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1.
Gan To Kagaku Ryoho ; 48(3): 385-387, 2021 Mar.
Artículo en Japonés | MEDLINE | ID: mdl-33790163

RESUMEN

A 50s old woman admitted to our hospital with anal pain, who was diagnosed as rectal gastrointestinal stromal tumor (GIST). After neoadjuvant therapy with imatinib mesylate for 6 months, the tumor reduced by 75% from its original size and anus preserving operation(low anterior resection)was performed. After operation adjuvant therapy with imatinib mesylate was performed for 2 years and 6 months. The patient is alive without recurrence 5 years after surgery. It is suggested that neoadjuvant therapy with imatinib mesylate is useful and safety for large rectal GIST, from the standpoint of anal preservation.


Asunto(s)
Antineoplásicos , Tumores del Estroma Gastrointestinal , Laparoscopía , Neoplasias del Recto , Canal Anal/cirugía , Antineoplásicos/uso terapéutico , Femenino , Tumores del Estroma Gastrointestinal/tratamiento farmacológico , Tumores del Estroma Gastrointestinal/cirugía , Humanos , Mesilato de Imatinib/uso terapéutico , Terapia Neoadyuvante , Recurrencia Local de Neoplasia , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/cirugía
2.
Gan To Kagaku Ryoho ; 48(3): 391-393, 2021 Mar.
Artículo en Japonés | MEDLINE | ID: mdl-33790165

RESUMEN

There are few reports on laparoscopic stoma creation; we report here our experience with laparoscopic stoma creation. PATIENTS AND METHODS: Seven patients who underwent laparoscopic stoma creation between April 2019 and December 2019 were studied and their clinical outcome was evaluated retrospectively. Operation approach: We performed a colostomy in the transverse colon. At first, we insert a 12 mm first port into the site of stoma marking. And more, we insert three 5 mm ports on the opposite side of the first port. We remove the adhesions of the intestinal tract and create a colostomy. RESULT: We changed open method 2 cases out of 7 cases due to extensive adhesion. In laparoscopically, we had an operation time of 97 (42-130) minutes and a blood loss of 5(2-40) mL. We had no postoperative complications or stoma problems. CONCLUSION: Laparoscopic stoma creation was useful due to few postoperative complications and can be rapidly transferred to chemotherapy.


Asunto(s)
Neoplasias Colorrectales , Laparoscopía , Estomas Quirúrgicos , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/cirugía , Colostomía , Humanos , Ileostomía , Estudios Retrospectivos
3.
Gan To Kagaku Ryoho ; 48(3): 403-406, 2021 Mar.
Artículo en Japonés | MEDLINE | ID: mdl-33790169

RESUMEN

Herein, we report on how we were able to reduce the operation time by simultaneously performing laparoscopic surgery and breast cancer surgery using a head-mounted monitor(HMS-3000MT, Sony corporation). Case 1: 60s, female. A 5.5 cm leiomyoma was found in the central thoracic esophagus, and a 1 cm breast cancer was found in the C region of the left mammary gland. Subtotal esophagectomy with right thoracotomy and laparoscopy and a left partial mastectomy were performed. For the abdominal surgery, HMS-3000MT was used under hand-assisted laparoscopy, and a left partial mastectomy was performed concurrently. Operation time was 367 minutes(simultaneous surgery for 56 minutes). Esophagus: leiomyoma, 50×45 mm; and mammary gland: 16×15 mm, pTis(DCIS), pN0(sn), cM0, and pStage 0. Case 2: 70s, female. A 3 cm sized GIST was found on the posterior wall of the middle gastric body, and a breast cancer of 1.3 cm was also found in the B region of the right mammary gland. Using HMS-3000MT, laparoscopic local resection of the stomach and right total glandectomy were performed concurrently. Operation time was 114 minutes(simultaneous surgery for 58 minutes). Stomach: GIST, 25×22 mm, and modified Flecher classification low risk; and mammary gland: invasive ductal carcinoma, 15×15 mm, pT1c, pN0(sn), cM0, and pStage Ⅰ. Conclusion: In 2 fields of surgery, simultaneous surgery using HMS-3000MT was considered to be a useful method to shorten the operation time.


