Prospective Randomized Trial Comparing HAL-RAR Versus Excisional Hemorrhoidectomy: Postoperative Pain, Clinical Outcomes, and Quality of Life.

PURPOSE: To compare outcomes of hemorrhoid artery ligation with recto-anal repair (HAL-RAR) and excisional hemorrhoidectomy (EH). The primary objective was to compare postoperative pain, and the secondary objectives were the following: symptom resolution rates, postoperative morbidity, recurrence, and changes in quality of life. METHOD: Prospective randomized controlled trial, including 40 patients with grades III-IV hemorrhoids who were allocated 1:1 to HAL-RAR and EH. Follow-up evaluation was performed at 15 days, 30 days, 6 months, 12 months, and then annually. Pain was measured using a Visual Analogic Scale and was self-recorded by patients. Quality of life was measured with Short Form Survey-36 questionnaire. RESULTS: Postoperative pain was lower in the HAL-RAR group during the first 30 postoperative days. Moreover, from day 7 onward more patients in the HAL-RAR group reported complete absence of pain (Visual Analogic Scale score = 0). Globally, symptom resolution was significantly higher ( P = .03) in the HAL-RAR group at day 15. Bleeding resolution was observed earlier in the HAL-RAR group than in the EH group ( P = .04), but no differences in the resolution of prolapse, itching, and soiling were observed during the 30-day follow-up. After a mean follow-up of 15 months (range 12-27 months), no differences in postoperative morbidity and no recurrences were observed. An improvement was observed in all sections evaluated by the Short Form Survey-36 questionnaire with both techniques. CONCLUSION: HAL-RAR provokes less postoperative pain during a shorter period than EH and achieves resolution of hemorrhoidal symptoms with less postoperative complaints. No differences in morbidity and recurrence rate were observed after 12 months of follow-up.

Resultados tras resección hepática laparoscópica: una opción adecuada en patología maligna / Results after laparoscopic liver resection: An appropriate option in malignant disease

Introducción El abordaje laparoscópico no ha tenido una gran difusión en la cirugía hepática, aunque ha demostrado ser seguro y factible en pacientes seleccionados incluso en enfermedad maligna. Se presenta la experiencia y resultados en el tratamiento de la enfermedad hepática maligna por laparoscopia. Material y método Entre febrero de 2002 y mayo de 2011 se realizaron 71 resecciones hepáticas laparoscópicas, 43 por enfermedad maligna (solo se incluyó a pacientes con más de un año de seguimiento). La edad media fue de 63 años y el 58% fueron varones. El 49% de las lesiones estaban situadas en los segmentos ii - iii . Se realizaron 30 segmentectomías, 7 resecciones limitadas y 6 hepatectomías mayores. Resultados El tiempo operatorio fue de 163 min. Hubo 3 conversiones. Cinco casos (11%) fueron transfundidos. La ingesta se inició a las 32 h y la estancia hospitalaria fue de 6,7 días. No hubo reintervenciones y sí un caso de mortalidad. Nueve pacientes (21%) presentaron complicaciones. El número medio de lesiones resecadas fue 1,2, con un tamaño de 3,5 cm. Todas las resecciones fueron R0. La supervivencia fue del 69 y del 43,5% a los 36 y 60 meses en metástasis hepáticas de cáncer colorrectal (MHCCR), y del 89 y 68% a los 36 y 60 meses en hepatocarcinoma (HCC).Conclusiones La resección hepática por laparoscopia en enfermedad maligna es factible y segura. Debe cumplir los mismos preceptos oncológicos que la cirugía abierta. En pacientes seleccionados ofrece resultados oncológicos a largo plazo similares a los obtenidos en cirugía abierta (AU)

