RESUMEN
PURPOSE: The use of open intra-peritoneal onlay mesh repairs (O-IPOMs) for treating medium/large incisional ventral hernias has come into question due to the development of minimally invasive and sublay procedures. This study aimed to identify factors that are associated with the use of O-IPOMs in France. METHODS: We analysed prospectively collected data from the French Hernia Registry on incisional ventral hernia repairs (IVHR) for hernias ≥ 4 cm in width. RESULTS: We obtained data for 2261 IVHR (from 11/09/2011 to 30/03/2020): 733 O-IPOMs and 1,528 other techniques. We found that the O-IPOMs were performed on patients with more patient-related risk factors compared with the other techniques. Specifically, there was a higher proportion of patients with ASA III/IV (40.47% vs. 28.02%; p < 0.00001) and at least one patient-related risk factor (66.17% vs. 58.51%; p = 0.0005). Of the 733 O-IPOMs, 195 used Ventrio ST™ (VST), the most commonly used mesh for such IPOMs in our database; the other 538 O-IPOMs used other meshes (OM). The VST subgroup had a higher proportion of patients with ASA III/IV (52.58% vs. 36.07%; p < 0.0001) and on anticoagulants (26.04% vs. 18.41%; p = 0.0229) compared with the OM subgroup; they also had a lower recurrence rate after 2 years (5.83% vs. 15.41%; p = 0.008). However, large (≥ 10 cm) or lateral defects were more common in the OM subgroup, and their mesh/defect area ratio was lower. CONCLUSION: O-IPOMs were performed on patients with more comorbidities and/or complex incisional hernias compared with other techniques.
RESUMEN
OBJECTIVES: Postoperative complications after Laparoscopic sleeve gastrectomy (LSG) can dramatically compromise patient's outcome. The aim of this study is to analyze the per- and postoperative short-term outcomes after LSG and to assess predictive risk factors of complications. METHODS: The study group consisted of 790 patients (610 women and 180 men) who underwent LSG In 2014. All interventions were performed by 18 experienced surgeons members of the Club Coelio. Data about preoperative work-up, surgical techniques, 30-days postoperative morbidity and mortality were collected. Endpoints were perioperative morbidity and mortality and assessment of potential risk factors for complications. RESULTS: Mean age and body mass index were respectively 39 years and 41.5kg/m2. Ninety-one patients (11.5%) had previous bariatric surgery. Morbidity rate was 4.7% (37/790) including 16 leaks (2.0%) and 9 bleedings (1.1%) and no deaths. Risk factors for leak were: previous adjustable banding (p = .0051), with no difference between removal of the banding and LSG in 1 or 2 steps, and type of endostapler (p = .0129). CONCLUSIONS: Leakage after Sleeve was rare but still observed even in experienced hands. The leak rate is particularly high when LSG is performed after adjustable gastric banding removal.
Asunto(s)
Gastroplastia/efectos adversos , Laparoscopía/efectos adversos , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/epidemiología , Adolescente , Adulto , Anciano , Bélgica/epidemiología , Femenino , Gastroplastia/métodos , Humanos , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia/tendencias , Adulto JovenRESUMEN
Tailgut cyst is a rare congenital presacral lesion. We report a case of a 24-year-old woman presenting a recurrent retrorectal mass with pain. Surgical resection by vaginal way found retrorectal cystic hamartoma. Differential diagnosis include cystic teratoma, epidermal cyst and rectal duplication cysts. The most important complications are recurrence, infection, perineal fistulas and the possibility of malignant transformation. So the complete surgical excision of these lesion is necessary.
Asunto(s)
Quistes/diagnóstico , Hamartoma/diagnóstico , Enfermedades del Recto/diagnóstico , Vagina/cirugía , Quistes/complicaciones , Quistes/patología , Quistes/cirugía , Diagnóstico Diferencial , Femenino , Procedimientos Quirúrgicos Ginecológicos , Hamartoma/complicaciones , Hamartoma/patología , Hamartoma/cirugía , Humanos , Enfermedades del Recto/complicaciones , Enfermedades del Recto/patología , Enfermedades del Recto/cirugía , Vagina/patología , Adulto JovenRESUMEN
The authors report a preliminary series assessing the feasibility of duodenal stenting using a surgical approach. The study included 16 patients with a malignant duodenal outlet obstruction for whom a biliaryobstruction necessitated a laparotomyor following an endoscopic stenting failure. The stent was efficient in 15 patients with a complete relieve of obstruction. These patients could have oral intake at the end of the first postoperative week. No stent obstruction occurred. The duodenal stenting by laparotomy could be a good alternative to palliative gastroenteral anasotomosis.
Asunto(s)
Neoplasias Duodenales/complicaciones , Obstrucción Duodenal/etiología , Obstrucción Duodenal/cirugía , Laparotomía/métodos , Cuidados Paliativos/métodos , Implantación de Prótesis/métodos , Stents , Duodenoscopía , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Resultado del TratamientoRESUMEN
Renal cell carcinoma is a malignant epithelial tumour which can always give rise to metastases, usually situated in the lungs, bone and liver. In contrast, pancreatic metastases are exceptional and can occur late. The authors report three cases of metachronous pancreatic metastases, 1, 4 and 10 years after nephrectomy. The procedures performed consisted of Whipple procedure, tumour excision and total duodenopancreatectomy. Although rare when isolated to the pancreas, these metastases can justify even audacious pancreatic resection.
Asunto(s)
Adenocarcinoma de Células Claras , Neoplasias Renales , Neoplasias Primarias Secundarias , Neoplasias Pancreáticas/secundario , Adenocarcinoma de Células Claras/secundario , Adenocarcinoma de Células Claras/cirugía , Anciano , Angiografía , Femenino , Humanos , Neoplasias Renales/diagnóstico , Neoplasias Renales/cirugía , Persona de Mediana Edad , Nefrectomía , Pancreatectomía , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/cirugía , Factores de Tiempo , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
We report, in an adult, an asymptomatic association between cystic dilation of the bile duct (type IV A in Todani's classification) and anomalous pancreatico-biliary ductal union (APBD) with stones in a long common channel. In APBD, the connection between the common bile duct and the main pancreatic duct is located outside the duodenal wall andis therefore not under the influence of the sphincter of Boyden. An abnormally long common channel is in excess of 15 mm. Two types of convergence anomalies are defined according to whether the bile duct opens into the main pancreatic duct (BP) or the main pancreatic duct into the bile duct (PB). In APBD, there is probably a reverse pressure gradient between the bile and pancreatic ducts, with regurgitation of pancreatic juice into the bile duct, repeated attacks of cholangitis, stenosis and cystic dilatation. A long common channel is associated with a higher incidence of carcinoma of the gall bladder of the bile duct.
Asunto(s)
Conducto Colédoco/anomalías , Quistes/congénito , Cálculos Biliares/diagnóstico , Conductos Pancreáticos/anomalías , Adulto , Quistes/diagnóstico , Quistes/cirugía , Supervivencia sin Enfermedad , Femenino , Cálculos Biliares/etiología , Cálculos Biliares/cirugía , Humanos , LaparotomíaRESUMEN
Multivisceral and orthotopic liver/small bowel transplantations have been performed to treat patients with intestinal failure associated with liver failure induced by parenteral nutrition. The aim of this experimental study was to determine the experimental liver-small bowel harvesting and transplantation technique that achieves the best compromise between liver and intestine ischemia times in pigs. Initial portal revascularization of the liver which reduces the hepatic warm ischemia time after cold ischemia preparation of the graft immersed in lactated ringer's solution at 4 degrees C, reduce the risk of primary non function of the graft.