Factors that influence bile fluid microbiology in cholecystectomized patients. / Factores que influyen en la microbiología del líquido biliar en los pacientes colecistectomizados.

INTRODUCTION AND AIM: Normally, the bile ducts are sterile, but up to 4.2% of healthy persons can present with positive cultures. Certain circumstances favor that situation, such as gallstones or biliary tree manipulation. The aim of the present study was to determine the factors that influence the presence of bacteriobilia, as well as its implications for clinical practice. MATERIALS AND METHODS: A prospective study was conducted on bile cultures from patients that underwent cholecystectomy at our hospital center within the time frame of 2013 to 2015. RESULTS: The study included 196 patients (42.3% women and 57.7% men) that underwent either open or laparoscopic cholecystectomy and in whom bile fluid samples were taken. The clinical, epidemiologic, and laboratory test characteristics of the patients were analyzed, as well as the surgical indication (urgent surgery or programmed surgery). With respect to microbiology, 47% of the bile cultures were positive: 56.5% presented with one microorganism, 25% with two, and 18.5% with three or more. CONCLUSION: Microbiologic bile analysis should not be systematically performed, given that its result is relevant only in cases that present with demonstrated risk factors. However, in those cases, said analysis is essential to establish adequate antibiotic treatment, in relation to activity spectrum and duration, to prevent complications and an increase in microbial resistance.

[Biliary microbiote in cholecystectomized patients: Review of empirical antibiotherapy]. / Microbiota biliar en pacientes colecistectomizados: Revisión de la antibioterapia empírica.

OBJECTIVE: Cholecystitis is an important cause of hospital admission. In moderate or severe cholecystitis, the delay in treatment can lead to serious complications. Our objective is to analyze the microorganisms isolated in bile from cholecystectomized patients and their sensitivity pattern, to evaluate the empirical treatment in those cases in which the surgical removal of the gallbladder should be delayed. METHODS: Prospective descriptive study of biliary cultures of patients undergoing cholecystectomy from May 2013 to February 2015, in the Surgery Department of the Hospital General Universitari de Castelló. RESULTS: We studied 196 patients, 83 women (42.3%) and 113 men (57.7%), with an average age of 61.5 years. The most used antibiotics as empiric treatment were piperacillin/tazobactam (77.8%) and amoxicillin/clavulanic (14.8%). In 46.4% of patients (91/196) bile cultures were positive. 165 microorganisms were isolated. The majority were Gram-negative bacilli (60.5%), mainly of the Enterobacterales order (91/54.5%), with Escherichia coli being the most frequent microorganism (24%) followed by Klebsiella spp. (12.5%). 3 E. coli with extended-spectrum beta-lactamase (ESBL) and 1 K. pneumoniae with ESBL were isolated. Microorganisms producing carbapenemase and methicillin-resistant Staphylococcus aureus were not isolated. CONCLUSIONS: The bile microbiota, with a predominance of Enterobacterales is similar to that found in european studies..

Usefulness of the log odds of positive lymph nodes to predict and discriminate prognosis in gastric carcinomas.

BACKGROUND: The lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) have been proposed to minimize the stage migration phenomenon. The value of the LODDS and LNR staging systems to predict and discriminate prognosis was assessed and compared to the International Union Against Cancer (UICC) TNM classification (pN). METHODS: Three hundred and twenty-six patients with gastric carcinoma were retrospectively studied. Disease-specific survival rates were calculated for every pN, LNR, and LODDS category. RESULTS: Four LNR categories (0, 1-25, 26-75, and >76 %) and four LODDS categories (-5 to -3, > -3 to -1, > -1 to 3, and >3 to 5) were established. In the multivariate analysis, only the stage pT3-4 versus pT1-2 (HR 1.88, 95 % CI 1.11-3.20, p=0.02) and LODDS as continuous variable (HR 1.40, 95 % CI 1.21-1.61, p<0.001) remained as independent prognostic factors. In patients with <16 lymph nodes retrieved, only the LODDS system could discriminate different disease-specific survival curves for every category. LODDS categories were able to discriminate subgroups with different prognoses in pN stages and LNR categories. CONCLUSIONS: The LODDS staging system was superior to the pN classification and LNR system to discriminate risk prognosis especially in patients with an insufficient number of retrieved lymph nodes.

