Experiencia con phs en cirugía mayor ambulatoria / No disponible

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Desviación del eje cardiaco por una recidiva local mediastínica de un liposarcoma retroperitoneal / Shift of the heart axis due to mediastinum recurrence of a retroperitoneal liposarcoma

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Biliodigestive anastomosis in liver transplantation: review of 13 years.

Hepaticojejunostomy is a good alternative technique for biliary reconstruction in liver transplantation. Among 517 liver transplants performed between March 1992 and July 2005, 33 involved hepaticojejunostomy, namely, 18 men and 12 women of average age: 44.8 years. The main cause for this technique was retransplant (n = 10), secondary biliary cirrhosis (n = 5), alcoholic cirrhosis (n = 5), HCV cirrhosis (n = 2), primary biliary cirrhosis (n = 1), cryptogenic cirrhosis (n = 1), sclerosing cholangitis (n = 3), fulminant liver failure (n = 1), autoimmune cirrhosis (n = 1), and insulinoma metastasis (n = 1). Choledochojejunostomy was performed for all Roux-en-Y loops, with an average cold ischemia time of 361.16 minutes (180-780). The biliary complications were biliary fistula in four cases (13.3%), including two who required surgery; stenosis of the anastomosis in two cases (6.6%) including one diagnosed by HIDA that resolved with medical treatment and the other, diagnosed by cholangio-MRI, requiring a new hepaticojejunostomy; and biliary peritonitis in three cases (10%), all of whom required surgery. The vascular complications were thrombosis of the hepatic artery (n = 1), which required retransplantation, and pseudoaneurysm of hepatic artery (n = 1). No biliary complications occurred. The 6-month patient survival was 80% and the 6-month graft survival was 77%; no patient died due to biliary complications. Hepaticojejunostomy is a technique with higher morbidity than choledocho-choledochostomy, but it is the best alternative when the latter is not possible.

Cancers of new appearance in liver transplant recipients: incidence and evolution.

OBJECTIVE: To investigate the incidence, time of appearance, treatment, and evolution of tumors appearing in liver transplant recipients at our hospital. MATERIAL AND METHODS: We undertook a retrospective analysis of our series of liver transplants between 1990 and 2005. Patients who died during the immediate postoperative period were excluded. RESULTS: Of the 515 patients, 25 died during the immediate postoperative period and therefore had no occasion to develop neoplasms. Of the remaining 490, 32 developed cancers (6.5%). The average age was 55.4 +/- 7.17 years. The reasons for transplant were alcoholic cirrhosis (n = 15), hepatitis C virus (2), hepatitis B virus (n = 1), alcoholic and viral cirrhosis (n = 7), primary biliary cirrhosis (n = 1), and cryptogenic cirrhosis (n = 1). Four patients developed multiple neoplasms. Most of the tumors were cutaneous: nine basal cell and six squamous cell carcinomas. Other locations were the lung, urothelium, stomach, thyroid, and brain. Eight patients presented metastasis at the time of diagnosis. The average tumor-free period was 3.36 years. Nine patients died as a result of the tumor. DISCUSSION: Patients with a liver transplant have a high risk of developing cancers as a result of the immunosuppression treatment, which is lifelong. Nevertheless, other factors can be involved, such as infection by cytomegalovirus or the original diagnosis leading to transplantation. The risk for developing cancers is significantly greater than in the general population, with a higher tendency to recurrence and later development of second neoplasms.

Laparoscopic treatment of cholelithiasis in cirrhotic patients.