Asunto(s)
Neoplasias de la Mama , Laparoscopía , Neoplasias de la Mama/cirugía , Esofagectomía , Femenino , Humanos , Mastectomía , Estudios Retrospectivos
4.
Gan To Kagaku Ryoho ; 48(3): 407-409, 2021 Mar.
Artículo en Japonés | MEDLINE | ID: mdl-33790170

RESUMEN

The advantages of robot-assisted surgery include: stable deployment of the robotic arm that enables excellent radical cure characteristics and preservation of function; the ability to perform precise surgery even in patients in whom performing laparoscopic surgery is difficult, such as those with pelvic or bulky tumors. However, there have been some reports on such issues as an increase in the incidence of postoperative complications and an increase in postoperative hospital stay in patients who underwent neoadjuvant chemotherapy(NAC); thus, we summarized and are reporting the short-term results of our experience in patients seen in our department to date. A total of 76 patients with rectal cancer who underwent robot-assisted surgery, and short-term postoperative results were compared between patients who underwent neoadjuvant chemotherapy (NAC group)and those who did not undergo neoadjuvant chemotherapy(non-NAC group). Of the 76 patients, 59 (77.6%)were male and 17(22.4%)were female, and 27(35.5%)in the NAC group. In the comparisons between the NAC and non-NAC groups, although the difference in operative time(523.5 vs 317.5 minutes, p<0.01)was significant, there were no significant differences in any of blood loss(59 vs 20g, p=0.22), postoperative hospital stay(14 vs 13 days: p=0.07), and onset of complications that were Clavien-Dindo Grade Ⅲa or higher(2 vs 1 patients, p=0.82). Robot- assisted surgery after NAC for rectal cancer was considered to be safe and very useful.


Asunto(s)
Laparoscopía , Neoplasias del Recto , Procedimientos Quirúrgicos Robotizados , Femenino , Humanos , Masculino , Terapia Neoadyuvante , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/cirugía , Estudios Retrospectivos , Resultado del Tratamiento
5.
Gan To Kagaku Ryoho ; 48(3): 422-424, 2021 Mar.
Artículo en Japonés | MEDLINE | ID: mdl-33790175

RESUMEN

We report a case of gastrointestinal submucosal tumor with an intraluminal growth pattern resected by laparoscopic wedge resection. A 62-year-old man was admitted because of melena. Upper gastrointestinal endoscopy revealed gastrointestinal submucosal tumor with an intraluminal growth pattern just below the gastric junction, and the pathological diagnosis was GIST. A laparoscopic wedge resections(percutaneous endoscopic intragastric surgery)was performed by a single access port. After laparotomy 5 cm above the umbilicus, the anterior wall of the middle part of the stomach was incised and fixed to the skin, and the tumor was dissected with a linear stapler. The final pathology result showed a high risk GIST of 70×40 mm with 110 mitotic images/50 HPF, and the patient was treated with imatinib mesylate adjuvant chemotherapy. There were no complications, including postoperative transit disturbances, and there were no local or distant metastatic recurrences.


Asunto(s)
Neoplasias Gastrointestinales , Tumores del Estroma Gastrointestinal , Laparoscopía , Neoplasias Gástricas , Gastrectomía , Tumores del Estroma Gastrointestinal/tratamiento farmacológico , Tumores del Estroma Gastrointestinal/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugía
6.
Gan To Kagaku Ryoho ; 48(3): 428-430, 2021 Mar.
Artículo en Japonés | MEDLINE | ID: mdl-33790177

RESUMEN

BACKGROUND AND PURPOSE: Simulation computed tomography colonography(sCTC), which combines CTC and 3-dimensional vascular imaging, is popular for the surgery of colorectal cancer. We experience anomaly, called arc of Riolan(aR), rarely but its definition and details are unclear. Using sCTC, we identified aR and investigated the simulation of aR-conserving high ligation. PATIENT AND METHOD: The patients were 3 cases of sigmoid colorectal cancer with aR in 369 patients who underwent sCTC before colorectal cancer surgery. We identified the running morphology of aR. And we classified Griffiths' point as presence(P)and absence(A). Narrow or mesh-shaped artery which were ischemic risk factors of intestinal tract was P groups and normal artery was A groups in the marginal artery of splenic flexure. We simulated aR-conserving lymph node dissection using sCTC. RESULT: Case 1. The patient was 60-year-old man with rectal cancer, cT4aN1M0, Stage Ⅲa. The running morphology of aR was between the left branch of middle colic artery(MCA lt)and LCA. Griffiths point: P. Surgical simulation was D3 lymph node dissection with preservation of aR and high ligation of IMA. Pathological findings was pT3N1M0, Stage Ⅲa. Case 2. The patient was 65-year-old woman with sigmoid colon cancer, cT3N2M0, Stage Ⅲb. The running morphology of aR was between MCA lt and IMA. Griffiths point: P. Surgical simulation was D3 lymph node dissection with preservation of aR and high ligation of IMA. Pathological findings was pT3N2M0, Stage Ⅲb. Case 3. The patient was 75-year-old woman with sigmoid colon cancer, cT1bN0M0, Stage Ⅰ. The running morphology of aR was between first jejunal artery and IMA. Griffiths point: A. Surgical simulation was D3 lymph node dissection with preservation of aR and high ligation of IMA. Pathological findings was pT1bN0M0, Stage Ⅲb. CONCLUSION: Using sCTC, we could identify the various running morphology of aR and simulate aR-conserving lymph node dissection in high ligation.


