[Parastomal hernia in Bricker urinary diversion as a reversible cause of obstructive uropathy: An exceptional complication.] / Hernia paraestomal en derivación urinaria tipo Bricker como causa reversible de uropatía obstructiva: una complicación excepcional.

OBJECTIVE: Parastomal hernia in patientswith ileal urinary diversion is insufficiently described in theliterature, and among its complications, the presence ofurinary obstruction is not usually reported. METHODS: We present a 74-year-old male with a Brickertype urinary diversion. He presented urinary infections withCT scan showing hydronephrosis with obstruction of theileal conduit probably related to a parastomal hernia. Thehernia growth runs in parallel to the ureterohydronephrosis,so we performed a hernioplasty to solve the obstruction. CTat 6 months shows no urinary obstruction and no hernia recurrence.No hydronephrosis in the follow-up at 14 months. RESULTS: We reviewed the literature and we only foundthree articles that related parastomal hernia in Bricker toureterohydronephrosis, although none of them proved thisrelationship with the correction of the urinary obstructionafter hernia surgery. CONCLUSIONS: Parastomal hernia should be consideredin the differential diagnosis of obstructive uropathy in patientswith ileal urinary diversion.

OBJETIVO: La hernia paraestomal en pacientescon derivación urinaria ileal está insuficientementedescrita en la literatura, y entre sus complicaciones no semenciona la presencia de uropatía obstructiva. MÉTODO: Presentamos caso de varón de 74 años conreconstrucción tipo Bricker. Presenta infecciones urinariascon TAC que muestra dilatación urinaria, con obstrucción anivel de la derivación en probable relación con una herniaparaestomal. La hernia progresa de forma paralela a laureterohidronefrosis, por lo que se realiza eventroplastiaparaestomal. En TAC a los 6 meses: ausencia de dilataciónde vía urinaria y de recidiva herniaria. No hidronefrosisa los 14 meses. RESULTADOS: Se realiza revisión de la literatura, encontrándosesólo tres artículos que relacionen hernia paraestomalen Bricker con ureterohidronefrosis, aunque ningunodemuestra esta relación causal con la corrección de laobstrucción tras la cirugía de la hernia. CONCLUSIONES: La hernia paraestomal debe ser tenidaen cuenta en el diagnóstico diferencial de la uropatía obstructivaen paciente con derivación tipo Bricker.

Hernia paraestomal en derivación urinaria tipo bricker como causa reversible de uropatía obstructiva: una complicación excepcional / Parastomal hernia in bricker type urinary diversion as a reversible cause of obstructive uropathy: an exceptional complication

Objetivo: La hernia paraestomal en pacientes con derivación urinaria ileal está insuficientementedescrita en la literatura, y entre sus complicaciones no semenciona la presencia de uropatía obstructiva. Método: Presentamos caso de varón de 74 años conreconstrucción tipo Bricker. Presenta infecciones urinariascon TAC que muestra dilatación urinaria, con obstrucción anivel de la derivación en probable relación con una herniaparaestomal. La hernia progresa de forma paralela a laureterohidronefrosis, por lo que se realiza eventroplastiaparaestomal. En TAC a los 6 meses: ausencia de dilatación de vía urinaria y de recidiva herniaria. No hidronefrosis a los 14 meses. Resultados: Se realiza revisión de la literatura, encontrándose sólo tres artículos que relacionen hernia paraestomal en Bricker con ureterohidronefrosis, aunque ningunodemuestra esta relación causal con la corrección de laobstrucción tras la cirugía de la hernia. Conclusiones: La hernia paraestomal debe ser tenidaen cuenta en el diagnóstico diferencial de la uropatía obstructiva en paciente con derivación tipo Bricker.(AU)

