Single-port access: a feasible alternative to conventional laparoscopic splenectomy.

HYPOTHESIS: The laparoscopic approach has become the gold standard for splenectomy despite the fact that the spleen is a solid organ located deep in the splenic fossa. There is currently a trend to reduce the invasiveness of minimally invasive procedures. Transabdominal or transumbilical single-incision laparoscopic (SILS) approaches are an alternative to natural orifice transluminal endoscopic surgery techniques, but no reports of their use have yet been published in relation to the spleen. AIM: To describe the SILS technique for splenectomy in 2 patients. MATERIAL AND METHODS: Two patients were approached by SILS, a 26-year-old male diagnosed of autoimmune thrombocytopenia and a 45-year-old male with recurrent Hodgkin disease. In both cases 3 trocars (1 of 12 mm and 2 of 5 mm) were inserted through the umbilicus in one and in a left subcostal in the other, and a curved transanal endoscopic microsurgery instrument, a flexible-tip 10-mm scope, and the UltraCision were introduced. Visualization of the spleen and standard dissection of attachments were feasible, and splenectomy was completed using transumbilicus stapling of the splenic hilum. The spleen was extracted through the umbilical incision, intact in one case and after morcellation in the other. RESULTS: The postoperative course was uneventful. Both patients had minimal postoperative pain and scarring and were discharged on the second postoperative day. CONCLUSIONS: SILS access can be safely used for operative visualization, hilum transection, and spleen removal with conventional instrumentation, reducing parietal wall trauma to a minimum. The clinical, esthetic, and functional advantages require further analysis.

[Quality of life and long-term results of reinterventions performed by laparoscopy after oesophageal hiatus surgery]. / Calidad de vida y resultados a largo plazo de las reintervenciones efectuadas por laparoscopia tras cirugía del hiato esofágico.

INTRODUCTION: Laparoscopic surgery has had a significant impact on gastro-oesophageal reflux disease (GORD), para-oesophageal hiatal hernia (POHH) and achalasia. There have been a percentage of poor results due to reappearance, persistence or appearance of new symptoms. Reinterventions of the hiatus are more complicated and are not always accompanied by a satisfactory clinical response. OBJECTIVE: To evaluate the long-term results of a series of 20 patients reintervened by laparoscopy and their quality of life. MATERIAL AND METHODS: A total of 20 patients operated on between February 1998 and December 2008 after previous surgery for the hiatus. The mean age of the patients was 56 (19-77) years. A total of 18 patients had been operated on due to GORD or POHH and 2 due to achalasia. They were followed up until December 2008 and a quality of life GIQLI test was performed. RESULTS: Of the 20 patients, 13 were operated on by laparoscopy and 7 by laparotomy. The mean pre-operative time was 74 (1-24) months. The reintervention was for GORD and HH in 12 (63%); dysphagia in 4 (21%) and POHH (3). Conversion was 10% and the operating time was 180 (105-300)min. The procedures were: pillar closure and re-Nissen (10), re-Nissen (2), Toupet (2), Collis (1), mesh removal (1), re-myotomy (2), and pexy (1). There was 16% morbidity and no mortality. After a follow up of 68 (1-116) months, 14 patients were symptom-free. The GIQLI score was 106 (97-124), which was less than standard (125). CONCLUSIONS: Reintervention of hiatus is reliable and effective over the long-term, but quality of life scores were lower than normal.

Nefrectomia de urgencias por traumatismo renal durante la práctica del esqui / Sports renal injury: Emergency nephrectomy

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Fenestración laparoscópica de un quiste esplénico mediante una técnica de acceso único / Laparoscopic fenestration of a splenic cyst using a single access technique

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Calidad de vida y resultados a largo plazo de las reintervenciones efectuadas por laparoscopia tras cirugía del hiato esofágico / Quality of life and long-term results of reinterventions performed by laparoscopy after oesophageal hiatus surgery

Introducción La cirugía laparoscópica ha tenido un importante impacto en el tratamiento de la enfermedad por reflujo gastroesofágico (ERGE), la hernia de hiato paraesofágica (HHPE) y la acalasia. Se acompaña de un porcentaje de malos resultados por reaparición, persistencia o aparición de nueva sintomatología. Las reintervenciones sobre el hiato son más complejas y no siempre se acompañan de respuesta clínica satisfactoria. Objetivo Resultados a largo plazo de una serie de 20 pacientes reintervenidos por laparoscopia y evaluar su calidad de vida. Material y métodos Se intervino a 20 pacientes entre febrero de 1998 y diciembre de 2008 tras cirugía previa del hiato, con una media de edad de 56 (intervalo, 19–77) años; 18 pacientes habían sido operados por ERGE o HHPE y 2, por acalasia. Fueron seguidos hasta diciembre de 2008 y se pasó el test de calidad de vida GIQLI.Resultados13 pacientes habían sido operados por laparoscopia y 7, por laparotomía. La media de tiempo preoperatorio fue 74 (1–24) meses. La reintervención fue: en 12 (63%) por ERGE y hernia de hiato, 4 (21%) por disfagia y 3 por HHPE. La conversión fue del 10% y el tiempo operatorio, 180 (105–300)min. Los procedimientos fueron: cierre de pilares y re-Nissen (10), re-Nissen (2), Toupet (2), Collis (1), extirpación de malla (1), remiotomía (2) y pexia (1). La morbilidad fue del 16% y no hubo mortalidad. Tras seguimiento de 68 (1–116) meses, 14 pacientes están libres de síntomas. El valor de GIQLI fue 106 (97–124), menor que el estándar (125).Conclusiones La reintervención del hiato es factible y eficaz a largo plazo, sin lograr valores de calidad de vida semejantes a la normalidad (AU)

Introduction Laparoscopic surgery has had a significant impact on gastro-oesophageal reflux disease (GORD), para-oesophageal hiatal hernia (POHH) and achalasia. There have been a percentage of poor results due to reappearance, persistence or appearance of new symptoms. Reinterventions of the hiatus are more complicated and are not always accompanied by a satisfactory clinical response.ObjectiveTo evaluate the long-term results of a series of 20 patients reintervened by laparoscopy and their quality of life.Material and methodsA total of 20 patients operated on between February 1998 and December 2008 after previous surgery for the hiatus. The mean age of the patients was 56 (19–77) years. A total of 18 patients had been operated on due to GORD or POHH and 2 due to achalasia. They were followed up until December 2008 and a quality of life GIQLI test was performed.ResultsOf the 20 patients, 13 were operated on by laparoscopy and 7 by laparotomy. The mean pre-operative time was 74 (1–24) months. The reintervention was for GORD and HH in 12 (63%); dysphagia in 4 (21%) and POHH (3). Conversion was 10% and the operating time was 180 (105–300)min. The procedures were: pillar closure and re-Nissen (10), re-Nissen (2), Toupet (2), Collis (1), mesh removal (1), re-myotomy (2), and pexy (1). There was 16% morbidity and no mortality. After a follow up of 68 (1–116) months, 14 patients were symptom-free. The GIQLI score was 106 (97–124), which was less than standard (125).ConclusionsReintervention of hiatus is reliable and effective over the long-term, but quality of life scores were lower than normal (AU)