[Boerhaave's syndrome: a review of our experience over the last 16 years]. / Síndrome de Boerhaave: revisión de nuestra experiencia en los últimos 16 años.

OBJECTIVE: Report our experience in the diagnosis and treatment of Boerhaave syndrome by retrospective study from 1997 to 2013. PATIENTS AND METHODS: A retrospective study was conducted covering the time frame of 1997 to 2013. RESULTS: There were a total of 5 men (71%) and 2 women (29%) and the mean age was 54 years (range: 33-80 years). Diagnosis was made through computed tomography scan in 5 cases (71%) and esophagogram in 2 cases (19%). Six patients (86%) had emergency surgery, whereas one case (14%) was managed conservatively. The surgical technique employed was primary suture and repair in 4 patients (67%) and esophageal resection and subsequent cervical esophagostomy in 2 patients (33%). CONCLUSIONS: Boerhaave's syndrome is a clinically rare entity with an elevated mortality rate. Therefore, a high degree of suspicion is necessary for making the diagnosis and providing early treatment that can result in improved outcome.

Prognosis for gastric carcinomas with an insufficient number of examined negative lymph nodes.

BACKGROUND: The optimal system for lymph node (LN) staging in gastric cancer is still a subject of debate. The aim of our study was to analyse the probability of error in negative LN (pN0) gastric carcinomas when a low number of LNs were harvested using a probabilistic model. METHODS: Patients with gastric carcinoma who underwent R0 resection at three university hospitals between 2004 and 2009 were retrospectively included. A Bayesian model was used to analyse the probability of error for negative LNs (pN0) gastric carcinomas. Kaplan-Meier survival curves and the log-rank test were used to compare the overall and specific mortality of prognosis groups. RESULTS: Of the 291 patients included, 123 were classified as pN0 (42%). A significant correlation was found between the extent of the LN dissection performed and the number of the LNs retrieved. According to the Bayesian model the carcinomas with 9 or fewer negative lymph nodes were considered to have a high risk (HR) of misclassification, whereas patients with 10-25 LNs analysed and those with more than 26 negative lymph nodes were considered to have a moderate risk (MR) and low risk (LR), respectively. The log-rank test showed a significant improvement in the disease-specific survival for the MR pN0 (p < 0.001) and LR pN0 (p < 0.04) but not for the HR pN0 patients compared to pN1 patients. CONCLUSIONS: The proposed probabilistic model is clinically useful for differentiating the prognosis in pN0 gastric carcinomas when an insufficient number of negative lymph nodes are retrieved.

[A preliminary experience in the laparoscopic approach to bowel obstruction]. / Experiencia inicial en el abordaje laparoscópico de la obstrucción intestinal.

BACKGROUND: The laparoscopic approach to bowel obstruction is still controversial. OBJECTIVE: To evaluate our initial results in the laparoscopic treatment of bowel obstruction. MATERIAL AND METHODS: A retrospective study on patients diagnosed with bowel obstruction that underwent laparoscopic surgery within the time frame of January 2008 to June 30, 2012. The variables employed were: age, sex, occlusion etiology, previous surgeries, clinical progression, pneumoperitoneum creation, use of an auxiliary incision, anesthesia duration, conversion rate, postoperative hospital stay, time needed to tolerate liquids, and complications. RESULTS: Twenty-six patients, 18 women (69.2%) and 8 men (30.8%), with a mean age of 64.35 years (range: 21-92 years) were analyzed. The most frequent obstruction etiology was secondary to adhesions and presented in 12 cases. Nine patients (34.6%) underwent a completely laparoscopic approach and laparoscopy was complemented by an auxiliary incision in another 9 patients (34.6%), resulting in 18 cases (69.2%) of successful laparoscopic approach. Eight patients (30.8%) required conversion to open surgery. The mean anesthesia duration was 95min (range: 55-165min), mean postoperative hospital stay was 6 days (range: 3-72 days), and the mean amount of time needed to tolerate liquids was 3 days (range: 1-10 days). The patients that underwent complete laparoscopic approach presented with shorter hospital stay, they were able to ingest liquids earlier, and they presented with a lower number of postoperative complications; this latter variable was the only one that was statistically significant. CONCLUSIONS: The initial results of our experience were good, although more patients are needed in order to standardize and extend the use of this technique.

