Punción, aspiración, instilación y re-aspiración en casos complejos de hidatidosis hepática / PAIR for complex hepatic hydatid disease

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Cistoadenocarcinoma biliar / Biliary cystadenocarcinoma

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Traumatismo hepático grave y rotura diafragmática en encierro taurino / Severe liver trauma and diaphragmatic rupture in a bull running event

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Seudotumor inflamatorio hepático: difícil diagnóstico preoperatorio en paciente oncológico / Hepatic inflammatory pseudotumor: A difficult preoperative diagnosis in an oncological patient

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Primer tiempo laparoscópico en una cirugía hepática en 2 tiempos / Laparoscopic first stage in a two-stage hepatectomy

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Rotura hepática secundaria a peliosis hepática / Ruptured liver caused by peliosis hepatis

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Wrapping in pancreatic surgery: a systematic review.

BACKGROUND: Wrapping in pancreatic surgery involves the use of the omentum or falciform ligament (FL) to wrap the local retroperitoneal vessels, the pancreatojejunal anastomosis or the pancreatic section of distal pancreatectomy. However, there is no clear evidence that wrapping in fact provides benefits. We have performed a systematic review of the literature about this topic. METHODS: We conducted a literature search in the PubMed/MEDLINE database (1966-2012) for any language using various combinations of the following terms: wrapping, omental, omentum, pancreas, pancreatoduodenectomy and falciform ligament. RESULTS: We selected 12 articles. Among five series that included a control group, only one obtained a statistically significant reduction in pancreatic fistula (PF) in the wrapping group and other series showed a lower percentage of post-operative haemorrhage in the wrapping group. In the seven series without control groups, a slight decrease in the rate of post-operative bleeding and PF was observed. CONCLUSIONS: On the basis of the literature available at present, we cannot recommend the use of wrapping with omentum and/or FL in pancreatic surgery. Prospective randomized studies applying a systematic wrapping technique are needed in order to establish whether its use should be generalized.

Ruta de reconstrucción gastroentérica tras duodenopancreatectomía: antecólica versus retrocólica / Gastroenteric reconstruction route after pancreaticoduodenectomy: antecolic versus retrocolic

Resumen: El retraso del vaciamiento gástrico (RVG) es una complicación relativamente frecuente tras duodenopancreatectomía cefálica (DPC). Su etiología no está aclarada y se considera que múltiples factores están relacionados con su aparición (hormonales, aparición de otras complicaciones especialmente la fístula pancreática, y de técnica quirúrgica). Entre los aspectos técnicos relacionados con el RVG se ha postulado que la ruta de reconstrucción gastroentérica (antecólica o retrocólica) pudiera modificar la incidencia de RVG. Material y métodos Hemos realizado una revisión sistemática de la literatura de los artículos que comparan ambas rutas de reconstrucción tras DPC, encontrando solo 11 artículos: 4 ensayos clínicos aleatorizados, un estudio prospectivo y 6 estudios retrospectivos. Las grandes diferencias metodológicas entre ellos no nos han permitido realizar un metaanálisis. Resultados En los 4 estudios aleatorizados, 2 son favorables a la ruta antecólica y 2 no observan diferencias entre ambas. En el único estudio prospectivo, la ruta antecólica obtiene una tasa de RVG muy inferior a la retrocólica. En los estudios retrospectivos, en 4 de ellos la ruta antecólica obtiene una tasa de RVG muy inferior. En otros 2 estudios retrospectivos, los resultados entre ambas rutas son similares, en uno de ellos levemente mejores en la ruta retrocólica. Conclusiones La literatura publicada no permite actualmente determinar que la ruta de reconstrucción gastroentérica se relacione con un menor RVG tras DPC (AU)

Introduction: Delayed gastric emptying (DGE) is a relatively common complication after cephalic pancreaticoduodenectomy (CPD). Its origin is not very clear, and it is believed that its appearance is due to multiple factors (hormones, appearance of other complications, particularly pancreatic fistulas, and the surgical technique). Among the technical aspects associated with DGE, it has been proposed that the route of gastroenteric reconstruction (antecolic or retrocolic) could have an effect on its incidence. Material and methods: A systemic review was made of the literature, searching for articles that compared both reconstruction routes after CPD, finding only 11 (..) (AU)

[Gastroenteric reconstruction route after pancreaticoduodenectomy: antecolic versus retrocolic]. / Ruta de reconstrucción gastroentérica trasduodenopancreatectomía: antecólica versus retrocólica.

