Short-term outcomes of minimally invasive retromuscular ventral hernia repair using an enhanced view totally extraperitoneal (eTEP) approach: systematic review and meta-analysis.

BACKGROUND: The enhanced view totally extraperitoneal (eTEP) approach is becoming increasingly more widely accepted as a promising technique in the treatment of ventral hernia. However, evidence is still lacking regarding the perioperative, postoperative and long-term outcomes of this technique. The aim of this meta-analysis is to summarize the current available evidence regarding the perioperative and short-term outcomes of ventral hernia repair using eTEP. STUDY DESIGN: A systematic search was performed of PubMed, EMBASE, Cochrane Library and Web of Science electronic databases to identify studies on the laparoscopic or robotic-enhanced view totally extraperitoneal (eTEP) approach for the treatment of ventral hernia. A pooled meta-analysis was performed. The primary end point was focused on short-term outcomes regarding perioperative characteristics and postoperative parameters. RESULTS: A total of 13 studies were identified involving 918 patients. Minimally invasive eTEP resulted in a rate of surgical site infection of 0% [95% CI 0.0-1.0%], a rate of seroma of 5% [95% CI 2.0-8.0%] and a rate of major complications (Clavien-Dindo III-IV) of 1% [95% CI 0.0-3.0%]. The rate of intraoperative complications was 2% [95% CI 0.0-4.0%] with a conversion rate of 1.0% [95% CI 0.0-3.0%]. Mean hospital length of stay was 1.77 days [95% CI 1.21-2.24]. After a median follow-up of 6.6 months (1-24), the rate of recurrence was 1% [95% CI 0.0-1.0%]. CONCLUSION: Minimally invasive eTEP is a safe and effective approach for ventral hernia repair, with low reported intraoperative complications and good outcomes.

Totally laparoscopic right-lobe hepatectomy for adult living donor liver transplantation: useful strategies to enhance safety.

The overriding concern in living donor liver transplantation is donor safety. A totally laparoscopic right hepatectomy without middle hepatic vein for adult living donor liver transplantation is presented. The surgical procedure is described in detail, focusing on relevant technical aspects to enhance donor safety, specifically the hanging maneuver and dynamic fluoroscopy-controlled bile duct division.

Intraductal papillary mucinous neoplasms (IPMN) of the pancreas: clinico-pathologic results.

BACKGROUND: intraductal papillary mucinous neoplasm (IPMN) shows a series of lesions which evolve from benign lesions -adenoma- to invasive carcinoma. AIM: To analyze the clinical and pathological results of 15 patients diagnosed of IPMN, and surgically treated according to the guidelines of International Consensus Conference. MATERIAL AND METHODS: A retrospective analysis of 15 patients surgically treated between March 1993 and September 2009, according to the International Consensus recommendation. Demographic, diagnostic tools, surgical report, pathologic database and actuarial survival were analyzed with a follow-up from one and a half month through nine years. RESULTS: 6 Patients underwent pancreaticoduodenectomies, 4 total pancreatectomies, 2 body or central pancreatectomies, 2 partial pancreatectomies (enucleation) and 1 distal pancreatectomy. A morbidity of 46 and 0% hospital mortality were assessed, with a median length hospital stay of 10 days. In five cases, the IPMN was combined type (both main and branch pancreatic ducts involved) in four main duct-type and branch duct-type in the another six as well. Several atypia (IPMN carcinoma in situ) was observed in 2 patients and invasive carcinoma with negative lymph nodes was identified in 3 patients. A patient without invasive carcinoma died at 66 months of follow-up for pancreas adenocarcinoma. The actuarial survival up to recurrence or death was 105,133 months with a range of follow-up from 1 month and a half until 9 years. CONCLUSIONS: IPMN main duct or mixed type warrants complete resection due to its incidence of invasive carcinoma or precursor lesions of malignancy as well. Due to its multifocal pattern, patients should be followed in long-term surveillance. The management of asymptomatic IPMN type branch less than 3 cm is controversial.

Neoplasia papilar mucinosa intraductal del páncreas: resultados clínico-patológicos / No disponible

