Retraso diagnóstico durante la pandemia por COVID-19: absceso hepático secundario a colecistitis aguda litiásica / Diagnostic Delay During the COVID-19 Pandemic: Liver Abscess Secondary to Acute Lithiasic Cholecystitis

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Two-stage versus single-stage procedure for the management of cholecystocholedocholithiasis in elderly patients: a retrospectively cohort study

Background: there is an increasing incidence rate of cholecysto-choledocholithiasis associated with the increasing proportion of senile individuals. Methods: a total of 100 elderly patients (over 80 years of age) suffering both from cholelithiasis and choledocholithiasis were retrospectively studied from January 2010 to December 2016. Patients were scheduled for either a single-stage or two-stage procedure. The LCBDE group (n = 54) included cases that underwent a single stage procedure of laparoscopic exploration of the common bile duct combined with cholecystectomy. The ERCP/EST group (n = 46) included cases that underwent a two stage procedure of preoperative endoscopic retrograde cholangiopancreaticography with endoscopic sphincterotomy followed by cholecystectomy. Comorbidity conditions, presenting symptoms, bile duct clearance, length of hospital stay and the frequency of procedural, postoperative and long-term complications were recorded. Results: the LCBDE group had a higher stones clearance rate than the ERCP/EST group (100.0% vs 89.1%, p < 0.05). Postoperative complications and hospitalization length were comparable in the two groups (p > 0.05). There were more procedural complications in the ERCP/EST group than in the LCBDE group (10.8% vs 0%, p < 0.05). Furthermore, a patient in the ERCP/EST group died due to duodenal perforation. More patients in the ERCP/EST group experienced long-term complications than those in the LCBDE group (23.9% vs 3.7%, p < 0.05) during a mean follow-up period of 28.4 months. Conclusions: the single-stage procedure is a safe and effective technique for elderly patients with cholecysto-choledocholithiasis. LCBDE provides a good stone clearance rate with few long term complications

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Estudio de la función vesicular y resultados a largo plazo de la colecistolitotomía / Gallbladder motility and long term results in cholecystolithotomy

Objetivos. La extracción de la litiasis vesicular conservando la vesícula es una alternativa a la colecistectomía que se viene realizando en nuestro servicio desde hace 25 años. Nuestra revisión tiene como objetivo valorar la tasa de recidiva y la función vesicular. Material y Métodos. A los pacientes intervenidos en nuestro servicio desde 1989 con esta técnica se les realizó una encuesta de problemas digestivos y un estudio ecográfico pre y postprandial tras la ingesta de un alimento graso para identificar la recidiva y para estimar el volumen y la contracción vesicular. Resultados. De los 20 pacientes intervenidos, 10 pacientes participaron en el estudio. Se identificó un cálculo en una paciente intervenida hace 2 años que presenta dolor abdominal (10%). La mediana de volumen preprandial fue 18,37 cc y la postprandial 7,16 cc. La mediana del porcentaje de reducción de volumen, 57,63%. Conclusiones. Solo se identificó un cálculo residual en el postoperatorio temprano. Todos los pacientes conservaron una función vesicular adecuada (valores superiores al 30%) por lo que consideramos que, de forma correctamente seleccionada, la colecistolitotomía es una alternativa a la colecistectomía en el paciente pediátrico

Introduction. Gallstone removal preserving the gallbladder is a therapeutic option in cholelithiasis. Our group has made use of this technique for twenty-five years in pediatric patients. The purpose of this review was to study gallstone recurrence and gallbladder motility. Materials and Methods. Patients who had gallstones removed with this technique from 1989 until 2013 were contacted and asked about digestive or other health problems. A sonographic assessment was made in order to look for gallstone recurrence and to measure gallbladder volumes and contraction after fasting and after consuming a fatty meal. Results. All patients are asymptomatic except a girl who suffered colic pain and who had a gallstone recurrence. The median of volume after fasting was 18.37 cc and after consuming the meal 7.16 cc. The median of gallbladder contraction was 57.63%. Conclusions. A gallstone relapse was identified (10%). Long-term follow up showed an excellent gallbladder function and contraction (greater than 30%) without other recurrences. Based on our experience, in patients properly selected cholecistolithotomy is an interesting option in children