Objetive: Parastomal hernia in patientswith ileal urinary diversion is insufficiently described in theliterature, and among its complications, the presence ofurinary obstruction is not usually reported. Methods: We present a 74-year-old male with a Brickertype urinary diversion. He presented urinary infections withCT scan showing hydronephrosis with obstruction of theileal conduit probably related to a parastomal hernia. Thehernia growth runs in parallel to the ureterohydronephrosis,so we performed a hernioplasty to solve the obstruction. CTat 6 months shows no urinary obstruction and no hernia recurrence. No hydronephrosis in the follow-up at 14 months. Results: We reviewed the literature and we only foundthree articles that related parastomal hernia in Bricker toureterohydronephrosis, although none of them proved thisrelationship with the correction of the urinary obstructionafter hernia surgery. Conclusions: Parastomal hernia should be consideredin the differential diagnosis of obstructive uropathy in pa-tients with ileal urinary diversion.(AU)

Influence of sarcopenia in major pancreatic surgery. A systematic review of the literature / Influencia de la sarcopenia en cirugía pancreática. Revisión sistemática de la literatura

Post-operative morbidity of pancreatectomies occurs in up to 40-50% of patients, even in modern series. There is a need to find a simple scale in order to identify patients with increased risk of developing major post-operative complications after pancreatic resections. Many studies have been published on sarcopenia and surgical outcomes. Aspects of sarcopenia are presented, along with a systematic review using PRISMA guidelines, in order to search for articles about sarcopenia and pancreatic surgery. The impact of sarcopenia on morbidity and mortality in pancreatic resections is still unclear. The studies presented have been carried out over long periods of time, and many of them compare patients with different diseases. There are also different definitions of sarcopenia, and this can influence the results, as some of the reviewed articles have already shown. It is necessary to unify criteria, both in the definition and in the cut-off values. Prospective studies and consensus on sarcopenia diagnosis should be achieved

La morbilidad postoperatoria de las pancreatectomías alcanza hasta el 40-50% de los pacientes, incluso en series modernas. Es necesaria una escala simple, capaz de identificar a los pacientes con mayor riesgo de desarrollar complicaciones postoperatorias después de las resecciones pancreáticas. Se han publicado múltiples estudios sobre sarcopenia y resultados quirúrgicos. En este trabajo revisamos aspectos sobre la sarcopenia, realizando una revisión sistemática, de acuerdo con las guías PRISMA, buscando artículos sobre sarcopenia y cirugía pancreática. El impacto de la sarcopenia en la morbimortalidad tras pancreatectomías aún no está claro. Los estudios presentados se han llevado a cabo en largos períodos de tiempo, muchos de ellos comparan pacientes con diferentes enfermedades. Además, la definición de sarcopenia es variada, pudiendo influir en los resultados como ya demuestran algunos de los artículos revisados. Deben realizarse estudios prospectivos, siendo necesario también unificar criterios en la definición y puntos de corte de la sarcopenia

Influence of sarcopenia in major pancreatic surgery. A systematic review of the literature.

Post-operative morbidity of pancreatectomies occurs in up to 40-50% of patients, even in modern series. There is a need to find a simple scale in order to identify patients with increased risk of developing major post-operative complications after pancreatic resections. Many studies have been published on sarcopenia and surgical outcomes. Aspects of sarcopenia are presented, along with a systematic review using PRISMA guidelines, in order to search for articles about sarcopenia and pancreatic surgery. The impact of sarcopenia on morbidity and mortality in pancreatic resections is still unclear. The studies presented have been carried out over long periods of time, and many of them compare patients with different diseases. There are also different definitions of sarcopenia, and this can influence the results, as some of the reviewed articles have already shown. It is necessary to unify criteria, both in the definition and in the cut-off values. Prospective studies and consensus on sarcopenia diagnosis should be achieved.

Reingresos tras colecistectomía laparoscópica. ¿Influye la realización de una CPRE previa a la colecistectomía? / Readmission rates after laparoscopic cholecystectomy: are they affected by ERCP prior to surgery?

