[Appendiceal carcinoid tumors. Evaluation of long-term outcomes in a tertiary level]. / Tumores carcinoides apendiculares. Evaluación de los resultados a largo plazo en un hospital de tercer nive.

BACKGROUND: Appendiceal tumors are found in about 1% of appendectomies performed and 0.5% of intestinal neoplasias. Appendiceal carcinoids are the predominant histology in this group and are usually casual after appendectomy for other reasons. The prognosis is excellent and survival is 95% at 5 years after surgery. METHODS: Retrospective analysis of all patients with appendiceal carcinoid surgery in our hospital for 20 years (1990-2010) and survival at 5 years. We also discuss the need for additional treatment and testing for follow-up visits. RESULTS: 42 patients underwent surgery for appendiceal carcinoid tumor. 38 of them were operated on urgently, mostly for suspected acute appendicitis, without having reached the carcinoid tumor diagnosed preoperatively in any of them. The predominant symptomatology at admission was abdominal pain. Surgical treatment was appendectomy in 34 patients (12 laparoscopic), 7 patients required colon resections over intraoperatively by colonic involvement; only one patient required reoperation to complete right hemicolectomy. 2 patients had disseminated disease at diagnosis (liver metastases). The 5-year survival is over 95%, with no recurrence. CONCLUSIONS: The appendiceal carcinoid tumor is difficult to diagnose preoperatively. Appendectomy surgical treatment is usually sufficient, although colonic resections may be needed for dissemination. The 5-year survival is over 95%.

Antecedentes: los tumores apendiculares se encuentran en cerca de 1% de las apendicectomías y representan 0.5% de las neoplasias intestinales. El tipo de tumor más frecuente es el carcinoide apendicular, que casi siempre es un hallazgo durante la apendicectomía por otro motivo. Su pronóstico es excelente y la supervivencia es mayor de 95% a cinco años de la intervención. Objetivo: reportar una serie de casos y analizar la supervivencia media a cinco años posteriores a la identificación el tumor. Material y métodos: análisis retrospectivo (1990-2010) de pacientes con tumor carcinoide apendicular intervenidos en el servicio de Cirugía General y del Aparato Digestivo del Hospital Universitario Virgen del Rocío, Sevilla, España. Se analizaron: la supervivencia a cinco años, la necesidad de tratamiento complementario y las pruebas para seguimiento en la consulta. Resultados: se encontraron 42 pacientes intervenidos por tener un tumor carcinoide apendicular. En 38 pacientes la operación fue de urgencia, la mayoría por sospecha de apendicitis aguda, sin que en ninguno se hubiera establecido el diagnóstico de tumor carcinoide antes de la operación. El síntoma predominante al ingreso fue el dolor abdominal. El tratamiento quirúrgico fue: apendicectomía en 34 pacientes (12 por laparoscopia), en el intraoperatorio siete pacientes requirieron resecciones colónicas mayores debido a la afectación del colon; sólo uno requirió la reintervención para completar la hemicolectomía derecha. Al momento del diagnóstico dos pacientes tenían enfermedad diseminada (metástasis hepáticas). La supervivencia a cinco años fue superior a 95%, sin recidivas o tratamiento posterior de la enfermedad. Conclusiones: el tumor carcinoide apendicular difícilmente se diagnostica antes del procedimiento quirúrgico. La apendicectomía suele ser suficiente aunque en algunos pacientes las resecciones colónicas son necesarias por diseminación. La supervivencia a 5 años es superior a 95%.

Surgical pathology associated with Meckel´s diverticulum in a tertiary hospital: 12 year review.

