[Gastric pull-up reconstruction in hypopharyngeal and cervical oesophageal cancer]. / Reconstrucción con interposición gástrica en el cáncer de hipofaringe y esófago cervical.

OBJECTIVE: To determine the results of gastric pull-up reconstruction following pharyngo-laryngo-esophagectomy. METHODS: The clinical data of 12 patients who were treated with pharyngolaryngo/esophagectomy were analysed, from 1995 to 2000. All patients had advanced disease, and required a gastric pull-up reconstruction. Clinical swallowing function and morbidity were evaluated postoperatively and the survival group was studied using a Kaplan-Meier survival curve. RESULTS: Five cases of hypopharyngeal cancer and seven cases of cervical esophageal cancer were studied. In three cases a regional flap was used. A total of 16 cervical dissections were carried out. Only in 2 patients the nodes were free of metastasis. There were four hospital deaths. At discharge, 7 patients out of the 8 had a good swallowing. The most common complications were pulmonary (58%). The five years survival was 31%. CONCLUSION: Gastric pull up transposition must be used for reconstruction following pharyngolaryngoesophagectomy. Proper selection of patients may reduce considerably the morbidity and mortality of this surgical procedure.

Reconstrucción con interposición gástrica en el cáncer de hipofaringe y esófago cervical / Gastric pull-up reconstruction in hypopharyngeal and cervical oesophageal cancer

Objetivo: Evaluar los resultados de la reconstrucción con una interposición gástrica tras la realización de una faringolaringoesofagectomía. Material y métodos: Se revisaron las historias clínicas de 12 pacientes consecutivos que fueron tratados de una faringolaringoesofagectomía entre 1995 y2000. Todos los pacientes tenían un estadio avanzado y seles realizó una reconstrucción con una interposición gástrica.Se valoraron en el postoperatorio la capacidad de deglución,las complicaciones y la supervivencia. Resultados: Se estudiaron5 casos primarios de hipofaringe y 7 de esófago cervical.En 3 casos fue preciso asociar a la reconstrucción un colgajo locorregional. Se realizaron un total de 16 vaciamientos a 8pacientes. Sólo en 2 pacientes los ganglios linfáticos no estaban afectos. La mortalidad perioperatoria ocurrió en 4 pacientes de 12. En el momento del alta el 7 de los 8 pacientes presentaban una buena deglución. Las complicaciones más frecuentes fueron las pulmonares en un 58%. La supervivenciaa los 5 años fue del 31%. Conclusión: La reconstrucción con una plastia gástrica está indicada en aquellos casos que sea preciso reconstruir la hipofaringe y el esófago en un mismo tiempo quirúrgico. Dado su elevada morbimortalidad se recomienda una cuidadosa selección de los pacientes (AU)

Objective: To determine the results of gastric pullup reconstruction following pharyngo-laryngo-esophagectomy. Methods: The clinical data of 12 patients who were treated with pharyngolaryngo/esophagectomy were analysed, from 1995 to 2000. All patients had advanced disease, and required a gastric pull-up reconstruction. Clinical swallowing function and morbidity were evaluated postoperatively and the survival group was studied using a Kaplan-Meier survival curve. Results: Five cases of hypopharyngeal cancer and seven cases of cervical esophageal cancer were studied. In three cases a regional flap was used. A total of16 cervical dissections were carried out. Only in 2 patients the nodes were free of metastasis. There were four hospital deaths. At discharge, 7 patients out of the 8 had a good swallowing. The most common complications were pulmonary(58%). The five years survival was 31%. Conclusión: Gastric pull up transposition must be used for reconstruction following pharyngolaryngoesophagectomy. Proper selection of patients may reduce considerably the morbidity and mortality of this surgical procedure (AU)

Manejo actual del quilotórax iatrogénico / Current management of iatrogenic chylothorax

La actitud quirúrgica agresiva en el tratamiento de procesos neoproliferativos ha condicionado un aumento en la frecuencia de un padecimiento iatrogénico poco frecuente fuera del ámbito quirúgico, en gran medida motivado por la diversidad de variantes anatómicas de drenaje linfático. La base de una terapéutica efectiva radica en la necesidad de un diagnóstico precoz, debatiéndose, en la actualidad, una actitud conservadora frente a una reintervención quirúrgica temprana. Exponemos el resultado de nuestra experiencia en 3 casos de pacientes operados, en nuestro servicio, de tumores de esófago y cardias al aplicar las actitudes diagnóstico-terapéuticas propuestas con mayor aceptación en la bibliografía. El quilotórax, aunque infrecuente, presenta una elevada morbimortalidad. A pesar de continuar en controversia, se apuesta por un tratamiento inicial conservador. Un fracaso precoz de éste establece, casi con seguridad, la indicación quirúrgica (AU)

Gallstone disease in patients over the age of 80. Surgery or long-term medical treatment?

