RESUMEN
PURPOSE: Technical challenges and a perceived higher risk of complications hinder a wide adoption of minimally invasive pancreatoduodenectomy. We aim to further define the place of minimally invasive pancreatoduodenectomy by comparison with the traditional open approach. METHODS: A comparison of the surgical outcomes and survival after laparoscopic (LPD) versus open pancreatoduodenectomy (OPD) was retrospectively performed from a prospectively kept database. To reduce the effect of bias and confounding, baseline characteristics of both groups were matched using propensity score matching (NCT05110573; Nov 8, 2021; retrospectively registered). RESULTS: From a total of 67 LPD and 105 OPD patients, propensity score matching resulted in two balanced groups of 38 patients. In both groups, 87% of surgeries were performed for cancer. In the LPD group, conversion rate was 22.4%. Mean operative time was significantly longer after LPD versus OPD (320.1 ± 53.8 vs. 277.7 ± 63.8 min; p = .008). Hospital stay was significantly shorter after LPD versus OPD (median 13.5 vs. 17.0 days; p = .039). No significant differences were observed in blood loss, total complication rate (73.7% vs. 86.8%; p = .249), major complication rate (26.5% vs. 10.5%; p = .137), postoperative pancreatic fistula rate (13.2% vs. 7.9%; p = .711), 90-day mortality rate (5.3% vs. 0%; p = .493), R0 resection rate (85.4% vs. 85.8%), or number of lymph nodes (median 10.0 vs. 8.5; p = .273). In cancer patients, no significant differences were observed in overall survival (median 27.1 vs. 23.9 months; p = .693), disease-free survival, or recurrence rate. CONCLUSION: LPD provided acceptable short-term and oncological outcomes. Compared to OPD, we noted a higher major complication rate, without compromising surgical safety or oncological outcomes.
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Laparoscopía , Neoplasias Pancreáticas , Humanos , Pancreaticoduodenectomía/métodos , Puntaje de Propensión , Tiempo de Internación , Neoplasias Pancreáticas/cirugía , Neoplasias Pancreáticas/complicaciones , Morbilidad , Complicaciones Posoperatorias/etiología , Laparoscopía/métodos , Estudios RetrospectivosRESUMEN
BACKGROUND: Lymphoepithelial cysts (LECs) of the pancreas are a rare type of true pancreatic cysts and represent an estimated 0.5% of all pancreatic cystic lesions. They are benign lesions and have no malignant potential. However, they are hard to differentiate from malignant lesions because their imaging and clinical presentation vary greatly. Seeing as these are benign lesions which are increasingly found incidentally during imaging for other indications, correct diagnosis is important to prevent unnecessary intervention and morbidity. CASE REPORT: We report the case of a 41-year-old female who presented with abdominal discomfort, bloating and dyspepsia. An abdominal computed tomography (CT) showed a large mass in the left fossa. We describe the diagnostic and therapeutic measures taken in this case. METHODS: We reviewed the literature for common features of the LEC. We grouped common imaging and histological features of the LEC of the pancreas to provide easily identifiable characteristics to facilitate diagnosis. For the review, we focused on papers, mostly case reports, presenting these common characteristics. We also reviewed the literature for key topics that should be taken into account when considering therapeutic interventions in a patient with a possible diagnosis of a LEC. CONCLUSION: Cysts of the pancreas are increasingly identified due to widespread use and improved resolution of cross-sectional imaging. To obtain the correct diagnosis, it is sometimes necessary to combine advanced imaging, i.e. CT and MRI-imaging, and endoscopic ultrasound with fine needle aspiration (EUS/FNA), while CA 19-9 also has diagnostic value. We summarize all diagnostic characteristics in a table for ease of use. Furthermore we summarized possible therapeutic interventions.