INTRODUCTION: Delayed gastric emptying (DGE) is a relatively common complication after cephalic pancreaticoduodenectomy (CPD). Its origin is not very clear, and it is believed that its appearance is due to multiple factors (hormones, appearance of other complications, particularly pancreatic fistulas, and the surgical technique). Among the technical aspects associated with DGE, it has been proposed that the route of gastroenteric reconstruction (antecolic or retrocolic) could have an effect on its incidence. MATERIAL AND METHODS: A systemic review was made of the literature, searching for articles that compared both reconstruction routes after CPD, finding only 11 articles: 4 randomised clinical trials, one prospective study, and 6 retrospective studies. A meta-analysis could not be performed on them, due to the large methodological differences between them. RESULTS: In the 4 randomised studies, 2 were in favour of the antecolic route, and 2 did not observe any differences between either of them. The antecolic route obtained a much lower DGE rate than the retrocolic one in the only prospective study. In 4 of the retrospective studies the antecolic route obtained a very low rate. The results of both routes were similar in another 2 retrospective studies, with the retrocolic route slightly better in one of them. CONCLUSIONS: Using the published literature, the gastric reconstruction route associated with less DGE after CPD cannot currently be determined.

Tratamiento quirúrgico de las metástasis hepáticas de melanoma / Surgical treatment of melanoma liver metastases

La aparición de metástasis hepáticas durante el seguimiento de un paciente con melanoma cutáneo se ha considerado clásicamente un signo de muy mal pronóstico. Las opciones terapéuticas son escasas ya que habitualmente estas lesiones son irresecables y forman parte de una enfermedad diseminada en varios órganos. En ciertos casos, en los que la enfermedad está restringida al hígado o acompañada de enfermedad extrahepática resecable, la hepatectomía puede ser útil, obteniendo supervivencias aceptables, cercanas al 25% a los 5 años, aunque la recidiva hepática o cutánea suele ser temprana. El escaso número de casos publicados, la ausencia de estudios aleatorizados y la heterogeneidad de las series no permiten extraer unas conclusiones para poder recomendar qué pacientes se benefician de la resección hepática con un nivel de evidencia científica aceptable, y así definir su utilidad real. Tampoco están definidas las pautas de actuación de cuándo y qué tipo de terapia adyuvante debemos emplear (AU)

The appearance of liver metastases during the follow-up of a patient with a skin melanoma has classically been considered a sign of a very poor prognosis. There are limited therapeutic options, since these lesions are non-resectable and form part of a disseminated disease in several organs. In certain cases, in those where the disease is restricted to the liver or accompanied by a resectable extra-hepatic disease, hepatectomy can be useful, obtaining acceptable survivals of about 25% at 5 years, although hepatic or skin recurrence is usually early. The limited number of patient cases published, the absence of randomised studies, and the heterogeneity of the series, makes it difficult to reach conclusions to be able to recommend which patients may benefit from liver resection, with an acceptable level of scientific evidence, and thus define its real usefulness. There are also no action plans defined as to when and what type of adjuvant therapy we should use (AU)

Frank intrabiliary rupture in liver hydatidosis located in the hilar plate: a surgical challenge.