Asunto(s)
Colonografía Tomográfica Computarizada , Laparoscopía , Neoplasias del Recto , Anciano , Femenino , Humanos , Ligadura , Escisión del Ganglio Linfático , Masculino , Arteria Mesentérica Inferior/diagnóstico por imagen , Arteria Mesentérica Inferior/cirugía , Persona de Mediana Edad , Neoplasias del Recto/cirugía
8.
Arch Esp Urol ; 74(3): 317-327, 2021 Apr.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33818428

RESUMEN

OBJECTIVES: Our aim was to compare nephrectomies with kidney resections in terms of their influence on renal function and blood loss. We compared laparoscopic nephrectomies with open nephrectomies in terms of the length of the procedure and the hospital stay. METHODS: We retrospectively included patients who were operated for renal tumors (n=148) between January 2016 to July 2018 in a single secondary center. We considered the type of operation (nephrectomies versus kidney resections), the approach to the kidney (open or laparoscopic) and compared the following outcomes: the length of the operation, perioperative blood loss, the changes in hemoglobin concentrations, in creatinine levels and in the estimated glomerular filtration rate (eGFR). RESULTS: Kidney resections when compared to nephrectomies resulted in a significantly smaller decline in the estimated glomerular filtration rates (ß=38.78 ml/min;p<0.001). When compared to baseline values, there was a significant drop in the eGFR on both day 1 and 3-6 months after the operation in the nephrectomy group (p<0.001 for both intervals); this drop was not present in the resection group. The decline in hemoglobin levels was bigger in the resection than in the nephrectomy group. However, during a follow up evaluation 3-6 months after the procedures, the values did not differ between the groups. We then compared open nephrectomies with laparoscopic nephrectomies. Laparoscopy involved more time (ß=38.6 minutes; p<0.001), was used for early stage tumors and involved a shorter hospital stay (ß=3 days;p<0.001) in comparison to open surgeries. CONCLUSIONS: Data from our center confirmed the findings from other literature that nephron-sparing surgeries lead to a lower decline in kidney function than with nephrectomies. This benefit for kidney function also remained during the follow-up. When performing a nephrectomy, the laparoscopic approach offers a shorter hospital stay for the patient than with an open surgery.


Asunto(s)
Carcinoma de Células Renales , Neoplasias Renales , Laparoscopía , Carcinoma de Células Renales/cirugía , Humanos , Neoplasias Renales/cirugía , Nefrectomía , Tempo Operativo , Estudios Retrospectivos , Resultado del Tratamiento
9.
Urologiia ; (1): 126-130, 2021 Mar.
Artículo en Ruso | MEDLINE | ID: mdl-33818948

RESUMEN

The article describes such fundamental and applied aspects of pathogenesis and clinical manifestations of such rare disease as endometriosis of ureters. Frequent involvement of left ureter in its pelvic part, close to distal colon, associated with its inflammatory diseases followed by leaky gut syndrome with bacterial spread to the fallopian tube causing its inflammation and dysfunction, provoking menstrual reflux and predisposing to affection of left ovary, peritoneum and contact spread of endometriosis to ureteral wall. This mechanism fits to the regurgitation theory of endometriosis. Surgery is the gold standard for endometriosis treatment and more beneficial, comparing with conservative treatment and essential for prevention of such dangerous complications as hydronephrosis and renal failure. But the early and in-time diagnostic of endometriosis depend on gynecologists, not urologist, that characterizes endometriosis as significant interdisciplinary problem. In the article symptoms, that must cause concern for this rare pathology are thoroughly described.