OBJECTIVE: To assess the safety and efficacy of laparoscopy in the treatment of symptomatic cholelithiasis in patients with Child's Class A and Class B cirrhosis. STUDY DESIGN: Descriptive and retrospective study. PATIENTS: We studied 14 patients (mean age 60 yrs) with Child's Class A and Class B hepatic cirrhosis who underwent laparoscopic cholecystectomy. We analyzed the occurrence of intraoperative and postoperative complications. RESULTS: Eight patients were women (57.14%) and 6 were men (42.85%). Eight of the 14 patients presented with Child's Class B cirrhosis and 6 patients with Class A. Cholecystectomy was programmed for all patients. The average duration of surgery was 77 min. Intraoperative complications occurred in 2 patients (14.28%) in the form of liver bed bleeding. Postoperative complications were observed in 3 patients (21.42%), 2 presented with ascites which led to a worsening of Child's Class in one of them, and the third patient presented with angina-like symptoms (acute, sharp pain in the chest irradiating to the back). Mean length of hospital stay was 3 days. No postoperative morbidity or mortality occurred, and there were no conversions. CONCLUSIONS: LC (laparoscopic cholecystectomy) is a safe and effective alternative for the treatment of symptomatic cholelithiasis in patients with well-compensated Child's Class A and Class B cirrhosis. Postoperative morbi-mortality is low, bleeding is unimportant, and both duration of surgical procedure and hospital stay are short.

Experiencia en el tratamiento laparoscópico de la colelitiasis del cirrótico / Laparoscopic treatment of cholelithiasis in cirrhotic patients

Objective: to assess the safety and efficacy of laparoscopy inthe treatment of symptomatic cholelithiasis in patients withChild´s Class A and Class B cirrhosis.Study design: descriptive and retrospective study.Patients: we studied 14 patients (mean age 60 yrs) withChild´s Class A and Class B hepatic cirrhosis who underwent laparoscopiccholecystectomy. We analyzed the occurrence of intraoperativeand postoperative complications.Results: eight patients were women (57.14%) and 6 weremen (42.85%). Eight of the 14 patients presented with Child´sClass B cirrhosis and 6 patients with Class A. Cholecystectomywas programmed for all patients. The average duration of surgerywas 77 min. Intraoperative complications occurred in 2 patients(14.28%) in the form of liver bed bleeding. Postoperative complicationswere observed in 3 patients (21.42%), 2 presented withascites which led to a worsening of Child´s Class in one of them,and the third patient presented with angina-like symptoms (acute,sharp pain in the chest irradiating to the back). Mean length ofhospital stay was 3 days. No postoperative morbidity or mortalityoccurred, and there were no conversions.Conclusions: LC (laparoscopic cholecystectomy) is a safe andeffective alternative for the treatment of symptomatic cholelithiasisin patients with well-compensated Child´s Class A and Class Bcirrhosis. Postoperative morbi-mortality is low, bleeding is unimportant,and both duration of surgical procedure and hospital stayare short

Objetivo: evaluar la seguridad y eficacia del uso de la laparoscopiaen pacientes cirróticos en estadio A y B de Child-Pugh concolelitiasis sintomática.Diseño del estudio: estudio descriptivo, retrospectivo.Pacientes: catorce pacientes con una edad media de 60 añosdiagnosticados de cirrosis hepática en estadios A y B que se lespracticó colecistectomía laparoscópica. Se estudia la aparición decomplicaciones intraoperatorias y postoperatorias tras la intervenciónResultados: ocho (57,14%) casos eran mujeres y 6 ( 42,85%)varones. De los 14 pacientes, 8 presentaban un estadio Child-Pugh B y 6 un Child-Pugh A. Todos los pacientes se intervienende colelitiasis de forma programada. El tiempo operatorio mediofue de 77 min. Dos (14,28%) de los pacientes presentaron complicacionesintraoperatorias, sangrado del lecho quirúrgico. Tres(21,42%) pacientes presentaron complicaciones postoperatorias:dos (14,28%) presentaron ascitis con empeoramiento del Child-Pugh en uno de ellos y el otro presentó un cuadro anginoso. Laestancia media de estos pacientes es de 3 días. No hubo ningunamuerte tras la intervención y no hubo ninguna reconversión.Conclusiones: la CL es una alternativa segura y efectiva en eltratamiento de colelitiasis sintomáticas en pacientes con cirrosisen estadio A y B compensada. Ofrece una baja morbimortalidadpostoperatoria con una escasa pérdida de sangre, un tiempo operatoriocorto y una reducida estancia hospitalaria