Laparo-endoscopic Rendezvous in the Treatment of Cholecystocholedocholithiasis: A Single Center Initial Experience

Cholecystocholedocholithiasis is a common disease worldwide; however, there is still no consensus regarding a gold standard therapy for its management. Nowadays, the preferred method is a "two-step" process, starting with an endoscopic common bile duct (CBD) stone extraction (endoscopic retrograde cholangiopancreatography [ERCP]) followed by a laparoscopic cholecystectomy (LC). Nevertheless, this "two-step" approach has shown some difficulties over time (i.e., need for two hospital admissions, need of at least two anesthesia inductions, higher rate of post-procedural pancreatitis, longer hospitalizations and thus, increased costs). On the other hand, the laparo-endoscopic rendezvous (LER), which is a simultaneous combined procedure for removing the gallbladder laparoscopically and clearing the CBD endoscopically, is another valid treatment modality that involves a "single-step" resolution of cholecystocholedocholithiasis applying a multidisciplinary approach of the patient. The aim of this study was to present our initial outcomes. We retrospectively analyzed eleven patients who consecutively underwent LER at our institution from May 2017 to March 2022. The patients' mean age was 50.6 years old (range, 34 - 68) and most were male 54.5% (6/11). LER successfully achieved CBD stone clearance in 90.9% (10/11) of the cases. Post-LER pancreatitis was not recorded in any case. Post-operative complications included one reoperation (1/11; 9.1%) due to bleeding from one of the laparoscopic trocar sites. Our group concluded that LER can be effectively applied in Perú with good mid-term results and confirmed its effectiveness in accomplishing CBD stone clearance. Based on our results, we recommend the use of LER as a safe and valid therapeutic option for our patients.

La colecistocoledocolitiasis es una enfermedad común a nivel mundial; sin embargo, aún no hay ningún consenso sólido acerca de una sola "terapia ideal" para su manejo. Hoy en día, el método mas utilizado es un procedimiento que involucra "dos estadios", el cual comienza con la extracción endoscópica de cálculos del conducto biliar común (CBD) (colangiopancreatografía retrógrada endoscópica [CPRE]) seguida de una colecistectomía laparoscópica (CL). Sin embargo, este enfoque de "dos estadios" ha mostrado algunas desventajas con el tiempo (necesidad de dos ingresos hospitalarios, necesidad de al menos dos inducciones anestésicas, mayor tasa de pancreatitis post-procedimiento, hospitalizaciones más prolongadas y, por lo tanto, mayores costos). Por otra parte, el rendezvous laparo-endoscópico (RLE), es otra modalidad de tratamiento que implica la resolución en "un solo paso" de la colecistocoledocolitiasis, aplicando un enfoque multidisciplinario hacia el paciente. El RLE es un procedimiento en el cual simultáneamente se realizan la CL y la extracción de cálculos coledocianos por vía endoscópica. El objetivo de este estudio fue presentar nuestros resultados iniciales. Analizamos retrospectivamente once pacientes que fueron intervenidos quirúrgicamente mediante la técnica de RLE en nuestra institución desde mayo de 2017 hasta marzo de 2022. La edad media de los pacientes fue de 50,6 años (rango de edad, 34 - 68) y la mayoría fueron varones 54,.5% (6/11). RLE logró eliminar con éxito los cálculos de CBD en el 90,9 % (10/11) de los casos. En ningún caso se registró pancreatitis post-RLE. Las complicaciones postoperatorias incluyeron una reintervención (1/11; 9,1%) por sangrado de uno de los trócares laparoscópicos. Nuestro grupo concluyó que la técnica RLE se puede aplicar de manera efectiva en Perú con buenos resultados a mediano plazo y confirmó su efectividad para lograr la eliminación de cálculos de CBD. En base a nuestros resultados, recomendamos el uso de RLE como una opción terapéutica segura y válida para nuestros pacientes.

Laparo-endoscopic Rendezvous in the Treatment of Cholecystocholedocholithiasis: A Single Center Initial Experience.

Cholecystocholedocholithiasis is a common disease worldwide; however, there is still no consensus regarding a gold standard therapy for its management. Nowadays, the preferred method is a "two-step" process, starting with an endoscopic common bile duct (CBD) stone extraction (endoscopic retrograde cholangiopancreatography [ERCP]) followed by a laparoscopic cholecystectomy (LC). Nevertheless, this "two-step" approach has shown some difficulties over time (i.e., need for two hospital admissions, need of at least two anesthesia inductions, higher rate of post-procedural pancreatitis, longer hospitalizations and thus, increased costs). On the other hand, the laparo-endoscopic rendezvous (LER), which is a simultaneous combined procedure for removing the gallbladder laparoscopically and clearing the CBD endoscopically, is another valid treatment modality that involves a "single-step" resolution of cholecystocholedocholithiasis applying a multidisciplinary approach of the patient. The aim of this study was to present our initial outcomes. We retrospectively analyzed eleven patients who consecutively underwent LER at our institution from May 2017 to March 2022. The patients' mean age was 50.6 years old (range, 34 - 68) and most were male 54.5% (6/11). LER successfully achieved CBD stone clearance in 90.9% (10/11) of the cases. Post-LER pancreatitis was not recorded in any case. Post-operative complications included one reoperation (1/11; 9.1%) due to bleeding from one of the laparoscopic trocar sites. Our group concluded that LER can be effectively applied in Perú with good mid-term results and confirmed its effectiveness in accomplishing CBD stone clearance. Based on our results, we recommend the use of LER as a safe and valid therapeutic option for our patients.