Objetivo: el objetivo de este estudio es evaluar los motivos y el momento de reingreso hospitalario después de colecistectomía comparando los pacientes en base a la realización de una colangiopancreatografía retrógrada endoscópica (CPRE) previa o no. Método: retrospectivamente, se revisaron todos los pacientes sometidos a colecistectomía en el Servicio de Cirugía General y del Aparato Digestivo del Hospital Universitario de Guadalajara entre enero de 2011 y diciembre de 2016. Se incluyeron pacientes sometidos a colecistectomía reingresados en cualquier servicio del hospital en los 90 días posteriores a la cirugía. Los criterios de exclusión fueron: colecistectomía asociada a otros procedimientos, patología oncológica activa en el momento de la colecistectomía, ingresos programados previamente por otra patología no relacionada y presencia de histología tumoral en la pieza de colecistectomía. Resultados: se estudiaron 1.714 pacientes, de los cuales 80 pacientes fueron readmitidos durante los 90 días posteriores al alta de la colecistectomía. La tasa de readmisión fue del 4,67%. La realización de CPRE previa a la cirugía se asoció a un aumento de la morbilidad postoperatoria (40% vs. 21,54%). La realización previa de una CPRE disminuyó la aparición de complicaciones de tipo biliar en los 90 días posteriores a la colecistectomía. Se observó también un aumento del número de días hasta que se produce el reingreso en estos pacientes (22 días con CPRE vs. siete días sin CPRE). Conclusión: en nuestra serie, los pacientes que precisaron una CPRE previa a la colecistectomía presentaron mayor morbilidad postoperatoria. Sin embargo, los pacientes que no precisaron CPRE presentaron más complicaciones biliares y tuvieron reingresos más tempranos

Aim: the aim of this study was to assess the reasons for and the time of hospital readmissions after cholecystectomy, according to whether an endoscopic retrograde cholangiopancreatography (ERCP) was performed. Method: all patients that underwent cholecystectomy at the Service of Digestive Diseases and General Surgery of the Hospital Universitario de Guadalajara between January 2011 and December 2016 were retrospectively reviewed. Patients who underwent cholecystectomy and were readmitted to any hospital service within 90 days of surgery were included. The following cases were excluded: patients that underwent cholecystectomy in combination with other procedures, an active oncological pathology at the time of cholecystectomy, admissions previously scheduled for another unrelated pathology and those with tumor histology in the cholecystectomy specimen. Results: of a total of 1,714 patients, 80 were readmitted within 90 days of discharge after cholecystectomy, which equates to a readmission rate of 4.6%. The performance of an ERCP prior to surgery was associated with an increase in postoperative morbidity (40% vs 21.54%). A prior ERCP reduced the rate of biliary complications during the 90 days after cholecystectomy. Furthermore, there was an increase in the number of days prior to readmission in these cases, with a mean period of 22 days with ERCP vs seven days without ERCP. Conclusion: patients in our series who required an ERCP prior to cholecystectomy had a greater postoperative morbidity. However, those that did not require ERCP had more biliary complications and were readmitted earlier

Intrabiliary metastases in colorectal cancer: a systematic review.

BACKGROUND: Liver metastases emerge during the course of colorectal cancer (CRC) in 25-50% of patients. A small proportion of patients present intrabiliary growth. The absence of large series means that little is known about intrabiliary metastasis (IBM), its radiological diagnosis, the most suitable surgical techniques, and its prognostic implications. METHODS: A systematic search without limits was performed. The studies selected included patients with a diagnosis of CRC and associated IBM, either synchronous or metachronous. RESULTS: Of 40 studies selected, 30 were case reports and 10 case series. The median time between diagnosis and IBM was 46.7 months (range 0-180). Most CRC metastases are CK7-/CK20+. Surgical treatment performed ranged from endoscopic resection to major hepatic resections combined with pancreatectomies. It seems that patients with IBM have a better survival than patients without this metastasis. CONCLUSION: In a patient with a history of CRC presenting dilatation of the bile duct, IBM should be considered. More studies are needed to determine the most appropriate type of liver resection. It is also necessary to standardize the definition and terminology of this pathology, since the existing definitions may cause confusion and make it difficult to carry out case studies and case series.

Readmission rates after laparoscopic cholecystectomy: are they affected by ERCP prior to surgery?

