Evolución del reflujo gastroesofágico tras la gastrectomía vertical laparoscópica. Estudio radiológico, manométrico y pH-métrico / Evolution of gastroesophageal reflux after laparoscopic vertical gastrectomy. A radiographic, manometric and pH-metric study

Introducción: la relación entre la gastrectomía vertical laparoscópica (GVL) y el reflujo gastroesofágico (RGE) es aún controvertida, por lo que su investigación tiene gran interés para llegar a conclusiones definitivas. Nuestro objetivo es determinar si la GVL modifica el RGE pH-métrico de los pacientes obesos y, en caso de que así sea, analizar algunos factores que pudieran explicarlo. Pacientes y métodos: incluimos los primeros 26 pacientes que recibieron una GVL en nuestro centro. Se realizaron un tránsito baritado, una pH-metría ambulatoria de 24 horas y una manometría intraluminal esofágica (MIE) con cuatro canales previamente y al año de la operación. Resultados: de los datos pH-métricos, el índice de DeMeester mostró un aumento significativo (p = 0.028) tras la intervención, mientras que los demás parámetros fueron similares. Por otra parte, se observó que el 50% de los pacientes con RGE pH-métrico preoperatorio mostraron tasas normales al año de la operación. En la MIE objetivamos que la presión del esfínter esofágico inferior (EEI) disminuyó, así como la amplitud media de las ondas en el tercio distal esofágico (p = 0,007 y p = 0,025, respectivamente). En el estudio radiológico la tasa de hernias de hiato "de novo" fue del 36,4%. Conclusión: la GVL determina un aumento leve del RGE, probablemente relacionado con la aparición de hernias de hiato así como con una disminución de la presión del EEI y de la capacidad de barrido esofágico. Sin embargo, no debe contraindicarse la GVL a pacientes con RGE preoperatorio pH-métrico pues puede negativizarse tras la operación

Introduction: the relationship between laparoscopic vertical gastrectomy (LVG) and gastroesophageal reflux (GER) is still controversial. Therefore, its study is of great interest in order to obtain definitive conclusions. The goal of the study was to establish whether LVG modifies pH-metric GER in obese patients and to analyze the associated factors. Patients and methods: the first 26 patients who underwent LVG in our institution were enrolled in the study. A barium swallow, 24-hour ambulatory pH-metry and four-channel intraluminal esophageal manometry (IEM) were all performed before and one year after surgery. Results: among the pH-metric data, there was a significant increase in the DeMeester index after the procedure (p = 0.028), while other parameters remained unchanged. Furthermore, 50% of patients with preoperative pH-metric GER had normal values at one year after surgery. IEM showed a decrease in lower esophageal sphincter (LES) pressure and in the mean wave amplitude at the distal third of the esophagus (p = 0.007 and p = 0.025, respectively). The rate of newly-developed hiatal hernias in the radiographic study was 36.4%. Conclusion: LVG mildly increases GER, which is likely related to the development of hiatal hernias and a decrease in LES pressure and esophageal sweep. However, LVG should not be contraindicated for patients with preoperative pH-metric GER, as this may clear after the procedure

Evolution of gastroesophageal reflux after laparoscopic vertical gastrectomy. A radiographic, manometric and pH-metric study.

INTRODUCTION: the relationship between laparoscopic vertical gastrectomy (LVG) and gastroesophageal reflux (GER) is still controversial. Therefore, its study is of great interest in order to obtain definitive conclusions. The goal of the study was to establish whether LVG modifies pH-metric GER in obese patients and to analyze the associated factors. PATIENTS AND METHODS: the first 26 patients who underwent LVG in our institution were enrolled in the study. A barium swallow, 24-hour ambulatory pH-metry and four-channel intraluminal esophageal manometry (IEM) were all performed before and one year after surgery. RESULTS: among the pH-metric data, there was a significant increase in the DeMeester index after the procedure (p = 0.028), while other parameters remained unchanged. Furthermore, 50% of patients with preoperative pH-metric GER had normal values at one year after surgery. IEM showed a decrease in lower esophageal sphincter (LES) pressure and in the mean wave amplitude at the distal third of the esophagus (p = 0.007 and p = 0.025, respectively). The rate of newly-developed hiatal hernias in the radiographic study was 36.4%. CONCLUSION: LVG mildly increases GER, which is likely related to the development of hiatal hernias and a decrease in LES pressure and esophageal sweep. However, LVG should not be contraindicated for patients with preoperative pH-metric GER, as this may clear after the procedure.