Asunto(s)
Endometriosis , Hidronefrosis , Laparoscopía , Uréter , Enfermedades Ureterales , Endometriosis/complicaciones , Endometriosis/cirugía , Femenino , Humanos , Hidronefrosis/diagnóstico por imagen , Hidronefrosis/etiología , Hidronefrosis/cirugía , Uréter/diagnóstico por imagen , Uréter/cirugía , Enfermedades Ureterales/etiología , Enfermedades Ureterales/cirugía
10.
Wiad Lek ; 74(2): 220-224, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33813475

RESUMEN

OBJECTIVE: The aim of the study was to determine the possibility and effectiveness of simultaneous surgical interventions in umbilical and paraumbilical hernia repair. PATIENTS AND METHODS: Material and methods: 148 case histories were analyzed concerning patients who were routinely admitted to the surgical department of the Kharkiv Regional Council's Municipal Non-Profit Enterprise «Regional Clinical Hospital¼ between 2017 and 2019, and who underwent umbilical and paraumbilical hernia repair simultaneously with operations related to some other surgical pathology (group 1, n = 67) or in separate interventions (group 2, n = 81). All patients were routinely operated after a set of mandatory and additional general clinical, laboratory and instrumental research conducted in accordance with the existing guidelines. The structure and results of surgical interventions related to the underlying disease and simultaneous operations were studied. RESULTS: Results: Simultaneous operations were performed for comorbid cholecystolithiasis, diaphragmatic esophageal hernia with gastroesophageal reflux, inguinal hernia, white line hernia, benign diseases of the uterus and uterine appendages et al. The frequency of complications and recurrences of hernia in patients with simultaneous and isolated of umbilical hernia repair did not differ significantly. The outcome of the operation mostly depended on the method of operation (postoperative complications were most often observed in open sutures repair and were absent in laparoscopic hernia repair). Additional risk factors were weight gain and diabetes. CONCLUSION: Conclusions: Summarizing the data obtained, it can be concluded that application of modern endovideoscopic techniques in surgery makes simultaneous surgical interventions not only possible but also necessary in the presence of concomitant abdominal pathology that requires surgical treatment.


Asunto(s)
Hernia Hiatal , Hernia Inguinal , Laparoscopía , Femenino , Hernia Inguinal/cirugía , Herniorrafia , Humanos , Recurrencia , Mallas Quirúrgicas
11.
Anticancer Res ; 41(4): 2171-2175, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33813429

RESUMEN

BACKGROUND: Although indications of laparoscopic hepatectomy have been expanded, the laparoscopic approach after right hepatic lobectomy has a very high burden. The purpose of this study was to evaluate patients undergoing laparoscopic repeat hepatectomy for recurrent hepatic tumors after open right lobectomy. PATIENTS AND METHODS: Five cases of laparoscopic repeat hepatectomy for recurrent hepatic tumors after open right lobectomy were included in the study. RESULTS: All the tumors in segment 3 were intraoperatively detected and curatively resected by partial hepatectomy. The tumors in segment 2 could not be detected intraoperatively due to hypertrophic liver deformity and adhesion. They were curatively resected by anatomical subsegmental approach. CONCLUSION: For recurrent tumors located in segment 2 after right lobectomy, anatomical subsegmental approach should be preferred, not only from an oncological standpoint, but also for securing curative laparoscopic resection and overcoming anatomical difficulties.


Asunto(s)
Carcinoma Hepatocelular/cirugía , Hepatectomía/métodos , Laparoscopía/métodos , Neoplasias Hepáticas/cirugía , Recurrencia Local de Neoplasia/cirugía , Reoperación/métodos , Anciano , Carcinoma Hepatocelular/patología , Humanos , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Tratamientos Conservadores del Órgano/métodos , Inducción de Remisión/métodos , Resultado del Tratamiento
12.
Anticancer Res ; 41(4): 2197-2201, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33813434

RESUMEN

BACKGROUND/AIM: To evaluate complications and risk factors associated with transumbilical incision as an organ removal site in laparoscopic pancreatectomy (LP). PATIENTS AND METHODS: In total, 52 patients who underwent LP between 2009 and 2017 were included in this study. The development of superficial surgical site infection (SSI) and transumbilical port-site incisional hernia was recorded. RESULTS: None of the patients had SSI. However, three (5.77%) presented with transumbilical incisional hernia. No variables were significantly associated with the risk of transumbilical incisional hernia. CONCLUSION: No evident risk factors correlated with hernia formation. Hence, incisional hernia might have occurred at a certain probability. In some cases, it was caused by technical problems. However, the use of transumbilical incision as an organ removal site was feasible, and a new incision for organ removal alone was not required.