AIM: the aim of this study was to assess the reasons for and the time of hospital readmissions after cholecystectomy, according to whether an endoscopic retrograde cholangiopancreatography (ERCP) was performed. METHOD: all patients that underwent cholecystectomy at the Service of Digestive Diseases and General Surgery of the Hospital Universitario de Guadalajara between January 2011 and December 2016 were retrospectively reviewed. Patients who underwent cholecystectomy and were readmitted to any hospital service within 90 days of surgery were included. The following cases were excluded: patients that underwent cholecystectomy in combination with other procedures, an active oncological pathology at the time of cholecystectomy, admissions previously scheduled for another unrelated pathology and those with tumor histology in the cholecystectomy specimen. RESULTS: of a total of 1,714 patients, 80 were readmitted within 90 days of discharge after cholecystectomy, which equates to a readmission rate of 4.6%. The performance of an ERCP prior to surgery was associated with an increase in postoperative morbidity (40% vs 21.54%). A prior ERCP reduced the rate of biliary complications during the 90 days after cholecystectomy. Furthermore, there was an increase in the number of days prior to readmission in these cases, with a mean period of 22 days with ERCP vs seven days without ERCP. CONCLUSION: patients in our series who required an ERCP prior to cholecystectomy had a greater postoperative morbidity. However, those that did not require ERCP had more biliary complications and were readmitted earlier.

Los top 100. Revisión de los artículos más citados en cirugía / The top 100: A review of the most cited articles in Surgery

Introducción: Llevamos a cabo un estudio de los 100 artículos más citados en las 5 revistas quirúrgicas con mayor factor de impacto según Journal Citation Report. Métodos: Seleccionamos las 5 revistas con mayor factor de impacto según JCR en el año 2015 (Annals of Surgery, British Journal of Surgery, JAMA Surgery, Surgery, and Journal of the American College of Surgeons). Realizamos una búsqueda de todos los artículos publicados en estas cinco revistas a fecha de enero de 2017 y seleccionamos los 100 artículos más citados según Web of Science. Evaluamos número de citaciones, año de publicación, tipo de artículo, país y hospital de procedencia, área de interés y número de autores. Resultados: La mediana del número de citaciones del top 100 de citaciones es de 490. El 20% se han publicado desde el año 2000. De forma general, el 70% son originales, el 8% ensayos aleatorizados, 11% revisiones, 1% metaanálisis y el 11% otro tipo de estudios. Más del 60% provienen de EE. UU. y el área hepatopancreatobiliar es la más frecuentemente abordada (33%). Conclusiones: El artículo incluido en el top 100 de artículos más citados en cirugía tiende a ser un artículo original sobre el área hepatobiliopancreática y procedente de EE. UU. La revista Annals of Surgery tiene el doble de citaciones que el resto de revistas estudiadas

Introduction: We performed a study of the top 100 most cited articles in the five general surgery journals with the highest impact according to Journal Citation Report. Methods: We selected the five journals with the highest impact in 2015: Annals of Surgery, British Journal of Surgery, JAMA Surgery, Surgery, and Journal of the American College of Surgeons. In January 2017, using the Web of Science application, we performed a search of all articles published by these journals and identified the 100 most cited articles (top 100). We evaluated the number of citations, year of publication, type of article, country and hospital of the article, area of interest and number of authors. Results: The median number of citations per top 100 paper was 490. Twenty percent of the top 100 papers have been published since 2000. Overall, 70% are original papers, 8% randomized control trials, 11% reviews, 1% meta-analyses and 11% other subtypes. There are 13% proceedings papers. Sixty-one percent are from the US. The most frequently discussed topic is hepato-pancreato-biliary surgery (33%). Conclusions: The top 100 most cited articles tend to be original articles describing studies carried out in the US, reporting significant surgical breakthroughs. Hepato-pancreato-biliary surgery is the most common subject area. Annals of Surgery had twice as many citations as the other journals studied. The archetypal article of the Top15 most cited is an original paper published in the twentieth century, with an average of 2000 citations

The top 100: A review of the most cited articles in Surgery. / Los top 100. Revisión de los artículos más citados en cirugía.