OBJECTIVE: We want to present our experience about surgical pathology of Meckel´s diverticulum by means of a retrospective study. MATERIAL AND METHODS: We report a group of patients of our Department of General and Abdominal Surgery and Paediatric Surgery of our Hospital with Meckel´s diverticulum since January 1997 to January 2010. We report the clinical presentation, complementary test, interventions, and the postoperative follow up. RESULTS: 45 patients were operated in total, 33 of them in emergency surgery under the clinical form of acute abdominal pain; and the others 12 in programmed surgery, these cases came up more frequently like a clinical manifestations of latent abdominal pain, rectal bleeding and anemia. The complementary tests were so varied; abdominal ultrasounds were used in 63% of emergency cases and the 40% of programmed cases, in these patients,gammagraphy with Tc99 was the second test in frequency. Laparoscopy was used in 10 cases (22%). The main surgery technique used was diverticulectomy (82%). CONCLUSIONS: The presence of Meckel´s diverticulum has to be clinically suspected in all patients with abdominal pain of unknow naetiology. Access to the abdominal cavity using routine laparoscopy provides essential information on the diagnosis and for the treatment.

Patología quirúrgica asociada a divertículo de Meckel en un hospital de tercer nivel. Revisión de 12 años / Surgical pathology associated with Meckel's diverticulum in a tertiary hospital: 12 year review

Objetivo: presentar nuestra experiencia en la patología quirúrgica del divertículo de Meckel mediante un estudio retrospectivo. Material y métodos: presentamos una serie de casos de pacientes afectos de divertículo de Meckel, en los Servicios de Cirugía General y del Aparato Digestivo y de Cirugía Pediátrica del Hospital Universitario Virgen del Rocío, en un periodo de tiempo comprendido entre enero de 1997 y enero de 2010. En la serie se recoge la tipología de paciente, la clínica de debut, las pruebas complementarias y el tipo de intervención realizada, así como el tiempo de seguimiento postoperatorio. Resultados: se intervinieron un total de 45 pacientes, 33 de forma urgente, bajo la forma de abdomen agudo, y 12 de ellos programada, estos casos se presentaron como un cuadro de dolor abdominal más larvado, acompañado a veces de anemia ferropénica, con rectorragia manifiesta o no. Las pruebas complementarias fueron muy variadas, la más utilizada, la ecografía abdominal, realizada en el 63% de los casos urgentes y en el 40% de los programados, en estos últimos cabe destacar también el empleo de la gammagrafía con Tc99. Se utilizó el abordaje laparoscópico en 10 casos (22% del total). La técnica quirúrgica mayoritaria consistió en diverticulectomía y enterorrafia (82% de los casos). Conclusiones: la sospecha clínica de divertículo de Meckel debe estar presente en todo paciente con dolor abdominal de etiología desconocida. Consideramos que el acceso por vía laparoscópica a la cavidad abdominal contribuye al diagnóstico y tratamiento de esta enfermedad(AU)

Objective: we want to present our experience about surgical pathology of Meckel’s diverticulum by means of a retrospective study. Material and methods: we report a group of patients of our Department of General and Abdominal Surgery and Paediatric Surgery of our Hospital with Meckel’s diverticulum since January 1997 to January 2010. We report the clinical presentation, complementary test, interventions, and the postoperative follow up. Results: 45 patients were operated in total, 33 of them in emergency surgery under the clinical form of acute abdominal pain; and the others 12 in programmed surgery, these cases came up more frequently like a clinical manifestations of latent abdominal pain, rectal bleeding and anemia. The complementary tests were so varied; abdominal ultrasounds were used in 63% of emergency cases and the 40% of programmed cases, in these patients, gammagraphy with Tc99 was the second test in frequency. Laparoscopy was used in 10 cases (22%). The main surgery technique used was diverticulectomy (82%). Conclusions: the presence of Meckel’s diverticulum has to be clinically suspected in all patients with abdominal pain of unknown aetiology. Access to the abdominal cavity using routine laparoscopy provides essential information on the diagnosis and for the treatment(AU)

Fijación con sutura frente a sellante de fibrina en hernioplastia con prótesis reabsorbible (ácido poliglicólico y carbonato trimetileno). Estudio experimental en animales / Mesh fixation with sutures versus fibrin sealant in hernioplasty with re-absorbable prosthesis (polyglycolic acid and trimethylene carbonate). Experimental study in animals