[Laparoscopic apendicectomy vs open approach for the treatment of acute appendicitis]. / Apendicectomía laparoscópica frente al abordaje abierto para el tratamiento de la apendicitis aguda.

BACKGROUND: There is no international consensus on the approach of choice for performing appendectomy. AIMS: To analyze and compare open and laparoscopic approaches in the surgical treatment of acute appendicitis. MATERIAL AND METHODS: A retrospective study was carried out on patients over 14-years-old operated on for suspected acute appendicitis between January 2007 and December 2009. Variables were: age, sex, body mass index, specialized surgeon or resident in training, progression duration, conversion rate, use of drains, abdominal cavity irrigation, macroscopic appearance of the appendix, onset time of anesthesia, ASA classification, postoperative hospital stay, resumption of intake of liquids, and complications. The patients were divided into two groups: laparoscopic approach (LA) and open approach (OA). RESULTS: A total of 533 patients were enrolled (290 LA and 243 OA). Onset time of anesthesia was 75 min (30-190 min) in LA vs 55 min (20-160 min) in OA (p<0,0001). COMPLICATIONS: intraabdominal abscesses in 17 LA cases vs 13 OA cases (p=0,79); surgical wound alterations in 16 LA cases vs 47 OA cases (p=0,0001); incisional hernias in 2 LA cases (1%) vs 10 OA cases (p=0,008). There were no statistically significant differences in postoperative hospital stay (3 days), resumption of intake of liquids (1 day) or readmission rate (8%). CONCLUSIONS: There are fewer surgical wound alterations and incisional hernias with the laparoscopic approach, but there is higher cost, lengthier surgery duration, and a longer learning curve. Our results cannot provide a clear indication for one approach or the other, and therefore each case must be evaluated on an individual basis.

Laparoscopy versus open surgery for advanced and resectable gastric cancer: a meta-analysis.

BACKGROUND: There are few studies in the literature comparing laparoscopic versus open Gastrectomy, predominantly for advanced gastric cancer (AGC). Most of the available studies and meta-analysis compare both approaches in the early gastric cancer. The meta-analysis, here presented, compares the clinical outcomes between these two procedures for AGC. OBJECTIVES: To evaluate the current status of both partial and total laparoscopic gastrectomy (LG), with regard to its short and long-term outcomes by comparing it to conventional open gastrectomy (OG) for AGC. DATA SOURCES AND REVIEW METHODS: original articles published in English language from January 1991 to October 2009 were searched in the Medline, Embase, Current Contents, Science Citation Index databases and Cochrane Controlled Trials Register. All articles comparing LG and OG for AGC were included, and those comparing outcomes only for early gastric cancer (EGC) were excluded. Clinical appraisal and data extraction were conducted independently by 3 reviewers. Statistical analysis was carried out following the DerSimonian-Laird random effects model. RESULTS: out of 2,344 studies, 7 studies were selected. One prospective randomized controlled trial, one comparative prospective study and five comparative retrospective studies were analyzed. These studies include a total of 452 patients with gastric cancer, 174 patients in the LG and 278 in the OG. The analyzed result variables were operative time, operative blood loss, hospital postoperative stay, number of dissected lymph nodes and cancer-related mortality risk. Compared to OG, LG was a longer procedure: weighted mean difference (WMD) 44 minutes; 95% confidence interval (CI) 20 to 69; I-squared = 91.6%, but was associated with a lower blood loss (WMD -122 cc; 95% CI -208 to -37; I-squared = 90.8%); this was more significant for hospital operative stay (WMD -6.2 days; 95% CI -9.4 to -2.8; I-squared = 67.8%). Moreover there were no significant differences between the two groups concerning the number of dissected lymph nodes (WMD -1.57; 95% CI -3.41 to 0.26; I-squared = 8.3) and no significant differences for cancer-related mortality risk (adjusted for 60 months of follow-up) although there was a tendency toward a protective effect for LG (Odds Ratio 0.53; 95% CI 0.23 to 1.22; I-squared 41%). CONCLUSION: Laparoscopic total and partial gastrectomy for AGC is associated with a longer operative time but lower blood loss and shorter postoperative hospital stay. Moreover there were similar outcomes between both approaches in terms of number of dissected lymph nodes and long-term follow-up (survival).

