The feasibility of laparoscopic cholecystectomy in patients with previous abdominal surgery.

A retrospective study was carried in 1500 patients submitted to elective laparoscopic cholecystectomy to ascertain its feasibility in patients with previous abdominal surgery. In 411 patients (27.4%) previous infraumbilical intraperitoneal surgery had been performed, and 106 of them (7.06%) had 2 or more operations. Twenty five patients (1.66%) had previous supraumbilical intraperitoneal operations (colonic resection, hydatid liver cysts, gastrectomies, etc.) One of them had been operated 3 times. In this group of 25 patients the first trocar and pneumoperitoneum were performed by open laparoscopy. In 2 patients a Marlex mesh was present from previous surgery for supraumbilical hernias. Previous infraumbilical intraperitoneal surgery did not interfere with laparoscopic cholecystectomy, even in patients with several operations. There was no morbidity from Verres needle or trocars. In the 25 patients with supraumbilical intraperitoneal operations, laparoscopic cholecystectomy was completed in 22. In 3, adhesions prevented the visualization of the gallbladder and these patients were converted to an open procedure. In the 2 patients Marlex mesh prevented laparoscopic cholecystectomy because of adhesions to abdominal organs. We conclude that in most instances previous abdominal operations are no contraindication to laparoscopic cholecystectomy.

Migracion de drenaje biliar (tubo de Kehr) transpapilar al duodeno. A proposito de un caso. / Transpapilary migration to the duodenum of a biliary drainage pipe (Kehr's tube). Apropos of a case

Los autores presentan una complicacion infrecuente de un drenaje biliar. Se trata de una migracion espontanea por via transpapilar del sector bifurcado de un drenaje de Kehr coledociano hacia al duodeno a posteriori de una papilotomia endoscopica

Tecnica quirurgica en la tiroidectomia para reducir la agresion recurrencial. / Surgical technic in thyroidectomy to reduce recurrent nerve injury

Proponemos una tecnica de tiroidectomia que no pretende ser original. Esta destinada fundamentalmente a mantener la indemnidad anatomica y funcional del nervio recurrente. La misma debe cumplir en forma ordenada y sistematica con los siguientes tiempos operatorios 1) Abordaje y seccion primaria del istmo tiroideo; 2) Abordaje del polo inferior del lobulo tiroideo y ligadura escalonada de las ramas de la tiroidea inferior contra la glandula; 3) busqueda sistematica del nervio recurrente; 4) ligadura del pediculo tiroideo medio, bien pegado a la capsula glandular; 5) ligadura por separado de las tres ramas del pediculo tiroideo superior

Megaesofago secundario a estenosis de neoboca en un antiguo gastrectomizado Billroth II. / Megaesophagus following stenosis of neostoma in a Billroth II gastrectomized patient

Presentamos el caso de un paciente gastrectomizado (Billroth II) y regastrectomizado que presento una entenosis benigna tardia de la neoboca con un megaesofago secundario a la misma. Se practico una nueva regastrectomia con excelente evolucion. El estudio histologico mostro una estenosis fibrosa de la neoboca. El megaesofago curo

La seccion - exclusion gastrica en la obstruccion neoplasica gastro-duodenal. / Gastric section-exclusion in gastroduodenal neoplastic obstruction

El procedimiento de seccion - exclusion gastrica (parcial o total) como tratamiento paliativo en las oclusiones neoplasticas gastro -duodenales es analizado en sus fundamentos tecnicos y fisiopatologicos. Se discuten sus ventajas e inconvenientes y se precisan sus indicaciones. Presentan una serie de 6 canceres irresecables (4 canceres gastricos 1 cancer de vesicula y 1 cancer de pancreas) tratados con este procedimiento