Introducción Dado que estudios actuales han mostrado la validez de la fijación atraumática con cola de fibrina (Tissucol®) frente a las suturas convencionales con malla de polipropileno, en este trabajo se quiere estudiar el comportamiento en las mallas reabsorbibles. Material y métodos Se utilizaron 20 ratas blancas Wistar. Se realizaron 2 defectos herniarios en la pared abdominal, que se repararon de forma preperitoneal con malla reabsorbible de ácido poliglicólico y carbonato trimetileno, en el lado de la derecha la malla se fijó con Tissucol® y en el lado de la izquierda se fijó con sutura convencional fijada a la fascia muscular. Se sacrificaron 10 ratas a los 14 días (serie A) y el resto a los 28 días (serie B). Se emplearon para comprobar la contingencia de la pared abdominal 2 test; el test de presión: neumoperitoneo mayor de 40mmHg mantenido durante 1min, y el test de tracción: dinamometría de la zona afectada mayor de 300g de tracción por cm2. Se analizó la pared abdominal para determinar la integración de la malla de nueva generación. Resultados La fijación de la malla tras los test de presión y de tracción no evidenció alteraciones estadísticamente significativas en los 2 grupos. La integración de la malla fue mayor en los casos de fijación con cola de fibrina, donde se observó un aumento del número de neovasos. Conclusiones La fijación con colas biológicas de fibrina equiparó a la convencional. La malla reabsorbible se integró adecuadamente y se comprobó que tanto la neoformación vascular como la propia integración de la malla es más notable al aplicar el sellante de fibrina que con la sutura convencional. (AU)

Introduction Current studies have shown the validity of the atraumatic fixation with fibrin glue (Tissucol®) compared to conventional sutures in polypropylene mesh fixation. We propose to study the behaviour of absorbable mesh. Material and methods We used 20 Wistar white rats. Two hernia defects were made in the abdominal wall, which were repaired using absorbable PGA-TMC preperitoneal mesh. The right side of the mesh was fixed with Tissucol and left side with conventional suture attached to the muscle fascia. One group of 10 rats were sacrificed at day 14 (Series A) and the other 10 rats at 28 days (Series B). We used two tests to assess the contingency of the abdominal wall; Pressure Test: pneumoperitoneum more than 40mmHg maintained for 1min, Traction Test: dynamometry of the affected area more than 300mg per cm2 of traction. Abdominal wall was analysed to determine the integration of the new generation mesh. Results The fixation of the mesh after the pressure and traction tests showed no statistically significant changes in either group. The integration of the mesh and vessel neoformation was higher in the cases of fixation with fibrin glue. Conclusions Biological fixation with fibrin glue is similar to the conventional. Absorbable mesh was suitably integrated and vascular neoformation and integration of the mesh was also found to be better than conventional sutures when fibrin sealant was applied (AU)

Glomangioma gigante en el pie derecho / Giant glomangioma in the right foot

No disponible

[Obstructive jaundice secondary to hepatic artery aneurysm]. / Ictericia obstructiva secundaria a aneurisma de la arteria hepática.

BACKGROUND: Aneurysm of the hepatic artery is relatively infrequent, representing 16-20% of aneurysms of the visceral arteries. Clinical presentation is nonspecific and may include abdominal pain, upper digestive system hemorrhage, or obstructive jaundice, as in the case presented here. CLINICAL CASE: We present the case of a 47-year-old patient referred to our service due to obstructive jaundice, verifying that the pathology was caused by an aneurysm of >7 cm in diameter in the hepatic artery. Despite elective treatment and intensive collaboration of different surgical specialists, the patient's prognosis was poor. DISCUSSION: These types of aneurysms occur infrequently and with an uncertain prognosis. Therefore, individualized treatment for each case is necessary. CONCLUSIONS: We must carefully select the approach that fits the needs of our patient. The endovascular route is often currently used. However, because of the complexity of the location of the injury, in some cases it is impossible and surgical intervention is necessary with trained hepatobiliary and vascular surgeons.