Asunto(s)
Laparoscopía/métodos , Páncreas/patología , Pancreatectomía/métodos , Enfermedades Pancreáticas/cirugía , Ombligo/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Humanos , Hernia Incisional/diagnóstico , Hernia Incisional/epidemiología , Hernia Incisional/etiología , Japón/epidemiología , Laparoscopía/efectos adversos , Laparoscopía/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Páncreas/cirugía , Pancreatectomía/efectos adversos , Pancreatectomía/estadística & datos numéricos , Enfermedades Pancreáticas/epidemiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de Riesgo , Manejo de Especímenes/efectos adversos , Manejo de Especímenes/métodos , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Ombligo/patología , Adulto Joven
13.
BMC Surg ; 21(1): 140, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33740923

RESUMEN

BACKGROUND: Proximal gastrectomy with double-tract reconstruction (DTR) has been used for upper third gastric cancer as a function-preserving procedure. However, the safety and feasibility of laparoscopic proximal gastrectomy (LPG) with DTR remain uncertain. This study compared open proximal gastrectomy (OPG) with DTR and LPG with DTR for proximal gastric cancer. METHODS: Sixty-four patients who had undergone OPG with DTR and forty-six patients who had undergone LPG with DTR were enrolled in this case-control study. The clinical characteristics, surgical outcomes and postoperative nutrition index were analysed retrospectively. RESULTS: The operation time was significantly longer in the LGP group than in the OPG group (258.3 min vs 205.8 min; p = 0.00). However, the time to first flatus and postoperative hospital stay were shorter in the LPG group [4.0 days vs 3.5 days (p = 0.00) and 10.6 days vs 9.2 days (p = 0.001), respectively]. No significant difference was found between the two groups in the number of retrieved lymph nodes, complications or reflux oesophagitis. The nutrition status was assessed using the haemoglobin, albumin, prealbumin and weight levels from pre-operation to six months after surgery. No significant difference was found between the groups. CONCLUSION: LPG with DTR can be safely performed for proximal gastric cancer patients by experienced surgeons.


Asunto(s)
Gastrectomía , Laparoscopía , Procedimientos Quirúrgicos Reconstructivos , Neoplasias Gástricas , Anciano , Estudios de Casos y Controles , Femenino , Gastrectomía/métodos , Humanos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Reconstructivos/métodos , Estudios Retrospectivos , Neoplasias Gástricas/cirugía , Resultado del Tratamiento
14.
BMC Surg ; 21(1): 158, 2021 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-33752652

RESUMEN

BACKGROUND: Laparoscopic paraesophageal hernia repair is associated with higher recurrence rate. Mesh is used to reduce the recurrence rate. This retrospective study is to review our experience of biological mesh fixed with suture and medical glue in hiatal hernias repairs. METHODS: A retrospective chart review was conducted for a consecutive series of patients undergoing laparoscopic hiatal herniorrhaphy between January 2018 and January 2019. After hiatus closure, a piece of biological prosthesis was fixed with medical glue and suture for reinforcement of the crural closure. Clinical outcomes were reviewed, and data were collected regarding operative details, complications, symptoms, and follow-up imaging. Radiological evidence of any size of hiatal hernia was considered to indicate a recurrence. RESULTS: Thirty-six patients underwent surgery uneventfully without any serious complication. There was no mortality. The follow-up was, on average, 18.4 months, and there was no symptomatic recurrence. There was one anatomical recurrence without any related presentation. The method of mesh fixation with medical glue and suture took 12 min on average, and the handling was fairly easy. CONCLUSIONS: Biological mesh fixed with suture and medical glue was safe and effective for repairing large hiatal hernias. Of course, a longer follow-up is still needed for determining long-term outcomes.


Asunto(s)
Hernia Hiatal , Herniorrafia , Laparoscopía , Adhesivos , Anciano , Anciano de 80 o más Años , Femenino , Hernia Hiatal/cirugía , Herniorrafia/métodos , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Mallas Quirúrgicas , Suturas , Resultado del Tratamiento
15.
BMC Surg ; 21(1): 154, 2021 Mar 21.
Artículo en Inglés | MEDLINE | ID: mdl-33743657