OBJECTIVE: Growth in the geriatric population is increasing the biliary pathology of the elderly, thus becoming more frequent in the medical environment. The different therapeutic methods that are at present in use, should be applied to this group, employing open cholecystectomy as a reference. MATERIAL AND METHODS: During a period of 5 years we have attended 209 patients over the age of 80 (13.8 of the total of gallstones), 76 patients (36.4%) underwent surgery and in 133 cases (63.6%) another therapeutic method was decided upon. The progression, complications and mortality rate are studied closely herein. RESULTS: The majority, 156 (74.6%) were not previous admissions and in 108 (51.7%) the symptoms had been present for less than one month. Eighty four (40.2%) were suffering from jaundice on admission (on average 4 days) and 89 (42.6%) showed signs of inflammation. 23 patients (11%) were submitted only to an endoscopic sphincterotomy. Of those patients who underwent surgery, 52 (67.5%) had a range of inflammatory phenomena. Open cholecystectomy was carried out on 65 patients (85.5%). Sixty one patients (29.2%) presented complications, 38 (50%) in the group underwent surgery. Twenty eight patients (13.4%) died-9 (11.8%) of the 76 patients were operated upon. CONCLUSIONS: Elderly patients can undergo surgery in selected cases with an acceptable mortality rate and high morbidity. Surgery is recommended in those of a lesser age, not always possible as many of them lacked prior symptoms.

[Postoperative digestive upper fistula. Study of 37 cases]. / Fístulas digestivas altas posquirúrgicas. Estudio de 37 casos.

We report a series of 37 patients with upper gastrointestinal fistulas, from a total of 90 postoperative fistulas, treated in our Department over a period of five years (1987-1991). 46% of these originated after peptic ulcer surgery. Most patients (54%) required surgical intervention mainly due to the presence of major intraabdominal sepsis, and only 12 (32.4%) had spontaneous fistula closure. Morbidity (59.4%) and mortality rates (32.4%) were high.

[Digestive hemorrhage caused by jejunoileal tumors]. / Hemorragia digestiva por tumoraciones yeyunoileales.

Between January-73 and February-92 twelve patients with digestive hemorrhage due to primary jejunoileal tumors were treated. Eight cases had rectal bleeding and four chronic gastrointestinal hemorrhage as first clinical manifestation. Patients underwent upper endoscopy, colonoscopy and barium enema. Three out of nine barium meals (33%), two out of four ultrasonographies (50%) and eight out of nine arteriographies (89%) were abnormal. The barium meals showed submucosal lesions on two occasions and a jejunal luminal mass. The ultrasonography detected two intrabdominal masses. All arteriographies, except one with extravased intestinal contrast and other which showed a hypovascular zone, depicted homogeneous hypervascular images. All patients were operated on. Seven segmental enterectomies, four limited resections and a polipectomy were performed. Seven tumours were found in the jejunum, three in the jejunoleum and two in the ileum. There were four leiomyosarcomas, three leiomyomas, two polyps, one leiomyoblastoma, one adenocarcinoma and one lymphoma. Rebleeding and mortality were absent.

[The prognosis of colorectal cancer with synchronous liver metastases]. / Pronóstico del cáncer colorrectal con metástasis hepáticas sincrónicas.

Between January 1985 and December 1989, 583 patients with carcinoma of the colon and rectum have been studied. In 85 with synchronous liver metastases discovered at laparotomy and followed-up, median survival time has been 5.8 months and 1 and 3 year survival 23 and 6 percent respectively. Favorable factors for survival were rectosigmoid location, single metastasis in the right hepatic lobe, normal values of alkaline phosphatase, resection of the tumor as well as stage II of Duke's classification.

[Gastric volvulus. Presentation of a new case and review of the literature]. / Vólvulo gástrico. Aportación de un nuevo caso y revisión de la literatura.

A case is presented of acute gastric volvulus associated with paraesophageal hernia. Gastric volvulus is an infrequent clinical entity that generally appears in chronic form secondary to diaphragmatic pathology. Pathogenesis rests on two factors, relaxation of the supporting ligaments and neighboring associated pathology that acts to trigger gastric distension. Early diagnosis and treatment of acute forms and prophylactic surgery of chronic forms would lead to practically null mortality figures. The surgical technique, aside from devolvulation, includes hiatal repair in cases associated with paraesophageal hernia, gastropexy being sufficient for other forms.