Introducción: la neoplasia papilar mucinosa intraductal(NPMI) del páncreas comprende una serie de lesiones que evolucionandesde lesiones benignas (adenoma) hasta carcinoma ductalinvasivo.Objetivo: analizar los resultados clínicos y patológicos de 15pacientes diagnosticados de NPMI e intervenidos según las recomendacionesde conferencia de consenso.Material y métodos: análisis retrospectivo de 15 pacientescon NPMI, intervenidos entre marzo de 1993 y septiembre de2009; según pautas de conferencias de consenso internacionales.Se recogieron datos demográficos, pruebas diagnósticas, tipo deintervención, histopatología y supervivencia actuarial con un seguimientoentre mes y medio y nueve años.Resultados: se realizaron 6 duodenopancreatectomías cefálicas,4 pancreatectomías totales, 2 pancreatectomías centrales,2 pancreatectomías parciales y una pancreatectomía distal. Se registróuna morbilidad del 40%, sin mortalidad operatoria, con unaestancia media de 10 días. En 5 casos la NPMI fue de tipo mixto,en 4 afectaba al conducto pancreático y en los 6 restantes a ramasaccesorias. Dos pacientes presentaron carcinoma in situ y 3carcinoma invasivo con ganglios negativos. Un paciente, sin carcinomainvasivo, falleció a los 66 meses por adenocarcinoma depáncreas. La supervivencia actuarial hasta recidiva o muerte fuede 105,133 meses; con un rango de seguimiento entre mes y medioy 9 años.Conclusiones: la NPMI tipo ductal y mixto exige la reseccióncompleta debido a la elevada incidencia de carcinoma invasivo ode lesiones precursoras de malignidad. Por su carácter multifocallos enfermos deben ser revisados a largo plazo. Existen controversiasen las NPMI tipo accesorio asintomáticas y menores de 3 cm(AU)

Background: intraductal papillary mucinous neoplasm(IPMN) shows a series of lesions which evolve from benign lesions–adenoma– to invasive carcinoma.Aim: to analyze the clinical and pathological results of 15 patientsdiagnosed of IPMN, and surgically treated according to theguidelines of International Consensus Conference.Material and method: a retrospective analysis of 15 patientssurgically treated between March 1993 and September 2009, accordingto the International Consensus recommendation. Demographic,diagnostic tools, surgical report, pathologic database andactuarial survival were analyzed with a follow-up from one and ahalf month through nine years.Results: 6 patients underwent pancreaticoduodenectomies,4 total pancreatectomies, 2 body or central pancreatectomies, 2 partialpancreatectomies (enucleation) and 1 distal pancreatectomy.A morbidity of 46 and 0% hospital mortality were assessed, witha median length hospital stay of 10 days. In five cases, the IPMNwas combined type (both main and branch pancreatic ducts involved)in four main duct-type and branch duct-type in the anothersix as well. Several atypia (IPMN carcinoma in situ) wasobserved in 2 patients and invasive carcinoma with negativelymph nodes was identified in 3 patients. A patient without invasivecarcinoma died at 66 months of follow-up for pancreas adenocarcinoma.The actuarial survival up to recurrence or deathwas 105,133 months with a range of follow-up from 1 monthand a half until 9 years.Conclusions: IPMN main duct or mixed type warrants completeresection due to its incidence of invasive carcinoma or precursorlesions of malignancy as well. Due to its multifocal pattern,patients should be followed in long-term surveillance. The managementof asymptomatic IPMN type branch less than 3 cm iscontroversial(AU)

[Laparoscopic bariatric surgery: proximal gastric bypass]. / Cirugía bariátrica laparoscópica: bypass gástrico proximal.

The spectacular increase in the prevalence of obesity in our society and the significant complications and comorbidities that it gives rise to have stimulated the interest of scientists and public in this pathology. Surgical treatment is at present the only efficient and lasting treatment for morbid obesity and in many cases it appreciably improves, and even definitively cures, associated complications such as the case of diabetes or hypertension. Amongst the different techniques of bariatric surgery, the gastric bypass (GBP) seems to be definitively establishing itself, since it offers an excellent balance between loss of weight (>70% of the excess), surgical risk and subsequent quality of life. The possibility of carrying out this technique employing a laparoscopic approach has improved its acceptance by doctors and patients while it has made it possible to reduce morbidity and mortality, length of hospital stay and costs. Proximal GBP is carried on those patients with an BMI <60 Kg/m2; for BMI >60 Kg/m2 the GBP employed is denominated distal. Between October 2003 and November 2005, our centre performed 55 laparoscopic proximal Roux-en-Y gastric bypasses via laparoscopy. These involved 42 women and 13 males with an average age of 44 years. The average BMI was 43.5 (35-55.8). The average basal weight was 116.15 Kg. There was no peroperative mortality, nor reinterventions. The BMI after 12 months was 28.4. The average basal weight was 74.2 Kg. Laparoscopic Roux-en-Y proximal gastric bypass is a safe and efficient technique for the treatment of morbid obesity.

[Hepatic and pancreatic laparoscopic surgery]. / Cirugía laparoscópica hepática y pancreática.

