Sexual effects and long-term outcomes of endoscopic lumbar sympathectomy for plantar hyperhidrosis in men: a cross-sectional study / Efeitos sexuais e resultados a longo prazo da simpatectomia lombar endoscópica para hiperidrose plantar em homens: um estudo transversal

Abstract Background Plantar hyperhidrosis (PHH) is a disease with high psychosocial impact, and endoscopic lumbar sympathectomy (ELS) has been shown to be the best choice for treatment, but with some concerns such as compensatory sweating (CS) and sexual effects (SE), particularly in men. Objectives The aim of this study is to evaluate the long-term effectiveness of ELS for controlling PHH in men, its side effects, and perceived sexual modifications. Methods A cross-sectional study including only male patients operated for PHH with ELS between 2014-2022 at a private practice. During remote interviews, patients were asked about symptoms before and after ELS and about the postoperative effects on PHH. They were also objectively asked about any SE during the postoperative period. Validated quality of life for hyperhidrosis and erectile function questionnaires were also administered. Results 10 male patients averaging 4.26±2.86 years post-ELS were interviewed. Eight of them (80%) achieved complete response (≥80% of sweat reduction) in the first month after surgery and this response was maintained up to the interview date. Two patients had partial response. In six patients, CS occurred, with 5 reporting it as non-troublesome. Six patients reported some type of SE, but none reported erectile dysfunction. Regarding the functional results, all patients rated ELS from good (10%) to very good (30%) or excellent (60%). Conclusions Endoscopic lumbar sympathectomy was effective for treatment of plantar hyperhidrosis in these patients, improving their quality of life and providing lasting PHH control, with some transient sexual dysfunctions that did not impair their sexual life.

Resumo Contexto A hiperidrose plantar (HHP) é uma doença de alto impacto psicossocial, e a simpatectomia lombar endoscópica (SLE) tem se mostrado a melhor escolha de tratamento. Porém, há algumas preocupações como suor compensatório (SC) e efeitos sexuais (ES), particularmente em homens. Objetivos O objetivo deste estudo foi avaliar a eficácia a longo prazo da SLE para controlar a HHP em homens, seus efeitos colaterais e as modificações sexuais percebidas. Métodos Tratou-se de um estudo transversal incluindo apenas pacientes do sexo masculino operados de HHP por meio de SLE entre 2014 e 2022 em consultório particular. Por meio de entrevistas remotas, os pacientes foram questionados sobre os sintomas antes e depois da SLE e sobre a evolução pós-operatória da HHP, assim como foram questionados objetivamente sobre qualquer ES percebido durante o pós-operatório. Também foram aplicados questionários validados de qualidade de vida para hiperidrose e função erétil. Resultados Foram entrevistados 10 pacientes do sexo masculino com média de 4,26±2,86 anos pós-SLE. Oito deles (80%) obtiveram resposta completa (≥80% de redução do suor) no primeiro mês após a cirurgia e mantiveram a resposta na entrevista. Dois pacientes tiveram resposta parcial. Em seis pacientes, ocorreu SC, com cinco relatando-a como não problemática. Seis pacientes relataram algum tipo de ES, mas nenhum apresentou disfunção erétil. Todos os pacientes avaliaram o resultado funcional da SLE como bom (10%), muito bom (30%) ou excelente (60%). Conclusões A SLE pode tratar de forma eficaz a HHP nesses pacientes, melhorando a qualidade de vida e proporcionando efeitos duradouros no controle da HHP, com algumas disfunções sexuais transitórias que não prejudicam a vida sexual.