Ictericia obstructiva secundaria a aneurisma de la arteria hepática / Obstructive jaundice secondary to hepatic artery aneurysm

BACKGROUND: Aneurysm of the hepatic artery is relatively infrequent, representing 16-20% of aneurysms of the visceral arteries. Clinical presentation is nonspecific and may include abdominal pain, upper digestive system hemorrhage, or obstructive jaundice, as in the case presented here. CLINICAL CASE: We present the case of a 47-year-old patient referred to our service due to obstructive jaundice, verifying that the pathology was caused by an aneurysm of >7 cm in diameter in the hepatic artery. Despite elective treatment and intensive collaboration of different surgical specialists, the patient's prognosis was poor. DISCUSSION: These types of aneurysms occur infrequently and with an uncertain prognosis. Therefore, individualized treatment for each case is necessary. CONCLUSIONS: We must carefully select the approach that fits the needs of our patient. The endovascular route is often currently used. However, because of the complexity of the location of the injury, in some cases it is impossible and surgical intervention is necessary with trained hepatobiliary and vascular surgeons.

[Prevention of surgical infection using reabsorbable antibacterial suture (Vicryl Plus) versus reabsorbable conventional suture in hernioplasty. An experimental study in animals]. / Prevención de la infección quirúrgica utilizando sutura reabsorbible antibacteriana (Vicryl Plus) en lugar de la sutura reabsorbible convencional en hernioplastias. Estudio experimental en animales.

INTRODUCTION: Surgical site infections are frequent in daily surgical practice. One of the main challenges currently facing surgeons is the prevention and treatment of infections, especially those involving prosthetic material. A new suture (Vicryl Plus) has become available. In vitro studies and experimental models have demonstrated the ability of this suture to inhibit bacterial growth and consequently prevent postsurgical infection. OBJECTIVES: To compare infections provoked in prosthetic implants fixed with reabsorbable conventional sutures with those in meshes fixed with reabsorbable sutures with antiseptic impregnation. MATERIAL AND METHOD: Twenty white Wistar rats were used. In each rat, two hernioplasties were performed: one fixed with Vicryl Plus and the other with normal Vicryl. Subsequently, each polypropylene mesh was infected with S. aureus, and the rats remained in individual cages for a week. After 1 week, the rats were sacrificed and the meshes were extracted for macroscopic, microscopic and microbiologic study. RESULTS: Most of the meshes fixed with the new suture (Vicryl Plus) showed macroscopically fewer infections than those fixed with conventional suture, without abscesses and without dehiscence of the hernioplasty. In the microbiological quantitative bacterial study, the number of bacteria quantified per gram of sample was also lower in prostheses fixed with Vicryl Plus. Pathological analysis showed lesser colonization of the mesh and lower inflammatory response with Vicryl Plus than with normal Vicryl. In the statistical analysis, comparison of the medians of both groups and the interquartile ranges of microbial quantification revealed a lower infection rate in the Vicryl Plus group. CONCLUSIONS: The infection rate in the surgical site can be reduced by mesh fixation using the new antimicrobial suture (Vicryl Plus). We believe that this type of suture constitutes a new weapon in the fight against postoperative infection, especially in hernioplasty, emergency surgery, and dirty or potentially contaminated surgery.