The development of laparoscopic surgery also includes the more complex procedures of abdominal surgery such as those that affect the liver and the pancreas. From diagnostic laparoscopy, accompanied by laparoscopic echography, to major hepatic or pancreatic resections, the laparoscopic approach has spread and today encompasses practically all of the surgical procedures in hepatopancreatic pathology. Without forgetting that the aim of minimally invasive surgery is not a better aesthetic result but the reduction of postoperative complications, it is undeniable that the laparoscopic approach has brought great benefits for the patient in every type of surgery except, for the time being, in the case of big resections such as left or right hepatectomy or resections of segments VII and VIII. Pancreatic surgery has undergone a great development with laparoscopy, especially in the field of distal pancreatectomy due to cystic and neuroendocrine tumours where the approach of choice is laparoscopic. Laparoscopy similarly plays an important role, together with echolaparoscopy, in staging pancreatic tumours, prior to open surgery or for indicating suitable treatment. In coming years, it is to be hoped that it will continue to undergo an exponential development and, together with the advances in robotics, it will be possible to witness a greater impact of the laparoscopic approach on the field of hepatic and pancreatic surgery.

[Laparoscopic biliary surgery]. / Cirugía laparoscópica biliar.

The following article briefly sets out the possible new protocols that can be applied in biliary pathology, arising from the changes brought about by the appearance of new techniques of laparoscopic biliary surgery. It offers a synthesis of the latest and most novel articles on surgical technique and management in different biliary pathologies such as choledocholithiasis and cholecystitis. It can be concluded that management will differ greatly, depending on the technical capacities of the centre that is called upon to deal with one of these pathologies. A standard protocol for everybody cannot thus be established at present. The differences between endoscopic retrograde cholangiopancreatography and intraoperative laparoscopic cholangiography have still to be demonstrated, it is not possible to make generalisations about whether one technique is more useful than the other. The same could be said about whether access to the main biliary path should be achieved through the cystic conduct or whether, on the contrary, a choledochotomy should be performed.

Cirugía bariátrica laparoscópica: bypass gástrico proximal / Laparoscopic bariatric surgery: proximal gastric bypass

El espectacular aumento en la prevalencia de la obesidad en nuestra sociedad y las importantes complicaciones y comorbilidades que origina ha despertado el interés de científicos y público en esta patología. El tratamiento quirúrgico es en la actualidad el único tratamiento eficaz y duradero para la obesidad mórbida y en muchos casos, mejora sensiblemente e incluso cura definitivamente complicaciones asociadas como es el caso de la diabetes o la hipertensión. De entre las diversas técnicas de cirugía bariátrica, parece imponerse definitvamente el by-pass gástrico (BPG), al ofrecer un excelente balance entre pérdida de peso (>70% del exceso) y riesgo quirúrgico y calidad de vida posterior. La posiblidad de realizar esta técnica mediante un abordaje laparoscópico ha mejorado su aceptación por parte de médicos y pacientes al tiempo que ha permitido disminuir morbimortalidad, estancia y costes. El BPG proximal se realiza en aquellos pacientes con un IMC <60 Kg/m2; para mayores se realiza uno denominado como distal. Entre octubre de 2003 y noviembre de 2005 se han realizado en nuestro centro 55 BPG proximales en Y de Roux vía laparoscópica. Se trata de 42 mujeres y 13 varones de edad media de 44 años. El IMC medio es de 43,5 (35-55,8). La media de peso basal es de 116,15 Kg. No hubo mortalidad peroperatoria ni reintervenciones. El IMC medio a los 12 meses es de 28,4. La media de peso basal es de 74,2 Kg. El BPG proximal en Y de Roux vía laparoscópica es una técnica segura y eficaz para el tratamiento de la obesidad mórbida

The spectacular increase in the prevalence of obesity in our society and the significant complications and comorbidities that it gives rise to have stimulated the interest of scientists and public in this pathology. Surgical treatment is at present the only efficient and lasting treatment for morbid obesity and in many cases it appreciably improves, and even definitively cures, associated complications such as the case of diabetes or hypertension. Amongst the different techniques of bariatric surgery, the gastric bypass (GBP) seems to be definitively establishing itself, since it offers an excellent balance between loss of weight (>70% of the excess), surgical risk and subsequent quality of life. The possibility of carrying out this technique employing a laparoscopic approach has improved its acceptance by doctors and patients while it has made it possible to reduce morbidity and mortality, length of hospital stay and costs. Proximal GBP is carried on those patients with an BMI 60 Kg/m2 the GBP employed is denominated distal. Between October 2003 and November 2005, our centre performed 55 laparoscopic proximal Roux-en-Y gastric bypasses via laparoscopy. These involved 42 women and 13 males with an average age of 44 years. The average BMI was 43.5 (35-55.8). The average basal weight was 116.15 Kg. There was no peroperative mortality, nor reinterventions. The BMI after 12 months was 28.4. The average basal weight was 74.2 Kg. Laparoscopic Roux-en-Y proximal gastric bypass is a safe and efficient technique for the treatment of morbid obesity