Autopsy findings of fatal retroperitoneal hemorrhage after traumatic rupture of bilateral renal angiomyolipoma

ABSTRACT The present work reports the autopsy findings of a unique case characterized by fatal retroperitoneal hemorrhage following the traumatic rupture of bilateral renal angiomyolipomas. Renal angiomyolipomas are generally benign tumors with an unpredictable clinical course, ranging from asymptomatic to sudden rupture and hemorrhagic shock. They may be associated with genetic disorders such as tuberous sclerosis complex. The case under investigation is unprecedented in the medical literature due to its bilateral nature and fatal outcome. Autopsy analysis revealed an extensive retroperitoneal hemorrhage originating from bilateral ruptured tumors. Microscopic examination found features consistent with bilateral renal angiomyolipoma. Circumstantial information identified a traffic accident before the death, considering it as the cause of the tumors' traumatic rupture. In this case, due to the severity of the situation, immediate medical measures—such as fluid resuscitation, coagulopathy correction, and surgical treatment, which are usually lifesaving—could not be performed. This led to the patient being declared dead at the scene of the crash.

Importancia del conocimiento anatómico del espacio extraperitoneal y su utilidad en los abordajes quirúrgicos / Importance of anatomical knowledge of the extraperitoneal space and its usefulness in surgical approaches

Introducción. El espacio extraperitoneal, se define como el segmento topográfico ubicado entre el peritoneo parietal internamente y la fascia transversalis externamente. Como resultado del desarrollo y consolidación de la cirugía laparoscópica, en particular de la herniorrafia inguinal por esta vía, se ha presentado un renovado y creciente interés en esta área anatómica, debido a la importancia de su conocimiento detallado en la cirugía de mínima invasión. Métodos. Se hizo una revisión narrativa de la literatura para presentar una información actualizada y detallada sobre la anatomía del espacio extraperitoneal y su importancia en diferentes procedimientos quirúrgicos realizados actualmente. Resultados. Por fuera del espacio peritoneal, se encuentran las áreas anatómicas externas al peritoneo parietal, que incluyen la preperitoneal y la retroperitoneal. Mediante la laparoscopia, se pueden localizar en estos espacios cinco triángulos anatómicos, además de la corona mortis y el triángulo supra vesical. Conclusión. El conocimiento del espacio extraperitoneal es de gran importancia para el cirujano general, teniendo en cuenta los múltiples procedimientos que requieren el abordaje de esta área topográfica

Introduction. The extraperitoneal space is defined as the topographic segment located between the parietal peritoneum internally and the fascia transversalis externally. As a result of the development and consolidation of laparoscopic surgery, particularly inguinal herniorrhaphy by this route, there has been a renewed and growing interest in this anatomical area, due to the importance of its detailed knowledge in minimally invasive surgery. Methods. A narrative review of the literature was made to present updated and detailed information on the anatomy of the extraperitoneal space and its importance in different surgical procedures currently performed. Results. Outside the peritoneal space are the anatomical areas external to the parietal peritoneum, including the preperitoneal and extraperitoneal. Using laparoscopy, five anatomical triangles, in addition to the corona mortis and the supravesical triangle, can be located in these spaces. Conclusion. Knowledge of the extraperitoneal space is of great importance for the general surgeon, taking into account the multiple procedures that require the approach of this topographic area

Biopsia percutánea core con aguja gruesa guiada por tomografía computada en lesiones retroperitoneales: Experiencia de 10 años / CT-guided core biopsy for retroperitoneal lesions. Experience in 136 procedures

Background: CT-guided core biopsy is a widely used diagnostic technique for retroperitoneal lesions. Aim: To evaluate the diagnostic yield and safety of this procedure. Material and Methods: Review of medical records of 136 patients aged 57 ± 16 years (55% males) subjected to core biopsies performed between 2006 and 2016. Procedure images, biopsy reports and patients' medical charts were reviewed. Diagnostic yield was calculated in those patients whose final diagnosis was confirmed using strict criteria for malignancy. Results: A final diagnosis was confirmed in 122/136 patients. Of these, 110 had malignant lesions. The sensitivity and global accuracy of the procedure for malignancy were 93%. In only 4 of 13 benign lesions (31%), a specific diagnosis was obtained with the biopsy. Only minor complications were reported (6 small, self-contained hematomas). There were no major complications. Conclusions: CT-guided core biopsy of retroperitoneal lesions is a safe procedure, with an excellent diagnostic yield.