Avances en pancreatitis aguda / Advances in acute pancreatitis

El presente artículo recopila la evidencia más reciente sobrelos últimos avances en el concepto, diagnóstico y tratamientode la pancreatitis aguda. El concepto de pancreatitis aguday sus complicaciones está cambiando, y la presencia de falloorgánico persistente es esencial para clasificar a un pacientecomo grave. En este contexto, un incremento en la permeabilidadintestinal se demuestra como un fenómeno precozcon importantes repercusiones pronósticas. La ecografía endoscópicase confirma como la exploración de primera elecciónen el estudio de pacientes con pancreatitis aguda idiopáticao de probable etiología biliar. Una reposiciónhidroelectrolítica agresiva durante las primeras horas de enfermedades clave para un curso clínico favorable. El tratamientoconservador y el empleo de necrosectomía endoscópicaestán desplazando al abordaje quirúrgico comotratamiento de primera elección de la necrosis pancreáticainfectada. Por último, se discuten en este artículo las últimasevidencias en la prevención de pancreatitis aguda tras la colangiopancreatografíaretrógrada endoscópica(AU)

The present article reports the most recent evidence on thelatest advances in the definition, diagnosis and treatment ofacute pancreatitis. The concept of acute pancreatitis and itscomplications is changing and the presence of persistent organfailure is essential to classify a patient as having severedisease. In this context, increased intestinal permeability isseen as an early phenomenon with important prognostic repercussions.Endoscopic ultrasonography is confirmed asthe investigation of choice in patients with idiopathic acutepancreatitis or suspected acute biliary pancreatitis. Aggressivewater and electrolyte replacement in the first few hoursafter onset is the key to a favorable clinical course. Conservativetreatment and the use of endoscopic necrosectomy arereplacing surgery as the treatment of choice of infected pancreaticnecrosis. Lastly, the present article discusses the latestevidence on the prevention of post- endoscopic retrogradecholangiopancreatography (ERCP) acute pancreatitis(AU)

Tratamiento de la coledocolitiasis en un tiempo por videolaparoscopia. Análisis de 10 años de experiencia / Single-stage management of common duct stones by video-assisted laparoscopy. Analysis of 10 years’ experience

Introducción. El manejo de los pacientes con litiasis vesicular y coledociana plantea controversias. El tratamiento en uno o en dos tiempos son las principales opciones. Material y método. Análisis retrospectivo de la experiencia de 10 años en el tratamiento en un tiempo de la coledocolitiasis en un centro terciario de alto volumen. Resultados. Se trató inicialmente por laparoscopia a 569 pacientes; se resolvieron con un abordaje transcístico 412 (76,3%); mediante coledocotomía laparoscópica, 128 (23,7%) y se convertió a cirugía abierta a 29 (5%). La morbilidad y la mortalidad general fueron del 2,46 y el 0,52%, respectivamente. Conclusiones. En centros de alto volumen el tratamiento en un tiempo y por laparoscopia de la coledocolitiasis es factible y seguro, con una alta proporción de pacientes que sólo necesitan de un abordaje transcístico (AU)

Introduction. The management of patients with gallstone disease and ductal calculi is controversial. The main options are one-stage or two-stage management. Material and method. We performed a retrospective analysis of the experience gained over 10 years in the one-stage management of common duct stones in a high-volume tertiary hospital. Results. A total of 569 patients were initially treated by laparoscopy. Of these, 412 (76.3%) underwent the transcystic approach, 128 (23.7%) underwent laparoscopic choledochotomy and 29 (5%) were converted to open surgery. Overall morbidity and mortality were 2.46% and 0.52%, respectively. Conclusions. In high-volume centers, one-stage laparoscopic management of common duct stones is safe and feasible, with a high proportion of patients that only require a transcystic approach (AU)

Colecistitis aguda litiásica como presentación excepcional de enfermedad celíaca / Acute lithiasic cholecystitis as an exceptional presentation of celiac disease

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