BACKGROUND: Frank intrabiliary rupture (FIR) is a severe complication that occurs in around 30% of patients with liver hydatidosis. When FIR is present, the contents of the cyst may pass into the common bile duct and cause a variety of complications. If the FIR is located in the hilar confluence, surgical repair is a challenge. Currently there are no data regarding its optimum treatment. MATERIAL AND METHODS: Between May 2007 and December 2012, we treated 59 patients with liver hydatidosis. Four patients, all women, with a mean age of 51.7 years, had hydatid cysts located between segments IVb and V and FIR affecting the hilar plate. In 3 cases, the initial clinical condition was obstructive jaundice. The fourth patient presented recurrence after having undergone two operations as a child. RESULTS: In each patient a major hepatectomy was performed with hilar plate reconstruction (3 left and 1 right). Morbidity included mild biliary fistula (1 patient) and abdominal collection resolved by percutaneous drainage (1 patient). There was no mortality. During follow-up (47 months), no recurrences of the disease or biliary strictures were recorded. CONCLUSIONS: FIR is a severe complication of liver hydatidosis. When it is located in the hilar confluence, liver resection may be the best surgical option for definitive resolution of the problem.

[Surgical treatment of melanoma liver metastases]. / Tratamiento quirúrgico de las metástasis hepáticas de melanoma.

The appearance of liver metastases during the follow-up of a patient with a skin melanoma has classically been considered a sign of a very poor prognosis. There are limited therapeutic options, since these lesions are non-resectable and form part of a disseminated disease in several organs. In certain cases, in those where the disease is restricted to the liver or accompanied by a resectable extra-hepatic disease, hepatectomy can be useful, obtaining acceptable survivals of about 25% at 5 years, although hepatic or skin recurrence is usually early. The limited number of patient cases published, the absence of randomised studies, and the heterogeneity of the series, makes it difficult to reach conclusions to be able to recommend which patients may benefit from liver resection, with an acceptable level of scientific evidence, and thus define its real usefulness. There are also no action plans defined as to when and what type of adjuvant therapy we should use.

Resección hepática menor y fenestración mediante abordaje laparoscópico con tres trócares / Minor liver resections and fenestrations using three-trocar laparoscopy

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Reseccion de metástasis hepáticas en presencia de enfermedad extrahepática / Resection of liver metastases in patients with extrahepatic disease

Los pacientes que presentan metástasis hepáticas y enfermedad metastásica extrahepática (EHD) se han considerado un subgrupo de pacientes con muy mal pronóstico. Por ello, la presencia de EHD fue tradicionalmente considerada una contraindicación para la resección hepática. Pero, supervivencias cercanas al 30% a los 5 años, y superiores a la conseguida solo con quimioterapia, obtenidas en algunos pacientes con metástasis hepáticas de origen colorrectal y EHD a los que se practicó resección de la enfermedad metastásica hepática y extrahepática, obliga a replantearse qué debemos realizar en estos pacientes. Hemos efectuado una revisión exhaustiva de la literatura intentando establecer unas pautas de actuación acordes con la evidencia científica actual. Como resumen podemos afirmar que la presencia de EHD resecable en pacientes con metástasis hepáticas no debe ser considerada una contraindicación absoluta para la resección hepática, aunque los resultados son inferiores a los obtenidos en pacientes sin EHD. Los pacientes con EHD localizada en los ganglios del tronco celíaco o aorto-cava presentan una supervivencia corta. El empleo de quimioterapia previamente a la cirugía es recomendable para operar a enfermos estables o que responden a la quimioterapia y no en progresión (AU)

Patients who have liver metastasis and extrahepatic metastatic disease (EMD) have been considered as a patient subgroup with a very poor prognosis. Therefore, the presence of EMD was traditionally considered a contraindication for liver resection. But, survivals of around30% at 5 years, and higher than that achieved with chemotherapy only obtained in some patients with liver metastasis of colorectal origin and EMD who had a resection performed on the hepatic and extrahepatic disease, obliges us to re-think what we must do in these patients.We have carried out an exhaustive review of the literature in an attempt to establish some working guidelines based on current scientific evidence. In summary, we can say that the presence of resectable EMD in patients with liver metastasis must not be considered as an absolute contraindication for liver resection, although the results are inferior to those obtained in patients without EMD. Patients with EMD localised in the ganglia of the celiac trunk or aorto-cava have a short survival. The use of chemotherapy prior to the surgery is recommended to operate stable patients, or who respond to the chemotherapy and not in progression (AU)