RESUMEN

BACKGROUND: Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon but important complication of ventriculoperitoneal (VP) shunts. While individual articles have reported many cases of abdominal CSF pseudocyst following VP shunts, no case of a hemorrhagic abdominal pseudocyst after VP shunts has been reported so far. CASE PRESENTATION: This article reports a 68-year-old woman with a 4-month history of progressive abdominal pain and distention. She denied any additional symptoms. A VP shunt was performed 15 years earlier to treat idiopathic normal pressure hydrocephalus and no other abdominal surgery was performed. Physical examination revealed an elastic palpable mass in her right lower abdomen, which was dull to percussion. Abdominal computed tomography (CT) scan indicated a large cystic collection of homogenous iso-density fluid in the right lower abdominal region with clear margins. The distal segment of the peritoneal shunt catheter was located within the cystic mass. Abdominal CSF pseudocyst was highly suspected as a diagnosis. Laparoscopic cyst drainage with removal of the whole cystic mass was performed, 15-cm cyst which found with thick walls and organized chronic hematic content. No responsible vessel for the cyst hemorrhage was identified. No further shunt revision was placed. Histological examination showed that the cyst wall consisted of outer fibrous tissue and inner granulation tissue without epithelial lining, and the cystic content was chronic hematoma. The patient had an uneventful postoperative course and remained asymptomatic for 8-mo follow-up. CONCLUSION: To the best of our knowledge, this is the first report of hemorrhagic onset in the abdominal pseudocyst following VP shunt. Such special condition can accelerate the appearance of clinical signs of the abdominal pseudocyst after VP shunts, and its mechanisms may be similar to the evolution of subdural effusion into chronic subdural hematoma (CSDH).


Asunto(s)
Abdomen/diagnóstico por imagen , Quistes/etiología , Hemorragia/etiología , Hidrocefalia/cirugía , Derivación Ventriculoperitoneal/efectos adversos , Anciano , Líquido Cefalorraquídeo , Quistes/diagnóstico por imagen , Quistes/cirugía , Drenaje , Femenino , Humanos , Laparoscopía , Complicaciones Posoperatorias , Tomografía Computarizada por Rayos X
16.
BMC Surg ; 21(1): 152, 2021 Mar 21.
Artículo en Inglés | MEDLINE | ID: mdl-33743667

RESUMEN

BACKGROUND: Inguinal hernia surgery is a frequent procedure among general surgeons in Costa Rica, but the management and technique are not uniform. The International Guideline for Groin Hernia management was published in 2018 to standardize the inguinal hernia surgery, but the diffusion of the guidelines and its adherence have been extremely varied. PURPOSE: Collect and analyze the current reality regarding groin hernia management in Costa Rica. Secondly evaluate the diffusion and development comparing it to the guideline's recommendations. METHOD: Questionnaire of 42 single and multiple answer questions according to the topics of the International Guideline directed to general surgeons. Diffusion of the inquiry through surgical and hernia association chats and email. Timeframe June-December 2019. RESULTS: 64 surveys were collected, which is a representative number of the general surgeons national college. The most frequent procedure between these was the abdominal wall surgery. Every surgeon did more than 52 groin hernia surgeries in one year, most of them outpatients. The epidural anesthesia was used the most and Lichtenstein's technique was the most frequently used (64%). 68% of the surgeons know how to perform a minimally invasive inguinal hernia surgery but with variable volumes. 38% of participants considered themselves experts in groin hernia management and 52% did not know the 2018 International Guideline. The recommendations of such guideline are followed only partially. CONCLUSIONS: The 2018 Hernia Surge International Guidelines have low diffusion among Costa Rican surgeons. The laparoscopic approach is widely accepted but there are no studies to assess the results and the quality. There should be protocols and studies adapted to Costa Rica's national situation.


Asunto(s)
Ingle/cirugía , Adhesión a Directriz/estadística & datos numéricos , Hernia Inguinal/cirugía , Herniorrafia/métodos , Laparoscopía/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/estadística & datos numéricos , Cirujanos , Adulto , Anestesia Local/estadística & datos numéricos , Costa Rica/epidemiología , Femenino , Herniorrafia/normas , Humanos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios , Encuestas y Cuestionarios
17.
Medicine (Baltimore) ; 100(12): e24908, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761649