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Quiste Pancreático , Neoplasias Pancreáticas , Femenino , Humanos , Adulto , Páncreas , Quiste Pancreático/diagnóstico por imagen , Quiste Pancreático/terapia , Endosonografía , Biopsia con Aguja Fina/métodos , Imagen por Resonancia Magnética , Neoplasias Pancreáticas/patologíaRESUMEN
BACKGROUND AND PURPOSE: Laparoscopic liver resections (LLR) of bilobar colorectal liver metastases (CRLM) are challenging and the safety and long-term outcomes are unclear. In this study, the short- and long-term outcomes and recurrence patterns of one-stage LLR for bilobar CRLM were compared to single laparoscopic resection for CRLM. METHODS: This single-center study consisted of all patients who underwent a parenchymal sparing LLR for CRLM between October 2011 and December 2018. Demographics, perioperative outcomes, short-term outcomes, oncologic outcomes and recurrence patterns were compared. Data were retrieved from a prospectively maintained database. RESULTS: Thirty six patients underwent a LLR for bilobar CRLM and ninety patients underwent a single LLR. Demographics were similar among groups. More patients received neoadjuvant chemotherapy in the bilobar group (55.6% vs 34.4%, P = 0.03). There was no difference in conversion rate, R0 resection and transfusion rate. Blood loss and operative time were higher in the bilobar group (250 ml (IQR 150-450) vs 100 ml (IQR 50-250), P < 0.001 and 200 min (IQR 170-230) vs 130 min (IQR 100-165), P < 0.001) and hospital stay was longer (5 days (IQR 4-7) vs 4 days (IQR 3-6), P = 0.015). The bilobar group had more technically major resections (88.9% vs 56.7%, P < 0.001). Mortality was nil in both groups and major morbidity was similar (2.8% vs 3.3%, P = 1.0). There was no difference in recurrence pattern. Overall survival (OS) was similar (1 yr: 96% in both groups and 5 yr 76% vs 66%, P = 0.49), as was recurrence-free survival (RFS) (1 yr: 64% vs 73%, 3 yr: 38 vs 42%, 5 yr: 38% vs 28%, P = 0.62). CONCLUSION: In experienced hands, LLR for bilobar CRLM can be performed safely with similar oncologic outcomes as patients who underwent a single LLR for CRLM.
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Neoplasias Colorrectales , Laparoscopía , Neoplasias Hepáticas , Neoplasias Colorrectales/cirugía , Hepatectomía , Humanos , Tiempo de Internación , Neoplasias Hepáticas/secundario , Estudios RetrospectivosRESUMEN
BACKGROUND: With growing popularity and experience in laparoscopic liver surgery, the options for more difficult procedures increase. Only small case series have been published regarding laparoscopic liver resection (LLR) for tumours in proximity to major vessels (MVs). The aim was to compare outcomes of LLR for tumours located less or more than 15â¯mm from MVs. METHODS: This was a retrospective analysis of a prospectively collected database of consecutive LLR (October 2011-August 2017). Proximity to MVs (PMV) was defined as lesions located within 15â¯mm to the caval vein, hepatic veins and portal vein (main trunk and first branches). The control group were all lesions located more than 15â¯mm from MVs. RESULTS: Some 60/235 LLR were performed for lesions in proximity to major vasculature (24%). In the PMV group, median IWATE Difficulty Score was higher (8.5 (IQR: 6.0-9.0) VS 5.0 (IQR: 3.0-6.0), pâ¯<â¯0.001) as was the use of CUSA® (45.0% VS 8.6%, pâ¯<â¯0.001) and Pringle manoeuvre (8.3% VS 1.7%; pâ¯=â¯0.028). Operative time was longer (180min (IQR: 140-210) VS 120min (IQR: 75-150), pâ¯<â¯0.001) and blood loss was higher (190â¯ml (IQR: 100-325) VS 75â¯ml (IQR: 50-220), pâ¯<â¯0.001) in the PMV group. There was no difference in perioperative blood transfusion (3.3% VS 1.7%, pâ¯=â¯0.60) or postoperative morbidity (15.0% VS 14.3%, pâ¯=â¯0.89). There was no mortality in both groups. On mean follow-up of 21 months, no significant differences could be found in disease free (pâ¯=â¯0.77) and overall survival (pâ¯=â¯0.12). CONCLUSION: In experienced hands, LLR of lesions in proximity to MVs is safe and feasible with acceptable short and long-term results.
