Laparoscopic surgery in 3D improves results and surgeon convenience in sleeve gastrectomy for morbid obesity.

PURPOSE: Advanced laparoscopic procedures are still challenging. One critical issue is the lack of stereoscopic vision. The aim of this surgical study is to evaluate whether 3D vision offers any advantages for surgical performance over 2D vision during sleeve gastrectomy for morbid obesity using a laparoscopic system that allows changing between 2D and 3D optics. METHODS: A total of 78 patients were analyzed, with 37 in the 2D group and 41 in the 3D group. Performance time, hospital stay, complications, and early outcomes were collected. To assess the quality of the 2D and 3D techniques, visual analog scales from 0 to 10 were designed, and image quality, depth of field, precision in performing tasks, and general ergonomics were measured. RESULTS: According to the vision system used, the mean duration of surgery was 85 ± 16.8 min for patients operated on with the 2D system and 69 ± 16.9 min for those operated on with the 3D system. There were no significant differences between the overall percentages of complications according to the type of vision used. However, postoperative complications were more severe in the 2D laparoscopy group. The average length of stay was shorter for patients in the 3D group. Regarding the differences perceived by the surgeon, the depth of field and the precision of tasks were better in the 3D vision group. CONCLUSION: The 3D system provided greater depth perception and precision in more complex tasks, enabling safer surgery. This led to a reduction in the operative time and hospital stay. Moreover, the severity of complications was less.

[Breast metastases]. / Metástasis en mama.

Metastases in the breast resulting from extra-mammary tumours are infrequent, and the prognosis is poor. The main challenge in diagnosis is to differentiate between this condition and that of primary breast cancer so as to avoid unnecessary surgery. We present two cases that we encountered recently.

Recurrent intestinal intussusception in an adult due to intestinal pseudopolyps not associated with inflammatory bowel disease: a case report.

INTRODUCTION: Intestinal intussusception is very rare in adults and, unlike in children, it is due to an organic cause, mainly benign or malignant tumors, in 90 % of cases. Recurrent intussusception in an adult is even more exceptional, and in the case reported it was due to repeated occurrence of intestinal pseudopolyps, which is exceptional according to the literature. Preoperative diagnosis is difficult, and surgery is always indicated because a tumor is usually present. The surgical procedure may be controversial, as some would prefer desintussusception before resection, while others would advocate initial resection because of the risk of dissemination if a malignant lesion exists. CASE PRESENTATION: We report the case of a 34-year-old Caucasian man who underwent emergency laparoscopic surgery for intestinal obstruction and was found to have a jejunal intussusception. Polyps or pseudopolyps, some of them large and causing the intussusception, were seen in the surgical specimen. Our patient had also undergone surgery for intussusception 10 years before, after which the pathological report also noted the presence of these formations. CONCLUSIONS: Recurrent intussusception in adults due to the presence of intestinal pseudopolyps is exceptional and, to the best of our knowledge, this is the first such case reported.

Three-Dimensional Laparoscopic Sleeve Gastrectomy: Improved Patient Safety and Surgeon Convenience.

One of the aims of laparoscopic surgery is to improve upon the results obtained by open surgery. This clearly appears to have been achieved in bariatric surgery. Two-dimensional (2-D) systems have been used to date, though new 3-dimensional (3-D) technologies have been introduced in an attempt to improve surgeon vision and thus increase the safety of the surgical techniques. Sixty obese patients underwent sleeve gastrectomy using a device equipped with 3-D optics allowing surgery to be viewed by the surgeon in 3 dimensions by using a specific monitor and wearing appropriate glasses. The mean patient age was 48.1 years. The mean weight was 114 kg (range, 92-172), with a mean body mass index (BMI) of 44 ± 5.21 kg/m(2). All surgeries were performed using the 3-D system, with a mean surgical time of 71 ± 49.6 minutes and a mean hospital stay of 3.0 ± 1.2 days. Only 1 intraoperative complication was recorded: retroperitoneal bleeding on insertion of the optical trocar. Over a mean follow-up period of 12 months, the mean body weight of the patients was 88 kg (range, 71-121), with a BMI of 30.56 ± 3.98 kg/m(2) and a percentage excess weight loss of 68.14% ± 7.89%. There was clear improvement of both the blood pressure and glucose levels. Three-dimensional sleeve gastrectomy is safe, viable, and fully reproducible compared with 2-D surgery, improving visualization of the surgical field, safety, and surgeon convenience. Randomized studies involving larger patient samples are needed for the comparison of results.