RESUMEN

OBJECTIVE: To systematically review and evaluate the safety, advantages and clinical application value of laparo-endoscopic single-site surgery (LESS) for endometrial cancer by comparing it with conventional laparoscopic surgery (CLS). METHODS: We conducted a systematic review of the published literature comparing LESS with CLS in the treatment of endometrial cancer. English databases including PubMed, Embase, Ovid, and the Cochrane Library and Chinese databases including Chinese National Knowledge Infrastructure, Wanfang and China Biology Medicine were searched for eligible observational studies up to July 10, 2019. We then evaluated the quality of the selected comparative studies before performing a meta-analysis using the RevMan 5.3 software. The complications, surgical time, blood loss during surgery, postoperative length of hospital stay and number of lymph nodes removed during surgery were compared between the 2 surgical approaches. RESULTS: Four studies with 234 patients were finally included in this meta-analysis. We found that there was no statistically significant difference in complications between the 2 surgical approaches [odds ratio (OR): 0.63, 95% confidence interval (CI): 0.18-2.21, P = .47, I2 = 0%]. There was no statistically significant difference in blood loss between the 2 surgical approaches [mean difference (MD): -61.81, 95% CI: -130.87 to -7.25, P = .08, I2 = 74%]. There was no statistically significant difference in surgical time between the 2 surgical approaches (MD: -11.51, 95% CI: -40.19 to 17.16, P = .43, I2 = 81%). There was also no statistically significant difference in postoperative length of hospital stay between the 2 surgical approaches (MD: -0.56, 95% CI: -1.25 to -0.13, P = .11, I2 = 72%). Both pelvic and paraaortic lymph nodes can be removed with either of the 2 procedures. There were no statistically significant differences in the number of paraaortic lymph nodes and total lymph nodes removed during surgery between the 2 surgical approaches [(MD: -0.11, 95% CI: -3.12 to 2.91, P = .29, I2 = 11%) and (MD: -0.53, 95% CI (-3.22 to 2.16), P = .70, I2 = 83%)]. However, patients treated with LESS had more pelvic lymph nodes removed during surgery than those treated with CLS (MD: 3.33, 95% CI: 1.05-5.62, P = .004, I2 = 32%). CONCLUSION: Compared with CLS, LESS did not reduce the incidence of complications or shorten postoperative hospital stay. Nor did it increase surgical time or the amount of bleeding during surgery. LESS can remove lymph nodes and ease postoperative pain in the same way as CLS. However, LESS improves cosmesis by leaving a single small scar.


Asunto(s)
Neoplasias Endometriales/cirugía , Laparoscopía/métodos , Pérdida de Sangre Quirúrgica , Neoplasias Endometriales/patología , Femenino , Humanos , Laparoscopía/efectos adversos , Tiempo de Internación , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Estadificación de Neoplasias , Tempo Operativo , Dolor Postoperatorio/prevención & control , Complicaciones Posoperatorias
18.
Adv Clin Exp Med ; 30(3): 233-237, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33757163

RESUMEN

BACKGROUND: Modern approach to the surgical treatment of Hirschsprung's disease (HD) consists in the earliest possible repair and reduction of the number of surgical interventions. Primary one-stage transanal endorectal pull-through (TEPT) technique requires preoperative determination of the length of aganglionic segment. The efficacy of the standard method - contrast enema - is questionable in patients with a poorly defined transitional zone. OBJECTIVES: To present the proposed laparoscopic method for the management pathway in patients with HD, in whom the determination of the length of aganglionic segment with contrast enema was not possible. MATERIAL AND METHODS: A retrospective analysis of the diagnostic and therapeutic management employed in 14 patients, from 2 weeks to 55 months of age, with diagnosed HD, treated between January 2013 and May 2020. Laparoscopic histological mapping was performed with the use of 3 laparoscopic ports of 3-5 mm diameter. RESULTS: In all patients, laparoscopic mapping allowed for the determination of the length of aganglionic segment and the mode of surgical treatment. Four children with determined short-segment disease underwent TEPT, while 2 underwent temporary colostomy formation using the Duhamel-Martin-Ikeda method. Five patients with long-segment HD underwent laparoscopic-assisted TEPT. One patient with long-segment disease was treated with a temporary double-barrel colostomy and definitive surgery was performed 3 months later using the Duhamel-Martin-Ikeda method. In 2 patients with an initial diagnosis of HD established using current diagnostic pathway, HD pathology was later excluded based on the results of laparoscopic mapping and repeat rectal suction biopsy. No complications related to the laparoscopic procedure were identified. CONCLUSIONS: The method of laparoscopic mapping is effective in the determination of the length of aganglionic segment in children with diagnosed HD. In doubtful cases, it can be the preferred option in establishing the final mode of surgical treatment.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo , Enfermedad de Hirschsprung , Laparoscopía , Niño , Enfermedad de Hirschsprung/cirugía , Humanos , Lactante , Complicaciones Posoperatorias , Estudios Retrospectivos , Resultado del Tratamiento
19.
Medicine (Baltimore) ; 100(12): e24697, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761637