Introduction Treatment of oesophageal cancer with curative intent requires a multidisciplinary approach. Neoadjuvant therapy, the radicality of resection and extension of lymphadenectomy have been associated with increased operative morbidity and mortality. The aim of this study was to assess the results of surgical treatment of oesophageal cancer since the presence of an interdisciplinary esophagogastric tumour board. Methods Patients with cancer of the oesophagus and oesophagogastric junction who underwent oesophagectomy between January 2005 and March 2012 were included in this retrospective study. Data concerning type of resection, postoperative complications, mortality and survival were analysed. Results Of the 392 patients with a diagnosis of oesophageal cancer over the study period, 100 underwent oesophagectomy. Seventy-four patients received neoadjuvant treatment. Eighty-two patients underwent transthoracic resection while a transhiatal was used in 10 patients. Colon interposition was required in 8 cases. An R0 resection was achieved in 98 patients. Anastomotic leaks developed in 15 patients, 9 were intrathoracic and 6 were cervical. Postoperative morbidity occurred in 42% of patients, and intra-hospital and 90-day mortality was 2%. Median length of hospital stay was 16 days. The respective actuarial survival at 1 and 5 years were 82% and 56%.ConclusionsSurgical treatment with curative intention for oesophageal cancer is only possible in a quarter of patients diagnosed. The high morbidity rate was mainly due to intrathoracic complications (AU)

[Results after laparoscopic liver resection: an appropriate option in malignant disease]. / Resultados tras resección hepática laparoscópica: una opción adecuada en patología maligna.

INTRODUCTION: The laparoscopic approach is not yet widely used in liver surgery, but has proven to be safe and feasible in selected patients even in malignant disease. The experience and results of a hepato-pancreato-biliary (HPB) surgery unit in the treatment of malignant liver disease by laparoscopic approach is presented. MATERIAL AND METHODS: Between February 2002 and May 2011, 71 laparoscopic liver resections were performed, 43 for malignant disease (only patients with more than one year of follow-up were included). Mean age was 63 years old and 58% of the patients were male. Forty-nine per cent of the lesions were located in segments ii-iii. Thirty segmentectomies were performed, 7 limited resections and 6 major hepatectomies. RESULTS: The median operative time was 163 min. There were 3 conversions. Five cases (11%) required blood transfusion. The oral intake began at 32 h and the median hospital stay was 6.7 days. There were no reoperations and there was one case of mortality. Nine patients (21%) had postoperative complications. The mean number of resected lesions was 1.2, with an average size of 3.5 cm. All resections were R0. The median survival after resection of colorectal liver metastases (CLM) was 69% and 43.5% at 36 and 60 months, respectively, and 89% and 68% at 36 and 60 months, respectively, in hepatocellular carcinoma (HCC). CONCLUSION: The laparoscopic liver resection in malignant disease is feasible and safe in selected patients. The same oncological rules as for open surgery should be followed. In selected patients it offers similar long-term oncological results as open surgery.

Estudio prospectivo aleatorizado comparativo entre colecistectomía laparoscópica versus colecistectomía por puerto único en régimen ambulatorio / A randomised prospective comparative study between laparoscopic cholecystectomy and single port cholecystectomy in a major outpatient surgery unit

Introducción: El objetivo de este estudio es comparar la colecistectomía laparoscópica (CL) con la realizada a través de una incisión única umbilical (SILC) en régimen de cirugía mayor ambulatoria (CMA).Material y métodos De octubre 2009 a junio 2011 se aleatorizaron prospectivamente 50 pacientes con colelitiasis sintomática; a 26 se les realizó SILC y a 24 CL en CMA. Se analizó el dolor postoperatorio, requerimientos de analgesia, presencia de náuseas y/o vómitos, tiempo operatorio, complicaciones, tasa de éxito de ambulatorización y resultados estéticos. Resultados No hubo diferencias en cuanto al dolor postoperatorio, la analgesia de rescate, náuseas y/o vómitos y tiempo operatorio (SILC 54 ± 21 min, CL 48,5 ± 17 min, p = 0,29). Hubo un caso de morbilidad en el grupo SILC que requirió reintervención. Se completó el procedimiento ambulatoriamente en el 77% de pacientes del grupo SILC y en el 83% del grupo CL. Seis pacientes del grupo SILC (23%) y 4 del grupo CL (17%) permanecieron ingresados más de 24 h (p = 0,58). Los resultados estéticos fueron valorados subjetivamente como muy bueno en el grupo SILC y bueno en el grupo CL. Conclusión La colecistectomía SILC es factible y segura comparándola con colecistectomía laparoscópica en pacientes seleccionados y obtiene resultados similares al aplicarla en CMA. Se requieren estudios más amplios para determinar los beneficios reales de este abordaje antes de recomendarlo como técnica rutinaria. Con mayor experiencia de los equipos quirúrgicos y mayor concienciación de los pacientes posiblemente aumente el número de candidatos a colecistectomía ambulatoria (AU)