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Carcinoma Hepatocelular/cirugía , Neoplasias Colorrectales/patología , Hepatectomía/métodos , Venas Hepáticas/patología , Laparoscopía/métodos , Neoplasias Hepáticas/cirugía , Vena Porta/patología , Vena Cava Inferior/patología , Anciano , Neoplasias de los Conductos Biliares/patología , Neoplasias de los Conductos Biliares/cirugía , Conductos Biliares Intrahepáticos , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Carcinoma Hepatocelular/patología , Colangiocarcinoma/patología , Colangiocarcinoma/cirugía , Transfusión de Eritrocitos/estadística & datos numéricos , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/secundario , Masculino , Márgenes de Escisión , Metastasectomía/métodos , Persona de Mediana Edad , Mortalidad , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Estudios RetrospectivosRESUMEN
OBJECTIVE: To assess short-term outcomes after minimally invasive (laparoscopic, robot-assisted, and hybrid) pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) among European centers. BACKGROUND: Current evidence on MIPD is based on national registries or single expert centers. International, matched studies comparing outcomes for MIPD and OPD are lacking. METHODS: Retrospective propensity score matched study comparing MIPD in 14 centers (7 countries) performing ≥10 MIPDs annually (2012-2017) versus OPD in 53âGerman/Dutch surgical registry centers performing ≥10 OPDs annually (2014-2017). Primary outcome was 30-day major morbidity (Clavien-Dindo ≥3). RESULTS: Of 4220 patients, 729/730 MIPDs (412 laparoscopic, 184 robot-assisted, and 130 hybrid) were matched to 729 OPDs. Median annual case-volume was 19 MIPDs (interquartile range, IQR 13-22), including the first MIPDs performed in 10/14 centers, and 31 OPDs (IQR 21-38). Major morbidity (28% vs 30%, P = 0.526), mortality (4.0% vs 3.3%, P = 0.576), percutaneous drainage (12% vs 12%, P = 0.809), reoperation (11% vs 13%, P = 0.329), and hospital stay (mean 17 vs 17 days, P > 0.99) were comparable between MIPD and OPD. Grade-B/C postoperative pancreatic fistula (POPF) (23% vs 13%, P < 0.001) occurred more frequently after MIPD. Single-row pancreatojejunostomy was associated with POPF in MIPD (odds ratio, OR 2.95, P < 0.001), but not in OPD. Laparoscopic, robot-assisted, and hybrid MIPD had comparable major morbidity (27% vs 27% vs 35%), POPF (24% vs 19% vs 25%), and mortality (2.9% vs 5.2% vs 5.4%), with a fewer conversions in robot-assisted- versus laparoscopic MIPD (5% vs 26%, P < 0.001). CONCLUSIONS: In the early experience of 14 European centers performing ≥10 MIPDs annually, no differences were found in major morbidity, mortality, and hospital stay between MIPD and OPD. The high rates of POPF and conversion, and the lack of superior outcomes (ie, hospital stay, morbidity) could indicate that more experience and higher annual MIPD volumes are needed.
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Procedimientos Quirúrgicos Mínimamente Invasivos , Enfermedades Pancreáticas/cirugía , Pancreaticoduodenectomía/métodos , Anciano , Europa (Continente) , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/mortalidad , Evaluación de Procesos y Resultados en Atención de Salud , Enfermedades Pancreáticas/mortalidad , Pancreaticoduodenectomía/mortalidad , Puntaje de Propensión , Estudios RetrospectivosRESUMEN
BACKGROUND: Laparoscopic pancreatic surgery still represents a challenge for surgeons. However, in recent decades the experience is expanding. Recent systematic reviews and meta-analyses confirm that laparoscopic pancreatic resection (LPR) is safe, feasible and worthwhile. This study analyses the first 100 consecutive LPRs in our centre. METHODS: A retrospective analysis was conducted of the first 100 LPRs in a single supra-regional Belgian centre, performed between January 2012 and January 2019. Pre-, peri- and postoperative data were retrieved from a prospectively maintained database. All procedures were performed laparoscopically by two attending surgeons, specialized in minimally invasive and hepatopancreatobiliary surgery. RESULTS: Of 100 procedures, 62 laparoscopic pancreatoduodenectomies (LPD) and 36 laparoscopic distal pancreatectomies (LDP) were performed, along with 1 enucleation and 1 central pancreatectomy. Indication was malignancy in 70%. Conversion rate was 24,2% in LPD and 11% in LDP. Median operative time was 330â¯min (IQR 300-360) in LPD and 150â¯min (IQR 142.5-210) in LDP. Median blood loss was 200â¯mL (IQR 100-487.5) in LPD and 150â¯mL (IQR 50-500) in LDP, transfusion rate was 22.6% and 8.3% respectively. Median length of stay (LOS) was 13 days (IQR 10-19.25) in LPD and 9 days (IQR 9-14) in LDP. R0 resection rate was 88.6% (62/70). Major complication rate (Clavien-Dindo grade III-IV) was 12%. Thirty-day mortality was 0%, 90-day mortality was 2%. CONCLUSION: Our results confirm that LPR is a feasible and safe alternative to open pancreatic surgery. Safe implementation with a clear strategy is fundamental to gain experience and overcome the learning curve of this technically demanding procedures.