[Reversion of oral anticoagulation in emergency surgery]. / Reversión de la anticoagulación oral en cirugía de urgencia.

EN: Bleeding is the most serious adverse effect of oral anticoagulants. Emergency surgery requires the rapid reversion of coagulation disorder though the use of such products as prothrombin complex, vitamin K, or activated recombinant factor VII. We analyze the cases of 5 patients on oral anticoagulants (vitamin K antagonists) who required emergency surgery in our hospital in the past year. We describe patient characteristics, laboratory findings before and after correction of anticoagulant effects, preoperative treatment of coagulation disorder, surgical interventions, and outcomes.

ES: La hemorragia es el efecto adverso más grave secundario al tratamiento con anticoagulantes. Es necesario revertir rápidamente la anticoagulación en enfermos que van a ser intervenidos de urgencia. Para la reversión se utilizan productos como complejo protrombínico, vitamina K y factor VII activado recombinante. En el último año, en nuestro hospital han sido intervenidos cinco pacientes que necesitaban una cirugía urgente y estaban en tratamiento con anticoagulantes orales (antagonistas de la vitamina K). Presentamos sus datos demográficos, la analítica antes y después de corregir los efectos anticoagulantes, el tratamiento preoperatorio de la anticoagulación, las intervenciones quirúrgicas y los resultados.

[Acute abdomen caused by eosinophilic enteritis: six observations]. / Abdomen agudo causado por enteritis eosinofílica: a propósito de seis observaciones.

BACKGROUND: Eosinophilic enteritis is a rather rare condition characterized by infiltration of the gastrointestinal tract by eosinophils; as a casue of acute abdomen it is really exceptional. The etiology is unclear and its description in the literature is sparse, but associations have been made with collagen vascular disease, inflammatory bowel disease, food allergy and parasitic infections as it was confirmed in one of our pathologic studies. CLINICAL CASES: From 1997 to 2011 six cases of eosinophilic enteritis that involved a small bowel segment were diagnosed. A partial resection by an irreversible necrosis was necessary in three of them; in the other three only a biopsy was necessary due to the inflammatory aspect of the affected loop causing the acute abdomen. CONCLUSIONS: Eosinophilic enteritis can originate acute abdomen processes where an urgent surgical treatment is necessary. The intraoperative aspect can be from a segment of small bowel with inflammatory signs up to a completely irrecoverable loop, where removing of the affected segment is the correct treatment, which can be done laparoscopically.

Antecedentes: la enteritis eosinofílica es un padecimiento raro y los casos de abdomen agudo que origina suponen un mínimo porcentaje. Su etiología aún no está aclarada pero se asocia con enfermedades del colágeno, intolerancias alimentarias e infestaciones por parásitos, como anisakis, descubierto en una de las histologías de nuestros casos. Casos clínicos: de 1997 a 2011 se diagnosticaron seis casos de abdomen agudo; en tres de ellos la enteritis eosinofílica causó necrosis irreversible de un segmento intestinal y hubo que practicar una resección intestinal segmentaria. En dos de ellos había un segmento intestinal con aspecto inflamatorio, que fue el único hallazgo causante del cuadro agudo y en los que sólo se practicó biopsia y otro caso donde fue un hallazgo sin relación con el proceso agudo. Conclusiones: la enteritis eosinofílica puede ocasionar cuadros de abdomen agudo que requieren intervención quirúrgica urgente. El aspecto intraoperatorio es el de un segmento con aspecto inflamatorio que puede llegar a ser macroscópicamente irreversible y donde sólo la resección parcial es el tratamiento correcto, que puede hacerse por vía laparoscópica.

[Testicular necrosis caused by Fournier's gangrene: an exceptional case]. / Necrosis testicular por gangrena de Fournier: un caso excepcional.

OBJECTIVE: To report an uncommon case of Fournier's gangrene caused by a perforated retrocecal acute appendicitis that compromised the scrotum and testis. METHODS: Herein we describe a patient that was admitted for abdominal pain localized to the right lower flank and generalized virulent sepsis. RESULTS: Resection of the right inguinal cord and testis was performed. The outcome was poor and the patient died of multiorgan failure. CONCLUSIONS: Fournier's gangrene basically arises from anorectal and urological pathologies, although occasionally it may arise from an intraabdominal source, which should be ruled out especially when the abdominal examination shows interesting findings.