Displasia neuronal intestinal en paciente con pseudoobstrucción colónica crónica / Intestinal neuronal dysplasia in a patient with chronic colonic pseudo-obstruction

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Resultados de las 100 primeras colecistectomías por puerto único en un hospital de segundo nivel / Results of the first 100 single port laparoscopic cholecystectomies in a secondary care hospital

INTRODUCCIÓN: Aunque los resultados de la colecistectomía laparoscópica estándar son excelentes, se continúa intentando minimizar el número de puertos con el objeto de disminuir el dolor postoperatorio, conseguir una recuperación más temprana y mejorar el resultado estético del paciente. El objetivo de este estudio es presentar los resultados de los primeros 100 casos de colecistectomía por puerto único practicados en un hospital de segundo nivel. MATERIAL Y MÉTODOS: Estudio prospectivo, observacional, unicéntrico. Se intervino a 100 pacientes entre enero de 2010 y abril de 2012. CRITERIOS DE INCLUSIÓN: pacientes mayores de 16 años con colelitiasis sintomática operados por colecistectomía simple mediante incisión umbilical única. Criterios de exclusión: antecedentes de colecistitis aguda, colangiopancreatografía retrógrada endoscópica, pancreatitis o sospecha de coledocolitiasis, IMC > 35 y laparotomías previas. Se estudiaron distintas variables epidemiológicas, quirúrgicas y de seguridad. RESULTADOS: La edad media de los pacientes fue de 39,89 ± 11,5 años. El tiempo quirúrgico medio fue de 67,94 ± 25,5 min. Presentaron complicaciones postoperatorias 2 pacientes: seroma y fuga biliar. En 2 casos fue necesaria la utilización de trocar accesorio. La estancia media fue de 1,13 ± 0,8 días. El 35% de los pacientes fueron tratados en régimen de cirugía mayor ambulatoria. Todos los pacientes se mostraron muy satisfechos con el resultado estético. CONCLUSIONES: La colecistectomía mediante incisión umbilical única es una buena técnica cuando se utiliza en casos seleccionados y por cirujanos expertos. Puede facilitar la práctica de la colecistectomía en régimen ambulatorio. No se han presentado complicaciones graves. El índice de satisfacción estética es muy elevado

INTRODUCTION: Despite the excellent results obtained with standard laparoscopic cholecystectomy, the efforts for minimizing the ports needed to reduce postoperative pain, for a quicker recovery and to improve the patient's cosmetics continue. The aim of this study is to report the results of the first 100 cases of single port laparoscopic cholecystectomy performed in a secondary care hospital. MATERIAL AND METHODS: Prospective, observational and unicentric study including 100 patients between January 2010 and April 2012. Inclusion criteria: symptomatic cholelythiasis patients over 16 years of age on whom a single port laparoscopic cholecystectomy was performed. Exclusion criteria: history of acute cholecystitis, pancreatitis or suspected choledocholithiasis, Endoscopic retrograde cholangiopancreatography, BMI > 35 and previous laparotomies. We studied epidemiological, surgical and safety variables. RESULTS: The mean patient age was 39.89 ± 11.5 years. The mean time of the surgical procedure was 67.94 ± 25.5 min. There were 2 cases of postoperative complications: a non-infected seroma and a biliar leak. In 2 cases the use of an accessory trocar was needed. The mean hospital stay was 1.13 ± 0.8 days. A total of 35% patients were included in the major ambulatory surgery program. The overall patient satisfaction survey rating showed a high level of cosmetic satisfaction in 100% of patients. CONCLUSIONS: Single port laparoscopic cholecystectomy is a good technique when performed in selected cases by expert surgeons. It is feasible to include the single port laparoscopic cholecystectomy in a major ambulatory surgery program. We have not had serious complications. There is a high cosmetic satisfaction index with this technique

Obstrucción colónica mecánica secundaria a hernia diafragmática. A propósito de un caso / Mechanical colonic obstruction due to diaphragmatic hernia. Report of a case

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Results of the first 100 single port laparoscopic cholecystectomies in a secondary care hospital.

INTRODUCTION: Despite the excellent results obtained with standard laparoscopic cholecystectomy, the efforts for minimizing the ports needed to reduce postoperative pain, for a quicker recovery and to improve the patient's cosmetics continue. The aim of this study is to report the results of the first 100 cases of single port laparoscopic cholecystectomy performed in a secondary care hospital. MATERIAL AND METHODS: Prospective, observational and unicentric study including 100 patients between January 2010 and April 2012. INCLUSION CRITERIA: symptomatic cholelythiasis patients over 16-years of age on whom a single port laparoscopic cholecystectomy was performed. EXCLUSION CRITERIA: history of acute cholecystitis, pancreatitis or suspected choledocholithiasis, Endoscopic retrograde cholangiopancreatography, BMI>35 and previous laparotomies. We studied epidemiological, surgical and safety variables. RESULTS: The mean patient age was 39,89 ± 11,5 years. The mean time of the surgical procedure was 67,94 ± 25,5 min. There were 2 cases of postoperative complications. A non-infected seroma and a biliar leak. In 2 cases the use of an accessory trocar was needed. The mean hospital stay was 1,13 ± 0,8 days. A total of 35% patients were included in the major ambulatory surgery programme.The overall patient satisfaction survey rating showed a high level of cosmetic satisfaction in 100% of patients. CONCLUSIONS: Single port laparoscopic cholecystectomy is a good technique when performed in selected cases by expert surgeons. It is feasible to include the single port laparoscopic cholecystectomy in a major ambulatory surgery programme. We have not had serious complications. There is a high cosmetic satisfaction index with this technique.

