ABSTRACT
Background: Cystic echinococcosis is a parasitic disease that develops in endemic areas due to the transmission of Echinococcus granulosus. The liver is the organ most affected. The most frequent symptoms include pain, palpable mass, jaundice, and fever. Diagnosis is based on epidemiologic history, examination, imaging, and serologic tests. Patients and Methods: We conducted a retrospective study of patients with hepatic echinococcosis diagnosed in our center. We collected data from our patients regarding personal history, cyst characteristics, surgery performed, and post-operative complications. Results: Sixteen patients were diagnosed with hepatic echinococcosis, 11 of whom underwent surgery. We found multiple cysts in six patients (37.5%) and a single cyst in 10 (62.5%). In 14 patients the cysts were found only in the right hepatic lobe (87.5%) and in two patients they were found in both lobes (12.5%). Segment 4 was affected in seven cases. The sizes ranged from 2.7 to 20 cm. Endoscopic retrograde cholangiopancreatography was prior to surgery in five patients. The interventions performed were partial cyst-pericystectomies in eight patients, a total cyst-pericystectomy in one case, and drains were placed in two cases of rupture. Post-operative fistulas were evident in five patients, four of which were closed. The fifth, which occurred after emergency surgery for rupture of the cyst, has maintained suppuration. The mean follow-up was 3.5 years. There was no post-operative mortality or recurrence to date. Conclusions: We can state that center without highly specialized hepato-biliary surgery units can assume the surgery of hydatid liver cysts excluding those with well-defined characteristics. The establishment of recommendations for the referral of patients with complex hydatid cysts may help in the optimal management of this pathology.
Subject(s)
Echinococcosis, Hepatic , Echinococcosis , Drainage , Echinococcosis, Hepatic/diagnosis , Echinococcosis, Hepatic/surgery , Humans , Retrospective StudiesABSTRACT
BACKGROUND: Up to 25% of patients with acute pancreatitis develop severe complications and are classified as severe pancreatitis with a high death rate. To improve outcomes, patients may require interventional measures including surgical procedures. Multidisciplinary approach and best practice guidelines are important to decrease mortality. METHODS: We have conducted a retrospective analysis from a prospectively maintained database in a low-volume hospital. A total of 1075 patients were attended for acute pancreatitis over a ten-year period. We have analysed 44 patients meeting the criteria for severe acute pancreatitis and for intensive care unit (ICU) admittance. Demographics and clinical data were analysed. Patients were treated according to international guidelines and a multidisciplinary flowchart for acute pancreatitis and a step-up approach for pancreatic necrosis. RESULTS: Forty-four patients were admitted to the ICU due to severe acute pancreatitis. Twenty-five patients needed percutaneous drainage of peri-pancreatic or abdominal fluid collections or cholecystitis. Eight patients underwent endoscopic retrograde cholangiopancreatography for choledocholithiasis and biliary sepsis or pancreatic leakage, and one patient received endoscopic trans-gastric endoscopic prosthesis for pancreatic necrosis. Sixteen patients underwent surgery: six patients for septic abdomen, four patients for pancreatic necrosis and two patients due to abdominal compartment syndrome. Four patients had a combination of surgical procedures for pancreatic necrosis and for abdominal compartment syndrome. Overall mortality was 9.1%. CONCLUSION: Severe acute pancreatitis represents a complex pathology that requires a multidisciplinary approach. Establishing best practice treatments and evidence-based guidelines for severe acute pancreatitis may improve outcomes in low-volume hospitals.