INTRODUCTION: We performed a study of the top 100 most cited articles in the five general surgery journals with the highest impact according to Journal Citation Report. METHODS: We selected the five journals with the highest impact in 2015: Annals of Surgery, British Journal of Surgery, JAMA Surgery, Surgery, and Journal of the American College of Surgeons. In January 2017, using the Web of Science application, we performed a search of all articles published by these journals and identified the 100 most cited articles (top 100). We evaluated the number of citations, year of publication, type of article, country and hospital of the article, area of interest and number of authors. RESULTS: The median number of citations per top 100 paper was 490. Twenty percent of the top 100 papers have been published since 2000. Overall, 70% are original papers, 8% randomized control trials, 11% reviews, 1% meta-analyses and 11% other subtypes. There are 13% proceedings papers. Sixty-one percent are from the US. The most frequently discussed topic is hepato-pancreato-biliary surgery (33%). CONCLUSIONS: The top 100 most cited articles tend to be original articles describing studies carried out in the US, reporting significant surgical breakthroughs. Hepato-pancreato-biliary surgery is the most common subject area. Annals of Surgery had twice as many citations as the other journals studied. The archetypal article of the Top15 most cited is an original paper published in the twentieth century, with an average of 2000 citations.

Laparoscopic gastrojejunostomy for gastric outlet obstruction in patients with unresectable hepatopancreatobiliary cancers: A personal series and systematic review of the literature.

The major symptoms of advanced hepatopancreatic-biliary cancer are biliary obstruction, pain and gastric outlet obstruction (GOO). For obstructive jaundice, surgical treatment should de consider in recurrent stent complications. The role of surgery for pain relief is marginal nowadays. On the last, there is no consensus for treatment of malignant GOO. Endoscopic duodenal stents are associated with shorter length of stay and faster relief to oral intake with more recurrent symptoms. Surgical gastrojejunostomy shows better long-term results and lower re-intervention rates, but there are limited data about laparoscopic approach. We performed a systematic review of the literature, according PRISMA guidelines, to search for articles on laparoscopic gastrojejunostomy for malignant GOO treatment. We also report our personal series, from 2009 to 2017. A review of the literature suggests that there is no standardized surgical technique either standardized outcomes to report. Most of the studies are case series, so level of evidence is low. Decision-making must consider medical condition, nutritional status, quality of life and life expectancy. Evaluation of the patient and multidisciplinary expertise are required to select appropriate approach. Given the limited studies and the difficulty to perform prospective controlled trials, no study can answer all the complexities of malignant GOO and more outcome data is needed.

Pancreatic Neuroendocrine Tumors and Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Systematic Review.

OBJECTIVES: This study aimed to identify factors that explain the association of intraductal papillary mucinous neoplasms-pancreatic neuroendocrine tumors (IPMNs-PNETs), radiological characteristics, and factors that might guide therapy. METHODS: We performed a systematic review of the literature to search for articles on concurrent IPMN-PNET, mixed endocrine-exocrine pancreatic tumors, and/or PNET with an intraductal growth pattern. RESULTS: A review of the literature suggests that there is some confusion about association of IPMNs-PNETs. Regarding this association, the studies collected data from 32 patients. Eleven patients presented concurrent tumors, 9 mixed endocrine-exocrine tumors, and no data were available in the remaining 7. In addition, the relationship IPMN-PNET focuses not only on the coexistence of the 2 lesions, but also on the possibility of the intraductal growth of the endocrine lesion. In the literature, in 4 cases, the preoperative radiological diagnosis had been IPMN. CONCLUSIONS: Intraductal papillary mucinous neoplasms and PNETs may be associated in a number of scenarios. The association may be due to the concurrent existence of independent lesions, may be a mixed endocrine-exocrine tumor, or may be due to intraductal growth of the endocrine lesion. But the literature is confusing. It is not known whether the association is accidental or whether there is an etiological reason. Further studies are needed to investigate this scenario.

Ninety-day readmissions after inpatient cholecystectomy: A 5-year analysis.

