How to treat hepatic pulmonary fusion: case report with review of literature.

Introduction: Hepatic pulmonary fusion (HPF) occurring with right diaphragmatic hernia is rare. Some sporadic reports exist in the literature. It may range from just fibrovascular communication to complete parenchymal fusion which may be complex to divide.Patients and methods: We report a case of a 1-day old newborn male presented with respiratory distress relevant to a right diaphragmatic hernia.Results: The patient was operated after initial stabilization. During surgery, a 10-cm wide posterolateral defect was found. The herniated liver was only partially reducible because of HPF. This rare condition was treated by the division of the fusion and diaphragm repair using a vicryl patch.Conclusion: Through our case and a review of the literature, we will discuss the different alternatives in the treatment of HPF.

Laparoscopic management of neuroendocrine tumors: state-of-the-art.

Over recent years, minimally invasive pancreatic resections have increasingly been reported in the literature. Even though pancreatic surgery is still considered a challenge for surgeons due to its technical difficulties and high morbidity, the consolidation of minimally invasive pancreatic surgery has included the treatment of pancreatic neuroendocrine tumors (PNETs). This article presents a systematic review of the literature with regards to the laparoscopic treatment of PNETs in order to assess the safety and feasibility of laparoscopic pancreatic resections.

By pass gástrico laparoscópico como cirugía de rescate posterior a procedimientos restrictivos fallidos / Laparoscopic gastric bypass as rescue surgery when restrictive procedures failed

Objetivo:Exponer la experiencia en la cirugía de conversión a bypass gástrico por laparoscopia posterior a procedimientos restrictivos fallidos,en el servicio de Cirugía 2 del Hospital Universitario de Caracas.Pacientes y métodos:Se realizó un estudio retrospectivo y descriptivo incluyendo los pacientes a quienes se les realizó bypass gástrico por laparoscopia como cirugía de rescate posterior a un procedimiento bariátrico restrictivo fallido, en el período comprendido entre enero 2007 y diciembre 2010. Resultados:Entre 2007 y 2010 se intervinieron 12 pacientes con edad promedio de 46,4 años y predominio del sexo femenino (58 %). A 8 se les había colocado una banda gástrica ajustable por laparoscopia ya 4 se les había realizado una gastrectomía vertical laparoscópica. El peso promedio antes de la primera cirugía fue de 125,7 Kg y el IMC 46 kg/m2. Todos los pacientes presentaron pérdida inadecuada de peso con un promedio de 9,8% del exceso de peso perdido, motivo por el cual se decidió realizar cirugía de revisión y bypass gástrico por laparoscopia. La media de tiempo entre el primer procedimiento y el bypass gástrico fuede 47 meses. Sólo 1 paciente presentó complicaciones poso peratorias y se resolvió medicamente. Posterior a 6 meses la pérdida del exceso depeso fue 53,3% y después de un año 70,4% con un IMC de 29,6 kg/m2. Conclusión:El bypass gástrico por laparoscopia es seguro y efectivo como cirugía de rescate luego de procedimientos restrictivos fallido(AU)

Objective: To expose the experience in the conversion to laparoscopic gastric bypass when restrictive procedures failed, at Hospital Universitario de Caracas. Surgery II service. Patients and methods: A retrospective and descriptive study was conducted including patients who under going gastric bypass surgery as rescue procedure after a bariatricrestrictive procedure failed, from January 2007 toDecember 2010. Results: 12 patients with median age of46.4 years and predominance of female (58%) involved.Eight had placed an adjustable gastric band surgery and4 had made a laparoscopic vertical gastrectomy. The aver-age weight before the first surgery was 125,7 Kg and BMI46 kg/m2. All the patients had inadequate weight losswith an average of 9.8% of excess weight lost, reason bywhich it was decided to review and performe laparoscopygastric bypass. The average time from the first procedurewas 47 months. Only 1 patient developed postoperativecomplications and resolved medically. After 6 months, the loss of excess weight was 53.3% and after a year 70.4 percent with a BMI of 29.6 kg/m2. Conclusion: Gastric bypass surgery is safe and effective as surgery of rescue after failed restrictive procedures(AU)