Totally Laparoscopic Radical Resection of Gallbladder Cancer: Technical Aspects and Long-Term Results.

INTRODUCTION: Gallbladder cancer (GBC) is a rare tumor in developed countries. Chile has one of the highest incidences worldwide. For patients affected by resectable T1b or more advanced GBC, radical cholecystectomy (RC) is considered the standard therapy. Our aim is to describe the surgical technique and clinical-pathological results of patients undergoing totally laparoscopic radical resection of GBC. METHODS: Patients undergo laparoscopic radical resection for primary and incidental GBC, between the years 2009 and 2016 in two centers from Chile. Patients in whom suspected bile duct invasion, frozen biopsy did not confirm cancer and para-aortic lymph node sampling was positive were excluded. RESULTS: Eighteen patients were operated, 77.8% were female with median age of 60.5 year, and 16 patients had previous cholecystectomy with incidental cancer finding. The median operative time was 490 min (400-550). No conversion to open surgery occurred. All patients achieved a R0 resection. Postoperative complications occurred in 2 patients (11.1%), and there was not mortality. After a median follow-up of 59 months, the 5-year survival was 80.7%. CONCLUSION: This study shows the technical feasibility of the totally laparoscopic approach for radical resection of GBC with the same principles of classical open surgery. It appears that long-term oncological findings would also be similar at least in less advanced lesions.

[Giant Meckel's diverticulum in an adult]. / Divertículo de Meckel gigante en un adulto.

Meckel's diverticulum results from a partial persistence of the omphalomesenteric duct and is the most common congenital anomaly of the gastrointestinal tract, affecting about 2% of the general population. Its presentation as a giant Meckel's diverticulum (>5 cm) is rare and is associated with major complications. We report a case of a 53 year-old woman with constipation for at least ten years. A colonoscopy from eight years ago suggested megacolon. The patient consults in the last month for abdominal pain associated with anorexia. The computed tomography scan image suggested an ileal megadiverticulum. An exploratory laparotomy revealed a saccular dilatation of the distal ileum of 6 x 15.5 cm, located 20 cm away from the ileocecal valve. We resected the involved segment of distal ileum and performed a manual ileo-ascendo anastomosis. The biopsy showed a saccular dilatation of the wall, lined by small intestinal mucosa with areas of gastric metaplasia, supporting the diagnosis of giant Meckel's diverticulum.

El divertículo de Meckel corresponde a la persistencia parcial del conducto onfalomesentérico, representa la anomalía congénita más frecuente del tracto gastrointestinal y afecta alrededor del 2% de la población general. La presentación como divertículo de Meckel gigante (>5 cm) es infrecuente y está asociada a una mayor tasa de complicaciones. Se presenta el caso de una mujer de 53 años que refiere constipación de al menos diez años; una colonoscopía de hace ocho años sugiere un megacolon y en el último mes la paciente ha presentado dolor abdominal asociado a anorexia. Se realiza una tomografía computarizada con imagen que sugiere la presencia de megadivertículo ileal, por lo que se decide realizar una laparotomía exploradora que evidencia una dilatación sacular del íleon distal a 20 cm de la válvula ileocecal de 15,5 x 6 cm aproximadamente. Se reseca el segmento comprometido del íleon distal, que queda cerrado a nivel de la válvula ileocecal, y se realiza una íleo-ascendo anastomosis manual. La biopsia informa dilatación sacular de la pared, revestida por mucosa de intestino delgado con áreas de metaplasia gástrica, hallazgos compatibles con un divertículo de Meckel gigante.