Tratamiento quirúrgico de las metástasis hepáticas del cáncer de mama. Estado actual / No disponible

Introducción y objetivos: En el cáncer de mama, la presencia de metástasis se ha considerado como sinónimo de enfermedad incurable, con una mediana de supervivencia de 2- 14 meses. La mayoría de tratamientos se han considerado paliativos en estos casos. Sin embargo, diversos autores han comunicado recientemente aumentos de la supervivencia y del intervalo libre de enfermedad tras el tratamiento quirúrgico y médico agresivo en cierto grupo de pacientes. El objetivo del presente estudio fue realizar una revisión bibliográfica sobre el estado actual de la cirugía de las metástasis hepáticas del cáncer de mama. Resultados: No existen ensayos clínicos que comparen la cirugía hepática en estos casos con otros tratamientos. La mayoría de trabajos son series de casos, con las limitaciones que esto conlleva en cuanto a niveles de evidencia científica. No obstante, tanto la cirugía del tumor primario como la cirugía de las metástasis parecen relacionarse con mayor probabilidad de supervivencia en pacientes adecuadamente seleccionadas. Conclusión: Existe un pequeño pero importante subgrupo de pacientes con cáncer de mama metastásico en el hígado que pueden beneficiarse de un tratamiento quirúrgico y sistémico agresivo(AU)

Introduction and aims: For breast cancer, the presence of metastasis has been considered as a synonymous of non-curable pathology, with a median survival of 2-14 months. Most treatments have been considered as palliative. Nevertheless, several authors have recently reported higher survival rates and disease free survival rates after surgical and systemic aggressive therapies in a selected group of patients. The objective of this study was to review scientific literature about current status of metastatic breast cancer surgery. Results: There are not clinical trials comparing hepatic surgery and other treatments in these patients. Most studies are case series, what represents a serious limitation regarding evidence based medicine. However, both primary tumour surgery and metastatic surgery seems to be related with a higher probability of survival in selected patients. Conclusions: There is a small but important group of patients with metastatic breast cancer that are candidates to aggressive surgical and systemic treatments(AU)

Ginecomastia y cáncer de mama en el varón. Estudio de 49 casos / No disponible

Objetivo: Estudiar la posible relación entre la ginecomastia y el cáncer de mama en el varón. Material y métodos: Estudio descriptivo retrospectivo con revisión de los pacientes varones, mayores de 14 años, con ginecomastia intervenidos quirúrgicamente en nuestro hospital desde enero del año 1996 hasta diciembre de 2009. Para el análisis de los datos, los casos se dividieron en 2 grupos, atendiendo a la benignidad o malignidad en el estudio anatomopatológico. Resultados: El número total de casos analizados fue de 49, de los que 10 presentaron un diagnóstico anatomopatológico de cáncer de mama y 39 de patología benigna. Se ha encontrado una relación estadísticamente significativa entre la edad de presentación de la ginecomastia y el riesgo relativo de padecer cáncer de mama (p = 0,002). Conclusiones: Aunque no se ha podido demostrar que la ginecomastia sea un factor de riesgo para el cáncer de mama, este debe ser un diagnóstico diferencial a tener en cuenta en pacientes con ginecomastia. Según nuestros resultados, esta sospecha debería ser mayor cuanto mayor sea la edad del paciente(AU)

Objetive: To study the possible association between gynecomastia and breast cancer in men. Material and methods: A retrospective case-control study was designed. Male patients older than 14 years old with breast disorder undergoing surgery in our hospital between January 1996 and December 2009 were included. Two groups of patients were made, those with malignant disease and those with benign lesions. Results: The total number of cases analyzed was 49, 10 with pathological diagnosis of breast cancer and 39 of benign disease. A significant difference was found only for age at onset of gynecomastia and relative risk of breast cancer (p = 0.002). Conclusions: Although it was not possible to demonstrate that gynecomastia is a risk factor for breast cancer, it must be a differential diagnosis to be considered in patients with gynecomastia. According to our results, this suspicion should be higher with increasing patient age(AU)

Impact of the total number of harvested lymph nodes after colon cancer resections on survival in patients without involved lymph node.