Subject(s)
Pancreatitis/surgery , Patient Care Team , Acute Disease , Adult , Aged , Cholangiopancreatography, Endoscopic Retrograde , Choledocholithiasis/surgery , Drainage/methods , Female , Hospitals, Low-Volume , Humans , Intensive Care Units , Male , Middle Aged , Pancreatitis/complications , Pancreatitis, Acute Necrotizing/surgery , Practice Guidelines as Topic , Retrospective Studies , SpainABSTRACT
Objetivo. Demostrar la relación entre la afectación endometriósica del apéndice cecal y el desarrollo de una apendicitis aguda. Pacientes y métodos. Presentamos una serie institucional de 8 pacientes con endometriosis apendicular diagnosticadas tras apendicectomía entre junio de 2009 y marzo de 2014. Resultados. La media de edad fue 40,6 años, 6 en edad fértil. En 5 (62,5%) la afectación endometriósica apendicular resultó única y en 3 (37,5%) múltiple, fundamentalmente en el ovario. Siete (87,5%) iniciaron los síntomas como una apendicitis aguda. Los implantes endometriósicos afectaban la capa serosa en 6 pacientes, la capa muscular en una y la grasa periapendicular en otra. Conclusión. El diagnóstico de endometriosis apendicular en mujeres con apendicitis aguda solo se puede realizar tras el examen de las piezas de apendicectomía, aunque puede ser sospechado en el contexto clínico. La laparoscopia permite un diagnóstico adecuado con exploración completa de la pelvis, la apendicectomía y el tratamiento de otras lesiones (AU)
Aim. To determine the relationship between endometriotic involvement of the appendix and the development of acute appendicitis. Patients and methods. We report a series of 8 patients with appendiceal endometriosis diagnosed after appendicectomy from June 2009 to March 2014. Results. The mean age was 40.6 years. Six patients were of reproductive age. Endometriotic appendiceal involvement alone was found in 5 patients (62.5%) and multiorgan involvement, mainly affecting the ovary, in 3 patients (37.5%). Clinical presentation was acute appendicitis in 7 patients (87.5%). Endometriotic implants involved the serous layer in 6 patients, the muscle layer in one patient, and periappendiceal fat in another patient. Conclusion. Diagnosis of appendiceal endometriosis in women with acute appendicitis can only be performed after specimen study, although it may be suspected in the clinical context. Laparoscopy allows pelvic and abdominal cavity examination, appendectomy, and the treatment of other lesions (AU)
Subject(s)
Adult , Female , Humans , Middle Aged , Appendicitis/complications , Appendicitis/diagnosis , Endometriosis/complications , Endometriosis/diagnosis , Laparoscopy/methods , Laparoscopy/trends , Appendectomy/methods , Appendectomy , Abdomen, Acute/complications , Abdomen, Acute/diagnosis , Appendix/physiopathology , Pelvis , Postmenopause/physiology , Laparotomy/methodsABSTRACT
BACKGROUND: Laparoscopic splenectomy is an effective and safe technique in the management of benign splenic pathologies. METHODS: We reviewed our 7-year experience to evaluate utility and safety of this procedure. RESULTS: Laparoscopic splenectomy was performed in 20 patients (13 women, 7 men), with a mean age of 49 years. Pathology included 19 cases of idiopathic thrombocytopenic purpura (ITP) and one case of autoimmune hemolytic anemia. Mean operative time was 165 min, including anesthetic procedure. There was only one conversion to open surgery. Accessory spleens were detected in 15% of patients. Early remission of hematological disorders was achieved in 70% of the cases and long-term remission in 90%. The complications rate was 20%, including two cases of subphrenic hematoma, one case of acute focal pancreatitis and one case of thrombosis of the portal venous system; all recovered with no sequelae. Mortality rate was 0%. CONCLUSIONS: Laparoscopic splenectomy obtains results identical to those of open surgery in terms of efficacy and safety but with the benefits of laparoscopic surgery. Therefore, it should be considered as the procedure of choice for the treatment of benign hematological pathologies unresponsive to medical therapy.
Subject(s)
Anemia, Hemolytic, Autoimmune/surgery , Laparoscopy , Purpura, Thrombocytopenic, Idiopathic/surgery , Splenectomy/methods , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Time FactorsABSTRACT
INTRODUCTION: Portal vein thrombosis is an unfrequent, but potentially deadly, complication of the laparoscopic splenectomy procedure. The laparoscopic approach has shortened the duration of hospital stay; portal vein thrombosis may appear after the patient has left the hospital, determining a later diagnosis. Because of the mild, nonspecific symptoms, the diagnosis can even be missed and only achieved when chronic complications take place. OBJECTIVES: In this study, we aimed to determine the appearance of portal vein thrombosis in a consecutive series of patients who underwent laparoscopic splenectomy by performing a contrast-enhanced computed tomography (CT) scan postoperatively. MATERIALS AND METHODS: A transversal study was established, performing in 2005 a contrast-enhanced CT scan on 20 patients who underwent laparoscopic splenectomy between 1999 and 2005 at Ramón y Cajal University Hospital (Madrid, Spain). The presence of thrombosis in the splenoportomesenteric axis was investigated. RESULTS: Two (2) cases (10%) of portal vein thrombosis were detected: 1 symptomatic case, 7 days after surgery, was treated with anticoagulation, resulting in the disappearance of the thrombus in a new CT scan 6 months later; the second case was asymptomatic and was discovered during the performance of this study. CONCLUSIONS: The contrast-enhanced CT scan shows the best accuracy for the diagnosis of portal vein thrombosis, and it must be performed when any clinical manifestation appear; also, it must still be determined if a contrast-enhanced CT scan should be systematically performed in high-risk thromboembolic patients. An ultrasound Doppler may present many diagnostic errors. It is probably advisable to prolong the antithromboembolic prophylaxis.