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Laparoscopía/métodos , Pancreatectomía/métodos , Pancreaticoduodenectomía/métodos , Anciano , Femenino , Humanos , Laparoscopía/efectos adversos , Laparoscopía/mortalidad , Masculino , Pancreatectomía/efectos adversos , Pancreatectomía/mortalidad , Pancreaticoduodenectomía/efectos adversos , Pancreaticoduodenectomía/mortalidad , Estudios RetrospectivosRESUMEN
INTRODUCTION: Small bowel obstruction (SBO) is a frequent complication after laparoscopic Roux-en-y gastric bypass (LRYGB). OBJECTIVES: We wanted to evaluate the effect of closure of the mesenteric defects on the incidence of SBO and postoperative complications after LRYGB. Furthermore, we wanted to identify possible risk factors for SBO. METHODS: This study was a retrospective cohort study of 1364 patients who underwent a LRYGB between July 2003 and October 2015. Cohort 1 contained 724 patients in whom mesenteric defects were not closed. Cohort 2 contained 640 patients in whom mesenteric defects were closed. Main outcome parameters were the incidence of SBO and postoperative complications as well as potential risk factors for SBO. RESULTS: Closure of the mesenteric defects was associated with a reduction in the incidence of SBO due to internal herniation (4.8% vs. 5.5, pâ¯=â¯0.02) but resulted in a higher incidence of SBO due to postoperative adhesions (4.8% vs. 1.7%, pâ¯=â¯0.004). Multivariate analysis identified smoking as a risk factor for SBO (pâ¯=â¯0.0187). We observed a higher incidence of late postoperative pain in cohort 2 (5.3% vs. 2.1%, pâ¯=â¯0.007). CONCLUSION: Although closure of the mesenteric defects is associated with a lower incidence of SBO due to internal herniation, this effect is countered by a higher incidence of SBO due to postoperative adhesions. Smoking is an independent risk factor for SBO after LRYGB. Closure of the mesenteric defects is associated with a higher incidence of late postoperative pain.
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Derivación Gástrica/efectos adversos , Hernia Abdominal/epidemiología , Obstrucción Intestinal/epidemiología , Mesenterio/cirugía , Complicaciones Posoperatorias/epidemiología , Adulto , Femenino , Derivación Gástrica/métodos , Hernia Abdominal/etiología , Humanos , Incidencia , Obstrucción Intestinal/etiología , Intestino Delgado/cirugía , Laparoscopía/efectos adversos , Laparoscopía/métodos , Masculino , Mesenterio/patología , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Adherencias Tisulares/epidemiología , Adherencias Tisulares/etiología , Resultado del TratamientoRESUMEN
PURPOSE: Laparoscopic right posterior sectionectomy (LRPS) is a technically demanding procedure. The aim of this article is to share our experience with LRPS and to highlight technical aspects of this procedure. METHODS: This is a single-center retrospective analysis of all patients who underwent LRPS between September 2011 and October 2017. Data were retrieved from a prospectively maintained database. Video-in-picture (VIP) technology is used to facilitate and to highlight the technical aspects of this procedure. RESULTS: In total, 18 patients underwent LRPS. Indication for surgery was mainly liver metastases (n = 11) and hepatocellular carcinoma (n = 6). The Glissonean approach for inflow control was used in 13 patients. Median operative time was 162 (140-190) minutes. Median blood loss was 325 mL (IQR: 150-450). One conversion (5.5%) was required. There were two minor complications and one major complication. Median hospital stay was 6 days (range 5-8 days). All patients had an R0 resection. There was no 90-day mortality. CONCLUSION: The results of our experience in LRPS add weight to the feasibility and safety of this approach.
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Pérdida de Sangre Quirúrgica , Hepatectomía/métodos , Laparoscopía/métodos , Neoplasias Hepáticas/cirugía , Posicionamiento del Paciente , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/cirugía , Estudios de Factibilidad , Femenino , Hepatectomía/efectos adversos , Humanos , Laparoscopía/efectos adversos , Tiempo de Internación , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios RetrospectivosRESUMEN
BACKGROUND: Patients with lesions in the posterosuperior (PS) segments of the liver have been considered poor candidates for laparoscopic liver resection (LLR). This study aims to compare short-term outcomes of LLR and open liver resections (OLR) in the PS segments. METHODS: This multicenter study consisted of all patients who underwent LLR in the PS segments and all patients who underwent OLR in the PS segments between October 2011 and July 2016. Laparoscopic cases were case-matched with those who had an identical open procedure during the same period based on tumor location (same segment) and the Brisbane classification of the resection. Demographics, comorbid factors, perioperative outcomes, short-term outcomes, necessity of adjuvant chemotherapy, and the interval between surgery and initiation of adjuvant chemotherapy were compared between the two groups. Data were retrieved from a prospectively maintained electronic database. RESULTS: Both groups were comparable for age, sex, ASA score, maximum tumor diameter, and number of patients with additional liver resections outside the posterior segments. Operative time was similar in both groups (median 140 min; p = 0.92). Blood loss was less in the LLR-group (median: 150 vs. 300 ml in OLR-group). Median hospital stay was 6 days in both groups. There was no significant difference in postoperative complications (OLR-group: 31.4% vs. LLR-group: 25.7%; p = 0.60). There was no significant difference in R0 resections (LLR: 97.2 vs. 100% in OLR; p = 1.00). Tumor-free margins were less in the LLR group (LLR: 5 vs. 9.5 mm in OLR; p = 0.012). Patients undergoing LLR were treated with chemotherapy sooner compared to those undergoing OLR (41 vs. 56 days, p = 0.02). CONCLUSION: This study suggests that laparoscopic parenchymal preserving liver resections in the PS segments can be performed with comparable short-term outcomes as similar OLR. The shorter interval to chemotherapy might provide long-term oncologic benefits in patients who underwent LLR.