BACKGROUND: The total number of harvested lymph nodes has been demonstrated to be of prognostic significance for colon cancer. Differences can occur in the total number of harvested lymph nodes between different specialists (surgeons and pathologists). OBJECTIVE: The aim of this study was to analyse if, in our centre, the number of analysed lymph nodes in patients with colon cancer that are classified as pN0 is also related to survival. MATERIAL AND METHODS: A retrospective study was designed, where 148 patients with colon adenocarcinoma (pN0 of TNM classification) who underwent elective surgery between 1 January 1995 and 31 December 2001, with curative intent were included. Three groups were created according to the number of analysed lymph nodes ( < 7, 7-14, > 14 lymph nodes). For survival analysis the Kaplan-Meier and CUSUM curves methods were used. RESULTS: The total number of analysed lymph nodes was 1,493 (mean 10.1 lymph nodes per patient). The rate of 5-years survival was 63.0% in the group with < 7 lymph nodes; 7-14 lymph nodes: 80.6% and those with > 14 lymph nodes: 91.8% (p < 0.01). Prognostic significance was also present for multivariate analysis. CONCLUSION: In our centre, harvesting a larger number of lymph nodes is related to improved rates of 5-years survival for patients with colon cancer staged as pN0. It seems reasonable to recommend obtaining as many lymph nodes as possible, and not to establish a minimum number of lymph nodes to be harvested.

Influencia del número total de ganglios analizados tras cirugía de resección en el cáncer de colon sobre la supervivencia en pacientes sin afectación ganglionar / No disponible

Introducción: el número total de ganglios analizados ha demostradosu influencia pronóstica en el cáncer de colon. Puedenexistir grandes diferencias en el número de ganglios obtenidos pordiferentes especialistas (cirujanos y anatomopatólogos).Objetivo: el objetivo del presente estudio fue analizar si, ennuestro medio, el número de ganglios analizados en pacientes concáncer de colon clasificados como pN0 se relaciona también conla supervivencia.Material y métodos: estudio retrospectivo, con inclusión de148 pacientes con adenocarcinoma de colon (pN0 de la clasificaciónTNM) intervenidos de forma programada con intención curativaentre 1 de enero de 1995 y 31 de diciembre de 2001. Se establecieron3 grupos según el número de ganglios analizados (< 7,7-14, > 14 ganglios). Para el análisis de la supervivencia se utilizaronel método de Kaplan Meier y las gráficas CUSUM.Resultados: el número total de ganglios analizados fue 1.493(media 10,1 ganglios por paciente). La supervivencia a 5 años fuedel 63,0% en el grupo con < 7 ganglios; del 80,6% en el grupocon 7-14; y del 91,8% en el grupo con > 14 ganglios analizados(p < 0,01). La influencia pronóstica se mantuvo en el análisis multivariante.Conclusión: en nuestro medio, la obtención de un mayor númerode ganglios analizados se relaciona con una mayor supervivenciaa los 5 años en pacientes con cáncer de colon clasificadoscomo pN0. Parece razonable recomendar la obtención de tantosganglios como sea posible en este tipo de cirugía y no recomendarun número mínimo de ganglios que se deberían analizar(AU)