Colangitis por obstrucción de asa aferente tras duodenopancreatectomía cefálica / Cholangitis due to afferent loop obstruction after cephalic duodenopancreatectomy

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Una nueva técnica quirúrgica para la hepatectomía derecha extendida: torniquete en la cisura umbilical y oclusión portal derecha (ALTPS). Caso clínico / A new surgical technique for extended right hepatectomy: Tourniquet in the umbilical fissure and right portal vein occlusion (ALTPS). Clinical case

Associating liver partition and portal vein ligation for staged (ALPPS) para las resecciones hepáticas en 2 tiempos, consigue la hipertrofia del volumen funcional residual (VFR) en 7 días, al ocluir las colaterales intrahepáticas entre ambos lóbulos. En marzo de 2012 publicamos una nueva técnica quirúrgica, asociando la colocación de un torniquete en la línea de Cantlie con ligadura portal derecha (Associating liver tourniquet and right portal vein occlusion for staging hepatectomy [ALTPS]). Ahora presentamos la técnica ALTPS en la cisura umbilical para hipertrofiar los segmentos II - III , realizada en un varón de 51 años con recidiva de hipernefroma renal derecho que invade todo el lóbulo derecho y la vena cava inferior. El VFR preoperatorio fue de 380 ml (20% del total) y aumentó un 150% a los 7 días (a 953 ml; 31% del total). En el segundo tiempo se realizó trisectorectomía derecha con resección de la vena cava inferior retrohepática, siendo sustituida por un injerto de goretex anillado de 2 cm de diámetro (AU)

ALPPS (associating liver partition and portal vein ligation for staged hepatectomy), in 2-stage liver resections, achieves hypertrophy of the functional liver remnant (FLR) in 7 days, and the objective of this technique is the occlusion of the intrahepatic collaterals. In March 2012 we published a new surgical technique associating the insertion of a tourniquet in Cantlie’ line and right portal vein ligation (ALTPS: Associating liver tourniquet and right portal vein occlusion for staged hepatectomy). In this paper we present this ALTPS technique placing the tourniquet in the umbilical fissure to obtain hypertrophy of segments II - III . It was performed in a 51 year-old patient with a recurrent right renal hypernephroma which involved all the anatomic right lobe and inferior vena cava. Preoperative FLR was 380 ml (20% of the total volume) increasing 150% at 7 days (to 953 ml, 31% of the total). In the second step, we performed a right trisectionectomy and retrohepatic inferior vena cava resection, replacing it by a 2 cm-ring goretex graft (AU)

[A new surgical technique for extended right hepatectomy: tourniquet in the umbilical fissure and right portal vein occlusion (ALTPS). Clinical case]. / Una nueva técnica quirúrgica para la hepatectomía derecha extendida: torniquete en la cisura umbilical y oclusión portal derecha (ALTPS). Caso clínico.

ALPPS (associating liver partition and portal vein ligation for staged hepatectomy), in 2-stage liver resections, achieves hypertrophy of the functional liver remnant (FLR) in 7 days, and the objective of this technique is the occlusion of the intrahepatic collaterals. In March 2012 we published a new surgical technique associating the insertion of a tourniquet in Cantlie' line and right portal vein ligation (ALTPS: Associating liver tourniquet and right portal vein occlusion for staged hepatectomy). In this paper we present this ALTPS technique placing the tourniquet in the umbilical fissure to obtain hypertrophy of segments II-III. It was performed in a 51 year-old patient with a recurrent right renal hypernephroma which involved all the anatomic right lobe and inferior vena cava. Preoperative FLR was 380 ml (20% of the total volume) increasing 150% at 7 days (to 953 ml, 31% of the total). In the second step, we performed a right trisectionectomy and retrohepatic inferior vena cava resection, replacing it by a 2 cm-ring goretex graft.