[Transparieto-hepatic dilation of benign biliary stenosis: 5 years experience]. / Dilatación transparietohepática de estenosis biliar benigna: experiencia de 5 años.

OBJECTIVE: To assess the results of percutaneous transparieto-hepatic dilation of benign biliary stenosis achieved over a period of 5 years. DESIGN: A retrospective study to assess the technique, complications and the clinical, analytical and radiology results. PATIENTS: Data was gathered on 13 patients diagnosed in our Hospital between the years 2002 and 2006 with benign biliary stenosis and who had been treated using percutaneous dilation. Patients diagnosed with malignant disease and those who had a prosthesis were excluded. Seven of the patients had received a liver transplant. One patient had an endoscopic dilation on two occasions, with the stenosis persisting. RESULTS: A clinical and radiological improvement was observed in 60% of the cases, and an analytical improvement in 69% (61% normal). Re-stenosis occurred in 30% of the cases, of which 50% were rescue support using re-dilation. The complications presented (30.7%) were resolved conservatively. No significant differences were observed between the transplanted and the non-transplanted groups. CONCLUSIONS: Transparieto-hepatic dilation of benign biliary stenosis is a fairly safe technique and has a high rate of resolution in the medium term, and avoids the use of surgery in 75% of patients. The results need to be confirmed in larger samples.

[Acute cholecystitis: is it still justified to delay surgery?]. / Colecistitis agudas: ¿está justificado hoy en día diferir la cirugía?

INTRODUCTION: Acute cholecystitis treatment may initially be surgical or conservative with subsequent surgery; we reviewed the cases found in our centre, including their treatment and outcome. MATERIAL AND METHODS: We conducted a retrospective study of treatment in 178 patients with acute cholecystitis during one year. We evaluated variables associated with patient characteristics, as well as clinical data, diagnostic tests, treatment and outcome. RESULTS: The majority (70.2%) was treated conservatively (group A), and 29.8% were operated on in the first 72 h (group B). In group A, 96 patients were treated with antibiotics, 15 with antibiotic therapy and cholecystectomy, and 12 with antibiotics and ERCP. In group B urgent laparoscopic cholecystectomy was performed in 60.4%, and 35.8% had open cholecystectomy. In group A, admission time was 11 days, with satisfactory progress in 79.2%, mortality rate of 5.6% and 10.7% of readmissions. In group B, operation time was 111 +/- 43 min, a mean of 8.7 days hospital stay, and 68% of cases did not require further treatment after surgery. Outcome was satisfactory in all but 7, there was no mortality in this group. We had a return rate of 2%. CONCLUSIONS: A significant proportion of conservative treatment was carried out at the expense of emergency surgery, although in absolute numbers conservative treatment seems to have a higher rate of complications, mortality and hospitalisation time.

Dilatación transparietohepática de estenosis biliar benigna: experiencia de 5 años / Transparieto-hepatic dilation of benign biliary stenosis: 5 years experience

Objetivo: Valorar los resultados de la dilatación percutánea transparietohepática de las estenosis biliares benignas durante un período de 5 años. Diseño: Estudio retrospectivo para evaluar la técnica, las complicaciones y los resultados clínicos, analíticos y radiológicos. Pacientes: Se recogieron datos de 13 pacientes diagnosticados de estenosis biliar benigna que se trataron mediante dilatación percutánea en nuestro centro entre los años 2002–2006. Se excluyó a los pacientes diagnosticados de enfermedad maligna y a aquellos pacientes a los que se les colocó una prótesis. Siete de los pacientes han sido receptores de trasplante hepático. Un paciente había recibido dilatación endoscópica en 2 ocasiones con persistencia de la estenosis. Resultados: Se comprobó mejoría clínica y radiológica en el 60% de los casos y analítica en el 69% de los casos (el 61% de normalización). El 30% de los casos presentó reestenosis, de los que el 50% fueron subsidiarios de rescate mediante redilatación. Las complicaciones que se presentaron (30,7%) se resolvieron de forma conservadora. No se observaron diferencias significativas entre el grupo de trasplante y el grupo sin trasplante. Conclusiones: La dilatación de las estenosis benignas de la vía biliar por vía transparietohepática es una técnica bastante segura, tiene una alta tasa de resolución a medio plazo y permite evitar la cirugía en más de un 75% de los pacientes. Los resultados deben confirmarse en muestras mayors (AU)