Úlcera cecal idiopática: reporte de un caso / Idiopathic cecal ulcer: report of a case

Las úlceras solitarias de ciego no específicas son raras en frecuencia, existen reportes de casos y pequeñas series en la literatura pero en el Perú aún no se han descrito. Son de etiología desconocida y diagnóstico diferencial amplio, presentamos el caso de un interno de medicina con historia de hemorragia digestiva baja y una úlcera cecal única a descartar neoplasia maligna, realizándose una hemicolectomía derecha laparoscópica de emergencia, luego de un amplio estudio, se concluye que se trata de una úlcera cecal idiopática.

The idiopathic cecal ulcer is rare in frequency, there are case reports and small series in the literature but in Peru have not been described yet. They are of unknown etiology and wide differential diagnosis, we report the case of a medical intern with lower gastrointestinal bleeding history and a solitary cecal ulcer that was suspected of being cancer, then an emergency laparoscopic right hemicolectomy was performed, after an extensive study we conclude that it is an idiopathic cecal ulcer.

[Idiopathic cecal ulcer: report of a case]. / Úlcera cecal idiopática: reporte de un caso.

The idiopathic cecal ulcer is rare in frequency, there are case reports and small series in the literature but in Peru have not been described yet. They are of unknown etiology and wide differential diagnosis, we report the case of a medical intern with lower gastrointestinal bleeding history and a solitary cecal ulcer that was suspected of being cancer, then an emergency laparoscopic right hemicolectomy was performed, after an extensive study we conclude that it is an idiopathic cecal ulcer.

[Hepatic angiosarcoma: case report and review of literature]. / Angiosarcoma hepático: reporte de un caso y revisión de literatura.

Hepatic Angiosarcoma is an uncommon neoplasia with an incidence between 0.5 to 2 % of primary hepatic tumors. Due to a nonspecific presentation it is very difficult to reach the diagnosis which is usually late and by that time the organ has been involved by tumor and surgical treatment is not possible. Because of CT limitations for staging and metastasis diagnosis, laparoscopy is used because it gives us better vision of the abdominal cavity and reliable information about tumor staging and prognosis. Final diagnosis is pathological and require inmunohistochemical confirmation with CD-31 and CD-34. Chemotherapy and radiotherapy have not demonstrated an improvement in the survival rate which is 6 months without treatment since diagnosis.We present a case of a 41 yo male patient without significant history with 2 months of nonspecific symptoms related to an hepatic tumor and ascites.

Angiosarcoma hépático: reporte de un caso y revisión de literatura / Hepatic angiosarcoma: case report and review of literature

El angiosarcoma hepático es una neoplasia rara cuya incidencia se reporta del 0,5 û 2% de las tumoraciones hepáticas primarias. Es de difícil diagnóstico debido a lo inespecífico de su presentación. Habitualmente el diagnóstico es tardío, cuando el órgano ya está muy comprometido y no es posible el tratamiento quirúrgico. A pesar de ello la laparoscopía es la técnica indicada debido a las limitaciones del estadiaje por tomografía, porque nos permite una visión directa de la cavidad y nos brinda información del estadío y pronóstico del tumor. El diagnóstico definitivo es anatomo-patológico y requiere confirmación por marcadores inmunohistoquímicos como el CD-31 y CD-34. La quimioterapia no ha demostrado mejorar la supervivencia al igual que la radioterapia. La supervivencia de estos pacientes sin tratamiento es de 6 meses aproximadamente desde el momento del diagnóstico. Presentamos el caso de un paciente de género masculino de 41 años sin mayores antecedentes de importancia con un tiempo de enfermedad de 2 meses, que se presenta con una tumoración hepática y ascitis, acompañado de síntomas inespecíficos.

Hepatic Angiosarcoma is an uncommon neoplasia with an incidence between 0.5 to 2 % of primary hepatic tumors. Due to a nonspecific presentation it is very difficult to reach the diagnosis which is usually late and by that time the organ has been involved by tumor and surgical treatment is not possible. Because of CT limitations for staging and metastasis diagnosis, laparoscopy is used because it gives us better vision of the abdominal cavity and reliable information about tumor staging and prognosis. Final diagnosis is pathological and require inmunohistochemical confirmation with CD-31 and CD-34. Chemotherapy and radiotherapy have not demonstrated an improvement in the survival rate which is 6 months without treatment since diagnosis. We present a case of a 41 yo male patient without significant history with 2 months of nonspecific symptoms related to an hepatic tumor and ascites.