Desarrollo y resultados de un nuevo programa de trasplante de páncreas en España: la visión del cirujano / Development and results of a novel pancreas transplant program in Spain: the surgeon's point of view

INTRODUCCIÓN: El trasplante simultáneo de páncreas-riñón se encuentra indicado para pacientes con diabetes tipo 1 y enfermedad renal terminal. Los resultados son excelentes aunque el número de procedimientos parece ser un factor que afecta a la supervivencia de paciente e injerto estando en relación con la morbilidad quirúrgica, derivada de complicaciones pancreáticas. el objetivo del estudio es describir el desarrollo de un nuevo programa y exponer los resultados en un centro con un volumen bajo de trasplantes. MÉTODOS: Analizamos 53 trasplantes simultáneos de páncreas-riñón, en un período de 7 años (2009-2016), con una mediana de seguimiento de 39 meses. RESULTADOS: Dos pacientes han fallecido, uno tras parada cardíaca en postoperatorio y otro tras accidente de tráfico complicado con una neumonía. Entre los 51 pacientes vivos se han perdido 2 injertos, uno por un rechazo crónico tras cuatro años del trasplante y otro por trombosis arterial a los 20 días del mismo, motivo, este último, de la única trasplantectomía realizada. En diez pacientes se han realizado una o más reintervenciones: pancreatitis (n=3), oclusión intestinal (n=4), trombosis arterial (n=1), fístula con peritonitis (n=1) y hemoperitoneo (n=1). La supervivencia del paciente y del injerto a 1, 3, y 5 años fue del 98, 95 y 95% y del 96, 93 y 89%, respectivamente. Conclusiones Los resultados muestran que un nuevo programa de trasplante pancreático puede conseguir resultados similares a los de grupos con mayor volumen y experiencia. Una adecuada selección de donantes y receptores, una técnica homogénea y el aprendizaje con grupos expertos garantizan estos resultados

INTRODUCTION: Simultaneous kidney-pancreas transplantation for patients with type 1 diabetes and end-stage chronic renal disease is widely performed. However, the rate of surgical morbidity from pancreatic complications remains high. The aim of this study was to describe the development and results of a new program, from the point of view of the pancreatic surgeon. METHODS: We analyzed 53 simultaneous kidney-pancreas transplantations performed over a period of seven years (2009-2016), with a median follow up of 39 months (range: 1-86 months). RESULTS: Out of the total of this series, two patients died: one patient because of cardiac arrest immediately after surgery; and another patient due to traffic accident, complicated by pneumonia. Among the 51 living patients, two grafts were lost: one due to chronic rejection four years after transplantation; and the other due to arterial thrombosis 20 days after transplantation (the only case requiring transplantectomy). In ten patients, one or more re-operations were necessary due to the following: graft pancreatitis (n=4), small intestinal obstruction (n=4), arterial thrombosis (n=1), fistula (n=1) and hemoperitoneum (n=1). Overall patient and graft survival rates after 1, 3 and 5 years were 98, 95 and 95% and 96, 93 and 89%, respectively. CONCLUSIONS: This study has shown that the results of a new pancreas transplant program, which relies on the previous experience of other groups, do not demonstrate a learning curve. Adequate surgeon education and training, as well as the proper use of standardized techniques, should ensure optimal results

Development and results of a novel pancreas transplant program in Spain: the surgeon's point of view. / Desarrollo y resultados de un nuevo programa de trasplante de páncreas en España: la visión del cirujano.

INTRODUCTION: Simultaneous kidney-pancreas transplantation for patients with type 1 diabetes and end-stage chronic renal disease is widely performed. However, the rate of surgical morbidity from pancreatic complications remains high. The aim of this study was to describe the development and results of a new program, from the point of view of the pancreatic surgeon. METHODS: We analyzed 53 simultaneous kidney-pancreas transplantations performed over a period of seven years (2009-2016), with a median follow up of 39 months (range: 1-86 months). RESULTS: Out of the total of this series, two patients died: one patient because of cardiac arrest immediately after surgery; and another patient due to traffic accident, complicated by pneumonia. Among the 51 living patients, two grafts were lost: one due to chronic rejection four years after transplantation; and the other due to arterial thrombosis 20 days after transplantation (the only case requiring transplantectomy). In ten patients, one or more re-operations were necessary due to the following: graft pancreatitis (n=4), small intestinal obstruction (n=4), arterial thrombosis (n=1), fistula (n=1) and hemoperitoneum (n=1). Overall patient and graft survival rates after 1, 3 and 5 years were 98, 95 and 95% and 96, 93 and 89%, respectively. CONCLUSIONS: This study has shown that the results of a new pancreas transplant program, which relies on the previous experience of other groups, do not demonstrate a learning curve. Adequate surgeon education and training, as well as the proper use of standardized techniques, should ensure optimal results.