AIM: To determine the incidence of readmission after cholecystectomy using 90 d as a time limit. METHODS: We retrospectively reviewed all patients undergoing cholecystectomy at the General Surgery and Digestive System Service of the University Hospital of Guadalajara, Spain. We included all patients undergoing cholecystectomy for biliary pathology who were readmitted to hospital within 90 d. We considered readmission to any hospital service as cholecystectomy-related complications. We excluded ambulatory cholecystectomy, cholecystectomy combined with other procedures, oncologic disease active at the time of cholecystectomy, finding of malignancy in the resection specimen, and scheduled re-admissions for other unrelated pathologies. RESULTS: We analyzed 1423 patients. There were 71 readmissions in the 90 d after discharge, with a readmission rate of 4.99%. Sixty-four point seven nine percent occurred after elective surgery (cholelithiasis or vesicular polyps) and 35.21% after emergency surgery (acute cholecystitis or acute pancreatitis). Surgical non-biliary causes were the most frequent reasons for readmission, representing 46.48%; among them, intra-abdominal abscesses were the most common. In second place were non-surgical reasons, at 29.58%, and finally, surgical biliary reasons, at 23.94%. Regarding time for readmission, almost 50% of patients were readmitted in the first week and most second readmissions occurred during the second month. Redefining the readmissions rate to 90 d resulted in an increase in re-hospitalization, from 3.51% at 30 d to 4.99% at 90 d. CONCLUSION: The use of 30-d cutoff point may underestimate the incidence of complications. The current tendency is to use 90 d as a limit to measure complications associated with any surgical procedure.

Colangiocarcinoma hiliar y sarcoidosis ganglionar periportal. Una asociación excepcional / Hilar cholangiocarcinoma and periportal lymph node sarcoidosis. An exceptional association

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Trombosis portal y necrosis hepática: complicación excepcional de la pancreatitis aguda / Portal thrombosis and liver necrosis: Exceptional complication of acute pancreatitis

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[Extrahepatic and extrapulmonary hydatidosis]. / Hidatidosis extrahepática y extrapulmonar.

BACKGROUND: Cystic echinococcosis is a zoonosis caused by larvae of the parasite Echinococcus that is endemic in many countries of the Mediterranean area. It can affect any organ, with the most common sites being liver (70%) and lung (20%). Splenic hydatid disease, despite being rare, is the third most common location. Other locations such as bone, skin, or kidney are exceptional. OBJECTIVE: To present our experience in extrahepatic and extrapulmonary hydatidosis. MATERIAL AND METHODS: Period: May 2007-December 2014. Health area: 251,000 inhabitants. During that period, a total of 136 patients with hydatid disease were evaluated in our Hepato-pancreatic-biliary Surgery Unit. Extrahepatic and extrapulmonary hydatid disease was found in 18 (13%) patients. A retrospective review was performed on all medical records, laboratory results, serology, diagnostic methods, and therapeutic measurements of all patients. An abdominal ultrasound and CT, as well as hydatid serology was also performed on all patients. RESULTS: The mean age of the patients was 44.5 years, with a range of 33-80 years. Half the patients (50%) had concomitant hepatic echinococcosis. Of the 18 patients with hydatid disease, 13 underwent surgery (radical surgery in 12 cases), and one underwent (endoscopic retrograde cholangiopancreatography)+puncture, aspiration, injection and re-aspiration. The remaining 4did not have surgery due to patient refusal (3), or advanced cancer (1). No recurrences have been observed. CONCLUSION: The best surgical treatment in these cases is closed total cystectomy to prevent recurrence, except in the spleen where splenectomy is preferred. Conservative techniques are indicated in cases of multiple hydatid disease and in patients with high surgical risk.

[Littré hernia: an unusual cause of intestinal obstruction.

BACKGROUND: Littre's hernia is the presence of a Meckel diverticulum within an orifice in the abdominal wall. There are few cases published in the literature and its frequency is not well described. CLINICAL CASE: We present the case of a 74-year-old patient who arrived at the emergency service with clinical signs of intestinal obstruction caused by an incarcerated right inguinal hernia. Emergency surgery was performed using a preperitoneal approach. Within the hernia, 5 cm of small bowel containing a Meckel diverticulum was found. Therefore, we decided to extirpate the diverticulum and repair the hernia placing a polypropylene mesh. CONCLUSIONS: Meckel diverticulum is the persistence of the omphalomesenteric duct. It is usually asymptomatic, producing bleeding, infection or intestinal obstruction as the main symptoms.