Neumoperitoneo preoperatorio progresivo en pacientes con hernias gigantes de la pared abdominal / Progressive preoperative pneumoperitoneum in patients with giant hernias of the abdominal wall

Introducción Los pacientes con hernias gigantes con pérdida de domicilio requieren una adecuada planificación de la reparación quirúrgica, porque en la mayoría se asocia una elevada comorbilidad. La técnica del neumoperitoneo progresivo preoperatorio descrita por Goñi Moreno permite una adaptación más fisiológica del paciente y de la cavidad abdominal al reintegro de las vísceras al abdomen, lo que permite una reparación quirúrgica adecuada. El objetivo es analizar nuestra experiencia en el tratamiento de este tipo de hernias. Materiales y métodos Estudio retrospectivo en que se analizan 11 pacientes portadores de grandes defectos de pared abdominal, con pérdida de domicilio, tratados mediante dicha técnica, en 2 centros entre los años 2005 y 2010.ResultadosDel total, ocho pacientes presentaban eventraciones abdominales y los otros 3 tenían hernias inguinales. El tiempo medio de insuflación fue de 2 semanas y la cantidad total de aire varió entre 6,6 y 18 l. Dos pacientes presentaron descompensación de su enfermedad pulmonar y se debió posponer temporalmente la insuflación. Otros 2 presentaron enfisema subcutáneo durante los últimos días de insuflación, que se resolvió espontáneamente y sin secuelas. Se utilizaron técnicas de eventroplastia abierta con malla en los 8 casos de eventraciones y técnica preperitoneal para las hernias inguinoescrotales. En el seguimiento posterior se objetivó un caso de recidiva. Conclusiones La técnica de Goñi Moreno sigue siendo una técnica segura para preparar a los pacientes con hernias gigantes con pérdida de domicilio, pues consigue reducir la morbilidad ocasionada por la hiperpresión abdominal tras la reparación de la pared abdominal (AU)

Introduction Patients with giant hernias with loss of domain require proper planning of surgical repair, because of the high associated comorbidity. The progressive preoperative pneumoperitoneum technique described by Goñi Moreno allows a more physiological adaptation of the patient and the abdominal cavity to the reinstatement of the viscera to the abdomen, enabling adequate surgical repair. The objective of this study was to analyze our experience in the treatment of this type of hernia. Materials and methods We carried out a retrospective study that included 11 patients with major abdominal wall defects and loss of domain who were treated with this technique in 2 centers between 2005 and 2010.ResultsEight patients had abdominal hernias and 3 had inguinal hernias. The average insufflation time was 2 weeks and the total amount of air was between 6.6 and 18 l. In 2 patients who showed pulmonary disease decompensation, insufflation had to be temporarily postponed. A further 2 patients had subcutaneous emphysema during the last few days of insufflation, which resolved spontaneously without sequelae. The open mesh repair technique was used in ventral hernias and the preperitoneal technique in all inguinal hernias. There was one recurrence during the 1-year follow-up. Conclusions Goñi Moreno's technique remains safe to prepare patients with giant hernias with loss of domain. This procedure can reduce the morbidity caused by the increase in abdominal pressure after abdominal wall repair (AU)

[Progressive preoperative pneumoperitoneum in patients with giant hernias of the abdominal wall]. / Neumoperitoneo preoperatorio progresivo en pacientes con hernias gigantes de la pared abdominal.

INTRODUCTION: Patients with giant hernias with loss of domain require proper planning of surgical repair, because of the high associated comorbidity. The progressive preoperative pneumoperitoneum technique described by Goñi Moreno allows a more physiological adaptation of the patient and the abdominal cavity to the reinstatement of the viscera to the abdomen, enabling adequate surgical repair. The objective of this study was to analyze our experience in the treatment of this type of hernia. MATERIALS AND METHODS: We carried out a retrospective study that included 11 patients with major abdominal wall defects and loss of domain who were treated with this technique in 2 centers between 2005 and 2010. RESULTS: Eight patients had abdominal hernias and 3 had inguinal hernias. The average insufflation time was 2 weeks and the total amount of air was between 6.6 and 18 l. In 2 patients who showed pulmonary disease decompensation, insufflation had to be temporarily postponed. A further 2 patients had subcutaneous emphysema during the last few days of insufflation, which resolved spontaneously without sequelae. The open mesh repair technique was used in ventral hernias and the preperitoneal technique in all inguinal hernias. There was one recurrence during the 1-year follow-up. CONCLUSIONS: Goñi Moreno's technique remains safe to prepare patients with giant hernias with loss of domain. This procedure can reduce the morbidity caused by the increase in abdominal pressure after abdominal wall repair.