Objective: To assess the results of percutaneous transparieto-hepatic dilation of benign biliary stenosis achieved over a period of 5 years. Design: A retrospective study to assess the technique, complications and the clinical, analytical and radiology results. Patients: Data was gathered on 13 patients diagnosed in our Hospital between the years 2002 and 2006 with benign biliary stenosis and who had been treated using percutaneous dilation. Patients diagnosed with malignant disease and those who had a prosthesis were excluded. Seven of the patients had received a liver transplant. One patient had an endoscopic dilation on two occasions, with the stenosis persisting. Results: A clinical and radiological improvement was observed in 60% of the cases, and an analytical improvement in 69% (61% normal). Re-stenosis occurred in 30% of the cases, of which 50% were rescue support using re-dilation. The complications presented (30.7%) were resolved conservatively. No significant differences were observed between the transplanted and the non-transplanted groups. Conclusions: Transparieto-hepatic dilation of benign biliary stenosis is a fairly safe technique and has a high rate of resolution in the medium term, and avoids the use of surgery in 75% of patients. The results need to be confirmed in larger samples (AU)

Colecistitis agudas: ¿está justificado hoy en día diferir la cirugía? / Acute cholecystitis: is it still justified to delay surgery?

Introducción: El tratamiento de la colecistitis aguda puede ser inicialmente quirúrgico o conservador con cirugía posterior, revisamos los casos encontrados en nuestro centro, cómo fueron tratados y la evolución de los mismos. Material y métodos: Realizamos un estudio retrospectivo del tratamiento realizado en 178 pacientes con colecistitis aguda durante un año. Se evalúan variables relacionadas con las características de los pacientes, clínica y exploración, técnicas diagnósticas, tratamiento realizado y evolución. Resultados: El 70,2% es tratado de forma conservadora (grupo A) y el 29,8% es intervenido en las primeras 72h (grupo B). En el grupo A se trataron 96 casos con antibioterapia, 15 con antibioterapia y colecistostomía y 12 con antibioterapia y CPRE. En el grupo B se realizó colecistectomía urgente laparoscópica en el 60,4% de los casos y abierta en el 35,8%. En el grupo A el tiempo de ingreso fue de 11 días, con evolución satisfactoria en el 79,2%, tasa de mortalidad del 5,6% y tasa de reingresos del 10,7%. En el grupo B el tiempo quirúrgico fue de 111+/−43, una media de 8,7 días de ingreso, no precisaron tratamiento además de la cirugía el 68% de los casos. La evolución fue satisfactoria en todos los casos menos en 7, no hubo mortalidad en este grupo. Tuvimos una tasa de reingreso del 2%. Conclusiones: Continuamos realizando una proporción importante de tratamiento conservador en detrimento de la cirugía urgente, en números absolutos este parece tener mayor tasa de complicaciones, de mortalidad y de tiempo de ingreso hospitalario (AU)

Introduction: Acute cholecystitis treatment may initially be surgical or conservative with subsequent surgery; we reviewed the cases found in our centre, including their treatment and outcome. Material and methods: We conducted a retrospective study of treatment in 178 patients with acute cholecystitis during one year. We evaluated variables associated with patient characteristics, as well as clinical data, diagnostic tests, treatment and outcome. Results: The majority (70.2%) was treated conservatively (group A), and 29.8% were operated on in the first 72h (group B). In group A, 96 patients were treated with antibiotics, 15 with antibiotic therapy and cholecystectomy, and 12 with antibiotics and ERCP. In group B urgent laparoscopic cholecystectomy was performed in 60.4%, and 35.8% had open cholecystectomy. In group A, admission time was 11 days, with satisfactory progress in 79.2%, mortality rate of 5.6% and 10.7% of readmissions. In group B, operation time was 111 +/− 43min, a mean of 8.7 days hospital stay, and 68% of cases did not require further treatment after surgery. Outcome was satisfactory in all but 7, there was no mortality in this group. We had a return rate of 2%. Conclusions: A significant proportion of conservative treatment was carried out at the expense of emergency surgery, although in absolute numbers conservative treatment seems to have a higher rate of complications, mortality and hospitalisation time(AU)

Hernia interna tras sigmoidectomía laparoscópica / Internal hernia after laparoscopic sigmoidectomy

No disponible