ABSTRACT
Introducción: La incidencia de pólipos vesiculares es del 0,3-12%. Es importante diferenciar los seudopólipos (pólipos de colesterol, adenomiomatosis o pólipos inflamatorios) de los pólipos verdaderos (adenomas y adenocarcinomas). Los principales factores de riesgo de malignización son el tamaño superior a 6-10mm, crecimiento rápido del mismo, morfología sésil, etnia india y colangitis esclerosante primaria. La ecografía es el gold standard para su diagnóstico. Sin embargo, la mayoría de los pólipos diagnosticados por ecografía son seudopólipos. El objetivo del estudio es analizar si la ecografía es precisa para diagnosticar los pólipos verdaderos en los pacientes cuya indicación quirúrgica ha sido este diagnóstico ecográfico. Métodos: Estudio observacional retrospectivo de los pacientes intervenidos en nuestro centro, desde el año 2007 al 2019, de colecistectomía electiva por presentar pólipos vesiculares. La cirugía se indicó en pacientes sintomáticos y/o con factores de riesgo. El estudio fue aprobado por el Comité Ético de Investigación Clínica de nuestro hospital. Resultados: Se han incluido 124 pacientes. En todos ellos se ha realizado colecistectomía laparoscópica. La edad media fue de 55,4 años y el 61% eran mujeres. El 65% tenían síntomas biliares. En nuestro estudio, solo 3 pacientes presentaron pólipos verdaderos (2,4%). Todos ellos, fueron adenomas tubulares. El resto de los pacientes resultaron falsos positivos (97,6%). El tamaño de los adenomas fue de 11, 6 y 5mm. La cirugía se indicó por tamaño o por clínica asociada. Conclusiones: La ecografía no es precisa para el diagnóstico de pólipos vesiculares verdaderos. La validación de otras pruebas complementarias para el diagnóstico de pólipos en pacientes asintomáticos podría ser relevante para evitar cirugías innecesarias. (AU)
Introduction: The incidence of gallbladder polyps is 0,3-12%. It is important to differentiate pseudopolyps (cholesterol polyps, adenomyomatosis, inflammatory polyps), which do not have the potential to become malignant, and true polyps (adenomas and adenocarcinomas). The main risk factors for malignancy are size>6-10mm, rapid growth, sessile morphology, Indian ethnicity and primary sclerosing cholangitis. Ultrasound is the gold standard for diagnosis. However, most polyps diagnosed by ultrasound are pseudopolyps. The main objective of this study is to analyze whether ultrasound is accurate for diagnosing true polyps in patients undergoing surgery for this reason. Methods: We conducted a retrospective observational study with prospective data entry of patients undergoing elective cholecystectomy for gallbladder polyps from 2007 to 2021. Surgery was indicated in symptomatic patients and in those with risk factors. The study was approved by the Clinical Research Ethics Committee of our hospital. Results: Our study included 124 patients who had undergone elective laparoscopic cholecystectomy. Mean age was 55.4 years, and 61% were women. In total, 65% were symptomatic at diagnosis. Only 3 patients had true polyps (2.4%), all of which were tubular adenomas. The remainig patients were false positives (97.6%). The adenoma sizes were 11, 6 and 5mm, respectively. The surgical indication was due to polyp size or due to associated biliary symptoms. Conclusion: Ultrasonography is not accurate for the diagnosis of gallbladder polyps. The validation of other complementary tests for the diagnose gallbladder polyps in asymptomatic patients could be relevant to avoid unnecessary surgeries. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Polyps/diagnostic imaging , Gallbladder Diseases/diagnostic imaging , Ultrasonography , Retrospective Studies , Risk Factors , Cholecystectomy , Gallbladder Diseases/surgeryABSTRACT
La toxina botulínica se ha aplicado en la reparación de defectos ventrales, pero la literatura sobre su aplicación en hernias inguinoescrotales es escasa. Presentamos el caso de un paciente con hernia inguinoescrotal gigante. Se realiza tomografía computada basal y otra a las 4 semanas de la administración de toxina botulínica en la musculatura oblicua y en el recto abdominal (reducción de grosor e incremento de longitud de la musculatura). Se repara la pared abdominal mediante la colocación de una malla tipo BioA intraperitoneal y otra tipo DynaMesh® retromuscular. La toxina puede tener un papel importante como adyuvante en la reparación de hernias inguinoescrotales con pérdida de domicilio.Botulinum toxin has been used in ventral defects repair, but literature on its application in inguinoscrotal hernias is scarce. Patient with giant inguinoscrotal hernia. A baseline CT scan is performed and it is repeated four weeks after botulinum toxin injection in oblique musculature and in the abdominal rectum (reduction in thickness and increase in muscle length is observed). The abdominal wall is repaired by placing an intraperitoneal BioA mesh and a retromuscular DynaMesh® mesh. The toxin can have an important role as an adjuvant in the reparation of inguinoscrotal hernias with loss of domain.
Subject(s)
Botulinum Toxins, Type A , Hernia, Inguinal , Hernia, Inguinal/surgery , Humans , RectumABSTRACT
BACKGROUND: The aim of this study is to assess the feasibility of transanal endoscopic surgery (TES) in obese patients. METHODS: Observational descriptive study evaluating the feasibility of TES in obese rectal tumors between June 2004 and January 2019. Patients were assigned to two groups: body mass index (BMI) < 30 kg/m2 and BMI ≥30 kg/m2, the latter defined as obese. RESULTS: From 775 patients, 681 were enrolled in the study, 145 (21.3%) of them obese. No statistically significant differences between groups were found with respect to overall morbidity (27, 18.6%).The obese patients presented trends towards shorter mean surgical time (65 min, IQR 48 min), less perforation in the peritoneal cavity (eight, 5.5%), and 133 (91.7%) presented a lower rate of lesion fragmentation. CONCLUSION: There were no significant differences in postoperative outcomes in obese patients (BMI ≥30 kg/m2). TES in those obese patients does not represent a factor of surgical difficulty.