Practical approach to primary retroperitoneal masses in adults / Abordagem prática de lesões retroperitoniais primárias no adulto

Abstract Primary retroperitoneal masses constitute a heterogeneous group of uncommon lesions and represent a challenge due to overlapping imaging findings. Most are malignant lesions. Although they are more prevalent in adults, they can occur at any age. Such lesions are classified as primary when they do not originate from a specific retroperitoneal organ and are divided, according to the image findings, into two major groups: solid and cystic. The clinical findings are nonspecific and vary depending on the location of the lesion in relation to adjacent structures, as well as on its behavior. The main imaging methods used for staging and surgical planning, as well as for selecting the biopsy site and guiding the biopsy procedure, are computed tomography and magnetic resonance imaging. In most cases, the treatment is challenging, because of the size of the lesions, vascular involvement, or involvement of adjacent organs. In this article, we present a review of the retroperitoneal anatomy and a practical approach to the main imaging features to be evaluated, with a view to the differential diagnosis, which can guide the clinical management.

Resumo As massas retroperitoniais primárias correspondem a um grupo heterogêneo de lesões incomuns e representam um desafio diagnóstico, devido à superposição dos achados de imagem. Essas lesões, em sua maioria, são representadas por tumores malignos e são mais prevalentes em adultos, mas podem ser encontradas em qualquer idade. São classificadas como primárias, quando não se originam de órgão retroperitonial específico, e divididas, conforme o aspecto de imagem, em dois grandes grupos: sólidas ou císticas. As manifestações clínicas são inespecíficas e dependem da localização e comportamento em relação às estruturas adjacentes. Os principais métodos de imagem utilizados no estudo dessas lesões são a tomografia computadorizada e a ressonância magnética, que servem para o estadiamento, planejamento cirúrgico e para selecionar e guiar o melhor local de biópsia. Na maioria dos casos, o tratamento é desafiador, em razão do tamanho das lesões e do comprometimento vascular ou de órgãos adjacentes. Neste artigo apresentamos uma revisão da anatomia retroperitonial e uma abordagem prática das características de imagem a serem avaliadas nas principais lesões retroperitoniais primárias do adulto, com vistas ao diagnóstico diferencial, que pode orientar a conduta clínica.

Laparoscopic Resection of Retroperitoneal Presacral Schwannoma: A Case Report

Retroperitoneal presacral schwannomas are uncommon and are usually diagnosed accidentally. We present here the case of a 23-year-old woman diagnosed with an expansive pelvic lesion during a routine gynecological examination. The precise location of the tumor, as well as its relation to adjacent structures, was determined through magnetic resonance imaging (MRI). The patient underwent laparoscopic lesion resection and the diagnosis was confirmed by immunohistochemistry. An MRI performed 2 months after surgery confirmed complete lesion resection.

Research advances in anatomical study on the diffusion routs of acute pancreatitis / 中华外科杂志

The retroperitoneum space comprises anterior pararenal space, perirenal space and posterior pararenal space. Pancreas is a retroperitoneal organ and located in the anterior pararenal space of the retroperitoneum. Left and right sides anterior pararenal space are potentially communicated, which contains many adipose tissues and a little connective tissues. The exacerbation of acute pancreatitis results in the lesion spreading into adjacent area of pancreas in the retroperitoneal space. In addition, the lesion could spread into bare area of stomach, posterior colonic region, subperitoneal space and pelvic retroperitoneal space through the same anatomical space or communicating space. Due to the fascia destruction by pancreatic enzymes or the lesion directly diffuse through the weak fascia, the lesion could also diffuse across fascia to perirenal space, posterior pararenal space, the peritoneal cavity and abdominal wall. Finally, a series of complications are developed. The diffusion paths of acute pancreatitis are complex and diverse. Familiarity with these diffusion paths is useful for determining the severity and guiding therapy.