Background: the total number of harvested lymph nodeshas been demonstrated to be of prognostic significance forcolon cancer. Differences can occur in the total number of harvestedlymph nodes between different specialists (surgeons andpathologists).Objective: the aim of this study was to analyse if, in our centre,the number of analysed lymph nodes in patients with coloncancer that are classified as pN0 is also related to survival.Material and methods: a retrospective study was designed,where 148 patients with colon adenocarcinoma (pN0 of TNMclassification) who underwent elective surgery between 1 January1995 and 31 December 2001, with curative intent were included.Three groups were created according to the number of analysedlymph nodes (< 7, 7-14, > 14 lymph nodes). For survival analysisthe Kaplan-Meier and CUSUM curves methods were used.Results: the total number of analysed lymph nodes was1,493 (mean 10.1 lymph nodes per patient). The rate of 5-years survival was 63.0% in the group with < 7 lymph nodes;7-14 lymph nodes: 80.6% and those with > 14 lymph nodes:91.8% (p < 0.01). Prognostic significance was also present formultivariate analysis.Conclusion: in our centre, harvesting a larger number oflymph nodes is related to improved rates of 5-years survival forpatients with colon cancer staged as pN0. It seems reasonableto recommend obtaining as many lymph nodes as possible, andnot to establish a minimum number of lymph nodes to be harvested(AU)

Cambios en el estadio evolutivo en el momento del diagnóstico tras 10 años de cribado poblacional de cáncer de mama / No disponible

Introducción: La finalidad de los programas de cribado decáncer de mama es realizar un diagnóstico cada vez más precoz.El objetivo del presente estudio fue analizar si, tras 10años de cribado poblacional, el diagnóstico de cáncer demama se realiza en estadios más precoces.Material y métodos: Estudio retrospectivo con revisión delos casos de cáncer diagnosticados en la unidad de prevencióndel cáncer de mama de Castellón (C. Valenciana, España). Secompararon los resultados de los años 1997, 1998, 2007 y2008. Como variables de estudio se consideraron el tiempoentre el primer contacto y la cirugía definitiva (tiempo terapéutico),el tipo histológico, el tamaño tumoral y la clasificaciónTNM anatomopatológica.Resultados: Se analizaron 126 pacientes; 34 en 1997, 30en 1998, 29 en 2007 y 33 en 2008. Se apreció una disminuciónprogresiva en el tiempo terapéutico. Asimismo, se objetivóuna tendencia de tipo lineal en cuanto a la proporción decasos infiltrantes con respecto a los carcinomas in situ (p =0,03). Durante los años 2007 y 2008, el porcentaje de carcinomasin situ fue superior al de los años 1997 y 1998. No seconsiguieron demostrar diferencias en el tamaño tumoral (p =0,61) ni en las categorías TNM (p = 0,99).Conclusión: Tras 10 años de implantación del programade cribado poblacional en nuestro medio, los casos de cáncerde mama son diagnosticados en estadios menos evolucionados.Serán necesarios nuevos estudios que permitan comprobarsi este diagnóstico más precoz se relaciona con un mejorpronóstico(AU)

Background: Final endpoint of breast cancer screeningprograms is to diagnose breast cancer in an early stage. Theobjective of present study was to evaluate if this diagnosis isearlier performed after 10 years of a poblational screeningprogram implantation.Material and methods: Retrospective analysis with revisionof breast cancer cases detected in the poblational screeningprogram of Castellon (C. Valenciana, Spain). Results from1997, 1998, 2007 and 2008 were compared. Therapeutictime, histologic type, tumour size and TNM classification wereanalyzed.Results: 126 patients were analyzed, 34 during 1997, 30during 1998, 29 during 2007 and 33 during 2008. A decreasingtherapeutic time was observed. A lineal tendency wasobserved regarding the proportion of in situ carcinomas andinvasive carcinomas (p = 0.03). During 2007 and 2008 ahigher proportion of in situ carcinomas was observed. It wasnot possible to demonstrate statistical differences regarding tumoursize or TNM categories.Conclusion: After 10 years of breast cancer screening program,breast cancer is detected in a earlier stage. New studiesshould confirm if this earlier diagnostic is related to a betterprognosis(AU)

Gallstone ileus: management options and results on a series of 40 patients.

