Hepaticoyeyunostomía asistida por Robot vs la técnica abierta en un Hospital de tercer nivel / Robotic-Assisted vs open technique Hepaticojejunostomy in a third level Hospital

Resumen A pesar de la evidencia científica de la seguridad, la eficacia de la cirugía robótica, existen pocas publicaciones en la reparación de la vía biliar. El principal objetivo de este estudio fue evaluar los resultados de la hepaticoyeyunostomía en Y de Roux asistida por robot (HYR) y la hepaticoyeyunostomía en Y de Roux abierta (HYA) en el HCM en el periodo de enero de 2012 a enero de 2019. Este es un estudio retrospectivo se recolectaron los datos sociodemográficos, las principales comorbilidades y se determinó la principal indicación quirúrgica de la hepaticoyeyunostomía; se agruparon según la indicación quirúrgica para comparar el sangrado transoperatorio, tiempo quirúrgico, los días de estancia hospitalaria y morbilidad entre la HYR vs HYA. Se registraron 78 hepaticoyeyunostomías (31 fueron HYR y 47 HYA), la edad promedio fue 55.2 ± 17.7 años predominio del género femenino, la principal comorbilidad fue la hipertensión arterial. La principal indicación quirúrgica de hepaticoyeyunostomía fue la disrupción de vía la biliar, en estos pacientes se encontró menor tiempo quirúrgico, días de hospitalización, y morbilidad en los pacientes sometidos a HYR que los pacientes tratados mediante HYA.

Abstract Despite the scientific evidence of safety, the efficacy of robotic surgery, there are few publications on bile duct repair. The main objective of this study was to evaluate the results of Robotic-assisted Hepaticojejunostomy (RHJ) versus open Hepaticoyejunostomy (OHJ) in the HCM during the period from January 2012 to January 2019. This is a retrospective study, database of patients was collected: sociodemographic data, the main comorbidities, and the main surgical indication of hepaticojejunostomy were determined. They were grouped according to the surgical indication to compare: transoperative bleeding, surgical time, hospital length of stay and morbidity RHJ vs. OHJ. Seventy-eight hepaticojejunostomies were registered (31 RHJ and 47 OHJ), the average age was 55.2 ± 17.7 years, predominantly female, the main comorbidity was arterial hypertension. The main surgical indication of hepaticoyeynostomy was bile duct disruption. Shorter surgical time, days of hospitalization, and morbidity were found in patients undergoing RHJ than patients treated with OHJ.

[Non-surgical management after blunt traumatic liver injuries: A review article]. / Tratamiento no operatorio de las lesiones hepáticas por trauma no penetrante: artículo de revisión.

Hepatic trauma is a common cause for admissions in the Emergency Room. Currently, non-surgical management is the standard treatment in haemodynamically stable patients with a success rate of around 85 to 98%. This haemodynamic stability is the most important factor in selecting the appropriate patient. Adjuncts in non-surgical management are angioembolisation, image-guided drainage and endoscopic retrograde cholangiopancreatography. Failure in non-surgical management is relatively rare but potentially fatal, and needs to be recognised and aggressively treated as early as possible. The main cause of failure in non-surgical management is persistent haemorrhage. The aim of this paper is to describe current evidence and guidelines that support non-surgical management of liver injuries in blunt trauma.

Prospective randomized trial of the effect of octreotide on pancreatic juice output after pancreaticoduodenectomy in relation to histological diagnosis, duct size and leakage.

BACKGROUND: Octreotide is generally administered based on the surgeon's interpretation of perceived risk for pancreatic fistula at the time of pancreaticoduodenectomy (PD). METHODS: A single-institution, prospective randomized trial was conducted between April 2009 and December 2011 involving 62 PD patients who were randomized to receive octreotide (100 µg subcutaneously every 8 h; n = 32) or placebo (n = 30). Pancreatic juice output was measured after the operation using a catheter inserted into the pancreatic duct. Postoperative complications were recorded. RESULTS: No significant differences in median output were found between the octreotide (82.5 ml) and placebo (77.5 ml) groups (P = 0.538). Median total output was significantly lower in patients with adenocarcinoma compared with those with periampullary tumours (P = 0.004) and in patients with a duct diameter of >5 mm compared with those with a duct diameter of <5 mm (P = 0.001). There were no significant differences in overall morbidity between the octreotide and placebo groups (P = 0.819). Grade B pancreatic fistula (International Study Group for Pancreatic Fistula) was observed in two and three patients in the octreotide and placebo groups, respectively. CONCLUSIONS: Morbidity did not differ significantly between the groups. This study did not demonstrate an inhibitory effect of octreotide on exocrine pancreatic secretion. Based on these results, the routine use of octreotide after PD cannot be recommended.