Prevención de la infección quirúrgica utilizando sutura reabsorbible antibacteriana (Vicryl Plus) en lugar de la sutura reabsorbible convencional en hernioplastias. Estudio experimental en animales / Prevention of surgical infection using reabsorbable antibacterial suture (Vicryl Plus) versus reabsorbable conventional suture in hernioplasty. An experimental study in animals

Introducción. En nuestra práctica diaria quirúrgica nos enfrentamos a infecciones del propio sitio quirúrgico con frecuencia. Uno de los grandes retos para el cirujano hoy en día es la prevención y el tratamiento de las infecciones, y en especial las infecciones de material protésico. En la actualidad disponemos de una nueva sutura (Vicryl Plus) que ha demostrado in vitro y en modelo experimental su capacidad para inhibir el crecimiento bacteriano y por lo tanto prevenir la tan temida infección posquirúrgica. Objetivos. Nos proponemos en nuestro estudio experimental realizar una comparación entre una infección provocada en una prótesis para tratar la enfermedad herniaria fijada con sutura reabsorbible convencional y la nueva sutura motivo del estudio, sutura reabsorbible con impregnación antiséptica. Material y método. Utilizamos como modelo animal ratas Wistar blancas (20), a las cuales les practicamos dos hernioplastias. Una fijada con Vicryl Plus y otra con Vicryl normal. Posteriormente se infecta cada malla de polipropileno con Staphylococcus aureus, y permanece en su jaula individual una semana. A la semana procedemos al sacrificio de las ratas y la extracción de las mallas para su estudio macroscópico, microscópico y mibrobiológico. Resultados. Comprobamos que la mayoría de las mallas fijadas con la nueva sutura (Vicryl Plus) presentaban macroscópicamente menos indicios de infección, sin abscesos ni dehiscencia de la hernioplastia, en contra de lo observado en aquellas fijadas con sutura convencional. En el estudio microbiológico cuantitativo bacteriano el número de bacterias cuantificadas por gramo de muestra es menor también en las prótesis fijadas con Vicryl Plus. En la anatomía patológica de la muestra observamos menor colonización de la malla y menor respuesta inflamatoria con la fijación con Vicryl Plus que con Vicryl normal. En el estudio estadístico se comprueba la menor tasa de infección al comparar las medianas de ambos grupos y los rangos intercuartílicos de la cuantificación microbiana. Conclusiones. Es posible disminuir el índice de infección del sitio quirúrgico tras la colocación de material protésico realizando su fijación con este nuevo tipo de sutura antimicrobiana (Vicryl Plus). Pensamos que es un nuevo aliado en la lucha contra la infección postoperatoria, y es de especial interés su uso en cirugía con hernioplastia, cirugía de urgencia y cirugía sucia o potencialmente contaminada (AU)

Introduction. Surgical site infections are frequent in daily surgical practice. One of the main challenges currently facing surgeons is the prevention and treatment of infections, especially those involving prosthetic material. A new suture (Vicryl Plus) has become available. In vitro studies and experimental models have demonstrated the ability of this suture to inhibit bacterial growth and consequently prevent postsurgical infection. Objectives. To compare infections provoked in prosthetic implants fixed with reabsorbable conventional sutures with those in meshes fixed with reabsorbable sutures with antiseptic impregnation. Material and method. Twenty white Wistar rats were used. In each rat, two hernioplasties were performed: one fixed with Vicryl Plus and the other with normal Vicryl. Subsequently, each polypropylene mesh was infected with S. aureus, and the rats remained in individual cages for a week. After 1 week, the rats were sacrificed and the meshes were extracted for macroscopic, microscopic and microbiologic study. Results. Most of the meshes fixed with the new suture (Vicryl Plus) showed macroscopically fewer infections than those fixed with conventional suture, without abscesses and without dehiscence of the hernioplasty. In the microbiological quantitative bacterial study, the number of bacteria quantified per gram of sample was also lower in prostheses fixed with Vicryl Plus. Pathological analysis showed lesser colonization of the mesh and lower inflammatory response with Vicryl Plus than with normal Vicryl. In the statistical analysis, comparison of the medians of both groups and the interquartile ranges of microbial quantification revealed a lower infection rate in the Vicryl Plus group. Conclusions. The infection rate in the surgical site can be reduced by mesh fixation using the new antimicrobial suture (Vicryl Plus). We believe that this type of suture constitutes a new weapon in the fight against postoperative infection, especially in hernioplasty, emergency surgery, and dirty or potentially contaminated surgery (AU)