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Adenocarcinoma/cirugía , Carcinoma Hepatocelular/cirugía , Hepatectomía/métodos , Laparoscopía , Neoplasias Hepáticas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Análisis por Apareamiento , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: In the field of liver surgery, evidence on the effectiveness of clinical pathways based on ERAS principles is limited. METHODS: This is a single-center observational study from a prospectively maintained database. Two cohorts were formed of all patients undergoing liver surgery during a defined period before (traditional management) and after introduction of a clinical pathway. Additionally, a case-match analysis-based on approach, tumor location, and Brisbane classification of resection-was performed. A cost analysis and patient satisfaction questionnaire were carried out. RESULTS: In both the overall analysis (n = 229) as well as the case-match analysis (n = 100), hospital stay was significantly reduced from 8 to 4 days and from 6.5 to 4 days, respectively (p < 0.05). Postoperative morbidity (traditional management 11/50 vs clinical pathway 5/50; p = 1.00) and readmission rate did not increase. Cost analysis showed a significant decrease in postoperative costs in favor of the clinical pathway (traditional management 3666.7 vs clinical pathway 1912.2; p < 0.001). Overall, 92.3% of the survey questions were answered with satisfied (86.0%) or very satisfied (6.3%). DISCUSSION: Implementation of clinical pathway for liver surgery is feasible and safe. A clinical pathway significantly reduces hospital stay without increasing postoperative morbidity and readmission rates. Postoperative costs are significantly reduced. Patient satisfaction is high.
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Vías Clínicas , Costos de Hospital , Neoplasias Hepáticas/cirugía , Atención Perioperativa/métodos , Anciano , Estudios de Casos y Controles , Análisis Costo-Beneficio , Vías Clínicas/economía , Femenino , Hepatectomía/efectos adversos , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Readmisión del Paciente , Satisfacción del Paciente , Atención Perioperativa/economía , Complicaciones Posoperatorias/etiologíaRESUMEN
BACKGROUND: The use of a self-expanding nitinol framed prosthesis (ReboundHRD®) for totally extraperitoneal laparoscopic inguinal hernia repair (TEP-IHR) could solve issues of mesh shrinkage and associated pain. We prospectively evaluated the use of the ReboundHRD® mesh for TEP-IHR. MATERIALS AND METHODS: All patients who underwent a TEP-IHR using the ReboundHRD® Large mesh from April 2014 till May 2015, were included. No mesh fixation was performed. Follow-up assessments were performed at the day of surgery, 1, 2, and 7 days, 1, 3, 6, and 12 months. Outcome measures include post-operative pain (visual analogue scale, VAS), operative details, complications, and recurrence rate. RESULTS: In total, 69 TEP-IHR procedures were performed in 54 patients (15 bilateral hernias). No perioperative and 5 (9%) postoperative complications occurred, all graded Clavien-Dindo I-II. The median length of stay was 1 day (range 0-3), with 78% of the operations performed in an ambulatory setting. Median VAS score decreased from 3 (range 0-4) on the day of surgery to 1 (range 0-2) on day 7. Patients were completely pain-free at a median time of 5 (range 1-60) days. The majority (80.4%, 37/46) of the active patients went back to work within 2 weeks (maximum 6 weeks). At a median follow-up of 19 months (range 16-26 months), no recurrences occurred. CONCLUSION: TEP-IHR using a self-expanding nitinol framed hernia repair device is a safe technique in longterm follow-up. The technique is associated with a low incidence of postoperative pain, a short hospital stay and quick return to normal activities.
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Aleaciones/uso terapéutico , Hernia Inguinal/cirugía , Herniorrafia/métodos , Laparoscopía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Herniorrafia/efectos adversos , Herniorrafia/instrumentación , Humanos , Laparoscopía/efectos adversos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/etiología , Complicaciones Posoperatorias/cirugía , Estudios Prospectivos , Recurrencia , Mallas Quirúrgicas/efectos adversosRESUMEN
BACKGROUND: Intraoperative hypovolemic phlebotomy (HP) has been suggested to reduce central venous pressure (CVP) before hepatectomy. This study aimed to analyze the impact of CVP drop after HP on intraoperative blood loss and postoperative renal function. METHODS: A retrospective review of a prospective database including 100 consecutive patients (43 males and 57 females; mean age, 65 years; range 23-89 years) undergoing liver resection with HP was performed. The primary outcome variable was estimated blood loss (EBL), and the secondary outcome was postoperative serum creatinin (Scr). A multivariate linear regression analysis was performed to identify predictors of intraoperative blood loss. RESULTS: The median CVP before blood salvage was 8 mmHg (range 4-30 mmHg). The median volume of hypovolemic phlebotomy was 400 ml (range 200-1000 ml). After HP, CVP decreased to a median of 3 mmHg (range -2 to 16 mmHg), resulting in a median CVP drop of 5.5 mmHg (range 2-14 mmHg). The median EBL during liver resection was 165 ml (range 0-800 ml). The median preoperative serum creatinin (Scr) was 0.82 g/dl (range 0.5-1.74 g/dl), and the postoperative Scr on day 1 was 0.74 g/dl (range 0.44-1.68 g/dl). The CVP drop was associated with EBL (P < 0.001). There was no significant impact of CVP drop on postoperative Scr. CONCLUSION: A CVP drop after HP is a strong independent predictor of EBL during liver resection. The authors advocate the routine use of HP to reduce perioperative blood loss and transfusion rates in liver surgery. As a predictive tool, CVP drop might help surgeons decide whether a laparoscopic approach is safe.
