Retroperitoneal paragangliomas in obese patients.

Obesity, the most significant metabolic problem in the world today, is associated with a wide range of diseases, including endocrine disorders. Paraganglioma is a rare chromaffin cell tumor that develops from the neural crest cells of the neuroendocrine system. Retroperitoneal paragangliomas can represent a surgical challenge due to their close relation to large vessels. We report two cases of functioning retroperitoneal paraganglioma in type-I obese patients (case 1: female; weight, 77 kg; body mass index, 30.1 kg/m(2); case 2: male; weight, 92 kg; body mass index, 31.1 kg/m(2)) who underwent elective endocrine surgery. The tumors (one interaortocaval and the other above the iliac artery) were completely excised by laparotomy without postoperative complications.

Laparoscopic adrenalectomy for a large pheochromocytoma in a morbidly obese patient.

The high prevalence of obesity is associated with diverse health problems, including endocrine disorders. Laparoscopic adrenalectomy has become the preferred approach for removal of the adrenal gland, but several authors still debate the role of laparoscopic adrenalectomy in pheochromocytoma. We describe a case of a morbidly obese man (weight, 142 kg; body mass index, 40.2 kg/m(2)) who underwent elective laparoscopic adrenalectomy for a large right pheochromocytoma without incidences.

Gastric necrosis: a possible complication of the use of the intragastric balloon in a patient previously submitted to nissen fundoplication.

The temporary use of the bioenterics intragastric balloon in morbid obesity is increasing worldwide. Generally, this is an effective procedure that helps bring about satisfactory weight loss and improvement in comorbidities after 6 months. However, in some cases, it causes complications such as acute abdomen due to gastric perforation and even death. We describe the case of a type II obese female (weight, 88 kg; body mass index, 35.2 kg/m(2)) who underwent emergency surgery for gastric necrosis caused by bioenterics intragastric balloon; the patient required total gastrectomy and intensive care.

Hepatic evisceration after cholecystectomy in a superobese patient.

Gallbladder pathology, in general, and cholelithiasis, in particular, are more common in the morbidly obese. Obesity is a risk factor for conversion to open surgery in laparoscopic cholecystectomy. Obesity is also a risk factor for evisceration after laparotomy in adults. Hepatic evisceration after cholecystectomy is rare. We describe a case of right liver lobe evisceration diagnosed by abdominal computed tomography in a superobese patient (body mass index 57 kg/m(2)) after emergency laparoscopic surgery for acute calculous cholecystitis converted to open surgery.

[Transthoracic and transhiatal esophagectomy using minimally invasive techniques. Experience in 50 patients]. / Esofagectomía transtorácica y transhiatal mediante técnicas mínimamente invasivas. Experiencia en 50 pacientes.

INTRODUCTION: Minimally invasive esophagectomy (MIE) can reduce surgical aggression and cardiopulmonary complications while maintaining basic oncological principles. We present the results of our initial experience with this technique in the treatment of esophageal cancer. PATIENTS AND METHOD: Fifty patients with a diagnosis of esophageal cancer were selected to undergo MIE. In 18 patients the tumour was located in supracarinal esophagus, in 24 in subcarinal esophagus and in 8 patients in the cardial region. The surgical procedures were: three-field esophagectomy (laparoscopy, thoracostomy and cervicotomy), transhiatal esophagectomy and Ivor Lewis procedure (thoracoscopy and laparoscopy). RESULTS: The laparoscopy approach was used in 48 patients and 13 by the thoracoscopy approach. Transhiatal esophagectomy was performed on 13 patients. The mean duration of intervention was 281 minutes. Morbidity was 48% and mortality was 8%. The mean hospital stay was 13.2 days. Survival analysis showed: 82% in stage I, 38% in stage II and 24% in stage III. The mean follow-up was 19 months. CONCLUSIONS: Minimally invasive techniques to resect the esophagus in patients with cancer were confirmed to be safe and comparable to an open approach with respect to postoperative recovery and cancer survival.

[Laparoscopic gastrectomy in gastric cancer: experience in a series of 56 patients]. / Gastrectomía por laparoscopia en el cáncer gástrico. Experiencia en una serie de 56 pacientes.

INTRODUCTION: The study presents the experience of the use of minimally invasive surgery in gastric cancer in our unit of Oesophageal-Gastric Pathology Unit. MATERIAL AND METHOD: We present the initial results in 56 patients. The gastric cancer was removed by the use of video-assisted surgery. In 24 patients the tumour was in the lower third of the stomach, in 26 in the middle third, in 3 in gastric fundus and in 3 in cardial region. We perform total or subtotal gastrectomy according to the tumour location and a D2 lymphadenectomy in tumours of the lower third and an extended D1 lymphadenectomy (groups 7, 8, 9 and 11) in the others. RESULTS: We performed a total gastrectomy in 41 patients (73%) and a subtotal gastrectomy in 15 (27%). The patients were staged with: 14 in stage IA, 5 in stage IB, 11 in stage II, 13 in stage IIIA and 5 in stage IV. The mean number of lymph nodes resected was 26.6. The mean duration of intervention was 223 minutes. Morbidity was 19.6% and a mortality of 3.5%. The mean hospital stay was 9.2 days. The 4-year overall survival rate was 66%. The mean follow-up was 19 months. CONCLUSIONS: Postoperative results are similar to conventional surgery. We have incorporated laparoscopic procedures and they have no serious consequences on the results. We performed the same gastric resections and lymphadenectomy as in open surgery. Oncology results in the medium to long-term are similar to open surgery.

Hepatic evisceration after cholecystectomy in a super obese patient.

Gallbladder pathology in general and cholelithiasis in particular are more common in the morbidly obese. Obesity is a risk factor for conversion to open surgery in laparoscopic cholecystectomy. Obesity is also a risk factor for evisceration after laparotomy in adults. Hepatic evisceration after cholecystectomy is rare. We describe a case of right liver lobe evisceration diagnosed by abdominal computed tomography (CT) in a super obese patient (BMI 57 kg/m2) after emergency laparoscopic surgery for acute calculous cholecystitis converted to open surgery.

[Laparoscopic surgery in cancer of the esophagus]. / Cirugía laparoscópica en el cáncer de esófago.

INTRODUCTION: For the last year we have substituted laparotomy with laparoscopy for the abdominal stage of esophageal cancer surgery. We report our experience of the introduction of video-assisted surgery in the treatment of esophageal cancer. PATIENTS AND METHOD: We report our experience of nine patients diagnosed with esophageal cancer. In seven patients laparoscopy was preceded by right thoracotomy and esophageal dissection. Then, a left anterolateral cervicotomy was performed to remove the specimen and to construct the esophagogastroanastomosis. In two patients the laparoscopic technique was performed first and the Ivor Lewis procedure was completed by right thoracotomy. RESULTS: Due to the reduced number of operated patients, the results are of little significance. Morbidity was 38.3%. The mean duration of the surgical procedure in laparoscopic patients was 4 h 50 min. However, perioperative blood loss, postoperative complications, analgesic requirements and mean length of hospital stay were reduced. CONCLUSIONS: Video-assisted esophagectomy can be performed as safely as conventional esophagectomy and has considerable perioperative advantages. The introduction of the laparoscopic procedure is the first step in using video-assisted surgery at all stages of esophageal cancer surgery.