[Expert opinion on the basic surgical technique for laparoscopic ventral hernia repair]. / Técnica quirúrgica básica consensuada para el tratamiento por vía laparoscópica de las hernias ventrales.

Laparoscopic ventral hernia repair is currently the subject of intense debate, even though it provides a series of advantages over open surgery and is feasible and safe. Various studies have shown this technique to be as effective as open repair with a lower recurrence rate. Despite the excellent results of laparoscopic repair of ventral hernias, there are numerous controversies associated with this procedure. These controversies concern the indications and contraindications of the procedure, and technical aspects such as how to create the pneumoperitoneum, perform adhesiolysis, manage the hernia sac, and insert and fix the mesh to the anterior abdominal wall. Also controversial are outcome, complications related to postoperative seroma, and which type and size of mesh should be used. The present article aims primarily to address many of these issues, based on the experience of distinct surgeons with expertise in this approach, in order to provide data to establish a consensus on how laparoscopic ventral hernia repair should be performed.

Acute typhlitis in inmunocompromised patient: an eight year experience.

INTRODUCTION: Acute typhlitis is usually associated with severe immunosuppressive conditions. Initially described as closely associated with infantile myeloid leukaemia, its incidence increased along the last decade. DESIGN: retrospective review. PATIENTS: 12 immunodepressed patients affected of acute typhilis in our hospital between 1994 and 2001. Suspected diagnosis was established by clinical symptoms and abdominal CT findings, and was confirmed with pathological finding in the surgical specimen. Clinical and radiological diagnosis, treatment, complications and survival of patients are discussed. RESULTS: 3 patients with a previous diagnosis af acute myeloid leukemia, 2 patients with non-Hodgkin lymphoma, 2 patients with aplastic anaemia, one patient with AIDS, and 4 patients with kidney transplantation were included in our study. Prednisone, cyclosporine, Ara-C and vincristine were the most frequently involved drugs. Most frequent clinical findings included abdominal pain, fever, nausea-vomiting and abdominal distension. CT diagnosis revealed caecum and colic involvement with rarefaction of pericaecal fat. Medical treatment was successful in only 33% of all patients, the other patients requiring a surgical procedure including right hemicolectomy with or without intestinal anastomosis. Mortality reached 58.3 per cent, representing multiorganic sepsis the main cause of death. CONCLUSIONS: although early diagnosis of acute typhlitis bears a better prognosis, mortality rates are up 50 % in spite of an established treatment.

Toxic megacolon: a rare presentation of primary lymphoma of the colon.

Primary colonic lymphoma is rare and accounts for less than 1% of colon malignancies. Moreover, diffuse neoplastic invasion of the colon is exceptional. This case describes a patient with primary non-Hodgkin's lymphoma of the colon presenting as toxic megacolon. This unique presentation is the first case reported in the literature of a diffuse colonic lymphoma diagnosed in the setting of a toxic megacolon. Histological confirmation was performed on the piece of colectomy.

A simple scoring system to reduce intraabdominal septic complications after laparoscopic appendectomy.

BACKGROUND: The development of intraabdominal abscess (IAA) following laparoscopic appendectomy (LA) is associated with significant morbidity. The aim of the present study was to validate an IAA risk score constructed from a previous review of 156 consecutive LA. METHODS: The score was tested in 250 subsequent consecutive LA and in patients with a positive risk score. Broad-spectrum antibiotics were administered in order to avoid IAA. RESULTS: Factors related to IAA included clinically complicated appendicitis, leucocytosis >15,000/microl, a difference of >1 degrees C between axillary and rectal temperature, intraoperative findings such as (gangrenes and perforation), and intraoperative perforation of the appendix. In this series, broad-spectrum antibiotic therapy in patients with a positive IAA risk score reduced the incidence of IAA from 7.05% to 1.60%. CONCLUSION: This policy of identifying high-risk patient via the scoring system and instituting subsequent antibiotic therapy in patients at risk reduces the incidence of IAA following LA.

Laparoscopic surgery for duodenal ulcer: first results of a multicenter study applying a personal procedure.

BACKGROUND/AIMS: First results from 14 different centers applying a personal procedure for the treatment of duodenal ulcer by laparoscopic surgery. METHODOLOGY: One hundred and thirty-six patients were operated on in 14 surgical centers between January 1991 and February 1995. All patients underwent posterior truncal vagotomy (PTV) and anterior linear gastrectomy (ALG) for chronic duodenal ulcer. RESULTS: The mean duration of operation was 65 min (range: 25-180) and there were no peroperative complications or deaths. Immediate post-operative morbidity rate was 2-9%, with a mean hospital stay of 3-1 days (range: 2-13). A total of 131 patients were evaluated between 6 and 33 months (mean: 25) after operation. Of these, 126 (96.2%) were graded as Visick I or II. Four (3.0%) were Visick III, and one patient (0.8%) was considered Visick IV. Gastric function studies were performed in 45 patients before and after operation, with a maximum acid output reduction of 83% 3 months after the operation CONCLUSIONS: Laparoscopic PTV with ALG constitutes a simple, efficient, rapid and safe method in the treatment of patients with chronic duodenal ulcer.

Laparoscopic surgery for duodenal ulcer: first results of a multicentre study applying a personal procedure.