RESUMEN

RATIONALE: Carcinosarcoma and sarcomatoid carcinoma of the stomach are rare, malignant, and biphasic tumors with high mortality. The differential diagnosis of these 2 diseases remains challenging. In the present study, we present 2 cases of carcinosarcoma and sarcomatoid carcinoma of the stomach. PATIENT CONCERNS: A 54-year-old woman was admitted with complaints of epigastric pain for 4 months, but she became serious for 10 days accompanied by melena. A 75-year-old man was admitted with complaints of epigastric pain for 1 month. DIAGNOSIS: The female had a Borrmann type III irregular ulcerative lesion (5.0 × 4.0 × 1.0 cm) originating from the gastric antrum. The male had Borrmann type I tumor polypoid exophytic (5.0 × 4.0 × 2.0 cm) in the fundus of stomach near the cardia. Both cases were identified as malignant neoplasms by endoscopic biopsy and further confirmed by performing laparoscopic proximal gastrectomy, esophagogastrostomy, and palliative distal subtotal gastrectomy. The postoperative histopathological morphology and immunohistochemistry studies revealed sarcomatoid carcinoma for the female and gastric carcinosarcoma for the male respectively. INTERVENTIONS: The female patient subsequently underwent laparoscopy-assisted radical distal gastrectomy for gastric cancer followed by systemic chemotherapy with oxaliplatin plus tegafur. The male patient underwent laparoscopic proximal gastrectomy and esophagogastrostomy were performed. OUTCOMES: The female had a mixture of a little poorly-differentiated adenocarcinoma and abundant sarcomatoid spindle cell elements, and is still alive healthy up to date for 2 and a half years after surgery by phone follow-up. The male patient had both adenocarcinoma and fibrosarcoma in a single tumor, and died 1 month after the operation. LESSONS: The present study provides insight into the clinical findings, differential diagnosis, and prognosis of carcinosarcomas and sarcomatoid carcinomas of the stomach. More cases are needed for further studies in the future.


Asunto(s)
Carcinoma/diagnóstico , Carcinosarcoma/diagnóstico , Neoplasias Gástricas/diagnóstico , Dolor Abdominal/etiología , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma/complicaciones , Carcinoma/patología , Carcinoma/terapia , Carcinosarcoma/complicaciones , Carcinosarcoma/patología , Carcinosarcoma/terapia , Quimioterapia Adyuvante , Diagnóstico Diferencial , Resultado Fatal , Femenino , Gastrectomía , Mucosa Gástrica/diagnóstico por imagen , Mucosa Gástrica/patología , Mucosa Gástrica/cirugía , Gastroscopía , Humanos , Biopsia Guiada por Imagen , Laparoscopía , Masculino , Melena/etiología , Persona de Mediana Edad , Oxaliplatino/uso terapéutico , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/patología , Neoplasias Gástricas/terapia , Tegafur/uso terapéutico , Resultado del Tratamiento
20.
BMC Surg ; 21(1): 171, 2021 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-33784995

RESUMEN

BACKGROUND: Clinically relevant pancreatic fistula (CRPF) is a serious complication following laparoscopic pancreaticoduodenectomy (LPD). This study aimed to determine if C-reactive protein (CRP) and procalcitonin (PCT) serum levels could be used as early biomarkers to predict CRPF after LPD. METHODS: In this retrospective study, we collected peri-operative data of patients who underwent LPD between January 2019 and November 2019. We compared serum levels of white blood cells (WBC), CRP, and PCT on post-operative days (POD) 1, 2, 3, 5, and 7 between the CRPF and non-CRPF groups and analyzed the predictive risk factors for CRPF. RESULTS: Among the 186 patients included in this study, 18 patients (9.7%) developed CRPF, including 15 and 3 patients with grade B and C fistulas, respectively. The mean WBC, CRP, and PCT levels were higher on most PODs in the CRPF group compared to the non-CRPF group. Receiver operating characteristic (ROC) analysis indicated that CRP levels on POD 2, 5, and 7 can predict CRPF development after LPD, with the area under the curve (AUC) value reaching the highest level on POD 2 (AUC 0.794). PCT levels on POD 2, 3, 5, and 7 were highly predictive of CRPF after LPD. The highest AUC value was achieved on POD 3 [PCT > 2.10 ng/ml (AUC 0.951; sensitivity 88.2%, specificity 92.9%, P < 0.001)]. CONCLUSIONS: Both CRP and PCT levels can be used to predict CRPF development after LPD, with PCT having a higher predictive value.


Asunto(s)
Proteína C-Reactiva , Fístula Pancreática , Pancreaticoduodenectomía , Polipéptido alfa Relacionado con Calcitonina , Biomarcadores/sangre , Proteína C-Reactiva/metabolismo , Humanos , Laparoscopía/efectos adversos , Fístula Pancreática/etiología , Pancreaticoduodenectomía/efectos adversos , Pancreaticoduodenectomía/métodos , Polipéptido alfa Relacionado con Calcitonina/sangre , Estudios Retrospectivos
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