Subject(s)
Portal Vein , Splenectomy/adverse effects , Tomography, X-Ray Computed , Venous Thrombosis/diagnostic imaging , Adolescent , Adult , Aged , Female , Hematologic Diseases/surgery , Humans , Male , Middle Aged , Splenectomy/methodsABSTRACT
INTRODUCTION: Laparoscopic splenectomy (LS) is gaining acceptance as an effective and safe alternative to open splenectomy (OS) in the treatment of benign hematologic disorders unresponsive to medical treatment. Among these disorders, the most important is idiopathic thrombocytopenic purpura (ITP). PATIENTS AND METHOD: We compared a cohort of 20 patients who had undergone LS in the previous 7 years, with a historical cohort of 38 patients who underwent OS between 1985 and 1999. All patients in the two groups were diagnosed with ITP unresponsive to medical treatment. RESULTS: The mean age of the patients was 41 years in the LS group and 39.7 in the OS group. Mean spleen size and weight were 11 cm and 150 g in the LS group and 9.9 cm and 190 g in the OS group. Preoperative platelet count was 78 x 10(9) in the LS group and 69 x 10(9) in the OS group. Accessory spleens were detected in 15% of patients in the LS group and in 16% of those in the OS group. The mean operative time was 180 minutes in LS and 85 minutes in OS (p < 0.001). The complications rate was 25% in LS and 21% in OS. The mean length of hospital stay was 3 days in the LS group and 9.4 days in the OS group (p < 0.001). No differences were observed in early and complete long-term remission. CONCLUSIONS: Compared with OS, LS requires a longer operative time and reduces hospital stay. Detection of accessory spleens, complication rates, and effectiveness in terms of early and long-term remission are similar in both procedures. In our opinion, LS should be considered the procedure of choice for the treatment of benign hematological disorders unresponsive to medical therapy.
Subject(s)
Laparoscopy/methods , Purpura, Thrombocytopenic, Idiopathic/surgery , Splenectomy/methods , Cohort Studies , Female , Humans , Male , Middle AgedABSTRACT
Introducción. La esplenectomía laparoscópica está ganando aceptación como alternativa segura y efectiva a la esplenectomía abierta en el tratamiento de trastornos hemáticos benignos refractarios a tratamiento médico, de los que la púrpura trombocitopénica idiopática es el más importante. Material y método. Comparamos una cohorte de 20 pacientes sometidos a esplenectomía laparoscópica (EL) en los últimos 7 años con una cohorte histórica de 38 casos sometidos a esplenectomía abierta (EA) entre 1985 y 1999. Todos los casos de ambos grupos estaban diagnosticados de púrpura trombocitopénica idiopática refractaria a tratamiento médico. Resultados. La media de edad de los pacientes del grupo EL era de 41 años, frente a 39,7 en el grupo EA. El tamaño medio y el peso medio del bazo fueron de 11 cm y 150 g en EL y 10,9 cm y 190 g en EA. El recuento plaquetario preoperatorio fue 78 x 109 en EL y 69 x109 en EA. Se detectaron bazos accesorios en el 15% de los casos del grupo EL y el 16% en el grupo EA. La duración media de la cirugía fue 180 min en EL y 85 min en EA (p < 0,001). La tasa de complicaciones fue del 25% en EL y el 21% en EA. La estancia media hospitalaria fue 3 días en el grupo EL y 9,4 días en el grupo EA (p < 0,001). No se observaron diferencias en las tasas de remisión precoz y remisión completa a largo plazo. Conclusiones. Comparada con la EA, la EL precisa mayor tiempo operatorio, son similares en la detección de bazos accesorios, la tasa de complicaciones y la efectividad en la remisión precoz y la remisión completa a largo plazo, y conlleva un menor tiempo de hospitalización. En nuestra opinión, la EL debe ser considerada el procedimiento de elección en el tratamiento de afecciones hemáticas benignas que no responden a tratamiento médico (AU)
