliopancreatic echoendoscopy. He was submitted to laparotomy with subtotal pancreatectomy and splenectomy and satisfactory evolution.

Giant choledochal cyst presenting during third trimester of pregnancy.

Biliary cystic disease is a rare entity. Twenty-five per cent of cases are diagnosed during adulthood and only a few reports have described this condition during pregnancy, where it represents a therapeutic challenge for both obstetricians and surgeons with regard to the risks it entails for the patient and the fetus.Definitive management is surgical resection, as cysts may progress to malignancy if untreated. During pregnancy, resection is generally deferred to after delivery, especially in the context of suspected cholangitis.A 19-year-old young woman with no previous prenatal control, presented to the emergency department on her 32nd week of gestation with abdominal pain and jaundice. A giant Todani I biliary cyst was observed on imaging along with dilation of the proximal biliary tree suggesting acute cholangitis. Fetal compromise prompted immediate delivery after which percutaneous biliary drainage was performed. Following recovery, the cyst was surgically resected.

Laparoscopic revisional surgery for an unusual complication of Roux-en-Y gastric bypass.

With the worldwide epidemic of obesity, there has been an increase in the numbers of primary and revisional procedures of bariatric surgery such as the Roux-en-Y gastric bypass (RYGBP). Nevertheless, this type of surgery is not exempt from complications. An excessive length of non-functional Roux limb proximal to the jejunojejunostomy can cause abnormal upper gastrointestinal symptoms after laparoscopic RYGBP. We present the case of a female patient who presented these unspecific abdominal symptoms after laparoscopic RYGBP who underwent laparoscopic resection in order to reduce the length of the dilated blind loop responsible for the symptoms.

Seis años de experiencia en cirugía digestiva asistida por robot / 6 years of experience with robotic assisted gastrointestinal surgery

Resumen Introducción Desde su aprobación, la cirugía robótica ha crecido como una técnica útil, prometedora y probablemente superior en muchas cirugías. El objetivo de este estudio es exponer y evaluar los resultados de 6 años de experiencia, en cirugía digestiva asistida por robot, utilizada en diferentes procedimientos gastrointestinales, a lo largo de estos años. Material y Método Realizamos una revisión retrospectiva de todos los pacientes consecutivos sometidos a cirugía asistida por robot, realizada por un cirujano digestivo del Departamento de Cirugía Bariátrica y Departamento de Cirugía Robótica de la Clínica Santa María, de Santiago de Chile, entre septiembre de 2011 y mayo de 2017. Resultados Un total de 290 pacientes fueron sometidos a cirugía digestiva asistida por robot durante 6 años. Todos los pacientes fueron operados por el mismo cirujano digestivo. Los procedimientos primarios realizados fueron bypass gástrico en Y-Roux con anastomosis manual, gastrectomía en manga, cirugía revisional bariátrica y no bariátrica, fundoplicatura de Nissen, colecistectomía con puerto único, miotomía de Heller con fundoplicatura de Dor, hernioplastías, y otros casos excepcionales. La mayoría de los procedimientos secundarios fueron colecistectomías, hernioplastías hiatales y adherenciolisis. La estadía hospitalaria promedio fue de 3 días. Se observaron complicaciones postoperatorias en 27 (9,3%) pacientes. De acuerdo a la clasificación de Clavien Dindo, 4 (1,4%) complicaciones fueron Clavien I, 5 (1,7%) Clavien II, 18 (6,2%) Clavien III, 0 Clavien IV, 0 Clavien V. No hubo mortalidad en este grupo. El tiempo total promedio de los procedimientos fue de 76 min. El tiempo quirúrgico promedio fue de 64 min. Conclusión La cirugía digestiva asistida por robot es una técnica confiable y segura, que se puede utilizar para muchas enfermedades.

Background Since its approval, robotic surgery has been growing as a useful, promising and probably superior technique for many surgeries. The aim of this study is to expose and evaluate the results of a 6-year experience, of a single surgeon, with robotic assisted surgery, used for different gastrointestinal procedures throughout this years. Study Design We conducted a retrospective revision of all consecutive robotic assisted gastrointestinal cases performed by a single gastrointestinal laparoscopic surgeon of the Bariatric Surgery Department and Robotics Surgery Department of Clínica Santa María of Santiago, Chile, between September 2011 and May 2017. Results A total of 290 patients underwent robotic gastrointestinal surgery during 6 years. All cases were performed by the same gastrointestinal surgeon. Primary procedures performed were totally hand sewn Roux-en-Y gastric bypass, sleeve gastrectomy, revisional bariatric and non-bariatric surgery, Nissen fundoplication, single port cholecystectomy, Heller myotomy with Dor fundoplication, hernia repairs, and other exceptional cases. A total of 512 procedures were performed in 290 patients. The majority of secondary procedures were cholecystectomies, hiatal hernia repairs and adhesiolysis. Average length of hospital stay was 3 days. Postoperative complications were observed in 27 (9.3%) patients. According to Clavien Dindo classification of surgical complications, 4 (1.4%) complications were Clavien I, 5 (1.7%) Clavien II, 18 (6.2%) Clavien III, 0 Clavien IV, 0 Clavien V. There were no deaths in this group. Mean operative time was 76 minutes. Mean surgical time was 64 minutes. Conclusion Robot assisted upper gastrointestinal surgery is a reliable and effective technique, that can be used in many diseases.