INTRODUCTION: Controversy remains about the management of gallstone ileus. While some authors propose enterotomy, others defend the one-stage procedure (simultaneously fistula repair). The objective of the present study was to analyze management options and comparative study their results. MATERIAL AND METHODS: Retrospective and descriptive study with revision of clinical stories of patients with the diagnosis of gallstone ileus between 1987 and 2008. All the following variables were recorded: dates of hospital admission, surgery and discharge, age, sex, pathological antecedents, preoperative or intraoperative diagnosis, treatment, location of the fistula and location of the obstruction. End-result variables were: postoperative complications, mortality, complications during the follow-up and biliary complications. RESULTS: A total of 40 patients were included of 46,648 admissions. Age, comorbidity, and intraoperative diagnosis were related with poorer short- and long-outcomes. The percentage of postoperative complications was similar for groups with and without fistula repair. Mortality was higher in the group with fistula repair (15 vs. 25%). Biliary complications were more frequent in the group without fistula repair (11 vs. 0%). Sex, location of the fistula and location of the obstruction did not be related with the prognosis. CONCLUSION: One-stage procedure is related with higher mortality rate than enterotomy alone. Nevertheless, fistula repair reduces the number of biliary complications during the follow-up.

Íleo biliar: opciones terapéuticas y resultados en una serie de 40 casos / Gallstone ileus: management options and results on a series of 40 patients

Introducción: todavía existe gran controversia sobre el mejor tratamiento del íleo biliar. Algunos autores proponen la enterotomía aislada, mientras otros defienden la reparación de la fístula bilioentérica en el mismo acto quirúrgico. El objetivo del presente estudio fue analizar las opciones terapéuticas en estos pacientes y estudiar sus resultados. Material y métodos: estudio retrospectivo y descriptivo, con revisión de las historias clínicas de los pacientes diagnosticados de íleo biliar desde 1987 hasta 2008. Se recogieron las fechas de ingreso, de intervención y del alta, edad, sexo, antecedentes patológicos, diagnóstico preoperatorio o intraoperatorio, tratamiento, lugar de la fístula y lugar de la obstrucción. Como variables de resultado se utilizaron las complicaciones postoperatorias, mortalidad, complicaciones en el seguimiento y complicaciones biliares. Resultados: se incluyeron 40 pacientes sobre 46.648 ingresos. La edad, la comorbilidad y el diagnóstico intraoperatorio se relacionaron con peores resultados a corto y largo plazo. El porcentaje de complicaciones postoperatorias fue similar para el grupo con abordaje de la fístula y para el grupo con enterotomía aislada. La mortalidad fue superior en el grupo con abordaje de la fístula (15 frente a 25%). Las complicaciones biliares fueron más frecuentes en el grupo sin abordaje de la fístula biliar (11 frente a 0%). El sexo, lugar de la fístula o el lugar de la obstrucción no demostraron diferencias. Conclusión: la cirugía en un solo tiempo se relaciona con mayor mortalidad que la enterotomía aislada. No obstante, añadir la reparación de la fístula reduce el número de complicaciones biliares en el seguimiento(AU)

Introduction: controversy remains about the management of gallstone ileus. While some authors propose enterotomy, others defend the one-stage procedure (simultaneously fistula repair). The objective of the present study was to analyze management options and comparative study their results. Material and methods: retrospective and descriptive study with revision of clinical stories of patients with the diagnosis of gallstone ileus between 1987 and 2008. All the following variables were recorded: dates of hospital admission, surgery and discharge, age, sex, pathological antecedents, preoperative or intraoperative diagnosis, treatment, location of the fistula and location of the obstruction. End-result variables were: postoperative complications, mortality, complications during the follow-up and biliary complications. Results: a total of 40 patients were included of 46,648 admissions. Age, comorbidity, and intraoperative diagnosis were related with poorer short- and long-outcomes. The percentage of postoperative complications was similar for groups with and without fistula repair. Mortality was higher in the group with fistula repair (15vs. 25%). Biliary complications were more frequent in the group without fistula repair (11 vs. 0%). Sex, location of the fistula and location of the obstruction did not be related with the prognosis. Conclusion: one-stage procedure is related with higher mortality rate than enterotomy alone. Nevertheless, fistula repair reduces the number of biliary complications during the follow-up(AU)