Between January 1991 and February 1995 data were gathered on 136 patients operated on in 14 surgical centres. All patients underwent posterior truncal vagotomy (PTV) and anterior linear gastrectomy (ALG) for chronic duodenal ulcer. Recurrence and repeated bleeding were the main indications for surgery. An antireflux technique was simultaneously carried out in 17 patients, while 13 underwent cholecystectomy. There were no peroperative complications or deaths, and the mean duration of operation was 65 (range 25-180) min. Immediate postoperative morbidity rate was 2.9 per cent, with a mean hospital stay of 3.1 (range 2-13) days. A total of 131 patients were evaluated between 6 and 33 (mean 25) months after operation. Of these, 126 (96.2 per cent) were graded as Visick I or II. Four (3.0 per cent) were Visick III, and one patient (0.8 per cent) was considered Visick IV. Gastric function studies were performed in 45 patients before and after operation, with a maximum acid output reduction of 83 per cent 3 months after the operation. Laparoscopic PTV with ALG constitutes a simple, efficient, rapid and safe method in the treatment of patients with chronic duodenal ulcer.

[Lynch syndrome. (Hereditary colonic carcinoma without polyposis)]. / Síndrome de Lynch. (Carcinoma hereditario de colon sin poliposis).

Colonic carcinoma is a well-defined tumor with a low frequency among young people. We report the case of a 34 year old patient having two synchronous colorectal carcinomas of the right colon, who also had a family history of colonic and extracolonic neoplasms. We performed an extended right colectomy without chemotherapy. Fourteen months after surgery he had tumor recurrence and liver metastases. We reviewed then the clinical features, inclusion criteria, screening and the discussed treatment of the hereditary non-poliposis colorectal cancer or Lynch Syndrome, limited to the colon or associated to extracolonic carcinoma (Lynch I and II). A clear and detailed familial history is the only definite criteria for the diagnosis. We recommend early colonoscopy follow-up on first degree relatives considered as a high risk population.

[Idiopathic segmental infarct of the epiploon. Apropos a new case and a review of the literature]. / Infarto segmentario idiopático de epiplón. A propósito de un nuevo caso y revisión de la literatura.

A case of epiploic segmental infarction is presented. The presenting symptoms were compatible with acute appendicitis, which was excluded by the pathological examination.

[Synchronous or metachronous extragastric neoplasms associated with gastric neoplasia. Common pathogenesis of gastric intestinal and colonic carcinoma?]. / Neoplasias extragástricas síncronas o metacronas asociadas a neoplasia gástrica. Patogénesis común del carcinoma gástrico intestinal y cólico?

Coexistence of syncronous or metacronous extragastric carcinomas, particularly of the colon and small bowel may favour the hypothesis of a common origin with gastric carcinoma. Three cases of colonic carcinoma coexisting with early gastric cancer, are presented. The etiopathogenesis of intestinal-type gastric cancer and colonic cancer are discussed in the light of a possible common mechanism.

[Adenocarcinoma at the site of colostomy. Is it local recurrence or subsequent cancer?]. / Adenocarcinoma de colostomía. Recidiva local o cáncer metacrónico?

This paper presents on case of adenocarcinoma at the site of colostomy in a patient treated by abdominoperineal amputation five years earlier due to rectal cancer. The case raised the doubt as to whether the carcinoma represented a late, local recurrence or a second metachronic neoplasia. The most frequent location and pathogenesis of each were analyzed. The role of follow-up of these patients in detecting cases such as the one presented here are discussed.

[Neoplasms of the Meckel diverticulum. Apropos of 2 new cases]. / Neoplasias del divertículo de Meckel. A propósito de dos nuevos casos.

We present two new cases of cancer in a Meckel's diverticulum, representing 3.3% of the complicated Meckel's diverticula encountered in our department. The first case was a carcinoid tumor encountered in a pathology study of an inflamed Meckel's diverticulum, and the second case was a leiomyosarcoma on a Meckel's diverticulum that presented as diverticular perforation. We emphasize the advanced age of the two patients and review the cases reported in Spain and in the Western literature.

[Colonic perforation in patients with kidney transplant]. / Perforación cólica en pacientes con trasplante renal.

Of a total of 320 renal transplants performed at our center in the last 8 years, two patients presented colonic perforation (0.62%). We emphasize the clinical manifestations, which were masked by the antiinflammatory properties of the steroids; for this reason, careful and repeated physical exams should be made out in the case of any episode of abdominal pain in these patients, as well as ancillary studies for early diagnosis. Surgical measures, which consist of exclusion of the septic focus in the peritoneal cavity, do not differ from those carried out in the general population with the same colonic pathology, although they require more cautious maneuvers and meticulous lavage of the peritoneal cavity. Alternatively, when exclusion is not possible, proximal colostomy and adequate drainage must be performed.

[Gastric leiomyosarcoma]. / Leiomiosarcoma gástrico.

We present a case of gastric leiomyosarcoma of special characteristics, given its clinical and pathologic divergence the existence of antecedents of sarcomatous neoplasm previously excised in the same patient. We emphasize the association of these tumors with the appearance of malignant neoplasms in other sites previously, synchronically or metachronically, and the necessary preoperative staging, based fundamentally on CAT and endoscopy, to establish the therapeutic approach according to the predicted behavior of these tumors.