Hematoma retroperitoneal como presentación de cáncer testicular / Retroperitoneal hematoma debut as testicular cancer

Resumen Introducción: El hematoma retroperitoneal (HR) es una enfermedad infrecuente con una elevada morbimortalidad, siendo complicado cuando se presenta con dolor y shock hipovolémico. Presentación del caso: Paciente del sexo masculino, de 20 años de edad, sin antecedentes mórbidos. Ingresa en Urgencias por dolor abdominal en el flanco izquierdo, irradiado a dorso y testículo ipsilateral, de 6 h de evolución, de inicio súbito e intensidad severa; el paciente está pálido, hemodinámicamente estable, sin signos de irritación peritoneal. Se solicita pielo-TC por sospecha de litiasis ureteral, que muestra un extenso HR, probable aneurisma aórtico roto. Una angio-TC informa HR adyacente y anterior a psoasilíaco izquierdo, de20 × 11 × 8,5 cm, volumen 972 cc, adenopatías retroperitoneales paraaórticas bilaterales sangrantes y múltiples nódulos pulmonares bilaterales indicativos de diseminación secundaria. Se constata testículo derecho duro, de tamaño normal, eco testicular con masa sólida quística, que indica de lesión orgánica. Discusión: Trauma y enfermedad tumoral son las principales causas de HR. El cáncer testicular suele presentarse en pacientes jóvenes, requiriendo una pronta derivación y estudio debido a su rápida progresión. En nuestro caso, el HR fue un hallazgo imagenológico, destacando que el sangrado de un conglomerado de adenopatías es anecdótico.

Abstract Introduction: Retroperitoneal hematoma (RH) is a rare disease with high morbidity, being complicated when presented with pain and hypovolemic shock. Case report: Male, 20 years old, no morbid history. Arrive to Emergency Service for abdominal pain in the left flank radiating to the back and ipsilateral testis, 6 h of evolution, sudden onset, high intensity; pacient pale, hemodynamically stable without signs of peritoneal irritation. Pielo-TC is requested on suspicion of ureteral stones showing extensive RH, likely ruptured aortic aneurysm. CT angiography reports RH and adjacent preceding left iliopsoas, 20 × 11 × 8.5 cm, volume 972 cc, retroperitoneal bleeding bilateral para-aortic lymphadenopathy and multiple bilateral pulmonary nodules suggestive of secondary spread. Hard right testicle with normal size, testicular ultrasound pointing solid cystic mass, suggestive of organic lesion. Discussion: Trauma and tumor pathology are the main causes of RH. Testicular cancer usually occurs in young patients, requiring early referal and study because of its rapid progression. In our case, the HR was an imaging finding, highlighting that the bleeding of a cluster of lymph nodes is anecdotal.

Conociendo una complicación poco frecuente de la colangiopancreatografía retrógrada endoscópica / Knowing an infrequent complication of endoscopic retrograde cholangiopancreatography

Objetivo: Describir las características clínicas y tomográficas en relación a la distribución extra peritoneal de colecciones y aire seguida de perforación periampular luego de la realización de colangiopancreatografía retrograda endoscópica (CPRE) con o sin esfinterotomía. Materiales y métodos: Estudio observacional, descriptivo y transversal, en pacientes con perforación periampular, después de CPRE con o sin enfinterotomía, tratados en el Servicio de Cirugía de Páncreas del Hospital Edgardo Rebagliati Martins, Lima, Perú, entre enero del 2013 y enero del 2015. Resultados: Se incluyeron 10 pacientes con perforación periampular, después CPRE. El 40% fue de sexo masculino. La edad media fue de 47,2 años. El 100% presento dolor abdominal, el 70% fiebre, el 60% presentó ictericia, intolerancia oral y vómitos. En el 100% de los casos la indicación del procedimiento fue por litiasis coledociana. Se describe canulación difícil en el 80% de los casos. Se encontró aire o líquido en el 90% en los espacios pararrenal anterior derecho y el perirrenal derecho, y el lugar en donde se distribuyó el aire o liquido con menor frecuencia fue la pelvis extra peritoneal derecha con el 20%, en ningún caso se evidenció aire en el mediastino. Conclusiones: El hallazgo de una colección líquida y/o aire en el espacio retroperitoneal derecho, después de CPRE, sin mayor afección de la glándula pancreática, debe hacernos pensar en perforación periampular, sobre todo si se encuentra en el espacio pararrenal anterior derecho y el espacio perirrenal derecho. A esta entidad nosotros la hemos denominado bilioretroperitoneo.