Introduction: The aim of this study is to compare laparoscopic cholecystectomy (LC) with that performed using single umbilical incision laparoscopic surgery (SILS) in a major outpatient surgery (MOS) unit. Material and methods: A total of 50 patients with symptomatic cholelithiasis were prospectively randomised between October 2009 and June 2011, with 26 of them subjected to SILS, and 24 to CL. The variables analysed were, postoperative pain, analgesia requirements, presence of nausea/vomiting, operation time, complications, outpatient success rate, and aesthetic results. Results: There were no differences as regards postoperative pain, analgesia rescue, nausea/vomiting, or operation time (SILS 54 21 min, CL 48.5 17 min, P = .29). There was one case of morbidity in the SILS group which required further surgery. The outpatient surgical procedure was completed in 77% of patients of the SILS group, and in 83% of the CL group. Six patients (23%) from the SILS group, and 4 (17%) from the CL group remained in the unit for more than 24 h (P = .58). The aesthetic results were subjectively assessed as ‘‘very good’’ in the SILS group, and ‘‘good’’ in the CL group. Conclusion: SILS cholecystectomy is feasible and safe when comparing it with laparoscopiccholecystectomy in selected patients, and obtains similar results when performed in a MOS unit. Larger studies are needed to determine the real benefits of this approach beforere commending it as a routine technique. With more experienced surgical teams and greater awareness of the patients could possibly increase the number of candidates for outpatient cholecystectomy (AU)

[A randomised prospective comparative study between laparoscopic cholecystectomy and single port cholecystectomy in a major outpatient surgery unit]. / Estudio prospectivo aleatorizado comparativo entre colecistectomía laparoscópica versus colecistectomía por puerto único en régimen ambulatorio.

INTRODUCTION: The aim of this study is to compare laparoscopic cholecystectomy (LC) with that performed using single umbilical incision laparoscopic surgery (SILS) in a major outpatient surgery (MOS) unit. MATERIAL AND METHODS: A total of 50 patients with symptomatic cholelithiasis were prospectively randomised between October 2009 and June 2011, with 26 of them subjected to SILS, and 24 to CL. The variables analysed were, postoperative pain, analgesia requirements, presence of nausea/vomiting, operation time, complications, outpatient success rate, and aesthetic results. RESULTS: There were no differences as regards postoperative pain, analgesia rescue, nausea/vomiting, or operation time (SILS 54 ± 21 min, CL 48.5 ± 17 min, P=.29). There was one case of morbidity in the SILS group which required further surgery. The outpatient surgical procedure was completed in 77% of patients of the SILS group, and in 83% of the CL group. Six patients (23%) from the SILS group, and 4 (17%) from the CL group remained in the unit for more than 24h (P=.58). The aesthetic results were subjectively assessed as "very good" in the SILS group, and "good" in the CL group. CONCLUSION: SILS cholecystectomy is feasible and safe when comparing it with laparoscopic cholecystectomy in selected patients, and obtains similar results when performed in a MOS unit. Larger studies are needed to determine the real benefits of this approach before recommending it as a routine technique. With more experienced surgical teams and greater awareness of the patients could possibly increase the number of candidates for outpatient cholecystectomy.