Outcome after laparoscopic enucleation for non-functional neuroendocrine pancreatic tumours.

BACKGROUND: Non-functional endocrine pancreatic tumours (NPT) of more than 2 cm have an increased risk of malignancy. The aim of the present study was: (i) to define the guidelines for laparoscopic enucleation (LapEn) in patients with a non-functional NPT ≤3 cm in diameter; (ii) to evaluate pancreas-related complications; and (iii) to present the long-term outcome. METHODS: Between April 1998 and September 2010, 30 consecutive patients underwent laparoscopic surgery for a non-functional NPT (median age 56.5 years, range 44-83). Only 13 patients with tumours ≤3 cm in size underwent LapEn. Local lymph node dissection to exclude lymph node involvement was performed in all patients. RESULTS: The median tumour size, operative time and blood loss were 2.8 cm (range 2.8-3), 130 min (range 90-280) and 220 ml (range 120-300), respectively. A pancreatic fistula occurred in five patients: International Study Group of Pancreatic Fistula (ISGPF) A in two patients and ISGPF B in three patients. The median follow-up was 48 months (12-144). Three patients with well-differentiated carcinoma are free of disease 2, 3 and 4 years after LapEn and a regional lymphadenectomy. One patient, 5 years after a LapEn, presented with lymph node and liver metastases. CONCLUSIONS: The present study confirms the technical feasibility and acceptable morbidity associated with LapEn. Intra-operative lymph node sampling and frozen-section examination should be performed at the time of LapEn; when a malignancy is confirmed, oncologically appropriate lymph node dissection should be performed.

Pancreaticogastrostomía versus pancreaticoyeyunostomía después de pancreaticoduodenectomía: análisis crítico de los ensayos prospectivos aleatorizados / Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: critical analysis of prospective randomised trials

Este es un análisis crítico de los ensayos prospectivos aleatorizados que comparan las técnicas de reconstrucción pancreática con el estómago y con el intestino, después de pancreaticoduodenectomía. Se utilizó un cuestionario de preguntas del Centro de Medicina Basada en Evidencias de la Universidad de Oxford (análisis PICO), y se han seguido los criterios en la evaluación de estudios prospectivos aleatorizados para intervenciones quirúrgicas de la Universidad de McMaster de Ontario. Se encontró que los estudios difieren en aspectos metodológicos, el más importante la falta de una definición uniforme de fístula pancreática. Las técnicas de realización de la pancreaticogastrostomía y pancreaticoyeyunostomía no fueron homogéneas. No existen diferencias en el porcentaje de fístula pancreática en tres de estos estudios; uno que modifica la técnica de pancreticogastrostomía presentó resultados más favorables. Los nuevos estudios comparativos deberán utilizar las nuevas definiciones de las complicaciones de la pancreaticoduodenectomía y estandarizar la técnica de reconstrucción pancreática (AU)

This is a critical analysis of prospective randomised trials that compare pancreatic reconstruction techniques with the stomach and the intestine, after pancreaticoduodenectomy. A questionnaire with questions from the Evidence Based Medicine Centre of Oxford University(PICO analysis) was used, following the criteria for the evaluation of randomised prospective studies for surgical interventions of the McMaster University in Ontario. It was found that the studies differed in methodological aspects, the most important being the lack of a uniform definition of a pancreatic fistula. The techniques for performing pancreaticogastrostomy and pancreaticojejunostomy were not homogeneous. There were no differences in the percentage of pancreatic fistula in three of these studies; one which modified the pancreaticogastrostomy technique had more favourable results. New comparative studies should use new definitions of the complications of pancreaticoduodenectomy and standardize the pancreatic reconstruction technique (AU)

[Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: critical analysis of prospective randomised trials]. / Pancreaticogastrostomía versus pancreaticoyeyunostomía después de pancreaticoduodenectomía: análisis crítico de los ensayos prospectivos aleatorizados.

This is a critical analysis of prospective randomised trials that compare pancreatic reconstruction techniques with the stomach and the intestine, after pancreaticoduodenectomy. A questionnaire with questions from the Evidence Based Medicine Centre of Oxford University (PICO analysis) was used, following the criteria for the evaluation of randomised prospective studies for surgical interventions of the McMaster University in Ontario. It was found that the studies differed in methodological aspects, the most important being the lack of a uniform definition of a pancreatic fistula. The techniques for performing pancreaticogastrostomy and pancreaticojejunostomy were not homogeneous. There were no differences in the percentage of pancreatic fistula in three of these studies; one which modified the pancreaticogastrostomy technique had more favourable results. New comparative studies should use new definitions of the complications of pancreaticoduodenectomy and standardise the pancreatic reconstruction technique.