Objective: Describe the clinical and tomographic characteristics in relation to the extra peritoneal distribution of collections and air in patients with periampullary perforation after performing endoscopic retrograde cholangiopancreatography (ERCP) with or without sphincterotomy. Materials and methods: Observational, descriptive study in patients with periampullary perforation after ERCP with or without sphincterotomy, treated in the Pancreas Surgery Service at Edgardo Rebagliati Martins Hospital, Lima, Peru between January 2013 and January 2015. Results: Ten patients with periampullary perforation after ERCP were included. 40% were male. The mean age was 47.2 years. 100% showed abdominal pain, fever 70%, 60% had jaundice, oral intolerance and vomiting. In 100% of cases the description of the procedure was for choledocolithiasis. Difficult cannulation is described in 80% of cases. Air or fluid was found in 90% in the right anterior pararenal space and the right perirenal, and the place where air or liquid is distributed less frequently was right extraperitoneal pelvis with 20%, in no case revealed air in the mediastinum. Conclusions: The finding of a liquid collection and / or air in the retroperitoneal space right after ERCP without further involvement of the pancreatic gland should make us think of periampullary perforation, especially if you are in the right anterior pararenal space and perirenal space. This entity we call bilioretroperitoneo.

Mortality risk factor analysis in colonic perforation: would retroperitoneal contamination increase mortality in colonic perforation?

PURPOSE: Colonic perforation is a lethal condition presenting high morbidity and mortality in spite of urgent surgical treatment. This study investigated the surgical outcome of patients with colonic perforation associated with retroperitoneal contamination. METHODS: Retrospective analysis was performed for 30 patients diagnosed with colonic perforation caused by either inflammation or ischemia who underwent urgent surgical treatment in our facility from January 2005 to December 2014. Patient characteristics were analyzed to find risk factors correlated with increased postoperative mortality. Using the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) audit system, the mortality and morbidity rates were estimated to verify the surgical outcomes. Patients with retroperitoneal contamination, defined by the presence of retroperitoneal air in the preoperative abdominopelvic CT, were compared to those without retroperitoneal contamination. RESULTS: Eight out of 30 patients (26.7%) with colonic perforation had died after urgent surgical treatment. Factors associated with mortality included age, American Society of Anesthesiologists (ASA) physical status classification, and the ischemic cause of colonic perforation. Three out of 6 patients (50%) who presented retroperitoneal contamination were deceased. Although the patients with retroperitoneal contamination did not show significant increase in the mortality rate, they showed significantly higher ASA physical status classification than those without retroperitoneal contamination. The mortality rate predicted from Portsmouth POSSUM was higher in the patients with retroperitoneal contamination. CONCLUSION: Patients presenting colonic perforation along with retroperitoneal contamination demonstrated severe comorbidity. However, retroperitoneal contamination was not found to be correlated with the mortality rate.

Error analysis and experience summary in setting up the retroperitoneal cavity for peritoneoscopy / 天津医药

Objective To explore errors and their causes in setting up the retroperitoneal cavity for peritoneoscopy. Methods The clinical data of 450 patients who were performed the laparoscopic surgery in our hospital from May 2009 to December 2016 were collected. According to the trocar puncture points, patients were divided into lumbar group (n=193) and iliac flap group (n=276). The problems were summarized and analyzed in the process of setting up the retroperitoneal cavity. Results The mistakes existed in setting up the retroperitoneal cavity including peritoneum rupture (10 cases), error in balloon expansion clearance (5 cases), homemade balloon rupture and fall off (7 cases), poor position of puncture port (34 cases), bleeding of puncture channel (6 cases), leaking around the trocar and subcutaneous emphysema. After peritoneal patching, re-establishment of the expansion of the gap, adjusting the trocar position and other appropriate measures for treatment, the operations were successfully in 450 patients. Conclusion We should choose the appropriate method for building cavity according to different conditions of patients, and know well the anatomy of the peritoneal cavity. All details should be emphasized in the process of building cavity to reduce the occurrence of errors.