Introduction. Laparoscopic splenectomy (LS) is gaining acceptance as an effective and safe alternative to open splenectomy (OS) in the treatment of benign hematologic disorders unresponsive to medical treatment. Among these disorders, the most important is idiopathic thrombocytopenic purpura (ITP). Patients and method. We compared a cohort of 20 patients who had undergone LS in the previous 7 years, with a historical cohort of 38 patients who underwent OS between 1985 and 1999. All patients in the two groups were diagnosed with ITP unresponsive to medical treatment. Results. The mean age of the patients was 41 years in the LS group and 39.7 in the OS group. Mean spleen size and weight were 11 cm and 150 g in the LS group and 9.9 cm and 190 g in the OS group. Preoperative platelet count was 78 x 109 in the LS group and 69 x 109 in the OS group. Accessory spleens were detected in 15% of patients in the LS group and in 16% of those in the OS group. The mean operative time was 180 minutes in LS and 85 minutes in OS (p < 0.001). The complications rate was 25% in LS and 21% in OS. The mean length of hospital stay was 3 days in the LS group and 9.4 days in the OS group (p < 0.001). No differences were observed in early and complete long-term remission. Conclusions. Compared with OS, LS requires a longer operative time and reduces hospital stay. Detection of accessory spleens, complication rates, and effectiveness in terms of early and long-term remission are similar in both procedures. In our opinion, LS should be considered the procedure of choice for the treatment of benign hematological disorders unresponsive to medical therapy (AU)
Subject(s)
Male , Female , Adult , Humans , Splenectomy/methods , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Purpura, Thrombocytopenic, Idiopathic/epidemiology , Purpura, Thrombocytopenic, Idiopathic/surgery , Surgical Procedures, Operative/methods , Platelet Transfusion/methods , Splenectomy/trends , Length of Stay/trends , Preoperative Care/methods , Preoperative Care/standards , Immunoglobulins/therapeutic use , Danazol/therapeutic use , Azathioprine/therapeutic use , Postoperative Complications/epidemiology , Postoperative Complications/therapyABSTRACT
INTRODUCTION: Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue neoplasm with low-intermediate grade of malignancy. It is a locally aggressive tumour with a high recurrence rate. Surgical excision with adequate margins is the main treatment. MATERIALS AND METHODS: We describe the clinicopathological features of 21 cases of DFSP. The mean size of the lesions was 5.6 cm, mostly located in trunk. 61.9% of the cases underwent surgical excision without previous biopsy. 52.4% of the patients presented positive margins, that required surgical extension. RESULTS: The recurrence rate was 28.6% (6 cases), five of them local recurrences treated with new surgical excision with wide margins. Median period free of illness was 32.5 months. Medium follow-up period was 33.25 months. CONCLUSIONS: DFSP has a locally high recurrence rate, that has been associated to inadequate surgical margins. The histological knowledge preoperatively would permit surgical excision with adequate margins, and probably this could reduce the recurrence rate. Radiotherapy could avoid the surgical extension of margins in these cases with positive ones. Chemotherapy could be indicated in metastasic cases. Most recurrences appear in the first 3 years, but it is important a long-term follow-up of these patients.
Subject(s)
Dermatofibrosarcoma/surgery , Skin Neoplasms/surgery , Adult , Dermatofibrosarcoma/pathology , Female , Humans , Male , Neoplasm Recurrence, Local , Retrospective Studies , Skin Neoplasms/pathologyABSTRACT
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Introduction. Dermatofibrosarcoma protuberans(DFSP) is an uncommon soft tissue neoplasm withlow-intermediate grade of malignancy. It is a locallyaggressive tumour with a high recurrence rate. Surgicalexcision with adequate margins is the maintreatment.Materials and methods. We describe the clinicopathologicalfeatures of 21 cases of DFSP. Themean size of the lesions was 5.6 cm, mostly locatedin trunk. 61.9% of the cases underwent sugical excisionwithout previous biopsy. 52.4% of the patientspresented positive margins, that required surgicalextension.Results. The recurrence rate was 28.6% (6 cases),five of them local recurrences treated with new surgicalexcision with wide margins. Median periodfree of illness was 32.5 months. Medium follow-upperiod was 33.25 months.Conclusions. DFSP has a locally high recurrencerate, that has been associated to inadequate surgicalmargins. The histological knowledge preoperativelywould permit surgical excision with adequatemargins, and probably this could reduce the recurrencerate. Radiotherapy could avoid the surgicalextension of margins in these cases with positiveones. Chemotherapy could be indicated in metastasiccases. Most recurrences appear in the first 3years, but it is important a long-term follow-up ofthese patients