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Pérdida de Sangre Quirúrgica/fisiopatología , Presión Venosa Central , Hepatectomía/efectos adversos , Hipovolemia/fisiopatología , Flebotomía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Volumen Sanguíneo , Creatinina/sangre , Femenino , Humanos , Hipovolemia/cirugía , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Periodo Preoperatorio , Estudios Retrospectivos , Adulto JovenRESUMEN
INTRODUCTION: All patients who underwent laparoscopic liver resections in the posterosuperior segments (LPSS) at our center were positioned in semiprone since August 2011. The aims of this study were to assess differences in perioperative outcomes between laparoscopic left lateral sectionectomies (LLLS) performed in supine position and LPSS in semiprone position. METHODS: We reviewed our prospectively collected database of all liver resections performed between January 2012 and January 2015. LLLS and LPSS were compared with respect to demographics and perioperative outcomes. RESULTS: Forty-five patients underwent LLLS (n = 20) or LPSS (n = 25). There were no differences in patient demographics or tumor diameter (p = 0.946). There were no conversions. Pringle maneuver was not used in both groups. There was no difference in peroperative central venous pressure (p = 0.511). The median operative time in the LLLS group was 100 min (60-260) and 160 min (95-270) in the LPSS group (p = 0.002) with median intraoperative blood loss in the LLLS group of 50 ml (0-550) versus a larger 150 ml (50-700) (p = 0.010) for patients receiving LPSS. No patients required transfusion. Intraoperative and postoperative complication rates were similar in both groups. Median hospital stay was 6 days in both groups (p = 0.554). CONCLUSION: LPSS in semiprone can be performed with similar clinical outcomes as a minor laparoscopic liver resection except for longer operative time and larger intraoperative blood loss without the need for transfusion.
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Hepatectomía/métodos , Complicaciones Intraoperatorias/epidemiología , Laparoscopía/métodos , Neoplasias Hepáticas/cirugía , Posicionamiento del Paciente , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hepatectomía/efectos adversos , Humanos , Laparoscopía/efectos adversos , Tiempo de Internación , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Tempo Operativo , Tratamientos Conservadores del Órgano , Posición Prona , Estudios Retrospectivos , Adulto JovenAsunto(s)
Obstrucción del Catéter/etiología , Catéteres de Permanencia/efectos adversos , Diálisis Peritoneal/efectos adversos , Anciano , Trompas Uterinas/patología , Femenino , Humanos , Glicoproteínas de Membrana/metabolismo , Proteínas de Microfilamentos/metabolismo , Diálisis Peritoneal/instrumentaciónRESUMEN
BACKGROUND AND OBJECTIVES: In this single-institution study, we aimed to compare the safety, feasibility, and outcomes of single-incision laparoscopic sigmoidectomy (SILSS) with multiport laparoscopic sigmoidectomy (MLS) for recurrent diverticulitis. METHODS: Between October 2011 and February 2013, 60 sigmoidectomies were performed by the same surgeon. Forty patients had a MLS and 20 patients had a SILSS. Outcomes were compared. RESULTS: Patient characteristics were similar. There was no difference in morbidity, mortality or readmission rates. The mean operative time was longer in the SILSS group (P=.0012). In a larger proportion of patients from the SILSS group, 2 linear staplers were needed for transection at the rectum (P=.006). The total cost of disposable items was higher in the SILSS group (P<.0001). No additional ports were placed in the SILSS group. Return to bowel function or return to oral intake was faster in the SILSS group (P=.0446 and P=.0137, respectively). Maximum pain scores on postoperative days 1 and 2 were significantly less for the SILSS group (P=.0014 and P=.047, respectively). Hospital stay was borderline statistically shorter in the SILSS group (P=.0053). SILSS was also associated with better cosmesis (P<.0011). CONCLUSION: SILSS is feasible and safe and is associated with earlier recovery of bowel function, a significant reduction in postoperative pain, and better cosmesis.