Retroperitoneal Extramedullary Plasmacytoma / 대한내과학회지

Extramedullary plasmacytoma (EMP) is a plasma cell tumor located outside of the bone marrow. It most often occurs in the upper respiratory tract (85%), as well as the head and neck, and very rarely occurs in the retroperitoneum. Here we report the case of a 57-year-old woman with retroperitoneal EMP.

Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria via extra-adipose capsule / 北京大学学报(医学版)

Objective:To evaluate the clinical effect of retroperitoneoscopic renal pedicle lymphatic disconnection via extra-adipose capsule in the management of chyluria and to discuss the management of its complications.Methods:From August 2013 to June 2008,five patients with chyluria were admitted. All the patients were female,aged from 26 to 73 years,and disease course from 1 to 10 years.All the five patients had complained of intermittently voiding milky urine with varying degrees of weight loss,and fa-tigue,of whom two presented with flank pain and one with anemia.Their urine chyle tests were con-firmed to be positive.Preoperative cystoscopy found that chyluria was from the left side in 3 cases,and from the right side in 2 cases.Their proteinuria ranged from +to ++++.All the cases had been treated with the modified procedure by which lymphatic ligation was performed to hilar vessels and proximalureter via extra-adiposecapsule without disconnection of perirenal fat tissues.The operation time,intraoperative blood loss,postoperative intestinal function recovery,catheter time,drainage tube removal time and com-plications during operation were collected.Results:All the five cases were performed successfully.The operation time ranged from 75 to 170 minutes,mean (126.0 ±39.6)minutes,with the intraoperative blood loss 20 to 60 mL,mean (38.0 ±16.4)mL,and the postoperative intestinal function recovery time 1 to 3 days,mean (1.9 ±0.4)days.The catheter time was 1 to 4 days,mean (2.1 ±0.3)days and the drainage tube removal time ranged from 3 to 15 days,mean (9.3 ±1.8)days.Postoperatively lym-phorrhagia was found in two cases.No renal vessels injury occurred during operation.Chyluria of all the patients disappeared on the operation day with negative chyluria test after surgery.Furthermore,urine test revealed that proteinuria was totally negative.No recurrence was detected in our patients in the 9 to 31 months’follow-up.Conclusion:This modified procedure does not have to disconnect perirenal fat tissues and nephropexy during operation.It was characterized with shorter operation time,definitive effect and fewer complications.

Acute Emphysematous Pancreatitis with Fulminant Multi-organ Failure / 대한췌담도학회지

An emphysematous pancreatitis is a rare, but fatal subtype of acute pancreatitis. Gas-forming bacteria from the bowel may penetrate the pancreas to cause emphysematous pancreatitis. It is characterized by the presence of gas within pancreas bed or retroperitoneal cavity at computed tomographic image and carries a high mortality rate. It requires fluid resuscitation and anti-bacterial therapy to control infection, and needs to consider percutaneous drainage or surgical management depending on the clinical condition. We report a case of 73-year-old patient presented with an emphysematous pancreatitis which developed fulminant multi-organ failure in spite of intensive medical treatment along with a review of the related literatures.

Effectiveness of a reusable low-cost balloon trocar dissection device in the creation of preperitoneal space during endoscopic surgery. An experimental study in swine