Cirugía laparoscópica hepática y pancreática / Hepatic and pancreatic laparoscopic surgery

El desarrollo de la cirugía laparoscópica incluye también los procedimientos más complejos de la cirugía abdominal como los que afectan al hígado y al páncreas. Desde la laparoscopia diagnóstica, acompañada de ecografía laparoscópica, hasta las resecciones mayores hepáticas o pancreáticas, el abordaje laparoscópico se ha ido extendiendo y abarca hoy la práctica totalidad de los procedimientos quirúrgicos en patología hepatopancreática. Sin olvidar nunca que el objetivo de la cirugía mínimamente invasiva no es un mejor resultado estético sino la disminución de las complicaciones postoperatorias, es innegable que el abordaje laparoscópico ha supuesto un gran beneficio para los pacientes en todo tipo de cirugías excepto, por el momento, en el caso de las grandes resecciones como la hepatectomía izquierda o derecha o las resecciones de segmentos VII y VIII.La cirugía pancreática ha tenido un gran desarrollo con la laparoscopia, especialmente en el campo de la pancreatectomía distal por tumores quísticos y neuroendocrinos, en los que el abordaje de elección es laparoscópico. Igualmente juega un importante papel la laparoscopia, junto con la ecolaparoscopia, en la estadificación de tumores pancreáticos, previa a la cirugía abierta o para indicar el tratamiento adecuado.En los próximos años, es de esperar que el desarrollo siga siendo exponencial, y, unido a los avances en robótica, permitirá asistir todavía a un mayor impacto del abordaje laparoscópico en el campo de la cirugía hepática y pancreática

The development of laparoscopic surgery also includes the more complex procedures of abdominal surgery such as those that affect the liver and the pancreas. From diagnostic laparoscopy, accompanied by laparoscopic echography, to major hepatic or pancreatic resections, the laparoscopic approach has spread and today encompasses practically all of the surgical procedures in hepatopancreatic pathology. Without forgetting that the aim of minimally invasive surgery is not a better aesthetic result but the reduction of postoperative complications, it is undeniable that the laparoscopic approach has brought great benefits for the patient in every type of surgery except, for the time being, in the case of big resections such as left or right hepatectomy or resections of segments VII and VIII. ;;Pancreatic surgery has undergone a great development with laparoscopy, especially in the field of distal pancreatectomy due to cystic and neuroendocrine tumours where the approach of choice is laparoscopic. Laparoscopy similarly plays an important role, together with echolaparoscopy, in staging pancreatic tumours, prior to open surgery or for indicating suitable treatment. ;;In coming years, it is to be hoped that it will continue to undergo an exponential development and, together with the advances in robotics, it will be possible to witness a greater impact of the laparoscopic approach on the field of hepatic and pancreatic surgery

Cirugía laparoscópica biliar / Laparoscopic biliary surgery

El siguiente artículo trata de exponer brevemente los posibles nuevos protocolos que se pueden aplicar en la patología biliar, a raíz de los cambios acaecidos con la aparición de las nuevas técnicas de cirugía biliar laparoscópica. Pretende realizar una síntesis de los últimos y más novedosos artículos sobre técnica quirúrgica y manejo en distintas patología biliares tales como coledocolitiasis o colecistitis.Se puede concluir que el manejo diferirá mucho según las capacidades técnicas de un centro sobre el que recaiga una de estas patologías. Por tanto, actualmente no se puede imponer un protocolo estándar para todo el mundo.Las diferencias entre colangiopancreatografía retrógrada endoscópica y colangiografía intraoperatoria laparoscópica, todavía están por demostrar, no pudiéndose generalizar sobre si una técnica tiene más indicación que la otra. Lo mismo se podría decir sobre si el acceso a la vía biliar principal debe hacerse desde el conducto cístico o por el contrario debe realizarse una coledocotomía

The following article briefly sets out the possible new protocols that can be applied in biliary pathology, arising from the changes brought about by the appearance of new techniques of laparoscopic biliary surgery. It offers a synthesis of the latest and most novel articles on surgical technique and management in different biliary pathologies such as Choledocholithiasis and cholecystitis. ;;It can be concluded that management will differ greatly, depending on the technical capacities of the centre that is called upon to deal with one of these pathologies. A standard protocol for everybody cannot thus be established at present. ;;Teh differences between endoscopic retrograde cholangiopancreatography and intraoperative laparoscopic cholangiography have still to be demonstrated, it is not possible to make generalisations about whether one technique is more useful than the other. The same could be said about whether access to the main biliary path should be achieved through the cystic conduct or whether, on the contrary, a choledochotomy should be performed