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Colectomía/métodos , Colon Sigmoide/cirugía , Diverticulitis del Colon/cirugía , Laparoscopios , Laparoscopía/instrumentación , Adulto , Anciano , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Roux-en-Y gastric bypass (RYGB) is considered the "gold standard" revision procedure. The purpose of this study was to compare the surgical outcome of primary laparoscopic RYGB (pLRYGB) to revisional open or laparoscopic Roux-en-Y gastric bypass surgery (rRYGB). METHODS: A retrospective analysis of all patients who underwent pLRYGB or rRYGB from January 2003 to December 2009 has been performed. Demographics, indications for revision, and complications have been reviewed. The rRYGB and pLRYGB patients have been compared. RESULTS: Seventy-two patients underwent rRYGB, and 652 patients underwent pLRYGB. Mean follow-up was 35 and 45 months, respectively. Fifty-six rRYGB procedures were performed laparoscopically. The primary operations had consisted of laparoscopic gastric banding (n = 28), laparoscopic vertical banded gastroplasty (n = 19), laparoscopic sleeve gastrectomy (n = 6), laparoscopic RYGB (n = 3), and biliopancreatic diversion with duodenal switch (n = 16). Indications included weight regain (n = 29), malabsorption (n = 16), gastrogastric fistula (n = 5), band-associated problems (n = 3), and refractory stomal ulceration (n = 1). There was no significant difference in early or late postoperative complications when comparing rRYGB to pLRYGBP patients (11.1% vs. 5.52%, P = 0.069 and 19.4% vs. 24.2%, P = 0.465 respectively). Five rRYGB patients (7.04%) required reintervention (3 internal hernias, 1 ventral hernia, 1 laparoscopic exploration) compared with 101 pLRYGB patients (15.71%; P = 0.051). None of the patients died. Mean hospital stay was not significantly longer in the rRYGB group (5.38 vs. 4.95 days, P = 0.058). CONCLUSIONS: In our series, hospital stay, morbidity, and mortality of rRYGB were not significantly higher compared with pLRYGB. Furthermore, we believe that this type of revisional bariatric surgery should be performed in high-volume bariatric centers.
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Derivación Gástrica/métodos , Laparoscopía/métodos , Obesidad Mórbida/cirugía , Adulto , Estudios de Factibilidad , Femenino , Humanos , Complicaciones Intraoperatorias/etiología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Reoperación , Estudios Retrospectivos , Insuficiencia del TratamientoRESUMEN
BACKGROUND: The aim of this study was to determine the incidence of symptomatic gallstone disease requiring cholecystectomy (CCE) after laparoscopic Roux-en-Y gastric bypass (LRYGBP) and to identify the peri-operative risk factors associated with postoperative symptomatic gallstone disease. METHODS: Between August 2003 and November 2009, 724 patients underwent LRYGBP at the Groeninge Hospital. Preoperative ultrasound was performed in 600 of 641 patients without history of CCE and 120 (20.0%) were diagnosed with cholecystolithiasis. RESULT: Six hundred twenty-five patients were included, 43(6.9%) developed delayed symptoms related to biliary disease. Of these 43 patients, 39 underwent post-LRYGBP CCE. Of these 39 patients, 9 (7.5%) had a positive ultrasound prior to LRYGBP. Multivariate analysis identified weight loss at 3 months post-LRYGB of more than 50% of excess weight [HR (95% CI), 2.04 (1.04-4.28); p = 0.037) as the sole significant independent predictor of delayed symptomatic cholecystolithiasis. CONCLUSIONS: Symptomatic gallstone disease occurred only in 6.9% of patients post-LRYGBP. Multivariate analysis identified weight loss at 3 months post-LRYGBP of more than 50% of excess weight as the sole significant independent predictor of delayed symptomatic cholecystolithiasis. Prophylactic CCE should not be recommended at the time of LRYGBP.