PURPOSE: To evaluate a new, low-cost, reusable balloon trocar device for dissection of the preperitoneal space during endoscopic surgery.METHODS:Twenty swine (weight: 15-37 kg) were randomized to two groups, according to whether the preperitoneal space was created with a new balloon device manufactured by Bhio-Supply (group B) or with the commercially available OMSPDB 1000(r) balloon device manufactured by Covidien (group C). Quality and size of the created preperitoneal space, identification of anatomic structures, balloon dissection time, total procedure time, balloon resistance and internal pressure after insufflation with 300 mL of ambient air, balloon-related complications, and procedure cost were assessed.RESULTS:No significant differences in dissection time, total procedure time, or size of the created preperitoneal space were found between the groups. Balloons in group B had a significantly higher internal pressure compared to balloons in group C. None of the balloons ruptured during the experiment. Three animals in group C had balloon-related peritoneal lacerations. Despite a higher individual device cost, group B had a lower procedure cost over the entire experiment.CONCLUSION:The new balloon device is not inferior to the commercially available device in terms of the safety and effectiveness for creating a preperitoneal space in swine.

Tumores retroperitoneales: experiencia de 11 años en un centro de referencia en cáncer en un país latinoamericano (2000-2011) / Retroperitoneal tumors: 11 years experience in a cancer reference center in a Latin-American country (2000-2011)

Objetivo: Describir las características clínico-patológicas, evolución postoperatoria y desenlaces oncológicos de los pacientes con diagnóstico de tumor retroperitoneal operados en el Instituto Nacional de Cancerología en un periodo de 11 años. Métodos: Se realizó un estudio descriptivo retrospectivo, incluyendo los pacientes operados en el INC entre los años 2000 y 2011. Resultados: En total fueron 101 pacientes. La mediana de la edad fue de 52 años con un 56,4% de mujeres. Entre los pacientes operados, 60,4% presentaban enfermedad primaria, el 23,8% enfermedad recurrente y 15,8% (n = 16) eran remitidos como irresecables. El principal método de imagen fue la tomografía abdominal helicoidal con doble contraste (89,1%). El tipo histológico más frecuente fue el liposarcoma bien diferenciado. Se alcanzó resección completa en el 74,3%, con resecciones viscerales en bloque en 68,3% de los pacientes. Se presentaron complicaciones intraoperatorias en 55,4% de los pacientes, siendo la más frecuente el sangrado. La mediana de seguimiento fue de 549 días, con una supervivencia global de 41,1% a 5 años. La recaída local fue de 54,2% y la progresión sistémica de 25%. Conclusión: Los tumores retroperitoneales son tumores raros que se suelen diagnosticar en estadio avanzado, tienen pobre pronóstico oncológico principalmente por alto porcentaje de recaída local. El manejo óptimo tiene como pilar la cirugía idealmente en centros de referencia. Inicia desde la sospecha diagnóstica e incluye el uso racional de imágenes, el análisis histológico por patólogos con experiencia, la planeación preoperatoria y la decisión de terapias neoadyuvantes o adyuvantes de acuerdo al tipo y estadio tumoral.

Objective: To describe the clinical-pathological features, postoperative and oncological outcomes of patients diagnosed with retroperitoneal soft tissue tumors operated at the National Cancer Institute (NCI), over a period of 11 years. Methods: A retrospective and descriptive study was performed that included patients operated in the NCI between years 2000 and 2011. Results: In total there were 101 patients. The median age was 52 years, with 56.4% of them women. Among the operated patients, 60.4% had primary disease, 23.8% recurrent disease, and 15.8% (n = 16) were submitted as unresectable. The main method of imaging was abdominal helical double-contrast tomography (89.1%). The most common histological type was well differentiated liposarcoma. Complete resection was achieved in 74.3%, with en bloc resections of involved structures in 68.3% of patients. Intraoperative complications occurred in 55.4% of patients, the most frequent being bleeding. Median follow-up was 549 days, with an overall survival of 41.1% at 5 years. Local recurrence was 54.2% and the systemic progression was 25%. Conclusion: Retroperitoneal tumors are rare tumors that are usually diagnosed in advanced stages. They have a poor prognosis, mainly due to a high rate of local relapse. The mainstay of optimal management is surgery, and starts from the suspected diagnosis, encompassing the rational use of images, histological analysis by experienced pathologists, preoperative planning, and the decision of neoadjuvant or adjuvant therapies according to the type and tumor stage.