Improving the outcome of acute cholecystitis: the non-standardized treatment must no longer be employed.

PURPOSE: Therapeutic recommendations of acute cholecystitis are not consistently implemented, which generates greater patient morbidity and higher health care costs. The aim of this article is to evaluate the burden of acute cholecystitis, to detect potentially modifiable variables, and to propose a therapeutic strategy that will allow us to improve the quality of care. METHODS: We carried out a retrospective study of patients who were admitted to the hospital from January 2010 to December 2012 using a univariate analysis of parameters including the admitting department, age, treatment administered, and length of stay. RESULTS: A total of 967 patients were admitted to the hospital with a diagnosis of acute cholecystitis, 692 (72%) to the Surgery Department, 257 (26%) to Internal Medicine-Digestive, and 18 (2%) to other departments. Four hundred ninety-eight (51.5%) were operated on: 107 (21%) on an urgent basis, 111 (22%) at an early stage (<96 h at diagnosis), 152 (30%) at a late stage (>96 h at diagnosis), and 128 (26%) at a delayed date (other admission). Patients who were admitted into the surgery department were five times more likely to be operated on than patients admitted into other departments (p<0.01). Patients operated on at a late stage had a longer length of stay than early stage surgery patients (p<0.05) and than non-operated ones (p<0.05). Patients<74 years old were more frequently operated than older ones (p<0.05). CONCLUSIONS: The non-standardized treatment of acute cholecystitis causes high clinical and surgical variability, long average stay, more readmissions, and high hospital costs. Therefore, patients with a diagnosis of acute cholecystitis should be admitted to the Surgery Department, thereby increasing the probability of receiving definite treatment.

[Giant splenic hydatid cyst]. / Quiste hidatídico esplénico gigante.

Hydatidosis is a relatively frequent parasitic disease in some geographical areas and is caused by infection with Echinococcus granulosus larvae leading to the development of cysts. The most frequently affected organs are the liver and lungs. Splenic involvement alone is rare and produces mild abdominal discomfort and a palpable mass in the left hypochondriac region. The treatment of choice is surgery. Radical surgery (splenectomy) is recommended, especially in large cysts. Conservative procedures are employed in pediatric patients or unresectable cysts. Laparoscopic techniques have had limited success.

Quiste hidatídico esplénico gigante / Giant splenic hydatid cyst

La hidatidosis es una parasitosis relativamente frecuente en determinadas áreas geográficas, y hace referencia al desarrollo en el organismo humano de tumoraciones quísticas que corresponden a la fase larvaria del Echinococcus granulosus. Los órganos más frecuentemente afectados son el hígado y los pulmones. La afectación esplénica única es rara y suele cursar con dolor abdominal y una masa palpable en el hipocondrio izquierdo. El tratamiento de elección es quirúrgico. Se recomienda la cirugía radical (esplenectomía), sobre todo en los quistes grandes, y la cirugía conservadora se deja para los pacientes en edad pediátrica o con quistes irresecables. La cirugía laparoscópica de esta patología tiene algunas limitaciones (AU)

Hydatidosis is a relatively frequent parasitic disease in some geographical areas and is caused by infection with Echinococcus granulosus larvae leading to the development of cysts. The most frequently affected organs are the liver and lungs. Splenic involvement alone is rare and produces mild abdominal discomfort and a palpable mass in the left hypochondriac region. The treatment of choice is surgery. Radical surgery (splenectomy) is recommended, especially in large cysts. Conservative procedures are employed in pediatric patients or unresectable cysts. Laparoscopic techniques have had limited success (AU)