Gastric plexiform fibromyxoma, an uncommon mesenchymal tumor.

Plexiform fibromyxoma (PF) is an uncommon primary tumor of the gastrointestinal tract, with a mesenchymal origin and a benign behavior. Herein, we report a case and provide a literature review. A 41-year-old male patient underwent surgery in our unit for a PF at the gastric antrum, after being admitted due to vomiting and weight loss. As illustrated by our case, the mean age at presentation is around 40 years, the antrum is the most common location and abdominal pain the most widely reported manifestation. None of the reviewed cases involved regional or distant spread.

Ascending the Learning Curve of Robotic Abdominal Wall Reconstruction.

BACKGROUND: Robotic complex abdominal wall reconstruction (r-AWR) using transversus abdominis release (TAR) is associated with decreased wound complications, morbidity, and length of stay compared with open repair. This report describes a single-institution experience of r-AWR. METHODS: A retrospective chart review was performed on patients who underwent r-AWR by a single surgeon (D.H.) from August 2015 through October 2018. RESULTS: Fifty-five patients underwent r-AWR (16 males [29%] and 39 females [71%]) with a mean age of 60.2 (range 33 to 87) years and a mean body mass index of 34.6 (range 23 to 54) kg/m2. Forty-one patients presented with an initial ventral hernia (74.5%) and 14 with a recurrent hernia (25.5%). Five patients had a grade 1 hernia (9.1%), 46 had a grade 2 hernia (83.6%), and 4 had a grade 3 hernia (7.3%) according to the Ventral Hernia Working Group system. Thirty-four (62%) patients underwent TAR, 21 (38%) patients underwent bilateral retrorectus release, and 10 (18.2%) patients underwent concomitant inguinal hernia repair. Mean operative time with TAR was 294 (range 106 to 472) minutes and 183 (range 126 to 254) minutes without TAR. Mean length of stay was 1.5 (range 0 to 10) days. Mean follow-up was 10.7 (range 1 to 52) weeks with no hernia recurrences. Seromas occurred in 6 (10.9%) patients, with 2 (3.6%) requiring drainage. Two (3.6%) 30-day readmissions occurred with no conversions to open or 30-day mortalities. CONCLUSIONS: r-AWR with and without TAR is a safe and feasible procedure associated with a short LOS, low complication rate, and low recurrence even within the surgeon's learning curve experience.

Influence of previous experience on the benefits of laparoscopic surgical training based on simulation. / Influencia de la experiencia previa en los beneficios del entrenamiento quirúrgico laparoscópico basado en la simulación.

INTRODUCTION: Surgical training based on simulation seeks the acquisition of skills in novice participants and ongoing sill development in experts. The aim of this study is to assess the evolution of students in an intensive laparoscopic anastomosis course and to analyse their results depending on their level and previous experience. METHODS: The students of all the anastomosis courses conducted during 30 months in the Valdecilla virtual hospital (Santander) were analysed. Manual side-to-side intestinal anastomoses with porcine 'ex vivo' viscera were performed in a laparoscopic endotrainer. The technical and quality differences between the first and the last anastomoses were analyzed and the progression between residents and specialists was compared. RESULTS: We analyzed 45 participants, 22 of them residents and 23 specialists. A statistically significant improvement of 80.5% was observed in all procedural parameters (94.8% residents vs. 67.3% specialists). The time was reduced by 48.1% in the residents and 43.2% in the specialists (p<.001). In terms of quality, significant improvements were obtained in the group of residents: an increase of 90% in adequate tension, and a reduction of 75% of everted edges and 60% of leaks. In addition, they obtained results comparable to the specialists (27.3% leak in the last anastomosis vs. 34.8% by the specialists, p=.59), which presented improvement without statistical significance. CONCLUSIONS: The group of residents presented a major and significant improvement in procedural skills and in the quality of the technique, reaching the level of the specialists after completion of the course.

Approach and Management of Traumatic Retroperitoneal Injuries. / Abordaje y manejo de las lesiones retroperitoneales traumáticas.

Traumatic retroperitoneal injuries constitute a challenge for trauma surgeons. They usually occur in the context of a trauma patient with multiple associated injuries, in whom invasive procedures have an important role in the diagnosis of these injuries. The retroperitoneum is the anatomical region with the highest mortality rates, therefore early diagnosis and treatment of these lesions acquire special relevance. The aim of this study is to present current published scientific evidence regarding incidence, mechanism of injury, diagnostic methods and treatment through a review of the international literature from the last 70 years. In conclusion, this systematic review showed an increasing trend towards non-surgical management of retroperitoneal injuries.