Single-port retroperitoneal renal biopsy using standard urological instruments

Objective To describe the surgical technique and initial experience with a single-port retroperitoneal renal biopsy (SPRRB). Materials and Methods Between January and April 2013, five children underwent SPRRB in our hospital. A single 1.5 cm incision was performed under the 12th rib at mid-axillary line, and an 11 mm trocar was inserted. A nephroscope was used to identify the kidney and dissect the perirenal fat. After lower pole exposure, a laparoscopic biopsy forceps was introduced through the nephroscope working channel to collect a renal tissue sample. Results SPRRB was successfully performed in five children. The mean operative time was 32 minutes, and mean estimated blood loss was less than 10 mL. The hospital stay of all patients was two days because they were discharged in the second postoperative day, after remaining at strict bed rest for 24 hours after the procedure. The average number of glomeruli present in the specimen was 31. Conclusion SPRRB is a simple, safe and reliable alternative to open and videolaparoscopic approaches to surgical renal biopsy. .

Occurrence of colonic liposarcoma after retroperitoneal liposarcoma

No abstract available.

Paraganglioma retroperitoneal no funcional: reporte de un caso en la Fundación Cardioinfantil, Bogotá, Colombia / Retroperitoneal non-functional paraganglioma: report of a case from the Cardioinfantil Foundation, Bogotá, Colombia

Los paragangliomas son tumores derivados de las células cromafines de la cresta neural y por ello tienen la capacidad de secretar catecolaminas, hormonas y péptidos; al ser tumores extraadrenales del sistema nervioso central se los puede encontrar en la base del cráneo, el cuello, el tórax y el abdomen; se clasifican en funcionales y no funcionales. En este artículo se describe un paciente de sexo masculino que cursó inicialmente con dolor inespecífico en el hipocondrio derecho; con base en los estudios imaginológicos iniciales se sospechó la presencia de un neuroblastoma, pero no fue posible diferenciarlo de un paraganglioma, un ganglioneuroblastoma o un neurofibroblastoma. Se lo intervino quirúrgicamente y el estudio patológico del espécimen reveló áreas hemorrágicas extensas, compatibles con un paraganglioma extraadrenal no funcional. Estos tumores son infrecuentes, de localización diversa y de tratamiento quirúrgico difícil.

Paragangliomas are tumors derived from chromaffin cells from the neural crest. They are able to secrete catecholamines, hormones and peptides. They can be found in the skull base, neck, thorax and abdomen, and may be functional or not-functional. We report the case of a male patient with non-specific pain in the right hypochondrium. Based on the initial imaginological studies a neuroblastoma was suspected, but it not possible to differentiate it from a paraganglioma, a ganglioneuroblastoma or a neurofibroblastoma. The pathological study of the surgical specimen revealed extensive hemorrhagic areas, consistent with a non-functional extra-adrenal paraganglioma. This is an infrequent neoplasia with difficult surgical treatment.

Teratoma retroperitoneal en niños: revisión del tema a propósito de un caso / Retroperitoneal teratoma in children: Report of a case and review of the literature

Los teratomas retroperitoneales constituyen el 3% del total de tumores en la población pediátrica. Sin embargo, en Colombia no existe un registro que soporte esta cifra, ni consenso sobre su diagnóstico, tratamiento y pronóstico. Se presenta un caso en una recién nacida en la ciudad de Bucaramanga, Colombia, diagnosticado por imágenes y tratado quirúrgicamente. Se revisa la literatura al respecto incluyendo los aspectos generales, el diagnóstico diferencial, las características histológicas y el tratamiento, con el fin de orientar al médico para que considere esta posibilidad diagnóstica.

Retroperitoneal teratomas constitute 3% of all pediatric tumors. However, no information is available in Colombia to support this frequency, and there is no consensus on the diagnosis, management and prognosis of this tumor. We report a case in a newborn girl in Bucaramanga, Colombia, diagnosed by means of imaginological studies and treated by surgery. We review the literature, considering general aspects, differential diagnosis, histological features and management, in order to guide physicians to consider this diagnostic possibility.