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Colecistectomía , Colecistolitiasis/etiología , Derivación Gástrica , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/etiología , Pérdida de Peso , Adolescente , Adulto , Anciano , Colecistolitiasis/diagnóstico por imagen , Colecistolitiasis/cirugía , Femenino , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad , Análisis Multivariante , Complicaciones Posoperatorias/cirugía , Modelos de Riesgos Proporcionales , Factores de Tiempo , Ultrasonografía , Adulto JovenRESUMEN
Reported incidence of small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass varies between 1.5% and 3.5%. It has been suggested that the antecolic antegastric laparoscopic Roux-en-Y gastric bypass (AA-LRYGB) is associated with a low incidence of internal herniation (IH). Therefore we routinely did not close mesenteric defects. The records of 652 consecutive patients undergoing primary AA-LRYGB from January 2003 to December 2009 in a single institution were retrospectively reviewed to determine the incidence, etiology, clinical symptoms, radiologic diagnostic accuracy and operative outcomes of SBO. Of the 652 patients, 63 (9.6%) developed SBO. The majority (6.9%, 45 patients) had a SBO due to IH. In 41 (91%) cases, the IH was at the jejunojejunostomy (JJ), four cases had an IH at Petersen's space. Adhesions and ventral hernia were found in 14 (2.1%) and four (0.6%) cases, respectively. Twenty-nine out of 63 cases had negative computed tomography (CT) findings and IH was diagnosed on CT in only 33% (14/45) of patients with IH. All patients underwent diagnostic laparoscopy. No bowel resections had to be performed. In contrast to previous reports, a high incidence of SBO with a high rate of IH at the JJ site was found in our series. Accuracy of CT is low and diagnostic laparoscopy is mandatory when SBO is suspected. Since 2010 we have started closing the JJ site, and data on SBO are collected prospectively. We believe that closing of the mesenteric defects is a mandatory step, even in an AA-LRYGB.
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Derivación Gástrica/efectos adversos , Derivación Gástrica/métodos , Obstrucción Intestinal/etiología , Enfermedades del Yeyuno/etiología , Laparoscopía , Adulto , Femenino , Humanos , Masculino , Mesenterio , Estudios Retrospectivos , Factores de TiempoRESUMEN
BACKGROUND: An open abdomen (OA) can result from surgical management of trauma, severe peritonitis, abdominal compartment syndrome, and other abdominal emergencies. Enteroatmospheric fistulae (EAF) occur in 25% of patients with an OA and are associated with high mortality. METHODS: We report our experience with topical negative pressure (TNP) therapy in the management of EAF in an OA using the VAC (vacuum asisted closure) device (KCI Medical, San Antonio, TX). Nine patients with 17 EAF in an OA were treated with topical TNP therapy from January 2006 to January 2009. Surgery with enterectomy and abdominal closure was planned 6 to 10 weeks later. RESULTS: Three EAF closed spontaneously. The median time from the onset of fistulization to elective surgical management was 51 days. No additional fistulae occurred during VAC therapy. One patient with a short bowel died as a result of persistent leakage after surgery. CONCLUSIONS: Although previously considered a contraindication to TNP therapy, EAF can be managed successfully with TNP therapy. Surgical closure of EAFs is possible after several weeks.
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Técnicas de Cierre de Herida Abdominal , Vendajes , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Fístula Intestinal/cirugía , Intestino Delgado/cirugía , Terapia de Presión Negativa para Heridas , Nutrición Parenteral Total , Cavidad Abdominal/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Síndromes Compartimentales/cirugía , Descompresión Quirúrgica , Femenino , Humanos , Fístula Intestinal/complicaciones , Laparotomía/métodos , Masculino , Persona de Mediana Edad , Terapia de Presión Negativa para Heridas/métodos , Resultado del Tratamiento , Cicatrización de HeridasRESUMEN
BACKGROUND: This retrospective study evaluated long-term weight loss, resolution of comorbidities, quality of life (QoL), and food tolerance after laparoscopic sleeve gastrectomy (LSG). METHODS: Between January 2003 and July 2008, 102 patients underwent LSG as a sole bariatric operation. A retrospective review of a prospectively collected database was performed. Demographics, complications, and percentage of excess weight loss (%EWL) were determined. Quality of life was measured using Medical Outcomes Survey Short Form 36 (SF-36) and Bariatric Analysis and Reporting Outcome System (BAROS) questionnaires, which were sent to all patients. The food tolerance score (FTS) was determined and compared with that of nonobese subjects. RESULTS: A total of 83 patients (81.4%) were eligible for follow-up evaluation. Their mean initial body mass index (BMI) was 39.3 kg/m(2). No major complications occurred. At a median follow-up point of 49 months (range, 17-80 months), the mean %EWL was 72.3% ± 29.3%. For the 23 patients who reached the 6-year follow-up point, the mean %EWL was 55.9% ± 25.55%. The mean BAROS score was 6.5 ± 2.1, and a "good" to "excellent" score was observed for 75 patients (90.4%). In the comparison of patients with a %EWL greater than 50% and those with a %EWL of 50% or less, the SF-36 scores were statistically different only for "physical functioning" and "general health perception." The mean FTS was 23.8, and 95.2% of the patients described their food tolerance as acceptable to excellent. CONCLUSION: Laparoscopic sleeve gastrectomy is a safe and effective bariatric procedure, although a tendency for weight regain is noted after 5 years of follow-up evaluation. Resolution of comorbidity is comparable with that reported in the literature. The LSG procedure results in good to excellent health-related QoL. Food tolerance is lower for patients after LSG than for nonobese patients who had no surgery, but 95.2% described food tolerance as acceptable to excellent.